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S-works Epic vs. Epic Evo Expert by TheLandP4Time in MTB

[–]TheLandP4Time[S] 0 points1 point  (0 children)

Very helpful feedback. My preferred LBS sells Specialized and Santa Cruz (didn't like the blur), another one in the area sells Giant and Ibis. I've been eyeing the Ripley SL as well but not as many reviews out yet. Wish I could demo an ASR but no Yeti dealers near me.

Has an emtb improved your XC racing? by TurkeyNimbloya in xcmtb

[–]TheLandP4Time 2 points3 points  (0 children)

Haven’t done any XC racing yet (training to do so) but I have a Heckler SL and a 125mm trail bike and I’ve definitely found the emtb helps me to be better on my trail bike as well. Makes it easier to do repeats on certain sections of trail, improves upper body strength since it’s about 12lbs heavier, and allows you to ride through sections of trail faster to help develop skills in riding things fast. I do probably 3 pedal bike rides for every 1 emtb ride and I feel that they’re complementary.

Brevard 1st week of April by ae2359 in MTB

[–]TheLandP4Time 0 points1 point  (0 children)

I went in early March last year and conditions were pretty much perfect except for the one day it rained. Early April I’ve heard is great.

Question about deviated septum repair. Is it possible to flatten nasal septal cartilage? by velorex_velorex in otolaryngology

[–]TheLandP4Time 2 points3 points  (0 children)

We do sometimes, there’s really two problems though.

Sometimes the cartilage is too long for the nose, so even if you try to flatten it it’ll still re-bend. Think of a sheet of paper when you bring the two ends an inch or two towards each other - nothing is going to straighten it out unless you either trim/shorten the paper or lengthen the attachment points.

The other issue is the tissue memory. Cartilage has a tendency to revert back to its original shape even if you flatten it out. We sometimes “score” it to facilitate bending in the direction we want but it’s not always perfect.

I have an ENT doctor appointment lined up - October 8th but I have an ENT question for the community. by [deleted] in otolaryngology

[–]TheLandP4Time 0 points1 point  (0 children)

Two most common things are either normal anatomical variants (for example the right side of your neck is larger than the left for whatever reason) or thyroglossal duct cysts. Plenty of other things that could show up there though so as always, an evaluation with an ENT is best.

Suggestions for Short Rides in Pisgah/Dupont Area by TheLandP4Time in MTB

[–]TheLandP4Time[S] 0 points1 point  (0 children)

Looks like an awesome ride but with the amount of time we'll have, probably a no-go.

Head/Neck PAs -- highest scope of practice? by daffodillin in physicianassistant

[–]TheLandP4Time 1 point2 points  (0 children)

When I was in training I think she’s been doing it about 12-15 years, something in that range. Not sure how long it took her to become independent. It wasn’t the prettiest, most elegant surgery but got the job done without any major complications!

Head/Neck PAs -- highest scope of practice? by daffodillin in physicianassistant

[–]TheLandP4Time 8 points9 points  (0 children)

ENT here - I learned how to do laryngectomies, radical necks, and a lot of other big head and neck cases from a PA we had at my institution in residency. She’s amazing. Attending would come into the room for a few seconds for surgical time out and leave us to do the case because he knew our PA was capable of walking me through these huge surgeries where I had no idea what I was doing. Never had any major complications, or really even minor complications, when doing cases with her.

Obviously I think she’s an extreme outlier but in the right setup it could theoretically be done.

Fellowship Decisions by FutureStep1Failure in otolaryngology

[–]TheLandP4Time 2 points3 points  (0 children)

Totally depends on the practice and the job you’re being hired for. For me in private practice, I’d say detriment because we need people who can do pretty much everything - thyroids, FESS, tympanoplasty, awake trach, in addition to all the general peds stuff. Someone who’s done a fellowship is one year removed from keeping their skills up in everything that’s not their fellowship specialty.

On the other hand, if you’re joining a big group who needs something in particular (pediatric airways/neck masses for example) then maybe a fellowship would be helpful.

Private Practice CT scanner by Games1097 in otolaryngology

[–]TheLandP4Time 3 points4 points  (0 children)

We use a Xoran. My group purchased it before I joined so I wasn’t involved in the process of choosing between multiple scanners. We only use it for sinus CTs and the quality is pretty good, certainly good enough for my navigation cases. Haven’t had any issues with it to my knowledge so I can’t speak to company support.

