Here is a view of the back to show the quilting.
Friday, April 30, 2010
Here is a view of the back to show the quilting.
Thursday, April 29, 2010
When the band fades to light pink, it is recommended to reapply sunscreen on your body and on the band.
When the band turns pale yellow, it is recommended to cover up or get out of the sun.
The bands are made of recycled plastic. Recycle them after use.
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)
Skin Cancer (March 24, 2010)
Wednesday, April 28, 2010
Hi I just came across this and I’m wondering if there’s anyone out there that can give me advice. I suffered an orbital fracture 3 years ago resulting in double vision. I had surgery once and it didn’t work. I still live with double vision and I’m thousands in debt. If there’s anyone out there that could give me advice it would be greatly appreciated (charity programs, grants, anything). My email is email@example.com
Here is a second essay from Dr. Robert Goldwyn’s book “The Operative Note: Collected Editorials” (published in August 1992).
Knowledge: What Kind and How Much?
A few years ago, when my daughter was a high school sophomore, she asked me to help her prepare for a biology quiz. She was astounded that this paterfamilias, a certified physician, was ignorant of the precise base sequence of DNA-RNA. In self-defense, I said that most of my colleagues would probably fail her test but were good doctors nevertheless.“but how can they take care of patients properly if they don’t know all about these important nucleic acids?” she asked.“Surprisingly,” I replied, “they do very well.”This incident, aside from revealing my daughter’s knowledge and my lack of it, is relevant to the greater considerations of learning – What kind and how much? Publilius Syrus, known for his maxims in the first centery B.C., said: “Better be ignorant of a matter than half know it.” Many centuries later, Alexander Pope expressed the same thought in his famous “a little learning is a dangerous thing.” Huxley’s retort was “Where is the man who has so much as to be out of danger?” In truth, most of us are in various stages of ignorance.A medical student asked me, “How much basic science do I have to know to be a good doctor?” The question, which may be unanswerable, is nevertheless perennial. Because knowledge and wisdom are not synonymous, the central query is how much of each is necessary. Any answer must take into account the individual’s needs at a particular time. Students regularly complain about the irrelevance of the material they must digest, and teachers constantly chide them for their lack of perspective in not realizing that what may seem useless today may be helpful tomorrow. What to teach and what to learn have stimulated curriculum committees to produce ponderous reports that rehash everything and resolve nothing. Rare is the year without another “definitive” statement on the aims and strategies of education.The human being functions astonishingly well knowing comparatively little. Global enlightenment is unnecessary. For most people, making a living in our complex society demands narrowness not breadth. We are job-specific. Major league pitchers would fail a high school physics test on mass, velocity, friction, and wind currents, yet they could easily strike out every professor at the Massachusetts Institute of Technology. So also can a doctor do considerable good for a patient with more know-how than knowledge. Deplorable, perhaps, but true.Let us take the example of reconstructing the breast in a 45-year-old woman who has had a mastectomy. How many plastic surgeons could discourse on the hormones at menopause? Could we pass a thorough examination on the various ways of treating breast cancer: radiation, chemotherapy, surgery? Are we well read in the history of each of these therapies? Do we have a picture in our minds of the histology of the most common kinds of breast cancer? Do we know the chemical structure of silicone and how the implant is made? During the procedure are we familiar with the anesthetic agents and their pharmacology and physiologic effects? Do we understand the manufacturing process of the surgical blade and suture material? And what about wound healing, not only the names of the classic stages but the biochemical and biomechanical aspects? Certainly, it would be better if we had this knowledge. However, even if we possessed it, we still would have to know when to operate, on whom, and how. And what about the not-so-small matter of being a compassionate physician with psychological understanding of this unfortunate person and a feeling of permanent responsibility toward her?This editorial is not a plea or an apologia for ignorance, not is it a eulogy to it. It is an attempt to recognize things as they are. Often we are hypocritical in being hypercritical. We usually demand more knowledge from others than from ourselves. Furthermore, within the medical sphere, if we are honest, we would admit that many errors arise not from lack of knowledge but from absence of what moralist one called “character.” In this situation, what motivates the doctor may imperial the patient to the detriment of both.Unfortunately, I cannot offer a solution to the problem that prompted this editorial: Knowledge: What Kind and How Much? What is certain, however, is that knowledge without wisdom is like a ship without a rudder. Correct timing and the proper application of information hopefully come with experience. Yet, as someone observed, there is a difference between a person who has 20 years of experience and someone with 20 years of 1 year’s experience. Let us hope, at least, for the former.
Tuesday, April 27, 2010
Hey laaaaadeeeeez! It's time again for Grand Rounds, ChronicBabe style, which means we've curated a collection of posts that are completely babelicious. We hope you enjoy this gathering of doctors, nurses, patients and just regular folk who like to write about medicine. And women.
A made-for-TV documentary, 55 minutes long and entitled Chasing Zero: Winning the War on Healthcare Harm, is being shown four times globally beginning April 2010 on the main Discovery Channel. After it has aired, a commercial-free DVD will be produced and distributed for free to all U.S. hospitals by TMIT, and will be sent to the chairmen of the governance boards and their CEOs. A second hour of content composed of digital short stories and concept messages will be added to the DVD.
