#HPM Tweet Chat 4:20:11

#hpm - Healthcare Social Media Transcript
6/27/12 11:39 AM
#hpm transcript
Healthcare Social Media Transcript
From: To: Wed Apr 20 18:00:00 PDT 2011 Wed Apr 20 19:15:00 PDT 2011 change time period
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PracticalWisdom
We want others 2 c us competent, not just nice.RT@doclake Powervs.Warmth applies 2 way #hpm prac. interacts @bedsidehttp://is.gd/OI5cqH #HPM
Wed Apr 20 18:00:31 PDT 2011
equijada
Hi everyone. For the next 6 min, I'll be in #hpm tweetchat. Come join the discussion. #hpm
Wed Apr 20 18:01:02 PDT 2011
equijada
@PracticalWisdom Hi Lisa, good to see you here #hpm

Wed Apr 20 18:01:25 PDT 2011
PracticalWisdom
Interested Pt Educ.RT@DianeEMeier:RT @ctsinclairNews/Research UPDATES: U.S. FDA Releases Long-Awaited Opioid-REMS http://hpm.md/g2AncC #HPM
Wed Apr 20 18:01:26 PDT 2011
RossJeanette
hi @equijada only 6 minutes? #hpm

Wed Apr 20 18:01:54 PDT 2011
KathyKastner
What about the other 54 minutes :)RT @equijada: Hi everyone. For the next 6 min, I'll be in #hpm tweetchat. Come join the discussion. #hpm
Wed Apr 20 18:02:02 PDT 2011
http://hashtags.symplur.com/healthcare-hashtag-transcript.php?ha&smin=0&tdate=04-20-2011&thour=19&tmin=15&ssec=00&tsec=00&img=1
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PracticalWisdom
My Pleasure. Thanks for being our Host. RT @equijada: @PracticalWisdom Hi Lisa, good to see you here #HPM
Wed Apr 20 18:02:28 PDT 2011
equijada
@KathyKastner ha, i mean for the next 60 min! #hpm

Wed Apr 20 18:02:46 PDT 2011
PracticalWisdom
@KathyKastner @equijada 54 Fun with our Friends. Brain Candy for All #HPM
Wed Apr 20 18:03:01 PDT 2011
KathyKastner
Wheewh. worried for a mo RT @equijada: @KathyKastner ha, i mean for the next 60 min! #hpm
Wed Apr 20 18:03:16 PDT 2011
equijada
@RossJeanette Hi Jeanette! 60 min...thinking faster than I type. Welcome. Good to see you here #hpm
Wed Apr 20 18:03:26 PDT 2011
FMDGirl
Hi everyone- listening in. Kari- RN/pt advocate #HPM

Wed Apr 20 18:04:10 PDT 2011
KathyKastner
H Lisa ! RT @PracticalWisdom:@equijada 54 Fun with our Friends. Brain Candy for All #HPM
Wed Apr 20 18:04:20 PDT 2011
equijada
@FMDGirl Hi Kari, welcome. #hpm

Wed Apr 20 18:04:54 PDT 2011
PracticalWisdom
@equijada: Hoping our Man from Down Under will join us tonight. The Rascal @Hughstephens. #HPM
Wed Apr 20 18:05:14 PDT 2011
revdoc
Pam Harris MD with Kansas City Hospice; also an ordained minister #hpm
Wed Apr 20 18:05:32 PDT 2011
SheyontheBay
Hello all, glad to see you #hpm

Wed Apr 20 18:06:31 PDT 2011
equijada
@PracticalWisdom will start with t1 in a min or so. Join us @hughstephens. Welcome Pam. Good to see you #hpm
Wed Apr 20 18:06:35 PDT 2011
revdoc
Good to tweet with y'all #hpm

Wed Apr 20 18:07:09 PDT 2011
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equijada
@SheyontheBay hi, good to see you. long time! #hpm

Wed Apr 20 18:07:12 PDT 2011
PracticalWisdom
@KathyKastner I'm always glad to see you. #HPM

Wed Apr 20 18:07:34 PDT 2011
teaminspire
Hi everyone--listening in, looking to learn--John Novack, Inspire (online patient support communities) #HPM
Wed Apr 20 18:07:45 PDT 2011
hughstephens
@PracticalWisdom @equijada still looking for cat :( might not make #hpm
Wed Apr 20 18:08:01 PDT 2011
equijada
t1: It's 420! What is the role of marijuana in patients with life threatening illness? #happy420 #hpm
Wed Apr 20 18:08:02 PDT 2011
equijada
For those not familiar with 420 The True Story Of How April 20 Became 'Weed Day' http://huff.to/hmP832 #hpm
Wed Apr 20 18:08:41 PDT 2011
equijada
420 (cannabis culture) - Wikipedia, the free encyclopedia http://bit.ly/f5aOqV #hpm

Wed Apr 20 18:08:49 PDT 2011
SheyontheBay
@equijada @SheyontheBay yes, sorry about that - lots going on in life!! ;) #hpm
Wed Apr 20 18:08:57 PDT 2011
equijada
@hughstephens welcome! #hpm

Wed Apr 20 18:09:06 PDT 2011
revdoc
T1--I am actually not very impressed with Marinol for sx control #hpm
Wed Apr 20 18:09:12 PDT 2011
FMDGirl
t1- question dear to my heart- close friend passed away from Fredrich ataxia- not legal, but only think that helped #HPM
Wed Apr 20 18:09:41 PDT 2011
KathyKastner
Clearly I need glasses. I put an 'e' in the middle of sx RT @revdoc: T1--I am actually not very impressed with Marinol for sx control #hpm
Wed Apr 20 18:10:19 PDT 2011
revdoc
Although Marinol does help for the wasting syndrome associated with AIDS #hpm
Wed Apr 20 18:10:21 PDT 2011
SheyontheBay
Dating myself: i remember teaching chemo pts how to smoke a joint, circa 1980!!! #hpm
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Wed Apr 20 18:10:23 PDT 2011
equijada
@FMDGirl if you don't mind, can you expand on the experience? what did it help? #hpm
Wed Apr 20 18:10:34 PDT 2011
equijada
I think that data on marinol and marijuana are actually different. Not sure. #hpm
Wed Apr 20 18:11:27 PDT 2011
revdoc
Can't speak to the effect of Marinol on sex... #hpm