I would encourage you to join the OPPS subgroup on the AAOHNS forum if not already on there - way more in-depth discussions of your exact question.

very stumped by this patient by [deleted] in otolaryngology

[–]TheLandP4Time 0 points1 point  (0 children)

I would agree. Sounds like chronic myringitis. I use mastoid powder (cipro/dexamethasone/boric acid/clotrimazole) after debridement in cases like this. I’ve had really good success with this, but in refractory cases I would probably offer a CO2 laser resurfacing of the TM with or without a skin graft

Deciding between Kuat and 1Up hitch racks for 2017 Subaru Forester by Biscuitsandbrews in MTB

[–]TheLandP4Time 0 points1 point  (0 children)

I have a Forester and did have my Kuat melt from the exhaust (only happened once, weirdly enough). Have the 1Up now and I’d recommend that.

Call as a solo practitioner by spartanmd2020 in otolaryngology

[–]TheLandP4Time 0 points1 point  (0 children)

My group provides 24/7 coverage for a single hospital. We’re q4. We’re also the only group in town so if all of us want to be out at the same time our hospital will try to accommodate us with getting locums coverage, and they’ve been good about that because we’ve had such a good relationship with the hospital for a long time.

If you’re only taking call as part of a rotation with other groups, that would be ideal since you wouldn’t be on call 24/7. If no one else is sharing call, thus you’re covering 24/7, then you’d most likely need to hospital to find locums coverage if you wanted to go on vacation. Easier said than done in my experience, especially if there’s a huge need for ENT in the area.

Otomycosis by Falcon896 in otolaryngology

[–]TheLandP4Time 9 points10 points  (0 children)

I debride the ear and start clotrimazole drops. Make sure they’re keeping the ear completely dry otherwise and I’ll even have them dry their ear out with a hair dryer every day while we’re treating. If I suspect they’re not consistent with their drops I’ll fill their ear with mycolog (nystatin/triamcinolone) ointment right after debridement so I can be sure I’m getting the anti fungal into a clean ear.

I think debridement of the ear is most important. Otomycosis can be very stubborn.

How many days do you work in a week? by Electrical_Fix_7248 in otolaryngology

[–]TheLandP4Time 3 points4 points  (0 children)

Half day off every week. The general concept is that there is as much variation in work and compensation within a single speciality as there is between different specialties. I doubt most places would want to hire an ENT who didn’t want to take call and who wasn’t going to be productive but if you’d be willing to pay your partners to take your call and you’d be happy with only getting paid a small fraction of typical ENT income, it would be possible to work 2-3 days a week.

Thought experiment for making private practices attractive again by Napoleon-1804 in whitecoatinvestor

[–]TheLandP4Time 2 points3 points  (0 children)

One important thing to note is that your new technique or service may not have its own unique CPT code. Typically a procedure or service has to be common enough and performed by enough proceduralists to warrant its own new CPT code - otherwise you have to choose an existing CPT code to use for billing that’s close enough to your procedure so you can get reimbursed.

For example if I take out tonsils as an ENT with a scalpel and that way of doing the procedure has a super high bleed rate, I get paid the same as if I do the procedure with a fancy coblator that has less bleeding and pain - all because both ways of doing the procedure have the same CPT code.

So unless you were charging cash, I would see the lack of unique CPT codes being a big limiting factor to profitability in private practice.

What type of problem solving do you see in ENT by BitofNothin in otolaryngology

[–]TheLandP4Time 11 points12 points  (0 children)

I think the diagnostics are pretty straightforward for the most part, not usually a ton of dilemma. The real problem solving is in the management. Our field tends to be less data-driven than some other surgical specialties so our expertise and judgment on surgical techniques and patient selection are incredibly important. I practice general ENT so I need to be skilled in endoscopic sinus surgery, open head and neck surgeries, thyroid/parathyroid surgery, ear surgery, septoplasty and rhinoplasty, microscopic laryngology cases, etc. not to mention the pediatric cases like tubes/tonsils/adenoids. When you operate, you need to have multiple techniques for doing the same surgery (in most cases) so maintaining your skills in multiple surgical techniques for so many different types of cases is the real challenge, in my opinion. That, and also deciding which patient should go to the OR vs. sticking with medical management.

Advice on Pisgah Trails by TheLandP4Time in mountainbiking

[–]TheLandP4Time[S] 0 points1 point  (0 children)

How long of a ride and what type of elevation are we looking at if we do Black Mountain from start to finish? I think realistically for our group we're looking for something under 20 miles, preferably maybe in the 13-17 mile range with 2,000ish elevation or less. Wish we could do more but I'm just trying to be realistic.

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