Radhika Sheth
@freeradhikal
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She/her | ID, crit care, & boba enthusiast | ID fellow @OHSU_ID via @HenryFordHealth | #IDTwitter #MedEd
Portland, OR
Joined September 2014
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Pinned Tweet
1/
I learned last week that almost all of
#IDTwitter
shares my hatred for BDG assays. So why not talk about another test that is routinely sent for no good reason: Galactomannan assays (GM)
A thread 🧵-
1/
Few tests are as polarizing as 1,3-beta-D-glucan (BDG) assay (Fungitell).
I spent the first 2 years of residency not understanding its utility. I spent the first year of my ID fellowship wishing I could cast it into the fiery depths of hell.
Let's talk about why in this 🧵
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@swethamaddipudi
Anglicized my name for the first two years of residency. I realized how silly that was in my third year. If doctors can say "dysdiadochokinesia", they can say our names.
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ID: no indication for antibiotics, we'll sign off.
Team: starts vanc anyway
*One week later*
Team: consult ID for vancomycin duration
Me:
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Life update:
So happy that I'll be moving to Portland, OR next year to train as an ID specialist at
@OHSU_ID
Watch me turn into an insufferable hipster soon!!
#IDtwitter
#Match2022
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#IDTwitter
My reaction to the primary team asking for vanc+ meropenem
On Gen ID: On Transplant ID:
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I don't know how to explain to my parents that as an ID fellow, my job is to chart review patients for people who couldn't be bothered to do it, and to convince surgeons to stick needles into places they don't want to.
#IDtwitter
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My internal monologue while taking ID in training exam:
What even is that?
What's an ocelot again- the one that makes the poop coffee?
Where in the world is...Togo?
That's TB, right?
That HAS to be TB...right?
WHY do you have a turtle?
Never even heard of it.
Ok, I give up
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1/
Few tests are as polarizing as 1,3-beta-D-glucan (BDG) assay (Fungitell).
I spent the first 2 years of residency not understanding its utility. I spent the first year of my ID fellowship wishing I could cast it into the fiery depths of hell.
Let's talk about why in this 🧵
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30
153
@IamSubhayu
Thank you for putting this feeling into words. I have no words or advice, only understanding. I hope you and your family are safe.
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Okay so how do we get TSwift to apply to ID?
#IDTwitter
Travis Kelce jerseys saw a nearly 400% spike in sales after Taylor Swift attended his game, TMZ reports.
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#IDTwitter
Explaining to the patient why I'm consulted on their case: "My job is just...antibiotics"
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@olsonplanner
Save up, move to Paris, and live in a studio above a used bookshop + coffee shop that I own.
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The fourth pressor, micafungin
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It's so frustrating when people think ID is boring. I can't change compensation structures, but maybe if we renamed ID and antibiotic stewardship, something cool and sexy like "precision medicine", more people would care about it.
#IDtwitter
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@incmnszmx
,
@IdBowl
’s first international team, is absolutely dominating the second round! 🎊 🇲🇽 🎉
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Spotify wrapped (ID version):
🎧Spent 53648 minutes writing a consult that will eventually be copied into the H&P
🎧Your top 5 consults: "fever", "Leucocytosis", "indeterminate quantiferon", "asymptomatic UTI", and "Staph bacteremia"
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Hi!! Been working on
#MedEd
stuff with the help of some awesome
#IDTwitter
folks & finally sharing it! Introducing Cruel Infections- a blog series around common ID❓encountered in clinical settings. These are aimed mostly at trainees (but really anyone involved with pt care!)
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Don't usually post personal stuff but UW Anesthesia matched the smartest person I know! We'll be PNW-ing together soon!
If you have leads on gen ID J1 waiver jobs (preferably in WA, but would be open to the Midwest too), pls let me know! I ❤️ ICU ID, HIV/STIs, & MedEd
#IDTwitter
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PGY-1s, remember! Abx don't come without adverse effects! Vanc & piptazo (VN+PT) are the commonest empiric abx used. However, nephrotoxicity is often a concern with this combo.
Let's talk about one of the big reasons why it's in every ID doctor's Burn Book! 🧵 -
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As an almost 2nd year ID fellow, at this point I'm too afraid to ask this, but seriously, how do you define a "deep-seated infection"?