Wed Apr 20 18:11:43 PDT 2011
equijada
@SheyontheBay was it helpful? #hpm

Wed Apr 20 18:11:46 PDT 2011
DianeEMeier
RT @doclake: Power poses vs. Warmth poses-good research that applies to the way a #hpm practitioner interacts @ the bedside http://is.gd ...
Wed Apr 20 18:11:49 PDT 2011
revdoc
In Kansas, marijuana is not legal, so we are stuck with Marinol #hpm

Wed Apr 20 18:12:13 PDT 2011
equijada
Cannabis use in palliative care http://bit.ly/huBHGx A nice review #hpm

Wed Apr 20 18:12:56 PDT 2011
FMDGirl
Yes, fredrich ataxia causes spasms- traditional meds did not help- up front with docs about using it, pts should be able use medically #HPM
Wed Apr 20 18:13:53 PDT 2011
SheyontheBay
@equijada@SheyontheBayIf they could get past the 'criminality' it helped, esp w/ nausea.po tabs seemed to get neutralized by gastric jc #hpm
Wed Apr 20 18:14:17 PDT 2011
equijada
@FMDGirl I hear that a lot from patients taking it. #hpm

Wed Apr 20 18:14:40 PDT 2011
SheyontheBay
Wasnt legal in Florida either... We ignored the smell of pot wafting down the corridor #hpm
Wed Apr 20 18:15:13 PDT 2011
DianeEMeier
RT @doclake: The New Old Age: A Mothers Nighttime Rage http://is.gd/ciHsMe delirium #hpm
Wed Apr 20 18:15:24 PDT 2011
equijada
It's legal in CA (I'm in CA). There are so many dispensaries. Many times the pts using don't seem legit. Hard to balance. #hpm
Wed Apr 20 18:16:14 PDT 2011
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RossJeanette
thanks for the information on 420. Since marijuana is ilegal in Texas I have no experience w/ this. #hpm
Wed Apr 20 18:17:15 PDT 2011
FMDGirl
Plus- it increases appetite, Dave- my friend wrote a book:http://amzn.to/hYJGVk #HPM

Wed Apr 20 18:17:28 PDT 2011
drpippa
Only anecdotal evidence Has been helpful for folks. Hard to balance legit use vs illicit use. Would prob not feel comfortable rxing #Hpm
Wed Apr 20 18:17:36 PDT 2011
revdoc
SAME ISSUE WITH OTHER PAIN MEDS RT @equijada: Its legal in CA (Im in CA). Many times the pts using dont seem legit. Hard to balance. #hpm
Wed Apr 20 18:17:58 PDT 2011
drpippa
@equijada Nice choice of topic for the day! #Hpm

Wed Apr 20 18:18:03 PDT 2011
equijada
I've let patients use it. I don't have a problem with it. I do get uncomfortable when they are using pot and oxyfast gets lost. #hpm
Wed Apr 20 18:18:32 PDT 2011
FMDGirl
@equijada How is it different from managing any other chronic patient that is on pain meds? #HPM
Wed Apr 20 18:18:40 PDT 2011
equijada
@FMDGirl thanks for the link. I'm going to check it out. #hpm
Wed Apr 20 18:19:02 PDT 2011
SheyontheBay
@equijada Have no idea how it was used or abused in the home. Hospital pts had to provide their own -> no quality control #hpm
Wed Apr 20 18:19:04 PDT 2011
revdoc
FDA proposing REMS on ALL opiates because of issues of abuse or diversion http://hpm.md/g2AncC #hpm #hpm
Wed Apr 20 18:19:07 PDT 2011
PracticalWisdom
Sorry had internet problems Kerri great to see you. #HPM

Wed Apr 20 18:19:22 PDT 2011
equijada
@FMDGirl it's not. I have to risk assess just like opioids. #hpm
Wed Apr 20 18:19:35 PDT 2011
BuddhishMD
@NYTimeskrugman Language is so important - it sometimes feels like the world of money and business has completely co-opted our lives. #hpm
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Wed Apr 20 18:20:13 PDT 2011
equijada
@FMDGirl I think the main difference is basically legal but in terms of prescribing - same as opoioids #hpm
Wed Apr 20 18:20:27 PDT 2011
equijada
@drpippa ha! thanks. #hpm

Wed Apr 20 18:20:49 PDT 2011
FMDGirl
@equijada pt on ms for cancer- it made him confused and he cut his feeding tube in half without realizing it- thought it was a string #HPM
Wed Apr 20 18:20:54 PDT 2011
PracticalWisdom
RT @drpippa: Only anecdotal evid. Has been helpful 4 folks. Hard 2 balance legi use vsillicit use.Would prob not feel comfortable rxing #HPM
Wed Apr 20 18:21:10 PDT 2011
PracticalWisdom
RT @FMDGirl: @equijadapton ms 4 cancer- made him confused& he cut his feeding tube in 1/2 without realizing it- thought it was a string #HPM
Wed Apr 20 18:21:48 PDT 2011
equijada
@PracticalWisdom @drpippa @AAHPM doesn't have an official stand on marijuana. Interesting discussion in Vancouver #hpm
Wed Apr 20 18:22:02 PDT 2011
PracticalWisdom
Rascal Topic for sure. I knew this would be a good one. RT @drpippa: @equijada Nice choice of topic for the day! #HPM
Wed Apr 20 18:22:17 PDT 2011
FMDGirl
easy to balance legal use, RX from an MD- get from a hospital pharmacy #HPM
Wed Apr 20 18:22:27 PDT 2011
drpippa
Still disappointed i missed it! RT @equijada: @AAHPM doesnt have an official stand on marijuana. Interesting discussion in Vancouver #Hpm
Wed Apr 20 18:23:09 PDT 2011
equijada
RT @FMDGirl: easy to balance legal use, RX from an MD- get from a hospital pharmacy #hpm
Wed Apr 20 18:23:20 PDT 2011
drpippa
RT @FMDGirl: easy to balance legal use, RX from an MD- get from a hospital pharmacy #Hpm
Wed Apr 20 18:23:44 PDT 2011
equijada
Moving on to t2 in a min or so #hpm

