Episode 236 -- August 2025 -- Part 2 AFP: American Family Physician

Summary

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AFP Podcast Episode 236 (August 2025, Part 2) — Summary

Podcast: AFP: American Family Physician
Date: August 29, 2025
Hosts: Dr. Steve Brown, Dr. Puneet Barot, Dr. Emily Eisenberg
Theme: Key clinical updates from the August 2025 issue of AFP, with practical pearls for family physicians.

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Episode Overview

This episode covers essential clinical updates from the August 2025 issue of American Family Physician, focusing on topics such as contraceptive counseling, delayed pushing in labor, management of bacterial vaginosis, outpatient care of premature infants, strategies for nocturnal leg cramps, and a rapid fire review of clinical answers. The resident and faculty hosts from University of Arizona College of Medicine-Phoenix bring a conversational, practical, and “patient-first” tone throughout, highlighting how new evidence and guidelines can improve everyday clinical practice.

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Key Discussion Points and Insights

1. Quality Contraception Services: New National Guidelines

• [01:17] The CDC and HHS updated guidelines on contraceptive services to be more patient-centered and accessible.
• Patient experiences and values, not just medical eligibility, should guide method choice.
  • Puneet Barot: “The priority is connecting with patients where they are. Instead of rattling off birth control options like a menu, the focus is on patient experiences and their values.” (02:14)
• Stepwise Counseling Approach:
  • Build rapport
  • Elicit contraceptive preferences
  • Decide collaboratively
  • Keep physical exams minimal (often just blood pressure unless IUD requested)
  • Avoid unnecessary barriers (e.g., pelvic exams, pregnancy or STI tests unless indicated)
  • Emily Eisenberg: “Most patients do not even need a pelvic exam or STI testing prior to starting contraception. Hear hear.” (03:01)
• Use checklist to rule out pregnancy before starting contraception without test, reducing delays ([03:33])
• Access Improvements:
  • Prescribe 1-year supplies
  • Offer self-administered depot shots
  • Provide telehealth and walk-ins for easier access, and pre-prescribe emergency contraception ([04:32])
• Patient-Oriented Updates:
  • Offer lidocaine or paracervical block for IUD placement pain
  • Do not use misoprostol routinely for IUD placement due to side effects ([04:55])
  • Manage irregular bleeding through reassurance, NSAIDs, or brief estrogen use as appropriate
  • Emphasize ongoing access and patient satisfaction
  • Emily Eisenberg: “They give us practical tools that make the whole process so much smoother and can keep care truly patient satisfaction centered.” (05:54)

2. Delayed Pushing in Labor

• [06:12] FPIN Inquiry: Is delayed pushing helpful for nulliparous women with epidural?
• Findings:
  • Delayed pushing: longer second stage by ~46 minutes, less active pushing by ~28 minutes ([06:29])
  • But: associated with increased risk of maternal infection, postpartum hemorrhage, neonatal acidemia
  • Large 2018 RCT stopped early due to safety concerns ([06:58])
  • Some meta-analyses suggest possible reduction in assisted vaginal deliveries and fatigue, but these benefits are offset by increased risks ([07:18–07:48])
• Guideline Summary:
  • ACOG (2024): Start pushing when fully dilated; delayed pushing not recommended
  • NICE (UK): Delayed pushing up to 2 hours may reduce assisted delivery, but benefits vs risks must be weighed ([08:13])
  • Bottom Line: Use shared decision-making with patients.
  • Steve Brown: “The right answer is always. Shared decision making.” (08:51)

3. Bacterial Vaginosis: Partner Treatment Study

• [08:56] New evidence on treating male partners to prevent recurrent BV in women
  • Randomized trial: Partners treated with oral metronidazole and topical clindamycin
  • Key finding: Number needed to treat of 3 to prevent recurrence at 12 weeks
  • Results consistent across intention-to-treat and per protocol populations
  • Adverse effects rare, making partner treatment a practical option in stable couples ([09:45–10:32])
  • Puneet Barot: “Treating the partner not only helps with recurrent infection, but it also provides ease of mind for your patient.” (10:32)

