Fat Grafting to the Breast and Oncologic Risks

Updated 3/2017-- photos and all links (except to my own posts) removed as many are no longer active and it was easier than checking each one.

Fat grafting to the breast has become an acceptable practice.  It is being used to repair small defects as well as to augment.  As I noted in my post (November 22, 2010), the two articles (2nd and 3rd references below) from researchers at the University of Pittsburgh School of Medicine suggests that it is NOT safe to use adipose-derived stem cells (ADSC) that may be part of fat grafting in any patient with active tumor cells.

This new article (first reference below) discusses potential risks of current and novel approaches to autologous fat grafting to the breast within the context of both the underlying science and clinical practice.  They conclude (bold emphasis is mine):

There are theoretical reasons why fat grafting might influence breast cancer growth or metastasis. Certain laboratory studies can be interpreted as supporting their negative impact on tumor development, metastasis, or recurrence. However, careful review of these concerns suggests that they arise from factors and situations that are not present to a significant extent in the clinical setting.

A study that approximates more closely the clinical situation of fat grafting into the breast has been presented in poster form.   This study investigated an orthotopic model of breast cancer in which human breast cancer cells were implanted into the mammary fat pad of immunodeficient animals, followed by placement of a human fat graft (with or without noncultured supplemental cells) immediately adjacent to the mammary fat pad containing the nascent tumor. The study found no increase in tumor growth with either an estrogen receptor-positive or an estrogen receptor-negative human breast cancer line. This is consistent with the absence of evidence for increased cancer risk in the many reports of fat grafting for breast reconstruction and augmentation. However, at this time, the number of patients with prolonged follow-up is only approximately 1000 and appropriate caution in proceeding is indicated.

……….In the clinical setting, several studies note the importance of good communication between the surgeon and an experienced radiologist to ensure accurate interpretation of breast imaging findings. Incorporation of these steps into good clinical practice and timely reporting of outcome data, including long-term follow-up—preferably in the form of multi-center clinical studies or a robust international patient registry—will ensure that the field develops in a safe and appropriate manner.

REFERENCES

1.  Oncologic Risks of Autologous Fat Grafting to the Breast; Fraser JK,  Hedrick MH, Cohen SR;  Aesthetic Surgery Journal January 2011 31: 68-75, doi:10.1177/1090820X10390922

2.  Regenerative Therapy and Cancer: In Vitro and In Vivo Studies of the Interaction Between Adipose-Derived Stem Cells and Breast Cancer Cells from Clinical Isolates; Ludovic Zimmerlin, Albert D. Donnenberg, J. Peter Rubin, Per Basse, Rodney J. Landreneau, Vera S. Donnenberg; Tissue Engineering Part A. September 2010, ahead of print.

3.  Regenerative Therapy After Cancer: What Are the Risks?; Vera S. Donnenberg, Ludovic Zimmerlin, Joseph Peter Rubin, Albert D. Donnenberg; Tissue Engineering Part B: Reviews. November 2010, ahead of print.

Florida Student Gets Hand Transplant

 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 is a difficult post for me to write.  As much as I admire the surgeons who are pushing this new advance I found myself bothered by this one.  Why?     That’s what I have been asking myself.  After all, Linda Lu, 21 year old, is a college student from Orlando, Florida is ecstatic about the new hand.

"I've already accepted it as my hand since the day I woke up," Linda Lu said during a Monday press conference at Emory University Hospital in Atlanta, where the surgery took place. "But just looking at it, sometimes I still can't believe that it's there... It kind of feels like magic."

"I'm in information technology," Lu said. "So, my primary goal is to be able to type."

Simple enough goal, isn’t it?   When playing the “what would I give up game” my hands are never given up easily.  I could probably learn to sew with only one hand, but it would be difficult and it would become mostly machine sewing.  I could still blog as I could type with one hand – not as fast, but it would get done. 

I would not be able to do surgery with one hand, but a hand transplant would not give that back to me anyway.  The dexterity would never be good enough.

Linda is reported to have lost her left hand when she was 1 year old.  The amputation was done due to complications from Kawasaki disease.

Still I’m left with this uneasy feeling.  Most people born with only one hand/arm adjust well.  For example, look at the baseball pitcher Jim Abbott. 

This healthy young woman will now be placed on anti-rejection medications for life.  It will make any pregnancies she has high-risk ones.  She will be more susceptible to infections.  Some anti-rejection medications increase the risk of cancers.

