Podcasts about urinalysis

  During pregnancy, lab tests play a crucial role in monitoring both maternal and fetal health, ensuring early detection of potential complications. Routine blood tests in early pregnancy include a complete blood count (CBC) to check for anemia or infections, blood type and Rh factor screening to prevent incompatibility issues, and tests for infectious diseases such as HIV, syphilis, and hepatitis B. Additionally, rubella immunity testing is done to assess whether the mother is protected against the virus, which can cause severe birth defects if contracted during pregnancy. Urinalysis is also standard to screen for infections, protein levels (which could indicate preeclampsia), and glucose levels, which may suggest gestational diabetes risk. Genetic screenings, such as non-invasive prenatal testing (NIPT) or carrier screening for conditions like cystic fibrosis and sickle cell disease, may also be recommended based on risk factors or family history. As pregnancy progresses, further lab tests are conducted to monitor emerging conditions and ensure fetal well-being. Between 24 and 28 weeks, the glucose challenge test (GCT) is typically performed to screen for gestational diabetes, a condition that can impact both mother and baby if left untreated. A repeat CBC may be ordered in the third trimester to reassess anemia, and Group B Streptococcus (GBS) testing is done around 36 weeks to determine whether antibiotics are needed during labor to prevent newborn infection. Additional testing, such as thyroid function tests, liver function tests, or expanded genetic screening, may be recommended based on the individual's health status and risk factors. These lab tests, combined with regular prenatal care, help guide clinical decisions, ensuring a safe pregnancy and a healthy birth outcome. Your feedback is essential to us! We would love to hear from you. Please consider leaving us a review on your podcast platform or sending us an email at info@maternalresources.org. Your input helps us tailor our content to better serve the needs of our listeners. For additional resources and information, be sure to visit our website at Maternal Resources: https://www.maternalresources.org/. You can also connect with us on our social channels to stay up-to-date with the latest news, episodes, and community engagement: Twitter: https://twitter.com/integrativeob YouTube: https://www.youtube.com/maternalresources Instagram: https://www.instagram.com/integrativeobgyn/ Facebook: https://www.facebook.com/IntegrativeOB Thank you for being part of our community, and until next time, let's continue to support, uplift, and celebrate the incredible journey of working moms and parenthood. Together, we can create a more equitable and nurturing world for all.

Welcome to "The Keto Vegan," where Rachel takes you on a journey through her plant-powered, low-carb lifestyle. In this episode, join Rachel as she and Molly (see episode 10: An Eating Disorder Battle) celebrate Molly's 18th Birthday and go to a West Sussex Thai restaurant. Get an exclusive peek into a day in the life of a keto vegan as she navigates dining out in the evening. But that's not all! Stick around until the end as Rachel shares insights from a thought-provoking blog by Veganuary on UPF, also known as Ultra Processed Food. Tune in to discover how Rachel combines her passion for keto and veganism with valuable knowledge on nutrition and wellness. Get ready to dive deep into the intersection of delicious food, health, and compassion with Rachel on "The Keto Vegan" podcast. Key Takeaways and helpful links # First thing every morning Rachel uses a Urinalysis stick to find out how many ketones she is burning. https://www.amazon.co.uk/gp/product/B07QVFHCJS/ref=ppx_yo_dt_b_asin_title_o05_s00?ie=UTF8&psc=1 # Also, in the morning Rachel takes various supplements: https://theartofantiaging.com/benefits-of-vitamin-b-12-best-plant-based-sources/ https://www.healthline.com/nutrition/best-keto-supplements#TOC_TITLE_HDR_5 # vegan omega 3 https://www.amazon.co.uk/dp/B07W8KB13J?psc=1&ref=ppx_yo2ov_dt_b_product_details # Natural Eye Complex https://www.amazon.co.uk/gp/product/B083WJGXXS/ref=ppx_yo_dt_b_asin_title_o05_s00?ie=UTF8&psc=1 # Vitamin B12 https://www.amazon.co.uk/gp/product/B08GG96FPL/ref=ppx_yo_dt_b_asin_title_o04_s00?ie=UTF8&psc=1 # Electrolyte Plus: https://horbaach.co.uk/products/electrolyte-plus-240-tablets?_pos=1&_sid=1afceacda&_ss=r # Normally Rachel will take 3 small pots of food into work. Today she takes two as she'll be eating in the evening # Out to dinner at The Lemongrass by Nasir in Rustington. Rachel orders a stir fry for her main and it comes covered in Tempura. https://lemongrassbynasir.co.uk/rustington/menu/ # Drinks – single G & skinny T for Rachel as she's driving. # UPFs (Ultra Processed Foods). Rachel wanted to share information from this Veganuary blog. Is it fair that vegan UPFs have been the target of so much criticism? To see the full blog: https://veganuary.com/plant-based-diet-ultra-processed-foods/   Valuable Resources For an extensive list of foods with their carb, fat and protein count, go here: https://www.rachelgtherapy.co.uk/1-what-why-and-how For a keto-vegan start-up menu and shopping list go here: https://www.rachelgtherapy.co.uk/1-what-why-and-how   Host Bio Rachel, a once morbidly obese individual, experienced a remarkable body transformation through the keto diet. Later, she embraced veganism and now shares her extensive knowledge and obsession with carbs in vegan proteins on The Keto Vegan podcast. Her goal is to demonstrate the simplicity of combining the keto diet with a vegan lifestyle. Resources: https://www.rachelgtherapy.co.uk/the-keto-vegan Watch here: https://www.youtube.com/@TheKetoVegan/podcasts Facebook group: https://www.facebook.com/groups/821471059206067 Email: contact@rachelgtherapy.co.uk https://theketovegan.podbean.com/

In this episode of the Family Pet Podcast, host Stephen and guest Dr. Holly Brown discuss the importance of lab work in pet healthcare. They cover topics such as the complete blood count (CBC), fecal testing, and urinalysis. They also explore the differences between in-house testing and reference labs. Dr. Brown emphasizes the value of baseline lab results and provides a fun fact about the origin of the word 'leukemia'. The episode concludes with a preview of Part 2, where they will delve deeper into specific aspects of lab testing.TakeawaysLab work is an essential part of pet healthcare and can provide valuable insights into a pet's overall health.The complete blood count (CBC) is a comprehensive test that examines red blood cells, white blood cells, and platelets.Fecal testing helps detect gastrointestinal parasites and is crucial for both the pet's health and public health.Urinalysis provides valuable information about kidney function, hydration status, and various metabolic processes.Choosing between in-house testing and reference labs depends on factors such as urgency, convenience, and the range of available tests.Performing lab work at different stages of a pet's life can establish baselines and detect abnormalities early on.Chapters00:00 Introduction and Funny Skits01:24 Introducing the Family Pet Podcast and Guest03:23 Lab Work and Its Importance06:19 Understanding the Complete Blood Count (CBC)09:09 Fecal Testing and its Significance13:01 The Urinalysis and its Role in Diagnosis16:31 In-House Testing vs. Reference Labs19:24 When to Perform Lab Work23:45 The Value of Baseline Lab Results24:30 Fun Fact: The Origin of the Word 'Leukemia'26:14 Conclusion and Preview of Part 2

When treating children with cancer and febrile neutropenia, you may ask yourself, "Are urinary cultures a waste of time?" Prof. Bob Phillips (1) of the ADC Archimedes podcast joins ADC Spotlight host Dr. Rachel Agbeko to reflect on this question, basing their discussion on the paper, "Role of urine culture in paediatric patients with cancer with fever and neutropenia: a prospective observational study". They consider the strength of evidence for urine culture testing in such cases, and whether there is an opportunity to reduce the burden on young cancer patients and their families. Read the paper: https://adc.bmj.com/content/108/12/982 (1) Department of Paediatric Haematology and Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, UK The ADC Spotlight podcast is the Archives of Disease in Childhood podcast covering areas that don't usually get much attention or might be taken for granted in children's health. This series is produced by Letícia Amorim and edited by Brian O'Toole. Please listen to our regular podcasts and subscribe on your favourite platform to get episodes automatically downloaded to your phone and computer. And if you enjoy the podcast, please leave us a review on Apple (https://apple.co/48Jhlo6) or Spotify (https://spoti.fi/491FAxu).

Welcome back for another great episode and thank you once again for your dedication and loyalty. Today we delve into several topics. First we break the ice talking about health and nutrition. Working out and dieting and mostly how to count calories and stay away from the scale. Next we get a little into covid, and the vaccination of our kids. I go on to talk about local politics in Pasco County Florida and some of the obstacles when trying to build a legitimate non-profit. And lastly we get into Tony failing his U/A and the emotions behind it... --- Send in a voice message: https://podcasters.spotify.com/pod/show/thethomasfreemepodcast/message

Welcome back for another great episode and thank you once again for your dedication and loyalty. Today we delve into several topics. First we break the ice talking about health and nutrition. Working out and dieting and mostly how to count calories and stay away from the scale. Next we get a little into covid, and the vaccination of our kids. I go on to talk about local politics in Pasco County Florida and some of the obstacles when trying to build a legitimate non-profit. And lastly we get into Tony failing his U/A and the emotions behind it... --- Send in a voice message: https://podcasters.spotify.com/pod/show/thethomasfreemepodcast/message

In this episode, host Alyssa Watson, DVM, is joined by Candice P. Chu, DVM, PhD, DACVP, to talk about her recent Clinician's Brief article, Top 3 Conditions Missed by Skipping Urinalysis. Dr. Chu discusses the most common reasons veterinarians skip this vital diagnostic step and how to perform in-house urinalysis both more efficiently and accurately. She also covers the importance of urinalysis in diagnosing subclinical bacteriuria, Fanconi syndrome, and proteinuria. Dr. Chu reveals a potential contaminant commonly found in veterinary clinics that may impact the accuracy of “tabletop” urine samples.Resources:https://www.cliniciansbrief.com/article/urinalysis-proteinuria-glucosuria-fanconi-syndrome-subclinical-bacteriuria-dogs-catshttps://www.cliniciansbrief.com/article/urinalysis-error-veterinary-medicine-sample-test-resultshttps://www.cliniciansbrief.com/article/management-subclinical-bacteriuriaContact us:Podcast@briefmedia.comWhere to find us:Youtube.com/@clinicians_briefCliniciansbrief.com/podcastsFacebook.com/cliniciansbriefTwitter: @cliniciansbriefInstagram: @clinicians.briefThe Team:Alyssa Watson, DVM - HostAlexis Ussery - Producer & Multimedia Specialist

Looking for more information on this topic? Check out the Renal Laboratory Tests and Urinalysis brick. If you enjoyed this episode, we'd love for you to leave a review on Apple Podcasts.  It helps with our visibility, and the more med students (or future med students) listen to the podcast, the more we can provide to the future physicians of the world. Follow USMLE-Rx at: Facebook: www.facebook.com/usmlerx Blog: www.firstaidteam.com Twitter: https://twitter.com/firstaidteam Twitter: https://twitter.com/mesage_hub Instagram: https://www.instagram.com/firstaidteam/ YouTube: www.youtube.com/USMLERX Learn more about Rx Bricks by signing up for a free USMLE-Rx account: www.usmle-rx.com You will get 5 days of full access to our Rx360+ program, including over 800 Rx Bricks.  After the 5-day period, you will still be able to access over 150 free bricks, including the entire collections for General Microbiology and Cellular and Molecular Biology.

Sponsored by Zoetis. Head to dvm360 Flex and login or create a free CE account and claim your credit after listening to this episode. Program Description: A urinalysis is an essential component of the minimum database, but it is often not performed for numerous reasons. It is important to understand the barriers to urinalyses being performed in order to propose productive solutions that will ensure best medicine for our patients. In addition, there may be a lack of standardization within urine sediment examinations leading to variability in results. This podcast will highlight current concerns around urine sediment analysis and discuss upcoming solutions to workflow efficiency and result consistency.  Program Agenda:  Review the justification for a urinalysis being an essential component of a minimum database along with the current recommendations for performing a urinalysis as part of diagnostic health screenings. Present current compliance towards performing a urinalysis within veterinary practice and what factors lead to its exclusion from a minimum database.  Discuss the segments of the urinalysis workflow that introduce potential error or imprecisions.   Introduce Artificial Intelligence and Differentiate Superficial vs Deep Learning AI. Introduce potential solutions to overcome workflow and standardization concerns. Learning Objectives:   List clinical instances in which a urinalysis would be performed. Understand current barriers to more frequent use of the urinalysis in veterinary hospitals. Evaluate potential sources of error or lack of standardization in urinalysis workflow and results within the veterinary hospital. Recognize the differences between various types of artificial intelligence and understand how deep learning artificial intelligence can advance the accuracy of urine sediment evaluation.

This episode features a conversation with Lisa Parlich, an Infection Preventionist, with a background in Medical Laboratory Sciences. Lisa joins the podcast to talk about an order for urinalysis that was implemented in her hospital. This order is the Urinalysis with Hold order panel. Those of you that work in the laboratory might be familiar with the Urinalysis with reflex to culture order, where if an urinalysis meets the positive criteria for a culture, an order for an urine culture is reflexed, How does this new order differ from traditional orders? How does it help the patients ? How does it work? Tune in to find out.

On this in-depth, investigative edition of Light ‘Em Up we expose what we maintain is an illegal invasion of your personal privacy and an illegal search and seizure in violation of the 4th Amendment.Picture this:  During your annual physical checkup — your doctor draws near to you with the stethoscope and asks you to perform a few deep breaths — is she really listening to your lungs or is she looking for signs of extensive drug use or smelling for the use of alcohol?This is a very odd dilemma.  The doctor writes a prescription for you, and has been doing so for years. Suddenly, without advanced notice, she has an “issue” with doing so. She says, “We need to run a toxicology screen on you”.   A what?You may have no clue whatsoever that your rights are even being violated — by, of all people, your primary care physician and local hospital. In an extension of the “War on Drugs” — as it continues to target the poor and the neediest among us, many hospitals across the country have begun drug testing their patients, especially Medicaid recipients, through urinalysis.The 4th Amendment has been hotly debated since its ratification in 1791.  How much do you know about the rights granted to you by the 4th Amendment?Subjecting patients, especially poor patients, seeking medication for a health condition to an intrusive seizure of his/her bodily fluids is an intentional act of intimidation. Threatening to withhold essential medications from patients — the use of condescending and coercive, bullying tactics through the use of a “pain contract” or a “controlled substance agreement” — serves only to further damage the quality of care that has already been compromised due to the way insurance companies have rigged the system in their favor.This bullying and forced compliance are completely contrary to the “do no harm” motto that has served as the foundational pillar of the medical profession since its inception.Who wants to have a medical doctor who in reality is a “narc” — eager to “report” anything she observes?  What benefit is it to have a “doctor” that violates the doctor-patient trust that is essential and at the core of quality, comprehensive care?If patients distrust their physician, or feel stigmatized or distrusted by them, this will impact greatly upon the therapeutic relationship and deeply compromise care.Lacking sufficient financial means should not be a criminal offense — nor should a course of action apply to only one group of people as a “suspect class”, treating them as if they are not  “worthy” to be afforded the same Constitutional rights as others.At Light ‘Em Up — we have always fought against THIS kind of disparate treatment.In this episode as we lobby for justice and speak truth to power, we shall:♦ Dissect the 4th amendment and provide analysis of what the U.S. Supreme Court says about this process as we delve into what a “pain contract” is.♦ Examine “controlled-substance agreements” for patients on chronic opioid therapy, with a keen eye on “indifferent enforcement” from a criminal justice perspective. Are they binding, or enforceable in a court of law?♦ Dig into our case study:  Rivers vs The Administration of Children Services (ACS) for the City of New York.It's easy to turn a blind eye when the violation of rights applies to someone else. What happens when it happens to you?Tune in - be empowered!  Check here for bonus content. Follow our sponsors Newsly &  Feedspot here:

Urine is more than a natural waste product—it can provide a wealth of information about an individual's overall health, and urinalysis is one of the oldest diagnostic tests in existence. Its use has been dated as far back as Mesopotamia and ancient Greek physician Hippocrates wrote extensively about the use of urinalysis in diagnosing disease in the 6th century BCE. Today, urinalysis can be used to detect a number of diseases and ailments including urinary tract infections, kidney disease, diabetes, and bladder cancer. In this episode, Will Hutt, Head of Primary Care, Acute Rapid & Decentralized Urinalysis at Siemens Healthineers, is joined by Nancy Brunzel, a medical laboratory scientist and author of the book Fundamentals of Urine and Body Fluid Analysis and Jon Stradinger, director of assay development for point of care at Siemens Healthineers. We'll also hear from two experts interviewed for Siemens Healthineers' recent five-part docuseries about the history of urinalysis: Medical Author and Educator Connie Mardis and Kelly St. Vrain, the head of marketing operations for diagnostics at Siemens Healthineers. They're discussing the current state of urinalysis, where it could go in the future, and what it all means for the overall patient experience.Watch Siemens Healthineers' five-part docuseries Urine, A Liquid Lens into Your Health What You'll Learn in This Episode: • Urinalysis is cost-effective and non-invasive—two reasons it is such a popular diagnostic tool. • Urinalysis can play an integral role in the early detection of serious diseases. • Advances in urinalysis such as automated test strip readers have brought new innovations in the consistency and quality control of the test. • There is a lot of potential for the role that artificial intelligence may come to play in interpreting the data of urinalysis results. • Urinalysis has existed for millennia, but it will remain an invaluable tool in healthcare.Connect with Will Hutt· LinkedInConnect with Nancy Brunzel· LinkedInConnect with Jon Stradinger· LinkedInConnect with Kelly St. Vrain· LinkedInConnect with Connie Mardis· LinkedIn Hosted on Acast. See acast.com/privacy for more information.

