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Erin C. Sanders, MSN, WHNP-BC (She/Her) Profile picture
@ErinSandersNP
Oct 15, 2022 • 32 tweets • 19 min read • Read on X
A core mission of mine has become deconstructing the false binary fallacy of clinician vs patient that is perpetuated by both sides.

And instead making space for the many clinicians & trainees who are also patients & bring hard earned patient wisdom to their practice & science🧵
2/ Being able to translate patient experience into the language of science, medicine and healthcare, and connect worlds of expertise has tremendous value.

These often painful experiences can enrich the care and wisdom we offer to others.

When you know better, do better ♥️
3/ On ableism and exclusion of disabled clinicians in healthcare:
4/ The rest of this thread, I’m going to link some accounts, books, and articles of clinicians who have been public ally open about also being patients and some lessons they have learned ♥️
5/ First up, my dear friend @RanaAwdish. Rana you are & have been a buoy in an endless sea of uncertainty for so many of us. There is so much power in witnessing & validating pain.

Your book #InShock is essential reading for anyone caring for patients. TY for art, light & hope
6/ (These amazing folks are not in any particular order other than the order of what my brain can recall)

Like Dr. @RanaAwdish, @marklewismd is also a cancer survivor. He is also an oncologist who cares for other patients with cancer. A brilliant clinician with epic dad jokes ♥️
7/ I call @DocZing a golden Zebra. She is an incredible clinician with training in orthopedics and preventive medicine. Alissa built her own practice #PRISM to care for patients with Ehlers Danlos Syndrome #EDS because she has the connective tissue disorder herself. ♥️🦓
8/ @MDaware works as an emergency medicine physician. In January, Seth detailed his journey of navigating our broken systems to get a rare diagnosis of paraneoplastic syndrome. He also plays the guitar & has a hilariously dry sense of humor.
9/ @RuhoyMD is one of those shooting star type of people. Ilene is a brilliant neurologist, an unrelenting medical detective, a fierce advocate, & an all around amazing human. She is also a cancer survivor & sees daily how our system fails patients. ♥️
10/ @Twitter's favorite ophthalmologist, @DGlaucomflecken, is also a survivor of cardiac arrest & cancer x 2. Will has spread laughter & joy during a horrific pandemic. I also appreciate his open stance against insurance companies unfettered corruption.
11/ @drjessigold has been such an incredible advocate for mental health, especially for healthcare professionals during the pandemic. Jessi has also been vulnerable about the stigma that comes with these diagnoses & the use of medications that can help.
12/ Dr. @Craig_A_Spencer survived Ebola infection & then fought #COVID on the frontlines in New York. When patients started talking about #LongCOVID, he was one of the few physicians who openly believed them and talked about his own long recovery journey.
13/ .@ShawnteJamesMD is joy personified. She is a pediatrician who cares for babies and delights @Twitter with stories of their adorableness. Dr. James is also an cancer survivor and shared her experience here for us:
14/ Dr. @Adamhill1212 is a pediatrician specializing in oncology and palliative care. As he details in his book, #LongWalkOutOfTheWoods, Adam is also in recovery from substance use disorder, depression & suicidal ideation. Your vulnerability is STRENGTH ♥️
15/ Both Dr. @rocketgirlmd (internal medicine) and Dr. Paul Kalanithi (neurosurgery) shared the story of navigating Paul's terminal lung cancer diagnosis during their medical training in the book #WhenBreathBecomesAir. It is an *incredible* read ♥️
16/ .@DrJenGunter is an OB/GYN and a fierce advocate for women's health and women's rights. Jen had a very complicated triplet pregnancy and lost one of her babies at 22 weeks. Her 2 other sons were born at 26 weeks & after their birth she became septic.
17/ .@jfitzgeraldMD is a female pelvic medicine reconstructive surgeon and OB/GYN rock star.

"I knew that if I was my own patient I would say, "just get an ultrasound!"--so I did, and I found a 7cm ovarian mass." (thankfully a benign Cystadenomafibroma)
18/ Dr. @arghavan_salles is a minimally invasive and bariatric surgeon and a thoughtful speaker in recognizing bias.

"Even those of us who love to control everything in our lives must surrender to the reality that we cannot control fertility."

19/ Dr. @DianaCejasMD is a pediatric neurologist. She was diagnosed with cancer in residency (a malignant carotid body paraganglioma) and shortly after suffered from a stroke.

Hear her story here:
20/ I am so grateful for @drannamvaldez because for as ableist as medicine is, nursing as a profession is almost worse 😞. Anna is a professor, and scholar and also has several autoimmune disorders, including Lupus. She is kind and compassionate and a powerful force for change ♥️
21/ And then there is me. November will be 3 years since I first got sick. It has been an odyssey and it’s not over. I keep collecting diagnoses like rare coins. I need a rollator & a cane to ambulate and my health has deteriorated to the point that I’m mostly house bound. 😔
22/ I still hold on to the hope that I will get better. It’s been incredibly healing to find others here who *get it*.

I know there are many more out there and it’s not always safe to disclose disability.

