The Curbsiders Internal Medicine Podcast

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.

Tackle the complex pathophysiology, diagnosis, and management of hepatorenal syndrome in this Curbsiders classic from #NephMadness 2019 featuring @kidney_boy Joel Topf, HRS expert Juan Carlos Velez (@veleznephhepato), and self-proclaimed most-handsome-nephrologist Bill Whittier (@TWhittier_RUSH) episode! Topics: hepatorenal physiology, renal ultrasound, urine electrolytes, terlipressin, norepinephrine, midodrine and octreotide, albumin challenge, crystalloids vs colloids, and more! Original show notes here. Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME! Credits Written and produced by: Justin Berk MD, Nora Taranto MD Infographic by: Alex M @nephroguy Host: Matthew Watto MD Edited by: Matthew Watto MD (audio), Emi Okamoto MD (written materials) Guests: Joel Topf MD, Juan Carlos Velez MD, Bill Whittier MD Show Segments NephMadness Kidney Pun Contest Disclaimer Intro, guest one-liners Case of acute kidney injury in a patient with cirrhosis Initial differential diagnosis and approach to newly elevated creatinine in cirrhosis (urinalysis, FeNa, urine sodium) History and physical in cirrhosis and AKI Fluid choice Diuretic therapy in cirrhosis and volume overload Is a Renal Ultrasound useful in AKI? Recap: the initial approach to AKI in cirrhosis Therapeutic trials when volume status is uncertain Hepatorenal physiology revisited Vasoconstrictor therapy with octreotide, terlipressin, or norepinephrine Type 1 versus type 2 hepatorenal syndrome Large-volume paracentesis (LVP) in cirrhosis with AKI; how much fluid to remove; use of diuretics or LVP in patients on norepinephrine?! Diagnostic criteria or HRS NephMadness matchups including bile cast nephropathy Outro Sponsors  Grammarly. Visit grammarly.com/curb for 20% off. Panacea Financial. Visit panaceafinancial.com a bank for doctors, by doctors.

We tackle the complexities of pain management in patients with chronic kidney disease in this reboot from @NephMadness 2019 that, on a scale of 1-10, will leave you feeling very relieved in addressing pain. Topics: Opioids, gabapentinoids, NSAIDS, pain ladders, why tramadol is tramadont, and more! Episodes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME! Credits Written and produced by: Justin Berk MD NephMadness Pain Region: Samantha Gelfand MD NephMadness Pun Contest produced by: Hannah R Abrams Cover art by: Kate Grant MBChB, Dip GUMed Hosts: Matthew Watto MD, Paul Williams MD, Stuart Brigham MD Edited by: Matthew Watto MD (audio), Emi Okamoto MD (show notes) Guests:  Samantha Gelfand MD, Matthew Sparks MD, David Juurlink MD Show Segments Kidney Pun Disclaimer, intro and guest bios Guest one-liners Clinical Case and Pain Management Disclaimer Modalities for pain meds in ckd Opioids for pain and their metabolites Dave Juurlink reframes the question, “what is our real goal with pain management?” Matt Sparks reiterates the dangers of morphine and codeine in patients with advanced CKD Communicating meds that are contraindicated or relatively contraindicated in CKD Buprenorphine What about the WHO Pain Ladder for CKD? Should we use more cannabinoids? Ketamine? Dave Juurlink rants on Tramadol NSAIDS and CKD Gabapentinoids (gabapentin and pregabalin) for neuropathic pain and driving?! Estimating eGFR in CKD and AKI. Which equation is best? How would each of our experts treat this patient with CKD and knee pain Outro Sponsors:  Birch by Helix birchliving.com/curb for $200 off all mattresses and 2 free eco-rest pillows BetterHelp betterhelp.com/curb for 10% of your first month Indeed indeed.com/internalmedicine for a $75 sponsored job credit  Squarespace squarespace.com/curb offer code: CURB to save 10%

