Yellow Flower

 Updated 3/2017--  all links (except to my own posts) removed as many no longer active.

This small art quilt was inspired by a photo of a multinodular goiter in a JAMA article (photo credit), the upper right image here.

I took the photo and enlarged it more than 400% to create this template on freezer paper.  I applied light-weight fusible web to the back of my black fabric and the freezer paper to the front.  Then using an #11 blade I cut out the design.

The black fabric was then fused to the background fabrics.  First the yellow print and then the gray print.  The raw edges were then machine appliqued.   The border consists of two thin strips (an inner black and then the print) and a larger black.

I machine quilted the piece.  Here is a  close view of the yellow flower which was fussy cut from a wonderful Batik.

Here is the back before I sewed on the label but after sewing on the sleeve for hanging.  The quilt measures 17.5 in X 19.5 in.

The quilt is for sale on Etsy.

Screening Prior to Cosmetic Breast Surgery – an article review

Updated 3/2017-- all links (except to my own posts) removed as many no longer active. 

How are we plastic surgeons with screening prior to cosmetic breast surgery?  This article from November 2009 (full reference below)  reviews this topic.  Note this survey was done prior to the release of the new USPSTF guideline recommendations for screening mammograms the same month.   I wonder if a new survey would have different outcomes.

The article reports on a study which looked at breast cancer screening practices of American plastic surgeons (self-reported) and the degree to which those practices adhere to the American Cancer Society guidelines.

The study was conducted using an online survey of the members of the American Society of Plastic Surgeons over a 5 month period (January 2008 to May 2008). The 20 multiple-choice questions were designed to assess physician practice composition and familiarity with American Cancer Society guidelines, and to ascertain specific practices for preoperative evaluation and breast cancer screening in patients seeking aesthetic breast surgery. The survey comprised four components: general practice information, breast cancer screening practice, criteria for obtaining breast cancer screening, and criteria for further evaluation of breast cancer risk.

There were 1094 respondents (out of 4520 society members), so only a 24% response rate.   Twenty-eight responses were excluded because these surgeons responded that they do not do breast surgery, do not operate, are pediatric surgeons, are retired, or work with cancer patients only on an initial screening question.

Of the 1066 included respondents, 82% were male and 73% were in private practice.  The participants were roughly evenly distributed with respect to total years in practice, and a majority of surgeons performed augmentation mammoplasty, reduction mammoplasty, and mastopexy (96%).

In total, only 47% appeared to follow the American Cancer Society guidelines.  Only 64% claimed familiarity.

Not all responders always reviewed risk factors preoperatively in their aesthetic breast surgery patients (only 89%), nor did all responders always perform a clinical breast examination preoperatively (86%).

• 89% of respondents claimed that they obtain mammographic screening based on age
• 57% claimed to do so based on positive family history, regardless of age
• 61% stated they followed the ACS screening guidelines, 61 percent stated that they did follow the guidelines
• 24% stated that they did not know the guidelines

Seventy-five percent (n = 799) of plastic surgeons considered a mammogram within 1 year to be valid, whereas 15% (n = 166) stated that this was age dependent.

The authors concluded:

Breast cancer is a major public health problem, for which screening is at least part of the solution. Plastic surgeons are in a unique position to screen women who may not otherwise receive screening. Knowledge of the American Cancer Society guidelines is an essential component of effective cancer screening, but unfortunately only somewhat more than half of plastic surgeon respondents who perform breast surgery have knowledge of these guidelines. Being male predicted more accurate knowledge of the guidelines, but being female resulted in more aggressive screening, and possibly more diagnoses. Familiarity with the American Cancer Society screening guidelines also resulted in a greater number of perioperative diagnoses. As plastic surgeons, we have an obligation to actively participate in the health and well-being of our patients, and this involves understanding and applying good breast cancer screening practices.

Related posts:
New Breast Cancer Screening Guidelines  (November 17, 2009)
The New Mammogram Guidelines - What You Need to Know (December 27, 2009; TBTAM)
Screening Mammogram Recommendations (January 7, 2010)
USPSTF Breast Screening Guidelines Pushback  (January 26, 2011)



REFERENCE

Breast Cancer Screening Prior to Cosmetic Breast Surgery: ASPS Members' Adherence to American Cancer Society Guidelines; Selber, Jesse C.; Nelson, Jonas A.; Ashana, Adedayo O.; Bergey, Meredith R.; Bristol, Mirar N.; Sonnad, Seema S.; Serletti, Joseph M.; Wu, Liza C.; Plastic & Reconstructive Surgery. 124(5):1375-1385, November 2009; doi: 10.1097/PRS.0b013e3181b988c4

Advances in Nipple-Sparing Mastectomy – an article review

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

There is a very nice review article of the advances in nipple-sparing mastectomy surgery in the March 2011 issue of the Aesthetic Surgery Journal (full reference below).

Dr. Patrick Maxwell and colleagues includes some history of nipple-sparing mastectomy (NSM):

NSM was attempted in the 1980s but never gained popularity owing to the controversies surrounding oncological safety. Now, better technologies for preoperative staging and assessment of lesion distance from the NAC, along with an increased understanding of the anatomy of the breast ducts with relation to the nipple, are encouraging a return to the concept. One of the key publications that renewed and increased enthusiasm for this technique was the multicenter publication of 192 patients undergoing NSM with only four recurrences, all of which occurred distant from the NAC. Recurrences were seen in the upper outer quadrant, where nearly all recurrences are found with simple mastectomies, at the junction of the tail of the breast and axillary tissue.

In recent years, there has been a sudden increase in reports of NSM for prophylaxis and cancer treatment. Of the approximately 1868 NSM procedures performed for breast cancer treatment and published in recent literature, only three local recurrences within the NAC have been reported, representing 0.16% of local events attributed to patients with NAC preservation. Note, however, that most of these studies have short follow-up periods, thus rendering definitive conclusions premature.

While NSM is not an option in all cases, it is an option that when available is worth using.  No surgeon can create a nipple as lovely as the one that would be removed by the mastectomy, so if it can be used it greatly adds to the finished results.

Exclusion criteria included tumors larger than 3 cm, clinical invasion of the NAC, tumors within 2 cm from the nipple, evidence of multicentric disease, a positive intraoperative retroareolar frozen section, and nodal disease, excluding isolated immunohistochemistry positivity.

The article does a quick review of some of the techniques for NSM (photo credit, 1st reference article):


The article is worth your time to read.



