Mayo Clinic Talks

Guest: Halena M. Gazelka, M.D. (@hmgazelkamd)Host: Tracy McRaeEpisode 1 of 10: Dr. Halena Gazelka, an anesthesiologist boarded in pain and palliative medicine at Mayo Clinic in Rochester walks us through the basics of opioids and the current state of this national crisis. What is an opioid? How bad is the opioid epidemic and how did we get here?Claim CME credit at ce.mayo.edu/opioidpc. This episode is required to be compliant with controlled substance prescribing guidelines in the state of Minnesota.

Guest: Robin M. Lloyd, M.D. (@DrRobinLloyd) Host: Darryl S. Chutka, M.D. (@ChutkaMD) Insomnia has a 25 – 50% incidence rate in children. Dr. Robin Lloyd discusses the patterns and differences of disordered sleep in pediatric patients. She covers the impact technology integration has had, sleep apnea, genetic conditions, and obesity. What are red flag snoring symptoms in children? What are the signs of sleep apnea? Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd. Deeper Dive: BEARS Screening Tool for Assessment of Sleep in Children: https://doi.org/10.1016/j.sleep.2004.07.015 American Academy of Sleep Medicine Recommended Amount of Sleep for Pediatric Populations: https://doi.org/10.5664/jcsm.5866 

Guest: Stephen L. Kopecky, M.D. (@DrSteveKopecky) and R. Scott Wright, M.D.Host: Darryl S. Chutka, M.D. (@ChutkaMD)  Dr. Stephen Kopecky and Dr. Steve Wright throw down in this debate over best practice and appropriate use of cholesterol-lowering medications. Listen in to get the perspective of two leading cardiologists on statins, PCSK9i's, fish oil, side effects, and patient education. Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

Guest: Jonathan D. Barlow, M.D. (@JonBarlowMD)Host: Darryl S. Chutka, M.D. (@ChutkaMD)Golfer’s Elbow, Tennis Elbow, Boat antifouling paint elbow…medial and lateral epicondylitis can result from a variety of repetitive activities. Dr. Jon Barlow lays out the differences between some commonly seen elbow pain generators and extends the discussion to radial tunnel syndrome, olecranon bursitis, stress fractures, and more.Dr. Barlow shares recommendations for treatment, including why you shouldn’t use steroid injections for elbow pain, when bracing may be beneficial, how to determine ulnar nerve involvement in medial epicondylitis, and ruling out referred pain.Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

Guest: Edward R. Laskowski, M.D. (@DrEdSportsMed)Host: Darryl S. Chutka, M.D. (@ChutkaMD)A MUST listen episode: 70% of Americans are overweight or obese and inactive and it’s not getting better. Dr. Ed Laskowski gives an eye-opening overview on our current state of health at a global level and what we can do about it for ourselves and for our patients. As little as 10 minutes of physical activity a week lowers all-cause mortality! To hear more from Mayo Clinic Sports Medicine, follow them on Twitter @MayoClinicSport.Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.Deeper Dive: Overweight, Obesity, and Mortality in a Large Prospective Cohort of Persons 50 to 71 Years Old; N Engl J Med 2006; 355:763-778 DOI: 10.1056/NEJMoa055643 https://www.nejm.org/doi/full/10.1056/NEJMoa055643?query=recirc_curatedRelated_articlePhysical Activity Guidelines for Americans https://www.hhs.gov/fitness/be-active/physical-activity-guidelines-for-americans/index.htmlBeneficial associations of low and large doses of leisure time physical activity with all-cause, cardiovascular disease and cancer mortality: a national cohort study of 88,140 US adults. British Journal of Sports Medicine 2019 http://dx.doi.org/10.1136/bjsports-2018-099254

Guest: J. Taylor Hays, M.D. (@jtaylorhays)Host: Darryl S. Chutka, M.D. (@ChutkaMD)How do you treat nicotine dependent patients with other substance use disorders, and which do you start with? Does quitting tobacco increase these patients’ risk for relapse of other substances? What should you do with the patient that has “tried everything?” Dr. Taylor Hays sheds light on helping some of your most challenging patients to quit smoking.Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

Guest: Esther Choo, M.D. (@choo_ek)Hosts: Anjali Bhagra, M.D. (@anjalibhagramd) and Joshua B. Murphy, J.D.As a health policy researcher, Dr. Esther Choo approaches problems analytically; critically examining the data and sharing the insights. She’s applied this to her work with TIME’S UP Healthcare to address gender equity and sexual harassment in medicine. Some of the same barriers that create health disparities impact the healthcare workforce. Addressing these issues will require changing organizational culture, how do we move to a more horizontal power structure without sacrificing all of the efficiencies of a vertical structure? Find more GRIT in Medicine episodes here. Deeper Dive: The National Academies of Sciences, Engineering, and Medicine Report on Sexual Harassment of Women- Climate, Culture, and Consequences in Academic Sciences, Engineering, and Medicine https://www.nap.edu/read/24994/chapter/1

Guest: J. Taylor Hays, M.D. (@jtaylorhays)Host: Darryl S. Chutka, M.D. (@ChutkaMD)Through a combination of health policy, smoke-free environmental changes, education, and treatment availability, smoking prevalence among adults has dropped significantly. But that’s not the case for our patients with mental health disorders. Dr. Taylor Hays dispels the myths around nicotine dependence and mental health disorders like depression, anxiety, bipolar disorder, and schizophrenia. He’ll fill you in on how to help these patients quit and what quitting looks like for this patient population.Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

Guest: Daniel L. Hurley, M.D.Host: Darryl S. Chutka, M.D. (@ChutkaMD)Communication helps to establish a relationship between practitioner and patient but how do you build the necessary trust within the short time frame of an appointment slot? Dr. Daniel Hurley covers some of the most common communication mistakes even the experts make and offers some tips you can use to communicate more effectively.Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

Guest: J. Taylor Hays, M.D. (@jtaylorhays)Host: Darryl S. Chutka, M.D. (@ChutkaMD)Quitting smoking is one of the hardest things for our patients to do. The clinical target of nicotine replacement and other quit therapies is not to smoke. Clinical outcomes vary among the pharmacologic treatments, relapses are common, and some patients become addicted to those treatments. Dr. J. Taylor Hays unravels some of the do’s and don’ts when it comes to counseling and treating these patients.Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

Guests: Philip T. Hagen, M.D. and Melanie D. Swift, M.D. (@swifzdh) Host: Darryl S. Chutka, M.D. (@ChutkaMD)Do you self-manage your health? Do you avoid regular routine screenings? Drs. Hagen and Swift from the Mayo Clinic Physician Health Center layout the evidence supporting the need for organizational support that directly addresses the barriers of time, safe space, and confidentiality. If you have a practitioner as a patient, how can you partner with colleagues in Occupational Medicine to confidentially, accurately, and efficiently evaluate what impact the conditions or medications may have on your patient’s ability to practice?Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.Deeper Dive: Mayo Clinic Physician Health Center https://www.mayoclinic.org/departments-centers/preventive-occupational-aerospace-medicine/physician-health-center/overview A survey of physicians’ perceptions of their health care needs Steffen MW, Hagen PT, Benkhadra k, Molella RG, Newcomb RD, Murad MH. Occupational Medicine, Volume 65, Issue 1, January 2015, Pages 49–53, https://doi.org/10.1093/occmed/kqu145 

Guest: Clayton T. Cowl, M.D., M.S. Host: Darryl S. Chutka, M.D. (@ChutkaMD)What conditions should trigger you to do a preflight assessment for your patients? What special precautions should be taken for patients with heart failure, who’ve recently had surgery, or are pregnant? Dr. Cowl dives into the physiological challenges a mildly hypoxic and high-altitude environment can have on your patients as they age and manage chronic illnesses. Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.Deeper Dive: Aerospace Medical Association – Medical Considerations for Airline Travel https://bit.ly/2qLAKVg American College of Chest Physicians – Guidelines and Resources https://bit.ly/2qJGSxi 

Guest: Tyler S. Oesterle, M.D., M.P.H. (@OesterleMD)Host: Darryl S. Chutka, M.D. (@ChutkaMD)What are the current trends in substance abuse in the adolescent population? Is nicotine still the primary gateway? What questions should you be asking patients and their families? Dr. Tyler Oesterle covers what leads to experimentation, how it is changing in today’s landscape, and how adolescent addiction and treatment differs from adults, and some medications that can be helpful.Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

Guest: Denise M. Dupras, M.D., Ph.D.Host: Darryl S. Chutka, M.D. (@ChutkaMD)How do new drugs make it to market? How do generics come to market and what are the differences in the approval process? Dr. Denise Dupras details the process from discovery to mass market release, safety, the electronic health record, rising costs, and a few affordability tips for your patients.Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

Guest: David R. Farley, M.D. Host: Darryl S. Chutka, M.D. (@ChutkaMD) What should you be looking for in your physical exam? How do you differentiate a femoral hernia from a swollen lymph node? Dr. David Farley breaks down common hernias, the importance of the history and the exam, when imaging studies like a CT scan may be needed, the impact of smoking, weight gain, and life style on incision healing, and when someone should be referred for surgery. Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd. 

