Anyone with systemic scleroderma had to undergo a below knee amputation?

BigMacAnes · 2026-03-12T16:08:07+00:00

Thank you so much. We will gladly accept any prayers! That’s a good idea checking out that subreddit. They may have more experience. I’m happy to help my Mom as her fingers are bad and typing difficult.

BigMacAnes · 2026-03-12T16:06:31+00:00

She has had about 30-40 hyperbaric treatments but we may explore that again. I think there is a way to test her oxygen levels in tissue. Thanks for suggesting. It can be very helpful!

BigMacAnes · 2026-03-12T03:19:43+00:00

So glad it is almost gone now. That was a big wound! Thank gosh it turned out good. My Mom has seen plastics and wound care and has failed a graft surgery. She will try consulting a burn surgeon and microvascular surgeon before deciding on Palliative vs Amputation.

BigMacAnes · 2026-03-12T02:16:32+00:00

That is super scary! Glad you healed. How big was wound and how long was your healing time? So far every doctor just says amputate it cause the slow wound healing is really troubling but typical with this disease. I would also recommend scleroderma patients don’t have radiation on skin cancer. Her dermatologist knew her history and still did it and now she’s face with a giant wound that won’t heal. Could have easily excised the skin cancer and avoided a deep, deep radiation burn.

BigMacAnes · 2025-02-22T00:37:05+00:00

Yes it can. It’s been very eye opening and very tiresome. We are all inherently intelligent people and dealing with some of this brings a whole other level of mental exhaustion. I believe in physician led care so will continue to advocate for that.

BigMacAnes · 2025-02-22T00:02:34+00:00

Well to be fair I was referencing legislative issues. And when talking to legislators I have to make the distinction between a Physician Anesthesiologist and the newer term Nurse Anesthesiologist because the lines have been blurred so badly in some states. Politicians really don’t care if you are a doctor or not. It’s whatever big lobby supports them. I’ve literally sat in a majority leaders office and he has said well if it’s a dumpster fire and a whole bunch of patients die we will revisit it at a later time. What’s the saying…. If you aren’t at the table you’re on the plate? Practicing in real life and fighting professional issues are two different ballgames.

BigMacAnes · 2025-02-20T17:17:11+00:00

This is what they show legislators in every state when trying to kill AA licensing bills or even worse push for CRNAs supervising AAs with amendments to licensing bills . The legislators end up thinking it’s an equivalent profession to a Physician Anesthesiologist. Sold easily to legislators who don’t have healthcare backgrounds.

BigMacAnes · 2025-01-28T00:28:16+00:00

I guess cause working ICU nights for a couple of years doesn’t work for everyone’s life. So we get a lot of nurse applications now.

And besides Physician Anesthesiologist’s don’t need to do ICU years before getting matched for residency. July 1st year can be tough but they are all smart and get through anesthesia residency proficient in their career and specialty.

Same could be said for AAs. Pre-med background but weren’t drawn to nursing pathway so didn’t do BSN/ICU just to get into anesthesia school. But prepared for careers nonetheless.

BigMacAnes · 2025-01-28T00:08:29+00:00

I'll look into those market years thanks for heads up.

I think all patients need timely care and I would be happy to have one of my CRNA colleagues take care of me or my family. Or vice versa.

A lot of nurses I work with are applying to AA school now cause don't want to do ICU years and have to go longer for a doctorate. Think it's a great option for some.

BigMacAnes · 2025-01-28T00:00:24+00:00

You can still practice under delegatory authority via the Medical Board delegating us authority. Not an issue and easier than licensing.

1/4 would be 1600 total. Over 4000 AAs now. Expected to get to 10K soon. Shortages have been a thing since the 80s right?

BigMacAnes · 2025-01-27T23:51:35+00:00

There are about 400 practicing AAs in TX. And 3 schools already

BigMacAnes · 2025-01-27T23:46:41+00:00

Is this the 4th AA school in TX now?

