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Thoughts on #endometriosis from the perspective of medical education 🧵
USMLE and shelf examinations make endo seem super easy. It’s a young woman with pelvic pain & some combo of infertility, dyspareunia, and dyschezia
Throw some OCPs at the problem and boom, case closed
Throw some OCPs at the problem and boom, case closed
Students don’t talk about endo as a cause of urinary symptoms. Many have it on their list as a cause of heavy abnormal bleeding.
Most have no idea that MRI is useful for diagnosis and few know when to refer for surgery or how to manage patients after surgery
Most have no idea that MRI is useful for diagnosis and few know when to refer for surgery or how to manage patients after surgery
So I spoke with the Health Care Authority of West Virginia who approves certificates of need in our state. A 🧵 by #folkreporter @folkreporters 1/
I spoke with Timothy Adkins, the interim director of the Certificate of Need program. He clarified the CON program for me, as it pertains to #obgyntwitter in West Virginia. 2/
If an ambulatory care center aka hospital or hospital affiliated clinic exists in your community, that entity DOES NOT need to apply for a CON to add #obgyntwitter care to it's existing facility. 3/
While assessing 2ndary Amenorrhea ⏬
Give progesterone > bleeds | It was the one lacking on board (anovulation/PCOS)
Give progesterone > doesnt bleed | try adding estrogen & simulate a menstrual cycle >> If then Bleeds🩸> something’s wrong with the FSH/LH fine tuning
Give progesterone > bleeds | It was the one lacking on board (anovulation/PCOS)
Give progesterone > doesnt bleed | try adding estrogen & simulate a menstrual cycle >> If then Bleeds🩸> something’s wrong with the FSH/LH fine tuning
If Estrogen + Progesterone does’nt lead to bleed🩸— check for uterine pathway blockage/structural defects (Asherman’s syndrome) esp. pt having h/o multiple D&C
I have been noticing more issues with low iron amongst my obstetrics and gynaecology patients lately so thought we should do a thread on iron...
Why is iron important?
Why can iron be low?
How can you get more iron?
#iron #anemia #pregnancy #periods #ObGynTwitter #MedTwitter
Why is iron important?
Why can iron be low?
How can you get more iron?
#iron #anemia #pregnancy #periods #ObGynTwitter #MedTwitter
Iron (Fe) is a super important mineral for us.
Iron the centre of the heme group, which sits in the centre of each subunit of the hemoglobin protein structure.
Hemoglobin proteins pack the inside of our red blood cells.
Iron the centre of the heme group, which sits in the centre of each subunit of the hemoglobin protein structure.
Hemoglobin proteins pack the inside of our red blood cells.
Iron at the core of each hemoglobin molecule binds oxygen.
There are ~260 million hemoglobin molecules in each red blood cell and we each have ~25 trillion red blood cells in circulation!
This is our transport system for oxygen to get from our lungs to our cells and organs.
There are ~260 million hemoglobin molecules in each red blood cell and we each have ~25 trillion red blood cells in circulation!
This is our transport system for oxygen to get from our lungs to our cells and organs.
Pregnant women are advised not to clean their cat litter tray and to wear gloves while gardening.
Avoid eating raw meat or from eating unwashed fruit and vegetables.
This is to prevent the infection of Toxoplasmosis which is deleterious to the baby inside..
Avoid eating raw meat or from eating unwashed fruit and vegetables.
This is to prevent the infection of Toxoplasmosis which is deleterious to the baby inside..
Toxoplasma Gondii is a parasite which can infect many mammals and birds, but can only sexually reproduce inside cats. Its normal lifecycle is to be shed into the environment in cat faeces, from where it may be picked up by rodents and birds, which are then eaten by cats..
For most people, it causes only a mild flu-like illness, but during pregnancy it can harm the fetus.
In people with weak immune systems, toxo can be deadly. .
In people with weak immune systems, toxo can be deadly. .
