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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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Discover common practices that persist in the hospital wards despite no proven benefit! We review how potassium replacement goals should not drive you bananas, extra oxygen should not give you comfort, and how you should maybe calm down with antipsychotics for delirium. Join returning guests: high-value care specialist Dr. Lenny Feldman (@DocLennyF, Johns Hopkins) and tweetorialist Dr. Tony Breu (@tony_breu, Harvard) as they walk us through round 3 of “Things We Do for No ReasonTM. SHM members can claim CME-MOC credit at https://www.shmlearningportal.org/curbsiders (CME goes live at 0900 ET on the episode’s release date). Note: The planners and faculty for this activity have no relevant relationships or conflicts to disclose. Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com Credits Written and Produced by: Burton H. Shen MD, Justin Berk, MD MPH MBA Infographic: Cover Art: Hosts: Justin Berk MD MPH MBA; Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FaCP Editor: Matthew Watto MD, FACP (written materials); Clair Morgan of Nodderly.com (audio) Guest: Lenny Feldman MD, Tony Breu MD Sponsors The Society of Hospital Medicine Hospital Medicine 2020 (HM20) is the Society of Hospital Medicine’s Annual Conference April 15th through the 18th in sunny San Diego. Don’t miss the largest hospital medicine meeting. Register now at https://shmannualconference.org/ and use the code CURBSIDERS to receive a $50 discount. Primary Care Internal Medicine of Ithaca Join a well established practice in beautiful upstate New York near the finger lakes and wine country! You'll have flexible hours and the ability to take the time you need with patients! Contact Dr. Ann Costello arcostello@gmail.com to find out more about this incredible opportunity to join the team at Primary Care Internal Medicine of Ithaca https://www.primarycareinternalmedicineofithaca.com/.  Time Stamps 00:00 Sponsors -SHM’s Annual Conference, HM20 (use code CURBSIDERS) and Primary Care Internal Medicine of Ithaca (email: arcostello@gmail.com) 00:38 Intro, disclaimer, guest bio 02:10 Guest one-liners 03:35 Picks of the Week*: Knives Out (film), Priced Out by Uwe E. Reinhardt; Crisis in the Red Zone by Richard Preston; CardioNerds podcast; Outbreak (film); Teaching Physiology on the Fly (faculty development course) 07:55 Sponsors -SHM’s Annual Conference, HM20 (use code CURBSIDERS) and Primary Care Internal Medicine of Ithaca (email: arcostello@gmail.com) 09:30 Case of Eric Lokay; Repleting potassium. Is it necessary to “buff the lytes” 20:30 Pathophysiology of hypokalemia; Final recommendations on potassium repletion 24:30 Supplemental oxygen; pO2 vs total oxygen content; Oxygen, vasoconstriction and potential harms 30:33 Evidence of harm from supplemental O2 35:00 Tony’s recommendations for use of supplemental O2 41:55 Case of delirium; Definition and diagnosis 46:20 Can we prevent delirium? Melatonin and ramelteon 50:33 Should we use antipsychotics? Benzodiazepines?; What should we do instead? 58:25 Take home points, Outro and a terrible 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 our Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra. Disclosures Dr. Feldman and Dr. Breu report no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.  Citation Feldman L, Breu T, Shen BH, Berk JL, Williams PN, Brigham SK, Watto MF. “#195 TWDFNRTM 3: Potassium, Oxygen, and antipsychotics”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. February 17, 2020.
