Podcasts about Hypertension

Andrea Sapienza,RN is a registered nurse functional medicine geek. Ten years ago, she transformed her health by ditching the (SAD) or Standard American Diet. As a result, she was able to get rid of high blood pressure, digestive issues, and depression. In addition to chaging her diet, she also changed her mindset to make her changes permanent.

Secondary hypertension is tested on essentially every USMLE exam in some way, shape, or form. The NBMEs love to integrate the topic with many other disciplines. If you struggle with this specific topic, this podcast is exactly what you need. I present numerous vignettes, integrations, and physiology/pathology tie-ins to help you make sense and simplicity … Continue reading Divine Intervention Episode 360 – The Clutch Secondary Hypertension Podcast (Step 1-3)

Dr. Ted Watkins

Radha Gajjar, M.D., MSCE and Diane Liu, M.D. discuss what parents should know about pediatric hypertension. The panelists talk about the optimal blood pressure for children and adolescents and possible causes of hypertension in younger patients. They also share how pediatricians screen for hypertension in children. Finally, they discuss what lifestyle factors can be modified or started to help manage this condition.To schedule with Dr. Diane Liu To schedule with Dr. Anuradha Gajjar

Change Your Habits, Change Your Future. Create Your Best Life Now! Featuring Dr. Lauren Keir Simmons We need to listen to our bodies. For whatever reason, even when we have a feeling that is abnormal, most will tend to kick it down the road until it develops into something more serious or worse yet, beyond help. It doesn't hurt to do some research to verify what we are told and don't hesitate to get a 2nd opinion. About Dr. Lauren  Dr. Lauren is a Certified Health Coach who went on a 2 year wellness journey in 2015. During this health journey, I experienced the hormonal ups and downs of an autoimmune disease which took me from 219lbs to 118lbs. After taking my autoimmune disease (Hashimoto Thyroiditis) into remission (in 8 months), I knew I had the skills to assist YOU at solving problems, changing bad habits and living a healthier lifestyle. Lauren Keir Wellness was born.  www.laurenkeirwellness.com www.feedingfatty.com Full Transcript Below Change Your Habits, Change Your Future. Create Your Best Life Now! Featuring Dr. Lauren Weir Simmons Sun, 8/1 4:12PM • 56:14 SUMMARY KEYWORDS eat, people, migraine, day, happening, body, autoimmune disease, medication, individuals, doctors, remission, pinched nerve, sugar, laughing, olive oil, symptoms, reiki, hypertension, food, Dr. Lauren, Change Your Habits, Change Your Future, Create Your best life SPEAKERS Terry, Dr. Lauren, Roy Barker Roy Barker  00:06 Hello, and welcome to another episode of feeding fatty. This is Roy,   Terry  00:09 this is Terry.   Roy Barker  00:09 So we're the podcast chronicling our journey to wellness. And of course, you know, when we started this, it was mostly about our diet, not a diet, but mostly you know what we were eating, trying to get that under control. And then we've talked a little bit about exercise, you know, and we've also pushed a lot into mindset, because even though a lot of us know what to do, it's actually getting it done, and then getting it done, where it's sustainable into the future. You know, I have to admit, I'm very good at getting something started. But you know, things change a month or so and then, you know, we're off track. So anyway, we're just looking for that path to where we can, you know, find the healthy wellness way and be able to stay on it. So a lot of times we talk about, you know what we're going through on our journey, but we also have professionals in the industry and today, we have Dr. Lauren with us, Terry, I'm gonna let you introduce her.   Terry  01:06 Dr. Lauren Keir Simmons is a certified health coach who went on a two year wellness journey in 2015. During this journey, she experienced the hormonal ups and downs of an autoimmune disease, which took her from 219 pounds to 118 pounds. After taking her autoimmune disease, harsh hashimotos thyroid thyroiditis, that's a mouthful into remission. She did that in eight months. She knew that she had the skills to assist you at solving problems, changing bad habits and living a healthier lifestyle. Lauren Keir wellness was born. Dr. Lauren, thank you so much for joining us today. I am so excited to hear about your journey. I have heard about it, but everybody else needs to hear about it because it is something else. tell tell us how how did you know i know i just read that. But tell us in your own words, what happened to get you onto this journey here?   Dr. Lauren  02:08 Yes, I was actually driving down the highway. And I experienced what I know now is an intractable migraine. And the the migraine, it was like a bolt of lightning that hit the top of my head and it zigzag through my body. And then it stopped at the bottom of my feet. Wow. And that was essentially the beginning of my wellness journey. I had no idea what it was at the time when it was happening. And I was driving down the highway, I thought that I was having a stroke. That's how bad it was. I you know, immediately, you know, turned around and went back to the nearest emergency room to find out you know, discover what was going on. And so that's what I learned after a little bit the initial restart, that it was what was diagnosed as an intractable migraine. So that's essentially what it is and what it was in a nutshell. And it has continued. It is essentially continue.   Terry  03:16 Well I'm What's the difference? I mean, what's the difference between a and I've had migraines off and on for years. What's the diff? What's an intractable mind? What does that mean?   Dr. Lauren  03:24 So so it laid the it was labeled and neurologists labeled it as an intractable migraine because it never stops? Oh, wow. Yeah, it just never said never stopped. They kept going on and on and on. And what happened was that neurologist at that time, she attempted to, you know, prescribe medications. And what she discovered was, was that medications would not, were not able to stop the migraine that it was. It was innnate. So it was biological, and it was not anything that they could do to No, there was no medication, you know, there there are general medications that they give you for them. The hypertension medications, they try seizure medications, and so forth. And none of that will work for me. So she said to me, at the end of 90 days, you're going to have to go natural. She said none of this will work for you. You're going to have to go natural.   Roy Barker  04:27 Yeah, no, just the question. I think you answered a little was, you know, was it you said it was biological, not like life circumstance. So what what is the trigger? Is it just something that was born genetically or was there something else that triggers that?   Dr. Lauren  04:45 Essentially, she did not know. And so what would what she meant by where I had was I had to go natural was I had to figure out like a natural solution. Whether it was How can I put it, whether it was a lack of nutrients in my body, whether it was food allergies that was causing it, you know, whether it was something environmental, possibly that was causing it. And you know, and I would have had to do the research, which I essentially did to learn, you know, what was happening. So there was several things that was that were going on at that time with my body. At that time, I had not yet been diagnosed with hashimotos thyroiditis. And so that was one thing that I learned. And then I had to get to, it went on to I had to get to the root cause of what was happening. You know, what, what brought on the hashimotos thyroiditis, because there is a root cause there's several root causes to Hashimoto thyroiditis, and most people never get to the bottom of their autoimmune disease, they just go ahead and take the prescription medication and the autoimmune disease never goes into remission. It just stays there. You're basically medicating it is what you're doing.   Terry  06:07 So putting a bandaid on,   Dr. Lauren  06:09 you're putting a bandaid on it. And so it was there was several things that were going on. At that time, I was perimenopausal, I had an autoimmune disease. And then I had the migraine. And so it was like what are we going to address first with the lesser of the evils? Yeah.   Terry  06:26 So what did you Where did you start? I mean, you have to get a hold of those migraines as much as you can. So yeah, the least function.   Dr. Lauren  06:36 So it's interesting, because I'm actually able to function with them, which is a bad, it's not a good thing at all. I learned to function with them. And I've had people to tell me, I don't know how you do it, because they bring me to my knees. Well, it's only a few of them that I've had that have actually like brought me to my knees where they makes me sort of kind of make me go blind, because you know that migraines will get behind one eye that I can I can literally function with them until it gets to that point. And then that's when I kind of you know, I kind of slow down. But I have, you know, since then began addressing the migraines, because you know, everything else is in check.   Terry  07:25 Right?   Roy Barker  07:27 So how have you found anything that has helped or anything that maybe you've cut out that has lessened either the intensity or the frequency of them.   Dr. Lauren  07:37 So the one thing, the one thing that I had to do was, I had to get through menopause, that was one. The second, the first thing was was that I brought the the autoimmune disease and that into remission, had to get through menopause, because that's what you know, they have hormonal triggers. And then the last thing was, you know, to try to figure out if it was something that was physical that was going on. And what I discovered, as it progressed, was that every time I would have, I would always get MRIs of my right on my right side of my brain, I would always get the right side of my brain scan, and they will find nothing, they like you're perfectly fine, you have nothing going on. I said, there's a problem, because every time I would get a migraine, they would see me doing this. My doctors would always see me doing this. And I was like what is wrong with your neck? And I'm like, I don't know, it just makes my you know, psychologically, it makes my head feel bad. And then one day I said, I said, Let me get my neck scan. And that's when we found out what was happening. So it was cervical radiculopathy a pinched nerve. Oh, wow. It was it was a pinched nerve. And so I began getting treated for that for a pinched nerve bestes that, you know, essentially what it is. So of course, you know, with a pinched nerve, you have to begin manipulating and this is me talking, manipulating the spine so that you can correct it and it can stop   Roy Barker  09:15 pressure on it, oh,   Dr. Lauren  09:17 pressure on it because it can cause it so it's it's behaving the same way that the sciatic nerve does. You know, when you have that pain in your lower back. It behaves the same way. And so, you know, for me if I sleep wrong or something like that, Oh, there goes a migraine and still feel natural, still have to go natural. So they had tricks and so on and so forth. You know, that you want to do to you know, to kind of manage them. Well, lots and lots of supplements. Yeah. Yeah, and a lot of people don't know that because You know, when you became begin medicating yourself, and and the medical profession, they're just throwing stuff at you like, okay, Here, take this, take this, take this, I'm not taking any of that stuff, because what happens is, you go back to, you begin medicating yourself with the prescription medications, and it will throw your autoimmune disease off. Okay? Yeah, and people don't pay attention to that stuff. And I'm like, I'm going to protect this first, because it's gonna take me out, if I let if I let it go out of remission is going to take me completely out. Yeah. So you know, certain things is, and there are many things that you can do, you can meditate. You can do Reiki, you know, you can do your Epsom salt. So, you know, the magnesium, magnesium relaxes your body more than anything, that you know that magnesium is very good, you know, for your body. And so it is extremely, you know, is extremely helpful. And it's extremely relaxing, you can get massages, massages can help to manage that. So, hat you have to I can't get my right now because, you know, I'm, you know, I'm being treated for, you know, being treated with a physical therapist, but you have to get them I get, I get the, you know, massages, just to control the, you know, for the environment and so forth. Because of, you know, all of the pollen and so forth, it clogs up my lungs, and I can't breathe. In the palate around here. It's very heavy. It's very heavy. So I get that so they can push, you know, my lungs out. And I can breathe. Right? Well, yeah,   Terry  11:52 well, and we also a couple of months ago, I guess it's been about two, maybe three months ago, we went to our first Reiki sessions. Like not just stayed away from it, because you know, the whole energy thing is just kind of, it's kind of those one of those strange things that you don't know too much about. So it's one you know, you have to research it so you can understand it, but it's so true. Everything is energy, I get it. It made made me feel great after my first one. And the second one, I was just like I was, I think I was trying to feel too much. So I didn't respond like I needed to, but Roy Roy had a really good experience, I think,   Roy Barker  12:32 yeah, it was interesting. And not that I'm a non believer, I just didn't know anything about it. And you really have to go into it. Just, you know, personally, I would say go into it, open minded and relaxed and you just have to see where it takes you. And it was very interesting. We actually taped an interview with the young lady I don't think it's aired yet that that we did it with but the heat that she pulled out of my body was incredible. I mean, just like she was over my forehead. And it felt like a hot coal was just on my head, forehead But anyway, and then it was also the other thing that was strange was kind of like got between that sleep and consciousness place. And I just had some you know, some things that came to me. I had three words patience, strength and wisdom which is like you know, I don't know where that came from   Terry  13:28 but must be met you   Roy Barker  13:33 you know it just it made my chest well up. Anyway, it was very interesting how that how that all went took place, but   Terry  13:41 it was very cool. Yeah,   Roy Barker  13:43 I was gonna ask about the the autoimmune. So how, how are you treating or how are you dealing with that? autoimmune. autoimmune disease? Yes.   