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!!
12 May 2010
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.
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
Seriously?!
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.
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...
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...
04 May 2009
Hydroxycut again
So, the recall on Hydroxycut products is growing. Please make sure to look at the FDA site list and warnings if you do use these products. There is also a site put out by Hydroxycut directly that you can peruse. If you currently have these products, according to both sites, you can return them directly to the store where the product was purchased.
Still, Hydroxycut Hoodia and Hydroxycut Cleanse products are not included in the recall at this time.
Still, Hydroxycut Hoodia and Hydroxycut Cleanse products are not included in the recall at this time.
01 May 2009
More...
So, it seems that Hydroxycut is now being recalled. This is a product that is quite well-known and advertised. I have seen it touted in the majority of magazines aimed at women, that I can say for sure... certainly in all of the women's fitness magazines. Now, it has been linked to serious liver injuries--including one that required a transplant, and one death secondary to liver failure. This is big!
Here are the products being recalled:
Hydroxycut Regular Rapid Release Caplets
Hydroxycut Caffeine-Free Rapid Release Caplets
Hydroxycut Hardcore Liquid Caplets
Hydroxycut Max Liquid Caplets
Hydroxycut Regular Drink Packets
Hydroxycut Caffeine-Free Drink Packets
Hydroxycut Hardcore Drink Packets (Ignition Stix)
Hydroxycut Max Drink Packets
Hydroxycut Liquid Shots
Hydroxycut Hardcore RTDs (Ready-to-Drink)
Hydroxycut Max Aqua Shed
Hydroxycut 24
Hydroxycut Carb Control
Hydroxycut Natural
Hydroxycut Cleanse and Hoodia are not being recalled at this time. And again, I will say, "Eating right and exercising are head and shoulders above any 'magic' pill."
Here are the products being recalled:
Hydroxycut Regular Rapid Release Caplets
Hydroxycut Caffeine-Free Rapid Release Caplets
Hydroxycut Hardcore Liquid Caplets
Hydroxycut Max Liquid Caplets
Hydroxycut Regular Drink Packets
Hydroxycut Caffeine-Free Drink Packets
Hydroxycut Hardcore Drink Packets (Ignition Stix)
Hydroxycut Max Drink Packets
Hydroxycut Liquid Shots
Hydroxycut Hardcore RTDs (Ready-to-Drink)
Hydroxycut Max Aqua Shed
Hydroxycut 24
Hydroxycut Carb Control
Hydroxycut Natural
Hydroxycut Cleanse and Hoodia are not being recalled at this time. And again, I will say, "Eating right and exercising are head and shoulders above any 'magic' pill."
29 April 2009
Just What We Need...
Boy, I sure haven't been here in a while. But, when I saw a certain FDA alert come across my email, I simply could not resist but put something here about it.
Apparently, there is a nail polish remover that could cause chemical burns to fingers. As if hand surgeons did not have enough to worry about, what with manicures and people accessorizing their fingernails.
Most chemical burns peel within a week like a sunburn would, but it is important to take a few steps if you should get a burn. First, stop using the product (simple, but important). If the chemical is dry (ie: lime), brush as much of it off as possible--wear a glove or do this with a towel so you do not burn the brushing hand. Next, take off any jewelry, rings, or contaminated clothing. Flush the affected body part with running cool water for at least 15 minutes. Apply a cool, wet cloth to relieve pain, and then dry and wrap loosely with a dry sterile dressing. Flush with more cool water if intense burning is still experienced. In the following days, wash the area with soap and water, dry thoroughly and apply a loose dry sterile dressing to the area until it heals. Once the skin has grown in, you can start massaging the area to lessen the chance of scar formation.
Seek emergency care if the victim feels faint, has shallow or rapid breathing, or is pale. Also, seek emergency care if the burn is over a joint, on the face, hands, or in the groin or is larger than 8 cm. If you are not sure what to do, call 911 or your poison control center.
Apparently, there is a nail polish remover that could cause chemical burns to fingers. As if hand surgeons did not have enough to worry about, what with manicures and people accessorizing their fingernails.
Most chemical burns peel within a week like a sunburn would, but it is important to take a few steps if you should get a burn. First, stop using the product (simple, but important). If the chemical is dry (ie: lime), brush as much of it off as possible--wear a glove or do this with a towel so you do not burn the brushing hand. Next, take off any jewelry, rings, or contaminated clothing. Flush the affected body part with running cool water for at least 15 minutes. Apply a cool, wet cloth to relieve pain, and then dry and wrap loosely with a dry sterile dressing. Flush with more cool water if intense burning is still experienced. In the following days, wash the area with soap and water, dry thoroughly and apply a loose dry sterile dressing to the area until it heals. Once the skin has grown in, you can start massaging the area to lessen the chance of scar formation.
Seek emergency care if the victim feels faint, has shallow or rapid breathing, or is pale. Also, seek emergency care if the burn is over a joint, on the face, hands, or in the groin or is larger than 8 cm. If you are not sure what to do, call 911 or your poison control center.
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