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Lancelot
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Posted: 10/18/2011 8:03:51 AM
Originally Posted By Rodent:
It's expensive, it has a limited shelf-life, and it's hardly ever needed.


HELOBRAVO
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Posted: 10/18/2011 8:18:08 AM
Originally Posted By nick89302:

Cost vs. Benefit


Hardly ever see a snake bite. Probably go a month or so at a time without one.
Most are smaller snakes and bites on fingers or web of hands. Either look at it and discharge or watch for a night.
We can get it PDQ if needed.

Quit running around your cage denying you're a squirrel.
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Posted: 10/18/2011 8:31:39 AM

Originally Posted By BakerMike:
Originally Posted By Polupharmakos:
It does, doesn't it? Right up until nobody wants to pay for your wonderful product.

Best stick to helping old geezers get it up. They'll pay for that.


Are you suggesting that inventing a product which has improved the quality of life of millions and millions of people is somehow not a worthy activity, and that the invention and sale of a product that would maybe improve the lives of a tiny minority of people would be somehow morally superior?

Sounds like some bullshit to me.

Oh, get off your high horse.

How about this: let's all just start by agreeing that helping old guys get it up is a morally excellent and worthy activity. OK? And let's dispense with this morally superior bull. We on the same page?

Somebody asked why all hospitals don't carry anti-venom routinely. The answer is money. It is expensive to get anti-venom. For you to carry anti-venom, that means you must at the very, very, very, very least break even on the anti-venom when you administer it. Probably not even that. You have some costs associated that you have to recoup somehow. You with me?

Let's step back. I'll throw a rhetorical question out there. What, for the financially ambitious medical professional, is the promised land? What do you go into if you want to make bank? Here's the answer: fields where you offer a service that people want to pay for; fields where you don't have to involve insurance; fields where you can turn away a patient unless there's cash on the barrel-head. No money? No workey.

Sound bad? Yup, but remember we're leaving morals out of things for the nonce.

So what fields are those? Amazingly, surprisingly, they aren't the fields, like, say, the ones where people give patients anti-venom, or cut cancers out of patients, or give them chemo, or see them regularly for their hypertension and diabetes, and give them vaccines. Nope. Because, you see, people have a right to that sort of thing! Sure, maybe the lady over there doesn't think her boob job and botox are really strictly necessary. She'll pay for those. But when she gets breast cancer? Does she want to pay for that? Should she pay for that? The prevailing attitude in this country seems to be no.

I worked with a pediatric orthopedic oncologist. He cut bone tumors out of kids. Kind of a complicated task. He did ok, money-wise. A colleague of his went into fixing bunions. Practically no overhead; relatively short procedure; relatively low risk; just fork over the cash and get your bunion out. Dude made bank.

But NO MORAL JUDGMENT HERE. I WANT TO MAKE THAT PLAIN, LEST YOU GET RILED.

Nope, no moral judgment at all, just simple observation.

Here's another one for you. I worked with a family doc who told me he lost money on every vaccine he administered. He only offered vaccines to try to get patients to schedule appointments for their kids, and he was considering having to stop giving them, because they weren't cost effective. Now, do vaccines improve the quality of life of enough people that your hackles don't get raised?

Now me, I'm fine with patient autonomy. And although I rag on those folks, I do admire my classmates who managed to keep their desire to help people alive throughout their training. And this rant isn't even really directed at you, more at the country at large.

But here's my point, restated. When you have a culture like ours, where people are happy to pay for elective stuff they don't really need, and aren't happy to pay for 'non-elective' stuff that they really do need, the ultimate outcome is that elective stuff is going to move forward in terms of innovation and technology, and the non-elective stuff is going to stagnate, if not regress. And sure, if patients are fine with that situation; if they are fine with investing in the future of ED drugs, cosmetic surgery, and the like, well then, that's ok. Their call. I don't have a problem in the world with that.

Just don't be surprised when you end up with the situation I saw this last summer, when the entire nation was scrambling for chemotherapeutics that simply weren't there. I wasn't keeping up with the viagra supply, but I'm willing to bet it wasn't in any danger.
Thanks dport!

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Posted: 10/18/2011 8:33:26 AM
Originally Posted By Rodent:
It's expensive, it has a limited shelf-life, and it's hardly ever needed.


Above
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Posted: 10/18/2011 8:45:21 AM
Originally Posted By PrivateContactor:
Originally Posted By Rodent:
It's expensive, it has a limited shelf-life, and it's hardly ever needed.


Venom One in Miami FL has pretty much the largest collection of antivenom in the US.....Loma Linda, in CA is another source. Some zoos that do research with cyber toxic snakes have a supply available. When I kept my elapids (coastal taipans, common browns, & king browns) Venom One, had some antivenom, however at the time they only had enough for a half-dosage (aka I would have been screwed) . Venom is utilized to produce anti-venom (produced differently depending on species). Venom can cost up to $3000 per microgram, which sufficient to say is very cost prohibited. Keeping a local variety of antivenom available is a good idea for larger hospitals, but for smaller ones it is just not cost effective. If you are outdoors in snake country, bring along an Extractor kit, and learn how to do a pressure bandage, which if quickly and properly applied can save your life, even on the deadliest of elapids. It will at least buy you a little time until you can get to medical help.

