WesElyMD Profile picture
Apr 26 6 tweets 4 min read
1/🧵 Does Alcohol shrink the brain?
 
Yes, all liquor can hurt our brains if we drink too much. The disease of Alcoholism, which is NOT the fault of the person afflicted, causes brain injury slowly over time.
 
A picture is worth 1,000 words. Look below at a diseased brain…
2/ Gray on this CT scan indicates actual brain tissue.

Do you see the black areas pointed out here by RED arrows?

These are called sulci (grooves).

This <40 year old person has VERY large grooves that show the amount of brain tissue as we would see in someone >80 w dementia.
3/ Normally brain grooves are small in young people. See example👇.

When someone gets dementia, s/he can lose actual brain tissue (less gray) and the area fills in with fluid (BLACK - sulci).

SO this is atrophy & manifest in life as memory problems & executive dysfunction.
4/ Patients with this problem are high risk for #delirium – eg, hallucinations, delusions, global brain problems.

The key to healing includes acute medical management and long-term recovery programs possibly w cognitive rehabilitation.
 
WebMD review:
wb.md/3OD4NF6
5/ Data: @TheLancetPH

Researchers analyzed data from more than a million adults in France diagnosed w dementia 2008  to 2013. They found that chronic, heavy drinking was a major risk factor for all dementia, especially early onset dementia.

Link: bit.ly/3MANi6H
6/fin
Everything in Moderation.

Alcohol is an elixir if imbibed in moderation. In 🧵👇, I went over all this.
 
To ease suffering, we must help our brothers/sisters find a path to long-term recovery.
 
Never blame. Never shame. Healing occurs one day at a time #ODAT

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More from @WesElyMD

Apr 28
1/🧵 What does it mean to be human?

How do I magnify human dignity?

I face this daily as we have dying ICU patients.

Recently 2 young men w #COVID, both progressive lung failure, chose not to be put on a ventilator.

Both young & fearful they wouldn’t survive if put on vent… Image
2/ I kept turning up HiFlow & Bipap. At one point each asked,

“What treatment is NEXT, Doc?”

Knowing I’d exhausted our solutions, I looked up again into each man’s eyes.

Honesty is the only way...

“Sir, your disease pushed beyond our tools. There’s no ‘next.’ No cure.”
3/ “What are you saying, Doc?

Then we went through his options again, which were narrow.

Talked with family, a holy time for all…still, no vent…

“Doc, are you saying I’m going to die? Wait, I want to go home.”
Read 8 tweets
Apr 25
1/🧵 I DARE YOU 👍

When we’re busy, relationships become I-It & should be “I-Thou”

How can we fix it?

I asked him 4 Questions:

What’s your favorite song, hobby, food, pet’s name?

Do this for 1 WEEK. How does it change the way you SEE & CARE for others?

Read on…(pic w perm)
2/ Hecame to our ICU service over night after his spinal fusion.

He would only be w us a short time & would then be gone. So why dive deeply into his history??

Because he’s an ENTIRE PERSON.

So every minute with him is a gift. What did I learn?
3/ His favorite 🎶 is anything by the Eagles. Hobby is cars. Food is Thai. Pet is a “white golden” named Hondo!
Read 11 tweets
Apr 7
1/🧵 You have a COVID ICU patient on benzos who doesn’t respond to needle injection of local anesthetic do to sedatives.
 
What depth of sedation do you consider this? (it was a CME question just now)
2/ The answer is GENERAL ANESTHESIA, which of course makes sense.

If a person is so deep that he/she doesn’t respond to getting stuck by a needle and the pain of lidocaine injection, that is general!

Why am I writing about this?
3/ Anyone working in the ICU this past few years of #COVID #PANDEMIC is seeing this depth of sedation on a regular basis.

We had almost gotten rid of this by 2019. Then COVID undid progress.

People now think this is normal for some reason.

It is NOT normal.

It is not OK.
Read 9 tweets
Apr 7
1/🧵 A personal story of misjudgment as a physician.
 
Years ago, when I was a young doctor, I had a patient in the ICU on a ventilator who was doing so poorly, day after day, that I was certain he was going to die.

I confidently told the family he was going to die.
2/ The family members all gathered and were extremely distraught. They listened and trusted me.
 
But I was wrong.

#PalliativeCare #EndofLife
3/ For many years to come, I received Christmas cards from this man.

It was extremely humbling.
 
Until I learned, this happened many other times in my life as an ICU doctor.

Sometimes I was off by just 2 weeks, sometimes 2 months, and other times by 2 years.
Read 8 tweets
Apr 6
1/🧵 #LongCovid is REAL & up to 23,000,000 ARE (not “may be”👇) suffering.

Yesterday, @POTUS announced expanded funding.

Becerra told reporters Tuesday. "Millions of Americans may be ⁉️struggling with lingering health effects…”

nbcnews.to/3ramyS3
2/ As part of its efforts, the White House said in a statement that Biden will push to accelerate a $1.5 billion study started last year by the National Institutes of Health to follow 40,000 individuals with and without long Covid to try to better understand the condition.
3/ Biden also proposed spending an additional $25 million on a $50 million study started last year by the Centers for Disease Control and Prevention to understand the risk factors, mechanisms of action and characteristics of long Covid, the White House said.
Read 4 tweets
Apr 5
1/🧵 Race & Medicine - #COVID

Dark-skinned people who get #COVID, or any disease lowering O2 levels, are more likely vs whites to suffer undetected hypoxemia (missed ⬇️ O2 levels).

Pulse oximeters are affected by skin color & read falsely high in Blacks.

Does it matter?
2/ It matters because undetected hypoxemia tripled the odds of DEATH 💀
 
This study of >128k measurements from 26,000 pts confirmed these inaccuracies that we’ve known about for 30 years.

Black, Asian & Am Indians were all included. #Disparity
 
bit.ly/3KaNAAj
3/ It’s not lost on me that this study comes at a time when we’re trying to get RID of false distinctions of race in medicine.

MYTHS generated by #racism about Blacks having different lung or kidney function are bogus.

But the Pulse Ox must addressed: bit.ly/3uZIrEG
Read 8 tweets

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