#444 Macrocytosis, Hemolytic Anemia, Myelodysplastic Syndrome

Join us as we review recent practice-changing articles on preventive PCI, andexanet alfa for ICH, aspirin for fatty liver, naltrexone in cirrhosis, pivmecillinam for UTI, cefepime vs pip-tazo, MDRO decolonization, microplastics and MACE, and more! 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! Episodes | Subscribe | Spotify | Swag! |Mailing List | Contact | CME! Credits Written and Hosted by: Rahul Ganatra MD, MPH; Nora Taranto MD; Paul Williams, MD, FACP, Matthew Watto MD, FACP Cover Art: Matthew Watto MD, FACP Reviewer: Rahul Ganatra MD, MPH; Emi Okamoto MD Technical Production: Pod Paste Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP Show Segments Intro, disclaimer Preventive PCI Andexanet alfa for ICH Aspirin for MASLD Naltrexone for AUD in cirrhosis Pivmecillinam for UTI MDRO decolonization Cefepime vs pip/tazo Microplastics Pax-NO-vid Outro 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: ACP MKSAP Learn more about ACP MKSAP at acponline.org/acpmksap  Sponsor: Litter Robot  Whisker is currently offering $50 off Litter-Robot bundles. As a special offer to listeners of the show, go tostopscooping.com/CURB and use promo code CURB to save an additional $50 on any Litter-Robot bundle.

Recorded LIVE! At Johns Hopkins Internal Medicine Grand Rounds Step up your anemia game as we explore the causes and diagnostic approach for macrocytic anemia, what to do with a reticulocyte count, the differential diagnosis for hemolytic anemia, the significance of the direct antiglobulin test, and diagnosis and management pearls for autoimmune hemolytic anemia (AIHA) and myelodysplastic syndrome (MDS). Plus, common questions and concerns regarding folate supplementation and the use of bone marrow biopsies. We’re joined by hematologist and pun enthusiast Dr. Rakhi Naik MD, MHS, @redcell_doc @hopkinsheme.  Claim CME for this episode at curbsiders.vcuhealth.org! Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CME Show Segments 00:00 Intro and Guest intro 05:53 Case 1: Elise - Macrocytic Anemia 14:59 Case 2: Jane - Hemolytic Anemia 23:24 Testing for Underlying Causes of Autoimmune Hemolytic Anemia 24:40 Association of Autoimmune Hemolytic Anemia with Lymphomas 25:10 Autoimmune Hemolytic Anemia: Diagnosis and Treatment 26:06 Management Approach for Autoimmune Hemolytic Anemia 27:30 Considerations for Outpatient Treatment of Autoimmune Hemolytic Anemia 28:18 Clotting Risk in Autoimmune Hemolytic Anemia 29:20 Treatment Options for Autoimmune Hemolytic Anemia 30:42 Long-Term Prognosis and Recurrence of Autoimmune Hemolytic Anemia 33:32 Diagnostic Challenges in Myelodysplastic Syndrome 35:00 Considerations for Folate Supplementation 36:24 Factors to Consider in the Management of Myelodysplastic Syndrome 39:30 When to Perform a Bone Marrow Biopsy in Myelodysplastic Syndrome 41:25 Shared Decision-Making in the Treatment of Myelodysplastic Syndrome Credits Writer and Producer: Matthew Watto MD, FACP Show Notes: Matthew Watto MD, FACP Cover Art and Infographic: Matthew Watto MD, FACP Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP    Reviewer: Fatima Syed MD, MSc Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP Technical Production: PodPaste Guest: Rakhi P. Naik MD, MHS Sponsor: Beginly Health Visit beginlyhealth.com/curbsiders job matching platform for every Physician and Advanced Practice Clinician, from training to practice. 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, for a limited time, at Babbel.com/CURB. 

Don’t just sit on that borderline calcium!  Learn how to approach hypercalcemia and work up primary hyperparathyroidism.  In this episode, we learn who goes to surgery, how to work them up, and some variants of typical primary hyperparathyroidism. We’re joined by Dr. Lindsay Kuo @lindsaykuo (Temple University Hospital) Claim CME for this episode at curbsiders.vcu health.org! Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CME Show Segments 00:00 Intro 03:31 Understanding Primary Hyperparathyroidism 09:03 Handling Mistakes and Complications in Surgery 11:44 Case Discussion: Hypercalcemia and Elevated PTH Levels 22:41 Symptoms of Primary Hyperparathyroidism 25:06 The Role of Vitamin D in Primary Hyperparathyroidism 28:07 Testing Considerations for Parathyroid Hormone (PTH) Levels 46:02 Considerations for Parathyroid Carcinoma 49:19 Parathyroid Imaging in Primary Hyperparathyroidism 52:23 The Surgical Procedure for Primary Hyperparathyroidism 57:45 Intraoperative Parathyroid Hormone Monitoring 01:00:15 Post-Operative Monitoring for Hypocalcemia 01:04:38 Normocalcemic Primary Hypoparathyroidism and Normohormonal Primary Hyperparathyroidism Credits Written and produced by: Paul Williams, MD, FACP Show Notes: Paul Williams, MD, FACP Infographic and Cover Art: Paul Williams, MD, FACP Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP    Reviewer: Fatima Syed, MD Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP Technical Production: PodPaste Guest: Lindsay Kuo, MD Sponsor: Freed You can try Freed for free by going to freed.ai. Use code CURB50 for $50 off your first month.  Sponsor: Panacea Financial  Visit panaceafinancial.com to learn more about a nationwide digital bank built for doctors, by doctors. Sponsor: Grammarly Get AI writing support that works where you work. Sign up and download for FREE at grammarly.com/PODCAST

