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Seeking help for a friend who has suffered long because of headaches, has been to multiple specialists/docs, they treat her temporarily, but her headaches come back in full force. She wants to get to the bottom of this and resolve it. Pls RT tweeps. 1/n @DrJoyeeta
The story is over a decade old. Her migraines started after 6 months after delivering her first child. She went to an ENT doc, who did MRI/CT scan and a few other tests. Reports were normal, was asked to take painkillers, since then she ends up just doing that. 2/n @SonaliVaid
Over the next few years, she realized the pain killers were giving her acidity and many a time, the vomiting also worsened, throwing out any and every medication she took. There were times she had to quickly rush to a hospital to get pain killers through IV. 3/n @HShewade
Read 17 tweets
A True Story about The War on Opioids, Narrated by Cy:
My new employer's health plan says I gotta use CVS. I use Walgreens. I'm nervous about switching, but I assume I'm being overly cautious. So I tell my new neurologist to send the prescriptions to CVS.
Prescriptions include Norco 7.5 mg with acetamenophine 3.25 mg. Take a pill twice a day. I have been on this regimen for five years. So I supplement with ice packs, neck traction, heating pads, massage therapy when I can afford it, & etc.
Read 28 tweets
As I embark on #PGY30 , I’m reflecting upon my transition to #Intern year and thinking of the new #Residents starting this week…a short thread 1/

#TipsForNewInterns Image
Don’t listen to the #intern jokes.

You are a doctor now and fully a part of the #HealthcareTeam …a VERY important part! 2/

#TipsForNewInterns Image
Take the opportunity to learn from everyone…especially your #nurses.

Also take note of the ppl who treat other staff and patients rudely.

You’re not too young in the game to gently correct them…as you’ve been part of the #HumanRace for a long time. 3/

#TipsForNewDocs Image
Read 8 tweets
#MedicalTwitter, this is not OK.
Please look at this story, & the responses, to see the uphill struggle we have to talk with compassion about CPR to people who are sick, frightened & not accompanied by their loved ones during this time of covid.
Some comments:
1/
Firstly, I have been the doctor whose words were relayed by a v sick patient to a relative, & what the relative heard was not what I said. But it WAS what the patient/family understood from what I said, so I was responsible for that miscommunication.
Communication matters.
2/
CPR isn't really 'treatment.' It's a bridge to treatment in an emergency. Sometimes it works. But it's not like on TV.
Most people don't know that, so how we explain it really matters.

3/
Read 17 tweets
Here's what happens when a disabled man writes about being 18, newly paralyzed, at a rehab facility, in 1978. And he publishes the essay in a national #bioethics journal.
ID: Bill Peace, aka The Bad Cripple, white man in a blue shirt w/ gray beard sits next to my former persona, Tipsy Tullivan, blonde. Mouth covered by headline "A Blowjob from the 1970s & the Censorship of Disabled Writers." Audio and #transcript avail from hobartpulp.com/web_features/a…
This happened in 2014. What has bioethics, as a field, done since then, to inspire the confidence of us #disabled people? #MedicalTwitter
Read 7 tweets
I just spit into a tube for my employer. So my keycard would be "unlocked" and I could get into my very own office. Where my property has been for very many months. Now yeah, I guess #COVID19 means this is just what #workers do now. But here are #disability implications:
-- my spit, which has my DNA of course, is now a QR code
-- my employer now has access to my DNA
-- my employer now knows I'm on #opiates
-- my employer now knows I'm on #Lexapro
-- my employer now knows things about me that I don't even know about me b/c I've never given DNA
In return for this enormous amount of data I've just given my employer, what do I get? Access to my property, that is, my #poetry books, my #journals, my mementos from across a decade & etc
Read 15 tweets
Happening now. The first panel of Philosophy, Disability & Social Change w/ Julie Maybee Slide reads on left: Making and Unmaking Disability. Book co
"There are three layers of embodiment. Or what we'll call the three bodies." Visual slide: 1 Personal body 2 Interpersonal body 3 Institutional body #PhiDisSoc2020
"The phenomenon of disability spread ... the idea that when a nondisabled person encounters disabled person the nondisabled thinks disability 'spreads' over the entire disabled persons body" (might be getting this wrong/paraphrase) #PhiDisSoc2020
Read 12 tweets
#Migraine is a neurological disorder, not a terrible, disabling #headache," expert @DavidDodick explains. #Pain is "just 1 clinical manifestation deriving from a sensory processing disturbance affecting the nervous system" (Morgan, Lancet 2020). /Thread thelancet.com/journals/laneu…
Billie lost her insurance when #migraine disabled her: “There are days I don't see anything except for shapes." Visual warnings are the most commonly recognized auras, but these symptoms are highly variable, both in different patients & on different days for the same patient. 2/
Difficulty speaking or speaking clearly is another common #migraine symptom, either preceding or during an attack.

Poor St. Husband. He watched this clip & said, "Yup, that's you." I spent a lotta years in school to talk like this. 3/
Read 7 tweets
“[W]idespread & variable dysfunction of the nervous system…comprises the aberrant brain state of a #migraine attack” (Charles 2017).

