A review of Osteoarthritis  for the the Pain Practitioner.

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Discussed:

Joint Replacement

DMARDs

NSAIDs

Syndesmophytes

Crepitus

Xray findings

Bouchards

AnesthesiaExam Podcast 

For more information, CME credit and MOCA and Primary Board Prep,

Go to AnesthesiaExam.com

For Basic and Advanced Anesthesia Exam Review, 

Go to ABAStagedExams.com

For the Pediatric Anesthesiology Board Review, Go to PedsAE.com

David Rosenblum, MD specializes in Pain Management and is the Director of Pain Management at Maimonides Medical Center and AABP Pain Managment

For evaluation and treatment of a Painful Disorder, go to www.AABPPain.com

718 436 7246

DISCLAIMER: Doctor Rosenblum IS HERE SOLELY TO EDUCATE, AND YOU ARE SOLELY RESPONSIBLE FOR ALL YOUR DECISIONS AND ACTIONS IN RESPONSE TO ANY INFORMATION CONTAINED HEREIN. This podcasts is not intended as a substitute for the medical advice of physician to a particular patient or specific ailment. 

You should regularly consult a physician in matters relating to yours or another’s health.  You understand that this podcast is not intended as a substitute for consultation with a licensed medical professional. 

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References

1. "Ankylosing Spondylitis -Professional reference for Doctors - Patient UK". Patient UK. Retrieved 26 May 2014.
2. Jump up ^ Jiménez-Balderas FJ, Mintz G (1993). "Ankylosing spondylitis: clinical course in women and men". J Rheumatol 20 (12): 2069–72. PMID 7516975.
3. Jump up ^ Longo, Dan Louis; Fauci, Anthony S.; Harrison, Tinsley Randolph; Kasper, Dennis L.; Hauser, Stephen L.; Jameson, J. Larry; Loscalzo, Joseph (2012). Harrison's Principles of Internal Medicine. Vol. 1 (18th ed.). McGraw-Hill. ISBN 978-0-07-163244-7.
4. Jump up ^ "Ankolysing Spondylitis". Arthritis Action. Retrieved 12 August 2015.
5. Jump up ^ Thomas E, Silman AJ, Papageorgiou AC, Macfarlane GJ, Croft PR (1998). "Association between measures of spinal mobility and low back pain. An analysis of new attenders in primary care". Spine 23 (2): 343–7. doi:10.1097/00007632-199802010-00011. PMID 9507623.
6. Jump up ^ Garrett S, Jenkinson T, Kennedy LG, Whitelock H, Gaisford P, Calin A (1994). "A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index". J Rheumatol 21 (12): 2286–91. PMID 7699630.
7. Jump up ^ Calin A, Garrett S, Whitelock H, Kennedy LG, O'Hea J, Mallorie P, Jenkinson T (1994). "A new approach to defining functional ability in ankylosing spondylitis: the development of the Bath Ankylosing Spondylitis Functional Index". J Rheumatol 21 (12): 2281–5. PMID 7699629.
8. Jump up ^ Toivanen A, Möttönen T (1998). "Ankylosing spondylitis: current approaches to treatment". BioDrugs 10 (3): 193–200. doi:10.2165/00063030-199810030-00003. PMID 18020595.
9. Jump up ^ Williams RO, Paleolog E, Feldmann M (2007). "Cytokine inhibitors in rheumatoid arthritis and other autoimmune diseases". Curr Opin Pharmacol 7 (4): 412–7. doi:10.1016/j.coph.2007.06.001. PMID 17627887.
10. Jump up ^ Kroon F, Landewé R, Dougados M, van der Heijde D (October 2012). "Continuous NSAID use reverts the effects of inflammation on radiographic progression in patients with ankylosing spondylitis". Ann. Rheum. Dis. 71 (10): 1623–9. doi:10.1136/annrheumdis-2012-201370. PMID 22532639.
11. Jump up ^ Chen J, Lin S, Liu C (27 November 2014). "Sulfasalazine for ankylosing spondylitis.". The Cochrane database of systematic reviews 11: CD004800. doi:10.1002/14651858.CD004800.pub3. PMID 25427435.
12. Jump up ^ Chen J, Veras MM, Liu C, Lin J (28 February 2013). "Methotrexate for ankylosing spondylitis.". The Cochrane database of systematic reviews 2: CD004524. doi:10.1002/14651858.CD004524.pub4. PMID 23450553.
13. Jump up ^ Braun J, van den Berg R, Baraliakos X, Boehm H, Burgos-Vargas R, Collantes-Estevez E, Dagfinrud H, Dijkmans B, Dougados M, Emery P, Geher P, Hammoudeh M, Inman RD, Jongkees M, Khan MA, Kiltz U, Kvien T, Leirisalo-Repo M, Maksymowych WP, Olivieri I, Pavelka K, Sieper J, Stanislawska-Biernat E, Wendling D, Ozgocmen S, van Drogen C, van Royen B, van der Heijde D (June 2011). "2010 update of the ASAS/EULAR recommendations for the management of ankylosing spondylitis". Ann. Rheum. Dis. 70 (6): 896–904. doi:10.1136/ard.2011.151027. PMC 3086052. PMID 21540199.
14. Jump up ^ Braun J, Sieper J (2007). "Ankylosing spondylitis". Lancet 369 (9570): 1379–90. doi:10.1016/S0140-6736(07)60635-7. PMID 17448825.
15. Jump up ^ Brulhart L, Nissen MJ, Chevallier P, Gabay C (February 2010). "Mixed response to tocilizumab for ankylosing spondylitis". Annals of the Rheumatic Diseases 69 (12): 2217–2218. doi:10.1136/ard.2009.126706. PMID 20851032.
16. Jump up ^ Rodríguez-Escalera C, Fernández-Nebro A (2008). "The use of rituximab to treat a patient with ankylosing spondylitis and hepatitis B". Rheumatology47 (11): 1732–1733. doi:10.1093/rheumatology/ken362. PMID 18786966.
17. Jump up ^ "Philadelphia Panel evidence-based clinical practice guidelines on selected rehabilitation interventions: overview and methodology". Phys Ther 81 (10): 1629–40. 2001. PMID 11589641.
18. Jump up ^ Dagfinrud H, Kvien TK, Hagen KB (23 January 2008). "Physiotherapy interventions for ankylosing spondylitis.". The Cochrane database of systematic reviews (1): CD002822. doi:10.1002/14651858.CD002822.pub3. PMID 18254008.
19. Jump up ^ Sieper J, Braun J, Rudwaleit M, Boonen A, Zink A (2002). "Ankylosing spondylitis: an overview". Ann. Rheum. Dis. 61 Suppl 3: iii8–18. doi:10.1136/ard.61.suppl_3.iii8. PMC 1766729. PMID 12381506.
20. Jump up ^ Bond D (2013). "Ankylosing spondylitis: diagnosis and management". Nurs Stand 28 (16-18): 52–9; quiz 60. doi:10.7748/ns2013.12.28.16.52.e7807. PMID 24345154.
21. ^ Jump up to: a b Alpert, Joseph S. (2006). The AHA Clinical Cardiac Consult. Lippincott Williams & Wilkins. ISBN 0-7817-6490-4.
22. Jump up ^ Ahn NU, Ahn UM, Nallamshetty L, Springer BD, Buchowski JM, Funches L, Garrett ES, Kostuik JP, Kebaish KM, Sponseller PD (2001). "Cauda Equina Syndrome in AS (The CES-AS Syndrome): Meta-analysis of outcomes after medical and surgical treatments". J of Spinal Disorders 14 (5): 427–433. doi:10.1097/00002517-200110000-00009. PMID 11586143.
23. ^ Jump up to: a b Bakland G, Gran JT, Nossent JC (November 2011). "Increased mortality in ankylosing spondylitis is related to disease activity". Ann. Rheum. Dis.70 (11): 1921–5. doi:10.1136/ard.2011.151191. PMID 21784726.
24. Jump up ^ Radford EP, Doll R, Smith PG (September 1977). "Mortality among patients with ankylosing spondylitis not given X-ray therapy". N. Engl. J. Med. 297(11): 572–6. doi:10.1056/NEJM197709152971103. PMID 887115.
25. Jump up ^ Del Din S, Carraro E, Sawacha Z, Guiotto A, Bonaldo L, Masiero S, Cobelli C (2011). "Impaired gait in ankylosing spondylitis". Med Biol Eng Comput 49(7): 801–9. doi:10.1007/s11517-010-0731-x. PMID 21229328
"Ankylosing Spondylitis -Professional reference for Doctors - Patient UK". Patient UK. Retrieved 26 May 2014.

