The Walls be Closing

[Joe Ferguson forever]

23 minutes ago, Doc said:

Yes, zero science.  Even Teflon Tony admitted they were useless at the outset.  And then this: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006207.pub6/full

 

Sure you didn't consider Trump.  You just considered the "danger" of HCQ, while telling your patients to adjust their masks and move a little further away from you.

 

And "real doctors" my ass.  Again, beyond masking and 6 feet, tell me what they said about remdesivir again, while pooh-poohing HCQ?  It would have been comical if it weren't so shameful.

this paper doesn't say what you think it says

https://www.cochrane.org/news/statement-physical-interventions-interrupt-or-reduce-spread-respiratory-viruses-review

once again, a little knowledge is a dangerous this but also shame on Cochraner for releasing such a poorly explained review and needing to apologize.

 

politics have never played a role in my medical decision making (or of anyone I personally know) regardless of what you think (really, why should anyone care what u think?)

 

The vast majority of real doctors questioned HCQ from the very beginning.  The studies were small and appropriately viewed with skepticism.  If you actually hold a medical degree, you were in a very small minority of doctors who were very clearly wrong and lost respect among their colleagues.

[Doc]

4 minutes ago, redtail hawk said:

this paper doesn't say what you think it says

https://www.cochrane.org/news/statement-physical-interventions-interrupt-or-reduce-spread-respiratory-viruses-review

once again, a little knowledge is a dangerous this but also shame on Cochraner for releasing such a poorly explained review and needing to apologize.

 

politics have never played a role in my medical decision making (or of anyone I personally know) regardless of what you think (really, why should anyone care what u think?)

 

The vast majority of real doctors questioned HCQ from the very beginning.  The studies were small and appropriately viewed with skepticism.  If you actually hold a medical degree, you were in a very small minority of doctors who were very clearly wrong and lost respect among their colleagues.

Masks were used a political tool because Trump refused to wear them.  They essentially did nothing. 

 

And like I care about political morons in the medical community who claimed HCQ was dangerous and therefore couldn't be used, when there was anecdotal evidence it did and we had nothing else to treat Wuhan virus with.  And your refusal to talk about remdesivir tells me all I need to know about you. 

Edited April 12, 2023 by Doc

[Joe Ferguson forever]

1 minute ago, Doc said:

Masks were used a political tool because Trump refused to wear them.  They essentially did nothing. 

 

And like I care about political morons in the medical community.  And your refusal to talk about remdesivir tells me all I need to know about you. 

Cochrane's biggest mistake was assuming only intelligent people would read the review and that people like you with political agendas wouldn't misinterpret and amplify the misinterpretation.  Remdesivir has nothing to do with physical barriers for decreased transmission but in comparison to Ivermectin and HCQ the early studies were more robust and convincing.  It appears the approval process was incorrect based on the unfulfilled promise of the early studies.  I wasn't part of the FDA panel that approved it.  They probably shouldn't have just as they shouldn't ever have for HCQ.  two wrongs don't make a right.

[Doc]

2 minutes ago, redtail hawk said:

Cochrane's biggest mistake was assuming only intelligent people would read the review and that people like you with political agendas wouldn't misinterpret and amplify the misinterpretation.  Remdesivir has nothing to do with physical barriers for decreased transmission but in comparison to Ivermectin and HCQ the early studies were more robust and convincing.  It appears the approval process was incorrect based on the unfulfilled promise of the early studies.  I wasn't part of the FDA panel that approved it.  They probably shouldn't have just as they shouldn't ever have for HCQ.  two wrongs don't make a right.

 

Right, and people like you with a political agenda weren't smart enough to see through the bull#### behind remdesivir versus the treatment of HCQ.  Again when there was no treatment for wuhan virus and HCQ was a perfectly safe enough drug for millions of people to be on daily for years/decades. 

[Joe Ferguson forever]

7 minutes ago, Doc said:

 

Right, and people like you with a political agenda weren't smart enough to see through the bull#### behind remdesivir versus the treatment of HCQ.  Again when there was no treatment for wuhan virus and HCQ was a perfectly safe enough drug for millions of people to be on daily for years/decades. 

you do realize that remdesivir is still approved for use in non hospitalized patients by the FDA and in many other countries.  It has proven effectiveness in this subset.  Not so for HCQ or Ivermectin.  But joust on Don Quixote...keep fighting those windmills.

 

https://www.cdc.gov/coronavirus/2019-ncov/your-health/treatments-for-severe-illness.html

Edited April 12, 2023 by redtail hawk

[All_Pro_Bills]

1 minute ago, redtail hawk said:

you do realize that remdesivir is still approved for use in non hospitalized patients by the FDA and in many other countries.  It has proven effectiveness in this subset.  Not so for HCQ or Ivermectin.  But joust on Don Quixote...keep fighting those windmills.

