The Curbsiders Internal Medicine Podcast

By Internists, Hospitalists, Clinician Educators: Matthew Watto, MD | Stuart Brigham, MD | Paul Williams, MD | Tony Sidari, MD

SHOW DESCRIPTION

The Curbsiders is an Internal Medicine Podcast featuring four board-certified Internists as they "curbside" the experts to provide listeners with clinical pearls and practice-changing knowledge. Enhance patient care and supercharge your medical education with Doctors Matthew Watto, Stuart Brigham, Paul Williams, and Tony Sidari as they serve up a little knowledge food for your brain hole. No boring lectures here, just high value content and a healthy dose of humor. Fantastic podcast for Internal Medicine, Family Medicine, Primary Care, and Hospital Medicine. Topics include heart disease, cardiac imaging, migraines, fibromyalgia, hypertension, cholesterol, osteoporosis, insomnia, testosterone, functional medicine and more!


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EPISODES LIST

#130 Work-Life Fit: Women In Medicine

Create a successful partnership and career withs tips from Wonder Woman, Sue Hingle MD of ACP.  Work-Life Balance: is it a myth, or attainable if we could just find the right fit? In this episode, we chat with Dr. Susan Hingle about identifying our work-life priorities and re-evaluating these priorities throughout our lives. We strategize about achieving personal and professional goals (pro tip: stop worrying about what others think!). Dr. Hingle is Professor in the Department of Internal Medicine and Vice Chair of Education and Faculty Development and Associate Internal Medicine Residency Program Director at Southern Illinois University. She is also the Immediate Past Chair of the Board of Regents of the American College of Physicians (ACP). She has served at the ACP in a variety of ways, including as a member of the ACP Women’s Task Force. Her clinical expertise is in women’s health, health promotion, and disease prevention. Enjoy the episode! ACP members can visit https://acponline.org/curbsiders to claim free CME-MOC credit for this episode and show notes (goes live 0900 EST). 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: Nora Taranto MS4, Shreya Trivedi MD, Leah Witt MD, Sarah P. Roberts MPH. CME Questions by: Shreya Trivedi MD Editors: Matthew Watto MD and Chris Chiu MD Hosts: Shreya Trivedi MD, Paul Williams MD, Leah Witt MD Guest: Susan Hingle MD Time Stamps 00:00 Disclaimer, intro and guest bio 02:52 Guest one liner, WIM Moment of awakening, advice for her younger self 07:45 Picks of the week 10:30 Physician with family and caregiver responsibility; How to plan for personal and professional goals 18:20 What to look for in a partner, how to work with them to achieve work life fit, and non-traditional roles 28:35 Advice on family planning 31:40 Residency programs and life events 32:55 Should you go part-time? 39:43 Work life balance? Or work life fit? And some examples/tips for success 49:54 Take home points 50:45 Outro 52:22 Bonus story

12.13.2018

#129 Depression and Suicide: Occupational Hazards of Practicing Medicine

Dr Elisabeth Poorman MD joins us to discuss the natural history of physician 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. 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). 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 either via email, private msg on FB or twitter (@DrPoorman), or any of us on twitter. We are happy to talk and see that you get support you need. 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: Nora Taranto MS4, 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 Disclaimer, Intro, Guest Bio 3:25 Wellness Recommendations: Find a Therapist 6:12 How to find a therapist in training 6:39 Licensing and Mental Health 12:14 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). 12:05 Shreya story 21:40 Stuart’s story 31:19 Elisabeth’s story 36:17 Watto’s story 37:41 Passive suicidal ideaiton, a definition   41:10 Suicide and Depression: Do they always coexist? (No) 42:20 Life Cycle of Depression and Suicide in the Medical Profession 47:15 Depression and Suicide in Primary Care 47:59 Mini-Cases 54:00 Noticing signs in a colleague: how to help 58:00 Specific programs doing things well 1:03:08: Questions from Social Media 1:03:10: Burnout vs. Depression 1:04:27: Will getting treatment affect your board applications 1:06:14 Take home points 1:08:00 Outro

12.10.2018

#128 Aspirin Overhyped and Overused

Aspirin’ to figure out if ASA can help prevent a heart attack? Interpreting all the new trials doesn’t have to cause chest pain! Join Dr. Ambarish Pandey from UT Southwestern as he helps The Curbsiders ASCEND the mountains of the latest studies to ARRIVE at some well-informed conclusions on the role of aspirin in primary prevention for cardiac events. The team also discusses secondary prevention, aspirin and dual (or triple) antiplatelet therapy, and whether it’s okay to stop giving aspirin to older adults without known CAD (Spoiler alert: it’s okay). ACP members can visit https://acponline.org/curbsiders to claim free CME-MOC credit for this episode and show notes (goes live 0900 EST). 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: Justin Berk MD, Matthew Watto MD CME questions by: Justin Berk MD Hosts: Matthew Watto MD, Paul Williams MD, Stuart Brigham MD Edited by: Matthew Watto MD and Chris Chiu MD Guest: Dr. Ambarish Pandey MD Time Stamps 00:00 Disclaimer, intro and guest bio 04:15 Guest one liner, book recommendation, career and research advice 11:07 Case of aspirin for primary prevention, aspirin’s public persona, and nocebo effects of statins 21:40 ARRIVE and ASCEND trials 28:14 Aspree trial 32:38 Coronary artery calcium; aspirin use for secondary prevention 37:42 Dual antiplatelet therapy and the DAPT score 41:25 Should we continue aspirin when a patient also needs a DOAC? 46:14 Should we continue DAPT in a patient who needs a DOAC (or warfarin)? 49:40 Deprescribing aspirin for primary prevention in older adults? 50:51 Closing remarks 52:33 Outro

12.03.2018

Hotcakes: Exercise, Aspirin, Fish Oil and Hypertension

Tony Breu MD joins us for some hotcakes, and “cold cakes” including: how aspirin and zodiac sign affect the treatment of acute MI, a recent study on how exercise is probably still good for you, the recently announced REDUCE-IT trial, and the evidence (or lack thereof) for the treatment of hypertensive urgency. Welcome to another edition of Hotcakes and Hot Takes, where we discuss the most interesting articles and news that we have been reading. Special guest is the prolific Dr. Tony Breu (@tony_breu) who is an Assistant Professor of Medicine at Harvard Medical School and a Hospitalist and Director of Internal Medicine Resident Education at the VA Boston Healthcare System. He is known for his series on "Things We Do For No Reason” as well as his thought-provoking “Tweetorials” online. ACP members can visit https://acponline.org/curbsiders to claim free CME-MOC credit for this episode and show notes (goes live 0900 EST on day of release). 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 CME Questions: Christopher Chiu MD Hosts: Matthew Watto MD, Stuart Brigham MD, Paul Williams MD, and Christopher Chiu MD Guest Presenter and Content Planning: Anthony Breu MD Editor: Christopher Chiu MD Cover-Art: Christopher Chiu MD Time stamps 00:00 Disclaimer, intro, guest bio 05:53 Discussion on Tweetorials 08:00 Cold Cake: ISIS-2 and the treatment of acute MI with aspirin 14:04 ISIS-2 and zodiac subgroup analysis 16:19 What is the relationship between cardiorespiratory fitness on mortality? 24:40 Discussion of the REDUCE-IT study 33:00 Cold Cake: VA Cooperative study and the evidence for treating essential hypertension 36:42 TWDFNR and the treatment of hypertensive urgency 46:36 Wrap-up and outro

11.29.2018

#127 STIs: Syphilis, Gonorrhea and Chlamydia

Master the diagnosis and management of common STIs (sexually transmitted infections) with tips from expert, Dana Dunne MD, Associate Professor of Medicine in Infectious Diseases at Yale. Topics include: the stages and many presentations of syphilis, syphilis treatment and counseling, the natural history, diagnosis, and screening guidelines for gonorrhea and chlamydia, treatment options in the age of growing resistance, and a discussion of partner notification and treatment. 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: Bryan Brown MD Hosts: Bryan Brown MD, Paul Williams MD, Matthew Watto MD Guest: Dana Dunne MD Special thanks to Kate Grant MBChB, Dip GUMed for her contribution of knowledge and artwork. Time Stamps 00:00 Announcement, disclaimer, intro and guest bio 04:29 Guest onliner, book recommendation, advice for learners/teacher, and picks of the week 11:00 A case of syphilis, clinical manifestations and discussion of the stages 26:05 Testing for syphilis 39:05 Mandatory reporting and partner tracing 42:40 Counseling patients with syphilis 44:44 A case of gonorrhea and chlamydia, clinical manifestations, screening guidelines 52:30 How to counsel patients to obtain samples from urethra, rectum, vagina, oropharynx; Mycoplasma genitalium 59:40 CDC treatment guidelines, Super gonorrhea, test of cure, and treatment of partners 72:35 Take home points 74:30 Outro

11.26.2018
11.19.2018

#125 Hidden Curriculum

Check out this audio treasure map to find the hidden curriculum and learn how it can change your practice. Learn how positive teaching spans not just the classroom or bedside but, how we simply talk about patients. Sanjay Desai MD, coauthor of ACP’s Position Paper on Hidden Curriculum and Internal Medicine program director at Johns Hopkins guides us through several cases that illustrate how our institutional norms can shape the practice of medicine...for better or worse. ACP members can visit https://acponline.org/curbsiders to claim free CME-MOC credit for this episode and show notes (goes live 0900 EST). 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: Sanjay Desai MD; Justin Berk MD, MPH, MBA; Matthew Watto MD CME questions by: Justin Berk MD Editors: Chris Chiu MD & Matthew Watto MD Hosts: Justin Berk MD, MPH, MBA; Matthew Watto MD; Paul Williams MD Guest: Sanjay Desai MD Time Stamps 00:00 Disclaimer, Intro and guest bio 04:00 Guest one liner, book recommendations, career advice 10:50 Intro to the hidden curriculum and ACP’s three recommendations 22:00 Case #1: A patient with schizophrenia 32:10 Case #2: The iPatient 38:07 Case #3: Attending forgets to wash their hands 41:10 Case #4: A dying patient’s primary care doctor saves the day 46:26 Case #5: A case of violating duty hours 60:10 Take home points 62:00 Outro

