Advances in surgeries with robots reduce risks and trim recovery times - Houston Chronicle

<base href="data:"><div style="color: black; text-align: left; "><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 1.25em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-top-style: none; border-right-style: none; border-bottom-style: none; border-left-style: none; border-color: initial; font-weight: normal; font-style: normal; vertical-align: baseline; outline-style: none; outline-width: 0px; outline-color: initial; color: rgb(0, 0, 0); font-variant: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); "><font class="Apple-style-span" face="'Helvetica Neue'">What if you could have a major surgery with only a short hospital stay, very little pain, low risk of infection, little blood loss, minimal scarring, and a fast recovery and return to normal daily activities?</font></p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 1.25em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-top-style: none; border-right-style: none; border-bottom-style: none; border-left-style: none; border-color: initial; font-weight: normal; font-style: normal; vertical-align: baseline; outline-style: none; outline-width: 0px; outline-color: initial; color: rgb(0, 0, 0); font-variant: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); "><font class="Apple-style-span" face="'Helvetica Neue'">Such a scenario is becoming increasingly possible thanks to the developing field of medical robotics and the increasing use of robots in surgical procedures. By using robots, surgeons can perform complex operations more easily and precisely, and in a less invasive way that improves results for patients.</font></p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 1.25em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-top-style: none; border-right-style: none; border-bottom-style: none; border-left-style: none; border-color: initial; font-weight: normal; font-style: normal; vertical-align: baseline; outline-style: none; outline-width: 0px; outline-color: initial; color: rgb(0, 0, 0); font-variant: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); "><font class="Apple-style-span" face="'Helvetica Neue'">"Robotics is an extension of laparoscopic surgery," said Dr. <a href="http://www.chron.com/?controllerName=search&action=search&channel=news%2Fhealth&search=1&inlineLink=1&query=%22Surena+Matin%22" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-weight: inherit; font-style: inherit; vertical-align: baseline; outline-style: none; color: rgb(234, 74, 18); text-decoration: none; ">Surena Matin</a>, an associate professor in the department of urology at the <a href="http://www.chron.com/?controllerName=search&action=search&channel=news%2Fhealth&search=1&inlineLink=1&query=%22University+of+Texas+M.D.+Anderson+Cancer+Center%22" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-weight: inherit; font-style: inherit; vertical-align: baseline; outline-style: none; color: rgb(234, 74, 18); text-decoration: none; ">University of Texas M.D. Anderson Cancer Center</a>. Matin also is medical director of MINTOS - the Minimally Invasive New Technology in Oncologic Surgery Collaborative Group at M.D. Anderson. "The improvement over laparoscopic techniques comes in terms of improving the surgeon's visibility and dexterity. Surgeons don't have to remove their eyes from the scene of surgery, and they have more range of motion through the wrists of the device than through scopes. (Laparoscopy) is like operating with chopsticks compared to the dexterity of the microwrists on the robotic system."</font></p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 1.25em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-top-style: none; border-right-style: none; border-bottom-style: none; border-left-style: none; border-color: initial; font-weight: normal; font-style: normal; vertical-align: baseline; outline-style: none; outline-width: 0px; outline-color: initial; color: rgb(0, 0, 0); font-variant: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); "><font class="Apple-style-span" face="'Helvetica Neue'">At least two of the most advanced surgical robotics systems are in use in the Houston area. Surgeons at<a href="http://www.chron.com/?controllerName=search&action=search&channel=news%2Fhealth&search=1&inlineLink=1&query=%22Memorial+Hermann+Sugar+Land+Hospital%22" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-weight: inherit; font-style: inherit; vertical-align: baseline; outline-style: none; color: rgb(234, 74, 18); text-decoration: none; ">Memorial Hermann Sugar Land Hospital</a> recently began using the <a href="http://www.chron.com/?controllerName=search&action=search&channel=news%2Fhealth&search=1&inlineLink=1&query=%22da+Vinci+Si+Surgical+System%22" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-weight: inherit; font-style: inherit; vertical-align: baseline; outline-style: none; color: rgb(234, 74, 18); text-decoration: none; ">da Vinci Si Surgical System</a> robot to perform procedures in urogynecology, gynecology, oncology and general surgery. St. Luke's Episcopal Hospital has added the same system to its suite of robotics technology to perform urological and gynecological procedures, and perhaps procedures for ear nose, throat and abdominal specialties in the future.</font></p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 1.25em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-top-style: none; border-right-style: none; border-bottom-style: none; border-left-style: none; border-color: initial; font-weight: normal; font-style: normal; vertical-align: baseline; outline-style: none; outline-width: 0px; outline-color: initial; color: rgb(0, 0, 0); font-variant: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); "><font class="Apple-style-span" face="'Helvetica Neue'">Dr. <a href="http://www.chron.com/?controllerName=search&action=search&channel=news%2Fhealth&search=1&inlineLink=1&query=%22Nina+Dereska%22" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-weight: inherit; font-style: inherit; vertical-align: baseline; outline-style: none; color: rgb(234, 74, 18); text-decoration: none; ">Nina Dereska</a>, a surgeon at Memorial Hermann Sugar Land, has been using the <a href="http://www.chron.com/?controllerName=search&action=search&channel=news%2Fhealth&search=1&inlineLink=1&query=%22da+Vinci%22" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-weight: inherit; font-style: inherit; vertical-align: baseline; outline-style: none; color: rgb(234, 74, 18); text-decoration: none; ">da Vinci</a> robotic systems for surgeries since 2009. The system allows for more surgical options with certain patients for whom traditional surgery presents a problem.</font></p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 1.25em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-top-style: none; border-right-style: none; border-bottom-style: none; border-left-style: none; border-color: initial; font-weight: normal; font-style: normal; vertical-align: baseline; outline-style: none; outline-width: 0px; outline-color: initial; color: rgb(0, 0, 0); font-variant: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); "><font class="Apple-style-span" face="'Helvetica Neue'">"With robotic surgery, small mechanical arms are inserted into the patient through tiny incisions," she explained. "Surgeons will be able to control the robotic movements, or the arms, through special hand and foot controls at a console several feet away from the operating table." The robot translates the surgeon's hand, wrist and finger movements at the control console into corresponding micro movements of the instrument's tip.