Rotations 2.0

Send us Fan MailEpisode 65.1  Ibogaine and Executive Order Shoot me any comments or questions @Rotations2ptoh  on XIntro/Outro: Night Detective by AmaksiCourtesy of Pixabay under Creative Commons for non-Commercial Educational use only.Produced by: Todd Fredricks DO MSS Edited by: Todd Fredricks DO MSSPapers referencedMosca, Alessio, Stefania Chiappini, Andrea Miuli, Gianluca Mancusi, Maria Chiara Santovito, Francesco Di Carlo, Mauro Pettorruso, John M. Corkery, Carlos Canessa, Giovanni Martinotti, and Massimo Di Giannantonio. “Ibogaine/Noribogaine in the Treatment of Substance Use Disorders: A Systematic Review of the Current Literature.” Current Neuropharmacology 21, no. 11 (2023): 2178–2194. Mackey, Katherine M., Johanna K. Anderson, Beth E. Williams, Rachel M. Ward, and Nicholas J. Parr. Evidence Brief: Psychedelic Medications for Mental Health and Substance Use Disorders. Washington, DC: Evidence Synthesis Program, Health Services Research and Development Service, Office of Research and Development, U.S. Department of Veterans Affairs, 2022.PRESIDENTIAL ACTIONS: ACCELERATING MEDICAL TREATMENTS FOR SERIOUS MENTAL ILLNESSExecutive Orders April 18, 2026Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSSRotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

Send us Fan MailEpisode 65 Atopic DermatitisShoot me any comments or questions @Rotation2ptoh  on XIntro Music: KI Instrumental (Rock Celtic) by Lyrium-2025Outro Music: Christmas by Alex GrohlCourtesy of Pixabay under Creative Commons non-commercial use. Produced by: Todd Fredricks DO MSS Edited by: Todd Fredricks DO MSS Answers for Episode 64 Psoriasis Question 1 — Psoriasis Comorbidities and Early DetectionA 36‑year‑old man with a 10‑year history of chronic plaque psoriasis presents for evaluation. He reports new-onset morning stiffness in his lower back lasting more than an hour and improving with activity. His exam shows limited lumbar flexion but no peripheral joint swelling. Radiographs of the sacroiliac joints are unremarkable. Which of the following is the most important reason to screen this patient promptly for psoriatic arthritis?D. Early diagnosis reduces the risk of irreversible joint damageQuestion 2 — Systemic Therapy Safety ConsiderationsA 29‑year‑old woman with erythrodermic psoriasis is prescribed a systemic retinoid. After one month of treatment, she reports dry lips, hair thinning, and peeling skin. She asks when she can safely become pregnant after stopping therapy. Laboratory studies show mild hyperlipidemia. Which medication is she most likely taking?C. AcitretinQuestion 3 — Treatment Escalation and ContraindicationsA 45‑year‑old woman with moderate to severe plaque psoriasis has failed topical therapy and methotrexate. She is being evaluated for biologic therapy. Her past medical history is significant for Crohn’s disease. Which biologic agent should be avoided in this patient?B. SecukinumabPaper for Next Week: Anders Boutrup Funch, Carsten Geisler, and Charlotte Menné Bonefeld.“Allergic Contact Dermatitis: Immunopathology and Potential Therapeutic Strategies.”Journal of Clinical Medicine 14, no. 20 (2025): 7175. https://doi.org/10.3390/jcm14207175.Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

Send us Fan MailEpisode 64 PsorasisShoot me any comments or questions @Rotation2ptoh  on XIntro Music: KI Instrumental (Rock Celtic) by Lyrium-2025Outro Music: Ambient Tension by Alex GrohlCourtesy of Pixabay under Creative Commons non-commercial use.Produced by: Todd Fredricks DO MSS Edited by: Todd Fredricks DO MSSAnswers for Episode 63 AcneQuestion 1A 17‑year‑old adolescent presents with moderate inflammatory acne on the face and back. Microbiome analysis of her lesions shows decreased alpha diversity and an overrepresentation of Enterococcaceae on both the face and back. Which of the following best explains these findings?D. Dysbiosis characterized by decreased microbial diversity and overgrowth of specific taxaQuestion 2A 19‑year‑old woman with moderate acne begins treatment with 2% supramolecular salicylic acid (SSA) for 8 weeks. At follow‑up, she reports clinical improvement. Microbiome analysis shows increased alpha and beta diversity and reductions in Staphylococcus, Ralstonia, and Streptococcus species. Which mechanism best explains these findings?B. Anti‑inflammatory effects with stabilization of microbial communitiesQuestion 3A researcher evaluates the impact of different acne treatments on the cutaneous microbiome. She notes that only one standard therapy consistently produced a statistically significant change in alpha diversity across multiple studies included in a meta‑analysis. Which treatment is she referring to?D. Topical benzoyl peroxide (BPO)Paper for Next Week:Wollenberg, A., M. Kinberger, B. Arents, N. Aszodi, S. Barbarot, T. Bieber, H. A. Brough, et al. 2025. “European Guideline (EuroGuiDerm) on Atopic Eczema: Living Update.” Journal of the European Academy of Dermatology and Venereology 39: 1537–1566. https://doi.org/10.1111/jdv.20639.Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.     

Send us Fan MailEpisode 63 AcneShoot me any comments or questions @Rotation2ptoh  on XIntro Music: KI Instrumental (Rock Celtic) by Lyrium-2025Outro Music: Epic Industrial Future by Alex GrohlCourtesy of Pixabay under Creative Commons non-commercial use.Produced by: Todd Fredricks DO MSS Edited by: Todd Fredricks DO MSSAnswers for Episode 62 PharyngitisQuestion 1: Adolescent with red flags after “sore throat”A 17-year-old previously healthy male presents with 5 days of worsening sore throat, high fevers, and new right-sided neck pain with swelling. A rapid antigen detection test (RADT) for group A Streptococcus done 2 days ago at an urgent care was negative. Today he appears toxic, and there is tenderness along the anterior border of the sternocleidomastoid. Which of the following is the most likely pathogen–complication pairing explaining this presentation?B. Fusobacterium necrophorum — Lemierre syndrome (internal jugular vein thrombophlebitis with anaerobic septicemia)Question 2: Testing strategy in a child with suspected GASAn 8-year-old girl presents with fever (39.3 °C), throat pain, and tonsillar exudates without cough. Her McIsaac score is 3. A point‑of‑care RADT for GAS is negative. Which of the following is the best next step?B. Send a throat culture (or molecular test if available) to confirm the negative RADTQuestion 3: Reemerging pathogen and optimal diagnostic confirmationA 32-year-old recent immigrant with unknown vaccination status presents with fever, malaise, and severe sore throat. Examination reveals a gray‑white adherent membrane over the pharynx and tender anterior cervical lymphadenopathy. Which diagnostic approach most rapidly and accurately confirms the suspected diagnosis?B. Duplex real‑time PCR on a throat swab to simultaneously detect Corynebacterium diphtheriae and the toxin‑encoding genePaper for Next Week:Chan, Jonathan J. “Psoriasis: An Update on Topical and Systemic Therapies.” Australian Prescriber 48, no. 3 (June 2025): 87–92. Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.   

Send us Fan MailEpisode 62 PharyngitisShoot me any comments or questions @Rotation2ptoh  on XIntro Music: KI Instrumental (Rock Celtic) by Lyrium-2025Outro Music: Childhood Memories by Alex GrohlCourtesy of Pixabay under Creative Commons non-commercial use.Produced by: Todd Fredricks DO MSS Edited by: Todd Fredricks DO MSSAnswers for Episode 61 Otitis MediaQuestion 1 — Initial management (observation vs antibiotics)A 28‑month‑old boy is brought in for 1 day of ear pain and fussiness. His temperature in clinic is 38.3 °C (100.9 °F). He is otherwise healthy, immunizations are up to date, and there has been no antibiotic use in the past month. Otoscopy shows a mildly bulging, erythematous tympanic membrane on the right with preserved landmarks; the left ear is normal. He is drinking adequately and has mild, controllable pain. What is the most appropriate next step in management?B. Watchful waiting for 48–72 hours with scheduled oral analgesics and clear return precautionsQuestion 2 — First‑line antibiotic and dosingA 3‑year‑old girl presents with 2 days of bilateral ear pain and poor sleep. She is well‑appearing, has no conjunctivitis, and has not taken antibiotics in the last 30 days. Otoscopy reveals moderate bulging of both tympanic membranes with middle‑ear effusions. What is the most appropriate initial antibiotic regimen?D. Amoxicillin 80–90 mg/kg/day PO divided twice dailyQuestion 3 — Duration of therapyA 6‑year‑old boy with non‑severe unilateral AOM is started on high‑dose amoxicillin. He has no tympanic membrane perforation, and symptoms are improving after 48 hours. What is the most appropriate total duration of antibiotic therapy for this patient?C. 5–7 daysPaper for Next Week:Podwojniak, A., Tan, I. J., Sauer, J., Neubauer, Z., Rothenberg, H., Ghani, H., Parikh, A. K., & Cohen, B. (2025). Acne and the cutaneous microbiome: A systematic review of mechanisms and implications for treatments. Journal of the European Academy of Dermatology and Venereology, 39, 793–805.Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.   