This paragraph of Drew’s post struck a chord with me:Critical Care Medicine has a fascinating qualitative study about surgeons and end of life care which speaks directly to this, and similar, situation. It's an excellent paper for the teaching file, particularly for fellows who don't have surgical backgrounds (which I assume is most, but thankfully not all, HPM fellows these days).The paper presents a small qualitative study of 10 physicians (mostly surgeons; a few non-surgeons who do extensive work in SICUs) …. and attitudes towards advance directives, ……..
I have a distinct memory of one of my attendings, early on in my palliative fellowship, talking with me about surgeons. ……. My attending told me something like 'Surgeons have a bond with their patients that is much stronger than internists. If you cut someone open, it changes your relationship with the patient in a way that internists just don't have.' I thought to myself at the time that that was really weird. Surgeons are cold heartless scalpel jockeys - how could they have a bond deeper than my patient-centered, humanistic, whole-person approach? Well like a good fellow I remembered what he said, and slowly came to realize he was right…..
At first I went into denial. …..I realized that the only choice not available to me was whether or not I had Parkinson's. Everything else was up to me. By choosing to learn more about the disease, I made better choices about how to treat it. This slowed the progress and made me feel better physically. …...So let me make this suggestion. Don't spend a lot of time imagining the worst-case scenario. It rarely goes down as you imagine it will, and if by some fluke it does, you will have lived it twice. When things do go bad, don't run, don't hide. It will take time, but you'll find that even the gravest problems are finite, and your choices are infinite.
I could tell it hurt by the expression on his face….I prepared the second needle,... Decided to tell a story while I was doing the fine needle aspirate ….."I was recruited hard by my high school basketball coach, because of my height. I was pretty shy in high school, so I resisted him for a long time. I realize in retrospect he probably looked at me and had big dreams of making a star."………….As I pulled the needle out of his skin I noticed his eyes were all crinkled up and there were tears forming at the corners. I worried that I had hurt him, but he started laughing uncontrollably.
"That is the funniest basketball story I have heard in a long time."
I smiled, pleased I was able to entertain him.
Do you have orphan blocks–blocks you made and loved but for which you have no project in mind? Then you might consider making a useful, beautiful tote bag of your own.This bag is approximately 12 inches high and 16 inches wide (at the top edge). The bottom is 8 inches square. It is constructed from 6-inch pieced quilt blocks and squares of fabric. It is based on Gay's So Sew Easy Schlep Bag pattern, which you can download from the linked page on her Sentimental Stitches site. My Summer Tote differs in the following ways:………….
5/6: Dr. Daniel Lewis, Family Physician, Talking about recent mission trip to Central America
5/13: Medical Student and Video Blogger, Bryan McColgan
5/20: Larry Bauer from the Family Medicine Education Consortium
Monday, April 26, 2010
On a recent trip to Hawaii, I learned that in the Polynesian dialect spoken there, the word for surgeon is kauka oki: doctor (kauka) who cuts (oki). While some of us surgeons might resent such a graphic, “cut and dry” definition, we cannot deny its verity. No matter how we may slice it, a surgeon is a doctor who makes incisions. In fact, the origin of the word surgery is Greek, from cheir, meaning “hand,” and ergon, meaning “work.” That surgeons work with their hands did not always bring honor. Centuries ago, one recalls that those who cut on others, with their permission, generally held a lower status than those who eschewed the knife.At the bottom were the barbers, and slightly above them, the surgeons. In England in 1462, the Guild of Barbers became the Company of Barbers, and under Henry VIII, the Barber Company was united with the smaller Guild of Surgeons to form the United Barber-Surgeon Company. In commenting on Henry VIII’s role in this episode, Garrison cites the painting by the younger Holbein, the court painter: “Henry VIII—huge, bluff, and disdainful—in the act of handing the statute to Vicary [Thomas Vicary, First Master of the United Barber-Surgeon Company], in company with fourteen other surgeons on their knees before the monarch, who does not condescend even to look at them.”1 Perhaps Henry was irate at having to leave his dinner table and his newest wife.The metamorphosis from the lowly barber to the glamorized surgeon has been long. I am sure that Henry VIII did not envision the consequences of his royal decree. The seesaw of history is marvelous as long as you are on the upswing. The rise of the surgeon did not erase the schism (in fact, it may have intensified it) between the so-called thinkers and the doers. This enmity, although lamentable, is centuries old. some, however, such as Lanfranchi of Milan (the first to describe concussion of the brain and to distinguish between cancer and hypertrophy of the female breast), did rise above the petty, professional fray. In his Chirurgia Magna, completed in 1296, he wrote:
- Why, in God’s name, in our days, is there such a great difference between the physician and the surgeon? The physicians have abandoned operative procedures to the laity, either, as some say, because they disdain to operate with their hands, or rather, as I think, because they do not know how to perform operations. Indeed, this abuse is so inveterate that the common people look upon it as impossible for the same person to understand both surgery and medicine. It ought, however, to be understood that no one can be a good physician who has no idea of surgical operations and that a surgeon is nothing if ignorant of medicine. In a word, one must be familiar with both departments of Medicine. 2We do accept the fact today that the best surgeon is one who knows not only how to operate, but when not to. Harvey Cushing, about the time that he became the first Surgeon-In-Chief of the Peter Bent Brigham Hospital, Boston, said in his letter to his counterpart in medicine, Henry Christian: “I would like to see the day when somebody would be appointed surgeon somewhere who had no hands, for the operative part is the least part of the work.” 3Cushing, of course, did have hands, good ones, and more important, a superior brain, which he used prodigiously. His remark was a hyperbole that reflected his correct view of surgery; it must grow from research and basic sciences and from its application to clinical problems. Surgery, despite the awe it now has (for those who doubt this, see the afternoon “soaps”), represents a failure of nonoperative medicine. Who would not want to take a pill rather than undergo an operation for cholecystitis, breast cancer, or benign prostatic hypertrophy if the results were the same? Would not genetic engineering by medication to prevent facial clefts be preferable to repairing them, no matter how meticulous and innovative the surgeon? The thought that a capsule could safely enlarge or reduce breasts or salve could eliminate Dupuytren’s contracture or a prominent dorsal hump may seem too fanciful even for the most imaginative, yet landing a man on the moon and retrieving him without mishap has long been a fait accompli. However, since medical Shangri-La is many years hence, we heirs of Pare will be continuing our manual ministrations, our barbers’ burden.
