Core IM | Internal Medicine Podcast

By Core IM Team

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Core Internal Medicine via following segments: 5 Pearls || Clinically relevant pearls on IM topics! Mind the Gap || Why do we do what we do? Hoofbeats || Dissecting clinical reasoning!

Episode Date
Hoofbeats: 47M with chest pain
<p>Dissect an interesting case and improve your clinical reasoning skills!</p> <p>Time Stamps:</p> <ul> <li>New features in this episode [00:25]</li> <li>Data point 1: Early hypothesis generation? [03:20]</li> <li>Data point 2: Pertinent negatives? [11:18]</li> <li>Data point 3: Representativeness heuristic over-represented in medical education? [13:28]</li> <li>Data point 4: Economical hypothesis generation by expert clinicians [19:20]</li> <li>Data point 5: Diagnosing diagnostic error [22:10]</li> <li>Data point 6: Moving toward a final diagnosis [27:11]</li> <li>Case resolution [29:50]</li> </ul> For full transcript and show notes: <a target="wp-preview-20903" href=";preview=true"></a>
Feb 13, 2019
#33 Barrett's Esophagus: 5 Pearls
<p>Solidify your knowledge on Barrett's Esophagus and more! Quiz yourself on the 5 pearls we will be covering:</p> <ol> <li>What is Barrett’s esophagus and why should we care? (4:12)</li> <li>Who do we screen for Barrett’s, and why? (8:41)</li> <li>How do we screen for Barrett’s and counsel? (13:50)</li> <li>How do we treat and monitor Barrett’s esophagus? (18:21)</li> <li>Take Aways (21:45)</li> <li>Throwback to trending troponins (23:05)</li> </ol> <p>For full transcript of the podcast, show notes and references: <a title="" href=""></a></p>
Jan 30, 2019
#32 A 34M with Fever, HA, Myalgias
<p>Dissect an interesting case and improve your clinical reasoning skills!</p> <p>Time stamps:</p> <ul> <li>Player three has entered the game! [0:15]</li> <li>Case presentation, part 1 [1:20]</li> <li>First impressions [3:24]</li> <li>Rethinking another provider’s diagnosis [4:36]</li> <li>Interpreting the test of treatment [8:48]</li> <li>Keeping your instincts on a leash? [10:58]</li> <li>Case presentation, part 2 [12:33]</li> <li>Diagnostic schemas [14:30]</li> <li>Our discussant’s differential and the final diagnosis [17:46]</li> <li>Shira’s cognitive autopsy [23:02]</li> </ul> <p>For full transcript and show notes: <a title="" href=""></a></p>
Jan 16, 2019
#31: Troponins: 5 Pearls Segment
<p>Solidify your knowledge on troponins and more! Quiz yourself on the 5 pearls we will be covering:</p> <ol> <li>What aspects of the history are concerning in a patient with a positive troponin? (4:00)</li> <li>What is the difference between the TIMI, GRACE, and HEART scores, and how should we use them in the evaluation of a patient with an elevated serum troponin? (8:42)</li> <li> How does the change in troponin over time help with diagnosis, and what should we consider in a patient with uptrending troponins but an unremarkable ECG? (14:48)</li> <li> What can a “negative but detectable” troponin tell you about any patient, not just those with suspected ACS? (21:31)</li> <li>Pearls Recap (25:26)</li> <li>Throwback – what are the first-line medications for alcohol use disorder? (28:36)</li> </ol> <p>For full transcript of the podcast, show notes and references: <a title="" href=""></a></p> <p>Tags: chest pain, cardiology, myocardial infarction, acute coronary syndrome</p>
Jan 02, 2019
#30 Acetaminophen/Fevers Pathophysiology and Patient Outcomes: Mind the Gap Segment
<p>Let's dive deeper into the world of acetaminophen and fever and how it may work and patient outcomes</p> <p dir="ltr">Time Stamps:</p> <p></p> <ol> <li dir="ltr"> <p dir="ltr">What data is there to support the use of acetaminophen as a fever reducer? (2:08)</p> </li> <li dir="ltr"> <p dir="ltr">Does acetaminophen improve patient outcomes? (4:30)</p> </li> <li dir="ltr"> <p dir="ltr">How does acetaminophen compare to other medications like NSAIDs? (9:56)</p> </li> <li dir="ltr"> <p dir="ltr">What is the mechanism of acetaminophen action? (10:50)</p> </li> <li dir="ltr"> <p dir="ltr">Review of teaching points (16:02)</p> </li> </ol> <p>For full show notes and transcript of audio: <a href="" title=""></a></p>
Dec 19, 2018
#29 A 43M with Diarrhea: Hoofbeats Segment
<p>Dissect an interesting case and think about the way clinicians think! Many clinical reasoning pearls here:</p> <p>Time stamps:</p> <ol> <li>Case [1:19]</li> <li>Diagnostic weight [8:42]</li> <li>Hypothesis driven reasoning [12:26]</li> <li>Anomalous clinical data [19:30]</li> <li>Final diagnosis [22:20]</li> <li>Take away points [31:21]</li> </ol> <p>Human Dx  Case link: <a title="" href=""></a></p> <p>For show notes: <a title="" href=""></a></p>
Dec 05, 2018
#28 What Would You Tell Your Younger Self?
