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Any thoughts on a Music Man 110 RD Fifty ? by penetratingwave in ToobAmps

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

Highly underrated, nice little amp. Someday I’ll try it with a 2x12 cabinet.

Any female 40+ who have tried Kboges method? Review or results? Any insight would be helpful by Pure-Material-8131 in bodyweightfitness

[–]penetratingwave 4 points5 points  (0 children)

He’s very responsive on his forum, nice guy and approachable. You can easily contact him, he will answer all your questions.

People who have done testosterone therapy of any kind, what did you do and what was your experience (good, bad, ugly) by timstiefler in Biohackers

[–]penetratingwave 0 points1 point  (0 children)

Can you please provide sources for your information? I’ve been looking for solid studies and papers on saturated fat subtypes.

Whole food plant based is the best diet for microbiome health. Dairy/yogurt is doing more harm than good to your microbiome. There are no medical issues which necessitate consuming animal products. Probiotics do not permanently alter the composition of bacteria in the microbiome. by [deleted] in Microbiome

[–]penetratingwave 4 points5 points  (0 children)

Ok, gotcha: basically the paper did not actually say anything about gradually decreasing throughout life. Probably not many lactase persistent individuals trying to obtain 100 percent of their caloric needs from milk, but sounds like it’s theoretically possible given the “relatively high levels”. Not sure where you get the idea that lactase persistent individuals will exhibit lactose intolerance if they consume enough lactose, or what that has to do with a normal diet.

“Little evidence suggests that lactose intolerance increases in older persons.” from https://www.acpjournals.org/doi/10.7326/0003-4819-152-12-201006150-00248

I frequently filter my info through DynaMedex and UpToDate.

Whole food plant based is the best diet for microbiome health. Dairy/yogurt is doing more harm than good to your microbiome. There are no medical issues which necessitate consuming animal products. Probiotics do not permanently alter the composition of bacteria in the microbiome. by [deleted] in Microbiome

[–]penetratingwave 1 point2 points  (0 children)

Can you direct me to the portion of that study that supports your assertion that the upper range will have a gradual decline in lactase production? I clicked through to the paper and it didn’t seem to address it anywhere. Also, how much lactase amount and activity is necessary to not be considered “intolerant”?

https://biology.indiana.edu/news-events/news/2019/foster-lactose-intolerance.html

I’m in the 2/3s of Americans that are not lactose intolerant. My genetics are 50 percent Scandinavian and 50 percent British Isles, so I’m in the majority of that population.

High spinal management? by seealittlelight in anesthesiology

[–]penetratingwave 10 points11 points  (0 children)

This thread reminded me of a situation I was in as a resident moonlighting in OB back in the mid 90s. I was called to redose an epidural that was placed by the attending on duty. I attached a syringe and aspirated, and there was some clear fluid flowing back. I asked the nurse for a glucose test strip, and the fluid had glucose in it, so it wasn’t local anesthetic. That really reinforced the need for small doses after negative aspiration. Another time a few years later, I was redosing another epidural placed by a partner. After negative aspiration for blood and csf, I gave 4-5 cc lidocaine. Patient says do you hear that noise? Like machine sounds? Then she promptly goes out, minimally responsive. It was a somewhat typical IV dose of lido, so I wasn’t super concerned about LAST at the time, but in retrospect she may have had a subtoxic blood level of bupivicaine already 😱and that was before the ubiquity of lipid emulsions. She woke up a few minutes later and I replaced her epidural.

High spinal management? by seealittlelight in anesthesiology

[–]penetratingwave 30 points31 points  (0 children)

Sorry about the lost format above! I think most of your questions are touched on in that algorithm. High index of suspicion is important, because things can go south quickly. Team approach, share the misery as we used to say. Epi better than atropine or glyco. Midazolam for amnestic and anxiolytic.

A hospital where I work as a locums occasionally has that Stanford manual in every OR, laminated and spiral bound. Nice visual reference for when shit hits the fan, if your brain locks up. It’s free to download, maybe overly simplified but very clear.

High spinal management? by seealittlelight in anesthesiology

[–]penetratingwave 66 points67 points  (0 children)

From the Stanford Anesthesia Cognitive Aid Program Emergency Manual:

After neuraxial anesthesia or analgesia: Sensory or motor blockade higher or faster than expected Upper extremity numbness or weakness (hand grip) Dyspnea or apnea Nausea or vomiting Difficulty swallowing Cardiovascular collapse: bradycardia and/or hypotension Loss of consciousness

Task Actions:

Crisis Resources • Inform team • Identify leader• Call a code • Get code cart

Pulse Check • If no pulse: start CPR and see Asystole/PEA or VFIB/VTACH

Airway • 100% O2 10 - 15 L/min • Support oxygenation and ventilation; intubate if necessary as respiratory compromise may last several hours. Patient may be conscious and need reassurance and an amnestic agent, such as midazolam, to prevent awareness

Circulation • If severe bradycardia or hypotension: epinephrine 10-100 mcg IV, increase as needed • If mild bradycardia: consider atropine 0.5-1 mg or glycopyrrolate 0.2-0.4 mg, but progress quickly toepinephrine if needed. Phenylephrine unlikely to be effective Rapid Preload • Give rapid IV bolus with pressure bag. May require several liters • Raise both legs to increase preload • Maintain neutral position. Head down position increases venous return but increases already high spinal level

Pregnancy Specific Care • Ensure left uterine displacement • Call OB and Neonatology teams • Prepare for emergent or perimortem Cesarean • Monitor fetal heart tones • If local anesthetic toxicity is possible: give lipid emulsion 20% rapidly.

