Wednesday, February 12, 2014


ROCHESTER, Minn., Feb. 9 (UPI) -- Cats bites can be dangerous -- 1-in-3 people bitten on the hand by a feline have to be hospitalized, U.S. researchers say.
Dr. Brian Carlsen, a Mayo Clinic plastic surgeon and orthopedic hand surgeon, says two-thirds of those hospitalized needed surgery.It's not that the mouths of cats have more germs than dogs' mouths or people's, it's because of the cat's sharp teeth, Carlson, the study leader, and colleagues say. "Dogs' teeth are blunter, so they don't tend to penetrate as deeply and they tend to leave a larger wound after they bite. The cats' teeth are sharp and they can penetrate very deeply, they can seed bacteria in the joint and tendon sheaths," Carlsen said in a statement. "It can be just a pinpoint bite mark that can cause a real problem, because the bacteria get into the tendon sheath or into the joint where they can grow with relative protection from the blood and immune system."In addition, the bacteria injected by a cat bite can include a strain common in animals that is particularly hard to fight with antibiotics, Carlson says. The study conducted by Carlson and his colleagues involved 193 Mayo Clinic patients with cat bites to the hand from Jan. 1, 2009, through 2011. Of those, 57 were hospitalized, with the average stay three days. Of those hospitalized, 38 needed to have their wounds surgically irrigated, or flushed out, and infected tissue removed, Carlson says. The study, published in the Journal of Hand Surgery, found eight patients needed more than one operation, and some needed reconstructive surgery. About half of the patients first went to the emergency room, and the others went to primary care. The mean time between the bite and medical care was 27 hours, the study said. Patients with bites directly over the wrist or any joint in the hand had a higher risk of hospitalization than people with bites over soft tissue, the study said. Physicians and victims of cat bites to the hand need to take the wounds seriously and carefully evaluate them, Carlsen says. If patients have inflamed skin and swelling, aggressive treatment should be pursued, Carlson said.

Wednesday, February 5, 2014


Part healer, part entrepreneur, and part "trapeze artist" trying to balance and wrestle with insurance companies, trial lawyers, hospital regulations, government red tape, patient demands and family pressures - this pretty much sums up the life of a solo practitioner.

"The self-employed physician straddles two worlds at once, responsible for tending to patients and keeping the lights on. Owning a practice means running a small business.  There is no end to the shift and no hour to clock out." 

The new breed of "physicians seem not to covet this life, and it's hard to blame them. After the long, hard slog of medical education and training which results in a tremendous debt burden, solo and small-group practice offers neither optimal work-life balance nor a guaranteed income level. This is to say nothing of the costs of malpractice insurance (as well as the constant worry about loosing everything in the "malpractice lottery"), the regulatory and administrative complexities of modern health care delivery, the expense of information technology, and the advent of new care and payment models.  Most self-employed physicians must invest thousands of dollars in office equipment and surgical instruments - oftentimes literally betting the house on the solvency of their practice."

 "The emerging model, featuring the physician as a labor unit, challenges the very notion of what it means to be a "good doctor."  In place of ingenuity, availability, and patient advocacy, the new philosophy is more likely to prize those who play well with others and meet quality improvement metrics.  Physicians who chafe at authority, pushing against bureaucratic hurdles as the champion of their patients, may find themselves in danger of being deemed relics at best, disruptive physicians at worst.  The men and women who run these small practices are, or at least were, the silent majority of the medical profession. They tend not to be found on the editorial boards of topflight journals, in charge of major professional organizations, or at the helm of blue-ribbon committees.  Frankly, they don't have time.   They are the "soldiers on the battleground" of medicine. 

The surgeon lives and dies by the labor of his two hands. It is an honorable profession and offers a comfortable income. I would not choose any other path in life - it has been, and continues to be, a joy and a blessing to me.  I want to continue on this path as long as my mind is sharp, my hand-eye coordination remains exceptional and patients continue to come to my door and offer me joy.

Insight and some commentary provided by Charles G. Kels, JD in the Office of Health Affairs, Dept. of Homeland Security and The Judge Advocate General's Corps, US Air Force Reserve.  Washington D.C.


Two network television news segments, major US newspapers and wire sources report that heroin use in the US has skyrocketed. NBC Nightly News (2/3, story 3, 2:30, Williams) reported, “The death Philip Seymour Hoffman at 46 is bringing attention to a heroin problem that is exploding among people in all walks of life across our country.” NBC News correspondent Kate Snow explained, “Heroin use in the US nearly doubled over the last five years. More than a quarter million people a year end up in the” emergency department.


A Congressional Budget Office (CBO) report released Tuesday touched off a partisan debate over how to interpret its conclusion that the Affordable Care Act will spur more than two million full-time workers to leave the labor force in the coming years. That debate played out across the media, garnering several front-page stories in major newspapers, over four minutes of airtime on the nightly news broadcasts, and many more print and online accounts.


Arlington Heights, Ill. - Patients who have undergone plastic surgery to change the appearance of their nose may also notice changes in the sound of their voice, reports a study in the February issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).
Changes in voice after rhinoplasty are perceptible to patients as well as to experts, but generally don't cause problems with speech function, according to the new research by Dr. Kamran Khazaeni and colleagues of Mashhad University of Medical Sciences, Iran. However, they believe that patients considering rhinoplasty -especially those who use their voice professionally-should be aware of "potential voice alterations."


HOUSTON, Jan. 29 (UPI) -- Vietnam War veterans who were exposed to the herbicide Agent Orange may be at higher risk for certain types of skin cancer in old age, U.S. researchers say.
Lead author Dr. Mark W. Clemens of The University of Texas MD Anderson Cancer Center and colleagues said the study adds to previous evidence risk of non-melanotic invasive skin cancer could increase even four decades after Agent Orange exposure, with at least some exposed veterans having unusually aggressive non-melanoma skin cancers. During the Vietnam War, Agent Orange was widely used as a herbicide to remove jungle vegetation. It has been linked to a wide range of cancers and other diseases, caused by the toxic dioxin contaminant TCDD."TCDD is among the most carcinogenic compounds ever to undergo widespread use in the environment," Clemens and co-authors said in a statement.