True art
Brief excursions from 59-86 degrees Fahrenheit are permitted
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True art
Nanny Ogg hasn’t adjusted. She does the adjusting. She’s great at making sure her environment maximizes her happiness and comfort. Icon.
I will *never* apologize for a post
it’s less than 10% of a sentence by character it’s fine
No worries! Anyone can be a vocalist at karaoke after 3 stiff drinks or in the shower stall.
📚 1. For more information, check the 🔥 new 2025 IDSA guidelines on complicated urinary tract infections: www.idsociety.org/practice-gui... 2. Nelson, Z., et al. UTI: A WikiGuidelines Group Consensus Statement. JAMA Netw Open. 2024;7(11):e2444495
💡 A: No, he does not have a complicated UTI. While it was previously thought that male gender, anatomic abnormalities, or immunocompromised status always indicated a complicated UTI, this is no longer supported by IDSA guidelines.(1,2) See Classification of UTI here:
🌟 ABX Pearl of the Day: UTI in males ❓ Q: My male patient with dysuria is growing E. coli (>100,000 CFU/mL) on urine culture. He has no systemic symptoms or signs of pyelonephritis or prostatitis. Does he have a complicated UTI? #IDsky #medsky #meded #pharmsky #skyRX #AMSsky
Today’s FDA panel on SSRIs in pregnancy lacked balance and failed to reflect the evidence. Untreated depression and anxiety can lead to serious health risks for pregnant patients—SSRIs can be lifesaving. Patients deserve access to evidence-based, compassionate care. Learn more: buff.ly/NcCZno8
I would argue that’s not face-to-face contact
🌟 ABX Pearl of the Day: penicillin allergies ❓ Q: My patient reports a reaction to penicillin (acute, self-limited rash) over 10 years ago. Can they safely receive cefazolin for their MSSA infection? #IDsky #medsky #meded #pharmsky #skyRX #AMSsky
Ten authors by whom I’ve read more than 5 books: Terry Pratchett Patricia C. Wrede Anne McCaffery Seanan McGuire Jim Butcher Patricia Briggs Madeline L’Engle Tamora Pierce Lois McMaster Bujold Courtney Milan
But the Luggage has to do everything Rincewind does sometimes even backward and in heels. Poor Trunkie.
Good pep talk!
🌟 ABX Pearl of the Day: ertapenem hypoalbuminemia ❓ Q: My ICU patient with hypoalbuminemia has ESBL E. coli pyelonephritis, resistant to PO abx. He improved (afeb, WBC WNL, off pressors) after 3d of meropenem. Should I avoid narrowing to ertapenem? #IDsky #medsky #meded #pharmsky #skyRX #AMSsky
Jail for 1,000 years
So delighted to be in the pharmacy business in this new age of snake oil salesmen.
NASA is being told to cancel 19 *active* missions to save $6B, which looks to be less than the ICE *hiring/retention* budget going forward. I need people to let that sentence sink into their bones for a minute.
Wow! Scientists engineered E. coli to convert plastic waste (PET) into pain medicine paracetamol (acetaminophen or Tylenol) in under 24 hours with up to 92% yield. www.nature.com/articles/d41... #medsky #pharmsky 🧪
Vaccination schedules on the CDC website have already started changing under RFK Jr. So we published a guide to the evidence-based vaccine recommendations in place *before* all 17 members of the advisory panel were abruptly dismissed by the new admin. www.scientificamerican.com/article/see-... 🧪
"Proposed recommendations regarding thiomersal..." Ffs how many times do we have to have this discussion with these morons. 1. Most US vaccines have had thiomersal removed for literally decade+ 2. We need to discuss again the difference between ethyl & methyl mercury... From my old website:
🌟 ABX Pearl of the Day: Corynebacterium in resp cultures- do I treat? ❓ Q: My patient’s sputum culture is growing Corynebacterium species in addition to normal respiratory flora. Do I need to treat this? 💡 A: In most cases, no tx is necessary. #IDsky #medsky #meded #pharmsky #skyRX #AMSsky
NYC Comptroller Brad Lander was just arrested by Trump’s ICE agents because he asked to see a judicial warrant. This is fascism and all New Yorkers must speak in one voice. Release him now.
Hi, this is Meg Barnette, Brad's wife. While escorting a defendant out of immigration court at 26 Federal Plaza, Brad was taken by masked agents and detained by ICE. This is still developing, and our team is monitoring the situation closely.
In her new book “Bad Company,” journalist Megan Greenwell chronicles how private equity upended industries from health care to local news—and the ways workers are fighting back. www.wired.com/story/megan-...
Same, completely. 19, Small Gods (what a gateway!) and it felt like a missing piece finally clicked. I had empathy, I even had vocabulary! I didn’t have that certain way of expressing the things I was feeling about the world until that point.
Bonus Discworld QOTD, from The Wee Free Men “Nac Mac Feegle! The Wee Free Men! Nae king! Nae quin! Nae laird! Nae master! We willna' be fooled again!”
www.professoraxelrod.com/p/the-tech-j... Cleanest explanation yet for how the Trump tax cuts in 2017 buried a landmine in software development starting in 2023, a cynical budget gimmick which has gutted American software development.
