Wednesday, March 22, 2017

IMPLANTS - TOUGH WORDS Midnight Special

"↓ Full text

"United States Epidemiology of Breast Implant-Associated Anaplastic Large Cell Lymphoma.

Doren EL, et al. Plast Reconstr Surg. 2017 "

Pub Med tonight

Terms - BI-ALCL   is Breast Implant associated ALCL

"CONCLUSIONS: This study suggests a statistically significant association between textured breast implants and BI-ALCL....... "

https://www.ncbi.nlm.nih.gov/m/pubmed/28157769/

OR Just Google

"9 Deaths Are Linked to Rare Cancer From Breast Implants"   NYTimes


I wish you health.

IMPLANTS? READ Coffee Break Bulletin See MEDSCAPE


If you missed this news in 2011, IT'S BACK.

On Twitter yesterday, MEDSCAPE notified us that a "maybe associated"  type of lymphoma,  ALCL has now more than "maybe" association with implants.

The article quotes FDA as saying they

" concur with the World Health Organization designation of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) as a rare T-cell lymphoma that can develop following breast implants,"

The article puts textured implants under a grey cloud.  The  Medical Device Reports FDA received that do mention surfaces far more often mention textured surface implants.

Of course, there are reminders that DEVICE problem reporting isn't gospel, etc.  but they're not ignoring the preponderant mentions of textured implants. And as for research as a whole, the agency says:

 "All of the information to date suggests that women with breast implants have a very low but increased risk of developing ALCL compared to women who do not have breast implants."

I wish  you health.

Source : Tw and view article/877518?src=soc_tw_170321_mscpedt_news_onc_implants

Thursday, March 16, 2017

A Ray of Sensible Med Thought to Save our pocket book Midnight Special


Bishal Gyawali got a re-tweet today referring to his list of what medics should stop to avoid wounding our pocketbooks (I love his phrase "avoiding financial toxicity" for patients.

One of the low-value practices to stop was ignoring cheaper drugs in supportive care.

Even though BC is not mentioned, the list gave me some hope for the future.  Also, if you can't get this on twitter, watch your sources for possible lists later of more low value behavior to drop.

Surely this will be more important if we end up short on insurance.


Tuesday, March 14, 2017

PATIENT SAFETY COFFEE BREAK HEADS UP

CT Center for patient safety announcement in my e-mail


Participate in the national Twitter chat on Tuesday March 14th at 1:00pm entitled: Patient Safety: What Patients Want (and Need) to Know.  Join Tuesday's Twitter chat with  #PSAW17chat.  The Connecticut Center for Patient Safety uses the Twitter ID @CTPatientSafety.

Monday, February 27, 2017

OOPS! EXERCISE CONFESSIONS AND...

Friday, pains were so strong (plus a migraine flare-up) that I had to go back to my morning stretch routine.

So, even tho I haven't needed to soak the eyelids in the morning, obviously I still need to do all the stretches I used to do during eye-care time. (Which, of course was also brew coffee time.)

PS The migraine images were a dead give-away that I had spent way too much time on Twitter.

And, no surprise (especially after a walk yesterday) I was just about  pain-free this morning.

Meanwhile, back at the allergies-- the area around the market and Starbucks was not a good place for that walk around 5pm - way too much car exhaust from the dinner crowd. Finding a time outside free from pollen and exhaust fumes is tricky.  And imperative!

Bottom line:  my all-body, PT approved stretches are a minimum - No exhaust fumes and pollen in here. So No excuse.

Okay, the other confessions:

The podiatrist is too polite to say my feet would hurt less if I lost weight.  I confess I gained back 4 or 5 pounds that I had lost after pre-diabetic diagnosis.  (Gee, they mean it when they say it's easier to lost than to keep it off.)  So grocery shopping is modified til I get that scales needle back toward the left.

And finally, my posture stinks.  And our postural muscles do burn calories, but only when we flex them.

Tuesday, February 21, 2017

HOW LONG MUST I TAKE BISPHOSPHONATES, OR?


This week, a tweet led me to a brief item from Mayo Clinic: 


Mayo Clinic

"Most people don't receive any additional fracture-prevention benefit after they have been taking intravenous bisphosphonates for more than three years or oral bisphosphonates for more than five years."