Wed Apr 20 18:23:52 PDT 2011
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PracticalWisdom
@equijada @drpippa @AAHPM T1: When I taught Pharmacology (Basic) 100 years ago Marijuana was complicated Dep/Stim Sometimes Hallacu? #HPM
Wed Apr 20 18:24:01 PDT 2011
revdoc
RT @FMDGirl: easy to balance legal use, RX from an MD- get from a hospital pharmacy [PEOPLE CAN LIE ABOUT SXS USING LEGAL SOURCES] #hpm
Wed Apr 20 18:24:10 PDT 2011
hollyby
Hi all! I don't rx it. Still a conflict btwn state & federal law. Not worth my DEA license. #hpm
Wed Apr 20 18:24:19 PDT 2011
RossJeanette
@equijada was the MJ discussion in Vancouver a specific session? I bought the Audio recording #hpm
Wed Apr 20 18:24:25 PDT 2011
PracticalWisdom
@PracticalWisdom: Is this still true? complicated? #HPM

Wed Apr 20 18:24:52 PDT 2011
equijada
RT @hollyby: Hi all! I dont rx it. Still a conflict btwn state & federal law. Not worth my DEA license. #hpm
Wed Apr 20 18:24:53 PDT 2011
FMDGirl
I do have a stand I do not use it- I would like to know it is available if I have a terrible stroke, should be MY choice not my states #HPM
Wed Apr 20 18:24:57 PDT 2011
hollyby
Lurking tonight, but wanted to say hello! Hugs to all! #hpm

Wed Apr 20 18:25:07 PDT 2011
mpf2011
@ctsinclair Have fun. #HPM

Wed Apr 20 18:25:08 PDT 2011
PracticalWisdom
Who wants another Hassle!RT @hollyby: Hi all! I dont rx it. Still a conflict btwn state & federal law. Not worth my DEA license. #HPM
Wed Apr 20 18:25:27 PDT 2011
ctsinclair
RT @drpippa: Only anecdotal evidence Has been helpful for folks. Hard to balance legit use vs illicit use. Would prob not feel comfortable rxing #Hpm
Wed Apr 20 18:25:28 PDT 2011
equijada
@RossJeanette yes, I forget the speakers name. Husband/wife team. Totally supported MJ but data equivocal #hpm
Wed Apr 20 18:25:31 PDT 2011
KathyKastner
RT @FMDGirl: I do have a stand I do not use it- I would like to know it is available if I have a terrible stroke, should be MY choice not my states #HPM
Wed Apr 20 18:25:43 PDT 2011
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mpf2011
RT @hospice_doctor: Aggressive treatment at the end of life, but where is the patient? New blog post: http://hospicedoctor.blogspot.com #palliative #hpm
Wed Apr 20 18:25:46 PDT 2011
revdoc
@ctsinclair Thought you were at concert? #hpm

Wed Apr 20 18:26:00 PDT 2011
FMDGirl
@revdoc @FMDGirl yes-people lie all the time to get narcs- but that should not prevent people who need pain relief from getting it #HPM
Wed Apr 20 18:26:46 PDT 2011
PracticalWisdom
PT Rights!RT @FMDGirl: I do have a stand I do not use it-I would like know it's ava.if I a stroke, should be MY choice not my states #HPM
Wed Apr 20 18:26:47 PDT 2011
PracticalWisdom
In the Lobby, Conversation too Good to be left out!RT @revdoc: @ctsinclair Thought you were at concert? #HPM
Wed Apr 20 18:27:23 PDT 2011
KathyKastner
RT @FMDGirl: @revdoc @FMDGirl yes-people lie all the time to get narcs- but that should not prevent people who need pain relief from getting it #HPM
Wed Apr 20 18:27:32 PDT 2011
equijada
t2 via @mpf2011 and @practicalwisdom - how do you communicate and advocate AD when what's said isn't what's done http://bit.ly/eU8wq5 #hpm
Wed Apr 20 18:27:42 PDT 2011
revdoc
@FMDGirl No argument; but having done chronic pain tx for years, it is not as simple as it seems #hpm
Wed Apr 20 18:27:59 PDT 2011
FMDGirl
@PracticalWisdom @FMDGirl EXACTLY Lisa- PT RIGHTS! Your better at this tweeting than me ;) #HPM
Wed Apr 20 18:28:00 PDT 2011
PracticalWisdom
Nope I'm older have more insurance.RT @FMDGirl:@PracticalWisdom@FMDGirl EXACTLY Lisa-PT RIGHTS! Your better at this tweeting than me ;) #HPM
Wed Apr 20 18:28:52 PDT 2011
equijada
@mpf2011 @practicalwisdom In this story, pt was "DNR" but her goals and wishes weren't exactly known #hpm
Wed Apr 20 18:28:53 PDT 2011
joshgriffin
RT @FMDGirl: @revdoc @FMDGirl yes-people lie all the time to get narcs- but that should not prevent people who need pain relief from getting it #HPM
Wed Apr 20 18:29:02 PDT 2011
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FMDGirl
@revdoc @FMDGirl yes, understand it is not easy, but either is living with pain- we must go the extra mile to ensure pt safety #HPM
Wed Apr 20 18:29:06 PDT 2011
revdoc
@FMDGirl Unfortunately, my experience with legislation to promote "safety" is that it makes my life a living hell! #hpm
Wed Apr 20 18:30:03 PDT 2011
equijada
RT @revdoc: @FMDGirl No argument; but having done chronic pain tx for years, it is not as simple as it seems #hpm
Wed Apr 20 18:30:19 PDT 2011
drpippa
T2- I try to get family talking about the person, not the disease. Get an idea of what they were like before. Helps inform #Hpm
Wed Apr 20 18:30:54 PDT 2011
PracticalWisdom
@equijada @mpf2011 @practicalwisdom: Frankly this ink unglued me. Why was her DNR not respected? Where was Clergy/Ethics. #HPM
Wed Apr 20 18:30:57 PDT 2011
SheyontheBay
T2. In 140 characters?really? #hpm

Wed Apr 20 18:31:12 PDT 2011
revdoc
T2 Encourage pt conversation with families, not relying on a piece of paper. Make sure your decision makers KNOW what you want #hpm
Wed Apr 20 18:31:18 PDT 2011
equijada
@SheyontheBay lol #hpm