Parent: She can't go to school on her period.
Me: 👀
"The school locks the girls bathroom and girls are only allowed 15 bathroom passes per semester."
"Are the boys bathrooms locked?"
"No"
Here's a stack of school notes for the whole class. #MedTwitter #obgyntwitter #MedEd
Me: 👀
"The school locks the girls bathroom and girls are only allowed 15 bathroom passes per semester."
"Are the boys bathrooms locked?"
"No"
Here's a stack of school notes for the whole class. #MedTwitter #obgyntwitter #MedEd
No one should be regularly missing school (or work) for their period. Heavy periods, painful periods, unpredictable periods, annoying periods, premenstrual symptoms, just hate having periods. There are so many options to make menstrual cycles less daunting.
NSAIDs (ibuprofen, naproxen) are the best for cramping. Most people aren't taking enough to be therapeutic. Start 1-2 days before each period (if able) and take around the clock (every 6-12 hours depending on the med). Catching up on pain is much harder than staying ahead of it.
1) Morning sickness --> another pearl from evolutionary medicine.
Nausea and vomiting (n/v) in early pregnancy are so common --> they are regarded as almost physiological.
But could they have an evolutionary benefit?
Nausea and vomiting (n/v) in early pregnancy are so common --> they are regarded as almost physiological.
But could they have an evolutionary benefit?
2) Firstly, its not called morning sickness anymore.
Its n/v of pregnancy aka NVP.
Why?
Because it takes place at all times of the day and night.
Its n/v of pregnancy aka NVP.
Why?
Because it takes place at all times of the day and night.
3) We have a graphical representation of the usual course of NVP here.
1) This is Kaiser Wilhelm II of Germany (1859-1941).
He strengthened the German Empire but his erratic personality and tactless behaviour antagonized the international community.
It is believed that his unstable foreign policy was one of the major reasons behind World War I.
He strengthened the German Empire but his erratic personality and tactless behaviour antagonized the international community.
It is believed that his unstable foreign policy was one of the major reasons behind World War I.
2) He was born on the midnight of 26th Jan, 1859 and had an extremely traumatic birth.
You can read an extensive account through this link.
roadstothegreatwar-ww1.blogspot.com/2017/09/the-tr…
You can read an extensive account through this link.
roadstothegreatwar-ww1.blogspot.com/2017/09/the-tr…
3) Long story short, his attending doctors were forced to operate within the confines of royal etiquette --> while dealing with a breech delivery --> with the patient under chloroform --> a relatively unknown substance.
How it started...
On this day, two years ago, I was hit head on by a distracted driver on the country highway by our home. My husband died instantly and I was careflighted to the local trauma center where I remained in critical condition. It was my fourth year of medical school
On this day, two years ago, I was hit head on by a distracted driver on the country highway by our home. My husband died instantly and I was careflighted to the local trauma center where I remained in critical condition. It was my fourth year of medical school
Over the next few months, as I dealt with the grief of losing my husband, I struggled to overcome my injuries - internal bleeding; open fracture of the femur, tibia, and fibula; and open fracture of the 5th digit of my (dominant) left hand at the MCP and DIP joints. I worked to
independently accomplish my activities of daily living when sitting on the side of the bed, transferring myself to the bedside commode, or feeding myself were feats in itself.
