Saturday, December 31, 2011

Top Eleven Posts of 2011

According to Google Analytics these eleven posts had the most traffic during 2011:
1. Inverted Nipples (November 5, 2007)
2.  Flexor Tendon Repair (July 10, 2008)
3.  Skin Complications from Drug Abuse (December 9, 2007)
4.  Panniculectomy vs Abdominoplasty (December 13, 2007)
5.  Glomus Tumor (October 29, 2007)
6.  Le Fort Fractures (January 17, 2008)
7. Scar Prevention  (June 9, 2007)
8. Late Reconstruction of the Nail Bed (February 11, 2008)
9.  Surgical Loupes (September 10, 2008)
10.  Tennis Star Brings Breast Reduction Surgery into Press (June 4, 2009)
11. Monkee Peter Tork Has Mouth Cancer  (March 12, 2009)

Notice none of them are from this year.  The same thing occurred last year with none of the top traffic went to posts of the current year.
Some from this year that I would like to highlight:

Thank you all for dropping by and reading. 
Happy New Year to you all

Friday, December 30, 2011

Christmas Knitting 2011

I didn’t do as much knitting this Christmas.  A nephew actually asked for a couple of caps so I happily obliged.  One uses Berroco Blackstone Tweed™ yarn and the other Berroco Vintage™ Chunky.
I managed to knit two scarves.  This one for a niece using the Artyarns Supermerino and the Undulating Leaves Shawl pattern which I altered to make the scarf.  It measures 6 in X 60 in.

This scarf I made for a sister-in-law.  For it I used Berroco Boboli™ and the pattern Kernel by Bonnie Sennott.  It measures  8 in X 68 in.

You can really see the lace pattern in this photo taken with the scarf hanging over a lamp shade.

Tuesday, December 27, 2011

Shout Outs

Updated 3/2017-- photos and all links removed as many no longer active.

The Boerewors Emergency Medicine Chronicles has a great post which I think is worth your time:  On alzheimer's
…….....I think it is beautifully written and provides a real window into the difficulty of loving someone who has this disease.
“The thing with this sentence, this arrest of dementia, is that its greatest victims aren’t those who have it. That’s not to say that the diagnosis isn’t dreadful for the recipient, but there is a peculiar and particular hammering sadness for those that love and care for an Alzheimer’s spouse or parent.
It is a wearying and lonely obligation, but with the added cruelty that the person you’re looking after vanishes, escapes before your eyes. In the end, you’re caring for the case that someone came in………”
Check out this post from @JordanGrumet who blogs at In My Humble Opinion:  From Birth To Death
As luck would have it, she happened to die while I was in the room. I sat with her family as the last breath precariously left her lips. We waited for the next as if it was a forgone conclusion. It never came.
Walking toward the nursing station, my mind wandered back to medical school.
I tentatively followed behind the resident as we entered the birthing room. ………….
Asystole is the Most Stable Rhythm  (@doctorblackbear) tells us The Real Reason, On CBC Today
When I am asked the reason I chose medicine, I almost never tell the truth. I feel a little protective of the real reason and how it might be perceived by others, so I usually reveal some of my less sentimental and more cerebral motivations for becoming a doctor.
But, when given the opportunity to create a small radio piece about my grandad and how he continues to medically inspire me, I happily got to work……..
Check out DinoDoc’s menorah’s
First Night of Hanukkah
Second Night of Hanukkah
Third Night of Hanukkah
Fourth Night of Hanukkah
Fifth Night of Hanukkah
Sixth Night of Hanukkah
Seventh Night of Hanukkah 
Moda Bake Shop has provided instructions for a Puzzle Box Quilt 

Saturday, December 24, 2011

Christmas or Anytime Cooking

Updated 3/2017 -- all links (except to my own posts) removed as many no longer active.

I probably won’t get most of these made this year, but am posting them for future reference to myself.  They definitely look worth trying.
H/T to @drmlb  for the link to this one:  Savory Omelet Muffins (Kath Eats Real Food Blog).  The recipe includes cottage cheese, eggs, whole wheat flour, smoked salmon, and parmesan cheese.  I make 5 muffins (a work week’s supply) and sound/look yummy.
From The Foodie Physician:  Holiday Spiced Nuts 
She includes a second recipe in the same post for Rosemary & Honey Glazed Nuts. ………….
Makes 2 ½ cups or 8-10 servings
¼ cup packed light brown sugar
1 tablespoon cinnamon
1 teaspoon kosher salt
½ teaspoon cumin
¼ - ½ teaspoon cayenne pepper (depending on how spicy you like it)
1 egg white
2 ½ cups assorted nuts such as walnuts, almonds and pecans
Preheat oven to 350 degrees F. …………….
Via @nytimeshealth Their Recipes for Health have had several vegetable soups recently which includes this one for Puréed Tomato and Red Pepper Soup and this one for Sweet Potato Soup With Ginger, Leek and Apple
TBTAM reposted her recipe for latkes:  The Latke Master’s Latkes
This latke recipe was good enough in 2007  to garner my blog a mention in the New York Times.  ……….
And don’t forget your dogs.  I posted a recipe for dog biscuits a few years ago.  Yesterday I made a some using another recipe.  Here it is:
2 cups whole wheat flour
1/2 cups all-purpose flour
1/2 cup milk
1 tsp salt
1 Tbsp molasses
6 Tbsp butter or margarine
6 Tbsp peanut butter
1 egg
Mix all the ingredients.  Knead for two minutes.  Roll out to a little less than 1/2 inch thick.  Cut with the cookie cutters shaped like bones/hearts/fire hydrants/etc.  Bake at 325 degree for 30 minutes.

Merry Christmas!

Friday, December 23, 2011

Backgammon Quilt

I used a cotton tea towel printed with a backgammon board for the center of this quilt.  I found the towel in the antique store when I discovered the bandana which I used for the “Say Cheese” baby quilt.  I framed the game board with black strips and the red and yellow squares, then added a simple border of black fabric with white specks.  The quilt is 48.5 in X 58.5 in.  It is machine pieced and quilted.
Here is a close up of the center.
And even closer.
Here’s the back.  The center strip is more golden yellow than it showed up in my photo.

Monday, December 19, 2011

Panniculectomy Prior to Renal Transplantation -- an Article Review

Updated 3/2017 -- all links removed (except to my own posts) as many no longer active.

There is an interesting article in the current edition of the Plastic & Reconstructive Surgery Journal (December 2011). The focus of the article is a small subset of renal patients who need kidney transplants but whose abdominal panniculus excludes them due. A significant panniculus creates an infrapannicular area prone to increased moisture, skin maceration, and elevated bacterial counts, predisposing the patient to postoperative wound infections, necrosis, and dehiscence. Not good for anyone, but really not for someone on immunosuppression.

The article discusses the use of abdominal panniculectomy in these patients in preparation for the transplant. Nine patients , 3 men and 6 women, with a mean age of 54.5 years and a mean BMI 28.3 are the focus of the article. The focus is not a cosmetic abdominoplasty but a functional panniculectomy, most often of just the lower abdominal excess skin and not addressing the area above the umbilicus.

It must be remembered that this is a high-risk group by definition: ESRD, requiring a kidney transplant. Mean length of hospital stay of 1.75 days. No one required blood transfusions. All patients were followed postoperatively for 3 months. Complications included an abscess and a skin dehiscence treated with local wound care.

