31 October 2010

What would YOU do?

Religion is always a touchy subject.

I was brought up without the routine of church every Sunday. I remember my 5th grade art teacher being appalled when I told her we had too much to do, we simply did not have time to sit in church. Yet, I turned out OK. (Then again, I have never been much of a sitter--more of a doer--I even have a hard time watching TV or a movie. I feel that there is so much more that I could fill that time with... such a waste.)

Let me say, before I lose the small audience that I do have, that I am a very spiritual person. I definitely believe in a higher power, but I am more inclined to believe in nature (Mother Nature) than in an overseeing man. hmmm, so, in effect, is it the sex of the force with which I take issue? I do not think so. Taoism somehow feels right to me, but I really have to study more. I also am very interested in Buddhism. So much to see and learn.

The reason I am bringing up this subject? What do I do, when a patient asks, "Are you Christian, doctor. Will you pray with me?" It has happened on more than one occasion, and in the past, I have prayed with them in my own way... but I always feel somewhat of a phony. This is especially true since prayer is not so much used in Taoism and Buddhism--more of a meditation or conjuring, for lack of a better term. Considering my field, I expect to be asked to pray many times in the future.

So, what do you do? What do you think is appropriate?

04 October 2010

little rant

I find it quite irksome when people who should know better "verb" adverbs or nouns. I just read an article that said, "... you can up your intake..." UP IS NOT A VERB, people!! Neither is lunch ("let's lunch"), Kohl's ("the more you know, the more you Kohl's"), and many more...

I remember in college, when I saw this on a t-shirt for one of the campus fraternities: "we've upped our standards, so up yours." It was funny then. And, they were fraternity brothers... they had an excuse. But this?!

I have seen this kind of grammatical suicide in news articles, magazines, on professional blogs... even have heard this on radio news. (I do not watch TV, so for all I know, it is happening there, too.) Is it laziness? simple lack of knowledge?! Are we allowing too much informality in our lives?

02 October 2010

Guatemalan experiments

I came across this in the news today, and was plainly shocked.

In today's society and times, human subjects are very closely guarded. Any time a researcher wants to do as much as reviewing charts, one has to get permission from the institute's IRB (Institutional Review Board), after taking a tutorial and test about human subjects.

The fact that a power such as the United States took advantage of the poor and minorities is incomprehensible to me. Between 1946 and 1948, Dr. John C. Cutler was involved in a study in Guatemala. He infected 696 people with syphilis (+/- gonorrhea) by sending infected prostitutes to call on prisoners and enlisted men alike... anyone resistant was inoculated directly. The records are fuzzy as to whether the men were then treated with penicillin, or what the dose was--never mind the prostitutes. Dr. Cutler was apparently also involved in the Tuskegee Study in Alabama. At the Tuskegee Institute between 1932 and 1972, 600 black men who had syphilis were followed (all in the name of science and medicine, certainly) without being offered treatment. In both of these cases, the people involved did not know that they were being used as human test tubes... experimental subjects.

The Eugenics movement started around the same time--in the early 1940s--with the introduction of Planned Parenthood. Eugenics is the belief that certain people are unfit to breed and pass on their genes--and so they should not. We all joke that there should be a permit to procreate--to have children--these people were not joking. For people like Margaret Sanger, population control was the name of the game. Honestly, I had no idea that this was the impetus behind Planned Parenthood!!

30 September 2010

calling names

I just ran across a blog written by a family practice resident, pontificating "What's in a name?" I find this to be an interesting topic, as I have struggled with it myself in the past.

This, I feel, is very generational, as well as regional. ie: I am much more comfortable calling my colleagues by their first name when they are close to my age (by which I mean within 20 years). However, my soon to be partner is 73, and although I call him by his first name in private conversation with my guy (always preceded by a pause and followed by a giggle), you can bet I call him Dr when speaking to him. (He, by the way, calls me everything from "gorgeous" to "sweets..." although generally, he calls me by my first name. In case you wonder, I don't mind--his demeanor is such that it completely does not sound crass or degrading.) I also have a neurologist friend who is about 3 years shy of being my parents' age. When he asked me to call him by his first name, it took a while (and several slip ups) to get used to.

