Lisa Foreman APRN-C 💜
@findmeabluebird
Followers
3,838
Following
2,855
Media
169
Statuses
12,815
Dermatology NP. #CovidisAirborne . Fit Test/Portacount Enthusiast. 🔗= N95 Dental Mask Hack. Mastodon: @findmeabluebird @zeroes .ca 💜
Atlanta
Joined March 2020
Don't wanna be here?
Send us removal request.
Explore trending content on Musk Viewer
Russian
• 1087018 Tweets
Putin
• 557475 Tweets
Rich Homie Quan
• 375743 Tweets
Venezuela
• 324477 Tweets
Cristiano Ronaldo
• 210460 Tweets
Messi
• 144377 Tweets
San Marino
• 115422 Tweets
Hunter Biden
• 100367 Tweets
Chiefs
• 98146 Tweets
#السعوديه_اندونيسيا
• 86550 Tweets
Thug
• 74979 Tweets
World Cup
• 64950 Tweets
Ravens
• 62167 Tweets
Paes
• 53676 Tweets
Liechtenstein
• 45292 Tweets
From Zero
• 43651 Tweets
#GHEstreno
• 41914 Tweets
كاس العالم
• 40998 Tweets
El Alto
• 36762 Tweets
Bolivia
• 32809 Tweets
مانشيني
• 32066 Tweets
Mahomes
• 31716 Tweets
سالم
• 30402 Tweets
المنتخب السعودي
• 20489 Tweets
Linkin Park
• 18077 Tweets
#الكويت_الاردن
• 17274 Tweets
店頭ビジュアル
• 16207 Tweets
Violeta
• 15083 Tweets
woody
• 14963 Tweets
Vinotinto
• 14805 Tweets
Milk Marie
• 12284 Tweets
Pinned Tweet
Anyone else feel like we’re being forced to play a video game against an unseen opponent where we’re constantly leveling up in difficulty, frantically searching for armor and tools, and everyone around us either denies that we’re playing it or thinks we’re playing in “easy mode”?
10
48
290
Who else thinks we’re heading into an absolutely stratospheric SARS2 wave? This will be our first fall/winter season of the pandemic with low booster uptake + less testing + almost no masking.
214
456
3K
📣 Can’t get Pax for Covid infxn? Or worried you won’t be able to? One-stop shop for info here. Bookmark and share!
Paxlovid: U.S. Resources— long 🧵
Bonus: Metformin info at the end--
57
880
2K
🚨 The Kids are not Alright! 🚨
We have a pediatric illness soup, boiling over with school closures and overflowing hospitals in over a dozen states. Why are we allowing the large-scale pain and suffering of innocent children? They’re depending on us to save them. 🧵
38
390
1K
Just did a “what is this rash” curbside consult for a friend. From pics and history, I’m 99.9% sure it’s multidermatomal shingles… in a 13 yr old. This type of shingles involves multiple adjacent dermatomes and is usually seen in patients who are immunocompromised. 🔽
29
212
1K
💥 Fit-Test Fun: 3M Aura Smash-Up 💥
Inspired by the question below, I recently decided to test a worn-out Aura to see if it was still protecting me. The results were surprising! See alt text for disclaimers.
⬇️
N95 Respirator Mask question: Can someone please explain how many times a mask can be reworn? I know it involves the build up of particles but I’m foggy on details.
I’m a bit embarrassed to ask in Year 5, but also, if I’m wondering this I’m probably not the only one. Thanks!
88
60
731
25
216
1K
Y'all masking? Yep, in fact I wore a PAPR for a colonoscopy today (not posting a pic of that scene).
GI doc: C19 is a cold, don't need masks
Me: I'm wearing a PAPR
GI doc: What's that? Can you spell it?
Now he knows.
#YallMasking
30
80
800
Oh--
@3M
, please make a black Aura and different mask sizes for different faces. Thanks!
/end
11
62
789
Two days ago, the CDC sent out this advisory to U.S. clinical labs. It contains instructions for conjunctival swab collection and other symptom-based swab types for suspected H5N1. Specimen collection graphic posted below--
7
274
751
I’d like to nominate my 10-year old daughter for a position as the new CDC Director. Her public health messaging this first week of school has been exemplary. Some examples of her answers to essential pandemic questions:
Q: What is that you’re wearing?
