Karl MD

31/07/2022

MOVING IS SO HARD!! But it’s worth it despite the pain in my back carrying couches and furniture. The end result is all good.

Good luck . So excited for you! No better thing to do for sure.

Of course had to get some token monument pics in the last few minutes before the airport😂😂

08/05/2022

!

My mom had one of those beehive hairdos. My dad was the original Ken Watanabe.

12/03/2022

08/03/2022

COLONOSCOPY REQUIRES A TEAM!

👏 Introducing Carmen and Yessica! Two of the outstanding GI techs at the endoscopy center.

👩‍🔧 Colonoscopy requires the skill of a GI tech to provide precise abdominal pressure to facilitate passing the colonoscope to the cecum (see the diagram demonstrating technique for applying abdominal pressure)

🏥 Occasionally, repositioning the patient is needed to negotiate turns and angulations. It can be physically demanding at times.

Love those GI techs!

03/03/2022

MARCH IS

♋️ The USPSTF (US Preventive Services Task Force) formally endorses age 45 as the starting age for colorectal cancer screening. While this guideline will protect patients in terms of insurance coverage, there are still some uncertainties.

♋️ This recommendation has not been supported by a randomized controlled trial. Furthermore, there will be an increased strain on the healthcare system due to increased demand.

♋️ Implementation of the new recommendations may worsen healthcare disparities in those communities that are already underserved as resources are shifted toward those who have better access to healthcare.

♋️ If we estimate that 4 million turn 50 every year in the USA, now multiply this 5 if we start colonoscopy at age 45. That’s a lot of colonoscopies, doctors, nurses, staff…a lot more stress on a healthcare system already stretched thin. Not to mention the cost!

♋️ Colonoscopy should be offered to high risk individuals (genetic colon cancer syndromes, history of inflammatory bowel disease, strong history of colon adenomas/polyps, family history of colon cancer). In reality, there will be noncompliance in terms of patients who do not want to get screened. It is important to realize that colon cancer screening can be customized. Although colonoscopy is considered the gold standard for colon cancer screening, there are other options:

💩 Stool based testing: for blood (FIT test annually) or stool DNA (MTsDNA–MultiTarget Stool DNA, AKA Cologuard (every one to 3 years)

🧬 Blood test: Septin 9 blood test is newer but not currently endorsed in colorectal cancer screening guidelines. Controlled trials are currently ongoing but early data demonstrated 48% sensitivity for cancer detection.

31/01/2022

Winding down to sleep. Instead of a , it’s a beat up bunny

08/01/2022

Just submitted my vote for the NBA west all star team. Tried to be as unbiased as possible.

25/12/2021

17/11/2021

ORAL MEDICATIONS FOR COVID-19,
TWO NEW DRUGS:

💊 MOLNUPIRAVIR(Merck) = 50% reduction in hospitalizations and prevented death when given within 5 days of symptoms. 5 day course.

💊 PAXLOVID (Pfizer) = 89% reduction in hospitalization and prevented death. 5 day course. Requires a second drug (ritonavir) to “boost” its effect.

💊 Both drugs–100% efficacy in preventing death. Study designs are different thus cannot directly compare two drugs. It’s unknown if a combination of the two drugs would be better (combo therapy is frequently used in viral diseases such as HIV).

💊 Both drugs were studied in UNvaccinated people. Thus, it’s unclear if oral medication would benefit vaccinated people with “breakthrough” infection. This is important since another oral med (made by Roche) was not effective in a study of vaccinated patients.

💊 Mechanism of action of the two are different. Molnupiravir is a nucleotide agonist (looks like an RNA building block) thus interferes with viral replication. Paxlovid is a protease inhibitor (blocks the enzyme that cuts down protein into functional proteins needed for replication). Protease inhibitors have been studied extensively (in HIV and hepatitis C). Molnupiravir has the potential to mutate DNA in mammalian cells. Long-term side effects unknown.

💊 Oral medications are cheaper and more convenient than IV monoclonal antibody therapies but direct comparison studies are not available.
💊 Oral medications need to be given EARLY in the illness and it’s unknown if vaccinated patients benefit. Sadly, it’s also unknown who qualifies to receive treatment or if insurance will cover the drugs.

Source: STAT 11/14/21

05/11/2021

01/11/2021

KOURAKU: the FIRST ramen 🍜 shop in America.

A classic Little Tokyo (downtown LA) restaurant for ramen and comfort food 👍🙌

05/10/2021