The item went on to indicate that we might want to stop bisphosphanates at that point, but with a qualifier that later, if our bones scanned as fragile, our physician might restart the medicine then.

For some reason, that item suddenly pulled me back to a study I saved a few years ago when I briefly considered bisphosphonates.  (For several reasons, I can't take them.)   

Before I went on to Prolia, I had accumulated a big file on bisphosphonates, and the following was in red in my BONES file: It's got good news and for some, bad news:

NEJM Catlyst:
Consequences of poor compliance with bisphosphonates.
Conclusions:

" Reductions in fracture risk and overall health costs can be detected in individuals achieving as little as 60% to 40% compliance with bisphosphonates. However, as many as 34% of patients in the first year of therapy and 52% by the third year will not reach even the minimal compliance levels required to receive benefits."
Published by Elsevier Inc.

So apparently, it's not just for how long, it's also how often (as in taking them on schedule.)

Why would someone pay for some of the pills or have some of the shots, then stop or delay too long?  
Are the side effects so miserable?  Is the cost so high?  Do some women just have so many demands on their time from job, family, money or distance that they can't continue?



Friday, February 10, 2017

WHEN TO STOP YOUR ANTIBIOTICS - BIG NEWS Don't miss this


Back in December, I had several stresses at once, including ongoing blepharitis.  Antibiotics I took months earlier had not helped.  My primary doctor offered an alternate antibiotic to start at once.

Got side effects as unpleasant as the disease.  The leaflet said to stop the meds if side effects got worse, but   I didn't stop.  Finally, close to the last dose, the night before my mammo aptmt. my eyes were badly blurring. Worried about driving to mammo the next morning, I left a msg for doctor, and I stopped taking the RX. 

That may have been my first time ever.  All my life we all heard warnings,

 DON'T STOP until all medicine is gone

Yes, everybody said that we should be sure we'd wiped out those little critters; If any were alive, we'd
stay sick or get sicker.

Then, Twitter led me to this:

"Why your doctor’s advice to take all your antibiotics may be wrong"


The old 'take all of it" warning started when penicillin was new;  we had a new "gun,' why not use it to the max.  After all, we don't want any bugs left that might make us sick all over again.

Why are there rumblings now in the medical community, more than whispers that the old "TAKE IT ALL" advice might be dangerous?

The answer: One word we weren't worried about when penicillin came out... now makes change imperative:


                                                RESISTANCE 

Bugs evolve when exposed to an enemy; they can emerge stronger. 

So if we don't need the drug any more, why give the bugs more fuel for their evolving?

Avoiding resistance makes changing medicine instructions critical.

Then I learned this position is not new.

Turns our Dr. Luis Rice of Brown U Alpert medical school has talked openly in recent years about the danger of giving bugs extra time with the enemy medicine.  . But this is no longer one man's theory.

The WHO in a meeting next month will consider changing antibiotic directions to patients and their doctors.  They already have drawn up a report in response to our fight to prevent resistant bugs evolving into something we will no longer be powerless against.

 We are, it seems at the threshold of a world full of immune, uncontrollable bugs.

But, it will be tough to wipe out the generations-old  warning so firmly lodged in our heads.  (Also, the author is brave enough to mention  that drug companies won't help speed change to find out how they can sell fewer pills!)

Before we turn the whole dosing thing upside down, the article discusses many individual situations where continuing a medicine longer has already proven the best course of action.

Dr. Lorri Hicks of the CDC summed up both sides of the situation by e-mail.  The CDC advice site had been sticking to the old warning, But now when we look at "CDC Get Smart About Antibiotics"  one bit of advice has a new ending:


  • "Never skip doses or stop taking an antibiotic early, even if you no longer feel sick, unless your healthcare professional tells you to do so."
I like very much their advice to talk to my MD about bug "resistance".  The time to do that is probably soon, before a new Rx is needed.  And, Heaven forbid, before I have to go to a bossy hospital where someone sees the OLD directions on pills I no longer even take.

Bottom line for me, I'm going to start by resisting refills on antibiotics that already proved they don't work for me.

https://www.statnews.com/2017/02/09/antibiotics-resistance-superbugs/