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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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How to initiate buprenorphine like a pro. Treating people with Opioid Use Disorder can be the most rewarding part of your practice!  Get comfortable with counseling and pharmacotherapy for OUD with tips from Dr. Michael Fingerhood, Associate Professor of Medicine at Public Health at Johns Hopkins.  We review building a therapeutic relationship with people with substance use disorders, the differences between the three FDA-approved medications for opioid use disorder (buprenorphine, methadone and extended-release naltrexone), and the nitty-gritty of prescribing buprenorphine. ACP members can claim CME-MOC credit at https://www.acponline.org/curbsiders (CME goes live at 0900 ET on the episode’s release date).  Show Notes | Subscribe | Spotify | Schwag! | Top Picks | Mailing List | thecurbsiders@gmail.com Credits Written and Produced by: Justin Berk, MD MPH MBA, Joseph “Seffy” Muller MD Infographic: Hannah R Abrams and Justin Berk MD, MPH, MBA Cover Art: Kate Grant MBChB DipGUMed Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP, Justin Berk, MD MPH MBA Editor: Matt Watto MD, FACP (written materials), Clair Morgan at Nodderly.com (audio) Guest: Michael Fingerhood MD Time Stamps 00:00: Introduction 04:40: Guest introduction & questions (great stories about addiction) Picks of the Week*: Papillon (film) and Papillon (book) per Dr. Fingerhood; Miami Connection (film) per Stuart, Watto and Paul; Use GREPMED as “the Pinterest of medical education”, per Dr. Justin Berk; ASAM Handbook of Addiction Medicine by Dr. Fingerhood and Dr. Darius Rastegar; Bup App (from Yale School of Medicine) 16:45: How to approach someone with addiction looking for help 20:00: Choosing between methadone and buprenorphine 24:15: Different formulations of buprenorphine 26:45: Coverage and costs of buprenorphine 28:20: Safety considerations of buprenorphine 33:40: How to divide buprenorphine films for specific dosing 35:00: Discussion of buprenorphine diversion 36:20: Home initiation of buprenorphine  40:00: Use of urine toxicology screens and addressing concurrent use 41:00: Initiation of buprenorphine in patients actively using 42:30: How to address precipitated withdrawal 45:00: Treating chronic pain and transitioning to buprenorphine 47:00: Treating acute pain for patients on buprenorphine 51:00: Dosing of buprenorphine 52:15: Perceived barriers to buprenorphine (e.g. counseling resources, “trading addiction”) 57:10: Historical context of opioid use disorder 60:00: Take home points 62:40: 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. Disclosures Dr. Fingerhood reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.  Citation Fingerhood M, Berk JL, Muller J, Williams PN, Brigham SK, Watto MF. “#187 Buprenorphine 2.0: Managing Opioid Use Disorder for the Generalist”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. December 9, 2019.
Make some gains with Drs. Feigenbaum (@Jordan_theCoach) & Baraki (@AustinBaraki) of Barbell Medicine as we delve into the topic of sarcopenia! Together we’ll learn what exactly is sarcopenia, how it is diagnosed, and explore approaches to both management and counseling including: exercise prescriptions,  recommendations for protein intake, and even how to treat patients with multiple comorbidities. Show Notes | Subscribe | Spotify | Schwag! | Top Picks | Mailing List | thecurbsiders@gmail.com Credits Written and Produced by:  Cyrus Askin MD Infographic: Cyrus Askin MD, Hannah Abrams Cover Art: Dr. Kate Grant MBChB DipGUMed Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP    Editors: Matthew Watto MD, FACP; Clair Morgan of Nodderly.com Guests: Jordan Feigenbaum MD; Austin Baraki MD Check Out our friends at Barbell Medicine! Learn more about Barbell Medicine through their website at www.barbellmedicine.com or their YouTube channel - Barbell Medicine. They also have their own Podcast, The Barbell Medicine Podcast and can be found on Instagram: @barbell_medicine, Twitter via @BarbellMedicine. Drs. Feigenbaum and Baraki can be found on instagram via Jordan_BarbellMedicine & Austin_BarbellMedicine. They can also be found on Twitter via @AustinBaraki, @Jordan_theCoach. Time Stamps 00:00 Intro, disclaimer, guest bio 03:20 Guest one-liners; Picks of the Week*: Explain Pain (book) and Explain Pain Super Charged; Range Why Generalists Triumph in a Subspecialized World (book) by David Epstein; The Sports Gene: Inside the Science of Extraordinary Athletic Performance (book); The Mind’s Eye (book) by Oliver Sacks; The Predator High Five (Gif); The Bacterionomicon 08:50 How Austin and Jordan got into coaching, fitness and lifestyle medicine 14:30 Case of chronic pain, lack of exercise and loss of muscle mass; Defining sarcopenia, cachexia, frailty 22:30 How to diagnose sarcopenia -measures of physical performance (Repeat Chair Sit to Stand; Timed Get Up and Go Test; Gait Speed); DXA scans; The SARC-F questionnaire; Serum Creatinine 33:30 Anabolic resistance; Sarcopenic obesity and Osteosarcopenic obesity 37:00 How to counsel patients about physical activity 40:00 The 10,000 step thing is based on marketing, not evidence 41:30 How to sell exercise to patients with comorbidities; Barriers to and safety of resistance training 49:39 Finding a physical trainer 53:18 Dietary protein intake recommendations 61:33 What kind of results might patients expect 65:55 Take home points 68:11 Plugs: Barbell Medicine podcast, Instagram, YouTube and Twitter 69:15 Outro and a pun *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 By the end of this episode, listeners will be familiar with sarcopenia as an important clinical entity, the risk factors for sarcopenia, how to assess a potential sacropenic patient and how to provide treatment and counsel towards preventing or reversing sarcopenia.  Learning objectives After listening to this episode listeners will…   Appreciate the clinical relevance/importance of sarcopenia Know who is at risk for sarcopenia and how to screen them Master the most recent exercise and nutrition recommendations for adults Be familiar with motivational interviewing techniques to help promote diet and exercise changes to combat sarcopenia Disclosures Dr. Feigenbaum is the owner of Barbell Medicine LLC which provides free, paid and retail content to include strength/nutrition coaching, strength/nutrition seminars, shirts, training gear and protein / pre-work out supplements. Dr. Baraki works part-time for Barbell Medicine LLC as a writer and coach for which he is paid. He does not receive any proceeds from the sale of supplements or other retail goods.  Citation Askin C, Baraki A, Feigenbaum J, Williams PN, Brigham SK, Watto MF. “#186 Sarcopenia: Raising the Bar in Primary Care”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. December 2, 2019.
