Friday, October 12, 2007

weekend coming up

Some thoughts before I start this breast biopsy.

1. Go Tribe. Sabathia against Beckett tonight. We'll see who really deserves the Cy Young.
2. Interesting info on Taxol based chemotherapy for breast cancer. A study in Europe suggests that it's not as useful for women with Her-2-Neu negative tumors.
3. I had a post op complication this week. We won't get into details but it involved bleeding, enough that mandated a return to the OR in the middle of the night. There's no job more humbling than being a surgeon. Errors are inevitable. This one was sort of fluky, but you always feel culpable. It's always tough facing the patient and their family afterward. How did this happen, they ask. I've found the best way to handle these potentially awkward situations is to be completely candid and humble. Don't lie. Tell them exactly what happened. I made a mistake. I found the problem. I fixed it. I think patients appreciate that. Just don't make too many mistakes.
4. I'm starting to really like the laparoscopic inguinal hernia. Patients recover quicker, unquestionably. I had a guy recently who does that Ultimate Fighting craziness, returned to training 3 weeks after a bilateral hernia repair.
5. Anyone out there utilizing the Mammosite partial breast irradiation technique? A rep is coming to our office next week to discuss the possibilities.


Anonymous said...

Doesn't look good so far for tonight, but I hope the Indians win the AL. Regardless, whoever wins this series wins the whole way the Sox or Tribe will be bested by either NL team.

Bongi said...

i'm not even sure of what sport you're referring to. but whatever it is, the RUGBY WORLD CUP is on and my team has a better than good chance of being crowned the best in the world!!! go bokke

Jeffrey Parks MD FACS said...

Good luck to your squad, Bongi. I played a little scrum half for a club in college. Great sport. Too many concussions. This is the time of the year for the American baseball playoffs.

Bongi said...

ok. i recently got satelite so i actually have watched a bit of baseball. seems quite a technical sport. a bit like cricket only completely different.

there are less concussions in rugby these days. they've tried to make it safer, but it happens. great sport

Sid Schwab said...

Grady Sizemore grew up in my town, went to high school here. For him, I root. I sort of emotionally lean toward the Sox, only because when they win it sticks a finger in the Yankee eyes. But having gone to med school in Cleveland, I can handle it if they win.

It will always feel terrible to have to reoperate for an error. Your approach is exactly right, and most people understand.

I never bought the lap hernia; in fact I saw several people who'd recurred after (which doesn't, per se, condemn the technique.) I did my own modification of the open approach, using a small incision, and placing a hand-fashioned mesh in the properitioneum, essentially sutureless. Took about 15 minutes. Patients recovered very fast. There's something to be said for the lap approach for a bilateral, though.

Jeffrey Parks MD FACS said...

No sutures? I'm visualizing some sort of Stoppa giant mesh placement in the preperitoneum....Love to hear about the technique. I do all my open repairs via the Plug and Patch method, learned from Keith Millikan in Chicago. I'm curious about this sutureless version though.

Sid Schwab said...

Of course, I said "essentially" sutureless. It was basically the placement of a large rectangular mesh in the preperitoneum, by opening the transversalis fascia at the internal ring, clearing the space digitally, and using a couple of deBakeys to insert and then unfold the mesh. I used a 4x6 and made a slit parallel to the long edge about one inch from the edge, and a couple of inches long, and I slipped that little "leg" lateral to the cord. I reduced or removed an indirect sac. The only suture in the mesh was the one stitch I used to reclose the transversalis at the internal ring, taking a bite of underlying mesh. WIth the mesh there, I never placed any postop restrictions other than common sense based on comfort. I can't claim the pain was as minimal as a lap repair, but it was pretty well tolerated, especially compared to a Bassini, etc, and most people were doing what they wanted in two or three days. I figured the time and money saved in avoiding the lap drill was worth it.