The Curbsiders Internal Medicine Podcast

Making all your nephrology dreams come true with part 2 of our interview with  @kidney_boy, Joel Topf, MD Salt Whisperer and Chief of Nephrology at Kashlak Memorial Hospital. Flush away your bad prescribing habits when it comes to nephrotoxic drugs in this fast paced run down of the medications which must stay on or off Santa’s naughty-list, backed up with a sack full of memorable research studies. Special thanks to Annie Medina, Justin Berk and Kate Grant for writing/producing this show and to physician artist, Kate Grant for her lovely/hilarious artwork (more at paintscientific.com). Full show notes available at http://thecurbsiders.com/podcast Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Time Stamps 00:00 Intro 03:00 Which medications should we exercise caution over in CKD? 03:31 Bactrim (Trimethoprim+Sulfamethoxazole) 07:00 NSAIDS 08:29 NSAIDS and the ‘Precision’ Trial NEJM 2016 looking at cardiovascular safety 12:50 The Male Physician Study JAMA 2001 13:50 Discussion about Nurses Health Study and use of analgesia, and CKD 15:15 Acute Interstitial Nephritis, Beta Lactam Antibiotics, and the risk of Acute kidney injury +/- CKD with Proton Pump Inhibitors 18:20 Advice for co-prescribing NSAIDS,ACE inhibitors and diuretics 20:39 Creatinine levels and ACE/ARB prescribing. How High can you go? 24:55 Facebook question from listener: measures to reduce proteinuria in hypertensive patients 27:20 Empagliflozin and renal protection in diabetic patients 32:00 Contrast Induced Nephropathy, the AMACING trial 2016. 38:00 Take Home Points 39:57 Outro Tags:  chronic, kidney, disease, nephrology, renal, glomerular, filtration, crcl, gfr, creatinine, medications, pharmacology, bactrim, nsaid

Steady your hand and annihilate tremor with tips from Neurologist, and Movement Disorder specialist, Andres Deik, MD, Assistant Professor of Clinical Neurology at Kashlak Memorial Hospital (we can’t tell you where he really works: ) We teach you to differentiate benign causes of tremor from Parkinson’s disease with simple history and physical exam skills, plus nonpharmacologic and pharmacologic therapies for tremor. Special thanks to Beth Garbitelli and Chris Thrash who wrote and produced this episode and the show notes! Full show notes available at http://thecurbsiders.com/podcast Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Time Stamps 00:00 Intro and disclaimer 01:08 Listener feedback - Paul is not fired. 02:09 Picks of the week. 05:35 Dr. Deik intro 07:19 Icebreaker questions 12:20 Wikipedia definition 13:02 Classifying tremor 14:33 Postural tremor vs. reemerging rest tremor 15:48 Important history questions 17:58 Medications that can induce tremor 21:39 Physical exam techniques 27:30 Exam characteristics between typical PD tremor and ET 28:36 History components to distinguish between PD and ET 34:10 Misdiagnosis of Parkinson’s 36:54 Imaging workup 39:03 Case from Dr Deik 41:33 Nonpharmacologic management 44:18 Pharmacologic management 49:06 Dosing propranolol 51:07 Distinguishing between physiologic tremor and pathologic tremor’ 54:06 Website recommendations 55:50 Handwriting 59:14 Take home points 61:34 Outro Tags: tremor, essential, postural, neurology, Parkinsons, disease, beta, blockers, primidone, movement, disorders, antidepressants, occupational, therapy, rest, intention

Take control of chronic kidney disease with tools, and tips from @kidney_boy, Joel Topf, MD Salt Whisperer and Chief of Nephrology at Kashlak Memorial Hospital. Learn which equation is best for eGFR, how to counsel patients about progression/prognosis, how to monitor patients in CKD, and who needs a referral to Nephrology. Special thanks to Annie Medina, and Justin Berk for writing/producing this show and to physician-artist, Kate Grant for her lovely and hilarious artwork (more at paintscientific.com).  Full show notes available at http://thecurbsiders.com/podcast Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.  Time Stamps 00:00 Intro 03:13 Pick of the weeks 08:49 Clinical Case 09:36 How to explain CKD to patients 12:16 Loss of GFR with age 13:22 Which equation should be used to estimate GFR 18:05 Creatinine clearance from 24 hour urine collection 22:25 Initial workup upon diagnosis of CKD 25:40 Interpreting tests for proteinuria 26:52 Staging and prognosis in CKD 32:00 Completing the initial workup for CKD 33:52 Who needs a referral to nephrology? 35:53 What labs to check in CKD and a discussion of secondary hyperparathyroidism 40:32 Take home points 42:30 Outro Tags: chronic, kidney, disease, nephrology, renal, glomerular, filtration, crcl, gfr, creatinine, prognosis, monitoring, iron, pth, proteinuria, hypertension, nephropathy, diabetes, albumin, protein, anemia, hyperparathyroidism, assistant, care, education, doctor, family, foam, foamed, health, hospitalist, hospital, internal, internist, nurse, meded, medicine, medical, primary, physician, resident, student

