Jan 2, 2017
Consolidate your knowledge and
reinforce the learning you’ve done with us in 2016. Enjoy this
holiday helping of knowledge food for your brain hole. The guys
offer their best of recommendations for 2016 and recap key teaching
points from the past year so you have the tools to dominate
Recommend a guest or topic and
give feedback at firstname.lastname@example.org
SPRINT trial debate
effects results seen in this trial. e.g. stopped early
pressure (BP) control may have been overestimated based on how BP
was measured leading to increased CV events (Stuart’s
measurements in trial likely reflected out of office BP so results
are useful (Paul’s view).
BP is probably safe, even in the elderly so be reluctant to back
off on meds.
- Verify BP reading and measurement
- Evaluate for pain, anxiety, volume overload,
nonadherence, or noncompliance
high BP with long term goals in mind (i.e. go up on
warfarin in patients with gastric bypass or Crohn’s with
SPARC tool to visually demonstrate risks and benefits of
anticoagulation in Afib.
- Physicians commonly underestimate benefit of
anticoagulation in older sicker patients and overestimate risk of
Fibromyalgia and chronic
- Recognize the constellation of fatigue, memory
problems, sleep disturbance, and multifocal pain as
the 2011 American College of Rheumatology criteria for diagnosis.
No tender point exam required!
- Nonpharmacologic therapies and education are
most effective (see video links below).
- Chronic painful conditions like rheumatoid
arthritis, or lupus can lead to fibromyalgia.
least 80% of your food should be whole foods.
the Dirty Dozen and Clean 15 to guide organic food
- Knowledge of pathophysiology and biochemistry
can be used to treat disease e.g. treating small intestinal
bacterial overgrowth can fix iron deficiency and indirectly treat
- Lowering LDL is key. Some statin is better than
none, so consider intermittent dosing (three times weekly) of
atorvastatin or rosuvastatin.
- Statins have a 20 year safety record, are
cheap, and will remain king for now.
baseline LDL and monitor percent decrease on statin therapy to
ensure desired effect (e.g. 50% drop in LDL for patient requiring
- Withdrawal of statins at end of life is
warranted and safe.
- Nonpharmacologic therapy is as good or better
than pharmacologic therapy.
- Benefits of nonpharmacologic therapy persist
1-2 years after discontinuation.
- Identify problem with sleep initiation versus
maintenance, or both, then choose agent.
long taper of sleep agent (several months) along with CBT for
nightly problems with sleep.
- Intermittent dosing of sleep agent okay if only
intermittent sleep trouble.
secondary hyperparathyroidism present, then target normal PTH not
just a Vit D level 30-50 ng/ml.
hip fracture, first normalize Vit D and/or PTH, then treat with
bone conserving agent.
holiday stops when bone density falls, fracture occurs, or risk
increases (e.g. steroid use).
- Patients may require multiple courses of
bisphosphonates or other bone conserving drugs.
contents of standard medical kit include:
prepared to improvise.
- Failure is essential to learning and
fall victim to “fear of being left out”. Saying “No” protects you
from being spread thin.
- Overcome the “curse of knowledge” by teaching
the basics and gearing lesson to level of learner.
The Curbsiders report no
relevant financial disclosures, but hope to have a long list of
them in the future.
02:54 Best of 2016
07:45 Best of 2016 Book
12:44 Best of 2016
15:49 SPRINT trial
33:00 Fibromyalgia and chronic
59:09 Lessons learned in
Links from the show:
pressure as a risk factor for headache and migraine: a prospective
population-based study. Eur J Neurol. 2015 Jan;22(1):156-62, e10-1.
doi: 10.1111/ene.12547. Epub 2014 Aug 25.
- Imbalanced insulin action in chronic
overnutrition: Clinical harm, molecular mechanisms, and a way
forward. Atherosclerosis. 2016
- Sniffing out significant “Pee values”: genome
wide association study of asparagus anosmia http://www.bmj.com/content/355/bmj.i6071
How Doctors Think
by Jerome Groupman
Multipliers: How the Best Leaders
Make Everyone Smarter by
by William Gibson
Carter Beats the Devil
by Glen David Gold
Evidence Based Physical
Diagnosis by Steven
- Download Google Drive
- Map My
- SPARC Tool for anticoagulation in atrial
- Warfarin use in heart failure patients may have
- Chronic Pain is it all in their
minute video on Chronic Pain from Australia (not the VA!)
- EWG.org (environmental work group) - gives
the Dirty Dozen and the Clean 15