April 10th, 2009 by RamonaBatesMD in Announcements, Better Health Network
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I was reminded that April is National Donor Month by a post over at Donorcycle. I am a strong organ donation advocate. My driver’s license is signed. My family has been informed of my wishes.
It is a point of a contention in my family, hopefully a small one that will be resolved (or never come up for real). My niece, K, who is in nursing school has signed her driver’s license to be an organ donor. Her mother, my sister, J, will not give her permission if asked – not readily anyway. “I don’t want my baby cut up.” That is her reason.
My niece, K, is a giving soul. Her wishes should be honored. She should be allowed to make that last gift if the time ever arises.
I need to find a way to reassure my sister that we don’t “butcher” the body when donor organs are harvested. I need to get her to read Dr Cris’ blog post “Organ Donation from the Inside”
Transplant surgeons care about donors. Staff respect them, and the decision they have made. Their job in this case is to implement the wishes of the donor and not waste their sacrifice. …… I have assisted at an organ retrieval for transplant, and that is why I am on the Organ Donor Register
Another of my sisters recently was widowed when her husband died of heart failure. He had had many heart attacks over the last several years. In the end, he was told he needed a heart transplant. He didn’t live long enough, but I use this to show that the need it there. The need is great. If we would be receivers of the organs, then we need to be givers when able.
**This blog post was originally published at Suture For A Living.**
March 22nd, 2009 by RamonaBatesMD in Better Health Network
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This isn’t really plastic surgery related, but considering that I am always trying to get patients to get more active or to remain active, then maybe it is. I like to tell my patients that I have the easy part, they have the hard part of maintaining the results. This is especially true for the liposuction or abdominoplasty patients where keeping their weight in line is an issue to outcome in years to come.
There is a new article published in Circulation: Journal of the American Heart Association earlier this week which looked at different types of exercise after a myocardial infarction (MI).
The authors, Dr Margherita Vona et al, did a controlled trial using 209 patients who were referred to cardiac rehabilitation after having an MI. These patients were then randomly assigned to one of four groups: aerobic training, resistance training, both combined, or no exercise.
The researchers looked at flow-mediated dilation (improve blood vessel function) at baseline after 4 weeks of exercise, and then again one month after stopping training. The flow-mediated dilation more than doubled with exercise, from about 4% to about 10% in all three exercise groups. Those in the no exercise group had a small increase from the baseline 4% to about 5%.
The benefits of physical activity did not last when the activity ended. Within a month of no exercise, the flow-mediated function returned to baseline levels.
The important finding of this study is as Dr Vona said, “Long-term adherence to training programs is necessary to maintain vascular benefits on endothelial function.”
Exercise / physical activity has to be like “brushing your teeth”. It needs to be something that you do regularly and not just once or this week, but for life.
It is not important which physical activity you choose to do, it is important that you do it. It is important that you continue to be physically active on a regular basis.
Source
“Effects of different types of exercise training followed by detraining on endothelium-dependent dilation in patients with recent myocardial infarction”; Circulation 2009; DOI: 10.1161/CIRCULATIONAHA.108.821736; Vona M, et al
**This blog post was originally published at Suture For A Living.**
March 12th, 2009 by RamonaBatesMD in Better Health Network
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There is an article (see reference below) in the June 12, 2008 issue of the New England Journal of Medicine (h/t Medpage Today) that shows some amazing regression of hemagiomas using propranolol.
Hemangiomas of infancy are the most common tumor of infancy. They typically appear within a few weeks after birth and peak within three months. Hemagiomas are more common in girls than boys, more common in white than other races, and more common in preemies. Most of these lesions are innocuous and regress without treatment. Up to 75% shrink to insignificance by the time the child reaches school age. However, 5-10% of the lesions that will ulcerate during the rapid growth phase in the first 6 months of life. Ulceration is the most common reason for referral to specialists, and may be associated with pain, bleeding, infection, disfigurement, and scarring.