References1. Garrison, F.H. An Introduction into the History of Medicine with Medical Chronology. Suggestions for Study and Bibliographic Data, 4th Ed. Philadelphia: Saunders, 1929; reprinted in 1960. Pp. 238-240.2. Lanfranchi of Milan. In M.B. Strauss (Ed.), Familiar Medical Quotations. Boston: Little, Brown, 1968. P. 583.3. Fulton, J.F. Harvey Cushing: A Biography. Springfield, Ill.: Charles C. Thomas, 1946. P. 352.
Sunday, April 25, 2010
Saturday, April 24, 2010
- You will get the tax write-off, not KFC.
- You might avoid a heart bypass procedure by eating healthier at home or elsewhere.
A 10-piece bucket of KFC fried chicken (including the sides) costs about $20. If you're really interested in supporting Komen for the Cure's efforts, why not just mail them a check directly?
“All done, just need a dressing.”
“Can you take a photo? I want to show my friends,” the teen holds out his cell phone.
“Sure, how’s your phone's camera work?” removing my gloves, I reach take the phone. “Do you want to know how many stitches?”
“No, just the pictures. Push this button.”
Friday, April 23, 2010
Last Friday I posted about Global Quilt Project Seeks Quilters Worldwide. I made/finished six quilt squares – four 9.5 inch squares and two 12.5 inch squares.
Here are the 9.5 inch squares. You may recognize some of the squares. The upper left and lower right were left over from this baby quilt. I added an extra round to make them large enough. The upper right one was left over from this quilt and was the perfect size already. The lower left was made up using left over blocks from this project.
This 12.5 inch square was made using left over pieces. You may recognize some of the fabric from this quilt.
This one was too. The floral fabric is left over from the back of this quilt.
Don’t forget they would like to have the donated blocks by May 30th in order to have the quilt pieced together and to allow time for showing and promoting this fund-raising project.
Thursday, April 22, 2010
B is for Blepharoplasty, Breast Reconstruction, Burns
C is for Cubital Tunnel Syndrome, Chemical Peels, Cleft Lip Repair
D is for Decubitus Ulcer Care, Dermabrasion
E is for Estlander Flap, Extensor Tendon Surgery
F is for Facial Reconstruction, Fingertip Injuries, Flaps
G is for Grafts, Gorlin’s Syndrome, Gynecomastia
H is for Hand Surgery, Hemagiomas, Hemifacia Microsomia
I is for Implants, Inverted Nipple Correction
J is for Juvederm, Jessner’s Solution
K is for Keloids, Kraissel’s Lines, K-wires
L is for Langer’s Lines, Le Fort Fractures, Liposuction
M is for Madelung’s Deformity, Melanoma, Mastectomy
N is for Nail Bed Injuries, Nevus Excision, Neuromas
O is for Omphaloceles, Orbital Fractures, Otoplasty
P is for Poland’s Syndrome, Port-wine Stains, Ptosis
Q is for Q-switch Ruby Laser, Quadriga Syndrome
R is for Rhinoplasty, Rhomboid Flaps, Rhytidectomy
S is for Scalp Reconstruction, Scaphoid Fractures, Syndactyly
T is for Tendon Repair, Thyroglossal Duct Excision, TRAM Flaps
U is for Ulnar Nerve Repair, Umbilicoplasty
V is for Vaginal Reconstruction, V-Y Advancement Flaps
W is for Wound Care/Repair, W-plasty, Wydase
X is for Xanthoma tuberosum, Xenografts
Y is for Yersinia (yes, I’m reaching here)
Z is for Z-plasty, Zygoma Fracture Repair
Wednesday, April 21, 2010
A is for Abdomen, Aorta, Appendix
B is for Bones, Brain, Breast
C is for Clavicle, Colon, Cornea
D is for Dermatomes, Diaphragm, Duodenum
E is for Ear, Epiglottis, Esophagus
F is for Face, Femur, Fibula
G is for Gallbladder, Ganglion, Glands
H is for Hand, Heart, Hip, Hyoid
I is for Ileum, Intestines, Iris
J is for Jaw, Joint, Jugular
K is for Kidney, Knee
L is for Ligament, Lip, Liver, Lung
M is for Mandible, Mouth, Muscles
N is for Nerves, Nipple, Nose
O is for Omentum, Orbit, Ovary
P is for Palate, Pancreas, Pelvis, Prostate
Q is for Quadriceps Muscle
R is for Radius, Rectum, Ribs
S is for Scalp, Spleen, Spine, Stomach
T is for Tendon, Thyroid, Tongue, Trachea
U is for Ulna, Umbilicus, Ureter, Uterus
V is for Vagina, Veins, Ventricle, Vertebra
W is for Wing (of sphenoid bone), Wrist
X is for Xyphoid
Y is for Y-chromosome
Z is for Zygoma
Tuesday, April 20, 2010
Welcome to Grand Rounds Vol.6 No. 30 here at the Sterile Eye (photo credit). The theme for this edition is Visual Communication. Some of the posts address this more directly than others, so to harmonize form and content I have chosen to represent the submitted posts not by words, but by 450×150 pixels each.
