How long is medical training? I asked our new EP where he went to college. He said Davidson. The Steph Curry Davidson? "Yeah I was 1 year behind him." So in the time it took for my colleague to get his FIRST JOB, Curry has 4 titles, 2 MVPs and the most 3-pointers in NBA history.
I've come to brag a bit today about my wife. She's not on Twitter and so can't get mad at me for posting this. When we met, she was a cardiology floor nurse and I was a resident. She was smart, funny, interesting, stubborn, witty, lovely, and she was a great nurse. 1/x
So now this daughter of a hard-charging refuge worked her way up from the bottom. She has overcome insidious doubt. Hard work and dedication and passion have won the day. She is the kind of person we would all want as our doctor. I could not be more proud of her. 10/10
Just over 4 yrs ago, The Wife found out she was going to be a doctor. Her path led her to love vascular surgery, which, of course, has about a 55% match rate. 😬
Today, she found out she's going to be a vascular surgeon.
Couldn't be more proud.
More to come... 🤞
#Match2023
Medical community: All that data about hydroxychloroquine and azithromycin is anecdotal. We need a rigorous randomized trial.
Also medical community: Proning seems to work.
People still getting mad at PCI. For me, it's pretty simple.
If no angina, don't stent.
If angina real & lesion low risk of complication, ⬇️threshold to stent.
If angina real and lesion high risk of complication, ⬆️meds.
1/x
The intern on service worked in Sri Lanka as the sole doc in a hospital during the civil war without any access to labs or imaging delivering babies, treating cobra bites and performing surgery with ketamine only, so yeah the papers I wrote during residency are REALLY impressive.
Just heard they're recalling 6F Langston dual lumen pigtails because when you power inject through it, the back end can pop off. IMHO if you're trying to power inject through a 3F catheter, YOU should probably be recalled.
When I was an intern, I sat down with
@CMichaelGibson
in a consult room outside the cath lab and told him how much I wanted to get involved in cardiology research. I was probably the 1,986th intern to do so in his career, but he treated me as if I was the 1st.
#EternallyGrateful
All it takes is one little page for “hey just letting you know the sodium dropped from 126 to 125, no other changes; my senior just wanted me to let you know” at 3:00am and now I can’t go back to sleep. I’m not worried or anything I just physically can’t fall back asleep.
She slogged through typing her damn undergraduate and graduate transcripts into the AAMC web site (is there no better way to do this in 2018?). She was asked to interview. She waited. And waited.
An email came this past week. ACCEPTANCE. And with that, a dream realized.
9/x
Removal of an Impella that was placed emergently can be a pain in the ass.
Here's my step-by-step guide to Impella (or any large-bore sheath). Takes 15-20 minutes, relatively cheap, and can be done at the bedside without fluoroscopy if necessary.
1/x
COVID-19 preys on our innate human desire to be with one another. And it can have devastating consequences for small lapses in judgment due to that desire. A tale of two patients of mine illustrates this heartbreaking reality.
A thread.
1/x
[Posted with their permission]
Needs some
#PFO
help from structural heart
#MedTwitter
. Early 30s with real stroke, no other cause identified, markedly positive bubble study. Longest tunnel I've dealt with. Measured 26-27 mm. Tried closing with 35 mm PFO Occluder but no dice no matter what I tried. 1/x
She worked days and studied nights and weekends. She had to relearn all that crap we practitioners have long and confidently forgotten (think Kreb's cycle) since the early days of medical school.
SHE. SMOKED. IT.
7/x
It has been one of the great joys of my life to watch this woman grind her way to this moment. Her compassion, intelligence, skill and grit will make her the kind of vascular surgeon we all deserve.
She will make Duke proud for having trained her.
Sky's the limit.
#Match2023
Resting in eternity as he finally deserves.
Went out on his own terms. We all deserve as beautiful a death. Teaching us til the very end.
Mike Pride
@HomerGlick
.
7/31/46-4/24/23
Moonlighting on the oncology service, I took care of a dying young woman with breast CA We were about the same age. We each had two kids. She died at 5 am. I walked out at 7 am. The sky was perfect blue. Why did I get to walk out? I cried all the way home.
