Benjamin Thomas

Checking out I think. Threads is enough, mastodon and bsky a bit on the side. For colleagues and friends going to @EAPCvzw in Barcelona - see you there! Might pop in again, but for now, not.

The processes of barriers to #PalliativeCare: Denial; Palliphobia; Pallilallia but goal is PALLIACTIVE!! @BrueraEduardo giving plenary session #ANZSPM2024 in Adelaide @ANZSPM

And very generous with his time! Thanks so much @BrueraEduardo for your wisdom and grace and patience at #anzspm2024

And he is such a genuinely delightful human!!

Reflections on amazing talk by @BrueraEduardo how to get palliative care activism through engaging institutions and administrators and stop just talking about it. #ANZSPM2024 @ANZSPM

In an interview as a trainee, I was asked what my biggest achievement was. I answered, “when @BrueraEduardo followed me back on Twitter”. Today I got to meet him ☺️. #ANZSPM2024

For all those who were there @EAPCvzw #eapc2024 and had a brief look at our interim and want to see the cookbook, our protocol has just been published! Hopefully more involved results and formal data are soon to appear! @Existential_Doc @Paul_Howard_IoW @ProfMarkTaubert

@Paul_Howard_IoW @Existential_Doc @drcrouchback That's... insane! 100 halo 0.5 tabs here is 7.99 aud with or without script - so around 4£

@Existential_Doc @drcrouchback Absolutely: £54.66 for a single arachis oil enema. Not a bad use of twitter to highlight unexpected high cost items. Here's mine: haloperidol 500mcg tablets: £295.92 for 28 (suggest oral solution as an alternative; both strengths under £10) #DrugPriceShocker

Ive found Clonidine a very helpful option for pain crises, bridging bigger opioid rotations from morphine/oxy to fully synthetics, agitation secondary to pain at EOL. The duration of effect is limited in some by tachyphylaxis. It’s cheaper than a peanut enema @drcrouchback 😂

Delightful playing desert island drugs with @Existential_Doc and finding that methadone, clonidine and levomepromazine have captured us both. Amusing it was right after I gave a talk on dexmedetomidine too (at least for me!) Great discourse in thread.

Methadone: cheap, long acting, effective, applications is malignant and non-malignant pain, chronic pain crossover. Less issues with hyperalgesia. Safe in renal failure. Used widely across the world. Levomepromazine: large dose range, broad spectrum antiemetic, useful for agitation ranging from mild to very severe. Lower risk in Parkinson’s disease than haloperidol. Seizure threshold impact has low evidence to support. Long acting. Clonidine: versatile and cheap. Analgesic and anxiolytic properties. Less sedating approach to managing agitation (also see dexmedetomidine), Opioid sparing effects, scut alternative to tizanidine for skeletal muscle spasticity, anti-secretory properties including secretory diarrhoea. There are other drugs that are vital of course- I could name many more. Where you practice (country, health care setting) and who you practice with will affect your answer. Many of the answers given are based around European and North American availability and practice. I’ve tried to think outside my own practice- cost, resources, distance, supply all factored in.

There are no right answers to this and you can’t cover every symptom- it’s just a really good way to reflect on what we do and how it differs across the world. My 3 for palliative care symptom control would be -Methadone -Levomepromazine -Clonidine I’ll explain why later on.

@Existential_Doc Haha i love it Tony, fantastic that it came up. Loving the replies

Palliative care question 🔍 If you only had access to three medications for symptom control what would they be and why? A discussion I had with @andiyarus recently. We both agreed on the same 3 medications despite working thousands of miles apart

"Culture eats strategy for breakfast"! Usually 17 years from trial to routine care Marie Fallon on the challenges of implementation #EAPC2024 #VittorioVentafridda

@dr_shai @Existential_Doc Rousablility not turbidity!

@dr_shai @Existential_Doc The most common question I've been asked today interestingly! Alpha2 selectivity mostly, and also significantly less BP effect, and the turbidity. That and I've been working with dexmed for 6-7 years so has been a cascade. I also find the rousable potential fascinating

Dexmedetomidine as an option for agitated delirium towards end of life. @andiyarus presenting at #EAPC2024 This kind of study is right up my street and a real pleasure to meet Ben in person

@dr_shai @Existential_Doc Hi Shai - yes midaz vs dexmed. Writing up the paper and hope to have out in the not too distant future.

@Existential_Doc @andiyarus Is it a comparative study Tony? I came across this for Clonidine a while ago and have been looking forwards to more data. spcare.bmj.com/content/13/e3/…

@reasonablewlvrn @Existential_Doc Hi Darren, not yet. Working on it gradually, the risk profile is reasonable okay at the doses using so watch this space :)

@Existential_Doc @andiyarus Any experience using it outside hospital?

@Existential_Doc Thanks Tony! It was fun to give and the room seemed to enjoy!

Paddy Stone sharing his methylphenidate vs placebo RCT - no sig. difference in end point of fatigue. Important clinical information for fatigue management in adv cancer. Paper live now! ascopubs.org/doi/10.1200/JC… @MCPCRD #eapc2024 @drol007 @nicolagwhite

Very interesting study comparing #dexmedetomidine and #midazolam in EOL #delirium Both effective drugs, DEX more expensive. More research needed particularly in non-EOL delirium in my opinions. Un that context DEX could be very useful. @EAPCvzw @wecareuic @SCBCPal #EAPC2024