Skin Cancer -- Basal Cell Carcinoma

Updated 3/2017-- photos and all links (except to my own posts) removed as many no longer active. and it was easier than checking each one.  

I’m going to repost my series on skin cancer that I did early on in the life of my blog for two reasons:  1) a blog friend is dealing with this issue (melanoma) in a loved one and 2) I’m going to be busy (hopefully) this week and next dealing with the charity auction. 

This post on basal cell carcinoma was originally posted on July 18, 2007.  I have reformatted it to make it easier to read (I hope) and added a few more pictures.

Basal Cell Carcinoma (BCC) is the most common skin cancer. It typically occurs in areas of chronic sun exposure. BCC is usually slow growing and rarely metastasizes, but it can cause significant local destruction and disfigurement if neglected or treated inadequately. BCC are most commonly seen in the head and neck. Therefore, disfigurement is not uncommon. Loss of vision or the eye may occur with orbital involvement. This skin cancer likes to spread along nerves (perineural spread) and this can result in loss of nerve function, as well as deep invasion of the tumor. BCC are prone to ulceration and this provides a nidus for infection. Death from BCC is extremely rare. Prognosis is excellent with proper therapy. Early treatment is necessary to avoid disfigurement. Photo Credit.

Many believe that BCCs arise from pluripotential cells in the basal layer of the epidermis or follicular structures. These cells form continuously during life and can form hair, sebaceous glands, and apocrine glands. Tumors usually arise from the epidermis and occasionally arise from the outer root sheath of a hair follicle, specifically from hair follicle stem cells residing just below the sebaceous gland duct in an area called the bulge. Causes include UV radiation, other radiation (X-ray, grenz-ray exposure), arsenic exposure, immunosuppression, Xeroderma pigmentosum, Nevoid BCC syndrome (basal cell nevus syndrome, Gorlin syndrome), Bazex syndrome, and a history of nonmelanoma skin cancer. Person with 1 nonmelanoma skin cancer are at increased risk of developing others in the future. The rate of new nonmelanoma skin cancer is 35% at 3 years and 50% at 5 years after an initial diagnosis of skin cancer.

Histologically, BCC is divided into 2 categories: undifferentiated

• Undifferentiated BCC has little or no differentiation and is referred to as a solid BCC. The subtypes of Undifferentiated (BCC with little or no differentiation is referred to as solid BCC) include Pigmented BCC, Superficial BCC, Morpheaform or Sclerosing BCC, and Infiltrative BCC.

differentiated

• Differentiated BCC often has slight differentiation toward cutaneous appendages, including hair (keratotic BCC), sebaceous glands (BCC with sebaceous differentiation), or tubular glands (adenoid BCC). Noduloulcerative (nodular) BCC usually is differentiated.

The 5 most typical characteristics of BCC can be seen in pictures here (photos credit). They are:

An Open Sore that bleeds, oozes, or crusts and remains open for a few weeks. This persistent, non-healing sore is a very common sign of an early BCC.

A Reddish Patch or irritated area. It may itch or hurt. Often these occur on the chest, shoulders, arms, or legs.

A Shiny Bump or nodule that is pearly or translucent and is often pink, red, or white. This bump may also be tan, black, or brown, especially in dark-haired people, and can be confused with a mole (moles aren’t shiny).

A Pink Growth with a slightly elevated, rolled border and a crusted indentation in the center. As the growth slowly enlarges, tiny blood vessels may develop on the surface.

A Scar-Like Area which is white, yellow, or waxy, and often has poorly defined borders. The skin may appear shiny and taut. This warning sign can indicate the presence of small roots, which make the tumor larger than it appears on the surface.

TREATMENT:
Medication:
Imiquimod 5% cream has been used to treat superficial BCC’s. Duration of treatment varies from 6-16 weeks. Cure rates of 70-100% should be expected after a 6 week course of 5 times-per-week application.

Topical 5-FU 5% cream is sometimes used to treat small, superficial BCC’s. In thin tumors, cure rates of approximately 80% have been obtained using a twice daily application for at least 6 weeks. Percutaneous absorption of 5-FU is its major limiting factor, as it penetrates only 1 mm into the skin.

Interferon alfa-2b has shown some success in treating small (less than 1 cm), nodular, and superficial BCC’s. It is administered intralesionally, 3 times-per-week for 3 weeks. In appropriate tumors, cure rates of up to 80% have been obtained. Interferon has not become a mainstay in treatment fo BCC’s because of its cost, the inconvenience of multiple visits, the discomfort of administration, and its adverse effects.