Just because we can do a procedure doesn’t mean we always should.  I hope my uneasiness regarding this one is misplaced.  After all, I am getting my information from news articles and not from a discussion with the patient.

Newsprint articles

Florida Student Receives Rare Hand Transplant Surgery, FoxNews.com, March 28, 2011

Valencia student has rare hand transplant at Emory University, LA Times, March 28, 2011 (video as well as print)

Related posts:
Double Hand Transplant on Twitter  (August 26, 2010)
Cost of Hand Transplantation?  (September 22, 2010)
Rejection  (December 1, 2010)
New Technology May Help Prevent Rejection in Hand Transplant Patients (December 13, 2010)

Shout Outs

Updated 3/2017-- photos and all links removed as many are no longer active and it was easier than checking each one.

Dr Mike Sevilla (formerly Dr. Anonymous), Family Medicine Rocks, is the host for this week’s of Grand Rounds! You can read this week’s edition here.

I'm honored to be hosting Grand Rounds for the fourth time. This is not the GR theme today, but I did want to mention that it's Doctor's Day tomorrow in the United States. Doctor's Day was first observed on March 30, 1933. Eudora Brown Almond, wife of Dr. Charles Almond, decided to set aside a day to honor physicians.

The red carnation is commonly used as the symbolic flower for National Doctors Day. In 1990, law was passed designating March 30 as "National Doctors Day." Big shout out to all my physician colleagues out there!  ……

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A very moving post by Richard Sheff, MD on KevinMD.com: Giving the patient and family precious minutes to say goodbye

Dorothy suffered a second heart attack, leaving more of her heart muscle damaged and causing her to slip into congestive heart failure. There was not much we could do to reverse the many blockages in her arteries. Yet she was cheerful, as were her four children.

One morning Mary came to find me. “Dorothy says she isn’t feeling well.” …………….

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HT to @hrana for the link to this HuffPost article by Robert M. Tornambe, M.D: "What Is Beauty? A Plastic Surgeon's Perspective"

Everything has beauty, but not everyone sees it. ~ Confucius

The word "beauty" is the most overused, misunderstood, poorly defined word in the English language. What makes a woman beautiful? The Holy Grail of beauty has never been completely understood. The cliché, "Beauty is in the eye of the beholder," is incorrect in my opinion. Perception is the key. It is "perception of beauty" that is in the eye of the beholder. Each of us, however, has a different perception of beauty. We all have different tastes, likes and dislikes, and this affects our definition and perception of beauty with regard to the American woman. As a plastic surgeon, it is my job to counsel people about this perception of beauty because so many misconceptions exist. ……….

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HT to @helenjaques for sharing this tweet “RT @BMAstudents Self experimenting doctors: Altruistic or self serving? http://bit.ly/fUFIMX”  (free registration required)

…. Rebecca Ghani investigates the long and sometimes bizarre tradition of self-experimenting doctors.

Self experimentation throws up problems around practicality, accuracy, reliability, and ethics. ….. And why do this when there’s an agreed medical and ethical protocol for clinical trials?

But delve a little deeper and …….

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The debate continues on whether organ donors should be paid.  The Baltimore Sun has a pro/con article:  The consequences of a donor kidney market

Should you be paid to part with a kidney?

It's an unseemly question, but it's one that medical professionals have been grappling with as the waiting list for kidneys gets longer, supply of the organs stagnates and other solutions fall short.  …….

Read on for two views on this topic. …….

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New York Times article by Paula Span:  Aging Without Children

…….How childless adults should approach their later years is a question that surfaces with some frequency among readers and commenters here. It’s true, as many attest, that being a parent doesn’t guarantee elder care. But it’s also true that the bulk of America’s old people are, in fact, cared for primarily by relatives: spouses first, then adult children.

“Children are a good insurance policy,” said Merril Silverstein, a prominent gerontologist at the University of Southern California. “In some other countries, that’s why people have children. Here, though it’s less certain, it’s still a pretty good bet.”  ……

It shouldn’t be that way, argued Debra Umberson, a sociologist at the University of Texas at Austin, who has written about childlessness and parenthood: “We shouldn’t have to have kids who work for us for free so we don’t have to go to a nursing home.” ………………

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A really nice instructional post on the Etsy Blog written by julieincharge: How-Tuesday: Make a Quilt Label

As anyone who has ever stitched, admired, or snuggled with a quilt knows, quilting has a history steeped in resourcefulness, storytelling, community, and warmth. In honor of National Quilting Month, which marks its 20th anniversary this year, Amy Milne, the director of the Alliance for American Quilts, has penned a how-to project and a call for the importance of labeling quilts (and artworks of all kinds) for the sake of staking a spot in handmade history and taking pride and authorship in your craft. Do you have a quilt that holds a special spot in your heart or family history? Be sure to share your story in the comments below. ………..

