Blog Action Day 2010

Updated 3/2017-- photos and all links (except to my own posts) removed as many are no longer active and it was easier than checking each one.

This years topic for Blog Action Day is water.  Many of us take clean water for granted, but even in the United States we are finding more and more that our drinking water is contaminated with prescription drugs.  Dry years put our water reservoirs at risk and often result in mandatory restrictions on water use.

I am guilty of taking water for granted.  I do try to use a full load when washing my clothes.  I do turn off the water while brushing my teeth.  I don’t water my lawn regularly.
But I am still guilt of taking it for granted.  I expect clean water to be there for me to drink and use for bathing.
Clean water is not the norm for many in the world.  Nearly one billion people lack basic access to safe drinking water.  That’s nearly 1 out of every 8 of us. 

Organizations like CharityWater.org are trying to bring clean wells to areas in Africa that lack clean water.

water as a catalyst: disease prevention.
charity: water focuses on life’s most basic need -- water. But to significantly cut down disease rates in the developing world, water is just the first step. Almost everywhere charity: water builds a freshwater well, we also require sanitation training. In some communities, we build latrines; at the very least, we promote simple hand-washing stations made with readily-available materials. Clean water can greatly alleviate the world’s disease burden, but only with education and hygienic practice. charity: water is committed to using water as a gateway to sanitary living.

Access to clean water would help eliminate the nearly 38,000 deaths of children under the age of 5 who die weekly from unsafe drinking water and unhygienic living conditions.

Learn more. Perhaps donate to one of the charities like CharityWater.org.  Sign the petition for an International Water Treaty to Provide Clean Water Everywhere.

Earlier this year I made some quilt blocks for Global Quilt Project who is making a quilt that will be auctioned off and 100% of the proceeds will go to a new well for a village in Central African Republic and a latrine for a school in CAR.

Pink Bandanna Quilt

I made this quilt for my sister Cathy using bandana’s given out at the Susan G. Komen Race for a Cure here in Little Rock, AR (though I don’t recall which year). The bandana’s were a “freebie” from Ford. This year’s race takes place tomorrow. I'll be walking the 5K with @gastromom and @potato_chip.

The quilt is machine pieced by me and hand quilted by Scottie Brookes. I then did the binding, finishing the quilt in July 2004. The quilt measures 75 in X 89 in.

Here is a close up to show the fabrics better.

Foreign Bodies in the Skin

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

I recently read a nice review article on the topic:  Diagnosis and Management of Foreign Bodies in the Skin.   Most humans at one time or another will have an experience with a foreign body – splinters, thorns, broken glass, etc.

Physicians see the worst ones.  The ones that aren’t easily removed or only partially removed.

The history of the injury is always the starting place.   It is important to know when (recent, days or weeks ago), where (home, farmyard, ocean, etc), how (sharp object, fist to mouth, blunt object), and if known the possible foreign body (splinter, fish spine, teeth, glass).

Remember fragments of the foreign body can be left in the wound even if you or the patient think it was removed.  Check to make sure the “needle” is complete, etc.

It is also important to remember with blunt penetration other materials may be embedded along with the offending agent.

If a nail penetrates both the shoe and the sock, it may also force leather, rubber, or sock material into the foot. A blunt object may push a plug of epidermis deep into the dermis. This traumatic implantation results in an epidermal inclusion cyst.

When assessing the patient remember 4 P's: pain, pulselessness, paresthesia, and pallor.

Pain to palpation over an embedded foreign body can help you locate it, especially when located under the skin but above the muscle layer as is the focus of this article.

Pulselessness and pallor can indicate a vascular injury.  Paresthesia can indicate a nerve injury.

The article has a nice section on radiologic evaluation of foreign bodies under the skin which can be very important in localization of the object.  Especially important when it’s an old injury with healed skin (visualization impossible), infected wound (patient won’t allow adequate palpation exam), foreign body deeper than 5 mm, etc.

Diagnostic tests used to determine the location of a foreign body in the skin, include x-ray, computed tomography (CT) scan, ultrasonography, and magnetic resonance imaging (MRI).

