Hospital and Internal Medicine Podcast
Hospital & Internal Medicine lectures are intended for the medical professional who enjoys learning for the sake of it. Dr. Porat is a practicing Hospitalist and Board Certified in Internal Medicine.
Episodes
When Stool Turns to Stone: Manually Disimpact Again or Buy Coca Cola? Fecalomas, Risks, and Treatments
Fecalomas—rock‑hard impacted stool that cause obstruction, stercoral colitis, perforation, and even death—most often in immobile elderly patients or those on opioids. Standard treatments include aggressive bowel regimens, enemas, manual disimpaction, endoscopic fragmentation, and surgery.
There are also case reports of using Coca‑Cola enemas to soften and reduce fecalomas when conventional measure
Does Mouthwash Cause Oral Cancer? Does Mouthwash Eliminate The Benefits of Exercise?
This episode examines the concerns about mouthwash and oral cancer. While ethanol can form the carcinogen acetaldehyde, how worried should we be?
Strong antiseptic rinses can alter the oral microbiome and may reduce bacteria that help produce nitric oxide, with a small study showing a blunted post-exercise blood pressure drop; does that justify abandoning exercise or ignoring dental guidance?
Recent Hyponatremia Correction Rate Data Is Becoming Harder to Ignore
Multiple studies in multiple journals are going against the norms and previous guidelines. The times they are a changing.
In the COBRRA Trial Apixaban Kicked The Asssssth of Rivaroxaban
For acute treatment of Venous Thromboembolism the debate of which direct oral anticoagulant to use appears to now be settled.
Heart Failure with Preserved Ejection Fraction (Diastolic CHF) and SGLT-2 Inhibitor Therapy
The double-blind, randomized phase III EMPEROR-Preserved trial showed a benefit of the sodium-glucose cotransporter-2 (SGLT2) inhibitor empagliflozin in patients with heart failure with preserved ejection fraction (HFpEF).
Now let us dig a bit more into those headlines.
Should You Postpone Interventions for INFECTED Necrotizing Pancreatitis?
An important recently published randomized control trial provides guidance on this controversy.
Spontaneous Bacterial Peritonitis - Unique Infections in Cirrhosis part 2
Unique Infectious Considerations in Cirrhosis - part 1
Diabetic Gastric Emptying Abnormalities (and sometimes normal) - Part 1
Almost nobody feels comfortable managing DELAYED gastric emptying (gastroparesis) and very few medical providers even think about RAPID gastric emptying in their diabetic patients. Even if you send these patients to GI specialists, your blood sugar co-management of these patients can be heavily impacted by these issues. Is delayed gastric emptying always a bad thing? When your patient has upper GI
Gastric Emptying Abnormalities - Part 2
Can we trust a nuclear study to nail the diagnosis? Are motor abnormalities really the cause of symptoms? What is a POP procedure?
Morphine for later stage COPD patients not on hospice
Does regular, low-dose, oral sustained-release morphine improve disease-specific health status or cause respiratory adverse effects in patients with moderate to very severe chronic breathlessness due to advanced chronic obstructive pulmonary disease? Digging in on the latest study.
The JAMA controversy and loss of conversation in medicine
My take on what went down at the Journal of the American Medical Association. I disagree with the comment there isn't "structural racism in health care", but was the backlash against the Editor who didn't say it (and actually opposed the comment) an over-reaction? Can we have discussions about the controversial issues that affect healthcare (like gun violence or abortion) without cancel culture ca
Cows Milk - Healthy or Not?
Psilocybin Mushrooms - will they become an accepted medicine?
Understand Basic Epigenetic Changes in Medicine and Everyday Life
This lecture provides a basic understanding of how epigenetic changes influence infections/sepsis, vaccinations, cancer, future generations, your muscles, and (of course) those sweet tan-lines you are rocking.
Every day you are living through epigenetic changes that have huge implications on your health and who you are.
Hyponatremia etiology by history and physical
Hyponatremia remains a challenging topic for many because they are trying to memorize algorithms and numbers. You can usually nail the etiology by history & physical and a brief chart review.
Cytokine Storm - part 1
If you use the term 'cytokine storm' and don't really know what you mean by it, you are far from unique. Let me help to try and clarify it for you just a bit.
Cytokine Storm - part 2
Do you know what CRP is (other than saying it is an inflammatory marker)? Should we always shut down cytokines? If so, how? Why should we avoid giving a glucocorticoid to a COVID patient before they develop an elevated CRP or hypoxia? So many questions! A few answers are provided.
The Most Important Person That Lived For Our Health and Wellbeing
Hint: That person died in 2017
An (old) New Weapon to Fight Leg Cellulitis
Acute Severe Hypertension - part 1
Acute Severe Hypertension - part 2
Multiple treatment issues are discussed. This includes theoretical ideal blood pressure lowering rates, oral options (for hypertensive urgency and specific populations), intravenous options (for hypertensive emergency or NPO patients), specific issues with aortic dissection, coronary syndromes, acute pulmonary edema & heart failure, labetalol, esmolol, nitroglycerin, and nitroprusside.