Panniculectomy in Preparation for Renal Transplantation: A New Indication for an Old Procedure to Reduce Renal Transplantation–Associated Wound Complications; Kuo, Jennifer H.; Troppmann, Christoph; Perez, Richard V.; Wong, Michael S.; Plastic & Reconstructive Surgery. 128(6):1236-1240, December 2011; doi: 10.1097/PRS.0b013e318230c7b8Abstract

Friday, December 16, 2011

Holly Hobbie Album Quilt

This is the quilt that will go to one of the twin girls (see last week’s).  It too uses the Holly Hobbie fabric.  This time the Holly’s are featured in the center of each album block.  The quilt is machine pieced and quilted.  It measures 34.5 in square.

Here is a close up of the center block.
Here is the lovely pink fabric with the butterflies I used for backing for both quilts.

Wednesday, December 14, 2011

Shout Outs

Updated 3/2017 -- all links removed (except to my own posts) as many no longer active.

My thanks to @jordangrumet for this tweet.  It gave me the motivation I needed to sit down and write.  I have lacked it lately, unsure where my blog is headed with the job transition, not wanting to lose contact with my fellow bloggers.  So thanks, Jordan. 
Glass Hospital is the host for this week’s Grand Rounds.  You can read this week’s edition here.
Welcome to Grand Rounds, where writers, readers, and bloggers send in their best stuff on a weekly basis to share, cross-pollinate, and build new audiences.
Tip of the hat to Grand Rounds co-creator Nick Genes, MD, PhD, an ER doc in NYC who knows a thing or two about blogging, tweeting and now Tumblr.
a timeless and inspiring read...
The theme of this week’s Grand Rounds is “Finding Meaning in Medicine,” with full attribution to Dr. Rachel Naomi Remen, author of the masterful book Kitchen Table Wisdom: Stories that Heal.  …………..
H/T to @medicallessons who tweeted about this very unusual medical case in the NEJM:  Disappearance of a Breast Prosthesis during Pilates (includes images)
A 59-year-old woman with a history of breast cancer who underwent bilateral mastectomy and placement of breast prostheses presented for evaluation, reporting that her “body swallowed one of the implants” during a Pilates stretching exercise ….
Another plastic procedure gone awry documented in a NEJM case report (h/t to @Neil_Mehta):  Blindness after Fat Injections
A 32-year-old man presented with vision loss in the left eye. one week earlier, while under local anesthesia, he had had an autologous fat injection into his forehead for correction of glabellar frown lines. The patient reported that while he was receiving the injection, he felt a sudden, severe periocular pain and had complete vision loss in his left eye. …..
I found out via a Christmas card I received last week that a classmate from medical school was diagnosed with early mild cognitive impairment(mci) amnestic type last December.  He began writing a blog to chronicle his journey as he progresses towards Alzheimer's disease:  organicgreendoctor. 
He was a Family Practice doc before he retired.  He was/is a super nice guy.
TBTAM has finally (smile) gotten around to giving us a list recommended NYC Restaurants
Home cooking is what I do best. And yet, the most frequent e-mail request I get from readers, friends and family is – “Where should we eat when we come to New York?”  And so, after years of wracking my brain for recommendations, I decided to create a list here of the places I go to and like. Some I’ve reviewed here on the blog – Most I have not (even though I have dozens of pics  and the best of intentions). But let me be clear – I am not a restaurant connoisseur. I’m just an ordinary New Yorker who knows what she likes. …..
I never get around to reading all the books recommended to me, but still…  Here’s a list from Seattle Times reviewers:  32 of the year's best books
………Here are the results — 32 books, 21 fiction (who says the novel is dead!?), 11 nonfiction. Top vote getters were three novels, "The Sense of an Ending" by Julian Barnes, "The Marriage Plot" by Jeffrey Eugenides and "Ed King" by David Guterson, and Erik Larson's work of nonfiction, "In the Garden of Beasts." ……..

Monday, December 12, 2011

DVT Prophylaxis – Two Articles

Updated 3/2017 -- all links removed (except to my own posts) as many no longer active.

There were two articles regarding deep venous thrombosis prevention in the November 2011 issue of the Plastic and Reconstructive Surgery Journal.  Both are worth reading.  I have supplied the full references below with links.
From the second article:
Between 1 and 7 percent of surgeons have personally experienced a venous thromboembolism–related patient death after high-risk plastic surgery.  Plastic surgeons' self-reported practice patterns indicate a disparity between clinical understanding and clinical practice. The majority of surgeons can identify patients at high risk for postoperative venous thromboembolism. However, examination of their self-reported practice patterns indicates that a substantial proportion of surgeons (>50 percent) provide inadequate levels of venous thromboembolism prophylaxis for high-risk patients.  In addition, surgeons recognize modifiable venous thromboembolism risk factors (such as oral contraceptive use) but may fail to modify those factors before surgery. 
“Never event” is a poor descriptor for venous thromboembolism, as it implies that all events are potentially preventable. Breakthrough venous thromboembolism events routinely occur in the face of rigorous protocols and criterion-standard prophylaxis, as has been reported in the plastic surgery, orthopedic surgery, and general surgery literature. We observed multiple breakthrough events in the Venous Thromboembolism Prevention Study enoxaparin group, although the distinct causes of these events remain unclear. Unrecognized hypercoagulability has been identified as a major contributor to venous thromboembolism risk.  Venous Thromboembolism Prevention Study data support the belief that a prior personal history of venous thromboembolism is an important risk factor as well (Table 3).
Venous thromboembolism represents a financial burden for patients and payers. The mean cost of hospitalization for an index deep venous thrombosis event is over $20,000.   Previous work has shown that enoxaparin is a cost-effective method of venous thromboembolism prevention.  In July of 2010, the U.S. Food and Drug Administration approved production of enoxaparin in generic form, which should result in substantially decreased costs to patients.
For a complete overview of venous thromboembolism in plastic surgery, we refer readers to two excellent reviews that have recently been published by Miszkiewicz and colleagues and Venturi and colleagues. These reviews built on the foundation of several outstanding reviews and consensus statements published previously.
I added the references mentioned in the last paragraph to the section below.  DVT prevention is important.  It can be done safely.  It needs to be done.

Related Posts:
Deep Venous Thrombosis Prevention  (June 19, 2007)
DVT Prevention (June 4, 2008)
Prevent Pulmonary Thromboembolism – an Article Review (February 23, 2009)
DVT Screening and Prevention (February 3, 2010)

1.  Changing Practice: Implementation of a Venous Thromboembolism Prophylaxis Protocol at an Academic Medical Center; Pannucci, Christopher J.; Jaber, Reda M.; Zumsteg, Justin M.; Golgotiu, Vlad; Spratke, Lisa M.; Wilkins, Edwin G.; Plastic & Reconstructive Surgery. 128(5):1085-1092, November 2011; doi: 10.1097/PRS.0b013e31822b67ff
2.  Postoperative Enoxaparin Prevents Symptomatic Venous Thromboembolism in High-Risk Plastic Surgery Patients; Pannucci, Christopher J.; Dreszer, George; Wachtman, Christine Fisher; Bailey, Steven H.; Portschy, Pamela R.; Hamill, Jennifer B.; Hume, Keith M.; Hoxworth, Ronald E.; Rubin, J. Peter; Kalliainen, Loree K.; Pusic, Andrea L.; Wilkins, Edwin G.; Plastic & Reconstructive Surgery. 128(5):1093-1103, November 2011; doi: 10.1097/PRS.0b013e31822b6817
3.  Miszkiewicz K, Perreault I, Landes G, et al.. Venous thromboembolism in plastic surgery: Incidence, current practice and recommendations. J Plast Reconstr Aesthet Surg. 2009;62:580–588.
4.  Venturi ML, Davison SP, Caprini JA. Prevention of venous thromboembolism in the plastic surgery patient: Current guidelines and recommendations. Aesthet Surg J. 2009;29:421–428.
5.  McDevitt NB. Deep vein thrombosis prophylaxis. American Society of Plastic and Reconstructive Surgeons. Plast Reconstr Surg. 1999;104:1923–1928.
6. Davison SP, Venturi ML, Attinger CE, Baker SB, Spear SL. Prevention of venous thromboembolism in the plastic surgery patient. Plast Reconstr Surg. 2004;114:43E–51E.
7. Young VL, Watson ME. The need for venous thromboembolism (VTE) prophylaxis in plastic surgery. Aesthet Surg J. 2006;26:157–175.

