Saturday, April 22, 2017

RIGHT NOW, Even if you hate science, READ THIS COFFEE BREAK

At least read part of it.  Do.

Five reasons blog posts are of higher scientific quality than journal articles via

With her opening shot at glittering generalizations and the case she makes against other journal no-noes,,, how could I resist this article?

Friday, April 21, 2017

FRAILTY -Your mom doesn't need it. Let's prevent it. - MIDNIGHT SPECIAL

 Frailty is probably defined differently by just about every one.  Someone I know whose arthritis is limited even some small pleasures has been considered frail.  Perhaps among many doctors it's when too many things stop working at once, enough to limit our getting around and taking any care of ourselves.

British Geriatric Society had an article on the 21st...

"Frailty is the most problematic expression of population ageing”

In which a geriatrician talked of what we must do.  The approach seemed very general and low on avoidance or prevention, to me.

OK, since it's my blog, I also need to say (again) when I was in college, glittering generalizations (as in not supported with facts) would get you an F.  No do overs..   I'm seeing articles on my pet subjects (aging is one, of course) that are loaded with generalizations and leave me knowing nothing new and nothing to do.

So I'm taking the liberty of sharing my reply to that geriatrician's article:

 Margaret Fleming on 22/04/2017 at 1:40 am said:W

Your comment is awaiting moderation. 

I need more of an overview, more specifics on what is frailty, and on why we have not been acting earlier (I’ve had two courses of PTh in the four years since lumbar fusion.) How we should be acting to prevent every bit as much as to treat.

Your comments to my thoughts here are welcome.
I wish you health.

Thursday, April 13, 2017


With all possible respect, must say I'm disappointed in the US News "False Negatives, False Positives" article. today.

This positive/negative issue has been discussed by leaders in the field.  US News could have called on more of them instead of starting by quoting Komen.

Then, only one doctor from a college health center (UF).   Dr. Shah's list for next steps from bad mammo “after an abnormal mammogram, the next step is a sonogram, a physical exam and eventually they may need an excisional biopsy” does not reflect practice everywhere.

Instead of ultrasound (the test that produces a  sonogram,) OR excisional biopsy, I was  persuaded to have a

stereotactic needle biopsy.  It uses image guidance
 to tell the "needle" where to take a small sample.

 The tech providing the images to the doctor had recently worked to teach others to use the image technology.  I wasn't delighted by it, but it was better than traditional "knife" biopsy.  It did detect a cancer, and made me feel okay to meet the cancer surgeon.  

 The was one place quoted as having changed
 their recommendations for screening.   I don't know a lot about them, I admit.

The main benefit I see from the article is:  It made me wonder why no other hospitals are included.  Are they all pushing screening?  Or are more hospitals than realized in controversy on what to do after DCIS diagnosis.  If anything.

As one who had surgery, radiation, and now tamoxifen for DCIS,  I'm still looking up what hospitals do what.  My surgeon said I could do nothing if I chose!  At that time, as far as I knew, that was a radical stand.  He then recommended I meet a certain radiation oncologist who, I feel, pushed me (or downright pressured me) into radiation.  I had, however seen some figures from one hospital that later led me to think the radiation might be good, especially after I saw my path report from surgery.
(Have I told you that story way too many times?)

Would be interested in your feedback if you read the US News article.

I wish you health.

Tuesday, April 4, 2017


#AACR17: Basket Trial for Experimental Drug Shows Promising Early Results

First, at this week's press conference: David Hyman, MD, from presented data from a phase II basket trial.

I'm going to quote heavily here from the article's intro to the story of SUMMIT phase 2 study.:

"Neratinib,  an experimental drug developed to target certain mutations that drive cancer growth, is showing promise for treating several types of cancer. The findings from a phase II study were presented at the 2017 AACR Annual Meeting."

" Basket trials are based on the idea that cancers originating in different parts of the body may carry the same genetic mutations.

  • Neratinib, the drug in this study, targets mutations in a protein called HER2. 
  • Researchers think the drug will work even better if it’s combined with other therapies".

  • (Not the same HER2 we've been thinking of in breast cancer.)

  • Breast Cancer, cervical cancer, and biliary cancer showed the best results - some tumors shrunk, some stopped growing.  Which leads us to a story from Dr. Robin Gillespie, a scientist who has taken the drug for two years!

    After chemo and having a lung removed, she had no other conventional choices.  She was tested for mutations that might qualify her for a clinical trial, she came to SK. 

    Metastatic since 2011:

    Her tumors have stopped growingShe has almost no side effectsShe can take the medicine as pills You might enjoy her study - and have a look at the whole article.
    I wish you health.

    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....... "

    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.