Thursday, May 23, 2013


On the op-ed page of The New York Times, the actress Angelina Jolie revealed she recently had a preventive double mastectomy, both breasts removed and then reconstructed. Her mother died of breast cancer at 56 and Jolie herself had been diagnosed with the inherited BRCA1 gene mutation, which significantly increases the risk of breast and ovarian cancer. And so, she writes: I decided to be proactive and to minimize the risk as much as I could. Of course, there are women everywhere who carry the same gene mutation as Angelina Jolie. The majority of breast cancers are not caused by a BRCA gene mutation. But if you do have the mutation, you're much more likely to develop breast or ovarian cancer. About five to seven percent of breast cancer and about 14 to 20 percent of ovarian cancer is due to a gene mutation - so, not the majority. And people who inherit a BRCA mutation are at very high risk for both cancers and also at somewhat higher risk for other cancers, too. There are national guidelines that determine who should and who will get the most benefit from a genetic evaluation. It's important to us to make sure people know that you should see an expert known as a genetic counselor, or a medical geneticist, in order to find out what your risk is, rather than just going out and getting a blood test. And if the chance of having a mutation is high enough, based on expert guidelines, most insurances will cover genetic counseling and genetic testing.


ARLINGTON HEIGHTS, Ill. - The American Society of Plastic Surgeons (ASPS) today announced its strong support of the "Breast Cancer Patient Education Act" (S. 931). This bipartisan legislation is being introduced today, coinciding with National Women's Health Week, in the U.S. House of Representatives by Reps. Leonard Lance (R-NJ) and Donna Christensen, M.D. (D-VI) and in the United States Senate by Sens. Roy Blunt (R-MO), Sherrod Brown (D-OH), with Jon Tester (D-MT) and Dianne Feinstein (D-CA) as original cosponsors.
Since 1998, health plans that offer breast cancer coverage have been required to provide coverage for breast reconstruction and prostheses. Yet published research shows that many women eligible for breast reconstruction following breast cancer, minorities in particular, are not informed of the variety of care options. Approximately 232,340 women will be diagnosed with breast cancer in 2013, according to the American Cancer Society's most recent estimates for breast cancer in the United States.

Monday, May 20, 2013


In adults, bacteria colonization is present on normal intact skin, with the estimated amounts being several million.  There may be a 1000 different bacterial species residing on the skin. Skin develops an ecosystem colonized with bacterial, viruses, fungi, and mites referred to the skin microbiome.  The acid nature of the skin keeps the resident bacterial attached to the skin and the consistent turnover or shedding of the outer layer of skin keeps the bacterial numbers fairly constant. Medical conditions (Diabetes; chronic renal failure; dermatitis; obesity); Certain medications (anti-inflammatories, prednisone; chemotherapy; immunosuppression drugs), age, geographic location of residence in terms of hot and cold climates and the products used on the skin and moisture affect the type and amount of bacteria present on the skin.

The identification of biofilms in wounds has complicated the diagnosis and treatment of wound infections.  A biofilm is a population or community of bacterial living in organized structures at the liquid interface.  Bacteria within a biofilm live in microcolonies that are encapsulated in a matrix composed of an extracellular polymeric substance separated by open waster channels.  The biofilm environment provides physical protection to bacterial and makes it difficult for antibiotics to penetrate and treat the infection.

Appropriate hand washing, disinfecting and hand drying with disposable paper towels are the most effective ways of removing bacteria from the skin.  Quantities of bacteria experience a temporary decrease after hand washing, but are back to their usual amount within 2-4 hours. Skin and its outer colonies of bacteria have a normally symbiotic relationship, but anything, externally or internally, can  disrupt the delicate relationship.   When a wound occurs in the skin, the potential for infection exists.  Probably the most important factor in preventing infection is the immune system of the individual.  Even intact immune systems can be overwhelmed if there are large amounts or very virulent bacterial introduced.

Wednesday, May 8, 2013


When you work the desk for long enough in a doctor’s office, interacting with your boss and co-workers, handling patients and taking their information, you may have occasionally entertained this thought: “Hey, I’ve been doing this so long I bet I could even perform that person’s rhinoplasty.”