REFERENCES

1.  Advances in Nipple-Sparing Mastectomy: Oncological Safety and Incision Selection;  Maxwell G.P., Storm-Dickerson T, P Whitworth P, Rubano C, and Gabriel A; Aesthetic Surgery Journal March 2011 31: 310-319, doi:10.1177/1090820X11398111

2.  Nipple-Sparing Mastectomy for Breast Cancer and Risk Reduction:  Oncologic or Technical Problem?; Sacchini V, Pinotti JA, Barros AC, et al; J Am Coll Surg 2006;203:704-714

Shout Outs

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

Dispatches from Second Base is the host for this week’s issue of Grand Rounds! You can read this week’s edition here.

Welcome to Grand Rounds! First, a quick shout-out to Nick Genes, an emergency medicine physician who blogs at blogborygmi (possibly the best blog name ever) and is one of the founders of Grand Rounds. I had no plans to host GR a second time until I saw Nick’s APB for April hosts. I had forgotten how much fun this was until the posts started coming in. So thanks, Nick.

The theme this time is what gives your life or work meaning. One of the loveliest, most contemplative posts I’ve seen on this topic is Nourishing Healthy Seeds from Deb Thomas, who blogs at Debbie’s Cancer Blog. ………..

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Last night a tornado all but wiped out the small town of Vilonia, AR.  I went to school there from the 4th through 12th grades.  I played basketball.  The town and school are much larger than when I went to school there (didn’t live in the town limits or postal zip code).  I have learned of at least one friend who lost her home in the storm, but all the family members are okay.

I know this is nothing compared to Japan’s disaster, but it is my hometown.  KATV has made it easy to donate to the Arkansas Red Cross (as well as the Japan Tsunami relief) here.

……………………………….

NPR reminds us the Sitting All Day: Worse For You Than You Might Think  (photo credit), so get up and move. 

Yes, exercise is good for you. This we know. Heaps of evidence point to the countless benefits of regular physical activity. Federal health officials recommend at least 30 minutes of moderate exercise, like brisk walking, every day. ….

But now, researchers are beginning to suspect that even if you engage in regular exercise daily, it may not be enough to counteract the effects of too much sitting during the rest of the day.  ……

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Another great interview by NPR.  This one by Terry Gross (Fresh Air) of Dr. Emery Brown on 'What Happens In Your Brain During Anesthesia' :

If you've gone in for surgery, it's likely that your anesthesiologist has told you to count backwards from 100 — and that you'll wake up after a nice deep sleep.

But that's not exactly true.

"Sleep is not the state you're going in, nor would it be the state in which someone could perform an operation on you," explains Emery Brown. "What we need to do in order to be able to operate on you — to perform a procedure which, is indeed, very invasive — is to put you in a state which is effectively a coma which we can readily reverse."  ……..

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NPR had a very interesting segment yesterday on interviewing Amy Stewart, the author of the book Wicked Bugs:  Where To Find The World's Most 'Wicked Bugs' (photo credit)

Japan is home to the world's largest — and most painful — hornet. With a wingspan of up to three inches, the Asian giant hornet can look more like a tiny flying bird.

And if you're a bird — or a bee — watch out.

The Asian giant hornet can inject "a deadly neurotoxin, [which] actually can be fatal," says science writer Amy Stewart. "In Asia, they call it a yak-killer because it has such a potent neurotoxin."  …..

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NPR’s Science Friday is a wonderful site. This past Friday they highlighted three space science videos. One uses candy corn to demonstrate how soap works and the last shows what happens to water balloons in space when you pop them (or how large would rain drops be with no gravity).  Here’s the one that answers the question of how a yo-yo works in space.

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More on Link Between Breast Implants and ALCL

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

I have written about this previously. 
ALCL and Breast Implants – an article review (March 9, 2011)
ALCL and Breast Implants (January 31, 2011)
Breast Implants and Lymphoma Risk (June 29, 2009)

A quick review:  In January, the Food and Drug Administration (FDA) released a safety alert warning of the possible association of acute large cell lymphoma (ALCL) with breast implants.

After the Plastic Surgery Societies got through being defensive (http://www.theplasticsurgerychannel.com/fda-issues-safety-signal-on-alcl-breast-implants/), they did the right thing  reviewed the literature (4th reference below) and the Plastic Surgery Foundation and the Aesthetic Surgery Education and Research Foundation commissioned RAND to conduct an exhaustive review of the medical literature and organize a panel of medical experts to evaluate the evidence for a potential link and its implications.

The results of this RAND review confirmed breast implants do indeed appear to be associated with the rare form of lymphoma ALCL.  The report notes there is not yet evidence to show that the cancer is caused by implants or to suggest an underlying mechanism for how the disease might develop.

The study, published online (3rd reference below) by the journal Plastic and Reconstructive Surgery, also finds that the disease takes a slow course and can be controlled by surgical removal of the implant and surrounding capsule.

The conclusions are based on an exhaustive review of the medical literature regarding breast implants and anaplastic large cell lymphoma or ALCL, a type of immune system cancer that was first linked to breast implants more than a decade ago, and input from a multidisciplinary expert panel.

"Much more research is still needed to explore the link between breast implants and ALCL and the clinical significance of this rare disease, but our findings provide useful information for both patients and physicians in the near term," said Dr. Soeren Mattke, the study's senior author and a senior scientist at RAND, a nonprofit research organization.

The panel concluded that the evidence suggests an association between breast implants and anaplastic large cell lymphoma, but cannot definitely prove that implants cause the disease nor explain how the implants might trigger ALCL.

The experts recommended that the appearance of a fluid-filled sac near a breast implant six or more months after surgery should lead to a thorough diagnostic evaluation for anaplastic large cell lymphoma. They also concluded that the diagnosis of anaplastic large cell lymphoma should result in a complete evaluation to rule out spread of the disease outside of the breast capsule (the lining that forms around the implant), followed by removal of the implant and capsule.

Experts did not believe that disease confined to the implant capsule warrants radiation treatment or chemotherapy after surgery and expressed the belief that the risk of recurrence or development of systemic disease following surgical removal was low, but that close clinical follow-up was necessary.

The U.S. Food and Drug Administration and the American Society of Plastic Surgeons recently announced an effort to create a registry that will collect information on women with breast implants who have been diagnosed with anaplastic large cell lymphoma in order to gather information that will help increase understanding of the disease.

Health care professionals are requested to report all confirmed cases of ALCL in women with breast implants to Medwatch, the FDA’s safety information and adverse event reporting program. Report online at http://www.fda.gov/Safety/MedWatch/default.htm or
by calling 800-332-1088.


