Despite being at home most of time in coronavirus epidemic , the state makes sure I am not slacking!

Great quote from an immunocompromised patient of mine “I’m on the Coronavirus Cafe menu, under the heading “Chef’s Speciality”

m.youtube.com/watch?v=sqyiYd…

Bridge bio “ negative” results on AG10 are, contrary to surprise expressed, completely anticipated. Drug is good but 12 month 6 min walk data in current era of earlier diagnosis was a major error in trial design , failing to understand disease natural history

Spontaneous biceps rupture patient on anticoagulant for AF- a strong clue for TTR amyloidosis!

Periorbital purpura after procedure (ablation for atrial arrhythmia).Think light chain amyloidosis (NOT TTR) with capillary fragility and cardiomyopathy ( it was!)

Activity for those in private practice, not those on academic salary! ( published in this month’s Consumer Reports. Shame can’t put it on my CV)

For anyone interested , a 20 min talk on current and future TTR amyloid therapies. Critiques and challenges welcome! dropbox.com/s/jh87pjq3i9pd…

abdominal X-ray from 1950’s showing collapsed vertebrae and radiopaque material in buttock: SYPHILITIC CHARCOTS ARTHROPATHY TREATED WITH BISMUTH! ( pre-penicillin therapy)

THE UPCOMING TTR AMYLOIDOSIS TREATMENT BATTLE. WILL SILENCERS OUTDO THE STABILIZER TAFAMIDIS ? We predict not doi.org/10.1002/ejhf.2…

Just returned from safari where I realized that zebras are not rare everywhere! Remember, amyloidosis is no longer a zebra and the definition of a “zebra disease” is in the eye of the beholder. If you don’t think of a diagnosis, the patient isn’t any less likely to have it!

But if you miss amyloidosis in the era of new therapies, the hyenas ( read “lawyers” ) will get you!!

Embarrassingly introduced at ACC session as “godfather of cardiac amyloidosis”’. ! All I can say is , with new therapies, the malpractice lawyers might “make an offer you can’t refuse” to docs who miss the diagnosis! So please think of it for your sake and that of your patients!

One year shortness of breath and brittle nails . DIAGNOSIS: AL amyloidosis cardiomyopathy with amyloid nail dystrophy. This disease can present to any type of specialist so ALWAYS look for multi system problems in a puzzling patient as a clue to correct and early diagnosis

William Harvey published his classic book “De Motu Cordis” describing the circulation of the blood in 1628. 72 years later sceptics, locked in pre-medieval thinking, still called it absurd. In the 21st century we still need to re-examine dogma if we want to make medical progress.

From Harvey’s famous book. “De Motu Cordis”. Published 1628

DIAGNOSTIC CONUNDRUM Medical diagnosis relies on precise thinking, yet ability to think outside the box. Ponder this: New patient complains of passing green urine. NO toxic or drug ingestion. He actually has a common condition. CLUE : what sex is the patient?