X-ray -- A plain film should be ordered first if a suspected foreign body is not visible to the eye during the initial exam.

Metal, aluminum, bone, some types of fish spines, teeth, graphite (from pencils), some types of plastics, glass, gravel, stone, wood, and sand are visible on plain x-ray.

Multiple projections can also be used to help estimate the location of the foreign body after placement of radiopaque skin markers, such as paper clips, on the skin at the wound site.

CT Scan may be more sensitive than plain-film x-ray, but they also cost more and have an increased radiation dose. 
Ultrasonography  is a great tool to use to locate foreign bodies made of wood, plastic, and radiolucent materials that are larger than 4 to 5 mm.

Ultrasonography has a sensitivity of 50% to 90% and may be used to estimate the depth and size of a foreign body, as well as determine its relationship to surrounding anatomic structures.

Magnetic Resonance Imaging  should not be used on foreign bodies suspected to be gravel or metal-containing.  As with CT scans, this choice can be more expensive and has a higher radiation dose than plain x-rays.

One of, if not the most important thing, to remember in removing foreign bodies is to inspect the removed object and try to assess whether is has been removed entirely rather than leaving part of it.

Otherwise, it’s good basic wound care – clean, irrigate, closure, tetanus status, antibiotics or not, etc.

REFERENCES
Diagnosis and Management of Foreign Bodies in the Skin; Winland-Brown, Jill E., Allen, Sandra; Advances in Skin & Wound Care. 23(10):471-476, October 2010; doi:  10.1097/01.ASW.0000383220.72147.e2

Pyoderma Gangrenosum of the Breast

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

I was prompted to delve into this topic not because I had a patient with the problem, but because of a MDLink to an article (the first one listed below, subscription required). 

The eMedicine article states:

Pyoderma gangrenosum (PG) is an uncommon ulcerative cutaneous condition of uncertain etiology. Pyoderma gangrenosum was first described in 1930. It is associated with systemic diseases in at least 50% of patients who are affected. The diagnosis is made by excluding other causes of similar appearing cutaneous ulcerations, including infection, malignancy, vasculitis, collagen vascular diseases, diabetes, and trauma. Ulcerations of pyoderma gangrenosum may occur after trauma or injury to the skin in 30% of patients; this process is termed pathergy.

The 2 primary variants of pyoderma gangrenosum are the classic ulcerative form, usually observed on the legs, and a more superficial variant known as atypical pyoderma gangrenosum that tends to occur on the hands.

Pyoderma gangrenosum (PG) is not common.   It occurs in about 1 person per 100,000 people each year in the United States.   Basically, PG is a noninfectious neutrophilic dermatosis.

Patients with PG may have involvement of other organ system, most commonly the heart, the central nervous system, the GI tract, the eyes, the liver, the spleen, bones, and lymph nodes.

It is characterized by the presence of 1 or more ulcerations that are typically violaceous with an undermined border. Diagnosis is clinical and dependent on the exclusion of other causes of cutaneous ulceration. No specific pathologic or laboratory findings exist. Concurrent systemic disease occurs in 50% of affected patients. Commonly associated conditions include inflammatory bowel disease, arthritis, and hematologic malignancy. The remaining cases are considered autoimmune or idiopathic

The 5th reference article is open access.   The article is a case presentation of PG localized on the breast (photo credit) in a 51-year-old woman who presented with a large, moderately painful ulceration on her right breast which began 12 days prior to presentation with no history of  injury or trauma. 

Along with the case presentation, the authors notes that in a literature review only 31 cases of PG had been reported (article published in (January 2010).

In most of these cases the lesions were related to previous surgical interventions, probably as the result of a pathergy phenomenon. The main differential diagnoses were skin and soft tissue infections including necrotizing fasciitis, and malignant neoplasms. Negative initial wound cultures and the relative sparing of nipple/areola complex helped to eliminate these disorders.

PG doesn’t respond to antibiotic therapy or the usual wound care.  This is a often the first tipoff.  The recommended therapy involves steroids not antibiotics.

