#Stent placement

[diseaseinfohub]

CAN YOU REFUSE A STENT AFTER KIDNEY STONE SURGERY?

Yes, it is possible to refuse a stent after kidney stone surgery. A stent, also known as a ureteral stent, is a thin tube that is placed in the ureter (the tube connecting the kidney to the bladder) to help urine drain properly. It is commonly used after certain kidney stone surgeries, such as ureteroscopy or lithotripsy, to promote healing and prevent complications.

However, the decision to have a stent placed or removed ultimately rests with the patient. If you have concerns or wish to refuse a stent, it is important to discuss your preferences with your urologist or surgeon. They can provide you with information about the potential risks and benefits of stent placement and alternative options, if available, based on your specific medical situation.

It is crucial to have an open and honest conversation with your healthcare provider to ensure that you make an informed decision that aligns with your preferences and overall health.

[zdravljeirecepti]

Majušna metalna mreža koja spašava živote poznata još i po imenu Stent.  

[sonalisa12]

Healing after a cardiac stent surgery

Stents work by keeping pressure off your heart so it can heal properly after an injury or surgery. They don't replace other treatments like medications or rehabilitation but instead complement them by allowing your body to recover faster than it would without them! Learn more:

[nikitakaur]

Can someone lead an everyday life after a 95% blockage of an artery?

Yes, but it's important to know what's going on in treatment. Angioplasty can open up an artery, but it's almost always followed with a stent. For the lining of the artery to accept the stent so it grows into place so blood clots can't form around it, it's utterly essential to take all your prescribed anticoagulants (blood thinners). If you have diabetes, you also have to keep your blood sugar levels under control, and you have to watch your blood pressure and cholesterol. All of this is pretty easy to do, but you do have to do it. That being said, you will probably feel better after treatment, and you will go back to living the everyday life you had forgotten. There are lots of things that can go wrong; there are lots of variations in treatment, but yes, many people do live everyday lives after angioplasty, stents, and bypass. Most feel tremendously better. But you have to change your lifestyle after Surgeries.

Lifestyle Changes

These modifications may be the only treatment required for some people.

Maintain a healthy weight by following a healthy diet to prevent or reduce high blood pressure and high cholesterol.

If you smoke, stop.

Be physically active.

If you're overweight or obese, you should lose weight.

Reduce your stress levels.

To reduce high blood pressure or high cholesterol, follow your doctor's instructions.

[daydreamtofiction]

Malicious Compliance // Surgeon Strange x Reader

Masterlist | Request a Fic

Summary: After a brief meeting with the world renowned neurosurgeon Doctor Stephen Strange, he plans to make you his latest conquest. He’s only interested in one thing, but that’s okay, because so are you. (female reader)

Word Count: 4.6K

Warnings: Strong language, explicit sexual content, pre-sorcerer Strange (arrogant, cocky). Smut: no strings attached, dominance & praise, oral sex (receiving), light choking, unprotected sex (sort of?). Readers must be 18+

A/N: Just a quick lil oneshot for you all. I literally thought of this today and the whole thing poured out of me in one sitting lmao. I like it though, hope you guys do too!

His eyes are glaciers. Cold, hard, yet always moving. They flit towards the window, sunlight turning them the crispest blue, then back down to the notebook on the table in front of him. They warm slightly when he looks over to Doctor Palmer, roll languidly whenever Doctor West speaks. But in the end, they always seem to settle back on you.

He’s as hubristic as you’d expected; leant back in his chair, elbows on the armrests, taking up as much space as his body will allow. He corrects a colleague when they call him Stephen. It’s Doctor Strange, he says, voice so deep and rich it’s almost tangible. 

He watches as you press your finger to the inner corner of your eye, trying to rub away the tired itch beginning to take root there. You wonder how offended he’d be if he knew you fell asleep reading one of his published papers last night, how you woke up in your hotel room this morning with your cheek pressed to page seventeen of The Strange Palmer Method. It would make his blood boil, you think, to know his work had been used as a pillow. You resist the urge to tell him. 

Coffee burns the roof of your mouth. You wince and place the cup back down on the boardroom table, sift through the pile of papers in front of you as the room waits for you to speak again.

“Honey,” says Doctor Strange. 

“I’m sorry?” you reply. 

He points to your mouth. “It’ll help with that burn.” 

You stare at him for a moment before shaking your head. “Oh I didn’t- It was just a little warmer than I expected. Thanks, though.” 

The corner of his mouth curls and he turns to look down the length of the table, the flecks of silver at his temple catching in the light.

You clear your throat as you find the document you were looking for. “So, pending approval from the ABMS, we would like to roll out training for the Strange Palmer Method in all of our hospitals.”

“What about my new technique for stent placement?” asks Doctor West. 

“Oh please, Nic,” Strange scoffs. “We’re talking about actual revolutionary surgical procedures here.” 

Doctor West’s back straightens, you open your mouth to speak but he gets there first.

“Excuse me, my stent technique could drastically cut down the amount of time a patient’s brain is open on the table! Do you even realise-” 

“Mhm, why don’t you go win some awards and make national news, then maybe we can talk.” 

Doctor Palmer’s head falls into her hands as the other surgeons groan and shift uncomfortably in their seats. You’ve met your fair share of asshole surgeons in this job; travelling up and down the country stroking egos and exalting god complexes. But this man sitting across from you is, without a doubt, the victor of them all. 

“The stent technique is very interesting,” you say, easing the tension in the room. “But we would need to see the results of a study or trial of some kind before taking it any further.” 

“Very diplomatic of you,” says Strange. 

“Not diplomatic. I just know a promising procedure when I see it.”

“Hm. Are you a doctor?”

Your gaze turns to a glare. “I am.” 

“Where do you practice?”

“I don’t anymore. My job is to keep other doctors at the top of their game. Hence why I’m here right now with all of you.”

He’s almost smirking, head cocked slightly, twiddling a pen between his fingers. It’s fitting, you think, to see a surgeon take such pleasure in getting under people’s skin. 

You hate that you find him attractive. That you’ve managed to fall victim to a charm buried so deep beneath layers of pure arrogance that you have to dig to find it. If he wasn’t so beautiful on the outside, you’re almost certain you wouldn’t bother fighting to find something redeemable within. But the way your body reacts to him; the warmth, the buzzing deep in your belly, it must be there. 

