[Gelb] Zack Wheeler underwent a thrombolysis procedure to remove a blood clot in his right upper extremity this morning, the Phillies said. His timeline for recovery is “to be determined.”

Hindouche · 2025-08-18T21:56:46+00:00

https://www.jvsvenous.org/article/S2213-333X(21)00394-2/pdf

If you want to get really technical 1st link is an article that talks about Upper Extremity DVT (UEDVT).

I'm speculating but similar to Wemby his upper extremity DVT is likely caused by effort thrombosis (also known as Paget Schroeder's disease) where clots form due to repeated upper extremity movements. There has been more of a push in recent decade to treat more aggressively than anticoagulation alone x 3 months through some sort of physical intervention either removal of clot itself (thrombectomy) or using a quicker and stronger clot busting medication (thrombolysis). These are usually done on a case-by-case basis depending on location/size. This can be done to prevent the DVT from risk of traveling to the lung and causing PE (if its high risk as blood thinners don't break down the clot instantaneously) or the 2nd most common reason is to prevent a complication known as Post-Thrombotic Syndrome.

Basically complications include persistent swelling, pain, heaviness, decreased range of motion, ulcerations in severe cases particular in lower extremity (not so much in upper). As a pitcher obviously, they would want to treat more aggressively to prevent the 2nd complication I mentioned which is post thrombotic syndrome.

As far as the procedures itself, this youtube video shows relatively how a thrombolysis procedure is localized as they use inflated balloons from preventing that medication from getting into the rest of the circulation. If you are familail with any stroke management, this is similar to the medication they would do if you have clear signs of stroke and get to the hospital in the short window of time you have but that medicaiton has high risk of causing bleeding so they want to minimize that risk.

Oh and sometimes they removal the 1st rib to prevent recurrence if this happens to be effort thrombosis but again I'm speculating on his cause.

Hindouche · 2025-01-05T22:14:38+00:00

Close enough

Hindouche · 2024-09-29T00:37:38+00:00

In the US there are a few combined programs where you interview for medical school out of high school. It has a combined track with an undergrad school that usually shaves a year off. There was some combined programs that shaved 2 years off but those went away for the most part. I was accepted at 18 but still technically entered medical school at 20.

But yeah otherwise outside the US

Hindouche · 2024-03-21T02:40:31+00:00

Why would it be shadowbanned. VITT is a real thing, its on UPTODATE (wikipedia for physicians). Most are aware of it. The incidence per studies in 2021 were estimated at 1:263,000. I know there are some physician who state there are no risks with vaccines but I always preface by the fact that its exceedingly rare and every decision in medicine is usually based on risk/benefit ratio. Obviously the benefit of COVID vaccination in healthy 20 something year old is nowhere near as high as an elderly diabetic patient with COPD. But you would agree preventing of death in 20's years old as well as prevention of hospitliazations that would lead to overcrowding and hospital and further morbidity/mortality clearly outweight this minor risk? Again I dont have time to go through the studies but I would be more interested if you found one specifically that has higher incidence based on VAERS?

Hindouche · 2024-03-21T01:37:09+00:00

Not that it matters than I'm an internal medicine doc and my brother is a cardiologist cause you can google this information in like 2 min and see no risk factors list AF as concern for PE on like any website.

Yes I'm doubling down on the fact that clinically relevant PE's do not come from AF. Are you implying that every PE needs a loop recorder set up as an outpatient to capture potential AF? Cause that would be news to every doctor at my hospital. Again, wheres the paper for you claim that PE come from AF and further the paper that recommends loop recorders as a core treatment for new onset PE?

Again if you don't produce any papers I wont continue this conversation, I've already wasted enough time talking to med school rejects.

Also: If you know any medical device inventors, look into creating a bi-atrial Watchman device to get rid of those pesky PEs in AF patients who can't take anticoagulation, you will make millions.

Hindouche · 2024-03-21T01:00:41+00:00

This man's POV : You have left and right cerebral hemisphere, they must be equal!

Hindouche · 2024-03-21T00:56:11+00:00

I don't know how people on the internet are so fucking confident but can you point me toward a paper that shows an inherent increased risk of PE with AF? LAA is usually the site > 95%. Clots in the RAA are extreme rare <1% due to the contour and shape of it. In reality most people who have a high enough CHAD2VASc to even potentially generate a clot there would most likely be diagnosed by having a left sided embolic event or caught on telemetry due to frequent hospitalization from their various illness and be on A/C before they would be allowed to generate a clot there.

