I know this is an old episode but hindsight is amazing. Even getting a 250~500ml of extra fluids makes such a dramatic difference in my daily function when I can get them, to the point that I have been begging for several years for regular IV fluid replenishment instead of several years of zofran that doesn’t work. The extra fluids help the nausea, and overall general feeling of unwell when trying to take supplements, meds and fluids. ( I have an irrational fear of vomiting and am always nauseous, on top of supposedly having crohn’s and a horseshoe kidney that loves collecting kidney stones). Thank you for this information

You know, until recently I hadn't realized that Mario updated his favorite way to tackle ED and it's a relief! Although what he previously suggested was pretty good, it was a real pain to follow... I just go'ogled the latest by Mario Volpstein, it's so much easier and potent now!

Are coping skills a hobby, not a prescription? I guess Dr.Jess has a pill for every 🤒 😷 Ill. What's the prognosis of taking psychotropic medications long-term on the various organ systems? I would like to see that study... I favor the least invasive but effective treatment possible to avoid neurotoxicity metabolic syndrome.

I wish I could weigh in on these conversation. I love this podcast. But I can tell you from experience they is a major difference between the high of smoking crack and snorting it

The Veterans Administration has me on 900 MCG buprenorpine I have chronic pain and this medication is not working but the VA doesn't want to hear about.. I have no quality of life because of the pain

Thank you for the great talk! I love that curbsiders has launched this addiction medicine podcast and is getting current, evidence based treatment recommendations out there! I did have a few comments about phenobarbital. First, I think that phenobarbital is an outstanding medication for benzodiazepine, refractory alcohol withdrawal, but the more widespread use of phenobarbital is perhaps not supported by the evidence yet. So far, the systematic reviews and meta-analyses that have been done do not support the more general use of phenobarbital . It is my suspicion that the enthusiasm for phenobarbital is due to the bad outcomes that have resulted from the widespread use of short acting symptom triggered regimens for essentially ALL patients by many institutions. This is not what is recommended in the current ASAM guidelines in that patients with severe symptoms or who are at high risk for complicated withdrawal should be given medication early, often given frontloading regimens, and should almost always be getting long acting agents. So, when these things are not happening, it is unsurprising that a very long acting agent like phenobarbital would have better outcomes. When you look at the evidence that existexists, the studies are almost always comparing phenobarbital to a comparator that is a symptom triggered, lorazepam regimen for all, which isn’t really the standard of care, and when phenobarbital has been compared to diazepam the outcomes have been equivalent, which supports my suspicion that we need a more nuanced, guideline driven approach to how we treat our alcohol withdrawal patients. The last comment I would make about phenobarbital is that the literature often erroneously states that phenobarbital impacts the NMDA receptor, but that is not the case. Phenobarbital has some effect on the AMPA receptor, which has a much less pronounced effect on alcohol withdrawal, so the clinical relevance of the glutamatergic effects of phenobarbital is unclear and probably minimal.

My brother was told for 2 years by his dr. he needed to quite drinking. My Brother told him, I only have 1 beer every other week. Finally someone tested him for haemochromotosis. He was off the charts with iron. Then the rest of us had to get tested and I was the only other lucky one. Phlebotomy every week for 3 months as a female at age 28. My arthritis got better until now. I have been discouraged by the doctors that seem to ignore these conditions. Along with Chronic Fatigue, Fibro myalgia are not small things. They are debilitating. All they have to do is some BLOOD WORK to change a life~!!! Better to Check than to Ignore or wait 2 years.

Health care providers sure don't seem to treat it as an emergency I'm about 70% deaf now as a result. I was only 50% deaf a few YEARS ago, deaf in left ear since birth. Apparently sudden sensorineural hearing loss in your only remaining ear isn't an emergency. I'm getting a hearing aid next week for the remaining ear. Hope like hell it helps.

You people are realy 10 years behind. Go for the data and facts to the Uk.

The songs...that was painful....I loved it.

Addicts like methodone beyter because you can still use on it

My doctor prescribed me Provera 10mg once daily for 10 days and my bleeding has significantly stopped on the first day taking it, should I continue the tablets or should I stop taking them?

