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Teasip

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  1. Thanks for the confirmation RC. When first diagnosed back in the late 80's on peroneal bx., treatment recommendation for IBM (my acronym) were gc steroids, which she deferred on. Literature since then however has suggested that risks outweigh benefits (smart decision on her part looking back). I agree with the therapy idea once we can get past the initial pain of the acute injury. Home health through the ECF will have PT/OT return for follow up but obviously there is no PT at this point for the actual shoulder but more for the remaining extremities due to immobility (we/she can sit her up on side of bed to at least minimize tissue pressure points) and frankly not much need for OT since she can feed herself with her dominant arm/hand (silver lining at least). We could also stand her at bedside if we had a point of contact for support on the left side. It is a horrible disease state. She has now developed the dorsal deviation of her hand digits and MCP variations of the hands such as one sees with RA making grip strength minimal at best. It also impacts esophageal motility so a "big bite of burger or steak" is not practical. She leaks CK like a sieve, especially following falls or even manually trying to just stand her up from a car seat to an upright position due to muscle strain to her system (we don't even bother with this any longer). When you factor in neural hearing loss and macular degeneration it really minimizes the overall quality of life for her, but to her credit she doesn't complain. It's a shame that one can assist all those other folks over years of practice yet you cannot help those closest to you other than providing emotional/moral support, but that is life itself. At least I can help her navigate through the system and check things that others might miss out on (they never checked her nasal septum for hematoma though the ED physician said she "broke her nose" so I checked before her discharge). Having dodged the need to focus on billing and the inherent Medicare billing/payment restrictions over my career it is interesting to see now from the patient perspective just how messed up the system is ("she can't be seen by two doctors on the same day" even though common sense says she requires stretcher transportation so you're saving one round-trip by completing your consultations this way at one location with only one trip as opposed to two). She is just down the street (quarter mile) from my home here in N. Texas.
  2. Elderly mom fell at ECF Thursday and was found to have the familiar horizontal plane impacted proximal humeral fracture near the greater trochanter (I was able to see the digital image upon a polite request of the ED physician, but only briefly). Based on my recollection from 26+ years ago, though I have seen quite a few in the ED in subsequent years but only in the acute phase, the long-term care is basically to watch for evidence of potential AVN but otherwise let it heal with usage of a shoulder immobilizer. Am I recalling this correctly? Unfortunately the source for the fall is the more chronic concern due to a polymyalgia/MD disorder that predisposes to falls. Inability to rise from a seated position due to proximal muscle weakness in the UE/LE's is not fun, thus motorized chairs/scooters are not an option and obviously bed confinement is not an option until it becomes a last resort. Since ambulation is with walker assistance only, both arms need to be functional which obviously will restrict her mobility at this point for quite some time (x-ray evidence of osteoporosis). For those inquisitive folks, check out inclusion body myositis. As an aside, a long-term referral group that I have sent an unknown number of insured cases to for over a decade declined to see her as a result of a request for ortho/PM&R consultation (I suspect that they didn't want to deal with it since she would also warrant stretcher transport to/from office). Needless to say, no further referrals to that group (the request for appt. I was told went through the requested orthopedist's "team" (PA who I don't know and I suspect didn't confer with the orthopod). I never made mention of my position or history of referrals to the group. Now, I guess I'll go ortho first, ask during appt. if they feel a rehab hospital assignment would be beneficial, and then go forward from there. What she really needs is a motorized wheelchair with a powered seat lift like she has on her room recliner.
  3. This is not the case in the N. Texas area. Many job postings by health care networks/hospitals specify that they want MS level PA's. Short-sided from the perspective of disqualifying those who may have more experience by having graduated with a BS before the MS programs became the norm but it may be a credentialing standard from their perspective. CVS branded MinuteClinic's will only consider MS as well. For some of us, getting the MS doesn't make financial sense due to anticipated time left in practice and the inherent cost of the program. There is a local network that will accept BS PA's who wish to work part-time such as myself as I go back to school for my paramedic certification.
  4. I wish so many more of them would give us this opportunity. While I concur with it being the most rewarding aspect of the job personally, I find that SO many reject this opportunity. I correlate it to taking your car to the mechanic and they're telling you that you have a bad fuel injector based on the diagnostics and you in turn tell them to just change the battery. You took it to them for a reason yet you aren't listening to what they're telling you.
  5. Primadonna, my wife would love it if I had such clinical abilities each evening when she gets home from work (popping her back)! I do believe that there is something to what you said with the added benefit of physical assessment versus heading straight to imaging.
  6. I just received my PANRE scores from last week (forget the three week turnaround they report apparently) and I was just curious if others had an arbitrary figure that they look for in addition to pass/fail as far as their overall percentage correct, i.e.-70, 80, 90% such as with a traditional exam score? One can figure their actual test score by applying the percentage correct to the weighted value of the segmental exam and then add the cumulative percentages. Now that I anticipate being done with PANRE forevermore I continued to see overall score improvement from cycle to cycle, though I still hope you don't ask me about your psych or derm concerns, at least based on their questions asked.
  7. I think HIPPO was fine for those who have been out for quite a while and are maybe specialized as opposed to PC. If your familiar with EMA/PCMA you'll like the format. I do wish that they would include the outtakes as part of the price. I'm sure none of the comments are things that we haven't heard previously.
  8. Yes, regarding the CME. There is also an optional EKG course as part of the paid package. I purchased it on a Thursday and took the exam this past Wed. without looking at the EKG portion. Lot of info in a quick time window. Some info was almost verbatim off exam. Ortho and endo need to be paid attention to. I've always thought more attention needed to be paid to PE assessment on the PANRE, which it isn't in my opinion.
  9. Buy the HIPPO PANRE/PANCE review and Mattu covers the EKG material in it, plus there's an extra CME part for EKG's alone (didn't look at it before taking my exam this week, and still haven't for that matter). While the program was $495, it does provide more Cat I CME than most, it's a good overall review on just about any topic you can imagine, and did I mention that it knocks out your CME Cat I requirement?
  10. Rick, what's the answer following your posting the link? I'm assuming that one shouldn't apply? I can remember PA's creating positions for themselves years ago, when things weren't as disadvantageous as they are today apparently, for NP posted positions.
  11. Rick, what's the answer following your posting the link? I'm assuming that one shouldn't apply? I can remember PA's creating positions for themselves years ago, when things weren't as disadvantageous as they are today apparently, for NP posted positions.
  12. I was able to write post-op Sch. II narcotics in an HCA facility back in the mid-80's IF it were written as ...."per Dr. Such and Such". I don't understand the statement above about "have my name in any way associated with them". You can write all the orders that you want, they just may not get carried out. I also don't understand why prescriptive privileges have to be so convoluted. If you can order such a medication I would think that you should be able to administer it. Don't the two go hand in hand?
  13. I was able to write post-op Sch. II narcotics in an HCA facility back in the mid-80's IF it were written as ...."per Dr. Such and Such". I don't understand the statement above about "have my name in any way associated with them". You can write all the orders that you want, they just may not get carried out. I also don't understand why prescriptive privileges have to be so convoluted. If you can order such a medication I would think that you should be able to administer it. Don't the two go hand in hand?
  14. Modified response. In a nutshell, yes, I think quality of care from the perspective of one-on-one time and personal interaction has deteriorated.
  15. Modified response. In a nutshell, yes, I think quality of care from the perspective of one-on-one time and personal interaction has deteriorated.
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