u/bretlc

Buyer orders item (May 31)

Seller ships item

Buyer issues request for refund since it hasn't arrived

August 10 -- receive alert of carrier scan

August 14 -- item delivered

I've seen issued a refund

Case closed so how do I get money back or its a lost cause.

I’m currently in the Philippines on vacation (Manila) and was wondering if there are special allotments to look for when I’m out. Heading to the mall of Asia next week

Since we've already given up our raise for the year, maybe give up the telework stipend and leave telework alone.

I'm guessing a savings of $90 million +

Thoughts

I am almost 3 weeks post op

I feel significantly better and more connected and aware.

Something that I’ve observed recently is when I have meals with a higher sodium content, the following morning I have minimal headaches and some minor tingling.
My remedy has been to increase water intake, take a Tylenol and 1000mg calcium carbonate.

I had teriyaki for lunch and made steak last night with a Santa Maria season (high salt content).

Last week I had similar reactions so - has anyone experienced this?

Does anyone have any experience with this train?

I know it’s only May and several months before we start open enrollment.

I highly recommend Anthem Access+
Diagnostics, lab work, tests, procedures - all covered.

I can’t speak for Kaiser but just putting it out there

Anthem + UC Davis!!

PREOPERATIVE DIAGNOSIS: Primary hyperparathyroidism. | POSTOPERATIVE DIAGNOSIS: Primary hyperparathyroidism.

OPERATION:

1. Left upper parathyroidectomy (CPT 60500)

2. Intraoperative ultrasound.

3. Intraoperative PTH monitoring.

4. Intraoperative recurrent laryngeal nerve monitoring.

 

ANESTHESIA: General with NIMS

FINDINGS:

1. Enlarged left upper parathyroid running along the esophagus

2. Recurrent laryngeal nerve was visualized. Normal nerve monitoring (VN1VN2 = 2mA, 200uV)

3. Intraoperative PTH results: Pre 1 = 140, Pre2 = 93, Post 1 = 29, Post 2 = 21, Post 3 = pending (Drawn from IJ)

4. On intraoperative ultrasound there was a heterogenous thyroid

 

DESCRIPTION OF OPERATION: The patient was taken to the operating room. General anesthesia was induced and an endotracheal tube with NIMS monitoring was placed. The patient positioned with a very gentle neck extension and all pressure points appropriately padded. I performed a preoperative ultrasound with the findings noted above. 0.25% Marcaine was administered in the anticipated incision. The neck was then prepped and draped sterilely in the usual fashion.

 

A skin crease incision was made. Subplatysmal planes were developed on each side. The strap muscles were then separated in the midline. We identified the Vagus nerve which stimulated well. We rolled the thyroid medially and dissected the peri-thyroidal tissues back to the spine using a combination blunt and sharp techniques. We found the recurrent nerve and it stimulated appropriately. We then identified an enlarged left upper parathyroid sitting along the esophagus. This was dissected off of the adjacent structures using both blunt and sharp dissection. This was elevated away from the recurrent nerve and the feeding vessel was taken with a Ligasure device. The parathyroid was removed and passed off the table for pathologic evaluation

 

Hemostasis was assured and a Valsala performed. The Vagus and recurrent nerve stimulated well at the end of the case. The wound was irrigated. Intraoperative PTH dropped appropriately. The muscle layers were then closed with interrupted 4-0 vicryl sutures. The skin was closed with 5-0 Monocryl and Dermabond. The patient tolerated the procedure well and was then taken to the recovery room in stable condition.

Final PTH 15.8

Throat is still scratchy and some soreness (expected).