im back!
i am coming out of my blogging hiatus to chronicle a little of my journey to be ECFMG-certified — i.e. attain a medical license to work as a medical doctor in the United States.
a little background, i graduated MBBS from Monash Uni (Australia) in 2010. i have 1 year working experience as a house officer (a.k.a. intern) in 3 different tertiary hospitals in Singapore. i was an average medical student back in the days – average grades, no awards, honors, or prizes.

so, lets see how this goes!

i really started studying in early-mid April 2012, i am done with Anatomy, Histology & Embryology. Currently on day 3 of Biochemistry.

Materials i am using:
1. Kaplan Lecture Notes 2010 + Videos
2. First Aid for the USMLE Step 1, 2012 edition
3. Clinical microbiology made ridiculously simple + Howard Shen Flashcards
4. Howard Shen Pharmacology Flashcards
5. And how can i forget, the legendary Goljan Path, i.e. Rapid Review Pathology 3rd edition by Dr Edward Goljan, together with audio + 46pg HY notes

Thats it for now. Im on the 1st pass phase — sort of following the Taus method (google in SDN forums).

Test period: May 1 – Oct 31
Test date: will schedule it in end August (just before i start my MPH program)

Target: 240

I must say my retirement from blogging is not because I have stopped writing entirely, but in fact i remained active in writing — only in a different form. Traditionally, we have established doctors who used to write in medical journals get fed up and decided to start a blog and write whatever they wanted without peer review. I sort of went the opposite way. I used to blog, now i try to write and get published. So far i have got 12 accepted papers, including a recent high profile Archives of Surgery commentary entitled “A President’s Emergency Plan for AIDS Relief for Surgery: A Call to Action for Surgical Care in Low- and Middle-Income Countries.” (PDF AVAILABLE in LINK)

http://www.ncbi.nlm.nih.gov/pubmed/21930994

You can easily pubmed me as “Jeffrey Leow” and you can see my work.

I am currently doing my surgical posting during my 1-year housemanship. I will be applying for surgical residency in Singapore, and continue to be very interested in surgery in developing countries, as such the focus of most of my published work.

I am intending to go to Tanzania in March-April 2012 for a surgical mission and survey of the district hospitals. In addition, in Nov 2011, I am going to San Diego for a global surgery conference entitled ASAP Meeting — more details: http://cme.ucsd.edu/asap/
It’s more of really an excuse to go to the USA and get MOHH to sponsor me to go — and i have to present an abstract on cancer surgery in Malawi. Making that poster now..

Thanks for following and have a good one. I will probably update this blog as i embark on those 2 upcoming journeys. But you know, facebook is kinda easier.

meanwhile, i am back in singapore enjoying the tropical climate and trying to absorb what has changed and what hasn’t. singapore is undergoing a revolution-transformation. we recently had 2 casino / resorts open, the Youth Olympics just concluded yesterday, the F1 night city circuit (one of its kind) will come soon, OK no i do not work for the Singapore Tourism Board.singapore definitely has much more buzz about it compared to just 45 years ago when it was merely a sleepy fishing town … we have come far in 45 years to become one of the richest cities / countries in the world. we are not  in the OECD countries however (not sure why so). we are open and welcoming to all foreigners and in fact sometimes the citizens feel that the government does not exhibit enough protectionist policies.

on a personal level, time back in singapore is always great because i think i feel back home. the concept of where home is has been in my mind recently. What’s home? Familiar sights, smells, food, language, people? Or wherever your loved ones are? or is it wherever you were born and spent the majority of your life in? i spent 20 years of my life in Singapore – completing my pre-tertiary education and serving a 2-year conscript requirement. i spent 5 years in melbourne pursuing my medical degree. it is no wonder i feel more home in singapore. however, if i spend the next 30 years in another country, will that place be my new home? what about people who  spend time in multiple countries multiple years? is home where your citizenship lies?

(by the way, singapore does not allow dual citizenship, though you are welcome to be a permanent resident of as many as countries as you wish.. but did you know also that the ministers are not allowed to have a PR-ship elsewhere?? perhaps as a show of patriotism )

i guess what im saying is, i am not sure where my future lies. neither does my significant other. we just know we should be together. the big day isnt far away n i do not anticipate it exceeds 2013. i wonder to myself, if i send invites to my blogger “friends”, would they come to visit this tiny island and share in my joy?

Believing that I cannot better reflect what the various excellent bloggers already have in their own words, I hereby present some of our regular surg bloggers’ recent posts!

Regular surg bloggers

Reflections in a Head Mirror – Two world collide

“There’s a consult downstairs, Campbell. Go check it out and I’ll catch up with you later.”

“Sure, OK.” I was a third-year medical student fumbling through my first clinical rotations. The resident headed off to whatever he needed to accomplish and I trotted down the back stairwell. I glanced at the consultation slip and found the patient’s room number.

56-year-old man with progressive medical problems. Please evaluate for central line placement.

Aggravated DocSurg – If they could only all be taken to Rampart Hospital

Trauma surgery for me is a whole lotta non-operative care interspersed with occasional surgery for things like a ruptured spleen…

Except in real life, where some patients die of their gunshot wound (GSW). Sometimes, the reasons are obvious — shot through the heart or the head with a fatal brain injury. Sometimes, the reasons are harder to understand —- see a description of irreversible coagulopathy here. As for the rest, we don’t have all of the answers, though not for a lack of searching.

Insurance Coverage Is Associated With Mortality After Gunshot Trauma is a recent retrospective study that is part of that searching.

…..

What do I think? Meh. Several things strike me at the same time.

other things amanzi – significant moments

i hate paediatrics. people who don’t understand the life of surgery may think this means i don’t like children, but in fact the contrast is true. surgery is suffering and heartache. surgery is pain and misery. it is stuff children are not supposed to experience. children are supposed to be caught up in the joys of life…

other things amanzi – ideal

i have been following the story of the baby that was brutally assaulted recently with more than a little horror….

recently in our beautiful land quite a number of fairly highly positioned politicians have publically encouraged the murder of afrikaaners…

i can’t help drawing parallels…

Respectful Insolence – Poor, poor pitiful me: Jenny McCarthy and Dr. Jay Gordon after The Vaccine War

Anti-quackery surgical oncologist makes an analogy between “sentinel” bleeds and small outbreaks of vaccinable diseases

… a “sentinel” bleed is generally a relatively small, self-limited upper GI bleed. The patient bleeds, then stops. Everything appears to have settled down. Then, usually hours although sometimes days later, the patient suffers a massive exsanguinating hemorrhage from the fistulae. There are other examples of herald bleeds…

The relatively small outbreaks, such as the measles outbreak in San Diego, could be viewed as being similar to sentinel bleeds, relatively small and self-limited. I fear the real outbreak, as well we all should. Thanks to the anti-vaccine movement, it’s a matter of time unless current trends reverse themselves. When I think about this, I become very depressed.

Unbounded Medicine – Uric Acid Nephrolithiasis

Fast facts about the above named condition. Welcome back Dr Jon!