Don’t pass up on passing out! Stand up to syncope as Dr. Dan Dressler (Emory University) guides us to confidently manage cases! We review a framework for understanding different types of syncope, and strategies for determining which low-risk patients can be safely discharged, and appropriate next steps to work up those high-risk and in-between cases.  Claim CME for this episode at curbsiders.vcu health.org! Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CME Show Segments Intro Picks of the Week Case 1: Tamara What is syncope? Categorizing Syncope Initial workup Risk scores Pulmonary embolism  Case 2: Travis Cardiac evaluation Take-home points Outro Credits Producer, Script and Show Notes: Emi Okamoto MD  Infographic and Cover Art: Caroline Coleman MD Hosts: Monee Amin MD and Meredith Trubitt MD Reviewer: Rahul Ganatra MD, MPH Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP Technical Production: PodPaste Guest: Daniel D. Dressler, MD, MSc, MHM, FACP 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: Pattern Request your disability insurance quotes with Pattern at patternlife.com/curbsiders. Sponsor: Pathway Download the Pathway app by visiting pathway.md

More clinical pearls from ACP #IM2024, including emerging infectious diseases in the US (malaria, dengue, super gonorrhea, and a resurgence of syphilis), new C. diff treatments, coagulopathy and cirrhosis, fatty liver disease, HFpEF, peripheral arterial disease, Lp(a) and ApoB, CAR T-cells for autoimmune disease, SGLT2i for gout, and hematology updates. Paul and Watto are joined by Drs. Nora Taranto, Beth Garbitelli, and of course Chris “The Chiu Man” Chiu. Claim CME for this episode at curbsiders.vcuhealth.org! Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CME Show Segments 00:00 Tropical Diseases: Resurgence of Malaria and Dengue Fever 03:44 Infectious Diseases: Syphilis Rates and New Treatments for C. diff 08:28 Coagulopathy and Cirrhosis: Managing Hemostasis and Portal Vein Thrombosis 11:34 Fatty Liver Disease: Risk Stratification and Treatment 14:59 Cardiology Updates: Cardiovascular Kidney Metabolic Syndrome 31:03 New Medications for Hypertension 32:54 Renal Denervation and Hypertension 33:51 Lp(a) Drugs and Their Potential 36:01 Peripheral Arterial Disease and Claudication 38:10 SGLT2 Inhibitors and Gout 41:50 APO-B and LDL Cholesterol 42:45 Secondary Hypogonadism and Head and Neck Radiation 45:30 VEXAS: A Genetic Autoimmune Condition 49:08 Obesity-Induced Leukocytosis 52:49 CAR T-Cell Therapy in Rheumatologic Diseases Credits Producers/Writers/Show Notes: Matthew Watto MD, FACP; Paul Williams MD, FACP, Nora Taranto MD, Chris Chiu MD, Beth Garbitelli MD CME, Cover Art: Beth Garbitelli MD Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP    Reviewer: Nora Taranto MD Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP Technical Production: PodPaste Sponsor: Litter Robot Go to stopscooping.com/CURB and enter promocode CURB to save an EXTRA $50 on any Litter-Robot bundle. 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: Beginly Visit beginlyhealth.com/curbsiders for the job matching platform for every Physician and Advanced Practice Clinician, from training to practice

Become a pro in Hepatitis B! Dr. Arthur Kim teaches us how to approach Hepatitis B screening and vaccination in primary care, provides pearls on counseling patients with chronic Hepatitis B infection, and summarizes considerations for Hepatitis B antiviral treatment and monitoring. Claim CME for this episode at curbsiders.vcuhealth.org! Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CME Show Segments Intro Case from Kashlak Hepatitis B screening - who should be screened? Hepatitis B screening - interpreting test results Hepatitis B vaccination Stages of Chronic HBV infection Counseling patients with chronic HBV about preventing transmission and protecting liver health Treatment of chronic HBV infection Screening for hepatocellular carcinoma Outro Credits Producer, Writer, Show Notes, Infographics, and Cover Art: Malini Gandhi  Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP    Reviewer: Fatima Syed MD Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP Technical Production: PodPaste Guest: Arthur Kim MD Sponsor: Babbel Get up to 60% off your Babbel subscription Babbel.com/curb Sponsor: Freed You can try Freed for free by going to freed.ai. Use code CURB50 for $50 off your first month.  Sponsor: Pattern Request your disability insurance quotes with Pattern at patternlife.com/curbsiders.