Welcome to this edition of Change of Shift. I’m sure you’ll all enjoy a little light reading after submitting your taxes weeellll beforehand, right? And surprisingly, none of this edition’s posts are money related. I guess that’s because we’re nurses and we know how much money we don’t make Dr. Dean (www.blog.themillionairenurse.com) can help with that though. Dr. Dean…?
So without further adieu…..
Gwen and Dan Olsen were a handsome couple with a stunning blonde eight-year-old daughter, Trina. They had just moved to the town where I did my residency and over the course of their first six months there I saw all three of them for routine health care needs.One day Gwen came in for nausea……
There is no question that the incidence and prevalence of autism are on the rise. Starting in the early 1990s and continuing to today, there has been a steady rise in the number of children diagnosed with autism. Prior to 1990 the estimates of autism prevalence were about 3 per 10,000. The most recent estimates from the CDC and elsewhere now have the number at about 100 per 10,000, or 1%.The burning question is – why are the rates increasing steadily?
In science it sometimes pays to ask silly questions. So let me ask, “Why are your bones not made of steel?”
It's a starting point for thinking about structural materials in nature, and in engineering……….So let's look at the facts. The bones in your body are made from material which has a tensile strength of 150MPa, a strain to failure of 2% and a fracture toughness of 4MPa(m)½. For a structural material that's not good. We can make alloy steels that are ten times better in all three of those properties. But of course there are some other factors we need to take account of in order to make a valid comparison. Bone is less dense than metals and this is important………
Hank Chien, MD, woke up one morning as a New York-based plastic surgeon. He went to bed early the following morning as a king -- the King of Kong.That day Dr. Chien scored 1,061,700 points in 2 hours, 35 minutes, breaking the world-record score for the classic arcade game Donkey Kong……..
Check out today's NASA picture of the day! Doctor's orders! http://antwrp.gsfc.nasa.gov/apod/
5/6: Dr. Daniel Lewis, Family Physician, Talking about recent mission trip to Central America
Monday, April 19, 2010
“Things were happening at lightning speed,” she recalled of the scene at Baptist. “I had a burst fracture of L-1 and needed spine surgery….They were moving me, cutting off my clothes. I was scared and still screaming in pain and frustration,” she said. “At that moment, ER doctor Wendel Phals, MD, was at the head of my bed. He held my face and calmly and quietly said, ‘Janet, you’re going to be alright. We’re going to take care of you.’ For the first time since I’d hit the culvert, I felt calm, secure.”
After his own recovery, Klitzman wanted to understand the rare, dual perspective of physicians who have confronted serious disease. His interviews revealed first and foremost that many physicians resist, at least initially, the idea of beiing “sick” or being “the patient.” Furthermore, many physicians most resist “not” being the doctor…..
Griffin found both emotional and practical aspects of being a patient surprised him. “I was surprised at the size of my bills,” said Griffin, adding that he understands now the number of medical bankruptcies. ….Also surprising to him was his embarrassment to ask for pain medicine. “I was afraid someone would think I was becoming addicted,” he said. “……..I imagine there are many more patients suffering from pain than are abusing pain meds.”
“As a physician, you never know what little thing a patient is going to latch onto…be impacted from,” she said, remembering that night eight months ago, in the Baptist ER. “As a patient, I felt my recovery began when amidst the chaos of the night, Dr. Pahls took a few moments to look at me and reassure me.”All of that medical knowledge can be a blessing and a curse, especially when physicians suffer from something serious or debilitating, Cathey implied. “For me to have a devastating injury, it really hit hard. Being a physician takes away some of the hope that you’d have if you didn’t know your limitations,” she said.
I was walking down the hall at work on a very ordinary day in December. I had sudden onset of excruciating right shoulder, neck, and upper arm pain. For the first time in my life, the "...if 10 is the worst pain you can imagine" finally had meaning. ……. The next 48 hrs were a whirlwind: emails, calls, and pages to my internist (I am usually a once a year-ish whether I need it or not patient), a possible diagnosis of multiple sclerosis, MRIs of my brain, spinal cord, shoulder, appts with ortho, neuro, and ultimately neuromuscular, including the test that provided a diagnosis: an EMG/NCS. The diagnosis was something rare called Parsonage-Turner Syndrome. I had never heard of it before (which is a very bad feeling as a doctor).So, what have I learned from this experience of being on the wrong side of the stethoscope? A lot that I am still struggling to put into words and a lot worth sharing.
Duration of EMR use and upper extremity musculoskeletal symptoms correlated. And I was blaming the blog.... http://bit.ly/bVbOvU
Extend and stretch both wrists and fingers acutely as if they are in a hand-stand position. Hold for a count of 5.