Children exposed to COVID in utero had developmental delays at age 24 months: 🧠36% cognitive delays 🗣️64% communication delays 🏃57% had motor delays 🧪 Specific developmental delays were related to specific inflammation cytokines found in their cord blood at birth. buff.ly/AQSfBm9 #Medsky #Pedsky 🛟😷
Vaccines have literally saved more than 150 million lives over the last 50 years and prevented much more morbidity but hold up guys somebody with a brain worm knows better
My kiddo was 3 and wore his mask like a champ. I won’t claim there were never tears, but it was far more traumatic trying to explain the boat carrying the dead bodies up the east river. He didn’t have a problem wearing a mask until other people stopped.
One of the best days of the pandemic was when I stopped having to walk by the refrigerated trucks at the end of every shift. One of the worst memories of the pandemic was when I was trapped in the pharmacy because the there were so many bodies in the hall they blocked our only door.
RFK Jr.‘s extreme anti-vax views — and his related conflicts of interest — were a huge problem during his confirmation process. So he promised not to change the vaccine advisory panel. Today, he fired every single expert on that panel. It's a public health disaster.
But will we get robot friends to help us keep our sanity?
🌟 ABX Pearl of the Day: revisiting Vancomycin Zosyn nephrotoxicity ❓ Q: Is the combination of vancomycin and piperacillin-tazobactam safe for the kidneys? #IDsky #medsky #meded #pharmsky #skyRX
Look, there are a lot of valid criticisms to make of the Ivies, but “fuck this administration, we’re making our civics courses free so you can understand WHY fuck this administration” is a baller move. 3 cheers for prosocial spite.
Have you ever wanted to say you’ve gone to Harvard? They’re now offering free classes on US gov, politics, and my favorites Ebola response and drug pricing pll.harvard.edu/subject/gove...
When Prasad says denying vaccinations for younger and healthier folks will generate "new data," he's saying we're the guinea pigs for a massive, gruesome public health experiment aimed at eventually eliminating vaccination programs for both present diseases (measles) and future ones (Covid-2X).
The comment period for this ends in 3 DAYS. Please leave a comment telling them EVERYONE should be able to get covid boosters. www.regulations.gov/commenton/FD...
Yep! Had an epidural bag burst in my hands and drip on my arm, leg, top of my foot and… nothing. Fentanyl on your skin is just not noteworthy unless it’s in a patch over many hours.
It’s a good trick to make the path of good behavior look easy and the path of bad behavior look hard.
🌟 ABX Pearl of the Day: Linezolid drug interactions ❓ Q: I'd like to prescribe linezolid but my patient is on serotonergic agents. What is the incidence of serotonin syndrome with this combination? #IDsky #medsky #meded #pharmsky #skyRX
🧵 THREAD: A federal whistleblower just dropped one of the most disturbing cybersecurity disclosures I’ve ever read. He's saying DOGE came in, data went out, and Russians started attempting logins with new valid DOGE passwords Media's coverage wasn't detailed enough so I dug into his testimony:
I said my main goal of this trip was to meet with Kilmar. Tonight I had that chance. I have called his wife, Jennifer, to pass along his message of love. I look forward to providing a full update upon my return.
Aw… I love Murderbot!
Those back orders are just never going to come in again, are they?
Today is the 5 year anniversary to when I slowly started losing my mind during the pandemic and began dressing up as works of art. As my Twitter account has long been abandoned, why not make a thread of my madness on BlueSky? This was “The Maid” by Wilhelm August Lebrecht Amberg, from 1862
As long as you can get them pointed in the right direction, it’s great! Who can get their shoes on first, get in the car, use the bathroom, get pjs on, etc. Less helpful in, say, clearing the table. Ask me how I know.
Ok. So. The US imports more peanut butter than we export- by ~20,000 metric tons. 20K tons isn't much compared to other goods. But it's also a lot, considering the US grows 2.75M tons of peanuts/yr. Why? Well, the US exports peanuts to other countries. They make the butter & sell it back to us.
Great thread, read all the way up and down, but tons of solid muscle with a bad attitude that’s also largely immune to anesthetics? Once again, happy to stick to the people side of medicine. Mad props to vets, though!
Um... let's debunk those wild measles claims... Measles is known for its characteristic rash, but it can have serious respiratory and neurologic complications that can be fatal. More from experts here:
A rule’s a rule
The coolest thing I’ve seen today is that a bunch of volunteer public health professionals and developers have restored the CDC website from before January 20th 2025. This differs from an archive in that they want to rebuild the links between pages and replicate the full website.
Now I hope the manufacturers will follow through, and nothing else will prevent people from taking care of themselves and their communities.
Always gotta share good news
Here’s a non-TikTok tutorial. bsky.app/profile/jenr...
They are also available on the @voices4vaccines.bsky.social website and will remain available with other credible vaccine information vetted by a scientific advisory board, not RFK: www.voicesforvaccines.org/fact-sheets/
Here is the pre-RFK vaccination schedule for your kids. Please download it before he is confirmed and changes/deletes it. Give it to your pediatrician and say this is the schedule you want your kids on. Making this my pinned post.
