Richard Appleby
@RNAppleby
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Daddy, Gastroenterologist, IBD specialist, bowel cancer screening colonoscopist, clinical information officer, veteran, cares about everyone and everything
London, England
Joined March 2013
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Got out of COVID isolation yesterday, went for a 5k run, my chest is absolutely shot, had to stop twice. I’m a triple vaccinated sub3h marathon runner, this doesn’t happen with colds, omnicron is still worth avoiding
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I am a NHS consultant. I am financially comfortable, in a job I love, so why am I striking tomorrow?
Answer: Because the next generation will not be able to live off what I do today. The juniors that will become these consultants know this and are leaving already.
Why? 🧵 👇
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A thread about medical taboo
#101
: Moving jobs as a consultant: After 5 happy years in London, I took the momentous decision to leave. It was almost as mochas a shock to me as it was to my colleagues, I thought I would stay forever, so why did I do it, and what did I learn? 1/11
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I will sleep well tonight, knowing my patients will be safe tomorrow, between the consultants on call and not striking, there’ll be more consultants working than a weekend, and my junior doctors are excellent, they really do deserve more, now and in the future. end/n
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Expecting your workforce to take second jobs to make ends meet is unethical if your are an Uber driver, it’s frankly insane for NHS senior leaders. 6/n
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Why don’t you earn extra money doing private care? I don’t, its a personal choice, I prefer to put all my energy into the NHS. The next generation should have this choice as well. 5/n
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I qualified from med school 18 years ago, but if I qualified today, I would have 3x more debt (>£100k) at a higher interest rate and during my junior doctor career (at least 8 years, for me it was 13!) I would earn 30-40% less under the current contracts 2/n
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The current junior doctors know this, they don’t see a future for them, they’re leaving. The gaps are everywhere already, every day we struggle to keep out services safe with the minimum number of doctors, it just gets worse. Full effect of this will not seen until 5 years 4/n
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I would not have reached financial security by consultancy, I would not be home owner. I would be starting a consultant job earning 20% less than I did a decade before. Despite having reached ‘the top’ I would struggling to cover my debt, childcare and housing. 3/n
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So your reasons are entirely altruistic? No, I have a vested self interest in preserving the job I love, within the greatest healthcare system in the world. It is facing an existential threat without consultants, who are todays junior doctors. 7/n
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We have to act now to stop the rot. Not all the problems can be solved with pay rises, but NHS workforce shortage will never improve if todays junior doctors can’t envisage financial security, even when the’ve reached the pinnacle of their career. 8/n
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Got home today to find that my wife and 2 kids were being visited by a friend and 2 kids, rather than break the law, I took myself to the pub for an hour
#COVIDhero
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The closing date for applications is 16th Feb, You may not be ready yet, but speak to me now, as there will be more rounds of recruitment soon. 11/11
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STEP4: your turn, talk to me, my DMs are open, we need 2-4 more consultants, any subspecialty can be accommodated. Looking back, I can’t believe how scared I was, yet the obstacle was my own mind, most of us are still in the same mental trap. 10/11
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So we took the leap. My family love it. We are rebuilding a dept with these same values. I’ve been here 3 months and I’m enjoying my clinical medicine more than ever, mostly because happy staff care more, and caring more, gives back more. 9/11
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@Hunterrider
@DrHarryThomas
Crikey! Sounds as if I’m the lucky one, too soon to say this is long COVID. My recovery from the ‘original’ COVID in 2020 took 6 weeks and felt very similar, I was hoping omnicron would be different. I hope you get in those long miles soon
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STEP3: I arranged a locum there. I was immediately struck by the happiness of the juniors. The right staff are rarer on the edges of the country, that means they are valued, trained and retained. It really changes the whole feel of the workplace. 7/11
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The NHS is tough at the moment, I’ve lived in London most of my life, never worked anywhere else, but living in London with a young family and decreasing spending power was loosing its appeal. For 19 years my career had taken precedence, it was time to put the family first. 3/11
