David Stevens

Love all things internal medicine, 🫀 disease, bioethics. Professional electrolyte repleter @IMResidencyDuke #DukeFam via @DukeMedSchool 🩺 @DukeTMCI @Yale

[David Stevens @DSteve37]

Thrilled beyond belief to be joining the legendary #DukeFam at @IMResidencyDuke! Thank you to all the family and mentors who have supported me, too many to list here, without whom none of this would be possible 😈💙🩺
@AimeeZaas #Match2024 #MatchDay #InternalMedicine #ForeverDuke

[David Stevens @DSteve37]

a terrible loss of a great scholar, introduced me to history as argument

[Pat Sobkowski @PJSobkowski]

Terribly sad news from Jack Rakove. Gordon Wood passed away in a traffic accident.

Perhaps the greatest historian of the American Revolution. May he rest in peace.

[NEJM @NEJM]

Presented at #ASCO26:

Among patients with previously treated metastatic pancreatic ductal adenocarcinoma, the RAS(ON) inhibitor daraxonrasib led to significantly longer overall survival and progression-free survival than chemotherapy. Full phase 3 RASolute 302 trial results: https://t.co/xwLWBZYRzq

@ASCO

[Josh Kalla @j_kalla]

This Report of the Yale Committee on Trust in Higher Education is well-worth reading in full. I hope my colleagues will take these recommendations seriously https://t.co/Tf58xMtWoY

[Jonathan Reiner @JReinerMD]

The last paragraph of this editorial is the first thing we teach our interventional fellows.
“In general, the benefit from any percutaneous intervention in cardiology is often the greatest with regard to the most acute or life-threatening problem the patient is facing. In contrast, in clinical situations in which the patient’s life is not directly at risk and the symptoms are controllable by medical treatment, conservative management should always be considered to be an equally effective alternative.”
https://t.co/9GkLLI0XT8

[David Stevens @DSteve37]

CLOSURE-AF: Time to close the book on LAA closure?

[NEJM @NEJM]

Among patients with atrial fibrillation at high risk for stroke and bleeding, left atrial appendage closure was not noninferior to medical therapy in reducing the risk of stroke, embolism, major bleeding, or death at 3 years. Full CLOSURE-AF trial results: https://t.co/qAMC2o36Mi

Editorial: Left Atrial Appendage Closure — Another Overused Method in Cardiology? https://t.co/KyOWdblUR3

[David Stevens @DSteve37]

@albertoortegana @Dr_Shiv_kumar_ @DrAkhilX @DrMedica_13 @drobiy12 @hemo_shk @fzn733 @shakilED i see brugada and josephson's signs - VT

[Muhammad Qudrat Ullah, MD @QudratUllahRana]

🚨 The 2026 AHA/ACC PE guidelines changed how we think about pulmonary embolism.
Not just new treatments — a new clinical framework.
Say goodbye to “massive vs submassive.”
Meet A–E PE Clinical Categories 🧵👇

[Radiology Business @RadiologyBiz]

Whole-body MRI provider @Prenuvo loses bid to limit damages in high-profile malpractice case. @fuchsberglaw https://t.co/O3ZtMQIdEJ

[CardiovascularCorner @TrackYourHeart]

🎄 Christmas Tree Sign on ECG

This rhythm strip from an elderly patient with palpitations and dizziness was initially puzzling during the ward round.

A simple but often forgotten trick solved it
🔵 Rotate the ECG strip 90° anticlockwise.

Suddenly, a repeating Christmas tree–like pattern emerges," the Christmas tree sign."

What does it represent?
🔵 Bidirectional ventricular tachycardia
🔵 Characterized by beat-to-beat alternation of the QRS axis
🔵 The alternating polarity creates a stacked, triangular outline resembling a Christmas tree 🎄

Classical associations to remember:
- Digitalis toxicity
- Catecholaminergic polymorphic VT (CPVT)

Key learning point:
In this patient, neither digitalis toxicity nor CPVT was the cause. The underlying substrate was dilated cardiomyopathy, reminding us that BDVT can occasionally appear outside its classic settings.

Merry Christmas

Credit: https://t.co/RZBkKIe7o5

[David Stevens @DSteve37]

Very sad news — He practiced politics honorably despite a political zeitgeist marked by superficiality, cravenness and dishonor

[Ben Sasse @BenSasse]

Friends-

This is a tough note to write, but since a bunch of you have started to suspect something, I’ll cut to the chase: Last week I was diagnosed with metastasized, stage-four pancreatic cancer, and am gonna die.

Advanced pancreatic is nasty stuff; it’s a death sentence. But I already had a death sentence before last week too — we all do.

I’m blessed with amazing siblings and half-a-dozen buddies that are genuinely brothers. As one of them put it, “Sure, you’re on the clock, but we’re all on the clock.” Death is a wicked thief, and the bastard pursues us all.

