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Erin Murphy Profile
Erin Murphy

@TheVeinBoss

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Joined April 2022
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@TheVeinBoss
Erin Murphy
3 years
A week of great friends and outstanding education. Fun at the meetings and out on the town! And yes, Kush Desai’s sign says Erin Murphy and I love it ;) @CXSymposium @kush_r_desai @GeorgeAdamsMD @KathleenGibson6
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@TheVeinBoss
Erin Murphy
3 years
Another outstanding Cx 2022 session. Currently speaking Eric Secemsky, MD presenting an expert consensus on IVUS use for PAD interventions. #IVUS #Ericsecemskymd
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@TheVeinBoss
Erin Murphy
3 years
In the past week I have had the opportunity to work with such great friends and colleagues! First stop - Miami to coordinate a Venous Summit with Peter Schneider sponsored by Philips. Thank you Philips for the opportunity! @PSchneiderMD @LessneVIR @KathleenGibson6 @PhilipsHealth
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@TheVeinBoss
Erin Murphy
2 years
@farkomd @HCrespoSotoMD @lahinchman @UkVenous @KaremHarthMD @LessneVIR @RKTvascular @theveinlady @ReneLizola @HYY1084 These are the venograms pre & post endophlebectomy and then after additional stenting. Note the CFV disease prior to endophlebectomy. Grateful to have a talented colleague like Dr CrespoSoto to do these cases with.
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@TheVeinBoss
Erin Murphy
3 years
The Charring Cross 2022 executive board at work. It was an honor to be involved and work with my highly esteemed colleagues. An excellent meeting. Look forward to the future. @CXSymposium @UkVenous @ManjGohel, Dr. Armando Mansilha
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@TheVeinBoss
Erin Murphy
3 years
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@TheVeinBoss
Erin Murphy
2 years
@VascularSVS @s_brathwaite @kush_r_desai @MinaMakaryMD @KaremHarthMD 2. If symptoms are primarily lower extremity or vulvar varicose veins, I generally will treat the presenting complaint with phlebectomy or sclerotherapy first and re-evaluate. If pelvic pain is the primary complaint, I obtain cross-sectional CTV imaging.
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@TheVeinBoss
Erin Murphy
2 years
@AmputationSuck 1. IVUS is important for an accurate diagnosis. It reduces the risk for over treatment while improving outcomes by helping ensure that disease is appropriate for stenting, stent sizing is adequate, landing zones are correct, & inflow is adequate.
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@TheVeinBoss
Erin Murphy
2 years
@VascularSVS @s_brathwaite @kush_r_desai @MinaMakaryMD @KaremHarthMD 1. I first evaluate the patient’s symptoms and perform a physical exam. I am interested in teasing out whether the patient’s symptoms are primary pelvic pain, labial varices, or lower extremity varicose veins that originate from a pelvic source.
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@TheVeinBoss
Erin Murphy
2 years
@VascularSVS @s_brathwaite @kush_r_desai @KaremHarthMD @MinaMakaryMD Venous ulcer disease is secondary to high venous pressures. It is important to evaluate all underlying causes of venous HTN inclusive of deep venous disease, superficial venous disease and medically induced venous HTN. Further treatment is then dictated by the underlying cause.
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@TheVeinBoss
Erin Murphy
3 years
@DrLizGenovese Thank you Liz! Curious about this twitter world ;).
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@TheVeinBoss
Erin Murphy
2 years
@KaremHarthMD @farkomd @HCrespoSotoMD @lahinchman @UkVenous @LessneVIR @RKTvascular @theveinlady @ReneLizola @HYY1084 Thanks Karem. This patient had bulky CFV scar that did not respond to angioplasty & blocked the profunda. My criteria is a healthy profunda (and ideally femoral) just prior to the confluence to assure good inflow. Stenting is then performed into the patch from the IJ.
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@TheVeinBoss
Erin Murphy
2 years
Our live Twitter Q&A from 5-6 pm CST on #IVUS will begin! Looking forward to chatting!.
@PhilipsLiveFrom
PhilipsLiveFrom
2 years
On November 15th, vascular experts @AmputationSuck, @TheVeinBoss, and @HadyLichaaMD will be answering all your IVUS questions during a live Twitter Q&A. Submit your questions now using #IVUS.