Guest: Lois J. Mc Guire, APRN, C.N.P., M.S. Host: Darryl S. Chutka, M.D. (@ChutkaMD) When do you begin cervical cancer screening in your patients? Is it really ok to go 5 years in between pap smears? Which algorithm should you use to determine next steps? Lois Mc Guire details the ins and outs of cervical cancer screening including pathology reports, follow up testing recommendations, intervals for routine screening, and some expert tips for performing pap smears. Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd. Deeper Dive: ASCCP Guidelines: http://www.asccp.org/guidelines US Preventative Services Task Force: https://bit.ly/31h88zR The American College of Obstetrics and Gynecologists: https://bit.ly/2IVhc7g 

Guests: Emily J. Holm, Pharm.D., BCACP, R.Ph. and Audrey J. Umbreit, Pharm.D., R.Ph. Host: Darryl S. Chutka, M.D. (@ChutkaMD) With over half of adults potentially taking an inappropriate medication some of the side effects can be very insidious. What can you do to mitigate these effects for your patients and how can you safely reduce the chance of a prescription cascade? Drs. Holm and Umbreit share tips on how you can help your patients take their medications correctly. Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd. Deeper Dive: Beers Criteria https://dcri.org/beers-criteria-medication-list/ STOPP/START Criteria for Potentially Inappropriate Prescribing in Older People Age and Ageing, Volume 44, Issue 2, March 2015, Pages 213–218, https://doi.org/10.1093/ageing/afu145 

Guest: Robert M. Jacobson, M.D. (@RobertJMD)Host: Darryl S. Chutka, M.D. (@ChutkaMD)What are the true contraindications for the flu vaccine? How early is too early for your patients to get vaccinated? Dr. Robert Jacobson discusses the ins and outs of vaccines, how to respond to common reasons patients don’t want to get vaccinated, and how to increase your practice’s vaccination rates.Tips @14:54: It’s more of a stop sign than “do you want fries with that?”TLDR: Listen at 19:21 for Dr. Jacobson’s must-know tips!Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

Guest: John M. Wilkinson, M.D. Host: Darryl S. Chutka, M.D. (@ChutkaMD) Dr. John Wilkinson and Dr. Darryl Chutka share the key takeaways from their decades of practice. Listen in to their pearls and share yours with us on Twitter with hashtag #MayoClinicTalks. Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd. 

Guest: Elie F. Berbari, M.D. (@DOCElie)Host: Darryl S. Chutka, M.D. (@ChutkaMD) Infection remains an uncommon but major complication of prosthetic joint replacement procedures. What increases your patient’s chance of getting an infected joint? What can you do to decrease the chance of infection? Do patients need antibiotics when having dental work? Dr. Elie Berbari discusses these questions and more in what Dr. Darryl Chutka calls “one of the best Grand Rounds” he’s heard. Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd. Deeper Dive: Appropriate Use Criteria For the Management of Patients with Orthopaedic Implants Undergoing Dental Procedures https://bit.ly/2QAn6LN  The use of prophylactic antibiotics prior to dental procedures in patients with prosthetic joints https://doi.org/10.1016/j.adaj.2014.11.012 

Guest: M. Regina Castro, M.D. Host: Darryl S. Chutka, M.D. (@ChutkaMD) What do you do when a patient presents with subclinical hypothyroidism? When do you treat and how do you treat? Dr. Regina Castro presents the discussion around treating subclinical hypothyroidism, thyroid extract, and how to differentiate common symptoms from non-thyroid causes. Dr. Castro covers nodules, fine needle aspirates, the Sensitive TSH test, Total T4, Free T4, and TPO antibodies, and the role of lab testing in diagnosis. Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd. 

Guest: Carol L. Kuhle, D.O., M.P.H. (@clkejd) Host: Darryl S. Chutka, M.D. (@ChutkaMD) A decline in sexual activity and an increase in sexual dysfunction commonly occurs in the elderly, but do you ask you patients about it? What questions should you be asking them? What are the reasons a decrease in function or desire occur? Dr. Carol Kuhle steps through the common causes, questions, and treatments encountered through her work and research at the Mayo Clinic Center for Women's Health (https://www.mayoclinic.org/departments-centers/womens-health/center-for-womens-health/overview or on Twitter @WHMayoClinic). Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.Deeper Dive: A Study of Sexuality and Health Among Older Adults in the United States August 23, 2007 N Engl J Med 2007; 357:762-774 DOI: 10.1056/NEJMoa067423

Guest: Jonathan T. Finnoff, D.O. (@FinnoffJonathan) Host: Darryl S. Chutka, M.D. (@ChutkaMD) Special Back to School Sports Medicine for the Primary Care Provider Series – Episode 5: Greater efficacy, lower cost, and quicker recovery, ultrasound-guided procedures are sure to change the landscape of medicine. What can be treated with these procedures? What’s the evidence behind them? Are they really safe? Dr. Jonathan Finnoff discusses ultrasound-guided procedures in application to carpal tunnel syndrome, trigger finger, de Quervain's tenosynovitis, adductor tendinopathy, and chronic exertional compartment syndrome. Listen now to hear more about this cutting-edge game changer and what it means for your patients. Hear more from Mayo Clinic Sport Medicine on Twitter @MayoClinicSport. Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd. 

Guest: Mark Denis P. Davis, M.D. Host: Darryl S. Chutka, M.D. (@ChutkaMD) Does skin not exposed to the sun have an increased chance of skin cancer when patients have had multiple sunburns? Are existing moles or new moles more likely to become a melanoma? Dr. Mark Denis Davis discusses skin cancer, sun exposure, and sunscreen. Dr. Davis also dives into rosacea, eczema, psoriasis, urticaria, onychomycosis, and warts. Who is at risk? What increases the risk? How do you treat it? Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd. 

Guest: Edward R. Laskowski, M.D. (@DrEdSportsMed) Host: Darryl S. Chutka, M.D. (@ChutkaMD) Special Back to School Sports Medicine for the Primary Care Provider Series – Episode 4: What are some of the common foot and ankle injuries seen in athletes? When is the wait and see approach not advised? When should patients be referred for surgery? Dr. Laskowski dives into detail on presentation and mechanism of injury, risk of recurrence, the role of bracing and proper balance and proprioceptive exercises. To hear more from Mayo Clinic Sports Medicine, follow them on Twitter @MayoClinicSport. Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd. 