11.15.2018
11.12.2018

#123 Sleep Apnea Pearls and Pitfalls

The sleep apnea episode that won’t put you to sleep. Become a sleep apnea guru with incredible insights from Barbara Phillips MD, MSPH, FCCP an expert in pulmonary medicine, critical care and sleep medicine who is also a past president of CHEST! We discuss high-yield topics in the world of obstructive sleep apnea including: home sleep studies vs in-lab polysomnography, the importance of oxygen saturation (the T90 and ODI) when interpreting sleep study results, tricks to improve CPAP adherence, and alternatives therapies for obstructive sleep apnea. ACP members can visit https://acponline.org/curbsiders to claim free CME-MOC credit for this episode and show notes. 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: Cyrus Askin MD CME questions by: Cyrus Askin MD Editor: Chris Chiu MD & Matthew Watto MD Hosts: Cyrus Askin MD & Matthew Watto MD Guest: Barbara Phillips, MD Cover-Art & Infographic - Beth Garbitelli, MS1 Time Stamps 00:00 Disclaimer, intro, guest bio 03:00 Guest one liner, book recommendation, advice for trainees 08:10 Clinical case of sleep apnea, some basic stats, and key predictors of sleep apnea 12:38 Barriers to diagnosis and treatment of OSA 15:23 Discussion of T90, hypoxemia and sleep fragmentation 17:05 How to read a sleep study report 21:55 Home sleep apnea testing 24:15 What are the consequences of sleep apnea 28:30 What is the efficacy of cpap for lowering blood pressure and mortality 31:45 Counseling a patient who is new to cpap 33:45 Choice of mask 40:10 Do alternatives to cpap work? e.g. surgery, mandibular advancement devices 44:17 Modafinil and z-drugs 47:15 Driver’s license issues in sleep apnea 48:35 Future of sleep medicine and take home points 51:15 Outro

11.05.2018

#122 Headaches Advanced Class

We delve into advanced management of headaches, including novel therapies, migraines with aura, migraines in complicated patients, and headaches of short duration with Dr. Rebecca Burch, a headache medicine specialist at the John R. Graham Headache Center at Brigham and Women’s Hospital. 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: Paul Williams MD Edited by: Matthew Watto MD Hosts: Paul Williams MD, Stuart Brigham MD, Matthew Watto MD Guest: Rebecca Burch MD Time Stamps 00:00 Disclaimer, intro and guest bio 03:28 Guest one-liner, movie and podcast recommendations, favorite failure and picks of the week from The Curbsiders 10:38 Clinical case of migraines; diagnosis and classification 14:12 Does medication overuse headache exist? 16:16 Chronic daily headache; Conversion from episodic to chronic and vice versa 21:43 Approaches to medication overuse headache 25:54 Case 2: migraine with aura and other types of migraine (retinal, hemiplegic, etc.) 32:09 Pathophysiology of migraine; how triptans work; How should aura effect management? 38:44 Migraine cocktails 41:15 Comorbid mood disorders; Use of psych meds and triptans 45:08 Migraines and oral contraceptives 48:42 Botulinum toxin and new CGRP therapies 53:36 What does success look like in migraine therapy? 55:32 Nonpharmacologic management 60:45 Case 3: headaches of short duration 66:36 Headache red flags; Imaging for headaches; pathophysiology of high and low pressure headaches 72:00 Idiopathic intracranial hypertension 75:25 Take home points 77:00 Outro  

10.29.2018

#121 HIV Care for the Internist

HIV care for the internist with author and HIV expert, Michael Saag MD, Professor of Infectious Diseases at University of Alabama and founder of the 1917 Clinic. We discuss the specifics of screening & diagnostic testing in HIV, monitoring CD4 counts and viral loads, first line antiretroviral therapy, harm reduction, and how to provide excellent HIV care in your primary care clinic. 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 & Produced by: Elena Gibson MS4, Justin Berk MD MBA MPH Artwork by: Elena Gibson MS4 Hosts: Matthew Watto MD, Paul Williams MD, Justin Berk MD MBA MPH Editor: Matthew Watto MD Guest: Michael Saag MD Time Stamps 00:00 Disclaimer, intro, and guest bio 04:35 Getting to know our guest, a movie recommendation, and words of wisdom 08:48 Clinical case, HIV screening, in-depth discussion of HIV testing & diagnosis 15:56 New diagnosis of HIV, counseling after diagnosis, confirmation, follow-up testing, the second visit 24:20 Treatment - what to start and when; some basic comments on therapy 30:05 Primary care after diagnosis, vaccines, cancer screening, cardiovascular disease prevention 34:35 Monitoring CD4 counts and viral load; interpreting CD4 count; time course of response for CD4 and viral load 42:02 Harm reduction counseling; addressing medication non-adherence 47:40 PCP prophylaxis 49:43 The 1917 Clinic, Ryan White Clinics, and linking patients to care 53:10 Take home points 55:40 Plugs 57:45 Will a cure or vaccine for HIV emerge? 59:16 Outro

10.22.2018
10.19.2018

#119 Nutrition Pearls, Heart Health and Bacon

Nutrition pearls from integrative cardiologist, Steven Devries MD, Associate Professor of Medicine, Northwestern Feinberg School of Medicine, Executive Director of The Gaples Institute. Clinicians receive little formal nutritional training in medical school and residency. It’s time to fill that gap! We discuss the strength of the literature supporting dietary interventions for cardiovascular health and review practical tips to help patients achieve healthy eating patterns. Patients need to hear from us that nutrition matters! 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 & Produced by: Molly Heublein MD Hosts: Matthew Watto MD, Paul Williams MD, Molly Heublein MD Guest: Stephen Devries MD Editor: Matthew Watto MD Special thanks to Elena Gibson MS4 for writing our show notes Time Stamps 00:00 Disclaimer 00:35 Intro and guest bio 02:40 Guest one-liner, book recommendation, favorite failure, nontraditional career path 10:10 Nutrition and medical education 12:45 Evidence for how nutrition can improve health outcomes 15:33 How to describe a heart healthy or Mediterranean diet to patients 25:16 Discussion of fats and oils 31:44 Food deserts, healthy snacking options 37:15 Calorie counting and use of healthy eating apps 40:55 How to frame the discussion about a healthful eating pattern with patients 47:18 Macronutrient content. Does it matter? 52:50 Intermittent fasting 54:24 A free resource for patients to learn about nutrition  

10.15.2018

#118 Female Sexual Problems with Stacy Lindau MD

Houston, we have a female sexual dysfunction problem. Female sexual problems, which can affect women of all ages, are underdiagnosed and undertreated--in part because clinicians are not the best at asking about sex in primary care visits. In the course of this episode, learn about how to have that sex talk you’ve (maybe) been avoiding, what to ask when working up sexual problems in women, and find the words to talk to patients about sex. Today, we’re lucky to have the female sexual health expert of experts, Dr. Stacy Lindau, MD, MA, Professor of Obstetrics and Gynecology and Medicine-Geriatrics at the University of Chicago Medicine, on the show to teach us the best “sex talk” language, the differential for female sexual problems, and explore therapies. Sadly, there’s no sildenafil-like magic bullet, but a multidisciplinary team can make real impact on female sexual problems. Don’t forget to check out http://womanlab.org 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: Nora Taranto MS4 Hosts: Leah Witt MD and Matthew Watto MD Infographic: Leah Witt MD Editor: Matthew Watto MD Guest: Stacy Lindau MD Time Stamps 00:00 Disclaimer 00:35 Intro and guest bio 03:30 Guest one liner, book recommendations, favorite failure, career advice and picks of the week 12:57 Clinical Case of female sexual dysfunction and some definitions 15:08 Are sexual problems a normal part of aging?; How to take a sexual history; Etiology of sexual dysfunction; “Diagnostic sex”; Red flags 27:54 Medications that contribute to sexual dysfunction 31:00 Labs 34:45 Treatment: pelvic PT, medications, counseling, flibanserin, herbal supplements 49:05 Screening for female sexual problems 51:58 Take home points; WomanLab.org 55:19 Outro Tags sexual dysfunction, female, gynecologist, ob-gyn, female sexual disorder, libido, sex, hormones, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

10.08.2018

#117 Clostridium Difficile: IDSA Guidelines, Bad Puns, and Random Pearls

Summary Conquer Clostridium difficile (Clostridioides difficile) with this “spore-tacular” episode featuring infectious diseases expert, Dr. Curtis Donskey, Professor at Case Western Reserve University and clinician at the Louis Stokes VA Hospital. We discuss the updates in the 2017 IDSA C. difficile guidelines plus a bunch of random pearls. If you have ever laid awake at night wondering how many pills are needed for a fecal transplant, then this is the episode for you!  We discuss why metronidazole was dropped as the first line therapy for Clostridium difficile infection (CDI) along with other hot topics such as two-step testing, loperamide use, which antibiotics are the least likely to cause CDI, and more. Do not miss this episode! 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: Carolyn Chan MD Produced by: Matthew Watto MD Hosts: Carolyn Chan MD, Matthew Watto MD, Paul Williams MD Editor: Matthew Watto MD Guest: Curtis Donskey, MD Time Stamps 00:00 Intro, disclaimer, guest bio 02:19 Getting to know our guest, recommendations for reading, career advice 06:40 Clinical case and CDI testing 09:30 Testing for CDI: PCR and Two step testing 16:30 Testing after treatment 20:00 Treatment of initial CDI episodes, metronidazole pharmacokinetics 24:15 Classification of CDI severity 29:30 Fidaxomicin pearls: when to use, cost, and tapers 34:10 Vancomycin tapers 36:05 Fecal transplant pearls: freeze dried capsules, c-scopes, treating fulminant CDI 44:44 Infection control: counseling homegoing patients, hand washing, and baths 47:50 Social media questions: immodium and toxic megacolon, antibiotics less likely to promote CDI, probiotics, and more! 59:14 Best CDI joke in the history of time 60:00 Take home points 62:42 Outro Tags Clostridium, difficile, cdi, C.Diff, infectious, diseases, diarrhea, IDSA, guideline, antibiotics, vancomycin, fidaxomicin, fmt, transplant, fecal, stool, toxin, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

10.01.2018

#116 Geriatric Psychiatry: Sleep, Dementia, and Behavioral Disturbances

Geriatric psychiatry returns. We tackle sleep problems and behavioral disturbances in patients with dementia with returning guest, and Geriatric Psychiatrist Dennis Popeo MD, Clinical Associate Professor of Psychiatry at NYU Langone Medical Center. Topics include: pharmacologic and nonpharmacologic management of insomnia; treating agitation and irritability; medical management of psychotic symptoms and paranoia; ethical concerns about the treatment of challenging behaviors in dementia; and the shortage of geriatricians and geriatric psychiatrists. 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 & Produced by: Jordana Kozupsky NP, Matthew Watto MD Artwork by: Kate Grant MD Hosts: Jordana Kozupsky NP, Matthew Watto MD Editor: Matthew Watto MD Guest: Dennis Popeo, MD Time Stamps 00:00 Intro and guest bio 01:55 Case of sleep disturbance in a patient with dementia; medications for sleep disturbances; nonpharmacologic strategies for sleep 11:32 Irritability and agitation versus paranoia, or psychotic symptoms; benzodiazepines in older adults 15:40 Antipsychotic medications, the black box warning and ethical concerns 23:50 Geriatricians, geriatric psychiatrists in short supply; Behavioral interventions 28:16 Outro Tags psychiatry, psych, geri, geriatrics, dementia, paranoia, psychosis, sleep, insomnia, agitation, antipsychotics, atypical, black, box, warning, adverse, zolpidem, benzodiazepine, side, effects, therapy, mirtazapine, gabapentin, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