Reimbursement for Surgical Dressings

Updated 3/2017-- all links removed as many are no longer active and it was easier than checking each one.

I opted out of Medicare many years ago, so I could skip articles like the one referenced below.  I don’t.  

Kathleen Schaum writes a very informative article on the ins & outs of reimbursement for surgical dressings.  She gives a self-test to help you and your team assess your knowledge:

….If you pass the LCD/Article self-test, congratulate yourself for a job well done. If you do not pass the self-test, you should immediately take steps to become compliant. Let's start the self-test now.

* Do you know how to find the LCD for Surgical Dressings and the Surgical Dressing Policy Article that is pertinent to the geography that you serve?

If yes, have you printed both documents, read them, and shared them with your entire wound care team? If no, the Web sites in Table 1 will connect you with each of the DME MACs' LCDs and Articles. Remember that your wound care patients are counting on you to understand and implement a process that will meet all the LCD/Article guidelines.

* Can you correctly answer these frequently asked questions?

Unfortunately, the LCD for Surgical Dressings and its attached Article have been either forgotten by or not introduced to some modern-day wound care professionals. ……...

Q: Why do medical suppliers tell my patients with skin tears that Medicare does not cover the dressings that I order?

A. Wound dressings are covered by Medicare when they are used on a surgical wound, partial-, or full-thickness skin wound, or partial- or full-thickness burn. Dressings are not covered for skin tears, abrasions, Stage I ulcers, first-degree burns, or cutaneous fistulas unrelated to a surgical procedure.

…….

The helpful web sites given in Table 1 of the article:
CIGNA Government Services (CIGNA) – http://www.cignagovernmentservices.com
National Government Services (NGS) – http://www.ngsservices.com
National Heritage Insurance company (NHIC) – http://www.medicarehic.com
Noridian Administrative Services (Noridian) – https://www.noridianmedicare.com




REFERENCES
Can You Pass the Surgical Dressing Ordering and Documentation Test?; Schaum, Kathleen D.; Advances in Skin & Wound Care. 24(3):112-117, March 2011; doi: 10.1097/01.ASW.0000395044.66516.02

Surrounded by Angels Baby Quilt

I made this baby quilt for my friends who recently celebrated their 20th wedding anniversary.  I had made a double wedding ring quilt quilt for them a year earlier.  I used the red and green fabrics from that quilt for this one.

Whole pineapple log cabin blocks make up the center.  The border is meant to mirror those blocks.  The quilt is machine pieced by me, but I had my friend Scottie Brooks do the hand quilting.  It was finished in October 1998.

My friend, Ben, took the photos for me.  The quilt is approximately 44 in square.

I named the quilt “surrounded by angels” due to the fabric I used as part of the back.
Here you can see the label and the angel fabric.

Following Instructions

“Take one to two pain pills by mouth every 4 to six hours”

To me that is clear.  I was reminded recently that it isn’t to all patients. 

A patient complained of lack of relief from her pain medicines after surgery.  Her description of the pain didn’t suggest any complications so I ask how she was taking them.  I was looking for a way to safely use NSAIDS or tylenol as a boost rather than giving her something stronger.

“I take one pain pill and then wait an hour to take another one.”
I prompted her to tell me when she took the next dose.
“I wait four hours and then take one pain pill, but I wait for six hours to take the next one.”

Ah!

I had mentioned to her and her caregiver that due to her small size she should begin with just one, then wait for 30 minutes to an hour to see if she needed the second one.  They were doing that, but the other part wasn’t clear.

“Take one to two pain pills by mouth every 4 to six hours”

1.  Take one pain pill every 4 hours.

2.  Take two pain pills every 4 hours.

3.  Take one pain pill every 6 hours.

4.  Take two pain pills every 6 hours.

….

Oh, but there are really more options aren’t there:

1.  Take one and half pain pill every 4 hours.

2.  Take one pain pill every 5 hours.

….

So she was taking the medicine in a correct way, but it wasn’t the optimal one for her.  We had a short discussion which seemed to help.

……………………..

There is much discussion about patients and compliance in taking medicine.  It starts with the physicians, nurse, and pharmacists.  I have to write good instructions.  Sometimes this is difficult to do and keep them short enough to go on the label.