Here are some sites with more exercises:
Typing Games to improve dexterity
Slide show: Hand exercises for people with arthritis by Mayo Clinic Staff
Finger Exercises for Arthritis By Kate McQuade, eHow
How to do Wrist Exercises to Help Arthritis in the Hand By LivingWellYoga, eHow
Finger injuries - causes, treatments and recovery exercises
Sunday, April 18, 2010
- Surgeonsblog (no longer posting, but old ones still available for reading) – check out his Limerick edition of SurgeXperiences or sample his other posts.
- IntraopOrate (rarely posting these days) – check out her post on “pet peeves”
- Counting Sheep (who’s site doesn’t even come up anymore)
- Papermask (posting infrequently) -- check out his post “Pssst! Pass it on!”
- Marianas Eye (last post November 2009) – check out his “funniest OR experiences” edition of SurgeXperiences
- Cut on the dotted line (last posted Feb 1, 2010, but let me refer you to this one – second chance)
- Made a Difference (has posted at that blog site since Oct 2009, now blogs at Coppola: A Pediatric Surgeon in Iraq, less on surgery and more on military/support issues) – check out his “Full Metal Scalpel: The love-hate relationship between surgery and war” edition
- The Chloroform RAG (blog has gone private, invitation only)
- Amanzimtoti (last posted November 2009, but can be found on twitter) -- check out her post “Collateral damage”
- Vitum medicinus (has not posted in 2010) – check out this post “The best part of spending two weeks with medevac? Not what you might think.”
- OpNotes (no posts since April 2008) – check out this one “The problem with laparoscopic training”
- “The scalpel is mightier than the sword” (this blog has been taken down)
- Just Up The Dose (no posts since October 2009) – check out this post “When it's someone you know”
- From Dupont to Abdoun (no new posts since April 2009) – check out this post “Before and After”
- other things amanzi (one of my favorite blogs) – check out these two posts “compassion fatigue” and “dogma”
- Reflections in a Head Mirror (another favorite) – check out his post “Time”
- Buckeye Surgeon (another favorite) – check out this non-surgical post of his “Believing in what you do”
- Notes of an Anesthesioboist (anesthesiologist who is a marvelous writer) -- check out this post “When Your Life ALMOST Flashes Before Your Eyes”
- Aggravated DocSurg – check out this post “If they could only all be taken to Rampart Hospital”
- The Sterile Eye (love your photos and history lessons) – check out this old post of his “Surgical history”
- Life in the Fast Lane (written by several ER docs in Australia) – check out this post “Minor Injuries 003”
- Scalpel’s Edge (Posts infrequently due to the birth of her third child and her thesis work. I do still have contact with her via twitter.) – check out her post “Mechanics and Surgeons”
- scan man’s notes (Posts infrequently, but active on twitter and Facebook so I still have contact with him.)
- Dr D J’s Surgical Adventures (a surgeon in India) -- check out this post “Voldemortish experience?”
- Unbounded Medicine – recent post highlights “Violinist having surgery while awake and playing”
- Jeffrey MD (remains active as he makes his way through medical school) – check out this post “Why Bother Learning Something We’ll Lose?”
- The Sandman (rare posts, but check out this one – a change of plans and A Veritable Madhouse)
- Education of a Knife (this medical student who is leaning towards surgery continues to blog) – check out this post “My patient died”
- survive the journey (a Cushing’s patient who bravely posts a “365 days with Cushing's”) -- check out her post “Transsphenoidal Surgery: Comparison of Techniques”
- Frankie’s Hideout (recollections, complete with flashbacks and derogative collioqy) – check out this post "You're Not Really A Doctor If"
- Adventures of a Funky Heart (an adult congenital heart survivor) – check out his post on his scars “Battle Wounds (NSFW)”
- Vagus Surgicalis (last, but not least as he is the founder of SurgeXperiences) -- check out his post “mischief in theatre”
Many people probably saw this already, it was printed in The New York Times on April 9th, but just in case you missed it, I thought I should give it a little bump: Doctors Remove Ammunition From Soldier’s HeadThe reason I'm posting this is not because it's one of those "Ripley's Believe It Or Not" medical stories (even though it is), but it's because if anything redeems the much maligned field of anesthesiology from the jaws of modern day television, in which we are all portrayed as lazy, unfeeling, drunken, drug-diverting billionaires who don't give a shit about our patients and leave whenever the going gets rough, it should be a story like this.
This is a very serious issue... and it comes up for discussion with our residents every now and then. A while back there was a young man in the emergency room of our institution. He claimed the CIA was after him and they injected him with a substance that made him pass out... When he woke up, his shoulder hurt and he had soiled his underwear. I was called because I was the attending on call for our department. My resident immediately dismissed all his complaints and was upset that he was called for a consult in the middle of the night. After I settled him down, we had a little talk...
One of the things I love about blogging is how a link leads to a link leads to a great story. SurgeXperiences 319 (available here ) related a link about Steve Jobs and his liver transplant. Most neurosurgeons spend a part of their residency learning the ins and outs of brain death testing-a critical link in the transplant world. At first it may seem gruesome and unnatural ….
Saturday, April 17, 2010
Friday, April 16, 2010
Yesterday, @GlobalChangeMe sent out this tweet:
Looking for quilters from around the world. Do you know any?stuboo then tweeted
.@GlobalChangeMe Looking for quilters from around the world. Do you know any? <-- Try @rlbates - she's good.And the introductions were made. I ask GlobalChangeMe for more details and received the following email:
Our organization is seeking quilters from around the world to join us in our Global Quilt Project that will benefit a village in Central African Republic. There are several ways to become involved in this project. We hope you can join us.
