Flights of Fantasy discussion

I'm STILL working my way through Oathbringer ! It's amazing, I just don't have a lot of time to read lately. I WILL finish it this month though! It is happening!

I understand, Dawn. That's exactly how I was with it..

For now, I've had a start/stop on Tower Lord, Lost Lore: A Fantasy Anthology & Wyrd Sisters. Not disliking, but completely stalled on reading with my eyeballs. Full on reading slump.

I blame school. It has been my nemesis for the last year and a half, but this particular semester is seriously killing me. Good news is that I'll be DONE in May.

As kind of a palate cleanser while my reading slump is on, I've been able to work on audio that's non-fantasy. Totally loving The Power of the Dog by Don Winslow.

Chris wrote: "Good news is that I'll be DONE in May...."

WOOHOO!

I'm apparently trying to read ALL of the books. As I do.

I'm still working on Stories: All-New Tales, The Road to the Dark Tower: Exploring Stephen King's Magnum Opus, Duma Key, and I will be Starting The Talisman... maybe Monday.

Because... why not.

Chris wrote: "I understand, Dawn. That's exactly how I was with it..

For now, I've had a start/stop on Tower Lord, Lost Lore: A Fantasy Anthology & Wyrd Sisters. Not..."

Yaaaaaay!!!!

Currently reading Beast Behaving Badly - it's moderately funny. Book #9 was hilarious but the rest so far has been meh.

Classes would be whooping my ass IF I was doing my classwork. Because issues: I has them

Currently dedicating myself to The Dragonbone Chair and Sword of Destiny. I managed to finish 6 books last month, buuuuuuuut I only actually started one of them in February. I'd been chipping away at most of the others for a while. I'm trying to cut down on time I waste on my phone and whatnot to squeeze in more reading time, so just maybe I'll keep up the pace in March. :)

Oh, and congrats on your schoolwork, Chris!

Thanks, ladies :)

Congrats, Chris. :)

***

I finished Caraval yesterday. Ended up giving it 2.5 stars. The concept was interesting, but the twist within a twist within a twist grew wearying, especially since it was very "telly" over showy. Also, the dialogue was pretty awful, and it was more romance than adventure, in the end.

Now I'm onto A Gathering of Shadows, and I'm in those early stages where I'm desperately trying to actually remember what happened in the first book...

Congrats Chris! :)

Thanks! Not quite there yet though. There's still time for me to say "fuck it" and just stop...lol

dont stop! you got dis!

I'm slowly making way through To Green Angel Tower, Part 2. On my Kindle, I have The Unremembered. Work has been quite busy, making it difficult to find time to read.

Duaa wrote: "dont stop! you got dis!"

😎

Good luck with your studies, Chris! Do you have exams to sit or a thesis to finish in May?

Just finished reading Boy Meets Boy and really enjoyed it. It's probably a 4-star read but I liked it too much and gave it 5!

Just finished A Memory of Light (WoT #14) and read A Wrinkle in Time. About to start Ready Player One

Bryce wrote: "Just finished A Memory of Light (WoT #14) and read A Wrinkle in Time. About to start Ready Player One"

Just read Ready Player One last month and thought it was an awesome read! Hope you enjoy it!

I have 3 books going at the same time:

Iron Gold- enjoying, but not as much as the original trilogy

The Miniaturist- also enjoying. I'm curious how this one is going to go considering the reviews.

Away Off Shore: Nantucket Island and Its People, 1602-1890- interesting read, but it is a little boring at times. My goal this year is to read more non-fiction but at the rate I'm going with this one I don't know if I'll be too keen to pick up another non-fiction anytime soon.

Chris wrote: "Thanks! Not quite there yet though. There's still time for me to say "fuck it" and just stop...lol"

YOU CAN DO IT!!!

Thanks, Greg. I'm actually done by May 1. I'll have some final projects to do in April, and between now and then I've been hammering out 600 medical cases to code in preparation for 60 cases that will be graded.

I've finished 400 of the cases so far lol.

