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Everything posted by GetMeOuttaThisMess

  1. I’ve had a DEA for six years and used it once. I don’t intend on being in a position to need it. I can live off retirement between now and 65 when I start with Medicare and my two pensions, in addition to my wife’s accounts. The need for licensure would be for non-care part-time position.
  2. Emp. Health for a company, gov’t. agency, or as in my case, a local school district.
  3. For those who might have retired, or are nearing retirement, how long did you, or are you considering, keeping your license/certification active? State licensure good through 2021 and I have hours logged for this NCCPA which expires end of the year. I'm at 60 but don't intend on providing direct care, though licensure would potentially assist with other part-time gigs such as an adjunct professorship. My personal thought is to keep NCCPA current with logged CME which I now have through my 2022 expiration (no longer need PANRE) then go emeritus, and my state licensure through its current expiration of 2021. If I go back to work in a capacity such as above then I've still got it active and can maintain CME online. If I don't, then I think two years to make a decision is plenty. Thoughts?
  4. I got the invite to Austin just for having a suspected partial-complex isolated seizure. Explained to the program physician (former spine specialist) why I was there and he in turn didn't know why I was there, or what to do with me. I had provided previously the clearance letter from my neurologist. I was no risk to patients unless I flopped an arm or leg against their face. Cost me $300 to sit with him for 30" to discuss my old spine days from the 80's. If I had been there for substance abuse concerns the initial visit would've been over a grand and I would've been out additional costs for drug testing. I will say that if they catch you falsifying your answers to the now bi-annual license renewal questionnaire that that qualifies you to have your license pulled as they say "Bye, Felicia".
  5. 1) Where do you see the profession being in 10 years were I to stay in-state? 2) What do you feel makes YOUR program special in comparison to others? 3) What are some, if any, challenges that you see with YOUR program? This isn't a one way street. You're screening them as well. I also pointed out that with my pre-entrance experience and stable GPA within a few tenths of a point from high school through college I gave them an idea of what they could expect. I may not be the hall-of-famer, though only time will tell; but I can assure you that I will be rock steady and not an embarrassment to the program. There was nothing that they could show me anatomically that I couldn't handle having seen any number of traumatic death scenarios.
  6. I'm going to ask the same question that I ask a lot of folks with similar posts. What got you into the profession to begin with, especially with required healthcare exposure before program acceptance? I don't fault your thought process about the profession, I'm just curious how you got sucked in?
  7. If you ever worked with "Dr. Quinn, Medicine Woman" I think that I'd come out of retirement and work a shift. Ahh, the allure of remote medicine. Hubba, hubba.
  8. I was thinking that back in the stone-age when bronchoscopies became available that there was a study (studies) that showed a dissociation between cultures from expressed sputum and those collected during bronchoscopy, thus we don't tend to see people provide sputum specimens any longer, EXCEPT in what situation (think outside the box a bit)?
  9. I always found the aroma from goo to be similar to the smell of napalm in the morning. Never minded the smell for some strange reason. Inject slowly, and avoid the 12 second NASCAR full tank fill method.
  10. I'm personally not defending anyone if your referencing my responses. I think the scenario for the provider leaves a lot to be desired based on the information provided. The only point that I was trying to bring up is IF you get a history of diminished kidney, liver, heart, lung function in a patient then you need to be aware of what potential interaction your treatment decision has and to thus make it a teaching moment to others to factor this consideration into the overall decision. In this case, as previously stated, I would've avoided this medication entirely since I have other options, and in my prior setting, lack of lab availability. Out of curiosity, is there an EMR out there that would flag such a thing automatically without a self-imposed flag of "diminished renal function"? Heaven knows the script writers flag everything else known to man. BTW, how were you able to discuss the treatment of this family member with the other provider (HIPAA)? I'm just curious.
  11. With regard to the benign nature of rhinosinusitis, many years ago I did have a patient walk into the ED sounding like she had a cleft palate. She had seen her doc the day before and had been placed on Augmentin. She's giving me the history and I'm looking at her trying to figure out why she sounds like a cleft palate but doesn't have the traditional appearance or accompanying surgical repair scar? When she had finished her story I simply asked her if this was her normal voice and she replied "no". I then asked her if she had sounded like that the day before at her PCP's office? She said "yes", and apparently it didn't warrant any further questioning by her PCP at that time. I then asked her how I could help her at this time? She replied "I'm here with this." She opened her mouth and had a thick string of phlegm extending from her palate to the back of her throat. She had eroded through her palate and apparently it hadn't been appreciated by her PCP. Needless to say, she ended up in the hospital and had subsequent surgery to close the defect.
