Episode 242 -- November 2025 -- Part 2 AFP: American Family Physician

Summary

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AFP: American Family Physician Podcast

Episode 242 – November 2025, Part 2
Date: November 29, 2025
Hosts: Jake, Justin, and Austin
Publisher: American Academy of Family Physicians & University of Arizona College of Medicine-Phoenix Family Medicine Residency

Episode Overview

In this episode, the hosts break down key clinical topics from the November 2025 issue of American Family Physician. Major discussions include the diagnosis and treatment of vaginitis, digital dependency and gaming disorders, interventions for back pain, developmental dysplasia of the hip, the impact of resistance training on cancer-related fatigue, and updated guidelines for managing peripheral artery disease. The episode is rich in clinical pearls and succinct evidence-based recommendations, aiming to help primary care providers translate current research and guidelines into everyday practice.

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Key Discussion Points and Insights

Vaginitis: Diagnosis and Treatment

(Starts at 01:14)

• Broad Categories: Infectious (bacterial vaginosis, vulvovaginal candidiasis, trichomoniasis) and non-infectious causes.
• Diagnosis:
  • Use microscopy, KOH, and pH testing when accessible.
  • BV diagnosis: 3 out of 4 Amsel criteria—discharge, positive whiff test, clue cells, and vaginal pH >4.5. (02:01)
  • Candidiasis: Identify hyphae or budding yeast.
  • Trichomonas: Look for motile flagellated protozoa; use NAAT if microscopy is unclear.
• Noninfectious Clues: Atrophic (menopause, lactation), irritant (products, poor hygiene), and inflammatory causes (vulvodynia, lichen planus).
• Testing Pearls: Self-collected swabs are effective; NAAT reduces return visits and cost. Don’t use Pap smears for diagnosing vaginitis. (02:49, 03:00)
• Treatment:
  • BV: Treat to relieve symptoms and reduce STI risk; partner treatment can lower recurrence.
    • "The CDC app is your friend here with BV." – Justin (03:08)
  • Alcohol & Metronidazole: No solid evidence for disulfiram-like reaction, but still recommended to avoid in postmenopausal patients.
    • "How many of us waste all that time warning patients about drinking alcohol with metronidazole?" – Jake (03:29)
  • Low-estrogen patients: Try topical estrogen first for atrophic vaginitis.
  • Pregnancy: Do not treat asymptomatic pregnant women for BV.
  • Yeast infections: Complicated cases (≥3/year, pregnancy, immune compromise) – confirm with culture or PCR, check for azole resistance.
    • Both oral and topical treatments are effective; boric acid may help with recurrence.
    • No evidence for probiotics.
  • Trichomoniasis: Over half are asymptomatic but may persist for years; increases risk for pregnancy complications and STI transmission. Retest after 3 weeks–3 months; send resistances to CDC lab if concerned.

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Gaming Disorders: Digital Dependency

(Starts at 05:03)

• Prevalence: 2/3 of Americans play video games; 83% in children (Gen Alpha), 60% of adults.
• Potential Benefits: Community, relationship building, improved cognitive processing, and educational use.
• Risks:
  • Excessive gaming linked to impaired control, worsening academic performance, insomnia, sedentary lifestyle, and "nomophobia."
• Diagnostic Criteria: WHO’s “gaming disorder” in ICD-11 (2018) – impaired control, persistent use despite consequences, lost opportunities, etc. (06:20)
• Prevalence: Roughly 10% in adolescents/young adults, higher in males.
• Screening Tools: Gaming Disorder Identification Test, Internet Gaming Disorder Scale Short Form.
• Prevention & Management:
  • Limit screen time to 1–2 hours/day, discourage gaming during meals/at night.
  • Avoid total device confiscation (can backfire).
  • Encourage interpersonal (non-digital) interactions.
  • Cognitive behavioral therapy recommended for problematic use; family media plan suggested (AAP).
    • "Completely removing games... can remove one's source of stress relief and their social circle." – Austin (07:54)
  • Consider psychiatry or addiction medicine referrals for severe cases; medication use requires more evidence.

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Back Pain: Injections vs. Radiofrequency

(Starts at 09:00)

• Guideline Review: From Dr. Alan Shaughnessy; focus on chronic cervical or lumbar pain without cancer or inflammatory disease.
• Findings:
  • Strong recommendation against steroid/local anesthetic injections, radiofrequency ablation, and intramuscular injections for chronic localized/radicular pain.
    • "None of the interventions had any evidence of benefit when compared with placebo or sham." – Austin (10:38)
  • Only consider potentially harmful treatments if clear evidence of benefit coexists, but in this case, no such evidence exists.
• Summary: Focus on alternative evidence-based strategies for chronic back pain.

