medical school

u https://dl.dropbox.com/u/9627011/photos/am0n.gif breh??

post-call, feeling sanguine, but that might be the 3hrs of sleep talking

:) good luck dude!! in these situations the waiting is the worst worst worst part by far ime

t-minus 30min

this is always how I feel http://youtu.be/A90TYC0BiwE (spoilers if u havent watched the wire)

http://img.photobucket.com/albums/v617/WidowOfDestiny/Jiggle_Panda.gif

http://www.netanimations.net/Dancing_skull.gif

WAHT DOES THIS MEAN

congratulations I bet

sorry, napping

MATCHED

http://novelnovice.files.wordpress.com/2010/11/matched_futures-rewritten_the-society.jpg

http://i.imgur.com/ZeO6hyk.jpg

BUT WHERE????

Awes gbx

Congratulations!

I am super disappointed I am working long on Friday, I would like very much to go and see where my 2013 dudes end up.

congrats man!!!

Yay!

But do you know where you matched yet?

congratulations!

Go, gbx!!

he'll know Friday

yup

https://dl.dropbox.com/u/9627011/photos/am0n.gif

http://m.youtube.com/#/watch?v=ajcGDaLy4Zw&desktop_uri=%2Fwatch%3Fv%3DajcGDaLy4Zw

LIVE FREE OR DIE

congratulations....

one giant leap for gbx

Congrats! Sooooo NH?

I'm not too good with the state mottos.

either that or he has started a crime spree

Yay! New England! Things were crazy here earlier with people talking about all this. Congrats, E.

http://i.imgur.com/O4fupWI.jpg

that's awesome, congratulations.

That sounds AMAZING!!! Congratulations!

Wait, if my jaymc.xls is correct, didn't you go there as an undergrad?

Because I am also going to where I went as an undergrad. Basically we need one more ilxor to go to med school and do this and then we'll have a trend piece!

Congratulations, now begins the weirdly bittersweet period of realizing everyone you'vegone through the past few years with is about to go away. 4th year 4-eva

haha I just remembered what school is in New Hampshire

epic gratz gbx

I've heard great things about the university of south new hampshire's medical school

Wait, if my jaymc.xls is correct, didn't you go there as an undergrad?

Because I am also going to where I went as an undergrad. Basically we need one more ilxor to go to med school and do this and then we'll have a trend piece!

Congratulations, now begins the weirdly bittersweet period of realizing everyone you'vegone through the past few years with is about to go away. 4th year 4-eva

that is my alma mater, it's true. kinda shocked it worked out, but thanks sorting hat!

it's all because i tried to jinx you, you're welcome

well thanks to you too!

hey, nice. congratulations!

OK I know the disclaimer about IANAD and all (though some of you ARE), but a hypothetical case here: total cholesterol 265; TG 228; HDL 55; calculated LDL 164; non-HDL cholesterol 210. Male, 40, nonsmoker, 20 miles per week runner, no family history of heart disease.

OK or "get thee on a statin immediately"?

grats to gbx

I don't know the US units, I guess that's not too high?

There's evidence that statins are effective for primary prevention of cardiovascular disease, but the number needed to treat is high (less than 2% would benefit after 5 years of treatment). http://summaries.cochrane.org/CD004816/statins-for-the-primary-prevention-of-cardiovascular-disease

Given that you're otherwise quite healthy, presumably the indication to treat would be even less in your case than in the evidence reviewed by Cochrane.

You should ask your doctor but I'd imagine it'd be reasonable to hold off on medications for now, try to change your diet and watch the numbers for a year.

plasmon, i always thought you were based in the US? where do you practice?

those labs are a little on the high side (assuming they're fasting numbers) but, assuming he's normotensive and non-diabetic, this guy's 10-year risk is something like 5%. if you look at the ATP III guidelines, iirc they say for a guy like this statin therapy should be considered if the LDL is above 190 (though word on the street is that ATP 4, if they ever are published, are gonna bump everyone's goals down by 30 mg/dl). IANAD but as plasmon says this might be a "refer to dietitian and see me in a few months" situation. with the caveat that i know only what you've posted, it's not a "holy shit start intensive therapy now" deal

Yeah I checked the ATP III guidelines and it looked like a statin wasn't a must at this point, but I'm going to be nag for him to get his numbers done again next year (he tends not to go to the doc for years at a time; only went this time due to spousal nagging). He had tried changing up his diet a few years ago, but it didn't really make an impact on either LDL or HDL. His blood pressure is consistently excellent and he is not overweight.

What about the high TG? I should have paid more attention to the prevention stuff when I was the managing editor for a cardiovascular medicine web site, but the docs I worked with there mostly interventionalists, so I know more about PCI than anything else!

what does the PCP say? he or she deals with patients like your dude daily and will have more experience dealing with his situation than a couple of neurologists, a med student, and a pharmacy student. i can say that my understanding of the data in this area is that the link between mildly elevated TG (in the absence of a high LDL) and CV disease is pretty tenous and i'm not aware of any any data that proves that lowering TG lowers your risk of CV disease, particularly in someone as healthy as him (others can correct me if i'm wrong)

We would definitely ask the PCP if he had one! I made him go to a doc-in-the box for a basic physical and labwork (which was e-mailed to us. For follow up he'd have to go back in, and we've already left town).

We have joined the millions of Americans who have basically no preventive medical coverage--when we quit our jobs, we said bye-bye to our affordable-ish coverage. We are now covered under a high-deductible plan that will, like, airlift us out of Mexico if needed, but on a tight budget we are doing what folks in our situation do--rationing our own health care and self-diagnosing/treating via the internets. Meanwhile, my Medicare mother's doctors order every available imaging test for her stiff knee. Unbelievable.

(sorry for rant)(and thanks for the info, confirms what we figured!)

i'm sorry if i sounded rude! i'm sorry you find yourselves in that situation, obviously everyone should have access to basic preventative care. will the ACA help next year?

you're a couple of the lucky ones, of course - i've seen plenty of people in their 30s who haven't seen a doctor since they were kids - and have no idea they have diabetes - come into the hospital with full-blown HHS and an A1C in the teens.

Oh you were not rude at all! We have been ridiculously lucky to have had pretty damn good insurance for many, many years, and also lucky to be in good health (I take a couple of Rx meds, but was able to get them all filled for a 6-mo time period while I was still covered under my employment insurance). Having that sort of insurance was something I took for granted, so it is really good for me to now see how lucky I/he was.

I will likely be doing social work in a medical setting when I finish my MSW, so I'll be learning more about the many downsides of our system in intimate detail, I'm afraid :(

120 pack-year history = 876,000 cigarettes