Surgery–
Curettage may be used. It is a blind technique in which the specimen cannot be examined for margin control. This limits the usefulness of curettage in high-risk areas, such as the face and ears. Furthermore, the aggressive subtypes, such as morpheaform, infiltrating, micronodular, and recurrent tumors, are usually not friable and therefore difficult to remove by using the curette.

Surgical excision may be used to excise the clinically apparent tumor and a margin of clinically normal-appearing skin. This can be done in an ambulatory setting and provides the pathologist with a specimen to examine the tissue margins. It is more time-consuming and costly than curettage, but the margin can be examined. Margin of up to 4 mm may be needed to achieve a 95% cure rate. This margin can be difficult to obtain near the canthus of the eye/eyelid.

Mohs surgery involves removal of the clinically apparent tumor and a thin rim of normal appearing skin. The margin specimen is sectioned and marked so that the entirety of the undersurface and outer edges of the tumor are examined microscopically to minimize sampling error. Use of the frozen-section technique allows for an examination of tissue while the patient is in the office. Tissue is mapped microscopically so if any foci of tumor persist, further excision can be directed to only those areas to spare the normal tissue. With the Mohs technique, almost 100% of the tissue margins are examined. Excision and repair can usually be done on the same day. Of most importance, Mohs micrographic surgical excision has the best long-term cure rates of any treatment modality for BCC. Cure rates for primary BCC are 98-99% with Mohs excision and 94-96% for recurrent BCC. The chief disadvantages of Mohs surgery are its increased expense and time required.

Radiation therapy can be an effective primary treatment for a variety of BCC’s. For most, cure rates approach 90%. It is especially useful for patients who cannot easily tolerate surgery. Radiation is also an excellent option in patients who refuse surgery because of the size of the lesion or its proximity to vital structures.

Cryotherapy is an effective treatment for nonaggressive BCC’s, with cure rates near 90%, in the hands of an experienced cryosurgeon. Patients must be willing to endure the immediate post-treatment swelling, resultant necrosis of treated areas, and unpredictable scarring that can occur with this approach.

Suggested Reading:

Rubin AI, Chen EH, Ratner D, "Basal-cell carcinoma." N Engl J Med. 2005 Nov 24;353(21):2262-9. Rubin AI, Chen EH, Ratner D, "Basal-cell carcinoma." N Engl J Med. 2005 Nov 24;353(21):2262-9.

Shout Outs

Updated 3/2017-- photos and all links (except to my own posts) removed as many no longer active. and it was easier than checking each one. 

Enrico, Mexico Med Student, is this week's host of Grand Rounds.   The “iPod” edition! You can read it here (photo credit).
 

Welcome to Grand Rounds! I am privileged to be your host for this week’s edition of the best posts of the medical blogosphere. As in the previous two times I’ve hosted, I will integrate music into this edition, but unlike before, I will focus on one piece of music: Tod und Verklärung (Death and Transfiguration) by the German composer Richard Strauss. I said when asking for contributions that adherence to a theme was not necessary; moreover no single theme could really encompass the excellent variety the medblogosphere has to offer. Since this musical selection is quite long–over 20 minutes at least–I have decided to present only excerpts so as to tell the basic story as we go along, placing musical interludes in the list of posts. Hopefully I still keep to the spirit of the piece while not detracting too much from the excellent contributions.

ReHabRN is the host of the current issue of Change of Shift (Vol 3, No 11).   You can find the schedule and the COS archives at Emergiblog.  Go check it out.

Welcome to the November 27, 2008 edition of Change of Shift. Many, many thanks to Kim from Emergiblog for letting me host this edition. Look around and if you like what you see, feel free to come on back!

Happy Thanksgiving to all of our US readers. As you're working on your unit or basting the turkey like me, have a look at all the submissions for this edition. You won't be disappointed by our cornucopia of submissions.

Kim at Emergiblog hosts the second edition of MetaCarnival here (photo credit).

Welcome to the second edition of the “MetaCarnival”!

Brainchild of Alvaro Fernandez of Sharp Brains, the MetaCarnival seeks to bring together the best of the blogosphere by sampling the diverse topics collected in the carnival format.

Carnival administrators send in two submissions from their respective compilations and these submissions compose the “MetaCarnival” which is posted once a month.  Let’s get started!

………………………………………………….