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Sympathy McDonalds brought to me by the endoscopy nurses during my all day list after being up with a bleeder at 3am. Cheaper and more effective than any resilience training
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I heard of an opportunity at North Devon District Hospital in Barnstaple. It was the relaxed beach lifestyle that pulled us. It had just merged with Exeter and the dept needed to be rebuilt following a spate of retirements. It was a blank slate, a gamble, but there was potential
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The merger with Exeter a large academic dept, gave all the opportunities for professional development. But there was the freedom to build something special. At NDDH there are depts that are thriving, because of uniqueness of the location and culture. We could replicate that. 8/11
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@BBC_HaveYourSay
I have followed you back, and happy to give context, but any media appearance has go through the BMA
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@UKGastroDr
@JSaeedian
Don’t pander to ignorance, I was mortally embarrassed last week when I asked a young doctor with a referral where she was from; ‘Sri Lanka’ she sheepishly replied, ‘no, I mean which ward?’ I’ve never felt so white and heartbroken for a junior
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Dear conspiracy theorists, please stick your phones in a -80C freezer, you will immediately realise why microchips can’t survive in vaccine, unfortunately you will not be able to tweet about it, so I will accept your apologies in advance
#CovidVaccines
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@MichaelVaughan
@JiffyRugby
@piersmorgan
OK, you’re professional sportsmen and you think competitiveness is a core skill, which I understand. I’m a doctor, I have to work collaboratively with all sorts of people, patients and professionals and it’s not about winning or loosing, children have to prepare for these careers
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STEP 2: But where? Had to be UK. If we were leaving London, then we wanted to make the most of an outdoor lifestyle. Job wise, colleagues and happiness were most important. Potential to innovate, improve and grow were also important for my own career satisfaction. 4/11
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STEP 1: recognise and question subconscious career assumptions. Consultant jobs are for life, I believed. If I ever left it would be for a ‘promotion’ to larger academic dept, I also believed. Were these prejudices standing in the way of my greater happiness? 2/11
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I was terrified of moving into an under-resourced dept. Would we miss the big city? Would a job in another city be the sensible move? But as an established consultant, did I really want to start as the 15th appointment in a large competitive dept? 6/11
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@SP_Duckworth
He’s talking about some (a very small minority) of nurses, that every doctor has encountered at some point in their career. He’s also talking about the most ridiculous cabinet minister of all time, so don’t see any issues here
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@JimMFelton
Any conspiracy theorists should freeze their phone at -80c, it will both convince them that microchips can’t survive vaccine storage and keep them off Twitter
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@RoryStewartUK
Damn you Stewart! You could at least let people have a coffee before dropping that one! I’m not deleting it
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@CountBinface
If you came out against the ULEZ, you’d have won, and could have enacted your positive agenda of pastry pricing limits and sensibly placed hand driers, I think your policy and campaign units need their heads knocking together
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Since this tweet is getting some attention, I thought I’d summarise some of the very kind and useful advice I got from the twitter community below, I hope people recovering from COVID find this useful 1/n
Got out of COVID isolation yesterday, went for a 5k run, my chest is absolutely shot, had to stop twice. I’m a triple vaccinated sub3h marathon runner, this doesn’t happen with colds, omnicron is still worth avoiding
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I’m taking a
#twittersebatical
for a week, after 2 weeks of frantic research, planning, reorganizing and communicating, our service is as ready as it can be for
#COVID19
I’m spending the next week with my 1 week old daughter before I take over a COVID19 ward
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@IvyGroveSurgery
Guys, take this down, I’d PM you if I could, it really doesn’t read well, I appreciate the extreme pressure and these issues must be raised in the medical and political communities, but this can’t be helpful to an anxious patient and could make things a lot worse
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@RoryStewartUK
It’s strange you can have a productive professional relationship with Boris Johnston after all the stuff you’ve said about him! I’m surprise if he gave you the time of day!
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@alderleyedgegp
That note seems a bit too well produced to me, is there some form of local or national campaign producing them? And if so, why the cowardly notes meant to do nothing more than demoralize?