</font></p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 1.25em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-top-style: none; border-right-style: none; border-bottom-style: none; border-left-style: none; border-color: initial; font-weight: normal; font-style: normal; vertical-align: baseline; outline-style: none; outline-width: 0px; outline-color: initial; color: rgb(0, 0, 0); font-variant: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); "><font class="Apple-style-span" face="'Helvetica Neue'">In other words, the robot can be set to scale down surgeon's movements so that a 1-inch movement on the surgeon's finger becomes a movement of only a fraction of an inch at the tip of the robotic instrument. Similar movements also control the camera to allow the surgeon to see inside the patient's body. The surgeon, sitting at the console, is able to continuously view the scene of surgery and perform highly precise surgical movements without nearly as much fatigue as in traditional surgical procedures, including "straight-stick" laparoscopy.</font></p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 1.25em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-top-style: none; border-right-style: none; border-bottom-style: none; border-left-style: none; border-color: initial; font-weight: normal; font-style: normal; vertical-align: baseline; outline-style: none; outline-width: 0px; outline-color: initial; color: rgb(0, 0, 0); font-variant: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); "><font class="Apple-style-span" face="'Helvetica Neue'">"Straight-stick surgery is hard on the body - my elbows are up in the air, my shoulders are hunched; it's very fatiguing," Dereska said. "Robotics surgery is much easier on the surgeon, which translates to being better for the patient."</font></p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 1.25em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-top-style: none; border-right-style: none; border-bottom-style: none; border-left-style: none; border-color: initial; font-weight: normal; font-style: normal; vertical-align: baseline; outline-style: none; outline-width: 0px; outline-color: initial; color: rgb(0, 0, 0); font-variant: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); "><font class="Apple-style-span" face="'Helvetica Neue'">Surgeons at the <a href="http://www.chron.com/?controllerName=search&action=search&channel=news%2Fhealth&search=1&inlineLink=1&query=%22Methodist+Hospital%22" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-weight: inherit; font-style: inherit; vertical-align: baseline; outline-style: none; color: rgb(234, 74, 18); text-decoration: none; ">Methodist Hospital</a> recently became the first to use the <a href="http://www.chron.com/?controllerName=search&action=search&channel=news%2Fhealth&search=1&inlineLink=1&query=%22Magellan+Robotic+System%22" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-weight: inherit; font-style: inherit; vertical-align: baseline; outline-style: none; color: rgb(234, 74, 18); text-decoration: none; ">Magellan Robotic System</a> to treat patients with peripheral vascular disease. "This new intravascular robotic system represents a fundamental step forward in the transformation of vascular intervention," said Dr. <a href="http://www.chron.com/?controllerName=search&action=search&channel=news%2Fhealth&search=1&inlineLink=1&query=%22Alan+Lumsden%22" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-weight: inherit; font-style: inherit; vertical-align: baseline; outline-style: none; color: rgb(234, 74, 18); text-decoration: none; ">Alan Lumsden</a>, chair of the department of cardiovascular surgery and medical director of the Methodist Debakey Heart & <a href="http://www.chron.com/?controllerName=search&action=search&channel=news%2Fhealth&search=1&inlineLink=1&query=%22Vascular+Center%22" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-weight: inherit; font-style: inherit; vertical-align: baseline; outline-style: none; color: rgb(234, 74, 18); text-decoration: none; ">Vascular Center</a>. "It allows us to offer less invasive endovascular options to a broader group of patients suffering from complex vascular disease."</font></p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 1.25em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-top-style: none; border-right-style: none; border-bottom-style: none; border-left-style: none; border-color: initial; font-weight: normal; font-style: normal; vertical-align: baseline; outline-style: none; outline-width: 0px; outline-color: initial; color: rgb(0, 0, 0); font-variant: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); "><font class="Apple-style-span" face="'Helvetica Neue'">The system allows a surgeon to more precisely steer a catheter inside and around blood vessels. Lumsden said it can be used for any procedure involving complex catheterization and will be especially useful in lower-extremity arterial interventions and branched endografts. In addition, the technology will help reduce both the procedure time and radiation exposure.</font></p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 1.25em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-top-style: none; border-right-style: none; border-bottom-style: none; border-left-style: none; border-color: initial; font-weight: normal; font-style: normal; vertical-align: baseline; outline-style: none; outline-width: 0px; outline-color: initial; color: rgb(0, 0, 0); font-variant: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); "><font class="Apple-style-span" face="'Helvetica Neue'">The chief drawback of robotics in surgery is the lack of haptic feedback - the ability surgeons have to visualize in their mind what they are feeling with their hands. "We don't have our fingerpads to feel and guide, so we have to learn with our eyes to see how the tissue reacts in order to get a 'feel' for it," Matin said. "This is more of an issue for late-stage cancers where the tactile feedback plays a heavier role in determining where to cut."</font></p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 1.25em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-top-style: none; border-right-style: none; border-bottom-style: none; border-left-style: none; border-color: initial; font-weight: normal; font-style: normal; vertical-align: baseline; outline-style: none; outline-width: 0px; outline-color: initial; color: rgb(0, 0, 0); font-variant: normal; letter-spacing: normal; line-height: 19px; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); position: static; z-index: auto; "><font class="Apple-style-span" face="'Helvetica Neue'">Increasingly, surgeons are being trained to use robotic systems in various specialty areas. <a href="http://www.chron.com/?controllerName=search&action=search&channel=news%2Fhealth&search=1&inlineLink=1&query=%22Peter+Herrera%22" style="margin-top: 0px; margin-right: 0px; margin-bottom: 0px; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; border-top-width: 0px; border-right-width: 0px; border-bottom-width: 0px; border-left-width: 0px; border-style: initial; border-color: initial; font-weight: inherit; font-style: inherit; vertical-align: baseline; outline-style: none; color: rgb(234, 74, 18); text-decoration: none; ">Peter Herrera</a> directs the Memorial Hermann Surgical Innovation and Robotics Institute in the Texas Medical Center. "The institute has trained numerous robotics surgical teams from around the country since we first opened in 2003," he said. "We are the largest training site for robotic surgery in the nation and the only one in the southwest USA."</font></p></div><a href="http://www.chron.com/news/health/article/Advances-in-surgeries-with-robots-reduce-risks-4293686.php"><font class="Apple-style-span" face="'Helvetica Neue'">http://www.chron.com/news/health/article/Advances-in-surgeries-with-robots-reduce-risks-4293686.php</font></a><div style="font-family: Helvetica; font-size: 14px; color: black; text-align: left; "><br class="webkit-block-placeholder"></div>