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Developmental Dysplasia of the Hip (DDH)

(Starts at 11:33)

• Prevalence: Most common joint condition in infants; spectrum from mild instability to dislocation.
• Importance of Early Dx: Pre-6 months detection is key to avoiding surgery and early arthritis.
• Risk Factors: Breech position most important; also female sex, family history, and tight swaddling.
• Diagnosis:
  • Use Ortolani and Barlow maneuvers up to 3 months; asymmetric skin folds, limited abduction after 2 months.
  • Screen at all well-child visits to 6–9 months.
  • Imaging (ultrasound) for infants with risk factors or equivocal exams; use X-ray after 4 months.
• Management:
  • Pavlik harness (abduction brace) for infants <6 months; worn 23h/day for 6–8 weeks—>90% avoid surgery.
    • "I'd take the harness over the OR any day. Early screening really pays off here." – Austin (14:55)
  • Rigid orthoses or closed reduction for non-responders/older infants; surgery for older children/adolescents.

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Resistance Training for Cancer-Related Fatigue

(Starts at 15:01)

• Question: Can resistance training improve fatigue and QoL for cancer patients (before, during, after treatment)?
• Findings:
  • Yes for fatigue—structured resistance training (≥5 sessions; any common modality) for up to 12 weeks led to a meaningful reduction in cancer-related fatigue (mean +3.9 points on FACIT-F scale; statistically significant).
    • "This isn't the kind of fatigue you can just sleep off. Cancer-related fatigue is deep, persistent exhaustion..." – Jake (15:44)
  • Limited evidence on quality of life improvement and unknown long-term risks.
  • National guidelines recommend resistance training twice weekly for cancer patients.

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Peripheral Artery Disease (PAD): Updated Guidelines

(Starts at 16:58)

• Guidelines: 2024 ACC/AHA; fully meets G Trust quality.
• Symptoms: Classic claudication (aching, burning, cramping, fatigue), often subtle.
• Screening: Use ABI (<0.9 = PAD); toe-brachial index if arteries are non-compressible.
• Risk Factors: Age >65; age 50–64 with CV risk factors; age <50 with diabetes + atherosclerosis.
• Management:
  • Lifestyle modification (smoking cessation, foot care, Mediterranean diet, exercise).
  • Structured exercise therapy ≥3 times per week for 12 weeks.
  • Medical Rx: Single antiplatelet therapy (clopidogrel), LDL-lowering, HTN/DM control.
    • "Triple therapy with all three clopidogrel, rivaroxaban, and low-dose aspirin should be avoided." – Justin (19:15)
  • Cilostazol reduces claudication; revascularization for function-limiting symptoms or threatened limbs.

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Notable Quotes & Memorable Moments

• "[No solid studies show a real disulfiram-like reaction with alcohol and metronidazole.]" – Austin (03:19)
• "Completely removing games... can remove one's source of stress relief and their social circle." – Austin (07:54)
• "None of the interventions had any evidence of benefit when compared with placebo or sham. What?" – Austin (10:38)
• "I'd take the harness over the OR any day. Early screening really pays off here." – Austin (14:55)
• "This isn't the kind of fatigue you can just sleep off. Cancer-related fatigue is deep, persistent exhaustion..." – Jake (15:44)
• "Triple therapy with all three clopidogrel, rivaroxaban, and low-dose aspirin should be avoided." – Justin (19:15)

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Timestamps for Key Segments

• Vaginitis Diagnosis and Treatment: 01:14–05:03
• Gaming Disorder & Digital Dependency: 05:03–08:56
• Chronic Back Pain Interventions: 09:00–11:33
• Developmental Dysplasia of the Hip: 11:33–15:01
• Resistance Training & Cancer Fatigue: 15:01–16:58
• Peripheral Artery Disease Guidelines: 16:58–19:55

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Summary

This episode provides up-to-date, practical clinical advice for family physicians, including diagnostic algorithms, evidence-based treatments, and key guideline updates. The hosts’ conversational style enriches the content with clinical context, humor, and memorable teaching points, making this episode a valuable resource for staying current in primary care.

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Transcript

[Justin]

The afp podcast is brought to you by the american academy of family physicians and by menopause and perimenopause cme for family physicians, a new live stream from the aafp. Join us april 23rd through the 24th. Find [e-mail] menopausecme.

