Podcasts about Creatinine

Creatinine does not work according to study. Jason Andrews discussing the Oncosure rapid cancer testing. Orlando might host the Jaguars. National medal Of honor museum opening. Volusia county spring break citations tripled this year. States not sure how to return money.

Listen to ASCO's Journal of Clinical Oncology Art of Oncology article, "I Hope So Too” by Dr. Richard Leiter from Dana-Farber Cancer Institute. The article is followed by an interview with Leiter and host Dr. Mikkael Sekeres. Leiter shares that even in the most difficult moments, clinicians can find space to hope with patients and their families. TRANSCRIPT  Narrator: I Hope So Too, by Richard E. Leiter, MD, MA  “You're always the negative one,” Carlos' mother said through our hospital's Spanish interpreter. “You want him to die.” Carlos was 21 years old. A few years earlier he had been diagnosed with AML and had undergone an allogeneic bone marrow transplant. He was cured. But now, he lay in our hospital's bone marrow transplant (BMT) unit, his body attacked by the very treatment that had given him a new life. He had disseminated graft-versus-host disease (GVHD) in his liver, his lungs, his gut, and, most markedly, his skin. The BMT team had consulted us to help with Carlos' pain. GVHD skin lesions covered his body. They were raw and weeping. Although the consult was ostensibly for pain, the subtext could not have been clearer. Carlos was dying, and the primary team needed help navigating the situation. As his liver and kidney function declined, the need to address goals of care with Carlos' mother felt like it was growing more urgent by the hour. Difficult cases, like a young person dying, transform an inpatient unit. Rather than the usual hum of nurses, patient care associates, pharmacy technicians, and unit managers going about their daily work, the floor becomes enveloped in tension. Daily rhythms jump a half step ahead of the beat; conversations among close colleagues fall out of tune. “Thank goodness you're here,” nurse after nurse told my attending and me, the weight of Carlos' case hanging from their shoulders and tugging at the already puffy skin below their eyes. I was a newly minted palliative care fellow, just over a month into my training. I was developing quickly, but as can happen with too many of us, my confidence sat a few steps beyond my skills. I thought I had a firm grasp of palliative care communication skills and was eager to use them. I asked for feedback from my attendings and genuinely worked to incorporate it into my practice. At the same time, I silently bristled when they took charge of a conversation in a patient's room. Over the ensuing week, my attending and I leaned in. We spent hours at Carlos' bedside. If I squinted, I could have convinced myself that Carlos' pain was better. Every day, however, felt worse. We were not making any progress with Carlos' mother, who mostly sat silently in a corner of his room. Aside from occasionally moaning, Carlos did not speak. We learned little, if anything, about him as a person, what he enjoyed, what he feared. We treated him, and we barely knew him. Each morning, I would dutifully update my attending about the overnight events. “Creatinine is up. Bili is up.” She would shake her head in sadness. “Doesn't she get that he's dying?” one of the nurses asked us. “I feel like I'm torturing him. He's jaundiced and going into renal failure. I'm worried we're going to need to send him to the ICU. But even that won't help him. Doesn't she understand?”  We convened a family meeting. It was a gorgeous August afternoon, but the old BMT unit had no windows. We sat in a cramped, dark gray family meeting room. Huddled beside Carlos' mother was everyone on the care team including the BMT attending, nurse, social worker, chaplain, and Spanish interpreter. We explained that his kidneys and liver were failing and that we worried time was short. Carlos' mother had heard it all before, from his clinicians on rounds every day, from the nursing staff tenderly caring for him at his bedside, and from us. “He's going to get better,” she told us. “I don't understand why this is happening to him. He's going to recover. He was cured of his leukemia. I have hope that his kidneys and liver are going to get better.” “I hope they get better,” I told her. I should have stopped there. Instead, in my eagerness to show my attending, and myself, I could navigate the conversation on my own, I mistakenly kept going. “But none of us think they will.” It was after this comment that she looked me right in the eyes and told me I wanted Carlos to die. I knew, even then, that she was right. In that moment, I did want Carlos to die. I could not sit with all the suffering—his, his mother's, and his care team's. I needed her to adopt our narrative—that we had done all we could to help Carlos live, and now, we would do all we could to help him die comfortably. I needed his mother to tell me she understood, to accept what was going on. I failed to recognize what now seems so clear. Of course, his mother understood what was happening. She saw it. But how could we have asked her to accept what is fundamentally unacceptable? To comprehend the incomprehensible?  At its best, serious illness communication not only empathetically shares news, be it good or bad, but also allows patients and families adequate time to adjust to it. For some, this adjustment happens quickly, and in a single conversation, they can digest difficult news and move to planning the next steps in care for themselves or their loved ones. For most, they need more time to process, and we are able to advance the discussion over the course of multiple visits. My attending led the conversations from then on. She worked with the BMT attending, and they compassionately kept Carlos out of the intensive care unit. He died a few days later, late in the evening. I never saw his mother again. I could not have prevented Carlos' death. None of us could have. None of us could have spared his mother from the grief that will stay with her for the rest of her life. Over those days, though, I could have made things just a little bit less difficult for her. I could have protected her from the overcommunication that plagues our inpatient units when patients and families make decisions different from those we would make for ourselves and our loved ones. I could have acted as her guide rather than as her cross-examiner. I could have hoped that Carlos stopped suffering and, genuinely, hoped he got better although I knew it was next to impossible. Because hope is a generous collaborator, it can coexist with rising creatinines, failing livers, and fears about intubation. Even in our most difficult moments as clinicians, we can find space to hope with our patients, if we look for it. Now—years later, when I talk to a terrified, grieving family member, I recall Carlos' mother's eyes piercing mine. When they tell me they hope their loved one gets better, I know how to respond. “I hope so too.” And I do. Dr. Mikkael Sekeres: Hello and welcome to JCO's Cancer Stories: The Art of Oncology, which features essays and personal reflections from authors exploring their experience in the oncology field. I'm your host, Mikkael Sekeres. I'm professor of Medicine and Chief of the Division of Hematology at the Sylvester Comprehensive Cancer Center at University of Miami. Today I am thrilled to be joined by Dr. Ricky Leiter from the Dana-Farber Cancer Institute. In this episode, we will be discussing his Art of Oncology article, “I Hope So, Too.” Our guest's disclosures will be linked in the transcript. Ricky, welcome to our podcast and thank you so much for joining us. Dr. Ricky Leiter: Thanks so much for having me. I'm really excited to be here. Dr. Mikkael Sekeres: Ricky, I absolutely adored your essay. It really explored, I think, a combination of the vulnerability we have when we're trying to take care of a patient who's dying and the interesting badlands we're placed in when we're also a trainee and aren't quite sure of our own skills and how to approach difficult situations. But before we dive into the meat of this, can you tell us a little bit about yourself? Where are you from and where did you do your training? Dr. Ricky Leiter: Sure, yeah. Thanks so much. So I grew up in Toronto, Canada, and then moved down to the States for college. I was actually a history major, so I never thought I was going to go into medicine. And long story short, here I am. I did a Post-Bac, did a year of research, and ended up at Northwestern Feinberg School of Medicine for med school, where I did a joint degree in medical humanities and bioethics. And that really shaped my path towards palliative care because I found this field where I said, “You know, wow, I can use these skills I'm learning in my Master's at the bedside with patients thinking about life and death and serious illness and what does that all mean in the broader context of society.” So, moved from Chicago to New York for residency, where I did residency and chief residency in internal medicine at New York Presbyterian Cornell, and then came up to the Harvard Interprofessional Palliative Care Program, where I did a clinical fellowship, then a research fellowship with Dana-Farber, and have been on faculty here since. Dr. Mikkael Sekeres: Fantastic. Any thoughts about moving back to Canada? Dr. Ricky Leiter: We talk about it every now and then. I'm really happy here. My family's really happy here. We love life in Boston, so we're certainly here for the time being. Definitely. Dr. Mikkael Sekeres: And the weather's so similar. Dr. Ricky Leiter: Yeah, I'm used to the cold. Dr. Mikkael Sekeres: I apparently did not move to Miami. I'm curious, this may be an unfair question, as you have a really broad background in humanities and ethics. Are there one or two books that you read where you think, “Gee, I'm still applying these principles,” or, “This really still resonates with me in my day to day care of patients who have cancer diagnosis”? Dr. Ricky Leiter: Oh, wow, that is a great question. There are probably too many to list. I think one is When Breath Becomes Air by Paul Kalanithi, which I didn't read in my training, I read afterwards. And I think he's such a beautiful writer. The story is so poignant, and I just think Paul Kalanithi's insights into what it means to be living with a serious illness and then ultimately dying from cancer as a young man, as someone in medicine, has really left an imprint on me. Also, Arthur Kleinman. The Illness Narratives, I think, is such a big one, too. And similarly, Arthur Frank's work. I mean, just thinking about narrative and patient stories and how that impacts our clinical care, and also us as clinicians. Dr. Mikkael Sekeres: And I suspect us as writers also. Dr. Ricky Leiter: Absolutely. Dr. Mikkael Sekeres: We imprint on the books that were influential to us. Dr. Ricky Leiter: Certainly. Dr. Mikkael Sekeres: So how about your story as a writer? How long have you been writing narrative pieces? Is this something you came to later in your career, or did you catch the bug early as an undergrad or even younger? Dr. Ricky Leiter: So I caught it early, and then it went dormant for a little while and came back. As a history major, as someone who is humanities minded, I loved writing my papers in college. Like, I was one of those nerds who got, like, really, really excited about the history term paper I was writing. You know, it was difficult, but I was doing it, particularly at the last minute. But I really loved the writing process. Going through my medical training, I didn't have as much time as I wanted, and so writing was sort of on the back burner. And then actually in my research fellowship, we had a writing seminar, our department, and one of the sessions was on writing Op-eds and perspective pieces. And we had a free write session and I wrote something sort of related to my research at the time I was thinking about, and Joanne Wolfe, who was helping to