As for regional: I did my med school clinicals all over the states, followed by residency/ fellowship in the East. I can tell you that in the midwest, it is much more common for Drs to introduce themselves by their first name to other healthcare professionals. It is understood that they, in turn, will be introduced as "Dr" to patients. As soon as I came to the East Coast, it was Drs all around. This makes me often feel pretentious, so I will frequently introduce myself by my first and last name, followed by my specialty. I let them decide what to call me. And, for the most part, I will eventually correct them to call me by my first name in private.

As for patients, I am not too interested in being buddies, so I introduce myself as Dr. Older patients appreciate the formality, for the most part. Although, I have had elderly patients insisting on knowing my first name--and then calling me by that name--which made me feel a little like I was talking to my grandparents. Also, being young and attractive, I have been hit on by patients (of all ages), and I believe that introducing myself as "Dr" nips that possibility in the bud--sometimes. On the other hand, introducing myself as my first name invites that kind of discussion.

Of course, things will be a little different very soon. I think that at my new position, I may introduce myself to patients as first and last name, and let them choose... or maybe the first name will suffice. Cancer is a place where it's nice to have a buddy.

20 September 2010

Prisoners and Food... and punishment

I have to admit, I am having very mixed feelings.

Yesterday, my guy and I went to our local farmers' market, where I picked up a throwaway magazine on local foods. Leafing through it, I found an article that caught my eye: "On the Line: Correctional Dining."

Before I got there, I read the editorial page. There had apparently been an article a few months ago which caused quite a stir. The editor pointed out the article to which I alluded above, and said that he "expect(s) much controversy surrounding it." I thought to myself, "Yes, from all of those human rights groups, I am sure, to protect the poor prisoners."

Then, I read the article.

I have to say, I am not sure what to think. Let me explain: I never realized that the prison system uses food as punishment. Apparently, there are three levels of punishment. In brief: if a prisoner is cited for a "level I infraction," (s)he may lose visitation rights. A tier II infraction may get them to solitary confinement. Tier III, however, may get the prisoner the joy of eating "the loaf."

Now, nowhere in the article do they state what the said loaf actually contains. However, apparently the prisoner has to have medical clearance to "go on the loaf" for all of the digestive disarray it causes. It is served simply, with water and boiled cabbage "to aid digestion." Of course, with the internet at my fingertips, I had to see if I could find out what is in this mystery concoction. The best I could do, was this recipe and report from NPR. I have to say, there has to be more to it, as this really sounds not all that bad. I mean, it doesn't sound gourmet, by any stretch, but not too horrid, either.

My initial thought was, "What the hell do I care what they eat--they are PRISONERS, after all. Let them eat bread and water for all I care." That being said, here is my quandary: Another (quiet, minuscule) portion of the original article mentioned that the rates of obesity, diabetes and hypertension are on the rise in prisons.

Damn, it makes sense. They are not getting nutritionally sounds meals, so diet-based diseases are rearing their ugly heads. (There are apparently quite a few prisons that try to cut costs by only serving breakfast and dinner Friday, Saturday, and Sunday. This forces inmates to fend for themselves--often in the form of ramen noodles and freeze-dried foods from care packages. beef jerky, anyone? hmmmm, salt, fat, sugar, and more salt) This pulls more of our tax dollars to treat these people. Their diets don't change, and it's a vicious cycle. In fact, the article goes so far as to state that if a prisoner cites that they have religious requirements for food (halal, kosher, or vegetarian, for instance), they are immediately under suspicion... for, although those meals are not significantly more nutritious, they are minutely more expensive to manufacture.

If we went for prevention instead of treatment, we would inevitably spend a lot less. Well, this, of course, works for health care all around. Unfortunately, when you can get a taco at Taco Bell for 89 cents, why should you shell out four bucks for a dozen farm-fresh eggs... or $2.50 for a bunch of kale, for that matter, which you will have to then (oh, horror!!) cook!!

