Q: Why do we use a stethoscope?
A: For many reasons, and here’s one of them that I will argue is undervalued. And is still at the heart (hint hint) of some ongoing research…

First described by Potain in 1880, the gallop rhythm refers to the presence and cadence of abnormal diastolic cardiac sounds, namely S3 and S4.

In 1989, Stevenson and Perloff described the previously unestablished relationship between physical exam signs, increased ventricular filling pressures, and decreased cardiac output in chronic HF patients. Stevenson et al. JAMA. 1989.

An excellent point is made in this paper: “While the relationship between physical signs and hemodynamic profile has a firm basis for acute congestive heart failure, the chronic state is characterized by a host of compensatory mechanisms that may cause disparities, …”

“…such as the absence of rales and peripheral edema despite symptomatic elevation of ventricular filling pressures.”

This cohort had quite the notable med regimen: digoxin (84%), furosemide (84%), vasodilators (56%), and milrinone (4%); 39/50 were being evaluated for transplant

It is hard to overstate what a catastrophic failure the Govt & SAGE’s policy of continual restrictions & lockdown has been.

Not only has it caused economic devastation & misery for millions, it has not stopped high rates & surges in infections, hospitalisations & deaths.

Over the past 6 months, UK governments have tried mask mandates, curfews, local restrictions, regional restrictions, tiers, short *firebreaks*, national lockdowns, stricter tiers, extra tiers.

All have caused enormous costs yet look where we are at with Covid. Time to rethink.

“But it’s just obvious that lockdowns will work."

It’s past the time to indulge in wishful thinking about what you think *must* or *should* happen. Like it or not, we have to face reality: the continual lockdown/restriction cycle has failed on every possible measure.

“But things would have been even worse without the restrictions”

Hard to see how but, if you believe that, where is the evidence? e.g. have places with lighter restrictions had demonstrably worse Covid outcomes? Switzerland, Denmark, Sweden, Norway, Florida, Brazil?

“But it would have been different if we’d locked down more things/earlier/longer …”

More collateral damage & misery for certain, but where is the evidence Covid outcomes would be better? Look at Belgium, Italy, Peru, Spain, Czechia, New York, Illinois, France, Argentina.

Good morning, early birds! The Oklahoma State Department of Health is considering privatizing at least the management of its new public health lab and the state's new pandemic center.

A letter to agency employees Tuesday from Commissioner of Health Dr. Lance Frye said, "This consideration will include the potential privatization of some functions, programs, services, units and/or divisions of the agency,"

A statement Wednesday by OSDH Deputy Commissioner Travis Kirkpatrick indicated the agency did not intend to privatize the lab as a whole and instead said it was considering a management agreement with Prairie One, a not-for-profit subsidiary of the OSU Research Foundation.

"This agreement, which has not been finalized, would allow OSDH to focus on and strengthen public health priorities to better serve Oklahomans and leverage public resources to maximize our capabilities," Kirkpatrick said.

"'Privatize' is broadly defined under state statute - it means to enter into a contract for the performance of a duty or function that is currently being performed by a state employee," he added.

🧵For months, healthcare professionals have been hanging on to the guardrails of the top deck of the Titanic.

We have been screaming at the top of our lungs that there is an iceberg dead ahead and begging the captain to turn the wheel.

We have had other passengers who are

in the food hall and can’t see the iceberg from where they are standing mocking us accusing us of lying about the iceberg.

“There is no iceberg. You’re seeing things”

“Even if there is an iceberg it is smaller than predicted based on available models”

“You’re getting paid

to claim there is an iceberg.”

We are on the ship too. So we are watching the ship approach an iceberg knowing full well that we are going down with the ship.

Do we keep screaming? Even though nobody is listening? Do we jump ship and save ourselves? The water is freezing

and we don’t want to desert our fellow passengers.

Do we gather up the other passengers who can see the iceberg and form a human shield to take the impact on ourselves? Do we bum rush the captain and demand he turn?

Or do we stand still, silent, frozen in a state of fight or

flight? Paralyzed with sheer terror.

Never in a 14 year career would I have imagined I would see this day.

