1/ Many think that Van Gogh was "dig toxic" and that it impacted his vision and painting. Was that really true? This #tweetorial explores whether the great artist was actually toxic on digitalis.
2/ First, we need to understand a couple of things:
▪️What ailed Van Gogh?
▪️How can digitalis affect vision?
3/
Many diagnoses have been applied to Van Gogh, from lead poisoning to porphyria.
Most historians believe his depression, mania, and convulsive episodes indicate:
⭐️Schizoaffective disorder
⭐️Epilepsy
Both of which were made worse by absinthe.
4/ After episodes of psychosis and self-harm (see: the famous ear-cutting incident) Van Gogh was admitted to the Saint-Remy asylum from 1889-1890. He was cared for by a Dr. Gachet and it is here that he may have been treated with digitalis.
Dr. Gachet 👇
5/
In the 19th century digitalis was used medically for many indications, from epilepsy to cough.
Visual changes are known side effects of digitialis, including yellow discoloration of vision (aka xanthopsia) and blurred halos around points of light.
6/
So how might digitalis have affected Van Gogh’s art? Art historians have pointed to his “Yellow Period” which coincided with his prolonged hospitalization at Saint-Remy...
7/
...As well as the famous halos in “Starry Night”, which he is thought to have painted from his window in the asylum.
8/ So, what is the evidence that Van Gogh even received digitalis? It's all circumstantial:
➡️Digitalis was commonly prescribed at the time for his ailments
➡️He featured the digitalis plant in portraits of his physician, Dr. Gachet (red arrows below)
9/ And there's actually ✅ evidence *against* the dig toxic theory...
10/ ✅ Analysis of Van Gogh's color palette over time revealed a gradual transition to predominantly yellow (rather than a sudden change that would be expected from a drug toxicity).
11/ ✅ Van Gogh rarely painted during his acute episodes, the times at which, if he was receiving digitalis, his serum drug levels should have been highest.
1/ Why can multiple sclerosis symptoms worsen with heat exposure, something known as the Uhthoff phenomenon?
This question is especially relevant in the era of record-breaking heat waves and climate change.
#tweetorial #medtwitter
2/ In 1890, Wilhelm Uhthoff noted multiple sclerosis (MS) patients having a “marked deterioration of visual acuity during exercise" or after a hot bath, which ⬆️ body temperature.
1 patient lost vision just by walking vigorously in Uhthoff's clinic.
3/ The Uhthoff phenomenon is now recognized as exceedingly common in MS.
Up to 80% of patients experience ⬆️ neurological symptoms w/ even small body temp increases. These can include diminished physical (eg gait) and cognitive (eg mental fog) function.
1/THREAD
Has it ever occurred to you that Graves' disease presents a conundrum?
Graves' involves an autoimmune antibody that ACTIVATES a receptor, which is relatively unique in the landscape of human disease.
Let's unpack this fascinating mechanism.
#medtwitter #tweetorial
2/ Graves’ disease was first described by English physician Caleb Parry in 1786, when he noted an association between thyroid enlargement, tachyarrythmias, and exopthalmos in 8 patients.
Parry’s son posthumously published his description in 1825.
I ask teams to focus on efficiency, ⬆️ time for teaching/ discussion
⏳⬇️ transitions b/w patients by alerting next RN
⏳Enter orders on rounds, w/ clearly defined roles as to who will do that
⏳Present from memory (if possible), focusing on critical issues
2️⃣ Education
🧠I ❤️ to teach but avoid overwhelming residents by teaching high yield points on 2-3 patients max. I supplement w/ PM chalk talks after lunch and notes are done
🧠 I also ask each learner to share one learning point from rounds, and do so myself as well