Check out Buckeye Surgeon’s post on “Trauma Center with Time on It’s Hands” on a practice he perceives as pouching

This article from the American College of Surgeons' monthly newsmagazine Surgery News pricked my interest. Dr Ernest Block, director of the trauma program at Orlando Regional Medical Center, tries to make a case for the "regionalization" of acute care surgery. In English, this means he wants to justify life-flighting acute appendicitis and hot gallbladders out of surrounding community hospital ER's and depositing them at the doorstep of the glorious Orlando Level I Trauma Center. Dr. Block rationalizes this proposed plundering with an economic argument.

then check out this post (Inexorable Trend) by Movin’ Meat as he continues the dialogue

I can't add much to Buckeye's commentary -- it's dead-on. This is a play for dollars and training cases, and completely unjustified from an economic, efficiency, and quality of care perspective. But there's another, tangentially related point here. Buckeye asks whether trauma surgery, as a specialty, is viable. In my humble opinion it is not, at least not on a large scale. As a niche it will persist as long as guns and motor vehicles do. What will happen, I predict, is that "Trauma surgery" ultimately will, in fact, transform itself into (or be replaced by) a new specialty of "Acute Care Surgery," which might be more simply described as "Surgical Hospitalists."

While we’re on the subject of change, check out the Rebranding being done by Jordan (In My Humble Opinion):

That's it. I'm taking a tip from the hospitalist movement. I'm rebranding. I'm no longer a primary care physician. "PCP" now seems to be synonymous with overworked, underpaid "loser" who at least by some people's opinions aren't carrying their weight. That's not me.
So starting today I will be known as a "PREHOSPITALIST". That my ticket. I see patient's before they get to the hospital and try to divert them before they get sick enough to be admitted. I see the sickest of the sick. End stage renal disease, transplant patients, double transplant patients, end stage copd, end stage chf, end stage anything, and frequent fliers.

Enrico gets around!  He is guest host for the Dr Anonymous' Blog Talk Radio show this week.  He has asked several of us (me, Dr Val, and others) to be a guest panel.   I hope you will check it out.

So come join us this Thursday night at 8 pm CST (or 1 am GMT) both to listen to the show and to participate in the chat room. That's where all the fun is.

“Silent” Charity Auction --

Updated 3/2017 -- all links (except to my own posts) removed as many no longer active and it was easier than checking each one.

Today’s the day that starts the bidding!  Be generous, it’s for a good cause.

That charity is  Childhood Brain Tumor Foundation - MD.  If you would like to simply donate to the charity rather than make a bid you can do so here. 

For the entire story (and more photos), see the previous posts here and here and here. 

The item being auctioned is this wall hanging quilt. It is a Lobster Hawaiian Appliqué.  It is 41 in X 41 in.  It is machine appliqued and machine quilted.  There is hand embroidery around the appliqued edges. 

Here are the rules for this silent on-line auction:

• I have set up an e-mail account for the sole purpose of this auction.  It is lobsterquilt(AT)gmail(DOT)com
  
• If you wish to make a bid, email me at the above address with “auction” in the subject line.  Include your name, the amount of the bid, and a working email address.  I will e-mail you back that the bid was received and give you an identifier number.  This will be how I “track” each bidder and their subsequent bids.
  
• The bidding will start at $200.  The minimal increment will be $10 for subsequent bids, though I would love to see the increments increase by $25 or more.
  
• Several times a day, during my awake hours and as work permits, I will tweet and post the current bid and time it was received.  The bidder’s name will not be posted, but the bidder’s identifier number will be.
  
• So you can check my tweets or check back here to see how the bid is going.  Take note:  I will mainly use twitter for the updates!
  
• If you have sent a bid to me that was higher than the one posted, please, be aware of the time received (it will be CST) and either recheck later or e-mail me again.  We all know that sometimes e-mails are lost.
  
• The auction will last two weeks.  Bidding starts Monday December 1st at 6 am (CST) and closes on  Monday December 15th at noon (CST).   I will notify the winner by e-mail shortly thereafter. 
  
• The winning bidder will be required to make a donation here at First Giving in the amount of the bid (or higher) and asked to leave a comment “I won the lobster quilt!”  They will then need to forward a copy of their receipt so that I can match the name/e-mail address to the winning bid.  This will need to be done within 48 hrs (or by December 17, 5 pm)
  
• Once the donation is confirmed, then arrangements will be made with the winning bidder on shipping.  Shipping costs and any insurance will be the winner bidders responsibility.  Options will be US Postal, Fed Ex, or UPS.
  

So let the bidding begin!

SurgeXperiences 212 – Call for Submissions

Updated 3/2017 -- all links (except to my own posts) removed as many no longer active and it was easier than checking each one. 

