Lou P Henle
@HenleLou
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mediocre nephrologist. full-time troll. aspiring retiree. |all tweets are solid medical advice| /join #LouCrew \ chill out this is parody
between convoluted tubules
Joined January 2020
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Just read a hospitalist note: "patient on chemotherapy, unclear which one, too many acronyms in oncologys note"
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Tip for all doctors:
Can't figure out a diagnosis? Order an ANA. If it comes back positive you can just refer them to rheumatology and it's their problem now.
#lousrules
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Tip for intensivists:
Don't ask nephrology before putting im a dialysis catheter. Place it and demand the nephrologist start dialysis. Having a dialysis catheter is an indication for dialysis.
#lousrules
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Dear hospitalist,
Your patient isn't confused because the BUN is 55, it's cuz their GFR is 9 and you've given them full dose cefepime for three days.
Sincerely,
A job secured nephrologist
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Tip for hospitalists:
Before consulting nephro for hyponatremia make sure to not order any urine studies. Instead sit on the consult for a couple of days and give some fluids, salt tabs, diuretics in any haphazard way you see fit. Then consult the day before discharge.
#lousrules
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Tip for hospitalists:
That BUN of 31 is definitely the cause of your patients encephalopathy and you should probably stop any additional work up and just consult nephrology for dialysis.
#lousrules
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I once heard a nephrologist say, "it's not their dry weight until the patient is crying." This is really really wrong to say... If they have tears, there's still fluid to be removed.
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Tip for nephrologists:
Make sure to set dry weights to really specific numbers, like 78.3kg. It makes you look much smarter than your colleagues who simply make it 78.5 or 78.
#lousrules
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I was just paged for decreased urine output in an ESRD patient..
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If the prison guards that accompany prisoners to the hospital are representative of all prison guards I'm like 80% sure I can escape from prison.
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An AKI patient presented to ER.
The physician wrote, "he may have some prerenal, intrarenal or post renal process going on."
I mean technically he's not wrong...
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Tip for surgeons:
When you want dialysis, don't ask nephrology to evaluate them for dialysis needs, just blatantly tell the nephrologist to start dialysis. Nephrologists respond well to direct commands like this and respect your alpha status as a surgeon.
#lousrules
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Me: Who the hell double-booked me?!
My medical assistant: you authorized that booking two weeks ago
I hate when my past self screws over my current self.
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Tip for hospitalists:
You know that AKI patient with hyperkalemia? Don't do anything, just wait 8h until around 4:30pm and consult renal. The nephrologist doesn't have a family to go home to.
#lousrules
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Welcome to the world little Glom. I promise to teach you the ways of trolling and sarcasm.
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Having end of life discussions can be difficult. But even more difficult when the patient is hard of hearing. By the end of the conversation, you're essentially just screaming "you're dying!" at a sweet, unexpecting old man. This job is weird.
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Gentle reminder to stop antihypertensives in patients on pressors.
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Dear nocturnist at my hospital,
Stop ordering urine studies for hyponatremia on my anuric ESRD patients.
Thanks,
A disgruntled nephrologist that keeps cancelling your orders
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Urine osm and urine sodium... This patients bladder is basically a salt shaker
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Tip for nephrologists:
For your CKD make sure to not document their baseline creatinine or their etiology. Other nephrologist enjoy the thrill of figuring out the baseline Cr is 1.3 from diabetes
#lousrules
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Me: what's your sugar typically run at home?
Patient: 120-150
Me: *checks chart- A1c 12%*
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I deserve a Nobel peace prize for not going off on the ER doctor who called me at 3am to ask if it was ok to use contrast in a dialysis patient
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Tip for PCPs:
If you start Lisinopril and the creatinine bumps from 1 to 1.2, immediately refer to nephrology. Dialysis is imminent.