Thanks, Mrs J ;)

Chris wrote: "Thanks, Greg. I'm actually done by May 1. I'll have some final projects to do in April, and between now and then I've been hammering out 600 medical cases to code in preparation for 60 cases that w..."

Wow, good luck with that. Seems like you've come too far to just say fuck it so keep plugging along.

I'm reading a few things atm but 2 that I am most excited about are The Final Empire and not fantasy but very good science fiction/ thriller Dark Matter.

Chris wrote: "Thanks, Greg. I'm actually done by May 1. I'll have some final projects to do in April, and between now and then I've been hammering out 600 medical cases to code in preparation for 60 cases that w..."

You are a certified beast, Chris! I'd die. I need to borrow some of your strength to get through my last 7 chapters, 8 quizzes, midterm and final.

Thanks, Jackie. This is true. I do feel like I have a handle on it, though it does seem difficult at times.

MrsJ, I don't know that there's much left to lend ;)

Chris wrote: "Thanks, Jackie. This is true. I do feel like I have a handle on it, though it does seem difficult at times.

MrsJ, I don't know that there's much left to lend ;)"

LOL

IKR?

Chris wrote: "Thanks, Greg. I'm actually done by May 1. I'll have some final projects to do in April, and between now and then I've been hammering out 600 medical cases to code in preparation for 60 cases that w..."

OMG How many pages per case are we talking about here? I'm hoping it's something like 1-2-page summaries at the most!

Some are 1-2 pages, but they get up to 10-12 at times. It's more than summary too, it's actual medical documentation on everything from office visits to brain surgery.

Here's an example. I'm putting it in spoiler tags because it's definite threadkill (view spoiler)[Clinical Record
OPERATION REPORT

PATIENT: Jermaine Smith
SEX: MALE AGE: 56
Private Payer (Medicare rules for 65 and older)
THIS PAYER REQUIRES THE USE OF LT AND RT modifiers

DATE OF OPERATION: 01/01/20XX

PREOPERATIVE DIAGNOSIS: PRIMARY DEGENERATIVE JOINT DISEASE, LEFT KNEE.

PROCEDURES: LEFT TOTAL KNEE ARTHROPLASTY.

POSTOPERATIVE DIAGNOSIS: PRIMARY DEGENERATIVE JOINT DISEASE, LEFT KNEE.

SURGEON: IGOR Kramer, M.D.,
.
ANESTHESIA: GENERAL.

ESTIMATED BLOOD LOSS: MINIMAL.

DRAINS: HEMOVAC, LEFT KNEE.

IMPLANTS: ZIMMER NEXGEN KNEE COMPONENTS AS FOLLOWS, NEXGEN LEGACY POSTERIOR
STABILIZED LPS-FLEX FEMORAL COMPONENT SIZE G, NEXGEN STEMMED TIBIAL COMPONENT SIZE 6, ALL POLYETHYLENE PATELLA COMPONENT OF SIZE 38 9.5-MM THICKNESS, LPS-FLEX TIBIAL ARTICULAR SURFACE 10-MM HEIGHT AND TAPER STEM PLUG FOR THE TIBIAL COMPONENT.

COMPLICATIONS: NONE.

POSTOPERATIVE CONDITION: STABLE.

INDICATIONS: The patient is a male with past medical history of hypertension, hepatitis-C and history of left ankle/foot triple arthrodesis ten years ago, has had chronic history of bilateral knee primary DJD for approximately ten years left greater than right. The patient has severe pain. The patient had no relief with
conservative therapy including anti-inflammatory pain medications, exercises, rehab, knee braces and steroid
injections. The patient was indicated for a total knee arthroplasty. Surgical option was explained to patient at length. Risks, benefits and alternatives of surgery were discussed with the patient at length. Risks explained included but were not limited to infection, bleeding, nerve vessel damage, possible need for transfusion, knee
stiffness, risks of deep venous thrombosis, pulmonary embolism, risks of pneumonia myocardial function, risk of anesthesia, need for temporary blood thinners, possible need for prolong rehab after surgery and possible
need for revision of surgery in the future.

