Author Topic: Medical Professionals: Peer Review/introduction Thread  (Read 77865 times)

Offline BerserkerPrime

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Re: Medical Professionals: Peer Review/introduction Thread
« Reply #60 on: November 09, 2009, 09:35:06 PM »
Great first post AMS!  Welcome aboard!  I hate to ask you to do it twice but can you introduce yourself on the intro thread? 
http://thesurvivalpodcast.com/forum/index.php?topic=89.0

V/r BP

Offline Sister Wolf

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Re: Medical Professionals: Peer Review/introduction Thread
« Reply #61 on: November 10, 2009, 01:57:12 AM »
AMS, you coming to DT10?  Sounds like you'd fit right in.  Pretty much everybody there (at least the instructors and a good 70% of the attendees) are bushcrafters, wilderness first aid folks, etc, etc, etc.

Offline DrBob

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Re: Medical Professionals: Peer Review/introduction Thread
« Reply #62 on: November 10, 2009, 09:00:10 PM »
Altered Mental Status,

Glad to have you aboard!!!
DrBob

Offline Altered Mental Status

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Re: Medical Professionals: Peer Review/introduction Thread
« Reply #63 on: November 10, 2009, 09:01:03 PM »
AMS, you coming to DT10?  Sounds like you'd fit right in.  Pretty much everybody there (at least the instructors and a good 70% of the attendees) are bushcrafters, wilderness first aid folks, etc, etc, etc.

yep, will be 1st time and planning on trying to make it an annual event.... Maybe one day I can Instruct....

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Re: Medical Professionals: Peer Review/introduction Thread
« Reply #64 on: November 12, 2009, 07:57:59 AM »
Im late to the party....

ER doc, finished 4 years residency for same in June, since then working at a busy ER in gorgeous new mexico.

Actually went to med school with cptcaver and his wife; they are great folks and they inspire and motivate my prepping. cptcaver has the best and most tolerant wife ever. I cant decide who is sexier; cptcaver or his wife.

Before medical school was a paramedic, EMT, did some volunteer sar around the mid-atlantic area. Am currently reading for written boards and also going through the candidate member program with the volunteer Mountain Rescue team here.

A lot of people have been commenting on their H1N1 experiences - we are still seeing sporadic cases; a few weeks ago we were just getting killed with flu cases - the overwhelming majority being motrin fluids work note home players, but I did send one to ICU for ARDS, a few diabetics with bad DKA, and a dozen or so cases of post flu pneumonia.


Well, I will have to say this about the swine flu.  I think the media overhypes everything.  They have gone on and on about the swine flu and vaccine shortages.  However, what they are leaving out is all the people dying from it.  I work in SC, one of the 2 states that are listed as NOT widespread.  With that said, we have had over 8 patients admitted to the ICU in the last 2 months and out of the 7 that have been discharged so far, 6 of them have been discharged to Jesus.  The only one that has survived was on Xigris.  These people are some of the sickest patients I have ever seen.  They come in with fever, then within 24-48 hours they are in severe ARDS and on a vent.  Then, they all go into renal failure and die like rats within 4 days to a week.  I have never seen anything like it.  We have also had 4 (I think) kids die.  I think this stuff is a lot worse than the media is letting on.  They want to hype up shortages and flu centers and this and that, but maybe it's a good think they are not reporting on the deaths.  It's crazy here, I don't know about anywhere else, though.  One more thing....all the patients basically have no underlying disease, maybe some HTN or something.  They are either healthy, pregnant or obese and all have been b/n 25-55 years old....a complete reversal from what we are seeing with the seasonal flu.

Offline dudekrtr

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Re: Medical Professionals: Peer Review/introduction Thread
« Reply #65 on: November 12, 2009, 05:30:06 PM »
Looks like we're finally addressing some of the statin overuse: [By the way, we actually don't get very many cautions like this, although the bulletin does come out regularly]