Overview Urinalysis Color & Clarity Protein RBC WBC Glucose Specific gravity Ketones pH Bilirubin/Urobilinogen Nursing Points General Normal value range Color & Clarity Normal – Yellow Other colors Drug interactions Propofol  – green Methylene blue – blue/green Trauma Red/Brown Liver failure Brown/tea colored Clear – Normal Cloudy Cell or contaminant related Turbid Severe presence of cells (WBC, RBC) pH ~6 Changes in body condition can change pH Metabolic acidosis/alkalosis Protein 0-trace Glomerular permeability/infection RBC 0-2 Bleeding Trauma/injury  below kidneys WBC Negative Sepsis/Infection/UTI Glucose Negative Diabetes Ketones Negative Presence of ketones can indicate endocrine disease like Diabetes Urine Specific Gravity 1.010-1.030 Facilities vary Ability to concentrate urine Hydration Overhydration Decreased USG Dehydration Increased USG Diabetes insipidus Causes increased diuresis SIADH (Syndrome of Inappropriate Antidiuretic Hormone) Causes decreased diuresis Bilirubin/Urobilinogen Negative Presence indicates potential liver problems Nursing Concepts Lab Values Elimination

Urinalysis can be a ship for fools, Dr. Pregerson says in this month's podcast where he explains why you need logic not to miss true UTIs. Read more in the Show Notes.

Digital technology is part of the laboratory. We see it on instruments in Urinalysis and Hematology where images such as those of cells are produced. What about Parasitology? Can it be used for it? Dr. Bobbi Pritt, from the Mayo Clinic Laboratory , joins the podcast to talk about it. An algorithm with Artificial Intelligence has been implemented in her lab for protozoa. How did it do? What are the components? Tune in to find out.

The First Principles of Right Upper Quadrant Pain that can get you through your general surgical rotation: Dr Sherman Kwan takes us through what we NEED to know about gallstones, the biliary tree, and everything in between. === Other Links === Check out our new website ⁠⁠⁠1pm.wiki⁠⁠⁠ for the ⁠⁠⁠Notion document⁠⁠⁠, free Anki flashcards, and podcast episodes. Check out our Instagram: ⁠⁠⁠https://www.instagram.com/firstprinciplesofmedicine/⁠⁠⁠ Recorded 26 July 2022 Co-hosts: Jason D'Silva, Daniel Bontempo, ⁠⁠⁠⁠⁠⁠⁠JT Yeung⁠⁠⁠⁠ & Adian Izwan feat. Dr Sherman Kwan. Produced by Jason D'Silva & Adian Izwan. If you have any ideas or feedback, comment on this Notion document, or shoot us an email at ⁠⁠⁠hello@1pm.wiki⁠⁠⁠ *** We're really excited to be collaborating with Becky from Becky's notes, a UK based resource, to produce an infographic for our visual learners out there. Becky's notes brings together all the key topics medical students need to know in a readily available place, reviewed by specialists in the field. These visually striking notes are a refreshing change from all the boring textbooks. You can check her out on instagram at @beckysnotes01 and get her books at ⁠⁠⁠https://linktr.ee/Beckysnotes⁠⁠⁠ === Timestamps === (02:37) What is the Gallbladder? (06:07) Admirand's Triangle (07:52) Colicky Pain (09:42) The Biliary Tree  (11:16) Bugs in the Tubes (11:43) The Case (12:29) The A to E (15:30) The History (20:14) Red Flags (22:33) Examination Findings (28:01) Murphy's Sign (29:42) Urinalysis (31:18) Investigations - Bloods (34:51) Investigations - Imaging (35:50) Management  

This week, Paul breaks down his latest set of bloodwork from March 2023. He not only reviews his own levels and ratios, but gives you an idea of what blood work you may want to order, and how to interpret it. 00:04:20 Why you may consider getting your own blood work done 00:11:00 What Paul eats in a day 00:13:40 Fasting insulin & prolactin 00:19:55 Cortisol to DHEA-S ratio 00:27:42 Sex hormones & phlebotomy 00:37:35 DHT 00:40:35 How to help (or hurt) your testosterone 00:48:45 Uric acid & GGT 00:50:30 Hemoglobin A1c & Comp. Metabolic Panel 00:53:20 Urinalysis  00:54:50 Amenorrhea profile, Prostate-Specific Ag, IGF-1, Reverse T3, Vitamin D, Lipoprotein (a), C-Reactive Protein 00:58:17 TMAO: is it harmful? 00:59:25 Homocysteine, Magnesium,  and TSH & Free T4 01:00:50 Lipids: do they matter? 01:05:20 CBC 01:06:20 Conclusions about blood work 01:07:45 NAFLD Paul's recommendations for what labs you should get: CBC Comprehensive Metabolic Panel Fasting Insulin PTH Full thyroid panel, TSH, antibodies, Free T3, Free T4, Testosterone, Free Testosterone, Sex hormone LH, FSH, Prolactin, DHT, Estrogens, Progesterone, Preglinulone, Cortisol, DHEA-S, HSCRP, Liver enzymes, Lipid panel, (Coronary Artery Calcium Scan), PTH. Sponsors: Heart & Soil: www.heartandsoil.co Carnivore MD Merch: www.kaleisbullshit.shop Make a donation to the Animal Based Nutritional Research Foundation: abnrf.org  Animal-based 30 Challenge: https://heartandsoil.co/animalbased30/ Earth Runners: www.earthrunners.com, use code PAUL for 10% off your order  Eight Sleep: $150 off the PodPro cover at www.eightsleep.com/carnivoremd Zero Acre: www.zeroacre.com/PAUL or use code PAUL for free shipping on your first order Bon Charge: boncharge.com, use code CARNIVOREMD for 15% off your order

Get a free nursing lab values cheat sheet at NURSING.com/63labs   Overview Urinalysis Color & Clarity Protein RBC WBC Glucose Specific gravity Ketones pH Bilirubin/Urobilinogen Nursing Points General Normal value range Color & Clarity Normal – Yellow Other colors Drug interactions Propofol  – green Methylene blue – blue/green Trauma Red/Brown Liver failure Brown/tea colored Clear – Normal Cloudy Cell or contaminant related Turbid Severe presence of cells (WBC, RBC) pH ~6 Changes in body condition can change pH Metabolic acidosis/alkalosis Protein 0-trace Glomerular permeability/infection RBC 0-2 Bleeding Trauma/injury  below kidneys WBC Negative Sepsis/Infection/UTI Glucose Negative Diabetes Ketones Negative Presence of ketones can indicate endocrine disease like Diabetes Urine Specific Gravity 1.010-1.030 Facilities vary Ability to concentrate urine Hydration Overhydration Decreased USG Dehydration Increased USG Diabetes insipidus Causes increased diuresis SIADH (Syndrome of Inappropriate Antidiuretic Hormone) Causes decreased diuresis Bilirubin/Urobilinogen Negative Presence indicates potential liver problems Nursing Concepts Lab Values Elimination

Welcome to the Paint The Medical Picture Podcast, created and hosted by Sonal Patel, CPMA, CPC, CMC, ICD-10-CM. Thanks to all of you for making this a Top 15 Podcast for 2 Years: https://blog.feedspot.com/medical_billing_and_coding_podcasts/ I'd love your continued support of this content-rich, value-add podcast to help you succeed in the business of medicine: https://podcasters.spotify.com/pod/show/sonal-patel5/support Sonal's 8th Season starts up and Episode 13 features her Newsworthy updates for the month's fraud, waste, and abuse cases. Trusty Tip features Sonal's compliance recommendations for the third CBR of 2023 - the CBR report issued on Laboratory Testing Urinalysis. Spark inspires us all to reflect on creativity based on the inspirational words of Pablo Picasso. Thanks to Advanced Coding Services, LLC: Website: https://advancedcodingservices.com/ Paint The Medical Picture Podcast now on: Spotify for Podcasters: https://podcasters.spotify.com/pod/show/sonal-patel5 Spotify: https://open.spotify.com/show/6hcJAHHrqNLo9UmKtqRP3X Apple Podcasts: https://podcasts.apple.com/us/podcast/paint-the-medical-picture-podcast/id1530442177 Google Podcasts: https://podcasts.google.com/feed/aHR0cHM6Ly9hbmNob3IuZm0vcy8zMGYyMmZiYy9wb2RjYXN0L3Jzcw== Amazon Music: https://music.amazon.com/podcasts/bc6146d7-3d30-4b73-ae7f-d77d6046fe6a/paint-the-medical-picture-podcast Breaker: https://www.breaker.audio/paint-the-medical-picture-podcast Pocket Casts: https://pca.st/tcwfkshx Radio Public: https://radiopublic.com/paint-the-medical-picture-podcast-WRZvAw Find Paint The Medical Picture Podcast on YouTube: https://www.youtube.com/channel/UCzNUxmYdIU_U8I5hP91Kk7A Find Sonal on LinkedIn: https://www.linkedin.com/in/sonapate/ And checkout the website: https://paintthemedicalpicturepodcast.com/ If you'd like to be a sponsor of the Paint The Medical Picture Podcast series, please contact Sonal directly for pricing: PaintTheMedicalPicturePodcast@gmail.com --- Send in a voice message: https://podcasters.spotify.com/pod/show/sonal-patel5/message Support this podcast: https://podcasters.spotify.com/pod/show/sonal-patel5/support

Today's Story: Poppy Seeds and Drug Tests

Dr. Jack Stockwell, www.forbiddendoctor.com & www.jackstockwell.com Phone: 866-867-5070. Included in this podcast: knowing the correct cholesterol levels, why you shouldn't be taking Statin drugs, fighting depression during and after the holidays, Dr Jack's warnings about Lipitor, urinalysis guidelines, treating thyroid issues, scientists growing blood in labs, tips for improving your cardiovascular health and much more.

Date: Dec 15, 2022 Reference: Mahajan et al. Serious bacterial infections in young febrile infants with positive urinalysis results. Pediatrics. October 2022 Guest Skeptic: Dr. Brian Lee is a pediatric emergency medicine attending at the Children's Hospital of Philadelphia and Assistant Professor of Pediatrics at the Perelman School of Medicine at the University of Pennsylvania. […] The post SGEM #387 Lumbar Punctures in Febrile Infants with Positive Urinalysis-It's Just Overkill first appeared on The Skeptics Guide to Emergency Medicine.

On this week's podcast, Paul takes you through his most recent blood work from November 2022, alongside his genetic results, as well as an abbreviated version of what he eats in a day. He talks about how his levels have changed since his previous bloodwork and, specifically, what he implemented to get his free testosterone up, and his sex-hormone binding globulin down. He clearly shows his transparent bloodwork to indicate that he has not, and does not, take any performance enhancing drugs. A note from Paul: Throughout my training and practice as a physician I have come to one very disappointing conclusion: Western medicine isn't helping people lead better lives. Now that I've realized this, I've become obsessed with understanding what makes us healthy or ill. I want to live the best life I can and I want to be able to share this knowledge with others so that they can do the same. This podcast is the result of my relentless search to understand the roots of chronic disease. If you want to know how to live the most radical life possible I hope you'll join me on this journey. Time Stamps: 00:08:26 Podcast begins 00:13:69 Paul's bloodwork (Testosterone) 00:18:06 Lowering his SHBG and Iron Labs 00:26:09 Paul's genetics 00:28:29 APOE44- How does this affect longevity? 00:37:015 The importance of the thyroid 00:38:59 CBC results 00:42:11 Urinalysis results 00:43:39 Cholesterol results 00:44:39 More bloodwork results and what levels look like if someone is taking growth hormones 00:50:06 Cronomoter breakdown of a day of Paul's food consumption 00:54:15 What labs should you get? Sponsors: Heart & Soil: www.heartandsoil.co Carnivore MD Merch: www.kaleisbullshit.shop Make a donation to the Animal Based Nutritional Research Foundation: abnrf.org White Oak Pastures: www.whiteoakpastures.com, use code CarnivoreMD for 10% off your first order or Carnivore5 for 5% off subsequent orders Bon Charge: https://boncharge.com, use code CARNIVOREMD for 15% off your order Colima Salt: drpaulsalt.com, for a free bag of Colima Sea Salt Shirttail Creek Farm: shirttailcreekfarm.com, use code CarnivoreMD20 for $20 off order of $100 or more

Join Jame and Callum as they take a deep dive into urinalysis, a commonly (mis)used test for UTI (and other conditions). This test put you into murky waters when used clinically and we hope to give some information to avoid being a pisse prophet.Some sources referred to in this episode:NICE Clinical knowledge summarySMI 41: Investigation of urineSummary article of PPV and NPV for urinalysis:- Diagnosis and treatment of urinary tract infections across age groups, AJOG, 2018Performance of LE and Nitrite at differing levels of bacteruria:-  Evaluation of Leukocyte Esterase and Nitrite urine dipstick, J Clin microbiol, 1999Review of urinalysis diagnostic utility by presenting symptoms:- Does this woman have an acute uncomplicated urinary tract infection? JAMA 2002Questions, comments, suggestions to idiotspodcasting@gmail.com or Tweet us @IDiots_podPrep notes for completed episodes can be found here: https://1drv.ms/u/s!AsaWoPQ9qJLShugmB2EOm8FMePNBtA?e=IKApb5If you are enjoying the podcast please leave a review on your preferred podcast app!Feel like giving back? Donations of caffeine gratefully received!https://www.buymeacoffee.com/idiotspod

Teaching renal anatomy & physiology is tricky and sometimes difficult. In The Pee Episode I'll tell you how I know that for sure. Plus, I'll share some possible strategies for providing the clarity needed to avoid confusion and that unhelpful kind of frustration that sometimes accompanies the renal module in our course. And there's a song from Greg Crowther! 00:00 | Introduction 00:47 | Adventures With Tarzan 06:51 | Making Heads or Tails or Loops 20:32 | Sponsored by AAA 21:31 | Big Picture of Renal A&P 32:27 | Pee Values With Greg Crowther 34:34 | Sponsored by HAPI 35:39 | Scared? 41:39 | Sponsored by HAPS 42:33 | Urinalysis 50:17 | Staying Connected   ★ If you cannot see or activate the audio player, go to: theAPprofessor.org/podcast-episode-125.html

Looking for more information on this topic? Check out the Renal Laboratory Tests and Urinalysis brick. If you enjoyed this episode, we'd love for you to leave a review on Apple Podcasts.  It helps with our visibility, and the more med students (or future med students) listen to the podcast, the more we can provide to the future physicians of the world. Follow USMLE-Rx at: Facebook: www.facebook.com/usmlerx Blog: www.firstaidteam.com Twitter: https://twitter.com/firstaidteam Twitter: https://twitter.com/mesage_hub Instagram: https://www.instagram.com/firstaidteam/ YouTube: www.youtube.com/USMLERX Learn more about Rx Bricks by signing up for a free USMLE-Rx account: www.usmle-rx.com You will get 5 days of full access to our Rx360+ program, including over 800 Rx Bricks.  After the 5-day period, you will still be able to access over 150 free bricks, including the entire collections for General Microbiology and Cellular and Molecular Biology.

Looking to screen potential new hires in Glendale for drug abuse issues? Get in touch with Aim 4 Recovery (818-369-7089) for timely lab urinalysis drug test results. Visit https://www.aim4recovery.com (https://www.aim4recovery.com) to get started.

