Tag Archives: surgery

Wordplay Wednesday: What If You Had to Really Give Your Heart Away?

Screen shot 2013-11-20 at 4.07.44 AMA few months ago a friend and I were talking about fairy tales and how they always end after the first kiss – after the initial decision to be together. You never see the work it takes to keep a relationship together. We grow up with these romantic notions embedded in our consciousness but all we ever see are two people who agree to give their hearts to each other, but we never see them actually do it, and that’s the hard part.  After that conversation I wrote the following piece about what it would look like if we had to literally follow through with the phrase “I’ll give you my heart.” 

There’s a difference between deciding to give your heart to someone and actually doing it. Deciding is relatively easy; it just sort of happens. Someone shows up and you have no control over your reaction to them, the attraction, the pull. Sometimes there are obstacles before you can actually voice the decision and some people like to wait, just to be sure. Ultimately, it’s an inside job. Your gut decides long before you ever choose to put words to it. Mentally you never really had a choice. It is the end of the fairy tale, get on your white horse together and ride off into the sunset.

For some people that’s enough – to just say the words, living on the idea that you decided to give your heart to someone, and you really would if you had to, but again, have you ever thought about what it really means? I like you so much I want to give you possession of my most vital organ. How do you even do it? Literally, how do you give your heart to someone? Would you hand them a scalpel and let them carve it out of your chest?

I’ve had a lot of people tell me that it’s easy if it’s the right person. Maybe I’ve seen too many episodes of Grey’s Anatomy, but if the idea of someone – even the most well-intentioned person you know – holding a knife to your chest doesn’t make you nervous then I think you’re doing something wrong. There’s a reason they leave it at “ever after.”

I’m not saying it’s impossible. I’m not discouraging it any sort of way. I’m just recently realizing that it isn’t as easy as Disney made it out to be. It’s actually really hard, and confusing, and terrifying, because it doesn’t just fade to black when the finale kiss ends in real life. You have to actually get out that scalpel at some point. You can delay by asking them, “Are you sure?” a few dozen more times, but if you’re going to do this for real then it means unbuttoning and letting them see the scars of all your previous hack jobs.

So you take a deep breath. One more “Are you sure?” just in case, and proceed, slowly. Lay yourself out. Take a deep breath. Close your eyes. Begin. It’s a delicate procedure and there’s no harm in being cautious. It’s barely started when the scalpel grazes over the bruise left over from that night seven months ago that left you feeling mortified and so stupid. You wince and the knife stops. Suddenly you’re freaking. out. because all you can think about are all the other scars still to be uncovered. The one from that guy who said it was a friendship ring but really they were engaged and you were too obsessed with your own feelings to see he was in love with someone else. Or the one from that time you said “forever” but he couldn’t  pretend to care enough to pick you up from the train station. There are dings and scrapes from all the ones before him that hurt you, that just walked away.

Now he’s wondering if this is just too hard. Maybe there is too much damage to continue. You don’t blame him because, honestly, you can’t tell if you’re more nervous that he’s going to walk away or keep going. You were naive enough to think you could just cringe your way through it, simply grit your teeth and bear it until it was over. You miss the kissing part. That was nice, warm and comfortable. The kissing was full of promise and this is full of fear. Can’t you just go back there and put the messy stuff off? Maybe that’s best for a little while. There are no words for how terrified you are of the possibly that he’ll finish cutting you open and find nothing but scraps and broken pieces. It’s far too much to ask of anyone to try and put it all back together. No one signed up for that.

Breathe. Just remember to breathe. Calm down. Yes, you have scars. Everyone does. But that night seven months ago that made you feel so stupid? That’s why you cherish anyone saying they can open up to you so much. The guy with the rings? That’s why you’re always honest, no matter how inconvenient it can be. That time you said forever? It’s why you never make promises you can’t keep. You’ve been hurt, a hazard of being human. Wounds heal and yes, leave scars – you’re not perfect (it’s okay, no one is). The scars make you who you are and you are more than damage. Believe that. You have to – it’s the only way to make him believe it too, that it’s worth picking up again. Be brave and don’t sweat the small stuff. Take a leap of faith. Trust.

