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Are You Kidding Me?

Mesothelioma update: shorter course of treatment and improved survival rates?

There have been some very exciting recent developments we (the Thoracic Surgery team at Swedish Cancer Institute) are utilizing in the treatment of malignant pleural mesothelioma (MPM).

Over the past year we have offered some of our patients deemed appropriate for surgery a more streamlined approach to their overall care. Previously we have tried to offer chemotherapy, surgery, and radiation to all patients who were healthy and strong enough to undergo the three treatments, as mesothelioma is an aggressive cancer requiring aggressive treatment to optimize survival. This new approach still offers both surgery and radiation, but chemotherapy is given only to those found to have cancer in lymph nodes in the center of chest during surgery.

The advantages of this new treatment paradigm are ...

When you should seek treatment for abdominal pain

As a general surgeon, the majority of my practice is spent evaluating patients with abdominal pain and deciding whether the cause of their pain requires surgical treatment. These patients are only a small fraction of the number of people who seek medical attention for abdominal pain. Abdominal pain is fairly common and something almost all of us have experienced. Usually it is not cause for alarm and resolves on its own after a limited course if we wait and treat symptomatically. We have all had a moment however when we wondered whether this time was more serious, and how would we know if it was?

Every organ in the abdomen and pelvis (including the muscles and skin of the abdominal wall) has nerve endings and can cause pain. While nearly everyone has experienced abdominal pain, it is usually self limited and mild. Think antacids for heartburn symptoms, diet modifications for food intolerances, fluids and time for gastroenteritis, stool softners for constipation. While more severe causes of abdominal pain are rare, it is important they are recognized as they may have more severe consequences to health.

Only 15%-20% of people with abdominal pain require surgical treatment (this number increases with age). The most common reasons for surgery are  ...

Am I Operating on Your Pain or Anxiety?

I have noticed this year that many patients with significant structural anatomic problems will improve or resolve their symptoms without surgery after engaging in a self-directed structured approach.  It appears that as the nervous system calms down that the pain threshold rises.

Surgical decision-making

The barometer I use before I help patients make the final decision about whether to have surgery is whether they are sleeping well and their anxiety levels have dropped under a 5 on a scale of 10. My experience with performing surgery on a patient with a “fired up” nervous system has consistently been less than satisfactory. Pain control is difficult and even the longer-term results are marginal. There is often still a significant amount of residual pain.

I recently saw ....

Taking the Mystery Out of Robotic Surgery

Robots? Surgery?
 
The da Vinci® Surgical System is not an R2-D2™ or C-3PO™ robot. It is technology that helps surgeons perform delicate operations. Robotic surgery got its name because the surgeon does not directly hold the surgical instruments.
 
Robotic surgery is minimally invasive. It allows a surgeon to operate through several tiny incisions, rather than one large incision.
 
“Robotic surgery instruments are flexible. They mimic the surgeon’s hands and wrists,” says ...

A New Contribution to Cardiothoracic Surgical Education

There is nothing more satisfying for a clinician than when a patient understands their ailment, comprehends the nature of the pathology involved, and is clear on the treatment/procedure they are about to undergo. This "satisfaction" is a joyous emotion reflecting successful communication -- it is what parents feel when their children first begin to read, and what educators aspire to when their students master the material at hand.

It is a privilege to share our most recent contribution to the cardiothoracic surgery community, the TSRA Primer of Cardiothoracic Surgery...

 

Surgical treatment options for GERD

Gastroesophageal reflux disease (GERD) is the most common disorder of the upper gastrointestinal track.  It's estimated that up to 40% of Americans take some form of anti-acid medication at least once a month, making it one of the most commonly used types of medication in the world. 

Heartburn is simply a burning sensation behind the breast bone, and is not necessarily from GERD.  It can be caused by a variety of other disorders, including heart disease, musculoskeletal disorders, and disorders of other parts of the gastrointestinal track, including the stomach, pancreas, gall bladder, liver, or intestine A simple way to differentiate GERD from heartburn is to take antacids or over the counter acid suppressants.  There are two classes of acid suppressants: H2 blockers like ranitidine/zantac; and proton pump inhibitors (PPIs) like prilosec/omeprazole.  If the symptom partially or completely responds, it is likely caused by stomach acid, particularly GERD.

How is GERD managed?

GERD is rarely life-threatening and can generally be managed symptomatically.  Some may ...

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