Wednesday, March 31, 2010
Please join us in remembering Dr. Goldwyn by reading his collected editorials, immortalized in the pages of PRS and gathered together in October 2004 in a special supplement.In 2004, the supplement of editorials by Dr. Goldwyn and tributes by a few of the people who had been close to him represented a small token of appreciation. Today, the supplement will serve as an enduring tribute to a wonderful scientific journal editor, physician, role model and friend.The supplement is complimentary and only available online at PRS.25 Years of Selected Editorials by Robert M. Goldwyn, MDJoin PRS in the weeks and months to come for further tributes to Dr. Goldwyn.
From PRS October 2004 - Volume 114 - Issue - p v
Biographical Note: Robert M. Goldwyn, M.D
Robert M. Goldwyn was born in Worcester, Massachusetts, in 1930. He attended Worcester Academy, Harvard College (A.B., 1952; Phi Beta Kappa, Magna cum Laude), and Harvard Medical School (M.D., 1956).He did his internship and residency in general surgery at the Peter Bent Brigham Hospital in Boston from 1956 to 1961. During this time he was the Harvey Cushing Fellow in Surgery at the Peter Bent Brigham Hospital. In 1960, he worked with Dr. Albert Schweitzer in Lambarene, Gabon.His plastic surgical training was at the University of Pittsburgh Medical Center from 1961 to 1963. He returned to Harvard Medical School and became Senior Surgeon at the Peter Bent Brigham Hospital and at the Beth Israel Hospital, where he was Chief of the Division of Plastic Surgery from 1972 to 1996. Since 1979, he has been the Editor of Plastic and Reconstructive Surgery and has authored or co-authored more than 300 articles and has edited several books: The Unfavorable Result in Plastic Surgery: Avoidance and Treatment (now in its third edition), Reconstructive Surgery of the Breast, Long-Term Results in Plastic and Reconstructive Surgery, and Reduction Mammaplasty.He has written The Patient and the Plastic Surgeon (two editions) and The Operative Note, a collection of his editorials, as well as a book for the general public: Beyond Appearance: Reflections of a Plastic Surgeon. With J. Saxe as translator, he wrote an introduction to G. Baronio's Degli Innesti Animali, 1804 (On Grafting in Animals). He also wrote the introduction for the first complete English translation by J. H. Thomas of G. Tagliacozzi's De curtorum chirur-gia per insitionem, 1597 (On the Surgical Restoration of Defects by Grafting, a facsimile edition).Dr. Goldwyn has served as President of the Massachusetts Society of Plastic Surgeons, the New England Society of Plastic Surgery, the American Association of Plastic Surgeons, which made him an Honorary Fellow, and the Harvard Medical Alumni Association.In 1972 he founded the National Archives of Plastic Surgery, housed at Harvard Medical School, and has since served as Chairman of the Archives Committee of the Plastic Surgery Educational Foundation.He was a founding member of Physicians for Social Responsibility and has written articles on world peace, opposition to chemical and biological warfare, and medical ethics.He has been Visiting Professor to more than 70 institutions, universities, and hospitals in this country and abroad and is an honorary member of more than a dozen national and international societies of plastic surgery. His other awards include the Dieffenbach Medal, the Honorary Kazanjian Lectureship, Clinician of the Year of the American Association of Plastic Surgeons, and the Special Achievement Award and the Presidential Citation of the American Society of Plastic and Reconstructive Surgeons. He has received numerous recognitions for his teaching and writing.
More information on this amazing man:
Boston Globe Obituary
Leonardo’s Hand – Dr. Robert Goldwyn
- Actively prewarm patients in preoperative area for approximately 1 hour with forced-air heating or resistive-heating blanket.
- Keep the ambient temperature of the operating room at a minimum of 73°F.
- Monitor core temperature throughout administration of general and regional anesthesia.
- Cover as much body surface area as possible with blankets or drapes to reduce radiant and convective heat loss through the skin.
- Actively warm patients intraoperatively with forced-air heaters or resistive-heating blanket to prevent heat loss and add heat content. Rearrange covers every time patient is repositioned to warm as much surface area as possible.
- Minimize repositioning time as much as possible so that the active warming method can be quickly continued.
- Warm intravenous fluids and/or infiltration fluids if large volumes are used. Warm incision irrigation fluids.
