Knowledgeable Provider

Recent medical news followed by a review of pathophysiology, clinical manifestations, diagnosis, and treatment of myasthenia gravis.News Articles:New federal vaccine schedule (KFF): https://www.kff.org/other-health/the-new-federal-vaccine-schedule-what-changed/HRT black box warning removal (FDA): https://www.fda.gov/news-events/press-announcements/hhs-advances-womens-health-removes-misleading-fda-warnings-hormone-replacement-therapyMore information about HRT warning label removal (Harvard Health): https://www.health.harvard.edu/womens-health/fda-removes-menopause-hormone-therapy-black-box-warningsHouse votes to extend ACA subsidies (PBS): https://www.pbs.org/newshour/politics/in-a-rebuke-of-gop-leadership-house-heads-toward-vote-to-extend-health-care-subsidiesReferences:Bird, S. J. Pathogenesis of myasthenia gravis. UpToDate. https://www.uptodate.com/contents/pathogenesis-of-myasthenia-gravisBird, S. J. Clinical manifestations of myasthenia gravis. UpToDate. https://www.uptodate.com/contents/clinical-manifestations-of-myasthenia-gravisBird, S. J. Diagnosis of myasthenia gravis. UpToDate. https://www.uptodate.com/contents/diagnosis-of-myasthenia-gravisBird, S. J. Overview of the treatment of myasthenia gravis. UpToDate. https://www.uptodate.com/contents/overview-of-the-treatment-of-myasthenia-gravis

Jody discusses ACA subsidies - what they are and why it matters that some of them are going away.Resources:1) Article on the Impact of Enhanced Subsidies Expiring (KFF)2) News Article on the Republican Healthcare Plan (Reuters)3) Interview About Subsidies Expiring (PBS)4) Federal Poverty Level (healthcare.gov)5) Reasons to Not Extend Enhanced Subsidies (CATO Institute)

Jody reviews LEGITIMATE information about hepatitis B vaccines in the wake of ACIP's recent recommendation to consider delaying vaccination for infants of non-infected mothers.References & Links:1) General Information on Hepatitis B Vaccines (OpenEvidence)2) ACIP Press Release3) Fact Check of the ACIP Press Release (PBS)4) Impact of Hepatitis B Vaccines in the United States (CDC, pre-RFK)5) Scientology Network Prescription for Violence (likely fake news)

Jody reviews pathophysiology, diagnosis, management, and prevention of kidney stones.References & Links:1) Curhan, G. C. Kidney stones in adults: Prevention of recurrent kidney stones. UpToDate. https://www.uptodate.com/contents/ kidney-stones-in-adults-prevention-of-recurrent-kidney-stones2) Curan, G.C., Aronson, M.D., & Preminger, G.M. Kidney stones in adults: Diagnosis and acute management of suspected nephrolithiasis. UpToDate. https://www.uptodate.com/contents/kidney-stones-in-adults-diagnosis-and-acute-management-of-suspected-nephrolithiasis3) Preminger, G.M., & Curhan, G.C. Kidney stones in adults: Evaluation of the patient with established stone disease. UpToDate. https://www.uptodate.com/contents/kidney-stones-in-adults-evaluation-of-the-patient-with-established-stone-disease4) CDC Revives Debunked "Link" Between Childhood Vaccines and Autism (NPR)5) Autism and Vaccines (CDC...FAKE NEWS!)

A novel non-opiate medication option for control of acute pain.References:1) OpenEvidence Information on Journavx2) FDA Information on Journavx3) GLP-1 Price Reduction Article (CNBC)4) Vanderbilt LifeFlight Crash (WBRC)

Jody discusses insomnia and how to treat it from a primary care perspective.Links & References:1) FDA Info on Flu Vaccines2) ACOG Position on Tylenol3) AAP Position on Tylenol4) Texas vs Tylenol Lawsuit5) History of Government Shutdowns (USA Today)6) CBT-I Coach App7) Zammit GK. Ramelteon: a novel hypnotic indicated for the treatment of insomnia. Psychiatry (Edgmont). 2007 Sep;4(9):36-42. PMID: 20532119; PMCID: PMC2880941.8) Bennett T, Bray D, Neville MW. Suvorexant, a dual orexin receptor antagonist for the management of insomnia. P T. 2014 Apr;39(4):264-6. PMID: 24757363; PMCID: PMC3989084.9) Episode-Specific Reference Material (OpenEvidence)