Last night, I worked my first night shift as an OBGYN resident and I find myself crying in realization
Last night, I worked my first night shift as an OBGYN resident and I find myself crying in realization
In my job as a pediatric neurologist, we consult with pregnant people if a brain abnormality was found on ultrasounds. We provide information on prognosis. If the prognosis is bad or high risk, elective pregnancy termination should be an option. (1/9)
We also prescribe anti seizure meds to people with epilepsy, who need to take these meds for months, often years. Some of these meds have potential to cause serious birth defects, or have unknown safety during pregnancy. (2/9)
Same goes for migraine meds, immunologic meds (treatment for multiple sclerosis, etc). Even if neurologists and insurance companies require a contract or proof of contraception, birth control isn’t 100% effective. (3/9)
"JUST GET A HYSTERECTOMY" thread
I am a 31 year old trans man. My periods have never been normal. They last way too long, are always way too heavy, and it seems there's a physical barrier keeping the lining from shedding effectively because it is always oxidized and clotted. 1/
I am a 31 year old trans man. My periods have never been normal. They last way too long, are always way too heavy, and it seems there's a physical barrier keeping the lining from shedding effectively because it is always oxidized and clotted. 1/
I first asked for a hysterectomy when I was 14. Obviously, this was denied. That makes perfect sense. I was put on birth control and they didn't look any further. That birth control caused me to have my period for over a year straight before I gave up. 2/
I asked for a hysterectomy or at least testing again at 21, when I still thought I was a cis woman. I was told that I might change my mind, and what if I found a partner someday that wanted me to have kids? I said "then they aren't going to be my partner." I was denied tests 3/
Parent: Is it true birth control pills are made to have monthly periods just to appease the church?
Me (having just read Malcolm Gladwell's book about this): It seems so, yes. There's no reason your child needs to have periods.
Parent: 😡 Why didn't anyone tell me that sooner! 🧵
Me (having just read Malcolm Gladwell's book about this): It seems so, yes. There's no reason your child needs to have periods.
Parent: 😡 Why didn't anyone tell me that sooner! 🧵
John Rock, a devout Catholic, was one of the inventors of the Pill, which was FDA-approved in 1960. The Catholic church bans any methods other than the rhythm method as 'mortal sin,' so the only acceptable way to avoid pregnancy is to not have sex during the fertile window.
Most hormonal birth control works by maintaining a thin uterine lining and preventing the cyclic changes of the hormones that trigger ovulation.
Myth: "My periods are so painful that I miss a couple days of school each month. Sometimes I think about calling 911 because of the pain. My doctor said this was normal and I'd grow out of them." 😱😱😱
THIS IS NOT NORMAL. 🧵
#MedTwitter #obgyntwitter #tweetorial
THIS IS NOT NORMAL. 🧵
#MedTwitter #obgyntwitter #tweetorial
Severe period cramps are common but they are absolutely not normal. If someone is missing school or activities because of cramping or heavy bleeding, this is not normal. There are so many options to make periods better and no one needs to have a period if they don't want to.
It's reasonable to treat the painful periods first and see if things get better. Not everyone needs an ultrasound to evaluate heavy, irregular, or painful periods. If cramping remains persistent or progressive, a pelvic ultrasound can check for an obstruction.
There's actually nothing special about Sunday. It doesn't matter what day your period starts and you don't have to start your #BirthControl the Sunday after your period starts. 🧵
#MedTwitter #tweetorial #obgyntwitter
#MedTwitter #tweetorial #obgyntwitter
Usually I tell people to start the first day of the period or as soon as they pick up the prescription. Starting during the period decreases risk of breakthrough bleeding and starting immediately gets them protected against pregnancy asap (and often makes next period lighter).
Pill packs come with these handy stickers so it's easy to change the labels to remember what day they're on.
I'll be adding short important points which would hopefully help in remembering certain concepts during #PLAB preparation, to this thread🧵every now and then as I take them out from my scattered notes. Feel free to comment your tips and tricks which would help others, as well 👇
Please don't take any of these as medical advice 😂🙏. Real life stuff is much more nuanced. These are just clinchers for the sake of the exam.
#PLAB
#PLAB
1. Drug contraindications...
-Avoid BAN drugs in Asthma (Beta blockers, aspirin, NSAIDS) &
-DAMN drugs in diarrhoea (Diuretics, ACEIs, Metformin, NSAIDs)
#PLAB
-Avoid BAN drugs in Asthma (Beta blockers, aspirin, NSAIDS) &
-DAMN drugs in diarrhoea (Diuretics, ACEIs, Metformin, NSAIDs)
#PLAB
Ready for another #PAG mystery?