Perfect
The men carrying out Musk's coup are Akash Bobba, Edward Coristine, Luke Farritor, Gautier Cole Killian, Gavin Kliger, and Ethan Shaotran. Make them famous. And, eventually, when possible, arrest them and charge them with multiple felonies. www.wired.com/story/elon-m...
The Trump administration is scrubbing the CDC’s website of documents on reproductive rights issues, sexual health, intimate partner violence, and more. I'm trying to save them. You can find the deleted docs at cdcguidelines.com - I'll be adding more over the weekend.
NEWS: The CDC's scientific journal, Morbidity and Mortality Weekly Report, was published without interruption for 52 years -- until Trump reclaimed office last week. Two interesting studies on bird flu were delayed as a result, @amymaxmen.bsky.social reports. kffhealthnews.org/news/article...
I just called, and it was great, even though I was nervous. Call the number, press 0, and then tell the person (see script from @pronounced-ing.bsky.social) They thanked me and said it really helps because they are getting nasty calls, too. They are keeping a list, and the CEO will see it.
Elizabeth Warren: "Robert Kennedy can kill off vaccines and make a profit while he does it. Children may die, but Robert Kennedy will cash in."
Yep. Sounds about right. Happy Tuesday, everyone.
OK, I'm going to take the like as a yes. So, to be clear, this thread hits on three things - dealing with worry, dealing with feeling helpless, and focusing on limited available paths to productively help. Maybe some of this stuff will work for you - all I can say for sure is that it has helped me.
GEORGE LUCAS IN 1999: a trade embargo is going to spark the galactic reckoning and collapse ME IN 2025: ah, okay
This is a good time to re-share one of the most fun videos I've ever seen on Youtube. www.youtube.com/watch?v=7ZWa...
It was a fantastic game, better than a lot of shareware/freeware. The squelching sounds will forever haunt my dreams
Deep hurting (affectionately)?
And also if you tried drugs your head might get cracked open and your brains fried like an egg. Nuclear war might have made the top 20 list of things to fear. Probably just after pop rock and soda death.
Ah. You don’t understand birds OR deserts of the SW US
Calzone. Or maybe dry and crunchy ravioli
Discworld QOTD, from Hogfather
A publicly-funded study of the venomous saliva of the Gila monster is exactly the kind of silly sounding basic science John McCain and Tom Coburn used to rail about in the Senate, but it changed the course of medicine pretty substantially in the last 20y. pmc.ncbi.nlm.nih.gov/articles/PMC...
People sometimes make fun of science that sounds stupid and random. Meanwhile, a study of lizard saliva turned into a peptide medication, which was turned into a diabetes medication, which was turned into a GLP1 weight loss drug, that just became the first therapy every approved for … sleep apnea
It's nearly time to reveal my Quote Of The Year 🥳 In preparation, here's last year's one: a corker, from The Guardian 🤣
Imagine being the person who cancels Sesame Street and just living your life after that
My favorite kind of Christmas lights
Why didn't they just put the photos inside a glass case that only the manager can open
Although the fever/chills/aches response to the COVID vac were more intense for the ~24 hours they lasted, having COVID was still worse for me than colds or the flu and with effects that lasted for the better part of a month. I’d rather schedule brief misery any day.
All for me jolly, jolly grog!
I don’t believe in violence. It is because I don’t believe in violence that I do believe we should prevent it, not by making proclamations about how not to be violent, but by not robbing people of the chance to meet their physical and emotional needs. Those who do the latter are doing violence.
We in America have publically been fed the political fiction that human life is sacrosanct, you can't put a dollar value on a life and that you must rely on the justice system to uphold this fundamental tenet of our societal fabric. And the strain of that lie is too much to bear.
Took me a bit but I've found the framing to put into words a way to express to the people fretting about the death of the UHC CEO why we just aren't heeding their admonishment: The social contract stipulates that all life is sacred, and Brian Thompson violated it. But it's more than that.
Today we remember the legacy of UnitedHealthcare CEO Brian Thompson
Do they really hate their CEO that much
Aw… but he’s so cute!
Interesting article. Have to wonder if reviving the enforcement of Robinson-Patman would at least go part of the way to allowing independent pharmacies, and even local hospitals start to thrive again. #pharmsky #medsky
1. The conventional explanation for food deserts—that these places are too poor or too rural to generate enough spending on groceries, or too Black to overcome racist corporate redlining — fail to grapple with a key fact: food deserts didn’t used to exist. My new piece in The Atlantic.
Sounds exciting.
Blues and purples and glittering constellations. I think I’m with Ernie and I’ll just visit.
“We choose to go to the moon. And goblins.” - JFK
This whole skeet had so much wrongness that it’s physically painful to me. Literally stopped me in my tracks. So, mission accomplished?
How grim is it that I’m sitting here thinking that maybe 38 forever wouldn’t be the worst?
To be especially feared if the mousepipes come out, or someone just needs a good kickin
I would love to tell you about the times vaccines prevented me from getting sick, but every time it happens, I don’t notice. I just keep feeling well. Neither do you. Public health, when it’s working, is invisible.