Friday, December 9, 2011

Holly Hobbie Trip Around the World Quilt

I made this quilt and the one to be shown next week for twin baby girls.  I didn’t want them to be just alike, but wanted them to be “connected” so I used some Holly Hobbie fabric I had left over from previous sewing/quilting in both quilts.   This one is a trip around the world.  It is machine pieced and quilted.  It measures 34.5 in square.

Here you can see the center area featuring Holly.

I used this lovely pink butterfly fabric for the backing on both quilts.  

Tuesday, December 6, 2011

Shout Outs

Updated 3/2017 -- all links removed (except to my own posts) as many no longer active.

Nick Genes is hosting this week’s Grand Rounds at his blogborygmi tumblr.  You can read this week’s edition here.
Hello and welcome to this collection of medical links from across the web, written by providers, patients and analysts that work on the frontlines of modern healthcare.
This is my sixth time hosting Grand Rounds (three prior times on blogborygmi’s blogspot site, twice on, and my first time with Tumblr.
I’ve been hearing about Tumblr for years, and after finally making the leap a few weeks back, I figured it might be a good fit for Grand Rounds today, as well. .….
@doctorblackbear who blog at Asystole is the Most Stable Rhythm has written a beautiful post: Trust
"So the patient has been temporarily paralyzed by the drugs, and you're the one keeping them alive by squeezing air into their pressure".
I was holding the mask as tightly against her face as I could, sealing the rubber to her cheeks in the effort to keep highly oxygenated air from leaking out. Looking down at her from the head of the bed I saw the patient from a different vantage point, a place that made her look so vulnerable.
And she was vulnerable.  …….
H/T to @antidoped who gave me the head’s up on @imapactednurse’s post:  1 shift, 3 stories
My name is Caleb.
Ive had this pain in my arse for 2 weeks now. The doc says its a hemorrhoid or something. All I know is, it fucking hurts like shit.
I am supposed to have surgery, but the hospital has cancelled it twice now. Says its too busy. ….
From Street Anatomy: A Woman’s Back is Beauty
Edinburgh-based photographer Diana Eastman shot this gorgeous photograph overlayed with a classic anatomical illustration from what I believe is Grey’s Anatomy……..

The Alliance for American Quilts received 119 quilts for it’s 2011 "Alliances: People, Patterns, Passion" contest.  My entry was “Redwork Quilt” and is included in this week’s (Week Four --Mon, Dec 5 – Dec 12) quilts being auctioned off on eBay.
All contest quilts will be auctioned via eBay starting on Monday, November 14, 2011 and ending December 12, 2011. All proceeds will support the AAQ and its projects. ….
Week FOUR auction guide: Monday, December 5 - Monday, December 12……
New this year: "Alliances" contest artist's were offered the chance to record their artist's statements thanks to the generous services of AAQ Business member, VoiceQuilt, visit them at

Monday, December 5, 2011

Is It Okay to Return to Work?

Updated 3/2017 -- all links removed (except to my own posts) as many no longer active.

When a patient asks you if it’s okay to return to work after an injury or surgery what do you base your decision on? 
When I was in practice I would base my on what the injury was, how the individual seemed to be healing, and what type of work they did.  It was simple when I could simply write a note that said something like “T. J. can return to light duty on  ____ and to full, unrestricted duty on _____.”
I did not like having to fill out the short term disability forms, but with my new understanding of the legal definitions of work (heavy, medium, light, sedentary) I would find it much easier to do.  I also understand how this is much more helpful to the individual’s work supervisor than my one line note.
Different jobs are classified as heavy, medium, light, and sedentary depending on the exertion required to do them.
Heavy Work
  • Can lift and carry up to, or more than 100 pounds frequently.
  • Can lift and carry up to 50 pounds occasionally
  • Is able to stand or walk, off and on, for a total 6 hours in an 8-hour workday
Types of heavy work include construction cleanup

Medium work
  • Can lift and carry up to pounds at a time occasionally
  • Can lift and carry up to 25 pounds frequently
  • Is able to stand or walk, off and on, for a total 6 hours in an 8-hour workday
Type of medium work include many skilled trade jobs such as construction, plumbing, etc.

Light work
  • Can lift and carry up to 20 pounds occasionally
  • Can lift and carry 10 pounds frequently
  • Is able to stand or walk, off and on, for a total 6 hours in an 8-hour workday
Types of light jobs include nurse, teacher, cashier, etc.

Sedentary work
  • Can lift and carry up to 10 pounds occasionally
  • Can lift and carry less than 10 frequently
  • Is able to stand or walk, off and on, for a total 2 hours in an 8-hour workday
Sedentary work is your basic “sit-down job” such as receptionist, dispatcher, assembler, etc.

Limitations of reaching, pushing, pulling, stair climbing, stooping, and crouching placed on a light work restriction can move the individual to a sedentary restriction by nature of the job requirements.
Limitations on fingering (keying, typing) can make it difficult for an individual to perform their work even when given a sedentary restriction.

“Occasionally” means occurring from very little up to one-third of the time. “Frequent” means occurring from one-third to two-thirds of the time.
Other things that affect an individuals ability to return to their work may involve the work place environment—dust, fumes, chemical exposure, etc.

For more information about  how Social Security defines the different exertional levels see SSR 83-10.  

Friday, December 2, 2011

Paper Airplane Quilt

I made this quilt almost 20 years ago in 1992 as part of challenge to use the selected fabrics.  I do not recall why I decided to use them to depict how a paper airplane was made, but as you can see that is what I did.
The quilt is machine pieced.  It is machine and hand quilted.  It measures 53 in X 15 in.
Here is the first panel which represents the unfolded sheet of typing paper. 
Follow the fabrics through the panels as the “sheet” is folded on itself.

The finished paper airplane.
I didn’t put a binding on this quilt.  It is finished by using a black piping trim.

Tuesday, November 29, 2011

Shout Outs

Updated 3/2017 -- photos/videos and all links removed (except to my own posts) as many no longer active.

