Metabolic Recovery

I’ve recently seen several people get dangerously sick from symptoms they thought could wait. That is the problem. Most people are never taught which symptoms are actually urgent. Here are 10 symptoms I tell people never to ignore 🧵1/13

diffuse subendocardial ischemia from GI bleed make sure to call GI & provide volume/blood resuscitation immediately avoid calling cardiology up-front (this may scare away GI) key: repeat ECG should normalize after resus troponin may go uncomfortably high

DON’T WATER THE PLANTS YOU DON’T WANT TO GROW: Simple line. Took me years to actually live it. Every time you replay an insult in your head, you’re watering it. Every time you revisit a regret on loop, you’re watering it. Every time you entertain a thought that makes you smaller, you’re watering it. And it grows. Slowly. Quietly. Until one day it’s the loudest thing in the room. Your mind is a garden. Finite space. Finite energy. Finite hours in a day. What you give attention to, grows. What you starve, dies. The anxious thought. The bitter memory. The comparison that eats you alive at 2am. Stop watering them. Not because they aren’t real. But because they don’t deserve your soil. Water what you want to see more of. Gratitude. Ambition. Clarity. Calm. You don’t get a bigger garden. You just get to choose what grows in it. 🙏🏻

Think about what you want your future to look like, clearly, and start filtering every decision: "Will it get you closer to this vision or not?" Cut ruthlessly. Say "No." Spend time on the things that build your future. You get this one life. Limit distractions.

🏛️ Masters of Mesopotamia: How Assyrian Soldiers Crossed the Tigris and Euphrates 🌊 This extraordinary Assyrian relief, dating to 865–860 BC, preserves one of the earliest known visual representations of military swimmers in history. Carved nearly 2,900 years ago, it depicts Assyrian soldiers crossing one of the great rivers of Mesopotamia—the mighty Tigris or Euphrates—using an ingenious technique that helped build one of the ancient world's most powerful empires. The soldiers are shown swimming while supported by inflated animal skins, usually goat or sheep skins, which served as portable flotation devices. These air-filled skins allowed warriors to cross deep and fast-flowing rivers while carrying weapons and equipment. Once ashore, the skins could be deflated, packed, and reused throughout the campaign. ⚔️ Why was this technique so important? 🔹 It allowed armies to cross rivers rapidly without bridges. 🔹 It enabled surprise attacks and swift military campaigns. 🔹 It facilitated the transport of soldiers, horses, weapons, and supplies. 🔹 It demonstrated advanced planning, engineering, and military organization. Ancient sources indicate that these flotation skins were widely used throughout Mesopotamia for both military and civilian purposes, making them one of the most practical innovations of riverine life in the region. Far more than a work of art, this relief offers a fascinating glimpse into the ingenuity of the Assyrians—masters of warfare, engineering, and adaptation. Long before modern military pontoon bridges and amphibious units, Assyrian soldiers were already mastering the waters of the Tigris and Euphrates, the lifelines of ancient Mesopotamia. 🌊🏹🐎 A timeless testament to the innovation and resilience of one of history's greatest civilizations. #Assyria #AssyrianEmpire #Mesopotamia #AncientMesopotamia #Tigris #Euphrates #AncientHistory #MilitaryHistory #Archaeology #Nimrud #Kalhu #NeoAssyrianEmpire #AncientEngineering #RiverCrossing #AncientWarfare #NearEast #HistoryLovers #ArchaeologicalHeritage #Cuneiform #Civilization

Anna Lembke es la psiquiatra de Stanford que demostró que vivir sin dolor ni aburrimiento es la causa real depresión y ansiedad Reveló 6 hábitos que haces todos los días y que están destruyendo tu cerebro: ↓↓ 1. Coger el móvil cada vez que sientes la más mínima incomodidad

According to this JAMA article, a meta-analysis showed that POCUS has ~90% sensitivity and specificity for diagnosis of CAP. I looked up the source of this citation, and it's exactly what I expected (figure below): 🫤 None of the studies were from the USA 🫤 Studies varied *widely* (making their combination in a meta-analysis invalid) In the USA where patients tend to have a high BMI and multi-morbidity, the performance would probably be lower. Also, performance in studies is generally superior to real life (Hawthorne effect). Bottom line: POCUS is good for CAP, but I'd still combine it with a chest radiograph. CXR surveys the entire thorax & highlights areas of pathology. POCUS provides fine anatomical detail about the lung periphery. And if this doesn't work, there's always the donut of truth left to sort things out (CT). 🍩

Imagine you're 85. Body slower. Energy thinner. You get one wish: To come back and do it over. You open your eyes. You're here. This age. Strong, adventurous, capable. With people you love still within reach. You have one do-over, and you're sitting in it. Live like it's your second time around.

