The Curbsiders Internal Medicine Podcast

by thecurbsiders@gmail.com

58m

average length

262

episodes

6

followers

Supercharge your learning and enhance your practice with this Internal Medicine Podcast featuring board certified Internists as they interview the experts to bring you clinical pearls, practice changing knowledge and bad puns. Doctors Matthew Watto, Stuart Brigham, Paul Williams and friends (a national network of students, residents and clinician educators) deliver a little knowledge food for your brain hole. Yummy! No boring lectures here, just high value content and a healthy dose of humor. Fantastic for Internal Medicine, Family Medicine, Primary Care, and Hospital Medicine.

Best The Curbsiders Internal Medicine Podcast episodes upvoted by the community

Last updated on September 22, 2020, 7:08 am

#2

#198 PCOS: Polycystic Ovary Syndrome with Katherine Sherif MD

March 09, 2020 • 67m

Polycystic ovary syndrome (PCOS) is more common than we think!  Listen as our esteemed guest Dr Katherine Sherif (@katherinesherif) reviews common patient complaints that should trigger PCOS in the differential, its pathophysiology, key physical exam findings, an algorithm for lab evaluation for PCOS diagnosis, and common treatments (OCPs, metformin, spironolactone and more!). Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com Credits Written and Produced by: Molly Heublein, MD Cover Art and Infographic: Kate Grant MBChB DipGUMed  Hosts: Matthew Watto MD, FACP; Molly Heublein, MD Editor: Emi Okamoto MD (written materials); Clair Morgan of Nodderly.com (audio) Guest: Katherine Sherif, MD Sponsors AccessMedicine is the acclaimed online medical resource that features Harrison's Principles of Internal Medicine and more trusted content from the best minds in medicine. Visit  AccessMedicine to learn more: http://bit.ly/MHCurbsiders.   Primary Care Physician Opportunity in beautiful Ithaca, NY! Join a well established practice in beautiful upstate New York near the finger lakes and wine country! You'll have flexible hours and the ability to take the time you need with patients! Contact Dr. Ann Costello arcostello@gmail.com to find out more about this incredible opportunity to join the team at Primary Care Internal Medicine of Ithaca https://www.primarycareinternalmedicineofithaca.com/.  Time Stamps 00:00 Sponsors - AccessMedicine.com (McGraw-Hill) http://bit.ly/MHCurbsiders; Primary Care Internal Medicine of Ithaca https://www.primarycareinternalmedicineofithaca.com/ 00:35 Intro, disclaimer, guest bio 03:00 Guest one-liner, book recommendation; Picks of the Week*: The Beginner’s Guide to the End: Practical Advice for Living Life and Facing Death, by Dr BJ Miller and Shoshana Berger; Overdrive App to download audio books and other media from libraries 07:58 AccessMedicine.com (McGraw-Hill) http://bit.ly/MHCurbsiders; Primary Care Internal Medicine of Ithaca https://www.primarycareinternalmedicineofithaca.com/ 09:30 Case of PCOS; Definition; Common presenting complaints 14:40 Hirsutism and terminal hair growth 17:05 Alopecia 20:25 Acne; Hidradenitis suppurativa 23:05 Irregular menses; Lab workup; Non-classic congenital adrenal hyperplasia 28:38 Hyperandrogenism lab workup (Testosterone, DHEA-S, Anti-Mullerian Hormone, utility of LH and FSH); Quick word on US 37:15 Recap of how to diagnose PCOS 38:15 Insulin resistance, body habitus in PCOS 40:04 Pathophysiology in PCOS (two schools of thought: Hypothalamus vs Insulin) 43:27 Dr. Sherif’s spiel to patients newly diagnosed with PCOS 46:40 Long term risks in PCOS 50:35 Approach to treatment of PCOS (OCPs, metformin, spironolactone, hair removal) 60:35 Treatment of alopecia; Lifestyle factors 63:55 Take home points and Outro *The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on our Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra. Goal Listeners will explain the basic pathophysiology, diagnosis, and management of PCOS. Learning objectives After listening to this episode listeners will…   List the criteria for diagnosis of PCOS. Explain the relationship between PCOS and metabolic risks. Determine first line treatments for PCOS symptoms including oligomenorrhea, hirsutism, acne and alopecia.  Counsel patients on long term risks associated with PCOS and how to mitigate these. Disclosures Dr Sherif reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.  Citation Sherif K, Heublein M, Grant K, Okamoto E, Watto MF.  “#198 PCOS: Polycystic Ovary Syndrome with Katherine Sherif MD”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. March 9, 2020.