Afternoon Nap Society is the host for this week’s Grand Rounds. You can read this week’s edition here.
………….This week, Grand Rounds is mine, and in selecting blog posts, I evaluated submissions based on their topicality, writing style, and personal appeal. What I look for in a blog as an ePatient may differ from what a physician or even another ePatient looks for; however, the goal of Grand Rounds is to foster dialogue, and more and more we are learning that in order for a healthcare dialogue to be truly effective, it must include the patient perspective. As a result, Sean Ahrens, an ePatient and software designer who is building Chronology, an online network on which patients with Crohn's and Colitis may connect and learn from one another, opens this week's session….….
In the current JAMA, a thoughtful commentary article by Traber Davis Giardina, MA, MSW and Hardeep Singh, MD, MPH:  Patient's direct access to test results - pros and cons. (subscription necessary for full access)
In the outpatient setting, between 8% and 26% of abnormal test results, including those suspicious for malignancy, are not followed up in a timely manner. Despite the use of electronic health records (EHRs) to facilitate communication of test results, follow-up remains a significant safety challenge. In an effort to mitigate delays, some systems have adopted a time-delayed direct notification of test results to patients (ie, releasing them after 3 to 7 days to allow physicians to review them).
On September 14, 2011, the Department of Health and Human Services jointly with the Centers for Medicare & Medicaid Services, the Centers for Disease Control and Prevention, and the Office for Civil Rights proposed a rule allowing patients to access test results directly from the laboratory by request (paper or electronic).  .……….
For those of you like me trying to follow the face transplant recipients and procedures progress, CBC News recently had an update on one of them:  Conn. woman mauled by chimp praised for new face
…….."I've had people tell me I'm beautiful," Nash said in the interview that aired Monday. "And they were not telling me I was beautiful before."
Nash said she was cheered by a simple "hello" from a child while she was shopping recently.
"That didn't happen before," she said. "It was nice. The little girl was saying 'hi' to me. ... I'm not scaring anybody." ……
This article from Science Daily caught my eye and I look forward to when it might be possible in humans:  Cleft Lip Corrected Genetically in Mouse Model
Scientists at Weill Cornell Medical College used genetic methods to successfully repair cleft lips in mice embryos specially engineered for the study of cleft lip and cleft palate. The research breakthrough may show the way to prevent or treat the conditions in humans. ...…….
H/T to @medicallessons for this tweet “Is a Ban on Drinking Water Hours Before Surgery Necessary? (maybe not) -- ttp://”  The link is to a New York Times Q & A article by C. Claiborne Ray:  Cool, Clear Water
Q. Is it really necessary to prevent patients from drinking water for many hours before surgery?
A. The well-known rule that a preoperative patient should have “nothing by mouth after midnight” was not based on scientific evidence, and many medical organizations now have more flexible guidelines. For example, American Society of Anesthesiologists guidelines generally permit clear liquids until two hours before surgery. .…….
Be sure you ask your surgeon and anesthesiologist what the rule is for you as the above is for healthy individuals.  It may vary depending on your set of health problems and the surgery you are scheduled to have.
I love watching my dog shake water off. 
H/T to @DrVes for the link to this NPR story by Robert Krulwich:  Shake It! How Dogs, Cats, Even Hummingbirds Keep Dry (photos, including the one below, and video)
The Alliance for American Quilts received 119 quilts for it’s 2011 "Alliances: People, Patterns, Passion" contest.   You can see all the quilts here. My entry was “Redwork Quilt” and is included in this week’s (Week Two --Mon, Nov. 21- Mon, Nov. 28) quilts being auctioned off on eBay.
All contest quilts will be auctioned via eBay starting on Monday, November 14, 2011 and ending December 12, 2011. All proceeds will support the AAQ and its projects. ….
Week THREE auction guide: Monday, November 28 - Monday, December 5  ……
New this year: "Alliances" contest artist's were offered the chance to record their artist's statements thanks to the generous services of AAQ Business member, VoiceQuilt, visit them at

Monday, November 28, 2011

Additional Benefits to Reduction Mammoplasty

Updated 3/2017 -- all links removed (except to my own posts) as many no longer active.

This article (full reference below) on the additional benefits an individual gains from having a reduction mammoplasty (RM) has been published online ahead of print.  The authors performed a systemic review of the literature focusing on functional outcomes after RM with regard to physical and psychological symptom improvement.
The authors performed a systematic review of the English literature using PUBMED for the period between 1977 to 2010. Studies were chosen that addressed the physical and psychological benefits of RM using a validated questionnaire.
The authors note that nearly eighty thousand breast reductions
were performed in 2009.  For insurance coverage in the United States a woman seeking breast reduction must have complaints of physical symptoms (ie neck pain, upper back pain, inframammary rashes, etc). 
The authors of this article choose to look at the other benefits a reduction mammoplasty can have:
Even less common are investigations on the effect of RM on weight loss, exercise, and eating behavior.  Women with large breasts often find exercising difficult due to public scrutiny and physical constraints. They may even develop eating disorders in an attempt to match their breast size to the rest of their body. ……..Women with macromastia often have
diminished self-esteem, poor psychosexual function, depression, and anxiety.
I want to applaud them for their article.  There are 52 article in their reference list.  Table I is a breakdown of 6 articles on physical symptoms/improvements.  Table II is a reference does the same for 8 articles on the effects of reduction mammoplasty on exercise, weight and eating behaviors.  Table III does the same for 5 articles on the effects of reduction mammoplasty on psyche.  Table IV summarizes 3 articles on the effects of reduction mammoplasty on appearance.
The results of their summary:
Women who undergo RM have a functional improvement in musculoskeletal pain, headaches, sleep, and breathing. Psychological benefits are vast and include improved self esteem, sexual function, and quality of life, as well as less anxiety and depression. Following RM, women appear to exercise more and have a reduction in eating disorders.
This is what I saw over my 21 years of practice in taking care of these women.
Related post: 
Reduction Mammoplasty (December 19, 2007)
Additional Benefits to Reduction Mammaplasty: A Systemic Review of the Literature; Singh, Kimberly A.; Losken, Albert; Plastic & Reconstructive Surgery., POST ACCEPTANCE, 15 November 2011; doi: 10.1097/PRS.0b013e31824129ee

Friday, November 25, 2011


Updated 3/2017 -- all links removed (except to my own posts) as many no longer active.

I am finally getting around to posting about the quilt I received as part of ALQS6.  I received it in the mail nearly a month ago.  It is lovely!  It was made by Jay who blogs at Creative Crone from studio Q.  She named the quilt Monarchs.

Jay sent me extra fabric so that I can sew a sleeve on the back and hang it.  The photos don’t do it justice.

Here is a link to the quilt (Mariner’s Compass Rose) I made for ALQS6.  It was mailed to Veronique in Chile.
Here are the posts of the quilts made and received from the first five ALQS.
1st: Laced Ribbons Quilt (went to Pennsylvania, May 2008)
2nd: Flower Basket Quilt (went to Indiana, September 2008)
3rd: Fractures I (went to Australia, June 2009)
4th:  Blue Hawaii Wall Hanging (went to   Great Britain, July 2010)
5th:  Winter  (went to the Netherlands,  January 2011)
1st: I Received My Quilt (from Denver, June 2008)
2nd: It's Arrived! (from Italy, November 2008)
3rd: Geverfde Quilt (from the Netherlands, August 2009)
4th:  Falling Stars  (from Great Britain, August 2010)
5th:  Pale Flowers (from  Florida, February 2011)

Wednesday, November 23, 2011

Engage with Grace

Updated 3/2017 -- all links removed (except to my own posts) as many no longer active.

