The Curbsiders Internal Medicine Podcast

Learn diagnostic and therapeutic management strategies for IBS, functional dyspepsia, and cyclic vomiting (aka disorders of gut brain interaction (DGBI))! It's like three episodes in one as we run through how to individualize evaluation and management for patients with functional dyspepsia, IBS, and cyclic vomiting. Topics: scripts for counseling patients, the pathophysiology of DGBI, which diagnostic tests are necessary, pharmacologic and nonpharmacologic options, and even hypnotherapy?! We’re joined again by the great Dr. Xiao Jing (Iris) Wang, (@IrisWangMD, Mayo Clinic) Claim free CME for this episode at curbsiders.vcuhealth.org! Episodes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME! Show Segments Intro, disclaimer, guest bio Guest one-liner, Picks of the Week* Case from Kashlak; Definitions (6:20)  Definition of Disorders of the Gut-Brain Interaction (7:30-11:00) Functional Dyspepsia: diagnostic criteria, definitions (15:30-24:30), and treatments  (24:30-36:00) Irritable bowel disease: diagnostics (41:00), testing algorithm, and treatments (55:00) Cyclic Vomiting Syndrome and Cannabis Hyperemesis Syndrome: definitions, diagnosis, and management (1:11) Take home points Outro Credits Producer: Elena Gibson MD Writer:Andréa Perdigão, Elena Gibson Show Notes and Infographics: Andréa Perdigão Cover Art: Kate Grant Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP    Associate Editor: Leah Witt Showrunner: Matthew Watto MD, FACP Editor: Clair Morgan of nodderly.com Guest: Dr. Xiao Jing (Iris) Wang MD Sponsor: Ten Thousand Go to tenthousand.cc/curb to receive 10% off. Sponsor: Pattern Visit patternlife.com/curbsiders to request a disability insurance quote. CME Partner: VCU Health CE The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit. 

We recap the top pearls from ACP #IM2022 including important drug interactions/intolerance (acetaminophen, tramadol, ticagrelor, nirmatrelvir-ritonavir), perioperative medicine (bridging, DOAC reversal agents, dental procedures, MINS), recognizing PMR, when to initiate urate-lowering therapy in gout, glucocorticoid-induced osteoporosis, food as medicine, dietary potassium, OSA, nocturia, telemedicine and health equity, a new obesity medicine paradigm, advances in HIV/PrEP, and rethinking atrial fibrillation!  Note: Due to a rapid turnaround there is no CME for this episode, but visit curbsiders.vcuhealth.org to claim credit for past episodes. Episodes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME! Show Segments Intro Tapering long-term opioids Physician Wellbeing Common drug interactions (acetaminophen, ticagrelor, tramadol, Nirmatrelvir-ritonavir) Perioperative medicine (bridging, DOAC reversal agents, dental procedures, MINS) Nocturia and OSA Food as Medicine Rheumatology (how to diagnose PMR, when to initiate ULT for gout and steroid-induced osteoporosis) Avi’s pearls on (diversity, telemedicine, telehealth, burnout) Obesity medicine (a new paradigm and a new medication) HIV in primary care (PrEP, long-acting injectable antiviral therapy) Atrial fibrillation Outro Credits Written, Produced, and Hosted by: Nora Taranto MD; Molly Heublein MD; Chris Chiu MD, FACP, FAAP; Avital O’Glasser MD, FACP; Alan Dow MD, FACP; Matthew Watto MD, FACP; Paul Williams MD, FACP   Show Notes: Matthew Watto MD, FACP Cover Art: Chris Chiu MD, FACP, FAAP Production team: Pod Paste Sponsor: Indeed Visit indeed.com/internalmedicine to claim you $75 credit now. Sponsor: Locumstory Visit Locumstory.com to learn more about locums