2.Jump up ^ Jiménez-Balderas FJ, Mintz G (1993). "Ankylosing spondylitis: clinical course in women and men". J Rheumatol 20 (12): 2069–72. PMID 7516975.

3.Jump up ^ Longo, Dan Louis; Fauci, Anthony S.; Harrison, Tinsley Randolph; Kasper, Dennis L.; Hauser, Stephen L.; Jameson, J. Larry; Loscalzo, Joseph (2012). Harrison's Principles of Internal Medicine. Vol. 1 (18th ed.). McGraw-Hill. ISBN 978-0-07-163244-7.

4.Jump up ^ "Ankolysing Spondylitis". Arthritis Action. Retrieved 12 August 2015.

5.Jump up ^ Thomas E, Silman AJ, Papageorgiou AC, Macfarlane GJ, Croft PR (1998). "Association between measures of spinal mobility and low back pain. An analysis of new attenders in primary care". Spine 23 (2): 343–7. doi:10.1097/00007632-199802010-00011. PMID 9507623.

6.Jump up ^ Garrett S, Jenkinson T, Kennedy LG, Whitelock H, Gaisford P, Calin A (1994). "A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index". J Rheumatol 21 (12): 2286–91. PMID 7699630.

7.Jump up ^ Calin A, Garrett S, Whitelock H, Kennedy LG, O'Hea J, Mallorie P, Jenkinson T (1994). "A new approach to defining functional ability in ankylosing spondylitis: the development of the Bath Ankylosing Spondylitis Functional Index". J Rheumatol 21 (12): 2281–5. PMID 7699629.

8.Jump up ^ Toivanen A, Möttönen T (1998). "Ankylosing spondylitis: current approaches to treatment". BioDrugs 10 (3): 193–200. doi:10.2165/00063030-199810030-00003. PMID 18020595.

9.Jump up ^ Williams RO, Paleolog E, Feldmann M (2007). "Cytokine inhibitors in rheumatoid arthritis and other autoimmune diseases". Curr Opin Pharmacol 7 (4): 412–7. doi:10.1016/j.coph.2007.06.001. PMID 17627887.

10.Jump up ^ Kroon F, Landewé R, Dougados M, van der Heijde D (October 2012). "Continuous NSAID use reverts the effects of inflammation on radiographic progression in patients with ankylosing spondylitis". Ann. Rheum. Dis. 71 (10): 1623–9. doi:10.1136/annrheumdis-2012-201370. PMID 22532639.

11.Jump up ^ Chen J, Lin S, Liu C (27 November 2014). "Sulfasalazine for ankylosing spondylitis.". The Cochrane database of systematic reviews 11: CD004800. doi:10.1002/14651858.CD004800.pub3. PMID 25427435.

12.Jump up ^ Chen J, Veras MM, Liu C, Lin J (28 February 2013). "Methotrexate for ankylosing spondylitis.". The Cochrane database of systematic reviews 2: CD004524. doi:10.1002/14651858.CD004524.pub4. PMID 23450553.

13.Jump up ^ Braun J, van den Berg R, Baraliakos X, Boehm H, Burgos-Vargas R, Collantes-Estevez E, Dagfinrud H, Dijkmans B, Dougados M, Emery P, Geher P, Hammoudeh M, Inman RD, Jongkees M, Khan MA, Kiltz U, Kvien T, Leirisalo-Repo M, Maksymowych WP, Olivieri I, Pavelka K, Sieper J, Stanislawska-Biernat E, Wendling D, Ozgocmen S, van Drogen C, van Royen B, van der Heijde D (June 2011). "2010 update of the ASAS/EULAR recommendations for the management of ankylosing spondylitis". Ann. Rheum. Dis. 70 (6): 896–904. doi:10.1136/ard.2011.151027. PMC 3086052. PMID 21540199.

