The Curbsiders Internal Medicine Podcast

Latest Episodes:

#218 Trauma-Informed Care with Megan Gerber MD Jun 08, 2020

Show notes

Join us as we delve into the paradigm-shifting ethos of trauma-informed care with renowned expert Dr. Megan Gerber, Associate Professor of Medicine at Boston University School of Medicine, Medical Director of Women’s Health for VA Boston where she directs the Women’s Health Fellowship, editor of “Trauma-informed Health Care Approaches: A Guide for Primary Care.” We discuss the framework for trauma-informed universal precautions, as well as basics about the prevalence of trauma, strategies for integrating a trauma-sensitive approach into primary care, practical changes for the office environment, modifications for physical exam methods, and more. We recognize this topic may be triggering. If you are struggling with thoughts of harming yourself, the national suicide prevention lifeline number is 1-800-273-8255.

Credits

Producer/Writer/Graphics: Beth Garbitelli
Co-Producer: Paul Williams MD
Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP, Beth Garbitelli
Editor: Molly Heublein MD (written materials); Clair Morgan of nodderly.com
Guest: Megan Gerber MD, MPH, FACP

Sponsor: ACP - Visit acponline.org/member

Sponsor: VCU Health CE - Check out curbsiders.vcuhealth.org and create your FREE account!

Time Stamps

Intro, disclaimer, guest bio (0:00 - 3:15)
Guest one-liner (3:30)
Kashlak Cases (13:45)
Epidemiology of trauma (15:18)
Trauma and #MeToo (18:10)
Defining Trauma-Informed Care (TIC) (19:00)
Integrating TIC into primary care (22:48)
Screening in TIC (25:00)
Containment and retraumatization (29:00)
Inquiring about trauma (30:45)
Recap and Office Visit Mechanics (35:30)
Building the Relationship (38:00)
Common Inquiry Mishaps (38:52)
TIC Physical Exam (40:20)
Resources for Patients (44:30)
Office Environment (48:00)
Provider Burnout (50:00)
TIC in Covid-19 (52:30)
Take-home Points (56:20)

Curious Clinicians Episode 1 - Clubbing Jun 03, 2020

Show notes

Introducing our friends, The Curious Clinicians:

Why do human bodies work how they do? Why do medications work, or not work? Do you miss digging into the “why” behind what we do every day? Join Hannah Abrams (@hannarabrams), Tony (@tony_breu), and Avi (@AvrahamCooperMD) in the Curious Clinicians podcast as they delve into these questions & more, starting with episode 1: Why does fingernail clubbing happen in so many different diseases? https://curiousclinicians.com/

Check out their website and subscribe on your favorite podcast player.

#217 COVID Cakes the Fourth: ACTT-1, Triple Therapy, PCR, Serology Jun 01, 2020

Show notes

Stay current with the emerging COVID-19 research including: ACTT-1 (remdesivir), triple therapy with interferon, and conundrums about SARS-CoV-2 PCR and serologic testing. We’re led by the one and only Curbsider/internist/epidemiologist, Rahul Ganatra MD MPH (@rbganatr). And...just in case you live outside of the habitat for murder hornets and your anxiety about the pandemic had begun to abate, we touch on the CDCs guidance to beware of hungry aggressive rats. Gross!

Credits

Written and Produced by: Rahul Ganatra MD, MPH, Deborah J. Gorth ScM, Emi Okamoto MD, Sarah P. Roberts MPH, and Matthew Watto MD
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

Sponsors: ACP and VCU Health CE

Time Stamps

00:00 Sponsors
00:30 Intro, disclaimer
02:40 Fomites, groceries and killer rats
08:22 Sponsor
09:22 ACTT-1 trial of remdesivir
18:22 Triple therapy with lopinavir/ritonavir, ribavarin and interferon
33:10 Background on PCR testing for SARS-CoV-2; How common are false negative PCR tests?
44:25 Serologic testing for SARS-CoV-2; Utility of antibody testing; Test characteristics
50:30 Outro

#216 Homeless Healthcare with Stefan Kertesz MD May 28, 2020

Show notes

Learn the nuances of caring for and building relationships with patients experiencing homelessness from expert internal medicine and addiction physician Stefan Kertesz, return guest from Episode 74 on Opioids and Health Policy (highly recommend a re-listen, y’all!). Topics: the challenge of creating a welcoming and useful space for individuals experiencing homelessness, how to meet patients where they’re at--both physically and mentally--the challenge of managing diuretics for those without stable access to a bathroom (avoid, if possible), and how absolutely essential the foot exam is.

