Coronary Disease in a Diabetic - Sermo Physicians Survey Results.
Andrew B. Chung, MD/PhD
Case Vignette
A 65-year-old man with hypertension, obesity, and type 2 diabetes
mellitus has been under your care for the past 5 years. He has been
receiving hydrochlorothiazide (25 mg daily) and metformin (500 mg
twice daily); his blood pressure is 130/82 mm Hg, his body-mass index
(the weight in kilograms divided by the square of the height in
meters) is 32, and his glycated hemoglobin is 7.5%. He comes to your
office seeking advice about the management of his recently diagnosed
coronary artery disease. Two weeks earlier, he had presented with
chest tightness and shortness of breath after walking two blocks. His
symptoms resolved within a few minutes at rest. An exercise-tolerance
test on a treadmill was performed according to the Bruce protocol,
along with myocardial perfusion imaging. The patient exercised for 8
minutes, stopping because of chest pressure and dyspnea; his peak
systolic blood pressure was 160 mm Hg, and his peak heart rate was 140
beats per minute. Electrocardiography showed ST-segment depression of
1 mm in the anterolateral leads. The perfusion study revealed a fixed
perfusion defect of moderate size in the anterior wall and a
reversible defect of moderate size in the anterolateral wall.
The patient underwent cardiac catheterization and was found to have
multivessel coronary artery disease, with occlusion of the first
diagonal branch of the left anterior descending coronary artery, a
long lesion with 70% stenosis in the midportion of the left anterior
descending coronary artery, 80% stenosis with a calcified lesion in
the proximal left circumflex coronary artery, and 50% stenosis of the
posterior descending coronary artery. A left ventriculogram obtained
during the procedure showed anterior-wall hypokinesis and a left
ventricular ejection fraction of 45%. The patient was advised to
discuss management of his coronary artery disease with you before
making a decision about how to proceed; you have received the results
of his exercise test and his catheterization report.
Treatment Options
What kind of initial treatment would you find most appropriate for
this patient? Three options are outlined and each is defended in a
short essay by an expert in the management of coronary artery disease;
read the essays and then cast your vote.
(1) Appropriate medical management and close follow-up for adherence
and efficacy.
(2) Appropriate medical management and PCI.
(3) Appropriate medical management and CABG.
******
This post has closed and the results are as follows for the 40 Sermo
physicians who voted for the three possible choices of managing their
type-2 diabetic patient who fails 5 years of appropriate medical
therapy to go on to develop severe occlusive CAD:
(1) Appropriate medical management and close follow-up for adherence
and efficacy - 40% (16/40) voted for this.
(2) Appropriate medical management and PCI - 20% (8/40) voted for
this.
(3) Appropriate medical management and CABG - 40% (16/40) voted for
this.
Wow ! The tide has turned against PCI probably because of the
results of the recent COURAGE Trial:
Such a patient for me would be someone who refuses to believe that
hunger is wonderful and would thus be someone who continues to overeat
and refuses to weigh his meals per the 2PD-OMER Approach thereby being
cured of his type-2 diabetes. Nothing like having ones chest cracked
open to bring about a change of heart so I would have tipped the
scales for the third option.
Please don't tell Bob Guyton this or I won't hear the end of it :-)
Appreciate the participation by everyone. May this inspire you, in
Jesus' name.
*******
Be hungry... be healthy... be hungrier... be blessed:
http://TheWellnessFoundation.com/PressRelease
Prayerfully in the infinite power and might of the Holy Spirit,
Andrew <><
--
Andrew B. Chung, MD/PhD
Lawful steward of http://EmoryCardiology.com
Bondservant to the KING of kings and LORD of lords.
J666
Michael Sand
>http://content.nejm.org/cgi/content/full/357/17/1762
>
>Case Vignette
You're starting a quiz?
Just to make it somewhat clearer:
PCI = Percutaneous coronary intervention
CABG = Coronary Artery Bypass Graft Surgery (Heart Bypass Surgery)
>Wow ! The tide has turned against PCI probably because of the
>results of the recent COURAGE Trial:
>
>http://EmoryCardiology.com
COURAGE is hard to interpret. Regarding the high percentage of ACVBs
and PTCAs (32,6% vs. 21,1% after PTCA) within the 4 years of
observation I don't see a clear benefit of the conservative branch.
It's a damned short time that you wangle.
>Such a patient for me would be someone who refuses to believe that
>hunger is wonderful and would thus be someone who continues to overeat
>and refuses to weigh his meals per the 2PD-OMER Approach thereby being
>cured of his type-2 diabetes. Nothing like having ones chest cracked
>open to bring about a change of heart so I would have tipped the
>scales for the third option.
And may I ask how you judged the situation? I'd have favoured 'CBAG':
According to what you cited above it's a coronary 3-vessel disease
with stenoses (mid LAD, prox CX, RCA) partially higher-grade and
thereby at high risk for a complete occlusion, which already happend
to the RD1, moreover a LV dyskinesia with a reduced EF in accordance
with an irreversible scintigraphic defect within the anterior wall,
maybe due to an (asymptomatic) MI or a chronic ischemia. Additionally,
in case of a long-term diabetic you have to reckon with smaller
peripherial blockages not seen on stress tests or in the cath lab, and
the neuropathy may mitigate angina symptoms and render them useless as
a prognostic factor.