14.Jump up ^ Braun J, Sieper J (2007). "Ankylosing spondylitis". Lancet 369 (9570): 1379–90. doi:10.1016/S0140-6736(07)60635-7. PMID 17448825.

15.Jump up ^ Brulhart L, Nissen MJ, Chevallier P, Gabay C (February 2010). "Mixed response to tocilizumab for ankylosing spondylitis". Annals of the Rheumatic Diseases 69 (12): 2217–2218. doi:10.1136/ard.2009.126706. PMID 20851032.

16.Jump up ^ Rodríguez-Escalera C, Fernández-Nebro A (2008). "The use of rituximab to treat a patient with ankylosing spondylitis and hepatitis B". Rheumatology 47 (11): 1732–1733. doi:10.1093/rheumatology/ken362. PMID 18786966.

17.Jump up ^ "Philadelphia Panel evidence-based clinical practice guidelines on selected rehabilitation interventions: overview and methodology". Phys Ther 81 (10): 1629–40. 2001. PMID 11589641.

18.Jump up ^ Dagfinrud H, Kvien TK, Hagen KB (23 January 2008). "Physiotherapy interventions for ankylosing spondylitis.". The Cochrane database of systematic reviews (1): CD002822. doi:10.1002/14651858.CD002822.pub3. PMID 18254008.

19.Jump up ^ Sieper J, Braun J, Rudwaleit M, Boonen A, Zink A (2002). "Ankylosing spondylitis: an overview". Ann. Rheum. Dis. 61 Suppl 3: iii8–18. doi:10.1136/ard.61.suppl_3.iii8. PMC 1766729. PMID 12381506.

20.Jump up ^ Bond D (2013). "Ankylosing spondylitis: diagnosis and management". Nurs Stand 28 (16-18): 52–9; quiz 60. doi:10.7748/ns2013.12.28.16.52.e7807. PMID 24345154.

21.^ Jump up to: a b Alpert, Joseph S. (2006). The AHA Clinical Cardiac Consult. Lippincott Williams & Wilkins. ISBN 0-7817-6490-4.

22.Jump up ^ Ahn NU, Ahn UM, Nallamshetty L, Springer BD, Buchowski JM, Funches L, Garrett ES, Kostuik JP, Kebaish KM, Sponseller PD (2001). "Cauda Equina Syndrome in AS (The CES-AS Syndrome): Meta-analysis of outcomes after medical and surgical treatments". J of Spinal Disorders 14 (5): 427–433. doi:10.1097/00002517-200110000-00009. PMID 11586143.

23.^ Jump up to: a b Bakland G, Gran JT, Nossent JC (November 2011). "Increased mortality in ankylosing spondylitis is related to disease activity". Ann. Rheum. Dis. 70 (11): 1921–5. doi:10.1136/ard.2011.151191. PMID 21784726.

24.Jump up ^ Radford EP, Doll R, Smith PG (September 1977). "Mortality among patients with ankylosing spondylitis not given X-ray therapy". N. Engl. J. Med. 297 (11): 572–6. doi:10.1056/NEJM197709152971103. PMID 887115.

25.Jump up ^ Del Din S, Carraro E, Sawacha Z, Guiotto A, Bonaldo L, Masiero S, Cobelli C (2011). "Impaired gait in ankylosing spondylitis". Med Biol Eng Comput 49 (7): 801–9. doi:10.1007/s11517-010-0731-x. PMID 21229328