The patient understood and accepted all the risks. Surgical consent was signed. Correct surgical site was marked.

PROCEDURE: The patient was brought into the operating room and placed supine on the operating table. IV Ancef 1 gm was given as antibiotic prophylaxis. After induction of general anesthesia by general anesthesia
staff, a Foley catheter was inserted. A bump was placed under the left hip to internal rotate the left lower extremity and the bump was placed on the table to facilitate the intraop traction. A tourniquet was applied to left upper thigh and set up to 300 mmHg. The left lower extremity was sterilely prepped and draped in standard surgical
fashion for a total knee arthroplasty. Esmarch bandage was used to exsanguinate the left lower limb and the tourniquet was inflated to 300 mmHg.

A longer approximately 15 to 20 cm incision was made longitudinally in the midline of the knee from approximately 4 to 5 cm above the patella sending over the patella and down to just below the tibial tubercle. Dissection
was carried through skin and superficial fascia and deep fascia in a single layer and then two flaps were elevated to expose the quadriceps mechanism.

In quadriceps mechanism, an incision was made through approximately starting the proximal aspect of incision approximately 5-mm lateral to the medial edge the quadriceps tendon extending distal towards the patella and
carrying medially around the patella and then going medial to the patella tendon up to the level of the tibial tubercle. The portion of the fat pad was then excised and patella was everted laterally to expose the knee joints.

Partial, medial and lateral meniscectomy was performed at this time to facilitate access to the knee. Following this, the periosteum and the superficial portion of the medial collateral ligaments were elevated subperiosteally from the medial tibial condyle to expose the medial tibial flare. At this point, anterior cruciate ligament and portion of posterior cruciate ligament were excised. On following this, a straight Cobb gauge was used to make a gouge just proximal to the attachment of the posterior cruciate ligament in intercondylar area. Following this a femoral canal was entered with a drill. The fat from the canal was irrigated and sucked out. An intramedullary guide was
then inserted in the femoral canal and external rotation guide was inserted over the femur and 3-degree external rotation was established by placing two pins through holes with 3-degree external rotation in the ___to posterior condylar axis.

Following this, the rough cut was made. Care was taken to ensure that there was no femoral notching. Following this, a distal femoral cutting block was applied to extend the femoral canal and 5-degree of valgus was set. Then the distal femoral cut was made. Following this, a sizer was used to estimate the size and size G femoral component was chosen.

After this anteroposterior cutting block was applied to the distal femur and secured with pins. Anterior and posterior cuts were made. After this the trochlea / box cutting guide was applied. The femoral cut guide was lateralized and anterior and posterior chamfer cut as well as the trochlea and box cuts were made. Following this, a 2-mm flex
cut was performed to give a normal flexion. Of note, the drill bits were used to drill the two lock holes for future insertion of prosthesis when the trochela/ box cutting guide was on. Again, 7A femoral trial was applied with excellent fit on distal femur. After this, with the knee flexion, the tibia was brought in front of the patellofemoral
condyle. Medial and lateral meniscectomies were completed to fully expose the surface of the tibia. Also, the extramedullary cutting guide was applied to the front of the tibia.

This was aligned to the midportion of the ankle with the tibial guide being parallel to the ankle and parallel to the tibial crest and medialized to the centre of ankle. The tibial cutting guide was drilled till slope of 7 degrees. The tibial cutting guide was adjusted to cut 10-mm off the highest points of the tibial condyle bone. So, with a power
saw, the tibial cut was performed. That was performed with a 7 degree posterior slope. A tibial tray was placed to assess the size of the tibial component and a size #6 tibial component was chosen. An alignment rod then used to ensure that the tibia component was used to confirm the coronal and rotational alignments. The footprints of the
tibial tray was marked. All the osteophytes were removed.