True confidence is quiet. Insecurity is loud. Inner confidence comes from evidence. Do the work to establish receipts. Insecurity tries to mask over lack of evidence with bravado and projection. Don’t be fooled by those who are loud.

Patients operated on by surgeons with social jet lag of ≥2 hours in the preceding month had a greater risk of major adverse events, independent of sleep duration or night shift frequency. Promoting regular sleep timing may improve patient safety. ja.ma/4o7bRMp

🧵regarding the 'figure-of-eight' suture. I did a similar one 3 yr ago, but the students and interns are new. We'll go over the surgical application of the 'figure-of-eight' stitch, some technical pointers, and compare it to a similar stitch (the' horizontal mattress'). (1/ )

Studies suggest that reducing calorie intake by just 10% to 15% can lower the risk of age-related diseases by improving heart health, reducing blood pressure, and supporting better glucose control. ow.ly/PM1s50Z3LbY

Cooking at home just once a week was linked to ~30% lower dementia risk in older adults. The biggest signal was in beginners: ~70% lower risk.

Drinking 2 to 3 cups of caffeinated coffee (or 1 to 2 cups of tea) daily can lower dementia risk by as much as 35%. This protective effect is most pronounced in adults 75 and under. Researchers believe caffeine protects the brain by reducing inflammation and harmful plaque buildup. Caffeine is Key: Studies show that decaffeinated coffee does not provide these protective cognitive benefits Caution: Overloading the body with caffeine can have the opposite effect, causing lack of sleep, which is a risk factor for dementia.

Hypereosinophilia can cause a variety of different stroke syndromes. #1 Most common = Watershed infarcts (case below) 1⃣ Not due to hypotension or carotid disease. 1⃣ Mechanism unclear, but might relate to some combination of vascular inflammation & eosinophil-platelet aggregates. #2 Cardioembolic strokes 2⃣ Due to endocardial thrombi (Loeffler endocarditis). 2⃣ Widely distributed in a typical cardioembolic pattern. Other stroke patterns are less common: - Single large territorial infarct - Lacunar & deep perforator infarcts - Cerebral venous sinus thrombosis Take-home messages: 🥡 Eosinophilia >1.5 k/uL is defined as hypereosinophilia. This is unlikely to be due to allergy and requires investigation. 🥡 Always get a CBC *with* differential (otherwise you will miss this). It's more effective to be systematic than smart. 🥡 Eosinophils are angry cells that can wreak havoc on the cerebral vasculature through a variety of mechanisms. Hypereosinophilia of any etiology can cause end-organ damage, including stroke. (Further discussion: IBCC chapter on eosinophilic lung diseases)

Here is the timeline of sauna benefits: 5-10 min - sweating starts 12 min - heart rate elevation 15 min - white blood cell count increases 15 min - growth hormone increases 20 min - cardiovascular benefits kick in 20-30 min - heat shock protein response 30 min - blood sugar reduction 30 min - insulin sensitivity improves 30+ min - risk of dehydration 60+ min - excessive loss of minerals 60+ min - risk of heat shock Based on a temperature of 70 C - effects can be different at higher temperatures Optimal duration: 20-30 min max

Why some don't fair well w/ extreme low-carb or carnivore If blood sugar keeps dropping, the body uses adrenaline & cortisol to save you That can feel like anxiety, panic, 3 a.m. waking, palpitations, or being wired-but-tired For these, LCHPMF was evolutionary designed

Top 10 evidence-based supplements: 1. Creatine 2. Omega-3s 3. Taurine 4. Melatonin 5. Ashwagandha 6. Berberine 7. Magnesium 8. Psyllium husk 9. Glycine 10. NAC

My personal truths as a clinical psychologist: #287 The nervous system confuses familiarity with safety. *People often stay with what they know, even when it hurts them. The familiar feels comfortable because it is predictable, not because it is good for us. A person may stay in a bad relationship because it feels more familiar than being alone. Someone may keep returning to the same unhealthy habits because change feels scary. Even a child who grows up around anger or chaos can come to see it as “normal.” Growth often feels uncomfortable at first. Sometimes the healthier choice feels strange, while the unhealthy choice feels like home. Learning the difference is part of healing.

A new review linked cannabis use to chronic cognitive impairment across: ↓ Memory ↓ Learning ↓ Attention ↓ Executive function Best not to take the risk.