#IDTwitter
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Yesterday--> matched into an ID fellowship
Today--> placed a consult to ID
Attending: Aren't you ID? Why did you think you needed them?
*Pls help*
#IDtwitter
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Hey
#IDTwitter
, what made you pick ID as a career? Help a confused PGY2-on-a-timeline out! Tagging
@IDdocAdi
@Sonali_Advani
@TMcCarty2010
for expert advice and amplification!
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Biggest takeaway from
@IDWeek2022
: "ID physicians have cared about social justice long before it was talked about... ID has owned that space & it has owned it for a really long time"
- Wendy Armstrong on everything that's amazing about ID & why more people need to be doing this
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1/
Back with a 🧵today about a test that I love to hate. This one is specifically for med students and residents!
#IDtwitter
: Quick poll before we dive in
1. Does your institution use procalcitonin (PCT) for starting/stopping abx?
Yes
323
No
376
What's procalcitonin?
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My favorite thing to do is introduce med students and residents interested in ID to
@febrilepodcast
@swinndong
#IDTwitter
This was until my med student remarked, "Y'all are nerds".
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There are good attendings.
There are great attendings.
Then there's attendings you'd go to war for ❤️
#IDtwitter
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@transplantID
It's really frustrating because ID is amazing and every time I get a student/resident interested, I lose them when they ask about compensation. And that's a totally valid reason too.
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@madison_healey
Free concierge service that will get your car serviced, tires/oil changed, pick up/drop off laundry, shop for groceries, buy gifts, etc for you.
Free cafeteria food i.e. food stipend on top of paycheck
@HFAHIMResidency
@HFAHMedEd
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Can't believe I submitted my application to ID fellowships. Match PTSD is acting up.
#IDTwitter
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It's always "Come on, Barbie, let's go party!" & never "Come on, Barbie, let me also compensate you for the endless stewardship and IPC work you do, on top of your clinical ID duties"
#IDTwitter
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H&P royalties is the only way I see ID specialists making more money
#IDTwitter
Every time an infectious disease consult note is copy pasted into a discharge summary, the ID specialist should get $50
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Celebrated the end of first-year of ID fellowship by taking away vanc-piptazo from an intensivist. What even is next??
#IDtwitter
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Has anyone successfully tried removing UAs and urine cultures from ER and admission order sets at their institutions and seen results? Because y'all, I can't with these ASB consults anymore.
#IDTwitter
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If you ever come across a name you can't pronounce, the correct response is "Can you help me say your name correctly?"
And not "Well, I won't even bother with that- hello, Dr. Something!"
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@dch1309
THISSS. And also programs where administration has ZERO IDEA how to help their visa candidates. If you're sponsoring visas, hire people who have worked in this area. Don't leave them to navigate things on their own.
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*patient comes in with altered mental status*
That one ID attending who is always diagnosing zebras:
#IDTwitter
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Meanwhile, my SO, after seeing me fangirling over
@swinndong
and Fauci/plushie microbe swag/
@IdBowl
pictures- "Soooo this is just Comic Con for ID folks then?"
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@Kavya_Davuluri
This!! I've had to unlearn my fear of failure and constant need for approval.
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Or you could just get a procalcitonin and consult ID because *infection*
#IDTwitter
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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@jointdocShields
@AshleyGWinter
2/ this hellscape room and reduces the prolapse real quick, yells at all of us because he was paged during surgery for a rectal bagel and then turned to me and said the words I will never forget : NEVER BE AFRAID OF A RECTUM.
My co-residents never let me forget that one.
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The hospital is serving bhindi masala in the cafeteria and my lil desi heart can't take it ❤️❤️
#MedTwitter
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Peak ID joke.
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@olsonplanner
Yes, except you can only use the paid version, they charge you for every swipe, there's no food during the date- only intrusive questions, and once you match, you HAVE to get married. No take-backs.
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ID SPICE girls having a CAPITAL time at
@IDWeek2022
@OHSU_ID
@Women_in_ID
@JulietaMadridMD
@pichetsurnthorn
@JahanaviMD
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@tony_breu
Thank you! This cleared up so much for me! Quick question though: the addition of azithromycin to oral steroids in COPD exacerbations- do their anti-inflammatory effects add up? How do the anti-inflammatory effects of azithro compare with the steroids were giving them?
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91 days before residency ends and fellowship at
@OHSU_ID
begins.
