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September 16, 2019
Dr Kimberly Manning joins to discuss imposter syndrome, how vacations affect health, and an update on the pneumonia vaccine, PCV13. Plus, hot takes on the dangers of vaping, and using procalcitonin and CRP to determine need for antibiotics.  Howdy, gentle listeners! It’s that special time of year when the school doors reopen, classrooms are awash in ‘new pencil’ smell, and FOAMed fans grab their trays and head to the cafeteria for some tasty knowledge food. Rest assured your Curbsiders friends have saved you a seat at the lunch table for this very special September 2019 episode!  Today we are joined by Dr. Kimberly Manning MD, FACP, FAAP, who is an Associate Professor of Medicine at Emory University School of Medicine. Dr. Manning authors a blog (“Reflections of a Grady Doctor”) that was named in 2010 by ‘O’ The Oprah Magazine as one of “four top medical blogs you should read.” She can also be found on Twitter, @gradydoctor. Thanks for listening! Full show notes at https://thecurbsiders.com/episode-list. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits  Written and Produced by: Sarah Phoebe Roberts MPH, Christopher Chiu MD, 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 Time stamps 00:00 Introduction/Disclaimer 03:15 Guest bio 05:00 Getting to know Dr. Manning 11:05 Picks of the week*: Reflections of a Grady Doctor, Dr. Kimberly Manning’s Blog; To Kill a Mockingbird by Harper Lee, audiobook narrated by Sissy Spacek; LeVar Burton Reads, a podcast; Aziz Ansari Right Now (comedy special) and Master of None (TV show); Garfield Minus Garfield, an existential take on a classic comic; Clue, the 1985 movie 17:15 Paul’s vaping update (CDC media statement) 20:10 Procalcitonin, CRP and antibiotic prescription for COPD exacerbation 24:30 Pneumococcal conjugate vaccine 30:00 Imposter syndrome 49:00 Vacation time and metabolic syndrome 57:00 Wrap-up and outro *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 my Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra.
September 11, 2019
  Recognize the importance of cost-of-care conversations and identify resources to facilitate these discussions with help from Gwen Darien, executive vice president at the National Patient Advocate Foundation, and Dr. Jessica Dine, Associate Professor and Chief of the division of Pulmonology and Critical Care at Perelman School of Medicine.  We review barriers to cost-of-care conversations and identify tools to help make these conversations a part of routine care discussions.  Full show notes 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 and Produced by: Elena Gibson, MD Infographic and Cover Art: Elena Gibson, MD Hosts: Elena Gibson MD; Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP   Editor: Matthew Watto MD, FACP; Emi Okamoto MD  Guest: Gwen Darien and Jessica Dine MD Partners and Grant Support The American College of Physicians. Check out this supplement to the Annals of Internal Medicine from May 2019 on Fostering Productive Health Care Cost Conversations https://annals.org/aim/issue/937992 The Robert Wood Johnson Foundation https://www.rwjf.org provided grant support for this episode. Time Stamps 00:00 Pun, disclaimer, sponsor 01:10 Intro, guest bios 06:10 Guest one-liners 07:22 Picks of the week*: Sing Unburied Sing (book) by Jesmyn Ward ; The Quiet American (book) by Graham Greene; An American Sickness: How Healthcare Became Big Business and How You Can Take It Back (book) by Elisabeth Rosenthal 09:35 Best Advice: Always question received wisdom; Listen! 14:10 Cost of treatment versus cost of care 15:35 How does cost of care affect outcomes?; Talking about money (finances) with patients 18:52 Defining “underinsured”; High deductible plans 22:41 Why are physicians scared to talk about cost? 26:16 Why is cost of care so difficult to determine? Who’s benefiting from lack of transparency? 28:35 Stuart explains his theory on why costs make no sense 30:00 How to have cost of care conversations 32:10 How to estimate cost; Specific tools 42:10 Cost of care plans 50:03 Take home points and plugs: National Patient Advocate Foundation; NeedyMeds.com; ACP High Value Care; AAFP Neighborhood Navigator Tool 53:00 Outro *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 my Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra. Goal Listeners will recognize the need for routine cost-of-care conversations and identify resources to improve the quality of such conversations in order to deliver high-value care.  Learning objectives After listening to this episode listeners will…   Recognize the importance of cost-of-care conversations between physicians and patients  Describe barriers to conversations concerning healthcare costs Feel comfortable initiating routine conversations with patients on the cost-of-care  Identify where and how to access resources to assist with healthcare cost conversations   Disclosures Gwen Darien and Dr. Jessica Dine report no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.  Citation Dine J, Darien G, Gibson E, Brigham SK, Williams PN, Okamoto E, Watto MF. “#172 Cost-of-Care Conversations”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list September 11, 2019.
September 9, 2019
Diagnose and treat lupus in primary care with tips from rheumatologist, Beth Jonas MD, FACR (UNC). We discuss the history and exam findings in lupus, initial lab workup, the dreaded ANA, who needs expanded lab testing, lifestyle factors in lupus, vaccinations, the basics of treatment...and Jethro Tull?!  Full show notes at https://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: 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 Time Stamps 00:00 Intro, disclaimer, guest bio 03:03 Guest one-liner; Book recommendation*: How Doctors Think (book) by Jerome Groupman; Career advice 10:50 A case of hematuria and rash, Ms Luna Wolferton 12:00 Differential diagnosis for a patient with symptoms suggestive of lupus 13:50 Clues for lupus on history and exam 15:42 Classification criteria versus making a clinical diagnosis of lupus (Dorner 2019) 18:17 ANA, what is it good for? 21:33 Basic lab workup (CBC, urinalysis and TSH) 25:10 Labs to send once lupus is suspected 28:15 Does Ms Wolferton have lupus?  29:10 Spiel for explaining lupus to a patient 31:20 ANA titers 33:02 Are there classic phenotypes of lupus? 34:40 Lifestyle factors 38:20 Bone density and chronic steroids 39:42 Vaccinations; Antimicrobial prophylaxis 41:55 Hydroxychloroquine; Treatment goals in lupus 44:38 Steroids and add on therapies e.g. methotrexate, Belimumab 47:55 The importance of hydroxychloroquine 49:15 Drug-induced lupus (e.g. hydralazine, isoniazid, minocycline, procainamide) 51:17 Take Home Points; Plug: Thurston Arthritis Center at UNC Chapel Hill 53:40 Outro Goals Listeners will recognize and diagnose various presentations of lupus (SLE) in primary care, counsel patients with a new diagnosis of lupus, learn the general approach to treatment, and provide preventive care.  Learning objectives After listening to this episode listeners will... Recognize its myriad manifestations and diagnose lupus.  Perform an initial workup for suspected lupus Interpret positive ANA titers and order appropriate follow up testing Counsel patients with a new diagnosis of lupus Educate patients on nonpharmacologic therapy for lupus Discuss the basics of lupus treatment and monitoring/prevention including vaccinations, control of vascular risk factors, antimicrobial prophylaxis and promotion of bone health Provide excellent primary care and preventive medicine to co-manage lupus Counsel patients with a new diagnosis of lupus  *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 my Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra. Disclosures Dr. Jonas reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures. Citation Jonas B, Williams PN, Watto MF. “#171 Lupus in Primary Care with Beth Jonas MD”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list September 8, 2019.
September 2, 2019
Solve hypernatremia with tips and tactics from Dr. Joel Topf, MD (@kidney_boy), our Kashlak Chief of Nephrology. We review the diagnostic workup for hypernatremia, polydipsia and polyuria, review the pathophysiology of diabetes insipidus, and how to differentiate between nephrogenic and central DI. Plus, we walk through how to treat hypernatremia in the acute setting and Dr. Topf shares clinical pearls on why hypernatremia is the opposite of hyponatremia… It’s easy! Full show notes 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 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 Check out Dr. Topf’s podcast! The NephJC podcast, Freely Filtered, discusses the latest NephJC topic every two weeks. Subscribe here or on iTunes.  Time Stamps 00:00 Intro, disclaimer, guest bio 03:25 Joel’s one liner and plug for his new podcast 05:34 Hannah shares a really weird analogy 07:10 Picks of the week*: In Shock (book) by Rana Awdish; HBO’s From the Earth to the Moon; Once Upon a Time in Hollywood (film); Glass(film) directed by M. Night Shyamalan (Stuart’s anti-pick)POCUS! Sign up for a course today from the ACP, AIUM or TRUST.  13:18 Why hypernatremia is easy 14:49 The case of Paula Uric - new onset hypernatremia with hypercalcemia 16:12 Hypernatremia risk factors; ADH, osmolality and the kidney  21:20 Loop of Henle and the sodium, potassium and 2 chloride channel 22:05 How hypercalcemia mimics nephrogenic diabetes insipidus 29:30 Hypercalcemia workup 33:10 Differentiating central from nephrogenic diabetes insipidus 37:35 DDAVP, desmopressin and treatment of nocturia 38:50 The case of Manny Uric - altered mental status and hypernatremia Na = 162; Why do patients in the ICU develop hypernatremia? 42:29 Calculate the fluid deficit; total body water 48:05 Estimate insensible losses (electrolyte free water clearance) 54:48 What if your hypernatremic patient is also hypovolemic? 57:30 Does fluid restriction work in heart failure? 58:35 Hypernatremia - Is there such a thing as too fast in adults?  63:44 Thiazides versus acetazolamide for nephrogenic DI 68:34 Take home points 71:20 Outro Links* In Shock (book) by Rana Awdish HBO’s From the Earth to the Moon Once Upon a Time in Hollywood (film) Glass (film) directed by M. Night Shyamalan (though consider avoiding, per Stuart) POCUS! Sign up for a course today from the ACP, AIUM or TRUST *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 my Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra. Disclosures Dr Topf lists the following disclosures on his website: “I have an ownership stake in a few Davita run dialysis clinics and a vascular access center. Takeda Oncology made a donation to MM4MM the program that is taking me to Mount Everest in 2018”. The Curbsiders report no relevant financial disclosures. Citation Topf J, Abrams HR, Brigham SK, Okamoto E, Watto MF. “170 Hypernatremia is Easy with Joel Topf MD”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. September 2, 2019.
August 28, 2019
Search and secure your first job after residency. Dr. Alia Chisty (Penn State) returns to school us on surviving the PGY3 and beyond, part of ACP’s IMpower series. Topics: finding mentors, how to plan ahead as an intern and PGY2, master the interview day, avoid common pitfalls and confidently enter your early career. We’re joined by Curbsider and recent graduate Justin Berk MD, MPH, MBA who shares his experiences from the job trail. Full show notes https://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: Paul Williams MD, FACP and Alia Chisty MD, MS  Cover Art: Matthew Watto MD, FACP Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP Editor: Matthew Watto MD, FACP Guests: Alia Chisty MD, MS; Justin Berk MD, MPH, MBA Sponsor Join The American College of Physicians today! Resident members get exclusive access to IMpower: Catalyzing your professional future.  Time Stamps 00:00 Pun 01:19 Intro, guest bio, disclaimer 04:00 Guest one-liner 05:35 Picks of the week*: Once Upon A Time In Hollywood (film), Visit Baltimore (city)!, Read with your kids!, Wolfie the Bunny (book), Tribe: Homecoming and Belonging (book) by Sebastian Junger 10:20 Intern year agenda: Get the lay of the land; Identify potential mentors 19:26 How to be a great mentee: Bring concrete questions, Ask how your mentor likes to operate 22:08 PGY2 and career development: Decide if you want to do fellowship. Explore electives in potential career paths (e.g. meded), A word of caution about signing a contract as a PGY2 26:30 PGY3: Polish your CV. Collect references. Reach out to your network. Email potential employers. 31:00 Resources for finding a career: ACP and NEJM website’s have career centers. Check LinkedIn and Doximity. Ask your program director and previous graduates from your program. 35:10 Recruiters: Should you use them? What are the pitfalls? 37:45 Dr. Chisty recaps the job application timeline 40:20 Interviewing: Phone interviews are a common first step; Make an elevator pitch; How to nail the interview day 45:28 How geographic needs affect the application process 47:52 Stuart is champing at the bit 49:04 The pie analogy and FTEs 52:36 Promotion tracks 55:26 More on the interview day 59:26 Making the emotional transition from PGY3 to early career; Pretending rounds; Imposter Syndrome; Article by Murthy, Dhaliwal on Early Careers of Master Clinicians 67:13 You are competent. There’s a committee that’s been monitoring your growth 68:28 Take home points: Use your network. Imposter syndrome is normal. You are competent and people believe in you. Reflect on the behaviors of your favorite educators. 72:18 Your tribe *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 my Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra.
August 26, 2019
Step up your diabetes game! We answer your questions from #MedTwitter with help from returning guest, Jeff Colburn MD, FACP, FACE (USU) Topics include: the pitfalls of A1C testing, the A1C target controversy, lifestyle interventions, continuous glucose monitoring, pathophysiology of T2DM, use of SGLT2 inhibitors, GLP1 agonists, and how to initiate and titrate insulin therapy. 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).  Full show notes at https://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 Writer (including CME Questions) and Producer: Matthew Watto MD, FACP Cover Art and Infographic: Bryan Brown MD Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP Editor: Matthew Watto MD, FACP; Emi Okamoto MD Guest: Jeff Colburn MD, FACP, FACE Time Stamps 00:00 Pun, Intro, disclaimer, and guest bio 03:55 Guest one liner 05:45 Picks of the week*: Illusions (book) by Richard Bach, Industrial Accident: The Story of Wax Track Records (Documentary), Free Solo (Documentary), Peter Attia’s The Drive (Podcast) -episode with Jason Fung MD 12:28 A case of Type 2 Diabetes (T2DM); Four potential pitfalls when checking A1C  19:58 Does tight glucose control improve outcomes? 24:05 Continuous glucose monitoring 29:08 Pathophysiology of diabetes and the metabolic syndrome 33:13 Beta cell regeneration 35:10 Can intensive lifestyle changes and T2DM; DIRECT trial  37:50 Next steps for patients uncontrolled on metformin; SGLT2 inhibitors - considerations for use, risk and benefits, how to counsel patients 42:40 SGLT inhibitors and degree of hyperglycemia; How real are concerns about amputations and Fournier’s gangrene?; How does eGFR affect their use and efficacy?; Euglycemic DKA 49:51 GLP1 agonists. Now available as oral agents. 53:40 2019 ADA guidelines for the management of hyperglycemia 54:51  How to manage the use of both insulin and oral hypoglycemic agents in combination 56:48 Insulin therapy. Choice of agent. How to start it. How to titrate. 60:40 Can patients with T2DM ever stop insulin? 62:00 Adding GLP1 and SGLT2 agents on top of insulin therapy 65:30 Using loop diuretics with SGLT2 inhibitors 66:30 Take home points 69:06 Outro
August 19, 2019
Take a deep dive into common CBC abnormalities. We recorded LIVE at joint grand rounds between Walter Reed NMMC and Uniformed Services University with hematologist, Dr. Mary Kwok MD. Topics include: which parts of the complete blood count (CBC) are most important, interpreting the differential, when to order flow cytometry, who needs a hematology consult and simplified approaches to patients with leukocytosis, leukopenia, erythrocytosis and thrombocytopenia.  Full show notes at https://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 and Edited by: Matthew Watto MD, FACP Cover Art and Infographic by: Matthew Watto MD, FACP Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP Guest: Mary Kwok MD   Sign Up for a course w/our Chief of POCUS, Dr. Renee Dversdal! ACP - acponline.org/pocus AIUM - Check out https://aium.org for upcoming events.  TRUST (Train the Ultrasound Trainers) https://www.ultrasoundtraining.com.au/courses/category/train-the-ultrasound-trainer-trust Time Stamps 00:00 Intro; Paul shame’s the audience; Guest bio 03:17 Guest one-liner, book recommendation* -Emperor of All Maladies (book) by Siddhartha Mukherjee, When Breath Becomes Air (book) by Paul Kalanithi; Career advice -set goals for whatever you’re learning. 08:43 Picks of the week: John Wick 3 (film); The Movies That Made Me (podcast) by Joe Dante; The Tim Ferriss Podcast with Julie Rice of Soul Cycle; Infinity Chamber (film) by Travis Milloy 11:50 A case of asymptomatic leukocytosis; Red flags; Repeat the CBC until it’s normal 17:30 The peripheral smear; Leukemoid reaction 20:00 The physical exam; When to send flow cytometry? 22:18 A case of lymphopenia; benign ethnic neutropenia; What to look for in the history 27:10 A case of erythrocytosis; Checking EPO levels; JAK2 mutation; Differential Diagnosis; Therapeutic Phlebotomy; Physical findings of Polycythemia Vera 36:53 A case of thrombocytopenia; Lab workup; Differential diagnosis; Pathophysiology; Culprit meds 45:35 Advice for internists 46:36 Take Home Points 47:46 Dr. Kwok’s disclaimer 48:10 Outro and post credit scene
August 14, 2019
Join us for this roundtable discussion of advocacy in healthcare and a rundown of hot topics: coding and billing, the Affordable Care Act, universal healthcare, gender equity, women’s health, gun violence and more! Returning guest, Dr. Robert McLean (@rmmclean84), current president of the American College of Physicians, helps us answer questions like, What is advocacy in healthcare? What are the issues that are impacting your profession? What can your medical home do for you? He’s been heavily involved in advocacy throughout his career including testifying before Congress. Guest hosts Drs. Fatima Syed MD, MSc and Deep Shah MD, MSc join!  Full show notes available at https://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: 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   Time Stamps 00:00 Intro, disclaimer, and guest bios 03:22 How can new docs in practice get involved in advocacy and shaping healthcare policy 11:30 Medicare’s proposed changes to billing and documentation 13:40 Who’s involved in changing Medicare policies? 16:09 What’s the purpose of policy papers? How are they written? 19:12 Getting involved in local and national councils as a student or resident 25:22 The Affordable Care Act and Universal coverage 29:25 What’s the risk of non-ACA approved insurance plans? 31:40 Why do people oppose the ACA? 34:40 Universal healthcare defined 40:23 The gender pay gap; Shout out to ACP’s CEO Darilyn Moyer MD, FACP 45:10 Women’s health policy paper 47:40 Gun violence and how advocacy issues take off 55:00 Take home points; Plug for Bob Doherty’s blog 60:36 Outro
August 12, 2019
Discover more common practices that persist in the hospital wards despite no proven benefit! We review how hospitals prescribe a “crapload” of docusate which only clogs up the medication list, how unnecessary echocardiograms are ordered enough times to make your head spin, and how basal insulin needs to slide back into your inpatient diabetes management instead of correctional insulin monotherapy. Join high-value care specialist Dr. Lenny Feldman (@DocLennyF, Hopkins) and tweetorialist Dr. Tony Breu (@tony_breu, Harvard) as they walk us through round 2 of “Things We Do For No Reason™.”  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. Full show notes at https://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits Written and Produced by: Justin Berk, MD MPH MBA, Matthew Watto MD Infographic: Justin Berk MD MPH MBA Cover Art: Matthew Watto MD Hosts: Stuart Brigham MD, Matthew Watto MD, and Paul Williams MD   Editor: Matthew Watto MD, Emi Okamoto MD Guest: Lenny Feldman MD, Tony Breu MD   Sponsor The Society of Hospital Medicine / Journal of Hospital Medicine - Things We Do For No Reason™series. Check out all the Things We Do For No ReasonTM articles here: Master Index of TWDFNR articles . Time Stamps 00:00 CME-MOC announcement https://www.shmlearningportal.org/curbsiders  00:50 Intro, disclaimer, guest bios 05:20 Guest one-liners, picks of the week 14:32 Things We Do for No ReasonTM (TWDFNR) defined 18:06 A case of syncope; definition 19:58 Do all patients with syncope need an echo? 23:30 What’s the diagnostic yield of echo for syncope? 29:36 Workup for new onset syncope 33:54 Aortic stenosis murmur 35:55 Docusate. Mechanism of action. Why is it so popular? What’s the harm? 42:08 Docusate. What does the evidence say? What should we use instead 50:05 A case of Sliding scale insulin (SSI); a brief history of insulin therapy and monitoring; SSI monotherapy: Risks, benefits, alternatives 59:30 Metformin in the hospital 65:35 Starting insulin in the hospital 68:20 Plugs- Things We Do For No ReasonTM. Become an author. 72:10 Outro and post-credits scene
August 7, 2019