As I have in the past few years at Thanksgiving, I am again joining  in the  Engage with Grace (#EWG) blog rallyIt is a time when families get together.  Please, use this time to discuss end-of-life issues with your family.
Here's a summary prepared by Alexandra Drane and others involved in this issue. Once again, this Thanksgiving we are grateful to all the people who keep this mission alive day after day: to ensure that each and every one of us understands, communicates, and has honored their end of life wishes.
Seems almost more fitting than usual this year, the year of making change happen. 2011 gave us the Arab Spring, people on the ground using social media to organize a real political revolution. And now, love it or hate it - it's the Occupy Wall Street movement that's got people talking.
Smart people (like our good friend Susannah Fox) have made the point that unlike those political and economic movements, our mission isn't an issue we need to raise our fists about - it's an issue we have the luxury of being able to hold hands about.
It's a mission that's driven by all the personal stories we've heard of people who've seen their loved ones suffer unnecessarily at the end of their lives.
It's driven by that ripping-off-the-band-aid feeling of relief you get when you've finally broached the subject of end of life wishes with your family, free from the burden of just not knowing what they'd want for themselves, and knowing you could advocate for these wishes if your loved one weren't able to speak up for themselves.
And it's driven by knowing that this is a conversation that needs to happen early, and often. One of the greatest gifts you can give the ones you love is making sure you're all on the same page. In the words of the amazing Atul Gawande, you only die once! Die the way you want. Make sure your loved ones get that same gift. And there is a way to engage in this topic with grace!
Here are the five questions, read them, consider them, answer them (you can securely save your answers at the Engage with Grace site), share your answers with your loved ones. It doesn't matter what your answers are, it just matters that you know them for yourself, and for your loved ones. And they for you.

We all know the power of a group that decides to assemble. In fact, we recently spent an amazing couple days with the members of the Coalition to Transform Advanced Care, or C-TAC, working together to channel so much of the extraordinary work that organizations are already doing to improve the quality of care for our country's sickest and most vulnerable.
Noted journalist Eleanor Clift gave an amazing talk, finding a way to weave humor and joy into her telling of the story she shared in this Health Affairs article. She elegantly sums up (as only she can) the reason that we have this blog rally every year:
For too many physicians, that conversation is hard to have, and families, too, are reluctant to initiate a discussion about what Mom or Dad might want until they're in a crisis, which isn't the best time to make these kinds of decisions. Ideally, that conversation should begin at the kitchen table with family members, rather than in a doctor's office.
It's a conversation you need to have wherever and whenever you can, and the more people you can rope into it, the better! Make this conversation a part of your Thanksgiving weekend, there will be a right moment, you just might not realize how right it was until you begin the conversation.
This is a time to be inspired, informed - to tackle our challenges in real, substantive, and scalable ways. Participating in this blog rally is just one small, yet huge, way that we can each keep that fire burning in our bellies, long after the turkey dinner is gone.
Wishing you and yours a happy and healthy holiday season. Let's Engage with Grace together.

To learn more please go to This post was developed by Alexandra Drane and the Engage With Grace team.

Tuesday, November 22, 2011

Shout Outs

Updated 3/2017 -- photos and all links removed (except to my own posts) as many no longer active.

Amy Tenderich, Diabetes Mine blog, is the host for this week’s Grand Rounds. You can read this week’s edition here.
Welcome to Grand Rounds, Vol. 8, No. 9, the 2011 Thanksgiving edition of the weekly summary of the best health and medical blog posts on the web. Many thanks to the organizers at Get Better Health for inviting us to host!
In a world where major economies are imploding and a climate catastrophe seems impending, there is still much to be thankful for — especially in the arena of health and medicine, where technology is empowering a revolution of sorts in hospitals, clinics and doctors’ offices, and in patients’ everyday lives.
What We’re Collectively Thankful for, from all around the med-blogosphere:
Last week’s host, Alvaro Fernandez at Sharp Brains, is thankful that everyone contributing to and reading Grand Rounds has a human brain (no bots, we hope!), and thankful that the human brain is not fully pre-wired.  .….
H/T to @gastromom  for the link to this Huffington Post article by Dr. Rebecca Palacios:  Learning to Cook and Cooking to Learn
The holidays offer wonderful opportunities to create learning experiences for children that center around cooking. These experiences are especially powerful because they involve all of the senses: smelling, tasting, touching, hearing, and seeing -- which is one reason that memories created in the kitchen can last a lifetime! With a little thought and preparation, you can use this time to build important understandings and skills in literacy, mathematics, science, health, and even art. ……….
H/T to @doctorwes for alerting me to this WSJ article: Doctor Revolt Shakes Disability Program.  His link required a subscription for full access, but @MDBuyline sent me a tweet with a link to full article.  I’m still thinking about it (as this is the work I am now doing), but my initial reaction is that the article is selectively biased.  The graphics with the article are impress though – take this one for example (check out the interactive map here)
See how the percentage of residents ages 18 to 64 receiving disability benefits has changed in each state since 2001.

H/T to @sandnsurf for this tweet with link:  “Cool... Free e-book: Oh Doctor, The Places You Will Go... Precious Bodily Fluids” 
  …….a parody of Dr Seuss' classic Oh, the Places You'll Go! It is a candid look at the journey people make in order to become doctors. I found it charming. Go download it. .…….
How about a book review by @medicallessons:  ‘Cutting For Stone,’ and Considering the Experience of Practicing Medicine
A short note on Cutting for Stone, a novel I’ve just read by Dr. Abraham Verghese. He’s an expert clin­ician and pro­fessor at Stanford. The author uses rich lan­guage to detail aspects of Ethiopian history, med­icine and quirks of human nature. The book’s a bit long but a page-​​turner, like some lives, taking a strange and some­times unex­pected course.
For today I thought I’d mention one passage that haunts me. …….…….
The Alliance for American Quilts received 119 quilts for it’s 2011 "Alliances: People, Patterns, Passion" contest.   You can see all the quilts here. My entry was “Redwork Quilt” and is included in this week’s (Week Two --Mon, Nov. 21- Mon, Nov. 28) quilts being auctioned off on eBay.
All contest quilts will be auctioned via eBay starting on Monday, November 14, 2011 and ending December 12, 2011. All proceeds will support the AAQ and its projects. ….
Week TWO auction guide: Monday, November 21 - Monday, November 28 ……
New this year: "Alliances" contest artist's were offered the chance to record their artist's statements thanks to the generous services of AAQ Business member, VoiceQuilt, visit them at

Monday, November 21, 2011


Updated 3/2017 -- all links removed (except to my own posts) as many no longer active.

A month ago during a storm with significant straight line winds we had a tree near the house loss it's top half. Upon inspection, it turned out the pine tree was infested with pine beetles. We were encouraged to burn the debris to help protect the other trees from the beetles.
This past week my husband cut up the felled tree (we still need to get a tree cutter out to cut down the 2/3s of the tree still standing) and carried it to an area of the front property.  Yesterday morning after a light rain, he decided it was a good time to set it afire and burn it.  Note the red container under the tree to the left.  It contains gasoline.  [Even though he told me he wouldn’t use an accelerant.]  He did run a water hose down from the house which is barely visible in the forefront of the photo.