The next edition (212) of SurgeXperiences will be hosted by QuietusLeo at the Sandman, on December 7th.  He is an Israel-based anesthesiologist.  He recently celebrated his 1st year blog anniversary.  You can read his own  call for submissions here.  I love his description of himself.

"An anesthesiologist in Israel. I put ‘em to sleep with my sparkling personality and rapier wit.”

The deadline for submissions is midnight on Friday, December 5th.  Be sure to submit your post via this form.

SurgeXperiences is a blog carnival about surgical blogs. It is open to all (surgeon, nurse, anesthesia, patient, etc) who have a surgical blog or article to submit.

Here is the catalog of past surgXperiences editions for your reading pleasure. If you wish to host a future edition, please contact Jeffrey who runs the show here.

Work in Progress

I did my general surgery residency in Wheeling, WV. When this fabric was “issued” more than 10 years ago, I knew I “had to have it”. There were 33 different fabrics in the collection called “Victorian Wheeling” which was designed by Jennifer Simpson. I bought a set that included a fat quarter of each fabric. I put it away. Recently I decided I really needed to decide what to do with it.

After a false start, I settled on the spool block. It seems right to me. It combines my sewing (the spool of thread) and does a nice job of showing off the fabrics.
Each spool block is six inches square. I machine pieced each block, but when I sewed the blocks together by machine I didn’t like the way the “points” came together. I took them apart and sewed the blocks together by hand. The quilt is going to be a wall hanger. I’m going to add a black border with more spools in the corners. I think I may hand quilt this one, but am not sure yet.

Engage with Grace

 Updated 3/2017 -- photos and all links (except to my own posts) removed as many no longer active and it was easier than checking each one.

We make choices throughout our lives - where we want to live, what types of activities will fill our days, with whom we spend our time. These choices are often a balance between our desires and our means, but at the end of the day, they are decisions made with intent. But when it comes to how we want to be treated at the end our lives, often we don't express our intent or tell our loved ones about it.

This has real consequences. 73% of Americans would prefer to die at home, but up to 50% die in hospital. More than 80% of Californians say their loved ones “know exactly” or have a “good idea” of what their wishes would be if they were in a persistent coma, but only 50% say they've talked to them about their preferences. But our end of life experiences are about a lot more than statistics. They’re about all of us. So the first thing we need to do is start talking.

Engage With Grace: The One Slide Project was designed with one simple goal: to help get the conversation about end of life experience started. The idea is simple: Create a tool to help get people talking. One Slide, with just five questions on it. Five questions designed to help get us talking with each other, with our loved ones, about our preferences. And we’re asking people to share this One Slide – wherever and whenever they can…at a presentation, at dinner, at their book club. Just One Slide, just five questions.

Lets start a global discussion that, until now, most of us haven’t had (photo credit).

Here is what we are asking you: Download The One Slide and share it at any opportunity – with colleagues, family, friends. Think of the slide as currency and donate just two minutes whenever you can. Commit to being able to answer these five questions about end of life experience for yourself, and for your loved ones. Then commit to helping others do the same. Get this conversation started.

Let's start a viral movement driven by the change we as individuals can effect...and the incredibly positive impact we could have collectively. Help ensure that all of us - and the people we care for - can end our lives in the same purposeful way we live them.

Just One Slide, just one goal. Think of the enormous difference we can make together.

(To learn more please go to www.engagewithgrace.org. This post was written by Alexandra Drane and the Engage With Grace team)

Shout Outs

Updated 3/2017 -- photos and all links (except to my own posts) removed as many no longer active and it was easier than checking each one. 

Sam Solomon, Canadian Medicine,  is this week's host of Grand Rounds.   You can read it here.

Welcome to Grand Rounds, the weekly anthology of the best of the health blogs. (For those of you unfamiliar with Grand Rounds, which is hosted by a different health blog every week, you can read more about it here.)

The 211 edition of SurgeXperiences is hosted by “M”, the scalpel is mightier than the sword.  The edition is late, but a good one.  I hope you will check it out.

Our friend, Moof, is back blogging and writing about dialysis and other things.  Give her a visit.

I enjoy all of  Dr Theresa Chan’s (Rural Doctoring), but was especially touched by a recent one, “Case:  Forrest vs Trees” (photo credit).

