Rick Pescatore
@rickpescatore.bsky.social
🩺 Clinically driven. Evidence-informed. Focused on real solutions that improve patient outcomes. Editorial Board Chair at EMNews.
🔬 From frontline decision-making to the gut-brain connection, breaking barriers and innovating for clinicians and patients.
🔬 From frontline decision-making to the gut-brain connection, breaking barriers and innovating for clinicians and patients.
I’m building tools to help with that.
For the brain. For the belly.
For the people who’ve been through enough already—and deserve to be seen before they disappear.
For the brain. For the belly.
For the people who’ve been through enough already—and deserve to be seen before they disappear.
April 13, 2025 at 9:19 PM
I’m building tools to help with that.
For the brain. For the belly.
For the people who’ve been through enough already—and deserve to be seen before they disappear.
For the brain. For the belly.
For the people who’ve been through enough already—and deserve to be seen before they disappear.
We have to start talking about dementia differently.
It’s not just forgetting.
It’s failing to function.
And if we catch it early, sometimes we can soften the landing.
That matters. Especially for the people we love most.
It’s not just forgetting.
It’s failing to function.
And if we catch it early, sometimes we can soften the landing.
That matters. Especially for the people we love most.
April 13, 2025 at 9:19 PM
We have to start talking about dementia differently.
It’s not just forgetting.
It’s failing to function.
And if we catch it early, sometimes we can soften the landing.
That matters. Especially for the people we love most.
It’s not just forgetting.
It’s failing to function.
And if we catch it early, sometimes we can soften the landing.
That matters. Especially for the people we love most.
I watch for it now in my dad.
The little signs. The shifts.
Not with panic—but with presence.
Because early recognition might mean we hold onto his story a little longer.
Or help him tell it the way he wants before it slips away.
The little signs. The shifts.
Not with panic—but with presence.
Because early recognition might mean we hold onto his story a little longer.
Or help him tell it the way he wants before it slips away.
April 13, 2025 at 9:19 PM
I watch for it now in my dad.
The little signs. The shifts.
Not with panic—but with presence.
Because early recognition might mean we hold onto his story a little longer.
Or help him tell it the way he wants before it slips away.
The little signs. The shifts.
Not with panic—but with presence.
Because early recognition might mean we hold onto his story a little longer.
Or help him tell it the way he wants before it slips away.
Now I scan brains for a living.
Leukoaraiosis. Lacunes. Atrophy.
White matter that looks moth-eaten and quietly dying.
And I watch patient after patient get dismissed as “baseline” or “difficult.”
But they’re not.
They’re injured. And fading.
Leukoaraiosis. Lacunes. Atrophy.
White matter that looks moth-eaten and quietly dying.
And I watch patient after patient get dismissed as “baseline” or “difficult.”
But they’re not.
They’re injured. And fading.
April 13, 2025 at 9:19 PM
Now I scan brains for a living.
Leukoaraiosis. Lacunes. Atrophy.
White matter that looks moth-eaten and quietly dying.
And I watch patient after patient get dismissed as “baseline” or “difficult.”
But they’re not.
They’re injured. And fading.
Leukoaraiosis. Lacunes. Atrophy.
White matter that looks moth-eaten and quietly dying.
And I watch patient after patient get dismissed as “baseline” or “difficult.”
But they’re not.
They’re injured. And fading.
Vascular dementia doesn’t start with forgetting.
It starts with friction:
Short temper.
Impulsivity.
Apathy.
Poor judgment.
And eventually—disconnect.
We’ve reduced “dementia” to memory loss. That mistake costs lives, relationships, and dignity.
It starts with friction:
Short temper.
Impulsivity.
Apathy.
Poor judgment.
And eventually—disconnect.
We’ve reduced “dementia” to memory loss. That mistake costs lives, relationships, and dignity.
April 13, 2025 at 9:19 PM
Vascular dementia doesn’t start with forgetting.
It starts with friction:
Short temper.
Impulsivity.
Apathy.
Poor judgment.
And eventually—disconnect.
We’ve reduced “dementia” to memory loss. That mistake costs lives, relationships, and dignity.
It starts with friction:
Short temper.
Impulsivity.
Apathy.
Poor judgment.
And eventually—disconnect.
We’ve reduced “dementia” to memory loss. That mistake costs lives, relationships, and dignity.
Years later, in medical training, I saw it clearly:
This wasn’t personality.
It was disease.
Specifically: Binswanger’s disease—a form of vascular dementia caused by chronic small-vessel brain injury.
The signs were all there. We just didn’t have the words for them.
This wasn’t personality.
It was disease.
Specifically: Binswanger’s disease—a form of vascular dementia caused by chronic small-vessel brain injury.
The signs were all there. We just didn’t have the words for them.
April 13, 2025 at 9:19 PM
Years later, in medical training, I saw it clearly:
This wasn’t personality.
It was disease.
Specifically: Binswanger’s disease—a form of vascular dementia caused by chronic small-vessel brain injury.
The signs were all there. We just didn’t have the words for them.