1. ^ Jump up to: a b c d e f g h i "Osteoarthritis". National Institute of Arthritis and Musculoskeletal and Skin Diseases. April 2015. Retrieved 13 May 2015.
2. ^ Jump up to: a b c d Glyn-Jones, S; Palmer, AJ; Agricola, R; Price, AJ; Vincent, TL; Weinans, H; Carr, AJ (3 March 2015). "Osteoarthritis.". Lancet. PMID 25748615.
3. Jump up ^ Berenbaum F (2013). "Osteoarthritis as an inflammatory disease (osteoarthritis is not osteoarthrosis!)". Osteoarthritis and Cartilage 21 (1): 16–21. doi:10.1016/j.joca.2012.11.012. PMID 23194896.
4. ^ Jump up to: a b Conaghan P (2008). "Osteoarthritis — National clinical guideline for care and management in adults" (PDF).
5. ^ Jump up to: a b March, L; Smith, EU; Hoy, DG; Cross, MJ; Sanchez-Riera, L; Blyth, F; Buchbinder, R; Vos, T; Woolf, AD (June 2014). "Burden of disability due to musculoskeletal (MSK) disorders.". Best practice & research. Clinical rheumatology 28 (3): 353–66. PMID 25481420.
6. Jump up ^ Elsternwick (2013). "A problem worth solving.". Arthritis and Osteoporosis Victoria.
7. Jump up ^ MedlinePlus Encyclopedia Osteoarthritis
8. Jump up ^ de Figueiredo EC, Figueiredo GC, Dantas RT (December 2011). "Influência de elementos meteorológicos na dor de pacientes com osteoartrite: Revisão da literatura" [Influence of meteorological elements on osteoarthritis pain: a review of the literature]. Rev Bras Reumatol (in Portuguese) 51 (6): 622–8. doi:10.1590/S0482-50042011000600008. PMID 22124595.
9. Jump up ^ "Water on the knee". MayoClinic.com.
10. ^ Jump up to: a b Brandt KD, Dieppe P, Radin E (January 2009). "Etiopathogenesis of osteoarthritis". Med. Clin. North Am. 93 (1): 1–24, xv. doi:10.1016/j.mcna.2008.08.009. PMID 19059018.
11. Jump up ^ Bosomworth NJ (September 2009). "Exercise and knee osteoarthritis: benefit or hazard?". Can Fam Physician 55 (9): 871–8. PMC 2743580. PMID 19752252.
12. Jump up ^ Deweber K, Olszewski M, Ortolano R (2011). "Knuckle cracking and hand osteoarthritis". J Am Board Fam Med 24 (2): 169–74. doi:10.3122/jabfm.2011.02.100156. PMID 21383216.
13. Jump up ^ Valdes AM, Spector TD (August 2008). "The contribution of genes to osteoarthritis". Rheum. Dis. Clin. North Am. 34 (3): 581–603. doi:10.1016/j.rdc.2008.04.008. PMID 18687274.
14. Jump up ^ Spector TD, MacGregor AJ (2004). "Risk factors for osteoarthritis: genetics". Osteoarthr. Cartil. 12 Suppl A: S39–44. doi:10.1016/j.joca.2003.09.005. PMID 14698640.
15. Jump up ^ Hogervorst T, Bouma HW, de Vos J (August 2009). "Evolution of the hip and pelvis.". Acta orthopaedica. Supplementum 80 (336): 1–39. doi:10.1080/17453690610046620. PMID 19919389.
16. Jump up ^ van der Kraan PM, van den Berg WB (April 2008). "Osteoarthritis in the context of ageing and evolution. Loss of chondrocyte differentiation block during ageing.". Ageing Research Reviews 7 (2): 106–13. doi:10.1016/j.arr.2007.10.001. PMID 18054526.
17. Jump up ^ Coggon D, Reading I, Croft P, McLaren M, Barrett D, Cooper C (May 2001). "Knee osteoarthritis and obesity". Int. J. Obes. Relat. Metab. Disord. 25 (5): 622–7. doi:10.1038/sj.ijo.0801585. PMID 11360143.
18. Jump up ^ Pottie P, Presle N, Terlain B, Netter P, Mainard D, Berenbaum F (November 2006). "Obesity and osteoarthritis: more complex than predicted!". Ann. Rheum. Dis. 65 (11): 1403–5. doi:10.1136/ard.2006.061994. PMC 1798356. PMID 17038451.
19. Jump up ^ Linn S, Murtaugh B, Casey E (May 2012). "Role of sex hormones in the development of osteoarthritis". PM R 4 (5 Suppl): S169–73. doi:10.1016/j.pmrj.2012.01.013. PMID 22632696.
20. Jump up ^ Tanamas SK, Wijethilake P, Wluka AE, Davies-Tuck ML, Urquhart DM, Wang Y, Cicuttini FM (June 2011). "Sex hormones and structural changes in osteoarthritis: a systematic review". Maturitas 69 (2): 141–56. doi:10.1016/j.maturitas.2011.03.019. PMID 21481553.
21. Jump up ^ Ma HL, Blanchet TJ, Peluso D, Hopkins B, Morris EA, Glasson SS (June 2007). "Osteoarthritis severity is sex dependent in a surgical mouse model". Osteoarthr. Cartil. 15 (6): 695–700. doi:10.1016/j.joca.2006.11.005. PMID 17207643.
22. Jump up ^ King KB, Rosenthal AK (2015). "The adverse effects of diabetes on osteoarthritis: update on clinical evidence and molecular mechanisms". Osteoarthritis Cartilage 23 (6): 841–50. doi:10.1016/j.joca.2015.03.031. PMID 25837996.
23. ^ Jump up to: a b c Maroudas AI (April 1976). "Balance between swelling pressure and collagen tension in normal and degenerate cartilage". Nature 260 (5554): 808–9. doi:10.1038/260808a0. PMID 1264261.
24. Jump up ^ Bollet AJ, Nance JL (July 1966). "Biochemical Findings in Normal and Osteoarthritic Articular Cartilage. II. Chondroitin Sulfate Concentration and Chain Length, Water, and Ash Content". J. Clin. Invest. 45 (7): 1170–7. doi:10.1172/JCI105423. PMC 292789. PMID 16695915.
25. ^ Jump up to: a b Brocklehurst R, Bayliss MT, Maroudas A, Coysh HL, Freeman MA, Revell PA, Ali SY (January 1984). "The composition of normal and osteoarthritic articular cartilage from human knee joints. With special reference to unicompartmental replacement and osteotomy of the knee". J Bone Joint Surg Am 66 (1): 95–106. PMID 6690447.
26. Jump up ^ Chou MC, Tsai PH, Huang GS, Lee HS, Lee CH, Lin MH, Lin CY, Chung HW (April 2009). "Correlation between the MR T2 value at 4.7 T and relative water content in articular cartilage in experimental osteoarthritis induced by ACL transection". Osteoarthr. Cartil. 17 (4): 441–7. doi:10.1016/j.joca.2008.09.009. PMID 18990590.
27. Jump up ^ Grushko G, Schneiderman R, Maroudas A (1989). "Some biochemical and biophysical parameters for the study of the pathogenesis of osteoarthritis: a comparison between the processes of ageing and degeneration in human hip cartilage". Connect. Tissue Res. 19 (2–4): 149–76. doi:10.3109/03008208909043895. PMID 2805680.
28. Jump up ^ Mankin HJ, Thrasher AZ (January 1975). "Water content and binding in normal and osteoarthritic human cartilage". J Bone Joint Surg Am 57 (1): 76–80. PMID 1123375.
29. ^ Jump up to: a b Venn M, Maroudas A (April 1977). "Chemical composition and swelling of normal and osteoarthrotic femoral head cartilage. I. Chemical composition". Ann. Rheum. Dis. 36 (2): 121–9. doi:10.1136/ard.36.2.121. PMC 1006646. PMID 856064.
30. Jump up ^ Madry H, Luyten FP, Facchini A (2012). "Biological aspects of early osteoarthritis". Knee Surg. Sports Traumatol. Arthrosc. 20 (3): 407–22. doi:10.1007/s00167-011-1705-8. PMID 22009557.
31. Jump up ^ Englund M, Roemer FW, Hayashi D, Crema MD, Guermazi A (2012). "Meniscus pathology, osteoarthritis and the treatment controversy". Nat. Rev. Rheumatol. 8 (7): 412–9. doi:10.1038/nrrheum.2012.69. PMID 22614907.
32. Jump up ^ Li G, Yin J, Gao J, Cheng TS, Pavlos NJ, Zhang C, Zheng MH (2013). "Subchondral bone in osteoarthritis: insight into risk factors and microstructural changes". Arthritis Res. Ther. 15 (6): 223. doi:10.1186/ar4405. PMID 24321104.
33. Jump up ^ Hill CL, Gale DG, Chaisson CE, Skinner K, Kazis L, Gale ME, Felson DT (2001). "Knee effusions, popliteal cysts, and synovial thickening: association with knee pain in osteoarthritis". J. Rheumatol. 28 (6): 1330–7. PMID 11409127.
34. Jump up ^ Felson DT, Chaisson CE, Hill CL, Totterman SM, Gale ME, Skinner KM, Kazis L, Gale DR (2001). "The association of bone marrow lesions with pain in knee osteoarthritis". Ann Intern Med. 2001 Apr 3;134(7):541-9 134 (7): 541–9. doi:10.7326/0003-4819-134-7-200104030-00007. PMID 11281736.
35. Jump up ^ Zhang W, Doherty M, Peat G, Bierma-Zeinstra MA, Arden NK, Bresnihan B, Herrero-Beaumont G, Kirschner S, Leeb BF, Lohmander LS, Mazières B, Pavelka K, Punzi L, So AK, Tuncer T, Watt I, Bijlsma JW (March 2010). "EULAR evidence-based recommendations for the diagnosis of knee osteoarthritis". Ann. Rheum. Dis. 69 (3): 483–9. doi:10.1136/ard.2009.113100. PMID 19762361.
36. Jump up ^ Bierma-Zeinstra SM, Oster JD, Bernsen RM, Verhaar JA, Ginai AZ, Bohnen AM (August 2002). "Joint space narrowing and relationship with symptoms and signs in adults consulting for hip pain in primary care". J. Rheumatol. 29 (8): 1713–8. PMID 12180735.
37. Jump up ^ Osteoarthritis (OA): Joint Disorders at Merck Manual of Diagnosis and Therapy Professional Edition
38. Jump up ^ Phillips CR, Brasington RD (2010). "Osteoarthritis treatment update: Are NSAIDs still in the picture?". Journal of Musculoskeletal Medicine 27 (2).
39. Jump up ^ Kalunian KC (2013). "Patient information: Osteoarthritis symptoms and diagnosis (Beyond the Basics)". UpToDate. Retrieved 15 February 2013.
40. Jump up ^ Altman R, Alarcón G, Appelrouth D, Bloch D, Borenstein D, Brandt K, Brown C, Cooke TD, Daniel W, Gray R (November 1990). "The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hand". Arthritis Rheum. 33 (11): 1601–10. doi:10.1002/art.1780331101. PMID 2242058.