A: It’s a gas mask.
⬇️
14
72
726
4
31
544
“I've done this job for 22 years. This isn't normal. We are literally killing these patients. Not letting them die, we are killing them.”
Oncology Infusion RN in Louisiana:
Today (2/12), I had 15 assigned chemo infusions over my 12-hour shift. (2 of 8 RN's still mask, avg 50% of patients). /1
10
148
535
5
141
506
One. In. Seven.
A mass disabling event— in full swing.
Study: 1 in 7 Americans have had long COVID
Americans who report having experienced long COVID said they also experienced more anxiety, low mood, and difficulty with memory.
15
155
299
16
158
437
The patient had already been seen by a provider, and for some reason given steroid dosepak but no antiviral. Not sure what diagnosis was given at point of service.
It’s a healthcare jungle out there— and appears to be an increasingly immunocompromised one. Be safe everyone.
2
33
430
See, Dr Walensky? It’s not hard. Tell the truth and give ppl the info they need to protect themselves and others.
No scarlet letter for my daughter!
P.S.- Wait until she finds out about CR boxes, ventilation and CO2 monitors. She’ll school the school— 😷📦🪟💨🎛
2
27
419
This person is a 13-yr old w past history of varicella vaxx and no known recent illness/comorbids.
In my 20+ yrs of practice, it’s been uncommon to see shingles even in younger adults, much less pediatric zoster— and it should be even less common w history of varicella vaxx. 🔽
4
40
384
Q: Why are you wearing a mask?
A: My mom makes me. You should see her— she wears five masks stacked on top of each other!
Q: I thought Covid was over?
A: No, it’s getting worse.
Q: But I already had Covid.
A: You can keep getting it over and over.
⬇️
2
25
356
Bonus if you’ve read this far: for those also interested in metformin Rx for long Covid prevention, here is a study to share w provider showing 40% overall risk reduction, and 63% reduced risk if started within 3 days:
10
67
333
Plus ever-increasing % of immunocompromised population due to prior Covid infections.
15
26
337
@danaparish
@CDCgov
@CDCDirector
His words of wisdom:
“You know Covid is never going away. You’re gonna be living w/ this forever.” (Yes, Captain Obvious, that’s why I asked about N95s & HEPA at preop visit)
“I’ve done this for 30 yrs, I know what I’m doing. I’ve never given anyone Covid.” (Where to start?)
9
23
318
I have worn a fit-tested N95 or elastomeric every hour/every day (except lunch in car) while seeing patients in the office since this rodeo started. Here’s me in an Envo in 2021. Husband does the same while working critical care at the hospital, but he won’t let me post his pic.
27
30
306
📣 Rapid molecular test developed for H5N1; reportedly detects all subtypes/sequences including poultry, bovine, and human—
4
102
294
Many ppl qualify as high-risk for severe C19: examples include ADHD, anxiety/depression, overweight, physical inactivity, racial/ethnic minority groups, lapsed vaccine status, etc. Providers may not be aware of these risk factors and thus can be reluctant to prescribe. 🔽
3
65
288
Let’s support our U.S. and CA mask manufacturers— they’ve been there for us! Order now before the inevitable back-to-school fall and winter surges. Upgrade to a more protective elastomeric respirator like one of these:
⬇️
6
80
272
@ANicholsJDMD
@nkagetsu
True story: Years ago an elderly gentleman refused to allow an Af/Am resident to treat him (used the N-word!) and demanded to see the attending. After all the staff had a laughing/crying fit and recovered, the resident went in w/ his attending… who was also Af/Am. 👨🏾⚕️👨🏾⚕️🤦🏾♀️😳😂
2
14
267
From now on, I’ll be more confident reusing Auras until the straps loosen or until they get dirty or smell off (except in high-risk situations which deserve a fresh mask). ⬇️
6
15
272
@danaparish
@CDCgov
@CDCDirector
I walked out of an oral surgeon's office recently after he refused to wear an N95 as promised at preop visit. His ego and stance on masking mattered more to him than almost $3000 cash for procedure. I also had taken what became an unneeded preop antibiotic. (cont'd)
8
31
254
I posted elsewhere in thread but including here too—
A sibling of mine in early 50’s w no comorbid conditions has periodic zoster sine herpete (pain w/o lesions) that began soon after C19.