<p>Women in medicine inspire us with what they would tell their younger selves. Some of the speakers with Shreya Trivedi MD @ShreyaTrivediMD at the Women in Medicine GirlMedLive Conference:</p> <p>Qaali Hussein MD @QaaliHussein1 Clinical Pearl @ClinicalPearl Marguerite Duane MD @mduanemd Kate Prior MBBS @doctorwibble C. Nicole Swiner MD @docswiner Carmen Landrau MD @DrLandrau Jessica Willett MD @jkwillettmd Ilene Brenner MD @irb123 Joannie Yeh MD @BetaMomma Karen Davidson, Esq Suzanne Feigofsky MD @DrSuzyFeigofsky GirlMedLive: <a title="" href=""></a></p> <p>Tags: career development, professional development, lifelong learning, burnout, imposter syndrome, mentorship, worklife balance</p>
Nov 21, 2018
#27 Treatment of Alcohol Use Disorder: 5 Pearls Segment
Solidify your knowledge on Alcohol Use Disorder (AUD) treatment and more! Quiz yourself on the 5 pearls we will be covering: <ol> <li>Throwback: At what levels of drinking does unhealthy alcohol use start, and how do you screen for unhealthy alcohol use? (1:47)</li> <li>What does the brief intervention and counseling part of SBIRT entail? (4:43)</li> <li>What are the first line medications for AUD and contraindications to them? (11:11)</li> <li>What are the  second-line medications for AUD and their limitations? (18:14)</li> <li>What new therapies are being studied for for alcohol use disorder? (22:09)</li> <li>Pearls Recap (25:06)</li> </ol> <p>For full transcript of the podcast, show notes and references: <a title="" href=""></a></p> <p>tag: naltrexone, acamprosate, gabapentin, topiramate, SBIRT, neuromodulation, nalmafene, psychaedelics, audit-c</p>
Nov 07, 2018
#26 A 85F with AMS Part 2: Hoofbeats Segment
<p>Dissect a working diagnosis through a process of validation!</p> <p>Time Stamps:</p> <ol> <li>Your collective differential [0:40]</li> <li>The test results (that you asked for) are in... [2:13]</li> <li>The hospital course, and the diagnosis (or is it?) [7:10]</li> <li>Validating a diagnosis: Base rate, adequacy, and coherence [8:30]</li> <li>Revisiting the differential [14:44]</li> <li>What to do when there <i>is </i>no final diagnosis? [17:39]</li> </ol> <p>For full show notes: <a title="" href=""></a></p> <p>Tags: Clinical reasoning, Diagnostic Uncertainty</p>
Oct 24, 2018
#25 A 85F with AMS Part 1: Hoofbeats segment
<p>Submit your diagnosis or differential for this episode's case at (free registration required): <a href="" title=""></a> ! Part 2 (releasing 10/24) will have the final diagnosis!</p> <p>Time stamps:</p> <ol> <li> A new challenge and the rules of the game (1:13)</li> <li> Introduction to Human Dx (3:06)</li> <li> The case: An 85 year-old woman with paranoid delusions (5:28)</li> <li> What exactly is problem representation? (15:15)</li> <li> Building the differential (19:53)</li> </ol> <p> </p>
Oct 10, 2018
#24 Meet the Producers
<p>Join us in this episode with Doctors Who Create where we explore how Core IM was started and some things that happen behind the scenes!</p>
Sep 27, 2018
#23 UTIs and Delirium: MInd the Gap Segment
<p> <p class="MsoNormal">Let's go deeper into the world of UTIs and delirium!</p> <ol type="1" start="1"> <li class="MsoNormal">The basics – what are the official (IDSA) definitions for bacteriuria, pyuria, and UTI? (02:07)</li> <li class="MsoNormal">The lay of the land – how common are bacteriuria and delirium? (07:09)</li> <li class="MsoNormal">The big money question – do UTIs really cause delirium and what does the evidence tell us? (10:50)</li> <li class="MsoNormal">Review of teaching points (15:59)</li> </ol> <p class="MsoNormal">Full show notes: <a title="" href=""></a></p> </p>
Sep 11, 2018
#22 Proton-Pump Inhibitors: 5 Pearls segment
<p>Solidify your knowledge on Proton-Pump Inhibitors (PPIs) and more! Quiz yourself on the 5 pearls we will be covering:</p> <ol> <li>What are associated adverse effects for patients are on long-term PPIs? (2:02)</li> <li>What are strategies to get your patient off PPIs?  (10:57)</li> <li>How do histamine-2 (H2) receptor antagonists blockers work and how can it explain why H2 blockers might not be as effective as PPIs? (13:30)</li> <li>How should you educate patients to take PPIs to get the maximize benefit? (16:48)</li> <li>How do you manage ongoing symptoms in patients on PPIs? (21:41)</li> </ol> <p>For full transcript of the podcast and references: <a title="" href=""></a></p> <p> </p>
Aug 29, 2018
#21 57F with confusion: Hoofbeats segment
<p>Dissect an interesting case and think about the way clinicians think! Many clinical reasoning pearls here:</p> <ol> <li>Case history and exam 00:40</li> <li>Causal models 11:24</li> <li>Facets versus diagnoses 13:25</li> <li>Problem representation 16:37</li> <li>Part two of the case 17:10</li> <li>Occam’s razor, Hickam’s dictum, and Crabtree’s bludgeon 23:00</li> <li>Diagnostic uncertainty 27:10</li> <li>Learning points 34:24</li> </ol> <p>For show notes: <a title="" href=""></a></p>
Aug 15, 2018
#20 Vancomycin: Mind the Gap Segment
<p>Lets go deeper into the misunderstood side of Vancomycin!</p> <ol> <li> Where did vancomycin come from, and why is it so controversial? (0:28)</li> <li> What is vancomycin-induced nephrotoxicity and how common is it? (4:37)</li> <li> Vancomycin trough monitoring – what is it good for?  (7:28)</li> <li> AUC to MIC ratio – the real math behind vancomycin dosing (7:53)</li> <li> Review of teaching points (10:27)</li> </ol> <p>Full show notes: <a href="" title=""></a></p>
Aug 01, 2018
#19 Unhealthy Alcohol Use: 5 Pearls segment
<p>Solidy your understanding of unhealthy alcohol use! Quiz yourself of the 5 Pearls we will be covering:</p> <ol> <li>What is alcohol use disorder (AUD), and how is it different from unhealthy alcohol use? </li> <li>Who should we screen for unhealthy alcohol use, and which screening tools are preferred?</li> <li>What are the consequences of unhealthy alcohol use? </li> <li>Can moderate alcohol be good for patients, and if so, how much is “moderate”? </li> <li>Who, how and how often should patients with chronic hepatitis B infection be screened for hepatocellular carcinoma?</li> </ol> <p>For full show notes, <a href="" title=""></a></p>
Jul 11, 2018
#18: A 54M with diarrhea: Hoofbeats segment
<p>Dissect an interesting case and think about the way clinicians think! Many clinical reasoning pearls here:</p> <ol> <li>Part one of case (0:56)</li> <li>Cognitive ease and strain (03:51)</li> <li>Metacognition and routine diagnostic timeout (08:15)</li> <li>Think outside the box of organ systems (11:19)</li> <li>Illness behavior (12:30)</li> <li>Part two of case (14:06)</li> <li>Algorithms (17:57) </li> <li>Fast thinking &amp; pattern recognition (19:30)</li> <li>Slow thinking &amp; analytical reasoning (21:31)</li> <li>Diagnosis (25:15)</li> <li>Takeaways (26:52)</li> </ol>
Jun 27, 2018
#17: Celebrating #ProudtobeGIM
<p>Be inspired by why so many are proud to be in General Internal Medicine (GIM)!</p>
Jun 20, 2018
#16 Steroids in COPD: Mind the Gap Segment
<p>Let’s take your breath away… with a review on steroids in treating COPD exacerbations!</p> <p>Time Stamps</p> <ol> <li>How does GOLD (Global Initiative for Chronic Obstructive Lung Disease) define a COPD exacerbation? (2:44)</li> <li>What outcomes do steroids actually improve in treating a COPD exacerbation? (5:08)</li> <li>What is the evidence behind a 5 day steroid “burst”? (7:20)</li> <li>Are IV steroids more powerful than PO? (9:00)</li> </ol> <p>For full show notes: <a href="" title=""></a></p>