Cut on the Dotted Line – absite as myth

I’ve been thinking: the surgery in-training exam is really like a recitation of legends, orally recounted histories, not too closely related to facts, that define our community.

The test runs through a long series of stories, which are so familiar to surgeons and surgeons-in-training, that we only have to mention a few words of the story, to have the whole thing immediately recognized and understood.

Suture for a Living – Dr Goldwyn’s “Surgeon”

After learning about Dr. Robert Goldwyn’s death, I pulled out his book “The Operative Note:  Collected Editorials” to reread (published in August 1992).  I’d like to share a few with you over the next weeks/months.

The first is entitled “Surgeon”

this is certainly a new series I look forward to!

Suture for a Living – Knowledge: What Kind and How Much?

Here is a second essay from Dr. Robert Goldwyn’s book “The Operative Note:  Collected Editorials” (published in August 1992). Knowledge:  What Kind and How Much?

SA Anaesthetist: Superman?

last week, on my private practice day, I counted how often I changed clothes. I went to 2 hospitals (one of them twice) during the day. Including getting out of my pyjamas into my street clothes, and then back into my pyjamas at the end of the day, I changed clothes 9 times.

SA Anaesthetist: Evacuate!

One of the problems with being the anaesthetist is that often, I don’t know the whole story. Sometimes it is better this way, other times not.

VIVA TIVA: Safety and security

Something very strange happened last night. I had to accompany an intubated & ventilated patient being transferred from our hospital, to an ICU in the capital city about 70 km away.

Other blog articles of interest

This week we also have a peek into the life of a trans-sexual who desires gender reassignment surgery. Jessica describes herself as  “a 32 year old natal male who identifies as a woman and desires to have vaginoplasty as part of gender transition”. As you might know, there are not many surgeons who do such surgeries and the handful that do have strict requirements, and hence Jessica has penned a “Surgery Letter”, which is a working draft letter for her cognitive/behavioural psychologist to the potential surgeon. Read it [HERE] and do check out her website to find out more about her journey.

Many surgeons (and for that matter physicians in general) have interests outside of medicine. A New York plastic surgeon, Dr Hank Chieng, has just set a new world record in Donkey Kong. Find out more about his story on how he did it [HERE]. This makes some wonder if there’s a link between surgery and video games. Celeste Biever of New Scientist blog addresses this query [HERE]

Katie a pre-med student from Case Western Reserve University blogs about her semester in the UK. Among many of her experiences which she chronicles in her blog “There’s No Place like London”, one was about the times she spent in the Operating Theatres watching OBGYN and cardiothoracic surgical procedures. Read more [HERE]!

Remote controlled heart surgery a world first! Read more about this groundbreaking feat performed at Leicester’s Glenfield Hospital [HERE].

Joke of the fortnight

A funny reconstructive surgery joke. Check it out [HERE]!

Finis

Meanwhile, should you desire more surgical blog reading, kindly avail yourself to the archives of SurgeXperiences, stored here (Season 2) and here (Season 1), along with the latest schedule of dates and host sites. You can also subscribe via RSS or email to SurgeXperiences over at this link. And of course, you can submit your posts VIA THIS FORM.

If you are interested in hosting SurgeXperiences, please contact me.

Join me in honouring them by visiting their blogs (those that still exist) available either through this latest edition (SurgeXperiences 321 ) or via the archives of SurgeXperiences as listed below:

• Season 1 (July 07 – June 08): 24 editions.
  
• Season 2 (July 08 – June 09): 26 editions
• Season 3 (July 09 – current)

If you would like to be part of SurgeXperiences, you can

1. Host an edition, kindly contact me.
2. Submit your blog post via this form.
3. Submit someone else’s  noteworthy post via this form.

Good day!

I have decided to leave out research articles as they can be found easily on the various surgical journals, unless a blogger has decided to blog about it. I try to avoid content similar to General Surgery News (free subscription)

The following are the best posts featured in order of submission:

Bongi, master story teller, recently nominated for best medical literary blog 2010 (i hope he wins), hailing all the way from Mpumalanga, begins one with,

“we can sometimes look good in our jobs. i suppose it comes with the territory. but sometimes this is not a good thing.” [READ HERE]

Are a frequent reader of Life in the Fast Lane? No? You ought to! Direct quote “This Medical Blog was born out of passionate (and usually unresolved) debate pertaining to the elements of eLearning; clinical cases; ECG interpretation; medical education; toxicology; medical history and information sharing strategies in the open source era.” The authors’ meticulous (exams, education, resources tab) yet absolutely humorous manner (what not to wear to the ED) is evident in the afore-linked posts. This makes them all so desirable to be hosting carnivals, just like this one!   Do check out a fantastic teaching case report about SC joint dislocation as well. [READ HERE]

Blogging does not necessarily mean you have to pen a long-ish article; one of the beauties of blogging (as opposed to writing to publish) is that it can be informal, and more often than not, fun! Relaying brief encounters at work for busier professionals has been a trend of late, with The Sandman (Israeli anesthesiologist) recounting his,

“Yesterday, I anesthetized a patient who sports the last name of one of the more prominent organized crime families.” [READ HERE]

and Dr Bates from Suture for a Living,

““It happened two days ago. I fell off a ladder,” she says, eyes averted.” [READ HERE]

Patient education is of paramount importance. We are in a time where we cannot ignore medicine 2.0 and some even say 3.0 Passionate surgeons like Dr Bates provides a scientific evidence-based approach and rewrites articles filled with medical jargon into simple comprehensible pieces to help millions of internet users out there to gain a proper perspective into the plastic surgical world, contrasted to other tabloid-like plastic surgical blogs. One example is regarding symmastia after breast augmentation mammoplasty; or paraphrased – “when breast implants sit too close to the middle of the patient’s chest.”  [READ HERE]

We as health professionals inadvertently come across interesting clinical cases, sometimes even so interesting we bother to write them for a case report to submit. If you come across one, and want to write an informal one, just do so via SurgeXperiences! With “chopsticks piercing toddlers brain in china”, Clinical Cases and Images show us that sometimes a video speaks much more. [READ HERE]

Finally to round off the edition, (and i have saved the best for last), do check out two new blogs and ALL The articles they have written so far; you wont be disappointed.

1. SA Anaesthetist – aka Doc-ZZZ – Random ramblings about life and work as a consultant anaesthesiologist in South African state and private practice.
2. VIVA TIVA – Mindmaps of a recently expatriated anaesthesiologist.

That is about all for now. Thank you for dropping by. I hope you enjoyed reading the articles as much as i did. 

Meanwhile, should you desire more surgical blog reading, kindly avail yourself to the archives of SurgeXperiences, stored here (Season 2) and here (Season 1), along with the latest schedule of dates and host sites. You can also subscribe via RSS or email to SurgeXperiences over at this link. And of course, you can submit your posts VIA THIS FORM.

If you are interested in hosting SurgeXperiences, please contact me.