lead the session, pediatric palliative care physician, she said, “You know, this is really great. Like, where are you going to publish this?” And I said, “Joanne, what do you mean? I just wrote this in this session as an exercise.” She said, “No, you should publish this.” And I did. And then the bug came right back and I thought, “Wow, this is something that I really enjoy and I can actually make a difference with it. You know, getting a message out, allowing people to think a little bit differently or more deeply about clinical cases, both in the lay press and in medical publications.: So I've essentially been doing it since and it's become a larger and larger part of my career. Dr. Mikkael Sekeres: That's absolutely wonderful, Ricky. Where is it that you publish then, outside of Art of Oncology? Dr. Ricky Leiter: So I've had a couple of pieces in the New York Times, which was really exciting. Some in STAT News on their opinion section called First Opinion, and had a few pieces in the New England Journal as well, and in the Palliative Care Literature, the Journal of Palliative Medicine. Dr. Mikkael Sekeres: Outstanding. And about palliative care issues and end of life issues, I assume? Dr. Ricky Leiter: Sort of all of the above. Palliative care, serious illness, being in medical training, I wrote a fair bit about what it was like to be on the front lines of the pandemic. Dr. Mikkael Sekeres: Yeah, that was a traumatic period of time, I think, for a lot of us. Dr. Ricky Leiter: Absolutely. Dr. Mikkael Sekeres: I'm curious about your writing process. What triggers a story and how do you face the dreaded blank page? Dr. Ricky Leiter: So it's hard to pin down exactly what triggers a story for me. I think sometimes I'm in a room and for whatever reason, there's a moment in the room and I say, “You know what? There's a story here. There's something about what's going on right now that I want to write.” And oftentimes I don't know what it is until I start writing. Maybe it's a moment or a scene and I start writing like, “What am I trying to say here? What's the message? And sometimes there isn't a deeper message. The story itself is so poignant or beautiful that I want to tell that story. Other times it's using that story. And the way I think about my writing is using small moments to ask bigger questions in medicine. So, like, what does it mean to have a good death? You know, one piece I wrote was I was thinking about that as I struggled to give someone what I hoped would be a good death, that I was thinking more broadly, what does this mean as we're thinking about the concept of a good death? Another piece I wrote was about a patient I cared for doing kidney palliative care. And she was such a character. We adored her so much and she was challenging and she would admit that. This was someone I wanted to write about. And I talked to her about it and she was honored to have her story told. Unfortunately, it came out shortly after her death. But she was such a vibrant personality. I said, “There's something here that I want to write about.” In terms of the blank page, I think it's overcoming that fear of writing and procrastination and all of that. I think I have a specific writing playlist that I put on that helps me, that I've listened to so many times. You know, no words, but I know the music and it really helps me get in the zone. And then I start writing. And I think it's one of those things where sometimes I'm like, “Oh, I really don't like how this is sounding, but I'm going to push through anyways.” as Anne Lamott's blank first draft, just to get something out there and then I can play with it and work with it. Dr. Mikkael Sekeres: Great. I love the association you have with music and getting those creative juices flowing and picking ‘le mot juste' in getting things down on a page. It's also fascinating how we sometimes forget the true privilege that we have as healthcare providers in the people we meet, the cross section of humanity and the personalities who can trigger these wonderful stories. Dr. Ricky Leiter: Absolutely. Absolutely. It's such a privilege and I think it often will go in unexpected directions and can really impact, for me certainly, my practice of medicine and how I approach the next patients or even patients years down the road. You remember those patients and those stories. Dr. Mikkael Sekeres: Right. You write with such obvious love and respect for your patients. You also write about that tenuous phase of our careers when we're not yet attendings but have finished residency and have demonstrated a modicum of competence. You know, I used to say that fellowship is really the worst of all worlds, right? As an attending, you have responsibility, but you don't have to do as much of the grunt work. As a resident, you do the grunt work, but you don't really have the responsibility. And in fellowship, you've got it all. You've got to do the grunt work, and you have the responsibility. Can you tie those two concepts together, though? How does our relationship to our patients change over the course of our careers? Dr. Ricky Leiter: Early on, if you think about the imprinting of patients as you go down the road, so many of the patients who have imprinted on me were the ones earlier in my career, before I was more formed as a clinician because of experiences like the one I wrote about in “I Hope so Too,” where the skills are forming, and sometimes where it's smooth sailing, and sometimes we're muddling through. And those cases where we feel like we're muddling through or things don't go as we hope, those are the ones that really leave an impact. And I think it's those little moments that sort of nudge your career and your skill set in different ways. I think the patients now, they still leave a mark on me, but I think it's in different ways. And I think oftentimes it's less about my skills. Although my skills are still very much developing, even, you know, almost a decade out, they impact me differently than they once did. I feel more confident in what I'm doing, and it's more about my relationship to this situation rather than the situation's impact on my skills. Dr. Mikkael Sekeres: Got it. Got it. It's interesting. I once wrote a piece with Tim Gilligan, who also spent some time at Dana Farber and is a communications expert, about how there's this kind of dualism in how we're trained. We're trained with communications courses and how to talk to patients, and it almost does the opposite. It kind of raises the flag that, “Wait a second, maybe I've been talking to people the wrong way.” And as you get more mature in your career, I almost feel as if you revert back to the way you were before medical school, when you just talked to people like they were people and didn't have a special voice for patients. Dr. Ricky Leiter: Yeah, I think that's right. And I think in palliative care, we spend so much time thinking about the communication. And this was the most challenging piece about fellowship because then- and our fellowship directors told this to us, and now we teach it to our fellows. You know that you come in, the people who choose to go into palliative care, have a love of communication, have some degree of skill coming in, and then what happens is we break those skills down and teach them a new skill set. So it gets clunkier before it gets better. And the time I was writing about in this piece was August of my fellowship year, exactly when that process was happening, where I'm trying to incorporate the new skills, I had my old way of doing things, and it's just not always aligning. And I think you're right that as the skills become embedded, as you go on throughout your career, where it feels much more natural, and then you do really connect with people as people still using the skills and the techniques that we've learned in our communication courses, but they become part of who you are as a clinician. Dr. Mikkael Sekeres: Nicely put. Your story is particularly poignant because the patient you described was dying from the very treatment that cured his leukemia. It's this, I'm going to use the term badlands again. It's this terrible badlands we sometimes find ourselves where, yes, the treatment has been successful, but at the cost of a human life. Do you think that as healthcare providers, we react differently when a patient is sick, from side effects to our recommendations, as opposed to sick from their disease? Dr. Ricky Leiter: I think we probably do. It's hard because I think every patient in every case pulls at us in different directions. And this case was Carlos, who I called him, it was such a challenging situation for so many reasons. He was young. He really couldn't communicate with us. We were talking to his mom. Like, there were so many layers to this. But I think you're right. that underlying this, there's a sense of “We did everything we could beautifully, to cure him of his disease, and now he's dying of that, and what does that mean for us as clinicians, physicians. That becomes really hard and hard to sit with and hold as we're going back every day. And I say that as the palliative care consultant. So I can only imagine for the oncology team caring for him, who had taken him through this, what that felt like. Dr. Mikkael Sekeres: Well, you describe, again, beautifully in the piece, how the nursing staff would approach you and were so relieved that you were there. And it was, you know, you got the sense- I mean, obviously, it's tragic because it's a young person who died, but you almost got the sense there was this guilt among the providers, right? Not only is it a young person dying, but dying from graft versus host disease, not from leukemia. Dr. Ricky Leiter: Absolutely. There was guilt because of what he was dying of, because of how he was dying that he was so uncomfortable and it took us so long to get his pain under control and we really couldn't get him that balance of pain control and alertness that we always strive for was pretty much impossible from the beginning. And so it was layer upon layer of distress and guilt and sadness and grief that we could just feel every day as we stepped onto the floor. Dr. Mikkael Sekeres: Yeah. I don't know if you've ever read- there's a biography of Henry Kaplan, who was considered the father of radiation therapy, where there was this incredible moment during his career when he presented at the AACR Annual Meeting the first cures for cancers, right? No one believed it. It was amazing, actually curing cancer. And then a couple years later, people started dribbling into his clinic with cancers because of the radiation therapy he gave, and he actually went into a clinical depression as a result of it. So it can affect providers at such a deep level. And I think there's this undiscussed guilt that permeates the staff when that happens. Dr. Ricky Leiter: Absolutely, absolutely. It's right there under the surface. And we rarely give ourselves the space to talk about it, right? To really sit down and say, how are we approaching this situation? How do we feel about it? And to sit with each other and acknowledge that this is horrible. It's a horrible situation. And we feel guilty and we feel sad and we feel grief about this. Dr. Mikkael Sekeres: It's been just terrific getting to know you and to read your piece, Ricky Leiternd, a we really appreciate your writing. Keep doing what you do. Dr. Ricky Leiter: Oh, thank you so much. It's a privilege to get the piece out there and particularly in JCO and to be here with you. So I really appreciate it. Dr. Mikkael Sekeres: Until next time, thank you for listening to JCO's Cancer Stories: The Art of Oncology. Don't forget to give us a rating or review and be sure to subscribe so you never miss an episode. You can find all of ASCO's shows at asco.org/podcasts.   The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.   Like, share and subscribe so you never miss an episode and leave a rating or review.  Guest Bio: Dr. Ricky Leiter is from the Dana-Farber Cancer Institute.