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 www.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, FACP and Renee Dversdal MD, FACP  Produced and CME questions by: Christopher Chiu MD, FACP Edited by: Matthew Watto MD, FACP  Hosts: Matthew Watto MD, FACP; Stuart Brigham MD; Christopher Chiu MD, FACP  Guest Expert: Renee Dversdal MD, FACP  Special thanks to our POCUS friends! ACP We can speak first hand that the following courses are amazing POCUS learning experiences! Sign up today Point-of-Care Ultrasound: Foundational Skills for Internists November 7-8, 2019 and November 9-10, 2019 (same 2-day course repeated back to back) Crowne Plaza O’Hare Hotel and Conference Center, Rosemont, IL Registration is now open at acponline.org/pocus Point-of-Care Ultrasound: Foundational Skills for Internists April 21-22, 2020 (during Internal Medicine Meeting 2020) Los Angeles Convention Center Registration will open at the end of September  Point-of-Care Ultrasound: Advanced Skills for Outpatient Practice April 22, 2020 (during Internal Medicine Meeting 2020) Los Angeles Convention Center Registration will open at the end of September AIUM A special thanks to our Chief of POCUS Dr. Renee Dversdal and the AIUM for hosting The Curbsiders at another fantastic AIUM Point of Care Ultrasound (POCUS) Conference in Portland, Oregon at OHSU, July 2019. Check out https://aium.org for upcoming events. Next year’s IM POCUS course will be July 2020 in Portland! Dates are still TBD. Stay tuned. TRUSTTM (Train the Ultrasound Trainers) Are you looking to boost your skills teaching POCUS? Well, Our Chief of POCUS in collaboration with Kashlak West & Zedu Ultrasound Training Solutions created a course just for people like you. Sign up here: https://www.ultrasoundtraining.com.au/courses/category/train-the-ultrasound-trainer-trust   Time Stamps  00:00 Intro, Disclaimer, POCUS announcements 05:00 Guest one liner, book recommendation, rapid fire Q & A 11:00 Dr Dversdal shares a story about failure/struggle 15:00 POCUS defined 19:00 Uptake of POCUS in Internal Medicine 22:45 Getting into the game. Cost, choice of device and how to get training 26:40 Dr Dversdal shares her journey into POCUS  31:00 Clinical case of indeterminate volume status and how POCUS helped 35:00 IVC and IJ POCUS exam discussed in detail 37:55 How to choose a machine and bring US to your institution 41:00 How to troll the wards and introduce yourself to patients for practice of POCUS 43:00 Billing and documentation for POCUS 46:43 How POCUS can improve physical exam 51:27 Uses for POCUS in the primary care clinic 53:40 Dr Dversdal’s top 5 POCUS exam findings 56:27 Patients love POCUS 58:30 Outro
August 5, 2019
Update your management of stroke and TIA in primary care. Stroke neurologist, Chris Favilla MD (University of Pennsylvania), walks us through the plumbing of the brain, so we can identify ischemic risks in stroke and TIA patients to prevent recurrences.  Learn factors that make a TIA high risk, which imaging studies to order, new research around aspirin dosing, dual antiplatelets, DOACs, cardiac monitoring and more! 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).  Full show notes at https://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 Producers: Molly Heublein MD; Matthew Watto MD, FACP Writer (including CME questions): Molly Heublein MD Cover Art: Bryan Brown MD Hosts: Stuart Bringham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP Editor: Emi Okamoto, MD; Matthew Watto MD, FACP Guest: Chris Favilla, MD Time Stamps 00:00 Intro, disclaimer, guest bio, and a bad pun 04:20 Chris’ one-liner, advice as a teacher, book recommendation -The Goldfinch,  07:40 Molly’s pick of the week -Extreme Measures (book) by Jessica Zitter 08:40 A case of TIA; definition of TIA 12:14 Stroke territories 14:24 New definition of TIA 16:00 Differentiation from complex migraine 19:17 Risk stratifying TIA and ABCD2 score 22:00 A bit on tPA 24:01 Workup for TIA; workup for amaurosis fugax 25:36 CNS imaging studies after stroke or TIA; Choice of imaging study 33:15 HINTS exam for posterior circulation stroke 34:48 Is an echo necessary? Bubble study for PFO? 38:32 Duration of afib monitoring 40:24 Echo reports: what to look for in patient with stroke or TIA; “soft markers” 41:55 Blood testing after Stroke and TIA (lipid panel, HbA1C; +/- RPR, coags, CBC) 43:50 Folic acid; Sparkle trial: high dose atorvastatin versus placebo for secondary prevention 47:00 Incidental finding: multiple patchy infiltrates in a patient without stroke or TIA; Is it significant? 48:50 Aspirin therapy after TIA; Dosage adjustment based on weight? 51:10 A case of stroke; TOAST trial and classification of acute stroke; ESUS; aortic arch atheromas 55:58 Large artery strokes (hypoperfusion, acute thrombosis, artery to artery embolization) 57:15 Antiplatelets after stroke and TIA; DAPT and duration of therapy 62:57 Antidiabetic drugs and stroke 63:40 Lightning round: CHA2DS2VASc score and women; how much afib is significant?; 66:32 Are all DOACs created equal?; 68:20 Regaining function after a stroke; 69:47 Silent infarcts on imaging 71:54 Resources for stroke: Decision making in neurology textbook 73:28 Outro
July 29, 2019
Summary The sun is shining, the cakes are hot, and the takes are even hotter. Welcome to our July 2019 Hotcakes episode! Join us as our beloved hosts Chris, Matt, Stuart and Paul share some of the latest practice-changing knowledge, news and research in medical science. Today’s discussion covers studies on the use of IV iron supplementation for heart failure, aspirin as VTE prophylaxis after arthroplasty, and the relationship between physician burnout and ability to address patients’ social determinants of health. Honorable mentions include a throwback to the life-changing magic of Pokémon GO.    Full show notes available at http://thecurbsiders.com/podcast. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits  Written and Produced by: Sarah Phoebe Roberts MPH, Christopher Chiu MD Hosts: Matthew Watto MD, Stuart Brigham MD, Paul Williams MD, and Christopher Chiu MD Editor: Christopher Chiu MD, Emi Okamoto MD Cover-Art: Matthew Watto MD Time stamps 00:20 Disclaimer, intro 02:30 Clinic capacity, provider burnout, and social determinants of health 15:00 Iron deficiency and heart failure meta-analysis (Zhou et al., 2019) 17:15 Iron deficiency and stable heart failure RCT (Ponikowski et al., 2015) 19:00 Iron deficiency and decompensated heart failure RCT (Yeo et al., 2018) 26:00 Aspirin as VTE prophylaxis after arthroplasty 38:00 Honorable mention (Pokémon Go!) 39:00 Wrap-up and outro
July 22, 2019
Dr. Reshma Jagsi (TIME’S UP Healthcare; UMichigan) schools us on sexual harassment and describes the systemic and cultural changes that need to happen to effect real change. She unpacks the definition of sexual harassment, describes the state of the #MeToo and TIME’s UP movements across the science and medicine fields and highlights how we all can recognize/respond to harassment. This is the third episode of our Women in Medicine series. Last August, you heard us talk to Dr. Vinny Arora about the paucity of women in leadership positions, finding sponsors for career advancement, and being bold about career decisions. In December, we spoke to Dr. Susan Hingle about work-life integration. Her advice? Stop worrying about what other people think, acknowledge that being a doctor is hard, especially for women due to disproportionate out-of-work responsibilities, and define a beautiful life that is individualized to you.  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: Leah Witt MD, Shreya Trivedi MD, Nora Taranto MD, Sarah P. Roberts MPH. Editor: Matthew Watto MD Hosts: Shreya Trivedi MD, Chris Chiu MD, Leah Witt MD Guest: Reshma Jagsi MD, DPhil Special thanks to: Hannah Abrams MS4, Beth Garbitelli MS2, and Molly Heublein MD  Time Stamps  00:00 Intro, disclaimer and guest bio 03:10 Guest one-liner, WIM moment of awakening, Dr. Jagsi’s advice to her younger self 10:40 TIME’S UP Healthcare, how to get involved 13:10 Picks of the week: This American Life (podcast); The Bon Appétit (YouTube), The Nocturnists (podcast); Twitter 17:05 Defining sexual harassment 21:05 A case of sexual harassment; Predictors of harrassment; Duty to report 27:30 Creating a system that makes reporting easy 30:19 How pervasive is sexual harassment? 34:33 Why/how does bad behavior go unreported? 36:22 Pregnancy, parenting and promotion  39:10 How is gender equity related to harassment? What can we do in our day to day? 42:13 An example from Radiation Oncology 46:43 How identity as sex intersects with many other identities (e.g. religion, sexual orientation)  48:15 Examples of how can institutions are changing academic culture and addressing gender equity 53:28 Anonynmous reporting of sexual harassment 58:01 Take Home Points 60:25 Outro
July 15, 2019
Tackle rashes with wisdom from Kashlak’s resident Skinternist (or Internist-Externist) Dr. Helena Pasieka (MedStar, Georgetown), board certified in both Internal Medicine and Dermatology.  She offers “a rash approach to rashes” including: initial triage, ‘inside job’ vs ‘outside job’, differential diagnosis, a review of common culprits, basic management techniques, and how to determine if the reaction is life-threatening. Plus, Dr Pasieka teaches us how to handle family and friends asking, “Can you take a look at this rash?”.  Full show notes at https://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: Beth Garbitelli MS2 Infographic and Cover Art: Beth Garbitelli MS2 Hosts: Stuart Bringham MD, Matthew Watto MD, Paul Williams MD   Editor: Matthew Watto MD Guest: Helena Pasieka MD  Time Stamps 00:00 Intro, disclaimer, guest bio 04:10 Guest one-liner, book recommendations  09:56 Case of a rash; initial thought process (sick versus not sick); review of systems 18:05 Grouping rashes: inside job versus outside job 22:07 Terminology: Many people dont speak derm 26:03 Skin itching versus Skin pain; Morbilliform drug eruption 30:08 Urticaria (hives) vs morbilliform rash; Cotton tipped applicators and dermatographism 35:42 Itching is not all about histamine; Treatment of hives 38:26 Treatment of morbilliform rash 40:00 Case summary and review of concepts learned thus far 41:00 AGEP 45:14 SJS/TEN; Nikolsky’s sign 53:20 Complications of TEN - Ocular surface disease; Vulvar disease 58:02 DRESS (now DIHS) 66:30 Tips for asking about time course of meds and symptoms; Recap of DRESS (DISH) 70:00 How to handle family and friends ask for rash evaluation 76:20 Outro 78:00 Post-credits scene
July 10, 2019
Confession: we have been holding out on you. Specifically, we’ve been sitting on a special episode of Hotcakes and Hot Takes that we recorded this March, with featured guest Armand Gottlieb, MD of the online publication The Scope. But here it is! We hope you’ll enjoy our discussion of topics like the ever-controversial e-cigarettes for smoking cessation question, outcomes related to antibiotic treatment of UTIs among elderly adults, and the role of sacubitril-valsartan for acute decompensated heart failure in inpatient settings (the PIONEER-HF study).  Special guest is Dr. Armand Gottlieb @ArmandGottlieb, who was a third year internal medicine resident at Columbia University Medical Center in New York City at the time of recording. He is a co-Editor of the The Scope, a free and brief weekly roundup of the most recent and relevant medical literature. Full show notes available at http://thecurbsiders.com/podcast. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits  Written and Produced by: Sarah Phoebe Roberts MPH, Christopher Chiu MD 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   Pick of the Week The SCOPE. The week’s best in evidence-based medicine, written in plain language and delivered to your inbox. Sign-up for weekly emails or download the app.  Time stamps 01:00 Disclaimer, intro, guest bio 06:30 E-cigarettes vs. nicotine replacement therapy (NRT) 15:50 Antibiotic treatment of urinary tract infections (UTIs) 27:45 Sacubitril-valsartan for acute decompensated heart failure (PIONEER-HF study) 42:30 Wrap-up and outro
July 8, 2019
Take control of atrial fibrillation with expert insights and pearls from cardiologist, Dr. James Furgerson, in this jam-packed episode! You’ll learn why atrial fibrillation is such a big deal, how to diagnose it, how to treat it and when to call in for reinforcements. Dr. James Furgerson, MD  is a cardiologist from San Antonio, Texas with over 20 years in academics. Buckle up - This episode is going to send your heart racing! You might even skip a beat! Full notes at https://thecurbsiders.com. 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).  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 Writer and Producer: Cyrus Askin MD Infographic: Cyrus Askin MD Cover Art: Cyrus Askin MD Hosts: Matthew Watto MD, Paul Williams MD, Cyrus Askin MD Editors: Matthew Watto MD Guest: James Furgerson MD   Time Stamps 00:00 Intro, disclaimer and guest bio 03:45 Guest one liner, a bit on physician well-being and some other randomness 08:15 A case of palpitations; risk factors for atrial fibrillation 12:17 Subclinical atrial fibrillation, overdiagnosis of afib; How much afib burden matters?  15:08 Case summary and next steps in initial work up 18:48 Counseling patient about afib and its consequences 21:40 Ischemic heart disease and atrial fibrillation 24:17 Recap of diagnosis, initial work up and risk stratification in atrial fibrillation 25:25 Rate versus rhythm control; AFFIRM trial 30:50 Strict versus lenient rate control;  RACE trial 33:30 Deciding on rate versus rhythm control; Downside of antiarrhythmic therapies; When to switch from rate to rhythm control strategy 36:52 Ablation for atrial fibrillation; CASTLE-AF, CABANA trials 40:40 When to refer to cardiology and electrophysiology 42:42 Choice of agent for anticoagulation and latest guidelines for atrial fibrillation; New definition for valvular atrial fibrillation 45:22 DOACs in CKD and some other nuances in choice of agent 52:27 Bleeding and anticoagulation 58:38 Cardioversion for atrial fibrillation (initial versus delayed) 63:32 Anticoagulation before and after cardioversion 67:48 Lifestyles measures for atrial fibrillation 70:45 Atrial fibrillation during critical illness, after CABG and in hyperthyroidism 74:12 Aspirin monotherapy is not appropriate for atrial fibrillation 76:42 Take home points 78:50 Outro
July 1, 2019
Expand your knowledge about how--and how well--we manage the health of incarcerated patients in the United States, with the expert knowledge of correctional health experts Drs. Aaron Fox @adfoxmd, Jon Giftos @JonGiftosMD, and Emily Wang @ewang422. Correctional medicine is a black box for many providers who do not work in prison and jail settings. But it’s ever more relevant to primary care physicians everywhere, with increasing rates of incarceration the last decade.  In this episode, recorded live at SGIM 2019 #SGIM19, Dr. Fox, Dr. Giftos, and Dr. Wang talk us through the variability of the correctional healthcare systems throughout the country, the challenges to health for patients both while incarcerated and in the transition after release, and some essential nuts and bolts for providers about how to provide better care to this vulnerable population.   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 and produced by: Justin Berk MD MPH MBA, Nora Taranto MD Cover Image: Beth Garbitelli MS2 Infographic: Beth Garbitelli MS2 Hosts: Matthew Watto MD, Paul Williams MD, Justin Berk MD MPH MBA Edited by: Matthew Watto MD Guests: Aaron Fox MD, Jon Giftos MD, Emily Wang MD MAS Sponsor This episodes was recorded LIVE at #SGIM19 in Washington DC! Join the Society for General Internal Medicine today! Time Stamps 00:00 Intro, disclaimer and guest bios 05:10 One liners, book recommendations, career advice 13:00 Why does incarceration matter for healthcare?; Defining terms: jail, prison, probation 18:47 What is healthcare like during incarceration? What services are available? Who provides the care? How does it breed “passive patients”? 21:10 HIV in incarcerated patients 27:02 Opioid use disorder in prisons -MAT is rarely available 31:44 Prison is a toxic environment —exposure to solitary confinement, PTSD, self harm 34:23 How to ask about incarceration 36:49 Trauma informed care and the unique challenges to providing patient care after release from prison 43:22 Systemic barriers after release from jail or prison e.g. lifetime ban from public housing or food stamps 44:45 Discharge planning and transitioning care after release from prison; community health workers 51:32 Resources for learning more and advocacy —AAJH, The Fortune Society, Just Health, Dr Wang’s research —why you should visit and learn more about the correctional settings in your locale 57:20 Outro
June 26, 2019
Bring back Bedside Rounds with tips from a master clinician educator, Jeff Wiese MD MACP (Tulane). How to accomplish teaching in the hospital is not on the curriculum for most folks in medical school or residency. This can feel especially daunting as you move from resident to attending. We address strategies to assess, monitor, teach, and coach the medical learners under your leadership with teaching wizard and coach extraordinaire, Dr. Jeff Wiese, recipient of over 50 teaching awards! ACP members can claim CME-MOC credit at https://acponline.org/curbsiders (CME goes live at 0900 ET on the release date). Full show notes available at http://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 and Produced by:  Matthew Watto MD FACP and Beth Garbitelli MS1 (almost MS2!) CME questions by: Matthew Watto MD FACP Hosts: Stuart Brigham MD, Paul Williams MD FACP, Matthew Watto MD FACP Images and infographics: Beth Garbitelli MS1 Edited by: Matthew Watto MD FACP, Emi Okamoto MD Guest: Jeff Wiese MD MACP Time Stamps 00:00 Intro, disclaimer, guest bio 03:28 Guest one-liner, love of Aaron Sorkin, book recommendations 10:52 Setting goals and expectations on day one 23:52 Preparing the resident for autonomy and assessing their place on the scale of supervision to autonomy 28:18 How to prepare for rounds as an attending to set yourself up for efficiency and success; The cardinal rule for being an attending 33:50 How long does it take determine a resident’s readiness for autonomy; Give your colleagues an “educational signout” 38:31 How to handle a request for card flipping; Prodiving a rationale for bedside rounds 43:54 The three Ds of Rounding; Should there be a fourth D 47:28 The choreography of bedside rounds; Privacy concerns; More on the rationale 63:00 How to handle unanswered questions in front of the patient 67:19 Resident as a “proud parent” on rounds 68:30 Rounding without the team (the afternoon) 73:18 Hand sanitizer (the Purell) 79:45 Advice to new PGY2s 81:35 When and how to incorporate teaching on high value care (specifically labs) 83:22 What’s the role of medical student on the wards team 85:18 Take home points 89:04 Plug: Teaching in the Hospital Deux 90:12 Outro      
June 24, 2019
Rethink how you’re diagnosing and managing chronic pain with high-yield tips from pain experts and primary care doctors Soraya Azari MD @azarimugs (UCSF), and Phoebe Cushman MD, MS (UMass Memorial). Because let’s face it, managing chronic pain can be very difficult. Expand your toolbox for management-- including the importance of activity, empowering your patient, risk stratification for patients prior to opioid initiation, how to identify opioid use disorder, and how to taper opioids. Plus, updates on recent practice changing articles in chronic pain. Full show notes at https://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits Written and produced by: Nora Taranto 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 Sponsor This episodes was recorded LIVE at #SGIM19 in Washington DC! Join the Society for General Internal Medicine today! Time Stamps 00:00 Intro, disclaimer, guest bios 04:50 Guest one-liners, book recommendations, picks of the week, career advice 14:50 A case of chronic pain; Group pain into 1 of 3 buckets 18:48 Use of pain scales; and taking a pain history; affirming positive behaviors surrounding pain 23:13 Nonpharmacologic measures for chronic pain 26:30 Cognitive behavior therapy (CBT) for chronic pain; remote CBT vs traditional CBT 30:32 Apps for Meditation, Affirmations 31:53 Back to the case: Should we trial opioids for our patient’s chronic pain? Our guests give their recommendations and how they counsel patients about opioids 34:55 Counseling about risk of opioids 37:42 Risk stratifying patients requesting opioids; Some risk tools (COMM, Opioid Risk Tool, DIRE); Don’t forget to screen for mood disorders 42:10 What to do if pain is not improved on high dose opioids; How to identify an opioid use disorder 45:13  How to taper patients off opioids; Forced tapers and the CDC guidelines; how to taper the right way 50:34 Buprenorphine for opioid use disorder and/or chronic pain 57:38 Gabapentin and risk for misuse and/or unintentional overdose in patients also using opioids 61:42 Plugs: Get your x-waiver, or better yet advocate for getting rid of the waiver
June 17, 2019
Build your knowledge base to improve primary care for LGBT patients! This episode is chock full of clinical pearls and updates for LGBT health from SGIM presenters, Dr. Jenny Siegel (Boston University) and Dr. Megan McNamara (Louis Stokes Cleveland VAMC). They define common gender identity terms and provide tips on how to take a sexual history. You’ll develop an approach to the unique clinical concerns of LGBT patients and learn how to phrase medical information in a gender neutral framework. This is a must listen episode for all health care providers! Full show notes at https://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: Carolyn Chan MD Graphics: Hannah Abrams Hosts: Carolyn Chan MD, Paul Williams MD, Matthew Watto MD Guest: Megan McNamara MD, Jenny Siegel MD   Sponsor This episodes was recorded LIVE at #SGIM19 in Washington DC! Join the Society for General Internal Medicine today! Time Stamps 00:00 Intro, disclaimer, guest bios 02:45 Guest one-liners, movie recommendations; favorite failures; Paul’s pick of the week 10:52 Defining terms of gender identity 14:20 What to do when you misgender someone or use the wrong term 17:10 Is it a mistake to think of the entire LGBT group as the same? 19:19 How to take a sexual history, the 5Ps 22:00 Unique clinical concerns of LGBT patients; what screening should be performed 24:20 Avoid focusing too much on sexuality and gender identity. Don’t forget to address their medical concerns 24:42 Screening for mental health disorders and asking about suicide 27:16 Cancer screening in transgender patients; a bit on transgener terminology; how to take an anatomy inventory 34:18 Vaccinations 37:05 Contraception considerations and VTE risk with hormonal therapy 41:40 Pre-exposure prophylaxis and risk of STIs 43:30 Impact of discriminatory state laws on LGBT mental health 47:32 Plugs: Fenway Health; UCSF trans health website; Guidelines from the Endocrine Society 49:35 Closing remarks 51:05 Outro