[Jake]

Welcome to the American Family Physician podcast for part two of the November 2025 issue. I'm Jake.

[Justin]

I'm Justin.

[Austin]

And I'm Austin.

[Jake]

And we are residents and faculty, mostly residents, of the University of Arizona College of Medicine, Phoenix Family medicine residency programs. Today on the podcast we'll talk about vaginitis, digital dependency, injection versus radiofrequency for back pain, developmental dysplasia of the hip, resistance training, and management of peripheral artery disease.

[Justin]

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.

[Jake]

We're on a mission Delivering the best from American Family Physician On a mission Delivering the best from American Family Physician let's kick things off with the main topic, vaginitis diagnosis and treatment, and it comes to us from doctors Gere and Clega from Advent Health Family Medicine Residency Program in Winter Park, Florida.

[Justin]

All right, vaginitis. It's a pretty broad topic that includes both infectious and non infectious causes. So think bv, yeast infections and trich on the infectious side and things like atrophic irritant inflammatory vaginitis on the non infectious side.

[Austin]

And the article lays out a great diagnostic algorithm. We'll highlight here if you've got access to microscopy, KOH and pH testing. BV is diagnosed when three of four AMSL criteria are met, then discharge positive whiff test, CLU cells and a vaginal pH over 4.5.

[Jake]

If you see hyphae or budding yeast, that's fulvovaginal candidiasis. And if you spot motile flagellated protozoa, that's trichomonas. If microscopy isn't clear, get a NAAT test for a trich and if that's negative, think non infectious causes instead.

[Justin]

Right, so atrophic vaginitis clues include menopause, lactation, oophorectomy or anything anti estrogenic irritant vaginitis. That's more from products, devices or poor hygiene habits. An inflammatory vaginitis shows up with things like vulvodynia or lichen planus.

[Austin]

Important reminder, you don't even need a speculum to collect a sample. A self collected swab inserted about an inch performs just as well. And using NAATs actually cuts down on return visits and cost.

[Jake]

Also, don't rely on Pap smears to diagnose infectious vaginitis. If something pops up there, confirm it before treating.

[Justin]

Now for treatment. So the CDC app is your friend here with bv Treat not only to relieve symptoms, but also because it lowers STI risk and partner treatment can reduce recurrence too.

[Austin]

And fun fact, despite the warnings, no solid studies show a real disulfiram like reaction with alcohol and metronidazole. What I know.

[Jake]

Oh my gosh. How many of us waste all that time warning patients about drinking alcohol with metronidazole?

[Austin]

I know hours and hours of time we could get back. Still, manufacturers recommend avoiding alcohol for postmenopausal patients.

[Jake]

Low estrogen makes BV uncommon. Try topical estrogen for six to eight weeks first and only treat BV if symptoms persist. And don't treat asymptomatic pregnant patients because there's no benefit.

[Justin]

Alright, switching to yeast infections. So cases are considered complicated if there are three or more episodes a year, or if the patient's pregnant, immunocompromised or has severe symptoms. In those cases, confirm with culture or PCR to look for azole resistance.

[Austin]

Otherwise oral and topical treatments work equally well. So just go with patient preference for recurrent infections. Boric acid, 600 milligrams intravaginally for three weeks can help.

[Jake]

And probiotics evidence doesn't really support them for treatment or prevention when it comes to yeast infections.

[Justin]

And finally trich, over half of infections are asymptomatic but can last for months or years. And importantly, that raises the risk for pregnancy complications, cervical cancer and HIV transmission.

[Austin]

Because recurrence is common. Retest with NAAT three weeks to three months after treatment.

[Jake]

And if you're worried about drug resistance, samples can actually be sent to the CDC parasitology lab for confirmation.

[Justin]

So that's the quick tour through vaginitis, efficient diagnosis, smart testing and evidence based treatment that saves everyone time and importantly improves outcomes.

[Jake]

Next up we have a curbside consultation, digital tips for diagnosis, screening and management of gaming disorders. And it comes to us from Dr. Shi from the Cleveland Clinic Mercy Medical center in Canton, Ohio.

[Justin]

Mmm, interesting topic.

[Austin]

Yeah. Video games are obviously everywhere nowadays. Nearly 2/3 of the US population play video games, including 83% of Gen Alpha ages 5 to 12 and 60% of adults.