Medscape has a really nice article with video by Kenneth L. Silverstein, MD; Stephanie Josephon --  Surgical Fires: How They Start and How to Prevent Them.
……….For those of you watching, you can find out more about the FDA's Preventing Surgical Fires Initiative on our Website. You can also download educational materials and other resources to help reduce the risk for fire at your facility. We hope you'll join our partnership to help eliminate surgical fires. Thank you for watching.
As with my husband’s fire, thought must be given to the surroundings, what in the area is flammable or the fuel (in the OR – surgical drapes, patient, etc), accelerants or oxidizers (in the OR – concentrated O2, etc), and igniters (in the OR – lasers, cautery).
There must be forethought to prevention, but there must also be thought given to what do we do if a fire starts.  Where is the fire extinguishers?  Does the staff know what to do? 

Sunday, November 20, 2011


Updated 3/2017 -- all links removed (except to my own posts) as many no longer active.

My new job requires that I review medical records of individuals who have filed for disability benefits. I am learning to think of these individuals as "claimants" rather than "patients." AND while some are never going to be allowed (nail bed injury), others break your heart and give you pause. So this Thanksgiving season finds me:
1. Grateful for my job
2. Grateful for my health which allows me to work
3. Grateful for the ability to learn
4. Grateful for family (those here and those represented by the empty chair at the table)
5. Grateful for my friends, all of you (meet in real life and meet only on-line, so far)

Friday, November 18, 2011

Scrappy Houses Baby Quilt

This baby quilt is another one using scrapes.  I tried to make it appear as if there were two houses with trees.  The quilt is 35 in X 37.5 in.  It is machine pieced and quilted. 

There are many interesting thing to find:  a peasant, a squirrel, a butterfly, carolers.
Here you can see a wise man on a camel, a football player, bees, skiers, a zebra.
Here you can find a hippo, a dog on a motorcycle, a robot.
The back is pieced using leftover Winnie the Pooh fabric and white muslin.

Tuesday, November 15, 2011

Shout Outs

Updated 3/2017 -- photos and all links removed (except to my own posts) as many no longer active.

Sharp Brains is the host for this week’s Grand Rounds. You can read this week’s myth buster’s edition here.
Wel­come to a new edi­tion of Grand Rounds blog car­ni­val, the weekly edi­tion of what’s best in the health and med­ical blo­gos­phere. This week, twenty four blog­gers share data, insights, ques­tions, reflec­tions and more. Enjoy!
On Improv­ing Care
Dr. Robert Oren­stein at ACP Hos­pi­tal­ist: thor­oughly clean­ing patient’s rooms can dra­mat­i­cally reduce healthcare-acquired infec­tions (HAI). ….
H/T to @SynapticSilence for the link to this NY Times article by Jo Craven McGinty about as he puts it “a kind of prolonged grief I doubt many of us, even those in the mental health profession, have considered” -- As 9/11 Remains Are Identified, Grief Is Renewed
On Nov. 19, 2001, Susan Ainbinder Hutchins received a call saying that her son, Kevin Colbert, who worked at an investment bank on the 89th floor of 2 World Trade Center, had been identified among the ground zero remains.
“I’m thinking, they found my son,” she said, “but …...
But the nightmare was not over. “The calls kept coming and coming and coming,” she said. For several years, at roughly two-month intervals, she was informed that another piece of her son had been identified.
“Nobody gets it,” she said. “They don’t understand why I’m stuck in such an awful place.”   ……….
H/T to @hjluks who tweeted “DOCs... like to doodle during patient interactions? draw MD - iPad Application #hcsm #thcsm @myen” 
I would use this app if I were still in practice!  I often sketched over the photos in brochures or attempted to draw my own.  It looks like most specialties are covered.  From the site:

About drawMD

Designed to improve patient understanding of medical problems, drawMD utilizes the iPad's unique interface to allow anyone to sketch, stamp, or type directly on detailed anatomic images. The included images are tailored to each specialty and provide the ability for doctors to communicate and explain treatment plans, including surgical procedures, as well as document these plans for patient records.
Check out Dr Val’s post:   Don’t Fly Delta: Airline Runs Anti-Vaccine Videos Against Medical Advice
I’ve been following the recent Delta airlines flu vaccine kerfuffle with interest and now amazement. After running in-flight infomercials by a notorious anti-vaccine group (NVIC), the American Academy of Pediatrics alerted Delta to the faux pas with a letter from president Robert W. Block, M.D. I had assumed that Delta would be grateful for the head’s up, and would immediately remove the infomercials. Instead, they chose to ignore the letter, denying that they saw any harm in associating themselves with anti-vaccine activists. Despite the warning, they will continue to run the ads through the month of November…..
Which means that I will NOT be flying Delta in the foreseeable future and I hope you won’t either. When US physician organizations are flat out ignored by corporate executives, it leaves us with only one choice – to speak with our feet. Sadly, the bottom line may matter more to them than the health and safety of their passengers.
You may sign a petition against Delta’s actions here. Or use the #DontFlyDelta hashtag on Twitter. …….
Another nice piece from @jordangrumet who blogs at In My Humble Opinion: If I Die Young
It's funny how a few words, a phrase, or music can bring back buried memories.
If I die young, bury me in satin
Lay me down on a, bed of roses
Sink me in the river, at dawn
Send me away with the words of a love song

The sharp knife of a short life, oh well
I've had just enough time

I heard this song on the radio this morning. A rush of memories flooded my brain in the form of the smiling face of a beautiful little girl.   …….
The Alliance for American Quilts received 119 quilts for it’s 2011 "Alliances: People, Patterns, Passion" contest.   You can see all the quilts here. My entry was “Redwork Quilt” and is included in Week Two (Mon, Nov. 21- Mon, Nov. 28) quilts being auctioned off.
All contest quilts will be auctioned via eBay starting on Monday, November 14, 2011 and ending December 12, 2011. All proceeds will support the AAQ and its projects. ….
Week ONE auction guide: Monday, November 14 - Monday, November 21 ……
New this year: "Alliances" contest artist's were offered the chance to record their artist's statements thanks to the generous services of AAQ Business member, VoiceQuilt, visit them at

Monday, November 14, 2011

Safe Medical Waste Disposal

Updated 3/2017 -- all links removed (except to my own posts) as many no longer active.

All medical offices must dispose of medical waste in a safe manner.  I closed my office at the end of September, but my last medical waste pickup is the first Friday of December.  My dear husband is going to open the office and wait for them.
How have you told patients over the years to deal with their medical waste?  Needles?  Syringes?  JP drains they pull out or that fall out before they get back for follow up? 
Last week the FDA sent out a press release announcing the launch a new website for patients and caregivers on the safe disposal of needles and other so-called “sharps” that are used at home, at work and while traveling.
…….Sharps disposal guidelines and programs vary by jurisdiction. For example, in 2008, California passed legislation banning throwing needles in household trash. Florida, New Jersey and New York have established community drop off programs at hospitals and other health care facilities. People using sharps at home or work or while traveling should check with their local trash removal services or health department to find out about disposal methods available in their area.
For the safe disposal of needles and other sharps used outside of the health care setting, the FDA recommends the following:
  • Immediately place used sharps in an FDA-cleared sharps disposal container to reduce the risk of needle-sticks, cuts or punctures from loose sharps. (A list of products and companies with FDA-cleared sharps disposal containers is available on the FDA website. Although the products on the list have received FDA clearance, all products may not be currently available on the market.)    
  • If an FDA-cleared container is not available, some associations and community guidelines recommend using a heavy-duty plastic household container as an alternative. The container should be leak-resistant, remain upright during use and have a tight fitting, puncture-resistant lid, such as a plastic laundry detergent container.
  • Keep sharps and sharps disposal containers out of reach of children and pets.
  • Call your local trash or public health department in your phone book to find out about sharps disposal programs in your area. 
  • Follow your community guidelines for getting rid of your sharps disposal container.
  • Throw loose sharps into the trash.
  • Flush sharps down the toilet.
  • Put sharps in a recycling bin; they are not recyclable.
  • Try to remove, bend, break or recap sharps used by another person.
  • Attempt to remove a needle without a needle clipper device.
For more information:
  • Needles and Other Sharps (Safe Disposal Outside of Health Care Settings)
  • Improperly Discarded ‘Sharps’ Can Be Dangerous – Consumer Update
  • Sharps Flickr Slideshow

Friday, November 11, 2011

Recent Knitting Projects

Updated 3/2017 -- all links removed (except to my own posts) as many no longer active.