Page 1 of 2
NATIONAL PBM BULLETIN
NOVEMBER 10, 2009
VETERANS HEALTH ADMINISTRATION (VHA) PHARMACY BENEFITS MANAGEMENT SERVICES (PBM),
MEDICAL ADVISORY PANEL (MAP), & CENTER FOR MEDICATION SAFETY (VA MEDSAFE)
SAFETY OF HIGH DOSE STATIN-FIBRATE COMBINATIONS
I. ISSUE
High dose HMG CoA Reductase Inhibitors (statins) combined with fibric acid derivatives have unclear benefit on clinical outcomes and may
cause harm through increased risk of muscle toxicity and rhabdomyolysis.
II. BACKGROUND
The clinical benefit of statin-fibrate combinations is not clear.1 However, the risk for muscle toxicity with combination therapy is greater than
that for either statins or fibrates alone.2 The Action to Control Cardiovascular Risk in Diabetes (ACCORD) study is investigating the effect of
the statin-fibrate combination versus a statin alone on cardiovascular outcomes. Results from ACCORD are expected in 2010.3 Until then, the
combination should be used with caution, and clinicians should consider that certain factors can also increase an individual’s risk for muscle
toxicity with the combination including further drug-drug interactions (see below under 3d, for examples) , advanced age, impaired renal
function, female gender, alcoholism and hypothyroidism. In general, high dose statins and fibrates should be avoided. Due to limited literature
and adverse event reporting, whether certain high-potency statins are safer when combined with a fibrate is unclear. 1 Moreover, there is as yet
little clinical evidence that one fibrate is safer than another when used with statins. 4
III. PROVIDER RECOMMENDATIONS1
1. Avoid routine use of statin-fibrate combinations because there is no evidence for additional cardiovascular event reduction with statinfibrate
combinations over statins alone; but there is evidence for an added risk of serious adverse events (e.g. rhabdomyolysis or severe
myalgia).
2. For patients already on a statin-fibrate combination:
a. If LDL-C lowering is paramount, discontinue the fibrate and use a statin as the primary agent, add other agents as necessary
(e.g., niacin, bile acid sequestrants) to reach goal.
b. If triglyceride lowering is the primary objective (e.g., with TG >500 mg/dL), discontinue the statin and continue the fibrate.
c. If LDL-C lowering and triglycerides require reduction, , discontinue the fibrate, titrate the statin as necessary (for LDL-C
lowering) and utilize niacin or fish oils, if at all possible.
d. Consider that there is little clinical evidence that one fibrate is safer than another when used in combination with a statin.
3. If combination therapy with a statin-fibrate is considered clinically necessary and benefits are deemed to outweigh the risks, then:
a. Use the lowest effective statin dose, regardless of the statin or fibrate used.
b. Adhere to statin dose limits in the product labeling (i.e., simvastatin 10 mg, lovastatin 20 mg or rosuvastatin 10 mg daily) in
combination with gemfibrozil. Atorvastatin does not list a maximum dose but the lowest effective dose of this agent should be
used when combined with a fibrate.
c. Only consider the combination if patients have normal renal (eGFR >60 ml/min), liver and thyroid function.
d. Use added caution in patients receiving other drugs known to inhibit statin metabolism (For example, serum concentrations of
simvastatin, lovastatin and atorvastatin are increased in the presence of macrolides, azole antifungals, protease inhibitors,
cyclosporine, amiodarone, verapamil, diltiazem, etc.).
e. Discuss the risks and benefits of combination therapy with patients and document the discussion in the patient’s medical record.
f. Warn the patient to report any new muscle pain, tenderness or weakness to their providers immediately.
4. When a statin-fibrate combination is used, the National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III5 and the
VA/DoD Dyslipidemia Guideline recommend a baseline creatine kinase (CK) level prior to initiating combination therapy. Measurement
of CK is repeated if the patient reports muscle symptoms resembling myopathy. Both groups also recommend discontinuing combination
therapy (both statin and fibrate) if CK is greater than 10 times the upper limit of normal with muscle symptoms (tenderness, pain or
weakness). Once symptoms resolve completely and CK has normalized, either drug can be restarted at a lower dose.
Page 2 of 2
IV. REFERENCES
1. STATIN-FIBRATE REPORT: Focus on Safety. Washington, DC: Pharmacy Benefits Management Services and theMedical Advisory
Panel, Veterans Health Administration, Department of Veterans Affairs. September 2004.
http://vaww.national.cmop.va.gov/PBM/Clinical%20Guidance/Clinical%20Recommendations/statin-fibrate%20safety%20report-
Final.doc (Accessed 9-30-09)
2. Shepherd J. Fibrates and Statins in the Treatment of Hyperlipidemia: An Appraisal of Their Safety and Efficacy. Eur Heart J 1995;
16:5-13.
3. http://clinicaltrials.gov/ct2/show/NCT00000620 (Accessed 9-30-09)
4. Jacobson TA. Myopathy with statin-fibrate combination therapy: clinical considerations. Nat Rev Endocrinol. 2009 Sep; 5 (9):507-18.
5. http://www.nhlbi.nih.gov/guidelines/cholesterol/atp3full.pdf (Accessed 9-30-09)
ACTIONS:
? Facility COS and Chief Nurse Executives: Forward this document to all appropriate providers who prescribe/use/handle this
agent (e.g., primary care providers cardiologists, lipidologists, and endocrinologists, including contract providers, etc.). In
addition, forward to the Associate Chief of Staff (ACOS) for Research and Development (R&D). Forward to other VA
employees as deemed appropriate.
? ACOS for R&D: Forward this document to Principal Investigators (PIs) who have authority to practice at the facility and to
your respective Institutional Review Board (IRB).

