I recently co-wrote my first ever book chapter 🤓📝📘!
Honored to contribute to the chapter on cardiovascular effects of substance use 🥃🚬
Thank you
@samitshahmd
for mentoring me through this process &
@ASAMorg
for the opportunity 🙏
Textbook available for pre-order here 👇
Principles of Addiction Medicine, 7th Edition
A fully reimagined resource, integrating the latest advancements and research in addiction medicine.
👉 Use code WQA001AA at checkout for 25% off + free shipping.
I’m on a renal consults elective and learning some cool stuff! Here’s a mini
#tweetorial
🧵 about something I learned today! What do you think of these labs?? Should we be worried about this patient 😱? 1/
Words this kid from Tirana, Albania 🇦🇱 never thought he’d say: I’m going to be an
@OslerResidency
Assistant Chief of Service (aka a Chief Resident) 😱🥳☺️
Honored to walk in the footsteps of some incredible Oslerians, alongside my 🤩🤩🤩 friends
@DrMRBMD
@rflick
& Angela Ma
In case anyone was wondering whether that first day of school feeling ever goes away, it really doesn’t! Even on your first day of being an attending 😆
Excited to embark on my
@OslerResidency
ACS year (
#thayer
#teamslytherin
) with this amazing squad 🤩🤩🤩
@rflick
I just wrapped up a busy few weeks of General Cardiology consults! After being on the receiving end of (many, many) consult requests, I wanted to share some tips for trainees calling consults & also for all the new rising fellows who will be responding to them in July 😉 1/
Today is a special day. 100% of our graduating class (the largest in the history of
@YaleMed
!) matched!!!! So excited to become a doctor, but even more excited that I get to do it with all of the people that I’ve gotten to know and love over the last 4+ years! 🎉🎉🎉
#Match2018
I’m working in a COVID ICU right now and the most consequential thing I did last night was to set up a Zoom so that a patient could see their family. Important to not lose sight of our patients’ humanity as we get caught up with vent/high flow settings, sedation, pressors etc.
On July 1, I completed the hardest, most intense, but most transformative & rewarding year of my life thus far: my
@OslerResidency
year as the 2022-2023 Thayer ACS.
THREAD: Really proud of this one...We conducted a post-hoc analysis of ALLHAT - the largest ever RCT of antihypertensive med therapy! - where we examined the association between socioeconomic context, blood pressure control & cardiovascular outcomes 1/
Pro tip for residents looking to do research: Find yourself a mentor who hypes your work the way
@ErinMichos
does for her mentees (& encourages you to study what excites you & challenges you to do your best)!!! Grateful to have such a dedicated and supportive mentor 🙏
This morning, 9:30 am, Early Career Award Investigator Semi-Finalist Dr
@andishahu
(from
@OslerResidency
) presents his oral presentation at
#QCOR20
: 23 - Income Disparity and Utilization of Cardiovascular Preventive Care Services in the Medical Expenditure Panel Survey (MEPS)
Proud to share our work, just published in
@AJPCardio
, examining the association between income disparity and utilization of cardiovascular preventive care services among adults in the U.S! 👇👇👇👇👇 1/
This week I’m working nights as the Wolf 🐺 (one of my favorite rotations!), wherein I help on-call interns on the Osler service care for their patients. Since I’m on nights, I made sure to cast my ballot early. If you haven’t already please make sure you
#vote
!!!!
#Vote2020
Raise your hand if you’ve had a patient not listed for liver transplant because they weren’t abstinent for >6 months 🙋🏻♂️
Amazing work by
@Kayleigh_HR
et al showing abstinence >6 mo. is NOT associated w/ better liver transplant outcomes 👏
cc
@MichelleMaMD
Thinking today about all the friends that made the last 3 years special and helped me become the doctor I am today.
But with every end comes a new beginning: tomorrow I’m a Cardiology fellow!
Some pics from the last few years:
Officially done with intern year!!! Today I had the distinct honor of signing out all our patients to my brilliant Assistant Chief of Service
@AmitGoyalMD
- the kindest, smartest, most generous (and tech-savvy!) mentor I could have asked for!
Thanks to some guidance from my wonderful ACS (chief resident)
@AmitGoyalMD
, I was able to put it all together into a poster and presented the case at the Maryland ACP conference today. Shout out to
@mikemorrison
for the
#betterposter
format (albeit with some modifications)!
