The Curbsiders Internal Medicine Podcast (The Curbsiders Internal Medicine Podcast)

Polycystic ovary syndrome (PCOS) is more common than we think!  Listen as our esteemed guest Dr Katherine Sherif (@katherinesherif) reviews common patient complaints that should trigger PCOS in the differential, its pathophysiology, key physical exam findings, an algorithm for lab evaluation for PCOS diagnosis, and common treatments (OCPs, metformin, spironolactone and more!).

Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com

Credits

• Written and Produced by: Molly Heublein, MD
• Cover Art and Infographic: Kate Grant MBChB DipGUMed 
• Hosts: Matthew Watto MD, FACP; Molly Heublein, MD
• Editor: Emi Okamoto MD (written materials); Clair Morgan of Nodderly.com (audio)
• Guest: Katherine Sherif, MD

Sponsors

AccessMedicine is the acclaimed online medical resource that features Harrison's Principles of Internal Medicine and more trusted content from the best minds in medicine. Visit  AccessMedicine to learn more: http://bit.ly/MHCurbsiders.

Primary Care Physician Opportunity in beautiful Ithaca, NY! Join a well established practice in beautiful upstate New York near the finger lakes and wine country! You'll have flexible hours and the ability to take the time you need with patients! Contact Dr. Ann Costello arcostello@gmail.com to find out more about this incredible opportunity to join the team at Primary Care Internal Medicine of Ithaca https://www.primarycareinternalmedicineofithaca.com/. 

Time Stamps

• 00:00 Sponsors - AccessMedicine.com (McGraw-Hill)

Stay current with the emerging COVID-19 research including: ACTT-1 (remdesivir), triple therapy with interferon, and conundrums  about SARS-CoV-2 PCR and serologic testing. We’re led by the one and only Curbsider/internist/epidemiologist, Rahul Ganatra MD MPH (@rbganatr). And...just in case you live outside of the habitat for murder hornets and your anxiety about the pandemic had begun to abate, we touch on the CDCs guidance to beware of hungry aggressive rats. Gross!

Show Notes | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | CME!

Credits

• Written and Produced by: Rahul Ganatra MD, MPH, Deborah J. Gorth ScM, Emi Okamoto MD, Sarah P. Roberts MPH, and Matthew Watto MD
• Cover Art: Deborah J. Gorth ScM
• Hosts: Matthew Watto MD, Rahul Ganatra MD MPH, Emi Okamoto MD, and Sarah P. Roberts MPH
• Editor: Matthew Watto MD (written materials); Clair Morgan of nodderly.com

Sponsors: ACP and VCU Health CE

Time Stamps

• 00:00 Sponsors
  
• 00:30 Intro, disclaimer
  
• 02:40 Fomites, groceries and killer rats
  
• 08:22 Sponsor
  
• 09:22 ACTT-1 trial of remdesivir
  
• 18:22 Triple therapy with lopinavir/ritonavir, ribavarin and interferon
  
• 33:10 Background on PCR testing for SARS-CoV-2; How common are false negative PCR tests?
  
• 44:25 Serologic testing for SARS-CoV-2; Utility of antibody testing; Test characteristics
• 50:30 Outro

Summary:

Get a-HEAD of concussions (aka traumatic brain injuries) with tools, tips, and tricks from The Concussion Guy, Dr. Evan Ratner, Medical Director of Gridiron Heroes. Learn to recognize concussions/traumatic brain injury, what questions to ask, physical exam maneuvers, and how to counsel patients and families on safe return-to-learn/play.

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.

Case from Kashlak Memorial: 29F with no significant PMH presents to primary care office less than 24 hours after she accidentally struck her head on the metal of her car door. She experienced temporary altered consciousness lasting about one hour along with a headache. No nausea, vomiting, speech, or vision changes. She rested at home last night, but didn’t feel up to reading, or watching TV. She drove herself to your office today.

Time Stamps

00:00 Intro

02:33 Listener feedback

05:35 Picks of the week

12:15 Getting to know our guest

19:41 Defining and classifying concussion

23:00 What questions to ask your patient

26:34 Physical exam for patient with concussion

28:50 Use of neurocognitive testing in concussion

30:45 Specifics of testing eye movements and balance

35:00 Who needs imaging?

41:51 Recap of what we’ve learned so far

43:40 Can you let someone with a concussion go to sleep?

47:08 Return-to-learn protocol

50:30 Return-to-play protocol

52:30 Post-concussive syndrome

53:55 Medications for post-concussive symptoms

58:58 Second impact syndrome

64:40 Counseling the patient with multiple concussions

67:08 Take home points

69:09 The Curbsiders recap their favorite teaching points

71:30 Outro

Tags: concussion, post, concussive, syndrome, tbi, traumatic, brain, injury, return, play, school, cognitive, rest, treatment, diagnosis, assistant, care, education, doctor, family, foam,

Recap the top pearls from recent shows on vulvovaginitis, cellulitis and bites, MGUS and the SPEP. Tales from the Curbside (TFTC) is pilot project providing a rapid review of recent Curbsiders episodes. Note: There is no CME for this mini-episode but visit curbsiders.vcuhealth.org to claim credit for #244, #246 and #247.

Episodes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME!

Credits

• Written, Produced and Hosted by: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP
• Infographics by: Kate Grant MBChb, MRCGP, Beth Garbitelli and Nora Taranto MD
• Cover Art: Matthew Watto
• Editor: Matthew Watto MD (written materials); Clair Morgan of nodderly.com

Sponsor: The American College of Physicians

Join us for ACP Internal Medicine Meeting 2021: Virtual Experience for 3 days of interactive, livestreaming education and events April 29 through May 1—plus on-demand post-meeting access to CME credit for up to 3 years.

“Early Bird” members get an additional $80 registration discount on top of their member discount. Visit annualmeeting.acponline.org and use the code IM21CURB.

Register now—Early Bird savings end January 31st!

Time Stamps*

*Note: Time Stamps refer to ad free versions.

• 00:00 Intro, disclaimer, guest bio
• 02:35 Vulvovaginitis
• 05:35 Cellulitis and Bites
• 09:45 SPEP it Up
• 15:15 Outro

Our team shares the top pearls of 2020 in our annual recap extravaganza featuring guest host, Chris “The Chiu Man” Chiu @cjchiu. Check out the video version at YouTube. Topics: hypothyroidism, women in medicine, hypothermia, diuretics, heart failure, AKI, lipids, post-op fever, refugee health, SGLT2 inhibitors, euglycemic DKA, UTIs, bat bites, rabies, ILD, statins in NAFLD, framework for hair loss, and more! Plus: Our picks of the year and the Curbsiders gift guide! Note: This episode is not available for CME but #208 through #247 are available for CME/MOC at curbsiders.vcuhealth.org for free!

Episodes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME!

Credits

• Producer: Chris Chiu MD, FACP, FAAP
• Written by: The Curbsiders Team
• Show Notes: Matthew Watto MD, FACP
• Cover Art: Chris Chiu MD, FACP, FAAP
• Hosts: Chris Chiu MD, FACP, FAAP, Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP
• Editor: Matthew Watto MD (written materials); Clair Morgan of nodderly.com
  

Sponsor: Panacea Financial

This episode is supported by Panacea Financial, digital banking built for doctors, by doctors. At Panacea Financial you can have your own free personal banker and a support team that works around the clock- just like you do. Open your free checking account today at panaceafinancial.com

Panacea Financial, a Division of Sonabank, Member FDIC

Get a grip on acute kidney injury (AKI) with Dr. Joel Topf (AKA @kidney_boy), Kashlak’s Chief of Nephrology! We’ve put together an AKI highlight reel - focusing on practical tips and tricks to help you identify, diagnose and manage AKI, plus how to recognize AIN and random myths and musings on vancomycin, NSAIDS, contrast nephropathy, and the risk of NSF from gadolinium. 

Show Notes | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME!

Credits

• Written (including CME questions) and Produced by: Cyrus Askin, MD
• Infographic by: Cyrus Askin, MD
• Cover Art: Kate Grant MBChb, MRCGP
• Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP   
• Editor: Matthew Watto MD, FACP (written materials); Clair Morgan of nodderly.com
• Guest: Joel Topf, MD

Sponsor: Pediatrics On Call 

Sponsor: VCU Health CE - Check out curbsiders.vcuhealth.org and create your FREE account!

Time Stamps

• 00:00 Intro
  
• 03:00 Guest one-liner, Picks of the Week*: Zoe Keating albums (Cellist); Mrs. America (TV series) on FX; The Last of Us (Videogame);
  
• 08:45 Sponsor
  
• 09:15 Definition of acute kidney injury (AKI) and fundamentals
  
• 11:00 Cardiorenal syndrome
  
• 12:24 Schema for AKI
  
• 17:30 Establish an etiology, determine urine output and address electrolyte abnormalities
  
• 21:22 AKI in the otherwise-healthy patient;
  
• 32:20 Rhabdomyolysis
38:21 Vancomycin
  
• 41:43 Acute interstitial nephritis (AIN)
  
• 44:52 Contrast induced nephropathy (CIN)
  
• 50:37 Gadolinium in AKI and/or CKD
  
• 52:53 Timing of dialysis
  
• 56:37 AKI in the out-patient setting and how to handle home meds e.g. TMP-SMX, RAAS inhibitors;
  
• 62:01 Is Ultrasound necessary in AKI
• 64:58 Dr. Topf’s take home points and Plug for Seminars in Nephrology

Join us for this recap of the key clinical pearls and favorite fan voted episodes from 2017 including: lipids, asthma, diuretics, hyponatremia, CKD, vertigo, and dizziness. Plus, Picks of the Year, exciting announcements for 2018, and Paul reveals that he has a wife! Matt, and Paul are joined by Curbsiders Correspondent, Dr. Chris Chiu, who wrote and produced this episode. Stuart was out with the Man Flu. My apologies to Dr. Bryan Brown whose name I forgot to shout-out when listing our Correspondents. Thanks to Kate Grant for her beautiful cover image.

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 Intro
• 01:18 Getting to know Chris Chiu introduction
• 03:07 Picks of the week and
• 06:10 Picks of the year and discussion of vancomycin and pip-tazo causing AKI
• 11:41 Recap of Scott Weingart and EM vs IM episode
• 17:45 Discussion of Lipids, PCSK9, CAC, CCTA
• 27:10 Asthma pearls recapped
• 32:43 Dizziness and vertigo recapped
• 38:40 Diuretics, diuretic resistance, and secondary hypertension diagnosis and treatment
• 44:35 Diuretic dosing
• 46:25 Hyponatremia, volume status, solute loads and SIADH
• 50:08 CKD, when to refer, and an argument about low protein diets
• 54:25 Matt, Paul, and Chris reflect on important lessons learned from 2017
• 59:32 Listener questions and comments
• 63:35 Wrap-up, and shout outs
• 66:22 Announcements for 2018
• 67:25 Outro

Tags: hyponatremia, salt, kidney, ckd, asthma, vancomycin, zosyn, injury, weingart, emcrit, emergency, lipids, pcsk9, statin, dizziness, vertigo, assistant, care, education, doctor, family, foam, foamed, health, hospitalist, hospital, internal, internist, nurse, meded, medical, medicine, practitioner, professional, primary, physician, resident, student

Dominate the diagnosis and management of dementia with tips from international expert Dr. Stephen Dekosky, Professor of Neurology, and deputy director of the McKnight Brain Institute at the University of Florida. Filled with clinical pearls, we cover everything from basic testing to advanced imaging modalities, as well as current and future therapies for dementia. This episode is a must listen. Big thanks to the American Academy of Neurology for setting up this interview.

Full show notes are available at http://thecurbsiders.com/podcast

Join our newsletter mailing list. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. 

