Brian Rifkin, MD
@brian_rifkin
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Interventional Nephrologist, Mississippian, @YaleMed , USAF (retired), T1DM, @NSMC intern 2021, @GlomCon fellow 2022, @NepSIM mentor
Joined August 2019
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Pinned Tweet
Apply to
@NephJC
NSMC internship, it might just change your life! Thanks again to
@kidney_boy
@Nephro_Sparks
and all the faculty for your leadership.
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@CatDocMD
Undocumented 38 yo with two small children. Refused dialysis. When I asked through a translator it turns out husband didn’t want her to get dialysis because she would be a burden. He would rather she died and then he would be able to remarry 🥺
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Remember how careful you were being last July and August? That's how careful you should be now. Vaccines will help but this is pandemic is not over. People are still dying and getting very, very sick every day. Please - mask, distance, and get the vaccine when/if you can.
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There have been 1,831,821 cases & 106,181 deaths from COVID19, a 5.8% conf case-fatality rate. To put it another way, 1 out of 17 Americans w/ confirmed SARSCoV2 has died. It is now the
#1
cause of death in the US. The message is getting lost: this pandemic is still very serious.
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These 14 states just hit their highest 7-day average of COVID-19 cases:
Alaska
Arizona
Arkansas
California
Florida
Kentucky
New Mexico
North Carolina
Mississippi
Oregon
South Carolina
Tennessee
Texas
Utah.
Also Puerto Rico.
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@jtrebach
You’re working a long shift in the ER and haven’t eaten all day. You are a poor resident and don’t have any money. You finally get a break and head out to the parking lot and find these mushrooms, do you eat them?
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Dialysis machine technology explained for the (average) nephrologist
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The ER gave potassium to a dialysis patient who came in directly after finishing dialysis?!
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@Jim_Jordan
American needs leadership. America needs a centralized pandemic plan. America needs freedom of speech. America needs to stick together. America needs innovation. America needs compassion for all citizens.
America wants football 🏈 . (See the difference?!)
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COVID is not gone.🦠
You will likely either 1) get COVID or 2) get the COVID vaccine💉
Getting vaccinated is the best option by far for every age group and risk category
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CT surgeon: I need you to put this pt on HD & optimize fluid removal for CABG.
Me: They are already on PD?!
CT: Yes, but I need fluid removed
Me: I was able to get 4L off with the cycler.
CT: I don’t trust PD.
Me: (imagines strangling CT with butterfly probe chord) 😡
END SCENE
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Channeling my inner Billy Joel:
We Didn’t Start the Fire 2020
MSM, fake news, fact checkers checking truths.
Be Best, Super Spreader, Kelly Conway.
NBA in a bubble, General Flynn’s pardoned troubles
Chadwick Boseman, Kobe Bryant, Sean Conner-ay
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BK Polyomavirus Nephropathy: The Never Ending Quest
Excellent blog by
@SayaliBThakare
Check it out 👀
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Hey
#NephTwitter
@ASDINNews
. Nurse is putting patient on dialysis and calls to show you this. No erythema, fever or drainage noted prior. Uses button hole technique, no recent access procedures. Now what?
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📢Tweetorial Alert (1/10)
KDIGO introduced new dialysis access guidelines in 2019.
Due to the pandemic, many of you may have missed this update.
So, let’s start from the beginning (it’s a very good place to start)- Guideline 1
@aishaikh
@edgarvlermamd
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If I could tell all the new medical interns one thing, it would be this-🩺🩹⚕️
Good doctors never stop learning, great doctors never stop teaching.
Thanks for the opportunities
#NMSC
@NephJC
@GlomCon
@Neph_SIM
@KIReports
@ASNKidney
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When they call for a nephrology consult at 5pm and haven’t done any lab work for 48 hours
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When the dialysis nurse tells you the patient has gained 12kg of fluid since their last treatment
#NephTwitter
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@jtrebach
Where’s the follow up paper that compares penis size with risk of being an a$$hole?!
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@mleader_3
@zachbraff
Hell, I would much rather have Dr Nick Riviera and Dr Julius Hibbert and they are actual cartoon characters
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@GarySingerMD
@DocElovitz
The best argument for diversity: “I’ll cover your holiday if you cover mine.”
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Evolution of Vancomycin-Associated Nephrotoxicity
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@jtrebach
🎤🎹🎻
All the hungry people
They only have a spoon
All the hungry people
Release the bowls soon
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@jessiprincey
@realDonaldTrump
So if this was illegal and/or unconstitutional for states to change their election laws then why have Trumps lawsuits failed? Either his lawyers are incompetent or it is neither of the above.
P.S. why only complain after the election?!
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TTP. Great graphic, why hadn’t I seen it explained like this before?
#Nephtwitter
🤩 NEJM 11/3/22
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🚨 Tweetorial Alert 🚨
☠️ ESKD has a 5 year mortality worse than most cancers…
🗑 So why are we throwing away so many kidney?
(1/23)
@DrBapuPod
#NephJC
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The cardiology versus nephrology diuretic dosing fight continues!
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@DGlaucomflecken
Hey, I’m am I nephrologist and I am highly insulted by this line of questioning, urine eletrylotes are very important...plus I always ask the ER for a stool velocity.
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My office for the day, the state capitol. Our state medical society sponsors a “Doctor of the day” while congress is in session.
