Topical Silicone Gel for Burn Scars

Updated 3/2017-- all links (except to my own posts) removed as many are no longer active and it was easier than checking each one.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 read the studies the promote the use of silicone sheets for scar treatment.  I know the claims Mederma and other silicone gel scar treatments make.  What do I tell my patients? 

“It doesn’t matter what you use.  It matters that you use it.  Mederma is non-scented and less greasy than Vit E or cocoa butter.  If that will entice you into doing your dailyscar massage, then use it.”

For most scars, I will stand by the above.  Burn scar are characterized by an increasing occurrence of redness, thickness, stiffness, pain, and itching, and a disturbance in pigmentation and surface roughness.   So when I saw there was a new study looking at the use of silicone gel in the treatment of burn scars, I read it (full reference below).

Burn scars are often treated with intralesional corticosteroid injections, occlusive dressings, custom-made pressure garments, and silicone sheets. 

The silicone sheets, introduced in the early 1980s, have been shown to helpful in improving scar appearance.  The drawbacks of their use include compliance issues on scars in visible areas, difficulty of use for scars on or adjacent to joints, and hygienic issues of prolonged use.  The sheets can trap moisture creating skin irritation or rashes.

The article looks at a topical silicone gel named Dermatix (Meda Pharma, Amstelveen, The Netherlands).  It can be applied easily and dries to form a thin, flexible coating that does not restrict movement.  Unlike the silicone sheets, cosmetics can be applied over the silicone layer to camouflage the scar.

Martijn van der Wal, M.D., VU University Medical Center, Netherlands, and colleagues conducted a randomized, double-blinded, within-subject comparative, placebo-controlled trial to investigate the effectiveness of topical silicone gel in the treatment of scars resulting from a burn injury.

Forty-six scars on 23 patients were included in the study and followed for 1 year.  The mean age of the scars at inclusion was 4 months.   The patients were given two blinded and coded products to be applied two times per day on the two included scars with instructions to not interchange the therapies between the two scars.   One tube held a placebo cream and the other tube held Dermatix (kindly provided by Meda Pharma BV).  Effectiveness on scar quality was evaluated at 1, 3, 6, and 12 months using the Patient and Observer Scar Assessment Scale and the DermaSpectrometer.

Over all visits, the benefit on surface roughness was statistically significant (p = 0.012).   The surface of the topical silicone gel–treated scars showed significantly less roughness (p = 0.014) at 3 months after start of the treatment, and the topical silicone gel–treated scars were significantly less itchy (p = 0.018 and p = 0.013, respectively) at 3 and 6 months.

On average, observers rated scars treated with topical silicone gel slightly better than scars treated with the placebo cream, but repeated measures analysis did not show a significant treatment effect (p = 0.154). The patients rated the scars treated with topical silicone gel and the placebo cream almost equally.

So while topical silicone gel may improve the surface roughness of burn scars and aid in decreasing the itching, it is no better in improving the  overall appearance of the scar than the placebo.  To me this implies or suggests that the simple act of scar massage regardless of the cream/gel used may be the most important in aiding the appearance of the scar.

REFERENCES
Topical Silicone Gel versus Placebo in Promoting the Maturation of Burn Scars: A Randomized Controlled Trial; van der Wal, Martijn B. A.; van Zuijlen, Paul P.; van de Ven, Peter; Middelkoop, Esther; Plastic & Reconstructive Surgery. 126(2):524-531, August 2010; doi: 10.1097/PRS.0b013e3181e09559

More Fabric Postcards

Last weekend I got into making more fabric postcards.  Here are two of them.  Both are 5 in X 7 in. 

This one I call “Wish you were here.”

Here’s the back.

The second one I have sent to @DrSnit loves pink flamingos.  I called it “Come away with me.”
Here’s the back of it.

Zach's Quilt

I made this quilt for my nephew Zach (who just turned 23) back in approximately 1992.  The label on the back has faded so much it’s illegible. 

The quilt is machine pieced and hand appliqued.  I machine quilted it.  It measures 58 in X 73 in.  The pattern was for the race cars, but I found the brown fabric with a western theme to use as the “dirt” so I could add more “boy” interest to the quilt.
The border fabric adds to the cowboys to the mix.

