- Joined
- Nov 21, 1998
- Messages
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Unconfirmed reports indicate that the action is in full swing and its atmospheric river of game-changing innovation. KOLs off leash and Reps have been deployed for interception. Stay tuned.
Unconfirmed reports indicate that the action is in full swing and its atmospheric river of game-changing innovation. KOLs off leash and Reps have been deployed forinterceptioninception. Stay tuned.
My social media has local docs snd reps living it up. I don’t like fun that much.
Can I stim loss of CN II?Joke of a conference. Couldn't force me to go if you put a BB gun to my eyeballs.
Howly Cow.
NANS is right now?
I am in Vegas for unrelated reasons.
And I'm pissed - Abysinthe prices are through the roof! They were way cheaper the last time I went.
It's still probably worth it though.
Any thoughts on the best comedy club?
Brad Garrett is sold out.Brad garrett
Absyinthe somewhat overrated
I go at least once a year to see Bill Maher when he's in Vegas.Howly Cow.
NANS is right now?
I am in Vegas for unrelated reasons.
And I'm pissed - Abysinthe prices are through the roof! They were way cheaper the last time I went.
It's still probably worth it though.
Any thoughts on the best comedy club?
Our field is a joke of pretend surgeons, KOLs, and I do it my way superstars.
Buy the SIS Guidelines.
Read the SIS Guidelines.
Do the SIS Guidelines.
If there is not an independent study on new devices/procedures, consider yourself a pioneer and doing human experimentation.
If you would not do the procedure on your mother, do not do it on your patients.
My salary cap was bumped up $100k this year.
Someone tell me what type of new shoes to get (beside the 1080s)
I was reading and nodding my head until you said, "If there IS not independent studies on new..."Our field is a joke of pretend surgeons, KOLs, and I do it my way superstars.
Buy the SIS Guidelines.
Read the SIS Guidelines.
Do the SIS Guidelines.
If there is not an independent study on new devices/procedures, consider yourself a pioneer and doing human experimentation.
If you would not do the procedure on your mother, do not do it on your patients.
My salary cap was bumped up $100k this year.
Someone tell me what type of new shoes to get (beside the 1080s)
Huh?I was reading and nodding my head until you said, "If there IS not independent studies on new..."
Sabotaged the entire post.
...are...
That grammar killed the entire post.Huh?
Read it again.That grammar killed the entire post.
You edited it. Carry on.
You've defeated me.Read it again.
Our field is a joke of pretend surgeons, KOLs, and I do it my way superstars.
Buy the SIS Guidelines.
Read the SIS Guidelines.
Do the SIS Guidelines.
If there is not an independent study on new devices/procedures, consider yourself a pioneer and doing human experimentation.
If you would not do the procedure on your mother, do not do it on your patients.
My salary cap was bumped up $100k this year.
Someone tell me what type of new shoes to get (beside the 1080s)
Actually it would be "were"I was reading and nodding my head until you said, "If there IS not independent studies on new..."
Sabotaged the entire post.
...are...
I Hope it’s not a bother to ask. I’m a pain applicant and I’m trying to justify my decision. I know I will feel hard pressed to push advanced procedures or any procedure lacking solid literature support on my future patients. I read through the SIS guidelines you mentioned and their sponsored meta analysis and it seems like even a large portion BB procedures have scarce evidence supporting their use. RFA, esi beyond lumbar region, etc. Even the more interesting/promising? stuff like DRG has crappy evidence. What gives? Is your practice really just MBB and esi? Do I really need to have a loose moral compass to practice pain med?Our field is a joke of pretend surgeons, KOLs, and I do it my way superstars.
Buy the SIS Guidelines.
Read the SIS Guidelines.
Do the SIS Guidelines.
If there is not an independent study on new devices/procedures, consider yourself a pioneer and doing human experimentation.
If you would not do the procedure on your mother, do not do it on your patients.
My salary cap was bumped up $100k this year.
Someone tell me what type of new shoes to get (beside the 1080s)
I cheated.You've defeated me.
Still below market. But a $3 per wrvu raise from last year.They raised your cap. Did they also raise your $/wRVU value?
