Hospital and Internal Medicine Podcast

Heart Failure with Preserved Ejection Fraction (Diastolic CHF) and SGLT-2 Inhibitor Therapy Jan 27, 2022

The double-blind, randomized phase III EMPEROR-Preserved trial showed a benefit of the sodium-glucose cotransporter-2 (SGLT2) inhibitor empagliflozin in patients with heart failure with preserved ejection fraction (HFpEF).

Now let us dig a bit more into those headlines.

Should You Postpone Interventions for INFECTED Necrotizing Pancreatitis? Oct 18, 2021

An important recently published randomized control trial provides guidance on this controversy.

Spontaneous Bacterial Peritonitis - Unique Infections in Cirrhosis part 2 Jun 27, 2021

Unique Infectious Considerations in Cirrhosis - part 1 Jun 15, 2021

Diabetic Gastric Emptying Abnormalities (and sometimes normal) - Part 1 May 09, 2021

Almost nobody feels comfortable managing DELAYED gastric emptying (gastroparesis) and very few medical providers even think about RAPID gastric emptying in their diabetic patients. Even if you send these patients to GI specialists, your blood sugar co-management of these patients can be heavily impacted by these issues. Is delayed gastric emptying always a bad thing? When your patient has upper GI symptoms, how often is it a gastric emptying abnormality? Time for some answers.

Gastric Emptying Abnormalities - Part 2 May 08, 2021

Can we trust a nuclear study to nail the diagnosis? Are motor abnormalities really the cause of symptoms? What is a POP procedure?

Morphine for later stage COPD patients not on hospice Apr 09, 2021

Does regular, low-dose, oral sustained-release morphine improve disease-specific health status or cause respiratory adverse effects in patients with moderate to very severe chronic breathlessness due to advanced chronic obstructive pulmonary disease? Digging in on the latest study.

The JAMA controversy and loss of conversation in medicine Apr 05, 2021

My take on what went down at the Journal of the American Medical Association. I disagree with the comment there isn't "structural racism in health care", but was the backlash against the Editor who didn't say it (and actually opposed the comment) an over-reaction? Can we have discussions about the controversial issues that affect healthcare (like gun violence or abortion) without cancel culture cancelling the people who want to have nuanced discussions? I fear we lost the ability to have dialogue in a field where every MD/DO/PA/NP by definition has an advanced degree - and therefore we should be able to dispute misinformed statements to bring about change without the outrage going so far as to fire a person who actually objected to the hurtful statement.

Cows Milk - Healthy or Not? Mar 06, 2021

Psilocybin Mushrooms - will they become an accepted medicine? Feb 19, 2021

Understand Basic Epigenetic Changes in Medicine and Everyday Life Feb 04, 2021

This lecture provides a basic understanding of how epigenetic changes influence infections/sepsis, vaccinations, cancer, future generations, your muscles, and (of course) those sweet tan-lines you are rocking.

Every day you are living through epigenetic changes that have huge implications on your health and who you are.

Hyponatremia etiology by history and physical Dec 23, 2020

Hyponatremia remains a challenging topic for many because they are trying to memorize algorithms and numbers. You can usually nail the etiology by history & physical and a brief chart review.

Cytokine Storm - part 1 Dec 01, 2020

If you use the term 'cytokine storm' and don't really know what you mean by it, you are far from unique. Let me help to try and clarify it for you just a bit.

Cytokine Storm - part 2 Dec 01, 2020

Do you know what CRP is (other than saying it is an inflammatory marker)? Should we always shut down cytokines? If so, how? Why should we avoid giving a glucocorticoid to a COVID patient before they develop an elevated CRP or hypoxia? So many questions! A few answers are provided.

