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 Updated 3/2017-- photos and all links (except to my own posts) removed as many are no longer active and it was easier than checking each one.

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

Welcome to the Doctor Who edition of Grand Rounds!

We’ll travel through the medical blogosphere of 21st century Earth, where we will find that Grand Rounds can be found on Twitter (@grandrounds) and on a website known as Facebook (Grand Rounds).

Our spaceship/time-machine, the TARDIS (Time And Relative Dimensions in Space), is standing by.

“All of time and space; everywhere and anywhere; every star that ever was. Where do you want to start?” – the Eleventh Doctor

The adventure begins…….

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Kim, Emergiblog, is the host of the latest edition of Change of Shift (Vol 5, No 10)! You can find the schedule and the COS archives at Emergiblog. (photo credit)

Welcome to the latest edition of Change of Shift!
Good stuff this week, so let’s get to it!
*****

A warm Change of Shift welcome to Erin, a school nurse who blogs at Tales of a School Zoned Nurse. Every single one of Erin’s posts would make a wonderful addition to CoS, but I was taken by One.  …..

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The New York Times has an article by Gardiner Harris on new cigarette labels:  F.D.A. Unveils Graphic Warning Labels for Cigarettes.  I approve this message!

Federal drug regulators unveiled 36 proposed warning labels for cigarette packages on Wednesday, including some that are striking pictures of smoking’s effects.

Designed to cover half of a pack’s surface area, the new labels are intended to spur smokers to quit by providing graphic reminders of tobacco’s dangers. .….

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Dr. Rich makes a great argument on How the Obesity Crisis Is Like the Mortgage Crisis

………..So, while few people actually stuck to a strict low-fat diet, many, many people became addicted to refined carbohydrates, and as a result became fat.
……….  We now hear somewhat more reasonable advice about good fats and bad fats, and good carbs and bad carbs. But much of the damage has been done, and at least partially because of the major push for low-fat diets, we Americans are fatter and less healthy than we used to be.
By the way, to this day it has never been shown that low-fat diets applied across the population would reduce the incidence of heart disease.  ……………..

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Fellow bloggers do you remember Wellsphere?  Well, the latest “thief” of our information using our reputations and twitter feeds in a similar way is Organized Wisdom.  Check out @laikas recent blog post on the topic:  Expert Curators, WisdomCards & The True Wisdom of @organizedwisdom

 Organized Wisdom (http://organizedwisdom.com and @organizedwisdom on Twitter) is a 3-4 year old company that uses a similar approach to filter useful health information out of the daily junk.  ……

Part of the problem may be that Organized Wisdom doesn’t only share links from “Health Centers”, but also from Wellness Centers (Aging, Diet, Exercise & Fitness etc) and Living Centers (Beauty, Cooking, Environment). Apparently one card can have information for 2 or 3 centers (diabetes and multivitamins for example)

I feel used.

Organized Wisdom uses the credibility of me and other curators, including so-called “top expert curators” as Dr Pho (Kevin MD – blog), to cover up the incredibility of others, with the intention to lure users in.  ……..

Just as with Wellsphere, I have asked Organized Wisdom to remove me from their expert curator list.  I hope you will do the same.

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From twitter: @ksboulden: I just RSVP to attended the meetup of Arkansas Women Bloggers. Can't wait!

Arkansas Women Bloggers Meetup Scheduled! (photo credit)

When: December 11, 2010 11am-1pm

Where: Museum of Discovery @ 500 President Clinton Avenue

Why: Meet other bloggers and help decide future activities/goals for AWB

We will keep you updated with event details as we pull them together.  

To RSVP, you can leave a comment on this post.  If you're on Facebook, you can RSVP and invite friends at the event page. You can also RSVP by emailing us at arkansasbloggers@gmail.com.

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The Alliance for American Quilts received 118 quilts for it’s “New from Old Quilt Contest Contest.” You can see all the quilts here. My entry was “Label Me” and is included in this weeks quilts being auctioned off.

Click on an auction week below to view or download an auction guide for that week.

Week Three: Monday,Nov. 15-Monday, Nov. 22

Week Four: Monday, Nov. 29-Monday, Dec. 6

The bidding for each quilt will start at $50 and each 7-day auction week starts and ends at 9:00 pm Eastern.

All proceeds will support the AAQ and its projects.

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There does not seem to be any Dr Anonymous’ show scheduled for this week. 