For medical professionals, the duty of care to patients does not cease just because of a festive season. Patients do not cease to require medical attention just because everyone is enjoying their holiday. In fact, according to a South African study by Meel,

Most of the pediatric deaths occurred during the festive months of December, January, and April; the death toll during these months was three to four times higher than in the rest of the year. [1]

This year, South African authorities also urge the public “not to put added strain on the health system during the festive season by putting oneself at unnecessary risk of injury or even death.” It is clear why MVCs or RTAs occur more frequently during festive seasons – they drink. Some people tend to do stupid regrettable things when they are drunk. “Blood alcohol levels were particularly elevated in firearm and sharp instrument homicides and among the pedestrians and drivers who die in motor vehicle crashes.” (emphasis mine) The National Injury Mortality Surveillance System (NIMSS) also  revealed that fatal injuries, especially as a consequence of violence and motor vehicle collisions, have been identified as a top South African public health priority. [2]

Venezeulan student Jacqueline Saburido was hit by hit by a drunk driver in Austin, Texas. She was pinned inside the vehicle as it caught on fire, leaving her with severe burns over 60 percent of her body. She lost her hair, her nose, her ears, he left eyelid and much of her vision. Her fingers were amputated. She’s become a spokesperson against drunk driving. (source)

Dedication

I would not imagine this to be much different anywhere else where alcohol is interweaved into the society’s fabric. As such, this edition is specially dedicated to the many people who, in one way or another, help to clean up the mess that drunkards cause on the roads, or anywhere else – paramedics, road traffic controllers, ED staff, and, since this is a surgical blog carnival, for patients who are stable and alive enough for some surgical therapy, theatre staff and trauma/general surgeons. Last but not least, because all our hearts are probably still wrenched by the story above, to the victims (dead or alive) of drunk driving.

Clinical Case 1 – Jane

First up, we have a clinical case. 21 year old Jane presents in the ED after a major motor vehicle accident. She was riding home from a party. Both her and the pillion rider were flung off across the tar road after colliding with an oncoming Prius. She suffered third-degree ‘friction’ burns (which looked similar to this one).

How would you manage Jane?

[Answer: Ask the Burn Surgeon. Online. For free. Yes. Let him tell you how he would treat Jane]

Featured

UnDead Doctor, who recently started blogging in October, describes himself as a “Surgeon by day. Anaesthetist by night. Not enough spare time in between.” In his first ever post, he introduces himself:

I am a medical doctor, with experience in the state and private sectors in South Africa, and more recently in the first world… … At this hospital, I spent my time split almost equally between surgery (daytime hours), and anaesthetics (after hours). I am currently looking for a post to begin specialising in surgery. I will let you know what happens in this regard in due course..

With such an introduction, it begets one to question his impetus behind starting blogging. What are his aims and hopes? All these are clearly addressed in the aforementioned intro post, of which this one captured my attention the most:

This sparked a thought – how can we effect change in our health care system through blogging if there are so few here! I decided I needed to start writing, so that maybe, on the off chance that someone of any importance stumbled across these pages, they might be enlightened to the plight of a South African doctor and his patients.

There are currently a total of 9 posts he has penned since October, a healthy 3 per month. All are great. I feel i might do him injustice if i feature one article over another, so kindly head on over to his blog to check out all 9.

Without going too much into patient details, we find out that this next patient of Dr Alice, who blogs at Cut on a Dotted Line, was actually not a candidate for surgery, or so the textbooks say. She describes her experience flying solo on a colectomy which was performed for this patient.

… He discussed the next steps with me as though I had any idea or say in the matter, and then let me do virtually every bit of the work, for the next several hours. And it was work. I had thought holding a retractor for hours at a time was hard work. Not much, compared to …

You absolutely have to read this excellent piece documented free for us here online about the transition from a surgical assistant to a REAL surgeon, which Alice aptly titled “in the deep end”.

The joy of a positive outcome for a patient, on which an invasive intervention has been performed, cannot be understated. A pathologist who blogs at Methodical Madness relays a lesson learnt from a patient encounter who had a FNA biopsy performed for a slow-growing parotid mass:

I won’t be so quick to pacify a patient, in the future. My idea of “no big deal,” isn’t every one’s. I’m not the one going under the knife – this week, anyway.

Speaking about learning lessons, Dr Alice rants about a recent referral to the surgical team about a young college-aged sexually active female with ?appendicitis but has had no WCC nor pelvic exam nor CT performed. She wonders if  “they’re teaching me how to be polite to frustrating referring physicians”

Technology

Dr Bates from Suture for a Living kindly provides a constructive review on the only iPhone app for surgeons – i-Surgery Notebook. Rightly so, a reader (TBTAM) raised issues about patient data being stored locally on an insecure platform and suggests logging onto a secure server to protect patients’ privacy. However, this has to be balanced against the inconvenience of requiring 3G or wifi access to edit or enter new information. Perhaps a secure ‘local’ solution can be sought for this app and the iPhone in general.

Surgery never fails to fascinate any onlookers. They can range from the circulating nurse, to the curious medical student, to the rep who just turned up to introduce some products to the orthopods. Even surgeons in training are interested to learn the best technique to do a particular thing. As such, it is not unusual for surgery to be properly videographed. Veteran medblogger KevinMD notifies us of several issues surrounding videotaping surgeries in the operating room.

There can oft be more than 1 way to do a certain procedure.  After reading an article from the British Journal of Surgery which compares two techniques of portacath insertion; the Seldinger technique vs. the venous cutdown, Buckeye Surgeon wonders aloud if ‘science’ can/should change one’s surgical practice.

Clinical Case 1b – Jane 4 years later

Four years later, Jane presents with acute onset of unrelenting abdominal pain and vomiting four years after a major motor vehicle accident. Link on to check out the CXR ordered and test yourself with a series of Q&As. Courtesy of Life in the Fast Lane.

The author behind Reflections of a Head Mirror, Dr Bruce Campbell, an otolaryngologist from MCW, shares with us the myriad of emotions his patients and himself experiences during his Cancer Center clinic day.

Over the course of the day, about 20 people will pass through the office. Their medical problems will vary but each one hopes to hear good news.

Benedict Carey from the NYTimes penned a great article about Henry Molaison — known during his lifetime only as H.M., to protect his privacy — who lost the ability to form new memories after a brain operation in 1953. Over the next half century he became the most studied patient in brain science. Now after his death, his brain is being studied, dissected and digitally mapped thoroughly. The findings could well change our current understanding of neuroscience.

Finito

This is a relatively short and belated edition of SurgeXperiences. The brevity is deliberate to help the reader focus on each quality article. The tardiness can be partly ascribed to my sister’s recent solemnisation; i am so delighted for her and my new brother-in-law. I was the cue master during the ceremony and all went well with military precision.

Meanwhile, should you desire more surgical blog reading over the holidays, kindly avail yourself to he archives of SurgeXperiences, stored here (Season 2) and here (Season 1), along with the latest schedule of dates and host sites. You can also subscribe via RSS or email to SurgeXperiences over at this link. And of course, you can submit your best VIA THIS FORM.

If you are interested in hosting SurgeXperiences, please contact me.

Merry Christmas and have a meaningful New Year ahead.

