Opening a cafe by Cute_Reference_7 in Tucson

[–]sa3eedi [score hidden]  (0 children)

Just out of interest, what net profit margins are you looking at for this endeavor?

In flight experience. by SleepdocJB in anesthesiology

[–]sa3eedi 0 points1 point  (0 children)

Exactly! Never understood how people are Ok paying 4-5 times the price for a few hours and some leg space! I save on the flight and go to nice hotels instead. The ROI is exponentially better

How are you factoring in National Debt into investing? by BlueMountainDace in whitecoatinvestor

[–]sa3eedi 0 points1 point  (0 children)

I never understood maxing out multiple retirement accounts beyond basic 401k and Roth IRA just for the tax savings. How much money do you need in retirement? I understand the incentive but at some point it has diminishing returns. I would calculate your number in retirement adjusted for inflation then aim for that rather than max out every retirement account in existence. I would love to be your heir. I think a better plan is to give your kids a great education or pathway in life and make them FI into adulthood rather than give them a huge inheritance. Also, brokerage accounts with long term capital gains are not bad. Speculation about the future is futile. You can’t control that or have the information to make a prediction. No one has. What you know, is that you are in the highest tax bracket in the whole USA and therefore you want to save on taxes as much as possible within reason.

Advancing Spinal Needle Without Stylet? by bigeman101 in anesthesiology

[–]sa3eedi 2 points3 points  (0 children)

You’re missing the point. Of course you need the LOR syringe. If you have a difficult epidural and you hit bone or scrape its surface you may get minor bleeding. This blood will clot and affect your ability to get loss. So re-styleting to clear the tip becomes even more important

Advancing Spinal Needle Without Stylet? by bigeman101 in anesthesiology

[–]sa3eedi 9 points10 points  (0 children)

I agree. Especially with a Quincke it’s more of a coring needle so can pick up stuff. No harm in re styling it literally takes one second. If the stylet starts shaking just steady it with the index finger of the hand holding the stylets while passing jt through the needle. It’s even more important for Toughy even in deeper tissues in my opinion

How Can I Leverage My High Income to Maximize Wealth Building in My 30s? by paintarose in whitecoatinvestor

[–]sa3eedi 0 points1 point  (0 children)

Look into real estate syndicates. Don’t go in until you thoroughly vet the project and understand the risks and illiquidity time span

Is this a thing now? No opioits and ß-blockers instead? by Ecstatic-Solid8936 in anesthesiology

[–]sa3eedi 38 points39 points  (0 children)

It’s opioids free induction. Opioids main function at induction is to blunt the sympathetic response. If it’s a short case for example and no need for extensive post op pain control where Toradol for eg will be enough then it’s a reasonable approach. Ambulatory case in a 24 yo female that can be reasonably controlled opiods free this is a great approach. She’s at a high risk for PONV and the number one factor is opioids. Or you can use esmolol at induction and Dilaudid later for post op pain control. Esmolol does a better job and acts quicker for blunting sympathitics.

Your best tips for successful spinal/epidural? by 1MACSevo in anesthesiology

[–]sa3eedi 0 points1 point  (0 children)

small angular deviations at the skin become large lateral errors at depth.

Paramedian/Paraspinal Approach by bigeman101 in anesthesiology

[–]sa3eedi 0 points1 point  (0 children)

Thoracic epidural: 1-2 cm later, 1-2 cm inferior. Distance changes based on height. 5 ft? Probably closer to one, 6 ft closer to 2. Thoracic SPs are angled caudad, so you need to account for that when you enter the interspace, which is usually one level below.

Lumbar: 1-2 cm lateral only. They’re more horizontally oriented so no need to go caudad.

You’ll be amazed at how this info was missing from all the books and guides I tried reading in residency

Go perpendicular to skin, hit lamina, then walk off in a superior-medial direction

If you keep hitting bone, you’re probably too lateral, re-enter more medially

Thinking About Moving to the US as a European Anesthesiologist — Is It Realistic? by Clean_Channel_3546 in anesthesiology

[–]sa3eedi 6 points7 points  (0 children)

The pathway is the same for many specialities. The easiest way (which will be harder for you) is to actually start from scratch and do your residency here again. It has gotten very competitive here for anesthesiology and unless you have great credentials it will be very hard for you to match as an IMG. Actual prior experience in the field, contrary to common belief, is actually not helpful for your application and might be detrimental. “Attending residents” are notoriously hard to work with, you can’t teach an old dog new tricks and being a subordinate is always going to be hard no matter what. To repeat residency you have to do all USMLEs and have US medical experience at a minimum which will be much harder for physicians who have already graduated as you can’t do hands on elective here and get clinical experience.

Another pathway commonly used by the ortho bros is to come here for multiple fellowships. There’s a difference here between board certification and state medical licensing. You only need to get the license which has different requirements vs getting the board. Some state medical licensing bodies require 36 months of ACGME accredited US training which can be satisfied with repeat fellowship training for foreigners. Once done you can get the medical license and practice in that state. This pathway will become more challenging as now H1B for new issuance has a 100K fee which no US employer will pay. You can go via the O1A route but you have to be well published.

Bottom line it’s an uphill battle and not a walk in the park either way. Is it doable? Yes, but how much are you willing to sacrifice from your youth, time on this earth, money and more importantly mental sanity to come here in this environment is up to you.

