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The Curbsiders Internal Medicine Podcast
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The Curbsiders Internal Medicine Podcast

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

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Supercharge your learning and enhance your practice with this Internal Medicine Podcast featuring board certified Internists as they interview the experts to bring you clinical pearls, practice changing knowledge and bad puns. Doctors Matthew Watto, Stuart Brigham, Paul Williams and friends (a national network of students, residents and clinician educators) deliver a little knowledge food for your brain hole. Yummy! No boring lectures here, just high value content and a healthy dose of humor. Fantastic for Internal Medicine, Family Medicine, Primary Care, and Hospital Medicine.
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Blazing hot tips to diagnose and treat hyperthyroidism with Dr Eve Bloomgarden, @evebmd (Northwestern). We cover a ton of ground including how to: interpret thyroid function tests, use your thumbs (or an ultrasound) to examine the thyroid, become an expert on Graves’ orbitopathy, prescribe methimazole and decide who needs surgery or radioactive iodine therapy. Plus, a bit on subclinical hyperthyroidism. This episode is on fire! Listeners can claim Free CE credit through VCU Health at curbsiders.vcuhealth.org (CME goes live at 0900 ET on the episode’s release date).  Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME!   Credits   Written and Produced by: Tima Karginov and Matthew Watto MD, FACP Cover Art: Kate Grant MBChb, MRCGP Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP    Editor: Matthew Watto MD, FACP (written materials); Clair Morgan of nodderly.com Guest: Eve Bloomgarden MD   Sponsors   Pediatrics On Call podcast by the American Academy of Pediatrics If you provide medical care to children, Pediatrics On Call — the new podcast from the American Academy of Pediatrics — will help you do it better. Each week, hear the latest news and research on children's health, on topics from obesity and mental health to keeping the kiddos safe when they’re stuck at home. Subscribe from your favorite podcast provider or find the latest episodes here. VCU Health CE The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit. Note: A free VCU Health CloudCME account is required in order to seek credit.   Time Stamps 00:00 Sponsors - VCU Health Continuing Education and the AAP’s Pediatrics On Call podcast
 00:30 Intro, disclaimer, guest bio 03:15 Guest one-liner, favorite failure, Picks of the Week*: After the Fall (How Humpty Dumpty Got Back Up Again) (children’s book), Circe (book), IMPACT https://www.impact4hc.com/ (Non-profit) 08:50 Sponsor - the AAP’s Pediatrics On Call podcast
 10:37 Background, Definition of Hyperthyroidism, thyrotoxicosis; Basic labs 14:20  Case from Kashlak, Symptoms of Hyperthyroidism 25:00 Grave’s eye disease: exam, therapy and counseling 32:35 Thyroid exam and ultrasound 38:55 Thyroid Stimulating Immunoglobulin 41:00 Biotin 44:30 Thyroid Scintigraphy 49:00 Causes of Thyrotoxicosis 52:00 Treatment & Adherence to antithyroid medication (methimazole) 56:20 Beta Blockers in thyrotoxicosis 64:50 Subclinical Hyperthyroidism 67:00 Take Home Points, Outro Sponsor - VCU Health Continuing Education   Links* After the Fall (How Humpty Dumpty Got Back Up Again (Children’s book) Circe (book) Impact4hc.com Dr Bloomgarden and friends started this non-profit to address the infodemic during COVID19    *The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on our Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra.   Goal Listeners will develop an approach to the diagnosis and management of hyperthyroidism and thyrotoxicosis.   Learning objectives After listening to this episode listeners will…   Recognize the signs and symptoms of thyrotoxicosis Perform the appropriate diagnostic evaluation to differentiate between the various causes of thyrotoxicosis Counsel and treat patients with thyrotoxicosis Develop an approach to subclinical hyperthyroidism   Disclosures Dr Bloomgarden reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.    Citation Bloomgarden E, Karginov T, Williams PN, Watto MF. “#228 Thyroid on Fire: Hyperthyroidism with Dr Eve Bloomgarden”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list Final publishing date August 3, 2020.  
The American Academy of Pediatrics (AAP) recommends that schools strive to reopen in the Fall, but there is hesitation from families and teachers alike. The Cribsiders speak with Dr. Sharfstein, a public health expert and pediatrician, regarding the importance of reopening schools for children, what criteria need to be met prior to opening, and how to keep children and teachers safe. Tune in to learn transmission amongst children, how other countries have reopened, why to cohort children, and how the primary care pediatrician can assist in the coming school year!   Credits Producers & Writers: Edward Corty, Nicholas Lee MD Infographic: Nicholas Lee MD Cover Art: Chris Chiu MD Hosts: Justin Berk MD, Chris Chiu MD, Edward Corty Editor:Justin Berk MD; Chris Chiu MD  Guest(s): Joshua Sharfstein MD   Sponsors Pediatrics On Call podcast by the American Academy of Pediatrics If you provide medical care to children, Pediatrics On Call — the new podcast from the American Academy of Pediatrics — will help you do it better. Each week, hear the latest news and research on children's health, on topics from obesity and mental health to keeping the kiddos safe when they’re stuck at home. Subscribe from your favorite podcast provider or find the latest episodes here.   VCU Health CE We are excited to announce that the Curbsiders are now partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Check out curbsiders.vcuhealth.org or cribsiders.vcuhealth.org!   Time Stamps Introduction 1:00 How to answer “What do you think about school openings?” 11:30 Risk Assessment of School Re-openings 14:40 Evidence of Transmission among Children 17:10 What Other Countries Have Done 19:40 Community Threshold for Re-Opening and Using Protocols 20:30 The Reasons to Cohort 22:45 How to Address Scenarios 24:20 Health Disparities and Return to School 27:00 Existing Inequities and Children’s Sacrifice of Education 29:00 “Opting Out” of School Return and Feeling Safe 31:30 How Can Governments Help Support the Return 35:50 Guidance to give as PCP 37:50 School Alternatives / Innovations to Going Back 40:10 The Difference Between Equity and Equality 42:50 Testing in Schools 43:45 Resources to Follow For More Information 46:00 Take-Away Points 47:10 Optimism 48:25 Picks of the Week 53:50   Resources AAP COVID-19 Planning Considerations: Guidance for School Re-entry Johns Hopkins school reopening tracker   Goal Listeners will explain the risks and benefits to school reopening during the COVID-19 pandemic. In addition, they will understand the most important steps to reopening being safe and what physicians can do to aid in school reopening.    Learning objectives After listening to this episode listeners will…   Recall the benefits of reopening schools. Be familiar with the risks of reopening and how to mitigate them. Recognize what students may be at increased risk of suffering if schools do not reopen and how to advocate for them in the future. Identify how pediatricians can help school systems remain functional during the COVID-19 pandemic.   Disclosures Dr Sharfstein reports no relevant financial disclosures. The Cribsiders report no relevant financial disclosures.
#227 Baffled by NAFLD?

#227 Baffled by NAFLD?