References:

1. Meel BL. Mortality of children in the Transkei region of South Africa. The American journal of forensic medicine and pathology : official publication of the National Association of Medical Examiners (2003) vol. 24 (2) pp. 141-7
2. allAfrica.com. South Africa: Extra Care called for during festive season. Dec 2009. Available at: http://allafrica.com/stories/200912080487.html

Thank you for dropping by this latest edition of SurgeXperiences, your one and only online Surgical Grand Rounds. Each fortnight, a different host take turns to host and present a digest of the best surgical related posts or articles he/she thinks its worthy for others to spend time reading.Today, it is my turn, and I shall do so in “bullet” style. Enjoy.

Featured

A newly discovered surgical blogs – Dr. D J’s Surgical Adventures. Dr. D J is a surgeon from Mumbai, India. This is how he introduces himself”

“A surgeon with a penchant for writing and a passion for revealing the truth behind the farce that is the Indian Medical Industry.”

He treats us with an account of his living nightmare on a Monday when he started work at 8am and finished on Tuesday 8pm.

“We started laparoscopically, found the rent in the oesophagus, tried to get at it, tried and tried. The liver was getting in our way, the spleen was oozing blood because its capsule was stretched to tearing, the camera kept fogging up, the omentum was playing policeman in the abdomen sealing everything off.” [READ HERE]

He then updates us about that patient whom he spent 12 hours operating on. [READ HERE]

Just to feature another of his not-so-recent post, Dr D J has a M&M incident to tell involving a NG tube and abdominal drain got muddled up. [READ HERE]  (P.S. interesting intra-operative picture)

Regulars

We have a triad of posts from the great bongi who blogs at “other things amanzi”. First up, he bemoans the poor state of the state constructed hospitals and the almost funny situation that creates in an emergency:

“to get a patient to theater from casualties therefore you needed to take the lifts…. but, as is typical of the maintenance ethic in south african state hospitals, only one lift worked at any given time. this added a unique aspect to an already high stress resus effort in casualties” [READ HERE]

While we are still on lifts, he has another story of funny times squeezing too many people in the small lift with an intern who has claustrophobia.

“his face was in my face and his eyes glazed over with hatred. i prepared to defend myself, but almost expected a phagocytotic attack” [READ HERE]

Bongi finally shares a little story on why he chose to specialise in Surgery. [READ HERE]

Ramona, a plastic surgeon in Little Rock, Arkansas, reviews 2 journal articles – 1 about peristomal skin complications and management [READ HERE] and the other about abdominal wall reconstruction [READ HERE].

Øystein, a Norwegian surgical videographer, shares with us a new procedure he has developed – “framectomy”. It involves a scapel, artery forceps, and some old photos [READ HERE].

Alice, a surgical resident, who regularly chronicles her ‘quest to become a Christian surgeon’ at Cut on a Dotted Line , tells us how life has been for us recently with night floats. [READ HERE]

Yours truly wrote a little post about surgical extended matching questions and how the options given in exams may not always reflect what one will do in real life. [READ HERE]

Surgical – opinion

Recently, the U.S Preventive Services Task Force issued new guidelines for breast cancer screening. It was met with criticism from the surgical community. Here are some of them:

A practicing breast surgeon, Alison Goldfarb, MD FACS, comments on the latest breast cancer screening guidelines laid out by the U.S Preventive Services Task Force [READ HERE].

Another breast cancer surgeon, Dr Megan Baker, answers a Q&A in this video exclusive. [SEE HERE]

The Swedish are saying “No Surgery” unless you quit smoking. Is this a good policy? Secondhand Smoke gives his reaction on this. [READ HERE]

Cool stuff

Ooh… Books! has an exclusive interview with Dr Chris Coppola, whom we all know from his previous blog at “Made a Difference for That One“. He was featured for his recent book “Coppola: A Pediatric Surgeon in Iraq“. [READ HERE]

Not Yet Published has a spiel on the distinction between physicians and surgeons, going into a little history about the term “mister” [READ HERE]. (P.S. a cool picture of a historic amputation kit awaits)

Has minimally invasive surgery hit the domain of breast surgery as well? [READ HERE]

Or even thyroid surgery? Apparently, a surgeon at Tulane has done the first scarless thyroid surgery. [READ HERE]

Next edition

To be hosted by Steve, an adult congenital health defect survivor! Read more about him here. He blogs over at Adventures of a Funky Heart, definitely worth checking out. You can submit your best surgical posts VIA THIS FORM.

The archives of SurgeXperiences are stored here (Season 2) and here (Season 1).

Subscribe via RSS or email to SurgeXperiences over at this link.

Without further ado, let’s check out the best in surgical blogging!

Regulars

Buckeye Surgeon take a (painful) trip down memory lane as he came across some survey published in the Archives of Surgery talking about public vs health professionals’ viewpoints on end-of-life interventions. [READ HERE]

Dr Chris Oliver, a UK orthopod, who chronicles his amazing journey from obesity to trialthons, shares 2 articles on his blog about lap-band and battling the obesity epidemic. [READ HERE] [AND HERE]

Marianas Eye, an ophthalmologist working in Saipan, shares his column contribution to the Saipan Tribune about healthcare reform. [READ HERE]

Dr Bruce Campbell shares another piece of his great literary writing in “The Save”. [READ HERE]

Just so we don’t forget, even though he’s been off the radar a bit, Surgeonsblog still has many fantastic posts worth reading. [READ HERE]

The Independent Urologist has some tips on how to quickly capture a patient encounter in the EMR within 5 minutes. [READ HERE]

IntraopOrate replies to an email from a “surgery addict” and sheds some light on how to get to be in the OR more often! [READ HERE]

Aggravated DocSurg rants about how doctors (really) think. [READ HERE]

Blogging about research

This is gaining popularity at the moment all over the medical blogosphere. I guess medical bloggers are realising it is much easier to provide an opinion via a blog than to write a letter to the editor or comment about it formally in the journals.

Are mastectomies overly used for breast cancer treatment? The latest JAMA issue, which focuses on surgical care, has a study that reports otherwise.. [READ HERE]

Plastic Surgery 101, penned by Dr Rob Oliver a board certified plastic surgeon, shares his thoughts on this as well [READ HERE]

In the same JAMA issue, comparison is made between prostate cancer surgeries done the old fashioned way, or the new sexy way with minimally invasive techniques – often with the assistance of Da Vinci robotic system. WSJ Blogs give you the low-down. [READ HERE]

Military-related

The work which supports the healthcare of the military or those hurt in war zones are indeed commendable.

Military pediatric surgeon Dr Coppola has recently published his 2nd book about this time in Iraq. His book is now available for pre-order. Reviews from many notable authors have been fantastic! [READ HERE]
Dr. Donn Chatham, who heads the American Academy of Facial, Plastic, and Reconstructive Surgery, has announced a new program to help soldiers who sustain serious facial wounds. The program, called Faces of Honor, aims to provide more expert care in surgically repairing soldiers and veterans who may not have access to cutting edge treatments in their veterans administration hospitals. [READ HERE]

Professional misconduct

It is sad that increasingly surgeons are dominating the medico-legal scene.