The meeting finishes and you remain at the table, straightening the wad of papers in front of you and slotting them back into your binder as everyone filters out of the room. When you’re alone, you stand and walk to the large window, taking a moment to gaze out at the view. Your eyes skim New York City, admiring the blend of old and new; small stone buildings wedged between tall skyscrapers, the late afternoon sun glinting across metal and glass, pockets of green peppered amongst brick and mortar. You wish you got to come here more often. 

You pick up your briefcase and drape your jacket over your arm as you make your way out of the boardroom. The corridor is bright and quiet, but the bustling of the hospital is a low hum. You close the door behind you and begin to walk, unfazed by the sight of a figure leaning against the wall up ahead. 

His arms are folded over his broad chest, dark blue scrubs doing little for his tall, robust frame. His legs are crossed at the ankles as he rests his weight back against the wall, head stooped slightly, but his eyes are on you. 

“Doctor Strange,” you say with a polite nod as you continue past him.

He smiles, allows you to pass, but you feel him move behind you. 

“You don’t really think Doctor West’s procedure holds any merit?” he asks, catching up to walk at your side. 

“I do.” You furrow your brow. “You don’t think there’s merit in improving the efficiency of existing surgeries?” 

He shrugs. “Just not all that exciting when you compare it to what I’m doing.” 

“You mean what you and Doctor Palmer are doing…” 

There’s a chuckle deep in his throat, like he enjoys the back and forth, watching his opponents fight for their lives while to him it’s just a sparring match. He quickens his pace to slip in front of you, turning to face you and forcing you to halt in the middle of the corridor. 

“Be honest,” he says. “You’re impressed.” 

“Of course we’re impressed. Why else would the board have sent me here?” 

“No I mean you, specifically.” 

You glare up at him, hiding your amusement with an eye roll. “Yes, Doctor,” you say slowly, your words empty and biting. “I am very impressed.” 

His cupid’s bow deepens as his lips curve into a self satisfied smile, lines forming in his cheeks and the corners of his eyes. He knows you find him infuriating, but it only seems to encourage him. There’s a moment of silence, long enough for his gaze to trail the length of you, just once. 

“You know, I’d love to talk more with you about it,” he says, looking down at his obviously expensive watch. “Maybe over dinner. Have you eaten?” 

You draw in a deep breath through your nose, letting it out in a sigh as you begin to speak. “I don’t need your superficial attempts to woo me, Doctor.” You reach into your briefcase and pull out a pen and a business card, scrawling on the back of it and handing it to him. “This is where I’m staying. Come by around eight.” 

You’re certain he’s going to protest, pretend he actually wants to go to dinner, talk, that he was ever interested in anything that didn’t involve the removal of your clothes. You wait in suspense as his eyes flit down to the card in his hand, then back up to your face.

“I prefer to fuck in my own bed,” he says bluntly. 

A wave crashes in your stomach, rushing down into your core, the sensation so strong and unexpected that your knees almost buckle. This isn’t the first time one of your work trips has ended in you going home with a surgeon, but the way this one doesn’t try to feign the ‘nice guy’, doesn’t pretend to want anything more from you than your body, that’s new.  

“Unless I’m on vacation, of course,” he adds with a cocky smile. 

“Of course…” 

He flips the card over and plucks the pen from your hand. You watch as he scribbles on it and hands it back to you. 

“So this is where I’ll be tonight,” he says. “You said eight works for you?”  

You press your tongue to the inside of your cheek, unsure if you’ve ever met anyone as imperious as this. You slip the card into your pocket and move to walk past him, stopping as your shoulders brush and looking up at him. 

“I hope your dick is as inflated as your ego.”

He smirks to himself, remaining quiet as you continue to walk away. 

Your skirt is riding up your backside. You reach back to yank it down for the hundredth time before pressing the buzzer on the wall of the apartment building. The setting sun is just a glow beneath the horizon but the streets are still busy, the air warm with a pleasant breeze. You lean back to stare up at the building, the mirrored windows stretching so high you can’t see an end to them. You wonder which one is his. 

There’s a scratching sound on the intercom, followed by a deep voice. “Yeah?” 

“It’s me,” you say, glancing over your shoulders as if you’re on some kind of secret mission, scared of being seen. 

He doesn’t speak again, instead there’s a quick buzz followed by the click of the heavy front door. You let yourself inside, heels clacking against the glossy marble floor as you hurry towards the elevators. When the doors slide open, you pull out your business card, punch in the floor number he’d scrawled in the bottom corner. It begins to ascend, making your already swirling stomach turn. 

You pull down the back of your skirt again as you step out into the hall, peering down the length of it in search of his apartment. The door is tall and wide, dark timber and a heavy metallic handle. You knock but your knuckles barely make a sound, the dense wood swallowing the echo. 

Still, he comes. You regard him quietly as you step inside, the snug sweater and tailored jeans, a pair of sneakers making you feel entirely overdressed. He’s already grinning; a smug, confident smile that reignites the ire in your chest. You ignore him and walk further in, eyes wide in awe at the vast, industrial space.

You walk over to the window that stretches the length of the apartment, floor to ceiling, wall to wall, framing a perfect snapshot of the city. 

“Now I understand why you make the women come to you,” you say. 

“Hm?” 

“This place. It’s impressive.” You glance over your shoulder at him. “That’s the point, right? You like to impress. To show off.”  

He laughs quietly and makes his way to the kitchen area, opening the extensive liquor cabinet. “You want something to drink?” 

“I have rules,” you say abruptly, turning around to face him from across the echoey room.

He straightens. “Go on…” 

“Nothing that happens here can be used for any type of professional leverage, good or bad, by either of us.” 

“Of course-”

“This isn’t a date. I don’t spend the night, I don’t keep in touch, I don’t call when I’m back in town so we can do this again. This is just tonight. And it’s just sex. Understood?” 

“Understood.” He returns to the cabinet and takes out a bottle. “So, about that drink…”

You’re already gone, wandering off through a door at the rear of the apartment in search of the bedroom. 

You find it. It’s a dark, cave-like space, large curtains draped across another huge window, only the faintest glow of the sunset fighting through the fabric. It’s clinical, just as you’d expect from a surgeon; sleek furniture void of any clutter or knick knacks, exposed brick walls with the occasional piece of art - no photographs. There’s a full length mirror, a small couch, and a bed so large you could sink into it and disappear. You wonder just how many women have delved beneath those sheets before you. 

