▪️Prof Greg teaches me to accept life on life’s terms
▪️ICU pts teach me how to traverse pain
▪️Gratitude is their close companion
▪️Gratitude is not just a tenet of etiquette – it’s an essential quality of well-being
2/ I can’t pay gratitude w a checkbook, only from the ❤️
📍My Gratitude Ledger is in deficit because I don’t nurture #Wisdom
📍I underutilize this superpower of recovery
📍Gratitude is Greg’s antidote to victimhood
📍It helps him rise above any situation
✔️ This fact is encoded in nature itself
✔️I came into existence completely & totally helpless & unaware of who I was
✔️Everything immediately following birth was done for me, except natural body functions & even these were tended to by others!
5/ Even as a child, I’d already accumulated innumerable gifts for which to be thankful & I plunged “into the red” in terms of gratefulness.
Somehow Greg never dipped into a well of self-pity
His heart remained where I want mine - constantly accepting what IS…
6/ Everything given to me has come at some sacrifice from someone else.
Sometimes these sacrifices were done voluntarily & joyfully, sometimes they were done begrudgingly.
Either way, sacrifices were made, and I do not stand alone on an island…
gratitude is in order…
7/ It is a difficult truth that in some cases I owe a debt of gratitude to people who have not been very virtuous themselves.
A child of a bad parent may have many legitimate complaints about that parent…
Yet immense gain is mine of I change my mindset.
8/One of the ways I get a sense of the importance of gratitude is by experiencing #ingratitude from others.
The feeling of being used is painful when I’ve given to others, or worse, when they deny the reality of the gift itself as if I had no role to play in their receiving it.
9/ Pain is greater when my gift was out of genuine love & not merely out of a sense of duty or pity.
Until I reach a greater state of spiritual enlightenment, the experience of ingratitude from others still leaves me feeling angry, betrayed & deeply hurt.
This is my error.
10/ Let’s go deeper on this topic…
Does Ingratitude diminish personhood❓
🔹I believe it’s in giving that I receive
🔹When my gift is not acknowledged, does it diminish me?
🔹Am I bereft because I gave at a cost?
11/ When ingratitude is present, the reciprocity that connects giver & recipient is absent.
There’s a lack of wholeness in the relationship that I had anticipated.
Expectations control my thinking 💥
Good news: I can drop expectations in favor of acceptance.
12/ A true gift is of course isn’t given with strings attached.
It’s not a fee paid for a service the giver expects to be rendered.
Gratitude is not the performance required after a purchased service.
13/ Those dynamics are appropriate to contractual agreements - not personal relationships.
Gratitude presupposes a genuine freedom on the part of both giver & recipient.
The giver is not compelled to give, the recipient is not coerced to receive.
14/ Gratitude is the spontaneous reaction of appreciation in response to a gift, no matter how small.
When true giving is met with genuine gratitude, both giver & recipient grow in goodness.
But should my growth or joy in giving be diminished by a recipient’s anemic response?
15/ As a father, I have allowed myself to take it personally when what I gave was discarded or unwanted.
This is because I manufactured expectations that were unrealized.
Again, my problem…not theirs.
16/ As a recipient of #Grace, my own ingratitude imprisons me
☑️In contrast, gratitude transforms me as a recipient
☑️Gratitude takes the focus off me & orients me to the generosity of the Giver
☑️Thankfulness liberates me & predisposes me to receive greater spiritual gifts
17/ Wherever you are, whatever your station, how grateful are you?
How often do I accept the gift but fail to give thanks to the giver?
How often do I cherry pick the gifts for which to be grateful?
#Greg is very consistent.
My patients are a close second in thankfulness.
18/ Ultimately I want to detach from what others say & do.
Except to draw on those experience & learn myself.
To become more like Greg, accepting of my place in this 🌎, I must SIMPLIFY my thinking.
🔸Let’s Unpack @NEJM
🔸Hear from patients
🔸We call LC a disease state
🔸It’s a clinical definition
🔸Adding Inclusion/Exclusion Criteria to our @theNASEM definition fosters great research definitions
🔸 I admit my early mistake…
“Long Covid is an IACC occurring after SARS-CoV-2 infection & present >=3 months as a continuous, relapsing and remitting, or progressive disease state that affects one or more organ systems.”