Dr. Rosenblum discusses Rheumatoid Arthritis

Discussed in this podcast:

Diagnosis

Treatment

SLE

Osteoarthritis

DMARDs

Methotrexate

PainExam/AnesthesiaExam Podcast

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For the Pediatric Anesthesiology Board Review, Go to PedsAE.com

David Rosenblum, MD specializes in Pain Management and is the Director of Pain Management at Maimonides Medical Center and AABP Pain Managment

For evaluation and treatment of a Painful Disorder, go to www.AABPPain.com

718 436 7246

DISCLAIMER: Doctor Rosenblum IS HERE SOLELY TO EDUCATE, AND YOU ARE SOLELY RESPONSIBLE FOR ALL YOUR DECISIONS AND ACTIONS IN RESPONSE TO ANY INFORMATION CONTAINED HEREIN. This podcasts is not intended as a substitute for the medical advice of physician to a particular patient or specific ailment. 

You should regularly consult a physician in matters relating to yours or another’s health.  You understand that this podcast is not intended as a substitute for consultation with a licensed medical professional. 

Copyright © 2015 QBazaar.com, LLC  All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, recording or otherwise, without the prior written permission of the author.

     References

Acute Back Pain

Diagnosis

MRI, CT scan, Bone Scintigraphy

X rays

Comorbid psychological illness, substance a buse

Cauda equina syndrome

Reference

Benzon HT Essentials of Pain Management and Regional Anesthesia. Second ed. 2005

p. 315-321

AnesthesiaExam Podcast 

For more information, CME credit and MOCA and Primary Board Prep,

Go to AnesthesiaExam.com

For Basic and Advanced Anesthesia Exam Review, 

Go to ABAStagedExams.com

For the Pediatric Anesthesiology Board Review, Go to PedsAE.com

David Rosenblum, MD specializes in Pain Management and is the Director of Pain Management at Maimonides Medical Center and AABP Pain Managment

For evaluation and treatment of a Painful Disorder, go to www.AABPPain.com

718 436 7246

DISCLAIMER: Doctor Rosenblum IS HERE SOLELY TO EDUCATE, AND YOU ARE SOLELY RESPONSIBLE FOR ALL YOUR DECISIONS AND ACTIONS IN RESPONSE TO ANY INFORMATION CONTAINED HEREIN. This podcasts is not intended as a substitute for the medical advice of physician to a particular patient or specific ailment. 

You should regularly consult a physician in matters relating to yours or another’s health.  You understand that this podcast is not intended as a substitute for consultation with a licensed medical professional. 

Copyright © 2015 QBazaar.com, LLC  All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, recording or otherwise, without the prior written permission of the author.

Brian Henck, MD, anesthesiology attending reviews the history, uses, and considerations of the Laryngeal Mask Airway.

AnesthesiaExam Podcast 

For more information, CME credit and MOCA and Primary Board Prep,

Go to AnesthesiaExam.com

For Basic and Advanced Anesthesia Exam Review, 

Go to ABAStagedExams.com

For the Pediatric Anesthesiology Board Review, Go to PedsAE.com

David Rosenblum, MD specializes in Pain Management and is the Director of Pain Management at Maimonides Medical Center and AABP Pain Managment

For evaluation and treatment of a Painful Disorder, go to www.AABPPain.com

718 436 7246

DISCLAIMER: Doctor Rosenblum IS HERE SOLELY TO EDUCATE, AND YOU ARE SOLELY RESPONSIBLE FOR ALL YOUR DECISIONS AND ACTIONS IN RESPONSE TO ANY INFORMATION CONTAINED HEREIN. This podcasts is not intended as a substitute for the medical advice of physician to a particular patient or specific ailment. 

You should regularly consult a physician in matters relating to yours or another’s health.  You understand that this podcast is not intended as a substitute for consultation with a licensed medical professional. 

Copyright © 2015 QBazaar.com, LLC  All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, recording or otherwise, without the prior written permission of the author.