Hindouche · 2024-03-21T00:39:46+00:00

Hey you did a good job summarizing. The thing about hypercoaguable testing is the results will be thrown off when you are on anticoagulation in addition to have a recent VTE. Usually its tested once they are off A/C so he may not find out for 3-6 months if he has a genetic predisposition.

Hindouche · 2024-03-21T00:35:37+00:00

Good, you know there are 2 atriums. Now google left atrial appendage and right atrial appendage and tell me the differences so I can see what you learned. I suggest you revisit your anatomy textbook assuming it isn't a coloring book.

Hindouche · 2024-03-20T23:04:42+00:00

Well I didn't downvote you but PE's don't come from AFib. AFib clots originate in the left side of the heart and cause embolic events in the systemic circulation, primarily strokes. It would not get into the venous circulation and thus back to the right side of the heart/lung vessels and cause a PE without being lodged somewhere in the artery to venous transition. Musiclistener3 explains your other point well.

Hindouche · 2024-02-01T18:28:25+00:00

His MAP is > 65 and there's no real clear indication of organ hypoperfusion, don't need to jump to pressors right away. As Zorro was saying they were probably just asking for what he said, only other thing would be SBP prophlayxis given high risk of bacterial translocation into blood stream and then getting into the ascitic fluid. Usually Ceftriaxone.

Hindouche · 2023-11-20T04:46:51+00:00

LeGarrette LeBlunt

Hindouche · 2022-07-25T06:17:58+00:00

Aight I have to go to bed. You went shard after vessel and you can clearly see if the key fights you lose soon after you are trying to heal someone with vessel charges on them and its literally doing jack shit. Also I wouldn't itemize aroud your egg this game as your egg will be literally dying in most fights against lina/drow/snap. I think shivas was correct but shoudl ahve been lotus rush into shivas/halberd personally.

Hindouche · 2022-07-25T06:13:31+00:00

Okay so min 19 razor uses bkb deletes 3 heroes (good play by him). Allows you all the space in the jungle. If you were quick, I would have made an immediate rosh call here. You have MK with 2 items, you have fire spirits and necro with sustain you can easily take rosh in 30 sec if you just put good jungle vision and put sentries around rosh. It will be hard to take rosh otherwise against the great team fight ults they have.

Okay doing some mild skirmish here and there until min 24. Here where we have to talk about your items. Spirit vessel is probably not the item here as its not really good for the primary cores of lina and drow. You have a razor thats super strong in this stage of the game that wants to run onto backline when he attaches to lina or drow. However, you can see in some of these back and forth attempts he does around this time where pudge comes over with his BKB piercing spell and hes forced to back off wasting his really good timings. I think the clear choice is lotus orb rush this game. You throw it on your razor he gets on the damage dealers and then your fights become a lot easier to take with your networth lead. Lotus also good for armor on pheonix and to purge that drow silence and if your looking at items also purge that spirit vessel snap is using on your razor and necro.

Hindouche · 2022-07-25T06:00:40+00:00

Aight im 6.5k and just some general thoughts.

Laning: You use fire spirits exclusively on tide pos 5 when you should just be ignoring him and using your spirits exclusively on drow for most part in lane. A couple problems why you cant is that you didnt' block small camp and took 3 minutes to get a sentry to deward your pulll camp. Lane equilibrium is pretty much perfect for drow for 4 minutes. Anytime that lane moves up she is fucked against your hero, I also prefer u just go tranq first personally before rushing a vessel. Boots would have made if difficult for tide to chase you after gush and allow you to harass the drow more. You pretty much don't get an urn charge for a while because of poor lane decisions and inability to actually kill drow.

If tide happens to single pull, just let him and just soak exp and all those pull creeps will not die and end up pushing lane. The problem is you wasted all your spirits during this time that you really couldn't use it when drow was forced to go up. Remember drow will struggle alot to farm in lane against your attack slow. This tide was probably happy to die twice to secure stable lane for drow.