-Private Contractor-



Just remember-DON'T use a tourniquet or pressure bandage for pitvipers(or most exotic vipers). You'll confine tissue destroying venom to a much smaller area and might lose the limb instead of havilg a lot of pain and a big doctor bill. With MOST viper bites it's hours or days before you're beyond help instead of minutes like with the high venom, high lethality elapids so you don't nbeed to try AS hard to "buy time". With American snake bites keeping a clear head and having someone get you to the hospital NOW is usually enough.
"The hawk does not fear you, boy, and the hawk never will. The hawk is God's gunslinger." -Stephen King
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Posted: 10/18/2011 8:47:52 AM
Originally Posted By DarkCharisma:
I had no idea that anti-venom was so expensive. Interesting... Remind me to not get bit by any snakes, I don't think I have $20,000 available on my FSA.


$20,000 might pay for the helicopter ride. I heard of a little girl in Florida who was bitten several years ago(granted, this is a severe bite) and her bill was $220,000. Her family had to sell their house to pay what insurance wouldn't. Moderate bites easily hit $45,000. Remember, you're likely paying for several days in an ICU bed as well as the antivenom.
"The hawk does not fear you, boy, and the hawk never will. The hawk is God's gunslinger." -Stephen King
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Posted: 10/18/2011 8:52:01 AM
Originally Posted By PrivateContactor:
Originally Posted By TheGrayMan:
Originally Posted By PrivateContactor:
Originally Posted By Rodent:
It's expensive, it has a limited shelf-life, and it's hardly ever needed.


Venom One in Miami FL has pretty much the largest collection of antivenom in the US.....Loma Linda, in CA is another source. Some zoos that do research with cyber toxic snakes have a supply available. When I kept my elapids (coastal taipans, common browns, & king browns) Venom One, had some antivenom, however at the time they only had enough for a half-dosage (aka I would have been screwed) . Venom is utilized to produce anti-venom (produced differently depending on species). Venom can cost up to $3000 per microgram, which sufficient to say is very cost prohibited. Keeping a local variety of antivenom available is a good idea for larger hospitals, but for smaller ones it is just not cost effective. If you are outdoors in snake country, bring along an Extractor kit, and learn how to do a pressure bandage, which if quickly and properly applied can save your life, even on the deadliest of elapids. It will at least buy you a little time until you can get to medical help.

-Private Contractor-




I'm not so sure I'd spend money on those.


I have always carried one, but never used one, so I can not attest to their effectiveness. I have heard they are better than nothing, but likewise I have also heard that they were just cleverly marketed where there are few other products available. Do you have any personal info, I replace mine every 3-4 years and have 2-3 of them in various packs, if it is money down the drain, please let me know.

-PC-



By the time you get an extractor out of your kit the venom's enxymes have already caused it to start doing its work. You're better off using that time to get to the hospital a couple minutes sooner. An extractor will draw out some venom(you will be able to see some in the cup) but not nearly enough to make a real difference. Absolutely DO NOT try the old cut and suck method either. If you have any type of open sore in your mouth(chapped lips, bleeding gums, scratch from eating potato chips) you'll get a secondary envenomation. In the mouth, it will make things worse, as in swelling and blocking your airway. Now you've got 5 minutes instead of 2 hours.
"The hawk does not fear you, boy, and the hawk never will. The hawk is God's gunslinger." -Stephen King
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Posted: 10/18/2011 8:55:17 AM
[Last Edit: 10/18/2011 9:03:05 AM by shack357]
Originally Posted By ikor:
Originally Posted By scottedward58:
Originally Posted By AFITLewis:
Originally Posted By scottedward58:
If you get bit by a poisonous snake the best thing you can do is hit the area with a high voltage shock such as from a stun gun, cattle prod, grill igniter, or from the ignition system from a gasoline engine. Strangely enough it is much more effective than antivenom. They believe the high voltage breaks down the venom. A high voltage shock only works though if you can do it before the venom has a chance to spread.


Ill stick with the anti venom.


It doesn't have to be one or the other, the high voltage shock is a first aid treatment but when the high voltage shock treatment is used properly it eliminates the need for antivenom. Do some research into it yourself before discounting something that could save your life.


There's research and then there's research. Some purports to show the voltage works but there have been NO scientific studies to show that is true...my guess is it is BS and several studies have indicated that as well, but people persist in believing it.

Trust the anti venom



Electricity is little more than a modern version of cut and suck. The times when it "worked" are most likely nothing more than dry bites(no venom anyway) or very mild envenomation. In a bad bite it might even make things worse-heart speeds up in response to pain, blood carrying venom goes faster.
"The hawk does not fear you, boy, and the hawk never will. The hawk is God's gunslinger." -Stephen King
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Posted: 10/18/2011 9:03:52 AM
Originally Posted By scottedward58:
Originally Posted By AFITLewis:
Originally Posted By scottedward58:
If you get bit by a poisonous snake the best thing you can do is hit the area with a high voltage shock such as from a stun gun, cattle prod, grill igniter, or from the ignition system from a gasoline engine. Strangely enough it is much more effective than antivenom. They believe the high voltage breaks down the venom. A high voltage shock only works though if you can do it before the venom has a chance to spread.


Ill stick with the anti venom.


