musings of a salt whisperer
I have been told that the tea houses where we will be staying offer WiFi. I will try to post updates here. However the MM4MM group will be posting frequently to the Moving Mountains 4 Multiple Myeloma Facebook page. You can find that here.
Just a few more days, in the meantime the Himalayan Mountain Hair is coming in nicely, though a bit whiter than the last time.
John Raithel and his doctor @Amyloid_Planet are part of my team trekking to Everest Base Camp #MM4MM @theMMRF https://t.co/zhKawBE0El
— Joel M. Topf, MD FACP (@kidney_boy) February 24, 2018
John Raithel and Jeffrey Zonder are on the Moving Mountains for Multiple Myeloma team going to Everest Base Camp. John’s story is incredible. Check out the video. (Despite the hosts claims, we are not climbing Everest next week. We are merely hiking up 18,000 to Everest Basecamp.)
Dig deep and give something. None of the money 
goes to buying my Ramen. All of it goes to the MMRF a 4-star charity that is delivering new treatments with amazing efficiency.
In late 2002, I was a second year nephrology fellow spending as much time as possible at The John Crerar Medical Library writing chapters for medical textbooks. It was an awesome year. During that time I got an e-mail from another nephrology fellow, who was also in Chicago. He was writing to say what a fan he was of the Fluid, Electrolyte and Acid-Base Companion. He also said he wanted to help write the next edition of the book. (Any day now I’ll get started on that second edition. Any day now.) That e-mail came from Edgar Lerma. Nothing ever came of that collaboration but we became Facebook friends and continued on our parallel journeys. We both went to academic university fellowships but then pursued private practice. But despite going into private practice, we both kept our toes in medical education. Me through this blog and social media, him by writing book after book after book.
Over the past fifteen years, Edgar has repeatedly provided me with some of the most interesting opportunities of my career. Edgar is a mentor disguised as a peer. In 2013, he invited me to write about KDIGO for ASN KidneyNews. This was my first national exposure, and that article has lead to subsequent opportunities.
He helped get me on the KDIGO App Workgroup.
But the biggest opportunity was a few years ago when he invited me to help him edit Nephrology Secrets. When he asked, I said, “yes” without hesitation. I said yes without thinking of the avalanche of work I just unleashed. The book is 656 pages long. I have read every one of those page 4 or 5 times. At times, my Secrets-to-do list stretched over the horizon. It was hard, exhausting, and for awhile, never ending. But it was also rewarding.
Thank-you Edgar.
It has been an honor to know you and delightful to work with you and Matt on Nephrology Secrets.
It is a travesty that a renal treasure like @edgarvlermamd has only 18 followers. People should be lining up to follow him.
— Joel M. Topf, MD FACP (@kidney_boy) January 7, 2013
And speaking of Nephrology Secrets, the fourth edition is now available on Kindle with the dead-tree version available (fingers crossed) at the end of March. If you have Nephrology Secrets third edition, understand this is a complete rewrite with many new authors. It reflects a decade of nephrology advances. As we prepared for editing the fourth edition we reviewed every chapter in the third edition. Nothing reinforces how far nephrology has come quite like reviewing a decade old textbook. From the introduction:
So take a look at the sample pages on Amazon and if inclined buy the book I don’t think you will be disappointed.
Last fall I crossed the $10,000 finish line that was established for every participant on the MM4MM trip to Everest Basecamp. To everyone who donated thank you! 🙏🏽
Now I want to squeeze the last bit of generosity 💵 from everyone in my network.
I’m raising the roof. The new goal is $14,000.
So once again I come to you with hat in hand.
I’m asking you.
I’m begging you.
If you have ever:
Then consider throwing a few bucks toward multiple myeloma research. I’d love $100 donations. But what I’m really asking for is a mountain of small donations. Can you spare 25 tax-deductible dollars? What about 10?
Part of me feels that if I can’t engage my network to raise money for something as good as the MMRF then what good is this whole social media thing?
If you are the suspicious type, take a look at what I wrote about the MMRF here. This charity is doing medical research right. They take steps to keep doctors in the drivers seat of study design and that strategy is paying off with new drugs and breakthroughs.
Lets make a great fund push in the last week before I ship out to Nepal!
Big review by a great group of people from #NephTwitter. This was a fun article to write. Nice to see those three perfect words…
And open access to boot!
The trek to Everest base camp is a once in a lifetime experience. I should be bouncing with excitement but that is not what I feel. I feel unease. I feel unsettled. I read about the side effects of high altitude trekking: weakness, confusion, headaches, insomnia, nausea. This makes me nervous.
