Suture for a Living

Monarchs

noreply@blogger.com (rlbates) — Fri, 25 Nov 2011 04:25:00 PST

I am finally getting around to posting about the quilt I received as part of ALQS6. I received it in the mail nearly a month ago. It is lovely! It was made by Jay who blogs at Creative Crone from studio Q. She named the quilt Monarchs.

Jay sent me extra fabric so that I can sew a sleeve on the back and hang it. The photos don’t do it justice.

Here is a link to the quilt (Mariner’s Compass Rose) I made for ALQS6. It was mailed to Veronique in Chile.

Here are the posts of the quilts made and received from the first five ALQS.

Made:

1st: Laced Ribbons Quilt (went to Pennsylvania, May 2008)

2nd: Flower Basket Quilt (went to Indiana, September 2008)

3rd: Fractures I (went to Australia, June 2009)

4th: Blue Hawaii Wall Hanging (went to Great Britain, July 2010)

5th: Winter (went to the Netherlands, January 2011)

Received

1st: I Received My Quilt (from Denver, June 2008)

2nd: It's Arrived! (from Italy, November 2008)

3rd: Geverfde Quilt (from the Netherlands, August 2009)

4th: Falling Stars (from Great Britain, August 2010)

5th: Pale Flowers (from Florida, February 2011)

Additional Benefits to Reduction Mammoplasty

noreply@blogger.com (rlbates) — Mon, 28 Nov 2011 04:29:00 PST

This article (full reference below) on the additional benefits an individual gains from having a reduction mammoplasty (RM) has been published online ahead of print. The authors performed a systemic review of the literature focusing on functional outcomes after RM with regard to physical and psychological symptom improvement.

The authors performed a systematic review of the English literature using PUBMED for the period between 1977 to 2010. Studies were chosen that addressed the physical and psychological benefits of RM using a validated questionnaire.

The authors note that nearly eighty thousand breast reductions
were performed in 2009. For insurance coverage in the United States a woman seeking breast reduction must have complaints of physical symptoms (ie neck pain, upper back pain, inframammary rashes, etc).

The authors of this article choose to look at the other benefits a reduction mammoplasty can have:

Even less common are investigations on the effect of RM on weight loss, exercise, and eating behavior. Women with large breasts often find exercising difficult due to public scrutiny and physical constraints. They may even develop eating disorders in an attempt to match their breast size to the rest of their body. ……..Women with macromastia often have
diminished self-esteem, poor psychosexual function, depression, and anxiety.

I want to applaud them for their article. There are 52 article in their reference list. Table I is a breakdown of 6 articles on physical symptoms/improvements. Table II is a reference does the same for 8 articles on the effects of reduction mammoplasty on exercise, weight and eating behaviors. Table III does the same for 5 articles on the effects of reduction mammoplasty on psyche. Table IV summarizes 3 articles on the effects of reduction mammoplasty on appearance.

The results of their summary:

Women who undergo RM have a functional improvement in musculoskeletal pain, headaches, sleep, and breathing. Psychological benefits are vast and include improved self esteem, sexual function, and quality of life, as well as less anxiety and depression. Following RM, women appear to exercise more and have a reduction in eating disorders.

This is what I saw over my 21 years of practice in taking care of these women.

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Reduction Mammoplasty (December 19, 2007)

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REFERENCE

Additional Benefits to Reduction Mammaplasty: A Systemic Review of the Literature; Singh, Kimberly A.; Losken, Albert; Plastic & Reconstructive Surgery., POST ACCEPTANCE, 15 November 2011; doi: 10.1097/PRS.0b013e31824129ee

Shout Outs

noreply@blogger.com (rlbates) — Tue, 29 Nov 2011 16:09:08 PST

Afternoon Nap Society is the host for this week’s Grand Rounds. You can read this week’s edition here.

………….This week, Grand Rounds is mine, and in selecting blog posts, I evaluated submissions based on their topicality, writing style, and personal appeal. What I look for in a blog as an ePatient may differ from what a physician or even another ePatient looks for; however, the goal of Grand Rounds is to foster dialogue, and more and more we are learning that in order for a healthcare dialogue to be truly effective, it must include the patient perspective. As a result, Sean Ahrens, an ePatient and software designer who is building Chronology, an online network on which patients with Crohn's and Colitis may connect and learn from one another, opens this week's session….….

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In the current JAMA, a thoughtful commentary article by Traber Davis Giardina, MA, MSW and Hardeep Singh, MD, MPH: Patient's direct access to test results - pros and cons. (subscription necessary for full access)

In the outpatient setting, between 8% and 26% of abnormal test results, including those suspicious for malignancy, are not followed up in a timely manner. Despite the use of electronic health records (EHRs) to facilitate communication of test results, follow-up remains a significant safety challenge. In an effort to mitigate delays, some systems have adopted a time-delayed direct notification of test results to patients (ie, releasing them after 3 to 7 days to allow physicians to review them).

On September 14, 2011, the Department of Health and Human Services jointly with the Centers for Medicare & Medicaid Services, the Centers for Disease Control and Prevention, and the Office for Civil Rights proposed a rule allowing patients to access test results directly from the laboratory by request (paper or electronic). .……….

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For those of you like me trying to follow the face transplant recipients and procedures progress, CBC News recently had an update on one of them: Conn. woman mauled by chimp praised for new face

…….."I've had people tell me I'm beautiful," Nash said in the interview that aired Monday. "And they were not telling me I was beautiful before."

Nash said she was cheered by a simple "hello" from a child while she was shopping recently.
"That didn't happen before," she said. "It was nice. The little girl was saying 'hi' to me. ... I'm not scaring anybody." ……

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This article from Science Daily caught my eye and I look forward to when it might be possible in humans: Cleft Lip Corrected Genetically in Mouse Model

Scientists at Weill Cornell Medical College used genetic methods to successfully repair cleft lips in mice embryos specially engineered for the study of cleft lip and cleft palate. The research breakthrough may show the way to prevent or treat the conditions in humans. ...…….

