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Reposted by Rupinder (Rup) Sahsi, MD 🧠💭

brett @birwin20.bsky.social · 1d

Watching the Portlanders protesting.

I was worried. He wants violence. I know you folks will fight but that is playing his game. You can't out-violence them.

So you are having a dance party. So freakin smart. I love you all. Ya'll got this.

Stay safe enough.

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Reposted by Rupinder (Rup) Sahsi, MD 🧠💭

Brent Toderian @brenttoderian.bsky.social · 1d

Just watched a smart, persuasive interview with @michaelemann.bsky.social & @peterhotezmdphd.bsky.social on US media.

They were asked if “naming names” about liars & their motivations risks coming across as “partisan.”

I think about that a lot as I do similar things in the city-building arena. 1/2

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Rupinder (Rup) Sahsi, MD 🧠💭 @hotsahs.sahsi.net · 1d

Bottom line, if a less sustainable Inhaler is what works for the patient, it's what works for the patient.

If there's room to consider a more sustainable option, do so. Y'know, patient-provider shared decision making and all those buzzwords n' stuff.

Even the little changes matter.

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Rupinder (Rup) Sahsi, MD 🧠💭 @hotsahs.sahsi.net · 1d

I saw some commenters refer to that CNN article as "ableist bullshit" which I don't think is entirely fair.

Nobody's asking to eliminate inhaled bronchodilator and corticosteroid therapies so we can hit emissions targets.

There is value in examining the underuse of more sustainable options.

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Rupinder (Rup) Sahsi, MD 🧠💭 @hotsahs.sahsi.net · 1d

For those calling this ableist bullshit, nobody's advocating for the elimination of lifesaving inhaled medications just so we can keep more cars and planes zipping around.

Read past the headline. It's worth discussing the impact and potential alternatives WHEN REASONABLE.

bsky.app/profile/hots...

Rupinder (Rup) Sahsi, MD 🧠💭 @hotsahs.sahsi.net · 1d

"Using shared decision-making, prescribers can counsel patients on the benefits and disadvantages of various inhalers, including their impact on climate change and consider switches to lower-carbon alternatives when appropriate."

Some text and images from www.inhalerguide.ca

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Rupinder (Rup) Sahsi, MD 🧠💭 @hotsahs.sahsi.net · 1d

CASCADES Canada has fantastic patient and prescriber educational materials on their site.

cascadescanada.ca/action-areas...

The main site has lots of other good ideas that support the healthcare community in transitioning towards high-quality, low-carbon, climate resilient care.

🧵 I'm

Sustainable Inhaler Alternatives chart from CASCADES Canada, graded by environmental impact.

Note the up-front caveat that switching inhalers should never be forced, especially in situations where doing so could affect level of symptom control and frequency of exacerbations.

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Rupinder (Rup) Sahsi, MD 🧠💭 @hotsahs.sahsi.net · 1d

"There is new evidence in children 12 years of age and adults that PRN budesonide/formoterol decreases exacerbations in comparison to PRN SABA, with different levels of evidence in those with very mild versus mild asthma."

🧵

Controller Therapy

ICS/LABA
Advair MDI
fluticasone/salmeterol
125/25; 250/25 mcg

Zenhale MDI
mometasone/formoterol
100/5; 250/5 mcg

Consider substituting:

≥ 6 years old:
Advair Diskus
fluticasone/salmeterol
100/50;250/50; 500/50 mcg

≥ 12 years old:
Symbicort Turbuhaler
budesonide/formoterol
100/6; 200/6 mcg

≥ 18 years old:
Breo Ellipta
fluticasone furoate/vilanterol
100/25; 200/25 mcg

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Rupinder (Rup) Sahsi, MD 🧠💭 @hotsahs.sahsi.net · 1d

"Metered-dose inhalers (MDIs) are a significant contributor to health care’s climate emissions. They contain high levels of hydrofluorocarbons that, when released into the atmosphere, act as potent greenhouse gases."