Paul shares the results from his August Bloodwork panel from Marek Health. He does a deep dive into Testosterone, Immunoglobulin, Boron, Genistein, Isoflavonoids and touches on TMAO, Uric acid, and GGT. A note from Paul: Throughout my training and practice as a physician I have come to one very disappointing conclusion:  Western medicine isn't helping people lead better lives. Now that I've realized this, I've become obsessed with understanding what makes us healthy or ill. I want to live the best life I can and I want to be able to share this knowledge with others so that they can do the same. This podcast is the result of my relentless search to understand the roots of chronic disease. If you want to know how to live the most radical life possible I hope you'll join me on this journey. Time Stamps: 00:09:43 Podcast begins 00:12:08 Paul's lipid panel  00:14:48 Is elevated LDL a risk factor for heart disease? 00:24:08 Paul's Plasma, Ammonia results 00:25:28 Paul's Anemia profile 00:32:08 Paul's Blood Count profile 00:34:08 Paul's Thyroid panel 00:36:53 Comprehensive metabolic panel 00:38:13 Paul's Urinalysis 00:40:13 Paul's hormones 00:42:53 Insulin sensitivity  00:47:30 Boron 00:59:58 How to optimize your testosterone and increase androgen receptors 01:03:18 The detriments of consuming soy 01:05:43 Paul's thoughts on TMAO 01:09:40 Paul reviews the remainder of his bloodwork Sponsors: Heart & Soil: www.heartandsoil.co Sign up for Animal Based Gathering 2023: animalbasedgathering.com  Make a donation to the Animal Based Nutritional Research Foundation: abnrf.org   Marek Health: marekhealth.com/fundamentalhealth, use code PAUL for 10% off your first lab order Primal Pastures: www.primalpastures.com, use code CarnivoreMD for 10% off your first order Eight Sleep: www.eightsleep.com/carnivoremd for exclusive Labor Day Savings through 9/11 and to get $150 off your order White Oak Pastures: www.whiteoakpastures.com, use code CarnivoreMD for 10% off your first order or Carnivore5 for 5% off subsequent orders

The TWiP team solves the case of the Woman Who Vomited Up a Worm, and discuss how malaria transmission intensity can modify the effectiveness of the RTS, S/AS01 vaccine in Africa. Hosts: Vincent Racaniello, Dickson Despommier, Daniel Griffin, and Christina Naula Subscribe (free): Apple Podcasts, Google Podcasts, RSS, email Links for this episode Malaria intensity modifies vaccine effectiveness (J Inf Dis) Letters read on TWiP 208 Become a patron of TWiP Case Study for TWiP 208 An adult female resident of Hawai'i presented to the emergency department (ED) with several days of fever, abdominal pain, urinary hesitancy, and generalized itchiness. white blood cell [WBC] count 14,000 cells/mL) without eosinophilia. Urinalysis suggested a urinary tract infection and she was treated for acute UTI and discharged home.  The following day she returned to the ED because of worsening abdominal pain, bilateral hip and leg pain, dizziness, diffuse hyperesthesia, and allodynia (Pain from stimuli which are not normally painful)  (worse on her feet and legs.) Urine culture from her initial ED visit grew normal urogenital flora. Her leukocytosis increased and she now had eosinophilia (WBC count 15,500 cells/mL; absolute eosinophil count 574). Laboratory evaluation was otherwise unremarkable. CT scans of the brain, abdomen, and pelvis were normal. She was hospitalized and her allodynia worsened despite treatment with analgesics. She also developed a sensation of “electric eels swimming through [her] body. Electromyography and nerve conduction studies were normal. The patient underwent a lumbar puncture and CSF examination was notable for eosinophilic meningitis with 138 WBCs and 13% eosinophils (absolute eosinophil count 18). Send your case diagnosis, questions and comments to twip@microbe.tv Music by Ronald Jenkees

This episode is hosted by Joshua Sommovilla, M.D, The Sanford R. Weiss, MD Center for Hereditary Colorectal Neoplasia at the Cleveland Clinic and features Matthew Kalady, M.D, The Ohio State University Wexner Medical Center and Mohammad Abbas, M.D., MPH, Northwestern University.Together they discuss “Evaluation of Urinalysis-Based Screening for Urothelial Carcinoma in Patients With Lynch Syndrome” which was published in the Journal of Dis Colon Rectum. and found here: https://pubmed.ncbi.nlm.nih.gov/34882627/This episode was recorded on April 25th, 2022 and reflects expert opinion at the time of the recording.

In this episode, we review the high-yield topic of Urinalysis from the Renal section. Follow Medbullets on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbulletsIn this episode --- Send in a voice message: https://anchor.fm/medbulletsstep1/message

Our previous episode focused on the most common blood panels. This week's follow-up episode focuses on the other common diagnostic tests that can be bundled with blood panels or as a stand-alone test. ZoeySmith, LVMT, joins the podcast today to explain what pet parents can expect from a fecal test and urinalysis at the veterinary clinic. Here are links to the information we talked about today: Zoonosis: What Is All the Fuss About? From Today's Veterinary Nurse Zoonotic Diseases and Pets FAQ from the American Veterinary Medical Association Fecal Testing in Cats & Dogs from Essentials PetCare Why Does My Pet Need a Urinalysis? from FirstVet Got a question for Michael and Stephen? Run across something interesting you want to share with the show? Do you have a topic idea for a future episode? Send it to us at thefamilypetpodcast@gmail.com. 

In this episode, listen as Karen H. Costenbader, MD, MPH, and Brad H. Rovin, MD, answer key questions about identifying patients at high risk for lupus nephritis, whether an elevated serum creatinine always signals lupus nephritis, the safety of newer therapies for lupus in women who are pregnant or breastfeeding, and the possibility of using SGLT2 inhibitors in patients with lupus nephritis.Presenters: Karen H. Costenbader, MD, MPHProfessor of MedicineDepartment of MedicineHarvard Medical SchoolDirector, Lupus ProgramDivision of Rheumatology, Inflammation and ImmunityBrigham and Women's HospitalBoston, MassachusettsBrad H. Rovin, MDProfessor and Director, Division of NephrologyThe Lee A. Hebert Professor of NephrologyMedical Director, The Ohio State Center for Clinical Research ManagementThe Ohio State University Wexner Medical CenterColumbus, OhioReview the downloadable slidesets at: https://bit.ly/3mlHOlaLink to full program:https://bit.ly/3aC2NNL

Ang Katiyakan ng Kaligtasan ay Nagpapatuloy

Ang Katiyakan ng Kaligtasan ay Nagpapatuloy

Pananatili kay Jesus

Pananatili kay Jesus

Wala Tayong Maidaragdag sa Ginawa ni Cristo

Wala Tayong Maidaragdag sa Ginawa ni Cristo

Bladder carcinoma   Bladder cancer is 3x as likely in men than women Transitional cell carcinoma is > 90% of bladder cancers. Risk Factors Smoking!! Chronic irritation Clinical Presentation –  Bloody urine is the most common presenting symptom Pyuria Dysuria Labs, Studies and Physical Exam Findings   Urinalysis shows hematuria   U/S, CT, MRI   […] The post S2 E097 Genitourinary Neoplasms and a small hack to help you through school appeared first on Physician Assistant Exam Review.

Dr. Diaz completes the renal diseases & urinalysis powerpoints.

Brandon Amalani has been involved in the wellness industry for 20 years with a focus on Traditional Chinese Medicine and Herbalism. He is the founder and owner of Shen Blossom and Blushield Global USA. Brandon is dedicated to helping people elevate their conscious awareness and health utilizing time honored and modern methods and tools. In this episode, you'll discover: -Brandon's journey into EMF mitigation and scalar technology...05:30 -Details on the technology used to test the impact of EMF...09:10 -EMF stands for electromagnetic field (or frequencies) and it is worth learning about for your health and well being...11:00 -Dr. Wiles recommendation for a basic primer on EMF...12:20 -https://www.amazon.com/Non-Tinfoil-Guide-EMFs-Stupid-Technology/dp/1976109124/ref=sr_1_1?gclid=CjwKCAiAvaGRBhBlEiwAiY-yMDU2mRr6q0ftDrInOjr2HvfjC_IwLww_nL_GAuRoW17T5Y01bwOJ8hoCm6YQAvD_BwE&hvadid=413890563546&hvdev=c&hvlocphy=9008540&hvnetw=g&hvqmt=b&hvrand=1366201998899528223&hvtargid=kwd-422516748870&hydadcr=3209_10392192&keywords=the+non+tin+foil+guide+to+emf&qid=1646884020&sr=8-1 (The Non-Tinfoil Guide to EMF: How to Fix Our Stupid Use of Technology) by Nicholas Pineault -On a physical level, our bodies are essentially electromagnetic field water machines...13:00 -https://www.emf-portal.org/en (www.emf-portal.org) is a resource with many scientific studies regarding EMF...16:30 -An explanation of non-native EMF vs. native EMF...17:00 -EMF: the chronic stress you didn't know you were dealing with...21:10 -Mitochondrial and cellular damage from EMF...24:30 -The $30 million FDA toxicology study...27:10 -Dr. Deborah Davis is a leading advocate to draw attention to the dangers of EMF...30:00 -Dr. Wiles keeps a Blushield in his pocket and wears https://getlambs.com/product/faraday-boxer-briefs (Lambs boxer briefs) that block EMF...33:00 -Brandon's expert opinion on defender cases and other devices that are marketed to block EMF...33:50 -Brandon's article https://www.blushield-us.com/can-you-actually-block-emf/ ("Can we actually block EMF?") -Brandon's elevator pitch about scalar energy...43:20 -How scalar energy helps protect you from EMF; it's like tuning the dial to the station you want...47:50 -Brandon explains the flashing light on the Blushield device...50:20 -The Cube is the top recommended product; find out why...54:00 -Your physiology becomes stronger and more adaptive as you are exposed to the Blushield technology...57:10 -Dr. Wiles personal experience with Blushield...1:03:20 -Improved sleep and sleep patterns resulting from the Cube...1:06:40 -New studies on animals that shows great promise for this technology...1:08:20 -Urinalysis study on humans shows decreased stress...1:12:05 -Brandon's company has sold products all over the world and has a less than 1% return rate...1:17:00 -Blushield is powerful enough for 5G because the body will always move towards what is beneficial and away from what is harmful...1:18:25 -The planet has never experienced this level of radiation and we will have to see what the impact is overall...1:21:10 -The Blushield website has a chart that clearly defines the specifications of each product...1:22:55 Resources mentioned: www.blushield-us.com (Coupon code DOCWILES) Guest's social media handles: https://www.instagram.com/blushieldusa/?hl=en (Blushield Global USA Instagram)

Dr. Wendie Trubow shares some staggering information about gluten sensitivity toxins, and how to get them right.  Dr. Trubow is acting President of the National Celiac Association and certified at the American Board of Obstetrics & Gynecology.  She's the author of Dirty Girl - Ditch the Toxins, Look Great and Feel FREAKING Amazing.  Find Optimal Performance Podcast episodes, discounts on health optimization gear and learn about the work I do as a Life Coach and Performance Coach at Seanmccormick.com  In this episode we cover:  •Celiac disease effects many people •How gluten opens the tight junctions in your gut •How stress and trauma can activate gluten sensitivity leading to celiac disease •Symptoms of different types of toxicity •Double check toxicity of household products here:  https://www.ewg.org/ •Urinalysis for toxicity levels •How can you test for mold toxicity •40% of humans have one or both of the genes that lead to celiac •Going from no problem with gluten to full autoimmune issues •How to understand •Adrenal, Liver and Gut (and vagina for women) are closely connected and important to health •The difference between, integrated, holistic and functional medicine •fivejourneys.com/promo email required @wendytrubowmd •IFM.org to find functional medicine practitioner

For such a seemingly simple sample there's a lot you can learn from a urinalysis. Many of us also have a fair amount of uncertainty around much of the 'how' of urine sample handling, analysis and interpretation. It's also the one bit of lab work where being good at in-house testing can make a big difference to the reliability of your results. We KNOW you'll have had some disagreements at some point in your career about at least a few of the questions we answer in this episode, like fridge vs benchtop, how old is too old for a urine sample, how long after starting antibiotics can you still culture, is it even worth culturing a free-flow sample, WHEN should I culture, can you trust your dipstick, can you trust AI, why some urinary bugs just won't die, and what the heck is the deal with casts?! I also suspect that, like us, you'll learn a few things that you didn't even KNOW you should know. Our guest is Dr Kristen Todhunter, a pathologist for the SVS Pathology Network who confesses to having a bit of a soft spot for all things microbiology. She answers all of the questions we've ever had around how to get the most from your urinalysis. Thanks to the SVS Pathology Network, who our Aussie listeners will know as Vetnostics in NSW, QML Vetnostics in Queensland, TML Vetnostics in Tasmania, ASAP in Victoria and Vetpath in WA, for providing us with the brainpower for our pathology series and for supporting the podcast. If you love new toys and tech (or if you like lasers!) you should definitely check out this video about Maldi TOF spectrometry - the amazing new technology that will explain why SVS clients will now get super-fast turnaround times for their microbiology testing. Go to thevetvault.com for show notes and to check out our guests' favourite books, podcasts and everything else we talk about in the show. If you want to lift your clinical game, go to vvn.supercast.com for a free 2-week trial of our short and sharp high-value clinical podcasts. We love to hear from you. If you have a question for us or you'd like to give us some feedback please leave us a voice message by going to our episode page on the anchor app and hitting the record button, via email at thevetvaultpodcast@gmail.com, or just catch up with us on Instagram. And if you like what you heard then please share the love by clicking on the share button wherever you're listening and sending a link to someone who you know will enjoy listening. --- Send in a voice message: https://anchor.fm/vet-vault/message

In the Chapter, "The Lost Art of Urinalysis," I describe two young dogs whose lives turn around once we isolated their individual pattern of imbalance causing a high urinary Ph in Lola, the Newfoundland and severe hematuria (blood in the urine) in Coco, the Aussie-doodle. If conventional veterinarians primarily looks at causative bacteria, they can miss some of the main imbalances which give rise to infections in the first place. In my book, Zen and the Art of Caring for Pets, I shine a light on various issues in our profession, two seemingly unrelated problems: One is veterinary burnout and the other is the lack of safe therapeutic options in chronic care. But by using botanical therapies and diet, patients can make miraculous recoveries. Clients are happier and in turn, veterinarians can experience a more fulfilled life dream to help animals. This chapter really emphasizes one difference between holistic and conventional medicine-whether you focus on the bacteria or virus or you focus on the immune system, that innate ability we all have to fight disease. If you or someone you know has a pet with chronic urinary issues, this podcast may be of interest to you. Please subscribe to my youtube channel and give me a review on Amazon if you can! More information is available on my website www.nwholisticpetcare.com. #urinarytractinfections #urine #canine #dog #UTI #sterilecystitis #cystitis #naturopathicpetdoc --- Support this podcast: https://anchor.fm/donna943/support

Dr. Bruce R. Gilbert MD discusses Microscopic Urinalysis 5/1/20

In this episode, Dr Matt & Dr Mike explore what information can be gathered from your wee! They review colour, smell, taste(?!), specific gravity, pH, glucose, ketones, red blood cells, proteins, nitrites, white blood cells, and bilirubin/urobilinogen.

Hot Bizitches, Pizza Rock, Urinalysis, Heart Horny, Easter A-Hole, Llama Drama, Death By Pizzaroll --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app Support this podcast: https://anchor.fm/hotbusiness/support

Ihahayag ng Panginoong Diyos sa kanyang mga anak ang mabuting pag-asa sa hinaharap.

#scuttlebutt #trainedtotrain Consider supporting on Patreon if you like this content: https://www.patreon.com/thescuttlebuttshow ScuttleButt Merch: https://scuttlebuttshow.com The ScuttleButt Show: https://anchor.fm/thescuttlebuttshow ScuttleButt Discord: https://discord.gg/EwDXr8Etzm VETERAN CRISIS LINE: 1-800-273-8255 or text 838255 https://www.veteranscrisisline.net --- Support this podcast: https://anchor.fm/thescuttlebuttshow/support

Many USMLE Qs are gotten right by having an accurate understanding and interpretation of the urinalysis results given in the stem. This podcast covers the vast majority of the urinalysis scenarios encountered on the USMLE Step 1-3 exams. You’ll be a master at navigating these scenarios after this. I also integrate a broad range of … Continue reading Divine Intervention Episode 287 – The Ultra HY USMLE Urinalysis Podcast.

