Dr Beaux-Arts

@DoctorbMD Agree this happens. Yet also many family members do not want to hear the truth, try to force further (incl) intensive treatment, get angry during code discussion, threaten personnell, disagree with medical decisions regarding no resuscitation, delay hospice decisions, etc.

@CoffeeBlackMD Hospice doc here. Biggest disservice in this scenario is how most patients are given delusional prognosis timelines as they are literally dying. Avg onc hospice LOS is <2 DAYS! When PPS decr to 30% it = <6wks life expectancy. Your only failure is failing to TELL THEM THE TRUTH!

It was kind of started as a slow week in the ICU. Busier the last two days. 7 out of the 10 patients I’ve admitted since Wednesday had stage 4 cancer. Two are now dead. One of them was 79 getting platinum based chemo therapy. Gone now. Probably one more tomorrow. The rest I’ll get tuned up and out for more. Look. I know I have some oncologist followers. And I’m not trying to get personal with you . But what the f*ck is this bullshit? I can’t help but feel bitter as a MFer when I’m the one bedside with the crying wife and son today after some hare brained Hail Mary bullsh*t. Hasn’t been an oncologist in sight all weekend. Do these patients even know what the end is going to look like in the hospital? Maybe there is a better way to approach these cases? Hang your chemo. Bill your weekly clinic full of multiple level 5 bills because it’s all toxic effects of the Hope. Get paid the big salary. And leave someone like me to shovel all the dogshit at the end. It’s a moral f*cking hazard. Seems like the decent thing would be to come in and see your patients as they die. And I couldn’t figure out what was eating me this week until tonight. And this just crashed on me. Over me. It pisses me off. I’m venting. Yes. I’m. Venting. And I’ll get over it. But f*ck guys. And that’s it. I get up at 5am on a Sunday. To do it again. For one last day this stretch of 7. You’re welcome.

@stateracetami @CoffeeBlackMD @poets1989 But is cured now because of the chemo, I suppose/hope?

@CoffeeBlackMD @poets1989 My husband had Stage 3 testicular cancer. He was treated with a cocktail of 3 chemo drugs. It took him to the brink of death but he was young/strong. I was so angry with his oncologist the whole time because I thought there has to be a better way than this. He lost over 40 pounds

@CoffeeBlackMD ..to better realize her body was failing, we were now able to step-wise discuss we would not provide invasive ventilation nor dialysis, and this led to good/better 'closure' I think. This was meaningful for the family, but preferably this would not have happened/been necessary.

I have no way to predict what posts will get attention. This one has and I want to make sure there are no misunderstandings about it. This is not an “anti” oncologist or chemotherapy or radiation post. This is not a post advocating alternative treatments. This is not a post advocating euthanasia. This was a frustrated vent. It does not exist to support any axe grinding agenda. I deal with death and dying. Too often. Such is my lot in life. This job has been a calling. Why would anyone just sign up? I’m serious about this. It’s probably fair enough that there is some confirmation bias with the cases. The good cases I don’t see. And those outnumber the bad. Ok. But the number of these cases I’m seeing is increasing. By a lot. And I’ve been doing this work for a minute. It may not always be clear because of my style that I’m advocating for patients. I won’t apologize for thinking a stage 4 anything should be UNCOMMON in the ICU. These should be planned out in a way that if things go badly everyone understands clearly the goals of care. And those goals should also rarely be “everything possible, no matter what” with proper planning. I also furthermore won’t apologize for thinking the oncologists need to be bedside. I’m not an unreasonable person. Not at 3am. But communication and days should be structured so you can know when a patient is very ill and you can stop by. I don’t need a “consult” - I don’t need recommendations. I need the oncologist to see THEIR patients. And participate in the less fun parts of doing the job. This will require chaging things around a bit. Im sure. I work a pulmonary clinic too. And I also know it’s not impossible. Regardless. I’ll keep doing what I do even if no one wants to what I think is the best things for patients and their situations. As always, I’m here to help. If I can.

@CoffeeBlackMD Or provide durable responses, or even cure. Sometimes these discussions are hard, e.g. if the message is not accepted (yet) or if we fail to make clear that ICU treatment will not change/improve the progressive underlying disease. Your description implies a different 'system',

@CoffeeBlackMD Of you would work at MD Anderson I could understand the nr of pts. I'm a Dutch oncologist and we try to avoid ICU admission at (clearly) end of life as much as possible (stage IV itself too unspecific as pts may have or have no option(s) left that can "bridge" them signific.)

Ik spreek me uit, voor vaccins, en voor chemotherapie wanneer dat nodig is. Ben ik nu ook een moedige arts?

@PurrdyPawws @atrupar It's make up/concealer and you know it

@atrupar I don’t think that’s a patch. I really think that’s his skin.