Dismantle alcohol use disorder with some evidence based tools for your toolbelt! We cover everything from ways to screen patients for risky drinking, to all the different treatment options with our guest expert Dr. Marlene Martin, @MarleneMartinMD, Director of the Addiction Care Team and Assistant Professor of Clinical Medicine at the UCSF. We learn how to initiate medications such as naltrexone and acamprosate for the treatment of alcohol use disorder, how to define treatment success, if psychosocial interventions such as Alcoholics Anonymous are effective, and what’s the deal with baclofen and gabapentin? After listening to this episode, listeners will feel ready to start prescribing medications such naltrexone to treat alcohol use disorder.  Your patients need you! 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: Carolyn Chan, MD Cover Art and Infographic: Carolyn Chan, MD Hosts: Carolyn Chan, MD; Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP    Editor: Matthew Watto MD, FACP (written materials); Clair Morgan of Nodderly.com (audio) Guest: Marlene Martin, MD Sponsor ACP’s Medical Knowledge Self Assessment Program, MKSAP 18. MKSAP provides the latest and most comprehensive educational content needed by internists today. It’s THE internal medicine go-to resource for continuous learning and Board preparation. Visit http://www.acponline.org/mksapcurbsiders to place your order! Time Stamps 00:00 Sponsor -ACP’s MKSAP 18 http://www.acponline.org/mksapcurbsiders  00:45 Intro, guest bio 01:30 Guest one-liner, book recommendation, favorite failure, career advice Picks of the week*: Project Runway (TV show); The Quiet Place (film); Tattoos on the Heart: The Power of Boundless Compassion (book) by: Gregory Boyle; Cats (film) 08:20 Sponsor -ACP’s MKSAP 18 http://www.acponline.org/mksapcurbsiders  09:05 Case of Mr Hops; Defining unhealthy alcohol use 13:37 Screening and diagnosis; assessing for tolerance; stratifying severity of AUD 16:56 Spiel and first steps after diagnosing a patient with unhealthy alcohol use; Motivational interviewing; Exploring motivation to change 22:12 Pharmacologic treatment options: Naltrexone, acamprosate, disulfiram 26:40 How effective are medications for alcohol use disorder; Defining success 29:41 Naltrexone prescribing, dose titration 34:25 Acamprosate prescribing; Naltrexone in advanced liver disease 38:05 Off label use of baclofen, gabapentin and topiramate 43:39 Risk stratifying for inpatient versus outpatient treatment; Non-pharmacologic interventions 49:26 Deciding duration of therapy 52:24 Take home points; Plug for AMERSA conference 53:57 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. Disclosures Dr Marlene Martin reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.  Citation Martin M, Chan, C, Williams PN, Brigham SK, Watto MF. “194 Treatment of Alcohol Use Disorder”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. February 10, 2020.
Join us as we discuss how to approach “The Struggling Learner” with Dr. Melissa McNeil (@missydoc0128), Professor Medicine and Associate Chief of General Internal Medicine at the University of Pittsburgh Medical Center (UPMC), recorded LIVE in Pittsburgh, PA!  In this episode, we discuss how to approach the struggling learner, highlighting the 5-Step process discussed in a recent article co-written by Dr. McNeil (Merriam 2019).  This episode is not intended to give educators a roadmap for how to develop and implement a corrective action plan, but was put together to provide a common toolset on how to approach a struggling learner.  As such, the topics discussed can be applied to all kinds of learners that struggle, not just in medicine. However, the techniques discussed involve a common framework routinely taught in medical education (assessment, diagnosis, and referral) and, therefore, is communicated using this shared language. Show Notes | Subscribe | Spotify | Schwag! | Top Picks | Mailing List | thecurbsiders@gmail.com Credits Written and Produced by: Stuart Brigham MD Infographic: Matthew Watto MD, FACP Cover Art: Stuart Brigham MD Hosts:  Matthew Watto MD, FACP; Paul Williams MD, FACP; Stuart Brigham, MD Editor: Stuart Brigham MD (written materials); Clair Morgan at Nodderly.com Guest: Melissa McNeil MD, MACP Special thanks to Dr. William Kelly, FACP, FCCP Sponsor ACP’s Medical Knowledge Self Assessment Program, MKSAP 18. MKSAP provides the latest and most comprehensive educational content needed by internists today. It’s THE internal medicine go-to resource for continuous learning and Board preparation. Visit http://www.acponline.org/mksapcurbsiders to place your order! Time Stamps 00:00 Sponsor - ACP’s MKSAP 18! 00:15 Intro, disclaimer, guest bio 05:50 Guest one-liner, favorite failure 10:30 Picks of the Weeks*: Book: Radical Candor; Movie: Clue (1985); Book: Awareness by Anthony De Mello; TV Series:  The Expanse (Season 4) on Amazon Prime 13:28 Sponsor - ACP’s MKSAP 18! 14:14 Case of a struggling learner; defining terms 20:24 Gathering data; Clarifying questions; Timing and feedback 28:30 Develop a differential diagnosis; Naming the behavior 37:42 SRL tool to evaluate deficits 42:55 Case of an overconfident learner 48:40 Concern for substance use in a struggling learner 52:02 Educational handoffs 54:53 Identifying learners who struggle with empathy 56:36 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 identify practical tools, tips, and techniques using skills developed for patient care and appreciate what they can do when a learner is struggling. Learning objectives After listening to this episode listeners will…   Develop an appreciation for how to approach the struggling learner  Recognize how to “diagnose” learners using clinical reasoning skills Appreciate the importance that timely, specific feedback plays in identifying why a learner struggles Identify why lack of insight can make addressing these struggles more difficult Disclosures Dr. McNeil reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.  Citation McNeil M, Brigham SK, Williams PN, Watto MF. “#193 The Struggling Learner with Dr Melissa McNeil”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. February 3, 2020.