Wed Apr 20 18:31:39 PDT 2011
FMDGirl
@revdoc @FMDGirl Agreed!!! That is why you have us nurses to do the paper work- he he :) #HPM
Wed Apr 20 18:31:51 PDT 2011
mpf2011
@equijada How was the pt DNR? She had a signed document?? Noted in Notes? #hpm
Wed Apr 20 18:31:59 PDT 2011
PracticalWisdom
T2: If a Pt does everything legally & your desire is not respected What (fill in the Blank) is going on. Seems like ego got in the way #HPM
Wed Apr 20 18:32:17 PDT 2011
SheyontheBay
@equijada ;D #hpm
Wed Apr 20 18:32:32 PDT 2011
revdoc
T2 Encourage pt conv w/ families, not relying on a piece of paper. Make sure your decision makers KNOW what you want B4 they need info #hpm
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Wed Apr 20 18:32:38 PDT 2011
equijada
@revdoc It seems when healthcare providers are told to #havethetalk it's interpreted as #signthepaper #hpm
Wed Apr 20 18:32:41 PDT 2011
drpippa
RT @revdoc: Encourage pt conversation with families, not relying on a piece of paper. Make sure decision makers KNOW what you want #Hpm
Wed Apr 20 18:32:46 PDT 2011
PracticalWisdom
THey Did RT @revdoc: T2 Encourage pt con. w/ families, not relying on a piece of paper. Make sure your decision makers KNOW what Uwant #HPM
Wed Apr 20 18:32:56 PDT 2011
FMDGirl
t2 question- did not get the link to workcan some one fill me in? #HPM
Wed Apr 20 18:33:07 PDT 2011
revdoc
@FMDGirl @revdoc Unfortunately, I am the housecall doc, so when I show up I AM the IDT! #hpm
Wed Apr 20 18:33:09 PDT 2011
equijada
@mpf2011 it was in her advance directive #hpm

Wed Apr 20 18:33:15 PDT 2011
PracticalWisdom
http://hospicedoctor.blogspot.com/RT @FMDGirl: t2 question- did not get the link to workcan some one fill me in? #HPM
Wed Apr 20 18:33:45 PDT 2011
KathyKastner
I'd LOL but it's true RT @equijada: @revdoc It seems when healthcare providers are told 2 #havethetalk interpreted as #signthepaper #hpm
Wed Apr 20 18:33:46 PDT 2011
SheyontheBay
Respectingchoices.org. Worksheet to #havethetalk #hpm

Wed Apr 20 18:33:48 PDT 2011
drpippa
So true. RT @equijada: @revdoc It seems when healthcare providers are told to #havethetalk its interpreted as #signthepaper #Hpm
Wed Apr 20 18:34:29 PDT 2011
mpf2011
RT @equijada: @mpf2011 it was in her advance directive #hpm | Was the pt conscious? Was family disputing it?
Wed Apr 20 18:34:42 PDT 2011
revdoc
T2 Not saying it doesn't happen, but I still think there are more problems not naming DPOA than having AD ignored #hpm
Wed Apr 20 18:34:53 PDT 2011
http://hashtags.symplur.com/healthcare-hashtag-transcript.php?h&smin=0&tdate=04-20-2011&thour=19&tmin=15&ssec=00&tsec=00&img=1
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RossJeanette
T2 bringing the person "in to the room" helps me understand better what makes life meaningful and make care recommendations #hpm
Wed Apr 20 18:34:59 PDT 2011
equijada
@FMDGirl sorry, try this http://bit.ly/eU8wq5 #hpm

Wed Apr 20 18:35:10 PDT 2011
PracticalWisdom
Is this a Legal Doc? Could there be Legal Challenges. RT @equijada: @mpf2011 it was in her advance directive #HPM
Wed Apr 20 18:35:19 PDT 2011
PracticalWisdom
RT @drpippa: So true.RT @equijada: @revdoc It seems when healthcare providers are told to #havethetalk its interpreted as #signthepaper #HPM
Wed Apr 20 18:35:37 PDT 2011
equijada
@FMDGirl in short - an elderly lady was "DNR" but no mentions of goals, wishes. Received aggressive care dialysis etc that didn't work #hpm
Wed Apr 20 18:35:55 PDT 2011
revdoc
As DPOA I did have to bully 4 providers into stopping aggressive care for my father despite my telling them his QOL was unacceptable #hpm
Wed Apr 20 18:36:26 PDT 2011
equijada
@revdoc there is good data that DPOA undergo significant stress and don't follow through thus AD. #hpm
Wed Apr 20 18:36:35 PDT 2011
equijada
@RossJeanette yes, agree. #hpm

Wed Apr 20 18:37:36 PDT 2011
PracticalWisdom
T2: Interesting Quote: How the health care system slants inexorably toward aggressive intervention regardless of the context. #HPM
Wed Apr 20 18:37:39 PDT 2011
mpf2011
@PracticalWisdom Here is the blog link: http://hospicedoctor.blogspot.com/ #HPM

Wed Apr 20 18:37:40 PDT 2011
equijada
@revdoc tough. You were able to advocate. Most people aren't as strong. #hpm
Wed Apr 20 18:38:13 PDT 2011
PracticalWisdom
RT @revdoc:As DPOA I did have 2 bully 4 providers stopping aggressive care 4 my father despite my telling them his QOL was unacceptable #HPM
Wed Apr 20 18:38:15 PDT 2011
revdoc
@PracticalWisdom Yes legal provisions for ADs in all states as well as for recognizing ADs legally enacted from others #hpm
Wed Apr 20 18:38:23 PDT 2011
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FMDGirl
@PracticalWisdom @FMDGirl Thanks Lisa! T2- We do take the Humanity out of charting why don't we include spiritual assessment in chart #HPM
Wed Apr 20 18:38:23 PDT 2011
RossJeanette
T2 sometimes teams pursue certain care b/cause they want to finish what was started eg "need 2 full weeks on vent for pneumonia Rx" #hpm
Wed Apr 20 18:38:35 PDT 2011
PracticalWisdom
@mpf2011: Thanks, I read it think FMDGirl Wanted it. #HPM

Wed Apr 20 18:38:54 PDT 2011
drpippa
Need to address doc side. Why do so many insist that aggressive, curative is only legit model of care? We can model alternatives #Hpm
Wed Apr 20 18:38:55 PDT 2011
revdoc
@equijada @revdoc It was sheer hell. #hpm

Wed Apr 20 18:39:12 PDT 2011
equijada
@FMDGirl @PracticalWisdom agree, well said. #hpm

Wed Apr 20 18:39:30 PDT 2011
revdoc
Stress on DPOA is often because we don't recognize the dying--we need to teach what dying looks like to learners! #hpm
Wed Apr 20 18:39:50 PDT 2011
PracticalWisdom
RT @drpippa: Need 3 address MD side. Why do so many insist aggressive, curative is only legit model of care? We can model alternatives #HPM
Wed Apr 20 18:40:01 PDT 2011
equijada
@drpippa modeling is our best model. #hpm