Time for Teal Toes (Again)

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

Last year I learned of and took part in the campaign “Teal Toes.”  It is a way to bring awareness to Ovarian Cancer.  I have had two friends die of ovarian cancer – a nurse friend Lisette  and medical school classmate Yoland Condrey-Tinker.  

Both would have loved  the “Teal Toes” campaign  (photo credit)

The month of September is Ovarian Cancer Awareness Month and to help bring attention to the fifth leading cause of cancer death in women, an organization called Teal Toes is asking women to wear teal polish on their piggies in September (and anytime, really!) to prompt conversations about ovarian cancer with other people who might see the color and compliment or question it.

This is a photo of my teal toes  (link no longer active -- removed 3/2017) from last year, but I promise you have have used the polish I bought last year at Wal-Mart again.   It is Nicole “Respect the World Nail” Lacquer by OPI. 

The Gynecologic Cancer Foundation, the Society of Gynecologic Oncologists and the American Cancer Society, with significant support from the Alliance formed a consensus statement on ovarian cancer. The Ovarian Cancer National Alliance has endorsed the consensus statement, which was announced in June 2007. The statement follows.

Historically ovarian cancer was called the “silent killer” because symptoms were not thought to develop until the chance of cure was poor. However, recent studies have shown this term is untrue and that the following symptoms are much more likely to occur in women with ovarian cancer than women in the general population. These symptoms include:

Bloating

Pelvic or abdominal pain

Difficulty eating or feeling full quickly

Urinary symptoms (urgency or frequency)

Women with ovarian cancer report that symptoms are persistent and represent a change from normal for their bodies. …... Early stage diagnosis is associated with an improved prognosis.

Please visit OCNA for more information.
 
You might also like:

For Lisette (& Yoland) -- Hope Hike 2009
My Friend Lisette
October – Breast Cancer Awareness Month

Infected or Exposed Breast Prosthesis

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

This is a tough situation for both patient and surgeon.  Dr. Scott Spear has published an article in the April issue of the Journal of Plastic and Reconstructive Surgery which reviews his management of this issue  (full reference below).

Rates of infection have ranged from 0.4 to 2.5 percent for augmentation mammaplasty and from 1 to 35.4 percent for prosthetic breast reconstruction. Furthermore, rates of exposure have been reported between 0.29 and 2 percent for breast augmentation and between 0.25 and 8.3 percent for device-based breast reconstruction.

Dr. Spear published an algorithm for the management of breast device infection and/or exposure in 2004.   The current article is a retrospective study of his experience with infected or exposed breast prosthesis between 1993 and 2008.   During this 15 year period, he managed 69 patients with 87 events of breast device infection and/or exposure.

The mean patient age was 49.8 years.  The average BMI was 23.4.   Other key traits:  smoking history 18.4%, history of chemotherapy use 35.6%, history of radiation therapy 23%.

Events of device infection and/or exposure were classified into one of seven groups using the published algorithm: 

group I, mild infection; group II, severe infection; group III, threatened exposure; group IV, threatened exposure with mild infection; group V, threatened exposure with severe infection; group VI, actual exposure with no/mild infection; and group VII, actual exposure with severe infection.

Mild infection was defined as warmth, swelling, cellulitis, or nonpurulent drainage that was responsive to initial antibiotic therapy.

Severe infection was defined as persistent or substantial warmth/erythema/swelling despite antibiotic therapy, purulent drainage, atypical organisms on wound culture (e.g., methicillin-resistant Staphylococcus aureus, Gram-negative rods, mycobacteria, or yeast), or serious signs and symptoms of systemic infection (e.g., high fever, hypotension).

“Device salvage” was defined as the continued presence of a prosthetic device after surgical intervention, though not necessarily retention of the original device.

Dr. Spear reports that the mean postoperative time to breast prosthesis infection/exposure was 5.5 months.  He managed to obtain an overall device salvage rate of 64.4%.

Thirty-four events involved breast prostheses with mild infection, classified as group I, and were associated with a 100 percent salvage rate.