Breathe. Just remember to breathe. Save your strength, because after you find a way through all of that you still have to convince him to hand the scalpel over to you.

***

Do you have a favorite or original poem you would like showcased on Wordplay Wednesday? We’d love to share it! Email the poem to editor@intent.com, and we will feature it in the series. Click here to view past Wordplay Wednesdays.

Thursday Morning Melody: All We Are

If you had to pick one song to be the last one you heard for the rest of your life, what song would it be? Do you think you’d be able to choose? Jessica Stone faced that choice five years ago when doctors discovered tumors in her ear drums. The surgery to remove them would save her life, but it would also leave her deaf.

Jessica chose “All We Are” by Matt Nathanson – a Boston native transplant to San Francisco who is known equally for his self-deprecating, witty stage banter as he is for his heart breaking ballads. “All We Are” is the last track on Nathanson’s breakthrough album “Some Mad Hope.” The song ends the record on a positive note, hoping to push people to be more than they are and into what we could all be. No wonder Jessica picked it as her last song.

Good Morning America  chronicled Jessica’s journey leading up to the surgery and afterwards, including getting the VIP treatment at one of Matt’s shows before she went into surgery. The cameras caught her listening to the song on her iPod as she was rolled into surgery.

You can listen to a stripped down acoustic version of the song in the video below.

Six months after the surgery Jessica Stone found out that she was a candidate for cochlear implants and had them put in! So all in all she was deaf for less than a year, but she still made the courageous leap to have the surgery, and “All We Are” will always have her story attached to make it even more special.

PS. If you loved this song and are in the LA area, Matt is performing at the Wiltern Theater tonight. You should definitely check it out because he has an amazing live show.

What are the songs that touch your heart? Send them to us for our next Thursday Morning Melody! 

The State of Reconstruction: Choices Before & After Mastectomy

It’s okay to say it: Breasts have a lot to do with your femininity, sexuality, and self-confidence. Breast cancer may threaten your life, but you plan on winning that battle. You will be here for years, so as a breast surgeon I want you looking and feeling good!

Breast reconstruction after mastectomy is a choice. It offers nothing in terms of cancer cure, but quite a bit for self-esteem. Since most local recurrences occur in the skin, your reconstruction won’t delay detection if you do have a recurrence. You don’t have to wake up from anesthesia “breast-less” – the reconstruction process can begin as soon as the mastectomy ends.

After Mastectomy:  4 Choices  

Flat and Fabulous: A woman might not mind a single thin scar across her chest, and can wear a prosthetic in her bra, if she chooses; no one is the wiser when she struts her stuff! Forgoing surgery is a great choice for those who simply don’t care to reconstruct, or who have serious medical conditions prohibiting an involved surgery.

Implants: These go underneath your chest wall muscle (pectoralis), which often requires a few months of gradual stretching by repeatedly filling a temporary implant, called a “tissue expander.” Your surgeon will eventually swap the expander for your final implant; saline and silicone implants are both safe.  If you opt for a one-step procedure, your surgeon will place the final implant at the time of mastectomy using an inert substance to hold it in place. This is not a good choice if you have had or will have radiation to the breast skin, since radiated skin loses elasticity and contracts around the implant.

Flap surgery: This operation will transfer your own tissue from either your lower abdomen, back, or buttocks to your chest. The transferred skin, fat, and/or muscle create a more natural breast shape and feel than implants do. However, this is major surgery, so brace yourself for a longer, more painful recovery than with implants.

Nipple reconstruction requires using either the skin at that spot or taking it from elsewhere, to match the look of your other nipple. Your reconstructed nipple has no sensation. An areola, the darker skin around the nipple, can be recreated by tattoo. Some women find it preferable to skip the nipple after reconstruction surgery; it remains semi-erect and often needs to be hidden under clothing, whereas without the nipple, you can always go bra-less and worry-free!

