@DCRjournal I’ve come across 3-4 patients with them in the past 14 years. They are very protective of their pouches and will go to great lengths to keep them. I wouldn’t feel comfortable trying to fix one. I basically offer excision and conversion to end ostomy or referral out.
@DCRjournal I came out of training doing Karydakis flaps, I’ve since moved to unroofing and debriding in the majority of cases, making the wound as small as possible. Meticulous wound care.
@WSJopinion I’m a colon and rectal surgeon. Patients frequently complain about this. I tell that if they can figure out a way to make it more pleasant then they can retire to their own private island… and have enough left over so that I can have my own island too. 🏝️
@kateiswell I always figured the sun was created first —light from darkness. The earth’s primordial atmosphere was probably incredibly thick. From the surface of the earth, the lights in the firmament did not appear (visible) until later in the creative process.
@thehonestlypod@NPR@uberliner@bariweiss I started listening to NPR 30 years ago as a teenager, it is literally the only thing I will listen to on the radio. The shift away from news with keen analysis and into heavy left propaganda is palpable and sad, I feel like can’t trust NPR to tell me the whole truth anymore :(