Twenty-six events concerned devices with severe infection, categorized as group II, and resulted in a 30.8 percent salvage rate.

He concludes:

Salvage of the infected and/or exposed breast prosthesis remains a challenging but viable option for a subset of patients. Keys to success include culture-directed antibiotics, capsulectomy, device exchange, and adequate soft-tissue coverage.

Relative contraindications to breast device salvage include atypical pathogens on wound culture, such as Gram-negative rods, methicillin-resistant S. aureus, and C. parapsilosis.

Patients with a prior device infection and/or exposure and a history of either radiotherapy or S, aureus on wound culture should be closely monitored for signs of recurrent breast prosthesis infection/exposure and managed cautiously in the setting of elective breast surgery.

REFERENCES

Management of the Infected or Exposed Breast Prosthesis: A Single Surgeon's 15-Year Experience with 69 Patients; Spear, Scott L.; Seruya, Mitchel; Plast Reconstr Surg 125(4):1074-1084, April 2010; doi: 10.1097/PRS.0b013e3181d17fff

Discussion: Management of the Infected or Exposed Breast Prosthesis: A Single Surgeon's 15-Year Experience with 69 Patients; Hammond, Dennis C.; Plast Reconstr Surg.125(4):1085-1086, April 2010; doi: 10.1097/PRS.0b013e3181d18289

The infected or exposed breast implant: Management and treatment strategies; Spear SL, Howard MA, Boehmler JH, Ducic I, Low M, Abbruzzesse MR.;  Plast Reconstr Surg. 2004;113:1634–1644.

Shout Outs

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

A Blog Around the Clock  is the host for this week’s  Grand Rounds.  You can read this week’s edition here.

The summer is almost over, but we can try to remain in the summery mood just a little bit longer. Perhaps we can go to a medical conference held at a lushious tropical island resort, listen to presentations, chat in the hallways, and then have great fun at the bar in the evenings. And call is Grand Rounds. No coats and ties allowed – this meeting is supposed to be fun!….

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Gruntdoc has written a sobering post:  Every driver is drunk – bet your life on it

A mentor recently mentioned, in passing, that he stopped riding motorcycles when cell phones came out, as he noticed the average driver distraction level had gone way up.  He said ‘its like everybody’s drunk’.  ….

I, like C&D, would like to point out that this doesn’t make driving under the influence okay, it doesn’t.  What it does do is put into perspective the astonishing diminution of skill with divided attention between driving and texting.  

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Another one from tweeter.  This one from @EvidenceMatters gives the link to an article in the Guardian by Ben Goldacre:

Costly life-[conserving] drugs: You have to draw the line somewhere. @bengoldacre on recent coverage of NICE & Avastin http://j.mp/byVdJQ

The article is well worth reading as it takes journalists and politicians to task:

…….Journalists can exploit these impossible decisions for outrage, and the pleasure of leading a popular campaign, but so can politicians………You're always going to draw the line somewhere, and if you paid £200,000 for six weeks of life there would still be more you could do.

Whoever draws that line, wherever it falls, is always going to be pilloried and despised. When you're writing about such an incredibly easy and emotive target, it might be fair to at least use a representative anecdote for illustration, instead of Barbara Moss.

And for a thorough review of the topic read David Gorsk’s (Science-Based Medicine) post:  Avastin and metastatic breast cancer: When science-based medicine collides with FDA regulation

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Dr Charles is hosting the first annual 2010 Charles Prize for Poetry.  Have you submitted one yet? Today is the last day to enter.   The entries have been amazing!

Open to everyone (patients, doctors, nurses, students, etc.). Limit 1 or 2 entries per person.

Poems should be related to experiencing, practicing, or reflecting upon a medical, scientific, or health-related matter……

Contest closes August 31st.

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KevinMD’s guest post by Shawn  Vuong  asks  Does a stereotypical surgical personality exist?

…… The stereotypical surgical personality is said to be “decisive, well organised, practical, hard working, but also cantankerous, dominant, arrogant, hostile, impersonal, egocentric, and a poor communicator.”

