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Posts Tagged ‘thoracic surgery’

As most of my long-time readers know, encounters with two surgeons in particular, during the writing of my first book had a profound impact on me – and ultimately led to significant changes in my career..  (It’s funny how unintended efforts / small encounters can have such effects.  I am sure that Dr. Gutierrez never anticipated that spending a day in the operating room, and visiting patients with a gringa nurse would lead to all this – I certainly never did.)

But this week was the first time I had the opportunity to see one of those surgeons, Dr. Edgard Gutierrez in quite a long time.  It was wonderful to see him – he remains as friendly and enthusiastic as always.  Even better – he tells me that he was recently joined in Cartagena by a second thoracic surgeon, so he finally has some relief from the 24/7 frantic pace of caring for a million-person plus city all on his own.  (The addition of a second surgeon also gives him more time to work on some of his academic projects, like writing up case reports on some of his more interesting surgeries. )

He also reports that he has done several more dual-port diaphragmatic repair cases since we last communicated, along with several other interesting cases.  (I could have talked to Dr. Gutierrez all day, but alas! we had a conference to attend.)  It was wonderful to see him – and to hear about all the work he has been doing.. I volunteered to be his gringa nurse, but ….

(Too bad- I am sure it would be an enlightening/ informative and valuable experience!)

(We were too busy catching up to remember to get any photos.)

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As a follow-up for all the overseasradio.com radio listeners (and all my loyal readers) I have posted some additional information on the topics covered during the radio program with Ilene Little from Traveling for Health.com including contact information for several of the physicians mentioned.

in the Operating Room at New Bocagrande Hospital

Thoracic Surgery

Esophageal cancer – during the segment we highlighted the importance of seeking surgical treatment for esophageal cancer at a high-volume center.  One of the centers we mentioned was the University of Pennsylvania Medical Center in Pittsburgh, PA – and the work of Dr. Benny Weksler, MD.

Dr. Benny Weksler*, MD

Hillman Cancer Center

5115 Centre Avenue

Pittsburgh, PA 15232

Phone: (412) 648-6271

He is an Associate Professor in Cardiothoracic Surgery and Chief of Thoracic Surgery at UPMC and the UPMC Cancer Center.  (For more information on Dr. Weksler, esophageal cancer, and issues in thoracic surgery – see my sister site, Cirugia de Torax.org)

(To schedule an appointment via UPMC on-line click here).

We also briefly mentioned Dr. Daniela Molena*, MD at John Hopkins in Baltimore, Maryland.

The Johns Hopkins Hospital

600 N. Wolfe Street

Baltimore, MD 21287

Phone: 410-614-3891

Appointment Phone: 410-933-1233

(The link above will take readers to the John Hopkins site where they can also make an appointment.)

* I would like to note that I have not observed either of these physicians (Weksler or Molena) in the operating room.

We also talked about several of the thoracic surgeons that I have interviewed and observed numerous times, including both Dr. Rafael Beltran, MD & Dr. Ricardo Buitrago, MD at the National Cancer Institute in Bogotá, Colombia.  These guys are doing some pretty amazing work, on a daily basis – including surgery and research on the treatment of some very aggressive cancers.

in the operating room with Dr. Rafael Beltran

Dr. Rafael Beltran is the Director of the Thoracic Surgery division, and has published several papers on tracheal surgery.   He’s an amazing surgeon, but primarily speaks Spanish, but his colleague Dr. Buitrago (equally excellent) is fully fluent in English.

Now the National Institute website is in Spanish, but Dr. Buitrago is happy to help, and both he and Dr. Beltran welcome overseas patients.

Dr. Buitrago recently introduced RATS (robot assisted thoracic surgery) to the city of Bogotá.

Now, I’ve written about these two surgeons several times (including two books) after spending a lot of time with both of them during the months I lived and researched surgery in Bogotá, so I have included some links here to the on-line journal I kept while researching the Bogotá book.  It’s not as precise, detailed or as lengthy as the book content (more like a diary of my schedule while working on the book), but I thought readers might enjoy it.

In the Operating Room with Dr. Beltran

There are a lot of other great surgeons on the Bogotá website, and in the Bogotá book – even if they didn’t get mentioned on the show, so take a look around, if you are interested.

in the operating room with Dr. Ricardo Buitrago

Contact information:

Dr. Ricardo Buitrago, MD 

Email: buitago77us@yahoo.com

please put “medical tourist” or “overseas patient for thoracic surgery” in the subject line.

We talked about Dr. Carlos Ochoa, MD – the thoracic surgeon I am currently studying with here in Mexicali, MX.  I’ve posted all sorts of interviews and stories about working with him – here at Cartagena Surgery under the “Mexicali tab” and over at Cirugia de Torax.org as well.  (Full disclosure – I assisted Dr. Ochoa in writing some of the English content of his site.)

out from behind the camera with Dr. Ayala (left) and Dr. Carlos Ochoa

He is easily reached – either through the website, www.drcarlosochoa.com or by email at drcarlosochoa@yahoo.com.mx

HIPEC / Treatment for Advanced Abdominal Cancers

I don’t think I even got to mention Dr. Fernando Arias’ name on the program, but we did talk about HIPEC or intra-operative chemotherapy, so I have posted some links to give everyone a little more information about both.

HIPEC archives at Bogotá Surgery.org – listing of articles about HIPEC, and Dr. Arias.  (I recommend starting from oldest to most recent.)

Dr. Fernando Arias

Oncologic Surgeon at the Fundacion Santa Fe de Bogotá in Bogotá, Colombia.  You can either email him directly at farias00@hotmail.com or contact the International Patient Center at the hospital.  (The international patient center will help you arrange all of your appointments, travel, etc.)