David Rosenblum, MD interviews EP Cardiologist Ron Shnitzer, MD

Topics discussed in this podcast include:

QT Prolongation

Tricyclic Medication Side Effects

Cardiac Clearance vs. Optimization

Interventional Procedures in the Anticoagulated Patient

AnesthesiaExam Podcast 

For more information, CME credit and MOCA and Primary Board Prep,

Go to AnesthesiaExam.com

For Basic and Advanced Anesthesia Exam Review, 

Go to ABAStagedExams.com

For the Pediatric Anesthesiology Board Review, Go to PedsAE.com

David Rosenblum, MD specializes in Pain Management and is the Director of Pain Management at Maimonides Medical Center and AABP Pain Managment

For evaluation and treatment of a Painful Disorder, go to www.AABPPain.com

718 436 7246

Download our iphone App!

Download our Android App!

DISCLAIMER: Doctor Rosenblum IS HERE SOLELY TO EDUCATE, AND YOU ARE SOLELY RESPONSIBLE FOR ALL YOUR DECISIONS AND ACTIONS IN RESPONSE TO ANY INFORMATION CONTAINED HEREIN. This podcasts is not intended as a substitute for the medical advice of physician to a particular patient or specific ailment. 

You should regularly consult a physician in matters relating to yours or another’s health.  You understand that this podcast is not intended as a substitute for consultation with a licensed medical professional. 

Copyright © 2015 QBazaar.com, LLC  All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, recording or otherwise, without the prior written permission of the author.

Dr. Rosenblum interviews Dr. Schwartz of AABP Pain Management

Topics Discussed

Combined Anethesia Pain Jobs vs. 100% Pain Jobs

Private Practice vs. Academic Practice vs. Hybrid Anesthesia/Pain Jobs

growing a pain practice

Ethical Pain Medicine

Hippa 

Encryption

Ultrasound utility in practice growth

ERAS protocol

Narcotic sparing 

Acute Pain Practice

AnesthesiaExam Podcast 

For more information, CME credit and MOCA and Primary Board Prep,

Go to AnesthesiaExam.com

For Basic and Advanced Anesthesia Exam Review, 

Go to ABAStagedExams.com

For the Pediatric Anesthesiology Board Review, Go to PedsAE.com

David Rosenblum, MD specializes in Pain Management and is the Director of Pain Management at Maimonides Medical Center and AABP Pain Managment

For evaluation and treatment of a Painful Disorder, go to www.AABPPain.com

718 436 7246

DISCLAIMER: Doctor Rosenblum IS HERE SOLELY TO EDUCATE, AND YOU ARE SOLELY RESPONSIBLE FOR ALL YOUR DECISIONS AND ACTIONS IN RESPONSE TO ANY INFORMATION CONTAINED HEREIN. This podcasts is not intended as a substitute for the medical advice of physician to a particular patient or specific ailment. 

You should regularly consult a physician in matters relating to yours or another’s health.  You understand that this podcast is not intended as a substitute for consultation with a licensed medical professional. 

Copyright © 2015 QBazaar.com, LLC  All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, recording or otherwise, without the prior written permission of the author.

David Rosenblum, MD interviews Pain Management Nurse, Darlene Saberito

Discussed on this Podcast:

Setting up a pain practice

Residents with bad attitudess

PI

Communication failures

Networking 

acute pain service

Alarm fatigue

regional anethesia service

AnesthesiaExam Podcast 

For more information, CME credit and MOCA and Primary Board Prep,

Go to AnesthesiaExam.com

For Basic and Advanced Anesthesia Exam Review, 

Go to ABAStagedExams.com

For the Pediatric Anesthesiology Board Review, Go to PedsAE.com

David Rosenblum, MD specializes in Pain Management and is the Director of Pain Management at Maimonides Medical Center and AABP Pain Managment

For evaluation and treatment of a Painful Disorder, go to www.AABPPain.com

718 436 7246

DISCLAIMER: Doctor Rosenblum IS HERE SOLELY TO EDUCATE, AND YOU ARE SOLELY RESPONSIBLE FOR ALL YOUR DECISIONS AND ACTIONS IN RESPONSE TO ANY INFORMATION CONTAINED HEREIN. This podcasts is not intended as a substitute for the medical advice of physician to a particular patient or specific ailment. 

You should regularly consult a physician in matters relating to yours or another’s health.  You understand that this podcast is not intended as a substitute for consultation with a licensed medical professional. 

Copyright © 2015 QBazaar.com, LLC  All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, recording or otherwise, without the prior written permission of the author.

Dr. Rosenblum Reviews Hot Board Review Topics:

Pronator Syndrome

Anterior Interiosseous Syndrome

Patient Controlled Analgesia

Ketamine

Hydromorphone

Methadone

Morphine

Fentanyl 

Suflentanil

For more information, CME credit and MOCA and Primary Board Prep,

Go to AnesthesiaExam.com

For Basic and Advanced Anesthesia Exam Review, 

Go to ABAStagedExams.com

For the Pediatric Anesthesiology Board Review, Go to PedsAE.com

David Rosenblum, MD specializes in Pain Management and is the Director of Pain Management at Maimonides Medical Center and AABP Pain Managment

For evaluation and treatment of a Painful Disorder, go to www.AABPPain.com

718 436 7246

DISCLAIMER: Doctor Rosenblum IS HERE SOLELY TO EDUCATE, AND YOU ARE SOLELY RESPONSIBLE FOR ALL YOUR DECISIONS AND ACTIONS IN RESPONSE TO ANY INFORMATION CONTAINED HEREIN. This podcasts is not intended as a substitute for the medical advice of physician to a particular patient or specific ailment. 

You should regularly consult a physician in matters relating to yours or another’s health.  You understand that this podcast is not intended as a substitute for consultation with a licensed medical professional. 

Copyright © 2015 QBazaar.com, LLC  All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, recording or otherwise, without the prior written permission of the author.

References

Rodner CM et al. Pronator Syndrome and anterior interosseous syndrome. J Am Acad Orthop Surg. 2013 May ;21 (5):268-75.