2
25
257
PSA just so everyone is clear:
1- It is not advisable to purposely make respirators dirty
2- This mask was probably worn for just a few hours prior to testing, so the testing is not necessarily representative of extended wear times
There, I feel better now!
6
10
252
Re-upping this dental mask hack vid: adding comments, fit testing results, ordering and discount/coupon info below. Please RT— we all need 🦷 work! ⬇️
14
76
242
They also may not be aware of the proven efficacy of Pax for long Covid risk reduction. Evidence-based CDC resource w citations to share w provider here: 🔽
1
39
237
📢 The WHO now recommends universal masking in health facilities. Email this link to all your providers including dental, PT, lab etc. When making appts, ask if they're following current WHO guidelines for universal masking.
This is a great link to share with all dentists and doctor’s offices
-Universal masking in health facilities, as well as appropriate masking, respirators and other PPE for health workers caring for suspected and confirmed COVID-19 patients.
5
30
92
7
98
231
Results: HMFF or harmonic mean fit factor (conservative average score) of 2650, which means the air inside the mask is 2650x cleaner than the air outside it. ⬇️
1
17
220
Many providers are not aware of this updated guidance, but it is important info w issues of false negative RATs/PCRs and + test result delay of up to a week after symptom onset. FDA reference here: 🔽
1
38
217
1) Testing: A positive PCR/RAT test IS NOT always needed. If you have symptoms +/- recent C19 exposure, the provider can make a clinical diagnosis and issue Rx w no test result or while PCR is pending. 🔽
2
30
211
Paxlovid treatment access continues to be an issue due to provider gatekeeping (“your case is mild, you’re not immunocompromised”), drug interaction concerns, and difficulty obtaining timely PCR or negative PCR despite symptoms and exposure. 🔽
2
28
210
How does this compare to my usual results with this mask and this type of testing? I usually get a HMFF of around 1500, which is a 3.2 log reduction and 99.90% filtration efficiency. In terms of actual protection, the worn-out Aura performed as well as a fresh one. ⬇️
2
22
187
This is equivalent to a 3.4 log reduction in the number of particles, and filtration efficiency of 99.93%. For reference, a fit factor of 100 is equivalent to N95-level protection for this type of testing. ⬇️
2
12
184
@organichemusic
Hang in there. Here's a pic of bluebird eggs in our birdhouse right now. Bluebirds are known as symbols of hope and happiness. I'll post more pics when they hatch!
3
1
170
2) HCP gatekeeping: Pax is indicated for children 12 yrs and older and adults 18 yrs and older with a current diagnosis of mild to moderate COVID-19 and who are at high risk for progression to severe COVID-19. 🔽
2
24
170
Dr B- $15 telehealth
*Per website: must be age 18+, have test results, must have high-risk condition 🔽
4
24
165
Covid is not a cold, and currently there is no evidence that it will attenuate to become one.
However, there IS evidence that about 75% of the population would have long Covid after three years of the twice-a-year installment plan. Graph below-- ⬇️
WATCH: Dr. Michael Osterholm explains that protecting older populations from Covid should be the focus going forward.
“My goal is to see everyone get Covid twice a year in this country but have it be nothing more than a common cold-like illness. That would be really a victory.”
359
35
87
16
44
167
@flowermusickids
@TheRealRhllor
@nkellyatJG
Also notice the huge bottle of hand sanitizer in the pic for AN AIRBORNE DISEASE!
7
9
163
NB: Level of protection will vary for everyone and for each type and brand of mask, so it's always a good idea to do a home or professional fit test. If you often reuse masks, consider fit-testing them again after a reasonable period of use to see if they still pass.⬇️
1
8
162
2
22
153
To clarify-- the convo took place at new patient visit prior to scheduling the procedure, so I was telling him that I wanted to wear a PAPR for the procedure. Luckily anesthesia was open to it, and now there's a precedent for others to follow if they want to do the same.