Wed Apr 20 18:40:01 PDT 2011
mpf2011
#hpm Unfortunately, even if pts sign an AD, the family hasn't talked to the pt. They don't want to let go despite a "piece of paper."
Wed Apr 20 18:40:01 PDT 2011
equijada
t3 coming up in a min or so. #hpm

Wed Apr 20 18:40:20 PDT 2011
drpippa
RT @revdoc: Stress on DPOA is often because we dont recognize the dying--we need to teach what dying looks like to learners! #Hpm
Wed Apr 20 18:40:23 PDT 2011
equijada
RT @revdoc: Stress on DPOA is often because we dont recognize the dying--we need to teach what dying looks like to learners! #hpm
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Wed Apr 20 18:41:04 PDT 2011
mpf2011
#hpm So much better if the talk is fully documented (and sometimes taped). Family members present too.
Wed Apr 20 18:41:07 PDT 2011
drpippa
Deep thoughts for a weds. RT @equijada: @drpippa modeling is our best model. #Hpm
Wed Apr 20 18:41:10 PDT 2011
PracticalWisdom
T2: I so Strongly Believe we so need you Pal MD's to gather more Power/Recognition/Understanding to help prevent this from happening. #HPM
Wed Apr 20 18:41:27 PDT 2011
revdoc
Not many families would advocate for aggressive care they can't even spell if docs did not tell them their loved ones needed it #hpm
Wed Apr 20 18:41:42 PDT 2011
equijada
@drpippa lol! Sincerely, Stuart Handy. #hpm

Wed Apr 20 18:41:44 PDT 2011
KathyKastner
Gr8 ideas RT @mpf2011: #hpm So much better if the talk is fully documented (and sometimes taped). Family members present too.
Wed Apr 20 18:41:58 PDT 2011
KathyKastner
RT @revdoc: Stress on DPOA is often because we don't recognize the dying--we need to teach what dying looks like to learners! #hpm
Wed Apr 20 18:42:19 PDT 2011
mpf2011
@PracticalWisdom When I was an ICU nurse, before becoming an atty, curative tx was the only option. #HPM
Wed Apr 20 18:42:30 PDT 2011
gailliardadults
RT @doclake: The New Old Age: A Mothers Nighttime Rage http://is.gd/ciHsMe delirium #hpm
Wed Apr 20 18:42:36 PDT 2011
equijada
@KathyKastner @mpf2011 I end up just placing "quotes" in my note and just type out the narrative. #hpm
Wed Apr 20 18:42:48 PDT 2011
PracticalWisdom
RT@KathyKastner:Gr8 ideas RT @mpf2011: #hpmSo much better if talk is fully documented (and sometimes taped). Family members present 2. #HPM
Wed Apr 20 18:42:58 PDT 2011
KathyKastner
RT @mpf2011: #hpm So much better if the talk is fully documented (and sometimes taped). Family members present too.#eldercarechat
Wed Apr 20 18:43:11 PDT 2011
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PracticalWisdom
RT @equijada: @KathyKastner @mpf2011 I end up just placing "quotes" in my note and just type out the narrative. #HPM
Wed Apr 20 18:43:29 PDT 2011
mpf2011
@PracticalWisdom I think docs see Palli as "giving up" which is shown by saying "there's nothing more we can do." Should add "to cure." #HPM
Wed Apr 20 18:43:46 PDT 2011
equijada
t3: How has caring for those in death and dying effected your personal life? I think about this a lot #hpm
Wed Apr 20 18:43:56 PDT 2011
PracticalWisdom
@PracticalWisdom @KathyKastner @mpf2011: Maybe include a section in a persons Facebook Page. #HPM
Wed Apr 20 18:44:09 PDT 2011
FMDGirl
health care providers need more education on process of dying, if they are scared of it- they will practice heroic measures #HPM
Wed Apr 20 18:44:42 PDT 2011
joshgriffin
RT @FMDGirl: health care providers need more education on process of dying, if they are scared of it- they will practice heroic measures #HPM
Wed Apr 20 18:45:11 PDT 2011
KathyKastner
RT @mpf2011: @PracticalWisdom I think docs see Palli as "giving up" which is shown by saying "there's nothing more we can do." Should add "to cure." #HPM
Wed Apr 20 18:45:13 PDT 2011
equijada
RT @FMDGirl: health care providers need more education on process of dying, if they are scared of it-they will practice heroic measures #hpm
Wed Apr 20 18:45:16 PDT 2011
drpippa
T3 - absoultely would not do what I do if it were not for my personal experiences. #Hpm
Wed Apr 20 18:45:27 PDT 2011
PracticalWisdom
@mpf2011 Yes, the Cure sometimes is Enough is Enough. #HPM

Wed Apr 20 18:45:28 PDT 2011
mpf2011
#hpm Our culture is trained by tv commercials to believe there is a cure (pill) for everything. We don't accept death well as part of life.
Wed Apr 20 18:45:35 PDT 2011
KathyKastner
RT @mpf2011: #hpm Our culture is trained by tv commercials to believe there is a cure (pill) for everything. We don't accept death well as part of life.
Wed Apr 20 18:45:52 PDT 2011
DITTO! It's changed my life RT @drpippa: T3 - absoultely would not do what I do if it were
http://hashtags.symplur.com/healthcare-hashtag-transcript.php?h&smin=0&tdate=04-20-2011&thour=19&tmin=15&ssec=00&tsec=00&img=1 Page 14 of 22
6/27/12 11:39 AM
equijada
not for my personal experiences. #hpm

Wed Apr 20 18:46:10 PDT 2011
mpf2011
#HPM There is still a lingering fear of litigation, I think. Despite documentation of pt wishes.
Wed Apr 20 18:46:20 PDT 2011
FMDGirl
t3 I am no longer afraid of death or dying #HPM

Wed Apr 20 18:46:37 PDT 2011
hospiceMTBC
t3: (Hi, folks!) Working in #hpm helps me enjoy the moment & go with the flow more in my life.
Wed Apr 20 18:47:33 PDT 2011
revdoc
I elected artificial feed 4 my father s/p ICH, leading to 8.5 yrs of disability, then death from ruptured appy. HPM kept me sane. #hpm
Wed Apr 20 18:47:35 PDT 2011
equijada
t3: I've seen love in action. It absolutely blows my mind. #hpm

