Jonathan DeLong, MD

Fantasia (Type 1)! 🔮

I saw this MRCP of a choledochal cyst and immediately recognized that I had seen it before. It took me a while, but I eventually figured it out…

@DrDiGiorgio @aribindi This is disingenuous. Access to standard of care, evidence-based, primary prevention, health maintenance, and routine cancer treatments covered under traditional insurance plans is not the same as suggesting universal access to heroic measures. You lost the plot.

The honest answer is yes. Imagine a wealthy individual who had a traumatic brain injury. I’m talking super wealthy. He and his family build a home gym, hire a score of physical, occupational, and speech therapists. He gets 24/7 home care from RNs. He has multiple neurosurgeons a phone call away. Every minor thing is scrutinized by multiple highly paid physicians and nurses. He has access to an exoskeleton robot to help him walk. He does great. A middle class or poor person in his situation would have a much worse outcome. They might even die. The same is true for cancer. The wealthy can fly to MD Anderson or MSK, pay out of pocket, hire advocates, get second and third opinions, and rearrange their entire lives around treatment. We cannot expect everyone to have the level of access of the super wealthy. Which means many will have suboptimal outcomes because they can’t afford the same access to care. So, yes, some people will die because they can’t afford healthcare. Just like some will die because they can’t afford a personal trainer to get them to an ideal weight, or a dietician to ensure they eat healthy, or a low-stress job. It’s not fair. It’s unfortunate. But pretending it can be otherwise is a fairy tale.

@PipeCabreraV @SWexner @pferrada1 @TomVargheseJr @BJSAcademy @juliomayol @CiruAndes2 Also, if you “pitch and catch” (ie throw with the needle driver & catch the needle tip w/ the Addison’s to finish the throw) then move forceps toward the contralateral side, the tension from the suture tail will spin the needle into position to reload w/ better economy of motion

@PipeCabreraV @SWexner @pferrada1 @TomVargheseJr @BJSAcademy @juliomayol @CiruAndes2 If you want to do a little spin, I certainly won’t stop you, but the purpose is to prevent memory build-up in a running suture. I see some spin on each side of the incision—ie 2x per travel—which builds up memory in the opposite direction & is essentially like not spinning at all

Palming, Cambridge twist and needle relocation for backward suture ⤵️! How to do it! @SWexner @pferrada1 @TomVargheseJr @BJSAcademy @juliomayol @CiruAndes2

@FDA just call mRNA pre-peptides #rebrand

What if it’s not the really about the IOC at all, but the friends we made along the way 🤔 @SAGES_Updates @AcademicSurgery @SurgJournal @AHPBA @SurgEndosc

🚨 Very excited to have published this Surgical Clerkship Guide for Medical Students with insights from residents and staff at the Mayo Clinic! Thank you to all those who helped 🙌 @AndrewDVogel @JohnTreffalls @JabaayMa @ACOS_MSS tinyurl.com/2pschue5

@AndrewZywiecMD Imagine this tweet not being the most embarrassing thing you’ve done.

Homosexuality should be illegal.

It would be challenging to understand if a medical student couldn’t tell the difference between a liver and a spleen. This— is incomprehensible

@DocBoxberger33 All. The. Time.

@jcdelo Had to deal with this on three separate cases this morning.

1. Most penicillin allergies aren’t real. 2. Ancef doesn’t cross react when they are. 3. Even when the reaction is anaphylaxis.

@Wisbaum_PharmD I just read that! Additionally, early studies didn’t distinguish between different cephalosporins, many (most?) of which do have cross-reactivity to varying degrees.

@jcdelo Pre-1980's, most cephalosporins were cross contaminated with penicillins due the manufacturing standards of the time

@dtmcdevitt Thank you for coming to my TED talk

@jcdelo “He’s PCN allergic. Do you still want to give Ancef?” EVERY. DAMN. TIME.

@Fringe_Centrist Exactly. Allergic reactions to these antibiotics are *usually* triggered by the R1 side chain, not the beta-lactam ring (which was previously assumed). Most cephalosporins have an R1 side chain that is structurally similar to penicillin. Cefazolin (Ancef)’s is unique.

@jcdelo Up to Date says that there could be cross reactivity between other beta-lactems and Cefozolin but there probably won’t be. I don’t know if that is a theoretical thing or if there are verified cases.

Contrast-induced nephropathy isn’t real.

@jcdelo Looks like you couldn't understand this at all. Giving you IQ , looks a possibility sir 😊

I will never be wealthy enough for Polywood.

@IamGopambuj But you’ve barely touched your consensus statement… 🤓 pubmed.ncbi.nlm.nih.gov/33015613/

@jcdelo You may 😊