Join Dr. Nathan Erdmann (@NerdmannID, University of Alabama Birmingham) as he walks us through inpatient covid management from antivirals, immune modulators and anticoagulation.  Claim free CME for this episode at curbsiders.vcuhealth.org! Episodes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME! Show Segments Intro, disclaimer, guest bio Guest one-liner, Picks of the Week* Case from Kashlak; Definitions Outpatient vs ER therapeutic options Considerations for labs to risk stratify  Antivirals Immunomodulators Anticoagulation Empiric Antibiotics Transitions of Care Take Home Points Outro Credits Producer: Monee Amin, MD Writers: Monee Amin, MD and Meredith Trubitt, MD Show Notes: Meredith Trubitt, MD Infographic and Cover Art: Monee Amin, MD Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP    Reviewer: Rahul Ganatra, MD Showrunner: Matthew Watto MD, FACP Production Team: PodPaste Guest: Nathan Erdmann, MD Sponsor: Panacea Financial  Visit panaceafinancial.com today to learn how a bank for doctors, by doctors can help you.   Sponsor: BetterHelp Visit betterhelp.com/curb for 10% of your first month. CME Partner: VCU Health CE The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit. 

More inpatient diabetes! In this part 2 of 2, we cover diabetic ketoacidosis (DKA), euglycemic DKA, how to handle insulin pumps in the hospital, continuous glucose monitors, and how to transition patients off an insulin drip! Our guest is Dr. Dave Lieb (@dclieb), an internist, endocrinologist and the endocrinology program director from Eastern Virginia Medical School.  Claim free CME for this episode at curbsiders.vcuhealth.org! Episodes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME! Show Segments Intro  DKA and HHS - introduction and therapy overview Insulin drips, closing the gap and transitioning to a subcutaneous regimen Euglycemic DKA Pumps and glucose monitors Final take home points Outro Credits Producer: Adam Barelski MD, Cyrus Askin MD Writer: Adam Barelski MD Show Notes:  Cyrus Askin MD Infographic: Edison Jyang Cover Art: Kate Grant MBChb, MRCGP Hosts: Matthew Watto MD, FACP; Adam Barelski MD Technical Production: Pod Paste Showrunner: Matthew Watto MD, FACP Content Editor: Emi Okamoto MD  Guest & Content Reviewer: David Lieb MD, FACE, FACP CME Partner: VCU Health CE The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit.  Sponsor: Bambee Visit bambee.com/curb for a free HR audit of your business. Sponsor: Grammarly Visit grammarly.com/curb for 20% off when you sign up

Dominate inpatient diabetes! In this part 1 of 2, we discuss how to handle oral hypoglycemics, how to choose an initial insulin regimen, the use of correction scale insulin monotherapy, how to titrate insulin, how to use NPH for steroid-induced hyperglycemia (check out this Twitter thread on safe dosing), and how to reconcile diabetes meds at discharge! Stay tuned for part 2 (drops Wed April 27th) covering diabetic ketoacidosis (DKA), euglycemic DKA, how to handle insulin pumps in the hospital, continuous glucose monitors, and how to transition patients off an insulin drip! Our guest is Dr. Dave Lieb (@dclieb), an internist, endocrinologist and the endocrinology program director from Eastern Virginia Medical School.  Claim free CME for this episode at curbsiders.vcuhealth.org! Episodes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME! Show Segments Intro #1, disclaimer, guest bio Guest one-liner, Picks of the Week* Inpatient diabetes - a bird’s eye view and the goal(s) of therapy Management of outpatient diabetes medications Inpatient insulin - options and dosing Correctional insulin (“sliding scale”) A word on the “Diabetic Diet” Steroids and hyperglycemia Discharge pearls for the patient with diabetes Outro #1 Credits Producer: Adam Barelski MD, Cyrus Askin MD Writer: Adam Barelski MD Show Notes:  Cyrus Askin MD Infographic: Edison Jyang Cover Art: Kate Grant MBChb, MRCGP Hosts: Matthew Watto MD, FACP; Adam Barelski MD Technical Production: Pod Paste Showrunner: Matthew Watto MD, FACP Content Editor: Emi Okamoto MD  Guest & Content Reviewer: David Lieb MD, FACE, FACP Sponsor: Bambee Visit bambee.com/curb for a free HR audit of your business. Sponsor: Grammarly Visit grammarly.com/curb for 20% off when you sign up CME Partner: VCU Health CE The Curbsiders partner with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit. 

