The Curbsiders Internal Medicine Podcast

By Matthew Watto MD, Stuart Brigham MD, Paul Williams MD

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Subscribers: 962
Reviews: 3

TG
 Jan 9, 2019
excellent podcast for internists. highly recommend


 Oct 21, 2018

Rachel Shemtov
 Oct 7, 2018

Description

Supercharge your learning and enhance your practice with this Internal Medicine Podcast featuring board certified Internists as they interview the experts to bring you clinical pearls, practice changing knowledge and bad puns. Doctors Matthew Watto, Stuart Brigham, Paul Williams and friends (a national network of students, residents and clinician educators) deliver a little knowledge food for your brain hole. Yummy! No boring lectures here, just high value content and a healthy dose of humor. Fantastic for Internal Medicine, Family Medicine, Primary Care, and Hospital Medicine.

Episode Date
#202 LIVE! Lymphadenopathy: Taking Your Lumps
43:58

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

 

Special Thanks!

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

 

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

 

Credits

  • Written and Produced by: Carrie Thompson MD and Matthew Watto MD, FACP
  • Infographic: Matthew Watto MD, FACP
  • Cover Art: Kate Grant MBChB DipGUMed
  • Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP   
  • Editor: Matthew Watto MD (written materials); Clair Morgan of nodderly.com
  • Guest: Carrie Thompson MD

 

Join The Curbsiders! 

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

 

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

[  ] A copy of your CV

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

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

 

Time Stamps

  • 07: 00 Lymphatic system
  • 09:19 Differential diagnosis for lymphadenopathy
  • 11:38 Taking a history (ALL AGES mnemonic), Red Flags

  • 19:15 Physical exam for lymphadenopathy
  • 22:30 Which labs to order; Flow cytometry
  • 26:05 Imaging
  • 
28:30 Counseling patients with LAD

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

  • 37:35 Take Home Points
  • 39:00 Audience Questions

  • 42:25 Outro

 

 

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

 

Goals

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

 

Learning objectives

After listening to this episode listeners will...

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

 

Disclosures

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

 

Citation

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

Mar 30, 2020
#201 COVID Narratives: Stories from Physicians at the Front Lines
01:05:41

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

 

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

 

Credits

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

 

Sponsor

Primary Care Internal Medicine of Ithaca

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

 

Time Stamps

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

 

 

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

 

Links*

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

 

Goal

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

 

Learning objectives

After listening to this episode listeners will…  

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

 

Disclosures

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

 

Citation

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

Mar 26, 2020
#200 COVID-19 with Paul Sax MD
54:20

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

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

 

Credits

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

 

Sponsor

Primary Care Internal Medicine of Ithaca

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

 

Time Stamps

 

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

52:30 Closing remarks and outro

 

Goals

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

 

Learning objectives

After listening to this episode listeners will know…

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

 

Disclosures

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

The Curbsiders report no relevant financial disclosures. 

 

Citation

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

Mar 22, 2020
#199 NephMadness: Hyperkalemia, Diet, Potassium Binders, Exercise
56:35

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

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

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

Credits

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

Sponsors

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

Time Stamps

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

Learning objectives

After listening to this episode listeners will…  

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

Disclosures

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

Citation

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

Mar 16, 2020
#198 PCOS: Polycystic Ovary Syndrome with Katherine Sherif MD
01:06:56

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

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

Credits

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

Sponsors

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

 

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

Time Stamps

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

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

Goal

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

Learning objectives

After listening to this episode listeners will…  

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

Disclosures

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

Citation

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

Mar 09, 2020
#197 Pulmonary Nodules and Lung Cancer Screening with Denitza Blagev MD
54:56

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

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

Credits

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

Sponsor

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

Time Stamps

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

Goal

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

Learning objectives

After listening to this episode listeners will...

 

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

 

  • ... appreciate the difference between the incidental pulmonary nodule and those found during lung cancer screening and thus the different systems (Fleischner vs. Lung-Rads) used to assess nodules.
  • ... have a framework for how to approach incidental pulmonary nodules, particularly with respect to the 2017 Fleischner Society Guidelines .
  • ... be able to educate peers & patients regarding who qualifies for lung cancer screening and who does not.
  • ... understand what makes a patient “high risk” vs. “standard risk” with respect to incidentally found pulmonary nodules.
  • ... appreciate the background and reasoning behind the current recommendation for lung cancer screening
  • ... discover how to determine follow up of a lung nodule found as part of a lung cancer screening CT using Lung-Rads.
  • ... learn strategies regarding how to discuss incidental nodules and nodules found on screening CTs with patients, as well as how to approach the discussion of whether or not to screen with the use of various readily available resources .

 

 

Disclosures

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

Citation

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

Mar 02, 2020
#196 LIVE! Refugee Health with Tanuja Devaraj MD
49:29

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

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

Credits

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

Sponsor

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

Time Stamps

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

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

Goal

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

Learning objectives

After listening to this episode listeners will…  

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

Disclosures

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

Citation

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

Feb 24, 2020
#195 TWDFNR 3: Potassium, Oxygen, and antipsychotics
01:01:42

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

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

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

Credits

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

Sponsors

The Society of Hospital Medicine

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

Primary Care Internal Medicine of Ithaca

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

Time Stamps

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

Disclosures

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

Citation

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

Feb 17, 2020
#194 Treatment of Alcohol Use Disorder with Dr. Marlene Martin MD
55:12

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

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

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

Credits

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

Sponsor

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

Time Stamps

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

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

Disclosures

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

Citation

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

Feb 10, 2020
#193 LIVE! The Struggling learner with Dr. Melissa McNeil
58:29

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

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

Credits

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

Sponsor

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

Time Stamps

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

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

Goal

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

Learning objectives

After listening to this episode listeners will…  

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

Disclosures

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

Citation

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

Feb 03, 2020
#192 Dialysis for the Internist with Joel Topf MD
01:13:29

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

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

Credits

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

Sponsor

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

Time Stamps

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

Disclosures

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

Citation

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

Jan 27, 2020
Season 9 Trailer and KIDNEYcon 2020 Announcement!
02:23

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

What: KIDNEYcon 2020 (www.kidneycon.org)

When: April 16-19, 2020

Where:
Little Rock, Arkansas

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

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

Click HERE to Register in January 2020

Jan 24, 2020
#191 Lipids Update with Erin Michos MD
01:12:03

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

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

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

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Credits

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

Sponsor

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

Time Stamps

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

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

Goal

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

Learning objectives

After listening to this episode listeners will…  

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

Disclosures

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

Citation

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

Jan 20, 2020
REBOOT #137 Hyperkalemia Master Class with Joel Topf MD
01:18:42

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

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

Sponsor

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

Credits

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

Time Stamps

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

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

Disclosures

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

Citation

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

Jan 13, 2020
REBOOT #129 Depression and Physician Suicide with Elisabeth Poorman MD
01:18:20

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

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

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

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

New episodes return January 20, 2020!

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

Sponsor

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

Credits

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

Time Stamps 

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

Goal

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

Learning objectives 

After listening to this episode listeners will

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

Disclosures

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

Citation

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

Jan 06, 2020
#190 Recap Extravaganza 2019
01:05:05

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

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

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

Credits

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

Time Stamps

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

Goal

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

Links*

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

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

Disclosures

The Curbsiders report no relevant financial disclosures. 

Citation

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

Dec 30, 2019
#189 Medical Overuse: Common Cases of Overtesting, Overdiagnosis, Overtreatment
01:03:53

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

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

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

Credits

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

Time Stamps

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

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

Goal

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

Learning objectives

After listening to this episode listeners will…  

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

Disclosures

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

Citation

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

Dec 23, 2019
#188 GERD and Dyspepsia with Dr. Amy Oxentenko MD
01:21:55

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

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

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

Credits

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

Time Stamps

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

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

Disclosures

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

Citation

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

Dec 16, 2019
#187 Buprenorphine Master Class: Managing Opioid Use Disorder for the Generalist
01:03:49

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

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

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

Credits

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

Time Stamps

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

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

Disclosures

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

Citation

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

Dec 09, 2019
#186 Sarcopenia: Raising the Bar in Primary Care
01:11:09

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

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

Credits

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

Check Out our friends at Barbell Medicine!

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

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

Time Stamps

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

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

Goal

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

Learning objectives

After listening to this episode listeners will…  

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

Disclosures

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

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

Citation

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

Dec 02, 2019
#185 Hotcakes: Updates on CAP, Asthma & Red Meat!
55:23

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

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

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

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

Time stamps

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

Meet Rahul:

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

Goals and Learning Objectives

Goals: 

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

Learning objectives:

After listening to this episode listeners will…

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

The Curbsiders report no relevant financial disclosures.

Citation: 

 

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

Nov 27, 2019
#184 Update in Sleep Medicine: LIVE from CHEST 2019!
58:13

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

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

Credits

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

Sponsor

The American College of Chest Physicians

Time Stamps

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

Goal

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

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

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

Disclosures

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

Citation

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

Nov 25, 2019
#183 Longevity, Healthspan and Lifespan with Peter Attia MD
01:08:41

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

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

Credits

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

 

Time Stamps

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

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

Goal

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

Learning objectives

After listening to this episode listeners will…  

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

Disclosures

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

The Curbsiders report no relevant financial disclosures. 

Citation

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

Nov 18, 2019
#182 Becoming a PGY3: Not Just a Repeat of PGY2
01:01:27

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

 

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

Credits

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

 

Sponsor - ACP IMpower: Catalyzing your professional future

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

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

Time Stamps

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

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

Disclosures

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

Citation

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

Nov 11, 2019
#181 The Multimorbidity Games
01:00:22

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

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

Credits

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

Time Stamps

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

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

Goal

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

Learning objectives 

After listening to this episode listeners will... 

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

Disclosures

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

Citation

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

Nov 04, 2019
#180 CHEST 2019 Recap Part 2
56:52

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

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

Credits

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

Time Stamps

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

Citation

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

Oct 30, 2019
#179 CHEST 2019 Recap Part 1
46:34

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

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

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

Credits

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

Time Stamps

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

Citation

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

Oct 28, 2019
#178 Tuberculosis Updates with Laila Woc-Colburn MD
01:13:40

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

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

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

Credits

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

Partners

 

Win a prize! Celebrate National Internal Medicine Day and tell us why you’re I.M. Proud.

Tell us why you are I.M. Proud and enter the contest by visiting www.acponline.org/improud to submit your story today! Answer one of the three questions below and share your story on social media using the hashtags #IMProud #NationalInternalMedicineDay, and tag @acpinternists. Prizes will be given out 3 times through June of 2020. The first group of winners will be announced on the first ever National Internal Medicine Day October 28, 2019!

  1. What makes you proud to practice internal medicine or one of the I.M. subspecialties? 
  2. What recent patient experience made you proud to be an internist or subspecialist?
  3. How is internal medicine unique from other subspecialties?

See us at the CHEST 2019 Annual Meeting in New Orleans!

We’ll be doing two live interviews on stage, plus recording two recap episodes to bring you high yield clinical pearls from the conference. Look out for us in our red Curbsiders shirts and say hello. Take a picture with Stuart! Give Paul a hug! 

  1. Sunday October 20 3:30-4:30 room 265-   Dr. Quinn Capers - Implicit Bias
  2. Monday October 21 7:30-8:30 room 281- Dr. Christine Won - Update in Sleep Medicine

Time Stamps

  • 00:00 Sponsor: ACP’s National Internal Medicine Day I.M. Proud Story Contest
  • 00:24 Disclaimer, Intro, Guest bio, Pun
  • 03:51 Guest one-liner, Career Advice; Picks of the Week*: Leonardo Da Vinci by Walter Isaacson; Aditya Shah (@IDdocAdi) antibiotic stewardship on Twitter; @EpicEMRParody on Twitter; Zima is a presumably delicious beverage (we’ve never tried it...ha)
  • 09:52 Sponsor: ACP’s National Internal Medicine Day I.M. Proud Story Contest
  • 11:30 Case of latent TB; Interpretation of PPD (Tuberculin Skin Test)
  • 17:05 PPD and BCG vaccine; Who needs an IGRA?
  • 19:20 LTBI treatment threshold; IGRA explained including what to do with “indeterminate results”
  • 25:22 LTBI natural history; Why endemic countries don’t treat LTBI
  • 30:08 TB infection, immunity and reinfection
  • 33:33 How to counsel patients about latent tuberculosis treatment
  • 38:25 Dietary and alcohol restrictions during LTBI therapy
  • 44:18 Screening of healthcare workers
  • 48:02 Case of active TB; AFB smears and nucleic acid amplification tests
  • 56:05 Initiation of antibiotics for tuberculosis and how to handle TB resistance
  • 58:13 Airborne precautions; Who needs them and how to isolate patients
  • 61:24 Direct observed therapy and why adherence to tuberculosis therapy is challenging
  • 68:11 Tuberculosis UV light and sanatoriums
  • 71:00 Take home points
  • 72:25 Outro

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

Goals

Listeners will learn the current standard of care for diagnosis, treatment, and surveillance of tuberculosis.

Learning objectives

After listening to this episode listeners will…  

  1. Recognize updates in tuberculosis screening and treatment guidelines
  2. Identify best diagnostic modalities for latent and active tuberculosis
  3. Identify best practices for the management of tuberculosis during the diagnostic period
  4. Employ treatment algorithms and best practices for latent and active tuberculosis

Disclosures

Dr. Woc-Colburn reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures. 

Citation

Woc-Colburn L, Abrams HR, Watto MF. “#178 Tuberculosis Updates with Laila Woc-Colburn MD”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list October 21, 2019.

Oct 21, 2019
#177 Osteoarthritis Master Class with Tuhina Neogi MD, PhD
01:15:12

ACR osteoarthritis guidelines author, Dr. Tuhina Neogi (Boston University; @tuhinaneogi) schools us on all things OA, including new understandings of pathophysiology, diagnosis, when to order imaging and labs, and an overview of pharmacologic and nonpharmacologic therapies. Plus, get answers to your questions from Twitter on CBD, turmeric, glucosamine, chondroitin, NSAIDS, intra-articular steroid and hyaluronic acid injections, tai chi, and more!

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

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

Credits

  • Written (including CME questions) and Produced by: Beth Garbitelli and Matthew Watto MD, FACP
  • Cover Art and Infographic by: Beth Garbitelli
  • Hosts: Beth Garbitelli, Matthew Watto MD, FACP; Paul Williams MD, FACP
  • Editor: Matthew Watto MD, FACP
  • Guest: Tuhina Neogi MD, PhD

Partners

Win a prize! Celebrate National Internal Medicine Day and tell us why you’re I.M. Proud.

Tell us why you are I.M. Proud and enter the contest by visiting www.acponline.org/improud to submit your story today! Answer one of the three questions below and share your story on social media using the hashtags #IMProud #NationalInternalMedicineDay, and tag @acpinternists. Prizes will be given out 3 times through June of 2020. The first group of winners will be announced on the first ever National Internal Medicine Day October 28, 2019!

  1. What makes you proud to practice internal medicine or one of the I.M. subspecialties? 
  2. What recent patient experience made you proud to be an internist or subspecialist?
  3. How is internal medicine unique from other subspecialties?

See us at the CHEST 2019 Annual Meeting in New Orleans!

We’ll be doing two live interviews on stage, plus recording two recap episodes to bring you high yield clinical pearls from the conference. Look out for us in our red Curbsiders shirts and say hello. Take a picture with Stuart! Give Paul a hug! Register today https://chestmeeting.chestnet.org/ !!!!

 

Time Stamps

  • 00:00 Sponsor: ACP’s National Internal Medicine Day I.M. Proud Story Contest
  • 00:15 Cold open, disclaimer, intro and guest bio
  • 05:44 Guest one-liner, Picks of the Week*: Joe Nesbo mystery novels, The Snowman (film), Midsommar (film), Won’t You Be My Neighbor (film), @vermontkitchen Beth’s food blog, Serious Eats; Buy Yourself a Ballistic Jump Rope
  • 07:55 Dr. Neogi’s Women in Medicine moment of awakening
  • 15:40 Sponsor: ACP’s National Internal Medicine Day I.M. Proud Story Contest
  • 17:35 Case of Osteoarthritis; Initial history and exam
  • 23:23 Imaging for osteoarthritis
  • 28:45 Physical exam for OA
  • 31:45 Osteoarthritis risk factors
  • 33:48 Pathophysiology of OA
  • 37:43 Targeted therapies for OA are in the pipeline; Weight loss and joint protection
  • 41:35 Mechanisms of pain in OA and recognizing pain phenotypes
  • 46:58 Mainstays of osteoarthritis treatment
  • 49:56 Capsaicin, Acetaminophen, and the importance of positivity
  • 52:22 Intra-articular injections with corticosteroids or hyaluronic acid
  • 57:25 Occupational therapy, More on Topical and Oral NSAIDS; SNRIs (duloxetine)  
  • 62:00 Questions from Twitter: CBD and marijuana (cannabis), turmeric, fish oil (omega 3 fatty acids)
  • 65:03 More from Twitter: Glucosamine/chondroitin, acupuncture, tai chi, yoga, mindfulness, meditation
  • 70:42 New targets for osteoarthritis; Take Home Points
  • 73:40 Outro

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

Goal

Listeners will learn to classify osteoarthritis (OA), assess symptom management, counsel patients on lifestyle modifications, manage pharmacologic interventions for OA, and counsel patients about complementary and alternative therapies commonly suggested by popular culture.

Learning objectives

After listening to this episode listeners will be able to...

  1. Differentiate OA from other joint pathologies like rheumatoid arthritis
  2. Diagnose osteoarthritis and select patients who warrant imaging or labs
  3. Describe the pathophysiology of osteoarthritis
  4. Counsel patients on appropriate lifestyle modifications for management of OA symptoms
  5. Choose appropriate pharmacotherapy for osteoarthritis and counsel patients about potential risks and benefits
  6. Counsel patients about supplements and complementary, alternative medicine therapies commonly suggested by popular culture

Disclosures

Dr Neogi has acted as a consultant to Pfizer and Novartis for osteoarthritis therapies still in clinical trials. No trade names were used during the podcast and a balanced range of therapeutic options was included in the discussion. The Curbsiders report no relevant financial disclosures. 

Citation

Neogi T, Garbitelli B, Williams PN, Watto MF. “#177 Osteoarthritis Master Class with Tuhina Neogi MD, PhD”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. October 14, 2019.

Oct 14, 2019
In-Flight Emergencies REBOOT
40:29

Dominate the most common in-flight emergencies with tools and tips from this classic Curbsiders episode. Our guest, Angelica Zen MD, (formerly an IM Chief Resident 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. Original air date November 21, 2016.

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

Credits

  • Written, produced and edited by: Matthew Watto MD, FACP
  • Cover Art by: Matthew Watto MD, FACP
  • Hosts: Stuart Brigham MD; Paul Williams MD, FACP; Matthew Watto MD, FACP
  • Guest: Angelica Zen MD

Partners

Win a prize! Celebrate National Internal Medicine Day and tell us why you’re I.M. Proud.

  • Tell us why you are I.M. Proud and enter the contest by visiting acponline.org/improud to submit your story today! Answer one of the three questions below and share your story on social media using the hashtags #IMProud #NationalInternalMedicineDay, and tag @acpinternists. Prizes will be given out 3 times through June of 2020. The first group of winners will be announced on the first ever National Internal Medicine Day October 28, 2019!
  1. What makes you proud to practice internal medicine or one of the I.M. subspecialties? 
  2. What recent patient experience made you proud to be an internist or subspecialist?
  3. How is internal medicine unique from other subspecialties?

See us at the CHEST 2019 Annual Meeting in New Orleans!

  • We’ll be doing two live interviews on stage, plus recording two recap episodes to bring you high yield clinical pearls from the conference. Look out for us in our red Curbsiders shirts and say hello. Take a picture with Stuart! Give Paul a hug! Register today https://chestmeeting.chestnet.org/ !!!!

Time Stamps

  • 00:00 Cold open; Disclaimer
  • 00:50 Sponsor: ACP’s National Internal Medicine Day 2019 www.acponline.org/improud 
  • 01:10 Intro, Guest Bio
  • 02:50 Guest onliner; Wellness tips; Tips for staying up on the literature
  • Pick of the Week*: How Doctors Think (book) by Jerome Groopman; MDCalc app; AHRQ app; Physician’s First Watch
  • 07:30 Sponsor: ACP’s National Internal Medicine Day 2019 www.acponline.org/improud 
  • 09:08 Dr. Zen tells her story
  • 19:27 Monitoring your patient in-flight
  • 20:05 Contents of the standard in-flight medical kit
  • 22:10 What Dr. Zen would have done differently
  • 23:05 How to use available resources in-flight
  • 24:20 Medical legal implications
  • 28:07 How to respond to common in-flight emergencies and how to respond
  • 29:35 Syncope and presyncope
  • 31:55 Hypoxia altitude simulation test (HAST)
  • 33:15 Altered mental status
  • 33:52 Anaphylaxis
  • 35:34 Stroke and acute coronary syndrome
  • 36:55 Dr. Zen’s take home points
  • 38:50 Outro

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

Goal

Listeners will comprehend 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 the 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. The Curbsiders report no relevant financial disclosures.

Citation

Zen A, Brigham SK, Williams PN, Watto MF. “#19 In-Flight Emergencies.” The Curbsiders Internal Medicine Podcast https://thecurbsiders.com/episode-list. Original air date November 21, 2016.

Oct 07, 2019
#176 Survive Intern Year: Becoming a PGY1
59:18

Tools, tips and tactics to survive intern year from Alex Glaser MD (PENN) and Saumil Chudgar MD @saumilchudgar (Duke). It’s our latest offering from ACP’s IMpower series for residents

The transition from medical student to intern is one of the world’s most notorious times in a career, and tales of woe from intern year have even permeated into TV shows and movies.  Ultimately, while the transition seems daunting with multiple challenges, it should not be feared. Many physicians look back fondly on this early time in their training, and life-long friendships often develop among an intern class.  This is a time of major growth, and unease about intern year should be met with excitement for the career that is yet to come!

For meeting notes, a discussion guide and facilitators guide visit https://www.acponline.org/impower. 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: Alex Glaser MD 
  • Cover Art: Matthew Watto MD, FACP
  • Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP
  • Editor: Emi Okamoto MD; Matthew Watto MD, FACP
  • Guests: Alex Glaser MD, Saumil Chudgar MD

 

Sponsor - ACP IMpower: Catalyzing your professional future

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

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

Time Stamps

  • 00:00 Pun, disclaimer
  • 00:58 Sponsor: ACP’s IMpower series
  • 01:40 Intro, guest bios
  • 04:10 Guest one-liners
  • 07:12 Picks of the Week: Wheel of Time Series (books); Attending Medicine Mindfulness and Humanity (book)
  • 09:20 Challenges transitioning to intern year -both personal and professional
  • 17:45 Wellness tips for intern year; Work life balance doesn’t exist; The “wellness battery”
  • 22:05 Gratitude journal is an evidence based wellness intervention for residents; Wellness is a systems issue
  • 27:25 Resources, tips and tactics for intern year struggles
  • 32:00 Key skills sets for interns
  • 40:05 Also some skills that are less important than you think
  • 43:38 Practices, habits to improve your skills as an intern; SMART goals; Soft Mentors
  • 48:02 An ideal workday for a Kashlak intern
  • 55:47 Take Home Points
  • 57:45 Outro and post credits scene
Oct 02, 2019
#175 Cervical Cancer Screening and HPV
01:01:25

We dive deep into the relationship between HPV and cervical cancer and identify when and how to screen women with tips from Dr. Karen Smith-McCune (UCSF), Professor in the Department of Obstetrics and Gynecology! We review common cytology findings, screening guidelines, and basic indications for HPV vaccination. 

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

Credits

  • Producer: Molly Heublein MD
  • Writer: Elena Gibson MD and Molly Heublein MD
  • Infographic: Beth Garbitelli MS2
  • Cover Art: Kate Grant MBChB DipGUMed
  • Hosts: Molly Heublein MD; Matthew Watto MD, FACP
  • Editor: Emi Okamoto MD; Matthew Watto MD, FACP
  • Guest: Karen K. Smith-McCune MD, PhD

 

Sponsors

Win a prize! Help ACP Celebrate National Internal Medicine Day and tell us why you’re I.M. Proud.