June 10, 2019
What do Judas Priest, surfing, and clots have in common? They are the passionate interests of expert Dr. Michael Streiff who guides us through the diagnosis and management of DVT and PE aka venous thromboembolism (VTE). By the end of the episode you will know how to catch a clot very Wells! We dive deep into the treatment options, literature, and some unique cases. ACP members can claim CME-MOC credit at https://acponline.org/curbsiders (CME goes live at 0900 ET on the episode’s release date). 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 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 Time Stamps 00:00 Intro, disclaimer and guest bio 04:40 Guest one-liner, book and music recommendations, advice about rejection, how to think about studies 11:15 A case of DVT and some basic terminology 15:37 Which DVT risk factors are most important? 18:40 Use of the Wells score and D-dimer testing; should we use an age adjusted D-dimer; What about the YEARS criteria 22:55 Classifying DVT; determining need and duration of anticoagulation [distal (calf vein) DVT, proximal DVT]; brief discussion of IVC filters & catheter directed therapies 27:56 IVC filters for trauma 29:30 Upper extremity DVT 33:12 Proximal vs whole leg ultrasound for diagnosis of DVT 36:25 A case of pulmonary embolism; how to diagnose pulmonary embolism and a bit on V/Q scans 40:35 PESI score and HESTIA criteria 42:05 Summary of how to diagnose DVT and PE 43:34 Choice of initial anticoagulation 45:29 DOACs for cancer 48:14 DOACs for patients with very high or very low BMI 49:33 Why apixaban is Dr Streiff’s favorite DOAC? 51:20 Duration of therapy for DVT and PE 53:33 Unprovoked DVT/PE: Risk scoring models 57:52 Is thrombophilia workup necessary? 58:28 Antiphospholipid antibody syndrome 59:58 An extensive cancer workup is unnecessary 60:33 Subsegmental pulmonary embolism: To treat or not to treat 61:49 Apixaban dosing in CKD and ESRD 63:51 AUGUSTUS trial for dual versus triple therapy 64:52 Plug for National Blood Clot Alliance “Stop the Clot”; Anticoagulation Forum website; new 2019 ASH guidelines 66:35 Outro 68:00 Post credit scene
June 3, 2019
Expand your idea of ischemic heart disease to include non-obstructive patterns, which as our guest, Dr Noel Bairey Merz, a clinical investigative cardiologist whose multiple roles include Director of the Barbra Streisand Women’s Heart Center and the Preventive Cardiac Center at the Smidt Cedars-Sinai Heart Institute, shares with us, is incredibly common, especially in women.  Learn to recognize these women and treat according to guidelines, preventing unnecessary IHD mortality in our female (and some male) patients. We review a variety of non-obstructive pathologies and the best techniques to evaluate them. 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: 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 Curbsiders' Schwag! We’ve got the perfect father’s day gift for every internal medicine nerd. The Curbsiders have opened our own online shop. Get your Curbsiders t-shirts, hoodies, stickers, and coffee mugs. Help support the show and gain instant bragging rights. Note: All purchases come with admitting privileges at Kashlak Memorial Hospital! Time Stamps 00:00 Intro, disclaimer and guest bio 04:36 Guest one-liner; Advice for success in research and clinical practice 07:07 A case of shortness of breath and chest tightness; Why the paradigm of obstructive coronary artery disease is flawed. 12:04 Why is there a sex difference in ischemic heart disease? 14:52 How to recognize ischemic heart disease in women; Are certain symptoms more likely in women; Categorizing angina 20:13 Who needs stress testing?; Screening for ischemic heart disease in women 24:52 How guidelines make good doctors great doctors 27:00 Diagnosis of NSTEMI in a woman without obstructive coronary disease 29:33 Medical therapy for non-obstructive ischemic heart disease 33:18 Additional testing: Cardiac MRI for myocarditis; perfusion reserve testing; CT coronary angiograms 35:48 How current non-invasive techniques fail to identify microvascular ischemic heart disease in women 39:10 Antianginal therapy 41:40 HFpEF in women 47:10 Weight loss for paroxysmal atrial fibrillation 48:45 New nomenclature for ischemic heart disease 50:18 Take home points 52:40 Outro
May 29, 2019
Dare to lead. Master the transition to PGY2 with tips from expert educator Abby Spencer MD, MS, FACP, IM Residency Program Director and Vice Chair for Education for the Medicine Institute at Cleveland Clinic and Shreya Trivedi MD, GIM Fellow at NYU School of Medicine. Topics include: how to run work rounds, preparing your team for attendings rounds, how to teach on the fly, finding your leadership style, and what to read during residency. This is the first of three episodes that we’re co-developing with the American College of Physicians for their Resident Transitions Series. 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: 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 Sponsor The Resident Transitions Series is brought to you by The American College of Physicians with support from its Council of Resident/Fellow Members. Visit acponline.org/resident to learn more about the benefits of Resident/Fellow Membership and join our proud internal medicine community today! Time Stamps 00:00 ACP’s Resident Transitions Series - Sponsor 01:50 Disclaimer, intro and guest bio 06:05 Guest one liner, book recommendations, favorite failure, advice for learners 14:10 Stuart’s tale of struggle from residency 18:05 New PGY2 resident thinks she has nothing to teach her learners 20:20 How to run work rounds and set expectations 31:55 How, when and where to teach as a resident 46:09 Leadership skills, understanding your learners, and giving difficult feedback 60:08 What to read during residency, how to find time, and some strategies to achieve your learning goals 71:30 Take home points 75:28 Outro 77:10 End credit sequence
May 27, 2019
Recognize common presentations of anaphylaxis and stop under-treating this deadly allergic reaction with tips from Dr. Olajumoke Fadugba, Assistant Professor of Medicine, University of Pennsylvania! We review the basic pathophysiology and the standard criteria for diagnosing anaphylaxis, treatment basics, the primary importance of epinephrine, and the utility of adjunctive therapies. Also included are great tips on counseling patients about auto-injectable epinephrine, and a reminder not to panic...even when you inject your own thumb?! ACP members can claim CME-MOC credit at https://acponline.org/curbsiders (CME goes live at 0900 ET on the episode’s release date). Full show notes available at https://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 Writer (interview, show notes & CME questions) and cover art: Emi Okamoto MD Infographic by: Emi Okamoto MD Hosts: Matthew Watto MD, FACP; Stuart Brigham MD Editors: Matthew Watto MD, FACP Guest: Olajumoke Fadugba MD Special thanks to Sarah Phoebe Roberts MPH for booking! Time Stamps 00:00 Intro and disclaimer 03:00 Guest one-liner, book recommendation, advice to fellows and trainees 07:15 Case of anaphylaxis with mucocutaneous and GI symptoms 09:05 Anaphylaxis (IgE mediated mast cell action) vs anaphylactoid (non-IgE mediated mast cell activation; e.g. contrast allergy, vancomycin) 12:34 Vancomycin and non-IgE mediated reactions 14:40 Common presentations of anaphylaxis and the three diagnostic criteria 22:09 Biphasic reactions and predicting severity 26:42 Counseling patients on the use of epinephrine 28:35 Stuart’s thumb question 30:00 Adjuvant medications: antihistamines and corticosteroids 33:20 Are there any contraindications to epinephrine use? 34:25 Use of tryptase levels when the diagnosis of anaphylaxis is uncertain 37:10 Outro
May 20, 2019
HFpEF (heart failure with preserved ejection fraction) with master cardiologist, Dr Clyde Yancy MD, Chief of Cardiology and Professor of Medicine (Cardiology) and Medical Social Sciences, Northwestern, Feinberg School of Medicine. Topics include: pathophysiology, HFpEF phenotypes, how to interpret a borderline ejection fraction, evidence based therapies, diuretics, and future directions (pulmonary artery monitors, intra-atrial shunts, ARNI compounds), and more! 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: Paul Williams MD, FACP; Sarah Phoebe Roberts MPH Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP; Stuart Brigham MD Show Notes: Justin Berk MD, MPH, MBA; and Beth Garbitelli MS1 Infographics: Beth Garbitelli MS1 Editor: Matthew Watto MD, FACP Guest: Clyde Yancy MD, MSc, MACC, FAHA, MACP, FHFSA Time Stamps 00:00 Thanks to our producers Sarah Phoebe Roberts, Beth Garbitelli and Justin Berk 00:50 Intro and guest bio 04:00 Guest one liner, career advice 08:20 Ms Diana Stolic has HFpEF. What’s the difference in HFpEF and diastolic dysfunction?   11:33 How should we think about borderline ejection fraction? 15:24 Pathophysiology and Phenotypes of HFpEF 18:57 More on the pathophysiology of HFpEF (nitric oxide, fibrosis, inflammatory signaling) 21:00 Are there morbidity and mortality differences for HFpEF versus HFrEF? 24:45 What historical factors are most important in HFpEF? 27:50 Pulmonary artery monitors for HFpEF 29:00 Does Diuretic therapy differ in HFpEF and HFrEF? 33:44 Ischemic workup for new HFpEF 35:33 Right heart cath for HFpEF 36:53 Future of HFpEF 41:04 Will ARNI compounds work for HFpEF? What are the current medications for HFpEF? 45:20 SGLT2 inhibitors for heart failure 46:30 Outro
May 17, 2019
Recap of random pearls and highlights from SGIM19 Day 2 including: methadone and buprenorphine, perioperative buprenorphine, medical cannabis, HPV vaccination, young adult medicine, academic promotions, long term sequelae of childhood kidney disease, stage 1 hypertension, some great free resources in addiction medicine, and more! Special thanks to the Society for General Internal Medicine 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: Paul Williams MD, Matthew Watto MD, Justin Berk MD, Carolyn Chan MD, Shreya Trivedi MD, Nora Taranto MS4 (soon to be MD!) Edited by: Matthew Watto MD Time Stamps and Links are included below 00:00 Intro and Disclaimer 02:30 Generalists receive the same number of grants, but publish fewer publications and are less likely to achieve professorship versus medical or surgical subspecialists (JGIM 2017) 05:30 GIM division directors differ in their emphasis on peer-reviewed publications for academic promotion (Acad Med 2015) 07:30 Only about 30% of patients are started on MAT after an overdose despite a known mortality benefit and a known mortality rate of 5% twelve month mortality in this population (Larochelle Annals Int Med 2018) 08:48 A representative in NYC has proposed a bill to get rid of the buprenorphine waiver program. 11:00 Stimulant use is not a contraindication to continuing buprenorphine (expert opinion from SGIM session on Addiction Medicine). 11:45 Perioperative buprenorphine: 1) Consider switching to full agonist therapy or 2) Dose buprenorphine 3-4 times daily and continue use during the perioperative period (Expert opinion from SGIM session titled “Buprenorphine 2.0”) 12:40 Options to transition from methadone to buprenorphine: Option 1) Taper methadone to 30-40 mg once daily. Then, hold methadone for 72 hours before starting buprenorphine. Option 2) “Microdosing” with buprenorphine patch while still on methadone and then start oral buprenorphine. Note: This is expert opinion so consult with your local expert before attempting this on your own! 13:46 UCSF has a “Warm Line” for free consultation about substance use https://nccc.ucsf.edu. Get a free buprenorphine waiver from https://pcss.org 15:10 New joint guidelines on transitions remind providers that young adults need help navigating the healthcare system. Many young adults have never accessed healthcare resources on their own (Pediatrics 2018) 18:50 Childhood kidney disease increases risk for end stage renal disease as an adult (NEJM 2018) 20:35 Two studies concluded that stage 1 hypertension in young adults confers an increased risk for morbidity and treating it confers a benefit (Yano AMA 2018; Son JAMA 2018) 23:35 HPV update: The 9 valent vaccine was approved for young adults age 27-45 years old, but this has not yet made it into the guidelines. The HPV vaccine is effective for preventing cervical cancer (Cochrane Review 2018) and provides some herd immunity (Clin Inf Dis 2018) 26:40 Dr Chan offers tips on how to handle resident mistreatment and phrases that you can use to defuse the situation. 31:30 Some broad comments on the use of medical cannabis for pain management (Expert opinion from SGIM session) 36:30 Newer data suggests that even one drink daily might have adverse health outcomes (Lancet 2019). 39:00 Outro Citation Paul Williams MD, Matthew Watto MD, Justin Berk MD, Carolyn Chan MD, Shreya Trivedi MD, Nora Taranto MS4. Recap SGIM19 Day 2”. The Curbsiders Internal Medicine Podcast https://thecurbsiders.com. May 17, 2019.
May 13, 2019
Recap of random pearls and highlights from SGIM19 Day 1 including: Kidney stone treatment (roller coasters, sex and tamsulosin), aspirin, SGLT2 inhibitors to reduce kidney events, oral antibiotics for endocarditis, preferred physician attire, sexual harassment, writing letters of recommendation, triple therapy for COPD, DAPT for stroke, and more! Special thanks to the Society for General Internal Medicine 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: Paul Williams MD, Matthew Watto MD, Justin Berk MD, Carolyn Chan MD, Shreya Trivedi MD, Abby Spencer MD, MS, Nora Taranto MS4 (soon to be MD!) Edited by: Matthew Watto MD Special Guest: Abby Spencer MD, MS  Time Stamps and Links are included below 00:00 Intro and Disclaimer 02:33 Abby explains what it means to attend SGIM 04:35 Tips for writing letters of recommendation 08:54 How to handle lapses of professionalism in a trainee 10:30 How to address sexual harassment 12:42 Oral antibiotics after 10 days of IV antibiotics are noninferior for left sided endocarditis in non-IVDU (NEJM 2019) 14:22 Patients prefer physicians to dress in more formal attire. (BMJ Open 2018) 16:29 Kidney stone passage occurs more frequently when sitting in the back car of a roller coaster (J Am Osteopath Assoc 2018) 18:00 Sexual intercourse three times weekly improves rate of kidney stone passage (Urology 2015) 18:58 Vancomycin coverage for hospital acquired pneumonia can safely be stopped after four days if cultures remain negative for MRSA (Chest 2019) 20:00 Notes that contain stigmatizing language are associated with negative provider feelings and less aggressive pain management (JGIM 2018) 21:10 Medication errors are less frequent if the medication reconciliation is performed at time of ICU discharge (Ann Intensive Care 2018) 21:56 Five of six pediatricians found Lego heads in their stool after intentional ingestion (J Paediatric Child Health 2018). 24:40 Canagliflozin (SGLT2 inhibitor) improved renal outcomes and cardiovascular events (Credence trial, NEJM 2019; Check out the Freely Filtered (NephJC podcast coverage)) Triple therapy for COPD with LAMA/LABA/ICS is superior to dual therapy (IMPACT trial NEJM 2018) 27:20 The ASCEND trial of aspirin for primary prevention in patients with diabetes contained 97 percent white patients and showed similar NNT to NNH for cardioprotection and bleeding respectively (ASCEND trial NEJM 2018) 28:45 Consider a short course of dual antiplatelet therapy for minor stroke or high risk TIA (BMJ 2018) 30:07 Omega-3 fatty acids decreased cardiovascular events in patients whose triglycerides remained elevated despite statin therapy (REDUCE-IT trial NEJM 2019) 30:24 Tamsulosin did not help pass stones under 5 mm, but might be effective for stones >5 mm (J Fam Pract 2018) 31:06 Trainees who are stressed during residency tend to stay stressed (I was unable to quickly locate this citation. Sorry. -Dr. Watto) 32:02 How does our team choose their pearls for the recap show 35:21 A needs assessment at University of Michigan found that female residents want to learn skills on leadership, negotiation and giving pitches to prepare them for careers in medicine (Poster by Dr Jennifer Lukela). 36:57 Abby Spencer received an AAIM Innovations grant: “Key steps to rise for women trainees in leadership development”. 38:42 Outro
May 6, 2019
Identify and treat the most common causes of hip pain in the outpatient setting with returning guest, Dr Ted Parks. A large majority of hip pain in the office setting will be due to one of three conditions (hip osteoarthritis, greater trochanteric pain syndrome, and lumbo-sacral back pain). Learn to easily identify these conditions, how to initiate conservative treatment, and more about hip replacements. 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: Molly Heublein MD, Nora Taranto MS4 CME questions by:  Molly Heublein MD, Nora Taranto MS4 Hosts: Matthew Watto MD, Paul Williams MD, Stuart Brigham MD, Molly Heublein MD Edited by: Matthew Watto MD, Emi Okamoto MD Guest Presenter: Ted Parks MD Time Stamps 00:00 CME announcement, disclaimer, intro and guest bio 04:05 Guest one-liner; advice for teachers and learners 08:30 Case of hip pain, review of hip anatomy, and the three buckets of hip pain 15:35 Greater trochanteric pain syndrome 16:20 The zebras of hip pain 18:12 Physical exam for hip pain 21:33 Hip osteoarthritis: imaging and initial therapy 24:18 Hip injections: Do steroids work? What about hyaluronic acid? 29:00 Who needs hip replacement surgery? How long will it last? 32:30 Greater trochanteric pain syndrome 35:58 Lumbar spine versus hip pain from OA 38:58 Hip replacement technology: materials; etiology of component loosening and need for re-operation 42:03 Take home points and outro
May 2, 2019
Electric cars, virtual reality, nanotechnology, and now… telemedicine? We chat with Dr. Ana María López MD, FACP about the future of telehealth, how to implement it in your practice, and the challenges you might face in doing so. Dr. López is immediate past president of the American College of Physicians (ACP) as well as Vice Chair of Medical Oncology and Chief of New Jersey Division Sidney Kimmel Cancer Center of Thomas Jefferson University. Her main areas of professional interest and expertise include cancer prevention and equity, integrative oncology, implementation of innovations in health care including telemedicine, and women’s health. We learned immensely from our talk with her and we hope you will, too! ACP members can claim free CME & MOC credit at https://acponline.org/curbsiders. Download Dr Brigham’s telehealth cheat sheet as a PDF 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, Stuart Brigham MD Cohosts: Matt Watto MD, Stuart Brigham MD, Paul Williams MD, Hannah Abrams Guest: Ana María López MD Time Stamps 00:00 Disclaimer, intro and guest bio 04:20 Guest one line, poetry recommendations, favorite failure 12:00 Defining telemedicine 14:12 What kind of services exist in telemedicine? How can the technology make your practice easier? 20:18 Is there good evidence for telehealth and telemedicine? 24:20 Concerns about telehealth and the loss of touch as part of the doctor-patient relationship; haptics and the remote physical exam 30:17 Providing telehealth across state lines 34:35 Consultation codes for telehealth and ECHO (remote consultations) 40:20 Basic steps and best practices to start implementing telehealth 44:30 Stuart’s shares some preliminary data on use of telehealth and workforce satisfaction 49:12 Adding access by using telehealth in primary care 51:40 Take home points 54:42 Stuart shares a pun  
April 29, 2019
This week we narrow in on the enlarging prostate and decipher the common issue of benign prostatic hyperplasia with Adam C. Reese MD, Associate Professor of Urology at the Lewis Katz School of Medicine at Temple University and Chief of Urologic Oncology at Temple University Hospital. Learn how to interpret the symptom profile for patients presenting with common urinary issues, what to feel for in the digital rectal exam, how to treat BPH, and when to refer. ACP members can visit https://acponline.org/curbsiders to claim free CME-MOC credit for this episode and show notes (goes live 0900 EST). See you at SGIM 2019! Find us in our red Curbsider’s t-shirts handing out Curbsiders and Kashlak stickers/patches at SGIM 2019 in Washington DC! We’ll be recording full length shows and daily recaps! Credits Written and produced by: Paul Williams MD Hosts: Paul Williams MD, Matthew Watto MD Images and infographics: Elena Gibson, Beth Garbitelli Show Notes: Elena Gibson, Beth Garbitelli Edited by: Matthew Watto MD, Chris Chiu MD Guest: Adam Reese MD Time Stamps 00:00 SGIM announcement 00:30 Disclaimer, intro and guest bio 03:20 Guest one liner, book recommendation, favorite failure and surgical M&M 10:56 Case of benign prostatic hyperplasia, defining terms and obstructive/voiding versus storage/irritative symptoms 16:11 IPSS score and evaluating symptoms 22:10 Digital rectal exam. Will this give any useful information? 26:55 Taking a history about BPH and some lifestyle modifications 29:20 Lab studies for urinary tract symptoms and interpreting PSA and free PSA 36:20 Initial therapy for BPH and managing patient expectations, alpha blocker side effects 39:25 Choice of agent and monitoring symptoms on therapy 42:25 Nonpharmacologic management of bladder complaints 45:10 Who and when to refer to urology 47:33 Counseling about use of 5 alpha reductase inhibitors, their side effects and is there a risk for high grade cancer? 52:35 Phosphodiesterase inhibitors for BPH symptoms 53:50 Urethral milking. NOT prostate milking 54:55 Desmopressin for nocturia 56:20 Take home points 59:03 Prostate volume and PSA 61:10 Outro Full show notes available at http://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.