I look at the weather and see temperatures in the low teens. And that is at Lukla, elevation 9,300 feet, only half as high as Kalapatthar, our ultimate goal. I think of the previous times that I have been to high altitude. The top of Breckenridge at a hair under 13,000 feet, the top of Mount Democrat at 14,154. When you are on these peaks it is cold and windy and the plan is always to quick snap some pictures and get down. In a couple of weeks, we’ll be at those altitudes and the plan will be to go further up the mountain. We will go nearly a mile higher than anything in the continental United States. This is unsettling.
But this nervousness is in the name of something much greater. Something bigger than my personal discomfort. This trek is not an adrenaline fix. It is not about putting a dent in the bucket list. This is more important than my uneasiness and general anxiety. This trek is about rewriting the medical textbooks. It is about changing the narrative of a disease that just a few years ago had a dismal and short disease course. Multiple myeloma has a new narrative, one that is filled with words like remission, and hope, and dare we say…cure.
The Multiple Myeloma Research Foundation is a new type of disease charity. One that is focused on real advances. The MMRF is bringing treatments to patients and lighting lanterns of hope for patients everywhere, because if the story of multiple myeloma can be rewritten, so can any disease.
And so we climb. We trek. We hike to altitudes found few places in the world. We do it to call attention to this disease and the patients that are beating it. We are a symbol of a better future and for that I will suppress my anxiety and ignore some discomfort. This is big.
Help me get to the bottom of Everest. Please use this link to donate to the MMRF through Moving Mountains for Multiple Myeloma
Other posts on my trip to Everest Base Camp
#NoRestTilEverest
My adult running career began with this post by Mac Developer and personal hero, Cabel Sasser.
I was inspired and the following year I bought a pair of Nikes and the Nike+ system and started slogging miles. I ultimately logged over 1,000 miles with the Nike+ system. I loved the Nike+ system. The Nike+ system was tied to the iPod and so it was a late innovation for a technology that was an evolutionary dead-end.
In 2008, I bought my first iPhone, an iPhone 3g, and downloaded one of the first running apps, RunKeeper. It used GPS to log your distance. The early iPhones had lots of holes. RunKeeper couldn’t play music, burned the battery, and crashed my phone. But the program kept getting better. Features came. Features left. The scrappy Boston start-up behind RunKeeper was bought by Big Shoe (Asics). But the program kept getting better.
For awhile I was alternating between Nike+ and RunKeeper. That was until September 19th, 2009. It was my 40th birthday and I went out for my first 20 mile training run. At mile 8, Nike+ crashed my iPod Nano and stopped recording my run. That was the last time I used it. Since that run, RunKeeper has tracked every run. Here is my review of RunKeeper after 1,000 miles. And my review of RunKeeper 2.0. And my review of the first RunKeeper Pro.
Since then I ran a Marathon (a better post), a number of half marathons, I spent a year where I averaged 3 miles/day everyday. And though my running has decreased, as is clear from the nomogram, there are very few months where I failed to get out there and run. I have successfully kept fitness high on the priority list.
Items at the bottom of the to-do-list never get done. And because you never get to the bottom, things that are important can’t be put there. If you only exercise when everything else is complete you will never exercise. You need to take care of yourself before everything else is done. Not before anything else is done, but before everything else is done.
Run on.
#NoRestTilEverest
Saw this on Twitter (thanks Brian):
for #bioPeerReview, my favorite thing ever said about publishing, by @cshirky https://t.co/mNamuztdvX pic.twitter.com/T1nAsniQu8
— Michael Eisen (@mbeisen) February 8, 2018
I retweeted it, but sometimes a retweet is not enough.
Publishing is not evolving. Publishing is going away. Because the word “publishing” means a cadre of professionals who are taking on the incredible difficulty and complexity and expense of making something public. That’s not a job anymore. That’s a button. There’s a button that says “publish,” and when you press it, it’s done.
It’s so good I think I will publish it, and by that I mean press a button:
One of the things that is intoxicating about social media is watching how many people see, interact and respond to your content. This is at the heart of the difference between the little red circle on Twitter (dopamine!) versus the the little red circle on Mail (dread!).
The simplest analytics are shown below the tweet and anyone can see them.
The next level of analytics can only done one’s own tweets. Select one of your tweets, preferably one with a picture or a link, or both, and press “View Tweet activity”
This opens up a panel that reveals two new analytics: Impressions and Total engagements.