5
9
155
2- Used both straps to slingshot mask across the room x 20 (cat did not appreciate this part). ⬇️
2
4
158
If provider is hesitant to Rx, explain that you want to discuss side effects (most common are altered taste and GI upset) and risk/benefit ratio. If you have no drug interactions or contraindications, point that out too. 🔽
1
23
146
“A whole generation who can't smell anything”
This means two senses are gone (taste and smell).
Cookies baking. Bread baking. Freshly-mown grass. After rain. Coffee. Bacon. Roses. Cinnamon. Vanilla. Lavendar. Pine trees. Citrus. Baby’s head. Popcorn. Dinner in the oven.
A stuent got roses today and after I smelled the bouquet and proclaimed how amazing the roses smell, 5 kiddos then smelled the bouquet and couldn't smell anything. They were amazed that I could smell the bouquet with a mask on. A whole generation who can't smell anything😵💫
112
955
8K
8
40
146
3) Drug interactions and contraindications: Pax can’t be given w some meds, but many others can be temporarily held or doses adjusted. There are separate dosing regimens for renal impairment and pediatrics. 🔽
2
22
142
Why are we seeing this cauldron of pediatric illness? Well, we know immune systems are impaired following SARS2 infection. 🧐
2
30
135
Paxlovid eligibility checklist for prescribers (esp those who don’t have much experience w Pax) here: 🔽
1
32
133
Prior knowledge of and familiarity w this info from the provider’s POV may be helpful in making your case if provider is reluctant to Rx. 🔽
1
17
134
Using this badly mistreated but well-seasoned mask, I ran a full set of 12 exercises with a Portacount in N99 mode, using an adversarial
@FitTestMyPlanet
protocol using a jaw spacer to simulate facial movement. ⬇️
1
5
137
C19 vaccines: Want Novavax access? Boosters for yourself and kiddos? Super-important thread here—
Send your comments to CDC ahead of the ACIP mtg. Deadline Sept 8th!
The CDC is meeting soon to vote on fall booster guidance- BUT it sounds like they might not recommend that updated boosters be given to ppl under 65 !!!
PLEASE SUBMIT A COMMENT THAT THE CDC NEEDS TO RECOMMEND BOOSTERS FOR ALL AGE GROUPS 👇🏽
25
308
482
1
69
136
"We cannot handwash our way out of an airborne pandemic. Pretending otherwise is futile..."
Please read and retweet this superb piece by Tess Finch-Lees. The article is paywalled but is available in full in this thread (via screenshot), but please click on the link to the article regardless, so the Irish Independent understands that people want to read great journalism!
28
385
891
0
38
133
@DaveKotlyar
Yes, that was the implication. Will be interesting to see if the age cutoff for Shingrix will be revised down from 50 in future, and if C19 will be interpreted by providers as immunocompromising condition for age 18 and up as currently indicated (given frequency of reinfxns).
4
17
135
There was just one problem: I didn’t have a totally worn-out Aura. Luckily, after searching the car I found a questionably past-its-prime 3M 9210+ Aura used for recent eclipse travel. ⬇️
1
5
129
There are only a few contraindications/cautions: allergy to drug or ingredient, significant renal or hepatic disease, and untreated HIV. 🔽
2
19
127
Hey
@CDC
and
@CDCDirector
: “You do you” doesn’t work in hospitals! Patients can’t one-way mask if they’re sedated, asleep, confused, etc. Also which transmission map will you be using for this guidance? The happy pastel one or the continuously blood red one? Just curious—
3
35
122
3- Wiped down kitchen counters and dining room table with outside of mask. ⬇️
5
5
122
Metformin dose regimen from study: 500 mg on day 1, 500 mg twice daily on days 2-5, then 500 mg in the morning and 1000 mg in the evening up to day 14
5
20
123
@MeetJess
Anecdotally, over past few months I’ve talked to several ppl with post-Omicron new onset cardiac arrhythmias and one of sudden death in spouse. These were all ppl in their 30’s.
2
36
117
Tennessee—
1
14
114
This is rage-inducing. In what world should ppl who are sick enough to be hospitalized have to spend one ounce of energy campaigning for their safety?
Patients are taking actions from their hospital beds to call to
#KeepMasksInHealthcare
!