09.27.2018

#115 Geriatric Depression

Summary Geriatric depression got you down? Boost your spirits with tips and tactics from Geriatric Psychiatrist, Dennis Popeo MD, Clinical Associate Professor of Psychiatry at NYU Langone Medical Center. Topics include: suicide in the older adults; how to diagnosis depression in older adults; how to counsel patients about antidepressants, how to choose an antidepressant, how to monitor and titrate medications, and how long to continue therapy. Stay tuned for part two of our discussion with Dr Popeo on managing sleep and behavioral problems in older adult patients with dementia. 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 & Produced by: Jordana Kozupsky NP, Matthew Watto MD Artwork by: Kate Grant MD Hosts: Jordana Kozupsky NP, Matthew Watto MD Editor: Matthew Watto MD Guest: Dennis Popeo, MD Time Stamps 00:00 A question for you, the listeners 01:12 Disclaimer, intro and guest bio 05:00 Getting to know our guest, recommendations for reading, and career advice 14:13 Case of geriatric depression; effective history taking; recognizing associated symptoms; depression scales 19:03 Suicide in older adults; firearm safety 24:26 Choice of therapy; Pharmacologic agents; Counseling patients and managing expectations; Dose titration and tracking symptoms 34:41 Augmenting therapy versus cross-titration to another agent; When is it okay to stop an antidepressant 40:50 Take home points 44:40 Outro Tags: psychiatry, psych, geri, geriatrics, depression, mdd, sleep, insomnia, appetite, agitation, suicide, SSRIs, side, effects, therapy, diagnosis, serotonin, mirtazapine, bupropion, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

09.24.2018

#114 High Value Care: Assess Quality, Mitigate Diagnostic Uncertainty, Overcome Barriers

Kick up the quality of your care with tips and tactics from Caitlin Clancy MD, coauthor of ACP’s High Value Care Curriculum. We learn to define quality and value in healthcare; the most common barriers to high value care; use of probability and likelihood ratios to boost clinical reasoning and combat diagnostic uncertainty; some useful tools to estimate cost; sources of healthcare waste; and some general pearls on how the healthcare system works...or doesn’t. ACP members can claim free CME-MOC at acponline.com/curbsiders (goes live 0900 EST on podcast release date). 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 & Produced by: Matthew Watto MD Hosts: Paul Williams MD, Stuart Brigham MD, Matthew Watto MD Guest: Caitlin Clancy MD Time Stamps 00:00 Disclaimer, intro and guest bio 03:50 Guest one-liner, some discussion on non traditional paths, and picks of the week 12:10 Case 1: Defining value, cost, quality; sources of healthcare waste; and how to avoid the waste of daily labs 23:00 Case 2: An uninsured patient who needs major surgery; costs for uninsured versus insured patients 28:35 Do insured patients have better outcomes? 31:15 How to determine cost and “fair market price” 36:29 Case 3: Clinical case of suspected heart failure 45:45 Case 4: Clinical case of patient requesting antibiotics; barriers to high value care and how to overcome them 57:05 Outro Tags: high, value, care, quality, cost, diagnostic, uncertainty, likelihood, ratio, testing, treatment, consumer, acp, college, american, insured, uninsured, bill, charge, reimbursement, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

09.17.2018

#113 Gout: Uric acid targets, urate lowering therapy, and random questions from social media

Master the management of gout with tips from expert, Tuhina Neogi MD, PhD, Professor of Medicine at Boston University School of Medicine. Topics include: how to initiate and titrate urate lowering therapy, guidelines controversy over uric acid targets, colchicine & NSAIDS for anti-inflammatory prophylaxis, uricosuric agents, febuxostat, HLA B5801, use of uric acid levels in the acute setting and more random gout facts. 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: Matthew Watto MD Hosts: Paul Williams MD, Stuart Brigham MD, Matthew Watto MD Guest: Tuhina Neogi MD, PhD Time Stamps 00:00 Intro and guest bio 01:30 Allopurinol initiation and titration 07:10 Uricosuric therapy 09:10 Controversy over uric acid targets for gout 17:40 Parachutes and randomized controlled trials 19:15 Colchicine or NSAIDS for prophylaxis 23:20 Who needs febuxostat? 26:20 When to refer for gout, HLA B5801, and checking uric acid levels in the acute setting   33:29 Take home points 36:15 Outro Tags: allopurinol, uric, urate, acid, level, therapy, management, gout, flare, crystal, arthritis, titration, probenecid, febuxostat, target, acr, acp, guidelines, nsaids, colchicine, hla b5801, septic, rheumatology, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

09.10.2018

#112 Gout Flares: Bathtubs and Firefighting

Crystalize your knowledge of gout and stop flares in their tracks with tips from expert, Tuhina Neogi MD, PhD, Professor of Medicine at Boston University School of Medicine. On this first of two gout episodes we learn to diagnose gout with or without arthrocentesis, how to treat flares, and how to counsel patients about gout, which apparently involves fire fighting and bathtubs. Don’t miss next week’s episode on urate lowering therapy, gout guidelines controversy, and answers to your gout questions from social media. 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: Matthew Watto MD Hosts: Paul Williams MD, Stuart Brigham MD, Matthew Watto MD Guest: Tuhina Neogi MD, PhD Time Stamps 00:00 Disclaimer, intro 01:40 Guest bio 03:20 Guest one liner, music recommendations, advice for researchers, and some comments on failure 09:15 Clinical diagnosis of gout 12:15 Is taking a diet history useful? 14:30 Classification criteria for gout 17:35 MSK ultrasound and Physical exam findings in gout 21:06 Arthrocentesis and MSU crystals 24:45 A recap of how to make the diagnosis of gout 26:50 The bathtub analogy and how to counsel a patient with a new diagnosis of gout 30:55 Pathophysiology of gout 34:55 Treatment for acute gout flares (steroids, colchicine, NSAIDS. And topical NSAIDS?)  45:30 Outro Tags: gout, crystal, colchicine, steroids, nsaids, joint, flare, acute, chronic, urate, uric, acid, arthritis, acr, exam, diagnosis, rheumatology, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

09.03.2018

#111: Hotcakes - Complementary Medicine in Cancer, Dosing Aspirin by Body Weight, Marijuana & Respiratory Symptoms, Penicillin Allergies and More!

Dr. Neda Frayha (@nedafrayha) of Primary Care RAP (Hippo Education) joins us this month for our thoughts and analysis of some recent (and not so recent) journal articles that interested us this month. Our articles spanned topics that include at cancer survival among patients pursuing treatment with complementary medicine, the effect of body weight on effectiveness of preventive aspirin dosing, strategies to promote physician leadership, respiratory symptoms in those with marijuana use and MRSA risk among patients with penicillin allergies. ACP members can claim free CME-MOC at acponline.com/curbsiders (goes live 0900 EST on podcast release date). Full show notes available at http://thecurbsiders.com/podcast. Join our mailing list to receive a PDF copy of our show notes every Monday! And hey, while you’re here, consider rating us on iTunes and leaving a review. The Curbsiders thank you! Thoughts on the Journal Club series? Article or guest nominations? Compliments or complaints? You can reach us at thecurbsiders@gmail.com. We are also on Facebook, Instagram, and Twitter: @thecurbsiders.   Credits: Written by: Sarah Phoebe Roberts MPH, Neda Frayha MD, Christopher Chiu MD Producers: Sarah Phoebe Roberts MPH, Christopher Chiu MD Hosts: Matthew Watto MD, Stuart Brigham MD, Paul Williams MD, and Christopher Chiu MD Editor: Matthew Watto MD  Time stamps: 00:00 Disclaimer, intro, guest bio 05:05 Do patients using complementary medicine for cancer therapy have worse outcomes? 13:11 Does low dose aspirin work for primary prevention of major adverse cardiac events? 19:16 Do physicians make better leaders? 24:55 Does marijuana cause respiratory symptoms? 30:40 Does penicillin allergy confer increased risk for C Diff and MRSA infection? 38:40 Wrap-up and outro Tags:​ aspirin, cardiac risk, mortality, cancer, complementary, alternative, conventional, therapy, marijuana, cannabis, respiratory, symptoms, leader, leadership, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

08.31.2018

#110: Driver’s safety for Older Adults: When is it Time to Give Up the Keys?

Get schooled on driver’s safety for older adults by expert, Alice Pomidor MD, Professor of Geriatrics at Florida State University. Whether or not older adults can continue to drive is a huge problem faced by for primary care clinicians, and will remain one until driverless cars become ubiquitous. Topics covered include: how to take a driving history, red flags, physical exam, cognitive exam, and vision assessment for driver’s safety, resources, when to refer, alternate means of transportation, and the legal repercussions of reporting...or not reporting. 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: Matthew Watto MD and Elizabeth Garbitelli MD Candidate 2022 Editor: Matthew Watto MD Cover Image by: Kate Grant MD Hosts: Matthew Watto MD, Stuart Brigham MD, Paul Williams MD Guest: Alice Pomidor MD  Time Stamps 00:00 Disclaimer 00:35 Intro and guest bio 03:10 Guest onliner, book recommendations, and career advice 10:43 Clinical case, and the 5 Rs of clinicians responsibility 19:15 Taking a history from older adult drivers 26:28 The clinical exam for driver’s safety (cognition, vision, and MSK tests) 37:24 How can we avoid patient anger towards clinician and family members? 41:10 When and where to refer for driving evaluation 47:00 Alternative transportation 52:00 What to do if someone refuses or forgets to stop driving 59:45 Reporting requirements and legal ramifications 69:15 Take home points 72:00 Outro  Tags: driving, elderly, geriatrics, dementia, treatment, prevention, cognition, seniors, drivers, safety, crash, motor, vehicle, car, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student  