Topical therapies include gentle local wound care and dressings, superpotent topical corticosteroids, cromolyn sodium 2% solution, nitrogen mustard, and 5-aminosalicylic acid. The new topical immune modifiers tacrolimus and pimecrolimus may have some benefit in certain patients.

Systemic therapies include corticosteroids, cyclosporine,  mycophenolate mofetil, azathioprine,  dapsone, tacrolimus, cyclophosphamide, chlorambucil, thalidomide, tumor necrosis factor-alpha (TNF-alpha) inhibitors, and nicotine.

Intravenous therapies include pulsed methylprednisolone, pulsed cyclophosphamide, infliximab,  and intravenous immune globulin.

Other therapy includes hyperbaric oxygen.

Surgery should be avoided, if possible, because of the pathergic phenomenon that may occur with surgical manipulation or grafting, resulting in wound enlargement. In some patients, grafting has resulted in the development of pyoderma gangrenosum at the harvest site. In the cases in which surgery is required, the best plan, if possible, is to have the patient on therapy in order to prevent pathergy.

REFERENCES

1.  Pyoderma gangrenosum of the breast: A diagnosis not to be missed; A. Duval, N. Boissel, J.M. Servant, C. Santini, A. Petit, M.D. Vignon-Pennamen; Journal of Plastic, Reconstructive & Aesthetic Surgery - 20 September 2010 (10.1016/j.bjps.2010.07.022)

2.  Pyoderma Gangrenosum; eMedicine article, March 23, 2010; J Mark Jackson, MD, Jeffrey P Callen, MD

3.  Pyoderma gangrenosum; Orphanet Encyclopedia, September 2003; Wollina U.

4.  Atypical Pyoderma Gangrenosum After Breast Reduction;  Karoly Gulyas, FrankW. Kimble; Aesthetic Plastic Surgery Vol 27, No 4, 328-331, DOI: 10.1007/s00266-003-3017-y

5.  Pyoderma gangrenosum on the breast: A case presentation and review of the published work; Ayşe Tülin Mansur, Deniz Balaban,  Fatih GÖKTAY, Sezen Takmaz, The Journal of Dermatology, Special Issue: Systemic Sclerosis (pages 1-84) Volume 37, Issue 1, pages 107–110, January 2010; DOI: 10.1111/j.1346-8138.2009.00756.x

Shout Outs

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

e-Patients is the host for this week’s Grand Rounds! You can read this week’s edition here.

This is e-Patients.net’s first opportunity to host Grand Rounds. which is a collection of some of the medical blogosphere’s best writing over the last week. We asked bloggers to look at our sister website, the peer-reviewed Journal of Participatory Medicine, and create posts inspired by or extending the articles there. We did this not to be self-serving, but because we think it’s important to shine a light on the Journal’s role as a source of peer-reviewed, evidence-based participatory medicine research. A group of us formed the Society of Participatory Medicine to advance the credibility and understanding of patient empowerment and patient advocacy.

We want to dedicate this edition of Grand Rounds to our friend and mentor, Dr. Tom Ferguson, founder of e-Patients.net and direct inspiration for the founding of the Society for Participatory Medicine and the Journal of Participatory Medicine. Tom’s selfless, tireless work in support of the empowered patient culminated in the creation of the seminal, visionary white paper, e-Patients: How They Can Help Us Heal Healthcare (pdf), published just after his death.

Thanks also to Nick Genes and Val Jones, instigators of Grand Rounds.

This week’s posts …

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Slate has a thoughtful article by Elaine Schattner: Who's a Survivor? An oncologist who's had breast cancer considers the problematic phrase "cancer survivor."

A few weeks ago, I stood among 21,000 people at the Susan G. Komen Foundation's annual Race for the Cure in New York City. The participants, including me and 1,500 other breast-cancer survivors, walked, ran, or wheeled their way to the finish line in Central Park. Nearby was a "survivors' village." I wandered about, uncertain whether I belonged.

Survivor seems a strange term for a patient like me, said by her oncologist to be in remission—meaning that there's no overt evidence of persistent cancer cells in the body. The National Cancer Institute defines a "cancer survivor" as someone who's had a malignant tumor and remains alive. …..

