The Curbsiders Internal Medicine Podcast

Dr. Robert Centor, a seasoned internal medicine professor, joins Neela Bajandas, an Assistant Professor at Temple University, to tackle the complexities of community-acquired pneumonia. They discuss the fine line between accurate diagnosis and misdiagnosis, the importance of biomarkers like procalcitonin, and the nuances of choosing antibiotics in emergency situations. Listeners will gain insights into evolving treatment guidelines, the impact of clinical tools, and a fresh perspective on the challenges within pneumonia management—all served with a side of humor.

Join us for this recap of the key clinical pearls and favorite fan voted episodes from 2017 including: lipids, asthma, diuretics, hyponatremia, CKD, vertigo, and dizziness. Plus, Picks of the Year, exciting announcements for 2018, and Paul reveals that he has a wife! Matt, and Paul are joined by Curbsiders Correspondent, Dr. Chris Chiu, who wrote and produced this episode. Stuart was out with the Man Flu. My apologies to Dr. Bryan Brown whose name I forgot to shout-out when listing our Correspondents. Thanks to Kate Grant for her beautiful cover image. 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 01:18 Getting to know Chris Chiu introduction 03:07 Picks of the week and 06:10 Picks of the year and discussion of vancomycin and pip-tazo causing AKI 11:41 Recap of Scott Weingart and EM vs IM episode 17:45 Discussion of Lipids, PCSK9, CAC, CCTA 27:10 Asthma pearls recapped 32:43 Dizziness and vertigo recapped 38:40 Diuretics, diuretic resistance, and secondary hypertension diagnosis and treatment 44:35 Diuretic dosing 46:25 Hyponatremia, volume status, solute loads and SIADH 50:08 CKD, when to refer, and an argument about low protein diets 54:25 Matt, Paul, and Chris reflect on important lessons learned from 2017 59:32 Listener questions and comments 63:35 Wrap-up, and shout outs 66:22 Announcements for 2018 67:25 Outro Tags: hyponatremia, salt, kidney, ckd, asthma, vancomycin, zosyn, injury, weingart, emcrit, emergency, lipids, pcsk9, statin, dizziness, vertigo, assistant, care, education, doctor, family, foam, foamed, health, hospitalist, hospital, internal, internist, nurse, meded, medical, medicine, practitioner, professional, primary, physician, resident, student

Combat opioid use disorder and the opioid epidemic as we review common clinical scenarios with addiction medicine specialists,  Dr. Stefan Kertesz, University of Alabama at Birmingham School of Medicine and Dr. Ajay Manhapra from the VA Hampton Medical Center in Hampton,Virginia. We need all hands on deck, and that means you! Learn the basics of opioid use disorder treatment as Dr. Manhapra gives us the scoop on “bup, bup, bup” (buphrenophine), and Dr. Kertesz primes us on opioid related health care policy and reminds us that “We can all do something about the opioid crisis”. Plus, Stuart and Paul express some concerns about how to approach these patients. Do not miss this episode filled with clinical pearls, policy, and joy! Special thanks to writers and producers, Dr. Carolyn Chan and Elena Gibson (MD Candidate, MS4), for their hard work on both of our addiction medicine episodes. 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.

Take the pain out of pain management with clinical pearls from addiction medicine specialists Dr. Stefan Kertesz at the University of Alabama at Birmingham School of Medicine and Dr. Ajay Manhapra from the VA Hampton Medical Center in Hampton, Virginia. They walk us through an approach to pain management in persons with a history of opioid use disorder (OUD), discuss treatment options for OUD, plus hot tips on how to interpret guidelines surrounding opioids, and more! What are you waiting for? Hit the play button! Special thanks to Elena Gibson, MD and Carolyn Chan, MD Episodes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME! Credits Producer: Elena Gibson and Carolyn Chan Writer: Carolyn Chan Infographic: Elena Gibson Cover Art: Elena Gibson Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP  Editor: Matthew Watto MD (written materials); Clair Morgan of nodderly.com Guest:  Dr. Stefan Kertez and Dr. Ajay Manhapra Time Stamps 00:00 Intro 01:58 Host picks of the week 04:10: Intro to the episode 04:35: Guest Bios 12:32: Case from Kashlak Memorial 13:40 Define substance dependence, substance use, unhealthy use 17:42 Where to go next conversation about pain control 17:54: Assessing risk of relapse 19:35 Screening Tools 20:10 Risk factors for developing OUD when initiating opioids. 25:10: CDC Guidelines length of prescription and risk of substance use disorder (7) 27:00: Defining optimal length of opioid after common surgical procedures (6) 30:30: Long term use of opioids 33:50: OUD treatment options 37:30: Duration of buprenorphine/naloxone treatment, tapering risks (8) 38:50: POATs: Prescription opioids (9) 40:05 Social support and mental health services for SUD treatment 41:10 Risk of abstinence and adverse outcomes 42:35 Protracted withdrawal 43:35: Editorial BMJ Golden Month of Opioid use disorder (10) 44:00 Overdose risk in patients on long term opioids 44:40 Op-Ed on the Hill (11) 45:40 Example of protracted withdrawal syndrome 47:40 Reducing Harms: Naloxone, who to prescribe to? 50:30 Take home points 53:40 Outro

Experts Dr. Jeffrey Colburn and Dr. Vin Tangpricha share tips on providing primary care for transgender patients. Topics include defining terms, counseling, hormonal therapy, surgical options, and fostering a welcoming environment. The podcast also explores guidelines for hormone therapy, barriers to medical therapy, and standards for gender affirmation surgery.

Knock the wind out of asthma with tips from Dr Denitza Blagev, a pulmonologist and intensivist who currently serves as Director for the Schmidt Chest Clinic at Intermountain Medical Center in Murray, Utah. We simplify the approach to diagnosis, spirometry, patient counseling, choice of agent, stepwise therapy, and de-escalation...plus, a little myth busting. Special thanks to Dr Cyrus Askin for writing and producing this episode and to Dr Bryan Brown for his wonderful infographics. 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. 

Dr Kevin Pho, founder KevinMD.com “Social Media’s Leading Physician Voice" schools Matt, Paul and Stuart on a potpourri of topics including physician advocacy, the dangers and benefits of social media, the pros and cons of electronic health records, health policy, health advocacy and lastly primary care and the integration of advanced practice providers/clinicians. Special thanks to Dr Chris Chiu who helped produce the show and write our 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 00:54 Picks of the week 06:58 Getting to know our guest 10:30 Why physicians need to understand health policy 11:21 Best advice Dr Poh has received in his career and why variety is important to avoid burnout 13:45 Advice to young physicians about to start using social media 16:40 Why are physicians afraid of social media 18:54 Risks of social media 21:20 Discussion of “Twitter bates” aka debates 23:20 Physician advocacy and social media 26:18 The next big health care debate...is it a right? 31:03 Why electronic health records are so painful to use? 34:49 How can charting be worked into clinic workflow? 37:50 Conspiracy theories on EHRs 39:11 Advanced practice providers/clinicians 46:40 Primary care shortage 50:16 Growth of medical administrators and how to take back control as physicians 52:38 Advice on how to break into medical writing 54:08 Paul ends the show with some wisdom and steals the show 55:59 Outro  Tags: kevinmd, advocacy, policy, health, care, ehr, chart, advanced, practice, clinician, physician, meded, foamed, social, media, twitter, kevin, pho, nurse, practitioner, medicine, internal, family, primary, education, internist, hospitalist

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