Hiding from Hep C? Dive in with experts Dr. Gina Simoncini, MD, MPH Associate Professor of Clinical Medicine at Temple University Hospital, & Dr. David Koren, PharmD, BCPS, AAHIVP,  board-certified pharmacotherapy specialist and infectious diseases clinical pharmacist at Temple University Hospital. They walk us through a simplified approach on whom to screen, how to start antiviral therapy, what to follow up on, and how to navigate insurance waters along the way. Special thanks to Sarah Roberts and Jordana Kozupsky who wrote and produced this episode and the show notes! Full show notes available at http://thecurbsiders.com/podcast Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Time Stamps 00:00 Intro 01:00 Guest bios 03:00 Getting to know our guests 05:35 Picks of the week 10:05 Clinical case 10:54 Diagnosing HCV 12:00 ASCEND study 13:14 Restrictions on HCV treatment 15:17 Ordering and interpreting pre-treatment tests 19:30 Prescribing medication 22:00 Genotyping and drug resistance 24:10 Patient counseling 25:49 Understanding drug classes 27:33 Drug interactions 30:06 Multidisciplinary approach to treatment 33:01 Follow-up 36:47 Reinfection/cure rates 39:35 Patient counseling revisited 41:25 Side effects of treatment 42:53 Screening 44:02 Take home points Tags: hepatitis, virus, hcv, direct-acting, antiviral, therapy, management, primary, care, liver, ultrasound, fibrosis, cirrhosis, side, effects, monitoring, hcc, hiv, infectious, disease, assistant, education, doctor, family, foam, foamed, health, hospitalist, hospital, internal, internist, nurse, meded, medicine, 

Fighting with Emergency Medicine colleagues is stupid. Learn how EM doctors think and avoid the petty infighting with tips from Dr. Scott Weingart, MD FCCM  FUCEM DipHTFU, host of the EMCrit podcast, Clinical Associate Professor and Chief, Division of Emergency Critical Care at Stony Brook Hospital, NY. We discuss decision making, how to avoid anchoring bias, the devil of the gaps, why the elderly always get admitted, how to build relationships with the ED, and Scott’s pet peeves. Full show notes available at http://thecurbsiders.com/podcast Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Time Stamps 00:00 Intro 01:10 Picks of the week 05:28 Guest bio 07:00 Getting to know our guest 12:00 Do EM and IM docs hate each other? 14:04 Where conflicts arise. 17:05 System 1 versus system 2 thinking 20:19 When the patient doesn’t match the story 23:55 Why does every 85 year old get admitted? 26:05 Transitions of care: form ED to medical ward 32:08 Is face-to-face signoff only needed for sick patients? 36:28 The devil in the gaps 41:03 Scott’s beer recommendation 42:17 BP cutoff for discharge home 43:44 Scott’s biggest pet peeve with primary care 45:04 How to make friends and collaborate with your EM colleagues 47:14 Take home points 50:35 Outro Tags: emergency, department, room, em, ed, im, conflict, devil, gaps, post-test, probability, illness, serious, system, one, bias, heuristic, assistant, care, education, doctor, family, foam, foamed, health, hospitalist, hospital, internal, internist, nurse, meded, medical, medicine, practitioner, professional, primary, physician, resident, student

Get schooled on medical homes, payer reform, and what the future might look like for primary care with Dr. Sue Bornstein, MD, FACP and Executive Director of the Texas Medical Home Initiative and Chair of the Health and Public Policy Committee at the ACP. Dr Alex Lane of Cooper University Hospital joins Matt as cohost! Full show notes available at http://thecurbsiders.com/podcast Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Time Stamps 00:00 Intro 02:42 Guest CV and background 04:42 Getting to know our guest 10:40 Helpful resources for learning health policy 12:10 Who are the major players/influencers in health care and how do their interests align 15:02 Defining “medical home” 18:45 Where did the idea for a “medical home” originate 22:33 How does medical home affect cost 29:45 Payer reform and the quality payment program (QPP) 33:06 Recap and defining terms 37:18 How will the QPP be implemented? 41:04 Repeal and replace 43:37 Cuts in funding for safety net hospitals that care for the poorest, sickest patients 46:59 Take home points 48:55 Outro Tags: medicare, medicaid, health, care, policy, spending, quality, improvement, advanced, payment, macra, mips, qpp, apm, medical, home, pcmh, affairs, super, utilizer, texas, physician, doctor, assistant, nurse, practitioner, foamed, meded