Tell us why you are I.M. Proud and enter the contest by visiting acponline.org/improud to submit your story today! Answer one of the three questions below and share your story on social media using the hashtags #IMProud #NationalInternalMedicineDay, and tag @acpinternists. Prizes will be given out 3 times through June of 2020. The first group of winners will be announced on the first ever National Internal Medicine Day October 28, 2019!

  • What makes you proud to practice internal medicine or one of the I.M. subspecialties? 
  • What recent patient experience made you proud to be an internist or subspecialist?
  • How is internal medicine unique from other subspecialties?

See us at the CHEST 2019 Annual Meeting in New Orleans!

We’ll be doing two live interviews on stage, plus recording two recap episodes to bring you high yield clinical pearls from the conference. Look out for us in our red Curbsiders shirts and say hello. Take a picture with Stuart! Give Paul a hug! Register today https://chestmeeting.chestnet.org/ !!!!

Time Stamps

  • 00:00 Sponsor: I.M. Proud National Internal Medicine Day Story Contest
  • 01:00 Reminder: We’ll be at CHEST 2019 in NOLA!
  • 01:33 Intro, guest bio
  • 04:35 Guest one-liner; Check out our classic Curbsiders’ Top Picks
  • 08:00 Sponsor: I.M. Proud National Internal Medicine Day Story Contest
  • 09:49 Case of HPV; Background; Is HPV an STI?
  • 13:47 Frequency of screening; Discussion of testing types & pitfalls
  • 18:11 Summary of testing for cervical cancer
  • 20:20 Is co-testing every helpful?
  • 24:05 Choosing a testing interval
  • 24:40 Colposcopy; Risks
  • 32:19 Screening women under 30 years old? Under 21 years old?
  • 33:22 Interpreting a PAP (cytology) result; Algorithm for cervical cancer screening
  • 42:08 Women over 65 years old; When to stop screening
  • 46:02 Will Vaginal swabs replace traditional cervical screening
  • 48:40 Screening after Hysterectomy or “Partial” hysterectomy
  • 50:25 HPV vaccine in older adults and shared decision making
  • 54:21 HPV vaccine in children, young adults
  • 58:12 Take home points
  • 59:40 Outro

Disclosures

Dr. Smith-McCune reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures. 

Citation

Smith-McCune K, Heublein M, Gibson E, Garbitelli B, Okamoto M, Watto MF. “#175 Cervical Cancer Screening and HPV”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. September 30, 2019.

Sep 30, 2019
#174 Dominate Perioperative Medication Management
01:31:29

Dominate perioperative medication management with tips from Kashlak’s newly minted Chief of Perioperative Medicine, @aoglasser, Avital O’Glasser MD, FACP, FHM (OHSU). We cover perioperative anticoagulation, why “bridging is dead”, aspirin, dual antiplatelet therapy, DMARDS, diabetic medications, buprenorphine, and much more! Be sure to check out Dr. O’Glasser’s previous episode #135 Perioperative Medicine: Assess and Optimize Risk to get a full overview of perioperative medicine.

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

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

Credits

  • Written and Produced by: Avital O’Glasser MD, FACP, FHM and Matthew Watto MD, FACP 
  • CME Questions: Matthew Watto MD, FACP
  • Infographic: Matthew Watto MD, FACP
  • Cover Art: Kate Grant MBChB DipGUMed
  • Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP 
  • Editor: Matthew Watto MD, FACP
  • Guest: Avital O’Glasser MD, FACP, FHM

Time Stamps

  • 00:00 Intro, disclaimer, guest bio
  • 03:20 Guest one-liner
  • 04:46 Picks of the Week*: A Moment of Lift (book) by Melinda Gates; Crawl (film); Rich Roll (podcast) episodes w/Valter Longo and David Sinclair
  • 09:35 Avi’s mantras for perioperative management and other core tenants
  • 14:40 NPO and The Consult Guys
  • 17:23 Medical cannabis (marijuana) in perioperative medicine
  • 19:24 Case #1 Ms. Bridge - perioperative anticoagulation: to bridge or not to bridge
  • 25:00 Low bleeding risk surgeries and anticoagulation
  • 27:25 Moderate to high bleeding risk surgeries and anticoagulation; What about the CHA2DS2 Vasc of 7?
  • 28:42 Bridging for venous thromboembolism (VTE)
  • 31:30 How to give instructions for holding warfarin
  • 32:30 Bridging a DOAC
  • 36:16 Recap on bridging VKAs and use of DOACs
  • 37:48 Neuraxial anesthesia and anticoagulation
  • 39:49 Biologic DMARDS; Nonbiologic DMARDS
  • 43:48 Supplements and herbals
  • 48:40 Case #1 wrap up
  • 50:16 Case #2 -Mr. DAPT; Perioperative Aspirin; DAPT -dual antiplatelet therapy
  • 57:20 Summary of perioperative antiplatelet therapy
  • 63:18 Statins
  • 64:45 Beta blockers
  • 67:21 ACEI and ARB; Diuretics
  • 69:17 Oral hypoglycemics and newer diabetes agents (SGLT2 inhibitors, GLP1 agonists); What about metformin?
  • 72:04 Insulin
  • 74:40 Case #2 wrap up
  • 75:35 Case #3 Ms. GB Stone who takes lithium and buprenorphine
  • 77:30 NSAIDS, Buprenorphine
  • 81:45 ART, transplant meds, Lithium, MAOIs, Levothyroxine; Watch out for lithium
  • 86:34 Case #3 wrap up
  • 87:25 Take Home Points
  • 88:45 Outro
  • 90:15 Avi and Mr. Rogers

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

Goals

Listeners will develop a practical approach to perioperative medication management and review special considerations for the various drug classes.

Learning objectives

After listening to this episode listeners will...

  1. Frame perioperative medication management decisions as another type of patient-centered, surgery-specific perioperative “risk/benefit” decision
  2. Discuss guideline recommendations for the perioperative management of multiple classes of medications
  3. Examine more nuanced or challenging medications to manage in the perioperative setting
  4. Explore professional, patient-centered and multidisciplinary communication techniques when disagreements arise regarding best medication management recommendations

Disclosures

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

Citation

O’Glasser A, Williams PN, Watto MF. “#174 Perioperative Medication Management”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. September 23, 2019.

Sep 23, 2019
#173 Hotcakes: Imposter syndrome, Vacations, Pneumonia vaccine, More!
01:00:42

Dr Kimberly Manning joins to discuss imposter syndrome, how vacations affect health, and an update on the pneumonia vaccine, PCV13. Plus, hot takes on the dangers of vaping, and using procalcitonin and CRP to determine need for antibiotics. 

Howdy, gentle listeners! It’s that special time of year when the school doors reopen, classrooms are awash in ‘new pencil’ smell, and FOAMed fans grab their trays and head to the cafeteria for some tasty knowledge food. Rest assured your Curbsiders friends have saved you a seat at the lunch table for this very special September 2019 episode! 

Today we are joined by Dr. Kimberly Manning MD, FACP, FAAP, who is an Associate Professor of Medicine at Emory University School of Medicine. Dr. Manning authors a blog (“Reflections of a Grady Doctor”) that was named in 2010 by ‘O’ The Oprah Magazine as one of “four top medical blogs you should read.” She can also be found on Twitter, @gradydoctor. Thanks for listening!

Full show notes at https://thecurbsiders.com/episode-list. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits 
  • Written and Produced by: Sarah Phoebe Roberts MPH, Christopher Chiu MD, FACP, FAAP
  • Hosts: Matthew Watto MD, FACP; Sarah Phoebe Roberts MPH, Paul Williams MD, FACP; and Christopher Chiu MD, FACP, FAAP
  • Editor: Christopher Chiu MD, FACP, FAAP; Emi Okamoto MD
  • Cover-Art: Christopher Chiu MD, FACP, FAAP
  • Guest: Kimberly Manning MD, FACP, FAAP
Time stamps
  • 00:00 Introduction/Disclaimer
  • 03:15 Guest bio
  • 05:00 Getting to know Dr. Manning
  • 11:05 Picks of the week*: Reflections of a Grady Doctor, Dr. Kimberly Manning’s Blog; To Kill a Mockingbird by Harper Lee, audiobook narrated by Sissy Spacek; LeVar Burton Reads, a podcast; Aziz Ansari Right Now (comedy special) and Master of None (TV show); Garfield Minus Garfield, an existential take on a classic comic; Clue, the 1985 movie
  • 17:15 Paul’s vaping update (CDC media statement)
  • 20:10 Procalcitonin, CRP and antibiotic prescription for COPD exacerbation
  • 24:30 Pneumococcal conjugate vaccine
  • 30:00 Imposter syndrome
  • 49:00 Vacation time and metabolic syndrome
  • 57:00 Wrap-up and outro

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

Sep 16, 2019
#172 Cost-of-Care Conversations
54:35

 

Recognize the importance of cost-of-care conversations and identify resources to facilitate these discussions with help from Gwen Darien, executive vice president at the National Patient Advocate Foundation, and Dr. Jessica Dine, Associate Professor and Chief of the division of Pulmonology and Critical Care at Perelman School of Medicine.  We review barriers to cost-of-care conversations and identify tools to help make these conversations a part of routine care discussions. 

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

Credits

  • Written and Produced by: Elena Gibson, MD
  • Infographic and Cover Art: Elena Gibson, MD
  • Hosts: Elena Gibson MD; Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP  
  • Editor: Matthew Watto MD, FACP; Emi Okamoto MD 
  • Guest: Gwen Darien and Jessica Dine MD

Partners and Grant Support

The American College of Physicians. Check out this supplement to the Annals of Internal Medicine from May 2019 on Fostering Productive Health Care Cost Conversations https://annals.org/aim/issue/937992

The Robert Wood Johnson Foundation https://www.rwjf.org provided grant support for this episode.

Time Stamps

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

Goal

Listeners will recognize the need for routine cost-of-care conversations and identify resources to improve the quality of such conversations in order to deliver high-value care. 

Learning objectives

After listening to this episode listeners will…  

  1. Recognize the importance of cost-of-care conversations between physicians and patients 
  2. Describe barriers to conversations concerning healthcare costs
  3. Feel comfortable initiating routine conversations with patients on the cost-of-care 
  4. Identify where and how to access resources to assist with healthcare cost conversations

 

Disclosures

Gwen Darien and Dr. Jessica Dine report no relevant financial disclosures. The Curbsiders report no relevant financial disclosures. 

Citation

Dine J, Darien G, Gibson E, Brigham SK, Williams PN, Okamoto E, Watto MF. “#172 Cost-of-Care Conversations”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list September 11, 2019.

Sep 11, 2019
#171 Lupus in Primary Care with Beth Jonas MD
54:58

Diagnose and treat lupus in primary care with tips from rheumatologist, Beth Jonas MD, FACR (UNC). We discuss the history and exam findings in lupus, initial lab workup, the dreaded ANA, who needs expanded lab testing, lifestyle factors in lupus, vaccinations, the basics of treatment...and Jethro Tull?! 

Full show notes at https://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: Kate Grant MBChB DipGUMed; Matthew Watto MD, FACP
  • Infographic: Matthew Watto MD, FACP
  • Cover Art: Kate Grant MBChB DipGUMed
  • Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP
  • Editor: Matthew Watto MD, FACP
  • Guest: Beth Jonas MD, FACR

Time Stamps

  • 00:00 Intro, disclaimer, guest bio
  • 03:03 Guest one-liner; Book recommendation*: How Doctors Think (book) by Jerome Groupman; Career advice
  • 10:50 A case of hematuria and rash, Ms Luna Wolferton
  • 12:00 Differential diagnosis for a patient with symptoms suggestive of lupus
  • 13:50 Clues for lupus on history and exam
  • 15:42 Classification criteria versus making a clinical diagnosis of lupus (Dorner 2019)
  • 18:17 ANA, what is it good for?
  • 21:33 Basic lab workup (CBC, urinalysis and TSH)
  • 25:10 Labs to send once lupus is suspected
  • 28:15 Does Ms Wolferton have lupus? 
  • 29:10 Spiel for explaining lupus to a patient
  • 31:20 ANA titers
  • 33:02 Are there classic phenotypes of lupus?
  • 34:40 Lifestyle factors
  • 38:20 Bone density and chronic steroids
  • 39:42 Vaccinations; Antimicrobial prophylaxis
  • 41:55 Hydroxychloroquine; Treatment goals in lupus
  • 44:38 Steroids and add on therapies e.g. methotrexate, Belimumab
  • 47:55 The importance of hydroxychloroquine
  • 49:15 Drug-induced lupus (e.g. hydralazine, isoniazid, minocycline, procainamide)
  • 51:17 Take Home Points; Plug: Thurston Arthritis Center at UNC Chapel Hill
  • 53:40 Outro

Goals

Listeners will recognize and diagnose various presentations of lupus (SLE) in primary care, counsel patients with a new diagnosis of lupus, learn the general approach to treatment, and provide preventive care. 

Learning objectives

After listening to this episode listeners will...

  1. Recognize its myriad manifestations and diagnose lupus. 
  2. Perform an initial workup for suspected lupus
  3. Interpret positive ANA titers and order appropriate follow up testing
  4. Counsel patients with a new diagnosis of lupus
  5. Educate patients on nonpharmacologic therapy for lupus
  6. Discuss the basics of lupus treatment and monitoring/prevention including vaccinations, control of vascular risk factors, antimicrobial prophylaxis and promotion of bone health
  7. Provide excellent primary care and preventive medicine to co-manage lupus
  8. Counsel patients with a new diagnosis of lupus

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

Disclosures

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

Citation

Jonas B, Williams PN, Watto MF. “#171 Lupus in Primary Care with Beth Jonas MD”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list September 8, 2019.

Sep 09, 2019
#170 Hypernatremia is Easy with Joel Topf MD
01:12:48

Solve hypernatremia with tips and tactics from Dr. Joel Topf, MD (@kidney_boy), our Kashlak Chief of Nephrology. We review the diagnostic workup for hypernatremia, polydipsia and polyuria, review the pathophysiology of diabetes insipidus, and how to differentiate between nephrogenic and central DI. Plus, we walk through how to treat hypernatremia in the acute setting and Dr. Topf shares clinical pearls on why hypernatremia is the opposite of hyponatremia… It’s easy!

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

Credits

  • Written by Hannah R. Abrams and Joel Topf MD
  • Producer: Hannah R. Abrams
  • Cover Art and infographic by: Hannah R. Abrams
  • Hosts: Hannah R. Abrams; Stuart Brigham MD; Matthew Watto MD, FACP
  • Editors: Matthew Watto MD, FACP; Emi Okamoto MD 
  • Guest: Joel Topf MD

Check out Dr. Topf’s podcast!

The NephJC podcast, Freely Filtered, discusses the latest NephJC topic every two weeks. Subscribe here or on iTunes

Time Stamps

  • 00:00 Intro, disclaimer, guest bio
  • 03:25 Joel’s one liner and plug for his new podcast
  • 05:34 Hannah shares a really weird analogy
  • 07:10 Picks of the week*: In Shock (book) by Rana Awdish;
    HBO’s From the Earth to the Moon; Once Upon a Time in Hollywood (film); Glass(film) directed by M. Night Shyamalan (Stuart’s anti-pick)POCUS! Sign up for a course today from the ACP, AIUM or TRUST
  • 13:18 Why hypernatremia is easy
  • 14:49 The case of Paula Uric - new onset hypernatremia with hypercalcemia
  • 16:12 Hypernatremia risk factors; ADH, osmolality and the kidney 
  • 21:20 Loop of Henle and the sodium, potassium and 2 chloride channel
  • 22:05 How hypercalcemia mimics nephrogenic diabetes insipidus
  • 29:30 Hypercalcemia workup
  • 33:10 Differentiating central from nephrogenic diabetes insipidus
  • 37:35 DDAVP, desmopressin and treatment of nocturia
  • 38:50 The case of Manny Uric - altered mental status and hypernatremia Na = 162; Why do patients in the ICU develop hypernatremia?
  • 42:29 Calculate the fluid deficit; total body water
  • 48:05 Estimate insensible losses (electrolyte free water clearance)
  • 54:48 What if your hypernatremic patient is also hypovolemic?
  • 57:30 Does fluid restriction work in heart failure?
  • 58:35 Hypernatremia - Is there such a thing as too fast in adults? 
  • 63:44 Thiazides versus acetazolamide for nephrogenic DI
  • 68:34 Take home points
  • 71:20 Outro

Links*

  1. In Shock (book) by Rana Awdish
  2. HBO’s From the Earth to the Moon
  3. Once Upon a Time in Hollywood (film)
  4. Glass (film) directed by M. Night Shyamalan (though consider avoiding, per Stuart)
  5. POCUS! Sign up for a course today from the ACP, AIUM or TRUST

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

Disclosures

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

Citation

Topf J, Abrams HR, Brigham SK, Okamoto E, Watto MF. “170 Hypernatremia is Easy with Joel Topf MD”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. September 2, 2019.

Sep 02, 2019
#169 PGY3 and Beyond with Alia Chisty MD
01:15:01

Search and secure your first job after residency. Dr. Alia Chisty (Penn State) returns to school us on surviving the PGY3 and beyond, part of ACP’s IMpower series. Topics: finding mentors, how to plan ahead as an intern and PGY2, master the interview day, avoid common pitfalls and confidently enter your early career. We’re joined by Curbsider and recent graduate Justin Berk MD, MPH, MBA who shares his experiences from the job trail.

Flip the classroom!

For meeting notes, a discussion guide and facilitators guide visit visit IMpower: Catalyzing your professional future

Credits

  • Written and Produced by: Paul Williams MD, FACP and Alia Chisty MD, MS 
  • Cover Art: Matthew Watto MD, FACP
  • Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP
  • Editor: Matthew Watto MD, FACP
  • Guests: Alia Chisty MD, MS; Justin Berk MD, MPH, MBA

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.

Sponsor

Join The American College of Physicians today! Resident members get exclusive access to IMpower: Catalyzing your professional future. 

Time Stamps

  • 00:00 Pun
  • 01:19 Intro, guest bio, disclaimer
  • 04:00 Guest one-liner
  • 05:35 Picks of the week*: Once Upon A Time In Hollywood (film), Visit Baltimore (city)!, Read with your kids!, Wolfie the Bunny (book), Tribe: Homecoming and Belonging (book) by Sebastian Junger
  • 10:20 Intern year agenda: Get the lay of the land; Identify potential mentors
  • 19:26 How to be a great mentee: Bring concrete questions, Ask how your mentor likes to operate
  • 22:08 PGY2 and career development: Decide if you want to do fellowship. Explore electives in potential career paths (e.g. meded), A word of caution about signing a contract as a PGY2
  • 26:30 PGY3: Polish your CV. Collect references. Reach out to your network. Email potential employers.
  • 31:00 Resources for finding a career: ACP and NEJM website’s have career centers. Check LinkedIn and Doximity. Ask your program director and previous graduates from your program.
  • 35:10 Recruiters: Should you use them? What are the pitfalls?
  • 37:45 Dr. Chisty recaps the job application timeline
  • 40:20 Interviewing: Phone interviews are a common first step; Make an elevator pitch; How to nail the interview day
  • 45:28 How geographic needs affect the application process
  • 47:52 Stuart is champing at the bit
  • 49:04 The pie analogy and FTEs
  • 52:36 Promotion tracks
  • 55:26 More on the interview day
  • 59:26 Making the emotional transition from PGY3 to early career; Pretending rounds; Imposter Syndrome; Article by Murthy, Dhaliwal on Early Careers of Master Clinicians
  • 67:13 You are competent. There’s a committee that’s been monitoring your growth
  • 68:28 Take home points: Use your network. Imposter syndrome is normal. You are competent and people believe in you. Reflect on the behaviors of your favorite educators.
  • 72:18 Your tribe

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

Aug 28, 2019
#168 Diabetes Update with Jeff Colburn MD
01:10:32

Step up your diabetes game! We answer your questions from #MedTwitter with help from returning guest, Jeff Colburn MD, FACP, FACE (USU) Topics include: the pitfalls of A1C testing, the A1C target controversy, lifestyle interventions, continuous glucose monitoring, pathophysiology of T2DM, use of SGLT2 inhibitors, GLP1 agonists, and how to initiate and titrate insulin therapy. ACP members can claim CME-MOC credit at https://www.acponline.org/curbsiders (CME goes live at 0900 ET on the episode’s release date). 

Full show notes at https://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

  • Writer (including CME Questions) and Producer: Matthew Watto MD, FACP
  • Cover Art and Infographic: Bryan Brown MD
  • Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP
  • Editor: Matthew Watto MD, FACP; Emi Okamoto MD
  • Guest: Jeff Colburn MD, FACP, FACE

Time Stamps

  • 00:00 Pun, Intro, disclaimer, and guest bio
  • 03:55 Guest one liner
  • 05:45 Picks of the week*: Illusions (book) by Richard Bach, Industrial Accident: The Story of Wax Track Records (Documentary), Free Solo (Documentary), Peter Attia’s The Drive (Podcast) -episode with Jason Fung MD
  • 12:28 A case of Type 2 Diabetes (T2DM); Four potential pitfalls when checking A1C 
  • 19:58 Does tight glucose control improve outcomes?
  • 24:05 Continuous glucose monitoring
  • 29:08 Pathophysiology of diabetes and the metabolic syndrome
  • 33:13 Beta cell regeneration
  • 35:10 Can intensive lifestyle changes and T2DM; DIRECT trial 
  • 37:50 Next steps for patients uncontrolled on metformin; SGLT2 inhibitors - considerations for use, risk and benefits, how to counsel patients
  • 42:40 SGLT inhibitors and degree of hyperglycemia; How real are concerns about amputations and Fournier’s gangrene?; How does eGFR affect their use and efficacy?; Euglycemic DKA
  • 49:51 GLP1 agonists. Now available as oral agents.
  • 53:40 2019 ADA guidelines for the management of hyperglycemia
  • 54:51  How to manage the use of both insulin and oral hypoglycemic agents in combination
  • 56:48 Insulin therapy. Choice of agent. How to start it. How to titrate.
  • 60:40 Can patients with T2DM ever stop insulin?
  • 62:00 Adding GLP1 and SGLT2 agents on top of insulin therapy
  • 65:30 Using loop diuretics with SGLT2 inhibitors
  • 66:30 Take home points
  • 69:06 Outro
Aug 26, 2019
#167 LIVE! Common CBC Abnormalities with Mary Kwok MD
50:03

Take a deep dive into common CBC abnormalities. We recorded LIVE at joint grand rounds between Walter Reed NMMC and Uniformed Services University with hematologist, Dr. Mary Kwok MD. Topics include: which parts of the complete blood count (CBC) are most important, interpreting the differential, when to order flow cytometry, who needs a hematology consult and simplified approaches to patients with leukocytosis, leukopenia, erythrocytosis and thrombocytopenia. 

Full show notes at https://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, Produced and Edited by: Matthew Watto MD, FACP
  • Cover Art and Infographic by: Matthew Watto MD, FACP
  • Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP
  • Guest: Mary Kwok MD

 

Sign Up for a course w/our Chief of POCUS, Dr. Renee Dversdal!

ACPacponline.org/pocus

AIUM - Check out https://aium.org for upcoming events. 