Kidney Boy Returns! Compare the types of dialysis, learn how nephrologists approach medication management in ESRD, and avoid the most common mistakes non-nephrologists make in patients on dialysis! Kashlak Chief of Nephrology Dr. Joel Topf, @kidney_boy, walks us through what you need to know to take care of a patient on dialysis and gives us an idea of how nephrologists think through mineral bone disease (calcium, phosphorus and vitamin D), anemia, iron repletion, and hypertension. We answer all your questions about co-managing patients on dialysis! Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com Credits Producer: Hannah R. Abrams Written and produced by: Hannah R. Abrams Cover Art and Infographic by: 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 (audio) Guest: Joel Topf MD Sponsor ACP's Internal Medicine Meeting 2020 April 23-25th in Los Angeles, CA at the LA Convention Center. Early bird rates are available through January 31, 2020. Don’t forget to use the code: IMCURB20 Time Stamps 00:00 Sponsor -ACP’s Internal Medicine Meeting 2020 00:15 Intro, disclaimer, guest bio 01:45 Guest one-liner, Picks of the Week*: KidneyCon, CATS (film) 06:00 Sponsor -ACP’s Internal Medicine Meeting 2020 06:50 Case of Anne Yuric; Assessing risk of progression to dialysis; Candidacy for dialysis and renal transplant 12:20 Why is mortality so high on dialysis 15:47 When to initiate dialysis 19:40 Types of dialysis; the importance of residual renal function 25:45 Why is peritoneal dialysis underutilized 28:10 Dialysis access 34:25 Return to our case: Mineral bone disease, and phos binders; Calcyphylaxis 44:40 Which problems are under the domain of the nephrologist and the dialysis unit?; Hypertension management in ESRD; Midodrine; 48:18 ACEI/ARB, spironolactone 51:55 Anemia and iron in ESRD; Screening in Primary Care for patients on dialysis; Statins in patients on dialysis 57:42 Medications to avoid 61:50 Renal diet; Warfarin and DOACs on dialysis 66:48 Common inpatient mistakes: Labs, PICC lines 69:36 Takes Home Points; Plug: NephMadness 2020 is coming! 72:19 Outro 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, Williams PN, Watto MF. “#192 Dialysis for the Internist with Joel Topf MD”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. January 27, 2020.