The United States public has, sadly, been lulled into a sense of instant gratification, sugar rush and fat/ carb coma included. But I digress...

Wouldn't it make more sense to have these prisoners spend some of their time tilling soil and producing their own food? That way, they would get more nutritious fare, but at the expense of work hours, not tax dollars. I mean, the inmates that behave are allowed to work in the kitchen. They just have to account for any utensils or can lids that they use or discard. The same could be done for garden/ farm work. Prisoners take classes, attend workshops... this would be just another offering.

I know, I am a dreamer...

17 September 2010

They are not alone!!

Apparently, there are more "sport supplements" which are being recalled. This is in addition to yesterday's shocker.

There is this one, for Advanced Muscle Science. Also, this recall from Fizogen is in effect.

All for the same key ingredient: aromatase inhibitors (AI). oh, brother.

The FDA has told Fizogen and Advanced Muscle Science that the particular AI "does not meet the definition of a dietary ingredient." Well, it's good that the Food and Drug Administration recognizes this.

16 September 2010

Holy CRAP!!

Wow, I am about to sound terribly naive, but... here goes:

OK, so being a breast oncoplastic surgeon, I am quite familiar with the medication Arimidex (generic: anastrazole). This medication is used as adjunctive therapy in post-menopausal breast cancer patients whose tumors manifest estrogen receptor positivity. In short, the medications decreases the amount of estrogen that a woman's body makes. The less estrogen that is present, the less the cancer "feeds," and this slows down or altogether stops cancer growth.

In case you think that this medication is the "white knight" in the middle of the dark nightmare of breast cancer, don't forget that it has its own host of risks. In fact, the active ingredient will chomp away at bone, leading to osteoporosis (why we are crazy about bone density tests and why dentists hate it when we use this--it can cause mandibular necrosis) and it can cause liver dysfunction (why we check liver function when you are on it).

Imagine my surprise, when I got this FDA alert today: G.E.T. Issues Vouluntary Recall of ArimaDex. Not only is voluntary misspelled, but I was aghast that Arimidex was misspelled... and then I actually READ what was in front of me. First off, I don't know who "G.E.T." (Genetic Edge Technologies) is, but Arimidex is made by AstraZeneca. The real shocker is that this (ArimaDex) medication "may (actually) contain an Aromatase Inhibitor." Oh. My. God.

The same active ingredient that is in the breast cancer drug is now available OVER THE COUNTER in your local sports supplement store!!!! In fact, I cannot place enough exclamation points behind that sentence. I am beyond appalled, flabbergasted... I don't even know the correct word. I think I want to cry, in fact.

I just googled this stuff, and it actually says that this is an "Estrogen blocker...(that has) been shown to enhance and maintain testosterone levels." um, well, yes. Even Amazon is selling it.

Please, please, spread the word--this is NASTY stuff. And yes, it has all of the risks I mentioned above... and more: kidney failure, adrenal insufficiency, not to mention decreased sperm function.

12 September 2010

geniuses... and seriously smart people

I had to share this story with you, so you could laugh, shake your head, or both. Apparently, some real savant was testing the wit of his local men in blues. Probably not a good idea to play with their toys... especially right under their noses!

And then there are the Romanian fortune tellers, who as far as I am concerned, are truly visionary. Again, they won the fight to avoid tax payment... and with solid reasons. nice.

02 September 2010

no one left behind

Just in case you thought that Whole Foods qualifies as a "local, small farm." It does not, and certainly the Whole Foods chain is not immune to its own FDA recall.

Granted, this is a preemptive recall of sorts--no one has reported getting ill, yet. But, during "routine sampling," the cheese in question was found to be contaminated with Listeria monocytogenes and Staphylococcus aureus.

buy local, know your food, support small farms

01 September 2010

watch out, furry ones

While the rest of the world blogs about docs stuck in chimneys (seriously?! what a dumb-ass) and fancy new google tools (well, not entirely new), I'd like to turn your attention to this: ANOTHER FREAKIN' CAT FOOD RECALL!!