It doesn't have to be one or the other, the high voltage shock is a first aid treatment but when the high voltage shock treatment is used properly it eliminates the need for antivenom. Do some research into it yourself before discounting something that could save your life. People carry those stupid snake bite kits that are supposed to suck the venom out even though they have been proved to be virtually ineffective, so why not do something that has actually been shown to work especially when it is so simple. A grill igniter is about the same cost as a snake bite kit, there is no reason not to do it.


I am unaware of any scientific study that supports the notion that high voltage, low amperage electircal shock will act as effective treatment for snake bite. Most the cases can be attributed to a "dry bite" which is more common than you'd think.

As a senior in high school, I designed a study that looked at this topic (this work actually got me a trip to Boston to present at the AAAS and then into college). Snake venom is this withces brew of enzymes and proteins. I ordered some freeze dried venom (cottonmouth) from Sigma-Aldrich. I was able to find a few of the known enzymes in that venom and bought those substrates. I then subjected those substrates to the venom and was able to monitor the cleavage of the substrate via UV detection. Once I established the control, I took a sample of venom (re-constituted) and then exposed it to the shock from an electrical fense shocker...this treated venom was then re-tested for it enzymatic activity. Some of the enzymes were completely unaffecetd by shock all together. Others, had reduced enzymatic activity but most of it came back over times (as the enzyme re-folded to the active conformation). None of the enzymes were denatured to the point of complete inactivity. I actually set up the vessel when there venom was treated so that my spark would arc through the venom sample. So I know that the shock I was giving was far more localized and potent that anything you can do in the field to a live subject.

End of the day, I found nothing to support this claim and I am unaware of any other scientific studies that support that electiracl shock can denature the venom to the point of calling it treatment.

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Posted: 10/18/2011 9:16:54 AM
Originally Posted By Polupharmakos:

snip...... A colleague of his went into fixing bunions. Practically no overhead; relatively short procedure; relatively low risk; just fork over the cash and get your bunion out. Dude made bank. Snip.....




Not anymore..... I did 3 Bunions over the last few weeks (of varying degrees of complexity), and they paid the practice $300 to $700 (depending on the insurance, not the degree of complexity...the $700 was the simplest, had good private insurance...the $300 was Medicaid...and we have a promise to pay...we'll get the $$ is about 5 or 6 months). The Post-op care is included up to the 90 day global period. No fee for service Bunions anymore...strictly insurance. We (as Podiatrists) can make more from a couple of ingrown nails...with less follow-ups and less risk of being sued.

AFARR
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Posted: 10/18/2011 9:32:50 AM
Originally Posted By Polupharmakos:


But here's my point, restated. When you have a culture like ours, where people are happy to pay for elective stuff they don't really need, and aren't happy to pay for 'non-elective' stuff that they really do need, the ultimate outcome is that elective stuff is going to move forward in terms of innovation and technology, and the non-elective stuff is going to stagnate, if not regress. And sure, if patients are fine with that situation; if they are fine with investing in the future of ED drugs, cosmetic surgery, and the like, well then, that's ok. Their call. I don't have a problem in the world with that.

Just don't be surprised when you end up with the situation I saw this last summer, when the entire nation was scrambling for chemotherapeutics that simply weren't there. I wasn't keeping up with the viagra supply, but I'm willing to bet it wasn't in any danger.


Thank you.

Any bleeding-heart Socialists should read that red-highlighted sentence again if it doesn't make sense. People act as if medicine is immune to the normal laws of economics, supply-and-demand, etc.

It is not.

Ever wonder why Lasik refractive surgery is getting better/cheaper/more-widely-available? It used to be $3-4000 per eye... and the lasers weren't as good... and there weren't that many people doing it. Now you can get it done for $1000 per eye, and the lasers are much more advanced.

And why is that? It's elective, and people are willing to pay for it. This makes it a profit-center, and the physicians are willing to advertise, cut prices to compete with the place down the street, and get better/faster/more-accurate lasers to produce a better product (and get more business as a result).

QED
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Posted: 10/18/2011 10:32:23 AM

Originally Posted By MrBear80229:
Originally Posted By WildBoar:
If you get bit by a Coral Snake down here, you are screwed. All the antivenin is gone.


if you get bit by a coral snake you either A. Had to work at it real hard as in dumb ass hard. or B. Are a child who wasn't taught better.

Coral snakes are non aggressive in the extreme and lacking true fangs they have to latch on and let their venom flow down their teeth. Also the coral snake has such a tiny mouth that fingers/toes are about the only place they can get a good bite at.

Duh. If you get bit by ANY snake you usually asked for it. That isnt the point of what I was getting at. I thought the antivenin supplies for Coral Snakes was expired now.


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Posted: 10/18/2011 10:33:56 AM

Originally Posted By Dru:
Originally Posted By MrBear80229:
Originally Posted By WildBoar:
If you get bit by a Coral Snake down here, you are screwed. All the antivenin is gone.


if you get bit by a coral snake you either A. Had to work at it real hard as in dumb ass hard. or B. Are a child who wasn't taught better.

Coral snakes are non aggressive in the extreme and lacking true fangs they have to latch on and let their venom flow down their teeth. Also the coral snake has such a tiny mouth that fingers/toes are about the only place they can get a good bite at.



Yea... the fool in the story above, let the thing crawl around under his shirt.

The only other coral snake bite I responded too was a , "Here.... Hold my beer and watch this!"

