Lolpoor paging Marcus Aurelius

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jpistolero02
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2:30p, 7/10/20
This is fascinating.

I went to my dermatologist not long ago as well. I wasn't prepared for her to look down my drawers. She then asked if my mom was in the waiting room. I told her I was 40 years old. She then had the nerve to say, "That's not the impression I got." I wasn't sure how to take all that.
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bigtruckguy3500
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2:39p, 7/10/20
It's like grand rounds up in here.
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88planoAg
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In reply to SunrayAg • 2:50p, 7/10/20
AG
SunrayAg said:
I'm a little concerned about what my nickname might be...
me too
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Squadron7
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In reply to Kool • 2:56p, 7/10/20
AG
Kool said:



https://i.imgur.com/



The intubation granuloma is easy. The posterior subglottic granulation tissue is possibly a bit of a challenge, as it looks pretty broad based. Not sure if I'll need some sort of steroid eluting stent postop (what a pain in the ass) vs just intralesional steroid injection. The real question I have is how much the tracheomalacia is going to be problematic for him, whether or not it relates to his COVID, etc. Especially if he thinks he is magically cured of his OSA now that he has possibly moved from the morbidly obese category to merely the obese category. This will be my first foray into the trachea in a post COVID patient. I must admit it has me a tad preoccupied. Thanks for your responses, Marcus.

Hope the pics came out OK. In addition to being lolpoor, I'm old.

I have nothing to add here.
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Kool
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In reply to Marcus Aurelius • 3:15p, 7/10/20
AG
Marcus Aurelius said:
Do you do laser/stents?
Lasers for sure. Love the fire risk.
As far as stents, it's been 100 years since I put in a stent in someone without a trach. Definitely going to inject intralesional steroids, I have a call in to my favorite CV surgeon and he and I are going to discuss the findings, will also discuss stenting. Thanks for giving me your digits, video sent your way. Cheers
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
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Marcus Aurelius
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In reply to Kool • 3:27p, 7/10/20
AG
Got it.

Damn. Those are some swole arytenoids. Dude had a hard time intubating him with the scope. I would have done LMA or GETA for that case. Anyway - the malacia is real. Not to mention his mucosa looks like hamburger. I would put him on a round of steroids. Systemic and inhaled. After a month - re bronch with anesthesia. Do your magic on the subglottic stenosis. If the malacia is still to that degree I don't think most interventionalists would stent it. If worse - maybe. Does he have COPD or asthma?

It certainly could be secondary to the ETT and or COVID. So inflamed. Fascinating.
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Squadron7
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3:30p, 7/10/20
AG
So.....is the FLK acronym still used?
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Kool
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In reply to Marcus Aurelius • 4:03p, 7/10/20
AG
Marcus Aurelius said:
Got it.

Damn. Those are some swole arytenoids. Dude had a hard time intubating him with the scope. I would have done LMA or GETA for that case. Anyway - the malacia is real. Not to mention his mucosa looks like hamburger. I would put him on a round of steroids. Systemic and inhaled. After a month - re bronch with anesthesia. Do your magic on the subglottic stenosis. If the malacia is still to that degree I don't think most interventionalists would stent it. If worse - maybe. Does he have COPD or asthma?

It certainly could be secondary to the ETT and or COVID. So inflamed. Fascinating.
Just got off the phone with CV and with patient's wife. Read him "the riot act". No COPD or asthma. O2 sat is 94 on RA at rest, per pulmonary. He can't come off of anything lower than about 30 mg of prednisone without getting SOB. Wife has convinced him to go on a Mediterranean diet and use his CPAP. He might now understand that a BMI of 36, even though he is 50 pounds lighter than when he got The Coronas, is not anything to be proud of.

CV doesn't think stenting will need to be done. Says the hospital just bought a sweet-ass new set of rigid bronch toys for them to play with, and he will share with me. Thanks for looking at the video. Wish me luck. Something tells me that, a couple of days before the case, I am going to have a change in my poopies.

And to Squadron 7: I'll never tell.
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AggieOO
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4:41p, 7/10/20
at least I know how my wife feels when she's around me and my co-workers and we are talking about IT/datacenter stuff.
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Seven Costanza
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5:11p, 7/10/20
AG
"Mr. McFattyFace, I'll be honest. I was initially a bit confused by what I saw during your scope, but then I got on the internet and got it all sorted out..."