Advances in surgeries with robots reduce risks and trim recovery times - Houston Chronicle

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Librarian III, Adult Services Librarian - Welles-Turner Memorial Library, Glastonbury

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Librarian III, Adult Services Librarian - Welles-Turner Memorial Library, Glastonbury

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Ovarian Cancer Study Finds Widespread Flaws in Treatment - NYTimes.com

<base href="data:"><div style="font-family: Helvetica; font-size: 14px; color: black; text-align: left; "><nyt_text style="color: rgb(51, 51, 51); font-family: Georgia, serif; font-size: 13px; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; "><div id="articleBody"><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">Most women with <a href="http://health.nytimes.com/health/guides/disease/ovarian-cancer/overview.html?inline=nyt-classifier" title="In-depth reference and news articles about Ovarian Cancer." class="meta-classifier" style="color: rgb(102, 102, 153); text-decoration: none; ">ovarian cancer</a> receive inadequate care and miss out on treatments that could add a year or more to their lives, a new study has found.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">The results highlight what many experts say is a neglected problem: widespread, persistent flaws in the care of women with this disease, which kills 15,000 a year in the United States. About 22,000 new cases are diagnosed annually, most of them discovered at an advanced stage and needing aggressive treatment. Worldwide, there are about 200,000 new cases a year.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; "><a href="http://health.nytimes.com/health/guides/disease/cancer/overview.html?inline=nyt-classifier" title="In-depth reference and news articles about Cancer." class="meta-classifier" style="color: rgb(102, 102, 153); text-decoration: none; ">Cancer</a> specialists around the country say the main reason for the poor care is that most women are treated by doctors and hospitals that see few cases of the disease and lack expertise in the complex surgery and <a href="http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/chemotherapy/index.html?inline=nyt-classifier" title="Recent and archival health news about chemotherapy." class="meta-classifier" style="color: rgb(102, 102, 153); text-decoration: none; ">chemotherapy</a> that can prolong life.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">"If we could just make sure that women get to the people who are trained to take care of them, the impact would be much greater than that of any new chemotherapy drug or biological agent," said Dr. Robert E. Bristow, the director of gynecologic oncology at the University of California, Irvine, and lead author of the new study presented on Monday <a href="https://www.sgo.org/education/annual-meeting-on-womens-cancer/" style="color: rgb(102, 102, 153); text-decoration: none; ">at a meeting of the Society of Gynecologic Oncology</a> in Los Angeles.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">The study found that only a little more than a third of patients received the best possible care, confirming a troubling pattern that other studies have also documented.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">Karen Mason, 61, from Pitman, N.J., had been a nurse for 28 years when she was found to have ovarian cancer in 2001. She scheduled surgery with her gynecologist, who was not a cancer surgeon.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">But her sisters would not allow it. They had gone on the Internet, and became convinced — rightly, according to experts — that she should go to a major cancer center.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">"They took the reins out of my hands," Ms. Mason said.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">She wound up having a long, complicated and successful operation performed by a gynecologic oncologist, which she does not believe her gynecologist could have done.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">Dr. Barbara A. Goff, a professor of gynecologic oncology at the University of Washington, in Seattle, who was not part of Dr. Bristow's study, said the problem with ovarian cancer care was clear: "We're not making the most use of things that we know work well."</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">What works best is meticulous, extensive surgery and aggressive chemotherapy. Ovarian cancer spreads inside the abdomen, and studies have shown that survival improves if women have surgery called debulking, to remove all visible traces of the disease. Taking out as much cancer as possible gives the drugs a better chance of killing whatever is left. The surgery may involve removing the spleen, parts of the intestine, stomach and other organs, as well as the reproductive system.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">The operations should be done by gynecologic oncologists, said Dr. Deborah Armstrong of Johns Hopkins University, who is not a surgeon. But many women, she said, are operated on by general surgeons and gynecologists.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">Some women prefer the obstetricians who delivered their children. Many are desperate to start treatment and think there is no time to find a specialist. Some do not know that gynecologic oncologists exist. Some inexperienced doctors may find the cancer unexpectedly during surgery and try to remove it, but not do a thorough job.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">"If this was <a href="http://health.nytimes.com/health/guides/disease/breast-cancer/overview.html?inline=nyt-classifier" title="In-depth reference and news articles about Breast cancer." class="meta-classifier" style="color: rgb(102, 102, 153); text-decoration: none; ">breast cancer</a>, and two-thirds of women were not getting guideline care that improves survival, you know what kind of hue and cry there would be," said Dr. Armstrong, who was not involved in the study. But in ovarian cancer, she said: "There's not as big an advocacy community. The women are a little older, sicker and less prone to be activists."</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">One patient advocacy group, the <a href="http://www.ovariancancer.org/report-card/" style="color: rgb(102, 102, 153); text-decoration: none; ">Ovarian Cancer National Alliance</a>, ranks the availability of a gynecologic oncologist as one of its criteria in comparing the quality of care among states.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">Surgeons who lack expertise in ovarian cancer should refer women to specialists if the women are suspected to have the disease, but often do not, Dr. Goff said.