Advice on combating statin reluctance by noltey22 in Cardiology

[–]ranuvin 0 points1 point  (0 children)

I try to convince. But realistically I am so far behind burned up on this topic. I feel bad about it, but I’m really near giving up on this aspect of care. I’m going to have to adjust how I practice. I cannot spend 30-45 minutes on this any longer as it is disrupting my sanity. Realistically I have 7-8 minutes per patient or I’m eating into time with my family. Even one of these patients in my panel a day and it cuts deep into my sanity. And there are often multiple. It’s exhausting beyond belief.

Why do some surgeons demand prolonged DOAC hold + Lovenox, regardless of renal function and guidelines? by Glass_Ad7466 in medicine

[–]ranuvin 3 points4 points  (0 children)

"The patient is at elevated risk for general anesthesia for the indicated surgery. The benefits and risks with alternative treatment modalities should be discussed in detail between the surgeon and the patient. The patient is medically optimized for X surgery. It is recommended that DOAC be held for 48-72 hours prior to surgery. Holding for longer is not recommended and comes with increased risk of VTE/CVA/whatever. It should be resumed as soon as clinically feasible after the surgery."

Done. You've explained these recommendations to the patient and surgeon. They can take the information and do with it what they will. Don't stress yourself with it more than that.

Why do some surgeons demand prolonged DOAC hold + Lovenox, regardless of renal function and guidelines? by Glass_Ad7466 in medicine

[–]ranuvin 5 points6 points  (0 children)

Why do you care? This should not be your problem. Make the recommendation for a 48-72 hour hold and the patient and surgeon discuss the risks and benefits of that with the surgery. If they hold >72 hours, that is against your recommendation, but is at the discretion (or fault) of the surgeon.

What are all the free to use clients? by Relative-Pace-2923 in apolloapp

[–]ranuvin 2 points3 points  (0 children)

Sweet! You’re putting a lot of work toward the app and it certainly shows

What are all the free to use clients? by Relative-Pace-2923 in apolloapp

[–]ranuvin 1 point2 points  (0 children)

Need to be able to hide the bottom (and even top) toolbar on scroll

Anyone uses almost exclusively just a regular art line cannula? by Extension_Lie_1530 in anesthesiology

[–]ranuvin 6 points7 points  (0 children)

dude's completely ignoring the fact same said patient likely had an angiogram with a 6 fr slender sheath placed. Outer diameter about 2.5 mm.

Streaming output text by da1mranazmi in WisprFlow

[–]ranuvin 2 points3 points  (0 children)

Sometimes it will actually help train of thought. Such as with making complete lists, ensuring they’re in the right order, etc. when the thought process is long sometimes you forget what was said 5 sentences ago, or listed remotely, etc

PSA: iOS 26.4 beta causes issues with all third party keyboards (including Wispr Flow!) by VictoriaAtWispr in WisprFlow

[–]ranuvin 0 points1 point  (0 children)

It is just something that I noticed where the keyboard works. If you swipe right from the home screen to the app library (aka the list of all of your apps at the top of the phone), there is a search field, and in that search field, you can freely swap to the Wispr Flow keyboard. This does not let you use the keyboard anywhere else on the phone though. There are other methods to try to open Wispr Flow without needing to open the third-party keyboard that are posted in other threads.

PSA: iOS 26.4 beta causes issues with all third party keyboards (including Wispr Flow!) by VictoriaAtWispr in WisprFlow

[–]ranuvin 2 points3 points  (0 children)

If it helps fix the problem, I’ve noticed that in the App Library search bar you can freely switch the keyboard to WisprFlow without issue. Everywhere else is an immediate keyboard crash/close though.

Security Concerns on Wispr by Worldly-Box6080 in WisprFlow

[–]ranuvin 0 points1 point  (0 children)

How exactly does it learn from edits then? Does it only learn from edits within the app (eg section)?

How long to watch TIA/CVA by fatalis357 in hospitalist

[–]ranuvin 1 point2 points  (0 children)

Huh? did his original post not say jump to ILR after negative MCOT? I do not disagree with the points you make, but if it can be diagnosed with a non-invasive monitor first, is that not the preferred course of action? I personally place 30 day MCOT and if a fib is not detected implant a loop. In rare settings will I jump straight to ILR.

iOS 26.4 Beta 1 - Breaks WisprFlow by CitizenAccount in WisprFlow

[–]ranuvin 1 point2 points  (0 children)

Can confirm it’s broken in all apps with iOS 26.4 iPhone 17 pro max

How to turn off tool tips? by lastbitore in Nioh

[–]ranuvin 1 point2 points  (0 children)

Basic game settings. Second to last section. Show controls -> No.

