David Warner (he/him)

Starting today, I’m launching a four-day, 15-stop listening tour across Ohio. Across the state, I’m meeting with families, teachers, and local leaders to hear what’s working—and what’s not. Because the best ideas come from the people living them.

On this day in 1747, James Lind began his study on sailors with scurvy, the world's "first clinical trial."
#ClinicalTrialsDay #NephSky

👉 www.bbc.com/news/uk-engl...

Ohio Appeals Court Rules Trans Care Is Healthcare, Strikes Down Ban For Trans Youth The ruling was in part based on a 2011 Amendment in the state guaranteeing healthcare freedom, originally meant to challenge Obamacare.

1. Incredible ruling! An Ohio appeals court has ruled that trans care is healthcare, strikes down youth trans care ban!

It made the ruling using the Republican-passed "health care freedom amendment" meant to overturn Obamacare!

Subscribe to support my journalism.

You'll want to read this one.

One of the biggest lessons I've learned in medical school is that almost everyone has some form of impostor syndrome. What defines success is whether you choose to let it inhibit you or allow it to motivate you. #MedSky #FoodForThought

AOA induction dinner! Congratulations to my amazing classmates; can’t wait to see where you end up in 2 weeks and hear about your future accomplishments! #Match2025 #UCCOMClassof2025

Summary:

🧠 MSCC is an onc emergency causing severe back pain + FND
🧠 Dx: whole-spine MRI
🧠 Tx: steroids, pain control, radiotherapy, +/- surgery

Sources:
1. 2023 NICE Guidelines: buff.ly/3DC4SrM
2. Review by Akanda/McKay: buff.ly/4iZOoK8.
3. Youtube: buff.ly/40koN7i

Surgical options include decompression and stabilization.

Indications:
🧠 Single level cord compression
🧠 Adequate baseline performance status
🧠 Spinal instability present
🧠 Uncontrolled pain
🧠 Radioresistant tumor
🧠 Histological diagnosis

Surgery is often followed by adjuvant radiotherapy.

Rades et. al published a validated scoring system to predict prognosis within 6 months to guide radiotherapy.

🧠 Score 20-30 = poor prognosis (short-course recommended)
🧠 Score 30-35 = intermediate prognosis
🧠 Score 36-45 = favorable prognosis (longer course recommended, as more likely to recur)

Radiotherapy:

🧠 Offer within 24 hrs if the pt is not a surgical candidate (unless pt has been tetra- or paraplegic for 2 wks and pain is managed)
🧠 Assess desire for future fertility
🧠 Repeat radiotherapy if good response and symptoms return >3 months after treatment

Management:

🧠 Spine immobilization
🧠 Corticosteroids (16 mg as soon as suspected, taper after radiotherapy/surgery)
🧠 Radiotherapy
🧠 Surgical decompression and/or stabilization
🧠 External spine support (e.g. halo vest or Milwaukee brace) if spine instability and not a surgical candidate

Workup:

🧠 MRI w/in 24 hrs: sagittal T1 and T2-weighted sequence of whole spine + axial imaging of detected lesions
🧠 CT + myelogram if MRI contraindicated
🧠 Bladder scan if relevant + Foley if needed
🧠 Assess for spinal instability (e.g. Spinal Instability Neoplastic Score)

Clinical features:

Back pain is the most common symptom.
🧠 Severe and localized
🧠 Worse when coughing, sneezing, defecating or lying down
🧠 Progressive worsening
🧠 Disturbs sleep

Other features
🧠 Weakness
🧠 Sensory disturbance
🧠 Autonomic dysfunction
🧠 Paralysis
🧠 Cauda equina syndrome

MSCC usually results from hematogenous spread to the vertebrae with the thoracic spine most commonly affected due to its blood supply.

The mechanisms of MSCC include
🧠 tumor invasion into the epidural space
🧠 encroachment of vertebrae on the spinal cord
🧠 obstruction of the epidural vein plexus

MSCC is most commonly caused by metastasis to the vertebrae caused most commonly by the following cancers:

Adults
🧠 Lung
🧠 Breast
🧠 Prostate
🧠 Less common: renal cell carcinoma, myeloma, lymphoma, GI cancers, melanoma

Children
🧠 Sarcomas
🧠 Neuroblastomas
🧠 Neuroectodermal tumors

Malignant spinal cord compress (MSCC) is an oncologic emergency that impacts about 5% of patients with cancer, leading to pain, weakness, and paralysis. Let's explore the physiology, anatomy, presentation, workup and treatment.