Time Stamps

00:00 Intro

02:20 Rapid fire questions

04:40 Defining dementia

08:40 Choosing a clinical test for dementia

17:20 Diagnostic labs

19:00 Genetic and CSF testing

25:46 Advanced brain imaging

28:18 Preclinical Alzheimer’s disease (AD)

32:17 Routine CNS imaging

36:18 Initiating medical therapy

39:35 Differentiating MCI and dementia

41:45 Vascular Dementia

44:10 CSF testing for AD

45:15 Vitamins, supplements, and foods as treatment or prevention

50:56 Mental exercise for AD prevention

52:36 Anticholinergic, benzos and dementia

54:46 Future directions

57:55 Outro

Tags: Alzheimers, assistant, care, education, dementia, disease, doctor, family, foam, foamed, health, hospitalist, hospital, internal, internist, neurology, nurse, medicine, medical, mri, pet, primary, physician, resident, student, vascular

Blazing hot tips to diagnose and treat hyperthyroidism with Dr Eve Bloomgarden, @evebmd (Northwestern). We cover a ton of ground including how to: interpret thyroid function tests, use your thumbs (or an ultrasound) to examine the thyroid, become an expert on Graves’ orbitopathy, prescribe methimazole and decide who needs surgery or radioactive iodine therapy. Plus, a bit on subclinical hyperthyroidism. This episode is on fire!

Show Notes | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME!

Credits

• Written and Produced by: Tima Karginov and Matthew Watto MD, FACP
  
• Infographic by: Tima Karginov
  
• Cover Art: Kate Grant MBChb, MRCGP
  
• Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP
  
• Editor: Matthew Watto MD, FACP (written materials); Clair Morgan of nodderly.com
  
• Guest: Eve Bloomgarden MD
  

Sponsors: Pediatrics On Call podcast by the American Academy of Pediatrics

If you provide medical care to children, Pediatrics On Call — the new podcast from the American Academy of Pediatrics — will help you do it better. Each week, hear the latest news and research on children's health, on topics from obesity and mental health to keeping the kiddos safe when they’re stuck at home. Subscribe from your favorite podcast provider or find the latest episodes here.

VCU Health CE

The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit.

Time Stamps

• 00:00 Intro
  
• 03:15 Guest one-liner, favorite failure, Picks of the Week*
  
• 08:50 Sponsor
  
• 10:37 Background, Definition of Hyperthyroidism, thyrotoxicosis; Basic labs
  
• 14:20  Case from Kashlak, Symptoms of Hyperthyroidism
  
• 25:00 Grave’s eye disease: exam, therapy and counseling
  
• 32:35 Thyroid exam and ultrasound
  
• 38:55 Thyroid Stimulating Immunoglobulin
  
• 41:00 Biotin
  
• 44:30 Thyroid Scintigraphy
  
• 49:00 Causes of Thyrotoxicosis
  
• 52:00 Treatment & Adherence to antithyroid medication (methimazole)
  
• 56:20 Beta Blockers in thyrotoxicosis
  
• 64:50 Subclinical Hyperthyroidism
• 67:00 Take Home Points, Outro

Join us in this roundtable discussion of patients before paperwork, administrative burden, the new CMS payment model proposal, and a bit on health insurance with cohost, Fatima Syed MD MSc and guest, Deep Shah MD MSc. Doctors Syed and Shah are both early career physicians with masters degrees in comparative social policy from Oxford University and are active members of the American College of Physicians. ACP members can visit https://acponline.org/curbsiders to claim free CME-MOC credit for this episode.

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: Fatima Syed MD MSc and Matthew Watto MD

CME questions by: Matthew Watto MD

Hosts: Fatima Syed MD MSc, Matthew Watto MD

Guest: Deep Shah MD MSc

Time Stamps

• 00:00 Disclaimer, intro, and guest bios
• 02:18 Guest one liners, book recommendations, picks of the week
• 11:00 Administrative burden
• 16:00 Will the documentation problem get better? Suggestions for improvement
• 25:11 Why do CMS rules spread to the private insurance sector?
• 29:30 What innovations might reduce administrative burden?
• 32:40 The Affordable Care Act, health insurance, price transparency
• 40:20 Take home points
• 43:20 Outro

Throw out your down pillows and join The Curbsiders for this lively discussion on interstitial lung disease. While the hundreds of interstitial lung disease types make this topic a bit overwhelming, breathe easy knowing that pulmonologist, Dr. Erin Narewski @erinnarewski (Temple), can boil things down to an easy to approach framework in less time than it takes to complete a few 6-minute walk tests. In this episode, we walk through the classification, relevant patient history, workup, and management of interstitial lung disease.

Show Notes | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | CME!

Credits

• Written and Produced by: Paul Williams, MD, FACP; Nicole Kus, David Madnick, and Peter Wikoff
  
• Infographic and Cover Art: Edison Jyang
  
• Show Notes: Deborah Gorth
  
• Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP
  
• Editor: Paul Williams MD, FACP (written materials); Clair Morgan of nodderly.com
  
• Guest: Erin Narewski DO, FCCP
  

Sponsor: ACP membership acponline.org/member

Sponsor: VCU Health CE - Check out curbsiders.vcuhealth.org and create your FREE account!

Time Stamps

• 0:00  Intro
  
• 03:14 Guest one-liner, career advice, favorite failure, Picks of the Week*: The Strain, FX Horror TV Show; One Hundred Years of Solitude (book) by Gabriel Garcia Marquez; Hypoallergenic pillows; Peanut butter whiskey
  
• 10:02 Sponsor - Join the ACP community! Be IM Proud Visit acponline.org/member and use the code ACPDISCOUNT
  
• 11:00 Case from Kashlak, Definitions
  
• 16:40 Buckets of ILD
  
• 32:06 Discussion of testing ILD: Labs and Imaging
  
• 44:20 Imaging findings in ILD
  
• 49:44 Basic Management of ILD
• 61:00 Take home points and Outro

Take a trip down memory lane with top clinical pearls and favorite moments from The Curbsiders in 2018.

Welcome to our 2018 Recap Extravaganza! Since last year, the Curbsiders team has grown substantially and the podcast has undergone several exciting developments. These include our collaboration with ACP that allows us to provide CME and MOC credit for select episodes, our new partnership with Human Dx as featured in our Kashlak Morning Reports, and the launch of our Women in Medicine series. For our 2017 year-end show, we had listeners vote for their favorite episodes from the past year. This year, we're changing it up a bit and have invited our Curbsider colleagues to share their picks for pearliest pearls and most illuminating episodes of 2018. We hope you’ll enjoy hearing the team’s highlights, and we’ll be back in 2019 with fresh content. Note: No CME-MOC credit for this episode, but stay tuned in 2019 for eligible episodes.

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: Chris Chiu MD and Sarah Phoebe Roberts, MPH

Hosts: Matthew Watto MD, Paul Williams MD, Stuart Brigham MD, Chris Chiu MD

Edited by: Chris Chiu MD

Time Stamps

• 00:00 Disclaimer, Intro
• 06:39 Clinical Reasoning Pearls
• 12:35 Pulmonary Hypertension Pearls
• 15:52 Women In Medicine Pearls
• 20:40 Iron Deficiency Pearls
• 24:52 Tick-Borne Illness Pearls
• 28:00 STI Pearls
• 31:00 Physical Exam Pearls
• 32:51 “Things we do for no reason” Pearls
• 36:16 Host Picks
• 42:38 Paul Wraps-up the Year
• 43:38 Outro and Curbsider Team sign-offs

• 00:00 Disclaimer
• 01:30 Introducing our new Correspondent Jordy
• 03:05 Listener feedback
• 04:40 Guest bio
• 06:25 Getting to know Dr Ryan
• 09:33 Picks of the week
• 15:20 Clinical case
• 16:35 How to explain pulmonary hypertension to a patient
• 18:12 Groupings of pulmonary HTN
• 21:20 Taking a history. Ask these questions.
• 23:30 Physical exam
• 25:45 Initial testing
• 27:40 Overnight pulse oximetry
• 29:00 Echo findings in pulmonary HTN
• 31:30 Transpulmonary gradient
• 33:33 What is a normal pulmonary artery pressure
• 35:15 Accuracy of PA pressure estimate by echo
• 39:04 Mechanism of shortness of breath in PH
• 40:10 Should you hold PAH meds in a hypotensive patient?
• 41:55 Therapy for PH and follow up
• 46:28 Who to refer
• 47:40 PAH risk factors
• 52:09 Mortality in PH
• 58:22 Take Home Points & Outro

• Written and produced by: Shreya Trivedi MD
• Graphics and Show Notes by: Hannah R Abrams
• Hosts: Paul Williams MD, FACP; Stuart Brigham MD; Matthew Watto MD, FACP; Shreya Trivedi MD
• Guest: Abby Spencer MD, MS, FACP

• 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

Explore the essentials of Wilderness Medicine and prepare yourself for austere environments as we discuss Altitude Sickness, Frostbite, Animal Bites, Thermoregulation, Wound Care and the proper way to apply a tourniquet.

Thinking about outdoor escapes and vacations now more than ever? Listen as our esteemed guest Dr. Thomas DeLoughery @Bloodman (Oregon Health & Science University) takes us through the fascinating, and at times chilling, world of Wilderness Medicine. This episode will empower you to explore the great outdoors as safely as possible.  We discuss the breadth of wilderness medicine, multiple unique clinical entities encountered in austere environments, and practical ways to protect yourself and others on your adventures.  This episode is truly wild!

Listeners can claim Free CE credit through VCU Health at http://curbsiders.vcuhealth.org/ (CME goes live at 0900 ET on the episode’s release date). 

Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME!

• Written, Produced, and Infographic by: Avital O’Glasser MD, FACP, FHM
• Show Notes: Deborah Gorth ScM and Avital O’Glasser MD, FACP, FHM
• Cover Art: Kate Grant, MD
• Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP; Avital O’Glasser MD, FACP, FHM
• Editor: Matthew Watto MD, FACP (written materials); Clair Morgan of nodderly.com
• Guest: Thomas DeLoughery MD, MACP, FAWM

Provider Solutions & Development is a community of experts dedicated to offering guidance and career coaching to physicians and clinicians throughout their entire career journey. With exclusive access to hundreds of opportunities across the nation, reach out today to begin the search for your perfect practice: www.psdrecruit.org/curbsiders.

The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit. See info sheet for further directions. Note: A free VCU Health CloudCME account is required in order to seek credit.

• Sponsor - Provider Solutions and Development https://curbsiders.vcuhealth.org/
• Sponsor - VCU Health CE curbsiders.vcuhealth.org   
• 00:00 Intro, disclaimer, guest bio
• 03:45 Guest one-liner, advice and Picks of the Week*
• 08:10 Sponsor - Provider Solutions and Development https://curbsiders.vcuhealth.org/
• 09:00 Case of mountaineering; What is Wilderness Medicine?

• 12:05 What’s in your first aid kit?

• 21:36 Altitude sickness: acute mountain sickness, high altitude cerebral edema and High altitude pulmonary edema

• 31:25 Hypothermia  
• 39:36 Frostbite 

• 47:25 Hyperthermia: Heat exhaustion and Heat stroke; How much water should you drink?

• 51:55 Bat bites and rabies

• 58:20 Snake bites

• 66:03 Wound care and tourniquets

• 75:40 Take Home Points; Outro; Bonus clip
• Sponsor - VCU Health CE curbsiders.vcuhealth.org   

1. De Gaulle by Julian Jackson 
2. Command and Control by Eric Schlosser
3. Auerbach's Wilderness Medicine, 2-Volume Set 
4. Whatever book Paul said he was reading, sounds nerdy (The First Law Trilogy) 
5. Wilderness Medicine Society
6. Stop The Bleed: Home 
7. Into Thin Air: A Personal Account of the Mt. Everest Disaster by Jon Krakauer
8. National Outdoor Leadership School
9. Advanced Wilderness Life Support 
10. Inside the ER at Mt. Everest 
11. Annapurna by Maurice Herzog 
12. K2, The Savage Mountain: The Classic True Story Of Disaster And Survival On The World's Second-Highest Mountain– by Charles Houston and Robert Bates 

*The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on our Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra.

