The Curbsiders Internal Medicine Podcast

Bradley D. Anawalt MD, endocrinologist and Chief of Medicine with expertise in male reproductive health. He walks through practical approaches to low testosterone: who to test and how, why lifestyle and weight loss often trump therapy, nuances of lab interpretation, fertility-preserving options, and choosing and monitoring treatment while watching for hematocrit and sleep apnea risks.

Dr. Ashley E. Mason, an associate professor of psychiatry at UCSF, shares her expertise on overcoming insomnia through cognitive behavioral therapy. She breaks down effective strategies like stimulus control and time-in-bed restriction. Learn how to optimize sleep hygiene, the impact of supplements and substances, and why consistent wake times are key. Dr. Mason also discusses the risks of sleep medications and the potential role of cooling bedding and proper wind-down routines. This informative discussion offers practical insights for better sleep.

Dr. Halima Amjad, a dementia specialist from Johns Hopkins, shares her insights on modern Alzheimer's diagnosis and treatment. She discusses the significance of blood-based biomarkers and when to utilize them, emphasizing their role in identifying symptomatic patients. Amjad navigates the eligibility for anti-amyloid therapies, the importance of patient counseling, and the monitoring of potential risks like ARIA. With a mix of compassion and clinical rigor, she provides key takeaways for healthcare providers navigating this complex field.

Dr. Bob Hollis, a colorectal surgeon specializing in diverticulitis and Dr. Andrew Webster, an infectious diseases physician, dive deep into managing diverticulitis. They clarify how to distinguish between uncomplicated and complicated cases, discussing when to use antibiotics and the importance of imaging. Surgical perspectives are shared, particularly on abscess management and the significance of deciding when to involve surgery. Nutrition advice for hospitalized patients rounds out their discussions, alongside debunking common myths around diet and diverticulitis.

In this enlightening discussion, experts explore the nuances of anticoagulation for venous thromboembolism. They dive into the pros and cons of DOACs, highlighting the preference for apixaban due to safety considerations. The hosts share insights on dosing strategies, duration of therapy, and when to conduct hypercoagulable testing. They tackle management of distal DVT and address special cases like bariatric patients. Plus, discover their exciting recommendations, including gripping novels and a visually stunning video game!

Dr. Jordana Cohen, a nephrologist and hypertension specialist at the University of Pennsylvania, tackles the latest in hypertension management. She delves into the importance of accurate blood pressure measurements and critiques wearable devices' limitations. Cohen highlights the 'time-in-target' concept for better risk prediction and discusses the value of fixed-dose combination pills for effective treatment. She also shares insights on managing hypertension during pregnancy and emphasizes the role of diet, particularly potassium intake, in blood pressure control.

Dr. Laurence Sperling, a leading preventive cardiologist and former director at Emory's Heart Disease Prevention Center, dives into cutting-edge advancements in ASCVD risk assessment. He introduces the innovative PREVENT risk calculator and discusses its significance in modern lipid management. The conversation highlights the importance of interpreting ApoB and Lp(a), the role of lifestyle changes, and how next-gen therapies could revolutionize treatment. Sperling also covers familial hypercholesterolemia and the strategic use of statins to enhance patient outcomes.

Dr. Rachel S. Rubin, a board-certified urologist and sexual medicine expert, transforms menopause care with her innovative insights. She discusses the evolution of guidelines post-WHI, addressing misconceptions surrounding hormone therapy. Rachel emphasizes the importance of individualized treatment options and the need to balance clinician fears with patient education. She also explores practical applications for vaginal and systemic therapies, including testosterone use in women, and shares a stepwise approach for managing menopause symptoms effectively.

Dr. Adam Cifu, a professor of medicine and general internist, joins the hosts to tackle a stack of intriguing topics. They dissect recent findings on PSA screening, revealing a strong push for shared decision-making rather than changing current practices. The discussion shifts to a systematic review suggesting a potential link between prenatal acetaminophen and neurodevelopmental disorders; the panel advises caution in interpreting these findings. Finally, they examine the AQUATIC trial, advocating against combining aspirin with anticoagulants in chronic coronary syndrome due to increased risks.

Scott Matherly, an associate professor of Hepatology and the transplant hepatology program director at Virginia Commonwealth University, shares his insights on cirrhosis management. He discusses the intricacies of diagnosing cirrhosis and highlights the significance of elastography and MR elastography. Matherly emphasizes the importance of physical exam clues and patient education, while detailing the risks associated with cirrhosis, including liver failure and hepatocellular carcinoma. He also dives into treatment strategies for decompensation and when to refer patients for transplant evaluation.