Dr. Lauren  13:54 Is there a remission? Is I just go about it? Yeah, I just go about it. Normally, I actually pulled mine into remission with food. And you know with supplements and so forth. Yeah, it worked for me. Let me just say this, it worked for me. So that was what that was what I required.   Terry  14:12 So what kinds of things did you what kinds of things affect you like do you can you have dairy? Can you have eggs, can you have gluten? Can you have any of that or did you like start just stripped down and then you took everything out and then added it in as you went?   Dr. Lauren  14:29 So I am gluten intolerant? But I do not eat gluten non gluten thing. I don't eat things that are labeled as non gluten. Ah, that don't have gluten. I don't eat things that don't have gluten in them. I eat things that are natural that are totally natural. Dairy. Most people that have autoimmune diseases cannot cannot ingest dairy at all. It's just not it's just not it doesn't work for you. Um, So for me, I can't do I cannot do dairy at all. It doesn't work for me.   Roy Barker  15:06 What were some of the symptoms of the autoimmune because I've never, I've never dealt with it with humans. I actually had an animal that had it in the best way the doctor put it on me was that his body was actually turning against itself. Is that kind of thing? Okay.   Dr. Lauren  15:25 Yeah, so yeah, but your body? Yes. Yep. Yeah, your body actually does. It attacks its own self is what it does. And it does not. So you are like a foreign body to your body. So is is how can I put it? It's like it's invading it like Space Invaders or something like that.   Terry  15:45 Exactly what I was thinking,   Dr. Lauren  15:47 yeah, like Space Invaders. And so you kind of attacking yourself. So you have to retrain your body to say, okay, no, this is what I belong here. And this is what I should be eating. So what happens is another way that I can put it is, is that the foods that you are eating like like my, my, I call it my native foods in New Orleans, my body is tapped out. It will not allow me to ingest anything that I used to eat as a child. So if I want to eat crawfish, I cannot eat crawfish. If I want to eat gumbo, jambalaya, shrimp creole, any of those things at all, because my body is tapped out, it's exhausted.   Roy Barker  16:32 Now, what were the symptoms that you had to, you know, get you to seek out medical help with that.   Dr. Lauren  16:39 I was I had adrenal fatigue. I, I was I had brain fog. I had, um, I had I was hoarse. So um, you know, my thyroid was was a little inflamed, it was a little inflamed. I couldn't I had a lot of it was the headache. I had, that my, a lot of the symptoms that I were having was crossing over along with the along with a pinched nerve. So I'm trying to isolate those. It was I had the initial inflammation. It was initial inflammation. And then I started losing weight like crazy afterwards. But it was initial Yeah, the amp, the inflammation that went to 219 pounds. I had never been that that heavy before. So I was always hovering like around, like maybe I'll say 150 pounds, maybe, which is like a size eight, then I I've expanded to like a balloon to 219 pounds, which was the size 16. And then when I went down to what should have been my normal weight all along. I was 118.   Terry  18:09 Wow, how long did how long of a time period did it take for you to inflate, inflate, deflate the original expansion and then the deflation was? Was it eight year? No, not eight.   Dr. Lauren  18:30 It came on. So my way came on over a period of maybe about five years, mate, maybe about five minutes. Alex outstretching and say 10 years, it was maybe like about maybe about five years, five to seven years. And I'm going Something is wrong, something that you know, something is wrong, something is wrong. Like I've never been this large. And you know, you know how people will not be honest with you. Oh, you're fine. Yeah, yeah, something's wrong. Something is wrong. So I kept investigating and investigating. And then when the migraine hit, I said, up, yes, something's really wrong. So that's when I started, you know, going to all of the specialists and so forth. So I started gathering my documentation. And you know, each person would give me their diagnosis of what they felt was going on. And so they felt this was going on, and I would get a pill for this. And then this was going on, and I would get a pill with this. And then by the time I was done, I think I had like 20 or 21 different medications that the doctors had given me that I did not take. I said this is insanity, but they didn't you know, they only know traditional medicine only knows what they know they treat stuff by symptom, right. And so they were going by what I was telling them I would never know You know, I would never bad mouth any of the doctors for what, you know, for what I went through, because that's what they're trying to do. They're trying to give you medication for, you know, your symptoms and so forth. And they don't know the, you know, holistic side of medicine.   Terry  20:19 Well, and how did you start looking into the holistic side of it?   Dr. Lauren  20:23 So I, I reached back at to some information that I had gotten 10 years prior to my, my incident. And so I started doing a little research because I'm a little, I'm a little flu. You know, I'm a little, I'm a little researcher, by nature, because I have a background in psychology. So I started doing a little research. And I said, something is not right with this. So I started going, you know what, let me lay off of the sugar. So that's the first thing that I did when I extracted all of the sugar out of my diet. And it was it was a lot of it, which you think is it actually does not have sugar in it actually has sugar in it. I said, Why in the world? are we adding sugar to potato chip?   Terry  21:20 addiction? Everything's cocaine.   Dr. Lauren  21:24 Oh, yeah. So everything, you know, not that I was a potato chip eater. But as I was doing my research, I was like, This is pure insanity. I began getting, you know, extracting the sugar out of my system. So I mean, I went cold turkey. The first 72 hours of me going cold turkey. I have withdrawal like a crackhead. And it was it was insane. I was I was like this, I was like, and I said, I'm having a panic attack. And my mother says, I know you all go lay down.   Terry  22:02 Lay down.   Dr. Lauren  22:03 Yeah. She says, I know you wash. She said go lay down. And this is literally how I was talking. And she says no, go lay down. She was like, I can't, I can't because there was really nothing that she could do. I went cold turkey withdraw. And then after that, I was fine. extracted the sugar. And then I began to do a little more research. I went to probably about seven or eight. It may have been more specialists than that. Anything would have ologists. On the back of it. I was on the back of their title. I went to it at everything. I had gone to a I had gotten a colonoscopy and end up endoscopy. I went to an allergist, I went to a cardiologist. I went to a it was insane. I had I probably I fired two cardiologists. I actually fired no one went to another one. Because the first cardiologist I went to she was on hypertension medication. I said, If she's on hypertension medication, she can't help me. She cannot help me because I'm not trying to go on on hypertension medication. Because I said I had hypertension. I said No, I don't. Well, yes,   Terry  23:20 I mean, your body knows best.   Roy Barker  23:23 And that's why I think we have to be sure we listen to ourselves. Because we and I'm not speaking for you, I'll speak for me, but you know, we tend to I had the feeling today and then we'll be okay tomorrow and we kind of kick this can down the road until it can, you know, even turn into a lot worse things.   Dr. Lauren  23:41 Right? I was fortunate I always tell people, listen to your body, you know, go to the doctors, you know, hear what they have to say, listen to them. But I knew for myself, I knew I did not have hypertension, what I did have was because they were following it was my heart would start racing. That is a characteristic of hashimotos. When your heart just starts racing, I would be I would be in the bed and I would be getting waking up at five o'clock in the morning. just waking up and my heart would start racing.   Roy Barker  24:21 Wow. So So you've taken all this information that you've kind of gathered upon yourself and then now you're starting to help others.   Terry  24:30 Yeah.   Dr. Lauren  24:32 Yes, as best I can. Um, I know, I know what I know. And a lot of I've been able to help a lot of people, you know, as it relates to a few lifestyle diseases because generally what I focus on, you know, I can, you know, generally help individuals with, you know, hypertension, you know, kind of extracting those inflammatory foods that they have in their system, you know, working with the doctors, I do not take any Want off of medication, I do not put it put anyone on medication, the medical doctors do that. But I can't work alongside of, you know, the medical doctors to help them to tweak their patient's diet, to, you know, kind of reduce that inflammation, and, you know, kind of work with them to help to make them you know, as well, you know, as you know, as I can't, but I have definitely helped individuals, you know, with diabetes, pre diabetes, and so forth, to get their numbers back in check. Because you don't want that inflammation in your body, the longer you have that inflammation in your body, the more damage that it can do. And so, you know, the longer you want a lot of that medication, the more damage that it does to your body. And so that's why I was fighting so much that I did not want to take the medication they were giving me, you know, I do have, I was diagnosed with asthma as a child, and I've never taken an ounce of medication, they gave me inhalers and all this, I said, I'm not taking that stuff, that stuff will raise your blood pressure. And, and then then when your blood pressure's high, they're going to give you what hypertension medication. Now, so for myself, and I always say this is for myself, always make sure that you, you know, check with your physicians and so forth, because they know your medical history far better than I do. And so you definitely want to check in with them to, you know, to see, you know, what your numbers are, get your blood work, get your annual checkup, and so forth. And then, you know, make sure that you're living a healthy life.   