Crying, she says: “Dr. Bates, my right implant has deflated. Help!”
“Don’t panic. It’ll be okay.”
We review the options and risks. Fortunately, her 9-year-old implants are covered by the 10-year plan.
“Dr. Bates, can I go bigger this time?”
“Yes, that’s an option.”
Smiling, “Then let’s do it.”
*This blog post was originally published at Suture for a Living*
I have written two posts in the past on proper disposal of unused medications, and I have always been mindful of the medicines as a source of environmental water pollution. This past week the American Chemical Society reminded (head-slapped me) that topical medications are a source of environmental water pollution from their active pharmaceutical ingredients (APIs). Yes, the simple act of bathing washes hormones, antibiotics, and other pharmaceuticals down the drain into the water supply.
Ilene Ruhoy, M.D., Ph.D. and colleague Christian Daughton, Ph.D. looked at potential alternative routes for the entry into the environment by way of bathing, showering, and laundering. These routes may be important for certain APIs found in medications that are applied topically to the skin — creams, lotions, ointments, gels, and skin patches. These APIs include steroids (such as cortisone and testosterone), acne medicine, antimicrobials, narcotics, and other substances. Read more »
*This blog post was originally published at Suture for a Living*
The entire March issue of Archives of Dermatology appears to be dedicated to skin cancer — melanoma and non-melanoma.
Basal cell carcinoma (BCC) represents 65% to 75% of all skin cancers. Most occur on sun-exposed parts of the face, ears, scalp, shoulders, and back. Intense short-term UVB exposure is important in the formation of BCC. Clinical features include pearly translucent flesh-colored papules or nodules with superficial telangiectasias (broken blood vessels). More active lesions may have rolled edges or ulcerated centers.
Squamous cell carcinoma (SCC) represent 30% to 65% of all cutaneous malignancies. SCCs are most attributable to UVB exposure, long-term or accumulative exposure over years. Clinical features include crusted papules and plaques that may become indurated, nodular, or ulcerated. SCC may arise in chronic wounds, scars, and leg ulcers. Recurrent SCC development within 3 years is 18%, a 10-fold higher incidence compared with initial SCC diagnosis in the general population.
Malignant melanoma (MM) represents the most serious of all cutaneous malignancies. It is estimated that approximately 65% to 90% are caused by UV exposure, predominantly UVA. Roughly 10% of all melanoma cases are strictly hereditary. Read more »
*This blog post was originally published at Suture for a Living*
Interesting article in the Huffington Post last week by Dr. Glenn D. Braunstein: Oh, You Beautiful Doll: Plastic Surgery Risks and Rewards. The article discusses the “Barbie Syndrome” or more accurately “Body Dysmorphic Disorder.” I love this line:
And, finally, try to have realistic expectations — it is unlikely that cosmetic enhancement is going to drastically change your life — after all, you are human, and not a plastic doll.
The article reminded me of my post on Suitability. Not all patients should have surgery. Their reasons for desiring surgery, goals, and expectations should be discussed during the consultation. Risks and benefits must be weighed.
*This blog post was originally published at Suture for a Living*
Until recently, the therapeutic use of non-cosmetic Botox (botulinum toxin) for adult upper extremity spasticity was considered off-label use. The U.S. Food and Drug Administration (FDA) has now approved Botox to treat spasticity in the upper extremity flexor muscles in adults.
Spasticity is common after stroke, traumatic brain injury, or the progression of multiple sclerosis. Spasticity is defined as:
“a motor disorder characterized by a velocity-dependent increase in tonic stretch reflexes (muscle tone) with exaggerated tendon jerks, resulting from hyper-excitability of the stretch reflex as one component of the upper motor neuron syndrome.”
Spasticity often creates problems with mobility, self-care, and function. The spastic muscles can become stiff. Associated joints can be affected by lack decreased range-of-motion with contractures forming. Read more »
*This blog post was originally published at Suture for a Living*
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…
I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…
Book Review: Is Empathy Learned By Faking It Till It’s Real?
I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…
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…
Eat To Save Your Life: Another Half-True Diet Book
I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…