"Christ, Doc, please tell me you didn't go to like wikipedia or something..."

"Oh no. I went to TexAgs.com. The football message board. Yeah. Talked to a guy that goes by Marcus Aurelius. In between replies, read about people peeing in the shower. Good stuff."
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Aust Ag
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In reply to SunrayAg • 5:16p, 7/10/20
AG
SunrayAg said:
Definitely interesting to listen in on the consultation.

But at the same time, after standing naked in front of my dermatologist and his nurse earlier this week, I'm a little concerned about what my nickname might be...
Haha, I thought I was the only one who was like, "Oh crap" when the clothes come off!!
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Infection_Ag11
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In reply to Marcus Aurelius • 7:44p, 7/10/20
AG
Quote:
Mounier-Kuhn syndrome


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JYDog90
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8:46p, 7/10/20
AG
I'm thinking we're gonna need some gauze pads. What do the rest of you doctors think?
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SoulSlaveAG2005
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8:51p, 7/10/20
AG
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wreckncrew
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10:32p, 7/10/20
AG
I dont know what on earth is going on but these type of discussions should have been happening a long time ago. Close down the M&W board. This is the kind of stuff I will pay to read.
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gunan01
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In reply to Mark Fairchild • 11:46p, 7/10/20
AG
Mark Fairchild said:
Impressive! I have never been privy to two (outstanding AGGIE doctors) discussing a case. I must say besides being very impressed, I am pretty confident that the U.S. medical profession still has great physicians, that care about their patients. Thanks for letting us sit in on your consultation. On a personal note, I hope the fat dude improves.


Yep. And to think that a couple months ago there were losers (mostly from F16) who were saying things to Marcus like "sorry your virus lost" and telling him to get out of the spotlight. Embarrassing.

Marcus and Kool and all other doctors and other HCPs are nothing short of heroes.
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Comeby!
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In reply to Aust Ag • 1:33a, 7/11/20
AG
Aust Ag said:
SunrayAg said:
Definitely interesting to listen in on the consultation.

But at the same time, after standing naked in front of my dermatologist and his nurse earlier this week, I'm a little concerned about what my nickname might be...
Haha, I thought I was the only one who was like, "Oh crap" when the clothes come off!!


I was diagnosed with white cost hypertension shortly after the cute young female doctor played with my thingies unexpectedly. Blood pressure skyrocketed every time I saw her after that.
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Captain Pablo
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10:26a, 7/12/20
AG
This is a great thread

Thanks, Docs

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Kool
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11:04a, 7/12/20
AG
I never figured so many people would be interested in such an esoteric subject. I've been following Marcus Aurelius on the thread and could tell he was very sharp and was seeing lots of COVID-19 (way too much, in fact). Marcus' wife could spot the abnormality immediately. Here is al slice from a CT of the patient. The radiologist read the study as "normal"


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Seven Costanza
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In reply to Kool • 11:21a, 7/12/20
AG
Little nubber on the posterior wall of the trachea?
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SoulSlaveAG2005
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11:23a, 7/12/20
AG
All I see is a fat cat yawning while wearing a bikini..

I
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Kool
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In reply to Seven Costanza • 11:29a, 7/12/20
AG
Seven Costanza said:
Little nubber on the posterior wall of the trachea?


Ding! Ding! Ding! That's what you're seeing in the midline on the bronchoscopy photos. Caused by the endotracheal tube and the cuff putting pressure on the area for two weeks. But I strongly suspect it won't go away because he creates all kind of negative pressure to breathe and probably sucks stomach acid into the area. Not good.
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Knucklesammich
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11:34a, 7/12/20
Sounds like a gong show of conditions combining to spiral into death by a thousand paper cuts or rather acid burns.

As a not skinny dude this makes me want to eat salad.
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ETFan
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In reply to gunan01 • 11:36a, 7/12/20
gunan01 said:
Mark Fairchild said:
Impressive! I have never been privy to two (outstanding AGGIE doctors) discussing a case. I must say besides being very impressed, I am pretty confident that the U.S. medical profession still has great physicians, that care about their patients. Thanks for letting us sit in on your consultation. On a personal note, I hope the fat dude improves.