REFERENCES
1.  RAND Corporation;  Press Release April 19, 2011
2.  FDA safety alert; January 2011

3.  Anaplastic Large Cell Lymphoma and Breast Implants: Results From a Structured Expert Consultation Process; Kim, Benjamin; Roth, Carol; Young, V. Leroy; Chung, Kevin C.; van Busum, Kristin; Schnyer, Christopher; Mattke, Soeren; Plastic & Reconstructive Surgery., POST ACCEPTANCE, 15 April 2011; doi: 10.1097/PRS.0b013e31821f9f23

4.  Anaplastic Large Cell Lymphoma and Breast Implants: A Systematic Review; Kim, Benjamin; Roth, Carol; Chung, Kevin C.; Young, V. Leroy; van Busum, Kristin; Schnyer, Christopher; Mattke, Soeren; Plastic & Reconstr Surgery., POST ACCEPTANCE, 25 February 2011; doi: 10.1097/PRS.0b013e3182172418

What They Hear….

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

This past week the comic strip Baby Blues has been doing a “When you say…..They must hear” series.  It has made me think this phenomenon in medical practice.

…..
Here’s one:
When a plastic surgeon says “Your scar will fade over time.”
Patients often hear “Your scar will disappear over time.”

Fracture II or Roses

A couple of years ago I made my first quilt using this technique called fracturing.  This time I started with four of these pieces of fabric I then cut into the pieces as described (see this post).

I mis-cut one of the four so ended up with a gap in the layout.
To correct this (as I didn’t have a fifth piece so I could just re-cut it), I inserted red squares so it would look like a ribbon woven in.
Here is the finished quilt.  It is machine pieced and quilted.  It measures approximately 29 in square.
I quilted it with gold metallic thread on the front using beige cotton thread in the bobbin.
Here is the back before I sewed on the sleeve and label.

More on Hand and Face Transplantation

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

There was a lovely news article on the first California hand transplant patient in the LA Times earlier this week:  Hand transplant patient speaks (bold emphasis is mine)

Emily Fennell, 26, last month became the first person in California to have the revolutionary surgery. Six weeks and many hours of therapy later, she has no regrets. …..

On March 5, Fennell became the first person to undergo a hand transplant in California and the 13th nationwide to have the revolutionary surgery. . ….

"It's crazy how good it looks," she said at her occupational therapy session one morning last week at UCLA, where she spends about eight hours a day working on learning how to move her new hand and fingers. "I knew the match wouldn't be perfect, but if you didn't know what happened, you'd think I just had some kind of orthopedic surgery."  ….

Doctors told her that the biggest risk from the surgery comes from the side effects of lifelong use of strong immunosuppressant medications, which can cause high blood pressure, kidney or liver damage, elevated cancer risks and lower resistance to infections. …..

"I decided the benefits were worth those risks," Fennel said. She has adjusted well to the medications.  ….

She has no sensation yet in the transplanted hand. The nerves grow about one millimeter a day from the connections the surgeons made to her arm, and it will be several more months before sensations develop.

"The hand is connected to me. It's mine," Fennell said. "But until I have feeling in it, it's not going to feel like mine."  ……….

Her therapists encourage her to say "my hand" instead of "the donor hand." It's a psychological adjustment that runs parallel to the physical challenges she deals with.  ……..

This news article coincides with my reading of the journal article on issues related to face transplantation (full reference below).  Both hand and face transplantation have similar issues to other solid organ transplantation.  One of the big issues with hand transplantation is whether the risks are worth it as a hand transplant is not a live-saving procedure as a heart or liver transplant is.

From the article

Two of the world's first four face transplant recipients acquired cytomegalovirus viral infection by means of their donated facial organs. Also, the French experience, and our own, has been challenged by cytomegalovirus reactivation and graft rejection, therefore necessitating a critical evaluation. The authors have also learned, from their own experience, that facial composite tissue allografts containing mucosa and paranasal sinuses present a distinct challenge with regard to their accompanying flora.

Conclusions: Although the risk of donor-derived cytomegalovirus is acceptable in life-saving solid organ transplantation, for face transplantation patients, the scenario is different. When the authors' team performed the first nearly total face/maxilla transplantation (December of 2008), there was little known regarding the consequences of cytomegalovirus-related donor transmission in face transplantation. Therefore, the authors now recommend that all candidates be fully informed as to the risks of cytomegalovirus/infectious transmission and that aggressive viral, bacterial, and fungal prophylaxis be instituted.

As with the young women who would give a year of life for a perfect body, it is a question for the individual (I am coming to believe) to decide.  But for them to decide, we surgeons/doctors must do a better than good job at educating them as to what the risks are AND as to the reality of the limitations that will remain.  The new hand will never work as well as the non-injured one did. 

Read Wolf’s comment on my blog post regarding the Florida student who had a hand transplant.

REFERENCE

Cytomegalovirus and Other Infectious Issues Related to Face Transplantation: Specific Considerations, Lessons Learned, and Future Recommendations; Gordon, C R; Avery, R K; Abouhassan, W; Siemionow, M; Plastic & Reconstructive Surgery. 127(4):1515-1523, April 2011; doi: 10.1097/PRS.0b013e318208d03c

Spring’s Poison Ivy Warning

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

This past weekend I helped my husband and his mother clean up some debris from the storms which had come through Thursday night/Friday morning.  Here are before and after photos.

Around the periphery of her yard and growing up her trees is poison ivy.

If you have read my blog over the past few years, you may recall that poison ivy and I don’t mix well.  I seem to have managed to not accidently grab any of it when picking up limbs and debris.   I am very thankful.

Still, it’s time to remind myself and you to watch out for poison ivy as you get outside to walk and play.

……

Here is a “updated” version of my post from May 23, 2008

I love to walk in the woods with my dog. I am lucky to have a neighbor who has a trail through her woods around her pond that she encourages us to use. This time of year I have to watch out for poison ivy. In the picture here you can see the poison ivy (leaves of three) intermingled with some Virginia Creeper (five leaves). I find both very pretty.

However, to the poison ivy I tend to react like this (photo credit):

Dr. Paul Auerbach wrote a review of the product Zanfel in 2008.  In the comment section White Coat left this helpful suggestion

One of the other things that helps to some degree is "Ivy Block" - it allegedly keeps the urushiol from binding to the skin.  http://www.ivyblock.com/ivyblock.php
Also, TechNu is reported to work as well as Zanfel, but is significantly less expensive.  http://www.teclabsinc.com/products.cfm?id=1F5604C8-9D05-4675-56129F6D83DF2417§ion=1

Also, check out the post he did “Poison Ivy – Son of an Itch”

REFERENCE
Leaves of Three, Let Them Be: If Only It Were That Easy; Medscape Article, May 28, 2004; Patricia L Jackson Allen, MS, RN, PNP, FAAN

Shout Outs

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

Bedside Manner is the host for this week’s issue of Grand Rounds! You can read this week’s edition here (photo credit).