99% of care is new patients, follow ups, ESI, joint, MBB/RF, peripheral nerve block/RF, kypho, SCS.I Hope it’s not a bother to ask. I’m a pain applicant and I’m trying to justify my decision. I know I will feel hard pressed to push advanced procedures or any procedure lacking solid literature support on my future patients. I read through the SIS guidelines you mentioned and their sponsored meta analysis and it seems like even a large portion BB procedures have scarce evidence supporting their use. RFA, esi beyond lumbar region, etc. Even the more interesting/promising? stuff like DRG has crappy evidence. What gives? Is your practice really just MBB and esi? Do I really need to have a loose moral compass to practice pain med?
Appreciate your input if you’re willing to share.
Being in a field that is just MBB/ESI as you say - is actually very comforting. It’s nice to live in a finite world. Can you imagine living in the infinite universe of primary care? Ugh.I Hope it’s not a bother to ask. I’m a pain applicant and I’m trying to justify my decision. I know I will feel hard pressed to push advanced procedures or any procedure lacking solid literature support on my future patients. I read through the SIS guidelines you mentioned and their sponsored meta analysis and it seems like even a large portion BB procedures have scarce evidence supporting their use. RFA, esi beyond lumbar region, etc. Even the more interesting/promising? stuff like DRG has crappy evidence. What gives? Is your practice really just MBB and esi? Do I really need to have a loose moral compass to practice pain med?
Appreciate your input if you’re willing to share.
I think where we can truly help patients is by being excellent spinal diagnosticians, and in a sense, gatekeepers of surgical need. This is especially the case if you have overly aggressive local surgeons that will fuse anyone with a disc bulge.I Hope it’s not a bother to ask. I’m a pain applicant and I’m trying to justify my decision. I know I will feel hard pressed to push advanced procedures or any procedure lacking solid literature support on my future patients. I read through the SIS guidelines you mentioned and their sponsored meta analysis and it seems like even a large portion BB procedures have scarce evidence supporting their use. RFA, esi beyond lumbar region, etc. Even the more interesting/promising? stuff like DRG has crappy evidence. What gives? Is your practice really just MBB and esi? Do I really need to have a loose moral compass to practice pain med?
Appreciate your input if you’re willing to share.
I'm a PM&R resident going pain and I feel like I speak to this topic all the time to different attendings and they stare at me like I just asked them what oxycodone is.Also, our world has improved vastly now that we only give a rare opioid.
I swear my time spent with patients have dropped probably an average 15 min per patient since I don’t have to spend so much time telling them all the ways that opioids are horrible and why they shouldn’t take them and why I won’t give them any. Such a time suck that was - and I’m not sure it ever worked anyway. I still had to do it though.
Depends on your area. I’ve been practicing like that for the last 5 years. Opioids only for acute injuries - compression fractures, acute disc herniation, acute post-procedural pain. Cancer pain is handled by their oncologist.I'm a PM&R resident going pain and I feel like I speak to this topic all the time to different attendings and they stare at me like I just asked them what oxycodone is.
My future practice goals are no opioids unless palliative/cancer pain, very acute injury (surgery, compression Fx, ect), or some other RARE occurrance. I feel like when I tell people this, their response is "So what do you do for the 50yo w/ severe OA?" or "How does pain management not give opioids?" Which to me, is a dated take on opioids and out of touch with the opioid epidemic we are currently in. I think they expect pain to just be addiction med without the counselling.
Seem accurate or am I off base?
I'm a PM&R resident going pain and I feel like I speak to this topic all the time to different attendings and they stare at me like I just asked them what oxycodone is.
My future practice goals are no opioids unless palliative/cancer pain, very acute injury (surgery, compression Fx, ect), or some other RARE occurrance. I feel like when I tell people this, their response is "So what do you do for the 50yo w/ severe OA?" or "How does pain management not give opioids?" Which to me, is a dated take on opioids and out of touch with the opioid epidemic we are currently in. I think they expect pain to just be addiction med without the counselling.
Seem accurate or am I off base?
There is hope for both of you. I almost didn't do pain because of the opioids I saw in academics (particularly 15 years ago). You both definitely need to spend time with some private practice pain docs.I Hope it’s not a bother to ask. I’m a pain applicant and I’m trying to justify my decision. I know I will feel hard pressed to push advanced procedures or any procedure lacking solid literature support on my future patients. I read through the SIS guidelines you mentioned and their sponsored meta analysis and it seems like even a large portion BB procedures have scarce evidence supporting their use. RFA, esi beyond lumbar region, etc. Even the more interesting/promising? stuff like DRG has crappy evidence. What gives? Is your practice really just MBB and esi? Do I really need to have a loose moral compass to practice pain med?