He appears in the doorway, looking you up and down. “You’re eager, little one,” he teases.

You roll your eyes, watching as he closes the door behind him and approaches you. You reach up to touch him, to kiss him, but instead he takes your wrists in his hands and lowers them back to your sides. 

“Mm, not yet.” 

You scoff in dispute, eyes following him as he strolls across the room and switches on the wall sconces, illuminating the area above the bed in a dim, warm light. 

“Look,” you say. “If you’re just going to mess with me then-”

“Well actually, after you left the hospital this afternoon, I got called to consult on a patient and ended up having to stay late. I just got home around fifteen minutes before you knocked on my door. So if you don’t mind, I would like to take a shower first. Is that alright with you?” he finishes sarcastically. 

You settle down, composing yourself and relaxing your shoulders. “Of course.” 

“Make yourself comfortable.” 

He pushes open a door to the right and you catch a glimpse of the luxurious, marbled master bathroom as he steps inside. The door closes behind him, leaving you alone again. You stand there for a moment, listening to him whistling to himself, his belt buckle unfastening and hitting the floor. Water bursts from the shower, the sound like soft static, and you immediately rush over to the mirror. 

You examine yourself carefully; fix your hair, press your nose to your skin and clothes, shift your underwear so it sits smoothly and undetectable beneath your skirt. Then you sit down at the foot of the bed, knee bouncing impatiently. You change your mind shortly after, moving to the small couch opposite the bed instead. 

Ten minutes or so pass, but it feels like an eternity. You picture him drawing it out on purpose, working the lather into his skin one section at a time, scrubbing at his hair for much longer than necessary, just to make you sweat. The water shuts off and you listen to him singing to himself, the hum of his voice through the door. When the door finally opens, steam escapes into the bedroom, the rich smell of citrus and cedar filling the air as he walks out, still humming quietly. 

You glance over at him, mouth falling open slightly to find him completely naked, your gaze falling immediately to the pronounced length hanging from his body as he pads across the room. You look away quickly, rolling your eyes and huffing with indignation. Of course he’s naked, you think, he likes to spar, and you’ve willingly stepped into the ring.

Droplets sit on his shoulders and roll down his torso as he moves around the bed. He climbs on and lays down right in the middle, hands resting behind his head, propped up slightly on the headboard. His hair is still damp, half-coiffed, the grey at his temples darker than it was before. His body is solid, the mystery beneath the scrubs now revealed to you in all its glory. His arms are thick as they flex either side of his head, divots of muscle creating shadows across his torso, cock resting proudly on his thigh as he parts his legs in wait. He’s exquisite, and you can’t help but bask in the sight. 

“So,” he says casually. “Are you just going to stay over there looking at me? Or are you going to come and sit on my face?” 

You glare at him, unamused. 

“What?” he shrugs gently. “You’re the one that said this was strictly sex. Forgive me for abiding by your rules.” 

“There’s a word for that, you know,” you reply. “Malicious compliance.”

“Mm, is it really malicious if I’m offering to eat you out?”

“Depends how good you are at it.” 

“Come here and find out.”  There’s no humour in his tone, but it’s still playful, like he’s goading you. 

You stand up and take a step towards the bed. 

“Clothes,” he demands. 

You stop, pressing your lips together tightly. His eyes never leave you, remaining locked on yours as you kick off your shoes and untuck your top from the waistband of your skirt. 

“They should study you,” you say. 

“Study me?” 

“Yeah.” You lift your top over your head and throw it to the floor, reaching down to unzip your skirt. “Look into how one singular person could possibly be such an ass.” 

“Clearly there’s a part of you that likes it, y’know, since you’re here… taking your clothes off for me.”

“What can I say? I’m partial to a surgeon. Think it’s the hands.” 

The skirt pools at your feet and you step out of it, extending your arms as if to say ‘ta da’. He smiles. 

No one has ever looked at you like this. So intense, like he’s studying every inch; relishing in every freckle and blemish, every curve and crease, mapping out the places he plans to touch, taste, explore. 

You continue towards him but he raises his palm, halting you again. “You haven’t finished,” he says. 

You glance down at yourself, then back up to him, letting out a grumbling sigh as you reach behind you to unclasp your bra. It pops open, the release of pressure on your skin as soothing as a deep breath. His gaze darkens as you slide the straps off your shoulders, watching your nipples harden as you reveal your bare breasts to him. 

“These too?” you ask, hooking your thumbs into the waistline of your underwear. 

“Mhm.” 

You take them off as gracefully as you can, shimmying them over your hips and thighs and kicking them away. His cock is hardening, swelling and rising towards his stomach. Your mouth twitches with a triumphant smile, but you suppress it as you climb onto the bed, crawling up to meet him. 

You lean down and press your lips to his, feeling your skin prick, arousal kindling in your core. His mouth is smart, but it’s also divine. The feeling intensifies, spreading through your belly and pounding between your legs as you sweep your tongue into his open mouth, feel his restraint wavering as your hot breaths mingle. You let your chest press against his, the feeling of skin on skin making you burn with need. 

You bring a hand up to his face, he brings his to your throat, bracketing it gently and peeling his mouth from yours. 

“I didn’t tell you to kiss me,” he says quietly. “I told you to sit on my face.” 

You pull back a little more, making eye contact, breathless as a million comebacks shutter through your mind. But in the end you say nothing, letting out a soft huff and slowly shifting your body up the bed.

You hold the top of the extravagant headboard with both hands and swing one leg over him, straddling his shoulders as his fingers reach up behind you to the small of your back. His touch is electric, lips searing as they plant a kiss on your inner thigh. A soft whimper escapes you in a breath, as though anticipation is its own foreplay. 

He wraps his arms around the backs of your thighs and pulls you down onto his mouth. Your grip tightens on the headboard, fingernails digging into the soft, cushiony fabric as he parts his lips against your centre, sucking softly on your already throbbing clit. Your head falls back when his tongue drags up the length of your slit, moulding itself to every pucker and groove, lapping you up like he adores you, and you wonder how many women have fallen for him in these moments. 

You groan quietly, closing your eyes as you focus on the flicks and strokes of his tongue, the sucking and swirling, the hums deep in his throat and he devours you. Your clit is sensitive, making you shudder, the pleasure so intense you can barely stand it. Your body raises up instinctively, but he tightens his hold on you, spitting on your clit and returning his mouth to the place that both aches and sings, somehow at the same time. 

