Interventional Cardiologist, CTO-PCI, CHIP, Peripheral vascular disease, acute PE. Views & opinions are my own.
Rapid City, SD
Joined February 2021
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The NFL has become unwatchable. Maybe I’ll watch a playoff game. Turned packers-lions off. Will go replace wiper blades instead.
What would you do?
MD orders gene test for suspected CTD. Multiple physical findings suggest possible abN. Insurance denies claim. Patient now asks MD to appeal the decision. MD already spent >60m on the case. Test was $1000
36%Charge $500/h
43%Do it for free
21%Do nothing
14 votes • Final results@Hragy @jbspadoni @djc795 @jedicath @jl35wilsonMD @aspergian1 @mmamas1973 @realarainmd @agtruesdell @drAliyor 70sM, decent shape, SOB/Chest pressure w exertion. Critical LM disease. BP drops on LM engagement. Ventricularization of waveform. Admit for urgent CABG or send home? No rest pain.
Tom Wilson retweeted
🚨 DOGE DAYS: Remember the "GOOD OLD DAYS" of @DOGE when we thought many agencies in the Federal Govt would be abolished.
DO YOU NOW THINK ANY GOVT AGENCY OR INSTITUTION WILL EVER BE ABOLISHED?
I'd also like to know who the players were in D.C. who successfully fought @elonmusk's valiant effort to do so...
Black hills and ponderosa pines—soundtrack of wind through the pines is addicting. @jl35wilsonMD has a nice pc of land up here.
If anyone is looking for a nice Benz wagon…cleaning house, or the garage.
No Reserve: 1995 Mercedes-Benz E320 Wagon bringatrailer.com/listing/19…
How does this job even exist? If there is a more useless task to complete I’d like to know. I pity a fool! The “HIM specialist” must love lyfe. Do they obsess over this BS in other countries? @CyborgPeds @HeartOTXHeartMD @MidlevelWTF
Ops check and Garmin database updates. #Outreach in Gillette, WY, Philip, SD, and hopefully another site in ND or NE within the next 2-3 months.
How to manage this? Elderly male, adm for PNA, on Abx, underlying ILD. Trop 6k, EF normal on Echo. EDP = 9. #stringsign @agtruesdell @drAliyor @cardiojaydoc02 @IntervnCardio @TomVargheseJr @DrIHHashmi1 @sandeep_jalli @realarainmd @jl35wilsonMD @Hragy @evandrofilhobr
Heading to work—beautiful sunrise. As an outpatient heart & vascular specialist, I travel to maintain acute MI/shock skills. #weekendwarrior
Tom Wilson retweeted
Study conclusion: Angiography guided PCI was associated with significantly higher risk for MACE, However, IVI-guided PCI had comparable risk with CABG in DM patients.
But there's a methodological concern hiding in the study design that the authors didn't discuss:
Immortal time bias.
1/
Thank you for the wonderful explanation. Two (more!) naive questions about immortal time bias.
With re: to this particular analysis, where CABG pts were part of a registry but the PCI cohorts were part of an RCT, is it fair to say that:
1) Immortal time bias should favor PCI (if at all) here since there was no delay to treatment in the CABG arm? Presumably the pts had surgery exactly at the start of the follow up period.
2) Immortal time bias is unlikely to explain the difference bet. angio and IVI guided PCI because the assigned treatment was delivered immediately after randomization?
Perhaps there are other confounding factors to explain the early high event rate in the angio PCI arm? 🤔
Tom Wilson retweeted
I have been outspoken on the massive misuse of CAC testing for a long time (excerpt from my book in 2011) and have never ordered one.
@farkomd @_backtable @JayMathewsMD @DrRajeshG1 @KPujdak @realarainmd @cardiojaydoc02 @SripalBangalore @IR_Doctor 70M, h/o SMA aneurysm w surg repair x2 (2010/18) at tertiary care center. Back w ASx enlarging SMA aneurysm. Next step? Pt has not done well w/ Surgery. Endo option?
It’s always challenging seeing a patient for the last time. But encouraging to see a supportive and loving family helping a mother live graciously outside of a nursing home.
#cardiotwitter @cingolani_oscar @cardiojaydoc02 @CMichaelGibson @JayMathewsMD @AntoniousAttall @SrihariNaiduMD 60s Male see on “urgent” basis. PA did CAC—6k. Told the patient “3000 in the widowmaker.” Said Cath was needed. No clear Sx, was told to cancel Vacation w friends. Now I tell him at mos one could argue a stress test could be ordered. Had FHx as well. Now I’m accused of “not doing enough” after spending 30m explaining everything about a CAC.
Tom Wilson retweeted
"The term [provider] should not be used to describe physicians, nor should physicians use it to describe themselves, their team members, or their trainees."
acpjournals.org/doi/10.7326/… @AnnalsofIM @ACPIMPhysicians
1st RDN case in South Dakota, MT, WY. Resistant HTN is a killer. Lowering SBP by 10 mmHg makes a difference! Why hasn’t this become more mainstream? Reimbursement in all likelihood. Thank you @MedtronicCRDN. Simple, easy, quick. Both myself & @jl35wilsonMD at Black Hills Heart & Vascular are making 🌊. Thank you to the team at BHSH here in Rapid City, SD.
Tyler Childress, Gavin Adcock, Tucker Westmore headlining the TG playlist tonight. What else to add? @jl35wilsonMD @txsportsdoc @Allison_Dupont @drjohnm @DrJayMohan @AntoniousAttall @AndrewJSauer