#459 DIGEST: Finerenone for Heart Failure, PCV21 and the latest Pneumonia Vaccine Recs, 24-hour vs 15-hour Oxygen Therapy, and PREVENT vs PCE for Cardiovascular Risk Estimation

A Bell-Ringer of a Presentation Is it a stroke or is it botox? No, it’s Bell’s palsy! Learn how to differentiate facial palsy from other sinister diagnoses. Join us as Dr. Jordan Amar (Assistant Professor of Clinical Neurology at USC Keck School of Medicine) gives us Bell’s palsy pointers (and a great mnemonic, if there is such a thing). Claim CME for this episode at curbsiders.vcuhealth.org! Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CME Show Segments Introduction Rapid fire questions and Reflex Hammers Case #1: Ms. Melanie Framework for Bell's Palsy Bell's Palsy vs Stroke: How to Differentiate  Approach to History and Physical Exam  Case #2: Mr. Lopez Red Flags in Facial Palsy (GROWLS FACE) Workup: From Imaging to Labs and What Not to Do Treatment: The Role of Steroids and Antivirals Supportive Care, Complications and Prognosis Take-Home Points Outro Credits Producer and Writer: Isabel Valdez, PA-C  Show Notes: Paul Wurtz MD, Ben Furman MPH MS3, Isabel Valdez, PA-C Infographic and Cover Art: Zoya Surani, MS2 Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP    Reviewer: Leah Witt, MD Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP Technical Production: PodPaste Guest: Jordan Amar, MD Sponsor: Beginly Health Ready to take control of your job search? Visit beginlyhealth.com/curbsiders to get started Sponsor: OpenEvidence  If you haven't tried it out yet check it out, it will save you time and help you make better decisions go to openevidence.com/curbsiders Sponsor: Freed You can try Freed for free right now by going to freed.ai. And listeners of Curbsiders can use code CURB50 for $50 off their first month. 

Preserve your sanity while treating heart failure with preserved ejection fraction.  Dr Michelle Kittleson @MKittlesonMD (Cedars Sinai) illuminates this confounding cardiac condition. Claim CME for this episode at curbsiders.vcuhealth.org! Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CME Show Segments 00:00 Introduction and Advice for Physicians 02:24 Case Presentation 04:16 Understanding HFpEF 08:11 Differential Diagnosis of Dyspnea and Edema 11:30 Diagnosing HFPEF: H2F-PEF Score and Testing 17:07 Managing Comorbidities in HFpEF 20:54 Non-Pharmacological Interventions: Weight Loss and Exercise 23:16 Understanding the Challenges of HFpEF 25:08 Medications 30:13 Promising Results of GLP-1 Receptor Agonists 36:38 Managing Salt and Water Intake Credits Writer and Producer: Deborah Gorth MD, PhD Infographic and Cover Art: Zoya Surani 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: Michelle Kittleson MD, PhD Sponsor: Freed You can try Freed for free right now by going to freed.ai. And listeners of Curbsiders can use code CURB50 for $50 off their first month.  Sponsor: Bombas Head over to Bombas.com/curb and use code curb for 20% off your first purchase. Sponsor: Beginly Health Ready to take control of your job search? Visit beginlyhealth.com/curbsiders to get started

Join us as we review recent articles and news featured in The DIGEST issues #56 and #57, including finerenone for heart failure, the skinny on pneumonia vaccines and the latest, PCV21, long-term oxygen therapy (the REDOX trial), and the PREVENT vs PCE cardiovascular risk equations.  Fill your brain hole with a fully digestible meal! Featuring Alex Chaitoff (@alexchaitoff), Rahul Ganatra (@rbganatra), Nora Taranto (@norataranto), and Matt Watto (@doctorwatto).  Note: **Update on Pneumonia Vaccine from ACIP: After we recorded and just before we published this episode, the CDC updated its vaccine guidance to include pneumonia vaccination for all adults aged 50 years and older to receive either PCV20, PCV21, or the combination of PCV15 followed by PPSV23 one year later (CDC site accessed 24 Oct 2024).** Claim CME for this episode at curbsiders.vcu health.org! Episodes | Subscribe | Spotify | Swag! |Mailing List | Contact | CME! Credits Written and Hosted by: Nora Taranto MD; Rahul Ganatra MD, MPH, Alex Chaitoff MD, MPH, Matthew Watto MD, FACP Cover Art: Matthew Watto MD  Reviewer: Emi Okamoto MD  Technical Production: Pod Paste Showrunners: Matthew Watto MD, FACP  Show Segments Introduction + Pun  Exploring Finerenone in Heart Failure Pneumonia Vaccines: The PCV21 Trial Long-Term Oxygen Therapy: The REDOX Trial Cardiovascular Risk Calculators: The PREVENT Equation Sponsor: Freed You can try Freed for free right now by going to freed.ai. And listeners of Curbsiders can use code CURB50 for $50 off their first month.  Sponsor: Quince Go to Quince.com/curb for free shipping on your order and 365-day returns. Sponsor: Beginly Health Ready to take control of your job search? Visit beginlyhealth.com/curbsiders to get started