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Literature, Arts, and Medicine Blog has a post on October 6, 2010:  Medical Humanities and Live Theater. See It Now! (the post’s link seems to be broken, so it’s a link to the blog itself)

For those living in or near New York City, there is an unusual opportunity to attend one or all of three plays that bear directly on individual experiences of illness, altered bodily states, and the cultural and social context in which those alterations occur. …

Angels in America, by Tony Kushner. Signature Theater Company."This play explores "the state of the nation"-the sexual, racial, religious, political and social issues confronting the country during the Reagan years, as the AIDS epidemic spreads. ….

Three Women, by Sylvia Plath. 59E59.
"three intertwining interior monologues, contextualized by a dramatic setting: " ‘A Maternity Ward and round about.’ . . The three women of the title are patients, and each describes a different experience."

Wings, by Arthur Kopit. Second Stage Theater.
"the sounds and sights inside and outside of Emily as well as her private dialogue are combined masterfully by Kopit to bring about a high degree of verisimilitude to the chaos produced by stroke."

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Fellow physician, blogger, twitterer, and "angel" Dr. Krupali Tejura's recent presentation: How the real-time web is changing the lives of my cancer patients

Click To Play

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I learned of this blog, Never Lose Spirit,  by a local breast cancer patient via our local newspaper.  I love her header (photo credit).  She is the mother of two daughters.

Welcome to my blog. I've created this blog to keep friends and faraway family up to date on my battle with Inflammatory Breast Cancer. When you’re a writer, there is no need to be reported about - right? So instead, I’m going to be the author of my own story. You keep praying while I fight this nasty disease. We’re going to win!

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Dr Anonymous’ show will be about Social Health Track at BlogWorld Expo. The show begins at 9 pm EST.

Upcoming shows:
10/16 : On Location
10/21 : About DigPharm Mtg
10/23 : Saturday Nite
10/28 : About FMEC Mtg
10/30 : On Location

Safe Pumpkin Carving

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

It’s that time of year again!  Carving pumpkins for jack o’lanterns can be fun, but if safety isn’t kept in mind can also result in cut fingers.

Minor cuts will often stop bleeding on their own or by applying direct pressure to the wound. Most of these cuts and scraps will be minor and can be treated by washing with soap and water initially. After this initial care, keep the wound clean and dry while it heals.

However, if the bleeding continues after 15 minutes or if you lose the ability to move the finger properly (very likely a tendon injury), then seek medical attention at a hospital emergency department.

Rather than treating injuries, let's prevent the injuries.

It is best to keep these tips in mind:

• Carve in a clean, dry, well-lit area.   If your tools, hands or cutting table are wet, this can cause slippage and lead to injuries.
• Always have adult supervision (without alcohol use).  Children under age five should never carve. Instead, allow kids to draw a pattern or face on the pumpkin and have an adult carve. Allow the child to be responsible for cleaning out the inside pulp and seeds. They can use their hands or a spoon for this. Children, ages five to ten, can carve but only with adult supervision.
• The right way to cut.   You should always cut away from yourself in small, controlled strokes. A sharp knife is not necessarily the best tool because it often becomes wedged in the thicker part of the pumpkin, requiring force to remove it. An injury can occur if your hand is placed incorrectly when the knife dislodges from the thicker part or slips.
• Use a pumpkin carving kit.
  Special pumpkin carving kits are available for purchase and  include small serrated saws that are less likely to get stuck in the thick pumpkin. If the saw does get stuck and then becomes free, it is not sharp enough to cause a major cut. Fewer injuries occur with use of carving kits.

Here’s my finished carving

Once carved, it is important to remember to KEEP dogs and cats away from Jack o'Lanterns or lighted candles as they could knock them over and start a fire.

Have a safe Halloween season!

Rushed Roses Quilt -- Work in Progress

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

One of my very early post on this blog featured the rushed roses on this quilt. The post is dated May 22, 2007. Yes, that means I have allowed this quilt top to languish for over three years. I admit I fell “out of love” with the quilt top. I love the rushed roses and center, but the blue border doesn’t work for me.