Repair and replace your old approach to shoulder pain! We cover shoulder anatomy, explain the continuum of impingement syndrome (from bursitis to tendonitis to rotator cuff tears to cuff tear arthropathy), how to take a good shoulder history, perform a high-yield physical exam, when to refer, and when to get an MRI. Plus, how to differentiate glenohumeral joint arthritis from frozen shoulder, and how to diagnose AC joint pathology. We’re joined by everyone’s favorite orthopedic surgeon, inventor, and renaissance man, Dr. Ted Parks. Claim CME for this episode at curbsiders.vcuhealth.org! Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CME Show Segments 00:00 Intro 05:38 Shoulder Anatomy 14:47 Continuum of Impingement Syndrome 33:41 When to order an MRI 36:28 Glenohumeral joint arthritis vs frozen shoulder 51:50 AC joint arthritis  62:25 Outro Credits Written and Produced by: Matthew Watto MD, FACP Show Notes: Matthew Watto MD, FACP Cover Art and Infographic: Beth Garbitelli MD 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: Ted Parks 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: Pattern Request your disability insurance quote online at patternlife.com/curbsiders. Sponsor: Panacea Financial  Visit panaceafinancial.com to learn more about a nationwide digital bank built for doctors, by doctors.

We went to it so you don’t have to We recap the top pearls for the hospitalist from #SHM #Converge24 covering discussions on heart failure, gastrointestinal bleeds, sepsis, updates in critical care, updates in hospital medicine, oncologic emergencies, pneumonia, COPD, transitions of care, vulnerable populations, AI, and more! Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CME Show Segments Intro Picks of the Week Heart Failure Patients with Disabilities POCUS on Inpatient Service GI Updates High Value Delivery of Medical Education Molecular Testing for Infectious Diseases Interhospital Transfers Artificial intelligence in Inpatient Care Care of the Incarcerated Patient Periop Updates Oncologic Emergencies--Neutropenic Fever Oral vs IV Antibiotics Updates in Hospital Medicine Updates in Critical Care & Guidelines in Hospital Medicine Post Acute Care Things We Do For No Reason ™ Iron Deficiency Anemia Updates in Community Acquired Pneumonia Updates in Palliative Care Outro Credits Written, produced and show notes by: Monee Amin MD, Caroline Coleman MD, Meredith Trubitt MD  Cover Art: Caroline Coleman MD Hosts: Monee Amin MD, Meredith Trubitt MD  Reviewer: Rahul Ganatra, MD, MPH Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP Technical Production: PodPaste Guests: Harika Gorti MD, Sneha Neurgaonkar 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: Pattern Request your disability insurance quote online at patternlife.com/curbsiders.

We cover angina, COPD-asthma overlap, home oxygen, colon cancer screening, cancer survivorship, tobacco cessation, e-cigarettes, step counts for health,  new drugs, the RSV vaccine, addiction medicine, interstitial lung disease, APOL1-mediated kidney disease, testosterone therapy, antimicrobial resistance, office-based allergy testing and more! The Curbsiders review highlights, clinical pearls, and practice-changing updates from the American College of Physician Internal Medicine Meeting #IM2024!  No CME for this episode due to rapid turnaround, but claim CME for most episodes at  curbsiders.vcuhealth.org! Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CME Show Segments Intro ACP Pearls Outro Credits Producers: Matthew Watto MD, FACP; Paul Williams MD, FACP, Molly Heublein MD, Nora Taranto MD, Chris Chiu MD, Rahul Ganatra MD MPH, Beth Garbitelli MD Show Notes: Matthew Watto MD, FACP; Paul Williams MD, FACP, Molly Heublein MD, Nora Taranto MD, Chris Chiu MD, Rahul Ganatra MD MPH, Beth Garbitelli MD Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP    Reviewer:Matthew Watto MD FACP Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP Technical Production: PodPaste Sponsor: Beginly Health Visit https://beginlyhealth.com/curbsiders for the job matching platform for every Physician and Advanced Practice Clinician, from training to practice 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.

Energize your education on endometriosis! Learn common clinical presentations, optimal diagnostic imaging tests, and how to counsel patient on treatment options. We are joined by Dr. Adela Cope (Mayo Clinic) and Dr. Isabel Green @isabelgreenMD (Mayo Clinic). 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 Introduction 06:45 Topic 07:30 Endo Definition & Symptoms 14:40 Endo phenotypes 21:30 Differential Diagnoses to Consider 25:47 Making a Diagnosis  31:00 Imaging to consider 37:40 Endo Hormonal Treatment Optiosn 48:30 Monitoring Treatment 52:20 When to Refer 57:30 Surgical Treatment 1:09:20 Pain Management 1:13:30 Take Homes 1:19:00 Outro Credits Producer, Show notes, Infographics: Carolyn Chan, MD, MHS Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP    Reviewer: Sai S Achi, MD, MBA Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP Technical Production: PodPaste Guest: Dr. Adela Cope and Dr. Isabel Green 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: Locumstory Tune in to The Locumstory Podcast on Spotify, Apple, or Google podcasts. Sponsor: Babbel Curbsiders listeners get 60% off at babbel.com/CURB