Roy Barker  26:47 Yeah, I think that's another good point is that there's, you know, and we're not medical doctors, and we always specify, they'll see a doctor take their advice. But you know, one thing I think we've learned is that, well, it first off inflammation, you know, as we as more research has come out, it's like, it's kind of the root of most of the evil in our bodies. But a lot of this can be influenced by our diet. And like you said, we don't know what, well, we know, there are a lot of things you would think doesn't have sugar, but, you know, we don't eat a lot of sugar. And not long ago, we ordered from a little Italian restaurant. Oh my gosh, I'm telling you that red sauce, it was sugar Laden. I mean, it was almost like eating a candy bar. So anyway, you know, people do that stuff, because it makes it taste better makes the kids eat it. But sometimes it can be that addictive factor. And going back to your withdrawals, I found the same thing coming off of carbohydrates. When my doctor first diagnosed me with type two diabetes, he said, You know, I want you to cut your carbs back. And so that was on a Thursday, Wednesday, Thursday, Friday night, I started like, right above my eyes, it felt like my head was gonna blow off. And I carried that with me through Sunday. And to be honest, I thought I was dying or have, like you said, having some kind of a stroke. And so I went to, you know, the CVS a little drugstore and had an auto machine, my blood pressure was escalated. So it scared me I call my doctor the next day. And he's like, we'll come in, he took my blood pressure and it was normal. He said, Well, first off, those machines aren't that great. But he said secondly, he said you're just having withdrawals from carbohydrate. Pisa is like a drug and you will have to come off of that.   Terry  28:41 Yeah, surely there are like rehab places where you can go and get, you know, have, you know, get withdrawn from sugar and carbs and things that if there aren't, there needs to be because it's a hard, you know, three days for sure, if not a little bit longer, but then you have to learn what you need to be putting into your body. So you don't have those cravings in the future and make sure that you're addressing whichever issue it is that you have, whether it's the hashimotos or or type two diabetes or whatever, right.   Dr. Lauren  29:19 And that's what I teach people. That's what I teach people how to do when they the first 72 hours of the worst when you withdrawing off of sugar. They it's the worst and so you just have to kind of take it for me. I wanted to get rid of the migraines and so I knew that I had to tolerate it. I'm like it's gonna stop eventually. And it did. But what people do is when they relapse so when people are on their own a diet as they like to call it instead of a lifestyle, lifestyle change the first 72 hours when they stop eating sugar. All they think you know, okay, so So what can I eat? Drink water? No, no, what can I eat, drink water. Because you're dehydrated is what's happening. And so they don't even think about that. Know what can I eat? Like, I can't eat this or fill in the blank with this and no drink water just drink water. Yeah, people were so much negative. So we're born with addictions. Because when you think about think about this, when you're born with it, what is the first thing that people that that moms are giving their babies? No.   Terry  30:26 Milk.   Dr. Lauren  30:28 What is milk having it? Sugar, sugar, sugar, breastfed even if the babies are breastfed, whatever it is that you've ingested. Guess what they're ingesting? Oh, yeah. So they're getting it straight from so we come in, we come into the world with that sugar addiction, and so we're predisposed to it. So unless, unless the mom's body is clean. And the mom has detox before she had the baby. Guess what's happening? The cycle is happening. So if mom has asthma guess what the baby's gonna have will have asthma as well. Oh, yeah. So people are wondering why these little ones are born or coming out with this asmin. So for Guess what?   Terry  31:20 That makes so much sense. Oh, my gosh. It's so true. Okay, so what would you tell? So like we're dealing with? So I have, at one point they, I was told that I had hashimotos. But then they came came back and said no, no, you have hypothyroidism. But hashimotos. And hypothyroidism? They're two separate issues, right? I mean, the hashimotos is auto immune, and then the thyroid. The hyperthyroidism? Is the gland itself. The disease? Yes. So I did differently.   Dr. Lauren  32:02 So what Yeah, so what probably happened was, is that it's hot hashimotos can actually turn into hypothyroidism if you don't catch it in time. So it's the it's the progression of it. Ah,   Terry  32:16 okay.   Dr. Lauren  32:16 It's the progression in this the way that the numbers look, that's the way that's the way that it was explained to me. And so you can have normal, if you have normal TSH levels like I do. They don't, they don't really test you for the hashimotos or the high hypothyroidism, if you have normal TSH level, what has to happen is you have to continue to you have to do the second layer of tests, which the doctors don't like to do. So you're looking at the, you know, the T three, t four, you're looking at all of those numbers. And that is how you determine what the what the what the hashimotos is. So, yeah, you can always, you know, get a second opinion, you know, from another doctor and so forth. But what they do even with the Hashimoto, they want to put you on the, you know, on the on the medication. Yeah, I was I, that wasn't my case. I was fortunate, I always tell people that that wasn't my case. And so I always guard, I always guard my food with my life and pay attention to what it is that I'm eating, so I don't eat out.   Terry  33:32 You don't eat out? I don't eat out at all. We might withdraw with that, too. We're gonna withdraw from doing that. Yeah. But   Roy Barker  33:44 yeah, but really, you know, in order to know what's in this stuff, you really just have to because it's not that people do it maliciously. They do it to make the taste better, where people come in, and things like that. But we just never know what those ingredients are.   Dr. Lauren  34:00 I do know what's in it. And that's why I don't eat out. Yeah, yeah. And I don't eat out and I tell people this, you don't eat anything? No, I know. restaurants, the food industry is not in it to they're not in it for health. They're in it to make money. I get that. I get that. And so and so I have to eat at home because most oftentimes if you ask the chef's what's in the food, and they don't even know. They don't even know I'll give you a perfect example. I used to enjoy eating Ed said restaurant, I won't give the name. I used to enjoy eating at a certain restaurant. And I said what type of oil Do you use on your lamb chops? And they said, Oh, we use olive oil. That's what the chef said. And I said, No, it's something else that is in that I said because I can taste it. I can taste it. It tastes like grease. So I asked the manager Because what I do know is, is that olive oil burn at that high on that high heat, there are only two oils that you can use at high heat. And almond oil is one of them. Almond Oil is too expensive for them to cook with. Olive oil is too It does not it burns too fast, right? So I asked the manager, I said, What is it? What type of oil is that? He said, Oh, that's olive oil. And it's mixed with canola oil. I said I knew it. I know I was very inflammatory for your system. So that is generally if they say they cook with olive oil is olive oil mixed with vegetable oil, or whatever it is that they're using so that they can cook at high heat on those grills.   Roy Barker  35:47 And I'm sure the cost factor to they can put a little drip of olive oil in there and tell you that we're cooking with olive oil. But the ratios, the ratios probably more skewed to the canola oil.   Dr. Lauren  36:01 Oh, yeah, of course. Of course it is. And I didn't ask that. I get it. I said I get it. I said thank you for sharing that with me. I never ate at the restaurant again.   Roy Barker  36:11 The other thing they kind of trained us up on too is eating. So such large volumes of weight for days have become crazy. And that's something that you know we have trouble with is, you know, Terry's a great cook. And so even even as we eat at home, I like you know, I want that second helping, where if I would just give myself a few minutes round will eventually be full. And you know, the other day, I don't know, I was kind of snacking we and we hadn't eaten too much. And I just said, Oh, I'm I'm hungry for some popcorn or something like that. And I said I want some popcorn. And she's like, aren't you not full? I said, and I thought for a minute. I say yeah, I really am full. But I felt that like ran through my chest. I just kind of had this sinking feeling you know? And it was it was probably dehydration, it could it was probably being a little bit tired. Because it was the end of the day. Yeah, there's all these other feelings that I've begun to realize that you know, that hunger or the desire to eat. I'm not gonna say hunger because it's usually not hunger, it's a desire to eat comes from a lot of other places than being hungry.   Terry  37:20 Yeah, and I'm always trying to you know, I'm always I am not a good cook. He's very sweet to say that, but he's just so happy that a bay is taking care of him. Anybody and I am really not that great of a good. But I my goal is to make sure that he doesn't get snacky and, you know, that's a hard because, you know, like he said, it was just really right, you know, within an hour after we ate and I was like, Are you full? Are you still cool? No. And the the fact that he realized, you know, that's just his pole in his chest. And that's kind of what his deal his schpeel is, before he goes to bed. He's got to go through this. Maybe if he can just grab some water or you know something, do something else and then go to bed. Just go to bed.   Dr. Lauren  38:14 That's hard. Cuz you cuz you'd like to snack? Oh my gosh, hard.   Roy Barker  38:21 Popcorn, you know, saucy stuff. And then I don't know, somewhere along the way, I develop a sweet tooth. And so now it's even doubly because like, I need a little bit of sweet and then a little salt. After that,   Terry  38:33 probably that's probably me. But I am the grocery shopper. So I don't have to bring that stuff home. But I'm feeling you know, usually when I go I'm hungry. So I want to go and you know, Oh, those look great. Well, I'm going to get them nuts. But I'm not going to get the wrong nuts. But then I'm going to Oh, there's some cookies, I'm going to grill just a little bit.   Dr. Lauren  38:55 hard. I tell you, it doesn't end when you when you're eating a healthy lifestyle like I do. It doesn't And trust me, the cravings don't in, you just have to you know, you just have to take it baby steps. Yeah, I tell people baby steps with that. Because it's traumatic for you to have to just stop it like all at once. It really is traumatic. So you just have to take baby steps. You have to be kind to yourself, as well. You know, if you fall off the wagon, or you kind of partially on a wagon, you know, just get back on it.   Roy Barker  39:32 That's all I usually fall off and then get ran over by the wagon. But yeah, I mean, it's a lot. It's a it's an adult thing. I don't remember it as a child so much but you know, it's an adult habit that I've done for years. And you know what, the other thing I've learned is it's usually because of getting sleepy. So at night if I got something I want to do in the And I was like, well have something quick to eat instead of just listening to my body and just go into bed, drinking that glass of water and just go into bed. It's it's difficult. But like you said, we have to be kind and not be like, Oh, well, I fell off. So I'm just going to continue on this bad path, because we never get it fixed when we do that.   Dr. Lauren  40:20 Yeah, yeah, don't beat yourself. Yeah, tell people don't beat yourself up. It won't happen overnight, everyone has to do it. You know, you have your own path. Right? You know, is your body you have your own path, and you have to do it in your own way. You just have the knowledge if you have the knowledge, then you know what it is that you can do. Right, you know? And so that's essentially what it is. You just have a few things that you want to work out at a time just a few things that net Arielle take everything all at once like I did I tell people do not follow my lead. Trust me when I'm telling you.   Terry  40:59 Yeah, the big picture is just so hard. If you it's easier. I say that it's easier if you chip away. That's what helps me better. But do I do it all the time? And everything? I do? No, but I should.   Roy Barker  41:13 Yeah, yeah. Yeah. I think that sets us up for failure. Because you know, and I'm this guy, I'm always telling off for myself. But, you know, you wake up one day fed up, and it's like, okay, no more sugar, no more cars, I'm going to the gym. You know, I'm going to go crazy. And like, you got so much commotion in your life that you've just developed, that, it's no wonder that we, you know, have these temporary setbacks. And so, you know, trying to take one thing, and then also, you know, maybe doing things gradual, if you if you have the luxury of the time, you know, sometimes people get to a position that they have to make drastic changes immediately. But if you can, you know, just yeah, just start cutting back a little here a little there until you get to the point where you really want to be Yeah,   Terry  42:03 exactly. Well, you're right. I was I'm sorry, go ahead.   