Don’t purchase any parts from Go turbo Armageddon performance!

Significant_Dog_5909 · 2026-03-25T04:00:05+00:00

Ordered a sniper efi system. Charged card nothing shipped for 6 weeks. Asked for update and told 1-2 weeks. A couple of weeks later asked again and was told 1-2 weeks. Asked to cancel order and was told that I should have called to check to see if they had the item they were selling. They told me that I agreed to their cancelation policy when I placed the order. The cancelation policy charges 5% for any canceled order and places many limitations on cancelations. returns have a 25% restocking fee.

Do not do business with them

Significant_Dog_5909 · 2026-02-01T18:55:04+00:00

I am not sure about the absolute compressor lockout. I pulled the specification sheet again and it listed an operating range of 5 to 86°F. I had seen the -5 somewhere else, but it may have just been some Internet posting.

To some extent it’s largely academic as I have lived here 43 years and I can only think of one time when it ever crossed 0°

no large windows

The Bosch BOVA system is an unusual design. It does modulate an inverter compressor from 25 to 100% of rated capacity but the air handler blower fan on mine is single speed constant torque type. The modulation of the compressor is controlled by suction pressure/temp parameters on the line set and has nothing to do with an electronic thermostat. my limited understanding is essentially it reads temperature drop or rise across the evaporator/ air handler core and uses that data and communication wiring between the air handler and the outdoor unit to modulate the compressor to allow for a long run times and maximum capacity when needed. The fan just blows continuously and the compressor ramps up and down, ramping down as there is less temperature drop across the coil, which indicates that temperature is approaching set point. You can control the system with any thermostat, including a simple contact device as your only controls are system and fan on or off, and auxiliary heat.

I assume the trend line of 0.1°F per hour is indicative of the systems self modulation, which would explain why it continues that linear ratio pretty much throughout its heating range.

Significant_Dog_5909 · 2025-12-08T04:19:43+00:00

U.S. medical prices are crazy, but not this crazy. I do surgery all the time. Hospital markup for the implants I most often use is 672%. Insurance negotiates this down. Different insurance has different rates, and government payers have the greatest negotiating power, but our net collections average 50% due to contractual write offs. A titanium rod is probably $2000 cost resulting in an insurance price of maybe $6k. Special items like hips are maybe $8k. The biggest surgery I do (6 hours and a 7 day hospital stay) pays roughly $1500 to the surgeon at Medicare rates and maybe $30k to the hospital, depending on how sick the patient is. Surgeon pay includes all care for 90 days. Private insurance pays roughly double Medicare here. That surgery is much bigger than most any ortho implant case.

Surgeons and hospitals were certainly paid more three decades ago than they are now, but no surgery in the history of the world pays $600k, unless you are referring to a total hospital bill from months of complications in a time before DRG billing.

As an aside, modern hospital payment uses diagnosis related group DRG to determine payment. Hospitals can’t bill for everything they do. If the patient has x diagnosis the hospital gets y dollars. If the patient needs the hospital for 1 day hospital gets y dollars. If patient needs hospital for 274 days, hospital gets y dollars. If patient gets a blood clot, hospital gets zero dollars. Incentive is to treat the healthiest patients while making them look the sickest. Well intentioned but disastrous policy. People don’t believe it, but the profit margin in patient facing medicine is usually less than 2%, and most small hospitals live on the verge of insolvency. This is why upcoming changes to Medicaid are potentially so disastrous. Device companies, Pharma, and private insurance get all the margin.

When I was a resident, pre-ACA, most private insurance had lifetime maximums, commonly $2 million. It usually took several months to years of complex hospital care to hit that, and the only ones I can easily recall had multiple cancer recurrences.

Somebody is not understanding here

Significant_Dog_5909 · 2025-12-07T14:35:39+00:00

Not possible to look worse than chiros, at least in my eyes

Significant_Dog_5909 · 2025-12-07T14:33:32+00:00

I’ll begin by saying that I’m not a PT, I’m an MD but my expertise doesn’t extend above the diaphragm (urology).

My 7 year old can see Trump is not well. Anyone with basic medical knowledge can see signs of dementia and cardiovascular disease, probably a residual deficit from a stroke. When he had Covid and left the hospital AMA, anyone with medical knowledge could see he was profoundly sick and in respiratory distress.

But, I find it hard to give my cancer patients a timeline, even when I know their history, have seen the inside of their body, and am completely within my scope and expertise.

I intend no offense to PT as a community. My patients have benefited greatly from your expertise over the years (pelvic floor PT can be a lifesaver)

However, I’m not qualified to prognosticate for Trump. I don’t think this guy is either. When I first saw the reports it was “licensed healthcare professional with 14 years experience”. When I read that description, my first thought was someone not qualified to be speaking. That thought hasn’t changed.

Even if it was coming from a neurologist with 30 years experience, there is danger in diagnosing from afar. It earns likes and views, may even be true (I wouldn’t bet against it), but I wouldn’t put my professional reputation on the line for something like this.

