Rachael Barr
@DoctorRach13
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Mum. Paeds reg. Lover of travel. Interested in paeds infectious diseases/critical care/global health. PhD fellow with GW4-CAT/Wellcome studying #strepA . She/her
Joined May 2019
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For clarity. Chris. When my surgical trainee husband was acutely suicidal the only ‘support’ from his employer was a letter saying his pay would stop soon…
@NHSPracHealth
on the other hand very literally saved his life.
Decommissioning ‘while you review’ will cost lives.
Lots of comment on
@NHSPracHealth
support service. For clarity.
@NHS
England is committed to ensuring all NHS staff receive the mental health support they need. The vast majority of this provision is, and always has been, via their employer’s health and wellbeing schemes... 1/x
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Sad to read in the news about a child’s death from invasive Group A Streptococcus (iGAS)
But the articles I’ve seen have been somewhat inaccurate and confused!
So I thought perhaps a little 🧵
From a paediatrician and budding GAS researcher…(1/)
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Doctors who left the NHS or left a speciality training no. - what do you do now?
Genuinely asking for a friend who feels incredibly trapped (quite senior reg in a surgical speciality that is making them miserable). Trying to show them there ARE other things…
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The UKHSA has issued a warning that there could be a large outbreak of
#measles
in the UK, specifically London, due to low vaccination rates.
Many clinicians in the UK who haven’t worked abroad may have never seen a case of measles so just signposting to some good info here🧵
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I hope this helps clarify some of the slightly confused reporting about which symptoms and syndromes we should be worried about following the sad reports of a school outbreak and death of a child.
End 🧵
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@DrNickTwit
@RoyalFreeNHS
We can all only hope that one day someone will speak of us with the same amount of love as you just spoke about your grandpa. He sounds wonderful. I’m so sorry for your loss ❤️ I hope you find ways to stay emotionally close with your family through this.
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@juliaisobela
Paediatrician here - examine from the right?! 😂😂 examine from where ever you happen to get the opportunity e.g. whilst crouched behind a play kitchen
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I have a PhD fellowship interview tomorrow, today my 9 month old is a poorly boy and only wants to be held, so I have been practicing my interview answers to him while cuddling and appear to have bored him to sleep in my arms😴😂❤️
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In personal news, this little chap arrived 6 days ago 🥰 I know I’m biased but come on 😩😩 he’s all sorts of gorgeous.
Massive thanks to
@NorthBristolNHS
for his safe arrival, and especially team NICU for taking such amazing care of us both this week ❤️
🤞🏻for home soon!
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@clhubes
My big brother hated me so much he tipped me out my high chair and when my mum yelled he shrugged and said ‘you should have strapped her in’ 😂😂😂😂 I mean he’s not wrong…
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@zackferguson
😂 when I was F2 got asked by F1 to see unresponsive lady - she was entirely unresponsive. Did an ABG - not a flinch. Full examination, cannula etc. nada. Called med reg, who arrived and said ‘hello Mrs smith’… she sits right up and says ‘Oo hello dear’ 🤦🏻♀️🤦🏻♀️🤦🏻♀️ come on!
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One of my very kind mat leave presents from the other reg’s at work was a voucher for a company that delivers healthy frozen meals including ‘new parent boxes’ - this is a present from people who know what it’s like to have a newborn isn’t it 😂🥰
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It’s worth noting that his mental health crisis was entirely precipitated by severe burnout and bullying in his trust…so approaching them for help in the midst of a crisis they caused wasn’t likely to happen/be helpful was it?
Listen to what those on the ground are screaming!
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In some personal news… am busy making my very own smoll person 🤰❤️
However as I enter my 15th week of pregnancy & 10th week of constant vomiting despite x2 regular anti emetics… all I can say to everyone who told me hyperemesis gets better in the 2nd trimester is you lied! 🤢
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I can hear my husband gently singing to our 5 month old as he goes off to sleep, so that I can submit my PhD application this morning (😱). My heart is full and I’m proud of myself for putting together something I think is strong with a newborn 💪🏼
#womenrule
#dadsalsorule
❤️
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Can confirm that 6am white buttery NHS toast fixes nearly as many things when you’re stuck as an inpatient as it does when you’re on night shift.
In other news please send animal pics to cheer up this very overdue, emotional, fed up mama to be!