Attempting to reset at the PDX Japanese Gardens (while actively not trying to think about apartment hunting on the West Coast during this insane market!) Happy Doctor's Day, I guess?
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Congratulations to
@JahanaviMD
who matched to ID/EIS at
@RushCCH_ID
An absolute rockstar, no one more deserving. I'll be telling people I knew her when...
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Late night consult at
@OHSU_ID
!
Fever in a returning traveler- peripheral smear showing intracellular Plasmodium falciparum ring forms.
#IDTwitter
-shared with permission-
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Our awesome PD
@BonuraErin
honored as an outstanding educator at
@IDWeek2022
#MedEd
@OHSU_ID
Also peep that amazing representation!!
@IDSAMedEdCOP
@Women_in_ID
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3/
So.. what is BDG?
A polysaccharide component of fungal cell wall, present in Aspergillus, Candida, Pneumocystis
But NOT in Cryptococcus and Mucorales
As you may have already guessed, bcz of this it is not specific to any one 🍄 infection
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All I wanted to do was take care of my patients, see cool bugs, and retire in the mountains. I have to adult, too?
#IDtwitter
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When the team calls about a patient with diabetic foot osteo and happily tells me they got cultures...superficial wound cultures
#IDtwitter
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@okwalding
Are you me?! I've tried explaining this to teams several times and it comes off as "needlessly difficult" even though I'm trying to be the best steward of hospital resources (plus I'm a woman so there's layers there).
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Let me start by saying that performance & PPV of any test depends on prevalence and the pretest probability. Ordering a test in the right clinical context matters.
Few things are worse than a result you can't interpret bcz you're not sure why you ordered it in the 1st place!
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@DanielleP_MD
@DGlaucomflecken
Or Brudzinski going, 'I bet I can make this meningitis patient do some crunches.'
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Team: We need recs on what antibiotics to put them on
ID: None, it's not an infection
Team: Okay, so vanc, Zosyn, and micafungin it is.
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This is the same arm where I had the BCG vaccine.
The same arm as my parents' smallpox vaccine.
That's the beauty of vaccines, and no one should die from a vaccine preventable diseases. What a day for science!
#IDTwitter
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@mahad_minhas
If these numbers are true, there were ~38k residency spots for ~28k US MD/DO applicants in 2021. Adding IMG/FMGs to the mixture, there is increased competition for these spots. Also, the government does a very poor job of incentivising working in rural places.
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Co-fellows who bring you food larger than your forearm.
Báhn-mì and boba with
@TDNguyenMD
@OHSU_ID
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Some days I'm just astounded by the amount of waste generated by the healthcare system in the US. A simple central line procedure wastes so much material.
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Teaching and talking about ID gives me IMMENSE joy so I hope this tweetorial is useful. I will be posting more of these in the coming weeks!
If you enjoyed this and would like to read more, here is the link to the full blog post with references:
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@JulietaMadridMD
It grows best on a Charcoal Matcha Johnson culture medium and stains a pale aubergine with a decaf rhodium acetate stain.
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@olsonplanner
Dozed off after a 24h, missed a red light and T-boned a car in the intersection, car totaled.
This was three days ago.
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This brown girl had zero writing experience prior to residency. An
#IDWeek
poster and an ACP win in the same month is something I wouldn't even have dreamed of three years ago
#IDTwitter
#MedTwitter
Congratulations to the Resident Research Poster Award Winners!!
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@samsfeelinggood
Instant Pot
Comfy scrubs and a jacket
Weighted blanket
A netflix subscription
Not something you can buy, but maybe get into a workout schedule. Mental health FTW!
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When I say I miss Ann Arbor, what I'm really saying is I miss walking to Literati on a Saturday morning after the farmer's market with a Sweetwater's coffee in my hand.
How to Sunday:
1. Visit the nearest bookstore.
2. Ignore a loved one who tells you that you have too many books.
3. Calmly explain to said loved one there’s no such thing as too many books.
4. Buy too many books.
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I often ask my patients if seeing their scans would be helpful. Most times they say yes and I pull the images up on the WoW. It can help when you aren't talking about abstract diagnoses and they are able to visualize it (sometimes even nerd out about it!)
It's August!
Tell me one super valuable, attending-level thing you taught a resident or fellow in the last month.
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