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

Special Thanks!

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

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

Credits

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

• Cover Art: Kate Grant MBChB DipGUMed

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

Join The Curbsiders! 

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

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

[  ] A copy of your CV

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

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

Time Stamps

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


• 07: 00 Lymphatic system

• 
09:19 Differential diagnosis for lymphadenopathy


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


• 19:15 Physical exam for lymphadenopathy

• 
22:30 Which labs to order; Flow cytometry

• 
26:05 Imaging

• 
28:30 Counseling patients with LAD


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


• 37:35 Take Home Points

• 
39:00 Audience Questions


• 42:25 Outro

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

Goals

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

Learning objectives

After listening to this episode listeners will...

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

Disclosures

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

Citation

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

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

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

Credits

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

Sponsor

Primary Care Internal Medicine of Ithaca

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

Time Stamps

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

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

Links*

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

Goal

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

Learning objectives

After listening to this episode listeners will…  

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

Disclosures

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

Citation

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

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

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

Credits

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

Sponsor

Primary Care Internal Medicine of Ithaca

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

Time Stamps

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

52:30 Closing remarks and outro

Goals

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

Learning objectives

After listening to this episode listeners will know…

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

Disclosures

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

The Curbsiders report no relevant financial disclosures. 

Citation

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

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

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

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

Credits

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

Sponsors

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

Time Stamps

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

Learning objectives

After listening to this episode listeners will…  

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

Disclosures

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

Citation

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

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

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

Credits

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

Sponsors

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

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

Time Stamps

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

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

Goal

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

Learning objectives

After listening to this episode listeners will…  

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

Disclosures

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

Citation

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

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

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

Credits

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

Sponsor

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

Time Stamps

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

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

Goal

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

Learning objectives

After listening to this episode listeners will...

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

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

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

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

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

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

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

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

Disclosures

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

Citation

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

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

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

Credits

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

Sponsor

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

Time Stamps

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

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

Goal

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

Learning objectives

After listening to this episode listeners will…  

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

Disclosures

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

Citation

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

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

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

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

Credits

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

Sponsors

The Society of Hospital Medicine

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

Primary Care Internal Medicine of Ithaca

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

Time Stamps

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

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

Disclosures

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

Citation

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

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

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

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

Credits

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

Sponsor

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

Time Stamps

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

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

Disclosures

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

Citation

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

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

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

Credits

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

Sponsor

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

Time Stamps

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

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

Goal

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

Learning objectives

After listening to this episode listeners will…  

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

Disclosures

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

Citation

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

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

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

Credits

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

Sponsor

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

Time Stamps

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

Disclosures

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

Citation

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

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

What: KIDNEYcon 2020 (www.kidneycon.org)

When: April 16-19, 2020

Where: Little Rock, Arkansas

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

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

Click HERE to Register in January 2020

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

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

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

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Credits

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

Sponsor

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

Time Stamps

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

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

Goal

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

Learning objectives

After listening to this episode listeners will…  

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

Disclosures

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

Citation

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

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

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

Sponsor

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

Credits

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

Time Stamps

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

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

Disclosures

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

Citation

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

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

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

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

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

New episodes return January 20, 2020!

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

Sponsor

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

Credits

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

Time Stamps 

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

Goal

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

Learning objectives 

After listening to this episode listeners will

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

Disclosures

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

Citation

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

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

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

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

Credits

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

Time Stamps

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

Goal

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

Links*

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

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

Disclosures

The Curbsiders report no relevant financial disclosures. 

Citation

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

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

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

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

Credits

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

Time Stamps

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

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

Goal

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

Learning objectives

After listening to this episode listeners will…  

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

Disclosures

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

Citation

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

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

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

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

Credits

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

Time Stamps

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

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

Disclosures

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

Citation

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

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

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

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

Credits

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

Time Stamps

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

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

Disclosures

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

Citation

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

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

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

Credits

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

Check Out our friends at Barbell Medicine!

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

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

Time Stamps

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

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

Goal

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

Learning objectives

After listening to this episode listeners will…  

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

Disclosures

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

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

Citation

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

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

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

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

Credits 

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

Time stamps

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

Meet Rahul:

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

Goals and Learning Objectives

Goals: 

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

Learning objectives:

After listening to this episode listeners will…

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

Disclosures: 

The Curbsiders report no relevant financial disclosures.

Citation: 

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

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

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

Credits

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

Sponsor

The American College of Chest Physicians

Time Stamps

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

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

Goal

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

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

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

Disclosures

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

Citation

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

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

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

Credits

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

Time Stamps

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

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

Goal

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

Learning objectives

After listening to this episode listeners will…  

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

Disclosures

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

The Curbsiders report no relevant financial disclosures. 

Citation

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

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

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

Credits

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

Sponsor - ACP IMpower: Catalyzing your professional future

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

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

Time Stamps

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

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

Disclosures

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

Citation

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

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

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

Credits

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

Time Stamps

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

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

Goal

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

Learning objectives 

After listening to this episode listeners will... 

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

Disclosures

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

Citation

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

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

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

Credits

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

Time Stamps

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

Citation

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

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

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

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

Credits

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

Time Stamps

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

Citation

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

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

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

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

Credits

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

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.

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.

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.

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

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.

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.

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.

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

• 00:00 Pun, disclaimer, sponsor
• 01:10 Intro, guest bios
• 06:10 Guest one-liners
• 07:22 Picks of the week*: Sing Unburied Sing (book) by Jesmyn Ward ; The Quiet American (book) by Graham Greene; An American Sickness: How Healthcare Became Big Business and How You Can Take It Back (book) by Elisabeth Rosenthal
• 09:35 Best Advice: Always question received wisdom; Listen!
• 14:10 Cost of treatment versus cost of care
• 15:35 How does cost of care affect outcomes?; Talking about money (finances) with patients
• 18:52 Defining “underinsured”; High deductible plans
• 22:41 Why are physicians scared to talk about cost?
• 26:16 Why is cost of care so difficult to determine? Who’s benefiting from lack of transparency?
• 28:35 Stuart explains his theory on why costs make no sense
• 30:00 How to have cost of care conversations
• 32:10 How to estimate cost; Specific tools
• 42:10 Cost of care plans
• 50:03 Take home points and plugs: National Patient Advocate Foundation; NeedyMeds.com; ACP High Value Care; AAFP Neighborhood Navigator Tool
• 53:00 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 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.

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.

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.

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.

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

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!

ACP - acponline.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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Curbsiders' Schwag!

We’ve got the perfect father’s day gift for every internal medicine nerd. The Curbsiders have opened our own online shop. Get your Curbsiders t-shirts, hoodies, stickers, and coffee mugs. Help support the show and gain instant bragging rights. Note: All purchases come with admitting privileges at Kashlak Memorial Hospital!

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

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

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