[Jake]

Count me in that 60% same me too. And gaming has shown to have several potential benefits. Recreational gaming with friends and family can help foster a sense of community, strengthen interpersonal relationships, and enable long distance socialization.

[Justin]

Through online services and research has shown improved cognitive processing, task management and learning or education with certain game genres.

[Austin]

However, there is concern that unrestricted gaming and screen time can lead to dependence and eventual addiction.

[Jake]

Oh Ugh.

[Austin]

Preoccupation with gaming and screen time during critical periods of development can affect neurobiological pathways that control reward and pleasure, with the big concern being resultant diversion of focus leading to poor grades, loss of self control and even something called nomophobia which is fear of any time away from devices.

[Jake]

Research into video game addiction dates back to the early 2010s and gaming disorder was coined by the World Health organization in the 2018 ICD.11 this diagnosis requires specific criteria to have been met by a patient within a 12 month period, like impaired control over gaming, continuation or escalation of gaming despite negative consequences and jeopardized opportunities due to gaming.

[Justin]

The overall prevalence of Internet gaming disorder in adolescents and young adults is estimated to be 9.9%, with the prevalence being much higher in males than females.

[Austin]

Addressing gaming disorders is challenging and complex. However, as family physicians we do have a role to play and although universal guidelines are not currently available, most research endorses a multidisciplinary, integrative approach that focuses on screening and preventing the adverse effects of excessive gaming.

[Justin]

Here are some pearls the Gaming Disorder Identification Test and the Internet Gaming Disorder Scale Short form are tools that can be used to screen for the disorders.

[Austin]

Educate patients on risks of gaming addiction, including development or worsening of existing mental disorders, suicidal ideation, dry eye, insomnia, poor academic performance and sedentary lifestyle.

[Justin]

The American Academy of Pediatrics recommends a Family Media plan approach that sets guidelines and limits for gaming and screen time.

[Austin]

Overall, screen time should be limited to less than one to two hours daily with dedicated media. Free time embedded into the daily routine to promote interactions outside of devices and.

[Justin]

Gaming during mealtime is discouraged and nighttime use should really be avoided. To prevent insomnia, circadian rhythm disruption and.

[Austin]

Problematic use, caregivers should limit easy access to devices, but completely removing games and devices can have adverse effects because complete confiscation can remove one's source of stress relief and their social circle.

[Justin]

Direct interaction with friends and others should be encouraged to prevent dependence on virtual interactions and to promote social skills.

[Austin]

Although using games as a reward or punishment for behavior can be enticing, it has not been shown to reduce problematic use and risks, but rather escalates resentment and emotional distress in young adolescent populations.

[Jake]

And when you do identify concerning gaming use and gaming addiction offer treatment. Most studies support cognitive behavioral therapy as having the most potential benefit in Internet gaming disorder management.

[Justin]

Use of bupropion, antidepressants, stimulants and other forms of therapy to help treat Internet gaming disorder requires further research. Integrative caregiver treatment, specifically psychiatry or addiction medicine specialists should be considered in cases of severe distress or lack of improvement following other measures.

[Austin]

We really do love our humanities here in family medicine because it's time for another poem.

[Justin]

Let us go then, you and I. Nope, stop.

[Austin]

Love the enthusiasm, but not that kind of poem. I mean patient oriented evidence that matters this time. It's a practice guideline about back pain.

[Justin]

Well, that's a lot less fun, but important, I guess.

[Jake]

Yeah. So this poem comes from Dr. Alan Shaughnessy and is titled Injections or Radiofrequency to treat Chronic Cervical, Spine or Low Back Pain. And this poem gives us strong evidence on recommending what to avoid in cases of chronic back pain.

[Justin]

This better be a good poem, Austin.

[Austin]

The guidelines data came from systematic reviews and meta analyses of randomized trials and observational studies. They included patients with three or more months of localized or radicular cervical, lumbar or sacroiliac pain. Patients with pain secondary to cancer or inflammatory arthropathies were excluded.

[Justin]

So what did they find?

[Jake]

Okay, so for localized pain, they recommend against steroid or local anesthetic, epidural or joint injections, radiofrequency ablation, and intramuscular local anesthetic injection for treatment of patients chronic pain.

[Austin]

And for radicular pain, they again recommend against steroid or local anesthetic epidural injection and against dorsal root ganglion radiofrequency ablation.

[Justin]

Okay, great. A lot of things we shouldn't do, but what should we do?

