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

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………”

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Check out this post from @JordanGrumet who blogs at In My Humble OpinionFrom 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. ………….

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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……..

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A nice post from ImpactedEDNurse with tips on Managing the patient with an intellectual disability.

Managing patients presenting to the Emergency Department with an intellectual disability ( ID ) is one of the more ‘out of the comfort zone’ experiences for many nurses. Even more so, for the patient, who finds them self in strange and unfamiliar surrounds. Hey, its scary in here. ………………

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Check out Street Anatomy’s post:  Skeleton Typogram (photo credit)

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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 (photo credit)

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Moda Bake Shop has provided instructions for a Puzzle Box Quilt  (photo credit)

Saturday, December 24, 2011

Christmas or Anytime Cooking

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.

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From The Foodie PhysicianHoliday 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. …………….

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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

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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.  ……….

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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.

The quilt is for sale on Etsy.

Monday, December 19, 2011

Panniculectomy Prior to Renal Transplantation -- an Article Review

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.




REFERENCE
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

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. 

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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.  …………..

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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 ….

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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. …..

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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.

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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. …..

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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

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.41

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)

 

REFERENCES

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

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 Medgadget.com), 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. .….

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@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 lungs...but...no pressure".

Gulp. 

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.  …….

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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. ….

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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……..

 

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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 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 www.voicequilt.com.

Monday, December 5, 2011

Is It Okay to Return to Work?

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.

Would anyone like to have this quilt?  Leave me a comment by Dec 16, 2011 over here