![]() I like to explain to patients that not having shocks programmed on makes you like me–or anybody else without an ICD. All we are doing by deactivating shocks is complying with a patient’s wishes. Consider that most terminal patients request to be DNR (do not resuscitate) or AND (allow natural death). The critical point here is that deactivating shocks on an ICD has no immediate effect for the patient. What’s more, and this is too often forgotten, a shock for sudden cardiac arrest prevents the kind of death most people hope for–a painless, quick and peaceful death. This is because shocks are painful and often anxiety provoking. When a patient with an ICD approaches end of life, it is appropriate to deactivate shocks. This differs from a pacemaker, which is used only to treat slow heart rates. Recall that an ICD serves two main functions: 1) it senses then treats dangerously fast rhythms with either painless overdrive pacing or (not painless) high-voltage shocks, and 2) all ICDs come with built-in pacing capability for slow heart rhythms. In the real world, the overwhelming majority of requests for deactivation (my guess is 999/1000) are to turn off ICD shocks. ![]() There are many important differences I will discuss the ones pertaining to deactivation later. The first two questions to clarify are: What is a cardiac device and what does it mean to deactivate it? When we say “cardiac device” we are referring to either an Internal Cardiac Defibrillator (ICD) or a pacemaker. ![]() Her coverage came about because of this Mayo Clinic paper published in JAMA-IM, which showed most patients with cardiac devices approach end of life without proper preparation. As I wrote yesterday, Paula Span of the NY Times covered this important issue earlier this week. The purpose of this post is to clarify important issues about cardiac devices as they relate to deactivation. ![]()
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![]() ![]() The Cincinnati Comic Expo was born when Director Andrew Satterfield-a lifelong Cincinnatian and comics collector-was traveling to yet another comic book show out of town when he was filled with the desire to bring a great comics and pop culture convention to Cincinnati. When I brought up the issues the agent was grateful for my input and promised the head mechanic would take care of them immediately.I want to go back to San Diego, tomorrow.but, will have to wait to clean up after Ian.This spend this week's episode reflecting on our time at the Cincinnati Comic Expo 2016! We discuss what we picked up, a few of the famous vehicles we saw, and everything that comes up in between. Even though they're a small company working their way up, I was grateful for the friendly service, the decent rate of rental and how I could get in and out without having to wait in a long line for an hour like I did at another rental company.The car I rented had some issues that might have thrown people off of it, but I found it reliable, economical and clean. My hotel stay at Old Town Inn was great! Location, cleanliness, friendly folk take care of you here.I also have to give a shout out to NU Car Rentals. Still, the weather was gorgeous, cool, foggy at times and clearing by mid-afternoon makes this the attraction it is. The Trolley is a relief to the congestion, but I know there are other methods of transportation this town has overlooked. Midway/Rosecrans area is still a mess traffic-wise as are the freeways. The roads are beat up, some of the area along Pacific Highway still looks the way it did back in the late 90's. When I returned for the first time in over 20 years I was surprised with the changes and the construction around the airport and other areas. San Diego is my home (then why am I living elsewhere?). ![]() Just over the border from Mexico’s Tijuana, San Diego has a distinctly Latin American vibe and a variety of accommodations encompassing apartments, motels, B&Bs and hotels. To see wildlife in its natural habitat head to La Jolla beach where harbor seals rest, or watch whales in season from Point Loma Lighthouse. One of the world’s largest zoos, it is well worth a visit, as is the fantastic SeaWorld, home to several killer whales. The city’s most famous attraction is its zoo in Balboa Park, a few blocks from San Diego International Airport. Also great for shopping are Horton Plaza and the boutiques in the beachfront neighborhoods. As original Spanish mission and first in California, it's has been relocated to the Mission Valley area, and Old Town San Diego still has many Colonial buildings and quirky shops. The city’s most recognizable landmark is the Hotel del Coronado, a wooden Victorian beach resort, now a National Historic Landmark. ![]() Its wonderful beaches and mild climate make it a favorite spring break destination, and with over 40 city breweries, there are plenty of ice cold beers to set the mood. ![]() Sweeping along the coast against a mountain backdrop, San Diego has easy living down to a fine art. ![]() ![]() ![]() If you're someone who goes with the flow, planning out your tattoo in advance might stifle your creativity. "I would make sure that your goals for your tattoo are communicated and clear, but that you also step back and trust your artist on what they think will work best for you," Wachob says. "Oftentimes people try to art direct their tattoo design, and it kills any sort of excitement or enthusiasm that may have existed for the idea." Gutierrez says if you like the style and the aesthetic of the artist, you'll be happy with whatever you end up with, even if it wasn't your idea.Īlthough it's important to communicate your vision to your artist, collaborate with your artist for the best design. "Think about the future you," Wachob says. "Think about you 10 years from now. If you feel like that design will still resonate with the future you, go for it."Īnother reason why it's important to choose the right artist first is that if you are unsure of the design you want, you can fully trust their input. ![]() ![]() But since your arm is such a prominent part of the body, choose a design that feels timeless to you and not too trendy. "And this is on you forever, after working on a large area with ample space, you have a lot of freedom when picking the design (or multiple designs). "Not everyone in the tattoo industry has the same skill set," she says. If the artist you've found isn't in your area, Wachob says it's definitely worth the travel. Once you have an artist in mind, Gutierrez suggests going in for a consultation to feel out the vibe of the studio and the artist and see if you're a match. "Signing up for someone's mailing list is always a great way to stay informed, too." But although Instagram is a great tool for finding your artist, Wachob advises against sending direct messages. "I'd check out their website and see if they have a preferred way of being contacted or if they open their books up at specific times," she adds. Thankfully, finding that perfect tattoo artist is much easier than it used to be with the help of social media. "There are so many amazing tattoo artists who specialize in different styles," Wachob says. "It wouldn’t make sense to approach an artist who does traditional Americana and ask them to do something delicate." In other words, find an artist whose work and overall aesthetic fits that vibe you're going for. But when it comes to prominent, large-scale designs, like a sleeve tattoo, the most important factor is choosing the right artist for the job. You're only interested in a tiny, hidden tattoo, you can probably get away with going to most artists. ![]() |
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