  12. I didn’t ask the question with regard to this specific facility. I was asking for general practice individuals who don’t have access to system lab results. I provided my answer in a previous post. Even if the patient says “I have kidney issues” they are not providing you with enough information to use the example medication first posted about at a traditional dose without pause. I was asking what you would do in a situation where you don’t have lab values accessible and the PCP is not returning your call. I later gave my answer, but it still doesn’t address the primary question of what to do with patients requiring possible medication dosing alterations in extenuating circumstances. I’d still like to hear answers from others in response to this question.
  13. And thats my point. If you cant get an answer to your important question then consider other alternatives. Here's the catch, you have to know what the appropriate alternatives are. The last five years i didn’t have a means with which to obtain lab in my setting yet how many folks can you imagine that i saw that met the unlikely criteria for bacterial rhinosinusitis? Quite a few. How many had questionable renal function unknown to even themselves (DM/HTN one/two punch). Some for sure. Thats why if i gave an abx it was doxy because what else were most of these folks doing? Coughing. That way i could cross-cover for atypicals in the chest. Doxy renal dosing? Same as normal,renal function patients. Sent from my iPad using Tapatalk
  14. V, I go back to my earlier hypothetical situation. How would you treat that patient, assuming you have a VALID reason to suspect a possible bacterial rhinosinusitis, and you have no way of obtaining a sCr, nor speaking with the PCP? Sent from my iPad using Tapatalk
  15. What would be nice would be those interactive cases that we had to take before PANRE was PANRE as part of the certification examination where you used a revealing marker to work your way through case histories. You could ask/order/diagnosis whatever you wanted as you worked your way through and it would tell you whether you killed the patient, saved the day, or ended up in a courtroom (made the last one up). I seem to recall that it would tell you if you were WAY off base as well. Ahhh, good 'ol day syndrome strikes again.
  16. Here you go. I'm in UC or a doc in the box without lab capability. You only tell me that you have "kidney issues". Your doc is not returning my phone call. What do you want me to do if Augmentin is your drug of choice (or frankly any other medication and not just antibiotics)? renal dosing [immediate-release form] CrCl 10-30: 250 mg/125 mg-500 mg/125 mg q12h; CrCl <10: 250 mg/125 mg-500 mg/125 mg q24h; Info: do not use 875 mg/125 mg tab for CrCl <30 HD: 250 mg/125 mg-500 mg/125 mg q24h, on dialysis days admin. after dialysis; consider supplement during and after dialysis if next maint. dose not due right after dialysis; PD: 250 mg/125 mg q12h; no supplement; Info: do not use 875 mg/125 mg tab [extended-release form] CrCl >30: not defined; CrCl <30: contraindicated HD: contraindicated; PD: not defined
  17. You modify the dosing in most cases, not discount the abx. As Cid has pointed out however you have to know the respective lab values (very unlikely). I realize that I'm "retireded", and am quickly trying to forget everything, but I used to keep a printout of the different CRF categories and their respective cut-offs above my Primary Care computer when I was in a separate employee health setting than my last one. I would recommend others do the same, or put them in your cellphone "Notes" section for reference.
  18. Can one of you please pick me up at the hospital today and take me back to my nursing home? Family is back in town and responsible for me later today.
  19. O..M..G! It pains me to even contemplate repeating part of the above statement. "I enjoy it." I'm falling out of my chair. All kidding aside, I'm so envious that you wish to continue working (I'm not that far behind) in this setting. I need to find something else to do but family circumstances are limiting my considerations due to having to be available at any point for an elderly parent. I like the teaching idea, especially if I got "PAID" for it as opposed to doing lectures voluntarily to help my wife's dental program. That being said, I'm not smart enough to teach medically. I "only have a BS". It's also fun telling others that your profession is "retired".
  20. It was just my usual C. Eastwood old man tongue-in-cheek response regarding how never having taken these courses impacted my clinical ability to function. I suspect that just like med school, these courses are a way to to help wean out applicants. This is not to imply that they aren’t relevant however. I’d probably understood things better if I had taken them but they weren’t required back in the stone-age.
  21. Lack of taking O. Chem and Physics never kept me from unnecessarily prescribing an antibiotic.
  22. You missed the obvious diagnosis. Drop off the problematic family member for admission so family can enjoy their holiday and a couple of extra days. Sent from my iPad using Tapatalk
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