The discolored area on the back of Trump's right hand seems to be getting larger and approaching his fingers. This photo was taken today as he spoke to reporters in Florida. (Roberto Schmidt/Getty)

HUMILIATING GOP MELTDOWN CAUGHT ON CAMERA: Rand Paul just pulled the chair out from under Marco Rubio in the Senate hearing — and the hypocrisy exploded in real time. Rand drops the hammer: “If another country bombed our air defenses, captured and removed our President on U.S. soil… would THAT be okay?” Rubio freezes. He starts frantically erasing his notes, forgets how to breathe, and looks like a Trump sycophant who just realized he sold his soul for nothing. Rand reminds him point-blank: Congress declares war. Congress controls the checkbook. That Constitution you swore an oath to? GOP loves executive power when Trump’s doing regime change abroad. But flip the script? Suddenly it’s not so sexy. Rubio couldn’t even choke out “NO.” He couldn’t defend the endless foreign adventures he’s been selling for years. Our tax dollars. Their cowardice. This isn’t politics. This is a bought-and-paid-for senator auctioning off the Constitution for donor dinners and Fox News applause. GOP in power = rules for thee, but never for me.

@Theo_Roy33 Je zou het bij een lokale natuurwinkel kunnen navragen, of zij ze willen verkopen

@henku @MickInWit @chrisklomp Ik bedoel wat je wel eet..

@beaux_dr @MickInWit @chrisklomp Door zoveel mogelijk conserveer middelen te vermijden. Daarbij soms Chinese kruiden. Je moet af en toe naar je tong kijken. Er mag geen dik wit of geel beslag op zitten.

De overheid geeft heel voorzichtig het advies om minder vlees te eten. Nederlanders be like: hier, een foto van een dik stuk vlees! Lekker puh! Strijders, hoor.

@Luv_Xcuses School shootings

@pvdbig @ballendraaister Mensen zijn massaal op zonvakanties gegaan Patrick. En bakken aan de kust. Maar doe je ding. Dermatoloog en oncoloog zijn er voor je als het nodig is.

@ballendraaister Dat is het hem nou juist, zonnebrand creme zit vol schadelijke stoffen die je huid intrekken. Voordat er zonnebrand crèmes waren kwam huidkanker minder vaak voor. De pm farmaceutische industrie zorgt ervoor dat ze klandizie hebben... Zonlicht is juist gezond.

Zat lekker een poosje in de zon. Wel met hoge factor bescherming. Heb mijn lesje geleerd. Had in 2021 een klein plekje op mijn wang. Pas na een jaar naar laten kijken. Biopsie. Kanker. Plastisch chirurg. Mohs operatie. 8 hechtingen. Zie pics. Bescherm je goed!!

@vester71 5 uur 08......

Wat is uw record op de marathon

@henku @MickInWit @chrisklomp Met welke voeding hou jij je darmflora en stoelgang goed, Henk?

@MickInWit @chrisklomp Dat zijn fabeltjes en legendes. Vezel doet niks anders dan zorgen dat mensen wiens darmen en darmflora verwoest zijn door processed food nog stoelgang kunnen krijgen door de darmen flink te irriteren. En het doet zeker niks voor bloedsuiker en hart en vaatziekten.

@Bob_Wachter @UCSF @audreyamadean @Pooja_L1 Wonderful!

One of most joyful events each year @UCSF medicine residency: Music night at my house, with performances by our crazy-talented group of residents. Highlight video below. Thanks to @audreyamadean & @Pooja_L1 for organizing. I'm on piano, my son singing, at the end of the video.

@HubertFeys @vester71 Dank! Dat ga ik proberen.. (en verticuteren..)

@vester71 De grootste tip is, het ganse jaar door, uw gras niet te kort afrijden. En zeker niet voor de winter. Er eens over heen op de hoogste stand en dan met rust laten. Je krijgt mosgroei omdat het gras te kort wordt afgereden, mos heeft dan lucht en kracht om te overheersen.

Heeft er iemand tips om mos weg te krijgen uit je gras

@DrSuneelDhand Pathologists..

The medical specialties most likely to be replaced by AI next few years: 1. Primary care doctors 2. Radiologists 3. Dermatologists 4. Psychiatrists 5. Ophthalmologists Least likely: Surgeons (although it’s still on the horizon) Did I miss any?

@spencolas Naar en jammer dat je die laatste woorden gebruikt.

@Banana_Oncology Maybe low-class topical steroids do the job as well (to reduce the inflammatory component that you see, even though it can be acneiform and in the face); have positive experiences, eg in pts with similar tox due to MEKi monotherapy.

@Banana_Oncology It's a nice experiment/early study, (yet) concerned 10 patients with gr 1-2 rash, with signs of efficacy (and/or improvement over time?) in the 2 lower cohorts and no effect or even worsening in 3rd/ highest dose level. Caused gr 1-2 skin AEs in 7 pts, too.

Great question. A little bit background: BRAF inhibitors had been developed to target BRAF mutant cancers. There had been success with such BRAFi in the BRAF mutant primary tumors. But to many people's surprise, the treatments also induced cutaneous squamous carcinoma. Subsequent research showed these BRAFi paradoxically activate MAPK pathway in BRAF WT cells There has been trials testing topical BRAFi for EGFRi induced rash in CRC. Haven't really followed how that goes or whether it's applicable to other MAPKi induced rash mdanderson.org/newsroom/aacr-…