#ShareAStoryinOneTweet
Hey
#cardiotwitter
I need your help to amplify a message about insurance denying payment on hospital days that, in my opinion, could lead to dangerous decisions by interventional cardiologists.
A thread. 1/x
Introducing Dr. Laura B. Pride, MD.
Congrats
@laurabpride
. Well deserved day of celebration of all your efforts.
Even got that photo with
@DGlaucomflecken
, who gave a poignant and relatable commencement address.
The way he figured out whether snake bites were from venomous snakes was to draw blood and set it on the counter. After 20 minutes, if it hadn't clotted the snake was venomous and he administered anti-venom. I get pissed if we don't have the balloon-tipped temp wire I like.
When a critical patient suddenly develops an intense and desperate thirst for water, they are about to crash until proven otherwise. Trust me on this one.
I had almost no money as a med student and had to fly from Boston to Houston, stay in a hotel on top of the exorbitant fees because I couldn't get a Step 2 CS appointment closer and in the time frame I needed it.
So glad this sham is over and no one else has to experience this.
(Fortunately, the scoring system is different than when I took it, so she couldn't officially do better than I had done. But, in actuality, she demolished my score.)
So she applied and we painstakingly worked through her essay and secondary applications. 8/x
Always very grateful to be a part of this profession, but especially grateful today. Post
#TAVR
follow up today with this 99-year-old survivor of the Battle of the Bulge. Truly the Greatest Generation. Survived capture by the Germans. Listen to their stories. They are amazing.
A first for me today. Saw a consult for cardiac risk assessment prior to skydiving. I enthusiastically deemed him low risk.
I did not tell him there was no randomized controlled trial evidence for parachutes.
She is heartbroken.
The other couple will never forgive themselves.
Because friends happened to be home.
And there was a momentary pull to have human connection.
I hate this virus.
It preys on the best part of us.
Stay safe.
Get vaccinated.
Please.
9/9
Those of you who know me from medicine don’t know much about my father, Mike Pride
@homerglick
. Others on here know him well. For those that don’t, for nearly 3 decades he helmed one of the preeminent small newspapers in the country as the editor of
@conmonnews
.
Thread 1/x
I love urban art (think Banksy), and I obviously love medicine. One of the artists I follow, FAKE, has given up copyright on one of his works. My worlds colliding.
Can be downloaded for use here.
I don't want any gifts today.
I want people to mask up and stay away from one another.
I want people with access to vaccines to get vaccinated.
I want this for selfish reasons.
A thread.
1/x
She flourished in the OR. She was amazed that people let her do what she was doing. She, again, excelled. But she still wanted more. And this year, at 32 years old, we had a long talk, and she decided to give it one last shot. She spent months preparing for the MCAT. 6/x
I can not be a responsible adult when left home alone with Doritos.
I can not be a responsible adult when left home alone with Cadbury mini eggs.
There will be empty bags.
I will not apologize.
Happy 7th anniversary to The Wife
@laurabpride
, my PIC and travelling companion, a total inspiration to me. Don't know how she does it all. Couldn't imagine slogging through this mess with anyone else.
I had a balloon-uncrossable lesion the other day and wanted to share a potential new tip that I hadn't heard described before (though it's not rocket science). It was a mid-LAD CTO. I was
#RadialFirst
, 7F EBU 3.75 guide, 6F guidelines as far as it would go.1/x
Well I didn't beat my 27-year-old self. Heat got to everyone the last 8 miles. But I finished 26.2 in under 4 hours. Plenty sore. Can't say I'll do this again in another 15 years.
Asked tech to pull as much as possible on syringe as I pulled filter + guideliner into guide and retracted the system out of the body in 1 motion. Guide spewed thrombus when I flushed it. Next shot below. Today, on 1 pressor, IABP out. No neuro deficits. Sphincter tone released.
My family is full of “losers” and “suckers,” and I am thankful for their sacrifice. I also frequently think of how lucky I am to be here given the overwhelming good fortune they had to make it through what they did alive and mentally intact.
1/x
My wife's mother is now the Associate VP for Programs at a major public health institution in Boston. As good a nurse as my then-girlfriend was, I knew she wanted to do more. She took night classes to fulfill pre-requisites for med school. 3/x
As you gain experience and build relationships, hopefully referrers learn to trust your judgment. You're not saying no. You're just saying no for now.