Offline Laiph

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Re: Medical Professionals: Peer Review/introduction Thread
« Reply #66 on: November 17, 2009, 08:55:14 AM »
Great thread - I'm a general surgeon & my husband is a PharmD.  I trained at Tulane in New Orleans & did trauma/critical care fellowship there. Washed up into the north part of Louisiana by the hurricane.  Look forward to getting to know ya'll. 

By the way, I might have officially become a conspiracy-tin foil hat type today.  During a government takeover of medicine we get the recommendation today to stop mammography screening in women under 50, change screening to q2yr in women under 60 & stop teaching women self-breast exam. Really????  Guess they need time to get the insurance companies on board to not pay for mammography before the final takeover.

Offline BerserkerPrime

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Re: Medical Professionals: Peer Review/introduction Thread
« Reply #67 on: November 17, 2009, 10:08:13 PM »
Welcome aboard Laiph!  Unfortunately I think that breast exam decision is just the first of many to come.  I watched my sister-in-law die of breast cancer 4 years ago and can't even imagine what the hell was behind this load of BS! 

Anyway, I look forward to your input and hope your enjoy your time here!

Berserker Prime

Offline dudekrtr

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Re: Medical Professionals: Peer Review/introduction Thread
« Reply #68 on: November 17, 2009, 10:25:42 PM »
By the way, I might have officially become a conspiracy-tin foil hat type today.  During a government takeover of medicine we get the recommendation today to stop mammography screening in women under 50, change screening to q2yr in women under 60 & stop teaching women self-breast exam. Really????  Guess they need time to get the insurance companies on board to not pay for mammography before the final takeover.

I saw that report. It adds up that they want to pay less for testing. But not teaching self examination?  ??? When my daughter was in a recent minor traffic accident, and had a nasty headache and neck pain later that evening, we felt she should get looked at, just in case. The ER MD, however, said they would not do a brain scan unless and/or until her symptoms got worse. I was OK with that, as long as we were establishing her as having seen someone for the injury early on, and could keep an eye on the situation. It was a bit of a departure from trying to cover all bases [and their butts] by testing extensively. Additionally, I knew that swelling in the brain can go on up to several days, and that we would watch her closely for that time period, so it made sense to me.

Now, at the VA, I have been working with meeting criteria for non-formulary drugs for quite some time, which those in the public sector are still getting used to using. Well, to me, this has been a system where we as providers know we have to be cost-conscious, [do we really need $500 worth of Plavix when a couple of dollars worth of aspirin will do the job for 80 or 90% of the patients?] but at least we have MDs and Pharmacists calling the shots. On the outside, when I have to call an insurance company for prior approval, who is it? I don't think it's some one who WANTS to provide the care, like we do; it's someone who will allow it, if they have to.

If you think back to the early 70s [sorry, I've been at this maybe a lot longer than many of you, but I do remember when people paid cash for rxs, and when birth control pills were $1.95 (!)], when Rx cards first became available, they seemed like a great idea (for the insurance company and the employer, for sure, and for the patient, who didn't know any better. ["Hey, I just pay a dollar and the insurance pays the rest!"]) Only thing is, they didn't pay all the rest, and, as time passed and the cards proliferated, [ask yourself if they proliferated because the insurance companies wanted to provide a convenience or because they were making a ton of money] they grew to control more and more of the market and thus, the profession, to the point where most independent Pharmacies are gone. (true: when the state government plan came into being, I saw my boss take the equivalent of my year's salary out of the bank to put into the business to keep it going while waiting to get paid by the state.) We even have insurance companies with there own mail order Pharmacies; it just seems so wrong.

