Is bicarbonate supplementation for metabolic acidosis in chronic kidney disease (CKD) a thing we do for no reason? We cover the pathophysiology and long-term consequences of metabolic acidosis, the history of bicarbonate use, alternative options for bicarbonate repletion including baking soda, lemon juice, fruits and veggies, whether the renal diet works, counseling patients with CKD, and common mistakes and pitfalls in managing metabolic acidosis in CKD. Our guest is Dr. Timothy Yau (@Maximal_Change, @WUNephrology, @AJKDOnline). It’s NephMadness 2024! Fill out your bracket today and check out the other podcasts participating in the NephMadness pod crawl!



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Show Segments



Time stamps refer to the ad-free version

00:00 Introduction and Guest Bio
07:46 Case Presentation
08:42 Initial Approach to CKD Management
09:10 Metabolic Acidosis in CKD
13:30 Consequences of Metabolic Acidosis
22:28 Administration of Bicarbonate
23:54 Alternative Options for Bicarbonate Repletion
24:47 Citrate and Bicarbonate
26:02 Sodium Bicarbonate for CKD
30:19 Dietary Modifications
33:35 Renal Diet
38:20 Counseling CKD Patients
41:39 Veverimer and Other Treatments
44:36 Mistakes and Pitfalls
46:55 Conclusion




Credits






Writer and Producer: Matthew Watto MD, FACP
Show Notes: Matthew Watto MD, FACP
Cover Art and Infographic: Matthew Watto MD, FACP
Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP   
Reviewer: Emi Okamoto MD
Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP
Technical Production: PodPaste
Guest: Timothy Yau MD




Sponsor: Rocket Money 



Cancel your unwanted subscriptions by going to RocketMoney.com/CURB





Sponsor: Freed



You can try Freed for free right now by going to freed.ai And listeners of Curbsiders can use code CURB 50 for $50 off their first month. 








#430 CKD, Metabolic Acidosis, Baking Soda vs Fruits and Veggies. It’s NephMadness 2024!

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

Education

Training

Language Courses

Higher Education

K-12

Educational Technology

Medicine

Science & Medicine

Science

Health & Fitness

We cover angina, COPD-asthma overlap, home oxygen, colon cancer screening, cancer survivorship, tobacco cessation, e-cigarettes, step counts for health,  new drugs, the RSV vaccine, addiction medicine, interstitial lung disease, APOL1-mediated kidney disease, testosterone therapy, antimicrobial resistance, office-based allergy testing and more! The Curbsiders review highlights, clinical pearls, and practice-changing updates from the American College of Physician Internal Medicine Meeting #IM2024! 



No CME for this episode due to rapid turnaround, but claim CME for most episodes at  curbsiders.vcuhealth.org!



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Show Segments






Intro
ACP Pearls
Outro




Credits








Producers: Matthew Watto MD, FACP; Paul Williams MD, FACP, Molly Heublein MD, Nora Taranto MD, Chris Chiu MD, Rahul Ganatra MD MPH, Beth Garbitelli MD
Show Notes: Matthew Watto MD, FACP; Paul Williams MD, FACP, Molly Heublein MD, Nora Taranto MD, Chris Chiu MD, Rahul Ganatra MD MPH, Beth Garbitelli MD
Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP   
Reviewer:Matthew Watto MD FACP
Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP
Technical Production: PodPaste




Sponsor: Beginly Health



Visit https://beginlyhealth.com/curbsiders for the job matching platform for every Physician and Advanced Practice Clinician, from training to practice





Sponsor: Freed



You can try Freed for free right now by going to freed.ai. And listeners of Curbsiders can use code CURB50 for $50 off their first month.












#437 Clinical Pearls ACP #IM2024

Energize your education on endometriosis! Learn common clinical presentations, optimal diagnostic imaging tests, and how to counsel patient on treatment options. We are joined by Dr. Adela Cope (Mayo Clinic) and Dr. Isabel Green @isabelgreenMD (Mayo Clinic).



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Show Segments






00:00 Intro 
03:00 Guest Introduction
06:45 Topic
07:30 Endo Definition & Symptoms
14:40 Endo phenotypes
21:30 Differential Diagnoses to Consider
25:47 Making a Diagnosis 
31:00 Imaging to consider
37:40 Endo Hormonal Treatment Optiosn
48:30 Monitoring Treatment
52:20 When to Refer
57:30 Surgical Treatment
1:09:20 Pain Management
1:13:30 Take Homes
1:19:00 Outro




Credits






Producer, Show notes, Infographics: Carolyn Chan, MD, MHS
Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP   
Reviewer: Sai S Achi, MD, MBA
Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP
Technical Production: PodPaste
Guest: Dr. Adela Cope and Dr. Isabel Green




Sponsor: Freed



You can try Freed for free right now by going to freed.ai. And listeners of Curbsiders can use code CURB50 for $50 off their first month.



Sponsor: Locumstory



Tune in to The Locumstory Podcast on Spotify, Apple, or Google podcasts.



Sponsor: Babbel



Curbsiders listeners get 60% off at babbel.com/CURB








#436 Endometriosis for the Internist with Dr. Cope & Dr. Green

A real pain in the neck (Get it?! We have fun.)



Protect your neck!  Learn how to evaluate a patient with neck pain, and differentiate between mechanical neck pain, radiculopathy, and myelopathy. You’ll learn who should be reassured, who should see a surgeon, and what nonoperative options are available.  We’re joined by Dr. Anthony Mikula @anthony_mikula from Mayo Clinic. 