- Aggressively treat postoperative shivering with forced-air heater or resistive-heating blanket and consider pharmacologic intervention.
REFERENCESThe minimum OR temperature recommended in the literature is 22°C (71.6°F), and most researchers agree that an ambient temperature of at least 23°C (73.4°F) is better. Sessler recommends an OR temperature of 25°C (77°F). One study by El-Gamal and colleagues determined that nearly all cases of perioperative hypothermia could be eliminated if OR temperatures were 26°C (79°F).
Tuesday, March 30, 2010
Welcome to Grand Rounds – the health care blogosphere’s ultimate blog carnival.This week’s version is something special. I asked for posts only about health care reform, and I am overwhelmed by the response. Below are the leading voices of the health care blogosphere.It is the Mother of All Health Care Reform Blog Round-Ups.So, evacuate the dance floor- you’re about to be infected by the sound of health care reform blogging.
Howdy everyone! Welcome to Change of Shift, here for the very first time! And we’ve got a mini-party here today, just as promised.So, domo arigato! How would you feel with a New Robotic “Coworker“? He speaks to you, moves around you, and even prefers to ride the elevator alone! He’s sitting at the Man-Nurse Diaries and he’s waiting to help you lift a saline bag or fifty.
Small Business Tax Credits
Offers tax credits to small businesses beginning in 2010 to make employee coverage more affordable. Tax credits of up to 35 percent of premiums will be immediately available to firms that choose to offer coverage. ….No Pre-existing Coverage Exclusions for Children
Prohibits health insurers from excluding coverage of pre-existing conditions for children. Effective six months after enactment, applies to all employer plans and new plans in the individual market. (This provision will apply to all people in 2014)……….
In Georgia, a young man killed himself because he could no longer endure his bullies. And in Mass., bullies left a 13-year-old paralyzed.These cases and others like them have focused attention on bully behavior: Why do they do it, and do they change?
You likely heard that Massachusetts is finally considering an anti-bullying law. It’s about time!My kids have both been bullied over the years…have yours? It is one of the most challenging situations to handle in all of parenting and the dramatic increase in technology among today’s kids and teens and made bullying via technology a contributing factor. 25% of kids being bullied is too many already. 42% of kids being cyber-bullied is unthinkable…but is the estimated number being victimized via technology…….
Show 19: Bullies In Your Back Yard 3: An Ounce of Prevention by Becoming Great Digital Citizens (April 9, 2010; 11 AM)
an Arkansas native who was in the first class of architecture students at the university, taught at the architecture school for 35 years and served as its first dean. In 2000, the American Institute of Architects named Jones one of the 10 most influential architects of the 20th century and recognized his Thorncrown Chapel as the fourth most significant structure of the 20th century.
Nestled in a woodland setting, Thorncrown Chapel rises forty-eight feet into the Ozark sky. This magnificent wooden structure contains 425 windows and over 6,000 square feet of glass. It sits atop over 100 tons of native stone and colored flagstone. The chapel's simple design and majestic beauty combine to make it what critics have called "one of the finest religious spaces of modern times."
Unlike the ALQS3, Round 4 will allow all quilt types - traditional, modern, contemporary, art and any other designation you can think of.All quilts should be roughly between 16"x16" and 24"x24". They do not have to be square, but the total area should be approximately the same.
4/22: DG & Tiffany Hollums and their adoption journey
Monday, March 29, 2010
The earth quakes. Haitians suffer.
The world tweets updates, texts donations, waits anxiously wanting to do more.
The woman extends her arm willingly, squeezing a fist in gentle rhythm as the life giving blood flows.
*** Found in my blog drafts, decided to go ahead and publish it.
Unused and Old Medications (January 1, 2008)
Unused Prescription Medications (June 15, 2009)
American Chemical Society
American Pharmacy Association
White House Drug Policy
Sunday, March 28, 2010
Saturday, March 27, 2010
Desires change to her abdomen.
Here for her third consultation in the past two years.
Worried about the drains, the scar, the pain, the recovery time.
“I have two weeks between trips here. Can’t we schedule it then?”
“No, I don’t think so. You’ll need more recovery time.”
Friday, March 26, 2010
The back has a 4 in sleeve sewn for hanging the quilt.