Lose your heart to NephMadness 2022! Dr. Joel Topf (@kidney_boy) and Dr. Sadiya Khan (@HeartDocSadiya) tackle the NephMadness 2022 Cardiorenal Syndrome region, leading us through the pathophysiology of cardiorenal syndrome, how to approach the creatinine “bump” with diuresis, managing patients with diuretic resistance, and more. This episode is part of our first ever NephMadness Pod Crawl, so check out the other podcasts, and fill out your NephMadness 2022 brackets! Credits Producer, Writer, Show Notes, Infographics: Malini Gandhi Cover Art:  Beth Garbitelli Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP    Reviewer: Emi Okamoto MD, FACP Executive Producer: Beth Garbitelli Showrunner: Matthew Watto MD, FACP Editor: Clair Morgan of nodderly.com Guest: Dr. Joel Topf MD, Dr. Sadiya Khan MD *Claim free CME for this episode at curbsiders.vcuhealth.org! *Available within 24 hours of release. Episodes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME! Show Segments Intro, disclaimer, guest bios Guest one-liners, Introduction to Nephmadness 2022 Case #1 from Kashlak: acute decompensated heart failure with elevated creatinine Definition and pathophysiology of cardiorenal syndrome Use of home ACE-is/ARBs and SGLT-2 inhibitors in cardiorenal syndrome Case #2 from Kashlak: the creatinine bump with diuresis Approach to the creatinine bump with diuresis Tips for the volume exam Interpreting cardiac biomarkers in patients with chronic kidney disease Case #3 from Kashlak: diuretic resistance Maximizing loop diuretic efficacy Sequential nephron blockade Use of hypertonic saline Outro NephMadness 2022 Pod Crawl Tues 3/15: The Drs. Washington - Inequities in Nephrology. Listen on Apple or Spotify. Website: https://www.drlatonyawashington.com/drswashingtonpodcast  Wed 3/16: The Cribsiders - Neonatal AKI. Listen on Apple or Spotify. Website: http://thecurbsiders.com/thecribsiders Thurs 3/17: Up My Nursing Game - Hemodialysis. Listen on Apple or Spotify. Website: www.upmynursinggame.com Fri 3/18: BS Medicine - #505: Albuminuria, basketball and the Great White North. Listen on Apple or Spotify. Website: https://therapeuticseducation.org/ Sat 3/19: Freely Filtered - Animal House Region. Listen on Apple or Spotify. Website: http://www.nephjc.com/freelyfiltered  Twitter: @thecurbsiders @TheCribsiders @NephJC_Podcast @drs_washington @upmynursinggame @medmyths Sponsor: ACP’s Internal Medicine Board Review The Greater Chicago course, beginning on May 23rd  through May 27th     or Washington, D.C., on July 11th through July 15th New registrants will receive 6 months of access to the course recordings. Visit acponline.org/imbr2022 to register or learn more. Sponsor: SquareSpace Go to Squarespace.com for a free trial, and when you’re ready to launch, go to squarespace.com/Curb to save 10% off your first purchase of a website or domain. Sponsor: Green Chef Go to GreenChef.com/curb130 and use code curb130 to get $130 off, plus free shipping! Sponsor: Masterworks Masterworks is giving listeners priority access to their newest offerings. Just head to masterworks.art/curbsiders  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. 

Find out whether balanced solutions beat saline in the ICU (fluid wars revisited), how sleep affects weight loss and calorie intake, whether or not Vitamin D can prevent autoimmune disease, new guidelines for pneumonia and hepatitis B (HBV) vaccination, and the utility of ultrasound to measure JVP! Time to fill your plate with a fresh stack of hotcakes! Drs. Paul Williams (@PaulNWilliamz), Rahul Ganatra (@rbganatra), Nora Taranto (@NoraTaranto), and Matt Watto (@doctorwatto) catch us up on recent practice-changing articles and guidelines!  Claim free CME for this episode at curbsiders.vcuhealth.org! Episodes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME! Credits Hosted and Written by: Nora Taranto MD; Rahul Ganatra MD, MPH; Paul Williams, MD, FACP, Matthew Watto MD, FACP Reviewer: Matthew Watto, MD, FACP Executive Producer: Beth Garbitelli Showrunner: Matthew Watto MD, FACP Editor: Clair Morgan of nodderly.com Sponsor: Green Chef Go to GreenChef.com/curb130 and use code curb130 to get $130 off, plus free shipping! Sponsor: BetterHelp Special offer for The Curbsiders listeners: get 10% off your first month at betterhelp.com/Curb Sponsor: Panacea Financial Visit panaceafinancial.com today for information on their student loan refinance loans and to learn about their “refer a friend” program. Sponsor: Indeed Go to Indeed.com/INTERNALMEDICINE to claim your $75 CREDIT before March 31st. 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.  Show Segments Intro, picks of the week Fluid wars: balance solution vs saline Sleep and energy intake, weight loss Vitamin D to prevent autoimmune disease New ACIP guidelines for Pneumonia and Hepatitis B (HBV) vaccines Ultrasound for JVP Outro