Global Change, Inc is a non profit organization that provides safe, clean water and basic sanitation to people living in extreme poverty throughout our world. In one of the villages in the Central African Republic (CAR) we are raising funds for, the ladies have been taught quilting and they are really enjoying it. These ladies have sent our organization 2 beautiful squares and we are hoping to put theses squares together with other squares from around the world to make a beautiful quilt that will be auctioned off and 100% of the proceeds will go to a new well for a village in Central African Republic and a latrine for a school in CAR.
The square tiled #1 in the attachment is exactly 12x12 inches
and the square in attachment #2 is exactly 9 1/2 x 9 1/2 inches.
We would very much like for you to join us in this project. We are seeking quilters from around the world to donate a square or squares to be added to this piece. I have a friend here in Central Florida who will connect the squares for this piece. The colors or patterns need not follow the same design as the 2 squares the ladies sent from CAR, nor does the squares need batted. We would appreciate any comments or suggestion about our project and would greatly appreciate it if you would forward this email to others you think might want to join this effort for a good cause. Letting others know about this project is a wonderful way to become involved. As soon as we have several participants, we will add the project to our web site and include the participant's name and link to their site if we have your permission to do so.
The finished quilt will be auctioned in conjunction with World Toilet Day...Yes, I said "World Toilet Day" which is held on November 19th. We would like to have the donated pieces by May 30th in order to have the quilt pieced together and to allow time for showing and promoting this fund-raising project.
It would help this project if you would reply to this email (either yes, I will participate or sorry I cannot participate) so we can have an idea of how many squares we will have for the quilt. I have also attached a participation form for you to fill out and email back to me. The donated squares can be sent to the address below.Our web site has information about our organizations and the projects we fund. Your donation will help stop the spread of disease due to lack of clean water and basic sanitation. People live more productive lives when they do not have to fight disease. Please take a look at our site and if you have any questions, please do not hesitate to contact me.www.globalchange.meThank you for your time and consideration.Amy Allen (407) 951-2826Co-Founder and Development DirectorPlease mail donated squares to:Global Change, Inc854 Blue Sage Street #102Celebration, Florida 34747
I plan on making a few and would like to encourage you to do so. Remember there is no set pattern or colors, so it would even be a nice way to share “orphan” blocks as long as they are the correct size: 12.5 in square or 9.5 in square.
Thursday, April 15, 2010
breast is normally soft and looks natural
breast is a little firm but looks normal
breast is firm and looks abnormal
breast is hard, painful, and looks abnormal
Capsular contracture may require reoperation, usually for Grades III and IV, and it may occur again.
Reported rates of capsular contractures vary widely, ranging from 1.3 to 30 percent of patients who receive implants.The longer the implants were in place, the greater the cumulative risk of developing contracture, which would suggest a direct correlation between when the implant is placed and the time to developing contractures.Approximately 92 percent of contractures occur within the first 12 months following surgery.A number of parameters seem to influence the occurrence of contractures, including the indications for surgery (breast reconstructions versus cosmetic augmentations), type of prosthesis used (smooth versus textured and saline versus silicone), and positioning of the implant (subglandular versus submuscular).
In the first meta-analysis, Barnsley et al. proved the protective effect of textured implants over smooth surfaces (relative risk, 0.19; 95 percent confidence interval, 0.07 to 0.52), with smooth implants showing a five-times greater risk of contracture formation.In the second meta-analysis, 235 patients were analyzed, and textured implants were shown to produce fewer capsular contractures when compared with smooth implants at 1 year (relative risk, 4.2; 95 percent confidence interval, 1.6 to 11.0), 3 years (relative risk, 7.3; 95 percent confidence interval, 2.4 to 21.7), and 7 years of follow-up (relative risk, 3.0; 95 percent confidence interval, 0.9 to 10.4).Only one study showed no significant differences between smooth versus textured implants for the occurrence of capsular contractures. However, this trial had a Jadad score of 2, indicating a poor methodologic quality with a high degree of variance in the results.
Seckel and Costas retrospectively studied 76 patients (146 breasts) who had undergone partial or total submuscular breast cosmetic augmentation. No difference was observed between the total and the partial musculofascial coverage for the occurrence of capsular contractures [zero of 35 (0 percent) versus one of 41 (0.02 percent); Fisher's exact test, p = not significant].Hendricks reviewed 650 patients who had received textured silicone gel implants beneath the pectoralis major muscle, the external oblique muscle, the rectus sheath, and the serratus anterior muscle fascia. In this study, no cases of Baker grade 3 or 4 capsular contractures were reported.
It is a nice review of the literature which points out the short comings of our knowledge.Ventura and Marcello retrospectively analyzed 100 patients who had received primary breast enlargement with textured implants positioned in the subfascial compartment and found that only two patients (2 percent) experienced Baker grade 2 capsular contractures.Finally, in a retrospective multicenter study of more than 500 patients, Gutowski et al. found that the use of subglandular positioning of the prosthesis increased the risk of capsular contractures by almost eight times.
