#493: Joint Pain in Older Adults with Dr. Una Makris

Grow your management tools for opioid withdrawal in the hospital. Investigate how to decide between methadone and buprenorphine, additional medications to manage symptoms and how and when to use short-acting opioids for management of withdrawal. We’re joined by Ashish Thakrar, MD at the University of Pennsylvania.  Claim CME for this episode at curbsiders.vcuhealth.org! By listening to this episode and completing CME, this can be used to count towards the new DEA 8-hr requirement on substance use disorders education. Episodes | Subscribe | Spotify | iTunes | [email protected] | CME! Show Segments Intro, disclaimer, guest bio Guest one-liner Case from Kashlak; Definitions Symptoms of opioid withdrawal Medications for the management of opioid withdrawal Buprenorphine precipitated withdrawal Starting Buprenorphine: Experiences and Strategies  Titrating Methadone: Dosage and Adjuncts Adjunctive short-acting opioids Emerging Trends in Drug Supply: Xylazine and Medetomidine Outro  Credits Producer, Show Notes: Zina Huxley-Reicher Infographics: Zina Huxley-Reicher MD and Zoya Surani Hosts: Carolyn Chan, MD MHS, Zina Huxley-Reicher MD, Shawn Cohen, MD Reviewer: Payel Jhoom Roy, MD, MSc Showrunner: Carolyn Chan, MD, MHS Technical Production: PodPaste Guest: Ashish Thakrar, MD MHSP Sponsor: Mint Mobile  Shop plans at MINTMOBILE.com/CURB Sponsor: Freed Use code: CURB50 to get $50 off your first month when you subscribe! Sponsor: FIGS  We’ve teamed up with FIGS, and now Curbsiders listeners can get 15% off. Just go to WearFIGS.com and use code FIGSRX.

In this high-yield episode of Curbsiders Addiction Medicine, we dive deep into a practical and compassionate approach to caring for patients using methamphetamines and/or living with methamphetamine use disorder. We explore the latest pharmacologic options, harm reduction strategies, contingency management, and innovative ideas for monitoring and supporting patients. Whether you’re in primary care or other subspecialty settings, this episode is packed with pearls for every clinician with our amazing guest, Dr. Phillip Coffin, Director of the Center on Substance Use and Health in the SFDPH.  Claim CME for this episode at curbsiders.vcuhealth.org! By listening to this episode and completing CME, this can be used to count towards the new DEA 8-hr requirement on substance use disorders education. Episodes | Subscribe | Spotify | iTunes | [email protected] | CME! Credits Producer/Script Writer/Show Notes: Era Kryzhanovskaya, MD Infographic and Cover Art: Zoya Surani Hosts: Carolyn Chan, MD. MHS and Era Kryzhanovskaya, MD Reviewer: Sarah Leyde MD Showrunner: Carolyn Chan, MD, MHS Technical Production: PodPaste Guest: Dr. Phillip Coffin Show Segments Intro, disclaimer, guest bio Guest one-liner Case from Kashlak; Definitions Four-tier approach to taking care of patients with methamphetamine use/use disorder Medications for treatment Psychosocial treatment Harm reduction New horizons in treatment  Outro Sponsor: Locumstory Learn about locums and get insights from real-life physicians, PAs and NPs at Locumstory.com Sponsor: Panacea Visit panaceafinancial.com and Panacea’s Resource Library for free student loan articles, guides, and webinars built to help you make informed decisions. Sponsor: Grammarly  Download Grammarly for free at Grammarly.com/PODCAST

We have a classic episode for you. Dive deep into upper respiratory viral infections with Dr Amber Bird, MD (Penn).  Feel confident on when to order testing, recommend symptom relieving treatments, and avoid unnecessary antibiotics. Sponsors Continuing Education Company Curbsiders listeners: use promo code Curb30 for 30% off all online courses and webcasts. Head to CMEmeeting.org/curbsiders to learn more. FIGS Curbsiders listeners can get 15% off. Just go to WearFIGS.com and use code FIGSRX. Freed Use code: CURB50 to get $50 off your first month when you subscribe at getfreed.ai