What story are you talking about? One guy was a tard and thought it was a Kingsnake and tried to pick it up. One quick strike and he got a dose.
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Posted: 10/18/2011 10:35:22 AM

Originally Posted By Dru:


Last month.....

The info I mentioned above was told to me by the lead medic who transported the patient, when he got back into quarters... this is what the ER staff told him.


Funny thing about this story.... was the patient and his wife kept the thing for a pet, in the house in an aquarium... As the medics where working on the patient, and getting fire control to see which hospital had anti venom, we asked the wife where the snake was for positive ID... She said "In here!" and walked us into the living room.... Were she proceeded to dig around the leaves they had piled in to the aquarium, my partner grabbed her hand and said, "Get your damn hand out of there and find a stick... what's wrong with you!" Anyhow... it was a positive ID as a coral....


The patient.... on the way to the ER... was asked about a missing finger on his right hand... he said years ago he had a pet alligator.


Then the fool said... he was going to get rid of the coral snake, because it wasn't nice... and try and find a rattle snake when he got out of the hospital.
LMAO @ the idiot. Some people just wont learn

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Posted: 10/18/2011 10:43:06 AM
Originally Posted By scottedward58:
If you get bit by a poisonous snake the best thing you can do is hit the area with a high voltage shock such as from a stun gun, cattle prod, grill igniter, or from the ignition system from a gasoline engine. Strangely enough it is much more effective than antivenom. They believe the high voltage breaks down the venom. A high voltage shock only works though if you can do it before the venom has a chance to spread.


In before some bubba gets some jumper cables...
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Posted: 10/18/2011 11:02:28 AM
This chick got bit by a rattlesnake in AZ.. Total bill was $140K, but they didn't seem to be complaining all things considered.

In my county, several people are bit every summer by copperheads. My wife works in the hospital and sees them come in from time to time; even though they're rarely if ever fatal, she says they're usually in intense pain for a day or two, and losing a limb is not uncommon. I think they use crofab.
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Posted: 10/18/2011 11:08:03 AM
Originally Posted By LongueCarabine:
Originally Posted By TheGrayMan:
Originally Posted By Rodent:
It's expensive, it has a limited shelf-life, and it's hardly ever needed.


Yep... like $2000-per-vial expensive... and a symptomatic bite will frequently require 10-12 vials minimum... some require much more.

And plenty of people who get themselves bitten? A lot of them are uninsured. Also, if they have an upper-extremity bite, they're also frequently drunk.

I don't know what the reimbursement is like for a snake-bite injury in an insured patient (it's been a while since I've had one, frankly...), but I wouldn't be surprised if the hospital thought it was too expensive to keep the stuff on-hand. They might be better-off financially to transfer that patient to a center that does stock the anti-venom, so that the larger facility can eat the loss.

In my worst month, I treated three symptomatic rattlesnake bites, and since I was on the P&T committee for the hospital, I was treated to a lot of complaining from the pharmacy folks.

It seems I blew their budget for the month.


Many of the hospitals in this area have sort of a "gentlemen's agreement" to assist in supplying each other in case of a serious snakebite. They keep minimum amounts on hand, will borrow from other hospitals and reimburse them in kind if they have to use theirs.

LC


in some place the hospital each have a small amount of the most common, and then split up the less common.

Each stocks one of the less common ones.

Even rabies vaccine is often only handled by a single pharmacy in any area.
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Posted: 10/18/2011 11:09:47 AM
Originally Posted By Rodent:
It's expensive, it has a limited shelf-life, and it's hardly ever needed.


yup.
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Posted: 10/18/2011 11:51:49 AM

Originally Posted By Dru:
Originally Posted By WildBoar:

Originally Posted By WaCPA:
Florida. Is it the snake capital of the US? Must be some southern state, I'd bet.


Pretty sure Florida is a southern State, but I guess I better double check.




Your reading comprehension lacking too?


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Posted: 10/18/2011 12:00:53 PM
Originally Posted By MrBear80229:
Originally Posted By WildBoar:
If you get bit by a Coral Snake down here, you are screwed. All the antivenin is gone.


if you get bit by a coral snake you either A. Had to work at it real hard as in dumb ass hard. or B. Are a child who wasn't taught better.

Coral snakes are non aggressive in the extreme and lacking true fangs they have to latch on and let their venom flow down their teeth. Also the coral snake has such a tiny mouth that fingers/toes are about the only place they can get a good bite at.



Coral snakes have hollow fangs right in the front of their mouths like any other elapids. But as you say the fangs are short and the mouth is small, so they cannot strike and inject venom like a viper can. They have to be able to grab and bite a small piece of the body, but when they do they can inject a fatal amount of venom instantly.
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Posted: 10/18/2011 12:53:30 PM

Originally Posted By WildBoar:

Originally Posted By Dru:
Originally Posted By MrBear80229:
Originally Posted By WildBoar:
If you get bit by a Coral Snake down here, you are screwed. All the antivenin is gone.


if you get bit by a coral snake you either A. Had to work at it real hard as in dumb ass hard. or B. Are a child who wasn't taught better.

Coral snakes are non aggressive in the extreme and lacking true fangs they have to latch on and let their venom flow down their teeth. Also the coral snake has such a tiny mouth that fingers/toes are about the only place they can get a good bite at.



Yea... the fool in the story above, let the thing crawl around under his shirt.

