Surgery

Angelina Jolie, media darling, actress, partner to Brad Pitt, and now a surgery patient after having prophylactic (preventative) double mastectomy surgery? It's true.  Angelina had both breasts removed earlier this year, and miracle of all miracles, successfully kept it out of the tabloids!

Why on earth would a beautiful woman who has made her fortune on the way her face (and breasts, to some extent) look choose to have her breasts removed? It's simple, as simple as genetics.  Risk drove the decision to have breast surgery.

Jolie is a BRCA1 gene carrier.  In the simplest terms, she has an astronomical risk of developing breast cancer (she stated this was an 87% chance) and additional 50% risk of ovarian cancer.  Her mother died of breast cancer at the age of 56. Jolie opted to have a double mastectomy and lower her risk of dying young of breast cancer to about 5%.  She doesn't address having a hysterectomy for the risk of ovarian cancer.

Why is this announcement, this uncharacteristic openness from Jolie? It may have to do with having children who will never see their grandmother. Children who deserve to have Angelina in their lives instead of her memory, but bigger picture, talking openly about breast cancer is about saving lives. Lots of them.

If you could save thousands of lives by talking about your own health, would you? Angelina Jolie can do exactly that.  She can choose to tell the world that she had a double mastectomy and get people talking about the fact that some women have to fight their insurance companies to prevent cancer.  Oh, they will pay when you have cancer and want a mastectomy, but to prevent cancer... well, that's a tougher battle.  Angelinas's getting the word out about BRCA1 & 2 to help prevent some of the nearly 500,000 cases of breast cancer diagnosed each year.

Angelina may have played many strong women who shoot guns and save lives, but this may be her finest moment, because she is using her fame to save lives in the real world instead of on celluloid.

So when you hear people talking about Angelina's "boobs" after the news hits in the morning, ask the women you love if they have a family history of breast cancer.  If they do, ask them if they have ever had genetic testing. There may be a delay in getting testing after the Jolie floodgates open, but that's ok, it's worth the wait to find out if Angelina may have inspired you to save a life that may be your own.

Q & A

What is a double mastectomy? It is a surgery to remove both breasts, also called a bilateral mastectomy.  A unilateral mastectomy or single mastectomy would remove one breast.

Where can I get more information about BRCA 1 & BRCA2?

What are the different types of mastectomies?

A Sarasota, Florida woman was arrested this week after performing a surgical procedure on the face of a patient in her office.

So what's the problem? Well, it was her office because she is the office manager, not because she is a physician, or even a nurse.  The woman in question, 44-year-old Christine Patterson, placed a surgical drain in a patient's face after noticing postoperative swelling.  The surgeon, Patterson's brother, was out of town and she decided to take action herself.

The moral of the story? Don't let anyone who isn't a physician or a nurse handle your wound care after surgery, unless you have been given specific instructions in how to do so.

Some credit Madonna's sinewy arms and others say Michelle Obama is to blame, but no one disputes that brachioplasty (arm lift) procedures are on the rise.  Seeking sexy pecs, people are heading to the plastic surgeon's office in droves to accomplish what diet and exercise have not: sleek, muscular arms.

A brachioplasty is a procedure to remove excess skin, and sometimes small amounts of fat via liposuction, from the upper arms.  The surgery is increasing in popularity as weight loss surgery helps patients shed their excess fat but leaves excess skin behind.

Not everyone who has the procedure is a weight loss surgery patient, but if the excess skin is a result of weight loss, the weight should be stable for a year or two prior to having surgery.  As with all surgery, not smoking before and after the procedure is essential to minimizing scars and having the best cosmetic outcome.

If you are having a procedure that requires the placement of a urinary catheter, you may be thinking "Holy Cow, you want to put what where?!?!?" Whether you need a standard indwelling urinary catheter (commonly known as a foley catheter) or you need to use another type of catheter (such as a condom catheter, a coude cathter, a straight catheter or a suprapubic catheter), you may be alarmed or confused.

It's ok.

Catheters, while not exactly something that people want, are typically not as bad as your imagination may have you thinking.  Find out how a catheter is inserted, how they are removed, the risks of having a catheter, and why a catheter should be removed as soon as possible after placement.

Just remember, in the vast majority of cases a catheter can improve your comfort during a recovery from surgery, or when you are unable to empty your bladder yourself (which can be a rather painful condition called urinary retention).

If you have been told that you need a PET scan, you may be utterly and completely confused about what will be done.  Is it a CT scan? Is it a PET scan? Is it both and why do you need another CT scan with your PET scan if you've already had one?

Never fear, a simple and straightforward explanation is here.

You know your drug addiction has led you to an all new low when you dress up like a nurse and head to the hospital to steal pain medication from the patients there.

A woman, wearing clothes and shoes like many nurses wear, snuck into a Seattle area hospital and attempted to steal prescription pain killers from the patients receiving them.  When asked who she was, she indicated that she was checking the IV pumps for the hospital.  In reality, she cut more than one patient's IV lines and may have stolen the medication infusing through the line. The actual bags of medication were untouched (which may indicate this thief isn't the sharpest knife in the drawer).

Take a look at the photos: Do You Know This Nurse Imposter?

Chad Billingsley, pitcher for the Dodgers, is the most recent in a long line of pitchers to head to the hospital for Tommy John surgery.

What exactly is Tommy John surgery?

It's a surgery done to repair the ulnar collateral ligament, and is named for Tommy John--who, incidentally, was a pitcher for the Dodgers--the first pitcher to make a successful comeback after having the ligament surgically repaired.

Billingsley is expected to be out the rest of the season, but hopes to return for the next.

It's hard to bring a guy like Dwayne Johnson down, after all, the guy is referred to as "The Rock", but an emergency surgery did just that.

Johnson had an emergency repair of multiple hernias, all of which were in his abdomen.  This type of hernia happens when there is a split between abdominal muscles that allow a portion of hernia to push through, where it can often be felt immediately under the skin.  The hernia in question was likely either an epigastric hernia or an umbilical hernia.

A hernia becomes a problem worthy of emergency surgery when the loop of intestine that is poking through the wall of muscle becomes "strangulated" meaning the blood supply is being cut off. This is typically very painful, and can be a very serious--even life-threatening--condition.

All About Hernias

Sidney Crosby of Pittsburgh Penguins fame is out of the game indefinitely for surgery.

Crosby, who was hit in the face with a puck during a game against the New York Islanders, has a broken jaw and will also require extensive dental work. Luckily, Crosby is not showing signs of a concussion, which has been an issue repeatedly in the past.

What to Expect When You Need Emergency Surgery

Have you been told that you need a central line, or that a central line will be placed during surgery? Do you have questions about central lines and the risks associated with central lines? Have no fear, answers are  here.

Central lines are larger than a standard IV and some of them can do some fairly high tech things like measure fluid volume status.  If you are having open heart surgery, you can pretty much plan on having a special central line, called a Swann-Ganz catheter, that allows for measurements that help determine how your heart is functioning after surgery.

The best part of having a central line may be that you don't have to be poked in order to have your blood drawn, which, for someone who is a "hard stick," can be a very good thing.

Central Lines Explained