“Guidelines” galore! From Community-Acquired Pneumonia to asthma to...red meat? While you may be listening to this around Thanksgiving, we actually recorded on October 30th‒the best and spookiest time of the year. To really set the mood I wanted to include some terrible skeleton puns, but the ones I found weren’t humerus. What we do have for you are some tasty knowledge treats, courtesy of our ghosts‒oops, I mean our HOSTS‒Chris, Matt, Stuart and Paul. Join us as we review the most terrifyingly relevant research findings and creepiest clinical pearls! Today also marks the debut of our newest Hotcakes team member, the frighteningly talented Dr. Rahul Ganatra. Rahul will now be our resident statistician/study design expert, and will use his research skulls‒no wait, SKILLS‒to provide even more insight into the practice-changing findings we love to highlight for you.   ACP members can claim CME-MOC at CME credit https://www.acponline.org/curbsiders. 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 Statistics Expert: Rahul Ganatra MD Editors: Christopher Chiu MD (audio/text), Emi Okamoto MD (text) Cover-Art: Sarah Phoebe Roberts MPH Music: Stuart Brigham MD Time stamps 00:00 Introduction/Disclaimer 03:18 Getting to know Dr. Rahul Gantra 05:35 Community-Acquired Pneumonia Guidelines 15:13 Sarah explains Hotcakes ratings 16:45 A new Asthma Strategy 17:26 Chris forgets what LABA stands for 27:37 Stuart makes a joke 29:00 A lot of meat talk 37:22 Rahul’s Napkin Calculations 51:40 Honorable Mentions 52:42 Take-away Points & Outtro Meet Rahul: Rahul Ganatra is a Medical Attending and Director of Continuing Medical Education for the Medical Service at the VA Boston Healthcare System.  He fell in love with clinical epidemiology and public health while taking night classes for his MPH during medical school. and went on to become an applied epidemiology fellow at the Centers for Disease Control and Prevention.  He completed his residency and chief residency in internal medicine at Beth Israel Deaconess Medical Center, where he worked as a hospitalist for two years before coming to the VA, where he is currently the faculty mentor for the resident journal club.  In addition to critical appraisal, he loves cool animal facts and subjecting friends and colleagues to tirades about animal physiology. Goals and Learning Objectives Goals:  Listeners will learn about relevant medical literature, with emphasis on breaking news and recently published research.  Learning objectives: After listening to this episode listeners will… Learn about important journal articles and their salient points Develop a framework to critically analyze journal articles in a practical way Learn what medical news is being widely reported in the lay media and the underlying evidence in the literature Review the current literature on the following subjects: (1)American Thoracic Society and Infectious Diseases Society of America updated guidelines for the diagnosis and treatment of Community Acquired Pneumonia; (2) updated asthma treatment strategy and recommendations from the Global Initiative for Asthma; (3) the association between red meat intake and mortality and cardiometabolic outcomes.  Disclosures:  The Curbsiders report no relevant financial disclosures. Citation:    Chiu CJ, Roberts SP, Ganatra R, Williams PN, Brigham SK, Watto MF. “Hotcakes: CAP, Asthma and Red Meat”. The Curbsiders Internal Medicine Podcast https://thecurbsiders.com/episode-list. November 27, 2019.
Score some great insights and clinical pearls from Dr. Christine Won on the incredibly important topic of sleep medicine during this live recording at CHEST! On this episode we’ll tackle why we sleep, how to treat insomnia, the “Z-drugs” 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).  Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com Credits Written and Produced by: Cyrus Askin MD, Matthew Watto MD, FACP  Infographic: Matthew Watto MD, FACP Cover Art: Kate Grant MBChB DipGUMed Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP    Editor: Matthew Watto MD, FACP; Emi Okamoto MD Guest: Christine Won, MD MSc Sponsor The American College of Chest Physicians Time Stamps 00:00 Intro, disclaimer, guest bio 06:10 Guest one-liner 10:15 Picks of the Week*: Become Your Child’s Sleep Coach (book) by Lynelle Schneeberg; Sleep in Art: How artists portrayed sleep and dreams in the last 7000 years (book) by Meir Kryger; The Toxic Avenger (film); Ballistyx Jump Rope; Weird Al - The Essentials 12:28 Case of Mr. S. Andman; Why we sleep 16:04 Spiel on how sleep affects health, testosterone 21:05 How much sleep do we need; Teens and sleep 28:05 Spiel to patients self medicating with sedatives; CBT for insomnia (CBTI) including online CBTI 32:10 Sleep hygiene, naps 34:10 Z drugs 39:17 How sleep apnea differs in women 41:52 Sleep trackers (wearables); Blue blockers and screens 45:00 Audience questions: Alarm clocks; Cultural sleep issues;  Shift work; Melatonin; 5-hydroxytryptophan 55:45 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 gain a broad overview of the purpose of sleep, its implications for promoting health and preventing disease, tips for improving sleep quality, plus answers to the most common sleep questions from patients. Learning objectives (After listening to this episode, you should be able to...) Explain the theories behind why we sleep and recognize the link between sleep, overall health, and various comorbid conditions Counsel patients about sleep and recall tips to improve their own sleep Answer common questions about over the counter supplements and prescription medications used for sleep  Discuss approaches to therapy for insomnia, specifically the role of prescription medications in conjunction with cognitive behavioral therapy and sleep hygiene Disclosures Dr. Won reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.  Citation Won, M, Williams PN, Brigham SK, Askin C, Watto MF. “#184 Update in Sleep Medicine: LIVE from CHEST 2019!”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list November 25, 2019.