2 plastic surgeons in Singapore are fined S$2000 and S$5000 by the Singapore Medical Council for professional misconduct: one failed to provide supervision for a laser lipolysis procedure performed by a nurse, one performed cell therapy involving the injection of animal foetal cells into patients for anti—ageing and rejuvenation purposes. [READ HERE]

A Pennsylvania plastic surgeon is being investigated for possible bribery. [READ HERE]

Special events

Over at the Clinical Congress of the American College of Surgeons, a trauma surgeon paints a bleak picture of the U.S. trauma system — 38% of the U.S. population may not be covered by a statewide trauma system. [READ HERE]

Many bloggers were off this weekend to the BlogWorld Expo at Las Vegas, including Bongi all the way from South Africa. Ramona who blogs at Suture for a Living, shares a little poem about her trip and provide links to all other similar posts about the great time they had. [READ HERE]

NEXT

Sorry no announcement about next host yet. But meanwhile, you can still submit your best surgical posts VIA THIS FORM.

The archives of SurgeXperiences are stored here (Season 2) and here (Season 1).

Subscribe via RSS or email to SurgeXperiences over at this link.

See you in 2 weeks!

Official SurgeXperiences logo, courtesy of Vitum Medicinus.

SurgeXperiences was set up to be the definitive Surgical Grand Rounds in the medical blogosphere. A surgically focused blog carnival featuring all the best posts related in anyway to the diverse field of Surgery.

SurgeXperiences was first started 1 July 2007. It is hosted by various hosts ranging from surgeons to anaesthesists to radiologists to students! It is on every fortnight and each season lasts approximately a year.

• Season 1 [Jul 2007 - Jun 2008] had 24 editions. An archive can be found here.
• Season 2 [Jul 2008 - Jun 2009] had 26 editions. An archive can be found here.

A big and special thank you to all previous hosts. Your time and efforts do not go unnoticed and i hope the traffic this carnival brings you is sufficient of a motivation to host another time!

Here’s to all 50 and 50 more!

Regular contributors

Q: What is “cell phone elbow”?

A: It is the layman term for “cubital tunnel syndrome”. For a detailed writeup, hop on over to Suture for a Living to have an expert tell you all ’bout it.

Q: We all know experience makes a difference, especially in surgery. But has this ever been validated by a study?

A: Yes! Aggravated DocSurg tells us so, in “I see Jimi in the mirror!“

Q: Who has had an eccentric superior and not know how to react to his comments/jokes?

A: Bongi! He tells us a story about his professor of thoracic surgery.

Q: What is Buckeye Surgeon suggesting over Quality Assurance Committees for physician-initiated healthcare reform?

A: Cost effectiveness! Why? Read here.

Q: What is “Dr Bard Parker’s” take on the working hours limits on surgical trainees nowadays?

A: “kids these days” sums it up. Link on to hear what he’s got to say over at his blog “A chance to cut is a chance to cure”!

Q: How can one cope better with having ‘difficult conversations’ with patients?

A: Find out here as Dr. T (Notes of an Anesthesboist) shares her experience on the recent ‘difficult conversations’ she has had.

Q: Is it possible to be ruthlessly kind, especially in the teaching of medicine?

A: Perhaps, as Bongi (Other Things Amanzi) relates an incident about treating a patient with a 3rd degree circumferential burn.

Newbies

Q: I notice there are not many Australia surgeon bloggers.. Are there any new ones who decided to write about their cool surgical lives?

A: Yes! The diary of a surgeon is revealed! Over at Crikey Bulletin, which features Prof Guy Maddern from Adelaide.

Q: What is it like after vision correction surgery? Is there someone who can tell us about his/her experience?

A: “I was surprised to discover I was immediately able to open my eyes and see normally.” Read all about it from web architect Matt Raible’s blog.

Q: What is the caption for the following advertisement? Who is the advertiser?

A: The caption is “Plastic Surgery Loans“. It is an ad by Fortis Bank.

Q: Speaking about plastic surgery, what is the title of the book Dr Maria Siemionow recently published?

A: Face to Face.

Q: What is this book about?

A: Dr Siemionow recounts her experience of leading a team who successfully performed the world’s first full face transplant at Cleveland Clinic. [link contains an exercept of the book as well]

Special tribute to a great surgeon

Q: What TV show did the late Prof Chris O’Brien (renowned head and neck surgical oncologist) star in?

A: Prof O’Brien was featured in an Australian reality medical TV series called Royal Prince Alfred, which showcases interesting cases and the doctors who work at this top Sydney hospital.

Q: What did Prof O’Brien die of?

A: Glioblastoma multiform, diagnosed in 2006. (source)

Q: What is the title of the book he wrote?

A: “Never say die.” Linked here is a 60-minutes interview with him after he was diagnosed.

Q: Who treated Prof O’Brien?

A: Dr Charlie Teo, a top (and some say controversial) neurosurgeon.  When contacted, he said this of his former colleague, “People face death in many different ways but he faced it with such dignity and tenacity … he taught me some great lessons on life….. He knew that he was fighting a formidable enemy and yet he still remained very positive until the bitter end.”

Surgical care

Q: Do doctors really read through the patient notes?

A: Apparently not, as Buckeye Surgeon discovers in a case where he recommended hospice care for a patient, but no one listened!

Q: Is it right for a surgeon to leave post-op care to the hospitalist?

A: No! Certainly not the not-so-Happy Hospitalist, who hears from another hospitalist that an orthopedic surgeon has been doing so and only seeing the patient on the discharge day. To quote, it’s “one of the worst examples of patient abandonment I can imagine.”

Q: How many pounds did Wrexham Maelor Hospital pay for surgical blunders made there over the last 3 years?

A: HALF A MILLION! Read more here.

A pinch of humour

Q: Is there a comic about medieval surgery that could make me laugh?

A: Maybe. Check one out at scanman’s posterous.

Q: What not to do or say when asking for an autograph from a sports star?

A: I’ll leave you to find out from yet another tale from Bongi, entitled “skande“

Some announcements

Q: What is so special about the next SurgeXperience edition?

A: It is the 50th edition!

Q: Who is the lucky blogger who gets to host SurgeXperiences on this very special occasion?

A: Dr Vijay, who blogs at scan man’s notes.. Be sure to submit your posts via this form. SurgeXperiences 226 will be hosted in 2 weeks’ time on 28 June 2009.

Q: Can i subscribe to SurgeXperiences using RSS or email?

A: Certainly! Do so over at this link.

Q: Where can i check out previous editions of this awesome surgical blog carnival?

A: The archives of SurgeXperiences are stored here(Season 2) and here (Season 1). Feel free to check them out!

~ ~ ~

Let’s  round up with a joke (that carries a little tinge of politics), courtesy of In From The Night:

“Three Californian surgeons were playing golf together and discussing surgeries they had performed.

One of them said, “I’m the best surgeon in California . In my favorite case, a concert pianist lost seven fingers in an accident, I reattached them, and 8 months later he performed a private concert for the Queen of England.”

The second surgeon said, “That’s nothing. A young man lost an arm and both legs in an accident, I reattached them and two years later he won a gold medal in track and field events at the Olympics.”

