Hey
#NeuroTwitter
, we wrote 2 editions of this
#neurology
board review book. They want a 3rd, but it’s a lot of ⏰ for pennies. 2 of our 4 authors have backed out on a 3rd edition. 2 of us are debating it. Did this book help you??
#Neuro
#MedEd
#MedTwitter
@CSWhiteMD
I tell people chronic migraine and chronic pain are electrical disorders, like a short circuit. This is why all the testing is always normal, because MRIs, etc. can’t visualize electrical problems, but we know it’s there based on symptoms. Thus, our treatments are targeting that.
I see
#headache
,
#migraine
and
#facialpain
pts from all over the country/world. They often claim their doctor said, “there’s nothing else I can do for you”. Can we change that mindset for the
#2020NewYear
!? I say, “there’s always hope and we’ll keep chipping away at it”!👍 🔨 🤕
This crossing guard has the most important job today
@ClevelandClinic
. Getting everyone pumped with his music and dancing on their walk into work, despite the rainy dreary day in Cleveland. We need him here every day please lol.
@kelsieswrites
@ChrisSnowCGY
I saw several young patients with acute strokes and arterial dissections directly after chiropractic manipulation through my neurology residency. One of them required a hemicraniectomy due to massive brain swelling. Definitely not a benign treatment, and they shouldn’t be calling
5 shots of
#espresso
have entered my 🧠.
#Caffeine
is blocking adenosine induced drowsiness, increasing my brain’s energy metabolism, releasing noradrenaline, dopamine, serotonin, and calcium. I take another sip. Inpatient
#neurology
hospital rounds are starting…
#NeuroTwitter
#Neurologist
#1
: U can’t have
#ChronicMigraine
since ur not crying + have too much control of ur life.
PCP: For neurologist
#2
, cry + be disheveled.
Neurologist
#2
: U need to 1st get control of ur life.
🤯
Run away.
Acting isn’t needed for
#migraine
and U deserve respect.
#MedTwitter
+
#NeuroTwitter
, never forget the importance to pts for u to just sit, listen, and let them tell u everything. Always catches me by surprise when pts (who have seen multiple docs) say, “Thank u for listening and taking time, I’ve never had that”. It should be the norm.
I spent 60 mins discussing an appeal for
#Ubrelvy
in a patient w/ clear
#migraine
who failed all abortives known to man, as all documented in faxed notes. I swear insurance companies purposely make this process as painful as possible to avoid paying. This process has to change!
#ChronicMigraine
patients often report many nonspecific
#neurologic
symptoms; poor memory, cognitive fog, paresthesias, visual, fatigue, etc. I explain it as the brain being stuck in a smoldering electrical storm which disrupts the normal electrical pathways.
#Migraine
#Headache
How did we get here, allowing insurance companies to unsafely practice medicine unlicensed? My patient failed several anticonvulsants + antidepressants.
#Botox
denied for
#ChronicMigraine
until beta blocker failure. She’s young. BP is low. I appealed, but still has to try.😡😤
🙏 that circulation was restored fast enough w/ good brain perfusion from
#CPR
to avoid an anoxic brain injury for
#DamarHamlin
. That’s my main concern at this point even if vitals are stable. This also highlights the importance of knowing
#CPR
.
#MedTwitter
#Hamlin
#HamlinStrong
@hyderabaddoctor
Sounds like a very classic case of glossopharyngeal neuralgia. I’m surprised no one picked it up sooner. Glad to hear he’s feeling better. For refractory cases to medications we also do MVD for glossopharyngeal neuralgia if there is vascular compression.
Not everyone’s migraine pathophysiology is dependent on the same biochemical, neuropeptide, and neurotransmitter pathways.
This is why people respond differently to different treatments. For some, a treatment is a miracle, to others it’s worthless. Some may have migraines that
Just had a colorful spreading aura, as Lashley described in 1941. Last time was in
#neurology
residency when I’d work 35 hrs and then go lift weights. Unsure if this was triggered by pushing 2 kids up and down the snowboard hill yesterday or 5 hrs of mycharting on a Sunday lol.
@BradyOlsonMD
Exactly. People that think
#doctors
went into
#medicine
to be rich/greedy are clueless. Maybe back in 1970s and 1980s lol. Anyone going into medicine nowadays with a goal of being rich (which would be a horrifying reason in the 1st place), will be sorely disappointed.