4. Outpatient Care of the Premature Infant

• [11:21] Premature births (~10% in the US); outpatient care is multifaceted
• Discharge Planning:
  • Focus on caregiver education, primary care, unresolved issues, home planning, support services, and follow-up ([11:34])
  • Family engagement is essential
  • Car seat testing: recent data shows discontinuation doesn’t worsen outcomes—use car beds if unable to tolerate car seats ([12:01])
• Immunizations:
  • Follow chronological age for schedules
  • Rotavirus at 6–15 weeks; Hep B within 24 hrs (>2kg) or within 1 month (<2kg)
  • RSV prevention: Nirsevimab (Beyfortus) for high-risk infants; maternal vaccine (Abrysvo) extends passive immunity ([13:02–13:55])
• Growth & Nutrition:
  • Use Fenton growth chart until 50 weeks GA; then WHO chart with age correction until 24 months ([14:10])
  • Prefer breast milk; fortify as needed
  • Vitamin D and iron supplementation standard ([14:25–14:57])
• Complications:
  • Necrotizing enterocolitis, retinopathy, chronic lung disease, SIDS, and more ([15:15])
  • Emphasize early screening for neurodevelopmental issues ([15:59])
• Feeding/Reflux:
  • Conservative management (feeding & position) is first-line; thicken feeds as needed; formula options may help ([16:12])
  • Medications only if conservative fails; acid suppression rarely needed ([16:59])

5. Nocturnal Leg Cramps: Vitamin K2 as Treatment

• [17:29] RCT of adults aged 65+ with at least 2 nocturnal cramps weekly
  • Vitamin K2 group: Cramps decreased from 2.6/week to 0.96/week; placebo group increased to 3.6/week ([18:15])
  • Severeity/duration also improved, though not formally analyzed ([18:32])
  • Vitamin K2 (menaquinone 7): found in fermented soybeans, cheese; avoid in patients on warfarin
  • Steve Brown: “This trial suggests vitamin K2 could be an interesting option for older adults with frequent night cramps, although it didn’t measure sleep quality or overall quality of life.” (19:08)

6. Rapid Fire Clinical Answers ([19:23])

• Alzheimer's agitation: Music therapy, risperidone, brexpiprazole; avoid routine antipsychotics (20:01)
• De Quervain’s tenosynovitis: Tenderness, swelling dorsal thumb; positive Finkelstein test ([20:08])
• Meniscal tear: Surgery not superior to physical therapy ([20:33])
• Pet therapy: Reduces self-reported anxiety (mostly dogs, some cats, and horses) ([20:39])
• HSV confirmation: Viral PCR assay is gold standard for genital lesions ([20:50])
• Bone stress injuries: Low-risk sites (fibula, posteromedial tibia) can be managed conservatively ([21:13])

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Notable Quotes & Memorable Moments

• On Contraceptive Access:
  • “Contraceptive counseling is such a major component of preventative health and something we do every day, these updates focus on making the process so much more patient centered and accessible.” — Emily Eisenberg (02:00)
• On Delayed Pushing:
  • “The right answer is always. Shared decision making.” — Steve Brown (08:51)
  • “Always.” — Emily Eisenberg (08:54)
• On BV Partner Treatment:
  • “Treating the partner not only helps with recurrent infection, but it also provides ease of mind for your patient.” — Puneet Barot (10:32)
• On Vitamin K2:
  • “This was new to me as well. ... People in the vitamin K2 group reported decreased duration and severity of their cramps as well, but the study did not formally analyze those outcomes.” — Emily Eisenberg (18:32)
  • “So we all need to be eating more miso and potentially some natto as well, right?” — Emily Eisenberg (19:03)

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Timestamps for Important Segments

| Topic | Timestamp | |----------------------------------------------------|-------------| | Contraceptive counseling updates | 01:17–06:12 | | Delayed pushing in labor | 06:12–08:54 | | Bacterial vaginosis partner treatment (POEM) | 08:56–10:53 | | Outpatient care of premature infants | 11:21–17:29 | | Vitamin K2 for nocturnal leg cramps (POEM) | 17:29–19:18 | | Rapid-fire clinical answers | 19:23–21:31 |

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Conclusion

A rich episode packed with practice-changing pearls, strong evidence summaries, and practical strategies—from patient-centered contraceptive counseling and nuanced labor management, to advances in care for premature infants and surprising options for managing leg cramps. The hosts combine evidence-based guidance with memorable, direct commentary and a collegial tone, making these updates both accessible and actionable for the busy family physician.