#lousrules
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Tip for PCPs:
When referring to nephrology for hyperkalemia, make sure not to stop the supplemental potassium. Nephrologists enjoy these easy victories
#lousrules
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@kramer_holly
True, definetely a good addition. ANA works best because you can really play dumb. "It said 'speckled pattern', I think that means super autoimmune lupus rheumatoid disease.. I need help"
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Baclofen: Hey ESRD patients! you can't feel your back spasm if you're in a coma.
#honestdrugslogans
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Me: have you ever been told you have kidney disease?
Patient: nope
Me: *looks in chart and sees patient had biopsy two months ago*
Me: dude, you don't remember them sticking a giant needle in you?
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I feel like if you are consulting both palliative care and nephrology at the same time, epic should have a safety catch and make you only choose one.
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Tip for cardiologist:
If someone has kidneys, always consult nephrology before Cath for clearance no matter what the GFR is. They need dialysis before and after Cath and some NAC for good measure to prevent that contrast injury.
#lousrules
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Tip for nephrologists:
Order a GN work up on a 95yo patient right before you go off service. Your colleagues will love you.
#lousrules
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Tip for hospitals:
Make sure the nephrologist's badge doesn't work to access the ICU. Nobody ever needs dialysis in there.
#lousrules
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Tip for hospitalists:
When consulting nephrology for an AKI, don't start any work up (UA,U/S, UPC, etc) and don't wait for a creatinine trend. If the creatinine is red, consult nephrology immediately! Nephrology enjoys having minimal information when approaching an AKI
#Lousrules
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If you use the word "hyperpotassemia" instead of "hyperkalemia" you're a "hyperpainintheassemia"
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Nephrology consult note template:
"Avoid nephroxins and hypotension"
99223
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Tip for docs and APPs doing nursing home rounds:
Make sure to refer your memory unit patients to nephrology for CKD3a. Nothing is better for patients with dementia than getting out of their routine and seeing a new doctor for no reason.
#lousrules
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New consult, creatinine 1.1, family requests nephrology...
Time to dialyze
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Me to 80yo patient with gfr of 35:
"Well your kidneys ain't a Cadillac, they're more like a used Honda. Reliable and going to get you where you're going"
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Tip for the primary team:
Don't read the consultant's note. They just enjoy being part of the team and don't care that you ignore all of their suggestions.
#lousrules
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Repeat after me:
If they have obstruction with hydro, call urology
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Tip for nurses:
Remember, urology and nephrology are the same specialty so if someone spikes a fever overnight after ureteral stent placement be sure to wake up the nephrologist on call.
#lousrules
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My wife is humming the theme to Lord of the Rings to put our kid down for a nap. With a mom like that and a dad as a nephrologost, this kid is going to be the coolest nerd ever.
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Tip for non-nephrologists:
Tell the patient their creatinine improved after dialysis and their kidneys are therefore getting better because of dialysis. This false hope is essential for the complete ESRD experience.
#dialysisfixedthekidneys
#lousrules
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Seen in chart:
"Patient remains sedated on ventilator. No complaints voiced"
#technicallytrue
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An angry surgeon came up to me asking for patient stickers thinking I was the unit secretary. Admittedly I let her think that for a while before saying "I'm the nephrologist" which then led to an awkward silence..
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Idk who needs to hear this but if the patient was net positive for the day, the AKI is not from "overdiuresis"
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my 103yo patient is on lipitor
...I think that's a little optimistic
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Has anyone ever proposed dialyzing off demons to the Catholic Church? If horror movies have taught me anything it's that exorcisms seem way more complicated than a four hour dialysis session.
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When the ICU team takes it up on themselves to order dialysis themselves.
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Your wife's OB appointment is not the time for an anatomy lesson
Me: you know he has a hole in his heart?
Lady Lou: what?!?
Me: yeah they all do until it closes at birth..
Lady Lou: *Glares*
#lessonlearned
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You want me to dialyze a patient with a K of 4.8 not on oxygen on a Sunday?
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Tip for PCPs:
Your 85yo patient with an eGFR of 58 needs a stat nephrology consult. In fact, go ahead and refer to vascular surgery for access due to their impending dialysis needs.