Still, I’ve got less time than I’d prefer. This is hard for someone wired to work and build, but harder still as a husband and a dad. I can’t begin to describe how great my people are. During the past year, as we’d temporarily stepped back from public life and built new family rhythms, Melissa and I have grown even closer — and that on top of three decades of the best friend a man could ever have. Seven months ago, Corrie was commissioned into the Air Force and she’s off at instrument and multi-engine rounds of flight school. Last week, Alex kicked butt graduating from college a semester early even while teaching gen chem, organic, and physics (she’s a freak). This summer, 14-year-old Breck started learning to drive. (Okay, we’ve been driving off-book for six years — but now we’ve got paper to make it street-legal.) I couldn’t be more grateful to constantly get to bear-hug this motley crew of sinners and saints.

There’s not a good time to tell your peeps you’re now marching to the beat of a faster drummer — but the season of advent isn’t the worst. As a Christian, the weeks running up to Christmas are a time to orient our hearts toward the hope of what’s to come.

Not an abstract hope in fanciful human goodness; not hope in vague hallmark-sappy spirituality; not a bootstrapped hope in our own strength (what foolishness is the evaporating-muscle I once prided myself in). Nope — often we lazily say “hope” when what we mean is “optimism.” To be clear, optimism is great, and it’s absolutely necessary, but it’s insufficient. It’s not the kinda thing that holds up when you tell your daughters you’re not going to walk them down the aisle. Nor telling your mom and pops they’re gonna bury their son.

A well-lived life demands more reality — stiffer stuff. That’s why, during advent, even while still walking in darkness, we shout our hope — often properly with a gravelly voice soldiering through tears.

Such is the calling of the pilgrim. Those who know ourselves to need a Physician should dang well look forward to enduring beauty and eventual fulfillment. That is, we hope in a real Deliverer — a rescuing God, born at a real time, in a real place. But the eternal city — with foundations and without cancer — is not yet.

Remembering Isaiah’s prophecies of what’s to come doesn’t dull the pain of current sufferings. But it does put it in eternity’s perspective:
“When we've been there 10,000 years…We've no less days to sing God's praise.”

I’ll have more to say. I’m not going down without a fight. One sub-part of God’s grace is found in the jawdropping advances science has made the past few years in immunotherapy and more. Death and dying aren’t the same — the process of dying is still something to be lived. We’re zealously embracing a lot of gallows humor in our house, and I’ve pledged to do my part to run through the irreverent tape.

But for now, as our family faces the reality of treatments, but more importantly as we celebrate Christmas, we wish you peace: “The people walking in darkness have seen a great light; on those living in the land of deep darkness a light has dawned….For to us a son is given” (Isaiah 9).

With great gratitude, and with gravelly-but-hopeful voices,
Ben — and the Sasses

[David Stevens @DSteve37]

can opened!

[RDU Airport @RDUAirport]

Update: traffic is now open to outbound international Drive only. Inbound international Drive to the airport remains closed. Use Airport Boulevard or Aviation Parkway.

[Mike Bird @Birdyword]

Our word of the year: Slop

[Amazing Maps @amazingmap]

Icelandic postal workers deliver a letter guided solely by a tourist’s sketch

[Duke Department of Medicine @dukemedicine]

Congratulations to all our residents who matched today in the fellowship match! 🥳 They are poised to make a tremendous positive impact on their future fellowships, and we can’t wait to see it! 💙✨#fellowmatch #match2025

[U.S. Senator Bill Cassidy, M.D. @SenBillCassidy]

Empirically, this is not true. Not all mothers have prenatal care. Some get infected between testing in the first trimester and delivery. In some cases, the test is overlooked. If a child is infected at birth, they have a 95% chance of becoming chronically infected UNLESS, they get one dose of hepatitis B vaccine. If they do, they have less than a 5% chance of being chronically infected.

[Amy Oxentenko, MD, MACP, MACG, AGAF @AmyOxentenkoMD]

Many #MASLD pearls by @ArchitaMD:

🔹MASLD is liver manifestation of metabolic syndrome
🔹Alcohol progresses MASLD
🔹FIB-4 useful primary assessment; don’t use if <35 yrs
🔹If elevated, do secondary assessment
🔹In F2-F3, GLP-1RA or resmetirom?

#ACGMWRegional
@AmCollegeGastro

[David Stevens @DSteve37]

@EM_RESUS Impression: large RA goomba
Ddx: clot in transit vs. myxoma vs. vegetation

[David Stevens @DSteve37]

@nkdstethoscope 🤔

[NEJM @NEJM]

Presented at #ASCO25:

A 3-year structured exercise program after adjuvant chemotherapy for colon cancer improved disease-free and overall survival, physical functioning, and fitness, as compared with health education alone. Full CHALLENGE phase 3 trial results: https://t.co/j3kWJDjuVz

@ASCO

[David Stevens @DSteve37]

@SteveCurryMD I see AGMA (partly from lactate), ∆∆ ~1 rules out 2º NAGMA. Could be CN tox from SNP, but SvO2 high (should be low)! IV benzo raises Q of osmotic alcohol buildup but normal osmolar gap, unlikely. But aha! SNP can be oxidizing ➡️ methemoglobinemia ➡️ antidote A. methylene blue.