(Doctor) Dale Hutchens is a recent cochlear implant recipient. He and Jody discuss his experience with hearing loss, receiving the implant, and brain training. Stick around for a special performance by Dale at the end of the episode!Links:1) Dale's Performance Video2) Sample Distortion Video 13) Sample Distortion Video 24) Sample Distortion Video 35) Sample Distortion Video 46) Sample Distortion Video 57) Alvin & The Chipmunks Theme8) R2D2 Sounds9) Mr. Roboto by Styx

Updates on current medical news, Jody's Epocrates exodus, and a review of hepatitis B pathophysiology, diagnosis, and treatment.References:Lok. A. S. F. Hepatitis B virus: Screening and diagnosis in adults. UpToDate. https://www.uptodate.com/contents/hepatitis-b-virus-screening-and-diagnosis-in-adultsLok. A. S. F., Hepatitis B virus: Overview of management. UpToDate. https://www.uptodate.com/contents/hepatitis-b-virus-overview-of-managementCDC ACIP Presentation: https://www.cdc.gov/acip/downloads/slides-2025-09-18-19/03-su-mmrv-508.pdfACIP Recommendation Statement: https://www.hhs.gov/press-room/acip-recommends-chickenpox-vaccine-for-toddlers.htmlTang LSY, Covert E, Wilson E, Kottilil S. Chronic Hepatitis B Infection: A Review. JAMA. 2018;319(17):1802–1813. doi:10.1001/jama.2018.3795. https://jamanetwork.com/journals/jama/fullarticle/2679946OpenEvidence Conversation: https://www.openevidence.com/ask/4dde6fd5-1bca-4a86-a6f3-3a335f0334a1AAP Recommended Vaccine Schedule for Children & Adolescents: https://publications.aap.org/redbook/resources/15585/AAP-Immunization-ScheduleVaccine History (Hep B Foundation): https://www.hepb.org/prevention-and-diagnosis/vaccination/history-of-hepatitis-b-vaccine/Vaccine History (CDC): https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5125a3.htm

Jody reviews recent developments in the US healthcare dystopia, then discusses pathophysiology, diagnosis, and treatment of gout.References:1) Merriman, T. Gout: Pathophysiology. UpToDate. https://www.uptodate.com/contents/gout-pathophysiology2) Gaffo, A. L. Gout: Clinical Manifestations and diagnosis. UpToDate. https://www.uptodate.com/contents/gout-clinical-manifestations-and-diagnosis3) Gaffo, A. L. Gout: Treatment of Flares. UpToDate. https://www.uptodate.com/contents/gout-treatment-of-flares4) Perez-Ruiz, F. Gout: Pharmacologic urate-lowering therapy and treatment of tophi. UpToDate. https://www.uptodate.com/contents/gout-pharmacologic-urate-lowering-therapy-and-treatment-of-tophi5) Neogi, T. Gout: Nonpharmacologic strategies for prevention and treatment. UpToDate. https://www.uptodate.com/contents/gout-nonpharmacologic-strategies-for-prevention-and-treatment6) https://www.science.org/content/article/attempt-oust-cdc-director-sparks-key-resignations-agency-officials7) The CDC's Vaccine Chief on Why Quitting Was His Only Option (The Daily via Spotify)Music:https://youtu.be/8GliyDgAGQI?si=F8NBaxJeaezO9V2Y

In a spin-off of last week's episode, Jody discusses making life and death decisions as a healthcare professional.

Lieutenant Colonel Rick Caniglia, U.S. Army, Retired, shares medical stories from his long military career.

Links:ACIP WebsiteHHS Statement on ACIP ReconstitutionRestoring Gold Standard Science Executive OrderExperts Sound Alarm After ACIP Members Removed (NFID)NPR Article on New ACIP Members

F is for Fournier! Jody reviews pathophysiology, diagnosis, and treatment of this (thankfully) uncommon condition.References:1) Stevens, D.L., & Baddour, L.M. Necrotizing soft tissue infections. UpToDate. https://www.uptodate.com/contents/ necrotizing-soft-tissue-infections2) Bersoff-Matcha SJ, Chamberlain C, Cao C, Kortepeter C, Chong WH. Fournier Gangrene Associated With Sodium-Glucose Cotransporter-2 Inhibitors: A Review of Spontaneous Postmarketing Cases. Ann Intern Med. 2019 Jun 4;170(11):764-769. doi: 10.7326/M19-0085. Epub 2019 May 7. PMID: 31060053.3) Jean Alfred Fournier. Wikipedia. https://en.wikipedia.org/ wiki/Jean_Alfred_Fournier

Jody reviews pathophysiology, assessment, and treatment of erectile dysfunction.References:1) Raymond, R.C., & Khera, M. Epidemiology and etiologies of male sexual dysfunction. UpToDate. https://www.uptodate.com/contents/epidemiology-and-etiologies-of-male-sexual-dysfunction2) Khera, M. Evaluation of male sexual dysfunction. UpToDate. https://www.uptodate.com/contents/evaluation-of-male-sexual-dysfunction3) Khera, M. Treatment of male sexual dysfunction. UpToDate. https://www.uptodate.com/contents/treatment-of-male-sexual-dysfunction

Jody went to a conference! Here's what he learned...