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Some people citing side effects of vaccination and natural immunity: again crazy, the effects of COVID on the unvaccinated are far more severe, I see this on my own wards, the vaccinated 90 year olds walk out after 3 days, while the unvaccinated 40 year olds go to ITU 8/n
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For the sake of the 1% of people living with inflammatory bowel disease (IBD) I have to correct
@campbellclaret
comment on
@RestIsPolitics
that ulcerative colitis (UC) can progress to Crohn’s disease. They are separate, albeit, closely related conditions. 1/2
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First of all, I definitely shouldn’t have gone running, It could have made things worse (update on this below). Yes I’m a doctor and should know better, but I’m also a human and a runner, whose been cooped up for 8 days, 5k really was nothing to me, or at least it used to be…2/n
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@DrBenLovell
The arrogance in this is astonishing, the insistence that only a someone with a medical degree can have a worthwhile or competent contribution to healthcare is so obstinate and harmful to teams and the patients they care for, that it is incompatible with medical practice, GMC?
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Today we changed all our
#IBD
clinic appointments to telephone consultations for the next month. It’s the least we could do
@AutoImmuneLiver
@LiverToronto
@hepatoMD
Gideon you have to tell your leadership to avoid patients to go to hospital unless for urgent, non-delayable needs. Limit access to hospitals/healthcare services as much as possible; it’s there that you have a super-spreading of contages
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Our first man down: Prof Sami Shousha, I’ll always remember him for his enthusiasm in the MDT showing his pink blob slides to a room of glazy-eyed surgeons and gastroenterologists. Still rocking a microscope at 79. Rest in peace Sami
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We had seen a concerning rise in
#VTE
in
#COVID19
patients on prophylaxis. This has prompted us to double prophylaxis in everybody, I highly recommend this, had a PE death before we switched and it hurt
#medtwitter
please retweet
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@ZainKhanMed
I was a junior, on strike at the last one, and it didn’t achieve anything, the ballot declined the improved deal, to the gov implemented the one we were striking against, the strike didn’t work. Just passing on my experience, as any consultant should
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I've made my very first meme, I predict it will make at least 2 gastroenterologists smile
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I’m off to wake up my daughter to start tennis training, I don’t care that it’s midnight and she only 1, we’ve got a $2.5M payday in 17 years time to prepare for!
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First sight of 5 year Lyric data, primary ileocaecal resection looking like a better and better option for localized crohns
#MondayNightIBD
#UEGW2019
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@ShaunLintern
@DrLKVaughan
I’ve been a full time consultant for 5 years, I work weekends and additional management roles and still have not reached the level of pay that you describe as ‘basic’ if you want write an article on how NHS official figures are misleading DM me
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@DrHarryThomas
I’m sure I will, exactly the same happened when I caught COVID in march 2020 and it took 6 weeks to get back fitness, but I am surprised that the symptoms have been exactly the same with ‘mild’ omnicron
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@Abi_Rimmer
Good luck! My question is when does it stop being my ethical responsibility? There are unfilled locum shifts every day, do I stop when I’m exhausted, or when my wife leaves me, or when I make my first clinical error? Judging by this thread, you’ll have plenty to write about!
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Genius! And I think they’ve inadvertently solved the problem of mass vaccination in nursing homes!
At this nursing home, the staff wanted to do something special.
So they gave out Nerf guns, put on antlers and reindeer costumes — and held a "deer hunt."
Just listen to their joy.
This is what we're here for!
♥🌎😀
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Saw a patient last week that was paying $25k PER INFUSION for ustekinumab in the US, it broke my heart to think of sacrifices he had to make for a drug that costs the NHS approx $5k per infusion and costs the patients nothing. Why on earth would we sell the
#nhstotheus
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Someone posted this link for guideline for athletes returning to training which has very good advice: 3/n
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@Naomimiii
FY1s should never be allowed to accept referrals, they are a completely unknown quantity and no specialist knowledge can be assumed so an ANP who can be trained once and doesn’t rotate seems a sensible idea.
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@DrAlanWatson
Thank you, it was either that, or throw a grouse into the house first and run in yelling KILL IT KILL IT! The law is the law
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Social distancing is recommended for all patients with IBD on Azathioprine, prednisolone or biologics. What is social distancing?
