Responsibility for your own health

I was shocked to see that the NHS could ban surgery for the obese and smokers.  That’s socialized medicine.  You take a conglomerate group of people (the UK) on a limited budget for healthcare… and basically find the cheapest most cost-effective way to deliver healthcare.  But in a way, it’s empowering patients to take responsibility for their own health.  Smoking, for sure — I agree 100% that surgery should be banned for this population.  Obesity is a bit trickier — there’s genetics and environmental factors at play in this one.  I don’t think anyone chooses to be obese.  But, people do have the power to change their eating and exercise habits.  Despite these efforts, there are some people who are still obese…. and these people should not be faulted.

Why single out the obese and smokers?

obesity-and-cv-disease-1ppt-44-728
From SlideShare
obesity-and-cv-disease-1ppt-43-728
From SlideShare
tobacco-health-statistics
From TobaccoFreeLife.org

Smokers and the obese have elevated surgical risk and mortality, which means more cost to treat and hospitalize and provide ongoing care.

150423sambydisease
From HealthStats

I think the NHS is on to something here.  They’re opening doors to moving the liability and responsibility away from physicians and towards patients.  This is a plus.  Outsiders may see it as separatism and elitist to only provide care for people who are healthy.  But look at the facts and the data…. obesity has a lot of co-morbidities associated.  Smoking has a lot of co-morbidities associated as well.  Why should physicians be penalized for re-admissions, poor wound healing, longer hospitalizations when the underlying conditions themselves are already challenging enough?  In fact, I would urge insurance companies to provide incentives to patients/the insured with discounted rates for good and maintained health and wellness.  With all the technologies, medications, and information out there, it’s time patients take responsibility for their own health.  I take responsibility for mine — watching my diet, exercising, working on getting enough rest, maintaining activities to keep my mind and body engaged, meditating for rest and relaxation.  It’s not easy, but my health is 100% my responsibility.  I refuse to pass the buck to my husband, my family, my physician, etc.  I do what I can to optimize my health and future — and if that doesn’t work… I call for backup.

Patients need to change their mindset re: health.  It is not your spouse’s responsibility to track your meds.  It is your responsibility to know your medical conditions and surgical history.  The single most important (and thoughtful) thing a patient can do is keep an up-to-date list of medications, past/current medical history, surgical history, and allergies to bring to every doctor’s appointment and surgery.  This helps streamline and bring to the forefront your conditions and how these will interplay with your medical and surgical plan and postoperative care.  Please do not forget recreational drugs, smoking habit, and drinking habit in this list.  It is very important to know all of these things.  Also, your emotional history is very important.  Depression, anxiety, failure to cope, etc.  This all helps tie in your current living situation with stressors and your medical history.

Links for educating yourself in taking responsibility for your health:

obesity
From SilverStarUK.org

Transthoracic Echocardiography (TTE)

Transthoracic echo: a beginner’s guide #tte #cardiac #echo #meded

Knowing how to do a quick focused echo exam can be instrumental in diagnosis as well as treatment.  This has helped me determine how severe cardiac tamponade has been in an emergent case prior to induction when there was no prior echo.  There are so many more useful answers that a bedside echo can provide.  Time to get acquainted.

Helpful links:

acoustic_windows
From Visible Heart Lab

Helpful articles:

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From ClinicalGate.com

Left atrial occlusion devices

Our hospital is starting to do more left atrial occlusion devices for people who have afib and aren’t able to tolerate blood thinners. Currently, two types are offered by our cardiologists: Watchman procedure (endocardial) vs Lariat procedure (epicardial).

Lariat

It look and acts similar to a lariat or lasso.  An external guide wire with a magnet at its tip is introduced outside the heart towards the left atrial appendage (LAA). Another wire with a magnet at its tip is introduced from a groin vein and it traverses the interatrial septum to sit at the most distal point inside the LAA. The magnets “connect” and the lariat is introduced along the external guide wire and essentially lassos the LAA.

Lariat procedure
Watchman

A large occlusion device is inserted via a groin vein and traverses the interatrial septum into the proximal (base or largest opening) left atrial appendage. The device gets deployed and successfully occludes the LAA.

Watchman

PPT on Watchman from Boston Scientific

Is one better than the other?