2020-07-2701:16:27

Swim through the sea of acronyms as Dr Scott Matherly (@liverprof) helps us become a little less baffled by the thought of NAFLD. We discuss the initial diagnosis of fatty liver disease, indications for additional evaluation with imaging and/or biopsy, and potential treatment options. With a quarter of the world affected, it’s crucial to understand the various forms of disease and how to counsel patients about this all-too-common condition!   Listeners can claim Free CE credit through VCU Health at http://curbsiders.vcuhealth.org/ (CME goes live at 0900 ET on the episode’s release date).    Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME!   Credits Written and Produced by: Elena Gibson MD Infographic and Cover Art: Elena Gibson MD Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP   Editor: Emi Okamoto MD (written materials); Clair Morgan of nodderly.com Guest: Scott Matherly MD   Sponsors Pediatrics On Call podcast by the American Academy of Pediatrics If you provide medical care to children, Pediatrics On Call — the new podcast from the American Academy of Pediatrics — will help you do it better. Each week, hear the latest news and research on children's health, on topics from obesity and mental health to keeping the kiddos safe when they’re stuck at home. Subscribe from your favorite podcast provider or find the latest episodes here. VCU Health CE We are excited to announce that the Curbsiders are now partnering with VCU Health Continuing Education to offer continuing education credits for physicians and other healthcare professionals. Check out curbsiders.vcuhealth.org and create your FREE account!   Time Stamps 00:00 Sponsors - VCU Health Continuing Education and the AAP’s Pediatrics On Call podcast
 00:30 Intro, disclaimer, guest bio
 03:15 Guest one-liner; Picks of the Week*
:  08:15 Sponsor - the AAP’s Pediatrics On Call podcast
 08:50 Case from Kashlak part 1; What is hepatic steatosis?
 11:43 NAFLD acronyms and definitions
 18:20 Alcohol and Fatty Liver
 23:15 Initial Evaluation of NAFLD
 35:12 Dr Matherly’s piel to patients with fatty 41:11 NASH/Fibrosis Risk Assessment
 48:54 Outcomes in NASH with Fibrosis 51:20 Statins are safe in liver disease 56:15 Treatment Options (surgery, Vitamin E, Pioglitazone, SLGT2 inhibitors and GLP1 agonists; Coffee?!) 
 71:42 Take home points and Outro   Links* Episode 100: Cirrhosis Initial Evaluation and Management  Episode 101: Cirrhosis Medications, Decompensation, Complications  The Last of Us Part II Not a Diet Book by James Smith Fooled by Randomness by Nassim Nicholas Taleb Beirut Band - Gallipoli and The Flying Club Cup Beat Saber *The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on our Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra.   Goal Listeners will develop an approach to the basic evaluation and initial management of NAFLD.    Learning objectives After listening to this episode listeners will…   Recognize the different etiologies of hepatic steatosis  Define terms:  non-alcoholic fatty liver disease (NAFLD), non-alcoholic fatty liver (NAFL) non-alcoholic steatohepatitis (NASH), alcoholic steatosis, cryptogenic cirrhosis   Define the risk factors associated with NAFLD  Develop an approach to the initial evaluation and management of NAFLD and NASH  Recognize the value of weight loss in the management of NAFLD Determine when and how to monitor patients for progression of NAFLD  Identify pharmacologic treatment options for patients with NASH and recognize when and how to use them.  Describe the outcomes of concern associated with NAFLD and NASH.  Disclosures Dr Matherly reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.    Citation Matherly S, Gibson EG, Williams PN, Okamoto E, Watto MF. “#227 Baffled by NAFLD”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list . Original air date July 27, 2020.
Get a grip on acute kidney injury (AKI) with Dr. Joel Topf (AKA @kidney_boy), Kashlak’s Chief of Nephrology! We’ve put together an AKI highlight reel - focusing on practical tips and tricks to help you identify, diagnose and manage AKI, plus how to recognize AIN and random myths and musings on vancomycin, NSAIDS, contrast nephropathy, and the risk of NSF from gadolinium.   Listeners can claim Free CE credit through VCU Health at http://curbsiders.vcuhealth.org/ (CME goes live at 0900 ET on the episode’s release date).    Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME!   Credits Written (including CME questions) and Produced by: Cyrus Askin, MD Infographic by: Cyrus Askin, MD Cover Art: Kate Grant MBChb, MRCGP Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP    Editor: Matthew Watto MD, FACP (written materials); Clair Morgan of nodderly.com Guest: Joel Topf, MD   Sponsors Pediatrics On Call podcast by the American Academy of Pediatrics If you provide medical care to children, Pediatrics On Call — the new podcast from the American Academy of Pediatrics — will help you do it better. Each week, hear the latest news and research on children's health, on topics from obesity and mental health to keeping the kiddos safe when they’re stuck at home. Subscribe from your favorite podcast provider or find the latest episodes here.   VCU Health CE We are excited to announce that the Curbsiders are now partnering with VCU Health Continuing Education to offer continuing education credits for physicians and other healthcare professionals. Check out curbsiders.vcuhealth.org and create your FREE account!   Time Stamps 00:00 Sponsors - VCU Health CE and Pediatrics On Call podcast by APP 00:30 Intro, disclaimer, guest bio 03:00 Guest one-liner, Picks of the Week*: Zoe Keating albums (Cellist); Mrs. America (TV series) on FX; The Last of Us (Videogame); 08:45 Sponsor - Pediatrics On Call podcast by APP 09:15 Definition of acute kidney injury (AKI) and fundamentals 11:00 Cardiorenal syndrome 12:24 Schema for AKI 17:30 Establish an etiology, determine urine output and address electrolyte abnormalities 21:22 AKI in the otherwise-healthy patient; 32:20 Rhabdomyolysis
38:21 Vancomycin 41:43 Acute interstitial nephritis (AIN) 44:52 Contrast induced nephropathy (CIN) 50:37 Gadolinium in AKI and/or CKD 52:53 Timing of dialysis 
 56:37 AKI in the out-patient setting and how to handle home meds e.g. TMP-SMX, RAAS inhibitors; 62:01 Is Ultrasound necessary in AKI
 64:58 Dr. Topf’s take home points and Plug for Seminars in Nephrology 68:45 Outro and Sponsor - VCU Health CE   Links* Dr. Topf: Nephrology & Social Media - May 2020, Vol 50, Issue 3, p 247-328 of Seminars in Nephrology Dr. Topf: Zoe Keating - cellist & composer Dr. Topf: Mrs. America a miniseries which dramatizes the women’s movement and fight for and against the Equal Rights Amendment in the 1970s Dr. Williams: Last of Us 2   *The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on our Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra.   Goal Listeners will develop a rational approach to the diagnosis and management of the patient with acute kidney injury (AKI).   Learning objectives After listening to this episode listeners will…   … be facile with the definition of AKI … have a framework for approaching AKI including an understanding of what features in a patient’s history may shed light on the diagnosis … appreciate prerenal azotemia and the relationship with ATN … develop an approach to rhabdomyolysis and AKI … be able to discuss the various types of AKI likely to be seen in the critically ill patient ... recognize the paradigm shift related to the safety when using iodinated contrast and gadolinium with regards to renal function … know common medications implicated in AKI … appreciate common AKI-related issues in the outpatient setting and have a head-start on how best to deal with them   Disclosures Dr. Topf has received honoraria from AstraZeneca and Cara Therapeutics. He is joint venture partner in Davita Dialysis centers receiving dividends. The Curbsiders report no relevant financial disclosures.    Citation Topf J, Askin CA, Williams PN,  Watto MF. “#226 Kidney Boy on Acute Kidney Injury: Myths & Musings”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. Original Air Date: July 20th, 2020.