 

Before Mastectomy: 3 Considerations 

Now or later?  Delaying reconstruction might be preferable when you need:

  1. Radiation after mastectomy. The reconstruction can get in the way of the radiation rays, and the breast will shrink or change afterwards.
  2. To lose weight. Obesity makes recovery difficult.
  3. To make up your mind. A girl’s got a right to change her mind – and to change it back again!

The “other girl” Your noncancerous breast might need to be lifted and/or reduced so that it better matches your new breast, if you have reconstruction.

Nipple-sparing mastectomy As long as the cancer is at least 2 centimeters away from the nipple, you can keep it. The downsides are that you have a slight cancer risk in the nipple, and not many surgeons perform this procedure.

 

Visit Breast Cancer: Healing the Whole Woman to read all of our breast cancer content.

Wishing you the “breast” of health always! 

Kristi Funk, M.D. is director of patient education and a surgical breast specialist at the Saul and Joyce Brandman Breast Center, A Project of Women’s Guild, at Cedars-Sinai Medical Center, in Los Angeles. For more on Dr. Funk, go to www.pinklotusmedical.com  

Fragrance Free: 10 Ways to Protect Yourself from Toxic Scents

Stinky, sweet smelling air fresheners, cologne, body sprays, and scented shampoo are made with synthetic fragrances, and they’re bad for your health…especially children and pregnant women. These factory-made fragrances contain phthalates, which are chemicals that can cause hormonal abnormalities, birth defects and reproductive problems.

I tell my clients not to buy artificially scented products for their home or office because they can also trigger migraine headaches, allergies and asthma attacks. A recent Institute of Medicine study sponsored by the EPA put fragrances in the same category as second hand smoke as a trigger for asthma in school-age children. Also, in homes where aerosol sprays and air fresheners were used frequently, studies found that mothers experienced 25% more headaches, and infants younger than 6 months old had 30% more ear infections.

Scented disinfectants and air fresheners are showing up everywhere! I now call ahead and request no air fresheners in rental cars and at hotels, just like asking for a non-smoking car or room. I ask my groomer not to use fragrance when she washes my dog. But it’s hard when you work at a school or non-service oriented business because most people think the person who is sensitive to fragrance is just plain weird. I know a chemically sensitive woman who was told to attend staff meetings by using Skype on her computer, so her co-workers wouldn’t have to give up using cologne or perfume. “They think it’s all in my head,” she said.

Even the mall isn’t a safe haven. The clothing store Abercrombie & Fitch sprays its signature fragrance Fierce inside as well as outside, so people are unknowingly being exposed to harmful chemicals by simply walking by the store. One environmental group,Teens Turning Green, held protests in San Francisco and New York demanding that the spraying stop. Their effort is supported by more than two dozen groups, including theCampaign for Safe Cosmetics, which revealed that A&F’s Fierce contains 11 secret chemicals that are not listed on the label.

When you see the word “fragrance” in an ingredient list, you can assume it’s all synthetic—and not a blend of natural flower extracts. The National Academy of Sciences (NAS) reports that “95% of the ingredients used to create fragrances today are synthetic compounds derived from petroleum, including benzene derivatives, aldehydes, and many other known toxins and sensitizers.” According to the EWG, there are potentially hundreds of chemicals in a single product’s secret fragrance mixture.

Be forewarned: Fragrances can contain neurotoxins and are among the top 5 allergens in the world.

Ten powerful ways to protect yourself from toxic synthetic fragrances:

  1. Avoid air fresheners. They are made with synthetic fragrances, containing phthalates.
  2. Watch for any product that lists “fragrance” or “parfum” on the label — these are FDA-approved catch-all words synonymous with hidden phthalates.
  3. Products that claim to be “fragrance free” or “unscented” could contain masking agents that give off a neutral odor, so it is best if the word “fragrance” does not appear on the label at all.
  4. Look for scents that are naturally derived or are plant-based or labeled as 100% essential oils. These are not the same thing as fragrance oils which are artificially created and contain synthetic chemicals.
  5. If a product says “Made with…” it can mean as little as 1 percent of the ingredients in the bottle.
  6. For scented candles, try those made from soy or beeswax, and make sure their fragrance is made from 100% essential oils.
  7. To clear the air use a non-aerosol citrus spray containing only citrus peel extracts, which are effective at dissolving airborne odors, instead of scented aerosol sprays, liquids that emit a continuous scent, or solid air fresheners.
  8. Labels that claim a product is “natural” or “biodegradable” do not mean that it is necessarily free of synthetic fragrances or other chemicals
  9. Certified Organic products do not contain synthetic fragrances.
  10. Make requests at hotels, car rental companies, dog groomers, schools, and offices to not use scented cleaning products.

Beth Greer, Super Natural Mom®, radio talk show host, former President of The Learning Annex, Certified Build It Green healthy home makeover specialist, eliminated a sizable tumor in her chest without drugs or surgery. She’s author of the bestseller, Super Natural Home, endorsed by Deepak Chopra, Ralph Nader, Peter Coyote, etc. She’s leading a movement of awareness and responsibility about healthy home environments and informs and inspires people to transform their homes into safe havens. Beth consults for residential and commercial clients nationwide.

Why Back Surgery Fails So Often

Researchers from Duke University show that back pain is usually caused by a person’s immunity attacking the disc in the same way that it attacks invading germs, not by a broken disc pressing on a nerve. They found that people with back pain associated with damaged discs have high levels of Interleukin-17, produced by your immune lymphocytes and known to cause asthma, rheumatoid arthritis and other autoimmune diseases.

The natural history of back pain from "disc disease" usually starts after you hurt your back. You often appear to recover after several weeks or months of pain.  However, the back pain can recur any time later, even many years after your original back problem.

 

The bones of your spine are separated by pads called discs. When you hurt your back, you can crack the outer layers of a disc, so the softer inner layers protrude through the cracks into the spinal canal. The softer inner layers of a disc normally are not exposed to the immune system. So the human immune system does not recognize it as self and attacks it in the same way that it attacks invading bacteria and viruses. The protruding inner portions of the disc then swell to press against nearby nerves to cause pain. This research implies that the immune reaction that attacks the protruding broken inner portion of the disc causes the disc to swell and press on nerves. The authors
feel that the pain is not caused primarily by broken pieces of a disc pressing on nerves so it is incorrect to use the common term "slipped disc".

If this is true, future treatment for disc disease would be to inhibit the lymphocytes that make interleukin-17. This would allow the treatment to reduce pain without blocking the body’s ability to prevent infections and tumors.  Either way, surgery for "disc disease of the back" has among the highest failure rates of any surgery today.

Plastic Surgeons vs. Cosmetic Surgeons: What You Need to Know

 It wasn’t until recently that I stumbled on the fact that there is a difference between cosmetic surgeons and plastic surgeons.  Did you know that there was one?  Not only is there a difference, but there is a huge difference and the cosmetic surgeons don’t want you to know this. 

 Plastic surgeons are surgeons who have specialized training in plastic surgery.  Not just a little training but a lot.  In order to be a plastic surgeon you need:  a degree from an accredited college in a premed major, 4 years at an accredited medical school, 4 to 5 years of residency training with the first 2 being in general surgery and the remaining 2 to 3 years being in plastic surgery.  To become board certified you also need to pass a written and an oral exam to assure your knowledge and competence. 

 Cosmetic surgeons are any M.D. who wants to call him/herself that.  It used to be that in order to get a certificate all you had to do was pay $200 and voila, you were a cosmetic surgeon.  That meant a dermatologist, a radiologist (the doctor who reads x-rays), even a psychiatrist could call themselves cosmetic surgeons and perform surgery on you!  Now in order to be a certified cosmetic surgeon you need:  an M.D. license (in any field) plus 450 hours of practice, or Continuing Medical Education units.  You also have to take a written and an oral exam.  450 hours of practice!!!!!!!