🧵

Controller Therapy

ICS
Qvar MDI
beclomethasone
50; 100 mcg

Flovent MDI
fluticasone propionate
50; 125; 250 mcg

Alvesco MDI
ciclesonide 100; 200 mcg

Consider substituting:

≥ 6 years old:
Flovent Diskus
fluticasone propionate
100; 250; 500 mcg

≥ 6 years old:
Pulmicort Turbuhaler
budesonide
100; 200; 400 mcg

≥ 12 years old:
Arnuity Ellipta
fluticasone furoate 100; 200 mcg

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Rupinder (Rup) Sahsi, MD 🧠💭 @hotsahs.sahsi.net · 1d

"Dry powder and soft mist inhalers (DPI and SMIs) do not contain propellants and have a substantially smaller carbon impact."

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Reliever Therapy

SABA
Ventolin or Teva-Salbutamol MDI
salbutamol 100 mcg

Consider substituting:

≥ 6 years old:
Bricanyl Turbuhaler terbutaline 0.5 mg

≥ 6 years old:
Ventolin Diskus salbutamol 200mcg

≥ 12 years old with Asthma:
Symbicort Turbuhaler
budesonide/formoterol
100/6; 200/6 mcg doses

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Rupinder (Rup) Sahsi, MD 🧠💭 @hotsahs.sahsi.net · 1d

"Using shared decision-making, prescribers can counsel patients on the benefits and disadvantages of various inhalers, including their impact on climate change and consider switches to lower-carbon alternatives when appropriate."

Some text and images from www.inhalerguide.ca

🧵

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Reposted by Rupinder (Rup) Sahsi, MD 🧠💭

The Left Independent ✊🏻✊🏼✊🏽✊🏾✊🏿 @left-indy.bsky.social · 9d

Millions Are Left In The Dark With No Covid Wastewater Coverage

#COVID19 #SARSCoV2 #Pandemic #CovidIsNotOver #CovidIsAirborne #H5N1 #Measles #WhoopingCough #RSV #Norovirus #Tuberculosis #Polio #Mpox #MaskUp #N95 #KeepMasksInHealthcare

www.youtube.com/watch?v=hMsv...

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Reposted by Rupinder (Rup) Sahsi, MD 🧠💭

Catherine McKenna @cathmckenna.bsky.social · 9d

I don't like talking about the hate & abuse I received in politics. I don't need sympathy. But we do need change. And I promised to support women & girls who want to go into politics. So here is my story. We need to stop this. Now.

🔗 thewalrus.ca/they-called-...

They Called Her “Climate Barbie.” She Fired Back | The Walrus

Catherine McKenna on misogyny, rage farming, and the toll of online violence in Canadian politics

thewalrus.ca

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Reposted by Rupinder (Rup) Sahsi, MD 🧠💭

Rogerman @rogerman99.bsky.social · 12d

Tara Moriarty's work, if I understand it correctly, documents an ongoing excess mortality in Canada of about 13%, something like 40,000 extra fatalities/year. She also documents ongoing major impacts on hospitals and public health. It's remains a catastrophe.

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Reposted by Rupinder (Rup) Sahsi, MD 🧠💭

Cat in the Hat @catinthehat.bsky.social · Jun 29

[27 Jun 2025] @DrTedros at WHO media briefing:

“We cannot talk about COVID-19 in the past tense. Although the crisis has passed, the virus remains.

It continues to evolve, it continues to kill, and millions of people continue to live with post COVID-19 condition or long COVID.”

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Rupinder (Rup) Sahsi, MD 🧠💭 @hotsahs.sahsi.net · 14d

"Those who accept must report for duty... after what amounts to a seven-month paid vacation, during which time the GSA in some cases racked up high costs... to stay in dozens of properties whose leases it had slated for termination or were allowed to expire."

www.fastcompany.com/91409893/hun...

Hundreds of federal employees laid off by DOGE are being asked to return by the Trump administration

The General Services Administration has given employees until the end of the week to decide on reinstatement.

www.fastcompany.com

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Rupinder (Rup) Sahsi, MD 🧠💭 @hotsahs.sahsi.net · 14d

Apparently we're going on vibes now. Numbers are hard.