Trailer for season 9 of The Curbsiders! Plus, our friends from NephJC and the Freely Filtered Podcast will be at KIDNEYcon 2020! It features 6 amazing hands on workshops and lots of celebrities from #NephTwitter. The deadline for travel grants is approaching (See below). What: KIDNEYcon 2020 (www.kidneycon.org) When: April 16-19, 2020 Where: Little Rock, Arkansas Who Should Attend: Internal Medicine Residents, Pediatric Residents, Adult and Pediatric Nephrology Fellows, Attending Nephrologists Travel Grants: Available for Adult and Pediatric Residents and Nephrology Fellows (Deadline to apply: February 1st ) Click HERE to Register in January 2020
Lipids Update! Get up close and personal with ASCVD prevention and lipid management guidelines, including changes in the 2018 update, with our discussion with Dr. Erin Michos @erinmichos, preventive cardiologist and associate professor of medicine at the Johns Hopkins University Hospital! We review the background on the ASCVD risk calculator, basics of primary and secondary prevention, statins benefits and misconceptions, appropriate follow up, cool things to look out for in the future, the deal with medications like aspirin and icosapent ethyl, among many other things! If that wasn’t enough, Dr. Michos also goes over great ways to counsel patients on healthy living and when that darn statin is giving you the “muscle aches”!  ACP members can claim CME-MOC credit at https://www.acponline.org/curbsiders (CME goes live at 0900 ET on the episode’s release date).  Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com Rate our infographics! Tell us what you think in this brief survey. Credits Producers: Christopher Chiu MD FACP FAAP; Jasneet Devgun DO; Justin Berk MD MPH MBA; Beth Garbitelli  Writers: Jasneet Devgun DO; Justin Berk MD MPH MBA Infographic: Beth “Garbs” Garbitelli Cover Art: Kate Grant MBChB DipGUMed Hosts: Christopher Chiu MD FACP FAAP; Matthew Watto MD FACP; Paul Williams MD FACP    Editors: Emi Okamoto MD (written materials); Clair Morgan of Nodderly.com (audio) Guest: Erin Michos MD MHS Sponsor ACP's Internal Medicine Meeting 2020 April 23-25th in Los Angeles, CA at the LA Convention Center. Early bird rates are available through January 31, 2020. Don’t forget to use the code: IMCURB20 Time Stamps 00:00:00 Intro 00:01:52 Getting to know Dr. Erin Michos 00:O6:50 Picks of the Week*: Sparking Joy- concept for Marie Kondo (book and show), The Life-Changing Magic of Tidying Up by Marie Kondo; Shadowland, book by Peter Straub; The Crown, Netflix series; Catch and Kill, book by Ronan Farrow; Trick Mirror, essay collection by Jia Tolentino; Make it Stick, book by Brown, Roediger, and McDaniel 00:11:50 Digging into ASCVD Risk Calculator 00:16:12 Who should get 10 year ASCVD Risk assessment and what are the categories? 00:18:13 How Dr. Michos discusses healthy lifestyle and “Primordial Prevention” 00:19:42 What are “Risk Enhancing Factors”? 00:22:36 Who should get biomarker testing vs CAC scoring? 00:29:35 How Dr. Michos discusses statin therapy with her patients 00:32:18 How to address risks of side effects 00:37:57 Primary vs Secondary Prevention 00:39:40 “What should my cholesterol be?” 00:42:03 How often to follow-up labs? 00:46:00 Differences between stain intensity 00:47:57 How to manage side effects 00:52:05 PCSK9 inhibitor discussion 00:55:06 Aspirin, Fibrates and Icosapent Ethyl 01:02:13 High Risk vs Stable ASCVD 01:06:50 Take home points and the future 01:10:50 Outtro *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 managing both primary and secondary prevention for ASCVD among different patient scenarios.  Learning objectives After listening to this episode listeners will…   Recognize the different risk levels and further ways to hone risk-stratification. Describe primary prevention management including how to discuss lifestyle changes, statins, and managing common statin-related complaints. Recognize the importance of lipid reduction for secondary prevention and different medications to achieve this. Disclosures Dr Erin Michos reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.  Citation Michos E, Devgun J, Garbitelli B, Chiu C, Berk J, Williams PK, Watto MF. “#191 Lipids Update with Erin Michos MD”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. January 20, 2020.