Acute Severe Hypertension - part 3
Did you know that intravenous labetalol and oral labetalol are not really similar? The great hydralazine debate. Things you must know about Clevidipine if you are going to use it.
Acute Severe Hypertension - part 4
Did you know systolic and diastolic blood pressure are NOT measured by automated BP cuffs? PRES (Posterior Reversible Encephalopathy Syndrome), also known as RPLS (Reversible Posterior Leukoencephalopathy Syndrome), is something you should recognize when you see it. Brief mentions of esmolol, nitroprusside, and other topics are scattered somewhere in between musings.
Interesting Studies, Facts, & Opinions - April 2020 edition
If you wonder why good food is more important than mortality and why ordering too many unnecessary consults worsens the food and doesn't impact mortality - this episode is for you. Tramadol is not well understood by many prescribers and there are some emerging facts we all need to know. A flashback to diuretic use in congestive heart failure with fluid overload and elevated creatinine is also disc
Balkan Reflections Forged By A Virus Lockdown
World War I was partly triggered by powerful allies of various nationalities being dragged into a Balkan conflict (nationalism, of course, was another major factor). The more recent Balkan conflict is even more preposterous - and here is my attempt to humorously explain the unexplainable.
Recent Interesting Internal Medicine Studies and Facts - December 2019
Correcting Hypernatremia in adults (finally, a real study!). An option for that scary patient with hemoptysis. How many nephrons you have (and your patient has) - it matters.
Anemia of Inflammation - finally understand this common anemia that accomplished doctors often can't explain
Anemia of Inflammation is also often referred to as Anemia of Chronic Disease. It is one of the most common anemias, yet often challenging to comprehend. This is an attempt is to try and simplify it.
Anemia of Inflammation - part 2
If you know why red blood cells survive less (and are made less) during inflammatory conditions, and already know why ferritin increases in inflammation, and don't want to hear a lousy Iron Man plot idea - then you are good to go on skipping this episode.
Anemia of Inflammation - part 3
Creatine - part 1
It occurs naturally in the body (because we synthesize it), it is in meat, and it is frequently used as a supplement. Since it is in you, why not understand what it is and what it does? Advice is provided on which supplement labels to particularly avoid. A brief reflection upon creatine within our brains (and the potential memory impact seen in one study) is utilized to make the point that when it
Creatine - part 2
The replenishing of muscle ATP is one (of the several) mechanisms that creatine helps with when it comes to heavy anaerobic exercise. Other topics discussed are things to know about lab testing the kidneys while taking creatine. Thoughts on why some don't respond to creatine supplementation.
Creatine - part 3
Is there a specific type of creatine to buy? What is creatine monohydrate? What is Creapure? What do some professional organizations have to say about the safety of creatine? The loading dose debate. Also dives into the several mechanisms of action for how creatine helps build muscle.
Medicare for All? (or maybe you call it Universal Healthcare or Single-Payer)
Are you surprised that GoFundMe and crowdfunding are not the solution to a family healthcare crisis? How about Medicare for All? Hmmmm.....
Part 5 of Muscle and Strength Gaining Tips - The Emotional Connection and Overcoming Temporary Pain
Clostridium Difficile - part 1
A deceivingly difficult topic. Not so obvious points are made about asymptomatic carriers, transmission, and who to test.
Clostridium Difficile - part 2
Specific initial treatment regimens are discussed. Topics include fulminant disease, Vancomycin, Fidaxomicin, Metronidazole, and recurrence rates/regimens.
Clostridium Difficile - part 3
Many of the latest studies in the 2017-2018 timeframe are reviewed. The importance of looking at the eosinophil count on the CBC, probiotic future directions, microbiome transplant options, antibody treatment (bezlotoxumab), "penicillin allergic" patients, and a brief mention of available testing.
Live From My Basement Bathroom
Experiences that taught me some lessons.
Type 2 Diabetes Treatment - Part 7 - GLP-1 Agonists and DPP-4 Inhibitors
Glucagon-Like Peptide 1 (GLP-1) mimetics are also referred to as the GLP-1 receptor agonists. While this talk mostly focuses on GLP-1 mechanisms and actions, the hope is you will also better understand The Dipeptidyl Peptidase-4 (DPP-4) inhibitors
The current GLP-1 Agonists include Exenatide (Byetta), Liraglutide (Victoza), Dulaglutide (Trulicity), Abiglutide (Tanzeum), Lixisenatide (Adlyxin), Se
Type 2 Diabetes Treatment - Part 6 - SGLT2 Inhibitors
Sodium-Glucose Transporter 2 Inhibitors decrease glucose re-absorbtion. The diuretic effect, weight loss, DKA, cardiac outcomes, blood pressure, genital infections and a whole bunch of other information is discussed.
SGLT2s include Canagliflozin (Invokana), Dapagliflozin (Farxiga), Empagliflozin (Jardiance), Ertagliflozin (Steglatro), with more to be released in the future.
Type 2 Diabetes Treatment - Part 5 - HgA1C
There is a lot more to understanding HgA1C then most realize (particularly the quality industry and big corporations).