You may want to listen to the shows in his Archives. Here are some to get you started:

GruntDoc, Sid Schwab, Dr. Val, Kevin MD, Rural Doctoring, Emergiblog, Crzegrl, Dr. Wes, TBTAM, Gwenn O'Keeffe, Bongi, Paul Levy, John Halamka, and ScanMan

Families and Plastic Surgery

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 read this article by Colin Stewart , Spouses often are jerks about plastic surgery (link removed 3/2017), a few weeks ago.  Since then I have been thinking about not just the husbands but families in general I see in my practice.  Remember I practice in Little Rock, Arkansas not Hollywood but I still find this to be true and not just of husbands.

Husbands of plastic surgery fans have a sensitive role to play.

It’s a challenge that most of them fail. Instead of communicating effectively and caringly with their wives about plastic surgery, husbands tend to act like jerks or wimps.

I think often the patient may also fail in communicating effectively to her spouse, significant other, family, and friends why she feels the need to have cosmetic/plastic surgery.  In defense of the spouse and others, it can be a mind-field.  After all, you don’t want to suggest your loved one is less than perfect with her small breasts or her saddle bags or the bat wings or her father’s nose or …..

It is easier for me to ask the question “why do you want to have ____?” in my office.  There’s less judging, not the same emotional baggage.  The individual is less likely to feel rejection from me if I suggest she re-examine her reasons or discuss them more fully with me.

I want the individual to be the one who initiated the visit to my office.  I certainly don’t want a pageant mom to bring in her daughter for liposuction or breast augmentation anymore than I want a husband to push his wife into having larger breasts.

The article mentions

The wimpy approach.

“You look wonderful, dear,” they say. “You don’t need any work done, but if it makes you happy, go ahead.”

The in-control approach.

Many other husbands go to the other extreme and become dictators. They demand their own way, whether it’s pro- or anti-plastic surgery.

It’s much nicer for all involve when the patient and her/his family discuss the options with respect for each other.  Some family members are anti-surgery because of fear of losing the person when they change themselves.  Some are anti-surgery because of the fear of losing the loved one to a complication of anesthesia or the surgery itself.

When those fears are voiced, the individuals can address the emotions.  Marriage counseling is often a better solution than surgery.  Bigger breasts won’t necessarily keep the husband from leaving for the younger woman.  And, yes, some women pre-plan their cosmetic surgery before the divorce.

Certainly a family member’s fear of losing the loved one to a death related to potential risks of surgery/anesthesia need to be addressed.  Complications happen.  Deaths happen, fortunately rarely, but they do happen.

The desired improvements must be weighed against those risks.  The patient (and her family) must be realistic regarding expectations. 

The article describes a successful discussion between a patient and husband.  She gave voice to specific reasons for desiring the surgery.  He voiced his concern.  They both listened to each other.  She won him over.

When Rinna began considering lip-reduction surgery to remove the scar tissue, she expected Hamlin to object, and she was right.

Plastic surgery is “never a good thing, in my opinion,” he told People magazine. “Plastic surgery is just an extension of that whole ‘let’s stay fresh and young’ vibe.”

She said, “I knew Harry would say, ‘Don’t touch it, don’t mess with it.’ He was like, ‘Maybe you should just leave it alone.’ He loves me the way I am.”

But she told him how important the operation was to her and what it was like to be the butt of never-ending snarky comments about her lips.

Family discussions can help the patient to be honest with herself regarding her reasons and expectations.

Bart and Amy's Quilt

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 made this quilt for my brother-in-law and sister-in-law.  He was in seminary school then, now is a chaplain in the Army recently returned to the United States from his second tour of duty in Iraq. 

Amy took these photos for me (thank you), but I’m not sure you can tell how lovely the fabrics are.  The dark fabrics are jewel tone in nature (ruby, sapphire, emerald, and brown topaz).  I think I pieced the quilt around 1994 (Amy thinks 2000 or 2001, but I think I pieced it much earlier and it just took that long to get it quilted).  It is machine pieced, 71 in X 97 in.  I don’t believe I did the quilting, unsure who did.

The setting is a play on the Jacob’s Ladder block to form a cross with the center block, God’s Eye (Ojo).

Upper two:   Crown of Thorns (Wedding Ring)/Robbing Peter to Pay Paul (Arizona)

The lower four – left (facing quilt) and right
Christmas Star  …………………..  unsure, maybe King David’s Crown
?Joseph’s Coat variation ……….David and Goliath (from The New Quilting & Patchwork Dictionary which is different from the link)

The fact that I can’t recall all the quilt block names is a great example of why we quilters should document our ideas, inspiration, and sources as we make our quilts.  If anyone can correct me, I’d be grateful.

