Fat Bastard

Nothing yet. All about halting progression. In some animal models, PCSK9–Inhibitors like Repatha and Praluent have shown evidence of plaque regression

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)

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.

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

Really? Figured it was Richard Simmons Lipid Panel and a coronary artery calcium score.

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)

Honest opinion? It’s a cash grab

Don’t care. Take it up with management. They’re the ones fucking u out of your tip

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.

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.

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

Don’t forget losing to shit ass OU

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

All coachable things. His hard nosed running between the tackles and always seemingly going forward, are not. He’s got talent and id like to see him pick up at least 10 runs or 2 dedicated series or more/game if he’s improved on the other issues in the offseason.

I’m not getting the Gibson shit. I thought that dude ran his ass off the limited reps he got and his 1st down conversion rate must’ve been 90+% when brought in for short yardage. I see a lot of promise in him. I haven’t paid any attention to his pass blocking and certainly that could explain why he hasn’t seen more PT but his fumblitis is nothing compared to Blue’s IMO, he’s our most pure RB on the roster. I was never blown away with Baxter’s performance when healthy.

I was at that game too. I still contend that that pussy ass motherfucker Mack Brown threw that game to garner a feel good story for those worthless fucks.

http:// SIAP

Sent to me just now by my aggy PA. I can’t think of anything more aggy than misspelling Aggies to Auggies. 🤣🤣🤣

lol. I work out of THI. If you want to take this to PM’s I can give you some recs and you can give me her contact info to pass along.

I should add that venous thrombectomy is a booming field and there tons of new devices on the market (Inari, Penumbra, AlphaVac, Jeti, etc). I’ve never used any of those for an IJ clot (only for DVT/PE) and know, without a shadow of a doubt, it has never been done for IJ thrombosis at my institution.

We more commonly see thrombosis (clots) in veins than stenosis (tightening). Usually when the internal jugular (IJ) goes down it’s from previous instrumentation from a cath or central venous line. It’s usually chronic and nothing needs to be done. If it’s known acute and, say, occurred during a recent hospitalization, we give Eliquis/Xarelto/or Coumadin based on what the patient can afford. I’d suggest making sure it’s the IJ that’s affected and not carotid artery (or subclavian artery) stenosis - which is treated much differently. And, if the patient is adamant about seeing a cardiologist, it would help to know what city they’re located in. I can give tons of recs in Houston, some in Dallas/Austin/El Paso. Don’t know many in San Antonio or other cities. Hope that helps.

Have had 3 minivans with the rear entertainment package as the nanny car for the kiddos over the last 10 years. They’re not into watching the same 100 dvd’s over and over again, and with an age span ranging from 5-12 the content was never agreed upon by all, so I said fuck it and got a Bronco Raptor Everyone loves it

Drumstick. Easy. Worst part of the bird. Way too much connective tissue

I think the days of having honorable grandpa types like Reagan are over. Since then, we’ve had multiple presidents who’ve done coke, gotten blowjobs in the Oval Office, have been unfaithful to their wives, etc and whatever Trump has done. As VY said before we went on our NC run, “we’ve got some gangstas too”

U wouldn’t help out someone stranded on the road if they have a maroon truck with saw em off shit on there?