Although it is apparent from the articles studied in this review that a great deal of progress has been made over the past few decades toward elucidating the etiopathogenesis of capsular contractures, the exact nature and contribution of molecular, immunologic, and microbiological factors remain unclear.Only a few studies have included large enough sample sizes, were conducted in a prospective manner, were adequately randomized, and achieved adequate follow-up periods to obtain a true measure of the rates of capsular contracture occurrence.Therefore, there is a scant and often inconclusive body of evidence relating to this complication. For example, the contribution of chemotherapy to the occurrence of capsular contractures warrants more thorough investigation.Likewise, the possibility of preventing this complication by use of experimental drugs needs to be looked at more closely.Revision surgery remains the only effective treatment option available to us at this time but is limited by its high associated risk of recurrences and complications (hematoma or pneumothorax) when the implant is originally placed in the submuscular position. It is hoped that future studies will focus on attempting to resolve some of the issues highlighted in this review.
Wednesday, April 14, 2010
Marta Rendon, MD (dermatologist) -- “For mild photodamage, I start with antioxidants and retinoids, and then add peels or lasers for stubborn cases.”Joel Schlessinger, MD (dermatologist) -- “Typically, these patients do well with intense pulsed light (IPL) or laser treatments, but these should always be accompanied by a homecare treatment regimen, such as Nu-Derm by Obagi or another hydroquinone-containing product such as Tri-Luma or Epiquin Micro by SkinMedica.”Leslie Baumann, MD (dermatologist) – “For patients with light skin I recommend monthly IPL treatments. For home care I suggest a glycolic cleanser, NIA24 niacinamide moisturizer or Aveeno Positively Radiant active soy, and a good sunscreen in the morning. For nighttime use, I prescribe Tri-Luma. For patients with darker skin, I use the same home care regimen, but offer a Jessner’s peel solution every two weeks instead of IPL. ”Tina Alster, MD (dermatologist) -- “For light-skin patients I use IPL or a Q-switched pigment specific laser (alexandrite or Nd:YAG), with or without mild to moderate chemical peels. For daytime home care, I suggest a topical vitamin C with sunscreen (SPF 30 or higher) and at night glycolic/retinoic/kojic acid on an alternating basis.”
Dr. Baumann “I recommend a glycolic cleanser in the morning, followed by a vitamin C serum, such as Skinceuticals CE Ferulic, and a moisturizing sunscreen, such as LaRoche Posay Anthelios 60 Sunscreen Fluid. At night, the patient uses the same glycolic cleanser followed by Tri-Luma topped with a moisturizer if they have dry skin.” She also recommends microdermabrasion followed by Jessner’s solution TCA peels twice a week until the hyperpigmentation clears.Dr. Alster “For melasma, I use only mild to moderate chemical peels (resorcinol, glycolic/lactic/mandelic or trichoracetic acid) in the office.”
Tuesday, April 13, 2010
After a hiatus of almost a year from hosting Grand Rounds, I am back today to welcome you all to GRAND ROUNDS, Volume 6, No. 29. This is my 6th time to host this weekly round-up of the best in med- and health blogs. If one is passionate about it, hosting can be a taxing experience. More often than not, it eats precious time one should allocate for sleeping. Thank God I live on the other side of the planet, and most of those who submitted are on the opposite side --- I can still rest tonight. 'Kidding! I am always proud to host. I thank Nick for the invitation this week. Thank you also for all those who joined.
I just finished Seth Godin’s Linchpin. …..
Physicians have to be remarkable to remain relevant. ... Physicians need to make a difference and in their own way and serve as real leaders and innovators in their relationships with patients and their communities.Physicians have to be linchpins…
This book is a remarkable compilation of essays, poems, and artwork by women neurosurgeons. It is a proud achievement for neurosurgeons who are women, enlightening for neurosurgeons who are men, and inspirational for both.One-half of US medical students are now women. The percentage of women in neurosurgery has slowly increased from 0% to 10% during the last century. It is evident that for neurosurgery to thrive as the future unfolds, the specialty must welcome more women and remove barriers to their success…………
Having experienced a piece of this 7.2 earthquake in San Diego this past week, it made me revisit my special emergency supply kit that I designed when I first started working for the department of public health. ……. No matter where you live, you need to be prepared for disasters, whether it’s for flooding, hurricanes, Tsunamis, tornadoes, fires, winter snow, or earthquakes.
The nine-time Wimbledon champion, who still plays tennis and ice hockey and competes in triathlons, says she is lucky, as she had not been getting regular checkups."I went four years between mammograms," she tells PEOPLE. "I let it slide. Everyone gets busy, but don't make excuses. I stay in shape and eat right, and it happened to me. Another year and I could have been in big trouble."
Blown away by Walter Lewin and his Physics lecture series... http://tinyurl.com/oemffe.
4/22: DG & Tiffany Hollums and their adoption journey
Monday, April 12, 2010
The Food and Drug Administration said recent research raises "valid concerns" about the possible health effects of triclosan, an antibacterial chemical found in a growing number of liquid soaps, hand sanitizers, dishwashing liquids, shaving gels and even socks, workout clothes and toys.The FDA and the Environmental Protection Agency say they are taking a fresh look at triclosan, which is so ubiquitous that is found in the urine of 75 percent of the population, according to the Centers for Disease Control and Prevention. The reassessment is the latest signal that the Obama administration is willing to reevaluate the possible health impacts of chemicals that have been in widespread use.
