[NPInfo] Now this is why housecalls are a good idea :)

Mon Nov 5 10:46:56 PST 2007

Christine,

  You made me laugh and want to moan with you at the same time!  Geez that must have been scary. And your daughters boyfriend of all people!  Wouldnt you know whenever you try to do a favor for someone... Back Bedroom Surgery has a nice ring to it though! Sounds like a sitcom! Carla 

Christine Smith <chrisbsmith at mindspring.com> wrote:
  I once did a toe nail resection on my daughter's boyfriend in my bedroom. It
was only the second toe I had ever done and he was hard as hell to get numb
despite what I thought was an excellent digital block. Plus, he was a wimp.
The whole time my kids were at my bedroom door "are you almost done yet"
making me nervous. 

That night he called me at 2am in agony. He was crying so hard, I thought
the damn toe must be necrotic and got worried I may have accidentally use
Lido with epi instead of plain lido. I could not sleep the rest of the night
thinking I was for sure going to lose my license, what with practicing back
bedroom surgery and all. Needless to say, he and his toe survived. I gave up
back bedroom surgeries though.

-----Original Message-----
From: npinfo-bounces at nurse.net [mailto:npinfo-bounces at nurse.net] On Behalf
Of Dena
Sent: Monday, November 05, 2007 6:53 AM
To: 'NP Info'
Subject: RE: [NPInfo] Now this is why housecalls are a good idea :)

I once did a PAP in my home on a fellow NP who had no insurance. I
"appropriated" all the needed equipment and supplies from my office, set up
the bed in my guest room, and even supplied my "patient" with a glass of
wine (oh, and one for the provider as well ). She remarked that it was
the best GYN exam she'd ever had...

I visited my best friend in Houston one time and she, her husband, and I
took turns freezing off "spots" on each other. 

Botox parties are just the tip of the iceberg... you can do a lot of
procedures outside the office setting and make it more fun and profitable.
The legal issues may be another story.........
Dena Galler

-----Original Message-----
From: npinfo-bounces at nurse.net [mailto:npinfo-bounces at nurse.net] On Behalf
Of Carla Anderson
Sent: Monday, November 05, 2007 3:29 AM
To: NP Info
Subject: RE: [NPInfo] Now this is why housecalls are a good idea :)

Hi Priscilla,

I have a pretty good medical bag, with pulse ox, (her pulse ox was 97%) no
rigors, fever below 100, age below 50, non smoker. No co morbid factors.
But definitely lower lobe, not bronchitis. I have Rochephin, etc. Did not
want to give away too much detail, for confidentiality reasons. And yes, I
do use the algorhythm guidelines in terms of co morbidities, age, etc, as to
when a patient should be treated as an inpatient vs outpatient etc,
antibiotic choices. And will check on her today. But thanks for putting it
out there in case others do not consider all the details or I forget
something. I also have seen MRSA in my office, although I did not know until
I did the culture which the patient did not want. I have seen two cases in
one month. I called CDC as I think they should be tracking more agressively
CAMRSA, and they said they are only tracking disseminated MRSA in the blood
or csf, which seems like others could be slipping through the cracks.

Hey, have you heard of those botox parties? Well I don't know about pap
parties, although it has a nice ring to it, ha ha , but I dont know about
the room arrangements , and it would not be a co ed party! Carla

Priscilla Merrill 
wrote:
This is great Carla. The only thing I thought I'd mention is to recommend
you check out the new guidelines on CAP to CYA. You didn't mention how high
her temp was, her age, how high her pulse, rigors, etc. was but the latest
guidelines say a macrolide isn't enough for more complicated pneumonias. 
They give a score and certain levels warrant hospitalization BUT we all know
this isn't always great either. 
Do you have rocephin to give in case she's not improved? A pulseox? My
past partner that did housecalls had everything in her bag of tricks. I'm
sure you'll be doing a f/u today to gauge response to initial treatment. 
I think house calls are a terrific idea and could really decrease exposure
to MRSA.
So next, instead of Tupperware, you could do in-home pap parties! ; )
Group visits are another way to make some decent money and provide great
networking services. The sky's the limit.
Thanks for sharing,

Priscilla

-----Original Message-----
From: npinfo-bounces at nurse.net [mailto:npinfo-bounces at nurse.net] On Behalf
Of Carla Anderson
Sent: Monday, November 05, 2007 5:51 AM
To: npinfo at nurse.net
Subject: [NPInfo] Now this is why housecalls are a good idea :)

I have a few people that I now do regular housecalls for in addition to
growing my new office practice. Saturday night I get a call, from a patient
that she thinks her mom has pneumonia but she "won't go to a doctor" because
she is afraid her job will fire her if she misses a day of work, and she is
too sick to want to go anywhere. I go to her house. Based on my assessment
her mother definitely has a serious lower respiratory infection, with fever,
rales, fatigue, and chest congestion. I give her a list of home
instructions, and call in the rx to the pharmacy which the daughter picks up
the same evening. The next night Sunday at 9pm, the daughter calls, saying
she herself is getting sick, and she thinks it is strep throat. She has had
many many cases of strep, and recently I referred her to ENT to have her
tonsils removed, which they were two months ago. I pick up my supplies
including my rapid strep kit, and go on over to the house. Often this
patient has had strep
throat but it was negative on the rapid strep, and positive when sent to
the lab. And I was a bit skeptical as she just had her tonsils out. But lo
and behold this time the rapid strep turned out positive right away. I was
in and out of her house in 20 minutes, and she was taken care of, all while
she was in her pjs. Now she and her mother did not have to drive, they did
not wait in a waiting room, and they did not expose others to their illness.
I feel that housecalls are useful for the elderly with mobility issues,
anyone with transportation issues or who do not drive, and those families
that have young children that would have to all go to the provider office,
when only one is ill, because they cannot be left alone. But housecalls are
also great just for those that "feel too sick to go to the clinic" and can
just be seen in the comfort of their own homes. Earlier today I saw
everyone in my cul d sac giving out flu shots in their homes,..great way to
get to know the
neighbors. My business is still not super busy, (it is 4 mos old) but
this is why I wanted my practice in my own town, to be part of the
community, and to treat people the way I want to be treated. 

It is not easy being out on your own, but I would encourage anyone who
thinks they can do it, even part time to give it a try, because no one gives
good old fashioned home care or even shots like a nurse..
Regards, Carla 

Carla R. Anderson, FNP-C
Healing Presence Family Practice, PC 
carla_rayne at yahoo.com
503 819 9726
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Carla R. Anderson, FNP-C
Healing Presence Family Practice, PC 
carla_rayne at yahoo.com
503 819 9726
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_______________________________________________
NPInfo mailing list
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*****************************

Carla R. Anderson, FNP-C
  Healing Presence Family Practice, PC  
  carla_rayne at yahoo.com
  503 819 9726