With such a constellation I wouldn't play for time and consider a
conservative therapy, though arguing in favour of a preinterventional
weight loss and improvement of his diabetes in order to reduce the
perioperative risk would be an option (in such a situation patients
are extremely compliant!). And due to the number of arteries affected
and the mentioned length of the LAD stenosis I also see no proper
indication for a PTCA, as the risk of a complication rises with every
implant. Thus no alternative to undergoing revascularization by an
ACVB supply, at best under improved metabolic conditions.
Now let's read what the others wrote ...
Mike
pendere
Mike
Agree Mike. You seem to have a lot of medical information.
jason
then perhaps Dr Chung could present what he has published, which is
his self-published book, to that group of doctors and ask a simple yea
or nay if he has presented data to support his diet plan which
includes 2 pounds a day AND hunger being good.
You can read the first part of the book about his personal experience
on-line, but seems to be only a few pages about the diet itself and
then a number of testimonials, so would only have to present the pages
about the diet itself and not the narrative before or the anecdotal
testimonials at the end, and find out what this group of doctors
think.
Unfortunately, this is unlikely to happen and would expect this to be
ignored or responded too with the usual quotes and slogans about
hunger.
As an aside, Dr Chung talks about being beaten to death, but no where
in his narrative is that documented that he was dead in the medical
sense.
Andrew B. Chung, MD/PhD
Would have favored CABG.
> According to what you cited above it's a coronary 3-vessel disease
> with stenoses (mid LAD, prox CX, RCA) partially higher-grade and
> thereby at high risk for a complete occlusion, which already happend
> to the RD1, moreover a LV dyskinesia with a reduced EF in accordance
> with an irreversible scintigraphic defect within the anterior wall,
> maybe due to an (asymptomatic) MI or a chronic ischemia. Additionally,
> in case of a long-term diabetic you have to reckon with smaller
> peripherial blockages not seen on stress tests or in the cath lab, and
> the neuropathy may mitigate angina symptoms and render them useless as
> a prognostic factor.
>
> With such a constellation I wouldn't play for time and consider a
> conservative therapy, though arguing in favour of a preinterventional
> weight loss and improvement of his diabetes in order to reduce the
> perioperative risk would be an option (in such a situation patients
> are extremely compliant!). And due to the number of arteries affected
> and the mentioned length of the LAD stenosis I also see no proper
> indication for a PTCA, as the risk of a complication rises with every
> implant. Thus no alternative to undergoing revascularization by an
> ACVB supply, at best under improved metabolic conditions.
>
> Now let's read what the others wrote ...
You will have to log onto Sermo for that.
Be hungry... be healthy... be hungrier... be blessed:
http://HeartMDPhD.com/PressRelease
J666
<heartdo...@emorycardiology.com> wrote:
You will have to log onto Sermo for that.
-------------
Regarding what others said, you can certainly you can give a summary,
without using someone else's words, of how many are from one extreme
of being enthusiastic enough that they have themselves started the
Approach and will start their patients on it and use the homework
model of convincing their neighbors to the other extreme of complete
and total disagreement disagreement or somewhere in the middle. How
many doctors in Sermo and how many voted and made comments - like any
study or statistics, numbers are important to know.
You concluded at the end: "Wow ! The tide has turned against PCI
probably because of the
results of the recent COURAGE Trial:" and then you cite
EmoryCardiology.com. Was that a specific question that the doctors
answered or did they all comment that was a reason or how did you come
to that conclusion.
You have got much criticism here for the repetitious nature of your
posts, any similar complaints on Sermo.
You have got much criticism here for the repetitious use of scriptures
to justify what is normally considered medical science, are there any
similar criticism on Sermo.
I do not see why there would be a problem with presenting a complete
summary of what was said.
pendere
I much prefer:
Be hungry... be healthy... be hungrier... be blessed ... be absolutely
the hungriest .... be malnourished
Andrew B. Chung, MD/PhD
> Andrew, in the Holy Spirit, boldly wrote:
>
> >
> > Be hungry... be healthy... be hungrier... be blessed:
> >
>
> ----------
>
> I much prefer:
>
> Be hungry... be healthy... be hungrier... be blessed ... be absolutely
> the hungriest .... be malnourished
Mike Tyson in his prime was one of the world's hungriest men ...
... and was anything but malnourished.
Similar are the Olympic gold medal contenders.
The hungriest people in the world are the most optimally nourished and
the healthiest people in the world.
Your inability to understand this simply shows that the Holy Spirit is
absolutely right to convict you:
http://HeartMDPhD.com/Convicts
May you wisely choose to surrender by publicly declaring with your
mouth that "Jesus is LORD:"
http://HeartMDPhD.com/HolySpirit/TheWay
Cary Kittrell
> convicted neighbor Sayaah/OMER/pendere wrote:
> > Andrew, in the Holy Spirit, boldly wrote:
> >
> > > http://groups.google.com/group/sci.med.cardiology/msg/7da72c75334a0bf1?