Yep. And to think that a couple months ago there were losers (mostly from F16) who were saying things to Marcus like "sorry your virus lost" and telling him to get out of the spotlight. Embarrassing.

Marcus and Kool and all other doctors and other HCPs are nothing short of heroes.


"Were"? They still are. It's maddening.

Love this thread.
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88planoAg
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In reply to SoulSlaveAG2005 • 11:40a, 7/12/20
AG
SoulSlaveAG2005 said:
All I see is a fat cat yawning while wearing a bikini..

I
Well **** now that is all I see.
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Kool
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In reply to SoulSlaveAG2005 • 11:44a, 7/12/20
AG
SoulSlaveAG2005 said:
All I see is a fat cat yawning while wearing a bikini..

I


You're right!!! That's TWO misses by the radiologist on this one. Sounds like some medical school owes that guy a refund.
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SoulSlaveAG2005
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In reply to Kool • 12:12p, 7/12/20
AG
Please pass my reimbursement sheet along to the guarantor of services:


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Seven Costanza
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In reply to SoulSlaveAG2005 • 12:53p, 7/12/20
AG
$8 cup of coffee?!
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Kool
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In reply to Seven Costanza • 12:59p, 7/12/20
AG
Seven Costanza said:
$8 cup of coffee?!

Agree. He must be an attorney. "Padding the bill"
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SoulSlaveAG2005
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1:06p, 7/12/20
AG


-not an attorney. Just a regular dude tryin to make a livin reading images on the interweb
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Marcus Aurelius
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In reply to gunan01 • 2:59p, 7/12/20
AG
gunan01 said:
Mark Fairchild said:
Impressive! I have never been privy to two (outstanding AGGIE doctors) discussing a case. I must say besides being very impressed, I am pretty confident that the U.S. medical profession still has great physicians, that care about their patients. Thanks for letting us sit in on your consultation. On a personal note, I hope the fat dude improves.


Yep. And to think that a couple months ago there were losers (mostly from F16) who were saying things to Marcus like "sorry your virus lost" and telling him to get out of the spotlight. Embarrassing.

Marcus and Kool and all other doctors and other HCPs are nothing short of heroes.
Yes. Never forget when I was told to "enjoy my 15 minutes of fame."
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Kool
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In reply to gunan01 • 4:34p, 7/12/20
AG
98% of the people here really seem like funny, engaging, kind-hearted, and well-meaning folks. Not unlike the Texas A&M I remember from back in the Stone Ages. But those 2% DO seem to post a lot, don't they?

Not a humble brag, but Marcus and I are not even close to being in the same category with regards to this disease. My income has taken a big hit, and I worry about getting the virus, because I am way up in the face of every patient I see, by the nature of my business. But Dr. Aurelius shared with me some stats and photos of what is going on in his hospital, and it is absolutely killing his hospital's ICU. Not to mention the toll it must be taking on him. 90% of what I do is pretty rote, and a well trained monkey (which I am) could do it. This particular case, for which I sought his opinion, was one of the "oddballs". This NOVEL virus requires constant thinking on your feet, and constant adaptation to the changing presentation and clinical course of the virus. And it's hard to watch people suffer and harder yet to watch some of them die, along with not knowing what the long-term ramifications are going to be for those who survive this NOVEL Coronavirus. A lot of sad cases in Dr. Aurelius' part of the world. Not to mention the fact that each and every one of those persons is shedding virus particles that endanger his health and his coworkers and family. Ugh. Kudos to him. And for edumacating all of us a bit.
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Tumble Weed
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10:55a, 7/13/20
This is the only Corona thread that made me laugh.

As for nicknames, I don't worry about those so much. I worry about what I will say when I am all goofed up after a surgery. I can still remember part of the discussion that I had with my doc during and after the big snip. He was a t sipper, and the conversation wasn't eloquent.
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ElephantRider
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12:15p, 7/13/20
AG
I see my comment about F16 got deleted. Way to go, staff
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atag
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3:55p, 7/13/20
AG
I have the weirdest (lady) boner....
proudest member of the fightin texas aggie class of 2005.
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