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.

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.

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.

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.

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.

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.

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.

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)

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

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.