With pain medicines it is nice for patients to know there is a range of effective, safe dosages. 

U.S. Pharmacopeia has proposed labeling standards which can be viewed here. Comments on the proposed standards may be submitted to 17PrescriptionContainerLabeling@usp.org through March 31, 2011.  One of the changes is:

Give explicit instructions—Instructions should clearly separate the dose itself from the timing of each dose and use numeric characters (e.g., “Take 2 tablets in the morning and 2 tablets in the evening” rather than “Take two tablets twice daily”). …

Ambiguous directions such as ‘‘take as directed’’ should be avoided unless clear and unambiguous supplemental instructions and counseling are provided (e.g., directions for use that will not fit on the prescription container label)

First Full Face Transplant in US

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

It continues to amaze me that colleagues are able to do such marvelous work to improve the lives of some.  For Dallas Wiens, 25, the benefits and hope of an improved life outweigh the risks of surgery and rejection (transplant).

He is a construction worker from Ft. Worth, TX who suffered severe burns to his head two and a half years ago when the boom lift he was operating drifted into a nearby power line. The nearly fatal accident left him in a coma for three months.

Related posts
Face Transplantation – First in the US Done (December 18, 2008)
Appearance Is A Function of the Face (December 30, 2009)
More on Facial Transplantation (March 1, 2010)
First Full Face Transplant Done!  (July 12, 2010)
Facial Prosthetics Restores Face (August 5, 2010)
First Full Face Transplant Done! (July 12, 2010)
Facing Monday  (January 24, 2011)

Shout Outs

Updated 3/2017-- photos and all links removed as many are no longer active and it was easier than checking each one.

Better Health is the host for this week’s “Emotional Issue”of Grand Rounds! You can read this week’s edition here.

Welcome to this week’s edition of Grand Rounds, the Cliff’s Notes of the medical blogosphere. Each week a different medblogger reads through peer submissions and summarizes/organizes them all into one blog post (using their own unique structure or theme). Instructions for participation (and hosting) are here.

When I host Grand Rounds I like to organize the posts into emotion categories – kind of the way that movies are categorized into “drama, action, comedy, etc.” …... Judging from the volume of posts in each category, it seems that the majority of you are either surprised or outraged!

I organized the submissions by emotion category, and then listed them in order of submission (the first one was submitted earliest within each category). I hope you enjoy meandering through the blog posts with this structure!   .. ……

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A beautiful post by Dr. Wes:  The Wren

It was beautiful sunny early Spring day, a Saturday as I recall. Trips were made to various stores to purchase items for school, then a last minute dash to the electronics store so I could pick up another charger for my cell phone. I ran ahead, my daughter and wife lagged behind, weary from the day's outing - at least so I thought …….

As I reflect of that experience ….., there was much to be learned from the experience of caring and offering compassion, one that mothers seem uniquely gifted at imparting to their children. Mothers are special that way. My mother showed me the importance of caring first-hand, never flinching even when the odds are stacked against you and your tiny aviary friend.   …………….

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I hope you will read these two related posts.  The first is from Bongi, other things amanzi:  The Graveyard

this is a difficult story to tell but if i am to be true to the complete experience of a surgeon, i do need to tell it.

one of my seniors used to say that every surgeon has a graveyard hidden away somewhere in the dark recesses of his mind. he went on to say it was unfortunately normal, so long as you remember all the names engraved on the tombstones. at the time i thought he was being a bit melodramatic, ….. unfortunately i learned what he meant.  ……

The second one was written by Movin Meat after he read Bongi’s post:  The Graveyard

Bongi is an amazing writer, and if you haven't, I strongly urge you to read his latest post, titled "The Graveyard."

I imagine that a huge number of doctors know exactly what he means. I remember being told by a surgeon, while I was in medical school, that "you're not a real doctor until you've killed someone." I thought at the time (and still think) that there was a puerile bravado behind that admonition, but there is also a grain of truth. I have my own graveyard. Curiously, not all of its inhabitants are dead. They are the cases where I screwed up, or, charitably, cases that went bad where I feel that maybe I could've/should've done things differently.  .…………..

And, yes, I have mine.  I just haven’t managed to write about it.

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Joshua Swimmer, MD puts the radiation issue in perspective in his post:  Radiation Chart  (be sure to click on the chart to view the enlarged version)

There’s a lot of discussion of radiation from the Fukushima plants, along with comparisons to Three Mile Island and Chernobyl. Radiation levels are often described as “<X> times the normal level” or “<Y>% over the legal limit,” which can be pretty confusing.