I don't know why this aggravates me so... oh, yeah, because their livelihood is in our hands--completely. And, wouldn't you know it? Salmonella is the culprit, yet again!

As for the huge egg recall, I'll just say, "I told you so." Yes, I have been touting the benefits of buying from local, small farms for a long time. Yes, it may be a little more expensive, but what price is your health? I speak from experience--I have had Salmonella poisoning before. Once on vacation: bad Chinese, and once more recently: the tomato recall. Granted the vacation bug was so, so much worse than the tomatoes, but, then again, I ate only one of the tainted fruits.

As for the Iams? Again? Iams cat food was recalled previously, and not that long ago--in fact, just a month ago. grrrrr

28 August 2010


Here's an unusual, but very realistic, way to get some money together.

With breast augmentation the second most popular elective plastic surgery procedure in the world (second only to liposculpture), this is not so far-fetched. In a country like Venezuela that needs a dramatic government overhaul, this sounds like a great idea to me!!

27 August 2010

the way of our words

Linguistics is just a cool field all-around.

This site
is very interesting, especially to those of us from other countries, or who grew up with accents surrounding our day-to-day. You can browse the sound of the English accent in different cities and countries. I think it would be even more poignant if they had a male and female version of each, but maybe that's just me...

What they do provide is information on each speaker, including: age, years speaking English, how they learned the language (naturally or academically), and whether they ever lived in an English-speaking country. Hell of a project, really.

23 August 2010

must... post

I wasn't planning to, as it is quite hard with only one functional upper extremity (more on that later). But, on a whim, I visited a site I hadn't in a while, and felt compelled.

You see, we had had a party a few weeks ago. I always make several types of sangria, but this time felt inspired to try something new. After a little research, as well as trips to three (yes, 3!!) liquor stores to find the magical ingredient, I made my own Pimm's Cup. Now it can be yours. Necessity being the mother of invention, you will find mine to be different from the original.

you need:
equal parts Pimm's No.1, fizzy lemonade, ginger ale (original, with ginger pieces floating inside)*
mint leaves--about 20
small cucumber--sliced
1/2 pint blueberries (I inadvertently had used the last of the strawberries for the sangria)

you do:
mix in a large pitcher
serve over ice

*of course, you could use one or the other, or even ginger beer, but I really thought that this was especially refreshing, and not too ginger-overpowering

this easily scales up or down :)


17 August 2010

corn--quintessential summer (kind of)

So, yes, corn IS the quintessential summer veggie, but the recipe I am about to throw at you is not, AT ALL, quintessentially summery... in fact, it is, quite frankly, late autumn-wintery. That being said, we do not have the luxury of an outdoor grill. And, well, oven-cooking is slightly less heat-inducing than stove-top cooking. So, there you have it...

"Oven-Roasted Corn"... or maybe "Oven-Braised Corn" would be a better title

you need:

6 ears of corn; peeled of leaves and silk, washed and split in half (dry lightly)
4-6 garlic cloves--minced
1/4C olive oil
1/4C vegetable broth*
couple of pinches of salt and pepper
few sprinkles of marjoram
(any other herbs/ spices to your liking)

you do:

-preheat oven to 350F
-place ears of corn in large enough baking dish that they are not overlapping, but cozy
-sprinkle corn with salt, pepper, marjoram, and any other herbs or spices you wish to use
-sprinkle with garlic
-mix olive oil and vegetable broth and pour over corn
-cover tightly with aluminum foil and place in oven for 30 minutes
-turn corn (add a little more broth or water if dish is dry)**
-cover again with foil, and back in the oven for another 30 minutes
-turn the oven up to 400F and take off foil (again, add broth or water as needed)**
-allow to bake an additional 15-20 minutes


*of course, home-made broth beats out any store-bought. in a pinch, I find Trader Joe's (!-yes, Trader Joe's) to work well
**remember that steam will be hot when you take off the foil--do this carefully, and away from your face!!