Physician Threatened by Libel Action

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 alerted to this issue by a couple of tweets:

@mariawolters: @rlbates please blog this if you can RT @DrEvanHarris: Libel threat to Doc w/ concerns abt  "Boob job" cream! http://bit.ly/a4bM5U

@baapsmedia: @beachbumbeauty @cosmetic_candy @rlbates Pls RT 2help defend medical scrutiny on unsubstantiated claims: http://tinyurl.com/37u6wal

Shouldn’t it be possible to voice a concern about a medical treatment, procedure, or claim without the fear of retaliation?  If the claims are backed by science, then simply addressing my concerns would be enough.

Fear of retaliation silences discussion.  Fear of retaliation makes it difficult to do the “right thing” when the public or an individual patient is at risk.

This incidence involves a British plastic surgeon threatened with libel action by the ‘Boob Job’ cream’s manufacturer after she voiced concerns/doubts of its effectiveness.

Sense About Science has a great summary of the entire affair:  Plastic surgeon threatened for comment on ‘Boob Job’ cream.

Dr Dalia Nield of The London Clinic was quoted in an article in the Daily Mail on 1st October 2010 saying that it was 'highly unlikely' the 'Boob Job' cream would increase a woman's breast size. The manufacturer, Rodial Limited had claimed that the cream, reported to be a favourite of Scarlett Johansson, can increase breast size by 2.5 cm. Dr Nield said the company had not provided a full analysis of tests on the cream and that if its claims that fat cells moved around the body were true it could be potentially dangerous. Rodial Limited has threatened Dr Nield with libel action. Dr Nield stands by her comments………..

Dr Dalia Nield said: "As a surgeon I am well aware of the necessity for claims on medical products to be based upon rigorous scientific testing, as well as the possible dangers which can result from treatments. It is my duty to speak out when products making these claims are not backed up by evidence. The safety and health of people could be at risk if I cannot do this."

Good for you Dr. Nield!  I agree with you and love this comment:

i want scientific proof, apply only to one boob the a side by side comparison after 56 days
- steve, usa, 1/10/2010 0:36

Injectables Roundup

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 have come across some interesting articles recently regarding injectables.  Let’s begin the non-controversial one: Behind the Lines by Linda W. Lewis, Nov/Dec 2010 MedEsthetics (pp 32-.  This one notes several filler discontinuations:

Johnson & Johnson (jnj.com) withdrew porcine collagen-based Evolence in November 2009; Allergan (allergan.com) discontinued its human and bovine collagen fillers, CosmoDerm, CosmoPlast, Zyderm and Zyplast, late last year and will stop distribution by the end of 2010.

The article mentions the latest filler introductions:

Juvederm XC from Allergan and Restylane-L and Perlane-L from Medicis (medicis.com).  These products differ from their predecessors only in the addition of lidocaine to the formulations.

Much greater changes are on the horizon, however, as manufacturers seek approval for exciting new products like Novabel (Merz Aesthetic, merzaesthetics.com) and Aquamid (Contura, aquamid.com).

The article also mentions that some physicians are using Restylane SubQ in buttock and breast enlargements.  This leads me to the next article (full reference below):   Macrolane(TM) for breast enhancement: 12-month follow-up.  The Swedish study used a new formulation of a stabilized hyaluronic acid-based gel of non-animal origin (NASHA(TM)-based gel) called Macrolane(TM) VRF30) in their open-label, multicentre, non-comparative study.

The aim of this study was to develop a reproducible technique for injecting NASHA-based gel posterior to the mammary gland (subglandular injection), and to assess treatment safety and efficacy. The feasibility of dual-plane submuscular injection was also explored.

Twenty-four non-pregnant, non-breastfeeding women (mean age 37 years) with small breasts were recruited, 20 of whom underwent subglandular injection.   Patients were treated in groups of four to enable step-wise revision of the injection technique. Safety and efficacy assessments (12-month follow-up) included adverse event (AE) reporting and the Global Esthetic Improvement Scale, respectively.

It’s a small study with the authors reporting 83% satisfaction in the post-procedure breast appearance at 6 months, 69% at 12 months.  I find it interesting that the most commonly reported adverse event was capsular contracture.   Obviously,  larger studies are needed before this can be routinely recommended to patients.