Send us Fan MailEpisode 61 Otitis MediaShoot me any comments or questions @Rotation2ptoh  on XIntro Music: KI Instrumental (Rock Celtic) by Lyrium-2025Outro Music: Innovation by Alex GrohlCourtesy of Pixabay under Creative Commons non-commercial use.Produced by: Todd Fredricks DO MSS Edited by: Todd Fredricks DO MSSAnswers for Episode 60 Mononucleosis Question 1 — Diagnostic strategy early in illnessA 19‑year‑old college student presents on day 3 of fever, severe sore throat, fatigue, and posterior cervical lymphadenopathy. A rapid heterophile (Monospot) test obtained today is negative. Her CBC shows 52% lymphocytes with 12% atypical lymphocytes. She does not take regular medications. Which of the following is the most appropriate next step?C. Order Epstein–Barr virus (EBV) viral capsid antigen (VCA) IgM/IgG serologyQuestion 2 — Therapeutics and special situationsA 17‑year‑old with confirmed infectious mononucleosis has progressive tonsillar hypertrophy, drooling, and muffled voice but maintains oxygen saturation at 97% on room air. Which of the following is the best next step?A. Administer a short course of systemic corticosteroidsQuestion 3 — Return‑to‑play and splenic complicationsA 20‑year‑old linebacker is diagnosed with infectious mononucleosis after 5 days of symptoms. He is afebrile today and wants to play in next week’s game. Which statement is most accurate for counseling?C. Most splenic ruptures occur within the first 21 days of symptom onset, and ~90% occur by day 31; therefore, no athletic activity should occur for the first 3 weeksPaper for Next Week:Caldwell, Jane M., Nathan A. Ledeboer, and Bobby L. Boyanton Jr. 2024. “Review: Known, Emerging, and Remerging Pharyngitis Pathogens.” The Journal of Infectious Diseases 230, Supplement 3: S173–S181.Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSSRotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

Send us Fan MailEpisode 59.2 Protecting Medical Part IIShoot me any comments or questions @Rotations2ptoh  on XIntro/Outro: Night Detective by AmaksiCourtesy of Pixabay under Creative Commons for non-Commercial Educational use only.Produced by: Todd Fredricks DO MSS Edited by: Todd Fredricks DO MSSPapers referenced:Erickson, Jon V. “Operating in a Multidomain Environment: Combat Support Training Exercise 86‑24‑02.” Military Review (January–February 2025): 96–102.Crowley, Julie, and John S. G. Wells. “Assaulting Medical Neutrality: Reflections on Attacks on Healthcare and Clinicians in the Two World Wars and Implications for Contemporary Conflicts.” Nursing Inquiry 32 (2025): e70052. https://doi.org/10.1111/nin.70052.If you are interested in this topic I have assembled quite a resource set, please contact me at [email protected] and I can provide you with them.Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSSRotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

Send us Fan MailShoot me any comments or questions @Rotation2ptoh  on XIntro Music: KI Instrumental (Rock Celtic) by Lyrium-2025Outro Music: Cloud Atlas by Alex GrohlCourtesy of Pixabay under Creative Commons non-commercial use.Produced by: Todd Fredricks DO MSS Edited by: Todd Fredricks DO MSSAnswers for Episode 58 AbcessesQuestion 1 – Diagnosis of Early Lyme DiseaseA 42‑year‑old woman from Pennsylvania presents with 5 days of fever, fatigue, headaches, and diffuse myalgias. She denies noticing a tick bite. Physical examination reveals no rash. Initial two‑tier Lyme serology (ELISA + Western blot) is negative. Which of the following is the most accurate interpretation of this test result?C. Serologic testing is often insensitive in early Lyme disease, and a negative early test does not exclude infectionQuestion 2 – Persistent Symptoms After TreatmentA 33‑year‑old man was treated for early Lyme disease 9 months ago with a standard course of doxycycline. He now reports debilitating fatigue, impaired concentration, unrefreshing sleep, and intermittent musculoskeletal pain that have persisted for 6 months and interfere with daily life. Which of the following features best supports the diagnosis of Post‑Treatment Lyme Disease Syndrome (PTLD)?B. Prolonged symptoms affecting functional ability ≥6 months after standard treatmentQuestion 3 – Antibiotic‑Refractory Lyme ArthritisA 55‑year‑old woman presents with persistent right‑knee swelling 3 months after completing two courses of oral doxycycline for Lyme arthritis. Synovial fluid analysis shows an inflammatory profile but no bacterial growth. Which mechanism best explains her persistent joint inflammation?C. Persistence of Borrelia peptidoglycan antigenic debris that promotes ongoing inflammationPaper for Next Week:El Feghaly, R. E., Nedved, A., Katz, S. E., & Frost, H. M. (2023). New insights into the treatment of acute otitis media. Expert Review of Anti-infective Therapy, 21(5), 523–534. Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS. Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

Send us Fan MailEpisode 59.1  Intro to Protecting Providers Part 1Shoot me any comments or questions @Rotations2ptoh  on X Intro/Outro: Night Detective by Amaksi Courtesy of Pixabay under Creative Commons for non-Commercial Educational use only Produced by: Todd Fredricks DO MSS Edited by: Todd Fredricks DO MSSReferences Full episode references available upon request just email me at [email protected] Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSSThe comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

Send us Fan MailEpisode 59 Lyme DiseaseShoot me any comments or questions @Rotation2ptoh  on XIntro Music: KI Instrumental (Rock Celtic) by Lyrium-2025Outro Music: Touch by Alex GrohlCourtesy of Pixabay under Creative Commons non-commercial use.Produced by: Todd Fredricks DO MSS Edited by: Todd Fredricks DO MSSAnswers for Episode 58 AbcessesA 26‑year‑old woman reports recurrent painful deep nodules in both axillae that have persisted for 4 months despite topical care. Which feature from the Lancet review most directly supports a clinical diagnosis of hidradenitis suppurativa in this patient?C. Persistence of one or more active lesions for at least 3 months.According to the review, which comorbidity is most commonly associated with hidradenitis suppurativa and is reported in up to half of affected patients, warranting routine screening?C. Metabolic syndromeWhich of the following systemic therapies approved for moderate‑to‑severe hidradenitis suppurativa acts primarily by inhibiting tumor necrosis factor (TNF)?D. AdalimumabPaper for Next Week:Sylvester, J. E., Buchanan, B. K., & Silva, T. W. (2023). Infectious mononucleosis: Rapid evidence review. American Family Physician, 107(1), 71–78. Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

Send us Fan MailShoot me any comments or questions @Rotation2ptoh  on XIntro Music: KI Instrumental (Rock Celtic) by Lyrium-2025Outro Music: Sidewinder by Alex GrohlCourtesy of Pixabay under Creative Commons non-commercial use. Produced by: Todd Fredricks DO MSS Edited by: Todd Fredricks DO MSSAnswers for Episode 57 CellulitisQuestion 1 A 68-year-old man is evaluated for recurrent lower extremity cellulitis. In counseling him about prognosis, you reference a 24-year CDC analysis of cellulitis-related mortality in U.S. adults aged ≥65 years from 1999 to 2023. According to this study, which of the following best describes the trend in age-adjusted mortality rates (AAMR per 1,000,000 population) over the study period?C) Overall increase with a steep rise from 2019 to 2023Question 2 During a public health lecture, you discuss disparities in cellulitis-related mortality among older U.S. adults (≥65 years) based on a recent 24-year CDC WONDER analysis. Which demographic group had the highest age-adjusted mortality rate (AAMR per 1,000,000 population) in this study?C) Non-Hispanic White individualsQuestion 3 A 72-year-old patient from a rural Midwest community presents with cellulitis. You consider population-level risk factors from a 24-year CDC analysis of cellulitis mortality in older adults. In which of the following settings was cellulitis-related age-adjusted mortality highest?D) Nonmetropolitan (rural) areasPaper for Next Week:Bobe, Jason R., Brandon L. Jutras, Elizabeth J. Horn, Monica E. Embers, Allison Bailey, Robert L. Moritz, Ying Zhang, Mark J. Soloski, Richard S. Ostfeld, Richard T. Marconi, John Aucott, Avi Ma’ayan, Felicia Keesing, Kim Lewis, Choukri Ben Mamoun, Alison W. Rebman, Mecaila E. McClune, Edward B. Breitschwerdt, Panga Jaipal Reddy, Ricardo Maggi, Frank Yang, Bennett Nemser, Aydogan Ozcan, Omai Garner, Dino Di Carlo, Zachary Ballard, Hyou‑Arm Joung, Albert Garcia‑Romeu, Roland R. Griffiths, Nicole Baumgarth, and Brian A. Fallon.“Recent Progress in Lyme Disease and Remaining Challenges.” Frontiers in Medicine 8 (2021): Article 666554. Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.  

Send us Fan MailEpisode 57 CellulitisShoot me any comments or questions @Rotation2ptoh  on XIntro Music: KI Instrumental (Rock Celtic) by Lyrium-2025Outro Music: Dark Countdown my Head in the Clouds by Alex GrohlCourtesy of Pixabay under Creative Commons non-commercial use.Produced by: Todd Fredricks DO MSS Edited by: Todd Fredricks DO MSS Answers for Episode 56 Herpes SimplexQuestion 1A 58-year-old man who underwent allogeneic hematopoietic cell transplantation 3 months ago presents with painful vesicular lesions on the vermilion border of the lower lip that have persisted despite 10 days of high-dose intravenous acyclovir (10 mg/kg every 8 hours) with documented adherence and adequate renal dosing. Viral culture confirms HSV-1. Which of the following is the most appropriate next step in management?C) Obtain genotypic or phenotypic drug susceptibility testing and consider transition to foscarnet or cidofovir pending results Question 2A 45-year-old woman with a history of solid organ transplantation is hospitalized for recurrent genital HSV-2 lesions unresponsive to 14 days of appropriately dosed intravenous acyclovir. Phenotypic susceptibility testing shows an EC₅₀ within the susceptible range, yet lesions continue to worsen. Which of the following is the most likely explanation for this clinical-phenotypic discordance?A)   Presence of an undetected minority drug-resistant variant within the viral quasispecies Question 3In the management of suspected acyclovir-resistant HSV infection in an immunocompromised patient, which of the following statements regarding alternative antiviral agents is most accurate according to current evidence?A) Pritelivir and amenamevir are generally well tolerated with fewer adverse effects than foscarnet or cidofovir and do not require thymidine kinase activation Paper for Next Week:Sabat, R., Alavi, A., Wolk, K., Wortsman, X., McGrath, B., Garg, A., & Szepietowski, J. C. (2025). Hidradenitis suppurativa. Lancet, 405, 420–438. Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0. 