Hoping to see and thank some representatives and senators for passing Mississippi’s Living Donor Protection Act!
@nephro_maniac
@MSMA1
#NephTwitter
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At the end of this chapter 7 of Burton Book, The Total Body Water and the Plasma Sodium Concentration, the team discusses the “underfill/overfill theory” and how you were taught wrong in medical school.
1/16
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Who needs a nephrology fellowship when you can read all there great blogs at
@KIReports
. Check out this one by recent
#NSMC
graduate
@thana_susan
#NephTwitter
Antiphospholipid syndrome: Exploring Patterns of Renal Injury
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Thiazides don’t change the incidence of recurrent kidney stones 😱 ⁉️
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If the people who keep calling everyone else sheep would stop taking livestock medicine, that would be great.
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Thank you
#NSMCinternship
@Nephro_Sparks
@kidney_boy
for an excellent year of learning and teaching. Hoping to pass it forward with mentoring NSMC and NephSIMS next year!
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@docmogwai
@DGlaucomflecken
I have to agree with Dr. G here. I am a Nephrologist with type 1 DM for 25 years and no retinopathy, but I don’t consider enducation of the patient confrontational. Yes, exploring the cause of elevated A1C and social determinants of lack of self care are also very important.
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@SciRocker
Too much paper work?? Checks notes…and he’s a lawyer who graduated from LSU law school 🤔
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Pinch hitter! Joel calls up
@rheault_m
from the audience to recap spartensetan in FSGS.
#NephJC
#KidneyWk
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@AvrahamCooperMD
@RanaAwdish
Do not forget the medical student lesson of the day. Patients don’t care how much you know until they know how much you care.
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Good morning day 4
#KidneyWk
. Hope you all have safe travels! I’m off to sing Handle’s Hallelujah Chorus. Meme you later.
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Never too old to become a “fellow” and learn new things to help your patients, thanks
@GlomCon
for the opportunity. Looking forward to working with young enthusiast nephrologist and GN experts.
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Wise words on “being with” despair and grief
There's a story in the Talmud (Brachot 5b). Or, rather, a series of stories.
Thread. 1/x
Rabbi Ḥiyya bar Abba, fell ill. Rabbi Yoḥanan entered to visit him, and said to him: Is your suffering dear to you? (aka Do you desire to be ill and afflicted?)
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@tatereeves
The irony of Tate demanding people return money 🙄.
I can resolutely condemn Hamas’ actions & using people as human shields.
Stand with Israel in recovery.
Acknowledge the innocent harmed by a blockade of Gaza.
Mourn with friends in Israel & mourn for the Palestinian people.
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I entered a piece in a local art contest called “Take A Seat”. Decorate or create a chair 🪑 🎨.
Mine is “Game of Glucose”, using old (unused) deconstructed insulin syringes 💉. 🥈
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@DrGolfShirt
Exhaustipated: too tired to give a 💩.
Use in a sentence...
The doctor was too exhaustipated to go to the committee meeting.
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@jtrebach
We need a Nephr-oil-gist. Make sure to change your fluids every 5,000 miles or every 50th COVID patient (whichever comes first).
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@GlomCon
debates today:
1. Membranous CYC vs Rituximab
-Rituximab good at low-moderate PLA2R levels
-Rituximab is 💰 and difficult to get around the world
-complications of CYC May have been overstated. At <10 gram cumulative dose there is limited infertility and no cancer
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@tatereeves
So point of clarification. Are you saying you are “philosophically uncomfortable” supporting poor mothers or just Black mothers?
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@acweyand
I know if I die taking care of COVID19 patients the story subtext will say “Doctor with Type 1 Diabetes”… because then we can all exhale and feel safe.👌
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Look 👀 who I found at
#ASDIN2024
, my old
#NSMC
pod mate Dr.Turk, Duke Nephrology Fellow
@Nephro_Sparks
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At first I thought the central government was disorganized, now I’m wondering how corrupt is it?
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Did you enjoy
#NephMadness
2022? Do you want to learn more nephrology in a nurturing environment? Learn how to create artful VAs and informative blogs? Think about joining
#NSMC
(applications Winter 2022)
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My youngest filling out his “emergency contact” form for school.
Remember it is important to train your consulting physicians while they are still young. 😝
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Does Hypertensive Nephrosclerosis (HNS, non-malignant HTN and aging) as a cause of CKD really exist?
Heck Yeah! 👍
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No Way! 👎
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Maybe...it depends 🤷♀️
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I don’t know? 🤦🏻
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Day 2
#ASDIN2024
shirt 2/3: Nephrologist-like a normal doctor only way cooler (see also legendary)
We now have a Hawaiian 🌺 shirt group, stay tuned
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Patient with hypoosmolar hypovolemic hyponatremia and a serum sodium 98 (yes, really with a Cl <50). Potassium of 2.9. Cannabinoid Hyperemesis Syndrome. Asymptomatic! What’s your fluid of choice
#NephTwitter
Normal Saline
439
1/2 NS
99
LR
181
3%
286
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Catching up on journals…
@NEJM
Extracorporeal Kidney Replacemtn Therapy for AKI 3/10/22. OK I know this is just medical illustrator prerogative, but did you have to put 2 catheters in every patient (femoral/IJ) and have a filter half the size of a person?
#NephTwitter
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