But I plan to keep adding to this thread as a reminder that we are human.
23/ In August, @DrDevikaB is a pediatrician and a former acting CA surgeon general shared her diagnosis of bipolar disorder.
24/ @dgurdasani1 has not only been an incredible voice of reason during the #COVID pandemic, she is trained in internal medicine and genetic epidemiology. She also has the autoimmune disease, ulcerative colitis.
25/ @AmyTanMD is trained in family medicine and palliative care. She almost died in a car accident and broke her spine in 4 places. She survived but has ongoing disability and pain.
26/ Dr. @jbullockruns is a research fellow in nephrology. He also published an incredibly genuine and honest account of his personal struggle with mental health as a physician in @NEJM. I am so grateful that you are here and that you have shared your story with all of us ♥️
27/ Dr. @annabonkhoff is now a research fellow in vascular neurology, But while she was a medical student she suffered from stroke and arterial dissection and underwent a thrombectomy. She wrote about her experience here on @Twitter & in this interview:

brainandlife.org/articles/docto…
28/ Dr. @AG_EM33 is dual trained in emergency medicine and critical care medicine. She also underwent a heart transplant for familial dilated cardiomyopathy that worsened after a viral infection in the middle of residency. She is amazing ♥️

29/ I love this thread so much, so I'm going to keep adding more brilliant patient-clinicians to it because it makes my heart happy. ♥️
30/ Dr. @MVGutierrezMD is trained as a physiatrist, she serves as Professor & Chair of the Department of Rehabilitation Medicine. She also has #LongCOVID. Despite her illness, she created a Post-COVID Recovery Clinic & is a fierce advocate for patients.
31/ Dr. @calirunnerdoc is a board-certified cardiologist, as well as Chief Medical Officer & Founding Director of a non-profit called Blooming Magnolia. She helps to research, advocate & support patients w/ #LongCOVID; tenacious patients just like her ♥️
@threadreaderapp please unroll, not sure how long this bird site is going to last 💔

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More from @ErinSandersNP

Erin C. Sanders, MSN, WHNP-BC (She/Her) Profile picture
Apr 12
The biology of neurotypical (allistic) brains is towards maximal efficiency. Microglia literally prune redundant synapses to strengthen neural connections. This works differently in autistic folks who have many more dendritic spines & less pruning🧵
Paper: nature.com/articles/nn.27…

Screenshot of line graph showing synapse formation over time with “Dendritic spine number” on y-axis and age/life phase on x-axis. Autistic Spectrum Disorder (ASD) is in magenta. Normal is in black. Schizophrenia (SZ) is in green. And Alzheimer’s disease (AD) is in Navy. Birth is marked as a vertical dashed line. Childhood is shown in light pink. Adolescence is in light green. Adulthood is light blue. Across all disease states dendritic spine formation and synapse formation increase rapidly after birth. With ASD extending the highest. This is followed by a rapid decline during adolescence ...
2/ These brains function differently. Many folks have superior pattern recognition. It’s not fully understood why. Some areas of the brain have shown more connectivity, some less. Many variables at play and lack of diagnosis especially in underrepresented groups are significant.
3/ Some literature cites higher incidence of neurodegenerative diseases in Autistic people but with the known diagnostic and representation issues, as well as how much we don’t understand about the brain, I’m not sure how much of that can be extrapolated to an entire population.
Read 12 tweets
Erin C. Sanders, MSN, WHNP-BC (She/Her) Profile picture
Mar 15
This is a really interesting thread on eugenics but has some glaring omissions like the connection with the current pandemic, ongoing US taxpayer funded genocide of Palestine, or that our country was founded on the genocide of Indigenous Americans and built by enslaved Africans🧵
2/ The glaring foundation of white supremacy, colonialism, patriarchy, ableism and capitalism should also be emphasized. Nazi propaganda of “useless eaters” is particularly relevant to our current moment in justifying the mass death of disabled people (as we disable more people)
3/ One could practically do a dissertation on the pandemic specifically explaining the harmful rhetoric and messaging from our administration, Walensky & Fauci regarding eugenics of “the vulnerable” when it’s *society* that MAKES people vulnerable

Here’s “falling wayside” Fauci:
Read 11 tweets
Erin C. Sanders, MSN, WHNP-BC (She/Her) Profile picture
Feb 14
Trump may have compromised the legitimacy of the CDC as a scientific institution but it was Biden and his appointees that gutted it.

So much needless suffering is about to happen.
It has *ALWAYS* been a workers rights issue. One could argue one of the largest in history.

If the people in power won’t protect themselves or their own families from infection, how little do you think they care about you and me? They prioritized “the economy” above all else.
Like let’s be crystal clear. This is WHY the disabled community was RIGHTFULLY FURIOUS at alleged pro-labor @SenSanders pushing the mild rhetoric.

Why saying Biden is “the most pro-labor president” DOESN’T MEAN HE CARES ABOUT YOU OR ME.
Read 7 tweets
Erin C. Sanders, MSN, WHNP-BC (She/Her) Profile picture
Jan 26
Cool. Cool. Now do reinfections…and multiple reinfections.