08.27.2018

#109: Things We Do For No Reason: A High Value Episode

Things We Do For No Reason #TWDFNR highlights some widespread practices that are difficult to justify based on lack of proven health benefits, but significant cost (both financial and non-financial harms). Avoid these low value practices and inflated medical bills with tips from expert, Dr Lenny Feldman, MD, FACP, Associate Professor of Medicine Johns Hopkins. Topics include: renal ultrasound and urine electrolytes in acute kidney injury (AKI), folate deficiency and anemia work-up, prealbumin and malnutrition, blood transfusions, shellfish and contrast allergies, monitoring after switch from IV or oral antibiotics, and “against medical advice” discharges. Don't forget to check out Clinicwiki.org a free, online resource for teaching ambulatory 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 and produced by: Justin Berk MD, MPH, MBA Editor: Matthew Watto, MD Hosts: Justin Berk MD, MPH, MBA; Matthew Watto MD; Paul Williams MD, FACP Guest: Lenny Feldman MD, FACP Goal: Listeners will recognize things we do for now reason aka low value practices with an unfavorable ratio of benefits to cost and/or harm. Learning objectives: After listening to this episode listeners will… Determine if renal ultrasound is indicated in acute kidney injury Recognize the limitations of urine electrolytes in AKI. Identify the shortcomings of folate testing. Explain the significance of low albumin and prealbumin. Identify patients at risk for serious allergic reactions from IV contrast administration Explain the futility in discharge Against Medical Advice (AMA) paperwork Counsel patients on harm reduction in “AMA” discharges Rationalize discharging patients immediately after switching from IV to  oral (PO) antibiotics. Time Stamps 00:00 Announcements 00:38 Disclaimer, intro, and guest bio 03:53 Guest one liner, some recommendations, and advice 08:35 Defining high value care and things we do for no reason (TWDFNR) 12:40 Why do clinicians order useless testing? 14:58 Urine electrolytes for acute kidney injury 20:30 Renal ultrasound for acute kidney injury 25:54 Stop ordering folate for anemia workup 31:47 How many units should I transfuse? 34:40 Prealbumin and albumin for malnourishment. 43:24 Iodine, shellfish and contrast allergy 50:28 Patient leaving against medical advice 56:45 Switching from IV to oral antibiotics 63:27 Dr Feldman’s plugs 65:36 Outro  Tags: high, value, choosing, wisely, acute, kidney, injury, renal, ultrasound, transfusion, AKI, malnutrition, folate, prealbumin, albumin contrast, allergy, antibiotics, AMA, TWDFNR, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

08.20.2018

#108: Point-of-care Ultrasound for the Internist

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 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 and Renee Dversdal MD Produced and CME questions by: Christopher Chiu MD Edited by: Matthew “Mike” Watto MD Hosts: Matthew Watto MD, Stuart Brigham MD, Christopher Chiu MD Guest Expert: Renee Dversdal MD Tags: point-of-care, acp, impocus, ultrasound, bedside, POCUS, CLUE, exam, training, lifestyle, management, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

08.13.2018

#107: Women in Medicine, Be Bold

“Women in medicine, be bold.” Medical World, powerful women are here to stay. Dr. Vineet (Vinny) Arora, Professor of Medicine at University of Chicago, an exemplary Woman in Medicine and Leadership, shares snippets of her own story, valuable career advice to folks at all levels of training, and fascinating data about the gender disparities that exist in training, promotion, and pay.  We hope you’ll learn from this episode, whether you have faced or anticipate facing these struggles as a Woman in Medicine or as a member of another marginalized group, or whether you’re an ally and want to learn more about the issue. Women are entering medical school now more than ever, and are learning to provide the best possible care to patients (didn’t you see that patients of female physicians have significantly lower mortality rates than patients of male physicians? (Tsugawa et al., 2016)).  The modern medical woman wants to teach, mentor, and lead--and be fairly evaluated, and promoted. That’s where We In Medicine (both women and men) have some work to do.  Because gender disparities (and other disparities hinging on identity) do exist. N.b. This episode is our inaugural in what we hope will be a Women in Medicine series for the Curbsiders.  We have many more topics with which we’d like to engage, from career trajectory to imposter syndrome to sexual harassment to balancing career and personal lives (as inequity is not only at work (Khullar. Being a Doctor is Hard. It’s Harder for Women. NYT 2017)), to conversations about race, gender, and LGBTQ identity in medicine.  We’re passionate, at The Curbsiders, about all these topics, and we want to dive deep into how to make Medicine a more welcoming and ceiling-less place for all.  We can’t wait to bring this series to you, not to mention to bring some more fabulous female experts on air. 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: Leah Witt MD, Shreya P. Trivedi MD, Nora Taranto AB, Sarah Phoebe Roberts MPH, Molly Heublein MD, Beth Garbitelli, Hannah R Abrams, Images by: Beth Garbitelli and Hannah Abrams Editor: Matthew Watto MD Hosts: Leah Witt MD, Shreya P. Trivedi MD, Matthew Watto MD Guest: Vineet Arora MD Time Stamps 00:00 Disclaimer and intro 03:15 Guest bio, and one liner 05:55 Dr Arora’s Women in medicine moment of awakening 11:05 Advice to young women, “Be bold” 13:20 Picks of the week 16:45 Mistaken identity. Women not recognized as physicians due to appearance 22:05 Gender bias starts early in training and why it's important to shout-out accomplishments 31:24 Contracts, promotions and the leaky pipeline 38:32 Defining coaches, sponsors, and mentors 44:06 How to use your team and shout-out your accomplishments 52:04 How to write effective evaluations and letters that avoid gender bias 53:55 Take home points 57:00 Outro Tags: women, medicine, wim, LeanIn, leadership, mentorship, doctor, education, family, assistant, career, sponsorship, vineet, arora, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

08.06.2018

#106: Hotcakes: Cardiac risk, diabetes, pulmonary embolism, opioid use disorder, neck ties and nose picking?

Short on time but hungry for knowledge? Curbsiders’ Journal Club gives you the speedy article analysis you crave. We provide brief summaries of recent research and news items in the field of internal medicine, so you can save time and stay on top of the literature. On this episode, we were joined by Kashlak Memorial’s very own Chair of Medicine, Dr. Robert Centor AKA @medrants on Twitter or “Uncle Bob” to the Curbsider Crew. This month’s topics include: estimating atherosclerotic cardiovascular disease risk, whether CT pulmonary angiography (CTPA) effectively rules out pulmonary embolism, discharging low risk patients with pulmonary embolism from the ED, metformin and risk of acidosis in patients with CKD, treating opioid use disorder after a nonfatal overdose, Canagliflozin and renal protection in type 2 diabetes, screening for diabetes among patients below age 40, and the association between nose-picking and staphylococcus. ACP members can claim free CME-MOC at acponline.com/curbsiders (goes live 0900 EST on podcast release date). Join our mailing list to receive a PDF copy of our show notes every Monday! And hey, while you’re here, consider rating us on iTunes and leaving a review. The Curbsiders thank you! Thoughts on the Journal Club series? Article or guest nominations? Compliments or complaints? You can reach us at thecurbsiders@gmail.com. We are also on Facebook, Instagram, and Twitter: @thecurbsiders.   Credits: Written by: Christopher J Chiu MD, Sarah Phoebe Roberts MPH Producers: Christopher J Chiu MD, Sarah Phoebe Roberts MPH Editor: Matthew Watto MD Hosts: Christopher J Chiu MD, Stuart Brigham MD, Paul Williams MD, and Matthew Watto MD Guest: Robert Centor MD Time stamps: 00:00 Disclaimer and Intro to Curbsiders Journal Club 04:00 Dr. Centor's Pick of the Week 06:10 Clinical Implications of the Revised Pooled Cohort Equations 12:10 Negative Predictive Value in CTPA for VTE 18:34 Can low risk patients with PE be discharged from the ED? 23:03 Is Metformin associated with Lactic Acidosis in those with low eGFR? 28:45 How do medications for opioid use disorder affect mortality after non-fatal overdose? 36:44 Canagliflozin and Renal Protection 43:00 Performance of USPSTF screening criteria for diabetes 46:08 Stuart on Nose picking 50:00 Chiu Bites: Infectious ties and physical attire 53:50 Outro Tags: atherosclerotic, cardiovascular, disease, risk, CT, pulmonary, angiography, CTPA, embolism, ED, metformin, acidosis, CKD, treatment, opioid, use, disorder, oud, mat, overdose, canagliflozin, renal, diabetes, screening, nose-picking, staphylococcus, ACP, CME, MOC, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

07.30.2018

#105: Lyme Disease and Tick-Borne Illness with ID Expert Paul Sax: Why you should never go outside or to Boston in the summer

Lyme disease and tick-borne illness deconstructed by Infectious Diseases expert, Paul E. Sax MD, of episode 78 fame. Oh, Summer Nights. The time for romance between Danny Zuko and good girl Sandy, the time to sit in the backyard around the bonfire, the time for sunset hikes in the woods and mountains…..and don’t forget, it’s also the time for those pesky woodland ticks who’ll go for a ride on you and maybe suck your blood (gross!). Dr. Sax takes us through the essentials of tick-borne illness, with a focus on Lyme Disease: diagnosing it, treating it, identifying possible co-infections, and managing Post-Lyme residual symptoms.   Our (And Dr. Sax’s) Disclaimer about this episode, and the shownotes: Tick-borne illness is a very serious problem in public health in the US, but management is quite a controversial issue. We’ve done our best with this episode to stay as evidence-based as possible. Moreover, given the limited time we have on air, we have tried to focus on what we think is most clinically relevant. 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: Shreya P. Trivedi MD, Nora Taranto AB Produced by: Shreya P. Trivedi MD, Nora Taranto AB Editor: Matthew Watto MD Images by:  Hannah R. Abrams Hosts: Shreya P. Trivedi MD, Matthew Watto MD, Paul Williams MD Guest: Paul E. Sax MD Time Stamps 00:00 Intro 02:17 Disclaimer 03:19 Guest bio 05:17 Getting to know Guest 08:33 Favorite hiking experiences 12:20 Disclaimer of Tick-borne illness 12:28 Clinical case of recent hiking in endemic area with a rash 20:59 Lyme testing limitations 27:38 Patient education to doxycycline 30:16 Case of elderly outdoorsy healthy male with flu-like symptoms in the summer 32:39 Differentiating anaplasmosis and babesiosis 33:17 Workup for patient with possible tick co-infections 39:22  Post-lyme disease residual symptoms 48:02  Case of tick attached to patient 56:19  Outro Tags: lyme, disease, anaplasmosis, babesiosis, treatment, prevention, coinfection, doxycycline, paul, sax, infectious, diseases, nejm, harvard, pcr, antibody, tick, borne, illness, chronic, post, syndrome, removal, endemic, anatomical, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