Listen as our expert guests, Kelly Graham, MD, MPH (@KellyGrahamMD) and Lekshmi Santhosh, MD MAEd (@LekshmiMD), detail the professional and personal challenges faced by women in medicine during the COVID-19 pandemic.   Listeners can claim Free CE credit through VCU Health at http://curbsiders.vcuhealth.org/ (CME goes live at 0900 ET on the episode’s release date).    Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME!   Credits Produced by: Leah Witt MD & Shreya Trivedi MD  Written by: Molly Heublein MD, Isabel Valdez PA-C, Leah Witt MD & Shreya Trivedi MD Infographic & Cover Art: Edison Jyang Hosts: Leah Witt MD & Shreya Trivedi MD, Justin Berk MD, MPH, MBA Editor: Molly Heublein MD and Matthew Watto MD (written materials); Clair Morgan of nodderly.com Guests: Kelly Graham, MD, MPH; Lekshmi Santhosh, MD MAEd    Sponsor VCU Health CE We are excited to announce that the Curbsiders are now partnering with VCU Health Continuing Education to offer continuing education credits for physicians and other healthcare professionals. Check out curbsiders.vcuhealth.org and create your FREE account!   Time Stamps 0:00 Intro, disclaimer 2:04 Introduction and bio for Kelly Graham, MD, MPH 2:30 Introduction and bio for Lekshmi Santhosh, MD MAEd 3:54 One-liner for Kelly Graham, MD, MPH 4:41 One-liner for Lekshmi Santhosh, MD MAEd 5:12 Gender Awakening Moments 10:08 Advice to their younger selves 13:15 Picks of the Week* 18:02 Case from Kashlak: Dr. Blackwell 20:10 Difficulty with lack of childcare while working 22:52 Hippocratic Oath paradox 26:02 Physician, educator, researcher, household manager & zoom homeschool teacher 27:14 Dr. Santhosh’s 3 Ps 28:08 Motherhood penalty-fatherhood bonus 32:00 Emotional Labor 35:10 Two Pandemics, One Response  36:25 Breadwinner-homemaker bias 39:34 Impact of pandemic on women physician productivity 39:58 Female physician burnout 41:38 Minority Tax 48:03 Silver Linings 55:35 Suggestions for addressing pandemic-related inequity 67:10 COVID contributions on CV 68:50 Take home points and Outro   Links* Dr. Santhosh’s recently published McSweeney’s piece: ““THANKS FOR ASSUMING I’M NOT THE FACULTY AND THAT MY FACULTY IS MALE”: TEXTS FROM FOUR WOMEN ICU PHYSICIANS ACROSS THE COUNTRY CARING FOR COVID PATIENTS” Leah’s pick of the week: Paint by Sticker book  Shreya’s pick of the week: Dr Giselle Corbie-Smith A Different Kind of Leader  Justin’s pick of the week: 13th movie Kelly’s pick of the week: Piece by Dr Kimberly Manning, When Grief and Crises Intersect: Perspectives of a Black Physician in the Time of Two Pandemics.  Conan O’Brien Needs a Friend podcast. Lekshmi’s pick of the week: The Nocturnists podcast and Smitten ice cream delivery   *The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on our Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra.   Goal Discuss how the new challenges of COVID and working from home mean that women are often doing extra double duty            Learning objectives After listening to this episode listeners will... Discuss the impact of COVID on the workload and productivity of women in medicine Anticipate the long-term implications that this pandemic will have on gender inequity Recognize areas where medicine may improve to promote gender equity when the second wave hits    Disclosures Kelly Graham, MD, MPH and Lekshmi Santhosh, MD MAEd report no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.    Citation Graham K, Santhosh L, Trivedi S, Berk J, Witt L, Valdez I, Heublein M, Watto MF. “#225 Women in Medicine: COVID Edition”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. Original air date: July 16, 2020.
Jump into an episode dedicated to hospital based addiction medicine, as we cover common scenarios hospitalists encounter.  In this episode we talk to Dr. Melissa Weimer @DrMelissaWeimer (Yale) about inpatient management of patients with substance use disorders. Dr. Weimer is board certified in Internal Medicine and Addiction Medicine. She is the Medical Director of the Yale Addiction Medicine Consult Service and is a passionate clinician educator. We discuss a wide range of topics this episode including the management of polysubstance withdrawal,  approaching acute pain management for a person with opioid use disorder, and inpatient harm reduction strategies. After this episode listeners will gain new tools to help them best care for hospitalized patients with substance use disorders.   Listeners can claim Free CE credit through VCU Health at curbsiders.vcuhealth.org (CME goes live at 0900 ET on the episode’s release date).    Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | CME!   Credits Writers and Producers: Carolyn Chan MD, Deb Gorth, and Nora Taranto MD Cover Art and Infographics by: Carolyn Chan, MD Hosts: Stuart Brigham MD; Paul Williams MD, FACP; Carolyn Chan MD    Editor: Emi Okamoto MD (written materials); Clair Morgan of nodderly.com Guest: Dr. Melissa Weimer   Sponsor VCU Health CE We are excited to announce that the Curbsiders are now partnering with VCU Health Continuing Education to offer continuing education credits for physicians and other healthcare professionals. Check out curbsiders.vcuhealth.org and create your FREE account!   Time Stamps Intro, disclaimer, guest bio : 00:00 Guest one-liner:    03:00 Picks of the Week*:   08:20  Case from Kashlak:  10:30 Urine Toxicology Screens 11:30 Discussing Urine Toxicology Screens with Patients  13:20 Management of Polysubstance Withdrawal 16:16 Tapering Benzodiazepines   19:56 Acute Pain Management and Opioid Use Disorder 30:35 Active Drug Use in the Hospital 38:52 Harm Reduction 40:00 Discharges - Planned 43:43 Perioperative Buprenorphine and Methadone: 46:50 QT Prolongation and Methadone - 52:53 Outro 56:21   Goal Listeners will discuss management of common inpatient addiction medicine scenarios.    Learning objectives After listening to this episode listeners will…   Describe clinical indications for inpatient urine drug testing.  Describe treatment management of polysubstance withdrawal.  Discuss taper strategies for patients with benzodiazepine use disorders. Discuss an approach to pain management in hospitalized patients with opioid use disorder.  Integrate harm reduction principles into individual patient care plans.  Manage treatment methadone in patients with prolonged QT in the hospital setting.   Disclosures Dr Melissa Weimer reports working with Path, an addiction medicine treatment company. No trade names were used and that a balance range of therapeutic options were included in the discussion. The Curbsiders report no relevant financial disclosures.    Citation Weimer MB, Chan CA, Taranto NT, Gorth DJ, Williams PN, Brigham SK, Okamoto E, Watto MF. “#224 Hospital Addiction Medicine”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list Original Air Date July 6, 2020.
This episode is Half COVID Cakes, Half Hotcakes, and entirely enlightening.  Our guest Dr. Utibe Essien MD, MPH @UREssien and Curbsider/epidemiologist, Dr. Rahul Ganatra MD, MPH @rbganatra discuss some Hot COVID Cakes including: racial differences in COVID-19 outcomes, why dogs and dexamethasone may hold the key to defeating COVID-19, how hormonal adjunctive therapies might be key for depression, and when to poo-poo probiotics versus when a side of Lactobacillus may be beneficial.    Listeners can claim Free CE credit through VCU Health at curbsiders.vcuhealth.org (CME goes live at 0900 ET on the episode’s release date).    Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | CME!   Credits Written and Produced by: Rahul Ganatra MD, MPH, Emi Okamoto MD; Sarah P. Roberts MPH; and Matthew Watto MD Show Notes and CME questions by: Deborah J. Gorth ScM Cover Art: Deborah J. Gorth ScM Hosts: Matthew Watto MD; Rahul Ganatra MD, MPH, Emi Okamoto MD, and Sarah P. Roberts MPH Editor: Matthew Watto MD (written materials); Clair Morgan of nodderly.com Guest: Utibe Essien MD, MPH   Sponsor VCU Health CE We are excited to announce that the Curbsiders are now partnering with VCU Health Continuing Education to offer continuing education credits for physicians and other healthcare professionals. Check out curbsiders.vcuhealth.org and create your FREE account!   Time Stamps 00:00 Intro, disclaimer, guest bio 02:20 Silver Linings / Picks of the Week: Chicken Run (2000) and Chicken Run 2 on Hulu; Philly Inquirer story on COVID sniffing dogs; Buy some peaches! And check out their Wikipedia page! 07:33 Hospitalizations and Mortality Among Black and White patients with COVID-19 26:10 Dexamethasone for COVID-19 28:55 Hormonal therapy for depression 38:16 Probiotics 45:00 Outro   Goal Listeners will learn about the role of race in COVID-19 outcomes, possible hormonal adjunctive therapies for depression, and when to recommend probiotics.  Learning objectives After listening to this episode listeners will…   Learn the effect of race on COVID-19 outcomes. Know the indications for adjunctive hormonal treatment for depression. Discuss the role of probiotics for the treatment of common gastrointestinal illness.    Disclosures Dr. Utibe Essien reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.    Citation Essien UR, Ganatra RB, Okamoto E, Roberts SP, Gorth DJ, Watto MF. “#223 Hot COVID Cakes: COVID19 Disparities, Steroids, Hormones for Depression, Probiotics”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. Original air date July 2, 2020.