This one series of photos shows the results:
Panel A shows the patient at 9 weeks of age, before treatment with propranolol, after 4 weeks of receiving systemic corticosteroids (at a dose of 3 mg per kilogram of body weight per day for 2 weeks and at a dose of 5 mg per kilogram per day for 2 weeks).
Panel B shows the patient at 10 weeks of age, 7 days after the initiation of propranolol treatment at a dose of 2 mg per kilogram per day while prednisolone treatment was tapered to 3 mg per kilogram per day. Spontaneous opening of the eye was possible because of a reduction in the size of the subcutaneous component of the hemangioma.
Panel C shows the patient at 6 months of age, while he was still receiving 2 mg of propranolol per kilogram per day. Systemic corticosteroids had been discontinued at 2 months of age. No subcutaneous component of the hemangioma was noted, and the cutaneous component had considerably faded. The child had no visual impairment.
Panel D shows the child at 9 months of age. The hemangioma had continued to improve, and the propranolol treatment was discontinued.
Christine Léauté-Labrèze, M.D., of Bordeaux Children’s Hospital, and colleagues used the drug to treat two infants with heart disease (one with cardiomyopathy, the another with increased cardiac output) who just happened to also have hemangiomas. Unexpectedly, the lesions began to fade. They then used propranolol on nine other children with hemangiomas with similar success.
Johns Hopkins researchers have developed a protocol for the beta-blocker as a first-line treatment for the skin disorder. Propranolol could replace or supplement steroids such as prednisone which are often used currently. The children receive 1 mg/kg of propranolol on the first day, divided over three doses, and 2 mg/kg — also divided in thirds — after that.
Prednisone use carries the side effects of growth retardation, elevated blood sugars, and reduced resistance to infection.
Propranolol has side effects that include hypotension and hypoglycemia, but these are short-lived.
So far, Dr. Cohen and Katherine Puttgen, M.D., also at Johns Hopkins, say they have treated 20 patients with propranolol. Working with cardiologists, they decided to hospitalize the infants for the first two days of treatment to monitor for possible side effects such as hypotension or hypoglycemia. (They have seen none so far.)
Dr. Léauté-Labrèze, and colleagues reported that they are applying for a patent for the use of beta-blockers in infantile capillary hemangiomas.
REFERENCES
Propranolol for severe hemangiomas of infancy; New Engl J Med 2008; 358: 2649-2651; Léauté-Labrèze, C et al
Ulcerated Hemangiomas of Infancy: Risk Factors and Management Strategies; eLiterature Review (John Hopkins Medicine) , Oct 2007, Vol 1, No 4; Bernard A. Cohen, MD, Susan Matra Rabizadeh, MD, MBA, Mark Lebwohl, MD, and Elizabeth Sloand, PhD, CRNP
Related Blog Posts
Vascular Birthmarks (July 15, 2007)
Early Surgical Intervention for Proliferating Hemagiomas of the Scalp — An Article Review (Sept 1, 2008)
**This post was originally published at the Suture For A Living blog**
December 7th, 2008 by Dr. Val Jones in Announcements, Medblogger Shout Outs
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Dr. Ramona Bates is a plastic surgeon who quilts. Dr. Rob Lamberts is a primary care physician who loves animals that begin with the letter “l” (such as lobsters and llamas). The two have put their creative minds together to benefit brain cancer – in honor of a fellow blogger whose young son is losing his battle with the disease.
This holiday season, you might consider bidding on Dr. Bates’ “lobster quilt” to support brain cancer research. There is a silent auction in progress here. Owning the quilt would make a good story, and the return on investment could be priceless. You can search for updates on the auction on Twitter: #lobsterquilt
P.S. Note that Dr. Rob has also started a traveling lobster initiative – where Zippy the plastic lobster is photographed by medical bloggers around the world to enhance awareness of brain cancer. I had the honor of hosting this little crustacean last summer, and took him to the White House. To learn more about Zippy’s travels, check out this website: http://funwithzippy.com/