I think that I am decisive, organized, practical, and hard working. But am I cantankerous, arrogant, hostile, impersonal and egocentric? I hope not. I can admit that my communication probably needs work. I think I’ll give my self the benefit of the doubt, and rate my communication and ‘average’ instead of ‘poor’.

So there it is, I am half the surgical personality according to the stereotype (in my eyes — maybe everyone else thinks I am hostile and egocentric and thus fit the stereotype perfectly).  ……..

I don’t think I have the stereotypical surgeon personality, but maybe I’m delusional.  I am decisive, organized, practical, and hard working.  I can be arrogant, but mostly not.  I am usually pleasant and not cantankerous.  I try to be kind, not hostile.  I try to be a good communicator though I know I have much improvement to be done in that area.

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If you like jigsaw puzzles, then perhaps you’ll like this one that features a quilt from 1932:

This week's Top 100 Puzzle was created by Jennie C. Trein in 1932.  It is called Sunday School Picnic. Jennie was quite a woman.  She made her first quilt at 10 and completed over 100 in her lifetime.  Quilting wasn't her only passion, she played the piano and cornet, sang in the church choir for over 60 years, taught bible classes to children and made over 300 rugs.

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Dr Anonymous doesn’t appear to have a show scheduled for this Thursday.

Preference for Scar Location

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

There is a nice main article along with a discussion article in the August issue of the Journal of Plastic and Reconstructive Surgery which focuses on the preference of the scar location from the woman’s (patient’s) standpoint when the latissimus dorsi muscle flap is used in breast reconstruction.

There is always a “robbing Peter to pay Paul” when donor tissue is used in any reconstruction. Some times there is not a choice in how the donor scar will be oriented, but when there is the patient should be involved in the choice.

The surgeon needs to explain the factors which make one scar choice his/her preference. Factors such as the patient’s age, body mass index, other scars, and amount of tissue needed will all factor into the surgeon’s choice.

The patient’s preference is most likely to be made on how they view their body and on the types of clothing they like to wear (or envision wearing). Will the scar be hidden or visible with the clothing choices?

The article surveyed 250 women between the ages of 20 and 80 years, including 50 women with a history of breast cancer. The participation rate was 96% for a total sample size of 240 subjects.

The women were grouped into the following age categories: 20 to 29 years (n = 46); 30 to 39 years ( n = 32); 40 to 49 years (n = 44); 50 to 59 years (n = 70); and 60 to 79 years (n = 48).

The survey for the article study was done used photographs of a patient's back showing the variations of the latissimus dorsi donor-site locations. I scanned this photo from the first reference article.

As with the above, this one was scanned from the first reference article.

The results of the survey found:

The majority of women (66%) noted that the location of the latissimus dorsi flap donor site was important.

The lower transverse scar was the preferred scar location in 54% of the women surveyed. The second most preferred site was the middle transverse scar location.

The ability to conceal the scar in a low-back top or swimwear was noted to be important by 32%. A chance to improve the body’s contour was noted to be important by 30%.

Women younger than 50 years of age were concerned primarily with concealing the scar with clothing options, whereas women older than 50 years were concerned with both clothing options and contour of the back.

The independent factors of age, body mass index, ethnicity, body image, and clothing options were not found to show any significant correlation with scar location.

Maurice Y. Nahabedian, M.D. notes in his discussion of the article:

Personal experience with the latissimus dorsi musculocutaneous flap resonates with the conclusions of this study. The middle and lower transverse incisions have been preferred because they are better concealed. Women are able to wear certain clothing items and not reveal the location of the scar. There is usually less distortion of the posterior thorax and a better quality scar when compared with oblique or vertical incisions. …….

A final thought on this article is in reference to the evolution of breast reconstruction. ……. The posterior thorax is an equally important though less frequent donor site than the anterior abdomen. However, donor-site issues such as strength, scar, contour, and seroma need to be optimized to improve outcomes and increase patient satisfaction. This study has addressed scar and contour issues related to the latissimus dorsi flap, provided data to support the conclusions, and provided a mechanism to improve outcomes.