#MaskWeekOfAction
43
600
2K
0
40
117
CDC recommends the following:
-- TWO swabs for eye symptoms only (conjunctival and NP)
-- THREE swabs for eye and respiratory symptoms (conjunctival, NP, and nasal/OP)
1
24
116
Our new normal: mass societal disablement. Can't be helped. Oh, well.
Get out there-- party like it's 2019!
What's a little brain damage among friends?
Shop till you drop! Organ damage builds character. What doesn't kill us makes us sicker, but that is to be expected in 2023.
Latest from Leana Wen:
"We might come to expect some frequency of post-covid symptoms, and the resulting disability, as a “new normal.” In that case, health resources must shift from avoiding the coronavirus to reducing and treating its worst consequences-including long covid."
182
281
1K
4
24
113
I then used the following improvised and totally unvalidated protocol: ⬇️
1
4
114
1- Squished entire mask, including nosewire, into little ball in hand x 20. ⬇️
1
3
113
North Carolina
1
13
106
Call on Doc- $70 telehealth, chat/video/phone options
*Per website: must be age 30+, have home or lab test results, and must have high-risk condition 🔽
1
14
107
-Get Pax from the comfort of your home! Know that telehealth sites treating C19 can have cookie-cutter type requirements to qualify for Pax. However, it’s ultimately at provider’s discretion whether to Rx, just as w in-person visit. 🔽
1
15
109
Excellent database by
@rrelyea
of searchable pharmacies w current stock (call pharmacy to confirm availability): 🔽
1
23
105
Resources and tips for accessing treatment, Rx, and locating Pax:
-Paxlovid is currently still free, but will transition to the commercial market once the federally-purchased supply is depleted. 🔽
2
21
106
Drug costs and copays will then apply, so consider asking PCP for Paxlovid script now to have on hand in case of infxn (especially if immunocompromised or for any upcoming travel). 🔽
1
16
105
Nebraska—
1
11
101
@joeolivermd
At this rate they might as well move classrooms into hospitals and urgent cares. That way, kids can get schoolwork done during their hours-long wait for medical care so they don't suffer the dreaded learning loss while repaying their immunity debt.
Endemic problems solved.
4
24
104
Virginia—
1
12
100
Short-term prediction: many ppl will soon regret not getting updated C19 vaxxes.
Longer-term prediction: we will regret our overuse of antibiotics, both in healthcare and in our food supply.
5
16
105
Planning to get a fall C19 booster? Don't be so sure, per Dr Offit--
"Because of the high prevalence of SARS-CoV-2 antibodies in the population, Paul Offit, MD, in an interview predicted “a focused recommendation by the CDC” regarding who should receive the XBB.1.5 vaccine." 🔽
28
28
104
The issue of rebound treatment is covered in the NIH treatment guidelines. It seems to be allowed at providers’ discretion, at least for immunocompromised patients. Source here: 🔽
2
20
101
@Sheep_in_fog
@1goodtern
“You know carbon monoxide builds up inside that N95”.
From PCP.
A few days ago.
13
4
101
@1goodtern
Can we get
#VioletHeartsforViolet
trending?
I added a violet heart 💜 to my bio to stand for this level of advocacy.
This generation is showing us the way.
Thank you Violet Affleck
22
86
670
12
49
101
Plush Care- accepts most insurance or $129 out of pocket
*Per website: must have high-risk condition and have test results 🔽
1
17
95
Adding here—
Re-upping this dental mask hack vid: adding comments, fit testing results, ordering and discount/coupon info below. Please RT— we all need 🦷 work! ⬇️
14
76
242
4
12
98
-If doing telehealth or having any electronic Rx sent in, call desired pharmacy before visit to ensure drug availability. 🔽
1
14
96
This public health messaging would be more effective if the Bridge Access program for C19 vaccines for the uninsured population was not expiring in 9 DAYS!
Vaccines are a safe and dependable way to build immunity against flu, COVID-19, and RSV.
Risk less and do more by encouraging your community to get vaccinated. Learn more:
#RiskLessDoMore
9
21
41
1
27
98
Virginia—
2
12
93
"SARS2 is an immune-dysregulating, airborne thrombotic vasculitis" would like to borrow the "it's mild, just a cold, kids will be fine, immunity debt" PR team. We need a catchier phrase.
7
25
94