Thursday, March 25, 2010
And, finally, try to have realistic expectations--it is unlikely that cosmetic enhancement is going to drastically change your life--after all, you are human, and not a plastic doll.
- In its simplest definition, it is an obsessive preoccupation with a slight, imperceptible, or actually nonexistent anatomic irregularity to the degree that it interferes with normal adjustment within society.
- This disorder may be present in varying degrees. It is the most common aberrant personality characteristic seen by the plastic surgeon.
- When postoperative dissatisfaction occurs (and in most cases, it will), it almost always is based on what the patient understood rather than what was actually said.
Wednesday, March 24, 2010
- "A" is for asymmetry (one-half of the mole does not match the other half);
- "B" is for border irregularity (the edges are ragged, notched, or blurred);
- "C" is for color (the pigmentation is not uniform, with variable degrees of tan, brown, or black);
- "D" is for diameter greater than 6 mm (about the size of a pencil eraser).
- Children should be taught the correct use of sunscreen. Sunscreen should be applied to all exposed skin at least 20 minutes before going into the sun, even if it is cloudy outside, and needs to be reapplied every 2 to 3 hours or more frequently if swimming or exercising. Use at least 1 oz per application, roughly equivalent to the volume of a shot glass.
- Select a product that contains the highest allowable percentage of zinc oxide (25%) and titanium dioxide (25%). Both do not undergo significant chemical change or photodegradation with exposure to UV light. Avobenzone (3%) is the only truly effective UVA absorber available and offers the greatest photostability.
- Everyone needs to wear a hat and sunglasses with 99% to 100% UVA absorption.
- Exposure should be avoided between the hours of 10 AM and 4 PM when the sun is the strongest. Sun-protective clothing and shade are helpful in avoiding exposure.
- There is no such thing as a safe tan. This includes those gotten in tanning salons.
Recent News Stories
Related blog posts:
Sun Protection (March 19, 2009)
Melanoma Review (February 25, 2008)
Skin Cancer—Melanoma (December 8, 2008)
Melanoma Skin Screening Is Important (April 29, 2009)
Skin Cancer -- Basal Cell Carcinoma (December 3, 2008)
Skin Cancer – Squamous Cell Carcinoma (December 4, 2008)
Moles Should Not Be Treated by Lasers (July 27, 2009)
Tanning Beds = High Cancer Risk (August 3, 2009)
Incidence Estimate of Nonmelanoma Skin Cancer in the United States, 2006; Arch Dermatol. 2010;146(3):283-287; Howard W. Rogers; Martin A. Weinstock; Ashlynne R. Harris; Michael R. Hinckley; Steven R. Feldman; Alan B. Fleischer; Brett M. Coldiron
Increased Risk of Second Primary Cancers After a Diagnosis of Melanoma; Arch Dermatol. 2010;146(3):265-272.; Porcia T. Bradford; D. Michal Freedman; Alisa M. Goldstein; Margaret A. Tucker
Economic Burden of Melanoma in the Elderly Population: Population-Based Analysis of the Surveillance, Epidemiology, and End Results (SEER)–Medicare Data; Arch Dermatol. 2010;146(3):249-256; Anne M. Seidler; Michelle L. Pennie; Emir Veledar; Steven D. Culler; Suephy C. Chen
Tuesday, March 23, 2010
In January 2006, Harvey P. Cole, M.D., of Atlanta Oculoplastic Surgery, d/b/a Oculus, performed CO2 laser resurfacing and a full facelift on appellee Betty Nestlehutt. In the weeks after the surgery, complications arose, resulting in Nestlehutt’s permanent disfigurement. Nestlehutt, along with her husband, sued Oculus for medical malpractice. The case proceeded to trial, ending in a mistrial. On retrial, the jury returned a verdict of $1,265,000, comprised of $115,000 for past and future medical expenses; $900,000 in noneconomic damages for Ms. Nestlehutt’s pain and suffering; and $250,000 for Mr.
Nestlehutt’s loss of consortium.
I want to thank you all for contributing such wonderful posts for this week's Grand Rounds. And, thank you for allowing me to make it a "women’s” theme as March is the month of International Women’s Day and Women’s History Month (here in the United States).
Sterile Eye tells us the story of Jan van Rymsdyk – Drawer of Wombs. Here is one of the beautiful sketches included in the post.