Daily/near-daily migraine is continuous migraine. Imaging shows our brains *always* look like brains during an "attack" (Brennan 2018). >thread
Recurrent #migraine & #pain aren't benign. “Long-lasting &/or repetitive pain over years leads to profound functional as well as structural changes in the brain networks" (Brennan).

Ineffective treatment is a leading risk of progression to continuous migraine. #MedicalTwitter
Brennan & Pietrobon's paper "A Systems Neuroscience Approach to #Migraine" (Neuron 2018) is @headsUPmigraine's favorite. I excerpted it for others like me who aren't fluent in #neurochemistry:

docs.google.com/document/u/2/d…
Read 4 tweets
Med Schools offer almost no instruction in the world's #1 cause of working-age disability. It'd be like Dental Schools not covering cavities.

7 words diagnose most #migraine: Recurrent #pain w/ hypersensitivity &/or nausea. 60% of patients go undiagnosed. #MedicalTwitter #PCP
#Migraine is PROGRESSIVE. A 40% diagnostic rate condemns some to lifelong #disability: Late diagnosis & ineffective treatment of acute #migraine are leading risks for continuous migraine. #PCP #MedicalTwitter mdedge.com/jcomjournal/ar…
🔴HOW DOES THIS CHILD GO 8 YEARS WITHOUT A DIAGNOSIS? She has textbook ICHD-3 #migraine! 1>sudden hypersensitivity (smell) 2>throbbing #pain 3>nausea 4>need for bedrest

She might've avoided #disability w/ early diagnosis & treatment. #PCP blogs.webmd.com/my-experience/…
Read 10 tweets
Risk of OD to prescribed #opioids is 0.13% (Kaiser, Jnl of Pain 2019), while risk of death by OD increases more than 300% with dose variability of ≥30% (JAMA 2019).

VHA study: discontinuation increases the risk of death by #OD or #suicide up to 6.8 times (BMJ 2020). / thread
0.13% = risk of OD to prescribed #opioids (Kaiser 2019). Dose reduction is "inconsistent" in lowering OD risk. Research found "no support for RSM [risk stratification & monitoring] as a means of decreasing overdose.”

Jnl of Pain 2019;20(1) jpain.org/article/S1526-…
0.1% to 0.23% = risk of OD to prescribed #opioids, per Canada's 2017 Guideline.

0.1% for <20 MED, 0.14% for 20–49, 0.18% for 50–99 MED, 0.23% for ≥100 MED.

Discontinuation carries a significantly higher risk of death.
#PCP #MedicalTwitter
ncbi.nlm.nih.gov/pmc/articles/P…
Read 10 tweets
Some of My Favorite Elfriede Jelinek Lines:

"Fathers, straggling home late, lunge into building entrances, ready to pounce on their families like dreadful hammers"

The Piano Teacher
"Health--how disgusting. Health is the transfiguration of the status quo."

The Piano Teacher

#MedicalTwitter #DisabilityTwitter
"He wants to talk to Erika about a novel by Norman Mailer, whom Klemmer admires as a man and as an artist. Kemmer saw such and such in the book; perhaps Erika saw something entirely different? Erika hasn't read it."

The Piano Teacher
Read 14 tweets
0.1% = rate of fatal #OD in the medical use of #opioids acc'g to 2019 research from Kaiser Permanente (link below).

Bwn 2006-2014, 41 of 31,142 died of OD, a rate of 5 per year. Risk stratification did not lower OD rates. Dose reductions were "inconsistent" (VonKorff). /thread
2,887 #vets died by #overdose or #suicide after their #opioid medicine was stopped by the VHA in FY2013 (90 fewer than on 9/11) (Oliva et al 2020).

Patients whose rx opioid was stopped were 3 times MORE likely to die by OD than those whose medicine continued (James 2019).
4.9% of discontinued patients died of OD.
1.7% of continued patients died of OD.

Discontinuation of rx #opioids was associated with 1.35 times the risk of death & 2.94 times the risk of fatal OD compared to patients whose rx continued (James et al 2019).
Read 12 tweets
Patient deaths & harm led #CDC to clarify in 2019 that people on long-term stable #opioid doses above 90 MME should be tapered "only if the risks [of continuing the medicine] seem to outweigh the benefits." Yet hard dosage caps continue as policy & law. /thread
In 2019, CDC, FDA, HHS, & medical experts also urged doctors to seek patient consent before tapering #opioids.

Forced tapers violate the cardinal rule "Do no harm," as forced & mandatory tapers put people at significantly higher risk of harm, distress, disability, & death.
🟠 #CDC recommends tapers of 10% per wk to 10% per month, noting the latter is better for people on long-term #opioids.