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#3

#69: CKD Prescribing Do’s and Dont’s with @kidney_boy, Joel Topf

November 27, 2017 • 41m

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, nsaids, ace-i, contrast, metformin, empagliflozin, nephropathy, care, education, doctor, family, foam, foamed, health, hospitalist, hospital, internal, internist, nurse, meded, medicine, medical, primary, physician, resident, student  

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#4

#85: Contraceptives: Pills, mini pills, and tiny pills

March 05, 2018 • 66m

Contraception simplified with clinical pearls from reproductive health and family planning experts, Dr Angeline Ti, and Dr Moira Rashid. We cover it all including: the menstrual cycle, mechanism of action for various methods of birth control, hormonal versus nonhormonal contraceptives (e.g. intrauterine devices, patches, pills, rings, implants), patient counseling, and lots of resources to make your job easier. Women’s health correspondent, Dr Molly Heublein returns as cohost. Take our self-assessment quiz! Written by: Molly Heublein, MD, Beth Garbitelli and Sarah Roberts, MPH. Edited by Matt Watto, MD 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 Disclaimer 00:35 Intro 01:32 Guest bios 03:45 One liners, app recommendations, picks of the week 09:32 Picks of the week 12:45 Intro to contraception and a clinical case 13:33 Starting a conversation about contraception 16:55 Is having a period needed? And, which agents cause amenorrhea? 19:28 The menstrual cycle reviewed 23:29 Pros and Cons of long acting progesterone only agents 26:55 Choosing between IUDs 30:00 Who should get a copper IUD 30:53 Mechanism of hormonal IUDs 31:37 Risk with IUDs 34:05 Why are there so many OCPs? 36:05 Counseling patients on risks of OCPs 38:00 Risk of breast cancer with hormonal contraception 42:10 Benefits of hormonal contraception 43:38 Migraines and hormonal contraception 44:53 Mono- vs bi- vs triphasic pills. Does it matter? 46:15 Starting dose for OCPs 48:31 Is the mini pill effective? 49:37 Patches and rings 51:15 Take home points 52:40 Whoops, almost forgot emergency contraception! 56:32 How do copper IUDs work? 58:10 The Curbsiders recap the episode, plus some clinical pearls from Molly about birth 65:00 Outro Tags: contraception, birth control, IUDs, LARCs, mirena, skyla, lilletta, Paragard, OCPs, minipill, birth, control, pills, menstruation, follicular, phase, luteal, side, effects, emergency, contraceptives, ulipristal, ella, plan B, levonorgestrel, women’s, health, internal, medicine, internist, primary, care, family, practice, nexplanon, depo-provera, breast, cancer, family, planning, CDC, MEC, eligibility, criteria, bedsiders, pregnancy, ovulation, meded, foamed, nurse, student, physician, assistant, doctor