A Curbsiders classic with a fresh intro by Hannah Abrams @hannahRabrams (soon to be MD)! Master the management of hyperkalemia with tools, tips and tactics from @kidney_boy, Joel Topf MD, Chief of Nephrology @KashlakHospital. We cover: common causes of hyperkalemia; the U-shaped curve of potassium levels and mortality; albuterol nebs; how to safely use insulin; potassium binding resins and colonic necrosis; Does it make sense to give loop diuretics and fluids?; Should we be using fludrocortisone?; Plus, answers to all your questions about a high potassium diet and oral potassium supplements! Join us for Dr Topf’s masterful insights on hyperkalemia and potassium homeostasis. Get deeper into potassium physiology with a FREE pdf copy of Joel’s book The Fluid Electrolyte and Acid Base Companion here. Show Notes | Subscribe | Spotify | Schwag! | Top Picks | Mailing List | thecurbsiders@gmail.com Sponsor ACP's Internal Medicine Meeting 2020 April 23-25th in Los Angeles, CA at the LA Convention Center. Early bird rates are available through January 31, 2020. Don’t forget to use the code: IMCURB20 Credits Written, edited and produced by: Matthew Watto MD, FACP Intro: Hannah R Abrams Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP; Stuart Brigham MD Infographic and Cover Art: Matthew Watto MD, FACP Guest: Joel Topf MD Time Stamps 00:00 Sponsor -ACP’s IM Meeting 2020 in LA 00:28 Disclaimer, intro and guest bio 03:00 Guest one-liner Picks of the week* —Peloton indoor bike; The Nice Guys (film) by Shane Black; Forgotten Anne (PS4 videogame), “your local library” 09:00 Sponsor -ACP’s IM Meeting 2020 in LA 09:55 Clinical case of hyperkalemia; discussion of pseudohyperkalemia 17:00 Hyperkalemia and the EKG 20:31 Threshold for treatment of hyperkalemia 24:20 Use of telemetry and the U-shaped curve for potassium and mortality 27:11 Choice of therapy for acute hyperkalemia 30:13 Albuterol for hyperkalemia 31:24 First rule out urinary obstruction and hyperglycemia; Use of IV insulin and dextrose and frequency of monitoring 36:44 Loop diuretics plus fluid; Distal sodium delivery and potassium handling in the nephron 40:10 Fludrocortisone for hyperkalemia 42:05 Calcium for elevated potassium 45:43 SPS, potassium binding resin 49:43 Risks of SPS (sodium polystyrene sulfonate) and colonic necrosis 55:28 Sodium bicarbonate for acute and chronic hyperkalemia 58:00 Back to the case; TMP-SMX, ace inhibitors (or ARBs) and hyperkalemia 60:05 Threshold for admission; Diet and potassium 62:52 Treatment of chronic hyperkalemia and a bit more on high potassium foods 65:45 Patiromer and sodium zirconium 68:51 Loop diuretics and empiric potassium supplementation 71:12 Can diet alone be used to treat HYPOkalemia? 72:26 Take home points 74:40 NephMadness is coming! March 2019 76:53 Outro 78:00 Stuart’s shares a few puns *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’s blog lists the following disclosures “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 were sponsored by ACP’s Internal Medicine Meeting 2019 for this episode. Citation Topf J, Williams PN, Brigham SK, Watto MF. “#137 Hyperkalemia Master Class with Joel Topf MD.” The Curbsiders Internal Medicine Podcast https://thecurbsiders.com/episode-list. Original air date: January 28, 2019. 