The need to appliqué all the small leaves slowed me down too. I admit it was easier to put it aside and piece a baby quilt or two instead.
The quilt top has literally hung on my design wall all this time. Granted often covered up by some other work-in-progress. I have decided it is time to re-design the border and breathe new life into the project.

I pulled out my books looking for inspiration. I found a pieced border I felt would work. It is the "double folded ribbon" pattern from Jenny Beyer's book: The Quilter's Album of Blocks & Borders which she credits to Nancy Nelson, 1979.
I like it much better. I have now removed the blue border and replaced it with the pieced one. I have machine appliqued the leaves in place.

Now I am trying to decide how I want to quilt it. This will also determine whether I need more roses/leaves in the corners.  While I decide I’m also working on more baby quilts.

The instructions for making a ruched rose can be found in American's Heritage Quilts published by Better Homes and Gardens, 1991.

Stem Cell Face-Lifts?

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

It’s been almost a month since the LA Times ran the article by Chris Woolston:  The Healthy Skeptic: Stem cell face-lifts on unproven ground.  It’s well written and presents a fairly balanced view.  While I am a fan of stem cell research, I think the “claims” are often put ahead of the science.  This is one of those times.  I can’t find any decent articles to support the claims of the plastic surgeons doing “stem cell face-lifts.”

My view is echoed in the article (bold emphasis is mine):

Rubin says he's excited about the potential of stem cells in the cosmetic field and beyond. Still, he adds, there are many unanswered questions about the cosmetic use of stem cells, and anyone who claims to have already mastered the technique is jumping the gun. As Rubin puts it, "Claims are being made that are not supported by the evidence."

While researchers in Asia, Italy, Israel and elsewhere are reporting decent cosmetic results with injections of stem cell-enriched fat, Rubin says that nobody really knows how the stem cells themselves are behaving. He points out that fat injections alone can improve a person's appearance, no stem cells needed.

Rubin believes it's possible that injected stem cells could create new collagen and blood vessels — as they have been shown to do in animals studies — but such results have never been proved in humans. And, he adds, the long-term effects of the procedures are an open question.

Stem cell face-lifts could someday offer real advances, says Dr. Michael McGuire, president of the American Society of Plastic Surgeons and a clinical associate professor of surgery at UCLA. But he believes that scientists are still at least 10 years away from reliably harnessing stem cells to create new collagen and younger-looking skin. Until then, promises of a quick stem cell face-lift are a "scam," he says.

The American Society for Aesthetic Plastic Surgery (ASAPS) issued a statement two weeks after the article first appeared --Stem cell therapy 'could offer women natural breast enhancement from stomach fat'

“Procedures with no solid science behind them, stem cells included, give unproven hope to patients and the marketing of them brings dishonor to our entire specialty,” said Felmont Eaves, III, MD of Charlotte, NC, President of ASAPS.  The Aesthetic Society is working together with the other core societies to address this through an evidence based medicine program that will rate any procedure or device on the legitimacy of the scientific evidence behind it.  This program is in its development stage and will be available to the public within the next 12 months”.

“The use of ‘stem cells’ in advertising for cosmetic surgical applications is a global problem," says Doug Sipp, Head of the Science Policy and Ethics Study Unit at the Center for Developmental Biology of RIKEN in Kobe, Japan, who monitors supposed stem cell treatment claims worldwide in all different specialties.  "There have been many cosmetics, nutraceuticals, and device makers who claim either to use stem cells in their products, or to use ingredients that activate the customer’s own stem cells. To the best of my knowledge, none of these has a basis in scientific evidence."

Marketing.  That seems to be the issue here.  And there is much money to be made in promises that may or may not be kept with the use of stem cells.  From the LA Times article:

Stem cell face-lifts: A Sept. 13 Health section story assessing stem cell face-lifts offered by two Beverly Hills doctors said that Dr. Nathan Newman charges between $5,500 and $9,500 for the procedure and Dr. Richard Ellenbogen charges $15,000 to $25,000. The story should have noted that Ellenbogen often performs a surgical face-lift along with his injection of stem cells. —

Liposuction Overview

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

I use the form of liposuction commonly called traditional though it is more accurately called superwet suction-assisted liposuction (SAL).   Why don’t I use ultrasound or laser assisted?  Cost mainly.  I find it difficult to purchase all the latest and greatest equipment.  I find it difficult to ask the hospitals/surgery centers I work at to do the same when I’m not sure I can guarantee them patients numbers needed to recoup the costs.

