Morning Report: Management of Hypercalcemia

Medicine 401 Teaching Award Recipients

Intern Highlights!

Calling all future Pulmonologists! Check out this webinar on Lung Transplantation, specifically in the era of COVID! August 12, 2020 from 6-7 PM!

Celebrating the Life of Civil Rights Leader John Lewis: “Stand up, speak up and speak out…”

JOHN LEWIS, the civil rights leader and congressman who died on July 17, wrote this essay shortly before his death.

Listen to his friend, Morgan Freeman, reading the essay out loud here:

Together, You Can Redeem the Soul Of Our Nation

While my time here has now come to an end, I want you to know that in the last days and hours of my life you inspired me. You filled me with hope about the next chapter of the great American story when you used your power to make a difference in our society. Millions of people motivated simply by human compassion laid down the burdens of division. Around the country and the world you set aside race, class, age, language and nationality to demand respect for human dignity. That is why I had to visit Black Lives Matter Plaza in Washington, though I was admitted to the hospital the following day. I just had to see and feel it for myself that, after many years of silent witness, the truth is still marching on. Emmett Till was my George Floyd. He was my Rayshard Brooks, Sandra Bland and Breonna Taylor. He was 14 when he was killed, and I was only 15 years old at the time. I will never ever forget the moment when it became so clear that he could easily have been me. In those days, fear constrained us like an imaginary prison, and troubling thoughts of potential brutality committed for no understandable reason were the bars. Though I was surrounded by two loving parents, plenty of brothers, sisters and cousins, their love could not protect me from the unholy oppression waiting just outside that family circle. Unchecked, unrestrained violence and government-sanctioned terror had the power to turn a simple stroll to the store for some Skittles or an innocent morning jog down a lonesome country road into a nightmare. If we are to survive as one unified nation, we must discover what so readily takes root in our hearts that could rob Mother Emanuel Church in South Carolina of her brightest and best, shoot unwitting concertgoers in Las Vegas and choke to death the hopes and dreams of a gifted violinist like Elijah McClain. Like so many young people today, I was searching for a way out, or some might say a way in, and then I heard the voice of Dr. Martin Luther King Jr. on an old radio. He was talking about the philosophy and discipline of nonviolence. He said we are all complicit when we tolerate injustice. He said it is not enough to say it will get better by and by. He said each of us has a moral obligation to stand up, speak up and speak out. When you see something that is not right, you must say something. You must do something. Democracy is not a state. It is an act, and each generation must do its part to help build what we called the Beloved Community, a nation and world society at peace with itself. Ordinary people with extraordinary vision can redeem the soul of America by getting in what I call good trouble, necessary trouble. Voting and participating in the democratic process are key. The vote is the most powerful nonviolent change agent you have in a democratic society. You must use it because it is not guaranteed. You can lose it. You must also study and learn the lessons of history because humanity has been involved in this soul-wrenching, existential struggle for a very long time. People on every continent have stood in your shoes, though decades and centuries before you. The truth does not change, and that is why the answers worked out long ago can help you find solutions to the challenges of our time. Continue to build union between movements stretching across the globe because we must put away our willingness to profit from the exploitation of others. Though I may not be here with you, I urge you to answer the highest calling of your heart and stand up for what you truly believe. In my life I have done all I can to demonstrate that the way of peace, the way of love and nonviolence is the more excellent way. Now it is your turn to let freedom ring. When historians pick up their pens to write the story of the 21st century, let them say that it was your generation who laid down the heavy burdens of hate at last and that peace finally triumphed over violence, aggression and war. So I say to you, walk with the wind, brothers and sisters, and let the spirit of peace and the power of everlasting love be your guide.

(Taken from The New York Times, July 30, 2020)

Genetic Profiling in NSCLC!!

Today at Jacob’s Oncology conference Dr. Hatim Husain reviewed non-small cell lung cancer (NSCLC)!! For decades, this groups of malignancies was approached with a more generic surgery, radiation, and chemo strategy based on TNM staging. However, the advents of immunotherapy and targeted gene therapies have changed the game!! Key points:

1. Remember, primary lung cancers are split into Small Cell Lung Cancer (SCLC) and Non-Small Cell Lung Cancer (NSCLC).
2. For SCLC, genetic profiling doesn’t matter as much, because chemoradiation (for limited disease) and chemo/immunotherapy (for systemic disease) are still the go-to approaches.
3. For NSCLC, there are many gene mutations that can be specifically targeted with therapy! Therapy that is SUPERIOR to chemotherapy or combination chemo/immunotherapy. It’s important to test for these genes when biopsy is done, because they can greatly impact treatment options and patient morbidity/mortality. Plus, they have fewer side effects!!

Hypercalcemia Morning report – 7/30/20

Today with the assistance of our amazing expert discussant, Dr. Hupfeld, we reviewed the basics of hypercalcemia. Our patient presented with anorexia, polyuria and polydipsia with 1 month duration. Labs showed severe hypercalcemia to 15.2 with low phosphorus. We first reviewed the basics of calcium metabolism as well as common signs and symptoms that are associated with hypercalcemia. When seeing these patient’s, the most important tests to order are PTH, CBC, Mag, Phos and albumin as an initial screen. Next we reviewed our differential for hypercalcemia including PTH dependent and PTH independent causes. For our patient given that he had an elevated PTH he was diagnosed with primary hyperparathyroidism! Lastly we discussed common PTH and calcium levels that would be expected in different disease states. Stay tuned next week for part two – Calcium management with Danielle!

Resident Kudos!

Congratulations to Morgan, our fantastic new intern and future Infectious Disease specialist, for his accepted manuscript! Morgan, alongside Dr Davey Smith and Dr Darcy Wooten, found an increase in internet searches for Infectious Disease Fellowship coinciding with the COVID19 pandemic! What does this mean? Maybe this pandemic, similar to the HIV pandemic, has inspired more medical trainees to consider a future in Infectious Disease!

Tocilizumab in COVID-19

Preliminary results have been released from the COVACTA trial, which evaluated the benefit of Tocilizumab in patients with severe COVID-19. Tocilizumab is an antibody that binds and blocks the receptor for cytokine IL-6. IL-6 is a key component of our immune system and the thought was that this medication, which has worked for autoimmune diseases and syndromes such as Rheumatoid Arthritis, Multiple Myeloma, and Cytokine Release Syndrome, might be able to improve outcomes in patients with COVID-19. These patients can experience an overwhelming inflammatory response to the initial virus infection, leading to complications such as ARDS and other effects. Ultimately, there was no difference in mortality, ventilator-free days, or infection rates in those who received Tocilizumab vs Placebo. More details of the study and it’s preliminary outcomes in the gallery below: