African Whole Cloth Quilt Finished!

I have finally finished!  As implied by the title, there was no piecing of this quilt top.  I loved the fabric so much I just couldn’t cut it into pieces so I just quilted it.  I attempted to do some machine trapunto.  The effect is less than I had hoped.  I think I should have used an even higher loft polyester batting for the trapunto.  I might even should have used it for the entire quilt rather than switching to Hobb’s Heirloom cotton batting.  Still, it is lovely and my photos don’t do it justice.

It is machine quilted in an echo pattern.  The quilt measures 52.75 in X 70 in. 

Here you can see the some of the echo quilting. Notice the animals could use a little more “stuffing.”
Another photo to try to show off the quilting.
Here’s the back (really the fabric is a lovely green)
Here you can see the quilting better.  Again not the animals could use a little more “stuffing.”
Another photo of some of the back detail
I haven’t decided what to do with this quilt.  I have a few options in mind, but am open to suggestions.

 

WIP -- African Whole Cloth Quilt (January 20, 2012)

Family T-Shirt Quilt

I made this quilt for my husband around 1997 (forgot to put a label on it).  He had all these t-shirts from Civil War reenactments, car stuff, etc but not quite enough.  I had some t-shirts from trips for meetings (Chicago, DC, San Francisco) and races (Elby’s 20K in Wheeling, WV and a few local ones).  So I combined them to make this quilt using old blue jeans (both of ours) in an attic windows setting.

The quilt is machine pieced.  It measures 79 in X 97 in.  I used iron-on interfacing to stabilize the t-shirt fabric before cutting it to the finished size.  I did not do the quilting (too thick for my basic machine), but sent it to Peg’s Quality Quilting to be machine quilted.  I did do the binding of thin denim fabric.

The two shirts on the left and the upper right were my husband’s.  The Smithsonian one was mine.
In this set, the two on the left and the lower right ones’ were my husband’s shirts.  The Chicago one was mine.
The upper left one here was my husband’s and the other ones were mine. 
All of these were my husband’s.  I brought the one from San Francisco to him from a meeting trip.
I love the words on the bottom of this t-shirt:  “From the lips of God to the hearts of man, let the past be past. Let the dead be dead now and forever American. Anonymous, 1863”

My Ring Pillow

I’m still working on the whole cloth African quilt, so I thought I’d show you the ring pillow I made in 1990 for my wedding.  I cross-stitched the design (don’t recall the source), then added some ribbons to tie the rings.

Here’s a closer view of the center.
Here’s the back edge with our initials and the year.
Here’s my nephew who was 3 yrs old then, now is a freshman in law school.  He loved the tux and did not want to return it. 

Old Cross Stitch Pieces and An Update

I’m still working on the Whole Cloth African quilt, so I ‘m just going to share a couple of old cross stitch pieces I did years ago.  The first one I did during medical school during my senior year pediatric rotation spent out-of-town shadowing a pediatrician in private practice.  It was good on many levels.  I loved watching him interact with his patients and their parents. 

This piece was framed at one time and hung on the walls of my apartments in Baton Rouge, Wheeling, Pittsburg, Boston, and even here in Little Rock.

This bookmark (one of the problems with e-books is these aren’t needed) I did in Boston during my plastic surgery residency.  I actually took a 6 week sailing class on the Charles River.  I haven’t done any sailing since moving back inland. 

Here’s a small segment of the Whole Cloth African quilt with the corresponding view from the back below.  The colors aren’t true in this first one.  The color is more green.
Here’s from the back.  Making progress, but at the point in the project where it’s seems to be slowed to a crawl.

Shout Outs

Updated 3/2017--all links removed as many no longer active.

Dr. Rob (@doc_rob), More Musings (of a Distractible Kind), is the host for this week’s Grand Rounds. You can read this week’s Grand Rounds Vol 8 No 25: Super Tuesday Edition here.

Welcome to grand rounds, the best around the world of medical blogging! 

For those expecting a silly recitation of today’s posts in rhyme, this post will let you down.  But don’t be sad, as I have provided with an alternate version of grand rounds on my other blog, Llamaricks, which (if you hadn’t guessed) is not quite as dedicated to the serious side of things. 

Since today is “Super Tuesday” ……

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Check out Doctor David’s (@david65) blog for as he put it on twitter:  the “story I won't forget. Watch the video -- the look on my patient's face says it all.”  The post:  Music Can Heal

Well, maybe music can't cure cancer, but it can certainly heal the spirit.
Drew Seeley released a new song today that he wrote for my patient.
Watch the video here……

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H/T to @tbtam who tweeted this: “ The Before. Sad, beautifully written , perfectly told. We docs have all been there. . jama.ama-assn.org/content/307/9/… (Need JAMA subscript).  The link is to an essay by Jennifer Frank, MD:  The Before

This is the before. A moment suspended like a bubble floating on a warm summer breeze gently but inevitably toward the ground. I feel the pop coming, an implosion of the very center of your life. Anticipating what this moment would hold, I nevertheless hoped for something different. To be able to eagerly dial your number and shout out the good news to you in a breathless rush. It's not what we thought. It's not cancer.

Instead I take a deep breath, pressing each number slowly, cautiously, drawing out the moment before the burst…………….

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Go read Elaine’s (was @medicallessons, now @elaineschattner) new post:  Harsh Words, and Women’s Health at Risk

I’ll open with a confession –

Women’s health has never really been at the heart of ML. Your author has, his­tor­i­cally, rel­e­gated sub­jects like normal men­stru­ation, healthy preg­nancy and repro­duction and natural menopause to her gyne­col­ogist friends. Sure, I learned about the facts of life. I even studied them in med school and answered ques­tions, some cor­rectly, along the way. By now, I’ve lived through these real life-​​phases directly. But these topics never drew me. That’s changed now.

Women’s care – and lives, in effect – are jeop­ar­dized on three fronts:……………..

Flag Kite Tail Quilt

As with the quilt I posted last Friday, this one was done for QOV.  It uses 4.5 in X 6.5 in fabric flags in a kite tail quilt pattern.  The quilt is machine pieced and quilted.  The quilt is approx 52 in X 73 in.

Here is a photo of the label made by the quilter (not me, I only pieced and did the binding for this one).

Leadership and Goal Play

Paul Levy’s (@paulflevy) book “Goal Play” is out!  If you read his blog you will recognize many of the vignettes as I did.   He teaches us lessons of leadership (not management) he has learned from coaching soccer. 

Easy to read.  Engaging stories as examples.  You can read from the beginning to end or flip through and read at random.  Either way you will gain valuable insights.

The book is available both at Amazon and at Createspace. 

Shout Outs

Updated 3/2017--photos and all links removed as many no longer active. 

Paul Ware, Life with Huntington's, is (suppose to be) the host for this week’s Grand Rounds. You can read this week’s edition here.

Next week’s host is Dr. Rob (@doc_rob): What’s Grand and Round and Comes in an RSS Feed?

……To submit your GR post for next week’s GR, fill out the attached submission form. I must have submissions in before Sunday, March 4th at 6 PM EST……

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H/T to @jilltomlinson who asks.

Was this 27yo man's life lost in ill-conceived race to perform "World 1st" surgery? bit.ly/x2bGEJ #retrospectoscope

The link is to this Mai lOnline article: Man, 27, who had world's first quadruple limb transplant dies days after operation.

A 27-year-old Turkish man who underwent the world's first would-be quadruple limb transplant died yesterday, hours after the limbs were removed due to metabolic failure, the hospital said…….

I thought it was too risky when I first heard about the transplant prior to them having to later remove the limbs. We are certainly pushing the limits with transplants these days with double hand, face, multiple organ, etc.

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From Letters of Notes a letter that gives a glimpse of breast Cancer in 1855. This woman had surgery with no pain meds: 'Deep Sickness Seized Me"

In September of 1855, Lucy Thurston — a 60-year-old missionary who had been living in Hawaii with her husband since 1820 — underwent a mastectomy after being diagnosed with breast cancer. Incredibly, she somehow endured the operation wide-awake, without any form of anaesthetic. She wrote the following letter to her daughter a month later and described the unimaginably harrowing experience.

The procedure was a success. Lucy Thurston lived for another 21 years………………

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From @Skepticscalpel comes a post with his take on the survey in the Archives of Surgery: Surgeons and alcohol abuse.

“Prevalence of alcohol use disorders among American surgeons” appeared in the February, 2012 issue of Archives of Surgery.

A survey of 7197 surgeons, all members of the American College of Surgeons [ACS], had a 28.7% response rate and revealed that 15.4% had scores on an alcohol use assessment test that indicated abuse of or dependence on alcohol. This is consistent with the rate of such alcohol problems in the general public…………….

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VIDEO: Kyle Dyer, 9NEWS anchor, interviews with the Denver Post

Channel 9 news morning anchor Kyle Dyer talked to the Denver Post on Wednesday, February 23, 2012, about the injuries she sustained from a dog bite and her road to recovery.……. Video by Mahala Gaylord

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H/T to @impactednurse ‏for this tweet:  “Very cool. Federico Carbajal's anatomical sculptures made with galvanized wire: bit.ly/yRSvFk”

Communicating

My malpractice is through SVMIC.  They periodically sent out a newsletter with upcoming seminars and an article or two on ways to improve your practice/ decrease your risk of getting sued.  The current issue’s article is “Communicating with Patients Who Are Deaf.”

The article reminds us in health care of the Americans with Disabilities Act (ADA) which prohibits all physician's offices (except those operated by religious entities but notes the similar Rehabilitation Act of 1973 covers physician’s offices operated by religious entities) from discriminating against people with disabilities, including those who are deaf.

Key Points:

1.  The physician’s office must provide effective communication which meet the patient’s individual needs.

2.  The physician’s office must pay for the cost – qualified interpreter, video interpreting service, etc.

3.  If there are two equally effective methods or sources, the physician has the right to chose the most cost effective.  The caveat here is equally effective for the individual patient. 

4.  The physician’s office is prohibited from passing along the cost of providing the auxiliary aids/services to the the patient.

5.   The ADA does allow physicians to refuse to provide a specific auxiliary aid/service if doing so will create an undue financial burden (significant difficulty or expense).  This is hard to prove, as it isn’t as simple as weighing the cost of the service against the payment for the appointment.

Examples of auxillary aids and service include 1) qualified interpreter, 2) note takers, 3) open or closed captioning, 4) video interpreting services, and 5) exchange of written notes.

REFERENCES

1.  Deaf Patients, Doctors, and the Law:  Compelling a Conversation about Communication (pdf file); 2008, Florida State Law Review, Vol 35:947

2.  Communication with Deaf and Hard-of-hearing People: A Guide for Medical Education; Barnett, Steven MD; Academic Medicine: July 2002 - Volume 77 - Issue 7 - p 694-700

3. Department of Justice ADA Enforcement page 〈http://www.usdoj.gov/crt/ada/enforce.htm〉. Accessed 2/26/12. United States Department of Justice, Washington, DC, 2001.

Patriotic Medallion Quilt

Though I haven’t in the past year, I have made several quilts for QOV (Quilts of Valor).   This is one I made starting with an orphan block which I used as a center medallion, then used left over squares to add the border.  To gain more length, I used two other orphan blocks and strip pieced the added portion.  I added a simple white border to increase the overall size.  I’m not sure of the overall size, but I think it is in the 50 in X 70 in range.  The top was machine pieced, then hand quilted.

Sorry the photos are better.  This quilt (& photos) are from around 2003 or 2004 (I think).

Hawaiian Quilt for a Friend

Years ago a friend asked me to make a quilt for his wife for their anniversary.  He wanted a queen size.  She like frogs and tropical stuff.  I took on the ambitious project of a Hawaiian appliqué quilt using fabric with frogs, parrots, lizards, etc for the center.  The entire appliqué was done by hand and took me almost 6 months.  I then had my friend Scottie Brooks to do the hand quilting.  I regret that I didn’t get a photo of the finished quilt.  This photo is of the finished top.  The quit was finished in November 2001 (quilted and bound).  It measures 104 in square.

I cropped the above photo to try to show more of the detail, but these photos do not do it justice.  And while I am still friends with the husband, he and she are no longer together, so I can’t get new and better photos. 

Spinal Accessary Nerve Injury

Updated 3/2017--all links removed as many no longer active. 

This injury will never result in an individual qualifying for SSI disability.  Not even when it occurs on the side of  your dominant hand.  That doesn’t mean it isn’t a serious problem and can result in significant shoulder dysfunction and pain.  It simply means it will never “meet” an SSI disability listing and will not result in more than a one-arm light RFC (residual functional capacity) rating. 

The spinal accessary nerve  supplies the sternocleidomastoid (SCM) and trapezius muscles.  So when the nerve is injured your ability to rotate, tilt, flex your head may be impaired (SCM).  Your ability to elevate your shoulder and draw your head back so the face is upward may also be impaired (trapezius muscle involvement).  The shoulder may exhibit a winged scapula which may be more apparent or exaggerated on arm abduction.

Causes of SAN injury include iatrogenic, traumatic, and neurologic. 

Most iatrogenic SAN injury occur following diagnostic lymph node biopsies of the posterior triangle of the neck. Injury rates from these procedures are reportedly 3-8%.   Functional neck dissections are another source of iatrogenic SAN injury.

As with other nerve injuries, if the injury is a transection and is recognized it can be repaired.  This may be done immediately or within 3 to 6 months after the injury. 

If it is uncertain if this nerve was indeed cut or is a closed injury (ie trauma), then close follow-up with serial electrical tests helps determine if surgery will be required. Physical therapy is the mainstay of treatment regardless of whether surgery is indicated. It improves range of motion and encourages a return of strength once contraction occurs.

Nerve regeneration can take 3-12 months, during which time physical therapy is performed. Patients with a spinal accessory nerve injury older than 1-2 years may not be a candidate for nerve surgery.  So the sooner the injury is recognized and diagnosed, the better. Options for these patients may include tendon/muscle transfer techniques to stabilize the scapula and reduce pain.

REFERENCES
1.  Cranial Nerve XI: The Spinal Accessory Nerve – Clinical Methods
2.  Accessory Nerve Injury; Rohan Ramchandra Walvekar, MD, et al; eMedicine, July 20, 2010
3.  Spinal Accessory Nerve Injury; NYU Medical Center