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@clare_eliza
This sends absolute chills right through me as both a paediatrician and a mother - the health service isn’t collapsing, it has collapsed… 😞
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Put a long line in a tricky poorly prem today on 2nd day back from mat leave and when the nurse in charge heard I’d got it in she smiled and said ‘she’s back!’ And I don’t think there’s a bigger compliment from a nurse 😂🥰🥳
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So excited to say I was successful in my application for PhD funding! (Pending references!)
Funded by
@gw4_cat
@wellcometrust
I am SO delighted and can’t wait to get started!!
Writing a PhD application and prepping for interview whilst on Mat leave…
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The measles rash.
Typically starts on the face/behind the ears then spreads to the rest of the body.
Crucial to know what it looks like on non-Caucasian skin as many of us will only have been exposed to Caucasian skin in textbooks 🙄
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Beyond thrilled to have won best poster
@ESPIDsociety
conference in Athens for my poster on Antibodies to Group A Streptococcal infection. Excited to talk more about it and hopefully some further progress in Lisbon next year!
#espid2022
#espid2023
#lisbon
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@clare_eliza
Middle of the night Cat 1 section which was 2 mins from knife to skin to baby out followed by a week on NICU also says she’s wrong 🤪
Support women who want to make this choice with all the info but saying it’s how all birth should be?! Get in the bin.
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But what is clear is that we need a vaccine.
One that will work on all the different strains across the globe, and help prevent some of the misery GAS causes.
This requires a global collaborative multi pronged research approach
In the meantime… (19/)
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Strike day!
A reminder that as a ‘junior doctor’, I’ve been qualified 8 years, overnight I’m the most senior paediatrician on site in my hospital & I could be leading your child’s cardiac arrest.
I deserve to be paid what I’m worth after years of cuts.
#JuniorDoctorsStrike
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Complications
Measles ISN’T benign
It can cause
❌ Blindness
❌ Encephalitis
❌ Severe respiratory infection
❌ Severe diarrhoea
❌ Miscarriage/Stillbirth/Prematurity
Years later Subacute sclerosing panencephalitis..
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The real problem underlying all this is the fall in vaccination rates.
Uptake of 2 doses of MMR is only 85% - well below the 95% the WHO says is needed for elimination.
The UKHSA is working hard to remedy this with strategic catch up programmes..
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But as healthcare professionals we should:
- be opportunistically checking children’s vaccine status and trying to bring them up to date (most cases of unvaccinated kids are NOT because of anti vaccine attitudes)
- report cases early
- keep it on your radar as a possibility!
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Had a lovely meeting with my ES recently about return to work post maternity leave. We talked about a drop in clinical confidence during the time I’ve been away… her response was perfect and made me feel so much better ❤️🧵(1/)
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Extremely proud to have been awarded the Sir Peter Tizard bursary to develop a study on paediatric Lyme Disease in the UK with
@BPSUtweet
. Working with a brilliant team of people to move this forward to phase 2!
#epidemiology
#paedsrocks
#BPSU
#PERUKI
#RCPCH
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I’ve put long lines in 500g babies so I know fiddly procedures - so could someone please explain why cutting your babies nails is THE most fiddly procedure?!
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…swollen red tongue (strawberry tongue 👅)
This should be treated with antibiotics and cases should be reported by doctors so outbreaks can be managed BUT most children can be managed at home with Scarlet fever and will make a full recovery quite quickly 👍 (10/)
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Tonsillitis! 🤒
Most tonsillitis is caused by viruses, but if it’s a bacteria then GAS is a likely culprit.
Most people will only be mildly unwell and will get better with a course of antibiotics.
Skin
Superficial skin infections may also be caused by GAS (4/)
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Firstly Measles is caused by a virus and is incredibly infectious.
The R number often quoted is 12-18 so an infected person will on average infect 12-18 others.
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This weekend was the toughest of my paeds career so far. Taken me all day to recover but now I’m sat in the sunshine, with my book, picking blackberries from the back of the garden and life is ok again. Grateful for car journey debriefs with friends for getting me through ❤️
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Struck me today as I got my little one vaccinated against varicella privately, the pharmacist said the service is REALLY popular at the moment… if we don’t approve it for routine schedule soon we’re really making varicella a disease of poverty and worsening inequality hugely
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Group A Strep (GAS) is a bacteria that causes lots of different types of infections.
It only affects humans.
By adulthood we will almost certainly have all had it at least once in some form.
First the common things… (2/)
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We like to think of paeds as a friendly speciality, and it often is - but 19% of trainees are at high risk of burnout in the latest GMC survey.
