Monday, May 28, 2012


We are blessed to live in a free society and to be able to express our opinions and disagree without punishment. On this day, we honor and thank our veterans and our active duty men and women for their dedicated service.


In simplistic terms, Hydraulic Fracturing, commonly called fracking, involves drilling a hole thousands of feet into the earth to reach shale formations where natural gas is trapped.  Water, sand and a proprietary mix of chemicals are then injected into the shale, fractruring the rock and releasing natural gas, which is captured when it flows up and out of the hole. This process allows access to previously inaccessible natural gas reserves. There are several "hot spots" for Fracking.  The Marcellus shale formation is found underground in Pennsylvania, New York, Ohio, West Virginia, Maryland and Virginia. Other areas with an abundance of natural gas bearing shale are the Fort Worth area, North Louisiana, North Dakota, and Wyoming.

The gas production industry states that fracking has been conducted for more than 60 years on more than a million wells without any major environmental or health issues. They tout this process as a step in reducing our dependence on foreign energy supplies and creating much needed jobs.

On the other hand, some public health and community leaders are calling for a moratorium on fracking until scientists determine the environmental and health risks, especially as it relates to drinking water resources. There will be much debate on this subject in the coming years, and at present, the verdict is still out.


"Creativity, as has been said, consists largely of rearranging what we know in order to find out what we do not know. Hence, to think creatively, we must be able to look afresh at what we normally take for granted."
                                                                                   -----George Kneller----


Patients with breast implants (either saline or silicone) may have some decreased visualization of breast tissue on a routine screening mammogram. In order to obtain the most accurate assessement of the breast tissue, diagnostic mammograms with additional views are needed. Specialized "push back" (Ecklund) views are performed to adquately image the breast tissue. Mammographic interpretation is more challenging for the radiologist. The patient with breast implants will be exposed to more radiation over her life time because of these additional views, although this additional exposure has not been shown to be a problem. It is important for women to perform monthly self breast examinations and to be diligent in their mammographic appointments.

Friday, May 25, 2012


Entities from multi-million dollar corporations to mom-and-pop businesses freely toss around the phrase customer service. But all too often, the promise of exceptional service is an empty one.

Customer service includes everything from greeting a customer and thanking her for her business to delivering what you promise and doing whatever it takes to satisfy the customer. Providing your customers with exceptional service will give you and your organization a competitive edge by increasing customer loyalty.
The following six basic principles of customer service, if mastered, will help you succeed as a small business owner.

1) Feel good about yourself. We tend to live in a negative world and to think negatively. It’s critical that you feel good about yourself, that you are confident, enthusiastic and positive. Each of us is responsible for how we feel about ourselves. You must believe in yourself, concentrate on your strengths, and recognize the importance of your role. Use affirmations and visualization. Read books on self-improvement and strive to be the best you can be. See yourself as you can be, not as you are.

2) Be courteous. It takes no more time to be nice and polite than it does to be rude. Every patient wants to feel important to you and your organization. Treat them with courtesy and respect. When you do, they will return to you time and time again.

3) Give positive communication. Smile, call patients by name, and give specific, genuine, sincere and timely feedback. When you communicate positively, you form a connection with the customer that says, ‘I am pleased that you patronize my practice, I value you, and I am here to ensure your needs are met."

4) Perform. Patients have the right to demand performance. They aren’t interested in your problems and excuses; they want you to take care of them. You can be polite and courteous but, if you don’t do what you say you will do, you will not meet the standards of good customer service. If you say you’ll call a patient on Tuesday, do it. Do what you say you will do -- and do it with speed and accuracy. 

5) Listen carefully. Listen to the patient, then clarify what he has said by repeating it. For example: “Ted, let me repeat what you said so I’m sure I’m on the right track.” Ask questions, get involved, and show that you care.

6) Learn and grow in your job. If a patient asks you to explain the difference between options A and B, she’s asking you to provide more than the difference in price. Study your organization’s offerings -- as well as those of your competitors -- so that you can provide your customers with the information they need to make a purchase decision.

These six principles might appear to be common sense, but common sense seems to be in short supply these days. If you focus on these principles, these fundamentals of customer service, you will keep your current customers and attract new customers.
John Tschohl, an international service strategist and speaker, is founder and president of the Service Quality Institute in Minneapolis. He has written several books on customer service, including Loyal for Life, e-Service, The Customer is Boss, Achieving Excellence Through Customer Service, Ca$hing In and Empowerment: A Way of Life. John’s bimonthly strategic newsletter is available online at no charge. Visit and

Wednesday, May 23, 2012


By Marty Sabota
FORT WORTH -- Alexus Duckett was watching her father cut the grass when she felt a stabbing pain in her throat. The Stephenville seventh-grader had been hit with a piece of rusted garden trim kicked up by the mower and shot toward her like a missile."It could have killed her," said her mother, Jayme Duckett.
The metal sliced almost 3 inches into her neck. Doctors at Cook Children's Medical Center removed it, and the 13-year-old was home within a day and at school a week later. Her only physical reminder is a 2-inch scar."It was only a millimeter from some of her major vessels," Duckett said. "Considering what could have happened, we were definitely blessed."