Superwet SAL has worked well for me and my patients.  I have found that the greatest improvements to liposuction since it’s introduction by Illouz in the 1980s have been the addition of the wetting technique and the improvement in cannula size (specifically much smaller ones available than the early years).

I have been trained to use ultrasonic liposuction and have used it, but without renting equipment it is not available routinely at all the facilities I work.  SAL is.

I wanted to state all the above before delving into the article “Updates and Advances in Liposuction” (full reference below) as a way of full disclosure.  The article is a very nice review of liposuction.

The authors point out the key elements to not just achieving a good result but to maintaining it.  Points which should be made to each patient: 

A successful body contouring patient must satisfy four key elements to achieve and maintain optimal results.
1. Lifestyle change
2. Regular exercise
3. Well-balanced diet
4. Body contouring

Notice the surgeon is only important in the last one.  The individual is the key in long-term satisfaction with liposuction.

In discussing the addition of wetting solutions (often lumped together incorrectly and simple called tumescent), the authors point out that initially when liposuction was done without any wetting solutions the blood loss was often up to 45% of the aspirate.  The addition of a wetting solution greatly reduces the amount of blood lost.

All of the formulations of wetting solution include some variant of fluid (NS/LR), epinephrine, and lidocaine.   Wetting solutions are used in three techniques:  wet, superwet, and tumescent.

The wet technique involves instillation of 200 to 300 mL of solution per area to be treated, regardless of the amount aspirated.

The superwet technique employs an infiltration of 1 mL per estimated mL of expected aspirate, and this is the technique practiced at our institution. 

Tumescent infiltration, popularized by Klein, involves infiltration of wetting solution that creates significant tissue turgor and results in infiltration of 3 to 4 mL of wetting solution per mL aspirated. 

Recent data suggest that, for patients undergoing general anesthesia with the superwet technique, the lidocaine component may be reduced and/or eliminated without postoperative sequela of increased pain.

I tend to use only epinephrine and not any lidocaine in my wetting solution.  I have a (healthy?) fear of lidocaine toxicity and since my liposuction patients have general anesthesia decided years ago there was no need for the added lidocaine.

Traditional liposuction is referred to as suction- assisted liposuction (SAL).  Other liposuction modalities include ultrasound-assisted liposuction (UAL), vaser-assisted liposuction (VAL), power-assisted liposuction (PAL), and laser-assisted liposuction (LAL).

SAL remains the most common modality for liposuction. As mentioned above, it is the one I use.  SAL uses variable-size cannulas and an external source of suction for removal of the aspirated fat.

PAL involves an external power source driving the cannula.  Advocates of PAL contend that it is best used for large volumes, fibrous areas, and revision liposuction.

UAL utilizes ultrasound energy to break down fat and allow removal.  With this technique, fat is emulsified, which allows removal through traditional liposuction cannulas.  This modality requires a superwet environment.

Advantages include less surgeon fatigue, as well as improved results in fibrous areas and in secondary procedures. 

Disadvantages have been reported to include larger incisions, longer operative times, and the possibility of thermal injury.  

VAL uses a newer generation ultrasound-assisted liposuction device.  The system uses less energy, decreasing its thermal component to the tissues.  VAL  may be better than the other modalities in large-volume liposuction as it has less blood loss. 

This is what the article has to say regarding LAL (bold emphasis is mine):

LAL has been at the forefront of marketing hype for the past several years. The treatment involves insertion of a laser fiber via a small skin incision. Depending on the manufacturer, the fiber may either be housed within a cannula or stand alone. ….  Most companies and physicians utilizing this technique employ a four-stage technique: infiltration, application of energy to the subcutaneous tissues, evacuation, and subdermal skin stimulation.  …… Currently, these devices are being heavily marketed for purported skin-tightening effects. The belief is that the heating of the subdermal tissue may in fact be the contributing factor for LAL’s possible skin tightening effect.  No large, prospective trials have been undertaken to examine the benefits of LAL over existing technologies, so unfortunately, most of the reports remain anecdotal. 