Join us as we review recent practice-changing articles on cannabidiol (CBD)-induced liver injury, IV iron for HFrEF, bedtime administration of blood pressure meds, carpal tunnel syndrome & rheumatoid arthritis , & FDA approval of finerenone for HFpEF. Fill your brain hole with a delicious stack of hotcakes! Featuring Paul Williams (@PaulNWilliamz), Rahul Ganatra (@rbganatra), Nora Taranto (@norataranto) and Matt Watto (@doctorwatto). Claim CME for this episode at curbsiders.vcuhealth.org! Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CME Credits Written and Hosted by: Rahul Ganatra MD, MPH; Nora Taranto MD, Paul Williams, MD, FACP, Matthew Watto MD, FACP Cover Art: Rahul Ganatra MD, MPH Reviewer: Emi Okamoto, MD Technical Production: Pod Paste Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP Show Segments Intro, disclaimer CBD-induced liver injury IV Iron in HFrEF Bedtime administration of BP medications Carpal tunnel syndrome and RA FDA approves Finerenone for HFpEF Outro Sponsor: Permanente Want to join thousands of physicians who've made TPMG their career destination? Discover more at northerncalifornia.permanente.org

Why we need to stop calling them “endemic” mycoses & more fungi fun! Feeling muddled about endemic mycoses? We tackle the clinical presentation of diseases like histoplasmosis, blastomycosis, and coccidioidomycosis, the importance of testing, and how to diagnose fungal infections  with our esteemed guest Dr. Andrej Spec, MD! Claim CME for this episode at curbsiders.vcuhealth.org! Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CME Show Segments Introduction and icebreaker,  Fish Club?!  00:00 Case 1 from Kashlak 07:27 Diagnostic framework for dimorphic fungi 11:58 Imaging presentations for fungal pneumonia, diagnostic schemas 18:23 Testing options 27:48 Treatment options 35:44 Dimorphic Fungi Mnemonics 45:50 Retail testing for mold 48:47 Case 2 from Kashlak 56: 42 Takeaways and Conclusions 1:05:19 Credits Producer, Writer, Show Notes:  Beth “Garbs” Gasperlin MD Infographic and Cover Art: Zoya Surani Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP,  Beth Gasperlin MD   Reviewer: Leah Witt Gaspard MD Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP Technical Production: PodPaste Guest: Andrej Spec MD Disclosures Dr. Spec reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.  Sponsor: Quince Go to Quince.com/curb for free shipping on your order and three hundred and sixty-five -day returns. Sponsor: Continuing Education Company  Special offer for Curbsiders listeners: Save 30% on all online courses and live webcasts with promo code CURB30. Visit www.CMEmeeting.org/curbsiders to explore all offerings and claim your discount. Sponsor: Freed Use code: CURB50 to get $50 off your first month when you subscribe!

Dominate C. diff! Learn to distinguish colonization from infection, select first-line therapies, and counsel patients on recurrence prevention and microbiome recovery. We’re joined by IDSA past president and expert on foodborne and intestinal infections, Dr. Cindy Sears (Johns Hopkins University) for a comprehensive update on Clostridioides difficile (C. diff, Cdiff, CDAD, CDI). Claim CME for this episode at curbsiders.vcuhealth.org! Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CME Show Segments 00:00 Intro 03:00 Guest bio and hobby 04:25 Case of Charles Fleur Fontaine 06:00 Risk factors and epidemiology 08:00 Antibiotic hierarchy of risk 10:00 Diagnosis, testing strategies 14:00 Defining severity 17:30 Treatment options 20:00 Microbiome recovery strategies 24:00 Probiotics and postbiotics 27:00 Infection control counseling 30:00 C. diff and colon cancer 32:00 Recurrent C. diff strategies 35:00 Why some FMT and bezlotoxumab were discontinued 38:00 Microbiota replacement therapies 43:00 Prophylaxis strategies 45:00 Future therapies and ongoing research 47:00 Audience Q&A 52:00 Outro Credits Written and Produced by: Matthew Watto, MD, FACP  Cover Art and Infographic by: Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP    Reviewer: Sai S Achi MD,MBA,FACP Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP Technical Production: PodPaste Guest: Cynthia Sears MD Disclosures Dr. Sears reports no relevant financial disclosures. Dr. Williams financial relationships disclosed include a Merck grant or research support. This relationship has not ended. Sponsor: Mint Mobile  This year, skip breaking a sweat AND breaking the bank. Get this new customer offer and your 3-month Unlimited wireless plan for just 15 bucks a month at mintmobile.com/CURB  Sponsor: Panacea Financial Let Panacea Financial take the financial stress off your plate,so you can get back to doing what matters most. Visit panaceafinancial.com  Sponsor: FIGS Get15% off your first order at wearfigs.com with the code FIGSRX