Fast forward, and what has or will this kind of practice of the insurance companies mean to medical providers? Well, how about his scenario: You practice in an area with several dominant insurance plans, and, as a practitioner, you are pretty much obligated to accept them all. Only thing is, they are watching how you practice very closely. In fact, they have actuaries who will come up with the "magic numbers", and when the first of the year comes around and it's time to renew your contract with ABC insurance, you instead get a letter saying:

"we're sorry, Doctor Jones, but your: [checked item]
__a. prescriptions
__b. lab tests
__c. referrals to specialties,
cost more than "X"%  of all our other providers, [X being 97.2% or 98.7% or whatever number the actuaries come up with, you get the idea] therefore ABC Insurance will not be renewing your contract."

So, overnight, your patient count goes down, say (PFA) 30%. That's not too far off, and, where an insurance has a strong presence, where there may be only one or two large employers in a town, with one plan, could it not even be as much as 50 or 60%? Sounds like a SHTF for a provider to me.

Now, throw the government in to the mix. Feel like reaching for the Pepto Bismol yet?

Sorry to be a bit gloomy,  :( but I've just felt for several years now that the insurance problem for MDs will be much more rapid, and even explosive in a way, instead of taking so many years, like it did for Pharmacy. I guess we were the easy pickings or practice run for them, since we were dealing with a more definable "product", and therefore cost, on their way to conquering the rest of healthcare.

<<also apologies for brief hijack>>

Offline phargolf

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Re: Medical Professionals: Peer Review/introduction Thread
« Reply #69 on: November 18, 2009, 05:45:12 PM »
Hi, new to this forum but and old hand at prepping. I too am an old pharmacist (actually old enough to be called a druggist, ha). I have been practicing in rural arkansas for 33 years (have my own pharmacy). small town so my experiences have been varied-we have to act as emt, ambulance driver,physician, psychiatrist at one time or another,LOL!  This forum looks great, i have never seen so many health professionals on a survival forum (and it is no small comfort that maybe i am not as crazy for prepping as i thought i was!)Thanks

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Re: Medical Professionals: Peer Review/introduction Thread
« Reply #70 on: November 18, 2009, 06:50:55 PM »
Great thread - I'm a general surgeon & my husband is a PharmD.  I trained at Tulane in New Orleans & did trauma/critical care fellowship there. Washed up into the north part of Louisiana by the hurricane.  Look forward to getting to know ya'll. 

By the way, I might have officially become a conspiracy-tin foil hat type today.  During a government takeover of medicine we get the recommendation today to stop mammography screening in women under 50, change screening to q2yr in women under 60 & stop teaching women self-breast exam. Really????  Guess they need time to get the insurance companies on board to not pay for mammography before the final takeover.


Well, I don't think that is tin-foil hat stuff, but if it is, I put mine on too.  This is one of the first of many things to come where the gov't is "rationing" care.  Why would they come out with some stupid recommendation like that on a test that detects the 2nd largest killer of women in the US?  So what if there are a bunch of "nodules, lumps, whatever" found and they are all biopsied and only 1 out of 12 turn out to be cancer....I don't think that's overtreating.  I would gladly have a breast lump (if I were a female) biopsied for my peace of mind.  And now, the people from Harvard, who no doubt voted for Obama, are concerned and acting shocked that the gov't would do this.  All I can say is they are getting what they voted for.

Offline Laiph

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Re: Medical Professionals: Peer Review/introduction Thread
« Reply #71 on: November 19, 2009, 07:21:26 AM »
dudekrtr - my husband sat on the state medicaid formulary committee for several years - very educational experience for me.  I have to say I was surprised to some degree by the magnitude of dollars saved by selecting one drug in a class over another.  In Louisiana, if I want to prescribe a med off formulary when I call the medicaid # I speak with a pharmacist so it's not too bad an experience.   But as a surgeon I don't need to do that much.  Pretty much just prescribe narcotics and antibiotics - so maybe it's more challenging for other specialties.

It seems the various medical societies (eg Amer Soc of Breast Surgeons) are being aggressive about denouncing the mammography recs. 