The third surgeon said, “You guys are amateurs. Several years ago a woman was high on cocaine and marijuana and she rode a horse head-on into a train traveling 80 miles an hour.All I had left to work with was the woman’s hair and the horse’s ass.

I was able to put them together and now she’s Speaker of the House!”

One of my clinical tutors at the hospital i rotated for Obstetrics & Gynaecology is semi-retired now; he comes in weekly for an antenatal clinic and gives us weekly tutorials on mainly obstetrics. I can see that is his passion.  Often, he goes to sub-sahara Africa for medical missions. He liaises with the government officials and recently i heard him speak at one of the Friday morning CME meetings, where he talked about maternal mortality at Sudan. He reflected about his experiences and how the introduction of misoprostol easily dropped the rates of maternal mortality (hugely contributed by uncontrolled post-partum haemorrhage). According to UNICEF, in Sudan, there is  a maternal mortality ratio of 1,107 deaths per 100,000 live birth. In Australia, the rate is 8-10 per 100,000. What a stark contrast eh? Between 1991-96, 1 woman died in Australia of PPH. Most of the 1107 women who die per year in Sudan die of PPH. 

My 9-week Obstetrics & Gynaecology rotation ended today. I clearly remember attending one labour ward night shift (9pm to 7am). I was quite happy because one of the ladies consented to having me around, watching and learning. It was indeed a privilege to attend their birthing process. The lady was in stage 1 labour, so nothing much was happening. The midwife was checking some of the drugs and preparing them. She taught me as she did – syntocinon, ergometrine, misoprostol … we use this if there is PPH. sync is to help the uterine contract.. in the event of a PPH, we might use ergo, miso PR, etc. 

If only the women in Sudan had access to these drugs …

My time in O&G land was an eye-opening experience. I attended many theatre sessions; that was where i could do Vaginal Examinations under Anaesthesia! Women really didn’t care what happened when they’re knocked out. Most threw in that comment when i asked them as they waited in the pre-surgical area. It’s weird though, most had no palpable pathologies. I did feel a couple of retroverted uteruses though. No adnexal masses. I stopped doing them when i hit the minimum of 5. We have a logbook to sign off. One of which was to watch 1 hysteroscopy. I ended up watching like 3o or sth. I can almost do one if they asked me to. Just have to know how to fiddle and connect the hysteroscope and attach the Hartman’s bag. 

I loathed Obstetrics. That’s because as a student, you follow the midwife. No offense to midwives, but i don’t find their job very interesting. I admire their patience and preserverance in sticking around with a women for her labour. Gawd its long and boring. I would much rather be a resident, who usually only comes in a couple of times to pop their head in and check how the woman is progressing. And they come in for the final crowning bit. Push! Damnit woman push!*

* ok, not they don’t say that.

Gynaecology is so much more interesting. In fact i like it. I scrubbed in for 2 total abdominal hysterectomies, one for a uterine myosarcoma and another for a massive 10cm fibroid. 

Another cool pic i had from my iPhone was that of a dermoid cyst. Now to understand this, you have to know that dermoid cysts can have ectodermal derivatives in them – epithelial tissue, hair, skin, even teeth! Too bad this one had no teeth!

So anyway, that’s that. We also had a week where u follow a private consultant and experience the  life of a specialist. He practises mainly obstetrics. He tells me an average OBGYN does about 120 deliveries a year, he does about 3 times of that. A quick search of his name yielded recommendations on Bubhub, and other mummy forums. its nice that he can see sisters of sisters, friends of friends who all like him so much, and even a GP who refers her patients to him for specialist care! he provides her complimentary antenatal and obstetric care! he made me reconsider obstetrics, but warned me of potential lifestyle issues. and oh, the malpractice coverage is huge! but i think if i ever stepped down that path, i might focus more on gynaecology, particularly gynae surgery, e.g. oncology, or endometriosis interest, etc.

that’s O&G in a nutshell. my exams are next friday 12 june and the OSCEs are on 16 june! 

Is Paddy Dewan, a renowned paedatric urologist, a saint or sinner? The Age, Melbourne’s newspaper, reports back in 2003. 

“There were charges of intimidation, protracted and ugly contract negotiations, complaints by Dewan about serious errors and patient deaths, and untold instability and upset on all sides.

Finally, the hospital’s chief executive, Kathy Alexander, recommended Dewan be sacked for disrupting the surgical department and effectively compromising patient care. The hospital board, after examining acidic statements by at least 14 surgeons, endorsed the highly unusual move.”

What exactly did this high profile surgeon do to incur the wrath and prompt “acidic” comments from 14 other surgeons? The reporter enlightens us:

“Dewan reported a total of 26 incidents to the Department of Human Services, the Australian Medical Association, the Medical Practitioners Board and even the Coroner. The incidents involve most of the 12 surgeons in the hospital’s department of general surgery. Surgeons see this as a personal attack.

However, Dewan says he went outside the hospital because he was not satisfied with the response of its patient safety committee, where he referred two incidents. “I was not being heard,” he insists.”

After generating sufficient drama at RCH, more ensues this day at Sunshine Hospital! Now the Professor of Paediatric Surgery over there, he has accused staff at Sunshine Hospital of manipulating surgery waiting lists to encourage patients to pay for private services.

“In a scathing submission to a parliamentary inquiry into hospital performance, Professor Dewan has also alleged the hospital’s suspension of his services in recent years meant children with appendicitis and twisted, dying testes did not get timely treatment.”

The drama never ends! Now patients, or rather, their appreciative parents, are rallying to support their beloved surgeon (source: The Wee Kids).

Professor Paddy  also volunteers with overseas missions for underserved paediatric populations with an organisation he set up – Kind Cuts for Kids. This included a trip to Gaza. Apparently Sunshine Hospital – his current employer – isn’t too pleased by his frequent trips overseas for these missions. 

I cannot help but wonder, are highly achieving, perfectionist individuals who care nothing but ensuring optimal care for their patients, bound to rub the wrong shoulders and cause undue friction amongst colleagues? Is Dewan a victim of the system, which to him doesn’t seem to value transparency as much as he does? Or is he a self-made timebomb of overflowing self-righteousness who is an inappropriate whistle-blower? 

I suspect only individuals who have worked directly with him or are involved in this entire saga can make an accurate assessment. But what do you think? Also, have you come across such individuals at your work place?

Curt Tribble, M.D.
Professor and Chief
Division of Thoracic and Cardiovascular Surgery
Vice Chairman, Department of Surgery
University of Florida College of Medicine
Gainesville, Florida

(from cover of Advanced Surgical Recall”

“It has been shown that the minimal annual procedure volume required to be designated as a center of excellence [125 cases per year] does not necessarily result in better outcomes, and that the minimum volume requirement is not evidence-based. Most importantly, this volume criterion significantly restricts access for bariatric surgery care,” 

“Designation as a bariatric surgery center of excellence does not ensure better outcomes. Neither does high annual procedure volume. Extra expenses associated with center of excellence designation may not be warranted,”

This led me to wonder the question as stated in this blog post’s title: Being a student at a Centre of Excellence – does it make a difference? Does rotating through a COE ensure one learns from the ‘very best’ in the field, assuming more of them are gathered there? How does it affect a student’s choice on which hospital he/she will choose to work at upon graduation from medical school? 