Five-year-old Christian Hernandez was not as fortunate. Doctors had to amputate the Granbury boy's leg below the knee.His mother, Rita Hernandez, said her 10-year-old son was on a riding mower cutting the grass on April 13, a Friday, and for the first time Christian hung on the back. Their father was nearby using the weed trimmer. The accident happened quickly. Now Christian is in a wheelchair. His brother is distraught even though his mother has repeatedly told him, "It was an accident."Hernandez hopes her son's injury will serve as a warning to others."I wish I had heard how dangerous this is," she said. "This never would have happened."As warm weather ushers in yardwork, numerous agencies are highlighting the dangers associated with mowing the lawn and are reminding people about proper safety precautions.

Common accidents

According to the U.S. Consumer Product Safety Commission, 253,000 people were treated for mower-related injuries in 2010, nearly 17,000 of them children under 19.

The most common accidents leading to injuries involve contact with the rotating blade, propelled objects such as rocks and glass, overturning -- including contact with the blades -- and running over someone. Treatment may require a team of physicians from various specialties.

Organizations promoting lawn mower safety include the American Society for Reconstructive Microsurgery, the American Society of Plastic Surgeons, the American Society of Maxillofacial Surgeons, the American Academy of Pediatrics and the American Academy of Orthopaedic Surgeons.

"I've seen broken and dislocated bones, deep cuts, missing fingers and toes, limb amputations, burns and eye injuries from lawn mower accidents," said Dr. Phillip Haeck, former president of the American Society of Plastic Surgeons. "The best way to treat a lawn-mower-related injury is to prevent it."

Tuesday, May 15, 2012


Study: Accredited outpatient facility matches hospital safety

A study of more than 400 reduction mammaplasty procedures at an accredited outpatient facility found safety and efficacy were similar to results from procedures performed in hospitals. It is still important to make sure plastic surgery providers are board-certified, and at least two states have cracked down after injuries caused by practitioners who lacked certification. HealthLeaders Media (5/10)


New procedure puts the freeze on wrinkles

California-based Myoscience is developing a treatment that freezes nerves to reduce the appearance of wrinkles. The results lasted up to four months in clinical trials. The procedure is approved in Canada and Europe for treating wrinkles and muscle pain. Plastic surgeon Larry Fan, who participated in the company's trial, said some patients may prefer the procedure over Botox because it is "completely natural." KGO-TV (San Francisco) (5/14)


Is Combining Hysterectomy and a Tummy Tuck Safe?

Yes, small study concludes, but some other experts disagree

By Serena Gordon
HealthDay Reporter
FRIDAY, May 11 (HealthDay News) -- New research suggests that combining two very different surgeries -- a hysterectomy and a tummy tuck -- is relatively safe, with no major complications seen in 65 women who had both procedures at the same time.
The rate of complications the researchers considered minor reached 32 percent, however.
"The results suggest that combined [tummy tuck] and hysterectomy is a safe and effective way to help patients attain both cosmetic and medically important outcomes in the same surgical procedure," wrote the study authors, from Florida International University in Hialeah.
One expert disagrees, however. "Any procedure that carries a 32 percent complication rate should be re-evaluated," said plastic surgeon Dr. Sherrell Aston. He also disagreed with the authors' definition of what a "minor" complication is. "Transfusion is a major complication, and it occurred in 3 percent of the surgeries," said Aston, who also is the surgeon director and chairman of the department of plastic surgery at the Manhattan Eye, Ear and Throat Hospital in New York City. The bottom line, he said: "I would not recommend doing these procedures together."

A hysterectomy is the surgical removal of a woman's uterus, the part of the reproductive system where a fetus grows during pregnancy. There are a variety of reasons why a woman might have a hysterectomy, including cancer, uterine fibroids (benign tumors in the uterus), endometriosis (which occurs when uterine cells grow in other areas of the body), abnormal bleeding or pelvic pain.
It is the second most commonly performed surgery on women in the United States, behind surgical delivery of a baby, according to the U.S. Office on Women's Health.
Hysterectomies can be done through an open incision in the abdomen or through tiny incisions in the abdomen with a device called a laparoscope. It also is possible to remove the uterus through the vagina. Dr. Angela Kerr, chief of the gynecology program at the Brooklyn Hospital Center in New York City said abdominal hysterectomy is still the most common. But, she noted, the other methods are gaining in popularity.

A tummy tuck, also known as abdominoplasty, is a surgical procedure that removes fat and excess skin from the lower abdominal area. It is not a substitute for weight loss, but is designed to tone loose skin or tissue, according to the American Association of Plastic Surgeons.