Listeners will learn the basics of wilderness medicine and how to approach a few common conditions. 

After listening to this episode listeners will…  

1. Appreciate Wilderness Medicine as a medicine subspeciality and understand why or how someone might pursue this clinical focus area
2. Recognize signs and symptoms of high altitude sickness
3. Develop an approach to treating animal bites and injuries
4. Learn high yield tips for administering first aid in the wilderness including field hemostasis

Dr DeLoughery reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures. 

O’Glasser AY, Gorth D, Deloughery T, Williams PN, Watto MF. “#242 Wilderness Medicine: Prfor Disaster”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list Original air date November 16, 2020.

Wilderness Medicine, Travel medicine, first aid, first aid kit, altitude sickness, acute mountain sickness, high altitude cerebral edema, high altitude pulmonary edema, acetazolamide, dexamethasone, hypothermia, frostbite, frostnip, heat exposure, heat exhaustion, heat syncope, hyperthermia, hyponatremia, animal bites, bats, rabies, snakes, antivenom, wound care, tourniquet, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

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

• 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

• Producer: Elena Gibson and Carolyn Chan
• Writer: Carolyn Chan
• Infographic: Elena Gibson
• Cover Art: Elena Gibson
• Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP 
• Editor: Matthew Watto MD (written materials); Clair Morgan of nodderly.com
• Guest:  Dr. Stefan Kertez and Dr. Ajay Manhapra

• 00:00 Intro
• 01:58 Host picks of the week
• 04:10: Intro to the episode
• 04:35: Guest Bios
• 12:32: Case from Kashlak Memorial
• 13:40 Define substance dependence, substance use, unhealthy use
• 17:42 Where to go next conversation about pain control
• 17:54: Assessing risk of relapse
• 19:35 Screening Tools
• 20:10 Risk factors for developing OUD when initiating opioids.
• 25:10: CDC Guidelines length of prescription and risk of substance use disorder (7)
• 27:00: Defining optimal length of opioid after common surgical procedures (6)
• 30:30: Long term use of opioids
• 33:50: OUD treatment options
• 37:30: Duration of buprenorphine/naloxone treatment, tapering risks (8)
• 38:50: POATs: Prescription opioids (9)
• 40:05 Social support and mental health services for SUD treatment
• 41:10 Risk of abstinence and adverse outcomes
• 42:35 Protracted withdrawal
• 43:35: Editorial BMJ Golden Month of Opioid use disorder (10)
• 44:00 Overdose risk in patients on long term opioids
• 44:40 Op-Ed on the Hill (11)
• 45:40 Example of protracted withdrawal syndrome
• 47:40 Reducing Harms: Naloxone, who to prescribe to?
• 50:30 Take home points
• 53:40 Outro

Delve into the diagnosis and management of GERD and dyspepsia with Dr. Amy Oxentenko (@AmyOxentenkoMD), Gastroenterologist and the Internal Medicine Residency Program Director, Associate Chair for the Department of Internal Medicine, and Professor of Medicine at Mayo Clinic in Rochester, MN. Our discussion features a review of the standard presentations of GERD and dyspepsia, alarm symptoms and who needs referral for endoscopy or other specialized testing (pH, impedance testing, screening for Barrett’s esophagus). Additionally, we comprehensively cover proton pump inhibitor (PPI) therapy including: choice of agent, dose, frequency, how taper, how to counsel patients about risk, what labs should be monitored and the use of adjuvant therapies like H2 blockers, antacids and even carafate. After this episode, you will be flexing on reflux!

ACP members can claim CME-MOC credit at https://www.acponline.org/curbsiders (CME goes live at 0900 ET on the episode’s release date). 

Show Notes | Subscribe | Spotify | Schwag! | Top Picks | Mailing List | thecurbsiders@gmail.com

Credits

• Written and Produced by: Paul Williams MD, FACP, Beth Garbitelli
• CME Questions: Beth Garbitelli, Matthew Watto MD, FACP
• Infographic: Beth Garbitelli 
• Cover Art: Kate Grant MBChB DipGUMed
• Hosts:  Matthew Watto MD, FACP; Paul Williams MD, FACP   
• Editor: Matthew Watto MD, FACP (written materials); Clair Morgan at Nodderly.com
• Guest: Amy Oxentenko MD

Time Stamps

• 00:00 Intro, disclaimer, guest bio
• 02:47 Guest one-liner, Picks of the Week*: Reality TV Shows: Survivor  and

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

Stop the madness! Diagnose and treat neuropathy like expert guest, Dr. Grace Kimbaris, Assistant Professor of Clinical Neurology from University of Pennsylvania. We cover the basics along with some random pearls on fluoroquinolones, small fiber neuropathy, alpha lipoic acid, and more! 

For full show notes visit http://thecurbsiders.com/podcast. 

Join our newsletter mailing list. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Tags: assistant, care, education, doctor, family, foam, foamed, health, hospitalist, hospital, internal, internist, nurse, medical, medicine, nerve, neuropathy, primary, physician, resident, student

Learn about the latest in COVID-19: Do masks prevent infection?, SARS-CoV-2 home testing, vaccine advice, and how to prevent and treat VTE in COVID-19. Join us as our tzar-of-clinical-appraisal Curbsider/internist/epidemiologist Rahul Ganatra MD MPH (@rbganatra) talks us through the controversial DANMASK-19 trial, plus Watto reports back on his conversation with Dr Parth Rali @parthrali (Temple Lung Center) who helped write the CHEST anticoagulation guidelines for COVID-19.

Episodes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME!

Credits

• Producer: Deb Gorth ScM
• Show Notes, Cover Art, and CME by: Deb Gorth ScM and Matthew Watto MD
• Written by: Matthew Watto MD, Paul Williams MD, and Rahul Ganatra MD MPH
• Hosts: Rahul Ganatra MD MPH, Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP
• Editor: Matthew Watto MD (written materials); Clair Morgan of nodderly.com
  

Sponsor: ACP’s I Raise the Rates

Join with other clinicians in working to raise influenza and other adult vaccination rates. Visit acponline.org/ai to access free tools and learn new strategies to support your efforts.

Sponsor: VCU Health CE

The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit.

Time Stamps

• 00:00 Intro, disclaimer, Picks of the week* and Vaccines
• 08:00 DANMASK-19
• 25:00 Anticoagulation in COVID-19
• 35:06 COVID-19 home PCR testing
• Outro
  

Get under the hood of SGLT2 inhibitors! Listen as our guests Dr. Harish Seethapathy, Dr. Matt Sparks, and Dr. Joel Topf give us a tour through the NephMadness 2020 SGLT2i region! How do these promising drugs work, and what evidence is there for using them in non-diabetic kidney disease or kidney transplant patients. Show Notes | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com

Credits

• Written and Produced by: Hannah R. Abrams
  
• Cover Art and Infographic by: Hannah R. Abrams
  
• Hosts: Hannah R Abrams, Matthew Watto MD, FACP
  
• Editor: Clair Morgan of Nodderly.com (audio), Emi Okamoto MD (written)
  
• Guests: Harish Seethapathy MD; Matthew Sparks MD; Joel Topf MD
  

Sponsor: McGraw Hill

Time Stamps

• 00:00 Sponsor
  
• 00:26 Intro, disclaimer, guest bio
  
• 02:57 Guest one-liner and Picks of the Week*: Michael Pollan audiobook on Coffee and Caffeine Addiction
  
• 03:52 SGLT2i definition, background, and why we now consider CV endpoints in diabetes
  
• 11:16 Sponsor
  
• 12:00 Tubuloglomerular feedback; Balloon analogy
  
• 17:40 Other mechanisms for SGLT2i
  
• 23:05 Back to the case; Risks from SGLT2i; Counseling and Monitoring
  
• 34:18 SGLT2i for non-diabetic kidney disease; Possible mechanisms: Joel’s caution against early adoption
  
• 41:42 SGLT2 inhibitors in kidney transplant
  
• 45:20 Take home points and picks for the SGLT2 inhibitor region
• 49:50 Outro

How to initiate buprenorphine like a pro. Treating people with Opioid Use Disorder can be the most rewarding part of your practice!  Get comfortable with counseling and pharmacotherapy for OUD with tips from Dr. Michael Fingerhood, Associate Professor of Medicine at Public Health at Johns Hopkins.  We review building a therapeutic relationship with people with substance use disorders, the differences between the three FDA-approved medications for opioid use disorder (buprenorphine, methadone and extended-release naltrexone), and the nitty-gritty of prescribing buprenorphine.

ACP members can claim CME-MOC credit at https://www.acponline.org/curbsiders (CME goes live at 0900 ET on the episode’s release date). 

Show Notes | Subscribe | Spotify | Schwag! | Top Picks | Mailing List | thecurbsiders@gmail.com

Credits

• Written and Produced by: Justin Berk, MD MPH MBA, Joseph “Seffy” Muller MD
• Infographic: Hannah R Abrams and Justin Berk MD, MPH, MBA
• Cover Art: Kate Grant MBChB DipGUMed
• Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP, Justin Berk, MD MPH MBA
• Editor: Matt Watto MD, FACP (written materials), Clair Morgan at Nodderly.com (audio)
• Guest: Michael Fingerhood MD

Time Stamps

• 00:00: Introduction
• 04:40: Guest introduction & questions (great stories about addiction)
• Picks of the Week*: Papillon (film) and Papillon (book) per Dr. Fingerhood;

• Written and produced by: Paul Williams MD
• Edited by: Matthew Watto MD
• Hosts: Matthew Watto MD, Stuart Brigham MD, Paul Williams MD
• Guest: Adam Ehrlich MD

• 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

Optimize perioperative risk and dominate perioperative medicine. Topics include surgical risk calculators, preoperative labs, stress testing, use of BNP and troponins, postoperative MI, cardiac and pulmonary risk stratification, and more! We’re joined by perioperative medicine expert, Avital O’Glasser MD, Associate Professor of Medicine at Oregon Health & Science University and Assistant Program Director for Scholarship and Social Media. 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: Matthew Watto MD

CME questions by: Matthew Watto MD

Hosts: Matthew Watto MD, Stuart Brigham MD

Edited by: Matthew Watto MD

Guest: Avital O’Glasser MD

Time Stamps

• 00:00 Disclaimer, intro and guest bio
• 04:20 Guest one-liner, book and movie recommendations, career advice
• 11:20 ACP Internal Medicine Meeting 2019 details
• 14:02 Patient with coronary artery calcifications going for elective hip surgery and wants "clearance"
• 20:50 Functional capacity
• 25:00 Preoperative stress testing and coronary revascularization
• 31:55 Canadian guidelines, BNP and troponin testing
• 36:30 The METS trial and predicting perioperative cardiac events and mortality
• 40:44 Preoperative testing (labs, imaging, urine studies)
• 50:24 Choosing your perioperative cardiac and surgical risk calculator (RCRI, MICA, ACS-NSQIP)
• 59:50 Communicating risk to patient and their surgeon
• 61:30 Pulmonary risk assessment and complications
• 70:35 Perioperative use of opioids
• 75:30 Who needs an echocardiogram prior to surgery?
• 79:00 Canceling a patient's surgery
• 82:55 Take home points
• 83:45 Outro

Practice solving diagnostic puzzles with The Curbsiders and Internist / Diagnostician, Reza Manesh MD, Assistant Program Director for Clinical Reasoning of the Osler Medical Training Program at Johns Hopkins! Solve along with us at these links: Case 1 http://hdx.org/I2B and Case 2 http://hdx.org/uM2. Topics include: clinical reasoning terminology, how to use cases to practice diagnostic reasoning, how to build a diagnostic schema, and how to conduct your own cognitive autopsy.