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Transcript

[Podcast Host/Announcer]

The AFP Podcast is brought to you by the American Academy of Family Physicians and by the Permanente Medical Group Incorporated. Seeking flexible schedules and competitive benefits, join our multidisciplinary practice at the Permanente Medical Group. We offer moving allowance, Northern California Home Buying Assistance and real work Life Balance. Explore opportunities@northern california.permanente.org welcome to the American.

[Steve Brown]

Family Physician podcast for part two of the August 2025 issue. I'm Steve.

[Puneet Barot]

I'm Puneet.

[Emily Eisenberg]

I'm Emily.

[Steve Brown]

We are residents and faculty, mostly residents from the University of Arizona College of Medicine, Phoenix Family Medicine Residency. Today on the podcast we're going to talk about contraception, delayed pushing in labor, bacterial vaginosis, the premature infant, nocturnal leg cramps, and we have a rapid fire AFP clinical answers.

[Emily Eisenberg]

The opinions expressed in the podcast are our own and do not represent the opinions of the American Academy of Family Physicians. The editor of American Family Physician or Banner Health do not use this podcast for medical advice. Instead, see your own family doctor for medical care.

[Steve Brown]

We're on a mission Delivering the Best from American Family Physician Automation Delivering the Best from American Family Physician okay, we're going to start with provision of quality Contraceptive services. Updates from National Guidelines this is from Drs. Klein, Forlini and Kremsreiter From Travis Air Force Base in California. In 2024, the center for Disease Control and Prevention and the U.S. department of Health and Human Services Office of Population affairs updated national guidelines on provision of quality contraceptive services and sexual and reproductive health care.

[Emily Eisenberg]

These updated guidelines truly are huge for primary care. Because contraceptive counseling is such a major component of preventative health and something we do every day, these updates focus on making the process so much more patient centered and accessible.

[Puneet Barot]

I appreciate that the priority is connecting with patients where they are. Instead of rattling off birth control options like a menu, the focus is on patient experiences and their values.

[Steve Brown]

Yeah, totally agreed. Contraceptive discussions can be overwhelmin, but I think these guidelines are super helpful in providing a helpful stepwise approach to counseling, which includes some important steps. Establishing and maintaining rapport. And you guys have that part nailed. Asking about contraceptive preferences based on your patient's experiences and medical eligibility, collaboratively deciding on a method, performing the necessary physical assessment, which I know you're going to talk about a little later, Emily, and then providing the method of choice with a follow up plan, ideally without delay.

[Emily Eisenberg]

Exactly. A central focus is removing these unnecessary barriers. So really, the physical exam can often be minimal. Most patients do not even need a pelvic exam or STI testing prior to starting contraception Hear hear.

[Puneet Barot]

Exactly why make it harder than it needs to be? All that's routinely required is a blood pressure check to ensure estrogen containing methods can be used. If a patient wants an iud, then a pelvic exam is warranted. Otherwise there's no need to delay for labs or STI screening unless there are specific concerns.

[Steve Brown]

Pregnancy testing is often another unnecessary barrier. This guideline includes a checklist which says a patient is very unlikely to be pregnant if she has one of these six things. Number one she's less than or equal to seven days after the start of a normal menses. Number two has not had intercourse since the start of the last menses. Number three has been correctly and consistently using contraception. Number four is less than or equal to seven days after spontaneous or induced abortion. Number five is within four weeks postpartum or number six is fully or nearly fully breastfeeding amenorrheic and less than six months postpartum.

