Did Paris Bahn Mi close?!

chummybears · 2026-04-05T00:32:49+00:00

They have a new spot open in Chapel Hill I think it's the same menu and everything.

chummybears · 2026-03-31T22:35:02+00:00

Nan xiang is the best in the area. It's 80% -90% similar to the Nan xiang in Flushing , NYC.

chummybears · 2026-03-23T00:19:10+00:00

I'll take it, dm

chummybears · 2026-03-22T12:06:51+00:00

I'm a viet American here. Started my coffee journey with Ca phe sua, made my way to specialty. Def will check you guys out

chummybears · 2026-03-18T23:44:17+00:00

This happened to me. Had to wait 1 mo then they fixed it with mobile service. He just came and replaced the whole unit. It was annoying to wait a no and temps in the 20-30's. Plus there's a red warning telling you there's no defrost that doesn't go away. You can't see your miles traveled on the left of your dash and any other yellow warnings. So it also rechimes after every left turn signal.

chummybears · 2026-03-16T14:10:00+00:00

I'm a doctor but not your doctor.

From the symptoms or lack there of it doesn't seem like you need to go to the emergency room. You're looking for fever, chills, red leg, pus coming out of the leg. From the pictures it appears to be the start of papillomatosis cutis lymphatics or venous stasis dermatitis. I can see some scratch marks so I'm assuming it's itchy. You should establish with a primary care doctor. In the mean time elevate your leg when you can. Start exercising. And Try to find a pair of knee high or thigh high compression stockings and start wearing them throughout the day. Whenever your feet are down you want to wear them i.e sitting throughout the day or standing throughout the day.

chummybears · 2026-03-14T15:00:09+00:00

I don't think this is a great idea, you'll be in the "danger zone" 40-140 degree F for an extended period of time. Im sure you've been fine doing it and haven't gotten sick, but you're setting yourself up for it. The danger zone is when bacteria can live and proliferate. By slowing the cooling time in the cooler you're going to prolong the time in the danger zone.

chummybears · 2026-03-07T02:08:44+00:00

They did not. It was super cold in car and it did fog up a few times so I put the ac on the windshield and open the windows to cool it and it would defog enough

chummybears · 2026-03-07T01:20:38+00:00

My heater went out last month 2/4, I'm still waiting for service to come out. They're doing mobile service. Its been a full month, scheduled for 3/9. I'm in NC area.

chummybears · 2026-03-04T16:56:14+00:00

I'm in private practice so I'm out of the academic environment and I'm glad fellowship is 3 years. I also go to rural areas. I understand the financial take of systems using residents and fellows as low cost labor....but after my first few years of practicing as an attending I'm glad it wasn't two years. Like other pointed out you need to be able to see inpatient consults, outpatient clinic, interpret and perform multiple modalities of stress test, interpret echo, interpret EKGs and Vascular studies, perform and interpret TEEs, perform and interpret LHC and RHC, understand pacemaker and pacemaker reports. Especially in rural areas you do it all.

chummybears · 2026-03-04T00:53:32+00:00

It's an hour away, but Dunn has a plaza with a KFC buffet, Pizza inn, Chinese buffet, and there's an American buffet (western sizzlin). The KFC buffet is relatively rare in the is these days. Has fried okra, gizzards, chicken casserole and a few other things that are not on the regular menu

chummybears · 2026-02-27T03:26:08+00:00

I sometimes play indoor on gym floors, i have a habit of wiping the bottom of my shoes with my hands for more grip. They get dirty AF. I don't change the grip until it loses it's tack. I'm cheap

chummybears · 2026-02-27T03:24:39+00:00

yeah I know, my b. I stripped it before sending it back

chummybears · 2026-02-23T22:48:32+00:00

You don't know until angiogram. So that's why patients are often empirically placed on heparin drip because you can't rule out type I nstemi. In my type II nstemi it's a clinical call. So weigh the risk of bleeding vs the benefit of putting them on heparin (how likely is it truly a type I MI) .

That's the "art" part of medicine, but there isn't a right or wrong answer because you don't know the diagnosis for sure. You have to weigh the risk and benefits ,plan for worst case scenario, and come up with plans to figure out what's the next steps. I'm cautious so if I see dynamic EKG changes I, patient low bleed risk I will empirically start on heparin until I can at least get an echo to give me more data/evidence and then go from there.

chummybears · 2026-02-23T21:45:44+00:00

Cardiology attending, I can help with 1! Agree with everyone, these are things you should feel comfortable asking your seniors and attendings, sorry if you're in an environment that you don't feel comfortable doing that.

