WesElyMD Profile picture
Mar 28 5 tweets 5 min read
1/🧵 True Medicine #LongCOVID
 
In #COVID & beyond, TRUE medicine, which is to say true healing ❤️‍🩹,  adapts itself to each suffering patient.
 
It’s the opposite of #gaslighting someone because her disease doesn't “fit” our model when she (eg) fails POTS criteria.

Instead…
2/ Our healing must have the character of MERCY, which means we #doctors & #nurses will bend our love to fit the shape of each suffering patient.

Only then can we lift her up.

It may means admitting we don't know what to do now other than listen more.

#Medtwitter #NurseTwitter
3/ I am drawn in by my patient's weakness, perhaps because I see even greater weakness in myself.
 
The person in front of me needs the help I can provide by mustering #compassion, the same compassion I seek from others for MY foibles, deficits & inabilities.
4/ My chief ERRORS at the bedside stem from pride, impatience, and from thinking I know “enough” and don't need to listen more.
 
Acknowledging the limitations of my ability to see the entire person forces me to ask more questions so that I can hear and see what is needed of me.
5/ fin
No more depersonalization chambers!👇

In #LongCOVID, what I hear so often from @CIBScenter survivors is that they feel depersonalized.

They are told it's all in their heads.

No.

Let’s work to create a system of #LongCOVID clinics & support groups for the millions.

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More from @WesElyMD

Mar 29
1/🧵Serious question:
Is it ok to CLAMP OFF blood vessels to a human brain to stop cell function & get organs for transplant?

A new procedure does this to ensure no blood reaches a person’s 🧠 as surgeons take organs from freshly ‘dead’ bodies. Discuss.

bit.ly/3tEZhtl Image
2/ We all want to relieve the suffering when people are dying of failing kidneys, lungs, hearts.

Transplant can be a great solution.

As a transplant physician myself, I directed lung transplantation at #Vanderbilt.

I worry this new approach is a breech of the dead donor rule. Image
3/ The “dead donor rule” (DDR) says donors must be determined dead according to established legal/medical criteria PRIOR to procurement of vital organs.

What if there are doubts?

Like ongoing neuronal activity?

Can we take it upon ourselves to stop blood flow?

My letter:👇 Image
Read 15 tweets
Mar 21
1/🧵 Wanna learn from a 61-year love affair? ❤️

They met at a drive-in burger joint in Memphis. Elvis blaring.

He peered into a car of 6 teenage girls & saw her.

💭 “That’s the most beautiful girl I’ve ever seen.”

They’ve been madly in love ever since.

(Pics & story w perm)
2/ Pain feeds pain, but love & gratefulness starve pain…

Mr. M came into the ICU w sepsis & shortness of breath.

We placed him on life support to help reduce his suffering. The disease proved too much.

Fortunately, sadness & despair took a back seat to what happened next…
3/ In 1961, the night they met, the teens went to a bowling alley.

She didn’t have permission, so she walked home.

He found the girls & asked, where’s your friend who was sitting in the back seat?

He couldn’t get his mind off her smile…
Read 14 tweets
Mar 16
1/🧵🎥 “It’s a very bad disease. It can be overcome.”
 
My #COVID patient tearfully speaks of his BIG DECISION on the ventilator.

This soldier & leukemia survivor made it through 3 weeks on a ventilator. How?
 
Video shown w his permission “to help others find hope, Doc.”
#Hope
2/ This immunocompromised man was in massive viral septic shock from COVID.

Huge doses of vasopressors.

Gargantuan levels of O2 & vent pressure to save his life.

Lungs, Kidneys, Heart and Brain all failed.
3/ His wife was there with him daily.

We put up pictures of his kids and pets.

We talked to him about the things he loved every day (even when sedated and seemingly unable to hear us).

Somewhere in all of that, he made a silent decision…
Read 8 tweets
Mar 11
1/🧵 Let’s learn about Ace inh-induced angioedema
 
His lips & tongue swelled up hours after taking a blood pressure med he’d been on 10 years - lisinopril.

📍What’s the treatment?
📍Is it an allergy?
📍What’s a common thought error?

(Pic w Perm - trigger warning tweets 2 & 4)
2/ Angioedema is potentially life-threatening
 
It’s very scary to see the tongue & lips swelling up so much and the airway compromised.

The patients are watched in the ICU so that intubation and even tracheostomy can occur emergently if required.

What’s the Dz Mechanism?
3/ Is ACE-inh induced Angioedema an allergy?
 
NO! It’s not an IGE mediated allergic reaction.

💥 Pro Tip:
People can get angioedema from allergies, but they would be very itchy, and my patient was not itching at all.

That's because it's mediated by a buildup of bradykinin.
Read 11 tweets
Mar 10
1/🧵 Let’s talk Long COVID:

I’m grouping several important & interesting articles about the reality of #LongCOVID.

By studying brain fluid, viral persistence & MRIs, we’re building our understanding of the “how” & “why” of this devastating malady.

A train is coming, read on…
2/ Cerebrospinal Fluid Offers Clues to #BrainFog

Most pts w new “thinking problems” after mild #COVID had abnormalities in fluid from lumbar punctures (image); controls did not.

Delayed #LongCOVID was common in younger people who thought they were safe.

bit.ly/3pS0JWN
3/ Believing those with #LongCOVID complaints is our 1st basic show of support!

“If people tell us they have new thinking & memory issues, I think we should believe them rather than require that they meet certain severity criteria.”
Dr. Apple UCSF

bit.ly/3sUNczF
Read 16 tweets
Mar 9
1/🧵 A sister & two brothers were born into a wonderful family. They led an exciting life. 4 months ago, 2 of them died young of #COVID, unprotected. The surviving sibling decided to get Vaxxed but stopped after 1 shot & is now on ventilator (CT scan) w COVID pneumonia. Read on…
2/ A teaching Point: This CT scan shows “holes” in his lung (red lines above & arrows👇) surrounded by white pneumonia.

The holes are previously damaged lung from smoking.

Millions in society, victims of misinformation, remain unprotected & the vaccine could save their lives.
3/ Let’s all do our part to teach others.

When polio hit, almost everyone wanted to be vaccinated despite the disclosed risk of getting polio from the live attenuated vaccine.

This vaccine is even safer and yet the untruths spewed by many have tainted our uptake.
Read 4 tweets

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