TRUST (Train the Ultrasound Trainers) https://www.ultrasoundtraining.com.au/courses/category/train-the-ultrasound-trainer-trust

Time Stamps

  • 00:00 Intro; Paul shame’s the audience; Guest bio
  • 03:17 Guest one-liner, book recommendation* -Emperor of All Maladies (book) by Siddhartha Mukherjee, When Breath Becomes Air (book) by Paul Kalanithi; Career advice -set goals for whatever you’re learning.
  • 08:43 Picks of the week: John Wick 3 (film); The Movies That Made Me (podcast) by Joe Dante; The Tim Ferriss Podcast with Julie Rice of Soul Cycle; Infinity Chamber (film) by Travis Milloy
  • 11:50 A case of asymptomatic leukocytosis; Red flags; Repeat the CBC until it’s normal
  • 17:30 The peripheral smear; Leukemoid reaction
  • 20:00 The physical exam; When to send flow cytometry?
  • 22:18 A case of lymphopenia; benign ethnic neutropenia; What to look for in the history
  • 27:10 A case of erythrocytosis; Checking EPO levels; JAK2 mutation; Differential Diagnosis; Therapeutic Phlebotomy; Physical findings of Polycythemia Vera
  • 36:53 A case of thrombocytopenia; Lab workup; Differential diagnosis; Pathophysiology; Culprit meds
  • 45:35 Advice for internists
  • 46:36 Take Home Points
  • 47:46 Dr. Kwok’s disclaimer
  • 48:10 Outro and post credit scene
Aug 19, 2019
#166 Advocacy and Hot Topics in Healthcare Policy with Robert McLean MD, FACP
01:02:21

Join us for this roundtable discussion of advocacy in healthcare and a rundown of hot topics: coding and billing, the Affordable Care Act, universal healthcare, gender equity, women’s health, gun violence and more! Returning guest, Dr. Robert McLean (@rmmclean84), current president of the American College of Physicians, helps us answer questions like, What is advocacy in healthcare? What are the issues that are impacting your profession? What can your medical home do for you? He’s been heavily involved in advocacy throughout his career including testifying before Congress. Guest hosts Drs. Fatima Syed MD, MSc and Deep Shah MD, MSc join! 

Full show notes available at https://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: Fatima Syed, MD, MSc; Matthew Watto MD, FACP
  • Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP; Fatima Syed, MD, MSc; Deep Shah, MD, MSc
  • Editor: Matthew Watto MD, FACP
  • Guest: Robert McLean MD, FACP

 

Time Stamps

  • 00:00 Intro, disclaimer, and guest bios
  • 03:22 How can new docs in practice get involved in advocacy and shaping healthcare policy
  • 11:30 Medicare’s proposed changes to billing and documentation
  • 13:40 Who’s involved in changing Medicare policies?
  • 16:09 What’s the purpose of policy papers? How are they written?
  • 19:12 Getting involved in local and national councils as a student or resident
  • 25:22 The Affordable Care Act and Universal coverage
  • 29:25 What’s the risk of non-ACA approved insurance plans?
  • 31:40 Why do people oppose the ACA?
  • 34:40 Universal healthcare defined
  • 40:23 The gender pay gap; Shout out to ACP’s CEO Darilyn Moyer MD, FACP
  • 45:10 Women’s health policy paper
  • 47:40 Gun violence and how advocacy issues take off
  • 55:00 Take home points; Plug for Bob Doherty’s blog
  • 60:36 Outro
Aug 14, 2019
#165 Things We Do For No Reason™ Part 2
01:14:27

Discover more common practices that persist in the hospital wards despite no proven benefit! We review how hospitals prescribe a “crapload” of docusate which only clogs up the medication list, how unnecessary echocardiograms are ordered enough times to make your head spin, and how basal insulin needs to slide back into your inpatient diabetes management instead of correctional insulin monotherapy. Join high-value care specialist Dr. Lenny Feldman (@DocLennyF, Hopkins) and tweetorialist Dr. Tony Breu (@tony_breu, Harvard) as they walk us through round 2 of “Things We Do For No Reason™.” 

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

Full show notes at https://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: Justin Berk, MD MPH MBA, Matthew Watto MD
  • Infographic: Justin Berk MD MPH MBA
  • Cover Art: Matthew Watto MD
  • Hosts: Stuart Brigham MD, Matthew Watto MD, and Paul Williams MD  
  • Editor: Matthew Watto MD, Emi Okamoto MD
  • Guest: Lenny Feldman MD, Tony Breu MD

 

Sponsor

The Society of Hospital Medicine / Journal of Hospital Medicine - Things We Do For No Reason™series. Check out all the Things We Do For No ReasonTM articles here: Master Index of TWDFNR articles .

Time Stamps

  • 00:00 CME-MOC announcement https://www.shmlearningportal.org/curbsiders 
  • 00:50 Intro, disclaimer, guest bios
  • 05:20 Guest one-liners, picks of the week
  • 14:32 Things We Do for No ReasonTM (TWDFNR) defined
  • 18:06 A case of syncope; definition
  • 19:58 Do all patients with syncope need an echo?
  • 23:30 What’s the diagnostic yield of echo for syncope?
  • 29:36 Workup for new onset syncope
  • 33:54 Aortic stenosis murmur
  • 35:55 Docusate. Mechanism of action. Why is it so popular? What’s the harm?
  • 42:08 Docusate. What does the evidence say? What should we use instead
  • 50:05 A case of Sliding scale insulin (SSI); a brief history of insulin therapy and monitoring; SSI monotherapy: Risks, benefits, alternatives
  • 59:30 Metformin in the hospital
  • 65:35 Starting insulin in the hospital
  • 68:20 Plugs- Things We Do For No ReasonTM. Become an author.
  • 72:10 Outro and post-credits scene
Aug 12, 2019
Reboot #108 POCUS: Point-of-care Ultrasound for the Internist
01:00:05

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 www.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, FACP and Renee Dversdal MD, FACP 
  • Produced and CME questions by: Christopher Chiu MD, FACP
  • Edited by: Matthew Watto MD, FACP 
  • Hosts: Matthew Watto MD, FACP; Stuart Brigham MD; Christopher Chiu MD, FACP 
  • Guest Expert: Renee Dversdal MD, FACP 

Special thanks to our POCUS friends!

ACP

We can speak first hand that the following courses are amazing POCUS learning experiences! Sign up today

Point-of-Care Ultrasound: Foundational Skills for Internists

  • November 7-8, 2019 and November 9-10, 2019 (same 2-day course repeated back to back)
  • Crowne Plaza O’Hare Hotel and Conference Center, Rosemont, IL
  • Registration is now open at acponline.org/pocus

Point-of-Care Ultrasound: Foundational Skills for Internists

  • April 21-22, 2020 (during Internal Medicine Meeting 2020)
  • Los Angeles Convention Center
  • Registration will open at the end of September 

Point-of-Care Ultrasound: Advanced Skills for Outpatient Practice

  • April 22, 2020 (during Internal Medicine Meeting 2020)
  • Los Angeles Convention Center
  • Registration will open at the end of September

AIUM

A special thanks to our Chief of POCUS Dr. Renee Dversdal and the AIUM for hosting The Curbsiders at another fantastic AIUM Point of Care Ultrasound (POCUS) Conference in Portland, Oregon at OHSU, July 2019. Check out https://aium.org for upcoming events. Next year’s IM POCUS course will be July 2020 in Portland! Dates are still TBD. Stay tuned.

TRUSTTM (Train the Ultrasound Trainers)

Are you looking to boost your skills teaching POCUS? Well, Our Chief of POCUS in collaboration with Kashlak West & Zedu Ultrasound Training Solutions created a course just for people like you. Sign up here: https://www.ultrasoundtraining.com.au/courses/category/train-the-ultrasound-trainer-trust

 

Time Stamps 

  • 00:00 Intro, Disclaimer, POCUS announcements
  • 05:00 Guest one liner, book recommendation, rapid fire Q & A
  • 11:00 Dr Dversdal shares a story about failure/struggle
  • 15:00 POCUS defined
  • 19:00 Uptake of POCUS in Internal Medicine
  • 22:45 Getting into the game. Cost, choice of device and how to get training
  • 26:40 Dr Dversdal shares her journey into POCUS 
  • 31:00 Clinical case of indeterminate volume status and how POCUS helped
  • 35:00 IVC and IJ POCUS exam discussed in detail
  • 37:55 How to choose a machine and bring US to your institution
  • 41:00 How to troll the wards and introduce yourself to patients for practice of POCUS
  • 43:00 Billing and documentation for POCUS
  • 46:43 How POCUS can improve physical exam
  • 51:27 Uses for POCUS in the primary care clinic
  • 53:40 Dr Dversdal’s top 5 POCUS exam findings
  • 56:27 Patients love POCUS
  • 58:30 Outro
Aug 07, 2019
#164 Stroke and TIA Deconstructed
01:14:53

Update your management of stroke and TIA in primary care. Stroke neurologist, Chris Favilla MD (University of Pennsylvania), walks us through the plumbing of the brain, so we can identify ischemic risks in stroke and TIA patients to prevent recurrences.  Learn factors that make a TIA high risk, which imaging studies to order, new research around aspirin dosing, dual antiplatelets, DOACs, cardiac monitoring and more! ACP members can claim CME-MOC credit at https://www.acponline.org/curbsiders (CME goes live at 0900 ET on the episode’s release date). 

Full show notes at https://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

  • Producers: Molly Heublein MD; Matthew Watto MD, FACP
  • Writer (including CME questions): Molly Heublein MD
  • Cover Art: Bryan Brown MD
  • Hosts: Stuart Bringham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP
  • Editor: Emi Okamoto, MD; Matthew Watto MD, FACP
  • Guest: Chris Favilla, MD

Time Stamps

  • 00:00 Intro, disclaimer, guest bio, and a bad pun
  • 04:20 Chris’ one-liner, advice as a teacher, book recommendation -The Goldfinch, 
  • 07:40 Molly’s pick of the week -Extreme Measures (book) by Jessica Zitter
  • 08:40 A case of TIA; definition of TIA
  • 12:14 Stroke territories
  • 14:24 New definition of TIA
  • 16:00 Differentiation from complex migraine
  • 19:17 Risk stratifying TIA and ABCD2 score
  • 22:00 A bit on tPA
  • 24:01 Workup for TIA; workup for amaurosis fugax
  • 25:36 CNS imaging studies after stroke or TIA; Choice of imaging study
  • 33:15 HINTS exam for posterior circulation stroke
  • 34:48 Is an echo necessary? Bubble study for PFO?
  • 38:32 Duration of afib monitoring
  • 40:24 Echo reports: what to look for in patient with stroke or TIA; “soft markers”
  • 41:55 Blood testing after Stroke and TIA (lipid panel, HbA1C; +/- RPR, coags, CBC)
  • 43:50 Folic acid; Sparkle trial: high dose atorvastatin versus placebo for secondary prevention
  • 47:00 Incidental finding: multiple patchy infiltrates in a patient without stroke or TIA; Is it significant?
  • 48:50 Aspirin therapy after TIA; Dosage adjustment based on weight?
  • 51:10 A case of stroke; TOAST trial and classification of acute stroke; ESUS; aortic arch atheromas
  • 55:58 Large artery strokes (hypoperfusion, acute thrombosis, artery to artery embolization)
  • 57:15 Antiplatelets after stroke and TIA; DAPT and duration of therapy
  • 62:57 Antidiabetic drugs and stroke
  • 63:40 Lightning round: CHA2DS2VASc score and women; how much afib is significant?; 66:32 Are all DOACs created equal?; 68:20 Regaining function after a stroke; 69:47 Silent infarcts on imaging
  • 71:54 Resources for stroke: Decision making in neurology textbook
  • 73:28 Outro
Aug 05, 2019
#163 Hotcakes: Burnout, iron for heart failure, aspirin & VTE prevention
42:03

Summary

The sun is shining, the cakes are hot, and the takes are even hotter. Welcome to our July 2019 Hotcakes episode! Join us as our beloved hosts Chris, Matt, Stuart and Paul share some of the latest practice-changing knowledge, news and research in medical science. Today’s discussion covers studies on the use of IV iron supplementation for heart failure, aspirin as VTE prophylaxis after arthroplasty, and the relationship between physician burnout and ability to address patients’ social determinants of health. Honorable mentions include a throwback to the life-changing magic of Pokémon GO.   

Full show notes available at http://thecurbsiders.com/podcast. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits 
  • Written and Produced by: Sarah Phoebe Roberts MPH, Christopher Chiu MD
  • Hosts: Matthew Watto MD, Stuart Brigham MD, Paul Williams MD, and Christopher Chiu MD
  • Editor: Christopher Chiu MD, Emi Okamoto MD
  • Cover-Art: Matthew Watto MD
Time stamps
  • 00:20 Disclaimer, intro
  • 02:30 Clinic capacity, provider burnout, and social determinants of health
  • 15:00 Iron deficiency and heart failure meta-analysis (Zhou et al., 2019)
  • 17:15 Iron deficiency and stable heart failure RCT (Ponikowski et al., 2015)
  • 19:00 Iron deficiency and decompensated heart failure RCT (Yeo et al., 2018)
  • 26:00 Aspirin as VTE prophylaxis after arthroplasty
  • 38:00 Honorable mention (Pokémon Go!)
  • 39:00 Wrap-up and outro
Jul 29, 2019
#162 Gender & Sexual Harassment in Medicine, #MeToo
01:02:05

Dr. Reshma Jagsi (TIME’S UP Healthcare; UMichigan) schools us on sexual harassment and describes the systemic and cultural changes that need to happen to effect real change. She unpacks the definition of sexual harassment, describes the state of the #MeToo and TIME’s UP movements across the science and medicine fields and highlights how we all can recognize/respond to harassment.

This is the third episode of our Women in Medicine series. Last August, you heard us talk to Dr. Vinny Arora about the paucity of women in leadership positions, finding sponsors for career advancement, and being bold about career decisions. In December, we spoke to Dr. Susan Hingle about work-life integration. Her advice? Stop worrying about what other people think, acknowledge that being a doctor is hard, especially for women due to disproportionate out-of-work responsibilities, and define a beautiful life that is individualized to you. 

Full show notes available at http://thecurbsiders.com/podcast. 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 Trivedi MD, Nora Taranto MD, Sarah P. Roberts MPH.
  • Editor: Matthew Watto MD
  • Hosts: Shreya Trivedi MD, Chris Chiu MD, Leah Witt MD
  • Guest: Reshma Jagsi MD, DPhil
  • Special thanks to: Hannah Abrams MS4, Beth Garbitelli MS2, and Molly Heublein MD 

Time Stamps 

  • 00:00 Intro, disclaimer and guest bio
  • 03:10 Guest one-liner, WIM moment of awakening, Dr. Jagsi’s advice to her younger self
  • 10:40 TIME’S UP Healthcare, how to get involved
  • 13:10 Picks of the week: This American Life (podcast); The Bon Appétit (YouTube), The Nocturnists (podcast); Twitter
  • 17:05 Defining sexual harassment
  • 21:05 A case of sexual harassment; Predictors of harrassment; Duty to report
  • 27:30 Creating a system that makes reporting easy
  • 30:19 How pervasive is sexual harassment?
  • 34:33 Why/how does bad behavior go unreported?
  • 36:22 Pregnancy, parenting and promotion 
  • 39:10 How is gender equity related to harassment? What can we do in our day to day?
  • 42:13 An example from Radiation Oncology
  • 46:43 How identity as sex intersects with many other identities (e.g. religion, sexual orientation) 
  • 48:15 Examples of how can institutions are changing academic culture and addressing gender equity
  • 53:28 Anonynmous reporting of sexual harassment
  • 58:01 Take Home Points
  • 60:25 Outro
Jul 22, 2019
#161 A Rash Approach to Rashes with Helena Pasieka MD
01:19:13

Tackle rashes with wisdom from Kashlak’s resident Skinternist (or Internist-Externist) Dr. Helena Pasieka (MedStar, Georgetown), board certified in both Internal Medicine and Dermatology.  She offers “a rash approach to rashes” including: initial triage, ‘inside job’ vs ‘outside job’, differential diagnosis, a review of common culprits, basic management techniques, and how to determine if the reaction is life-threatening. Plus, Dr Pasieka teaches us how to handle family and friends asking, “Can you take a look at this rash?”. 

Full show notes at https://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: Beth Garbitelli MS2
  • Infographic and Cover Art: Beth Garbitelli MS2
  • Hosts: Stuart Bringham MD, Matthew Watto MD, Paul Williams MD  
  • Editor: Matthew Watto MD
  • Guest: Helena Pasieka MD 

Time Stamps

  • 00:00 Intro, disclaimer, guest bio
  • 04:10 Guest one-liner, book recommendations 
  • 09:56 Case of a rash; initial thought process (sick versus not sick); review of systems
  • 18:05 Grouping rashes: inside job versus outside job
  • 22:07 Terminology: Many people dont speak derm
  • 26:03 Skin itching versus Skin pain; Morbilliform drug eruption
  • 30:08 Urticaria (hives) vs morbilliform rash; Cotton tipped applicators and dermatographism
  • 35:42 Itching is not all about histamine; Treatment of hives
  • 38:26 Treatment of morbilliform rash
  • 40:00 Case summary and review of concepts learned thus far
  • 41:00 AGEP
  • 45:14 SJS/TEN; Nikolsky’s sign
  • 53:20 Complications of TEN - Ocular surface disease; Vulvar disease
  • 58:02 DRESS (now DIHS)
  • 66:30 Tips for asking about time course of meds and symptoms; Recap of DRESS (DISH)
  • 70:00 How to handle family and friends ask for rash evaluation
  • 76:20 Outro
  • 78:00 Post-credits scene
Jul 15, 2019
#160 Hotcakes: E-cigarettes, UTIs, Heart Failure
44:50

Confession: we have been holding out on you. Specifically, we’ve been sitting on a special episode of Hotcakes and Hot Takes that we recorded this March, with featured guest Armand Gottlieb, MD of the online publication The Scope. But here it is! We hope you’ll enjoy our discussion of topics like the ever-controversial e-cigarettes for smoking cessation question, outcomes related to antibiotic treatment of UTIs among elderly adults, and the role of sacubitril-valsartan for acute decompensated heart failure in inpatient settings (the PIONEER-HF study).  Special guest is Dr. Armand Gottlieb @ArmandGottlieb, who was a third year internal medicine resident at Columbia University Medical Center in New York City at the time of recording. He is a co-Editor of the The Scope, a free and brief weekly roundup of the most recent and relevant medical literature.

Full show notes available at http://thecurbsiders.com/podcast. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits 

  • Written and Produced by: Sarah Phoebe Roberts MPH, Christopher Chiu MD
  • Hosts: Matthew Watto MD, Stuart Brigham MD, Paul Williams MD, and Christopher Chiu MD
  • Guest Presenter and Content Planning: Armand Gottlieb, MD
  • Editor: Christopher Chiu MD
  • Cover-Art: Christopher Chiu MD

 

Pick of the Week

The SCOPE. The week’s best in evidence-based medicine, written in plain language and delivered to your inbox. Sign-up for weekly emails or download the app

Time stamps

  • 01:00 Disclaimer, intro, guest bio
  • 06:30 E-cigarettes vs. nicotine replacement therapy (NRT)
  • 15:50 Antibiotic treatment of urinary tract infections (UTIs)
  • 27:45 Sacubitril-valsartan for acute decompensated heart failure (PIONEER-HF study)
  • 42:30 Wrap-up and outro
Jul 10, 2019
#159 Atrial Fibrillation Review and Update with James Furgerson MD
01:20:05

Take control of atrial fibrillation with expert insights and pearls from cardiologist, Dr. James Furgerson, in this jam-packed episode! You’ll learn why atrial fibrillation is such a big deal, how to diagnose it, how to treat it and when to call in for reinforcements. Dr. James Furgerson, MD  is a cardiologist from San Antonio, Texas with over 20 years in academics. Buckle up - This episode is going to send your heart racing! You might even skip a beat! Full notes at https://thecurbsiders.com.

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

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

  • Writer and Producer: Cyrus Askin MD
  • Infographic: Cyrus Askin MD
  • Cover Art: Cyrus Askin MD
  • Hosts: Matthew Watto MD, Paul Williams MD, Cyrus Askin MD
  • Editors: Matthew Watto MD
  • Guest: James Furgerson MD

 

Time Stamps

  • 00:00 Intro, disclaimer and guest bio
  • 03:45 Guest one liner, a bit on physician well-being and some other randomness
  • 08:15 A case of palpitations; risk factors for atrial fibrillation
  • 12:17 Subclinical atrial fibrillation, overdiagnosis of afib; How much afib burden matters? 
  • 15:08 Case summary and next steps in initial work up
  • 18:48 Counseling patient about afib and its consequences
  • 21:40 Ischemic heart disease and atrial fibrillation
  • 24:17 Recap of diagnosis, initial work up and risk stratification in atrial fibrillation
  • 25:25 Rate versus rhythm control; AFFIRM trial
  • 30:50 Strict versus lenient rate control;  RACE trial
  • 33:30 Deciding on rate versus rhythm control; Downside of antiarrhythmic therapies; When to switch from rate to rhythm control strategy
  • 36:52 Ablation for atrial fibrillation; CASTLE-AF, CABANA trials
  • 40:40 When to refer to cardiology and electrophysiology
  • 42:42 Choice of agent for anticoagulation and latest guidelines for atrial fibrillation; New definition for valvular atrial fibrillation
  • 45:22 DOACs in CKD and some other nuances in choice of agent
  • 52:27 Bleeding and anticoagulation
  • 58:38 Cardioversion for atrial fibrillation (initial versus delayed)
  • 63:32 Anticoagulation before and after cardioversion
  • 67:48 Lifestyles measures for atrial fibrillation
  • 70:45 Atrial fibrillation during critical illness, after CABG and in hyperthyroidism
  • 74:12 Aspirin monotherapy is not appropriate for atrial fibrillation
  • 76:42 Take home points
  • 78:50 Outro
Jul 08, 2019
#158 Medicine and Incarceration
59:00

Expand your knowledge about how--and how well--we manage the health of incarcerated patients in the United States, with the expert knowledge of correctional health experts Drs. Aaron Fox @adfoxmd, Jon Giftos @JonGiftosMD, and Emily Wang @ewang422. Correctional medicine is a black box for many providers who do not work in prison and jail settings. But it’s ever more relevant to primary care physicians everywhere, with increasing rates of incarceration the last decade.  In this episode, recorded live at SGIM 2019 #SGIM19, Dr. Fox, Dr. Giftos, and Dr. Wang talk us through the variability of the correctional healthcare systems throughout the country, the challenges to health for patients both while incarcerated and in the transition after release, and some essential nuts and bolts for providers about how to provide better care to this vulnerable population.  

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

Credits

  • Written and produced by: Justin Berk MD MPH MBA, Nora Taranto MD
  • Cover Image: Beth Garbitelli MS2
  • Infographic: Beth Garbitelli MS2
  • Hosts: Matthew Watto MD, Paul Williams MD, Justin Berk MD MPH MBA
  • Edited by: Matthew Watto MD
  • Guests: Aaron Fox MD, Jon Giftos MD, Emily Wang MD MAS

Sponsor

This episodes was recorded LIVE at #SGIM19 in Washington DC! Join the Society for General Internal Medicine today!

Time Stamps

  • 00:00 Intro, disclaimer and guest bios
  • 05:10 One liners, book recommendations, career advice
  • 13:00 Why does incarceration matter for healthcare?; Defining terms: jail, prison, probation
  • 18:47 What is healthcare like during incarceration? What services are available? Who provides the care? How does it breed “passive patients”?
  • 21:10 HIV in incarcerated patients
  • 27:02 Opioid use disorder in prisons -MAT is rarely available
  • 31:44 Prison is a toxic environment —exposure to solitary confinement, PTSD, self harm
  • 34:23 How to ask about incarceration
  • 36:49 Trauma informed care and the unique challenges to providing patient care after release from prison
  • 43:22 Systemic barriers after release from jail or prison e.g. lifetime ban from public housing or food stamps
  • 44:45 Discharge planning and transitioning care after release from prison; community health workers
  • 51:32 Resources for learning more and advocacy —AAJH, The Fortune Society, Just Health, Dr Wang’s research —why you should visit and learn more about the correctional settings in your locale
  • 57:20 Outro
Jul 01, 2019
#157 Teaching in the Hospital: The 4Ds of Rounding
01:31:45

Bring back Bedside Rounds with tips from a master clinician educator, Jeff Wiese MD MACP (Tulane). How to accomplish teaching in the hospital is not on the curriculum for most folks in medical school or residency. This can feel especially daunting as you move from resident to attending. We address strategies to assess, monitor, teach, and coach the medical learners under your leadership with teaching wizard and coach extraordinaire, Dr. Jeff Wiese, recipient of over 50 teaching awards! ACP members can claim CME-MOC credit at https://acponline.org/curbsiders (CME goes live at 0900 ET on the release date).