You gasp in response, eyelids fluttering as you swear under your breath. He releases one of your thighs and you glance over your shoulder to see his hand wrapping around his cock. He begins to stroke it forcefully, working himself to the rhythm of his mouth, and you almost fall to pieces. 

“Oh my god,” you moan, slumping forward and pressing your forehead to the headboard. 

Your thighs clamp around his head, but it only spurs him on, making him bury his face deeper, and you can’t remember the last time he came up for air.

“I can’t,” you whisper. 

The nerves in your clit are screaming, dancing on the precipice between pain and pleasure. He continues to lap at your centre, pushing you to the edge until you’re clinging on for dear life. Pressure swells in your core, flooding you with a tingling heat that softens your bones and turns you to liquid. Until finally you’re there, falling, melting. 

He growls as your body begins to shake, working his tongue over you one last time before releasing you from his grasp. You collapse next to him, sliding down the pillows until you’re lying at his side. You’re breathless, chest rising and falling heavily as you stare up at the ceiling. 

He rolls onto his side to face you. “You’re quiet when you come,” he says, placing a kiss into the crook of your neck, another at the dip of your collarbone.  

“I’ve spent the past two years practically living in hotel rooms,” you reply. “I’ve learned to be inconspicuous.” 

“Hm.” He props himself up on his forearm and leans over you, his other hand trailing softly down the side of your body. “Let’s see if we can do something about that.” 

Before you can reply, he’s kissing you. His mouth is slick, it tastes of you. Your body is spent, limbs heavy, yet still you find it responding to his touch. He shifts further onto you, spreading your legs with his hands and settling himself between them. You can feel his cock nudging your centre as he rocks his hips, sliding along the soaking wet mess he left there and brushing his head over your clit. It’s sensitive, raw, makes you gasp. But he swallows the sound with a heady kiss.

He’s big. Thick. Hard. Maybe that’s where he stores his arrogance. He continues to tease you, soaking himself in the mix of spit and slick as he wraps his hands around your neck, kisses you so deeply you can feel him drawing a moan from your throat.

He pulls away and looks down at you for a moment. “Condom?” he asks casually.

You’re on the pill. Have been since you were seventeen. But still, you know you should say yes. Yesterday, this man was a stranger; a face you only knew from TV and the medical articles you’d read.

“No.” You shake your head and reach down, gripping his cock and directing it into you.

He chuckles, the sound deep and low. “What a good girl.” 

You sigh as he teases at your entrance, pushing the head of his cock in and out but never breaking all the way through. 

“Were you thinking about this today in the meeting?” he taunts softly. 

You groan and buck your hips, desperate for him to take you. 

He eases back slightly and tuts. “I saw you squirming in your seat. How hot and flustered you got when I looked at you. Tell me how much you wanted this.” 

“What I wanted,” you begin quietly. “Was to wring your neck.” 

The corner of his mouth curls into a smirk. “Really…” 

“Really.” 

He squeezes his fingers gently around your throat and you exhale softly. The desire is almost painful, your core throbbing, pussy aching. 

“Funny how things work out,” he says. 

You let out a stifled moan as he sinks into you, filling you so completely you’re certain you can’t take it.

“That’s it,” he mutters as he looks down, watching his cock disappear all the way to the hilt. 

You whimper and tighten around him. He sucks the air in through his teeth, returning his gaze to your eyes with a mischievous smile. 

“I’m gonna need you to not do that,” he says. “You’ll have me finishing in seconds.” 

“Are you telling me the great Doctor Stephen Strange lacks self discipline?” You contract your walls again, this time on purpose.

He bows, forehead resting on your chest, and growls deep in the back of his throat. Then suddenly, without warning, he draws his hips back and buries himself in you again. You gasp, fingers digging into the blades of his shoulders as he repeats his thrusts, building to a firm, steady rhythm. 

A small cry escapes you; a sound you’ve never heard yourself make before. He hums in response, keeping you pinned to the bed with his hands around your neck as he snaps his hips, punishing you from the inside out. 

“Wrap those legs around my back,” he demands. 

You do as you’re told, locking your ankles and gasping as he sinks further, the head of his cock kissing the deepest parts of you and sending jolts of pure electricity through your stomach. 

“You’re going to break me,” you whisper.

“Not this time. Maybe later,” he replies, still so arrogant it makes you want to reach up and slap him. 

But your hands are stuck to his back, nails digging into the smooth, taut flesh. Another unfamiliar sound falls from your lips, somewhere between a grunt and a hum. He likes it, you can tell in the way he closes his eyes to compose himself.

“Jesus,” he hisses.

His movements begin to stutter and he rests his forehead against yours. You feel his cock throbbing, your pussy growing wetter until it’s dripping. He lets out a long, satisfied groan and begins to slow down, every rock of his hips like the promise of another climax. 

“Don’t stop,” you whisper desperately. “Please don’t stop, I’m so close.”

He doesn’t open his eyes, but still he obliges; continuing to stroke into you as you squirm beneath him.

“Oh god,” you groan. “Harder. I need- harder.” 

He grunts, screwing his eyes shut tightly, and begins pounding his cock into you with such force you can feel your body shifting up the mattress. You know he already came, you know how sensitive he must be. But somehow, knowing that makes this all the more delicious.

The electricity builds again, every thrust like a lightning strike through your core. Your legs begin to shake and you finally let go, giving in to the current and letting it course through you. Your orgasm is intense, sharp and tingly, making you shudder, body stiffening until it passes. 

He slows to a stop, resting his full weight on top of you. You welcome the pressure, like a weighted blanket; warm and grounding, soothing the ache beginning to settle in your limbs. 

After a few moments, he slides out of you carefully, rolling over to lie at your side. “You want that drink now?” he asks. 

Hair sticks to your forehead with sweat, you brush it back, sucking in deep breaths as you stare up at the ceiling. “No, I’m good.” 

Silence envelops you, neither one of you speaking again until your hearts stop thumping. 

“So… I guess this means you’re going to approve the training for my method,” he says. 

You turn your head, glaring at him in stunned silence. 

“I’m kidding,” he says with a smile, greatly amusing himself. 

“God, surgeons are assholes,” you mutter.

[wheelie-sick]

Explaining dysphagia

Dysphagia is simultaneously a symptom and a diagnosable condition. Most people think of it (if they think of it at all) as the choking on food disease but in reality it's much more complicated than that.