Listen as our esteemed guest Dr. Utibe Essien MD, MPH @UREssien walks us through key terminology and evidence necessary to understand anti-Black racism in medicine. Dr. Essien provides insights into ways that racism impacts our work in the clinical and academic settings and offers approaches for addressing anti-Black racism in these settings.    Listeners can claim Free CE credit through VCU Health at http://curbsiders.vcuhealth.org/ (CME goes live at 0900 ET on the episode’s release date).  Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | CME!   Credits Producer and Writer: Joniqua Ceasar MD, Hannah Abrams MD Cover Art: Hannah Abrams MD Infographic: Beth Garbitelli Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP; Joniqua Ceasar MD    Editor: Paul Williams MD, Chris Chiu MD (written materials); Clair Morgan of nodderly.com Guest: Utibe Essien MD, MPH   Sponsor We are excited to announce that the Curbsiders are now partnering with VCU Health Continuing Education to offer continuing education credits for physicians and other healthcare professionals. Check out curbsiders.vcuhealth.org and create your FREE account!   Time Stamps 00:00 Intro, disclaimer, guest bio
 02:40 Guest one-liner, Picks of the Week*: Just Mercy
 09:20 Statement from the show; Importance of discussing racism in medicine
 14:11 Definitions
 18:06 Identifying how racism manifests in the clinical setting
 37:46 Ideas for advocacy
 49:50 Take points 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 our Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra.   Goal Listeners will understand the way that structural racism pervades medicine and develop approaches for addressing the effects of racism within their clinics and communities.   Learning objectives After listening to this episode listeners will…   Define common terms: race, structural racism, white supremacy, health disparities  Develop an approach to talking to patients about the effects of structural racism on health Develop an approach for advocating to colleagues and within institutions on the effects of structural racism Identify situations in which historical myths and structural racism in medicine may alter clinician judgment: race-based formulas, disparities in pain management, and disparities in screening and treatment of common conditions.   Disclosures Dr. Essien and Dr. Ceasar report no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.    Citation Essien UR, Ceasar JN, Abrams HR, Williams PN, Watto MF. “#222 Addressing Anti-Black Racism in Medicine”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list June 26, 2020.
Throw out your down pillows and join The Curbsiders for this lively discussion on interstitial lung disease. While the hundreds of interstitial lung disease types make this topic a bit overwhelming, breathe easy knowing that pulmonologist, Dr. Erin Narewski @erinnarewski (Temple), can boil things down to an easy to approach framework in less time than it takes to complete a few 6-minute walk tests. In this episode, we walk through the classification, relevant patient history, workup, and management of interstitial lung disease.    Listeners can claim Free CE credit through VCU Health at http://curbsiders.vcuhealth.org/ (CME goes live at 0900 ET on the episode’s release date).    Credits Written and Produced by: Paul Williams, MD, FACP; Nicole Kus, David Madnick, and Peter Wikoff Infographic and Cover Art: Edison Jyang Show Notes: Deborah Gorth Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP    Editor: Paul Williams MD, FACP (written materials); Clair Morgan of nodderly.com Guest: Erin Narewski DO, FCCP Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | CME!   Sponsors   Join the ACP Community! Join the American College of Physicians today! Post-training physicians can take advantage of an exclusive limited-time $100 dues discount. Visit acponline.org/member and use the code ACPDISCOUNT. Discount is only available until June 30, 2020.   VCU Health CE We are excited to announce that the Curbsiders are now partnering with VCU Health Continuing Education to offer continuing education credits for physicians and other healthcare professionals. Check out curbsiders.vcuhealth.org and create your FREE account!   Time Stamps 0:00  Sponsor - Join the ACP community! Be IM Proud Visit acponline.org/member and use the code ACPDISCOUNT 00:30 Intro, disclaimer, guest bio 03:14 Guest one-liner, career advice, favorite failure, Picks of the Week*: The Strain, FX Horror TV Show; One Hundred Years of Solitude (book) by Gabriel Garcia Marquez; Hypoallergenic pillows; Peanut butter whiskey  10:02 Sponsor - Join the ACP community! Be IM Proud Visit acponline.org/member and use the code ACPDISCOUNT 11:00 Case from Kashlak, Definitions 16:40 Buckets of ILD 32:06 Discussion of testing ILD: Labs and Imaging 44:20 Imaging findings in ILD 49:44 Basic Management of ILD 61:00 Take home points and Outro   *The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on our Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra.   Goal Listeners will feel comfortable with the basic pathophysiology, diagnosis, and management of interstitial lung disease.    Learning objectives After listening to this episode listeners will…   Be able to define the lung interstitium.  Develop a mental framework for the basic subtypes of interstitial lung disease.  Learn with the types of questions necessary to elucidate the pathophysiology of their patient’s ILD.  Know the steps to initiate a workup for ILD. Become familiar with the treatment strategy for ILD.      Disclosures Dr Narewski reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.    Citation Narewski E, Gorth DJ, Kus N, Madnick D, Wikoff P, Williams PN, Jyang E, Brigham SK, Watto MF. “#221 Interstitial Lung Disease with Erin Narewski DO”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list . June 22, 2020.  
We’re going upstream! Dr. Karen DeSalvo (@KBDeSalvo) talks social determinants of health, arming us with a framework to consider this very challenging aspect of patient care. As Society for General Internal Medicine President and Chief Health Officer at Google Health, she shares her clinical and public health experience, including weathering Katrina in New Orleans. While our clinical care largely focuses on the downstream medical consequences, we must recognize the upstream social context to address the barriers to health and wellbeing.    Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | CME!   Credits Written and Produced by: Emi Okamoto MD Cover Art: Kate Grant MBChb, MRCGP Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP; Emi Okamoto MD Editor: Matthew Watto MD (written materials); Clair Morgan of nodderly.com Guest: Karen DeSalvo MD, MPH, MSc   Sponsor We are excited to announce that the Curbsiders are now partnering with VCU Health Continuing Education to offer continuing education credits for physicians and other healthcare professionals. Check out curbsiders.vcuhealth.org for and create your FREE account!   Time Stamps Intro, disclaimer, guest bio 0:44 Dr Desalvo’s one-liner 3:34 Picks of the Week*- The Great Influenza  5:01 Dr Desalvo’s advice and past experience 6:10 Case from Kashlak 10:30 What about the evidence for social determinants? 13:40 What to do about this in the clinic, and is it worth screening? 16:06 Approaching as a team and with the community 19:40 How do we affect the upstream, before the downstream consequences? 22:40 NAM recommendations and framework 26:00 The role of technology 30:00 What the SDOH are, and who they affect 34:00 Start paying attention to SDOH 37:00 Outro 38:49   *The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on our Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra.   Goal Listeners will recognize the ubiquity of SDOH and their effects on individual well-being and disease.   Learning objectives After listening to this episode listeners will…   Recognize social determinants of health and the impact on health Give a framework for how to improve patient care by focusing on social determinants Recognize how to leverage care teams and technology in innovative ways to improve health of individuals   Disclosures Dr DeSalvo was a former board member of Humana. The Curbsiders report no relevant financial disclosures.    Citation DeSalvo KB, Okamoto EE, Williams PN, Watto MF. “#217 Social Determinants of Health with Karen DeSalvo MD”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list June 18, 2020.
