AW: [HSF] Abnormal LIMA (ot)

Wed Oct 3 14:42:17 EDT 2007

I am glad that you did not ask about the quality of good. For a simple base line let's just use the so called "naive view" of good that I often discuss. Using that view, good is per Bob Frater, "Absolutely obvious!"
Perfect requires a second component, that of the universal or authoritian theory, in which the good fits precisely or at least completely. An example might be Hal's mitral valve repair done by Hal. (Sorry Hal.)If the same "good" result was done by me with the use of different theory, it could not qualify as perfect since luck or other flawed or uncontrolled artifact was attached to the good result no matter what the good result looked like.

Based on these terms and ideas I have two qualifications for a suitable theory required for perfection:
1)One it must include room for the naive truth or that what is "absolutely obvious".
2)It must not universalize the detail that is "the absolutely obvious" from one or even many (contexts) to all (contexts). 

I believe that all of our top down views fail the second test, eg universal health care (there is no universal care only the kind we currently give or someone now wants to get), universal precautions, (universal) regulations, (universal) guidelines eg. use of Lima , consensus, authority, CRTs, etc. This is, I believe, because we fail to separate our naive view from from all possible contexts and and all possible views or interactions. It is nearly impossible to resist the tendency to universalize our naive or flat view of the world. Per our many discussions our complete inability to precisely locate an idea when we try suggests our universal views can not be located in reality. Adding numbers or statisitics to our location(s) just moves our "obvious" but imprecise location into the universal world of numbers. If we apply numbers to an observation the result remains, but we may choose to give it a different meaning or cause. It does not likely mean our
 intrepretation of a detail is universal since very little is.

That we doctors talk in these terms, ie universalizing terms, is not just a CMS or USA problem, but, if I may, a universal one. 

tea

I must be on to something since "little is universal" is quite a paradox.

----- Original Message ----
From: Ben Bidstrup <benjamin.bidstrup at bigpond.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Wednesday, October 3, 2007 2:37:20 AM
Subject: Re: AW: [HSF] Abnormal LIMA

So Tea , what is perfect ?

>I think that good is almost always better than 
>perfect as we frequently discuss...even in 
>women. tea ----- Original Message ---- From: 
>David Harris <drdharris at yahoo.co.uk> To: 
>OpenHeart-L at lists.hsforum.com Sent: Tuesday, 
>October 2, 2007 3:15:52 PM Subject: Re: AW: 
>[HSF] Abnormal LIMA I have used quite a few 
>radial that have a good lumen (old patients - 
>tend to have less spasm), but patchy areas of 
>calcium. This has not put me off, as they were 
>very large radials, and sofar there have been no 
>come-backs. But I have often wondered if these 
>radials with small areas of calcium are BETTER, 
>as they can obviously never spasm! Dave --- "Dr. 
>Roberto Battellini" 
><battr at medizin.uni-leipzig.de> wrote: > We do 
>the same as you did. With Intuition and > 
>experience. Last year we > discarded a big 
>atherosclerotic LIMA in an > coarctatio aortae 
>operated > patient who came 30 years later for 
>AVR (bicuspid > valve) and bypass. I have > 
>discarded also many  radial arteries because 
>of > calcification. > Roberto > > 
>-----Ursprüngliche Nachricht----- > Von: 
>openheart-l-bounces at lists.hsforum.com > 
>[mailto:openheart-l-bounces at lists.hsforum.com] 
>Im > Auftrag von > MDavalle at aol.com > Gesendet: 
>Montag, 1. Oktober 2007 17:20 > An: 
>OpenHeart-L at lists.hsforum.com > Betreff: Re: 
>[HSF] Abnormal LIMA > > In a similar "vein", I 
>am wondering what do do when > I take down a 
>LIMA and > it > has small islands of non 
>obstructive plaque.  I have > seen this mostly 
>in > young diabetics and went ahead and used 
>them > documenting good flow at > completion > 
>with Medi-stem.  What do others think? > > > > 
>************************************** See 
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>----------------------------------------- > Dr. 
>David G. Harris, FCS, MMED, Cardiothoracic 
>Surgeon        Suite 207 
>Kuils River Private Hospital,        PO Box 
>1200, Kuils River, 7579, Cape Town, South 
>Africa.            Tel +27-21-9006411 
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--
Ben Bidstrup FRACS FRCSEd FEBCTS
Consultant Cardiothoracic Surgeon
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