Pictures of the Week

[SSdoc33]

ALIF time

Nope. Its already fused. Probably just a decompression, but I agree with the MRI

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[lobelsteve]

L1 over a year ago. Pickle ball injury. Prolia given at that time. Lost to follow-up, skipped Prolia. T7 tomorrow in office with local. Lifting weights. Altered comfort vs sports geriatrics? And we will restart Prolia before procedure. Great pedicles up that high.

 

[lobelsteve]

 

[SSdoc33]

View attachment 254480

? old C4-5 fusion or congenital?

need an axial, but it looks like there is some CSF anteriorly at that level

 

[lobelsteve]

? old C4-5 fusion or congenital?

need an axial, but it looks like there is some CSF anteriorly at that level

Does not look as bad in axial. DDD, no prior surgery.

 

[SSdoc33]

mbb - yes, ESI- no

 

[Tapspatellas]

Rule out prior osteo

 

[nvrsumr]

Kaiser refugee. Paid cash to see me yesterday. Cash to get MRI done yesterday. Direct admit thru ER to my NS buddy today for surgery. Her Kaiser PCP told her to go to Kaiser chiro for 6 weeks .

Taste of the future with socialized med.

 

[chudat]

View attachment 254783

Kaiser refugee. Paid cash to see me yesterday. Cash to get MRI done yesterday. Direct admit thru ER to my NS buddy today for surgery. Her Kaiser PCP told her to go to Kaiser chiro for 6 weeks .

Taste of the future with socialized med.

mening?

 

[nvrsumr]

.

 

[lobelsteve]

View attachment 254783

Kaiser refugee. Paid cash to see me yesterday. Cash to get MRI done yesterday. Direct admit thru ER to my NS buddy today for surgery. Her Kaiser PCP told her to go to Kaiser chiro for 6 weeks .

Taste of the future with socialized med.

Kaiser ordered to pay woman more than $28 million

The Kaiser way.

 

[SSdoc33]

View attachment 254783

Kaiser refugee. Paid cash to see me yesterday. Cash to get MRI done yesterday. Direct admit thru ER to my NS buddy today for surgery. Her Kaiser PCP told her to go to Kaiser chiro for 6 weeks .

Taste of the future with socialized med.

cant you just manipulate that mass right out of there? it may just be a bad subluxation

 

[cowboydoc]

cant you just manipulate that mass right out of there? it may just be a bad subluxation

Don't be silly, that's what a cold laser is for.

 

[Orin]

Don't be silly, that's what a cold laser is for.

Back in my day you sucked that up with a 14g Tuohy. Saddle up!

 

[cbest]

Nobody thought the clonus and hyperreflexia I’m assuming was on exam might prompt an expedited work up?! Yikes!

 

[lobelsteve]

And then.....

 

[callmeanesthesia]

And then.....

View attachment 255230

Thanks, I needed a good laugh this morning

 

[lobelsteve]

Thanks, I needed a good laugh this morning

These a==holes in the ER gave him 15 more. And no, not my patient.

 

[Ducttape]

what did you expect them to do? keep that acute chest pain patient seated in the waiting room while he gets toradol, xrays, MRI and ortho referral, all to avoid a negative PG score?

hes a GTFO patient.

 

[lobelsteve]

SOS. LOL. @drusso

 

[drusso]

View attachment 255465


SOS. LOL. @drusso

The good life...

 

[callmeanesthesia]

T

View attachment 255465


SOS. LOL. @drusso

Thanks for the $2 million+ in facility fees and ancillary services. We have free massages as an anti-burnout initiative. Too bad you won’t be able to get one because we’ve scheduled you to work through lunch.

 

[drusso]

T

Thanks for the $2 million+ in facility fees and ancillary services. We have free massages as an anti-burnout initiative. Too bad you won’t be able to get one because we’ve scheduled you to work through lunch.

It's no different than Sackler/Purdue. That $2million + is blood money.

Employed Physicians Create Almost $2.4M a Year in Hospital Revenue

“Employed primary care physicians may be more likely to direct tests, therapies and other services ‘in-house’ to their hospital or hospital system employer, rather than to outside resources such as radiology groups or labs, which may have been their pattern when they were in independent practice,” the report stated."

Who can defend that? No one at the White Coat Ceremony could ever imagine it.

 

[lobelsteve]

Karma. Done office at 1130 for OR case at 130. Show up at 12 hoping to go early. OR overflow and case bumped til after 3. This means 4 to go back. 430 to start. So no lunch or massage for me tomorrow. But i am at gym on bike for an hour to blow off steam. Lemons ....lemonade

 

[lobelsteve]

35 min into my 60 min ride at gym and OR 2 opens. Duty calls. Gotta shower up and operate. Who thinks I should go to hospital early for an omelette?

Bond film over. Peace out.
To the nerds. Pic taken earlier.