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@TheVeinBoss
Erin Murphy
2 years
@VascularSVS @s_brathwaite @kush_r_desai @KaremHarthMD @MinaMakaryMD My follow-up for deep venous interventions is US stent checks at 2 weeks, 3- 6- and 12- months then annually. For Patients with IVC stents, I generally obtain an additional CTV at the post-op 3-6 month point. While not routine in all practices, I perform US 2 days after RFAs.
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@TheVeinBoss
Erin Murphy
3 years
@farkomd Thank you Frank :) We have sure come a long way in the past 18 years!! Hard to believe I have known you that long….
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@TheVeinBoss
Erin Murphy
2 years
@HadyLichaaMD @AmputationSuck I anchor these stents well into the EIV to assure adequate stent fixation. This prevents both (1) landing of shorter stents in the dilated distal CIV and (2) Landing shorter stents in the pelvic curve with resultant frequent complications.
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@TheVeinBoss
Erin Murphy
2 years
@VascularSVS @s_brathwaite @kush_r_desai @KaremHarthMD @MinaMakaryMD I evaluate superficial disease with duplex US and deep disease with US of the iliac veins and cross-sectional imaging, typically CTV.
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@TheVeinBoss
Erin Murphy
2 years
@KaremHarthMD @farkomd @HCrespoSotoMD @lahinchman @UkVenous @LessneVIR @RKTvascular @theveinlady @ReneLizola @HYY1084 Luckily, I have great colleagues to partner with on these complex cases. Hector is a rockstar.
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@TheVeinBoss
Erin Murphy
2 years
@AmputationSuck 1. Deep venous related leg ulcers should be managed comprehensively. This includes evaluation and management of superficial venous disease and deep venous obstruction. Perforator disease may have a role in some patients.
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@TheVeinBoss
Erin Murphy
3 years
@LessneVIR @farkomd Two admirable and talented physicians. Sorry I missed this one!.
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@TheVeinBoss
Erin Murphy
2 years
@t_intheleadcoat @HCrespoSotoMD @farkomd @lahinchman @UkVenous @KaremHarthMD @LessneVIR @RKTvascular @theveinlady @ReneLizola @HYY1084 Initial DVT was managed with AC only. Recurred after stopping AC & was treated with indefinite AC. I attempted an endo approach 1st but the cfv disease was very bulky, unresponsive to venoplasty & blocked profunda flow. Inflow prior to the fem/profunda confluence was healthy.
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@TheVeinBoss
Erin Murphy
2 years
@VascularMD @farkomd @jmills1955 Darren… agree that @jmills1955 is charged with promoting the specialty of vascular surgery. Also believe he set us back dramatically in that end. He should instead be suspending the svs membership of the surgeons who contributed to that NYT article for unprofessional behavior.
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@TheVeinBoss
Erin Murphy
2 years
@HadyLichaaMD @AmputationSuck In diffuse PTS, the more difficult aspect is finding a landing zone clear of disease and ensuring no disease is left between the end of the stent and the profunda-femoral confluence.
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@TheVeinBoss
Erin Murphy
3 years
@jcgeorgemd @SCAI @EricSecemskyMD @sahilparikhmd My honor to speak at SCAI and share the stage with such esteemed colleagues! Great to see you all!.
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@TheVeinBoss
Erin Murphy
3 years
@drochohan @ImagingDoctor @LessneVIR @kush_r_desai @CHICKVIR @IR_Doctor @bonesz @VenousForum Fracture of wallstents through septum - left was previously collapsed by right but I dilated them and fractured them. Next post is end result. Converted double barrel to one large stent then extended down iliacs.
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@TheVeinBoss
Erin Murphy
2 years
@VascularSVS @s_brathwaite @kush_r_desai @KaremHarthMD @MinaMakaryMD In my practice, I find RFA & sclerotherapy produce excellent results in the vast majority of patients with little need for deviation. Providers with alternative technology preferences also have great results. Decisions depend on device cost, comfort, safety, & success profiles.
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@TheVeinBoss
Erin Murphy
2 years
@kmadass @AmputationSuck 2. However, in most cases, recurrent thrombosis is more often associated with profunda inflow (overlooked with PMT devices without lysis), failure to treat the outflow obstruction adequately, as well as technical errors with stenting.
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@TheVeinBoss
Erin Murphy
2 years
@HadyLichaaMD @AmputationSuck In these cases sizing is actually easier. I size to normal vein sizes which roughly are CFV: 12, EIV: 14, CIV 16. So generally I will use 14 stents distally and 16 stents cranially.