[Jake]

Well, the authors did recommend considering treatments with moderate to high certainty evidence of harm to patients only if those treatments also came with moderate to high certainty evidence of benefit. Makes sense.

[Austin]

And drum roll please. None of the interventions had any evidence of benefit when compared with placebo or sham. What?

[Justin]

You're saying none of our interventions work well?

[Austin]

I think the article puts it best did not work better than placebo is not the same as did not work as. There is often a profound response to both. Either way, in terms of back pain, better is better, but some of our interventions come with significant risks of harm. Very important to consider. We'll be right back.

[Justin]

The AFP podcast is sponsored by the American Academy of Family Physicians and by the journal fpm. FPM Journal provides you with simple yet powerful solutions to your everyday practice challenges. Available in print and online. Subscription information is [e-mail] fpm.

[Jake]

We have another main topic, developmental dysplasia of the hip. And it comes to us from Drs. Kim, Kim and Covey from Fairfield, California in Bethesda, Maryland.

[Austin]

Keeping with October's Part 2 episode where we discussed SCFAE, we're sticking with the peds hip theme. This time it's all about developmental dysplasia of the hip or ddh.

[Jake]

Yeah, so DDH is actually the most common joint condition in infants. It covers a whole spectrum from mild instability to full on dislocation. The key thing is catching it early before six months since later diagnoses mean higher risks for early arthritis and more surgeries down the road.

[Justin]

So what actually causes ddh?

[Austin]

Well, it's a mix of factors. Hip development depends a lot on how the baby is positioned in utero. So anything that messes with that contact between the femoral head and acetabulum can cause issues.

[Justin]

Got it. That's why breech position is the biggest risk factor. And also why we tell parents to avoid tight swaddling with the legs straight.

[Jake]

Exactly. Female sex and having a first degree relative with DDH are also two big risk factors.

[Justin]

Alright, so how do we diagnose it? I know imaging isn't routine for everyone, so do we just rely on physical exam like those Ortelani and Barlow maneuvers?

[Austin]

Well, that's right. Those are your go to's from birth to about three months. But don't stop there. Check for asymmetric skin folds at any time, a positive Galeazi sign or limited hip abduction after two months. Once they're walking, look for Trendelenburg gait.

[Jake]

Good. Lots of screening options since the AAP recommends checking at every well child visit until about 6 to 9 months age. But what do we do when we get a positive or unclear result?

[Austin]

Well, it's best to split it into two babies with risk factors for DDH and babies without. For those low risk infants with an equivocal exam, recheck the exam in two weeks. If it's still unclear, get imaging and then refer if there's any degree of dysplasia. If there are risk factors, any equivocal exam means a referral to pediatric ortho.

[Justin]

And for those positive exams, when you find a clear dislocation or subluxation, the risk factors don't matter. They all go right to peds ortho.

[Jake]

Great. So we've covered about 5% of cases. What about the other 95% of exams that are totally normal?

[Austin]

Well, if no DDH risk factors, that's just routine follow up. But if there are risk factors, regardless of any exam findings, those kids get a screening ultrasound around four to six weeks. If dysplasia is mild on imaging, you can follow with serial physical exams. Moderate or severe dysplasia goes straight to Ortho.

[Justin]

One other imaging pearl if imaging is needed after four months, so switch to plain radiographs instead of ultrasound. Now let's wrap things up with treatment.

[Jake]

Jake for infants under six months, abduction bracing with a pavlic harness is the mainstay, helping the femoral head sit properly in the socket. While this harness needs to be worn 23 hours a day for six to eight weeks, success rates are great. If diagnosed with a positive Barlow, over 90% don't need surgery.

[Justin]

So if the Pavlic harness doesn't stabilize things, more rigid orthoses are the next step. After six months, closed reduction might be needed and older kids or teens sometimes need surgical correction.

[Austin]

I'd take the harness over the OR any day. Early screening really pays off here.

[Jake]

Moving right along, we have a Cochrane for clinicians resistance training for fatigue in people with cancer. And it comes to us from Drs. Eckert and Valvis from BB Healthcare Family Medicine Residency in Lowe's, Delaware and Dr. Leggett from USIS in Bethesda.

[Justin]

Okay, here's our clinical question. Does resistance training improve cancer related fatigue and quality of life before, during or after treatment?

[Austin]

In short, yes, at least for fatigue. In studies lasting up to 12 weeks, resistance training led to a significant drop in cancer related fatigue compared with no exercise. The effect on quality of life was less clear though, and there isn't enough data to say much about potential risks.

