Discussion about this post

User's avatar
Hesham A. Hassaballa, MD, FCCP's avatar

Thank you for this review. This is one of the best Medical Substacks around.

Expand full comment
cools's avatar

Thanks again. Potentially useful recommendation. The safety is likely reassuring. Last weekend had 88yo guy bad gi bleed - got scoped had duodenal ulcer a visible type of vessel - and gi intervened sprayed and he was momentarily better. Bled again dropped 4gm hgb and needed pressors and more blood - ir said can’t embolize, surgery was stating no proecedure due to potential mets from renal cancer near pancreas and that he would need a Whipple. Got family ready to say goodbye at least got the dni/dnr - and gave vitamin k (inr was 1.36 but why not he was dying) and transaxemic for the first instance in like years - more like a least we are doing something (gi also said why rescope - you can’t so quickly after spray?) - guy freakin lived and stopped bleeding! N=1 for sure and did a couple things and he has lived his life and did something likely safe (especially after reading your piece feel it likely is). The kicker - he was on prophylactic aspirin to prevent that first mace - at 88 and despite having cancer too.

Expand full comment
1 more comment...

No posts