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

Credits

  • Written and Produced by:  Matthew Watto MD FACP and Beth Garbitelli MS1 (almost MS2!)
  • CME questions by: Matthew Watto MD FACP
  • Hosts: Stuart Brigham MD, Paul Williams MD FACP, Matthew Watto MD FACP
  • Images and infographics: Beth Garbitelli MS1
  • Edited by: Matthew Watto MD FACP, Emi Okamoto MD
  • Guest: Jeff Wiese MD MACP

Time Stamps

  • 00:00 Intro, disclaimer, guest bio
  • 03:28 Guest one-liner, love of Aaron Sorkin, book recommendations
  • 10:52 Setting goals and expectations on day one
  • 23:52 Preparing the resident for autonomy and assessing their place on the scale of supervision to autonomy
  • 28:18 How to prepare for rounds as an attending to set yourself up for efficiency and success; The cardinal rule for being an attending
  • 33:50 How long does it take determine a resident’s readiness for autonomy; Give your colleagues an “educational signout”
  • 38:31 How to handle a request for card flipping; Prodiving a rationale for bedside rounds
  • 43:54 The three Ds of Rounding; Should there be a fourth D
  • 47:28 The choreography of bedside rounds; Privacy concerns; More on the rationale
  • 63:00 How to handle unanswered questions in front of the patient
  • 67:19 Resident as a “proud parent” on rounds
  • 68:30 Rounding without the team (the afternoon)
  • 73:18 Hand sanitizer (the Purell)
  • 79:45 Advice to new PGY2s
  • 81:35 When and how to incorporate teaching on high value care (specifically labs)
  • 83:22 What’s the role of medical student on the wards team
  • 85:18 Take home points
  • 89:04 Plug: Teaching in the Hospital Deux
  • 90:12 Outro

 

 

 

Jun 26, 2019
#156 Chronic Pain, Opioids, Tapers
01:05:31

Rethink how you’re diagnosing and managing chronic pain with high-yield tips from pain experts and primary care doctors Soraya Azari MD @azarimugs (UCSF), and Phoebe Cushman MD, MS (UMass Memorial). Because let’s face it, managing chronic pain can be very difficult. Expand your toolbox for management-- including the importance of activity, empowering your patient, risk stratification for patients prior to opioid initiation, how to identify opioid use disorder, and how to taper opioids. Plus, updates on recent practice changing articles in chronic pain.

Full show notes at https://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: Nora Taranto MD
  • Hosts: Nora Taranto MD, Paul Williams MD, Matthew Watto MD
  • Edited by: Emi Okamoto MD, Matthew Watto MD
  • Guests: Soraya Azari MD; Phoebe Cushman MD, MS

Sponsor

This episodes was recorded LIVE at #SGIM19 in Washington DC! Join the Society for General Internal Medicine today!

Time Stamps

  • 00:00 Intro, disclaimer, guest bios
  • 04:50 Guest one-liners, book recommendations, picks of the week, career advice
  • 14:50 A case of chronic pain; Group pain into 1 of 3 buckets
  • 18:48 Use of pain scales; and taking a pain history; affirming positive behaviors surrounding pain
  • 23:13 Nonpharmacologic measures for chronic pain
  • 26:30 Cognitive behavior therapy (CBT) for chronic pain; remote CBT vs traditional CBT
  • 30:32 Apps for Meditation, Affirmations
  • 31:53 Back to the case: Should we trial opioids for our patient’s chronic pain? Our guests give their recommendations and how they counsel patients about opioids
  • 34:55 Counseling about risk of opioids
  • 37:42 Risk stratifying patients requesting opioids; Some risk tools (COMM, Opioid Risk Tool, DIRE); Don’t forget to screen for mood disorders
  • 42:10 What to do if pain is not improved on high dose opioids; How to identify an opioid use disorder
  • 45:13  How to taper patients off opioids; Forced tapers and the CDC guidelines; how to taper the right way
  • 50:34 Buprenorphine for opioid use disorder and/or chronic pain
  • 57:38 Gabapentin and risk for misuse and/or unintentional overdose in patients also using opioids
  • 61:42 Plugs: Get your x-waiver, or better yet advocate for getting rid of the waiver
Jun 24, 2019
#155 LGBT Health in Primary Care
52:36

Build your knowledge base to improve primary care for LGBT patients! This episode is chock full of clinical pearls and updates for LGBT health from SGIM presenters, Dr. Jenny Siegel (Boston University) and Dr. Megan McNamara (Louis Stokes Cleveland VAMC). They define common gender identity terms and provide tips on how to take a sexual history. You’ll develop an approach to the unique clinical concerns of LGBT patients and learn how to phrase medical information in a gender neutral framework. This is a must listen episode for all health care providers!

Full show notes at https://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: Carolyn Chan MD

Graphics: Hannah Abrams

Hosts: Carolyn Chan MD, Paul Williams MD, Matthew Watto MD

Guest: Megan McNamara MD, Jenny Siegel MD

 

Sponsor

This episodes was recorded LIVE at #SGIM19 in Washington DC! Join the Society for General Internal Medicine today!

Time Stamps

  • 00:00 Intro, disclaimer, guest bios
  • 02:45 Guest one-liners, movie recommendations; favorite failures; Paul’s pick of the week
  • 10:52 Defining terms of gender identity
  • 14:20 What to do when you misgender someone or use the wrong term
  • 17:10 Is it a mistake to think of the entire LGBT group as the same?
  • 19:19 How to take a sexual history, the 5Ps
  • 22:00 Unique clinical concerns of LGBT patients; what screening should be performed
  • 24:20 Avoid focusing too much on sexuality and gender identity. Don’t forget to address their medical concerns
  • 24:42 Screening for mental health disorders and asking about suicide
  • 27:16 Cancer screening in transgender patients; a bit on transgener terminology; how to take an anatomy inventory
  • 34:18 Vaccinations
  • 37:05 Contraception considerations and VTE risk with hormonal therapy
  • 41:40 Pre-exposure prophylaxis and risk of STIs
  • 43:30 Impact of discriminatory state laws on LGBT mental health
  • 47:32 Plugs: Fenway Health; UCSF trans health website; Guidelines from the Endocrine Society
  • 49:35 Closing remarks
  • 51:05 Outro
Jun 17, 2019
#154 DVT and PE Master Class with Michael Streiff MD
01:08:38

What do Judas Priest, surfing, and clots have in common? They are the passionate interests of expert Dr. Michael Streiff who guides us through the diagnosis and management of DVT and PE aka venous thromboembolism (VTE). By the end of the episode you will know how to catch a clot very Wells! We dive deep into the treatment options, literature, and some unique cases. ACP members can claim CME-MOC credit at https://acponline.org/curbsiders (CME goes live at 0900 ET on the episode’s release date).

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

Credits

  • Written and produced by (including CME questions): Justin Berk MD, MPH, MBA
  • Cover art by: Kate Grant MBChB DipGUMed
  • Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP; Stuart Brigham MD
  • Edited by: Matthew Watto, MD, FACP
  • Guest:  Michael Streiff MD

Time Stamps

  • 00:00 Intro, disclaimer and guest bio
  • 04:40 Guest one-liner, book and music recommendations, advice about rejection, how to think about studies
  • 11:15 A case of DVT and some basic terminology
  • 15:37 Which DVT risk factors are most important?
  • 18:40 Use of the Wells score and D-dimer testing; should we use an age adjusted D-dimer; What about the YEARS criteria
  • 22:55 Classifying DVT; determining need and duration of anticoagulation [distal (calf vein) DVT, proximal DVT]; brief discussion of IVC filters & catheter directed therapies
  • 27:56 IVC filters for trauma
  • 29:30 Upper extremity DVT
  • 33:12 Proximal vs whole leg ultrasound for diagnosis of DVT
  • 36:25 A case of pulmonary embolism; how to diagnose pulmonary embolism and a bit on V/Q scans
  • 40:35 PESI score and HESTIA criteria
  • 42:05 Summary of how to diagnose DVT and PE
  • 43:34 Choice of initial anticoagulation
  • 45:29 DOACs for cancer
  • 48:14 DOACs for patients with very high or very low BMI
  • 49:33 Why apixaban is Dr Streiff’s favorite DOAC?
  • 51:20 Duration of therapy for DVT and PE
  • 53:33 Unprovoked DVT/PE: Risk scoring models
  • 57:52 Is thrombophilia workup necessary?
  • 58:28 Antiphospholipid antibody syndrome
  • 59:58 An extensive cancer workup is unnecessary
  • 60:33 Subsegmental pulmonary embolism: To treat or not to treat
  • 61:49 Apixaban dosing in CKD and ESRD
  • 63:51 AUGUSTUS trial for dual versus triple therapy
  • 64:52 Plug for National Blood Clot Alliance “Stop the Clot”; Anticoagulation Forum website; new 2019 ASH guidelines
  • 66:35 Outro
  • 68:00 Post credit scene
Jun 10, 2019
#153 Heart Disease in Women with Dr Bairey Merz
54:13

Expand your idea of ischemic heart disease to include non-obstructive patterns, which as our guest, Dr Noel Bairey Merz, a clinical investigative cardiologist whose multiple roles include Director of the Barbra Streisand Women’s Heart Center and the Preventive Cardiac Center at the Smidt Cedars-Sinai Heart Institute, shares with us, is incredibly common, especially in women.  Learn to recognize these women and treat according to guidelines, preventing unnecessary IHD mortality in our female (and some male) patients. We review a variety of non-obstructive pathologies and the best techniques to evaluate them.

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: Shreya Trivedi MD, Molly Heublein MD
  • Hosts: Paul Williams MD, FACP; Shreya Trivedi MD; Molly Heublein MD
  • Edited by: Matthew Watto MD, FACP; Emi Okamoto MD
  • Graphics by: Hannah Abrams
  • Guest: Dr. C Noel Bairey Merz MD, FACC, FAHA

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Time Stamps

  • 00:00 Intro, disclaimer and guest bio
  • 04:36 Guest one-liner; Advice for success in research and clinical practice
  • 07:07 A case of shortness of breath and chest tightness; Why the paradigm of obstructive coronary artery disease is flawed.
  • 12:04 Why is there a sex difference in ischemic heart disease?
  • 14:52 How to recognize ischemic heart disease in women; Are certain symptoms more likely in women; Categorizing angina
  • 20:13 Who needs stress testing?; Screening for ischemic heart disease in women
  • 24:52 How guidelines make good doctors great doctors
  • 27:00 Diagnosis of NSTEMI in a woman without obstructive coronary disease
  • 29:33 Medical therapy for non-obstructive ischemic heart disease
  • 33:18 Additional testing: Cardiac MRI for myocarditis; perfusion reserve testing; CT coronary angiograms
  • 35:48 How current non-invasive techniques fail to identify microvascular ischemic heart disease in women
  • 39:10 Antianginal therapy
  • 41:40 HFpEF in women
  • 47:10 Weight loss for paroxysmal atrial fibrillation
  • 48:45 New nomenclature for ischemic heart disease
  • 50:18 Take home points
  • 52:40 Outro
Jun 03, 2019
#152 Dare to Lead: Becoming a PGY2
01:18:05

Dare to lead. Master the transition to PGY2 with tips from expert educator Abby Spencer MD, MS, FACP, IM Residency Program Director and Vice Chair for Education for the Medicine Institute at Cleveland Clinic and Shreya Trivedi MD, GIM Fellow at NYU School of Medicine. Topics include: how to run work rounds, preparing your team for attendings rounds, how to teach on the fly, finding your leadership style, and what to read during residency. This is the first of three episodes that we’re co-developing with the American College of Physicians for their Resident Transitions Series.

Full show notes available at http://thecurbsiders.com/podcast. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

  • Written and produced by: Shreya Trivedi MD
  • Graphics and Show Notes by: Hannah R Abrams
  • Hosts: Paul Williams MD, FACP; Stuart Brigham MD; Matthew Watto MD, FACP; Shreya Trivedi MD
  • Guest: Abby Spencer MD, MS, FACP

Sponsor

The Resident Transitions Series is brought to you by The American College of Physicians with support from its Council of Resident/Fellow Members. Visit acponline.org/resident to learn more about the benefits of Resident/Fellow Membership and join our proud internal medicine community today!

Time Stamps

  • 00:00 ACP’s Resident Transitions Series - Sponsor
  • 01:50 Disclaimer, intro and guest bio
  • 06:05 Guest one liner, book recommendations, favorite failure, advice for learners
  • 14:10 Stuart’s tale of struggle from residency
  • 18:05 New PGY2 resident thinks she has nothing to teach her learners
  • 20:20 How to run work rounds and set expectations
  • 31:55 How, when and where to teach as a resident
  • 46:09 Leadership skills, understanding your learners, and giving difficult feedback
  • 60:08 What to read during residency, how to find time, and some strategies to achieve your learning goals
  • 71:30 Take home points
  • 75:28 Outro
  • 77:10 End credit sequence
May 29, 2019
#151 Anaphylaxis with Dr Olajumoke Fadugba MD
39:04

Recognize common presentations of anaphylaxis and stop under-treating this deadly allergic reaction with tips from Dr. Olajumoke Fadugba, Assistant Professor of Medicine, University of Pennsylvania! We review the basic pathophysiology and the standard criteria for diagnosing anaphylaxis, treatment basics, the primary importance of epinephrine, and the utility of adjunctive therapies. Also included are great tips on counseling patients about auto-injectable epinephrine, and a reminder not to panic...even when you inject your own thumb?! ACP members can claim CME-MOC credit at https://acponline.org/curbsiders (CME goes live at 0900 ET on the episode’s release date).

Full show notes available at https://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

  • Writer (interview, show notes & CME questions) and cover art: Emi Okamoto MD
  • Infographic by: Emi Okamoto MD
  • Hosts: Matthew Watto MD, FACP; Stuart Brigham MD
  • Editors: Matthew Watto MD, FACP
  • Guest: Olajumoke Fadugba MD
  • Special thanks to Sarah Phoebe Roberts MPH for booking!

Time Stamps

  • 00:00 Intro and disclaimer
  • 03:00 Guest one-liner, book recommendation, advice to fellows and trainees
  • 07:15 Case of anaphylaxis with mucocutaneous and GI symptoms
  • 09:05 Anaphylaxis (IgE mediated mast cell action) vs anaphylactoid (non-IgE mediated mast cell activation; e.g. contrast allergy, vancomycin)
  • 12:34 Vancomycin and non-IgE mediated reactions
  • 14:40 Common presentations of anaphylaxis and the three diagnostic criteria
  • 22:09 Biphasic reactions and predicting severity
  • 26:42 Counseling patients on the use of epinephrine
  • 28:35 Stuart’s thumb question
  • 30:00 Adjuvant medications: antihistamines and corticosteroids
  • 33:20 Are there any contraindications to epinephrine use?
  • 34:25 Use of tryptase levels when the diagnosis of anaphylaxis is uncertain
  • 37:10 Outro
May 27, 2019
#150 HFpEF with Dr Clyde Yancy MD
47:54

HFpEF (heart failure with preserved ejection fraction) with master cardiologist, Dr Clyde Yancy MD, Chief of Cardiology and Professor of Medicine (Cardiology) and Medical Social Sciences, Northwestern, Feinberg School of Medicine. Topics include: pathophysiology, HFpEF phenotypes, how to interpret a borderline ejection fraction, evidence based therapies, diuretics, and future directions (pulmonary artery monitors, intra-atrial shunts, ARNI compounds), and more!

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: Paul Williams MD, FACP; Sarah Phoebe Roberts MPH
  • Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP; Stuart Brigham MD
  • Show Notes: Justin Berk MD, MPH, MBA; and Beth Garbitelli MS1
  • Infographics: Beth Garbitelli MS1
  • Editor: Matthew Watto MD, FACP
  • Guest: Clyde Yancy MD, MSc, MACC, FAHA, MACP, FHFSA

Time Stamps

  • 00:00 Thanks to our producers Sarah Phoebe Roberts, Beth Garbitelli and Justin Berk
  • 00:50 Intro and guest bio
  • 04:00 Guest one liner, career advice
  • 08:20 Ms Diana Stolic has HFpEF. What’s the difference in HFpEF and diastolic dysfunction?  
  • 11:33 How should we think about borderline ejection fraction?
  • 15:24 Pathophysiology and Phenotypes of HFpEF
  • 18:57 More on the pathophysiology of HFpEF (nitric oxide, fibrosis, inflammatory signaling)
  • 21:00 Are there morbidity and mortality differences for HFpEF versus HFrEF?
  • 24:45 What historical factors are most important in HFpEF?
  • 27:50 Pulmonary artery monitors for HFpEF
  • 29:00 Does Diuretic therapy differ in HFpEF and HFrEF?
  • 33:44 Ischemic workup for new HFpEF
  • 35:33 Right heart cath for HFpEF
  • 36:53 Future of HFpEF
  • 41:04 Will ARNI compounds work for HFpEF? What are the current medications for HFpEF?
  • 45:20 SGLT2 inhibitors for heart failure
  • 46:30 Outro
May 20, 2019
Recap SGIM19 Day 2
41:21

Recap of random pearls and highlights from SGIM19 Day 2 including: methadone and buprenorphine, perioperative buprenorphine, medical cannabis, HPV vaccination, young adult medicine, academic promotions, long term sequelae of childhood kidney disease, stage 1 hypertension, some great free resources in addiction medicine, and more! Special thanks to the Society for General Internal Medicine for their hospitality.

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

Credits

  • Written, produced, and cohosted by: Paul Williams MD, Matthew Watto MD, Justin Berk MD, Carolyn Chan MD, Shreya Trivedi MD, Nora Taranto MS4 (soon to be MD!)
  • Edited by: Matthew Watto MD

Time Stamps and Links are included below

  • 00:00 Intro and Disclaimer
  • 02:30 Generalists receive the same number of grants, but publish fewer publications and are less likely to achieve professorship versus medical or surgical subspecialists (JGIM 2017)
  • 05:30 GIM division directors differ in their emphasis on peer-reviewed publications for academic promotion (Acad Med 2015)
  • 07:30 Only about 30% of patients are started on MAT after an overdose despite a known mortality benefit and a known mortality rate of 5% twelve month mortality in this population (Larochelle Annals Int Med 2018)
  • 08:48 A representative in NYC has proposed a bill to get rid of the buprenorphine waiver program.
  • 11:00 Stimulant use is not a contraindication to continuing buprenorphine (expert opinion from SGIM session on Addiction Medicine).
  • 11:45 Perioperative buprenorphine: 1) Consider switching to full agonist therapy or 2) Dose buprenorphine 3-4 times daily and continue use during the perioperative period (Expert opinion from SGIM session titled “Buprenorphine 2.0”)
  • 12:40 Options to transition from methadone to buprenorphine: Option 1) Taper methadone to 30-40 mg once daily. Then, hold methadone for 72 hours before starting buprenorphine. Option 2) “Microdosing” with buprenorphine patch while still on methadone and then start oral buprenorphine. Note: This is expert opinion so consult with your local expert before attempting this on your own!
  • 13:46 UCSF has a “Warm Line” for free consultation about substance use https://nccc.ucsf.edu.
  • Get a free buprenorphine waiver from https://pcss.org
  • 15:10 New joint guidelines on transitions remind providers that young adults need help navigating the healthcare system. Many young adults have never accessed healthcare resources on their own (Pediatrics 2018)
  • 18:50 Childhood kidney disease increases risk for end stage renal disease as an adult (NEJM 2018)
  • 20:35 Two studies concluded that stage 1 hypertension in young adults confers an increased risk for morbidity and treating it confers a benefit (Yano AMA 2018; Son JAMA 2018)
  • 23:35 HPV update: The 9 valent vaccine was approved for young adults age 27-45 years old, but this has not yet made it into the guidelines. The HPV vaccine is effective for preventing cervical cancer (Cochrane Review 2018) and provides some herd immunity (Clin Inf Dis 2018)
  • 26:40 Dr Chan offers tips on how to handle resident mistreatment and phrases that you can use to defuse the situation.
  • 31:30 Some broad comments on the use of medical cannabis for pain management (Expert opinion from SGIM session)
  • 36:30 Newer data suggests that even one drink daily might have adverse health outcomes (Lancet 2019).
  • 39:00 Outro

Citation

Paul Williams MD, Matthew Watto MD, Justin Berk MD, Carolyn Chan MD, Shreya Trivedi MD, Nora Taranto MS4. Recap SGIM19 Day 2”. The Curbsiders Internal Medicine Podcast https://thecurbsiders.com. May 17, 2019.

May 17, 2019
Recap SGIM19 Day 1
40:04

Recap of random pearls and highlights from SGIM19 Day 1 including: Kidney stone treatment (roller coasters, sex and tamsulosin), aspirin, SGLT2 inhibitors to reduce kidney events, oral antibiotics for endocarditis, preferred physician attire, sexual harassment, writing letters of recommendation, triple therapy for COPD, DAPT for stroke, and more! Special thanks to the Society for General Internal Medicine for their hospitality.

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

Credits

  • Written, produced, and cohosted by: Paul Williams MD, Matthew Watto MD, Justin Berk MD, Carolyn Chan MD, Shreya Trivedi MD, Abby Spencer MD, MS, Nora Taranto MS4 (soon to be MD!)
  • Edited by: Matthew Watto MD
  • Special Guest: Abby Spencer MD, MS 

Time Stamps and Links are included below

  • 00:00 Intro and Disclaimer
  • 02:33 Abby explains what it means to attend SGIM
  • 04:35 Tips for writing letters of recommendation
  • 08:54 How to handle lapses of professionalism in a trainee
  • 10:30 How to address sexual harassment
  • 12:42 Oral antibiotics after 10 days of IV antibiotics are noninferior for left sided endocarditis in non-IVDU (NEJM 2019)
  • 14:22 Patients prefer physicians to dress in more formal attire. (BMJ Open 2018)
  • 16:29 Kidney stone passage occurs more frequently when sitting in the back car of a roller coaster (J Am Osteopath Assoc 2018)
  • 18:00 Sexual intercourse three times weekly improves rate of kidney stone passage (Urology 2015)
  • 18:58 Vancomycin coverage for hospital acquired pneumonia can safely be stopped after four days if cultures remain negative for MRSA (Chest 2019)
  • 20:00 Notes that contain stigmatizing language are associated with negative provider feelings and less aggressive pain management (JGIM 2018)
  • 21:10 Medication errors are less frequent if the medication reconciliation is performed at time of ICU discharge (Ann Intensive Care 2018)
  • 21:56 Five of six pediatricians found Lego heads in their stool after intentional ingestion (J Paediatric Child Health 2018).
  • 24:40 Canagliflozin (SGLT2 inhibitor) improved renal outcomes and cardiovascular events (Credence trial, NEJM 2019; Check out the Freely Filtered (NephJC podcast coverage))
  • Triple therapy for COPD with LAMA/LABA/ICS is superior to dual therapy (IMPACT trial NEJM 2018)
  • 27:20 The ASCEND trial of aspirin for primary prevention in patients with diabetes contained 97 percent white patients and showed similar NNT to NNH for cardioprotection and bleeding respectively (ASCEND trial NEJM 2018)
  • 28:45 Consider a short course of dual antiplatelet therapy for minor stroke or high risk TIA (BMJ 2018)
  • 30:07 Omega-3 fatty acids decreased cardiovascular events in patients whose triglycerides remained elevated despite statin therapy (REDUCE-IT trial NEJM 2019)
  • 30:24 Tamsulosin did not help pass stones under 5 mm, but might be effective for stones >5 mm (J Fam Pract 2018)
  • 31:06 Trainees who are stressed during residency tend to stay stressed (I was unable to quickly locate this citation. Sorry. -Dr. Watto)
  • 32:02 How does our team choose their pearls for the recap show
  • 35:21 A needs assessment at University of Michigan found that female residents want to learn skills on leadership, negotiation and giving pitches to prepare them for careers in medicine (Poster by Dr Jennifer Lukela).
  • 36:57 Abby Spencer received an AAIM Innovations grant: Key steps to rise for women trainees in leadership development”.
  • 38:42 Outro
May 13, 2019
#149 Hip Pain for Primary Care
44:31

Identify and treat the most common causes of hip pain in the outpatient setting with returning guest, Dr Ted Parks. A large majority of hip pain in the office setting will be due to one of three conditions (hip osteoarthritis, greater trochanteric pain syndrome, and lumbo-sacral back pain). Learn to easily identify these conditions, how to initiate conservative treatment, and more about hip replacements. ACP members can visit https://acponline.org/curbsiders to claim free CME-MOC credit for this episode and show notes (goes live 0900 EST).

