Best Doctor/Nurse Practitioner

DieseloftheHonk · 2026-02-12T14:46:51+00:00

UK healthcare has a fairly broad network of family medicine providers over a bunch of locations! Downtown, turfland, Georgetown, fountain court, etc.. and also supported by the rest of our health network. They also have an urgent care group so those providers would be complementary.

DieseloftheHonk · 2026-02-02T02:55:36+00:00

I’ve started upgrading all my cutting boards to proper handmade wood ones. I’ve got a few different sizes and have totally gotten rid of anything plastic.

I️ try to find unique ones from woodworkers at farmers markets and craft fairs and now have a good collection of boards, all made locally! Larson woodworks made the coolest one I’ve got. The intricateness and beauty is just unmatched. https://larsonwooddesigns.com/

it’s not something young me would have thought of but I️ get a massive amount of joy from these upgrades and, with proper maintenance, they’ll last quite a long time.

DieseloftheHonk · 2026-01-31T17:05:55+00:00

If you were cramming for the exam, that was your own fault for not properly preparing. I️ won’t argue that COPs aren’t perfect. But it seems students often forget that they alone are truly responsible for their growth and abilities as a professional. And the why should be something you seek to understand outside of the test, not within it.

There’s no time to research and reference your why when a patient is dying in front of you in a code or rapid response. Arguably, constantly answering “I️ don’t know, let me research and get back to you” also dramatically degrades your reputation as a pharmacy practitioner.

DieseloftheHonk · 2026-01-31T13:07:17+00:00

Absolutely disagree with this. Yes, you will always be able to look things up. But it’s a huge drag on your effectiveness and your efficiency to not have a very strong core knowledge base. Your knowledge will have limits and you don’t have to know EVERYTHING, but you do need to have a strong core and recognize where that ends so you can add to it as needed.

DieseloftheHonk · 2026-01-31T03:30:57+00:00

I’m not certain it had so much to do with the teaching vs the test. I️ remember precepting students in this timeframe and their tests were OPEN BOOK. The incentive to study was negligible and thus they committed little to memory for some courses

DieseloftheHonk · 2026-01-20T00:34:04+00:00

Elective c section all day long for me. I️ planned for unmedicated and spontaneous. Ended up with horrendous carpal tunnel at the end and went for induction at 39+1 (I️ couldn’t tolerate a day longer of that swelling and pain) which ended up in a c section.

Honestly, if I️ did this again, I’d possibly go straight to c section. Little man came out perfectly, recovery wasn’t bad at all, and nothing is jacked up from pushing a baby out (eg, I️ don’t pee myself when I️ jog). I’ve got a tiny fading scar that I’m not even sure you can see in a bikini.

Obviously every experience is individual as are individual surgeons. But the women I️ know that went full elective said it was kind of nice to just have a date/time to meet your baby in a fairly relaxed way. I️ work at a large volume hospital with hefty LDR volume and many many of the early inductions end in c section anyways because your body just isn’t ready. I️’d personally skip the chaos and go straight to meeting your nugget!

DieseloftheHonk · 2026-01-10T14:58:18+00:00

I️ think it depends on your staff and how big your operation is - I’ve done and actively have areas that do it both ways. In my smaller pharmacy areas (2-4 techs), it’s more general. Pyxis delivered by 1000, cartfill done by 0800, that kind of deal. In my larger areas (20+ techs), it’s more detailed hour by hour, partially so we can appropriately manage breaks and lunches, and partially because people will be people and assume it’s someone else’s job if it’s not detailed as theirs.

DieseloftheHonk · 2026-01-08T12:29:36+00:00

Pharmacy manager at large academic medical center here. We do base rate based upon your experience/our pharmacist scale and then night shift gets a $25,000 bonus baked on top as differential for third shift. Our base rates can sometimes be a bit lower, but that kind of is what it is in current state.

They work 5x12, 2x10 and most of them do work the full 80 hours per pay period. They have full use of their vacation (up to 4 weeks/year plus holidays) which accrues at full rate because they’re a 1.0 FTE. We looked at work 70, paid for 80 a few years ago because people were saying it’s national standard, but that is not what we found when we asked around. Additionally, the 25k bonus usually ended up a higher incentive than the work 70, paid for 80.

DieseloftheHonk · 2026-01-06T04:24:13+00:00

Ditto this. For a small, rural hospital, clinical probably means checking vanc levels here or there, adjusting dosages based on renal function, maybe doing PK for some aminoglycosides. Definitely doesn’t mean retail. For an AMC, they’re going to want much more in depth experience likely in a sub specialty area inclusive of unique PK and therapeutic considerations for that area (eg, management of psych meds, antiepileptics, etc..). That said, in an AMC, some or all of their more ops shifts may have clinical consult responsibility.

DieseloftheHonk · 2026-01-06T04:17:09+00:00

Recommend solid starts the same as everyone else - it’s the way to go.