How are we supposed to feel when a critically ill patient has survived cardiac arrest

Do people understand what I actually mean in my bio when I say I am a poster child for mental health. 😅

It means I experience a wide spectrum of mental health conditions, and I go to a lot of therapy. It doesn't mean I know everything (or anything). I have two full time treating clinicians. I speak from lived experience, and some days I feel like I know nothing.

Sometimes I am deeply unwell, and still so much risk I need to be hospitalised. Other times I can go speak at a national conference about suicide prevention. It isn't meant to be like some weird humble brag that I am the picture of perfect health.

At so much risk (see, still not proofreading).
I'm really thankful for the pocketfam, for the supports, the friendships, the jokes, the sometimes challenging ideas.
I have no certainty in what I say as being right (often I think it is wrong?) And I try to question and learn

All of the time. I am human, I make mistakes (much bigger ones than my endless typos), I try not to do harm, I try to acknowledge the privileges I have, and I try to use that privilege to improve the world.

[THREAD] memory loss and mental health. It is something that we don’t often put together. However, it is a very common issue for many individuals whose mental health is not doing well. So why do we get that memory loss? Is it permanent? Are there ways to cope with that?

The reason why memory loss happens is not because our brains are not working well or somehow not registering events but because we are so tuned in to our thoughts and emotions that we are not paying attention to our environment.

Given that we are not paying attention to what is going on around us, we are less likely to remember them. Also, issues such as depression and anxiety affect the way we sleep and sleep has been proven to be the time when short term memories are transferred into long term memory.

When we can’t sleep well, that process is disturbed and we may lose some memories during that process shift. Also, we may feel as unable to access our childhood or even recent memories when our mental health is not doing well and we may be scared that it is permanent.

However, in this situation, it is not so much that we have lost our memories. It is more a problem of retrieval. The memories are still there in our big library, but we just can’t find them. Furthermore, memories are highly dependent on our mood.

Health in Europe starts 2021 by going global! Join us for a panel discussion on the new EU health policy special issue of @JHPPL and "European" health care! 12pm (UK) Weds 13 Jan 2021 - [email protected] for info/access. (1/8)

Professor Katherine Fierlbeck @kfierlbeck

Dr Tomislav Sokol @TomislavSokol

Dr Eleanor Brooks @Ellie_Brooks

Professor Tamara Hervey @TamaraHervey

1/ It's like the B117s are playing "Love Shack" there's so much dancing around whether it's here. Look at UK and Ontario case count and age infection charts. If you still think it's not circulating here then assume it is and take the appropriate action based on that "assumption".

2/ Government action, when they're finally motivated enough to do something, must be based on the worst case scenario, not the best case held together by prayer and duct tape. You cannot have 500 people wandering around Home Depot, Costco, Walmart etc. in a zombie like state.

3/ All retail, bar "true" grocery stores and pharmacies, must be curbside pickup only. Walmart and Costco are not grocery stores so must be closed for inside shopping. They, more than any others, will figure out an efficient curbside pickup strategy. Ford must ignore the retail

4/ lobby because pissed-off shareholders are acceptable whereas hundreds or thousands more unnecessary deaths are NOT. The list from the March lockdown was good but might not be enough to suppress case counts from the VOCs.

6/ We are not far away from an influx of vaccine supply and the return of warmer weather so now is the time to act firmly and quickly.
Businesses forced to close must be compensated from the 9-12 billion $$ of Federal funds the government are sitting on as must employees of

Thread on #AyurvedicSurgeons

I have been quiet on this issue because I have read history of medicine in India & written about it in my published articles. You can check them out on my blog

Ayurveda got stoned by the British during the period they ruled India. Let us agree that+

Let us also agree that the tradition of Guru Shishya Parampare was lost during this period in Ayurveda.

Creation of Medical Register & Registered Medical Practitioners where traditional medicine doctors including Ayurveda were not registered literally killed Ayurveda practices+

Ayurveda practitioners of 18th & early 19th century had to face lot of problems because of this.

Did you know that Apothecaries & Doctors of Allopathic medicine were the first brown sahibs??

