Reality Check 2

I still hate the questions about what to do FIRST, as though you are alone in a room out in the woods with no help and a table containing a fish hook, a ball of yarn and a bottle of aspirin and someone has chest pain. Those are loaded questions - assuming no prehospital care, no triage and no nurses, techs, etc simultaneously working the patient. My first response was always - check your own pulse then check the patients and say HI and ask what is going on…. I guess I am dumb though to think of common sense.

Just yesterday, pt chronically anemic with known bone marrow dysplasia. A tad more anemic but not bad, Hgb 10. Hx of GIB and PUD. RECENT hx of heme positive stool - visible. He tells me onc is planning bone marrow bx, but no one has checked his stool again or asked about the NSAIDs he has been taking….. So, how about we look for obvious cause of blood LOSS before we do a bone marrow bx?…. Just a thought

I think I am in the window to start this for my 10 yr recert. This Pathway II type thing is very appealing. Might even learn something. Regardless of the functionality, I have my "C" and plan to keep it - as trying to get it back would be painful and costly. So, I keep it. Hate paying an organization that doesn't really support us - but - it is a choice to keep my "C". If I am counting correctly and hell doesn't freeze over, I should only have to recert one more time before potential retirement................ Deep sigh

Breaking news from NCCPA. I did Pathway II eons ago and liked it. What are the thoughts now? Discuss...... From NCCPA: NCCPA is pleased to announce that beginning in 2023, PAs will have two options for their recertification assessment. The traditional PANRE that is administered at Pearson VUE test centers will remain as one option, and NCCPA will also launch an official alternative longitudinal, take-at-home process.... The application period will open later this year for PAs who are due to recertify in 2024, 2025, and 2026 and want to participate in this new process. The registration period will close December 15, 2022, and the first block of exam questions will be available in January 2023. So, what does the new PANRE-LA look like? Here’s an overview: Each quarter, 25 questions will be administered in an online format that PAs can take anywhere, anytime, and on any compatible device. Each question will have a five-minute time limit, and PAs may use online or printed references to help inform their answer selection. Before opening an exam question, PAs will be provided information on the content category that will be assessed and can decide to move forward with opening the question or defer it until later in the quarter. This way PAs know in advance what content area will be coming up in case they want to review the exam blueprint topics or reference materials before opening the question. Immediate feedback will be provided to PAs to let them know if the answer they submitted was correct, and they will be provided a rationale and references that can be accessed for additional information. The content of questions that have been completed and the rationales will be available throughout the process so PAs can review it anytime, at their convenience. PAs will have three years to complete the new process. During the 12 available quarters, PAs will be required to complete eight quarters and may skip up to four quarters. This allows PAs more flexibility to participate in quarters that fit best with their schedules. There are benefits for getting started right away and working straight through. PAs who complete the first eight quarters may be able to finish the process in two years, if they reach the passing standard. PAs who have not met the passing standard may continue in the program, and scores will be recalculated at the end of each subsequent quarter, using the best eight quarters. This provides PAs an opportunity to improve their performance before the end of the 12-quarter process. PAs will apply for the PANRE-LA process in the year six of their certification maintenance cycle and the exam questions are administered in years 7-9. As previously noted, one of the foundational principles of the PANRE-LA process is to help PAs identify and close core medical knowledge gaps, and NCCPA anticipates that only a very small percent of PAs will not reach the passing standard after completing the PANRE-LA. However, another benefit of this process is that PAs will still have up to three opportunities to take and pass PANRE in the tenth year of their recertification cycle before their certification expires.

I did have an employer take money out for 401K but never send it to the investment company. Used it to pay overdue bills and personal expenses. But, it is correct that one must enroll in 401K to participate. This whole job sounds like a nightmare.

Follow your dreams, be professional about leaving other job. MAKE SURE this job is the dream it appears to be. Ask hard questions. Regrets suck.

I saw the bull riders in Texas all the time. Lose a testicle - no big deal…. Gored in the chest and inches from the heart - meh, ready to ride again Stomped and compartment syndrome in the leg or foot - just a normal day I had to resign myself to the idea that they were out of the gene pool - usually. Because the next incident would likely be fatal and the tight jeans and bucking were not sperm friendly. Similar issues with my motocross folks. One BENT the IM rod in his tibia when he hit a tree - AGAIN. And wanted a boot instead of surgery or cast - he could still ride….. I have to use the mantra - give good advice, document the hell out of it, hope they make good decisions Deep sigh

