BlocDoc

I certainly could not attest to your first observation but I CAN to the second!

Topomax exerts clinical effects consistent with a group of drugs known as central membrane stabilizers. While an off-label use (very legal!) they are helpful in the treatment of neuropathic pain, manifested as pain arising from central pain sensitization- Other drugs include Amitriptyline, gabapentin, tegretol and most recently, pregabalin. read:http://www.wellcome.ac.uk/en/pain/mi.../science4.html Hope this will help!

OOH, boy- two controversial questions! Ok, "how many" has been and continues to be a topic of some debate- Many talk about 3 shots and you're out--However, the number is not the key-Bottom line- it is really patient specific, ie- depends upon the dosage of steroid per injection and over what period of time- Let's take methylprednisolone for example: - dosages per injection can vary from 40mg to 120mg -3 injections at 40 mg= 120mg total -3 injections at 120mg= 360mg -- see the point? Steroids mimic the action of Cortisol- Cortisol production is controlled by adrenocorticotropic hormone (ACTH), which is released from the pituitary gland at the base of the brain. The pituitary responds to a range of signals to release ACTH which, in turn, stimulates cortisol release by the adrenals. Too much steroid over time?-The following effects usually come about over time, and are related to the dose and duration of treatment. More rarely, side-effects occur as a result of abnormal secretion of ACTH by the pituitary gland. The effects of too much cortisol include: -weight gain in the face, chest and abdomen with weight loss in the legs and arms (Jerry Lewis) -muscle weakness -avascular necrosis of the large weight bearing joints -thinning of the skin with increased bruising and poor wound healing -diabetes -high blood pressure -immune suppression with increased infections -osteoporosis The key then, as it is with anything is proper patient selection, use the least dose possible, and allow time in between series of steroid use. -BTW- also consider any oral steroid use and any injections elswhere in the body (knee, shoulder, etc) when considering peridural steroids In terms of benefit, corticosteroids have the greatest anti-inflammatory effect available but that is the key- They only work if there is inflammation- ESI's work as well for spine related pain as do joint injections of the knees, shoulders, hips, etc- Many times it is miraculous and in other conditions, it does not help at all I have many patients who receive up to 3 injections (4 in rare cases) in a 10-12 month period and others who require 1 injection every 3 months- In many other cases, patients can go for years with relief- Again, one must use careful patient selection. Regardless of the area of medical treatment, one must treat the individual- This is the means by which we apply the science to the art- Keep in mind- such treatment is NOT typically curative in degenerative states but rather a treatment and control of a disease process for which there is no good "fix".

Like Diabetes, HTN, Throid disease, CAD, Hypercholesterolemia, etc, chronic pain is a disease- In terms of the treatment ramifications, there is no "fix" for the disease, therefore, varied treatments, to include medications, are used to manage the disease prgression, to minimize symptoms and optimize quality of life- If the B/p doesn't respond to the current medication dose, then we raise it and add other meds until the number falls into line- If the blood sugar is too high, we adjust dietary restrictions, increase the oral meds or increase the insulin dosage- In thyroid we go up to .5, .75, .88, 1.0 and in some case, above 1.5 ! Nobody gaives this a second thought - This is perfectly fine from a societal standpoint- You don't find 2 healthcare workers in the hall or 2 people on the street whispering "Do you believe the dose of Cardizem Mrs. Johnson is taking!? She looks fine to me!" The perception regarding the treatment od chronic pain isn't a patient perceptual problem. It is one of misguided societal mores. If you believe that a patient has pain, then it deserves the very same aggressive treatment consideration their blood pressure requires. We are in the business of caring for people- Lets keep our eye on the ball.

I would certainly wait for aspentree13's response but I would venture this. I don't know what that particular college is actually offering- The sticking point was whether or not it was a true Physician Assistant program as that would make a HUGE difference in "real life" - You may be aware that in many physician's offices, a medical or nursing assistant can be referred to as the "Doctor's Assistant" or even the "Physician's Assistant" which of course is an important, but nonetheless, tech level position. As a corollary there are some RN's who have an issue with the fact that whether you were a CNA, an LPN, an RN or a BSN, they were all called a "Nurse". I am not here to try to stir that pot but rather draw some distinction between educational levels pooled together under the same nomenclature. I hope you would agree that it CAN make things a little sticky. I think that aspentree13 was speaking about something along this line but I could be wrong! Having said that, we will await the reply!

Sorry so long to respond- Life calls! I was an ADN when I went into PA school- (10 years experience) I had many certifications but just the ADN. I received a BS in Physician Assistant Studies and there was no Masters program (1994) for a few years yet. I hope all of you will find this information helpful direct from the AAPA web site- http://www.aapa.org/glance.html This information is with respect to existing PA programs, entrance requirements and other important information. PA's do NOT make more than NP's as a rule. What we make is simply the result of scope of priviliges, geographic demand, competence and what the practice is willing to pay- I think you will find that an NP would be paid based upon these same criteria. As such a PA can't make more just because they are a PA. It is ALL about what you can bring to the table and the degree will simply get you through the door. In short, it is not what you ARE but what you DO (ability to generate revenue) that will ultimately determine your rate of pay. Knowledge exists without repect to what letters are after your name.

Hello- I worked first as a nursing assistant for 2 summers in high school. I worked as a unit secretary in a hospital in Philadelphia while I went through nursing school. The two gave me great comfort in the hospital setting as well as just being comfortable with people- I say go for it!

