iiinova — where your digital self keeps evolving

Perchance to Dream @lazaruslong.medsky.social · 19/07/2026

I agree. There are always wide variations in how patients respond to anesthesia/analgesia, and we deal accordingly. I’m just saying that on average, redheads may have a different response level.

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Perchance to Dream @lazaruslong.medsky.social · 17/07/2026

Difficult to do a proper study. But most anesthesiologists are aware that redheads tend to require more anesthesia. Several textbooks mention this.

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Perchance to Dream @lazaruslong.medsky.social · 17/07/2026

What hospital or surgicenter would discharge someone so disoriented?

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Reposted by Perchance to Dream

Alison Bays, MD (she/her) @alisonbays.bsky.social · 16/06/2026

Most prior-auth denials are never appealed. In Medicare Advantage, only 11.7% of denied requests were appealed in 2023 — and when patients did appeal, 81.7% were overturned. The friction is the point: deny, and bank on people not fighting back. kff.org

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Perchance to Dream @lazaruslong.medsky.social · 31/03/2026

In over 40 yrs of clinical practice, I have never before been accused of being a sadist. But I understand that you are angry. I have spent my career caring for patients to the best of my ability in inner city areas. I have nothing to prove. I wish you luck and health

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Perchance to Dream @lazaruslong.medsky.social · 31/03/2026

Proper patient care requires looking at and questioning all relevant clinical aspects. Sometimes that involves difficult questions. Sometimes clinicians get it wrong. I am sorry if your husband was caught up in a difficult situation esp if it was undeserved.

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Perchance to Dream @lazaruslong.medsky.social · 31/03/2026

Every patient is different. Every pain syndrome is different. Some respond very well to AEDs and other meds. Some do not. For most patients, finding the best combination is a matter of trial and error.

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Perchance to Dream @lazaruslong.medsky.social · 31/03/2026

I understand that very well. No one “wishes” that drug seeking behavior was the case. But it is a reality of the modern world that we must face. There are clinical and legal obligations that must be observed

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Perchance to Dream @lazaruslong.medsky.social · 31/03/2026

Before administering and/or prescribing. I am sorry that your husband was caught up in this.

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Perchance to Dream @lazaruslong.medsky.social · 31/03/2026

It is unfortunate. I am not in pain management myself. But it is true that many patients with chronic pain exhibit drug seeking behavior. This became much worse with the Purdue Pharma scandal. In most states, the clinicians have certain obligations …

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Perchance to Dream @lazaruslong.medsky.social · 31/03/2026

I am assuming that this is the clinic that your state board shut down.

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Perchance to Dream @lazaruslong.medsky.social · 31/03/2026

I suspect that you don’t have a good handle on the income of anesthesiologists. Seven figures is quite a bold claim.

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Perchance to Dream @lazaruslong.medsky.social · 31/03/2026

I don’t know what epidural injections you are referring to. And I don’t know why you feel that most pain patients in the U.S. can’t get appropriate medical care

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Perchance to Dream @lazaruslong.medsky.social · 31/03/2026

Why do you believe that we would prefer our patients to be desperate? That is antithetical to good patient care.

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Perchance to Dream @lazaruslong.medsky.social · 31/03/2026

I agree that if you need, for example, a laminectomy, you should have it done by a neurosurgeon or orthopedic surgeon

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Perchance to Dream @lazaruslong.medsky.social · 31/03/2026

An anesthesiologist is not the person you want to perform surgery. However, anesthesiologists are much more experienced in performing many of the interventional approaches in pain management, such as nerve blocks and many of the injections.

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Perchance to Dream @lazaruslong.medsky.social · 31/03/2026

And yes, unfortunately both state medical boards and the legal proceedings are slow processes

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Perchance to Dream @lazaruslong.medsky.social · 31/03/2026

There has been a lot of research in the use of bone marrow concentrates for musculoskeletal pain. HOWEVER, it should be performed only when appropriately indicated and by adequately trained personnel.

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Perchance to Dream @lazaruslong.medsky.social · 31/03/2026

I know nothing about your local clinic, its practitioners or what practices they may have engaged in. But it sounds like your state medical board is doing its job.

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Perchance to Dream @lazaruslong.medsky.social · 31/03/2026

You are arguing against yourself. A pain management specialist in anesthesia does a fellowship after the anesthesia residency. The fellowship includes didactic training and clinical care under attending supervision.

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Perchance to Dream @lazaruslong.medsky.social · 30/03/2026

Pain medicine is a well known subspecialization in the field of anesthesiology.

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Perchance to Dream @lazaruslong.medsky.social · 16/03/2026

Good luck. I hope you have a basement

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Perchance to Dream @lazaruslong.medsky.social · 12/03/2026

“My first thought was, he lied in every word…”. Childe Roland by Browning

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Perchance to Dream @lazaruslong.medsky.social · 22/02/2026

General anesthesia for surgery really wasn't a thing until 1846 (1847 in the UK). Unfortunately Abigail Adams lived prior to that time. President Polk, when he was a teen, needed bladder surgery and couldn't get anesthesia for the same reason. They got him drunk instead.

