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Jessina Graham
4.8K posts
Jessina Graham
@PotsyNP
C-NP, FNP, Zoologist, EDS specialist. Right patient, right diagnosis. Dysautonomias, Endocrinology, IM, ICU, Hospice. All info is for education purposes only.
Madison, WI Beigetreten Ocak 2020
481 Folgt845 Follower
@hoitoharhautus @Gmwetz @ImmunoFever Sometimes this can be autoimmune triggered, and those aren’t as clean to track since tissue gets actively damaged. This was a little different.
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@hoitoharhautus @Gmwetz @ImmunoFever When you flare, your symptoms probably follow a pattern. Here, the symptom pattern completely changed. Not worsened or improved, but presented dynamically different across systems. And labs reflected the body’s new baseline pretty clearly.
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No wonder reading has been so difficult for years after my tick infection… 🫣🙄😳
Michal Tal, PhD@ImmunoFever
I want to ask you to follow this dot with your eyes. Was that easy? Without you even having to give that much thought, your brain is telling your eye muscles where to move to keep your focus on that dot. 1/
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@angryhacademic @PanickedFoodie I see why you may have thought I only meant attention, but my stimulus comment addition was meant to include other forms of stimulus, sensory or otherwise.
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@PotsyNP @PanickedFoodie It sounds like he had a bit of a mental health crisis. Im not sure what kind of attention youd want from swallowing a banana condom in the privacy of your own home
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Banana in a Condom: An Unusual Cause of Small Bowel Obstruction
cureus.com/articles/12685…
"To the best of our knowledge, the present case appears to be the first case in which a condom containing a banana was swallowed"
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@PanickedFoodie @angryhacademic I wonder how much of this was for attention or stimulation.
Inmates will swallow razors, but wrap them first so they don’t start causing issues until later in the process.
Boredom and time allows for some interesting human behavioral adaptations!
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@angryhacademic I do not understand this part:
"He admitted to having swallowed a banana stuffed in a condom amidst a “hormonal rage” approximately 24 hours prior to his presentation."
I thought for sure it went up the other end, and he was fibbing about that lol.
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@ImmunoFever @Gmwetz @hoitoharhautus Absolutely. I suspect that’s often a downstream response to upstream drivers, or at least plastic.
The genetic pieces seem to shape baseline architecture.
Clinically I’ve tracked a phenotype flip where brain stem involvement clearly looks state dependent.
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@Gmwetz @hoitoharhautus We are indeed seeing a lot that traces back to brainstem dysfunction and I can't wait to get more pieces of the puzzle in to figure out what's driving that.
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It’s not just an adrenergic alpha 2 agonist. It has effects on mast cell stabilization and immune profiling.
That expands the field of patients this may have effects on.
We also have an oral form available now for acute psychosis.
#pots #mcas
pmc.ncbi.nlm.nih.gov/articles/PMC91…
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I do so love Precedex.
It’s far from benign. In addition to mental state alteration there are blood pressure and heart rate effects. But I like it in dysautonomia cohorts.
I’d be very interested to see trials similar to how we use ketamine.
#pots #hEDS #dysautonomia
SfN Journals@SfNJournals
#JNeurosci: Khabbaz, Pradhan et al. show that one dose of dexmedetomidine in mice can quickly & safely lower body temperature after spinal cord injury, creating a protective “pharmacological hypothermia” without the equipment normally required for cooling. doi.org/10.1523/JNEURO…
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@ZebraLoveCo @PneumaNeura @AndrewG76201347 Interesting, thanks. There is some data that beyond modulating upstream inflammatory signaling, it may shift intracellular signaling like cAMP and improve metabolic dynamics.
That’s likely part of how you see effects on insulin resistance and possibly tissue-level function.
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@PotsyNP @PneumaNeura @AndrewG76201347 I think it may most likely be a vascular/immune. They were tight and wouldn't release but also they literally were physically shortened from damage that would heal if I gave it enough time. I also may have an iliac vein compression which is contributing. I have an MPO of 5300
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@HalfThePerson @PutrinoLab I suspect you would see more than 2 subgroups emerge, but there’s some extrapolation happening in my modeling.
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@PotsyNP @PutrinoLab Yes, and hemodynamic abnormalities=>tissue hypoperfusion could be dysautomia-specific, while oxygen utilization abnormalities downstream to it could be ME-specific?
Ofc oversimplifying this now, X posts are not the right format to get into intricacies
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Shame, but I’ve not found the work around two day CPET to be compelling as a biomarker or even feasible as a test for many who are more severe. Interested in Systrom’s work on invasive CPET to understand the physiology and Wust’s work on muscle biopsy as a biomarker. Onward!
ME/CFS Science@mecfsskeptic
1) Unfortunately, it looks like Benjamin Natelson's group failed to replicate the 2-day exercise testing results in ME/CFS. "The data do not support using the 2 day CPET protocol to define PEM or disability."
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@HalfThePerson @PutrinoLab You’re narrowing in on exactly why I want to see ocular testing vs global flow dynamics.
These tests don’t reflect all pathology. SPECT and similar imaging assume blood flow ≈ oxygen/utilization, but they don’t capture how well tissue responds to demand.
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@PotsyNP @PutrinoLab Study I posted above found that dysautonomia pts have reduced cBF even while supine
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@KimJDay12 @PutrinoLab symptoms that concern me and other providers, but they haven’t gotten many clear answers despite how disabling the visual patterns can be.
Also some of the options on the table for them are invasive and life altering, so I tread carefully.
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@KimJDay12 @PutrinoLab So sorry you experienced such a devastating loss.
I saw that you were tracking some of your lactate levels. May I ask if you had any visual snow symptoms, or other visual symptoms that presented before your loss, and how that progressed?
I ask because I have several pts with
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@amyrochlin @PutrinoLab Right now so much of MCAS/POTS management is empiric, and without better functional stratification it’s hard to know which pathways are actually driving symptoms in a given patient.
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@amyrochlin @PutrinoLab That’s why I keep coming back to downstream physiology. If we can’t reliably measure the signal, we may need to focus on how it’s expressing.
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@PutrinoLab That alone would start to break patients into groups we currently lump together and make treatment responses easier to interpret. Not exactly Twitter-friendly to unpack, but it’s where I’d start.
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@PutrinoLab For feasibility, stratification, and treatment relevance, I’d pair TCD with flicker-induced vasodilation. You capture global flow and local response, something we’re not separating well right now.
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@ZebraLoveCo @PneumaNeura @AndrewG76201347 Trying to understand if this was more tone, perfusion, or neuromuscular.
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@ZebraLoveCo @PneumaNeura @AndrewG76201347 Thanks for sharing, that’s really helpful.
When you say you couldn’t straighten your legs, was it like:
•tight/resistant (almost like they wouldn’t release)
•true weakness
•or more of a pressure/pain limitation?
And did it fluctuate at all or stay pretty constant?
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