Welcome to Get Better Health’s Grand Rounds, Volume 7, Number 30.  This week’s theme borrows from Patriot’s Day which commemorates the anniversary of the Battles of Lexington and Concord, Massachusetts, the first battles of the American Revolutionary War, on April, 19, 1775.    …….…..

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Emily, @crzegrl15, who used to blog at crzegrl, flight nurse has come back to blogging with a new blog name:  FlightEMS.com.  She tells her blogging story in her post, After Seven and a half years, crzegrl.net becomes FlightEMS.com

Seven and a half years is a long time. My very first post on crzegrl was on 12 November 2011, a fitting date for me as so many major events have happened on that day for me.

I swore into the Army.
I closed on my first home.
My friend Danny died.
My blog was born.

I remember purchasing my first domain in 1999 (homesickangel.net) and struggling to create what was, then, an online journal, on software that didn’t easily support the idea. Who would have predicted that I would be considered an old timer in the blogging world. ……

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H/T to @drval, Better Health,  for putting together her #HealthyRT : Join The HealthyRT Experiment: Let’s Use Twitter To Drown Out Health Misinformation

A few days ago I published a blog post about Dr. Mehmet Oz NOT being a trustworthy source of health information. It set off a firestorm of blog comments, tweets, and Facebook sharing – all because people (like me) had developed sincere concerns about the safety of viewers who might take his advice to heart. The outpouring of commentary, and the rapidity of the response made me wonder: can we harness this power for future good? Could we counter Dr. Oz’s (and others like him) misinformation with peer-reviewed content that’s easily accessible by Twitter and Facebook? ……….

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Check out the guest post on KevinMD  by Roy Benaroch, MD:  Should the HPV vaccine be given to boys?

Beth wrote, “I plan on having my daughter vaccinated against HPV when she’s the right age (which is what by the way?). Recently, some friends were saying they were planning to have their sons receive the vaccine as well because although males obviously don’t get cervical cancer, they can spread HPV and put their future partners at risk. Is this true?”

Yes, men can catch HPV infections, and spread them to women. But that might not be reason enough to have your son vaccinated.

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The current edition of the American Quilter magazine has an article: Children Speak Through Quilting – which features Ramona Lindsey’s project which began when she was a teacher at Woodlawn Community School.  Because a subscription is required to view the online article (p 30-32), I went searching for a free article to show you the work:  Check Out the Stop the Violence Traveling Quilts Exhibit (photo credit)

Mrs. Ramona Lindsey’s Fourth graders, in partnership with Woodlawn Community School, are taking their feelings about the high level of violence in Chicago through the Stop the Violence Traveling Quilts Exhibit.  Drawings are used to share how they really feel.  While some pictures spoke louder than others, the messages were all the same – STOP THE VIOLENCE!

Topical Treatment of Hypertensive Leg Ulcers – an Article Review

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

An interesting little article in the April issue of the Archives of Dermatology (full reference below) by Senet and colleagues on the treatment of hypertensive leg ulcers with platelet-derived growth factor-BB.  Interesting, in that, it reported a negative outcome or lack of superiority for one treatment over another.

First, what is a hypertensive leg ulcer (HLR)?

According to the Graves and colleagues (second article referenced below), Martorell, a Spanish cardiologist (1906-1984) first noticed the relationship between hypertension and alterations in arterioles and leg ulcers in 1945.  Martorell called these ulcers hypertonic or hypertensive ulcers of the legs and published the first 4 cases. 

Originally, Martorell described the following diagnostic criteria:

a) Ulcer located anterolaterally on the lower legs,

b) arterial diastolic hypertension of the lower legs,

c) hyperpulsatility of the arteries of the lower legs,

d) absence of arterial calcification,

e) absence of CVI (chronic venous insufficiency),

f) symmetric lesions (either ulceration at the same time or as a result of previous ulceration of the opposite leg),

g) increased pain in horizontal position, and

h) female sex.

Graves also noted that soon after Martorell reported his 4 cases, 11 other cases were published by Hines and Farber confirming the existence of these ulcers -- thus, the ulcer is also called the "hypertensive ulcer of Hines-Farber."

Senet and colleagues note, “Hypertensive leg ulcers (HLUs), first described in the 1940s, were renamed Martorell HLUs or necrotic angiodermatitis by American and European dermatologists.”

So HLU’s are also known as “hypertensive ulcer of Hines-Farber” and as necrotic angiodermatititis.

……

Whatever it is called, HLR’s are extremely painful, superficial, rapidly spreading, necrotic wounds on the dorsolateral part of the leg which have red purpuric margins.  The pathophysiologic characteristics of HLUs include dermal and subdermal vessel arteriosclerosis, inappropriate local vasoconstriction, but no significant involvement of the large deeper vessels.

Senet and colleagues note the medical management of HLU is currently symptomatic: controlling hypertension and diabetes, wound debridement, and application of the usual dressings.  Surgical management is often skin grafts.

Senet and colleagues conduced a multicenter, randomized controlled trial from March 2004 to June 2009 to determine the effect of topical becaplermin gel on HLU healing.

Eligible participants (n=59) were randomly assigned to receive either topical becaplermin gel-BB, 0.01% (Regranex gel) or hydrogel (Duoderm Hydrogel).

For both groups, treatment began 1 week after randomization, during the second visit (week 0), and all patients received the same daily local care: wound irrigation with normal saline, application of a continuous thin layer of gel on the wound, covering with a moist saline gauze and a bandage.

Each reference wound surface was estimated on treatment day 1 by measuring wound length and width to determine the appropriate becaplermin gel or hydrogel volume to apply that was maintained throughout the study [a single 15-g tube is enough to treat a 5-cm² wound for 6 weeks (1 cm of gel/cm²/d)].

The patient or his/her caregiver was instructed on proper wound care, gel application, and wound dressing, which was continued until complete healing or for a maximum of 8 weeks.   All patients were observed through week 12.

Topical becaplermin, compared with hydrogel dressing, did not improve the complete wound closure rate (primary outcome measure) after treatment week 8 and had no significant effect on quality of life, pain, or median wound area.

Complete wound closure rates for becaplermin and hydrogel, respectively, were 18% (5 of 28 patients) and 10% (3 of 31 patients), respectively, at week 8 (an 8 percentage-point difference; 95% confidence interval [CI], –10.3 to 26.0) and 36% (10 of 28 patients) and 26% (8 of 31 patients) at week 12 (10 percentage-point difference; 95% CI, –13.6 to 33.4).

