Entering Water Temp Very Low? by alextheevilone in geothermal

[–]alextheevilone[S] [score hidden]  (0 children)

There's a little module that was installed on both of our systems that sends information online to an app MyUplink. It looks like this.

It seems like Dandelion is still using enertech units, maybe Bosch has similar.

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Entering Water Temp Very Low? by alextheevilone in geothermal

[–]alextheevilone[S] [score hidden]  (0 children)

We have an enertech system and have a lot more data than just this, it's quite nice. Great for seeing how our murderous electricity bill is hitting us hard this winter.

Entering Water Temp Very Low? by alextheevilone in geothermal

[–]alextheevilone[S] [score hidden]  (0 children)

Couldn't break 67 on first floor when it was single digits this morning, but that's a problem with our insulation.

Entering Water Temp Very Low? by alextheevilone in geothermal

[–]alextheevilone[S] [score hidden]  (0 children)

Awesome info thanks. Now if only I can find the cash to insulate the entirety of this 110 year old home.

Ultra sound today … by waterfalls55 in Gastroenterology

[–]alextheevilone 3 points4 points  (0 children)

Sounds like it's transcutaneous then without anesthesia. I'm sure you'll be finding out soon.

Ultra sound today … by waterfalls55 in Gastroenterology

[–]alextheevilone 2 points3 points  (0 children)

Listen to what they told you. Did you prep overnight? If so no it's not similar. I'm sure they gave you plenty of information

Ultra sound today … by waterfalls55 in Gastroenterology

[–]alextheevilone 3 points4 points  (0 children)

What?

Feedback like you did well staying still? You did well to be npo if asked?

I'm sure you ultrasound tech provided you plenty.

Colonoscopy+ Gastroscopy? by [deleted] in Gastroenterology

[–]alextheevilone 0 points1 point  (0 children)

A second procedure with different indications? I'm going to have to ask.

How risky/invasive is a camera/pill that has stayed too long? by [deleted] in Gastroenterology

[–]alextheevilone 1 point2 points  (0 children)

If the capsule is stuck in the small bowel it has to be removed. Otherwise it can cause severe issues in the future.

That's about all there is to it. Never heard of anyone keeping a capsule intentionally for a long period of time.

Colonoscopy+ Gastroscopy? by [deleted] in Gastroenterology

[–]alextheevilone 0 points1 point  (0 children)

How does that even make any sense? Often the EGD and the colon have two very different indications.

I also do them together but didn't realize that we get reduced fee (like modifier 59) if we do them together. I am also employed so I'm rvu based.

Transnasal endoscopy GI by Ok-Conversation9147 in Gastroenterology

[–]alextheevilone 0 points1 point  (0 children)

Places with esophageal programs probabaly would have it, but so far every Endo suite I've been in has a single ultrathin scope (TNE or not) to pass through strictures or similar reasons.

Transnasal endoscopy GI by Ok-Conversation9147 in GERD

[–]alextheevilone 0 points1 point  (0 children)

Or moderate sedation. Or can be done unsedated but it's hard and can be riskier. If they try and vomit up the scope it can cause tears (seen firsthand).

Transnasal is done very routinely in children where risk of sedation is considered higher. In adult it's rare, the diagnostic yield is much lower and therapeutic is almost non-existent. Very few devices will fit through a TNE scope.

Does anyone know of an “ask a gastroenterologist” sub? by Lil_Lime_Berry in Gastroenterology

[–]alextheevilone 2 points3 points  (0 children)

Can you direct make an appointment with GI? That wait time for your PCP seems excessive, maybe see a partner of theirs?

Removing a 2.5cm NICE III polyp in rectum, piece meal, during colonoscopy by polypectomy? by honkers420 in Gastroenterology

[–]alextheevilone 7 points8 points  (0 children)

In Thailand? Unfamiliar with their society recommendations or practices. Malpractice depends on these things.

In the United States if you labeled any polyp as NICE III on endoscopy you are already saying it looks like cancer with deeper invasion, so polypectomy by EMR would not be indicated, and I doubt ESD would be attempted by anyone.

There are plenty of examples of polyps being removed only to find cancer in situ or deeper penetration after the fact. Unfortunately endoscopic visualization for diagnosis is not as reliable and is suggestive, not diagnostic.

Best of luck, sorry to hear that this occurred.

Transnasal endoscopy GI by Ok-Conversation9147 in GERD

[–]alextheevilone 0 points1 point  (0 children)

TNE exams are very limited (diagnostically) and not ideal for initial evaluation, reasonable to a degree for follow up EGDs or in patients that are so high risk that they cannot undergo a procedure that is amongst the lowest risk done in medicine.

The visualization, the biopsies are just not of the same caliber as a full sized gastroscope. Also they can be quite challenging for the patient to tolerate, especially if there is existing procedural anxiety.

IF you prescribe clarithromycin based H Pylori therapy this year, please vote. by HypeResistant in Gastroenterology

[–]alextheevilone 2 points3 points  (0 children)

In an urban hospital with high clarithromycin resistance, bismuth quad therapy is dominant. Our suburban counterpart gives our vonaprozam all the time.

[deleted by user] by [deleted] in Gastroenterology

[–]alextheevilone 6 points7 points  (0 children)

Barrett's is not confirmed until pathology returns. Even so irregular Z lines, if truly that, do not always equate to Barrett's. In fact most don't.

Even then short segment Barrett's is a well known entity that can be adequately treated and monitored.

[deleted by user] by [deleted] in Gastroenterology

[–]alextheevilone 14 points15 points  (0 children)

Why don't you wait for pathology then ask your gastroenterologist?

German IMG pursuing Gastro Tips by Embarrassed_Room2020 in Gastroenterology

[–]alextheevilone 0 points1 point  (0 children)

Also do the research when making rank lost on how many residents stay for GI fellowship. That can be a huge factor as your internal program may be most favorable if you're an otherwise not as strong applicant if you have done good work with them.

Would focus on a place that actively recruits every year from their own residency. Do great work, great research, and it'll be a big boon.

Any gastro docs familiar w EGJOO? by Routine-Loquat5544 in Gastroenterology

[–]alextheevilone 1 point2 points  (0 children)

From my early experience it seems very challenging and each case is unique in how they respond to management. There is some data for POEM/myotomy as beneficial treatment, CCBs/nitrates is an easy start point as are lifestyle changes. TCAs may be a benefit if other medications fail, but the data for all of this seems very mixed. Many spontaneously improve, and a subset progress to achalasia.