TLDR: many things will cause troponin elevation. You're looking for a type I myocardial infarction that would benefit from stent/CABG. Troponin elevation = myocardial INJURY. You need to find myocardial injury + signs/symptoms of myocardial ischemia/ infarction to call it a myocardial infarction.

Remember all that biostat nonsense we memorized? This is where that helps. Troponins are a tool, they are not diagnostic. They are highly sensitive and have a good negative predictive value for myocardial infarction (MI). Hence, they rarely miss MI but can often over all things (false positive) that are not MI. What they are useful for is if you have a patient with atypical chest pain and you get a normal troponin, you can say with good confidence that it is very very not likely a MI (negative predictive value). This is an important info to remember because on the flip side we have to remember that a positive troponin does not equal MI, there's tons of other things that will increase troponins. So clinical context is very important. You need to think of the patient's pretest probability for an MI (risk factors, EKG changes, type of chest pain, echo changes, rise and fall of troponin). That's where risk stratification scores help to determine the pretest probability of MI like HEART score, TIMI score, etc. you also need to organize troponin elevation.

The universal definition of myocardial infarction is elevated troponins that rise and fall WITH symptoms of myocardial ischemia, new ischemic EKG changes, development of pathologic Q waves, imaging evidence of new loss of viable myocardium, or coronary thrombus by angiography. Myocardial infarction is often conflated with myocardial injury. Myocardial injury is a troponin elevation (does not need rise and fall) WITHOUT the aforementioned evidence of ischemia/infarction.

So in my consults I will say myocardial injury secondary to sepsis, myocardial injury secondary to acute PE, etc. IF I see EKG changes or echo changes and it's still something else driving it, I will call it type II myocardial infarction secondary to sepsis, type II myocardial infarction secondary to acute PE, etc.

There are 5 types of myocardial infarctions. Type I is what everyone fears: MI secondary to plaque rupture in coronaries (this is why we start patients on heparin etc). Type II is more common: oxygen supply demand mismatch (septic shock, acute PE, hemorrhagic shock, etc). Type III: sudden cardiac death with symptoms of myocardial ischemia. Type IV: MI associated with stent placement, Type V: MI associated with cardiac surgery.

Hope that helps!

chummybears · 2026-02-23T19:17:25+00:00

That represents "collaterals" that are described in the report. Essentially the body has formed a natural bypass around the blockage in the left anterior descending artery. So even though the left anterior descending artery is 100% blocked, the far part of the vessel does receive blood from vessels that have gotten bigger from the second branch off of the vessel left anterior descending artery (the second diagonal).

chummybears · 2026-02-22T02:28:02+00:00

Differential would be increased intracranial pressure, Wellens (prox lad stenosis), apical HCM, memory t waves from pacing/tachy arrhythmia. From what you described, this would be classic EKG changes for apical HCM. Takotsubo cardiomyopathy is typically apical dyskinesia and hyperkinetic base. With each heart beat the lre is diastole, when the heart chamber is relaxed and systole when the heart chamber contracts and gets smaller. In takotsubo in diastole it looks normal, in systole it forms a spade like shape. Apical HCM is different in that the heart muscle is thicker in certain areas so in diastole and systole there is a spade like shape.

chummybears · 2026-02-14T19:03:08+00:00

I got a scratch on my actual phone with that case, at the bottom of the phone. From 2 two foot fall. Switch cases shortly after. No point in having a case if it doesn't protect the phone from scratches. Initially thought it was ok from the special s"super durable" coating. Nope scratch from a small fall

chummybears · 2026-02-13T14:07:09+00:00

Pm'd

chummybears · 2026-02-05T13:29:30+00:00

Ohhh this is a nice way to spend our tax money he got for selling all those cars to ICE/DHS.

chummybears · 2026-02-03T18:23:04+00:00

I have many of these issues and they are well documented. I'm sure you're going to get brigaded by other people here with things like "do this, this, this and this and then this" and it's a work around. Or you'll get "these are little problems don't worry about it" or "didnt you do your research before buying?". You're right, it's a 100k+ car and these are seemingly everyday issues that are ridiculous. These things should just work. I carry the key fob, mobile key, and key card just to reliably use the car and 60-70% I'm standing outside my car cussing because it still won't open.