Beth Garbitelli and Nora Taranto MD add a new intro and share their own insights on this Curbsiders classic! Physician suicide is a problem. There, we said it. We all have that story; Many of us have experienced the symptoms of depression or suicidal ideation ourselves, or have the colleague, mentor, friend, teacher, sibling, parent, or significant other who has experienced these signs and symptoms. Some of us (probably more than you’d think) have lost someone meaningful to suicide. And yet, we don’t talk about suicide and mental health in medicine, or at least, not enough. So, today, we at the Curbsiders are trying to change that.  The problem of depression and suicide is a particularly real one in medicine, a profession that is, by its very nature traumatic and emotionally draining (both in terms of work demands and also the sick and dying patients we treat). In this episode, we talk with expert Dr. Elisabeth Poorman about the natural history of depression in residency and beyond. We share some of our own personal stories, and discuss how we can support one another and reach out for help, how to take care of our mental health in an emotionally demanding career, how to deal with licensing questions and worry about stigma, and what systemic changes may be coming (read: we think need to be coming) down the line.  N.b. This is a sensitive topic. If this is triggering for anyone listening, the national suicide hotline number 1-800-273-8255. Moreover, if anyone needs or wants guidance on available resources, Dr. Elisabeth Poorman has made herself available via email at doctorpoorman@gmail.com, or you may reach out to any of us on Twitter. We are happy to talk and see that you get the support you need. New episodes return January 20, 2020! Show Notes | Subscribe | Spotify | Schwag! | Top Picks | Mailing List | thecurbsiders@gmail.com Sponsor ACP's Internal Medicine Meeting 2020 April 23-25th in Los Angeles, CA at the LA Convention Center. Early bird rates are available through January 31, 2020. Don’t forget to use the code: IMCURB20 Credits Written and produced by: Nora Taranto MD, Shreya Trivedi MD Hosts: Stuart Brigham MD, Shreya Trivedi MD, Matthew Watto MD Edited by: Matthew Watto MD  Guest: Elisabeth Poorman, MD  Time Stamps  00:00 Sponsor - ACP’s Internal Medicine Meeting 2020 in LA 00:45 Fresh intro by Beth Garbitelli and Nora Taranto MD 10:15 Sponsor - ACP’s Internal Medicine Meeting 2020 in LA 11:08 Guest one-liner 12:18 Wellness Recommendations: Find a Therapist  15:05 How to find a therapist in training; Licensing and Mental Health  21:07 Disclaimer and Trigger Warning: Stories are Sensitive. National suicide hotline info  Next, Dr Poorman and each of The Curbsiders share their personal experiences with mental health (see below). 22:25 Shreya story 30:30 Stuart’s story 40:12 Elisabeth’s story 45:10 Watto’s story 55:27 Passive suicidal ideaiton, a definition; Suicide and Depression: Do they always coexist? (No); Life Cycle of Depression and Suicide in the Medical Profession  56:07 Depression and Suicide in Primary Care  56:44 Mini-Cases  62:39 Noticing signs in a colleague: how to help  66:40 Specific programs doing things well  71:55 Questions from Social Media: Burnout vs. Depression; Will getting treatment affect your board applications  75:03 Take home points 76:49 Outro Goal Listeners will learn about the risk factors for depression and suicide in medical training, and be empowered to advocate for themselves and their colleagues to be safe. Learning objectives  After listening to this episode listeners will Learn about the life cycle of depression in training and its prevalence at different stages in our careers. Analyze the risk factors that lead to depression and why depression is becoming more prevalent in doctors over time. Evaluate barriers to effective care for physicians and the impact of stigma on those experiencing depression or suicidal thoughts. Assess effective strategies for supporting physicians and physicians-in-training facing depression at different stages in their career. Disclosures Dr. Poorman reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures. Citation Poorman E, Trivedi S, Taranto N, Brigham SK, Watto MF. “#129 Depression and Suicide: Occupational Hazards of Practicing Medicine”. The Curbsiders Internal Medicine Podcast https://thecurbsiders.com/episode-list. Original air date December 10, 2018. 