[Emily Eisenberg]

If any of these six are true, of course, along with no pregnancy symptoms, then there is a negative predictive value of 99 to 100% for pregnancy. So at that point the patient really does not need testing with a pregnancy test prior to starting contraception.

[Puneet Barot]

That's really good to know. Limiting barriers to access is also highlighted in these updates. Recommendations include prescribing one year supplies when available, offering self administered subcutaneous depo injections, providing telehealth and walk in options for easier access, and also giving prescriptions for emergency contraception which can ultimately help reduce cost.

[Steve Brown]

Some additional patient oriented changes include IUD insertion using pain management this is a hot topic right now. We talked about IUD insertion pain management in episode 228 of the podcast. Topical lidocaine or a paracervical block should be offered and can help reduce discomfort but don't improve placement success. Misoprostol is not recommended for routine IUD placement due to increased side effects, but it may improve success on a second insertion attempt but not the first.

[Emily Eisenberg]

Such an important topic follow up considerations are also highlighted in these updated steps. Irregular bleeding with contraception is something that we all know is so common. The article provides a really helpful algorithm for management of these concerns.

[Puneet Barot]

Often reassurance is enough if the bleeding is expected, but NSAIDs or short term estrogen can be offered when symptoms are bothersome depending on the contraception that was used exactly.

[Emily Eisenberg]

These guidelines emphasize both starting contraception and ensuring ongoing access and support, all while keeping patient satisfaction front and center. They give us practical tools that make the whole process so much smoother and can keep care truly patient satisfaction centered.

[Steve Brown]

Now we have an FPIN Clinical Inquiry. FPIN is the Family Physician Inquiries Network, and the topic here is use of delayed pushing in nulliparous patients with an epidural from doctors Dressang and librarian Leslie Christensen from the University of Wisconsin.

[Puneet Barot]

Let's start with the 2020 meta analysis of 12 randomized control trials. It showed that delayed pushing extended the second stage of labor by 46 minutes, but reduced active pushing by nearly 28 minutes.

[Emily Eisenberg]

But of course, there's a trade off. That same review showed increased risks of infections like chorioamnionitis and low umbilical cord ph in the delayed group. Based on those findings, the authors actually recommend against delayed pushing, and a large.

[Puneet Barot]

2018 RCT backs that up. It compared immediate versus delayed pushing in over 2,400 nulliparous patients. Delayed pushing led to higher rates of postpartum hemorrhage, chorioimmunitis and neonatal acidemia. The study was even stopped early due to these safety concerns.

[Emily Eisenberg]

On the other hand, a 2021 meta analysis found that delayed pushing might reduce assisted vaginal deliveries in Western countries and lowered postpartum fatigue. So while there are some potential benefits, they do come with real risks.

[Puneet Barot]

That's where things get tricky. A 2017 Cochrane review found that delayed pushing may slightly increase spontaneous vaginal delivery rates and lower pushing time. But again, it also found higher rates of low umbilical cord blood ph.

[Emily Eisenberg]

And yet Another review in 2012 showed similar trends longer second stage, shorter pushing, but no clear benefit for spontaneous vaginal birth.

[Puneet Barot]

So what do we do in terms of clinical guidelines, ACOG's 2024 recommendations are clear. Patients should start pushing once they are fully dilated. That's based on strong evidence, including the 2018 RCT we mentioned earlier.

[Emily Eisenberg]

Meanwhile, NICE guidelines from the UK actually take a slightly different approach. They suggest that delayed pushing up to two hours might reduce the need for assisted delivery. But again, it's about weighing benefits and risks.

[Puneet Barot]

So what's the bottom line? Delayed pushing may offer some benefits like reduced fatigue and less time pushing, but it also increases the overall labor time and the risk of complications for both mother and baby.

[Emily Eisenberg]

That's why the best approach is shared decision making. Clinicians should review the evidence and discuss preferences and risks with their patients, especially for first time births with epidural use.

[Steve Brown]

The right answer is always. Shared decision making.

[Emily Eisenberg]

Always.

