Doctor here- love CostPlus drugs for patients and myself! Here's another thought- help Rivian be the rival to Tesla they ought to be. OR buy Tesla- should go for cheap right now and revitalize its brand and make it respectable again. :) Sort of joking-not about Rivian though-they are great.
This is exactly the "loophole" though their language about "medical necessity" clouds that and would make me more aggressive at taking legal action if the opportunity arose. Deciding medical necessity IS a determination that should require specific expertise and knowledge of THAT patient. Hmmm
@spaqisociety.bsky.social underway with a full house. Best conference, high yield info from true pioneers & experts in this field.
This is Marco Rubio explaining how the USA promised to defend Ukraine forever if they got rid of their nuclear arsenal left after the Soviet Union fell.
This is why lil marco was sinking into the couch. He was hoping we wouldn’t find it…so don’t RT right now this very second.
Done
Call log showing multiple calls from the dept of justice
Sergeant Gonell @sergeantaqgo.bsky.social sent me this picture. This is his call log. Each call is an automated Dept of "Justice" notification saying "The defendant you testified against is being released from the dept of corrections."
Each defendant assaulted him.
I can hear and feel it to my core.
got the new edition audiobook. At least there is some comfort in knowing I'm not alone in my disbelief of the level of disdain people have for experts or intelligence.
Starting the book again because... here we go again. I hoped that ignorance on display to such a severe degree would swing the pendulum back to intellectual curiosity and desire for actual knowledge, but it's only gotten worse-. People WANT to be ignorant and want ignorant to lead them.
#DonTCare is still in concept phase.
There used to be honor and decorum. They changed the rules and there is no longer an expectation of fairness and justice prevailing. Protect those who tried to protect us.
He needs to pre-emptively pardon the media, Dr. Fauci, the generals who criticized him, everyone they can think of for any imagined 'crimes', etc- generic blanket pardon for anyone who may be targeted by the new police state with an agenda of revenge for criticizing dear leader.
#periop #periopsky
If anemic (but not prohibitive for surgery) or s/s of GI bleed, we sometimes see rec for scope post op since anticoagulation may not be considered. And definitely can see readmissions for GI bleeding once on high dose aspirin. If signs are there preop, potentially preventable.
Preop / Periop Thought:
If Preop'ing pts, don't forget that they may be anti coagulated after surgery (example: with joint replacement, up to 325 asa BID for 2-4 weeks or DOAC, etc).
If you have reason to think they may have GI bleeding, even if not severe or anemic, consider scope BEFORE surgery.
This Thanksgiving I am grateful that vaccines have eliminated or greatly reduced the harm caused by many terrible diseases.
Animation showing the prevalence of vaccine preventable diseases in the USA over time.
Vaccines save lives.
Same! One question- quite polite & sincere- poof, blocked me, lol.
hello. 🐌
Copying from the other place, other account to save for posterity.
Jan 25, 2017
@realDonaldTrump
Have you picked a name for replacement for Obamacare? Might I suggest #DonTCare? Seems apt.
We need more #periop peeps over here. #periopsky
Most of our usual consultants are amazing and collaborative. Sometimes, maybe b/c we are rural, some city academics seem to think we know nothing and are pretty condescending when we ask for info ="I said the patient was cleared, why do you need to get the echo report, just avoid hypotension". SIGH
Right now, today. #periop
Being in a rural setting in the U.S., there are limitations of resources, but trying to turn some of the limitations into advantages is a challenge I love. We are small, so we lack specialty care (disadvantage) BUT we are small so it's easier to work and communicate with other docs (advantage).
Small steps then. If you identify an issue, even if you can't fix it, quick note to the outpatient care team can help the patient and docs going forward. Primary care (hero work) is SO hard with so many issues and limited time, at least here in the U.S., that they may appreciate the information.
Disclaimer: I work in a small, rural hospital with amazing medicine colleagues. We have an easy time collaborating so our services overlap in the best ways. What *I* do may not fall strictly within guidelines because of how we are structured. So I offer my thoughts as an example, not rules.
Patients who have surgery often come back for more surgery. Maybe I see this more being in a small hospital where names will be familiar when I see them again. Next year when they get their other knee done, maybe they WILL have their CPAP and be treated and that's a pretty awesome impact to have.
Important: Perioperative medicine isn't just 'preop' anymore and I love that. We can make a lot of difference even by helping patients plan for their health after surgery is long over. So, starting the process of addressing OSA is important even if you can't fully optimized before this surgery.
So we discuss precautions for discharge with them and caregivers, lifestyle modifications (avoid etoh for example), treat concurrent issues like htn, observe longer in PACU, keep overnight if needed and so on.
We let patients know the choice is always there to delay surgery if they wish. BUT, most surgeries even if called elective aren't really purely elective but are somewhat time-sensitive for quality of life, to avoid further debility or health issues, increased reliance on opioid pain meds, etc.
W/o sleep study, overnight pulse ox may be possible. Echo can be indicated depending on the situation/severity. Venous blood gas can be drawn with other preop labs and can help, even for baseline, esp if obesity hypoventilation is suspected.
IF we can get the sleep study, it's still unlikely to get a device/CPAP to the patient AND get it titrated AND have them use it long enough to make a difference (other than immediate risk of OSA post op which is important) in longer term cardiopulmonary risk. We do what we can & talk to the patient.