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@TheVeinBoss
Erin Murphy
2 years
@farkomd @ISETNews @JayMathewsMD @docTPlive @patrickmuckmd Thank you Frank! Was a great meeting.
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@TheVeinBoss
Erin Murphy
2 years
@HYY1084 @HCrespoSotoMD @farkomd I thought of you two and your Atrium socks when I was given these to wear in clinic this morning.
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@TheVeinBoss
Erin Murphy
2 years
@kush_r_desai @VascularSVS @s_brathwaite @KaremHarthMD @MinaMakaryMD A few less IVC filters when we are done with them :).
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@TheVeinBoss
Erin Murphy
2 years
@kush_r_desai @VascularSVS @s_brathwaite @MinaMakaryMD @KaremHarthMD This is such an important perspective. This can make early ventures into this space discouraging if you do not have a team approach.
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@TheVeinBoss
Erin Murphy
2 years
@kmadass @AmputationSuck 1. It is certainly not wrong to use tibial vein access for lysis so I am not actively discouraging this approach even in the first attempt if that is an interventional preference.
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@TheVeinBoss
Erin Murphy
2 years
@s_brathwaite @limbsalvagedr @VascularSVS @kush_r_desai @KaremHarthMD @MinaMakaryMD I treat early with ulcer bed sclerotherapy, often at time of venous closure. I do wait 6 weeks before considering perforator treatment.
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@TheVeinBoss
Erin Murphy
3 years
@LessneVIR Gallons per year?? Yikes… Im way behind. But I am catching on to this twitter thing.
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@TheVeinBoss
Erin Murphy
2 years
@AmputationSuck In the awake patient, I use both Valsalva and breath-hold maneuvers while using IVUS to image the suspected compression. Valsalva alone can cause compression via contraction of abdominal muscles (will resolve with breath hold). Under anesthesia, Valsalva is sufficient.
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@TheVeinBoss
Erin Murphy
2 years
@DejahJudelson @VascularSVS @s_brathwaite @kush_r_desai @MinaMakaryMD @KaremHarthMD I find that my decision between MRV and CTV depends on your comfort level and the quality of those imaging modalities at your institution. I find CTV more universally applicable but MRV works great if your radiology division does a great job with these.
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@TheVeinBoss
Erin Murphy
2 years
@UkVenous @MDTVascular @myAVLS @TheVEINSatVIVA Back at you Stephen. Always an honor to work with you.
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@TheVeinBoss
Erin Murphy
2 years
@SriniTummala @LessneVIR @SIRspecialists @VascularSVS @kush_r_desai @lahinchman @KaremHarthMD @kmadass @Watts_IR @AmputationSuck @keithppereira @SDhandMD @ABrandisMD @t_intheleadcoat Mark- That is 2 men that commented on your looks… I must be losing my touch or… you are THAT impressive! Hmmm… both?.
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@TheVeinBoss
Erin Murphy
2 years
@jmills1955 @VascularMD @farkomd Likewise, if there are professional concerns, the clear pathway to address them exists. This pathway should not be the New York Times. As a society maybe we could address that as inappropriate?.
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@TheVeinBoss
Erin Murphy
2 years
@jmills1955 @VascularMD @farkomd From the policies you referenced… Likely not professional or smart for physicians to discuss colleagues and medical professional issues with the NYT. Is that the environment we want to practice medicine in? Or is this an issue for professional conversations and medical boards?
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@TheVeinBoss
Erin Murphy
2 years
@kush_r_desai @VascularSVS @s_brathwaite @KaremHarthMD @MinaMakaryMD With superficial veins, you need to make sure you use tumescent to keep the vein 1cm from the skin or perform phlebectomy if outside the fascia.
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@TheVeinBoss
Erin Murphy
2 years
@AmputationSuck 2. Overall, IVUS improves patient selection and reduces complications to improve outcomes.
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@TheVeinBoss
Erin Murphy
2 years
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@TheVeinBoss
Erin Murphy
2 years
@kush_r_desai @VascularSVS @s_brathwaite @KaremHarthMD @MinaMakaryMD As long as there is a short straight segment of vein cranially you can utilize RFA followed by sclero once the cranial portion of the main vein is closed.
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@TheVeinBoss
Erin Murphy
2 years
@farkomd @AmputationSuck Yeah… um… Frank? Maybe share exactly what happened to that bird that got in your house? I think I heard this story… I seem to recall key words of salt gun? Bookshelf? Someone will find its body someday?.