April 22, 2019
Random pearls from ACP #IM2019 Day 3. The Curbsiders crew is joined by Dr Alan Dow of VCU to discuss highlights from ACP’s Internal Medicine Meeting in Philadelphia including: sleep deprivation, the glymphatics system, inflammatory back pain, heart failure, dermatology pearls, a new definition for pulmonary hypertension and more! "Sorry, no time stamps or full show notes for this one. We're too tired." -The Curbsiders 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. #IM2019 Curbsiders Crew Guest: Renee Dversdal MD, Alan Dow MD, Alia Chisty MD Cohosts: Paul Williams MD, Stuart Brigham MD, Shreya Trivedi MD, Molly Heublein MD, Emi Okamoto MD, Justin Berk MD, Cyrus Askin MD, Matthew Watto MD, Chris Chiu MD Director of operations: Chris Chiu MD Twitter: Cyrus Askin MD, Hannah Abrams MS3 Instagram: Beth Garbitelli MS1 Facebook: Chris Chiu MD Off-air producer: Sarah Phoebe Roberts MPH, Nora Taranto MS4 Marketing: Jen Watto
April 19, 2019
Random pearls from ACP #IM2019 Day 2. The Curbsiders crew is joined by Dr Alia Chisty (future PD at Penn State Hershey) at ACP’s Internal Medicine Meeting in Philadelphia to discuss highlights including: baloxavir a new drug for flu, stress testing and coronary CT angiography pearls, celiac disease, H. pylori pearls, and a bunch of random pearls from infectious diseases, palliative care and more! "Sorry, no time stamps or full show notes for this one. We're too tired." -The Curbsiders 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. #IM2019 Curbsiders Crew Guest: Renee Dversdal MD, Alan Dow MD, Alia Chisty MD Cohosts: Paul Williams MD, Stuart Brigham MD, Shreya Trivedi MD, Molly Heublein MD, Emi Okamoto MD, Justin Berk MD, Cyrus Askin MD, Matthew Watto MD, Chris Chiu MD Director of operations: Chris Chiu MD Twitter: Cyrus Askin MD, Hannah Abrams MS3 Instagram: Beth Garbitelli MS1 Facebook: Chris Chiu MD Off-air producer: Sarah Phoebe Roberts MPH, Nora Taranto MS4 Marketing: Jen Watto  
April 15, 2019
Random pearls from #IM2019 Day 1. The Curbsiders crew is joined by Kashlak’s POCUS Chief, Renee Dversdal MD at ACP’s Internal Medicine Meeting in Philadelphia to discuss day 1 highlights inlcuding: POCUS, lyme rash, back pain, syphilis, women’s health, patient handoffs, the flip-flop fungal sign a ton of cardiology pearls (ie diuretics, paracentesis for CHF, beta blockers, LBBB, when is it safe to have intercourse after an MI?) and more! "Sorry, no time stamps or full show notes for this one. We're too tired." -The Curbsiders 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. #IM2019 Curbsiders Crew Guest: Renee Dversdal MD, Alan Dow MD, Alia Chisty MD Cohosts: Paul Williams MD, Stuart Brigham MD, Shreya Trivedi MD, Molly Heublein MD, Emi Okamoto MD, Justin Berk MD, Cyrus Askin MD, Matthew Watto MD, Chris Chiu MD Director of operations: Chris Chiu MD Twitter: Cyrus Askin MD, Hannah Abrams MS3 Instagram: Beth Garbitelli MS1 Facebook: Chris Chiu MD Off-air producer: Sarah Phoebe Roberts MPH Marketing: Jen Watto
April 8, 2019
Join(t) us in learning about rheumatoid arthritis care for the internist with Robert McLean MD, rheumatologist, Associate Clinical Professor at Yale, and President Elect of the ACP! We discuss the complexity of rheumatoid arthritis, how to differentiate from other arthritic conditions, and how to have a patient-centered framework for the evaluation and treatment of affected patients. ACP members can claim CME-MOC credit at on ACP's site.. 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 Writer (Interview & CME questions): Cyrus Askin MD Show Notes and Infographic by: Elena Gibson MS4 Hosts: Matthew Watto MD, Stuart Brigham MD Editors: Matthew Watto MD, Emi Okamoto MD Guest: Robert McLean MD Time Stamps 00:35 Disclaimer, intro and guest bio 03:38 Guest onliner; Nudge (book) on behavioral economics 08:30 Favorite failure; Stuart’s pick of the week 12:24 Key historical features of RA 15:30 Differential diagnosis 19:20 Physical findings in RA 20:58 Initial labs orders for suspected inflammatory arthritis; CRP vs high sensitivity (cardio) CRP assays 27:45 Epidemiology of RA; Is there a utility for scoring systems?; A bit more on inflammatory markers 32:30 Recap and test interpretation 36:22 High yield physical exam in RA 40:56 Initial counseling after RA diagnosis 46:00 Therapeutic trial with NSAIDS or steroids for inflammatory arthritis 50:29 When to reach for the DMARDS 52:40 Are steroids considered DMARDS? 54:50 Primary care considerations for patients starting steroids or DMARDS (TB, vaccinations) 60:34 When and how long to hold DMARDS for surgery or acute illness 62:10 Drug-drug interactions and monitoring with methotrexate, hydroxychloroquine, sulfasalazine 70:10 Anti-inflammatory diets 73:30 Take home points 76:00 Outro
April 1, 2019
Pain management in patients with chronic kidney disease (CKD) often goes something like this: NSAIDs are evil, acetaminophen hardly works, opioids are dangerous, and all the rest (tramadol, gabapentinoids, antidepressants) are messy. But, we tackle the complexities of pain management in patients with chronic kidney disease in this special @NephMadness 2019 episode that, on a scale of 1-10, will leave you feeling very relieved in addressing pain. Full show notes available at https://thecurbsiders.com/episode-list. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Earn CME and read about each region in NephMadness 2019 at AJKD blog. Credits Written and produced by: Justin Berk MD, Samantha Gelfand MD NephMadness Pun Contest produced by: Hannah R Abrams MS3 Cover art by: Kate Grant MBChB, Dip GUMed Hosts: Matthew Watto MD, Paul Williams MD, Stuart Brigham MD Edited by: Matthew Watto MD, Emi Okamoto MD Guests:  Samantha Gelfand MD, Matthew Sparks MD, David Juurlink MD  Time Stamps 00:00 Kidney Pun 01:19 Disclaimer, intro and guest bios 06:30 Guest one-liners 10:42 Books recommendations, staff picks and a patient complaint 15:25 Clinical Case and Pain Management Disclaimer 16:33 Modalities in pain medicine 18:20 Opioids for pain and their metabolites 20:44 Dave Juurlink reframes the question, “what is our real goal with pain management?” 24:42 Matt Sparks reiterates the dangers of morphine and codeine in patients with advanced CKD 27:44 Communicating meds that are contraindicated or relatively contraindicated in CKD 30:40 Buprenorphine 32:40 What about the WHO Pain Ladder for CKD?; 33:32 Should we use more cannabinoids? Ketamine? 37:07 Dave Juurlink rants on Tramadol 44:20 How to pick winners in NephMadness 46:06 NSAIDS and CKD 57:07 Gabapentinoids (gabapentin and pregabalin) for neuropathic pain and driving?! 65:57 Estimating eGFR in CKD and AKI. Which equation is best? 70:38 How would each of our experts treat this patient with CKD and knee pain 75:20 NephMadness 2019 picks for the pain region 82:55 Outro
March 25, 2019
Does your sympathetic nervous system get activated when you notice acute kidney injury in patients with cirrhosis? Ever wonder how to really diagnose hepatorenal syndrome (HRS)? Think you have the bile-acid-stones to start diuretics on a patient requiring pressor support for kidney failure? You have come to the right place! Listen to @kidney_boy Joel Topf, HRS expert Juan Carlos Velez (@veleznephhepato), and self-proclaimed most-handsome-nephrologist Bill Whittier (@TWhittier_RUSH) tackle the complex pathophysiology and treatment of hepatorenal syndrome in this NephMadness 2019 special episode! Fill out your bracket for NephMadness 2019 today and sign up as part of The Curbsiders! Earn CME and read about each region at AJKD blog. 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 and produced by: Justin Berk MD, Nora Taranto MS4 Infographic by: Alex M @nephroguy Hosts: Matthew Watto MD Edited by: Matthew Watto MD, Emi Okamoto MD Guests: Joel Topf MD, Juan Carlos Velez MD, Bill Whittier MD Sponsor Get your ACP membership today and use the code CURB100 to save $100 when you join by March 31, 2019. Time Stamps 00:00 NephMadness Kidney Pun Contest 01:04 Disclaimer 01:38 Sponsor - Become an ACP member today! 02:12 Intro, guest bio 04:38 Guest one-liners, some career advice and Joel’s pick of the week 13:14 Sponsor - Become an ACP member today! 14:48 Case of acute kidney injury in a patient with cirrhosis 16:37 Initial differential diagnosis and approach to newly elevated creatinine in cirrhosis (urinalysis, FeNa, urine sodium) 21:34 History and physical in cirrhosis and AKI 24:56 Hepatorenal physiology 26:45 Fluid choice 30:27 Diuretic therapy in cirrhosis and volume overload 34:38 Is a Renal Ultrasound useful in AKI? 40:05 Recap: the initial approach to AKI in cirrhosis 40:52 Therapeutic trials when volume status is uncertain 46:02 Hepatorenal physiology revisited 50:03 Vasoconstrictor therapy with octreotide, terlipressin, or norepinephrine 62:24 Type 1 versus type 2 hepatorenal syndrome 63:55 Large volume paracentesis (LVP) in cirrhosis with AKI; how much fluid to remove; use of diuretics or LVP in patient on norepinephrine?! 71:18 Diagnostic criteria or HRS 73:00 NephMadness matchups including bile cast nephropathy 78:40 Outro
March 20, 2019
Some precocious policy wonks take a deep dive into the evolving trends and future directions for our primary care workforce. Experts, Dr. Fatima Syed and Dr. Deep Shah return to school us on Physician Supply and Demand, the Access Gap, role of NPs and PAs, Retail Clinics, and Managed Care Clinics. ACP members can visit https://acponline.org/curbsiders to claim free CME-MOC credit for this episode and show notes (goes live 0900 EST). Catch up on our previous discussions with Dr. Syed and Dr. Shah: Episode #62: Pod Save Health Care: The Curbsiders Foray into health policy and Episode #120 Health Policy, Patients, Payments, Paperwork for more context. We also did an overview of health care policy essentials with Dr. Sue Bornstein in Episode #64: Stuff You Should Know About Health Policy Full show notes available at http://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 and produced by: Fatima Syed MD, MSc; Deep Shah MD, MSc CME questions by: Chris Chiu MD, Beth Garbitelli MS1, Hosts: Stuart Brigham MD, Paul Williams MD, Matthew Watto MD, Images and infographics: Beth Garbitelli MS1 Edited by: Matthew Watto MD, Chris Chiu MD Guest: Fatima Syed MD, MSc, Deep Shah MD, MSc   Time Stamps 00:00 Disclaimer, intro, guest bios 04:40 Picks of the week 11:40 Defining physician supply and demand 21:30 Why are physicians less productive? 28:23 What does the supply demand mismatch mean for patients? 30:19 Discussion of various care delivery models (retails health clinics, minutes clinics, urgent care centers) 42:15 Physician compensation 53:50 Take home points from Fatima and Deep 59:39 Outro
March 18, 2019
Inpatient hypertension is tricky. What’s the best way to answer those overnight nursing phone calls for elevated blood pressures? What’s the role of treating hypertensive urgency in the hospital? Plus, Our nephrology experts put a new issue on the generalist’s radar: are ACE-inhibitors dangerous to give (or hold) during an operation? This NephMadness 2019 episode, features special guests Dr. Pascale Khairallah (@Khairallah_P), Dr. Charlie Wray (@WrayCharles) and Dr. Joel Topf (@kidneyboy) to better understand the role of anti-hypertensives in the inpatient setting and keep your blood pressure down on those overnight calls. Fill out your bracket for NephMadness 2019 today and sign up as part of The Curbsiders! 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 and produced by: Justin Berk MD, MPH, MBA; Pascale Khairallah MD Hosts: Matthew Watto MD, Paul Williams MD, Stuart Brigham MD Edited by: Matthew Watto, MD Guest:  Pascale Khairallah MD, Charlie Wray DO, Joel Topf MD Sponsor Get your ACP membership today and use the code CURB100 to save $100 when you join by March 31, 2019. Time Stamps 00:00 Kidney Pun Contest with Hannah Abrams 01:16 Disclaimer 01:45 Sponsor - Become an ACP Member today! 02:14 Intro and guest bios 03:50 Picks of the weeks 06:00 Sponsor - Become an ACP Member today! 07:20 Case of acute severe hypertension; Does hypertensive urgency exist? Should we treat it? 26:40 Case of perioperative medicine. Should we hold the ace inhibitor? Is there evidence to guide us? 35:02 Take home points 36:54 Everyone picks their NephMadness winners for the hospital medicine region 43:13 Outro
March 15, 2019
The battle over the superiority of resuscitation fluids is coming to a boil. Enter the Fluid Wars. Are Lactated Ringers superior to normal saline? Will LR increase a patient’s lactate? What about albumin? The Curbsiders quench the thirst for knowledge by turning to masters Dr. Pascale Khairallah (@Khairallah_P), Dr. Charlie Wray (@WrayCharles) and Dr. Joel Topf (@kidneyboy) for guidance in this special @NephMadness episode that will get your feet wet with the complicated world of fluid resuscitation. Fill out your bracket for NephMadness 2019 today and sign up as part of The Curbsiders! 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. Credits Written and produced by: Justin Berk MD, Pascale Khairallah MD NephMadness Pun Contest produced by: Hannah R Abrams MS3 Hosts: Matthew Watto MD, Paul Williams MD, Stuart Brigham MD Edited by: Matthew Watto MD Guest:  Pascale Khairallah MD, Charlie Wray DO, Joel Topf MD Time Stamps 00:00 Nephmadness pun contest 02:18 Disclaimer 02:52 Intro to the show and NephMadness, guest bios 08:04 Guest one-liners, 10:58 Joel explains NephMadness 12:58  Guest book recommendations and career advice 17:30 Clinical case; goals of fluid resuscitation; choice of initial IV fluid Corporate (TV series) Comedy Central 19:41 Complications of normal saline 21:29 Colloids versus crystalloids LR versus normal saline is not an innocuous decision 26:32 Saline versus balance fluids. What’s the makeup? 28:19 Does lactated ringers elevate lactate? 31:03 Is hyperkalemia a contraindication for LR? 32:39 Lactated ringers versus plasma-lyte and cost of fluid 34:49 In vitro risks of normal saline 40:31 SMART and SALT-ED trial 46:08 Stuart finds the IV fluid price list 44:37 Each panelist weighs in on saline versus balanced fluids 46:45 Why do patients with metabolic alkalosis thrive on saline? 49:04 Outro
March 11, 2019
Cirrhosis TIPS for the decompensated cirrhotic & acute on chronic liver failure from expert hepatologist and keto-practitioner Scott Matherly MD, @liverprof and chief hepatologist at @KashlakHospital. We walk through acute management of variceal bleeds, when to suspect SBP in decompensated cirrhosis (all the time, it turns out), how much fluid to remove in paracentesis, and some definitions about what decompensated cirrhosis and acute on chronic liver failure really mean. Take our pretest on cirrhosis! Full show notes available at http://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 and produced by: Nora Taranto MS4, Matthew Watto MD Pretest by: Cyrus Askin MD Hosts: Matthew Watto MD, Paul Williams MD, Images and infographics: Hannah Abrams MS3 Edited by: Matthew Watto MD Guest: Scott Matherly MD Sponsor  Get your ACP membership today and use the code CURB100 to save $100 when you join by March 31, 2019. Time Stamps 00:00 NephMadness teaser 00:50 Sponsor - Become an ACP Member today! 01:25 Intro, guest bio 03:45 Guest one-liner, keto diet 07:40 Picks of the week from Paul, Matt and Scott 11:50 Sponsor - Become an ACP Member today! 13:26 Clinical case of bleeding and altered mental status in cirrhosis 16:10 Interpretation of our patient’s labs and physical exam 18:53 Defining terminology in cirrhosis (decompensated vs compensated vs acute on chronic liver failure) 24:48 Initial workup, resuscitation and stabilization in variceal bleeding 26:10 Why occult blood and ammonia levels are unhelpful in cirrhosis 29:00 Fluid choice for the cirrhotic patient with hypotension; octreotide (or terlipressin); antibiotics prophylaxis 33:10 Proton pump inhibitors and ulcers from variceal banding 34:00 Mechanism of action for octreotide and terlipressin 35:54 Prevention of recurrent bleeding with TIPS, or nonselective beta blockers 40:40 Scores for prognostication in the acute setting 44:00 Coagulopathy of cirrhosis and should DVT prophylaxis be used 48:38 Elevated INR and procedures 56:55 Paracentesis in the acute setting and interpretation of fluid studies:cell count, total protein, SAAG, blood culture vial; pathophysiology of ascites 67:30 Treatment of SBP: antibiotics, IV albumin; plus, Hepatorenal physiology explained 79:04 Hepatic encephalopathy is a shunt phenomen; how to evaluate for causes; treatment of HE 87:58 Rifaximin 89:10 Take home points 91:02 Outro
March 4, 2019
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, 2019. Time Stamps 00:00 Sponsor - Become a member of the American College of Physicians 00:28 Disclaimer, Intro, Recap of upcoming shows, Corrections and Omissions 05:50 Guest one-liner, Discussion of social media in medical education, Joel’s book 12:45 Twitter for medical education including NephJC and NephMadness 19:50 Sponsor - Become a member of the American College of Physicians 21:30 Intro to diuretics, mechanism of action and a brief review of renal physiology 28:26 Use of thiazide diuretics 30:18 Chlorthalidone versus hydrochlorothiazide 34:47 Diuretics and hyponatremia, Monitoring electrolytes and renal function on diuretics 39:05 Leg (muscle) cramps and pickle juice 42:55 Thiazides, osteoporosis and fracture prevention 45:32 Resistant hypertension and  the workup for secondary hypertension 53:36 Loop diuretics: how to choose an agent, dosing 62:15 Take home points 67:00 Outro
February 25, 2019
Demystify chronic wound care management with high yield pearls from wound care expert Dr. Elizabeth (Foy) White-Chu. She takes us through a simple yet thorough approach to manage complex chronic wounds. We discuss everything from selecting a dressing, to pain management, and what kind of water should you really use when cleansing a wound. Answers to all of these burning questions and more await you, so don’t waste anymore time! Press play and let Dr. White-Chu take you on a journey through evidence based practices for the management of chronic wounds. 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 by: Carolyn Chan MD CME questions by: Justin Berk MD Produced by: Matthew Watto MD Hosts: Matthew Watto MD, Paul Williams MD, Carolyn Chan MD Guest: Dr. Elizabeth (Foy) White-Chu Sponsor Check out the ACP's Medical Knowledge Self Assessment Program, MKSAP 18. Time Stamps 00:00 Sponsor - ACPs MKSAP 18 00:25 Disclaimer, intro, guest bio 03:58 Guest one-liner, movie recommendation, favorite failure, career advice 11:40 Picks of the week 15:58 Sponsor - ACPs Medical Knowledge Self Assessment 18 17:50 Clinical case of lower extremity ulcer; describing a wound 21:04 Taking a wound focused history 26:28 Differentiating wound types 29:04 Edema and compression therapy; Should diuretics be used? 36:43 Description of the multi-component wrap 38:10 Counseling a patient about wound care and setting expectations for healing 41:29 High value options for each wound type 44:35 Gardening and wound bed preparation 51:32 A bit on silver therapy 53:40 Back to the case; Red flags in wound care 55:40 Culturing a wound 58:17 Instructions on how to write wound care orders 62:00 Rundown of topical therapies for wound care 65:04 Negative pressure wound therapy aka “wound vac” 66:14 How often are dressing changes needed? 68:27 Take home points 70:20 Outro 71:30 Carolyn gives a wound care PUN!