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">Dr. Bristow's research, which has been submitted to a medical journal but not yet published, was based on the medical records of 13,321 women with ovarian cancer diagnosed from 1999 to 2006 in California. They had the most common type, called epithelial. Only 37 percent received treatment that adhered to <a href="http://www.nccn.com/files/cancer-guidelines/ovarian/index.html#/1/zoomed" style="color: rgb(102, 102, 153); text-decoration: none; ">guidelines</a> set by the <a href="http://www.nccn.com/" style="color: rgb(102, 102, 153); text-decoration: none; ">National Comprehensive Cancer Network</a>, an alliance of 21 major cancer centers with expert panels that analyze research and recommend treatments. The guidelines for ovarian cancer specify surgical procedures and chemotherapy, depending on the stage of the disease.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">Surgeons who operated on 10 or more women a year for ovarian cancer, and hospitals that treated 20 or more a year, were more likely to stick to the guidelines, the study found. And their patients lived longer. Among women with advanced disease — the stage at which ovarian cancer is usually first found — 35 percent survived at least five years if their care met the guidelines, compared with 25 percent of those whose care fell short.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">But most of the women in the study, more than 80 percent, were treated by what the researchers called "low-volume" providers — surgeons with 10 or fewer cases a year, and hospitals with 20 or fewer.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">Dr. Bristow said women should ask surgeons how often they operate on women with ovarian cancer and how often they achieve complete debulking. But he also acknowledged that many patients hesitate to ask for fear of offending the doctor who may operate on them.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">Ovarian cancer has unusual traits that make it more treatable than some other cancers. It is less likely to spread through the bloodstream and lymph system to distant organs like the lungs and brain. The tumors do spread, but usually within the abdomen and pelvis, where they tend to coat other organs but not eat into them and destroy them, said Dr. Matthew A. Powell, a gynecologic oncologist and associate professor at <a href="http://topics.nytimes.com/top/reference/timestopics/organizations/w/washington_university/index.html?inline=nyt-org" title="More articles about Washington University" class="meta-org" style="color: rgb(102, 102, 153); text-decoration: none; ">Washington University</a> School of Medicine in St. Louis.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">And most ovarian cancers are extremely sensitive to chemotherapy, experts said.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">In 2006, a study was published that many doctors thought would change the field forever. It compared standard intravenous chemotherapy with a regimen that pumped the drugs directly into the abdomen. The test regimen was highly toxic, and not all patients could tolerate it. But median survival on it was 65.6 months, compared with 49.7 months on the standard treatment — a survival difference of 15.9 months.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">The gain was huge, almost unheard of. New cancer drugs are often approved if they buy patients just a few months. The test treatment — called intraperitoneal, or IP therapy — did not even use new drugs. It just gave the old ones in a different way. Several previous studies had had similar findings for IP therapy, but the 2006 study, led by Dr. Armstrong, had the most definitive results.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">The <a href="http://topics.nytimes.com/top/reference/timestopics/organizations/n/national_cancer_institute/index.html?inline=nyt-org" title="More articles about National Cancer Institute" class="meta-org" style="color: rgb(102, 102, 153); text-decoration: none; ">National Cancer Institute</a> took a rare step, one it reserves for major advances. It issued a "clinical announcement" to encourage doctors to use the IP treatment, and to urge patients to ask about it. Cancer specialists predicted that the announcement would lead to widespread changes in treatment. Expert guidelines said it should be offered to every patient considered strong enough to endure it.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">Seven years later, Dr. Armstrong and other physicians said, IP therapy still has not caught on.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">Part of the reason may involve money, Dr. Armstrong said. With IP chemotherapy, patients also need a lot of intravenous fluids, which means unusually long treatment sessions. Oncologists are paid for treatments, not for time, so for those in private practice, long sessions can eat away at income.</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">"You don't make a lot of money with somebody in the chair getting IV fluids," Dr. Armstrong said. "Chair time is money. I'm being a cynic here, but I think that is part of the issue."</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">Dr. Goff said: "Where I live, in the Pacific Northwest, IP chemotherapy is pretty much only being done in the major medical centers, and by very few private-practice oncologists. Many say it's too difficult, and they don't even offer it to patients, which I think is unethical."</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">Ms. Mason had six hours of surgery at the Fox Chase Cancer Center in Philadelphia, with a gynecologic oncologist. The cancer had spread to lymph nodes, and was Stage 3. The surgeon removed her ovaries, fallopian tubes, various lymph nodes, uterus, cervix and omentum (part of the tissue that lines the inside of the abdomen).</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">"Ovarian cancer looks like Rice Krispies all over the place," Ms. Mason said. "She spent most of the time picking out each little visible Rice Krispy, and left nothing behind that she could see with her naked eye."</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">Then, Ms. Mason had chemotherapy (not IP, because it was not being done at the time). The disease has not recurred. Had she stuck with the first doctor, she believes, "I would be gone."</p><p itemprop="articleBody" style="color: black; font-size: 1.2em; margin: 0px 0px 1em; line-height: 24px; ">"I feel so strongly about letting women know that you need to get to a center of excellence," Ms. Mason said. "It's shocking to think it's still not happening."</p><nyt_correction_bottom><div class="articleCorrection" style="margin-bottom: 2.8em; "></div></nyt_correction_bottom><nyt_update_bottom></nyt_update_bottom></div></nyt_text><span style="color: rgb(51, 51, 51); font-family: Georgia, serif; font-size: 13px; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); display: inline !important; float: none; "></span></div><a href="http://www.nytimes.com/2013/03/12/health/ovarian-cancer-study-finds-widespread-flaws-in-treatment.html?&pagewanted=print">http://www.nytimes.com/2013/03/12/health/ovarian-cancer-study-finds-widespread-flaws-in-treatment.html?&pagewanted=print</a><div style="font-family: Helvetica; font-size: 14px; color: black; text-align: left; "><br class="webkit-block-placeholder"></div>