Guest: Maria L. Collazo-Clavell, M.D. Host: Darryl S. Chutka, M.D. (@ChutkaMD) What is the true key to weight loss? What about maintaining that loss? How do you manage these conversations with your patients? What framing of those conversations leads to more effective outcomes? Dr. Maria Collazo-Clavell discusses approaches for effectively discussing health concerns and obesity with our patients. How to identify their goals and build upon them utilizing motivational interviewing and partnering effectively with other health care providers. Dr. Collazo-Clavell also covers medications and referral for bariatric procedures.Deeper Dive: Maintenance of Lost Weight and Long-Term Management of Obesity Kevin D. Hall Ph.D. and Scott Kahan M.D., M.P.H. Medical Clinics of North America, 2018-01-01, Volume 102, Issue 1, Pages 183-197 DOI: 10.1016/j.mcna.2017.08.012

Guest: David B. Soma, M.D. (@DrDaveSoma)Host: Darryl S. Chutka, M.D. (@ChutkaMD)Special Back to School Sports Medicine for the Primary Care Provider Series – Episode 3: How are overuse injuries different in youth and what trends are occurring in these patients? What conversations should you have with parents of child athletes? What sports put our patients at highest risk? Dr. David Soma discusses the what role should imaging play in this population, the significance of the history and physical, the age-related prevalence of certain conditions and their underlying etiology, and the long-term complications our patients may face if these are not recognized and addressed. To hear more from Mayo Clinic Sports Medicine, follow them on Twitter @MayoClinicSport. Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

Guest: Suzanne M. Norby, M.D. (@SuzanneNorby) Host: Darryl S. Chutka, M.D. (@ChutkaMD) When should we be concerned about an elevated creatinine level? What role should the creatinine level, GFR, BUN, and cystatin C play in determining renal function? Dr. Suzanne Norby discusses the common findings in renal function testing, the various factors that can influence the test results, and when to consider imaging. Deeper Dive: https://news.mayocliniclabs.com/2016/05/05/ask-the-expert-cystatin-c-and-creatinine-complementary-markers-of-gfr/ 

Guest: Daniel P. Montero, M.D. (@DanMonteroMD) Host: Darryl S. Chutka, M.D. (@ChutkaMD) Special Back to School Sports Medicine for the Primary Care Provider Series – Episode 2: Who can do these types of exams? What questions are important to cover in the history? What’s the ideal lead time prior to participation that patients should be screened? Dr. Montero discusses the ins and outs of pre-participation sports physicals and the common findings from his practice. To hear more from Mayo Clinic Sports Medicine, follow them on Twitter @MayoClinicSport. Deeper Dive: American Academy of Pediatrics – Pre-Participation Evaluation: https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Pages/PPE.aspx 

Guest: Ying Ying (Christina) Chen, M.D. Host: Darryl S. Chutka, M.D. (@ChutkaMD) Preventative health care becomes more complicated as patients age. Do screening tests continue to improve the quality and duration of our elderly patient’s lives? Dr. Christina Chen discusses her process for determining the appropriateness of preventative health screening for patients over 65 and steps through what a generalist should know about the comprehensive geriatric assessment to help maximize independence for our patients. Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd. Deeper Dive: US Preventative Health Task Force https://www.uspreventiveservicestaskforce.org/Page/Name/tools-and-resources-for-better-preventive-care  

Guest: Cara C. Prideaux, M.D. Host: Darryl S. Chutka, M.D. (@ChutkaMD) Special Back to School Sports Medicine for the Primary Care Provider Series – Episode 1: According to the CDC, sports concussions have reach epidemic levels. Dr. Cara Prideaux discusses risks for concussions, evaluation signs and symptoms, and when referral and imaging is recommended. What should be happening on the sidelines when one of your patients has an event? What are the recommendations for recovery and returning your patients to school and sports? Dr. Prideaux details the dangers of returning too early and what to do when patients are making a delayed transition back to normality. To hear more from Mayo Clinic Sports Medicine, follow them on Twitter @MayoClinicSport. Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.Deeper Dive: American Medical Society for Sports Medicine Position Statement on Concussion in Sport Harmon KG, Clugston JR, Dec K, et al American Medical Society for Sports Medicine position statement on concussion in sport British Journal of Sports Medicine 2019;53:213-225. http://dx.doi.org/10.1136/bjsports-2018-100338 

Guest: Robert Haddon, M.D., M.S. & Maryjane (MJ) F. Harris, D.O. Host: Darryl S. Chutka, M.D. (@ChutkaMD) Who decides when the plane needs to land due to a medical emergency and what’s involved in those decisions? What’s the protocol for CPR on board and what tools are available to help with resuscitation? What happens when a passenger dies on a flight? Drs. Haddon and Harris step through the intricacies of responding to in-flight emergencies and the ethics involved. Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

Guests: Robert Haddon, M.D., M.S. & Maryjane (MJ) F. Harris, D.O. Host: Darryl S. Chutka, M.D. (@ChutkaMD) Are you required to respond? If you do, what are your responsibilities? What are your liability risks and protections? Dr. Harris steps through some recommendations for responding to in-flight emergencies. Dr. Haddon runs through what you should ask as part of the physical exam while in-flight and why these questions are important. Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

Guest: Stephanie L. Hansel, M.D., M.S. (@SLHanselMD)Host: Darryl S. Chutka, M.D. (@ChutkaMD)What causes Irritable Bowel Syndrome (IBS)? What diets are recommended? What is gut-brain access and what does it have to do with IBS? Dr. Hansel covers treatment recommendations for IBS-diarrhea predominant, IBS-constipation predominant, and IBS-mixed type, including the role of bile acid malabsorption.Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.Deeper Dive: Bile Acid Malabsorption Testing: https://news.mayocliniclabs.com/2018/03/09/michael-camilleri-m-d-leslie-donato-ph-d-discuss-testing-bile-acid-malabsorption-clinical-practice/ 

Guest: Matthew A. Bartlett, M.B., B.Ch., B.A.O. Host: Darryl S. Chutka, M.D. (@ChutkaMD) Who can be treated outpatient and who really needs to be evaluated in the ED? When does the risk of treatment outweigh the benefits? What tools can you use to help make these decisions? Dr. Matthew Bartlett discusses when to treat, options for treatment – including direct oral anticoagulants, follow up care, and preventative measures for patients with thrombotic disease. Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd. 

Guests: Catherine W. Njathi-Ori, M.D., Erin K. O'Brien, M.D. (@ErinOBrienMD), Nafisseh S. Warner, M.D. (@nafisseh_warner) Host: Darryl S. Chutka, M.D. (@ChutkaMD) What are microaggressions? How do you recognize them? How do you address them? Efficient teams and effective health care require diverse and inclusive environments. Drs. Njathi-Ori, O’Brien, and Warner present on microaggressions in medicine, the evidence in gender gap research, and give you tools to address microaggressions when they happen in your environment.Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

Guest: Stephen L. Kopecky, M.D. Host: Darryl S. Chutka, M.D. (@ChutkaMD) What are the updated guidelines for managing hyperlipidemia and how do the risk modifiers change how patients should be treated? What do you do when a patient starts a statin and there is no change in cholesterol levels? What do you do when increasing the dose or switching to a stronger drug continues to have little to no impact? Dr. Kopecky discusses the updated guidelines, challenges with statin therapy, and additional tactics to consider in treating hyperlipidemia. Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd. Deeper Dive: 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines http://www.onlinejacc.org/content/early/2018/11/02/j.jacc.2018.11.003 Cardiovascular Risk Reduction with Icosapent Ethyl for Hypertriglyceridemia https://www.nejm.org/doi/full/10.1056/NEJMoa1812792 

Guest: Gregory A. Poland, M.D. (@drgregpoland)Host: Darryl S. Chutka, M.D. (@ChutkaMD) The World Health Organization has listed vaccine hesitancy as a Top 10 Global Health Threat. How do you discuss vaccine myths with vaccine hesitant patients? What are the true risks associated with vaccines? How do you navigate conversation with a patient who refuses a flu vaccine because they had one in the past and still got the flu? Dr. Gregory Poland discusses vaccine hesitancy, immunization in pregnancy, late-season flu vaccines, antigenic burden and the evidence behind single session multiple vaccine administration, and the ethics of health care provider immunizations.Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd. Deeper Dive: Poland GA, Jacobson RM. The age-old struggle against the antivaccinationists. N Engl J Med. 2011 Jan 13;364(2):97-9. doi: 10.1056/NEJMp1010594. https://www.nejm.org/doi/10.1056/NEJMp1010594 Poland GA. Influenza vaccine failure: failure to protect or failure to understand? Expert Rev Vaccines. 2018 Jun;17(6):495-502. https://doi.org/10.1080/14760584.2018.1484284 Poland CM, Poland GA. Vaccine education spectrum disorder: the importance of incorporating psychological and cognitive models into vaccine education. Vaccine. 2011 Aug 26;29(37):6145-8. https://doi.org/10.1016/j.vaccine.2011.07.131 