Dr. Lauren  42:08 You're right. That's what that's why a lot of people do fall off the wagon. And they're like, Oh, well, you know, and then you have the other individuals that are go, okay, I've eaten Well, all week. What cheat meal Am I gonna have this weekend? Why   Terry  42:24 the weekend, we're celebrating,   Roy Barker  42:26 saying, I can't do that. Because if I have one taste of this, whatever the cheat is, I want it more and more. So you know, some people can handle that. But I just have to say I'm not one I have to go to the extreme of just not having it. You know, cuz like those little I always say the cat, I don't know, the company. Somebody came out with these little 100 calorie little ice cream sandwiches a few years ago. Oh, yeah. I love those things. But you know, I eat four or five of them at, you know, at a setting down. So it really wasn't doing me any good. You know?   Terry  43:06 You had more so you were full. I   Roy Barker  43:08 didn't need anymore. I'd have been better eating the old original big ones. I probably only had 250 calories. Like, I just get a little taste for it. And then you know, it's just uncontrollable. I love it. Yeah.   Terry  43:22 Okay. Dr. Lauren, I wanted to let's, let's kind of Reel back I know, we're talking about all over the place. But so you're a certified Health Coach, what kind of programs do you offer on your website? And you have a new one that I want you to talk about as well?   Dr. Lauren  43:37 Yes, I have it. So it's called the metamorphosis health coaching program. And my signature program is the bee fly the top. So eventually, initially, I did a 21 day just to get people started. But what I discovered was, because I'm so adamant about it, I could do it. But other people like this is over whelming so what I did was I reeled it back in, and I wrote I'm rolling it back out on September the sixth. And it is going to be a self paced program is six modules. And it's going to be a self paced program. So you go at your own pace, and you can, you know, move it along, or you know, kind of stopping, you know, as you need to and then you know, you can kind of help yourself as you go along. And then you get me to answer your questions in our own little group on Facebook. So I get to you can come in there and ask as many questions as you can, as much as your heart desires. To talk about that you also get a you also get a health consultation, so that you can learn about out what it is that you know, you can eat, you know, we look at all of your habits your eating, past present, and what you're going to be eating in the future, because you're going to do a lifestyle change. And you know, we just kind of go from there.   Roy Barker  45:19 And I think I'll put this more as a question. But you know, for me, I find that sleep, I have come to realize sleep is pretty much my trigger for all my downfalls. Because here's how the pattern goes, stay up late, don't get enough sleep, and then get up in the morning need extra fuel food to get moving, but then you're too tired to get out and move in. I know that when we talk about weight loss, you know, it's more 80% diet. But for me, you know, I feel like I need to move every day and I don't I walk from you know, the bedroom to the office and sit down and stay here pretty much where I need that movement. But the other thing is, when I'm out moving, I'm not eating. So you know, it kind of works twice, double for me as it gets me moving. It's good for the rest of my body. But also, it's an opportunity not to be in front of food.   Dr. Lauren  46:19 Yeah, I give. So I have a couple of people who I coach who they work from home. And when they're not working from home, they travel. And I said, so this is what I need you to do. I need you to set an alarm at lunchtime, get up at lunchtime and go walk for half an hour. And then then you know, of course it was the excuses that came. Okay. So this is what I need you to do. If you need to take a phone call, if you are on a conference call, do it on your cell phone and go walk while you are on that conference call. Because a half an hour a day will be so much more helpful for you to do that walk in even if you if you need to be in the house and you have stamps in your house, do the steps. Yeah, the steps up and down. Even if it's just for 10 minutes, do those steps so you can get those get the walking in to get your body moving. Yeah. You know, so you have to kind of set that time aside in order to do that.   Roy Barker  47:21 Yeah. And it's easy, because I can't do all of mine that way. But the ones I can make the announcement. I'm gonna be breathing hard. I'm not being chased. I'm not dying. So don't worry, it's just me walking,   Terry  47:34 because I hurry up with your meeting so I can get on with it.   Roy Barker  47:37 But you know, the other thing we've talked a little bit about is I, my my big name, fitness watch. Kind of pooped out on me. And so I started using a different one the Fitbit again. And I really like it because it the other one may have had it, I just didn't use it. But this one has a every hour it wants me to get 250 steps in. So I get a little prompt like, Hey, you got this many. And I do what you said, if I can't get out, I will just get up and walk around the house. I can still get it in. But the awesome thing is that at the end of the day, I've got about 2500 steps, you know, to kind of get started, I'd like to get more than that. But it's a great start with just a little bit of effort throughout the entire day. Right now, you know, I'm telling you, I had to I was back out in the field this week for one day. And we were doing some field visits. And I was with two colleagues that just wore me out we had like, you know, 5500 steps through this day and I came home and was just   Terry  48:41 it was zero doubt. Yeah,   Roy Barker  48:42 after you know, sitting at home in a chair for so long.   Dr. Lauren  48:46 Yeah. I tell you something else that you can try. If that wears you out, you know yoga will give you cardio as well. Yeah. If you get up in the morning and do that. Do that breathing and so forth. Yoga, I love yoga. If you if you tell me something about running or walking or something like that. Yeah, I'm not doing it. Yeah. Yeah, I'm not doing it. But yoga, I will do 90 minutes of yoga. A day. I will start out with it in the morning and I will do it in the evening. And that is that is equivalent to the walking that you need to do. And it will wear you completely out.   Roy Barker  49:32 Yeah. Yeah, you know, that's a great thing about our day and time is you know, there's the negatives of the food and the drive throughs and all of that but the positive we have so many tools at our disposal, that if we will use them that they will help because you know like the watches it also it makes me input my water so I can keep up because again, that's another bad habit is I can go through to three days and not ever drink any water. Drink Coffee. Yeah, so I can put my water in. But we can also do the yoga on the computer, we've got a DVD where we could do it at home, you don't even have to get out of your pajamas to do it. So, you know, we got so many great things to take advantage of, I think we just have to make up our mind and just try to have that discipline to do it.   Terry  50:21 I think we even had a guest who said that she does. She does it in bed. Like when she first wakes up. I mean, there's just really not any excuse. If you want to lay down and do it in bed, then do yoga in bed. There's there's an app for that there's that you can watch a YouTube, whatever. And it's been in bed, yo. And we also, we also just talked to somebody about laughter yoga. Oh my gosh, if you have never experienced it, you have got to do it. Because you just laugh from deep, your diaphragm belly loud. You know, you go into it thinking, huh? What is that everybody's just going head. It's just kind of like a canned thing. That's what you think, Well, no, bye, bye. You know, 1015 minutes, everybody's laughing at everybody else's laughs you're there, to screen fulls of people and they were just dying. laughing. It was hilarious. But it's also good   Roy Barker  51:13 for the stress. Because, you know, when, when one of us gets stressed, the other one will start that, you know, laughter and the other one can't help but start laughing and then, you know, for myself, it takes me out of that. Not so great place and it'll put me in a better place to carry forward with the rest of the day where, you know, instead of just getting all stuck in the mud with wherever I was. I love it. Yeah, it's, uh, it was it's, it's kind of a blessing for fine. I'm, I can be a little intense at times. And so she can be like,   Terry  51:51 I'll just start laughing. I'll just look at him. Like, really? Just start laughing. He's like, what's funny? I'm like, nothing. Just laugh.   Roy Barker  52:02 With Dr. Lauren, we appreciate your time. We've gone way long. I know that but such a good conversation. So many great things to think about. You know, one of our questions we always ask is, so what is a habit or tool? What is something that you use in your daily life professional or personal that you feel adds a lot of value?   Dr. Lauren  52:22 For me, when I we just started talking about the yoga I do Reiki? Okay. Every morning, when I get up, I do Reiki It is so relaxing, before I start my day, and so I find that that relaxes my complete Body before I get going and so that's very helpful for me if I don't do anything else, you know, before I you know, before I leave out and in the morning, that is one thing that I do is my Reiki.   Roy Barker  52:52 Awesome, Alreight. Well tell everybody, who do you like to work with? How can you help them? And then of course, how can they reach out and get a hold of you.   Dr. Lauren  53:02 So I like working with individuals who are either trying to change their lifestyle, who want to learn how to eat healthier, those individuals who are who are plagued with lifestyle diseases such as hypertension, diabetes, obesity, and they want to change their lifestyle. I like working with those individuals. And, you know, genuinely, you know, when you're working with me, you're going to lose weight. For those individuals who want to bikini bodies, I can do that as well. I don't, you know, I don't specifically market to that population. But the individuals that I do work with those that do have, you know, the lifestyle diseases, and I do that through The B-Fly Detox Program. I also have, you know, work with individuals who have special events going on, you know, such as, you know, lifestyle, life events, you know, like weddings and so forth. I work with those individuals, red carpet events, I work with those individuals to get them prepared for that. And so, all of this is under my umbrella of The Metamorphosis Health Coaching Program, and they can find me at my website, which is www dot Laurenkeirwellness.com.   Roy Barker  54:31 Okay, it would be sure to put all that in the show notes. Speaking of weddings, just I'm a dude, so I don't get this I guess, but they we have a toll road authority here in town that's been advertising the last two days. Somebody lost their wedding dress. They found this really nice wedding dress on the side of the road. And they feel like it belongs to somebody they're trying to figure out well, how do you bet there's some bride that is absolutely beside herself thinking about her dresses laying on the side of the highway   Terry  55:00 So that's that's kind of an extreme way to say I really don't want to get married or maybe they were mad. Maybe they were getting divorced. Throw it out. I was out and yeah,   Dr. Lauren  55:12 I don't think that bride lost it. I think she you know, there was all times I think brides to get bridges on throw that guy's away time away. Well, okay,   Roy Barker  55:22 well hopefully she went on her way to the chapel when she threw it out the car window. Alright guys, well, thanks again. that's gonna do it for another episode of Feeding Fatty. Of course, I   Terry  55:33 am Roy. I'm Carrie.   Roy Barker  55:35 And you can find us at www.feedingfatty.com we're on all the major podcast platforms, iTunes, Stitcher, Google Spotify. If we're not a one that you listen to, if you'll reach out, I'll be glad to get it added so you can make your Lee's listening easier. Also, we're on all the major social media platforms hang out on Instagram a little bit more than any other place. So reach out we'd love to engage with you there. And a video of this interview will go up on our YouTube channel when the episode goes live. So be sure and check that out as well. Again, thanks for listening. Take care of yourself and take care of your health. www.laurenkeirwellness.com www.feedingfatty.com

