That lady you hate 🐀

Only funny on Facebook. I follow a lot of people that are probably assholes. I don’t speak for them.

[That lady you hate 🐀 @thatladyyouhate]

If you are wondering how your child can be abused through the @USAGym system, I'm going to tell you. You can ask almost anyone that's been through it and the process is almost textbook. (1)

[That lady you hate 🐀 @thatladyyouhate]

@TakeThatNurses I can relate.

[That lady you hate 🐀 @thatladyyouhate]

@katienotopoulos I can possibly see this being helpful if it were “Siri, book me a reservation at 7 pm” but by the time I’ve opened up any AI and typed anything in, I’ve used as much time as I would save.

[Kevin Pho, M.D. @kevinmd]

An autoimmune disease more common than lupus has zero approved treatments. And 30 to 40 percent of the people who have it show completely normal blood work.

Sjogren's disease affects about 1 in 100 people. Roughly 90 percent are women. Most clinicians learned it as a dryness syndrome, dry eyes and dry mouth, an afterthought at the end of the autoimmune lecture.

Kara Wada learned it differently. She's an adult and pediatric allergy, immunology, and lifestyle medicine physician, and she became the patient. A dental hygienist at a routine cleaning told her that her mouth tissues looked dry, and years of symptoms snapped into place: dry eye that ended her contact lenses, mascara she couldn't wear without looking like a raccoon, back pain that eased during pregnancy when everyone else's got worse, fatigue like gravity turned up a few notches.

She was fortunate. As an immunologist she knew which labs to order, and hers came back blatantly abnormal. For 30 to 40 percent of Sjogren's patients, they don't.

What she wants clinicians to know is that dryness will rarely be the chief complaint. Patients come in with body pain that sounds like fibromyalgia. Fatigue from the moment they wake up until they go to bed. Autonomic problems: trouble swallowing, gastric motility issues, constipation, dizziness on standing, heat intolerance. Sjogren's is a common cause of POTS and other forms of dysautonomia.

The diagnosis is clinical. Labs support it, but they aren't the end-all.

Treatment is where it gets uncomfortable. Hydroxychloroquine, methotrexate, and in severe cases rituximab are all used off label. Nothing is approved for Sjogren's itself. Several drugs are in phase 3 trials now, and Wada is going through screening for one of them. She says there's an undercurrent of hope in the patient community for the first time.

The cost is real even when the disease is held in check. After a significant flare, Wada cut her clinic time to half for a while, rebuilt her life around sleep and pacing, and describes her energy like an old iPhone battery: slower to recharge, quicker to drain. She is back up to about three-quarter time and has since had another child.

Meanwhile, some rheumatologists still describe it as a nuisance disease, and patients describe being gaslit when their pain and fatigue aren't taken seriously.

Her ask of colleagues is small and specific: "Just at least have Sjogren's on your differential. And it doesn't always mean just dry eyes and dry mouth."

Listen to the full conversation on The Podcast by KevinMD. Link in the replies.

What condition were you taught to treat as minor that your patients experience as anything but? #ThePodcastbyKevinMD

[That lady you hate 🐀 @thatladyyouhate]

@hoosiernavy @GeauxGabrielle The Nicene Creed just vaguely refers to Revelation.

[That lady you hate 🐀 @thatladyyouhate]

@ciderpunk20 @IvanaDGreco Look up Glerups. They aren’t cheap and they take a little while to break in, but they are excellent quality and super comfortable.

[That lady you hate 🐀 @thatladyyouhate]

@FlatironFlusher Check @RockBottomGolf in a few weeks.

[That lady you hate 🐀 @thatladyyouhate]

@mm_jiselle My husband took our honeymoon with some printed out Mapquest instructions and I’m honestly surprised we returned still married. Not sure we could still do it today.

[That lady you hate 🐀 @thatladyyouhate]

@WillGFootman @fu_rams92 @carlyb_ Wow! Except it doesn’t actually read based on the traditional definition of that word, but why don’t you tell us more about your superficial understanding of how AI works?

[That lady you hate 🐀 @thatladyyouhate]

@jaylyn600 @carlyb_ If you can use turbo tax, you financed aren’t complicated enough and you aren’t wealthy enough to need an accountant. Few real accountants use turbo tax at all.

[That lady you hate 🐀 @thatladyyouhate]

@WillGFootman @fu_rams92 @carlyb_ Accounting isn’t all numbers. You think bookkeeping is accounting. Regulations & statutes contradict other regulations & statutes. Laws change. Regulators change. Interpretation & nuance is a large part of the job. So is making judgement calls.

[That lady you hate 🐀 @thatladyyouhate]

@TomasBarre61852 @TheCAThomas @carlyb_ Have you read any regulations? Oftentimes they are written by politicians & officials that don’t even understand what they are requiring. Different statutes contradict each other. Accountants discuss interpretations, consult case law & policy papers, & use judgement.

[That lady you hate 🐀 @thatladyyouhate]

@WillGFootman @fu_rams92 @carlyb_ Reading, interpreting, and explaining regulations, statutes and tax code is not repetitive. Not saying AI won’t be involved but sounds like you only understand a small piece of what accountants do.

[That lady you hate 🐀 @thatladyyouhate]

@TreeMcPickle @sharghzadeh Health insurance is broken. But other types of insurance are not. Insurance companies take the premiums customers pay and invest them. Many actually lose money on operations but make money on the investing. Others make money on both. But they are not profitable just on premiums.

[That lady you hate 🐀 @thatladyyouhate]

@mandalynns23 I actually loved our open concept when the kids were young, but as they grew into teens it became an actual nightmare for all of us. Who doesn’t want to hang out with their crush and their entire family in one giant room?

[That lady you hate 🐀 @thatladyyouhate]

@Cackalacman Had to use card on acct I usually just use to pay mrtg because needed new card for main acct. 1st pymt fine. 2nd declined. 3rd I realized they shut it down for susp fraud, but no call, text, nothing. I get why it flagged, but if it was fraud were they just not going to tell me?

[That lady you hate 🐀 @thatladyyouhate]

@SolarArchivist @muheediva01 I once was buying flour and when the cashier picked it up from the belt, the bottom of the flour gave out and she, along with the whole lan, were literally covered in flour. The package seemed fine when I selected it. I felt so bad.

[That lady you hate 🐀 @thatladyyouhate]

@hank_soup @macksypowwa We also called it “the box” when I was a kid. 😂

[That lady you hate 🐀 @thatladyyouhate]

@LarryGreer20 @wilsonhlthcoach Curious, if a high-risk woman has had mammograms for years, but also got an ultrasound this year and mammogram showed nothing, but ultrasound had a few spots they want rechecked in 6 mo, wouldn’t mammogram have shown something first if it’s better at detecting early cancer?

[That lady you hate 🐀 @thatladyyouhate]

@MotownMels @snotrocketeer No, move Indiana and Ohio out of our box.

[That lady you hate 🐀 @thatladyyouhate]

@larissaphillip I’ve thought for years that there’s an untapped market for high interest low reader books for teens & adults.

A lot of the content could be similar to kid’s books, especially for nonfiction, but it would need to be marketed differently. Could help those learning English too.