So at least a few (or maybe more?) in your work place…
Given paeds already high attrition rate we need…(1/)
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I did a thing.
Again 😂 but this time with all the people we love the most 🥰
Wasn’t going to let covid take this moment away from me ❤️
#married
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This bug keeps getting worse…
It is also capable of producing toxins once you have an infection
The toxins can cause a range of problems including Scarlet Fever 🥵
This is common in kids and they may have: fever, sore throat, rash that feels like sandpaper..(9/)
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Is there a bigger compliment in paediatrics than being given a sticker by the nurse in charge for doing a good job? 😂🥳
#paedsrocks
#toystory
#stickers
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After an infection has happened, some people can go on to get complications caused, in overly simple terms, by their immune systems response to the bacteria
Post-Streptococcal Glomerulonephritis - quite a mouthful… this is kidney disease that happens after a GAS infection (13/)
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We are lucky not to see much of it in the UK, but it is a massive problem in other areas of the world 🌍 including Aus, NZ, Pacific islands, Africa and SE Asia
It is a truly awful illness and research is desperately underfunded relative to the devastation it causes (17/)
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This is much more serious and would need to be treated in hospital
Pre-covid there were ~2-3000 cases of invasive GAS/year in England with a little over 10% being in children
This reduced over the pandemic due to lockdown measures interrupting community transmission of GAS (7/)
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Huge thanks to
@ESPIDsociety
for the research presentation award and chance to share a small amount of my Group A Strep research
#ESPID2023
#myespid
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Toxins can be more troublesome in some patients, causing streptococcal toxic shock syndrome with clinical shock and organ failure, or necrotising fasciitis - a severe soft tissue infection that the media love to describe as the flesh eating bacteria. (11/)
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🚨IMPORTANT THREAD FOR ALL NHS WORKERS🚨
You may not be aware that today it was announced that NHS Practitioner Health won’t be accepting new registrations from secondary care staff needing help in a mental health crisis as of this coming Monday (15th April 24) 1/🧵
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Go on then, just a brief moment of being proud of myself! Dr. Rachael Barr MBChB (dist.), DTM&H (dist.) and now adding.... MRCPCH!!!
#clinicalsdone
#paedsrocks
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Carriage
Lots of us will carry GAS in our throats or on our skin for periods of time and know nothing about it.
We aren’t sick and after an average period of ~ 10 weeks our body gets rid of it.
There are a few unknowns about what role this plays in transmission etc. (3/)
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A bit of happy news for the weekend. My out of office is going on... screw this covid badness, I’m off to get married! 🥰🥰😁🥳🥳
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GAS can also cause ‘invasive’ infections or iGAS.
This is a bit of a generic term and essentially means GAS infection in a part of the body that is normally completely sterile and clean.
It could be pneumonia 🫁meningitis 🧠 joint infection 🦵septicaemia 🩸or many others.(6/)
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So nice to hear I was nominated for Junior trainee of the year at the Severn deanery
#PAFTAs
last night 🥰 little things like that, that make you feel loved, appreciated and good at your job are the best!
#paedsrocks
#lovemyjob
#mostofthetimeanyway
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Alright paeds Twitter... got my first registrar rota recently, stepping up in 6 weeks or so, mostly terrified... tips?!?
@Leena_Patel
@alessglover
@dr_emmacoombe
@DrNickTwit
@DrMagsW
@DrSeanMon
and anyone else!
#paedsrocks
#ahhhhhh
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SO delighted to have been offered a clinical primer position through
@EBIBristol
for 6 months of research. Couldn’t have done with without an incredible supervision team that I’m humbled to be supported by
@anu_goenka
@adamhfinn
@alice_ahalliday
#groupastrep
#research
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This years numbers of reported cases are still far below average
(Source: UKHSA GAS seasonal activity report)
An individuals chance of dying of iGAS will vary depending on their own health, type of infection etc but each year some children and adults will die in the UK. (8/)
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… for example cellulitis or impetigo.
Again, in most cases this can be managed with a course of appropriate antibiotics.
Now things get a little more tricksy with this bug…😫 (5/)
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Both of these toxin based illnesses require rapid medical attention and may be fatal.
You’re starting to see how troublesome this one bacteria can be… but it doesn’t stop there… (12/)
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RHD is permanent damage to the heart valves from rheumatic fever. It causes symptoms of heart failure. It affects predominantly children and young adults and kills approx 250,000 a year globally in a slow and miserable fashion.