> > >
> > > Be hungry... be healthy... be hungrier... be blessed:
> > >
> > > http://HeartMDPhD.com/PressRelease
> >
> > ----------
> >
> > I much prefer:
> >
> > Be hungry... be healthy... be hungrier... be blessed ... be absolutely
> > the hungriest .... be malnourished
>
> Mike Tyson in his prime was one of the world's hungriest men ...
>
> ... and was anything but malnourished.
>
> Similar are the Olympic gold medal contenders.
>
> The hungriest people in the world are the most optimally nourished and
> the healthiest people in the world.
>
And of course you have research, conducted according to accepted
protocols in the field, to back up what might otherwise appear to be
merely a bald and unsupported statement?
-- cary
Andrew B. Chung, MD/PhD
> Andrew, in the Holy Spirit, boldly wrote::
> > convicted neighbor Sayaah/OMER/pendere wrote:
> > > Andrew, in the Holy Spirit, boldly wrote:
> > >
> > > > http://groups.google.com/group/sci.med.cardiology/msg/7da72c75334a0bf1?
> > > >
> > > > Be hungry... be healthy... be hungrier... be blessed:
> > > >
> > > > http://HeartMDPhD.com/PressRelease
> > >
> > > ----------
> > >
> > > I much prefer:
> > >
> > > Be hungry... be healthy... be hungrier... be blessed ... be absolutely
> > > the hungriest .... be malnourished
> >
> > Mike Tyson in his prime was one of the world's hungriest men ...
> >
> > ... and was anything but malnourished.
> >
> > Similar are the Olympic gold medal contenders.
> >
> > The hungriest people in the world are the most optimally nourished and
> > the healthiest people in the world.
>
> And of course you have research, conducted according to accepted
> protocols in the field, to back up what might otherwise appear to be
> merely a bald and unsupported statement?
It remains obvious to the discerning.
May you wisely surrender by publicly declaring with your mouth that
Cary Kittrell
> convicted neighbor Cary Kittrell wrote:
> > Andrew, in the Holy Spirit, boldly wrote::
> > > convicted neighbor Sayaah/OMER/pendere wrote:
> > > > Andrew, in the Holy Spirit, boldly wrote:
> > > >
> > > > > http://groups.google.com/group/sci.med.cardiology/msg/7da72c75334a0bf1?
> > > > >
> > > > > Be hungry... be healthy... be hungrier... be blessed:
> > > > >
> > > > > http://HeartMDPhD.com/PressRelease
> > > >
> > > > ----------
> > > >
> > > > I much prefer:
> > > >
> > > > Be hungry... be healthy... be hungrier... be blessed ... be absolutely
> > > > the hungriest .... be malnourished
> > >
> > > Mike Tyson in his prime was one of the world's hungriest men ...
> > >
> > > ... and was anything but malnourished.
> > >
> > > Similar are the Olympic gold medal contenders.
> > >
> > > The hungriest people in the world are the most optimally nourished and
> > > the healthiest people in the world.
> >
> > And of course you have research, conducted according to accepted
> > protocols in the field, to back up what might otherwise appear to be
> > merely a bald and unsupported statement?
>
> It remains obvious to the discerning.
In other words, not a shred of actual medical research to back
up your claim.
-- cary
pendere
And of course you have research, conducted according to accepted
protocols in the field, to back up what might otherwise appear to be
merely a bald and unsupported statement?
-- cary
-------
Chung is called ECHO for a good reason, he just repeats over and over
the same thing.
You have to remember that his views are based on faith not medical
science and therefore no proof is need or possible and there is
nothing, even scientific thought, that can change his mind. In matters
of faith, no proof is needed and there this nothing that can be
offered as counter it.
Could any scientist get the Pope to change his mind about faith? But,
a doctor can, and should, change his/her mind with proven studies.
That is the difference.
I would imagine in getting his medical and PhD degrees he had to
function in the world of science and not the world of faith and
somewhere afterwards he way changed worlds. There is nothing wrong
with having strong beliefs, as many doctors do, but when treating with
patients they rely on science.
pendere
It may be "obvious to the discerning," but you may want to buy your
wine based on the discerning of the wine experts, but you want your
medical treatment based on medical science.
Jackie Patti
> Just to make it somewhat clearer:
> PCI = Percutaneous coronary intervention
> CABG = Coronary Artery Bypass Graft Surgery (Heart Bypass Surgery)
CABG = SUCKS!
pendere
"Your inability to understand this simply shows that the Holy Spirit
is
absolutely right to convict you:"
So rather than teaching, the Holy Ghost convicts.
J666
<heartdo...@emorycardiology.com> wrote:
convicted neighbor Sayaah/OMER/pendere wrote:
Your inability to understand this simply shows that the Holy Spirit is
absolutely right to convict you:
--------
It is this very attitude that leads to so much maiming, killing and
misery whether it is intolerance just like the fundamentalist Islamic
who use their children for suicide missions or any of the killings in
the world. This is EVIL and all who go along with it are EVIL.
Second, Chung (leaving out on purpose the "Dr" and "MD") got his
medical degree based on medical science and not practices not based on
medical science and yet he still calls himself a medical doctor and
patients expect to be treated according to medical science and that is
FRAUD.