In this special bonus episode, Dr. Linda Blustein (Bendy Bodies https://bit.ly/m/BendyBodies) addresses listener questions about Ehlers-Danlos syndrome (EDS) and hypermobility spectrum disorders. 00:00 – Introduction 00:59 – Can PCPs diagnose hEDS without a geneticist? 03:19 – Limitations of the Beighton Score 05:40 – 2017 hEDS criteria & upcoming revisions 10:29 – How to find a knowledgeable provider 12:52 – SVT vs POTS in a patient with EDS family history 19:53 – How to ask your provider if they’re comfortable treating dysautonomia 22:17 – MTHFR variants and hEDS 29:23 – Celiac, gluten sensitivity & EDS 31:48 – Food allergy vs sensitivity testing 34:11 – Lipoedema and hypermobility 39:00 – LDN, Ketotifen, and Cromolyn 43:41 – Medication sensitivity in EDS/POTS/MCAS patients 45:47 – Wrap up and resources ​FIGS Get 15% off your first order at wear figs.com with the code FIGSRX Locumstory ​Locumstory.com is simply a free, unbiased educational resource about locum tenens Grammarly Download Grammarly for free at Grammarly.com/PODCAST

We have a classic Curbsiders episode for you. Expert guest Dr. Elliot Tapper (@ebtapper) shares his framework for approaching NAFLD/MASLD and the treatment tools he recommends including lifestyle modifications and medications. 

An age-friendly approach to arthralgias. Attack arthralgias with ease! Learn how to evaluate and manage common joint complaints in older adults. We’re joined by Dr Una Makris, @unamakris.bsky.social (UT Southwestern). Claim CME for this episode at curbsiders.vcuhealth.org! Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CME Show Segments Intro Case 1 from Kashlak General approach to joint pain in older adults Diagnosing osteoarthritis Management of osteoarthritis in older adults Non-pharmacological interventions Pharmacological interventions: topicals, orals, injectables When to refer for joint replacement Case 2 from Kashlak Diagnosis of Late onset rheumatoid arthritis (LORA) Differential Diagnosis and Distinguishing features Lab work/Imaging When to refer to rheumatology Approach to managing LORA The 5Ms framework Initial treatment with glucocorticoids Ageism as a driver of undertreatment in older adults Treating to target Key takeaways  Outro  Credits Producers, Writers and Show Notes: Joseph (Lee) Young, MD, Leah Witt, MD, Rachel Miller, MD Cover Art and Infographic: Leah Witt, MD Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP    Reviewer: Emi Okamoto, MD Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP Technical Production: PodPaste Guest: Dr. Una Makris Disclosures Dr. Makris reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures. Sponsor: Heart of Care If you care about patient safety, team performance, and building a culture of readiness, subscribe to In the Heart of Care. Available now, wherever you get your podcasts. Sponsor: FIGS Curbsiders listeners can get 15% off. Just go to wearFIGS.com and use code FIGSRX. 

Here is a classic Curbsiders episode with one of our favourite guests of all time, Dr Joel Topf. Learn how to manage diabetes and hypertension in chronic kidney disease with expert tips from Kidney Boy, Kashlak’s Chief of Nephrology, Dr. Joef Topf @kidney_boy.  Finerenone is FDA approved for managing CKD in patients with diabetes. **Update as of July 2025: The non-steroidal mineralocorticoid recepter antagonist, finerenone is now FDA approved to treat heart failure with LVEF at or above 40% based on results of the FINEARTS-HF trial. ** Claim CME for this episode at curbsiders.vcuhealth.org! Heart of Care If you care about patient safety, team performance, and building a culture of readiness, subscribe to In the Heart of Care. Available now, wherever you get your podcasts. Quince Go to Quince.com/curb for free shipping on your order and three hundred and sixty-five -day returns.