• Content count

  • Joined

  • Last visited

  • Days Won


ral last won the day on December 10 2017

ral had the most liked content!

Community Reputation

155 Excellent

About ral

  • Rank

Recent Profile Visitors

405 profile views
  1. Had a mid-60's lady come in end of last week. Extremely pleasant. Typical upper respiratory stuff. Then she says, "My chiropractor adjusted my sinuses but, I'm still not quite well." Having heard exactly what she said, I pretended I didn't and said, "I'm sorry, what was that?" She repeated herself. "Okay then," says I, "let's take a look and listen to a few things." as I started my exam. I just don't know anymore. Guess I should let people spend their money.
  2. Not that I wouldn't anyway but, my current employer requires that I remain certified. As you know, Texas doesn't require NCCPA certification beyond initial licensing. I have more than a few old buddies who stopped writing the exams years ago. Most are nearing or semi-retired. One says he cannot compete with these new book-smart kids coming out of school and skewing the curve...lol.
  3. Just got the notice in my email yesterday, that I was randomly selected. Why am I never randomly selected for Publishers Clearing House's $5000/wk for the rest of my life? They pulled my name out of the hat. State medical board did the same thing last year. I always do at least the minimum number of hours; typically twice the required Cat 1 stuff, just because I enjoy learning, plus I don't bother to jot down the countless hours of reading I do that would credit towards Cat 2 time. Will gather up my records and mail them in this week. Still pisses me off though. Seriously, I don't need to be babysat by any of these morons. Never liked being hassled by "the Man", in any aspect of my life.
  4. Here’s a great one for discussion: Pediatrician colleague of mine (who has since passed away) in general conversation twenty-something years ago, was emphatic that the Johnson & Johnson campaign for treating kids’ fever with Tylenol, while spreading terror about ASA and Reye syndrome, was the greatest marketing ploy ever created. Don’t you guys and gals remember all of the kids in your neighborhood coming down with Reye’s, since we were all given aspirin for our fevers? (Me rolling my eyes)
  5. My interpretation of the above: "We realize that we are making you eat a lot of shit sandwiches right now but, in a few months, we will start sprinkling sugar on them." I will never be that hungry.
  6. Ral's Fact #37: You can write a prescription for two kicks to the head if you want. You are not allowed to say who does the kicking. Compounding pharmacies compound. Unless the one your patients are being directed to has some superior proprietary ingredient list, I would say you are skating on very thin ice. Had a local compounding pharmacy rep visit the clinic a couple of weeks ago. I asked if they make Newman's Nipple Cream. "We do, except I think ours is called Triple Nipple." "That'll work.", says I.
  7. Okay, found it. This could be a whole new thread on its own but, I considered this to be a decent read. Those of you who have time, could read the entire article. Those who want to get to the beef, scroll to about two thirds of the way down the page, and start at "Antiviral Therapy". Each person may take away a different opinion, and it matters not to me which conclusion you draw. From my homeland of Canada, I bring you: http://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(14)62800-7/fulltext
  8. HMtoPA: I'll join you at the minority table. I discuss it, explain the risk vs benefit, and then ask the patient what they would like to do. I don't see the big deal here. I have a study saved somewhere that I might share if I can remember where I put it.
  9. Valve stem tool + doc's BMW = Smile and wave as you drive past him at closing time.
  10. Do FM. Urgent Care clinics are predominantly about seeng as many patients as possible, and keeping those patients happy. That means steroids and Zpaks for everyone, or you will hear about the negative Yelp reviews. Using your brain in Urgent Care is frowned upon.
  11. Middle of a cold snap here in North Texas, with temps down into the teens some nights.
  12. ^^^ Nothing wrong with OP treatment of pyelo, if patient doesn't look bad, and is able to tolerate po (not vomiting). In such cases, I will document pros/cons of admit discussed with patient, and their understanding that OP tx is not always successful, so not necessarily an AMA. Another thing to keep in mind is, remember the difference between antibiotics that are bacteriostatic vs batericidal. If you are truly worried about a possible failed outpatient treatment, give a big dose of Rocephin, which theoretically gives you 24 hours of bactericidal coverage (and this is coming from a guy who hates ordering shots). I recall an older version of 5-minute ER Consult stating a rule of 2's for pyelo: 2 liters of fluid, 2 grams of Rocephin, and 2 Tylenol ES to get things rolling. Averting the progression to "really sick" is the goal. Finally, outpatient treatment for pyleo really should last for a full 14 days.
  13. I was wondering as well. Best I could come up with was "Offering Vaginal Inspection". Although not necessarily a misdemeanor, it could earn you a face slap, especially if proposed to a stranger at the mall.
  14. Curious as to whether or not the problem also occurs when auscultating abdomens. This might sound totally crazy but, try these few things: 1. Auscultate something that doesn't make noise, such as your thigh. 2. You listen while someone else holds the stethescope bell against their own or a patient's chest. 3. Have someone else listen while you hold the bell against yourself or a patient. Do you still hear the artifact sounds in the first two situations? Does the other listener hear artifact sounds in number 3?