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





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






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





Credits






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


#146 NephMadness: Pain Meds in Chronic Kidney Disease

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

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





Make a bigger impact at work with Grammarly. Sign up and download for FREE at grammarly.com/PODCAST


#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



Claim CME for this episode at curbsiders.vcuhealth.org!



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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!



Claim CME for this episode at curbsiders.vcuhealth.org!



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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.










#433 CGMs, Insulin, and How to Adjust Diabetes Meds to Glucose Patterns

Join us as we review recent practice-changing articles on E-cigarettes for smoking cessation, Gabapentin and COPD exacerbations, lidocaine patches for mechanical neck pain, Cdiff risk by antibiotic type, and “dosing by clicks” for GLP1 agonists. Fill your brain hole with a delicious stack of hotcakes! Featuring Paul Williams (@PaulNWilliamz), Rahul Ganatra (@rbganatra), and Matt Watto (@doctorwatto).



Claim CME for this episode at curbsiders.vcuhealth.org!



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Credits






Written and Hosted by: Rahul Ganatra MD, MPH; Paul Williams, MD, FACP, Matthew Watto MD, FACP
Cover Art: Matthew Watto MD, FACP
Reviewer: Rahul Ganatra MD, MPH
Technical Production: Pod Paste
Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP






Show Segments






Introduction and disclaimer
E-cigarettes for smoking cessation
Gabapentinoids and COPD exacerbations
Topical lidocaine for neck pain
Association between specific antibiotics and C. diff infection
Shortage of GLP-1 agonists and “dosing by clicks”




Sponsor: Locumstory



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





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. 

#432 Hotcakes: E-cigarettes for smoking cessation, Gabapentin and COPD exacerbations, Lidocaine for neck pain, C diff risk by antibiotic type, and “dosing by clicks” for GLP1’s


Show description: 

Join us as we review the diagnosis and treatment of pericarditis, myocarditis, peri-myocarditis, myo-pericarditis…and everything in between! We are joined by our esteemed guest, Dr. Vivek Kulkarni (@VivekKulkarniMD), a clinical cardiologist and assistant program director for the Cardiovascular Disease Fellowship at Cooper University Health Care, who helps us get to the heart of the matter! 



Claim CME for this episode at curbsiders.vcuhealth.org!



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Show Segments






Intro, disclaimer
A case of pericarditis
Diagnosing pericarditis
The difference between pericarditis, myocarditis, myopericarditis, and perimyocarditis
Etiologies of pericarditis and initial testing recommendations
Treatment of acute uncomplicated pericarditis
Using colchicine to prevent recurrent pericarditis
Patient counseling after diagnosing pericarditis
A case of myocarditis
Interpreting elevated troponin levels
Distinguishing between myocardial infarction and myocardial injury
Diagnostic testing for suspected myocarditis
When to pursue cardiac MRI and endomyocardial biopsy
The spectrum of myocarditis presentations
Fulminant myocarditis
Common etiologies of myocarditis
Immune checkpoint inhibitor myocarditis
Myocarditis from mRNA vaccines and from SARS-CoV-2 infection
Management of patients with myocarditis
Activity restrictions for patients with myocarditis
Outro




Credits






Hosts: Paul Williams, MD, FACP, Matthew Watto MD, FACP
Guest: Vivek Kulkarni, MD, FACC
Producer, Script, and Show Notes: Adam Barelski, MD
Infographics and Cover Art: Edison Jyang
Reviewer: Leah Witt, MD
Technical Production: Pod Paste
Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP




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



Sponsor: Factor



Head to factormeals.com/curb50 and use code curb50 to get 50% off.

#146 NephMadness: Pain Meds in Chronic Kidney Disease

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