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Female Wounded Warriors

I am a proud University of Arkansas alumni. The current issue of the alumni magazine has a short segment on Janet Cater and her work with female wounded warriors. Her research on military women amputees earned her a doctoral degree in rehabilitation counseling.

I did a Google search and was happy to find she has a blog: Female Wounded Warriors Posterous. There were only four entries but they allow an understanding of her research project.

The first one, Institutional Review Board Information (November 10, 2009), lays out the goal:

I am seeking to understand the psychosocial adjustment issues experienced by women veterans who have had a traumatic amputation. I am interested in your life experience.

The second one, Volunteer To Help Future Wounded Women Warriors, presented the goal and method again:

My study seeks to understand the adjustment issues faced by American women warriors who experience a traumatic amputation. At the present time there is no published research. As the number of women warriors returning with physical disabilities increases, it is vital that medical and mental health support staff understand the unique challenges these women face. Over 220,000 female soldiers have been deployed to Iraq and Afghanistan for one or more tours of duty. As of August 2009, a total of 121 women warriors have died, and it is estimated over 620 have received serious injuries. This study will use internet interviews using Skype to understand this life experience. Each woman will be invited to tell her story of how she adjusted to life as an amputee with the assurance of confidentiality. Read more »

*This blog post was originally published at Suture for a Living*

About Weightlifting And Breast Cancer

Last August, Kathryn Schmitz, PhD, MPH and colleagues published the results of their study Weightlifting in Women with Breast-Cancer–Related Lymphedema (BCRL) in the New England Journal of Medicine. They have now published a similar study in the Archives of Internal Medicine (see full reference below).

While the NEJM article focused on breast cancer survivors with lymphedema, the Archives article focuses on breast cancer survivors without lymphedema. The new study adds weight for the need to change historic dogma which cautions breast cancer patients to avoid weight training after a mastectomy and or axillary dissection. Read more »

*This blog post was originally published at Suture for a Living*

About Male Breast Cancer, Gynecomastia, And Testing

Most medical centers routinely perform or require that breast tissue be sent to pathology for histologic examination.  The authors of the article (referenced below) question whether this is useful when the breast tissue excised comes from an adolescent male with gynecomastia considering the benign nature of the condition.

Furthermore, the authors point out male breast cancer is rare and when it does occur it is most often in older males, not adolescent males:

In 2009, there were an estimated 1,910 new cases and 440 deaths related to male breast cancer, accounting for just 0.25% and 0.15% of all new cases of cancer and cancer deaths for males in the entire United States, respectively, with historical cohorts demonstrating that the peak incidence of male breast cancer occurs at approximately 71 years of age. More significantly, breast cancer becomes increasingly uncommon among younger age groups.

To look at the issue, the authors did a retrospective chart review  of their patients younger than 21 years of age who had undergone subcutaneous mastectomy for gynecomastia between 1999 and 2010. A review of the literature was done, as was an informal survey of major children’s hospitals regarding their practice of histologic examination for adolescent gynecomastia. Read more »

*This blog post was originally published at Suture for a Living*

Hand Or Arm Transplantation: When The Body Rejects It

Dr. Richard Edwards, a chiropractor from Oklahoma and the nation’s third double-hand transplant, was recently in the news again. This time it a report that he “may lose the fingertips on his right thumb and pinkie because his body started to reject the new limbs.”

Dr. Edwards’ surgery was live tweeted when it was done in August by Louisville surgeons at The Jewish Hospital Hand Care Center.

Jeff Kepner, the first patient in the United States to receive two hands simultaneously, experienced an episode of rejection which was dealt with successfully.

Rejection is never a good thing in a transplant patient no matter which organ or body part is transplanted. Even though I applaud the advances being made, we must always consider the cost of the proposed treatment and ask: Is there a better option for this individual? Read more »

*This blog post was originally published at Suture for a Living*

The Rationing Of Healthcare

Do you recall the severe rationing of food and water the Chilean miners had to endure to survive? The rationing was done to stretch their limited resources. I would argue the state of Arizona’s new policy to not cover organ transplants for patients on Arizona Health Care Cost Containment System (AHCCCS) or their version of Medicaid is a similar form of rationing.

AHCCCS, as many Medicaid programs, is underfunded. They are trying to operate on a limited budget. Something has to give. Sadly in this case, many (NPR reports 98) had already been granted approval for organ transplants which they may not receive.

Francisco Felix, 32, who due to hepatitis-C needs a liver transplant, is reported to have made it to the operating room, prepped and ready for his life-saving liver transplant when doctors told him the state’s Medicaid plan wouldn’t cover the procedure. The liver he was to receive went to someone else. Read more »

*This blog post was originally published at Suture for a Living*

Latest Interviews

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It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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