In October 2008 I visited the Hunterian Museum in Glasgow, where William Hunter’s great book of obstetrics was on display. Published in 1774, The Anatomy of the Human Gravid Uterus did much to advance the understanding of human pregnancy. The book contains 34 copper engravings. 31 of these magnificent medical illustrations were made by a mysterious man called Jan van Rymsdyk.
Our medical librarian Laika, Laika’s MedLibBlog, tells us about a wonderful woman scientist in her post Stories  – Polly Matzinger, the Bunny & the Dog.
….He continued with his typical Czech accent, serious but with a twinkle in his eyes.
“It is a SHE” …….
“It is a she and ….… a very beautiful one”
Then he told us that Polly Matzinger, for that was her name, was once a Playboy bunny and a waitress at a bar frequented by scientists………..
The building had four stories. In a narrow street in Baoji, west of Xi'an, the damp shell of a structure housed backpackers on its top three floors. The dorms exuded marijuana, travel must and provided many visitors with a fresh case of athletes' foot or worse. The occupants sat, huddled in the subzero temperatures playing cards and sharing a bong, partly for warmth, partly just to negate the feelings of loneliness and despair Baoji seemed to extract from twenty-something global travelers. …….
…... The poem is about Beth’s effort to imagine this patient’s experience and to empathize with her suffering…….
Let me know what you think of the poem.
Leylo and the Land Mine *
An ebony leg leaned
against the clinic wall,
on its sandal-clad foot
R.N. just died.
She was my first breast cancer patient out of fellowship and training. My first breast cancer patient where I was the "doctor". No backup. Nobody to turn to for advice. I write the orders, I explain the side effects. I hold the hands.
From Mothers in Medicine comes the first Topic Week post: Tips for Surviving Call while Pregnant. There are actually, good tips for non-preggers folks too. There are ten great tips. Check them out and check out the blog.
……….An advocate is someone who realizes there is a lot more to a successful outcome (surgical or otherwise) than simply what data reveals.
We all deserve advocate
Kevin,MD feels Pelvic exam simulators do medical students a disservice due to the missing communication (feedback) between patient and doctor
….no matter how good the simulator is, it cannot replicate an actual person. Especially for men, doing a pelvic exam is more than the procedure itself, but learning how to interact with the female patient from beginning to end……
Dr Am Ang Zhang, The Cockroach Catcher, notes this is the 30th Anniversary of the National Women’s History Project with her post: NWHP: Writing Women Back into History. “It was an interesting experience looking back at “treatment modalities” of mental disturbance in one of the most cultured city in Europe at the start of the 20th Century.”
Step over the red line
Stripped of dignity and clothes…
One of the most striking features of those suffering from anorexia nervosa is their perception of their bodies. You can put them in front of a mirror and they will still tell you they’re to fat when in fact they’re skinny. A recent publication in Nature Proceedings has an explanation
Mmmm. I just discovered non-homogenized milk – the kind with the thick layer of cream on top and more watery milk below. You have to shake it up before each serving, and the little flecks of buttery cream never quite disappear. …. But the taste is far superior to homogenized milk. Think milk with a hint of butter.
And while Dr Charles makes the point “In terms of diet, weight loss, and optimal health, moderation seems prudent” Bob Vineyard, InsureBlog, writes about a woman who doesn’t seem to believe in moderation. Bob ask Who is the Biggest Loser?, the woman who wants to gain weight or society who will end up paying for her efforts. (photo credit)
Donna Simpson is proud of her plus size 600 pound figure and wants everyone to know it. Her 150 pound husband not only approves but is encouraging her to continue her pursuit of tipping the scales at 1000 pounds.
Happy Hospitalist weighs in on the same woman in his post: Super Morbid Obesity: Woman Proclaims "I Want To Be 1000 pounds. Happy and I both see this as a sad story of a woman who's main goal in life is to weight 1000 pounds so men can watch her eat in bikini.
It seems apparent that Mrs. Simpson doesn’t care to exercise, but I am a fan of exercise. I believe it is important for good health. So does Dr. Ves Dimov, Clinical Cases and Images: CasesBlog, who tells us How to Exercise While Blogging or Doing Other Computer Work. Good information!