Description Is a urinalysis required for a DOT physical? Link: https://rankingmastery.com/edit_questions.asp?action=info&id=1247&a=9022&p= Answer is: Firstly, we're looking for glucose, which is sugar. Then we're looking for protein, blood, and specific gravity. All of those together give us a good picture of whether or not your kidneys are functioning. If you have any indications of diabetes, if you need to be referred out further for evaluation from someone else. It just gives us a good idea to see whether or not a baseline of you being healthy.     That's www.drivershealthclinic.com.   Watch on Video: https://www.youtube.com/watch?v=VbXEajvBJ20 We hope you learned something of value from this video. To reach Bethany with Drivers Health Clinic directly go to: https://drivershealthclinic.com or email them at: drdixon@drivershealthclinic.com Do you want to get discovered on the web like all or our Guests RankingMastery Podcast Go to the RankingMastery website at https://rankingmastery.com

UCR 035: E&M 2021 Q&A: Other qualified health professional definition, Data - can I count note and PSAs in the note as separate data points? Is BCG with assessment a level 2 E/M? Prescription drug management clarification.January 15, 2021Mark, Ray, and Scott discuss several questions about the new 2021 E&M rules from the Urology Coding and Reimbursement Group:Question 1It's now 2021 and I'm reviewing the coding seminar that I attended virtually in September. On the discussion of E&M coding based on time the phrase:Distinct time spent by physician and "other qualified health professional" for the visit on the E/M encounter on the date of serviceappeared on one of the slides. (The quotes and italics were added by myself.) What is the definition of "other qualified health professional?" Is that a nurse? Could that be a certificated medical assistant who takes time to track down a lab result or helps the patient fill out an IPSS score sheet?Question 2Regarding the 2021 E&M new rules, if I see a new patient for elevated psa and review the referring doctor's clinic note including three psa tests that are in that note does that count as four items in Element 2 of Medical Decision making?For example, I review the note (one item), I review a unique psa from 2/4/2018 (second item), I review another psa from 3/5/2019 (third item), I review another psa from 6/2/2020 (fourth item). All the psa tests share a similar CPT code but they are from different dates and are unique tests. I reviewed them from the doctor's note and not directly from the Lab Corps documents. Did I get 4 items for Element 2?Second question. For Element 2 do I just need to qualify for Category 1 or Category 2 or Category 3 or do I need to qualify in two out of three of the categories in Element 2?Question 3 Would it be considered legitimate to bill a level 2 E/M with BCG with assessment below? The reasoning is at the time of service, the decision to proceed is based on results of UA performed that day, & how well the patient did with prior treatment so they are evaluating and making a decision for the procedure on the same day even though it is scheduled in advance.Would you consider it ok to bill for a level 2 E/M with a BCG?"Bladder cancer Here for #6 out of 6 of BCG induction therapy which he has tolerated well. Urinalysis ordered today shows moderate pyuria and microscopic blood, no bacteria. This is consistent with his BCG treatments, no signs or symptoms of infection. He feels well with no urinary symptoms today. Proceeded with instillation of half dose BCG."Question 4 We have had a couple of questions from our providers that we’d like clarification on. They are as follows:If you are continuing a medication on a patient but they don’t need refill is it acceptable to renew the med in urochart but not send to a pharmacy? This way you get credit for prescription drug management and still bill a level 4.Is there a place where I can get clarification on the wall chart information like what classifies as a “minor risk” and “new interpretation of test” and “new ordering of test”.I’ve watched several webinars and gone through power point slides, but I think examples are the most helpful. For example, does a PVR count as a “review of unique test” or “order of unique test”?If I review CT images and summarize my findings is that “independent interpretation test”? Is that true if it was performed at UA or ARA?What is a minor surgery without risk? Where can I find a list of “risks”?Element 2 explanations are giving me the most trouble.

The doctor's exam room can be an intimidating place when you're sitting there in your hospital gown, all drafty in the back and all. Sometimes just getting the feel for the sound of all those lab tests and what they might mean, may make the experience less overwhelming. Today I go over several different groups, or panels, which screen your blood for signs of any problems. Here are the cliff notes, if you want to see the numbers in writing: fasting blood sugar (FBS): 65 – 100 is normal. You may also see 110 as an upper limit of normal. Random blood sugar (RBS): 100 – 140. You may also see 160 as an upper limit of normal. If you have diabetes, 180 might be considered normal for you. Hemoglobin A1C (also called glycosylated hemoglobin): 4.3 – 6.1 is normal. If you are diabetic, up to 7.0 might be considered normal for you. All pregnant women should undergo a glucose tolerance test at around 24 weeks gestation. Abnormally high glucose levels should be treated aggressively. Symptoms of low blood sugar include clamminess, shakiness, rapid heartbeat, anxiety, and eventually (if on insulin) even coma. Symptoms of high blood sugar include increased thirst, frequent urination, extreme fatigue, weight loss, blurred vision, trouble concentrating, and severe headaches. Urinalysis: sugar should be negative (if positive, your doctor will definitely check for diabetes and probably a UTI). Protein should be negative. Positive protein could imply a problem with your kidneys. Ketones should be negative. The urine should be clear. Cloudy urine could mean infection and amber color urine could mean severe dehydration. A Chem 20 or metabolic panel includes: potassium: 3.6 – 5.1. Sodium: 136 – 145 chloride: 98 – 107 if threes 3 are high, you could simply be dehydrated. If they are extremely high, that could signal a possible kidney problem. Carbon dioxide: less than 32. This measures how well your lungs are expelling air. Blood urea nitrogen (BUN): less than 20 Creatinine: less than 1.1. This could go as high as 6.0, which might signal acute kidney disease. Albumin: 3.5 – 5.2. Low indicates a sign of malnutrition. High values may mean kidney dysfunction, so your Dr. will look at other labs for more information. Calcium: 8.9 – 10.3 Alkaline phosphatase (ALT): 10 – 35. This is a liver function test. A CBC panel tests for infection. The most common value is:   White blood cell count (WBC): 4 – 11.  A sign of infection if high.   A high MCV may mean you have large but too few of those Iron-containing cells. Your doctor will look into a deficiency of active vitamin B12. this is called pernicious anemia. A low MCV may be a sign of iron deficiency anemia. lipid panel: total cholesterol: less than 200 (closer to 150 is ideal) HDL: 40 – 60 LDL: less than 90 LDL/HDL ratio: less than 5.1                                          Triglycerides: 150 or less (this will be high with diabetes) As always, if you have any specific questions about any nutrition-related lab tests, feel free to contact me on my contact page, on my Healing outside the box.com website.

Are U Talkin’ UTIs Re: Me? Infectious Diseases expert, Dr Boghuma Titanji MD, PhD  @boghuma (Emory; TED) schools us on the diagnosis and management of urinary tract infections: updated definitions of complicated and uncomplicated UTI, pitfalls of the urinalysis, first line antibiotics, duration of therapy and which agents to use for complicated UTI. This episode is liquid gold!  Listeners can claim Free CE credit through VCU Health at http://curbsiders.vcuhealth.org/ (CME goes live at 0900 ET on the episode’s release date).  Show Notes | Subscribe | Spotify | Swag! | Top Picks | Mailing List | thecurbsiders@gmail.com | Free CME!   Credits Written and Produced by: Matthew Watto MD, FACP  Cover Art and Infographic by: Edison Jyang Hosts: Matthew Watto MD, FACP; Paul Williams MD, FACP    Editor: Molly Heublein MD (written materials); Clair Morgan of nodderly.com Guest: Boghuma Kabisen Titanji MD, PhD Sponsor - 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. See info sheet for further directions. Note: A free VCU Health CloudCME account is required in order to seek credit.   Time Stamps Sponsor - VCU Health Continuing Education 00:30 Intro, disclaimer, guest bio 02:50 Guest one-liner, Picks of the Week*: Urban gardening, Behave (book) by Robert Sapolsky 08:54 Defining UTI; Framework for UTI 16:35 Case 1 - Cath Foley; Acute uncomplicated cystitis; Interpreting the Urinalysis 28:00 Women with recurrent UTIs 38:55 Case 2 - UTI in a man 47:15 Treatment of complicated infections; Duration of therapy 52:27 Case 3 - Catheter associated UTI; MRSA UTI 61:25 Duration of therapy for bacteremia from UTI 64:40 Take home points, plugs and outro Sponsor - VCU Health Continuing Education   Links* Behave (book) by Robert Sapolsky Boghuma’s blog theiddoc.net Boghuma’s TED Talk  Emory’s ID fellowship program   *The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on our Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra.   Goals Listeners will appropriately recognize, diagnose and treat the various presentations of urinary tract infection.   Learning objectives After listening to this episode listeners will... Define UTI and feel confident making the diagnosis of UTI based on lab tests, history and exam findings Differentiate between complicated and uncomplicated UTI Recognize how UTI may presents differently in differ groups (paraplegic, chronic foley catheter, men and women) Choose the appropriate antibiotic and duration with an eye towards antibiotic stewardship Determine an approach to the patient with recurrent UTIs, including who may benefit from long term antibiotic prophylaxis.    Disclosures Dr Titanji reports no relevant financial disclosures. The Curbsiders report no relevant financial disclosures.    Citation Titanji BK, Williams PN, Watto MF. “#231 U Talkin’ UTIs Re: Me”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list Final publishing date August 24, 2020.

Have Questions? Send yours to askjeff@comeonover.com! He may just answer it in a future podcast!  IGQ&A - Jeff’s Instagram Links & Recipes#Heyguys it’s the Drinking EpisodeRecipesCocktail Recipes From Andrea, Your Local Neighborhood BartenderFollow AndreaWatch Jeff open the awesomest birthday gift ever! (From Emily of course).Want to jam out again to those face-melting theme songs?Click HERE to listen to all of Jeff’s one-of-a-kind tunes. And guess what….there will be new ones each week! 

Join Yvonne Brandenburg, RVT, VTS SAIM and Jordan Porter RVT, LVT, VTS SAIM as we talk about: Bladder stones, prostates, and UTIs; OH MY! We discuss common urolithiasis, inflammation vs infection of the prostate, and urinary infections as a whole.    Remember, this episode counts for 1 hour of RACE approved CE. Find out more at https://internalmedicineforvettechsmembership.com    Question of the Week Would anyone in our amazing group be interested in a urinalysis “how-to” crash course for basic urine cytology?  Leave a comment at https://imfpp.org/episode40   Resources We Mentioned in the Show  Linda Merrill, L. V. (2012). Small Animal Internal Medicine for Veterinary Technicians and Nurses. Ames: Wiley-Blackwell. Eclin Path:  https://eclinpath.com/urinalysis/    Thanks so much for tuning in. Join us again next week for another episode!  Get Access to the IMFVT Membership Site https://internalmedicineforvettechsmembership.com   Get Access to the Technician Treasure Trove  Sign up at https://imfpp.org/treasuretrove    Thanks for listening!  – Yvonne and Jordan

Urinalysis Urine Crystals UTI

A look at the top medical headlines for the week of March 29, 2020, including: A treatment combining radiation and chemotherapy could be much more effective for colorectal cancer. Then, scientists have discovered that a WWI helmet is actually superior to even modern equipment when it comes to protecting its wearers from shock waves. And finally, doctors can tell whether you’re rich or poor through urinalysis.

Join us for a discussion of how we make sure that labs are reviewed in a way that maximizes ideal health from a Functional Medicine perspective as we focus on Female Pelvic Care and particularly a loss of intimacy. Chances are you have an issue that labs can reveal. Labs reviewed in a way you may not have seen include: CBC, Metabolic Panel, A1C, Cholesterol, Urinalysis, Iron and ferritin, Thyroid labs (inc. TSH, T4, Free T3, Reverse T3, Antithyroid Antibodies), Vitamin D, RBC Magnesium, CRP, B12, Folate, Homocysteine, GGT, Microalbumin/Cr ratio, IGF-1/Somatomedin ~ Growth Hormone, Cortisol timed x 4, Estrogen, Progesterone, Testosterone. For info on how I interpret the labs email us at Info@drmcwhorter.com and we will email a guide.

Show Notes Differentiating bronchiolitis from asthma and reactive airway disease in young children can be challenging, and a rapidly changing clinical presentation can confound accurate assessment of the severity of the illness. This episode reviews risk factors for apnea and severe bronchiolitis; discusses treatments/therapies and provides evidence-based recommendations for the management of pediatric patients with bronchiolitis. Show More v Pathophysiology Bronchiolar narrowing and obstruction is caused by: Increased mucus secretion Cell death and sloughing Peri-bronchiolar lymphocytic infiltrate Submucosal edema Smooth muscle constriction seems to have a limited role, perhaps explaining the lack of response to bronchodilators. Median duration of illness is 12 days in children 2 yo.3 Late fall epidemic peaking Nov-March, in the US.4 Human Metapneumovirus (HMPV) accounts for 3-19% 5,6 Similar seasonal variation to RSV. Parainfluenza, influenza, adenoviruses, coronaviruses, rhinoviruses, and enteroviruses are other causes.4-6 Rhinoviruses have been shown to play a larger role in Asthma.7 Presentation The American Academy of Pediatrics defines it as any of the following in infants: 1 Rhinitis Tachypnea Wheezing Cough Crackles Use of accessory muscles Nasal flaring Differential Diagnosis Emergent Causes Infection: pneumonia, chlamydia, pertussis Foreign body: aspirated or esophageal Cardiac anomaly: congestive heart failure, vascular ring Allergic reaction Bronchopulmonary dysplasia exacerbation Non-acute Causes Congenital anomaly: tracheoesophageal fistula, bronchogenic cyst, laryngotracheomalacia Gastroesophageal reflux disease Mediastinal mass Cystic fibrosis Clinical Pearls Vomiting, wheezing, and coughing associated with feeding; consider GERD. Wheezing associated with position changes; consider tracheomalacia or great vessel anomalies. Wheezing exacerbated by flexion of neck and relieved by neck hyperextension; consider vascular ring. Multiple respiratory tract infections and failure to thrive; consider cystic fibrosis or immunodeficiency. Wheezing with heart murmur, cardiomegaly, cyanosis, exertion or sweating with feeding; consider cardiac disease. Sudden onset of wheezing and choking; consider foreign body. Risk Factors for Severe Bronchiolitis Age < 6-12 weeks11-13 Prematurity < 35-37 weeks’ gestation11-13 Underlying respiratory illness such as bronchopulmonary dysplasia1 Significant congenital heart disease; immune deficiency including HIV, organ or bone marrow transplants, or congenital immune deficiencies14,15 Altered mental status (impending respiratory failure) Dehydration due to inability to tolerate oral fluids Ill appearance12 Oxygen saturation level ≤ 90%1 Respiratory rate: > 70 breaths/min or higher than normal rate for patient age1,12 Increased work of breathing: moderate to severe retractions and/or accessory muscle use1 Nasal flaring Grunting Risk Factors for Apnea Full-term birth and < 1 month of age16,17 Preterm birth (< 37 weeks’ gestation) and age < 2 months post birth11-13,17 History of apnea of prematurity Emergency department presentation with apnea17 Apnea witnessed by a caregiver17 Diagnostic Testing Xray Radiographs increase the likely hood of a physician giving antibiotics, even if the X-ray is negative.18-20 Routine radiography is discouraged, but may be helpful when severe disease requires further evaluation or exclusion of foreign body. Viral testing is not necessary for the diagnosis but may help when searching for the cause of fever in young infants. 2016 ACEP fever guidelines note that positive viral testing can impact further workup of fever for a serious bacterial infection (SBI).21 In infants 90% Clinicians may choose not to use continuous pulse oximetry (weak recommendation due to low-level evidence and reasoning)1 Fluids IV or NG administration of fluids to combat dehydration, until respiratory distress and tachypnea resolve. Suctioning Routine use of “deep” suctioning may not be beneficial and may be harmful.1 Nasal suction should be used to help infants with respiratory distress, poor feeding or sleeping. Bronchodilators1,25,26 Generally nor recommended for routine use. May trial in infants with: Severe bronchiolitis (these were excluded in the studies). History of prior wheezing. Family history of atopy/asthma in an older infant. Anticholinergic Agents (ipratropium bromide) No evidence for improvement in bronchiolitis.31-34 Corticosteroids AAP1, Cochrane Review27, and PECARN28 study all recommend against, finding no evidence for improvement. One small study (70 patients) found a benefit utilising 1 mg/kg oral dexamethasone followed by 0.6 mg/kg daily for 5 days. However, the study limited by size and increased prevalence of family history of atopy. Recommendations remain against use in first time wheezers with bronchiolitis. Racemic Epinephrine Not recommended1. Further study needed. Racemic Epinephrine + Oral Dexamethasone Pediatric Emergency Research Canada trial at 8 Canadian pediatric EDs involving 800 infants aged 6 weeks to 12 months with bronchiolitis found that the epinephrine-dexamethasone group had a lower admission rate over 7 days than the placebo group (17.1% vs 26.4%). This was not statistically significant. Further study needed. 30 Hypertonic Saline AAP guidelines do not recommend use in the ED but note clinicians may utilize it in the inpatient setting. 1 Cochrane reviews in 2013 and 2017 found some inpatient benefit, but a conflicting publication found it may worsen cough.35-37 High Flow Nasal Cannula (HFNC) Several small pediatric ICU studies show a benefit in severe cases. No large ED randomized trials exist, to date. Study protocols included weight based or age based flow rates. Nasal CPAP Shows benefit in pediatric ICU settings. Evidence vs HFNC is limited. Disposition Consider admission if any of the following are present: Risk for apnea Risk for severe bronchiolitis Respiratory distress, particularly if it interferes with feeding Hypoxia (oxygen saturation ≤ 90%) Decreased feeding and/or dehydration An unreliable caregiver (ie, unable to ensure patient care and appropriate 24-hour follow-up) All patients with severe bronchiolitis should be admitted.