Ovarian Cancer Study Finds Widespread Flaws in Treatment - NYTimes.com

Most women with  ovarian cancer  receive inadequate care and miss out on treatments that could add a year or more to their lives, a new stud...

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Anxiety: Intensive Care - NYTimes.com

<base href="data:"><div style="font-family: Helvetica; font-size: 14px; color: black; text-align: left; "><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Our son was born healthy, large and pink-skinned, with a newborn assessment score of a perfect 10, but an hour after his birth, a nurse told us that something was wrong. He was jaundiced. It was not a typical case of jaundice; his bilirubin levels kept increasing at an alarming rate. I'd only seen him for a few moments — he'd been delivered by C-section, then whisked away for the usual tests and procedures — but now, as I was moved to a recovery room, the doctors couldn't tell me when I might see my baby again.</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">The doctors also didn't know the cause of the jaundice. They were running tests, but it was getting more severe. I panicked. Was it an infection? A rare cancer? A genetic disease? They couldn't say.</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">At that point in my life, hospitals and I weren't on the best of terms. When I walked through their sliding doors, a version of the slogan from Roach Motel ads ran through my head: They check in, but they don't check out. More than 20 years ago, when I was still in my teens, my mother had been admitted to New York University Medical Center with stomach pains. Doctors initially thought she had an ulcer, and then they suspected hepatitis. They finally diagnosed it as melanoma that had metastasized to her liver. She died nine days later.</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">"Your mother comes in here with a stomach ache and finds out she's a dying woman!" her gastroenterologist had said to me in the hall two days before she died, throwing his hands up in the air, as if he was exasperated that someone might have the audacity to die after such a minor symptom.</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Seven years after that, my father checked in to the same hospital with pressure in his chest. He had a massive heart attack in the hospital the next day, and died.</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Their deaths made me anxious about any seemingly small health problem. A fever could lead to a coma. Knee pain was obviously a tumor. Even after 20 years, I can't erase the image of my mother in the hospital bathroom, her urine turning the color of coffee as her liver failed. In her last days she writhed and wrestled with so much pain that she could barely speak. I can't forget the moment my father's doctor called on the phone and said, "Come at once, it's very serious," and how I sobbed quietly during the taxi ride over the 59th Street Bridge to the hospital, knowing what lay ahead, as the driver glanced in the rear view mirror and asked, "Whatsa matter, honey? Something wrong?"</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">My son's bilirubin levels continued to rise, despite intensive phototherapy. He soaked up the light while in a bassinet covered in aluminum foil, like a toaster oven tray. His tiny heels resembled pincushions, speckled with marks from countless needle pricks. He wore an eye mask that was secured to his head with little Velcro patches, which looked like the buds of fuzzy alien antennae.</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Every hour, as I recovered from my surgery, the nurses wrote his bilirubin levels on a whiteboard at the foot of my bed. I went to sleep looking at those levels, and woke up staring at them. The nurses encouraged me to pump my milk, though I wondered if my baby would live to drink it.</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">When the tests were completed, we were told that our baby had hemolytic disease, a result of ABO incompatibility. Because my type O blood and the baby's type B blood were incompatible, he'd been born with antibodies to his own blood type that were destroying his red cells. The severity of his case was extremely rare. The doctors wanted to perform an exchange transfusion, which meant removing my son's blood through his belly button and replacing it with donor blood. They explained the risks: clots, heart and lung problems, infection, shock, death. The hospital had only performed the procedure once during the previous year.</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">I cried and blamed myself. I'd caused this. I'd broken too many pregnancy rules, recklessly eating sushi, deli meat, unpasteurized cheese. Or maybe it was the worry itself, my deep-seated anxiety that had hurt him. I'd already had one healthy baby, my daughter, and I was greedy to expect to have another. Two nurses sat on either side of my bed, held my hands, and assured me that it wasn't my fault.</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">The doctor began the procedure. He removed my son's blood a teaspoonful at a time, and replaced it. They checked the bilirubin levels again and again. Finally, the numbers began to decrease.</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">My baby began to recover, but we weren't completely in the clear. "There could be long-term neurological effects," one doctor warned us. "It's hard to know for certain." One of the first signs of damage from high bilirubin is hearing loss. The doctor scheduled a hearing test in three days.</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">I braced for the worst. My blood pounded every time I approached the NICU's high-security doors and gave my name to the nurse stationed as a sentry. I felt seasick as I scrubbed under my fingernails with the special disinfectant soap, and used the foot pedal to work the faucets — all these precautions because any germ could devastate these infants struggling to survive.</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Despite everything, the NICU nurses seemed unfailingly hopeful. Theresa, Belinda, Patty and Wanda spoke to my son in tender, gentle voices; they gingerly touched his tiny hands. We stayed in the hospital over New Year's Eve, and Belinda decorated my son's eye mask with "2010" drawn in bright magic marker, so he looked like he was recovering from a night partying in Times Square.</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">"He's going to be O.K.," Patty told me.</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">"He's a good person," Wanda said. "You can tell their personality from day one, you know. He's a good one."</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">My son, for his part, seemed to take the whole NICU experience in stride, relaxing on his toaster oven tray as if he was sunbathing in the Hamptons. When I nursed him — the only time he was allowed out from under the lights — he cooed and sighed, as if he'd never imagined such bliss.</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">While my baby slept, Wanda showed me a wall covered with pictures of beaming children, and letters and holiday cards from kids who'd been through these doors and thrived. Her voice softened as she pointed to a picture of one little boy. "He weighed 12 ounces at birth," she told me. "The size of a soda can." There were photos of smiling children on horses, or playing soccer and hockey and football, or gathered around Christmas trees and family dogs.</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">The day of the hearing test arrived. My husband and I clutched hands as the audiologist attached nodes to our baby's head and studied multicolored bars on a screen — and finally told us our son had passed the test. He was fine.</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Six months later, he had his second, and final, hearing test. He passed that also. Now, three years later, the only physical reminder of the experience is a Christmas ornament the nurses made for us, with my son's footprint next to a sparkly snowflake.</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Those terrifying days live on, though. My husband can't bear to think or speak of that time at all. He'd never expected that the world might suddenly turn a healthy baby into an unhealthy one, that the universe could be so cruel as to taunt you with that pain. As for me, I don't mind speaking of it. I realize it's the experience that changed my feelings about hospitals: People do come out every day. Babies who would have died years ago now live.</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">One of those babies is now a toddler, a sweet 3-year-old boy who crawls into my lap and says, "I need huggies! I need kisses!" not knowing that he's the first gravely ill person I've loved who was cured. As Wanda walked us to the car after he was discharged, I thanked her, in tears. "I'm going to raise him the best I can," I said. "To be kind, and thoughtful, and — a good person."</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Wanda said, "That's how we change the world."</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">My son wasn't the only one who came out of the NICU healed. There were two of us.</div><div style="color: rgb(51, 51, 51); font-size: medium; margin-top: 0px; margin-right: 0px; margin-bottom: 0.7em; margin-left: 0px; padding-top: 0px; padding-right: 0px; padding-bottom: 0px; padding-left: 0px; line-height: 1.375em; font-family: Georgia, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: -webkit-left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); position: static; z-index: auto; "><em>Margo Rabb is the author of the novel "Cures for Heartbreak." Her work has appeared in The Atlantic, One Story, Best New American Voices and elsewhere.</em></div></div><a href="http://opinionator.blogs.nytimes.com/2013/03/10/intensive-care/?pagewanted=print">http://opinionator.blogs.nytimes.com/2013/03/10/intensive-care/?pagewanted=print</a><div style="font-family: Helvetica; font-size: 14px; color: black; text-align: left; "><br class="webkit-block-placeholder"></div>

