[HSF] RCA osteal lesion-osteal reconstruction

Tue Apr 29 17:49:32 EDT 2008

so you stop getting lab, having IV access, VS q4 etc, and just give a get out of jail free card?
tea

----- Original Message ----
From: Michael Firstenberg <msfirst at gmail.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Tuesday, April 29, 2008 3:18:16 PM
Subject: Re: [HSF] RCA osteal lesion-osteal reconstruction

tried everything......... so I have just given up.
they leave when they leave - I have enough problems to worry about

-m

On 4/29/08, Prasanna Simha M <prasannasimha at gmail.com> wrote:
>
> So you can start the go home process 2 days earlier so that the added 2
> days
> become equal to the old one. I usually tell patients that they can go home
> earlier so that they can bargain for another day or 2  so that they can go
> home on schedule !! Funny how the mind of humans work.Frankly after
> tubesand
> lines  are out and patients are ambulant they really don't need to be in
> the
> hospital - just to see my ugly mug in the morning.But some patients like
> to
> see it.
> Prasanna
>
> On Wed, Apr 30, 2008 at 12:18 AM, Michael Firstenberg <msfirst at gmail.com>
> wrote:
>
> > For us, length of stay is a big joke - it is something that for the most
> > part we (and probably many) have little control over.  I have done many
> > LIMA-LADs off-pump where the patient can go home then next day.  The
> > problem
> > is they dont want to go, or it take a couple of days to figure out if
> they
> > want to go to a nursing home, figure out their insurance, get their
> > medications, their families go on vacation, and so on.  I had one CABG
> pt,
> > already to go home on POD 4 - early for us and his wife slips at work
> and
> > has a concussion.  She gets sent home with no support what so ever - but
> I
> > didnt feel comfortable sending him home.  Things are not any different
> on
> > the Cardiology/Heart Failure service - elective procedures are one
> thing.
> >
> > Besides now CMS says that you cant "kick" anyone out of the hospital -
> and
> > if patients dont want to leave they can appeal their DC which
> > automatically
> > gets them another 2 days (unclear who will pay for that!)
> >
> > -michael
> >
> >
> > On 4/29/08, Edward P Raines <dukeb60 at aol.com> wrote:
> > >
> > > Hal,
> > >    Very well said.  I couldn't agree more.
> > >
> > >                Ed
> > >
> > > Sent from my iPod
> > >
> > > On Apr 29, 2008, at 6:34 AM, Hgrmd at aol.com wrote:
> > >
> > > Tom,
> > > >  I beg to differ.  Have you honestly ever sent a patient home on
> >  POD#2
> > > > after a complex mitral valve repair?  I have.  Though the  learning
> > > > curve is
> > > > daunting, I'm quite satisfied that I can offer selected  patients an
> > > > operation
> > > > comparable or even better than the open approach.  For one thing,
> the
> > > > high
> > > > percentage of CO2 in the closed right chest means I  virtually never
> > see
> > > > bubbles on
> > > > the left side of the heart during TEE.  In  contrast, that never
> > occurs
> > > > with
> > > > sternotomy.  None of the nearly 50  robototic valve patients I've
> done
> > > > have had
> > > > a postop neurologic deficit. With  the optics on the robot, I can
> see
> > > > the
> > > > subvalvular structures better than with a  sternotomy.  I'm now
> doing
> > > > repairs
> > > > robotically that are at least as complex  as what I do open.  I
> still
> > > > don't use
> > > > robotics for calcified annuli.  The instruments are too flimsy to
> > > > reliably
> > > > excise those areas.
> > > >  Anyway, Tom, for us to stay relevant, we have to innovate.
> > Otherwise,
> > > > we
> > > > will eventually go the way of the blacksmith.  In understand  your
> > > > reluctance
> > > > to embrace minimally invasive approaches.  What are the  residents
> > going
> > > > to
> > > > do?  One thing I can tell you the stuff I'm doing can't  be done by
> a
> > > > kid who
> > > > was taking out colons 2 years earlier.  It's a tough  problem, but
> we
> > > > have to
> > > > embrace it.  I'm hearing the same things about  AVI's.  Well, if you
> > > > don't learn
> > > > to do that, you will probably lose a fair  amount of your aortic
> valve
> > > > work.
> > > >
> > > > Hal
> > > >
> > > >
> > > >
> > > > **************Need a new ride? Check out the largest site for U.S.
> > used
> > > > car
> > > > listings at AOL Autos.
> > > > (http://autos.aol.com/used?NCID=aolcmp00300000002851)
> > > > _______________________________________________
> > > > OpenHeart-L mailing list
> > > >
> > > > Send postings to:
> > > > OpenHeart-L at lists.hsforum.com
> > > >
> > > > To UNSUBSCRIBE, to CHANGE email address, or to view archives:
> > > > http://mmp.cjp.com/mailman/listinfo/openheart-l
> > > >
> > > > All messages transmitted by the OpenHeart-L are subject to the
> > policies
> > > > and
> > > > disclaimers posted at:
> > > > http://www.hsforum.com/listdisclaim
> > > > -----------------------------------------
> > > >
> > > _______________________________________________
> > > OpenHeart-L mailing list
> > >
> > > Send postings to:
> > > OpenHeart-L at lists.hsforum.com
> > >
> > > To UNSUBSCRIBE, to CHANGE email address, or to view archives:
> > > http://mmp.cjp.com/mailman/listinfo/openheart-l
> > >
> > > All messages transmitted by the OpenHeart-L are subject to the
> policies
> > > anddisclaimers posted at:
> > > http://www.hsforum.com/listdisclaim
> > > -----------------------------------------
> > >
> > _______________________________________________
> > OpenHeart-L mailing list
> >
> > Send postings to:
> >  OpenHeart-L at lists.hsforum.com
> >
> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:
> > http://mmp.cjp.com/mailman/listinfo/openheart-l
> >
> > All messages transmitted by the OpenHeart-L are subject to the policies
> > and
> > disclaimers posted at:
> > http://www.hsforum.com/listdisclaim
> > -----------------------------------------
> >
>
>
>
> --
> Prasanna Simha M
> _______________________________________________
> OpenHeart-L mailing list
>
> Send postings to:
> OpenHeart-L at lists.hsforum.com
>
> To UNSUBSCRIBE, to CHANGE email address, or to view archives:
> http://mmp.cjp.com/mailman/listinfo/openheart-l
>
> All messages transmitted by the OpenHeart-L are subject to the policies
> and
> disclaimers posted at:
> http://www.hsforum.com/listdisclaim
> -----------------------------------------
>
_______________________________________________
OpenHeart-L mailing list

Send postings to:
OpenHeart-L at lists.hsforum.com

To UNSUBSCRIBE, to CHANGE email address, or to view archives:
http://mmp.cjp.com/mailman/listinfo/openheart-l

All messages transmitted by the OpenHeart-L are subject to the policies and 
disclaimers posted at:
http://www.hsforum.com/listdisclaim
-----------------------------------------