We want to live longer… and healthier too! Dr Peter Attia, a physician focusing on the applied science of longevity, walks us through lifespan and healthspan, exploring tactics aimed at extending both. Listeners will challenge the conventional approach to primary care and explore tactics to optimize exercise, nutrition, and health, including counseling on different dietary patterns, fasting, exercise, emotional well-being and how to prepare for the Centenarian Olympics! Show Notes | Subscribe | Spotify | Schwag! | Top Picks | Mailing List | thecurbsiders@gmail.com Credits Written and Produced by: Matthew Watto MD, FACP and Elena Gibson MD  Cover Art and Infographic: Elena Gibson MD Hosts: Elena Gibson MD, Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP    Editor: Emi Okamoto MD Audio Editor: Clair Morgan of Nodderly Guest: Peter Attia MD    Time Stamps 00:00 Intro, disclaimer, guest bio 04:22 Guest one-liner, Career Advice, Picks of the Week* 14:30 Case: A couple seeking maximize longevity; Defining longevity, healthspan, lifespan and the 4 types of death 19:30 Lifespan, the longevity curve and the long tail 23:50 Peter’s approach to shepherding patients toward longevity; Exploring motivations 32:06 Back to our couple: What exercises should they perform 42:09 Peter’s advice on nutrition; the standard American diet; Intermittent fasting; Dietary Restriction 51:20 Periodic fasting and water only fasting 54:33 Genetics and longevity 56:40 Metformin; SGLT2 inhibitors; Allopurinol and uric acid lowering 61:47 Peter’s take home points and a plug for David Foster Wallace’s commencement speech from Kenyon College 66:40 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 learn a framework for thinking about longevity and practical tips for improving lifespan and healthspan. Learning objectives After listening to this episode listeners will…   Define longevity, healthspan,and lifespan  Recall the four types of death. Explain the objectives of improved aging (longer lifespan, delayed rate of decline, and compressed period of morbidity). Learn basic dietary principles to improve lifespan/healthspan and compare various dietary patterns Describe some tactics to promote lifespan/healthspan (in nutrition, exercise physiology, sleep, distress management, medications and supplements, etc.) Explore the possible longevity benefits of fasting Disclosures Dr Peter Attia reports the following relevant financial disclosures: Peter receives speaking honorariums from organizations including hospitals and health-related businesses when he is asked to speak on longevity, metabolic-related topics, athletic performance, and his personal experience. Peter is the co-founder and Chief Medical Officer of the fasting app Zero. Peter is an advisor to, and/or investor in, the companies Virta Health, Hu Kitchen, Oura Health Oy, Magic Spoon Cereal, Inevitable Ventures, Salutoceuticals, and Supercast. Further information can be found at his website https://peterattiamd.com/about/.  The Curbsiders report no relevant financial disclosures.  Citation Attia P, Gibson E, Williams PN, Brigham SK, Watto MF. “#183 Longevity, Healthspan and Lifespan with Peter Attia MD”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list November 18, 2019.
This podcast covers several concrete steps that residents can do or program directors can suggest to help residents transition to assuming the role of PGY3. A year is a long time, but requires a strategic approach to ensure that residents get the most out of it. It’s our latest offering from ACP’s IMpower series for residents featuring our friends from Walter Reed IM Residency: Joshua Hartzell MD (@joshuadhartzell); Kim Fabyan MD (@kfabsMD); Jeff Gray MD (@theotherDrGray).   If you are a PGY3 you should: LEAD like someone’s life depends on it! Credits Written and Produced by: Joshua Hartzell MD, MS-HPEd, FACP, FIDSA; Kim Fabyan MD; Jeff Gray MD Infographics: Joshua Hartzell MD, MS-HPEd, FACP, FIDSA; Kim Fabyan MD; Jeff Gray MD Cover Art: Matthew Watto MD, FACP Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP Editor: Matthew Watto MD, FACP Guests:  Joshua Hartzell MD (@joshuadhartzell); Kim Fabyan MD (@kfabsMD); Jeff Gray MD (@theotherDrGray)   Sponsor - ACP IMpower: Catalyzing your professional future Each month, ACP IMpower offers non-clinical tools and resources expertly crafted to support residents during their training and catalyze their professional future. Crafted by ACP leaders, experienced internists, and prominent podcasters, IMpower covers a wide variety of topics valuable to residents at every stage of their training, and beyond. Visit https://www.acponline.org/impower. Time Stamps 00:00 Sponsor, disclaimers, intro, guest bios 05:10 Guest one-liners 07:43 Precocious Passion for teaching 09:30 Picks of the Week*: High Life (film); @MedicalPuns; The Culture Code (book); Quiet: The Power of Introverts (book); Every Patient Tells A Story (book) 14:02 How does PGY3 differ from PGY2 18:18 Coaching in Medicine 23:42 Goal setting (short, intermediate and long term) 32:25 Tips for Internal Medicine Board Prep 40:30 Skills to develop during PGY3 year 42:28 Improve your skills as a medical educator;  Developing Leadership Skills 47:47 Feedback Fridays 50:00 Coaching the PGY3 resident to run rounds 55:20 Quality improvement and IHI 56:31 Take Home Points from Josh, Kim and Jeff 60:04 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. Disclosures Doctors Hartzell, Fabyan and Gray report no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.  Citation Hartzell J, Fabyan K, Gray J, Williams PN, Brigham SK, Watto MF. “#182 Becoming a PGY3: Not Just a Repeat of PGY2”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list November 11, 2019.