[Steve Brown]

It's time for a poem. Poems are patient oriented evidence that matters and this poem is entitled Oral and Topical Treatment of Male partners of women with bacterial vaginosis from Dr. Abel the clinical question here is does treatment of bacterial vaginosis or BV in male partners reduce the likelihood of bacterial vaginosis recurrence.

[Emily Eisenberg]

And women we have a randomized trial here of 164 women over the age of 18 and their regular male partner of at least eight weeks.

[Puneet Barot]

The women were diagnosed with BV with three or more AMSL criteria and treated with oral metronidazole or topical agents.

[Steve Brown]

If contraindicated, they randomized the male partners in the non blinded treatment group to receive oral metronidazole and topical clindamycin cream applied to the glands.

[Emily Eisenberg]

Lo and behold, women whose partners were randomized to the treatment group were less likely to get recurrent BV at 12 weeks with a number needed to treat of three.

[Steve Brown]

That's impressive.

[Puneet Barot]

So impressive results were similar for the intention to treat population and the per protocol population.

[Steve Brown]

Oh, we gotta get nerdy here.

[Emily Eisenberg]

So let's just remind ourselves, intention to treat means analyzing people in the groups to which they were assigned. The opposite type of analysis is per protocol, which is analyzing people who actually got the full treatment only, and in.

[Steve Brown]

This case they were. It showed us the same outcome. I definitely suggest reading this article in full to see whether you think it's generalizable to your patient population, but this study seems like kind of a game.

[Puneet Barot]

Changer and I agree adverse effects were not many, so likely worth a try for women with BV and stable male partners. I actually recently saw this on my Emergency Medicine rotation and treating the partner not only helps with recurrent infection, but it also provides ease of mind for your patient. Great.

[Emily Eisenberg]

That's awesome.

[Steve Brown]

Changing practice.

[Emily Eisenberg]

Excellent work.

[Steve Brown]

We'll be back after the break.

[Podcast Host/Announcer]

The AFP podcast is brought to you by the American Academy of Family Physicians and by the AFP's free live CME webinar Harm Reduction in Primary Care Principles, Practice and Partnerships Presenting the latest in managing opioid use disorder. [e-mail] Sud Next Outpatient care of their.

[Steve Brown]

Premature infant from Drs. Bybel, Delaney and Kobel from Florida, Georgia.

[Puneet Barot]

And Texas in the US about 10% of all births are preterm, meaning they are less than 37 weeks gestation.

[Steve Brown]

Discharge from the NICU isn't just about weight and feeding anymore. The American Academy of Pediatrics recommends six key components Caregiver education, primary care setup, evaluating unresolved medical issues, home care planning, identifying support services and establishing follow up.

[Puneet Barot]

Discharge planning should also include early family engagement so that at least two caregivers can demonstrate safe feeding and basic care.

[Emily Eisenberg]

The AAP recommends that premature infants undergo car safety seat assessments before transport home. I know I saw my fair share of little babies in these tiny car seats on my nursery rotation. However, a recent study showed that discontinuing this intervention did not change 30 day adverse outcomes. For infants who cannot tolerate sitting in a semi upright position, a prone or supine car bed should be used. Let's talk about some immunizations now, particularly when discussing long term complications. Immunization guidelines are key. Vaccination schedules follow chronological age because premature infants need the same protection just with added caution.

[Steve Brown]

Current guidelines recommend administration of rotavirus in premature infants between six and 15 weeks of age, hepatitis B immunizations within 24 hours for all infants weighing more than 2,000 grams or within the first month of life if weighing less.

[Puneet Barot]

The real game changer has been Nirsevimab or Bay Fortis, a long acting monoclonal antibody approved in 2023 to prevent RSV in high risk preemies. As we know, RSV bronchiolitis is the leading cause of hospitalization in infants within the US. Historically, high risk premature infants with bronchopulmonary dysplasia received five monthly palivizumab or synergist injections during their first RSV season. Now Bifortis is recommended for preterm infants younger than 8 months born during or entering the first RSV season. Infants between 8 and 19 months of age who are at increased risk and entering their second season are also eligible.