Not to avoid your question, but let me ask another: What is the "standard" background for an MD, a DO, a lawyer, a banker, a school teacher, or an RN- The fact that advanced practice nursing programs require that you first be an RN, does not preclude that what I will call "alternative life experiences" cannot adequately prepare an individual for a career in a particular field- These programs are designed to provide the necessary education and clinical skills to enter the work force. And just so there is no misinterpreting the answer to my question, the answer is that there is no standardization, as I think you might agree. I will tell you the fact that I worked as a nursing assistant and then a unit secretary gave me a clear familiarity and ease into my nursing education. However, I went to nursing school with people who did everything BUT interact with the medical field and yet became very competent and productive nurses. My hope is that I have provided an answer to your question and we leave the "can" alone;)

I hate to make a generalization here but for me, I had so many interests that I never stayed put in a particular area for more than a year or 2- I jumped around from specialty to specialty- Phenomenal for a resume in terms of breadth of experience, but clearly not good in terms of demonstrating staying power. I had this tendency LONG before I became a PA- As a nurse I worked in most every inpatient and outpatient arena, from the military to the private sector. Fortunately for me, the good lord let my lead out a bit and let me discover my true love on my own (or so I would like to think). I am proud to say that I have "stayed put" now for 12 years in the pain arena and showing no signs of moving on! I have only had three jobs as a PA. Thanks for the question!

Thanks for the welcome. Anything I tell you will be just one opinion and it would not be anything factual, just opinion. However, I might refer you to a thread over on the PA forum where such discussion goes on endlessly as one might expect. http://www.physicianassistant.net/forums/showthread.php?t=6369&highlight=prior+experience No one knows the minds of college admission committees and I have spoken to very well experienced individuals who have been passed by college selection boards. I think this sort of thing is possible in any area of education. Sometimes you "have the goods" but don't interview well. Worse, you would interview well, if it were not for the "Hello is this microphone on?" blank looks you get from interview teams. Ultimately, if one feels called to move on from the field of nursing, the education and the role makes you an excellent candidate for any medical discipline (IMHO) and represents a perspective of patient interaction that is not ingrained in any other discipline. Therefore, I feel that the 2 year RN is the best core knowledge program of study going, yet still facilitates progression into other areas of study.

I think your heart is in the right place with your post but I don't know that I agree with some of your perceptions. As a PA, the only "observation" that takes place is (granted) that my charts are co-signed. In that sense you are correct- However, that co-signature typically occurs days to weeks later. Please know that, however, that as I have my own medicare u-pin number and my care ia accepted by 70% of third party carriers, I bill direct and those notes require NO co-signature. In this case, the only observation that occurs is my physician partners seeing the revenue that I generate. Second, after 25 years in medicine, I know of no one (reasonably intuitive and humble) that doesn't bounce things off of sombody though such "bouncing" is not required of a PA, at least in Pennsylvania where I have worked for the last 12 years. From a medicolegal perspective, it is actually a good idea to discuss more complicated cases as this offers a venue to consider another perspective that one might have overlooked, or to receive validation that one is thinking reasonably. As to you perception that only NP's are (legalities aside) able to practice independently, with self-motivation and confident in their skills; well, you are certainly entitled to your opinion. Please know that I disagree as to the generality of this assertion. The biggest problem with the written word is that one cannot hear the vocal tone, where the pauses in speech occur, nor the body language that is important to avoid misunderstanding what someone is writing (or in this case typing!) Therefore it is possible that I am mis-reading you entirely. I became a PA for one reason: I wanted to preserve the total sub-specialty preparedness of my RN training that would later allow me to work in nearly every area of nursing, and train within that same construct as a medical provider. That decision has served me well. I went from internal med, to surgery to pain intervention and I am not aware of a NP track that would have given me this flexibility back in 1991. Maybe it is a "guy" thing, but I didn't know what area I wanted to work within so the PA model fit me. I think all of the posts here are well considered and I am pleased to see it. I think that the poser would do well to consider all of them. Respectfully- Matthew , RN, PA-c,MS.,D.Sc. Acute and Chronic Pain Intervention

As a teenager, I started as an orderly, putting nursing home residents on the commode- I did this ALL day long. A few years later I became a unit clerk ( a white male in a South Philly hospital with all black female UC's-think that won't humble you?) while going to nursing school. I went on to work for years in the hospital system- Was a USAF flight nurse, did ICU/CCU and open heart-Moved to Level one trauma and then to PA school (couldn't pass organic chem to save my life but I wanted to do more) I chose PA school because it preserved my ability to "move around" which, clinically, is something that I had demonstrated a propensity to do. I never wanted med school because I didn't think I had the drive for the long haul program and bills- My wife was a professional (non-medical) and had her own career aspirations- Plus I had a kid and a mortgage- Nursing allowed me to work 24/40 weekends for the 3 years I did the PA thing. I have been a PA for 11 years- I have a great job. I work with NP's on occasion- I know several in fact- After the first year or so, I find that things play out and the two are (in my opinion) indistinguishable in a given clinical area. I don't mind the supervision requirement. Whether we believe it or not, there is always someone supervising all of us. I find the NP/PA relationship to be analogous to the MD/DO relationship- Trained under different philosophies- Boarded and legislated in some ways the same and in others, differently. But in the end, both are much needed commodities. Say what you will to each other. But in the end consider yourselves blessed to be working and serving. On any given day, I am still the guy putting residents on the commode- Because it needs to be done... Matthew R. Miller, RN, CEN, FN, PA-c, DSc. FRCSc Director-Pain Management Division Penn Surgery Institute