#190 Recap Extravaganza 2019

#190 Recap Extravaganza 2019

2019-12-3001:05:011

Recap extravaganza 2019 featuring top pearls from our staff’s favorite episodes of 2019 and voicemails from Kashlak faculty, Dr. Avital O’Glasser (@aoglasser), Dr. Kimberly Manning (@gradydoctor), Dr. Renee Dversdal (@DrSonosRD) and The Curbsiders team. Topics include: HFpEF, the PARAGON-HF trial, Buprenorphine, Opioid Use Disorder, Cirrhosis, Coagulopathy, SBP, Hyperkalemia treatment, Multimorbidity, and how to think about NNT. Plus, the team shares a bunch of other favorite moments and random pearls! Upcoming shows: The next two weeks will feature REBOOT episodes with fresh intros from The Curbsiders team. Season 9 starts January 20, 2020 with a Lipid Update from Cardiologist Dr. Erin Michos (@ErinMichos) Show Notes | Subscribe | Spotify | Schwag! | Top Picks | Mailing List | thecurbsiders@gmail.com Credits Produced by: Sarah Phoebe Roberts MPH and Chris Chiu MD, FACP, FAAP  Writer: Sarah Phoebe Roberts MPH Infographic: Sarah Phoebe Roberts MPH Cover Art: Kate Grant MBChB DipGUMed Hosts: Chris Chiu MD, FACP, FAAP; Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP    Editor: Chris Chiu MD, FACP, FAAP (audio), Matthew Watto MD, FACP (show notes) Time Stamps 00:00 Intro and disclaimer 04:25 Picks of the year*: The Expanse (TV show) -Chiu Man’s pick; Midsommar (film) -Paul’s pick; Point-of-care-ultrasound (ACP course at IM2020 in LA or AIUM courses with Dr. Renee Dversdal @DrSonosRD) -Matt’s pick; Sleep!!! -Stuart pick 08:37 Hyperkalemia Master Class Joel Topf MD 14:53 Multimorbidity Games with Josh Uy MD 21:54 Buprenorphine Master Master Class with Michael Fingerhood MD 27:50 Cirrhosis TIPS for Acute Complications with Scott Matherly MD 31:55 HFpEF with Clyde Yancy MD 39:50 Chronic pain, sickle cell disease, opioid tapers 43:13 Teaching in the Hospital 46:00 A quote from Paul Williams 47:35 Celebrity voicemails from Avital O’Glasser MD, Kimberly Manning MD,  and Renee Dversdal MD 51:55 Voicemails and favorite pearls from our Curbsiders team! 62:23 Outro Goal Listeners will recall some of the top pearls from Curbsiders episodes on cirrhosis, buprenorphine, HFpEF, multimorbidity and hyperkalemia. Links* The Expanse (TV show) -Chiu Man’s pick Midsommar (film) -Paul’s pick Point-of-care-ultrasound (ACP course at IM2020 in LA or AIUM courses with Dr. Renee Dversdal @DrSonosRD) -Matt’s pick Sleep!!! -Stuart pick *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 The Curbsiders report no relevant financial disclosures.  Citation Roberts SP, Chiu CJ, Williams PN, Brigham SK, Watto MF. “#190 Recap Extravaganza 2019”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. December 30, 2019.
Team up with the authors of the JAMA Medicine series on Medical Overuse, Dr. Dan Morgan @dr_dmorgan (University of Maryland) and Dr. Deborah Korenstein @DKorenstein (Memorial Sloan Kettering). We discuss procalcitonin (again!), the dangers of incidentalomas, risks of chest CT for lung cancer screening, the easiest place to get antibiotics for a viral infection, and why not to treat subclinical hypothyroidism despite guidelines. Trying to find ways to shed the fat off of some common medical practices? Look no further.  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 Infographic: Justin Berk, MD MPH MBA Cover Art: Matthew Watto MD, FACP Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP    Editor: Molly Heublein MD, Matthew Watto MD, FACP, Emi Okamoto MD (written materials); Clair Morgan of Nodderly.com (audio) Guest:  Daniel Morgan MD, Deborah Korenstein MD, FACP Time Stamps 00:00 Intro, disclaimer, guest bios 04:45 Guest one-liners Picks of the Week*: The Fifth Season is part of The Broken Earth Trilogy by NK Jemisen; The Great Believers: A Novel by Rebecca Makkai; A Constellation of Viral Phenomena by Anthony Marra 09:22 Best advice 11:18 Defining Medical Overuse and defining categories 19:20 Procalcitonin testing for pneumonia 27:42 Imaging and incidentalomas 37:38 Lung cancer screening CT scan; the Bach model 46:25 Urgent care and antibiotic prescriptions for viral illnesses 52:43 Subclinical hypothyroidism 58:32 Take home points 61:00 Outro and Stuart tells us about his knee pain *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 consider 5 of the top articles from 2018 that demonstrate signs of medical overuse that seem to offer more harm than benefit to patients. Learning objectives After listening to this episode listeners will…   Define medical overuse Discuss recent data about the utility of procalcitonin for antibiotic stewardship in respiratory infections. Recall the frequency incidentalomas on imaging and which modalities are associated with the highest risk. Identify the differences in benefits of annual lung cancer screening with CT based on baseline risk Recall the lack of evidence for treatment of asymptomatic subclinical hypothyroidism Describe the locations that are associated with more antibiotic prescriptions for viral infections. Disclosures Dr. Morgan and Dr. Korenstein report no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.  Citation Morgan D, Korenstein D, Berk J, Williams PN, Brigham SK, Watto MF. “#189 Medical Overuse”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. December 23, 2019.