May 30, 2018
#15 Contrast-Induced Nephropathy: 5 Pearls segment
<p>Solidify your understanding of contrast-induced nephropathy (CIN)! Quiz yourself on the 5 pearls we will be covering:</p> <ol> <li>Are there diagnostic criteria for CIN? (2:11)</li> <li> Is there a difference between exposure to intra-arterial vs. intra-venous contrast in terms of risk of CIN? (6:28)</li> <li> What are the biggest risk factors for CIN? (14:48)</li> <li> What preventive measures have been shown to best reduce the risk of CIN? (19:41)</li> <li> Can ESRD patients on hemodialysis still suffer from CIN? (23:32)</li> <li> Recap (25:49)</li> </ol> <p>For full show notes: <a title="" href=""></a></p> <p> </p>
May 16, 2018
#14 A 36F with weakness: Hoofbeats segment
<p>Dissect an interesting case and think about the way clinicians think! So many clinical reasoning pearls here:</p> <p></p> <ol> <li>Part 1 Case (2:05)</li> <li>Framing bias (7:07)</li> <li>Data-driving reasoning  (11:48)</li> <li>Hypothesis-driven approach (12:38)</li> <li>Periodic paralysis syndromes (16:08)</li> <li>Representativeness heuristic (17:26)</li> <li>Part 2 Case (20:51)</li> <li>Pivot Points (31:36)</li> <li>Diagnosis (35:55)</li> <li>Take aways (37:20)</li> </ol> Check out the key teaching points: <a title="" href=""></a>
May 02, 2018
#13 Chronic Adrenal Insufficiency: 5 Pearls segment
<p>Solidify your knowledge on adrenal insufficiency! Quiz yourself on the 5 pearls we will be covering:</p> <ol> <li>What are signs and symptoms of chronic adrenal insufficiency (AI)? What is the most sensitive? (2:02)</li> <li>How do we diagnose and differentiate types of adrenal insufficiency? (6:05)</li> <li>How sensitive and specific are the diagnostic tests for AI &amp; at what cutoffs? (12:06)</li> <li>Can we both test and treat adrenal insufficiency <i>at the same time</i>? (16:40)</li> <li>Throwback: How do hypokalemia and hepatic encephalopathy connected? (24:55)</li> <li>Dr. Nidhi Agrawal Recap (19:20)</li> </ol> <p>For full show notes: <a title="" href=""></a></p>
Apr 18, 2018
#12 Latent TB: 5 Pearls segment
Solidify your knowledge on latent TB! Quiz yourself on the 5 pearls we will be covering: <ol> <li>Who should be screened for latent tuberculosis infection (LTBI)? (1:45)</li> <li>What screening tests are available and how do they differ? (6:30)</li> <li>What are the LTBI treatment options available? (10:24)</li> <li>What are the major adverse drug effects to consider? (13:28)</li> <li>How frequently should you check liver function tests in a patient being treated for LTBI? What do you do with the results? 17:43</li> <li>Dr. Caplan-Shaw Recap (21:29)</li> </ol> <p>For full show notes: <a title="" href=""></a></p>
Mar 28, 2018
#10 Albuminuria: 5 Pearls segment
<p>Solidify your knowledge on albuminuria! Quiz yourself on the 5 Pearls we will be covering:</p> <ol> <li>How good is a dipstick, urinalysis and UACR in detecting albuminuria? (1:42)</li> <li> What conditions that lead to transient proteinuria? What is the appropriate interval to recheck and how should be it be repeated? (5:14)</li> <li>Who should be screened for albuminuria and can it prognosticate risk for cardiovascular mortality? (7:47)</li> <li> Does increasing RAAS inhibition improve renal outcomes? (10:57)</li> <li> Throwback Question: How do you prescribe oral iron and what tips do you tell your patients? (13:11)</li> </ol> <p>For full show notes: <a href="" title=""></a></p>
Feb 28, 2018
#9 COPD Classifications: Mind the Gap segment