February 18, 2019
Dive deep into the psychopharmacology of depression with Dr Patrick Finley, PharmD at UCSF. Learn practical tips including how to switch from one antidepressant to another, what to expect with SSRI and SNRI withdrawal, and how to choose a second (or third) antidepressant for refractory depression. We also summarize the safety around antidepressants in the peripartum period. 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: Molly Heublein, MD CME questions by: Molly Heublein, MD Hosts: Matthew Watto MD, Paul Williams MD, Stuart Brigham MD, Molly Heublein, MD Edited by: Matthew Watto MD Guest Presenter: Patrick Finley, PharmD BCPP Sponsor Check out the ACP's Medical Knowledge Self Assessment Program, MKSAP 18. Time Stamps 00:00 Sponsor ACP’s MKSAP 18 00:25 Disclaimer, intro and guest bio 04:33 Guest one-liner, book recommendation, and first patient complaint 08:04 Picks of the week 12:10 Sponsor ACP’s MKSAP 18 14:03 Clinical case of depression; assessing target symtpoms to characterize depression; choice of initial SSRI 17:49 Discussion of iron, ferritin, folate and L methylfolate as they relate to treatment refractory depression 20:12 Postpartum depression, iron, genetics and environmental factors 22:35 How to switch from one SSRI to another; Cross-titration from SNRI to SSRI or from SSRI to SNRI 26:05 Withdrawal symptoms from SSRIs or SNRIs and a bit more on switching and cross titration 31:33 Is paroxetine ever a good idea? 33:03 Ultra-rapid metabolizers of SSRIs and pharmacogenomics 34:43 Postpartum depression and treatment with antidepressants during pregnancy and lactation 39:25 Monitoring response to therapy with antidepressants ie PHQ-9 40:53 Augmentation for partial response; bupropion for augmentation and sexual side effects; 43:58 Counseling patients about discontinuation of therapy 47:00 How to choose an agent for augmentation of antidepressant therapy 51:02 Mirtazapine 52:41 Vortioxetine 53:24 Atypical antipsychotics for augmentation 55:37 Pregabalin and gabapentin for augmentation 57:42 Dr Finley’s take home points 60:48 Outro
February 11, 2019
Join us at the forefront as we talk genetic testing in primary care with Dr Dallas Read, esteemed gynecologist and **the only** medical geneticist at Tufts Medical Center. Topics include: what internists should be comfortable testing for in the office, how and when to refer for screening, what tests to order, how to interpret test results, how to handle direct-to-consumer results or requests, and so much more! For years, the medical community has been talking about the immense potential for genetic testing to guide diagnosis and treatment. But has it realized its full potential? The answer to that seems to be a resounding no at the moment--but the days of ubiquitous genetic testing to identify disease and disease risk may not be so far off after all. ACP members can visit https://acponline.org/curbsiders to claim free CME-MOC credit for this episode and show notes (goes live 0900 EST). Coming to you from the Curbsiders, we hope you’ll enjoy this latest episode about the genes you wear, whether you want to put them on or not. Genes, Genes, they’re (maybe) good for your heart. But do patients want to know if they are, or if they aren’t? Full show notes available at http://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 and produced by: Nora Taranto MS4 CME questions by: Nora Taranto MS4 Hosts: Stuart Brigham MD, Matthew Watto MD, Nora Taranto MS4 Images and infographics: Beth Garbitelli MS1 Edited by: Matthew Watto MD, Chris Chiu MD Guest: Dr. Dallas Reed MD Sponsor  Check out the ACP's Medical Knowledge Self Assessment Program, MKSAP 18. Time Stamps 00:00 Announcement 00:37 Sponsor: ACP’s MKSAP 18 01:04 Disclaimer, intro, guest bio 06:31 Guest one liner, book recommendations, career advice 12:23 Cohost picks of the week 16:22 Sponsor: ACP’s MKSAP 18 18:12 Dr Reed walks us through the genetic machinery from the top down (genome, chromosomes, exons, genes, SNPs, and epigenetics) 26:18 A clinical case of Jeanne Sequence; What are the indications for genetic testing? 29:54 What is actually being tested? 33:57 What is the turnaround time for testing? What resources are available for counseling? Why is this challenging in primary care? 38:58 Variant of Uncertain Significance 41:22 Direct to consumer genetic testing 44:54 Back to our case of Jeanne Sequence; How to take a history for patients with family history of breast cancer. 50:41 Guidelines on use of genetic testing; Deciding which family member to test 59:49 Laws about genetic testing and discrimination; How does this effect life insurance or disability insurance eligibility 63:47 Is routine whole genome testing practical? Will this be commonplace in the future? 68:22 What genetics resources are useful for primary care practitioners? 72:13 Cost of genetic testing 77:32 Take home points 82:57 Outro
February 4, 2019
Learn expert tips for the diagnosis and management of inflammatory bowel disease (IBD) from Dr. Adam Ehrlich, Assistant Professor of Medicine and co-director of the Inflammatory Bowel Disease Program at Temple University Hospital.  In this episode, we learn about the initial work-up, general principles of management, and important primary care considerations for Crohn’s disease and ulcerative colitis (ie endoscopic surveillance, immunizations, bone health/osteoporosis, and more!). 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 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 Sponsor Check out the ACP's Medical Knowledge Self Assessment Program, MKSAP 18.   Time Stamps 00:00 Sponsor: MKSAP 18 00:32 Disclaimer, Intro, guest bio 04:05 Guest one-liner, Adam’s movie rec - RBG (documentary), career advice, Paul’s movie rec - Edge of Tomorrow 09:25 Sponsor: ACP’s MKSAP 18 11:25 Definitions and pathophysiology of inflammatory bowel disease (IBD) Ulcerative Colitis 13:40 A case of ulcerative colitis; Classic symptoms; Initial approach and basic differential diagnosis 19:10 Smoking and ulcerative colitis 21:17 Initial workup for suspected IBD; Fecal calprotectin 25:50 A bit more on CRP and IBD 26:55 When to refer for colonoscopy 27:58 Back to the case; a typical colonoscopy reports in ulcerative colitis (UC) 30:33 Extraintestinal manifestations of UC 34:50 Initial counseling for newly diagnosed IBD; natural history of IBD, prognosis 39:50 Treatment of ulcerative colitis 43:02 Some specifics on steroids, plus topical therapies Crohn’s disease 47:05 A case of Crohn’s disease; initial approach and differential diagnosis 50:25 Initial diagnostic testing; colonoscopy findings in Crohn’s; IBD trivia 53:58 Treatment of Crohn’s disease 58:26 Specifics about biologic therapy for IBD; Endpoints 62:25 Steroid sparing agents, immunomodulators like azathioprine, 6-mercaptopurine 64:48 Can drug therapy be stopped or tapered in IBD? 66:50 Prognosis in Crohn’s and initial patient counseling Primary Care considerations 68:35 Surveillance endoscopy, 71:47 Do diet and lifestyle changes for IBD work? What about pregnancy? 76:31 Immunizations 79:25 Bone health, osteoporosis and IBD, screening for iron and nutritional deficiencies 82:27 Take home points 86:28 Outro
January 28, 2019
Master the management of hyperkalemia with tools, tips and tactics from @kidney_boy, Joel Topf MD, Chief of Nephrology @KashlakHospital. We cover: common causes of hyperkalemia; the U-shaped curve of potassium levels and mortality; albuterol nebs; how to safely use insulin; potassium binding resins and colonic necrosis; Does it make sense to give loop diuretics and fluids?; Should we be using fludrocortisone?; Plus, answers to all your questions about a high potassium diet and oral potassium supplements! Join us for Dr Topf’s masterful insights on hyperkalemia and potassium homeostasis. 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 Join us at ACP's Internal Medicine Meeting 2019 April 11-13th in Philadelphia, PA . We'll see you there! Credits Written and produced by: Matthew Watto, MD Hosts: Matthew Watto MD, Paul Williams MD, Stuart Brigham MD Infographic: Matthew Watto MD Edited by: Matthew Watto MD Guest: Dr Joel Topf MD   Time Stamps 00:00 Ad disclaimer, intro and guest bio 05:11 Guest one-liner and picks of the week —Peloton indoor cycle, “your local library”, The Nice Guys (film) by Shane Black, and Forgotten Hand (PS4 game) 11:17 ACP Internal Medicine Meeting 2019 details 12:55 Clinical case of hyperkalemia; discussion of pseudohyperkalemia 19:55 Hyperkalemia and the EKG 23:38 Threshold for treatment of hyperkalemia 27:20 Use of telemetry and the U-shaped curve for potassium and mortality 30:11 Choice of therapy for acute hyperkalemia 33:13 Albuterol for hyperkalemia 34:24 First rule out urinary obstruction and hyperglycemia; Use of IV insulin and dextrose and frequency of monitoring 39:44 Loop diuretics plus fluid; Distal sodium delivery and potassium handling in the nephron 43:10 Fludrocortisone for hyperkalemia 45:05 Calcium for elevated potassium 48:43 SPS, potassium binding resin 52:43 Risks of SPS (sodium polystyrene sulfonate) and colonic necrosis 58:28 Sodium bicarbonate for acute and chronic hyperkalemia 61:00 Back to the case; TMP-SMX, ace inhibitors (or ARBs) and hyperkalemia 63:05 Threshold for admission; Diet and potassium 65:52 Treatment of chronic hyperkalemia and a bit more on high potassium foods 68:45 Patiromer and sodium zirconium 71:51 Loop diuretics and empiric potassium supplementation 74:12 Can diet alone be used to treat HYPOkalemia? 75:26 Take home points 77:40 NephMadness is coming! March 2019 79:53 Outro 81:00 More Kidney Boy!
January 21, 2019
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
January 14, 2019
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
January 7, 2019
“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
December 31, 2018
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
December 24, 2018
Master the diagnosis and management of Genital Herpes with tips from expert, Robert Bettiker MD . Topics include: the natural history, diagnosis & screening guidelines for genital herpes; cold sores; options for primary and recurrent episodes including prophylaxis; and consideration of specific populations including symptomatic and asymptomatic patients, pregnancy and MSM (men who have sex with men). We also discuss partner notification and treatment. Full show notes available at http://thecurbsiders.com/podcast. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits Written and produced by: Kate Grant MBChB DipGUMed, Matthew Watto MD Images by: Kate Grant MBChB DipGUMed Hosts: Stuart Brigham MD, Paul Williams MD, Matthew Watto MD Guest: Robert Bettiker MD Time Stamps 00:00 Disclaimer, guest bio, intro 01:50 Guest one liner, memorable teaching moment and a few failures 10:50 Intro to herpes 12:25 Case 1: Genital herpes in a married man 15:42 Overview of testing options 18:50 Marital counseling in Herpes 22:18 Prophylaxis in serodiscordant partners and asymptomatic shedding 25:08 Case 2: Severe outbreak of genital herpes in a young woman 31:50 Case 3: Young male with recent exposure to herpes 38:45 Herpes 1 (HSV1) versus Herpes 2 (HSV2) 44:12 Case 4: Herpes in pregnancy 50:45 Do topical agents work for herpes 55:05 Take home points 56:10 Outro 57:52 Stuart shares a PUN!
December 19, 2018
Sharpen your diagnostic schema for abdominal pain and eosinophilia with this mystery case http://hdx.org/Rxg (click link to follow along). Reza Manesh MD, editor of Global Morning Report at The Human Diagnosis Project aka Human Dx attempts to solve this challenging case with the help of The Curbsiders. Use this link http://hdx.org/Rxg to follow along with the case on the Human Dx app 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 01:20 Picks of the week 05:42 How Reza fell in love with clinical reasoning 08:58 Case of 50 yo male with abdominal pain 21:14 Some unexpected findings 43:00 Case conclusion/answer, cognitive autopsy and Reza’s take home points 48:35 Outro
December 17, 2018
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
December 13, 2018
Create a successful partnership and career withs tips from Wonder Woman, Sue Hingle MD of ACP.  Work-Life Balance: is it a myth, or attainable if we could just find the right fit? In this episode, we chat with Dr. Susan Hingle about identifying our work-life priorities and re-evaluating these priorities throughout our lives. We strategize about achieving personal and professional goals (pro tip: stop worrying about what others think!). Dr. Hingle is Professor in the Department of Internal Medicine and Vice Chair of Education and Faculty Development and Associate Internal Medicine Residency Program Director at Southern Illinois University. She is also the Immediate Past Chair of the Board of Regents of the American College of Physicians (ACP). She has served at the ACP in a variety of ways, including as a member of the ACP Women’s Task Force. Her clinical expertise is in women’s health, health promotion, and disease prevention. Enjoy the episode! ACP members can visit https://acponline.org/curbsiders to claim free CME-MOC credit for this episode and show notes (goes live 0900 EST). Full show notes available at http://thecurbsiders.com/podcast. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits Written and produced by: Nora Taranto MS4, Shreya Trivedi MD, Leah Witt MD, Sarah P. Roberts MPH. CME Questions by: Shreya Trivedi MD Editors: Matthew Watto MD and Chris Chiu MD Hosts: Shreya Trivedi MD, Paul Williams MD, Leah Witt MD Guest: Susan Hingle MD Time Stamps 00:00 Disclaimer, intro and guest bio 02:52 Guest one liner, WIM Moment of awakening, advice for her younger self 07:45 Picks of the week 10:30 Physician with family and caregiver responsibility; How to plan for personal and professional goals 18:20 What to look for in a partner, how to work with them to achieve work life fit, and non-traditional roles 28:35 Advice on family planning 31:40 Residency programs and life events 32:55 Should you go part-time? 39:43 Work life balance? Or work life fit? And some examples/tips for success 49:54 Take home points 50:45 Outro 52:22 Bonus story
December 10, 2018
Dr Elisabeth Poorman MD joins us to discuss the natural history of physician depression in residency and beyond. We share some of our own personal stories, and discuss how we can support one another and reach out for help, how to take care of our mental health in an emotionally demanding career, how to deal with licensing questions and worry about stigma, and what systemic changes may be coming (read: we think need to be coming) down the line. The problem of depression and suicide is a particularly real one in medicine, a profession that is, by its very nature traumatic and emotionally draining (both in terms of work demands and also the sick and dying patients we treat). N.b. This is a sensitive topic. If this is triggering for anyone listening, the national suicide hotline number 1-800-273-8255. Moreover, if anyone needs or wants guidance on available resources, Dr. Elisabeth Poorman has made herself available either via email, private msg on FB or twitter (@DrPoorman), or any of us on twitter. We are happy to talk and see that you get support you need. Full show notes available at http://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits Written and produced by: Nora Taranto MS4, Shreya Trivedi MD Hosts: Stuart Brigham MD, Shreya Trivedi MD, Matthew Watto MD Edited by: Matthew Watto MD Guest: Elisabeth Poorman, MD Time Stamps 00:00 Disclaimer, Intro, Guest Bio 3:25 Wellness Recommendations: Find a Therapist 6:12 How to find a therapist in training 6:39 Licensing and Mental Health 12:14 Disclaimer and Trigger Warning: Stories are Sensitive. National suicide hotline info Next, Dr Poorman and each of The Curbsiders share their personal experiences with mental health (see below). 12:05 Shreya story 21:40 Stuart’s story 31:19 Elisabeth’s story 36:17 Watto’s story 37:41 Passive suicidal ideaiton, a definition   41:10 Suicide and Depression: Do they always coexist? (No) 42:20 Life Cycle of Depression and Suicide in the Medical Profession 47:15 Depression and Suicide in Primary Care 47:59 Mini-Cases 54:00 Noticing signs in a colleague: how to help 58:00 Specific programs doing things well 1:03:08: Questions from Social Media 1:03:10: Burnout vs. Depression 1:04:27: Will getting treatment affect your board applications 1:06:14 Take home points 1:08:00 Outro
December 3, 2018
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
November 29, 2018
Tony Breu MD joins us for some hotcakes, and “cold cakes” including: how aspirin and zodiac sign affect the treatment of acute MI, a recent study on how exercise is probably still good for you, the recently announced REDUCE-IT trial, and the evidence (or lack thereof) for the treatment of hypertensive urgency. Welcome to another edition of Hotcakes and Hot Takes, where we discuss the most interesting articles and news that we have been reading. Special guest is the prolific Dr. Tony Breu (@tony_breu) who is an Assistant Professor of Medicine at Harvard Medical School and a Hospitalist and Director of Internal Medicine Resident Education at the VA Boston Healthcare System. He is known for his series on "Things We Do For No Reason” as well as his thought-provoking “Tweetorials” online. ACP members can visit https://acponline.org/curbsiders to claim free CME-MOC credit for this episode and show notes (goes live 0900 EST on day of release). Full show notes available at http://thecurbsiders.com/podcast. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits Written and Produced by: Sarah Phoebe Roberts MPH, Christopher Chiu MD CME Questions: Christopher Chiu MD Hosts: Matthew Watto MD, Stuart Brigham MD, Paul Williams MD, and Christopher Chiu MD Guest Presenter and Content Planning: Anthony Breu MD Editor: Christopher Chiu MD Cover-Art: Christopher Chiu MD Time stamps 00:00 Disclaimer, intro, guest bio 05:53 Discussion on Tweetorials 08:00 Cold Cake: ISIS-2 and the treatment of acute MI with aspirin 14:04 ISIS-2 and zodiac subgroup analysis 16:19 What is the relationship between cardiorespiratory fitness on mortality? 24:40 Discussion of the REDUCE-IT study 33:00 Cold Cake: VA Cooperative study and the evidence for treating essential hypertension 36:42 TWDFNR and the treatment of hypertensive urgency 46:36 Wrap-up and outro
November 26, 2018
Master the diagnosis and management of common STIs (sexually transmitted infections) with tips from expert, Dana Dunne MD, Associate Professor of Medicine in Infectious Diseases at Yale. Topics include: the stages and many presentations of syphilis, syphilis treatment and counseling, the natural history, diagnosis, and screening guidelines for gonorrhea and chlamydia, treatment options in the age of growing resistance, and a discussion of partner notification and treatment. Full show notes available at http://thecurbsiders.com/podcast. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits Written and produced by: Bryan Brown MD Hosts: Bryan Brown MD, Paul Williams MD, Matthew Watto MD Guest: Dana Dunne MD Special thanks to Kate Grant MBChB, Dip GUMed for her contribution of knowledge and artwork. Time Stamps 00:00 Announcement, disclaimer, intro and guest bio 04:29 Guest onliner, book recommendation, advice for learners/teacher, and picks of the week 11:00 A case of syphilis, clinical manifestations and discussion of the stages 26:05 Testing for syphilis 39:05 Mandatory reporting and partner tracing 42:40 Counseling patients with syphilis 44:44 A case of gonorrhea and chlamydia, clinical manifestations, screening guidelines 52:30 How to counsel patients to obtain samples from urethra, rectum, vagina, oropharynx; Mycoplasma genitalium 59:40 CDC treatment guidelines, Super gonorrhea, test of cure, and treatment of partners 72:35 Take home points 74:30 Outro
November 19, 2018
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
November 15, 2018
Check out this audio treasure map to find the hidden curriculum and learn how it can change your practice. Learn how positive teaching spans not just the classroom or bedside but, how we simply talk about patients. Sanjay Desai MD, coauthor of ACP’s Position Paper on Hidden Curriculum and Internal Medicine program director at Johns Hopkins guides us through several cases that illustrate how our institutional norms can shape the practice of medicine...for better or worse. ACP members can visit https://acponline.org/curbsiders to claim free CME-MOC credit for this episode and show notes (goes live 0900 EST). Full show notes available at http://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits Written and produced by: Sanjay Desai MD; Justin Berk MD, MPH, MBA; Matthew Watto MD CME questions by: Justin Berk MD Editors: Chris Chiu MD & Matthew Watto MD Hosts: Justin Berk MD, MPH, MBA; Matthew Watto MD; Paul Williams MD Guest: Sanjay Desai MD Time Stamps 00:00 Disclaimer, Intro and guest bio 04:00 Guest one liner, book recommendations, career advice 10:50 Intro to the hidden curriculum and ACP’s three recommendations 22:00 Case #1: A patient with schizophrenia 32:10 Case #2: The iPatient 38:07 Case #3: Attending forgets to wash their hands 41:10 Case #4: A dying patient’s primary care doctor saves the day 46:26 Case #5: A case of violating duty hours 60:10 Take home points 62:00 Outro
November 12, 2018
Shoulder pain made simple. Develop your confidence and skills with tips from sports medicine specialist Dr. Carlin Senter MD. We discuss her simplified approach to the basic shoulder exam, including when and how to do special tests, high yield exam maneuvers, when to refer shoulder pain patients to orthopedic surgery, and who can be managed conservatively. 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: Molly Heublein MD and Nora Taranto MS4 Editor: Matthew Watto MD Hosts: Molly Heublein, MD, Paul Williams MD, Matthew Watto MD Guest: Carlin Senter, MD Time Stamps 00:00 Disclaimer, intro, and guest bio 03:15 Guest one liner, book recommendation, career advice, and some picks of the week 13:20 Clinical case of shoulder pain; helpful historical features 18:54 Differentiating referred pain from c-spine pathology from shoulder pathology 21:00 A framework for shoulder pain, HIP-ROT, and using ROM to generate a differential 27:40 Frozen shoulder aka adhesive capsulitis 31:57 Glenohumeral joint arthritis 33:52 Rotator cuff disease 40:53 Specific testing for rotator cuff tears 51:45 Impingement syndrome versus bursitis 56:25 Counseling patient with shoulder pain or injury 59:03 Steroid injections, topical therapy, and AC joint arthritis 65:18 When to refer to surgery and some take home points