Kittleson Rules Outpatient Heart Failure Volume 1 Provide superb outpatient care for your patients with HFrEF. Identify underlying causes of heart failure and titrate medications with ease. Dr Michelle Kittleson @MKittlesonMD (Cedars Sinai) breaks down the nuances of treating this common cardiac condition.  Claim CME for this episode at curbsiders.vcuhealth.org! Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CME Show Segments 00:00 Introduction  03:22 Case Presentation: Newly Diagnosed Heart Failure 07:26 Using Physical Exam Findings to Guide Diuresis 11:58 The Four Pillars of Guideline-Directed Medical Therapy for Heart Failure 15:07 Optimizing Therapy and Follow-Up in Heart Failure Patients 22:10 The Benefits of High-Intensity Initiation and Titration of Guideline-Directed Medical Therapy 28:02 Consideration of Other Medications 40:02 Referral to Advanced Heart Failure Specialist 49:11 Optimizing Therapy and Follow-Up 55:33 Conclusion and Book Recommendation Credits Writer and Producer: Deborah Gorth MD, PhD Infographic and Cover Art: Zoya Surani 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: Michelle Kittleson MD, PhD Sponsor: Freed You can try Freed for free right now by going to freed.ai. And listeners of Curbsiders can use code CURB50 for $50 off their first month.  Sponsor: Litter Robot Right now, Whisker is offering $75 off Litter-Robot bundles. AND, as a special offer to listeners, you can get an additional $50 off when you go to stopscooping.com/CURB. Sponsor: Beginly Health Ready to take control of your job search? Visit beginlyhealth.com/curbsiders to get started

Treating colds, flu, and more with Dr Amber Bird! 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. Claim CME for this episode at curbsiders.vcuhealth.org! Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CME Show Segments 00:00 Introduction and Setting the Agenda 03:07 Getting to Know the Guest and Rapid Fire Questions 05:51 Case from Kashlak: Mateo with Common Cold Symptoms 06:12 Defining and Diagnosing the Common Cold 09:08 Approach to History and Physical Exam 13:23 Viral Respiratory Testing and Its Indications 17:36 Symptomatic Treatment Options for the Common Cold 24:25 Managing Cough and Nasal Congestion 35:03 Home Remedies and natural products 42:16 Prescribing Antivirals for Influenza 46:33 Antibiotics and Counseling Patients 52:07 Contagiousness and Risk to Family Members 54:52 Recurring Colds and Risk Factors 59:38 Vaccination recommendations 01:01:23 Key Takeaways and Conclusion Credits Producer: Leah Witt, MD and Molly Heublein, MD Show Notes/CME: Molly Heublein, MD Cover Art and Infographic: Leah Witt, MD Hosts, writers: Leah Witt and Molly Heublein, MD   Reviewer: Fatima Syed, MD Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP Technical Production: PodPaste Guest: Amber Bird, MD Sponsor: Babbel Get up to 60% off at Babbel.com/CURB.  Sponsor: Freed You can try Freed for free right now by going to freed.ai. And listeners of Curbsiders can use code CURB50 for $50 off their first month. Sponsor: Panacea Legal  Let Panacea Legal help you today at Panacea.Legal

Supplemental oxygen is ubiquitous and yet there is a tremendous amount of uncertainty related to prescription and management in the outpatient setting. Have no fear, we’ve got your back! On this episode of The Curbsiders we host special guest Susan Jacobs, RN, MS who is a bonafide, world-class expert in outpatient oxygen therapy. How to prescribe? What’s out there? What do you do when your patient travels? She joins us to tackle these questions and so much more so make sure to tune in and snag some knowledge food for that old brain hole! Claim CME for this episode at curbsiders.vcuhealth.org! Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CME Show Segments Intro Getting to know our guest Basics of oxygen prescribing and devices Caveats for the patient who only has exertional hypoxemia How to prepare for travel Key points & take aways Outro Credits Producer, Writer, Infographic and Cover Art Artist: Leah Witt, MD Show Notes: Cyrus Askin, MD Reviewer:  Fatima Syed, MD Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP    Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP Technical Production: PodPaste Guest: Susan Jacobs, RN, MS Sponsor: UVA Health To learn more about UVA Health, visit https://uvahealth.com/ Sponsor: Beginly Health Ready to take control of your job search? Visit beginlyhealth.com/curbsiders to get started. Sponsor: Freed AI You can try Freed for free right now by going to freed.ai. And listeners of Curbsiders can use code CURB50 for $50 off their first month. View full show notes at thecurbsiders.com