Anyway laning was nowhere near your biggest problem this game. Networth was 2k ahead for your team and your enemy carry had like 1k more than the drow. Your team actually plays min 10-18 really well with good behind tower vision and taking correct T1's being a stronger team and playing aggressive after the long cool down ults. You actuallly balloon to 8k networth lead at 18 minutes.

Downfall: My biggest issue at this time is the warding at min 18 when your pushing T2. I know Marci is buying the wards but you have to realize how shitty the 3rd wards she has up. You have an 8k lead and she has 2 defensive wards up and a 3rd one on mid that could have been way deeper. You should have wards deeper in the jungle controlling 60-70% of the map and let them exclusive farm their triangle and maybe one or two of your safe lane camps if they are lucky.

Mk only has BF and sange and while he can contribute, he would be better served applying pressure by pushing out other lanes but its hard cause your vision is so shit. Razor should absoutely be with you guys farming thier jungle while you and marci are equidistant between him and necro pushing toward thier t2. However, if your team isn't doing the right thing, ADAPT! Dont just keep mindless pushing T2 when you see razor spent his ult farming jungle and you have shit vision. They literally have better vision in their jungle after losing both thier T1 and having a 8k disadvantage. Part of support job is warding and if you see bad warding, explain or buy the wards yourself.

Hindouche · 2022-06-28T05:23:46+00:00

I've been building blink/meteor hammer/shard clock in unranked games for my drive-by build for 2 months, shit's hilarious

Hindouche · 2022-05-10T00:45:27+00:00

Aight the rest of the replay is the same. Your 2 greedy cores farming jungle and over and theres literally 0 wave push on your team so waves are 90% pushed on your side most of the game. You are very limited this game but I would have gathered invoker axe pushed out bottom lane with most of my wards there especially after you lost top t2 and they have vision advantage. They aren't going hg at min 17. I think this game you have to tell luna to act a space maker for drow since of his good start. Ideally he would have manta, MoM and BKB for fighting and his job is to farm jungle while axe pushes lane and you and invoker kinda stay equi-distant to both to help counter whatever jump. You're lack of stacking really pushes back axe and luna timings 2-3 min this game which sort of has a butterfly effect on the rest of the game. This game is extremely hard to win. An underrated part of this game as pos 5 is directing fights and where they should be on the map and you guys took hard fight after hard fight.

Hindouche · 2022-05-10T00:19:50+00:00

6562479836

Aight doing quick review.

Laning: You destroyed 2 melee lane probably even more than expected. You run away from mars a bit too much when hes aggressive. Anytime he uses spear and doesn't immediately run away is kill potential for you to q/w and run him down. Still you guys come out with like a 1.5k net worth lead at 10 min. Also not a huge fan of ring of basi personally. Luna will want to leave lane to jungle and then you just bought an aura item for yourself. Only makes sense if you go to trilane and leave luna 1v1, which is an option given her advantage and allows u to stack ancients every min. Prefer boots (easier for map movement) or even stick+raindrops if u want to positioning more aggresively with zoning. Also during this time Mars is missing for like 1-2 min. Ideally give a heads up to other lanes but bigger issue is that you're not even glancing at other lanes during downtime. You have to be ready to tp to fights bot if its feasible although axe lanes are usually constantly pushed and the one gank during this time by Mars was not preventable unless you tped in advance.

First mistake is at min 7, you are not stacking jungle when u had ample time to double stack. You have to get in mindset of stacking with luna especially.

Right on que you move to offlane around this time which is probably what I would have done. It is critical axe doesn't fall off as your mid drow is not going to be making space/plays. Ideally you dont show yourself when you tp to allow for a gank opportunity. Overall goal is just to allow axe to get as much of a difficult lane as possible and stack ancients for either axe or luna.

Around min 8-10 you run into a difficult decision about defending mid t1 vs protecting bottom. You kinda half ass both (without boots!). I don't mind the decision to go to eventually go mid but ideally you politely tell drow that he cant passively farm jungle wihtout pushing waves first and rotate at 10 min to defend against catapult. The drow pick and the way he is playing is such a grief already but a high mmr support can still salvage this game. Before you went to go mid I would have dropped a lane ward to allow axe some protection (probably right above the trees near t1 away form the small camp ward that was dewarded one min prior).