There are four categories of dysphagia: oropharyngeal, esophageal, esophagogastric, and paraesophageal

only two of those categories (oropharyngeal and esophageal) are commonly used and diagnosed so those are the main two I'll be talking about.

The diagnosis of dysphagia is a fairly complicated process involving a lot of radiological testing and things stuck up your nose and down your throat.

lost the source :(

source

the ICD 10 further divides dysphagia into unspecified, oral phase, oropharyngeal phase, pharyngeal phase, pharyngoesophageal phase, and other dysphagia which includes cervical dysphagia and neurogenic dysphagia

Oropharyngeal dysphagia

Oropharyngeal dysphagia occurs when someone has difficulty initiating a swallow. It's often accompanied by coughing, choking, feeling food stick in the throat, and nasal regurgitation. Other symptoms include frequent repetitive swallows, frequent throat clearing, a gargly voice after meals, hoarse voice, nasal speech and dysarthria, drooling, and recurrent pneumonia.

Oropharyngeal dysphagia is diagnosed with a modified barium swallow and/or a transnasal video endoscopy.

Some of the consequences of oropharyngeal dysphagia include aspiration pneumonia, upper respiratory infections, and weight loss. Common treatment includes rehabilitative swallowing exercises, botox, surgery, and/or a feeding tube.

Esophageal Dysphagia

Esophageal dysphagia is dysphagia where there is a problem with the passage of food or liquids through the esophagus between the upper and lower esophageal sphincter. Esophageal dysphagia is usually a result of abnormal motility in the esophagus or a physical obstruction to the esophagus. Symptoms of esophageal dysphagia vary depending on cause.

Motility: People with esophageal motility disorders will experience problems with swallowing both liquids and solids. Motility disorders consist of abnormal numbers of contractions in the esophagus, abnormal velocity of contractions, abnormal force of contractions, abnormal coordinated timing of contractions, or several of these simultaneously. People with esophageal motility disorders may also experience spasms or chest pain.

Obstruction: People with an esophageal obstruction will have more difficulty swallowing solids than liquids.

Some symptoms of both include pain when swallowing, the inability to swallow, sensation of food being stuck in your throat or chest, drooling, and regurgitation.

Esophageal dysphagia can be diagnosed with a barium swallow, upper endoscopy, esophageal manometry, and an endoFLIP.

Some common treatments for esophageal dysphagia include medication, esophageal dilation, surgery, stent placement, and/or a feeding tube.

Esophagogastric Dysphagia

Esophagogastric dysphagia occurs when there is a problem with material passing from the lower esophageal sphincter into the gastric fundus.

Paraesophageal Dysphagia

Paraesophageal dysphagia occurs when the esophagus is narrowed due to extrinsic compression.

The ICD 10 Classifications

Oral phase - difficulty moving food or liquid to the back of the throat

Oropharyngeal phase - difficulty initiating swallowing

Pharyngeal phase - difficulty swallowing when food or liquid is at the top of the throat

Pharyngoesophageal phase - unable to find information

Other dysphagia- cervical dysphagia (caused by problems with the cervical spine) or neurogenic dysphagia (caused by problems with the central or peripheral nervous system)

Sources

x x x

+ some others I definitely (/sarcasm) didn't lose the link to

[cosmicpuzzle]

Astro Observations

✩7th lord in 2nd house can mean your partner is frugal and may not share his resources with you.

✩Venus in 4th house could drive a luxury car.

✩Rahu in 7th house could have an inter religion cross cultural marriage.

✩7th lord in 6th house could marry a Virgo rising or Virgo Moon.

✩Planets in Ardra star can be a major disappointment especially during rahu Dasha.

✩Sun Mars can cause operation in the heart (Stent placement etc)

For Readings, Please DM

[darkmaga-retard]

Part 1: How Demonizing Essential Nutrients Has Led To Widespread Illness and Needless Death

Brucha Weisberger

Aug 07, 2024

BS”D

Could there be a greater cruelty than convincing people that the foods which they need to remain healthy are dangerous for them, so that they avoid the very things their bodies require most, and become sick as a result of misguided efforts at staying well?

Yet, this is exactly the quackery that has been perpetrated upon us since the 1960’s.

In this article, I will lay out some of the overwhelming evidence showing that the demonization of animal fat (along with the concordant elevation/proliferation of vegetable oils and processed carbohydrates) has been the greatest cause of the enormous plague of modern vascular and neurological illnesses in recent decades. (P.S. The list of illnesses induced by lack of cholesterol and saturated fat include “mental” illness as well.)

In a striking example of the healing powers of animal fats, a brilliant scientist I’m that I’m privileged to be friends with cured her brand-new husband, who was then in his early sixties, of his partially-occluded arteries by feeding him a high saturated fat diet of lamb fat, butter, etc. (as well as removing inflammatory processed carbohydrates and vegetable oils from his diet.) When he returned for his checkup - having been told the previous year that he may need “intervention” (i.e. stent placement) - his arteries were, thank G-d, perfectly clear, and he was asked “Why are you here?” In fact, all his health problems, typical for a man his age in the Western world, rapidly reversed on the healthful, high animal fat diet, and he no longer requires any medications. (Imagine a world where everyone knew how to eat in this way - Pharma’s profits would go down the drain!)

This story makes total sense when you understand the critical functions of cholesterol and saturated fat in our bodies, and the true causes of heart disease (which are not cholesterol and saturated fat!)

As my scientist friend puts it, believe it or not, the animal fats act as a drain cleaner for your arteries.

[kampflesben]

What I really want back is the passion I had for writing when I wrote about Pariston getting a Prion Disease. Reading through medical journals to make it as accurate as possible. That was passion. I think I just need to find a new niche disease/ailment to write about.

Unfortunately, my every day life now consists of encountering heart disease, which is mostly not that exciting to write about. I don't feel passionate about writing "Pariston gets a Coronary angiography with potential stent placement" "Pariston didn't take his blood pressure medications and now has a systolic 210mmHg" "Pariston has ST Elevations in his EKG". The closest I CAN get to it is "Pariston almost bleeds out after a surgeon didn't secure the access for the PFO-Closing correctly". But that's scraping the bottom of the barrel.