It is awful. (16/)
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This time you might see fever, painful joints, fatigue, chorea, rashes (erythema marginatum), subcut nodules or symptoms suggestive of carditis.
(See modified Jones criteria)
Repeated episodes of rheumatic fever can go on to cause rheumatic heart disease (RHD). (15/)
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They may be fatigued, have coca-cola coloured urine, oedema, oliguria, high blood pressure.
This needs management with specialist renal doctors - (of which I am not one!!)
Rheumatic Fever
Another problem that happens after GAS infection (14/)
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Say her name, not his
Remember her by the wonderful person she clearly was. Not for the terrible things that happened to her.
Women - it’s ok to feel vulnerable & angry today.Problem is the monsters don’t look like monsters, they look like normal men.
#saraheverard
#SabinaNessa
"She was caring. She was funny. She was clever. She was a beautiful dancer, a wonderful daughter. She was always there to listen, to advise. She knew right from wrong and lived by those values. She was a good person." - Susan Everard
RIP
#SarahEverard
💔
#SheWasJustWalkingHome
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Arriving for my last night shift
@NorthBristolNHS
and my last ever paeds SHO shift. From next week I’ll be a paeds reg which is only mildly terrifying 😂 had a lovely 6 months with a great NICU team to finish my SHO years
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@taylorfritz04
A real life super hero ❤️ Sam will leave an imprint on this world forever. The bravest of decisions at the most impossible of times. From my time working in PICU the children who became donors left some of the biggest impacts on my soul. Thank you Sam.
#childrensavelivestoo
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Sitting in St Mikes hospital by the main entrance waiting to start my first tertiary NICU job and thinking about my parents walking out the same door with me in a little bundle 27 and a half years ago!
#fullcircle
#paedsrocks
#dadmisseditbecausehecouldntpark
😂
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So you can see that GAS is a complicated little beast.
It causes a huge range of problems, some of which are common & straightforward and others which can be fatal
There remain many research unknowns about this bug that I won’t go into now because this is already v long (18/)
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Well...reading my MSF just made me nearly cry! I’ve had such a lovely 6 months at St Mikes & I’m so sad to leave. Someone wrote that they love ‘how much I chat to the babies’ and I duno if that’s a sign of insanity or a good paediatrician.. or maybe a bit of both? ❤️
#paedrocks
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OK so lastly some stats from UKHSA:
From Jan to April 2023 49 cases - 67% of which were in London
40% in children under 5
At least some of the cases represented local community transmission.
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Survived the first reg night 😃 nice to see some familiar faces
@musomedic
!
And man some senior paeds people are just wonderful at spotting when you need that little confidence boost aren’t they?!
@drdanmagnus
🥰
Paeds is so great sometimes 😃
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@Medic_Russell
Should do you… it cannot be overstated how excellent bubbles are. Once had a toddler genuinely not notice a cannula because of bubbles combined with a brilliant play therapist! 🥳🥳
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Some days I barely feel like I’m functioning as a new mum but some days… we have lovely play time, get outside for a walk, bake cookies together and then he breastfeeds to sleep whilst I draft my PhD proposal and I feel like I might be doing ok? 🥰
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Measles is a notifiable disease in the UK and the R number should highlight just how crucial it is that as health professionals we are reporting cases promptly to allow our public health colleagues to respond appropriately.
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Woke at 1am to my infant with classic croupy cough and my brain decides to go…
‘Oh children with croup are really hard to intubate’
Yes thank you for that thought!
He’s fine.
My middle of the night, seen too much paediatrician brain needs some help. 😂🤪😴🥱
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National incident declared in relation to recent measles surge…
I echo my colleagues who are urging people to get their children vaccinated. It is an excellent vaccine that gives near total protection…
BUT… (1/)
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So how do we spot cases?
I’d argue it’s not the easiest thing to spot, especially if it’s not something you’re used to seeing or considering!
NHS website states measles typically begins with:
🦠 Cold like symptoms
🦠 Fever
🦠 Conjunctivitis
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First week of clinical paeds ID/Immunology and it’s so brilliant.. Fascinating pathology, puzzle solving, interactions with almost every speciality, great mentors, time to think all coupled with just brilliant general paediatrics... just want to learn more and more!
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A small but very proud moment today, I appeared on the Bristol University directory just below my wonderful Dad after getting an honorary research contract ☺️
#babysteps
#proudmoment
#followinginsomebigfootsteps
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Consultants got all the juniors a little thank you present today following the craziness of covid... this key ring was one of said presents... I’ve never felt more seen 😩😂😂
#sotired
#PICU
#kickingass
p.s. my bosses are awesome, and have been throughout this entire thing!