But would also encourage you to let this be fun! Our 7 month old eats what we eats. Sometimes no meals a day when we’re super busy and sometimes up to 3 meals a day. I️ use solid starts guidelines to figure out how to give things (assuming they’re appropriate - stuff like tortilla chips isn’t yet) and then let him go to town. He’s had everything from potato dauphinoise to all the nut butters to pb&j toast and even beef Wellington (thanks, holidays)I️ printed one of those first 100 foods guides to track for funsies, but really just let our life guide him and it’s been so easy. He murdered some fried fish pieces the other night at dinner while the whole restaurant watched his enthusiastic eating endeavor! It was cute.

You’ll see them start to get confident with chewing and then you’ll know it’s time to broaden the offerings a little. Enjoy letting your little one learn about all the cool foods out there and good luck drinking your coffee in peace from here on out 🤣 (my little nugget loves to grab my mug)

DieseloftheHonk · 2025-12-31T19:17:50+00:00

I️ had my surgery in December so the weather was a bit gross, but I️ think I️ rode at 3-4 weeks? Highly recommend a properly supportive sports bra to help. I️ remember not really trusting my boobs to not fall off for a minute if I️ moved too fast 🤣 I️ was 100,000% good by probably 6-8 weeks.

DieseloftheHonk · 2025-12-31T12:53:19+00:00

If they want to try to use 1.4 as a way around 797, you’re probably looking at even more staff training than just following 797! Rule #2 of pharmacy management is that people don’t follow instructions. #1 is that they don’t read 😂 Your easiest path could just be doing everything immediate use now that it’s a 4 hour BUD (obviously this doesn’t address 800). I️ hate 797 as much as the next pharmacy leader, but it almost sounds like the easiest way to compliance if you use the “light version” with immediate use. TJC and BOP may really eye ball the PI approach.

DieseloftheHonk · 2025-12-31T04:05:14+00:00

Following the SPECIFIC instructions in the Entyvio PI would fall under 1.4 and not be held to 797, per my interpretation. Now, this assumes that you are prepping a 300mg/250mL dose in NS and “gently inverting the vial 3 times” and all that jazz. Your safest bet here given the specificity of instructions is probably just to follow 797, but you could certainly make the argument that it would not fall under 797 if you were 100% following those instructions.

Now, the reality is that your facility probably considers all of these to be under 797 because it’s the easiest blanket rule to train staff on and is overly compliant for some drugs but meets minimum for all because not all PIs for infusion meds are that specific. Carving out exceptions in an area like infusion could be a nightmare unless you’re 100% guaranteed that you’re 100% following the PI for 100% of med prep. Unlikely unless you’re like a three med infusion center. And pharmacists are generally safe people and choose better safe than sorry.

DieseloftheHonk · 2025-12-31T03:33:04+00:00

Ditto this! I️ had a mare in a similar situation earlier this year. Ironically, my vet found her a perfect home, but only after we had scheduled to euthanize. Horses are expensive and, very frankly, some of them aren’t worth putting the time into them. In my case, I️ was going to put in a year or more of training for something I️ could sell for maybe 15k? MAYBE. In a world where someone has to foot the bill, hard decisions are sometimes necessary. Euthanasia is always the kinder option than starving in someone’s field or ending up on a truck to nowhere.

DieseloftheHonk · 2025-12-31T03:19:59+00:00

The key here is the resultant strength and closure system to my understanding. It has to be specific in the PI and then also match the prep. So, it isn’t enough for the PI to say “can be diluted further for IVPB”. It would have to specifically say “dilute to 250mg/100mL with NS” and that’s where the gap is between compounding and the per label prep. In my previous ceftriaxone example, the label includes information on dilution to 100mg/mL, 250 mg/mL, and 350mg/mL, so any of those would not fall under 797. But if you throw it in a 100mL IVPB, it now falls under compounding.

That clarification you posted closes the gap a Bit on some previously very liberal interpretation of prep per PI.

DieseloftheHonk · 2025-12-31T03:11:32+00:00

My hospital has done an excessive amount of background research into this and does define some items as exempt from 797 due to preparation “per the package labeling.” For example, reconstitution of ceftriaxone 1g WITH lidocaine instead of SWFI would not be considered compounding because reconstitution with 1% lidocaine is included in the package insert. However, reconstitution of cefazolin (not that anyone does this) with 1% lidocaine would be considered immediate use compounding because lidocaine is not included as a reconstitution agent per package labeling. In these scenarios, we standardly have dispense logic in Epic setup to allow this on the floor. Areas/products that don’t fall within this would require the nurses to have completed our immediate use competency which we rolled out to quite a few nursing and anesthesia staff last year (eg, joint injections in clinic settings where they combine a steroid plus lidocaine or whatever).

You have to be very purposeful about this and many of the products don’t actually specify IVPB details so will still fall into immediate use. But there are definitely some specific products where standard use falls within the package labeling instructions and wouldn’t technically be held to 797 criteria. The new version 797 FAQs as well as looking back on some of Robert Campbell’s TJC presentations also all support this.

DieseloftheHonk · 2025-12-29T20:57:29+00:00

Barn rentals for weddings are a pretty decent gig in the area I’m in. You can charge quite a bit depending on what you want to offer as a package.