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: Molly Heublein MD, Nora Taranto MS4

CME questions by:  Molly Heublein MD, Nora Taranto MS4

Hosts: Matthew Watto MD, Paul Williams MD, Stuart Brigham MD, Molly Heublein MD

Edited by: Matthew Watto MD, Emi Okamoto MD

Guest Presenter: Ted Parks MD

Time Stamps

  • 00:00 CME announcement, disclaimer, intro and guest bio
  • 04:05 Guest one-liner; advice for teachers and learners
  • 08:30 Case of hip pain, review of hip anatomy, and the three buckets of hip pain
  • 15:35 Greater trochanteric pain syndrome
  • 16:20 The zebras of hip pain
  • 18:12 Physical exam for hip pain
  • 21:33 Hip osteoarthritis: imaging and initial therapy
  • 24:18 Hip injections: Do steroids work? What about hyaluronic acid?
  • 29:00 Who needs hip replacement surgery? How long will it last?
  • 32:30 Greater trochanteric pain syndrome
  • 35:58 Lumbar spine versus hip pain from OA
  • 38:58 Hip replacement technology: materials; etiology of component loosening and need for re-operation
  • 42:03 Take home points and outro
May 06, 2019
Telehealth with Ana María López MD
55:16

Electric cars, virtual reality, nanotechnology, and now… telemedicine? We chat with Dr. Ana María López MD, FACP about the future of telehealth, how to implement it in your practice, and the challenges you might face in doing so. Dr. López is immediate past president of the American College of Physicians (ACP) as well as Vice Chair of Medical Oncology and Chief of New Jersey Division Sidney Kimmel Cancer Center of Thomas Jefferson University. Her main areas of professional interest and expertise include cancer prevention and equity, integrative oncology, implementation of innovations in health care including telemedicine, and women’s health. We learned immensely from our talk with her and we hope you will, too! ACP members can claim free CME & MOC credit at https://acponline.org/curbsiders. Download Dr Brigham’s telehealth cheat sheet as a PDF at http://thecurbsiders.com/podcast.

Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

Written and produced by: Hannah Abrams, Stuart Brigham MD

Cohosts: Matt Watto MD, Stuart Brigham MD, Paul Williams MD, Hannah Abrams

Guest: Ana María López MD

Time Stamps

  • 00:00 Disclaimer, intro and guest bio
  • 04:20 Guest one line, poetry recommendations, favorite failure
  • 12:00 Defining telemedicine
  • 14:12 What kind of services exist in telemedicine? How can the technology make your practice easier?
  • 20:18 Is there good evidence for telehealth and telemedicine?
  • 24:20 Concerns about telehealth and the loss of touch as part of the doctor-patient relationship; haptics and the remote physical exam
  • 30:17 Providing telehealth across state lines
  • 34:35 Consultation codes for telehealth and ECHO (remote consultations)
  • 40:20 Basic steps and best practices to start implementing telehealth
  • 44:30 Stuart’s shares some preliminary data on use of telehealth and workforce satisfaction
  • 49:12 Adding access by using telehealth in primary care
  • 51:40 Take home points
  • 54:42 Stuart shares a pun

 

May 02, 2019
#148 Benign Prostatic Hyperplasia for the Internist
01:02:23

This week we narrow in on the enlarging prostate and decipher the common issue of benign prostatic hyperplasia with Adam C. Reese MD, Associate Professor of Urology at the Lewis Katz School of Medicine at Temple University and Chief of Urologic Oncology at Temple University Hospital. Learn how to interpret the symptom profile for patients presenting with common urinary issues, what to feel for in the digital rectal exam, how to treat BPH, and when to refer.

ACP members can visit https://acponline.org/curbsiders to claim free CME-MOC credit for this episode and show notes (goes live 0900 EST).

See you at SGIM 2019!

Find us in our red Curbsider’s t-shirts handing out Curbsiders and Kashlak stickers/patches at SGIM 2019 in Washington DC! We’ll be recording full length shows and daily recaps!

Credits

Written and produced by: Paul Williams MD

Hosts: Paul Williams MD, Matthew Watto MD

Images and infographics: Elena Gibson, Beth Garbitelli

Show Notes: Elena Gibson, Beth Garbitelli

Edited by: Matthew Watto MD, Chris Chiu MD

Guest: Adam Reese MD

Time Stamps

00:00 SGIM announcement

00:30 Disclaimer, intro and guest bio

03:20 Guest one liner, book recommendation, favorite failure and surgical M&M

10:56 Case of benign prostatic hyperplasia, defining terms and obstructive/voiding versus storage/irritative symptoms

16:11 IPSS score and evaluating symptoms

22:10 Digital rectal exam. Will this give any useful information?

26:55 Taking a history about BPH and some lifestyle modifications

29:20 Lab studies for urinary tract symptoms and interpreting PSA and free PSA

36:20 Initial therapy for BPH and managing patient expectations, alpha blocker side effects

39:25 Choice of agent and monitoring symptoms on therapy

42:25 Nonpharmacologic management of bladder complaints

45:10 Who and when to refer to urology

47:33 Counseling about use of 5 alpha reductase inhibitors, their side effects and is there a risk for high grade cancer?

52:35 Phosphodiesterase inhibitors for BPH symptoms

53:50 Urethral milking. NOT prostate milking

54:55 Desmopressin for nocturia

56:20 Take home points

59:03 Prostate volume and PSA

61:10 Outro

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

Apr 29, 2019
Random Pearls #IM2019 Day 3
35:39

Random pearls from ACP #IM2019 Day 3. The Curbsiders crew is joined by Dr Alan Dow of VCU to discuss highlights from ACP’s Internal Medicine Meeting in Philadelphia including: sleep deprivation, the glymphatics system, inflammatory back pain, heart failure, dermatology pearls, a new definition for pulmonary hypertension and more!

"Sorry, no time stamps or full show notes for this one. We're too tired." -The Curbsiders

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.

#IM2019 Curbsiders Crew

  • Guest: Renee Dversdal MD, Alan Dow MD, Alia Chisty MD
  • Cohosts: Paul Williams MD, Stuart Brigham MD, Shreya Trivedi MD, Molly Heublein MD, Emi Okamoto MD, Justin Berk MD, Cyrus Askin MD, Matthew Watto MD, Chris Chiu MD
  • Director of operations: Chris Chiu MD
  • Twitter: Cyrus Askin MD, Hannah Abrams MS3
  • Instagram: Beth Garbitelli MS1
  • Facebook: Chris Chiu MD
  • Off-air producer: Sarah Phoebe Roberts MPH, Nora Taranto MS4
  • Marketing: Jen Watto
Apr 22, 2019
Random Pearls #IM2019 Day 2
44:58

Random pearls from ACP #IM2019 Day 2. The Curbsiders crew is joined by Dr Alia Chisty (future PD at Penn State Hershey) at ACP’s Internal Medicine Meeting in Philadelphia to discuss highlights including: baloxavir a new drug for flu, stress testing and coronary CT angiography pearls, celiac disease, H. pylori pearls, and a bunch of random pearls from infectious diseases, palliative care and more!

"Sorry, no time stamps or full show notes for this one. We're too tired." -The Curbsiders

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.

#IM2019 Curbsiders Crew

  • Guest: Renee Dversdal MD, Alan Dow MD, Alia Chisty MD
  • Cohosts: Paul Williams MD, Stuart Brigham MD, Shreya Trivedi MD, Molly Heublein MD, Emi Okamoto MD, Justin Berk MD, Cyrus Askin MD, Matthew Watto MD, Chris Chiu MD
  • Director of operations: Chris Chiu MD
  • Twitter: Cyrus Askin MD, Hannah Abrams MS3
  • Instagram: Beth Garbitelli MS1
  • Facebook: Chris Chiu MD
  • Off-air producer: Sarah Phoebe Roberts MPH, Nora Taranto MS4
  • Marketing: Jen Watto

 

Apr 19, 2019
Random Pearls #IM2019 Day 1
47:59

Random pearls from #IM2019 Day 1. The Curbsiders crew is joined by Kashlak’s POCUS Chief, Renee Dversdal MD at ACP’s Internal Medicine Meeting in Philadelphia to discuss day 1 highlights inlcuding: POCUS, lyme rash, back pain, syphilis, women’s health, patient handoffs, the flip-flop fungal sign a ton of cardiology pearls (ie diuretics, paracentesis for CHF, beta blockers, LBBB, when is it safe to have intercourse after an MI?) and more!

"Sorry, no time stamps or full show notes for this one. We're too tired." -The Curbsiders

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.

#IM2019 Curbsiders Crew

  • Guest: Renee Dversdal MD, Alan Dow MD, Alia Chisty MD
  • Cohosts: Paul Williams MD, Stuart Brigham MD, Shreya Trivedi MD, Molly Heublein MD, Emi Okamoto MD, Justin Berk MD, Cyrus Askin MD, Matthew Watto MD, Chris Chiu MD
  • Director of operations: Chris Chiu MD
  • Twitter: Cyrus Askin MD, Hannah Abrams MS3
  • Instagram: Beth Garbitelli MS1
  • Facebook: Chris Chiu MD
  • Off-air producer: Sarah Phoebe Roberts MPH
  • Marketing: Jen Watto
Apr 15, 2019
#147 Rheumatoid Arthritis for the Internist
01:17:43

Join(t) us in learning about rheumatoid arthritis care for the internist with Robert McLean MD, rheumatologist, Associate Clinical Professor at Yale, and President Elect of the ACP! We discuss the complexity of rheumatoid arthritis, how to differentiate from other arthritic conditions, and how to have a patient-centered framework for the evaluation and treatment of affected patients. ACP members can claim CME-MOC credit at on ACP's site..

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

Writer (Interview & CME questions): Cyrus Askin MD

Show Notes and Infographic by: Elena Gibson MS4

Hosts: Matthew Watto MD, Stuart Brigham MD

Editors: Matthew Watto MD, Emi Okamoto MD

Guest: Robert McLean MD

Time Stamps

  • 00:35 Disclaimer, intro and guest bio
  • 03:38 Guest onliner; Nudge (book) on behavioral economics
  • 08:30 Favorite failure; Stuart’s pick of the week
  • 12:24 Key historical features of RA
  • 15:30 Differential diagnosis
  • 19:20 Physical findings in RA
  • 20:58 Initial labs orders for suspected inflammatory arthritis; CRP vs high sensitivity (cardio) CRP assays
  • 27:45 Epidemiology of RA; Is there a utility for scoring systems?; A bit more on inflammatory markers
  • 32:30 Recap and test interpretation
  • 36:22 High yield physical exam in RA
  • 40:56 Initial counseling after RA diagnosis
  • 46:00 Therapeutic trial with NSAIDS or steroids for inflammatory arthritis
  • 50:29 When to reach for the DMARDS
  • 52:40 Are steroids considered DMARDS?
  • 54:50 Primary care considerations for patients starting steroids or DMARDS (TB, vaccinations)
  • 60:34 When and how long to hold DMARDS for surgery or acute illness
  • 62:10 Drug-drug interactions and monitoring with methotrexate, hydroxychloroquine, sulfasalazine
  • 70:10 Anti-inflammatory diets
  • 73:30 Take home points
  • 76:00 Outro
Apr 08, 2019
#146 NephMadness: Pain Meds in Chronic Kidney Disease
01:24:06

Pain management in patients with chronic kidney disease (CKD) often goes something like this: NSAIDs are evil, acetaminophen hardly works, opioids are dangerous, and all the rest (tramadol, gabapentinoids, antidepressants) are messy. But, we tackle the complexities of pain management in patients with chronic kidney disease in this special @NephMadness 2019 episode that, on a scale of 1-10, will leave you feeling very relieved in addressing pain.

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

Earn CME and read about each region in NephMadness 2019 at AJKD blog.

Credits

  • Written and produced by: Justin Berk MD, Samantha Gelfand MD
  • NephMadness Pun Contest produced by: Hannah R Abrams MS3
  • Cover art by: Kate Grant MBChB, Dip GUMed
  • Hosts: Matthew Watto MD, Paul Williams MD, Stuart Brigham MD
  • Edited by: Matthew Watto MD, Emi Okamoto MD
  • Guests:  Samantha Gelfand MD, Matthew Sparks MD, David Juurlink MD 

Time Stamps

  • 00:00 Kidney Pun
  • 01:19 Disclaimer, intro and guest bios
  • 06:30 Guest one-liners
  • 10:42 Books recommendations, staff picks and a patient complaint
  • 15:25 Clinical Case and Pain Management Disclaimer
  • 16:33 Modalities in pain medicine
  • 18:20 Opioids for pain and their metabolites
  • 20:44 Dave Juurlink reframes the question, “what is our real goal with pain management?”
  • 24:42 Matt Sparks reiterates the dangers of morphine and codeine in patients with advanced CKD
  • 27:44 Communicating meds that are contraindicated or relatively contraindicated in CKD
  • 30:40 Buprenorphine
  • 32:40 What about the WHO Pain Ladder for CKD?; 33:32 Should we use more cannabinoids? Ketamine?
  • 37:07 Dave Juurlink rants on Tramadol
  • 44:20 How to pick winners in NephMadness
  • 46:06 NSAIDS and CKD
  • 57:07 Gabapentinoids (gabapentin and pregabalin) for neuropathic pain and driving?!
  • 65:57 Estimating eGFR in CKD and AKI. Which equation is best?
  • 70:38 How would each of our experts treat this patient with CKD and knee pain
  • 75:20 NephMadness 2019 picks for the pain region
  • 82:55 Outro
Apr 01, 2019
#145 NephMadness: Hepatorenal Syndrome vs AKI
01:20:56

Does your sympathetic nervous system get activated when you notice acute kidney injury in patients with cirrhosis? Ever wonder how to really diagnose hepatorenal syndrome (HRS)? Think you have the bile-acid-stones to start diuretics on a patient requiring pressor support for kidney failure? You have come to the right place! Listen to @kidney_boy Joel Topf, HRS expert Juan Carlos Velez (@veleznephhepato), and self-proclaimed most-handsome-nephrologist Bill Whittier (@TWhittier_RUSH) tackle the complex pathophysiology and treatment of hepatorenal syndrome in this NephMadness 2019 special episode!

Fill out your bracket for NephMadness 2019 today and sign up as part of The Curbsiders! Earn CME and read about each region at AJKD blog.

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

Credits

Written and produced by: Justin Berk MD, Nora Taranto MS4

Infographic by: Alex M @nephroguy

Hosts: Matthew Watto MD

Edited by: Matthew Watto MD, Emi Okamoto MD

Guests: Joel Topf MD, Juan Carlos Velez MD, Bill Whittier MD

Sponsor

Get your ACP membership today and use the code CURB100 to save $100 when you join by March 31, 2019.

Time Stamps

  • 00:00 NephMadness Kidney Pun Contest
  • 01:04 Disclaimer
  • 01:38 Sponsor - Become an ACP member today!
  • 02:12 Intro, guest bio
  • 04:38 Guest one-liners, some career advice and Joel’s pick of the week
  • 13:14 Sponsor - Become an ACP member today!
  • 14:48 Case of acute kidney injury in a patient with cirrhosis
  • 16:37 Initial differential diagnosis and approach to newly elevated creatinine in cirrhosis (urinalysis, FeNa, urine sodium)
  • 21:34 History and physical in cirrhosis and AKI
  • 24:56 Hepatorenal physiology
  • 26:45 Fluid choice
  • 30:27 Diuretic therapy in cirrhosis and volume overload
  • 34:38 Is a Renal Ultrasound useful in AKI?
  • 40:05 Recap: the initial approach to AKI in cirrhosis
  • 40:52 Therapeutic trials when volume status is uncertain
  • 46:02 Hepatorenal physiology revisited
  • 50:03 Vasoconstrictor therapy with octreotide, terlipressin, or norepinephrine
  • 62:24 Type 1 versus type 2 hepatorenal syndrome
  • 63:55 Large volume paracentesis (LVP) in cirrhosis with AKI; how much fluid to remove; use of diuretics or LVP in patient on norepinephrine?!
  • 71:18 Diagnostic criteria or HRS
  • 73:00 NephMadness matchups including bile cast nephropathy
  • 78:40 Outro
Mar 25, 2019
HCP: Primary Care Workforce with Fatima and Deep
01:01:33

Some precocious policy wonks take a deep dive into the evolving trends and future directions for our primary care workforce. Experts, Dr. Fatima Syed and Dr. Deep Shah return to school us on Physician Supply and Demand, the Access Gap, role of NPs and PAs, Retail Clinics, and Managed Care Clinics. ACP members can visit https://acponline.org/curbsiders to claim free CME-MOC credit for this episode and show notes (goes live 0900 EST).

Catch up on our previous discussions with Dr. Syed and Dr. Shah: Episode #62: Pod Save Health Care: The Curbsiders Foray into health policy and Episode #120 Health Policy, Patients, Payments, Paperwork for more context. We also did an overview of health care policy essentials with Dr. Sue Bornstein in Episode #64: Stuff You Should Know About Health Policy

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

Credits

Written and produced by: Fatima Syed MD, MSc; Deep Shah MD, MSc

CME questions by: Chris Chiu MD, Beth Garbitelli MS1,

Hosts: Stuart Brigham MD, Paul Williams MD, Matthew Watto MD,

Images and infographics: Beth Garbitelli MS1

Edited by: Matthew Watto MD, Chris Chiu MD

Guest: Fatima Syed MD, MSc, Deep Shah MD, MSc

 

Time Stamps

  • 00:00 Disclaimer, intro, guest bios
  • 04:40 Picks of the week
  • 11:40 Defining physician supply and demand
  • 21:30 Why are physicians less productive?
  • 28:23 What does the supply demand mismatch mean for patients?
  • 30:19 Discussion of various care delivery models (retails health clinics, minutes clinics, urgent care centers)
  • 42:15 Physician compensation
  • 53:50 Take home points from Fatima and Deep
  • 59:39 Outro
Mar 20, 2019
#144 NephMadness: Inpatient Hypertension
45:09

Inpatient hypertension is tricky. What’s the best way to answer those overnight nursing phone calls for elevated blood pressures? What’s the role of treating hypertensive urgency in the hospital? Plus, Our nephrology experts put a new issue on the generalist’s radar: are ACE-inhibitors dangerous to give (or hold) during an operation? This NephMadness 2019 episode, features special guests Dr. Pascale Khairallah (@Khairallah_P), Dr. Charlie Wray (@WrayCharles) and Dr. Joel Topf (@kidneyboy) to better understand the role of anti-hypertensives in the inpatient setting and keep your blood pressure down on those overnight calls.

Fill out your bracket for NephMadness 2019 today and sign up as part of The Curbsiders!

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

Credits

Written and produced by: Justin Berk MD, MPH, MBA; Pascale Khairallah MD

Hosts: Matthew Watto MD, Paul Williams MD, Stuart Brigham MD

Edited by: Matthew Watto, MD

Guest:  Pascale Khairallah MD, Charlie Wray DO, Joel Topf MD

Sponsor

Get your ACP membership today and use the code CURB100 to save $100 when you join by March 31, 2019.

Time Stamps

  • 00:00 Kidney Pun Contest with Hannah Abrams
  • 01:16 Disclaimer
  • 01:45 Sponsor - Become an ACP Member today!
  • 02:14 Intro and guest bios
  • 03:50 Picks of the weeks
  • 06:00 Sponsor - Become an ACP Member today!
  • 07:20 Case of acute severe hypertension; Does hypertensive urgency exist? Should we treat it?
  • 26:40 Case of perioperative medicine. Should we hold the ace inhibitor? Is there evidence to guide us?
  • 35:02 Take home points
  • 36:54 Everyone picks their NephMadness winners for the hospital medicine region
  • 43:13 Outro
Mar 18, 2019
#143 NephMadness: Fluid Wars
51:58

The battle over the superiority of resuscitation fluids is coming to a boil. Enter the Fluid Wars. Are Lactated Ringers superior to normal saline? Will LR increase a patient’s lactate? What about albumin? The Curbsiders quench the thirst for knowledge by turning to masters Dr. Pascale Khairallah (@Khairallah_P), Dr. Charlie Wray (@WrayCharles) and Dr. Joel Topf (@kidneyboy) for guidance in this special @NephMadness episode that will get your feet wet with the complicated world of fluid resuscitation.

Fill out your bracket for NephMadness 2019 today and sign up as part of The Curbsiders!

Full show notes available at https://thecurbsiders.com/episode-list. Join our mailing list and receive a PDF copy of our show notes every Monday.

Credits

Written and produced by: Justin Berk MD, Pascale Khairallah MD

NephMadness Pun Contest produced by: Hannah R Abrams MS3

Hosts: Matthew Watto MD, Paul Williams MD, Stuart Brigham MD

Edited by: Matthew Watto MD

Guest:  Pascale Khairallah MD, Charlie Wray DO, Joel Topf MD

Time Stamps

  • 00:00 Nephmadness pun contest
  • 02:18 Disclaimer
  • 02:52 Intro to the show and NephMadness, guest bios
  • 08:04 Guest one-liners,
  • 10:58 Joel explains NephMadness
  • 12:58  Guest book recommendations and career advice
  • 17:30 Clinical case; goals of fluid resuscitation; choice of initial IV fluid
  • Corporate (TV series) Comedy Central
  • 19:41 Complications of normal saline
  • 21:29 Colloids versus crystalloids
  • LR versus normal saline is not an innocuous decision
  • 26:32 Saline versus balance fluids. What’s the makeup?
  • 28:19 Does lactated ringers elevate lactate?
  • 31:03 Is hyperkalemia a contraindication for LR?
  • 32:39 Lactated ringers versus plasma-lyte and cost of fluid
  • 34:49 In vitro risks of normal saline
  • 40:31 SMART and SALT-ED trial
  • 46:08 Stuart finds the IV fluid price list
  • 44:37 Each panelist weighs in on saline versus balanced fluids
  • 46:45 Why do patients with metabolic alkalosis thrive on saline?
  • 49:04 Outro
Mar 15, 2019
#142 Cirrhosis TIPS: Acute Complications
01:32:34

Cirrhosis TIPS for the decompensated cirrhotic & acute on chronic liver failure from expert hepatologist and keto-practitioner Scott Matherly MD, @liverprof and chief hepatologist at @KashlakHospital. We walk through acute management of variceal bleeds, when to suspect SBP in decompensated cirrhosis (all the time, it turns out), how much fluid to remove in paracentesis, and some definitions about what decompensated cirrhosis and acute on chronic liver failure really mean.

Take our pretest on cirrhosis!

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

Credits

Written and produced by: Nora Taranto MS4, Matthew Watto MD

Pretest by: Cyrus Askin MD

Hosts: Matthew Watto MD, Paul Williams MD,

Images and infographics: Hannah Abrams MS3

Edited by: Matthew Watto MD

Guest: Scott Matherly MD

Sponsor 

Get your ACP membership today and use the code CURB100 to save $100 when you join by March 31, 2019.