The Most Important Person That Lived For Our Health and Wellbeing Nov 27, 2020

Hint: That person died in 2017

An (old) New Weapon to Fight Leg Cellulitis Aug 12, 2020

Acute Severe Hypertension - part 1 Apr 28, 2020

Acute Severe Hypertension - part 2 Apr 28, 2020

Multiple treatment issues are discussed. This includes theoretical ideal blood pressure lowering rates, oral options (for hypertensive urgency and specific populations), intravenous options (for hypertensive emergency or NPO patients), specific issues with aortic dissection, coronary syndromes, acute pulmonary edema & heart failure, labetalol, esmolol, nitroglycerin, and nitroprusside.

Acute Severe Hypertension - part 3 Apr 27, 2020

Did you know that intravenous labetalol and oral labetalol are not really similar? The great hydralazine debate. Things you must know about Clevidipine if you are going to use it.

Acute Severe Hypertension - part 4 Apr 25, 2020

Did you know systolic and diastolic blood pressure are NOT measured by automated BP cuffs? PRES (Posterior Reversible Encephalopathy Syndrome), also known as RPLS (Reversible Posterior Leukoencephalopathy Syndrome), is something you should recognize when you see it. Brief mentions of esmolol, nitroprusside, and other topics are scattered somewhere in between musings.

Interesting Studies, Facts, & Opinions - April 2020 edition Apr 23, 2020

If you wonder why good food is more important than mortality and why ordering too many unnecessary consults worsens the food and doesn't impact mortality - this episode is for you. Tramadol is not well understood by many prescribers and there are some emerging facts we all need to know. A flashback to diuretic use in congestive heart failure with fluid overload and elevated creatinine is also discussed somewhere in the mix. Ohhh...and stop systematically prescribing nicotine replacement at high dosages for all hospitalized smokers.

Stevens JP, Hatfield LA, Nyweide DJ, Landon B. Association of Variation in Consultant Use Among Hospitalist Physicians With Outcomes Among Medicare Beneficiaries. JAMA February 21, 2020

“Twenty Common Mistakes Made in Daily Clinical Practice” American Journal of Medicine 2020:133(01):1-3

Cristobal Young, Xinxiang Chen, Patients as Consumers in the Market for Medicine: The Halo Effect of Hospitality, Social Forces

Tramadol is an odd, unpredictable opioid, scientists say - By The Associated Press - December 13, 2019

Balkan Reflections Forged By A Virus Lockdown Apr 23, 2020

World War I was partly triggered by powerful allies of various nationalities being dragged into a Balkan conflict (nationalism, of course, was another major factor). The more recent Balkan conflict is even more preposterous - and here is my attempt to humorously explain the unexplainable.

Recent Interesting Internal Medicine Studies and Facts - December 2019 Dec 10, 2019

Correcting Hypernatremia in adults (finally, a real study!). An option for that scary patient with hemoptysis. How many nephrons you have (and your patient has) - it matters.

Anemia of Inflammation - finally understand this common anemia that accomplished doctors often can't explain Sep 30, 2019

Anemia of Inflammation is also often referred to as Anemia of Chronic Disease. It is one of the most common anemias, yet often challenging to comprehend. This is an attempt is to try and simplify it.

Anemia of Inflammation - part 2 Sep 30, 2019

If you know why red blood cells survive less (and are made less) during inflammatory conditions, and already know why ferritin increases in inflammation, and don't want to hear a lousy Iron Man plot idea - then you are good to go on skipping this episode.

Anemia of Inflammation - part 3 Sep 30, 2019

Creatine - part 1 Aug 20, 2019

It occurs naturally in the body (because we synthesize it), it is in meat, and it is frequently used as a supplement. Since it is in you, why not understand what it is and what it does? Advice is provided on which supplement labels to particularly avoid. A brief reflection upon creatine within our brains (and the potential memory impact seen in one study) is utilized to make the point that when it comes to a performance enhancer, like creatine, it's not solely about the ramifications on muscle strength and endurance.

Creatine - part 2 Aug 06, 2019

The replenishing of muscle ATP is one (of the several) mechanisms that creatine helps with when it comes to heavy anaerobic exercise. Other topics discussed are things to know about lab testing the kidneys while taking creatine. Thoughts on why some don't respond to creatine supplementation.