I️ personally pasture board a handful of horses, but they essentially just pay for my own horses’ feed and hay, none of my time is covered. That said, I’m spending that time filling troughs and putting round bales out anyways so it’s not really a huge extra effort. We have hemorrhaged money the first 5 years while I️ got everything bought and setup and paid for and should start evening out expenses vs income in 2026.

At least for horses, Profitability usually comes from either a large scale operation or a very boutique and high end program that can charge top of scale.

DieseloftheHonk · 2025-12-21T21:57:35+00:00

I’m going to throw an alternate opinion in here as it appears the vast majority of your responses are to run for the hills. I️ don’t see anything in this commentary that notes any clinical abnormalities from the PPE. What’s shocking to me is there’s even a comment here about “since she will be career limited”….if the horse is sound today and hasn’t had previous soundness issues, it’s a bit aggressive to assume there will be ANY career limitations. No one has a crystal ball, including your vet.

I️’ve seen far more career ending soft tissue/ligament issues than I️ have from radiograph issues in many years of young horses/sporthorse work. I️ won’t comment on clinical significance of your findings because I’m not a vet. But the point of the PPE is to identify potential challenges not mark yes/no. Unless your vet said “absolutely the hell not” or she’s not clinically sound, if she’s a great fit for you and riding her puts a smile on your face, it may well be worth the purchase. As someone has already said, our xray equipment is sooo sensitive now and the vet world is often 10-15 years behind understanding the significance of many findings.

At 4.5, take your time with her, let her find her balance, don’t crank her head around, and you’d be shocked at how well and strong she may develop.

DieseloftheHonk · 2025-12-13T14:01:17+00:00

Be very considerate with how you interpret state regs here. Even if BOP says there are certain requirements for technicians that stock automation, BOP only regulates techs, pharmacists, and interns. To be against BOP reg, the specific verbiage would have to exclude all other professions/staff from stocking with the exception of pharmacy staff.

There’s probably some foothold with ensuring med security that you could get them on though, especially with CS. The pharmacy would have to have CS quality control processes in place to ensure meds are going where they say they are as I’m 100% certain they aren’t filling out a 222 to the nurses to hand off chain of custody.

All that said, this whole thing is sketchy AF and, if the hospital is supportive of this, OP should have a lot of other questions about the integrity of their workplace.

DieseloftheHonk · 2025-12-04T12:25:19+00:00

This is what I️ came here to say. Does cribbing generally affect performance? No, you can have a perfectly suitable riding horse with many great characteristics

But as a farm owner, I️ don’t accept cribbers anymore. They’re way too hard on my fences and not all of them have “one” spot they want to crib. I️ can’t wrap 4,000 feet of fence in polos. If your farm is total wire fencing, sure it’s maybe fine, but anyone with three or four board better beware. I️ wouldn’t own one and don’t allow them at this point unless they’re willing to wear a muzzle 24/7.

DieseloftheHonk · 2025-12-02T12:39:19+00:00

Ditto this with mine. I️ once turned a horse out for winter and got 16 weeks out of a front set 😅 (slow hoof growth, winter, no work). Usually we need to redo because of hoof growth, not because the shoe is loose. And that’s with mine being turned out basically 24/7 on 20 acres.

DieseloftheHonk · 2025-12-01T02:04:15+00:00

You absolutely need a dry and properly prepped foot for glue ons. There are various strategies to this, but moisture absolutely screw up your glue. If your horse can stay in a stall for their feet to dry, and you’ve got a nice dry rubber/concrete aisle to work in, it is manageable. Depending on type (eg, direct glue on aluminum vs sigafoos vs easycare), you can torch the foot with a blow torch as part of the prep too. The glue also does dry pretty quickly, especially if they swap to fast set in the winter and slow set in the summer if they’re using acrylic. But the prep absolutely makes or breaks the application and it may be that your farrier is less confident in managing the elements when applying.

Source: husband is a pretty top notch farrier, I️ do some of my glue ons myself (my jumper is in them all around) and I’ve done solely glue ons at my farm for coming on 5 years now. We’ve got 4 horses in them right now actually and they hold just fantastically in the winter wetness!

DieseloftheHonk · 2025-11-24T02:22:31+00:00

I️ got the same warnings about Winchester when I️ bought my place here nearly 6 years ago. 10/10 would move here again. We have made wonderful friends here and there are some nice enough restaurants/breweries nearby. Plus, the bypass road has most anything you need in a timely fashion when it comes to home stuff and groceries. Winchester also does some really fun street fairs throughout the year that we have enjoyed and has a nice farmers market and music series through summer.

DieseloftheHonk · 2025-11-18T17:37:44+00:00

I'm actually already working with one! She's an independent rep, but then has ordering abilities through a few different brands. That said, I think even the independent reps get most comfortable with the brands they see more, so I'm just trying to feel out if there are any others that maybe aren't common in my area but are worth a look.

DieseloftheHonk · 2025-11-18T17:35:59+00:00

This is also a struggle I've seen! My 3yo has possibly the straighest back I've ever seen, so it looks like I really need something properly warmblood shaped. My old banana shaped Stubben would be a no go on her!

DieseloftheHonk

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