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: Hannah Abrams

Hosts: Hannah Abrams, Paul Williams MD, Stuart Brigham MD, Matthew Watto MD

Guest: Reza Manesh MD

Special thanks to: Doctors Steph Sherman, Zaven Sargsyan, Anand Jagannath, John Inou Hwang, and Rabih Geha for contributing cases

Time Stamps

• 00:00 Disclaimer, intro and guest bio
• 04:02 Guest one liner, book recommendation, favorite failure, advice for learners
• 11:27 Human Dx Project and Global Morning Report
• 15:35 Diagnostic terminology
• 21:25 Case #1, Reza solves
• 33:40 Diagnostic autopsy and teaching points for case #1
• 38:00 Case #2, The Curbsiders solve
• 57:30 Diagnostic autopsy and teaching points for case #2
• 61:33 Take home points and a plug
• 64:30 Outro

Does the thought of managing acute decompensated heart failure (ADHF) give you paroxysmal nocturnal dyspnea?  Recline for a bit while Dr. Michelle Kittleson MD, PhD @MKittlesonMD (Cedars Sinai) takes us through the Zen of jugular venous pressure (JVP) exams, how to approach diuresis, and the fine points of hospital discharge. This knowledge food is easier to swallow than an oral potassium replacement.

Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME!

Credits

• Written and Produced by: Deborah Gorth ScM
  
• Cover Art and Infographic by: Edison Jyang
  
• Hosts: Matthew Watto MD, FACP and Paul Williams MD, FACP
  
• Editor: Cyrus Askin MD (written materials); Clair Morgan of nodderly.com
  
• Guest: Michelle Kittleson MD, PhD
  

Sponsor - VCU Health CE

The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit.

Time Stamps

• 00:00 Intro
  
• 02:40 Guest one-liner; Picks of the Week
  
• 08:33 Case from Kashlak part 1, Definition of acute decompensated heart failure (ADHF), Factors that lead to ADHF (FAILURE mnemonic)
  
• 13:39 Historical clues for ADHF; Is salt restriction needed? Fluid restriction?
  
• 20:42 More on History and Physical exam for ADHF; JVP exam in detail; Crackles are worthless?!
  
• 28:36 Labs to trend during an ADHF admission
  
• 33:15 Recap of history, physical exam, and initial approach; Initiating diuresis; Goal urine output; Diuresis in HFrEF vs HFpEF phenotypes
  
• 45:32 Diuretic resistance and when to use a drip, metolazone; Do K and Mg need to be 4 and 2?
  
• 49:05 When to hold guideline directed medical therapy (Beta blockers, ARNI, ACEI/ARB)
  
• 56:05 Who needs a right heart cath?
  
• 59:30 Endpoints for discharge; Switch to PO diuretics; Approach to discharge and transitions of care
  
• 64:04 SGLT2i in heart failure
• 68:15 Take home points and outro

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

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

Lipids Update! Get up close and personal with ASCVD prevention and lipid management guidelines, including changes in the 2018 update, with our discussion with Dr. Erin Michos @erinmichos, preventive cardiologist and associate professor of medicine at the Johns Hopkins University Hospital! We review the background on the ASCVD risk calculator, basics of primary and secondary prevention, statins benefits and misconceptions, appropriate follow up, cool things to look out for in the future, the deal with medications like aspirin and icosapent ethyl, among many other things! If that wasn’t enough, Dr. Michos also goes over great ways to counsel patients on healthy living and when that darn statin is giving you the “muscle aches”! 

ACP members can claim CME-MOC credit at https://www.acponline.org/curbsiders (CME goes live at 0900 ET on the episode’s release date). 

Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com

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Credits

• Producers: Christopher Chiu MD FACP FAAP; Jasneet Devgun DO; Justin Berk MD MPH MBA; Beth Garbitelli 
• Writers: Jasneet Devgun DO; Justin Berk MD MPH MBA
• Infographic: Beth “Garbs” Garbitelli
• Cover Art: Kate Grant MBChB DipGUMed
• Hosts: Christopher Chiu MD FACP FAAP; Matthew Watto MD FACP; Paul Williams MD FACP   
• Editors: Emi Okamoto MD (written materials); Clair Morgan of Nodderly.com (audio)
• Guest: Erin Michos MD MHS

Sponsor

ACP's Internal Medicine Meeting 2020 April 23-25th in Los Angeles, CA at the LA Convention Center. Early bird rates are available through January 31, 2020. Don’t forget to use the code: IMCURB20

Time Stamps

• 00:00:00 Intro
• 00:01:52 Getting to know Dr. Erin Michos
• 00:O6:50 Picks of the Week*: Sparking Joy- concept for Marie Kondo (book and

• Written and Produced by: Alex Glaser MD 
• Cover Art: Matthew Watto MD, FACP
• Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP
• Editor: Emi Okamoto MD; Matthew Watto MD, FACP
• Guests: Alex Glaser MD, Saumil Chudgar MD

DVT / PE Triple Distilled! Our favorite VTE pearls summarized in this fast paced recap gleaned from our discussions with Dr Oren Friedman #92 Pulmonary Embolism for the Internist and hematologist, heavy metal enthusiast, Dr Michael Streiff #154 DVT and PE Master Class. Introducing our new Triple Distilled sub-series offering shorter episodes that reinforce and refresh key concepts from past shows along with any pertinent updates. 

Listeners can claim 2 hours of Free CE credit through VCU Health at http://curbsiders.vcuhealth.org/ (CME goes live at 0900 ET on the episode’s release date). 

Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME!

• Written and Produced by: Matthew Watto MD, FACP
• Cover Art by: Matthew Watto MD, FACP
• Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP   
• Editor: Matthew Watto MD (written materials); Clair Morgan of nodderly.com

The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit. Note: A free VCU Health CloudCME account is required in order to seek credit.

• 00:00 Intro, disclaimer
• 01:40 Making the diagnosis of VTE
• 09:07 Triage and risk stratify Pulmonary Embolism
• 14:00 Anticoagulant choice; Duration of therapy after unprovoked DVT / PE
• 21:00 Workup for unprovoked DVT / PE; DOACs in special populations: at extremes of weight,  advanced CKD and in antiphospholipid syndrome
• 28:22 IVC filters 
• 30:20 Outro

Check out the full show notes from previous Curbsiders’ shows covering VTE. 

1. Dr Oren Friedman #92 Pulmonary Embolism for the Internist 
2. Dr Michael Streiff #154 DVT and PE Master Class

Listeners will feel confident in the diagnosis and management of VTE

After listening to this episode listeners will...

• Diagnose (VTE) DVT and PE using imaging, risk scores and clinical gestalt

• Risk stratify patients with pulmonary embolism

• Choose the appropriate initial anticoagulant for VTE

• Decide duration of anticoagulation for VTE

• Recall real risks and questionable benefits of IVC filters in DVT / PE

• Determine need for cancer or thrombophilia workup in unprovoked DVT / PE

The Curbsiders report no relevant financial disclosures. 

Watto MF, Williams PN, Brigham SK, Watto MF. “#238 DVT / PE Triple Distilled”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list Final publishing date October 22, 2020.

Pulmonary embolism, vte, dvt, pe, heparin, anticoagulation, right ventricle, RV, left ventricle, LV, circulation, hypotension, shock, IVC filter, TPA, echocardiogram, CT scan, bleed, clot, deep, vein, thrombosis, DOAC, NOAC, anticoagulation, d-dimer, Wells, primary care, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

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,

Hone your diagnostic skills with this mystery case of cough and dyspnea http://hdx.org/pdp (click link to follow along). The Curbsiders deconstruct the case and discuss their diagnostic schemas for these common problems with the help of returning guest, Reza Manesh MD, editor of Global Morning Report at The Human Diagnosis Project aka Human Dx.

Use this link http://hdx.org/pdp to follow along with the case on the Human Dx app or website and check out more Global Morning Report cases.

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: Hannah R Abrams

Hosts: Matthew Watto MD, Paul Williams MD, Stuart Brigham MD

Edited by: Matthew Watto MD

Guest: Reza Manesh MD

Special thanks to: Steph Sherman, Zaven Sargsyan, Anand Jagannath, John Inou Hwang, and Rabih Geha for contributing and editing the cases; and to Tyler Brandon for helping to coordinate these wonderful episodes.

Time Stamps

• 00:00 Announcement, disclaimer, intro, guest bio
• 03:13 When and how to practice clinical reasoning
• 05:53 Creating diagnostic schemas and Clinical Problem Solvers Podcast
• 09:40 A bit on Human Dx and the show format
• 12:00 Case of a 40 yo male with a cough
• 23:22 Some insights from Reza on “signal versus noise”
• 37:10 Case conclusion/answer, cognitive autopsy and Reza’s take home points
• 45:36 Outro

Learn how to approach the geriatric patient with multimorbidity and how to parse through and prioritize a mile-long problem list with Dr Josh Uy, master geriatrician at the University of Pennsylvania. We review different approaches to a clinic visit with a patient who takes fifteen daily medications with just as many chief complaints, all in a thirty minute (or less!) appointment time. We discuss what the term “multimorbidity” even means, how to ask about patient preferences and use them to inform the treatment plan, and what the evidence has to say about adjusting treatment goals of common conditions for individual patients. (Spoiler alert: It all depends on the patient, comorbid conditions and goals!) 

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

Credits

• Producer: Nora Taranto MD 
• Writer:  Nora Taranto MD, Leah Witt MD 
• Infographic:  Leah Witt MD 
• Cover Art: Nora Taranto MD 
• Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Leah Witt MD, Paul Williams MD, FACP
• Editor: Matthew Watto MD, FACP; Clair Morgan
• Guest: Josh Uy MD

Time Stamps

• 00:00 Pun, Intro, disclaimer, guest bio
• 04:30 Guest one-liner; Career advice; 
• Picks of the Week*: Unbroken (book), Down Dog Yoga (app); Check out Dimash’s music on YouTube; Off Your Rocker (TV show); Finishing Well to the Glory of God (book)
• 12:30

Master the management of hyperglycemia, DKA, and learn to avoid common pitfalls. This episode is packed with clinical pearls from repeat guest, Endocrinologist, Dr. Jeffrey Colburn.

Recommend a guest or topic and give feedback at thecurbsiders@gmail.com  

Get full show notes at http://thecurbsiders.com/category/podcast

Tags: assistant, care, diabetes, dka, doctor, endocrinology, family, health, hospitalist, hospital, hyperglycemia, internal, internist, ketoacidosis, nurse, medicine, medical, primary, physician, student, resident

• Written and produced by (including CME questions): Justin Berk MD, MPH, MBA
• Cover art by: Kate Grant MBChB DipGUMed
• Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP; Stuart Brigham MD
• Edited by: Matthew Watto, MD, FACP
• Guest:  Michael Streiff MD

Dominate the treatment of menopause with tips from expert, Dr. Amy Tremper, Assistant Professor of Obstetrics and Gynecology at the University of Michigan Medical School. We discuss hormone replacement therapy, the Women’s Health Initiative, bio-identical hormones...and game shows?!

For full show notes visit http://thecurbsiders.com/podcast.