The only other coral snake bite I responded too was a , "Here.... Hold my beer and watch this!"

What story are you talking about? One guy was a tard and thought it was a Kingsnake and tried to pick it up. One quick strike and he got a dose.


"Red against yellow will kill a fellow."



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Posted: 10/18/2011 2:19:15 PM
Originally Posted By Polupharmakos:
Oh, get off your high horse.


Negative. This horse is a Cadillac, son! Livin' the life of luxury, up here.

How about this: let's all just start by agreeing that helping old guys get it up is a morally excellent and worthy activity. OK? And let's dispense with this morally superior bull. We on the same page?


I bristled at your remark because I feel like whenever people shit-talk the cash-money (and, as you say, elective) side of medicine, I always feel like they're going to segue into a justification for reaching into other people's pockets at gunpoint. That's clearly not what you intended, so I was wrong.

I consider all of the choices above to be morally irrelevant.

Somebody asked why all hospitals don't carry anti-venom routinely. The answer is money. It is expensive to get anti-venom. For you to carry anti-venom, that means you must at the very, very, very, very least break even on the anti-venom when you administer it. Probably not even that. You have some costs associated that you have to recoup somehow. You with me?


I got angry at what I thought you were implying with your disdain for Viagra, not because I don't understand Economics. In two months I'll have a Bachelor's degree in the fucking subject, after all.

Let's step back. I'll throw a rhetorical question out there. What, for the financially ambitious medical professional, is the promised land? What do you go into if you want to make bank? Here's the answer: fields where you offer a service that people want to pay for; fields where you don't have to involve insurance; fields where you can turn away a patient unless there's cash on the barrel-head. No money? No workey.


Oh hell yes. Why would I ever enslave myself for people who can't pay?

Sound bad?


No. Doctors don't owe anyone anything. Having a pulse doesn't entitle anyone to enslave anyone else so that they can continue having it.

She'll pay for those. But when she gets breast cancer? Does she want to pay for that? Should she pay for that? The prevailing attitude in this country seems to be no.


Agreed.

I worked with a pediatric orthopedic oncologist. He cut bone tumors out of kids. Kind of a complicated task. He did ok, money-wise. A colleague of his went into fixing bunions. Practically no overhead; relatively short procedure; relatively low risk; just fork over the cash and get your bunion out. Dude made bank.
But NO MORAL JUDGMENT HERE. I WANT TO MAKE THAT PLAIN, LEST YOU GET RILED.
Nope, no moral judgment at all, just simple observation.


I want to make it plain that I understand the economics of these situations.

Here's another one for you. I worked with a family doc who told me he lost money on every vaccine he administered. He only offered vaccines to try to get patients to schedule appointments for their kids, and he was considering having to stop giving them, because they weren't cost effective. Now, do vaccines improve the quality of life of enough people that your hackles don't get raised?


I'm all in favor of vaccines, I think they're great, and I think it sucks whole ass that people don't want to pay up for the things which have enhanced the lives of hundreds of millions of human beings. Sounds like your buddy had a crappy business plan.

Now me, I'm fine with patient autonomy. And although I rag on those folks, I do admire my classmates who managed to keep their desire to help people alive throughout their training. And this rant isn't even really directed at you, more at the country at large.



But here's my point, restated. When you have a culture like ours, where people are happy to pay for elective stuff they don't really need, and aren't happy to pay for 'non-elective' stuff that they really do need, the ultimate outcome is that elective stuff is going to move forward in terms of innovation and technology, and the non-elective stuff is going to stagnate, if not regress. [span style='font-weight: bold;']And sure, if patients are fine with that situation; if they are fine with investing in the future of ED drugs, cosmetic surgery, and the like, well then, that's ok. Their call. I don't have a problem in the world with that.


The non-elective stuff you're talking about is hideously expensive, and like you've said, doctors not only have difficulty making money off of it, in many cases they're actively prevented from so doing by the kinds of laws that compel them to get screwed over by patients who can't pay for the non-elective stuff. On top of that, the elective stuff, as you say, is cheap and makes people happier (rather than just not-dead, which is nothing to scoff at, certainly) and therefore experiences orders of magnitude more demand, so the doctors get tons of work.

The incentives are fucked up, for sure: the facts of the market for non-elective care make for weak incentives to go into those fields, while there are tons of incentives to go into elective medicine.

Now: so what? I still don't understand what you want to happen. I got all bowed up at your remark because I assumed what comes after the disdain for the elective-medicine guys is a call for some kind of governmental intervention to force doctors to do this or that, but I certainly jumped the gun on that subject. So how do we change the structure of the incentives so that the non-elective, life-saving stuff is incentivized, too?

Just don't be surprised when you end up with the situation I saw this last summer, when the entire nation was scrambling for chemotherapeutics that simply weren't there. I wasn't keeping up with the viagra supply, but I'm willing to bet it wasn't in any danger.


Yep. And the lines for gasoline at the stations ended almost instantly once the price controls on it were removed during the Oil Crisis. People respond to incentives. How do you propose to change the incentives? I'm just an undergrad econ student, I don't know enough about the market for medicine and pharmaceuticals to make the call.
"Everything I do and say and the way I do and say it annoys me." ~William F. Buckley, Jr.
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Posted: 10/18/2011 2:36:36 PM
Originally Posted By Dru:
Originally Posted By WildBoar:

Originally Posted By Dru:
Originally Posted By WildBoar:
If you get bit by a Coral Snake down here, you are screwed. All the antivenin is gone.