1. Avoid contact with someone who is displaying symptoms of
#coronavirus
. Symptoms are high temperature and/or new and continuous cough 1/4
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‘Vlad, if you invade Ukraine, I swear to god I’ll commission an enquiry a year later to tell me if you invaded Ukraine or not’
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I don’t support mandatory vaccination, but getting vaccinated is a NO BRAINER, COVID in the unvaccinated is a much more severe disease, regardless of your age and the more severe COVID, the more likely you are to get long COVID 9/n
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NHS to the US
Saw a patient last week that was paying $25k PER INFUSION for ustekinumab in the US, it broke my heart to think of sacrifices he had to make for a drug that costs the NHS approx $5k per infusion and costs the patients nothing. Why on earth would we sell the
#nhstotheus
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This isn’t long COVID (yet) this can only diagnosed at least 4 weeks after the infection, my run was 8 days after, although my LFTs were negative x2 and I was asymptomatic at home, I am still in the acute phase 6/n
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Some people seem to be using this story as an excuse to get vaccinated: this is crazy. There’re is absolutely no evidence linking vaccination to long covid, there are plenty of long COVID cases from the first wave, when no one was vaccinated 7/n
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Just changed my email signature:
Consultant gastroenterologist
Chelsea and Westminster NHS Foundation Trust GC
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Family time so important for most healthcare professionals right now, too bad I spent all Saturday making this cake in secret! I hope it will be worth it tomorrow!
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@noodles_nood
But stick with it, working once qualified is a great leveller, many of your colleagues will be living in houses they own, but the graft and humility you have learnt during your struggle will pay dividends in the real world, you’ll be a great doctor and the money isn’t too bad
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Progressive dysphagia to solids, painless jaundice, PR bleeding 🚩🚩🚩🚩🚩🚩🚩🚩🚩🚩🚩🚩🚩🚩🚩🚩🚩🚩🚩🚩🚩🚩🚩🚩🚩🚩🚩🚩🚩🚩🚩🚩🚩🚩🚩🚩🚩🚩
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On this
#internationalwomensday2021
I wish to applaud every woman who had the courage to remove themselves from a toxic environment. One day society will respect women’s right to choose their path, I hope the media follow suit
#HarryandMeghanonOprah
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I wish it to be recorded in the annuals of history that on this day in the year of the great pandemic, I was challenged by my good lady wife to make a chocolate fondant in the time it takes her to get our eldest to bed, thus was presented on her return and met with satisfaction
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Exactly this: I don’t know of a single doctor who has taken a public antivax stance who didn’t directly profit through lucrative alternative medicine clinics, the most the average doctor gets from big pharma is a sandwich, yet we’re the corrupt ones
I saw this nonsense floating around a conspiracy nut board, and it made something click for me: These folks are basically operating on cinematic epistemology. They believe what would be true if the news were a Hollywood movie.
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@maroitoje
@EnglandRugby
No one believed we’d get even close to SA, you played the conditions and your opponents perfectly and you almost pulled it off, too often we believe that the result is pre-ordained, this was one of those moments that reminded me of the magic unpredictability of rugby, thank you
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@bottomline_ibd
No official clarification for IBD, but I would recommend self isolation for those on steroids (any age) or on any immunosuppression (not mesalazine) and over the age of 60. 12 weeks isolation will still be impossible for most, so hand hygiene remains the most important
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IBDtwitter, A young lady with a rectovaginal fistula needs dating advice! Beyond the bland medical reassurances of sex and pregnancy are safe, we need your top tips on dealing with smells, leaks and noises and how you broach the subject without spoiling the mood!
@bottomlineibd
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Of course if he was being treated in the NHS with our superbly trained colonoscopists, anaesthesia would not be necessary…but I’m glad Harris gets to hold the button for a while
Harris to become first woman with presidential power while Biden is under anesthesia for routine colonoscopy
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How to help NHS patients and staff with one intervention: employ more clinical psychologists. A thread 🧵 👇1/n
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300 nurses would be really useful right now, and 300 Filipino nurses are worth 600 others!