I was under the impression remdesivr was only formulated for IV/Infusion.  Which restricts use to inpatient situations.  Is there an approved oral or self-injectable?  

I know HCL and Ivermectin are both taken orally.  One being an anti-inflamatory and the other a protease inhibitor.  I believe approved Paxlovid is also a protease inhibitor but much more expensive.

 

[Doc]

16 minutes ago, redtail hawk said:

you do realize that remdesivir is still approved for use in non hospitalized patients by the FDA and in many other countries.  It has proven effectiveness in this subset.  Not so for HCQ or Ivermectin.  But joust on Don Quixote...keep fighting those windmills.

 

https://www.cdc.gov/coronavirus/2019-ncov/your-health/treatments-for-severe-illness.html

 

Great that it's still approved by the FDA.  No one is prescribing it anymore and lawsuits are piling up over it causing renal failure/death.  And initial trials showed it was useless but it was still pushed.  So again, why did they claim HCQ was dangerous and couldn't be used?

Edited April 12, 2023 by Doc

[Joe Ferguson forever]

15 minutes ago, All_Pro_Bills said:

I was under the impression remdesivr was only formulated for IV/Infusion.  Which restricts use to inpatient situations.  Is there an approved oral or self-injectable?  

I know HCL and Ivermectin are both taken orally.  One being an anti-inflamatory and the other a protease inhibitor.  I believe approved Paxlovid is also a protease inhibitor but much more expensive.

 

lots of iv drugs are given in these places called infusion centers.  Remdesivir was also given in ER's IV.  Still is as far as I know.  Not keeping up with trends and the literature as much these days.  I did just see a paper that showed improved mortality for non ventilator inpatients with it vs placebo and it's still approved for that. Neither HCQ or Ivermectin are approved for Covid in any pt.  Paxlovid is approved and oral.  It's all in the link I gave earlier.

11 minutes ago, Doc said:

 

Great that it's still approved by the FDA.  No one is prescribing it anymore and lawsuits are piling up over it causing renal failure/death.  And initial trials showed it was useless but it was still pushed.  So again, why did they claim HCQ was dangerous and couldn't be used?

There are dangers with any drug, even aspirin (GI bleeding especially) and zantac (confusion, aspiration etc) and drug interactions with anything prescribed.  It's about risk/benefit.  If there are no demonstrable benefits than the finite risks of HCQ outweigh its use.  It's Not rocket surgery "Doc"

Edited April 12, 2023 by redtail hawk

[Doc]

7 minutes ago, redtail hawk said:

There are dangers with any drug, even the aspirin (GI bleeding especially) and zantac (ZE syndrome, aspiration etc).  It's about risk/benefit.  If there are no demonstrable benefits than the finite risks of HCQ outweigh its use.  It's Not rocket surgery "Doc"

 

LOL!  Go perform an EKG "doc."

Edited April 12, 2023 by Doc

[Tommy Callahan]

If one changed hcq for say mifepristone in the story above.  Same voices would be arguing about choice and availability.    

[Joe Ferguson forever]

25 minutes ago, Chris farley said:

If one changed hcq for say mifepristone in the story above.  Same voices would be arguing about choice and availability.    

not following.  please diagram your argument cuz I can't.

27 minutes ago, Doc said:

 

LOL!  Go perform an EKG "doc."

Almost never performed them and neither do anesthesiologists.  Techs or nurses perform them.  Doctors interpret them and make often difficult medical decisions based on these interpretations..  Same with EEG's or CT's, echos, stress tests, sleep studies, plain films, labs etc.  Do you practice in a 3rd world country?

Edited April 12, 2023 by redtail hawk

[Doc]

3 minutes ago, redtail hawk said:

Almost never performed them and neither do anesthesiologists.  Techs or nurses perform them.  Doctors interpret them.  Same with EEG's or CT's, sleep studies, plain films, labs etc.  Do you practice in a 3rd world country?

 

Stick with what you know, whatever that is.  We always use EKG monitoring in the OR. 

[Joe Ferguson forever]

26 minutes ago, Doc said:

 

Stick with what you know, whatever that is.  We always use EKG monitoring in the OR. 

yeah, I've never seen an anesthesiologist place his own EKG electrodes which the word "perform" would imply.  And intraoperatively, it's almost always a monitor strip with limited leads and not an actual 12 lead EKG.  stop digging...and NC calls me a quack and leaves you unquestioned.  You guys are so transparent and disingenuous.  truth isn't often part of any of your arguments.  Why is that?  hmmmm...Is reality that unflattering?