#lousrules
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"I've got a consult for you"
"Oh man, were the phones broken this morning?"
"No why?"
"Oh I was just wondering why you waited until late afternoon to consult me"
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Tip for PCPs:
When the radiologist writes "benign renal cyst, no follow up needed" refer them to nephrology anyway. You can never be too careful.
#lousrules
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Patient wanted me to switch her from jardiance to farxiga because she saw a farxiga commerical...
Well played astrazeneca... Well played..
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Anyone else just have those days where they wake up and think "I'm ordering a cystatin c today"?
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Tip for insurance companies:
1) reject med
2) send letter telling doc that for the med to get covered the pt must meet crazy criteria
3) receive letter of doc meeting ridiculous commands
4) reject again
#lousrules
@Humana
@UnitedHealthGrp
@BCBSAssociation
@Cigna
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Referral for an 80yo with a Cr of 1.1... somebody go get the dialysis machine..
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My son is in the 90 percentile for weight. Only 4months old and already better than most of his peers... We start SAT prep next week.
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Tips for old doctors:
Remind your younger colleagues how much harder your training was than theirs, they appreciate your insight from an era when the only antibiotic you had to choose from was penicillin.
#lousrules
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New consult in ER:
ESRD. They've got him on IVFs and are giving him orange juice...
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Just saw "CKD 6" written in a note.
If this was a real thing, what would it represent?
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In her defense even my own family finds it hard to believe I'm a doctor
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The person in front of me at the store bought 20bottles of Worcestershire sauce. Which of you nerds can answer this...
How high will her sodium be after drinking all 20 bottles? Assuming she has baseline sodium of 140 and she is 60kg and drives a Volvo.
#Worcestershirechallenge
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Tip for new doctors:
Only use the labs that support your claim. Ignore the labs that go against your preconceived notions.
#lousrules
#noonecaresabouturobilinogen
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I'm talking to my nonmedical wife about 24h urine collections.. cuz our marriage is thriving..
Her: so you have to pee every single hour?
Me: what? No, you just pee when you pee.
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If you use these books for anything other than a monitor stand, you're lying
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When the filspari rep shows me an article.
Me: "oh
@rheault_m
is one of the authors"
Rep: "you know her?"
Me: "nah, she just follows my troll account on Twitter"
Rep: *visibly confused*
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Anyone else enjoy the pastime of trolling naturopathic doctors on tiktok?
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Tip for primary care providers:
When referring to nephro, send your last office note. But instead of putting all that silly stuff like their history, medications, labs, etc, just keep it minimalistic. Nephrologists enjoy the thrill of going in blind.
#lousrules
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Real talk for a second, no sarcasm. I just saw the phrase "horrendously noncompliant" in an HPI... Can we not put stuff like this in notes? It doesn't serve any meaningful purpose except to demonize the pt
...it almost hurt me to be serious for a second.. Back to joking around
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PCP: *stops scheduled NSAIDs in CKD patient*
Me: Nice!
PCP: *starts baclofen*
Me: Oh.... that's really not the solution you think it is..
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#Sponsored
#Influencer
This week's tweets are brought to you by the dialysis patient that's having a full conversation on speaker phone during treatment.
If you know, you know.
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Me: "who scheduled a follow up with this 99yo with GFR of 40?"
*Looks at chart and sees my name*
Me: 😳
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Tip for hospitals:
Instead of designing your hospital in a simple shape like a rectangle, try something fun like a wheel with spokes. And instead of numbering the rooms in order, number them randomly. We enjoy the thrill of spending 30 minutes trying to find a patient.
#lousrules
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#sponsored
#influencer
This week's tweets are brought to you by 4pm consults. You can complain about them, but they're not going to stop.
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If the hospital runs out of PD fluid you can just substitute Gatorade right? It's just sugar and electrolytes
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Signing dialysis orders is like signing apple terms of service, y'all just scroll to the bottom and agree. Don't lie..
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In a recent clinical trial (conducted at my house) bourbon was noted to be successful at alleviating sinus pain associated with acute sinusitis.
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