Time Stamps

  • 00:00 NephMadness teaser
  • 00:50 Sponsor - Become an ACP Member today!
  • 01:25 Intro, guest bio
  • 03:45 Guest one-liner, keto diet
  • 07:40 Picks of the week from Paul, Matt and Scott
  • 11:50 Sponsor - Become an ACP Member today!
  • 13:26 Clinical case of bleeding and altered mental status in cirrhosis
  • 16:10 Interpretation of our patient’s labs and physical exam
  • 18:53 Defining terminology in cirrhosis (decompensated vs compensated vs acute on chronic liver failure)
  • 24:48 Initial workup, resuscitation and stabilization in variceal bleeding
  • 26:10 Why occult blood and ammonia levels are unhelpful in cirrhosis
  • 29:00 Fluid choice for the cirrhotic patient with hypotension; octreotide (or terlipressin); antibiotics prophylaxis
  • 33:10 Proton pump inhibitors and ulcers from variceal banding
  • 34:00 Mechanism of action for octreotide and terlipressin
  • 35:54 Prevention of recurrent bleeding with TIPS, or nonselective beta blockers
  • 40:40 Scores for prognostication in the acute setting
  • 44:00 Coagulopathy of cirrhosis and should DVT prophylaxis be used
  • 48:38 Elevated INR and procedures
  • 56:55 Paracentesis in the acute setting and interpretation of fluid studies:cell count, total protein, SAAG, blood culture vial; pathophysiology of ascites
  • 67:30 Treatment of SBP: antibiotics, IV albumin; plus, Hepatorenal physiology explained
  • 79:04 Hepatic encephalopathy is a shunt phenomen; how to evaluate for causes; treatment of HE
  • 87:58 Rifaximin
  • 89:10 Take home points
  • 91:02 Outro
Mar 11, 2019
Reboot - Diuretics, leg cramps, and resistant hypertension
01:07:31

Listen to our first ever discussion with @kidney_boy, Joel Topf MD. It’s a classic episode with a fresh intro as we prepare for @NephMadness 2019 with our friends from Twitter and @AJKDonline

Dominate leg cramps, diuretic therapy, and resistant hypertension with tips from @kidney_boy, Joel Topf MD @kidney_boy, Chief of Nephrology Kashlak Memorial Hospital, co-creator @NephMadness. We start with basic renal physiology and build up to the treatment of resistant hypertension.

Corrections: Dr Topf posted the following corrections on his blog PBfluids.com 3/22/2017

“I enjoyed the experience immensely, but in an hour of talking off the cuff I made some embarrassing mistakes:

In describing water reabsorption I said it occured in the cortical collecting duct rather than the medullary collecting duct.

In describing my cure for cramps I tell the story of Gitelman’s and say it is like congenital loop diuretics rather than congenital thiazide diuretics

I mucked up the story about the MRFIT story and how it allowed a head to head comparison of HCTZ and chlorthalidone. I really oversold what happened.”

 

Full show notes at https://thecurbsiders.com/podcast. Join our newsletter mailing list. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

Written by: Matthew Watto MD

Produced by: Stuart Brigham MD and Matthew Watto MD

Cohosts: Stuart Brigham MD and Matthew Watto MD

Guest: Joel Topf MD

Sponsor

Get your ACP membership today and use the code CURB100 to save $100 when you join by March 31, 2019.

Time Stamps

  • 00:00 Sponsor - Become a member of the American College of Physicians
  • 00:28 Disclaimer, Intro, Recap of upcoming shows, Corrections and Omissions
  • 05:50 Guest one-liner, Discussion of social media in medical education, Joel’s book
  • 12:45 Twitter for medical education including NephJC and NephMadness
  • 19:50 Sponsor - Become a member of the American College of Physicians
  • 21:30 Intro to diuretics, mechanism of action and a brief review of renal physiology
  • 28:26 Use of thiazide diuretics
  • 30:18 Chlorthalidone versus hydrochlorothiazide
  • 34:47 Diuretics and hyponatremia, Monitoring electrolytes and renal function on diuretics
  • 39:05 Leg (muscle) cramps and pickle juice
  • 42:55 Thiazides, osteoporosis and fracture prevention
  • 45:32 Resistant hypertension and  the workup for secondary hypertension
  • 53:36 Loop diuretics: how to choose an agent, dosing
  • 62:15 Take home points
  • 67:00 Outro
Mar 04, 2019
#141 Wound Care Pearls
01:12:56

Demystify chronic wound care management with high yield pearls from wound care expert Dr. Elizabeth (Foy) White-Chu. She takes us through a simple yet thorough approach to manage complex chronic wounds. We discuss everything from selecting a dressing, to pain management, and what kind of water should you really use when cleansing a wound. Answers to all of these burning questions and more await you, so don’t waste anymore time! Press play and let Dr. White-Chu take you on a journey through evidence based practices for the management of chronic wounds. ACP members can visit https://acponline.org/curbsiders to claim free CME-MOC credit for this episode and show notes (goes live 0900 EST).

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: Carolyn Chan MD

CME questions by: Justin Berk MD

Produced by: Matthew Watto MD

Hosts: Matthew Watto MD, Paul Williams MD, Carolyn Chan MD

Guest: Dr. Elizabeth (Foy) White-Chu

Sponsor

Check out the ACP's Medical Knowledge Self Assessment Program, MKSAP 18.

Time Stamps

  • 00:00 Sponsor - ACPs MKSAP 18
  • 00:25 Disclaimer, intro, guest bio
  • 03:58 Guest one-liner, movie recommendation, favorite failure, career advice
  • 11:40 Picks of the week
  • 15:58 Sponsor - ACPs Medical Knowledge Self Assessment 18
  • 17:50 Clinical case of lower extremity ulcer; describing a wound
  • 21:04 Taking a wound focused history
  • 26:28 Differentiating wound types
  • 29:04 Edema and compression therapy; Should diuretics be used?
  • 36:43 Description of the multi-component wrap
  • 38:10 Counseling a patient about wound care and setting expectations for healing
  • 41:29 High value options for each wound type
  • 44:35 Gardening and wound bed preparation
  • 51:32 A bit on silver therapy
  • 53:40 Back to the case; Red flags in wound care
  • 55:40 Culturing a wound
  • 58:17 Instructions on how to write wound care orders
  • 62:00 Rundown of topical therapies for wound care
  • 65:04 Negative pressure wound therapy aka “wound vac”
  • 66:14 How often are dressing changes needed?
  • 68:27 Take home points
  • 70:20 Outro
  • 71:30 Carolyn gives a wound care PUN!
Feb 25, 2019
#140 Psychopharmacology 2.0 - Antidepressant Master Class
01:01:33

Dive deep into the psychopharmacology of depression with Dr Patrick Finley, PharmD at UCSF. Learn practical tips including how to switch from one antidepressant to another, what to expect with SSRI and SNRI withdrawal, and how to choose a second (or third) antidepressant for refractory depression. We also summarize the safety around antidepressants in the peripartum period. ACP members can visit https://acponline.org/curbsiders to claim free CME-MOC credit for this episode and show notes (goes live 0900 EST).

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: Molly Heublein, MD

CME questions by: Molly Heublein, MD

Hosts: Matthew Watto MD, Paul Williams MD, Stuart Brigham MD, Molly Heublein, MD

Edited by: Matthew Watto MD

Guest Presenter: Patrick Finley, PharmD BCPP

Sponsor

Check out the ACP's Medical Knowledge Self Assessment Program, MKSAP 18.

Time Stamps

  • 00:00 Sponsor ACP’s MKSAP 18
  • 00:25 Disclaimer, intro and guest bio
  • 04:33 Guest one-liner, book recommendation, and first patient complaint
  • 08:04 Picks of the week
  • 12:10 Sponsor ACP’s MKSAP 18
  • 14:03 Clinical case of depression; assessing target symtpoms to characterize depression; choice of initial SSRI
  • 17:49 Discussion of iron, ferritin, folate and L methylfolate as they relate to treatment refractory depression
  • 20:12 Postpartum depression, iron, genetics and environmental factors
  • 22:35 How to switch from one SSRI to another; Cross-titration from SNRI to SSRI or from SSRI to SNRI
  • 26:05 Withdrawal symptoms from SSRIs or SNRIs and a bit more on switching and cross titration
  • 31:33 Is paroxetine ever a good idea?
  • 33:03 Ultra-rapid metabolizers of SSRIs and pharmacogenomics
  • 34:43 Postpartum depression and treatment with antidepressants during pregnancy and lactation
  • 39:25 Monitoring response to therapy with antidepressants ie PHQ-9
  • 40:53 Augmentation for partial response; bupropion for augmentation and sexual side effects;
  • 43:58 Counseling patients about discontinuation of therapy
  • 47:00 How to choose an agent for augmentation of antidepressant therapy
  • 51:02 Mirtazapine
  • 52:41 Vortioxetine
  • 53:24 Atypical antipsychotics for augmentation
  • 55:37 Pregabalin and gabapentin for augmentation
  • 57:42 Dr Finley’s take home points
  • 60:48 Outro
Feb 18, 2019
#139 Genetic Testing in Primary Care
01:24:40

Join us at the forefront as we talk genetic testing in primary care with Dr Dallas Read, esteemed gynecologist and **the only** medical geneticist at Tufts Medical Center. Topics include: what internists should be comfortable testing for in the office, how and when to refer for screening, what tests to order, how to interpret test results, how to handle direct-to-consumer results or requests, and so much more! For years, the medical community has been talking about the immense potential for genetic testing to guide diagnosis and treatment. But has it realized its full potential? The answer to that seems to be a resounding no at the moment--but the days of ubiquitous genetic testing to identify disease and disease risk may not be so far off after all. ACP members can visit https://acponline.org/curbsiders to claim free CME-MOC credit for this episode and show notes (goes live 0900 EST).

Coming to you from the Curbsiders, we hope you’ll enjoy this latest episode about the genes you wear, whether you want to put them on or not. Genes, Genes, they’re (maybe) good for your heart. But do patients want to know if they are, or if they aren’t?

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

Credits

  • Written and produced by: Nora Taranto MS4
  • CME questions by: Nora Taranto MS4
  • Hosts: Stuart Brigham MD, Matthew Watto MD, Nora Taranto MS4
  • Images and infographics: Beth Garbitelli MS1
  • Edited by: Matthew Watto MD, Chris Chiu MD
  • Guest: Dr. Dallas Reed MD

Sponsor 

Check out the ACP's Medical Knowledge Self Assessment Program, MKSAP 18.

Time Stamps

  • 00:00 Announcement
  • 00:37 Sponsor: ACP’s MKSAP 18
  • 01:04 Disclaimer, intro, guest bio
  • 06:31 Guest one liner, book recommendations, career advice
  • 12:23 Cohost picks of the week
  • 16:22 Sponsor: ACP’s MKSAP 18
  • 18:12 Dr Reed walks us through the genetic machinery from the top down (genome, chromosomes, exons, genes, SNPs, and epigenetics)
  • 26:18 A clinical case of Jeanne Sequence; What are the indications for genetic testing?
  • 29:54 What is actually being tested?
  • 33:57 What is the turnaround time for testing? What resources are available for counseling? Why is this challenging in primary care?
  • 38:58 Variant of Uncertain Significance
  • 41:22 Direct to consumer genetic testing
  • 44:54 Back to our case of Jeanne Sequence; How to take a history for patients with family history of breast cancer.
  • 50:41 Guidelines on use of genetic testing; Deciding which family member to test
  • 59:49 Laws about genetic testing and discrimination; How does this effect life insurance or disability insurance eligibility
  • 63:47 Is routine whole genome testing practical? Will this be commonplace in the future?
  • 68:22 What genetics resources are useful for primary care practitioners?
  • 72:13 Cost of genetic testing
  • 77:32 Take home points
  • 82:57 Outro
Feb 11, 2019
#138 Inflammatory Bowel Disease: Crohn’s and Ulcerative Colitis
01:28:24

Learn expert tips for the diagnosis and management of inflammatory bowel disease (IBD) from Dr. Adam Ehrlich, Assistant Professor of Medicine and co-director of the Inflammatory Bowel Disease Program at Temple University Hospital.  In this episode, we learn about the initial work-up, general principles of management, and important primary care considerations for Crohn’s disease and ulcerative colitis (ie endoscopic surveillance, immunizations, bone health/osteoporosis, and more!).

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

Credits

  • Written and produced by: Paul Williams MD
  • Edited by: Matthew Watto MD
  • Hosts: Matthew Watto MD, Stuart Brigham MD, Paul Williams MD
  • Guest: Adam Ehrlich MD

Sponsor

Check out the ACP's Medical Knowledge Self Assessment Program, MKSAP 18.

 

Time Stamps

  • 00:00 Sponsor: MKSAP 18
  • 00:32 Disclaimer, Intro, guest bio
  • 04:05 Guest one-liner, Adam’s movie rec - RBG (documentary), career advice, Paul’s movie rec - Edge of Tomorrow
  • 09:25 Sponsor: ACP’s MKSAP 18
  • 11:25 Definitions and pathophysiology of inflammatory bowel disease (IBD)

Ulcerative Colitis

  • 13:40 A case of ulcerative colitis; Classic symptoms; Initial approach and basic differential diagnosis
  • 19:10 Smoking and ulcerative colitis
  • 21:17 Initial workup for suspected IBD; Fecal calprotectin
  • 25:50 A bit more on CRP and IBD
  • 26:55 When to refer for colonoscopy
  • 27:58 Back to the case; a typical colonoscopy reports in ulcerative colitis (UC)
  • 30:33 Extraintestinal manifestations of UC
  • 34:50 Initial counseling for newly diagnosed IBD; natural history of IBD, prognosis
  • 39:50 Treatment of ulcerative colitis
  • 43:02 Some specifics on steroids, plus topical therapies

Crohn’s disease

  • 47:05 A case of Crohn’s disease; initial approach and differential diagnosis
  • 50:25 Initial diagnostic testing; colonoscopy findings in Crohn’s; IBD trivia
  • 53:58 Treatment of Crohn’s disease
  • 58:26 Specifics about biologic therapy for IBD; Endpoints
  • 62:25 Steroid sparing agents, immunomodulators like azathioprine, 6-mercaptopurine
  • 64:48 Can drug therapy be stopped or tapered in IBD?
  • 66:50 Prognosis in Crohn’s and initial patient counseling

Primary Care considerations

  • 68:35 Surveillance endoscopy,
  • 71:47 Do diet and lifestyle changes for IBD work? What about pregnancy?
  • 76:31 Immunizations
  • 79:25 Bone health, osteoporosis and IBD, screening for iron and nutritional deficiencies
  • 82:27 Take home points
  • 86:28 Outro
Feb 04, 2019
#137 Hyperkalemia Master Class with Joel Topf MD
01:21:40

Master the management of hyperkalemia with tools, tips and tactics from @kidney_boy, Joel Topf MD, Chief of Nephrology @KashlakHospital. We cover: common causes of hyperkalemia; the U-shaped curve of potassium levels and mortality; albuterol nebs; how to safely use insulin; potassium binding resins and colonic necrosis; Does it make sense to give loop diuretics and fluids?; Should we be using fludrocortisone?; Plus, answers to all your questions about a high potassium diet and oral potassium supplements! Join us for Dr Topf’s masterful insights on hyperkalemia and potassium homeostasis.

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.

Sponsor

Join us at ACP's Internal Medicine Meeting 2019 April 11-13th in Philadelphia, PA . We'll see you there!

Credits

Written and produced by: Matthew Watto, MD

Hosts: Matthew Watto MD, Paul Williams MD, Stuart Brigham MD

Infographic: Matthew Watto MD

Edited by: Matthew Watto MD

Guest: Dr Joel Topf MD

 

Time Stamps

  • 00:00 Ad disclaimer, intro and guest bio
  • 05:11 Guest one-liner and picks of the week —Peloton indoor cycle, “your local library”, The Nice Guys (film) by Shane Black, and Forgotten Hand (PS4 game)
  • 11:17 ACP Internal Medicine Meeting 2019 details
  • 12:55 Clinical case of hyperkalemia; discussion of pseudohyperkalemia
  • 19:55 Hyperkalemia and the EKG
  • 23:38 Threshold for treatment of hyperkalemia
  • 27:20 Use of telemetry and the U-shaped curve for potassium and mortality
  • 30:11 Choice of therapy for acute hyperkalemia
  • 33:13 Albuterol for hyperkalemia
  • 34:24 First rule out urinary obstruction and hyperglycemia; Use of IV insulin and dextrose and frequency of monitoring
  • 39:44 Loop diuretics plus fluid; Distal sodium delivery and potassium handling in the nephron
  • 43:10 Fludrocortisone for hyperkalemia
  • 45:05 Calcium for elevated potassium
  • 48:43 SPS, potassium binding resin
  • 52:43 Risks of SPS (sodium polystyrene sulfonate) and colonic necrosis
  • 58:28 Sodium bicarbonate for acute and chronic hyperkalemia
  • 61:00 Back to the case; TMP-SMX, ace inhibitors (or ARBs) and hyperkalemia
  • 63:05 Threshold for admission; Diet and potassium
  • 65:52 Treatment of chronic hyperkalemia and a bit more on high potassium foods
  • 68:45 Patiromer and sodium zirconium
  • 71:51 Loop diuretics and empiric potassium supplementation
  • 74:12 Can diet alone be used to treat HYPOkalemia?
  • 75:26 Take home points
  • 77:40 NephMadness is coming! March 2019
  • 79:53 Outro
  • 81:00 More Kidney Boy!
Jan 28, 2019
#136 Sickle Cell Disease, Management & Complications
01:11:37

Stuck on sickle cell disease? We hammer out the basics of diagnosis, common sickle cell variants and their manifestations, preventive medicine, acute and chronic pain management, opioid use, and how to recognize and treat common complications like anemia, fever and acute chest syndrome. Sickle cell expert, Sophie Lanzkron MD, Associate Professor of Medicine and Oncology and Director of the Sickle Cell Center for Adults at Johns Hopkins joins!

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.

Sponsor

ACP's Internal Medicine Meeting 2019 April 11-13th in Philadelphia, PA. We'll see you there!

Credits

Written (including CME questions) and produced by: Justin Berk MD, Martha Brucato MD PhD, Beth Garbitelli MS1

Hosts: Paul Williams MD, Justin Berk MD, Matthew Watto MD

Edited by: Matthew Watto MD

Guest: Sophie Lanzkron MD MHS

Time Stamps

  • 00:00 Announcements, intro
  • 02:30 A quick refresher on hemoglobinopathy
  • 03:45 Guest bio
  • 05:03 Guest one-liner, movie recommendation, career advice, picks of the week
  • 10:53 ACP Internal Medicine Meeting 2019 (ad read)
  • 12:33 Clinical case; defining sickle cell; pathophysiology
  • 16:23 Different types of hemoglobinopathy genotypes and phenotypes
  • 20:20 Preventive care for sickle cell disease
  • 22:56 Taking a history at the initial visit in patient with sickle disease
  • 26:40 Life expectancy in SCD
  • 28:30 Hydroxyurea
  • 30:40 Chronic red blood cell transfusion therapy; complications; monitoring
  • 37:07 Silent cerebral infarcts and mild cognitive impairment in SCD 
  • 40:10 Chronic pain management; opioid use disorder in sickle cell disease
  • 46:00 Acute pain crisis management; PCAs vs bolus therapy
  • 54:08 Reticulocyte count in sickle cell disease
  • 55:40 Itching, opioids and naloxone?
  • 58:10 Red blood cell transfusion threshold in sickle cell disease (anemia)
  • 60:03 Acute fever in SCD
  • 61:48 Acute chest syndrome
  • 66:45 Transition from pediatrics to adult medicine in sickle cell
  • 68:00 Incentive spirometry to prevent acute chest syndrome
  • 68:45 Take home points
  • 70:00 Outro
Jan 21, 2019
#135 Perioperative Medicine
01:25:15

Optimize perioperative risk and dominate perioperative medicine. Topics include surgical risk calculators, preoperative labs, stress testing, use of BNP and troponins, postoperative MI, cardiac and pulmonary risk stratification, and more! We’re joined by perioperative medicine expert, Avital O’Glasser MD, Associate Professor of Medicine at Oregon Health & Science University and Assistant Program Director for Scholarship and Social Media. ACP members can visit https://acponline.org/curbsiders to claim free CME-MOC credit for this episode and show notes (goes live 0900 EST).

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: Matthew Watto MD

CME questions by: Matthew Watto MD

Hosts: Matthew Watto MD, Stuart Brigham MD

Edited by: Matthew Watto MD

Guest: Avital O’Glasser MD

Time Stamps

  • 00:00 Disclaimer, intro and guest bio
  • 04:20 Guest one-liner, book and movie recommendations, career advice
  • 11:20 ACP Internal Medicine Meeting 2019 details
  • 14:02 Patient with coronary artery calcifications going for elective hip surgery and wants "clearance"
  • 20:50 Functional capacity
  • 25:00 Preoperative stress testing and coronary revascularization
  • 31:55 Canadian guidelines, BNP and troponin testing
  • 36:30 The METS trial and predicting perioperative cardiac events and mortality
  • 40:44 Preoperative testing (labs, imaging, urine studies)
  • 50:24 Choosing your perioperative cardiac and surgical risk calculator (RCRI, MICA, ACS-NSQIP)
  • 59:50 Communicating risk to patient and their surgeon
  • 61:30 Pulmonary risk assessment and complications
  • 70:35 Perioperative use of opioids
  • 75:30 Who needs an echocardiogram prior to surgery?
  • 79:00 Canceling a patient's surgery
  • 82:55 Take home points
  • 83:45 Outro
Jan 14, 2019
#134 Urinary Tract Infections Delirium and Voltaire
54:49

“Urinary tract infections” (UTIs) are overdiagnosed. Antibiotics are overprescribed. UTIs are inappropriately blamed for geriatric syndromes (eg delirium) despite little supporting evidence. Our guest, Tom Finucane MD, Emeritus Professor of Medicine at Johns Hopkins makes us question everything. Topics: How can we diagnose “UTI”? Who needs treatment? Do urinary tract symptoms matter? Does malodorous urine correlate with infection? Who’s at risk for pyelonephritis and sepsis? Don’t miss this paradigm changing episode. And stop using the term “urinary tract infection” unless it’s prefaced by air quotes!

Sponsor: Join ACP's Internal Medicine Meeting 2019 April 11-13th in Philadelphia, PA . We'll see you there!

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: Matthew Watto MD

Hosts: Matthew Watto MD, Paul Williams MD

Edited by: Matthew Watto MD

Guest: Tom Finucane MD, MACP

Time Stamps

  • 00:00 Disclaimer, intro and guest bio
  • 04:00 Guest one liner, book recommendation, career advice
  • 08:22 The “medical ignorome”
  • 13:40 ACP Internal Medicine Meeting 2019 details
  • 16:20 Case of malodorous urine; Urine is NOT sterile; Defining terms
  • 25:14 Stop saying UTI unless using air quotes
  • 28:34 What symptoms or history matters in evaluation for “UTI”? And can we predict who will become systemically ill?
  • 34:47 Voltaire and when treatment is warranted for “urinary tract infections”
  • 37:15 Delirium in an older adult with possible UTI, how to work it up, and who warrants antibiotics
  • 51:55 Take home points
  • 53:38 Outro
Jan 07, 2019
2018 Recap Extravaganza
52:07

Take a trip down memory lane with top clinical pearls and favorite moments from The Curbsiders in 2018.

Welcome to our 2018 Recap Extravaganza! Since last year, the Curbsiders team has grown substantially and the podcast has undergone several exciting developments. These include our collaboration with ACP that allows us to provide CME and MOC credit for select episodes, our new partnership with Human Dx as featured in our Kashlak Morning Reports, and the launch of our Women in Medicine series. For our 2017 year-end show, we had listeners vote for their favorite episodes from the past year. This year, we're changing it up a bit and have invited our Curbsider colleagues to share their picks for pearliest pearls and most illuminating episodes of 2018. We hope you’ll enjoy hearing the team’s highlights, and we’ll be back in 2019 with fresh content. Note: No CME-MOC credit for this episode, but stay tuned in 2019 for eligible 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.

Credits

Written and produced by: Chris Chiu MD and Sarah Phoebe Roberts, MPH

Hosts: Matthew Watto MD, Paul Williams MD, Stuart Brigham MD, Chris Chiu MD

Edited by: Chris Chiu MD

Time Stamps

  • 00:00 Disclaimer, Intro
  • 06:39 Clinical Reasoning Pearls
  • 12:35 Pulmonary Hypertension Pearls
  • 15:52 Women In Medicine Pearls
  • 20:40 Iron Deficiency Pearls
  • 24:52 Tick-Borne Illness Pearls
  • 28:00 STI Pearls
  • 31:00 Physical Exam Pearls
  • 32:51 “Things we do for no reason” Pearls
  • 36:16 Host Picks
  • 42:38 Paul Wraps-up the Year
  • 43:38 Outro and Curbsider Team sign-offs
Dec 31, 2018
#133 Herpes for Everyone
58:21

Master the diagnosis and management of Genital Herpes with tips from expert, Robert Bettiker MD . Topics include: the natural history, diagnosis & screening guidelines for genital herpes; cold sores; options for primary and recurrent episodes including prophylaxis; and consideration of specific populations including symptomatic and asymptomatic patients, pregnancy and MSM (men who have sex with men). We also discuss partner notification and treatment.