My doctor just prescribed me Sprintec x5 the first day, x4 the second day then so on. I have been bleeding for almost 2 months where it stopped for only a week then started again. Is it safe to take that much birth control at once? I’m nervous to take it 🙁

I had borderline Calcium and PTH for years. Depressed, Anxiety,. Constipation, Bone pain, exhausted, weight gain, horrible brain fog, insomnia. My doctor just pushed Prozac and B12 shots. I had enough and started going through my labs. I noticed two things. VERY LOW Vitamin D, and High Blood Calcium. I went in for ultra sounds, CT Scans, Sestamibi parathyroid scan, all showed NOTHING. But I pushed my surgeon who agreed to go looking and there it was. A large Adenoma on my lower left side. Week one after surgery I WAS 18 again. No more brain fog, energy you couldn't believe, no more constipation, I felt AMAZING. UP until 8 months ago when it's all come raging back. PTH 33 cALCIUM 9.9, horrible constipation again, brain fog, anxiety, etc etc etc. All over again. So, I'm hoping to get another surgery.

Had a DVT 12/31/23 (yes New Years Eve LOL)... then PE both lungs. Now on Warfarin and just trying to learn more about APS. This was informative even as a regular person with no medical background. Thank You :D

What about new onset of abnormal bleeding in between periods with a normal result ultrasound AND normal labs? 40/Female. Extremely frustrating.

I’ve been cursed with dysfunctional uterine bleeding in my 20s 30s and now 40s. It comes and goes throughout the year. The Norethindeone mini pill I simply cannot tolerate as it gives me extreme psychological mental breakdowns. I’ve had 8 D&C’s the bleeding always just eventually comes back. I am cursed and the only cure long term is going to be a hysterectomy. I don’t want that right now and feel severely saddened and defeated.

Time is of the essence! Not sure why all symptomatic patients should not be automatically tested regardless of their lifestyle. 23andme has an affordable health test that includes Hereditary Hemochromatosis among other things including Alpha 1 Anti-trypsin Deficiency which can also lead to cirrhosis of the liver.

This is the best instructive video for steroid induced secondary adrenal insufficiency Treatment. 💖🙏

Thanks fellas 👍🏾

Thank you!

Suboxene films didn’t work for my pain . I have rotater cuff tear and an infection in my arm. I was in so much pain I wanted to die. I went to 10 hospitals not one gave me any relief. I never abused pills because I new one day I would need them for pain but because I’m on suboxene I have a stigma against me and that F bull crap. Now I understand why people that have pain they commit suicide!

Great overall discussion BTW.

Interesting on the telehealth heavy services vs non-telehealth heavy death rates but how did the study tease out the elephant in the room difference between those two groups, ie the Covid 19 pandemic and couldn:t the telehealth vs non-telehealth just be a confounder of a more obvious risk factor such as the Covid 19 pandemic? Am I missing something here ?

Just got a midline placed 10 minutes ago

Regarding the 6m mark.. is it typical for tremors to start on the right hand? Also, any thoughts on the theory proposed by Heiko Braak that suggests PD starts in the gut and that the alpha synuclein (Lewy body) spreads through the nervous system to the brain.. and that severing the Vagus Nerve (truncal vagotomy) can stop the progression of the disease? Personally, it seems likely that the non-motor-symptoms* that develop decades before tremors or bradykinesia, are a giant clue.. most notably constipation ( increased Akkermansia and decreased SCFAs-producing bacteria). The link between gingivitis and Alzheimer's disease suggest that also may be a bacterial brain infection that doesn't clear. Would love to see a way an accurate way of measuring alpha synuclein, and if if inhaling anti-bacterial essential oils (EOs) / volatile oils (VOs) can cross directly from the nose to the brain, to reduce lewy bodies. *Insomnia dysphonia / low voice volume REM (Sleep) Behavior Disorder (RBD) asymmetry arms not swinging when walking

Excellent episode! Thanks, so long and thanks for all the puns! Sorry, but...just have to say : I'm guessing Dr. Naik's heard all the "Attila the Pun" lines😁

I had gross hematuria for 4 days. Spefic gravity always high. Dr checked bladder via scope and all clear. Plus no infection per urine. Who do i need to see?

Cant wait for the full podcast. 👍🏾

Great episode. A lot of nice clinical pearls.

