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Fat Bastard

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Posts posted by Fat Bastard

  1. Picked up my first Ruger today. MKIV 22/45 Tactical. Had already purchased a Holosun 507C-GR-X2 with the ACSS reticle. Maybe a better question for Handcrusr but anyone know where to get a comparable Picc mount for the optic? And which one? TIA

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    Forgot pic

  2. Heading up next week for 5 days with wife and kids (12, 10, 5). Want to do a nice sushi place but the two younger ones won’t eat sushi unless there’s a good robata program for the beef (youngest also likes karaage). Any recs? Staying at the Times Square Edition if that helps. 

  3. Just picked up my newest toy. Put a Surefire x300 Turbo and Holosun EPS on it. Went back and forth on the optic with the EPS vs Trijicon RCR vs Aimpoint Acro. Wanted an enclosed emitter for sure. If it sucks I’ll throw it on my p226 and get the RCR


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  4. PFO closure is indicated in patients who have cryptogenic stroke with no other, more commonly identifiable etiology, such as atrial fibrillation, carotid artery stenosis, etc. 

     

    For patients younger than 65 who have had a 30 day event monitor to rule out atrial fibrillation and a carotid ultrasound to rule out carotid artery stenosis, we perform a transesophageal echo (TEE) to assess the morphology of the PFO (she’s probably already had a transthoracic echo (TTE) with bubbles to prove she has a PFO. 
     

    if she’s deemed a good candidate, we perform the closure. It takes 30 minutes, is extremely low risk, and she goes home the same day. If the cardiologist is doing it without ICE (intracardiac echo), they’re a hack. 
     

    There are 2 commonly available devices used, one from Abbott, the other from Gore. Both good with similar results and ease of implantation. 
     

    Good luck!

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  5. Firs time to Vegas in 2 years. Went a spent a day at the Bronco Off-Roadeo which was awesome. Got a suite at the Fontainebleau - hotel is meh and I won’t go back. 
     

    food was meh.
     

    Maybe it’s because I’m in my mid-40’s and have been going to Vegas almost twice a year since I was 13 (slowed down to mostly annually once I had kids, but I never remember the place overall being so fucking trashy. Yeah, yeah, I know walking along the strip you see all the unwashed, but even in the nicer hotels I gambled/ate in, just nasty looking people who’d I just as soon like to take a flamethrower to as if they were homeless people living in a tent city. 

  6. 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!

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  7. 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

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  8. 20 minutes ago, Bevo said:

     

    Is there anything out there that is proven to reverse blockages (foods, medicines, treatments) or is the course of action mainly to keep blockages from worsening and limiting bloodflow?

    Nothing yet. All about halting progression. 
     

    In some animal models, PCSK9–Inhibitors like Repatha and Praluent have shown evidence of plaque regression

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  9. 22 minutes ago, Bevo said:

     

    Yeah, my grandfather on my mom's side died getting an angiogram when they use to go in through the neck 50 years ago so it isn't like I'm asking for it. But, I'm also a bit of a hypochondriac about heart issues because my dad has had lots of issues and was in good health until he wasn't.  I wish there was something diagnostic but less invasive.

    Or just ask surly

    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)

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  10. 3 hours ago, Bevo said:

    So no angiogram? I thought calcium scores weren’t diagnostic.

    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. 

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  11. 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 

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  12. 2 hours ago, Tonesky said:

    Dr. Kenneth Cooper pretty much invented the field of aerobics. 

    Really? Figured it was Richard Simmons

    2 hours ago, Bevo said:

     

    I forgot what you told me (a long time ago), but for someone in good health with good habits and good BMI but with a family history of MI, what tests would you recommend as they enter their 50s, 60s, etc?

    Lipid Panel and a coronary artery calcium score. 

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  13. 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)

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  14. 2 hours ago, royiv said:

    Are you under the impression that the fee goes to the guys doing the work? You stuffing some kid is a dick move. That five bucks you’re saving doesn’t move the needle for you.

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

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  15. 1 hour ago, royiv said:

    You’re a dick. Don’t stiff people providing you a service. You’re not making some sort of statement fucking over the little guy.

    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. 

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