WesElyMD Profile picture
Sep 7, 2020 4 tweets 4 min read
1/ CXR Rounds ⏰ #26:
Mediastinum refresher!

See anatomy below. Look at CXR. What compartment is this lesion in?What is the differential dx of lesions in this space?


#tipsfornewdocs #medstudenttwitter #medtwitter #pulmcc ImageImageImage
2/ CXR Rounds ⏰ #26:
CXR on tweet #1 was Adenoid Cystic cancer in MIDDLE + POST MEDIASTINUM. 

You can’t distinguish those two compartments easily on CXR so they go together for Diff Dx! See these other masses below in the same space. What are they?
#radiology #tipsforolddocs ImageImageImageImage
3/ CXR Rounds #26:
First, what is the Diff Dx of lesions in Mid/Post Mediastinum?
Answer: Bronchogenic Cysts. Infxn – Mediastinitis. Neoplasia – goiter, cancer, lymphoma, mets, esophageal CA. CV – Aortic Aneurysms. Traumatic Hemorrhage. Hiatial Hernia
4/fin CXR Rounds #26:
Both patients’ images in tweet #2 are aortic aneurysms. 1st was Mycotic (infected) in prox descending Thoracic Aorta in 22 yo man. 2nd is in same location but saccular aneurysm from atherosclerosis in 87 y/o man.

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More from @WesElyMD

Aug 8
1/🧵 The Animal Rule & TPoxx for MonkeyPox

📌This antiviral drug Tecovirimat or TPoxx was FDA-approved for SmallPox by testing it in animals (not humans) w #MPox

📌 We need lots more data in humans to know how good it is.

What does this mean?

bit.ly/3PWJWwI Image
2/ First, be clear that the vesicles & pustules of #MonkeyPox rash can be super painful.

The infection can include eyes and soft tissue super infections.
Stay clear of close skin to skin contact with anyone infected (contagious for duration of rash, ie, 2 to 4 weeks-ish). Image
3/ I highlighted this fascinating @NEJM paper for you...
Essentially the drug approval process for TPoxx, a med you’ll get if you get seriously sick with MPox, goes back 34 years to the HIV epidemic and also Small Pox.
Read up…link to this paper is in tweet #1 ImageImage
Read 7 tweets
Aug 3
1/🧵 MonkeyPox, ChickenPox, SmallPox:

Let’s talk poxpoxpox…
✔️#MonkeyPox has 4 deaths
✔️Is it a panedmic?
✔️What do you need to know?
✔️Here are key take homes
JAMA -bit.ly/3S6IKs9
2/ Many people are holding off calling #MonkeyPox a pandemic.
Epidemics that “get passports” travel.
Mpox seems to have a global passport.
Sustained spread in >80 countries seems likely.
3/ The window for controlling Mpox is closing - eternal optimists are hoping enough vaccination can beat it.
Judging by how we handled #COVID, I’m betting Mpox will win.
@DrEricDing @kavitapmd make great points:

Read 18 tweets
Jul 29
1/🧵 Worrying
If I’m #worrying, I’m usually either troubled over a past event or fearful of some hypothetical future event that might never happen.

📍Neither is real time.

The #present moment is where the action is if I really want to make a difference & find peace.
2/ In #Al-Anon (a spiritual but non-religious program I attend), we say that worrying is like a rocking chair. I’m doing something, but I’m getting nowhere.

If I want to get to a place of spiritual enlightenment, I must learn to #Live in the #NOW.

It’s easier said than done.
3/ Try moving thoughts of the past & future from your mind to create space in your 🧠 to completely soak up the “now” you’re living in. Imagine when you remove those past & future thoughts that are you actually have space to allow the present moment to fill your thoughts.
Read 4 tweets
Jul 18
1/🧵 Training Young Docs & Nurses💥

#JULY is a big time of year for medical trainees who move to the next level of their careers.

Question: How do I best serve them as a teacher & help them succeed?

Tip: this helps me be a better dad & husband, too.

2/ As a “coach” of younger doctors (or my kids or athletes, etc), there are certain truths I have learned:

Ultimately, students’, athletes’ and children’s successes and failures are their own. Not mine.

I shouldn’t take credit for their successes nor blame for their failures.
3/ I must, of course, protect patients from misdiagnoses & treatment errors.

While overseeing younger physicians’ progress to independence, I have to prioritize patient safety.
Read 8 tweets
Jun 27
1/🧵 Hacked on Twitter - what did I learn⁉️

I & other physicians’ @verified @Twitter accts were hacked last week…
This “micro-dose” of being silenced reminds me to do all I can to amplify the voice of others.
And it made me want to share a few thoughts about this platform…
2/ How did it make me feel?

📍At the mercy of others
📍Out of control

Of course, it’s just social media

But how we handle ourselves here prepares us to fight #Testimonial #Injustice

No one wins if we stifle the voice & truth of another person.
3/ Detachment

I’ve been working on detachment from the lure of worldly things.

When the hackers stole control of my account, my 1st thought was that this was a perfect opportunity for me to practice detachment.

If I’m truly detached, my pulse should remain a calm 46 bpm 😎
Read 11 tweets
Jun 15
1/🧵 Long COVID Brain Science: 🧠

For ~100M suffering 🌎, let’s use data to combat myths & #Misinformation

COVID is biologically dangerous long after virus is gone

#LongCOVID affects our….

📍Olfactory & Limbic Systems
📍 Interferon Autoimmunity
📍PET scans

How? Image
2/ First, Epidemiological comparisons…


Survivors of viral infxns like #Flu don’t complain of 200 long-term symptoms & ~90% ongoing mood disorders.

#LongCOVID pts do.

Flu kills 0.5M/year vs COVID has killed 10X that (5M) in just 2 years.

3/ Consider this:

A study of 150k COVID survivors, hospitalized & not.

COVID survivors had 10-15X ‼️higher risk of considering #suicide at 1 year than 11M control patients.

This is horrifying, yet people still deny #LongCOVID’s importance.


bit.ly/3HnHZpB ImageImageImage
Read 27 tweets

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