In the new study, the researchers looked back at results for 65 women who underwent both procedures at the same time. The surgeries were done between 1995 and 2011.The average age of the women was 46, and their average weight was 184 pounds, according to the study. Their average body-mass index (a measure of body fat based on height and weight) was 31.9, which is considered obese. The average length of the hospital stay was 3.8 days. The overall complication rate among these procedures was 32 percent. Ten percent of women had a fever, 8 percent had wound complications and 2 percent had a urinary tract infection. Three percent had to have a blood transfusion, and 9 percent of the women had atelectasis, which is a partially or totally collapsed lung. "In my opinion, I would want separate procedures," Aston said."  [The surgery] could be safe for some patients," Kerr said. "But it depends on patient selection: Do the patients have other conditions like diabetes or hypertension? That may play a role in the risk of complications. And a lot depends on the expertise of the surgeons." The study authors said the potential benefits of combining the surgeries included reduced overall healing time, decreased time spent in the hospital and a reduction in the risks associated with anesthesia. Another reason to have both surgeries at the same time is to save money. Plastic surgery procedures generally aren't covered by insurance, and by combining the two surgeries women might be able to save on the total cost of the tummy tuck.
Results of the study were to be presented this week at the American College of Obstetricians and Gynecologists annual meeting in San Diego. Research presented at meetings should be viewed as preliminary until published in a peer-reviewed medical journal.

Wednesday, May 9, 2012


Background: Acellular dermal matrix is commonly used in implant-based breast reconstruction to allow for quicker tissue expansion with better coverage and definition of the lower pole of the breast. This study was performed to analyze complications associated with its use in immediate two-stage, implant-based breast reconstruction and to subsequently develop guidelines for its use.

Methods: A retrospective analysis of 628 consecutive immediate two-stage tissue expander breast reconstructions at a single institution over a 3-year period was conducted. The reconstructions were divided into two groups: reconstruction with acellular dermal matrix and reconstruction without it. Demographic information, patient characteristics, surface area of acellular dermal matrix, and complications were analyzed and compared.
Results: A total of 407 patients underwent 628 immediate two-stage, implant-based breast reconstructions; 442 reconstructions (70.3 percent) used acellular dermal matrix and 186 (29.6 percent) did not. The groups had similar patient characteristics; however, major complications were significantly increased in the acellular dermal matrix group (15.3 versus 5.4 percent; p = 0.001). These complications included infection requiring intravenous antibiotics (8.6 versus 2.7 percent; p = 0.001), flap necrosis requiring excision (6.7 versus 2.7 percent; p = 0.015), and explantation of the tissue expander (7.7 versus 2.7 percent; p = 0.004).
Conclusions: Use of acellular dermal matrix in immediate two-stage, implant-based breast cancer reconstruction is associated with a significant increase in major complications. Therefore, it should only be used in specific patients and in minimal amounts. Indications for its use include single-stage permanent implant reconstruction and inadequate local muscle coverage of the tissue expander.

Wednesday, May 2, 2012


Fractional laser treatments can help treat severe burns; mitigating disfigurement and improving functionality of scarred tissue. And this technology can help treat many of the soldiers returning from tours of duty in Iraq and Afghanistan who have been severely burned and disfigured by an Individual Explosive Device (IED), according to information presented at the 32nd Annual Conference of the American Society for Laser Medicine and Surgery in Kissimmee, Florida.
Approximately 1 million Americans survive serious burns each year, but many are left severely disfigured. “What we have learned recently is that early intervention with laser scar treatments can achieve extraordinary results, “says Dr. Jill Waibel, MD, medical director at Miami Dermatology and Laser Institute, in a press release. “The good news is that fractional ablative lasers have become an amazing tool for correcting both the aesthetic and functionality issues presented by serious burn scars.”
Waibel performed one of the first fractional laser treatments on burn patients in 2008 and used a fractional ablative laser to treat a burn patient in 2009. Since then she and her colleagues have been working on optimizing the technique and hope to publish a paper later this year.
“Basically, we all believe that in combination with reconstructive surgery we think lasers are the gold standard that can help patients by increasing function of contracture scars and reducing the extent of disfiguring scars they often have.”
Waibel has visited Walter Reed National Military Medical Center in Bethesda, Maryland and the Naval Medical Center in San Diego to train physicians treating military patients to use the laser techniques she has developed. “IEDs are being placed at head level so we are seeing a lot more facial scarring in military patients,” she says.
Additionally, these lasers have been especially effective in treating large body surface areas and when used in the early stages of scarring in combination with steroid treatments.
“Scars tend to get worse 3-7 months after the injury,” Waibel explains. “The severe scarring typically doesn’t appear among patients during the time they’re recovering in the burn unit. We hypothesize and see it clinically that if we treat the scarring early, we can minimize the severity of the scar and see increased functional range of motion.”
[Source: American Society for Laser Medicine and Surgery]