Appreciate your input if you’re willing to share.
I agree with you.Also, our world has improved vastly now that we only give a rare opioid.
I swear my time spent with patients have dropped probably an average 15 min per patient since I don’t have to spend so much time telling them all the ways that opioids are horrible and why they shouldn’t take them and why I won’t give them any. Such a time suck that was - and I’m not sure it ever worked anyway. I still had to do it though.
ESI. No opioids for this usually. Maybe Tramadol or Nucynta.I agree with you.
Since you’re more experienced than I am how do you recommend dealing with hot radiculopathy? Seems like a handful of opioids until the epidural is reasonable. Of course Gabapentin/Lyrica as the mainstay.
Feel free to chime in others with more experience
ESI. No opioids for this usually. Maybe Tramadol or Nucynta.
I agree with you.
Since you’re more experienced than I am how do you recommend dealing with hot radiculopathy? Seems like a handful of opioids until the epidural is reasonable. Of course Gabapentin/Lyrica as the mainstay.
Feel free to chime in others with more experience
Practical. Thanks.yep.
It should be rare for you to give opioids for a radic. You will notice over time that the patients who didn't get opioids, will show up promptly for their procedure, while those that did get opioids are more likely to reschedule their ESI and/or ask for opioid refill before/after their ESI.
One thing you might consider for patients who appear particularly bad off is to do a quick TPI with 30mg of toradol (15 if petite/certain medical issues). The patient feels like you are doing something for them now and more likely to accept no opioids and just TPI+gaba/lyrica until their ESI. If you have 3 rooms and your staff is properly trained, it should only take you 90 seconds to do the TPI, which is quicker than arguing about opioids. Also many commercial insurances pay as much for a TPI as they do for a joint injection, which takes more time for you and the staff than a TPI.
Still below market. But a $3 per wrvu raise from last year.
Just got home from NANS! One of the main DRG stim utilizers told me that “there’s people who can perform DRG stim, and those who unfairly question its efficacy” and that if I can’t perform DRG stim, send my focal neuropathic pain patients to someone who can.
Where do you all stand on DRG stim? I saw too many procedural issues in my fellowship that I vowed to wait until the procedure and it’s complications improved. But am I missing something with DRG stim? Have not done it myself post-fellowship.
and 95% of that is New patients, Office visits, ESI, MBB/RF. Many many docs only do these procedures and nothing "advanced" or non-spine. Some don't even do necks.99% of care is new patients, follow ups, ESI, joint, MBB/RF, peripheral nerve block/RF, kypho, SCS.
That's because your attendings are old. Get through fellowship then practice evidence-based medicine. Opioids aren't just a time suck, they aren't effective for chronic pain.I'm a PM&R resident going pain and I feel like I speak to this topic all the time to different attendings and they stare at me like I just asked them what oxycodone is.
My future practice goals are no opioids unless palliative/cancer pain, very acute injury (surgery, compression Fx, ect), or some other RARE occurrance. I feel like when I tell people this, their response is "So what do you do for the 50yo w/ severe OA?" or "How does pain management not give opioids?" Which to me, is a dated take on opioids and out of touch with the opioid epidemic we are currently in. I think they expect pain to just be addiction med without the counselling.
Seem accurate or am I off base?
I didn't do DRG in fellowship, but do in private practice. It's been great for focal neuropathic pain. I don't think it works any better than dorsal column overall, but it is more precise and you can avoid unintended sensations easier.Just got home from NANS! One of the main DRG stim utilizers told me that “there’s people who can perform DRG stim, and those who unfairly question its efficacy” and that if I can’t perform DRG stim, send my focal neuropathic pain patients to someone who can.
Where do you all stand on DRG stim? I saw too many procedural issues in my fellowship that I vowed to wait until the procedure and it’s complications improved. But am I missing something with DRG stim? Have not done it myself post-fellowship.
1883 LucchesesOur field is a joke of pretend surgeons, KOLs, and I do it my way superstars.
Buy the SIS Guidelines.
Read the SIS Guidelines.
Do the SIS Guidelines.
If there is not an independent study on new devices/procedures, consider yourself a pioneer and doing human experimentation.
If you would not do the procedure on your mother, do not do it on your patients.
My salary cap was bumped up $100k this year.
Someone tell me what type of new shoes to get (beside the 1080s)
Stay pointy my friendsIt's getting hot in here...
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