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H/T to @medicallessons for this tweet “Is a Ban on Drinking Water Hours Before Surgery Necessary? (maybe not) -- ttp://nyti.ms/uTAQgl” The link is to a New York Times Q & A article by C. Claiborne Ray: Cool, Clear Water

Q. Is it really necessary to prevent patients from drinking water for many hours before surgery?

A. The well-known rule that a preoperative patient should have “nothing by mouth after midnight” was not based on scientific evidence, and many medical organizations now have more flexible guidelines. For example, American Society of Anesthesiologists guidelines generally permit clear liquids until two hours before surgery. .…….

Be sure you ask your surgeon and anesthesiologist what the rule is for you as the above is for healthy individuals. It may vary depending on your set of health problems and the surgery you are scheduled to have.

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I love watching my dog shake water off.

H/T to @DrVes for the link to this NPR story by Robert Krulwich: Shake It! How Dogs, Cats, Even Hummingbirds Keep Dry (photos, including the one below, and video)

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The Alliance for American Quilts received 119 quilts for it’s 2011 "Alliances: People, Patterns, Passion" contest. You can see all the quilts here. My entry was “Redwork Quilt” and is included in this week’s (Week Two --Mon, Nov. 21- Mon, Nov. 28) quilts being auctioned off on eBay.

All contest quilts will be auctioned via eBay starting on Monday, November 14, 2011 and ending December 12, 2011. All proceeds will support the AAQ and its projects. ….

Week THREE auction guide: Monday, November 28 - Monday, December 5 ……

New this year: "Alliances" contest artist's were offered the chance to record their artist's statements thanks to the generous services of AAQ Business member, VoiceQuilt, visit them at www.voicequilt.com.

Paper Airplane Quilt

noreply@blogger.com (rlbates) — Fri, 02 Dec 2011 04:25:00 PST

I made this quilt almost 20 years ago in 1992 as part of challenge to use the selected fabrics. I do not recall why I decided to use them to depict how a paper airplane was made, but as you can see that is what I did.

The quilt is machine pieced. It is machine and hand quilted. It measures 53 in X 15 in.

Here is the first panel which represents the unfolded sheet of typing paper.
Follow the fabrics through the panels as the “sheet” is folded on itself.

The finished paper airplane.
I didn’t put a binding on this quilt. It is finished by using a black piping trim.

Would anyone like to have this quilt? Leave me a comment by Dec 16, 2011 over here.

Is It Okay to Return to Work?

noreply@blogger.com (rlbates) — Mon, 05 Dec 2011 04:26:00 PST

When a patient asks you if it’s okay to return to work after an injury or surgery what do you base your decision on?

When I was in practice I would base my on what the injury was, how the individual seemed to be healing, and what type of work they did. It was simple when I could simply write a note that said something like “T. J. can return to light duty on ____ and to full, unrestricted duty on _____.”

I did not like having to fill out the short term disability forms, but with my new understanding of the legal definitions of work (heavy, medium, light, sedentary) I would find it much easier to do. I also understand how this is much more helpful to the individual’s work supervisor than my one line note.

Different jobs are classified as heavy, medium, light, and sedentary depending on the exertion required to do them.

Heavy Work

Can lift and carry up to, or more than 100 pounds frequently.
Can lift and carry up to 50 pounds occasionally
Is able to stand or walk, off and on, for a total 6 hours in an 8-hour workday

Types of heavy work include construction cleanup

Medium work

Can lift and carry up to pounds at a time occasionally
Can lift and carry up to 25 pounds frequently
Is able to stand or walk, off and on, for a total 6 hours in an 8-hour workday

Type of medium work include many skilled trade jobs such as construction, plumbing, etc.

Light work

Can lift and carry up to 20 pounds occasionally
Can lift and carry 10 pounds frequently
Is able to stand or walk, off and on, for a total 6 hours in an 8-hour workday

Types of light jobs include nurse, teacher, cashier, etc.

Sedentary work

Can lift and carry up to 10 pounds occasionally
Can lift and carry less than 10 frequently
Is able to stand or walk, off and on, for a total 2 hours in an 8-hour workday

Sedentary work is your basic “sit-down job” such as receptionist, dispatcher, assembler, etc.

Limitations of reaching, pushing, pulling, stair climbing, stooping, and crouching placed on a light work restriction can move the individual to a sedentary restriction by nature of the job requirements.

Limitations on fingering (keying, typing) can make it difficult for an individual to perform their work even when given a sedentary restriction.

“Occasionally” means occurring from very little up to one-third of the time. “Frequent” means occurring from one-third to two-thirds of the time.

Other things that affect an individuals ability to return to their work may involve the work place environment—dust, fumes, chemical exposure, etc.

For more information about how Social Security defines the different exertional levels see SSR 83-10.

Shout Outs

noreply@blogger.com (rlbates) — Tue, 06 Dec 2011 16:06:41 PST

Nick Genes is hosting this week’s Grand Rounds at his blogborygmi tumblr. You can read this week’s edition here.

Hello and welcome to this collection of medical links from across the web, written by providers, patients and analysts that work on the frontlines of modern healthcare.

This is my sixth time hosting Grand Rounds (three prior times on blogborygmi’s blogspot site, twice on Medgadget.com), and my first time with Tumblr.

I’ve been hearing about Tumblr for years, and after finally making the leap a few weeks back, I figured it might be a good fit for Grand Rounds today, as well. .….

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@doctorblackbear who blog at Asystole is the Most Stable Rhythm has written a beautiful post: Trust

"So the patient has been temporarily paralyzed by the drugs, and you're the one keeping them alive by squeezing air into their lungs...but...no pressure".

Gulp.