So Andrew is EVIL and a FRAUD
Andrew B. Chung, MD/PhD
> Michael Sand wrote:
>
> > Just to make it somewhat clearer:
> > PCI = Percutaneous coronary intervention
> > CABG = Coronary Artery Bypass Graft Surgery (Heart Bypass Surgery)
>
> CABG = SUCKS!
This motivates us to work unceasingly to help cure people of their
insulin resistance (IR/MetS):
Andrew B. Chung, MD/PhD
Teaching the undiscerning would be meaningless.
Will continue to pray for you:
http://HeartMDPhD.com/Convicts/CaryKittrell
J666
up your claim."
ECHO (Chung) - "Teaching the undiscerning would be meaningless"
Bingo - Chung's treatment does not rely on medical research but on
discerning.
I will look on your web site and under your name on these posts that
your treatment is based on discernment and not medical research.
I wonder if the Georgia State Board of Medical Examiners would like to
know that. Why don't you notify them of that
Cary Kittrell
I have not the slightest difficulty being persuaded by well-conducted
medical research.
So, how about a few references:
-- cary
Andrew B. Chung, MD/PhD
You remind me of the blind man who would feign wisdom by asking the
seeing to prove to him that they have the gift of vision with well-
conducted medical research.
"HE (GOD) changes times and seasons; HE sets up kings and deposes
them. HE gives wisdom to the wise and knowledge to the
discerning." (Daniel 2:21)
Amen.
Without GOD, you will have neither wisdom nor knowledge, Cary.
Instead, you will be left with only delusions.
Still praying for you:
Michael Sand
>Michael Sand wrote:
>> Andrew B. Chung, MD/PhD wrote:
>>
>> >http://content.nejm.org/cgi/content/full/357/17/1762
>> Now let's read what the others wrote ...
>
>You will have to log onto Sermo for that.
Meanwhile I read the experts' opinions ('treatment options') at the
website above. Fortunately I was able to access the comments (a lot of
stuff!) as well. Skimming through them I found one valuable additional
aspects I didn't mention: Check for nightly breathing disorders =
obstructive sleep apnea (OSA) resp. the necessity of a CPAP therapy,
though I think thats a minor problem compared with DM and HT.
Some passages I liked most:
Option 1:
'I would suggest strict vegeterian diet (NO milk or milk products but
allow Salmon kind of fish), yoga and meditation.' ... which of course
wasn't this person's only recommendation.
'I would recommend a diet of no animal meat, no eggs or dairy
products, and no oils.' ... to a diabetic!?
Option 2:
'... along with advanced age 65 years, would be a poor candidate for
open heart surgery ...'. IMHO that's a relatively young patient, after
weight reduction and in a better metabolic condition without doubt
suited for an elective surgery, which I'd prefer over a future
emergency intervention accompanied by a high mortality.
Now I see why you spoke of COURAGE. Indeed, many of the participants
referred to this study, sometimes even in a misleading way adding
bypass surgery to angioplasty as being equal to a conservative
approach. Moreover, I see no reason to consider COURAGE at all, as
there usually is much more detailed information given about the status
of a patient that allows to avoid such undifferenciated sweeping
decisions. E.g., who would treat a patient with a singular filiform
proxomal LAD stenosis conservatively based on the outcome of this
study? If she died from that I'd call it second-degree murder.
Mike
Michael Sand
>Michael Sand wrote:
>
>> Just to make it somewhat clearer:
>> PCI = Percutaneous coronary intervention
>> CABG = Coronary Artery Bypass Graft Surgery (Heart Bypass Surgery)
>
>CABG = SUCKS!
Myocardiac infarction and cardiac insufficiency, maybe causing death,
suck more. The only strategy that doesn't suck at all but add quality
of life is primary prevention.
Regards
Mike
Jackie Patti
I had the MI *and* the CABG.
Never tried death though, so can't say how it compares. ;)
Cary Kittrell
Still not even a tiny shred of scientific support for the absurd claim:
The hungriest people in the world are the most optimally
nourished and the healthiest people in the world.
-- cary
John Williamson
> Still not even a tiny shred of scientific support for the absurd claim:
>
> The hungriest people in the world are the most optimally
> nourished and the healthiest people in the world.
>
Cary, this guy's in just about everybody else's killfile. He knows
nothing except what "the Lord" has revealed to him. He has been peddling
the same junk for years, & will never see the error of his ways.
Replying to his posts only makes him feel better about himself.
If you *must* reply to him, please keep it to the group you read it on &
don't spread his spam throughout the net by repeating it. Thanks.
The websites he keeps referring people to are owned by him, run by his
sock puppets & exist only to sell his books.
--
Tciao for Now!
John.
Andrew B. Chung, MD/PhD
> Andrew, in the Holy Spirit, boldly wrote:
> >> Andrew, in the Holy Spirit, boldly wrote:
> >>
> >> >http://content.nejm.org/cgi/content/full/357/17/1762
>
> >> Now let's read what the others wrote ...
> >
> >You will have to log onto Sermo for that.
>
> Meanwhile I read the experts' opinions ('treatment options') at the
> website above. Fortunately I was able to access the comments (a lot of
> stuff!) as well.
The presentation is well done.
> Skimming through them I found one valuable additional
> aspects I didn't mention: Check for nightly breathing disorders =
> obstructive sleep apnea (OSA) resp. the necessity of a CPAP therapy,
> though I think thats a minor problem compared with DM and HT.