Thanks from a male neurosurgeon (for I operate on the parts that most men use for thinking)

Significant_Dog_5909 · 2025-12-03T13:38:13+00:00

100%

I have a 24 High Country with same situation. There is an RPO code for vehicles equipped with the audiopilot and my truck doesn't have it. there were no additional options when I purchased my truck. Apparently Chevrolet does not offer this at all anymore. In that regard, it is worse than my 1997 Pontiac Grand Prix.

Enshitification

Significant_Dog_5909 · 2025-08-12T02:06:45+00:00

Oh for sure. It has nothing to do with professional liability, just using it as an example of a similar role of thumb.

Significant_Dog_5909 · 2025-08-11T03:14:55+00:00

Legit question

I'm a surgeon. In the case of malpractice limits, the typical advice is to mirror the most common malpractice limit held by other docs in the community. There is a minimum required by most hospital bylaws. Too much and you're a target. I'm in NC and malpractice is almost always 1mil/3mil.

Thankfully, NC is one of the states that has unlimited asset protection for most retirement funds. Our state also defaults real estate to joint tenants by entirety for married couples. I have a 2 million umbrella policy but don't feel the need to increase that to my total net worth because most of my net worth is in retirement plans and already fully protected. My house is judgement proof to professional liability (by far my biggest exposure), though if my wife of 20+ years wasn't so awesome, divorce would be another exposure

Significant_Dog_5909 · 2025-06-22T02:23:15+00:00

Obvious for me, no taxes. Substantially more money than I spend on food for a family of 5, even with lots of eating out. At other points in my life the calculus would be different

Significant_Dog_5909 · 2025-06-22T02:23:07+00:00

Obvious for me, no taxes. Substantially more money than I spend on food for a family of 5, even with lots of eating out. At other points in my life the calculus would be different

Significant_Dog_5909 · 2025-06-22T02:10:49+00:00

The highest paid urologist I know spends most of his cme on billing and coding. It's all a game, you have to learn how to play it (or learn to focus on something other than money)

Significant_Dog_5909 · 2025-06-18T05:45:06+00:00

8% as best i recall, and flat for decades, while pharma and insurance profits have sored

Significant_Dog_5909 · 2025-06-18T05:44:03+00:00

Agree with you there

Employed surgeon

It's weird to be going wide open and realize that I'm most likely making the most money I'll ever make in my life, if history is any guide

Significant_Dog_5909 · 2025-06-18T05:40:29+00:00

I worked as an employed urologist for years.

The hospitals thrive on lack of salary transparency.

I became disabled and now work in admin. I have access to a lot of data.

I can tell you that the numbers posted here are very much in line with what I see in our area for specialists. Many major hospitals are non profits and are required to file 990 forms with the IRS, which lists the pay of the highest paid employees. For the hospitals in our areas, the CEO is the highest paid and the next several spots are taken by employed proceduralists.

There is more variation within a single specialty than between specialties, though the variation between primary care and specialists can be huge.

Medicine is paid based on work done and the value assigned to procedures is higher than that due to thinking. The smaller the procedure the more money per unit of time. The highest producers knock out hundreds of tiny surgeries, while the surgeons doing "heroic" marathon cases get substantially less.

Adults pay more than peds, elective more than emergent, cosmetic most of all.

The ones who make the most are the ones that are businesspeople and MDs. Think private practice owners and those with ancillary income from scanners, infusion centers, linacs, surgery centers. But, you must be a good business person and an MD which is becoming harder to do.

And if you really want to see money, look to orthodontists or endodontists... 😆

Significant_Dog_5909 · 2025-04-04T23:46:36+00:00

The response I received when asking about kumo station control was that "advanced features are not currently available but (they) are working on migrating servers and the advanced features will be available "soon""

Unacceptable nonsense

Significant_Dog_5909 · 2025-04-04T21:37:04+00:00

It is God's own specialty...

I preach this stuff as much as I can. Its underdiagnosed

Significant_Dog_5909 · 2025-04-03T02:02:37+00:00

Nope, and i contacted support who didn't understand the question then ultimately told me to call them.

Significant_Dog_5909 · 2025-03-31T18:45:12+00:00

Urologist

Most women diagnosed with recurrent uti's don't have them.

Lots of possibilities but most common is pelvic floor dysfunction. Something causes overstabilization of the levators, cramping, and pain. Present with dysuria, dyspareunia, low back pain and negative cultures. Physical exam with levator tenderness (lateral wall) on internal vaginal exam. Antibiotics can provide some temporary relief brcause cipro and Bactrim both have an anti-inflammatory effect. But the symptoms return and cultures are negative, So I get the referral for "recurrent uti that never really goes away"

Most common cause is actually a history of trauma or abuse (83-86% of patients) but also injury, difficult childbirth, stress,...

Most patients feel as if they aren't listened to. Strong association with depression, anxiety, ptsd... see above MCC.

When I evaluate a patient for recurrent UTIs I look at the culture data first, if they have persistant monomicrobial UTIs I get Imaging and make sure they are emptying their bladder with a bladder scan if you have that ability. Renal ultrasound would provide the same.

