Neurologist, Director of #Dysautonomia Clinic, Clinical Associate Professor @Jacobs_Med_UB. Trained @MayoClinic #LongCovid #POTS #EDS, tweets🚫med advice
Dec 31, 2023 • 11 tweets • 4 min read
🎉Happy New Year! Back by popular demand, here is my top 10 list of noteworthy #POTS studies of 2023! 🎉✍️
1/🧵
#NeuroTwitter #MedTwitter #MedEd
In no particular order:
1⃣ "Postural tachycardia was significantly less in the active arm compared with the sham arm at 2 months. Antiadrenergic autoantibodies & inflammatory cytokines were lower in the active arm compared with the sham arm at 2 month." sciencedirect.com/science/articl…
Sep 13, 2023 • 6 tweets • 2 min read
Here we go: a great teaching case from a patient I just saw a minute ago. 1/🧵
🧠 60-yo woman with diabetes type 2
🧠 complaints of chronic dizziness and lightheadedness for a year
👇 screenshot from a note by her local neurologist
#tweetorial #MedEd #NeuroTwitter #MedTwitter
✅ Pt denies vertigo and headache
✅ Pt denies falls or stumbling
✅ Pt denies tachycardia, chest pain or fluctuating BP
👉 Pt does have numbness in the feet, worse over the past few years
👉 Pt does walk less now, fearful of not being able to return home from a walk
2/🧵
Jun 27, 2023 • 7 tweets • 2 min read
Reading the articles in the mainstream media on #LongCovid and mental health got me thinking: when did mental health become the basis of a disease process? Mental health is important in health and disease, but is not a substitution for scientific advancement. 1/n
We have zero FDA-approved treatment for #LongCovid. Nothing has been developed, everything is used off label. Talking about CBT and exercise for Long Covid is like talking about CBT and exercise for treatment of post-Covid diabetes before insulin was invented.
2/n
Jun 13, 2023 • 6 tweets • 2 min read
Saw a patient for a 2nd opinion on "weakness" and rule out #myasthenia. Lots of medical records from different specialists that I had to review prior to her appointment.
1/🧵
#NeuroTwitter
Patient had a mediastinal mass found on CT, initially thought to be lymphoma, then fortunately, diagnosed as residual thymus tissue. Acetylcholine receptor antibodies and EMG were unremarkable. She did not have any bulbar weakness, only subjective arm and leg weakness.
2/🧵
Jun 1, 2023 • 6 tweets • 4 min read
Participated in a very interesting multidisciplinary POTS conference at @HopkinsMedicine on the topic of #FND, #syncope and #POTS where we discussed and debated the numerous issues surrounding FND diagnosis in our patient population. 1/🧵 #MedTwitter#NeuroTwitter@HopkinsMedicine After conference, saw a patient who highlighted the issues discussed at conference.
👩🦽30 yo woman with POTS/MCAS/EDS triad with one TTT positive for POTS, but a 2nd TTT negative
❌ A neurologist diagnosed her with FND
💉 She is on allergy shots & many H1/H2 blockers.
2/🧵
frontiersin.org/articles/10.33…@Dysautonomia What the study found:
✅ Out of 59 patients who qualified for #FND diagnosis by DSMV criteria, 88% had autonomic symptoms!!!
✅ 27% were positive for ganglionic acetylcholine receptor antibody (gAchR Ab) via LIPS assay.
✅ 50% had #POTS.
✅ 50% had orthostatic hypotension.
2/🧵
Feb 9, 2023 • 5 tweets • 3 min read
On biomarkers: Patients with #Dysautonomia have preload failure. Invasive caridopulmonary testing or cardiac catheterization proves it. I just had a patient with post-Covid #POTS who had the tests done to rule out heart disease. She had no CAD, but did have preload failure. 1/🧵
Her excellent cardiologist @FudimMarat identified the problem and correctly diagnosed it. His findings were consistent with Dr. Systrom's study on preload failure. 2/🧵 onlinelibrary.wiley.com/doi/10.1086/68…
Feb 2, 2023 • 5 tweets • 2 min read
I love it when a patient tells me that they feel 70% better compared to a few months ago. How did we achieve this? By using MEDICATIONS. I see so many #POTS patients who's seen many doctors for years, but barely any meds have been tried. Finding the right meds is the key. 1/🧵
Most of my patients have seen dozen of doctors before. They're not interested in me recommending increased fluid and salt intake: they've already tried it, and it's not enough. They want symptomatic relief. They want regaining their ability to work. They want solutions! 2/🧵
Jan 3, 2023 • 10 tweets • 7 min read
✍️ Inspired by others, here is my top 10 list of noteworthy 2022 studies on #POTS & other common forms of #Dysautonomia (in no particular order). #MedTwitter 🧵1/10
Believers that #LongCovid is "all in your mind" because there are on specific biomarkers or routine diagnostic tests are "normal" need to look at other autoimmune/inflammatory disorders. In #MultipleSclerosis, or example, it took decades to refine the diagnostic criteria. 1/🧵
First, before MRI/CT scans were invented, many #MS pts were misdiagnosed with psych disorders, including hysteria. Spinal taps in MS patients did not always reveal abnormalities. Many patients had various non-specific white matter lesions in MRI, but some had few or none. 2/🧵
Dec 5, 2022 • 5 tweets • 2 min read
🧵The new generation of doctors should be trained in compassion & non-biased approach in patients with chronic illness. Many of us have been trained to think "it's just anxiety" or "they're somatizing" when faced with a difficult patient. We were primed to dismiss & gaslight. 1/n
I remember attendings teaching us that if a nonparalyzed pt is in a wheelchair w/ sunglasses on for light sensitivity, that's a bad sign (ie a sign that they have psych problems, not real physical illness). I didn't know then that they would be my patients with #Dysautonomia. 2/n
Nov 8, 2022 • 10 tweets • 4 min read
A 🧵on an article that I won't repost here that claims there are "both sides" to #MECFS and #LongCovid with the sides being "psychological" vs. "physical." As a neurologist specializing in post-infectious syndromes, with #MECFS being a common subtype, I see a lot of confusion. 1/
This confusion is especially prominent by physicians and non-physicians who do not see patients with these disorders. It's natural for people to want to reduce the complexities of disabling chronic illness to easily quantifiable, diagnosable and treatable disorders, but... 2/
Sep 24, 2022 • 13 tweets • 7 min read
The authors from the @Brain1878 study with a false claim that #POTS is psychogenic respond to all of the letters with more false claims. I'll try to outline them here 🧵: 1. They say, "the underlying cause of POTS remains elusive, and regrettably, there is no effective 1/n
@Brain1878 treatment."
- No, the cause is not elusive, there are multiple causes and multiple treatments.
"Working hypothesis largely overlooked the role of cortical neurons."
-No, I published a paper with a working hypothesis that POTS is a CNS disorder. link.springer.com/article/10.100…
Aug 26, 2022 • 4 tweets • 2 min read
Very happy to share our new study on #immunotherapy in #POTS. We conclude that patients w/ severe, treatment-refractory POTS experienced significant improvement with subcutaneous immunoglobulin or PLEX. Randomized controlled trials are needed. #MedTwitter link.springer.com/epdf/10.1007/s