(**headdesk**)

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Reposted by Rupinder (Rup) Sahsi, MD 🧠💭

Dr. Lucky Tran @luckytran.com · 15d

“We are told by leaders that we are the future. But when it comes to the ongoing pandemic, our present is being stolen right in front of our eyes.”

Incredible speech by Violet Affleck who warned about the ongoing dangers of COVID & Long Covid, & advocated for masks and clean air at the UN today!

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Reposted by Rupinder (Rup) Sahsi, MD 🧠💭

Rupinder (Rup) Sahsi, MD 🧠💭 @hotsahs.sahsi.net · Jan 23

"We tend to think of misinformation as a universal problem, with all sides of the political spectrum equally guilty of bending the truth or spreading falsehoods. A new study shows otherwise."

Misinformation isn’t just a problem — it’s a political strategy.

New study shows radical-right populists are fueling a misinformation epidemic

Misinformation isn’t just a problem — it’s a political strategy.

www.zmescience.com

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Reposted by Rupinder (Rup) Sahsi, MD 🧠💭

Oh The Urbanity! @ohtheurbanity.bsky.social · 17d

The most underappreciated issue in urbanism is the Anglosphere’s transit construction cost problem.

It’s not just that we’re spending too much money on any particular project.

It’s that we could be getting *much more transit* for the *same amount of money we’re currently spending*.

How This Small City Built Light Rail For Cheap

YouTube video by Oh The Urbanity!

youtu.be

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Reposted by Rupinder (Rup) Sahsi, MD 🧠💭

Jennifer Ouellette @jenlucpiquant.bsky.social · 17d

"history is also going to remember the cowards who definitely knew better but still let things happen—whether it was for money, convenience, or just comfort. Use ... the only phrase that can genuinely make a weak bully go away: F**k you. Make me.”" www.pajiba.com/news/john-ol...

John Oliver Offers Four Defiant Words of Advice to Disney Over the Kimmel Situation

It works. Try it out, Bob Iger.

www.pajiba.com

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Rupinder (Rup) Sahsi, MD 🧠💭 @hotsahs.sahsi.net · 16d

As am I. You're doing it right. 🫡

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Reposted by Rupinder (Rup) Sahsi, MD 🧠💭

Gregg Gonsalves @gregggonsalves.bsky.social · 17d

The @washingtonpost.com story on Tylenol & autism leaves out a MAJOR 2.5M sibling-controlled study of children in Denmark, which "found no evidence that acetaminophen use during pregnancy was associated with children’s risk of autism, ADHD or intellectual disability." jamanetwork.com/journals/jam...

Acetaminophen Use During Pregnancy and Children’s Risk of Autism, ADHD, and Intellectual Disability

This nationwide cohort study with sibling control analysis examines the association of acetaminophen use during pregnancy with children’s risk of autism, ADHD, and intellectual disability.

jamanetwork.com

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Rupinder (Rup) Sahsi, MD 🧠💭 @hotsahs.sahsi.net · 17d

Here's Ontario's plot. Anticipate schools to drive respiratory transmission rates higher.

There's still a fair amount of entero/rhinovirus (12.1% positivity) and a hint of parainfluenza (1.2%) so it isn't "all COVID" out there, but 9.0% for SARS-CoV-2 makes it worth considering if symptomatic.

Plot of SARS-CoV-2 percent positivity in Ontario compared to the number of tests performed per week.

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Rupinder (Rup) Sahsi, MD 🧠💭 @hotsahs.sahsi.net · 17d

I've lost track of the number of people I've heard discount the possibility of COVID-19 exposure/transmissions because their symptoms are mild.

We're back to "not bad enough to keep me home from work/school" territory, with a side order of "COVID isn't a thing any more." 🤦🏽‍♂️

We've learned nothing.

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Rupinder (Rup) Sahsi, MD 🧠💭 @hotsahs.sahsi.net · 17d

Hrm.

Plot of the rate of ascent of SARS-CoV-2 detections over the last three weeks (Canada).

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