Type 2 Diabetes Treatment - Part 4 - Metformin
Tackles - Vitamin B12, kidney disease, CHF, cancer, Impaired Glucose Tolerance (IGT), dosing, side-effects, lactic acidosis, cost, drinkers, hypoxic patients, glucose lowering, and a few other moments of erudation.
Type 2 Diabetes Treatment - Part 3 Glucagon
If you want to understand drug classes like DPP-4 inhibitors, GLP-1 (GLUCAGON-like peptide) therapies, treating hypoglycemia, and an important player among the many etiologies of Type 2 diabetes - then you must understand the basics about glucoagon.
Type 2 Diabetes Treatment - Part 2 - Reversing The Disease With Lifestyle Changes
Type 2 Diabetes Treatment - Part 1
Internal Medicine Pearls #5
Diuretic therapy for congestive heart failure treatment, antibiotics for diabetic osteomyelitis after foot surgery, and practical tips with new-onset seizures - is among the knowledge dropped (because, after all, school can't teach us everything).
Some Recent Studies Worth Knowing About - February 2018
Some new stuff about Vitamin D & Calcium supplementation, another about the timing of hip fracture surgery, etc
Forcing Atheist Doctors to Play With God
Internal Medicine Pearls #4
Checking glucose levels in Type 2 Diabetes, ACE Inhibitors for women, and using Azithromycin in Asthma.
Medical Podcasts, Skiing, and Imperfect Relationship Advice
Patent Foramen Ovale Evaluation and Closure After a Stroke - part 2
Patent Foramen Ovale Evaluation and Closure After a Stroke - part 1
The Overhead Airplane Request for Medical Assistance - A No Win Situation
A Severe Case of Healthcare Violence 2 Years Later
Bedbugs 4 The Dark Night Returns
Bedbugs 3 Live Free and Die Hard
Bedbugs 2 Fast and 2 Furious
Bedbugs - part 1
Urine Drug Testing - Misinterpretation is Very Common
You know all those people on social media wanting mandatory drug testing for welfare recipients? Perhaps, reasonable in theory, if the test wasn't frequently producing false-positives and false-negatives. Making accurate clinical decisions is always challenging, but particularly with urine drug testing. The consequences of misinterpretation can be awful.
The death of Chris Cornell and calling my doctor
Internal Medicine Pearls #3
A look at some new data: COPD and Oxygen use - low serum creatinine levels - BMI considerations - the RDW - the age of blood.
Let's do this! Simple changes to healthcare that nearly everyone can agree on.
Vocational Confrontation and Political Rumination
I'm a nerd looking at the world and shamelessly speaking my mind
Renal and Ureteral Stones (Nephrolithiasis - Kidney Stones) - part 4
Oxalate intake reduction, thiazide diuretics, and tamsulosin are some of the therapies discussed in this lecture.
Renal and Ureteral Stones (Nephrolithiasis - Kidney Stones) - part 3
Stone analysis, labs, calcium & fluid intake, sodium in the diet, and beverage choices.
Renal and Ureteral Stones (Nephrolithiasis - Kidney Stones) - part 2
A few words about the proximal ureter, I.V. Fluids, colic, and hematuria.
Renal and Ureteral Stones (Nephrolithiasis - Kidney Stones) - part 1
This episode discusses symptoms, the importance of size, and a few other pearls.
Part 4 of Muscle and Strength Gaining Tips for Men, Women, Bodybuilders, and Beginners
Lifestyle, carbohydrates, protein, and eccentric weight training are part of the focus of this sermon.
Part 3 of Muscle and Strength Gaining Tips for Men, Women, Bodybuilders, and Beginners
This episode is part philosophy, part motivation, and a discussion of some traps men and women get caught in.
Part 2 of Muscle and Strength Gaining Tips for Men, Women, Bodybuilders, and Beginners
Muscle and Strength Gaining Tips for Men, Women, Bodybuilders, and Beginners - part 1
Pulmonary Embolism - Part 4
The use of Inferior Vena Cava (IVC) filters and the length of anticoagulation in unprovoked DVT/PE are considered. A rant about hyper-coagulable panels in provoked DVT/PE is opined.
Pulmonary Embolism - part 3 - Massive PE
Understanding what causes hypotension in PE is essential to understanding the severity of the situation. The relevance of the stressed right ventricle is emphasized. Thrombolytic therapy for hypotension and other clinical scenarios resulting from pulmonary embolism are contemplated.
Pulmonary Embolism - part 2
The treatment challenges of subsegmental pulmonary embolism, with emphasis on the 2016 guidelines are reviewed. Ventilation/perfusion (V/Q) scan interpretations in those unable to get a CT scan are considered.
Pulmonary Embolism - part 1
The topics covered are D-Dimer testing, false positive over-diagnosis of PE on CT scanning, the ADJUST-PE study, and clinical signs and symptoms of a pulmonary embolism.
The Healthcare Consumer in a Fictitious Market
A commentary.
Iron Deficiency Anemia - part 3
Various topics regarding intravenous iron are pondered, especially some of the new data available that has not yet seemed to obtain the influence that the information deserves.
Iron Deficiency Anemia - part 2
This episode mostly centers around oral iron replacement.
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