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#6

In-Flight Emergencies REBOOT

October 07, 2019 • 40m

Dominate the most common in-flight emergencies with tools and tips from this classic Curbsiders episode. Our guest, Angelica Zen MD, (formerly an IM Chief Resident at UCLA), recounts a harrowing tale of heroism at 30,000 feet and schools us on how to throw down in an in-flight emergency. We review what’s available in the standard medical kit, common conditions encountered, and the medical legal implications of responding to in-flight emergencies. This episode is a must listen before you next step on a plane. Original air date November 21, 2016. Full show notes https://thecurbsiders.com/episode-list. 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. Credits Written, produced and edited by: Matthew Watto MD, FACP Cover Art by: Matthew Watto MD, FACP Hosts: Stuart Brigham MD; Paul Williams MD, FACP; Matthew Watto MD, FACP Guest: Angelica Zen MD Partners Win a prize! Celebrate National Internal Medicine Day and tell us why you’re I.M. Proud. Tell us why you are I.M. Proud and enter the contest by visiting acponline.org/improud to submit your story today! Answer one of the three questions below and share your story on social media using the hashtags #IMProud #NationalInternalMedicineDay, and tag @acpinternists. Prizes will be given out 3 times through June of 2020. The first group of winners will be announced on the first ever National Internal Medicine Day October 28, 2019! What makes you proud to practice internal medicine or one of the I.M. subspecialties?  What recent patient experience made you proud to be an internist or subspecialist? How is internal medicine unique from other subspecialties? See us at the CHEST 2019 Annual Meeting in New Orleans! We’ll be doing two live interviews on stage, plus recording two recap episodes to bring you high yield clinical pearls from the conference. Look out for us in our red Curbsiders shirts and say hello. Take a picture with Stuart! Give Paul a hug! Register today https://chestmeeting.chestnet.org/ !!!! Time Stamps 00:00 Cold open; Disclaimer 00:50 Sponsor: ACP’s National Internal Medicine Day 2019 www.acponline.org/improud  01:10 Intro, Guest Bio 02:50 Guest onliner; Wellness tips; Tips for staying up on the literature Pick of the Week*: How Doctors Think (book) by Jerome Groopman; MDCalc app; AHRQ app; Physician’s First Watch 07:30 Sponsor: ACP’s National Internal Medicine Day 2019 www.acponline.org/improud  09:08 Dr. Zen tells her story 19:27 Monitoring your patient in-flight 20:05 Contents of the standard in-flight medical kit 22:10 What Dr. Zen would have done differently 23:05 How to use available resources in-flight 24:20 Medical legal implications 28:07 How to respond to common in-flight emergencies and how to respond 29:35 Syncope and presyncope 31:55 Hypoxia altitude simulation test (HAST) 33:15 Altered mental status 33:52 Anaphylaxis 35:34 Stroke and acute coronary syndrome 36:55 Dr. Zen’s take home points 38:50 Outro *The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on my Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra. Goal Listeners will comprehend their role and potential liabilities during in-flight emergencies and effectively utilize available resources for triage, patient care, and decisions about diverting the plane. Learning objectives By the end of this podcast listeners will: Be familiar with the contents of the standard medical kit Think outside the box to identify, improvise and utilize the available resources for patient care Recognize the medical legal consequences of providing emergency medical care on a plane Confidently evaluate and manage common in-flight emergencies using the available resources Disclosures Dr. Zen reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures. Citation Zen A, Brigham SK, Williams PN, Watto MF. “#19 In-Flight Emergencies.” The Curbsiders Internal Medicine Podcast https://thecurbsiders.com/episode-list. Original air date November 21, 2016.

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#8

#97: Curbside Journal Club: Hotcakes and Hot Takes May 2018

May 28, 2018 • 39m

Keep current with this monthly journal club covering landmark articles through May 2018, plus rapid fire hot takes from the medical literature and health news. We rate each article according to a highly scientific ‘Hotcakes’ scale to highlight what practice-changing knowledge we’ll take to work this month. Topics: Hypertension, blood pressure monitoring, prostate cancer screening, Intimate Partner Violence screening, alcohol is killing you, new diabetes drugs and mortality, DPP-4 inhibitors and IBD risk, NT-proBNP-guided therapy vs usual care, effect of teaching status on mortality, and more! If you’re a listener and have something interesting for us to discuss, please send it our way. Join our mailing list to 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. We are also on Facebook, Instagram, and Twitter: @thecurbsiders. Credits: Written and produced by: Christopher J Chiu MD, Sarah Phoebe Roberts MPH Hosts: Christopher J Chiu MD, Stuart Brigham MD, Paul Williams MD, and Matthew Watto MD Editor: Matthew Watto MD Time Stamps:  00:00 The Curbsiders need a web master 00:50 Disclaimer 01:25 Intro to the format 03:25 Ambulatory BP monitoring and mortality 09:08 Blood pressure treatment strategies: CVD risk score vs systolic BP targets 14:14 Repeated BP measurements important at office visits and future directions of BP management 21:25 Hot takes in order of appearance: Prostate cancer screening, intimate partner violence, alcohol, DPP4 inhibitors mortality and IBD, teaching status and mortality in US hospitals, 5 lifestyle factors that may add to life expectancy, NT pro-BNP, BNP and mortality 38:12 Outro Tags: Hypertension, blood, pressure, monitoring, cuff, automatic, ambulatory, prostate, cancer, screening, Intimate, Partner, Violence, alcohol, mortality, DPP4, sglt2, glp1, IBD, risk, BNP, teaching, assistant, care, doctor, education, family, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

