#22: Best of 2016 Recap and Recommendations

Summary:

Consolidate your knowledge and reinforce the learning you’ve done with us in 2016. Enjoy this holiday helping of knowledge food for your brain hole. The guys offer their best of recommendations for 2016 and recap key teaching points from the past year so you have the tools to dominate 2017.

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Clinical Pearls:

SPRINT trial debate

1. Bias effects results seen in this trial. e.g. stopped early
2. Blood pressure (BP) control may have been overestimated based on how BP was measured leading to increased CV events (Stuart’s view).
3. BP measurements in trial likely reflected out of office BP so results are useful (Paul’s view).
4. Lower BP is probably safe, even in the elderly so be reluctant to back off on meds.

HTN Urgency

1. Verify BP reading and measurement technique
2. Evaluate for pain, anxiety, volume overload, nonadherence, or noncompliance
3. Treat high BP with long term goals in mind (i.e. go up on chronic/long-acting meds)

Anticoagulation

1. Avoid warfarin in patients with gastric bypass or Crohn’s with ileitis.
2. Use SPARC tool to visually demonstrate risks and benefits of anticoagulation in Afib.
3. Physicians commonly underestimate benefit of anticoagulation in older sicker patients and overestimate risk of bleeding.

Fibromyalgia and chronic pain

1. Recognize the constellation of fatigue, memory problems, sleep disturbance, and multifocal pain as fibromyalgia.
2. Use the 2011 American College of Rheumatology criteria for diagnosis. No tender point exam required!
3. Nonpharmacologic therapies and education are most effective (see video links below).
4. Chronic painful conditions like rheumatoid arthritis, or lupus can lead to fibromyalgia.

Functional Medicine

1. At least 80% of your food should be whole foods.
2. Use the Dirty Dozen and Clean 15 to guide organic food choices.
3. Knowledge of pathophysiology and biochemistry can be used to treat disease e.g. treating small intestinal bacterial overgrowth can fix iron deficiency and indirectly treat iron deficiency.

Lipids

1. Lowering LDL is key. Some s