Join our newsletter mailing list. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Tags: assistant, care, doctor, education family, foam, foamed, health, hormone, hospitalist, hospital, hot flashes, internal, internist, nurse, medicine, medical, menopause, physician, practitioner, primary, replacement, resident, student, therapy

Breathe easy with these airway management principles and expert tips for managing the patient with COVID-19 related lung disease (i.e. pneumonia, hypoxemia, ARDS). In the COVID-19 era, non-intensivists are being called upon to care for critically ill patients across the globe. At the Curbsiders, we understand that this can be a stressful proposition! Therefore, we’ve enlisted the help of the renowned medical intensivist & USUHS Chair of Medicine, Dr. Kevin Chung (@chungk1031) to teach us what we need to know about airway management  in these challenging times. Show Notes | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com

Credits

• Written and Produced by: Cyrus Askin MD, Michael Rose MD, Kathleen Hiltz MD
  
• Show Notes: Cyrus Askin MD
  
• Infographic: Elena Gibson, MD
  
• Cover Art: Dr. Kate Grant MBChB DipGUMed
  
• Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP; Cyrus Askin, MD
  
• Editor: Matthew Watto MD, FACP (written materials); Clair Morgan of nodderly.com
  
• Guest: COL Kevin Chung, MD, FACP
  

Sponsors: McGraw Hill

Time Stamps

• 00:00 Intro
  
• 03:15 Guest one liner, chicken wings (Miller Lite marinade), career advice
  
• 07:40 Sponsor
• 08:20 Case of hypoxemic respiratory failure; Rapid evaluation, initial labs
  
• 16:03 Initial assessment of a COVID-PUI; HFNC and non-invasive ventilation
  
• 23:40 Proning patients for hypoxemia
  
• 29:15 ARDS basics: diagnostic criteria, Brief Recap
  
• 33:22 Mechanical ventilation: Initial settings, following the blood gas
  
• 40:55 Peak and plateau pressure, Lung compliance and  Troubleshooting a high pressures
  
• 51:30 Ventilator dyssynchrony; Lung compliance and traditional ARDS vs COVID-19 lungs
  
• 62:55 Advanced ARDS - The 5 Ps of therapy and differences with COVID-19
  
• 68:10 Take home points; Plugs; Outro
  

Introducing our friends, The Curious Clinicians:

Why do human bodies work how they do? Why do medications work, or not work? Do you miss digging into the “why” behind what we do every day? Join Hannah Abrams (@hannarabrams), Tony (@tony_breu), and Avi (@AvrahamCooperMD) in the Curious Clinicians podcast as they delve into these questions & more, starting with episode 1: Why does fingernail clubbing happen in so many different diseases? https://curiousclinicians.com/

Check out their website and subscribe on your favorite podcast player.

• Written by: Bryan Brown, MD and Beth Garbitelli
• Edited by: Matthew Watto, MD
• Infographics by: Bryan Brown, MD
• Cover image by: Beth Garbitelli

Welcome to The Curbsiders tutorial on how to create your own medical podcast. @doctorwatto and @paulnwilliamz walk you through how to conceptualize your podcast, build your team, choose your equipment and the basics of how to setup hardware and software recording. Be sure to browse the accompanying show notes for a true step-by-step guide complete with links to videos, web pages, and blog posts that we found helpful when starting our show. If it’s not in this document, then it can easily be found on YouTube, or via a Google search. Show Notes | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com

Credits

• Written and produced by: Matthew Watto MD
• Cover art and Infographic by Matthew Watto MD
• Hosts: Matthew Watto MD and Paul Williams MD
• Editor: Clair Morgan of Nodderly.com

Time Stamps

• 00:00 Announcement, Intro, Disclaimer
• 02:53 Our top podcasting pearls
• 07:01 Find your niche
• 09:46 Logistics
• 13:25 Business, finances and legal matters
• 14:40 Equipment
• 21:48 Recording and editing
• 24:56 Website, web and media hosting
• 28:53 How to setup and record your podcast
• 35:08 Editing software
• 35:58 Search engine optimization
• 37:45 Post-processing
• 39:49 Take home points and outro

• Written and produced by: Shreya Trivedi MD, Molly Heublein MD
• Hosts: Paul Williams MD, FACP; Shreya Trivedi MD; Molly Heublein MD
• Edited by: Matthew Watto MD, FACP; Emi Okamoto MD
• Graphics by: Hannah Abrams
• Guest: Dr. C Noel Bairey Merz MD, FACC, FAHA

• 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

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

Learn the latest in lipid lowering therapy in this extensive discussion with Dr. Paul S. Jellinger, MD, MACE, Professor of Medicine at the University of Miami and Chair of the writing committee for the American Association of Clinical Endocrinologists (AACE) 2017 Guidelines for the Management of Dyslipidemia and Prevention of Cardiovascular Disease (CVD). Topics include ezetimibe, PCSK9, FOURIER trial, statin myopathy, CoQ10, fish oil, fibrates and more. For a more basic discussion of dyslipidemia check out episode #10.

Full show notes are available at http://thecurbsiders.com/podcast

Join our newsletter mailing list. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Time Stamps

00:00 Intro

03:10 Rapid fire questions

08:15 Dyslipidemia defined

10:26 Classifying dyslipidemia

13:21 Diagnosing Familial Hypercholesterolemia

17:48 A difficult lipid case discussed

22:40 Lp (a), Apo B and LDL particle concentration

28:40 What labs to order

31:31 ACC/AHA versus other risk scores

38:21 IMPROVE-IT

41:35 Non-statin medications discussed

45:05 Hypertriglyceridemia fibrates and fish oil

48:25 How often to check the lipid panel

49:58 Statin Myopathy and CoQ10

54:17 FOURIER, PCSK9 and very low LDLs

59:43 Extreme risk category discussed

62:34 Is plaque regression possible?

64:12 Take home points

67:08 Outro

Tags: assistant, care, cholesterol, doctor, education family, fish oil, foam, foamed, health, hospitalist, hospital, internal, internist, ldl, lipid, medicine, medical, myopathy, nurse, pcsk9, physician, practitioner, primary, statin, resident, student

Create your own online curriculum for #meded with this Step-by-Step guide for medical educators by Drs. Kat Zechar MD, @inked_caduceus and Amreet Sidhu MD, @Brosencephalon. They teach us how to identify learner’s needs and develop an online curriculum complete with self assessment tools, remote lectures, audio & video content and interactive cases. We discuss specific software tools and the basic hardware that you’ll need to get your online meded curriculum up and running.

Show Notes | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com

Credits

• Written and Produced by: Paul Williams MD, FACP
  
• Cover art and Show notes by: Matthew Watto MD, FACP
  
• Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP
  
• Editor: Matthew Watto MD (written materials); Clair Morgan of nodderly.com
  
• Guest: Kat Zechar MD and Amreet Sidhu MD
  

Time Stamps

• 00:00 Announcement: We’re looking for pre-med and medical Student members. Send applications to thecurbsiders@gmail.com by deadline April 10, 2020.
  
• 01:22 Intro, disclaimer and guest bios
  
• 03:38 Guest one-liners, Picks of the week
  
• 09:30 Why you might need an online meded curriculum
  
• 16:33 Overview of Amreet and Kat’s online curriculum
  
• 21:15 Website, domain name, media hosting, software (Vimeo, Zoom meeting software) and WordPress plugins; Zoom can record audio, video or screen recording (i.e. for a speaker going through slides) and equipment
  
• 36:35 How to generate self-assessment tools: ABIM blueprint, quiz questions and interactive cases (from twinery.org)
  
• 46:35 Time commitment
• 50:55 Take home points and Outro

• Written and produced by: Nora Taranto MD
• Hosts: Nora Taranto MD, Paul Williams MD, Matthew Watto MD
• Edited by: Emi Okamoto MD, Matthew Watto MD
• Guests: Soraya Azari MD; Phoebe Cushman MD, MS

Listen to our first ever discussion with @kidney_boy, Joel Topf MD. It’s a classic episode with a fresh intro as we prepare for @NephMadness 2019 with our friends from Twitter and @AJKDonline

Dominate leg cramps, diuretic therapy, and resistant hypertension with tips from @kidney_boy, Joel Topf MD @kidney_boy, Chief of Nephrology Kashlak Memorial Hospital, co-creator @NephMadness. We start with basic renal physiology and build up to the treatment of resistant hypertension.

Corrections: Dr Topf posted the following corrections on his blog PBfluids.com 3/22/2017

“I enjoyed the experience immensely, but in an hour of talking off the cuff I made some embarrassing mistakes:

In describing water reabsorption I said it occured in the cortical collecting duct rather than the medullary collecting duct.

In describing my cure for cramps I tell the story of Gitelman’s and say it is like congenital loop diuretics rather than congenital thiazide diuretics

I mucked up the story about the MRFIT story and how it allowed a head to head comparison of HCTZ and chlorthalidone. I really oversold what happened.”

Full show notes at https://thecurbsiders.com/podcast. Join our newsletter mailing list. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Credits

Written by: Matthew Watto MD

Produced by: Stuart Brigham MD and Matthew Watto MD

Cohosts: Stuart Brigham MD and Matthew Watto MD

Guest: Joel Topf MD

Sponsor

Get your ACP membership today and use the code CURB100 to save $100 when you join by March 31, 201

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

Fall in love with the thyroid all over again, as we deconstruct hypothyroidism with thyroid expert, Susan Mandel MD, MPH (PENN). We review common causes, symptoms, diagnosis and treatment and how these may differ for those who are Pregnant, over age 65, or have existing Heart disease. Plus, Dr Mandel schools us on her approach to treatment with levothyroxine (T4), and even explains when she trials liothyronine (T3) replacement! Warm up those thumbs for the thyroid exam...it’s on!

Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME!

Credits

• Written and Produced by: Elena Gibson MD
  
• Cover art and Infographic by: Dr Kate Grant MBChb MRCGP
  
• Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP
  
• Editor: Emi Okamoto (written materials); Clair Morgan of nodderly.com
  
• Guest: Susan Mandel MD, MPH
  

Sponsor: VCU Health CE

Time Stamps

• 00:00 Intro, disclaimer, guest bio
  
• 02:43 Guest one-liner; Pick of the week: Waiting for Godot (Play); Favorite Failure; Career Advice
  
• 09:40 Case from Kashlak Part one; Hypothyroidism signs and symptoms
  
• 13:20 When to Test for Hypothyroidism
  
• 17:43 Biotin interaction
  
• 19:49 Which thyroid tests should we order?
  
• 26:15 Subclinical hypothyroidism
  
• 29:00 Etiology/Types of hypothyroidism
  
• 33:30 Case from Kashlak Part two; Initial Medication dosing; Physical Exam
  
• 37:10 Levothyroxine replacement time of administration
  
• 42:10 TSH goal
  
• 46:00 Levothyroxine manufacturers
  
• 48:33 Dosing in older adults
  
• 50:27 T3 treatment
  
• 56:52 Pregnancy
  
• 59:42 Dose adjustments
  
• 61:43 Estrogen and thyroid binding protein
  
• 63:33 Who needs a referral?
• 65:40 Plugs, Outro

How to individualize learning for yourself, and your learners with tips from Dr. Philip A. Masters, editor-in-chief of MKSAP and IM Essentials, Vice President of Membership/International Programs at the American College of Physicians (ACP) and an Adjunct Professor of Medicine at the University of Pennsylvania School of Medicine. Dr. Masters schools us on work life balance, how to recognize and diagnose struggling learners, what resources to use, teaching exercises, and how to generate a study plan.

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 Intro

01:50 Listener feedback

04:18 Announcements

04:58 Picks of the Week

10:37 Guest bio and credentials

12:36 Getting to know our guest

18:05 Wellness and work life balance

22:55 How medical education has changed

28:55 Choosing resources as a learner

38:00 Case of a struggling learner

41:50 Learners with knowledge deficits and the role of the clinician (non-professional educator)

47:56 Resources to improve your skills as a medical educator

51:01 Take home points 

Tags: study, resources, MKSAP, acp, learner, educator, academic, assistant, care, education, doctor, family, foam, foamed, health, hospitalist, hospital, internal, internist, nurse, meded, medical, medicine, primary, physician, resident, student

• Written by Hannah R. Abrams and Joel Topf MD
• Producer: Hannah R. Abrams
• Cover Art and infographic by: Hannah R. Abrams
• Hosts: Hannah R. Abrams; Stuart Brigham MD; Matthew Watto MD, FACP
• Editors: Matthew Watto MD, FACP; Emi Okamoto MD 
• Guest: Joel Topf MD

Avoid common pitfalls, recognize prescribing cascades, and deprescribe like a champ with tips from Clinical Pharmacist, Dr. Sean M. Jeffery, Clinical Professor of Pharmacy at the University of Connecticut School of Pharmacy, and Chair of the Polypharmacy Special Interest Group for the American Geriatrics society. We discuss how to create better medication lists, tools and tips for deprescribing, how to counsel patients on polypharmacy, and safe use of medication in the elderly.