Guest: John B. Kisiel, M.D. (@DrJohnKisiel) Host: Darryl S. Chutka, M.D. (@ChutkaMD) Who is a good candidate for multitarget stool DNA testing and what do you do when it’s positive but the colonoscopy is discordant? Do you have a surveillance plan for your patients with ulcerative colitis and irritable bowel disease? What are the current screening recommendations for the general public versus patients with a family history? Dr. John Kisiel discusses these recommendations and the evidence behind them. He shares tips on managing patients on anticoagulant therapy going for polypectomy and when to stop screening in the elderly. Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

Guest: J. Taylor Hays, M.D. (@jtaylorhays)Host: Darryl S. Chutka, M.D. (@ChutkaMD)What’s the difference between e-cigarettes, vaping, and the newly FDA authorized “heat-not-burn” or IQOS devices? Do they really help our patients stop smoking and what data is available on the safety of these products? Listen now to hear Dr. Taylor Hays discuss these points and more.Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.Deeper Dive: The FDA Authorization of IQOS: https://bit.ly/2XV2cLw A Randomized Trial of E-Cigarettes versus Nicotine-Replacement Therapy: https://www.nejm.org/doi/full/10.1056/NEJMoa1808779 

Guest: Sandhya Pruthi, M.D. (@DrSandhyaPruthi)Host: Darryl S. Chutka, M.D. (@ChutkaMD)How can we help women at high risk of breast cancer manage their risk? How do you rank these risks and approach their management? Dr. Pruthi discusses what you can do and tools that you can use to help calculate risk and what to do with the information you have.Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.Deeper Dive: Breast cancer risk assessment tools:Gail model https://bcrisktool.cancer.gov/ IBIS tool http://www.ems-trials.org/riskevaluator/ 

Guest: Ashley Laganiere, CVSO Host: Darryl S. Chutka, M.D. (@ChutkaMD) Female veterans can face significant barriers to receiving proper care. As the number of female service members increases, what can we do to help address these barriers and facilitate access to the care they need? What resources exist and how do we identify this population if they do not readily self-identify as veterans? Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd. Deeper Dive: National Association of County Veterans Service Officers: https://www.nacvso.org/Minnesota Association of County Veterans Service Officers: https://www.macvso.org/index.htmlVA Women’s Health Research Network: https://www.hsrd.research.va.gov/for_researchers/womens_health/ Military Health and Health Care https://www.rand.org/topics/military-health-and-health-care.html 

Guest: Bobbi S. Pritt, M.D. (@ParasiteGal) Host: Darryl S. Chutka, M.D. (@ChutkaMD) How do you detect Lyme’s disease without the rash? What are the implications for our patients if we miss it? If you practice in an endemic area what are the guidelines for treatment when your patient has been bitten by a tick? Dr. Bobbi Pritt discusses Lyme disease detection, prophylaxis, and some of the long-term consequences of Lyme disease. Listen now to learn the ABCs of tick bite prevention. Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.Deeper Dive: CDC Guidelines for Tick Bite Prophylaxis: https://www.cdc.gov/ticks/tickbornediseases/tick-bite-prophylaxis.htmlDr. Pritt's “Creepy, Dreadful, Wonderful Parasites” blog https://parasitewonders.blogspot.com/ 

Guest: Kenneth G. Poole, Jr., M.D., M.B.A. Host: Darryl S. Chutka, M.D. (@ChutkaMD) Does perception of care equal quality of care? Healthcare is increasingly consumer-centric and patient experience data can inform us about how we compare within our own institution and across healthcare. But the data can also be influenced by the nature of your practice and implicit bias present in our patients. What are some of the unintended implications of patient experience data? How can we responsibly interpret and utilize it? What scores should we be striving for? What is the sweet spot?Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.Deeper Dive: Dr. Poole’s article in the New England Journal of Medicine: https://www.nejm.org/doi/full/10.1056/NEJMp1813418 A brief webcomic by Whit Taylor and Chris Kindred on the Tuskegee Experiment: https://thenib.com/tuskegee-experiment?utm_campaign=web-share-links&utm_medium=social&utm_source=link 

Guest: Stacey A. Rizza, M.D. (@DrStaceyRizza) Host: Darryl S. Chutka, M.D. (@ChutkaMD) How close are we to having an immunization for HIV? What’s on the horizon? When should your patients be referred to an HIV center or clinic for care? How do you connect a patient that wants local care when a center isn’t close by? Dr. Rizza discusses the management of HIV, pharmacotherapy, and goals of treatment in the second episode of this two-part HIV mini-series.Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

Guest: Stacey A. Rizza, M.D. (@DrStaceyRizza) Host: Darryl S. Chutka, M.D. (@ChutkaMD) Can you predict who has HIV and who doesn’t? Do you order universal HIV screening? What screening tests should be ordered and what happens when the results are positive or equivocal? When is a false negative possible? What is the effective window for post-exposure prophylaxis? Dr. Stacey Rizza discusses HIV and progression to AIDS, medical exposures, and screening in the first episode of this two-part HIV mini-series.Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.Deeper Dive: Universal screening: https://doi.org/10.1016/j.mayocp.2012.06.021 

Guest: S. Vincent Rajkumar, M.D. (@VincentRK) Host: Darryl S. Chutka, M.D. (@ChutkaMD) Why are prescription drug costs so high in the United States? What role does the rebate system potentially play in drug availability? What is value-based pricing? Vincent Rajkumar, M.D. discuss research in this area and provides resources for health care providers to have discussions with patients about drug affordability. Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd. Deeper Dive: https://doi.org/10.1016/j.mayocp.2012.07.007 https://doi.org/10.1016/j.mayocp.2015.01.014 

Guest: Jeffrey S. Brault, D.O. (@JeffBrault) Host: Darryl S. Chutka, M.D. (@ChutkaMD) When should patients be referred to a physiatrist versus a physical therapist? What services can you expect when referring your patient to physical medicine and rehabilitation? Can they help your patients avoid surgery? What resources do they utilize to decrease pain and increase function? Listen as Dr. Jeff Brault discusses his five-finger approach to treatment of chronic and degenerative disease. Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

Guest: Sharonne N. Hayes, M.D. (@SharonneHayes) Host: Darryl S. Chutka, M.D. (@ChutkaMD) The healthcare system is not immune to bias, harassment, and discrimination. How do we create a climate of mutual respect? How do we empower bystanders to step up? How do we create systems and procedures to ensure consistent messaging and action when these things occur? Listen in as Dr. Sharonne Hayes discusses the Time’s Up Healthcare movement and what you can do to get involved. Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd. Deeper Dive: https://www.timesuphealthcare.org 

Guest: Richard J. Caselli, M.D. Host: Darryl S. Chutka, M.D. (@ChutkaMD) When does forgetfulness become a red flag for dementia? What’s normal aging and what’s underlying disease process? When is a mental status exam not enough and what should you do next? Dr. Richard Caselli discusses dementia diagnosis, risk factors, treatment, and research. Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd. 

Guest: Ying Ying (Christina) Chen, M.D. Host: Darryl S. Chutka, M.D. (@ChutkaMD) How does integrative medicine differ from alternative and complementary medicine? Are the practices evidence-based? How and when can these techniques be applied in your current practice? Listen as Dr. Christina Chen discusses the practice of integrative medicine and its impact on her patients. Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd. 

Guest: Stephen P. Merry, M.D. Host: Darryl S. Chutka, M.D. (@ChutkaMD) Primary care providers can make a difference in the health disparities experienced internationally. Impact can range from directly providing care to educating staff and building enduring local capacity. Listen for some points to consider when planning a global health trip or medical mission. How do you get started? What skills do you need as a health care provider? How do you pick a location? Where can you find more reliable in-depth information on global health? Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd. 