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Dentist are “pushing” their scope of practice beyond the teeth/dentition to include Botox and fillers.   While dentists may know how to do injections well and should know facial nerve/muscle anatomy well, I personally feel this is beyond the definition of dental practice.  I suppose it will be up to state dental and medical boards to work this out.

 The Evolving Role of Dentist in the Injectables Business by Jeff Frentzen, PSP Blog  leads you to the full article: The next revolution in dentistry: facial injectables by Bruce G. Freund, DDS, Oct 25, 2010.

REFERENCE

Macrolane(TM) for breast enhancement: 12-month follow-up; Per Hedén; Plastic & Reconstructive Surgery: POST ACCEPTANCE, 14 October 2010; doi: 10.1097/PRS.0b013e318200ae57; Original Article: PDF Only

Longevity of SMAS Face Lift

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 think it is safe to say that all plastic surgeons have been asked, “How long will my face lift last?”  As pointed out, by Dr. Sundine and colleagues (first reference article) this question is difficult to answer using our current literature.  They tried to answer the question focusing specifically on the two-layer superficial musculoaponeurotic system (SMAS) face lift.

To do this, Sundine and colleagues conducted a retrospective chart review of 42 patients who underwent secondary face lifts performed by the senior author from January of 2001 to December of 2008. Patients who had their primary face lift performed by another surgeon were excluded.  The charts were reviewed for the dates of the initial surgery and subsequent operations, patient data, procedures performed, and complications. The patient photographs were also reviewed.

The average age at the time of the primary face lift was 50.7 years (range, 34.9 to 69.9 years), and the average age at the time of the secondary face lift was 61.9 years (range, 43.6 to 77.2 years).

The average length of time from the primary to secondary face lift was 11.9 years (range, 1.0 to 34.5 years). ….

One glaring shortcoming of the study is the failure of the authors to contact every patient the senior author performed a primary face lift (there were 299 during the time frame) to determine whether any patients received a secondary face lift with another surgeon.

So while the over-simplified answer may be “approximately 10 years,” there really is no simple answer.  Patients give many reasons for desiring a second facelift.  (second reference)

Readers of this article will already know that people have a universe of reasons for having a face lift. In practice, one commonly notes not only unhappiness with the mirror but also the loss of a spouse or the anticipation of finding one: the patient's social milieu and group dynamics (face lifts as a rite of passage). Some people perceive an advantage in finding or maintaining employment, all reasons that may have little to do with the face itself but with life conditions of the person requesting the procedure. In other words, subjectivity and life forces are major factors, and the decision to have such a procedure may have little relationship to how the patient actually appears.

Biological factors such as skin quality, facial weight, and the age at which the initial procedure is performed significantly affect both the quality of the initial result and its duration, and the same cultural and personal forces remain. There is no distinct tissue endpoint for undergoing a secondary lift, just as there is no distinct biological point at which a primary lift becomes “necessary.” With so many factors to be considered, the longevity of any type of face lift remains a difficult question to answer with any certainty.

In addition, to the above there are the constraints of life that may prevent a patient from returning for a desired facelift – poor health, financial concerns, family reasons, and perhaps even a poor experience the first time.

REFERENCE

Longevity of SMAS Facial Rejuvenation and Support; Sundine, Michael J.; Kretsis, Vasileios; Connell, Bruce F.; Plastic & Reconstructive Surgery. 126(1):229-237, July 2010.; doi: 10.1097/PRS.0b013e3181ce1806

Discussion: Longevity of SMAS Facial Rejuvenation and Support; Lambros, V.; Stuzin, J. M.; Plastic & Reconstructive Surgery. 126(1):238-239, July 2010; doi: 10.1097/PRS.0b013e3181dab6f3

The Measure of Face-Lift Patient Satisfaction: The Owsley Facelift Satisfaction Survey with a Long-Term Follow-Up Study [Outcomes Article]; Friel, M.T.; Shaw, R. E.; Trovato, M. J.; Owsley, J. Q.; Plastic & Reconstructive Surgery. 126(1):245-257, July 2010; doi: 10.1097/PRS.0b013e3181dbc2f0

Discussion: The Measure of Face-Lift Patient Satisfaction: The Owsley Facelift Satisfaction Survey with a Long-Term Follow-Up Study [Outcomes Article]; Pusic, A.L.; Klassen, A. F.; Scott, A. M.; Cano, Stefan J.; Plastic & Reconstructive Surgery. 126(1):258-260, July 2010; doi: 10.1097/PRS.0b013e3181dbba19

Shout Outs

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.