Read caveats in text box…
3/ Patients describing Long COVID – read text box
“My long Covid life remains terrifying. Last weekend I washed my car, dried it, put it back in the garage. Then I got violently sick and could hardly get up to get food. I was unable to read or even call my mom. I’m a shell of myself. But my physical issues aren’t half as bad as my brain problems. It’s hard to describe. You can say brain fog, but that doesn’t come close to doing it justice.”
“At work my brain is just begging for rest. I struggle with finding words and completing tasks in a timely manner. … I’ll be in a meeting and know exactly what I want to say before I say it. …I’ll get to a word, and I just cannot think of the word. I’ll just be like, ‘Give me a moment,’ and I’ll go through my brain cycling through words. This week the word was “consistent.” I couldn’t think of the word consistent. I kept thinking it was coincident or concentric or constant. I used to build prototypes multiple days a week, and now if I do anything in the lab, I’m pretty much wiped out for a week. …I mean, I’ve had to dig real deep. How much longer will I feel like this? I’m scared.”
2/ Tryptophan is an essential amino acid - we don’t make it.
So if we’re “programmed” to absorb ⬇️ from our diet, we sleep poorly, think worse, and all sorts of other bodily functions go awry.
Will SSRI & SNRI meds help, or anti-virals, or immuno-modulators?
Trials will tell.
3/fin
This study by @maayanLevy_lab is a marvel of dozens of avenues of science that all point to a greater understanding of the realities of #LongCOVID as a chronic disease state.
Through work like this, we legitimize not only LC, but also #MECFS #LongLyme etc & take one step closer to finding medical solutions for past & future post-infectious states + syndromes like #PICS
1/🧵Catatonia - shocking & hopeful insights into a mysterious neurological disorder 💥
Did Oliver Sacks’s Catatonic “Awakening” Patients have a treatable Autoimmune Disease?
Here I unpack story & science from a stunningly well-done @WashingtonPost article
2/ Amazing Discoveries of Autoimmune Disease causing Decades of Catatonia, Schizophrenia
Autoantibodies and treatment with immunosuppressive medications are waking some patients up with crazy cool results. Here’s the article and my highlighted excerpts:
3/ “The first conclusive evidence was in her bloodwork: It showed that her immune system was producing copious amounts and types of antibodies that were attacking her body. Brain scans showed evidence that these antibodies were damaging her brain’s temporal lobes, brain areas that are implicated in schizophrenia and psychosis.”
📌 I didn’t think #MECFS was real till #LongCOVID opened my eyes
📌 It’s “mysterious” & we weren’t taught it in med school
📌 Yet 1,000s are suffering a disease traditional medicine doesn’t understand
📌 Let’s find answers
2/ Long COVID is estimated at 6% of US Population… @CDCgov
“Prevalence of #longCOVID among U.S. adults ≥18 ⬇️ from 7.5% during June 2022 to 6.0% during June 2023.”
More than 1 in 4 w LC have activity limitations, ie, it’s a LIFE altering disability.
📌A picture is emerging
📌It’s not pretty
📌Most pts w months-long symptoms aren’t recovered @ 2-yrs
📌The cluster including neurocognitive & cardiovasc symptoms is ominous
📌These data fuel trial design
2/ This Lancet investigation of just over 500 patients is not particularly large but is well done. The methodology used LC patients from Catalonia Spain from 3/2020 to 2/2022.
They included people who were unable to obtain Covid test but who had an acute onset of symptoms extremely consistent with the syndrome and who developed the same long-term definition of long Covid.
Some may argue about this point but the longCovid community has taught me how important these patients are to include in such research.
3/ Looking at this figure you can see the heat map emphasizing symptoms in clusters B & C that the authors are most confident indicate persistence.
📌Include ~340k COVID patients vs ~7M controls out to 2 yrs
📌Organ dysfunction persists in 33%
📌Levels of disability from #LongCOVID exceed those of cancer & heart disease‼️
Links at end of this thread
2/ Remember that these data complement the 8 or so other studies showing similar findings, and EXTEND the information using VERY large control groups w censoring if those controls got COVID.
✏️Thus, older and more white than the average #LongCOVID person
✏️They also do NOT help us with Delta and Omicron variant COVID
✏️These findings are robust and statistically sound and published by very astute and qualified investigators
✏️But they must be extended scientifically in cohorts that include a high number of younger women, people of color and lower SEC as well as newer COVID variants.