Daniel Leininger

There’s so much “news” about student loans that’s just a bunch of hot air. Nothing actionable yet beyond what we’ve already discussed. That’s why I’m not writing much about it. Otherwise I’m just a newsie selling headlines. When there’s actionable info, I’ll let you know.

🚨 THREAD: The 6 biggest things happening in medicine right now that you need to know about. Buckle up. 🧵👇

@EM_RESUS Additional comorbidities have to be mentioned here, type 1 dm? CKD? Rheum dz? Familial hyperchol? Demographic framing is part of clinical reasoning.

Here's a video I made breaking down this very important #ECG case of a 28-year-old young man who walked into the ER with chest pain #FOAMed

@USRenaLink @LouiseNBLU Those are good numbers😁

Greenville is a lively town full of outdoor activities, local and state parks, top-notch restaurants and breweries, and a great music scene. 🌳 JV investment opportunities 🌳 Call 1:6 to 1:8 weekdays and weekends with APP support 🌳 2 year partnership track 🌳 DM @louiseNBLU

@VPrasadMDMPH The 1900s is considered the 20th century

If I walk to get groceries, fires will stop

@GlassockJ @askrenal Exactly, it was an consult for 2grams of nearly normal proteinuria

@askrenal @dleininger17 A miscalculation. Should be 254 mg/gm creatinine (slightly normal range, but maybe not abnormal if this is a spot sample obtained after exercise .

An Ask Renal question for the #NephTwitter #NephX by - @dleininger17 👇 twitter.com/dleininger17/s…

Can anyone spot the problem here? #askrenal #medtwitter #nephrologyconsult

@EM_RESUS Never have a heart attack during a game of charades

Save a life in one tweet

@JustinTrudeau Why does Canada not have term limits? I’m truthfully uneducated in this.

We’re going to have fewer temporary foreign workers in Canada. We’re bringing in stricter rules for companies to prove why they can’t hire Canadian workers first.

@kidney_boy What are your thoughts about histological findings of tubular vacuolization etc?

One of the common criticisms of NephroCheck and other biomarkers of AKI is that since we don't have a treatment for AKI, checking these do not change what we do. But I think this view isn't thoughtful. Given that most of the contrast associated nephropathy we see after cardiac cath has been shown to be meaningless hemodynamic changes in creatinine and not actual tubular damage, we could have avoided scaring a generation of doctors in to believing in contrast nephropathy had we evolved from creatinine to biomarkers. Similarly, how many heart failure patients have gotten inadequate diuresis because of panic over a bump in creatinine? I suspect, had we transitioned to biomarkers of kidney injury, cardiologists and nephrologists would have been more confident in pressing forward with needed diuresis. Better diagnosis would allow better management despite not having an AKI pill (yet).

@bryan_johnson @talmagejohnson_ Plasma pheresis is not without risk Substantial removal of important antibodies and blood clotting factors especially if he is replacing his entire plasma with only albumin. Quite frankly dangerous. Also no one would say you have “clean plasma”

Completed my first total plasma exchange (TPE). Removing all the plasma in my body and replacing with Albumin. This is different from what I did last year: removing 1 L of plasma from my body and then replacing it with 1 L of plasma from my blood boy @talmagejohnson_ . I gave my one liter of plasma to my father. This time around there's no blood boy involved. TPE removes all of my body’s plasma and replaces it with Albumin. The therapy objectives are to remove toxins from my body. The evidence is emergent. Others use TPE for autoimmune disorders, blood disorders, neurological conditions, transplant-related complications, and replacement of missing plasma components. As we normally do, we completed a bunch of baseline measurements before this therapy including toxins but other things too such as speed of aging, organ ages, microplastics and many other biomarkers. I'll do six total treatments. The operator, who’s been doing TPE for 9 years, said my plasma is the cleanest he’s ever seen. By far. He couldn’t get over it. When we finished, he couldn’t bring himself to throw it away. He was imagining all the good that it could do in the world. On people’s face as PRP therapy. In their body, rejuvenating organs. There is probably a path to auction off or donate my plasma on this next go around. Liquid gold. Remember that when my father received 1 L of my plasma his speed of aging dropped by 25 years and stayed that way for six months. We don’t know if it was from my super plasma or if it was from removing his plasma, but the results are interesting nonetheless. The whole procedure took just under 2 hours.

#HurricaneHelene damaged the factory responsible for manufacturing over 60% of all IV fluids used in the US, leading to a major national shortage. As clinicians what can we do to about the #IVFluidShortage and how can we prevent this crisis from happening again? A thread 🧵 1/

@WCInvestor Maybe they have already gifted their planned inheritance to their kids when it impacts them the most. @DieWithZero

Net worth surveys of physicians in their 60s, generally at the end of a 30+ year career, show that one-quarter of them have a net worth of less than $1 Million, and 12% have a net worth of less than $500,000! Why do you think such a large proportion of late career physicians has such a low net worth?

@TrekDocFan @nickmmark I’m actually not joking. One of my patients had a miso soup pack today in his bag and the bedside nurse helped heat up a cup of water.

@dleininger17 @nickmmark Actually, not a joke. After the Abombing of Hiroshima and Nagasaki, Japanese physicians were trying to rehydrate A-bomb victims with miso soup without IV fluids. The soup's kelp had iodine that saved many from radiation sickness and the ORS helped as well. US needs NS & LR!

There is an IV fluids shortage (0.9% MS & LR) due to hurricane Helene. Because of the shortage everyone should stop ordering routine maintenance fluids for the next 2-4 weeks. Because of good medical practice everyone should stop ordering routine maintenance fluids forever.

@IM_Crit_ Bowel surgery? Impaired enterohepatic metabolism of Propofol?

ICU Snapshots: What happened to this patient ~30 minutes earlier?

@TPP_MD “I’m in the pee pee business” (nephrology)

Doctors in public: Stranger: “What do you do?” Me: I work down town “Where?” At the hospital “What do you do there?” I work in the operating room “Doing what?” I take care of people “Are you a doctor?” Yes. I’m a doctor. “Oh, can I ask you about…” 🤦‍♂️ #MedTwitter

@kicks The Olympics are for the worlds greatest athletes, not artists.

Raygun’s response reflects the ongoing debate in breakdancing: Should it prioritize technical skill or creative expression? Her comments suggest that she sees herself as an artist first, athlete second. But does this justify the alleged manipulation?

Australian breakdancer ‘Raygun’ is being accused of ‘rigging’ her way to the 2024 Olympics 😳 A thread 🧵

@AaronGoodman33 😂

@jjfitzgeraldMD Why don’t you post a guideline, perhaps the one you follow. I mean this genuinely, perhaps it will be helpful for med twitter physicians

I cannot stand by when I am seeing female patients being treated monthly with Cipro for recurrent UTIs, developing resistance, C. diff, needing a PICC line, almost dying, when they could have just been put on vaginal estrogen years ago 🤬