This wasn’t personality.
It was disease.
Specifically: Binswanger’s disease—a form of vascular dementia caused by chronic small-vessel brain injury.
The signs were all there. We just didn’t have the words for them.
Soon.
If you’ve ever felt unheard, misunderstood, or told “it’s all in your head”—
This is for you.
If you’ve ever felt unheard, misunderstood, or told “it’s all in your head”—
This is for you.
April 12, 2025 at 11:15 AM
Soon.
If you’ve ever felt unheard, misunderstood, or told “it’s all in your head”—
This is for you.
If you’ve ever felt unheard, misunderstood, or told “it’s all in your head”—
This is for you.
Something’s coming.
Not a product.
A shift.
Built by doctors. Driven by data.
Rooted in belief that no patient should be dismissed for what they feel.
Not a product.
A shift.
Built by doctors. Driven by data.
Rooted in belief that no patient should be dismissed for what they feel.
April 12, 2025 at 11:15 AM
Something’s coming.
Not a product.
A shift.
Built by doctors. Driven by data.
Rooted in belief that no patient should be dismissed for what they feel.
Not a product.
A shift.
Built by doctors. Driven by data.
Rooted in belief that no patient should be dismissed for what they feel.
BellyMD isn’t here to sell a miracle.
It’s here to give people tools.
To offer clarity. Advocacy.
And most of all: the feeling that someone finally gets it.
It’s here to give people tools.
To offer clarity. Advocacy.
And most of all: the feeling that someone finally gets it.
April 12, 2025 at 11:15 AM
BellyMD isn’t here to sell a miracle.
It’s here to give people tools.
To offer clarity. Advocacy.
And most of all: the feeling that someone finally gets it.
It’s here to give people tools.
To offer clarity. Advocacy.
And most of all: the feeling that someone finally gets it.
So we built something.
A platform powered by AI.
Informed by patients.
Structured by science.
Built to help the ones medicine has failed—especially in the gut-brain world.
A platform powered by AI.
Informed by patients.
Structured by science.
Built to help the ones medicine has failed—especially in the gut-brain world.
April 12, 2025 at 11:15 AM
So we built something.
A platform powered by AI.
Informed by patients.
Structured by science.
Built to help the ones medicine has failed—especially in the gut-brain world.
A platform powered by AI.
Informed by patients.
Structured by science.
Built to help the ones medicine has failed—especially in the gut-brain world.
As a physician, I was trained to look for what’s measurable.
But what if the most important things can’t be measured yet?
What if suffering isn’t always in the labs, but still real? Still worthy?
But what if the most important things can’t be measured yet?
What if suffering isn’t always in the labs, but still real? Still worthy?
April 12, 2025 at 11:15 AM
As a physician, I was trained to look for what’s measurable.
But what if the most important things can’t be measured yet?
What if suffering isn’t always in the labs, but still real? Still worthy?
But what if the most important things can’t be measured yet?
What if suffering isn’t always in the labs, but still real? Still worthy?
Most of them had normal labs.
Many were told it was “just stress.”
Some were laughed at, labeled, or offered another SSRI.
But what they were really experiencing was this:
A system never designed to believe them.
A system designed to gaslight and dismiss them.
Many were told it was “just stress.”
Some were laughed at, labeled, or offered another SSRI.
But what they were really experiencing was this:
A system never designed to believe them.
A system designed to gaslight and dismiss them.
April 12, 2025 at 11:15 AM
Most of them had normal labs.
Many were told it was “just stress.”
Some were laughed at, labeled, or offered another SSRI.
But what they were really experiencing was this:
A system never designed to believe them.
A system designed to gaslight and dismiss them.
Many were told it was “just stress.”
Some were laughed at, labeled, or offered another SSRI.
But what they were really experiencing was this:
A system never designed to believe them.
A system designed to gaslight and dismiss them.
We don’t treat monitors.
We treat patients.
And sometimes, the most dangerous thing in the room is the illusion that you’re safer because a waveform says so.
Read the column:
The Waveform That Cried Wolf
👉 journals.lww.com/em-news/full...
We treat patients.
And sometimes, the most dangerous thing in the room is the illusion that you’re safer because a waveform says so.
Read the column:
The Waveform That Cried Wolf
👉 journals.lww.com/em-news/full...
The Waveform That Cried Wolf : Emergency Medicine News
An abstract is unavailable.
journals.lww.com
April 4, 2025 at 10:20 AM
We don’t treat monitors.
We treat patients.
And sometimes, the most dangerous thing in the room is the illusion that you’re safer because a waveform says so.
Read the column:
The Waveform That Cried Wolf
👉 journals.lww.com/em-news/full...
We treat patients.
And sometimes, the most dangerous thing in the room is the illusion that you’re safer because a waveform says so.
Read the column:
The Waveform That Cried Wolf
👉 journals.lww.com/em-news/full...
Capnography gives us more data.
But not better decisions.
It’s not a magic tool. It’s another voice in the chaos.
And in emergency medicine, attention is a finite resource.
