Families mourned & Docs Cried on ICU rounds

🔹3 DEATHS in one morning
🔹3 times we did “THE PAUSE”
🔹A voluntary 30-60 sec unscripted bedside silence
🔹Do it for the patient
🔹Do it for yourself
🔹Do it for your team members

Pass it on…The Pause🙏

APP: apple.co/3Cj01qj

2/ Tryptophan is an essential amino acid - we don’t make it.

So if we’re “programmed” to absorb ⬇️ from our diet, we sleep poorly, think worse, and all sorts of other bodily functions go awry.

Will SSRI & SNRI meds help, or anti-virals, or immuno-modulators?

Trials will tell.

Long COVID Disease State
 
COVID infects us & Interferon causes 3 dastardly plots:
📌 We absorb ⬇️ tryptophan & convert ⬇️ Serotonin
📌 Platelet pathology ⬇️ stores of Serotonin
📌 Vagal nerve signals peripherally ⬆️ impairs brain function & memory

bit.ly/3M5F9ZV

Everyone deserves a place at the table of #Life‼️

🎈Human Flourishing is a worthy goal
🎈Greg works at the Nashville “Friend’s Life” Treat Truck
🎈@FriendsLifeCom1 works to integrate adults w disabilities into community

Its a model of human flourishing

(pic w perm)

1/🧵 Long COVID - new @TheLancet data

📌A picture is emerging
📌It’s not pretty
📌Most pts w months-long symptoms aren’t recovered @ 2-yrs
📌The cluster including neurocognitive & cardiovasc symptoms is ominous
📌These data fuel trial design

Thoughts?

bit.ly/3sHrwt9

30 new mutations to #Spike

Keep your loved ones safe from Pirola BA.2.86👇

I’m flying to see Mom. She’s suffering dementia & called to ask if I’d get her “Hair Did.”

“You bet, Mom & we’ll get some great gumbo & shrimp busters”‼️

(new pic w her perm)

bit.ly/3sxkZBf

2 recent & important studies on Long COVID
 
📌Include ~340k COVID patients vs ~7M controls out to 2 yrs
 📌Organ dysfunction persists in 33%
 📌Levels of disability from #LongCOVID exceed those of cancer & heart dz‼️
 
Links:
Nature Med - go.nature.com/3OMNfHl
JAMA: bit.ly/45mk8lw

Pt w new visual problems.

In ICU, unvaccinated diabetic pt COVID+ and 4+ Staph Sepsis from infected dialysis catheter (now removed). Retinal exam to look for Roth Spots (pic w arrows) & find fluffy white spots…

He’s on COVID tx & anti-Staph ATBs.

1. What else does he have?
2. What should we add?

Reading CXRs - pro tips 🏆 

Get the most out of your pts CXRs…

You can see my measurements showing a normal VPW on the first which support other data that her SOB was not due to volume overload.
The other chest x-ray shows a wide VPW -supported more diuresis & w 2.5 L out he’s much better.

As a Doctor, I live in a state of Reverence💥

🔹Healing merits my reverence (ie deep respect)
🔹Reverence begets humility
🔹Humility allows me to see her pricelessness & mystery

Once I see her pricelessness, I am in a better place to serve

What do you think of this cascade?

During COVID, who got “unilateral DNR” orders?

ie, team chose FOR you

📍Black & LatinX – Odds 4-6X
📍Spanish Speaking – Odds 4.5X
📍Covid Pos vs Neg – Odds 8x

Communication barriers ⬆️ vulnerability of having a doc choose EOL plan FOR you.

Is this OK?

Link: bit.ly/44PGWtn

Real Suffering: Long COVID

We need to discover scientific answers & medical treatments

In our recent Neuro LongCOVID paper
Link: https://bit.ly/458yuW2

With permission we present this husband, firefighter, EMT who developed mild acute COVID-19 in 2021 & now has long COVID w bilateral hearing aids

On Acceptance💥

This weekend we went to a wedding. Of 200+ people, guess who had the best time & why?

It was Greg (my brother-in-law, pic w his perm). He ACCEPTS life on life’s terms better than anyone I’ve ever met.

What’s your TOP TAKE HOME about Acceptance?