Credits

Written and Produced by Nora Taranto MD
Infographics by Nora Taranto MD
Cover Art by Kate Grant MBChB, MRCGP
Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP, Nora Taranto MD
Editor: Carolyn Chan (written materials); Clair Morgan of nodderly.com
Guest: Stefan Kertesz MD

Sponsor: VCU Health CE

Time Stamps

00:00 Intro, disclaimer, guest bio
3:17 Guest one-liner
8:55 Picks of the Week*: Dr. Kertesz’s Book Recommendation: Saul Weiner’s On Becoming A Healer; Nora’s Pick of the week: BackStory (especially their episode on dynamite!) https://www.backstoryradio.org/
10:07 Case from Kashlak
10:56 Language: How to ask where a patient lives?
13:25 Terminology: Persons Experiencing Homelessness:
14:35 The stats on prevalence of health and illness in the homeless population, and the importance of both medical and environmental factors
20:44 How to start the visit, and how to establish trust early on?
27:40 Why is the mortality rate higher?
35:15 Special conditions and Medication Considerations: Hypertension, Diuretics, Insulin and Food Insecurity, Substance Use Disorders, Feet, and Hepatitis C
54:15 COVID and homeless healthcare
57:00 Care Models
62:30 Take Home Points and Outro

#215 Medical Myths: Challenge Dogma with Dr. Douglas Paauw May 25, 2020

Show notes

Chase that metronidazole with a beer! Pop some 30 year old pills! Retrain your brain as our esteemed guest Dr. Douglas Paauw goes over his popular annual ACP presentation on Medical Myths. Learn about how some common medical myths originate and continue in our practice. We discuss why it’s okay to drink on metronidazole, take expired medications, inject epinephrine into extremities and why recurrent sinusitis may not really exist.

Credits

Written and Produced by: Justin Berk, MD MPH MBA
Infographic and Cover Art: Beth Garbitelli
Hosts: Justin Berk, MD, MPH, MBA; Matthew Watto MD, FACP; Paul Williams MD, FACP
Editor: Emi Okamoto MD (written materials); Clair Morgan of nodderly.com
Guest: Douglas Paauw, MD

Sponsor: VCU Health CE

Time Stamps

00:00 Intro, disclaimer, guest bio
02:22 Guest one-liner; Career Advice, Picks of the Week*: Being Mortal, book by Atul Gawande; The Band Played On, book by Randy Shilts; Lagunitas Hoppy Refresher: zero alcohol, zero calories!
06:15 Medical Myth Definitions
10:20 Dogma: Metronidazole and Alcohol; Healthy RCT Metronidazole and Alcohol
19:09 Expired Medications; Military Stockpiling Study
24:22 Aspirin and Nitroglycerin; Unopened eye drops; Epi-Pens; Expired Med Recap
31:13 Sinus Headaches; Trigeminal Nerve; Pearl: Recurrent headaches; Study showing Effectiveness of treatment (92%)
41:07 Epinephrine in extremity; RCT of Epi in Extremities
Study showing Experts use it; Podiatry journal
48:39 Take home points and Outro

#214 COVID Cakes 3: Llamas, Remdesivir, Strokes, Predicting the Future, and More! May 18, 2020

Show notes

Elevate your critical appraisal skills as we review the first RCT of remdesivir and share the latest and greatest COVID-19 stories including: Llama antibodies, Stroke statistics, Future Waves, Exit Strategies and Awake Proning. We’re joined by everyone’s favorite Curbsider/internist/epidemiologist, Rahul Ganatra MD MPH (@rbganatra). Rahul provides critical appraisal of the newest randomized control trial (RCT) on remdesivir from the Lancet, and gives us a lesson on why statistical power is so important to consider. We also share updates on strokes, awake proning, pandemic predictions, and we reveal another reason to love llamas (besides those luscious lashes). Llama mia, here we go again!