But not better decisions.
It’s not a magic tool. It’s another voice in the chaos.
And in emergency medicine, attention is a finite resource.
April 4, 2025 at 10:20 AM
Capnography gives us more data.
But not better decisions.
It’s not a magic tool. It’s another voice in the chaos.
And in emergency medicine, attention is a finite resource.
But not better decisions.
It’s not a magic tool. It’s another voice in the chaos.
And in emergency medicine, attention is a finite resource.
And like the boy who cried wolf, the waveform keeps yelling.
Eventually, no one listens.
Or worse—we miss the real signal because we’re buried in false ones.
Eventually, no one listens.
Or worse—we miss the real signal because we’re buried in false ones.
April 4, 2025 at 10:20 AM
And like the boy who cried wolf, the waveform keeps yelling.
Eventually, no one listens.
Or worse—we miss the real signal because we’re buried in false ones.
Eventually, no one listens.
Or worse—we miss the real signal because we’re buried in false ones.
The real issue?
It alarms. A lot.
And most of those alarms are meaningless—transient, irrelevant, self-correcting.
We act anyway. Because we’re conditioned to.
It alarms. A lot.
And most of those alarms are meaningless—transient, irrelevant, self-correcting.
We act anyway. Because we’re conditioned to.
April 4, 2025 at 10:20 AM
The real issue?
It alarms. A lot.
And most of those alarms are meaningless—transient, irrelevant, self-correcting.
We act anyway. Because we’re conditioned to.
It alarms. A lot.
And most of those alarms are meaningless—transient, irrelevant, self-correcting.
We act anyway. Because we’re conditioned to.
In respiratory cases?
It tells us what we already know.
Wheezing? Sharkfin.
BiPAP? Flat-ish slope.
It confirms—but rarely informs.
The waveform doesn’t change care. It just makes us feel like we’re doing more.
It tells us what we already know.
Wheezing? Sharkfin.
BiPAP? Flat-ish slope.
It confirms—but rarely informs.
The waveform doesn’t change care. It just makes us feel like we’re doing more.
April 4, 2025 at 10:20 AM
In respiratory cases?
It tells us what we already know.
Wheezing? Sharkfin.
BiPAP? Flat-ish slope.
It confirms—but rarely informs.
The waveform doesn’t change care. It just makes us feel like we’re doing more.
It tells us what we already know.
Wheezing? Sharkfin.
BiPAP? Flat-ish slope.
It confirms—but rarely informs.
The waveform doesn’t change care. It just makes us feel like we’re doing more.
In procedural sedation?
Capnography = more airway maneuvers, more interruptions, more second-guessing.
But no meaningful drop in hypoxia.
Same trajectory, just more drama.
Capnography = more airway maneuvers, more interruptions, more second-guessing.
But no meaningful drop in hypoxia.
Same trajectory, just more drama.
April 4, 2025 at 10:20 AM
In procedural sedation?
Capnography = more airway maneuvers, more interruptions, more second-guessing.
But no meaningful drop in hypoxia.
Same trajectory, just more drama.
Capnography = more airway maneuvers, more interruptions, more second-guessing.
But no meaningful drop in hypoxia.
Same trajectory, just more drama.
Capnography is baked into EM life now:
— Resus
— Sedation
— Asthma, COPD
It’s sold as safety. Early detection. Smarter care.
But more monitoring doesn’t mean better outcomes. It often means more noise.
— Resus
— Sedation
— Asthma, COPD
It’s sold as safety. Early detection. Smarter care.
But more monitoring doesn’t mean better outcomes. It often means more noise.
April 4, 2025 at 10:20 AM
Capnography is baked into EM life now:
— Resus
— Sedation
— Asthma, COPD
It’s sold as safety. Early detection. Smarter care.
But more monitoring doesn’t mean better outcomes. It often means more noise.
— Resus
— Sedation
— Asthma, COPD
It’s sold as safety. Early detection. Smarter care.
But more monitoring doesn’t mean better outcomes. It often means more noise.
That’s very kind of you!
March 28, 2025 at 11:15 AM
That’s very kind of you!
Big things are coming.
New frameworks.
New formulations.
New frontiers.
It’s time to start moving again.
New frameworks.
New formulations.
New frontiers.
It’s time to start moving again.
March 28, 2025 at 2:36 AM
Big things are coming.
New frameworks.
New formulations.
New frontiers.
It’s time to start moving again.
New frameworks.
New formulations.
New frontiers.
It’s time to start moving again.
The next era of medicine won’t be won in journals.
It’ll be built at the bedside, in code, through shared stories and smart tools.
Not despite the gray areas—but because of them.
It’ll be built at the bedside, in code, through shared stories and smart tools.
Not despite the gray areas—but because of them.
March 28, 2025 at 2:36 AM
The next era of medicine won’t be won in journals.
It’ll be built at the bedside, in code, through shared stories and smart tools.
Not despite the gray areas—but because of them.
It’ll be built at the bedside, in code, through shared stories and smart tools.
Not despite the gray areas—but because of them.