16yo with primary amenorrhea (never started periods).
What questions do you want to ask?
#MedTwitter #MedEd #tweetorial #OBGYNtwitter
16yo with primary amenorrhea (never started periods).
What questions do you want to ask?
#MedTwitter #MedEd #tweetorial #OBGYNtwitter
There are many reasons someone might not have periods. I usually divide them into sections to make them easier to rule out:
- hormonal: either repro hormones not cycling normally and/or abnormal levels of other hormones
- structural: could be a blockage or underdeveloped organs
- hormonal: either repro hormones not cycling normally and/or abnormal levels of other hormones
- structural: could be a blockage or underdeveloped organs
Things to think about:
- any evidence of puberty (breasts, pubic/axillary hair, growth spurt)?
- could she be pregnant?
- any other symptoms (acne, facial hair, breast discharge, hot flashes, night sweats)?
- any (cyclic/monthly) abdominal pain?
- exercise and eating habits?
- any evidence of puberty (breasts, pubic/axillary hair, growth spurt)?
- could she be pregnant?
- any other symptoms (acne, facial hair, breast discharge, hot flashes, night sweats)?
- any (cyclic/monthly) abdominal pain?
- exercise and eating habits?
In honor of #EndometriosisAwarenessMonth: This is for the #MedTwitter community - especially #OBGYNTwitter - with the hope that it will help at least 1 future endo patient have a better experience than I did. A long 🧵: 1/?
3 weeks ago, I had an 8+ hours-long endo excision surgery that resulted in a unilateral #salpingectomy, an #appendectomy, & a partial #BowelResection. The thing is, it didn’t have to be this way. 2/?
I’ve had horribly painful periods since I was a teenager. Doctor said it was normal, just start taking ibuprofen a couple days early. By 18yo, oral contraceptives were recommended to manage it. That ‘worked’ for about 10 years? 3/?
During each visit, I always try to talk about the #HPV vaccine if they need it. One mom said, "we don't need that yet, her PCP said she had until age 26 to get it." 🤦♀️
Please start as early as possible (age 11-12). I'll tell you why 🧵
#tweetorial #MedTwitter #MedEd #obgyntwitter
Please start as early as possible (age 11-12). I'll tell you why 🧵
#tweetorial #MedTwitter #MedEd #obgyntwitter
#HPV (human papillomavirus) is the most common #STI in the US; 80% of sexually active people will get it. There are 100s of different strains; many asymptomatic, others cause genital warts, abnormal pap smears, and cancer (cervical, vaginal, anal, penile, vulvar, oropharyngeal).
The HPV vaccine (gardasil in the US) protects against the 9 highest risk strains, significantly reducing the risk of cervical dysplasia and the cancers mentioned above. More than 90% of #cervicalcancer is caused by HPV.
🧵 Part 14 of my #Tweetorial Series for #Match2022: Rank Order List 🧵
Let's talk about what to consider when making your ROL!
@FuturePedsRes @Inside_TheMatch @InternalMed_Res @FutureGenSurg @futureradres @NMatch2022 @IMG_Advocate @FutureAnesRes @futureENTres @FamilyMed_app
1/
Let's talk about what to consider when making your ROL!
@FuturePedsRes @Inside_TheMatch @InternalMed_Res @FutureGenSurg @futureradres @NMatch2022 @IMG_Advocate @FutureAnesRes @futureENTres @FamilyMed_app
1/
In this thread, I’ll be sharing what I feel are the Top 15 most important things to consider when formulating your rank order list (ROL) of residency programs.
So without further ado, let’s get started!
In no particular order:
2/
So without further ado, let’s get started!
In no particular order:
2/
Resident Vibe
Virtual meet-and-greets are different than in-person socials, but you should have been able to get a general sense of the vibe of the residents from each program. What are the kind of people you want to be around? How did the residents make you feel?