Today we're joined by Professor Naveed Sattar for a summary of some of the key takeaways from the International Diabetes Federation Virtual Congress 2021. Professor Sattar is Professor of Metabolic Medicine at the University of Glasgow, and was Committee Lead for the Cardiovascular Disease & Hypertension stream at the congress. For more free education, go to diabetes.knowledgeintopractice.com, where you can see all past episodes of the podcast as well as other free CME resources. Follow us on Twitter (@dkipractice) or connect on LinkedIn. Disclosures: Professor Naveed Sattar declares the following: Advisory board: Amgen, AstraZeneca, Boehringer Ingelheim, Eli Lilly, Merck Sharp & Dohme, Novartis, Novo Nordisk, Pfizer, Sanofi Speaker honoraria: Amgen, AstraZeneca, Boehringer Ingelheim, Eli Lilly, Novo Nordisk, Sanofi Institutional research grant: Boehringer Ingelheim All conflicts have been mitigated prior to this activity. This independent educational activity is supported by an educational grant from Novo Nordisk A/S. The educational content has been developed by Liberum IME in conjunction with an independent steering committee; Novo Nordisk A/S has had no influence on the content of this education.

Diabetes Core Update is a monthly podcast that presents and discusses the latest clinically relevant articles from the American Diabetes Association's four science and medical journals – Diabetes, Diabetes Care, Clinical Diabetes, and Diabetes Spectrum. Each episode is approximately 20 minutes long and presents 5-6 recently published articles from ADA journals. Intended for practicing physicians and health care professionals, Diabetes Core Update discusses how the latest research and information published in journals of the American Diabetes Association are relevant to clinical practice and can be applied in a treatment setting. This issue will review: Remission of Type 2 Diabetes Following a Short-term Intensive Intervention With Insulin Glargine, Sitagliptin, and Metformin Gestational Diabetes Mellitus and the Risks of Overall and Type-Specific Cardiovascular Diseases Chlorthalidone for Hypertension in Advanced Chronic Kidney Disease Changes in the Prevalence of Symptoms of Depression, Loneliness, and Insomnia in U.S. Older Adults With Type 2 Diabetes During the COVID-19 Pandemic Relationships of Changes in Physical Activity and Sedentary Behavior With Changes in Physical Fitness and Cardiometabolic Risk Profile in Individuals With Type 2 Diabetes Risk of Incident Dementia According to Glycemic Status and Comorbidities of Hyperglycemia     For more information about each of ADA's science and medical journals, please visit www.diabetesjournals.org. Presented by: Neil Skolnik, M.D., Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Associate Director, Family Medicine Residency Program, Abington Jefferson Health John J. Russell, M.D., Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Director, Family Medicine Residency Program, Chair-Department of Family Medicine, Abington Jefferson Health