#medical
#Migraine
fluctuates between cycles of high frequency/severity and low frequency/severity. Constant insurance denials for meds because the patient is not at a specific frequency at a specific point in time, or they are in rebound
#headache
makes ZERO sense and is an archaic view.
A patient from Peru who says she has seen every single neurologist there for headache (with a list), with all records in Spanish, and trying to look at her scans under the ceiling light (since they stopped putting in XR light boxes!) is always a great way to start the morning!
Hypertension fluctuates between high and low levels. It’s not episodic or chronic. It’s hypertension. Migraine fluctuates between high and low frequencies. It shouldn’t be episodic or chronic. It’s
#migraine
. Insurance wrongly exploits this for denials. Revise it!!!
#NeuroTwitter
75 year old man told me if he was a younger man he’d name his firstborn after me😊. The majority of migraineurs never seek/delay eval for yrs. Thus, why frontline
#primarycare
serve a crucial role of screening for migraine early to stop years of misery.
#MedTwitter
#NeuroTwitter
“Acute vascular atypical migraine” referral highlights how poor migraine medical education is. “Vascular headache” is an outdated term based on the defunct vascular theory of
#migraine
. The wastebasket term “atypical migraine” is not an ICHD3 diagnosis.
#NeuroTwitter
#MedTwitter
Can we make it a thing that
#neurology
isn’t consulted in an elderly or MS patient w/ dizziness, fatigue, urinary frequency before excluding clear UTI?
#Neuro
shouldn’t have to make that diagnosis constantly. A basic
#medical
work up 1st is all I ask...
#NeuroTwitter
#MedTwitter
Me: Describe to me how your headache feels.
Patient: If I was being robbed in my house, I would ask the burglar to shoot me.
And there you have it lol.
✅ Migraine
#Headache
#Migraine
#ChronicMigraine
#Pain
I cringed when I saw the
#TuaTagovailoa
#concussion
last night🙏. What you saw was the impact against the brainstem (unmasks a primitive reflex w/ fencing posture), but can also reflect seizure activity which can cause stiffening and distortion of the hands and extremities.
#NFL
For best response of
#Botox
in
#ChronicMigraine
, hitting bone/burying needle in muscle is missing the
#migraine
target and too deep! The injection targets are sensory nerves above muscular layer. I also rub in each spot to hit as many nerve endings as I can.
#NeuroTwitter
#Neuro
Day so far.
#Trigeminalneuralgia
x 10 yrs. Never had neuro/physical exam or MRI w/ her docs. "What's an exam"?
Chronic cluster HA x 6 years. PCP: "nothing can be done for
#clusterheadache
". Gave Propranolol, "update me in a year".
Um, yeah we need more
#headache
specialists!🤯
#Migraine
18-20% of women (1/5) have it.
39 million Americans and 1 billion globally have it.
2nd leading cause of years lived with disability after chronic back pain, peaks in prime work years.
Causes 50% of
#neurologic
disability.
Costs the US 36 billion/yr.
Pass it on.
Public service announcement to always listen👂 to your patient and take them seriously. What sound like minor basic details and common sense are many times not so common and a really important thing for you and them!
#MedTwitter
#NeuroTwitter
#Neurology
#Neuro
#Medical
#Health
Can we PLEASE eliminate episodic/chronic migraine terminology and just call it migraine (which often alternates between high/low frequency cycles so can vary) for prior auth purposes? Did an
@OptumRx
peer to peer with a non-HA specialist today.
#NeuroTwitter
#MedTwitter
1/3
As I always say, patients have variability in which
#migraine
biochemical pathways their pathophysiology is driven by. Thus, why people respond differently to different treatments. I love that feeling of when you find the right match for the right patient though! Headache
If ever unable to recall someone’s name or a word, slowly run through the alphabet in your head, concentrate on each letter as you pass it, while trying to recall the word. Your
#brain
will often click once the right letter hits. Thank me later😉.
#Neurology
#NeuroTwitter
#Neuro
Inpatient
#neurology
hospital service always resets perspectives. Life can change immediately and drastically in so many ways of badness at ANY age. Also, this apple fritter looks more like a huge atherosclerotic chunk pulled from an ICA terminus
#stroke
😂.