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@TheVeinBoss
Erin Murphy
2 years
@GrahamSlessor @LessneVIR @farkomd @VascularSVS @SIRspecialists Maybe his lead helped me to channel his skill… and this way he also gets partial credit for my case without showing up ;).
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@TheVeinBoss
Erin Murphy
2 years
@UkVenous @academicaorta @farkomd @HCrespoSotoMD @lahinchman @KaremHarthMD @LessneVIR @RKTvascular @theveinlady @ReneLizola @HYY1084 Agree selection is key. This patient had no great endo alternatives as the cfv disease was unresponsive to venoplasty & blocked profunda inflow. Fortunately the profunda & femoral v were healthy before the confluence. The residual iliac occlusive disease was treated with stenting.
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@TheVeinBoss
Erin Murphy
2 years
@drochohan @AmputationSuck @kmadass Since we do not have great interventional options for fem-pop DVT later on, I generally treat these with lovenox and re-evaluate improvement @ 2 weeks. I reserve intervention for highly functional patients who will not tolerate even mild PTS and who are still symptomatic at 2 wks.
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@TheVeinBoss
Erin Murphy
2 years
@JayMathewsMD Omg! Be safe and enjoy the accommodations 😂♥️.
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@TheVeinBoss
Erin Murphy
2 years
@docmrjaff @bsc_pi @bsc_vascular @sahilparikhmd Outstanding meeting! Proud to collaborate with Boston Scientific and an amazing group of physician leaders. Well done.
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@TheVeinBoss
Erin Murphy
3 years
@drochohan @ImagingDoctor @LessneVIR @kush_r_desai @CHICKVIR @IR_Doctor @bonesz @VenousForum Caval wallstent and arterial (smart) stents? The Ivus would dictate treatment. Smart stents can be broken and restented larger if not occluded. Also If collapsed in IVC can possibly fracture the septum and convert to a large caval stebt then extend down iliacs as needed.
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@TheVeinBoss
Erin Murphy
2 years
@AmputationSuck 2. Medical management of disease contributing to venous HTN is essential (Obesity, heart failure, etc). Compression, wound care and lymphatic care are also important.
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@TheVeinBoss
Erin Murphy
3 years
@docmrjaff @YolandaCDBryce @MaureenKohi @MdTabori @kush_r_desai @drksterling Excellent topics and top notch physicians! Thank you Boston Scientific for supporting education and field advances!.
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@TheVeinBoss
Erin Murphy
2 years
@TobyRichardsUWA @farkomd @HCrespoSotoMD @lahinchman @UkVenous @KaremHarthMD @LessneVIR @RKTvascular @theveinlady @ReneLizola @HYY1084 Agreed. In this case the disease was involving the origin of the profunda inflow. A CFV stent would have left the profunda flow severely compromised.
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@TheVeinBoss
Erin Murphy
2 years
@farkomd Do they have a venous course? I need that one.
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@TheVeinBoss
Erin Murphy
3 years
@AmputationSuck @JillSommerset I met her too! New bestie.
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@TheVeinBoss
Erin Murphy
3 years
@dr_ashishg @PSchneiderMD @LessneVIR @KathleenGibson6 @PhilipsHealth Thank you. It was so great to meet you as well.
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@TheVeinBoss
Erin Murphy
2 years
@UkVenous @VenousForum Excellent work and an excellent presentation!.
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@TheVeinBoss
Erin Murphy
3 years
@JillSommerset @LessneVIR @farkomd @HCrespoSotoMD I plan to fly in and out for a talk. Not much focus on venous. But I will let you know as soon as I make travel plans- We WILL make it happen :).
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@TheVeinBoss
Erin Murphy
3 years
@luisalamomd @VascularSVS @FutureVascSurgn Thank you! An honor to present.
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@TheVeinBoss
Erin Murphy
2 years
@HadyLichaaMD With the current stents on the market, the risk for stent fracture is very rare (or a never yet event for some of them). To minimize pain and risk, make sure to size accurately (generally 14 mm stents across the ligament) and avoid overlapping stents across this location.
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@TheVeinBoss
Erin Murphy
2 years
@AmputationSuck @kmadass 1. Inflow is very important to the eventual outcome for patients as is the amount of thrombus removal. In general, I access the popliteal vein as complete thrombus removal above this followed by relief of associated obstruction with stenting allows the tibial clot to resolve.