Anxiety: Intensive Care - NYTimes.com

Our son was born healthy, large and pink-skinned, with a newborn assessment score of a perfect 10, but an hour after his birth, a nurse told...

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Too Many Colonoscopies in the Elderly - NYTimes.com

<base href="data:"><div style="font-family: Helvetica; color: black; text-align: left; "><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 1em; margin-left: 0px; line-height: 1.5em; color: rgb(51, 51, 51); font-family: georgia, 'times new roman', times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Bill Fullington doesn't remember exactly where he read that all adults over age 50 should be screened for colon cancer. A magazine? Maybe the local paper?</p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 1em; margin-left: 0px; line-height: 1.5em; color: rgb(51, 51, 51); font-family: georgia, 'times new roman', times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">In any case, Mr. Fullington, a retired teacher in Birmingham, Ala., takes excellent care of his health; he never smoked, doesn't drink, hits the gym daily. "Everybody thinks I'm 30 years younger than I am, because of my zip," Mr. Fullington said in an interview. So he dutifully arranged to have a colonoscopy in 2008, when he was 80.</p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 1em; margin-left: 0px; line-height: 1.5em; color: rgb(51, 51, 51); font-family: georgia, 'times new roman', times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">The doctor removed two small polyps — "the size of BBs," Mr. Fullington said — and sent him home to recover. The next day, "I woke up screaming in pain."</p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 1em; margin-left: 0px; line-height: 1.5em; color: rgb(51, 51, 51); font-family: georgia, 'times new roman', times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">At the emergency room at Brookwood Medical Center, tests showed that the procedure had perforated his colon. Mr. Fullington underwent a colostomy and spent a week in intensive care — and that was just the beginning.</p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 1em; margin-left: 0px; line-height: 1.5em; color: rgb(51, 51, 51); font-family: georgia, 'times new roman', times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">March is Colorectal Cancer Awareness Month, so you may be reading and hearing a lot about the importance of screening. You may even get to walk through the eight-foot-high inflatable simulated colon that makes appearances around the country — and see what polyps look like from the inside. But you may not hear much about when colon cancer screening should stop.</p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 1em; margin-left: 0px; line-height: 1.5em; color: rgb(51, 51, 51); font-family: georgia, 'times new roman', times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Even the <a href="http://fightcolorectalcancer.org/" style="color: rgb(102, 102, 153); text-decoration: underline; ">Fight Colorectal Cancer</a> Web site, from the major advocacy group working to make Americans aware of the disease and its prevention, says that all adults over age 50 should be screened. "Don't wait. Talk to your doctor," it urges.</p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 1em; margin-left: 0px; line-height: 1.5em; color: rgb(51, 51, 51); font-family: georgia, 'times new roman', times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">But in 2008, just a few months after Mr. Fullington's colonoscopy, the United States Preventive Services Task Force reviewed years of research and<a href="http://www.uspreventiveservicestaskforce.org/uspstf/uspscolo.htm" style="color: rgb(102, 102, 153); text-decoration: underline; ">recommended against routine screening for colorectal cancer in adults over age 75</a> and against any screening in those over 85.</p><div style="margin-top: 0px; margin-right: 0px; margin-bottom: 1em; margin-left: 0px; line-height: 1.5em; color: rgb(51, 51, 51); font-family: georgia, 'times new roman', times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); "><span id="more-14858"></span><br class="webkit-block-placeholder"></div><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 1em; margin-left: 0px; line-height: 1.5em; color: rgb(51, 51, 51); font-family: georgia, 'times new roman', times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Let's be clear: Screening those over age 50, the group most at risk, makes complete sense. Removing the polyps that may become cancerous years later (but also may not) can prevent the disease. But while colonoscopy is underused by the poor and uninsured, it's overused by the elderly.</p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 1em; margin-left: 0px; line-height: 1.5em; color: rgb(51, 51, 51); font-family: georgia, 'times new roman', times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Dr. James Goodwin, a geriatrician at the University of Texas Medical Branch in Galveston, has led much of the overtesting research. In 2011, using a 5 percent national sample of Medicare beneficiaries, his team showed that <a href="http://newoldage.blogs.nytimes.com/2011/05/25/unnecessary-colon-screenings-for-elderly-patients/" style="color: rgb(102, 102, 153); text-decoration: underline; ">older people underwent colonoscopies too often</a>. Medical guidelines call for a repeat test 10 years after the first negative colonoscopy, but their study found that nearly half of patients with negative colonoscopies had another in less than seven years, often within three or five. About a quarter took place without any clear medical indication.</p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 1em; margin-left: 0px; line-height: 1.5em; color: rgb(51, 51, 51); font-family: georgia, 'times new roman', times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Now, using Medicare data for every patient over age 70 who had a screening colonoscopy in Texas in 2008 or 2009, Dr. Goodwin and company have found that <a href="http://archinte.jamanetwork.com/article.aspx?doi=10.1001/jamainternmed.2013.2912" style="color: rgb(102, 102, 153); text-decoration: underline; ">23 percent were "potentially inappropriate"</a> because the patients were over age 75 or because they had a repeat screening too soon after the last one for no clear medical reason. The study appeared on Monday in the journal JAMA Internal Medicine.</p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 1em; margin-left: 0px; line-height: 1.5em; color: rgb(51, 51, 51); font-family: georgia, 'times new roman', times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Gastroenterologists more likely to perform inappropriate colonoscopies were older, male, graduates of United States rather than overseas medical schools, and working in high-volume practices. "There are these factories that do colonoscopies on everyone they see," Dr. Goodwin said.</p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 1em; margin-left: 0px; line-height: 1.5em; color: rgb(51, 51, 51); font-family: georgia, 'times new roman', times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Why not screen everyone? Because, he explained, at older ages the benefits diminish. "It's difficult to have this conversation, to say, 'You don't need this because you're not going to live long enough to benefit,'" he acknowledged. But colon cancer develops slowly, and in the many years it takes for small polyps to evolve into cancer, if they do, most old people will have died of other diseases.</p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 1em; margin-left: 0px; line-height: 1.5em; color: rgb(51, 51, 51); font-family: georgia, 'times new roman', times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Meanwhile, the risks increase. Mr. Fullington, who'd lost 30 pounds, returned to the hospital two months after his perforation to have his colostomy reversed. Discharged, he developed a painful "crimp" in the stomach. Doctors call it ileus, and it's not uncommon after bowel surgery at older ages.</p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 1em; margin-left: 0px; line-height: 1.5em; color: rgb(51, 51, 51); font-family: georgia, 'times new roman', times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">He returned to the hospital, where the ileus uncrimped without further surgery. But trying to get to the bathroom, "I sat up and went headfirst onto the floor," Mr. Fullington said. Bloodied and bruised, he needed head X-rays and stitches.</p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 1em; margin-left: 0px; line-height: 1.5em; color: rgb(51, 51, 51); font-family: georgia, 'times new roman', times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">He's fine today, happily. And complications like his are very rare.</p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 1em; margin-left: 0px; line-height: 1.5em; color: rgb(51, 51, 51); font-family: georgia, 'times new roman', times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">But, Dr. Goodwin noted, for older patients the prep for the colonoscopy itself can cause weeks of cycling between diarrhea and constipation. "It's not death, it's not hospitalization, but it's feeling sick and humiliated and helpless," he said. "That is a big price."</p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 1em; margin-left: 0px; line-height: 1.5em; color: rgb(51, 51, 51); font-family: georgia, 'times new roman', times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Yet public health campaigns have done such a persuasive job that some people, data to the contrary notwithstanding, believe they need <a href="http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm" style="color: rgb(102, 102, 153); text-decoration: underline; ">routine mammograms</a> and <a href="http://newoldage.blogs.nytimes.com/2011/12/12/when-pap-smears-are-no-longer-needed/" style="color: rgb(102, 102, 153); text-decoration: underline; ">Pap smears</a> and colonoscopies forever. As another study in this week's JAMA Internal Medicine shows, older adults may feel <a href="http://archinte.jamanetwork.com/article.aspx?doi=10.1001/jamainternmed.2013.2903" style="color: rgb(102, 102, 153); text-decoration: underline; ">"a strong moral obligation" to continue testing</a> and are skeptical of government panels and statistics telling them to stop.</p><p style="margin-top: 0px; margin-right: 0px; margin-bottom: 1em; margin-left: 0px; line-height: 1.5em; color: rgb(51, 51, 51); font-family: georgia, 'times new roman', times, serif; font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; orphans: 2; text-align: left; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px; background-color: rgb(255, 255, 255); ">Bill Fullington, however, vows he'll never have another colonoscopy. And at 85, he's not a candidate for one. "This whole thing would've killed 9 out of 10 80-year-olds," he said. "I'm one tough nut."</p><div><br></div></div><a href="http://newoldage.blogs.nytimes.com/2013/03/12/too-many-colonoscopies-in-the-elderly/?">http://newoldage.blogs.nytimes.com/2013/03/12/too-many-colonoscopies-in-the-elderly/?</a><div style="font-family: Helvetica; font-size: 14px; color: black; text-align: left; "><br class="webkit-block-placeholder"></div>

Too Many Colonoscopies in the Elderly - NYTimes.com

Bill Fullington doesn't remember exactly where he read that all adults over age 50 should be screened for colon cancer. A magazine? Mayb...

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Daily Education and Technology News for Schools 03/12/2013

<ul class="diigo-linkroll"> <li> <p class="diigo-link"> <a href="http://www.wirewax.com">wireWAX - interactive video tool</a> </p> <p class="diigo-description">Interesting new tool that lets you overlay and tag people, etc. in a video. There are interesting (and some scary) applications for this. This is one of those sites you'll want to play with. The neat thing is that you can add tags to objects as well. This could have some fascinating applications for flipping the classroom. "The tool is free to use, so everything you saw in the video example I sent would be possible when you sign in to wireWAX studio. The only limitation for a free user is the size of the overlay is limited to 200px by 200px, but apart from that we hope there is plenty of scope to do as much creative stuff as you like, from using the overlay boxes or the inbuilt widgets (Flickr, Instagram, Youtube, Facebok, Twitter etc). </p> <p class="diigo-tags"> <span>tags:</span> <a href="https://www.diigo.com/user/coolcatteacher/education">education</a> <a href="https://www.diigo.com/user/coolcatteacher/tumblr">tumblr</a> <a href="https://www.diigo.com/user/coolcatteacher/news">news</a> <a href="https://www.diigo.com/user/coolcatteacher/app">app</a></p> </li> </ul><p class="diigo-ps">Posted from <a href='https://www.diigo.com'>Diigo</a>. The rest of my favorite links are <a href='https://www.diigo.com/user/coolcatteacher'>here</a>.</p>

Daily Education and Technology News for Schools 03/12/2013

wireWAX - interactive video tool Interesting new tool that lets you overlay and tag people, etc. in ...