Dr Livingston’s article can be found in the April issue of Archives of Surgery. .

• Contrary to what Hollywood scriptwriters may think, to do most operations properly, probably requires no more than average manual dexterity. In the author’s opinion, anyone who can write neatly probably has enough manual dexterity to do most surgical operations. The qualities that distinguish a superior surgeon from an average one are far more subtle, reside in the cerebral cortex rather than the cerebellum, and mainly involve complex decision-making and judgement

Addenum [15/4/09]

• The ANZ Journal of Surgery published a special edition in March 2009 (Vol. 79, Iss. 3) on surgical education.
• An article seems to portray differing opinions from Mr Whalan.

Gallagher, Leonard and Traynor wrote about the “Role and feasibility of psychomotor and dexterity testing in selection for surgical training”.

Finally they reveal what is done at the Royal College of Surgeons in Ireland. “… all short-listed candidates for Higher Surgical Training now undergo formal testing of both technical skills and fundamental abilities (psychomotor skills, visuospatial ability and depth perception). Reports on each candidate’s performance are supplied to the interview committee. Furthermore, a prospective database is being kept for correlation with future surgical performance. We believe that selection into surgical training should take account of attributes that we know are important for safe and efficient surgical practice.”

“Although technical proficiency is definitely an important prerequisite for a successful outcome, other qualities such as intellectual abilities, personality and communication skills, and a commitment to practice are important elements in the profile of a competent surgeon.”

I discovered i am not a natural with babies/toddlers, in terms of rapport establishing, etc. I guess i lack the experience with limited interaction with my cousins/nephews/nieces. I tried, but I am not a natural. If I am to be blessed with a wife and children in the future, then these 9 weeks of experience with kids might come in handy… but as they grow older, its easier; you can ask them about school. who’s your favourite teacher? who’s your best friend at school? what’s your favourite subject? what do you wanna be when you grow up? etc etc

Paediatric surgery was fun. We had cool stuff happening; gastroschisis, sacro-cocccygeal teratoma, duodenal atresia, colonic atresia and then several boys came in with blunt trauma to pancreas after bicycle accidents. one even had a distal pancreatectomy. Highlight was scrubbing in late night for perf appendix, which i used for my case report.  classic RIF region of maximal tenderness, widespread peritonitis. great thing was, when the paed surg reg, W,  was arranging for an ICU bed, while the pt was having his fluid resus, we students went to grab some Mackers (and offered to get him something too). it was a legendary night that will stay in my memory. (oh, W requested fries and guess what – strawberry milk shake! we teased him a lil about it later, made him all the more self conscious. lol) opreatively, had the suction ready when the peritoneum was next to be cut. frank pus +++.  manual breaking of adhesions in abdo cavity. we had a lili trouble finding the appendix but got it in the end. 

another lap case i watched was a neonate case. lap removal of adrenal ?mass. most likely extra-pulmonary sequestration. 

Oh, and an extremely rare thing i came across at Paed Haem/Onc clinic. 7 month old infant scheduled for orchidopexy for right undescended testes. when testes was brought down, some other tissue was attached to the testicle. it was resected. discharged with no complications. over the next few months, mum noticed lump was getting bigger and when she went back to get it checked out at the same hospital, they dismissed it as scar tissue. she sought a 2nd opinion. the surgeon took it out. pathology came back –> wilm’s tumour, with all the characteristic classical histological features. he had intensive chemo for 5 months. he has to be monitored for mets and any primary occurence in the kidney. thankfully renal US and CXR to date (he is now 3) are clear. saw him at outpatients. 

Interesting / confronting issues: 

Bushfires in Melbourne: When asthma kids come from bushfire-affected areas, i must admit i do not quite know what to say. The doctors are Melbourne-based. They can say the right phrases to display sympathy. They ask the right questions that display practical concern: are you making plans to evacuate? They factored in their empathy whilst explaining the asthma management plans. As we got further away from Black Saturday, residents made comments like “It’s gonna be a smoky day this weekend. More kids will come in. (with a tinge of urgh)”

Childhood obesity: We had a week of lectures as a “Paeds in Sem 1″ Cohort. During this week, we were also supposed to prepare a 10-min presentation on Contemporary Issues in Paediatrics. There were 10, but more interesting to me were things like educating children with disabilities, youth suicide in Australia, immunisation, water fluoridation. My  group was given a science-y topic : childhood obesity. I guess I’m thankful because a topic like “health indicators in indigenous children” or “socioeconomic status and health of Aussie children” will be more difficult, especially in terms of finding information. When i was in 3rd year, my conclusion from dealing with the moderately to super obese was to lap band them, because it is the only thing that works. Educate them it is not a one-stop fix. Involve a dietician. Make them promise (and follow them up) re diet and exercise. Be their partner in health. Banding is the only thing that actually works, as the evidence and literature quite unaminously proves. screw orlistat. Lapbanding helps kick start and continue their lifestyle changes. But how does this change in kids?

We were chatting to a General Paed Surgeon after his list one arvo. He was really nice. He told us one time he attended a Paed Surgical conference and someone presented something on banding. That person was “absolutely lynch-ed”. The anaesthetist chipped in. He had a patient die on him once. There are difficult to intubate, and hard to manage peri-operatively. But he still reckoned it is the only thing that works, at least for adults. 

Obesity is an epidemic in Western societies and considering how a big percentage of the entire world lives in starvation, you cannot help but wonder why. 

New people: i’ve always been a rather introverted person, compensating with a outward show of extroverted-ness. inherently, i am shy. when i tell friends that, some chuckle because i don’t portray that side often. Meeting new people has been interesting. There are still people within my graduating class whom i do not know at all, or very well. Years 4 & 5 will change that as we move around hospitals. Occasionally, an anti-social nonchalant thought creeps in “i’m not gonna stay in Melbourne for good anyway, why bother?” i usually mentally smack myself after.

E for electives. tweeted a bit about it. plans still uncertain. hope to go to S america. plan to learn spanish. if i master it, then i can speak the 3 most common languages in the world. (english, mandarin). right, as if it was so easy.  though i must admit, when i acted as a mandarin translator at one of the Paeds clinic, i was a lil rusty and struggled a little with medical terminology and sentence structure. parents could tell i don’t speak it everyday, but were nonetheless grateful, as they would have waited ages for the official hospital mandarin translator to come. 

now my 9-week O&G term starts. i will blog and sum up about it when its over again. probably will include things like my 1st pap, vaginal exam, normal vaginal delivery, colposcopy ,etc etc. till then, thanks for listening and dropping by my humble blog.

The mechanic shouted across the garage, “Hey, Doc, can I ask you a question?” The surgeon a bit surprised, walked over to the mechanic working on the motorcycle.

The mechanic straightened up, wiped his hands on a rag and asked, “So Doc, look at this engine. I open its heart, take valves out, fix ‘em, put ‘em back in, and when I finish, it works just like new. So how come I get such a small salary and you get the really big bucks, when you and I are doing basically the same work?”