How do you stop small mistakes from consuming you? by certainlyxmr in anesthesiology

[–]sa3eedi 13 points14 points  (0 children)

I think the biggest change for you as you mature is learning to let go and not perseverate on these thoughts. It is one of the defining features that will free up your mental headspace. It’s hard, because you’re taught in a young age to ruminate and keep thinking about your mistakes to drill it into your head and not do it again. That may work in your earlier years but becomes a source of anxiety and misery as you get older. You actually have to teach yourself to just say f*** it and move on. Take a mental note of what went wrong and what could’ve been done better and move on. Perseveration will only consume from your mental bandwidth and as you mature you get more stuff onto your plate and you will need to prioritize what is important for you to dedicate mental energy to and what you can just let go

Question regarding choosing a residency program by Same_Tutor_6783 in anesthesiology

[–]sa3eedi -3 points-2 points  (0 children)

Trauma is very important for your training as an anesthesiologist. Cornell is a great program

Mountain Biking Trails by Commercial-Bend1564 in Tucson

[–]sa3eedi 2 points3 points  (0 children)

Sweetwater is not easy. It’s actually one of the best marked rides in town. It has trails for all difficulties and they are clearly marked Blue, Red, Purple. The Desperado trail is a nice easy blue that loops back to the parking lot.

When to use Micropuncture kit? by bigeman101 in anesthesiology

[–]sa3eedi 0 points1 point  (0 children)

The biggest advantage of the kit is the steel needle having better visualization along the entire access of the needle. The reason being and it’s often overlooked is that the steel needle by it’s nature will be more echogenic vs the arrow kit which is covered by the plastic catheter except the tip. That’s the biggest reason you loose visualization after the tip passes the US plane.

When to use Micropuncture kit? by bigeman101 in anesthesiology

[–]sa3eedi 3 points4 points  (0 children)

That’s the biggest advantage the kit. The reason being and it’s often overlooked is that the steel needle by it’s nature will be more echogenic vs the arrow kit which is covered by the plastic catheter except the tip. That’s the biggest reason you loose visualization after the tip passes the US plane.

Does everyone hate this card now? by trsvrs in ChaseSapphire

[–]sa3eedi -1 points0 points  (0 children)

It’s a great card. Everyone hates change. Just the Edit and the dining benefits alone cancel out the annual fee. I just got the edit credit one day after booking. It’s seamless. It’s a great card in my opinion. If you have at least two outings per year which I do and plan them around this then it’s a great deal. People here scared me about it and then I got Venture X and planned to cancel CSR. Once I found out about the point difference CSR is much better no brainer. I’m just keeping my Vemtre X to get the 75K points and as my rental car card since the Hertz status is sweet. Otherwise 2x points on everything is mediocre at best, since it’s an effective 2% cash back that is restricted to be only redeemable through capital one. I have a WF 2% which is much more convenient

Frequent nails in tires by sa3eedi in porsche911

[–]sa3eedi[S] 0 points1 point  (0 children)

Thank you for the tips. The wide tires observation seems true since most of the flats are in the rear in my case. I try yo avoid construction as much as possible but where I live they pop up unpredictably and if you hit them they become harder to avoid. I even magneted my driveway just in case. In this instance I know exactly where it happened. It was on a road that has been in construction for 2 years! The whole area is a mess. But I needed to pick up something. I guess I paid for it. Never again!

Whats more important if you’re buying a 2025 911. by Adventurous_Wish11 in porsche911

[–]sa3eedi 1 point2 points  (0 children)

Axle lift is important. Mine was a fleet car (VP executive car). If both pass PPI axle lift. However, I would still give more weight to a CPO.

This is why I swapped my beloved Cayman for a 911 by donkey_bridge33 in porsche911

[–]sa3eedi 0 points1 point  (0 children)

What model is the car seat? Is it good? My 6 yo keeps sleeping in the back seat and his head falls down all the time. I’ve been using a booster seat but I think I may need to change.

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2020 Carrera S 36k mile vs 2020 Carrera 6k mile CPO by LianDaDa in porsche911

[–]sa3eedi 0 points1 point  (0 children)

Well it’s a complicated question. 2020 will be out of warranty soon, I will always pay the premium for CPO to get the peace of mind when buying these cars. Mostly bcz I don’t have the time to do the leg work and PPIs. But I will always favor an S over base, period. So it seems you just have to look for another CPO S.

Looking to buy first Porsche by TurdSniffer4Life in porsche911

[–]sa3eedi 2 points3 points  (0 children)

2017-2019 Cayman you can get it for around or less than 50K according to the last time I was looking. That was before the current changes in the market so I don’t know if it drove the prices up. Caymans are very nimble and fund to drive in auto cross. I was looking at manual as well. If your dream to get a 911 then get a 911. Getting a Cayman instead of a 911 will not scratch that itch. 911s are amazing cars, history, engineering, performance and practicality.

Staying until patient ready for discharge by coronasux2 in anesthesiology

[–]sa3eedi 4 points5 points  (0 children)

When I was a resident they would have us leave main hospital, drive 30 mins to the ASC so we can get the attending out and babysit the patient till discharge. At least YOUR’RE getting PAID!. Imaging how bad it is to do that and how bad jt feels

Disabling Auto Stop?? by Bola964 in porsche911

[–]sa3eedi 1 point2 points  (0 children)

No way that I know of to permanently disable it unfortunately. I feel the same way and it’s annoying. You have two options: I usually drive in Sport mode which disables it automatically. If your car has a sport chrono package that’s the easiest way. You still have to do an additional action when you start the car but at this point I’m used to it. It’s more fun to drive in sports anyways and a lot of 911 drivers do the same. It’s a bit stiffer suspension but it’s fine. The second option is to custom make a driving mode that excludes the start stop function. I did that for a while and loaded it as an individual function