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#9

#172 Cost-of-Care Conversations

September 11, 2019 • 55m

  Recognize the importance of cost-of-care conversations and identify resources to facilitate these discussions with help from Gwen Darien, executive vice president at the National Patient Advocate Foundation, and Dr. Jessica Dine, Associate Professor and Chief of the division of Pulmonology and Critical Care at Perelman School of Medicine.  We review barriers to cost-of-care conversations and identify tools to help make these conversations a part of routine care discussions.  Full show notes at https://thecurbsiders.com/episode-list. 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. Credits Written and Produced by: Elena Gibson, MD Infographic and Cover Art: Elena Gibson, MD Hosts: Elena Gibson MD; Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP   Editor: Matthew Watto MD, FACP; Emi Okamoto MD  Guest: Gwen Darien and Jessica Dine MD Partners and Grant Support The American College of Physicians. Check out this supplement to the Annals of Internal Medicine from May 2019 on Fostering Productive Health Care Cost Conversations https://annals.org/aim/issue/937992 The Robert Wood Johnson Foundation https://www.rwjf.org provided grant support for this episode. Time Stamps 00:00 Pun, disclaimer, sponsor 01:10 Intro, guest bios 06:10 Guest one-liners 07:22 Picks of the week*: Sing Unburied Sing (book) by Jesmyn Ward ; The Quiet American (book) by Graham Greene; An American Sickness: How Healthcare Became Big Business and How You Can Take It Back (book) by Elisabeth Rosenthal 09:35 Best Advice: Always question received wisdom; Listen! 14:10 Cost of treatment versus cost of care 15:35 How does cost of care affect outcomes?; Talking about money (finances) with patients 18:52 Defining “underinsured”; High deductible plans 22:41 Why are physicians scared to talk about cost? 26:16 Why is cost of care so difficult to determine? Who’s benefiting from lack of transparency? 28:35 Stuart explains his theory on why costs make no sense 30:00 How to have cost of care conversations 32:10 How to estimate cost; Specific tools 42:10 Cost of care plans 50:03 Take home points and plugs: National Patient Advocate Foundation; NeedyMeds.com; ACP High Value Care; AAFP Neighborhood Navigator Tool 53:00 Outro *The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on my Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra. Goal Listeners will recognize the need for routine cost-of-care conversations and identify resources to improve the quality of such conversations in order to deliver high-value care.  Learning objectives After listening to this episode listeners will…   Recognize the importance of cost-of-care conversations between physicians and patients  Describe barriers to conversations concerning healthcare costs Feel comfortable initiating routine conversations with patients on the cost-of-care  Identify where and how to access resources to assist with healthcare cost conversations   Disclosures Gwen Darien and Dr. Jessica Dine report no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.  Citation Dine J, Darien G, Gibson E, Brigham SK, Williams PN, Okamoto E, Watto MF. “#172 Cost-of-Care Conversations”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list September 11, 2019.

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#11

#94: Random Pearls: Microbiome, POTS, Gabapentin, and Leonardo Da Vinci

May 07, 2018 • 29m

A random serving of knowledge food for your brain hole with returning guest, Dr. Alan Dow, Professor of Internal Medicine at Virginia Commonwealth University School of Medicine. Our final live recap show from ACP 2018 covering: human microbiome, copper deficiency, POTS syndrome, substances of abuse, drugs for delirium and how to be more like Leonardo Da Vinci. Please let us know what you liked, didn’t like and how we can make the show better. Full show notes available at http://thecurbsiders.com/podcast Join our mailing list and receive a PDF of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. We are also on Facebook, Instagram, and Twitter: @thecurbsiders. Time stamps: 00:00 Disclaimer 01:30 Guest bio 03:19 Getting to know our guest, podcast, and book recommendations 08:55 Human microbiome 11:05 A case of anemia and neuropathy 13:30 Physiology and treatment of POTS syndrome 17:00 Novel substances of abuse 20:17 Benzodiazepines for delirium 24:00 Leonardo Da Vinci versus the modern physician 27:18 Outro Tags: microbiome, transplant, bupropion, gabapentin, pregabalin, copper, POTS, substance, use, disorder, leonardo, da, vinci, acp, journal, article, literature, news, media, doctor, education, family, foam, foamed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