REFERENCES

1.  Topical Treatment of Hypertensive Leg Ulcers With Platelet-Derived Growth Factor-BB: A Randomized Controlled Trial; Patricia Senet; Eric Vicaut; Nathalie Beneton; Clelia Debure; Catherine Lok; Olivier Chosidow; Arch Dermatol. 2011;0(2011):archdermatol.2011.84. 

2.  Martorell Hypertensive Leg Ulcer:  Case Report and Concise Review of the Literature; Graves JW, Morris JC, Sheps SG. J Human Hypertension. 2001;15:279-283. (pdf file)

3.  Las ulcers supramalleolares por arteriolitis de las grandes hipertensas; Martorell F.;  Actas del Instituto Policlinico de Barcelona. 1945;1:6-9. (not read by me)

4.  Ulcer of the leg due to arteriosclerosis and ischemia occurring in the presence of hypertensive disease; Hines EA Jr, Farber EM.; Mayo Clin Proc. 1946;21:337-346.  (not read by me)

Stairway to Heaven Baby Quilt

This baby quilt was made back in 1996 for my friend Marla who left her surgery residency after the fourth year to pursue her love of languages.  She now does medical translation work for John Hopkins.

The center area of the quilt is composed of courthouse step blocks.  I machine pieced the quilt but had Scottie Brooks do the hand quilting for me.  The quilt measures 38.5 in X 61.5 in.

The young man holding the quilt is the “baby” it was made for all those years ago.  Thank you Marla for the photos.

Another view with it oriented upright.
A close up to show the lovely fabrics.

Reminders to Self

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

My husband had a screening colonoscopy last Friday.  His nurse in the recovery is the only one I had issues with.  I, not my husband. 

All went well, but let me tell you he is not an ePatient Dave.  He did not read his instructions about when to quit eating and the prep.  I did.  I then reminded him along the way:  “Only clear liquids today.”  “You must take the Ducolax at 3 pm.  Do you want me to text you a reminder?”

Sometimes the instructions we give patients are clear, but not always read.

The staff at the front desk were very kind and organized.  Calls had been made the day before and I had insured the insurance information they had was correct.   I did not tell anyone I was a doctor.  I’m not sure if my husband did later or not.

…..

When I was called back by the nurse, she mispronounced my name calling me Rhonda (which I forgave easily).  She did not introduce herself to me.

As we entered the recovery area, she did not take me to my husband and assure me he was okay.  She took me to the desk and abruptly said, “You need to sign this.”

No explanation of what “this” was, so I replied, “What is it I am signing?  I don’t sign anything until I have read it.”

She then said, “It’s the discharge instructions.  He’s already been given them.”

Note she had not reviewed them with me.  I would be the caregiver.  Note also that I had no way of knowing if she had reviewed them with my husband (who is not an engaged ePatient Dave) prior to sedation or in his current state of post-sedation fogginess.

She said, “Sign it when you’ve read them then” and quickly moved on to some other task.  I felt like a box that was simply being checked off.

I reviewed them, signed it, and moved over to my husband’s bedside.

The nurse with no name came by soon after and told him it was time to get up and go to the bathroom.  She led him over and said to me, “You can go to the bathroom with him.” 

Me, “Why would I want to go to the bathroom with him?”

Her, “Well, you don’t have to.”  [I think she found me difficult and perhaps uncaring.]

She left him alone in the bathroom with his clothes.  After standing there for about five minutes, I knocked on the door and entered.  “Are you okay?”  He was dressed, but swayed as he bent over to try to put his boot on.

Me to my husband, “You can sit in this other area where we are to wait on your doctor and put your boots on.  Here let me help you.”

In hindsight, I think she meant for me to help him get dressed in the bathroom, not to watch him actually use the bathroom. 

………

Reminders to myself

1.  Check names.

2.  Always introduce myself.

3.  Slow down and tell patients/family what is going on and why. 

4.  Patients and caregivers need to be given the instructions.

Longevity or Perfect Figure?

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

I’ve spent some time thinking about this survey.   I couldn’t find any better information on the survey than the press release from the University of the West of England (UWE).  Perhaps in the future it will be published in a journal for better review.

The  survey was apparently done by the  new eating disorder charity The Succeed Foundation in partnership with the University of the West of England (UWE).  The editor’s notes indicate 320 women (ages 18 – 65 years, average age 24.49)  studying at 20 British universities completed The Succeed Foundation Body Image Survey in March 2011.  

Notably, the survey found that 30% of women would trade at least one year of their life to achieve their ideal body weight and shape.

The research has also found that in order to achieve their ideal body weight and shape:

•        16% would trade 1 year of their life
•        10% would trade 2-5 years of their life
•        2% would trade 6-10 years of their life
•        1% would trade 21 years or more of their life

I would love to see an age breakdown of the respondents here.  Do we women become more comfortable with our bodies as we age?  Or did as many of the over 50 year olds want to trade longevity for “the perfect body” as the 20 year olds?

In addition to longevity, the survey also notes that in order to achieve their ideal body weight and shape, 26% of the women surveyed were willing to sacrifice at least one of the following:

•         £5000 from their annual salary (13%)
•         A promotion at work (8%)
•         Achieving a first class honors degree (6%)
•         Spending time with their partner (9%)
•         Spending time with their family (7%)
•         Spending time with their friends (9%)
•         Their health (7%)

Again, I would love to see an age breakdown.  It would be interesting to see how this might differ between the younger respondents vs the older (over 50 year olds) ones.

The survey results suggest that body dissatisfaction was common among the women surveyed, with 1 in 2 women saying that more needs to be done on their university campus to promote healthy body image.

•         46% of the women surveyed have been ridiculed or bullied because of their appearance.
•         39% of the women surveyed reported that if money wasn’t a concern they would have cosmetic surgery to alter their appearance. Of the 39% who said they would have cosmetic surgery, 76% desired multiple surgical procedures. 5% of the women surveyed have already had cosmetic surgery to alter their appearance.
•         79% of the women surveyed reported that they would like to lose weight, despite the fact that the majority of the women sampled (78.37%) were actually within the underweight or ‘normal’ weight ranges. Only 3% said that they would like to gain weight.
•         93% of the women surveyed reported that they had had negative thoughts about their appearance during the past week. 31% had negative thoughts several times a day 

Yes, I know as a plastic surgeon I make a living (in part) from cosmetic procedures, but I feel strongly that my nieces and other young women should be grow up to love themselves and their bodies.  