<p>Let’s go deeper into to why we think about diseases the way we do: COPD Classifications through the years!</p> Time Stamps:<ol> <li>How did prior understanding of COPD pathophysiology lead to COPD classifications in the past? (3:25)</li> <li>How is COPD diagnosed? (6:13)</li> <li>How has COPD been classified and why? (6:42)</li> </ol> <p></p> <p>For full show notes: <a title="" href=""></a></p>
Feb 14, 2018
#8 Chronic Hepatitis B (Part 2) Management: 5 Pearls segment
<p>Quiz yourself on the following 5 Pearls on Chronic Hepatitis B (HBV) Management!</p> <ol> <li>What is the focused history, physical and lab workup in a patient with chronic HBV? (1:40)</li> <li>What is the best imaging to evaluate for intermediate stages of liver fibrosis? (4:06) <ul> <li>What scoring tools can you use to estimate fibrosis and what are their limitations?</li> </ul> </li> <li>What factors do you use to assess which patients get treatment? (7:41)</li> <li>What drugs are available for HBV treatment and how do you choose? (11:18)</li> <li>Which chronic HBV patient should be screened for HCC, and how often? (14:45)</li> </ol> <p>For full show notes: <a title="" href=""></a></p>
Jan 31, 2018
#7: Chronic Hepatitis B Part 1: 5 Pearls segment
<p dir="ltr">Solidify your knowledge on Chronic Hepatitis B (HBV) screening and vaccinations! Quiz yourself on the 5 Pearls we will be covering:</p> <ol> <li>Who do you screen for HBV? (3:37) <ul> <li>How is HBV transmitted and who is at risk for HBV reactivation?</li> </ul> </li> <li>What tests do you order when screening for HBV?   (10:48) <ul> <li>In which populations is HBV vaccination recommended?</li> </ul> </li> <li>What are the four possible meanings of an isolated positive total anti-HBc? (13:55)</li> <li>In an asymptomatic adult, is it necessary to send an anti-HBc IgM to distinguish acute from chronic HBV infection? (15:01)</li> <li>What are the implications of seroconversion of HBeAg from positive to negative? (16:19)</li> </ol> <p>For full show notes: <a title="" href=""></a></p>
Jan 17, 2018
#6 The Wonderful World of Albumin: Mind the Gap segment
Let's go deeper as to why we do what we do: albumin in spontaneous bacterial peritonitis (SBP) ! Time Stamps:1. How much albumin is recommended in SBP? (1:45)2. What antibiotics are used for the treatment of SBP? (2:30)3. Why do we give albumin in SBP? (4:15) - How does albumin compare to crystalloid? (7:15) - Do we always have to give to albumin? (9:00) For full shownotes: <a title=" " href=""></a> <p></p>
Jan 03, 2018
Hepatic Encephalopathy: 5 Pearls Edition Ep3
Cement your knowledge on Hepatic Encephalopathy (HE)! <i>Quiz yourself </i><i>on the following 5 Pearls we’ll be covering on HE</i>: <b></b> <b>Time Stamps</b> <ol> <li>What are other causes of altered mental status in cirrhotics? (1:45) <ul> <li>What are common precipitants for an acute episode of HE? </li> </ul> </li> <li>What is asterixis? (6:10) <ul> <li>What is the diagnostic utility of a cirrhotic with asterixis? </li> </ul> </li> <li>How do lactulose &amp; rifaximin reduce symptoms of HE? (11:00) <ul> <li>What are their indications? </li> </ul> </li> <li>What is the connection between hypokalemia and HE? (14:10)</li> <li>What is the discriminatory power of an ammonia level in HE? (16:40) <ul> <li>In what situation does the NH3 has stronger predictive value? </li> </ul> </li> </ol> <p>For full shownotes: <a title="" href=""> </a></p> <p></p>
Dec 13, 2017
Mind The Gap Ep2: Part 2 of Paracentesis
<p>Part 2 on Abdominal Paracentesis ! Let's go deeper</p> <p>Time Stamps</p> <p>Should a cirrhotic’s INR and platelets deter you from doing a paracentesis? (3:15)</p> <p>Do generalist have worse procedure complications than specialists?  (5:40)</p> <p>Do you need to send ascites fluid in blood culture bottles? (6:10)</p> <p>For full shownotes: <a href="" title=""></a></p>