Agree.
> Some passages I liked most:
>
> Option 1:
>
> 'I would suggest strict vegeterian diet (NO milk or milk products but
> allow Salmon kind of fish), yoga and meditation.' ... which of course
> wasn't this person's only recommendation.
>
> 'I would recommend a diet of no animal meat, no eggs or dairy
> products, and no oils.' ... to a diabetic!?
There are vegetable sources of protein and complex carbohydrates,
though I do not favor such a diet over a regular ADA/AHA diet as long
as folks eat less, down to the optimal amount per the 2PD-OMER
Approach..
> Option 2:
>
> '... along with advanced age 65 years, would be a poor candidate for
> open heart surgery ...'. IMHO that's a relatively young patient, after
> weight reduction and in a better metabolic condition without doubt
> suited for an elective surgery, which I'd prefer over a future
> emergency intervention accompanied by a high mortality.
>
> Now I see why you spoke of COURAGE. Indeed, many of the participants
> referred to this study, sometimes even in a misleading way adding
> bypass surgery to angioplasty as being equal to a conservative
> approach. Moreover, I see no reason to consider COURAGE at all, as
> there usually is much more detailed information given about the status
> of a patient that allows to avoid such undifferenciated sweeping
> decisions. E.g., who would treat a patient with a singular filiform
> proxomal LAD stenosis conservatively based on the outcome of this
> study? If she died from that I'd call it second-degree murder.
The angiographic appearance of a stenotic coronary lesion short of the
presence of ulceration and/or thrombus has very little predictive
value.
Many folks who cite COURAGE also remember VANQWISH from 1998:
http://content.nejm.org/cgi/content/abstract/338/25/1785
(Full text is available with registration).
Be hungry... be healthy... be hungrier... be blessed:
http://TheWellnessFoundation.com/PressRelease
Andrew B. Chung, MD/PhD
Now the blind man attempts to prove that the seeing do not have the
gift of vision...
... and fails.
Please know that you remain in my prayers:
Cary Kittrell
> Cary Kittrell wrote:
>
> > Still not even a tiny shred of scientific support for the absurd claim:
> >
> > The hungriest people in the world are the most optimally
> > nourished and the healthiest people in the world.
> >
> Cary, this guy's in just about everybody else's killfile. He knows
> nothing except what "the Lord" has revealed to him. He has been peddling
> the same junk for years, & will never see the error of his ways.
> Replying to his posts only makes him feel better about himself.
>
> If you *must* reply to him, please keep it to the group you read it on &
> don't spread his spam throughout the net by repeating it. Thanks.
Okay, I will attempt to remember, but I need to know: what group
are you reading this from?
-- cary
DonnaB shallotpeel
<fhf8ns$j12$1...@stable.tornevall.net>, John Williamson
<johnwil...@btinternet.com> wrote:
> Cary Kittrell wrote:
>
> > Still not even a tiny shred of scientific support for the absurd claim:
> >
> > The hungriest people in the world are the most optimally
> > nourished and the healthiest people in the world.
>
> Cary, this guy's in just about everybody else's killfile.
Some people use people who reply to him as another way into killfiles.
--
DonnaB shallotpeel, T2 since June 06, USA, last HbA1c 5.3
"We live our lives like water flowing down a hill, going more or less in one
direction until we splash into something that forces us to find a new
course." - Arthur Golden, MEMOIRS OF A GEISHA (1997)
John Williamson
s.
>
> Okay, I will attempt to remember, but I need to know: what group
> are you reading this from?
>
But you don't need to know that, as you know what group *you* read it
on, & can just remove all the groups except that from the list when you
reply.
Unless, of course, you're using Google to read the groups, then it's a
bit harder.
Oh, and the only reason I read your post is that I disabled the filter
that ignores any thread with Chunk in it on this group by accident. It
will be re-enabled very shortly.
Cary Kittrell
> In alt.support.diabetes on Wed, 14 Nov 2007 17:06:00 +0000 in Msg.#
> <fhf8ns$j12$1...@stable.tornevall.net>, John Williamson
> <johnwil...@btinternet.com> wrote:
>
> > Cary Kittrell wrote:
> >
> > > Still not even a tiny shred of scientific support for the absurd claim:
> > >
> > > The hungriest people in the world are the most optimally
> > > nourished and the healthiest people in the world.
> >
> > Cary, this guy's in just about everybody else's killfile.
>
> Some people use people who reply to him as another way into killfiles.
That's probably actually a very good idea, but you need to be
selective. Killfile me, obviously, and others like Ferd
and Flying Rat and Jacknapes -- but there are a few who
reply to Andy, like Marilyn Mann to take one example,
whose input you would not want to cut off.
-- cary
Cary Kittrell
> Cary Kittrell wrote:
> s.
> >
> > Okay, I will attempt to remember, but I need to know: what group
> > are you reading this from?
> >
> The .uk one.
> But you don't need to know that, as you know what group *you* read it
> on, & can just remove all the groups except that from the list when you
> reply.
> Unless, of course, you're using Google to read the groups, then it's a
> bit harder.
No, I'm reading on a text-based UNIX program, which means that I
get to see everything, and more.