Where's here? Florida as a whole? Or your area?

Shands at UF has some on hand, last coral snake bite we transported, they indicated to us they had two vials on hand, which is what they normally keep on hand for coral snakes... the patent took both!

If more was needed....shandscare would have either hauled ass to shands jacks or to tallahasse to get more.

Miami-dade fire rescue also has 'Venom-1".....Thank god for these guys!
Venom-1
I thought that it had all expired in an no more was coming in. How long ago was the bite?



Last month.....

The info I mentioned above was told to me by the lead medic who transported the patient, when he got back into quarters... this is what the ER staff told him.


Funny thing about this story.... was the patient and his wife kept the thing for a pet, in the house in an aquarium... As the medics where working on the patient, and getting fire control to see which hospital had anti venom, we asked the wife where the snake was for positive ID... She said "In here!" and walked us into the living room.... Were she proceeded to dig around the leaves they had piled in to the aquarium, my partner grabbed her hand and said, "Get your damn hand out of there and find a stick... what's wrong with you!" Anyhow... it was a positive ID as a coral....


The patient.... on the way to the ER... was asked about a missing finger on his right hand... he said years ago he had a pet alligator.


Then the fool said... he was going to get rid of the coral snake, because it wasn't nice... and try and find a rattle snake when he got out of the hospital.


Darwin will get that dude one of these days.
No one, repeat, no one, will conquer America, from outside or within, until its citizenry are disarmed.

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Posted: 10/18/2011 2:44:41 PM
Originally Posted By scottedward58:
If you get bit by a poisonous snake the best thing you can do is hit the area with a high voltage shock such as from a stun gun, cattle prod, grill igniter, or from the ignition system from a gasoline engine. Strangely enough it is much more effective than antivenom. They believe the high voltage breaks down the venom. A high voltage shock only works though if you can do it before the venom has a chance to spread.


This nonsense has been thoroughly studied and utterly discredited

Don't do this to yourself, your friend, or your dog.
Some of you might consider trying it on your spouse...
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Posted: 10/18/2011 2:50:45 PM
Originally Posted By TheGrayMan:
Originally Posted By PrivateContactor:
Originally Posted By Rodent:
It's expensive, it has a limited shelf-life, and it's hardly ever needed.


Venom One in Miami FL has pretty much the largest collection of antivenom in the US.....Loma Linda, in CA is another source. Some zoos that do research with cyber toxic snakes have a supply available. When I kept my elapids (coastal taipans, common browns, & king browns) Venom One, had some antivenom, however at the time they only had enough for a half-dosage (aka I would have been screwed) . Venom is utilized to produce anti-venom (produced differently depending on species). Venom can cost up to $3000 per microgram, which sufficient to say is very cost prohibited. Keeping a local variety of antivenom available is a good idea for larger hospitals, but for smaller ones it is just not cost effective. If you are outdoors in snake country, bring along an Extractor kit, and learn how to do a pressure bandage, which if quickly and properly applied can save your life, even on the deadliest of elapids. It will at least buy you a little time until you can get to medical help.

-Private Contractor-



I'm not so sure I'd spend money on those.


As of my most recent training no kind of extraction, cutting, or sucking is reccomended.
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Posted: 10/18/2011 2:57:32 PM
Originally Posted By Windustsearch:
Originally Posted By MrBear80229:
Originally Posted By WildBoar:
If you get bit by a Coral Snake down here, you are screwed. All the antivenin is gone.


if you get bit by a coral snake you either A. Had to work at it real hard as in dumb ass hard. or B. Are a child who wasn't taught better.

Coral snakes are non aggressive in the extreme and lacking true fangs they have to latch on and let their venom flow down their teeth. Also the coral snake has such a tiny mouth that fingers/toes are about the only place they can get a good bite at.



Coral snakes have hollow fangs right in the front of their mouths like any other elapids. But as you say the fangs are short and the mouth is small, so they cannot strike and inject venom like a viper can. They have to be able to grab and bite a small piece of the body, but when they do they can inject a fatal amount of venom instantly.


Well damn. I've always heard they're rear-fanged. Just poked around the Internet a bit and whadoyakno, they're front-fanged.
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Posted: 10/18/2011 3:39:09 PM
Originally Posted By d-rail:
Originally Posted By Windustsearch:
Originally Posted By MrBear80229:
Originally Posted By WildBoar:
If you get bit by a Coral Snake down here, you are screwed. All the antivenin is gone.


if you get bit by a coral snake you either A. Had to work at it real hard as in dumb ass hard. or B. Are a child who wasn't taught better.

Coral snakes are non aggressive in the extreme and lacking true fangs they have to latch on and let their venom flow down their teeth. Also the coral snake has such a tiny mouth that fingers/toes are about the only place they can get a good bite at.



Coral snakes have hollow fangs right in the front of their mouths like any other elapids. But as you say the fangs are short and the mouth is small, so they cannot strike and inject venom like a viper can. They have to be able to grab and bite a small piece of the body, but when they do they can inject a fatal amount of venom instantly.


Well damn. I've always heard they're rear-fanged. Just poked around the Internet a bit and whadoyakno, they're front-fanged.