Answers to common questions in post-op care with our Kashlak Chief of Perioperative Medicine Dr. Avital O’Glasser. She provides updates in delirium prevention, perioperative medication management, pain control, and even clarifies a lesson from Meredith Grey about causes of post-op fever.   Listeners can claim Free CE credit through VCU Health at http://curbsiders.vcuhealth.org/ (CME goes live at 0900 ET on the episode’s release date).    Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | CME!   Credits Written: Hannah Abrams MD, Avital O’Glasser MD Produced by, Infographic and Cover Art by: Hannah Abrams MD Hosts: Hannah Abrams MD; Matthew Watto MD, FACP; Paul Williams MD, FACP    Editor: Avital O’Glasser MD (written materials); Clair Morgan of nodderly.com Guest: Avital O’Glasser MD   Sponsors   Join the ACP Community! Join the American College of Physicians today! Post-training physicians can take advantage of an exclusive limited-time $100 dues discount. Visit acponline.org/member and use the code ACPDISCOUNT. Discount is only available until June 30, 2020.     VCU Health CE We are excited to announce that the Curbsiders are now partnering with VCU Health Continuing Education to offer continuing education credits for physicians and other healthcare professionals. Check out curbsiders.vcuhealth.org and create your FREE account!   Time Stamps 00:00 Sponsors 00:30 Intro, disclaimer, guest bio 02:53 Guest one-liner, Picks of the Week*: 12 Angry Men 1957 Movie; Hedwig and the Angry Inch Cast Recording; PCSSNow Buprenorphine Waiver Training for Medical Students 09:28 Sponsor -Visit acponline.org/member 10:17 Kashlak case; How to collaborate with our surgical colleagues 13:45 Questions to ask at the time of transfer
 23:00 Routine Post-Op Care: Bowel regimen, pain control, delirium prevention, glucose, antihypertensives, and nausea 44:25 Comanaging Complications and Fever/Tachycardia; Brief discussion of VTE prophylaxis
 57:55 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 our Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra.   Goal Listeners will effectively comanage perioperative patients with surgical colleagues.   Learning objectives After listening to this episode listeners will…   Identify effective strategies to improve safety at the time of transfer acceptance. Develop an approach for asking appropriate perioperative questions to the surgical team. Recognize common mistakes that hospitalists make when accepting a transfer. Become familiar with evidence based post-operative care to prevent and treat common post-op complications Develop a differential diagnosis and management approach for post-op fever Develop a differential diagnosis and management approach for delirium   Disclosures Dr O’Glasser reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.    Citation O’Glasser AY, Abrams HR, Williams PN, Watto MF. “#219 Post-Op Care and Complications with Avital O’Glasser MD”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list June 15, 2020.
Join us as we delve into the paradigm-shifting ethos of trauma-informed care with renowned expert Dr. Megan Gerber. Dr. Gerber is an Associate Professor of Medicine at Boston University School of Medicine and serves as Medical Director of Women’s Health for VA Boston where she directs the Women’s Health Fellowship. Dr. Gerber edited the textbook, “Trauma-informed Health Care Approaches: A Guide for Primary Care.”  We discuss the framework for trauma-informed universal precautions, as well as basics about the prevalence of trauma, strategies for integrating a trauma-sensitive approach into primary care, practical changes for the office environment,  modifications for physical exam methods, and more.   We recognize this topic may bring up upsetting thoughts or memories for some of our listeners. We will provide some self-care and trauma-informed resources in our show notes. The practice of medicine, especially during times of national crisis, can increase our exposure to traumatic events and reactivate difficult memories, predisoposing folks to depression and suicide risk. We just want to reiterate that you are not alone. If you are struggling with thoughts of harming yourself, the national suicide prevention lifeline number is 1-800-273-8255.    Listeners can claim Free CE credit through VCU Health at http://curbsiders.vcuhealth.org/ (CME goes live at 0900 ET on the episode’s release date).    Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME!   Credits Producer/Writer/Graphics: Beth Garbitelli Co-Producer: Paul Williams MD Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP, Beth Garbitelli  Editor: Molly Heublein MD (written materials); Clair Morgan of nodderly.com Guest: Megan Gerber MD, MPH, FACP   Sponsors Join the ACP Community! Join the American College of Physicians today! Post-training physicians can take advantage of an exclusive limited-time $100 dues discount. Visit acponline.org/member and use the code ACPDISCOUNT. Discount is only available until June 30, 2020.     VCU Health CE We are excited to announce that the Curbsiders are now partnering with VCU Health Continuing Education to offer continuing education credits for physicians and other healthcare professionals. Check out curbsiders.vcuhealth.org and create your FREE account!   Time Stamps Intro, disclaimer, guest bio (0:00 - 4:09) Guest one-liner (4:24) Picks of the Week*: Keep Going: 10 Ways to Stay Creative in Good Times and Bad by Austin Kleon; Pilgrim at Tinker Creek by Annie Dillard; Molly’s Challah on King Arthur Flour website from cook/food writer Molly Yeh; OXO Good Grips Stainless Steel Food Scale with Pull-Out Display; Buffy the Vampire Slayer on Hulu, Amazon Prime; Devs on Hulu, Amazon Prime; Terry Pratchett’s Discworld series (Book 1 of 40: The Color of Magic, Night Watch) and The Wee Free Men; On Becoming a Healer by Saul J. Weiner MD (10:16)  Kashlak Cases (14:39) Epidemiology of trauma (16:11) Trauma and #MeToo (19:04) Defining Trauma-Informed Care (TIC) (19:56) Integrating TIC into primary care (23:42) Screening in TIC (25:56) Containment and retraumatization (29:56) Inquiring about trauma (31:39) Recap and Office Visit Mechanics (36:24) Building the Relationship (38:56) Common Inquiry Mishaps (39:46) TIC Physical Exam (41:14) Resources for Patients (45:24) Office Environment (48:56) Provider Burnout (50:56) TIC in Covid-19 (53:24) Take-home Points (57:14) Outro (65:44)   *The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on our Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra.   Goal Listeners will gain fluency in trauma-informed care practices, methods, and perspectives in order to deliver compassionate care to patients who have experienced trauma and reduce the impacts of trauma in the healthcare setting.    Learning objectives After listening to this episode listeners will…   Define trauma-informed care and discuss the various forms of trauma.  Develop increased awareness of prevalence of adverse childhood experience, post-traumatic stress disorders, sexual violence, and intimate partner violence. Foster a safe, calm, welcoming clinical environment for patients who have experienced trauma.  Manage trauma disclosures and assess appropriate next steps for care and referrals. Cultivate advanced communication skills and strategies on the topics of sexual violence, intimate partner violence, and other trauma-related experiences.  Be able to engage in harm reduction strategies when caring for patients with trauma history.      Disclosures Dr. Gerber reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.    Citation Garbitelli EC, Gerber MR, Williams PN, Heublein M, Watto MF. “#218 Trauma-Informed Care with Megan Gerber MD”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list June 8, 2020.  