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@TheVeinBoss
Erin Murphy
2 years
@farkomd Joint statement from all and a public apology from SVS.
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@TheVeinBoss
Erin Murphy
3 years
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@TheVeinBoss
Erin Murphy
2 years
@farkomd @LessneVIR @VascularSVS @SIRspecialists I asked the same thing!.
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@TheVeinBoss
Erin Murphy
2 years
@AmputationSuck @kmadass 2. The SSV is also a helpful access to clear popliteal clot as long as the SSV in fact communicates with the popliteal vein.
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@TheVeinBoss
Erin Murphy
3 years
@LessneVIR I now love your sister….
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@TheVeinBoss
Erin Murphy
3 years
@HCrespoSotoMD @LessneVIR Yes! Large pelvic varices for sure! So much for menopause fixes pelvic congestion- not always the case.
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@TheVeinBoss
Erin Murphy
2 years
@HadyLichaaMD @AmputationSuck I avoid stenting into the profunda or femoral vein but you can venoplasty these vessels.
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@TheVeinBoss
Erin Murphy
2 years
@HCrespoSotoMD @HYY1084 @farkomd I just know that is referring to the scrubs and not how I am wearing them 😜 We cannot all be as cool as you guys and your socks :).
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@TheVeinBoss
Erin Murphy
3 years
@DrLizGenovese @CXSymposium @kush_r_desai @GeorgeAdamsMD @KathleenGibson6 You would have fit in perfectly- look forward to seeing you again soon :).
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@TheVeinBoss
Erin Murphy
2 years
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@TheVeinBoss
Erin Murphy
3 years
@KathleenGibson6 I am impressed :) That is a cool case. Nice Job.
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@TheVeinBoss
Erin Murphy
2 years
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@TheVeinBoss
Erin Murphy
2 years
@JayMathewsMD @UkVenous @theveinlady Owes? Well I am not so sure about that… But I do share well with friends :).
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@TheVeinBoss
Erin Murphy
2 years
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@TheVeinBoss
Erin Murphy
3 years
@VenousNews Honored to be a part of this meeting. Important work.
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@TheVeinBoss
Erin Murphy
2 years
@KutsenkoMD @farkomd @VascularSVS Yes interesting timing… .SvS- “Don’t worry we will train you”.Recent NYT cardiologist “I was teaching you at the recent 2023 VAM meeting”.
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@TheVeinBoss
Erin Murphy
2 years
@EstherSHKimMD @Angiologist @herbaronowMD @RKolluriMD @evratchford @SVM_tweets Esther! I look forward to meeting you soon. I am also at Sanger :).
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@TheVeinBoss
Erin Murphy
2 years
@JamesHBlackMD @farkomd Have you reviewed these cases? Has SVS? Neither has the radiology & cardiology community. Condemning a physician publically in response to a sensationalized news story that acts like there is a public conspiracy committed by physicians and industry is arrogant, sloppy & dangerous.
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@TheVeinBoss
Erin Murphy
3 years
@JillSommerset @LessneVIR @farkomd @HCrespoSotoMD Jill! Will you be at SCAI or NCVH? Maybe we can finally meet up?.
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@TheVeinBoss
Erin Murphy
3 years
@KathleenGibson6 So cool!.
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@TheVeinBoss
Erin Murphy
2 years
@lahinchman @JohnMoynes Haha… I just practiced that out loud a few times… Makes me sound more Irish! Making Murphy’s proud :).
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@TheVeinBoss
Erin Murphy
2 years
@drmcumming @AmputationSuck There is certainly some of this which is not encouraged. But there is also the many decades of undervaluing of the significance of venous disease by vascular providers with the resultant under treatment of patients. There is some continued dismissal still evident here.
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@TheVeinBoss
Erin Murphy
2 years
@farkomd @jmills1955 @DHidlayVIR @shamitsdesai @chrisharnain @VascularSVS @ashkan_1670 “Some”…. Hard to hide bigotry even when trying to hide bigotry.
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@TheVeinBoss
Erin Murphy
2 years
@GrahamSlessor @LessneVIR @farkomd @VascularSVS @SIRspecialists Who? Another doctor … that’s who ;).
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@TheVeinBoss
Erin Murphy
2 years
@GhostofDotter @KutsenkoMD @farkomd @VascularSVS Hmm- Frank. I’ll vote for that.
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