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Sagrada Familia on 60 Minutes

On Sunday 60 Minutes aired a really good piece on Antoni Gaudi's Sagrada Familia in Barclona. Below is that clip with some extra footage that CBS has posted online.<br /><br /><embed src="http://cnettv.cnet.com/av/video/cbsnews/atlantis2/cbsnews_player_embed.swf" scale="noscale" salign="lt" type="application/x-shockwave-flash" background="#333333" width="640" height="420" allowFullScreen="true" allowScriptAccess="always" FlashVars="si=254&&contentValue=50142539&shareUrl=http://www.cbsnews.com/video/watch/?id=50142539n&utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+cbsnews%2Ffeed+(CBSNews.com)" /><br /><br /><embed allowfullscreen="true" allowscriptaccess="always" background="#333333" flashvars="si=254&&contentValue=50142498&shareUrl=http://www.cbsnews.com/8301-504803_162-57573479-10391709/the-construction-zone-tour-of-sagrada-fam-237-lia/" height="420" salign="lt" scale="noscale" src="http://cnettv.cnet.com/av/video/cbsnews/atlantis2/cbsnews_player_embed.swf" type="application/x-shockwave-flash" width="640"></embed>

Sagrada Familia on 60 Minutes

On Sunday 60 Minutes aired a really good piece on Antoni Gaudi's Sagrada Familia in Barclona. Below is that clip with some extra footage...

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St. Patrick Loves I'm With Stupid!!

<div dir="ltr" style="text-align: left;" trbidi="on"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjh2TYTG5dxdbwHlzexk_pN6jB3-7TDqL-PZEhSvA-3gQ65fuLryqcxez46IZ8tm01gavWuGHZU9qiwHqLw1a-1ft1DqUi5VGRJnsxTAGrMqg6QrhCAGXOpzGGiBhellORPkf-lK1TiMRI/s1600/St.+Patrick.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjh2TYTG5dxdbwHlzexk_pN6jB3-7TDqL-PZEhSvA-3gQ65fuLryqcxez46IZ8tm01gavWuGHZU9qiwHqLw1a-1ft1DqUi5VGRJnsxTAGrMqg6QrhCAGXOpzGGiBhellORPkf-lK1TiMRI/s400/St.+Patrick.jpg" width="236" /></a>Greetings and O’Cheers readers of the O’IWS website.  St. Patrick here for O’I’m With Stupid.<br /><br />O’uuch.<br /><br />Could we please refrain from using the o’ before every word when March 17th comes rolling around?  I mean really…<br /><br />I wasn’t even O’Irish.  God Damn It!!  Now you even have me o’doing it!!  O’Arrrrrgh!!!<br /><br />O’fuck you!!  O’anyhoo…<br /><br />As the patron saint of Ireland, well at least the good part, I caught wind via a trans-Atlantic breeze that these two Irish blooded IWS guys are doing a big St. Patrick’s Day show in my honor this Sunday on Blog Talk Radio from Noon-2 P.M. ET.<br /><br />Frankly, I am so damn excited.  I have heard them in the past, and I know they do great radio, and now?  They have a two hour time slot!!  O’Jeebus!!<br /><br />I hear they have o’plenty planned for their foray into seriously comedic radio.<br /><br />I am told that Matt-Man and Jayman, or as I call him now that his radio show is premium, P-Jay, have forty shades of entertainment lined up for your enjoyment.<br /><br />Kirk Douglas will be providing a Dublin weather report.  Dixie Ozark will be reporting on local Redneckville, AR. news.<br /><br />Their token gay guy…er…homosexual man Joshua, will have some entertainment offerings, and…<br /><br />Paul Piatt will be tripping the pentameters iambically with some poetry, prose and maybe a polemic or two.<br /><br />Also, and o’dig it…damn…<br /><br />P-Jay and Matt-Man will also be calling out in order to talk to Party Marty who is the lead singer of Bagwine, Ohio’s best band, The Dreamboats, as Party Marty and his mates prepare for their big St. Me gig.<br /><br />They may even get a chance to talk to the shadowy figure known only as Big Dick and ask him why he gave them the $400.00 to go premium on BTR, and have all this time and power on their hands.  I o’shudder to think of Big Dick’s reasoning!!<br /><br />Annnnnnnd kids…they may have some big news coming out of Cincinnati to tell you about.  A British guy who sells Bulgarian wine out of Porkopolis may be interested in joining the IWS family.  Yeah, we shall o’see about that.<br /><br />On top o’that there will be music, singing, debauchery and the taking of your calls at 661.244.9852 on the Big Dick Hotline.<br /><br />This show is going to be hotter than a Northern Ireland Catholic ass being rubber bulleted by a UDF guy.  Itsa gonna be smokin’ hot bitches!!<br /><br />O’Word to your mutha!!<br /><br />So, to o’reiterate…<br /><br />This Sunday LIVE from NOON-2 P.M. ET, Matt-Man and P-Jay are going to be tripping the airwaves fantastic, so join them LIVE.<br /><br />Their IWS Radio page is <a href="http://www.blogtalkradio.com/im-with-stupid" target="_blank"><i><span style="color: blue;">HERE</span></i></a>.<br /><br /><span id="goog_1372683203"></span>Annnnnnd…you can always help them get to 200 hundred “likes” on their Facebook page by clicking <a href="http://https//www.facebook.com/iwsradio"><i><span style="color: blue;">HERE.</span></i></a><span id="goog_1372683204"></span><br /><br />Until Sunday LIVE from NOON-2 P.M. ET this is St. Patrick saying…<br /><br />I’m o’outta here!!<br /><br />St. o’P<br /><br /><a href="mailto:mattmaniws@ymail.com">mattmaniws@ymail.com</a><br /><a href="https://twitter.com/MattMan_IWS">@mattman_iws</a></div>

St. Patrick Loves I'm With Stupid!!

Greetings and O’Cheers readers of the O’IWS website.  St. Patrick here for O’I’m With Stupid. O’uuch. Could we please refrain from using the...

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Monday, Monday

<span style="font-weight: bold;"><a href="http://www.archidose.org/wp/">A Weekly Dose of Architecture</a> Updates:</span><br /><br />This week's dose features the <a href="http://archidose.org/wp/2013/03/11/alexandre-arrechea-no-limits/">No Limits</a> in New York City by Alexandre Arrechea:<br /><a href="http://archidose.org/wp/2013/03/11/alexandre-arrechea-no-limits/"><img alt="this week's dose" src="http://archidose.org/wp/wp-content/uploads/2013/03/Mar13-11-1024x768.jpg" title="This week's dose" width="640" /></a><br /><br />The featured past dose is <a href="http://www.archidose.org/Mar05/030705.html">Crown Fountain</a> in Chicago, Illinois by Jaume Plensa/Krueck and Sexton:<br /><a href="http://www.archidose.org/Mar05/030705.html"><img alt="this week's dose" src="http://www.archidose.org/Mar05/crown1.jpg" title="featured past dose" width="640" /></a><br /><br />This week's book review is <a href="http://archidose.org/wp/2013/03/11/candide-no-6/"><i>Candide No. 6</i></a> edited by Susanne Schindler, Andres Lepik, Axel Sowa (L):<br /><a href="http://archidose.org/wp/2013/03/11/candide-no-6/"><img alt="this week's book review" height="300" src="http://archidose.org/wp/wp-content/uploads/2013/03/candide6.jpg" title="This week's book review" /></a> <a href="http://archidose.org/wp/2011/10/03/2020/"><img alt="this week's book review" height="300" src="http://archidose.org/wp/wp-content/uploads/2011/10/20-20.jpg" title="This week's book review" /></a><br />(R): The featured past book review is <a href="http://archidose.org/wp/2011/10/03/2020/"><i>20/20: Editorial Takes on Architectural Discourse</i></a> edited by Kirk Wooller.<br /><br />: : : : : : : : : : : : : : : : : : : : : : :<br /><br /><span style="font-weight: bold;">American-Architects <a href="http://www.american-architects.com/en/pages/50x50">Building of the Week</a>:</span><br /><br /><a href="http://www.american-architects.com/en/projects/project-current-review/40205_hinman_research_building">Hinman Research Building</a> in Atlanta, Georgia, by NADAAA/Lord, Aeck and Sargent:<br /><a href="http://www.american-architects.com/en/projects/project-current-review/40205_hinman_research_building"><img alt="this week's Building of the Week" src="http://c214210.r10.cf3.rackcdn.com/files/projects/40205/images/900:w/HinmanPhoto2.jpg" title="Current Building of the Week on american-architects.com" width="640" /></a>

