30 September 2013

Doctor Builds New Nose on Man's Forehead

Story first appeared in the Detroit Free Press.

Behold the thinking man's nose job.

Using skin and cartilage from a patient's ribs, Chinese doctors are growing a replacement nose on the forehead of a 22-year-old man injured in a car accident last year, according to a Reuters report picked up by news organizations.

The technique, reportedly a first, updates a common practice in reconstructive plastic surgery, doctors say.

The patient, nicknamed Xiaolian, received only basic treatment after the August 2012 wreck and could not afford surgery. His nose has become so badly infected that it cannot be saved.

Doctors in Fuzhou City, in Fujian province, decided to try the novel approach to growing a nose, which has taken about nine months.

LiveScience explains the procedure:

The man's doctors placed tissue expanders, which create space to stretch the skin, under the man's forehead, and created the rough shape of a nose, probably using screws and plates. They then harvested cartilage from his ribs to fill in the nose. Once the nose is ready, they will rotate the entire assemblage — skin, blood vessels, cartilage and all — and move the new nose to where his current nose sits.The lead plastic surgeon, Guo Zhihui, from Xiehe Hospital, said that the transplant would happen soon and that Xiaolian could lead a normal life afterward.

David Cangello, a plastic surgeon at Lenox Hill Hospital and Manhattan, Eye Ear and Throat Hospital in New York, told LiveScience that the procedure is "a different take on a principle that we commonly use in reconstruction." He was not involved in the surgery.

Last year, a British man who lost his nose to cancer had a replacement grown on one of his arms. His doctors said his appearance and sense of smell should be as they were before the transplant.

18 September 2013


 Story first appeared on CNCB.com.

Cancer may be the most feared diagnosis, but Americans are getting disorganized care and they're often not even getting treatment based on the best scientific evidence, a panel of experts reports.

It's often too expensive, and the most privileged are getting far better care than people with lower income, minorities, people who live away from big cities and the elderly. And most cancer patients who are doomed to die still wrongly believe they might be cured.

And as the baby boomer generation ages, the U.S. is going to be hit with a tsunami of new cancer cases. It's time to get organized, the Institute of Medicine committee says.

"As a nation we need to chart a new course for cancer care," says Dr. Patricia Ganz, chair of the committee that wrote the report and a professor at the University of California, Los Angeles, School of Medicine and School of Public Health. "We need to make the healthcare system better."

Read more from NBC News:

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The Internet brings a unique opportunity to change this, with ways to make sure doctors follow the best protocols for treating patients, and making sure patients understand what they need and what is possible, the committee says.

Cancer is the No. 2 cause of death in the United States after heart disease, killing more than 500,000 Americans every year.

Because cancer becomes more likely as people get older, the numbers will go up exponentially. By 2030, the report projects, cancer rates will go up 45 percent, to 2.6 million cases a year.

Cancer is common, so a range of doctors and other specialists treat it. Often the care is very good, but too often it isn't.
 "One would expect an entire system to snap into place that would ensure that this patient receives all the treatments he or she needs," Dr. Neil Wenger of UCLA, one of the committee members, says in a video released with the report.

"That is not the way that this system works. We have the most highly trained oncologists but because we don't have coordination among all clinicians, this care doesn't serve patients well. Sometimes it even harms patients."

So someone with colon cancer who goes to his community hospital maybe treated by a surgeon who doesn't know to take out certain lymph glands for testing to see if the cancer has spread, says Ganz. "They may do too many tests," she told NBC News.

(Read more: Studies support fast track for Roche breast cancer drug: FDA)

Often doctors order too many CT scans or unnecessary MRIs, Ganz said. "These kinds of variations lead to potential risk or harm to the patient," she said. "Obviously if you don't have good access, you won't get good care." Plus it can be costly -- and patients often must pay a large chunk of this pricey and unnecessary care.

But patients shouldn't have to rely on being able to get to big, famous cancer centers like MD Anderson in Houston, Memorial Sloan-Kettering Cancer Center in New York or Fred Hutchison Cancer Center in Seattle, says Ganz.

"The truth is, not everybody can travel," says Dr. Clifford Hudis, president of the American Society of Clinical Oncology, who was not on the panel. "We have a golden opportunity now that we are in the age of bioinformatics." Electronic communications can help doctors connect to one another and share expertise, and it needs to happen more often, Hudis and the panel agree.

"Why shouldn't any doctor who is using a computer and electronic records ultimately be able to gain from the experience of everyone? Then it won't matter quite so much if you wander into a one-person office in a rural center," Hudis says.

(Read more: Rare disease at hospital raises concerns about VA health care)

Patients also need to get more informed, and they can't be left to the mercy of misinformation on the Internet, adds Ganz. "We do recommend there be good quality information available in both written and social media," she said. "What is out there and what is on blogs can be very distressing."

The report points out that Americans often don't understand a cancer diagnosis. Up to 80 percent given a diagnosis of incurable cancer don't fully get it — they think they can still be cured, the panel points out.