More from the Washington Post article:Allergic reactions to suture materials are rare and have been specifically associated with chromic gut. However, Johnson and Johnson mention known triclosan allergy as a contraindication for use of certain sutures (see below). Contact allergy to triclosan is uncommon…….MONOCRYL Plus Antibacterial suture should not be used in patients with known allergic reactions to Irgacare MP(triclosan).PDS Plus Antibacterial suture should not be used in patients with known allergic reactions to Irgacare MP (triclosan).VICRYL*suture should not be used in patients with known allergic reactions to Irgacare MP (triclosan). [In rechecking facts, I found that only Vicryl Plus has the triclosan, so simple vicryl or coated vicryl should be okay.]
The FDA was responding to inquiries from Rep. Edward J. Markey (D-Mass.), who has been pushing federal regulators to take stronger action to restrict the use of triclosan and other chemicals that have been shown in laboratory tests to interfere with the delicate endocrine system, which regulates growth and development………Markey wants triclosan banned from all products designed for children and any product that comes into contact with food, such as cutting boards.
Sunday, April 11, 2010
Saturday, April 10, 2010
“Can you remove this scar?”
“No, only change it.” She looks deflated. I ask “What happened?”
“My ex-husband stabbed me,” she quietly says.
“I’m sorry. I can’t remove the scar or it’s history. We’ll give it a new story.”
“A new scar. Let it’s story begin there.”
Friday, April 9, 2010
Thursday, April 8, 2010
On April 7, 2010, FDA announced it had sent warning letters to six medical spas in the United States—and a cyber letter to a company in Brazil—for making false or misleading statements on their Web sites about drugs used in the procedure, or for otherwise misbranding lipodissolve products.The U.S. medical spas receiving warning letters make various unsupported claims about lipodissolve, such as assertions that the products used in lipodissolve
- are safe and effective
- have an outstanding safety record
- are superior to other fat-loss procedures, including liposuction
- None of the drugs/products used in the procedure have been evaluated or approved by the FDA.
- The FDA is not aware of evidence supporting the effectiveness of the substances used in lipodissolve for fat elimination.
- The safety of the substances used in lipodissolve, when used alone or in combination, is unknown.
- The FDA is not aware of clinical studies to support medical uses of lipodissolve.
- permanent scarring
- skin deformation
Many over-the-counter (OTC) cosmetic products contain retinoids and are promoted (advertised) as anti-aging products. This article (first reference below) in the February issue of the Aesthetic Surgery Journal is a review of the evidence behind retinoids in cosmeceutical products. It turns out there isn’t much.
First, let’s begin with some definitions:
Retinoids include Vitamin A and its derivatives which may be either natural or synthetic.
Cosmeceutical products are formulations which are not classified as prescription medications.
Retinoids which are prescription medications include tretinoin, isotretinoin, alitretinoin, tazarotene, and adapalene. Because they are classified as prescription medications, these do not qualify as cosmeceuticals.
This is an important distinction as there is a large body of evidence to support tretinoin in the treatment of photoaging. This article focused on the cosmeceutical retinoids.
The article looks at retinyl-acetate and retinyl-palmitate, both vitamin A ester derivatives; retinol, a precursor to retinaldehyde and retinoic acid; and topical retinaldehyde.
The authors conclusions:
There is a substantial amount of evidence supporting the efficacy of tretinoin in the treatment of photoaging. The evidence supporting retinoid-based cosmeceuticals, however, remains sparse. There are a number of in vitro studies, with a smaller number of in vivo studies. Based on the hierarchical levels of evidence (with well-designed, randomized, controlled trials providing the highest level), retinaldehyde appears to be the only retinoid-based cosmeceutical to be effective in the treatment of photoaging. A large, randomized, controlled trial assessing retinyl propionate concluded that it had no significant effect on photoaging. There is evidence from a small, randomized, controlled trial showing that retinol has effects on human skin and supporting its potential as an agent against photoaging.
However, large-scale clinical studies would need to be undertaken to investigate this further. Therefore, we conclude that products containing retinyl-acetate or retinyl-palmitate are unlikely to have a significant beneficial effect, but retinaldehyde-containing cosmeceuticals have evidentiary support for their benefits in patients with aging skin. Retinol has potential benefit, but more research is needed.
Cosmeceuticals: The Evidence Behind the Retinoids; Aesth Surg Journ Vol 30, No 1, February 2010; Babamiri, Kajal MD, Nassab, Reza MBChB
Clinical Review: Topical Retinoids; Medscape article, December 2003; Sheri L. Rolewski
Retinoids: Progress in Research and Clinical Applications; Plastic and Reconstructive Surgery. 98(1):180, July 1996; Ship, Arthur G.
Treatment of Photodamaged Skin with Topical Tretinoin: An Update; Plastic and Reconstructive Surgery. 102(5):1672-1675, October 1998; Heffel, Dominic F.; Miller, Timothy A.
Cosmetic Dermatology: Principles and Practice; Plastic and Reconstructive Surgery. 113(3):1064-1065, March 2004; Chavis, Dion D.
Wednesday, April 7, 2010
- Been recommended or scheduled for surgery that has not been complete?
- Been recommended to have or is anyone contemplating infertility treatment or been treated for infertility?
- Received or been recommended to have any treatment for alcoholism, alcohol or drug abuse or addiction or mental or nervous conditions?
- Been cited for operating a moving vehicle under the influence of alcohol or drugs?
- Received a diagnosis for any serious medical condition such as heart disease, stroke, cancer, diabetes, HIV, AIDS, or any other progressive disabling condition?
- Been incapacitated or hospitalized due to an accident or illness?
A simple 23% increase rather than a 36% increase.
If you missed them, check out the posts by Shadowfax here and here on Assurant Health.