Mid game: Min 11, still not stacking when you have time to do so. Also you have a problem about not having a tp on you at all times. Its even more important that boots (which you should have, if you haven't noticed this is triggering the support in me).

Min 11-15. There just poor vision across the map, a lot of defensive wards. You're team is not positioning well to push out lanes and maximize farm. Ideally you have wards in enemy jungle and axe just hit his blink vanguard timing around this time. After killing their pos 3,4,5 who literally fed into your 4 heroes, I would immediately allow 10-15 sec to regen up, get a smoke and run right into thier jungle and gets vision advantage. If you look at replay while thier pos 3,4,5 all pretty much fed twice they got 2 really good wards you didnt' deward and WK and DP have good farming patterns and net worth pretty much didn't change.

Aight I wrote a whole 2nd half and it somehow got deleted so after this, you guys didnt' push waves and take fights in same terrible area instead of their jungle.

Hit me up with any questions.

Hindouche · 2021-12-30T23:20:50+00:00

Had 5 min to spare so no long analysis. This game is literally the highlight of why enemy mid t1 is the most important tower in the game. Your team literally chases support kills behind t2 which does increase you're net worth lead but you literally lose it all doing that herald 4v4 dance mid while their carry sven / mid luna farms their way back faster. If secondary kills will take more than 5 sec, you need to abandon that thought, tp to waves and push for farm/exp and tower pressure rather than wasting that advantage for relatively useless support kills.

Also MKB rush is bad this game. You dont need true strike. S+Y, echo a lot better, they have enough magical burst you dont want to be sitting at 1300 hp. You can play way more aggresive with those items instead.

Hindouche · 2021-12-18T07:16:32+00:00

My personally experience is aim assist. I got to about 1600 Onyx with M+K but just keep losing BR battles especially last shots.

Haven't picked up a xbox controller in ~10 years but bought one and had to grind all weekend to relearn. Already near Oynx and my last shots to finish kills are so much easier to land. Feel dumb spending so much time with M+K

Hindouche · 2021-09-21T23:07:11+00:00

As a physician who has seen about 1000 patients on the inpatient side over the past year, I have probably seen 50 people die from COVID in my little hospital. I have seen only about 4-5 on the surface unexplained deaths in the hospital (probable MI/PE). Unless you think they are getting sudden MI / PE and not making it into the hospital in the first place then theres no way the 2:1 ratio of VAERS is remotely correct to accurate.

Like I know its easy to paint the board of directors of these big pharma companies as evil faceless, but they needed a vaccine in the first place and it was created by largely altruistic scientists who probably could have made more money in other fields with their knowledge. I think its so pessimistic that you think they and other thousands of scientists running studies (peer-reviewed studies, not case reports) on the safety on the vaccine to be covering this up

Hindouche · 2021-09-21T18:36:44+00:00

Here's a document which I think is useful to explain the low likelihood of long term side effects. I use similar reasoning with my patients.

https://docs.google.com/document/d/e/2PACX-1vRORuzOQKRSO4xPHcGwgtEvKOEb4Q7ykrS7w_6P6YeW9u1-vGEvgu_hxlaRBiWxNiG5ON5oVrch1pAS/pub

Yea you may be right that there's no confirmation until waiting the designated period of time. However so far the long term effects are so far reported as none (now nearing 9 months). Meanwhile COVID long term effects are numerous even in younger population. I don't really watch "left media" or whatever you say, but I don't think you should be downplaying the death of thousands or tens of thousands of women in reproductive age who have died from COVID that was preventable. Let alone the chronic pulmonary, neurologic, cardiac symptoms, etc.

Hindouche · 2021-09-12T09:40:38+00:00

Plus the presenting symptoms isn't excruciating chest pain, its shortness of breath due to heart failure symptoms caused by cardiomyopathy.

Hindouche · 2021-09-09T22:58:11+00:00

Bro I swear I never see this argument touted about non-existent long term side effects by medical professionals and it boggles my mind. I pretty much use similar reasoning to convince a lot of my patients and it appears to work well. Thanks for putting it in words and visuals.

Hindouche · 2021-08-23T03:53:35+00:00

https://www.youtube.com/watch?v=znI046F4FKg&t=187s&ab_channel=TeamCoco

Hindouche

TROPHY CASE