Monday, Monday

A Weekly Dose of Architecture Updates: This week's dose features the No Limits in New York City by Alexandre Arrechea: The featured pa...

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Financial Analyst ( Forecasting | Strategic Planning | Management Reporting) (#109203)

<div dir="ltr" style="text-align: left;" trbidi="on"><div class="WordSection1"><div class="MsoNormal"><b><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Position:</span></b><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"> Financial Analyst<o:p></o:p></span></div><div class="MsoNormal"><b><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Location:</span></b><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"> Milpitas, CA<o:p></o:p></span></div><div class="MsoNormal"><b><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Duration:</span></b><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"> Full time<o:p></o:p></span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><b><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Job Description:<o:p></o:p></span></b></div><div class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">KLA-Tencor has manufacturing sites across the globe, including Belgium, China, Germany, Israel, Singapore and Milpitas (CA). The Global Operations (GOPS) team, comprised of Manufacturing, Supply Chain Management, Manufacturing Engineering, Installation, and Quality, is responsible for manufacturing our leading-edge technology. We partner with our world-wide supply base and our design engineering teams to bring new products to market. The GOPS team is continuously working to build our products Better, Faster, Cheaper.<o:p></o:p></span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><b><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">The Role:  Financial Analyst</span></b><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"><o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">We are looking for a sharp finance professional to join our Global Operations Financial Planning and Analysis team who will be responsible for forecasting, strategic operations planning, analysis, and management reporting. The ideal candidate would have an interest in manufacturing operations and the metrics that help to drive improvements. You will be a key contributor to driving Operations headcount planning, Gross Margin improvement, Inventory management and Materials Cost reduction. You will interact with executives and have high visibility throughout the company. Successful candidate will be a top performer who has a passion to champion positive change throughout the organization.<o:p></o:p></span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><b><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Essential Functions:<o:p></o:p></span></b></div><div class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">- Provide financial and analytical support for the company's forecasts and results<o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">- Create and implement process improvement across the company in all regions<o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">- Create new reports and models to meet the business' needs and drive decisions<o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">- Perform ad hoc financial analyses and special projects<o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">- Perform ad hoc financial analyses in support of US Operations<o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">- Prepare quarter end executive reports<o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">- Support improvements of our financial planning models and system<o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">- Participate in all budgeting and forecasting processes<o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">- Monitor and report operating results against budget and forecast<o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">- Create and distribute scalable weekly, monthly and quarterly management reports<o:p></o:p></span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><b><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Skill Requirements:<o:p></o:p></span></b></div><div class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">- Team player with a positive attitude<o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">- Strong Analytical skills<o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">- Strong computer skills and extensive knowledge of Excel<o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">- Fast learner with new tools and systems.<o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">- Ability to think strategically and proactively<o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">- Organized, detail-oriented, and able to multi-task<o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">- Strong ability to partner and build relationships<o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">- Ability to meet deadlines and prioritize; to troubleshoot and problem solve.<o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">- Must be comfortable presenting data to senior management. <o:p></o:p></span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><b><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Preferred Qualification:<o:p></o:p></span></b></div><div class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">MBA preferred<o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Experience with Cognos TM1 preferred but not required<o:p></o:p></span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><b><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Basic Qualifications:<o:p></o:p></span></b></div><div class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Bachelor's Level Degree with at least 3 years of experience.<o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">OR <o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Master's Level Degree with at least 2 years of experience.<o:p></o:p></span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Proficiency with Microsoft Excel and PowerPoint<o:p></o:p></span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Kindly send your resume to <b><a href="mailto:raju.balaji@kla-tencor.com">raju.balaji@kla-tencor.com</a></b><o:p></o:p></span></div></div></div>

Financial Analyst ( Forecasting | Strategic Planning | Management Reporting) (#109203)

Position: Financial Analyst Location: Milpitas, CA Duration: Full time Job Description: KLA-Tencor has manufacturing sites across the glo...

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Mother's Day

We had dinner in my mam's yesterday for Mothers Day. My mother makes the best cakes! Ciaran loves her apple strudel while I adore her cream slices. <br/><br/><div class="separator"style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhxoWIGnNpFvnUU5NnpzCywXWY4UH8KksvlWjt4BEyar11qjXdxNMREXRdMwh-GpHTCqfHHZS5Ov4ClbJIN_PkxjDT84Vk6tvqoCp9IhZgx6CNTkamuTWf4GBcFaoJVh3K2TLtMSOSLJack/s640/blogger-image--427532232.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhxoWIGnNpFvnUU5NnpzCywXWY4UH8KksvlWjt4BEyar11qjXdxNMREXRdMwh-GpHTCqfHHZS5Ov4ClbJIN_PkxjDT84Vk6tvqoCp9IhZgx6CNTkamuTWf4GBcFaoJVh3K2TLtMSOSLJack/s640/blogger-image--427532232.jpg" /></a></div> <br/><br/><div class="separator"style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjESMC7obcchrwYbdbV5aIaIexgVkZu0IgZEl4DqDU_YqgfrXd6WEMjB5Mo5BUkyfsrDZUAv5gKMcLWBTalmoSLdFbIGarnyXG2A1aK7DqHEC23RhM7FK7rTrGdUcyjRANA9AZjQP_9het1/s640/blogger-image-1595604025.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjESMC7obcchrwYbdbV5aIaIexgVkZu0IgZEl4DqDU_YqgfrXd6WEMjB5Mo5BUkyfsrDZUAv5gKMcLWBTalmoSLdFbIGarnyXG2A1aK7DqHEC23RhM7FK7rTrGdUcyjRANA9AZjQP_9het1/s640/blogger-image-1595604025.jpg" /></a></div>

Mother's Day

We had dinner in my mam's yesterday for Mothers Day. My mother makes the best cakes! Ciaran loves her apple strudel while I adore her ...

Read more »