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#12

#118 Female Sexual Problems with Stacy Lindau MD

October 08, 2018 • 56m

Houston, we have a female sexual dysfunction problem. Female sexual problems, which can affect women of all ages, are underdiagnosed and undertreated--in part because clinicians are not the best at asking about sex in primary care visits. In the course of this episode, learn about how to have that sex talk you’ve (maybe) been avoiding, what to ask when working up sexual problems in women, and find the words to talk to patients about sex. Today, we’re lucky to have the female sexual health expert of experts, Dr. Stacy Lindau, MD, MA, Professor of Obstetrics and Gynecology and Medicine-Geriatrics at the University of Chicago Medicine, on the show to teach us the best “sex talk” language, the differential for female sexual problems, and explore therapies. Sadly, there’s no sildenafil-like magic bullet, but a multidisciplinary team can make real impact on female sexual problems. Don’t forget to check out http://womanlab.org Full show notes available at http://thecurbsiders.com/podcast. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits Written and produced by: Nora Taranto MS4 Hosts: Leah Witt MD and Matthew Watto MD Infographic: Leah Witt MD Editor: Matthew Watto MD Guest: Stacy Lindau MD Time Stamps 00:00 Disclaimer 00:35 Intro and guest bio 03:30 Guest one liner, book recommendations, favorite failure, career advice and picks of the week 12:57 Clinical Case of female sexual dysfunction and some definitions 15:08 Are sexual problems a normal part of aging?; How to take a sexual history; Etiology of sexual dysfunction; “Diagnostic sex”; Red flags 27:54 Medications that contribute to sexual dysfunction 31:00 Labs 34:45 Treatment: pelvic PT, medications, counseling, flibanserin, herbal supplements 49:05 Screening for female sexual problems 51:58 Take home points; WomanLab.org 55:19 Outro Tags sexual dysfunction, female, gynecologist, ob-gyn, female sexual disorder, libido, sex, hormones, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

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#13

#186 Sarcopenia: Raising the Bar in Primary Care

December 02, 2019 • 71m

Make some gains with Drs. Feigenbaum (@Jordan_theCoach) & Baraki (@AustinBaraki) of Barbell Medicine as we delve into the topic of sarcopenia! Together we’ll learn what exactly is sarcopenia, how it is diagnosed, and explore approaches to both management and counseling including: exercise prescriptions,  recommendations for protein intake, and even how to treat patients with multiple comorbidities. Show Notes | Subscribe | Spotify | Schwag! | Top Picks | Mailing List | thecurbsiders@gmail.com Credits Written and Produced by:  Cyrus Askin MD Infographic: Cyrus Askin MD, Hannah Abrams Cover Art: Dr. Kate Grant MBChB DipGUMed Hosts: Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP    Editors: Matthew Watto MD, FACP; Clair Morgan of Nodderly.com Guests: Jordan Feigenbaum MD; Austin Baraki MD Check Out our friends at Barbell Medicine! Learn more about Barbell Medicine through their website at www.barbellmedicine.com or their YouTube channel - Barbell Medicine. They also have their own Podcast, The Barbell Medicine Podcast and can be found on Instagram: @barbell_medicine, Twitter via @BarbellMedicine. Drs. Feigenbaum and Baraki can be found on instagram via Jordan_BarbellMedicine & Austin_BarbellMedicine. They can also be found on Twitter via @AustinBaraki, @Jordan_theCoach. Time Stamps 00:00 Intro, disclaimer, guest bio 03:20 Guest one-liners; Picks of the Week*: Explain Pain (book) and Explain Pain Super Charged; Range Why Generalists Triumph in a Subspecialized World (book) by David Epstein; The Sports Gene: Inside the Science of Extraordinary Athletic Performance (book); The Mind’s Eye (book) by Oliver Sacks; The Predator High Five (Gif); The Bacterionomicon 08:50 How Austin and Jordan got into coaching, fitness and lifestyle medicine 14:30 Case of chronic pain, lack of exercise and loss of muscle mass; Defining sarcopenia, cachexia, frailty 22:30 How to diagnose sarcopenia -measures of physical performance (Repeat Chair Sit to Stand; Timed Get Up and Go Test; Gait Speed); DXA scans; The SARC-F questionnaire; Serum Creatinine 33:30 Anabolic resistance; Sarcopenic obesity and Osteosarcopenic obesity 37:00 How to counsel patients about physical activity 40:00 The 10,000 step thing is based on marketing, not evidence 41:30 How to sell exercise to patients with comorbidities; Barriers to and safety of resistance training 49:39 Finding a physical trainer 53:18 Dietary protein intake recommendations 61:33 What kind of results might patients expect 65:55 Take home points 68:11 Plugs: Barbell Medicine podcast, Instagram, YouTube and Twitter 69:15 Outro and a pun *The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on my Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra. Goal By the end of this episode, listeners will be familiar with sarcopenia as an important clinical entity, the risk factors for sarcopenia, how to assess a potential sacropenic patient and how to provide treatment and counsel towards preventing or reversing sarcopenia.  Learning objectives After listening to this episode listeners will…   Appreciate the clinical relevance/importance of sarcopenia Know who is at risk for sarcopenia and how to screen them Master the most recent exercise and nutrition recommendations for adults Be familiar with motivational interviewing techniques to help promote diet and exercise changes to combat sarcopenia Disclosures Dr. Feigenbaum is the owner of Barbell Medicine LLC which provides free, paid and retail content to include strength/nutrition coaching, strength/nutrition seminars, shirts, training gear and protein / pre-work out supplements. Dr. Baraki works part-time for Barbell Medicine LLC as a writer and coach for which he is paid. He does not receive any proceeds from the sale of supplements or other retail goods.  Citation Askin C, Baraki A, Feigenbaum J, Williams PN, Brigham SK, Watto MF. “#186 Sarcopenia: Raising the Bar in Primary Care”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. December 2, 2019.