What this case illustrates is the downside of highly specialized care.  Any healthy child gets serial screening eye exams from birth until they register to vote…………  but at least a primary care doctor shines a light into the pupil specifically in search of an abnormal flash of white.  I suspect this part of her exam had not been done for years, or done only perfunctorily, by the specialists who were so involved in her kidney disease.  Please understand, I'm not blaming them for missing this diagnosis.  I just wish she'd had regular contact with a primary care pediatrician who might be rusty on anti-rejection protocols for transplant patients but who would have reached for the ophthalmoscope out of years of habit and care.

Kathleen, A Respository for Bottled Monsters, has made more discoveries (photo credit).  The photo is the third one in the post.  I hope she finds the final picture and shares it.

I found this series when doing research for someone the other day.  The initial photo of Albert Bauer, a soldier wounded in World War 1. 

The first medical illustration demonstrating the surgical procedure used to correct it.

And the continuation of the procedure:

I haven't come across the final picture but hope I do. I'd really like to see the finished reconstruction.

Enrico, Mexico Medstudent, discusses how HIIPA is sometimes hostile (or maybe just the people who interpret it are).

In my case, I called wanting a report from a minor surgery a few weeks after I had it done. I had already called the surgeon’s office and they said that while they did have a copy via their electronic medical record (EMR), the actual operative report was the hospital’s property and they couldn’t give me a copy; they just had viewing privileges, I was told…..

Obviously it didn’t, but the fun was just about to begin….

There will be no  Dr Anonymous' Blog Talk Radio show this week.  When the show returns on December 4, Enrico will be the guest host.   I hope you will check it out.

SurgeXperiences 211 is up!

The 211 edition of SurgeXperiences is hosted by “M”, the scalpel is mightier than the sword. She has this to say:

Apologies about the lateness of this issue but fear not, my tardiness in no way reflects the quality of this round's submissions. This round's theme is one that is rather close to my heart. Surgery, for whatever reasons, is a defining act. Regardless of our respective roles in the operating room--whether it be as patient, surgeon or orderly-- it forces us to acknowledge our own mortality, our limitations and our boundaries. Though an old cliche, it is the struggle that gives shape.

The next edition (212) will be hosted by Quietus, the Sandman, on December 7th. The deadline for submissions is midnight on Friday, December 5th. Be sure to submit your post via this form.

SurgeXperiences is a blog carnival about surgical blogs. It is open to all (surgeon, nurse, anesthesia, patient, etc) who have a surgical blog or article to submit.

Here is the catalog of past surgXperiences editions for your reading pleasure. If you wish to host a future edition, please contact Jeffrey who runs the show here.

Bikini Lip Reduction

Updated 3/2017 -- photos and all links (except to my own posts) removed as many no longer active and it was easier than checking each one. 

Just now getting to writing up this article.  I think it is a really nice approach to oversized lips and a good procedure to add to one’s skills.  The article is The “Bikini” Lip Reduction: An Approach to
Oversized Lips by Drs Fanous, Brousseau, and Yoskovitch.  The full reference is given below.  It is a simple, but elegant description of a technique for lip reduction.

Sir: 
………. The reduction of very large lips is not a new procedure but remains a relatively unused one and has received little attention in the literature.  The following presents a modified method for lip reduction referred to as the “bikini” reduction, consisting of excising a “bikini top” (two cups and a middle strap) from the upper lip, and a  “bikini bottom” (a triangle) from the lower lip. This  technique is unique in that it focuses not only on lip reduction but also on labial contouring and volume balance. ……………..

The patient is asked to close the lips gently. A marker
is used to place a dot in the midline between both upper and lower lips at the actual dry/wet junction (Fig. 1, center, points a and a=). The patient is then asked to open the lips slightly, as the surgeon manipulates the
lips with his or her fingers by rotating them inward,
attempting to make them appear smaller.  The patient
then closes the lips. This is repeated until the size of the
showing vermilion is adequately reduced, ensuring the lower lip remains roughly 40 to 50 percent more voluminous than the upper one.

Then, another dot is made in the midline on the newly created dry/wet interface (Fig. 1, center, points b and b=). The patient then opens the lips, revealing four central dots (a, a=, b, and b=).

The bikini design is now implemented (Fig. 1, center).
The bikini top is marked by drawing the central strap
as two parallel lines between a and b for a distance of
approximately 1 cm, then diverging to form two oval
cups bilaterally. The cups’ anteroposterior dimension
(c to d) should be approximately double that of a to b
and should end in a tapered manner a few millimeters
before the commissures. The bikini bottom is drawn as
a triangle (e to b= to f), with points e and f stopping a few millimeters from the commissures……..

I hope you will look up the article and read the entire work.  For more information on lip reduction, also, check the other references and the post I did on lip reduction back in January.

