Cows Milk - Healthy or Not?
March 6th, 2021
Psilocybin Mushrooms - will they become an accepted medicine?
February 19th, 2021
Understand Basic Epigenetic Changes in Medicine and Everyday Life
February 4th, 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
December 23rd, 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
December 1st, 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
December 1st, 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.
Covid Treatment (for Hospitalized Patients) Update
November 30th, 2020
Dealing with hypoxia, anticoagulation, steroids, Remdesivir, VTE, self-proning, labs, plasma, etc.
I do not get into the epidemic numbers or politics or vaccines or outpatient treatments (this is really a HOSPITALIZED TREATMENT discussion for frontline providers in hospitals). Some of what is discussed is likely going to change over the next months, as has often been the case with COVID19.
The Most Important Person That Lived For Our Health and Wellbeing
November 27th, 2020
Hint: That person died in 2017
An (old) New Weapon to Fight Leg Cellulitis
August 12th, 2020
Acute Severe Hypertension - part 1
April 28th, 2020
Acute Severe Hypertension - part 2
April 28th, 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
April 27th, 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
April 25th, 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
April 23rd, 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 -
Balkan Reflections Forged By A Virus Lockdown
April 23rd, 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
December 10th, 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
September 30th, 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
September 30th, 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
September 30th, 2019
Creatine - part 1
August 20th, 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
August 6th, 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
August 5th, 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)
July 1st, 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
April 8th, 2019
Clostridium Difficile - part 1
January 25th, 2019
A deceivingly difficult topic. Not so obvious points are made about asymptomatic carriers, transmission, and who to test.
Clostridium Difficile - part 2
January 23rd, 2019
Specific initial treatment regimens are discussed. Topics include fulminant disease, Vancomycin, Fidaxomicin, Metronidazole, and recurrence rates/regimens.
Clostridium Difficile - part 3
January 23rd, 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
December 23rd, 2018
Experiences that taught me some lessons.
Type 2 Diabetes Treatment - Part 7 - GLP-1 Agonists and DPP-4 Inhibitors
December 17th, 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
September 26th, 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
August 26th, 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 27th, 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 16th, 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 1st, 2018
Type 2 Diabetes Treatment - Part 1
May 1st, 2018
Internal Medicine Pearls #5
April 3rd, 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
February 1st, 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
December 22nd, 2017
Internal Medicine Pearls #4
November 14th, 2017
Checking glucose levels in Type 2 Diabetes, ACE Inhibitors for women, and using Azithromycin in Asthma.
Medical Podcasts, Skiing, and Imperfect Relationship Advice
October 4th, 2017
Patent Foramen Ovale Evaluation and Closure After a Stroke - part 2
September 26th, 2017
Patent Foramen Ovale Evaluation and Closure After a Stroke - part 1
September 22nd, 2017
The Overhead Airplane Request for Medical Assistance - A No Win Situation
September 20th, 2017
A Severe Case of Healthcare Violence 2 Years Later
August 31st, 2017
Bedbugs 4 The Dark Night Returns
August 31st, 2017
Bedbugs 3 Live Free and Die Hard
August 10th, 2017
Bedbugs 2 Fast and 2 Furious
July 30th, 2017
Bedbugs - part 1
July 15th, 2017
Urine Drug Testing - Misinterpretation is Very Common
May 28th, 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.