REFERENCES

Breast Reconstruction with the Latissimus Dorsi Flap: Women's Preference for Scar Location; Bailey, S; Saint-Cyr, M; Zhang, K; Mojallal, A; Wong, C; Ouyang, Da; Maia, M; Zhang, S; Rohrich, R J.; Plastic & Reconstr Surgery. 126(2):358-365, August 2010, doi: 10.1097/PRS.0b013e3181de1b41

Discussion: Breast Reconstruction with the Latissimus Dorsi Flap: Women's Preference for Scar Location; Nahabedian, Maurice Y; Plastic & Reconstructive Surgery. 126(2):366, August 2010; doi: 10.1097/PRS.0b013e3181de1963

Replantation Sonnet

There lays the severed pale digit on ice

Atop the table, freshly draped in blue.

Here rests the clean hand with French nails so nice

The team calmly moves, there is much to do.

K-wires fix  jagged bone ends together.

Tiny arteries stitched, loupes magnify

Hair-fine suture, careful not to gather.

Tourniquet loosened to a rose colored high

Signal transporting cables, yes, the nerves

Repaired; not yet emitting clear signals.

Ribbons, not blue or red, but  white swerve

Into line, moving fingers into balls.

Wound edges, matching pinks, together mold

Into a ring which should have been of gold.

Thronebeary Baby Quilt

This quilt was made in early 1987 for my sister Cathy when she was pregnant with her first baby.  The name of the quilt is a play on her (then) last name – Throneberry.

When I made the quilt, she didn’t know the sex of the baby who turned out to be her son Zach.  He has grown into a very nice young man.

The quilt is machine pieced and quilted.  It features a few square of cross-stitching.  It is 45 in X 45 in.

Here you can see the cross-stitched bears better.
And another.

Double Hand Transplant on Twitter

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

 

Louisville surgeons at The Jewish Hospital Hand Care Center recently performed the 3rd double hand transplant done in the United States.  It is the first to be live tweeted.

The procedure began around 7 p.m. on Tuesday, August 24, and finished late Wednesday afternoon, August 25.  Lead surgeon, Warren C. Breidenbach, M.D, with Kleinert Kutz & Associates, and his team of surgeons focused on the surgery while senior hand fellow Christiana Savvidou, M.D. used a laptop just outside the operating room to document the surgery as it takes place.

This bilateral transplant is the third double hand transplant to be done in the United States.  The first two double hand transplants were done at the University of Pittsburgh Medical Center, the first in May 2009 and the second in February 2010.  Louisville doctors performed the nation's first five single hand transplants.

Savvidou used the tweeter account @jewishhospital (www.twitter.com/jewishhospital) and the hashtag #handtx.

Here are some of the tweets which are a good representation of how the surgery progresses and how much time it takes.

jewishhospital

1st tweet ~ 7 pm ET, shortly before start of surgery

Want to know how a hand transplant is done? This is your chance- we are live tweeting a double hand transplant 2day starting @ 7pm! #handtx

approx 2 hrs later

The recipient’s right hand is fully prepped and awaiting the transplantation of the donor limb. #handtx

Education of terms: “prepped” = hand is being scraped & sterile dressing. “Started” = skin has been cut and surgery begun. #handtx

approx 4 hrs after start

Continuing donor and recipient dissection tendon identification and nerve identification in both recipient hands. Going smoothly. #handtx

approx 5 hrs after start

Removal of non-functioning hand tissue in preparation for donor limb attachment. #handtx

Both donor hands are on the table. Preparing for bone work - bone fixation at forearm of right recipient wrist. #handtx

@stacyluvsyah The bones are reattached with plates and screws similar to how a broken bone may be repaired. #handtx

approx 6 hrs after start

Bone fixation completed successfully in both hands. #handtx

Surgeons are now preparing the arteries. This will be the most important part of the operation. #handtx

approx 7 hrs after start

The connecting of the donor and recipient vessels (arteries and veins) is progressing very well in both hands. #handtx

approx 8 hrs after start

The hand replantation is progressing well. Surgeons are joining the tendons. #handtx

approx 10 hrs after start

Both hands are now vascularized and we are approximately 3/4 of the way complete. All is progressing well. #handtx

approx 11 hrs after start

Tendon suturing nearing completion. Nerve repair to follow. This includes suturing nerves of each finger from donor to recipient. #handtx

approx 12 hrs after start

Due to the number of nerves and tendons, this current stage could take a while…update coming when we near completion of this stage #handtx

approx 13 hrs after start

Nerve repairs on the left hand are now complete. #handtx

approx 14 hrs after start

The left hand is currently approximately 2/3 closed and final work on veins is occurring. #handtx

approx 16 hrs after start

Finishing right hand nerve repair. Due to new technique, this patient should have better feeling & motion than previous recipients #handtx