In this episode, Dr. Sushrut Waikar takes us through his approach to interpreting a urinalysis. We work through classic patterns, caveats, and discuss when to consider a further workup. This episode is a helpful review of some of the basics with the addition of helpful clinical pearls that will help you on the wards. www.runthelistpodcast.com/nephrology/#urinalysis Click here for this episode's handout: http://bit.ly/urinalysis_pdf

A quick follow-up on the Peyronie's conversation from last week and then the Doc explains why urinalysis test results might need a second opinion before rushing to get that prescription. Please leave a rating and a review on iTunes: https://podcasts.apple.com/us/podcast/two-men-and-a-doc/id1464231512 Click on 'Listen on Apple Podcasts' From there you can leave a review, rate us, and subscribe! Send us your comments and questions: mail@twomenandadoc.com twitter: @twomenandadoc Dr. Hyman's info: www.drhymanla.com --- Send in a voice message: https://anchor.fm/twomenandadoc/message

Who wants to talk about pee? In this episode, we’ll review the different components of urinalysis including dipstick, microscopy, and culture. We’ll hit the different types of casts and stones, trying to understand when and why they form. Get excited to interpret some urine! 

Show Notes Jeff: Welcome back to EMplify the podcast corollary to EB Medicine’s Emergency Medicine Practice. I’m Jeff Nusbaum and I’m back with Nachi Gupta for the 30th episode of EMplify and the first Post-Ponte Vedra Episode of 2019. I hope everybody enjoyed a fantastic conference. This month, we are sticking in the abdomen for another round of evidence-based medicine, focusing on Emergency Department Management of Patients With Complications of Bariatric Surgery. Nachi: As the obesity epidemic continues to worsen in America, bariatric procedures are becoming more and more common, and this population is one that you will need to be comfortable seeing. Jeff: Thankfully, this month’s author, Dr. Ogunniyi, associate residency director at Harbor-UCLA, is here to help with this month’s evidence-based article. Nachi: And don’t forget Dr. Li of NYU and Dr. Luber of McGovern Medical School, who both played a roll by peer reviewing this article. So let’s dive in, starting with some background. Starting off with some real basics, obesity is defined as a BMI of greater than 30. Jeff: Oh man, already starting with the personal assaults, I see how this is gonna go… Show More v Nachi: Nah! Just some definitions, nothing personal! Jeff: Whatever, back to the article… Obesity is associated with an increased risk of hypertension, hyperlipidemia, and diabetes. Rising levels of obesity and associated co-morbidities also lead to an increase in bariatric procedures, and thereby ED visits! Nachi: One study found a 30-day ED utilization rate of 11% for those undergoing bariatric surgery with an admission rate of 5%. Another study found a 1-year post Roux-en-y ED visit rate of 31% and yet another found that 25% of these patients will require admission within 2 years of surgery. Jeff: Well that’s kind worrisome. Nachi: It sure is, but maybe even more worrisome is the rising prevalence of obesity. While it was < 15% in 1990, by 2016 it reached 40%. That’s almost half of the population. Additionally, back in 2010, it was estimated that 6.6% of the US population had a BMI> 40 – approximately 15.5 million adults!! Jeff: Admittedly, the US numbers look awful, and honestly are awful, but this is a global problem. From the 80’s to 2008, the worldwide prevalence of obesity nearly doubled! Nachi: Luckily, bariatric surgical procedures were invented and honed to the point that they have really shown measurable achievements in sustained weight loss. Along with treating obesity, these procedures have also resulted in an improvement in associated comorbidities like hypertension, diabetes, NAFLD, and dyslipidemia. Jeff: A 2014 study even showed an up to 80% reduction in the likelihood of developing DM2 postoperatively at the 7-year mark. Nachi: Taken all together, the rising rates of obesity and the rising success and availability of bariatric procedures has led to an increased number of bariatric procedures, with 228,000 performed in the US in 2017. Jeff: And while it’s not exactly core EM, we’re going to briefly discuss indications for bariatric surgery, as this is something we don’t often review even in academic training programs. Nachi: According to joint guidelines from the American Society for Metabolic and Bariatric Surgery, the American Association of Clinical Endocrinologists, and The Obesity Society, there are three groups that meet indications for bariatric surgery. The first is patients with a BMI greater than or equal to 40 without coexisting medical problems. The second is patients with a BMI greater than or equal to 35 with at least one obesity related comorbidity such as hypertension, hyperlipidemia, or obstructive sleep apnea. And finally, the third is patient with a BMI of 30-35 with DM or metabolic syndrome though current evidence is limited for this group. Jeff: Based on the obesity numbers, we just cited – it seems like a TON of people should be eligible for these procedures. Which again reiterates why this is such an important topic for us as EM clinicians to be well-versed in. Nachi: As far as types of procedures go – while there are many, there are 3 major ones being done in the US and these are the lap sleeve gastrectomy, Roux-en-Y gastric bypass, and lap adjustable gastric banding. In 2017, these were performed 60%, 18%, and 3% of the time. Jeff: And sadly, no two procedures were created alike and you must familiarize yourself with not only the procedure but also its associated complications. Nachi: So we have a lot to cover! overall, these surgeries are relatively safe with one 2014 review publishing a 10-17% overall complication rate and a perioperative 30 day mortality of less than 1%. Jeff: Before we get into the ED specific treatment guidelines, I think it’s worth discussing the procedures in more detail first. Understanding the surgeries will make understanding the workup, treatment, and disposition in the ED much easier. Nachi: Bariatric procedures can be classified as either restrictive or malabsorptive, with restrictive procedures essentially limiting intake and malabsorptive procedures limiting nutrient absorption. Not surprisingly, combined restrictive and malabsorptive procedures like the Roux-en-y gastric bypass tend to be the most effective. Jeff: Do note, however that 2013 guidelines do not recommend one procedure over another and leave that decision up to local surgical expertise, patient specific risk factors, and treatment goals. Nachi: That’s certainly an important point for the candidate patient. Let’s start by discussing the lap gastric sleeve. In this restrictive procedure, 80% of the greater curvature of the stomach is excised producing early satiety and weight loss from decreased caloric intake. This has been shown to have both low mortality and a low overall rate of complications. Jeff: Next we have the lap adjustable gastric band. This is also a restrictive procedure in which a plastic band is placed laparoscopically around the fundus leaving behind a small pouch that can change in size as the reservoir is inflated and deflated percutaneously. Nachi: Unfortunately this procedure is associated with a relatively high re-operation rate – one study found 20% of patients required removal or revision. Jeff: Even more shockingly, some series showed a 52% repeat operation rate. Nachi: 20-50% chance of removal, revision, or other cause for return to ER - those are some high numbers. Finally, there is the roux-en-y gastric bypass. As we mentioned previously this is both a restrictive and a malabsorptive procedure. In this procedure, the duodenum is separated from the proximal jejunum, and the jejunum is connected to a small gastric pouch. Food therefore transits from a small stomach to the small bowel. This leads to decreased caloric intake and decreased digestion and absorption. Jeff: Those are the main 3 procedures to know about. For the sake of completeness, just be aware that there is also the biliopancreatic diversion with or without a duodenal switch, as well as a vertical banded gastroplasty. The biliopancreatic diversion is used infrequently but is one of the most effective procedure in treating diabetes, though it does have an increased risk of complications. Expect to see this mostly in those with BMIs over 50. Nachi: Now that you have a sense of the procedures, let’s talk complications, both general and specific. Jeff: Of course, it should go without saying that this population is susceptive to all the typical post-operative complications such as venous thromboembolic disease, atelectasis, pneumonia, UTIs, and wound complications. Nachi: Because of their typical comorbidities, CAD and PE are still the leading causes of mortality, especially within the perioperative period. Jeff: Also, be on the lookout for self-harm emergencies as patients with known psychiatric disorders are at increased risk following bariatric surgery. Nachi: Surgical complications are wide ranging and can be grouped into early and late complications. More on this later… Jeff: Nutritional deficiencies are common enough to warrant pre and postoperative screening. Thiamine deficiency is one of the most common deficiencies. This can manifest within 1-3 months of surgery as beriberi or later as Wernicke encephalopathy. Symptoms of beriberi include peripheral neuropathy, ataxia, muscle weakness, high-output heart failure, LE edema, and respiratory distress. Nachi: All of that being said, each specific procedure has it’s own unique set of complications that we should discuss. Let’s start with the sleeve gastrectomy. Jeff: Early complications of sleeve gastrectomy include staple-line leaks, strictures, and hemorrhage. Leakage from the staple line typically presents within the first week, but can present up to 35 days, usually with fevers, tachycardia, abdominal pain, nausea, vomiting sepsis, or peritonitis. This is one of the most serious and dreaded early complications and represents an important cause of morbidity with an incidence of 3-7%. Nachi: Strictures commonly occur at the incisura angularis of the remnant stomach and are usually due to ischemia, leaks, or twisting of the gastric pouch. Patients with strictures usually have n/v, reflux, and intolerance to oral intake. Jeff: Hemorrhage occurs due to erosions at the staple line, resulting in peritonitis, hematemesis, or melena. Nachi: Late complications of sleeve gastrectomies include reflux, which occurs in up to 25% of patients, and strictures, which lead to epigastric discomfort, nausea, and dysphagia. Jeff: I’m getting reflux and massive heartburn just thinking about all of these complications, or the tacos i just ate…. Next we have the Roux-en-Y bypass. Nachi: Early complications of the Roux-en-Y Gastric Bypass include anastomotic or staple line leaks, hemorrhage, early postoperative obstruction, and dumping syndrome. Jeff: Leak incidence ranges from 1-6%, usually occurring at the gastro-jejunostomy site. Patients typically present within the first 10 days with abdominal pain, nausea, vomiting, and the feeling of impending doom. Some may present with isolated tachycardia while others may present with profound sepsis – tachycardia, hypotension, and fever. Nachi: Similar to the sleeve, hemorrhage can occur both intraperitoneally or intraluminally. This may lead to hematemesis or melena depending on the location of bleeding. Jeff: Early obstructions usually occur at either the gastro-jejunal or jejuno-jejunal junction. Depending on the location, patients typically present either within 2 days or in the first few weeks in the case of the gastro-jejunal site. Nachi: If the obstruction occurs in the jejuno-jejunostomy site, this can cause subsequent dilatation of the excluded stomach and lead to perforation, which portends a very poor prognosis. Jeff: Next, we have dumping syndrome. This has been seen in up to 50% of Roux-en-Y patients. Nachi: Early dumping occurs within 10-30 minutes after ingestion. As food rapidly empties from the stomach, this leads to distention and increased contractility, leading to nausea, abdominal pain, bloating, and diarrhea. This usually resolves within 7-12 weeks. Jeff: Moving on to late complications of the roux-en y - first we have marginal ulcers. Peptic ulcer disease and diabetes are risk factors and tobacco use and NSAIDs appear to increase your risk. In the worse case, they present with hematemesis or melena. Nachi: Internal hernias, intussusception, and SBOs are also seen after Roux-en-y gastric bypass. Patients with internal hernias usually present late in the postoperative period following significant weight loss. Jeff: Most studies cite a rate of 1-3% for internal hernias, with mortality up to 50% if there is strangulation. Nachi: And unfortunately for us on the front lines, diagnosis can be challenging. Presenting symptoms may be vague and CT imaging may be negative when patients are pain free, thus laparoscopy may be needed to definitively exclude an internal hernia. Jeff: Strictures may occur both during the early and late period. Most are minor, but significant strictures may result in obstruction. Nachi: Trocar site hernias and ventral hernias are also late complications, usually found after significant weight loss. Jeff: Cholelithiasis is another very common complication of bypass surgery, occurring in up to one third of patients, usually occurring during a peak incidence period between 6-18 months. Nachi: For this reason, the current recommendation is that patients undergoing bypass be placed on ursodeoxycholic acid for 6 months preventatively. Jeff: Some even go as far as to recommend prophylactic cholecystectomy to prevent complications, but as of 2013, the recommendation was only ‘to consider’ it. Nachi: Nutritional deficiencies are also common complications. Vitamin D, B12, Calcium, foate, iron, and thiamine deficiencies are all well documented complications. Patients typically take vitamins postoperatively to prevent such complications. Jeff: And next we have late dumping syndrome, which is far more rare than the last two complications. In late dumping syndrome, 1-3 hours after a meal, patients suffer hypoglycemia from excessive insulin release following the food bolus entering the GI tract. Symptoms are those typical of hypoglycemia. Nachi: Lastly, let’s talk about complications of lap adjustable gastric band surgery. In the early post op period, you can have esophageal and gastric perforations, which typically occur during balloon placement. Patients present with abd pain, n/v, and peritonitis. These patients often require emergent operative intervention. Jeff: The band can also be overtightened resulting in distention of the proximal gastric pouch. Presenting symptoms include abd pain with food and liquid intolerance and vomiting. Symptoms resolves once the balloon is deflated. The band can also slip, allowing the stomach to move upward and within the band. This occurs in up to 22% of patients and can cause strangulation. Presentation is similar to bowel ischemia. Nachi: Later complications include port site infections due to repeated port access. The infection can spread into connector tubing and the peritoneal cavity causing systemic symptoms. Definitely start antibiotics and touch base with the bariatric surgeon. Jeff: The connector can also dislodge or rupture with time. This can present as an arrest in weight loss. It’s diagnosed by contrast injection into the port. Of note, this complication is less common due to changes in the technique used. Nachi: Much like early band slippage and prolapse, patients can also experience late band slippage and prolapse after weeks or months. In extreme cases, the patients can again have strangulation and symptoms of bowel ischemia. More mild cases will present with arrest in weight loss, reflux, and n/v. Jeff: The band can also erode and migrate into the stomach cavity. If this occurs, it usually happens within 2 years of the initial procedure with an incidence of 4-11%. Presenting symptoms here include epigastric pain, bleeding, and infections. You’ll want to obtain emergent imaging if you are concerned. Nachi: And lastly there are two rare complications worth mentioning from any gastric bypass surgery. These are nephrolithiasis, possibly due to increased urinary oxalate excretion or hypocitraturia, and rhabdomyloysis. Jeff: That was a ton of information but certainly valuable as most EM clinicians, even ones in practice for decades, are unlikely to have that depth of knowledge on bariatric surgery. Nachi: And truthfully these patients are complicated. Aside from the pathologies we just discussed, you also have to still bear in mind other abdominal conditions unrelated to their surgery like appendicitis, diverticulitis, pyelo, colitis, hepatitis, pancreatitis, mesenteric ischemia, and GI bleeds. Jeff: Moving on to my favorite - prehospital care - as always, ABCs first. Consider IV access and early IV fluids in those at risk for dehydration and intra-abdominal infections. In terms of destination, if it’s feasible and the patient is stable consider transport directly to the nearest bariatric center - early efforts up front will really expedite patient care. Nachi: Once in the ED, you will want to continue initial stabilization. Special considerations for the airway include a concern for a difficult airway due to body habitus. Make sure to position appropriately and preoxygenate the patients if time allows. Keep the patient upright for as long as possible as they may desaturate quickly when flat. Jeff: We both routinely raise the head of the bed for all of our intubations. This is ever more important for your obese patients to help maximize your chance of first pass success without significant desaturation. Nachi: And though I’m sure we all remember this from residency, it’s worth repeating: tidal volume settings on the ventilator should be based on ideal body weight, not actual body weight. At 6 to 8 mL/kg. Jeff: Tachycardic patients should make you concerned for hypovolemia 2/2 dehydration, sepsis, leaks, and blood loss. Consider performing a RUSH exam (that is rapid ultrasound for shock and hypotension) to identify the cause. A HR > 120 with abdominal pain should make you concerned enough to discuss urgent ex-lap with the surgeon to evaluate for the post op complications we discussed earlier. Nachi: If possible, obtain a view of the IVC also while doing your ultrasound to assess for volume status. But bear in mind that ultrasound will undoubtedly be more difficult if the patient has a large body habitus, so don’t be disappointed if you’re not getting the best views. Jeff: Resuscitation should be aimed at early fluid replacement with IV crystalloids for hypovolemic patients and packed RBC transfusions for patients presumed to be unstable from hemorrhage. No real surprises there for our listeners. Nachi: Once stabilized, gather a thorough history. In addition to the usual questions, ask about po intolerance, early satiety, hematemesis, and hematochezia. Definitely also gather a thorough surgical history including name of procedure, date, known complications post op, and name of the surgeon. Jeff: You might also run into “medical tourism” or global bariatric care. Patients are traveling overseas to get their bariatric care more and more frequently. Accreditation and oversight is variable in different countries and there isn’t a worldwide standard of care. Just an important phenomenon to be aware of in this population. Nachi: On physical exam, be sure to look directly at the belly, making note of any infections especially near a port-site. Given the reorganized anatomy and extent of soft tissue in obese patients, don’t be reassured by a benign exam. Something awful may be happening deeper. Jeff: This naturally brings us into diagnostic testing. Not surprisingly, labs will be helpful in these patients. Make sure to check abdominal labs and a lipase. Abnormal LFTs or lipase may indicate obstruction of the biliopancreatic limb in bypass patients. Nachi: A lactic acid level will help in suspected cases of hypoperfusion from sepsis or bowel ischemia. Jeff: And as we mentioned earlier, these patients are often at risk for ACS given their comorbidities. Be sure to check a troponin if you suspect cardiac ischemia. Nachi: If concerned for sepsis, draw blood cultures, and if concerned for hemorrhage, be sure to send a type and screen. Urinalysis and urine culture should be considered especially for early post op patients, symptomatic patients, or those with GU complaints. Jeff: And don’t forget the urine pregnancy test for women of childbearing age, especially prior to imaging. Nachi: Check an EKG immediately after arrival for any patient that may be concerning for ACS. A normal ekg of course does not rule out a cardiac cause of their presentation. Jeff: As for imaging, plain radiographs certainly play a role here. For patients with respiratory complaints, check a CXR. In the early postoperative period, there is increased risk for pneumonia. Nachi: Unstable patients with abdominal pain will benefit from an emergent abdominal series, which may show free air under the diaphragm, pneumatosis, air-fluid levels, or even dilated loops of bowel. Jeff: Of course don’t forget that intra abd air may be seen after laparoscopic procedures depending on how recently the operation was performed. Nachi: Plain x-ray can also help diagnose malpositioned or slipped gastric bands. But a negative study doesn’t rule out any of these pathologies definitively, given the generally limited sensitivity and specificity of x-ray. Jeff: You might also consider an upper GI series. Emergent uses include diagnosis of slipped or prolapsed gastric bands as well as gastric or esophageal perforations. Urgent indications include diagnosis of strictures. These can also diagnose gastric band erosions and help identify staple-line or anastomotic leaks in stable patients. Nachi: However, upper GI series might not be easy to obtain in the ED, so it’s often not the first test performed. Jeff: This brings us to the workhorse for diagnostic evaluation. The CT. Depending on suspected pathology, oral and/or IV contrast will be helpful. Oral contrast can help identify gastric band erosions, staple-line leaks, and anastomotic leaks. Leaks can be identified in up 86% of cases with oral contrast. Nachi: CT will also help diagnose internal hernias. You might see the swirl sign on CT, which represents swirling of the mesenteric vessels. This is highly predictive of an internal hernia, with a sensitivity of 78-100% and specificity of 80-90% according to at least two studies. Jeff: While CT is extremely helpful in making this diagnosis, note that it may be falsely negative for internal hernias. A retrospective review showed a sensitivity of 76% and a specificity of 60%. It also showed that 22% of patients with an internal hernia on surgical exploration had a negative CT in the ED. Another study found a false negative rate of 32%. What does all this mean? It likely means that a negative study may still necessitate diagnostic laparoscopy to rule out an internal hernia. Nachi: While talking about CT, we should definitely mention CTA for concern of pulmonary embolism. In order to limit contrast exposure, you might consider doing a CTA chest and CT of the abdomen simultaneously. Jeff: Next up is ultrasound. Ultrasound is still the first-line imaging modality for assessing the gallbladder and for biliary tract disease. And as we mentioned previously, ultrasound should be considered for your RUSH exam and for assessing the IVC. Nachi: We also should discuss endoscopy, which is the test of choice for diagnosing gastric band erosions. Endoscopy is also useful for evaluating marginal ulcers, strictures, leaks, and GI bleeds. Endoscopy additionally can be therapeutic for patients. Jeff: When treating these patients, attempt to contact the bariatric surgeon for guidance as needed. This shouldn’t delay imaging however. Nachi: For septic patients, make sure your choice of antibiotics covers intra-abdominal gram-negative and anaerobic organisms. Port-site infections require gram-positive coverage to cover skin flora. Additionally, give IV fluids, blood products, and antiemetics as appropriate. Jeff: Alright, so this month, we also have 2 special populations to discuss. First up, the kids. Nachi: Recent estimates from 2015-2016 put the prevalence of obesity of those 2 years old to 19 years old at about 19%. As obese children are at higher risk for comorbidities later in life and bariatric surgery remains one of the best modalities for sustained weight loss, these surgical procedures are also being done in children. Jeff: Criteria for bariatric surgery in the adolescent population is similar to that of adults and includes a BMI of 35 and major comorbidities (like diabetes or moderate to severe sleep apnea) or patients with a BMI 40 with other comorbidities associated with long term risks like hypertension, dyslipidemia, insulin resistance and impaired quality of life. Nachi: Despite many adolescents meeting criteria, they should be referred with caution as the long term effects are unclear and the adolescent experience is still in its infancy with few pediatric specific programs. Jeff: Still, the complication rate is low - about 2.3% with generally good clinical outcomes including improved quality of life and reducing or staving off comorbidities. Nachi: Women of childbearing age are the next special population. They are at particular risk because of the unique caloric and nutrient needs of a pregnant mother. Jeff: Pregnant women who have had bariatric surgery have an increased risk of perinatal complications including prematurity, small for gestational age status, NICU admission and low Apgar scores. However, these risks come with benefits as other studies have shown reduced incidence of pre-eclampsia, large for gestational age neonates, and gestational diabetes. Nachi: 2013 guidelines from various organizations recommend avoiding becoming pregnant for at least 12-18 months postoperatively, with ACOG recommending a minimum of 2 years. Bariatric surgery patients who do become pregnant require serial monitoring for fetal growth and higher doses of supplemental folate. Jeff: We also have 2 pretty cool cutting edge techniques to mention this month before getting to disposition. Nachi: Though these are certainly not going to be done in the ED, you should be aware of two new techniques. Recently, the FDA approved 3 new endoscopic gastric balloon procedures in which a balloon is inflated in the stomach as a means of simulating a restrictive procedure. Complications include perforation, ulceration, GI bleeding, and migration with obstruction. As of now, they are only approved as a temporary modality for up to 6 months. Jeff: And we also have the AspireAssist siphon, which was approved in 2016. With the siphon, a g tube is placed in the stomach, and then ⅓ of the stomach contents is drained 20 minutes after meals, thus limiting overall digested intake. Nachi: Pretty cool stuff... Jeff: Yup - In terms of disposition, decisions should often be made in conjunction with the bariatric surgical team. Urgent and occasionally emergent surgery is required for those with hemodynamic instability, anastomotic or staple line leaks, SBO, acute band slippage with dilatation of the gastric pouch, tight gastric bands, and infected port sites with concurrent intra abdominal infections. Nachi: And while general surgeons should be well-versed in these complications should the patient require an emergent surgery, it is often best to stabilize and consider transfer to your local bariatric specialty facility. Jeff: In addition to the need for admission for surgical procedures, admission should also be considered in those with dehydration and electrolyte disturbances, those with persistent vomiting, those with GI bleeding requiring transfusions, those with acute cholecystitis or choledococholithiasis, and those with malnutrition. Nachi: Finally, patients with chronic strictures, marginal ulcers, asymptomatic trocar or ventral hernias, and stable gastric band erosions can usually be safely discharged after an appropriate conversation with the patient’s bariatric surgeon. Jeff: Definitely a great time to do some joint decision making with the patient and their surgeon. Nachi: Exactly. Let’s close out with some Key points and clinical pearls. Jeff: Bariatric surgeries are being performed more frequently due to both their success in sustained weight loss and improvements in associated comorbidities. Nachi: There is an increased risk of postoperative myocardial infarction and pulmonary embolism after bariatric surgery. There is also an increased risk of self-harm emergencies after bariatric surgery, mostly in patients with known psychiatric co-morbidities. Jeff: Nutritional deficiencies can occur following bariatric surgery, with thiamine deficiency being one of the most common. Look for signs of beriberi or even Wernicke encephalopathy. Nachi: Staple-line leaks are an important cause of postoperative morbidity. Patients often present with abdominal pain, vomiting, sepsis, and peritonitis. Jeff: Strictures can also present postoperatively and cause reflux, epigastric discomfort, and vomiting. Nachi: Intraperitoneal or intraluminal hemorrhage is a known complication of bariatric surgery and may present as peritonitis or with hematemesis and melena. Jeff: After significant weight loss, internal hernias with our without features of strangulation are a late complication. Nachi: Late dumping syndrome is a rare complication following Roux-en-Y bypass occurring months to years postoperatively. It presents with hypoglycemia due to excessive insulin release. Jeff: Esophageal or gastric perforation are early complications of adjustable gastric band surgery. These patients require emergent surgical intervention. Nachi: Overtightening of the gastric band results in food and liquid intolerance. This resolves once the balloon is deflated. Jeff: Late complications of gastric band surgery include port-site infections, connector tubing dislodgement or rupture, band slippage or prolapse, and band erosion with intragastric migration. Nachi: Given the myriad of possible bariatric surgeries, emergency clinicians should be cognizant of procedure-specific complications. Jeff: Consider obtaining a lactic acid level for cases of suspected bowel ischemia or sepsis. Nachi: Endoscopy is the best method for diagnosing and treating gastric band erosions. Jeff: Septic patients should be treated with antibiotics that cover gram-negative and anaerobic organisms. Suspected port site or wound infections require gram positive coverage. Nachi: Pregnant patients who previously had bariatric surgery are at risk for complications from their prior surgery as well as pregnancy-related pathology. Jeff: A plain radiograph may be useful in unstable patients to evaluate for free air under the diaphragm, pneumatosis, air-fluid levels, or dilated loops of bowel. Nachi: CT of the abdomen and pelvis is the mainstay for evaluation. Oral and/or IV contrast should be considered depending on the suspected pathology. Jeff: Have a low threshold for emergent surgical consultation for ill-appearing, unstable, or peritonitic patients. Nachi: So that wraps up Episode 30! Jeff: As always, additional materials are available on our website for Emergency Medicine Practice subscribers. If you’re not a subscriber, consider joining today. You can find out more at ebmedicine.net/subscribe. Subscribers get in-depth articles on hundreds of emergency medicine topics, concise summaries of the articles, calculators and risk scores, and CME credit. You’ll also get enhanced access to the podcast, including any images and tables mentioned. PA’s and NP’s - make sure to use the code APP4 at checkout to save 50%. Nachi: And the address for this month’s cme credit is ebmedicine.net/E0719, so head over there to get your CME credit. As always, the [DING SOUND] you heard throughout the episode corresponds to the answers to the CME questions. Lastly, be sure to find us on iTunes and rate us or leave comments there. You can also email us directly at EMplify@ebmedicine.net with any comments or suggestions. Talk to you next month! Most Important References Altieri MS, Wright B, Peredo A, et al. Common weight loss procedures and their complications. Am J Emerg Med. 2018;36(3):475-479. (Review article) Colquitt JL, Pickett K, Loveman E, et al. Surgery for weight loss in adults. Cochrane Database Syst Rev. 2014(8):CD003641. (Cochrane review; 22 trials) Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient—2013 update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity (Silver Spring). 2013;21 Suppl 1:S1-S27. (Society practice guidelines) Phillips BT, Shikora SA. The history of metabolic and bariatric surgery: development of standards for patient safety and efficacy. Metabolism. 2018;79:97-107. (Review article) Contival N, Menahem B, Gautier T, et al. Guiding the nonbariatric surgeon through complications of bariatric surgery. J Visc Surg. 2018;155(1):27-40. (Review article) Parrott J, Frank L, Rabena R, et al. American Society for Metabolic and Bariatric Surgery integrated health nutritional guidelines for the surgical weight loss patient, 2016 update: micronutrients. Surg Obes Relat Dis. 2017;13(5):727-741. (Society practice guidelines) Chousleb E, Chousleb A. Management of post-bariatric surgery emergencies. J Gastrointest Surg. 2017;21(11):1946-1953. (Review article) Goudsmedt F, Deylgat B, Coenegrachts K, et al. Internal hernia after laparoscopic Roux-en-Y gastric bypass: a correlation between radiological and operative findings. Obes Surg. 2015;25(4):622-627. (Retrospective review; 7328 patients) Michalsky M, Reichard K, Inge T, et al. ASMBS pediatric committee best practice guidelines. Surg Obes Relat Dis. 2012;8(1):1-7. (Society practice guidelines)