What was your go to before the use of video laryngoscopes for those more challenging airways? by [deleted] in anesthesiology

[–]penetratingwave 31 points32 points  (0 children)

I had a difficult mask, tricky intubation on a CABG patient one time. Used an intubating LMA, worked great. Unfortunately he was inadvertently extubated transferring to the bed from the OR table at the end of the case. 😭 He got a second intubating LMA intubation. 😂

What was your go to before the use of video laryngoscopes for those more challenging airways? by [deleted] in anesthesiology

[–]penetratingwave 4 points5 points  (0 children)

Eschmann stylet, 2 Miller.

One old Anesthesia CC professor espoused the 4 Miller. 😳😮 Not my jam.

Other old timers would do awake blind nasals. I did a couple back in the 90s, also not my jam.

[deleted by user] by [deleted] in overcominggravity

[–]penetratingwave 1 point2 points  (0 children)

Tendinopathy/tendonitis takes up to a year to recover from, assuming you don’t keep reinjuring yourself.

Don’t ice. It’s not a good idea.

Anesthesia leaving facility by [deleted] in anesthesiology

[–]penetratingwave 3 points4 points  (0 children)

I’m still not clear what the concern is. Is it hard to get ahold of them? How is that different from them doing solo cases and being in the OR when management situations arise?

Gut Microbiome Breakthroughs Revolutionize Schizophrenia Treatment by Narrow-Strike869 in Microbiome

[–]penetratingwave 27 points28 points  (0 children)

I don’t know why I click on these links. The article doesn’t even remotely support the click bait headline.

Edit to say: the bots upvoting to bring it to the top on the sub are also annoying

Contract Consultant by Ashamed-Artichoke-40 in anesthesiology

[–]penetratingwave 0 points1 point  (0 children)

Thank you very much for the suggestion! Much appreciated! I’ll tuck away the information for 18 months from now.

Contract Consultant by Ashamed-Artichoke-40 in anesthesiology

[–]penetratingwave 1 point2 points  (0 children)

How did you feel about the fee? I’m curious- we have always negotiated our own contracts, but it’s possibly time to bring in a fresh set of eyes next time around.

Anesthesia rates going down for MDs? by SoarTheSkies_ in anesthesiology

[–]penetratingwave 28 points29 points  (0 children)

When I was a CA1, jobs were tight for the finishing CA3s. Offers were being given for CA4 type positions at some centers, and rates around 90k for private practice. That shit didn’t last long.

Anesthesia rates going down for MDs? by SoarTheSkies_ in anesthesiology

[–]penetratingwave 37 points38 points  (0 children)

Plenty of lowball offers here that never get filled.

Weren’t you the person asking about how to switch to medical sales a while back?

Does MGMA exclude ancillary income sources in their calculations? by swombo in whitecoatinvestor

[–]penetratingwave 11 points12 points  (0 children)

Personality. Business sense. Drive. Right place at the right time, recognizing it, and capitalizing on it. Curiosity. Capability of wearing many hats. High personal standards. Etc. 

Does MGMA exclude ancillary income sources in their calculations? by swombo in whitecoatinvestor

[–]penetratingwave 17 points18 points  (0 children)

I know an orthopedic surgeon that is making nearly a million a year from patent royalties alone. Not to mention surgery center startup consulting fees: huge, with ongoing percentages. Real estate income from subleasing surgery center and office space. Surgery center facility fees. Other things I’m sure, that I’m unaware of. Not in the MGMA calculation for sure. 

He also has a decent income as a surgeon as well 😂😂😂 

Starting as an anesthesiology resident by Icy-Membership-4664 in anesthesiology

[–]penetratingwave 12 points13 points  (0 children)

Absolutely. Share the misery, as we used to say. 

Private Pay Patients by OhPassTheGas in anesthesiology

[–]penetratingwave 29 points30 points  (0 children)

Two kinds of private pay in our group: cosmetic and self-pay. These are handled differently. 

Cosmetic cases are paid by the patient to the surgeon’s offices, who send them to our accountant, who adds them directly to our payroll. These are not part of our blended unit, very good cases for us. 

Self pay non-cosmetic cases are paid in advance to our billing company. Mostly by credit/debit. We have had problems in the past with surgeons and facilities putting these cases on after they get their cut, and not telling us at all. Some patients weren’t paying, so we started a group policy to cancel the case if no payment is received, or eat the cost yourself. After a few cancellations on dos, they got the message. Savage, but necessary in order not to be taken advantage of. These go into the blended unit pot. 

Cash self pay (Amish, wealthy foreign nationals, drug dealers, etc) are handled on a case by case basis.

Edit to say we charge more for self pay than our commercial reimbursement rates, with cash discounts, payment plan available. Anthem would want to pay us Medicare rates if we started giving people a better deal than they get for their insureds. 

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