These three items were completed over the summer months.  The first one is a small shawl that I knitted as part of my first KAL (knit along).   I used three shades of Berroco Ultra Alpaca Fine yarn.  I plan on giving it as a gift to my stepmother-in-law for her upcoming birthday.

I used some of the leftover yarn from the above shawl to knit this child-size hat.  It uses the pattern Selbu Modern by Kate Gagnon Osborn.  It will go to one of my nieces or great-nieces.
Same hat, but top view.
This Jester Hat by Bernat Design Studio, also child-size, was made using left over Patons Kroy Socks Jacquards yarn.

Tuesday, November 8, 2011

Shout Outs

Updated 3/2017 -- photos and all links removed (except to my own posts) as many no longer active.

Better Health is the host for this week’s Grand Rounds. You can read this week’s myth buster’s edition here.
As regular readers of the Better Health blog already know, I am opposed to health misinformation. In fact, I started this very blog because of my disappointment with the sheer volume of false claims, misleading stories, and pseudoscience actively promoted to patients.
It was my hope that gathering together key medical blogger “voices of reason” would promote health sanity on Google. You could argue that we’re tilting at windmills, but tilt we must – and I’m proud to say that our membership now includes contributions from the CDC, the American College of Physicians, Harvard Health publications, Diario Medico (Spain’s premier MD website) and over 100 independent bloggers who are standing with us in an attempt to provide smart health commentary to patients and providers alike.
And with that, let us begin our terrific Grand Rounds tradition (now in its eighth year – which in blog years is about 120) of highlighting this week’s best of the medical blogosphere… (And yes, that’s me with Mythbuster’s TV host Adam Savage, circa 2009).………….
H/T to @MtnMD and @drmlb for the link to this:  Healing power of poetry which features the poem "Lumpectomy" by Joan Baranow
………Below is Joan’s poem.
by Joan Baranow
The moon is a little dented tonight
on the right side
where an arm would be
and that’s natural
to the moon
as well as certain situations—………….
A heart warming story by MSNBC written by Linda Carroll:  Organ donor's family meet the man their father saved
……….“When we got the letter from the donor’s family, my wife and I just sat there and cried, because I didn’t expect it,” Watson, who received a life-saving heart, liver and kidney transplant, told TODAY. “I didn’t expect it to impact me as much as it did. But it was just emotional realizing that this person gave the last gift to me that he could, and it saved my life.”
Read the letter: Click here to read the Jessica Lyngaas's letter to the Watsons
Organ recipients aren’t supposed to contact the families of donors - those are the rules.
But on rare occasions, when the donor family reaches out as Jessica Lyngaas did and the recipient is willing, institutions can give way. ……
Check out Dr. Wes’s post:   Smile! You're on Candid Camera!
They sat anxiously waiting for their loved one to enter the holding area after the procedure, one nervously clutching her purse, another today's paper, and a third, her cellphone. The air was tense as they awaited the news of how the procedure went. All the preparation, the concern, and the questioning come down to this moment when they learn if they made the right decision to go forward with the procedure. Will there be elation or despair?
So of course they want to videotape the moment.
The door opened, there was their loved one, looking no worse for wear, followed by the doctor. As he came forth to tell them the good news, the cellphone video recorder captured the discussion, ….. The doctor was caught completely off-guard.
In this case, the news was happy. All went well. But what should happen if the news weren't so good or even devastating? …….
Another nice piece from @jordangrumet who blogs at In My Humble Opinion: I Could
Adapted from the poem "I Could"
Cook County hospital 1998
Breast center
Who's next?
He calls to the residents, as if he is a bank teller waiting to accept his next deposit. He walks from room to room with the medical students trailing behind. He enters the cubicle without taking the time to introduce himself. He touches breast tissue with precision and tenderness. Yet to put his arm around the shoulder of a suffering patient would be considered to intimate.  …….
An article in the by Melanie Warner Spencer:  Modernism emerges in quilting world
……….I believe I’ve discovered a quilting genre that appeals to my personal aesthetic.
The fast-growing modern quilt movement is inspired by modern art and architecture.
Modern quilters embrace the tenets of modernism, including simplicity, minimalism, clean lines, the use of negative space, experimentation and new ways of looking at old ideas……

Monday, November 7, 2011


Updated 3/2017 -- all links removed (except to my own posts) as many no longer active.

This past Friday a twitter/blog friend @jabulani9 notified me that another of our twitter/blog friends @trilisakay had died the day before. 
I first began following Lisa when she blogged at The Tale of My Left Foot and more recently at Call Me Dr. Lisa.  She began the second blog as she put it (August 2009):
I have decided that The Tale of My Left Foot is done. 34 monthes ago, I had my first surgery on my ankle and 1 month later learned I had cancer. I have documented my journey, my triumphs, my failures, my fears and last weekend I completed a triathlon. So, now the "Tale" feels done. Thanks for travelling this road with me.
In January of this year she underwent a major surgery with reconstruction (a gracilis flap) when her cancer returned.  I answered some questions for her regarding the flap, etc.  I tried to encourage her as she recovered and began training again for another triathlon.  Truth is, she was encouraging to me as she remained more upbeat than not and pushed forward.  I would have loved to have known her in real life.
Her last blog post was October 26 and remains upbeat:  Taking my Training to the Pool
……I remain as committed as ever to complete my first half marathon just short of the one year anniversary of my surgery. I continue to feel incredibly fortunate to be on this journey with some of the most amazing and inspirational people I’ve ever met. I appreciate everyone’s support more than you know.
If you are so inclined you can still donate in her name to her TEAM.

Friday, November 4, 2011

Hounds Tooth Baby Quilt

This is the hounds tooth quilt pattern.   This is the second time I’ve used this pattern.  The first one can be seen here.  This baby quilt is machine pieced and quilted.  Each block has one item of interest (cat, dog, etc).  It is 39 in square.  I have given it to a sister-in-law who is due in the spring with her third child.

This block features Winnie the Pooh and Piglet.

This block features dogs.
This block features a fast car.

Tuesday, November 1, 2011

Shout Outs

Updated 3/2017 -- photos/videos and all links removed (except to my own posts) as many no longer active.