#NeuroTwitter
#Neuro
Anytime you have a continuous one sided
#headache
with ANY autonomic features (or even if they are lacking), always rule out
#HemicraniaContinua
with an Indocin trial (if medically able). A foreign body sensation in the eye (sand, hair, etc.), is often a good clue too.
#migraine
I ❤️ insurance rules when they deny a med until a random different one (🎲 roll) is used 1st. They then require a prior auth on their own required med trials… and then often deny those! Often there is a peer to peer that needs to be scheduled… which is usually a waste of time
I’m 100% certain that these insurance companies are at the point of just making up random number of
#migraine
day requirements to justify their med denials. Does anyone have ANY idea of where they came up with this random 9 minimum
#headache
day requirement??
#NeuroTwitter
#Neuro
Today… Saw a patient who fell, hit her head, lost consciousness, and tore her scalp open. Oh and just to spice it up, she blacked out ON A BEES’ NEST. Woke up to stings all over and staples in the head.
My diagnosis: Concuzzzzzzzzzzzzzzzzzzzion🐝.
Saw a cop with
The Thatcher Effect: Our
#brain
can't process an upside down face since it’s programmed to recognize faces upright. A mental map recognizes the face in parts (eyes, mouth, nose), which all seem normal. Now turn the face upright...
#Neurology
#Neuro
#NeuroTwitter
#MedTwitter
#Med
To my awesome
#headache
,
#migraine
, and
#facialpain
patients, I’ve been “drafted” to a
#COVID19
team, so my whole April schedule was cancelled. My apologies if you’ve been waiting forever! If so, message me and I’ll add you back when normalcy resumes. Be safe!
#CoronaVirus
#COVID
My dad and grandmother immigrated from
#Kiev
#Ukraine
, so I’m proud of the
#Ukrainians
defense in this
#UkraineRussiaWar
. Humanity of every country (including
#Russia
) hates this. I ordered potassium iodide tabs today. I hate that. Spring is coming, hopefully with an end to this.
My out of state patient w/ daily
#headache
/
#chronicmigraine
for decades went from 30 days to 4
#migraine
days/month. Those 4 days are triggered by her angry husband who is having a hard time adjusting to the “new her” doing so well, and they’re now in marital counseling.
@Zak_Bagans
Seen
@thecure
and
@RobertSmith
, and as awesome as you’d expect... and look at that ticket price lol. Grew up with them playing on repeat, hope to see them again someday...
If you are getting an MRI for
#TrigeminalNeuralgia
or
#FacialPain
, make sure it is the right one! We see a lot of referrals for this, and typically only a basic MRI has been done. To avoid an insurance battle to try to repeat it for the right one, please order as below👇👇👇.
1/2
Ode to my pager of 16 years. We walked the
#ClevelandClinic
halls at 4AM on endless 30 hour
#residency
call shifts. You prevented sleep. I hated your voice. You gave me bad/good news. You’ve finally died, forcing me to route pages to my iPhone. RIP...
#MedTwitter
#MedEd
#Medical
#Opiates
/
#Opioids
,
#Cannabinoids
/
#Cannabis
have been heavily stigmatized and penalized.
Neither is right for everyone’s
#pain
.
But one is right for some, and may be the only thing maintaining function and quality of life.
Drowning in
#ChronicPain
isn’t fair to those ones.
It’s 2021. Insurance companies still deny
#Botox
for
#ChronicMigraine
for “experimental treatment”.
They exist detached from reality in a parallel hellish universe, meant to torture patients.
Botox is proven and was FDA approved for chronic
#migraine
10/2010.
Mind blowing 🤯.
Excited to get these
@avulux
#migraine
glasses into the hands of some of my patients to try both abortively and preventively. Impressive data published and anecdotal evidence with pending studies treating Vestibular Migraine, Visual Snow Syndrome, and Sharp Edge Vision Syndrome
Does anyone else’s
#telemedicine
visits often consist of writing sticky notes to get the patient to get it to work😂? That back and forth talking without hearing is always awkward lol. I’m going to just keep these with me at all times.
#DigitalHealth
#ehealth
#mhealth
#MedTwitter