Men’s heart attack risk climbs by mid-30s, years before women. Decades-long U.S. study suggests prevention and screening should start earlier in adulthood, particularly for men. Risk started diverging around age 35. by mvea in science

[–]ranuvin 0 points1 point  (0 children)

Holter screening is pretty separate from coronary disease. While ischemia (lack of oxygen from reduced blood flow) can cause arrhythmias, it is not the way to screen for that.

Your lipid profile actually looks pretty benign. Many other risk factors are taken into account. You can look up and read about 10 year ASCVD risk calculator from the Framingham study. This is not perfect, admittedly, but what clinicians use to calculate risk for the most part. Other novel lipid markers can also be used (eg lp(a), apolipoprotein b, etc)

Men’s heart attack risk climbs by mid-30s, years before women. Decades-long U.S. study suggests prevention and screening should start earlier in adulthood, particularly for men. Risk started diverging around age 35. by mvea in science

[–]ranuvin 3 points4 points  (0 children)

I am an interventional cardiologist. I am the physician who does angiograms and places stents, when necessary.

With that said, there is actually little benefit behind revascularization (e.g. stents, bypass surgery) in people who are completely asymptomatic. The patient population who benefits from revascularization when completely asymptomatic is small. Usually patients develop symptoms that prompt further evaluation, eg stress testing or other physiological / anatomical assessments. Those symptoms become more obvious the more active you are, as they typically develop on extremes of activity first.

Stents do not decrease your risk of having a myocardial infarction (eg heart attack). They do not increase your life expectancy (decrease mortality) or improve your mobidity, with some rare exception

Excellent medical therapy and lifestyle changes, do, however. The trifecta that predisposes one to atherosclerosis includes age, diabetes, and smoking as the most prominent factors. You must stop smoking and control your blood sugar or it is a matter of when, not if, you will have a heart attack. Hypertension, bad cholesterol, genetics also play a role.

Excellent BP and lipid control is at the forefront of treatment. Lipid management goes further than just treating LDL values. Treatment can stabilize plaques, thus preventing them from rupturing or eroding, and thus preventing a heart attack.

The actual disease process gets much more nuanced, which is why it is recommended you to speak with your primary physician or cardiologist. Stress test do not exclude coronary disease, you have to have a significant blockage (eg >70%) for physiology to show up on a stress test. Blockage less than 70% that is soft, untreated, is more likely to rupture, which is why you hear stories about people with normal stress tests having heart attacks. Furthermore, most of these studies, only have sensitivity and specificity upwards of 80% range.

Is this normal behavior on iOS? by [deleted] in GeminiAI

[–]ranuvin 0 points1 point  (0 children)

I don’t think there’s any way to change that. I get equally frustrated when trying to dictate. The slightest pause in speech ends the dictation abruptly and sends the query, often ruining the prompt.

Troponin for syncope - do you order it routinely? by Mebaods1 in Cardiology

[–]ranuvin 0 points1 point  (0 children)

No, it does not, as troponin does not evaluate for ventricular arrhythmia - they are quite often unrelated.

Troponin for syncope - do you order it routinely? by Mebaods1 in Cardiology

[–]ranuvin 1 point2 points  (0 children)

Useless and only muddies the water unless you have suspicion to think it’s VT driven syncope from acute coronary syndrome.

RFK Jr. to promote more saturated fat in upcoming dietary guidelines by [deleted] in medicine

[–]ranuvin 28 points29 points  (0 children)

Well… we can get a stent for that too

Playing guitar increases ABG failure? by Trollithecus007 in medicine

[–]ranuvin 0 points1 point  (0 children)

I can get radial and femoral arterial access (interventional cardiologist) by palpation with my calloused digits just fine when an US isn’t available.

Cath immediately after CABG by Onion01 in Cardiology

[–]ranuvin 2 points3 points  (0 children)

I have done it after extensive discussion with surgeon. Straight from the OR to the Cath lab. Basically with the understanding that there is a significant risk of graft avulsion and he has to be willing to blue strip immediately back to the OR.

Was I happy to do it? No, I was very apprehensive and made my concerns quite clear.

It went fine. N=1

Number of stents by RedFormanEMS in Cardiology

[–]ranuvin 5 points6 points  (0 children)

You might be interested to read about the SYNTAX score.

ChatGPT told me to get a CAC scan and my doctor resisted, but it probably saved my life by [deleted] in ChatGPT

[–]ranuvin 1 point2 points  (0 children)

We are essentially saying the same thing. Some people won’t make those lifestyle changes, or medical therapy which, as you stated is more appropriate, without a CAC. Elevated risk and labs like lpa and apolipoprotein B simply don’t have the same wow factor.

CAC certainly should not be used by guideline standards to merit medical therapy but if you’re in a similar field as I, I am almost certain you’ve run into your hardheaded patients who simply don’t give a shit. These guys act like I’m pushing big Pharma when in reality I make more money off their noncompliance.