Endocardial (Watchman) vs epicardial (Lariat) left atrial appendage exclusion devices: Understanding the differences in the location and type of leaks and their clinical implications.  Pillarisetti J, et al. Heart Rhythm. 2015.

CONCLUSION: The Lariat device is associated with a lower rate of leaks at 1 year as compared with the Watchman device, with no difference in rates of cerebrovascular accident. There was no correlation between the presence of residual leak and the occurrence of cerebrovascular accident.

Anesthesia

For these cases, we typically have a good flowing peripheral IV and intubate these patients for general anesthesia. There’s a fair amount of TEE required for placement and verification of correct positioning of the device. Both procedures require transseptal access. Watch for hypotension as there is a risk for pericardial effusion.

TEE for Lariat

TEE for Lariat


TEE for Watchman

Watchman TEE

Echo Essentials for Endoluminal LAA Closure: April 2014 Cardiac Interventions Today

The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation: J Vis Exp. 2012; (60): 3671

Anesthesia and Transesophageal Echocardiography for WATCHMAN Device Implantation: December 2016Volume 30, Issue 6, Pages 1685–1692.

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From JACC: Cardiovascular Interventions
PDF Article

Percutaneous Left Atrial Appendage Closure
Procedural Techniques and Outcomes

3D Echo inside the Cath Lab – A must in LAA Closure. London, 2016.

ECHONOMY:Tools for Echocardiographic Calculations

YouTube: LEFT ATRIAL APPENDAGE CLOSURE PROCEDURE : Role of Transesophageal Echocardiography

YouTube: TCTAP 2015 SHD Live Case Session: LAA Closure

YouTube: How to image the inter-atrial septum using 3D-TEE “RATLe-90 maneuver”

YouTube: TOE in LA Appendage Assessment by Jason Sharp

 

Which programming language to learn for beginners? #code #coding #progamming

Medicine and technology should merge. Check out the best programming languages to learn for a beginner.

Love. Laughter. Life. Medicine.

When starting something new… ask the experts!

Ever since graduating college, I’ve always had an interest in technology.  In fact, it probably started before college when I got my first Commodore 64.  However, a busy life and other hobbies have always led me to pursue those passions over my technological curiosity.  Well, now that I’m in a great place in my life to explore other venues and really use my creativity to explore…I want to know where to start!

So, I went to Google (of course!).

Radar: Which Language Should You Learn First? –> Javascript

Lifehacker: 5 Best Programming Languages for First-time Learners –> Java, Ruby, Python, C/C++, Javascript

Screen Shot 2015-02-28 at 11.41.59 AM

Lifehacker: Which programming language should I learn first?

The Next Web: Best programming languages breakdown

Bento: Showcases the best resources for learning to code  –> Bento

Best Programming Languages to Learn 2014 –> Java, C, C++, Python, C#, PHP, JavaScript, Ruby…

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Maybe Slack could finally end some corporate seat time discussions

Maybe give it a try!

https://gaspassers.slack.com

The Context Of Things

Slack could end seat time

Last April, I wrote about how maybe Slack could revolutionize the workplace; then in February, I wrote about how they got to a $2 billion valuation with no CMO, which is insanely rare for a lot of companies.

There’s something much better than either of those posts currently on Medium and while there are about 90 different individual parts of interest, here’s one that makes a lot of sense (to me, at least):

Butterfield, Slack’s CEO, saw a larger problem with email, an organizational memory problem: “Whether you’re the CEO or an intern, on your first day at an email-based organization, you can’t see into anything — it’s all locked in people’s inboxes. You literally have no access to anything that happened in the past. There might’ve been hundreds of thousands or millions of messages exchanged at the company before you got there.” Slack doesn’t make everything transparent, but it brings…

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Starting to learn to code was a good idea

writing with the stethoscope

I admit, tech-entrepreneur hype took over me when I was in my last year of medical school. I do not remember how I started to read about entrepreneurship, it just occured. I am Forbes, FastCompany, Entrepreneur… magazine subscriber and it is being very inspirational reading through some of the success stories in mentioned articles. Aha, I remember now. it was when I read this article by Vinod Khosla: Technology will replace 80 % of what doctors do. 

As a medical student I was not keen about the idea. After all I spend long years studying medicine and now computers will take over our position. I remember being so absorbed in studies that I barely had time to think or do anything else. I do not regret it but I do think that having broader picture of how world function is not bad idea at all. Let’s go back to the…

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