DeLiver on the promise of elimination with Dr. Christian Ramers Let’s deLiver on the promise of hepatitis C elimination! Dr. Christian Ramers @cramersmd brings hepatitis C diagnosis, care, and cure into the primary care clinic with a simplified algorithm for workup and treatment. Claim free CME for this episode at curbsiders.vcuhealth.org! Episodes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME! Show Segments Intro, disclaimer, guest bio Guest one-liner, Picks of the Week* Case from Kashlak; Definitions Who should we screen? Patient Workup  Preparing for treatment Treating hepatitis C Opportunities for integration of care Outro Credits Producer, writer, co-host: Emi Okamoto MD, FACP Show Notes, infographic, cover art: Lyan Chang Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP    Reviewer: Leah Witt, MD Executive Producer: Beth Garbitelli Showrunner: Matthew Watto MD, FACP Editor: Clair Morgan of nodderly.com Guest: Christian Ramers MD, MPH, FIDSA Sponsor: BetterHelp Visit betterhelp.com/curb for 10% of your first month. Sponsor: MedMastery Visit www.medmastery.com/curbsiders for a 15% lifetime discount! Sponsor: Birch Matresses Visit birchliving.com/curb to claim your $200 off any Birch Mattress plus two free pillows Sponsor: Indeed Visit Indeed.com/internalmedicine and get a $75 credit to sponsor your first job CME Partner: VCU Health CE The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit.  Update Description

Fill up with delicious practice-changing knowledge food from #SGIM22 as The Curbsiders team discusses breast cancer survivorship, sexual dysfunction, How climate change will affect health, Are PT consults necessary in the hospital?, Do we need antibiotics for aspiration events?, bias in note writing, Are plant-based meats a healthy?, complications after breast implantation, how to get breast reduction approved, doxycycline for chlamydia, the metronidazole and alcohol myth, pearls for clinician-educators, telehealth, TEACHIM.org, CGMs help lower a1c, PT for rotator cuff disease, Is it safe to taper antidepressants? and how to treat methamphetamine use disorder!  Note: There is no CME for this episode, but claim CME for prior episodes at curbsiders.vcuhealth.org! Episodes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME! Credits Written and Hosted by: Nora Taranto MD, Beth Garbitelli (about to be an MD!), Era Kryzhanovskaya MD, Justin Berk MD, MPH, MBA, Shreya Trivedi MD, Chris Chiu MD, Paul Williams MD, Matthew Watto MD Show Notes and Cover Art: Matthew Watto MD, FACP Showrunner: Matthew Watto MD, FACP Technical Production: Pod Paste Show Segments Intro A few ambulatory teaching models include the One Minute Preceptor, SNAPS (summarize, narrow, analyze, probe, plan, and select), PIPP (precepting in the presence of the patient) [see Community Preceptor Toolbox] Ikigai is a Japanese term indicating a motivational force or reason for living. It is associated with decreased mortality [Tanno, 2009]. Explore your ikigai here (PositivePsychology.com). Listening to podcasts while driving does not affect knowledge retention (Gottleib et al. 2021) Treatment of Hot flashes: Avoid paroxetine, fluoxetine, and sertraline in breast cancers survivors taking tamoxifen. Instead use venlafaxine (or another SNRI), citalopram, or escitalopram. Gabapentin given at bedtime is also an option.  (Clinical Update 2019: Tamoxifen and Antidepressants) Distress in patients with cancer can be measured using the NCCN screening tool [NCCN Distress Thermometer] Don’t forget to ask for a Cancer Survivorship Plan from oncology [CDC Cancer Survivorship Care Plans] Ask about sexual dysfunction in cancer survivors. How will climate change impact our patient’s health? NIH framework; CH2OPD2 environmental screening tool [CH2OPD2 ]; and the 15 steps of climate communication. Use the AM-PAC score cutoff of >18 to avoid a PT consult in hospitalized patients (Martinez 2021).  Early antibiotics after an aspiration event do not improve outcomes (Aga 2021).  Biased language is more common in notes about Black patients (Beach 2021). Be thoughtful about what you write and role model good behavior. While plant-based meats are more eco-friendly than animal-sourced meats, they are heavily processed foods (van Vliet 2021) and may have high sodium. Silicone breast implant rupture can be insidious. Guidelines recommend screening with MRI after 6 years, then every 2-3 years (FDA 2020, More FDA info) (Note: FDA’s most recent guidance also recommends ultrasound as an alternative screening method, so always check with the patient's insurance about which modality will be covered) Document a trial of NSAIDs, physical therapy, attempted weight loss, and supportive bra usage before breast reduction surgery for macromastia.  Doxycycline is now first line for chlamydia rather than azithromycin [STI Treatment Guidelines Update], BUT the most effective treatment is the one your patient will take! Metronidazole does not cause a disulfiram-like reaction and is no longer recommended by the guidelines [STI Treatment Guidelines Update] More clinician-educator pearls from Era: Don’t be afraid to brand yourself! Network with like-minded individuals (e.g. interest groups).  BST mode: bite-sized teaching pearls can help reduce extrinsic load and improve retention [Manning, 2021] A guided discussion based on Scrubs episodes can improve resident wellness [Holtzclaw 2021] Chris recaps some posters (click links to see them on Twitter!): Telehealth disparities and tech equity (poster 1, poster 2); TeachIM.org (poster) Continuous glucose monitors can help lower a1c in patients on basal insulin [Martens 2021] A single session of PT improved shoulder pain. The benefits of steroid injections were limited to 8 weeks in the GRASP trial [Hopewell 2021] There is a high risk of recurrence after tapering antidepressants [Lewis 2021] Methamphetamine use disorder can be treated with IM naltrexone every 3 weeks, plus oral bupropion 450 mg daily [Trivedi 2021]. Limitations include cost and co-use of opioids.  Outro Sponsor: Masterworks Get started at masterworks.art/curbsiders.   Sponsor: Ten Thousand Get 15% off at tenthousand.cc/curb Sponsor: Green Chef Go to GreenChef.com/curb130 and use code curb130 to get $130 off, plus free shipping! Sponsor: Blueland Get 20% off your first order at blueland.com/curb 