Creatine - part 3 Aug 05, 2019

Is there a specific type of creatine to buy? What is creatine monohydrate? What is Creapure? What do some professional organizations have to say about the safety of creatine? The loading dose debate. Also dives into the several mechanisms of action for how creatine helps build muscle.

Medicare for All? (or maybe you call it Universal Healthcare or Single-Payer) Jul 01, 2019

Are you surprised that GoFundMe and crowdfunding are not the solution to a family healthcare crisis? How about Medicare for All? Hmmmm.....

Part 5 of Muscle and Strength Gaining Tips - The Emotional Connection and Overcoming Temporary Pain Apr 08, 2019

Clostridium Difficile - part 1 Jan 25, 2019

A deceivingly difficult topic. Not so obvious points are made about asymptomatic carriers, transmission, and who to test.

Clostridium Difficile - part 2 Jan 23, 2019

Specific initial treatment regimens are discussed. Topics include fulminant disease, Vancomycin, Fidaxomicin, Metronidazole, and recurrence rates/regimens.

Clostridium Difficile - part 3 Jan 23, 2019

Many of the latest studies in the 2017-2018 timeframe are reviewed. The importance of looking at the eosinophil count on the CBC, probiotic future directions, microbiome transplant options, antibody treatment (bezlotoxumab), "penicillin allergic" patients, and a brief mention of available testing.

Live From My Basement Bathroom Dec 23, 2018

Experiences that taught me some lessons.

Type 2 Diabetes Treatment - Part 7 - GLP-1 Agonists and DPP-4 Inhibitors Dec 17, 2018

Glucagon-Like Peptide 1 (GLP-1) mimetics are also referred to as the GLP-1 receptor agonists. While this talk mostly focuses on GLP-1 mechanisms and actions, the hope is you will also better understand The Dipeptidyl Peptidase-4 (DPP-4) inhibitors

The current GLP-1 Agonists include Exenatide (Byetta), Liraglutide (Victoza), Dulaglutide (Trulicity), Abiglutide (Tanzeum), Lixisenatide (Adlyxin), Semaglutide (Ozempic).

The current DPP-4 Inhibitors include Alogliptin (Nesina), Linagliptin (Tradjenta), Saxagliptin (Onglyza), Sitagliptin (Januvia).

Type 2 Diabetes Treatment - Part 6 - SGLT2 Inhibitors Sep 26, 2018

Sodium-Glucose Transporter 2 Inhibitors decrease glucose re-absorbtion. The diuretic effect, weight loss, DKA, cardiac outcomes, blood pressure, genital infections and a whole bunch of other information is discussed.

SGLT2s include Canagliflozin (Invokana), Dapagliflozin (Farxiga), Empagliflozin (Jardiance), Ertagliflozin (Steglatro), with more to be released in the future.

Type 2 Diabetes Treatment - Part 5 - HgA1C Aug 26, 2018

There is a lot more to understanding HgA1C then most realize (particularly the quality industry and big corporations).

Type 2 Diabetes Treatment - Part 4 - Metformin May 27, 2018

Tackles - Vitamin B12, kidney disease, CHF, cancer, Impaired Glucose Tolerance (IGT), dosing, side-effects, lactic acidosis, cost, drinkers, hypoxic patients, glucose lowering, and a few other moments of erudation.

Type 2 Diabetes Treatment - Part 3 Glucagon May 16, 2018

If you want to understand drug classes like DPP-4 inhibitors, GLP-1 (GLUCAGON-like peptide) therapies, treating hypoglycemia, and an important player among the many etiologies of Type 2 diabetes - then you must understand the basics about glucoagon.

Type 2 Diabetes Treatment - Part 2 - Reversing The Disease With Lifestyle Changes May 01, 2018

Type 2 Diabetes Treatment - Part 1 May 01, 2018

Internal Medicine Pearls #5 Apr 03, 2018

Diuretic therapy for congestive heart failure treatment, antibiotics for diabetic osteomyelitis after foot surgery, and practical tips with new-onset seizures - is among the knowledge dropped (because, after all, school can't teach us everything).