03 August 2010


OK, so for crazy people like myself, this is reason enough to have a baby!!

It is such a cool contraption--it does EVERYTHING!! And they have funky, chic little freezer trays for left overs. I have always thought that if I had a child, I would definitely cook my own baby food. This little guy makes it effortless. I am considering buying one now... joking! (OK, only partially joking)

Obviously, I would have to buy every one of the accessories. OK, no buying... this is THE ONLY thing that needs to go on the baby shower list, as far as I am concerned. (That and a remote-controlled helicopter for my guy, of course.)

02 August 2010

babies... and recalls...

Another day of recalling. This time on NeoProfen, which is an injectable ibuprofen.

This is a form of non-steroidal anti-inflammatory which is used in neonates with patent ductus arteriosus. In this congenital malformation, there is aberrant blood flow between the aorta and pulmonary artery. This type of blood flow is actually normal in fetal anatomy, but the connection normally closes soon after birth. The abnormality is relatively common in the United States, occurring in 8 per 1000 births.

The injectable medication in question has a specific patient profile, including gestational age and weight. In this case, the medication did not meet a quality standard, and this recall will result in a shortage, since the lots that are being recalled are the only lots available.

People that need to know: parents of patients, pediatricians, neonatal cardiologists, pediatric surgeons, and anesthesiologists.

30 July 2010


One of my favorite patients, who has become a friend, just reminded me of something terribly important.

When we are medical students, interns, residents... we LOVE the adrenaline rushes. We love the interesting patients.. the "once in a lifetime"s... We want to see and experience all of the 'wows.' We trade stories, often elaborating and honing our emphasis on this or that, to make it sound that much more dramatic, we accentuate, we underline, we really lay it on--suddenly, there is blood everywhere, guts are flying, the nurses are frantic, and then we come in and save the day. Don't get me wrong. Sadly, it really is like that, sometimes. But as attendings, it's just our day-to-day... and not the pleasant part of day-to-day.

As an intern in Michigan, we didn't have the 80 hour work week. We worked often in 36 hour shifts, to go home and sleep (hell, who am I kidding, we didn't, actually, sleep--we partied and danced), to come back and do it all over again. We RAN to codes, to see interesting patients. We stayed much past those 36 hours often, to see a rare, or "cool" case, or even just to hang around, in case one came in.

For my surgical residency, I chose to come to New York, but not some posh little hospital. Nope, I went for the hell-hole, in the middle of a crime-ridden area, which farmed us out to other crime-ridden areas in every borough (save Staten Island) and Jersey. During my 3rd year (I think) the 80 hour work week came into effect. We were threatened by our superiors to lie on the forms, as NONE of us worked fewer than 100 hours/ week... although usually more, we lost track... and most of us (yours truly at the top of the list) didn't mind lying. How else would we see all of those funky, excellent cases?!

Hand fellowship--no different. But by this point, my philosophy changed a little. I did this in the South Bronx at a city hospital. Scary place, scary patients... a lot of unethical people (hospital personnel included)--exactly what I wanted--because I knew I would train here and see the worst of the worst so that I could handle anything... Even though I hoped I would never see it again.

When we come to our own as attendings, we really love boring. We don't want to see those one in a million cases. Don't get me wrong, we can handle it, because we are wired to do so--especially as surgeons, I think we are such adrenaline junkies that we LOVE those cases as much as we HATE them. We still boast to our colleagues, all the while praying to whoever our Gods are that we never have to face that again... and going to the hospital at all hours to check up on that patient. just in case.

My breast fellowship, I approached differently. Of course, this was after a few years "out in the field." I knew exactly what I wanted out of it, and I made sure that I got it. Yes, I did see some interesting cases, and yes, I made some mistakes. In the end, the attitude was "well, now I know how to handle it, and I really hope I never see it again." (By the way, in regards to my earlier post, I met a very successful plastic surgeon, who said that he had no less than 10--TEN!!--such cases in his first year. The candidacy and straighforwardness were almost more alarming than the fact.)