Learn how to approach the geriatric patient with multimorbidity and how to parse through and prioritize a mile-long problem list with Dr Josh Uy, master geriatrician at the University of Pennsylvania. We review different approaches to a clinic visit with a patient who takes fifteen daily medications with just as many chief complaints, all in a thirty minute (or less!) appointment time. We discuss what the term “multimorbidity” even means, how to ask about patient preferences and use them to inform the treatment plan, and what the evidence has to say about adjusting treatment goals of common conditions for individual patients. (Spoiler alert: It all depends on the patient, comorbid conditions and goals!)  Full show notes https://thecurbsiders.com/episode-list. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits Producer: Nora Taranto MD  Writer:  Nora Taranto MD, Leah Witt MD  Infographic:  Leah Witt MD  Cover Art: Nora Taranto MD  Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Leah Witt MD, Paul Williams MD, FACP Editor: Matthew Watto MD, FACP; Clair Morgan Guest: Josh Uy MD Time Stamps 00:00 Pun, Intro, disclaimer, guest bio 04:30 Guest one-liner; Career advice;  Picks of the Week*: Unbroken (book), Down Dog Yoga (app); Check out Dimash’s music on YouTube; Off Your Rocker (TV show); Finishing Well to the Glory of God (book) 12:30 A case of multimorbidity; Where to start? 15:30 How to focus the visit; Lumping and the problem list; 18:20 Dr Uy’s framework for multimorbidity 28:08 Questions (scripts) for eliciting patient preferences 30:20 Hypertension; All cause mortality; Number needed to treat; The danger of adding blood pressure medications in the hospital, the Jenga analogy 35:30 How to frame  potentially ineffective treatments (e.g. statins for primary prevention of stroke) and align treatments with a patient and family’s goals 44:18 Dr Uy runs through common comorbid conditions and time to benefit starting with longevity minded (45:43); Palliative minded approach (47:50) 48:49 Afib, anticoagulation and falls; Cancer screening 54:30 Take Home Points *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 develop an approach to managing older adults with multimorbidity in primary care   Learning objectives  After listening to this episode listeners will...  Define multimorbidity and its implications for triaging multiple chief complaints and chronic conditions Recognize the time frame to benefit of treatments for several chronic conditions Learn to ask patients about health care values and goals of care in order to optimize shared decision-making Identify the barriers to treating multimorbidity and strategize approaches for optimal primary care delivery for patients with multimorbidity Disclosures Dr Uy reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.  Citation Uy J, Taranto N, Witt LJ, Williams PN, Brigham SK, Watto MF. “#181 The Multimorbidity Games”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list November 4, 2019.
#180 CHEST 2019 Recap Part 2

#180 CHEST 2019 Recap Part 2

2019-10-3000:56:521

CHEST 2019 Recap Part 2 featuring random pearls and highlights from #CHEST2019 in New Orleans including: tips for addressing futile end-of-life care, bleeding in the ICU, DOAC reversal agents, use of procalcitonin and monocyte distribution width to identify sepsis, vitamin C for sepsis treatment, small particles and lung cancer risk, augmented reality/virtual learning, and tech as a teaching tool. Special thanks to Dr. Bill Kelly and his team at CHEST (@accpchest) for their hospitality.  Full show notes available at https://thecurbsiders.com/episode-list. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits Written, produced, and co-hosted by: Sarah Phoebe Roberts MPH; Paul Williams MD, FACP; Stuart Brigham MD; Matthew Watto MD, FACP Edited by: Matthew Watto MD, FACP Special Guests: Nina Maouelainin DO, MBA (@lungsolutions); Erin Narewski DO, FCCP (@erinnarewski); Chidinma Chima-Melton MD, FCCP (@LABritishLady), Kim Fabyan MD (@kfabsMD) Time Stamps 00:00 Pun, Disclaimer, Intro 03:58 Dr Erin Narewski on end of life conversations 13:30 Bleeding in the ICU 15:40 DOACs and reversal agents 18:40 Dr Chidinma Chima-Melton on ICU visiting hours 22:50 Vitamin C use in the ICU, Stuart’s Vitamin C rant 29:22 Monocyte distribution width for identifying patients with sepsis 30:55 Sarah Phoebe Roberts on Procalcitonin and CRP for sepsis 39:36 Dr Nina on technological innovations in MedEd: Virtual bronchoscopy; Dropping a computer in a remote village 46:49 Sarah Phoebe Roberts on Small particles and lung cancer risk 54:48 Outro Citation Narewski E, Chima-Melton C, Maouelainin N, Roberts SP, Williams P, Brigham S, Fayban K, Watto MF. “CHEST 2019 Recap Part 2”. The Curbsiders Internal Medicine Podcast https://thecurbsiders.com/episode-list. October 30, 2019.