November 5, 2018
The sleep apnea episode that won’t put you to sleep. Become a sleep apnea guru with incredible insights from Barbara Phillips MD, MSPH, FCCP an expert in pulmonary medicine, critical care and sleep medicine who is also a past president of CHEST! We discuss high-yield topics in the world of obstructive sleep apnea including: home sleep studies vs in-lab polysomnography, the importance of oxygen saturation (the T90 and ODI) when interpreting sleep study results, tricks to improve CPAP adherence, and alternatives therapies for obstructive sleep apnea. ACP members can visit https://acponline.org/curbsiders to claim free CME-MOC credit for this episode and show notes. Full show notes available at http://thecurbsiders.com/podcast. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits Written and produced by: Cyrus Askin MD CME questions by: Cyrus Askin MD Editor: Chris Chiu MD & Matthew Watto MD Hosts: Cyrus Askin MD & Matthew Watto MD Guest: Barbara Phillips, MD Cover-Art & Infographic - Beth Garbitelli, MS1 Time Stamps 00:00 Disclaimer, intro, guest bio 03:00 Guest one liner, book recommendation, advice for trainees 08:10 Clinical case of sleep apnea, some basic stats, and key predictors of sleep apnea 12:38 Barriers to diagnosis and treatment of OSA 15:23 Discussion of T90, hypoxemia and sleep fragmentation 17:05 How to read a sleep study report 21:55 Home sleep apnea testing 24:15 What are the consequences of sleep apnea 28:30 What is the efficacy of cpap for lowering blood pressure and mortality 31:45 Counseling a patient who is new to cpap 33:45 Choice of mask 40:10 Do alternatives to cpap work? e.g. surgery, mandibular advancement devices 44:17 Modafinil and z-drugs 47:15 Driver’s license issues in sleep apnea 48:35 Future of sleep medicine and take home points 51:15 Outro
October 29, 2018
We delve into advanced management of headaches, including novel therapies, migraines with aura, migraines in complicated patients, and headaches of short duration with Dr. Rebecca Burch, a headache medicine specialist at the John R. Graham Headache Center at Brigham and Women’s Hospital. Full show notes available at http://thecurbsiders.com/podcast. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits Written and produced by: Paul Williams MD Edited by: Matthew Watto MD Hosts: Paul Williams MD, Stuart Brigham MD, Matthew Watto MD Guest: Rebecca Burch MD Time Stamps 00:00 Disclaimer, intro and guest bio 03:28 Guest one-liner, movie and podcast recommendations, favorite failure and picks of the week from The Curbsiders 10:38 Clinical case of migraines; diagnosis and classification 14:12 Does medication overuse headache exist? 16:16 Chronic daily headache; Conversion from episodic to chronic and vice versa 21:43 Approaches to medication overuse headache 25:54 Case 2: migraine with aura and other types of migraine (retinal, hemiplegic, etc.) 32:09 Pathophysiology of migraine; how triptans work; How should aura effect management? 38:44 Migraine cocktails 41:15 Comorbid mood disorders; Use of psych meds and triptans 45:08 Migraines and oral contraceptives 48:42 Botulinum toxin and new CGRP therapies 53:36 What does success look like in migraine therapy? 55:32 Nonpharmacologic management 60:45 Case 3: headaches of short duration 66:36 Headache red flags; Imaging for headaches; pathophysiology of high and low pressure headaches 72:00 Idiopathic intracranial hypertension 75:25 Take home points 77:00 Outro  
October 22, 2018
HIV care for the internist with author and HIV expert, Michael Saag MD, Professor of Infectious Diseases at University of Alabama and founder of the 1917 Clinic. We discuss the specifics of screening & diagnostic testing in HIV, monitoring CD4 counts and viral loads, first line antiretroviral therapy, harm reduction, and how to provide excellent HIV care in your primary care clinic. Full show notes available at http://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits Written & Produced by: Elena Gibson MS4, Justin Berk MD MBA MPH Artwork by: Elena Gibson MS4 Hosts: Matthew Watto MD, Paul Williams MD, Justin Berk MD MBA MPH Editor: Matthew Watto MD Guest: Michael Saag MD Time Stamps 00:00 Disclaimer, intro, and guest bio 04:35 Getting to know our guest, a movie recommendation, and words of wisdom 08:48 Clinical case, HIV screening, in-depth discussion of HIV testing & diagnosis 15:56 New diagnosis of HIV, counseling after diagnosis, confirmation, follow-up testing, the second visit 24:20 Treatment - what to start and when; some basic comments on therapy 30:05 Primary care after diagnosis, vaccines, cancer screening, cardiovascular disease prevention 34:35 Monitoring CD4 counts and viral load; interpreting CD4 count; time course of response for CD4 and viral load 42:02 Harm reduction counseling; addressing medication non-adherence 47:40 PCP prophylaxis 49:43 The 1917 Clinic, Ryan White Clinics, and linking patients to care 53:10 Take home points 55:40 Plugs 57:45 Will a cure or vaccine for HIV emerge? 59:16 Outro
October 19, 2018
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
October 15, 2018
Nutrition pearls from integrative cardiologist, Steven Devries MD, Associate Professor of Medicine, Northwestern Feinberg School of Medicine, Executive Director of The Gaples Institute. Clinicians receive little formal nutritional training in medical school and residency. It’s time to fill that gap! We discuss the strength of the literature supporting dietary interventions for cardiovascular health and review practical tips to help patients achieve healthy eating patterns. Patients need to hear from us that nutrition matters! Full show notes available at http://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits Written & Produced by: Molly Heublein MD Hosts: Matthew Watto MD, Paul Williams MD, Molly Heublein MD Guest: Stephen Devries MD Editor: Matthew Watto MD Special thanks to Elena Gibson MS4 for writing our show notes Time Stamps 00:00 Disclaimer 00:35 Intro and guest bio 02:40 Guest one-liner, book recommendation, favorite failure, nontraditional career path 10:10 Nutrition and medical education 12:45 Evidence for how nutrition can improve health outcomes 15:33 How to describe a heart healthy or Mediterranean diet to patients 25:16 Discussion of fats and oils 31:44 Food deserts, healthy snacking options 37:15 Calorie counting and use of healthy eating apps 40:55 How to frame the discussion about a healthful eating pattern with patients 47:18 Macronutrient content. Does it matter? 52:50 Intermittent fasting 54:24 A free resource for patients to learn about nutrition  
October 8, 2018
Houston, we have a female sexual dysfunction problem. Female sexual problems, which can affect women of all ages, are underdiagnosed and undertreated--in part because clinicians are not the best at asking about sex in primary care visits. In the course of this episode, learn about how to have that sex talk you’ve (maybe) been avoiding, what to ask when working up sexual problems in women, and find the words to talk to patients about sex. Today, we’re lucky to have the female sexual health expert of experts, Dr. Stacy Lindau, MD, MA, Professor of Obstetrics and Gynecology and Medicine-Geriatrics at the University of Chicago Medicine, on the show to teach us the best “sex talk” language, the differential for female sexual problems, and explore therapies. Sadly, there’s no sildenafil-like magic bullet, but a multidisciplinary team can make real impact on female sexual problems. Don’t forget to check out http://womanlab.org Full show notes available at http://thecurbsiders.com/podcast. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits Written and produced by: Nora Taranto MS4 Hosts: Leah Witt MD and Matthew Watto MD Infographic: Leah Witt MD Editor: Matthew Watto MD Guest: Stacy Lindau MD Time Stamps 00:00 Disclaimer 00:35 Intro and guest bio 03:30 Guest one liner, book recommendations, favorite failure, career advice and picks of the week 12:57 Clinical Case of female sexual dysfunction and some definitions 15:08 Are sexual problems a normal part of aging?; How to take a sexual history; Etiology of sexual dysfunction; “Diagnostic sex”; Red flags 27:54 Medications that contribute to sexual dysfunction 31:00 Labs 34:45 Treatment: pelvic PT, medications, counseling, flibanserin, herbal supplements 49:05 Screening for female sexual problems 51:58 Take home points; WomanLab.org 55:19 Outro Tags sexual dysfunction, female, gynecologist, ob-gyn, female sexual disorder, libido, sex, hormones, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student
October 1, 2018
Summary Conquer Clostridium difficile (Clostridioides difficile) with this “spore-tacular” episode featuring infectious diseases expert, Dr. Curtis Donskey, Professor at Case Western Reserve University and clinician at the Louis Stokes VA Hospital. We discuss the updates in the 2017 IDSA C. difficile guidelines plus a bunch of random pearls. If you have ever laid awake at night wondering how many pills are needed for a fecal transplant, then this is the episode for you!  We discuss why metronidazole was dropped as the first line therapy for Clostridium difficile infection (CDI) along with other hot topics such as two-step testing, loperamide use, which antibiotics are the least likely to cause CDI, and more. Do not miss this episode! Full show notes available at http://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits Written by: Carolyn Chan MD Produced by: Matthew Watto MD Hosts: Carolyn Chan MD, Matthew Watto MD, Paul Williams MD Editor: Matthew Watto MD Guest: Curtis Donskey, MD Time Stamps 00:00 Intro, disclaimer, guest bio 02:19 Getting to know our guest, recommendations for reading, career advice 06:40 Clinical case and CDI testing 09:30 Testing for CDI: PCR and Two step testing 16:30 Testing after treatment 20:00 Treatment of initial CDI episodes, metronidazole pharmacokinetics 24:15 Classification of CDI severity 29:30 Fidaxomicin pearls: when to use, cost, and tapers 34:10 Vancomycin tapers 36:05 Fecal transplant pearls: freeze dried capsules, c-scopes, treating fulminant CDI 44:44 Infection control: counseling homegoing patients, hand washing, and baths 47:50 Social media questions: immodium and toxic megacolon, antibiotics less likely to promote CDI, probiotics, and more! 59:14 Best CDI joke in the history of time 60:00 Take home points 62:42 Outro Tags Clostridium, difficile, cdi, C.Diff, infectious, diseases, diarrhea, IDSA, guideline, antibiotics, vancomycin, fidaxomicin, fmt, transplant, fecal, stool, toxin, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student
September 27, 2018
Geriatric psychiatry returns. We tackle sleep problems and behavioral disturbances in patients with dementia with returning guest, and Geriatric Psychiatrist Dennis Popeo MD, Clinical Associate Professor of Psychiatry at NYU Langone Medical Center. Topics include: pharmacologic and nonpharmacologic management of insomnia; treating agitation and irritability; medical management of psychotic symptoms and paranoia; ethical concerns about the treatment of challenging behaviors in dementia; and the shortage of geriatricians and geriatric psychiatrists. Full show notes available at http://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits Written & Produced by: Jordana Kozupsky NP, Matthew Watto MD Artwork by: Kate Grant MD Hosts: Jordana Kozupsky NP, Matthew Watto MD Editor: Matthew Watto MD Guest: Dennis Popeo, MD Time Stamps 00:00 Intro and guest bio 01:55 Case of sleep disturbance in a patient with dementia; medications for sleep disturbances; nonpharmacologic strategies for sleep 11:32 Irritability and agitation versus paranoia, or psychotic symptoms; benzodiazepines in older adults 15:40 Antipsychotic medications, the black box warning and ethical concerns 23:50 Geriatricians, geriatric psychiatrists in short supply; Behavioral interventions 28:16 Outro Tags psychiatry, psych, geri, geriatrics, dementia, paranoia, psychosis, sleep, insomnia, agitation, antipsychotics, atypical, black, box, warning, adverse, zolpidem, benzodiazepine, side, effects, therapy, mirtazapine, gabapentin, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student
September 24, 2018
Summary Geriatric depression got you down? Boost your spirits with tips and tactics from Geriatric Psychiatrist, Dennis Popeo MD, Clinical Associate Professor of Psychiatry at NYU Langone Medical Center. Topics include: suicide in the older adults; how to diagnosis depression in older adults; how to counsel patients about antidepressants, how to choose an antidepressant, how to monitor and titrate medications, and how long to continue therapy. Stay tuned for part two of our discussion with Dr Popeo on managing sleep and behavioral problems in older adult patients with dementia. Full show notes available at http://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits Written & Produced by: Jordana Kozupsky NP, Matthew Watto MD Artwork by: Kate Grant MD Hosts: Jordana Kozupsky NP, Matthew Watto MD Editor: Matthew Watto MD Guest: Dennis Popeo, MD Time Stamps 00:00 A question for you, the listeners 01:12 Disclaimer, intro and guest bio 05:00 Getting to know our guest, recommendations for reading, and career advice 14:13 Case of geriatric depression; effective history taking; recognizing associated symptoms; depression scales 19:03 Suicide in older adults; firearm safety 24:26 Choice of therapy; Pharmacologic agents; Counseling patients and managing expectations; Dose titration and tracking symptoms 34:41 Augmenting therapy versus cross-titration to another agent; When is it okay to stop an antidepressant 40:50 Take home points 44:40 Outro Tags: psychiatry, psych, geri, geriatrics, depression, mdd, sleep, insomnia, appetite, agitation, suicide, SSRIs, side, effects, therapy, diagnosis, serotonin, mirtazapine, bupropion, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student
September 17, 2018
Kick up the quality of your care with tips and tactics from Caitlin Clancy MD, coauthor of ACP’s High Value Care Curriculum. We learn to define quality and value in healthcare; the most common barriers to high value care; use of probability and likelihood ratios to boost clinical reasoning and combat diagnostic uncertainty; some useful tools to estimate cost; sources of healthcare waste; and some general pearls on how the healthcare system works...or doesn’t. ACP members can claim free CME-MOC at acponline.com/curbsiders (goes live 0900 EST on podcast release date). Full show notes available at http://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits: Written & Produced by: Matthew Watto MD Hosts: Paul Williams MD, Stuart Brigham MD, Matthew Watto MD Guest: Caitlin Clancy MD Time Stamps 00:00 Disclaimer, intro and guest bio 03:50 Guest one-liner, some discussion on non traditional paths, and picks of the week 12:10 Case 1: Defining value, cost, quality; sources of healthcare waste; and how to avoid the waste of daily labs 23:00 Case 2: An uninsured patient who needs major surgery; costs for uninsured versus insured patients 28:35 Do insured patients have better outcomes? 31:15 How to determine cost and “fair market price” 36:29 Case 3: Clinical case of suspected heart failure 45:45 Case 4: Clinical case of patient requesting antibiotics; barriers to high value care and how to overcome them 57:05 Outro Tags: high, value, care, quality, cost, diagnostic, uncertainty, likelihood, ratio, testing, treatment, consumer, acp, college, american, insured, uninsured, bill, charge, reimbursement, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student
September 10, 2018
Master the management of gout with tips from expert, Tuhina Neogi MD, PhD, Professor of Medicine at Boston University School of Medicine. Topics include: how to initiate and titrate urate lowering therapy, guidelines controversy over uric acid targets, colchicine & NSAIDS for anti-inflammatory prophylaxis, uricosuric agents, febuxostat, HLA B5801, use of uric acid levels in the acute setting and more random gout facts. Full show notes available at http://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits: Written and produced by: Matthew Watto MD Hosts: Paul Williams MD, Stuart Brigham MD, Matthew Watto MD Guest: Tuhina Neogi MD, PhD Time Stamps 00:00 Intro and guest bio 01:30 Allopurinol initiation and titration 07:10 Uricosuric therapy 09:10 Controversy over uric acid targets for gout 17:40 Parachutes and randomized controlled trials 19:15 Colchicine or NSAIDS for prophylaxis 23:20 Who needs febuxostat? 26:20 When to refer for gout, HLA B5801, and checking uric acid levels in the acute setting   33:29 Take home points 36:15 Outro Tags: allopurinol, uric, urate, acid, level, therapy, management, gout, flare, crystal, arthritis, titration, probenecid, febuxostat, target, acr, acp, guidelines, nsaids, colchicine, hla b5801, septic, rheumatology, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student
September 3, 2018
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
August 31, 2018
Dr. Neda Frayha (@nedafrayha) of Primary Care RAP (Hippo Education) joins us this month for our thoughts and analysis of some recent (and not so recent) journal articles that interested us this month. Our articles spanned topics that include at cancer survival among patients pursuing treatment with complementary medicine, the effect of body weight on effectiveness of preventive aspirin dosing, strategies to promote physician leadership, respiratory symptoms in those with marijuana use and MRSA risk among patients with penicillin allergies. ACP members can claim free CME-MOC at acponline.com/curbsiders (goes live 0900 EST on podcast release date). Full show notes available at http://thecurbsiders.com/podcast. Join our mailing list to receive a PDF copy of our show notes every Monday! And hey, while you’re here, consider rating us on iTunes and leaving a review. The Curbsiders thank you! Thoughts on the Journal Club series? Article or guest nominations? Compliments or complaints? You can reach us at thecurbsiders@gmail.com. We are also on Facebook, Instagram, and Twitter: @thecurbsiders.   Credits: Written by: Sarah Phoebe Roberts MPH, Neda Frayha MD, Christopher Chiu MD Producers: Sarah Phoebe Roberts MPH, Christopher Chiu MD Hosts: Matthew Watto MD, Stuart Brigham MD, Paul Williams MD, and Christopher Chiu MD Editor: Matthew Watto MD  Time stamps: 00:00 Disclaimer, intro, guest bio 05:05 Do patients using complementary medicine for cancer therapy have worse outcomes? 13:11 Does low dose aspirin work for primary prevention of major adverse cardiac events? 19:16 Do physicians make better leaders? 24:55 Does marijuana cause respiratory symptoms? 30:40 Does penicillin allergy confer increased risk for C Diff and MRSA infection? 38:40 Wrap-up and outro Tags:​ aspirin, cardiac risk, mortality, cancer, complementary, alternative, conventional, therapy, marijuana, cannabis, respiratory, symptoms, leader, leadership, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student
August 27, 2018
Get schooled on driver’s safety for older adults by expert, Alice Pomidor MD, Professor of Geriatrics at Florida State University. Whether or not older adults can continue to drive is a huge problem faced by for primary care clinicians, and will remain one until driverless cars become ubiquitous. Topics covered include: how to take a driving history, red flags, physical exam, cognitive exam, and vision assessment for driver’s safety, resources, when to refer, alternate means of transportation, and the legal repercussions of reporting...or not reporting. Full show notes available at http://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits: Written and produced by: Matthew Watto MD and Elizabeth Garbitelli MD Candidate 2022 Editor: Matthew Watto MD Cover Image by: Kate Grant MD Hosts: Matthew Watto MD, Stuart Brigham MD, Paul Williams MD Guest: Alice Pomidor MD  Time Stamps 00:00 Disclaimer 00:35 Intro and guest bio 03:10 Guest onliner, book recommendations, and career advice 10:43 Clinical case, and the 5 Rs of clinicians responsibility 19:15 Taking a history from older adult drivers 26:28 The clinical exam for driver’s safety (cognition, vision, and MSK tests) 37:24 How can we avoid patient anger towards clinician and family members? 41:10 When and where to refer for driving evaluation 47:00 Alternative transportation 52:00 What to do if someone refuses or forgets to stop driving 59:45 Reporting requirements and legal ramifications 69:15 Take home points 72:00 Outro  Tags: driving, elderly, geriatrics, dementia, treatment, prevention, cognition, seniors, drivers, safety, crash, motor, vehicle, car, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student  
August 20, 2018