REFERENCES
1.  The “Bikini” Lip Reduction: An Approach to Oversized Lips; Plastic and Reconstructive Surgery:Volume 122(1)July 2008, pp 22e-23e; Nabil Fanous, M.D., Vale´rie J. Brousseau, B.Sc.H., M.D.C.M., Adi Yoskovitch, M.D.
2.  Reduction cheiloplasty for upper lip hemangiomas; Plast. Reconstr. Surg. 88: 222, 1991.; Hauben, D. J.
3.   A simple surgical remedy for iatrogenic excessively thick lips. Plast. Reconstr. Surg. 110: 1329, 2002; Botti, G., Botti, C. H., and Cella, A.
4.  Reduction cheiloplasty: An adjunctive procedure in the black rhinoplasty patient. Arch. Otolaryngol. Head Neck Surg. 114: 779, 1988; Stucker, F. J.
5.  Correction of thin lips: “Lip lift.” Plast. Reconstr. Surg. 74: 33, 1984; Fanous, N.

Thank You!

Updated 3/2017 -- all links (except to my own posts) removed as many no longer active and it was easier than checking each one. 

Thanks to Dr Rob (Musings of a Distractible Mind) who has just given me the Kreativ Blogger Award!  Each winner of the award gets to list six things he or she is happy about.  With Thanksgiving upon us, it seems like a perfect time to do this list.
1.  I’m thankful for my family.   Yes, we sometimes disagree but that’s okay.  My dear husband still loves me, even after 18 years of marriage.
2.  I’m thankful for my friends, both real life and all of you (via the web).
3.  I’m thankful for my health.  Despite a few aches and pains (now that I’m over 50 yr) my hands still work and I can still walk/ jog / dance (okay not well, but with joy).
4.  I’m thankful for my neighbors.  One lets me use her walking trail with pond for my dog.  We look out for each other.  I know I could call them if I needed to do so.
5.  I’m thankful for the leaves I need to rake.  It means that I have trees to shade my yard in the summer.  And today, thankful for the rain that allowed me to put off raking those leaves.

So who should I tag for this MEME?   I went back to Dr Rob’s and to Bronnie (HealthSkills Blog) to be sure I didn’t duplicate them.   I thought I would go international.
TBTAM – a New York Beauty.  I wish I could cook like she does.
Dr Cris – another female surgeon who sews and knits in Australia
Silvia – the Italian quilter who sent me the lovely little quilt
Sterile Eye –a talented videophotographer in Norway



Dr Rob’s are the first four (his fifth was me) and Bronnie’s the last six.

Vijay - The nicest radiologist in southern India I know.

Theresa - at Ruraldoctoring - Remains nice despite her job turmoil

Liz - who blames me for her Mac purchace.  Even though I am hurt, I pick her.

Fizzlemed - a premed fixing to take the plunge.  Aghast at nasal suction devices.

Borealnz beautiful blog - stunning photographs and commentary from New Zealand

cb’s Fighting Monsters blog - a social worker in Britain with a wonderful wit and insightful thoughts

Salford University Occupational Therapy Education blog - learn more!

Musings of a Distractible Mind - Dr Rob’s humour is almost as nutty as mine! I have no llama.

Shrinkrap - a trio of psychiatrists, as they say ‘a place to talk where no-one has to listen’

HumanAntiGravitySuit - heady intellectual stuff from a Professional Human Primate Social Groomer and Contented “Neuroplastician” (a.k.a. Physiotherapist) 

It's Arrived!

Did you remember that I took part in ALQS (Another Little Quilt Swap)? I received my little quilt yesterday! I think it is beautiful! It came to me from Silvia who lives in Italy!!!

The quilt I made for the swap can be seen here.

Cracker Baby Quilt

Updated 3/2017 -- all links (except to my own posts) removed as many no longer active and it was easier than checking each one. 

This past Monday (Nov 17) I mailed this quilt to fellow blogger, Fat Doctor, for the new baby she and her husband are adopting. the baby is due soon. She beat me to posting about the quilt (smile).

I first saw this quilt block pattern, cracker block, over at Kate’s Quilting Blog. She had noted that instructions for it were available here. I bookmarked it. It is a nice block for using fabric that you only have in small amounts (partial or full fat quarters). Each block is 6 in square. This small baby quilt is 42 in X 42 in. I machine pieced and quilted it.

Here is two detail photos. I used a golden yellow thread for the quilting. There are hearts in the center muslin squares and around the border.