But I'm a little unresolved about your idea of cutting off all
other groups; there appear to be some in groups other than
the ones I read this on -- alt.support.diabetes, to take
one example -- who approve of seeing Andrew's ascientific
silliness called to task at every opportunity.
But in any event: yes, I will attempt to remember to trim
alt.support.diabetes.uk in the future.
-- cary
Zen Cohen
>
> Some people use people who reply to him as another way into killfiles.
I've been on usenet off and on for some 10 years and I've probably earned my
way into more people's killfiles in the last coupla months from replying to
Chung's lunacy than all the rest of my time combined. Chung brings out the
worst in me.
I'd like to take a survey of who has kf'd me from replying to Chung but how
would the kf'ers know to reply? ;-)
John Williamson
> In article <zbudnfNSRaTV2aba...@bt.com> John Williamson <johnwil...@btinternet.com> writes:
>> Cary Kittrell wrote:
>> s.
>>> Okay, I will attempt to remember, but I need to know: what group
>>> are you reading this from?
>>>
>> The .uk one.
>> But you don't need to know that, as you know what group *you* read it
>> on, & can just remove all the groups except that from the list when you
>> reply.
>> Unless, of course, you're using Google to read the groups, then it's a
>> bit harder.
>
> No, I'm reading on a text-based UNIX program, which means that I
> get to see everything, and more.
>
> But I'm a little unresolved about your idea of cutting off all
> other groups; there appear to be some in groups other than
> the ones I read this on -- alt.support.diabetes, to take
> one example -- who approve of seeing Andrew's ascientific
> silliness called to task at every opportunity.
>
> But in any event: yes, I will attempt to remember to trim
> alt.support.diabetes.uk in the future.
>
Thank you for that:-)
I think it's better to just ignore him totally. By common consent he
never seems to have anything useful to contribute, & once he joins a
thread, it degenerates into a mantra of eat less, stay hungry, the
hungrier the better, with other posters replying calling him an idiot or
worse, usually without trimming. I *have* taken the bait in the past, to
my regret:-/
I have *never* seen him contribute anything useful.
Anyone who says anything disagreeing with his assertions or asking for
proof of the effectiveness of his "treatments" gets told they're
convicted by Christ or are dismissed as not understanding the problem,
which always turns out to be either not being permanently hungry or
excessive Visceral Adipose Tissue. I suppose a service to the innocent
newbie is done each time somebody exposes him as an idiot yet again, but
is it worth the bandwidth & time taken?
If you doubt any of this, check his posting history. You might like to
check out the websites he refers to as well.
It *could* be viewed as entertainment I suppose, but I post from what is
officially and effectively (as officially and effectively as anything on
usenet ever is) a support group for diabetics. As such, I expect to see
posts (normally) more or less on topic and at least slightly relevant to
the subject of diabetes and the problems thereof unless otherwise
indicated in the title. For entertainment on usenet, I look elsewhere:-)
DonnaB shallotpeel
> > In article <zbudnfNSRaTV2aba...@bt.com> John Williamson <johnwil...@btinternet.com> writes:
> >> Cary Kittrell wrote:
> >> s.
> >>> Okay, I will attempt to remember, but I need to know: what group
> >>> are you reading this from?
> >>>
> >> The .uk one.
> >> But you don't need to know that, as you know what group *you* read it
> >> on, & can just remove all the groups except that from the list when you
> >> reply.
> >> Unless, of course, you're using Google to read the groups, then it's a
> >> bit harder.
> >
> > No, I'm reading on a text-based UNIX program, which means that I
> > get to see everything, and more.
> >
> OK, then.
>
> > But I'm a little unresolved about your idea of cutting off all
> > other groups; there appear to be some in groups other than
> > the ones I read this on -- alt.support.diabetes, to take
> > one example -- who approve of seeing Andrew's ascientific
> > silliness called to task at every opportunity.
Huh? I would say that a clear majority prefer filtering it out entirely.
An ASDer, ...
--
DonnaB shallotpeel, T2 since June 06, USA, last HbA1c 5.3
"We are starting to play the ethnic card in Iraq, just as the Soviets played
it in Afghanistan. You only play it when you're losing and by playing it,
you simply speed up the process of losing." - former CIA chief of
Afghanistan operation Milt Bearden
Michael Sand
>Michael Sand wrote:
>> Jackie Patti wrote:
>>
>>> Michael Sand wrote:
>>>
>>>> Just to make it somewhat clearer:
>>>> PCI = Percutaneous coronary intervention
>>>> CABG = Coronary Artery Bypass Graft Surgery (Heart Bypass Surgery)
>>> CABG = SUCKS!
>>
>> Myocardiac infarction and cardiac insufficiency, maybe causing death,
>> suck more. The only strategy that doesn't suck at all but add quality
>> of life is primary prevention.
>
>I had the MI *and* the CABG.
Well, this context reveals your remark in a different light. I'm
sorry.
>Never tried death though, so can't say how it compares. ;)
Don't waste your time with that. It would be useless, as you won't be
able to tell. ;-)
Andrew B. Chung, MD/PhD
> Michael Sand wrote:
> > Jackie Patti wrote:
> >> Michael Sand wrote:
> >>
> >>> Just to make it somewhat clearer:
> >>> PCI = Percutaneous coronary intervention
> >>> CABG = Coronary Artery Bypass Graft Surgery (Heart Bypass Surgery)
> >> CABG = SUCKS!