Send us Fan MailEpisode 56 Herpes SimplexShoot me any comments or questions @Rotation2ptoh  on XIntro Music: KI Instrumental (Rock Celtic) by Lyrium-2025Outro Music: Traces in Time by Alex GrohlCourtesy of Pixabay under Creative Commons non-commercial use.Produced by: Todd Fredricks DO MSS Edited by: Todd Fredricks DO MSSAnswers for Episode 55 HIV AIDSQuestion 1 — Policy shock and key populationsA public health team in a sub‑Saharan African country reports that PrEP coverage among key populations exceeds 10%. During a funding review, several policy changes are proposed. Which change is most likely to produce the largest immediate rise in new HIV infections among key populations? B. The government suspends PEPFAR‑funded PrEP services specifically for key populations, including female sex workers, MSM, transgender women, and people who inject drugs.Question 2 — Prevention paradox and PrEP efficiencyA regional primary‑care consortium is planning PrEP scale‑up. Epidemiologic data show incidence is approximately 3 per 100 person‑years in the target cohort. Approximately how many individuals must receive PrEP to prevent one new HIV infection under these conditions? B. Thirty‑three people must receive PrEP to prevent one infection.Question 3 — Integration, equity, and clinical outcomesA community clinic serving diverse patients with HIV is reevaluating its care model. Among its patients are transgender women on ART with variable adherence. Which programmatic change is most likely to improve viral suppression rates in this group according to evidence cited in the editorial?C. Integrate HIV care with gender‑affirming care, including provision of exogenous estrogen therapy as clinically appropriate.Paper for Next Week:Faheem, M. S. B., Munir, S. U., Javed, M., Hassan, S. T., Masood, M. B., Maryam, K. U. E., Cheema, S., Samadi, S., & Khan, M. I., Mortality trends for cellulitis-related death in older adults in the United States: 24-year CDC analysis of gender, race, and geographical disparities. Annals of Medicine & Surgery, (2025).  87, 8471–8477. Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0. 

Send us Fan MailEpisode 55 HIV/AIDSShoot me any comments or questions @Rotation2ptoh  on XIntro Music: KI Instrumental (Rock Celtic) by Lyrium-2025Outro Music: Leap in the Dark by Alex GrohlCourtesy of Pixabay under Creative Commons non-commercial use.Produced by: Todd Fredricks DO MSS Edited by: Todd Fredricks DO MSSAnswers for Episode 54 STIQuestion 1: Gonorrhea treatment and AMRA 22-year-old man presents with dysuria and purulent urethral discharge after unprotected sex. NAAT for Neisseria gonorrhoeae is positive and Chlamydia trachomatis NAAT is negative. He has no drug allergies and no signs of disseminated infection. According to current evidence in the review, which is the preferred first-line regimen for uncomplicated urogenital gonorrhea?A. Ceftriaxone monotherapyQuestion 2: Syphilis diagnostic algorithmA 28-year-old pregnant patient at her first prenatal visit has risk factors for sexually transmitted infections but no symptoms. You plan screening for syphilis. Which testing strategy best aligns with the diagnostic approach in the review?A. Screen with a nontreponemal test (VDRL or RPR) and confirm positives with a treponemal test (TPPA or FTA‑ABS)Question 3: Persistent NGU and Mycoplasma genitaliumA 30-year-old man is treated for presumed non-gonococcal urethritis (NGU) with azithromycin and returns 2 weeks later with persistent dysuria and urethral discharge. Repeat NAATs for C. trachomatis and N. gonorrhoeae are negative. Which next step is most consistent with the review’s recommendations?C. Order NAAT for Mycoplasma genitalium with resistance testing and treat with a resistance‑guided or two‑step regimenPaper for Next Week: Dähne T, Jaki L, Gosert R, Fuchs J, Krumbholz A, Nägele K, Pletz MW, Khanna N, Leuzinger K, Panning M. Herpes simplex virus and drug resistance—comprehensive update on resistance mutations and implications for clinical management: a narrative review. Clinical Microbiology and Infection. 2025 Sep;31(9):1484-1490Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.     

Send us Fan MailEpisode 54 STIShoot me any comments or questions @Rotation2ptoh  on XIntro Music: KI Instrumental (Rock Celtic) by Lyrium-2025Outro Music: Claim We Are Able by Alex GrohlCourtesy of Pixabay under Creative Commons non-commercial use.Produced by: Todd Fredricks DO MSS Edited by: Todd Fredricks DO MSSNot So Quiet on the Western Front- VDhttps://not-so-quiet.com/supporters/audio/193970?utm_medium=copy-share-link&utm_source=share-link&utm_campaign=post-share-supporterAnswers for Episode 53 UTIQuestion 1 — Pathophysiology of CAUTI in a Post‑operative PatientA 68‑year‑old man undergoes hip arthroplasty. He receives tranexamic acid perioperatively to limit bleeding and has a Foley catheter in place for 48 hours. On day 3 he develops fever (38.4 °C), suprapubic discomfort, and leukocyturia. Urine culture is negative, but catheter tip culture later shows E. faecalis, UPEC, and Candida albicans in a mixed biofilm. Which mechanism best explains his severe catheter‑associated UTI (CAUTI) presentation and the negative urine culture?C. Antifibrinolytic therapy causes fibrin accumulation that scaffolds fibrin(ogen)‑dependent polymicrobial biofilms on the catheter and urothelium, under‑represented in planktonic urine culturesQuestion 2 — Antibiotic Selection & Dosing in CAUTIA 72‑year‑old woman in a nursing facility has a 7‑day indwelling catheter and develops dysuria and suprapubic pain. Empiric TMP–SMX 160/800 mg orally for 3 days is started for presumed UTI. She returns 48 hours later with persistent symptoms. Which management is most appropriate given CAUTI treatment outcomes cited in the review?B. Switch to an oral fluoroquinolone (e.g., ciprofloxacin or levofloxacin) 500–1,000 mg daily for 5–7 days, while tailoring to urine culture and resistance dataQuestion 3 — uUTI Symptom Control & COX‑2 BiologyA 45‑year‑old otherwise healthy woman presents with an uncomplicated UTI (uUTI): dysuria, frequency, and suprapubic pain for 24 hours. She asks whether she can avoid antibiotics if possible. Which statement best reflects the clinical evidence and mechanistic context presented in the article?B. In a randomized 3‑day pilot trial, ibuprofen (COX‑2 inhibition) and ciprofloxacin produced a similar ~50% reduction in mean symptomatic scores, with the ibuprofen arm showing no additional adverse effects or need for rescue antibioticsPaper for Next Week: Beyrer, C., Ratevosian, J., Gelderblom, H., & Rosenberg, N. E. (2025). The HIV/AIDS pandemic: where are we now? AIDS, 39(11), 1497–1504.Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators a

Send us Fan MailEpisode 53 UTI (Now with Chapter Markers!)Shoot me any comments or questions @Rotation2ptoh  on XIntro Music: KI Instrumental (Rock Celtic) by Lyrium-2025Outro Music: Fate Embrace by Alex GrohlCourtesy of Pixabay under Creative Commons non-commercial use.Produced by: Todd Fredricks DO MSS Edited by: Todd Fredricks DO MSS Answers for Episode 52 Brain Immune Gut AxisQuestion 1Which of the following best describes the role of short-chain fatty acids (SCFAs) in the gut–immune–brain axis?C. SCFAs modulate immune responses by promoting regulatory T cell differentiation and influencing microglial maturationQuestion 2Which immune cell type is most associated with IL-17A production in the meninges, influencing synaptic plasticity and anxiety-like behaviors?C. γδ T cellsQuestion 3Which statement about the vagus nerve in gut–brain communication is correct?C. Vagus nerve acts as a bidirectional pathway, transmitting microbial and immune signals to the brain and modulating gut immunityQuestion 4Which of the following best explains the mechanism by which maternal immune activation (MIA) increases autism spectrum disorder (ASD) risk in offspring?C. IL-17A produced by Th17 cells in response to segmented filamentous bacteria disrupts fetal brain developmentQuestion 5Which of the following is a therapeutic implication of targeting the gut microbiota in neurodegenerative disorders such as Alzheimer’s disease (AD)?C. Administering probiotics to reduce microglial activation and improve barrier integrityQuestion 6Which of the following best describes the role of astrocytes in neuroinflammation?C. Astrocytes release TNF-α and IL-6, amplifying microglial activation and sustaining neuroinflammationPaper for Next Week:Esin S, Del Bono L, Pistello M. Sexually Transmitted Infections: Global Trends, Diagnostic Advances, and Emerging Challenges. New Microbiol. 2025 Jul;48(2):113-136. PubMed PMID: 41123498. Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.   