Impressions are a bit confusing. Here Impressions represent the number of people the Tweet was actually displayed to. So someone that was scrolling through twitter and this tweet passed her eyes would add one to the impression. This is very different than how that same term is used by Symplur (see below).
Engagements are the total number of people who have interacted with the tweet in some way. Click View all engagements to see what that means.
Twitter does a nice job of tracking and breaking down the elements that make up engagements.
The next level in analytics is looking at your twitter account. Make sure you are logged into your twitter account on the web and then type in https://analytics.twitter.com
The analytics page has an explosion data. The top gives you your 28 day trend for Twitter.
There is a menu of additional pages of information. The only one that I find useful is Tweets. More on that later.
Scrolling down you see a summary of every month you have been on Twitter Actually I’m not sure how far it goes back, but pretty far. For each month it tells you:
Next to these four pieces of information is a summary of your use of Twitter that month. I find it interesting to scroll through and see how your Twitter activity climbs and falls month to month.
Now click on Tweets at the top of the page (between Home and Audiences)
At the top Twitter shows you a histogram with the number of tweets (grey) and impressions (blue). On the right rail there are a series of histograms with the daily count of some of the components that make up engagements.
The bulk of the page is a collection, in reverse chronologic order, of all of your Tweets for the month. If you want to look at another time period you can do that with the date picker in the top right corner of the page. For each tweet you can see impressions and engagements and the rate (engagements/impressions). For each tweet you can click to reveal the full breakdown of engagements. You can sort and filter the list by pressing Top Tweets and get a short list of your top Tweets.
There are a few more tabs to explore in Analytics, but I have not found them useful.
At the end of every #NephJC and #AskASN, Matt and I race to see who can post the analytics for the chat first. To do this we are taking advantage of a service called Symplur. Symplur tracks all health hashtags. If you come up with a new health hashtag for a conference, you should go to Symplur and register that a hashtag. To use Symplur, go to their homepage and click on the magnifying glass and enter your medical hashtag.
Then click on #NephJC in the search result page. 
This take you to the #NephJC page in Symplur.
Ignore the schedule in Symplur, NephJC moves around inside the month enough that they never have it right. To get the Symplur analytics for an event you need to scroll to the bottom of that page, use the date picker to select the time you are interested in and press Get Analytics.
This will give you the analytics for that time period. Here is the analytics for the ACC/AHA Hypertension chat on January 16th.
Mentions is the number of times a person on Twitter was mentioned along side the hashtag in question (#NephJC in this case). Tweets is the number of tweets composed by the individual which contains the hashtag. And then there is Impressions. These impressions are not the same as the impressions that Twitter tracks. Twitter impressions are real. Symplur impressions are a lie. Symplur impressions are the number of tweets multiplied by the number of followers the author has. Since I have 11k followers, each of my tweets increases my impression count by 11k. Impressions rack up gaudy numbers fast and often a larger conference will have impression counts in the 100s of millions. This is absurd. Do not believe impressions. Matt and I, when we tweet the analytics for the chat, edit out impressions. However in one of our publications we did publish impression counts for NephJC. Matt swears it wasn’t him and I swear it wasn’t me but it’s in there. Sorry.
Good 2 know. Impressions don't have a primary place in #SoMe Best Practices. Your recent 2/2017 paper gives a different portrayal pic.twitter.com/S1WhD5J2uM
— Tejas Desai, MD MBA (@nephondemand) November 5, 2017
That’s the basics on Twitter analytics. A number of people have developed more advanced analytics that you might want to explore but I have not found that they add much witter experience. This is enough for me. Your mileage may vary.
The St John Nephrology Fellowship is excellent. One of the reasons it is good is we continually use feedback to fix holes. In last year’s in-service exam we found some weakness in calcium so I was asked to buff the fellows calcium knowledge.
Today I started that with a lesson on CKD-MBD where we focused on the KDIGO 2017 update. I pulled what I feel are the the most important articles in this area published recently. Here is what I pulled:
What did articles did I miss? What are your favorite CKD-MBD articles
P.S. My favorite part of the guidelines, the part that tell you everything you need to know about KDIGO is 4.2.2:
Here it is in 2009:
And here it is in 2017
And the best part is how the level of evidence has not changed. 2C for both. It’s like they just woke one morning on a different side of the bed.
Great update from Swapnil
How about the top line recommendation to do BMD?
Mostly based on research done by this researcher: https://t.co/6IAWiYPRDD+ (see the @AJKDonline retraction) pic.twitter.com/eADgja8PGm
— Swapnil Hiremath @hswapnil@bsky.social (@hswapnil) January 27, 2018