In this podcast, Dr. Tracy Anderson-Haag, Dr. Sandra Kane-Gill, and Dr. Andrew Webb discuss the AJHP Descriptive Report, “Moving forward from Cockcroft-Gault creatinine clearance to race-free estimated glomerular filtration rate to improve medication-related decision-making in adults across healthcare settings: A consensus of the National Kidney Foundation Workgroup for Implementation of Race-Free eGFR-Based Medication-Related Decisions,” with host and AJHP Editor in Chief Dr. Daniel Cobaugh. The information presented during the podcast reflects solely the opinions of the presenter. The information and materials are not, and are not intended as, a comprehensive source of drug information on this topic. The contents of the podcast have not been reviewed by ASHP, and should neither be interpreted as the official policies of ASHP, nor an endorsement of any product(s), nor should they be considered as a substitute for the professional judgment of the pharmacist or physician.

Darshan H. Brahmbhatt, Podcast Editor of JACC: Advances discusses a recently published original research paper on cardiac surgery-specific subtle perioperative serum creatinine change in defining acute kidney injury after coronary surgery.

Contributor: Kiersten Williams MD, Travis Barlock MD, Jeffrey Olson MS2 Show Pearls Hypertensive disorders of pregnancy are one of the leading causes of maternal mortality worldwide. Hypertension (HTN) complicates 2-8% of pregnancies The definition of HTN in pregnancy is a systolic >140 or diastolic >90, measured 4 hours apart There is a range of HTN disorders Chronic HTN which could have superimposed preeclampsia (preE) on top Gestational HTN in which there are no lab abnormalities PreE w/o severe features Protein in urine Urine protein >300 mg in 24 hours Urine Protein to Creatinine ratio of .3 +2 Protein on urine dipstick PreE w/ severe features Systolics above 160 mmHg Diastolics above 110 mmHg Headache, especially not going away with meds, or different than previous headaches Visual changes, anything that lasts more than a few minutes RUQ pain, which could present as heartburn Pulmonary edema Low platelets, if

AST, ALT, CPK, BUN, what do all of these mean and what should you expect as a bodybuilder? PLUS NPP in a cut? Testing GH with Lab work TIME STAMPS BELOW Muscle Minds - Dr Scott Stevenson & Scott McNally ✅ Get Private Lab Work Done Here : https://www.privatemdlabs.com/?refid=ddh4nap7 ✅ Amino Asylum code THINK for 20% off research chems, peptides, l-carnitine and more https://aminoasylum.shop/ref/122/ 0:00 intro 1:30 Lab work as a bodybuilder 3:00 AST & ALT 8:40 CPK 11:30 BUN 12:35 Creatinine 17:00 Cystatin C 18:50 High Protein diet & Kidneys 26:00 What causes kidney problems in bodybuilding? 36:30 NPP in a Cut? 44:30 Using blood work to check GH quality 53:00 SubQ shots for cycles 1:03:40 Not growing on current diet

N Engl J Med 2013;369:999-1010Background: Adding P2Y12 inhibitors to aspirin improves outcomes in patients with acute coronary syndrome. Yet, debate persisted regarding the optimal timing for administering these drugs in patients undergoing percutaneous coronary intervention (PCI). The ATLANTIC trial showed that pre-hospital administration of ticagrelor did not improve outcomes compared to in-hospital administration, in patients with ST elevation myocardial infarction.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.The ACCOAST trial sought to test the hypothesis that administering the P2Y12 inhibitor, prasugrel, 2-48 hours before angiography in non-ST elevation myocardial infarction patients is superior to administering it during PCI.Patients: Patients were enrolled if they had non-ST elevation myocardial infarction. Patients were scheduled to undergo angiography with possible PCI within 2-48 hours after randomization. Patients were excluded if they had cardiogenic shock, refractory ventricular arrhythmias, prior hemorrhagic or ischemic stroke or TIA, history of intracranial neoplasms, history of intracranial AV malformations or aneurysm, surgery within 4 weeks, active bleeding or history of bleeding diathesis or had high risk of bleeding based on the judgement of the investigator.Baseline characteristics: The average age of patients was 64 years with 72% being men. The average weight was 82 kg. About 20% had diabetes, 45% had hyperlipidemia, 62% had hypertension and 33% were current smokers. Creatinine clearance was ≤ 30 ml/min in 3% of the patients and GRACE score was < 140 in 77% of them. Beta-blockers were given in 84% of the patients, statins in 90%, angiotensin-receptor blockers in 13% and ACE inhibitors in 70%.After randomization, 68.7% of the patients underwent PCI while 25.1% were treated medically. CABG within 7 days was performed in 6.2% of the patients.Procedures: Patients were randomized 1:1 to receive pretreatment with prasugrel or matching placebo (control group). Those in the pretreatment group received a 30 mg loading dose of prasugrel before coronary angiography with an additional 30 mg if angiography confirmed the need for PCI. Patients in the control group received placebo before coronary angiography and a 60 mg loading dose of prasugrel in patients undergoing PCI. Only the initial 30 mg loading dose of prasugrel or placebo were administered, if a decision, after coronary angiography, was made to pursue CABG or medical therapy.Endpoints: The primary efficacy end point was a composite endpoint of death from cardiovascular causes, myocardial infarction, stroke, urgent revascularization, or the need for rescue therapy with glycoprotein IIb/IIIa inhibitors. Follow up for the primary endpoint was 7 days post randomization. Secondary endpoints included death from any cause, stent thrombosis and a composite endpoint of death from cardiovascular causes, myocardial infarction, or stroke.Safety end points were major or minor bleeding according to Thrombolysis in Myocardial Infarction (TIMI) criteria.Statistical analysis was performed on the intention-to-treat principle. To achieve 80% power with two-sided alpha of 0.05 for detecting 24% relative risk reduction in the pretreatment compared to the control group, 400 patients with the primary outcome and approximately 4,100 enrolled patients would be needed.Results: The trial randomized 2,037 patients to the pre-treatment group and 1,996 to the control group. The median time from the initial loading dose to PCI was 4.3 hours.The incidence of the composite primary end point was similar between both treatment groups (10.0% in the pre-treatment group vs 9.8% in the control group, HR: 1.02, 95% CI: 0.84 – 1.25; p= 0.81). There was no significant difference between both treatment groups in any of the components of the primary end point, death from any cause, or stent thrombosis. Results were similar for patients who underwent PCI (about two thirds of study participants).There were more major bleeding events at 7 days in the pretreatment group (2.6% vs 1.4%, HR: 1.90, 95%: 1.19 – 3.02; p= 0.006). Major bleeding events not related to CABG were also higher in the pre-treatment group (1.3% vs 0.5%; p= 0.003). In the PCI cohort, 12 patients in the pre-treatment group had life-threatening bleeding compared to 2 in the control group. Most bleedings in this cohort were access site bleeding, pericardial bleeding and retroperitoneal bleeding.Subgroup analysis for the primary efficacy endpoint did not identify any subgroup who would benefit from pre-treatment with prasugrel.Conclusion: In patients with non-ST elevation myocardial infarction undergoing coronary angiography within 48 hours of admission, pre-treatment with prasugrel did not improve ischemic events and resulted in more major bleeding.The results of this trial led to the recommendation that prasugrel should be used after coronary anatomy is defined and PCI is chosen as the treatment strategy. This approach will reduce the risk of bleeding complications without increasing the risk of ischemic events.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber. Get full access to Cardiology Trial's Substack at cardiologytrials.substack.com/subscribe

Younger generations are facing higher cancer risk due to accelerated biologic aging, new study finds. Support your Intermittent Fasting lifestyle with the Berberine Fasting Accelerator by MYOXCIENCE: bit.ly/berberine-fasting-accelerator Use code podcast at checkout to save Link to Show Notes: https://bit.ly/3UUQVvb Key Timestamps: 0:00 Intro 0:07 The rise in cancer 1:13 Cancer and Biologic aging 1:47 High profile cancer case in young people 2:12 Biomarkers that predict cancer 2:49 Berberine for food cravings 3:49 New Study 5:02 Low Albumin 6:00 Creatinine 7:04 Glucose 8:16 MCV and MCH 8:50 Inflammation and high WBC 11:11 Preventing cancer 12:30 Metabolic Health        