 

[drusso]

Karma. Done office at 1130 for OR case at 130. Show up at 12 hoping to go early. OR overflow and case bumped til after 3. This means 4 to go back. 430 to start. So no lunch or massage for me tomorrow. But i am at gym on bike for an hour to blow off steam. Lemons ....lemonade

I'd go crazy. Plus, the revenue lost in the office while everyone at the hospital circle jerks...

 

[drusso]

View attachment 255465


SOS. LOL. @drusso

 

[lobelsteve]

 

[drusso]

View attachment 258358

You violated my HIPPA rights. My attorney will be in touch!

 

[cowboydoc]

View attachment 258358

A doctor who self-treats has a fool for a patient.

 

[lobelsteve]

Funny guy. Wife is far left and he is far right. Married 40+years.

 

[lobelsteve]

Told this lady her hip looks good for 100.

She said thanks. She is 102.

 

[geauxg8rs]

Told this lady her hip looks good for 100.



View attachment 261021

Doesn’t look a day over 96





She said thanks. She is 102.

 

[cowboydoc]

1. My best Lobel impression.
2. An argument in favor of MRI before MBBs. (I often don't do MR if high suspicion for facet mediated pain, no red flags or other concerns. This lady had axial back pain, remote history of BRCA with lumpectomy and no further treatment. I saw her for LBP in 2017, discussed MBBs if failure of course of PT, didn't follow up until last week with worsening axial back pain...)

 

[lobelsteve]

Xray showed old fx? H/o brca means mri.

 

[Ducttape]

1. My best Lobel impression.
2. An argument in favor of MRI before MBBs. (I often don't do MR if high suspicion for facet mediated pain, no red flags or other concerns. This lady had axial back pain, remote history of BRCA with lumpectomy and no further treatment. I saw her for LBP in 2017, discussed MBBs if failure of course of PT, didn't follow up until last week with worsening axial back pain...)

the fact that she apparently chose not follow up for 2 years and subsequently returns might be the red flag in and of itself

 

[pmrmd]

1. My best Lobel impression.
2. An argument in favor of MRI before MBBs. (I often don't do MR if high suspicion for facet mediated pain, no red flags or other concerns. This lady had axial back pain, remote history of BRCA with lumpectomy and no further treatment. I saw her for LBP in 2017, discussed MBBs if failure of course of PT, didn't follow up until last week with worsening axial back pain...)

An MRI before every mbb? You are going to see that badness on fluoro.

 

[cowboydoc]

An MRI before every mbb? You are going to see that badness on fluoro.

That's not my norm at all. Some have advocated for that. I was pretty far on the other end of that spectrum, but getting more MRIs than in the past. The brca hx on this pt. is a good argument for MR before procedure, but many fall into a more gray zone, and there are many opinions on who gets what before procedure in that cases.

Of course you'll see this on fluoro, but I prefer not to make many new diagnoses during a procedure.

 

[lobelsteve]

Did this block today. I feel like I picked targets at random. Lots of deformity on that femur.

 

[cowboydoc]

View attachment 263503






Did this block today. I feel like I picked targets at random. Lots of deformity on that femur.

 

[lobelsteve]

Something missing?

 

[SSdoc33]

View attachment 263684


Something missing?

psoas. although her paraspinals are heavily marbled as well. that'd taste good.

 

[SommeRiver]

MBB twice with ropi 0.5% 0.5 cc and 100% relief. I placed RFA needles at exactly the same site, with 0% relief. This is what I always do...Anything wrong with these probes? I do 80 Celsius x 2. These are 18g Abbott regular probes. Neurotherm.

 

[DODOCSS]

looks good

did u check F/E films, if clean then PHQ9 is dirty

 

[SSdoc33]

MBB twice with ropi 0.5% 0.5 cc and 100% relief. I placed RFA needles at exactly the same site, with 0% relief. This is what I always do...Anything wrong with these probes? I do 80 Celsius x 2. These are 18g Abbott regular probes. Neurotherm.
View attachment 264127View attachment 264128View attachment 264129

sometimes the RF just doesnt work. there is a known failure rate. somewhere around 10%, i think

 

[SommeRiver]

sometimes the RF just doesnt work. there is a known failure rate. somewhere around 10%, i think

Yeah. I guess I am at the point that I'm wondering if it is Neurotherm or not. Seems this happens frequently despite two great low volume MBB.

 

[BobBarker]

T6 kypho I performed. T2 and T5 by another physician previously.

 

[MD87]

MBB twice with ropi 0.5% 0.5 cc and 100% relief. I placed RFA needles at exactly the same site, with 0% relief. This is what I always do...Anything wrong with these probes? I do 80 Celsius x 2. These are 18g Abbott regular probes. Neurotherm.
View attachment 264127View attachment 264128View attachment 264129

I was taught to place the probes depth-wise to about mid-SAP. So, these look a little dorsal to me. Angle of the probes looks great, though.

 

[lobelsteve]

C7-T1 ILESI. 25g 3.5" spinal needle. CLO

 

[SommeRiver]

Pt sent to me for LBP. Jan this year had cement augmentation for a fracture. An interesting picture...