Dr. Jolie Bookspan, The Fitness Fixer, relays how New Healthy Employment Programs for Developmentally Disabled can be accomplished.
Peggy Santamaria is bringing my healthy daily life techniques to developmentally disabled adults. She has made a new program to transition developmental disability to Developmental Ability. After her success story appeared - Shoveling Snow - Reader Wins Mother Nature's Fitness Challenge with Fitness Fixer,…
Did you know that a history of abuse - emotional, physical and sexual – is common in women who have headaches. A history abuse is also associated with depression and stress. So reports a new study by Gretchen Tietjen, a Professor of Neurology at the University of Toledo and Director of their Headache Treatment and Research Program.
An oncologist friend spotted my blog post (Overuse of mammography in elderly women with cognitive impairment) …..…..
I’d like to see the debate broadened to include a frank discussion of the potential harm from too much screening. Excessive screening and associated harm to the frail elderly population is one aspect of that story.
Women are talking about their bodies and their health - which is good! Right?
You would not think so if you are following the debate around the new UbyKotex.com marketing campaign, which I think is brilliant! …….
Joseph Kim, NonClinicalJobs.com, ask if the question To CME or not to CME?
The other day, I was speaking with a physician about job opportunities in the CME (continuing medical education) industry. There are fewer jobs in CME compared to 5 or even 3 years ago. Why?
….I know we should avoid generalizations, but isn't it the case that all social workers are nice? Perhaps it is this niceness, combined with their knowledge and skills that makes them so indispensable. …….
Geriatrics practice would be impossible without social workers.
One of the web's more popular doctor bloggers, the
anonymous* Dr. Lucy Hornstein (aka #1 Dinosaur - her blogging pseudonym), recently posted an entry titled: Palliative Care: An Unnecessary Specialty.
Now before you get too mad or defensive (like I first did), go read the post and the comments. She is a family medicine doctor and the main thrust of the article (despite the provocative title) is that all doctors and especially primary care doctors should be skilled in palliative care. …….
David Harlow, Health Care Law Blog, interviewed Peter Neumann, Director, Tufts Center for the Evaluation of Value and Risk in Health, about the role of cost-effectiveness research in health care policy.
The national debate on health care reform is currently focused on health insurance reform -- coverage, one of the proverbial three legs of the health care reform stool: coverage, cost and quality.
In order to bend the cost curve -- no matter what the approach to health care reform: be it federal legislation, state initiatives, federal pilots and demonstration projects, and/or private sector initiatives -- most would agree that we need a rational approach to cost-effectiveness research, or comparative effectiveness research that we can all rely upon……….
Kim, Emergiblog, has some thoughts regarding health care reform legislation which she addresses in her post: between the lines of fear and blame
…..Our system has issues, no question.
So, will the new health care legislation make for healthier communities by providing jobs, parks, grocery stores, education opportunities and health care clinics to poverty-stricken neighborhoods?……
Dr. Mary Johnson, Dr J’s HouseCalls, tells us about the horrific ordeal of being sued for “libel” even though the suit was unsuccessful in her post: On Oprah Winfrey And Nomvuyo Mzamane And A Defamation Lawsuit In Philly.
part of the job is to treat some unsavoury people. sometimes you know what it is they have done. mostly you don't. sometimes you even may make a difference. but mostly you just do your job. after all it is not our part to play judge and jury (and, in our case, executioner)……..
….It’s true I am fascinated by the concept of risk, and decision-making in environments that are time-pressured and information-limited. Nevertheless, Dr. David Schriger raised more than a few points in his talk that even the most ‘risk averse’ person would find interesting, some of which I’ll discuss below…….
Beka, Medscape Blogs, wants to hear from fellow nurses regarding input about Charge experiences.. has it changed over time...? Do You Recall Your First Shift Charge Nurse Experience? (free registration required).
Amy, Diabetes Mine, wants to educate us on the FDA Hearings on Blood Glucose Meters – A Patient Advocate’she Perspective
Experts are always split on these issues it seems, so I’m sure you are as curious as I am as to what came out of this great debate. I was fortunate to spend some time on the phone with Ellen Ullman, a patient advocate and research associate at Close Concerns — who was the ONE AND ONLY PATIENT REPRESENTATIVE invited to speak at these FDA hearings.