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Contributor: Ricky Dhaliwal, MD Educational Pearls: What are DKA and HHS? DKA (Diabetic Ketoacidosis) and HHS (Hyperosmolar Hyperglycemic State) are both acute hyperglycemic states. DKA More common in type 1 diabetes. Triggered by decreased circulating insulin. The body needs energy but cannot use glucose because it can't get it into the cells. This leads to increased metabolism of free fatty acids and the increased production of ketones. The buildup of ketones causes acidosis. The kidneys attempt to compensate for the acidosis by increasing diuresis. These patients present as dry and altered, with sweet-smelling breath and Kussmaul (fast and deep) respirations. HSS More common in type 2 diabetes. In this condition there is still enough circulating insulin to avoid the breakdown of fats for energy but not enough insulin to prevent hyperglycemia. Serum glucose levels are very high – around 600 to 1200 mg/dl. Also presents similarly to DKA with the patient being dry and altered. Important labs to monitor Serum glucose Potassium Phosphorus Magnesium Anion gap (Na - Cl - HCO3) Renal function (Creatinine and BUN) ABG/VBG for pH Urinalysis and urine ketones by dipstick Treatment Identify the cause, i.e. Has the patient stopped taking their insulin? Aggressive hydration with isotonic fluids. Normal Saline (NS) vs Lactated Ringers (LR)? LR might resolve the DKA/HHS faster with less risk of hypernatremia. Should you bolus with insulin? No, just start a drip. 0.1-0.14 units per kg of insulin. Make sure you have your potassium back before starting insulin as the insulin can shift the potassium into the cells and lead to dangerous hypokalemia. Should you treat hyponatremia? Make sure to correct for hyperglycemia before treating. This artificially depresses the sodium. Should you give bicarb? Replace if the pH < 6.9. Otherwise, it won't do anything to help. Don't intubate, if the patient is breathing fast it is because they are compensating for their acidosis. References Andrade-Castellanos, C. A., Colunga-Lozano, L. E., Delgado-Figueroa, N., & Gonzalez-Padilla, D. A. (2016). Subcutaneous rapid-acting insulin analogues for diabetic ketoacidosis. The Cochrane database of systematic reviews, 2016(1), CD011281. https://doi.org/10.1002/14651858.CD011281.pub2 Chaithongdi, N., Subauste, J. S., Koch, C. A., & Geraci, S. A. (2011). Diagnosis and management of hyperglycemic emergencies. Hormones (Athens, Greece), 10(4), 250–260. https://doi.org/10.14310/horm.2002.1316 Dhatariya, K. K., Glaser, N. S., Codner, E., & Umpierrez, G. E. (2020). Diabetic ketoacidosis. Nature reviews. Disease primers, 6(1), 40. https://doi.org/10.1038/s41572-020-0165-1 Duhon, B., Attridge, R. L., Franco-Martinez, A. C., Maxwell, P. R., & Hughes, D. W. (2013). Intravenous sodium bicarbonate therapy in severely acidotic diabetic ketoacidosis. The Annals of pharmacotherapy, 47(7-8), 970–975. https://doi.org/10.1345/aph.1S014 Modi, A., Agrawal, A., & Morgan, F. (2017). Euglycemic Diabetic Ketoacidosis: A Review. Current diabetes reviews, 13(3), 315–321. https://doi.org/10.2174/1573399812666160421121307 Self, W. H., Evans, C. S., Jenkins, C. A., Brown, R. M., Casey, J. D., Collins, S. P., Coston, T. D., Felbinger, M., Flemmons, L. N., Hellervik, S. M., Lindsell, C. J., Liu, D., McCoin, N. S., Niswender, K. D., Slovis, C. M., Stollings, J. L., Wang, L., Rice, T. W., Semler, M. W., & Pragmatic Critical Care Research Group (2020). Clinical Effects of Balanced Crystalloids vs Saline in Adults With Diabetic Ketoacidosis: A Subgroup Analysis of Cluster Randomized Clinical Trials. JAMA network open, 3(11), e2024596. https://doi.org/10.1001/jamanetworkopen.2020.24596 Summarized by Jeffrey Olson MS2 | Edited by Meg Joyce & Jorge Chalit, OMSII

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Episode 157: Urine TestingThis episode includes the pitfalls of urine tests, how to detect adulterated urine, and more.  Written by Janelli Mendoza, MSIV, Ross University School of Medicine. Editing by Hector Arreaza, MD. Comments by Carol Avila, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Introduction: Urine drug screenings are valuable tools used every day by physicians to monitor illicit substance use, as well as proper use or misuse of prescription drugs. However, studies suggest that physicians using “clinical judgment” on who and when to test is often wrong and confounded by implicit racial bias. The implications of this are an inappropriate discontinuation of treatment.For example, a study by Gaither, Gordon, and Crystal et. al found that compared to white patients, black patients were 10% more likely to undergo urine drug screening. In addition, they were 2-3 times more likely to have long-term opioid medication abruptly discontinued as a result of a UTOX positive for marijuana.False positive urine tests:Before getting into the current guidelines, let's discuss the interpretation of Urine Drug Screenings. It's important to be aware of prescription drugs that may cause false positives:· Bupropion, labetalol, pseudoephedrine, trazodone → Amphetamines· HIV antivirals, sertraline → Benzodiazepines· HIV antivirals, NSAIDs, PPI's → Cannabinoids· Diphenhydramine, Naloxone, Quetiapine, Quinolones, Verapamil → Opioids· Dextromethorphan, diphenhydramine, ibuprofen, tramadol, venlafaxine → PhencyclidineTampering of urine: Other factors to consider are the tampering of collected urine. The tampering of collected urine may include diluting the urine, or adding other chemicals and substances. Laboratory results that should prompt consideration of adulteration are: Creatinine

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Dr. Morgan Grams provides an overview of the findings of her study, "Discrepancies between Cystatin C–Based and Creatinine-Based Estimated Glomerular Filtration Rates," on behalf of her colleagues.

In my recent interview with 'Carnivore Diet Amy', her transformative journey with the carnivore diet was unveiled. Having been on the diet for a year, Amy attributes her miraculous recovery from Stage 3 kidney disease primarily to a regimen of ribeye steaks and fasting methods inspired by Jason Fung. Originally, her eGFR was alarmingly at 46 - a level dangerously close to necessitating dialysis. However, with her strict meat and animal fat diet, it shot up to an impressive 84. Furthermore, Amy saw her Creatinine levels reduce from 1.36 to just 0.83.However, Amy's journey wasn't without its setbacks. When she reverted to her previous eating habits, not only did she regain weight, but she also added an additional 30 pounds. This frightening experience prompted her to firmly adopt the carnivore diet on August 1st, 2022. Within a year, she shed an astonishing 60 pounds. Amy refers to the carnivore diet as a literal life-saver, resorting to it for reasons she described as 'life and death'. To emphasize the dire state she was in before starting the diet, she revealed that her doctor had bleakly assessed her kidneys as being irreparably damaged, likening her bloodwork to that of a nonagenarian (someone of 90 years old)Amy's motto: NOT PERFECTION JUST PROGRESShttps://www.instagram.com/_carnivore_diet_biohacker/https://www.facebook.com/profile.php?id=100091976945667Thank you so much for listening to my podcast. I hope you enjoyed it. Your support means the absolute world to me. And if you're enjoying the show, I've got a small favor to ask you. I'd be incredibly grateful if you would consider becoming a supporter and make a small monthly donation. Your contribution will really help to improve the show. It's a small monthly contribution. You can cancel at any time, and the link is in the show notes. Support the showAll my links in 1 easy list, including booking and personal training workout plans at LINKTREE You can now download the carnivore experience appApple direct link for apple devices Google play store direct link to app for Android Coach Stephen's Instagram Book me for coaching My growing UK carnivore YouTube channel I have set up a community that is all about eating low-carb and specifically carnivore. CLICK HERE Support my podcast from just £3 per monthBECOME A SUPPORTER Success stories Optimal Health 5 Star reviews All my facebook and other reviews are here Thanks to www.audionautix.com for any music included. Ple...