A 🧵

#PhysiologyFriday #MedStudentSky #OncSky

Just completed a module on lead reversals as part of my M4 EKG elective, which has suddenly unlocked a series of trust issues I didn’t know I had 😳 #TrustButVerify @fuqekgs.medsky.social

James Harrison, whose blood donations saved over 2 million babies, has died Harrison, whose plasma contained a rare antibody, rolled up his sleeve 1,173 times from 1954 to 2018. The Australian is credited with helping 2.4 million babies and advancing scientific research.

Harrison, whose plasma contained a rare antibody, rolled up his sleeve 1,173 times from 1954 to 2018. The Australian is credited with helping 2.4 million babies and advancing scientific research.

Welcome to #NephMadness 2025 Here it is, the 13th edition of NephMadness!  Whether you’re new to the competition or just want to relive past glories, we have all the info you need for NephMadness 2025: What is NephMadnes…

#NephMadness 2025 is live on the #AJKDBlog: bit.ly/WelcomeNM25

Topics include:
- Resistant Hypertension
- Obesity
- Green House
- Minimal Change Disease
- Disaster Nephrology
- Genetics
- Hemodialysis
- CAR-T for Kidney Disease

Looking forward to the fun and learning with all of you!

Can't wait to hear all of these podcasts covering #NephMadness topics

An overview of the clinical presentation, etiologies, diagnosis, and treatment of the superior vena cava syndrome - a serious complication of non-small cell ... SVC Syndrome (Oncologic Emergencies)

Sources:

1. 2023 Umbrella review by Shah, et. al: buff.ly/3DCwnkJ
2. Overview of Etiologies, Manifestations, and Treatments by Quencer: buff.ly/41ZXIrs
3. Excellent Youtube video by Dr. Strong: buff.ly/4gVG1gP
4. Amboss (Oncological Emergencies)

Summary:

🫀SVC syndrome is a medical emergency most commonly caused by malignancies (NSCLC, SCLC, NHL)
🫀Increasingly caused by thrombosis from catheters or pacemakers
🫀Oropharyngeal, respiratory, or cerebral involvement are red flags
🫀Stenting is now the treatment of choice for symptomatic pts

Treatment for catheter-associated thrombosis

🫀Catheter-directed thrombolysis or thrombo-aspiration
🫀If severe symptoms, mechanical thrombectomy
🫀Anticoagulation for at least 3 months

Management

🫀If severe symptoms present, emergency endovascular stent
🫀If laryngeal edema present, intubate!
🫀Steroids may be beneficial for laryngeal edema, as well as lymphoma and thymoma (but biopsy first!)
🫀Treat underlying malignancy

Scoring systems have been created to guide management:

🫀 The Kishi scoring system
- Score >3 indicates need for stenting

🫀 The Yu grading system
- Score of 3 or 4 indicates need for stenting

🫀The Stanford Method
- Venography used to identify patients at risk for airway or brain involvement

Workup:

Unstable patients
🫀Invasive venography

Stable patients
🫀CXR
🫀CT chest with CT venography (MRI with MRI venography if contraindicated - e.g. pregnancy)
🫀Doppler US for pacemaker or catheter-associated thrombosis

Clinical Features:

🫀 Facial, neck, and arm swelling
🫀 Non-pulsatile JVD
🫀 Dysphagia
🫀 Dyspnea
🫀 Stridor
🫀 Cough
🫀 Hoarseness
🫀 Symptoms worse when lying down or bending forward

Red flag symptoms:
🫀 Laryngeal edema
🫀 Hemodynamic instability
🫀 Increased ICP
🫀 Confusion
🫀 Blurry vision

🫀 The drainage of dilated chest wall veins to the left portal vein via the veins of Sappey can lead to perfusion changes and a "hot quadrate sign" around the falciform ligament, seen on this CT.

Review of anatomy:

🫀SVC drains blood from the brachiocephalic veins, which receive blood from the head and upper extremities
🫀Collateral supply is important in SVC syndrome
🫀Upper/mid esophageal veins drain into the esophagus, causing "downhill esophageal varices"

SVC syndrome can be intraluminal (neoplastic invasion, thrombosis) or extraluminal (Pancoast tumor, mediastinal mass) and has malignant and benign causes.

Most common malignancies:
🫀 NSCLC
🫀 SCLC
🫀 NHL

Benign causes
🫀 Thrombosis from pacemakers or central line
🫀 Mediastinal fibrosis