So now, when I hear that my patient... my friend... had an uneventful chemo day--after too many events, too much excitement (and not the pleasant kind) on this road of breast cancer diagnosis and treatment--I am no less than thrilled.

29 July 2010

Food, revealed

Apparently, I am on a food-writing kick. But I really couldn't allow you to pass this up. This is such a cool site, and I highly recommend you check it out!! It takes a little while to load, as there are big files. Be patient, it is soooo worth it!!

You have never seen your fruits and veggies like this before. My favorites are the watermelon and corn--they look like they are fluttering--and the mushroom--which looks like a sea creature. Wouldn't you love to see a chanterelle or a wood's ear? Or ANY of these beauties!! (It helps that mushrooms are some of my favorite things to eat, too.)

OK, that's it for today. Have fun!!

26 July 2010

Renaissance Fantasies

I am seriously jonesing... (OK, given the context, that's pretty funny: my computer, not recognizing 'jonesing' offered to replace with 'jousting.')

At any rate, I am having Ren Fest withdrawl. Have you been? I adore Renaissance Festivals. Everything from the wardrobes to the mysticism, to the "English" accents (let's face it... they often sound Irish in truth... or sometimes even Russian--Master Card and Lady Visa is just cooky enough to make me smile every time), to the food... the jewelry (ah! the jewelry), and the shows--the bawdy comedy is probably my favorite.

I have attended Renaissance Festivals in Kansas City, Michigan, and now in my new home--New York. Each has been attended by yours truly multiply. Yes, I even dress up--usually as a gypsy, which is easy for me (what does that say?) and not crazy weird (just weird enough). My favorite faire is likely Kansas City. I think because it was my first, and I have many wonderful memories of that particular one.

They are all big, and full of adventure. You are likely to see a wedding, or two. Lots of kids dressed up on some adventure... or playing a game. Belly dancers, people eating huge turkey legs (not terribly appetizing to see, if you ask me, but it's all part of the fun), hawks and vultures, strong man contests, jousting, even, if you are so inclined (I, somehow, never have been, but...)

So, wanna come to the Renaissance Faire?

13 July 2010

Zucchini--yellow (green) bean--dill soup

OK, so another recipe. The original was given to me by a buddy, but I have changed it around quite a bit to make it my own. I suggest you do the same!

This is a great summer soup--light, yet filling. It would be great with some crusty bread and olive oil, or with an herb salad.

You need:

1T grapeseed oil*
5 medium zucchini (yellow or green) sliced in half, then into thin half-moons**
1 small onion--roughly chopped
5 (or so) fresh garlic cloves--finely chopped
1/2 C fresh dill--finely chopped
1/2 C fresh cilantro--finely chopped
1C yellow or green beans**--cut into ~1cm pieces
4C veggie stock (yours or a good quality)
3-4C water (depending on how thick you want this soup)
salt and pepper to taste

You do:

1. heat the oil in a nice-sized soup pot.
2. saute all of the veggies, with the dill and cilantro, in the oil.
3. once everything is nice and soft (at least 15 minutes), pour in your stock and water (if using). allow to simmer about 10 minutes to marry the flavors.
4. add salt and pepper to taste.
5. allow to cool a bit and puree in batches in a table top blender... alternatively, you can use a hand-held submersible blender--just be aware that if this splatters and is still hot, you WILL burn yourself. I like to puree just a bit and still leave some chunky veggies.

* you can also use the same measure of olive oil or butter
** if you want a pretty soup, stay with one color--ie: if you use yellow zucchini, then use the yellow beans, if you use green zucchini, use green beans. You could also just leave the beans out.