In my experience, WDS tends to know his stuff when it comes to snakes. I've often suspected him of being a closet herpetologist.
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Posted: 10/18/2011 7:42:55 PM
Hey BakerMike, we're on the same page. I hope we're cool. My comment was just an off-the-cuff pop at society at large. You'll have to forgive me; I'm studying for an exam that that has almost nothing whatsoever to do with my field. It's not an excuse, but whenever I get stressed, I tend to become that a-hole who rubs consequences in people's faces just for the hell of it.

So when I'm in that state of mind and I hear a question like the OP's (and AFITLewis, I feel I also owe you an apology, because it isn't a bad question by any means and doesn't deserve attitude from my corner, and because I've hijacked the thread a bit), I tend to bristle a bit myself, precisely because of the undertones of what you mention here:

Originally Posted By BakerMike:

Now: so what? I still don't understand what you want to happen. I got all bowed up at your remark because I assumed what comes after the disdain for the elective-medicine guys is a call for some kind of governmental intervention to force doctors to do this or that, but I certainly jumped the gun on that subject. So how do we change the structure of the incentives so that the non-elective, life-saving stuff is incentivized, too?

I am, at the moment, frankly sick of this country's tendency to provide tremendous incentive for trivial stuff, grouse about paying for stuff that keeps you alive, and then when something like anti-venom or chemotherapy turns up in short supply, to wring its hands and plaintively cry "why doesn't somebody do something?" It isn't the first part that annoys me - if people want to be stupid, I'm fine with that. It's the second part; the part that has me feeling protectively for my wallet.

As for what is to be done, well, I leave the supposed quick fixes to the politicians. They're better at lying. The problem is intractable as long as you have people looking at the cost of their annual doctor's visits and routine blood work and screening, and then complain about it to their friends using their smart phone with its upgraded data plan, as they drive home to watch their cable TV. It is intractable as long as you have people who, far from being concerned about their mortality, are concerned about that wrinkle popping up next to their mouth, and ohmygod is that a gray hair?!

The problem is intractable because you can't really do anything to force a sea-change in incentives. People want what they want; they pay for what they want; incentive in the market derives from that, and try as hard as you may to change people, you will always be fighting a losing battle. Neither you, nor I, nor all the politicians in D.C. can change that; the only thing that changes that is actually staring into the abyss, and it is almost always way too late by then individually, and it doesn't happen to enough people for the masses to collectively get the point.

So I just listen to the screams of "why doesn't somebody do something?" and mentally disengage myself as much as possible, until I'm stressed enough that I scuttle out of my hole and take potshots at folks, and sometimes they probably aren't really deserved.

So again, I apologize, and stop hijacking the thread.
Thanks dport!

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Posted: 10/18/2011 7:50:01 PM
Originally Posted By PrivateContactor:
Originally Posted By Rodent:
It's expensive, it has a limited shelf-life, and it's hardly ever needed.


If you are outdoors in snake country, bring along an Extractor kit, and learn how to do a pressure bandage, which if quickly and properly applied can save your life, even on the deadliest of elapids. It will at least buy you a little time until you can get to medical help.



The latest thing on the extractor kit is that they can do more harm than good. I'm not a medical professional, but I was told one of the issues is that since the snake injects the venom deep into the tissue, you are extracting it through previously undamaged tissue and doing more harm.
The advice I got was ice, keep the site below the heart, pressure bandage, and haul ass to the hospital.
I carry pressure bandages and instant cold packs in my backpack.
Note to self: 2T2 is still not a pilot.
30calTBLkid
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Posted: 10/18/2011 7:51:03 PM
Originally Posted By scottedward58:
If you get bit by a poisonous snake the best thing you can do is hit the area with a high voltage shock such as from a stun gun, cattle prod, grill igniter, or from the ignition system from a gasoline engine. Strangely enough it is much more effective than antivenom. They believe the high voltage breaks down the venom. A high voltage shock only works though if you can do it before the venom has a chance to spread.


I've heard that as well, but never from a doctor.
Note to self: 2T2 is still not a pilot.
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Posted: 10/18/2011 9:22:02 PM
[Last Edit: 10/18/2011 9:51:49 PM by WildBoar]

Originally Posted By WaCPA:

"Red against yellow will kill a fellow."



Sadly folks cant remember it properly. I hear people say "Red and yellow is a fellow". Wrong of course but so many people mix it up. I tell them to just NEVER touch it. If they have to recall the saying in their head, they have no business touching the snake.

For ID purposes I just tell them to think of a stop light. "Yellow, Red, Stop" folks seem to remember that one as there is no other saying that even comes close and its something they can relate to.

Here is a little guy that was hunting skinks around my golf cart.
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Posted: 10/18/2011 9:24:18 PM
Originally Posted By WaCPA:


"Red against yellow will kill a fellow."





Only with North American corals. With South Americans(which can sometimes be found roaming warm states due to escaped or released pets) the oppisite is often true.
"The hawk does not fear you, boy, and the hawk never will. The hawk is God's gunslinger." -Stephen King
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Posted: 10/18/2011 9:27:31 PM
Originally Posted By 30calTBLkid:
Originally Posted By PrivateContactor:
Originally Posted By Rodent:
It's expensive, it has a limited shelf-life, and it's hardly ever needed.