The left hand is currently being sewn shut. #handtx

approx 17 hrs after start

The left hand is now fully wrapped in surgical gauze and cotton padding. #handtx

approx 18 hrs after start

Surgeons are starting to close up the right hand #handtx

approx 19 hrs after start

Extra tissue is needed to finish closing the right hand. A skin graft is being taken from the patient's leg for this. #handtx

almost 20 hrs after start

Skin graft on right hand finished and hand is completely closed. Starting cleansing and bandaging. #handtx

(photo credit)

 

While we embrace the new ways to educate the public, Dr. Wes reminds us of  The Risks of Hospitals Live-Tweeting Surgeries.

For more information on hand transplant surgeon visit the teams’ website: www.handtransplant.com. 

“Women’s Health and Cancer Rights Act of 1998’’

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

Recently the New York signed into law requiring hospitals and doctors to discuss breast reconstruction options with the patient prior to her undergoing cancer surgery. 

It troubled me that this law was needed.  Is it not the duty of the physicians and surgeons to educate the patient on the options available? 

We need to make sure the patient and their family know of the treatment options which may vary depending on the diagnosis and stage.  Radiation.  Chemotherapy.  Surgery – lumpectomy, mastectomy, axillary dissection.  A combination of treatments.

Even if the patient and her physicians don’t chose to do immediate reconstruction, isn’t the discussion and information part of the discussion?  At least inform the patient of the option.

Do we physicians and surgeons need another law to ensure we do right by our patients?

Not all patient’s have health insurance so reconstruction may become unattainable due to finances.   Susan G. Komen has a nice resource page for financial assistance available for breast cancer patients.  I did not see any that would cover reconstruction.  Many will help will obtaining a prosthetic.

Patient’s that do have health insurance are afforded protection under the “Women’s Health and Cancer Rights Act of 1998.”   However, as I was reviewing and researching the WHCRC for this piece I learned that it’s not a blanket protection:

Generally, group health plans, as well as their insurance companies and HMOs, that provide coverage for medical and surgical benefits with respect to a mastectomy must comply with WHCRA.

However, if your coverage is provided by a "church plan" or "governmental plan", check with your plan administrator. Certain plans that are church plans or governmental plans may not be subject to this law.

Breast Reconstruction—Part I (October 2007)
Breast Reconstruction – Part II (October 2007)
Patient Satisfaction Following Breast Reconstruction Using Implants  (June 7, 2010)

REFERENCES

Before Breast Is Removed, a Discussion on Options; New York Times article, August 18, 2010; Anemona Hartocollis

“Women’s Health and Cancer Rights Act of 1998’’ Summary; American Society of Plastic and Reconstructive Surgeons website

Your Rights After A Mastectomy...Women's Health & Cancer Rights Act of 1998; Department of Labor

Shout Outs

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

Fizzy, A Cartoon Guide to Becoming a Doctor, is the host for this week’s  Grand Rounds.  You can read this week’s edition here (photo credit).

I am proud and honored to be hosting this week's grand rounds. As usual, I'm going to open with a cartoon:

And finally, Webster's Dictionary defines "grand rounds" as nothing, because it's not even in there. ……

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Kim, Emergiblog, is the host of the latest edition of Change of Shift (Vol 5, No 4) which is in its 5th year!   You can find the schedule and the COS archives at Emergiblog. (photo credit)

Welcome to Change of Shift – a day late, but hopefully not a dollar short!

We have some old friends and some new additions.  Our submissions cover the best of nursing and the most difficult moments. Some share successes and others could use some collegial support.