Special thanks to the American Geriatrics Society for setting up this interview.

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 Intro

01:12 Listener feedback

01:56 Picks of the week

06:28 Topic intro and guest bio

07:49 Getting to know our guest

13:05 Defining polypharmacy and related terms

16:30 Clinical Case of polypharmacy

20:34 Making better medication lists

25:01 Clinical Case from Kashlak Memorial

28:40 Beers Criteria

35:41 Statins in frail, elderly patients

38:00 Treating insomnia in the elderly

44:15 Dosing of meds in patients with CKD

45:50 Tool for analysis of drug-drug interactions

48:10 Take home points from Dr. Jeffery

50:00 Outro

Tags: polypharmacy, deprescribing, prescribing, cascade, pharmacist, drug, therapy, medications, side, effects, adverse, reaction, beers, criteria, interaction, disease, anticholinergic, assistant, care, education, doctor, family, foam, foamed, health, hospitalist, hospital, internal, internist, nurse, medicine, medical, primary, physician, resident, student

Listen as our esteemed guest Dr. Nina Mingioni (Jefferson) walks us through her approach to fatigue, from differential diagnosis, to the evidence behind physical exam, laboratory workup, and beyond!

Show Notes | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME!

Credits

• Writer, Producer, Infographic, and Cover Art: Hannah R. Abrams
  
• Hosts: Hannah R Abrams, Matthew Watto MD, FACP; Paul Williams MD, FACP
  
• Editor: Matthew Watto MD, FACP (written materials); Clair Morgan of nodderly.com
  
• Guest: Nina Mingioni MD, FACP

Sponsor: VCU Health CE

Time Stamps

• 00:00 Intro, disclaimer, guest bio and a bad pun
  
• 03:00 Guest one-liner
  
• 07:10 Case from Kashlak, Defining fatigue; Taking a general history
  
• 11:36 Most common causes of fatigue and how to elicit them from the history
  
• 20:39 Physical exam for fatigue; Medications that cause fatigue;
  
• 25:25 Exam findings and LRs for anemia; Sleep apnea
  
• 30:55 Lab workup for fatigue; Expanded testing: Ferritin, Vitamins, EBV, Rheumatologic diseases, Celiac disease, Lyme
  
• 47:55 Spiel to the patient when no answer is found
  
• 51:14 Other diagnoses to consider: Fibromyalgia, Myalgic Encephalomyelitis
• 55:09 Take home points and Outro

Recap of random pearls and highlights from #CHEST2019 including: A pop quiz on inhaler use, interstitial lung disease, pulmonary fibrosis (IPF), limitations of supplemental oxygen, lung cancer screening, imposter syndrome, and is it safe to use beta blockers in COPD. 

Special thanks to Dr. Bill Kelly and his team at CHEST (@accpchest) for their hospitality. 

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

Credits

• Written, produced, and cohosted by: Sarah Phoebe Roberts MPH; Paul Williams MD, FACP; Stuart Brigham MD; Matthew Watto MD, FACP
• Edited by: Matthew Watto MD, FACP
• Special Guests: Leah Witt MD (@leahJwitt); Nina Maouelainin DO, MBA (@lungsolutions); Erin Narewski DO, FCCP (@erinnarewski); Hassan Bencheqroun MD, FCCP (@drBcalifornia); Chidinma Chima-Melton MD, FCCP (@LABritishLady)

Time Stamps

• 00:00 Intro, disclaimer
• 05:20 Dr Leah Witt @leahwitt (UCSF) quizzes us on inhalers.
• 09:55 Dr Leah Witt on ILD in geriatric patients
• 13:09 Dr Erin Narewski @erinnarewski (Temple) on supplement oxygen. 
• 15:07 Dr Erin Narewski discusses the brand new BLOCK trial.
• 18:11 Dr Chidinma Chima-Melton

Learn the nuances of caring for and building relationships with patients experiencing homelessness from expert internal medicine and addiction physician Stefan Kertesz, return guest from Episode 74 on Opioids and Health Policy (highly recommend a re-listen, y’all!).  Topics: the challenge of creating a welcoming and useful space for individuals experiencing homelessness, how to meet patients where they’re at--both physically and mentally--the challenge of managing diuretics for those without stable access to a bathroom (avoid, if possible), and how absolutely essential the foot exam is.

Show Notes | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME!

Credits

• Written and Produced by Nora Taranto MD
  
• Infographics by Nora Taranto MD
  
• Cover Art by Kate Grant MBChB, MRCGP
  
• Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP, Nora Taranto MD
  
• Editor: Carolyn Chan (written materials); Clair Morgan of nodderly.com
  
• Guest: Stefan Kertesz MD
  

Sponsor: VCU Health CE

Time Stamps

• 00:00 Intro, disclaimer, guest bio
  
• 3:17 Guest one-liner
  
• 8:55 Picks of the Week*: Dr. Kertesz’s Book Recommendation: Saul Weiner’s On Becoming A Healer; Nora’s Pick of the week: BackStory (especially their episode on dynamite!) https://www.backstoryradio.org/
  
• 10:07 Case from Kashlak
  
• 10:56 Language: How to ask where a patient lives?
  
• 13:25 Terminology: Persons Experiencing Homelessness:
  
• 14:35 The stats on prevalence of health and illness in the homeless population, and the importance of both medical and environmental factors
  
• 20:44 How to start the visit, and how to establish trust early on?
  
• 27:40 Why is the mortality rate higher?
  
• 35:15 Special conditions and Medication Considerations: Hypertension, Diuretics, Insulin and Food Insecurity, Substance Use Disorders, Feet, and Hepatitis C
  
• 54:15 COVID and homeless healthcare
  
• 57:00 Care Models
• 62:30 Take Home Points and Outro

We want to live longer… and healthier too! Dr Peter Attia, a physician focusing on the applied science of longevity, walks us through lifespan and healthspan, exploring tactics aimed at extending both. Listeners will challenge the conventional approach to primary care and explore tactics to optimize exercise, nutrition, and health, including counseling on different dietary patterns, fasting, exercise, emotional well-being and how to prepare for the Centenarian Olympics!

Show Notes | Subscribe | Spotify | Schwag! | Top Picks | Mailing List | thecurbsiders@gmail.com

Credits

• Written and Produced by: Matthew Watto MD, FACP and Elena Gibson MD 
• Cover Art and Infographic: Elena Gibson MD
• Hosts: Elena Gibson MD, Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP   
• Editor: Emi Okamoto MD
• Audio Editor: Clair Morgan of Nodderly
• Guest: Peter Attia MD 

Time Stamps

• 00:00 Intro, disclaimer, guest bio
• 04:22 Guest one-liner, Career Advice, Picks of the Week*
• 14:30 Case: A couple seeking maximize longevity; Defining longevity, healthspan, lifespan and the 4 types of death
• 19:30 Lifespan, the longevity curve and the long tail
• 23:50 Peter’s approach to shepherding patients toward longevity; Exploring motivations
• 32:06 Back to our couple: What exercises should they perform
• 42:09 Peter’s advice on nutrition; the standard American diet; Intermittent fasting; Dietary Restriction
• 51:20 Periodic fasting and water only fasting
• 54:33 Genetics and longevity
• 56:40 Metformin;

• Written and Produced by: Sarah Phoebe Roberts MPH, Christopher Chiu MD
• Hosts: Matthew Watto MD, Stuart Brigham MD, Paul Williams MD, and Christopher Chiu MD
• Guest Presenter and Content Planning: Armand Gottlieb, MD
• Editor: Christopher Chiu MD
• Cover-Art: Christopher Chiu MD

• Written and Produced: Kate Grant MBChB DipGUMed; Matthew Watto MD, FACP
• Infographic: Matthew Watto MD, FACP
• Cover Art: Kate Grant MBChB DipGUMed
• Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP
• Editor: Matthew Watto MD, FACP
• Guest:  Beth Jonas MD, FACR 

LIVE! from Mayo Clinic, a practical approach to lymphadenopathy with Carrie Thompson MD @cathompsonmd (Hematology Oncology, Mayo Clinic). Dr. Thompson provides her simplified approach to the history, differential diagnosis, high yield lab testing, imaging, how to counsel patients with adenopathy and tips on when, where and how to biopsy!

The Curbsiders are insanely grateful to the Mayo Clinic  Internal Medicine Residency Chief Residents @mayomn_imres (@JasonEckmannMD @SamiRyanMD @BHuffmanMD @CourtHarrisMD) and their amazing program director @AmyOxentenkoMD for an amazing trip to Rochester!

Show Notes | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com

Credits

• Written and Produced by: Carrie Thompson MD and Matthew Watto MD, FACP
  
• Infographic: Matthew Watto MD, FACP
  
• Cover Art: Kate Grant MBChB DipGUMed
  
• Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP
  
• Editor: Matthew Watto MD (written materials); Clair Morgan of nodderly.com
  
• Guest: Carrie Thompson MD
  

Time Stamps

• 00:00 Announcement: We’re looking for Medical Student members. Send applications to thecurbsiders@gmail.com by April 10, 2020.
  
• 01:20 Intro, guest bio, one-liner, career advice; Pick of the week*: In Shock by Rana Awdish
  
• 07: 00 Lymphatic system
  
• 09:19 Differential diagnosis for lymphadenopathy
  
• 11:38 Taking a history (ALL AGES mnemonic), Red Flags
  
• 19:15 Physical exam for lymphadenopathy
  
• 22:30 Which labs to order; Flow cytometry
  
• 26:05 Imaging
  
• 28:30 Counseling patients with LAD
  
• 31:10 Biopsy: How to choose type and location
  
• 37:35 Take Home Points
  
• 39:00 Audience Questions
• 42:25 Outro

“Urinary tract infections” (UTIs) are overdiagnosed. Antibiotics are overprescribed. UTIs are inappropriately blamed for geriatric syndromes (eg delirium) despite little supporting evidence. Our guest, Tom Finucane MD, Emeritus Professor of Medicine at Johns Hopkins makes us question everything. Topics: How can we diagnose “UTI”? Who needs treatment? Do urinary tract symptoms matter? Does malodorous urine correlate with infection? Who’s at risk for pyelonephritis and sepsis? Don’t miss this paradigm changing episode. And stop using the term “urinary tract infection” unless it’s prefaced by air quotes!

Sponsor: Join ACP's Internal Medicine Meeting 2019 April 11-13th in Philadelphia, PA . We'll see you there!

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: Matthew Watto MD, Paul Williams MD

Edited by: Matthew Watto MD

Guest: Tom Finucane MD, MACP

Time Stamps

• 00:00 Disclaimer, intro and guest bio
• 04:00 Guest one liner, book recommendation, career advice
• 08:22 The “medical ignorome”
• 13:40 ACP Internal Medicine Meeting 2019 details
• 16:20 Case of malodorous urine; Urine is NOT sterile; Defining terms
• 25:14 Stop saying UTI unless using air quotes
• 28:34 What symptoms or history matters in evaluation for “UTI”? And can we predict who will become systemically ill?
• 34:47 Voltaire and when treatment is warranted for “urinary tract infections”
• 37:15 Delirium in an older adult with possible UTI, how to work it up, and who warrants antibiotics
• 51:55 Take home points
• 53:38 Outro

A recap and highlights from ACP 2017, Internal Medicine's largest national conference, with Dr. Alan Dow MD, MSHA, FACP, Professor of Medicine from Virginia Commonwealth University. We discuss iron supplementations, shellfish allergies and IV contrast, proton pump inhibitors, and more!