Some Recent Studies Worth Knowing About - February 2018 Feb 01, 2018

Some new stuff about Vitamin D & Calcium supplementation, another about the timing of hip fracture surgery, etc

Forcing Atheist Doctors to Play With God Dec 22, 2017

Internal Medicine Pearls #4 Nov 14, 2017

Checking glucose levels in Type 2 Diabetes, ACE Inhibitors for women, and using Azithromycin in Asthma.

Medical Podcasts, Skiing, and Imperfect Relationship Advice Oct 04, 2017

Patent Foramen Ovale Evaluation and Closure After a Stroke - part 2 Sep 26, 2017

Patent Foramen Ovale Evaluation and Closure After a Stroke - part 1 Sep 22, 2017

The Overhead Airplane Request for Medical Assistance - A No Win Situation Sep 20, 2017

A Severe Case of Healthcare Violence 2 Years Later Aug 31, 2017

Bedbugs 4 The Dark Night Returns Aug 31, 2017

Bedbugs 3 Live Free and Die Hard Aug 10, 2017

Bedbugs 2 Fast and 2 Furious Jul 30, 2017

Bedbugs - part 1 Jul 15, 2017

Urine Drug Testing - Misinterpretation is Very Common May 28, 2017

You know all those people on social media wanting mandatory drug testing for welfare recipients? Perhaps, reasonable in theory, if the test wasn't frequently producing false-positives and false-negatives. Making accurate clinical decisions is always challenging, but particularly with urine drug testing. The consequences of misinterpretation can be awful.

The death of Chris Cornell and calling my doctor May 22, 2017

Internal Medicine Pearls #3 May 11, 2017

A look at some new data: COPD and Oxygen use - low serum creatinine levels - BMI considerations - the RDW - the age of blood.

Let's do this! Simple changes to healthcare that nearly everyone can agree on. Apr 30, 2017

Vocational Confrontation and Political Rumination Apr 05, 2017

I'm a nerd looking at the world and shamelessly speaking my mind Mar 07, 2017

Renal and Ureteral Stones (Nephrolithiasis - Kidney Stones) - part 4 Feb 22, 2017

Oxalate intake reduction, thiazide diuretics, and tamsulosin are some of the therapies discussed in this lecture.

Renal and Ureteral Stones (Nephrolithiasis - Kidney Stones) - part 3 Feb 15, 2017

Stone analysis, labs, calcium & fluid intake, sodium in the diet, and beverage choices.

Renal and Ureteral Stones (Nephrolithiasis - Kidney Stones) - part 2 Feb 13, 2017

A few words about the proximal ureter, I.V. Fluids, colic, and hematuria.

Renal and Ureteral Stones (Nephrolithiasis - Kidney Stones) - part 1 Feb 01, 2017

This episode discusses symptoms, the importance of size, and a few other pearls.

What is Taurine? Jan 25, 2017

You see it in energy drinks. It is in our food, supplements, it naturally occurs in multiple organs, and most people don't know anything about it.

Part 4 of Muscle and Strength Gaining Tips for Men, Women, Bodybuilders, and Beginners Dec 29, 2016

Lifestyle, carbohydrates, protein, and eccentric weight training are part of the focus of this sermon.

Part 3 of Muscle and Strength Gaining Tips for Men, Women, Bodybuilders, and Beginners Dec 23, 2016

This episode is part philosophy, part motivation, and a discussion of some traps men and women get caught in.

Part 2 of Muscle and Strength Gaining Tips for Men, Women, Bodybuilders, and Beginners Oct 26, 2016

Muscle and Strength Gaining Tips for Men, Women, Bodybuilders, and Beginners - part 1 Oct 21, 2016

Pulmonary Embolism - Part 4 Oct 10, 2016

The use of Inferior Vena Cava (IVC) filters and the length of anticoagulation in unprovoked DVT/PE are considered. A rant about hyper-coagulable panels in provoked DVT/PE is opined.