The labourers estates of South India were converted to churchi using their influence

Traditional medicine had to be reigned in to use modern medicine as manna & to convert the unwashed masses where their God had not reached.

I am happy that Traditional medicine is getting its due now. However it should not become Ayurveda vs Allopathy like it is depicted now +

Surgery is a specialised branch of Healthcare. As a hospital administrator I know how difficult it is to ensure that the patient gets the best care.

Do you know that Operation theatres have undergone sea change just in past 20 years. Even the air inside changed every few minutes

ON FAITH PART 8: HEALTH AND WEALTH

Begins now 👇

#Illuminare

1. The Bible says to visit the house of mourning if you want cogitative wisdom. Ecclesiastes 7:2-4. The house of mourning is not necessarily a funeral parlor. A hospital qualifies as house of mourning. #Illuminare

2. You become sober when you visit a hospital. It’s the opposite of a house of mirth – a night club or beer parlor. What is alarming is the continual supply of patients. The flow just never stops. #Illuminare

3. There is a political dimension to disease. Disease has an ideological posture. By nature, it is an oppressor. The oppression is so powerful there’s collegiate resignation by the afflicted. They simply bow powerless. Sickness is hell bent on subjugating the human soul.

4. The affliction of a disease like cancer induces unimaginable terror. The Bible acknowledges the political ideology of disease. It also identifies the personage behind the oppression. We’re told Jesus went about doing good and healing all that were OPPRESSED - #Illuminare

https://t.co/ZLzH00ba8Q

“Men . . . go mad in herds, while they only recover their senses slowly, and one by one.”

Mijn dagelijkse portie 'sanity' and 'mental health'

#coronamaatregelen #coronavirus #vaccination

"So wrote Scottish journalist Charles Mackay in his 1841 book Extraordinary Popular Delusions and the Madness of Crowds, which for good reason to this day remains in print."

"The Covid-19 hysteria, scientifically called mass psychogenic illness, that began in March has yet to peak. And if some have it their way it will continue indefinitely, merely going, in medical terminology, from epidemic to endemic."

"That is, it will never fully go away no matter what."

"Except. For. One. That’s total elimination of the disease."

"That may be close to impossible and incredibly expensive to even try, but like eliminating all carbon emissions in a decade it is a goal."

"The problem, of course, is that we’ve never eliminated an airborne virus by quarantining healthy people and there’s no scientific breakthrough that has made that any more possible now than it’s ever been."

So this weekend you heard from our friends @BukuRenal that mismanagement of IV fluids can cause harm.

A group we’d like to highlight who can come to serious harm from ⬆️/⬇️ fluids is patients with

💦DIABETES INSIPIDUS 💦

See below 👇

#medtwitter #FOAMed

Diabetes insipidus (DI) is the inability to hold onto water due to lack of /resistance to ADH.

Remember ADH is released as serum osmolality ⬆️ to ⬆️ renal water reabsorption, but in patients with DI this doesn’t occur and so they pass large vol watery urine - can be >10L/day!🛁

Note diabetes insipidus has nothing to do with glucose/sugar like diabetes mellitus! ⛔️❌⛔️

Misunderstandings are so common (even with HCPs) that there is a campaign to change the name to "pituitary insipidus"

#NoTimeToDI

Cranial DI (ADH not released) is usually due to pituitary/hypothalamic surgery, infiltration (inflammation/malignancy - rare) or head trauma. Can also be genetic.

Pituitary adenomas themselves can cause lots of hormone dysfunction, but don't typically cause DI.

Nephrogenic DI (ADH resistance) can be caused by
- renal disease
- electrolytes (⬇️ K, ⬆️ Ca – hence why hyperCa is dehydrating)
- drugs - can be seen with up to 15% of people taking LITHIUM 💊

#RunBetter👣
WHAT KIND OF KNEE PROBLEM DO YOU HAVE?

Does your knee hurt after a run or other workout? It’s not always runner’s knee; you may be suffering from jumper’s knee or pes anserinus syndrome.