Wed Apr 20 18:47:42 PDT 2011
KathyKastner
RT @Paulflevy: Palli Care on WIHI: Palli Care = Quali Care 21/4,2:- 3PM Eastern TimeGue... http://bit.ly/ggJqEB #hpm
Wed Apr 20 18:47:49 PDT 2011
revdoc
RT @FMDGirl: t3 I am no longer afraid of death or dying. THERE ARE A LOT WORSE THINGS THAN DEAD #hpm
Wed Apr 20 18:47:55 PDT 2011
FMDGirl
Have learned there can be dignity in death #HPM

Wed Apr 20 18:47:58 PDT 2011
mpf2011
#hpm Plus docs tend to focus on their "body system" so nephro says to family "kidneys are better today" and they hear "pt is better."
Wed Apr 20 18:48:05 PDT 2011
equijada
@hospiceMTBC hi, welcome. I love the moment. #hpm

Wed Apr 20 18:48:16 PDT 2011
KathyKastner
AMEN RT @revdoc: RT @FMDGirl: t3 I am no longer afraid of death or dying. THERE ARE A LOT WORSE THINGS THAN DEAD #hpm
Wed Apr 20 18:48:25 PDT 2011
PracticalWisdom
Seen this so many times. Courage Too!RT @FMDGirl: Have learned there can be dignity in death #HPM
Wed Apr 20 18:48:43 PDT 2011
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6/27/12 11:39 AM
PracticalWisdom
RT @equijada: t3: Ive seen love in action. It absolutely blows my mind. #HPM
Wed Apr 20 18:48:54 PDT 2011
FMDGirl
@revdoc @FMDGirl you can say that again- why as a society are we so afraid- is because people are afraid of hell? Religion play a part? #HPM
Wed Apr 20 18:49:18 PDT 2011
equijada
t3: I've learned about my Higher Power #hpm

Wed Apr 20 18:49:24 PDT 2011
PracticalWisdom
RT @equijada: DITTO! Its changed my life RT @drpippa: T3 absoultely would not do what I do if it were not 4 my personal experiences. #HPM
Wed Apr 20 18:49:25 PDT 2011
revdoc
I have seen healings, reconciliation, courage, love--I should PAY to do this work. (But don't tell my boss, I have a mortgage) #hpm
Wed Apr 20 18:50:21 PDT 2011
PracticalWisdom
Accept the things I cannot change Keeps me balanced. RT @equijada: t3: Ive learned about my Higher Power #HPM
Wed Apr 20 18:50:27 PDT 2011
drpippa
Sometimes miracles. RT @equijada: t3: Ive seen love in action. It absolutely blows my mind. #Hpm
Wed Apr 20 18:50:38 PDT 2011
equijada
@FMDGirl @revdoc just finished reading Love Wins by Rob Bell re: hell. Religion has done a disservice #hpm
Wed Apr 20 18:50:43 PDT 2011
mpf2011
#hpm It is the HPM team that has 2 teach how 2 see pt holistically, rather thn the sum of body systems. LOOK at the pt. not go thru motions.
Wed Apr 20 18:50:43 PDT 2011
revdoc
@FMDGirl Not always, but that can be one aspect. People not grounded in anything besides here and now #hpm
Wed Apr 20 18:50:59 PDT 2011
revdoc
RT @equijada: just finished reading Love Wins by Rob Bell re: hell. Religion has done a disservice [not all of us are like that!] #hpm
Wed Apr 20 18:51:36 PDT 2011
PracticalWisdom
T3: Was a clergy Wife for 13 years. Have seen families in their last moments at Re: worst and best. Learned not to sweat small Stuff #HPM
Wed Apr 20 18:51:39 PDT 2011
AmandaBinDC
RT @ctsinclair: Pain-Topics.org News/Research UPDATES: U.S. FDA Releases Long-
Page 16 of 22
6/27/12 11:39 AM
Awaited Opioid-REMS http://hpm.md/g2AncC #HPM

Wed Apr 20 18:51:49 PDT 2011
RossJeanette
T3 I feel very priviledged in working with people at a difficult time. It makes my problems seem minor. #hpm
Wed Apr 20 18:51:58 PDT 2011
KathyKastner
RT @equijada: @FMDGirl @revdoc just finished reading Love Wins by Rob Bell re: hell. Religion has done a disservice #hpm
Wed Apr 20 18:52:13 PDT 2011
PracticalWisdom
Book Club? RT @equijada: @FMDGirl @revdoc just finished reading Love Wins by Rob Bell re: hell. Religion has done a disservice #HPM
Wed Apr 20 18:52:31 PDT 2011
FMDGirl
@revdoc @FMDGirl great point- I brought that up because when I was a child I was so scared of death, sunday school...impressionable #HPM
Wed Apr 20 18:52:45 PDT 2011
PracticalWisdom
@equijada @FMDGirl @revdoc: What was the main Lesson? #HPM

Wed Apr 20 18:53:02 PDT 2011
SheyontheBay
@equijada wow.... #hpm

Wed Apr 20 18:53:05 PDT 2011
hospiceMTBC
T3: Denial=suffering, letting go=peace. #hpm

Wed Apr 20 18:53:17 PDT 2011
FMDGirl
@KathyKastner @equijada @FMDGirl @revdoc I will have to read it! #HPM

Wed Apr 20 18:53:23 PDT 2011
equijada
@FMDGirl @revdoc totally. #hpm

Wed Apr 20 18:53:41 PDT 2011
phlu
RT @doclake: Power poses vs. Warmth poses-good research that applies to the way a #hpm practitioner interacts @ the bedside http://is.gd ...
Wed Apr 20 18:53:48 PDT 2011
PracticalWisdom
T3: Learned we can be alive but Dead. #HPM

Wed Apr 20 18:54:00 PDT 2011
equijada
@FMDGirl check it out. History is not tragic, in the end, love wins. #hpm
Wed Apr 20 18:54:02 PDT 2011
FMDGirl
@hospiceMTBC you said it well #HPM

Page 17 of 22
6/27/12 11:39 AM
Wed Apr 20 18:54:07 PDT 2011
PracticalWisdom
RT @hospiceMTBC: T3: Denial=suffering, letting go=peace. #HPM