When I was 8, my family immigrated from Albania to the US with the hope that my sister and I could someday have the chance to follow our dreams. For as long as I can remember, I dreamed of becoming a doctor, and this week that dream came true!!! 👨🎓➡️👨🏻⚕️👐🏽
Spending my Thanksgiving on call in the
@HopkinsBayview
CCU with my buddy
@RichardAFerraro
(on MICU!) 👨🏻⚕️Shout out to my fellow docs, nurses, PAs, techs and other clinical team members out there working in the 🏥 & caring for your patients this Thanksgiving! 🦃🙏🏽
Learning 🔥 pearls on Renal Consults from
@NityaSrialluri
and
@JohnSperati
this week! Here's a 🧵 about adequacy of hemodialysis:
Look at these lytes! First set are shortly before HD and 2nd set are shortly after. Is this patient getting enough HD? 1/
#tweetorial
#FOAMed
Wrapped up my 4th (of 5) months on the Osler service, our hardest/most educational intern rotation! Incredible month of growth thanks to my kind, funny, supportive co-interns/seniors, and the best boss/mentor/teacher I could ask for
@AmitGoyalMD
. On to vacation!
#FirmOfChoice
My last AHA blog post 🤗 in which I reflect on life as a Cardiology fellow 👨🏻⚕️ 🫀, how
@DrNasrien
inspired me to apply to be an
@AHAScience
@AHAMeetings
early career blogger, and more!
I’ve lived in Baltimore for 5 years - I rented my 1st apt, met my best friends, became an adult here. As an MD I now take care of its citizens. I see their struggles, celebrate their triumphs, am inspired by their resilience. I’m with
#Baltimore
#WeAreAllBaltimore
#BeautifulBalty
On ACS rounds these last two days, I taught our interns about:
- Evaluation for COVID-19
- Staph bacteremia
- Identification and management of sepsis
- Cellulitis
- How to read ECGs
- How to read CXRs
- How to approach chest CTs
#NewsSAR
#FirmOfChoice
Spent Christmas Eve and half of Christmas on call in the MICU, watching amazing families pull through & make the best of really tough situations so they could be there & celebrate the holiday with their very sick loved one
Congratulations to everyone that matched into residency today!!! I’ve never witnessed so much joy on my Twitter timeline 🤗
Congratulations especially to the next
@OslerResidency
intern class! We are lucky to have you join the
#OslerFam
🤩🤩🤩
#OslerPride
Honored to have the opportunity to talk about my research and why I’m passionate about it, and to meet so many wonderful faculty members. Also loved meeting some amazing IM residents from across the US who have been doing some incredible work!
#OslerPride
#OslerFridays
Congratulations to Dr. Andi Shahu-winner of the Levine Award for research in health disparities! He showed in an RCT that pts living in areas of lower income were half as likely to achieve BP control and had higher risks of mortality and other health events.
SO excited to join the 2020-2021 class of
#AHAEarlyCareer
bloggers and be a SoMe ambassador for
@AHAMeetings
this weekend!! Looking forward to live tweeting with you all this weekend. Which sessions are YOU excited about??
Announcing Social Media Ambassadors for SUNDAY, Nov.15 at
#AHA20
!! Be sure to follow these ambassadors for the latest updates on the event and the sessions they attend!
Spent 2 weeks exploring my original hometown Tirana and reuniting with family I hadn’t seen in years. Blown away by how much Tir😍na has changed since I left in 1999. A city that was torn apart by political & economic unrest in the 1990s is reborn
#Tirana
#APlaceBeyondBelief
Thus, the final diagnosis was reverse pseudohyperkalemia in the setting of hematologic disorder, marked leukocytosis and labs being drawn in heparanized tubes, leading to destruction of fragile WBC, hemolysis and ultimately falsely high whole blood K results! 13/
I’m typically not a big podcast listener, but one that I have been loving lately is
@CPSolvers
. The presentation of the cases is super digestable/filled with clinical pearls, & I love the camaraderie! Plus 2 of the coolest
@JohnsHopkinsDOM
people
@DxRxEdu
@ArsalanMedEd
are on it!
🚨 New
@JAMACardio
Co-Author Paper 🚨
"These findings highlight the ⬆️ importance of nonbiological risk factors—including structural racism & access to health care—in racial disparities in hypertension control and downstream adverse cardiovascular risk."
Given the patient’s malignancy, high WBC and the discrepancy in potassium labs, we suspected pseudohyperkalemia! 🧐
Pseudohyperkalemia occurs in patients with hematologic disorders and marked leukocytosis due to release of K from the breakage of fragile WBC. 8/
Some Wednesday motivation for anyone out there who has been procrastinating on their research: my grandfather is still writing review articles at 85 years old (and about tectonic plates in Albania, no less)!
Every patient I saw in clinic today had either already gotten or was scheduled to get the COVID vaccine and they were all really excited about it 🤩🤩🤩. What a difference a few months makes!
Mayor of Tirana, ALB
@erionveliaj
showing the world that it only takes a little creativity to radically change the way people get around 🚴♀️🚴 in a densely populated city that has struggled with high pollution 💨 for decades. This is true leadership 👏🏽
Highlights 🚨🚨🚨 from hottest 🔥🔥🔥 topics in heart failure for all cardiologists!!
