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

Thu May 3 11:43:05 EDT 2007

I do agree that an oculocardiac reflex sharpens the fists :)
And as you say
"Where is he evidence" :D
Prasanna

On 5/3/07, hgrmd at aol.com <hgrmd at aol.com> wrote:
>
> 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 >>> ca
> rdiac >>>>> 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
> >>>>>
> >>>>>
> >>>>> ************************************** See what's free at >>>>>
> http://>>> www.aol.com. >>>>>
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-- 
Prasanna Simha M