Guest: Anjali Bhagra, M.D. (@anjalibhagramd) Host: Darryl S. Chutka, M.D. (@ChutkaMD) How does our brain react to stress and setback? How can we harness what neuroscience tells us about these responses to combat the stresses in our lives we cannot currently change? Dr. Anjali Bhagra steps through the three F’s- focus, fatigue, and fear, to dig a little deeper into how we’re geared to respond and what we can do to intentionally navigate our responses. Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd. 

Guest: Darryl S. Chutka, M.D. (@ChutkaMD) Host:  Thomas C. Shives, M.D. (@DrTomShives) The tables turn as Thomas Shives, M.D., long-time host of Mayo Clinic Radio, interviews Darryl Chutka, M.D., about his career highlights and how he became involved in the Mayo Clinic Talks Podcast.Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

Guest: Thomas P. Pittelkow, D.O., M.P.H. Host: Darryl S. Chutka, M.D. (@ChutkaMD) Does medical marijuana have proven benefits? Who can prescribe it? What are the potential harms in using it? Dr. Thomas Pittelkow, a Mayo Clinic anesthesiologist specializing in pain management for cancer patients and advanced interventions in end of life care, discusses the differences between recreational and medical marijuana. Listen in for more on hopes and limitations in cannabis research, best practices for patient conversations, state vs. federal regulations, and the importance of communication with dispensaries. Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd. Deeper Dive: Detailed information about Medical Cannabis, visit https://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/medical-marijuana/art-20137855. State-to-state regulations, visit http://www.ncsl.org/research/health/state-medical-marijuana-laws.aspx. 

Guest: Katherine W. Arendt, M.D. (@arendt_katie)Host: Darryl S. Chutka, M.D. (@ChutkaMD)We practice effective communication with our patients but how effectively do we communicate with our co-workers? At home after a long day? Dr. Katie Arendt discusses how to utilize humility and emotional intelligence to communicate effectively and build awareness of confirmation bias and ladders of inference.Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

Guest: Sandhya Pruthi, M.D. (@DrSandhyaPruthi)Host: Darryl S. Chutka, M.D. (@ChutkaMD)Dr. Sandhya Pruthi, a breast disease specialist in Mayo Clinic’s Breast Diagnostic Clinic, discusses why we don’t use ultrasound as a primary screening test for breast cancer. Listen in for the pros and cons of different types of imaging studies and which are used for screening versus diagnostic testing. Also discussed is the role genetic testing should play in breast cancer screening, who should have testing done, and what tests are available, including when a care plan should include a genetic counselor.Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

Guest: Mitchell R. Humphreys, M.D. (@MayoMitch)Host: Darryl S. Chutka, M.D. (@ChutkaMD)Prostate cancer is a very common malignancy in men, second only to skin cancer. Despite the fact that it’s one of the more treatable malignancies, it remains the 2nd leading cause of cancer death in men. When diagnosed early, it has an excellent prognosis. The 5-year survival rate approaches 100% in those with local or regional disease. Although screening for prostate cancer is available, the use of screening tests has been controversial and recommendations regarding its use, confusing. Listen in to get a urologist’s perspective.Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

Dr. Jacob Sellon discusses advances in treatment of musculoskeletal pain and osteoarthritis, covering common questions about platelet-rich plasma and stem cell injections. Do they work? What’s the efficacy demonstrated in literature so far? What are the benefits and risks we need to discuss with our patients? What is FDA compliant versus FDA approved treatment and how does this influence insurance coverage and care management? Where does regenerative medicine research need to go?

Dr. Sharonne Hayes discusses the impact of unconscious bias in medicine and how providers can take steps to acknowledge, address, and mitigate these cultural imprints on our automatic thought processes. She then turns the tables discussing patient bias and how health systems and providers can protect and support staff who have been harassed, along with processes that can be put in place to systematically address existing practices that fosters bias. Project implicit can be found here: https://implicit.harvard.edu/implicit/takeatest.html.

Traumatic brain injury in children represents a significant public health problem and they account for over one-half million emergency department visits per year. It’s estimated that traumatic brain injuries affect as many as one in five children by the age of 15. These brain injuries can have lifelong effects on a child’s development, including their ability to learn and participate effectively in social activities. Today we’re joined by Dr. Sherilyn Driscoll, a consultant in Pediatric Physical Medicine and Rehabilitation at the Mayo Clinic Children’s Center in Rochester. Her areas of interest include brain and spinal cord injury, cerebral palsy, and spina bifida.For more information about the CDC’s Heads Up program, visit https://www.cdc.gov/headsup/.

Our topic for discussion today is benign prostatic hyperplasia, or BPH. By age 60, it’s estimated that 50% of men will have some symptoms of BPH. While BPH is not a life-threatening condition, and only rarely does it result in serious health consequences, it commonly causes symptoms affecting men’s lifestyle. Our guest today is Dr. Mitchell Humphreys, chair of the Department of Urology at Mayo Clinic Arizona and Dean of the Mayo Clinic School of Continuous Professional Development.

We’ve all heard this many times “Exercise is good for you.” We know we should all participate in some form of exercise and we commonly recommend exercise to our patients. We’re very busy, our patients are very busy. So how do we develop a regular exercise program that we can adhere to and how do we get our patients to realize the benefits they can achieve with exercise? To help answer these questions, we have with us today Dr. Robert Scales, an exercise physiologist and director of Cardiac Rehabilitation & Wellness at Mayo Clinic, Arizona.

Today’s special episode is an excerpt from the Mayo Clinic Pediatric Days Conference. This annual conference provides an interdisciplinary update in the latest strategies for providing timely and effective evidence-based diagnosis and management plans for multiple aspects of pediatric and young adult health. Today’s selected presentation, “You Did What? Uncovering What Kids are Ingesting” is presented by Dr. Charlotte S. Van Dorn, a Mayo Clinic Pediatric and Intensive Care Specialist.

Guest: Michael H. Silber, M.B., Ch.B. Host: Darryl S. Chutka, M.D. (@ChutkaMD) We spend about one third of our life asleep, yet not all of us wake up refreshed and recharged the next morning. Insomnia is common and medications to help us sleep are extremely popular, but are they effective and are they safe? To discuss these issues regarding sleep, we are pleased to have as our guest today, Dr. Michael Silber, a neurologist and sleep expert. Dr. Silber works in the Center for Sleep Medicine at Mayo Clinic, Rochester.Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

Guest: Arne H. Graff, M.D. (@arne_graff)Host: Darryl S. Chutka, M.D. (@ChutkaMD)Child abuse is a serious problem, both within the U.S. and around the world. In 2012, Child Protective Services agencies estimated that approximately 9 out of 1000 children in the U.S. were victims of child maltreatment and this was felt to underestimate the true scope of the problem. A recent study by the CDC estimated that one in four children experience some form of maltreatment in their lifetimes. Today we’re joined by Dr. Arne Graff, a family physician and Division Chair of Child Abuse and Pediatrics, practicing at Mayo Clinic, Rochester, Minnesota.Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

Guest: Ekta Kapoor, M.B.B.S. (@Ektasinghkapoor)Host: Darryl S. Chutka, M.D. (@ChutkaMD)For years, healthcare providers routinely prescribed hormone therapy for the management of women with postmenopausal symptoms as well as to reduce the risk of cardiovascular disease and the treat osteoporosis. Then, in 2002, the Women’s Health Initiative was published and our views of hormone therapy changed. Parts of the study’s findings were criticized leading to confusion as to whether hormone therapy was as effective as we assumed as well as whether hormone therapy was exposing women to excessive health risks. To help us sort out the benefits and risks of hormone therapy in women, we’re joined by Dr. Ekta Kapoor, a Mayo Clinic internist and specialist in the Menopause and Women’s Sexual Health Clinic.Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