[ivyduncane]

I have posted an update on Kirk’s GoFundMe. He is currently on a ventilator at the cardiovascular intensive care unit here at the university of Utah. There are a combination of complications that occurred with the placement of the second stent yesterday. Kirk has quite a few blood clots that have formed in his right lung and there’s thought that perhaps this is causing his pulmonary hypertension and his inability to sustain acceptable, oxygen saturation rates. Please keep praying for this family and please keep sharing this GoFundMe. I know these GFM posts can feel redundant but we need all the help and the love. Charly has filed for SSDI and we’re waiting on that to be processed. Please keep us in your thoughts. 🙏

https://www.gofundme.com/f/help-charly-navigate-through-crisis

[jobrookekarev]

The Beating of Two Hearts: Chapter Five

Chapter: Five of Nine

Words: 2,318

Summary: Jo's heart fails and she's rushed into surgery as Alex's entire world falls apart.

Fandom: Grey’s Anatomy.

Relationship: Alex Karev/Jo Wilson.

Characters: Alex Karev, Jo Wilson, Atticus Lincoln, Meredith Grey, Carina DeLuca, Cristina Yang.

Rating: Teen and Up Audiences.

Additional Tags: Alternate Universe, Pure Angst, Medical, Illness.

Read at AO3

Read at FFN

AN: So 2 weeks ago I started moving. I was like, it's not going to interfere with my updating, it did. Anyway, here it is!

…………………………………………………………………

It happened when he was getting Jo, her favorite take out. Things were good, Jo was doing well and joking with him as she made him go get it. They had just put the girls back in daycare after spending the morning with them. It was the start of a good day. He almost forgot they were planning on doing the surgery that evening. Cristina had flown in that night and met with them to discuss the surgery. She was sleeping now, but Alex felt at ease that she was here.

Then his pager went off. As he read the page for an emergency in O.B., he didn't think much of it. Alex got paged to O.B. for newborns all the time. Until a nurse ran up to him. Before she even opened her mouth, he knew it was about Jo. 

“Dr Karev, it's your wife. She fainted and her heart….” 

His own heart was in his throat. Alex didn’t hear anything else from the nurse. He had already taken off, running down the hall and abandoning the chinese food on the nearest surface. He raced up to Jo's room as fast as he could. He didn't bother taking the elevator, but just ran up the stairs two at a time. He went so fast that he nearly tripped. Finally, he got to the Maternity ward and saw a flurry of motion in Jo's room. He just stood there watching, not even seeing Jo from outside the room admits all the chaos. Until Meredith saw him and grabbed him as she pulled him into the room. 

“We were talking and she got up to use the bathroom and fainted, but unlike before I couldn't rouse her, she wouldn't fully wake up. Her heart rate is lower and we're preparing an OR. Cristina says she can put in the new stent in ten minutes.” 

Meredith pulled him into the room and one of the nurse's ran out, leaving a space for him to see her. Alex just stared at his pregnant wife, pale and lifeless on the bed, hooked up to a thousand monitors. Her sleep shirt was cut off and the blankets were thrown back to her feet, but she still had her favorite black sweatpants on. Alex came up to her and saw Carina at her bedside, working out of her specialty as she tried to help Jo’s heart. Alex quickly ran up to her, taking a hold of her hand.

“Jo,” Alex said to her, but she barely heard his voice.

Then she saw him and her hazy eyes locked onto his. “Alex, I don't feel good. Can you hold me, please?”

He kissed her hand and held it close, despite everything, her talking to him was a good sign. “I’ll do anything you want, Jo, just please stay.”

She looked up at him still hazy and he knew she was trying to hold his gaze. Time stood still as they locked eyes and Jo even gave him a small smile. For a moment it was all going to be okay. But it was gone too soon and Meredith was pulling him back. 

“Alex, Alex, we gotta go, they have to take Jo now,” Meredith said as she pulled him away, but he couldn't let Jo go.

The room was abuzz with work as Carina shouted orders at everybody. She grabbed the rails of the bed as they started to move. They ran down the hallway and Alex held her hand as she tried to hold his gaze. 

“It shouldn't take Cristina very long to know if her heart can work on its own after the stent placement again or if she needs a pacemaker,” Meredith said, glancing over at him as they ran down the hall. He wasn't surprised that she knew Cristina's surgery plan.

“What about the baby? She's only 28 weeks if you deliver now…” Alex trailed off as he looked down at her small bump, holding the even smaller baby inside her.

“We're hoping to avoid that,” Carina said, glancing at him. “But if we can't, your baby has a good chance in the NICU.”

“Hayes is going to meet us up there and be ready just in case,” Meredith said, seeing the look in his eyes and putting hand on his arm.

It was an 80% chance of survival. Alex knew the numbers and he knew how those numbers could change. Especially with a sick mother and low blood flow.  Alex didn't say anything else as they boarded the elevator. Jo closed her eyes as they boarded the elevator and he rubbed her cheek with his thumb as he tried To get her to open them again but she remained asleep. Alex put a hand on her bump as he felt a good kick from her belly. He took the little bit of reassurance that he got, but jumped as the alarms went off. 

Her heart rate was still low causing the alarms to beep, as this was his new nightmare. Each beep, and alarm made him jump and get antsy in a way he never was before. Meredith saw him react to each beep and reached over to turn off the alarm. The monitor still flashed and displayed the alarm, but he no longer jumped at each minute. Carina and tied on her scrub cap and the nurses around him double checked the IVs and monitors as they talked to each other in numbers and milligrams talking about the medications they would need for surgery.

“Jo, Jo,” Alex said, trying to rouse her and her heart back to life, but she was completely out of it. Her eyes closed and she couldn't wake up. Suddenly he was plagued by the thought of never seeing her brown eyes again. He could feel the tears fill his eyes. “Please be okay, please pull through this.”

Alex whispered to her in a plea of desperation, but she didn't respond. The elevator doors opened up and the moment was over and the rush began again. Hayes greeted them in the hallway and grabbed the end of the bed and started pushing it forward.

“The cath lab is prepped and ready. Cristina's already in there ready to operate,” Hayes said as he looked at Jo before his eyes glanced at Alex, but he didn’t say anything when he saw Alex’s tears. Cormac of all people knew Alex’s pain and fear now, having lived through his own wife’s death.

Meredith nodded and they pushed the bed to the cath lab. As they got to the door Meredith grabbed him, forcing him to let go of Jo's hand as they pushed through the doors without him. He fought it, trying to follow them and be with Jo as he pushed against Meredith, but Link grabbed him too and held him back.