07.23.2018

#104: Renal tubular acidosis with Kidney Boy, Joel Topf MD

Renal tubular acidosis aka RTA deconstructed by @Kidney_Boy, Joel Topf MD, Chief of Nephrology at Kashlak Memorial Hospital. We review the three buckets of non gap metabolic acidosis, normal renal physiology & acid base handling, points of failure in RTA, complications and treatment of RTA. Check out Dr Topf’s awesome slides on renal tubular acidosis 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: Matthew Watto MD and Joel Topf MD Produced by: Matthew Watto MD Hosts: Matthew Watto MD, Stuart Brigham MD, Paul Williams MD Guest: Joel Topf MD Time Stamps 00:00 Announcements 01:02 Disclaimer 01:40 Intro and guest bio 04:00 Joel’s one liner 06:05 Joel’s “favorite failure” 11:45 Paul shares a failure 13:20 Tweetorials 16:39 Clinical case of non gap metabolic acidosis 18:06 Three buckets of NAGMA and GI losses 21:02 Chloride intoxication and normal saline 25:14 Renal tubular acidosis and normal role of kidney in acid base 35:03 Proximal (type 2) RTA 40:33 Cases of proximal RTA 43:38 Distal (type 1) RTA 53:15 Bicarbonate dosing and titration 55:28 Type 4 RTA (hypoaldosteronism) 62:09 Urinary anion gap and ammonium 67:26 Replacing GI losses of bicarbonate 70:25 Joel reviews quick cases of RTA and NAGMA 74:49 Outro  Tags: renal, tubular, acidosis, non, gap, rta, nagma, metabolic, kidney, diarrhea, sodium, normal, saline, ringer's, lactate, tubule, bicarbonate, physiology, acid, base, ammonia, ammonium, nephrolithiasis, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

07.16.2018

#103: Train Your Brain: Mapping out your road to expertise

Expert diagnostician, Dr. Gurpreet Dhaliwal, again joins The Curbsiders to dive deeper into the topic of clinical expertise.  Topics include, and are mainly focused on, Dr. Dhaliwal’s “training regimen:” feedback, simulation, quizzing, learning from consultants, and how to read the medical literature as a clinician.  While we found this episode to be incredibly useful (and entertaining to record), don’t let our bias sway your opinion! In fact, just listen to the episode and listen for practical advise on how to improve your own clinical acumen.   Dr Brigham’s comment:  Be forewarned, much of what we talk about is seemingly common sense, but, upon listening to the episode many times, I realize that we have, over time, overly complicated the fundamentals of expertise.  I’m just as guilty as the next physician. 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:  Stuart Brigham MD Hosts: Stuart Brigham MD, Paul Williams MD, Matthew Watto MD Guest: Gurpreet Dhaliwal MD Images by: Beth Garbitelli Edited by:  Matthew Watto MD Time Stamps 00:00 Disclaimer, Intro 02:25 Guest Bio 03:57 Pun 04:25 Dr. Dhaliwal 05:57 Pick of the Week - Move, “Jiro Dreams of Sushi” 08:00 Pick of the Week - Podcast, “Unspooled” 09:06 Pick of the Week - Water Putty, “Durham’s Rock Hard Water Putty” 10:20 “Clinical Case” Introduction 12:00 Developing expertise, introduction 15:50 Developing a patient log 21:30 Asking the wrong question leads to the wrong answer 23:35 Telling a colleague they were wrong 26:00 Five to one ratio 28:58 Understanding the why 33:57 Simulation in practice 37:35 Quote on learning… Just listen. 41:00 Quizzing and consolidating memory 44:24 Reading the literature as a clinician 50:10 Bottom line 57:10 Outro Tags: clinical, reasoning, diagnosis, diagnostician, accuracy, Osler, misdiagnosis, train, brain, care, test, self, Dhaliwal, Gurpreet, Curbsiders, podcast, patients, cats, funny, educational, inspirational, educator, school, free, doctor, education, family, foam, foamed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, physician assistant, resident, student

07.09.2018

#102: Curbsiders Journal Club Hotcakes and Hot Takes June 2018

Curbsiders’ Journal Club features rapid summary and critical appraisal of recent articles and news stories in internal medicine by The Curbsiders. This month’s topics include: asthma, maintenance versus as needed inhaler use, procalcitonin, Pneumocystis pneumonia prophylaxis, colon cancer screening, smoking cessation, cannabis and cognitive impairment, LDL cholesterol and mortality, plus some medical podcast recommendations. Over the last month, we have developed a list of more than 40 interesting articles and news stories that we have been feeding our own brain holes. From this list we have plucked a select few that we really wanted to highlight and share with you. Join our mailing list to receive a PDF copy of our show notes every Monday! And hey, while you’re here, consider rating us on iTunes and leaving a review. The Curbsiders thank you! We are also on Facebook, Instagram, and Twitter: @thecurbsiders. Credits: Written by: Christopher J Chiu MD, Sarah Phoebe Roberts MPH Producers: Christopher J Chiu MD, Sarah Phoebe Roberts MPH Hosts: Christopher J Chiu MD, Stuart Brigham MD, Paul Williams MD, and Matthew Watto MD Editor: Matthew Watto MD Time Stamps: 00:00 Announcements 00:20 Disclaimer 01:00 Intro to Curbsiders Journal Club 03:07 Mild asthma and as needed versus maintenance inhaler use 09:50 Smoking cessation, e-cigarettes, and financial incentives 17:23 Pneumocystis pneumonia prophylaxis 22:18 Cannabis and cognitive impairment 26:15 Colorectal cancer screening update by American Cancer Society 30:37 Procalcitonin for lower respiratory tract infections in the ED 37:29 Cholesterol, baseline LDL-C, mortality and cardiovascular events 41:01 Incorrect symbology and some podcast recommendations 46:22 Outro Tags: asthma, maintenance, inhaler, procalcitonin, Pneumocystis, pcp, pneumonia, prophylaxis, colon, cancer, screening, crc, smoking, cessation, marijuana, cannabis, cognitive impairment, LDL, cholesterol, mortality, cardiovascular, podcast, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

07.02.2018

#101: Cirrhosis: Medications, decompensation, complications

Cirrhosis. Take control of cirrhosis and treat your patients like the pros! In this episode of The Curbsiders, Dr. Scott Matherly, assistant professor in the Dept of Medicine at Virginia Commonwealth University and board certified hepatologist, builds upon his introduction to cirrhosis. You already know what to look out for and how to diagnose these patients, now it’s time to build your knowledge and medical repertoire against this deadly condition! Topics include: high protein diet, ascites, diuretics, hepatic encephalopathy, lactulose vs rifaximin, portal hypertension, esophageal varices, beta blockers, spontaneous bacterial peritonitis prophylaxis and more pathophysiology! 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: Cyrus Askin MD Infographics: Beth Garbitelli Produced by: Cyrus Askin MD and Matthew Watto MD Hosts: Cyrus Askin MD, Matthew Watto MD, Stuart Brigham MD, Paul Williams MD Guest: Scott Matherly MD Time Stamps 00:00 Announcements 00:54 Disclaimer 01:30 Guest bio 02:28 NASH, diet, vitamin E, pioglitazone and prevention of cirrhosis 06:56 Clinical case of decompensated cirrhosis 09:02 Pathophysiology of circulatory dysfunction in cirrhosis and use of diuretics 18:25 Hepatic encephalopathy, ammonia, lactulose and rifaximin 25:10 Timing of medical therapy 26:39 MAP of 82 mmHg, beta blockers and variceal bleeding 31:04 Use of midodrine for hypotension 33:45 Prophylaxis of SBP 36:05 Take home points 38:04 Outro Tags: cirrhosis, liver, high, protein, diet, sodium, restriction, ascites, diuretics, furosemide, spironolactone, hepatic, encephalopathy, lactulose, rifaximin, portal, hypertension, esophageal, varices, beta, blockers, spontaneous, bacterial, peritonitis, prophylaxis, pathophysiology, sbp, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

06.25.2018

#100: Cirrhosis: Initial Evaluation and Management

Cirrhosis. Finally. Take your liver game to the next level with tips from @liverprof, Scott Matherly MD, Assistant Professor of Medicine at Virginia Commonwealth University. Topics include: exam findings in cirrhosis, interpreting liver function tests, incidental cirrhosis on imaging, fatty liver disease, steatohepatitis, hep c, shear wave elastography, screening for varices and hepatocellular carcinoma, pathophysiology, and lifestyle measures for initial management. This episode is sponsored for CME-MOC credit by the American College of Physicians. ACP members can claim free credit at acponline.org/curbsiders (goes live at 9am on release date). 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: Cyrus Askin MD CME questions by: Cyrus Askin MD Produced by: Cyrus Askin MD and Matthew Watto MD Hosts: Cyrus Askin MD, Matthew Watto MD, Stuart Brigham MD, Paul Williams MD Guest: Scott Matherly MD Time Stamps 00:00 Announcements 00:45 Disclaimer 01:19 Intro to the show and our guest 04:15 Guest one liner, books recommendations, and career advice 09:04 Cyrus’ pick of the week 10:14 Clinical case of abnormal liver functions tests 11:12 Seven hand findings of cirrhosis 13:28 Should we screen for NASH? 15:28 Incidental finding of cirrhosis on imaging 17:47 Next steps after diagnosis of cirrhosis 20:36 Non-invasive scoring systems to predict cirrhosis 23:55 Liver biopsy 25:33 Shear wave elastography 29:10 Recap of what we learned so far 31:58 Three ways cirrhosis can kill you 33:56 Counseling patients about cirrhosis 36:05 Management of NASH and early  cirrhosis 42:55 Screening for varices and hepatocellular carcinoma 46:28 Outro Tags: cirrhosis, liver, function, shear, wave, elastography, fibroscan, imaging, fatty, liver, disease, nash, nafld, steatohepatitis, hepatitis, hep c, hcv, screening, varices, hepatocellular, carcinoma, pathophysiology, lifestyle, management, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

06.18.2018

#99 Cancer Survivorship: What to do when the treatment is done

Step up your primary care of cancer survivors with tips from Dr Regina Jacob, Assistant Professor of Medicine at Temple University. Care of the cancer patient does not end when their cancer treatment is over, and there is more to a past diagnosis of cancer than surveillance. We discuss cancer survivorship care with Dr. Regina Jacob, including the changing demographics of survivorship, the importance of survivorship care plans, and how survivorship is largely just good primary care. 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: Paul Williams MD Hosts: Stuart Brigham MD, Matthew Watto MD, and Paul Williams MD Produced by: Paul Williams MD Edited by: Matthew Watto MD Guest: Regina Jacob MD  Time Stamps 00:00 Disclaimer 00:35 Intro to the topic and guest bio 02:15 Guest one liner, book and app recommendations 06:58 Paul’s pick of the week. 07:40 Clinical case, definitions, and phases survivorship 12:36 Survivorship statistics 15:04 Co-survivorship 17:41 Care models for survivorship 20:56 Assigning roles in care of cancer survivors 22:59 Sample survivorship care plan 27:39 Childhood, adolescent and young adult cancer survivorship 34:18 Sexual dysfunction in cancer survivorship Turn down Watto and Regina tracks 35:56 Stressors in young adult cancer survivors 37:33 Fatigue 43:28 Guidelines on survivorship 45:06 Late cardiac toxicity 46:23 Support groups and resources 49:04 Take home points 50:29 Outro  Tags: Survivorship, cancer, breast, ovarian, colon, radiation, chemotherapy, side, effect, fatigue, sexual, dysfunction, care, plan, surveillance, doctor, education, family, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