Stay current with the emerging COVID-19 research including: ACTT-1 (remdesivir), triple therapy with interferon, and conundrums  about SARS-CoV-2 PCR and serologic testing. We’re led by the one and only Curbsider/internist/epidemiologist, Rahul Ganatra MD MPH (@rbganatr). And...just in case you live outside of the habitat for murder hornets and your anxiety about the pandemic had begun to abate, we touch on the CDCs guidance to beware of hungry aggressive rats. Gross!   Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | CME!     Credits Written and Produced by: Rahul Ganatra MD, MPH, Deborah J. Gorth ScM, Emi Okamoto MD, Sarah P. Roberts MPH, and Matthew Watto MD Cover Art: Deborah J. Gorth ScM Hosts: Matthew Watto MD, Rahul Ganatra MD MPH, Emi Okamoto MD, and Sarah P. Roberts MPH Editor: Matthew Watto MD (written materials); Clair Morgan of nodderly.com     Sponsors ACP Join the American College of Physicians today! Post-training physicians can take advantage of an exclusive limited-time $100 dues discount. Visit acponline.org/member and use the code ACPDISCOUNT. Discount is only available until June 30, 2020.   VCU Health CE We are excited to announce that the Curbsiders are now partnering with VCU Health Continuing Education to offer continuing education credits for physicians and other healthcare professionals. Check out curbsiders.vcuhealth.org for more information.   Time Stamps 00:00 Sponsors 00:30 Intro, disclaimer 02:40 Fomites, groceries and killer rats 08:22 Sponsor 09:22 ACTT-1 trial of remdesivir 18:22 Triple therapy with lopinavir/ritonavir, ribavarin and interferon 33:10 Background on PCR testing for SARS-CoV-2; How common are false negative PCR tests? 44:25 Serologic testing for SARS-CoV-2; Utility of antibody testing; Test characteristics 50:30 Outro   Goal Listeners will practice their critical appraisal skills as they update themselves on the latest COVID-19 research.   Learning objectives After listening to this episode listeners will... Describe the quality of evidence put forth by and the implications of the recent Lancet paper on triple therapy for COVID-19 Be familiar with the results of the ACTT-1 trial or remdesivir for COVID-19 Appreciate the complexities of PCR in testing for SARS-CoV2 Gain insight into the role of serological testing for SARS-CoV2   Disclosures The Curbsiders report no relevant financial disclosures.    Citation  Gorth DJ, Ganatra RB, Okamoto E, Roberts SP, Watto MF. “#217 COVID Cakes 4 the Fourth”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. June 1, 2020.
Learn the nuances of caring for and building relationships with patients experiencing homelessness from expert internal medicine and addiction medicine physician, Stefan Kertesz MD, return guest from Episode 74 on Opioids and Health Policy (highly recommend a re-listen, y’all!).  To teach us the tricks of the trade, Dr. Kertesz draws on his many years of treating the underserved and researching homelessness, housing, and addiction in Birmingham, Alabama, where he currently serves as professor at UAB and Birmingham VA Medical Center.  In the course of this episode, we discuss the challenge of creating a welcoming and useful space for individuals experiencing homelessness (this is the preferred term, per Dr. Kertesz), how to meet patients where they’re at--both physically and mentally--the challenge of managing diuretics for those without stable access to a bathroom (avoid, if possible), and why the foot exam is of paramount importance.    Listeners can claim Free CE credit through VCU Health at http://curbsiders.vcuhealth.org/ (CME goes live at 0900 ET on the episode’s release date).    Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | CME!   Credits Written and Produced by Nora Taranto MD Infographics by Nora Taranto MD Cover Art by Kate Grant MBChB, MRCGP Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP, Nora Taranto MD     Editor: Carolyn Chan (written materials); Clair Morgan of nodderly.com Guest: Stefan Kertesz MD    Sponsor We are excited to announce that the Curbsiders are now partnering with VCU Health Continuing Education to offer continuing education credits for physicians and other healthcare professionals. Check out curbsiders.vcuhealth.org for and create your FREE account!   Time Stamps 00:00 Intro, disclaimer, guest bio  3:17 Guest one-liner 8:55 Picks of the Week*: Dr. Kertesz’s Book Recommendation: Saul Weiner’s On Becoming A Healer; Nora’s Pick of the week: BackStory (especially their episode on dynamite!) https://www.backstoryradio.org/  10:07 Case from Kashlak  10:56 Language: How to ask where a patient lives?  13:25 Terminology: Persons Experiencing Homelessness:  14:35 The stats on prevalence of health and illness in the homeless population, and the importance of both medical and environmental factors 20:44 How to start the visit, and how to establish trust early on?  27:40 Why is the mortality rate higher?   35:15 Special conditions and Medication Considerations: Hypertension, Diuretics, Insulin and Food Insecurity, Substance Use Disorders, Feet, and Hepatitis C  54:15 COVID and homeless healthcare 57:00 Care Models 62:30 Take Home Points and Outro   Goal Listeners will learn the unique health challenges posed to individuals who are experiencing homelessness, and the best practices for addressing these challenges.    Learning objectives After listening to this episode listeners will… Screen for and identify patients experiencing homelessness Identify the unique challenges facing this population  Identify best practices in caring for this population Differentiate between different structures of healthcare delivery, and their advantages and disadvantages for the homeless population.     Disclosures Dr Kertesz reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.    Citation Kertesz S, Taranto NT, Williams PN, Brigham SK, Chan, Caroyn, Watto MF. “#216: Homeless Healthcare with Stefan Kertesz MD”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. May 28,2020.
Chase that metronidazole with a beer! Pop some 30 year old pills! Retrain your brain as our esteemed guest Dr. Douglas Paauw goes over his popular annual ACP presentation on Medical Myths. Learn about how some common medical myths originate and continue in our practice. We discuss why it’s okay to drink on metronidazole, take expired medications, inject epinephrine into extremities and why recurrent sinusitis may not really exist.      Listeners can claim Free CME credit through VCU Health at curbsiders.vcuhealth.org/ (CME goes live at 0900 ET on the episode’s release date).      Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | CME!     Credits Written and Produced by: Justin Berk, MD MPH MBA Infographic and Cover Art: Beth Garbitelli Hosts: Justin Berk, MD, MPH, MBA; Matthew Watto MD, FACP; Paul Williams MD, FACP    Editor: Emi Okamoto MD (written materials); Clair Morgan of nodderly.com Guest: Douglas Paauw, MD     Sponsor We are excited to announce that the Curbsiders are now partnering with VCU Health Continuing Education to offer continuing education credits for physicians and other healthcare professionals. Check out curbsiders.vcuhealth.org/ for more information.     Time Stamps 00:00 Intro, disclaimer, guest bio 02:22 Guest one-liner; Career Advice, Picks of the Week*: Being Mortal, book by Atul Gawande; The Band Played On, book by Randy Shilts; Lagunitas Hoppy Refresher: zero alcohol, zero calories! 06:15 Medical Myth Definitions 10:20 Dogma: Metronidazole and Alcohol; Healthy RCT Metronidazole and Alcohol 19:09 Expired Medications; Military Stockpiling Study 24:22 Aspirin and Nitroglycerin; Unopened eye drops; Epi-Pens; Expired Med Recap 31:13 Sinus Headaches; Trigeminal Nerve; Pearl: Recurrent headaches; Study showing Effectiveness of treatment (92%) 41:07 Epinephrine in extremity; RCT of Epi in Extremities Study showing Experts use it; Podiatry journal 48:39 Take home points 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 our Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra.     Goal Listeners will challenge the dogma of specific medical practices that have been spread without evidence basis.     Learning objectives After listening to this episode listeners will... Counsel patients taking metronidazole on alcohol use Describe the risks associated with taking expired medications Diagnose and treat commonly defined “sinus headaches” Describe the risks associated with epinephrine injections in the extremities      Disclosures Dr Paauw reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.      Citation Pauuw D, Berk J, Williams PN, Watto MF. “#215 Medical Myths: Challenge Dogma with Dr. Douglas Paauw”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list May 25, 2020.