[Jake]

Remember, this isn't the kind of fatigue that you can just sleep off. Cancer related fatigue is deep persistent exhaustion that affects both body and mind driven by the disease and the treatments themselves.

[Justin]

So the review only included structured training programs requiring at least five in person sessions and more than 20 participants. These exercises included body weight, free weights, machines and resistance bands.

[Austin]

Unfortunately, none of the studies describe participants baseline fitness levels, which makes it much harder to compare across groups.

[Jake]

Outcomes were measured using the Functional Assessment of Chronic Illness Therapy Fatigue scale. That's a 0 to 52 point scale with higher scores being better. Those who did resistance training during treatment improved by about 3.9 points compared to those who didn't train and that was statistically significant.

[Justin]

Quality of life also improved slightly but not enough to be considered clinically meaningful and the one identified long term study didn't show significant results. So we still don't know the benefits of prolonged resistance training.

[Austin]

Still, both the American Cancer Society and the American College of Sports Medicine recommend regular exercise including resistance training at least two days a week before, during and after treatment.

[Jake]

Bottom line here Resistance training helps reduce cancer related fatigue, but we need more research to know which cancers benefit most and what the risk might be. We're going to wrap things up with a practice guideline the American College of Cardiology and American Heart association have released guidelines for the management of peripheral artery disease, or pad. This review comes to us from Assistant Medical Editor for the American family physician, Dr. Michael Arnold.

[Justin]

Importantly, this guideline checks all eight boxes of the G Trust Scorecard, meaning that it is an overall useful guideline.

[Jake]

Here are the highlights from the guideline.

[Austin]

PAD can present with the classic exertional claudication, including aching, burning, cramping or fatigue in the buttock, thigh, calf or ankle that resolves after less than 10 minutes of rest. However, PAD symptoms can be subtle or delayed, so it's important to recognize risk factors for PAD and help identify patients who may benefit from further investigation.

[Justin]

So risk factors include age older than 65, patients 50 to 64 years of age with risk factors for atherosclerosis such as diabetes, a history of smoking, dyslipidemia, hypertension, chronic kidney disease or a family history of PAD, and then for patients younger than 50 years with diabetes and additional signs of atherosclerosis.

[Austin]

The ABI should be used for the diagnosis of PAD in patients with findings suggestive of or at high risk for PAD. An abnormal ABI is a ratio of 0.9 or less, borderline is 0.91 to 0.99 and normal is 1.0 to 1.40 for an ABI of more than 1.40, meaning the arteries are non compressible. A toe brachial index should be measured with an index of 0.70 or less being diagnostic for PAD.

[Justin]

Treatment should include a focus on lifestyle changes including smoking, cessation, foot care, education, considering a Mediterranean diet, and of course, exercise. Structured exercise therapy is recommended at least three times per week for 12 weeks in patients with chronic symptomatic PAD and improves walking distance, functional status and quality of life.

[Austin]

Guideline Directed medical therapy includes antithrombotic therapy, lipid lowering therapy, management of comorbid conditions like hypertension and diabetes, and symptom control.

[Justin]

Single antiplatelet therapy with CLOPIDOGREL is recommended for symptomatic pad. Low dose rivaroxaban combined with low dose aspirin benefits select high risk patients that have a low risk for bleeding. However, triple therapy with all three clopidogrel, rivaroxaban and low dose aspirin should be avoided.

[Austin]

Solostazole reduces claudication symptoms and may reduce restenosis after endovascular therapy.

[Justin]

And finally, revascularization is recommended for patients that are either asymptomatic but reconstruction of diseased arteries is needed for other procedures for patients with function limiting symptoms despite medication treatment and lastly for patients with either acute or chronic limb threatening ischemia.

[Jake]

Foreign. Send us your thoughts by emailing [e-mail] follow on Instagram @ afpjournal. Please subscribe and rate us wherever you get your.

[Austin]

Podcasts. Escuchenos en Espanol Arrevista Medica a.

[Jake]

Fap Our podcast team is Jake Anderson, Puneet Baro, Steve Brown, Justin Chettiak, Sarah Coles, Austin Cotter, Rachel Dunn, Emily Eisenberg, Alaina Kelly, Chisum Okuagu, and Kari.

[Justin]

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

[Austin]

Jenkins. This podcast is brought to you by the residents and faculty of the University of Arizona College of Medicine, Phoenix Family Medicine Residency.

[Justin]

Programs. We'll talk to you soon for the next edition of the American Family Physician Podcast.