I was holding the mask as tightly against her face as I could, sealing the rubber to her cheeks in the effort to keep highly oxygenated air from leaking out. Looking down at her from the head of the bed I saw the patient from a different vantage point, a place that made her look so vulnerable.

And she was vulnerable. …….

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H/T to @antidoped who gave me the head’s up on @imapactednurse’s post: 1 shift, 3 stories

My name is Caleb.
Ive had this pain in my arse for 2 weeks now. The doc says its a hemorrhoid or something. All I know is, it fucking hurts like shit.
I am supposed to have surgery, but the hospital has cancelled it twice now. Says its too busy. ….

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From Street Anatomy: A Woman’s Back is Beauty

Edinburgh-based photographer Diana Eastman shot this gorgeous photograph overlayed with a classic anatomical illustration from what I believe is Grey’s Anatomy……..

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The Alliance for American Quilts received 119 quilts for it’s 2011 "Alliances: People, Patterns, Passion" contest. You can see all the quilts here. My entry was “Redwork Quilt” and is included in this week’s (Week Four --Mon, Dec 5 – Dec 12) quilts being auctioned off on eBay.

All contest quilts will be auctioned via eBay starting on Monday, November 14, 2011 and ending December 12, 2011. All proceeds will support the AAQ and its projects. ….

Week FOUR auction guide: Monday, December 5 - Monday, December 12……

New this year: "Alliances" contest artist's were offered the chance to record their artist's statements thanks to the generous services of AAQ Business member, VoiceQuilt, visit them at www.voicequilt.com.

Holly Hobbie Trip Around the World Quilt

noreply@blogger.com (rlbates) — Fri, 09 Dec 2011 04:25:00 PST

I made this quilt and the one to be shown next week for twin baby girls. I didn’t want them to be just alike, but wanted them to be “connected” so I used some Holly Hobbie fabric I had left over from previous sewing/quilting in both quilts. This one is a trip around the world. It is machine pieced and quilted. It measures 34.5 in square.

Here you can see the center area featuring Holly.

I used this lovely pink butterfly fabric for the backing on both quilts.

DVT Prophylaxis – Two Articles

noreply@blogger.com (rlbates) — Mon, 12 Dec 2011 04:35:00 PST

There were two articles regarding deep venous thrombosis prevention in the November 2011 issue of the Plastic and Reconstructive Surgery Journal. Both are worth reading. I have supplied the full references below with links.

From the second article:

Between 1 and 7 percent of surgeons have personally experienced a venous thromboembolism–related patient death after high-risk plastic surgery. Plastic surgeons' self-reported practice patterns indicate a disparity between clinical understanding and clinical practice. The majority of surgeons can identify patients at high risk for postoperative venous thromboembolism. However, examination of their self-reported practice patterns indicates that a substantial proportion of surgeons (>50 percent) provide inadequate levels of venous thromboembolism prophylaxis for high-risk patients. In addition, surgeons recognize modifiable venous thromboembolism risk factors (such as oral contraceptive use) but may fail to modify those factors before surgery.

“Never event” is a poor descriptor for venous thromboembolism, as it implies that all events are potentially preventable. Breakthrough venous thromboembolism events routinely occur in the face of rigorous protocols and criterion-standard prophylaxis, as has been reported in the plastic surgery, orthopedic surgery, and general surgeryliterature. We observed multiple breakthrough events in the Venous Thromboembolism Prevention Study enoxaparin group, although the distinct causes of these events remain unclear. Unrecognized hypercoagulability has been identified as a major contributor to venous thromboembolism risk. Venous Thromboembolism Prevention Study data support the belief that a prior personal history of venous thromboembolism is an important risk factor as well (Table 3).

Venous thromboembolism represents a financial burden for patients and payers. The mean cost of hospitalization for an index deep venous thrombosis event is over $20,000. Previous work has shown that enoxaparin is a cost-effective method of venous thromboembolism prevention. In July of 2010, the U.S. Food and Drug Administration approved production of enoxaparin in generic form, which should result in substantially decreased costs to patients.⁴¹

For a complete overview of venous thromboembolism in plastic surgery, we refer readers to two excellent reviews that have recently been published by Miszkiewicz and colleagues and Venturi and colleagues. These reviews built on the foundation of several outstanding reviews and consensus statements published previously.

I added the references mentioned in the last paragraph to the section below. DVT prevention is important. It can be done safely. It needs to be done.

Deep Venous Thrombosis Prevention (June 19, 2007)

DVT Prevention (June 4, 2008)

Prevent Pulmonary Thromboembolism – an Article Review (February 23, 2009)

DVT Screening and Prevention (February 3, 2010)

REFERENCES

1. Changing Practice: Implementation of a Venous Thromboembolism Prophylaxis Protocol at an Academic Medical Center; Pannucci, Christopher J.; Jaber, Reda M.; Zumsteg, Justin M.; Golgotiu, Vlad; Spratke, Lisa M.; Wilkins, Edwin G.; Plastic & Reconstructive Surgery. 128(5):1085-1092, November 2011; doi: 10.1097/PRS.0b013e31822b67ff

2. Postoperative Enoxaparin Prevents Symptomatic Venous Thromboembolism in High-Risk Plastic Surgery Patients; Pannucci, Christopher J.; Dreszer, George; Wachtman, Christine Fisher; Bailey, Steven H.; Portschy, Pamela R.; Hamill, Jennifer B.; Hume, Keith M.; Hoxworth, Ronald E.; Rubin, J. Peter; Kalliainen, Loree K.; Pusic, Andrea L.; Wilkins, Edwin G.; Plastic & Reconstructive Surgery. 128(5):1093-1103, November 2011; doi: 10.1097/PRS.0b013e31822b6817

3. Miszkiewicz K, Perreault I, Landes G, et al.. Venous thromboembolism in plastic surgery: Incidence, current practice and recommendations. J Plast Reconstr Aesthet Surg. 2009;62:580–588.