Benzon HT.  Essentials of Pain Medicine and Regional Anethesia. 2nd ed 2005 p 239-245

Dr. Rosenblum Reviews this hot Anesthesia Board Topic

Mentioned in this Podcast:

WDN

Glutamate

NMDA

Peripheral and Central Sensitization

GABA analogs (Pregabalin, Gabapentin)

Hyperalgesia

Allodynia

Dr. Rosenblum Reviews this hot Pain Management Board Topic

Mentioned in this Podcast:

WDN

Glutamate

NMDA

Peripheral and Central Sensitization

GABA analogs (Pregabalin, Gabapentin)

Hyperalgesia

Allodynia

For more information on Pain Management Topics and keywords

Go to PainExam.com

David Rosenblum, MD specializes in Pain Management and is the Director of Pain Management at Maimonides Medical Center and AABP Pain Managment

For evaluation and treatment of a Painful Disorder, go to www.AABPPain.com

718 436 7246     

References

Go to AnesthesiaExam.com

For Basic and Advanced Anesthesia Exam Review, 

Go to ABAStagedExams.com

For the Pediatric Anesthesiology Board Review, Go to PedsAE.com

David Rosenblum, MD specializes in Pain Management and is the Director of Pain Management at Maimonides Medical Center and AABP Pain Managment

For evaluation and treatment of a Painful Disorder, go to www.AABPPain.com

718 436 7246

References

Mishra AK.  Pre-emptive analgesia: Recent trends and evidences

Dr. Rosenblum interviews Michael Steinberg, DDS, author of 

Inside Job

The World's Leading Dentists Reveal the Secrets to Total Body Health

From the inside out!

Topics discussed:

Airway Difficulties

TMJ pain

Tension, Migraine, Occipital Headaches

Dental Sleep Medicine

For more information, CME credit and MOCA and Primary Board Prep,

Go to AnesthesiaExam.com

For Basic and Advanced Anesthesia Exam Review, 

Go to ABAStagedExams.com

For the Pediatric Anesthesiology Board Review, Go to PedsAE.com

David Rosenblum, MD specializes in Pain Management and is the Director of Pain Management at Maimonides Medical Center and AABP Pain Managment

For evaluation and treatment of a Painful Disorder, go to www.AABPPain.com

718 436 7246

DISCLAIMER: Doctor Rosenblum IS HERE SOLELY TO EDUCATE, AND YOU ARE SOLELY RESPONSIBLE FOR ALL YOUR DECISIONS AND ACTIONS IN RESPONSE TO ANY INFORMATION CONTAINED HEREIN. This podcasts is not intended as a substitute for the medical advice of physician to a particular patient or specific ailment. 

You should regularly consult a physician in matters relating to yours or another’s health.  You understand that this podcast is not intended as a substitute for consultation with a licensed medical professional. 

Copyright © 2015 QBazaar.com, LLC  All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, recording or otherwise, without the prior written permission of the author.

Dr. Rosenblum, discusses:

-Withdrawel, abuse, misuse, dependency, and detox

-Strategies and Keywords and asked on the Pain Medicine Boards

Opiate use in the patient with a history of substance abuse

For more Board Review information go to AnesthesiaExam.com

20 CME credits and Referenced Board Review material available

For Basic and Advanced Anesthesia Board Review go to ABAStagedExams.com

Reference

Benzon HT, Essentials of Pain Medicine and Regional Anesthesia. Second ed. 2005 p. 209-219

Dr. Rosenblum continues his Anesthesia Board Review featuring the Pain Management Unit focusing on techniques such as accupuncture, biofeedback, cognitive restructuring, hypnosis, relaxation techniques and coping strategies to alleviate pain.

Anesthesiology Board Review

For CME credits and Anesthesia Board Prep, MOCA prep go to AnesthesiaExam.com

For Basic and Advanced Anesthesia Exam Reviews, go to 

ABAStagedExams.com

References

Benzon HT. Essentials of Pain Medicine and Regional Anesthesia. Second edition. 2005. p. 203-211

Dr. Rosenblum reviews rehab and physical therapy modalites to treat pain for the Anesthesiology Boards

Podcast includes

Heat Therapy

Cryotherapy

Ultrasound therapy

Excercise

 For more information go to ABAStagedExam.com (Basic and Advanced Exam Review)

AnesthesiaExam.com (MOC and CME credits)

MyKidsSurgery.com or Amazon.com to view/purchase

"Welwyn Ardsley and the Cosmic Ninjas: Preparing your Child and Yourself for Anesthesia and Surgery."

Reference

Benzon HT, Essentials of Pain Medicine and Regional Anesthesia. Second edition 2005. p. 196-208

DISCLAIMER: Doctor Rosenblum IS HERE SOLELY TO EDUCATE, AND YOU ARE SOLELY RESPONSIBLE FOR ALL YOUR DECISIONS AND ACTIONS IN RESPONSE TO ANY INFORMATION CONTAINED HEREIN. This podcasts is not intended as a substitute for the medical advice of physician to a particular patient or specific ailment. 

You should regularly consult a physician in matters relating to yours or another’s health.  You understand that this podcast is not intended as a substitute for consultation with a licensed medical professional. 

Copyright © 2015 David Rosenblum All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, recording or otherwise, without the prior written permission of the author.

ABAStagedExams.com  (Review for the Basic and Advanced Anesthesia Exams)

AnesthesiaExam.com  (CME review, Boards and MOCA)

Anesthesia Board Prep Instructor, David Rosenblum, MD discusses diagnosis, pathology, prevention and treatment of Postherpetic Neuralgia.

Discussed:

Pathology of the Varicella Zoster infection

Gabapentin

Lyrica

Amitriptyline

Capsaicin

Lidocaine patch

Valacyclovir

Zostavax- zoster vaccine

References

Nagel MA, Postherpetic Neuralgia: New Perspectives on Pathogenesis and Treatment.  Pain Medicine News, 2015

Dworkin RH, Schmader KE.  Herpes Zoster and Postherpetic Neuralgia.  Essentials of Pain Medicine and Regional Anesthesia.  Second Edition. 2005 p. 386-393

DISCLAIMER: Doctor Rosenblum IS HERE SOLELY TO EDUCATE, AND YOU ARE SOLELY RESPONSIBLE FOR ALL YOUR DECISIONS AND ACTIONS IN RESPONSE TO ANY INFORMATION CONTAINED HEREIN. This podcasts is not intended as a substitute for the medical advice of physician to a particular patient or specific ailment. 

