Sunday, May 24, 2015

Dr. Bob Dylan Weighs In On MOC

MOC Times Are A Changin'

Come gather 'round doctors
In your office or home
And admit that the waters
Around you have grown
And accept it that soon
You'll be drenched to the bone.
If your time to you
Is worth savin'
Then you better start swimmin'
Or you'll sink like a stone
For the times they are a-changin'.

Come Chiefs & Professors
Who prophesize with your pen
And keep your eyes wide
The chance won't come again
And don't speak too soon
For the wheel's still in spin
And there's no tellin' who
That it's namin'.
For the loser now
Will be later to win
For the times they are a-changin'.

Come EVP's, Officers
Please heed the call
Don't stand in the doorway
Don't block up the hall
For he that gets hurt
Will be he who has stalled
There's a battle outside
And it is ragin'.
It'll soon shake your windows
And rattle your walls
For the times they are a-changin'.

Come all Academics
Throughout the land
And don't criticize
What you can't understand
Your housestaff, Attendings
Are beyond your command
Your old road is
Rapidly agin'.
Please get out of the new one
If you can't lend your hand
For the times they are a-changin'.

The line it is drawn
The curse it is cast
The slow one now
Will later be fast
As the present now
Will later be past
Your old road is
Rapidly fadin'.
And the first one now
Will later be last
For the times they are a-changin'.

Wednesday, March 25, 2015

Angelina Jolie and Risk Reduction Surgery

You may remember the story of Angelina Jolie's decision to have her breasts removed as she was a very high risk for breast cancer. Now, she's undergone further surgery to remove her tubes and ovaries.

From the NY Times:

“Prophylactic removal of ovaries and fallopian tubes is strongly recommended in women before age 40 in BRCA1 and BRCA2 mutation carriers,” said Dr. Susan Domchek, executive director of the University of Pennsylvania’s Basser Research Center, which specializes in BRCA mutations. “There is no effective screening for ovarian cancer and too many women with advanced stage ovarian cancer die of their disease.”

Writing for The New York Times’s Op-Ed page, Ms. Jolie Pitt, 39, said she had expected to have her ovaries and fallopian tubes removed, a procedure called a laparoscopic bilateral salpingo-oophorectomy, but that a cancer scare made her decide to undergo the procedure sooner. Her mother, aunt and grandmother died of cancer.

“To my relief, I still had the option of removing my ovaries and fallopian tubes and I chose to do it,” she wrote.

Two years ago, she ignited a worldwide discussion about options for women at high risk for breast cancer when she wrote that she had had both breasts removed because BRCA1, the same genetic mutation that prompted her surgery last week, increased her risk of breast cancer.

Allow me to clear up one misconception. This is not "Prophylactic Surgery" but rather Risk Reduction Surgery. Even following removal of the tubes and ovaries, there is a small residual risk of cancer inside the abdominal cavity, histologically identical to ovarian cancer.

For more info, you can go here.

Wednesday, March 11, 2015

Nice Work If You Can Get It

To Commemorate NY's Silver Debacle, I've played with the lyrics to a Dire Straits Classic.

$$$ Por NADA

Look at them yo yo's - that's the way you do it
Legislators in the L.O.B.
That ain't working - that's the way you do it
Money for nothing and your trips for free.
Now that ain't working that's the way you do it
Lemme tell ya those pols ain't dumb
Maybe holding more fundraisers
Maybe give taxpayers a crumb

We gotta drain the stinking swamp
Democracy Recovery
We must remove the legislators
We owe it to our progeny

I shoulda learned to get donations
I shoulda learned to raise the funds
Look at that charmer muggin for the camera
Man we coulda had some fun
Look he's up there, makin campaign noises
Kissing babies for them all to see
That ain't working, that's the way you do it
Money for nothin and your trips for free

We gotta drain the stinking swamp
Democracy Recovery
We must remove the legislators
We owe it to our progeny

Now that ain't working, that's the way you do it
Money for nothin get your trips for free
Money for nothin and your trips for free

Term Limits Anyone?

Thursday, November 13, 2014

Do Not Go Gentle Into That Good Night

Ezekiel Emanuel, MD, PhD penned a controversial opinion piece for The Atlantic on why he would hope to die at 75. This piece created a firestorm of pushback, including a resolution at the recent interim AMA meeting by MSSNY's own Greg Pinto, MD to rebuke Dr. Emanuel. While the resolution was ultimately defeated, Dr. Pinto's principled stance was not the only voice heard in opposition to Dr. Emanuel. One piece in particular by Brant Mittler MD JD was posted on MedpageToday.

My reaction to Zeke's article is one of disgust and outrage. Even if he is the smartest guy in the room, he's dumb when it comes to understanding what the average person wants. How dare he claim to know that someone over age 75 who walks slowly, has some memory lapses, and has some medical disabilities and limited resources doesn't deserve to enjoy music, sunsets, or the company of children and grandchildren?

And why will Zeke stop at age 75? When will he and his political cronies -- of both major political parties -- decide that a disabled paraplegic wounded warrior is consuming more than he is contributing?

While Emanuel claims he's only musing about his own personal decision to forgo colonoscopy after age 65 and flu shots, antibiotics, cancer care, and doctor visits after age 75, his writings are dangerous because they influence major media and national leaders.

The subtitle of this irresponsible article proves he wants to influence you to follow his lead, while he admits at the end of the article he reserves the right to change his mind. Sure, you jump off the cliff first. Zeke will follow you. Not.

Do not go gentle into that good night,
Old age should burn and rave at close of day;
Rage, rage against the dying of the light.

Dylan Thomas

Wednesday, October 22, 2014

Ebola: Don't Believe The Hype

There's a lot of news about Ebola lately. It's tough to separate concern from hyperbole. The Medical Society of the State of New York has provided this presentation by Dr. William Valenti, an Infectious Disease specialist, on Ebola. This was originally a webinar geared toward physicians so please forgive me if it seems overly technical. However, if you're a physician, this is definitely must see.

I do hope you find this helpful.

Monday, September 8, 2014

3D Trumps 2D For Localizing IUD's

In the August issue of OBG Management, NYU's Dr.Steven R. Goldstein penned an article suggesting that we stop relying on the standard 2D ultrasound for localizing an IUD. The reason: that 3D or volume ultrasound allows visualization of planes, specifically a coronal plane, not often seen on the standard sonogram. Why is this important? Read on.

Dr. Goldstein's article demonstrates several images from studies in which the IUD's location doesn't look unusual on the 2D image. However, in the coronal plane of 3D imaging, a problem is demonstrated. Benacerraf et al found that 75% of patients with abnormally situated IUD's presented with either pain or bleeding - more than twice the rate of women whose IUD's were found normally situated. We recently saw a young woman who had been in the Emergency Department complaining of pelvic pain for whom the diagnosis of her problem was far from clear. Visualization of the IUD in the coronal plane of her 3D sonogram clearly showed that not only was the device malpositioned in the lower uterus but one of the lateral arms penetrated the wall as well.

So now that you know a 3D study is superior, where should it be done? My answer would be more shameless self-promotion. For more information or to schedule a 3D ultrasound, please call (718) 925-6277.