David, Health Business Blog, is the host for this week’s Grand Rounds. You can read this week’s edition here.
Welcome to the latest edition of the Grand Rounds blog carnival, the weekly roundup of medical blog posts!
The Blog That Ate Manhattan kicks us off with the Meaningful Use Song, surely the most antic entry I’ve ever hosted. Can’t beat the zippy refrain “I am the model user of an EMR that’s meaningful.” ………….
Have you discovered Joanna Cannon’s blog yet? Here’s a nice post: Abor Vitae
The oak tree was worn and tired and sat in a field, where it waited to die.
“I have lived my life,” said the oak tree, “I have felt the seasons turn beneath my roots and I have watched the years unfold and spill themselves through my branches. Now it is time for me to move on.”
The other trees were distressed and pleaded with the oak tree to stay. ……
bongi, other things amanzi, has a new post after a hiatus: physician, heal thyself
even doctors get sick, but there is often a difference.
i was rotating through orthopaedics and was on call that night. …... once i had finished operating i rushed through the change rooms to get back to casualties. while i was changing i heard the unmistakable sounds of someone throwing up in the toilet cubicle. quite soon the door opened and out came the orthopaedic registrar who was on call that night with me. he did not look good……….
My friend Elizabeth, Methodical Madness, has a nice post: Fan Mail
I've had a handful of readers over the past couple of years e-mail me to ask me questions about pathology and advice about medicine but no one, until last Thursday, has ever prefaced their question as "Fan Mail." I was tickled pink. A first year medical student from a far away institution asked this, and kindly allowed me to answer in a post:
"My question for you is, are there times when you wished non-pathologist physicians remembered more about histology? What would you like them to know?"
The short answer is this: NOTHING. ……….
H/T to @hrana for the link to the Wall Street Journal article by Robert Johnson: Plastic surgery is on the rise among older Americans
Mary Lou Ray decided at age 65 that she had seen enough of the person in her mirror.
"My life led up to this. I had been divorced for 13 years, my children were grown, and with the death of my mother—not to be unkind—I was finally free of criticism about things like dyeing my hair," she says.
So last year she spent $13,000 on a face lift and other cosmetic procedures that proved rejuvenating.
"I'm absolutely thrilled," says Ms. Ray, a real-estate agent in Roanoke, Va. "I think a lot of friends in my age bracket would like to try this, but they're afraid of getting that unnatural, yanked-up look. I don't have that; I still look like me." ……..
H/T to @DrVes for the link to the Lancet article: Haemorrhagic herpes zoster 

Check out this NPR article by Adam Cole: Visualizing How A Population Grows To 7 Billion   

Monday, October 31, 2011

Never Too Old to Donate?

Updated 3/2017-- all links removed as many no longer active.

I happened to see this press release from American Society of Nephrology via Eurekalert regarding an article in an upcoming issue of the Clinical Journal of the American Society Nephrology (CJASN) advocating the safety of kidney donation in individuals over 70 years old.  The press release does note that kidneys from these elderly donors do not last as long as those from younger living donors.
Currently, as noted on the University of Maryland Medical Center website:
Donors need to be between the ages of 18 and early 70s and can include parents, children, siblings, other relatives, and friends. An ideal donor should have a genuine interest in donating and a compatible blood type with the recipient.
Donors should be in good general health. Donors do not need to be genetically related. Typically, someone who has cancer, diabetes, kidney disease, heart disease, liver disease, sickle cell disease, HIV or hepatitis will not qualify to be a donor. However, these diseases are not all absolute contraindications to donation. Every donor will be considered on an individual basis.
Many individuals over 70 years of age are ineligible simply due to chronic illnesses.   This recent article (full reference below) is a result of a study done by John Hopkins University School of Medicine. 
Jonathan Berger, MD, Dorry Segev, MD, PhD , and their colleagues studied 219 healthy adults over the age of 70 years who donated kidneys and compared them with healthy elderly individuals who were not organ donors.  The surgeries were done at 80 of the 279 transplant centers in the United States.
The researchers found that among recipients of older live donor allografts, graft loss was significantly higher than matched 50-to 59-year-old live donor allografts (subhazard ratio [SHR] 1.62, 95% confidence interval [CI] 1.16 to 2.28, P = 0.005) but similar to matched nonextended criteria 50-to 59-year-old deceased donor allografts (SHR 1.19, 95% CI 0.87 to 1.63, P = 0.3).
Mortality among living kidney donors aged ≥70 was no higher than healthy matched controls drawn from the NHANES-III cohort.
I don’t have full access to the article (only the abstract).  I wonder how old the oldest donor was (ie 72? or 82?).  I wonder if the risk is different for the 70-75 age group vs the 75-80 age group.

Living Donors Online: FAQ (kidney donation)

Living Kidney Donors Ages 70 and Older: Recipient and Donor; Jonathan C. Berger, Abimereki D. Muzaale, Nathan James, Mohammed Hoque, Jacqueline M. Garonzik Wang, Robert A. Montgomery, Allan B. Massie, Erin C. Hall, and Dorry L. Segev;  Outcomes CJASN October 27, 2011 CJN.04160511; published ahead of print October 27, 2011, doi:10.2215/CJN.04160511 (full article is not open access)

Friday, October 28, 2011

Cheerful Robots Baby Quilt

I found this robot fabric at Hobby Lobby.  It became the center piece of this baby quilt.  I used bright colors in a basket weave pattern to frame the robots (red, orange, yellow, green, blue, and purple – though the photos don’t show them well).
The quilt is machine pieced and quilted.  It measures 37 in square.  I sent it to our blog friend Dr. Smak.
Here you can see one of the robots who is actually surrounded by orange, green, yellow, and purple strips.
And this smiling robot.
The back is a pretty yellow and white fabric.

Thursday, October 27, 2011

Prophylactic Mastectomy in BRCA Carriers: Can the Nipple Be Preserved? (an article review)

Updated 3/2017 -- photos and all links removed as many no longer active.

The entire article is available via open access (full reference below).  Women with the BRCA gene (both 1 and 2) often elect to have prophylactic mastectomy to reduce their risks of developing breast carcinoma.  This is even more so for the contralateral breast when a primary is found.  Skin-sparing mastectomies (SSM) and nipple-sparing mastectomies (NSM) greatly improve the cosmetic results for women undergoing reconstruction.  Traditionally, the NAC has been removed due to concerns of possible tumor recurrence or development of a new primary in the remaining breast tissue of the NAC. 
The article notes "numerous retrospective studies have shown a wide range(0-58%) of nipple involvement by tumor in mastectomy specimens." 
This retrospective study involves a small cohort of 33 patients (25 BRCA1, 8 BRCA2) who underwent mastectomy between March 1987 and June 2009 treated at Mayo Clinic.  The entire nipple-areolar complex (NAC) was excised and evaluated histologically.  There was a total of 62 NACs available for evaluation. [TDLS = terminal duct lobular units]
Sixty-two NACs from 33 women (25 BRCA1, 8 BRCA2) were studied. TDLUs were present in 15 (24%) NAC specimens. No evidence of atypical hyperplasia, carcinoma in situ, or invasive carcinoma was found in any of the 33 prophylactic mastectomy specimens. Among the 29 breasts with cancer and available tissue, 2 (7%) had malignant findings and 1 (3%) had atypia in the NAC. One woman who underwent bilateral mastectomy for bilateral invasive carcinoma had one nipple with tumor within lymphatics, and her contralateral nipple had atypical lobular hyperplasia. A second woman had ductal carcinoma in situ involving a single major lactiferous duct..
They conclude the probability of premalignant or malignant lesions in the NAC of BRCA carriers is low overall.  It must be remembered that it is higher (10%) in the subgroup of women undergoing therapeutic mastectomy.  It may be safe for select women with BRCA mutations to have a nipple sparing procedure, but she and her physicians (oncologist and surgeon) should have a frank discussion about her individual case.