> >
> > Myocardiac infarction and cardiac insufficiency, maybe causing death,
> > suck more. The only strategy that doesn't suck at all but add quality
> > of life is primary prevention.
>
> I had the MI *and* the CABG.
You are not alone.
Cardiovascular disease remains by far the number one medical cause of
death and disability in American women. It is killing an American
woman every minute.
Here's what we are doing to get the word out about this:
> Never tried death though, so can't say how it compares. ;)
I have though:
http://HeartMDPhD.com/BeHungry
Life is infinitely better :-)
It is only when we are hungry can we be absolutely certain that we are
not dying while we remain in this world.
Be hungry... be healthy... be hungrier... be blessed:
http://TheWellnessFoundation.com/PressRelease
pendere
<heartdo...@emorycardiology.com>
"Mike Tyson in his prime was one of the world's hungriest men ...
... and was anything but malnourished. "
ROFLOL
Yup, MIke Tyson was on the 2 pound diet - no doubt that is why he did
not swallow Evander Holyfield's Ear when he bit him in the ear.
Wonder why the 2 pound diet has not become the standard of heavy
weight boxers. Now it does not take a professional athlete trainer to
know that during training for a bout do not want to sit down for big
meal and then go out and do a lot of physical activity.
Mike Tyson's hunger is not the hunger for food but the hunger to win
as an athlete
From the promo from Rocky III - capitalization hunger my doing
"Rocky Balboa (Sylvester Stallone) is now the heavyweight champ in the
third thrilling episode of the Rocky saga, ROCKY III. Living in
splendor with his wife, Adrian (Talia Shire) and their infant child,
he spends his restless idle time participating in charity wrestling
matches. But Rocky's dignity is affronted by a baiting challenger,
Clubber Lang (Mr. T). He accepts a match over the objections of his
ailing trainer, Mickey (Burgess Meredith) who feels the champ is not
ready for the bloodthirsty Lang. The careless Rocky is soundly beaten
by the ruthless challenger. Despondent, Rocky is taught to be
determined again by his former opponent Apollo Creed (Carl Weathers)
who supervises his training. After Rocky acquires the needed HUNGER to
win, he is ready for the brutal and nail-biting rematch with Lang."
This keeps better and better - with the TV writers out on strike, this
is funnier than most sitcoms.
Michael Sand
>Michael Sand wrote:
>> Andrew B. Chung, MD/PhD wrote:
>> >Michael Sand wrote:
>> >> Andrew B. Chung, MD/PhD wrote:
>> >>
>> >> >http://content.nejm.org/cgi/content/full/357/17/1762
>>
>> >> Now let's read what the others wrote ...
>> >
>> >You will have to log onto Sermo for that.
>>
>> Meanwhile I read the experts' opinions ('treatment options') at the
>> website above. Fortunately I was able to access the comments (a lot of
>> stuff!) as well.
>
>The presentation is well done.
Right. And it's interesting to read what physicians from all parts of
the world have to consider when making their decisions.
>> Now I see why you spoke of COURAGE. Indeed, many of the participants
>> referred to this study, sometimes even in a misleading way adding
>> bypass surgery to angioplasty as being equal to a conservative
>> approach. Moreover, I see no reason to consider COURAGE at all, as
>> there usually is much more detailed information given about the status
>> of a patient that allows to avoid such undifferenciated sweeping
>> decisions. E.g., who would treat a patient with a singular filiform
>> proxomal LAD stenosis conservatively based on the outcome of this
>> study? If she died from that I'd call it second-degree murder.
>
>The angiographic appearance of a stenotic coronary lesion short of the
>presence of ulceration and/or thrombus has very little predictive
>value.
I'm no cardiologist, so, of course apart from further inevitable
examinations, what else than location, degree and anatomy of a
stenosis as well as myocardial contractility, all of which you get by
coronary angiography and ventriculography, would you consider in order
to come to a decision?
>Many folks who cite COURAGE also remember VANQWISH from 1998:
>
>http://content.nejm.org/cgi/content/abstract/338/25/1785
>
>(Full text is available with registration).
I only have access to the abstract, but we may agree, that that's a
totally different story. It's no elective but an emergency situation
with angioplasty compared with thrombolysis. E.g., the period of time
until reopening of the occluded vessel plays a major prognostic role,
and I could imagine, that in this respect, apart from specialized
centers with a 24/7 in-house standby duty that can act without delay,
a non-invasive treatment has a relevant advantage. But, as I said, I
had no opportunity to read the whole paper.
Mike
Andrew B. Chung, MD/PhD
> Andrew, in the Holy Spirit, boldly wrote:
> > friend Michael Sand wrote:
> >> Andrew, in the Holy Spirit, boldly wrote:
> >> > friend Michael Sand wrote:
> >> >>
> >> >> >http://content.nejm.org/cgi/content/full/357/17/1762
> >>
> >> >> Now let's read what the others wrote ...
> >> >
> >> >You will have to log onto Sermo for that.