Offline swoods

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Re: Medical Professionals: Peer Review/introduction Thread
« Reply #72 on: November 19, 2009, 07:41:00 AM »
I too saw that in the paper the other day. I am a breast cancer survivor, diagnosed at 40 just before I went for my baseline mammo, tumor was very large and had been there for at least three years according to the dr. If I had waited til 50 I would be dead.

I wonder if the American Cancer Society is going to jump in the fray............I cannot see them sitting by not rebuking the govn't "findings."

All of this is very frightening. Do you suppose the folks who are saying this will get their mammos at 40 or will they wait til they are 50. And do you suppose the ACS will stop printing the self exam shower cards or say they have been wrong all these years and gosh, sure, just wait til you are 50? 

As it was I had to fight with my insurance carrier about mammograms and where I wanted to go as opposed to where they wanted me to go. They actually told me they had my best interest in mind when they were telling me to go where they wanted me to go!

My daughter is a rad tech and I value her opinion of where not to go, so I went where I wanted to go and asked my oncologist to send a letter indicating he preferred this particular place, the films were better/more accurate. The insurance did pay, but why the heck did I have to go through all of that for insurance coverage that I PAY FOR.

Sorry, this post probably doesn't belong here, I will stop now.

Offline BerserkerPrime

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Re: Medical Professionals: Peer Review/introduction Thread
« Reply #73 on: November 19, 2009, 08:12:36 AM »
Good call SWoods.  This cancer discussion is huge and has a place on the forum.  Feel free to start its own thread if you all feel more discussion is wanted.  We'll keep this one for intros/peer reviews. 

Thank you all for jumping in and laying it out there and hope you keep it up!

V/r Berserker Prime

Offline phargolf

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Re: Medical Professionals: Peer Review/introduction Thread
« Reply #74 on: November 19, 2009, 05:28:50 PM »
Cave Dweller,
I like the thread idea, but i don't know how many of us will speak up.  I rarely admit to being a physician online because of the concerns of liability in our society.  However, i'll jump in and see how many others will as well (Doc K and scrubs obviously have already admitted their careers).
School: University of Illinois
Experience: Rural practice for several years.
Specialty: Family Practice.

And i agree, pharmacists would be worthwhile as well...they have saved my bacon on more than one occasion.  ;)
I think one point that is missing is the drug store owner- owns drugs! No one can afford to stockpile a lot of medications or in bulk because of expiration dates (i know they last longer than what is on the bottle but they will eventually expire). If you have a retreat group it might behoove each group to get a pharmacist to join, then raid the drug store at the last minute if possible. I think it would be nice for all concerned if you had bottles of 1000 antibiotics on hand, bottles of 1000 BP meds, etc. Not trying to hijack this thread, i would consider it an honor to go into greater detail if anyone desires it. thanks
« Last Edit: May 01, 2013, 12:54:21 AM by Archer »

Offline dudekrtr

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Re: Medical Professionals: Peer Review/introduction Thread
« Reply #75 on: November 19, 2009, 06:07:14 PM »
He may "own" them, but they all carry a federal warning not to dispense without the order of a prescribe, so I would include an MD in your group, too. Plus, you would have to compensate him, which I'm sure could be worked out. The big problem is that most Pharmacies are now chain stores. The "owner" is nowhere to be found.

Again, we drift from introduction. There must be another thread for post SHTF medical care.

Offline phargolf

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Re: Medical Professionals: Peer Review/introduction Thread
« Reply #76 on: November 19, 2009, 07:10:51 PM »
I really apologize, did not want to hijack original thread. (I would love it if someone would start a new thread) :-[

Offline BerserkerPrime

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Re: Medical Professionals: Peer Review/introduction Thread
« Reply #77 on: November 19, 2009, 07:34:11 PM »
He may "own" them, but they all carry a federal warning not to dispense without the order of a prescribe, so I would include an MD in your group, too. Plus, you would have to compensate him, which I'm sure could be worked out. The big problem is that most Pharmacies are now chain stores. The "owner" is nowhere to be found.

Again, we drift from introduction. There must be another thread for post SHTF medical care.

Start it Dudekrtr ;D!  Good subject to discuss!

BP

Offline Cave Dweller

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Re: Medical Professionals: Peer Review/introduction Thread
« Reply #78 on: November 20, 2009, 12:07:12 AM »
Veterinarians store drugs too, but aren't bound by the same federal regs.