Elevate your critical appraisal skills as we review the first RCT of remdesivir and share the latest and greatest COVID-19 stories including: Llama antibodies, Stroke statistics, Future Waves, Exit Strategies and Awake Proning. We’re joined by everyone’s favorite Curbsider/internist/epidemiologist, Rahul Ganatra MD MPH (@rbganatra). Rahul provides critical appraisal of the newest randomized control trial (RCT) on remdesivir from the Lancet, and gives us a lesson on why statistical power is so important to consider. We also share updates on strokes, awake proning, pandemic predictions, and we reveal another reason to love llamas (besides those luscious lashes). Llama mia, here we go again!   Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | CME!     Credits Written and Produced by: Sarah P. Roberts MPH, Rahul Ganatra MD, MPH, Emi Okamoto MD, Paul Williams MD and Matthew Watto MD Cover Art: Beth Garbitelli Hosts: Sarah P. Roberts MPH, Matthew Watto MD, Paul Williams MD, Rahul Ganatra MD MPH, Emi Okamoto MD    Editor: Matthew Watto MD (written materials); Clair Morgan of nodderly.com     Sponsors We are excited to announce that the Curbsiders are now partnering with VCU Health Continuing Education to offer continuing education credits for physicians and other healthcare professionals. Check out curbsiders.vcuhealth.org for more information.   Time Stamps 00:00 Intro 02:10 Fun animal facts: Llama antibodies 09:10 Remdesivir RCT by Wang et al 12:40 Power and Sample Size 16:32 Baseline Characteristics, Results and Author’s conclusions 19:15 Rahul’s conclusions: How chance and bias effected the results 24:00 Right censoring; Viral load and timing of antivirals 30:30 Final thoughts on Remdesivir RCT by Wang et al; Looking ahead to the NIAID (ACTT) trial 33:53 Are patients really having less strokes and heart attacks? 38:20 Awake proning 43:30 Paul teaches us not to use the term “happy hypoxemic” 45:00 CIDRAP viewpoint on future waves and exit strategies 50:22 Outro   Goal Listeners will hone their skills in critical appraisal as they update themselves on all things COVID-19   Learning objectives After listening to this episode listeners will... Critically appraise recent research on remdesivir as a treatment for COVID-19 Recognize the consequences of COVID-19 on strokes Discuss the potential benefits of proning for COVID-19 patients Describe different scenarios likely for the pandemic’s future     Disclosures The Curbsiders report no relevant financial disclosures.      Citation Ganatra R, Okamoto E, Williams P, Roberts SP, Watto MF. “#214 COVID Cakes 3: Llamas, Remdesivir, Strokes, Predicting the Future, and More!”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list May 18, 2020.
Listen as our esteemed guest Dr. Nina Mingioni walks us through her approach to fatigue, from differential diagnosis, to the evidence behind physical exam, laboratory workup, and beyond!   Listeners can claim Free CME credit through VCU Health at curbsiders.vcuhealth.org/ (CME goes live at 0900 ET on the episode’s release date).    Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME!   Credits Writer, Producer, Infographic, and Cover Art: Hannah R. Abrams Hosts: Hannah R Abrams, Matthew Watto MD, FACP; Paul Williams MD, FACP    Editor: Matthew Watto MD, FACP (written materials); Clair Morgan of nodderly.com Guest: Nina Mingioni MD, FACP   Announcement Join in! We’re hosting a LIVE! COVID Cakes discussion of Remdesivir and other hot COVID-19 stories this coming Tuesday May 12, 2020 at 8:30 pm ET @thecurbsiders on Twitter and Periscope!   Sponsor We are excited to announce that the Curbsiders are now partnering with VCU Health Continuing Education to offer continuing education credits for physicians and other healthcare professionals. Check out curbsiders.vcuhealth.org/ for more information.   Time Stamps 00:00 Intro, disclaimer, guest bio and a bad pun 03:00 Guest one-liner 07:10 Case from Kashlak, Defining fatigue; Taking a general history 11:36 Most common causes of fatigue and how to elicit them from the history 20:39 Physical exam for fatigue; Medications that cause fatigue; 25:25 Exam findings and LRs for anemia; Sleep apnea 30:55 Lab workup for fatigue; Expanded testing: Ferritin, Vitamins, EBV, Rheumatologic diseases, Celiac disease, Lyme 47:55 Spiel to the patient when no answer is found 51:14 Other diagnoses to consider: Fibromyalgia, Myalgic Encephalomyelitis 55:09 Take home points and Outro   Goal Listeners will develop an approach to caring for patients with fatigue symptoms.   Learning objectives After listening to this episode listeners will…   Identify top causes of fatigue Develop an evidence-based approach to assessing a patient with fatigue Describe evidence-based screening tools for fatigue   Disclosures Dr. Mingioni reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.    Citation Mingioni N, Abrams HR, Williams PN, Watto MF. “#213 Fatigue for Primary Care with Nina Mingioni MD”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. Air date May 11, 2020.
Summary Crush those 11 pm “STAT: Patient agitated” pages with this expert guide to assessing for and treating alcohol withdrawal!  Dr. Joji Suzuki MD, addiction psychiatrist extraordinaire at the Brigham and Women’s Hospital, walks us through how to think about the risk of severe withdrawal, the different ways to manage it, and how to engage with patients as they’re leaving the hospital. In the course of this Car-Talk (well, not exactly the same as the critically acclaimed radio show, but he did record in his car….), Dr. Suzuki demystifies withdrawal and debunks some common myths: that we must manage withdrawal inpatient, that banana bags are the cure to a hangover and alcoholic malnutrition, and that we tend to under-medicate with benzos (actually, it’s the opposite!).     Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | CME   Credits Written and Produced by Nora Taranto MD  Infographic and Cover Art by: Nora Taranto MD Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP    Editor: Cyrus Askin MD, Matthew Watto MD (written materials); Clair Morgan of nodderly.com Guest: Joji Suzuki MD    Announcement Join in! We’re hosting a LIVE! COVID Cakes discussion of Remdesivir and other hot COVID-19 stories this coming Tuesday May 12, 2020 at 8:30 pm ET @thecurbsiders on Twitter and Periscope!   Sponsor We are excited to announce that the Curbsiders are now partnering with VCU Health Continuing Education to offer continuing education credits for physicians and other healthcare professionals. Check out curbsiders.vcuhealth.org for more information.   Time Stamps 00:00 Intro, disclaimer, guest bio 02:52 Guest one-liner; Career advice; Picks of the Week*: Why We Do What We Do (book); Fargo (film) 08:10 A Case from Kashlak and Screening for Alcohol Use and Severe Withdrawal Risk 17:32 Outpatient Versus Inpatient Treatment 25:27 Gabapentin for alcohol withdrawal 27:10 Indicators for ICU level Care 31:53 Symptom-Driven versus Fixed-Dose Protocols , Benzos vs. Barbs 36:55 And which benzo?   39:47 A Natural History of Withdrawal 44:10 Banana Bags and Thiamine Deficiency 48:17 The Transition Home: Naltrexone, Bridge Clinics, and Motivational Interviewing 56:36 Outro and Bonus clip   *The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on our Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra.   Goal Listeners will be able to screen patients for risk of alcohol withdrawal and decide on management strategies that are individualized to the patient.    Learning objectives After listening to this episode listeners will… Screen and identify for patients at high risk of withdrawal  Identify who would benefit from inpatient withdrawal, and ICU vs floor level care   Identify the best withdrawal management protocol  List indications and contraindications of first line therapy for alcohol use disorder.   Disclosures Dr Suzuki reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.    Citation Suzuki J, Taranto NT, Williams PN, Askin C, Watto MF. “#212 Sober Talk: Managing Alcohol Withdrawal with Joji Suzuki, MD”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list May 7, 2020.