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Show Segments






00:00 Introduction 
06:14 Anatomy and Pain Generators
09:58 Approach to Neck Pain
22:57 Differentiating Radiculopathy from Non-Specific Neck Pain
24:05 Management of Mechanical Neck Pain
27:36 Indications for Imaging
29:21 Terminology and Explanation of Spondylosis, Spondylolisthesis, and Spondylolysis
30:48 Diffuse Idiopathic Skeletal Hyperostosis (DISH)
32:23 Imaging Terminology and Plain Films
36:19 Pathophysiology of Cervical Radiculopathy
38:34 Physical Examination for Cervical Radiculopathy
44:54 Diagnostic Work-up for Radiculopathy
51:53 Interventions for Cervical Radiculopathy
53:53 Considerations for Surgery
57:49 Recognizing Cervical Myelopathy
01:00:17 Natural History of Myelopathy
01:02:25 Referral and Treatment for Myelopathy
01:09:28 Summary and Takeaways




Credits






Written and Produced by: Paul Williams, MD, FACP
Show Notes: Paul Williams, MD, FACP
Infographic and Cover Art: Paul Williams, MD, FACP
Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP   
Reviewer: Leah Witt, MD
Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP
Technical Production: PodPaste
Guest: Anthony Mikula, MD




Sponsor: Freed



You can try Freed for free right now by going to freed.ai. And listeners of Curbsiders can use code CURB50 for $50 off their first month.



Sponsor: Grammarly





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#435 Neck Pain with Dr. Anthony Mikula

It’s NOT Always a UTI!



Sounds like another UTI but it could be more than that! Time to explore the entire pelvic floor and see what more you can treat. School’s in session with the Bladder Teacher,  Kellen Choi, DO from the University of Louisville @KellenChoi



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Show Segments






Intro
Rapid fire questions/Picks of the Week
Case #1 and Definitions
Bowel habits
Water intake 
Case #2
Vaginal Estrogen
Non-antibiotic prophylaxis
Antibiotic in prophylaxis
Pelvic Floor Physical Therapy
Take-home points
Outro




Credits






Producer, Writer & Show Notes: Isabel Valdez, PA
Infographic & Covert Art: Edison Jyang
Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP   
Reviewer: Fatima Syed, MD
Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP
Technical Production: PodPaste
Guest: Kellen Choi DO, FAOCS




Sponsor: Freed



You can try Freed for free right now by going to freed.ai. And listeners of Curbsiders can use code CURB50 for $50 off their first month.



Sponsor: Locumstory



Tune in to The Locumstory Podcast on Spotify, Apple, or Google podcasts.








#434: Ur-INe for Recurrent UTI?!  with Dr. Kellen Choi, DO  AKA The Bladder Teacher

Step up your diabetes game! Learn the ins and outs of continuous glucose monitors (CGM) including key features, what and how to order, interpreting CGM data (time in range, time above range, etc.), and how to make adjustments to a patient’s insulin regimen, aka “insulin pattern matching”. We discuss common scenarios including overnight hypoglycemia, exercise-induced hypoglycemia, post-prandial hyperglycemia, what to do when the patient runs high all the time, and how to incorporate GLP1 agonists and SGLT2 inhibitors into a patient's regimen. Returning guest and Paul’s favorite frenemy, Dr. Jeff Colburn (VCU Health) returns!



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Show Segments






00:00 Introduction and Diabetes Puns
01:00 Introduction of Guest and Topic
09:12 Qualifications and Eligibility for CGMs
11:32 Types of CGMs and Sensor Placement
24:47 Interpreting CGM Data and Alarms
34:30 Troubleshooting Patterns and Adjustments
35:23 Understanding Hypoglycemia and Counter Regulatory Hormone Responses
36:15 The Rule of 15 and Addressing Hypoglycemia
37:10 Reducing Basal Insulin to Address Nocturnal Hypoglycemia
38:29 Addressing Postprandial Highs with GLP-1, SGLT-2 Inhibitors, or Prandial Insulin
39:51 Managing Exercise-Induced Hypoglycemia
41:43 Preventing Exercise-Induced Hypoglycemia with Snacks
43:42 Managing Nocturnal Hypoglycemia with Sulfonylureas
45:31 Addressing Postprandial Hyperglycemia with GLP-1, SGLT-2 Inhibitors, or Prandial Insulin
46:54 Adjusting Basal Insulin to Address Morning Hyperglycemia
51:18 Troubleshooting High Blood Sugars with Basal Insulin and Mealtime Insulin
56:49 Managing High Blood Sugars with Basal Insulin and Mealtime Insulin
57:44 Addressing Adherence and Medication Barriers
59:39 Using Continuous Glucose Monitors (CGMs) for Diabetes Management
01:02:30 Using Sulfonylureas and Basal Insulin Combination as a Stopgap
01:05:49 Considering Patient Adherence and Barriers to Treatment




Credits






Writer and Producer: Matthew Watto MD, FACP
Show Notes: Matthew Watto MD, FACP
Cover Art and Infographic: Matthew Watto MD, FACP
Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP   
Reviewer: Emi Okamoto MD
Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP
Technical Production: PodPaste
Guest: Jeff Colburn MD




Sponsor: Freed





You can try Freed for free right now by going to freed.ai. And listeners of Curbsiders can use code CURB50 for $50 off their first month.



Sponsor: Panacea Financial





Download the 2024 Residents & Fellows Survey Report for free at panaceafinancial.com/report.










#430 CKD, Metabolic Acidosis, Baking Soda vs Fruits and Veggies. It’s NephMadness 2024!

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