Here you will find an overview of the three most common problems

A🧵

3 COMMON KNEE PROBLEMS:
#RunBetter👣

RUNNER’S KNEE:

If it hurts on the outside of the knee and extends toward the hip, it is runner’s knee.
#RunBetter👣

JUMPER’S KNEE

Isolated pain in the front of the knee on the lower pole of the patella is also called “patellar tendinopathy” (jumper’s knee).
#RunBetter👣

PES ANSERINUS SYNDROME:

If pain develops on the inner side of the shinbone directly below the knee joint, it is most likely pes anserinus syndrome.
#RunBetter👣

Lord Sumption to a lady with stage 4 cancer:

'I didn't say your life was not valuable, I said it was less valuable.'

Let's really break this down and realise just how awful a statement it is and the repercussions it may

Firstly, it's more than worth saying it was an abhorrent and thoughtless comment devoid of empathy. No matter what utilitarian argument you may field, it cannot be made on a 1:1 basis, or on the inherent value of life. That is beyond any of us.

The secondary issue here, the primary being how this person now feels and will feel, is the impact it will have on those in similar positions and how the public may perceive this overall and in groups. This may be complicated.

A large public outcry built of empathy is inevitable, and I am doing the same here. It is callous and cruel. But the complexity of balancing resources is one where decisions made on population levels will inevitably leave deserving people left behind. I hate that.

Balancing a pandemic with urgent services was always going to be tricky. Both are urgent, both require resources, and the NHS has adapted as it can. The most urgent of non-covid cases are being dealt with as rapidly as possible, but we cannot say that everything will be caught.

@KathyGrants @slomoshun1966 @kk131066 @foe_us @nature_org @jane__eden @impakterdotcom @sillymickel @vegix @how_sustainable @JamesrossrJames @climatemessages @sustainableuni1 @LolaGayleC @ResisterForever @mmpadellan @AdamParkhomenko @glennkirschner2 @morethanmySLE All the clinical Neuropsychological and forensic testing manuals that match the clinical measures we use...
Then made cheat sheets. (ok geek comment alert) the reason to do this is because if you don't understand the base rates and how they were derived, the populations 1/

@slomoshun1966 @kk131066 @foe_us @nature_org @jane__eden @impakterdotcom @sillymickel @vegix @how_sustainable @JamesrossrJames @climatemessages @sustainableuni1 @LolaGayleC @ResisterForever @mmpadellan @AdamParkhomenko @glennkirschner2 @morethanmySLE sampled to gain those "norms" and the year in which this was done, your interpretation of testing data will be significantly "off". If you can't assess the accurate diagnosis (meaning you misdiagnose) you end up causing pain and suffering not to mention treatment especially 2/

@slomoshun1966 @kk131066 @foe_us @nature_org @jane__eden @impakterdotcom @sillymickel @vegix @how_sustainable @JamesrossrJames @climatemessages @sustainableuni1 @LolaGayleC @ResisterForever @mmpadellan @AdamParkhomenko @glennkirschner2 @morethanmySLE if it involves psychopharm (meds)doesn't treat what actually ails the patient. When this happens, at best no one's treated for the actual illness they have which causes undue pain & suffering, at worst symptoms are exacerbated and or meds cause adverse reactions that can 3/

@slomoshun1966 @kk131066 @foe_us @nature_org @jane__eden @impakterdotcom @sillymickel @vegix @how_sustainable @JamesrossrJames @climatemessages @sustainableuni1 @LolaGayleC @ResisterForever @mmpadellan @AdamParkhomenko @glennkirschner2 @morethanmySLE have lasting effects (more pain and suffering) not to mention totally messing with the outcomes of legal cases
In short an inaccurate Diagnosis totally messed with people's lives.
. ..... So, if I use a measure you can bet Ive read the manual and understand the cautions, and 4/

@slomoshun1966 @kk131066 @foe_us @nature_org @jane__eden @impakterdotcom @sillymickel @vegix @how_sustainable @JamesrossrJames @climatemessages @sustainableuni1 @LolaGayleC @ResisterForever @mmpadellan @AdamParkhomenko @glennkirschner2 @morethanmySLE when to augment via clinical judgement. That often puts me at odds with folks in terms of opinions but I can back it all up via research and what's written in the manuals which often have caveats re use and application that people miss. More, as I went along it became obvious 5/