Dr. Ted Watkins

Uno studio condotto all’Università di Kyoto in Giappone e pubblicato sulla rivista Hypertension sottolinea i benefici del cammino per il nostro cuore. A Obiettivo salute il commento del prof. Claudio Borghi, direttore dell'unità operativa di medicina interna al Policlinico Sant'Orsola-Malpighi di Bologna.

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-256   Overview: Live at Pri-Med East! In this episode, each podcaster will discuss the most impactful paper and podcast of the year.   Episode resource links: Ngan, H.Y, et al (2021), Diabet Med, 38: e14525. https://doi.org/10.1111/dme.14525 J Clin Gastroenterol 2021: DOI: 10.1097/MCG.0000000000001561 Mehta RS, etal. JAMA Intern Med. doi:10.1001/jamainternmed.2020.7238 https://www.uspreventiveservicestaskforce.org/uspstf/draft-recommendation/aspirin-use-to-prevent-cardiovascular-disease-preventive-medication Hypertension. 2021;78:591–603. DOI: 10.1161/HYPERTENSIONAHA.120.16667   Guest: Susan Feeney, DNP, FNP-BC, NP-C, Alan M. Ehrlich, MD, FAAFP, Jill M. Terrien, PhD, ANP-BC, Jillian Joseph, MSPAS, PA-C   Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-256   Overview: Live at Pri-Med East! In this episode, each podcaster will discuss the most impactful paper and podcast of the year.   Episode resource links: Ngan, H.Y, et al (2021), Diabet Med, 38: e14525. https://doi.org/10.1111/dme.14525 J Clin Gastroenterol 2021:  DOI: 10.1097/MCG.0000000000001561 Mehta RS, etal.  JAMA Intern Med. doi:10.1001/jamainternmed.2020.7238 https://www.uspreventiveservicestaskforce.org/uspstf/draft-recommendation/aspirin-use-to-prevent-cardiovascular-disease-preventive-medication Hypertension. 2021;78:591–603. DOI: 10.1161/HYPERTENSIONAHA.120.16667 Guest: Susan Feeney, DNP, FNP-BC, NP-C, Alan M. Ehrlich, MD, FAAFP, Jill M. Terrien, PhD, ANP-BC, Jillian Joseph, MSPAS, PA-C   Music Credit: Richard Onorato

You might be considering adding losing weight to your list of resolutions for next year. Dr. Drew Payne, an internal medicine practitioner for Texas Tech Physicians and an associate professor for the Texas Tech University Health Sciences Center (TTUHSC) School of Medicine, has advice on how to start your weight loss journey so that it's effective and healthy. For those not looking to lose weight, Dr. Payne has suggestions on how to maintain a healthy weight. 