Mother Jones RN, Nurse Ratched's Place,  is the host for this week’s Grand Rounds! You can read this week’s Veteran’s Day edition here (photo credit).

Welcome to the Veterans Day edition of Grand Rounds. Elvis and I are delighted that you dropped by. The King is very excited today because we are saluting celebrities that have served in the Armed Forces. Elvis said that his days in the army were memorable. I imagine having Life Magazine take your picture while you’re sitting in your underwear would be a memorable experience. My co-host and I want to thank everyone for their submissions, and we especially want to thank Dr. Nick Genes for allowing us to hold Grand Rounds at Nurse Ratched’s Place. ….

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Really patient-centered! via Paul Levy (Running a Hospital):  Here comes the bride - at Anne Arundel Medical Center by Wendi Winters (Capital Gazette)

The bride wore an elegant strapless gown and a radiant smile. The nervous groom was impeccable in his spotless Air Force dress uniform and a TV-sized heart monitor.  …….

"The wedding must go on," senior nursing director Ann Marie Pessagno said as she arranged the chairs for the ceremony that almost wasn't.  ………

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Dr Margaret Polaneczky updates us on HRT and breast cancer in her post:  HRT and Breast Cancer Deaths – Just in Case You Weren’t Listening the First Time…

…………….While the breast cancer risks associated with HRT use appear to be quite real, for a individual woman, they are not that large. Here’s how I explain the risks to my patients ……………..

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From tweeter  @IVLINE “For all your fracture naming needs http://bit.ly/98agy2 with pictures included.”  The link is to LITFL’s Eponymous Fractures.  Here’s an example of the great information you will see there:

Barton’s fracture
John Rhea Barton
1794-1871, American surgeon
Description/ Mechanism of injury:
Fall on outstretched hand

Intra-articular fracture of the distal radius with dislocation of the radiocarpal joint. Fractures may be displaced volar or dorsal direction

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From twitter: @docgrumpy: “The iPhone/iPod app "Nerve Whiz" is awesome for peripheral nerve help- and it's free (I wasn't paid for this, FYI)”

Nerve Whiz is an app designed by a neuromuscular neurologist at the University of Michigan.

Nerve Whiz is a free application for medical professionals interested in learning the complex anatomy of nerve roots, plexuses, and peripheral nerves. Select which muscles are weak, or point to areas of sensory loss, and the application can provide you with distinguishing features and detailed information, complete with relevant pictures and detailed information, complete with relevant pictures and diagrams.

NOTE: Nerve Whiz is intended to be an educational tool only. Nerve distributions vary between patients, and central or multifocal processes can mimic focal peripheral lesions. As such, this application should not be relied upon to make clinical decisions.

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The Alliance for American Quilts received 118 quilts for it’s “New from Old Quilt Contest Contest.” You can see all the quilts here. My entry was “Label Me.” The quilts are now being auctioned off.

Click on an auction week below to view or download an auction guide for that week.

Week One: Monday, Oct. 25-Monday, Nov. 1

Week Two: Monday, Nov.8-Monday, Nov. 15

Week Three: Monday,Nov. 15-Monday, Nov. 22

Week Four: Monday, Nov. 29-Monday, Dec. 6

The bidding for each quilt will start at $50 and each 7-day auction week starts and ends at 9:00 pm Eastern. No Daylight Savings Time changes this year to contend with--DST changes on November 7.

All proceeds will support the AAQ and its projects.

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There does not seem to be any Dr Anonymous’ show scheduled for this week. 

You may want to listen to the shows in his Archives. Here are some to get you started:

GruntDoc, Sid Schwab, Dr. Val, Kevin MD, Rural Doctoring, Emergiblog, Crzegrl, Dr. Wes, TBTAM, Gwenn O'Keeffe, Bongi, Paul Levy, John Halamka, and ScanMan

Stem Cells

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.

The October issue of the Plastic and Reconstructive Surgery Journal has a nice review article of stem cells (bold emphasis is mine).  The article gives an overview of current advancements in the field of stem cell research, as well as perspectives for future clinical applications.

Stem cells are defined by their capacity to both self-renew and differentiate into multiple cell lines. Traditionally, they have been divided into two main groups based on their potential to differentiate. Pluripotent stem cells (embryonic) can differentiate into every cell of the body, whereas multipotent stem cells (adult) can differentiate into multiple, but not all, cell lineages.