[Steve Brown]

And don't forget Abrizvo, the maternal RSV vaccine given between 32 to 36 weeks gestation to moms to protect infants through.

[Puneet Barot]

Passive immunity, let's talk about growth and nutrition along with immune protection. Nutrition is everything for preterm catch up growth. Inadequate growth, especially of the head, is associated with impaired neurodevelopment and poor cognitive outcomes.

[Steve Brown]

The AAP suggests using the Fenton preterm growth chart until 50 weeks of gestational age. After this, the percentiles match those of the WHO growth standards which are then used with corrected age until 24 months.

[Emily Eisenberg]

When it comes to feeding, these premature infants demonstrate lower catch up growth and lower bone mass accumulation if they are small for gestational age. Of course, breast milk remains the recommended source of nutrition for all newborns and infants and breast milk can be fortified with formula to be concentrated to increase caloric intake as needed.

[Steve Brown]

Once catch up growth is achieved, fortification of the breast milk or use of nutrient enriched formula should be discontinued to prevent hypervitaminosis obesity and hypertension.

[Puneet Barot]

While breast milk is preferred due to the immunologic benefits, nutrient enriched premature formula can also provide superior initial growth support. In addition to breast milk, supplementation with vitamin D during the first six months of life and iron within the first two months of life is recommended.

[Emily Eisenberg]

Let's pivot to some common complications. Let's talk about what these infants are up against. Due to the higher survival rates in early prematurity, we now have increased incidence of long term complications including necrotizing enterocolitis, retinopathy of prematurity, chronic lung disease, crypt orchidism, gastrointestinal reflux, hernia and sudden infant death. Table 3 in the article does an outstanding job of outlining all of these potential medical complications and key patient considerations.

[Puneet Barot]

Additionally, these conditions increase the risk of cerebral palsy, intellectual disability along with hearing and vision impairment. It's why we emphasize screening and especially screening early.

[Steve Brown]

Exactly. So it's recommended to do developmental screenings using corrected age at 9, 18 and 30 months, plus autism screening at 18 and 24 months using validated screening tools.

[Emily Eisenberg]

Okay, let's transition to reflux and sleep. While these more serious complications that we discussed are quite concerning, the most common complaints seen in outpatient clinics include reflux babies.

[Puneet Barot]

Aww.

[Emily Eisenberg]

From happy spitters to cranky colickers. I even saw one today.

[Puneet Barot]

Premature infants often have gastroesophageal reflux, but treatment starts conservatively by adjusting feeds and their positioning. The AAP recommends remaining upright for 30 minutes after each feed and remaining in the prone or left lateral position while awake.

[Steve Brown]

Also, you can think about thickening feeds, which reduces the frequency and severity of reflux symptoms in full term infants. Although there's unclear benefit in premature babies.

[Emily Eisenberg]

If conservative treatments fail, a two week trial of hydrolyzed or amino acid based formulas can be considered to manage a potential underlying milk protein allergy or intolerance. Acid suppression typically is not warranted, but PPIs are recommended as a first line agent and very rarely surgical intervention can be considered.

[Puneet Barot]

I feel like I see this pretty frequently. And for our babies with reflux I find that thickened feeds often have good outcomes.

[Steve Brown]

Nice. That was a pretty solid review of care of the premature infant. We have a poem now. Poems are patient oriented evidence that matters. And this one, it was completely new to me. Vitamin K2 is effective to decrease nocturnal leg cramps from Dr. Shaughnessy. So the clinical question here is vitamin K2 effective in decreasing nocturnal leg cramps in older people?

[Emily Eisenberg]

This was new to me as well. This comes from a randomized controlled trial of 199, not 200 participants, all 65 years or older, who had at least two nocturnal leg cramp episodes in the prior two weeks.

[Puneet Barot]

They were randomized to get either placebo or vitamin K2 taken in the evening for two months.

[Steve Brown]

The results show, impressively, the average number of weekly cramps significantly decreased from 2.6 at baseline to 0.96 per week in the vitamin K2 group, while while the placebo group actually increased to 3.63 per week.

