Endocrine Emergencies are rare but deadly conditions that can be hard to diagnose and manage. This can lead to long treatment delays and potentially life-threatening complications.

In podcast 63, Dr Wahid and Dr. Dimitre will cover some of the most common emergencies relating to the thyroid (myxedema coma, thyroid storm, thyroiditis), adrenal glands (adrenal crisis, pheochromocytoma), and pancreas (diabetic ketoacidosis, hyperglycaemic hyperosmolar non-ketotic coma, euglycemic DKA.

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Posted on 15/06/2019 by Dr. Dimitre

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The post Episode 63: Endocrine Emergencies with Dr. Pabani appeared first on Primary Medicine Podcast.

Approximately 60% of women will experience a urinary tract infection if their lifetime. Up to twenty percent of them will experience multiple current episodes on a yearly basis.

For the first time, the American Urological Association (AUA) has issued a guideline for the diagnosis and treatment of uncomplicated recurrent urinary tract infections (UTIs), which emphasizes the importance of cultures and antibiotic stewardship.

In this podcast episode, Dr. Dimitre will summarize the recommendations of the guideline and discuss who to incorporate them into everyday family practice.

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Posted on 15/06/2019 by Dr. Dimitre

This Podcast is eligible for 0,25 Mainpro Non-Certified credits. Login to CFPC to claim them

The post Episode 62: New Urinary Tract Infection Guidelines appeared first on Primary Medicine Podcast.

For podcast 61, Dr. Wahid makes a comeback to talk about Familial Hypercholesterolemia (FH) while Dr. Dimitre bemoans the weather in Ottawa yet again.

Familial Hypercholesterolemia (FH) is a condition that affects about 1 in 500 Canadians and is an important cause of early cardiovascular death yet it is relatively unknown by primary care physicians. Patients should be screened according to current lipid guidelines and if they present with a premature cardiovascular event, physical stigmata of hypercholesterolemia, or premature cardiovascular disease in their immediate family members. Formal diagnosis requires the use of the Dutch Criteria Cardiovascular risk is underestimated by the usual risk calculators. Consider all patients with FH as high risk and treat accordingly.

Posted on 18/04/2019 by Dr. Dimitre

This Podcast is eligible for 0,25 Mainpro Non-Certified credits. Login to CFPC to claim them.

The post Episode 61: Familial hypercholesterolemia with Dr. Pabani appeared first on Primary Medicine Podcast.

Dear Listeners,

After a bit of an unplanned hiatus, we are back with podcast number 60 and with Dr Pabani, rural doc extraordinaire. Aspirin is having a really tough time lately with three studies taking the shine off its role in primary prevention of cardiovascular disease.

During the podcast, Dr. Dimitre and Dr. Wahid go over the ASCEND, ARRIVE, and ASPREE trial and discuss how they have changed their approach to using the venerable medication in their practice.

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Posted on 24/02/2019 by Dr. Dimitre

The post Podcast 60: Aspirin in Primary Prevention for Cardiovascular Disease appeared first on Primary Medicine Podcast.

Dear Listeners,

For our last podcast of the year, Dr. Dimitre talks about Marfan syndrome.

It is an autosomal dominant disorder of the connective tissue that affects three major systems: cardiovascular, muskuloskeletal, and ocular.

Most individuals who have Marfan’s are asymptomatic until complications arise. Most commonly they will have aortic dilation, mitral valve prolapse, scoliosis and ectopia lentis.

Diagnosis is clinical and based on the Ghent criteria. This is a calculator that can simplify the process. With proper follow up and prevention individuals with this syndrome will live normal lives.

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Posted on 29/11/2018 by Dr. Dimitre

The post Podcast 59: Marfan Syndrome appeared first on Primary Medicine Podcast.

Dr. Kevin is back for our 58th podcast to talk about his approach to diagnosing inconsolable infants.

Unexplained irritability in the clinic setting needs to be assessed as an urgent medical presentation. Up to 5% of fussy children will have an organic cause to their distress.

As Dr. Kevin explains, there are a lot of badnesses lurking in the abdomen and head of an inconsolable crying infant including meningitis, trauma, intussusception, and appendicitis. Keep your differential broad and do a full physical exam even if you find a red tympanic membrane.

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Posted on 30/10/2018 by Dr. Dimitre

The post Podcast 58: Irritable Child with Dr. Kevin appeared first on Primary Medicine Podcast.

Dr. Dimitre is back with the 57th episode of the primary medicine podcast! Acquired long QTc syndrome is a disorder of the rhythm of the heart. It can lead to ventricular arrhythmias, such as Torsades de Pointe, and possibly ventricular fibrillation and death.

It is caused by QTc prolonging medications which include antidepressants, antibiotics, antibiotics, antipsychotics and antiarrhythmics. Acquired Long QTc syndrome can also be potentiated by hypokalemia and hypomagnesemia.

Diagnosis is based on the calculated interval time in a resting ECG. Consider ordering one in a patient who has 2 or more of the syndrome causing medications. Patients who are symptomatic (palpitations, presyncope and syncope) should be referred to cardiology.

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Posted on 28/09/2018 by Dr. Dimitre

The post Podcast 57: Acquired Long QTc Syndrome appeared first on Primary Medicine Podcast.

Dr. Wahid Pabani, rural doctor extraordinaire, is back for our 56th podcast to talk about Nocturnal Leg Cramps! OUCH!

This very common and distressing condition has many causes from the mundane (such as muscle fatigue) to the serious (such as peripheral vascular disease, or Parkinson Disease).

Thankfully, a focused history and physical exam can help rule out most worrisome etiologies.  Unfortunately, Nocturnal Leg Cramps can be difficult to manage due uncertainties in optimal treatments. There is some limited evidence that exercise and stretching, vitamin B12 and Magnesium, and Calcium Channel blockers may be helpful.

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Posted on 18/08/2018 by Dr. Dimitre

The post Podcast 56: Nocturnal Leg Cramps with Dr. Pabani appeared first on Primary Medicine Podcast.

Dr. Kevin is back four our 55th podcast and he brought a surprise tiny guest. He will be talking about Intussusception. This is a life-threatening condition which mostly affects children below the age of three. It occurs when one part of the intestine slides into the adjacent part of the intestine. This causes bowel ischemia, obstruction, and possible perforation.

The cause of most cases of intussusception in children is unknown. Though rare in adults, most cases of adult intussusception are the result of an underlying medical condition, such as a tumor.

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Posted on 17/06/2018 by Dr. Dimitre

The post Podcast 55: Intussuception with Dr. Kevin appeared first on Primary Medicine Podcast.

After a short hiatus, Dr. Dimitre is back to talk about subclinical hypothyroidism. Sometimes referred to as mild thyroid failure, it is diagnosed when peripheral thyroid hormone (T3 and T4) levels are within the normal range, but thyroid stimulating hormone (TSH) is mildly elevated.

It is common, occurring in 10% of the population, and carries a risk of progression to overt hypothyroidism of around 5% per year. There is no consensus on which patients should be treated, although there are some recommendations.

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Posted on 17/06/2018 by Dr. Dimitre

The post Podcast 54: Subclinical Hypothyroidism appeared first on Primary Medicine Podcast.