 The problem here is not only are cosmetic surgeons potentially untrained to do surgery but the board of cosmetic surgery is not a recognized board.  In other words, according to the American Medical Specialties Board being certified in cosmetic surgery is meaningless.  The AMSB is the board who oversees all board certifications in all the medical specialties.  This should concern you!

 Dr. Lawrence Koplin, renowned plastic surgeon in Beverly Hills, is a double board certified surgeon, and plastic surgeon.  He told me that in the last few years, due to the recession, doctors are having trouble making a living.  This has caused a "free for all" with dermatologists,  gynecologists and even general practice doctors calling themselves "cosmetic surgeons" and performing everything from breast augmentation, liposuction to facelifts.  Dr. Di Saia, who is a board certified plastic surgeon, came across an ENT who was doing penile enlargement surgery.  ENT’s (ear, nose and throat docs) are trained to do surgery from the neck up, like sinus surgery, deviated septum surgery, etc…but completely untrained from the neck down.  An ENT can become a "cosmetic surgeon" and voila, can convince you that they are qualified to operate on any part of your body.

Dr. Koplin told me he sees people all the time who come in mangled after being operated on by a "cosmetic surgeon".  Don’t let this happen to you.  If you are considering plastic surgery, seek out a highly qualified, board certified PLASTIC surgeon.  Be well! 

 

Intent: Lose 100#. Avoid Stomach Surgery.

One of the best ways to help people transform their lives and create their own food revolution is to share with you the intent of my patients: this is #6 of 7.*

Kathi uses seat belt extenders on airplanes and airplane trays ride up on her stomach. Her car seat is back as far as it can go.

She owns no pants without elastic waists, except those that do not fit. Sometimes she stops breathing when she sleeps. Her sister died of diabetic ketoacidosis last year.

I recommended that Kathi see a bariatric surgeon for a gastric bypass. It does carry risk and means learning new eating habits, but it works very well.

She refused. She had taken every diet pill and intimidated every dietitian she had met. She rejected theories of genetic fatalism. She knew that I could help her.

So I agreed to try. I drew a plate. Three-quarters vegetables and one-quarter other foods—foods she chose. She would see me and her physician regularly.

We have continued to work at it. As Oprah has said, “I’ve been through lots of diet programs, and there’s nothing like getting up and getting going and going for a walk in the morning.”

Over 3 years she lost 120 pounds. And has kept off 60, after 5 years. Not perfect. But better.

*adapted from my ChefMD’s Big Book of Culinary Medicine.

 

Nutrition During & After Treatment

If you’re recovering from surgery, receiving chemotherapy or radiation, or having other breastcancertreatment, your main focus is on getting rid of the cancer. Eating well will help you stay strong by giving your body the nutrients it needs.

You and your doctor can’t predict exactly how your treatment will affect you. Your general health and weight before your diagnosis play a role. So do the type, amount, and length of treatment you are receiving. As you move through your treatment, listen to your body and respond to what it needs.

You may continue to enjoy cooking and eating and have a normal appetite. Or you might have days when you don’t feel like eating anything, days when you want to eat everything, and times when only some things taste good. It’s best to have a flexible, healthy eating plan to help you deal with your body’s changing needs and wants.

A healthydiet—one with a variety of foods that includes lots of fruits and vegetables and regular protein—gives you the reserves of nutrients you need to keep your strength up while you’re fighting breast cancer. These reserves also help rebuild your body’s tissues and keep your immune system strong to help fight off infection. Plus, a healthy diet can help you cope with treatment side effects. There is evidence that some cancer treatments actually work better in people who are eating enough calories and protein. While you’re having breast cancer treatment, it’s more important than ever that you eat a healthy diet.

For more on nutrition while you’re undergoing treatment, go to breastcancer.org. 

Marisa Weiss, M.D. is the founder of breastcancer.org and the co-author of Taking Care of Your “Girls”: A Breast Health Guide for Girls, Teens, and In-Betweens (Three Rivers Press, 2008).

 

Visit Breast Cancer: Healing the Whole Woman to read all of our breast cancer content.