Send us Fan MailEpisode 52 Brain Immune Gut AxisShoot me any comments or questions @Rotation2ptoh  on XIntro Music: KI Instrumental (Rock Celtic) by Lyrium-2025Outro Music: Trap Beat (Dripin’ Sauce) by Alex GrohlCourtesy of Pixabay under Creative Commons non-commercial use.Produced by: Todd Fredricks DO MSS Edited by: Todd Fredricks DO MSSAnswers for Episode 51 Sprains and Strains 1) Acute management and expected outcomeA 24‑year‑old recreational basketball player presents 36 hours after an inversion injury. Examination is consistent with a grade II lateral ankle sprain; Ottawa ankle rules are negative. He asks what intervention is most likely to reduce his pain at rest over the next 1–2 weeks. Which is the best evidence‑based recommendation? A. Early, supervised physical therapy using a multimodal program (e.g., progressive exercise, stretching, thermotherapy/ultrasound or hydrotherapy, and functional training)2) Outcome interpretationA 19‑year‑old soccer player undergoes early physical therapy after a grade I ankle sprain. At follow‑up, the clinician reviews expected benefits from the literature. Which outcome did not show a significant difference between physical therapy and conventional treatment in the pooled analysis?C. Dorsiflexion range of motion (ROM)3) Evidence synthesis and methodologyIn the same review, Trial Sequential Analysis (TSA) showed the Z‑curve crossed the monitoring boundary and reached the required information size for the primary pain outcome. What is the best interpretation of this finding?A. The cumulative evidence is sufficient to conclude that physical therapy reduces pain versus conventional care while controlling for type I and type II errors Paper for Next Week:Jonathan J. Molina, Ana L. Flores-Mireles, CAUTIon – not all UTIs are the same, Nat Rev Urol. 2025 December ; 22(12): 799–814Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

Send us Fan MailEpisode 51 Sprains and Strains Shoot me any comments or questions @Rotation2ptoh  on XIntro Music: KI Instrumental (Rock Celtic) by Lyrium-2025Outro Music: Power of the Hero by Alex GrohlCourtesy of Pixabay under Creative Commons non-commercial use.Produced by: Todd Fredricks DO MSS Edited by: Todd Fredricks DO MSSAnswers for Episode 50 TendonitisQuestion 1A 32-year-old marathon runner presents with chronic Achilles tendon pain for 3 months. He has tried rest and NSAIDs without improvement. According to current evidence, which of the following is the most effective treatment for his condition?C. Heavy slow resistance training programQuestion 2A professional soccer player sustains an acute hamstring strain. Which rehabilitation approach is associated with the fastest return to play and lowest re-injury rate?B. Early initiation of progressive eccentric exercises and running drillsQuestion 3A 40-year-old recreational basketball player suffers an acute Achilles tendon rupture. He asks about long-term outcomes. Which statement is most accurate based on current evidence?C. Both surgical and non-surgical treatments often lead to permanent functional deficitsPaper for Next Week:O’Riordan KJ, Moloney GM, Keane L, Clarke G, Cryan JF.The gut microbiota-immune-brain axis: Therapeutic implications.Cell Reports Medicine. 2025; 6Park JC, Chang L, Kwon H-K, Im S-H.Beyond the gut: decoding the gut–immune–brain axis in health and disease.Cellular & Molecular Immunology. 2025; 22:1287–1312Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

Send us Fan MailEpisode 50 TendonitisShoot me any comments or questions @Rotation2ptoh  on XIntro Music: KI Instrumental (Rock Celtic) by Lyrium-2025Outro Music: Operation Biscuit by Alex GrohlCourtesy of Pixabay under Creative Commons non-commercial use.Produced by: Todd Fredricks DO MSS Edited by: Todd Fredricks DO MSS Answers for Episode 49 Carpal Tunnel SyndromeQuestion 1A 52-year-old woman presents with numbness and tingling in her thumb, index, and middle fingers. Physical exam shows a positive Phalen’s test. You suspect carpal tunnel syndrome. Which diagnostic modality is considered the gold standard for assessing disease severity?C. Nerve conduction studies (NCS)Question 2Which of the following ultrasound measurements is most commonly used to diagnose carpal tunnel syndrome?C. Median nerve cross-sectional area (m-CSA)Question 3A neurologist uses the inching technique during electrodiagnostic testing for CTS. What is the primary advantage of this technique?C. It improves localization of nerve compression and diagnostic accuracyPaper for Next Week:Yang C, Gao W, Jia Z, Li J, Tang M. Physical therapy versus conventional treatment for grade I and II acute ankle sprains: trial sequential analysis and meta-analysis. J Orthop Surg Res. 2025;20:861. doi:10.1186/s13018-025-06272-3Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency. Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0. 

Send us Fan MailEpisode 49 Carpal Tunnel SyndromeShoot me any comments or questions @Rotation2ptoh  on XIntro Music: KI Instrumental (Rock Celtic) by Lyrium-2025Outro Music: The New Awakening by Alex GrohlCourtesy of Pixabay under Creative Commons non-commercial use.Produced by: Todd Fredricks DO MSS Edited by: Todd Fredricks DO MSSAnswers for Episode 48 Osteoporosis/RAQuestion 1A 64-year-old postmenopausal woman with rheumatoid arthritis presents after sustaining a vertebral fracture. Which factor most strongly contributes to her increased fracture risk compared to age-matched controls?B. Chronic systemic inflammation activating osteoclasts Question 2According to current recommendations, which patient should undergo bone mineral density (BMD) screening for osteoporosis?C. A 42-year-old woman with RA taking ≥2.5 mg prednisolone daily for 4 monthsQuestion 3Which medication is most effective for increasing bone mineral density and reducing vertebral fractures in patients with RA and glucocorticoid-induced osteoporosis?C. DenosumabPaper for Next Week:Michael Kj, Jesper Petersen, Michael Ries Dünweber, Jesper L.vind Andersen, Lars Engebretsen, Stig Peter Magnusso,Dilemma in the Treatment of Sports Injuries in Athletes: Tendon Overuse, Muscle Strain, and Tendon Rupture, Scandinavian Journal of Medicine & Science in Sports, 2025; 35:e70026Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.   

Send us Fan MailEpisode 48 OsteoporosisShoot me any comments or questions @Rotation2ptoh  on XIntro Music: KI Instrumental (Rock Celtic) by Lyrium-2025Outro Music: A Promise Kept by Alex GrohlCourtesy of Pixabay under Creative Commons non-commercial use.Produced by: Todd Fredricks DO MSS Edited by: Todd Fredricks DO MSSAnswers for Episode 47 FibromyalgiaQuestion 1: PathophysiologyA 42-year-old woman presents with chronic widespread pain, fatigue, and cognitive difficulties. Functional MRI reveals increased activation in the posterior insula and secondary somatosensory cortex. Which of the following neurotransmitters is most likely elevated in her cerebrospinal fluid and contributes to her pain hypersensitivity?B. Substance PQuestion 2: DiagnosisAccording to the 2016 American College of Rheumatology (ACR) criteria, which of the following combinations is sufficient to establish a diagnosis of fibromyalgia?C. WPI = 5, SSS = 9, symptoms for 3 monthsQuestion 3: TreatmentA 50-year-old female with fibromyalgia is started on pharmacologic therapy. Which of the following medications is FDA-approved for fibromyalgia and has shown efficacy at doses of 300–600 mg/day?B. PregabalinPaper for Next Week:Mikahla E. Gay, Jose G. Lima, Vanessa Vieites, Starlie C. Belnap, Richard MorganComparison of Diagnostic Modalities for Carpal Tunnel Syndrome: A Systematic Review, Cureus, September 17, 2025 Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

Send us Fan MailEpisode 47 Fibromyalgia Shoot me any comments or questions @Rotation2ptoh  on XIntro Music: KI Instrumental (Rock Celtic) by Lyrium-2025Outro Music: Beats Through the Ashes by Alex GrohlCourtesy of Pixabay under Creative Commons non-commercial use.Produced by: Todd Fredricks DO MSS Edited by: Todd Fredricks DO MSS Answers for Episode 46 GoutQuestion 1: Pathophysiology and Molecular MechanismsA 58-year-old male presents with recurrent gout flares. Genetic testing reveals a mutation in the NFAT5 gene. Based on recent findings, which of the following best describes the role of NFAT5 in gout pathogenesis?C. NFAT5 enhances uric acid production through a feedback loop involving aldose reductaseQuestion 2: Diagnostic Imaging in GoutAccording to the 2023 EULAR recommendations, which imaging modality is most effective for both diagnosing gout and monitoring crystal deposition and inflammation?C. Dual-Energy Computed Tomography (DECT)Question 3: Therapeutic InnovationsA new oral drug, dapansutrile (OLT1177), is being evaluated in Phase II/III trials for gout. What is its primary mechanism of action?C. Selective inhibition of the NLRP3 inflammasomePaper for Next Week: Fiona Kirkham-Wilson, Elaine Dennison1, Osteoporosis and Rheumatoid Arthritis: A Review of Current Understanding and Practice, British Journal of Hospital Medicine, 2024 Nov 30;85(11):1-11.Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0. 

Send us Fan MailEpisode 46 GoutShoot me any comments or questions @Rotation2ptoh  on XIntro Music: KI Instrumental (Rock Celtic) by Lyrium-2025Outro Music: Fall Dreaming (Chill Ambient) by Alex GrohlCourtesy of Pixabay under Creative Commons non-commercial use.Produced by: Todd Fredricks DO MSS Edited by: Todd Fredricks DO MSSAnswers for Episode 45 Neck Pain Question 1A 35-year-old patient presents with chronic mechanical neck pain lasting 8 months. The physician considers dry needling (DN) as a treatment option. Based on the systematic review and meta-analysis by Aleid et al., which of the following outcomes is MOST likely to show significant improvement after DN compared to control therapy?B. Pain Pressure Threshold (PPT)Question 2In the same meta-analysis, which statement BEST describes the effect of dry needling on cervical range of motion?B. DN improves flexion and right rotation but not extension or lateral flexionsQuestion 3Which of the following is TRUE regarding the overall evidence quality and limitations of the studies included in the meta-analysis?C. Most studies had high risk of bias and lacked adequate blindingPaper for Next Week: Filipovic T, Filipović A, Nikolic D, Gimigliano F. Stevanov J, Hrkovic M, & Bosanac I, Fibromyalgia: Understanding, Diagnosis and Modern Approaches to Treatment. Journal of Clinical Medicine, 2025, 14(3), 955. Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.  

