PJ Spencer

You're a 19 year old kid. You are critically wounded and dying in the jungle somewhere in the Central Highlands of Viet Nam . Its November 14, 1965 . LZ (landing zone) X-ray. Your unit is outnumbered 8-1 and the enemy fire is so intense from 100 yards away, that your CO (commanding officer) has ordered the MedEvac helicopters to stop coming in. You're lying there, listening to the enemy machine guns and you know you're not getting out. Your family is half way around the world, 12,000 miles away, and you'll never see them again. As the world starts to fade in and out, you know this is the day. Then - over the machine gun noise - you faintly hear that sound of a helicopter. You look up to see a Huey coming in. But.. It doesn't seem real because no MedEvac markings are on it. Captain Ed Freeman is coming in for you. He's not MedEvac so it's not his job, but he heard the radio call and decided he's flying his Huey down into the machine gun fire anyway. Even after the MedEvacs were ordered not to come. He's coming anyway. And he drops it in and sits there in the machine gun fire, as they load 3 of you at a time on board. Then he flies you up and out through the gunfire to the doctors and nurses and safety. And, he kept coming back!! 13 more times!! Until all the wounded were out. No one knew until the mission was over that the Captain had been hit 4 times in the legs and left arm. He took 29 of you and your buddies out that day. Some would not have made it without the Captain and his Huey. Medal of Honor Recipient, Captain Ed Freeman, United States Army, died at the age of 81, in Boise, Idaho. God bless our vets!

@TomVargheseJr @MayoAZSurg Mayo rocks

Wow…Surgery Intern starter packs have come a long way… Kudos on the swag @MayoAZSurg

@DrorLeviner @georgetolisjr Dr Schaff wrote up the issue with anticoagulation in 2001.

@PJSpen1982 @georgetolisjr Hello. Totally agree. Do you have good data to back these numbers?

A bioprosthesis implanted on a young patient does not only expose them to the risk of a reoperation but more importantly to a second lifetime cycle of LV strain (aortic) or pulmonary hypertension (mitral) as well to development of endocarditis of the degenerated bioprosthesis.

@drjohnm @georgetolisjr Mechanical valve vs repair depending on the pathology would be my recommendation for sure

@PJSpen1982 @georgetolisjr The solution? I’m asking. Mechanical valve? Repair?

@sjauhar @anish_koka The patients go back to the icu, ventilator and pressors don’t restart because they’ve already elected comfort care only, and the vast majority of time the patients die in the next few hours without organ donation.

@anish_koka They already are, though, Anish. Doctors typically declare death after five minutes of heart stoppage, yet the heart has been known to reanimate after that point. We already take social considerations like organ viability into account when we define death.

I have a child alive today because of an organ transplant and consider myself a an advocate for organ donation. I do understand where @sjauhar is coming from with regards to the desperate need for organs, but definitions of death cannot be driven by need.

@sjauhar @anish_koka If the family then wants to pursue organ donation a workup ensues, then they go through the process of vent and pressor removal. If they arrest we wait five minutes and only then recover organs. If they don’t arrest organ donation doesn’t happen.

@sjauhar @anish_koka Wait a minute. We define death as 5 min after a heart has stopped in a person who has been in an ICU for a time after an event with time for all care givers involved to regain neurologic function.

@RichardHirth @GeBaiDC @epictetusMD Well put

@PJSpen1982 @GeBaiDC @epictetusMD A solution to yesterday’s problem. A cause of today’s problem

We disagree. "Health systems are already enforcing physician referrals within the entity with which physicians have a financial relationship—the very activity the Stark Law prohibits for self-employed physicians... The Stark Law tilts the playing field in favor of large health systems and integrated group practices at the expense of independent physician practices. The result has been a wave of physicians seeking corporate employment. Unfortunately, the resulting vertical integration has raised prices, reduced competition, and compromised physician autonomy... The Stark Law is also largely incompatible with the transition to value-based care systems, hindering physicians from adopting innovative care delivery and payment arrangements..." Full text of our article @Health_Affairs Forefront: Rationalizing Physician Regulation healthaffairs.org/content/forefr… Link to Mr. Bob David's comment: linkedin.com/feed/update/ur…

@ZainKhalpey From what I’ve seen cardiac robotic surgery is for highly selected, thinner, young pts, with minimal co-morbid conditions. Rarities in modern cardiac surgery practice.

Robotic cardiac surgery isn’t about replacing surgeons, it’s about enhancing them. Smaller incisions. Faster recovery. Smarter care. The future is here. #MedTwitter #RoboticSurgery #HeartHealth #AIinMedicine

@GeBaiDC @epictetusMD Imagine a physician referring out of their system because they believe the oncology, ortho, or cardiology practice, etc is more suitable for their patient.

@ACCinTouch @HeartOTXHeartMD It’s so nice to open a journal and read these 2 serious papers, free of industry persuasion, that are laser directed at improving the options for our patients. A huge congratulations to the authors.

Donation after circulatory death without thoracoabdominal normothermic regional perfusion or commercial ex situ perfusion systems is possible using a novel technique – rapid recovery with extended ultraoxygenated preservation. More: bit.ly/44XPf7W #CardioX #Hearttx

@Olivia_Reingold The Democratic Party in NYC should’ve come up with better opponents then a disgraced former governor and an incumbent who had to be rescued from indictment by a sitting president… he won the primary because his opposition was cartoon level terrible.

I read all 16,100 of Zohran Mamdani’s tweets. First takeaway: yeah, he’s actually a socialist.

@PhilGouzoule @GYGSheena @MGHHeartHealth @KottonNelson @GLewisCardiol @CNewtonCheh Amazing!!

Celebrating the 7th anniversary of my ❤️ transplant today. Forever grateful to my donor and all of you that have been part of my journey. 🙏🏻 @GYGSheena @MGHHeartHealth @KottonNelson @GLewisCardiol @PJSpen1982 @CNewtonCheh

We must be careful not to believe things simply because we want them to be true. No one can fool you as easily as you can fool yourself. - Richard Feynman

Once you give a charlatan power over you, you almost never get it back.

@HYY1084 @farkomd @JeanBismuth Halim, I have fat thumbs. I am so happy for your success my old co-resident.

@HYY1084 @farkomd @JeanBismuth Halon!!! Congratulations man.

Thank you Frank @farkomd . It’s a bittersweet moment. Grateful for everything over the past 9 years and excited to start a new chapter working alongside @JeanBismuth and the team at TGH! #mentors #family

@linamkhan @epictetusMD @FTC It’s nearly impossible to cancel subscriptions.

To recap: Firms have been making people jump through endless hoops just to cancel a subscription, trapping Americans in needless bureaucracy and wasting their time & money. @FTC began writing a “click-to-cancel” rule promoting efficient cancellation, a rulemaking process that took 3+ years and required reviewing 16k comments & giving industry a chance to present their views at an FTC hearing. Big business interests sued to block the “click-to-cancel” rule—and Republican-appointed judges tossed it out, concluding that industry needed MORE time and process to explain why they opposed the rule. This exemplifies big obstacles to effective governance that deserve much more scrutiny than they currently receive.