Once the tibial cut was completed, flexion and extension gaps were rechecked. There was some mild tightness in both flexion and extension. Using a tibial recutter guide two more millimeters of tibial articular surface
were re-cut. Flexion and extension gaps were checked again with good stability and good placement full extension was achieved.

Once the gaps were checked again the alignment rod was used to double-check the rotational alignment of the tibial components. Finally with the knee in flexion, the tibia was again brought in front of the knee. A #6 tibial tray template was applied with the center of the tibial tray centered on the medial one third of tibial tubercle as evidenced by previously marked footprint on the tibia. Then a drill bushing was applied to the proximal tibia and the proximal tibia was drilled to appropriate marking with a drill. Following this, a tibial ___ point was used to cut the
appropriate amount of bone from _____ tibial trial component.

From this, a 10-mm plastic inset was placed in the trial tibial component, the knee was brought to full extension and the soft tissue balance was judged again in both flexion and extension. The soft tissue balance was
judged appropriate. The components were stable and the full extension was achieved.
At this point with the patella everted, a caliper was used to measure appropriate length of the patella. The patella
osteophytes were removed and using the patella reamer, appropriate amount of patella was reamed until all the articular cartilage area surface was gone and a thick uniformed layer of bone remained.

A size 38 patella component was chosen, this was medialized slightly to improve patella tracking. Three drill holes were made in the patella. A trial 38-mm tri-peg patella was placed in its seat. The knee was again taken
through full range of motion with excellent patella tracking and no evidence of lateral patella subluxation or instability. At this point all the trial components were removed. All the cut bone surface were irrigated with
pulse lavage and dried. Two bags of Palacos bone cement was mixed with monomer liquid and mixed in the bone. At approximately, two space consistency. The cement was applied first with finger on the cut surface of the
patella. An O plastic 38-mm dome patella with three pegs were inserted into its seat and pressurized with a patellar clamp. All excess cement was removed. The femoral component was inserted next, A size G femoral
component. Cement was applied and pressurized to prepare the area of the distal femoral bone in a horseshoe shape. Also, some cement was placed on the posterior aspect of the femoral component. So, femoral component was applied and pressurized in its seat. All excess cement was removed.

Following this, a Hohmann retractor was placed behind the tibia to bring the tibia forward. The medial and lateral retractors were in place. The tibial component with cement applied to its undersurface was also pressurized in its seat. Of note, prior to cementing the tibial component, a _____ plug with an extension placement screw were
applied to the tibial component on the _____. Again, all excess cement was removed.

Once the pressurization was done a trial 10-mm plastic instrument was applied over the tibia and knee was taken full extension and was held in that position until cement became hard. After this, the wound was thoroughly
irrigated. All extra cement was removed. Again, the knee was taken through range of motion and after the trial plastic tibial tray was removed. A 10-mm plastic tibial tray was inserted on top of the tibial component and snapped in place with a locking mechanism. The knee was reduced again taking full range of motion confirming good stability and good ligamentous balancing in flexion and extension as well as good patellofemoral tracking with no evidence of instability.

Again, the wound was thoroughly irrigated. A large Hemovac was brought out from inside the knee anterolaterally. The knee was closed in layers. The quadriceps mechanism was closed with 0-Vicryl interrupted figure-of-eight
sutures followed by several subcutaneous 0-Vicryl sutures, followed by superificial subcutaneous 2-0 Vicryl interrupted buried sutures. The skin was closed with skin staples.

Sterile surgical dressing was applied as well as a compression bandage. Tourniquet was deflated at this time. After the ankle was deflated, the patient received one more dose of IV Ancef___ antibiotic prophylaxis.

Once the patient was extubated, he was transferred to recovery room in stable condition.

Igor Kramer, MD
Electronically signed by IGOR KRAMER, MD 1/1/20XX
(hide spoiler)]

Why did I read that?? D:

Chris wrote: "Some are 1-2 pages, but they get up to 10-12 at times. It's more than summary too, it's actual medical documentation on everything from office visits to brain surgery.

Here's an example. I'm putti..."