We need a few days to process the highlights from #SGIM22 in Orlando, FL. We'll be dropping a DELUXE recap and highlights episode this Friday April 15, 2022 covering Updates in Hospital Medicine, Primary Care, Breast Health, Sexual Health, Addiction Medicine, Meded and more!

Learn what you really need to diagnose pancreatitis, when to use imaging sources and what is most important in management! Rapidly treating Acute Pancreatitis might change its course! We’re joined by Dr. Kaveh Sharzehi @sharzehi of Oregon Health & Science University (@OHSUNews). Claim free CME for this episode at curbsiders.vcuhealth.org! Episodes | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME! Show Segments Intro, disclaimer, guest bio Guest one-liner Case from Kashlak Risk factors for severe course Use of Scoring Systems  Requirements to make the diagnosis  Rational use of imaging  Initial management: fluids, analgesia, and nutrition When to use antibiotics  When to perform cholecystectomy  Most common complications and interventions  How to follow up in the outpatient setting  Credits Producer & Scriptwriters: Monee Amin MD and Meredith Trubitt MD Show Notes & Infographics: Andréa Perdigão  Cover Art: Monee Amin MD Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP    Reviewer: Molly Heublein MD Executive Producer: Beth Garbitelli Showrunner: Matthew Watto MD, FACP Editor: Clair Morgan of nodderly.com Guest: Kaveh Sharzehi MD, MS Sponsor: BetterHelp Visit betterhelp.com/curb for 10% of your first month. Sponsor: MedMastery Visit www.medmastery.com/curbsiders for a 15% lifetime discount! CME Partner: VCU Health CE The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit. 

Recognize common presentations of anaphylaxis, diagnosing criteria, and treatment basics. Importance of epinephrine and utility of adjunctive therapies. Tips on counseling patients about auto-injectable epinephrine and a reminder not to panic. Overview of the podcast format and introduction to the guest speaker. Book recommendations, advice for fellows, and career goals. Discussion on biphasic reactions, predicting severity, and monitoring recommendations. Importance of educating patients on epinephrine usage.