4. Venturi ML, Davison SP, Caprini JA. Prevention of venous thromboembolism in the plastic surgery patient: Current guidelines and recommendations. Aesthet Surg J. 2009;29:421–428.

5. McDevitt NB. Deep vein thrombosis prophylaxis. American Society of Plastic and Reconstructive Surgeons. Plast Reconstr Surg. 1999;104:1923–1928.

6. Davison SP, Venturi ML, Attinger CE, Baker SB, Spear SL. Prevention of venous thromboembolism in the plastic surgery patient. Plast Reconstr Surg. 2004;114:43E–51E.

7. Young VL, Watson ME. The need for venous thromboembolism (VTE) prophylaxis in plastic surgery. Aesthet Surg J. 2006;26:157–175.

Shout Outs

noreply@blogger.com (rlbates) — Wed, 14 Dec 2011 16:42:45 PST

My thanks to @jordangrumet for this tweet. It gave me the motivation I needed to sit down and write. I have lacked it lately, unsure where my blog is headed with the job transition, not wanting to lose contact with my fellow bloggers. So thanks, Jordan.

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Glass Hospital is the host for this week’s Grand Rounds. You can read this week’s edition here.

Welcome to Grand Rounds, where writers, readers, and bloggers send in their best stuff on a weekly basis to share, cross-pollinate, and build new audiences.

Tip of the hat to Grand Rounds co-creator Nick Genes, MD, PhD, an ER doc in NYC who knows a thing or two about blogging, tweeting and now Tumblr.

a timeless and inspiring read...

The theme of this week’s Grand Rounds is “Finding Meaning in Medicine,” with full attribution to Dr. Rachel Naomi Remen, author of the masterful book Kitchen Table Wisdom: Stories that Heal. …………..

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H/T to @medicallessons who tweeted about this very unusual medical case in the NEJM: Disappearance of a Breast Prosthesis during Pilates (includes images)

A 59-year-old woman with a history of breast cancer who underwent bilateral mastectomy and placement of breast prostheses presented for evaluation, reporting that her “body swallowed one of the implants” during a Pilates stretching exercise ….

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Another plastic procedure gone awry documented in a NEJM case report (h/t to @Neil_Mehta): Blindness after Fat Injections

A 32-year-old man presented with vision loss in the left eye. one week earlier, while under local anesthesia, he had had an autologous fat injection into his forehead for correction of glabellar frown lines. The patient reported that while he was receiving the injection, he felt a sudden, severe periocular pain and had complete vision loss in his left eye. …..

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I found out via a Christmas card I received last week that a classmate from medical school was diagnosed with early mild cognitive impairment(mci) amnestic type last December. He began writing a blog to chronicle his journey as he progresses towards Alzheimer's disease: organicgreendoctor.

He was a Family Practice doc before he retired. He was/is a super nice guy.

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TBTAM has finally (smile) gotten around to giving us a list recommended NYC Restaurants

Home cooking is what I do best. And yet, the most frequent e-mail request I get from readers, friends and family is – “Where should we eat when we come to New York?” And so, after years of wracking my brain for recommendations, I decided to create a list here of the places I go to and like. Some I’ve reviewed here on the blog – Most I have not (even though I have dozens of pics and the best of intentions). But let me be clear – I am not a restaurant connoisseur. I’m just an ordinary New Yorker who knows what she likes. …..

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I never get around to reading all the books recommended to me, but still… Here’s a list from Seattle Times reviewers: 32 of the year's best books

………Here are the results — 32 books, 21 fiction (who says the novel is dead!?), 11 nonfiction. Top vote getters were three novels, "The Sense of an Ending" by Julian Barnes, "The Marriage Plot" by Jeffrey Eugenides and "Ed King" by David Guterson, and Erik Larson's work of nonfiction, "In the Garden of Beasts." ……..

Holly Hobbie Album Quilt

noreply@blogger.com (rlbates) — Fri, 16 Dec 2011 04:25:00 PST

This is the quilt that will go to one of the twin girls (see last week’s). It too uses the Holly Hobbie fabric. This time the Holly’s are featured in the center of each album block. The quilt is machine pieced and quilted. It measures 34.5 in square.

Here is a close up of the center block.
Here is the lovely pink fabric with the butterflies I used for backing for both quilts.

Panniculectomy Prior to Renal Transplantation -- an Article Review

noreply@blogger.com (rlbates) — Mon, 19 Dec 2011 05:47:10 PST

There is an interesting article in the current edition of the Plastic & Reconstructive Surgery Journal (December 2011). The focus of the article is a small subset of renal patients who need kidney transplants but whose abdominal panniculus excludes them due. A significant panniculus creates an infrapannicular area prone to increased moisture, skin maceration, and elevated bacterial counts, predisposing the patient to postoperative wound infections, necrosis, and dehiscence. Not good for anyone, but really not for someone on immunosuppression.

The article discusses the use of abdominal panniculectomy in these patients in preparation for the transplant. Nine patients , 3 men and 6 women, with a mean age of 54.5 years and a mean BMI 28.3 are the focus of the article. The focus is not a cosmetic abdominoplasty but a functional panniculectomy, most often of just the lower abdominal excess skin and not addressing the area above the umbilicus.

It must be remembered that this is a high-risk group by definition: ESRD, requiring a kidney transplant. Mean length of hospital stay of 1.75 days. No one required blood transfusions. All patients were followed postoperatively for 3 months. Complications included an abscess and a skin dehiscence treated with local wound care.