Next week Grand Rounds will be hosted by Evan Falchuk, See First Blog. Thanks to Dr. Val Jones and Dr. Nick Genes for the work they do to ensure the continued success of Grand Rounds. If you would like to be a future host, please contact Nick.
Monday, March 22, 2010
There is an extensive table listing the preferred biopsy site for different suspected pathologies. Some of those listed include:This is probably the most important question for healthcare professionals dealing with wound care. Benefits of biopsy in a wound can be divided into 3 groups that reflect the 3 main causes of wounds in general:
1. to diagnose the etiology of a wound (wound edge),
2. to rule out malignancy (wound edge), and
3. to obtain tissue for bacterial quantitative culture or to identify an infecting organism.The next question to consider is: Are there any contraindications to wound biopsy?
There are 2 relative contraindications to wound biopsy11:
1. blood dyscrasia with the risk of uncontrollable bleeding
2. venous congestion and extremely vascular wounds (arterial insufficiency) in a setting that access to care is limited or the biopsy wound is unlikely to heal.
- Basal cell carcinoma (superficial) -- It is best to do a shave or curette biopsy of the rolled margin.
- Basal cell carcinoma (other variants) – It is best to do a deep punch or excisional biopsy of the base or wound edge.
- Squamous cell carcinoma -- It is best to do a punch or excisional biopsy of the deep wound base.
- Pyoderma gangrenosum -- It is best to do a punch or deep wedge biopsy of the wound ulcer border and center. The biopsy should include cultures to rule out infection.
- Vasculitis (large vessel) – It is best to do a deep incisional wedge biopsy of the center of the lesion. DIF (direct immunofluorescence) should be considered.
Sunday, March 21, 2010
You know, I am hearing a lot about March Madness from my American friends on twitter and facebook. I am not knowing what that really means, but I am thinking it must have something to do with their healthcare reform bill which I am growing sick of hearing about. So I was thinking I will use this March Madness thing as a theme for this edition of SurgeXperiences. Since I am already telling you that I am not knowing anything about what this March Madness is about, I am going to let you guess how I am using it as my theme. *
Saturday, March 20, 2010
Friday, March 19, 2010
I made this quilt using some of the left over autograph blocks from the Blog World Expo quilt. It is a baby quilt for a niece who is due in June (my husband’s youngest brother and his wife). The quilt is machine pieced and quilted. It is 34 in square.
Thursday, March 18, 2010
Wednesday, March 17, 2010
“a motor disorder characterized by a velocity-dependent increase in tonic stretch reflexes (muscle tone) with exaggerated tendon jerks, resulting from hyper-excitability of the stretch reflex as one component of the upper motor neuron syndrome.”
FDA News Release
Tuesday, March 16, 2010
Welcome to Grand Rounds Vol 6 No 25. Grand Rounds is a weekly summary of the best health blog posts on the Internet. I wish to also extend a special thanks to those medical bloggers who are participating in Grand Rounds for the first time. This week, we had many submissions, so let's get started.
It's not too late to donate.Heading down for the shaving. Zippy didn't make it, alas. Pics to follow soon. Donations total $10,500 as of this moment. Yay!Also, taking a moment to remember Nathan Gentry and Henry Scheck, the reasons we go through with this whole affair.Had a very productive day. Fixed the kitchen faucet AND shaved my head for kids' cancer! http://bit.ly/bWfyGi Guess which one was harder...The razor left about 1/8-1/4 inch of stubble behind. Gotta go shave clean now. Wouldn't be giving my donors their money's worth otherwise.
As a bereaved father of two children, my mission is to leave a legacy in honor of my daughter Katie and my son Noah who left this world all to soon.Based on my own realization and first hand knowledge of the lack of support services and information available to fathers suffering the loss of a child, I have chosen to reach out to all men that are traveling this lonely and what appears to be a never ending road known as unspeakable loss.The goal of this site is to ultimately create a social documentary focused on a cross-section of bereaved fathers and tragic circumstances related to child loss. Men of all ages, locations, ethnicity, socio economic status and religious beliefs are welcomed at this site, regardless of the circumstances of your loss…..
