🧵1/ Here’s your “Big Picture” of COVID & Long COVID for 2022
See my new Figure👇 summarizing #COVID19 Management & Outcomes
Two years in & we have splendid choices.
Stay in peaceful waters of prevention (green) or risk treacherous cliffs of #LongCOVID & Death (red & black)… 2/ Knowledge is Power, and our knowledge has grown dramatically.
Let’s take a look at where we were just 2 years ago - even though it seems like 20 yrs ago.
April 2020: our approach & understanding of COVID looked like this👇.
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… 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.”
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.
Apr 25 • 11 tweets • 3 min read
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?
Apr 7 • 9 tweets • 3 min read
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?
Apr 7 • 8 tweets • 4 min read
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.
Becerra told reporters Tuesday. "Millions of Americans may be ⁉️struggling with lingering health effects…”
nbcnews.to/3ramyS32/ 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.
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.
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.
Mar 3 • 13 tweets • 9 min read
1/🧵 WAKE UP - #COVID is a Ball & Chain for heart disease & stroke.
This 154,000 pt study & others solidify COVID as a PREDICTOR of a variety of CardioVascular Dzs.
Translation: #LongCOVID pts suffer heart attacks, strokes & much more.
go.nature.com/3pxKjmi2/ SHOCKER: Amazing work scientifically. Every med student is taught to gauge Cardiovascular risk history: Smoking, Obesity, HTN, Cholesterol, Family History…
Add COVID to the list. Solid data from @NatureMedicine of US Veterans used >11M contemporary + historical controls!
Feb 28 • 16 tweets • 11 min read
1/🧵 Are you happy?
My brother w #DownSyndrome is teaching me tons of life lessons.
In medicine & in life, I make big decisions based on guesstimates of other’s Quality of Life #QOL.
I often GET IT WRONG!
What do adults w #disability teach me about TRUTH?
Can I learn?
2/🎥 How do we “calculate” someone’s #QOL?
#Confession: I get it all wrong when I impose MY judgment onto THEIR life.
Greg, my 57 y/o brother-in-law with Down Syndrome, has a better QOL than I do.
2/ Dr. Farmer started his vocation of #SocialJustice by serving the beautiful people of Haiti, the world’s 1st Black republic. He looked in their eyes & saw their needs…HIV, malaria, Tb, hunger, poverty, neglect.
In response he took action…
(paintings below by my daughter)
Feb 21 • 10 tweets • 9 min read
1/🧵 Why is COVID hospitalization like 2X sticks of dynamite 🧨?
Prevent this w 3 steps:
📌Avoid #COVID by Vax & Mask
📌Avoid severe COVID by Paxlovid & Monoclonal Ab
📌👇 read here about PICS & how to reduce injury in the ICU
2/ Here’s what you must know if you get too sick & land in an ICU.
History Lesson 📝
In the past, too many decisions in #CriticalCare were guided by fear. We oversedated patients for too long out of worry they might self-extubate & pull off restraints.