If you are outdoors in snake country, bring along an Extractor kit, and learn how to do a pressure bandage, which if quickly and properly applied can save your life, even on the deadliest of elapids. It will at least buy you a little time until you can get to medical help.



The latest thing on the extractor kit is that they can do more harm than good. I'm not a medical professional, but I was told one of the issues is that since the snake injects the venom deep into the tissue, you are extracting it through previously undamaged tissue and doing more harm.
The advice I got was ice, keep the site below the heart, pressure bandage, and haul ass to the hospital.
I carry pressure bandages and instant cold packs in my backpack.


Cold packs are bad when it comes to pitviper bites too. Slows circulation and allows the venom to stay in a more localized area to destroy tissue instead of just damaging tissue.
"The hawk does not fear you, boy, and the hawk never will. The hawk is God's gunslinger." -Stephen King
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Posted: 10/18/2011 9:42:45 PM
Originally Posted By eastonj:
I took care of a guy about 3 months ago who got bitten by a huge tarantula from India and Sri Lanka. Apparently, he raises and sells/trades exotic spiders. This sucker was about 10" with the legs and bit him on the finger. It's fairly poisonous, but there have never been any reported fatalities. Unfortunately, there's no anti-venom for it. He was having severe, stabbing, burning pain all the way up his arm. Nausea, diarrhea, headache, rapid heartbeat, sweats, the whole deal. I got the species name and called poison control. They told me that you just treat the symptoms, cover for infection and tetanus, and wait for him to get better. We loaded him up on Valium, Percocet, antibiotics, tetanus shot, and nausea pills.

I saw him a couple of weeks ago. He was all better, but said that his arm hurt for about two weeks.

The weird part is this: He came in with his girlfriend, and she seemed like a very nice, pleasant, attractive, normal person. I asked her, "So, you actually sleep in the same house as this spider? How many spiders does he have?"

Her: "200".
Me: "What?!?!?!?!? I don't even want to live in the same zip code as your house." All the while I'm thinking that we need to lift off and nuke the site from orbit.

The spider was a Poecilotheria Pederseni. You can find it on Wikipedia. If I ever see one, it's going to require a 12 Gauge with Buckshot to take it down.


Even the bad bites from Old World Ts like Pokies, Baboons, Cobalt Blues etc still are nowhere in the league of a venomous snake.

Old World Tarantulas are not to be fucked with. They move lightning fast, bite multiple times, and have bad a demeanor.

New World Tarantulas are not bad bite wise. The flicking of urticating hairs into your eyes is much more dangerous.

Cain/Perry or Perry/Cain in 2012. The 2 best choices for America.

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30calTBLkid
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Posted: 10/18/2011 10:23:48 PM
Originally Posted By shack357:
Originally Posted By 30calTBLkid:
Originally Posted By PrivateContactor:
Originally Posted By Rodent:
It's expensive, it has a limited shelf-life, and it's hardly ever needed.


If you are outdoors in snake country, bring along an Extractor kit, and learn how to do a pressure bandage, which if quickly and properly applied can save your life, even on the deadliest of elapids. It will at least buy you a little time until you can get to medical help.



The latest thing on the extractor kit is that they can do more harm than good. I'm not a medical professional, but I was told one of the issues is that since the snake injects the venom deep into the tissue, you are extracting it through previously undamaged tissue and doing more harm.
The advice I got was ice, keep the site below the heart, pressure bandage, and haul ass to the hospital.
I carry pressure bandages and instant cold packs in my backpack.


Cold packs are bad when it comes to pitviper bites too. Slows circulation and allows the venom to stay in a more localized area to destroy tissue instead of just damaging tissue.


No shit? Now I've got something for show and tell.
Note to self: 2T2 is still not a pilot.
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Posted: 10/18/2011 10:25:01 PM
Originally Posted By shack357:
Originally Posted By 30calTBLkid:
Originally Posted By PrivateContactor:
Originally Posted By Rodent:
It's expensive, it has a limited shelf-life, and it's hardly ever needed.


If you are outdoors in snake country, bring along an Extractor kit, and learn how to do a pressure bandage, which if quickly and properly applied can save your life, even on the deadliest of elapids. It will at least buy you a little time until you can get to medical help.



The latest thing on the extractor kit is that they can do more harm than good. I'm not a medical professional, but I was told one of the issues is that since the snake injects the venom deep into the tissue, you are extracting it through previously undamaged tissue and doing more harm.
The advice I got was ice, keep the site below the heart, pressure bandage, and haul ass to the hospital.
I carry pressure bandages and instant cold packs in my backpack.


Cold packs are bad when it comes to pitviper bites too. Slows circulation and allows the venom to stay in a more localized area to destroy tissue instead of just damaging tissue.


No ice and nothing that can impede circulation like a pressure bandage.
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Posted: 10/19/2011 12:01:30 AM

Originally Posted By substandard:

Originally Posted By DamascusKnifemaker:
Originally Posted By Rodent:
It's expensive, it has a limited shelf-life, and it's hardly ever needed.


This

In Ireland it is the law that all food stores and drug stores keep anti-venom on hand for all indigenous snakes.















(waiting, waiting.....)

Finland is the same way. They call it Uhrho's Law.
My aim is not to pass laws, but to repeal them. -Barry Goldwater

There are lots of legitimate reasons for open carry but the most compelling is this: It is not the state's job to tell free men how and whether to carry arms. Any questions? -bluefalc
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