“No let me go, let me in there,” Alex yelled as he begged her, but Meredith and Link stood firm and pulled him back to the hallway.

“Trust me Alex, the last thing you want to do is see Jo on the table,” Meredith said looking into his eyes and he knew she was right, but he still fought her.

“Please Mer,” Alex's voice breaking as his tears took over and his vision blurred with the sat water in his eyes. “If it was Zola or anyone else, you'd be in there!” 

“You forget that I've done this with Zola, Alex. You don't want to see what happens in there, you don’t want to see your wife cut open. Let Cristina work, she can save Jo and the baby.”

“She's right, Alex. Cristina, Carina, and Hayes are going to take good care of Jo and the baby. We have to trust them and as much as it sucks, we have to go sit in the waiting room,” Link said, letting go of him a little, as Alex stopped struggling. 

“Okay, we have two options. We can go to the waiting room and sit there or we can go down to the daycare and you can play with girls for a bit,” Meredith offered to him, but he didn’t want either of those.

He knew he should go see the girls. They were struggling with Jo being in the hospital and going home with Link and Meredith instead of him. They were rowdy and unsettled and their behaviors were increasing. Helena had started biting and Luna had withdrawn into herself. The only time she would sign or talk was when she was snuggled with Jo or him. Therefore, last night they asked Link to take the girls to their home. Then Alex would join them for bedtime and the morning routine. However it didn’t go as planned. 

The second he walked into the house, he smelled Jo's perfume and saw the coffee mug she left on the counter the morning before she fainted. Alex didn't know what to do. He couldn't breathe. He ran out of the house and hid in the car until he could breathe again. Thankfully the girls didn't see him and Link pretended he didn’t. He double checked that they were okay and then left them with Link for the night. He agreed to help him out further and bring them to daycare tomorrow, while Alex went back to the hospital. 

Jo was having a hard time too. Her hormones made it worse and she was struggling with her mental health. She cried when they left although she had tried to put on a brave face. When he came back, he had seen the tear streaks on her cheeks. One of the nurses had told them that she hadn't stopped crying after he left that night. Although she had quickly wiped them away and put a smile on. Her anxiety was high the whole night until she fell asleep in his arms. It was rough all around. With everybody doing their best to try and help them out. But the only thing they all needed was for Jo to come home safe and sound.

“Alex we have to go to the waiting room,” Meredith said, grabbing onto his arms but he wouldn't let her move him. 

He watched as nurses Ginger and Anna ran into the Cath lab. Alex considered sneaking in with the nurses, although he wasn’t sure if they would allow him in there. For him they wouldn't, but for Jo they would.

Then he saw his chance. No one was in the hall and Link turned to walk towards the waiting room. Alex ran for it. He rushed into the scrub room barely stopping to grab a mask before he ran into the OR. There he saw Jo on the table. She was laying there as Cristina stood over her with a scalpel in her hand. He ran over to Jo and grabbed her hand, giving it a squeeze as he watched over her. 

“Alex? Get out!” Cristina yelled at him.

“No, I’m not leaving!” Alex insisted, planting his feet as he stared at Jo. 

“And I’m not cutting your wife in front of you,” Cristina said as she put the scalpel down. “Somebody get him out of here!”

“Alex you can't be here, we have to go,” Meredith said, grabbing his arm and trying to drag him away. 

“No no,” Alex said, desperate to stay, but before he knew it, Link had grabbed him and all but dragged him out. “Jo, no.”

He was forced to let go of Jo’s hand and his eyes stayed fixed on her as they took him away. Alex fought the arms around him that pulled him back trying to dig in his heels and stay in the OR, but it was a useless battle. They quickly pulled him out of the OR. Cristina went right back to where she was, grabbing the scalpel again. The last thing he saw as he watched through the window of the scrub room was Cristina cutting into Jo's thigh. There was a little bit of blood that came from the cut and it made him sick to see her cut his wife. 

Suddenly the doors were in front of him and he was pushed out into the long hallway. He felt like he couldn't breathe. He had to get back in there. He had to be with Jo. He couldn’t let anything bad happen to her. There was a tightness in his chest that seemed to hold his heart in a choke hold. 

“No, Jo, Jo!” Alex called out for her as Meredith held him back as she wrapped her arms around him, but he didn't want to hug her. “Meredith please, I need to be with her!” 

“Alex, breathe,” Meredith said gently as she rubbed his back. “You have to trust Cristina. I know it's hard, but you have to stay here.”

His chest was tight as he struggled to breathe as his mind swirled with thoughts of Jo. He was consumed by thoughts of her dying, Jo was dying. Her heart was failing right now and he wasn't there with her. He couldn't comfort her and hold her hand. All he could think of was, what if she died there, alone? What if their baby was born alone without its mother or father there? What if he never saw her smile again, never heard her laugh, never felt the glare of her eyes as she scolded him, never felt her lips melt into his? What if he never held her in his arms again? 

“Alex, Alex, take a deep breath,” Meredith said steadily as she held him. “You're having a panic attack.”

He didn't fully register what she said and even then, he didn't believe her. everything overwhelmed him and the tightness in his chest spilled over into tears onto his cheeks. Alex cried as his whole world came crashing down around him.

[sonalisa12]

Stent implant to avoid heart attacks

Cardiac stent surgery is the best way to get rid of heart attacks and also doesn't have any after effects.

Learn more:

[lifeinkinder]

It's 5am so why not put on my big kid pants. My therapist will be so proud.

Little Man's primary cardiologist gave me a timeline potentially for surgery in 6-8 weeks and a discussion with the team in weeks at his appointment on the 12th. She encouraged me to schedule the ordered echo with his local cardiologist to support her view that he needs the full repair basically asap (I wrote about it on the day of the appointment).

She released his after visit notes in mychart yesterday which indicated full repair at 6-8 months and discussion with the team in 1-2 months pending his o2 saturations. 6-8 is the original timeline that was talked about pre placement of the 3rd stent. So I sent a mychart message, since I'm up with babies anyway, requesting help understanding the discrepancy between th3bdiscussion we had in clinic and what was documented.

And not that I said this, but this has happened at nearly every appointment where what we discuss regarding timelines and what she documents regarding the timeline is vastly different.

[mcatmemoranda]

Patient is a [ ] yo male/female presenting to the clinic for a preoperative evaluation.

