Posts

Posted on

Wifi, board review and modern learners

The first day of the ASN Board Review Course I sat down for lunch and the topic of conversation was, “Where is the internet?”

The conference organizers had not purchased WiFi for the conference. The fifth floor of the Chicago Marriott was described by one participant as a Verizon black hole. Another participant added that Sprint was useless too. The only cellular service with reasonable penetration to our fortress of IP solitude was AT&T.

No WiFi for You!

It was interesting hearing why doctors wanted the internet while at a conference. One would think that being locked in lectures from 6:30AM to 6:30PM while various experts sprayed information at you would satisfy any urges for more details. But instead, doctors want to engage with the material. One Baltimore nephrologiast wanted to look up an article at CJASN that she saw referenced. Another wanted to fact check something she thought was unreliable against UpToDate. I wanted to be tweeting.

Earlier that day, as I walked from my Airbnb apartment to the conference, I traded texts with Kenar Jhaveri and Matt Sparks about live tweeting the board review conference. They agreed when I promised to save any snark for my own tweet stream and just tweet the facts on eAJKD. I checked with the ASN representative at the registration desk if they had a social media policy.

That went down as follows:

@kidney_boy I don’t really know = “sure, go ahead.”
— Michael Katz (@MGKatz036) August 10, 2013

Unfortunately my plan to live tweet the conference dried up up without WiFi or cellular service. After the first day of the conference I found an AT&T store and bought a Unite mobile hotspot. I used it to live tweet the conference for the next 4 days. It worked great. I returned it before leaving Chicago. The whole buy and return plan amounted to $40 for wifi access for 4 days. Actually a bit better than typical hotel charges.

I think it is misguided for the ASN BRC not to provide internet access at their class. As modern day information warriors doctors use the internet everyday in protean ways.

  • We use it to educate our patients
  • We use it to verify the wild claims of drug companies
  • We use it to jog our memory of barely remembered facts that suddenly become clinically relevant

It is absurd to expect us to go through the most intense learning experience without that crutch.

The lack of WiFI makes the conference organizers seem out of touch. The ASN need to recognize that for modern doctors, the internet is as essential as oxygen.

@kidney_boy RT @mdcounselling: An update to Maslow’s hierarchy of needs! pic.twitter.com/KnkRAE5IJw
— Matt Sparks (@Nephro_Sparks) August 17, 2013

Posted on

House and MUDPILES

I just came back from the ASN Board Review Course. A couple of the professors referred to an episode of House where they run through MUDPILES. I found the relevant clips.


Here is a link to the .mov file

Chase recites MUDPILES.

The patient had methanol poisoning. House gives a pretty garbled explanation of how ethanol can act as an antidote.

Posted on

An editorial on hyponatremia

I wrote a short editorial on hyponatremia and it’s effect on mortality for eAJKD. I like the comparison of tolvaptan to Epo. Hopefully we will not have to wait two decades for a properly done RCT with patient oriented outcomes. We know the drug raises the sodium, now let’s see if it reduces fractures, falls and mortality.

Posted on

The Quantified Self in the Nephrology Clinic

I am a big believer in home blood pressure monitoring. In fact, I don’t think you can be serious about treating blood pressure without getting readings outside of the clinic. Everyone thinks about white coat hypertension which is surprisingly frequent. But don’t forget masked hypertension which should call to question normal office blood pressures readings. I did a great interview about this for eAJKD.
A few weeks ago I had a patient bring in a pile of home blood pressure readings and in order to make sense of it I did an informal histogram in our EMR:

Home blood pressure nomogram in my EMR. Tufte would be proud. pic.twitter.com/6bw47ihWXl
— Joel Topf (@kidney_boy) July 10, 2013

Clearly this was not ideal blood pressure control and showing the histogram to the patient convinced him to intensify his treatment.

Edgar Lerma then asked for an app-based solution

@ChristosArgyrop @kidney_boy Can you recommend a Free APP that does useful Home BP Tracking/ Plotting? I realize not everyone can do it 🙁
— Edgar V. Lerma (@edgarvlermamd) July 12, 2013

I linked to an old post on PBFluids that highlighted iBP but in the last few weeks patients have shown me two new free options:

BP Companion on iOS and BPwatch on Android. I do not have a full review, but both seemed like well designed apps and the patients really liked them.

Posted on

Significant change to my Sodium and Water handout.

I re-worked my sodium and water handout to better track my IV fluid and diuretic lecture that I do for residents in July. The old hand-out focused on IV fluids and dysnatremia. The new one goes deeper into IV fluids including new data on the advantages of LR over NS, and the problem of iatrogenic fluid overload. I then stripped a bunch out on the principles of total body sodium and put an abridged section on hyponatremia with more contemporary view on vaptans and their role the treatment of hyponatremia. I removed the hypernatremia section.

The next step is to remove the dysnatremia section completely and make that a stand alone book.

Work in progress.

Posted on

More on the Electrolyte Handbook

I am making a significant commitment to the The Electrolyte Handbook. I plan on making continuous tweaks, corrections, and additions. A quick list of ideas include:

  • More references
  • More pictures
  • More tables and lists
  • Integrated calculator in the e-book version
  • Acid-base chapters
  • Sodium
  • IV fluids
  • CKD
  • ARF

The fact that this is going to be a living book leads to some problems. A website always shows the most up-to-date version, but since the PDF and e-book don’t auto-update I have a problem on how to get the most up-dated version in to the hands of users. I have not worried about this issue with my existing hand-outs because the content is entirely conceptual so mistakes did not have clinical implications.

This handbook, however is intended to guide therapy so I need a way to notify users of fixes. So I am going to build an e-mail list. I will only send e-mails when updated versions of the handbook come out. I have no plans to spam. This e-mail is designed to help you, by making sure you are using the most up to date version of the Electrolyte Handbook.

Latest version of the Electrolyte Handbook:

Change log:

Posted on

Introducing the electrolyte handbook

This is a quick guide to correcting electrolytes designed for new interns. It works in Apple iBooks. PDF format and e-Pub format are forthcoming. I also plan adding: IV fluids, sodium, acid-base and acute renal failure to be a quick, on-call guide for interns.

electrolyte handbook
New link: More on the Electrolyte Handbook
This is a work in progress so send me feedback.
Posted on

Rhabdo, in the news

Giants pitcher, Chad Gaudin, was arrested Jan. 27 and charged, July 3 with open and gross lewdness.

“Chad Gaudin was examined in the emergency room of a local hospital while experiencing symptoms believed to be related to acute renal failure due to a condition known as rhabdomyolysis. The symptoms included confusion, dehydration and loss of orientation and/or consciousness. Although he has been accused of improperly touching another hospital patient while on the premises that night, there are differing and exonerating versions of what occurred that have been reported by eye witnesses.”