Pulmonary Embolism - part 3 - Massive PE Aug 29, 2016

Understanding what causes hypotension in PE is essential to understanding the severity of the situation. The relevance of the stressed right ventricle is emphasized. Thrombolytic therapy for hypotension and other clinical scenarios resulting from pulmonary embolism are contemplated.

Pulmonary Embolism - part 2 Jul 24, 2016

The treatment challenges of subsegmental pulmonary embolism, with emphasis on the 2016 guidelines are reviewed. Ventilation/perfusion (V/Q) scan interpretations in those unable to get a CT scan are considered.

Pulmonary Embolism - part 1 Jun 03, 2016

The topics covered are D-Dimer testing, false positive over-diagnosis of PE on CT scanning, the ADJUST-PE study, and clinical signs and symptoms of a pulmonary embolism.

The Healthcare Consumer in a Fictitious Market May 26, 2016

A commentary.

Iron Deficiency Anemia - part 3 May 15, 2016

Various topics regarding intravenous iron are pondered, especially some of the new data available that has not yet seemed to obtain the influence that the information deserves.

Iron Deficiency Anemia - part 2 Apr 27, 2016

This episode mostly centers around oral iron replacement.

Iron Deficiency Anemia - etiology and diagnosis Mar 03, 2016

Natriuretic Peptides in Congestive Heart Failure Jan 14, 2016

BNP use as a lab and therapeutic are discussed. The episode also explores the PARADIGM-HF trial and Neprilysin inhibition. The novel combination medication sacubitril/valsartan (Entresto) for systolic CHF is evaluated in depth. Clinical tips for avoiding angioedema and other clinical pearls are provided.

Healthcare Mergers and Acquisitions Dec 08, 2015

If you think the seismic shift in U.S. healthcare is all a result of the Affordable Care Act, you may not be seeing a large part of the picture. This has become an era of "BIG MEDICINE" and that phenomenon is increasing through mergers and acquisitions. Some of these mergers are strategic, while others are defensive. Practical advice on how doctors and companies can improve their chances of merging successfully is provided. The lecture concludes with potential implications of the insurance-industry merger wave on patients and those working in the healthcare industry.

Acute Pancreatitis (part 3) - Pseudocysts, Pain Control, and a few other pearls Oct 01, 2015

This episode offers some advice in thinking about the very difficult topic of pancreatic pseudocysts. Some philosophical waxing about pain control and some items not addressed in the previous episodes are also discussed.

Acute Pancreatitis (part 2) - Severe Pancreatitis, Pancreatic Necrosis, Antibiotic & Surgical Considerations Aug 23, 2015

Imaging, fluid resuscitation, fine needle aspiration, determining sterile vs infected necrosis, and suggestions from the guidelines are discussed.

Acute Pancreatitis - part 1 Jul 29, 2015

This episode addresses some of the debates regarding nutrition timing in acute pancreatitis. Methods such as nasogastric, nasojejunal, and oral feeding are compared.

Hypercalcemia Treatment Jun 07, 2015

Treatments that include hydration, cinacalcet, calcitonin, bisphosphonate, denosumab, and other options are reviewed.

Hyperparathyroidism - Hypercalcemia part 3 Jun 06, 2015

Indications for parathyroidectomy, pre-operative localization issues, diagnosing hyperparathyroidism, and a brief summary of the guidelines are among the topics addressed in this episode.

Hypercalcemia - Clinical Symptoms and Diagnostic Testing Mar 31, 2015

Special attention is paid to gastrointestinal, bone, and cardiovascular disease as a result of hypercalcemia. Laboratory interpretation of calcium and phosphorus levels is also discussed.