Procedure [ ]

Scheduled date of procedure [ ]

Surgeon performing procedure requesting consultation for preop is [ ] and can be contacted at [ ]

This patient is/is not medically optimized for the planned surgery, see below for details.

EKG collected in office, interpreted personally and under the direct supervision of attending physician as follows- sinus rate and rhythm, no evidence of ischemia or ST abnormalities, no blocks, normal QTc interval.

The following labs are to be completed prior to surgery, and will be evaluated upon completion. Procedure is to be performed as scheduled barring any extraordinary laboratory derangements of concern.

Current medication list has been thoroughly reviewed and should not interfere with surgery as written.

Patient has no prior history of adverse reactions to anesthesia, problems with airway management, difficult IV access, prolonged emergence, or postoperative nausea/vomiting.

Airway Mallampati score: This patient is a Grade based on the criteria listed below

-Grade I Tonsillar pillars, soft palate, entire uvula

-Grade II Tonsillar pillars, soft palate, part of uvula

-Grade III Soft palate, base of uvula

-Grade IV Hard palate only, no uvula visualized

Patient is a low/medium/high risk for this low/medium/high risk surgical procedure.

Will send documentation of this preoperative visit to surgeon [ ].

**** ADDITIONAL INFORMATION****

Patient Risk for Elective Surgical Procedure as Determined with the Criteria Below:

1- Very Low Risk

No known medical problems

2- Low Risk

Hypertension

Hyperlipidemia

Asthma

Other chronic, stable medical condition without significant functional impairment

3- Intermediate Risk

Age 70 or older

Non-insulin dependent diabetes

History of treated, stable CAD

Morbid obesity (BMI > 30)

Anemia (hemoglobin < 10)

Mild renal insufficiency

4- High Risk

-Chronic CHF

-Insulin-dependent diabetes mellitus

-Renal insufficiency: creatinine > 2

-Moderate COPD: FEV1 50% to 70%

-Obstructive sleep apnea

-History of stroke or TIA

-Known diagnosis of dementia

-Chronic pain syndrome

5- Very High Risk

-Unstable or severe cardiac disease

-Severe COPD: FEV1 < 50% predicted

-Use of home oxygen

-Pulmonary hypertension

-Severe liver disease

-Severe frailty; physical incapacitation

Surgical Risk Score Determined as Below:

1- Very Low Risk

Procedures that usually require only minimal or moderate sedation and have few physiologic effects

-Eye surgery

-GI endoscopy (without stents)

-Dental procedures

2- Low Risk

Procedures associated with minimal physiologic effect

-Hernia repair

-ENT procedures without planned flap or neck dissection

-Diagnostic cardiac catheterization

-Interventional radiology

-GI endoscopy with stent placement

-Cystoscopy

3- Intermediate Risk

Procedures associated with moderate changes in hemodynamics, risk of blood loss

-Intracranial and spine surgery

-Gynecologic and urologic surgery

-Intra-abdominal surgery without bowel resection

-Intra-thoracic surgery without lung resection

-Cardiac catheterization procedures including electrophysiology studies, ablations, AICD, pacemaker

4- High Risk

Procedures with possible significant effect on hemodynamics, blood loss

-Colorectal surgery with bowel resection

-Kidney transplant

-Major joint replacement (shoulder, knee, and hip)

-Open radical prostatectomy, cystectomy

-Major oncologic general surgery or gynecologic surgery

-Major oncologic head and neck surgery

5- Very High Risk

Procedures with major impact on hemodynamics, fluid shifts, possible major blood loss:

-Aortic surgery

-Cardiac surgery

-Intra-thoracic procedures with lung resection

-Major transplant surgery (heart, lung, liver)

High risk surgery: yes/no

Hx of ischemic heart disease: y/n

Hx of CHF: y/n

Hx of CVA/TIA: y/n

Pre-op tx with insulin: y/n

DM/how are blood sugars?

Pre-op Cr >2mg: y/n

OTHER EVALUATIONS BASED OFF PATIENT HISTORY SEE BELOW:

1. CARDIAC EVALUATION

A. Ischemic Cardiac Risk- Describe any history of cardiovascular disease and list the cardiologist/electrophysiologist. For CAD, report the results of the most recent stress test or cardiac cath, type of procedures or type of stents, date of MI, and recommendations for perioperative management. Include antiplatelet management. Continue baby aspirin for patients with cardiac stents - unless having neurosurgery, then coordinate with surgeon.

B. Ventricular function - include most recent echocardiogram evaluation ideally performed within the past 2 years

C. Valvular heart disease- include most recent echocardiogram, type of prosthetic valve

D. Arrhythmias - include any implanted devices and recent interrogation report, contact electrophysiology about device management during the surgery and include recommendations provided. For A-Fib, include CHA2DS2-VASc score

E. Beta blockade - All patients on chronic beta blockers should have these medications continue throughout the perioperative period unless there is a specifically documented contraindication.

F. Hypertension - Other than for cataract surgery, ACEI inhibitors and ARBs should be held for 24hours prior to surgery and diuretics should be held the morning of surgery

G. Vascular disease - include antiplatelet management and dates of strokes

2. PULMONARY EVALUATION

A. COPD/Asthma - include any recent exacerbations, intubations, chronic O2 use, amount of rescue inhaler use

B. OSA risk - STOPBANG score - address severity of sleep apnea and CPAP use

3. HEMATOLOGIC EVALUATION

A. Bleeding Risk - assess the bleeding risk and history for every patient

B. VTE Prophylaxis/Thrombotic risk - estimate risk and provide recommendations

C. Anticoagulation management - include pre-op and post-op medication instructions

D. Anemia - pre-op treatment plan

D. Oncology - history and treatments

4. ENDOCRINE EVALUATION

A. Diabetes mellitus - include type, medication use, recent A1c, pre-op and post-op management instructions

B. Adrenal insufficiency risk - assess for prolonged steroid use in the last year

5. RENAL EVALUATION

A. CKD - include stage, baseline labs

B. ESRD - include dialysis schedule, type, access, dry weight, location of dialysis. Generally, surgery should not be scheduled on a dialysis day.

C. Electrolyte abnormalities

6. GI EVALUATION

A. Liver disease - including MELD score and Child-Pugh classification

7. OTHER relevant comorbidities or anesthesia considerations

[substance abuse, chronic pain, delirium risk, PONV (post-operative nausea and vomiting) risk, psych disorders, neurologic disorders, infectious disease, etc.]