For full show notes visit http://thecurbsiders.com/podcast.

Join our newsletter mailing list. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Tags: acp, allergy, assistant, care, contrast, doctor, education, family, foam, foamed, health, hepcidin, hospitalist, hospital, internal, internist, iron, nurse, medicine, medical, physician, ppi, practitioner, primary, resident, shellfish, student

Answers to common questions in post-op care with our Kashlak Chief of Perioperative Medicine Dr. Avital O’Glasser. She provides updates in delirium prevention, perioperative medication management, pain control, and even clarifies a lesson from Meredith Grey about causes of post-op fever.

Show Notes | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | CME!

Credits

• Written: Hannah Abrams MD, Avital O’Glasser MD
  
• Produced by, Infographic and Cover Art by: Hannah Abrams MD
  
• Hosts: Hannah Abrams MD; Matthew Watto MD, FACP; Paul Williams MD, FACP
  
• Editor: Avital O’Glasser MD (written materials); Clair Morgan of nodderly.com
  
• Guest: Avital O’Glasser MD
  

Sponsor: ACP - acponline.org/member

Sponsor: VCU Health CE -Check out curbsiders.vcuhealth.org and create your FREE account!

Time Stamps

• 00:00 Intro
  
• 02:53 Guest one-liner, Picks of the Week*: 12 Angry Men 1957 Movie; Hedwig and the Angry Inch Cast Recording; PCSSNow Buprenorphine Waiver Training for Medical Students
  
• 09:28 Sponsor
  
• 10:17 Kashlak case; How to collaborate with our surgical colleagues
  
• 13:45 Questions to ask at the time of transfer
  
• 23:00 Routine Post-Op Care: Bowel regimen, pain control, delirium prevention, glucose, antihypertensives, and nausea
  
• 44:25 Co-managing Complications and Fever/Tachycardia; Brief discussion of VTE prophylaxis
• 57:55 Outro

• Written and Produced by: Sarah Phoebe Roberts MPH, Christopher Chiu MD, FACP, FAAP
• Hosts: Matthew Watto MD, FACP; Sarah Phoebe Roberts MPH, Paul Williams MD, FACP; and Christopher Chiu MD, FACP, FAAP
• Editor: Christopher Chiu MD, FACP, FAAP; Emi Okamoto MD
• Cover-Art: Christopher Chiu MD, FACP, FAAP
• Guest: Kimberly Manning MD, FACP, FAAP

Develop your approach to refugee health in the primary care setting.  We discuss important considerations for primary care of the refugee patient with Dr. Tanuja Devaraj (Penn State), an internist with expertise in migration health.  We review barriers to primary care, how to take a migration history, and common health concerns that occur in this patient population.  We also discuss strategies for screening for trauma and mental health issues, which are common among patients who have gone through migration.

Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com

Credits

• Producer: Paul Williams MD, FACP
• Writer: Tanuja Devaraj MD and Paul Williams MD, FACP
• Infographic: Emi Okamoto MD
• Cover Art: Paul Williams MD, FACP
• Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP   
• Editor: Clair Morgan of Nodderly.com (audio), Emi Okamoto MD (written)
• Guest: Tanuja Devaraj MD

Sponsor

ACP’s Medical Knowledge Self Assessment Program, MKSAP 18. MKSAP provides the latest and most comprehensive educational content needed by internists today. It’s THE internal medicine go-to resource for continuous learning and Board preparation. Visit http://www.acponline.org/mksapcurbsiders to place your order!

Time Stamps

• 00:00 Sponsor -ACP’s MKSAP 18 http://www.acponline.org/mksapcurbsiders 
• 00:15 Intro, disclaimer, guest bio
• 02:08 Guest one-liner, book recommendations, career advice
• 07:12 Picks of the Week*:

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

Stuck on sickle cell disease? We hammer out the basics of diagnosis, common sickle cell variants and their manifestations, preventive medicine, acute and chronic pain management, opioid use, and how to recognize and treat common complications like anemia, fever and acute chest syndrome. Sickle cell expert, Sophie Lanzkron MD, Associate Professor of Medicine and Oncology and Director of the Sickle Cell Center for Adults at Johns Hopkins joins!

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.

Sponsor

ACP's Internal Medicine Meeting 2019 April 11-13th in Philadelphia, PA. We'll see you there!

Credits

Written (including CME questions) and produced by: Justin Berk MD, Martha Brucato MD PhD, Beth Garbitelli MS1

Hosts: Paul Williams MD, Justin Berk MD, Matthew Watto MD

Edited by: Matthew Watto MD

Guest: Sophie Lanzkron MD MHS

Time Stamps

• 00:00 Announcements, intro
• 02:30 A quick refresher on hemoglobinopathy
• 03:45 Guest bio
• 05:03 Guest one-liner, movie recommendation, career advice, picks of the week
• 10:53 ACP Internal Medicine Meeting 2019 (ad read)
• 12:33 Clinical case; defining sickle cell; pathophysiology
• 16:23 Different types of hemoglobinopathy genotypes and phenotypes
• 20:20 Preventive care for sickle cell disease
• 22:56 Taking a history at the initial visit in patient with sickle disease
• 26:40 Life expectancy in SCD
• 28:30 Hydroxyurea
• 30:40 Chronic red blood cell transfusion therapy; complications; monitoring
• 37:07 Silent cerebral infarcts and mild cognitive impairment in SCD 
• 40:10 Chronic pain management; opioid use disorder in sickle cell disease
• 46:00 Acute pain crisis management; PCAs vs bolus therapy
• 54:08 Reticulocyte count in sickle cell disease
• 55:40 Itching, opioids and naloxone?
• 58:10 Red blood cell transfusion threshold in sickle cell disease (anemia)
• 60:03 Acute fever in SCD
• 61:48 Acute chest syndrome
• 66:45 Transition from pediatrics to adult medicine in sickle cell
• 68:00 Incentive spirometry to prevent acute chest syndrome
• 68:45 Take home points
• 70:00 Outro

Discover common practices that persist in the hospital wards despite no proven benefit! We review how potassium replacement goals should not drive you bananas, extra oxygen should not give you comfort, and how you should maybe calm down with antipsychotics for delirium. Join returning guests: high-value care specialist Dr. Lenny Feldman (@DocLennyF, Johns Hopkins) and tweetorialist Dr. Tony Breu (@tony_breu, Harvard) as they walk us through round 3 of “Things We Do for No Reason^TM.

SHM members can claim CME-MOC credit at https://www.shmlearningportal.org/curbsiders (CME goes live at 0900 ET on the episode’s release date). Note: The planners and faculty for this activity have no relevant relationships or conflicts to disclose.

Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com

Credits

• Written and Produced by: Burton H. Shen MD, Justin Berk, MD MPH MBA
• Infographic:
• Cover Art:
• Hosts: Justin Berk MD MPH MBA; Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FaCP
• Editor: Matthew Watto MD, FACP (written materials); Clair Morgan of Nodderly.com (audio)
• Guest: Lenny Feldman MD, Tony Breu MD

Sponsors

The Society of Hospital Medicine

Hospital Medicine 2020 (HM20) is the Society of Hospital Medicine’s Annual Conference April 15th through the 18th in sunny San Diego. Don’t miss the largest hospital medicine meeting. Register now at https://shmannualconference.org/ and use the code CURBSIDERS to receive a $50 discount.

Primary Care Internal Medicine of Ithaca

Dominate syncope with tools, tips, and tricks from The Curbsiders. No guest on this episode, just doctors Watto, Brigham, and Williams deconstructing the frustrating topic of syncope to provide listeners with some shiny clinical pearls and practice changing knowledge.

For full show notes visit http://thecurbsiders.com/podcast

Join our newsletter mailing list. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.

Tags: assistant, cardiology, care, doctor, education, epilepsy, family, foam, foamed, guideline, health, hospitalist, hospital, internal, internist, nurse, medicine, medical, physician, practitioner, presyncope, primary, resident, student, syncope

Listen to our medical education heroes, Dr. Abby Spencer, @abbyCCim (Cleveland Clinic), and Dr. Alia Chisty, @aliachisty (Penn State Health), school us on how to give effective and meaningful feedback! Topics include: the ADAPT framework, how to give difficult feedback, keywords and phrases when giving feedback, how to avoid gender and racial bias when giving feedback, giving feedback to your peers and how to solicit effective feedback as a team leader.  

Listeners can claim Free CE credit through VCU Health at http://curbsiders.vcuhealth.org/ (CME goes live at 0900 ET on the episode’s release date). 

Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME!

• Written and Produced by Paul Williams MD, FACP
• Cover Art: Paul Williams, MD, FACP
• Infographic: Edison Jyang
• Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP   
• Editor: Matthew Watto MD (written materials); Clair Morgan of nodderly.com
• Guests: Abby Spencer MD and Alia Chisty MD

Provider Solutions & Development is a community of experts dedicated to offering guidance and career coaching to physicians and clinicians throughout their entire career journey. With exclusive access to hundreds of opportunities across the nation, reach out today to begin the search for your perfect practice: www.psdrecruit.org/curbsiders.

The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit. Note: A free VCU Health CloudCME account is required in order to seek credit. 

• Sponsor - Provider Solutions & Development www.psdrecruit.org/curbsiders.
• Sponsor - VCU Health Continuing Education
• 00:30 Intro, disclaimer, guest bio, pun
• 04:00 Guest one-liners, Picks of the Week* (see links below)
• 10:25 Sponsor - Provider Solutions & Development www.psdrecruit.org/curbsiders.
• 11:00 Case from Kashlak, Feedback definitions
• 15:00 Addressing perceived barriers to feedback
• 31:45 ADAPT model of feedback
• 38:10 Addressing potentially gendered feedback; 
• 42:45 Giving feedback to those who lack insight
• 48:29 Feedback and racial bias
• 52:25 Giving peer feedback
• 58:10 Tips for soliciting feedback as a supervisor
• 69:05 Does giving difficult feedback mean people won’t like you?
• 75:10 Take home points and Outro
• Sponsor - VCU Health Continuing Education

1. Radical Candor (book)
2. Host (film)
3. Percy Jackson & The Olympians: The Lightning Thief movie 
4. Hamilton on Disney Plus
5. Her (film) 

*The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on our Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra.

Listeners will demonstrate effective techniques to deliver and solicit meaningful feedback.

After listening to this episode listeners will…  

1. Discuss the definitions and terms used to discuss feedback.
2. Deliver effective feedback that is concordant with the learning goals of their trainees.
3. Address potential perceived barriers to feedback.
4. Utilize the ADAPT framework to partner with their learners and develop shared goals.
5. Develop strategies to mitigate against using gender- or racially-biased narrative language.
6. Deliver feedback to learners with limited insight by leveraging the impact of perception on achieving goals.
7. Solicit effective and meaningful feedback despite being in a position of authority

Drs. Spencer and Chisty report no relevant financial disclosures. The Curbsiders report no relevant financial disclosures. 

Williams PN, Spencer A, Chisty A, Brigham SK, Jyang E, Watto MF. “#233 Giving effective feedback with Abby Spencer and Alia Chisty”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list Final publishing date September 21, 2020.