Guest: Robin G. Molella, M.D., M.P.H. (@rmolella) Host: Darryl S. Chutka, M.D. (@ChutkaMD) The percentage of the US population that uses a cell phone is increasing every year. Currently, it is estimated that over 95% of the population own a cell phone and over 75% own some type of smartphone. This is up from 35% compared to statistics from 2011. While these devices certainly make our life more interesting, they can also serve as a major distraction. Studies suggest that drivers using a mobile phone are four times more likely to be involved in a motor vehicle accident. Nearly half of all adults who text say they have either sent or read a text message while driving. Today we are joined by Dr. Robin Molella, a Mayo Clinic physician in the Division of Preventative, Occupational and Aerospace Medicine, and an expert in public health issues.Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

Guest: Kurt A. Kennel, M.D. (@KurtKennel) Host: Darryl S. Chutka, M.D. (@ChutkaMD) Hip fractures have a major impact on our healthcare system with an economic burden estimated to be over $20 billion per year. Due to the increasing age of our population, hip fractures will have an even greater impact. In addition to the economic burden, hip fractures are associated with an increase in mortality and often result in major changes in one’s lifestyle. As a result, the detection, prevention and treatment of osteoporosis becomes an important health strategy. Today’s topic is osteoporosis, calcium and vitamin D and to discuss this topic, we’re joined by Dr. Kurt Kennel, a Mayo Clinic Endocrinologist and specialist in bone metabolism. Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

Guest: Kurt A. Kennel, M.D. (@KurtKennel) Host: Darryl S. Chutka, M.D. (@ChutkaMD) Hip fractures have a major impact on our healthcare system with an economic burden estimated to be over $20 billion per year. Due to the increasing age of our population, hip fractures will have an even greater impact. In addition to the economic burden, hip fractures are associated with an increase in mortality and often result in major changes in one’s lifestyle. As a result, the detection, prevention and treatment of osteoporosis becomes an important health strategy. Today’s topic is osteoporosis, calcium and vitamin D and to discuss this topic, we’re joined by Dr. Kurt Kennel, a Mayo Clinic Endocrinologist and specialist in bone metabolism. Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

Guest: Jacqueline M. Thielen, M.D. (@JacquelineThie5)Host: Darryl S. Chutka, M.D. (@ChutkaMD)Hypoactive sexual desire in females is one component of sexual dysfunction in women. It’s a sensitive topic and one that doesn’t often get discussed in the clinician’s office. What’s the best way to ask about this problem and how do we manage it once we know it exists in our patients? We’ll discuss these issues with a women’s health specialist Dr. Jacqueline Thielen, a Mayo Clinic general internist in the Menopause & Women’s Sexual Health Clinic at Mayo Clinic in Rochester.Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

Guest: Stephen L. Kopecky, M.D. Host: Darryl S. Chutka, M.D. (@ChutkaMD) About 35% of men ages 40 to 70 years have moderate-to-complete erectile dysfunction (ED), and 15% of men aged 70 have complete ED. Of those with ED, it’s estimated that 50-70% are due to cardiovascular disease. Until recently, only urologists were interested in patients with erectile dysfunction. Now with the knowledge of the relationship between ED and cardiovascular disease, cardiologists are taking an interest in these patients as well. Today we’re joined by Dr. Stephen Kopecky, a Mayo Clinic Preventative Cardiologist. Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd. 

Guest: Thom W. Rooke, M.D. Host: Darryl S. Chutka, M.D. (@ChutkaMD) Varicose veins are common, and become more common with advance in age. Fortunately, in most cases they’re asymptomatic, but in some cases can cause symptoms and occasionally serious health problems. Today we’re joined by Dr. Thom Rooke, a vascular specialist at Mayo Clinic’s Vascular Center and specialist in peripheral artery disease, varicose veins, and sclerotherapy.

It’s estimated that approximately 70% of Americans are either overweight or obese. Obesity in the United States is a major health issue, resulting in an increased risk of coronary artery disease, type 2 diabetes, and stroke. It also carries significant economic costs. As a result, the diet industry is booming. It’s thought that the weight loss industry has over $20 billion in annual revenue. Some diets are legitimate, while others are not only ineffective but may be dangerous to one’s health. To help us sort out diets and weight loss, we’re joined by nutrition expert Dr. Donald Hensrud, a Mayo Clinic physician in Preventative Medicine. He is also the medical director for the Mayo Clinic Healthy Living Program here in Rochester and editor in chief of two books on dieting, the Mayo Clinic Diet and the Mayo Clinic Diabetes Diet. Keeping up to date in our field is easier when you can network with colleagues from all specialties. Join us for the 19th Annual Nutrition and Wellness in Health and Disease conference held at the Swissotel Chicago, Illinois, September 23 and 24, 2019. This and all Mayo Clinic CME are found at ce.mayo.edu

Transgender is a term for individuals whose gender identity or behavior does not conform to that associated with the sex to which they were assigned at birth. It’s difficult to estimate the number of transgender individuals, primarily because there are no population studies that accurately account for the range of gender identity and gender expression. What common health risks do transgender patients face? How does healthcare screening and preventive strategies differ in transgender patients who have been on hormonal therapy? Today we’re joined by Dr. Caroline Davidge-Pitts, an Endocrinologist and a core member of the Transgender and Intersex Specialty Care group at Mayo Clinic. For more information, join us in Washington D.C., Oct 4 – 6 at the Principles in the Care of Transgender and Intersex Patients 2018 Conference.

Guest: Bruce Sutor, M.D.Host: Darryl S. Chutka, M.D. (@ChutkaMD)Depression is a common disorder seen in primary care practice. The majority of patients with depression are evaluated and treated not by psychiatrists, but by primary care providers, and it’s been shown that we correctly diagnose depression only about half of the time. Despite the fact that we have some very good treatment options for depression, those on treatment often have continued symptoms. Dr. Sutor is a Mayo Clinic Psychiatrist and Practice Chair of Psychiatry and Psychology in Rochester, Minnesota. Connect with the Mayo Clinic’s School of Continuous Professional Development online at https://ce.mayo.edu/ or on Twitter @MayoMedEd.

It is estimated that more than 80% of Americans will experience an episode of low back pain at some time in their lives, with total annual costs estimated at $100 billion. What are some important questions to ask patients regarding their low back pain? Are there any red flag symptoms that patients may have which would alert us to a potentially serious cause for their back pain? Today we are joined by Dr. Edward Laskowski, a Mayo Clinic Physician and Professor in Physical Medicine and Rehabilitation. Dr. Laskowski is also a co-course director for the 28th Annual Mayo Clinic Symposium on Sports Medicine in Rochester, Minnesota, November 9th and 10th, 2018. For more information, visit ce.mayo.edu.

This week we’re talking about constipation. What are some of the causes of chronic idiopathic constipation? Are there any medications which can cause constipation or make constipation worse? When would a patient’s complaint of constipation raise your suspicion of something ominous causing the symptoms? Do prunes actually help? Today we’re joined by Dr. Amy Foxx-Orenstein, a Mayo Clinic Physician in the Division of Gastroenterology and Hepatology.

Is weight gain an unavoidable result of aging? Do we need to just plan that our bodies will be aching and sore all the time? How can the physiologic changes of aging translate into physical problems for our elderly patients? Can anything be done to maintain our flexibility as we age? Today we are joined by Dr. Edward Laskowski, a Mayo Clinic Physician and Professor in Physical Medicine and Rehabilitation. Dr. Laskowski is also a co-course director for the 28th Annual Mayo Clinic Symposium on Sports Medicine in Rochester, Minnesota, November 9th and 10th, 2018. For more information, visit ce.mayo.edu.

Sexually transmitted infections are at an unprecedented high with 50-60% affecting young people. Today we’re talking about recent trends in sexually transmitted infections and the best way to screen for STI’s. Presented by Dr. Janice Blair, a physician in the Mayo Clinic Division of Infectious Diseases, today’s special episode is an excerpt from the Mayo Clinic Women’s Health Update held in Scottsdale, Arizona. This annual conference addresses a variety of health issues that are unique to women while highlighting medical conditions that may cause different symptoms in women. The Mayo Clinic 15th Annual Women’s Health Update will be held at The Scott Resort and Spa in Scottsdale, Arizona, February 28 - March 2, 2019. We invite you to network with your colleagues and Mayo Clinic faculty by registering at ce.mayo.edu.

Why is it important to talk about sexual history? What questions should we ask to get a detailed sexual history? Today we’re talking about sexual history taking and why sexual health matters. Presented by Dr. Suneela Vegunta, a physician in the Mayo Clinic Women’s Health Center, today’s special episode is an excerpt from the Mayo Clinic Women’s Health Update held in Scottsdale, Arizona. This annual conference addresses a variety of health issues that are unique to women while highlighting medical conditions that may cause different symptoms in women. The Mayo Clinic 15th Annual Women’s Health Update will be held at The Scott Resort and Spa in Scottsdale, Arizona, February 28 - March 2, 2019. We invite you to network with your colleagues and Mayo Clinic faculty by registering at ce.mayo.edu.

It’s estimated that up to 10% of cognitively intact elderly and up to 47% of adults with dementia have experienced some form of abuse. What are some warning signs we should look for? Are there recommended questions we should be asking our elderly patients? This week we’re talking with Dr. Paul Takahashi, a Mayo Clinic geriatrician and physician in Community Internal Medicine, about recognizing abuse in the elderly.

Hyperlipidemia is one of the most common healthcare problems seen by primary care providers. Stephen Kopecky, a Mayo Clinic physician in the Division of Cardiovascular Medicine, discusses non-pharmacological treatment of hyperlipidemia, and which diets can improve the lipid profile. Dr. Kopecky also explains how nutritional supplements, exercise, and weight loss can help lower LDL cholesterol levels.

Headache is one of the most common medical complaints seen by medical providers, and although the vast majority don’t represent any serious underlying conditions, they can cause patients a great deal of anxiety and daily disruption. In today’s talk “Doctor I Have a Splitting Headache,” Dr. Jerry Swanson, a Mayo Clinic neurologist and headache specialist, helps shed light on this common complaint. Visit with Dr. Swanson and other experts at the March 2019 Headache Symposium in Phoenix, Arizona. Sign up for the mailing list at ce.mayo.edu.

Widespread pain. Fatigue. Depression. Why does the diagnosis of Fibromyalgia engender so much fear and trembling? How do we as physicians determine Fibromyalgia from the many other widespread muscle pain syndromes? Today’s selected presentation, “Fibromyalgia in a 20 Minute Office Visit” is presented by Dr. Jeffrey Thompson of the Mayo Clinic. Dr. Thompson, an award-winning educator, is board certified in physical medicine and rehabilitation as well as sports medicine. The March 2019 Mayo Clinic Principles of Pain and Palliative Care: Essential Tools for the Clinician conference will be held at the JW Marriott Desert Springs in Palm Desert, California. This annual conference targets the integration of pain and palliative services across disciplines. We invite you to network with your colleagues and Mayo Clinic faculty by registering at ce.mayo.edu. Links to the course can be found in this podcast’s description.

There are few patients that are more challenging to care for than those who have medically unexplained symptoms. They require a great deal of our time and huge medical costs can result. When should we suspect symptoms represent a functional disorder? How do we help patients when we have determined that their symptoms don’t represent a serious disorder? Do patients have a common fear regarding what their symptoms represent? Dr. Kevin Fleming, a Mayo Clinic physician in General Internal Medicine joins us to delve into medically unexplained symptoms.

Up to 30% of adults and children suffer from seasonal allergies. Allergic Rhinitis accounts for nearly 2 million lost school days and 6 million lost work days per year. Are there any non-pharmacologic ways to treat or manage seasonal allergies? Today, Dr. Gerald Volcheck is joining us to talk about allergic Rhinitis. Dr. Volcheck is a Mayo Clinic physician and chair of the Division of Allergic Diseases.He is also course director for the Mayo Clinic Clinical Updates in Allergy and Immunology conference held July 2018 in Coronado, California. Visit ce.mayo.edu/allergy2018 and register today. Use coupon code ALLERGY to receive $100 off the registration fee. Offer is limited.

How can we diagnose a food allergy from an often vast array of symptoms? Is it possible to desensitize to the food we are allergic to? What are the best methods we have to test for food allergies? Today Dr. Gerald Volcheck is joining us to talk about food allergies. Dr. Volcheck is a Mayo Clinic physician and chair of the Division of Allergic Diseases.He is course director for the Mayo Clinic Clinical Updates in Allergy and Immunology conference held July 2018 in Coronado, California. Visit ce.mayo.edu/allergy2018 and register today. Use coupon code ALLERGY to receive $100 off the registration fee. Offer is limited.

Hyperlipidemia is one of the most common healthcare problems seen by primary care providers. Dr. Stephen Kopecky, a Mayo Clinic physician in the Division of Cardiovascular Medicine, discusses pharmacological treatment of hyperlipidemia and the potential long-term risks of using statins. Dr. Kopecky also talks about how to treat the patient who develops myalgias from several different statins and discusses the gender differences in the benefits seen from statins.

For physicians like Mark Mannenbach, trampoline injuries are “what they do in the summertime.” Today’s selected presentation, “What I Won’t Let my Kids Do” is presented by Mayo Clinic pediatrician and pediatric emergency medicine physician, Mark Mannenbach, MD. Dr. Mannenbach discusses the top three sport activities he sees the most injuries from and goes on to offer some potential strategies to mitigate these “far too common” injuries. Topics like these are discussed at the Mayo Clinic Pediatric Days conference. This annual conference provides an interdisciplinary update on the latest strategies for providing timely and effective evidence based diagnosis and management plans for multiple aspects of pediatric and young adult health. This year’s conference will be held in October at Chicago’s Westin Hotel on Michigan Avenue. We invite you to network with your colleagues and Mayo Clinic faculty by registering at http://ce.mayo.edu/pediatricdays2018.

Medical ethics is not new, it actually dates back many centuries. In fact, there’s evidence that this topic dates back to medieval times. Dr. Darryl Chutka welcomes Dr. Jon Tilburt, to review cases where an ethical decision has to be made.

Hypertension is extremely common in our society, affecting nearly 1 in every 3 individuals in the United States. The treatment of hypertension is the most common reason for office visits in non-pregnant adults to healthcare providers and the most common reason for use of prescription medications. Dr. Darryl Chutka, a general internist at Mayo Clinic in Rochester, along with Dr. Gary Schwartz, a consultant in the Division of Nephrology and Hypertension at Mayo Clinic in Rochester, discuss the evaluation and management of hypertension and the new hypertension treatment guidelines.

Healthcare professionals are more prone to stress and professional burnout compared to many other occupations. Chronic exposure to stress can decrease a provider’s efficiency and could result in negative consequences on our health and family life. It can lead to mental health issues, alcoholism, and other substance abuse. Debbie Fuehrer is a Licensed Professional Clinical Counselor in the Mayo Clinic Mind Body Medicine program and is the coordinator of the Mayo Clinic Complementary and Integrative Mind Body Medicine program. Debbie discusses how stress affects us as well as techniques health care professionals can use to manage stress.

Despite the fact that we have a wide variety of antihypertensive medications available, it’s estimated that up to half of the patients with hypertension are not adequately controlled. Dr. Darryl Chutka welcomes Dr. Gary L. Schwartz to discuss hypertension and the new hypertension guidelines.

Dr. Darryl Chutka, a general internist at Mayo Clinic in Rochester and Dr. Donald Hensrud, a physician in Preventative Medicine and the medical director for the Mayo Clinic Healthy Living Program in Rochester, Minnesota discuss the risks and benefits of drinking coffee.

Bonus Ep2 of 2: Dr. Molly Feely, who is board certified in palliative care, internal medicine, and family medicine now practicing full time palliative care at Mayo Clinic Rochester, talks about best practices for Management of Opioid Side Effects. This podcast is brought to you by the Opioid conference held each year as a part of Mayo Clinic’s Continuing Medical Education. Healthcare providers looking to claim CME credit for this podcast series should go to ce.mayo.edu/opioidpc.

Bonus Ep1 of 2: Dr. Halena Gazelka, an anesthesiologist boarded in pain and palliative medicine at Mayo Clinic in Rochester, talks about best practices for Opioid Monitoring and Considerations for Tapering. This podcast is brought to you by the Opioid conference held each year as a part of Mayo Clinic’s Continuing Medical Education. Healthcare providers looking to claim CME credit for this podcast series should go to ce.mayo.edu/opioidpc.

Ep3 of 3: Which patients should be placed in monitored beds? Are there other factors to consider besides the troponin values when treating patients with ACS? Dr. Jamie Newman, a hospitalist at Mayo Clinic-Rochester and Dr. Allan Jaffe, a cardiologist and consultant at Mayo Clinic-Rochester share their insights on inpatient care, including pre- and post-surgery patients. Healthcare providers looking to claim CME credit for this podcast series should go to ce.mayo.edu/troponinpc and register.

Ep2 of 3: Dr. Jamie Newman, a hospitalist at Mayo Clinic-Rochester and Dr. Casey Clements, an emergency physician from Mayo Clinic-Rochester discuss how the new 5th generation assay for troponin will affect emergency medicine. What are the benefits and potential difficulties associated with the new test?Healthcare providers looking to claim CME credit for this podcast series should go to ce.mayo.edu/troponinpc and register.

Ep1 of 3: How does the 5th generation assay differ from the 4th generation assay? Will a more sensitive assay improve clinical practice? Dr. Jamie Newman, a hospitalist at Mayo Clinic-Rochester and Dr. Allan Jaffe, a cardiologist and consultant at Mayo Clinic-Rochester walk us through the new 5th generation assay for troponin. Healthcare providers looking to claim CME credit for this podcast series should go to ce.mayo.edu/troponinpc and register.

Ep1 of 8: Dr. Halena Gazelka, an anesthesiologist boarded in pain and palliative medicine at Mayo Clinic-Rochester walks us through the basics of opioids and the current state of this national crisis. What is an opioid? How bad is the opioid epidemic and how did we get here? Healthcare providers looking to claim CME credit for this podcast series should go to ce.mayo.edu/opioidpc.

Ep2 of 8: What are the different guidelines when treating chronic versus acute pain with opioid therapy? Dr. Halena Gazelka, an anesthesiologist boarded in pain and palliative medicine at Mayo Clinic-Rochester, talks about the importance of “starting low and going slow.” What are the alternatives for chronic pain management? Healthcare providers looking to claim CME credit for this podcast series should go to ce.mayo.edu/opioidpc.

Ep3 of 8: Dr. David Patchett, family practitioner at Mayo Clinic-Arizona, answers common questions family practitioners often face when treating patients with pain management issues. What are best practices when prescribing opioid therapy? How do you weigh the potential benefits of opioid therapy with the identified risks? Healthcare providers looking to claim CME credit for this podcast series should go to ce.mayo.edu/opioidpc.

Ep4 of 8: Family practitioner, Dr. David Patchett, from Mayo Clinic-Arizona shares the additional challenges associated with prescribing opioids to special populations, and discusses how and when to reassess a patient’s therapy. How do you know when to taper a patient? What are the symptoms of opioid withdrawal and how can you mitigate them? Healthcare providers looking to claim CME credit for this podcast series should go to ce.mayo.edu/opioidpc.

Ep5 of 8: Dr. Casey Clements, an emergency physician and practice leader, who works in the opioid stewardship program at Mayo Clinic-Rochester, shares his insights on opioid therapy from the Emergency Department perspective. What is drug diversion? How do you know a patient isn’t receiving prescriptions from multiple physicians? Healthcare providers looking to claim CME credit for this podcast series should go to ce.mayo.edu/opioidpc.

Ep6 of 8: How do you assess whether a patient has become addicted? What do you do if you suspect opioid use disorder or addiction? Dr. Casey Clement, an emergency physician and practice leader, who works in the opioid stewardship program at Mayo Clinic-Rochester, shares his insights on treating opioid misuse in the emergency setting. Healthcare providers looking to claim CME credit for this podcast series should go to ce.mayo.edu/opioidpc.

Ep7 of 8: Dr. Holly Geyer, an internal medicine physician, who serves on the opioid stewardship program at Mayo Clinic-Arizona, discusses issues of dependency and addiction. What’s the difference between dependency and addiction? Healthcare providers looking to claim CME credit for this podcast series should go to ce.mayo.edu/opioidpc.

Ep8 of 8: What legal/ethical obligations do physicians have when prescribing opioids? How can we address systemic issues that need improvement? Dr. Holly Geyer, internal medicine physician at Mayo Clinic-Arizona, shares her thoughts on what is currently being done to combat the opioid crisis and what additional steps can be taken to make a difference. Healthcare providers looking to claim CME credit for this podcast series should go to ce.mayo.edu/opioidpc.

What are some tips for interpreting common infectious diseases tests (Syphilis, Hepatitis B, Lyme, Quantiferon, etc.)?How do I treat common infections in patients with antimicrobial allergies?What are the major emerging infectious disease concerns that I need to be aware of?

What are the key elements of effective sleep hygiene? How effective are over the counter agents in treating insomnia? How do I choose which pharmacologic therapy to recommend? For patients who require long-term pharmacologic therapy, what are the most appropriate options?

Which patients should receive anticoagulation for atrial fibrillation?How do I choose which anticoagulant to use?What should be done when atrial fibrillation is detected incidentally?Do patients with transient atrial fibrillation after non-cardiac surgery need long term anticoagulation?Do patients need chronic anticoagulation after ablation?

How do I decide which topical steroid potency to use? What vehicles are suitable for different clinical situations? What quantity should be prescribed?

When should I consider metformin in patients with impaired fasting glucose? What are the different types of insulin available and how do I choose the best agent for my patient with DM2? Which commonly used performance measures are least supported by evidence? What are some key take home points from the new guidelines?

How do I individualize the approach to acne treatment?What are the different subtypes of rosacea and how are they treated?What new agents are available for treating acne and rosacea?

Dr. Volcheck will cover the following questions in this podcast: What is the best diagnostic strategy for asthma?What new treatment options are available and how do they compare with currently available agents?What are some key take home points from the new guidelines?

What is the most efficient strategy for determining who needs further evaluation? What are the most common medical conditions that present with memory loss? For those patients who need further evaluation, what is the most cost-effective strategy?

During this talk, Dr. Stephen C. Textor will answer the following questions: - How do I apply the SPRINT trial findings to my patients? - What is the role of ambulatory blood pressure for diagnosis and monitoring hypertension? - Is there a role for aldosterone antagonists in primary hypertension?

A review of sexuality changes in woman related to aging and chronic disease. Discussion includes assessment of sexual functioning along with sexual wellness in aging women and what practitioners can do to help patients enhance their sexual wellness.

This week’s talk, Working Effectively with Patients with Borderline Personality Disorder, was presented by Dr. Brian Palmer at the Clinical Reviews conference held on November 14, 2016 in Rochester, MN. ©2016 Mayo Foundation of Medical Education and Research

This week’s talk, Celiac Disease: 10 things every primary care provider should know, was presented by Dr. Margaret Gill at the Clinical Reviews conference held on November 14, 2016 in Rochester, MN.©2016 Mayo Foundation of Medical Education and Research

This week’s talk, Menopause Management in 2016, was presented by Dr. Stephanie Faubion at the Clinical Reviews conference held on November 14, 2016 in Rochester, MN.©2016 Mayo Foundation of Medical Education and Research

Today’s talk, Truthful and Fearless - Talking Through Vaccine Hesitancy, was presented by Nicole K. Callahan, Certified Nurse Practitioner and Dr. Derek L. Weyhrauch. It was given at the Internal Medicine Review Conference in September, 2015 in Rochester, Minnesota. ©2016 Mayo Foundation of Medical Education and Research