3/
Virtual meet-and-greets are different than in-person socials, but you should have been able to get a general sense of the vibe of the residents from each program. What are the kind of people you want to be around? How did the residents make you feel?
3/
#idweek2021 @IDSAInfo
#idtwitter #chasingthesun #COVID19 clincial case 4 #idmedEd #medEd #pregnancy #obgyntwitter
#idtwitter #chasingthesun #COVID19 clincial case 4 #idmedEd #medEd #pregnancy #obgyntwitter
#idweek2021 @IDSAInfo #idtwitter #chasingthesun #COVID19 clincial case 4 #idmedEd #medEd #pregnancy #obgyntwitter mab; no pregnant patients on this study though
#idweek2021 @IDSAInfo Implications of #COVID19 in African-American & Latinx communities by Dr Hewlett Jr #idtwitter #medEd
#idweek2021 @IDSAInfo #disparities
Implications of #COVID19 in #BLM African-American & #Latinx communities by Dr Hewlett Jr #idtwitter #medEd #pregnancy #obgyntwitter
Implications of #COVID19 in #BLM African-American & #Latinx communities by Dr Hewlett Jr #idtwitter #medEd #pregnancy #obgyntwitter
#idweek2021 @IDSAInfo #disparities Implications of #COVID19 in #BLM African-American & #Latinx communities by Dr Hewlett Jr #idtwitter #medEd #diabetes #obesity #race #FrontlineWorkers vascular disease
#APC #TumorBoardTuesday #GITwitter #LiverTwitter #PrecisionMedicine #ColonCancer #oncology @ASCO @TumorBoardTues @CCAlliance @GeneticsSociety #Genetics #Genomics
Many of the mutations happen in the MCR region, WE should investigate the Armadillo Repeats regions for therapeutics
Many of the mutations happen in the MCR region, WE should investigate the Armadillo Repeats regions for therapeutics
1/ OK, so today #OBGynInternChallenge diagnosed an ectopic! What do you do once that's accomplished? Let's talk about treatment with a #tweetorial! We'll do these occasionally to cover content we couldn't get to in our @learnarist course. Bonus knowledge! #MedEd #FOAMed #FOAMob
2/ When you think about #treatment for any medical condition, it can be helpful to organize your thoughts into three broad categories: #medical, #surgical, and #expectant. We often forget about that last one! #MedTwitter #OBGynTwitter
3/ With #ectopic #pregnancy, #surgery is what you probably think of first. It's appropriate in three cases: 1) hemodynamically unstable patient; 2) a patient who desires surgery instead of medical therapy; 3) a patient has a contraindication to medical therapy.
PREPARING YOUR BODY FOR PREGNANCY
Start taking folic acid at least 3 months before trying for a baby.
If you are on any medication, see your doctor to be sure it is safe in pregnancy or change it to a safer option.
Stop consuming herbs and concoction.
Image from google
Start taking folic acid at least 3 months before trying for a baby.
If you are on any medication, see your doctor to be sure it is safe in pregnancy or change it to a safer option.
Stop consuming herbs and concoction.
Image from google
If you drink alcohol or smoke, stop to avoid the possible negative effect on your baby. This applies for both the man and the woman.
If you haven't carried out some basic tests, do them before pregnancy especially those that can affect your baby.
@aproko_doctor
@DrZobo
If you haven't carried out some basic tests, do them before pregnancy especially those that can affect your baby.
@aproko_doctor
@DrZobo
Reduce stress while you stay active.
Be on the same page with your partner, you need all the support you can get.
Eat balanced diet
Pray for success
#NaijaOBGYNdoctor
#pregnancy
#obgyntwitter
Be on the same page with your partner, you need all the support you can get.
Eat balanced diet
Pray for success
#NaijaOBGYNdoctor
#pregnancy
#obgyntwitter