06.11.2018

#98: Knee Pain: History, exam, bracing, x-rays, and injectables

Knee pain is easy with practical tips from Orthopedist, medical educator, car-builder, and inventor extraordinaire Dr. Ted Parks. He teaches us the four buckets of knee pain, how to perform a 30-second knee exam, choose a knee brace, order x-rays, and the red flags to look for in a history and physical that should have you shouting for your closest neighborhood orthopedic surgeon. This episode is brought to you in partnership with the American College of Physicians. ACP members can claim free CME-MOC credit at acponline.org/curbsiders. Check out our video of the Parks-Approved 30-second knee exam! Credits: Written by: Nora Taranto BA, Matthew Watto MD Produced by: Chris Chiu MD and Nora Taranto BA Edited by: Matthew Watto MD. Hosts: Matthew Watto MD, Stuart Brigham MD, Paul Williams MD. Guest: Ted Parks MD.   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.  Time Stamps 00:00 Announcement 01:00 Disclaimer 01:35 Intro and guest bio 04:08 Dr Parks’ one-liner, book recommendation, inventions, and career advice 10:52 A case of knee pain, and recognizing emergencies 14:17 Four buckets of knee pain 17:40 Initial approach to treatment of knee pain 20:19 Corticosteroid injection controversy 22:47 Hyaluronic acid injections 24:50 Topical agents 27:03 Taking a history about knee pain 29:39 Knee locking or giving out Practical Office Orthopedics by Ted Parks 31:44 How to order knee X-rays 36:45 Knee braces 41:00 How to perform a 30 second knee exam Ms Anita Bones has left knee pain and recent fall. 53:00 PRP, stem-cell injections 61:00 Glucosamine chondroitin 63:09 Take home points 64:36 Outro Tags: orthopedics, knee, pain, ortho, joint, exam, osteoarthritis, arthritis, xray, physical, injection, corticosteroid, hyaluronic, hyaluronate, prp, stem, cell, bracing, nsaids, glucosamine, chondroitin, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

06.04.2018

#97: Curbside Journal Club: Hotcakes and Hot Takes May 2018

Keep current with this monthly journal club covering landmark articles through May 2018, plus rapid fire hot takes from the medical literature and health news. We rate each article according to a highly scientific ‘Hotcakes’ scale to highlight what practice-changing knowledge we’ll take to work this month. Topics: Hypertension, blood pressure monitoring, prostate cancer screening, Intimate Partner Violence screening, alcohol is killing you, new diabetes drugs and mortality, DPP-4 inhibitors and IBD risk, NT-proBNP-guided therapy vs usual care, effect of teaching status on mortality, and more! If you’re a listener and have something interesting for us to discuss, please send it our way. Join our mailing list to 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. We are also on Facebook, Instagram, and Twitter: @thecurbsiders. Credits: Written and produced by: Christopher J Chiu MD, Sarah Phoebe Roberts MPH Hosts: Christopher J Chiu MD, Stuart Brigham MD, Paul Williams MD, and Matthew Watto MD Editor: Matthew Watto MD Time Stamps:  00:00 The Curbsiders need a web master 00:50 Disclaimer 01:25 Intro to the format 03:25 Ambulatory BP monitoring and mortality 09:08 Blood pressure treatment strategies: CVD risk score vs systolic BP targets 14:14 Repeated BP measurements important at office visits and future directions of BP management 21:25 Hot takes in order of appearance: Prostate cancer screening, intimate partner violence, alcohol, DPP4 inhibitors mortality and IBD, teaching status and mortality in US hospitals, 5 lifestyle factors that may add to life expectancy, NT pro-BNP, BNP and mortality 38:12 Outro Tags: Hypertension, blood, pressure, monitoring, cuff, automatic, ambulatory, prostate, cancer, screening, Intimate, Partner, Violence, alcohol, mortality, DPP4, sglt2, glp1, IBD, risk, BNP, teaching, assistant, care, doctor, education, family, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

05.28.2018

#96: Diabetes: A1C targets & ACP guidelines controversy

Get schooled on hemoglobin a1c targets in type 2 diabetes mellitus by American College of Physicians guidelines coauthor, Devan Kansagara MD MCR, Associate Professor of Medicine, Oregon Health Sciences University. We summarize outcomes from the landmark diabetes trials (ACCORD, ADVANCE, VADT, UKPDS 33 & 34), how a1c targets effect microvascular and macrovascular events, estimating life expectancy, and how to personalize diabetes control for your patients. We’re proud to announce our new partnership with the ACP to provide free CME credit and MOC points on select episodes of The Curbsiders. ACP members can visit acponline.org to redeem free CME/MOC credit. Full show notes available at http://thecurbsiders.com/podcast Join our mailing list to 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. Hosts: Stuart Brigham MD, Paul Williams MD, Matthew Watto MD. Guest: Devan Kansagara MD, MCR Time Stamps 00:00 Announcement 00:48 Disclaimer and intro 03:11 Getting to know our guest: one liner, book recommendation, mentorship 06:50 How and why did ACP write their guidance statement on diabetes, A1C targets 09:18 Landmark trials in type 2 diabetes 11:36 Does tight control prevent micro or macrovascular complications 13:20 Trials of newer agents like SGLT2i, GLP-1 and DPP4i 14:33 How do ACP’s guidelines differ from other published guidelines 17:20 Quick recap of landmark trial findings 22:24 Personalizing glycemic control 24:30 Controversy over an A1C goal of 7-8% 28:05 Clinical inertia 30:26 Legacy effect and metabolic memory 34:00 Deintensifying therapy 38:29 Life expectancy and comorbid conditions 43:15 Performance measures in diabetes 44:42 Take-home points 46:30 The Curbsiders recap and give some closing remarks 49:13 Outro  Tags: diabetes, a1c, target, dm, hypoglycemia, glycemic, intensive, tight, glucose, control, cardiovascular, risk, outcome, mortality, death, metformin, insulin, acp, guideline, accord, advance, vadt, ukpds, microvascular, macrovascular, aace, ada, VA, DoD, assistant, care, doctor, education, family, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

05.21.2018

#95: Food allergy, food intolerance and celiac disease

Separate the wheat from the chaff when it comes to food allergy, food intolerance, and celiac disease. Featuring renowned gastroenterologist and current president of the American Gastroenterological Association, Dr. Sheila Crowe MD FRCPC FACP FACG AGAF, we discuss how to differentiate a food allergy from an intolerance, what diagnostic testing is appropriate, and why fructans might be the real culprit in patients with ‘gluten sensitivity’. 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: Sarah P. Roberts, MPH Guest: Sheila Crowe, MD Hosts: Matthew Watto, MD; Stuart Brigham, MD; Paul Williams, MD Producers: Sarah P. Roberts, MPH and Chris Chiu, MD Editor: Matthew Watto, MD Time Stamps: 00:00 Disclaimer 03:35 Getting to know our guest, book recs, and career advice 10:35 Clinical case 11:40 Defining allergy, intolerance 14:05 Food intolerance and FODMAP 18:02 Taking a history in patient with potential food allergy vs intolerance 21:34 Dermatitis herpetiformis, gluten ataxia, and extraintestinal manifestations of celiac 26:12 Diagnosing celiac disease 30:53 Next steps if celiac testing is negative; lactose, fructose intolerance, IBS 33:48 Non-celiac gluten sensitivity (NCGS) 37:48 Study of NCGS 40:41 Olmesartan and drug-induced enteropathy 43:38 Dieticians, dietary recs, elimination diets 48:10 “Voodoo” testing 52:36 Counseling patients on diet 54:35 Take home points 55:50 Outro Tags: food, allergy, intolerance, sensitivity, celiac, disease, diarrhea, diet, fodmap, paleolithic, paleo, weight, loss, lactose, olmesartan, refractory, protein, gluten, fructan, wheat, anaphylaxis, tTG, genetic, gene, testing, assistant, care, doctor, education, family, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

05.14.2018

#94: Random Pearls: Microbiome, POTS, Gabapentin, and Leonardo Da Vinci

A random serving of knowledge food for your brain hole with returning guest, Dr. Alan Dow, Professor of Internal Medicine at Virginia Commonwealth University School of Medicine. Our final live recap show from ACP 2018 covering: human microbiome, copper deficiency, POTS syndrome, substances of abuse, drugs for delirium and how to be more like Leonardo Da Vinci. Please let us know what you liked, didn’t like and how we can make the show better. Full show notes available at http://thecurbsiders.com/podcast Join our mailing list and receive a PDF of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. We are also on Facebook, Instagram, and Twitter: @thecurbsiders. Time stamps: 00:00 Disclaimer 01:30 Guest bio 03:19 Getting to know our guest, podcast, and book recommendations 08:55 Human microbiome 11:05 A case of anemia and neuropathy 13:30 Physiology and treatment of POTS syndrome 17:00 Novel substances of abuse 20:17 Benzodiazepines for delirium 24:00 Leonardo Da Vinci versus the modern physician 27:18 Outro Tags: microbiome, transplant, bupropion, gabapentin, pregabalin, copper, POTS, substance, use, disorder, leonardo, da, vinci, acp, journal, article, literature, news, media, doctor, education, family, foam, foamed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

05.07.2018

#93: Clinical Pearls ACP 2018 with Nina Mingioni MD

A fast moving recap of hot topics and clinical pearls live from Internal Medicine’s largest national conference, ACP 2018 in New Orleans! Dr. Nina Mingioni, Clinical Associate Professor and director of Undergraduate Medical Education in Internal Medicine at Thomas Jefferson University Hospital serves up some knowledge food for our brain holes. Topics: the athlete as a patient, sports physicals, food as medicine, medical marijuana (cannabis), and more! Listeners, please let us know what you liked, didn’t like and how we could make this better. YouTube video of this episode available here: ACP 2018 Recap with Nina Mingioni.  You can 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. We are also on Facebook, Instagram, and Twitter: @thecurbsiders.    Time stamps: 00:00 Music and disclaimer 02:48 Getting to know our guest 06:07 The athlete as a patient 10:20 Relative energy deficiency in sports 12:00 Drug interactions 15:51 Food as medicine 21:56 Marijuana 30:24 Outro Credits:  Written by: Nina Mingioni MD, Hannah Abrams. Producer/videographer: Chris Chiu MD. Hosts: Matthew Watto MD, Stuart Brigham MD, Paul Williams MD. Editor: Matthew Watto MD Tags: food, microbiome, marijuana, athlete, ekg, ecg, physical, sports, training, energy, relative, deficiency, cannabinoid, entourage, effect, cannabidiol, thc, cannabis, acp, 2018, assistant, care, doctor, education, family, foam, foamed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