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Huge love to every NICU parent out there today. Even if it was 20 years ago this weeks news is hugely triggering 😔
Also to all my paeds colleagues working on NICU who feel devastated and sickened. Support each other that little bit more this week ❤️
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Lastly - infantilisation of paeds trainees is a huge problem in my eyes.
ST1-3s can be really pretty experienced and are often just used as ward round scribes or to do every heel prick in the hospital.
Then we wonder why so many struggle with the step up to registrar (8/)
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@timricketts_
No greater complement in paeds than a senior colleague saying they would trust you to treat their own child 🥰
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One of the key reasons I chose paediatrics is so I can wear this offensively bright scrub top on a Monday morning and no one bats an eye 😂
#paedsrocks
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In the sky above the hospital today 🥰
@uhbwNHS
@thegrandappeal
making me smile on weekend long days!
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@HelenRibee
Totally get this, sending hugs, my boy is too young for his MMR too. But the reason it’s not given earlier is at least in part because little ones still have circulating antibodies to measles from you that have crossed the placenta, so they are not totally unprotected 😊
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Some signs that might help a little bit more:
Koplik spots
Little white spots, often on erythematous background, on the buccal mucosa. Usually precede the rash.
Sadly not as pathognomic as once thought. Not always seen in measles, can be seen in other viruses 🤷🏻♀️
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Short little celebration of our amazing GP surgery. I was a bit worried about my 6 month old this afternoon. Called GP at 4. Call back from doctor at 4:20. Seen in person at 4:45. He was thoroughly examined, appropriate investigations done and lots of lovely reassurance… (1/)
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COVID-19 in kids, brilliant and informative as usual from
@apsmunro
and the
@DFTBubbles
team. Currently looks like a less severe illness in kids, but still massive potential implications for provision of safe paeds care.
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It’s my first day solo with the small one today 🤪 why does it feel much harder than looking after a whole ward of sick smalls?! 😂 send solidarity and caffeine!
Also - v grateful husband able to take 6 weeks shared parental leave, how does anyone do this alone at 2 weeks?!
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ST1 ARCP ✅ I guess I can be a paediatrician! Taking just a brief moment to be proud of how far I’ve come since I first came to Bristol as a little med student.
#paedsrocks
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Do you know the one thing that would make my well being as a doctor infinitely better?
Payroll.
If payroll could just pay me correctly each month or even just provide someone to speak to when it inevitably gets screwed up, and some sort of apology. I’d be much less stressed.
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Although data suggests this is actually quite variable and should ideally be worked out with local data
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First 6 months as a paeds reg? Completed it mate! (Unfortunately completed it by being sent home via eye hosp for abx for eye infection but that’s not the point!). So grateful for all the support, advice, cups of tea and hugs when needed! Onto new exciting things.
#research
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Very grumpy about the broken foot, it’s true that doctors make terrible patients... but at least I have some time to finally read this gem! Cheers for the recommendation
@yvettepyne
!
@BarristerSecret
I fear I’m about to find out that criminal justice is as broken as the NHS?!
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Ok this post has slightly irritated (read enraged..) me this evening…
It compares co-sleeping with your baby to drink driving.
Let’s talk about safe sleep a bit.
All info quoted here is from the
@LullabyTrust
who are THE most excellent evidence based sleep resource!
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As a paediatrician I really resent anyone comparing the way
@realDonaldTrump
is behaving to a toddler having a tantrum... I think it’s really unfair on toddlers. Most toddlers I’ve met will pick up their toys and say sorry after a meltdown.
#PatheticTrump
#Election2020
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@kiityc
@nysuri
@NHSPracHealth
Sadly I couldn’t agree more - doctors will die, while platitudes about ‘employer support’ are thrown around, but the single NHS staff service that is held in high regard is dismantled.
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Got funding for a PhD
Presented my research at an international conference
Travelled abroad with my under 1 year old twice 💪🏼
Returned to clinical work from maternity leave
Here’s to 2024 🥳
EVERYONE INCLUDED; Please brag to me about a thing you did in 2023 that you’re proud of?
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Exciting to see the results of the HARMONIE trial out in the NEJM.
RSV is a nasty virus that kills a lot of children globally every year, but also has a huge impact in terms of hospitalisations and so pressure on paediatric teams over winter months… (1/)
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