Welcome to the NSP Nutrition Show - Episode 95

Please Subscribe and Review: Apple Podcasts | RSS Submit your questions for the podcast here News Topic:   Type 1 diabetes and low carbohydrate diets—Defining the degree of nutritional ketosis Show Notes: Association of Immune Thrombocytopenia and Celiac Disease in Children: A Retrospective Case Control Study Questions:    Diet and Digestion Andrew writes: Hi Robb! I'm loving the podcast! Just started listening and got your information from the lady who started the Debug Your Health blog which goes over diet and parasite elimination. She recommended for diet just doing grass fed meat and veggies. I did that for a few days but had severe leg cramps and sleep disturbances. Also, I've been constipated for awhile now and just can't seem to find the right diet for addressing this issue. I will go to the bathroom once every three days and my gut just doesn't feel right whatsoever. Also, I have A- blood type so I should be having more frequent bowel movements but that is not the case. I am only 21 years old and want to live my life. My suspicion is that it may be related to parasites, heavy metals, and maybe nutritional deficiencies. Any suggestions on how to get rid of this constipation with diet, parasite cleansing, or even enemas? Keep up the great work and I am excited to hear your response!   Immune thrombocytopenia ITP Allen writes: Hello, My wife has an immune system disorder called Immune thrombocytopenia ITP. It is triggered by pregnancy. Her platelet count drops, which means she is at greater risk for hemorrhaging. The underlying cause of ITP is unknown according to our doctors and what I've read. For her first pregnancy, the doctors prescribed two treatments to ameliorate the platelet count: prednisone and IVG (this is standard treatment AFAICT) but these treatments had minimal/no effect. As the disease is evidently related to immune system health, I wondered if there are any dietary or environmental things we might look at which could help. Any advice getting pointed in the right direction would be much appreciated. Thank you!   eGFR results while on a high protein diet Richard writes:  I went to the doctor for a full feeling in my throat that was affecting my voice. Nothing was found but some of the bloodwork results have me a little worried.Creatinine 1.3, Total bilirubin 2.1, GFR 60. Should I be concerned with high meat intake? I follow a ketovore diet that averages less than 20g of carbs per day. Protein falls between 150 and 250 per day. The day of the test I had about a pound of meat for breakfast 6:00AM and nothing else before the bloodwork at 2:00PM. The doctor didn't express any concern over the results but a GFR of 60 is kidney disease according to all the charts on the web. I'm going to get retested but I'm wondering if my diet makes these tests unreliable. How would you prepare for the second test to insure that the results are accurate?   Sponsor: The Healthy Rebellion Radio is sponsored by our electrolyte company, LMNT. Proper hydration is more than just drinking water. You need electrolytes too! Check out The Healthy Rebellion Radio sponsor LMNT for grab-and-go electrolyte packets to keep you at your peak! They give you all the electrolytes want, none of the stuff you don't. Click here to get your LMNT electrolytes Transcript: Coming soon at Robbwolf.com

Serum creatinine is an indicator of lean body mass and muscle quality, new studies find. Sponsored: Support your Workout Sessions and Healthy Hydration with this Creatine Electrolyte Combo by MYOXCIENCE Save 12% with code podcast at checkout Links to Studies, Images and Video: https://bit.ly/44D6Kce Time Stamps: 00:00 Creatinine is independently associated with lean body mass, muscle strength, and muscle quality. 00:25 Serum creatinine is a marker of impaired kidney function. 00:40 Creatinine is a normal waste product of muscle metabolism. 00:50 Levels can be impacted by declining kidney function, inflammation, and blood pressure reduction medications. 01:00 Concentrations are impacted by age, sex, and body size. 01:30 Average muscle protein per kilo of body weight was higher in omnivores. 02:10 Serum creatinine is significantly lower in vegetarians. 03:00 There are statistically significant differences in hand grip strength between omnivores and vegetarians. 05:10 Creatinine levels over 1.4 mg/dl may be a marker of chronic kidney disease and poor kidney function. 06:00 Abnormal urinary creatinine to albumin ratio is a marker of kidney dysfunction. 07:05 Low serum creatinine can indicate acute illness, severe liver disease, loss of muscle mass, malnutrition, muscular dysfunction, dehydration, or sarcopenia. 07:30 Vegetarian diet, low body mass, and reduced strength are linked to low serum creatinine. 08:30 There is a correlation between quality of protein, quality of muscle tissue, and serum creatinine. 09:05 Omnivores have significantly greater dietary protein intake, serum creatinine levels, and grip strength. 09:45 Increasing protein above the RDA has beneficial effects on strength level in vegetarians.

Overview Creatinine Normal Value Range Pathophysiology Special considerations Elevations in creatinine Decreases in creatinine Nursing Points General Normal values 0.7 – 1.4 mg/dL Pathophysiology Muscle breakdown and use Creatine -> creatinine Released into bloodstream Filtered through kidneys Excreted in urine Creatinine more specific to kidney function Special considerations Green top Submitted with renal panels or chems Creatinine clearance Tests creatinine in urine Compare to serum creatinine 24 hour urine Toss first urine sample, then start On ice Increased creatinine values Renal disease Rhabdomyolysis Muscle breakdown Trauma Extreme workouts Congestive heart failure Dehydration Shock Decreased creatinine values Loss of muscle mass Muscular dystrophy Decreased protein intake Pregnancy Liver disease Assessment Assess patient's nutritional status Assess urine output Consider other causes for increase in creatinine Muscle Therapeutic Management Treat cause of renal insufficiency Dialysis vs medication Nursing Concepts Lab Values Elimination

Objective: Determine the significance and clinical use of measuring Creatinine Clearance in clinical practice   Lab Test Name: Creatinine Clearance – CrCl   Description: Healthy kidneys remove creatinine from the blood. It then passes out of your body through urine. Creatinine is created in the body as a byproduct from normal wear and tear on muscles and protein in your diet.   Creatinine Clearance is a test that compares the level of creatinine in the blood against the level in the urine and evaluates Glomerular Filtration Rate. Hydration, blood volume status, blood pressure, and the state of the glomeruli impact GFR.    Remember that GFR is the amount of blood cleaned each minute by tiny filters in your kidneys called glomeruli.   An increase in CrCl indicates an increase in GFR.   Indications: The creatinine clearance test is done when your healthcare provider thinks that the eGFR result given with your blood creatinine level may not be accurate. This would be in patients who have diabetes, those with HF, those with kidney disease, and is sometimes evaluated in those with hypertension. Kidney Function GFR Diabetes Heart Failure Hypertension   Normal Therapeutic Values: Normal – Creatinine clearance rates go down as you age Male: 97 to 137 mL/min  Female: 88 to 128 mL/min  For every decade after age 40, a normal test result is 6.5 mL/min less than the numbers above. Collection: Plasma separator tube for serum Urine is collected for 24 H in a plastic container First void is flushed Date and time recorded, and urine collected and stored at room temperature Processed once collection is complete   What would cause increased levels? Increased Creatinine Clearance→ Increased GFR Pregnancy- higher blood volume Large protein intake Exercise   What would cause decreased levels? The kidneys are solely responsible for removing Creatinine from the blood. If kidney function is declining, the creatinine level increases in the blood, but less creatinine is excreted into the urine. Decreased Creatinine Clearance→ Decreased GFR Abnormal kidney function Poor perfusion Dehydration Bladder obstruction Nephrotoxic medications

Maddy Conte and Seyma Yildirim introduce a new series on the podcast: “The Rafael Medina Subspecialty Series,” which will always be in loving memory of our dear friend and CPSolvers family member, Dr. Rafael Medina. Rafa presents a nephrology clinical unknown to Drs. Ashita Tolwani and Mustafa Muhammad. The goal of this series is to… Read More »Episode 286 – Rafael Medina Subspecialty Series – Elevated Creatinine

In this podcast, I dive deep into the creatinine blood test and its importance for kidney health. Learn about creatinine, how it's measured, its normal levels, and how it relates to kidney function. I also discuss additional tests you may need, what happens if you're diagnosed with kidney disease, and how to manage and prevent kidney problems. Plus, I touch on drugs and supplements that may interfere with creatinine blood tests. Let's explore everything you need to know about creatinine and what it means for your health!VISIT OUR STOREStore: https://www.selfelements.comFOLLOW USwww.selfprinciple.orgwww. youtube.com/selfprinciplewww.youtube.com/plantbasedkidneyhealthwww.instagram.com/seanhashmimd

The following question refers to Section 9.5 of the 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure.  The question is asked by Keck School of Medicine USC medical student & CardioNerds Intern Hirsh Elhence, answered first by Duke University cardiology fellow and CardioNerds FIT Ambassador Dr. Aman Kansal, and then by expert faculty Dr. Javed Butler. Dr. Butler is an advanced heart failure and transplant cardiologist, President of the Baylor Scott and White Research Institute, Senior Vice President for the Baylor Scott and White Health, and Distinguished Professor of Medicine at the University of Mississippi. The Decipher the Guidelines: 2022 AHA / ACC / HFSA Guideline for The Management of Heart Failure series was developed by the CardioNerds and created in collaboration with the American Heart Association and the Heart Failure Society of America. It was created by 30 trainees spanning college through advanced fellowship under the leadership of CardioNerds Cofounders Dr. Amit Goyal and Dr. Dan Ambinder, with mentorship from Dr. Anu Lala, Dr. Robert Mentz, and Dr. Nancy Sweitzer. We thank Dr. Judy Bezanson and Dr. Elliott Antman for tremendous guidance. Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. Question #14 Mrs. Hart is a 70-year-old woman hospitalized for a 2-week course of progressive exertional dyspnea, increasing peripheral edema, and mental status changes. She has a history of coronary artery disease, hypertension, and heart failure for which she takes aspirin, furosemide, carvedilol, lisinopril, and spironolactone. On physical exam, the patient is afebrile, BP is 80/60 mmHg, heart rate is 120 bpm, and respiratory rate is 28 breaths/min with O2 saturation of 92% breathing room air. She is sitting upright and is confused. Jugular venous pulsations are elevated. Cardiac exam reveals an S3 gallop. There is ascites and significant flank edema on abdominal exam. Her lower extremities have 2+ pitting edema to her knees and are cool to touch. Her labs are significant for an elevated serum Creatinine of 3.0 from a baseline of 1.0 mg/dL, lactate of 3.0 mmol/L, and liver enzyme elevation in the 300s U/L. Which of the following is the most appropriate initial treatment? A Increase carvedilol B Start dobutamine C Increase lisinopril D Start nitroprusside Answer #14 Explanation The Correct answer is B – start dobutamine. This patient with progressive congestive symptoms, mental status changes, and signs of hypoperfusion and end-organ dysfunction meets the clinical criteria of cardiogenic shock. The Class 1 recommendation is that in patients with cardiogenic shock, intravenous inotropic support should be used to maintain systemic perfusion and maintain end-organ performance (LOE B-NR). Their broad availability, ease of administration, and clinician familiarity favor such agents as first line when signs of hypoperfusion persist. Interestingly, despite their ubiquitous use for management of cardiogenic shock, there is a lack of robust evidence to suggest the clear benefit of one agent over another.  Therefore, the choice of a specific agent is guided by additional factors including vital signs, concurrent arrhythmias, and availability. For this patient, dobutamine is the only inotrope listed. Although she is tachycardic, her lack of arrhythmia makes dobutamine relatively lower risk and does not outweigh the potential benefits. Choice A – Increase carvedilol – is not correct. Beta-blockers should be continued in HF hospitalization whenever possible; however, in a patient with low cardiac output and signs of shock, beta-blockers should be discontinued due to their negative inotropic effects. Choice C – Increase lisinopril – is not correct. Afterload reduction is reasonable to decrease myocardial oxygen demand. However, given the hypotension and renal dysfunction, increasing lisinopril could be potentially dangerous by fur...