The middle-aged woman lay in the intensive-care unit, observing the tumult around her. …….In the afternoon she had taken her teenage daughter shopping. As her daughter disappeared down an aisle, the woman struggled to keep up. Her breath was rapid and ragged. She could hear her blood pounding with each heartbeat. Suddenly the whole right side of the world seemed to go out of focus, color and shapes blending together. She didn’t want to frighten her daughter, so she said nothing. “Please just let me get home,” she prayed silently. She drove with her bad eye shut, and when she got home she promptly lay down. ……When the patient arrived at the emergency room, her blood pressure was 225/115 — terrifyingly high…….
A new patient blog, VERY good writer: Gastrically Changed. (Gastric bypass pt, labor & delivery RN) http://is.gd/a9T3e
Mammogram screening for breast cancer continues to simmer in the news.The recent USPSTF guidelines, no longer recommending a routine mammogram for women between the ages of 40 and 49, continue to stir controversy between physicians and their patients.In a recent survey from the Annals of Internal Medicine, it looks like the debate between doctors and patients will continue for the foreseeable future…….
Since South American fire ants arrived in Mobile, Alabama, in the 1940s, they have spread to become one of the most reviled pests in the Sunbelt. There have been several failed, and heavily politically influenced, eradication campaigns. The fire ants (red or black) are very aggressive and build nests in mounds of fresh soil.
Say you live in jazz-age New York and want to get rid of someone — but you don't want to get caught. What would be your poison of choice?Author Deborah Blum recommends arsenic — otherwise known as "inheritance powder" — which was pretty much untraceable until the 1920s."Arsenic, as it turns out, is fairly tasteless, and if you give it at just the right dose ... you can actually make it mimic a gastrointestinal illness," Blum tells NPR's Guy Raz. …….
In 1942, the United States was faced with a severe shortage of pilots, and leaders gambled on an experimental program to help fill the void: Train women to fly military aircraft so male pilots could be released for combat duty overseas.The group of female pilots was called the Women Airforce Service Pilots — WASP for short. In 1944, during the graduation ceremony for the last WASP training class, the commanding general of the U.S. Army Air Forces, Henry "Hap" Arnold, said that when the program started, he wasn't sure "whether a slip of a girl could fight the controls of a B-17 in heavy weather."
3/25 : Gerry Tolbert
Monday, March 15, 2010
Sunday, March 14, 2010
Saturday, March 13, 2010
Friday, March 12, 2010
Imagine antique quilt blocks, trims, color palettes, and stitches translated and transformed by state-of-the-art sewing machines, vibrant modern fabrics, and new techniques by the innovative quiltmakers of today.
It is a quilt I’m not sure I want to give up, so as a trial run I have put it up for sale on Etsy. If it doesn’t sale by the contest’s entry date, then I will enter it in the contest.
Thursday, March 11, 2010
In the March 3, 2010 issue of JAMA, there is a poem by Sarah Wells called “Hymn of Skin.” While I enjoyed the whole poem, my favorite part is:
Plastic surgeon of the heavens, how I delight
in a furrowed brow, crow's feet, age spots—
wrinkle me up a dozen times to show I lived
hard, good, funny—after all beauty, being what it is,
is only skin deep—may my soul seep through
dry scales of later hands, resting tranquil in my lap.
O omniscient dermatologist, what ingenuity,
past hurts evident in scrapes and scars—
a clumsy stumble down uneven concrete stairs,
knees and ankle raw and dripping; pockmarked cheeks
from teenage zits—all healed, in the end, but not forgotten.
How often we need reminders of where we’ve been.
Wednesday, March 10, 2010
Here is part of the opinion statement from Dr. Rudnicki published online:
Given the ever-increasing problem of obesity, it is not surprising that the number of patients who undergo bariatric surgery continues to rise. ………….Ideally, one would like to prevent these neuropathies, but there is no consensus of opinion as to what vitamins and micronutrients need to be taken following bariatric surgery. In addition, many patients who take supplements early on fail to maintain the regimen even though some of the neuropathies can occur fairly late. Supplements frequently recommended include a multivitamin, iron, vitamin D, folic acid, calcium citrate, and vitamin B12. Although thiamine is typically included in a multivitamin, the amount is fairly small, so I recommend adding 100 mg daily for at least the first year. Some have suggested zinc supplementation, but this is potentially problematic because exogenous zinc may interfere with copper absorption. Obtaining blood work every 6 months after surgery will help to identify and treat nutritional deficiencies early.For those patients who have had a bariatric procedure and then develop a neuropathy, evaluating levels of thiamine, copper, vitamin B12, methylmalonic acid, and homocystine is indicated. In addition, since one deficiency is frequently associated with others, obtaining levels of vitamin A, C, D, K, and E, as well as iron, zinc, selenium, and magnesium is worthwhile. Checking total protein, albumin, and cholesterol also gives a sense of general nutritional status. Occasionally, no clear-cut deficiency of a vitamin, mineral, or trace element can be identified in patients with various peripheral nervous system manifestations. Nevertheless, these patients may have at least some recovery with improving nutritional intake and vitamin supplementation, suggesting that we still do not fully understand how nutritional status affects the peripheral nervous system.
