Heart Failure with Preserved Ejection Fraction (Diastolic CHF) and SGLT-2 Inhibitor Therapy

The double-blind, randomized phase III EMPEROR-Preserved trial showed a benefit of the sodium-glucose cotransporter-2 (SGLT2) inhibitor empagliflozin...

Should You Postpone Interventions for INFECTED Necrotizing Pancreatitis?

An important recently published randomized control trial provides guidance on this controversy.

Spontaneous Bacterial Peritonitis - Unique Infections in Cirrhosis part 2

Unique Infectious Considerations in Cirrhosis - part 1

Diabetic Gastric Emptying Abnormalities (and sometimes normal) - Part 1

Almost nobody feels comfortable managing DELAYED gastric emptying (gastroparesis) and very few medical providers even think about RAPID gastric emptyi...

Gastric Emptying Abnormalities - Part 2

Can we trust a nuclear study to nail the diagnosis? Are motor abnormalities really the cause of symptoms? What is a POP procedure? 

Morphine for later stage COPD patients not on hospice

Does regular, low-dose, oral sustained-release morphine improve disease-specific health status or cause respiratory adverse effects in patients with m...

The JAMA controversy and loss of conversation in medicine

My take on what went down at the Journal of the American Medical Association. I disagree with the comment there isn't "structural racism in health car...

Cows Milk - Healthy or Not?

Psilocybin Mushrooms - will they become an accepted medicine?

Understand Basic Epigenetic Changes in Medicine and Everyday Life

This lecture provides a basic understanding of how epigenetic changes influence infections/sepsis, vaccinations, cancer, future generations, your musc...

Hyponatremia etiology by history and physical

Hyponatremia remains a challenging topic for many because they are trying to memorize algorithms and numbers. You can usually nail the etiology by his...

Cytokine Storm - part 1

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 jus...

Cytokine Storm - part 2

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...

The Most Important Person That Lived For Our Health and Wellbeing

Hint: That person died in 2017

An (old) New Weapon to Fight Leg Cellulitis

Acute Severe Hypertension - part 1

Acute Severe Hypertension - part 2

Multiple treatment issues are discussed. This includes theoretical ideal blood pressure lowering rates, oral options (for hypertensive urgency and spe...

Acute Severe Hypertension - part 3

Did you know that intravenous labetalol and oral labetalol are not really similar? The great hydralazine debate. Things you must know about Clevidipin...

Acute Severe Hypertension - part 4

Did you know systolic and diastolic blood pressure are NOT measured by automated BP cuffs? PRES (Posterior Reversible Encephalopathy Syndrome), also k...

Interesting Studies, Facts, & Opinions - April 2020 edition

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 mortal...

Balkan Reflections Forged By A Virus Lockdown

World War I was partly triggered by powerful allies of various nationalities being dragged into a Balkan conflict (nationalism, of course, was another...

Recent Interesting Internal Medicine Studies and Facts - December 2019

Correcting Hypernatremia in adults (finally, a real study!). An option for that scary patient with hemoptysis. How many nephrons you have (and your pa...

Anemia of Inflammation - finally understand this common anemia that accomplished doctors often can't explain

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 comprehe...

Anemia of Inflammation - part 2

If you know why red blood cells survive less (and are made less) during inflammatory conditions, and already know why ferritin increases in inflammati...

Anemia of Inflammation - part 3

Creatine - part 1

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 unde...

Creatine - part 2

The replenishing of muscle ATP is one (of the several) mechanisms that creatine helps with when it comes to heavy anaerobic exercise. Other topics dis...

Creatine - part 3

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...

Medicare for All? (or maybe you call it Universal Healthcare or Single-Payer)

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

Clostridium Difficile - part 1

A deceivingly difficult topic. Not so obvious points are made about asymptomatic carriers, transmission, and who to test.

Clostridium Difficile - part 2

Specific initial treatment regimens are discussed. Topics include fulminant disease, Vancomycin, Fidaxomicin, Metronidazole, and recurrence rates/regi...

Clostridium Difficile - part 3

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 dir...

Live From My Basement Bathroom

Experiences that taught me some lessons. 

Type 2 Diabetes Treatment - Part 7 - GLP-1 Agonists and DPP-4 Inhibitors

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 a...

Type 2 Diabetes Treatment - Part 6 - SGLT2 Inhibitors

Sodium-Glucose Transporter 2 Inhibitors decrease glucose re-absorbtion. The diuretic effect, weight loss, DKA, cardiac outcomes, blood pressure, genit...

Type 2 Diabetes Treatment - Part 5 - HgA1C

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

Tackles - Vitamin B12, kidney disease, CHF, cancer, Impaired Glucose Tolerance (IGT), dosing, side-effects, lactic acidosis, cost, drinkers, hypoxic p...

Type 2 Diabetes Treatment - Part 3 Glucagon

If you want to understand drug classes like DPP-4 inhibitors, GLP-1 (GLUCAGON-like peptide) therapies, treating hypoglycemia, and an important player...