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Fat Bastard

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  1. This can be tackled by any competent CT surgeon in any of the major medical centers. I sure as hell wouldn’t recommend getting it done in Amarillo, though. Houston, Dallas, Austin, SA you’ll be fine. I can give you a dozen recs in Houston if you’re interested. PM me if u want them. Good luck!
  2. Did someone earlier really complain about her legs?? She has the definition of perfect legs. If I could draw up my perfect female physique it would have those legs. sounds like somebody is too used to fucking fat ass zepol cholas
  3. Nothing yet. All about halting progression. In some animal models, PCSK9–Inhibitors like Repatha and Praluent have shown evidence of plaque regression
  4. I have tons of patients that have come to me from other cardiologists who milk the system getting yearly nuclear tests, asking for a nuclear for themselves. All of them asymptomatic. there’s a misconception that stents prevent heart attacks. Completely untrue. There are only two good indications for coronary stents: 1) during an acute heart attack - to save the patient’s life and prevent further myocardial necrosis 2) to limit symptoms of angina when medications haven’t helped when we Cath patients, we frequently encounter blockages that are 20-60% that we do absolutely nothing about besides aspirin, statin and BP meds. We are only supposed to stent blockages that are >70% stenosed because it’s at that point that there’s flow limitation downstream. getting a nuclear on an asymptomatic pt is bad medicine, and if positive, puts us in a bad predicament because at that point we’re left having to perform an unnecessary angiogram on a pt and possibly stenting them, commuting them to 2 blood thinners, and the risk of the invasive procedure which becomes even riskier when you’re “fixing” the artery, all for an asymptomatic pt. You did all that shit for a patient who never had any symptoms to begin with (all while not decreasing their MI risk)
  5. Calcium scores are not diagnostic. You just said you’re in good health, with no major risk factors. A coronary artery calcium score will risk stratify you and let us know if we need to be aggressive with risk factor modification like aspirin and statins.
  6. Angiograms should only be for those with classic symptoms of angina (nit controlled with anti-anginals), positive stress tests (in the setting of angina), pre-op for valve surgery to make sure you don’t need concomitant bypass surgery and myocardial infarctions. I put stents in for a living and there’s nothing more I like doing than opening up a blocked coronary artery. But, when I bring a patient to the Cath lab for an angiogram, my hit rate is >75%. When I’m doing a Cath for one of my partners and they don’t have the appropriate indications, it falls to <30% and pisses me off. Heart caths are invasive procedures and carry risk to the patient (including emergency bypass surgery and death). We need to have a good indication to justify the benefits being > risks. That doesn’t always happen “in the community” unfortunately if you’re asymptomatic, you don’t need an angiogram (or a nuclear stress test). There are obviously extenuating circumstances, eg, if you’re going for an intermediate/high risk surgery and have multiple risk factors, a nuclear is not unreasonable for pre-op risk stratification
  7. Really? Figured it was Richard Simmons Lipid Panel and a coronary artery calcium score.
  8. Any of you old enough to be seeing a cardiologist regularly and they order yearly nuclear stress tests, echos, and other dopplers (carotid/lower extremity, etc) are seeing criminals who just generate revenue and milk the system. None of that is based off sound medicine or guideline directed. there are exceptions (if you’ve had previous valve surgery, a yearly echo is fine for surveillance, or if you’ve had abdominal aneurysm repair, AAA ultrasounds or CTA’s to evaluate for endoleaks/AAA growth, is acceptable)
  9. Don’t care. Take it up with management. They’re the ones fucking u out of your tip
  10. A “complimentary” valet or one that does not have an upfront fee, gets standard $10 from me or if they park my car up front, $20. U upfront charge me? Nothing. That’s not going to change. The hotel $50/day definitely gets nothing.
  11. If the hotel charges me $50 for hotel valet/day there’s no other tipping involved similarly, if at a restaurant, valet has a cost associated with it, I take that to be their tip. No extra cash is transacted.
  12. Never heard of them. But through skimming their webpage seems like they preach healthy living and preventive medicine, which is what any good cardiologist would. Unfortunately, the bulk of my patients come to me after a lifetime of poor dietary indiscretion with diabetes, hypertension and hyperlipidemia +/- tobacco history on board, and we are left with slowing progression (and, if necessary, invasive treatment) of their atherosclerosis
  13. Small sample size obviously because of his injury history, but from what I saw, his play didn’t correlate with his recruiting ranking. Again, just my opinion, but I didn’t see someone who was clearly once/10 yr back like Bijan
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