REFERENCE
Panniculectomy in Preparation for Renal Transplantation: A New Indication for an Old Procedure to Reduce Renal Transplantation–Associated Wound Complications; Kuo, Jennifer H.; Troppmann, Christoph; Perez, Richard V.; Wong, Michael S.; Plastic & Reconstructive Surgery. 128(6):1236-1240, December 2011; doi: 10.1097/PRS.0b013e318230c7b8Abstract

Backgammon Quilt

noreply@blogger.com (rlbates) — Fri, 23 Dec 2011 04:35:00 PST

I used a cotton tea towel printed with a backgammon board for the center of this quilt. I found the towel in the antique store when I discovered the bandana which I used for the “Say Cheese” baby quilt. I framed the game board with black strips and the red and yellow squares, then added a simple border of black fabric with white specks. The quilt is 48.5 in X 58.5 in. It is machine pieced and quilted.

Here is a close up of the center.
And even closer.
Here’s the back. The center strip is more golden yellow than it showed up in my photo.

The quilt is for sale on Etsy.

Christmas or Anytime Cooking

noreply@blogger.com (rlbates) — Sat, 24 Dec 2011 07:59:29 PST

I probably won’t get most of these made this year, but am posting them for future reference to myself. They definitely look worth trying.

H/T to @drmlb for the link to this one: Savory Omelet Muffins (Kath Eats Real Food Blog). The recipe includes cottage cheese, eggs, whole wheat flour, smoked salmon, and parmesan cheese. I make 5 muffins (a work week’s supply) and sound/look yummy.

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From The Foodie Physician: Holiday Spiced Nuts

She includes a second recipe in the same post for Rosemary & Honey Glazed Nuts. ………….

Makes 2 ½ cups or 8-10 servings
¼ cup packed light brown sugar
1 tablespoon cinnamon
1 teaspoon kosher salt
½ teaspoon cumin

¼ - ½ teaspoon cayenne pepper (depending on how spicy you like it)

1 egg white
2 ½ cups assorted nuts such as walnuts, almonds and pecans
Preheat oven to 350 degrees F. …………….

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Via @nytimeshealth Their Recipes for Health have had several vegetable soups recently which includes this one for Puréed Tomato and Red Pepper Soup and this one for Sweet Potato Soup With Ginger, Leek and Apple

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TBTAM reposted her recipe for latkes: The Latke Master’s Latkes

This latke recipe was good enough in 2007 to garner my blog a mention in the New York Times. ……….

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And don’t forget your dogs. I posted a recipe for dog biscuits a few years ago. Yesterday I made a some using another recipe. Here it is:

2 cups whole wheat flour

1/2 cups all-purpose flour

1/2 cup milk

1 tsp salt

1 Tbsp molasses

6 Tbsp butter or margarine

6 Tbsp peanut butter

1 egg

Mix all the ingredients. Knead for two minutes. Roll out to a little less than 1/2 inch thick. Cut with the cookie cutters shaped like bones/hearts/fire hydrants/etc. Bake at 325 degree for 30 minutes.

Merry Christmas!

Shout Outs

noreply@blogger.com (rlbates) — Tue, 27 Dec 2011 04:25:00 PST

The Boerewors Emergency Medicine Chronicles has a great post which I think is worth your time: On alzheimer's

…….....I think it is beautifully written and provides a real window into the difficulty of loving someone who has this disease.

“The thing with this sentence, this arrest of dementia, is that its greatest victims aren’t those who have it. That’s not to say that the diagnosis isn’t dreadful for the recipient, but there is a peculiar and particular hammering sadness for those that love and care for an Alzheimer’s spouse or parent.

It is a wearying and lonely obligation, but with the added cruelty that the person you’re looking after vanishes, escapes before your eyes. In the end, you’re caring for the case that someone came in………”

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Check out this post from @JordanGrumet who blogs at In My Humble Opinion: From Birth To Death

As luck would have it, she happened to die while I was in the room. I sat with her family as the last breath precariously left her lips. We waited for the next as if it was a forgone conclusion. It never came.
Walking toward the nursing station, my mind wandered back to medical school.
*
I tentatively followed behind the resident as we entered the birthing room. ………….

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Asystole is the Most Stable Rhythm (@doctorblackbear) tells us The Real Reason, On CBC Today

When I am asked the reason I chose medicine, I almost never tell the truth. I feel a little protective of the real reason and how it might be perceived by others, so I usually reveal some of my less sentimental and more cerebral motivations for becoming a doctor.

But, when given the opportunity to create a small radio piece about my grandad and how he continues to medically inspire me, I happily got to work……..

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A nice post from ImpactedEDNurse with tips on Managing the patient with an intellectual disability.

Managing patients presenting to the Emergency Department with an intellectual disability ( ID ) is one of the more ‘out of the comfort zone’ experiences for many nurses. Even more so, for the patient, who finds them self in strange and unfamiliar surrounds. Hey, its scary in here. ………………

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Check out Street Anatomy’s post: Skeleton Typogram (photo credit)

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Check out DinoDoc’s menorah’s

First Night of Hanukkah

Second Night of Hanukkah

Third Night of Hanukkah

Fourth Night of Hanukkah

Fifth Night of Hanukkah

Sixth Night of Hanukkah

Seventh Night of Hanukkah (photo credit)

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Moda Bake Shop has provided instructions for a Puzzle Box Quilt (photo credit)

Christmas Knitting 2011

noreply@blogger.com (rlbates) — Fri, 30 Dec 2011 04:31:00 PST

I didn’t do as much knitting this Christmas. A nephew actually asked for a couple of caps so I happily obliged. One uses Berroco Blackstone Tweed™ yarn and the other Berroco Vintage™ Chunky.

I managed to knit two scarves. This one for a niece using the Artyarns Supermerino and the Undulating Leaves Shawl pattern which I altered to make the scarf. It measures 6 in X 60 in.

This scarf I made for a sister-in-law. For it I used Berroco Boboli™ and the pattern Kernel by Bonnie Sennott. It measures 8 in X 68 in.

You can really see the lace pattern in this photo taken with the scarf hanging over a lamp shade.

Shout Outs

noreply@blogger.com (rlbates) — Tue, 03 Jan 2012 15:07:07 PST

Peggy (@tbtam), TBTAM, is this week’s host of Grand Rounds. You can read this week’s twitter edition here (photo credit).