Wed Apr 20 18:54:21 PDT 2011
revdoc
RT @PracticalWisdom: What was the main Lesson? We have only the present: laugh, love, do your best, don't trade today waiting 4 2morro #hpm
Wed Apr 20 18:54:52 PDT 2011
PracticalWisdom
Idea to read book discuss on #HPM later time? RT @FMDGirl: @KathyKastner @equijada @FMDGirl @revdoc I will have to read it! #HPM
Wed Apr 20 18:55:00 PDT 2011
FMDGirl
RT @hospiceMTBC: T3: Denial=suffering, letting go=peace. #HPM

Wed Apr 20 18:55:02 PDT 2011
RossJeanette
got to leave now! goodbye nice tweetchat hosting Earl! #hpm

Wed Apr 20 18:55:10 PDT 2011
equijada
@equijada @FMDGirl it's this out of this world love I see at the bedside of death (on occasion). #hpm
Wed Apr 20 18:55:36 PDT 2011
FMDGirl
@PracticalWisdom @FMDGirl @KathyKastner @equijada @FMDGirl @revdoc Iam in! #HPM

Wed Apr 20 18:55:47 PDT 2011
PracticalWisdom
Thank you! RT @revdoc: RT @PracticalWisdom: We have only the present:laugh/love/do your best, dont trade 2day waiting 4 2morro #HPM
Wed Apr 20 18:55:54 PDT 2011
drpippa
Love this idea!RT @PracticalWisdom: Idea to read book discuss on #HPM later time? ! #Hpm
Wed Apr 20 18:55:57 PDT 2011
mpf2011
#HPM Sadly, ppl don't know how hard it is to take away treatment once started. If u can't breathe, pee or eat on your own, u r dying!!
Wed Apr 20 18:55:58 PDT 2011
equijada
Final thoughts and parting words of wisdom...Thanks all. #hpm

Wed Apr 20 18:56:02 PDT 2011
PracticalWisdom
Good Night Thanks RT @RossJeanette: got to leave now! goodbye nice tweetchat hosting Earl! #HPM
Wed Apr 20 18:56:07 PDT 2011
Page 18 of 22
6/27/12 11:39 AM
equijada
@RossJeanette good to see you again. Thanks for coming. #hpm

Wed Apr 20 18:56:18 PDT 2011
FMDGirl
forgiveness and acceptance and death comes peacefully #HPM

Wed Apr 20 18:56:43 PDT 2011
PracticalWisdom
@FMDGirl: Lam In? I don't get it? #HPM

Wed Apr 20 18:56:46 PDT 2011
KathyKastner
Too true! RT @mpf2011: #HPM Sadly, ppl don't know how hard it is to take away treatment once started. #eldercarechat
Wed Apr 20 18:56:57 PDT 2011
PracticalWisdom
RT @KathyKastner: Too true! RT @mpf2011: #HPM Sadly, ppl dont know how hard it is to take away treatment once started. #eldercarechat #HPM
Wed Apr 20 18:57:27 PDT 2011
PracticalWisdom
RT @FMDGirl: forgiveness and acceptance and death comes peacefully #HPM

Wed Apr 20 18:57:31 PDT 2011
FMDGirl
@PracticalWisdom @FMDGirl opps- I am in- read the book and chat- pick a date :) #HPM
Wed Apr 20 18:57:38 PDT 2011
revdoc
Thanks for hosting, Earl! #hpm

Wed Apr 20 18:57:42 PDT 2011
equijada
RT @FMDGirl: forgiveness and acceptance and death comes peacefully #hpm

Wed Apr 20 18:57:49 PDT 2011
PracticalWisdom
T3: I'm afraid to live in Pain don't think I'm afraid to die. #HPM
Wed Apr 20 18:57:53 PDT 2011
hospiceMTBC
Thank you, all, for the work you do & the passion you bring to the bedside. #hpm
Wed Apr 20 18:57:55 PDT 2011
equijada
@revdoc thanks for coming. #hpm

Wed Apr 20 18:58:28 PDT 2011
PracticalWisdom
@hospiceMTBC: Thank you!!!! #HPM

Wed Apr 20 18:58:46 PDT 2011
FMDGirl
RT @hospiceMTBC: Thank you, all, for the work you do & the passion you bring to the bedside. #HPM
Wed Apr 20 18:58:51 PDT 2011
Page 19 of 22
6/27/12 11:39 AM
drpippa
@equijada thanks for a night of thought and feeling! Great hosting. #Hpm
Wed Apr 20 18:58:55 PDT 2011
KathyKastner
Final thoughts: thanks Earl @equijada for gr8 hosting. Thanks to all #hpm-ers for the learning.
Wed Apr 20 18:59:13 PDT 2011
mpf2011
#HPM Thanks everyone. Great chat.

Wed Apr 20 18:59:15 PDT 2011
equijada
@drpippa thanks! hope to catch you next week. happy week to you. #hpm
Wed Apr 20 18:59:32 PDT 2011
FMDGirl
@PracticalWisdom that is why we need to legalize medical marijuana #HPM

Wed Apr 20 18:59:41 PDT 2011
equijada
Good night all. Thanks again! #hpm

Wed Apr 20 19:00:06 PDT 2011
kathydavisku
Catrina Lootens and Marilyn Sampilo sentn in great proposal to SDBP on student school reentry for kids with chronic conditions. #pedpc #hpm
Wed Apr 20 19:00:13 PDT 2011
KUKidsHP
Catrina Lootens and Marilyn Sampilo sent in great proposal to SDBP on student school reentry for kids with chronic conditions. #pedpc #hpm
Wed Apr 20 19:00:13 PDT 2011
PracticalWisdom
So complicated. I'm neutral on this 1 but not Pt RightsRT @FMDGirl: @PracticalWisdom that is why we need to legalize medical marijuana #HPM
Wed Apr 20 19:00:28 PDT 2011
revdoc
Goodnight, all! Blessings of Passover and Easter to my Jewish and Christian friends! #hpm
Wed Apr 20 19:00:37 PDT 2011
amyrnbsn
RT @FMDGirl: health care providers need more education on process of dying, if they are scared of it- they will practice heroic measures #HPM
Wed Apr 20 19:00:44 PDT 2011
FMDGirl
Wow! That was the fastest tweet hour ever- you picked all my favorite topics! Thank you everyone for your wisdom. #HPM
Wed Apr 20 19:00:49 PDT 2011
FMDGirl
@revdoc thank you for inspiring words, it was a pleasure to meet you. #HPM
Wed Apr 20 19:01:32 PDT 2011
Page 20 of 22
6/27/12 11:39 AM
revdoc
@FMDGirl @revdoc You too! #hpm