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#14

#171 Lupus in Primary Care with Beth Jonas MD

September 09, 2019 • 55m

Diagnose and treat lupus in primary care with tips from rheumatologist, Beth Jonas MD, FACR (UNC). We discuss the history and exam findings in lupus, initial lab workup, the dreaded ANA, who needs expanded lab testing, lifestyle factors in lupus, vaccinations, the basics of treatment...and Jethro Tull?!  Full show notes at https://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. Credits Written and Produced: Kate Grant MBChB DipGUMed; Matthew Watto MD, FACP Infographic: Matthew Watto MD, FACP Cover Art: Kate Grant MBChB DipGUMed Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP Editor: Matthew Watto MD, FACP Guest: Beth Jonas MD, FACR Time Stamps 00:00 Intro, disclaimer, guest bio 03:03 Guest one-liner; Book recommendation*: How Doctors Think (book) by Jerome Groupman; Career advice 10:50 A case of hematuria and rash, Ms Luna Wolferton 12:00 Differential diagnosis for a patient with symptoms suggestive of lupus 13:50 Clues for lupus on history and exam 15:42 Classification criteria versus making a clinical diagnosis of lupus (Dorner 2019) 18:17 ANA, what is it good for? 21:33 Basic lab workup (CBC, urinalysis and TSH) 25:10 Labs to send once lupus is suspected 28:15 Does Ms Wolferton have lupus?  29:10 Spiel for explaining lupus to a patient 31:20 ANA titers 33:02 Are there classic phenotypes of lupus? 34:40 Lifestyle factors 38:20 Bone density and chronic steroids 39:42 Vaccinations; Antimicrobial prophylaxis 41:55 Hydroxychloroquine; Treatment goals in lupus 44:38 Steroids and add on therapies e.g. methotrexate, Belimumab 47:55 The importance of hydroxychloroquine 49:15 Drug-induced lupus (e.g. hydralazine, isoniazid, minocycline, procainamide) 51:17 Take Home Points; Plug: Thurston Arthritis Center at UNC Chapel Hill 53:40 Outro Goals Listeners will recognize and diagnose various presentations of lupus (SLE) in primary care, counsel patients with a new diagnosis of lupus, learn the general approach to treatment, and provide preventive care.  Learning objectives After listening to this episode listeners will... Recognize its myriad manifestations and diagnose lupus.  Perform an initial workup for suspected lupus Interpret positive ANA titers and order appropriate follow up testing Counsel patients with a new diagnosis of lupus Educate patients on nonpharmacologic therapy for lupus Discuss the basics of lupus treatment and monitoring/prevention including vaccinations, control of vascular risk factors, antimicrobial prophylaxis and promotion of bone health Provide excellent primary care and preventive medicine to co-manage lupus Counsel patients with a new diagnosis of lupus  *The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on my Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra. Disclosures Dr. Jonas reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures. Citation Jonas B, Williams PN, Watto MF. “#171 Lupus in Primary Care with Beth Jonas MD”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list September 8, 2019.

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#15

#123 Sleep Apnea Pearls and Pitfalls

November 05, 2018 • 52m

The sleep apnea episode that won’t put you to sleep. Become a sleep apnea guru with incredible insights from Barbara Phillips MD, MSPH, FCCP an expert in pulmonary medicine, critical care and sleep medicine who is also a past president of CHEST! We discuss high-yield topics in the world of obstructive sleep apnea including: home sleep studies vs in-lab polysomnography, the importance of oxygen saturation (the T90 and ODI) when interpreting sleep study results, tricks to improve CPAP adherence, and alternatives therapies for obstructive sleep apnea. ACP members can visit https://acponline.org/curbsiders to claim free CME-MOC credit for this episode and show notes. Full show notes available at http://thecurbsiders.com/podcast. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits Written and produced by: Cyrus Askin MD CME questions by: Cyrus Askin MD Editor: Chris Chiu MD & Matthew Watto MD Hosts: Cyrus Askin MD & Matthew Watto MD Guest: Barbara Phillips, MD Cover-Art & Infographic - Beth Garbitelli, MS1 Time Stamps 00:00 Disclaimer, intro, guest bio 03:00 Guest one liner, book recommendation, advice for trainees 08:10 Clinical case of sleep apnea, some basic stats, and key predictors of sleep apnea 12:38 Barriers to diagnosis and treatment of OSA 15:23 Discussion of T90, hypoxemia and sleep fragmentation 17:05 How to read a sleep study report 21:55 Home sleep apnea testing 24:15 What are the consequences of sleep apnea 28:30 What is the efficacy of cpap for lowering blood pressure and mortality 31:45 Counseling a patient who is new to cpap 33:45 Choice of mask 40:10 Do alternatives to cpap work? e.g. surgery, mandibular advancement devices 44:17 Modafinil and z-drugs 47:15 Driver’s license issues in sleep apnea 48:35 Future of sleep medicine and take home points 51:15 Outro