> >>
> >> Meanwhile I read the experts' opinions ('treatment options') at the
> >> website above. Fortunately I was able to access the comments (a lot of
> >> stuff!) as well.
> >
> >The presentation is well done.
>
> Right. And it's interesting to read what physicians from all parts of
> the world have to consider when making their decisions.
... and around the U.S. on Sermo.
> >> Now I see why you spoke of COURAGE. Indeed, many of the participants
> >> referred to this study, sometimes even in a misleading way adding
> >> bypass surgery to angioplasty as being equal to a conservative
> >> approach. Moreover, I see no reason to consider COURAGE at all, as
> >> there usually is much more detailed information given about the status
> >> of a patient that allows to avoid such undifferenciated sweeping
> >> decisions. E.g., who would treat a patient with a singular filiform
> >> proxomal LAD stenosis conservatively based on the outcome of this
> >> study? If she died from that I'd call it second-degree murder.
> >
> >The angiographic appearance of a stenotic coronary lesion short of the
> >presence of ulceration and/or thrombus has very little predictive
> >value.
>
> I'm no cardiologist, so, of course apart from further inevitable
> examinations, what else than location, degree and anatomy of a
> stenosis as well as myocardial contractility, all of which you get by
> coronary angiography and ventriculography, would you consider in order
> to come to a decision?
Knowing the patient.
> >Many folks who cite COURAGE also remember VANQWISH from 1998:
> >
> >http://content.nejm.org/cgi/content/abstract/338/25/1785
> >
> >(Full text is available with registration).
>
> I only have access to the abstract
Not if you choose to register (it is free).
>, but we may agree, that that's a
> totally different story.
It is a situation where one would have expected a greater and not
lesser indication for invasive procedures. I remember Dr. Boden's
talk at Emory when presented his study to us, who were at the "mecca"
for PTCA.
> It's no elective but an emergency situation
> with angioplasty compared with thrombolysis. E.g., the period of time
> until reopening of the occluded vessel plays a major prognostic role,
> and I could imagine, that in this respect, apart from specialized
> centers with a 24/7 in-house standby duty that can act without delay,
> a non-invasive treatment has a relevant advantage. But, as I said, I
> had no opportunity to read the whole paper.
Would suggest you read it. Simply register and the access will be
free.
Be hungry... be healthy... be hungrier... be blessed:
http://HeartMDPhD.com/PressRelease
Andrew B. Chung, MD/PhD
> neighbor Mike wrote:
> > Andrew, in the Holy Spirit, boldly wrote:
> >
> >
> > Now let's read what the others wrote ...
> >
>
> Agree Mike. You seem to have a lot of medical information.
You are certainly welcome to copy the comments of our Sermo physician
colleagues here onto Usenet if you choose because you are not bound by
the promise I have made to them that I would not.
Be hungry... be healthy... be hungrier... be blessed:
http://TheWellnessFoundation.com/BeHealthy
yama...@aol.com
> Bondservant to the KING of kings and LORD of lords.
I'm a long time lurker, first time poster and a physician. Chung is a
delusional, paranoid schizophrenic. He may be a licensed physician and
a boarded cardiologist, but he doesn't have a verfiable, legitimate
practice anywhere. He doesn't have hospital privileges. He lives in a
fantasy world. He doesn't have one supporter anywhere (other than MU).
He gives dangerous medical advice that could be harmful. He can't cite
any supporters or references that agree with him. He repeatedly cites
only his own vanity websites. He uses a profile portrait that hasn't
been updated in > 14 years. He twists bible passages. He is soundly
trounced and ridiculed no matter where he posts. He was kicked off of
Sermo, a physician only networking website after about a week of this
nonsense.
I used to find him annoying. Now I just find him pitiful. I wonder if
there is anyone who knew him or cared about him in his early days who
is still in touch with him or his family and could see that he gets
some psychiatric help.
Why bother to do anything? At first baiting and bantering with him
seemed like fun sport. Yet he is concrete in his thinking and only
able to respond in a stereotypical, way with prewritten macros or else
evading or twisting anything he doesn't want to answer truthfully. He
destroys the integrity of any site that he joins.
Andrew B. Chung, MD/PhD
> Andrew, in the Holy Spirit, boldly wrote:
> > convicted neighbor Sayaah/pendere wrote:
> > > neighbor Mike wrote:
> > > > Andrew, in the Holy Spirit, boldly wrote:
> >
> > > > >http://groups.google.com/group/alt.health.diabetes/msg/6536c39b09c22ce4?
> >
> > > > Now let's read what the others wrote ...
> >
> > > > Mike
> >
> > > Agree Mike. You seem to have a lot of medical information.
> >
> > You are certainly welcome to copy the comments of our Sermo physician
> > colleagues here onto Usenet if you choose because you are not bound by
> > the promise I have made to them that I would not.
> >
> > Be hungry... be healthy... be hungrier... be blessed:
> >
> > http://TheWellnessFoundation.com/BeHealthy
>
Indeed:
http://HeartMDPhD.com/Convicts/Rebukesatan
Suggested reading for others:
http://HeartMDPhD.com/SermoExposed
Additional background information:
Dan Parkhurst
> Now let's read what the others wrote ...
>
> Mike
>
>
> Agree Mike. You seem to have a lot of medical information.
>
>