"Part of this has to do with human nature and the belief that you will be the exception," Hudis says. But many oncologists are also reluctant to deliver the bad news that a patient will never be cured.

Americans often emphasize fighting cancer, characterizing patients as courageous survivors who either beat the odds, or went down after a good fight. But evidence suggests that so-called palliative care — designed to ease pain and other symptoms -- not only makes patients more comfortable, but can help them live longer than intense chemotherapy.

And people shouldn't die of cancer in an intensive care unit, the report says — even though this is still happening far too often. Quality hospice care provides a better alternative.

On the other side, people often panic when they get a cancer diagnosis and may rush into treatment, says Ganz. "We don't want to frighten patients," she says. "I think the quality of care in many places around the country is really high and of a high standard. Patients need to understand that once they are told they have cancer, it is rarely an emergency."

With the exception of an unusual brain tumor or some forms of leukemia, there is usually not a hurry. "Most of the time you can make up your mind over several weeks," Ganz says.

"It will take training of professionals and it will take big changes at a policy level including how care is reimbursed," says Betty Ferrell, an oncology nurse researcher at the City of Hope cancer center in California who was on the IOM panel. "But everything that we are advocating for is ultimately extremely possible."

09 September 2013

Cancer Battle

Story first appeared in the Detroit News.

At the same time Diana Nyad, 64, was celebrating her successful 110-mile swim from Cuba to Florida, I was with my 65-year-old brother during his five-hour chemotherapy infusion at the University of Michigan Cancer Center.

The New York Times said Nyad’s fifth attempt came “after four years of grueling training, precision planning and single-minded determination.”

I think the same could be said of Peter. Diagnosed in September of 2007 with stage four inoperable prostate cancer, the average survival time back then was 2½years. That was six years ago.

For most people, an infusion room is the least happiest place on Earth. Save the supremely accommodating nurses and staff, no one is expected to be pleasant here. No one is in a good mood. Except my brother.

Escorting us to the infusion room on the upper floor, a nurse asked: “How are you today, Mr. Rich?”

“Wonderful, just wonderful.“

As Peter took his place in the chair he gestured with one arm like a concierge. “So what do you think?” he said. “I call this ‘The Penthouse.” And “How ’bout that view? You should be here when the storms roll in. Magnificent!”

I was there for four hours. The man never shut up. In fact, after three tries, his blood pressure was still too high to start the IV. The nurses had to ask me to leave for a few minutes to get him to stop talking. Later he explained: “Early on, I didn’t want to forge any relationships. I didn’t want to join any cancer club. I was going to get in and get out. I was tough, you know. Then I decided to let my guard down and you know what? I’ve made a whole lot of friends.”

Out of the gate, Peter has been pragmatic. He asked his oncologist: “Will I die from this?” From the moment she said yes, he determined he would do everything in his power to increase his time left, to outlive the statistics. He has.

In all, he’s been through almost two years of hormone therapy, several rounds of chemo and radiation. He is now in his third clinical trial. A diligent researcher, he stays one step ahead of the clinical trials and keeps track of the maze of eligibility requirements.

The challenge in buying time is that each drug is only effective for the length of time it takes for the cancer to outwit the treatment.

With hormone therapy Peter got 22 months, with conventional chemotherapy he got 18 months. With one clinical trial, he got 46 weeks. With another clinical trial, he got nothing. In fact, the cancer advanced.

Then there are the side effects. He gained 32 pounds, only to lose almost twice that. All his hair fell out, including his eyebrows. He’s fought off pneumonia, flus and urinary tract infections. One drug turned him ghost white and blew up his face: He looked like the man in the moon. At one low point, his prostate swelled so much from the cancer he had to have stent put in his ureter.

But he’s also walked a daughter down the aisle. He completed a triathlon. He was there in the labor and delivery room when his first grandchild was born. He and his wife, Carol, welcomed another daughter home after a long absence. And too, this year’s harvest of apples, pears and pumpkins on the several acres of farmland he owns in South Lyon is the most plentiful in years.

He says his job and that of his “team” — meaning the coterie of doctors that a teaching hospital accords him — is to get “as much quality and quantity of life as possible.” Judging from the number of clinical trials being fast-tracked and the advances in gene therapy and molecular biology, he says, “I’m adding more tools to my toolbox all the time.”

Now, more than halfway through a 30-week clinical trial, he’s sick about four days a month. On those days he says he “makes adjustments.” In Peter’s world, that means it may take twice as long to finish painting the barn or he won’t be able to run as fast chasing Sage, his 2-year-old granddaughter. “And that’s just fine with me,” he says, smiling at the very thought of that special little girl.

When Nyad finished her swim on Monday after nearly 53 hours in an ocean brimming with sharks, jelly fish and squalls, she said “I have three messages. One is we should never, ever give up. Two is you never are too old to chase your dreams. Three is it looks like a solitary sport, but it takes a team.”

If I didn’t know better, I’d say my brother and this endurance swimmer were reading the same playbook.

From The Detroit News: http://www.detroitnews.com/article/20130906/LIFESTYLE01/309060015#ixzz2eQtcT6Ps