Things We Do For No Reason #TWDFNR highlights some widespread practices that are difficult to justify based on lack of proven health benefits, but significant cost (both financial and non-financial harms). Avoid these low value practices and inflated medical bills with tips from expert, Dr Lenny Feldman, MD, FACP, Associate Professor of Medicine Johns Hopkins. Topics include: renal ultrasound and urine electrolytes in acute kidney injury (AKI), folate deficiency and anemia work-up, prealbumin and malnutrition, blood transfusions, shellfish and contrast allergies, monitoring after switch from IV or oral antibiotics, and “against medical advice” discharges. Don't forget to check out Clinicwiki.org a free, online resource for teaching ambulatory medicine. Full show notes available at http://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.  Credits: Written and produced by: Justin Berk MD, MPH, MBA Editor: Matthew Watto, MD Hosts: Justin Berk MD, MPH, MBA; Matthew Watto MD; Paul Williams MD, FACP Guest: Lenny Feldman MD, FACP Goal: Listeners will recognize things we do for now reason aka low value practices with an unfavorable ratio of benefits to cost and/or harm. Learning objectives: After listening to this episode listeners will… Determine if renal ultrasound is indicated in acute kidney injury Recognize the limitations of urine electrolytes in AKI. Identify the shortcomings of folate testing. Explain the significance of low albumin and prealbumin. Identify patients at risk for serious allergic reactions from IV contrast administration Explain the futility in discharge Against Medical Advice (AMA) paperwork Counsel patients on harm reduction in “AMA” discharges Rationalize discharging patients immediately after switching from IV to  oral (PO) antibiotics. Time Stamps 00:00 Announcements 00:38 Disclaimer, intro, and guest bio 03:53 Guest one liner, some recommendations, and advice 08:35 Defining high value care and things we do for no reason (TWDFNR) 12:40 Why do clinicians order useless testing? 14:58 Urine electrolytes for acute kidney injury 20:30 Renal ultrasound for acute kidney injury 25:54 Stop ordering folate for anemia workup 31:47 How many units should I transfuse? 34:40 Prealbumin and albumin for malnourishment. 43:24 Iodine, shellfish and contrast allergy 50:28 Patient leaving against medical advice 56:45 Switching from IV to oral antibiotics 63:27 Dr Feldman’s plugs 65:36 Outro  Tags: high, value, choosing, wisely, acute, kidney, injury, renal, ultrasound, transfusion, AKI, malnutrition, folate, prealbumin, albumin contrast, allergy, antibiotics, AMA, TWDFNR, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student
August 13, 2018
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
August 6, 2018
“Women in medicine, be bold.” Medical World, powerful women are here to stay. Dr. Vineet (Vinny) Arora, Professor of Medicine at University of Chicago, an exemplary Woman in Medicine and Leadership, shares snippets of her own story, valuable career advice to folks at all levels of training, and fascinating data about the gender disparities that exist in training, promotion, and pay.  We hope you’ll learn from this episode, whether you have faced or anticipate facing these struggles as a Woman in Medicine or as a member of another marginalized group, or whether you’re an ally and want to learn more about the issue. Women are entering medical school now more than ever, and are learning to provide the best possible care to patients (didn’t you see that patients of female physicians have significantly lower mortality rates than patients of male physicians? (Tsugawa et al., 2016)).  The modern medical woman wants to teach, mentor, and lead--and be fairly evaluated, and promoted. That’s where We In Medicine (both women and men) have some work to do.  Because gender disparities (and other disparities hinging on identity) do exist. N.b. This episode is our inaugural in what we hope will be a Women in Medicine series for the Curbsiders.  We have many more topics with which we’d like to engage, from career trajectory to imposter syndrome to sexual harassment to balancing career and personal lives (as inequity is not only at work (Khullar. Being a Doctor is Hard. It’s Harder for Women. NYT 2017)), to conversations about race, gender, and LGBTQ identity in medicine.  We’re passionate, at The Curbsiders, about all these topics, and we want to dive deep into how to make Medicine a more welcoming and ceiling-less place for all.  We can’t wait to bring this series to you, not to mention to bring some more fabulous female experts on air. Full show notes available at http://thecurbsiders.com/podcast Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits: Written and produced by: Leah Witt MD, Shreya P. Trivedi MD, Nora Taranto AB, Sarah Phoebe Roberts MPH, Molly Heublein MD, Beth Garbitelli, Hannah R Abrams, Images by: Beth Garbitelli and Hannah Abrams Editor: Matthew Watto MD Hosts: Leah Witt MD, Shreya P. Trivedi MD, Matthew Watto MD Guest: Vineet Arora MD Time Stamps 00:00 Disclaimer and intro 03:15 Guest bio, and one liner 05:55 Dr Arora’s Women in medicine moment of awakening 11:05 Advice to young women, “Be bold” 13:20 Picks of the week 16:45 Mistaken identity. Women not recognized as physicians due to appearance 22:05 Gender bias starts early in training and why it's important to shout-out accomplishments 31:24 Contracts, promotions and the leaky pipeline 38:32 Defining coaches, sponsors, and mentors 44:06 How to use your team and shout-out your accomplishments 52:04 How to write effective evaluations and letters that avoid gender bias 53:55 Take home points 57:00 Outro Tags: women, medicine, wim, LeanIn, leadership, mentorship, doctor, education, family, assistant, career, sponsorship, vineet, arora, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student
July 30, 2018
Short on time but hungry for knowledge? Curbsiders’ Journal Club gives you the speedy article analysis you crave. We provide brief summaries of recent research and news items in the field of internal medicine, so you can save time and stay on top of the literature. On this episode, we were joined by Kashlak Memorial’s very own Chair of Medicine, Dr. Robert Centor AKA @medrants on Twitter or “Uncle Bob” to the Curbsider Crew. This month’s topics include: estimating atherosclerotic cardiovascular disease risk, whether CT pulmonary angiography (CTPA) effectively rules out pulmonary embolism, discharging low risk patients with pulmonary embolism from the ED, metformin and risk of acidosis in patients with CKD, treating opioid use disorder after a nonfatal overdose, Canagliflozin and renal protection in type 2 diabetes, screening for diabetes among patients below age 40, and the association between nose-picking and staphylococcus. ACP members can claim free CME-MOC at acponline.com/curbsiders (goes live 0900 EST on podcast release date). Join our mailing list to receive a PDF copy of our show notes every Monday! And hey, while you’re here, consider rating us on iTunes and leaving a review. The Curbsiders thank you! Thoughts on the Journal Club series? Article or guest nominations? Compliments or complaints? You can reach us at thecurbsiders@gmail.com. We are also on Facebook, Instagram, and Twitter: @thecurbsiders.   Credits: Written by: Christopher J Chiu MD, Sarah Phoebe Roberts MPH Producers: Christopher J Chiu MD, Sarah Phoebe Roberts MPH Editor: Matthew Watto MD Hosts: Christopher J Chiu MD, Stuart Brigham MD, Paul Williams MD, and Matthew Watto MD Guest: Robert Centor MD Time stamps: 00:00 Disclaimer and Intro to Curbsiders Journal Club 04:00 Dr. Centor's Pick of the Week 06:10 Clinical Implications of the Revised Pooled Cohort Equations 12:10 Negative Predictive Value in CTPA for VTE 18:34 Can low risk patients with PE be discharged from the ED? 23:03 Is Metformin associated with Lactic Acidosis in those with low eGFR? 28:45 How do medications for opioid use disorder affect mortality after non-fatal overdose? 36:44 Canagliflozin and Renal Protection 43:00 Performance of USPSTF screening criteria for diabetes 46:08 Stuart on Nose picking 50:00 Chiu Bites: Infectious ties and physical attire 53:50 Outro Tags: atherosclerotic, cardiovascular, disease, risk, CT, pulmonary, angiography, CTPA, embolism, ED, metformin, acidosis, CKD, treatment, opioid, use, disorder, oud, mat, overdose, canagliflozin, renal, diabetes, screening, nose-picking, staphylococcus, ACP, CME, MOC, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student
July 23, 2018
Lyme disease and tick-borne illness deconstructed by Infectious Diseases expert, Paul E. Sax MD, of episode 78 fame. Oh, Summer Nights. The time for romance between Danny Zuko and good girl Sandy, the time to sit in the backyard around the bonfire, the time for sunset hikes in the woods and mountains…..and don’t forget, it’s also the time for those pesky woodland ticks who’ll go for a ride on you and maybe suck your blood (gross!). Dr. Sax takes us through the essentials of tick-borne illness, with a focus on Lyme Disease: diagnosing it, treating it, identifying possible co-infections, and managing Post-Lyme residual symptoms.   Our (And Dr. Sax’s) Disclaimer about this episode, and the shownotes: Tick-borne illness is a very serious problem in public health in the US, but management is quite a controversial issue. We’ve done our best with this episode to stay as evidence-based as possible. Moreover, given the limited time we have on air, we have tried to focus on what we think is most clinically relevant. Full show notes available at http://thecurbsiders.com/podcast Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits: Written by: Shreya P. Trivedi MD, Nora Taranto AB Produced by: Shreya P. Trivedi MD, Nora Taranto AB Editor: Matthew Watto MD Images by:  Hannah R. Abrams Hosts: Shreya P. Trivedi MD, Matthew Watto MD, Paul Williams MD Guest: Paul E. Sax MD Time Stamps 00:00 Intro 02:17 Disclaimer 03:19 Guest bio 05:17 Getting to know Guest 08:33 Favorite hiking experiences 12:20 Disclaimer of Tick-borne illness 12:28 Clinical case of recent hiking in endemic area with a rash 20:59 Lyme testing limitations 27:38 Patient education to doxycycline 30:16 Case of elderly outdoorsy healthy male with flu-like symptoms in the summer 32:39 Differentiating anaplasmosis and babesiosis 33:17 Workup for patient with possible tick co-infections 39:22  Post-lyme disease residual symptoms 48:02  Case of tick attached to patient 56:19  Outro Tags: lyme, disease, anaplasmosis, babesiosis, treatment, prevention, coinfection, doxycycline, paul, sax, infectious, diseases, nejm, harvard, pcr, antibody, tick, borne, illness, chronic, post, syndrome, removal, endemic, anatomical, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student
July 16, 2018
Renal tubular acidosis aka RTA deconstructed by @Kidney_Boy, Joel Topf MD, Chief of Nephrology at Kashlak Memorial Hospital. We review the three buckets of non gap metabolic acidosis, normal renal physiology & acid base handling, points of failure in RTA, complications and treatment of RTA. Check out Dr Topf’s awesome slides on renal tubular acidosis at http://thecurbsiders.com/podcast . Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits: Written by: Matthew Watto MD and Joel Topf MD Produced by: Matthew Watto MD Hosts: Matthew Watto MD, Stuart Brigham MD, Paul Williams MD Guest: Joel Topf MD Time Stamps 00:00 Announcements 01:02 Disclaimer 01:40 Intro and guest bio 04:00 Joel’s one liner 06:05 Joel’s “favorite failure” 11:45 Paul shares a failure 13:20 Tweetorials 16:39 Clinical case of non gap metabolic acidosis 18:06 Three buckets of NAGMA and GI losses 21:02 Chloride intoxication and normal saline 25:14 Renal tubular acidosis and normal role of kidney in acid base 35:03 Proximal (type 2) RTA 40:33 Cases of proximal RTA 43:38 Distal (type 1) RTA 53:15 Bicarbonate dosing and titration 55:28 Type 4 RTA (hypoaldosteronism) 62:09 Urinary anion gap and ammonium 67:26 Replacing GI losses of bicarbonate 70:25 Joel reviews quick cases of RTA and NAGMA 74:49 Outro  Tags: renal, tubular, acidosis, non, gap, rta, nagma, metabolic, kidney, diarrhea, sodium, normal, saline, ringer's, lactate, tubule, bicarbonate, physiology, acid, base, ammonia, ammonium, nephrolithiasis, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student
July 9, 2018
Expert diagnostician, Dr. Gurpreet Dhaliwal, again joins The Curbsiders to dive deeper into the topic of clinical expertise.  Topics include, and are mainly focused on, Dr. Dhaliwal’s “training regimen:” feedback, simulation, quizzing, learning from consultants, and how to read the medical literature as a clinician.  While we found this episode to be incredibly useful (and entertaining to record), don’t let our bias sway your opinion! In fact, just listen to the episode and listen for practical advise on how to improve your own clinical acumen.   Dr Brigham’s comment:  Be forewarned, much of what we talk about is seemingly common sense, but, upon listening to the episode many times, I realize that we have, over time, overly complicated the fundamentals of expertise.  I’m just as guilty as the next physician. Full show notes available at http://thecurbsiders.com/podcast Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits Written and produced by:  Stuart Brigham MD Hosts: Stuart Brigham MD, Paul Williams MD, Matthew Watto MD Guest: Gurpreet Dhaliwal MD Images by: Beth Garbitelli Edited by:  Matthew Watto MD Time Stamps 00:00 Disclaimer, Intro 02:25 Guest Bio 03:57 Pun 04:25 Dr. Dhaliwal 05:57 Pick of the Week - Move, “Jiro Dreams of Sushi” 08:00 Pick of the Week - Podcast, “Unspooled” 09:06 Pick of the Week - Water Putty, “Durham’s Rock Hard Water Putty” 10:20 “Clinical Case” Introduction 12:00 Developing expertise, introduction 15:50 Developing a patient log 21:30 Asking the wrong question leads to the wrong answer 23:35 Telling a colleague they were wrong 26:00 Five to one ratio 28:58 Understanding the why 33:57 Simulation in practice 37:35 Quote on learning… Just listen. 41:00 Quizzing and consolidating memory 44:24 Reading the literature as a clinician 50:10 Bottom line 57:10 Outro Tags: clinical, reasoning, diagnosis, diagnostician, accuracy, Osler, misdiagnosis, train, brain, care, test, self, Dhaliwal, Gurpreet, Curbsiders, podcast, patients, cats, funny, educational, inspirational, educator, school, free, doctor, education, family, foam, foamed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, physician assistant, resident, student
July 2, 2018
Curbsiders’ Journal Club features rapid summary and critical appraisal of recent articles and news stories in internal medicine by The Curbsiders. This month’s topics include: asthma, maintenance versus as needed inhaler use, procalcitonin, Pneumocystis pneumonia prophylaxis, colon cancer screening, smoking cessation, cannabis and cognitive impairment, LDL cholesterol and mortality, plus some medical podcast recommendations. Over the last month, we have developed a list of more than 40 interesting articles and news stories that we have been feeding our own brain holes. From this list we have plucked a select few that we really wanted to highlight and share with you. Join our mailing list to receive a PDF copy of our show notes every Monday! And hey, while you’re here, consider rating us on iTunes and leaving a review. The Curbsiders thank you! We are also on Facebook, Instagram, and Twitter: @thecurbsiders. Credits: Written by: Christopher J Chiu MD, Sarah Phoebe Roberts MPH Producers: Christopher J Chiu MD, Sarah Phoebe Roberts MPH Hosts: Christopher J Chiu MD, Stuart Brigham MD, Paul Williams MD, and Matthew Watto MD Editor: Matthew Watto MD Time Stamps: 00:00 Announcements 00:20 Disclaimer 01:00 Intro to Curbsiders Journal Club 03:07 Mild asthma and as needed versus maintenance inhaler use 09:50 Smoking cessation, e-cigarettes, and financial incentives 17:23 Pneumocystis pneumonia prophylaxis 22:18 Cannabis and cognitive impairment 26:15 Colorectal cancer screening update by American Cancer Society 30:37 Procalcitonin for lower respiratory tract infections in the ED 37:29 Cholesterol, baseline LDL-C, mortality and cardiovascular events 41:01 Incorrect symbology and some podcast recommendations 46:22 Outro Tags: asthma, maintenance, inhaler, procalcitonin, Pneumocystis, pcp, pneumonia, prophylaxis, colon, cancer, screening, crc, smoking, cessation, marijuana, cannabis, cognitive impairment, LDL, cholesterol, mortality, cardiovascular, podcast, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student
June 25, 2018
Cirrhosis. Take control of cirrhosis and treat your patients like the pros! In this episode of The Curbsiders, Dr. Scott Matherly, assistant professor in the Dept of Medicine at Virginia Commonwealth University and board certified hepatologist, builds upon his introduction to cirrhosis. You already know what to look out for and how to diagnose these patients, now it’s time to build your knowledge and medical repertoire against this deadly condition! Topics include: high protein diet, ascites, diuretics, hepatic encephalopathy, lactulose vs rifaximin, portal hypertension, esophageal varices, beta blockers, spontaneous bacterial peritonitis prophylaxis and more pathophysiology! Full show notes available at http://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits: Written by: Cyrus Askin MD Infographics: Beth Garbitelli Produced by: Cyrus Askin MD and Matthew Watto MD Hosts: Cyrus Askin MD, Matthew Watto MD, Stuart Brigham MD, Paul Williams MD Guest: Scott Matherly MD Time Stamps 00:00 Announcements 00:54 Disclaimer 01:30 Guest bio 02:28 NASH, diet, vitamin E, pioglitazone and prevention of cirrhosis 06:56 Clinical case of decompensated cirrhosis 09:02 Pathophysiology of circulatory dysfunction in cirrhosis and use of diuretics 18:25 Hepatic encephalopathy, ammonia, lactulose and rifaximin 25:10 Timing of medical therapy 26:39 MAP of 82 mmHg, beta blockers and variceal bleeding 31:04 Use of midodrine for hypotension 33:45 Prophylaxis of SBP 36:05 Take home points 38:04 Outro Tags: cirrhosis, liver, high, protein, diet, sodium, restriction, ascites, diuretics, furosemide, spironolactone, hepatic, encephalopathy, lactulose, rifaximin, portal, hypertension, esophageal, varices, beta, blockers, spontaneous, bacterial, peritonitis, prophylaxis, pathophysiology, sbp, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student
June 18, 2018
Cirrhosis. Finally. Take your liver game to the next level with tips from @liverprof, Scott Matherly MD, Assistant Professor of Medicine at Virginia Commonwealth University. Topics include: exam findings in cirrhosis, interpreting liver function tests, incidental cirrhosis on imaging, fatty liver disease, steatohepatitis, hep c, shear wave elastography, screening for varices and hepatocellular carcinoma, pathophysiology, and lifestyle measures for initial management. This episode is sponsored for CME-MOC credit by the American College of Physicians. ACP members can claim free credit at acponline.org/curbsiders (goes live at 9am on release date). Full show notes available at http://thecurbsiders.com/podcast Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits: Written by: Cyrus Askin MD CME questions by: Cyrus Askin MD Produced by: Cyrus Askin MD and Matthew Watto MD Hosts: Cyrus Askin MD, Matthew Watto MD, Stuart Brigham MD, Paul Williams MD Guest: Scott Matherly MD Time Stamps 00:00 Announcements 00:45 Disclaimer 01:19 Intro to the show and our guest 04:15 Guest one liner, books recommendations, and career advice 09:04 Cyrus’ pick of the week 10:14 Clinical case of abnormal liver functions tests 11:12 Seven hand findings of cirrhosis 13:28 Should we screen for NASH? 15:28 Incidental finding of cirrhosis on imaging 17:47 Next steps after diagnosis of cirrhosis 20:36 Non-invasive scoring systems to predict cirrhosis 23:55 Liver biopsy 25:33 Shear wave elastography 29:10 Recap of what we learned so far 31:58 Three ways cirrhosis can kill you 33:56 Counseling patients about cirrhosis 36:05 Management of NASH and early  cirrhosis 42:55 Screening for varices and hepatocellular carcinoma 46:28 Outro Tags: cirrhosis, liver, function, shear, wave, elastography, fibroscan, imaging, fatty, liver, disease, nash, nafld, steatohepatitis, hepatitis, hep c, hcv, screening, varices, hepatocellular, carcinoma, pathophysiology, lifestyle, management, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student
June 11, 2018
Step up your primary care of cancer survivors with tips from Dr Regina Jacob, Assistant Professor of Medicine at Temple University. Care of the cancer patient does not end when their cancer treatment is over, and there is more to a past diagnosis of cancer than surveillance. We discuss cancer survivorship care with Dr. Regina Jacob, including the changing demographics of survivorship, the importance of survivorship care plans, and how survivorship is largely just good primary care. Full show notes available at http://thecurbsiders.com/podcast Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits: Written by: Paul Williams MD Hosts: Stuart Brigham MD, Matthew Watto MD, and Paul Williams MD Produced by: Paul Williams MD Edited by: Matthew Watto MD Guest: Regina Jacob MD  Time Stamps 00:00 Disclaimer 00:35 Intro to the topic and guest bio 02:15 Guest one liner, book and app recommendations 06:58 Paul’s pick of the week. 07:40 Clinical case, definitions, and phases survivorship 12:36 Survivorship statistics 15:04 Co-survivorship 17:41 Care models for survivorship 20:56 Assigning roles in care of cancer survivors 22:59 Sample survivorship care plan 27:39 Childhood, adolescent and young adult cancer survivorship 34:18 Sexual dysfunction in cancer survivorship Turn down Watto and Regina tracks 35:56 Stressors in young adult cancer survivors 37:33 Fatigue 43:28 Guidelines on survivorship 45:06 Late cardiac toxicity 46:23 Support groups and resources 49:04 Take home points 50:29 Outro  Tags: Survivorship, cancer, breast, ovarian, colon, radiation, chemotherapy, side, effect, fatigue, sexual, dysfunction, care, plan, surveillance, doctor, education, family, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student
June 4, 2018
Knee pain is easy with practical tips from Orthopedist, medical educator, car-builder, and inventor extraordinaire Dr. Ted Parks. He teaches us the four buckets of knee pain, how to perform a 30-second knee exam, choose a knee brace, order x-rays, and the red flags to look for in a history and physical that should have you shouting for your closest neighborhood orthopedic surgeon. This episode is brought to you in partnership with the American College of Physicians. ACP members can claim free CME-MOC credit at acponline.org/curbsiders. Check out our video of the Parks-Approved 30-second knee exam! Credits: Written by: Nora Taranto BA, Matthew Watto MD Produced by: Chris Chiu MD and Nora Taranto BA Edited by: Matthew Watto MD. Hosts: Matthew Watto MD, Stuart Brigham MD, Paul Williams MD. Guest: Ted Parks MD.   Full show notes available at http://thecurbsiders.com/podcast. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.  Time Stamps 00:00 Announcement 01:00 Disclaimer 01:35 Intro and guest bio 04:08 Dr Parks’ one-liner, book recommendation, inventions, and career advice 10:52 A case of knee pain, and recognizing emergencies 14:17 Four buckets of knee pain 17:40 Initial approach to treatment of knee pain 20:19 Corticosteroid injection controversy 22:47 Hyaluronic acid injections 24:50 Topical agents 27:03 Taking a history about knee pain 29:39 Knee locking or giving out Practical Office Orthopedics by Ted Parks 31:44 How to order knee X-rays 36:45 Knee braces 41:00 How to perform a 30 second knee exam Ms Anita Bones has left knee pain and recent fall. 53:00 PRP, stem-cell injections 61:00 Glucosamine chondroitin 63:09 Take home points 64:36 Outro Tags: orthopedics, knee, pain, ortho, joint, exam, osteoarthritis, arthritis, xray, physical, injection, corticosteroid, hyaluronic, hyaluronate, prp, stem, cell, bracing, nsaids, glucosamine, chondroitin, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student