1. Ende J. Feedback in Clinical Medical Education.  JAMA.  1983. . [https://pubmed.ncbi.nlm.nih.gov/6876333/] 
2. Brown B.  2018.  Dare to Lead.  Random House.
3. Stone D and Heen S.  2014.  Thanks for the Feedback.  Penguin Books.
4. Scott K.  2019.  Radical Candor.  St. Martin’s Press.
5. Fainstad T et al.  Feedback can be less stressful: Medical trainee perceptions of using the Prepare to ADAPT (Ask-Discuss-Ask-Plan Together) framework.  Cureus.  2018. [https://pubmed.ncbi.nlm.nih.gov/30906679/] 
6. Rojek AE et al.  Differences in narrative language in evaluations of medical students by gender and under-represented minority status.  J Gen Int Med.  2019.  [https://pubmed.ncbi.nlm.nih.gov/30993609/] 
7. Mueller AS et al.  Gender differences in attending physicians’ feedback to residents.  JGME.  2017.  [https://pubmed.ncbi.nlm.nih.gov/29075375/] 
8. Ross, DA et al.  Differences in words used to describe racial and gender groups in Medical Student Performance Evaluations.  PLoS ONE.  2017.  [https://pubmed.ncbi.nlm.nih.gov/28792940/] 

Listen as our expert guests, Kelly Graham, MD, MPH (@KellyGrahamMD) and Lekshmi Santhosh, MD MAEd (@LekshmiMD), detail the professional and personal challenges faced by women in medicine during the COVID-19 pandemic.

Show Notes | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME!

Credits

• Produced by: Leah Witt MD & Shreya Trivedi MD 
• Written by: Molly Heublein MD, Isabel Valdez PA-C, Leah Witt MD & Shreya Trivedi MD
• Infographic & Cover Art: Edison Jyang
• Hosts: Leah Witt MD & Shreya Trivedi MD, Justin Berk MD, MPH, MBA
• Editor: Molly Heublein MD and Matthew Watto MD (written materials); Clair Morgan of nodderly.com
• Guests: Kelly Graham, MD, MPH; Lekshmi Santhosh, MD MAEd 

Sponsor: VCU Health CE - Check out curbsiders.vcuhealth.org and create your FREE account!

Episode Breakdown

• Intro, disclaimer
  
• Introduction and bio for Kelly Graham, MD, MPH
  
• Introduction and bio for Lekshmi Santhosh, MD MAEd
  
• One-liner for Kelly Graham, MD, MPH
  
• One-liner for Lekshmi Santhosh, MD MAEd
  
• Gender Awakening Moments
  
• Picks of the Week*
  
• Case from Kashlak
  
• Difficulty with lack of childcare while working
  
• Hippocratic Oath paradox
  
• Dr. Santhosh’s 3 Ps
  
• Motherhood penalty-fatherhood bonus
  
• Two Pandemics, One Response
  
• Breadwinner-homemaker bias
  
• Female physician burnout
  
• Minority Tax
  
• Silver Linings
  
• Take home points and Outro

Ease the tension around blood pressure goals in older adults and get inside the hypertension guidelines released by the ACP and ACC/AHA in 2017 with the sagacity of Dr. Mary Ann Forciea, MD, MACP, Professor of Medicine at University of Pennsylvania. We cover: how to properly measure blood pressure, how to diagnose hypertension, blood pressure targets, why BP goals differ by society, how to guidelines are written and how to interpret them with a critical eye, plus a hot take on the 2017 ACC/AHA guidelines. Dr. Shreya Trivedi joins as cohost. Special thanks to Hannah Abrams for her wonderful infographics and to Dr Trivedi for compiling our show notes.

Time Stamps

• 00:00 The setup
• 02:15 Disclaimer
• 03:32 Picks of the Week
• 08:13 Getting to know Dr Forciea
• 13:35 Broad overview and a clinical case of geriatric hypertension
• 14:45 Brief history on BP targets
• 18:05 How do you measure a blood pressure? What type of monitors are available?
• 22:13 How to standardize BP in the office?
• 23:55  Ambulatory BP monitoring
• 24:55 Home blood pressure monitoring
• 26:11 Standing blood pressure readings and orthostatic hypotension
• 27:53 How guidelines are written
• 30:51 Evaluating evidence quality and strength of recommendation
• 32:35 Timeline and process for guideline generation
• 34:27 How to read guidelines with a “critical eye”
• 36:15 Return to our case of uncontrolled hypertension
• 38:25 Blood pressure targets from ACP guidelines and BP management in frail older adults
• 40:33 Counsel patients on BP targets   
• 42:25 Low diastolic blood pressure
• 45:35 SPRINT and the ACP BP guidelines
• 48:58 Take home points from Dr Forciea
• 50:07 HTN targets and pay for performance in clinical practice
• 51:45 Curbsiders recap the ACP guidelines
• 53:45 Matt and Paul recap the AHA guidelines
• 54:47 AHA definitions of hypertension
• 56:15 Diagnosing hypertension and how to measure a blood pressure
• 60:35 Choosing a blood pressure monitor and HBPM
• 62:29 Blood pressure goals in ACC guidelines
• 66:08 Non-pharmacologic measures
• 69:15 Will we follow these new strict targets?
• 72:45 Outro

Tags:hypertension, blood, pressure, monitor, cuff, heart, aha, acc, act, stroke, cardiac, cardiovascular, event, guidelines, assistant, care, doctor, education, family, foam, foamed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resid

Take your salt game to the next-next level. We brushed off this fan favorite episode and rebooted #48 hyponatremia deconstructed with our Chief of Nephrology, Dr. Joel Topf aka @kidney_boy aka The Salt Whisperer for your CME earning pleasure. Learn the correct steps to diagnose and manage this common and dangerous condition. Topics covered include: true versus false hyponatremia, SIADH, tea and toast hyponatremia, beer potomania, safe rates of sodium correction, IV fluid choice, vaptans and more.

Listeners can claim Free CE credit through VCU Health at http://curbsiders.vcuhealth.org/ (CME goes live at 0900 ET on the episode’s release date). 

Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME!

• Original episode written and produced by: Matthew Watto MD, FACP 
• Show Notes and CME questions by: Deb Gorth ScM
• Cover Art and Infographic by: Edison Jyang
• Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP   
• Editor: Molly Heublein (written materials); Matthew Watto MD (audio) 
• Guest: Joel Topf MD

A novel, collaborative, POCUS fellowship training is available at the University of Pennsylvania for IM and FM graduates!  In 2016 they leveraged the robust EM ultrasound fellowship training infrastructure with UPenn’s progressive Department of Medicine to create the 1st multi-specialty clinical ultrasound fellowship.  Their graduating fellows have made them proud by accepting leadership positions, and if you want to be on the cutting edge, you should join their team.  

Interview season is in full swing and they’re actively accepting applications.  Please go to pennultrasound.org or contact nathaniel.reisinger@pennmedicine.upenn for information.  You can apply for fellowship using the eusfellowships.com portal.

The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit. Note: A free VCU Health CloudCME account is required in order to seek credit.

• 00:00 Intro
• 03:30 Guest interview
• 07:15 Pick of the week w/Dr. Topf
• 16:20 Clinical case of hyponatremia
• 17:48 False hyponatremia normal osmolality
• 19:34 False hyponatremia high osmolality
• 20:36 Understanding why osmolality matters
• 23:28 Workup false hyponatremia
• 24:45 Recap of discussion so far
• 25:40 ADH dependent vs independent hyponatremia
• 27:00 Psychogenic polydipsia
• 289:15 Renal failure and hyponatremia
• 30:03 Tea and toast, and Beer Drinker’s potomania
• 35:22 ADH dependent hyponatremia
• 38:15 Volume versus osmolality
• 40:00 Volume status exam
• 45:14 Additional testing with urine lytes and uric acid
• 47:30 Treatment for SIADH 
• 52:42 Discussion of the vaptans
• 58:21 Additional testing in SIADH
• 62:50 When to admit patient for hyponatremia
• 63:59 Clinical case of hyponatremia complications
• 68:56 Fluids and rate of correction
• 73:36 DDAVP clamp
• 76:30 Moderate hyponatremia
• 78:35 Diuretic dosing DOES matter!
• 81:59 Loop diuretics for SIADH
• 84:25 Take home points
• 87:25 Outro

1. Dr. Joel Topf’s Textbook
2. Dr. Joel Topf’s Blog
3. Dungeons and Dragons
4. Tartine (cookbook) by Elizabeth M. Prueitt
5. I Hate You, Don’t Leave Me by Hall Strauss
6. Intentional Parenting by Sissy Goff
7. Mindset by Carol Dweck
8. Nintendo Switch
9. 8.0 Bit Techno- The Curbsiders Theme Song by Stuart Kent Brigham
10. Ure-Na 
11. European Society of Endocrinology Clinical Practice Guidelines. 
12. Don’t miss Dr. Topf on twitter aka @kidney_boy.

*The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on our Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra.

Listeners will recall the pathophysiology of hyponatremia and develop a systematized approach to identifying the type and cause of hyponatremia, as well as how to safely manage hyponatremia. 

After listening to this episode listeners will…  

1. Differentiate true and false hyponatremia
2. Recall the pathophysiology of true and false hyponatremia 
3. Interpret blood and urine tests to identify the cause of hyponatremia
4. Recall the limitations of the volume status exam
5. List ADH dependent causes of hyponatremia
6. List ADH independent causes of hyponatremia 
7. Explain the pathophysiology of beer drinker’s potomania and “tea and toast” hyponatremia
8. Use uric acid to differentiate SIADH from other causes of hyponatremia
9. Basic therapy for SIADH
10. Recall safe rates of correction for hyponatremia

Dr. Topf has received honoraria from AstraZeneca and Cara Therapeutics. He is joint venture partner in Davita Dialysis centers receiving dividends. The Curbsiders report no relevant financial disclosures. 

Topf J, Gorth DJ, Williams PN, Brigham SK, Heublein M, Jyang E, Watto MF. “REBOOT #48 Hyponatremia Deconstructed”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list Original air date: July 17, 2017; Updated September 7, 2020.

• Written and Produced by: Fatima Syed, MD, MSc; Matthew Watto MD, FACP
• Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP; Fatima Syed, MD, MSc; Deep Shah, MD, MSc
• Editor: Matthew Watto MD, FACP
• Guest: Robert McLean MD, FACP

Our very first Cribsiders/Curbsiders crossover episode! Learn about cystic fibrosis care across the lifespan. We dive into the diagnosis of CF (don’t lick your patients!), management of pulmonary and extrapulmonary complications, and the future of CF. You’ll also get tips on CF in adolescents and young adults, as well as recognizing undiagnosed CF in older patients. Our guest, Dr. Whittney Warren, is a pulmonary critical care doctor and the medical director of the Adult Cystic Fibrosis clinic in an academic hospital in Texas. Show notes: https:/www.thecribsiders.com/.

Credits

• Writer, Producer, Infographic, CME Questions: Clara Mao 
• Cover Art: Christopher Chiu MD
• Hosts: Justin Berk MD, Christopher Chiu MD, and Matthew Watto MD
• Editor: Justin Berk MD; Clair Morgan of nodderly.com
• Guest: Whittney Warren DO 

Time Stamps

• Intro / Disclaimer 0:00
• Guest bio 2:25
• Guest one-liner, picks of the week 3:15
• Explaining CF to patients, life expectancy  7:00
• Types of CF mutations and phenotypes 11:50
• Presentation of CF in older patients 15:20
• Screening and diagnosis 16:40
• PFTs and airway clearance 25:20
• Nutrition and the “CF diet” 29:10
• CF exacerbations and antibiotic selection 32:25
• Extrapulmonary manifestations 39:35
• Transition of care for CF adolescents (alcohol, exercise, sex) 43:50
• CFTR modulator therapy 51:35
• Lung transplantation 54:45

Goal

Listeners will develop a systematic approach towards long-term management and acute exacerbations of cystic fibrosis.

Learning objectives

After listening to this episode listeners will…  

1. Explain the pathophysiology underlying cystic fibrosis.
2. Identify maintenance therapies that optimize pulmonary function and nutritional status in patients with cystic fibrosis.
3. Choose evidence-based practices in the management of cystic fibrosis-associated pulmonary exacerbations.