Wow! I guess some of these reports must be swimming before your eyes having done 400 of them already!

Is the course you're taking, then, to do with converting handwritten/typed medical records into database entries (with links to other entries, etc.)? And, if so, is the assessment based on a comparison of 60 random database entries you've typed up compared with the original handwritten files in terms of accuracy, linkages with other entries, and so forth?

Greg, no it's not that complicated. I just look over that report and turn it into medical codes.

Such as (view spoiler)[Score: 3
Answers Answer Key Comments/Rationale

27447 27447 Documentation states that a particular type of incision was made (i.e.; pfannenstiel, vertical, horizontal) which indicates that an open incision was performed. With this in mind, one would select a CPT code which states the procedure was performed using an open approach as opposed to a laparoscopic approach for this particular service. Because this procedure has laterality involved, it is necessary to indicate which side of the body the procedure was performed on. The “RT or LT” Modifier is necessary to indicate this.

LT LT

1 1

M17.0 M17.12 Due to the documentation of "Degenerative Joint Disease Left Knee" the code is M17.12

---

27447 was the procedure code, then I had to find the correct diagnosis code of M17.12. As you see, I was close but not quite on the diagnosis.
(hide spoiler)]

Sorry, Becky. You should get credit for reading that, in GR pages or something.

And for those wondering if we've gotten off topic, not so much. This is exactly the shit I've been reading for two months now! lol

OH MY WORD

I shall stop whining now. O_O

I finally finished Oathbringer! It was awesome, despite taking me more than 2 months to read. I just can't plow through books like I used to.

Switching it up and am now doing Odd Child Out on my kindle, and Strange Weather as an audio book on my commute.

I'd also like to get to Artemis, Into the Water, and The Core this month.

I'm STILL working on Stories: All-New Tales, The Road to the Dark Tower: Exploring Stephen King's Magnum Opus.

I finished Duma Key, and started The Talisman like 2 weeks ago and have read 15%. Rocking this reading thing!

Awesome, Dawn. Now only 2 more years until the next Stormlight :)

Chris wrote: "Awesome, Dawn. Now only 2 more years until the next Stormlight :)"

Which I vow not to re-read before!

Chris wrote: "Awesome, Dawn. Now only 2 more years until the next Stormlight :)"

And hey, bright side, it'll still be out before a new Martin or Rothfuss!

And now I'm depressed.

LOL, for real.

Doing my best to read the last 100 or so pages of The Dragonbone Chair (Memory, Sorrow, and Thorn, #1). I'm enjoying it, but allergies have been making my eyes go fuzzy. I'm not a fast reader, either, so it's taking foreeeeever.

Michelle *The Bookish Hobbit* wrote: "Doing my best to read the last 100 or so pages of The Dragonbone Chair (Memory, Sorrow, and Thorn, #1). I'm enjoying it, but allergies have been making my eyes go fuzzy. I'm not a fast read..."

I'm sorry :(

Chris wrote: "Greg, no it's not that complicated. I just look over that report and turn it into medical codes.

Such as Score: 3
Answers Answer Key Comments/Rationale

27447 27447 Documentation states that a..."

Oops! I can't believe I didn't respond to this previously! I don't think I got an alert from GR about your post but I also experienced heavy snow over the following 3 days which is rare for where I live (I might've been a bit distracted). In any case, I see now what you mean by coding those cases. Still, that's a lot of reading you had to do! :O

On March 7th, I finished reading Helen's Daimones, a short dark fantasy/weird fiction novel, the second book in the Dyscrasia Fiction series.

Today, I finished 13 Days of Midnight a fun, 5-star, YA fantasy/horror read!

In between, I'd read some medieval history articles of relevance to a book I'm co-authoring.

Currently concentrating on Crossroads of Twilight. I've been in a bit of a slump in the second half of March and really only reading Crossroads because I have to read something. Don't get me wrong, I actually want to finish the Wheel of Time series, but I feel so ambivalent about everything. :-/