04.30.2018

#92: Pulmonary Embolism for the Internist

Wow the crowd with your knowledge of pulmonary embolism! What are the red flags? What tools are available to guide you? How on Earth do you triage a patient with pulmonary embolism (PE)? What exactly is the RV spiral & how do PEs really cause morbidity and mortality?! Get schooled by pulmonary embolism expert, Dr. Oren Friedman, associate director of the Cardiac-Surgical Intensive care unit at the Cedars-Sinai Heart Institute. Doctors Cyrus Askin and Chris Chiu join as co-hosts. Test Yo’ Self Pulmonary embolism quiz Written by Cyrus Askin, MD, Justin Berk, MD, MBA, MPH. Figure by Cyrus Askin, MD. Edited by Matthew Watto, MD 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.  Time Stamps 5:10 - Start of Interview / Introduction 10:00 - Case Presentation - Introduction of DVT / PE Spectrum and Pathophysiology 16:18 - How to Triage and Work-Up Pulmonary Embolism (CT, Echo, troponins, “eyeball”) 23:30 - Other ways to risk-stratify (Other CT findings, clot burden) 28:45 - What does a low-risk patient look like? 30:35 - When to consider treatment modalities other than general anticoagulation 35:12 - Anticoagulation treatment options 36:38 - Next step intensive interventions after anticoagulation 42:00 - Evidence behind catheter-directed lysis 44:05 - IVC Filter discussion 47:22 - Discharge criteria for PE 50:00 - Incidental PEs 52:40 - Interdisciplinary PERT Team Tags: pulmonary, embolism, thrombolysis, heparin, anticoagulation, right, ventricle, RV, left ventricle, LV, circulation, hypotension, shock, IVC, vena, cava, filter, catheter, TPA, echocardiogram, CT, scan, computed, tomography, shock, bleed, clot, deep, vein, thrombosis, vte, venous, embolism, assistant, care, doctor, education, family, foam, foamed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

04.23.2018
04.21.2018
04.20.2018

#91: Curbside Journal Club: Hotcakes and Hot Takes April 2018

Keep up-to-date with this fast moving discussion of recent journal articles and thought-provoking headlines in medicine. Welcome to the first-ever Curbsiders journal club covering landmark articles from March to April 2018, plus rapid fire hot takes and the unveiling of our new hotcake based rating system. Please let us know what you liked, didn’t like and how we can make this better next month. Topics: Resident work hours, saline versus balanced IV fluids, barber shops and hypertension, coffee causes cancer, Twitter based medicine, clonidine versus spironolactone, opioids versus nonopioids and aromatherapy for nausea! Written by: Chris J Chiu, MD; Producer: Sarah Phoebe Roberts MPH; Edited by: Matthew Watto, MD 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. We are also on Facebook, Instagram, and Twitter: @thecurbsiders.  Time stamps: 00:00 Disclaimer 00:35 Host intros, featuring special guest and correspondent Chris Chiu, MD 01:30 Introducing a new Curbsiders segment! 03:20 First article: Duty-Hour Flexibility Trial 08:55 Second article: Trial of Blood-Pressure Reduction in Black Barbershops 14:27 Third article: SALT-ED Trial 20:00 Hot takes—intro 20:36 Hot take #1, Dr. Milton Packer and Twitter-based medicine 24:07 Hot take #2, Coffee and cancer risk 26:24 Hot take #3 Aromatherapy for nausea 28:10 Hot take #4 Opiates vs. non-opiates for chronic pain 29:00 Hot take #5, Surgeon general’s statement on naloxone 29:46 Hot take #6, Spironolactone vs clonidine for resistant HTN 31:54 Outro & announcements Tags: duty, hours, salt, balanced, ivf, saline, normal, barber, shop, hypertension, alcohol, nausea, spironolactone, clonidine, coffee, cancer, opioid, pain, naloxone, twitter, journal, article, literature, news, media, doctor, education, family, foam, foamed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

04.16.2018

#90: Clinical Reasoning: Become an expert diagnostician

Become an expert diagnostician like Dr Gurpreet Dhaliwal, Professor of Medicine at UCSF. Join us for this deep dive into clinical reasoning and how doctors think! Topics include: how to improve your own clinical reasoning and diagnostic skills, how to teach these skills, and the initial steps to building your own expertise/mastery in clinical medicine! Dr. Osler once admonished his students to build experiential wisdom and follow-up with their clinical cases (clear cases, doubtful cases, and mistakes), but to do so, one must “...learn to play the game fair, no self-deception, no shrinking from the truth; mercy and consideration for the other man, but none for yourself, upon whom you have to keep an incessant watch.” Test yo’ self: Take our quiz here Written and produced by:  Stuart Brigham, MD; Images by Hannah Abrams; Edited by:  Matthew Watto, MD 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. Goal: Listeners will gain an appreciation for the Clinical Reasoning process and the difficulties that underpin building expertise in medicine. Learning objectives: After listening to this episode listeners will… Develop an appreciation for clinical reasoning. Recall the importance that the educator plays in role modeling. Learn how to improve diagnostic accuracy by keeping a patient log. Identify the common nomenclature used in clinical reasoning and how teaching this common verbiage could serve to improve diagnostic accuracy Recognize that misdiagnosis is common in clinical practice and every clinician could benefit from deliberate practice. Explain the difference between experience and expertise. Time Stamps 00:00 Disclaimer, Intro 02:30 Guest Bio 04:50 Dr. Dhaliwal 06:45 Book recommendation 09:14 App recommendation 11:34 Advice for learners and teachers (Pearl #1) 12:40 Can a computer out-think a human? 15:49 Defining Clinical Reasoning 18:38 “Train the Brain” introduced 20:30 Knowledge is a precondition 21:46 A learner who lacks synthesis 24:23 How to provide learner feedback 27:04 Defining problem representation, illness scripts, etc. 29:20 How to start teaching clinical reasoning 31:00 Focus on the “why” and not the “what” 32:11 Teaching the nomenclature of clinical reasoning 36:07 “You can’t get the right answer if the brain is solving the wrong problem” 36:34 Osler and his “Incessant Watch” 40:40 Being wrong feels exactly the same as being right 42:00 Patient tracking (Dr. Dhaliwal’s recommendation) 45:30 Why keeping a patient log is so important 47:00 Are heuristics beneficial? 48:55 Can you debias yourself? 50:00 “Going slow just makes you slow.” 52:00 All evidence has flaws, but knowledge is still king. 55:13 Clinical reasoning on multi-disciplinary teams 59:27 Take-home points Tags: clinical, reasoning, diagnosis, diagnostician, accuracy, Osler, misdiagnosis, train, brain, care, test, self, Dhaliwal, Gurpreet, Curbsiders, podcast, patients, cats, funny, educational, inspirational, educator, school, free, doctor, education, family, foam, foamed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, physician assistant, resident, student

04.09.2018

#89: Conjunctivitis: Red Eye in Pr-eye-mary Care with Dr Glaucomflecken

Revolutionize your approach to the red eye in pr-eye-mary care! Dr. Glaucomflecken (of GomerBlog/Twitter--fame) teaches us to recognize and manage common eye complaints. You’ll develop an approach to diagnosing and treating your patient with the dreaded red eye. We answer: What presentations should have us running down the hallway for that prized ophtho consult? What on earth does glaucomflecken stand for? Which eye drops are best? What is an eye dentist? Plus, answers to your twitter questions, and so much more! By the end of this episode, you’ll be sure to say “Eye Understand!” Self Assessment Questions: Take the ophtho self-assessment! Donate at FirstDescents.org to support young cancer survivors like Dr. Glaucomflecken! Written and produced by: Nora Taranto AB, Carolyn Chan MD; Original art by: Bryan Brown, MD. Edited by: Matthew Watto, MD. 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.  Times Stamps 00:00 Disclaimer 02:33 Guest bio 04:15 Dr Glaucomflecken 05:40 Best advice as a learner 06:05 Book recommendation 07:33 App recommendation 08:32 Clinical case 10:02 Corneal ulcers and contact lense hygiene 12:10 Indicators of urgent eye problems 13:39 The eye exam 18:00 Visual acuity exam without an eye chart 21:15 Approach to the red eye, blepharitis, allergic conjunctivitis 23:45 Approach to vision loss 25:52 Angle closure glaucoma, and other emergencies 27:37 Bacterial conjunctivitis 29:00 Viral conjunctivitis 31:26 Return to school or daycare after “pink eye” 34:00 Rundown of common eye medications 38:35 OTC redness relievers 40:30 Breast milk eye drops?! 42:07 How to correctly use an eye drop bottle 44:16 What does Glaucomflecken mean? 45:40 Questions from Twitter: Floaters, diabetic retinopathy treatments, blurry vision from high glucose 50:15 Eye dentists? 53:10 Take home points 54:28 Plug for First Descents charity 56:54 Outro Tags: eye, ophthalmology, eyedrop, GOMER, conjunctivitis, twitter, red, glaucoma, glaucomflecken, acute, angle, closure, glaucoma, bacterial, viral, blepharitis, assistant, care, doctor, education, family, foam, foamed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

04.02.2018

#88: Acid base, boy bands, and grandfather clocks with Joel Topf MD

Dominate acid-base disturbances with the wisdom of @kidney_boy aka Joel Topf, MD, Chief of Nephrology at Kashlak Memorial Hospital.  Master his 5 key steps for interpreting acid-base disorders and decode any ABG, VBG, and BMP to find the primary disorder, and any other disorders tucked away in the ABG! Plus: Henderson-Hasselbach and pH simplified; the anion gap, should your correct it?; choice of IV fluid; osmolar gaps, methanol, ethylene glycol, isopropyl alcohol; and how metabolic disorders are like a boy band. Be sure to follow along the Dr. Topf’s brilliant acid-base powerpoint. Written and produced by Joel Topf MD, Shreya Trivedi MD, Xavi Jimenez MD; Images by Hannah Abrams; Edited by Matthew Watto MD 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.  Time Stamps 00:00 Announcement 01:00 Disclaimer 01:34 Intro 02:45 The setup and guest bio 03:15 How does Dr Topf compensate for difficulty 07:10 What has helped Dr Topf become successful as an educator 10:40 With which electrolyte do you most closely identify? 14:05 Picks of the week 16:05 Nephmadness explained 19:50 Joel’s big picture look at acid base 22:17 Acid base and logorhythmic scale 24:28 A caution about ABGs 27:23 Clinical case from Kashlak Memorial Hospital 28:05 Misinterpretation of low bicarb on a metabolic panel 29:20 Step 1 of acid base 32:00 Metabolic disorders and One Direction 35:15 Acidemia vs acidosis; alkalemia vs alkalosis 37:52 Compensation for acid base disorders 40:45 ABG apps and analyzers 42:40 Step 2 Is there a second primary disorder? Use equations for determining if compensation is appropriate. 51:31 How to determine if respiratory compensation is acute or chronic 54:26 Step 3 The anion gap 57:21 Correcting the anion gap 60:33 What causes a low anion gap? 63:58 Anion gap acidosis 66:05 GOLDMARK 69:15 Step 4 Is there an osmolar gap? 71:48 Toxic ingestions: Methanol, ethylene glycol, and isopropyl alcohol 76:15 Calculating the osmolar gap 79:08 Step 5 Gap-gap calculation aka “the bicarbonate before” 85:05 Choice of IV crystalloid fluid and when to use a bicarbonate drip 88:15 Bicarbonate in DKA 90:18 NephMadness plug 91:10 Outro Tags: acid, base, anion gap, metabolic, respiratory, toxic alcohol, goldmark, mudpiles, albumin, acidosis, alkalosis, compensation, nephrology,  Henderson-Hasselbalch, equation, ABG, VBG, bicarbonate, pCO2, assistant, care, doctor, education, family, foam, foamed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