  Let's Talk about Annual Physical Exam... On this week's episode of the Lunch and Learn with Dr. Berry I am here to start off men's health month with an episode on just what to expect during your annual wellness exams. Last week on the empower yourself for better health series, I talked about the biggest reasons why men are dying earlier is that we are just unaware of our health statuses. Our lack of going to the doctor, being educated on what are our biggest killers has attributed to the majority (8/10) top 10 leading causes of death worldwide to all disproportinately affect men greater. In fact it would likely be 9/10 if not for the fact that Alzheimers usually increases with age but we are dying to soon to experience it. The annual physical exam is the most appointment you can make when you see a doctor because it allows the doctors to essentially check you from head to toe on what is going on. It is also where we can discover the most problems so it is extremely important to make sure your friends and family members are listening to this episode so they know what to expect. Remember to subscribe to the podcast and share the episode with a friend or family member. Listen on Apple Podcast, Google Play, Stitcher, Soundcloud, iHeartRadio, Spotify Sponsors: Lunch and Learn Community Online Store (code Empower10) Pierre Medical Consulting (If you are looking to expand your social reach and make your process automated then Pierre Medical Consulting is for you) Dr. Pierre's Resources - These are some of the tools I use to become successful using social media Links/Resources: Empower Yourself Series - Episode 65 Social Links: Join the lunch and learn community – https://www.drberrypierre.com/joinlunchlearnpod Follow the podcast on Facebook – http://www.facebook.com/lunchlearnpod Follow the podcast on twitter – http://www.twitter.com/lunchlearnpod – use the hashtag #LunchLearnPod if you have any questions, comments or requests for the podcast For More Episodes of the Lunch and Learn with Dr. Berry Podcasts https://www.drberrypierre.com/lunchlearnpodcast/ If you are looking to help the show out Leave a Five Star Review on Apple Podcast because your ratings and reviews are what is going to make this show so much better Share a screenshot of the podcast episode on all of your favorite social media outlets & tag me or add the hashtag.#lunchlearnpod Download Episode 112 Transcript Episode 112 Transcript... Introduction Dr. Berry: And welcome to another episode of the Lunch and Learn with Dr. Berry I’m your host, Dr. Berry Pierre, your favorite Board Certified Internist. Founder of drberrypierre.com, who start the Lunch and Learn with Dr. Berry as well as the CEO of Pierre Medical Consulting, helping you empower yourself for better health with the number one podcast for patient advocacy. This week we bring you episode 112, the focuses on men and their wellness exams. And of course if you listen to this on the month of June, it is men's health month. And if you happen to catch my recent live series on Empower Yourself for Better Health where I essentially kind of lay out the fact that men are dying out here because they're not aware of their health and you know, I hope to put a charge in someone's battery or you know, someone's relative, spouse, somebody to like really push the mill, friends and family members that we have to go get their routine checkups. And a few I want to check out drberrypierre.com/youtube where you can check out that most recent episode where I go through the top 10 causes for death in men and I really kind of lay out the law that says like, Hey, we really don't have any excuses to deal with the issues that we're dealing with now. So check if you have the chance. So again, today we're going to be talking about the wellness exam. The annual physical exam. Most people call it and a lot of times is probably the only way you can actually get your significant other, your brother, your father, your cousin. It's usually the only time you can get them to come into the doctor's office, right? Because again, a lot of times I don't see them very often but if I can almost see him one time, it's usually for their wellness exam. So I want you to just take a little step back and take some tips on what to expect for the physical exam and you know, understand why we might like crunch a lot of things in there because sometimes, especially with our male patients, we understand that that the likelihood that they're going to come back at sometimes kind of low. So we want to take advantage of it when we got a chance. Before I want to go I do want to give a shout out to Dr. Coreos who is a friend in the social media space. She actually runs the hashtag somedocs. And reason why I love her is the fact that she is champion physicians to want to get on social media and really take advantage of all of this stuff that it offers. You guys know for a long time I've really been championed that bill that says like, no, we have to get on social media. Our patients are on social media. And if you want to be respected, if you want to be accredited in your patient’s eye. Again, not talking about accredited in the physician’s eye where you know, you have a couple of journal articles and do some poster presentations and you may speak at a medical conference and two. Because for the most part, most of your patients don't care about that, right? One because they don't go to those conferences. They don't read those magazines so they don't even know. But would they do knows that they check their Twitter, they checked their Instagram and they check their Facebook, they checked their YouTube and you're not there. So she's a big part of this promotion and you know, making it okay for your physicians to one get on social media. And another thing I love about her is that with her hashtags somedocs. If you have a blog posts and video posts, whatever, and you feed tag or she will actually retweet it and kind of share it out. So again, thank you Dr. Coreos for that. I'm definitely much appreciated it. Just wanted to make sure I gave her a nice one shout out because she's definitely helped the show grow for the Lunch and Learn community. So it definitely appreciative all our efforts. So getting back, we're talking about episode 112. We’re gonna talk about men. We’re talking about the annual wellness exam. And sit back for great episode and I'll see you guys later. Episode Dr. Berry: Alright guys. So this is episode 112. This is gonna be a solo episode. And it's funny because obviously if you've been rocking with the show for quite some time, you know and that we started out as a solo episode. This is something that we do and I think we do well. And when we made the change over this past season, season three, we really wanted to make a concerted effort to get the best of the best when it comes to topics of discussion, especially for Lunch and Learn community. And I was very fortunate enough to do that. We've got like two months, almost two months in a row of just amazing guests and like I said, definitely happy for all of their expertise and their support and you know, does the knowledge that they kicked over these past couple months. But I am back with a solo episode and it's funny because actually this episode was going to be a group episode as well, but I was unable to connect with this week's guest. His schedule was busy. My schedules is busy so we were unable to connect. But we'll definitely make sure, you know, we get them onto the shows at some time. Right. We'll, it'll happen for sure. But of course this is June. We're talking about men's health and this episode we're talking about the wellness exam, the quote unquote the physical exam that a lot of times it's the only time I can see some of my male patients and it's something that a lot of times as a physician we kind of cherish and we really take advantage of. Because we understand that if I don't order these tests and I don't ask these questions, there's a chance I may not see this patient in front of me for another year. And for most of my patient specialized outpatient medicine, most of my patients, that's exactly was the case. They were like, doc, I love you but I'm not coming to see you more than once a year. So get whatever you need to get, do whatever tests you to do, ask whatever question you need to ask while I'm here cause it ain't happen. And once I leave and I respected it and I love that. And that definitely took advantage. So what I want to do is first, you know, do you listened to the episode 65, right? Empower Yourself for Better Health Series where I talked about how the lack of awareness and our health has been killing us. And like us, I mean men, right? It's been absolutely killing us. And I talked about top 10 causes of death in that episode. So go ahead, check that out on the YouTube page. But when we stress all of these different factors here, a lot of these things can sometimes, and I hate to say it, but a lot of them could be avoided if they would just comfort a checkup and they would just come and see regularly. And that's why we take so much advantage when we do have you in our office. Right? Because we don't know what's the next time you get to come see us. So if you listen, right? If you're able to get that at your male, father, your cousin, your relative, your friend, spouse, whatever. If you were able to get them to the office, right? Like what should they expect when they get there? Right? I think that's always a question at hand, right? It's like this unknown cloud of secrecy, right? Again, they don't go to the doctor often and a lot of times it's out of fear. Right? And a lot of times it's out of this superhuman attitude that men tend to have. Like, I'm not sick, I don't get sick. I'm okay. Like nothing's bothering me. I think one of the most important questions that we'd like to ask, especially in a hospital setting is do you have any medical history? Right? As usually our questions, right? And for my men, I'm usually keen on asking, okay, if you say you have no medical history, what is the last time he saw a doctor? Because it's very easy to have no medical history if you've been avoiding us for five to 10 years. Right? Like if you haven't seen a doctor, and again that five to 10 years, may sound crazy to some of my Lunch and Learn community members. But I know some people who have not seen a doctor in five to 10 years, like that's just the way they're rocking and you know, God bless them, right? God bless them that something's not clicking up on the inside that we don't know about. But let's say you know, it's been five, it's been 10 years, right? And they haven't seen the doctor. And of course when you ask them to have any medical history, they say no cause they really don't because no one's ever told them. Right? But you are able to get this person into your office and you're able to get the quote unquote physical exam, right. Because first of all, let me tell you something. The physical exam, the actual physical part is, you know, the easiest part that probably takes like three to five minutes at most. But what's most important is all of the ancillary questions you're gonna ask your patient in front of you why you got in there, right? So why you got them there, right? And I always like to start head to toe, right? So first and foremost, for people who may not be familiar with the annual exams, right? The annual exam is the doctor's appointment that you go to, it's usually your longest doctor's appointment and not only is it a long the doctor's appointment, It usually has a whole bunch of labs are kind of associated with it, right? So that's usually when your doctor orders lasts for just about everything. And we're going to talk about those labs later. But it's one of those ones where your doctors has to take advantage and get you, you know, while you're there. And they really liked it, you know, strike while it's hot. So they order every test as every question because they aren't sure if they're not going to see you again. Right? And for some people was honest, right? I used to take care of patients who are in their 19, 20, 21-year-old. Like I don't want to see you in my office more than once a year. Right? Cause there's really no reason, especially if you have no medical history, that you should be seeing me that often. Not say that you can come to me if you, you know, you have a cold or you know, get sick or I'm not saying that. But they were just coming just for like a regular checkup and you have no medical history. You're not taking medications. Right. I don't expect you to be seen more often then, you know, once or twice a year. Right. Maybe you might see him every six months just to kind of keep them in the loop, but you're not seeing them any more than that. So you have your male, right? Let's just, we'll call the male Berry. Right? So Berry, you know, finally mustered up the courage and he makes the doctor's appointment, right? And I talked about this before. A lot of times what pushes Berry to making a doctor's appointment is they have a person like Maria screaming in their ear saying, hey, you need to go see the doctor and they finally do it. Or there's something, some sexual dysfunction issues going on. And Berry's frustrated and he's like, no, I gotta go see a doctor. I got to take care of this. Right? I've seen a commercial, I can take a blue pill and I'm good. I need someone to prescribe a blue pill. So those are usually the top two reasons why, you know, men tend to go to the doctor's office, at least in my experience. So you know, you're able to get buried to come to the doctor's office and you know, he's in a waiting room and you know, he finally get stay room and now he's ready. So usually what tends to occur, especially in your annual wellness exam is. Your doctor usually does a head to toe approach, right? In terms of how am I going to assess this person, how am I going to see what's going on? So usually, obviously from head, we start. I always like to check for vision issues, right? As men, because we're so machismo with it, right? Like wearing glasses is like this taboo thing that a lot of us don't like to do unless we absolutely have to do it. And for the most part there's a lot of diseases that are kind of manifesting with vision issues. So a lot of times when you're thinking, we're just asking about your vision and vision history is because we want to make sure that it may not be contributing and contributed to from another disease like high blood pressure or diabetes, which is very common. So we tend to ask for a vision issues. We want to make sure your eyes are checked. If you wear glasses, you want to make sure he got that done. And we want to make sure you're eating well. And again, the eating well is goes along with the bowel habits because we know the older you get, the more likely you are to have these issues with bowel and bowel dysfunction. And if you're one of my 50 year old gentlemen, right, or 45, depending on your race, right? Uh, and really just kind of varies but just kinda in general, you know, its colonoscopy time, right? And again, it's one of those times where we want to make sure the plumbing is working all the way through and through. Because one of the top 10 leading causes of death for men is cancer, right? So colon cancer is something in screen, when you hit that age because it is something that we should be preventing as long as you get a regular checkup. So a colon cancer is a big one, right? So again, I know I skipped down, but like, so we're checked the vision, now we're checking the heart, right? And the heart exam. Not only goals or just you know, just for listening, but you know, we're checking the blood pressure, we're checking your heart rate. Usually when you came in, right? We want to make sure that you don't have this underlying problem that could lead to disastrous effects that rock. Like I tell people all the time, blood pressure is one of those things that your body can deal with and deal with it a lot until it can't. And once it can't, now we're talking about stroke. Now we're talking about heart attack. Now we’re talking about disease in the feet, right? Like you can't feel and you're foot, right? That’s what happens when your blood pressure becomes such a problem that your body says all right, yeah I'm done. And so making sure that your blood pressure's fine, right? Because again, blood pressure is one of those things that you don't really feel symptoms from low blood pressure, especially when it's high, until it's a problem, right? If you're at the point when you're starting to feel symptoms because of blood pressures on the high side, you need to go see your doctor immediately, right? If you're listening to this and you know when your blood pressure is high, like you can feel it. That means I need to go to the doctor because you should not be feeling it. And if you're at the point where you're feeling when your blood pressure's high, that is a problem. So for heart, we're talking about blood pressure, we're talking about a heart rate. I kind of move actually for men, right? And not important for women. Is that the prostate exam? And this is something that I think personally scares men a lot, not only from doing regular checkups, but because of the prostate exam and the digital administration of the endoscopic scope. I think a lot of men dish, you know, shy away from that whatsoever. And it's funny because I've had men who meet the criteria who meet the age. And I said, okay, all right, let me, uh, let me check your prostate, see how that's doing. And they get stage fright, right? Hey, it's so, it's such a terrifying thing for them, right? It's very weird. I in that instance, right. Especially when you know cancer's a leading cause of death, right? All we have to do is this, there's physical exam tests that we do in our office. And of course it was sometimes was hanging out with blood work, right? But in our office, and you still refuse, you know? Yeah. I'm kind of weary of your decision making. So that's definitely something to think about, especially when we're doing about the abdominal pelvic exam is in the men at certain ages need to be checked for prostate, right. In large prostates. Now I've always said this a lot, that a patient will always tell you what's going on before you have to do any tests, right? So most of your patients, if they're going to talk about, you know, in large prostate, they're going to tell you urinary symptoms, complaints, they're gonna punch in that direction. That still doesn't mean you're not supposed to check but they will kind of point you in that direction to make sure you're going in the right way. So talked about the eyes, we talked about the mouth, we talked about the heart, talk about the abdomen, the lungs as well. Lungs is a big one. I know a lot of you may have seen these COPD commercials. Again, COPD top 10 leading causes of death for men. And you may have seen COPD commercials where this random person is sitting by a lake and because of the COPD medication, now they can breathe again and they can go outside again. And that's all great and dandy, but they don't tell you that usually the patient has COPD because they were a smoker and they were smoking for five years, 10 years, 20 years or they always kind of skip that part, right? That's always tell my patients like you can't skip the fact that this person was smoking for 20 years. Right? So it's not surprising that they're going to have some lung issues. So making sure that your lungs are working well, make sure you're not getting shorter breath easy. That is something you want to be very forthcoming with your physician. And for men, I could tell you what tends to happen with men is that we're so secretive, right, that we're so secretive to our family members, to our friends. So that's why we don't go to the doctor in the first place. But you would think once they get to the doctor's office, this, the veil of secrecy would leave? Nope. A lot of them are secret to the end. Like this to the point where you almost have to call them out like, hey, you know what? Maria sent me over here and said you were having issues with your bowels, but yours ain't they're not. Which is true, right? More often than not. If a person, if a male is sent over to the doctor's office by a female relative, a spouse, someone who says like you need to go to the doctor's office, a lot of times they'll, they'll be in the room with you and not because you know, they don't trust you. It's because they don't trust that their partner is actually going to tell them all of the problems. And that happens with men a lot. We tried to internalize everything and you know, try not to seek help and you know, that's where problems definitely will arise because of it. So I think, so we've talked about heart, we talked about lung, I talked about abdominal pelvis. We talked about the eyes making sure eyes are check as well too. And we had Dr. Candrice who talked about skin cancer, a couple of shows back. So again, the importance of, making sure there's no weird moles or rash or anything that your, your family members kind of played off. We don't want that. So making sure, and again, your skin exams, your regular physician can definitely take care of that while they got you here and kind of move. And if you need something else then see to the dermatologist. So skin exams, definitely an important one as well. And I think last but not the least, is it comes some of the blood testing. So what actually gets tested when we go to get our physical exam? So I could tell you this from a slew of tests, right? We don't have to mention the names because the names that are really important is what they're looking for. Some of our testing, right? We'll look for signs of inflammation, we'll look signs for infection. Some of our tests within that will check to see how stable is the person's blood count is? And blood count is a very important a number to think about because if you have this patient who's coming in and they're giving you symptoms concerning that, they may be bleeding somewhere. You want to make sure that blood count is good. And stable. So blood count is definitely something that thinks about. And then we check for your electrolytes. We check for potassium and we check for sodium, we check calcium, chloride. We check for all of these different things here because we want to make sure your electrolyte nutritional status is adequate because if not we have to take care of it. And we'd take a look at the kidneys. Kidneys are important. You'll notice when I stop and mentioned the disease is because it probably hits the top 10 diseases that killed men every year. And kidney disease is definitely in that ball park, right? So kidney disease, and again, this is a routine test. Again, I know my patient Berry's not going to come for another year, so I got to make sure I get all of these tests done while I got him here. So again, we're checking for kidney function, we're checking for electrolytes, we're checking to make sure your blood counts stable, we're checking to make sure you know the signs of inflammation or infection. And then, moving all, we check for the big gun right? We talk about cholesterol. Cholesterol is a big one for us, right? So we want to check your cholesterol, make sure your cholesterol was doing well. And we had previous episodes where we talked about the thoughts of cholesterol and good and bad, and what medications to take. We're not going to do this here. Moving forward, we checking for your diabetes? Diabetes is one of those things. It's one of those, and I wrote a blog post about this. It's a disease I probably not wish would not wish on my enemy, right? Because there's not a system that's not affected by diabetes. And I think what's happening, it's probably our fault, is that when we talk about diabetes, especially in the General Public Forum, a lot of people focus on the sugar aspect. Like, oh yes, my sugar is high, but they don't realize for us, right? When we hear your sugar's high, I hear, wow, you have concerns that you're going to have some vascular damage, right? Because diabetes is an extremely fast schuller disease, right? It affects the heart. It affects the legs, it affects obviously our kidneys, brain too. So every system that can be fed through the blood system, right, which is everything diabetes can effect, especially when it's uncontrolled. So we're checking for that. So again remember and the test that we run lets me know how well you did in the past three months. So not one of these things where I have to be concerned that this like oh maybe a little bit false or you just had some cheeseburger the next day. Like that's not going to necessarily change this testing here and may adjust your cholesterol testing but it's not going to change that you're testing for your diabetes or how severe your diabetes is. I will sometimes check for thyroid as well cause I want to make sure, and again I'm, I'm kind of foreshadowing get right cause I want to make sure all of your hormones are regulated correctly cause we've already seen that when your hormones are not regulated correctly. Because thyroid is out of whack, it doesn't matter if your hormones get back into that normal rhythm. Your thyroid has to be a normal rhythm as well. So thyroid hormones, a big one as well that we checked quite often. We've checked the urinalysis. Your urinalysis is a big one. And it's big one because it's cheap, but it tells us so much information, right? Urinalysis can tell me if you had blood in your urine, right? You're now tell me if you have an infection. Urinalysis can tell me if you have a stone in your kidney. So all of these different things that your urinalysis does a great job and educating us on, and it's a cheap test as a quick test. Definitely, something that I always like to glean information from. Last but not least, and this is the big one, right? Testosterone levels. Because I know, especially for my men, someone's gonna want to know about testosterone, right? They're gonna want to know about, you know, artificial mutation of testosterone when needed. So a testosterone levels. And usually, it's not, it doesn't come with the annual wellness exam. But if you're giving me complaints and concerns that sexual health may be affected. I'm going to do something about it, right? So I will check a testosterone level just to make sure all your hormones are kind of in line. So that's really the big crux of the annual exam for my men and I really try to kinda hit home all of the big take-home parts to really to let you know that it's not a difficult thing to do. It's not a test you need to be scared of. And I think knowing the answer, right? Because I think a lot of times when we talk about disease processes, some people just don't want to know the answer. But when it comes to, you know, taking care of your health and taking care of your wellness, you have to know what the answer is, right? Because we have no choice because it's killing us, right? And I hate to be doom and gloom, but I really want to stress the point, especially when you have this month of June and you know, everyone's hype about men's health month, but I know what's next month comes around, people ain't going to be at hype anymore. So I want to like make sure I'm shouting it from the rooftops, the importance of getting our stuff together men. So again, I want to thank everyone for listening with me - Dr. Berry. We’re back with a solo episode like I missed you guys. But again, I want to thank you guys for all your support, has been absolutely phenomenal in this past season, this season, right? Season three that we're in as far as the support and effort and people downloading and people leaving five-star reviews. You now had a chance leave that five-star review for me and you guys have a great and blessed day. I'm going to see you guys next week and next week we do have a special guest, right? So you don't have to worry about hearing my voice again solo. Next week we do have a special guest. Because like I said, we like special guests. You guys have a great and blessed day.   Download the MP3 Audio file, listen to the episode however you like.