 

Under the Knife: What You Need to Know About Breast Surgery

“You have cancer.” Three words — and now, countless questions.

Surgery is usually the first line of defense when it comes to treating breast cancer and it typically includes two parts: first, excising the cancer from the breast, and second, checking the lymph nodes in the armpit (axilla) to see if the cancer has spread.

Here’s some very good news: Cancer confined to the breast – and yes, even when in lymph nodes – is curable! When the cancer is very large, or we know it has spread to other organs, chemotherapy becomes the first choice to shrink the tumor. Surgery follows chemotherapy once the breast tumor has shrunk, and/or the cancer in other organs has disappeared.

Here are some terms you should know that relate to breast surgery: 

Lumpectomy – Surgery to remove cancer with a surrounding margin of healthy breast tissue in all directions around the cancer. With rare exception, everyone who has a lumpectomy for cancer receives radiation therapy to the breast afterwards.

Mastectomy – Surgery to remove the entire breast, usually including the nipple and areola, but leaving the majority of overlying skin and underlying muscles.

Sentinel Node Biopsy (SNB) – The surgical removal of the first lymph node(s) in the armpit. This node(s) receives lymphatic drainage of the breast and can be analyzed microscopically to determine if cancer has spread beyond the breast.

Complete Axillary Node Dissection (CAND) – The surgical removal of all armpit lymph nodes when one or more nodes have cancer. Since the total number of nodes a woman has varies from 10 to 35, and you have hundreds in your body, you shouldn’t miss these particular nodes.

Lymphedema – A condition characterized by chronic arm swelling. This uncommon complication of CAND, which ranges from imperceptible/mild to debilitating, can occur after the removal of axillary lymph nodes when the lymph in the arm doesn’t drain and backs up.

Radiation While this isn’t a form of surgery, this treatment – in which energy rays are delivered to the remaining breast tissue – is common after surgery to essentially sterilize the breast cells and minimize the chances of a recurrence. The typical timeframe for radiation treatment is Monday through Friday, every day for 6½ weeks (33 treatments), with each session lasting about 1 to 3 minutes. Brachytherapy, also called “accelerated partial breast irradiation”, radiates only the tissue near the original cancer site, with as few as 10 5- to 7-minute treatments in five days.

If you took 2,000 women with a cancer under 5 centimeters and divided them into three groups who receive either lumpectomy alone, lumpectomy followed by radiation, or mastectomy, who do you think has the highest chance of dying, and in whom has the cancer been likelier to return?

Here’s the surprising answer: The chances of dying are the same for all three groups. The chances that breast cancer comes back (what’s called the recurrence rate) are highest for lumpectomy alone (40%) but they are identical for lumpectomy followed by radiation as compared to mastectomy (6-8%). So, chin up! Most women don’t have to lose their breast to save their life.

But there are reasons women opt for a mastectomy over a lumpectomy. Here are six common ones: 

  1. She has a small breast and a large tumor. In cases where a lumpectomy would be deforming, a woman may choose a mastectomy with reconstruction because it would look much better.
  2. She has more than one cancer in different parts of the breast.  
  3. She will not have radiation after lumpectomy, for any number of reasons, including distance from a treatment center, serious medical conditions (usually involving the heart or lung) that prohibit it, a physical handicap that limits radiation delivery, or a fear of radiation or radiation toxicity.
  4. She’s already had radiation for a previous breast cancer in the same breast. Breast skin and tissue cannot handle a second round of radiation.
  5. She has a BRCA genetic mutation, or a strong family history of breast cancer. She may consider removing the other breast as well, even if it’s healthy, to prevent a tumor.
  6. She simply doesn’t want a mastectomy.

Wishing you the “breast” of health always! 

 

Visit Breast Cancer: Healing the Whole Woman to read all of our breast cancer content.

 

Kristi Funk, M.D. is director of patient education and a surgical breast specialist at the Saul and Joyce Brandman Breast Center, A Project of Women’s Guild, at Cedars-Sinai Medical Center, in Los Angeles. For more on Dr. Funk, go to www.pinklotusmedical.com 

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