THREAD 4

#ALEPH2020:

So many people don’t realize that they have OCD because actual obsessive compulsive disorder is rarely talked about openly. So here are the basics: 🧵(thread)

I think that a lot of people forget that OCD is a mental illness, emphasis on the MENTAL. When it’s portrayed on TV, it’s always shown as a very behavioral disorder. And while it’s true that overt behavioral compulsions are part of OCD, they don’t begin to tell the whole story

OCD stands for obsessive compulsive disorder. That’s obsessive thoughts and compulsive behaviors. The OCD cycle is the cycle of obsessions that lead to compulsions that lead to more obsessions that lead to more compulsions etc etc etc.

People with OCD experience intrusive thoughts (which become obsessions.) Intrusive thoughts are unwanted and invasive, and they’re generally REALLY disturbing. It’s a common misconception that people with OCD are exclusively concerned with tidiness and cleanliness. This is false

TW/ OCD subtypes

Intrusive thoughts can be about anything, but there are a few common “subtypes” of obsessions. These include harm OCD, self harm OCD, sexual OCD, pedophelia OCD, relationship OCD, contamination OCD, religious OCD, moral OCD, health OCD and “just right”

A staple of anti-lockdown conspiracism in yoga/wellness is that public health measures are oppressive, authoritarian, and stifling what it means to be human. Masks suppress identity and speech. Vaccines assault the sovereign body. Influencers must rise up against tyranny! /1

Ironically, pandemic management in economies where yoga/wellness is lucrative has been a neoliberal, choose-your-own-adventure mess in which centre-right governments barter with public health to enact a patchwork of half-measures that punish the poor and marginalized. /2

The goal is not universal health rights, or protecting medical systems, or saving as many lives as possible. The goal is to return to business-as-usual, using public health as a pit stop on a productivity race off a cliff. The ice caps aren’t melting fast enough, I guess. /3

Right-leaning governments, like influencers, have assessed the COVID threat with the magical bias of limitless optimism. Then they work to normalize COVID casualties as a new cost of doing business. *This* is what alt-healthers and Qamoms call “socialist”, or “communist”. /4

Centre-right governments and wellness influencers share a goal: get back to the optimism of making productivity heroic and consumption virtuous, without any reflection on structural issues of injustice, or what universal health care funding and standards would look like. /5

“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.…

@sbarnettARK Epigenomic biomarkers are becoming more established for #LiquidBiopsy and #CancerScreening, and we have seen the big players positioning themselves in this #epigenomics race recently.

Catching signs of #cancer early is crucially important to the disease management and survival rates, so the question is: how can we find out if there is something wrong going on early enough?

The first generation of high-throughput technologies was predicated on finding mutated (tumor) DNA in the individual's body (somatic), different from their (normal) DNA. Tumor/Normal (T/N) comparisons of the individual's samples, biopsies or ctDNA will indicate if there

are signs of cancer already underway. So why do we need #epigenomic profiling if we can do all this with the detection of mutations? Well, the argument is that if you can see sufficient mutated copies of DNA, cancer may already have progressed beyond the initial stages.

Then people asked the question: is there an earlier mark that we can detect for earlier stages of cancer before the Tumor/Normal mutations signal amps up? Here is where #epigenomics profiling took hold.