1/ Awesome visual summary of key outcomes for
#DAPAHF
and
#EMPEROR
showing CV benefits of SGLTs in HFrEF
@AHAMeetings
#AHA20
Congrats
@andishahu
of
@OslerResidency
!
@YaleCardiology
struck gold w/ matching you into their Cardiology Fellowship program. So thrilled you are going back to
@YaleMedicine
where I know you will continue to excel & shine so bright. It has been my honor to be one of your mentors.
Had my first (ever?) French-speaking patient today! Still used an interpreter for interviews, physical exams & discussions about clinical care but felt so good to break out a language I spent so much time learning to chat about life. Totally changed the therapeutic relationship!
How did we break the tie? We asked the team to draw another whole blood potassium into a non-heparinized syringe (like the ones used for ABG). Et voilà! 12/
You might find it annoying that all your health professional friends are posting photos about getting the COVID vaccine. We truly are overjoyed to take this step towards COVID immunity, BUT this is also part of a public health campaign! 1/
Proud of my grandpa, Professor/Dr. Shyqyri Aliaj, who was recognized for his life’s work & contributions to the field of
#seismology
in
#Albania
and beyond by Mayor of Tirana
@erionveliaj
this week 🤩🤩🤩
For any fellow clinicians looking for a quick primer on the main takeaways of the 2019 CVD prevention guidelines, we’ve got you covered! I had the privilege of writing this piece with my wonderful mentor
@ErinMichos
🙏🏽. Check it out here👇🏽
It’s actually not important at all. What’s ACTUALLY important is that George Floyd was murdered and the responsible police officers need to be punished. We need to stop trying to find reasons to justify what happened. There are none.
Important from autopsy: The combined effect of George Floyd being restrained by the police, along with his underlying health conditions and any potential intoxicants in his system likely contributed to his death, according to the criminal complaint.
Looking forward to
#AHA21
starting tomorrow, and excited to be a social media ambassador for the conference as well as a senior blogger for the AHA Early Career blogging program!
“But plans, it turns out, are only plans.” Love this piece.
I had the privilege of working with
@guptaarjun90
on Solid Oncology last year. I was blown away by his knowledge, passion for oncology and his compassion for the patients.
Thank you
@NEJM
for sharing Ms. M's journey through two cancers and one pandemic.
''Plans and Pandemics''
ft. The
@RoyalFamily
,
@StevieWonder
, and my good friend
@abshk40
's wedding.
🧵 I’d like to share a
@Pulsevoices
essay I wrote about working in a
#COVID19
ICU, finding humanity and beauty amidst tragedy, and my favorite
@CorinneBRae
song (which gives the piece its title!) 1/
Blown away by this week’s
@CPSolvers
episode. I see so much iron deficiency anemia and I’ve never once considered this medication 🤭 as possible etiology (won’t spoil it if you haven’t listened yet!). Check out this awesome tweetorial that explains the underlying mechanism
1/
Why do we use Vitamin C (ascorbic acid) to promote iron absorption?
This question will lead us down fascinating historical paths and eventually provide an explanation to the recently posted
@CPSolvers
case.
Be sure to listen to the episode first!
You CAN go home again! I couldn’t be more thrilled to match at
@HopkinsMedicine
for Internal Medicine residency!!!!! I can’t wait to start my career as a physician in June after so many years of dreaming, studying, and preparing. Baltimore I’m coming for ya!
#Match2018
From 2016-2018, I had the chance to lead & implement a reflective writing curriculum for clerkship-year med students under the guidance of a brilliant, supportive mentor
@annareisman
. In the process I got to witness the power of reflective writing & became a better writer myself!
I’m so excited to be a part of this
@cardionerds
episode, in particular because I got to ask my mentor
@ErinMichos
about her approach to mentorship and what it means to be a good mentor and mentee
#goals
🤩🤩🤩
The unit I’m currently working on with all-star team
@KatBaileyNP
@krb_patel
@MichaelVelaetis
@JenniferForti7
flipped and became a COVID ICU again today. Our case numbers are skyrocketing. Please please please protect your loved ones and STAY AWAY FROM THEM this Thanksgiving 🙏🏼
A 🔥 thread on maternal codes. Hoping it never ever happens🤞🏽but I *have* had pregnant/peri-partum patients on our Cardiology (floor/CCU) services lately and as the senior resident (and thus code leader) this is incredibly helpful to know.
🚨Code Blue🚨 = patient in cardiac arrest. You've got your ACLS algorithms ready to go.
But…what if that patient is PREGNANT? 😳
I’ll leave ACLS pearls to my Medicine and EM colleagues. They all still apply! Here are a few notable things about running a maternal code.
Today I had the privilege of meeting some of the amazing doctors working in Cardiology & Endocrinology at Nënë Tereza Hospital in Tirana, AL!! Wonderful opportunity to share experiences & learn a bit about medicine/health care in Albania 🙏🏽
PC 📸: my grandpa 😂
#OslerInAlbania
My latest blog for
@AHAMeetings
!