Recap of random pearls and highlights from #CHEST2019 including: A pop quiz on inhaler use, interstitial lung disease, pulmonary fibrosis (IPF), limitations of supplemental oxygen, lung cancer screening, imposter syndrome, and is it safe to use beta blockers in COPD.  Special thanks to Dr. Bill Kelly and his team at CHEST (@accpchest) for their hospitality.  Full show notes available at https://thecurbsiders.com/episode-list. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits Written, produced, and cohosted by: Sarah Phoebe Roberts MPH; Paul Williams MD, FACP; Stuart Brigham MD; Matthew Watto MD, FACP Edited by: Matthew Watto MD, FACP Special Guests: Leah Witt MD (@leahJwitt); Nina Maouelainin DO, MBA (@lungsolutions); Erin Narewski DO, FCCP (@erinnarewski); Hassan Bencheqroun MD, FCCP (@drBcalifornia); Chidinma Chima-Melton MD, FCCP (@LABritishLady) Time Stamps 00:00 Intro, disclaimer 05:20 Dr Leah Witt @leahwitt (UCSF) quizzes us on inhalers. 09:55 Dr Leah Witt on ILD in geriatric patients 13:09 Dr Erin Narewski @erinnarewski (Temple) on supplement oxygen.  15:07 Dr Erin Narewski discusses the brand new BLOCK trial. 18:11 Dr Chidinma Chima-Melton @LABritishLady (UCLA) discusses the latest in interstitial lung disease (ILD) treatment and gives a rapid overview of ILD. 29:15 Dr Nina Maouelainin @lungsolutions discusses lung cancer screening 39:40 Dr Hassan Bencheqroun MD @drBcalifornia on how to overcome imposter syndrome by asking yourself “what if”. 44:39 Outro Citation Witt LJ, Maouelainin M, Narewski E, Bencheqroun H, Chima-Melton C, Roberts SP, Williams P, Brigham S, Watto MF. “CHEST 2019 Recap Part 1”. The Curbsiders Internal Medicine Podcast https://thecurbsiders.com/episode-list. October 28, 2019.
Catch up on the latest guidelines and insights on tuberculosis with help from Dr. Laila Woc-Colburn, @docwoc71 (Baylor)! We cover new recommendations for screening health care workers, treatment of both latent and active TB, and best practices for counseling patients throughout the process. Listen to find out more… And say goodbye to the annual PPD? 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 notes https://thecurbsiders.com/episode-list. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits Written and Produced by: Hannah R. Abrams Cover Art and Infographic by: Hannah R. Abrams Hosts: Hannah R. Abrams; Matthew Watto MD, FACP Editors: Matthew Watto MD, FACP; Emi Okamoto MD Guest: Laila Woc-Colburn, MD, FACP Partners   Win a prize! Celebrate National Internal Medicine Day and tell us why you’re I.M. Proud. Tell us why you are I.M. Proud and enter the contest by visiting www.acponline.org/improud to submit your story today! Answer one of the three questions below and share your story on social media using the hashtags #IMProud #NationalInternalMedicineDay, and tag @acpinternists. Prizes will be given out 3 times through June of 2020. The first group of winners will be announced on the first ever National Internal Medicine Day October 28, 2019! What makes you proud to practice internal medicine or one of the I.M. subspecialties?  What recent patient experience made you proud to be an internist or subspecialist? How is internal medicine unique from other subspecialties? See us at the CHEST 2019 Annual Meeting in New Orleans! We’ll be doing two live interviews on stage, plus recording two recap episodes to bring you high yield clinical pearls from the conference. Look out for us in our red Curbsiders shirts and say hello. Take a picture with Stuart! Give Paul a hug!  Sunday October 20 3:30-4:30 room 265-   Dr. Quinn Capers - Implicit Bias Monday October 21 7:30-8:30 room 281- Dr. Christine Won - Update in Sleep Medicine Time Stamps 00:00 Sponsor: ACP’s National Internal Medicine Day I.M. Proud Story Contest 00:24 Disclaimer, Intro, Guest bio, Pun 03:51 Guest one-liner, Career Advice; Picks of the Week*: Leonardo Da Vinci by Walter Isaacson; Aditya Shah (@IDdocAdi) antibiotic stewardship on Twitter; @EpicEMRParody on Twitter; Zima is a presumably delicious beverage (we’ve never tried it...ha) 09:52 Sponsor: ACP’s National Internal Medicine Day I.M. Proud Story Contest 11:30 Case of latent TB; Interpretation of PPD (Tuberculin Skin Test) 17:05 PPD and BCG vaccine; Who needs an IGRA? 19:20 LTBI treatment threshold; IGRA explained including what to do with “indeterminate results” 25:22 LTBI natural history; Why endemic countries don’t treat LTBI 30:08 TB infection, immunity and reinfection 33:33 How to counsel patients about latent tuberculosis treatment 38:25 Dietary and alcohol restrictions during LTBI therapy 44:18 Screening of healthcare workers 48:02 Case of active TB; AFB smears and nucleic acid amplification tests 56:05 Initiation of antibiotics for tuberculosis and how to handle TB resistance 58:13 Airborne precautions; Who needs them and how to isolate patients 61:24 Direct observed therapy and why adherence to tuberculosis therapy is challenging 68:11 Tuberculosis UV light and sanatoriums 71:00 Take home points 72:25 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. Goals Listeners will learn the current standard of care for diagnosis, treatment, and surveillance of tuberculosis. Learning objectives After listening to this episode listeners will…   Recognize updates in tuberculosis screening and treatment guidelines Identify best diagnostic modalities for latent and active tuberculosis Identify best practices for the management of tuberculosis during the diagnostic period Employ treatment algorithms and best practices for latent and active tuberculosis Disclosures Dr. Woc-Colburn reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.  Citation Woc-Colburn L, Abrams HR, Watto MF. “#178 Tuberculosis Updates with Laila Woc-Colburn MD”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list October 21, 2019.