Delve into the diagnosis and management of GERD and dyspepsia with Dr. Amy Oxentenko (@AmyOxentenkoMD), Gastroenterologist and the Internal Medicine Residency Program Director, Associate Chair for the Department of Internal Medicine, and Professor of Medicine at Mayo Clinic in Rochester, MN. Our discussion features a review of the standard presentations of GERD and dyspepsia, alarm symptoms and who needs referral for endoscopy or other specialized testing (pH, impedance testing, screening for Barrett’s esophagus). Additionally, we comprehensively cover proton pump inhibitor (PPI) therapy including: choice of agent, dose, frequency, how taper, how to counsel patients about risk, what labs should be monitored and the use of adjuvant therapies like H2 blockers, antacids and even carafate. After this episode, you will be flexing on reflux! ACP members can claim CME-MOC credit at https://www.acponline.org/curbsiders (CME goes live at 0900 ET on the episode’s release date).  Show Notes | Subscribe | Spotify | Schwag! | Top Picks | Mailing List | thecurbsiders@gmail.com Credits Written and Produced by: Paul Williams MD, FACP, Beth Garbitelli CME Questions: Beth Garbitelli, Matthew Watto MD, FACP Infographic: Beth Garbitelli  Cover Art: Kate Grant MBChB DipGUMed Hosts:  Matthew Watto MD, FACP; Paul Williams MD, FACP    Editor: Matthew Watto MD, FACP (written materials); Clair Morgan at Nodderly.com Guest: Amy Oxentenko MD Time Stamps 00:00 Intro, disclaimer, guest bio 02:47 Guest one-liner, Picks of the Week*: Reality TV Shows: Survivor  and Naked and Afraid; Book: Blind Eye: The Terrifying Story Of A Doctor Who Got Away With Murder by James B. Stewart 08:50 Favorite failure 10:55 Best Advice 13:34 A case of GERD, Defining GERD, basic pathophysiology and risk factors 19:18 A bit more on diagnosis of GERD 21:56 Chest pain, mimics of GERD, red flag symptoms 25:12 Are labs required for diagnosis?, testing for Barrett’s esophagus 28:43 Who needs lifelong PPI therapy?, Choice of PPI 33:09 Lifestyle changes and GERD 37:50 H2 blocker vs PPI therapy, Risks of PPI therapy 44:40 How to counsel patients about the risks and benefits of PPI therapy; Recent 3 year RCT investigating safety of PPI therapy 48:18 Adjuvant therapy and further workup for patients with refractory GERD 51:57 pH and impedance studies 54:29 Duration of PPI therapy; Intermittent and On-Demand PPI therapy; Weaning off long term PPI therapy 59:30 Who may benefit from anti-reflux surgery 63:48 Dyspepsia 68:17 Workup of dyspepsia; Definition and diagnosis of functional dyspepsia 74:09 2nd line therapy for dyspepsia (TCAs, Buspirone, GI psychologist, STW 5, complementary and alternative therapies, etc.) 78:13 Take Home Points; Plugs *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. Oxentenko reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.  Citation Oxentenko A, Williams PN, Garbitelli B, Watto MF. “#188 GERD and Dyspepsia with Amy Oxentenko MD”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. December 16, 2019.
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.
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Comments (3)

setareh abdoli

very good but please attach algorithm and link

Dec 20th
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Daniel B

Amazing podcast for medical students. Highly recommend!

Sep 29th
Reply

Aman Kaur

Internal medicine

Jun 21st
Reply
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