Then do a follow up test the next day because of cognitive PEM.

And maybe just listen to patients. Because they’ve been saying this since 2020.
cc: @sunsopeningband @tessfalor @WesElyMD

PAPER: thelancet.com/journals/eclin…




Screenshot text: “Pre-existing psychological or neurological conditions did not differentiate patients with PCC on objective performance neither (Fig. 6B). Given that depression was the most prevalent of the pre-existing conditions here (45%, see Supplementary Materials), this result is consistent with the absence of the aforementioned relationship between depression and cognitive slowing in PCC. Does the cognitive impairment get better with time? Patients with PCC showed the reverse trend: prolonged duration of PCC was linked with more severe cognitive slowing (r= 0.21, P= 0.003, Fig. 6C...
Figure 6 in paper How did the acute COVID-19 infection affect objective performance? (A) Although hospitalised individuals, regardless of PCC status, demonstrated no difference in RT in SRT (left) or NVT (middle), they were significantly less accurate (right). N (No PCC inpatients) = 7, N (No PCC outpatients) = 56, N (PCC
Fig. 1 Patients with PCC were slower than people without PCC, including those who had previously contracted COVID-19. (A) Simple Reaction Time (SRT)
Image
Computer based tests like this exist and patients can do them remotely at home. Because many patients with LC are severely disabled and just getting to a clinic is cognitively and physically exhausting.
Furthermore, in addition to the mountain of brain data we have on COVID and SARS2, there was this important finding from @PutrinoLab👇
Read 4 tweets
Erin C. Sanders, MSN, WHNP-BC (She/Her) Profile picture
Nov 28, 2023
“The @theNCI did not respond to multiple interview requests…” -@FortuneMagazine

It’s so dystopian that business magazines continue to have some of the best media coverage on COVID and longCOVID.

Oncogenic potential IS in the realm of possibility folks. And COVID is not over
The discovery of Hep B Virus was an EMBARASSMENT to @theNCI exactly because of the heavily funded and largely failed *Special Virus Cancer Program* from a scientist who LEFT the NCI in the 1960s exactly because of his interdisciplinary curiosity! Work that led to the HBV vaccine.
@theNCI The first virus discovered to cause cancer in humans was EBV (virus that causes mono) and Burkitt’s Lymphoma in 1958 by an Irish surgeon, Dennis Burkitt and two British virologists.

Caused a whole scurry of chaos with media printing “Cancer may be infectious!” in @LIFEmagazine.
Read 10 tweets
Erin C. Sanders, MSN, WHNP-BC (She/Her) Profile picture
Oct 16, 2023
Neurologic effects of SARS-CoV-2 transmitted among dogs. #NeuroCOVID

Kim D-H, Kim D-Y, Kim K-S, Han S-H, Go H-J, Kim J-H, et al.

@CDCgov Emerg Infect Dis. 2023 Nov. DOI: 10.3201/eid2911.230804
Original Publication Date: October 13, 2023

.

ABSTRACT 👇 wwwnc.cdc.gov/eid/article/29…
Evidence suggests that SARS-CoV-2 can induce brain pathology in humans and other hosts. In this study, we used a canine transmission model to examine histopathologic changes in the brains of dogs infected with SARS-CoV-2. We observed substantial brain pathology in SARS-CoV-2-infected dogs, particularly involving blood-brain barrier damage resembling small vessel disease, including changes in tight junction proteins, reduced laminin levels, and decreased pericyte coverage. Furthermore, we detected phosphorylated tau, a marker of neurodegenerative disease, indicating a potential link between ...
“According to our results, the brains of dogs infected with SARS-CoV-2 demonstrate severe BBB disruptions and consequent SVD-like pathologic signs, including axonopathy, glial activation, and potential neurodegenerative changes even WITHOUT neurologic signs.” #Asymptommatic #MILD
Screenshot “Furthermore, activation of the astrocytes and microglial cells was maintained up to 40 dpi, even when the virus was cleared from the brain. That finding strongly suggests that the glial cells activated by SARS-CoV-2 potentially harm axons or other components of neuronal cells, even when virus is absent in the brain. That topic could be the focus of future research that requires further in vitro/in vivo studies to reveal the mechanistic link between glial activation and neuronal damage mediated by SARS-CoV-2 infection. Tau phosphorylation is the hallmark of Alzheimer's disease. T...
Screenshot “our study has value as translational research to predict neuropathologic changes in the early phase of asymptomatic SARS-CoV-2 infection in humans because we have observed the kinetic pathologic changes in the brains of dogs that did not show any neurologic signs. Compared with other animal models, dogs are genetically similar to humans and their brain structures are similar to those of humans making our extrapolation more reliable. According to our results, the brains of dogs infected with SARS-CoV-2 demonstrate severe BBB disruptions and consequent SVD-like pathologic signs, i...
It’s been over 3 years since my review of the initial SARSCOV2 neuro case studies came out.

But now we’ve got autopsy studies and non-human primate studies showing virus in the brain (h/t @DaniBeckman)

And a dog model showing asymptomatic infection resulting in brain damage.
Read 7 tweets

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