Ellen, a friend ……suggested a chart might help put different amounts of radiation into perspective, and so with her help, I put one together. She also made one of her own; it has fewer colors, but contains more information about what radiation exposure consists of and how it affects the body.

……I don’t include too much about the Fukushima reactor because the situation seems to be changing by the hour, but I hope the chart provides some helpful context.

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Two related stories from NPR: Old-Time Methods Yield Spring Greens All Winter and Cooking Up Healthy Winter Greens At Nora's  

Wilted Hardy Greens with Garlic

Note: If baby greens (with a 2- to 3-inch leaf) are not available, you may use larger greens (10- to 12-inch), but be sure to remove the tough center rib. Slice the leaves into 1/2-inch to 1-inch strips before cooking.
1 pound mixed baby greens (kale, swiss chard, mustard greens)
1 to 1 1/2 tablespoons olive or sunflower oil
1 to 2 teaspoons chopped garlic
2 tablespoons water, vegetable broth or white vermouth (optional)
Wash the greens and drain in a colander, leaving some moisture on the leaves. Heat a saute pan large enough to accommodate all of the greens over medium heat. Add oil, then the chopped garlic. Saute until softened, about 1 minute, stirring often to prevent the garlic from burning. Add the greens. Toss and saute them until they are wilted. Season with salt and pepper. If too dry, add more liquid. …………

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From Core77 Design Magazine & Resource:  Andrew Myers Screws People to Make Portraits (photo credit) by hipstomp

……….Of course, it never occurred to me that the screw heads could be painted, that the evenly-spaced pegboard holes could be the basis for pixels, and that screws driven to different depths could be used to create depth perception. And that's why Andrew Myers is an artist and I am just a blogger who writes about artists. ……….

Stopping Smoking Before Surgery

 Updated 3/2017-- all links removed as many are no longer active and it was easier than checking each one.

Physicians and surgeons all agree on the link between smoking and postoperative complications.  We don’t agree (or know) how much time is required between cessation of smoking and surgery for optimal risk reduction.

Dr.Thomas Fiala wrote a nice blog post, Smoking Cessation and surgical complications, recently  discussing the 3rd reference article below.

Smokers that quit smoking before surgery had 41% fewer complications. The researchers found that each week of cessation increases the effect by 19%.

Trials of at least 4 weeks' smoking cessation had a significantly larger treatment effect than shorter trials (P = .04).

Smokers that quit had lower rates of total complications, fewer wound healing complications, and fewer pulmonary complications.

The first two articles referenced below were evaluated in an article written by Michael Smith for MedPage Today:  Smokers Who Quit Preop Seem to Do Okay Postop.  Those two articles looked at pulmonary complications not wound healing complications.

There was also no significant benefit or harm when the analysis was restricted to the three studies with biochemical validation of quitting, the researchers reported. The relative risk was 0.57, with a 95% confidence interval from 0.16 to 2.01.

As noted by Clara and Chow (2nd reference, review of 1st reference article) (bold emphasis is mine):

While the review performed by Myers et al provides valuable information, it does not definitively answer the question raise……

Physicians should ideally try to get their patients to stop smoking several months prior to their surgery. The appropriate advice regarding the optimal timing of smoking cessation for patients seen close to their scheduled surgery awaits further research.

I tend to agree with Dr. Fiala who writes, “There is no safe minimum number of cigarettes that you can sneak before surgery. Even a couple can do you in.”

Related posts
Smoking in Facial Aesthetic Surgery Patients (December 28, 2009)


REFERENCES

1.  Stopping smoking shortly before surgery and postoperative complications: A systematic review and meta-analysis; Katie Myers; Peter Hajek; Charles Hinds; Hayden McRobbie; Arch Intern Med. 2011;0(2011):archinternmed.2011.97.

2.  The optimal timing of smoking cessation before surgery; Clara K. Chow; P. J. Devereaux; Arch Intern Med. 2011;0(2011):archinternmed.2011.88.

3.  Smoking Cessation Reduces Postoperative Complications: A Systematic Review and Meta-analysis; Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO; The American Journal of Medicine - February 2011 (Vol. 124, Issue 2, Pages 144-154.e8, DOI: 10.1016/j.amjmed.2010.09.013)

Animal Names Word Quilt – WIP

I previewed some of the word blocks for this quilt earlier.  I have now completed the piecing.  Here’s how the top looks.  Now I have to do the quilting.