Dr. Ted Watkins

KHOU-11 Houston reported Fifty percent of persons who died from COVID 19 in Houston, Texas were diagnosed with diabetes. It is reported by the Houston Health Department that 13.5 % or 311,118 of 2,304,580 Houstonians have diabetes. If the risk factors related to diabetes are Obesity and Overweight; Hypertension; High Cholesterol; and Cigarette Smoking according to the U.S. Department of Health and Human Services (Office of Minority Health), why is there not more emphasis on lifestyle changes rather than vaccine mandates? https://www.minorityhealth.hhs.gov/omh/browse.aspx?lvl=3...

Today on MedNet21, we're going to discuss Hypertension Update.

In this episode, Dr. Deepak Bhatt and Dr. George Bakris discuss the diagnosis of resistant hypertension, strategies to manage patient lifestyle, and the use of combination therapy.   Educational grant support provided by Medtronic. To visit the hub for the Overcoming Challenges in Hypertension Management grant, click here.   Subscribe on iTunes | Subscribe on Google Play |

L'hypertension artérielle correspond à une élévation anormale de la pression du sang sur la paroi des artères. Elle touche, selon l'OMS, plus d'un adulte sur trois, et peut entraîner un infarctus ou un AVC (Accident Vasculaire Cérébral). En effet, une tension trop élevée provoque un vieillissement accéléré des organes comme le cœur, le cerveau et les reins. Pourquoi est-il fondamental de surveiller sa tension ? Quelles sont les complications qui peuvent survenir si l'on n'est pas mis sous traitement ? Pr Michel Azizi, cardiologue, professeur de Médecine vasculaire à la Faculté de Médecine de l'Université de Paris. Chef de Service du Centre d'Excellence en Hypertension Artérielle de l'Hôpital Européen Georges Pompidou, Paris. Il dirige également le Centre d'Investigations Clinique 1418 APHP-INSERM et une équipe de recherche au sein de l'hôpital ► Retrouvez l'émission en intégralité ici

Dr. Ted Watkins

Don't sweat inpatient hypertension any longer. Who needs guidelines when Dr. Noble Maleque (@nobility75, Emory University, Division of Hospital Medicine) explains the spectrum of hypertensive disorders in the inpatient setting, and an approach for thinking about treatment. Claim free CME for this episode at curbsiders.vcuhealth.org! Episodes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME! Credits Production, Script, Infographic, and Cover Art: Monee Amin, MD, Meredith Trubitt, MD MPH  Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP, Monee Amin, MD, Meredith Trubitt, MD MPH  Reviewer: Adam Barelski MD Executive Producer: Beth Garbitelli Showrunner: Matthew Watto MD, FACP Editor: Clair Morgan of nodderly.com Guest: Noble Maleque MD Sponsor: Panacea Financial Join the growing number of doctors nationwide that expect more from their bank and have switched to Panacea Financial. Visit panaceafinancial.com today for information on their student loan refinance loans and to learn about their “refer a friend” program. Panacea Financial is a division of Primis, Member FDIC Sponsor: Ten Thousand Ten Thousand is offering our listeners 15% off your purchase! Go to tenthousand.cc and enter code CURB  to receive 15% off your purchase!. Sponsor: Locumstory Locum tenens may sound like a funky Latin word, but you'd be surprised what it can mean for your career in medicine.  Locumstory is your source for all things locum tenens! Check out their website,  locumstory.com,  for resources, FAQs, and more! CME Partner: VCU Health CE The Curbsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit curbsiders.vcuhealth.org and search for this episode to claim credit.  Show Segments Intro, disclaimer, guest bio Guest one-liner, Picks of the Week* Definitions Case from Kashlak Elevated blood pressure / hypertensive urgency Contributing factors to elevated blood pressure in the hospital Hypertensive urgency—to treat or not to treat Transitions of care and case against intensification of treatment Case from Kashlak Hypertensive emergency diagnosis and treatment Secondary Hypertension Outro

This week on Primary Care Update we talk about group PT visits for urinary incontinence in women older than 60, managing uncomplicated forearm fractures in children, a COVID testing strategy for keeping kids in school, and a quadpill for treating hypertension

Dr. Ted Watkins

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-253   Overview: ACE (angiotensin-converting enzyme) inhibitors and ARBs (angiotensin receptor blockers) are both recommended as first-line treatments for hypertension. ACE inhibitors have known side effects, such as cough, that are frustrating for many patients, while ARBs appear to have less annoying side effects. This podcast will review a recently published retrospective, comparative cohort study comparing the effectiveness and safety of ACE inhibitors vs ARBs in the first-line treatment of hypertension.   Episode resource links: Hypertension. 2021;78:591–603. DOI: 10.1161/HYPERTENSIONAHA.120.16667   ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/ NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018;71:e127–e248. doi: 10.1016/j.jacc.2017.11.006 Guest: Robert A. Baldor MD, FAAFP   Music Credit: Richard Onorato

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-253   Overview: ACE (angiotensin-converting enzyme) inhibitors and ARBs (angiotensin receptor blockers) are both recommended as first-line treatments for hypertension. ACE inhibitors have known side effects, such as cough, that are frustrating for many patients, while ARBs appear to have less annoying side effects. This podcast will review a recently published retrospective, comparative cohort study comparing the effectiveness and safety of ACE inhibitors vs ARBs in the first-line treatment of hypertension.   Episode resource links: Hypertension. 2021;78:591–603. DOI: 10.1161/HYPERTENSIONAHA.120.16667   ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/ NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018;71:e127–e248. doi: 10.1016/j.jacc.2017.11.006 Guest: Robert A. Baldor MD, FAAFP   Music Credit: Richard Onorato

Vol 215, Issue 11: 6 December 2021. Professor Alta Schutte is Professor of Cardiovascular Medicine at UNSW Sydney, and a Professorial Fellow at The George Institute for Global Health. Professor Markus Schlaich is the Dobney Chair of Clinical Research at the University of Western Australia. They discuss hypertension control rates in Australia and why they need urgent improvement, and how we can do that. This podcast accompanies their MJA Perspective, published here. With MJA news and online editor, Cate Swannell. 

According to the CDC, nearly half of all adults in the U.S. have hypertension or are taking medication to control it. Of these individuals, only about 1 in 4 actually have their condition under control, whether through improved diet and exercise, making different lifestyle choices such as not smoking, or with prescription medications. Knowing when to start treating someone for hypertension is extremely important, as elevated blood pressure can lead to heart disease, stroke, and even death. However, there can be some uncertainty in the medical community on when it is appropriate to begin medication, as guidelines are frequently revised, and that decision can also vary from patient-to-patient based on additional factors. Anthony Bonifonte with Denison University joins me for this episode to discuss brand new research that can help guide a physician's decision of when to begin medicating for hypertension, as well as when to increase dosages. This study, “An Analytics Approach to Guide Randomized Controlled Trials in Hypertension Management” will be published in the INFORMS journal Management Science.

In this episode, Dr. Suzanne Oparil and Dr. Sandra Taler discuss strategies to address deteriorating control rates of hypertension, including leveraging combinations of antihypertensive drugs, improving patient adherence, and increasing clinician inertia.   Educational grant support provided by Medtronic. To visit the hub for the Overcoming Challenges in Hypertension Management grant, click here.   Subscribe on iTunes | Subscribe on Google Play |

In this episode, Jason Weidman, SVP and President of Coronary & Renal Denervation at Medtronic, says he's doing exactly what he set out to do when he became an engineer over 20 years ago, creating lifesaving medical devices. Weidman is leading Medtronic's push to secure FDA approval for Medtronic Symplicity Spyral™ RDN system, which uses renal denervation to reduce hypertension. Medtronic's clinical trials of Symplicity have been among the most closely watched - and most difficult to execute - in the industry. Weidman will discuss the challenges while also sharing his reasons for optimism.