A plea for help. Anyone who knows how to help my 300 Filipino nurse colleagues who are stranded in the Philippines atm due to lockdown? They are all working in the NHS and all NMC registered. They exhausted all avenues- no government would help atm, no commercial flights. 1/2
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@bottomline_ibd
So deputy chief medical officer this morning clarified that IBD on any immunosuppressive should be social distancing (taking all sensible precautions, not barricading yourself in your house!) see
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@Overthe86335404
I was in The Army for 7 years. They make the worst pants ever, no thank you, I’ll stick with my own PPE
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@noodles_nood
I feel for you, been there and done that, I remember having a completely ridiculous conversation with a student when I was about to be thrown out for £4000 worth of hall fees, he really couldn’t understand how I could pay them! It was easier then, I only qualified in 45k of debt
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@drphiliplee1
Terrible discharge summary, no mention of a dementia or frailty screen or resus status
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@jm_blackwell
@UKGastroDr
@JSaeedian
Yes, well... I can’t help being white, male and 6’2” anymore than she can help being the opposite, partly my point is that we all need to be aware of our outward demeanor and how it impacts on colleagues. Start pile on now....
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Across a country of 65mil people, even if this saved 2 broken hips, it would be worth the 30 mins it took a comms officer to put this press release together, that is how you slash the horrific waiting lists
The NHS needs to move away from offering such pointless and patronising 'advice', and focus more on slashing horrific waiting lists.
Brits don't need advice on how to walk in cold conditions, they need timely and effective care.
Let's please cut out this nonsense.
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in mid-March we had a baby, 1 week later I came down with COVID19, my wife was dealing with a newborn, a 2yo and the prospect of coming down with COVID19 just as I was returning to work, grandparents were ruled out, we would have to cope, this was before the lockdown 1/2
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We sometimes change a diagnosis from UC to CD based on new information over time, but that isn’t progression. UC can rarely (2%) progress to colorectal cancer after 8 years which can be prevented with regular colonoscopy. I hope you’ve had yours! 2/2
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Someone else pointed to this interesting proposed mechanism involving a receptor I’ve never heard of: 4/n
Long term
#COVID
is associated with alteration of Ryanodine receptor
#calcium
#ionchannels
and leads to activation of neuropathological pathways that are also found in the brains of
#Alzheimer
’s Disease patients 👉
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@MarcusBlimi
Actually, based upon the animal models mortality is 100%. The mice were killed 60 days post vaccine to do tests, I’m 60 days past my vaccine now, thankfully the government hasn’t sent someone to kill me yet
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Love this slide from
@jamesfreed5
when people ask why I’m a clinical information officer when I know (almost) nothing about computers, I can now answer ‘but I am digitally willing!’
#FCI2021
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Why do we write 6MP when we mean mercaptopurine?
Well today I found out the hard way; saw a patient with an IBD flare, saw her thiopurine metabolites were undetectable, so accused her of not taking her 6MP. She adamantly denied this 1/3
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@Jonathansegal85
Honored doctor Segal Jonathan, we urgently invite you to submit most excellent article for publication in BUM the Brexit Journal of Gastroenterology without delay, no rejections for most excellent work just $499.99 for special honored doctor
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Lots of people sharing their experience of long COVID, thank you and my sympathies, it sounds truly awful. Best advice seems to be: hang in there, take it slowly, baby steps and it will get better, one day 5/n
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Hey
@TreasuryMog
and
@Number10cat
your species is on the rise! I salute our COVID19 immune feline overlords!
In order not to repeat the mistakes of past administrations we have elected the cat as prime minister of the household lockdown government. Best to have a species that is immune from COVID19 leading at this time. Here she is looking statesmanlike
#BorisJohnsonCoronavirus
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@RestIsPolitics
@campbellclaret
@RoryStewartUK
listening to the Mary McAleese interview I was struck by how little I understand the role of president, we’re all familiar with the executive type of presidency such as US, but where are the lines drawn between PM and president in countries such as Ire, Ger and Fra
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