Full show notes available at http://thecurbsiders.com/podcast. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

Written and produced by: Kate Grant MBChB DipGUMed, Matthew Watto MD

Images by: Kate Grant MBChB DipGUMed

Hosts: Stuart Brigham MD, Paul Williams MD, Matthew Watto MD

Guest: Robert Bettiker MD

Time Stamps

  • 00:00 Disclaimer, guest bio, intro
  • 01:50 Guest one liner, memorable teaching moment and a few failures
  • 10:50 Intro to herpes
  • 12:25 Case 1: Genital herpes in a married man
  • 15:42 Overview of testing options
  • 18:50 Marital counseling in Herpes
  • 22:18 Prophylaxis in serodiscordant partners and asymptomatic shedding
  • 25:08 Case 2: Severe outbreak of genital herpes in a young woman
  • 31:50 Case 3: Young male with recent exposure to herpes
  • 38:45 Herpes 1 (HSV1) versus Herpes 2 (HSV2)
  • 44:12 Case 4: Herpes in pregnancy
  • 50:45 Do topical agents work for herpes
  • 55:05 Take home points
  • 56:10 Outro
  • 57:52 Stuart shares a PUN!
Dec 24, 2018
#132 A Case of Abdominal Pain
50:29

Sharpen your diagnostic schema for abdominal pain and eosinophilia with this mystery case http://hdx.org/Rxg (click link to follow along). Reza Manesh MD, editor of Global Morning Report at The Human Diagnosis Project aka Human Dx attempts to solve this challenging case with the help of The Curbsiders.

Use this link http://hdx.org/Rxg to follow along with the case on the Human Dx app and check out more Global Morning Report cases.

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: Hannah R Abrams

Hosts: Matthew Watto MD, Paul Williams MD, Stuart Brigham MD

Edited by: Matthew Watto MD

Guest: Reza Manesh MD

Special thanks to: Steph Sherman, Zaven Sargsyan, Anand Jagannath, John Inou Hwang, and Rabih Geha for contributing and editing the cases; and to Tyler Brandon for helping to coordinate these wonderful episodes.

Time Stamps

  • 00:00 Announcement, disclaimer, intro, guest bio
  • 01:20 Picks of the week
  • 05:42 How Reza fell in love with clinical reasoning
  • 08:58 Case of 50 yo male with abdominal pain
  • 21:14 Some unexpected findings
  • 43:00 Case conclusion/answer, cognitive autopsy and Reza’s take home points
  • 48:35 Outro
Dec 19, 2018
#131 A Case of Cough and Dyspnea
47:48

Hone your diagnostic skills with this mystery case of cough and dyspnea http://hdx.org/pdp (click link to follow along). The Curbsiders deconstruct the case and discuss their diagnostic schemas for these common problems with the help of returning guest, Reza Manesh MD, editor of Global Morning Report at The Human Diagnosis Project aka Human Dx.

Use this link http://hdx.org/pdp to follow along with the case on the Human Dx app or website and check out more Global Morning Report cases.

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: Hannah R Abrams

Hosts: Matthew Watto MD, Paul Williams MD, Stuart Brigham MD

Edited by: Matthew Watto MD

Guest: Reza Manesh MD

Special thanks to: Steph Sherman, Zaven Sargsyan, Anand Jagannath, John Inou Hwang, and Rabih Geha for contributing and editing the cases; and to Tyler Brandon for helping to coordinate these wonderful episodes.

Time Stamps

  • 00:00 Announcement, disclaimer, intro, guest bio
  • 03:13 When and how to practice clinical reasoning
  • 05:53 Creating diagnostic schemas and Clinical Problem Solvers Podcast
  • 09:40 A bit on Human Dx and the show format
  • 12:00 Case of a 40 yo male with a cough
  • 23:22 Some insights from Reza on “signal versus noise”
  • 37:10 Case conclusion/answer, cognitive autopsy and Reza’s take home points
  • 45:36 Outro
Dec 17, 2018
#130 Work-Life Fit: Women In Medicine
53:24

Create a successful partnership and career withs tips from Wonder Woman, Sue Hingle MD of ACP. 

Work-Life Balance: is it a myth, or attainable if we could just find the right fit? In this episode, we chat with Dr. Susan Hingle about identifying our work-life priorities and re-evaluating these priorities throughout our lives. We strategize about achieving personal and professional goals (pro tip: stop worrying about what others think!). Dr. Hingle is Professor in the Department of Internal Medicine and Vice Chair of Education and Faculty Development and Associate Internal Medicine Residency Program Director at Southern Illinois University. She is also the Immediate Past Chair of the Board of Regents of the American College of Physicians (ACP). She has served at the ACP in a variety of ways, including as a member of the ACP Women’s Task Force. Her clinical expertise is in women’s health, health promotion, and disease prevention. Enjoy the episode!

ACP members can visit https://acponline.org/curbsiders to claim free CME-MOC credit for this episode and show notes (goes live 0900 EST). Full show notes available at http://thecurbsiders.com/podcast. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

Written and produced by: Nora Taranto MS4, Shreya Trivedi MD, Leah Witt MD, Sarah P. Roberts MPH.

CME Questions by: Shreya Trivedi MD

Editors: Matthew Watto MD and Chris Chiu MD

Hosts: Shreya Trivedi MD, Paul Williams MD, Leah Witt MD

Guest: Susan Hingle MD

Time Stamps

  • 00:00 Disclaimer, intro and guest bio
  • 02:52 Guest one liner, WIM Moment of awakening, advice for her younger self
  • 07:45 Picks of the week
  • 10:30 Physician with family and caregiver responsibility; How to plan for personal and professional goals
  • 18:20 What to look for in a partner, how to work with them to achieve work life fit, and non-traditional roles
  • 28:35 Advice on family planning
  • 31:40 Residency programs and life events
  • 32:55 Should you go part-time?
  • 39:43 Work life balance? Or work life fit? And some examples/tips for success
  • 49:54 Take home points
  • 50:45 Outro
  • 52:22 Bonus story
Dec 13, 2018
#129 Depression and Suicide: Occupational Hazards of Practicing Medicine
01:09:28

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

N.b. This is a sensitive topic. If this is triggering for anyone listening, the national suicide hotline number 1-800-273-8255. Moreover, if anyone needs or wants guidance on available resources, Dr. Elisabeth Poorman has made herself available either via email, private msg on FB or twitter (@DrPoorman), or any of us on twitter. We are happy to talk and see that you get support you need.

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: Nora Taranto MS4, Shreya Trivedi MD

Hosts: Stuart Brigham MD, Shreya Trivedi MD, Matthew Watto MD

Edited by: Matthew Watto MD

Guest: Elisabeth Poorman, MD

Time Stamps

  • 00:00 Disclaimer, Intro, Guest Bio
  • 3:25 Wellness Recommendations: Find a Therapist
  • 6:12 How to find a therapist in training
  • 6:39 Licensing and Mental Health
  • 12:14 Disclaimer and Trigger Warning: Stories are Sensitive. National suicide hotline info
  • Next, Dr Poorman and each of The Curbsiders share their personal experiences with mental health (see below).
  • 12:05 Shreya story
  • 21:40 Stuart’s story
  • 31:19 Elisabeth’s story
  • 36:17 Watto’s story
  • 37:41 Passive suicidal ideaiton, a definition  
  • 41:10 Suicide and Depression: Do they always coexist? (No)
  • 42:20 Life Cycle of Depression and Suicide in the Medical Profession
  • 47:15 Depression and Suicide in Primary Care
  • 47:59 Mini-Cases
  • 54:00 Noticing signs in a colleague: how to help
  • 58:00 Specific programs doing things well
  • 1:03:08: Questions from Social Media
  • 1:03:10: Burnout vs. Depression
  • 1:04:27: Will getting treatment affect your board applications
  • 1:06:14 Take home points
  • 1:08:00 Outro
Dec 10, 2018
#128 Aspirin Overhyped and Overused
53:46

Aspirin’ to figure out if ASA can help prevent a heart attack? Interpreting all the new trials doesn’t have to cause chest pain! Join Dr. Ambarish Pandey from UT Southwestern as he helps The Curbsiders ASCEND the mountains of the latest studies to ARRIVE at some well-informed conclusions on the role of aspirin in primary prevention for cardiac events. The team also discusses secondary prevention, aspirin and dual (or triple) antiplatelet therapy, and whether it’s okay to stop giving aspirin to older adults without known CAD (Spoiler alert: it’s okay). ACP members can visit https://acponline.org/curbsiders to claim free CME-MOC credit for this episode and show notes (goes live 0900 EST).

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: Justin Berk MD, Matthew Watto MD

CME questions by: Justin Berk MD

Hosts: Matthew Watto MD, Paul Williams MD, Stuart Brigham MD

Edited by: Matthew Watto MD and Chris Chiu MD

Guest: Dr. Ambarish Pandey MD

Time Stamps

  • 00:00 Disclaimer, intro and guest bio
  • 04:15 Guest one liner, book recommendation, career and research advice
  • 11:07 Case of aspirin for primary prevention, aspirin’s public persona, and nocebo effects of statins
  • 21:40 ARRIVE and ASCEND trials
  • 28:14 Aspree trial
  • 32:38 Coronary artery calcium; aspirin use for secondary prevention
  • 37:42 Dual antiplatelet therapy and the DAPT score
  • 41:25 Should we continue aspirin when a patient also needs a DOAC?
  • 46:14 Should we continue DAPT in a patient who needs a DOAC (or warfarin)?
  • 49:40 Deprescribing aspirin for primary prevention in older adults?
  • 50:51 Closing remarks
  • 52:33 Outro
Dec 03, 2018
Hotcakes: Exercise, Aspirin, Fish Oil and Hypertension
49:44

Tony Breu MD joins us for some hotcakes, and “cold cakes” including: how aspirin and zodiac sign affect the treatment of acute MI, a recent study on how exercise is probably still good for you, the recently announced REDUCE-IT trial, and the evidence (or lack thereof) for the treatment of hypertensive urgency. Welcome to another edition of Hotcakes and Hot Takes, where we discuss the most interesting articles and news that we have been reading. Special guest is the prolific Dr. Tony Breu (@tony_breu) who is an Assistant Professor of Medicine at Harvard Medical School and a Hospitalist and Director of Internal Medicine Resident Education at the VA Boston Healthcare System. He is known for his series on "Things We Do For No Reason” as well as his thought-provoking “Tweetorials” online. ACP members can visit https://acponline.org/curbsiders to claim free CME-MOC credit for this episode and show notes (goes live 0900 EST on day of release).

Full show notes available at http://thecurbsiders.com/podcast. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

Written and Produced by: Sarah Phoebe Roberts MPH, Christopher Chiu MD

CME Questions: Christopher Chiu MD

Hosts: Matthew Watto MD, Stuart Brigham MD, Paul Williams MD, and Christopher Chiu MD

Guest Presenter and Content Planning: Anthony Breu MD

Editor: Christopher Chiu MD

Cover-Art: Christopher Chiu MD

Time stamps
  • 00:00 Disclaimer, intro, guest bio
  • 05:53 Discussion on Tweetorials
  • 08:00 Cold Cake: ISIS-2 and the treatment of acute MI with aspirin
  • 14:04 ISIS-2 and zodiac subgroup analysis
  • 16:19 What is the relationship between cardiorespiratory fitness on mortality?
  • 24:40 Discussion of the REDUCE-IT study
  • 33:00 Cold Cake: VA Cooperative study and the evidence for treating essential hypertension
  • 36:42 TWDFNR and the treatment of hypertensive urgency
  • 46:36 Wrap-up and outro
Nov 29, 2018
#127 STIs: Syphilis, Gonorrhea and Chlamydia
01:15:54

Master the diagnosis and management of common STIs (sexually transmitted infections) with tips from expert, Dana Dunne MD, Associate Professor of Medicine in Infectious Diseases at Yale. Topics include: the stages and many presentations of syphilis, syphilis treatment and counseling, the natural history, diagnosis, and screening guidelines for gonorrhea and chlamydia, treatment options in the age of growing resistance, and a discussion of partner notification and treatment.

Full show notes available at http://thecurbsiders.com/podcast. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

Written and produced by: Bryan Brown MD

Hosts: Bryan Brown MD, Paul Williams MD, Matthew Watto MD

Guest: Dana Dunne MD

Special thanks to Kate Grant MBChB, Dip GUMed for her contribution of knowledge and artwork.

Time Stamps

  • 00:00 Announcement, disclaimer, intro and guest bio
  • 04:29 Guest onliner, book recommendation, advice for learners/teacher, and picks of the week
  • 11:00 A case of syphilis, clinical manifestations and discussion of the stages
  • 26:05 Testing for syphilis
  • 39:05 Mandatory reporting and partner tracing
  • 42:40 Counseling patients with syphilis
  • 44:44 A case of gonorrhea and chlamydia, clinical manifestations, screening guidelines
  • 52:30 How to counsel patients to obtain samples from urethra, rectum, vagina, oropharynx; Mycoplasma genitalium
  • 59:40 CDC treatment guidelines, Super gonorrhea, test of cure, and treatment of partners
  • 72:35 Take home points
  • 74:30 Outro
Nov 26, 2018
#126 Kashlak Morning Report with Human Dx
01:06:11

Practice solving diagnostic puzzles with The Curbsiders and Internist / Diagnostician, Reza Manesh MD, Assistant Program Director for Clinical Reasoning of the Osler Medical Training Program at Johns Hopkins! Solve along with us at these links: Case 1 http://hdx.org/I2B and Case 2 http://hdx.org/uM2. Topics include: clinical reasoning terminology, how to use cases to practice diagnostic reasoning, how to build a diagnostic schema, and how to conduct your own cognitive autopsy.

Full show notes available at http://thecurbsiders.com/podcast. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

Written and Produced by: Hannah Abrams

Hosts: Hannah Abrams, Paul Williams MD, Stuart Brigham MD, Matthew Watto MD

Guest: Reza Manesh MD

Special thanks to: Doctors Steph Sherman, Zaven Sargsyan, Anand Jagannath, John Inou Hwang, and Rabih Geha for contributing cases

Time Stamps

  • 00:00 Disclaimer, intro and guest bio
  • 04:02 Guest one liner, book recommendation, favorite failure, advice for learners
  • 11:27 Human Dx Project and Global Morning Report
  • 15:35 Diagnostic terminology
  • 21:25 Case #1, Reza solves
  • 33:40 Diagnostic autopsy and teaching points for case #1
  • 38:00 Case #2, The Curbsiders solve
  • 57:30 Diagnostic autopsy and teaching points for case #2
  • 61:33 Take home points and a plug
  • 64:30 Outro
Nov 19, 2018
#125 Hidden Curriculum
01:03:12

Check out this audio treasure map to find the hidden curriculum and learn how it can change your practice. Learn how positive teaching spans not just the classroom or bedside but, how we simply talk about patients. Sanjay Desai MD, coauthor of ACP’s Position Paper on Hidden Curriculum and Internal Medicine program director at Johns Hopkins guides us through several cases that illustrate how our institutional norms can shape the practice of medicine...for better or worse. ACP members can visit https://acponline.org/curbsiders to claim free CME-MOC credit for this episode and show notes (goes live 0900 EST).

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: Sanjay Desai MD; Justin Berk MD, MPH, MBA; Matthew Watto MD

CME questions by: Justin Berk MD

Editors: Chris Chiu MD & Matthew Watto MD

Hosts: Justin Berk MD, MPH, MBA; Matthew Watto MD; Paul Williams MD

Guest: Sanjay Desai MD

Time Stamps

  • 00:00 Disclaimer, Intro and guest bio
  • 04:00 Guest one liner, book recommendations, career advice
  • 10:50 Intro to the hidden curriculum and ACP’s three recommendations
  • 22:00 Case #1: A patient with schizophrenia
  • 32:10 Case #2: The iPatient
  • 38:07 Case #3: Attending forgets to wash their hands
  • 41:10 Case #4: A dying patient’s primary care doctor saves the day
  • 46:26 Case #5: A case of violating duty hours
  • 60:10 Take home points
  • 62:00 Outro
Nov 15, 2018
#124 The Shoulder - Simplify Your Approach
01:11:47

Shoulder pain made simple. Develop your confidence and skills with tips from sports medicine specialist Dr. Carlin Senter MD. We discuss her simplified approach to the basic shoulder exam, including when and how to do special tests, high yield exam maneuvers, when to refer shoulder pain patients to orthopedic surgery, and who can be managed conservatively.

Full show notes available at http://thecurbsiders.com/podcast. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

Written and produced by: Molly Heublein MD and Nora Taranto MS4

Editor: Matthew Watto MD

Hosts: Molly Heublein, MD, Paul Williams MD, Matthew Watto MD

Guest: Carlin Senter, MD

Time Stamps

  • 00:00 Disclaimer, intro, and guest bio
  • 03:15 Guest one liner, book recommendation, career advice, and some picks of the week
  • 13:20 Clinical case of shoulder pain; helpful historical features
  • 18:54 Differentiating referred pain from c-spine pathology from shoulder pathology
  • 21:00 A framework for shoulder pain, HIP-ROT, and using ROM to generate a differential
  • 27:40 Frozen shoulder aka adhesive capsulitis
  • 31:57 Glenohumeral joint arthritis
  • 33:52 Rotator cuff disease
  • 40:53 Specific testing for rotator cuff tears
  • 51:45 Impingement syndrome versus bursitis
  • 56:25 Counseling patient with shoulder pain or injury
  • 59:03 Steroid injections, topical therapy, and AC joint arthritis
  • 65:18 When to refer to surgery and some take home points
Nov 12, 2018
#123 Sleep Apnea Pearls and Pitfalls
52:20

The sleep apnea episode that won’t put you to sleep. Become a sleep apnea guru with incredible insights from Barbara Phillips MD, MSPH, FCCP an expert in pulmonary medicine, critical care and sleep medicine who is also a past president of CHEST! We discuss high-yield topics in the world of obstructive sleep apnea including: home sleep studies vs in-lab polysomnography, the importance of oxygen saturation (the T90 and ODI) when interpreting sleep study results, tricks to improve CPAP adherence, and alternatives therapies for obstructive sleep apnea. ACP members can visit https://acponline.org/curbsiders to claim free CME-MOC credit for this episode and show notes.

Full show notes available at http://thecurbsiders.com/podcast. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

Written and produced by: Cyrus Askin MD

CME questions by: Cyrus Askin MD

Editor: Chris Chiu MD & Matthew Watto MD

Hosts: Cyrus Askin MD & Matthew Watto MD

Guest: Barbara Phillips, MD

Cover-Art & Infographic - Beth Garbitelli, MS1

Time Stamps

  • 00:00 Disclaimer, intro, guest bio
  • 03:00 Guest one liner, book recommendation, advice for trainees
  • 08:10 Clinical case of sleep apnea, some basic stats, and key predictors of sleep apnea
  • 12:38 Barriers to diagnosis and treatment of OSA
  • 15:23 Discussion of T90, hypoxemia and sleep fragmentation
  • 17:05 How to read a sleep study report
  • 21:55 Home sleep apnea testing
  • 24:15 What are the consequences of sleep apnea
  • 28:30 What is the efficacy of cpap for lowering blood pressure and mortality
  • 31:45 Counseling a patient who is new to cpap
  • 33:45 Choice of mask
  • 40:10 Do alternatives to cpap work? e.g. surgery, mandibular advancement devices
  • 44:17 Modafinil and z-drugs
  • 47:15 Driver’s license issues in sleep apnea
  • 48:35 Future of sleep medicine and take home points
  • 51:15 Outro
Nov 05, 2018
#122 Headaches Advanced Class
01:18:11

We delve into advanced management of headaches, including novel therapies, migraines with aura, migraines in complicated patients, and headaches of short duration with Dr. Rebecca Burch, a headache medicine specialist at the John R. Graham Headache Center at Brigham and Women’s Hospital.

Full show notes available at http://thecurbsiders.com/podcast. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

Written and produced by: Paul Williams MD

Edited by: Matthew Watto MD

Hosts: Paul Williams MD, Stuart Brigham MD, Matthew Watto MD

Guest: Rebecca Burch MD

Time Stamps

  • 00:00 Disclaimer, intro and guest bio
  • 03:28 Guest one-liner, movie and podcast recommendations, favorite failure and picks of the week from The Curbsiders
  • 10:38 Clinical case of migraines; diagnosis and classification
  • 14:12 Does medication overuse headache exist?
  • 16:16 Chronic daily headache; Conversion from episodic to chronic and vice versa
  • 21:43 Approaches to medication overuse headache
  • 25:54 Case 2: migraine with aura and other types of migraine (retinal, hemiplegic, etc.)
  • 32:09 Pathophysiology of migraine; how triptans work; How should aura effect management?
  • 38:44 Migraine cocktails
  • 41:15 Comorbid mood disorders; Use of psych meds and triptans
  • 45:08 Migraines and oral contraceptives
  • 48:42 Botulinum toxin and new CGRP therapies
  • 53:36 What does success look like in migraine therapy?
  • 55:32 Nonpharmacologic management
  • 60:45 Case 3: headaches of short duration
  • 66:36 Headache red flags; Imaging for headaches; pathophysiology of high and low pressure headaches
  • 72:00 Idiopathic intracranial hypertension
  • 75:25 Take home points
  • 77:00 Outro

 

Oct 29, 2018
#121 HIV Care for the Internist
01:00:31

HIV care for the internist with author and HIV expert, Michael Saag MD, Professor of Infectious Diseases at University of Alabama and founder of the 1917 Clinic. We discuss the specifics of screening & diagnostic testing in HIV, monitoring CD4 counts and viral loads, first line antiretroviral therapy, harm reduction, and how to provide excellent HIV care in your primary care clinic.

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 & Produced by: Elena Gibson MS4, Justin Berk MD MBA MPH

Artwork by: Elena Gibson MS4

Hosts: Matthew Watto MD, Paul Williams MD, Justin Berk MD MBA MPH

Editor: Matthew Watto MD

Guest: Michael Saag MD

Time Stamps

  • 00:00 Disclaimer, intro, and guest bio
  • 04:35 Getting to know our guest, a movie recommendation, and words of wisdom
  • 08:48 Clinical case, HIV screening, in-depth discussion of HIV testing & diagnosis
  • 15:56 New diagnosis of HIV, counseling after diagnosis, confirmation, follow-up testing, the second visit
  • 24:20 Treatment - what to start and when; some basic comments on therapy
  • 30:05 Primary care after diagnosis, vaccines, cancer screening, cardiovascular disease prevention
  • 34:35 Monitoring CD4 counts and viral load; interpreting CD4 count; time course of response for CD4 and viral load
  • 42:02 Harm reduction counseling; addressing medication non-adherence
  • 47:40 PCP prophylaxis
  • 49:43 The 1917 Clinic, Ryan White Clinics, and linking patients to care
  • 53:10 Take home points
  • 55:40 Plugs
  • 57:45 Will a cure or vaccine for HIV emerge?
  • 59:16 Outro
Oct 22, 2018
#120 Policy, Patients, Payments, Paperwork
44:27

Join us in this roundtable discussion of patients before paperwork, administrative burden, the new CMS payment model proposal, and a bit on health insurance with cohost, Fatima Syed MD MSc and guest, Deep Shah MD MSc. Doctors Syed and Shah are both early career physicians with masters degrees in comparative social policy from Oxford University and are active members of the American College of Physicians. ACP members can visit https://acponline.org/curbsiders to claim free CME-MOC credit for this episode.