Liposuction is a shaping technique, not a weight-loss solution.  Liposuction will also not treat cellulite and can in fact make it appear worse.

Risks should be discussed with patients as with they are with all surgical procedure.  The risks common to all modalities of liposuction include contour deformity, ecchymosis, edema, seroma, infection, paresthesia/dysesthesia, anesthesia and cardiac complications, cannula trauma to skin and/or internal organs, volume loss/overload from bleeding or excess fluid administration, hypothermia, deep venous thrombosis (DVT)/ pulmonary embolism (PE), and death.  

In a questionnaire to board-certified members of ASAPS, Hughes reported a significant increase in complications when liposuction was combined with other procedures. This increase in the complication rate was most notable in liposuction combined with abdominoplasty. …….

Incidence of DVT in liposuction has been reported at <1%, but a marked increase in this percentage is demonstrated when liposuction is combined with other surgery (abdominoplasty/belt lipectomy).

Prolonged edema can occur up to three months from surgery and is best treated with supportive care and lymphatic massage.

Postoperative paresthesia/dysesthesia can occur in all forms of liposuction, is usually reversible, but may take up to 10 weeks to recover.  Improvement of paresthesia/dyesthesia issues are generally felt to be quicker with SAL than with UAL.  The newer technologies have not been investigated in this manner.

The most common postoperative complication from liposuction is contour deformity, which can occur in up to 20% of patients.

REFERENCES

Stephan, Phillip J., Kenkel, Jeffrey M.; Updates and Advances in Liposuction;  Aesthetic Surgery Journal January 2010 , 30: 1: 83-97, doi:10.1177/1090820X10362728

Shout Outs

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

Sharp Brains is the host for this week’s  Grand Rounds!  You can read this week’s edition here.

Wel­come to Grand Rounds, the weekly col­lec­tion of best health and med­ical blog posts. This week we invite you to enjoy a broad range of insights, tips, and first-hand sto­ries, pre­sented as a Q&A con­ver­sa­tion with blog­gers will­ing to answer, below, a total of 22 good questions. ………….

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Kim, Emergiblog, is the host of the latest edition of Change of Shift (Vol 5, No 7) which is in its 5th year!   You can find the schedule and the COS archives at Emergiblog. (photo credit)

Welcome to Change of Shift!
While this is a bit of a “mini” version of the nursing blog carnival, it is far from “lite”.
There are old friends and new blogging colleagues; musings, opinions and rants…it’s all here!
Let’s get it started! …………..

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Interesting NPR segment last Thursday on their show Here and Now:   “The Skinny on Supplements”  (photo credit)

More than half of all adult Americans spent nearly 27 billion dollars last year on dietary supplements to get healthy, stay healthy, lose weight and gain an edge on the sports field and in the bedroom. And in the process, some of them got seriously sick. We talk with Nancy Metcalf, senior program editor for Consumer Reports-Health about the findings of their recent investigation, “Dangerous Supplements, What You Don’t Know, Could Hurt You.”

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From  tweeter@grahamwalker last Thursday (September 30)

I'm announcing my new website: TheNNT.com -- an evidence-based resource for medical interventions. Spread the word! #sa10 #thennt

NNT stands for “number needed to treat” and is explained:

There is a way of understanding how much modern medicine has to offer individual patients. It is a simple statistical concept called the “Number-Needed-to-Treat”, or for short the ‘NNT’. The NNT offers a measurement of the impact of a medicine or therapy by estimating the number of patients that need to be treated in order to have an impact on one person. The concept is statistical, but intuitive, for we know that not everyone is helped by a medicine or intervention — some benefit, some are harmed, and some are unaffected. The NNT tells us how many of each.

Check out Graham’s new website.  It is full of useful information.

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If you are free later this morning (11:30 am CST, my local time) you might want to join in on the first #MDchat on twitter.