Send us Fan MailEpisode 45 Neck Pain Shoot me any comments or questions @Rotation2ptoh  on XIntro Music: KI Instrumental (Rock Celtic) by Lyrium-2025Outro Music: Through the Ashes by Alex GrohlCourtesy of Pixabay under Creative Commons non-commercial use.Produced by: Todd Fredricks DO MSS Edited by: Todd Fredricks DO MSSAnswers for Episode 44 Low Back Pain Question 1A 45-year-old patient presents with chronic midline low back pain that worsens with sitting and forward flexion. MRI shows Modic type 1 changes at L4-L5. Conservative therapy has failed. Which pharmacologic intervention is supported by some evidence for this patient’s condition?B. Long-term oral antibiotics (amoxicillin ± clavulanic acid)Question 2Which of the following statements about provocative discography is TRUE?C. It involves injecting contrast into the nucleus pulposus under controlled pressure to reproduce concordant pain.Question 3Which minimally invasive intervention has moderate evidence supporting its use for refractory discogenic low back pain?C. Biacuplasty (cooled radiofrequency)Paper for Next Week: L. Punzi, L. Scagnellato, P. Galozzi, C. Baggio, A. Damasco, F. Oliviero, R. Ramonda, Gout: one year in review 2025, Clin Exp Rheumatol 2025; 43: 799-808.Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

Send us Fan MailEpisode 44.1  Medical Malpractice with Johnathan Robe esq. Part 2Shoot me any comments or questions @Rotations2ptoh  on XIntro/Outro: Night Detective by AmaksiCourtesy of Pixabay under Creative Commons for non-Commercial Educational use only.Produced by: Todd Fredricks DO MSS Edited by: Todd Fredricks DO MSSRotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSSRotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

Send us Fan MailEpisode 44 Low Back Pain  Shoot me any comments or questions @Rotation2ptoh  on XIntro Music: KI Instrumental (Rock Celtic) by Lyrium-2025Outro Music: Vision of Tomorrow by Alex GrohlCourtesy of Pixabay under Creative Commons non-commercial use.Produced by: Todd Fredricks DO MSS Edited by: Todd Fredricks DO MSSAnswers for Episode 43 Rheumatoid Arthritis Question 1: Pathogenesis and Risk FactorsA 45-year-old woman with a family history of rheumatoid arthritis (RA) presents with fatigue and intermittent joint stiffness. Laboratory testing reveals the presence of anti-citrullinated protein antibodies (ACPAs) and rheumatoid factor (RF), but no clinical synovitis is observed. Which of the following best describes the current understanding of the pathogenesis of RA in this patient?C. Autoantibodies may originate in mucosal tissues and spread systemicallyQuestion 2: Imaging and Early DetectionA 38-year-old man with anti-CCP positivity and musculoskeletal symptoms undergoes ultrasound imaging, which reveals subclinical synovitis. According to recent studies, what is the clinical significance of this finding?B. Subclinical synovitis is a strong predictor of imminent inflammatory arthritisQuestion 3: Pharmacologic Prevention of RAA clinical trial evaluates the use of abatacept in patients with undifferentiated arthritis and positive anti-CCP antibodies. Participants receive weekly subcutaneous injections of 125 mg abatacept for six months. What was the primary outcome of this intervention according to the ADJUST trial?B. Abatacept reduced RA development and structural damagePaper for Next Week: Abdulsalam M. Aleid, et al. Dry needling for mechanical neck pain: A systematic review and meta-analysis of randomized controlled trials, Surgical Neurology International, 2025, 16 (44)Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.    

Send us Fan MailEpisode 43.1  Johnathan Robe esq. Part 1Shoot me any comments or questions @Rotations2ptoh  on XIntro/Outro: Night Detective by AmaksiCourtesy of Pixabay under Creative Commons for non-Commercial Educational use only.Produced by: Todd Fredricks DO MSS Edited by: Todd Fredricks DO MSSRotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSSRotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

Send us Fan MailEpisode 43 Rheumatoid ArthritisShoot me any comments or questions @Rotation2ptoh  on XIntro Music: KI Instrumental (Rock Celtic) by Lyrium-2025Outro Music: Upbeat Yacht Club Fashion House Lounge by Alex GrohlCourtesy of Pixabay under Creative Commons non-commercial use.Produced by: Todd Fredricks DO MSS Edited by: Todd Fredricks DO MSSAnswers for Episode 42 Osteoarthritis Question 1: Epidemiology and Risk FactorsA 52-year-old woman presents with early-onset knee pain. She has a BMI of 32 and a history of asthma. Based on recent epidemiological data, which of the following is most likely associated with an increased risk of developing osteoarthritis?C. Atopic diseaseQuestion 2: Hand OA TreatmentA 60-year-old patient with inflammatory hand osteoarthritis is being considered for disease-modifying therapy. Which of the following treatments showed statistically significant pain reduction in a randomized controlled trial?C. Methotrexate 20 mg/weekQuestion 3: Knee OA TherapyA clinical trial is evaluating novel therapies for knee osteoarthritis. Which of the following interventions showed no significant difference in pain or function compared to corticosteroid injection over 12 months?B. Umbilical cord-derived mesenchymal stromal cellsPaper for Next Week: Wouter K. M. van Os et al. Update of Evidence-Based Interventional Pain Medicine According to Clinical Diagnoses: Discogenic Low Back Pain, Pain Practice, 2025; 25Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.  

Send us Fan MailEpisode 42.1  Intro to Medical MalpracticeShoot me any comments or questions @Rotations2ptoh  on XIntro/Outro: Night Detective by AmaksiCourtesy of Pixabay under Creative Commons for non-Commercial Educational use only.Produced by: Todd Fredricks DO MSS Edited by: Todd Fredricks DO MSS Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSSRotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0. 

Send us Fan MailEpisode 42 OsteoarthritisShoot me any comments or questions @Rotation2ptoh  on XIntro Music: KI Instrumental (Rock Celtic) by Lyrium-2025Outro Music: Hard Rock to Drive to Survive Adrenaline Sport by Alex GrohlCourtesy of Pixabay under Creative Commons non-commercial use. Produced by: Todd Fredricks DO MSS Edited by: Todd Fredricks DO MSSAnswers for Episode 41 HemorrhoidsQuestion 1:A 45-year-old patient with grade III internal hemorrhoids is concerned about postoperative pain and urinary retention. The surgeon recommends a modified office-based procedure that uses negative pressure and an elastic coil instead of a traditional band. Which treatment is being described?B. Modified rubber band ligation (RBL)Question 2:A patient with grade II hemorrhoids and a bleeding tendency is seeking a minimally invasive treatment with low risk of complications. The physician recommends a sclerosant that has shown high patient satisfaction but carries a rare risk of anaphylactic shock. Which agent is being described?B. Polidocanol foamQuestion 3:A colorectal surgeon is evaluating treatment options for a patient with grade III hemorrhoids. The goal is to reduce postoperative pain, bleeding, and hospital stay. Which combination of procedures has been shown to achieve these outcomes more effectively than stapled hemorrhoidopexy (SH) alone?C. SH with Doppler-guided hemorrhoidal artery ligation (DG-HAL)Paper for Next Week: Andrea Di Matteo and Paul Emery, “Rheumatoid arthritis: a review of the key clinical features and ongoing challenges of the disease,” Panminerva Medica, December 2024, Vol. 66, No. 4, pp. 427–442. Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.Listeners interested in specifics from the paper authors should contact them directly through their respective institutions. Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.   

Send us Fan MailEpisode 41 HemorrhoidsShoot me any comments or questions @Rotation2ptoh  on XIntro Music: KI Instrumental (Rock Celtic) by Lyrium-2025Outro Music: Mellow Future Bass (Bounce on it) by Alex GrohlCourtesy of Pixabay under Creative Commons non-commercial use.Produced by: Todd Fredricks DO MSS Edited by: Todd Fredricks DO MSSAnswers for Episode 40 Diarrhea Paper for Next Week: Alice Courties, Inès Kouki, Nadine Soliman, Sylvain Mathieu, Jérémie Sellam, Osteoarthritis year in review 2024: Epidemiology and therapy, Osteoarthritis and Cartilage,  32 (2024) 1397–1404 Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS. Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency. Listeners interested in specifics from the paper authors should contact them directly through their respective institutions. Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0. 

Send us Fan MailEpisode 40 DiarrheaShoot me any comments or questions @Rotation2ptoh  on XIntro Music: KI Instrumental (Rock Celtic) by Lyrium-2025Outro Music: Endless Universe (Dreamy Summer) by Alex GrohlCourtesy of Pixabay under Creative Commons non-commercial use.Produced by: Todd Fredricks DO MSS Edited by: Todd Fredricks DO MSS“The Ghost Map” by Steven Berlin Johnson, Riverhead 2006Some good You Tube presentations on this.“Superiority” by Arthur C. Clarke  https://nob.cs.ucdavis.edu/classes/ecs153-2019-04/readings/superiority.pdfWHO rehydration formula: https://www.who.int/publications/i/item/WHO-FCH-CAH-06.1I didn’t discuss POCUS for Hydration Assessment: https://www.pocus.org/inferior-vena-cava-ivc-assessment-for-volume-status-in-point-of-care-ultrasound-pocus-setting/Answers for Episode 39 Constipation Question 1:A 68-year-old woman with chronic constipation is prescribed magnesium oxide. After several weeks, she presents with lethargy and muscle weakness. Her serum magnesium level is elevated. Which of the following factors most likely contributed to her condition?C. Delayed colonic transit timeQuestion 2:Which of the following medications acts by inhibiting the ileal bile acid transporter (IBAT) and promotes colonic motility through serotonin release?C. ElobixibatQuestion 3:A randomized controlled trial compared the efficacy of polyethylene glycol (PEG) 3350 to placebo in patients with chronic constipation. What was the reported treatment success rate in the PEG group?C. 52%Paper for Next Week:Sung Il Kang, Latest Research Trends on the Management of Hemorrhoids, Journal of the Anus, Rectum and Colon (2025; 9(2): 179–191):Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0. 