ACR osteoarthritis guidelines author, Dr. Tuhina Neogi (Boston University; @tuhinaneogi) schools us on all things OA, including new understandings of pathophysiology, diagnosis, when to order imaging and labs, and an overview of pharmacologic and nonpharmacologic therapies. Plus, get answers to your questions from Twitter on CBD, turmeric, glucosamine, chondroitin, NSAIDS, intra-articular steroid and hyaluronic acid injections, tai chi, 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/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 (including CME questions) and Produced by: Beth Garbitelli and Matthew Watto MD, FACP Cover Art and Infographic by: Beth Garbitelli Hosts: Beth Garbitelli, Matthew Watto MD, FACP; Paul Williams MD, FACP Editor: Matthew Watto MD, FACP Guest: Tuhina Neogi MD, PhD Partners Win a prize! Celebrate National Internal Medicine Day and tell us why you’re I.M. Proud. Tell us why you are I.M. Proud and enter the contest by visiting www.acponline.org/improud to submit your story today! Answer one of the three questions below and share your story on social media using the hashtags #IMProud #NationalInternalMedicineDay, and tag @acpinternists. Prizes will be given out 3 times through June of 2020. The first group of winners will be announced on the first ever National Internal Medicine Day October 28, 2019! What makes you proud to practice internal medicine or one of the I.M. subspecialties?  What recent patient experience made you proud to be an internist or subspecialist? How is internal medicine unique from other subspecialties? See us at the CHEST 2019 Annual Meeting in New Orleans! We’ll be doing two live interviews on stage, plus recording two recap episodes to bring you high yield clinical pearls from the conference. Look out for us in our red Curbsiders shirts and say hello. Take a picture with Stuart! Give Paul a hug! Register today https://chestmeeting.chestnet.org/ !!!!   Time Stamps 00:00 Sponsor: ACP’s National Internal Medicine Day I.M. Proud Story Contest 00:15 Cold open, disclaimer, intro and guest bio 05:44 Guest one-liner, Picks of the Week*: Joe Nesbo mystery novels, The Snowman (film), Midsommar (film), Won’t You Be My Neighbor (film), @vermontkitchen Beth’s food blog, Serious Eats; Buy Yourself a Ballistic Jump Rope 07:55 Dr. Neogi’s Women in Medicine moment of awakening 15:40 Sponsor: ACP’s National Internal Medicine Day I.M. Proud Story Contest 17:35 Case of Osteoarthritis; Initial history and exam 23:23 Imaging for osteoarthritis 28:45 Physical exam for OA 31:45 Osteoarthritis risk factors 33:48 Pathophysiology of OA 37:43 Targeted therapies for OA are in the pipeline; Weight loss and joint protection 41:35 Mechanisms of pain in OA and recognizing pain phenotypes 46:58 Mainstays of osteoarthritis treatment 49:56 Capsaicin, Acetaminophen, and the importance of positivity 52:22 Intra-articular injections with corticosteroids or hyaluronic acid 57:25 Occupational therapy, More on Topical and Oral NSAIDS; SNRIs (duloxetine)   62:00 Questions from Twitter: CBD and marijuana (cannabis), turmeric, fish oil (omega 3 fatty acids) 65:03 More from Twitter: Glucosamine/chondroitin, acupuncture, tai chi, yoga, mindfulness, meditation 70:42 New targets for osteoarthritis; Take Home Points 73:40 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 learn to classify osteoarthritis (OA), assess symptom management, counsel patients on lifestyle modifications, manage pharmacologic interventions for OA, and counsel patients about complementary and alternative therapies commonly suggested by popular culture. Learning objectives After listening to this episode listeners will be able to... Differentiate OA from other joint pathologies like rheumatoid arthritis Diagnose osteoarthritis and select patients who warrant imaging or labs Describe the pathophysiology of osteoarthritis Counsel patients on appropriate lifestyle modifications for management of OA symptoms Choose appropriate pharmacotherapy for osteoarthritis and counsel patients about potential risks and benefits Counsel patients about supplements and complementary, alternative medicine therapies commonly suggested by popular culture Disclosures Dr Neogi has acted as a consultant to Pfizer and Novartis for osteoarthritis therapies still in clinical trials. No trade names were used during the podcast and a balanced range of therapeutic options was included in the discussion. The Curbsiders report no relevant financial disclosures.  Citation Neogi T, Garbitelli B, Williams PN, Watto MF. “#177 Osteoarthritis Master Class with Tuhina Neogi MD, PhD”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. October 14, 2019.