Expand your consciousness around medical cannabis (aka marijuana) with expert Dr Donald Abrams, Chief of the Hematology-Oncology Division at San Francisco General Hospital and a Professor of Clinical Medicine at the University of California San Francisco. We explain the cannabinoid system, THC, CBD aka cannabidiol, limitations surrounding cannabis research, current and future medical uses for medical cannabis (marijuana), and potential conditions it may benefit. We take a deep dive on the potential harms of medical cannabis and how to counsel patients on safe use. Plus, the return past guest and new correspondent, Dr Molly Heublein, Assistant Professor of Medicine from UCSF. Thanks to Dr Molly Heublein for writing and producing this episode and it’s show notes! Full show notes available at http://thecurbsiders.com/podcast Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Clinical case from Kashlak Memorial:  MM is a 62 yo woman with a history of osteoarthritis and breast cancer, now on an aromatase inhibitor. She struggles with aching and stiffness in her hands, shoulders, knees, and hips. A friend suggested she try medical marijuana. She wants her provider’s opinion on if this is safe and effective. Time Stamps 00:00 Intro 01:30 Picks of the week 03:40 Guest bio 05:11 Getting to know our guest 11:03 Clinical case 11:40 Limitations for cannabis research 12:59 Discussion of THC and cannabidiol 14:50 Smoking versus ingesting cannabis products 16:40 Recap of cannabinoid mechanism of action 18:30 Cannabis and cannabinoid products available 20:20 Synthetic THC (dronabinol) 21:46 How “recommending” cannabis and dispensaries work 25:46 Conditions that respond to medical cannabis 29:15 Potential harms of medical cannabis 34:51 Future directions of cannabinoid medicine research 37:24 Cannabis induced hyperemesis syndrome 39:00 Possible lung cancer risk 40:12 Take home points 42:54 The Curbsiders recap and share their views on the medical cannabis controversy 49:40 Outro

Remedy your ignorance as we review some basics of health care policy with Dr. Fatima Syed, Chair of the Council of Residents and Fellows for the American College of Physicians. Dr. Syed is early career physician whose work is already affecting health policy at a national level. You can do it too and we’ll teach you where to start along with defining basic, but poorly understood concepts like The Affordable Care Act, universal health care, single payer health care, MACRA, MIPS, and how “quality” is really measured. Don’t miss this part one in our health care policy for beginners series. Full show notes available at http://thecurbsiders.com/podcast Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com.  Time Stamps 00:00 Intro 03:20 Getting to know our guest 07:23 How to get involved in a professional organization 09:37 Resources to learn health policy 14:06 The Affordable Care Act and ObamaCare 17:56 What is MACRA, MIPS and how do they affect physicians? 23:09 Nationalized health care in the US versus other countries 25:33 Universal and “single payer” health care defined 27:00 How is quality health care defined? Why is the US rated so poorly? 32:53 Recap and summary of what we’ve learned 34:09 Dr. Syed’s take home points 35:36 Outro Tags: policy, healthcare, macra, mips, aca, affordable, care, act, health, acp, advocacy, quality, payments, reimbursement, kaiser, commonwealth, assistant, care, education, doctor, family, foam, foamed, health, hospitalist, hospital, internal, internist, nurse, meded, medical, medicine, practitioner, professional, primary, physician, resident, student

Learn about the diagnosis and management of vasculitis and Giant Cell Arteritis with a rheumatologist. Topics include interpreting ESR levels, diagnosing GCA in elderly patients, and the overlap between GCA and Polymyalgia Rheumatica. Discover the chewing gum test and the challenges of steroid treatment for GCA.

Dr. Philip A. Masters, editor-in-chief of MKSAP and an educator at the University of Pennsylvania, shares invaluable insights into medical education. He discusses how to individualize learning for different styles and recognize struggling learners. Dr. Masters emphasizes the importance of maintaining work-life balance and adapting teaching methods in our fast-evolving field. He also highlights vital resources for educators to enhance their teaching skills and the continuous journey of learning necessary in medicine.