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Reposted by Perchance to Dream

Elizabeth Jacobs, PhD @elizabethjacobs.bsky.social · 21/02/2026

Remember when RFK Jr. unilaterally decided that COVID19 vaccines should no longer be recommended during pregnancy? Well, COVID19 increases the risk of preeclampsia. And it turns out that getting boosted, either before or during pregnancy, significantly reduces the risk of preeclampsia.

thelancet.com

COVID-19 vaccination status during pregnancy and preeclampsia risk: the pandemic-era cohort of the INTERCOVID consortium

COVID-19 vaccination with a booster reduces the odds of PE by 30% approaching 60% reduction among women with pre-existing morbidities.

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Perchance to Dream @lazaruslong.medsky.social · 21/02/2026

Seems unlikely. SCOTUS appears to have made it a practical impossibility to prosecute a former president.

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Perchance to Dream @lazaruslong.medsky.social · 03/08/2025

Information now estimating 3.0 magnitude quake centered in Hasbrouck Heights, NJ

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Perchance to Dream @lazaruslong.medsky.social · 23/07/2025

I agree. But if I dare to suggest such a thing, it’s guaranteed to get a response of “0kay, boomer”

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Reposted by Perchance to Dream

FactPost @factpostnews.bsky.social · 23/07/2025

Reporter: The FDA has a new AI tool that's intended to speed up drug approvals. But several FDA employees say the new AI helper is making up studies that do not exist. One FDA employee telling us, 'Anything that you don't have time to double check is unreliable. It hallucinates confidently'

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Reposted by Perchance to Dream

Elizabeth Warren @warren.senate.gov · 23/07/2025

Zia, an Afghan interpreter who risked his life to help U.S. troops, is being detained by ICE in Massachusetts. He's been living in the U.S. LEGALLY for fear of retribution if he returns to Afghanistan. Targeting Zia and other Afghan allies is dangerous and wrong.

courant.com

Ex-U.S. military translator from Afghanistan arrested by ICE in CT. Attorney calls it ‘nonsensical.’

The 35-year-old husband and father of five was taken into custody by ICE agents outside a routine green card appointment in East Hartford.

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Perchance to Dream @lazaruslong.medsky.social · 23/07/2025

Absolutely true. And I could certainly posit a case where I would defend my use of a spinal. But I have given testimony in enough malpractice cases to know that good reasoning isn’t always enough to protect you.

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Perchance to Dream @lazaruslong.medsky.social · 23/07/2025

There is much that can be said about healthcare in the US. But it is certainly not free.

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Perchance to Dream @lazaruslong.medsky.social · 23/07/2025

In our trauma center, the patients are usually started on heparin when admitted. Much easier to deal with than longer acting agents. An NOF will be in the OR within 48 hours unless medically contra-indicated

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Perchance to Dream @lazaruslong.medsky.social · 23/07/2025

Fentanyl- yes. Alfentanil is no longer available in the U.S. A common tiva combo is propofol-remi-rocuronium

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Perchance to Dream @lazaruslong.medsky.social · 23/07/2025

Usage has skyrocketed here with our TIVA divas.

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Perchance to Dream @lazaruslong.medsky.social · 23/07/2025

Medici-legal is a HUGE concern here in the US. This is not really a debate for us. The spinal would be a no-go

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Perchance to Dream @lazaruslong.medsky.social · 19/07/2025

My first successful epidural as a resident on the labor floor. The Mother was so happy, she named the baby after me.

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Perchance to Dream @lazaruslong.medsky.social · 18/07/2025

Most people do not dream under general anesthesia because, unlike sleep, there is no REM stage. Under sedation (rather than GA), dreams can occur

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Reposted by Perchance to Dream

The New York Times @nytimes.com · 17/07/2025

100,000 U.S. patients a year feel significant pain during C-sections and hardly anyone knows about it. Here’s some information, not to freak you out, or to saddle you with the burden of addressing this problem, but to help you get the care you deserve. trib.al/wamJuju

A text graphic titled "How to Advocate for Yourself During a C-Section" followed by five bullet points. - You need a birth plan not just to avoid a C-section, but to anticipate one. One in three women who give birth in the U.S. this year will do so by cesarean. - Ask questions. Something like, “I’ve heard that blocks can fail. If that happens, what are my choices?” is a reasonable question. General anesthesia should be discussed as an option. - Don’t be pressured into saying you’re ready for the surgery to start. If you’re not sure if your anesthesia is working, it probably isn’t. - Speak up about pain during the surgery. If you feel pain, it is very likely to get worse. Do not hold on hoping the pain will pass. - Anticipate sensation, but not severe pain. A doctor may tell you that you’ll feel “just pressure.” Pressure can be extremely painful. There are options to treat your pain.

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Perchance to Dream @lazaruslong.medsky.social · 17/07/2025

I would not have guessed that the global usage of ketamine was that high.

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Perchance to Dream @lazaruslong.medsky.social · 16/07/2025

Thank you. I’m actually a few years older than you, but I was unaware of this change.

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Perchance to Dream @lazaruslong.medsky.social · 16/07/2025

Not available in the U.S. since 2007. November one will sell it to us

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