Then you chuckle because you’re a smart person and you know that you’re not actually certified to perform rhinoplasty on human beings. Or animals for that matter, because that would just be weird.
This tiny detail appears to have escaped Christine Patterson.
As the Herald-Tribune reports, Patterson, an office manager at her brother’s Sarasota, Fla. plastic surgery clinic, stands accused of treating one of her brother’s patients in his absence.
The patient reportedly came in for a post-op follow-up the day after her surgery in April 2011. With her brother out of town, Patterson allegedly examined the patient, rewrapped her bandages and sent her on her way. Not surprisingly, the patient returned the next day with major swelling. The term used by a pair of witnesses was “swollen like a pumpkin,” which is probably not the look she was going for when she submitted to voluntary cosmetic surgery.
Patterson is said to have drained the patient’s excess swelling herself, telling a witness she’d seen it done “plenty of times.” "Not only did she diagnose her facial swelling with a hematoma, she put in a drain to drain the excess fluid," Wendy Rose, a spokesperson for the Sarasota County Sheriff's Office, told Tampa’s Channel 10 News.
Using that logic, most of us should be qualified to fly commercial jets and filibuster our way through five years of city council. But anyway, you can imagine how well that went for the poor patient, who described the pain as “excruciating.” Police charged the 44-year-old woman with practicing medicine without a licence, a charge her husband denies. "My wife never went to medical school," John Patterson told the news network. "She won't even know how to attempt to do something like that."

Wednesday, May 1, 2013


Exotic dancers, robotic squirrels, and a reality TV show in India—your tax dollars supported all of these this year. Two reports just released—“Federal Spending by the Numbers 2012” by The Heritage Foundation and “Waste Book 2012,” a report by the office of Senator Tom Coburn (R–OK)—shed light on these and other examples of Washington’s irresponsible spending.

If you value your tax dollars, you’re sure to be outraged by these wasteful projects. Following are the top 10 examples, five from each report. Though not necessarily the biggest ticket items, they are no doubt wasteful and representative of Washington’s spending addiction that must end.

Federal Spending by the Numbers 2012:

1.A reality TV show in India. The Department of Agriculture’s Market Access Program spends $200 million a year to help U.S. agricultural trade associations and cooperatives advertise their products in foreign markets. In 2011, it funded a reality TV show in India that advertised U.S. cotton.

2.Studying pig poop. The Environmental Protection Agency awarded a $141,450 grant under the Clean Air Act to fund a Chinese study on swine manure and a $1.2 million grant to the United Nations for clean fuel promotion.

3.Amtrak snacks. Federally subsidized Amtrak lost $84.5 million on its food and beverage services in 2011 and $833.8 million over the past 10 years. It has never broken even on these services.

4.Using military exercises to boost biofuels. The U.S. Navy bought 450,000 gallons of biofuels for $12 million—or almost $27 per gallon—to conduct exercises to showcase the fuel and bring it closer toward commercialization. It is the largest biofuel purchase ever made by the government.

5.Conferences for government employees. In 2008 and 2009 alone, the Department of Justice spent $121 million to host or participate in 1,832 conferences.

Waste Book 2012:

1.“RoboSquirrel.” $325,000 was spent on a robotic squirrel named “RoboSquirrel.” This National Science Foundation grant was used to create a realistic-looking robotic squirrel for the purpose of studying how a rattlesnake would react to it.

2.Cupcakes. In Washington, D.C., and elsewhere across the country, cupcake shops are trending. The 10 cupcake shop owners who received $2 million in Small Business Administration loan guarantees, however, can only boast so much of their entrepreneurial ingenuity, since taxpayers are backing them up.

3.Food stamps for alcohol and junk food. Though they were intended to ensure hungry children received healthy meals, taxpayer-funded food stamps were instead spent on fast food at Taco Bell and Burger King; on non-nutritious foods such as candy, ice cream, and soft drinks; and on some 2,000 deceased persons in New York and Massachusetts. Food stamp recipients spent $2 billion on sugary drinks alone. Improper SNAP payments accounted for $2.5 billion in waste, including to one exotic dancer who was making $85,000 per year.

4.Beer brewing in New Hampshire. Despite Smuttynose brewery’s financial success and popularity, it is still getting a $750,970 Community Development Block Grant to build a new brewery and restaurant facilities.

5.A covered bridge to nowhere. What list of government waste would be complete without a notorious “bridge to nowhere”? In this case, it’s $520,000 to fix the Stevenson Road Covered Bridge in Green County, Ohio, which was last used in 2003.

Some of this waste hardly amounts to a rounding error by current federal budget standards. However, no spending cut is too small. Congress should root out even small instances of waste. Doing so will build momentum for it to tackle difficult, long-term budget challenges, such as entitlement program reform.

Fiscal year 2012 is the fourth consecutive year with a trillion-dollar-plus deficit. Total federal debt has surpassed $16 trillion. Federal spending reached $3.6 trillion—or 22.9 percent as a share of the economy—in 2012. Despite these frightening figures, which are on track to worsen, Congress continues to expand government.

Wasteful spending is intrinsic in big government, because government is concerned primarily with getting checks out the door and only secondarily with spending the money properly.

As both “Federal Spending by the Numbers 2012” and “Waste Book 2012” warn, it is long past time for Congress to put the brakes on this wasteful spending—full stop.