Leo Reap

Frustrated? Want to know the why behind COVID-19? Answer one simple question and so much will start to become clear: "What is the likelihood of contracting ANY illness after exposure?" Follow me down the (in)sanitized rabbit hole. Let's explore.

@drcibarbenitez Meant to include this but hard to fit into 25 characters. For the purposes of the question VWF activity level was normal when I checked it

@Leo_ReapDO Vwf activity and if ok…ASA………………and pray??

AML Conundrum of the Day#2: How do you balance AML cytopenias against severe cytoses from an underlying MPN during the count recovery phase? 74 yo man JAK2+ ET controlled on hydrea + ASA for years Transformation to unfavorable risk AML, ASXL1 mutated Aza+Ven induction x 2 cycles, attains CRi Not a candidate for transplant. Continues on Aza+Ven until progression However, during each count recovery, he gets severe thrombocytosis of 1.5 million + What do you do to control his platelet count until the next cycle?

I feel like this problem could use more data around it and will become more prevalent as Aza+Ven adoption for borderline fit patients increases with time. Open to any and all suggestions! @majorajay @AaronGoodman33 @Daver_Leukemia

And in the ~5-10% of patients where CR/CRi and MRD- is not able to be attained, what would you pursue then?

AML Conundrum of the Day: What would you do for consoldiation? 64 yo woman Favorable risk NPM1+ mutated AML Very ill at the time of diagnosis, not felt to be candidate for 7+3 due to PS Receives Aza+Ven x 2 cycles, attains CR and recovers fully to ECOG 0-1 But, flow still MRD+ for NPM1 Do you:

It's now permanently lol-o'clock in our household. Even microwaves are laughing at the state of the world currently.

@pete_rizzo_ legiscan.com/MI/text/HB4087… Link to the bill for those interested

BREAKING: MICHIGAN LEGISLATURE INTRODUCES STRATEGIC #BITCOIN RESERVE BILL NOW 22 STATES AND COUNTING 🚀

I think one's understanding of Bitcoin is largely predicated on what foundational philosophy of economics one learns and/or espouses. Within traditional Keyesian economic philosophy, Bitcoin lands as a purely speculative asset. Many of Bitcoin's foundational principles are antithetical to Keynesian economics as they lie entirely outside of government control, leading to bewilderment why it would ever be adopted as a hard asset or store of value over time. Austrian economic theory (as outlined by Ludwig von Mises), however, explains the value of Bitcoin with much greater clarity IMO. @saifedean's most recent book Principles of Economics is probably the most approachable book I've found to Austrian economic theory and is a good addition to your list for those looking to deepen their understanding.

As a self-proclaimed index fund fan boy (still true) … IMO, those who openly mock Bitcoin holders simply haven’t put in the time to understand it (this was me until recently) If you want to learn more, I recommend starting with 1) The Bitcoin Standard 2) The Price of Tomorrow

@AshleyGWinter Any tips for how to defray the cost of topical vaginal estrogen creams? Recently wrote for it for a patient but was floored when I saw it was several hundred dollars. Congrats on the recent addition to your family!

Phagocytosis😋

@VincentRK I've always thought a small part of mental fatigue helps with limiting the amount of inhibitory thought when it comes to writing. Words just tend to flow with less overthinking then. I find my best writing is also at the end of a long busy day or late at night.

I’m most productive with my writing and getting things done when I already have a busy day.

Today marks a major celebration for every internal medicine physician and specialist out there. This change meaningfully improves physician burnout epidemic by not being shackled to meaningless modules that sap time and autonomy.

This image highlights a striking drop in public trust in physicians and hospitals—from over 70% in 2020 to just 31.4% in 2024. Marc Andreessen comments that this trend could continue toward zero. Pro-Physician, Anti-Health System Takeaway For those advocating for physicians and opposing large health systems, this drop in trust reinforces the narrative that corporate-driven healthcare is eroding patient confidence. Large health systems, often focused on revenue over patient care, contribute to this erosion. This data could serve as a powerful argument for promoting independent, physician-owned hospitals and practices where the focus is truly on quality care rather than corporate metrics. #healthcare

**Brand new music from John Mayer and Zedd** ...is this the perfect song for holding during prior authorization requests? open.spotify.com/track/5Am6AXlD… I feel like @marklewismd would appreciate this track. Please take note @BCBSM @Cigna @PriorityHealth

Timelapse flying by Hurricane Milton about 2 hours ago. 1/6400 sec exposure, 14mm, ISO 500, 0.5 sec interval, 30fps

@majorajay @Jacawalk Congrats! Best job ever, hours and pay are terrible.

Excited to announce I've been promoted to a new position! Unpaid and work-life balance is not great, but so far I'm loving it. #dad ❤️👶🏽🍼

The one basophil being overlooked on the diff again

Just your regular reminder that ~40% of menstruating adolescents (and likely even higher proportion of adults) suffer from iron deficiency and yet we don’t universally screen. tinyurl.com/JAMAFe

To all hematology trainees: be sure to check out Hematopoiesis, the publication that we founded through the @ASH_hematology Trainee Council as a collaborative space by and for hematology trainees. They are seeking new submissions! #hemetwitter #onctwitter hematology.org/education/trai…