03.26.2018

#87: Toxicology 101: Talking Tox with The Dantastic Mr. Tox & Howard

Want to look cool like a toxicology consultant, sipping coffee on rounds? Ever check a patient for armpit sweat? Learn the secrets of tox from the titans of toxicology podcasting, The Dantastic Mr. Tox & Howard (AKA Dr. Dan Rusyniak and Dr. Howard Greller), as they loquaciously dish on all things tox. Topics include: how to approach the patient with an unknown overdose, are toxidromes clinically useful, clues on physical exam, is GI decontamination still recommended, and why they hate bupropion and tramadol. We recommend cautious ingestion of fluids while listening because this was a seriously funny episode. Try our Self Assessment Questions Toxicology 101 Quiz. Written and produced by: Christopher Chiu, MD; Graphics by: Beth Garbitelli; Edited by: Matthew Watto, MD 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.  Time Stamps 00:00 Disclosures 00:35 Intro 01:19 Guest bios both real and sarcastic 04:38 Getting to know our guests 06:33 Multiple choice toxicology 09:13 Book recommendations 11:30 Advice for learners and teachers 15:48 Clinical case from Kashlak Memorial Hospital 16:27 Initial approach and some thoughts on toxidromes 21:59 Physical exam, a toxicologist’s approach 27:09 Review of physiology: anticholinergic, cholinergic, sympathomimetic and how to recognize these findings on exam 34:18 Different speech patterns seen in toxicology 35:30 History taking and how much detective work is truly necessary 40:05 The approach to overdose on multiple substances or in setting of polypharmacy 45:52 Seinfeld, ipecac, and the controversy about gastrointestinal decontamination 63:10 Antidotes and when to give them 67:15 EKGs and overdose. Antidote for long QTc versus wide QRS 71:25 Tramadol and Egypt 73:45 Bupropion and bath salts 78:00 Outro Tags: antimuscarinic, anticholinergic, cholinergic, sympathomimetic, overdose, tramadol, bupropion, quetiapine, wellbutrin, seroquel, pupil, overdose, naloxone, narcar, toxicology, tox, toxidrome, poisoning, gi, decontamination, charcoal, ipecac, antidote, dantastic, howard, ekg, qrs, qtc, bicarbonate, assistant, care, doctor, education, family, foam, foamed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

03.19.2018

#86: COPD: Diagnosis, treatment, PFTs, and nihilism

Take a deep breath and tune in to this week’s episode full of COPD diagnosis and management pearls, with expert Dr. Denitza Blagev, a pulmonologist, intensivist, and Medical Director for Quality, Speciality Care at Intermountain Healthcare in Utah with a particular interest in physician wellness and issues related to women in medicine. We cover: history taking, interpreting PFTs, patient counseling, inhalers and medications, exacerbations, antibiotics, steroids, and who needs BIPAP...so basically everything you ever wanted to know about chronic obstructive pulmonary disease. Take our self assessment here. Sponsored by @nephmadness. Registration opens March 15th at AJKDblog.org Written and produced by: Leah Witt, MD, Cyrus Askin, MD. Edited by Matthew Watto, MD 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. Time Stamps 00:00 NephMadness announcement 01:10 Disclaimer 01:45 Intro 03:50 Guest bio 05:03 One liner; What advice would you give our younger self?; Should I do a fellowship?; Book recommendations 10:30 Picks of the week 15:50 Case of COPD from Kashlak Memorial 16:55 Initial approach to a potential case of COPD 18:34 Misdiagnosis of COPD 20:10 Classic spirometry in COPD and GOLD 0 21:30 Diagnosis of emphysema 23:18 Diagnosis of chronic bronchitis 24:54 Counseling the patient with a new diagnosis of COPD 27:00 Spirometry 28:45 How to read PFTs 33:29 How to order PFTs and get what you want 36:00 Why does pre- and post-bronchodilator response matter? 38:45 Asthma COPD overlap syndrome 40:13 Staging of COPD, does it matter? 42:50 Prognosis in COPD 45:00 Therapies with mortality benefit 48:29 Therapies to improve symptoms and prevent exacerbations 52:00 Azithromycin as chronic therapy 53:00 Counseling patients on therapy 55:00 Short acting inhalers in COPD 56:20 Treatment of COPD exacerbations 59:18 Antibiotics, who needs them in exacerbation 61:52 Nebulized inhaled steroids 63:18 Duration of antibiotics and steroids during an exacerbation 66:30 Who needs BIPAP chronically? 69:22 Who needs BIPAP during an exacerbation? 71:33 How often should PFTs be repeated? 73:00 When should we suspect PE in COPD exacerbation? 74:25 Which labs should be check in the initial COPD workup? 76:46 Take home points Tags: copd, chronic, pulmonary, disease, asthma, emphysema, bronchitis, inhaler, nebulizer, steroids, embolism, exacerbation, bipap, cpap, antibiotics, azithromycin, doxycycline, mortality, oxygen, spirometry, dlco, fev1, fvc, pfts, #nephmadness, assistant, care, doctor, education, family, foam, foamed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

03.12.2018

#85: Contraceptives: Pills, mini pills, and tiny pills

Contraception simplified with clinical pearls from reproductive health and family planning experts, Dr Angeline Ti, and Dr Moira Rashid. We cover it all including: the menstrual cycle, mechanism of action for various methods of birth control, hormonal versus nonhormonal contraceptives (e.g. intrauterine devices, patches, pills, rings, implants), patient counseling, and lots of resources to make your job easier. Women’s health correspondent, Dr Molly Heublein returns as cohost. Take our self-assessment quiz! Written by: Molly Heublein, MD, Beth Garbitelli and Sarah Roberts, MPH. Edited by Matt Watto, MD 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. Time Stamps 00:00 Disclaimer 00:35 Intro 01:32 Guest bios 03:45 One liners, app recommendations, picks of the week 09:32 Picks of the week 12:45 Intro to contraception and a clinical case 13:33 Starting a conversation about contraception 16:55 Is having a period needed? And, which agents cause amenorrhea? 19:28 The menstrual cycle reviewed 23:29 Pros and Cons of long acting progesterone only agents 26:55 Choosing between IUDs 30:00 Who should get a copper IUD 30:53 Mechanism of hormonal IUDs 31:37 Risk with IUDs 34:05 Why are there so many OCPs? 36:05 Counseling patients on risks of OCPs 38:00 Risk of breast cancer with hormonal contraception 42:10 Benefits of hormonal contraception 43:38 Migraines and hormonal contraception 44:53 Mono- vs bi- vs triphasic pills. Does it matter? 46:15 Starting dose for OCPs 48:31 Is the mini pill effective? 49:37 Patches and rings 51:15 Take home points 52:40 Whoops, almost forgot emergency contraception! 56:32 How do copper IUDs work? 58:10 The Curbsiders recap the episode, plus some clinical pearls from Molly about birth 65:00 Outro Tags: contraception, birth control, IUDs, LARCs, mirena, skyla, lilletta, Paragard, OCPs, minipill, birth, control, pills, menstruation, follicular, phase, luteal, side, effects, emergency, contraceptives, ulipristal, ella, plan B, levonorgestrel, women’s, health, internal, medicine, internist, primary, care, family, practice, nexplanon, depo-provera, breast, cancer, family, planning, CDC, MEC, eligibility, criteria, bedsiders, pregnancy, ovulation, meded, foamed, nurse, student, physician, assistant, doctor

03.05.2018

#84: Anemia, Iron Deficiency, IV iron, and Tony Stark

Abolish anemia, and iron deficiency w/tips on IV iron therapy from real life iron man, Michael Auerbach, MD, FACP, Clinical Professor of Medicine Georgetown University School of Medicine. Topics include oral versus IV iron therapy, safety of IV iron, ferritin cutoffs, and how to diagnosis/ treat iron deficiency in patients with chronic inflammation, chronic kidney disease, pregnancy, heart failure, and more! Take our Self Assessment Test Here. Images by Beth Garbitelli; Written and produced by Justin Berk, MD and Matthew Watto, MD. 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. Time Stamps 00:00 Disclaimer 00:35 Intro 01:27 Listener feedback 02:35 Guest bio 04:49 Basics of diagnosing iron deficiency, ferritin, soluble transferrin receptor, a new definition 07:09 Getting to know our guest 08:27 Book recommendations 09:33 Brief history of iron deficiency and IV iron 15:20 Iron deficiency from menorrhagia 19:55 IV iron cures symptoms of iron deficiency, pica immediately 20:40 Iron and neurologic symptoms, restless leg syndrome 23:30 Iron restricted erythropoiesis, anemia of chronic inflammation 26:02 Overview of iron absorption 28:35 Iron deficiency without anemia, treatment 33:52 Time to improvement with iron therapy 34:45 Indications for IV iron 38:09 Comparing the oral iron formulations 40:05 Iron deficiency and pregnancy 42:54 Diagnosis of iron deficiency 46:20 Should IV iron be given to patients getting blood transfusion 48:40 Is iron safe during active infection? 49:17 Iron in congestive heart failure 51:50 Questions from social media 53:35 Minor infusion reaction from IV iron 54:35 Comparison of different IV iron formulations 57:35 Take home points 60:35 Outro Tags: iv, iron, ferrous, sulfate, ferric, sucrose, dextran, anemia, deficiency, oral, dosing, fatigue, pregnancy, ckd, heart, failure, chf, bleed, blood, loss, ferritin, transferrin, erythropoiesis, esa, transfusion, reaction, infusion, assistant, care, doctor, education, family, foam, foamed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

02.26.2018
The Curbsiders Internal Medicine Podcast Podcast

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