De-stress your approach to stress fractures (and trochanteric pain syndromes and meniscus tears)! Follow along as the great Dr. Senter guides us through the diagnosis, workup, and treatment of an all-star lineup of sport injuries. Part 2 covers stress fractures, relative energy deficiency in sports, trochanteric pain, meniscus tears, and the ongoing quest to diagnose Paul’s mysterious hip injury.  Claim CME for this episode at curbsiders.vcuhealth.org! Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CME Show Segments Case 1 - Hip stress fracture  Approach to hip injuries in runners   Relative Energy Deficiency in Sports (RED-S) Imaging consideration for bone stress injuries Surgical and treatment consideration for hip stress fractures Osteoporosis evaluation Case 2 - Greater trochanteric pain syndrome  Hip and trochanter anatomy   Treatment and imaging of trochanteric tendinopathies Case 3 - Meniscus tear Knee evaluation and physical exam   Bucket handle tears and surgical considerations Special physical exam maneuvers  Imaging and further surgical considerations  Outro & Take Home Points  Credits Producer and Show Notes: Peter Wikoff MD Writer, Infographic and Cover art: Edison Jyang MD  Reviewer: Sai S Achi MD MBA FACP Hosts and Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP    Technical Production: PodPaste Guest: Dr. Carlin Senter MD Sponsor: ClinicalKey AI To learn more about ClinicalKey AI, visit Elsevier.health/AI  Sponsor: Beginly Health Ready to take control of your job search? Visit beginlyhealth.com/curbsiders to get started.  Sponsor: Freed AI You can try Freed for free right now by going to freed.ai. And listeners of Curbsiders can use code CURB50 for $50 off their first month.

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.  Claim CME for this episode at curbsiders.vcuhealth.org! Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CME Credits Written and Produced by: Fatima Syed, MD, MSc Infographic and Cover Art: Zoya Surani, MD  Show Notes: Fatima Syed, MD, MSc Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP Reviewer: Sai S Achi, MD, MBA, FACP Showrunners: Matthew Watto MD, FACP and Paul Williams MD, FACP Technical Production: Pod Paste Guest: Joel Topf, MD Sponsor: Mint Mobile To get this new customer offer and your new 3-month premium wireless plan for just 15 bucks a month, go to mintmobile.com/CURB.  Sponsor: ClinicalKey AI ClinicalKey AI is an award-winning solution that combines trusted, evidence-based clinical content with conversational search powered by generative AI. To unlock the power of AI in clinical decision-making with ClinicalKey AI, visit Elsevier.health/AI” Sponsor: Freed You can try Freed for free right now by going to freed.ai. And listeners of Curbsiders can use code CURB50 for $50 off their first month.

Follow along as the great Dr. Senter guides us through the diagnosis, workup, and treatment of an all-star lineup of sport injuries. Part 1 covers concussions, femoroacetabular  impingement (FAI), and the ongoing quest to diagnose Paul’s mysterious hip injury.  Claim CME for this episode at curbsiders.vcuhealth.org! Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CME Show Segments 00:00 Introduction  08:43 Case 1 - Concussion  9:39 Approach and Workup of Concussions  18:08 Treatment of Concussions (Return to Activity)  24:10 Consideration of Head Imaging  33:20 Case 2 - Hip Pain (FAI)  34:15 Hip Anatomy and Differential Diagnosis  38:41 Hip Physical Exam  45:41 Hip Imaging  47:28 Treatment of FAI Outro & Take Home Points  Credits Producer and Show Notes: Peter Wikoff MD Writer, Infographic and Cover art: Edison Jyang MD  Reviewer: Sai S Achi MD MBA FACP Hosts and Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP    Technical Production: PodPaste Guest: Dr. Carlin Senter MD Sponsor: ClinicalKey AI ClinicalKey AI is an award-winning solution that combines trusted, evidence-based clinical content with conversational search powered by generative AI. To unlock the power of AI in clinical decision-making with ClinicalKey AI, visit Elsevier.health/AI Sponsor: Freed You can try Freed for free right now by going to freed.ai. And listeners of Curbsiders can use code CURB50 for $50 off their first month. Sponsor: Babbel Get up to 60% off your Babbel subscription - but only for our listeners at Babbel.com/CURB.

Expand your NAFLD/MASLD knowledge! Expert guest Dr. Elliot Tapper (@ebtapper) shares his framework for approaching NAFLD/MASLD and the treatment tools he recommends including lifestyle modifications and medications.  Claim CME for this episode at curbsiders.vcuhealth.org! Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CME Show Segments Intro Rapid Fire Segment Case 1 Part 1 NAFLD/MASLD terminology and differential diagnoses PEth testing  Diagnostic tools for NAFLD/MASLD: Fib4 Score Imaging When to Refer to a Hepatologist? Treatment options Lifestyle modifications  Role of GLP-1 agonists Role of new FDA approved medications Outro Credits Producer: Sai S Achi, MD, MBA, FACP; Matthew Watto MD, FACP  Writer, Show Notes, Cover Art, and Infographics: Sai S Achi, MD MBA, FACP Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP    Reviewer: Leah Witt MD Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP Technical Production: PodPaste Guest: Dr. Elliot Tapper MD Sponsor: Freed You can try Freed for free right now by going to freed.ai. And listeners of Curbsiders can use code CURB50 for $50 off their first month. Sponsor: The University of Virginia Visit uvahealth.com website to explore this exceptional opportunity and submit your application today. Sponsor: Beginly Health Ready to take control of your job search? Visit beginlyhealth.com/curbsiders to get started.