Related posts:
Steriod Use in Girls  (February 21, 2008)
Get Girls to Focus on Skin’s Appearance  (May 19, 2010)
Maternal Influence  (January 3, 2011)


REFERENCE

30% of women would trade at least one year of their life to achieve their ideal body weight and shape; UWE press release, March 31, 2011

Shout Outs

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

iMedicalApps is the host for this week’s Doctor Watson issue of Grand Rounds! You can read this week’s edition here (photo credit).

This is the first time iMedicalApps is hosting Grand Rounds, and to those not familiar, Grand Rounds is weekly collection of medical blog posts with different themes — hosted by various blogs.

To be perfectly honest, I had no idea what Grand Rounds was until very recently. When I started iMedicalApps in November 2009, we were a rag tag team of physicians and medical students, and I had no experience with the “medical blogosphere” — I didn’t even know it existed, I just wanted to review medical apps and provide a quality resource for medical professionals.  ………..

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These two are both breast cancer survivor related.  Powerful!

HT @medicallessons who tweeted “Make Them Hear You: Voices of Metastatic Breast Cancer - http://t.co/4Jmkzrh”

Last weekend, the Metastatic Breast Cancer Network (MBCN) launched an e-newsletter called “Voices.”

The name reminded me of a video MBC and LBBC  helped with last year: “Faces of Metastatic Breast Cancer.”

The low-key video shows a variety of women doing every day things with their families and commenting on MBC. It’s not a public service awareness message–it’s not preachy. Some people are serious, but many are laughing, playing with their kids and so on. It’s well worth a look!

Here are some other women who have inspired me: 

Molly Ivins:

“Having breast cancer is massive amounts of no fun. First they mutilate you;
then they poison you; then they burn you. I have been on blind dates better
than that.”
–Molly Ivins 1944 – 2007, columnist, political commentator and humorist

Plastic surgeon @mchrysopoulo tweeted about a video his group put together and posted on their Facebook page: Tattoos that tell Breast Cancer stories. Go watch the video!

…………………………….

Recently @seattlemamadoc shared her “Ultimate Disaster Kit” segment and interview she did.  Great advice!

Where can people find out more about emergency preparedness?
· On my Seattle Mama Doc blog, I recently wrote a post about emergency preparedness.
· I’d also recommend checking out the American Red Cross’ Website and 3 Days 3 Ways for more information.

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H/T to @crzegrl15 who tweeted:  Nursing hero: Evacuation of war-wounded in Libya: first-person account by MSF nurse http://bit.ly/gaiZS6

Editor's note: Alison Criado-Perez, a nurse with Doctors Without Borders (Medecins Sans Frontieres, or MSF) shares this first-person account of evacuating war-wounded people out of Misrata. Ali is a nurse working for MSF in Libya and Tunisia. She has previously worked in Nigeria, Colombia, Uganda and Central African Republic. The video embedded in this blog post shows Ali actually treating a patient on the boat described in the account shared below. ………

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H/T to @Allergy who shared this on twitter:  Lost in translation: the warning "I am deathly allergic to nuts" accidentally became "I am absolutely dying for nuts" http://goo.gl/h8Myp

Ted Leonsis, founder of the company that owns the Capitals, Wizards, and Mystics sports teams, along with Verizon Center in Washington D.C., ……

He's also had to deal with his allergy in a foreign country. He recently visited Paris, and before leaving, asked the stewardess to translate into French the following message: "I am deathly allergic to nuts. Please do not serve me any nuts or nut products." He then passed the note to a server at a French restaurant. The message was lost in translation, accidentally becoming "I am absolutely dying for nuts. I must have nuts." The error was discovered when the waiter brought ten plates of nuts out for Leonsis. ……….

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H/T to @grahamwalker who shared this tweet:  Awesome. NEJM Clinical Practice review on "Care of Transsexual Persons." Very progressive of them. nejm.org/doi/full/10.10…

It truly is a very nice article which I would encourage all physicians to read.

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Threads has a wonderful article on the recreation of this jacket created for Plimoth Plantation in Massachusetts: Threads seamstress contributed to jacket on display at Winterthur Museum

The jacket is currently on loan to the Textiles Gallery at Winterthur Museum, Library and Garden in Wilmington, Delaware: The Plimoth Jacket: A Paradise in Silk and Gold (photo credit)

On loan to Winterthur from Plimoth Plantation, the Plimoth Jacket is not an exact reproduction. Rather, it was re-created from two examples in the Victoria & Albert Museum in London. One was chosen for the cut and construction of the jacket and the other for the design of the embroidery. Both originals date to the 1620s. ……

The sewing, embroidery, and lace were all entirely done by hand. The lace spangles (the tear-drop shaped sequins hanging from the lace) were created using tools made specifically for the project. The tools and techniques replicate those from the 1600s. Even the lining was hand-woven and dyed with natural indigo.

Learn More
View a PDF presentation about the creation of the jacket.

Rare Facial Replantation Performed at UAMS

UAMS mails out a publication called UAMS Consult a few times each year. I found a pdf file of their March 2007 issue online (no longer active, 2013) but couldn’t find the current one with this case report. So I’m taking the liberty (they may ask me to take it down) to publish it here.

The 20-year-old patient presented to the UAMS Emergency Department via ambulance from Malvern, about 50 miles away. The patient’s nose, upper lip and most of his right cheek were amputated by the edge of a hollow metal pole that came through the patient’s windshield during the single-vehicle rollover accident. He also had multiple facial fractures with extensive damage to the palate and teeth.

At the accident site, the property owner directed emergency responders to the severed portion of the patient’s face some distance from the vehicle. The avulsed tissue was properly stored and brought to the ED along with the patient.

Only One Choice

Mauricio Moreno, MD, director of the UAMS Head and Neck Cancer Division and a fellowship-trained microvacsular surgeon, saw the patient in the ED and determined that the only choice was to attempt one of the largest known composite facial replantation surgeries in medical literature.

The ischemia time was critical to the outcome since most successful replantations of facial tissues are performed in less than 8 hours. Due to inclement weather, an effort to fly the patient to UAMS had been aborted, and nearly six hours had passed when the patient was taken to surgery.

Without a successful replantation, the patient’s prognosis was poor for both function and appearance. No amount of plastic and reconstructive surgery would provide a cosmetically satisfactory result, and the patient’s ability to eat, drink, or speak would be severely affected.

Prior to surgery, Moreno consulted with UAMS’ Marcus Moody, MD, a facial plastic and reconstructive surgery specialist, who agreed that the facial bone fractures could be repaired at a later date.