Credits

Written and Produced by: Sarah P. Roberts MPH, Rahul Ganatra MD, MPH, Emi Okamoto MD, Paul Williams MD and Matthew Watto MD
Cover Art: Beth Garbitelli
Hosts: Matthew Watto MD, Paul Williams MD, Rahul Ganatra MD MPH, Emi Okamoto MD , Sarah P. Roberts MPH,
Editor: Matthew Watto MD (written materials); Clair Morgan of nodderly.com

Sponsor: VCU Health CE

Time Stamps

00:00 Intro
02:10 Fun animal facts: Llama antibodies
09:10 Remdesivir RCT by Wang et al
12:40 Power and Sample Size
16:32 Baseline Characteristics, Results and Author’s conclusions
19:15 Rahul’s conclusions: How chance and bias affected the results
24:00 Right censoring; Viral load and timing of antivirals
30:30 Final thoughts on Remdesivir RCT by Wang et al; Looking ahead to the NIAID (ACTT) trial
33:53 Are patients really having fewer strokes and heart attacks?
38:20 Awake proning
43:30 Paul teaches us not to use the term “happy hypoxemic”
45:00 CIDRAP viewpoint on future waves and exit strategies
50:22 Outro

#213 Fatigue for Primary Care with Nina Mingioni MD - A Common Sense Framework May 11, 2020

Show notes

Listen as our esteemed guest Dr. Nina Mingioni (Jefferson) walks us through her approach to fatigue, from differential diagnosis, to the evidence behind physical exam, laboratory workup, and beyond!

Credits

Writer, Producer, Infographic, and Cover Art: Hannah R. Abrams
Hosts: Hannah R Abrams, Matthew Watto MD, FACP; Paul Williams MD, FACP
Editor: Matthew Watto MD, FACP (written materials); Clair Morgan of nodderly.com
Guest: Nina Mingioni MD, FACP

Sponsor: VCU Health CE

Time Stamps

00:00 Intro, disclaimer, guest bio and a bad pun
03:00 Guest one-liner
07:10 Case from Kashlak, Defining fatigue; Taking a general history
11:36 Most common causes of fatigue and how to elicit them from the history
20:39 Physical exam for fatigue; Medications that cause fatigue;
25:25 Exam findings and LRs for anemia; Sleep apnea
30:55 Lab workup for fatigue; Expanded testing: Ferritin, Vitamins, EBV, Rheumatologic diseases, Celiac disease, Lyme
47:55 Spiel to the patient when no answer is found
51:14 Other diagnoses to consider: Fibromyalgia, Myalgic Encephalomyelitis
55:09 Take home points and Outro

#212 Inpatient Alcohol Withdrawal: Sober Talk with Joji Suzuki, MD May 07, 2020

Show notes

Crush those 11 pm “STAT: Patient agitated” pages with this expert guide to assessing for and treating alcohol withdrawal! Dr. Joji Suzuki MD, addiction psychiatrist extraordinaire at the Brigham and Women’s Hospital, walks us through how to think about the risk of severe withdrawal, the different ways to manage it, and how to engage with patients as they’re leaving the hospital. In the course of this Car-Talk (well, not exactly the same as the critically acclaimed radio show, but he did record in his car….), Dr. Suzuki demystifies withdrawal and debunks some common myths: that we must manage withdrawal inpatient, that banana bags are the cure to a hangover and alcoholic malnutrition, and that we tend to under-medicate with benzos (actually, it’s the opposite!).