Contraception 2021 Sep 20;[EPub Ahead of Print], D Grossman, S Raifman, N Morris, A Arena, L Bachrach, J Beaman, MA Biggs, C Hannum, S Ho, EB Schwarz, M GoldSTUDY DESIGNThis is an interim analysis of an ongoing prospective cohort study conducted at five sites. Clinicians assessed patients in clinic and, if they were eligible for medication abortion and ≤63 days' gestation, electronically sent prescriptions for mifepristone 200 mg orally and misoprostol 800 mcg buccally to a mail-order pharmacy, which shipped medications for next-day delivery. Participants completed surveys three and 14 days after enrollment, and we abstracted medical chart data for this interim analysis.  In this prospective cohort study, researchers estimated the effectiveness, feasibility, and acceptability of medication abortion with mifepristone dispensed by a mail-order pharmacy with next-day delivery after in-person clinical assessment. The researchers found that complete medication abortion occurred for 96.9% of participants; 88.4% reported being very satisfied receiving medications by mail, and 89.6% said they would use the mail-order service again if needed. Of the 4.9% who experienced adverse events, none were related to mail-order dispensing. This research suggests that mail-order pharmacy dispensing of mifepristone is effective and acceptable to patients, providing further evidence that the in-person dispensing requirement for this medication should be removed.  IMPLICATIONSThe in-person dispensing requirement for mifepristone, codified in the drug's Risk Evaluation and Mitigation Strategy, should be removed.      Stevens SM et al. Antithrombotic therapy for VTE disease: Second update of the CHEST Guideline and Expert Panel Report. Chest 2021 Aug 2; [e-pub]. (https://doi.org/10.1016/j.chest.2021.07.055)  The ninth edition of the CHEST Clinical Practice Guidelines for managing venous thromboembolism (VTE) — published in 2012 and updated in 2016 — now has a second update, which addresses 14 clinical questions and offers 32 guidance statements for clinicians who manage patients with VTE. The 2012 guideline (Chest 2012; 141:Suppl:e419S and the 2016 update (NEJM JW Emerg Med Feb 2016 and Chest 2016; 149:315) both are publicly available.Key Recommendations Patients with isolated subsegmental pulmonary embolism (PE): Rule out proximal deep venous thrombosis (e.g., with ultrasonography). If risk for recurrent VTE is low, surveillance is recommended over anticoagulation. If risk for recurrent VTE is high, anticoagulation is recommended. (Weak recommendation, low-certainty evidence) Patients with incidentally discovered asymptomatic PE (other than isolated subsegmental PE): Same initial and long-term anticoagulation that patients with symptomatic PE receive should be used. (Weak recommendation, moderate-certainty evidence) Patients with cancer-associated VTE: Direct-acting oral anticoagulants (DOACs; i.e., apixaban, edoxaban, or rivaroxaban) should be used for the treatment phase of therapy (strong recommendation, moderate-certainty evidence). Caveat: for patients with luminal gastrointestinal malignancies, apixaban or low-molecular-weight heparin is preferred to reduce bleeding risk. Patients with antiphospholipid syndrome: Warfarin (target international normalized ratio, 2.5) is recommended over DOAC therapy during the treatment phase for VTE. (Weak recommendation, low-certainty evidence) Catheter-assisted mechanical thrombectomy: Recommended for patients with PE and hypotension who also have high bleeding risk, failed systemic thrombolysis, or shock that is likely to lead to death before systemic thrombolysis can take effect. (Weak recommendation, low-certainty evidence) Initial anticoagulation setting: Outpatient treatment is recommended over hospitalization in patients with low-risk PE, if access to medications and outpatient care is available. (Strong recommendation, low-certainty evidence) Treatment-phase anticoagulants: DOACs are recommended over warfarin. (Strong recommendation, moderate-certainty evidence) Extended-phase therapy (beyond 3 months) for VTE: Extended anticoagulation should be offered to patients with unprovoked VTE — i.e., with no major or minor transient risk factors. Risk for recurrent VTE, risk for bleeding, and patients' values and preferences should be considered in decisions about extended anticoagulation therapy. (Strong recommendation, moderate-certainty evidence) Low-dose apixaban or rivaroxaban is recommended over full doses of these agents. (Weak recommendation, very low-certainty evidence) Aspirin is recommended for patients who are stopping anticoagulation. (Weak recommendation, low-certainty evidence) Ingason AB et al. Rivaroxaban is associated with higher rates of gastrointestinal bleeding than other direct oral anticoagulants: A nationwide propensity score–weighted study. Ann Intern Med 2021 Oct 12; [e-pub]. (https://doi.org/10.7326/M21-1474) The study used icelands National databank to compare GI bleeding among almost 6000 patients receiving  apixaban, dabigatran, and rivaroxaban for the first time.  Patients were followed for 1-1/2 years and GI bleeding was verified by review of the medical records.  Once there was a propensity score analysis it was deemed that rivaroxaban had significantly high rates of minor and major gastrointestinal bleeding compared to apixaban with a number needed to treat of around 40 or 50.  However there was no difference between rivaroxaban and dabigatran.  I think this goes to what we have all seen and that the bleeding risk among most anticoagulate medications is not equal but unfortunately which medication the insurance companies will pay for it is also not equal.  However if your patient is at large risk for GI bleed likely should consider not using rivaroxaban                     Chen R et al. Comparative first-line effectiveness and safety of ACE (angiotensin-converting enzyme) inhibitors and angiotensin receptor blockers: A multinational cohort study. Hypertension 2021 Sep; 78:591. (https://doi.org/10.1161/HYPERTENSIONAHA.120.16667) In this retrospective study of patients who initiated monotherapy for hypertension, researchers used eight large observational databases to compare outcomes for 2.3 million new users of ACE inhibitors and nearly 700,000 new users of ARBs.  Myocardial infarction, stroke, and heart failure occurred with similar frequency in the two groups, after extensive adjustment for demographic and clinical variables. However, cough, angioedema, pancreatitis, and gastrointestinal bleeding occurred significantly more often in ACE-inhibitor users than in ARB users.            Long-Term Risk for Major Bleeding During Extended Oral Anticoagulant Therapy for First Unprovoked Venous Thromboembolism: A Systematic Review and Meta-analysis: Annals of Internal Medicine: Vol 174, No 10 (acpjournals.org) What happens if you extend anticoagulation past the 3 to 6 months for an individual who has a first unprovoked venous thromboembolism.  Often this is a debate in the clinical practice of while you seem low risk so maybe we should discontinue this anticoagulation or well you had his lab value is off to me we should continue anticoagulation.  The scary thing is you do not want to discontinue the anticoagulation and the may have a massive saddle embolism and die!  It is easy to start a medication but it is always so hard to stop the medication.  this study looked at that exact question --it looked at 14 randomized control trials and 13 cohort studies with just over 17,000 patients taking either vitamin K antagonist or DOACs.  The patient had to have received a minimum of at least 9 months of anticoagulation in order to be enrolled in the final analysis and they looked at patients who had had extended anticoagulation up to 5 years.In the end the incidence of major bleeding with warfarin was 1.7 events per year per 100 patients and much lower with the DOACs at 1.12 events per year per 100 people.  While that does not sound like a lot with the newer agents he has remember that is only after 1 year if he looked at the 5-year cumulative incidence of major bleeding for those individuals on either warfarin or a DOAC it was 6.3% which is certainly at significant risk of bleeding especially when you consider that the case fatality rate was 8.3% expirationThat was a whole bunch of numbers but basically I guess with this meta-analysis is really saying is that the current recommendations for anticoagulation after a unprovoked venous thromboembolism are 3 to 6 months and if you are going to extend that out to 9 months or a year or even up to 5 years he better have a darn good reason given that the eventual rates of bleeding are so high and the mortality rate from those bleeds are also so high.