REBOOT #421 Antiphospholipid Syndrome with Dr. Arielle Langer

It's a potpourri of Infectious Diseases with tips from expert, Dr Paul Sax, MD, Clinical Director of the Division of Infectious Diseases at Brigham and Women's Hospital, and Professor of Medicine at Harvard Medical School. We discuss the man flu, the flu vaccine, travel medicine, malaria, lyme disease, post lyme syndrome, chronic lyme, shingles, cellulitis, abscesses, antibiotics, c diff, antibiotic associated diarrhea, the dangers of fluoroquinolones, why doxycycline is awesome, and more! Told you it was a potpourri. Dr Shreya Trivedi joins Matt and Paul as guest host. Show Notes, MCQ by Shreya Trivedi, MD Edited by Matthew Watto, MD Infographics and cover image by Matthew 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 Announcement 01:38 Intro 03:46 Picks of the Week 06:47 Guest bio 08:47 Getting to know our guest 15:40 Flu vaccination 19:54 Barriers to the flu vaccine 23:34 Can you give the flu vaccine to an ill patient 24:14 Man flu 26:27 Travel Medicine 30:35 Tick bites 33:49 Lyme serologies 35:38 Lyme prophylaxis 37:37 Chronic lyme disease and post lyme syndrome 38:55 Penicillin and antibiotic allergies 41:48 Fluoroquinolones and adverse reactions 45:24 Should antibiotics be given after an I&D of an abscess  49:34 Antibiotic associated diarrhea, C diff 52:10 Probiotics, stool transplantation, and C diff 54:50 Shingles, recurrent zoster, complications, and the new subunit vaccine 61:45 Using salad tongs at a buffet 63:04 Take home points 64:26 Outro Tags:  ID, infectious, diseases, disease, flu, influenza, lyme, doxycycline, cdiff, antibiotics, infection, cellulitis, abscess, vaccine, zoster, shingles, malaria, travel, assistant, care, doctor, education, family, foam, foamed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resident, student

15 Jan 20181h 6min

Ease the tension around blood pressure goals in older adults and get inside the hypertension guidelines released by the ACP and ACC/AHA in 2017 with the sagacity of Dr. Mary Ann Forciea, MD, MACP, Professor of Medicine at University of Pennsylvania. We cover: how to properly measure blood pressure, how to diagnose hypertension, blood pressure targets, why BP goals differ by society, how to guidelines are written and how to interpret them with a critical eye, plus a hot take on the 2017 ACC/AHA guidelines. Dr. Shreya Trivedi joins as cohost. Special thanks to Hannah Abrams for her wonderful infographics and to Dr Trivedi for compiling our show notes. Time Stamps 00:00 The setup 02:15 Disclaimer 03:32 Picks of the Week 08:13 Getting to know Dr Forciea 13:35 Broad overview and a clinical case of geriatric hypertension 14:45 Brief history on BP targets 18:05 How do you measure a blood pressure? What type of monitors are available? 22:13 How to standardize BP in the office? 23:55  Ambulatory BP monitoring 24:55 Home blood pressure monitoring 26:11 Standing blood pressure readings and orthostatic hypotension 27:53 How guidelines are written 30:51 Evaluating evidence quality and strength of recommendation 32:35 Timeline and process for guideline generation 34:27 How to read guidelines with a “critical eye” 36:15 Return to our case of uncontrolled hypertension 38:25 Blood pressure targets from ACP guidelines and BP management in frail older adults 40:33 Counsel patients on BP targets    42:25 Low diastolic blood pressure 45:35 SPRINT and the ACP BP guidelines 48:58 Take home points from Dr Forciea 50:07 HTN targets and pay for performance in clinical practice 51:45 Curbsiders recap the ACP guidelines 53:45 Matt and Paul recap the AHA guidelines 54:47 AHA definitions of hypertension 56:15 Diagnosing hypertension and how to measure a blood pressure 60:35 Choosing a blood pressure monitor and HBPM 62:29 Blood pressure goals in ACC guidelines 66:08 Non-pharmacologic measures 69:15 Will we follow these new strict targets? 72:45 Outro Tags:hypertension, blood, pressure, monitor, cuff, heart, aha, acc, act, stroke, cardiac, cardiovascular, event, guidelines, assistant, care, doctor, education, family, foam, foamed, health, hospitalist, hospital, internal, internist, meded, medical, medicine, nurse, practitioner, professional, primary, physician, resid

8 Jan 20181h 15min

Conquer community acquired pneumonia and avoid misdiagnosis with tips from Dr. Robert Centor, Professor Emeritus University of Alabama and newly appointed Chair of Medicine at Kashlak Memorial Hospital. We discuss diagnosis, misdiagnosis, procalcitonin, steroids for severe pneumonia, pneumonia severity index versus CURB-65, and how to determine antibiotic choice and duration. Special thanks to Correspondents Neela Bhajandas (cohost), Justin Berk and Bryan Brown who all contributed several articles, resources, and questions to prep for this show. Cover image by Dr Kate Grant 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.

1 Jan 20181h 7min

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

25 Des 20171h 9min

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.

22 Des 20171h 15min

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

18 Des 201754min

Trans patients need excellent primary care and you can provide it with expert tips from endocrinologists, Dr Vin Tangpricha, Professor of Medicine at Emory University School of Medicine, and Dr Jeffrey Colburn, Assistant Professor of Medicine at Uniformed Services University. Learn practical tips in caring for transgender patients including: defining terms like gender dysphoria, gender nonconformity, transgender; use of pronouns; patient counseling; fertility concerns; initiating and monitoring hormonal therapy; surgical options; and how to help trans patients navigate the complexities of gender affirming therapy. 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.

11 Des 20171h 1min

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.

4 Des 20171h 2min