Nov 29, 2017
5 Pearls Ep2: Iron Deficiency Anemia
Solidify your knowledge on iron deficiency anemia! Quiz yourself on the 5 Pearls we will be covering: <ol> <li>Should patients be screened for iron deficiency? If so, who and how often? (1:40)</li> <li>What are the indications for diagnostic endoscopy in iron deficient patients? (3:23)</li> <li>How should you advice patients to take oral iron? (5:53) <ul> <li>What is optimal dosing for oral iron? </li> </ul> </li> <li>In which patients would you consider IV iron? What are the risks? (11:41)</li> <li>Throwback Question: What is a medication-overuse HA? (14:44)</li> </ol> For full shownotes: <a href="" title="" target="_blank"></a>
Nov 15, 2017
CORE IM podcast: Mind The Gap on Admission Paracentesis
<p>You have always been told to do a diagnostic paracentesis on admission in cirrhotics with ascites, but why? Can you just get away with clinical judgement to rule out SBP? Is faculty judgement any better? And if you’re going to do a paracentesis on admission, do you need to do it right away? Go deeper with Dr. Steve Liu and Dr. Janine Knudsen!</p> <p>Click the link for the full show notes: <a title="Show Notes" href=""></a></p> <p>Time Stamps</p> <ol> <li> What do guidelines say about diagnostic paracentesis in cirrhotics with ascites? (1:51)</li> <li>Can we just use clinical judgement to decide if paracentesis is warranted? (3:13) <ul> <li>Do attendings have better clinical judgement than residents to rule out SBP?</li> </ul> </li> <li> Does timing of paracentesis on admission matter for mortality? (6:33)</li> </ol>
Nov 01, 2017
Core IM Podcast: 5 pearls on Headaches - Core IM | Internal Medicine | Medical Education | FOAMed | Family Medicine | Physician Assistant | Resident | Nurse Practitioner | Medical Student | Hospitalist | Primary Care
<p>Cement your knowledge on headaches with 5 Pearls on when imaging is indicated, approach to abortive medications, medication overuse headaches, when to use migraine prophylaxis and effective non-pharmacological treatment for migraines!</p> <p>For full shownotes: <a title="" href=""></a></p> <p>Time Stamps</p> <ol> <li>What are the indications for imaging for HA? (1:36)</li> <li>What is your approach to abortive therapy for migraines? (4:45)</li> <li>How do you diagnose medication overuse HA? (6:41)</li> <li>What is your approach to migraine prophylaxis? (8:29)</li> <li>What are some evidence based nonpharmacological therapies for migraines?  (10:42)</li> </ol>
Oct 18, 2017
Introducing the CORE IM Podcasts: 5 Pearls & Mind the Gap - Core IM | Internal Medicine | Medical Education | FOAMed | Family Medicine | Physician Assistant | Resident | Nurse Practitioner | Medical Student | Hospitalist | Primary Care
<p>CORE IM is an independent consortium of educators aligned to create internal medicine-specific portable learning tools in the form of podcasts, corresponding show notes and illustrations. Segments include 5 Pearls and Mind The Gap.</p> <p>For more information: <a href="" title=""></a></p> <p>Sincerely,</p> <p>CORE IM team:</p> <p>Executive Producer: Shreya P. Trivedi, MD (@ShreyaTrivediMD)</p> <p>Five Pearls Producer: Marty Fried, MD (@Marty_Fried)</p> <p>Mind the Gap Producer: Steve Liu, MD</p> <p>Advisors: Neil Shapiro MD, John Hwang MD, Vincent Santillo MD</p> <p>Podcast editing and technical set-up: Harit Shah and Steven Liu MD</p> <p>Director of Sound Design, Theme song: Shaun Finnegan</p> <p>Artistic director: Dr. Mike Natter (@mike_natter)</p>
Oct 13, 2017