The Challenge

Success depended on reintroducing blood supply via a microvascular anastomosis of the facial artery to the angular artery and microvascular anastomosis of the retromandibular vein to the facial vein. Given the nature of the injury, the vessels were severely damaged at the point where they were transected. In order to overcome this problem the vessels were dissected from the transection site until they appeared less damaged, and the anastomosis was made at that point. This was one of the most technically challenging aspects of the case. Very short vessels forced the release of some tissues in the face and neck in order to achieve a tension-free anastomosis.

Moreno worked as quickly as possible, completing the replantation in about two hours, maintaining the total ischemia time just under eight hours.

Six days after surgery, while the patient remained sedated in the ICU, the retromandibular vein thrombosed and the patient was taken back into surgery to repair the clotted vessel. Two days later the same vessel thrombosed again requiring a third – and final – microsurgical procedure.

The episodes of thrombosis likely were related to the vessel trauma that resulted from the accident.

Leeches Help

Because the tissue was unable to accommodate the increased blood flow, medical leeches were flown to UAMS and applied to the replanted tissue for 72 hours. The leeches corrected the venous insufficiency, which can have the same deleterious effect as when replanted tissue gets too little blood supply.

The replantation was a success. It appears to be the largest composite nasal replantation in the medical literature of about 15 cases described worldwide.

Ninety percent of the tissue survived; only a small portion of the patient’s nose and right cheek did not survive, but that tissue can be replaced.

The patient lost vision in his right eye, and the right side of his face is paralyzed as a result of the trauma. Multiple procedures will be needed to repair the numerous facial fractures, restore facial symmetry and achieve the best possible cosmetic and functional outcome.

………..

Kudos to UAMS.

Animal Word Quilt -- Finished!

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

It’s finished!

I recently gave it to the husband/wife team of veterinarians who have taken care of my dogs over the years. You can check them out at their website or Facebook page.

The quilt is machine pieced and quilted. It is 52.5 in X 62.5 in.
I love this
Still haven’t decided which word block I like the best. Sometimes I think it’s just certain letters like the “k” in monkey or the “a” in toucan or the “a” in gator
or the “E” in horse or the “b” in bear or the “d” and “o” in dog.
Or this “C” in cow which ended up sticking out into the border. I had to hand applique that portion down.
Here is the back.

Previous posts on this quilt:
Word Play Quilting
Animal Names Word Quilt – WIP

Breast Self Exam Poster

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

HT to Street Anatomy for the link to this great poster (photo credit)  by iHeartGuts!

Related posts:
Breast Self-Exam (October 8, 2009)
October – Breast Cancer Awareness Month (October 2, 2008)
Mammograms (October 13, 2008)
Breast Cancer Screen in Childhood Cancer Survivors – An Article Review (February 2009)
Indications for Breast MRI – an Article Review (March 2009)

The Angry Face Syndrome

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

I must say when I first read the title of this article (full reference below) I thought it was a joke. Apparently, I was just unaware this syndrome exist.

The authors state, “The finding of frontal bossing, deep radix, straight nasal dorsum, and an over projection of the nasal tip constitutes the angry face syndrome.” (photo credit, from article)

The authors note, “When the syndrome components of frontal bossing, a deep radix, and nasal tip projection are present but include a significant nasal dorsal hump (instead of a straight dorsum), the angry face syndrome does not apply. Somehow the dorsal hump negates the message of anger to the observer.”

Their solution is a rhinoplasty

with attention to a major radix augmentation graft and substantial reduction of the nasal tip projection. In addition, as with the illustrative cases described herein (Figures 1, 2, and 3), we also correct other offending features at the same time (eg, dependent nasal tip, boxy tip, poor alar support, alar base width, wide nasal bones).

Their conclusion:

In all of our years of teaching rhinoplasty, we have always maintained that in considering surgery, the patient must understand that nothing in the external world will change because the of the patient's rhinoplasty. The only thing that will change is the way the patient feels about himself or herself, ie, their self-esteem.

Rhinoplasty for the angry face syndrome, however, may be the exception to the rule.

REFERENCE
The Angry Face Syndrome; Pastorek NJ, White WM; Arch Facial Plast Surg 2011;13(2):131-133; doi:10.1001/archfacial.2011.14

Shout Outs

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

Kim, Emergiblog, is the host for this week’s Angry Birds issue of Grand Rounds! You can read this week’s edition here (photo credit).

Welcome to the Angry Birds edition of that weekly compendium of medical blogosphere goodness, Grand Rounds! I’ve chosen my addiction du jour, Angry Birds, as the theme for my 7th turn as host.

For those who are not familiar, Angry Birds is a game in which Green Pigs steal Bird eggs, causing the Birds to become angry, start screeching and begin catapulting themselves from sling shots in an attempt to destroy the Pigs, who house themselves in various structures and giggle at the Birds.

Got it?
Okay then! Let’s get started!  ………..

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Last Tuesday @EvidenceMatters alerted me via twitter to a panel discussion regarding Vitamin D “Vigorous panel talk: Boosting Vit D - Not enough or too much? Liveblog: http://bit.ly/gL9JuX Video: http://bit.ly”

The webcast of the panel discussion can be viewed here.

The consensus report:  Dietary Reference Intakes for Calcium and Vitamin D

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I caught part of this great  @radiorounds episode (#509) this past Sunday afternoon.  The episode kicked off “Donate Life” month and  focused on the topics of organ donation and the organ shortage crisis.  It aired live on April 3 and will be available on April 5 on their iTunes page!   

The featured guests included:

• Dr. William K. Rundell, Director of Transplant Surgery at Miami Valley Hospital in Dayton, Ohio and Clinical Professor of Surgery at the Wright State Univ. Boonshoft School of Medicine

• Dr. John Donnelly, Asst. Professor of Family Medicine at the Wright State Univ. Boonshoft School of Medicine… and a pancreas transplant recipient

• Dr. Alex Tabarrok, Professor of Economics at George Mason University and co-author of the economics blog Marginal Revolution

……………….………….

Victoria (@vpmedical), Beyond the Bedside, wrote her own post in response to mine:    Hand Transplant vs. Prosthesis

…. As a life care planning expert in amputation injury and limb loss, I find hand transplantation somewhat disturbing.  I can appreciate the technology and biological advances that have allowed transplantation to occur. …….

One need only to review the case of Mr. Jeff Kepner, a bilateral hand transplant patient, to understand the concerns of such a procedure.  One year after his transplant he still regretted his life changing decision. In his words……….

Be sure to read the comment from Wolf on my post.  It is very insightful.

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Engadget had an article by Christopher Trout yesterday:  Bionic eye closer to human trials with invention of implantable microchip

We've had our eye -- so to speak -- on Bionic Vision Australia (BVA) for sometime, and with the invention of a new implantable microchip it's coming ever closer to getting the bionic eye working on real-deal humans. The tiny chip measures five square millimeters and packs 98 electrodes that stimulate retinal cells to restore vision. ……...