The articles I searched indicated that, at any one given time, about 10% of the military is not deployment ready. Mostly for medical reasons. They did not count pregnancy and post partum in that batch. Any type of cancer was a NO-GO for deployment. Thus, HPV cancers would meet that index. What if a soldier is deployed and cannot have routine medical screenings and develops HPV, thus becoming a potential burden on his/her unit when disease develops and has to be medivac'ed or taken out of duty to deal with this diagnosis? Why couldn't we prevent that issue by vaccinating? Reduction in costs and manpower, training, transport, etc. Anal warts can be huge and painful. Abnormal menstrual bleeding and pelvic pain can be debilitating. Throat cancer can cause dysphagia and weight loss or coughing up blood. That doesn't help your military unit. What about the soldier who develops HPV and doesn't know until LONG after deployment and suffers unneeded consequences or loss of fertility, etc due to having to have more aggressive HPV treatment? Why couldn't we just prevent something before it happens? It is completely naïve to think that troops aren't having sex when deployed. And more naïve to think they are always using condoms or that sex is always consensual. Why NOT vaccinate to reduce one type of issue that can and likely will arise in a set of soldiers. Men under age 30 were more likely to seroconvert to HPV during their military tenure than any others. Men can spread HPV to partners - men and women - and those in other countries with whom they associate which widens the web of spread. So, again why NOT prevent a potentially harmful disease with somewhat unpredictable outcomes? If you just want to argue to argue - go ahead. I am done arguing. I see logic and forward thinking and - again and again - A CHANCE TO PREVENT A CANCER - SERIOUSLY, WE CAN DO THAT NOW. Why would you NOT get an HPV vaccine???

HPV accounts for more medical visits than the next two STIs combined. it DOES take people out of rotation for combat or deployment readiness and is obviously affecting the overall health of troops. THE first sentence of the abstract.

They vaccinate up to age 45 now…. read the regs. HPV is everywhere. Vaccinate all the troops. Vaccinate whenever possible.

As long as military sexual trauma - rape - exists - then, YES, the military should protect against a sexually transmitted cancer. Men are traumatized as well. ANY protection against insult to injury - ie cancer after being raped - yeah, that helps. All vaccines have a purpose - this one is huge.

Camus followed absurdist philosophy which has some facets of nihilism - basically who gives a flying F***. A very dark outlook. I certainly hope that is not where we are headed. I will stick with my belief in humanity and the desire to live. Maybe even the idea that humans are responsible to each other. To each his own…..

I was a study provider for a version of an HPV vaccine in the early 2000s. The entire concept of preventing CANCER was amazing. I cannot stress that enough - Amazing that during my lifetime we could prevent a cancer!! My kids are HPV vaccinated - no question - no argument - they got the shots. I have vaccinated a TON of women and some men over the age of 20 and even had those OVER 45 pay for the shots - they are widowed, divorced and joining the dating world and HPV and STDs are SUPER REAL. My experience treating veterans has shown me that - once out - some don't want to BE TOLD to do anything again - sorry folks - price of citizenship. A lot of angst spread from a bad batch of Anthrax vaccines and some problems they did actually cause. The loss of faith in science and the ability to spread flagrant BS conspiracy theories is damaging public health and making it very hard for practitioners to properly educate their patients to the reality of science. This should not be hard. It is real and it freaking works. My mum died from ovarian cancer at age 55. I hope to see in my lifetime a way to find this f'ing cancer earlier or even prevent it. Let's take a win and run with it. Cancer sucks. Science is real. Public Health should be required.

I wish we could make administrators come work with us - paired at the hip.......... They go where you go, they pee when you pee, etc. The insanity first hand. Even 20 yrs ago in an urban ER, we were expected to see 50 in a 12 hour shift. Some sort of trophy for seeing over 50. I pointed out during a staff meeting that the over 50 Glee Club had the highest rate of bouncebacks and bad outcomes. Crickets........................ meeting adjourned. Medicine isn't McDonalds and you can't have fries with that.

I have not yet been asked about this but feel it coming................ These folks should lose their licenses for spreading medieval myth and garbage. ===================================================================== In a TikTok video that has garnered hundreds of thousands of views, Dr. Carrie Madej outlined the ingredients for a bath she said will “detox the vaxx” for people who have given into Covid-19 vaccine mandates. The ingredients in the bath are mostly not harmful, although the supposed benefits attached to them are entirely fictional. Baking soda and epsom salts, she falsely claims, will provide a “radiation detox” to remove radiation Madej falsely believes is activated by the vaccine. Bentonite clay will add a “major pull of poison,” she says, based on a mistaken idea in anti-vaccine communities that toxins can be removed from the body with certain therapies. Then, she recommends adding in one cup of borax, a cleaning agent that’s been banned as a food additive by the Food and Drug Administration, to “take nanotechnologies out of you.”....... It gets worse further into the article