The surgeon paused, smiled and leaned over, and whispered to the mechanic… “Try doing it with the engine running.”

(source: somewhere on the net )

SurgeXperiences logo created by vitum of vitum medicinus.

To a medical student like me, the field of surgery is very intriguing, to say the least. The daily working life of a surgeon, or even that of a surgical trainee, can be jam-packed full of action, blood, guts and gore. Dull moments in surgery are hard to come by. Surgeons are able to test their hypotheses and see rapid, graphic results from their work. Students are often awed by this process. What also draws me to surgery is the immense satisfaction of being able to completely excise a cancer (hence providing a definitive cure), or relieve the pain of an intra-abdominal catastrophe, e.g. perforated appendix. 

General Surgery

Merriwether (a patient) recently had some lipomas excised and shares his experience and some post-op photos.   

After a colostomy and ileocystostomy, a patient’s daugher (Tiger by the tale) blogs about the aftermath and impending ICU stay. Wish him a speedy recovery.

Neurosurgery

An obese man is being surgically implanted with electrodes inside his brain and exposed to electrical currents trying to make him weight. This is a first of its kind and I leave it up to the reader to comment at the article re: human experimentation. (image credit)

 

Talking about experimenting on humans, this Italian neurosurgeon was certainly pushing the boundaries when he decided to continue surgery on his patient despite suffering from an anginal spasm himself. “I couldn’t leave [the patient] at such a delicate moment… I’m not a hero, I only did my duty.” Read all about it here.

 

A Russian teenager dies after a rare brain stem operation. The father is now suing the Oklahoma City surgeon in a civil lawsuit for medical negligence.

Obstetrics

Some might argue obstetricians are not surgeons. In South Africa, interns perform Caesarean Sections commonly, but before they do, they have to earn a right to do so, just like any surgical procedure. Dr Karen Little (Just Up the Dose) writes about obtaining this license to cut at where she practices medicine – the Crater vs Civilization. (image credit)

Orthopaedic Surgery

An orthopaedic surgeon from the Philippines, Bone MD (The Orthopedic Logbook)addresses a post to young / junior doctors regarding career choices, and how it is OK to be lost. (image credit)

 

A cerebral palsy patient pays an orthopaedic surgeon a visit at his clinic, recounting an awkward moment.

Ophthalmology

Valerian, a recent customer of eye surgery, shares about his PRK experience. 

 

A Repository for Bottled Monsters shares a journal article about eye injuries and prosthetic restoration in the American Civil War years. Cool pictures and great historical information. (image credit)

Peri-operative medicine

Dr Bates (Suture for a Living) reviews an article on the requirement of perioperative stress doses of corticosteroids.

Plastic surgery

Plastic surgeon Dr Ramona Bates (Suture for a Living) educates us on medical lasers and the law after reading an article from a “throwaway” journal “MedEsthetics”. (image credit)

Sometimes, veterinary surgeons can take pointers from their counterparts who operate on real human beings, just like a certain Dr Michael Pavletic. This vet, faced with a tumour on a cat’s face, turned to an older human reconstructive surgery textbook that suggested a simple skin flap might do the trick. He took what was a routine technique in human surgery and tailored the procedure for a cat. It worked. Today, he is a pioneer in veterinary reconstructive plastic surgery. Read about him here. 

Moving back our focus to human surgery, chronic refractory pilonidal disease can result in an undesirable cosmetic effect after multiple incisions and drainages. Dr Lisa Marcucci (Inside Surgery) describes a commonly-used technique “Z-plasty” to overcome this problem. 

Although cosmetic surgery is only a part of plastic surgery, it is very prominent in the community and considerable attention is dedicated to who had it, should you have it, and the like. I thought i might throw in something since everyone knows about this former King of Pop. Apparently he is having some cosmetic procedures to “doll up” before his return to stage.

Well it seems that some ‘doctors’ have also jumped onto the bandwagon and pretend to be plastic surgeons when they are not. Adventures in Plastic Surgery reports. 

Trauma surgery

Dr Parker (A Chance to Cut is a Chance to Cure) is back with a shout with a continuation of his “Tales from the Trauma Service” series at XVIII.

Transplant surgery

Dr Jeffrey Parks (Buckeye Surgeon) talks about transplant chains, or NEAD (non-simultaneous, extended altruistic) donor chains. He highlights an important issue of moral obligation of those involved to donate their organs to “keep the chain going”.

Diagnostic services

Radiological imaging are sometimes indispensable to a surgeon before he/she takes a patient to surgery. Good ol’ Dr Vijay (Catscanman) has contributed a post full of 3D reformatted images from a post-CABG Coronary CT Angiogram. Check it out; very cool. (image from link above)

Below, articles are not grouped according to surgical sub-specialties anymore. 

The surgical career..

Dr Crippen (NHS Blog Doctor) thinks out loud … “What is a surgeon?“, when a patient of his shows him who did his inguinal hernia repair.

Regarding inter-profession relations, Dr Parker (A Chance to Cut is a Chance to Cure) updates us on some of the drama that has been going on, and what he reckons, in R-E-S-P-E-C-T —  parts ONE and TWO. 

Surgical training … the tough years ahead. at least for me. Surgical resident Dr Alice (Cut on the dotted line) reflects on why “tough love” is best love for educating interns and medical students.

It is no wonder then, why some surgeons are soooo tired. But is tough surgical training to blame in this following case? A plastic surgeon at Beth Israel Deaconess was so fatigued from previous day’s activities that he dozed off during surgery. Now it is big hoo-ha in the news, at least in Boston. 

Advances in surgery

The Medical Quack reports that the world’s first robotic distal pancreatectomy was performed at Fox Chase Cancer Centre via the VikY system. 

Over at Abu Dubai, a surgeon performs the first telesurgery at UAE in front of various colleagues.

Surgical media

Oystein (The Sterile Eye) is a medical videographer from Norway. He has the following articles/media links to contribute. 

• Of background music in surgical videos. What do YOU think?
• The National Museum of Health and Medicine are digitizing their vast archive of meical photos. Check it out.
•  He also recorded a video of a laparoscopic  liver resection, with a brief summary. 
• Lastly, a video of ERCP. 

Gabrielle Eden has a short write up on the background of the famous picture of a foetus grabbing onto a neonatal surgeon’s hand. It is entitled “The Hand of Hope“. 

Will you be in Italy from Oct 27 to Nov 8? If so, you could join in the Vesalius Trust Art and Anatomy Tour – a tour of wax anatomical models at several anatomical museums. Even if you can’t go, the spine-chilling pictures at Morbid Anatomy might suffice. Here’s a preview:

That rounds up this edition of SurgeXperiences. What i lack in terms of humour or expertise in commentary, i hope i have made it up with the images i included.

Next edition will be hosted on 19 Apr at Suture for a Living. 

You can submit your blog posts via the carnival submission form, and check out all the previous editions. You can also subscribe to SurgeXperiences via RSS feed or email.

If you would like to host a future edition, don’t hesitate to contact me.