May 28, 2018
Keep current with this monthly journal club covering landmark articles through May 2018, plus rapid fire hot takes from the medical literature and health news. We rate each article according to a highly scientific ‘Hotcakes’ scale to highlight what practice-changing knowledge we’ll take to work this month. Topics: Hypertension, blood pressure monitoring, prostate cancer screening, Intimate Partner Violence screening, alcohol is killing you, new diabetes drugs and mortality, DPP-4 inhibitors and IBD risk, NT-proBNP-guided therapy vs usual care, effect of teaching status on mortality, and more! If you’re a listener and have something interesting for us to discuss, please send it our way. Join our mailing list to receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. We are also on Facebook, Instagram, and Twitter: @thecurbsiders. Credits: Written and produced by: Christopher J Chiu MD, Sarah Phoebe Roberts MPH Hosts: Christopher J Chiu MD, Stuart Brigham MD, Paul Williams MD, and Matthew Watto MD Editor: Matthew Watto MD Time Stamps:  00:00 The Curbsiders need a web master 00:50 Disclaimer 01:25 Intro to the format 03:25 Ambulatory BP monitoring and mortality 09:08 Blood pressure treatment strategies: CVD risk score vs systolic BP targets 14:14 Repeated BP measurements important at office visits and future directions of BP management 21:25 Hot takes in order of appearance: Prostate cancer screening, intimate partner violence, alcohol, DPP4 inhibitors mortality and IBD, teaching status and mortality in US hospitals, 5 lifestyle factors that may add to life expectancy, NT pro-BNP, BNP and mortality 38:12 Outro
May 21, 2018
Get schooled on hemoglobin a1c targets in type 2 diabetes mellitus by American College of Physicians guidelines coauthor, Devan Kansagara MD MCR, Associate Professor of Medicine, Oregon Health Sciences University. We summarize outcomes from the landmark diabetes trials (ACCORD, ADVANCE, VADT, UKPDS 33 & 34), how a1c targets effect microvascular and macrovascular events, estimating life expectancy, and how to personalize diabetes control for your patients. We’re proud to announce our new partnership with the ACP to provide free CME credit and MOC points on select episodes of The Curbsiders. ACP members can visit acponline.org to redeem free CME/MOC credit. Full show notes available at http://thecurbsiders.com/podcast Join our mailing list to receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits: Written, produced, and edited by: Matthew Watto MD. Hosts: Stuart Brigham MD, Paul Williams MD, Matthew Watto MD. Guest: Devan Kansagara MD, MCR Time Stamps 00:00 Announcement 00:48 Disclaimer and intro 03:11 Getting to know our guest: one liner, book recommendation, mentorship 06:50 How and why did ACP write their guidance statement on diabetes, A1C targets 09:18 Landmark trials in type 2 diabetes 11:36 Does tight control prevent micro or macrovascular complications 13:20 Trials of newer agents like SGLT2i, GLP-1 and DPP4i 14:33 How do ACP’s guidelines differ from other published guidelines 17:20 Quick recap of landmark trial findings 22:24 Personalizing glycemic control 24:30 Controversy over an A1C goal of 7-8% 28:05 Clinical inertia 30:26 Legacy effect and metabolic memory 34:00 Deintensifying therapy 38:29 Life expectancy and comorbid conditions 43:15 Performance measures in diabetes 44:42 Take-home points 46:30 The Curbsiders recap and give some closing remarks 49:13 Outro  Tags: diabetes, a1c, target, dm, hypoglycemia, glycemic, intensive, tight, glucose, control, cardiovascular, risk, outcome, mortality, death, metformin, insulin, acp, guideline, accord, advance, vadt, ukpds, microvascular, macrovascular, aace, ada, VA, DoD, assistant, care, doctor, education, family, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student
May 14, 2018
Separate the wheat from the chaff when it comes to food allergy, food intolerance, and celiac disease. Featuring renowned gastroenterologist and current president of the American Gastroenterological Association, Dr. Sheila Crowe MD FRCPC FACP FACG AGAF, we discuss how to differentiate a food allergy from an intolerance, what diagnostic testing is appropriate, and why fructans might be the real culprit in patients with ‘gluten sensitivity’. Full show notes available at http://thecurbsiders.com/podcast Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits: Written by: Sarah P. Roberts, MPH Guest: Sheila Crowe, MD Hosts: Matthew Watto, MD; Stuart Brigham, MD; Paul Williams, MD Producers: Sarah P. Roberts, MPH and Chris Chiu, MD Editor: Matthew Watto, MD Time Stamps: 00:00 Disclaimer 03:35 Getting to know our guest, book recs, and career advice 10:35 Clinical case 11:40 Defining allergy, intolerance 14:05 Food intolerance and FODMAP 18:02 Taking a history in patient with potential food allergy vs intolerance 21:34 Dermatitis herpetiformis, gluten ataxia, and extraintestinal manifestations of celiac 26:12 Diagnosing celiac disease 30:53 Next steps if celiac testing is negative; lactose, fructose intolerance, IBS 33:48 Non-celiac gluten sensitivity (NCGS) 37:48 Study of NCGS 40:41 Olmesartan and drug-induced enteropathy 43:38 Dieticians, dietary recs, elimination diets 48:10 “Voodoo” testing 52:36 Counseling patients on diet 54:35 Take home points 55:50 Outro Tags: food, allergy, intolerance, sensitivity, celiac, disease, diarrhea, diet, fodmap, paleolithic, paleo, weight, loss, lactose, olmesartan, refractory, protein, gluten, fructan, wheat, anaphylaxis, tTG, genetic, gene, testing, assistant, care, doctor, education, family, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student
May 7, 2018
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
April 30, 2018
A fast moving recap of hot topics and clinical pearls live from Internal Medicine’s largest national conference, ACP 2018 in New Orleans! Dr. Nina Mingioni, Clinical Associate Professor and director of Undergraduate Medical Education in Internal Medicine at Thomas Jefferson University Hospital serves up some knowledge food for our brain holes. Topics: the athlete as a patient, sports physicals, food as medicine, medical marijuana (cannabis), and more! Listeners, please let us know what you liked, didn’t like and how we could make this better. YouTube video of this episode available here: ACP 2018 Recap with Nina Mingioni.  You can join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. We are also on Facebook, Instagram, and Twitter: @thecurbsiders.    Time stamps: 00:00 Music and disclaimer 02:48 Getting to know our guest 06:07 The athlete as a patient 10:20 Relative energy deficiency in sports 12:00 Drug interactions 15:51 Food as medicine 21:56 Marijuana 30:24 Outro Credits:  Written by: Nina Mingioni MD, Hannah Abrams. Producer/videographer: Chris Chiu MD. Hosts: Matthew Watto MD, Stuart Brigham MD, Paul Williams MD. Editor: Matthew Watto MD Tags: food, microbiome, marijuana, athlete, ekg, ecg, physical, sports, training, energy, relative, deficiency, cannabinoid, entourage, effect, cannabidiol, thc, cannabis, acp, 2018, assistant, care, doctor, education, family, foam, foamed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student
April 23, 2018
Wow the crowd with your knowledge of pulmonary embolism! What are the red flags? What tools are available to guide you? How on Earth do you triage a patient with pulmonary embolism (PE)? What exactly is the RV spiral & how do PEs really cause morbidity and mortality?! Get schooled by pulmonary embolism expert, Dr. Oren Friedman, associate director of the Cardiac-Surgical Intensive care unit at the Cedars-Sinai Heart Institute. Doctors Cyrus Askin and Chris Chiu join as co-hosts. Test Yo’ Self Pulmonary embolism quiz Written by Cyrus Askin, MD, Justin Berk, MD, MBA, MPH. Figure by Cyrus Askin, MD. Edited by Matthew Watto, MD Full show notes available at http://thecurbsiders.com/podcast Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.  Time Stamps 5:10 - Start of Interview / Introduction 10:00 - Case Presentation - Introduction of DVT / PE Spectrum and Pathophysiology 16:18 - How to Triage and Work-Up Pulmonary Embolism (CT, Echo, troponins, “eyeball”) 23:30 - Other ways to risk-stratify (Other CT findings, clot burden) 28:45 - What does a low-risk patient look like? 30:35 - When to consider treatment modalities other than general anticoagulation 35:12 - Anticoagulation treatment options 36:38 - Next step intensive interventions after anticoagulation 42:00 - Evidence behind catheter-directed lysis 44:05 - IVC Filter discussion 47:22 - Discharge criteria for PE 50:00 - Incidental PEs 52:40 - Interdisciplinary PERT Team Tags: pulmonary, embolism, thrombolysis, heparin, anticoagulation, right, ventricle, RV, left ventricle, LV, circulation, hypotension, shock, IVC, vena, cava, filter, catheter, TPA, echocardiogram, CT, scan, computed, tomography, shock, bleed, clot, deep, vein, thrombosis, vte, venous, embolism, assistant, care, doctor, education, family, foam, foamed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student
April 21, 2018
Random clinical pearls from day 2 of ACP 2018 live in New Orleans. Topics include: Perioperative medicine, DOACs, anticoagulation, reversal agents, ACP statements on hidden curriculum, physician well being and burnout, modeling behavior, dermatology pearls, rashes, venous stasis ulcers, pentoxifylline, biotin and Grave's disease, dermatology pearls, Stuart's tips on sports doping, and how chocolate milk improves recovery time. Doctors Chris Chiu and Chris Thrash join us to discuss their favorite teaching points from today's sessions. Cochrane Review on Venous Ulcers https://bit.ly/2JdQAMu Joinour 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.
April 20, 2018
The Curbsiders share random clinical pearls from day 1 of ACP 2018 live in New Orleans. Topics covered include: breast density and cancer risk, patients before paperwork, diverticulitis, social determinants of health, migraine prevention, PrEP and thunderclap headaches. Doctors Chris Chiu and Chris Thrash join us on air to discuss their favorite teaching points from today's sessions. 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.    
April 16, 2018
Keep up-to-date with this fast moving discussion of recent journal articles and thought-provoking headlines in medicine. Welcome to the first-ever Curbsiders journal club covering landmark articles from March to April 2018, plus rapid fire hot takes and the unveiling of our new hotcake based rating system. Please let us know what you liked, didn’t like and how we can make this better next month. Topics: Resident work hours, saline versus balanced IV fluids, barber shops and hypertension, coffee causes cancer, Twitter based medicine, clonidine versus spironolactone, opioids versus nonopioids and aromatherapy for nausea! Written by: Chris J Chiu, MD; Producer: Sarah Phoebe Roberts MPH; Edited by: Matthew Watto, MD Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. We are also on Facebook, Instagram, and Twitter: @thecurbsiders.  Time stamps: 00:00 Disclaimer 00:35 Host intros, featuring special guest and correspondent Chris Chiu, MD 01:30 Introducing a new Curbsiders segment! 03:20 First article: Duty-Hour Flexibility Trial 08:55 Second article: Trial of Blood-Pressure Reduction in Black Barbershops 14:27 Third article: SALT-ED Trial 20:00 Hot takes—intro 20:36 Hot take #1, Dr. Milton Packer and Twitter-based medicine 24:07 Hot take #2, Coffee and cancer risk 26:24 Hot take #3 Aromatherapy for nausea 28:10 Hot take #4 Opiates vs. non-opiates for chronic pain 29:00 Hot take #5, Surgeon general’s statement on naloxone 29:46 Hot take #6, Spironolactone vs clonidine for resistant HTN 31:54 Outro & announcements
April 9, 2018
Become an expert diagnostician like Dr Gurpreet Dhaliwal, Professor of Medicine at UCSF. Join us for this deep dive into clinical reasoning and how doctors think! Topics include: how to improve your own clinical reasoning and diagnostic skills, how to teach these skills, and the initial steps to building your own expertise/mastery in clinical medicine! Dr. Osler once admonished his students to build experiential wisdom and follow-up with their clinical cases (clear cases, doubtful cases, and mistakes), but to do so, one must “...learn to play the game fair, no self-deception, no shrinking from the truth; mercy and consideration for the other man, but none for yourself, upon whom you have to keep an incessant watch.” Test yo’ self: Take our quiz here Written and produced by:  Stuart Brigham, MD; Images by Hannah Abrams; Edited by:  Matthew Watto, MD Full show notes available at http://thecurbsiders.com/podcast Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Goal: Listeners will gain an appreciation for the Clinical Reasoning process and the difficulties that underpin building expertise in medicine. Learning objectives: After listening to this episode listeners will… Develop an appreciation for clinical reasoning. Recall the importance that the educator plays in role modeling. Learn how to improve diagnostic accuracy by keeping a patient log. Identify the common nomenclature used in clinical reasoning and how teaching this common verbiage could serve to improve diagnostic accuracy Recognize that misdiagnosis is common in clinical practice and every clinician could benefit from deliberate practice. Explain the difference between experience and expertise. Time Stamps 00:00 Disclaimer, Intro 02:30 Guest Bio 04:50 Dr. Dhaliwal 06:45 Book recommendation 09:14 App recommendation 11:34 Advice for learners and teachers (Pearl #1) 12:40 Can a computer out-think a human? 15:49 Defining Clinical Reasoning 18:38 “Train the Brain” introduced 20:30 Knowledge is a precondition 21:46 A learner who lacks synthesis 24:23 How to provide learner feedback 27:04 Defining problem representation, illness scripts, etc. 29:20 How to start teaching clinical reasoning 31:00 Focus on the “why” and not the “what” 32:11 Teaching the nomenclature of clinical reasoning 36:07 “You can’t get the right answer if the brain is solving the wrong problem” 36:34 Osler and his “Incessant Watch” 40:40 Being wrong feels exactly the same as being right 42:00 Patient tracking (Dr. Dhaliwal’s recommendation) 45:30 Why keeping a patient log is so important 47:00 Are heuristics beneficial? 48:55 Can you debias yourself? 50:00 “Going slow just makes you slow.” 52:00 All evidence has flaws, but knowledge is still king. 55:13 Clinical reasoning on multi-disciplinary teams 59:27 Take-home points Tags: clinical, reasoning, diagnosis, diagnostician, accuracy, Osler, misdiagnosis, train, brain, care, test, self, Dhaliwal, Gurpreet, Curbsiders, podcast, patients, cats, funny, educational, inspirational, educator, school, free, doctor, education, family, foam, foamed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, physician assistant, resident, student
April 2, 2018
Revolutionize your approach to the red eye in pr-eye-mary care! Dr. Glaucomflecken (of GomerBlog/Twitter--fame) teaches us to recognize and manage common eye complaints. You’ll develop an approach to diagnosing and treating your patient with the dreaded red eye. We answer: What presentations should have us running down the hallway for that prized ophtho consult? What on earth does glaucomflecken stand for? Which eye drops are best? What is an eye dentist? Plus, answers to your twitter questions, and so much more! By the end of this episode, you’ll be sure to say “Eye Understand!” Self Assessment Questions: Take the ophtho self-assessment! Donate at FirstDescents.org to support young cancer survivors like Dr. Glaucomflecken! Written and produced by: Nora Taranto AB, Carolyn Chan MD; Original art by: Bryan Brown, MD. Edited by: Matthew Watto, MD. Full show notes available at http://thecurbsiders.com/podcast Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.  Times Stamps 00:00 Disclaimer 02:33 Guest bio 04:15 Dr Glaucomflecken 05:40 Best advice as a learner 06:05 Book recommendation 07:33 App recommendation 08:32 Clinical case 10:02 Corneal ulcers and contact lense hygiene 12:10 Indicators of urgent eye problems 13:39 The eye exam 18:00 Visual acuity exam without an eye chart 21:15 Approach to the red eye, blepharitis, allergic conjunctivitis 23:45 Approach to vision loss 25:52 Angle closure glaucoma, and other emergencies 27:37 Bacterial conjunctivitis 29:00 Viral conjunctivitis 31:26 Return to school or daycare after “pink eye” 34:00 Rundown of common eye medications 38:35 OTC redness relievers 40:30 Breast milk eye drops?! 42:07 How to correctly use an eye drop bottle 44:16 What does Glaucomflecken mean? 45:40 Questions from Twitter: Floaters, diabetic retinopathy treatments, blurry vision from high glucose 50:15 Eye dentists? 53:10 Take home points 54:28 Plug for First Descents charity 56:54 Outro Tags: eye, ophthalmology, eyedrop, GOMER, conjunctivitis, twitter, red, glaucoma, glaucomflecken, acute, angle, closure, glaucoma, bacterial, viral, blepharitis, assistant, care, doctor, education, family, foam, foamed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student
March 26, 2018
Dominate acid-base disturbances with the wisdom of @kidney_boy aka Joel Topf, MD, Chief of Nephrology at Kashlak Memorial Hospital.  Master his 5 key steps for interpreting acid-base disorders and decode any ABG, VBG, and BMP to find the primary disorder, and any other disorders tucked away in the ABG! Plus: Henderson-Hasselbach and pH simplified; the anion gap, should your correct it?; choice of IV fluid; osmolar gaps, methanol, ethylene glycol, isopropyl alcohol; and how metabolic disorders are like a boy band. Be sure to follow along the Dr. Topf’s brilliant acid-base powerpoint. Written and produced by Joel Topf MD, Shreya Trivedi MD, Xavi Jimenez MD; Images by Hannah Abrams; Edited by Matthew Watto MD Full show notes available at http://thecurbsiders.com/podcast Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.  Time Stamps 00:00 Announcement 01:00 Disclaimer 01:34 Intro 02:45 The setup and guest bio 03:15 How does Dr Topf compensate for difficulty 07:10 What has helped Dr Topf become successful as an educator 10:40 With which electrolyte do you most closely identify? 14:05 Picks of the week 16:05 Nephmadness explained 19:50 Joel’s big picture look at acid base 22:17 Acid base and logorhythmic scale 24:28 A caution about ABGs 27:23 Clinical case from Kashlak Memorial Hospital 28:05 Misinterpretation of low bicarb on a metabolic panel 29:20 Step 1 of acid base 32:00 Metabolic disorders and One Direction 35:15 Acidemia vs acidosis; alkalemia vs alkalosis 37:52 Compensation for acid base disorders 40:45 ABG apps and analyzers 42:40 Step 2 Is there a second primary disorder? Use equations for determining if compensation is appropriate. 51:31 How to determine if respiratory compensation is acute or chronic 54:26 Step 3 The anion gap 57:21 Correcting the anion gap 60:33 What causes a low anion gap? 63:58 Anion gap acidosis 66:05 GOLDMARK 69:15 Step 4 Is there an osmolar gap? 71:48 Toxic ingestions: Methanol, ethylene glycol, and isopropyl alcohol 76:15 Calculating the osmolar gap 79:08 Step 5 Gap-gap calculation aka “the bicarbonate before” 85:05 Choice of IV crystalloid fluid and when to use a bicarbonate drip 88:15 Bicarbonate in DKA 90:18 NephMadness plug 91:10 Outro Tags: acid, base, anion gap, metabolic, respiratory, toxic alcohol, goldmark, mudpiles, albumin, acidosis, alkalosis, compensation, nephrology,  Henderson-Hasselbalch, equation, ABG, VBG, bicarbonate, pCO2, assistant, care, doctor, education, family, foam, foamed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student
March 19, 2018
Want to look cool like a toxicology consultant, sipping coffee on rounds? Ever check a patient for armpit sweat? Learn the secrets of tox from the titans of toxicology podcasting, The Dantastic Mr. Tox & Howard (AKA Dr. Dan Rusyniak and Dr. Howard Greller), as they loquaciously dish on all things tox. Topics include: how to approach the patient with an unknown overdose, are toxidromes clinically useful, clues on physical exam, is GI decontamination still recommended, and why they hate bupropion and tramadol. We recommend cautious ingestion of fluids while listening because this was a seriously funny episode. Try our Self Assessment Questions Toxicology 101 Quiz. Written and produced by: Christopher Chiu, MD; Graphics by: Beth Garbitelli; Edited by: Matthew Watto, MD Full show notes available at http://thecurbsiders.com/podcast Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.  Time Stamps 00:00 Disclosures 00:35 Intro 01:19 Guest bios both real and sarcastic 04:38 Getting to know our guests 06:33 Multiple choice toxicology 09:13 Book recommendations 11:30 Advice for learners and teachers 15:48 Clinical case from Kashlak Memorial Hospital 16:27 Initial approach and some thoughts on toxidromes 21:59 Physical exam, a toxicologist’s approach 27:09 Review of physiology: anticholinergic, cholinergic, sympathomimetic and how to recognize these findings on exam 34:18 Different speech patterns seen in toxicology 35:30 History taking and how much detective work is truly necessary 40:05 The approach to overdose on multiple substances or in setting of polypharmacy 45:52 Seinfeld, ipecac, and the controversy about gastrointestinal decontamination 63:10 Antidotes and when to give them 67:15 EKGs and overdose. Antidote for long QTc versus wide QRS 71:25 Tramadol and Egypt 73:45 Bupropion and bath salts 78:00 Outro Tags: antimuscarinic, anticholinergic, cholinergic, sympathomimetic, overdose, tramadol, bupropion, quetiapine, wellbutrin, seroquel, pupil, overdose, naloxone, narcar, toxicology, tox, toxidrome, poisoning, gi, decontamination, charcoal, ipecac, antidote, dantastic, howard, ekg, qrs, qtc, bicarbonate, assistant, care, doctor, education, family, foam, foamed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student
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