Jody's CHD lecture for nursing students.Case study links:Case Study 1Case Study 2Case Study 3

Jody responds to the American College of Physicians' Annals On Call Podcast episode released on May 19th, 2025.Links:Advanced Practice Clinicians Cannot Replace Primary Care Physicians. Annals On Call Podcast, 5-29-25Physician Assistant and Former PA-Turned-Physician Discuss the State of the Profession. Patients At Risk Podcast, 7-25-21 (Spotify)New Workforce Model Suggests Continued Physician Shortages In Nonprimary Care Specialties (AAMC Article)Christin Giordano McAuliffe. There Is No Substitute for Primary Care Physicians: A Response to the Association of American Medical Colleges’ Workforce Model. Ann Intern Med.2025;178:590-591. [Epub 4 March 2025]. doi:10.7326/ANNALS-24-03806University of South Alabama Dual Role NP CurriculumRazavi, Moaven PhD*; O’Reilly-Jacob, Monica RN, PhD, FNP-BC†; Perloff, Jennifer PhD*; Buerhaus, Peter RN, PhD, FAAN, FAANP(h)‡. Drivers of Cost Differences Between Nurse Practitioner and Physician Attributed Medicare Beneficiaries. Medical Care 59(2):p 177-184, February 2021. | DOI: 10.1097/MLR.0000000000001477 McMenamin A, Turi E, Schlak A, Poghosyan L. A Systematic Review of Outcomes Related to Nurse Practitioner-Delivered Primary Care for Multiple Chronic Conditions. Medical Care Research and Review. 2023;80(6):563-581. doi:10.1177/10775587231186720Kippenbrock T, Emory J, Lee P, Odell E, Buron B, Morrison B. A national survey of nurse practitioners' patient satisfaction outcomes. Nurs Outlook. 2019 Nov-Dec;67(6):707-712. doi: 10.1016/j.outlook.2019.04.010. Epub 2019 May 4. PMID: 31607371.Haas, D., Pozehl, B., Alonso, W. W., & Diederich, T. (2023). Patient Satisfaction With a Nurse Practitioner–Led Heart Failure Clinic. Journal for Nurse Practitioners, 19(4), Article 104496. https://doi.org/10.1016/j.nurpra.2022.11.006https://www.techtarget.com/patientengagement/news/366584669/Nurse-Practitioners-Boost-Patient-Satisfaction-Quality-Outcomeshttps://www.aanp.org/advocacy/advocacy-resource/position-statements/quality-of-nurse-practitioner-practicehttps://www.aacnnursing.org/news-data/all-news/rounds-with-leadership-focusing-on-the-outcomes-of-np-practiceStanik-Hutt, J., Newhouse, R. P., White, K. M., Johantgen, M., Bass, E. B., Zangaro, G., Wilson, R., Fountain, L., Steinwachs, D. M., Heindel, L., & Weiner, J. P. (2013). The quality and effectiveness of care provided by nurse practitioners. Journal for Nurse Practitioners, 9(8), 492-500.e13. https://doi.org/10.1016/j.nurpra.2013.07.004Savard I, Al Hakim G, Kilpatrick K. The added value of the nurse practitioner: An evolutionary concept analysis. Nurs Open. 2023 Apr;10(4):2540-2551. doi: 10.1002/nop2.1512. Epub 2022 Dec 17. PMID: 36527435; PMCID: PMC10006655.

D is for deprescribing! Jody wrestles with this very complicated and grey area of medical practice.Resources:Beers Criteria (AGS)STOPP/START CriteriaDeprescribing.orgMedStopperNO TEARSNICE Medicines Optimization GuidelinesEMPOWER BrochuresThe list of deprescribing resources was generated by ChatGPT.

Jody is joined by one of the world's foremost AI experts, ChatGPT itself, to discuss how AI is impacting healthcare currently and how it might change the medical field in the future.

C is for constipation! Jody discuss pathogenesis, diagnosis, and treatment of this surprisingly common problem.References:American College of Gastroenterology GuidelinesRome FoundationChronic Constipation in Adults: Management (UpToDate)NIDDK on ConstipationMayo Clinic Constipation ArticleMerck Manual Constipation ArticleDiagnosis & Management of Constipation (AAFP)The outline for this episode was created in part by chatGPT.