[HSF] Too scared to touch.....

Thu May 3 02:00:02 EDT 2007

Don,
  Let's kick Prasanna's butt!
Hal 

-----Original Message-----
From: donross at bigpond.com
To: OpenHeart-L at lists.hsforum.com
Sent: Wed, 2 May 2007 6:45 PM
Subject: Re: [HSF] Too scared to touch.....

Prasanna, 
Indeed, a lot of what we practice will be found to be imperfect , but a lot of the so called evidence based practice is also bullshit. 
Do you really believe all Bojan's waiting list deaths had critical LM disease? 
Remember the bikini and statistics? 
Don 

PS It is great to have Hal onside for a change! 

On 02/05/2007, at 9:20 PM, psimha wrote: 

> Hal, 
> Please read carefully, In never said anything about critical left > mains. 
> Also if you carefully see what I said I said where is the > evidence . Some things that we practice need not necessarily be right. 
> 
> Prasanna 
> hgrmd at aol.com wrote: 
>> Don, 
>> I agree with you. If Prasanna wants to send out critical LM's >> or LAD's hanging by a hair after an MI, that's his business. >> Around here, if such patient went home without surgery and boxed, >> we'd definitely hear about it. 
>> Hal -----Original Message----- 
>> From: donross at bigpond.com 
>> To: OpenHeart-L at lists.hsforum.com 
>> Sent: Wed, 2 May 2007 4:40 AM 
>> Subject: Re: [HSF] Too scared to touch..... 
>> 
>> 
>> When they have LM or TVD + poor LV....... most of my patients. I >> hope, therefore, you are not trying to put me out of a job? Don On >> 02/05/2007, at 10:53 AM, prasannasimha wrote: 
>>> Where in literature has it been shown that a patient who is >>> stable > after an MI benefits from urgent in house >>> revascularization ? Prasanna 
>>> Donald Ross wrote: 
>>>> Also, one wonders about the not infrequent peri-op AMIs during >>>> non->> cardiac surgery that come our way for revascularisation >>>> prior to >> discharge. Is this unnecessary surgery as well, >>>> given it carries the same >> indications as regular coronary >>>> surgery? Don On 01/05/2007, at 10:04 PM, Hgrmd at aol.com wrote: 
>>>> 
>>>>> Ajit, I invested the time it took to read all of Prasanna's >>> >>>>> abstracts. I'm still not convinced that medical therapy with >>>>> beta-blockers is >>> the way to go for nearly every case. >>>>> Again, if a stress test in an asymptomatic >>> patient shows a >>>>> lot of myocardium with reversible ischemia, it would be >>> >>>>> potentially foolhardy not to cath that patient. Over the years, >>>>> we've been >>> referred lots of patients with left mains or >>>>> critical 3vd that were cathed prior >>> to an elective >>>>> noncardiac procedure (usually carotid, ischemic leg, or AAA). >>>>> >>> We did the CABG, they eventually got the vascular >>>>> procedure, and they did >>> fine. I've yet to recall "graft >>>>> closure" while the subsequent case was done. In >>> light of >>>>> the problems with DES, the cardiologists are much more likely >>>>> to use >>> bare metal stents in such scenarios. I do agree that >>>>> beta blockade, possible Swan, and a competent >>> cardiac >>>>> anesthesiologist suffice for the vast majority of cardiac >>> >>>>> patients getting noncardiac surgery. However, there are plenty >>>>> of asymptomatic >>> cardiac time bombs waiting to explode for >>>>> those that never cath and treat >>> preemptively. Hal 
>>>>> 
>>>>> 
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