So, grab a latte, put your feet up and enjoy..
Change of Shift.  ………..

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KevinMD has published a guest post by  Peter J Polack, MD:  Balancing a surgeon’s beliefs with the needs of the practice

Not long ago, we interviewed a physician for possible partnership in our practice. After showing him around our town, some of us partners had dinner with him to discuss business. He was a quite pleasant fellow, well trained, and seemed to be a good ‘fit’ for our practice. As dessert was being served, he said he needed to get one more thing off his chest: he prays aloud in the operating room before starting each surgical case. If we couldn’t allow him to do this, it would be a “deal-breaker.”

So, what would you have done?  …………….

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Dr Charles is hosting the first annual 2010 Charles Prize for Poetry.  Have you submitted one yet? You only have until August 31st to do so.   The entries have been amazing!

Open to everyone (patients, doctors, nurses, students, etc.). Limit 1 or 2 entries per person.

Poems should be related to experiencing, practicing, or reflecting upon a medical, scientific, or health-related matter……

Contest closes August 31st.

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The flood in Pakistan has not gotten the attention on tweeter or in the medical blogs (from me or the ones I read) that the earthquake disaster in Haiti received.  So let me do a small part in passing along how you can donate to the relief effort.  This information is from the U.S. State Department:

Text "FLOOD" to 27722. Your $10 will go to the State Department Fund for Pakistan Relief…..  See Pakistan Relief Fund Page»

Text "SWAT" to 50555. Your $10 goes to UNCHR, which is also collecting Pakistan relief aid.

Additional Organizations: The most effective way people can assist relief efforts is by making cash contributions to humanitarian organizations that are conducting relief operations.  Learn More»

SAVE THE CHILDREN  Donation Phone #: 1-800-728-3843  Website: http://savethechildren.org

IRC  Donation Phone #: 1-877-REFUGEE
Website: http://www.theIRC.org

OXFAM  Donation Phone #: 1-800-77-OXFAM
Website: http://oxfamamerica.org

MERLIN  Donation Phone #: 202-449-6399
Website: http://www.merlin-usa.org

ACTED  Donation Phone #: 202-341-6365
Website: http://www.acted.org/en/support-us

AMERICAN RED CROSS   Donation Phone #: 1-800-435-7669  Website: http://www.redcross.org

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A tweet last week from @DrVes  led me to this CNN article by Cody McCloy:  Do-it-yourself solar power for your home  (photo credit).  I look forward to this “plug-in” technology.

Imagine outfitting your house with small, affordable solar panels that plug into a socket and pump power into your electrical system instead of taking it out.

That's the promise of a Seattle, Washington-based start-up that is working to provide renewable energy options -- solar panels and wind turbines -- for homes and small businesses. The panels cost as little as $600 and plug directly into a power outlet.

The company, Clarian Power, aims to be the first to bring a plug-in solar power system to the market, in 2011.  ……………….

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Another “building” story came my way via a RT from @EvidenceMatters “@snowcroft  Did the ancients build to please ears as well as eyes? Claims of acoustic archaeologists: http://is.gd/evLxo (RT @bldgblog)”    The link is to an article in New Scientist by Trevor Cox:  Echoes of the past: The sites and sounds of prehistory

……….Might we be missing here something that both Hardy and our prehistoric ancestors understood? Some archaeologists have begun to think so. They argue that sound effects were an important, perhaps even decisive, factor in how early humans chose and built their dwellings and sacred places. Caves that sing, Mayan temples that chirp, burial mounds that hum: they all add up to evidence that the aural, and not just the visual, determined the building codes of the past. But is that sound science?

Assessing the claims of "acoustic archaeology" rapidly encounters a fundamental problem: sound is ephemeral.  ………….

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I seem to be on a building this week.  Do you like tree houses?  Check out 39 Crazy Tree Houses.  Not sure which is my favorite, but I do like this one

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Dr Anonymous’ BTR show will be a celebration of the 3rd Anniversary of the show.  Come join us.

Upcoming shows (9pm ET)

8/26: Dr. A Show 3rd Anniversary