6 months carnivore diet, intermediate fasting, sun light for 30 min am pm sun, simple yoga with breathing techniques 2 times a day, grounding for 45 minutes, take care of your gut, supplement: Taurine, magnesium, vitamin D3, B12, Zinc copper. Sleep by 10 pm, anxiety is the main culprit, dont panic, dont read negative comments & stop googling, learn neuroplasticity techniques, with in a year your central nervous system will become normal & you can achieve silence. Tinnitus is not for life.

My favorite clinical problem. Thank you!

Can you put the link here ?

Sub doesn't help pain..... dnt even tell ppl that bs.... iv been on it since 2015.. i know many ppl on it.. they would laugh hearing it helps with pain 😂😂... but i tell ya what you can 110% mix bupe n oxy together and bupe and lortab together... but yall want tell ppl that... doctors dnt know... most dont... they only know what their classes told em.. most never got addicted but if they ever was put on opiods for a hot min.. they would understand... but they dont... they dont know what it feels like , they dont know what its like living with it.. nor do they know what withdrawal feels like truly... they been told , but experiencing it is totally different.. they wouldn't last 24hours in active withdrawal. It would cripple them n destroy them. Imagine not being able to sleep , at all. Maybe 5 mins per hr. Skin crawling in the arms legs , constantly stretching , yawning , stomach sickness n pain , feverish , eyes watering nose running body feels like its being crushed 24/7 it doesnt stop. It just dissappears after so many days weeks depending.. and when i hear these doctors say they know , or try to act like they know.. i shake my head.. suboxone is fckn evil , that sht had no place in the world of medicine. I been on opiods for a very long time more than half my life. Its trillion × easier to come off oxycodone n lortab then bupe.. its not even a competition.. bupe takes months to come off , oxycodone 2 to 3 day tops.. so why n the fck do that to ppl.?.??? Money... drs charge 100 a week others 150 a week. For it... they are legal drug dealers period.. bupe is a much worse drug then oxy ever was. Drs can taper ppl off oxy easily , you try that with subs your asking for releapse cause 1% can do it n survive that sufering. Bupe fcks the brain so bad its insane. And yet you still wanna push it on ppl... just use lortab n oxycodone to get ppl off opiods. Iv gotten off oxy multiple times. My mistake was choosing to try sub... i dropped to 1/8th a day... n i been on 1/8th sub a day for a yr now.... and here it is day 2.5 and the withdrawal is fckn ridiculous worse than oxy ever was

My dr wants to try me on buph for my severe chronic pain but has stated she isn’t going to take me off Percocet but just add the bup I’m sure she will take me down on the amount of Percocet but not take me off. I’m very nervous to make a change however I’m just not getting the relief much anymore. I’m going to go ahead and try it after I get my shoulder replacement done. I’m not wanting the patch or the film so she said I could do the pill, I hear you saying the pill is more for opioid abuse but can it be used for chronic pain also?

Do not use this junk. It is an AWFUL medication. If you start it for any reason, you will be sorry you did.

Matt do you really say " i dunno" to patients :D ? That made me laugh. P.s amazing episode <3 thankyou Team Curbsiders. <3

Can Meniere's disease, which causes hearing loss, be cured or improved? I have a 37db hearing loss, what treatment would be better to improve my hearing and resolve the fullness issue, as well as the occasional mild vertigo that lasts for 10 seconds and tinnitus that lasts for 1 minute?"

The problem we're all aware about by now tho with going up on the dose of Oxycodone in this case, is that it's inevitable that this issue will result again and again each time you increase the dose, since Opioids for the most part don't have the phenomenon of a ceiling effect/dose, so technically this could continue as a trend every so often until you've reached hundreds of milligrams per dose. A dose which you'd of course be tolerant to, but wouldn't necessarily relieve your pain, due to the opioid receptors becoming accustomed to the presence of the drug. (please correct me if I'm wrong)

Great show. Wished he lived in my area

What medications extend screening past 75?

excellent podcast honestly. How I wish you also had one for paediatrics.

welcome to Baltimore gentlemen

I wish there was an actual cure and diagnosis for aps , I hade dvt in my leg and it took me until I was coughing up blood to go to the hospital , I had pneumonia too . They said there was no direct cause for the aps and no cure just a blood thinner for the rest of my life .

The first 7 minutes need to be edited out. What a waste of time!

Why is this 1 min 39 seconds??

These updated recommendations would definitely have favourable results, if applied to a resource limited countries like ours

😮

Excellent explanation. He simplified it in such a way that we can remember.

Some Drs do and Some Drs don't