Credits

Written and Produced by Nora Taranto MD
Infographic and Cover Art by: Nora Taranto MD
Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP
Editor: Cyrus Askin MD, Matthew Watto MD (written materials); Clair Morgan of nodderly.com
Guest: Joji Suzuki MD

Sponsor: VCU Health CE

Time Stamps

00:00 Intro, disclaimer, guest bio
02:52 Guest one-liner; Career advice; Picks of the Week*: Why We Do What We Do (book); Fargo (film)
08:10 A Case from Kashlak and Screening for Alcohol Use and Severe Withdrawal Risk
17:32 Outpatient Versus Inpatient Treatment
25:27 Gabapentin for alcohol withdrawal
27:10 Indicators for ICU level Care
31:53 Symptom-Driven versus Fixed-Dose Protocols , Benzos vs. Barbs
36:55 And which benzo?
39:47 A Natural History of Withdrawal
44:10 Banana Bags and Thiamine Deficiency
48:17 The Transition Home: Naltrexone, Bridge Clinics, and Motivational Interviewing
56:36 Outro and Bonus clip

#211 COVID Cakes: Remdesivir, Anticoagulation, and Transmission May 01, 2020

Show notes

In this episode we tackle treatment with remdesivir, management with anticoagulation, and presymptomatic transmission. Welcome back to COVID Cakes, a rundown of recent COVID articles and news stories. What does the latest Gilead medication have to offer? Why should we wear masks? And if you thought 6 feet was THE safe distance…we’ve got some bad news about running. But it’s not all bad! We’re joined by everyone’s favorite Curbsider/Internist/Epidemiologist, Rahul Ganatra MD MPH (@rbganatra), who provides critical appraisal of the newest COVID-19 treatment article. Pull up a chair, bring your own syrup, and join us!

Credits

Producer: Sarah P. Roberts MPH, Rahul Ganatra MD MPH, Emi Okamoto MD
Writer: Emi Okamoto MD, Rahul Ganatra MD MPH,
Cover Art: Chris Chiu MD
Hosts: Chris Chiu MD, Rahul Ganatra MD MPH, Emi Okamoto MD
Editor: Matthew Watto MD (written materials); Clair Morgan of nodderly.com

Sponsors: Apollohct.com and VCU Health CE

Time Stamps

00:30 Intro, disclaimer
02:30 Picks of the Week
6:36 Remdesivir trial rundown
21:52 Thrombosis in COVID-19
29:50 Asymptomatic/Presymptomatic transmission
41:42 Quick takes
49:00 Outro

#210 Kidney Transplant for the Internist with Freely Filtered (NephMadness) Apr 27, 2020

Show notes

It’s NephMadness! Get inside the black box of transplant medicine as we discuss: Kidney transplant for the internist. Join Dr. Cyrus Askin, @askins_razor, one of our Curbsiders Correspondents, as he teams up with the fine folks from the Freely Filtered Podcast led by Dr. Samira Farouq, @ssfarouk, a Mount Sinai transplant nephrologist. Topics: indications for kidney transplant, immunosuppressive agents, what to watch out for in your post-transplant patients and so much more! Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | CME

Credits

Written and Produced by: Cyrus Askin MD, Matthew Watto MD and the Freely Filtered Crew
Infographic: Cyrus Askin MD
Cover Art: Kate Grant MBChB DipGUMed
Hosts: Cyrus Askin MD, Joel Topf MD, Samira Farouk MD, Swapnil Hiremath MD, Jennie Lin MD & Matt Sparks MD
Editor: Matthew Watto MD (written materials); Clair Morgan of nodderly.com

Sponsor: VCU Health CE

Time Stamps

00:00 Announcement, Intro to Freely Filtered and NephMadness
04:00 Case of advanced CKD; Who/when to refer for transplant
12:05 Benefits of renal transplant
16:22 Counseling patients with advanced CKD about transplant and a bit on living donors
20:40 Medications after transplant; Drug-drug interactions
25:50 Dr. Sparks’ 30 second exam for the transplant patient; Diarrheal illness
32:07 Calcineurin inhibitor levels
36:42 Prophylaxis for long term complications
40:21 Allograft rejection; BAMF criteria
50:40 Cardiovascular risk; Statins
56:11 Malignancy after kidney transplant
60:00 NephMadness Transplant Region: Biomarkers vs Biopsy
72:23 Outro

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Sponsor: ACP - Visit acponline.org/member

Sponsor: VCU Health CE - Check out curbsiders.vcuhealth.org and create your FREE account!

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