Offline antsyaunt

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Re: Medical Professionals: Peer Review/introduction Thread
« Reply #79 on: December 13, 2009, 05:33:50 PM »
Another physical therapist here...I have a doctorate in P.T. from Upstate Medical University.  I was an EMT for a rural volunteer ambulance service about 20 years ago. 

Offline BerserkerPrime

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Re: Medical Professionals: Peer Review/introduction Thread
« Reply #80 on: December 13, 2009, 08:12:12 PM »
Welcome Alpha Chicken!  Tons of experience here. 

BP

Offline Sapper22

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Re: Medical Professionals: Peer Review/introduction Thread
« Reply #81 on: December 18, 2009, 11:52:51 AM »
Good Day all.  My name is Brandon and I am a CCTEMT-P here in Florida.  Served a few years in the Army as a SOCM and am currently working through the Paramedic to RN bridge program.  There appears to be a wealth of information and experience here on the forum.  I have never seen so many medically trained members (especially all you active MD's!).  I look forward to learning a lot and hopefully contributing were I can.  Been into prepping for about 6 years now, but really kicked it into gear this last 2 or so (wife finally got on board and she is more serious about it than I now!). 
Brandon

Offline BerserkerPrime

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Re: Medical Professionals: Peer Review/introduction Thread
« Reply #82 on: December 18, 2009, 08:03:33 PM »
Glad to have you on board Sapper!

Offline phargolf

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Re: Medical Professionals: Peer Review/introduction Thread
« Reply #83 on: December 19, 2009, 12:30:19 PM »
Welcome Sapper! Great board and lots of nice folks. 8)

Offline No Prob Rob

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Re: Medical Professionals: Peer Review/introduction Thread
« Reply #84 on: January 10, 2010, 07:37:30 PM »
Hey everyone,

Old time prepper for many years. Went to West Texas A&M and received a bachelor of science degree in nursing. As an RN I have spent the last two years after graduation in the ER here in Amarillo Texas. Switched careers at age 48 so somewhat new to nursing but loving what I do so far.

In my former life I was a diesel mechanic, welder, shop foreman, transportation manager. Worked my way through nursing school doing building maintenance, plumbing, carpentry, a/c and heating, electrical, painting, roofing, etc. Growing up I worked on a bee farm for six years as a kid right up until I went to a trade school to become a diesel mechanic. 

I have been on other survival forums but this one feels like home with people of like mind and interests. Plus enough traffic to keep it interesting. I really like the mission statement and what Jack has created. I hope to be here a loooong time.

NPR

Offline BerserkerPrime

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Re: Medical Professionals: Peer Review/introduction Thread
« Reply #85 on: January 10, 2010, 09:45:21 PM »
Welcome No Prob Rob!  It the SHTF, I humbly request that you and your stay at my compound!  I wish I had all those skills!

BP

Offline Tosser

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Re: Medical Professionals: Peer Review/introduction Thread
« Reply #86 on: January 10, 2010, 11:17:13 PM »
I started out as medic (68w) in a line unit in the National Guard then off to street EMS.  Got my BA in nothing medically oriented and now working on applications for nursing school.   I am an AHA instructor for multiple things.  It is nice to see a wide range of people with varying levels of medical expertise on the board.

Offline Tosser

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Re: Medical Professionals: Peer Review/introduction Thread
« Reply #87 on: January 10, 2010, 11:24:18 PM »
I started out as medic (68w) in a line unit in the National Guard then off to street EMS.  Got my BA in nothing medically oriented and now working on applications for nursing school.   I am an AHA instructor for multiple things.  It is nice to see a wide range of people with varying levels of medical expertise on the board.

Forgot to add on a large incident response team through the state.  I also did structrual fire fighting and rescue for a while.  Now I just ride the ambulance out of choice.

Offline Sapper22

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Re: Medical Professionals: Peer Review/introduction Thread
« Reply #88 on: January 13, 2010, 07:03:08 AM »
Welcome Tosser!  There is a ton of knowledge here from all levels of providers! 

Offline phargolf

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Re: Medical Professionals: Peer Review/introduction Thread
« Reply #89 on: January 13, 2010, 07:37:46 PM »
Welcome Tosser! Lots of health professionals and related fields here (more than i have ever seen on other forums)! ;)