11 July 2010

great summer dinner

My guy made a fantastic dinner last night that I wanted to share with you. It is light, summery, delicious and versatile... I think you should make it today!!

you need:
1/2 medium head of cabbage--shredded*
3 large carrots--shredded
1/2 medium onion--chopped
1 small apple**--shredded
6 oz water-packed tuna, drained
6 oz water-packed crab, drained (we used Trader Joe's--great quality)
glug or two of balsamic vinegar
salt to taste

* easiest way to shred cabbage is with a good bread knife, I have found. then again, I do not have a mandolin...hmmm, used to, now that I think of it, wonder where it is...
** my guy used a red fuji--he wanted some sweetness, and it was what was in the fruit bowl. I think that a granny smith +/- some raisins would have been equally awesome

you make:

So easy, just dump everything into a large bowl and mix--add salt as needed.

You can have this as a salad--with tomatoes on a bed of lettuce (personally, I think that tomatoes go phenomenally with fish), on a sandwich, in a crepe, in an omelet... next to some brown rice, or a sweet potato. Let your imagination go wild. This makes quite a bit, so get creative!!


09 July 2010

Benadryl, Motrin, Tylenol and Children's Tylenol recall

Yes, it has been ages since I last wrote--I have been super busy (as is everyone, I know)... Hopefully, I will have a chance to write something "real" soon.

For now, I have another FDA recall that needs attention. This one is a recall of very common medicines, and not only in the US, but also in the Dominican Republic, Puerto Rico, Guatemala, Fiji, Trinidad, Tobago, and Jamaica.

In other words, it's big. Fortunately, it seems to be a voluntary recall, mainly for a smell that has infiltrated the medicines from being on the same pallet as a chemical when they were shipped. Either way, it's there--you make the decision. Also, please let your loved ones in the other countries know.

12 May 2010

Never get complacent

It is not everyday that you look down, and your "routine" breast case has turned into a chest case. THANK goodness that it is not everyday!!

Young woman--35--diagnosed with breast cancer 3 years ago. At that time, she had her (unilateral) mastectomy and tissue expander placement. Then, skin necrosis and excision, followed by failed tissue expander--they were unable to expand...

So, she went through her chemo, never had radiation, and we come to this year and her care with me. Back in February, I exchanged her tissue expander for a new one (in fact, there was a hole identified in the old one--presumably from a needle stick). I expanded her over the next 3 months. She is finally happy with size, so we schedule an implant swap--gel (silicone) in place of saline tissue expander--and to augment the other side to match. Enter yesterday...

Cancer side: trying to release capsule, I made a plane inside the pectoralis. I caught it right away, but still... not the way things are supposed to go. "Prophylactic side:" Tooling along, releasing the pec and suddenly I am looking at lung. It was not my day.

Cancer side: oversewed muscle plane and started over again... finished capsulorrhaphy and placed implant--success.
Prophylactic side: oversewed intercostal muscles over a red rubber catheter, oversewed with pec... got a post-op chest xray: tiny apical PTX

Kept her overnight, got serial chest xrays. She is fine, felt greal this morning, pneumo is resolving, and she went home. She feels like a queen, and couldn't stop thanking me. I feel like crap. I consider myself a safe, conscientious surgeon--not a cowboy or careless. How could this happen?! I have heard from a few people that the only way to become an expert is to make and overcome the mistakes.

So, maybe I don't want to be an expert!!

18 March 2010

Oh, boy...

I just read this fantastic entry at The Blog That Ate Manhattan, and I am having doubts about my choices... not that any choices have been made, per se, but the potential and the direction of my choices. Let me explain.

I moved to New York--THE City--10 years ago, to start residency, then fellowship, and then to work. Because my residency farmed us out all over the area--including Jersey and Long Island, Queens, Brooklyn, etc.--living in Manhattan was actually most central. It was wonderful!! I adored living in the city, everything from convenience, to the people, to being able to run in the street at night completely feeling safe (because of all of the people and the light), to the restaurants... oh, I could go on and on. It was incredible. For me, it was peaceful; it felt like home. (This is very hard to explain to non-Manhattanites, but it is so true.) And, as for TBTAM, September 11th, that most awful of all days, made me feel even more tied to the city. as hard as it was.