ONCE UPON TIME…

Before Facebook and Twitter and Google+, and long before the word “social media” became religion, something called the Medical Blogging made its appearance on the world-wide web.

In those days, there was a small, close-knit community of medical bloggers ……..

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H/T @jilltomlinson for the link to this Lost Angeles, CA blog post which gives a great viewpoint on disfigurement, identity, perception & reconstructive surgery. It is from December 2010 but worth the read: MIRRORINGS: The late great Lucy Grealy on her face, tragedy, beauty and identity

There was a long period of time, almost a year, during which I never looked in a mirror. It wasn’t easy, for I’d never suspected just how omnipresent are our own images. I began by merely avoiding mirrors, but by the end of the year I found myself with an acute knowledge of the reflected image, …….

Long-term plastic surgery is not like in the movies. There is no one single operation that will change everything, and there is certainly no slow unwrapping of the gauze in order to view the final, remarkable result………

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Medpage Today’s article by Michael Smith, Face Transplants Offer High Yield With One Procedure:

Despite enormous complexity, full-face transplants can repair functional defects and improve major surface deficits that would otherwise take multiple reconstructive procedures if they were possible to do at all, researchers reported.

That conclusion comes in a report, online in the New England Journal of Medicine, on three full-face procedures carried out this year at Brigham and Women's Hospital in Boston…….

The NEJM article: Pomahac B, et al "Three patients with full facial transplantation" N Engl J Med 2011.

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H/T to @jordangrumet for the heads up on a new blog by @WilliamDale_MD. The blog is entitled WilliamDaleMD. His nice first post is Medical Health Record: a Personal Journey Down the Rabbit Hole

The Problem

“They told me I had to get the information myself,” she said.

“What? Why?” I responded, annoyed.

“They said it wasn’t in their computer, and that I’d have to get it myself. They said since you’re a doctor here, you could easily check the computer yourself and get it from medical records,” my wife continued.

“That’s crazy! I’m not allowed to look at the computer records; I could lose my job! And it’s much easier for them to get the paper records than me! ” I was incensed.…………….

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From DinoDoc, Musings of a Dinosaur , comes a thoughtful post: In the Trenches: Quality of Life

Why is it easier to talk about quality of life with patients who are dying? Why don’t we factor these considerations into the decision-making for patients with conditions that aren’t fatal?

The presence of a terminal illness serves to focus everyone’s attentions. Widespread cancer metastases? Concerns about tight blood glucose control fade away. End-stage liver disease? Blood pressure control doesn’t matter so much any more. Bony pain from prostate cancer? Narcotic and sleeping pill addiction doesn’t even occur to anyone. …….

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H/T to @tbtam for this tweet: “The year in street photography wp.me/p1Gna5-gh via @wordpressdotcom A young photographer hones her craft. I envy her.” So do I. Please check out her photography (better on a screen larger than your iPhone).

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A couple of weeks ago CBS Sunday Morning had a nice feature segment on the art of shopping bags. Check this out: The Museum of Bags (photo credit)

Handmade Journal

noreply@blogger.com (rlbates) — Fri, 06 Jan 2012 04:35:00 PST

I follow (loosely) the blog Sketchbook Challenge. It is a great source of inspiration (and intimidation). Several months ago I noticed the instructions (pdf file) for creating a fabric journal from Sue Bleiweiss. Here is my first attempt at creating a handmade fabric journal. It’s purple, so of course I mailed it to @purplesque.

Here is the base of the journal with the fabric fused to the pelmet vilene, bound, and pressed.

Here it is folded, prior to adding the paper.
Paper added.

I wasn’t sure how to do the closure. Will have to get more creative if I make another one. I sent two options: elastic gold ribbon

or tied with more purple ribbon.

Stephen Hawking, ALS, and Disability

noreply@blogger.com (rlbates) — Sun, 08 Jan 2012 13:47:30 PST

Stephen Hawking turns 70 today. He was diagnosed with ALS almost 50 years ago when he was only 21. It’s very unusual for someone with ALS to survive more than 5 years after being diagnosed. It is because of this dire prognosis that SSI gives a person who meets the listing (11.10) for ALS begins benefits without having to endure the normal waiting period (pdf file).

………individuals with disabilities must wait five-months before receiving SSDI benefits. Finally, after receiving their SSDI benefits, individuals must wait an additional 24 months before they receive Medicare coverage. (Exceptions to the waiting period have been
made for individuals with ALS, and for those with end-stage renal disease.)

Scientific America has a very nice article by Katherine Harmon: How Has Stephen Hawking Lived to 70 with ALS?

Stephen Hawking turns 70 on Sunday, beating the odds of a daunting diagnosis by nearly half a century.

The famous theoretical physicist has helped to bring his ideas about black holes and quantum gravity to a broad public audience. For much of his time in the public eye, though, he has been confined to a wheelchair by a form of the motor-neuron disease amyotrophic lateral sclerosis (ALS). And since 1985 he has had to speak through his trademark computer system—which he operates with his cheek—and have around-the-clock care.

But his disease seems hardly to have slowed him down. Hawking spent 30 years as a full professor of mathematics at the University of Cambridge. And he is currently the director of research at the school's Center for Theoretical Cosmology. …….

More Surgeon’s Caps

noreply@blogger.com (rlbates) — Fri, 13 Jan 2012 04:35:00 PST

These are caps I made between just before Christmas and the first part of January.

The first ones went to @doctorwes after he made his request for photos of Christmas themed clothing seen at work. Here’s a photo (credit) of him and a co-worker wearing the Christmas themed caps I made and sent to him.

I then decided I needed to use some of this lovely fabric from Africa given to me by an old high school friend to make @Bongi1 and @globalsurgeon surgeon’s caps. I gave bongi his choice and he chose the colorful ones. No photo of him wearing his, but received this nice tweet.