In addition to the traditional stem cell classification, a new class of stem cells has recently been described—induced pluripotent stem cells—which are derived from genetically reprogrammed adult cells. These diverse cell populations will provide researchers and clinicians with an expanded armamentarium to treat diseased and dysfunctional organs.

Embryonic stem cells

• are derived from the inner cell mass of the blastocyst and have the capacity to differentiate into all tissues of the body.
• at least 225 human embryonic stem cell lines have been generated by researchers
• the pluripotentiality and unlimited ability for self-renewal that make embryonic stem cells attractive for cell replacement therapy also simultaneously translates into unregulated differentiation and formation of teratomas and teratocarcinomas, especially in undifferentiated states
• significant political and ethical hurdles that hinder further investigations of human embryonic stem cells

Adult stem cells

1. avoid the ethical concerns regarding fetal tissue harvest
2. well-studied adult stem cell population includes mesenchymal stem cells
3. Mesenchymal stem cells have been isolated from bone marrow, umbilical cord blood, and adipose tissue.
4. Adipose tissue–derived stem cells can be readily harvested during a minor liposuction procedure under local anesthesia.

Induced pluripotent stem cells

1. Takahashi and Yamanaka published a landmark article in 2006 that defined a specific set of transcription factors capable of reverting differentiated cells back into a pluripotent state, thus creating “induced” pluripotent stem cells.
2. It is widely accepted that mouse and human induced pluripotent stem cells closely resemble molecular and developmental features of blastocyst-derived embryonic stem cells

While the clinical potential for stem cell use is huge as noted in the article

Stem cell–based clinical trials are still in the early stages of development. In a preliminary case study, three patients were treated with autologous bone marrow stem cells seeded onto porous ceramic scaffolds for limb cortical defects ranging from 4 to 7 cm.  ………

In another case report, a 7-year-old girl with a critical-sized calvarial defect was successfully treated with cancellous iliac bone grafts in combination with autologous adipose tissue–derived stem cells.

In a case series, 20 patients with severe symptoms or irreversible functional skin damage due to radiotherapy were treated with autologous adipose tissue–derived stem cells delivered by computer-assisted injections.  …….

Interestingly, the first clinical phase I trial for utilizing adipose tissue–derived stem cells was carried out in patients with Crohn's disease. …..
In another phase I clinical trial, eight patients with Duchenne disease were treated with myogenic (muscle-derived CD133⁺) stem cells. ….

there is abuse of the term stem cell.  Stem cells facelifts are a marketing scheme (IMHO) which are promising results that haven’t been studied.

Stem Cell Face-Lifts?
Stem Cell Facelift: Fact or fiction?
The Newest Untested Fad:  Stem-Cell Facelifts
and from Dr. Thomas Fiala’s this blog post The "Stem Cell" facelift

But so far, we have no evidence - zip, zilch, nada - that there is any actual regenerative effect on skin when the turbo-charged fat is added to the face. We know you get more volume in the treated areas, so the treatment could be useful for those with a volume-depleted area, or those who want fuller cheeks - but that's about it.

Furthermore, under FDA rules, when stem cells get involved with fat transfers, the procedure falls under a whole new set of regulations. The fat and stem cell combo is now seen as a "biologic agent" by the FDA, and regulated as a drug. In the eyes of the FDA, stem cells and fat represent a non-approved drug. Investigational, yes - approved, no.

Interestingly, one of the spin-offs of this change to drug status is a change in whether physicians can advertise this process. They are no longer just advertising a procedure (the stem cell facelift), but they are doing direct-to-consumer marketing for a drug (the fat and stem-cell mixture) which has not yet been cleared by the FDA. And it's illegal to promote non-approved drugs.

Dr. Barry Eppley disagrees with the above stance in his post:  Stem Cell Facelifts - Science or Science Fiction?

Conversely, the hopeful part of a Stem Cell Facelift is that it is a perfectly natural procedure that has no harmful effects, an almost organic procedure if you will. It is all the patient’s own tissues and may exemplify the appealing concept of ‘heal thyself’. Because one’s own cells are being used (recycled?), it is not a procedure that requires FDA approval or that of any governing medical organization. (so don’t be misled that it is an FDA-approved procedure or technique) At the worst, one gets the benefit of fat grafting whether the stem cells really become alive or not. And the use of fat grafts to the face with our current appreciation of what happens as our face ages is a proven benefit.