Send us Fan MailEpisode 39 ConstipationShoot me any comments or questions @Rotation2ptoh  on XIntro Music: KI Instrumental (Rock Celtic) by Lyrium-2025Outro Music: A Comedy Funny (Dream Lullaby) by Alex GrohlCourtesy of Pixabay under Creative Commons non-commercial use.Produced by: Todd Fredricks DO MSS Edited by: Todd Fredricks DO MSSAnswers for Episode 38 Diverticulitis Question 1: Pathophysiology and Risk FactorsA 65-year-old male presents with left lower quadrant abdominal pain and fever. CT confirms acute uncomplicated diverticulitis. Which of the following lifestyle factors is most strongly associated with a decreased risk of developing diverticulitis?C. Vigorous cardiovascular activityQuestion 2: Diagnostic ImagingWhich of the following imaging modalities is considered the gold standard for diagnosing acute diverticulitis?C. Computed Tomography (CT) scan with or without IV contrastQuestion 3: Treatment GuidelinesAccording to recent evidence and guidelines, which of the following patients with acute uncomplicated diverticulitis should still be treated with antibiotics?C. A 70-year-old immunocompromised patientPaper for Next Week:Christopher J. Black & Alexander C. Ford (2025) An evidence-based update on the diagnosis and management of irritable bowel syndrome, Expert Review of Gastroenterology & Hepatology, 19:3, 227-242,Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

Send us Fan MailEpisode 38 DiverticulitisShoot me any comments or questions @Rotation2ptoh  on XIntro Music: KI Instrumental (Rock Celtic) by Lyrium-2025Outro Music: Breaking Free by Alex GrohlCourtesy of Pixabay under Creative Commons non-commercial use.Produced by: Todd Fredricks DO MSS Edited by: Todd Fredricks DO MSSAnswers for Episode 37 CholelithiasisQuestion 1: Pathophysiology and Risk FactorsA 45-year-old woman presents with intermittent right upper quadrant pain after meals. She has a BMI of 32 and is on estrogen-containing oral contraceptives. Ultrasound confirms the presence of gallstones. Which of the following best explains the pathophysiology of her condition?B. Supersaturation of bile with cholesterol leading to crystal formationQuestion 2: Diagnostic ImagingA 60-year-old man presents with fever, jaundice, and right upper quadrant pain. Labs show elevated bilirubin and alkaline phosphatase. Ultrasound reveals gallstones but no ductal dilation. Which imaging modality is most appropriate to both diagnose and treat a suspected common bile duct obstruction?C. Endoscopic retrograde cholangiopancreatography (ERCP)Question 3: Pharmacologic TherapyA patient with asymptomatic cholesterol gallstones is not a surgical candidate. Which of the following pharmacologic agents is most appropriate for attempting gallstone dissolution?C. Ursodeoxycholic acid (ursodiol)Paper for Next Week:Mariko Hojo, Tomoyoshi Shibuya and Akihito Nagahara, Management of Chronic Constipation: A Comprehensive Review, Intern Med 64: 7-15, 2025Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

Send us Fan MailEpisode 37 GallstonesShoot me any comments or questions @Rotation2ptoh  on XIntro Music: KI Instrumental (Rock Celtic) by Lyrium-2025Outro Music: Abstract Future Bass Pursuit by QubesoundsCourtesy of Pixabay under Creative Commons non-commercial use. Produced by: Todd Fredricks DO MSS Edited by: Todd Fredricks DO MSS Answers for Episode 36 Hepatitis Question 1: Hepatitis A Prognosis and ManagementA 68-year-old man presents with fatigue, jaundice, and elevated liver enzymes. He is diagnosed with acute hepatitis A. Which of the following factors is most associated with increased risk of fulminant hepatitis A and poor prognosis?C. Advanced age (>75 years)Question 2: Hepatitis B Treatment StrategyA 35-year-old man with chronic hepatitis B is started on antiviral therapy. After one year, his HBV DNA is undetectable and he has achieved e-antigen seroconversion. What is the most appropriate next step in management?C. Continue nucleos(t)ide therapy to reduce relapse riskQuestion 3: Hepatitis C Screening and TreatmentA public health initiative aims to reduce hepatitis C prevalence in a U.S. population. Which of the following strategies is supported by recent clinical trial data and national guidelines?C. Implement universal screening for adults aged 18–79 and treat with pan-genotypic DAAsPaper for Next Week:Sonia Wu,  Maher Al Khaldi, Carole S. Richard, François Dagbert, “Diverticulitis: A Review of Current and Emerging Practice-Changing Evidence”  Clinics in Colon and Rectal Surgery(2024;37:359–367):Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

Send us Fan MailEpisode 36 HepatitisShoot me any comments or questions @Rotation2ptoh  on XIntro Music: KI Instrumental (Rock Celtic) by Lyrium-2025Outro Music: Yearning by dferunCourtesy of Pixabay under Creative Commons non-commercial use.Produced by: Todd Fredricks DO MSS Edited by: Todd Fredricks DO MSSAnswers for Episode 35 Inflammatory Bowel DiseaseQuestion 1: Diagnosis and BiomarkersA 35-year-old patient presents with chronic gastrointestinal symptoms. Endoscopic and histologic findings are inconclusive for either ulcerative colitis or Crohn’s colitis. Which of the following biomarkers is most useful in differentiating Crohn’s colitis from ulcerative colitis in cases of indeterminate colitis?C. Human alpha defensin 5 (DEFA5)Question 2: Surgical ManagementWhich of the following surgical procedures is considered the gold standard for treating refractory ulcerative colitis while preserving fecal continence?B. Restorative proctocolectomy with ileal pouch-anal anastomosis (RPC-IPAA)Question 3: COVID-19 and IBD CareDuring the COVID-19 pandemic, which of the following strategies was most commonly implemented to maintain continuity of care for patients with inflammatory bowel disease?C. Virtual consultations and contact center services (CCS)Paper for Next Week:Mark W. Jones ; Connor B. Weir ; Mia Marietta, Gallstones (Cholelithiasis) StatPearls [Internet], Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Last Update: June 2, 2025.Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

Send us Fan MailEpisode 35 Inflammatory Bowel DiseaseShoot me any comments or questions @Rotation2ptoh  on XIntro Music: KI Instrumental (Rock Celtic) by Lyrium-2025Outro Music: Comedy Quirky Funny Background Music by Background Music for VideosCourtesy of Pixabay under Creative Commons non-commercial use.Produced by: Todd Fredricks DO MSS Edited by: Todd Fredricks DO MSSAnswers for Episode 34 Irritable Bowel SyndromeQuestion 1: PathophysiologyA 34-year-old woman presents with chronic abdominal pain and alternating bowel habits. She is diagnosed with IBS. Which of the following findings is most consistent with the current understanding of IBS pathophysiology?C. Altered gut microbiota and increased visceral hypersensitivityQuestion 2: Treatment – IBS-DA 45-year-old male with IBS-D has failed dietary and lifestyle interventions. He is now being considered for pharmacologic therapy. Which of the following medications is most appropriate as a first-line treatment for diarrhea and abdominal pain?B. Eluxadoline 100 mg BIDQuestion 3: Dietary ManagementA 29-year-old female with IBS-D reports worsening symptoms after meals. She is interested in dietary interventions. Which of the following is the most evidence-based dietary strategy for symptom relief?C. Low-FODMAP diet with phased reintroductionPaper for Next Week:Matthew August Odenwald and Sonali Paul, Viral Hepatitis: Past, present, and future, World Journal of Gastroenterology, April 14, 2022, 28, 14Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agencyListeners interested in specifics from the paper authors should contact them directly through their respective institutions.Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

Send us Fan MailEpisode 34 Irritable Bowel SyndromeShoot me any comments or questions @Rotation2ptoh  on XIntro Music: KI Instrumental (Rock Celtic) by Lyrium-2025Outro Music: Slow Trap by Anton VlasovCourtesy of Pixabay under Creative Commons non-commercial use.Produced by: Todd Fredricks DO MSS Edited by: Todd Fredricks DO MSSAnswers for Episode 33 Peptic Ulcer DiseaseQuestion 1: H. pylori Eradication TherapyA 45-year-old male patient is diagnosed with a peptic ulcer and tests positive for Helicobacter pylori. He has no history of NSAID use. According to the JSGE guidelines, which of the following is the most appropriate first-line eradication regimen?C. Vonoprazan + amoxicillin + clarithromycinQuestion 2: NSAID-Induced Ulcer ManagementA 68-year-old female with osteoarthritis is on chronic NSAID therapy and has a history of peptic ulcer bleeding. According to the guidelines, which of the following is the most appropriate strategy to prevent ulcer recurrence?C. Continue NSAIDs and add celecoxib with a proton pump inhibitorQuestion 3: LDA-Related Ulcer PreventionA 72-year-old male with coronary artery disease is prescribed low-dose aspirin (LDA). He has a history of peptic ulcer disease. According to the guidelines, which of the following is the best strategy to prevent recurrence of LDA-related peptic ulcers?B. Vonoprazan 10 mg dailyPaper for next week: Amosy Ephreim M’Koma, Inflammatory Bowel Disease: Clinical Diagnosis and Surgical Treatment-Overview, Medicina 2022, 58, 567.Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0. 