Then, about a year after I started working, I moved out to Queens. I suffered from SEVERE withdrawl. It is just not that easy to get into the city, although it should be, when you have a life outside of the city. My beloved did not understand--although he, too, lived in Queens, his office was in the city. This meant that he was in the city on a daily basis, and for completely different reasons than I had been. He thought of the city as a crazy, busy, dirty place... quite the opposite of my belief.

Now, in fellowship again, we moved even further away--1 hour north, to be exact. It is a nice place, but WOW! I miss Manhattan so much. But, we have had a taste of peace, tranquility... and still with a healthy dose of convenience (although I still do not feel safe running here at night--too dark, too deserted).

As I look forward to practice again, we have geared our search to warmer climes--this past year was not a kind one to the Northeast--or places in the Midwest, to be closer to family. So, it is in these areas that we are considering larger cities. My love has told me time and time again that The City is just too expensive, and if we stay, he would prefer Queens (most likely), or one of the other Boroughs. Whereas for my tastes, I would prefer to live IN Manhattan, or not at all.

My heart breaks at the thought of truly leaving... there had better be something spectacular out there for me! But I also cannot imagine again living in New York, and not in The City.

02 March 2010


So, I am still getting my little FDA recall emails daily. If I posted on all of them... well, let's just say I really wouldn't have much of an audience. But, from time to time, there is a recall that is simply striking, for one reason or another.

Take, for instance, this one! I mean, seriously?! PEPPER is being recalled?? The stuff you ask the guy at the restaurant to grind a little of onto your salad?! The stuff that makes you sneeze?! The stuff that seems so innocuous that one of the OR techs puts it on her baby's thumbs to make him stop sucking them?! (It doesn't work, by the way--the toddler apparently loooves pepper.)

And, wouldn't you know it? Salmonella is again to blame. What are they doing at the pepper factory, exactly--grinding pepper with the same grinder they use for chicken parts? I mean, really?? It just seems a little insane, no? Many of you don't know, but I recently decided to dive in and become vegan. It is an interesting exercise--one that makes you really think about what you are eating. I am doing this for my own reasons, and certainly I am not a fervent PETA activist (although I have developed a fondness for this cult that surprises even me)... but, shouldn't pepper be safe? I mean, it is one of the things that vegans, even raw foodists, can use because it is of plant origin and it DOES NOT NEED TO BE COOKED!

If you haven't noticed, I am thoroughly perplexed. If any of you have any input on this insanity, please, share the light. In the meantime, I guess I will stick to non-peppery spices: anise, curry, and the such.

28 February 2010

Has it really been almost a year?!

WOW! It has been a long, long time... anyone still checking in from time to time?

I have had a bit of a career change--I am currently in a fabulous Breast Oncoplastic Fellowship. This means that I am training to do everything from breast oncologic procedures (and those for benign disease) to the reconstructive aspects of breast... as well as aesthetic breast surgeries. So, everything breast, in a nutshell. I am very much enjoying this, but I have been quite busy.

In addition, I am trying to figure out what is next--in other words, do I want to start a private (solo) practice, or be hired by a hospital... or something in between? and where to? yet another question. We have decided that we either want to be close to family, or in a warm place. and yet... it has not been easy to find something. I have tried recruiters, but the majority want me to either do general surgery with some breast, or they need someone in New York. As for the first, I have not done general surgery in more than 5 (five!!) years, and although I was very good at it at one point, it has been a looooong time. I really am not wanting to experiment on patients... As for the second, New York is terribly saturated with both breast surgeons and plastic surgeons... and it is cold... and I have really had enough... it is time to move on (figuratively and literally).

So, there you have it--the main headers to my brain's thoughts of late. There is much more, but this is enough for now.

So, any ideas or thoughts from the peanut gallery? ;) Are any of you hospital administrators looking for an assertive, passionate breast surgeon? Or maybe you are in need of a partner, tired of doing breast? I can wish...