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A lovely essay on the origin of how human hair wigs are sourced, created and distributed by Julia Sherman:  She Goes Covered

Following the global hair trade, from the braid-laden Peruvian highlands to the sheitel machers of Borough Park.

I.     In the fall of 2009, Helene Rosen, her husband, Yoni, and eight of their eleven children moved from Baltimore to Cusco, Peru, to harvest human hair.1 Helene is a forty-four-year-old Orthodox Jew and self-proclaimed “master sheitel designer” who began making wigs fifteen years ago, for ten dollars an hour; her custom hairpieces now sell for up to two thousand. “You can bring me any wig,” she said this past winter, sitting at the table in her spare dining room in Cusco, “and I can tell you how old it is, how much it has been worn, and if it has ever been repaired. I can tell you everything about it.”   ……….

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Arkansas Literary Festival begins this Thursday (April 7-13).  One of the authors this year is the son of a long time friend (from college days, a fellow physics grad who now works for Lockheed Martin in laser research). 

Benjamin Hale is a graduate of the Iowa Writers Workshop, where he received a Provost's Fellowship to complete his novel, which went on to win a Michener-Copernicus Award. He has been a night shift baker, security guard, trompe l'oeil painter, pizza deliverer, cartoonist, illustrator, and technical writer. He grew up in Colorado and now lives in New York. The Evolution of Bruno Littlemore is his first novel.

To visit Benjamin Hale's website, click here

Decision-Making in Severe Lower Leg Trauma

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

About the time I was reading the journal article on decision-making process for patients with severe lower leg trauma (full reference below), @sospokesaroj shared news article via twitter:  Nine-year-old loses leg while saving little sister’s life.

Another news article on the accident notes

Surgeons worked on Anaiah from 1 p.m. to midnight on Friday, Davis says, to try and save a shattered left leg.

On Saturday the leg was amputated. The brute force of the accident also broke Anaiah’s right leg, fractured her neck, damaged her spleen and destroyed one kidney.

Which brings me back to the journal article which is a qualitative analysis of patient preferences for amputation or reconstruction. Twenty patients with type IIIB or IIIC open tibial fractures participated in the study. These patients had undergone either amputation (4 primary, 5 secondary) or reconstruction (14) between 1997 and 2007. There were 15 men and 5 women, mean age was 47 (23 – 68) years.  Semi-structured interviews were conducted and qualitative outcomes were assessed.

It must be noted that current research has shown minimal difference in functional outcomes between patients who have below-knee amputation and those who have lower limb reconstruction following a severe open tibial fracture.

The interviews highlighted several issues involved with medical decision-making. Participants described not having a role in deciding which medical treatment to choose.

“I didn’t decide! Hospital decided for me…They all made the decision; I didn’t make no decision on nothin’.  I didn’t even see it.  All I know is that [my wife] told me that when she came to the hospital they told her that they had to take it off.”  --- Male, 67, primary amputation, 12 year post-injury

“I was conscious until I got here [to the hospital], but when I got here… from that time I was in a morphine daze for several days.  And most of those decisions were being made by my wife.”  --- Male, 53, primary amputation, 8 years post-injury

“I’m lucky my brother was here for 3 months, I mean he was here like the day after it happened… Because I wasn’t terribly coherent, I mean, it’s not that I wasn’t conscious, I was on a lotta drugs.  I had my own little morphine clicker.”  --- Female, 56, reconstruction, 8 years post-injury

As you can see from the interview snippets included (and there are others in the article), family and spouses played a greater role than the patient in decision making, often because of patients being medicated when needing to make a treatment choice.

The article notes both amputation and reconstruction patients described being satisfied with the outcomes of their surgical treatments, but also expressed second thoughts about their treatment choices.

“I have to say I am happy with the results of the surgery, who my surgeon was.  However, the problems …. Mine are not what everybody gets.  Some people never have bone spurs, some people never have neuromas.  But I do.  And why people that have trauma injuries suffer more than pain, I don’t know.  Why do we get a bursa?  It’s just there.  It’s painful.  There’s nothing they can do about it.”  --- Female, 62, primary amputation, 9 years post-injury

“I was kinda angry about it, you know, like why did they have to take my right [latissimus dorsi] one? ‘cause I’m right handed.  Like, why couldn’t they take my left?  I was really mad about it.”  -- Male, 36, reconstruction, 12 years post-injury

“No, as of today, sitting here I wouldn’t have changed my decision [to do the reconstruction], but we did second guess it, several times, as we went through the multiple surgeries and everything else that came as a result of that.”  --- Male, 41, reconstruction, 10 years post-injury

 
REFERENCES

A Qualitative Analysis of the Decision-Making Process for Patients with Severe Lower Leg Trauma; Aravind, Maya; Shauver, Melissa J.; Chung, Kevin C.; Plastic & Reconstr Surgery Vol 126(6):2019-2029, December 2010; doi: 10.1097/PRS.0b013e3181f4449e

Shadowfold Play I Quilt

The center motif of this small art quilt is an exercise in using the techniques from the book Shadowfolds by Jeffrey Rutzky and Chris Palmer.  The book is full of interesting was to make geometric designs by creating folds in fabric.

Using border fabric I added a mitered border.  The border is machine quilted.  I used the beads to quilt the center motif which was made using white fabric.  There is a layer of blue-green fabric between the quilt and the batting so the folds show more.  The quilt measures 9.5 in square.

Here is a close up to show the border, the folds, and the beads.
The back is a lovely gold fabric with triangles for ease of hanging.  A bamboo skewer is used along with a picture hanging hook.

Hugs and Kisses Quilt

This is one of my early quilts.  I finished it back in April 1992.  It was made for my husband.  It is machine pieced and quilted.  It measures 42 in X 67 in.  

Here you can see the fabrics and quilting.
I was just learning to machine quilt at that time.  I used a method that involves quilting in segments and then sewing the segments together.  I actually like the way the back looks, but often on the front the quilting (at least for me at that time) didn’t match up.
Here is another view of the back.

New York Times Punked Once Again

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

The NY Times initiated a pay wall earlier this week. The timing is fortuitous as they have been taken again by an April Fool's prank. You may recall how New York personal-injury lawyer and blogger Eric Turkewitz began last year’s prank with his April 1st post where he claimed he’d been appointed official White House law blogger. He and a cohort of bloggers and tweeters posted corroborating responses and updates throughout the day. Eventually the Times picked up the story.

Get more details of this year’s prank here.