@globalsurgeon did share a photo of @ReinouGroen via twitter wearing one of his (theirs): yfrog.com/kk54exnj

These two went to @bramzo after he made an innocent comment in regards to @Bongi1 receiving his.

I have shared my pattern via google docs (pdf file).

Surgeon’s Caps (April 18, 2009)

Razorback Surgeon's Caps for a Colleague (Oct 17, 2010)

Shout Outs

noreply@blogger.com (rlbates) — Tue, 17 Jan 2012 06:37:10 PST

Gina (@geeners), Code Blog: Tales of a Nurse, is this week’s host of Grand Rounds. You can read this week’s twitter edition here.

How’d we get to Volume 8 already?! I think hosting this Grand Rounds finally ties me up with GruntDoc, who has hosted 7 times. Grand Rounds is the weekly round-up of blog posts by medical bloggers.

Whereas in the past the host would post nearly every link they received, it appears that we are now moving towards more curated content. I said in my previous post that I wasn’t going to institute a theme, but I was definitely more drawn to the personal-story type posts. Thanks to everyone that submitted! ……..

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Dr Rob is finally back blogging! His recent Musings Post explains: Plugging Back In.

This post is to announce two things:

I am back blogging again.

I am not blogging on this blog. I have a new blog called More Musings (of a Distractible Kind).

I also have a new project, Llamaricks, which is a blog that will hopefully draw audience participation. It’s a place for poetry; poetry by me and poetry submitted by my readers (assuming I have any). Hopefully there are people talented and/or shameless enough to submit their prose to me on that site.

OK, so I am already being untruthful. I really had three announcements. ……..

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There’s a nice discussion going on over at doc2doc: Poll: Should doctors self prescribe? Various opinions. Here are a few:

Probably antibiotics for infections would be ok, and something like Voltaren for artritis, or celebrex, but no controlled substances, this is where the water gets muddied.

……..

Doctors should not self prescribe nor under any obligation prescribe any medication for a family member or friend without their own "clinical consent" in regard to the medical condition in question.

……..

Generally doctors should not prescribe for themselves and any narcotic prescribing for self or family is a definite No. There is a saying that 'the doctor who treats himself has a fool for a patient' ….

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Then there’s this via @skepticscalpel: “Why internists shouldn’t operate MT @hhask @writeo After-hours surgery resulted in woman's death http://bit.ly/AA2DHL”

The link is to an article in The Oregonian by Nick Budnick: Oregon Medical Board sheds light on cosmetic surgery by Northeast Portland doctor that led to woman's death

For botching an after-hours cosmetic surgery that caused her friend's death, a Northeast Portland physician faces administrative charges and could lose her license.
Soraya Abbassian committed "gross or repeated" negligence while performing the Dec. 15, 2010 surgery, including administering what an autopsy found to be a fatal overdose of local anesthesia, according to a disciplinary complaint issued by the Oregon Medical Board on Thursday. ……….

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H/T to @scanman for the link to this letter written by John Steinbeck to his eldest son, Thom: Nothing good gets away

In November of 1958, John Steinbeck — the renowned author of, most notably, The Grapes of Wrath, East of Eden, and Of Mice and Men — received a letter from his eldest son, Thom, who was attending boarding school. In it, the teenager spoke of Susan, a young girl with whom he believed he had fallen in love.

Steinbeck replied the same day. His beautiful letter of advice can be enjoyed below. …..

Dear Thom:
We had your letter this morning. I will answer it from my point of view and of course Elaine will from hers.

First—if you are in love—that’s a good thing—that’s about the best thing that can happen to anyone. Don’t let anyone make it small or light to you.…………..

And don’t worry about losing. If it is right, it happens—The main thing is not to hurry. Nothing good gets away.

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Jordan Grumet Interviews Himself on his blog In My Humble Opinion (twitter handle @jordangrumet)

…….

Q: Taken as a whole, what is your blog about? What are the major themes?
A: If you asked me this question a few years ago, I would have said that my blog is a love letter to my patients. As I grow wiser, I realize that it is more accurately a love letter to my father.

When my father (a prominent oncologist) died, I was seven years old. As silly as it sounds, I spent a great deal of my childhood and young adult years trying to forgive myself for his death. Even though I knew I wasn't responsible for his aneurysm, I struggled with issues of being worthy of love.

As I read my own writing, I'm struck by the parallels. I fight to be protect my patients and lead them through the dying process, much in the way I wish I could have done for my father. …………

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Via Jackie-ES blog post: Join Patternfish and HeartStrings in Supporting WomenHeart (photo credit). I purchased the pattern, now to finish the projects I have started so I can knit this beautiful scarf.

Patternfish also launched a monthly charitable support initiative starting this month where the Designer of the Month picks a favorite charity and to which Patternfish will make a contribution. And I am the first to help kick off this initiative by choosing WomenHeart, the lifeblood organization devoted to improving the quality of life and the healthcare of women living with heart disease.

Patternfish will be donating $1.00 for each Thinking of You Scarf pattern sold during January to WomenHeart and I will match that dollar for dollar.

WIP -- African Whole Cloth Quilt

noreply@blogger.com (rlbates) — Fri, 20 Jan 2012 04:25:00 PST

A friend from high school gave me some gorgeous fabric from her travels. She was cleaning out her closets and I won the lottery. This gorgeous fabric is from the African continent (the stickers fell off so I don’t know for sure which country). It measures approximately 56 in X 76 in (photo only shows part of it). I couldn’t bring myself to cut it up into smaller pieces so have decided to make a whole cloth quilt.

I felt the animals and trees needed to be three dimensional, so have opted to use the trapunto method of sewing polyfil batting to the fabric and then trimming around each piece to remove the batting from areas that aren’t meant to “stand out.”