@MD_chat: Let's nudge more physicians onto Twitter. Tuesday 10/5 12:30pm EDT is #MDchat - http://MDchat.org #hcsm Plz support them! :)

For more information on MDchat, check out Phil Baumann, RN’s explanation:

………..So rather than waiting for doctors’ orders, I am launching @MD_chat for physicians to participate in advancing our collective understanding of the influences of emerging technologies on our culture, health, privacy, dignity and many other aspects of the human condition.

Below is a slideshow introducing MDchat and explaining how it works (if you can’t see it, you can view it here or here): ……………….

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An article in Evansville Courier Press by Karen Owen-Phelps:  Quilts help old barns become art form -- Local quilters use them like a canvas (photo credit)

An old barn is more than a storehouse for hay and livestock in the eyes of some area folk-art lovers. It's a canvas for their favorite art form — the quilt.

Quilting enthusiasts in Western Kentucky are encouraging farmers to let them hang large panels painted in traditional quilt patterns on their barns.

"The first time I saw a barn quilt I thought, 'I want one of those!'" said Judi Inge, 55, of Owensboro, Ky., who is active in the Owensboro Area Quilters Guild. "My mother felt the same way."  ……….

The article provides links for more info and photos:

Ohio County Barn Quilt Trail
Kentucky Arts Council:  Quilt Trails
Ohio Barns:  Quilt Barns  (photo credit)

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Dr Anonymous’ guest this week will be Dana Lewis & Swedish 2010 Health Care Symposium.      The show begins at 9 pm EST.

Upcoming shows:       
10/9 : From Seattle
10/14 : About Social Health Track at BlogWorld Expo
10/16 : On Location
10/21 : About DigPharm Mtg
10/23 : Saturday Nite
10/28 : About FMEC Mtg
10/30 : On Location

Running in Heels

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

October has become known as “breast cancer awareness” month. The Susan G. Komen Race for a Cure will be held here in Little Rock, Arkansas on October 16th. It will not be run in heels!

Last Tuesday, Venus Embrace Closest Stiletto Race took place in Sidney, Australia. The racers wore 3 in stilettos!
The Pinkette, Brittney McGlone, Laura Juliff, Casey Hodges and Jessica Penny, set the world record for the fastest stiletto relay race. (photo credit)

Here is a video that includes the relay race:

Related posts:
Breast Self-Exam (October 8, 2009)
October – Breast Cancer Awareness Month (October 2, 2008)
Mammograms (October 13, 2008)
ARM Technique (October 15, 2008)
Breast Reconstruction—Part I (October 2007)
Breast Reconstruction – Part II (October 2007)
Breast Cancer Reconstruction Webcast (April 2008)
Silicone Implants and Health Issues (March 2008)

Rani's Baby Quilt

This quilt was made for my cousin Sherry’s daughter.  I made it using a quilt-as-you-go technique that makes hexagon blocks.  I found the technique in an old quilt magazine (sorry I don’t recall the name or date of the magazine).

I used 6.5 in circles to make the hexagons which are approximately 3.5 in.  The quilt measures 32 in X 48 in.  I finished the quilt in February 2001. 

The photos of the quilt were supplied to me by my cousin, so I apologize for not having a “full” photo.

You can see the details of the pink rabbits in the yellow fabric with this photo, as well as the added quilting (wanted to ensure it would hold together with use).  The back of the quilt looks like the front.

Okay, I’m going to try to give instructions on how to make the hexagons.   Begin with a circle at least twice as wide as you want the finished hexagon to be.  I used 6.5 in circles.

I press the circles into halves to find the center.  You will then fold the two points labeled “A” to meet at the center.

I press after each new fold though I’m not sure it is necessary.  Next, the two points labeled “B” get folded into the center.

Next the points labeled “C” get folded into the center.
Thus creating a hexagon!  Before placing a tacking stitch to hold the points together, you want to place a hexagon of scrap batting inside.
The hexagons can then be sewn together by hand or machine.  If by machine, use a faggoting or zigzag stitch.

I hope these instructions are clear enough.