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#16

#117 Clostridium Difficile: IDSA Guidelines, Bad Puns, and Random Pearls

October 01, 2018 • 64m

Summary Conquer Clostridium difficile (Clostridioides difficile) with this “spore-tacular” episode featuring infectious diseases expert, Dr. Curtis Donskey, Professor at Case Western Reserve University and clinician at the Louis Stokes VA Hospital. We discuss the updates in the 2017 IDSA C. difficile guidelines plus a bunch of random pearls. If you have ever laid awake at night wondering how many pills are needed for a fecal transplant, then this is the episode for you!  We discuss why metronidazole was dropped as the first line therapy for Clostridium difficile infection (CDI) along with other hot topics such as two-step testing, loperamide use, which antibiotics are the least likely to cause CDI, and more. Do not miss this episode! 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. Credits Written by: Carolyn Chan MD Produced by: Matthew Watto MD Hosts: Carolyn Chan MD, Matthew Watto MD, Paul Williams MD Editor: Matthew Watto MD Guest: Curtis Donskey, MD Time Stamps 00:00 Intro, disclaimer, guest bio 02:19 Getting to know our guest, recommendations for reading, career advice 06:40 Clinical case and CDI testing 09:30 Testing for CDI: PCR and Two step testing 16:30 Testing after treatment 20:00 Treatment of initial CDI episodes, metronidazole pharmacokinetics 24:15 Classification of CDI severity 29:30 Fidaxomicin pearls: when to use, cost, and tapers 34:10 Vancomycin tapers 36:05 Fecal transplant pearls: freeze dried capsules, c-scopes, treating fulminant CDI 44:44 Infection control: counseling homegoing patients, hand washing, and baths 47:50 Social media questions: immodium and toxic megacolon, antibiotics less likely to promote CDI, probiotics, and more! 59:14 Best CDI joke in the history of time 60:00 Take home points 62:42 Outro Tags Clostridium, difficile, cdi, C.Diff, infectious, diseases, diarrhea, IDSA, guideline, antibiotics, vancomycin, fidaxomicin, fmt, transplant, fecal, stool, toxin, assistant, care, doctor, education, family, FOAM, FOAMim, FOAMed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