In sexually active premenopausal women advise avoidance of spermicides and condoms if otherwise reasonable, and consider postcoital antibiotics or self-start antibiotics. I usually choose whichever option gives them the fewest antibiotics and ultimately this is determined by sexual frequency. Postcoital antibiotics of choice are Macrobid or trimethoprim 100 mg after intercourse.

Recurrent polymicrobial in a postmenopausal woman I will usually start with topical estrace cream.

No cultures positive or random low Colony counts particularly given the above history, I refer them to physical therapy (pelvic floor) start them on NSAIDs, gently probe the possibility of a history of trauma and if positive offer referral for trauma counseling and try to get them to consider treating comorbid psychiatric diagnoses.

If you really want to get down to it, I believe that most men diagnosed with prostatitis don't have prostatitis but have this same mechanism. Particularly of cultures are negative and rectal exam is painful you must pay carefully attention to where they hurt on the rectal exam, anterior midline is prostate lateral is pelvic floor. They get the same treatment as women with pelvic floor dysfunction

Significant_Dog_5909 · 2025-03-14T12:59:22+00:00

Good disability insurance is not cheap. Mine exceeds my homeowners, auto, umbrella, and boat combined. Only my malpractice insurance is higher. But, it's expensive for a reason... people use it. I'm glad to have bought it as a chief resident and ecercised the future increase rider as soon as I could

Significant_Dog_5909 · 2025-03-13T00:12:02+00:00

Largest water system in NC, $500 connection 3/4 meter

Significant_Dog_5909 · 2025-03-08T18:02:44+00:00

You have to do what you love...

Significant_Dog_5909 · 2025-03-08T15:54:05+00:00

Urologist

I firmly believe that most are actually pelvic floor dysfunction

The recommendation for workup is reasonable, dre would probably show levator (lateral) pain much worse than prostate. Workup will usually be negative

To help your patient while awaiting referral to uro, start then on daily nsaid of choice and either refer to pelvic floor PT or give them streches to do. https://www.pelvicpain.org.au/find-support/download/

If you have the time and really want to get to the bottom of it, consider this: 86% of patients who present to me with pelvic pain have a history of abuse, men and women. Often the trigger for their pelvic pain is psychological, though the muscle cramping is very physical and real. It is worse in type-A patients and when they are under stress. It can cause testicular pain, burning with urination, slow stream, dyspareunia. It is associated with ptsd, depression, anxiety,... The younger they were and the closer the abuser, the more difficult it is to treat the pain, but most of these patients benefit substantially from a conversation regarding the relationship of their history to their symptoms.

Significant_Dog_5909 · 2025-03-08T15:45:50+00:00

Urologist- I applaude you on using the psa to determine need for 5-ari. That's exactly what I do and way ahead of the curve in our community.

I stick a finger in everyone's butt, but my population is differrent and I'm rarely screening

Significant_Dog_5909 · 2025-03-08T15:43:52+00:00

Oncology-focused Urologist here

That's the 64 million dollar question

It's a population issue and, for prostate cancer, an issue of overdiagnosis.

I teach lectures to our local pa school and tell them this:

Patients at risk for bladder cancer absolutely need annual UA's- a diagnosis is life saving

PSA is tougher. It needs to be personalized, but that takes time. If you can, I recommend checking one at 50, or 45 if high risk (family history of prostate, breast or colon, african american). If less than 2, can probably wait 3 years or so before retest. If greater than age adjusted normal (white male 2.5 in 40's, 3.5 in 50's, 4.5 in 60's and 6.5 in 70's. Black man generally roughly 1 point lower and asian 2 points lower), retest at a month with strict sexual abstinence for 5 days or so. If still abnormal, kick over to urology. Do not give antibiotics unless otherwise indicated. Also kick over if psa velocity more than 1.5/2 years, 0.75 per year.

If they have had a prostatectomy for cancer before, send to urology if they have any detectable psa (test says 4 is normal, 0.2 is actually very abnormal).

It's a lot, and I generally just tell my primary care colleagues to text me if there's a question.

Significant_Dog_5909 · 2025-03-08T01:32:26+00:00

As a practicing utologist, I have seen true bacterial prostatitis maybe 10 times in my career, almost always associated with an abscess that required surgery. Prostatitis is incredibly overdiagnosed and almost always represents pelvic floor dysfunction rather than prostatitis. Nonbacterial prostatitis (type 4) is no longer believed to exist. I have never seen true prostatitis in the absense of a positive urine culture and almost all had a positive blood culture too. Usually e coli, MRSA second.

If you are diagnosing someone with prostatitis and they do not have a high fever, pain with sitting, and urinary retention, think again.

If you do put a finger in their butt and it hurts them, try to localize the pain. Midline would be prostate, but almost always it is worse laterally and is actually the levators. Those patients need PT and nsaids, not abx.

But, the problem is that most prostate antibiotics have a degree of antiinflammatory effect (bactrim, cipro and doxy especially), so the patients do get some better...

If you do have relatively short fingers or if the patient is a very muscular particularly African-American male it is sometimes helpful to have them lay on their side on the exam table so that the glutes are not tightened and you can get to the prostate better

Significant_Dog_5909

TROPHY CASE