You should regularly consult a physician in matters relating to yours or another’s health.  You understand that this podcast is not intended as a substitute for consultation with a licensed medical professional. 

Copyright © 2015 QBazaar.com, LLC  All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, recording or otherwise, without the prior written permission of the author.

A review of the various Pain scales used to measure pain.

Podcast includes, VAS, VRS, McGill, Pain Questionnaire, FACES, FLACC, etc.

For more info go to AnesthesiaExam.com (CME Credits-MOC)

ABAStagedExams.com

(Basic and Advanced Board Prep)

For information on Children's Book Welwyn Ardsley and the Cosmic Ninjas: Preparing your Child and yourself for Anesthesia and Surgery

Go to Amazon.com or MyKidsSurgery.com

References

Stites M.  Observational Pain Scales in Critically Ill AdultsCrit Care Nurse June 2013  vol. 33  no. 3  68-78       

von Bayer CL.  Children’s self-reports of pain intensity: Scale selection, limitations and interpretation. Pain Res Manag. 2006 Autumn; 11(3): 157–162. 

Benzon H.  Essentials of Pain Medicine and Regional Anesthesia.  Second ediciton. 2005. p.29-33

DISCLAIMER: Doctor Rosenblum IS HERE SOLELY TO EDUCATE, AND YOU ARE SOLELY RESPONSIBLE FOR ALL YOUR DECISIONS AND ACTIONS IN RESPONSE TO ANY INFORMATION CONTAINED HEREIN. This podcasts is not intended as a substitute for the medical advice of physician to a particular patient or specific ailment. 

You should regularly consult a physician in matters relating to yours or another’s health.  You understand that this podcast is not intended as a substitute for consultation with a licensed medical professional. 

Copyright © 2015 QBazaar.com, LLC  All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, recording or otherwise, without the prior written permission of the author.

Dr. Rosenblum quotes and comments on a fantastic review article on Obesity and Chronic Pain.

Narouze S, Souzdalnitski D.  Obesity and Chronic Pain.  Systematic Review of Prevalence and Implications for Pain Practice.  Reg Anesth Pain Med 2015;40:91-111

For Anesthesiology board reveiw go to AnesthesiaExam.com

or ABAStagedExam.com

DISCLAIMER: Doctor Rosenblum IS HERE SOLELY TO EDUCATE, AND YOU ARE SOLELY RESPONSIBLE FOR ALL YOUR DECISIONS AND ACTIONS IN RESPONSE TO ANY INFORMATION CONTAINED HEREIN. This podcasts is not intended as a substitute for the medical advice of physician to a particular patient or specific ailment. 

You should regularly consult a physician in matters relating to yours or another’s health.  You understand that this podcast is not intended as a substitute for consultation with a licensed medical professional. 

Copyright © 2015 QBazaar.com, LLC  All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, recording or otherwise, without the prior written permission of the author.

Dr. Rosenblum reviews Steve Berman's (Anesthesia Business Consultants) presentation and goes over changes that may impact your practice due to the implementation of the ICD-10.

DISCLAIMER: Doctor Rosenblum IS HERE SOLELY TO EDUCATE, AND YOU ARE SOLELY RESPONSIBLE FOR ALL YOUR DECISIONS AND ACTIONS IN RESPONSE TO ANY INFORMATION CONTAINED HEREIN. This podcasts is not intended as a substitute for the medical advice of physician to a particular patient or specific ailment. 

You should regularly consult a physician in matters relating to yours or another’s health.  You understand that this podcast is not intended as a substitute for consultation with a licensed medical professional. 

Copyright © 2015 QBazaar.com, LLC  All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, recording or otherwise, without the prior written permission of the author.

Dr. Rosenblum discusses atypical opiate analgesics, such as tramadol and tapentadol

References

Benzon

Package insert

DISCLAIMER: Doctor Rosenblum IS HERE SOLELY TO EDUCATE, AND YOU ARE SOLELY RESPONSIBLE FOR ALL YOUR DECISIONS AND ACTIONS IN RESPONSE TO ANY INFORMATION CONTAINED HEREIN. This podcasts is not intended as a substitute for the medical advice of physician to a particular patient or specific ailment. 

You should regularly consult a physician in matters relating to yours or another’s health.  You understand that this podcast is not intended as a substitute for consultation with a licensed medical professional. 

Copyright © 2015 QBazaar.com, LLC  All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, recording or otherwise, without the prior written permission of the author.

A continuation of last weeks discussion on the ASRA guidelines for the performance of neuraxial procedures in patients, pregnant women and those with drug induced coagulopathy.  

Also discussed, herbal supplements and their influence over the clotting pathways.

DISCLAIMER: Doctor Rosenblum IS HERE SOLELY TO EDUCATE, AND YOU ARE SOLELY RESPONSIBLE FOR ALL YOUR DECISIONS AND ACTIONS IN RESPONSE TO ANY INFORMATION CONTAINED HEREIN. This podcasts is not intended as a substitute for the medical advice of physician to a particular patient or specific ailment. 

You should regularly consult a physician in matters relating to yours or another’s health.  You understand that this podcast is not intended as a substitute for consultation with a licensed medical professional. 

Copyright © 2015 QBazaar.com, LLC  All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, recording or otherwise, without the prior written permission of the author.

Dr. Rosenblum discusses ASRA's guidelines to Local anesthetic toxicity and anticoagulation guidelines for patients undergoing neuraxial anesthesia.

DISCLAIMER: Doctor Rosenblum IS HERE SOLELY TO EDUCATE, AND YOU ARE SOLELY RESPONSIBLE FOR ALL YOUR DECISIONS AND ACTIONS IN RESPONSE TO ANY INFORMATION CONTAINED HEREIN. This podcasts is not intended as a substitute for the medical advice of physician to a particular patient or specific ailment. 

You should regularly consult a physician in matters relating to yours or another’s health.  You understand that this podcast is not intended as a substitute for consultation with a licensed medical professional. 

Copyright © 2015 QBazaar.com, LLC  All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, recording or otherwise, without the prior written permission of the author.