Trials, tribulations & takeaways: what worked and what didn’t on the 2020 Cardiology fellowship virtual interview trail
“There was a rapid reduction in risk of CV death or worsening HF when dapagliflozin was initiated in patients with HFreF, with particularly large absolute risk reductions in patients with a more recent heart failure hospitalization.” 🔥🔥🔥
@JAMACardio
@RichardAFerraro
There is a rapid clinical impact when initiating dapagliflozin in patients with HFrEF, with particularly large absolute risk reductions in patients with a more recent HF hospitalization.
@ddbergMD
@TIMIStudyGroup
Making time to work out during intern year is SO hard...which is why I signed up for a race that would force me to make the time & train 😂. Cherry blossoms are one of the many reasons I love my hometown!
#cherryblossom10miler
#WashingtonDC
Took a brief break from my regularly scheduled clinical programming to work in the U.S. House of Representatives! It was a privilege to learn how policy is made and how various stakeholders influence that policy. The view on my walk home every night wasn’t too bad either 🤪
The suspected mechanism of action postulates that the WBCs in these patients are already fragile & prone to hemolysis but also have higher consumption of metabolic fuels, leading to impaired Na/K ATPase pump activity ➡️ increase release of K from the high # of WBC! 9/
@colleenmfarrell
One thing I do which felt silly when I was a kid is a minute of silence. I’m not religious and don’t pray but this feels meaningful for me. Right after I pronounce someone, I stop what I’m doing, don’t think about what I’m doing next and just take a minute.
This is so real. I’ve lost count of the times I’ve called our pharmacists asking for help and almost always the conversation leaves me feeling calmer and more reassured 🙏🏽
Pharmacists out there, does part of your curriculum include a course called “kindness and patience via telephone”
Bc uniformly 100% of the time you all are SO nice and SO helpful during my many, many struggling resident phone calls.
I’m at work today. I started wearing my mask when I left my house at 5:30 am, and I’ll continue to wear it until I get home at 7:30 pm. Thank you in advance for wearing one when you go out to run your errands/pick up dinner/go for a walk 🙏🏽 - your friendly neighborhood doctor
My grandpa is my
#researchinspo
. At 83YO he is still a leading earthquake expert in Albania & wrote this article explaining how they happen after the recent quake in Albania. He always reads my papers cover to cover & encourages me to do more research. Who’s your
#researchinspo
?
Sometimes I think about how
@especially_APT
(my
#firmJAR
who literally taught me how to discharge patients when I was a July intern in 2018) & graduated
@OslerResidency
<1 year ago, is already a leading voice & doing groundbreaking work in Addiction Medicine
#OslerPride
#shook
🔥
Excited to share our novel method for starting buprenorphine using micro-doses of IV buprenorphine from
@JAM_ASAM
. Thanks to all 3 co-authors, none on twitter.
First day of intern year! ✅ As I left work, I realized how tough these first few months will be. But I was also so excited to take care of patients and be their doc 👨🏻⚕️. My goal every day will be to do right by my patients. Everything else will fall into place 🙏🏽
Beta blockers are a first line agent for treatment of hypertension!
Hydralazine/ISDN are my preferred GDMT for HFrEF patients!
Please put this asymptomatic and well-appearing patient with afib on a diltiazem drip!
I hereby CLEAR this patient for any & all surgeries ☺️
A true legend of the O.
@sanjayvdesai
taught me that true leaders know how to inspire and uplift others, always! No one does that better than you, Sanjay. Thank you, and congratulations! Can’t wait to see your next chapter 🙌
I completed my tenure as the Director of the
@OslerResidency
this week to join as the Chief Academic Officer of the
@AmerMedicalAssn
, and wanted to share a few reflections. While I am overwhelmed with many emotions, the one that stands out most is gratitude. 1/5
I’m back on echo and having a blast scanning with our amazing techs.
A patient, to the tech, while I was scanning: “I think the doctor is substituting pressure for technique.”
Touché, sir 😂
#echofirst
#CardiologyFellow
As a resident, I spend most of my waking hours desperately trying to make sure that people DON’T die. Every death I witness drives daggers into my soul and weighs heavily on my conscience. To see a cop take someone’s life away like this...is unspeakably horrific and disgusting.
Well, the pseudohyperkalemia phenomenon is especially pronounced if there is heparin-induced cell membrane damage 🤔.
The serum K was drawn into a tube that did NOT contain heparin...but the whole blood K was drawn in a heparin containing tube. 11/
I had an affirming patient experience recently. When I was in the MICU I took care of a young patient, not much older than me, who had been very sick, on ECMO, intubated, deconditioned. A month later, I was walking into work and ran into him outside.