Send us Fan MailEpisode 33 Peptic Ulcer DiseaseShoot me any comments or questions @Rotation2ptoh  on XIntro Music: KI Instrumental (Rock Celtic) by Lyrium-2025Outro Music: Best Dramatic Music by OnoychenkoCourtesy of Pixabay under Creative Commons non-commercial use.Produced by: Todd Fredricks DO MSS Edited by: Todd Fredricks DO MSSAnswers for Episode 32 GERDQuestion 1: Diagnostic StrategyA 45-year-old male presents with persistent heartburn and regurgitation despite an 8-week trial of single-dose PPI therapy. He denies dysphagia, weight loss, or gastrointestinal bleeding. Endoscopy reveals no erosive esophagitis or Barrett’s esophagus. What is the most appropriate next step in management? C. Perform prolonged wireless pH monitoring off PPI therapyQuestion 2: Pharmacologic ManagementWhich of the following adjunctive therapies is most appropriate for a patient with GERD who experiences breakthrough symptoms despite optimized PPI therapy?A. Alginate antacidsQuestion 3: Surgical ConsiderationsA 52-year-old obese female with confirmed GERD and a large hiatal hernia is considering surgical intervention. Which of the following procedures is most appropriate as a primary anti-reflux intervention?C. Roux-en-Y gastric bypassPaper for next week:Kai-Yue Huang, Feng-Yun Wang, Mi Lv, Xiang-Xue Ma, Xu-Dong Tang, Lin Lv, Irritable bowel syndrome: Epidemiology, overlap disorders pathophysiology and treatment, World J Gastroenterol 2023 July 14; 29(26): 4120-4135 Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0. 

Send us Fan MailEpisode 32 GERD Shoot me any comments or questions @Rotation2ptoh  on X Intro Music: KI Instrumental (Rock Celtic) by Lyrium-2025Outro Music: Comedy Cartoon Funny Background Music by HitslabCourtesy of Pixabay under Creative Commons non-commercial use.Produced by: Todd Fredricks DO MSS Edited by: Todd Fredricks DO MSSAnswers for Episode 31 Vitamin DQuestion 1: Vitamin D MetabolismA 45-year-old woman with chronic liver disease is found to have low serum 25-hydroxyvitamin D [25(OH)D] levels despite adequate sun exposure and oral vitamin D₃ supplementation. Which of the following best explains her low 25(OH)D levels? B. Impaired hepatic 25-hydroxylationQuestion 2: Clinical Application of SupplementationA 68-year-old man with a history of bariatric surgery presents for evaluation of vitamin D status. His serum 25(OH)D is 12 ng/mL. Which of the following is the most appropriate form of vitamin D supplementation for this patient?C. Calcifediol (25-hydroxyvitamin D)Question 3: Vitamin D ToxicityA 55-year-old woman presents with fatigue, nausea, and confusion. Labs reveal hypercalcemia, suppressed PTH, and a serum 25(OH)D level of 180 ng/mL. She reports taking high-dose vitamin D supplements for several months. Which of the following best explains her condition?C. Exogenous vitamin D toxicityPaper for next week:Tomoari Kamada, Kiichi Satoh, Toshiyuki Itoh, Masanori Ito, Junichi Iwamoto, Tadayoshi Okimoto, Takeshi Kanno, Mitsushige Sugimoto, Toshimi Chiba, Sachiyo Nomura, Mitsuyo Mieda, Hideyuki Hiraishi, Junji Yoshino, Atsushi Takagi, Sumio Watanabe,Kazuhiko Koike,Evidence-based clinical practice guidelines for peptic ulcer disease 2020, J Gastroenterol (2021) 56:303–322 Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS. Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency. Listeners interested in specifics from the paper authors should contact them directly through their respective institutions. Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

Send us Fan MailEpisode 31 Vitamin DShoot me any comments or questions @Rotation2ptoh  on XIntro Music: KI Instrumental (Rock Celtic) by Lyrium-2025Outro Music: Epic Dramatic Cinematic Mover Underscore by Aleksei BezruchkoCourtesy of Pixabay under Creative Commons non-commercial use.Produced by: Todd Fredricks DO MSS Edited by: Todd Fredricks DO MSS Answers for Episode 30 Testosterone DeficiencyQuestion 1: Diagnosis and ManagementA 58-year-old male presents with fatigue, decreased libido, and erectile dysfunction. His total testosterone (TT) level is 11.5 nmol/L on two separate morning measurements. His free testosterone (FT) is 210 pmol/L. Luteinizing hormone (LH) is elevated. Which of the following is the most appropriate next step?C. Initiate lifestyle modification and consider testosterone therapyQuestion 2: Adverse EffectsA 65-year-old man on long-acting testosterone undecanoate injections presents for routine follow-up. His hematocrit has increased from 46% to 55% over the past 6 months. He is otherwise asymptomatic. What is the most appropriate management?B. Switch to a transdermal testosterone formulationQuestion 3: ContraindicationsA 52-year-old male with a history of prostate cancer (Gleason 7, treated with radical prostatectomy 2 years ago) presents with symptoms of testosterone deficiency. His PSA is undetectable, and digital rectal exam is normal. His TT is 7.8 nmol/L. What is the most appropriate next step?B. Begin testosterone therapy with close monitoringPaper for next week:FNU Tanvir , Gurkamal Singh Nijjar , Smriti Kaur Aulakh , Yasmeen Kaur , Sumerjit Singh ,Kanwarmandeep Singh , Abhinandan Singla , Ajay Pal Singh Sandhu , Shivansh Luthra , Harman Antaal (August 24, 2024) Gastroesophageal Reflux Disease: New Insights and Treatment Approaches. Cureus 16(8): e67654.Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

Send us Fan MailEpisode 30 Testosterone DeficiencyShoot me any comments or questions @Rotation2ptoh  on XIntro Music: KI Instrumental (Rock Celtic) by Lyrium-2025Outro Music: Flying Through the Valley an Epical TrailerCourtesy of Pixabay under Creative Commons non-commercial use.Produced by: Todd Fredricks DO MSS Edited by: Todd Fredricks DO MSSAnswers for Episode 29 Gestational DiabetesQuestion 1:  A 32-year-old Hispanic woman, G3P2, presents for her 28-week prenatal visit. Her 1-hour 50-g glucose challenge test is elevated, and a follow-up 3-hour 100-g oral glucose tolerance test confirms gestational diabetes mellitus (GDM). She is otherwise healthy, with a BMI of 33 kg/m². She asks whether her condition will resolve after delivery.Which of the following best explains the underlying pathophysiology of her condition?B. Chronic β-cell dysfunction unmasked by pregnancyQuestion 2: A 29-year-old woman with a history of GDM is enrolled in a longitudinal study. Her disposition index (DI) is measured annually. Over 5 years, her DI steadily declines, although her fasting glucose remains within the normal range. Which of the following best describes the clinical significance of a declining disposition index in this patient C. It reflects progressive β-cell failure and precedes hyperglycemiaQuestion 3: A randomized controlled trial evaluates the effect of troglitazone in Hispanic women with prior GDM. Participants are stratified by changes in insulin sensitivity and insulin secretion after 3 months of treatment. One group shows a 50% reduction in insulin output and a 0% annual incidence of diabetes. Which of the following best explains the protective effect observed in this group?B. Reduced β-cell secretory load due to improved insulin sensitivityPaper for next week:Andrea Giustina, et. al., Consensus Statement on Vitamin D Status Assessment and Supplementation: Whys, Whens, and Hows Endocr Rev, 2024 Apr 27;45(5):625–654. Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

Send us Fan MailEpisode 29 Gestational DiabetesShoot me any comments or questions @Rotation2ptoh  on XIntro Music: KI Instrumental (Rock Celtic) by Lyrium-2025Outro Music: Modern Classical Inspirational Cinematic Motivational MusicCourtesy of Pixabay under Creative Commons non-commercial use.Produced by: Todd Fredricks DO MSS Edited by: Todd Fredricks DO MSSAnswers for Episode 28 Polycystic Ovarian syndromeQuestion 1: Diagnosis and PathophysiologyA 24-year-old woman presents with irregular menstrual cycles and concerns about excessive facial hair. Physical examination reveals mild hirsutism and acne. Laboratory testing shows mildly elevated total testosterone and normal thyroid function. Transvaginal ultrasound reveals 24 follicles in the right ovary and an ovarian volume of 12 mL. Which of the following best explains the underlying pathophysiology of this patient’s condition?C. Increased luteinizing hormone (LH) secretion and insulin resistanceQuestion 2: ManagementA 29-year-old woman with PCOS and a BMI of 32 kg/m² presents with concerns about infertility. She has been attempting to conceive for 8 months. Her cycles are irregular, occurring every 40–60 days. She is not on any medications. Which of the following is the most appropriate first-line pharmacologic treatment to induce ovulation?B. LetrozoleQuestion 3: Long-Term ComplicationsA 35-year-old woman with a history of PCOS presents for a routine follow-up. She has a BMI of 28 kg/m² and reports daytime fatigue and snoring. Which of the following long-term complications is she at significantly increased risk for, independent of her BMI?B. Obstructive sleep apneaPaper for next week:Geoffrey Hackett, Michael Kirby, Rowland W. Rees, T. Hugh Jones, Asif Muneer,  Mark Livingston, Nick Ossei-Gerning, Janine David, Jeff Foster, Philip A. Kalra, Sudarshan Ramachandran, The British Society for Sexual Medicine Guidelines on Male Adult Testosterone Deficiency, with Statements for Practice, World J Mens Health 2023 Jul 41(3): 508-537 Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS. Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency. Listeners interested in specifics from the paper authors should contact them directly through their respective institutions. Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