In this episode we tackle treatment with remdesivir, management with anticoagulation, and presymptomatic transmission. Welcome back to COVID Cakes, a rundown of recent COVID articles and news stories. What does the latest Gilead medication have to offer? Why should we wear masks? And if you thought 6 feet was THE safe distance…we’ve got some bad news about running. But it’s not all bad! We’re joined by everyone’s favorite Curbsider/Internist/Epidemiologist, Rahul Ganatra MD MPH (@rbganatra), who provides critical appraisal of the newest COVID-19 treatment article. Pull up a chair, bring your own syrup, and join us!    Listeners can claim Free CME credit through VCU Health at curbsiders.vcuhealth.org/ (CME goes live at 0900 ET on the episode’s release date).    Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | CME!   Credits Producer: Sarah P. Roberts MPH, Rahul Ganatra MD MPH, Emi Okamoto MD    Writer: Emi Okamoto MD, Rahul Ganatra MD MPH,     Cover Art: Chris Chiu MD Hosts: Chris Chiu MD, Rahul Ganatra MD MPH, Emi Okamoto MD    Editor: Matthew Watto MD (written materials); Clair Morgan of nodderly.com   Sponsors Apollo If you’re a healthcare worker looking for an opportunity to volunteer with the COVID relief efforts or you’ve been furloughed and are in need of work, please check out apollohct.com to see jobs and volunteer opportunities in your area and across the states. All you have to do is make a profile, input your preferences, and Apollo will do the searching for you.   VCU Health Continuing Education We are excited to announce that the Curbsiders are now partnering with VCU Health Continuing Education to offer continuing education credits for physicians and other healthcare professionals. Check out curbsiders.vcuhealth.org for more information.   Time Stamps 00:00 Sponsors, Intro, disclaimer 02:30 Picks of the Week 6:36 Remdesivir trial rundown 21:52 Thrombosis in COVID-19 29:50 Asymptomatic/Presymptomatic transmission 41:42 Quick takes 49:00 Outro   Picks of the Week / Links You Bet Your Garden podcast with Mike McGrath Ologies podcast with Alie Ward Frosted Mini Wheats   Goal Listeners will hone their skills in critical appraisal as they update themselves on all things COVID-19   Learning objectives After listening to this episode listeners will... Critically appraise recent research on remdesivir as a treatment for COVID-19 Review emerging literature and guidelines on thrombotic complications of COVID-19  Interpret new data on asymptomatic transmission of COVID-19    Disclosures The Curbsiders report no relevant financial disclosures.    Citation Ganatra R, Chiu CJ, Okamoto E, Roberts SP, Watto MF. “COVID Cakes: Remdesivir, anticoagulation, and presymptomatic transmission”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list April 29, 2020.
Get inside the black box of transplant medicine as we discuss: Kidney transplant for the internist. Join Dr. Cyrus Askin, @askins_razor, one of our Curbsiders Correspondents, as he teams up with the fine folks from freely Filtered in this NephMadness episode exploring topics in kidney transplant! On this show, the gang turns to Dr. Samira Farouq, @ssfarouk, a Mount Sinai transplant nephrologist, to take the reins during this guided tour of concepts in transplant medicine that internists should be familiar with. During this episode, you’ll learn about indications for kidney transplant, immunosuppressive agents, what to watch out for in your post-transplant patients and so much more! And of course, we will talk a little NephMadness as we wrap things up. So maybe you need to learn about kidney transplant or perhaps you’re still mourning the loss of March Madness 2020 - either way, we encourage you to take a listen and hope you’ll enjoy!   Listeners can claim free CE credit for this episode at curbsiders.vcuhealth.org (goes live at 1200 ET on the episode’s release date).    Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | CME   It's time for NephMadness 2020! Fill out your bracket before the April 30, 2020 deadline and be sure to list The Curbsiders as your team.  Read this year’s region posts here. Submit an individual or team bracket here. Discuss your picks with #NephTwitter!   Credits Written and Produced by: Cyrus Askin MD, Matthew Watto MD and the Freely Filtered Crew Infographic: Cyrus Askin MD Cover Art: Kate Grant MBChB DipGUMed Hosts: Cyrus Askin MD, Joel Topf MD, Samira Farouk MD, Swapnil Hiremath MD, Jennie Lin MD & Matt Sparks MD Editor: Matthew Watto MD (written materials); Clair Morgan of nodderly.com   Sponsor We are excited to announce that the Curbsiders are now partnering with VCU Health Continuing Education to offer continuing education credits for physicians and other healthcare professionals. Check out curbsiders.vcuhealth.org for more information.   Time Stamps 00:00 Announcement, Intro to Freely Filtered and NephMadness 04:00 Case of advanced CKD; Who/when to refer for transplant 12:05 Benefits of renal transplant 16:22 Counseling patients with advanced CKD about transplant and a bit on living donors 20:40 Medications after transplant; Drug-drug interactions 25:50 Dr. Sparks’ 30 second exam for the transplant patient; Diarrheal illness 32:07 Calcineurin inhibitor levels 36:42 Prophylaxis for long term complications 40:21 Allograft rejection; BAMF criteria 50:40 Cardiovascular risk; Statins 56:11 Malignancy after kidney transplant 60:00 NephMadness Transplant Region: Biomarkers vs Biopsy 72:23 Outro   Goal Listeners will learn valuable skills to assist in the management and counseling of pre- and post- kidney transplant patients.   Learning objectives After listening to this episode listeners will…   Recognize the criteria for kidney transplant referral and evaluation, as well as the importance of referring a patient as soon as they are eligible.  Be able to counsel a patient regarding what to expect before, during and after the transplant process. Know the main classes of medication used after patients have received transplants, to include their side effects and any relevant monitoring.  Be familiar with the different types of rejection, the clinical signs/symptoms of rejection and the utility / limitations of kidney biopsy. Be able to discuss the post-transplant complications of kidney transplantation (cardiovascular, malignancy, etc.) as well as what type of prophylactic medications should be considered in these patients.   Disclosures Drs. Cyrus Askin MD, Samira Farouk MD, Swapnil Hiremath MD, Jennie Lin MD & Matt Sparks MD report no relevant financial disclosures. Dr. Topf has received honoraria from Astra Zeneca and Cara Therapeutics. He is joint venture partner in Davita Dialysis centers receiving dividends. The Curbsiders report no relevant financial disclosures.    Citation Cyrus A, Topf J, Farouk S, Swapnil H, Lin J, Sparks M, Watto MF. “#210 NephMadness: Kidney Transplant for the Internist”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. April 27, 2020
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Comments (4)

David Clements

Thanks for info about the Abbott SARS-cov-2 IgG blood test. Note that Labcorp exclusively uses this test. Quest uses this test for some samples.

Jun 10th
Reply

setareh abdoli

very good but please attach algorithm and link

Dec 20th
Reply

Daniel B

Amazing podcast for medical students. Highly recommend!

Sep 29th
Reply

Aman Kaur

Internal medicine

Jun 21st
Reply
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