Meds save lives & prevent MI in stable CAD. Stents help with angina relief.
It's a difficult concept, but it's true.
3/x
Sweden plays Switzerland in the World Cup tomorrow. What percentage of Americans do you think will be surprised to find out that Sweden and Switzerland are different countries?
We started dating when I was an IC fellow. I met her family. It is a matriarchal clan. Her mother is a Chilean refuge who moved to this country with a child at 21, cleaned houses to make ends meet and put food on the table before managing to get her MPH. 2/x
A middle-aged man shopping by himself collapses at a local store and is defibrillated in the field with brief CPR and relatively prompt ROSC but not consciousness. His ECG en route demonstrates an anterior STEMI. He is unable to provide consent. What do you do? Please RT/discuss.
She pivoted and applied to PA school. She was accepted to Emory, I got a job outside Atlanta, we moved to the South. She excelled at school in a way she had not been able to before. She took a job as a vascular surgery PA and quickly became an integral part of their practice. 5/x
Mid 70s man, low risk for SAVR. 730 annulus, dagger of calcium in LVOT, very calcified annulus, valve. Options for us are surgery, oversized 29 S3 or Evolut R 34 plus postdil. He wants TAVR. Want to make sure I'm not crazy for pushing surgery here.
Posted w/ permission.
#TAVR
So proud of this cath lab team. First BASILICA performed
@NorthsideHosp
Gwinnett last week went off without a hitch. What an amazing time we live in.
#TAVR
She tried to balance that with work, including extra shifts because of her crushing undergraduate student debt. At the same time, she studied for and took the MCAT. It was too much at once. She did poorly. She applied anyway, but didn't get asked for an interview. 4/x
Even still, some patients just want to be "fixed."
It's ok if you don't do it. You know the data. If they end up going to someone else to be "fixed," that's ok. You will do plenty of PCIs.
But it's understably difficult to tell yourself that early in your career.
4/4
Amazing how much LBBB freaks people out.
I'm talking healthcare providers.
As in "You can't have a colonoscopy with this ECG you might die."
Or "You need to see cards right away you need a stress test you might die."
Right bundle be so mad. Like, "Bro we got this."
I put holes in your tubes so I can put in long plastic tubes through which I put in little metal tubes to open up your heart tubes. And sometimes valves.
3am call.
"84yo who's been in the hosp for >30 days and had been on hospice just had PEA arrest & ST-elevation on tele during PEA but now has no ST changes on 12-lead. Do you want to do anything?"
Yes, I'd love to go back to sleep, but I'm pretty sure I'm gonna stew for 3 hrs.
Tomorrow morning,
@laurabpride
will walk into a patient’s room and say, “Hi, I’m Dr. Pride.”
It will be the culmination of over 15 years of overcoming countless obstacles.
You have arrived, Dr. Pride, and you belong. Now go and show them what you can be.
I am so proud of you.
Having administered local anaesthetic to a large swath of men and women in my brief career, this is undoubtedly a yes.
Man: WHAT DID YOU JUST DO TO ME!?!?
Woman: That's it?
If men had to have babies, there would be about four per year, and it would be done under general.
Cool CTO from a couple weeks ago. Prior stent from LAD into diag at site of occlusion. Blind proximal cap inside stent to LAD that looked below the artery. Able to wire with Pilot 200 and Corsair, but wire was clearly subintimal.
Surprising - prolonged (>12 months) clopidogrel MONOtherapy after PCI in ACS patients not only reduces bleeding but also ischemic events (!) compared to DUAL therapy including aspirin -
OPT-BIRISK trial
#ESCCongress
The Wife presenting a case report for the first time as a first-year med student at Georgia Vascular Society annual meeting.
First of many meeting presentations to come, I'm sure.
So proud.
We talk a lot about financial and other types of conflicts of interest investigators might have. Shouldn't we hold major academic journals to the same standards? I wonder how much
@NEJM
and
@JACCJournals
make from pharma and device industries. Shouldn't they disclose, too?
A memorial for my father, Charles Michael Pride, will be held Saturday, June 3, at 2 pm at St. Paul's Church, 21 Centre Street, Concord, NH. Reception to follow. Llamas will be present (per my father's request). Any and all welcome. Help get the word out. Did I mention llamas?