LISTENER QUESTION EPISODE Q: "What's the difference between BUN and Creatinine, and do I need to pay more attention to one or the other with PKD, or with my diet?" A: Listen and Learn the PKD Dietitian's answer! RESOURCES: GFR Calculator Master Your Labs For PKD HAVE A QUESTION? Submit your question or topic request to the PKD Dietititian

We take a Pre-operative study from the Annals of Surgery and talk about perioperative risk management for patients with low serum creatinine.

 February 10, 2023Mark, Ray, and Scott discuss questions and current topics."Good afternoon,Our practice has a lot of mid-level physicians.  The question has arose about “direct'  supervision and provider being immediately available.   I provided the below-How does Medicare define direct physician supervision?Direct supervision: The physician or AP providing supervision must be “immediately available” and “interruptible” to provide assistance and direction throughout the performance of the procedure; however, he or she does not need to be present in the room when the procedure is performed.One of the mid levels shared this:  In the office but not immediately available.  Remind physicians that they should not perform procedures while supervising incident-to visits.  The supervising physician must be able to drop what they are doing right away, even if the physician is performing a relatively simple procedure such as a trigger point injections, that would break the requirement that the physician be ready if the non-physician practitioner needs help or guidance.Now I am getting all kinds of questions.The rule above is only pertaining to “incident to” situations correct?  if the APP is listing a supervising provider for the day for insurance purposes only: such as the insurances that don't recognize /credential mid-levels (UHC for instance) would/should you follow the same rule as above?  How are other practices handling this?Hello  *Independent Interpretation of test*If we own the CT and US machines can our providers still get credit for interpreting films done in our office? We do bill these studies global once the radiologists does his reading.Our office has purchased equipment to start doing creatinine tests (82565) on contrast CT patients in the office.  Is this billable? And what codes would we bill?  What are the documentation requirements?If I bill only for CPT 51798 and 51741. Can only the MA /technician being the signer or does it need to be MD as a billing provider.Thank you! Purchase the PRS Urology Documentation, Coding, and Billing Plan and start implementing it today!Pricing and More Information The Thriving Urology Practice Facebook Grouphttps://www.facebook.com/groups/ThrivingPracticeDr. John Lin's interview with Dr. Sarabeth Martin https://youtu.be/_N2NfWBiAqA Urology Advanced Coding and Reimbursement Seminar  - Registration OpenNew Orleans, LA - January 27-28, 2023Register Now Please submit scenarios you would like us to cover to info@prsnetwork.comJoin the discussion:Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom.Click Here to Start Your Free Trial of AUACodingToday.com 

Get a free nursing lab values cheat sheet at NURSING.com/63labs   What is the Lab Name for Creatinine (Cr) Lab Values? Magnesium   What is the Lab Abbreviation for Creatinine? Mg   What is Creatinine in terms of Nursing Labs? Magnesium (Mg) is a cation necessary for protein synthesis, nucleic acid synthesis, muscle contraction, ATP (adenosine triphosphate) use, nerve impulse conduction, and blood clotting. Magnesium affects the absorption of sodium, calcium, phosphorus, potassium.   What is the Normal Range for Magnesium? 1.6 - 2.6mg/dL   What are the Indications for Magnesium? Monitor: Renal failure Chronic alcoholism Cardiac arrhythmias   What would cause Increased Levels of Magnesium? Renal insufficiency Uncontrolled Diabetes Mellitus (DM) Addison Disease Dehydration Hypothyroidism Overuse of antacids Tissue trauma   What would cause Decreased Levels of Magnesium? Alcoholism Diabetic acidosis Renal failure: Glomerulonephritis Hypercalcemia Malnutrition Malabsorption Hypoparathyroidism Diarrhea

In this episode, I discuss the importance and limitations of Serum creatinine and creatinine clearance for renal function assessment.

What exactly is creatinine and how is it related to kidney health? What kind of dietary changes are needed to manage kidney problems?

In this episode, Jill Blumenthal, MD, MAS, and Jennifer Cocohoba, PharmD, share how they manage possible antiretroviral (ARV)-associated toxicities in transgender individuals, including:Strategies on how to approach different ARV-related toxicitiesOther factors to consider when assessing possible ARV-related toxicities (eg, weight gain, cardiovascular disease), such as gender-affirming care and nonmedication risk factors (eg, smoking, life stressors)Clinically relevant drug–drug interactions related to HIV and gender-affirming careMethods to reduce barriers to ART adherenceFaculty: Jill Blumenthal, MD, MASAssociate Professor of MedicineInfectious Diseases and Global Public HealthUniversity of California, San DiegoSan Diego, CaliforniaJennifer Cocohoba, PharmDProfessorDepartment of Clinical PharmacyUniversity of California, San FranciscoPharmacistWomen's HIV ProgramUniversity of California San Francisco Medical CenterSan Francisco, CaliforniaLink to full program:https://bit.ly/3PM3nYeFollow along with the slides at:https://bit.ly/3NpAYI1

Listen to Sara Choi gave her presentation of "The use of urine sodium to creatinine ratio as a marker of total body sodium in infants with intestinal failure" at the first ever Best of the Best in Pediatric Surgery event.

Get a free nursing lab values cheat sheet at NURSING.com/63labs   Objective: Determine the significance and clinical use of measuring Creatinine Clearance in clinical practice   Lab Test Name: Creatinine Clearance – CrCl   Description: Healthy kidneys remove creatinine from the blood. It then passes out of your body through urine. Creatinine is created in the body as a byproduct from normal wear and tear on muscles and protein in your diet. Creatinine Clearance is a test that compares the level of creatinine in the blood against the level in the urine and evaluates Glomerular Filtration Rate. Hydration, blood volume status, blood pressure, and the state of the glomeruli impact GFR.  Remember that GFR is the amount of blood cleaned each minute by tiny filters in your kidneys called glomeruli. An increase in CrCl indicates an increase in GFR.   Indications: The creatinine clearance test is done when your healthcare provider thinks that the eGFR result given with your blood creatinine level may not be accurate. This would be in patients who have diabetes, those with HF, those with kidney disease, and is sometimes evaluated in those with hypertension. Kidney Function GFR Diabetes Heart Failure Hypertension   Normal Therapeutic Values: Normal – Creatinine clearance rates go down as you age Male: 97 to 137 mL/min  Female: 88 to 128 mL/min  For every decade after age 40, a normal test result is 6.5 mL/min less than the numbers above. Collection: Plasma separator tube for serum Urine is collected for 24 H in a plastic container First void is flushed Date and time recorded, and urine collected and stored at room temperature Processed once collection is complete   What would cause increased levels? Increased Creatinine Clearance→ Increased GFR Pregnancy- higher blood volume Large protein intake Exercise   What would cause decreased levels? The kidneys are solely responsible for removing Creatinine from the blood. If kidney function is declining, the creatinine level increases in the blood, but less creatinine is excreted into the urine. Decreased Creatinine Clearance→ Decreased GFR Abnormal kidney function Poor perfusion Dehydration Bladder obstruction Nephrotoxic medications

Get a free nursing lab values cheat sheet at NURSING.com/63labs   What is the Lab Name for Creatinine (Cr) Lab Values? Creatinine   What is the Lab Abbreviation for Creatinine? Cr   What is Creatinine in terms of Nursing Labs? Creatinine (Cr) is a byproduct of creatine metabolism, and it is excreted by the kidneys. Creatinine is created in proportion to muscle mass and usually stays stable.   What is the Normal Range for Creatinine? 0.7-1.4 mg/dL   What are the Indications for Creatinine? Identify: Muscular disorders Renal disease   What would cause Increased Levels of Creatinine? Gigantism Acromegaly Renal disease Rhabdomyolysis Congestive Heart Failure (CHF) Dehydration Shock Hyperparathyroidism   What would cause Decreased Levels of Creatinine? Loss of muscle mass Muscular Dystrophy Inadequate protein intake Pregnancy Liver disease