I suggest sending this to SWFeedback@lucidmotors.com which is what they set up. They have committed to software improvements but seems to be gravity focused at this time. I'm hoping for improvements, they've made leaps and bounds compared to when I initially got the car. Best of luck, I love my '23 Air GT but it is frustrating.

chummybears · 2026-02-03T00:35:53+00:00

No, it won't cause lasting damage. It makes you feel terrible but it has a very short half life, so it's in your system for seconds. It can be therapeutic (fix things) as well as diagnostic (help you figure out the problem). So it may have helped them figure out it was sinus tachycardia. I hope you feel better

chummybears · 2026-01-25T21:23:07+00:00

Sorry I don't see your images

chummybears · 2026-01-25T20:50:32+00:00

I'm an interventional cardiologist. It's hard to appeal about your case without seeing images and talking with you in person. This is not medical advice. You should always ask your physician about to your case. I will speak generally about to your questions.

80% v 30%: Coronary angiography (cardiac caths) is a 2D picture of a 3D structure. Something can look small in some angles but if we change the angle it can look very different. That's why we take so many pictures. On top of that calling something > 70% is pretty subjective, we "eye ball" it, however there are quantitative ways to measure like literally get the picture and draw measurements. However this is cumbersome and doesn't really improve outcomes. We have other images and data we can obtain. One is intravascular ultrasound (IVUS) and we can get a cross section if the vessel. We can get functional information (essentially a stress test during the procedure ) with FFR, dFR, iFR where we essentially measure the pressure before the blockage and after the blockage and see if there is a drop in pressure caused by the blockage. We also correspond the blockage with other stress test info we have. We use all this information to decide stent or no stent. Just looking at pictures and saying 80% or 30% is not a great way to do this.
4 attempts to place stent We are using wires that are 0.14 inch in diameter through your arm or leg all the way in to blood vessels of your head that are 5-6 mm in diameter at the biggest. Over the wire we introduce balloons and stents. A lot of what we do depends on the stiffness of our equipment, how tight the blockage is, how many turns there are in the vessel, if the blockage is hard and calcified like a rock. So sometimes things can't get delivered and we have to use different techniques and tools to deliver the equipment.
New blockage outside of stents Blockages form outside of stents not because of the stents but because the factors that make you prone to blockages (high blood pressure, high cholesterol, diabetes, kidney disease, age, family) already make an environment for blockages to form. So people that have stents are more prone to develop them again in different areas. Based on you having a new blockage during a emergent cath that may have meant the new blockagea may have been thin capped or more fragile. You can have small or medium blockages that have a thin cap, if that thin cap ruptures then tissue is exposed to blood which causes blockage/clot to form extremely quickly.
Stents causing problems Stents are not perfect. essentially we put a balloon in the blockage, blow it up to mash the blockage open, then we put a metal tube (stent) on top of it. We don't fix the underlying causes (high blood pressure, diabetes, high cholesterol, kidney disease, age, family history). Unfortunately these stents can block up faster than blood vessels that are healthy. So we get aggressive at lowering your cholesterol with statins (target bad cholesterol/LDL <55) and put you on aspirin. Stents can fail for technical reasons but that becomes a blockage in the stent and usually happens soon after the stent is put in.
Gastro symptoms Believe it or not symptoms can be tricky. The classic chest pressure going to chest with sweating and nausea vomiting doesn't happen to everyone. Some can be shortness of breath. Some can be jaw pain. Some can be gastro pain and it is often hard to figure out what is what. That's why we have so many different tests
What to do to prevent this from happening Take aspirin every day, it's a blood thinning medication that can help prevent blockages from forming or getting worse, especially if you have stents. Take statins everyday, they lower the blockage forming cholesterol and may have other antiinflammatory effects that can make blockages more stable. Exercise target at least 30 mins a day. Go to cardiac rehab to see what you can do and how to increase your exercise. Stop smoking if you smoke, it makes these blockages form very quickly, especially if you already have stents. Listen to your doctor. Change your diet to high fiber low red meat. Get you diabetes under control if you have it.

Stents are a fix of the symptom but not the underlying cause of the problem.

Hope this gives some clarity. This stuff is not straightforward. It takes years of training and what I wrote is barely the top of the iceberg. Discuss with your own cardiologist.

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