However, in checking the FDA’s own website, I find that I would disagree with Dr. Eppley and agree with Dr. Fiala:  What are stem cells? How are they regulated?

Stem cells, like other medical products that are intended to treat, cure or prevent disease, generally require FDA approval before they can be marketed. At this time, there are no licensed stem cell treatments.

REFERENCES

Stem Cells; Behr, Björn; Ko, Sae Hee; Wong, Victor W.; Gurtner, Geoffrey C.; Longaker, Michael T.; Plastic & Reconstructive Surgery 126(4):1163-1171, October 2010; doi: 10.1097/PRS.0b013e3181ea42bb

Cathy's Scarf Quilt

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.

Today would have been my mother’s 76th birthday, so it seems appropriate to share a quilt made for my sister of  old scarves embroidered both by our mother and us girls.  Back in June I shared the quilt I made for my sister Susan from some of the old scarves.

I machine pieced this small wall hanging, 34 in X 34 in, somewhere around 2000.  Cathy hand quilted.

Here you can see some of the embroidered areas better.

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This post has been added to the Blogger’s Quilt Festival Fall 2010.  There are many lovely quilts.  Go check them out.

I Need to Reschedule You

Over the past 20 years, there have been very few times I have asked patients to reschedule.  Even though I tell patients they have nothing to apologize for when they then to cancel, I always apologize.   This is especially true when it comes to asking them to reschedule surgery.

Yes, I know you have asked for time of work.  Yes, I know you have arranged for someone to help care for you, for your children, etc.  Yes, I realize you may have airline tickets to come into town to stay with family here while recovering.

Yes, I keep all that in mind, so if I ask you to reschedule it truly will be a handful of good reasons:

I am sick or need surgery myself.  I had to ask a patient to reschedule her breast reduction early in my solo career.  I had an acute herniated disc (C6-C7) which left me with numbness in my left  index and long fingers and loss of triceps function, not to mention the pain.  I had to explain to her that it was not safe for me to do her surgery until after my own.  [She did reschedule.]

A family member is sick or dying.   I had to ask a patient last May to reschedule after my mother had her stroke during her CABA.  After we made the decision to AND (allow natural death), we did not know how long it would be.  I did not want to be in surgery when it happened.  I thought it was reasonable.  [She never rescheduled.]

I have a funeral to attend.  I have not canceled or rescheduled a surgery for this (yet), but have rescheduled a few office visits.  As I and my friends get older, I can see this happening more frequently in the future.  I will try to be considerate of both my friend/family and my patients.

Usually, when I ask a patient to reschedule it will be a last minute thing.  I regret this, but as you can see from the reasons I allow myself to make this request it will always be last minute.  Some things are tough to plan.

Believe me when I say I am sorry to have to ask you to reschedule.  I truly mean it.

Know Your Surgeon

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 would caution anyone who elects to have cosmetic or plastic surgery to go to a surgeon’s office.  Meet your surgeon.  Along with learning about the procedure, ask about their training.  If your procedure is to take place outside of a hospital (for example, in a surgery center), ask if your surgeon has privileges to do the procedure in a major hospital (the hospital should have checked their training when doing the credentialing).

Treat cosmetic/plastic surgery as surgery with all the benefits AND risks of non-elective surgery.

I stumbled across this article Owner of Cosmetic Surgery Clinic Sentenced in New York for Health Care Fraud.

Arthur Kissel,a/k/a "Arthur Froom," was sentenced October 25th in Manhattan federal court to 10 years in prison for healthcare fraud offenses.  Neither Kissel nor his wife Sonia LaFontaine are doctors, but they engaged in a series of fraudulent practices out of their Manhattan cosmetic surgery clinic.  (pdf file of press release from United States Attorney Southern District of New York)

LaFONTAINE and KISSEL, along with several coconspirators including doctors who worked at LRMA, engaged in four different types of fraud at the clinic:
•  LaFONTAINE performed procedures which were billed as if they had been performed by licensed physicians.
•  LRMA billed cosmetic procedures as medically necessary procedures so that health insurance companies would be duped into paying for them.
•  KISSEL and LaFONTAINE submitted claims to health insurance companies for procedures that were never performed.
•  KISSEL and LaFONTAINE exaggerated insurance claims by increasing the number and complexity of procedures.
KISSEL and LaFONTAINE were indicted in March 1998 with conspiracy to commit health care fraud. KISSEL was extradited from Canada in 2008 and pled guilty on September 4, 2009.