Send us Fan MailEpisode 28 Polycystic Ovarian SyndromeShoot me any comments or questions @Rotation2ptoh  on XIntro Music: KI Instrumental (Rock Celtic) by Lyrium-2025Outro Music: Science Documentary by Lexin Music Courtesy of Pixabay under Creative Commons non-commercial use.Produced by: Todd Fredricks DO Edited by: Todd Fredricks DOAnswers for Episode 27 Metabolic SyndromeQuestion 1: PathophysiologyA 52-year-old male with central obesity, elevated triglycerides, and hypertension is diagnosed with metabolic syndrome. Which of the following best describes the role of free fatty acids (FFAs) in the development of insulin resistance in this condition?C. FFAs impair insulin signaling by altering the insulin receptor substrate pathwayQuestion 2: Clinical BiomarkersWhich of the following biomarkers is most consistently decreased in patients with metabolic syndrome and is known for its anti-inflammatory and insulin-sensitizing properties?C. AdiponectinQuestion 3: Diagnostic CriteriaAccording to the harmonized definition by the International Diabetes Federation and the American Heart Association/NHLBI, which of the following combinations qualifies a patient for a diagnosis of metabolic syndrome?C. Central obesity, low HDL cholesterol, and elevated blood pressurePaper for next week:Thomas A. Buchanan, Anny H. Xiang, Kathleen A. Page, and Richard M. Watanabe, What Is Gestational Diabetes—Really?, Diabetes 2025;74:1037–1046Important legal things:Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

Send us Fan MailEpisode 23.1  Amber Healy DO DiabetologistA fantastic conversation with one of my favorite colleagues. A lot to learn from Dr. Healy’s wisdom about a massive problem for American Medicine. I hope you enjoy the discussion as much as I did.Shoot me any comments or questions @Rotations2ptoh  on X Intro/Outro: Night Detective by AmaksiCourtesy of Pixabay under Creative Commons for non-Commercial Educational use only.Produced by: Todd Fredricks DO MSS Edited by: Todd Fredricks DO MSS Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSSRotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

Send us Fan MailEpisode 27 Metabolic SyndromeShoot me any comments or questions @Rotation2ptoh  on XIntro Music: KI Instrumental (Rock Celtic) by Lyrium-2025Outro Music: Ki Instrumental Celtic Rock 357740 by Lyrium-2025Courtesy of Pixabay under Creative Commons non-commercial use. Produced by: Todd Fredricks DO Edited by: Todd Fredricks DOAnswers for Episode 26 ObesityQuestion 1: Clinical Decision-Making in Obesity PharmacotherapyA 45-year-old woman with a BMI of 34 kg/m² and type 2 diabetes has attempted multiple lifestyle interventions with limited success. She is interested in pharmacologic therapy for weight loss. Which of the following medications is most likely to result in the greatest average weight loss?C. Tirzepatide 15 mg subcutaneous weeklyQuestion 2: Understanding Lifestyle Intervention OutcomesWhich of the following statements best describes the expected outcome of intensive lifestyle intervention (ILI) for obesity management?B. ILI leads to an average weight loss of 2–9% at 1 year, with some regain over time.Question 3: Post-Medication Management StrategyA 52-year-old man with obesity (BMI 38 kg/m²) has been taking semaglutide 2.4 mg weekly for 12 months and has lost 17% of his initial body weight. He asks if he can stop the medication now that he has reached a “normal” BMI. What is the most appropriate response?C. Continue the medication, as discontinuation is associated with significant weight regain.Paper for next week: Ebernella Shirin Dason M, Olexandra Koshkina, Crystal Chan, Mara Sobel, Diagnosis and management of polycystic ovarian syndrome, CMAJ 2024 January 29;196:Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.   

Send us Fan MailEpisode 26 ObesityShoot me any comments or questions @Rotation2ptoh  on XIntro Music: KI Instrumental (Rock Celtic) by Lyrium-2025Outro Music: Tree of Life by Alex GrohlCourtesy of Pixabay under Creative Commons non-commercial use.Produced by: Todd Fredricks DO Edited by: Todd Fredricks DOAnswers for Episode 25 HyperthyroidismQuestion 1: Diagnosis and PathophysiologyA 35-year-old woman presents with weight loss, palpitations, and heat intolerance. On examination, she has a diffusely enlarged thyroid with a bruit and mild exophthalmos. Laboratory tests reveal suppressed TSH and elevated free T4. Which of the following is the most appropriate next step to confirm the diagnosis?C. TRAb (TSH receptor antibody) assayQuestion 2: Pharmacologic ManagementA 42-year-old woman with newly diagnosed Graves’ disease has a free T4 level that is 2.5 times the upper limit of normal. She is not pregnant. Which of the following is the most appropriate initial dose of methimazole?C. 30–40 mg dailyQuestion 3: Treatment ComplicationsA 29-year-old woman with Graves’ disease is started on methimazole. Three weeks later, she presents with fever and sore throat. Which of the following is the most appropriate next step?B. Order a complete blood count immediatelyPaper for next week:Gracia Fahed, Laurence Aoun, Morgan Bou Zerdan, Sabine Allam, Maroun Bou Zerdan, Youssef Bouferraa and Hazem I. Assi, Metabolic Syndrome: Updates on Pathophysiology and Management in 2021, Int. J. Mol. Sci. 2022, 23, 786Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

Send us Fan MailEpisode 25 HyperthyroidismShoot me any comments or questions @Rotation2ptoh  on XIntro Music: KI Instrumental (Rock Celtic) by Lyrium-2025Outro Music: Blockbuster TrailerCourtesy of Pixabay under non-commercial creative commons useProduced by: Todd Fredricks DO MSSEdited by: Todd Fredricks DO MSSAnswers for Episode 24 HypothyroidismQuestion 1: Cardiovascular ComorbiditiesA 58-year-old woman with a 10-year history of subclinical hypothyroidism presents for routine follow-up. Her TSH is persistently 6.8 mIU/L. She reports no symptoms. Which of the following best describes her current cardiovascular risk profile according to population-based evidence?C. She has an increased risk of cardiovascular disease, even in the absence of symptomsQuestion 2: Persistent Symptoms Despite LT4 A 42-year-old man on levothyroxine (LT4) for overt hypothyroidism has normalized TSH but reports persistent fatigue and difficulty losing weight. Labs reveal normal free T4 and T3 levels. What is the most appropriate next step in management?D. Assess for non-thyroidal causes of symptoms and comorbiditiesQuestion 3: Comorbidity PatternsWhich of the following is most accurately described as a comorbidity that shares a possible genetic or autoimmune pathogenesis with hypothyroidism?B. Rheumatoid arthritisPaper for next week:Susan Z. Yanovski,Jack A. Yanovski, Approach to Obesity Treatment in Primary Care: A Review, JAMA Intern Med. 2024 July 01; 184(7): 818–829.Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0. 

Send us Fan MailEpisode 24 HypothyroidismShoot me any comments or questions @Rotation2ptoh  on XIntro Music: KI Instrumental (Rock Celtic) by Lyrium-2025Outro Music: KI Instrumental Classic-Waltz by Lyrium-2025 Siggi Würtz Courtesy of Pixabay under non-commercial creative commons Produced by: Todd Fredricks DO MSS Edited by: Todd Fredricks DO MSSAnswers for Episode 23 Type 1 DMQuestion 1: Clinical Application of Technology in Older AdultsA 75-year-old man with long-standing Type 1 diabetes is experiencing frequent episodes of severe hypoglycaemia, including nocturnal events. He lives independently with minimal caregiver support. Which of the following interventions is most likely to reduce his risk of hypoglycaemia and improve his quality of life?C. Initiation of continuous glucose monitoring (CGM) with predictive alertsQuestion 2: Understanding Glycaemic VariabilityWhich of the following best describes the clinical significance of glycaemic variability (GV) in older adults with diabetes?B. GV is associated with increased risk of cognitive decline, frailty, and mortalityQuestion 3: Barriers to Technology UseAn 82-year-old woman with Type 1 diabetes, moderate cognitive impairment, and visual deficits is being considered for diabetes technology. Which of the following is the most appropriate next step?C. Assess cognitive function, dexterity, and social support before initiating technologyPaper for next week:Sun Y. Lee, Elizabeth N. Pearce, MD, Hyperthyroidism: A Review, JAMA. 2023 October 17; 330(15): 1472–1483.Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSS.Rotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.Listeners interested in specifics from the paper authors should contact them directly through their respective institutions.Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.

Send us Fan MailEpisode 12.1  Thoughts on VapingShoot me any comments or questions @Rotations2ptoh  on X Intro/Outro: Night Detective by AmaksiCourtesy of Pixabay under Creative Commons for non-Commercial Educational use only.Produced by: Todd Fredricks DO MSS Edited by: Todd Fredricks DO MSSPapers referenced: Avian V.White, David W. Wambui, Lok R. Pokhrel, Risk assessment of inhaled diacetyl from electronic cigarette use among teens and adults, Science of the Total Environment 772 (2021) E Andrew L. Pipe and Hassan Mir, E- Cigarettes Reexamined: Product Toxicity, Canadian Journal of Cardiology, Volume 38 2022 Rotations  2.0 is copyrighted. But you can use any content from the podcast for non-commercial purposes under Creative Commons….BUT, BUT, BUT, you must cite Rotations 2.0 and Todd Fredricks DO MSS as the source of the material AND AND AND you cannot alter or edit the content in any manner without expressed permission of Todd Fredricks DO MSSRotations 2.0 is made possible by the generous understanding and accommodation of my beloved institution, Ohio University. The comments and ideas expressed on Rotations 2.0 are that of the content creators alone and may not reflect official policy or the opinion of the Ohio University, the State of Ohio, or the US Government or any other state, person or governmental agency.Any therapeutic ideas discussed should not be taken as any kind of medical advice or recommendations by the content creators and the content creators are not offering medical advice but discussing topics from an academic perspective. Listeners seeking advice about any medical care or decision-making should consult their own physician or medical provider and the content creators of Rotations 2.0 assume no liability for any listener's care or decision-making stemming from the topics discussed on Rotations 2.0.