In-Flight Emergencies REBOOT

In-Flight Emergencies REBOOT

2019-10-0700:40:291

Dominate the most common in-flight emergencies with tools and tips from this classic Curbsiders episode. Our guest, Angelica Zen MD, (formerly an IM Chief Resident at UCLA), recounts a harrowing tale of heroism at 30,000 feet and schools us on how to throw down in an in-flight emergency. We review what’s available in the standard medical kit, common conditions encountered, and the medical legal implications of responding to in-flight emergencies. This episode is a must listen before you next step on a plane. Original air date November 21, 2016. Full show notes https://thecurbsiders.com/episode-list. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits Written, produced and edited by: Matthew Watto MD, FACP Cover Art by: Matthew Watto MD, FACP Hosts: Stuart Brigham MD; Paul Williams MD, FACP; Matthew Watto MD, FACP Guest: Angelica Zen MD Partners Win a prize! Celebrate National Internal Medicine Day and tell us why you’re I.M. Proud. Tell us why you are I.M. Proud and enter the contest by visiting acponline.org/improud to submit your story today! Answer one of the three questions below and share your story on social media using the hashtags #IMProud #NationalInternalMedicineDay, and tag @acpinternists. Prizes will be given out 3 times through June of 2020. The first group of winners will be announced on the first ever National Internal Medicine Day October 28, 2019! What makes you proud to practice internal medicine or one of the I.M. subspecialties?  What recent patient experience made you proud to be an internist or subspecialist? How is internal medicine unique from other subspecialties? See us at the CHEST 2019 Annual Meeting in New Orleans! We’ll be doing two live interviews on stage, plus recording two recap episodes to bring you high yield clinical pearls from the conference. Look out for us in our red Curbsiders shirts and say hello. Take a picture with Stuart! Give Paul a hug! Register today https://chestmeeting.chestnet.org/ !!!! Time Stamps 00:00 Cold open; Disclaimer 00:50 Sponsor: ACP’s National Internal Medicine Day 2019 www.acponline.org/improud  01:10 Intro, Guest Bio 02:50 Guest onliner; Wellness tips; Tips for staying up on the literature Pick of the Week*: How Doctors Think (book) by Jerome Groopman; MDCalc app; AHRQ app; Physician’s First Watch 07:30 Sponsor: ACP’s National Internal Medicine Day 2019 www.acponline.org/improud  09:08 Dr. Zen tells her story 19:27 Monitoring your patient in-flight 20:05 Contents of the standard in-flight medical kit 22:10 What Dr. Zen would have done differently 23:05 How to use available resources in-flight 24:20 Medical legal implications 28:07 How to respond to common in-flight emergencies and how to respond 29:35 Syncope and presyncope 31:55 Hypoxia altitude simulation test (HAST) 33:15 Altered mental status 33:52 Anaphylaxis 35:34 Stroke and acute coronary syndrome 36:55 Dr. Zen’s take home points 38:50 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 comprehend their role and potential liabilities during in-flight emergencies and effectively utilize available resources for triage, patient care, and decisions about diverting the plane. Learning objectives By the end of this podcast listeners will: Be familiar with the contents of the standard medical kit Think outside the box to identify, improvise and utilize the available resources for patient care Recognize the medical legal consequences of providing emergency medical care on a plane Confidently evaluate and manage common in-flight emergencies using the available resources Disclosures Dr. Zen reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures. Citation Zen A, Brigham SK, Williams PN, Watto MF. “#19 In-Flight Emergencies.” The Curbsiders Internal Medicine Podcast https://thecurbsiders.com/episode-list. Original air date November 21, 2016.
Tools, tips and tactics to survive intern year from Alex Glaser MD (PENN) and Saumil Chudgar MD @saumilchudgar (Duke). It’s our latest offering from ACP’s IMpower series for residents!  The transition from medical student to intern is one of the world’s most notorious times in a career, and tales of woe from intern year have even permeated into TV shows and movies.  Ultimately, while the transition seems daunting with multiple challenges, it should not be feared. Many physicians look back fondly on this early time in their training, and life-long friendships often develop among an intern class.  This is a time of major growth, and unease about intern year should be met with excitement for the career that is yet to come! For meeting notes, a discussion guide and facilitators guide visit https://www.acponline.org/impower. 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: Alex Glaser MD  Cover Art: Matthew Watto MD, FACP Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP Editor: Emi Okamoto MD; Matthew Watto MD, FACP Guests: Alex Glaser MD, Saumil Chudgar MD   Sponsor - ACP IMpower: Catalyzing your professional future Each month, ACP IMpower offers non-clinical tools and resources expertly crafted to support residents during their training and catalyze their professional future. Crafted by ACP leaders, experienced internists, and prominent podcasters, IMpower covers a wide variety of topics valuable to residents at every stage of their training, and beyond. Visit https://www.acponline.org/impower. Time Stamps 00:00 Pun, disclaimer 00:58 Sponsor: ACP’s IMpower series 01:40 Intro, guest bios 04:10 Guest one-liners 07:12 Picks of the Week: Wheel of Time Series (books); Attending Medicine Mindfulness and Humanity (book) 09:20 Challenges transitioning to intern year -both personal and professional 17:45 Wellness tips for intern year; Work life balance doesn’t exist; The “wellness battery” 22:05 Gratitude journal is an evidence based wellness intervention for residents; Wellness is a systems issue 27:25 Resources, tips and tactics for intern year struggles 32:00 Key skills sets for interns 40:05 Also some skills that are less important than you think 43:38 Practices, habits to improve your skills as an intern; SMART goals; Soft Mentors 48:02 An ideal workday for a Kashlak intern 55:47 Take Home Points 57:45 Outro and post credits scene