[Emily Eisenberg]

Certainly no placebo effect there. Not at all. People in the vitamin K2 group reported decreased duration and severity of their cramps as well, but the study did not formally analyze those outcomes.

[Puneet Barot]

A quick Note on vitamin K2, also known as menaquinone 7, it's found in fermented products such as fermented soybeans as well as hard cheeses. While vitamin K1 is the type in leafy green veggies. It's generally safe, but it can interfere with warfarin, so avoid it in those patients.

[Emily Eisenberg]

So we all need to be eating more miso and potentially some natto as well, right?

[Steve Brown]

This trial suggests vitamin K2 could be an interesting option for older adults with frequent night cramps, although it didn't measure sleep quality or overall quality of life.

[Emily Eisenberg]

Might be worth a try.

[Puneet Barot]

I can already see another poem forming.

[Steve Brown]

Okay, we got a rapid fire segment here at the end. In every issue, American Family Physicians provides a one page of rapid fire clinical tidbits from previous issues. So how well do you remember previous episodes of the American Family Physician podcast? So let's see. Ready, Emily? You get the first one.

[Emily Eisenberg]

Oh, boy.

[Steve Brown]

Yes. What treatments have been effective for Alzheimer's disease induced agitation?

[Emily Eisenberg]

Well, there's music therapy, risperidone, and brexpiprazole. However, don't use antipsychotics routinely because there is an elevated risk of mortality.

[Puneet Barot]

Nice.

[Steve Brown]

So, Puneet, what physical examination findings are seen in De Quervain tenosynovitis?

[Puneet Barot]

You often see tenderness and swelling in the first dorsal compartment. That's your thumb, by the way. You would be surprised. Yes. And positive Finkelstein test. You'll often see this in new moms, especially when they're busy pushing strollers and picking up their children.

[Steve Brown]

Okay. Is arthroscopic surgery superior to physical therapy for degenerative meniscal tears?

[Emily Eisenberg]

No.

[Steve Brown]

Okay. Puneet, does pet therapy improve anxiety?

[Puneet Barot]

Pet therapy definitely reduces self reported anxiety. Mostly dogs, but there's some research on cats, too.

[Steve Brown]

And horses.

[Emily Eisenberg]

And even horses. My goodness, how sweet.

[Steve Brown]

All right, two more, Emily. Here we go. What is the most reliable method to confirm suspected herpes simplex virus in a patient presenting with genital lesions?

[Emily Eisenberg]

Okay, I see you give him the pet therapy question and then you give me the one on hsv.

[Puneet Barot]

But I do.

[Emily Eisenberg]

I do know it. Okay, so there's type specific viral PCR assay is the best for confirming HSV and clinically apparent lesions.

[Steve Brown]

All right, Puneet, bring us home. Do all bone stress injuries require referral?

[Puneet Barot]

As someone who just finished his pediatric sports medicine rotation, absolutely not. Low risk injuries, for example, on the fibula and the posteromedial tibial shaft, can be treated conservatively.

[Steve Brown]

Nice. And we are out.

[Puneet Barot]

Bye. Bye.

[Emily Eisenberg]

See you later. Send us your thoughts by emailing us@afpp.

[Steve Brown]

Podcastafp.Org follow on Instagram fpjournal. Please subscribe and rate us wherever you get your podcasts. Escuchenos en espanol Arrevista Medica A fap.

[Puneet Barot]

Our podcast team is Jake Anderson, Puneet Barot, Steve Brown, Justin Chettiak, Sarah Coles.

[Emily Eisenberg]

Austin Cotter, Rachel Dunn, Emily Eisenberg, Elena Kelly, Chisholm Okuwagu, and Kari Stauss.

[Puneet Barot]

Our sound and technical guru is Tyler Cole. Our theme song is written and recorded by family physicians Bill Dabs, Ryan Evans, and Justin Jenkins.

[Steve Brown]

This podcast is brought to you by the residents and faculty of the University of Arizona College of Medicine, Phoenix Family Medicine Residency Programs. We'll talk to you soon for the next edition of the American Family Physician Podcast.