Tuesday, March 9, 2010
David E. Williams' Health Business Blog is this week's host of Grand Rounds. You can read this week’s edition here.
Welcome to Grand Rounds 6:24. Regular readers know I provide a mix of health care wonkery, cheerleading of entrepreneurs, and light-hearted, humorous Grand Rounds. But this week’s batch of submissions is mostly in the pain and suffering category.If you think I’m joking, read on.Pain and sufferingOther Things Amanzi is profoundly affected by the death of a kidney transplant patient. The fellow walked into the hospital with the realistic hope of life without dialysis and departed on a cold morgue slate. Can’t win ‘em all, but that’s not much comfort in this case.
A year ago I was still in nursing school and in total awe of all the nurse bloggers I was reading when I should have been studying. Now not only am I working my dream job, I am hosting Change of Shift! It is such an honor to be counted among the ranks of all those nurse bloggers I am still so in awe of. I hope you all enjoy reading this edition.We’re starting off with Mother Jones and her commentary on Change of Shift: The Art of Giving Report. It really is an art……
Yup, St Patrick's day is soon approaching, and that means that St Baldrick's day is also approaching….This is my third year doing this, and I do it in memory of my friend Nathan Gentry, who lost his battle with Neuroblastoma at age seven, and in memory of Henry Scheck, who passed away from Medulloblastoma.Thanks for your consideration.
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…If you adore Science Verse, the same author and illustrator have given us Math Curse, Scieszka and Lane, Viking, 1995.A young student with math anxiety discovers that his whole life is comprised of various math problems, but fortunately, math also offers him a solid solution. The illustrations are just as epic in silliness as Science Verse, as are the problems he encounters. From the moment he gets out of bed, he's presented with math problems as he tried to get dressed for school:I have 1 white shirt,
3 blue shirts,
3 striped shirts,
and that 1 ugly plaid shirt my Uncle Zeno sent me.
How many shirts is that all together?
How many shirts would I have if I threw away that awful plaid shirt?
When will Uncle Zeno stop sending me such ugly shirts?
Everything seems to be a problem.
Check out nice article on my blog: http://www.boston.com/bostonglobe/editorial_opinion/oped/articles/2010/03/05/health_and_care/
PRIMARY CARE medicine may be on the decline in prestige and pay, but the fancy surgical specialties can’t offer the same daily dose of satisfaction, heartbreak, and connection. Judy Paley, a primary care doctor with a two-person practice and a load of bills in Denver, has started a blog brimming with what she calls “close encounters of the life-saving kind.’’ Reading it is good for what ails you.
One of the cornerstones of medical ethics is the concept of patient autonomy. MedicineNet.com provides a succinct definition: “The right of patients to make decisions about their medical care without their health care provider trying to influence the decision. Patient autonomy does allow for health care providers to educate the patient but does not allow the health care provider to make the decision for the patient.”……..
It's Tree Streets, an urban forestry project that is no more complicated than planting trees along public right of ways in the center city. It is about to plant its 1,000th tree. Think of the canopy of shade this work will provide for years after all the hole diggers, planters and waterers are gone.
3/18 : Dr. Lucy Hornstein from Musings Of A Dinosaur
Monday, March 8, 2010
In the setting of capsular contracture, physical examination with or without mammogram is as accurate as magnetic resonance imaging in determining implant integrity. Although magnetic resonance imaging is a sensitive diagnostic tool, in symptomatic patients with capsular contracture, it cannot be viewed as infallible