Edited April 12, 2023 by redtail hawk

[Doc]

Just now, redtail hawk said:

yeah, I've never seen an anesthesiologist place his own EKG electrodes which the word "perform" would imply.  And intraoperatively, it's almost always a monitor strip with limited leads and not an actual 12 lead EKG.  stop digging...and NC calls me a quack and leaves you unquestioned.  You guys are so transparent and disingenuous.

 

First off, you missed the joke.  Second of all, even a 3 lead EKG is more than most other doctors perform typically and it's not hard to place the other 8 (or 6 if you're using 5 leads).  But I can diagnose virtually anything with it (if I want ST monitoring I use a 5-lead) and even diagnosed a patient with a previously undiagnosed Mobitz Type II a few weeks ago. 

[Joe Ferguson forever]

16 minutes ago, Doc said:

 

First off, you missed the joke.  Second of all, even a 3 lead EKG is more than most other doctors perform typically and it's not hard to place the other 8 (or 6 if you're using 5 leads).  But I can diagnose virtually anything with it (if I want ST monitoring I use a 5-lead) and even diagnosed a patient with a previously undiagnosed Mobitz Type II a few weeks ago. 

Oh wow!!!  Did a cardiologist read the preop EKG and miss heart block?  c'mon.  stop lying.  6 if you're using 5 leads?  your math isn't great either. btw, heart block recognition is required of nurses to pass advanced CPR.  It's not difficult.

 

https://www.aclsmedicaltraining.com/rhythm-recognition/

and no. I didn't take a prep course for ACLS ever.  Knew these rhythms in med school.

Edited April 12, 2023 by redtail hawk

[Doc]

9 minutes ago, redtail hawk said:

Oh wow!!!  Did a cardiologist read the preop EKG and miss heart block?  c'mon.  stop lying.  6 if you're using 5 leads?  your math isn't great either. btw, heart block recognition is required of nurses to pass advanced CPR.  It's not difficult.

 

Exactly, it's not hard.  And no, there was no preop EKG.

Edited April 12, 2023 by Doc

[Joe Ferguson forever]

23 minutes ago, Doc said:

 

Exactly, it's not hard.  And no, there was no preop EKG.

So why were you bragging about it?  btw, this was a test and you failed.  The scenario you described is unlikely but possible.  Heart block can be intermittent and if you knew what you were talking about that would have been the obvious rebuttal.  but you don't.  and you better start doing preop EKG's on pt's susceptible to any cardiac condition if you want to avoid getting sued.  Clinical testing med students and residents is part of our training so I'm very familiar with this type of questioning.  If you were on rounds with me as the attending, you'd have been very embarrassed.  But you would have learned.

 

EKG: Men over the age of 50 and women over the age of 60 should have a 12-lead EKG if one has not been performed in the past year. A patient of any age with cardiopulmonary disease, renal disease, hypertension, or diabetes, should also have a preoperative EKG performed close to the date of the procedure.

 

Guidelines for Preoperative Cardiac and Pulmonary Testing

Edited April 12, 2023 by redtail hawk

[Doc]

Just now, redtail hawk said:

So why were you bragging about it?  btw, this was a test and you failed.  The scenario you described is unlikely but possible.  Heart block can be intermittent and if you knew what you were talking about that would have been the obvious rebuttal.  but you don't.  and you better start doing preop EKG's on pt's susceptible to any cardiac condition if you want to avoid getting sued.

 

We don't do EKGs on otherwise healthy 53 year olds, which she was.  And yes it was intermittent.  What that has to do with it happening and me diagnosing it is a good question. 

[Joe Ferguson forever]

27 minutes ago, Doc said:

 

We don't do EKGs on otherwise healthy 53 year olds, which she was.  And yes it was intermittent.  What that has to do with it happening and me diagnosing it is a good question. 

fail.  That should have been an immediate, spontaneous response from any anesthesiologist I've ever met.  Should not have required prompting. You are either really bad at your job or you're not an anesthesiologist.  Oh, and for men 50 is the cutoff for EKG's per the guideline.  In all the hospitals I've worked in an EKG over a month old wouldn't suffice despite the caveat in the guidelines for 1 year.  Why take the risk?  This 53 yo could have easily gone into 3rd degree HB on your table and you' and he would be screwed.  BTW, what happened to the patient?  Was the case presented at M and M?  What was the surgeon's response.  Will he still work with you?  Did you have to defend your decision not to do a preop EKG to your peers?

Edited April 12, 2023 by redtail hawk

[Doc]

2 minutes ago, redtail hawk said:

fail.  That should have been an immediate, spontaneous response from any anesthesiologist I've ever met.  Should not have required prompting. You are either really bad at your job or you're not an anesthesiologist.

 

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