Here you can see the bear and camel blocks.
Here is the elephant hiding out in the “n”
Here is the gator in the “a”

A Lasting Gift

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

Monday I read with interest the Amednews.com article by Kevin O’Reilly:  1 in 3 Surrogate Decision-makers Carries Lasting Emotional Burden: a new study finds that advance directives ease stress when making treatment choices for others.

"We had always thought about documenting your wishes and knowing what the patient wanted as a protection and a benefit for the patient," said Wendler, head of the Unit on Vulnerable Populations at the National Institutes of Health Clinical Center's Dept. of Bioethics. "This study suggests that there is an additional benefit as a protection for the family. Just leaving decisions up to the family may well be counterproductive and make it harder on the family, not easier."

I and my siblings can attest to the lasting gift our mother gave us.  There is a peace in knowing we followed her wishes when she had the massive intra-operative stroke which ended her life.

She repeatedly over the years told us what she wanted and what she didn’t want.  We are able to discuss it without feeling morbid.  My husband is not.

My dear husband finds it uncomfortable when I want to tell him what my wishes are when the time comes for tough choices.  I tell my siblings and hope they will help him (and me) when the time comes.

I don’t know what his wishes are.  So if I have to make the choices for him, I may in reality be making the choices I would want made.  Because it won’t be clear, there may be conflict between what his family (parents and siblings) would chose verse my choices.

Many of us medical bloggers promote Engage With Grace (a movement aimed at having all of us understand and communicate our end-of-life wishes) over the Thanksgiving weekend.  The Annuals of Internal Medical article (full reference below) reinforces the importance of this discussion between family members. 

I would go so far as to say the discussion should occur between friends as well. 

Having the discussion may become a lasting gift of peace you and I can give each other.

Here are my Five Wishes (pdf file):

1. I would ask my sister (CD) to help my husband (BH) make care decisions for me when I can't.

2. If there is no chance of recovery from the illness, then simple make me comfortable.  Do not do anything and everything.  If there is no chance of recovery from a major trauma, then do what needs to be done to preserve the organs for donation.  If the doctors don’t remember to ask, then tell them.  Donate everything that is usable – this includes the face, the hands, bones, heart, liver, everything.  As I wish to be cremated, it will be nice to know someone is helped.

3. I am not fond of pain, but hate the foggy headedness and nausea I get from the pain medicines I have taken.  If possible find a compromise for me so I can be aware of visitors, listen to music and books, etc.

4. I want visitors who will tell me jokes and stories, who will read books (novels, adventure stories, mysteries, newspapers, etc) to me.  If I am able, I will play cards and checkers with you.  Bring the dogs along.  Watch movies and TV with me.   Cover me with a colorful quilt.

5. I want all of you to know I love you.   Here are My Funeral Wishes.  If we (BH and I) still live at the same house when my death does occur (hopefully years from now), then spread my ashes under the oak tree in back (the one with the wind chimes) where the ashes of Columbo, Ladybug, and Girlfriend reside.

REFERENCE

Systematic review: the effect on surrogates of making treatment decisions for others; Wendler D, Rid A.; Ann Intern Med. 2011 Mar 1;154(5):336-46.

Walking a Dog

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

Earlier this week there was an article in the NY Times by Tara Parker-Pope  --Forget the Treadmill. Get a Dog.  -- which states in a more elegant way what I have been saying for years now. 

……Several studies now show that dogs can be powerful motivators to get people moving. …..

Just last week, researchers from Michigan State University reported that among dog owners who took their pets for regular walks, 60 percent met federal criteria for regular moderate or vigorous exercise. …….

A study of 41,500 California residents also looked at walking among dog and cat owners as well as those who didn’t have pets. Dog owners were about 60 percent more likely to walk for leisure than people who owned a cat or no pet at all. ……..

I have called my dog Rusty my personal trainer.  He never lets me off the hook.  We walk daily regardless of the weather (hot, cold, rain, snow).

I also use a pedometer to remind me to get up and move more.  It it a nice device to motivate me to not sit (& blog, read, knit, quilt) too much.

Here’s a replay of my tribute to Rusty, My Personal Trainer (January 2010)

“Five more minutes,” I tell him as he nimbly places his paws on my knees, brown eyes imploring.
“Okay, you win.” 
Orange ball cap on my head, gloved hands grab the leash.
We exit the gate, the January sun cold as we jog toward the neighbors woods. 
Will there be ducks on the pond today?