Waching daily Jan 30 2019

Probably the most common question I get.

We do both of these procedures at our institution, but we do more radiofrequency (RF) than cryoablation.

That's just because of how we grew up at our place.

Some places are sort of enamored with cryo.

But, the thing you need to know is they both work in people with paroxysmal afib if done correctly,

with someone with experience with the procedure.

I don't see a difference.

Now, I'll sometimes send a patient of mine for a cryoablation

based on what I see in that patient.

And, sometimes, if you held my feet to the fire and say,

"Why exactly that patient," it's kind of a gestalt.

But, if you said the cryo wasn't working that day, I'd say do the RF.

I don't think there's a difference, in my opinion.

The world's literature would tend to back that up.

Again, both techniques are good.

It's not the technique; it's the hands and mind behind the technique

that's going to ensure your best outcome.

For more infomation >> Is Radiofrequency or Cryo Ablation Better for Afib Patients? - Duration: 1:21.

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Dem Sen: Stone Collusion Report Is Blockbuster, Rebuts Wikileaks | The Beat With Ari Melber | MSNBC - Duration: 8:25.

For more infomation >> Dem Sen: Stone Collusion Report Is Blockbuster, Rebuts Wikileaks | The Beat With Ari Melber | MSNBC - Duration: 8:25.

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GOLF MENTALITY: What is your ceiling of consistency? - Duration: 0:45.

when we make these changes it's not because you don't have the potential to

go out there with your current swing or current game and play really good golf and hit awesome shots

so there might be let's say a ceiling of potential with what you can achieve with your current action

but then there's also a ceiling

of consistency so let's say may one day go out one day and shoot a 72 with your action

"oh I just need to do that more often"

but your ceiling of consistency may be just that because of some technical pieces in your

full swing, short game and putting then if we upgrade those your consistency which may

range from 72-84 will then maybe measure up to 70-78

and even though you might not go out and always shoot your best score all the time

your average will get better and better and better.

For more infomation >> GOLF MENTALITY: What is your ceiling of consistency? - Duration: 0:45.

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Craig Davis on Why it is Harder than Ever to Be a Remarkable Leader - Duration: 1:43.

For more infomation >> Craig Davis on Why it is Harder than Ever to Be a Remarkable Leader - Duration: 1:43.

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Body of 2 Year Old Boy Trapped in Well Is Found by Spanish Authorities The New York Times - Duration: 2:07.

Body of 2 Year Old Boy Trapped in Well Is Found by Spanish Authorities The New York Times

By The Associated Press

Spanish authorities said early Saturday that rescuers had found the dead body of a 2 year old boy who fell into a deep well 13 days ago.

A spokesperson with the governments office in the southern province of Málaga said rescue crews had finished digging a tunnel and found the remains of the toddler, Julen Roselló.

At 1:25 a.m., the rescue teams reached the area of the well where they were looking for Julen and they found the lifeless body of the little one, said a government spokesperson in Málaga.

There had been no signs of life since the boy had , as his family was walking through a private estate in Totalan in southern Spain. Rescuers found the well was blocked with soil, raising fears the well had collapsed on top the child.

Officials had tried various routes to the toddler, whose body was trapped some two thirds into the shaft and behind hardened soil and rock that blocked rescue workers and equipment.

Jorge Martin, a spokesman with the Málaga Civil Guard, said a fourth controlled explosion was needed to complete the last 45 centimeters, or almost 18 inches, of an almost 12.5 foot long horizontal tunnel that mining experts have been digging since Thursday.

The tunnel is some 230 feet underground, beginning from a vertical shaft drilled over recent days to bring miners and rescue experts up and down in turns. The governments office in Málaga said Friday it took around 16 hours to dig the first half.

Before finding his body, the authorities had confirmed that he was in the well with hair found in mud excavated from the well, which a preliminary DNA test confirmed belonged to the boy. The rescue operation included specialists dispatched from Asturias, the coal mining region of northern Spain, as well as a Swedish company that provided the technology to help trapped for two months underground in 2010.

For more infomation >> Body of 2 Year Old Boy Trapped in Well Is Found by Spanish Authorities The New York Times - Duration: 2:07.

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Is There a Window of Opportunity to Have a Successful Ablation? - Duration: 2:53.

One of the most disheartening consults I get is the following:

a 64-year-old gentleman comes in to see me.

He's been in atrial fibrillation, by his reckoning, at least four to five years.

We're not exactly sure. Yeah, he has some symptoms.

He's been a little fatigued, and he's getting a little worse. Right. Okay.

His wife tells me, "By the way, you know, he's not remembering as much."

And, he says, "You know, Dr. Prystowsky, the reason I'm coming to see you is

I know you guys have a big ablation center. I need to be ablated."

Okay, so then you say, "You've had four-plus years of constant atrial fib."

I know right away what I'm going to get into.

I can bet money his left atrium is dilated and fibrosed,

which is going to make any ablation much, much harder to do.

And, then you go get your studies.

You get either an MRI, or you get echo[cardiogram]s, and it confirms everything.

And, then you just have to be honest with the patient, and say, "Look, I'll do it

because drugs almost surely won't work, but you need to know a single procedure success rate is low.

If somebody told you it was 60 percent, either they were drinking something

they shouldn't have been drinking,

or they're just trying to build business, but they're not telling the truth. Okay?"

You don't get a 60-percent one-procedure success

with somebody who's been in afib for four-plus years, and has a huge left atrium.

So, prevention is the issue.

Do not let somebody stay in afib four years.

If they don't want sinus rhythm, and you've had that discussion four years ago, fine.

I think they made a decision.

This is why every patient who has afib needs to see some specialist early on

to figure out what their options are now and in the future.

Atrial fib is a lifelong disease for most people. Okay?

And, therefore, decisions made today will affect your life for decades, sometimes, to come.

So, try to avoid that situation.

We're happy to try the ablation, if you go into it, eyes open, realizing that

we have a likelihood of success that's low.

Some patients will say anyway, that's fine.

That's okay.

As long as we've been honest with the patient, we'll do it.

But, once the patient realizes what they're up against,

sometimes they just say, "You know what? Forget about it."

But, you don't want that to have to happen.

That could have all been avoidable if the patient had this discussion four years ago.

For more infomation >> Is There a Window of Opportunity to Have a Successful Ablation? - Duration: 2:53.

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What is a Fellow of the Heart Rhythm Society (FHRS)? - Duration: 1:28.

One of the things you can do, and people ask me this about trying to find a good doctor

in your area, is to go to the Heart Rhythm [Society] website, hrsonline.org.

There's a section on there that says "Find a Specialist," and then you can kind of look

at your area, your area code,

and you can figure out kind of a geographic area you're comfortable looking for someone.

There's codes in there; one of them is Fellow of the Heart Rhythm Society (FHRS).

Now, I'm going to tell you that doesn't guarantee, you know some, it's like a stamp of approval;

you know, the Good Housekeeping seal.

It does tell you they have at least a certain level of accomplishment.

They're not going to tell you how good their hands are.

They're not going to tell you if they think through every problem right.

But, they do tell you they've at least become a Fellow of the Heart Rhythm Society,

and certainly, not everyone gets to that point.

So, if you don't know anything, you at least know that you're dealing with somebody who's

been given a designation that says they passed a certain hurdle.

And, that's a good starting point if you don't know anyone.