Ashtangha Yoga or the eight limbs of Yoga-

After therapy sessions, it is occurring to me how my parents and maybe most desi parents don't really grow as parents. For example, a person would be a very different to a baby and to a teenager because the needs and vulnerabilities are so different.

But here, I feel that growth for parents stagnants sometime around when a child is 12-13. None of our parents really talk to us about puberty and growing up. None of us are taught or can talk about relationships because of moral reasons. So what do you have?

You have parents who are still parenting their adult children like kids, not apologising to us but asking us to eat, reminding us to wear jackets, locking up cars. They care. But they are coming from a care where the parent is always concerned about keeping the kid safe and alive

which imo really reduces the kind of parental advice and care one needs as an adult. Because adults know enough about the world to no longer be infantilized but we still have parents who expect us to be the same children because they're still the same kind of parents.

This is why so many of our parental relationships are strained or just based on civilities. We're forced to hide a lot from them because parents refuse to grow as parents and acknowledge us as adults. How many of us are still lectured, have curfews, other restrictions?

“Should I give them more fluid?”

Extremely common question during AKI referrals from junior docs.

⛔️ Fluid management is tricky, often misunderstood, & can cause huge iatrogenic harm ⛔️

We try to convey important principles in THREAD 👇

#tipsfornewdocs #medtwitter #tweetorial

Currently too often patients with high creatinine are given too much IV fluid, driven by an AKI ➡️ fluid reflex

We’ve seen 7 litres be given in one shift.

Medics & surgeons, juniors & seniors, it seems everyone loves to reach for extra IV fluid (especially if urine output poor)

Why does huge volume IV fluid ‘resuscitation’ consistently occur?

Lots of reasons, including FALSE beliefs:
🛑 IV fluid always “treats AKI”
🛑 Hypotension = hypovolaemia
🛑 Lactate >2 means fluid deficiency
🛑 Septic patients are very hypovolaemic

The rule with IV fluids and AKI is to remember this 5 word phrase:

💥 💥 Aim for euvolaemia, then stop💥 💥

Fluid status is like Goldilocks - hypovolaemia is bad for the kidneys BUT excess volume is also harmful for renal function and will cause other complications too.

It is easy to say “target euvolaemia” - but we agree it is more difficult to do!

Fluid status assessment is certainly made harder by a belief that we must only rely on a snapshot assessment of examination features which are NOT specific / sensitive / reliable to elicit like.…

Folks, we need to talk about this Vitamin D trial. I have no stake in this game - take Vitamin D if you want but this pre-print is super sus.

The paper is presented as a randomized trial of vitamin D supplementation in hospitalized patients with COVID. Interesting and important question! And the results appear dramatic:

If true, this would be one of (if not THE most) effective treatments for COVID. But there are problems...

The first clue something is up is that the randomized groups aren't the same size:

It took me a while to figure out why this was, then I saw in the text that INDIVIDUALS were not randomized, WARDS in the hospital were.

Many of us who have been health activists have been crying hoarse for years about the need to strengthen our health system, focus on public health
Last summer brought policy and public focus to this dire need. One thought lessons were learnt.
Clearly not.

There is INCREDIBLE stress on the health system right now in many parts of the country. Health professionals over worked, burning out, turning positive with families in droves. And sometimes cannot find beds for themselves or their family in the hospitals they are working in.

I have never seen this kind of a situation before. Lots of people reaching out for help. To provide care, advice, help patients and those in medical need is what health providers are trained for. It is what this is unique about health as a profession.

Imagine not being able to help because there is no capacity, no bed, because there are multiple claimants for that one bed all with medical need. Where the only way a bed might be available is a patient discharge or sadly, a patient death

Ambulances lined up outside hospitals waiting to be able to transfer the patient to the facility, and at times to ferry out those who could not make it.