This episode is also available as a blog post: https://gailraegarwood.wordpress.com/2017/05/08/recreating-creatinine/

Welcome to PICU Doc On Call, a podcast dedicated to current and aspiring intensivists. I am Pradip Kamat. I am Rahul Damania, a current 3rd year pediatric critical care fellow. I am Kate Phelps- a second year pediatric critical care medicine. We come to you from Children's Healthcare of Atlanta Emory University School of Medicine. We are delighted to be joined by guest expert Dr Stephanie Jernigan Assistant Professor of Pediatric-Pediatric nephrology, Medical Director of the Pediatric Dialysis Program at Children's Healthcare of Atlanta. She is the Chief of Medicine and Campus Medical Director at Children's Healthcare of Atlanta, Egleston Campus. Her research interests include chronic kidney disease, and dialysis. She is on twitter @stephaniejern13 I will turn it over to Rahul to start with our patient case... A 3 year old previously healthy male presents with periorbital edema. Patient was initially seen by a pediatrician who prescribed anti-histamines for allergy. After no improvement in the eye swelling after a two week anti-histamine course, the patient was given a short course of steroids, which also did not improve his periorbital edema. The patient progressed to having abdominal distention and was prescribed miralax for constipation. Grandparents subsequently noticed worsening edema in his face, eyes, and feet. The patient subsequently had low urine output, low appetite and lack of energy patient was subsequently brought to an ED and labs were obtained. Grandparents denied any illness prior to presentation, fever, congestion, sore throat, cough, nausea, vomiting, gross hematuria, or diarrhea. In ED patient was noted to be hypertensive (Average systolic 135-highest 159mm HG), tachycardic (HR 130s-140s), breathing ~20-30 times per minute on RA with SpO2 92%. Admission weight was recorded at 16.5Kg. Physical exam showed periorbital edema, edema of ankles, there was mild abdominal distention (no tenderness and no hepatosplenomegaly), heart and lung exams were normal. There were no rashes on extremities. Labs at the time of transfer to the PICU: WBC 10 (62% neutrophils, 26% lymphocytes) Hgb 7.2, Hct 21, Platelets 276. BMP: Na 142/K 8.4/Cl 102/HCO3 19/BUN 173/creatinine 5.8. Serum phosphorus was 10.5, Total Ca 6.4 (ionized Ca= 3.4), Mag 2.0, albumin 2.6, AST/ALT were normal. An urine analysis showed: 1015, ph 7.5, urine protein 300 and rest negative. Chest radiograph revealed small bilateral pleural effusions. After initial stabilization of his hyperkalemia-patient was admitted to the PICU. PTH intact 295 (range 8.5-22pg/mL). Respiratory viral panel including for SARS-COV-2 was negative. C3 and C4 were normal. A nephrotic syndrome/FSGS genetic panel was sent. A renal US showed: bilateral echogenic kidneys and ascites (small volume). Pradip: Dr Phelps what are the salient features of the above case presented? Kate Phelps: This patient has a subacute illness characterized by edema, anemia, and proteinuria. His labs show that he has severe acute kidney injury with significantly elevated BUN and Creatinine, hyperkalemia, hyperphosphatemia, and hypocalemia. Rahul: Dr Jernigan welcome to PICU Doc on Call Podcast. Thanks Kate, Rahul and Pradip for inviting me to your podcast. This is a such a great way to provide education and it is my pleasure to come today to speak about one of my favorite topics, pediatric dialysis. I have no financial disclosures or conflicts of interest and am ready to get started. Rahul: Dr Jernigan as you get that call from the ED and then subsequently from the PCCM docs, as a nephrologists whats going on in your mind ? When I get the call from the outside hospital my first job is to make sure the patient is safe and stable for transfer to a tertiary care center. This includes concern about airway, breathing and level of alertness. From a renal standpoint, I am worried about elevated blood pressure, electrolyte abnormalities, in this case primarily the hyperkalemia, and fluid...

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If you are in need of a kidney transplant, finding a living donor can sound scary and overwhelming. Where should you start and what's the best way to share your story with the world? In this episode, you will hear from transplant recipients who once stood in your shoes.   In this episode, we spoke with: Dorothy Muench, LCSW Dori Muench is a post-transplant social worker with the Abdominal Organ transplant department with Wake Forest Baptist Medical Center for the past 5 years. In this capacity, she works with numerous individuals who have received a kidney or pancreas transplant and works to provide concrete and emotional support. Before this, Dori worked in dialysis for close to 10 years and has seen and heard the effects people have while on dialysis. She works hard to advocate for people to be transplant and find living donors so they can decrease as much time on dialysis as possible. Dori lives in North Carolina with her husband, 2 daughters and golden retriever. Gisela Delgado At the age of 14, Gisela was rushed to the emergency room after having Coca Cola colored urine. It took 6 months of various testing to eventually be diagnosed with IgA Nephropathy via kidney biopsy. The doctors told her and her parents that there was no cure, no proven treatment and that this disease would likely lead to kidney failure in 20-25 years. This was very upsetting and also left the family with a lot of unanswered questions. At the age of 30, Gisela was then rushed to the emergency room with flu-like symptoms. The doctors flagged GFR and Creatinine levels. She was then put on a course of meds to help with Proteinuria and to treat high blood pressure. At the age of 38 Gisela reached end stage kidney failure requiring a kidney transplant. Luckily she was able to receive a pre-emptive transplant from a living donor (her brother). For those that do not know - a kidney transplant is still considered a type of treatment for kidney failure. Today Gisela is a huge advocate for living donation and volunteers with The IgA Nephropathy Foundation as their Director of Brand + Creative. She looks forward to being “in the room where it happens” as the foundation is working hard with several Pharmaceutical partners to not only finding treatment but a cure for IgA Nephropathy. Morgan Reid Morgan Reid joined the National Kidney Foundation as the Director of Transplant Policy & Strategy in November 2021. In this role, Morgan will implement strategies and help create policies that promote equitable access to quality kidney healthcare and transplantation. Before joining NKF, Morgan worked for two Organ Procurement Organizations and a well-known transplant center. She has a deep passion for improving organ donation and transplant processes. A dear college friend donated a kidney to Morgan on January 9, 2007, after several years of dealing with an IgA Nephropathy diagnosis with nearly two years on peritoneal dialysis. She will use her personal experience and professional expertise to advocate for underserved communities that face barriers to kidney transplantation.   Additional resources: Information on living donation Looking for a living donor Kidney Donation: How to Make the Ask The Top 3 Reasons People Are Afraid to Ask for a Kidney—and How to Overcome Them 5 Ways To Inspire Living Kidney Donation Living Donation: Sample Letter to Family and Friends Episode transcript   Do you have comments, questions, or suggestions? Email us at NKFpodcast@kidney.org. Also, make sure to rate and review us wherever you listen to podcasts!

In todays episode Dr. Chris Hardy will be going over the top 3 pre-workout supplements he believes would be the most beneficial for the bjj practioner and the reasons behind that. They are: Creatinine, Beta Alanine, and Sodium Bicarbonate. Hey, if you have any questions for Dr. Chris or Bill and Olivia. Just email GrapplingWithPodcast@gmail.com or message the social media pages. Check us out on our social and YouTube where we have full episodes. Instagram: @GrapplingWithPodcastFacebook: www.facebook.com/GrapplingWithPodcast YouTube: https://www.youtube.com/c/GrapplingWithPodcastDr. Hardy is a licensed physician and BJJ practitioner, but the contents of the podcast are meant for educational purposes only, and should not be taken as medical advice. Please seek out personalized care from your own medical provider prior to implementing any medical treatment or intervention. 