Hypercalcemia etiology - Vitamin D, Calcium Supplements, Diuretics, Malignancy, Sarcoidosis, and other causes Mar 10, 2015

Memory - part 2 - Memory in disease and health Dec 29, 2014

Memory - part 1 - Memory in disease and health Dec 21, 2014

Ebola Virus Disease - part 3 Oct 31, 2014

Ebola Virus Disease - part 2 Oct 30, 2014

Ebola Virus Disease - part 1 Oct 29, 2014

Hospital Credentialing Oct 05, 2014

Pneumonia part 5- Treatment of Healthcare Associated Pneumonia Aug 14, 2014

Pneumonia part 4 - Ventilator Associated Pneumonia Prevention Aug 03, 2014

Pneumonia- part 3- Legionella & Pseudomonas Jun 18, 2014

Pseudomonas aeruginosaand Legionella pneumophila bacterial lower respiratory tract disease are explored in depth.

Pneumonia - Part 2 - Pneumococcal Pneumonia May 03, 2014

Streptococcus pneumoniae is a frequent cause of pneumonia. What makes this organism unique? Listen and find out.

Pneumonia - Part 1 Apr 26, 2014

Does the patient really have pneumonia? Differential diagnosis and mimics are considered in this common clinical problem. Dive deeper into how microbes and the immune system interact in lower respiratory infections.

Acute Liver Injury From Drugs (other than acetaminophen) Apr 06, 2014

Hepatotoxicity from antibiotics, NSAIDs, dietary supplements and other sources are explored. Idiosyncratic drug induced immune related and non-immune related injuries are differentiated, which can change treatment.

Influenza - part 4 - diagnostic testing for the the flu Jan 02, 2014

Influenza - part 3 - Avian H7N9 & H5N1 (Bird Flu) Jan 01, 2014

Influenza - part 2 - Lessons From H1N1 Pandemics Dec 30, 2013

Was H1N1 accidentally released from a laboratory? Is it really a "swine flu"or is it a misnomer?What is this H3N2 swine flu we periodically hear about in the media?What makes a pandemic?Find these answers and more in this episode.

Influenza - The Flu - part 1 Dec 29, 2013

Some years the vaccine is better than others - but there is still good reason to get it. Let's discuss those reasons.How is flu transmitted?How do weather patterns influence the spread of influenza?Get these answers and more in this episode.

Pancreatic Cancer - Pancreatic Ductal Adenocarcinoma Oct 13, 2013

Internal Medicine Pearls - Part 2 Aug 12, 2013

Anger Management in the Healthcare Setting Aug 10, 2013

MRSA - The basics about Methicillin Resistant Staphylococcal Aureus May 12, 2013

Resistance and virulence mechanisms are discussed. Clinical presentations as well as the difference between colonization and infection are considered.Screening, prevention, and understanding Community Acquired MRSA vs Healthcare Acquired MRSA strains can be challenging, so practical information is presented for the common questions patients, families, and health care workers will often have.

Quality of Care and U.S. Payment Reform Jan 14, 2013

End-of-Life Facts and Sentiments - Part 2 Jan 01, 2013

End-of-Life Facts and Sentiments - Part 1 Dec 03, 2012

Factor 5 Leiden - Part 2 Oct 23, 2012

Factor 5 Leiden - Activated Protein C Resistance part 1 Sep 25, 2012

Urinalysis Pearls for Managing Adult Patients Aug 30, 2012

Azithromycin, COPD, and the Heart Aug 23, 2012

Brain Death - Part 2 Jul 14, 2012

Brain Death - Part 1 Jul 02, 2012

Lithium Toxicity and Side Effects - Clinical Considerations for Hospitalists and Acute Care Provider Jul 02, 2012

Acute Mitral Regurgitation - A review for Internal Medicine and Critical Care Physicians Jul 02, 2012

The problem with Acute Mitral Regurgitation is that it is frequently fatal unless quickly recognized. The listener will learn about organic and functional etiologies of this precipitator of acute respiratory distress. Lessons from the SHOCK trial are scrutinized to help guide therapy in the setting of myocardial ischemia.

Osteomyelitis Jul 02, 2012

Anaphylaxis and Anaphylactic Shock Jul 02, 2012