Interview begins: 07:09Debrief begins: 49:20Luke Heron is the co-founder and CEO of Testcard.TestCard is a medical diagnostic test contained within a traditional postcard. The unique, patent-pending ‘flat-pack' product is embedded with three fold-out urine dipsticks. The accompanying easy-to-use mobile application turns a mobile phone's camera into a clinical grade scanner, providing the user with an immediate and accurate result from the TestCard, communicated in easy-to-understand wording on the phone screen.This episode was recorded at CES 2019, where Testcard was named a Top Emerging technology by Digital Trends.Testcard was founded in 2017 and based in London, UK.Learn more about Testcard: https://testcard.com/Follow upside on Twitter: https://twitter.com/upsidefm Subscribe to the update: https://upside.fm/update

Kidney disease is more common as dogs age. It is estimated that more than 1 in 10 dogs will develop kidney disease over a lifetime1,3, so it’s an important topic to understand. When healthy, the two kidneys efficiently: Filter the blood Process protein wastes and excrete them into the urine Conserve and balance body water, salts and acids Help to maintain normal red blood cells Kidney disease occurs when one or more of these functions are compromised or reduced. Unfortunately, it typically goes undetected until the organs are functioning at approximately 33% to 25% of their capacity. Dogs with moderate to severe chronic kidney disease (CKD) are prone to dehydration and you may notice that your dog is lethargic and has a poor appetite. Treatment options for advanced kidney disease are usually limited to treating the symptoms because dialysis and kidney transplants are not readily available for dogs. Protecting your pooch from kidney disease means you should be prepared to look for problems early. Causes of of chronic kidney disease in dogs The International Renal Interest Society or IRIS is a group of veterinary specialists studying  kidney disease in dogs and cats. They list several risk factors that make pets more susceptible to kidney disease, such as age or breed, and investigate reversible factors that initiate or accelerate kidney damage. Such factors include: Glomerulonephritis Pyelonephritis (kidney infection) Nephrolithiasis (kidney stones) Ureteral obstruction & hydronephrosis (stones causing a blockage) Tubulointerstitial disease (involving the kidney tubules) Leptospirosis Cancer Amyloidosis (protein problem) Hereditary nephropathies (genetic problem) Signs of chronic kidney disease in dogs One of the earliest signs of kidney disease in dogs is urinating and drinking more (polyuria/polydipsia or PU/PD). Often, dogs need to urinate at nighttime (nocturia) or have "accidents." There are many other causes of PU/PD, but kidney disease is one of the most serious concerns. Taking water away from your dog could make chronic kidney disease worse, so please don’t try to do this without your veterinarian’s direction. Having your dog examined promptly when you note a change in water intake and urine production is key! Dogs tend to be pretty sensitive to changes in their blood levels of waste so even mild to moderate changes may cause signs of illness. Other signs of chronic kidney disease include: Urinary incontinence (urine leakage) Dehydration Lethargy Reduced appetite Vomiting Weight loss Bad breath with a chemical odor Oral ulcers Pale appearance Testing your dog for chronic kidney disease Your veterinarian will often suggest these basic tests: Physical Examination— The first test your veterinarian is likely to perform will be a physical examination, and remember that taking your dog in for routine physical examinations is an excellent way to help protect him. Even normal physical exams may be useful later as a baseline of comparison. During the exam, your veterinarian might detect: Enlarged, painful kidneys Back or flank pain Changes in the prostate or urinary bladder A rectal examination can give more detail about the possibility of urethral, bladder or prostatic disease that might relate to kidney disease. Finding a large bladder in a dehydrated pet, or other, less specific, findings may also warn your veterinarian about a kidney problem, for example: Low body temperature Excessive skin tenting Dry gums (showing dehydration) Unkempt hair coat Other testing may include: Complete blood count (CBC)—The CBC may reveal anemia (too few red blood cells) or an elevation in white blood cells consistent with infection, stress or inflammation. Less commonly, blood parasites or circulating cancer cells are found. Chemistry profile with electrolytes Urinalysis with sediment exam—Examining a urine specimen, especially prior to any treatment, is a simple and economical way to gauge urine quality.   Urine culture with susceptibility Urine protein to creatinine ratio Infectious disease testing—Regular testing for heartworm infection and for vector borne diseases such as Ehrlichiosis andLyme can identify risk factors for kidney disease. Diagnostic imaging—Using radiography (X-rays) and diagnostic ultrasound to identify changes in the size, shape and architecture of the kidneys may suggest a specific blockage that needs emergency treatment. Blood pressure measurement—High blood pressure is common in dogs with chronic kidney disease. Kidney Sampling Management and monitoring of chronic kidney disease Sick pets with signs of kidney disease that include dehydration will likely require more intensive care in a hospital setting, while those that are happy tail waggers and are completely self-supporting will often be treated at home. Your veterinarian will work diligently to find a treatable cause of kidney disease and make individual recommendations for your dog.   General treatment goals for dogs with kidney disease include: Providing adequate and appropriate nutrition with a kidney friendly diet (always check with your veterinarian before making any diet changes). Ensuring excellent hydration. Balancing salts and acid-base levels. Aggressively treating any protein problems or high blood pressure, since these conditions tend to worsen kidney damage2. Keeping plenty of fresh water available—this is essential! Keep in mind that dogs with kidney disease are usually going to need more trips outside for bathroom breaks, so building this into the household schedule will be important. A friendly neighbor can help out, or a professional dog walker can come to give your pooch a midday break and help you avoid coming home to a puddle or two on the floor. He really can’t help it! Your pet’s condition, any other illnesses found and your personal goals for treatment will help determine the course of treatment and dictate how often you visit the veterinarian. Chronic kidney disease prognosis/advances Some dogs with chronic kidney disease will live years after diagnosis and have a good quality of life. Others will not be so lucky. Your veterinarian will evaluate after testing is finished. As a motivated pet guardian you can take an active role in your pet’s preventive care by planning for wellness exams and routine lab testing. Team up with your veterinarian to address any problems before they get worse. The discovery of new biomarkers for kidney function, such as SDMA, provides for early recognition of kidney disease before other blood values change and offers the prospect of earlier intervention and kidney care3. If you have any questions or concerns, you should always visit or call your veterinarian -- they are your best resource to ensure the health and well-being of your pets. Resources: Brown SA. Renal dysfunction in small animals. The Merck Veterinary Manual website. Updated October 2013. Accessed January 14, 2015. Polzin DJ et al. Evidence-based management of chronic kidney disease. In Bonagura J, Twedt D (eds), Kirk’s Current Veterinary Therapy XIV, Elsevier Saunders, St Louis 2009: 872-879. https://www.idexx.com/small-animal-health/solutions/articles/sdma-diagnose-kidney-disease.html

In this PECARN series, Dr. Jason Woods discusses the sensitivity and specificity of the urinalysis for febrile infants ≤60 days old with the first authors of the 2018 Pediatrics article, Dr. Leah Tzimenatos. Tzimenatos L, Mahajan P, Dayan PS, et al; Pediatric Emergency Care Applied Research Network (PECARN). Accuracy of the Urinalysis for Urinary Tract Infections in Febrile Infants 60 Days and Younger. Pediatrics. 2018 Feb;141(2). https://www.ncbi.nlm.nih.gov/pubmed/29339564

Normal values, abnormal findings, and more related to routine, in office urinalysis screens for midwives. This is primarily focused on urinalysis as part of prenatal care.

Pediatric “Sepsis” Consider in any toxic appearing child/neonate Especially with fever (or hypothermia) Treatment Early antibiotics Fluid bolus “Serious Bacterial Infections” (SBI) Consider in any baby with fever Three classic categories Age

The doctor's exam room can be an intimidating place when you're sitting there in your hospital gown, all drafty in the back, and all. Sometimes just getting the feel for the sound of all those lab tests and what they might mean, may make the experience less overwhelming. Today I go over several different groups, or panels, which screen your blood for signs of any problems. Here are the cliff notes, if you want to see the numbers in writing: Fasting blood sugar (FBS): 65-100 is normal. You may also see 110 as upper limit. Random blood sugar (RBS): 100- 140. You may also see 160 as an upper limit... or even 180 in people who are have diabetes. Hemoglobin A1C (also called glycosylated hemoglobin): 4.3-6.1 is normal. All pregnant women should undergo a glucose tolerance test around 24 weeks gestation. Abnormally high glucose levels should be treated aggressively. Symptoms of low blood sugar include: clamminess, shakiness, rapid heartbeat, anxiety, and eventually coma. Symptoms of high blood sugar include: increased thirst, frequent urination, extreme fatigue, weight loss, blurred vision, trouble concentrating, and severe headaches. Urinalysis: sugar should be negative (if positive, your doctor will definitely check for diabetes and probably a UTI. Protein should be negative. Positive protein could imply a problem with your kidneys. Ketones should be negative. The urine should be clear- cloudy could mean in infection and amber color could mean dehydration. A chem 20 or metabolic panel includes: potassium: 3.6- 5.1 sodium: 136 -145 chloride:98-107 if these 3 are high you could simply be dehydrated... If they are extremely high that could signal a possible kidney problem. Carbon dioxide: less than 32. This measures how well your lungs are expelling air. Blood urea nitrogen (BUN): less than 20 creatinine: less than 1.1 the two above labs measure kidney function. Albumin: 3.5- 5.2 low indicates a sign of malnutrition. High values may mean kidney dysfunction. Calcium: 8.9- 10.3 Alkaline phosphatase (ALT):10-35 this is a liver function test. A CBC panel tests for infection. The most common value is: white blood cell count (WBC): 4-11 lipid panel: total cholesterol: less than 200 HDL: 40- 60 LDL: less than 90 LDL/HDL ratio: less stand 5.1  As always, if you have any questions you may contact me on my contact page. I will also have this list on my website, episode 152.

In this episode, dream interpreter Yvonne Ryba deconstructs the subconscious messages in a client's dream that involves something we all do (whether we like to discuss it or not): pee. But the strange presence of urine in this dream is indicative of something much deeper: the client's cleansing of excess emotions as she plans to move into an important new phase of her life. The exposure she feels during the dream -- and an important dampened document she tries to hide -- are all part of her subconscious's attempt to show her how using creativity and imagination can help her overcome life's obstacles. For more of Yvonne's dream interpretation -- including her previous analyses of dreams involving scorpions and bulls as prescient signs of the Zodiac -- check out season one of "re:awakening" in Chris's 2011-2013 podcast "Reimagine That!" All 22 episodes are available on Chris's Retroality.TV YouTube channel:http://YouTube.com/RetroalityTV Host: Chris Mann Life coach/dream interpreter: Yvonne Ryba Announcer: Linda Kay Created by: Chris Mann Producers: Linda Kay, Chris Mann Copyright 2016 by ChrisMann.TV / RisingActionMedia.com

We're continuing our series on The 8 Pillars Of Perfect Health. Xenobiotics are "strangers to the body" and are anything that take our bodies away from homeostasis. In this episode, find out: --How Pathogens, Viral Infections, Bacterial Infections, Fungal Infections, Parasites, Toxins, Heavy Metals (like Arsenic, Lead, and Mercury), and Allergens are all considered Xenobiotics. --Why one person's poison can be another person's cure (such as Gluten).  And how even too much Vitamin D can damage the liver and can become a Xenobiotic to the body. --The role that the lungs, the liver (the hero that cleans our body up by removing toxins), bowels, kidneys, spleen, and our immune system play in fighting Xenobiotics. --Why a liver detox is so important for Cancer patients to improve their survival rate. And how a malfunctioning Liver can lead to Cancer and a properly functioning liver reduces your chances of developing Cancer. --How food allergies and any type of autoimmune disease relates to Xenobiotics causing stress on the immune system. And why Dr. Prather says autoimmune diseases like Hashimoto's Disease, Sjogren's syndrome, Graves' Disease, Rheumatoid Arthritis, Ulcerative Colitis, and Crohn's Disease are usually involved in delayed allergy reactions (such as food allergies). --The diagnostic tests for Xenobiotics in your body including a stool kit (G.I. Effects test), blood work, Urinalysis, ALCAT food sensitivity test, and Hair Analysis. --How there are more cells in your body that aren't "you" than the number of cells that are "you" ( and have your DNA). And how we need those "critters" to help maintain our health. --How weight loss can occur once certain bacteria in the gut are eliminated. --The Diathermy machine (which are large magnets) that is one of Dr. Prather's favorite methods of detoxification for his patients. --The amazing story of the Colon Cancer patient scheduled for surgery who was treated by Dr. Prather for parasitic infection throughout the colon (which is a leading cause of Colon Cancer). When he went in for a scan prior to his surgery, the Cancer was gone!   www.TheVoiceOfHealthRadio.com

AAP Guideline on Urinary Tract Infection: Clinical Practice Guideline for the Diagnosis and Management of the Initial UTI in Febrile Infants and Children 2 to 24 Months http://pediatrics.aappublications.org/content/128/3/595.long UK NICE guideline: Urinary tract infection in children http://guidance.nice.org.uk/cg54 Summary: For children with fever, UTI should be suspected. For children at a very low risk for UTI, […] The post Pediatric UTI appeared first on Family Pharm Podcast.

Urinary tract infections (UTIs) are common in our veterinary patients, and can sometimes be tricky to diagnose and treat appropriately. An aerobic urine culture is the gold standard, allowing identification of the infectious agent and a sensitivity profile to direct treatment; however, this test takes several days to get back, and treatment (in other words, appropriate use of antibiotics!) is often required in the meantime. This veterinary podcast reviews the importance of Gram staining urine versus evaluating an unstained urine sediment exam for the detection of bacteriuria in dogs with suspected UTI. Stain your urine!

Urinary tract infections (UTIs) are common in our veterinary patients, and can sometimes be tricky to diagnose and treat appropriately. An aerobic urine culture is the gold standard, allowing identification of the infectious agent and a sensitivity profile to direct treatment; however, this test takes several days to get back, and treatment (in other words, appropriate use of antibiotics!) is often required in the meantime. This veterinary podcast reviews the importance of Gram staining urine versus evaluating an unstained urine sediment exam for the detection of bacteriuria in dogs with suspected UTI. Stain your urine!

In this episode we complete our discussion on “Fever Without a Source” in the 2-3 month old population and also cover the 3-month plus age group. Again Dr. Andrea Cruz a subspecialist in emergency medicine and infectious disease at The Texas Children’s Hospital gives us some further insight into when and how to work these kids up.Full disclosure: The author on two of the articles below is LCDR Sherry Rudinsky who is an old navy friend of mine. We were interns together and then attended the same Naval Flight School class. Dr. Carstairs is also an aquantaince; she was a resident when I was a Navy Surgical Intern. I was stationed at the Naval Medical Center San Diego when they were collecting their data, but I had no part in this study. They are simply dang good reads so check them out.iTunes Link Fever AlgorithmFever Part 2 - MP3 VersionReferences:Reardon JM, Carstairs KL, Rudinsky SL, Simon LV, Riffenburgh RH, Tanen DA. Urinalysis is not reliable to detect a urinary tract infection in febrile infants presenting to the ED. Am J Emerg Med. 2009 Oct;27(8):930-2. PubMed PMID: 19857409.Rudinsky SL, Carstairs KL, Reardon JM, Simon LV, Riffenburgh RH, Tanen DA. Serious bacterial infections in febrile infants in the post-pneumococcal conjugate vaccine era. Acad Emerg Med. 2009 Jul;16(7):585-90. Epub 2009 Jun 15. PubMed PMID: 19538500.Carstairs KL, Tanen DA, Johnson AS, Kailes SB, Riffenburgh RH. Pneumococcal bacteremia in febrile infants presenting to the emergency department before and after the introduction of the heptavalent pneumococcal vaccine. Ann Emerg Med. 2007 Jun;49(6):772-7. Epub 2007 Mar 6. PubMed PMID: 17337092.Podcast 3 - Fever of Unknown Source Part Two

This podcast addresses the topic of proteinuria in children. The podcast helps students develop an approach to the evaluation of proteinuria. There is a brief overview of common causes of proteinuria in children. This podcast was written by Peter Gill and Dr. Verna Yiu. Peter is a medical student at the University of Alberta. Dr. Yiu is a pediatric nephrologist at the Stollery Children’s Hospital in Edmonton, Alberta, Canada. These podcasts are designed to give medical students an overview of key topics in pediatrics. The audio versions are accessible on iTunes. You can find more great pediatrics content at www.pedscases.com. Related Content: Case: Generalized Edema in an 18 month male Podcast: Approach to Pediatric Periorbital Edema

This podcast addresses the topic of hematuria in children. The podcast helps students develop an approach to the evaluation of hematuria. There is a brief overview of common causes of hematuria in children. This podcast was written by Peter Gill and Dr. Verna Yiu. Peter is a medical student at the University of Alberta. Dr. Yiu is a pediatric nephrologist at the Stollery Children’s Hospital in Edmonton, Alberta, Canada. These podcasts are designed to give medical students an overview of key topics in pediatrics. The audio versions are accessible on iTunes. You can find more great pediatrics content at www.pedscases.com. Related Content: Podcast: Systemic Lupus Erythematosus

Urinalysis in a patient with AKI from purely cardiorenal syndrome? (~02:05)What is bioavailability, duration of action, and outcomes with furosemide, torsemide, and bumetanide? (~08:47)How can spot urine sodium measurements be used to assess diuretic response? (~18:08)What are the differences between thiazides (PO Metolazone vs. IV Chlorothiazide) and acetazolamide augment diuresis? (~27:35)Spaced Repetition: RAAS inhibitors or SGLT2 inhibitors as GMDT in CKD? (~35:08)Sponsor: Freed is an AI scribe that listens and writes your note in < 30 seconds. Freed learns your style over time and is HIPAA compliant! Use the code CORE50 to get 50% off your first month with FreedGet CME-MOC credit with ACP!Tags: nephrology, cardiology, primary care, CoreIM, IMcore, nurse practitioner, physician assistant, hospital medicine, pharmacy, diuretic resistanceFind the best disability insurance for you: https://www.patternlife.com/disability-insurance?campid=497840Advertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy