In episode 76, Mike and James explore the topic of the treatment of the frail elderly. To do this properly, we bring in an “expert”, Dr John Sloan, who has spent the majority of his practice driving to the homes of the frail elderly and taking care of them. In the first of three episodes on this topic, we philosophize on the general issues of how to deal, or not deal, with the frail elderly – symptoms first, and then if you have any left over time deal with the other issues. At the end, Mike tells James he is closer to being a frail elderly person than he is and decides it’s important to get all of James’ lab values to what he had when he was age 19.

Show notes

Not many notes this week because there isn’t much evidence surrounding the frail elderly

A Bitter Pill – By John Sloan

In episode 75, Mike and James get together with Tina one more time to talk about two topics that have nothing to do with each other (starting insulin in type II diabetics and treating acute musculoskeletal pain in children). However, through the magic of podcasts we transition seamlessly from one topic to the other without any pain and without having to start insulin. Be amazed.  At the end, Mike and James are thrilled they got through yet another podcast, but it was painful and at the end we were both hypoglycemic.

Show notes

1) Tools for Practice

2) Using insulin in a type 2 diabetic – complicated versus less complicated regimens

4-T study

N Engl J Med 2009;361:1736-47

APOLLO

Lancet 2008;371:1073–84

INITIATE

Diabetes Care 2005;28:260-5

JDDM

Diabetes Res Clin Pract 2008;79:171-6

3) Pain control for musculoskeletal injuries in children

Single dose – ibuprofen vs acetaminophen vs codeine

Pediatrics 2007;119:460-7

Ibuprofen vs acetaminophen plus codeine

Acad Emerg Med 2009;16:711-16

Ann Emerg Med 2009;54:553-60

In episode 74, Mike (Bert) and James (Ernie), along with Tina (Betty Lou) continue their stroll down medical Sesame Street and take a look at the evidence behind Vitamins (Letters) A,B,C, and E. Lo and behold, they find that not all letters are created equal and some are even quite bad. At the end, both Mike and James join the Cookie Monster for some Vitamin enriched (just D that is) treats and, they get Tina to pay.

Show notes

1) Tools for Practice

2) Two systematic reviews shows increased mortality for beta-carotene, Vitamin A, Vitamin E, but not for selenium and Vitamin C

JAMA 2007;297:842-57

Cochrane Database Syst Rev 2008;(2):CD007176

3) BMI – not too fat and not too skinny

Lancet 2006;368:666–78

J Am Geriatr Soc 2010;58:234–41

4) Vitamin B (folic acid) and homocysteine – 1 positive trial, 3 negative trials

JAMA 2002; 288:973-9

N Engl J Med 2004;350:2673-81

JAMA 2004;291:565-75

J Am Coll Cardiol 2003;41:2105-13

4) Measuring hsCRP—An Important Part of a Comprehensive Risk Profile or a Clinically Redundant Practice?
PLoS Med 2010;7:e1000196

In episode 73, we try to put Vitamin D levels into context and Tina Korownyk once again is here to help us decipher the evidence for Vitamin D supplementation when it comes to fractures, falls and overall mortality. At the end of the podcast Mike, James and Tina don their swim gear and go outside without sunscreen on to make some Vitamin D, although Mike and Tina quickly realise they live in Edmonton and it’s wintertime.

Show notes

1) CRP paper by Mike and James

PloS article – Measuring hsCRP—An Important Part of a Comprehensive Risk Profile or a Clinically Redundant Practice?

2) Meta-analyses of Vitamin D and impact on fractures, falls and mortality

Arch Intern Med 2009;169:551-6

JAMA 2004;291:1999-2006

Arch Intern Med 2007;167:1730-7

BMJ 2010;340:b5463

3) Toxicity of Vitamin D

Am J Clin Nutr 2007;85:6-18

4) Sun and Vitamin D3

J Clin Endo Metab 2009;94:1092–3