We dive deep into the relationship between HPV and cervical cancer and identify when and how to screen women with tips from Dr. Karen Smith-McCune (UCSF), Professor in the Department of Obstetrics and Gynecology! We review common cytology findings, screening guidelines, and basic indications for HPV vaccination.  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 Producer: Molly Heublein MD Writer: Elena Gibson MD and Molly Heublein MD Infographic: Beth Garbitelli MS2 Cover Art: Kate Grant MBChB DipGUMed Hosts: Molly Heublein MD; Matthew Watto MD, FACP Editor: Emi Okamoto MD; Matthew Watto MD, FACP Guest: Karen K. Smith-McCune MD, PhD   Sponsors Win a prize! Help ACP Celebrate National Internal Medicine Day and tell us why you’re I.M. Proud. Tell us why you are I.M. Proud and enter the contest by visiting acponline.org/improud to submit your story today! Answer one of the three questions below and share your story on social media using the hashtags #IMProud #NationalInternalMedicineDay, and tag @acpinternists. Prizes will be given out 3 times through June of 2020. The first group of winners will be announced on the first ever National Internal Medicine Day October 28, 2019! What makes you proud to practice internal medicine or one of the I.M. subspecialties?  What recent patient experience made you proud to be an internist or subspecialist? How is internal medicine unique from other subspecialties? See us at the CHEST 2019 Annual Meeting in New Orleans! We’ll be doing two live interviews on stage, plus recording two recap episodes to bring you high yield clinical pearls from the conference. Look out for us in our red Curbsiders shirts and say hello. Take a picture with Stuart! Give Paul a hug! Register today https://chestmeeting.chestnet.org/ !!!! Time Stamps 00:00 Sponsor: I.M. Proud National Internal Medicine Day Story Contest 01:00 Reminder: We’ll be at CHEST 2019 in NOLA! 01:33 Intro, guest bio 04:35 Guest one-liner; Check out our classic Curbsiders’ Top Picks 08:00 Sponsor: I.M. Proud National Internal Medicine Day Story Contest 09:49 Case of HPV; Background; Is HPV an STI? 13:47 Frequency of screening; Discussion of testing types & pitfalls 18:11 Summary of testing for cervical cancer 20:20 Is co-testing every helpful? 24:05 Choosing a testing interval 24:40 Colposcopy; Risks 32:19 Screening women under 30 years old? Under 21 years old? 33:22 Interpreting a PAP (cytology) result; Algorithm for cervical cancer screening 42:08 Women over 65 years old; When to stop screening 46:02 Will Vaginal swabs replace traditional cervical screening 48:40 Screening after Hysterectomy or “Partial” hysterectomy 50:25 HPV vaccine in older adults and shared decision making 54:21 HPV vaccine in children, young adults 58:12 Take home points 59:40 Outro Disclosures Dr. Smith-McCune reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.  Citation Smith-McCune K, Heublein M, Gibson E, Garbitelli B, Okamoto M, Watto MF. “#175 Cervical Cancer Screening and HPV”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. September 30, 2019.
Dominate perioperative medication management with tips from Kashlak’s newly minted Chief of Perioperative Medicine, @aoglasser, Avital O’Glasser MD, FACP, FHM (OHSU). We cover perioperative anticoagulation, why “bridging is dead”, aspirin, dual antiplatelet therapy, DMARDS, diabetic medications, buprenorphine, and much more! Be sure to check out Dr. O’Glasser’s previous episode #135 Perioperative Medicine: Assess and Optimize Risk to get a full overview of perioperative medicine. 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 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: Avital O’Glasser MD, FACP, FHM and Matthew Watto MD, FACP  CME Questions: 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: Avital O’Glasser MD, FACP, FHM Time Stamps 00:00 Intro, disclaimer, guest bio 03:20 Guest one-liner 04:46 Picks of the Week*: A Moment of Lift (book) by Melinda Gates; Crawl (film); Rich Roll (podcast) episodes w/Valter Longo and David Sinclair 09:35 Avi’s mantras for perioperative management and other core tenants 14:40 NPO and The Consult Guys 17:23 Medical cannabis (marijuana) in perioperative medicine 19:24 Case #1 Ms. Bridge - perioperative anticoagulation: to bridge or not to bridge 25:00 Low bleeding risk surgeries and anticoagulation 27:25 Moderate to high bleeding risk surgeries and anticoagulation; What about the CHA2DS2 Vasc of 7? 28:42 Bridging for venous thromboembolism (VTE) 31:30 How to give instructions for holding warfarin 32:30 Bridging a DOAC 36:16 Recap on bridging VKAs and use of DOACs 37:48 Neuraxial anesthesia and anticoagulation 39:49 Biologic DMARDS; Nonbiologic DMARDS 43:48 Supplements and herbals 48:40 Case #1 wrap up 50:16 Case #2 -Mr. DAPT; Perioperative Aspirin; DAPT -dual antiplatelet therapy 57:20 Summary of perioperative antiplatelet therapy 63:18 Statins 64:45 Beta blockers 67:21 ACEI and ARB; Diuretics 69:17 Oral hypoglycemics and newer diabetes agents (SGLT2 inhibitors, GLP1 agonists); What about metformin? 72:04 Insulin 74:40 Case #2 wrap up 75:35 Case #3 Ms. GB Stone who takes lithium and buprenorphine 77:30 NSAIDS, Buprenorphine 81:45 ART, transplant meds, Lithium, MAOIs, Levothyroxine; Watch out for lithium 86:34 Case #3 wrap up 87:25 Take Home Points 88:45 Outro 90:15 Avi and Mr. Rogers  *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. Goals Listeners will develop a practical approach to perioperative medication management and review special considerations for the various drug classes. Learning objectives After listening to this episode listeners will... Frame perioperative medication management decisions as another type of patient-centered, surgery-specific perioperative “risk/benefit” decision Discuss guideline recommendations for the perioperative management of multiple classes of medications Examine more nuanced or challenging medications to manage in the perioperative setting Explore professional, patient-centered and multidisciplinary communication techniques when disagreements arise regarding best medication management recommendations Disclosures Dr O’Glasser reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.  Citation O’Glasser A, Williams PN, Watto MF. “#174 Perioperative Medication Management”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. September 23, 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.
  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.
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.
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.
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. Flip the classroom! For meeting notes, a discussion guide and facilitators guide visit visit IMpower: Catalyzing your professional future.  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 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 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.
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Comments (2)

Daniel B

Amazing podcast for medical students. Highly recommend!

Sep 29th
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Aman Kaur

Internal medicine

Jun 21st
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