Kissel and LaFontaine’s practices actually led to the death of one patient:

In imposing the maximum sentence permitted by law,Judge CHIN rejected KISSEL's claims of "ignorance and dumbness"and found that he "acted out of greed." He also stated that his crimes "led directly to the death" of JOEL CUNNINGHAM, who died on January 8, 1998, while undergoing an outpatient abdominal liposuction procedure at LRMA. CUNNINGHAM had wanted to become a NYPD police officer, but was too heavy to meet the entrance standards. He decided to have a liposuction procedure at LRMA,which used extensive advertising claiming that it was operated and supervised by a "world renowned surgeon," when in fact it was operated and supervised by KISSEL and LaFONTAINE. Evidence presented at a subsequent wrongful death suit in state court indicated that Cunningham had died of complications from anesthesia, which had been administered by an LRMA anesthesiologist who was at the time on professional probation due to drug and alcohol abuse.

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.

Dr Wes is the host for this week’s Grand Rounds! You can read this week’s edition here (photo credit).

Welcome to this week's mid-term edition of the medical blog-o-sphere's Grand Rounds! Before we begin, be SURE to get to the polls to VOTE!
This week submissions were classified by state or country of origin. Politically incorrect posts by state were colored RED whereas politically correct posts by state were colored BLUE. (States with both extremes are represented in PURPLE.)
Now what would any political post be without a POLITICAL MAP of the states represented in this week's Grand Rounds?  …………….

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Kim, Emergiblog, is the host of the latest edition of Change of Shift (Vol 5, No 9)! You can find the schedule and the COS archives at Emergiblog. (photo credit)

Welcome to Change of Shift!
After a Vegas-induced vacation, our nursing blog carnival is back!
There has been lots of activity in the blogosphere over the last four weeks, so let’s get right to the heart of it! ………..

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Check out Dr. Rob’s recent House Call Doctor podcast: When Should You Worry About a Nosebleed?

……….Doctors call nosebleeds epistaxis. I’ve mentioned before that doctors like fancy names for things; it just sounds smarter to use a Latin or Greek word. It’s especially good at parties. ……….

As someone who has had many nosebleeds within my life, you may also want to check out my old post from two years ago: Nose Bleeds. Either way, Dr. Rob and I have you covered.

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An ethical question comes up regarding the use of social media as noted by @dreamingspires

A Tweeting Hospital and Kidney Patient: The Case of the tweeting Kidney Patient has caused a small whirlpool of a ... http://bit.ly/dfsREG

The original nhssm's posterous blog post: 2nd Case Study - St George's Healthcare NHS Trust and the Tweeting Kidney Patient

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From twitter: RT @MargaretAtwood @DrSnit @kidney_boy: Hey, you're famous! http://ow.ly/30LR1. The link is to a Guardian.co.uk article by Esther Addley: Margaret Atwood creates superhero outfits for Twitter avatars

With more than a dozen novels, 17 poetry collections and countless literary awards including the 2000 Man Booker prize to her name, Margaret Atwood's credentials as one of the world's greatest living writers are not in question. ……..

in a remarkable exchange over Twitter, which saw the Canadian writer contacting two readers who had expressed admiration for her work, and offering to design "superhero comix costumes" for their avatar alter-egos, @kidney_boy and @DrSnit.

"[They] both have excellent Twitter names – suitable for superheroes – and were comix fans, and were discussing Comic.con, as I recall," she told the Guardian. ………..

This tweet links to a companion article:

@steve_lieber Some of the @PeriscopeStudio artists (incl. me) have drawn @margaretatwood's Kidney Boy and Dr. Snit. http://periscopestudio.com/?p=3638

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The Alliance for American Quilts received 118 quilts for it’s “New from Old Quilt Contest Contest.” You can see all the quilts here. My entry was “Label Me.” The quilts are now being auctioned off.

Click on an auction week below to view or download an auction guide for that week.

Week One: Monday, Oct. 25-Monday, Nov. 1

Week Two: Monday, Nov.8-Monday, Nov. 15

Week Three: Monday,Nov. 15-Monday, Nov. 22

Week Four: Monday, Nov. 29-Monday, Dec. 6

The bidding for each quilt will start at $50 and each 7-day auction week starts and ends at 9:00 pm Eastern. No Daylight Savings Time changes this year to contend with--DST changes on November 7.

All proceeds will support the AAQ and its projects.

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Dr Anonymous’ show will be follow-up to FMEC Mtg. The show begins at 9 pm EST.