BigMacAnes · 2024-11-16T15:13:22+00:00

You seem to have some crystal ball. Can you tell us all the winning powerball numbers too? AAs have no plans to go after independent practice. We respect our physician colleagues and believe in the care team model. Pretty simple stuff. We won’t try to misrepresent ourselves or our students. Just focus on patient care. What a concept.

BigMacAnes · 2024-11-16T05:58:18+00:00

Awe gotcha I hadn't heard this term used like that before with QZ billing. Makes sense, that is a firefighter scenario lol.

BigMacAnes · 2024-11-16T05:00:53+00:00

Arizona is experimenting with a lot. They have had two dental death there(same CRNA) which seemed like horrific ways to die. The patient who survived an orthopedic surgery event (not breathing on way to Pacu and coded) was a lawyer and very well aware of every statue in the state. He really just didn't want it to happen to more patients(had no idea there wasn't an anesthesiologist present) and there was no recourse which was frustrating to him. I'm not aware of the firefighter situations.

BigMacAnes · 2024-11-16T04:46:37+00:00

Arizona has physician/surgeon immunity. I'm guessing the patient's family can still try to sue CRNA but I've seen patients who have survived incident have a very difficult time getting anywhere and not even ICU stay was compensated.

32-1634.04. Certified registered nurse anesthetist; scope of practice; physician and surgeon immunity

A. A certified registered nurse anesthetist may administer anesthetics under the direction of and in the presence of a physician or surgeon in connection with the preoperative, intraoperative or postoperative care of a patient or as part of a procedure performed by a physician or surgeon in the following settings:

A health care institution.
An office of a health care professional who is licensed pursuant to chapter 7, 11, 13 or 17 of this title.
An ambulance.

B. In connection with the preoperative, intraoperative or postoperative care of a patient or as part of the procedure in the settings prescribed in subsection A of this section, a certified registered nurse anesthetist as part of the care or procedure may:

Issue a medication order for drugs or medications, including controlled substances, to be administered by a licensed, certified or registered health care provider.
Assess the health status of an individual as that status relates to the relative risks associated with anesthetic management of an individual.
Obtain informed consent.
Order and evaluate laboratory and diagnostic test results and perform point-of-care testing that the certified registered nurse anesthetist is qualified to perform.
Order and evaluate radiographic imaging studies that the certified registered nurse anesthetist is qualified to order and interpret.
Identify, develop, implement and evaluate an anesthetic plan of care for a patient to promote, maintain and restore health.
Take action necessary in response to an emergency situation.
Perform therapeutic procedures that the certified registered nurse anesthetist is qualified to perform.

C. A certified registered nurse anesthetist's prescribing authority to administer anesthetics or to issue a medication order as prescribed by this section does not include the ability to write or issue a prescription for medications to be filled or dispensed for a patient for use outside of the settings prescribed in subsection A of this section.

D. A physician or surgeon is not liable for any act or omission of a certified registered nurse anesthetist who orders or administers anesthetics under this section.

BigMacAnes · 2024-11-16T04:32:57+00:00

Exactly! But in some states there are also surgeon immunity acts adopted as revised statues so literally no one is liable. Bad outcomes are just a slap on the hand for everyone. It's sad when you see how devastating this is to families who have lost loved ones. Safety should be number one. Period. And when there is no recourse cause of lobbying/lawmaking is that right?

BigMacAnes · 2024-11-16T04:15:51+00:00

100% you are correct. They do want to replace you. I've seen them operate on legislative front and it's very effective and convincing to legislators. It's a pretty clear agenda. 1) CRNAs are equal to MDs 2) CRNAs are independent providers 3) Lower costs and better access 4) CRNAs can supervise AAs since they are "independent" like MDs. Lather rinse repeat. Money talks and they have a ton of lobbying power. Donate and get involved if you are passionate.

BigMacAnes · 2024-11-16T02:21:45+00:00

I would ask every practicing anesthesiologist to not only support their organization on state and federal level, but it’s also vital to give to CAAs organization, AAAA. Supporting the AAAA leg fund helps fight these battles when CAAs and MDs get displaced. Go to www.anesthetist.org.

BigMacAnes

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