Full show notes available at http://thecurbsiders.com/podcast. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

Written and produced by: Fatima Syed MD MSc and Matthew Watto MD

CME questions by: Matthew Watto MD

Hosts: Fatima Syed MD MSc, Matthew Watto MD

Guest: Deep Shah MD MSc

Time Stamps

  • 00:00 Disclaimer, intro, and guest bios
  • 02:18 Guest one liners, book recommendations, picks of the week
  • 11:00 Administrative burden
  • 16:00 Will the documentation problem get better? Suggestions for improvement
  • 25:11 Why do CMS rules spread to the private insurance sector?
  • 29:30 What innovations might reduce administrative burden?
  • 32:40 The Affordable Care Act, health insurance, price transparency
  • 40:20 Take home points
  • 43:20 Outro
Oct 19, 2018
#119 Nutrition Pearls, Heart Health and Bacon
57:45

Nutrition pearls from integrative cardiologist, Steven Devries MD, Associate Professor of Medicine, Northwestern Feinberg School of Medicine, Executive Director of The Gaples Institute. Clinicians receive little formal nutritional training in medical school and residency. It’s time to fill that gap! We discuss the strength of the literature supporting dietary interventions for cardiovascular health and review practical tips to help patients achieve healthy eating patterns. Patients need to hear from us that nutrition matters!

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 & Produced by: Molly Heublein MD

Hosts: Matthew Watto MD, Paul Williams MD, Molly Heublein MD

Guest: Stephen Devries MD

Editor: Matthew Watto MD

Special thanks to Elena Gibson MS4 for writing our show notes

Time Stamps

  • 00:00 Disclaimer
  • 00:35 Intro and guest bio
  • 02:40 Guest one-liner, book recommendation, favorite failure, nontraditional career path
  • 10:10 Nutrition and medical education
  • 12:45 Evidence for how nutrition can improve health outcomes
  • 15:33 How to describe a heart healthy or Mediterranean diet to patients
  • 25:16 Discussion of fats and oils
  • 31:44 Food deserts, healthy snacking options
  • 37:15 Calorie counting and use of healthy eating apps
  • 40:55 How to frame the discussion about a healthful eating pattern with patients
  • 47:18 Macronutrient content. Does it matter?
  • 52:50 Intermittent fasting
  • 54:24 A free resource for patients to learn about nutrition

 

Oct 15, 2018
#118 Female Sexual Problems with Stacy Lindau MD
56:30

Houston, we have a female sexual dysfunction problem. Female sexual problems, which can affect women of all ages, are underdiagnosed and undertreated--in part because clinicians are not the best at asking about sex in primary care visits. In the course of this episode, learn about how to have that sex talk you’ve (maybe) been avoiding, what to ask when working up sexual problems in women, and find the words to talk to patients about sex. Today, we’re lucky to have the female sexual health expert of experts, Dr. Stacy Lindau, MD, MA, Professor of Obstetrics and Gynecology and Medicine-Geriatrics at the University of Chicago Medicine, on the show to teach us the best “sex talk” language, the differential for female sexual problems, and explore therapies. Sadly, there’s no sildenafil-like magic bullet, but a multidisciplinary team can make real impact on female sexual problems. Don’t forget to check out http://womanlab.org

Full show notes available at http://thecurbsiders.com/podcast. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

Written and produced by: Nora Taranto MS4

Hosts: Leah Witt MD and Matthew Watto MD

Infographic: Leah Witt MD

Editor: Matthew Watto MD

Guest: Stacy Lindau MD

Time Stamps

  • 00:00 Disclaimer
  • 00:35 Intro and guest bio
  • 03:30 Guest one liner, book recommendations, favorite failure, career advice and picks of the week
  • 12:57 Clinical Case of female sexual dysfunction and some definitions
  • 15:08 Are sexual problems a normal part of aging?; How to take a sexual history; Etiology of sexual dysfunction; “Diagnostic sex”; Red flags
  • 27:54 Medications that contribute to sexual dysfunction
  • 31:00 Labs
  • 34:45 Treatment: pelvic PT, medications, counseling, flibanserin, herbal supplements
  • 49:05 Screening for female sexual problems
  • 51:58 Take home points; WomanLab.org
  • 55:19 Outro

Tags

sexual dysfunction, female, gynecologist, ob-gyn, female sexual disorder, libido, sex, hormones, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

Oct 08, 2018
#117 Clostridium Difficile: IDSA Guidelines, Bad Puns, and Random Pearls
01:03:46

Summary

Conquer Clostridium difficile (Clostridioides difficile) with this “spore-tacular” episode featuring infectious diseases expert, Dr. Curtis Donskey, Professor at Case Western Reserve University and clinician at the Louis Stokes VA Hospital. We discuss the updates in the 2017 IDSA C. difficile guidelines plus a bunch of random pearls. If you have ever laid awake at night wondering how many pills are needed for a fecal transplant, then this is the episode for you!  We discuss why metronidazole was dropped as the first line therapy for Clostridium difficile infection (CDI) along with other hot topics such as two-step testing, loperamide use, which antibiotics are the least likely to cause CDI, and more. Do not miss this episode!

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: Carolyn Chan MD

Produced by: Matthew Watto MD

Hosts: Carolyn Chan MD, Matthew Watto MD, Paul Williams MD

Editor: Matthew Watto MD

Guest: Curtis Donskey, MD

Time Stamps

  • 00:00 Intro, disclaimer, guest bio
  • 02:19 Getting to know our guest, recommendations for reading, career advice
  • 06:40 Clinical case and CDI testing
  • 09:30 Testing for CDI: PCR and Two step testing
  • 16:30 Testing after treatment
  • 20:00 Treatment of initial CDI episodes, metronidazole pharmacokinetics
  • 24:15 Classification of CDI severity
  • 29:30 Fidaxomicin pearls: when to use, cost, and tapers
  • 34:10 Vancomycin tapers
  • 36:05 Fecal transplant pearls: freeze dried capsules, c-scopes, treating fulminant CDI
  • 44:44 Infection control: counseling homegoing patients, hand washing, and baths
  • 47:50 Social media questions: immodium and toxic megacolon, antibiotics less likely to promote CDI, probiotics, and more!
  • 59:14 Best CDI joke in the history of time
  • 60:00 Take home points
  • 62:42 Outro

Tags

Clostridium, difficile, cdi, C.Diff, infectious, diseases, diarrhea, IDSA, guideline, antibiotics, vancomycin, fidaxomicin, fmt, transplant, fecal, stool, toxin, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

Oct 01, 2018
#116 Geriatric Psychiatry: Sleep, Dementia, and Behavioral Disturbances
29:37

Geriatric psychiatry returns. We tackle sleep problems and behavioral disturbances in patients with dementia with returning guest, and Geriatric Psychiatrist Dennis Popeo MD, Clinical Associate Professor of Psychiatry at NYU Langone Medical Center. Topics include: pharmacologic and nonpharmacologic management of insomnia; treating agitation and irritability; medical management of psychotic symptoms and paranoia; ethical concerns about the treatment of challenging behaviors in dementia; and the shortage of geriatricians and geriatric psychiatrists.

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 & Produced by: Jordana Kozupsky NP, Matthew Watto MD

Artwork by: Kate Grant MD

Hosts: Jordana Kozupsky NP, Matthew Watto MD

Editor: Matthew Watto MD

Guest: Dennis Popeo, MD

Time Stamps

  • 00:00 Intro and guest bio
  • 01:55 Case of sleep disturbance in a patient with dementia; medications for sleep disturbances; nonpharmacologic strategies for sleep
  • 11:32 Irritability and agitation versus paranoia, or psychotic symptoms; benzodiazepines in older adults
  • 15:40 Antipsychotic medications, the black box warning and ethical concerns
  • 23:50 Geriatricians, geriatric psychiatrists in short supply; Behavioral interventions
  • 28:16 Outro

Tags

psychiatry, psych, geri, geriatrics, dementia, paranoia, psychosis, sleep, insomnia, agitation, antipsychotics, atypical, black, box, warning, adverse, zolpidem, benzodiazepine, side, effects, therapy, mirtazapine, gabapentin, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

Sep 27, 2018
#115 Geriatric Depression
45:47

Summary

Geriatric depression got you down? Boost your spirits with tips and tactics from Geriatric Psychiatrist, Dennis Popeo MD, Clinical Associate Professor of Psychiatry at NYU Langone Medical Center. Topics include: suicide in the older adults; how to diagnosis depression in older adults; how to counsel patients about antidepressants, how to choose an antidepressant, how to monitor and titrate medications, and how long to continue therapy. Stay tuned for part two of our discussion with Dr Popeo on managing sleep and behavioral problems in older adult patients with dementia.

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 & Produced by: Jordana Kozupsky NP, Matthew Watto MD

Artwork by: Kate Grant MD

Hosts: Jordana Kozupsky NP, Matthew Watto MD

Editor: Matthew Watto MD

Guest: Dennis Popeo, MD

Time Stamps

  • 00:00 A question for you, the listeners
  • 01:12 Disclaimer, intro and guest bio
  • 05:00 Getting to know our guest, recommendations for reading, and career advice
  • 14:13 Case of geriatric depression; effective history taking; recognizing associated symptoms; depression scales
  • 19:03 Suicide in older adults; firearm safety
  • 24:26 Choice of therapy; Pharmacologic agents; Counseling patients and managing expectations; Dose titration and tracking symptoms
  • 34:41 Augmenting therapy versus cross-titration to another agent; When is it okay to stop an antidepressant
  • 40:50 Take home points
  • 44:40 Outro

Tags: psychiatry, psych, geri, geriatrics, depression, mdd, sleep, insomnia, appetite, agitation, suicide, SSRIs, side, effects, therapy, diagnosis, serotonin, mirtazapine, bupropion, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

Sep 24, 2018
#114 High Value Care: Assess Quality, Mitigate Diagnostic Uncertainty, Overcome Barriers
58:28

Kick up the quality of your care with tips and tactics from Caitlin Clancy MD, coauthor of ACP’s High Value Care Curriculum. We learn to define quality and value in healthcare; the most common barriers to high value care; use of probability and likelihood ratios to boost clinical reasoning and combat diagnostic uncertainty; some useful tools to estimate cost; sources of healthcare waste; and some general pearls on how the healthcare system works...or doesn’t. ACP members can claim free CME-MOC at acponline.com/curbsiders (goes live 0900 EST on podcast 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 & Produced by: Matthew Watto MD
  • Hosts: Paul Williams MD, Stuart Brigham MD, Matthew Watto MD
  • Guest: Caitlin Clancy MD

Time Stamps

  • 00:00 Disclaimer, intro and guest bio
  • 03:50 Guest one-liner, some discussion on non traditional paths, and picks of the week
  • 12:10 Case 1: Defining value, cost, quality; sources of healthcare waste; and how to avoid the waste of daily labs
  • 23:00 Case 2: An uninsured patient who needs major surgery; costs for uninsured versus insured patients
  • 28:35 Do insured patients have better outcomes?
  • 31:15 How to determine cost and “fair market price”
  • 36:29 Case 3: Clinical case of suspected heart failure
  • 45:45 Case 4: Clinical case of patient requesting antibiotics; barriers to high value care and how to overcome them
  • 57:05 Outro

Tags: high, value, care, quality, cost, diagnostic, uncertainty, likelihood, ratio, testing, treatment, consumer, acp, college, american, insured, uninsured, bill, charge, reimbursement, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

Sep 17, 2018
#113 Gout: Uric acid targets, urate lowering therapy, and random questions from social media
38:01

Master the management of gout with tips from expert, Tuhina Neogi MD, PhD, Professor of Medicine at Boston University School of Medicine. Topics include: how to initiate and titrate urate lowering therapy, guidelines controversy over uric acid targets, colchicine & NSAIDS for anti-inflammatory prophylaxis, uricosuric agents, febuxostat, HLA B5801, use of uric acid levels in the acute setting and more random gout facts.

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: Matthew Watto MD
  • Hosts: Paul Williams MD, Stuart Brigham MD, Matthew Watto MD
  • Guest: Tuhina Neogi MD, PhD

Time Stamps

  • 00:00 Intro and guest bio
  • 01:30 Allopurinol initiation and titration
  • 07:10 Uricosuric therapy
  • 09:10 Controversy over uric acid targets for gout
  • 17:40 Parachutes and randomized controlled trials
  • 19:15 Colchicine or NSAIDS for prophylaxis
  • 23:20 Who needs febuxostat?
  • 26:20 When to refer for gout, HLA B5801, and checking uric acid levels in the acute setting  
  • 33:29 Take home points
  • 36:15 Outro

Tags: allopurinol, uric, urate, acid, level, therapy, management, gout, flare, crystal, arthritis, titration, probenecid, febuxostat, target, acr, acp, guidelines, nsaids, colchicine, hla b5801, septic, rheumatology, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

Sep 10, 2018
#112 Gout Flares: Bathtubs and Firefighting
47:35

Crystalize your knowledge of gout and stop flares in their tracks with tips from expert, Tuhina Neogi MD, PhD, Professor of Medicine at Boston University School of Medicine. On this first of two gout episodes we learn to diagnose gout with or without arthrocentesis, how to treat flares, and how to counsel patients about gout, which apparently involves fire fighting and bathtubs. Don’t miss next week’s episode on urate lowering therapy, gout guidelines controversy, and answers to your gout questions from social media.

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: Matthew Watto MD
  • Hosts: Paul Williams MD, Stuart Brigham MD, Matthew Watto MD
  • Guest: Tuhina Neogi MD, PhD

Time Stamps

  • 00:00 Disclaimer, intro
  • 01:40 Guest bio
  • 03:20 Guest one liner, music recommendations, advice for researchers, and some comments on failure
  • 09:15 Clinical diagnosis of gout
  • 12:15 Is taking a diet history useful?
  • 14:30 Classification criteria for gout
  • 17:35 MSK ultrasound and Physical exam findings in gout
  • 21:06 Arthrocentesis and MSU crystals
  • 24:45 A recap of how to make the diagnosis of gout
  • 26:50 The bathtub analogy and how to counsel a patient with a new diagnosis of gout
  • 30:55 Pathophysiology of gout
  • 34:55 Treatment for acute gout flares (steroids, colchicine, NSAIDS. And topical NSAIDS?) 
  • 45:30 Outro

Tags: gout, crystal, colchicine, steroids, nsaids, joint, flare, acute, chronic, urate, uric, acid, arthritis, acr, exam, diagnosis, rheumatology, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

Sep 03, 2018
#111: Hotcakes - Complementary Medicine in Cancer, Dosing Aspirin by Body Weight, Marijuana & Respiratory Symptoms, Penicillin Allergies and More!
42:09

Dr. Neda Frayha (@nedafrayha) of Primary Care RAP (Hippo Education) joins us this month for our thoughts and analysis of some recent (and not so recent) journal articles that interested us this month. Our articles spanned topics that include at cancer survival among patients pursuing treatment with complementary medicine, the effect of body weight on effectiveness of preventive aspirin dosing, strategies to promote physician leadership, respiratory symptoms in those with marijuana use and MRSA risk among patients with penicillin allergies. ACP members can claim free CME-MOC at acponline.com/curbsiders (goes live 0900 EST on podcast release date).

Full show notes available at http://thecurbsiders.com/podcastJoin 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: Sarah Phoebe Roberts MPH, Neda Frayha MD, Christopher Chiu MD
  • Producers: Sarah Phoebe Roberts MPH, Christopher Chiu MD
  • Hosts: Matthew Watto MD, Stuart Brigham MD, Paul Williams MD, and Christopher Chiu MD
  • Editor: Matthew Watto MD 

Time stamps:

  • 00:00 Disclaimer, intro, guest bio
  • 05:05 Do patients using complementary medicine for cancer therapy have worse outcomes?
  • 13:11 Does low dose aspirin work for primary prevention of major adverse cardiac events?
  • 19:16 Do physicians make better leaders?
  • 24:55 Does marijuana cause respiratory symptoms?
  • 30:40 Does penicillin allergy confer increased risk for C Diff and MRSA infection?
  • 38:40 Wrap-up and outro

Tags:​ aspirin, cardiac risk, mortality, cancer, complementary, alternative, conventional, therapy, marijuana, cannabis, respiratory, symptoms, leader, leadership, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

Aug 31, 2018
#110: Driver’s safety for Older Adults: When is it Time to Give Up the Keys?
01:13:24

Get schooled on driver’s safety for older adults by expert, Alice Pomidor MD, Professor of Geriatrics at Florida State University. Whether or not older adults can continue to drive is a huge problem faced by for primary care clinicians, and will remain one until driverless cars become ubiquitous. Topics covered include: how to take a driving history, red flags, physical exam, cognitive exam, and vision assessment for driver’s safety, resources, when to refer, alternate means of transportation, and the legal repercussions of reporting...or not reporting.

Full show notes available at http://thecurbsiders.com/podcastJoin 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: Matthew Watto MD and Elizabeth Garbitelli MD Candidate 2022
  • Editor: Matthew Watto MD
  • Cover Image by: Kate Grant MD
  • Hosts: Matthew Watto MD, Stuart Brigham MD, Paul Williams MD
  • Guest: Alice Pomidor MD 

Time Stamps

  • 00:00 Disclaimer
  • 00:35 Intro and guest bio
  • 03:10 Guest onliner, book recommendations, and career advice
  • 10:43 Clinical case, and the 5 Rs of clinicians responsibility
  • 19:15 Taking a history from older adult drivers
  • 26:28 The clinical exam for driver’s safety (cognition, vision, and MSK tests)
  • 37:24 How can we avoid patient anger towards clinician and family members?
  • 41:10 When and where to refer for driving evaluation
  • 47:00 Alternative transportation
  • 52:00 What to do if someone refuses or forgets to stop driving
  • 59:45 Reporting requirements and legal ramifications
  • 69:15 Take home points
  • 72:00 Outro 

Tags: driving, elderly, geriatrics, dementia, treatment, prevention, cognition, seniors, drivers, safety, crash, motor, vehicle, car, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

 

Aug 27, 2018
#109: Things We Do For No Reason: A High Value Episode
01:07:05

Things We Do For No Reason #TWDFNR highlights some widespread practices that are difficult to justify based on lack of proven health benefits, but significant cost (both financial and non-financial harms). Avoid these low value practices and inflated medical bills with tips from expert, Dr Lenny Feldman, MD, FACP, Associate Professor of Medicine Johns Hopkins. Topics include: renal ultrasound and urine electrolytes in acute kidney injury (AKI), folate deficiency and anemia work-up, prealbumin and malnutrition, blood transfusions, shellfish and contrast allergies, monitoring after switch from IV or oral antibiotics, and “against medical advice” discharges.

Don't forget to check out Clinicwiki.org a free, online resource for teaching ambulatory 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 and produced by: Justin Berk MD, MPH, MBA
  • Editor: Matthew Watto, MD
  • Hosts: Justin Berk MD, MPH, MBA; Matthew Watto MD; Paul Williams MD, FACP
  • Guest: Lenny Feldman MD, FACP

Goal: Listeners will recognize things we do for now reason aka low value practices with an unfavorable ratio of benefits to cost and/or harm.

Learning objectives:

After listening to this episode listeners will…

  1. Determine if renal ultrasound is indicated in acute kidney injury
  2. Recognize the limitations of urine electrolytes in AKI.
  3. Identify the shortcomings of folate testing.
  4. Explain the significance of low albumin and prealbumin.
  5. Identify patients at risk for serious allergic reactions from IV contrast administration
  6. Explain the futility in discharge Against Medical Advice (AMA) paperwork
  7. Counsel patients on harm reduction in “AMA” discharges
  8. Rationalize discharging patients immediately after switching from IV to  oral (PO) antibiotics.

Time Stamps

  • 00:00 Announcements
  • 00:38 Disclaimer, intro, and guest bio
  • 03:53 Guest one liner, some recommendations, and advice
  • 08:35 Defining high value care and things we do for no reason (TWDFNR)
  • 12:40 Why do clinicians order useless testing?
  • 14:58 Urine electrolytes for acute kidney injury
  • 20:30 Renal ultrasound for acute kidney injury
  • 25:54 Stop ordering folate for anemia workup
  • 31:47 How many units should I transfuse?
  • 34:40 Prealbumin and albumin for malnourishment.
  • 43:24 Iodine, shellfish and contrast allergy
  • 50:28 Patient leaving against medical advice
  • 56:45 Switching from IV to oral antibiotics
  • 63:27 Dr Feldman’s plugs
  • 65:36 Outro 

Tags: high, value, choosing, wisely, acute, kidney, injury, renal, ultrasound, transfusion, AKI, malnutrition, folate, prealbumin, albumin contrast, allergy, antibiotics, AMA, TWDFNR, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

Aug 20, 2018
#108: Point-of-care Ultrasound for the Internist
01:01:15

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/podcastJoin 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

Aug 13, 2018
#107: Women in Medicine, Be Bold
59:08

“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

Aug 06, 2018
#106: Hotcakes: Cardiac risk, diabetes, pulmonary embolism, opioid use disorder, neck ties and nose picking?
55:37

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

Jul 30, 2018
#105: Lyme Disease and Tick-Borne Illness with ID Expert Paul Sax: Why you should never go outside or to Boston in the summer
58:42

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

Jul 23, 2018
#104: Renal tubular acidosis with Kidney Boy, Joel Topf MD
01:15:55

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

Jul 16, 2018
#103: Train Your Brain: Mapping out your road to expertise
58:35

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

Jul 09, 2018
#102: Curbsiders Journal Club Hotcakes and Hot Takes June 2018
49:06

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

Jul 02, 2018
#101: Cirrhosis: Medications, decompensation, complications
39:38

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/podcastJoin 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

Jun 25, 2018
#100: Cirrhosis: Initial Evaluation and Management
48:11

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

Jun 18, 2018
#99 Cancer Survivorship: What to do when the treatment is done
52:03

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

Jun 11, 2018
#98: Knee Pain: History, exam, bracing, x-rays, and injectables
01:05:55

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/curbsidersCheck 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/podcastJoin 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

Jun 04, 2018
#97 Hotcakes: Hypertension, Prostate Cancer Screening, Lifestyle & Mortality
39:26

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
May 28, 2018
#96: Diabetes: A1C targets & ACP guidelines controversy
50:29

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

May 21, 2018
#95: Food allergy, food intolerance and celiac disease
57:38

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

May 14, 2018
#94: Random Pearls: Microbiome, POTS, Gabapentin, and Leonardo Da Vinci
28:56

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

May 07, 2018
#93: Clinical Pearls ACP 2018 with Nina Mingioni MD
31:52

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

Apr 30, 2018
#92: Pulmonary Embolism for the Internist
57:22

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

Apr 23, 2018
Random Clinical Pearls ACP 2018 Day 2
22:55

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.

Apr 21, 2018
Random Clinical Pearls ACP 2018 Day 1
18:07

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.

 

 

Apr 20, 2018
#91 Hotcakes: Fluid Wars, Barbershops, HTN, Aromatherapy, Coffee
33:43

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
Apr 16, 2018
#90: Clinical Reasoning: Become an expert diagnostician
01:04:08

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




Apr 09, 2018
#89: Conjunctivitis: Red Eye in Pr-eye-mary Care with Dr Glaucomflecken
58:18

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

Apr 02, 2018
#88: Acid base, boy bands, and grandfather clocks with Joel Topf MD
01:33:24

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

Mar 26, 2018
#87: Toxicology 101: Talking Tox with The Dantastic Mr. Tox & Howard
01:19:33

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

Mar 19, 2018
#86: COPD: Diagnosis, treatment, PFTs, and nihilism
01:20:40

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

Mar 12, 2018
#85: Contraceptives: Pills, mini pills, and tiny pills
01:06:00

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

Mar 05, 2018
#84: Anemia, Iron Deficiency, IV iron, and Tony Stark
01:02:24

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

Feb 26, 2018
#83: Valvular heart disease, anticoagulation, TAVR, and primary care
01:08:29

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

Feb 19, 2018
#82: Dementia Dos and Don’ts: The GeriSiders
01:21:25

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.

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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

Feb 12, 2018
#81: Placebos, nocebos, and the doctor as a placebo
52:37

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

 

Feb 05, 2018
#80: Pulmonary hypertension, freeways, and cows in heart failure
01:02:46

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

Jan 29, 2018
#79: Dermatitis: Atopic to Remember w/The DermSiders
01:13:28

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