Wed Apr 20 19:02:07 PDT 2011
PracticalWisdom
@equijada: Thank you for Hosting tonight. You added your own Flavor/Wisdom. Having different Hosts I think adds a great deal! Thanks #HPM
Wed Apr 20 19:02:10 PDT 2011
PracticalWisdom
AGree 100RT @FMDGirl: Wow! That was the fastest tweet hour ever- you picked all my favorite topics! Thank you everyone for your wisdom. #HPM
Wed Apr 20 19:02:23 PDT 2011
PracticalWisdom
Agree! RT @FMDGirl: @revdoc thank you for inspiring words, it was a pleasure to meet you. #HPM
Wed Apr 20 19:02:33 PDT 2011
PracticalWisdom
@FMDGirl Tonight makes me realize how much I've missed you. O.K. enough mushy Gooshy from me. My Amazing Friend. #HPM
Wed Apr 20 19:03:17 PDT 2011
PracticalWisdom
Quaker Girl Say Keeping in the LIght! RT @revdoc: Goodnight, all! Blessings of Passover and Easter to my Jewish and Christian friends! #HPM
Wed Apr 20 19:04:21 PDT 2011
FMDGirl
@PracticalWisdom Miss you too! I was so excited when I saw your tweet about #HPM I so happy I follow you! Your awesome Lisa!
Wed Apr 20 19:04:40 PDT 2011
PracticalWisdom
RT @RossJeanette: T3 I feel very priviledged in working with people at a difficult time. It makes my problems seem minor. #HPM
Wed Apr 20 19:05:15 PDT 2011
revdoc
RT @RossJeanette: T3 I feel very priviledged in working with people at a difficult time. It makes my problems seem minor. #hpm
Wed Apr 20 19:05:56 PDT 2011
PracticalWisdom
RT @KathyKastner:RT @revdoc: Stress DPOA is often B/cause we dont recognize the dying we need 2teach what dying looks like to learners! #HPM
Wed Apr 20 19:06:44 PDT 2011
PracticalWisdom
RT @drpippa: T3 - absoultely would not do what I do if it were not for my personal experiences. #HPM
Wed Apr 20 19:07:00 PDT 2011
PracticalWisdom
Hope you R able 2 share w/ Med. Students RT@drpippa: T3 - absoultely would not do what I do if it were not 4 my personal experiences. #HPM
Wed Apr 20 19:08:30 PDT 2011
Page 21 of 22
6/27/12 11:39 AM
PracticalWisdom
@revdoc: Pam, Thankful I got the chance to learn & listen to you tonight. Great Contributions. Peace out. #HPM
Wed Apr 20 19:11:57 PDT 2011
Page 22 of 22

#HPM Tweet Chat 4:20:11

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#hpm - Healthcare Social Media Transcript

@PracticalWisdom Hi Lisa, good to see you here #hpm

hi @equijada only 6 minutes? #hpm

#hpm - Healthcare Social Media Transcript

@KathyKastner ha, i mean for the next 60 min! #hpm

Hi everyone- listening in. Kari- RN/pt advocate #HPM

@FMDGirl Hi Kari, welcome. #hpm

Hello all, glad to see you #hpm

Good to tweet with y'all #hpm

#hpm - Healthcare Social Media Transcript

@SheyontheBay hi, good to see you. long time! #hpm

@KathyKastner I'm always glad to see you. #HPM

420 (cannabis culture) - Wikipedia, the free encyclopedia http://bit.ly/f5aOqV #hpm

@hughstephens welcome! #hpm

#hpm - Healthcare Social Media Transcript

Wed Apr 20 18:10:23 PDT 2011

Can't speak to the effect of Marinol on sex... #hpm

@SheyontheBay was it helpful? #hpm

In Kansas, marijuana is not legal, so we are stuck with Marinol #hpm

Cannabis use in palliative care http://bit.ly/huBHGx A nice review #hpm

@FMDGirl I hear that a lot from patients taking it. #hpm

#hpm - Healthcare Social Media Transcript

Plus- it increases appetite, Dave- my friend wrote a book:http://amzn.to/hYJGVk #HPM

@equijada Nice choice of topic for the day! #Hpm

Sorry had internet problems Kerri great to see you. #HPM

#hpm - Healthcare Social Media Transcript

Wed Apr 20 18:20:13 PDT 2011

@drpippa ha! thanks. #hpm

Moving on to t2 in a min or so #hpm

#hpm - Healthcare Social Media Transcript

@PracticalWisdom: Is this still true? complicated? #HPM

Lurking tonight, but wanted to say hello! Hugs to all! #hpm

@ctsinclair Have fun. #HPM

#hpm - Healthcare Social Media Transcript

@ctsinclair Thought you were at concert? #hpm

#hpm - Healthcare Social Media Transcript

T2. In 140 characters?really? #hpm

@SheyontheBay lol #hpm

#hpm - Healthcare Social Media Transcript

Wed Apr 20 18:32:38 PDT 2011

@mpf2011 it was in her advance directive #hpm

Respectingchoices.org. Worksheet to #havethetalk #hpm

#hpm - Healthcare Social Media Transcript

@FMDGirl sorry, try this http://bit.ly/eU8wq5 #hpm

@RossJeanette yes, agree. #hpm

@PracticalWisdom Here is the blog link: http://hospicedoctor.blogspot.com/ #HPM

#hpm - Healthcare Social Media Transcript

@mpf2011: Thanks, I read it think FMDGirl Wanted it. #HPM

@equijada @revdoc It was sheer hell. #hpm

@FMDGirl @PracticalWisdom agree, well said. #hpm

@drpippa modeling is our best model. #hpm

t3 coming up in a min or so. #hpm

#hpm - Healthcare Social Media Transcript

Wed Apr 20 18:41:04 PDT 2011

@drpippa lol! Sincerely, Stuart Handy. #hpm

#hpm - Healthcare Social Media Transcript

@mpf2011 Yes, the Cure sometimes is Enough is Enough. #HPM

#hpm - Healthcare Social Media Transcript

not for my personal experiences. #hpm

t3 I am no longer afraid of death or dying #HPM

t3: I've seen love in action. It absolutely blows my mind. #hpm

Have learned there can be dignity in death #HPM

@hospiceMTBC hi, welcome. I love the moment. #hpm