Gonna say it and keep saying it: vitamin D is a reverse acute phase reactant and also is low in most chronic disease. It stands to reason the lower the vitamin D the more someone is at risk of hospitalization or dying from COVID, but the low vitamin D is a marker for other issues
Massive vitamin D supplementation has never been shown to help any condition except frank vitamin D deficiency. Take your pills in the winter but there is not some massive conspiracy against vitamin D among physicians.
I will say that I have caught hyperparathyroidism 3x in people who start supplementing and a ton of cognitive and joint pain issues get worse so there’s that.
If something is a reverse acute phase reactant sometimes you gotta wonder if there is a good reason the body ratchets down 25 (OH) vit D3 when you are sick.
questions about the hyperparathyroidism...there’s a lot of overlap between refractory depression and pain/fibromyalgia and brain fog just keep your ears open, because all those are symptoms of hyperparathyroidism too. If just started vit D or you measure a vit D and super low...
Be suspicious and get a calcium level.
Honestly this is the hardest part of telepsych. Mailing labs. Not being able to see people and their complexion and how they walk and if they have nicotine stains on their fingers or if their buttons are buttoned. I feel like I’m missing a lot of medical stuff.

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More from @evolutionarypsy

28 Dec 20
Well this is interesting nytimes.com/2020/12/28/hea…
...honestly I would discount any patients super sick in the hospital reports as “new onset psychosis” it’s probably delirium. But the outpatient cases sound like delusional disorders. Unlike schizophrenia which tends to hit late teens, 20s for men and 20s-30s for women...
...or there’s a second peak for women at menopause, delusional disorder tends to strike middle age people. Not surprised there could be an infectious (inflammatory) precipitant.
Read 7 tweets
28 Dec 20
Still mad they named it COVID-19 and SARS-CoV-2 in the age of cell phone keyboards. WTF.
Get it together, WHO
COVID and SARS2 are good enough
Read 4 tweets
28 Dec 20
Gentle note to writers: opioid use *constricts* the pupil. Withdrawal causes dilation.
If you are a writer and want a nice layperson introduction to effects of opioid intoxication and withdrawal, trainspotting does a great job.
This is a very nitpicky point but “opiates” cover opioids derived from the poppy plant whereas opioids covers all of them including the man-made ones like methadone.
Read 6 tweets
11 Dec 20
Now that we have a few vaccines that seem to work do y’all want to hear my really grim theoretical predictions for the pandemic if the worst things happened?
I hadn’t widely shared them because they are awfully negative. Fortunately I think we will most likely be spared at this point. But their possibility made the #flubro crowd especially irritating to me.
we know sars-cov-2 infects many other species (rodents, cats, dogs), though not necessarily to them and back to humans. However they definitely go to minks and back to humans. This means it’s really really tough to get rid of completely. Also more opportunity for mutation.
Read 8 tweets
11 Dec 20
Trying to imagine the pandemic course if we had a competent federal government. That 6 week testing delay cost us a lot of lives. Earlier surveillance and testing would have meant spring lockdowns started a bit earlier, eliminating the northeast huge peak in April.
Nothing would have prevented the southern states from opening up without care => the summer peak, but lower levels of virus in the country from the spring might have mitigated it a little.
By September a government that had it together probably could have blanketed the country with rapid tests. Frequent testing + social distancing measures mitigated and prevented outbreaks in colleges in Massachusetts and the NBA and entertainment and news industries.
Read 4 tweets
10 Dec 20
Y’all there is one Malaysian factory that produces most of the world’s medical grade nitrile gloves and they had >20k workers sick with COVID and several large medical centers are going to run out of gloves by the weekend.
The US reserve stockpile of nitrile gloves is almost extinguished.
Restaurant grade could be a substitute for many indications but the raw materials are the same and the backlog is extensive.
Read 5 tweets

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