I then made a quilt sandwich of the quilt front, cotton batting (Hobbs), and the quilt back (which is a lovely green though the below photo has washed it out). I am now in the process of machine quilting the piece. I’m using outline or echo quilting.

Nice reference videos

ABC's of Quilting, Trapunto 101, Part 1

ABC's of Quilting, Trapunto 101, Part 2

Mindful of Two Breast Implant Scandals

noreply@blogger.com (rlbates) — Sun, 22 Jan 2012 07:32:35 PST

This year began with a breast implant scandal. This one has brought back memories of the one early in my private practice.

The current one involves the PIP-branded breast implants produced by the French company Poly Implant Prothese and rebranded by the Dutch company Rofil as Rofil M-implants breast implants. The first one involved silicone implants made by American companies including Dow Corning who no longer makes breast implants.

This picture of 3 implants includes: top -- an old McGhan double lumen (silicone gel implant surrounded by a saline implant); bottom left – Dow Corning textured silicone implant; and bottom right – Dow Corning smooth silicone implant. Dow Corning has not made breast implants since approximately 1992.

My post Breast Implants -- Some History (March 3, 2008) covers much of the history of implants in the United States. Kira Cochrane, The Guardian, wrote about the first patient to receive a breast implant:

It was in 1962 that Timmie Jean Lindsey was offered a solution to a non-existent problem. A factory worker from Texas, ….. And the doctors had another proposal. Had she ever thought about breast implants?

Lindsey had not. ….

……...She's 80 today, still living in Texas, working night shifts in a care home, and those first, experimental globes remain in her chest. ……

I would love to know if they are soft or have become hardened by capsular contractures. The article doesn’t say.

In the current breast implant scandal, I haven’t noticed anyone urging a class action lawsuit against the French company Poly Implant Prothese or the Dutch company Rofil. The big issues are 1. do the implants need to be removed or just checked and 2. who will pay for the removal, the government or the private clinics. The issue isn’t just a European one, it affects women in South American, Mexico, and the United States.

The old scandal in the early 1990s was handled by a class action lawsuit. I had not been in practice long enough for it to truly affect my then current patients, but I saw many who’s doctors were no longer in practice or non-plastic surgeons who has decided due to the scandal to quit doing breast implants. I did exams for free, but not the surgeries. I did, however, not raise prices or take advantage of the situation.

When I was in practice, I encouraged my breast implant patients to return every year or two for a complimentary breast exam. This keep us in contact so if anything (ie ALCL and implants, or faulty implants) came up I had current addresses. I made sure each woman had the information on her implants and encouraged her to keep up with it. I also encouraged the extended warranty on the implants. This helps settle who pays for what, at least for the first 10 years.

Women and their doctors need to be mindful that implants are foreign bodies we are placing into the human body. Women and their doctors should be mindful of future costs that might be incurred from breast implant surgery. In the United States, many things related to implants, especially those placed for cosmetic reasons only, are not covered by insurance or the extended warranty.

Breast Implants -- Some History (March 3, 2008)

FDA Updates Safety Data for Silicone Breast Implants (June 23, 2011)

ALCL and Breast Implants (January 31, 2011)

REFERENCES

1. Breast implant scandal: now women with Rofil M-implants 'are at risk'; The Telegraph, Matthew Holehouse, January 5, 2012

2. Breast implants – a brief history of the first 50 years; The Guardian, Kira Cochrane, January 11, 2012

3. Q&A: PIP breast implant s health scare; BBC Health News, James Gallagher, January 11, 2012

4. Confusion Reigns Abroad Over Faulty Breast Implants; MedPage Today, Cole Petrochko, January 13, 2012

5. PIP breast implants: European Commission says reform needed; BBC Health News, James Gallagher, January 14, 2012

6. Keeping patients safe: The case for a breast implant registry; The Atlantic, Anna Yukhananov, January 5, 2012

Sitting All Day is Damaging

noreply@blogger.com (rlbates) — Thu, 26 Jan 2012 15:48:16 PST

I take this type of information even more seriously than I used to given my new job which is very sedentary. Thanks DoctorMama for the link to this LifeHacker article: How Sitting All Day Is Damaging Your Body and How You Can Counteract It (photo credit)

Pedometers and Physical Activity (November 30, 2007)

Getting Back Into Shape (November 13, 2008)

Exercise Only Good if Done (March 18, 2009)

Finger and Wrist Exercises (April 19, 2010)

Get Up and Move (January 28, 2010)

re-su yukata Sweater

noreply@blogger.com (rlbates) — Fri, 27 Jan 2012 04:32:00 PST

I undertook this challenge back in October 2011. I recently finished it. I love/hate it.

The sweater is a shortened version of the re-su yukata pattern from the book Knit Kimona Too. The yarn is The Fibre Company Terra in black walnut.

I like how the sleeves fit. I like how the back looks.

I’m not happy with the tension of my band edge which always it to “wave.” The neck looks unsymmetrical to me.
I love the button and the I-cord closure.

I’ve put it aside for now. Trying to decide whether to keep it or give it to someone who wouldn’t see the flaws and would love it.

Suture for a Living

Monarchs

Additional Benefits to Reduction Mammoplasty

Shout Outs

Paper Airplane Quilt

Is It Okay to Return to Work?

Heavy Work

Medium work

Light work

Sedentary work

Shout Outs

Holly Hobbie Trip Around the World Quilt

DVT Prophylaxis – Two Articles

Shout Outs

Holly Hobbie Album Quilt

Panniculectomy Prior to Renal Transplantation -- an Article Review

Backgammon Quilt

Christmas or Anytime Cooking

Shout Outs

Christmas Knitting 2011

Top Eleven Posts of 2011

Shout Outs

Handmade Journal

Stephen Hawking, ALS, and Disability

More Surgeon’s Caps

Shout Outs

WIP -- African Whole Cloth Quilt

Mindful of Two Breast Implant Scandals

Sitting All Day is Damaging

re-su yukata Sweater