To those saying that those who have got their public health advice wrong earlier in the pandemic should put up their hands and apologise... a little cautionary lesson from another sector

A short 🧵

1/

OK, so it's a fortnight away - the "Digital Party Conference" of the CDU to decide who the next party leader will be

And whoever wins this is going to have a good chance of being Chancellor, succeeding Merkel after the election in September this year

There are three main candidates in the running - all middle aged men from Nordrhein Westfalen
- Friedrich Merz
- Armin Laschet
- Norbert Röttgen

So who's going to win?

For ages it looked like Laschet was the clear front runner. Prime Minister of Nordrhein Westfalen (NRW), and with a kind of folksy-beergarten manner, it looked good for him.

But then came COVID, and in the first wave it looked like NRW was pushing to open up too early, and questions started to be raised as to whether he would be up to the job...

Laschet's star is falling

The candidate profiting is Merz. The comeback kid at 65 years of age would take the CDU more to the right - which seems to be what a slew of the 1001 delegates (esp those from the states of eastern Germany) want. That despite the pragmatic line of Merkel being +popular than ever.

OK then.

So the new CDU Party Leader #CDUvorsitz is known - it's Armin Laschet.

This 🧵 will explain why he won, explain what he means, and outline what happens next.

1/20

At the CDU's party congress today, the three candidates - Laschet, Friedrich Merz & Norbert Röttgen - gave 15 min speeches

That was the first signal of what was to come... Today we saw the very best of Laschet - playing the reliable, careful person, not heavy on detail

2/20

Merz by contrast gave an ill focused speech, and did not make a single reference to Merkel or AKK, the outgoing party leader. He seems to have learned nothing

Röttgen, long the outsider, gave a speech with a lot more detail - especially on green issues and the future

3/20

1001 Delegates - these were the results

Round 1 🗳
Merz 385
Laschet 380
Röttgen 224

Round 2 🗳
Laschet 521
Merz 466

About 1/3 of Röttgen's vote went to Merz, 2/3 to Laschet

4/20

It's important to emphasise how absolutely *average* Laschet is in the CDU. If you were to imagine your archetypal CDU politician it would be him. Not to edgy, not too sharp, not too radical, not too conservative, not too dashing... it would be him

5/20

"Red wall voters will not forgive Boris Johnson if he sells out to get a trade deal with Brussels, polls show"

It's in The Sun. Harry Cole wrote it...

So let's dig a

The poll was done by @SavantaComRes and the PDF of the results is here:

P. 57
If this 'no deal' scenario occurs, to what extent would you be
more or less likely to vote Conservative at the next General Election?

+ likely, total: 20%
no difference: 41%
- likely, total: 32%

P. 59

I don't actually know what these questions mean

"The UK establishes a new relationship with the EU that is based on EU law" What *is* that?

"The UK maintains political alignment with the EU after the Brexit Transition Period, such as a common foreign and security policy" What is political alignment? And does CFSP work?

"The UK cannot pass its own laws and ensure its courts enforce them" Oh come on.

I gave masks the benefit of the doubt in the spring/summer of 2020. I have since changed my mind and see no scenario where it makes sense to wear them in public.

Even if they provided 100% protection, I believe masks to be harmful. An explanation below 👇👇👇

Let's say masks provide 100% protection to both the wearer and others (perhaps non-masked individuals) in close proximity. This is perhaps the worst scenario.

The immune system requires a consistent influx of both microbes and viruses to remain trained.

Halting the exposure to microbes and viruses is extremely harmful in the long run and leaves you exposed to enormous risk in the future.

Without training, you will become susceptible to even weaker microbes that your immune system would have normally handled with ease.

This is no different than laying in bed for a prolonged period of time. Walking up stairs, an activity that normally would not be a challenge, would all of a sudden become difficult.

Your immune system would slowly degrade similarly not able to complete previous tasks.

This is particularly harmful to children who's immune systems do not have the training of adults and would leave them more vulnerable. Children have the most life to lose so it harms them the most.

Ashtangha Yoga or the eight limbs of Yoga-

Many people think Yoga is just an Indian physical exercise but that's wrong. Yoga is a way to connect with the Supreme in Hinduism and attain Moksha(liberation).
The proper yoga as described in Hindu scriptures consists of 8 limbs:

1) Yamas- They are the 5 ethical rules of Hinduism. The 5 Yamas are:
i) Ahimsa: Nonviolence (this also includes not eating meat)
ii) Satya: truthfulness
iii) Asteya: non-stealing
iv) Brahmacharya: chastity, sexual restraint
v) Aparigraha: non-avarice, non-possessiveness

2) Niyamas- They are the 5 "do's". The five Niyamas are:
i) Shaucha: purity of mind, speech and body
ii) Santosha: contentment
iii) Tapas: austerity, self-discipline
iv) Svadhyaya: study of Vedas(Holy books of Hindus)
v) Ishvarapranidhana: contemplation of the Ishvara (God)

3) Aasana or the physical yoga-
Asana is a posture that one can hold for a period of time, staying relaxed, steady, comfortable and motionless. The aasana postures are believed to have been given by Mahadeva (Hindu God) himself. Hatha Yoga Pradipika mentions 84 aasanas.

“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.…

Thrd: Menstruation/Dysphoria

1/ Difficult periods are sometimes the first catalyst for young women becoming alienated from their bodies.

Some have given congratulatory speeches about the vague accomplishment of "becoming a woman."

2/ Others learned about periods through a mundane sex-ed lesson at school. Yet others knew very little about their periods except they are sometimes painful, can be embarrassing, and make activities they’d taken for granted,

3/ like swimming and outdoor play, all-of-a-sudden much more difficult.

When young women hate their periods, they might be told, in a matter-of-fact grumbling way, “well, nobody likes having a period, honey. It’s just a part of life.”

4/ On a personal note, till my early/mid 30s, I knew very little about the menstrual cycle. For me it had always been completely out of sight, out of mind. Once a month, I’d be reminded it exists and I’d have a kind of “oh crap!” moment.

5/ I’d complete the necessary hygiene and try to move on with my life. I was often plowing through various stages of this monthly cycle with little acknowledgement or understanding of how my entire mind, body, and mood was ebbing and flowing. Every month, for years on end.

My uncle passed away from cancer when I was 16 years old.

I’ve since spent 100’s of hours researching how to avoid and fight cancer naturally.

Here’s what I found:

1) Boost your stem cells

Your body slowly regenerates using stem cells.

Foods that promote stem cell growth:

• Seafood & fatty fish
• Berries (black, blue, raspberry)
• Broccoli, cauliflower, brussels sprouts

More stem cells = lower chance of cancer

Fasting is also a viable option for increasing your stem cells.

You could do a 24 hour fast once a week.

Or go extreme like my business partner @taylinsimmonds

And fast for 4-7 days at a time.

I’ll stick with 24 hours tops ;)

2) Hack DNA repair for longevity

To amplify DNA repair:

• Sleep 7+ hours
• Exercise regularly
• Try intermittent fasting

Natural DNA repair prevents your cells from mutating.

Eat foods that amplify DNA repair:

• Greens
• Mangoes
• Greek yogurt

The best cancer cure is prevention.