2019 JAMA study of +100k people found 1 in 5 were tapered faster than 40% per month & 5% faster than 60% per month. ncbi.nlm.nih.gov/pmc/articles/P…
Read 9 tweets
2017 Review: “Expert guidelines recommend reducing or discontinuing long-term #opioid therapy when risks outweigh benefits, but evidence on the effect of dose reduction on patient outcomes has not been systematically reviewed.” / #cpp thread.
🟠 How can guidelines be "expert" recommendations if researchers haven't carefully investigated how patients will react when their rx #opiod med is stopped or reduced?

Are we going to feel better or worse? Are we going to live or die?
In 2017, #VA-funded researchers identified 67 studies about #opioid dosage reduction or discontinuation.

Study quality was deemed “poor” in 76% of the 67, the lowest rating.
Read 21 tweets
What have false assumptions about rx #opioids cost people in #pain? Damn near everything.

@Brian_Goldstone's report ought to be required reading for every #PCP & every legislator who wants to play doctor. #MedicalTwitter harpers.org/archive/2018/0…
For 4 yrs, an rx #opioid let Austin Sell escape the cage of pain, care for his kids, study to become a physician asst to help others w/ #ChronicPain. Then lawmakers in DC imposed a limit on what his clinic could prescribe. "And that was it. The app'ment lasted about 10 minutes."
Dr @StefanKertesz told @Harpers: “In a time of incredible tragedy, there’s a desire for something simple to latch onto as a way of explaining it. A story that has a clear-cut villain, with doctors as dupes and patients as innocent victims, is about as easy to sell as any story.”
Read 25 tweets
.@AmerMedicalAssn STILL hasn't read a study they published in 2019 showing rx #opioid limits "have failed" to reduce #ODs.

@AmericanCancer Society explains: People "very rarely" become addicted from medical use. Thread: Research shows pushing patients off opioids can kill them.
"#Addiction is very rare" when #opioid pain meds are taken as prescribed (American Cancer Society). Large studies have put the rate of addiction in medical use at under 1%. #cpp

-Brat bmj.com/content/bmj/36…
-Ciesielski
amjmed.com/article/S0002-…
-AmCancer
pdffox.com/get-help-for-c…
Chen et al: Restrictions on rx #opioids "have failed" to reduce ODs. Complex mathematical modeling shows they'll likely have a "modest effect, at best" on expected rises in ODs, which are fueled by illegal drugs. jamanetwork.com/journals/jaman…
Read 10 tweets
In 2017 @cdcorg didn't know that chronic, continuous #migraine is a thing. In fact, it's the world's #1 cause of working-age disability, & using objective metrics, @WHO ranked severe migraine in the highest class of disability burden w/ terminal-stage cancer & active psychosis. Image
This is what happens when Med Schools fail to include instruction the 1st & 2nd most common medical complaints (per NIH): #headache & #migraine. The #1 complaint is cavities. It's literally like #dentists getting maybe an hour on cavities at #Dental School. #MedicalTwitter
I did a quick search for her contact info & didn't find it. I'll write up my basic migraine spiel (NIH, Global Burden, prevalence, progression) sometime & send it to you to tidy up. Then we can easily email or tweet people the "It's CM. WTF?" basics. cdc.gov/injury/pressro…
Read 4 tweets
Following on from our #Tweetorial looking at silver trauma on this week’s #FractureFriday we’re taking a look at the (grand)mother of all fractures, so important they only take 3 letters to recognise – NOF!!
These patients are so important to manage appropriately as there is a 10% mortality in 30 days and 30% at a year post injury!! The Nottingham hip fracture score helps calculate the individuals risk based on various parameters.
Although these injuries can occur in younger patients as a result of high energy mechanisms the vast majority occur in older patients as a result of low energy injuries.
Read 18 tweets
Today's episode of "What in the Caucasity?" should be the LAST. In 1795, an anthropologist sorting human skulls into groups liked a female skull from the Caucasus Mts best & reasoned that since Europeans were the best-looking people, all Europeans must be from the Caucasus Mts.
"Caucasian" isn't simply a racial term, it's a #racist term, selected in 1795 solely because the anthropologist who published the 1st classification of humans into biological "races" thought Europeans were the world's best-looking people.
latimes.com/opinion/story/…
"Caucasian" is widely used in medical research as a synonym for "white." C'mon #MedicalTwitter: you can fix this. discovermagazine.com/mind/stop-usin…
Read 7 tweets
Thread:

12 reasons that <some> doctors disbelieve patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome #MECFS

1. Doctors tended to see #pwME as having “certain personality traits"

#SickNotWeak #MedEd #MedicalTwitter
bmj.com/content/328/74…
2. Doctors felt that #MyalgicE lacks a plausible pathological mechanism and its symptoms couldn't be ascribed to a precise location

3. There has been variation in the diagnostic criteria for #MECFS which has delegitimised the disease

#SickNotTired
bmj.com/content/328/74…
4. Doctors felt that #pwME had a poor work ethic

5. Doctors felt that #pwME had a poor attitude, they lacked stoicism and did not make every effort to get better as quickly as possible

#chronicillness #MedEd
bmj.com/content/328/74…
Read 8 tweets

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