On this episode of This Thing Called Life Podcast, host Andi  is going to talk to Mr. Idris Gray, who will share his experience about kidney donation. Mr. Idris is extremely resilient, and he had some health challenges throughout his life, but he always maintained, “I can do it, don't quit, push forward attitude.” Tune in now for his story.   Episode Highlights:  Idris used to play football but didn't maintain his lifestyle. Due to poor eating habits, family history, and sedentary lifestyle at the age of 16 he was diagnosed with type 2 diabetes. At the age of 27, something wasn't right about Idris's body. One day at home, coming back from the office, he collapsed on the couch. The doctor at the hospital told him that he needed to control his diabetes and get more rest because he had acute kidney failure. The doctor told Idris that if he didn't receive a kidney in two years, he would start dialysis, and he was right. Idris experienced other health conditions like diabetic retinopathy, which rendered him blind for three months. He was blessed to have surgery on his left eye, but his right eye is still gone. Idris also has a diabetic condition called diabetic circles, which is a deterioration of the midfoot joining the right foot. In July 2013, Idris received a phone call from the kidney and pancreas transplant department at UC, and they asked if  he was ready for kidney transplant. This donation and transplantation journey isn't like a linear path. Idris explains. Many times, the more we ignore the symptoms, the diseases grow into a bigger monster than they could have been before. Idris's keypoint to share is prevention over intervention because you are going to have to deal with it, but you have a chance to stop it from forming complications.  It took about a month and a half for Idris to recover from immune suppression and anti-rejection medications because those medications are extremely strong.  We live in one of the wealthiest countries in the world, and people should not have to choose what they can pay for when it comes to medications that will keep them healthy. Creatinine is crucial in your body, created by the kidneys, and the higher the creatinine levels, the more prone that your kidney is to go through failure. Creatinine level 1,1.2, or 1.3 is a good range for kidney patients, but Idris' level was about 3.4. In November 2019, Idris again started experiencing the major symptoms like itching of the skin, fatigue, swelling, and he started outpatient dialysis in March 2020, in the middle of the pandemic. There are certain blood tests you have to do, and you have to go through orientation, and there is a whole different process that you have to do just to become a candidate for another transplant. As humans, we tend to try to put our best foot forward for people to see, and when we are candid about certain things, it gives other people strength to be candid as well.  Idris had parathyroid surgery, and many people don't understand what parathyroids do, but it controls certain hormones in your body, including your calcium. Idris follows the law of divine oneness too. Everything is connected to everything elsewhere, and the same feeling and belief have a corresponding effect on others and the universe around us. Your health is wealth. If you are not feeling well or ever exhibiting any of the symptoms, please go and get tested. 3 Key Points: People tend to ignore symptoms that they are experiencing. In Idris's situation, he ignored it out of fear and thinking that he didn't have time for his health.   Idris explains the process that one has to go through for a second kidney transplant. Your health is wealth. Idris often looks at other people's situations and says, you know what, mine is not that bad. He knows he has to move on, and be an advocate for other people.  Resources Mentioned: LifeCenter | Website | Facebook | Instagram | YouTube|  Twitter Andi Johnson  website |LinkedIn  Organ Donation Website nkf.org

KFLS - Talkshow From Home Non-Nakes Tanggal 2 Maret 2022 at Zoom, 13:00 - 14:00 WIB Tema : Ask Me Anything N-49 Guest Star : Arip Putra - Warrior KF 5 Bulan Link tentang Creatinine: https://www.kidney.org/atoz/content/what-creatinine Ending Music: Music : Roa - One Day Watch : https://youtu.be/MEhqMwZUyI0 Stream / Download : https://hypeddit.com/roamusic/oneday License : https://roa-music.com

Welcome to Hot Takes with Keenan and Kyle! Join us on this journey of sports, interviews, bets, with two friends who have no idea what they're talking about! The Dorsal Daddies are back with another episode just before Playoff weekend! We have special guest Pauly with his Niners Corner. Got a Hot Take? Email us at Hottakesferda@gmail.com --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app

Dr. Martin answers questions sent in by our listeners. Some of today's topics include: Creatinine levels Uric acid & the kidneys Oxalates Alkalizing of urine Instant coffee vs brewed Scleroderma Birth control with estrogen Reducing bilirubin Thyroid nodules Benefits of pork Bile salts  

In this episode, we answer your questions! We are discussing how to decrease proteinuria, improve your creatinine, what is safe for alcohol, and more. If you have a question, email us and we will address it in one of our upcoming episodes. 

With each patient who comes through your pharmacy, you want to give them the quality of care they deserve. Knowing a patient's serum creatinine allows you to ensure your patient's kidneys are fully functioning and helps you evaluate treatment plans to provide the best care. In this week's conversation, Jake Galdo talks with Courtney Tigges, a Clinical Pharmacist at Towncrest Pharmacy and PGY-1 Resident at The University of Iowa about the importance of documenting your patient's serum creatinine to provide quality care in your pharmacy.HostJake Galdo, PharmD, MBA, BCPS, BCGPCourse Content and Developer, CEimpactClinical Pharmacist, Ross Bridge PharmacyCEO, Seguridad, IncGuest Courtney Tigges, PharmDClinical Pharmacist, Towncrest PharmacyPGY-1 Resident, The University of IowaTakeawaysCourtney's residency project is gathering serum creatinine for patients over 50 to ensure it is within range and documenting it in the patient record.This provides collaborative care by building trust and relationship with both physicians and patients in your practice. You can start by having these conversations with your patients and documenting their serum creatinine.Looking for more on improving patient care? Take this course, It's Time to Deprescribe!PharmacistTechnicianCheck out Choose My Pharmacy to begin bringing back quality to your patient care. Choose My Pharmacy™ is about you, a stakeholder in healthcare, becoming empowered to understand community pharmacy quality. 

This episode is also available as a blog post: https://gailraegarwood.wordpress.com/2018/12/24/a-creatinine-christmas-present/

The Curious Clinicians head all the way back to June, 2020 and reboot episode 3, exploring why trimethoprim/sulfamethoxazole can cause an isolated rise in creatinine.  Check out the show notes here.  Claim your CE/MOC credits here. 

This week in Mind With Muscle Podcast, Topic of the week is Joint Health. How joint health affects your gym goals and also what you can do if you have joint related issues. In 'What I'm Doing or Using' section, I'm talking about my blood reports. My high creatinine levels and my cholesterol levels, and what you can learn from them. Enjoy the episode --- Send in a voice message: https://anchor.fm/mindwithmuscle/message

Inaugural episode of the podcast where anything goes except hemolyzed samples. Join us today to learn about saline and solution dynamics, creatinine, and who will be sponsoring this podcast. Any and all comments and opinions are simply a reflection of the inner workings of my brain and not those of my employers or my academic institutions.

Alternative medicine quacks like Dr Oz and Junger, celebrities, and your lunch table buddies, have claimed that our bodies gather up toxins from our food, drinks and air we breathe. No one ever specifies what these so-called toxins really are, so there's no way these claims can be tested explicitly for a particular chemical.So are these toxins real? We dive into the toxic pond to figure out what's going on.Further Reading and ReferencesBloodletting: https://www.bcmj.org/premise/history-bloodlettingFunctional Medicine: https://sciencebasedmedicine.org/functional-medicine-the-ultimate-misnomer-in-the-world-of-integrative-medicine/Vaccines: https://www.berationable.com/rationable-blog/2019/7/20/antivax-poking-holes-in-their-argumentsAyurveda: http://www.holistic-online.com/ayurveda/ayv-treatment-panchakarma.htmChinese Medicine: http://www.itmonline.org/arts/bleeding.htmUnani: http://www.greekmedicine.net/therapies/Hygienic_Purification_Therapies.htmlPoisons & Toxins: https://www.sciencelearn.org.nz/resources/364-poisons-and-toxinsBotulism: https://www.medicinenet.com/botulism/article.htmVenoms: https://www.sciencedirect.com/topics/agricultural-and-biological-sciences/venomsPlant toxins: https://www.sciencedirect.com/topics/medicine-and-dentistry/plant-toxinApple seeds and Apricot Kernels: https://www.berationable.com/rationable-blog/2019/5/31/3ndxjj5ynmu7qz0rbvejj34ve201uhPoison Mushrooms: https://www.britannica.com/list/7-of-the-worlds-most-poisonous-mushroomsMetals: https://rarediseases.org/rare-diseases/heavy-metal-poisoning/Particulate Pollutants: https://www.toppr.com/guides/chemistry/environmental-chemistry/particulate-pollutants/Creatinine: https://www.kidney.org/atoz/content/what-creatinineLiver: https://www.webmd.com/digestive-disorders/picture-of-the-liver#1Intestines: https://www.health.harvard.edu/staying-healthy/the-dubious-practice-of-detoxKidneys: https://www.niddk.nih.gov/health-information/kidney-disease/kidneys-how-they-workDetox your liver: https://www.hopkinsmedicine.org/health/wellness-and-prevention/detoxing-your-liver-fact-versus-fictionLose weight: https://www.berationable.com/rationable-blog/2017/02/06/lose-belly-fatJuices: https://www.soundbitesrd.com/6-food-myths-dietitians-love-hate/Fibre: http://www.bbc.com/future/story/20181231-is-juicing-actually-good-for-youScience Based Medicinehttps://sciencebasedmedicine.org/the-one-thing-you-need-to-know-before-you-detox/https://sciencebasedmedicine.org/detox-scams-are-worthless-and-potentially-dangerous/https://sciencebasedmedicine.org/top-ten-signs-your-detox-may-be-a-scam/https://sciencebasedmedicine.org/detox-what-they-dont-want-you-to-know/https://sciencebasedmedicine.org/the-detox-scam-how-to-spot-it-and-how-to-avoid-it/Other articles on detoxinghttps://www.hopkinsmedicine.org/health/wellness-and-prevention/detoxing-your-liver-fact-versus-fictionhttps://www.futuremarketinsights.com/reports/detox-products-markethttps://www.health.harvard.edu/staying-healthy/the-dubious-practice-of-detoxhttps://www.hopkinsmedicine.org/health/wellness-and-prevention/detoxing-your-liver-fact-versus-fictionhttps://www.theguardian.com/lifeandstyle/2014/dec/05/detox-myth-health-diet-science-ignorancehttps://www.self.com/story/myths-detoxing-totally-falseIntro and outro music: Don't Stop performed by Nothing More, from their album, The Stories We Tell Ourselves. The sound clips have been used with their permission.Questions, suggestions or just want to get in touch? Find me on Instagram and Twitter @berationable and on Facebook @Rationable. Join the conversation on the Rationable Conversations Facebook group and email me at abhijit@berationable.com. For more content like this, visit www.berationable.com.