Discover and read the best of Twitter Threads about #medicaltwitter

Most recents (21)

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:
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.
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.

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…
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…
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:…
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…
🔴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…
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)…
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…
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.…
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…
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

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.…
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.…
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.…
"Caucasian" is widely used in medical research as a synonym for "white." C'mon #MedicalTwitter: you can fix this.…
Read 7 tweets

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…
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

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…
Read 8 tweets

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