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#19

#190 Recap Extravaganza 2019

December 30, 2019 • 65m

Recap extravaganza 2019 featuring top pearls from our staff’s favorite episodes of 2019 and voicemails from Kashlak faculty, Dr. Avital O’Glasser (@aoglasser), Dr. Kimberly Manning (@gradydoctor), Dr. Renee Dversdal (@DrSonosRD) and The Curbsiders team. Topics include: HFpEF, the PARAGON-HF trial, Buprenorphine, Opioid Use Disorder, Cirrhosis, Coagulopathy, SBP, Hyperkalemia treatment, Multimorbidity, and how to think about NNT. Plus, the team shares a bunch of other favorite moments and random pearls! Upcoming shows: The next two weeks will feature REBOOT episodes with fresh intros from The Curbsiders team. Season 9 starts January 20, 2020 with a Lipid Update from Cardiologist Dr. Erin Michos (@ErinMichos) Show Notes | Subscribe | Spotify | Schwag! | Top Picks | Mailing List | thecurbsiders@gmail.com Credits Produced by: Sarah Phoebe Roberts MPH and Chris Chiu MD, FACP, FAAP  Writer: Sarah Phoebe Roberts MPH Infographic: Sarah Phoebe Roberts MPH Cover Art: Kate Grant MBChB DipGUMed Hosts: Chris Chiu MD, FACP, FAAP; Stuart Brigham MD; Matthew Watto MD, FACP; Paul Williams MD, FACP    Editor: Chris Chiu MD, FACP, FAAP (audio), Matthew Watto MD, FACP (show notes) Time Stamps 00:00 Intro and disclaimer 04:25 Picks of the year*: The Expanse (TV show) -Chiu Man’s pick; Midsommar (film) -Paul’s pick; Point-of-care-ultrasound (ACP course at IM2020 in LA or AIUM courses with Dr. Renee Dversdal @DrSonosRD) -Matt’s pick; Sleep!!! -Stuart pick 08:37 Hyperkalemia Master Class Joel Topf MD 14:53 Multimorbidity Games with Josh Uy MD 21:54 Buprenorphine Master Master Class with Michael Fingerhood MD 27:50 Cirrhosis TIPS for Acute Complications with Scott Matherly MD 31:55 HFpEF with Clyde Yancy MD 39:50 Chronic pain, sickle cell disease, opioid tapers 43:13 Teaching in the Hospital 46:00 A quote from Paul Williams 47:35 Celebrity voicemails from Avital O’Glasser MD, Kimberly Manning MD,  and Renee Dversdal MD 51:55 Voicemails and favorite pearls from our Curbsiders team! 62:23 Outro Goal Listeners will recall some of the top pearls from Curbsiders episodes on cirrhosis, buprenorphine, HFpEF, multimorbidity and hyperkalemia. Links* The Expanse (TV show) -Chiu Man’s pick Midsommar (film) -Paul’s pick Point-of-care-ultrasound (ACP course at IM2020 in LA or AIUM courses with Dr. Renee Dversdal @DrSonosRD) -Matt’s pick Sleep!!! -Stuart pick *The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on my Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra. Disclosures The Curbsiders report no relevant financial disclosures.  Citation Roberts SP, Chiu CJ, Williams PN, Brigham SK, Watto MF. “#190 Recap Extravaganza 2019”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. December 30, 2019.

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#20

#223 Hot COVID Cakes: COVID19 Disparities, Steroids, Hormones for Depression, Probiotics

July 02, 2020 • 47m

This episode is Half COVID Cakes, Half Hotcakes, and entirely enlightening.  Our guest Dr. Utibe Essien MD, MPH @UREssien and Curbsider/epidemiologist, Dr. Rahul Ganatra MD, MPH @rbganatra discuss some Hot COVID Cakes including: racial differences in COVID-19 outcomes, why dogs and dexamethasone may hold the key to defeating COVID-19, how hormonal adjunctive therapies might be key for depression, and when to poo-poo probiotics versus when a side of Lactobacillus may be beneficial.    Listeners can claim Free CE credit through VCU Health at curbsiders.vcuhealth.org (CME goes live at 0900 ET on the episode’s release date).    Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | CME!   Credits Written and Produced by: Rahul Ganatra MD, MPHl Emi Okamoto MD; Sarah P. Roberts MPH; and Matthew Watto MD Show Notes and CME questions by: Deborah J. Gorth ScM Cover Art: Deborah J. Gorth ScM Hosts: Matthew Watto MD; Rahul Ganatra MD, MPH, Emi Okamoto MD, and Sarah P. Roberts MPH Editor: Matthew Watto MD (written materials); Clair Morgan of nodderly.com Guest: Utibe Essien MD, MPH   Sponsor VCU Health CE We are excited to announce that the Curbsiders are now partnering with VCU Health Continuing Education to offer continuing education credits for physicians and other healthcare professionals. Check out curbsiders.vcuhealth.org and create your FREE account!   Time Stamps 00:00 Intro, disclaimer, guest bio 02:20 Silver Linings / Picks of the Week: Chicken Run (2000) and Chicken Run 2 on Netflix; Philly Inquirer story on COVID sniffing dogs; Buy some peaches! And check out their Wikipedia page! 07:33 Hospitalizations and Mortality Among Black and White patients with COVID-19 26:10 Dexamethasone for COVID-19 28:55 Hormonal therapy for depression 38:16 Probiotics 45:00 Outro   Goal Listeners will learn about the role of race in COVID-19 outcomes, possible hormonal adjunctive therapies for depression, and when to recommend probiotics.  Learning objectives After listening to this episode listeners will…   Learn the effect of race on COVID-19 outcomes. Know the indications for adjunctive hormonal treatment for depression. Discuss the role of probiotics for the treatment of common gastrointestinal illness.    Disclosures Dr. Utibe Essien reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.    Citation Essien UR, Ganatra RB, Okamoto E, Roberts SP, Gorth DJ, Watto MF. “#223 Hot COVID Cakes: COVID19 Disparities, Steroids, Hormones for Depression, Probiotics”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. Original air date July 2, 2020.

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