Fundacion Santa Fe de Bogota

   www.fsfb.org.co

Ms. Ana Maria Gonzalez Rojas, RN

Chief of the International Services Department

Calle 119 No 7- 75

Bogota, Colombia

Tele: 603 0303 ext. 5895

ana.gonzalez@fsfb.org.co  or info@fsfb.org.co

Now – one thing I would like to caution people is that email communications are treated very differently in Mexico and Colombia, meaning that you may not get a response for a day or two.  (They treat it more like we treat regular postal mail.  If something is really important, people tend to use the phone/ text.)

Of course, I should probably include a link to the books over on Amazon.com – and remind readers that while the Mexicali ‘mini-book’ isn’t finished yet – when it is – I’ll have it available on-line for free pdf downloads.

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Wow..  a long couple of days – but I am sure not complaining!  Still having a blast – and as they teased me in the operating room, “Cristina, Cristina, Cristina!” I felt more like I belonged – instead of as a student, often lost/ confused.  Even more so – when I found myself irritated on rounds – irritated when the answers were obvious!!  Obvious – that’s certainly making progress..  (Irritated is such an improvement over clueless, I must say..) But the interns are a good bunch, even if they don’t love surgery like I do!

Residents at Mexicali General

The good doc gave me some homework – as we work on a ‘mystery diagnosis’ which I am enjoying.  Of course, it won’t be a mystery as soon as the pathology comes back, but I am surely enjoying the intellectual challenge (and kind of hoping that my preliminary leaps aren’t completely off-base..)  Of course – the doc is so smart – he probably already has it all figured out, and is just checking on the faculties of his student.  (He is secretly brilliant, and just hides it behind his braces and freckles.. Kind of scares me sometimes.. )

Deceptively normal looking..

Bumped into Dr. Ramirez and Dr. Perez (the anesthesiologist) this morning, which reminds me that I still need to write about my visits to his operating room last week.  So I haven’t forgotten – expect it in just a couple of days..

It’s nice too when we run into people I know as we round at different hospitals around the city..  But then – as I glance at the calendar and realize that time is passing – I get a little sad.  Just as I am starting to understand things (Spanish, the hospital systems etc..) and I am enjoying it here so much, learning so much, yet time is flying, and before you know it – I will be returning home again (wherever that is!)

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It’s my first week in Mexicali, and it’s already been an interesting and educational one!   It took a few days to get hooked up to the internet – but I must say Telnor is certainly faster, more efficient (and cheaper!) that any internet service provider I’ve had before.

So far, everything has worked out with fewer complications that I’d expected, and I’ve already been back to the operating room with the good doctor, and visiting several of his patients.

Right now I am working on creating a pre-operative optimization protocol for the thoracic patients with one of the respiratory therapists at the Mexicali General Hospital.  (You may remember hearing about Jose Luis during my first visit.)  The doctor I am studying with is pretty easy-going but that doesn’t mean he lets things slide.  When I first proposed the ‘pre-op plan’ he said – “sure, sure, by all means… but I want to see a review of the literature on the items you want to include” (pulmonary toileting exercises, pre-operative beta blockade, patient teaching methods).  So, yeah – I’ve got homework, but I am enjoying the intellectual exercise.

I am almost finished with the English version of a patient education brochure, so once he looks it over – I’ll start trying to translate it into Spanish (with lots of help!)

Saw a couple of cases yesterday and Friday – including a pediatric case on a little tiny two-year old girl with an empyema, which meant I also got to meet one of the pediatric surgeons who was assisting on the case.

Dr. Ochoa, VATS case

 

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As you all know, thoracic surgery is my life, and my love.  But it has been a while since I’ve hit the road and done some serious writing.  A year ago, I was researching and writing my second book, living ‘on location’ in Bogota, Colombia – and I miss it!

I miss the life of a traveling writer; meeting new people, and learning (learning, learning, learning!) new things, and writing about all of it; the highs, the lows, the things that are mundane in everyday life but somehow become new and interesting when you are doing it somewhere else..  Why is riding the bus in your hometown boring and frustrating, but that same bus in Madrid, Bogota or London becomes a mini-adventure in itself?  (It’s not just the second story in London that makes it fun.)

But at the same time, it is always so difficult for me to be away from my patients, thoracic surgery and nursing –  all the things that I do so much better than my mediocre writing.

Now I have a chance to do both.  It’s a dream come true, even if like most dreams – the nitty-gritty details don’t always stand out; no salary (yet again), but I am thrilled with the opportunity nonetheless.   I’ll be studying as a student at the elbow of a young, energetic and up- and-coming thoracic surgeon.  In him – I’ve met my match (and then some!)  He has the energy and the passion for thoracics that brings joy to long days, and hours on your feet..  But he is also a talented surgeon, who is excited about teaching – and that pleases me to no end.

Right now, my family is preparing to move; boxing up our lives, and getting ready to immerse ourselves into my newest endeavor – and I am taking all of my readers with me.  It will be a change from the usual posts, but one I hope that everyone will enjoy.

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A look at week’s posting at Cartagena Surgery and our sister sites.

Here at Cartagena Surgery we’ve been talking about the role of the acute care nurse practitioner, more about TAVI (transcatheter therapies of aortic stenosis), and our new features on domestic tourism.

Over at Bogotá Surgery.org we have a new, upgraded (free) Android application that we are testing out.  We also have a new post talking about the latest research results for uniport or single port laparoscopy.  We were pleased to see more information about Dr. Fernando Arias’s HIPEC program on the web, but a little dismayed at the borrowed content.

Also, at Cirugia de Torax.org, we recently completed a series on the lung transplant program at Duke  and updated our HITHOC files with information about the thoracic surgery program at the University Medical Center in Regensburg, Germany.

It’s been a busy week but we’ll try to keep up the pace for all of our readers out there!

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Another study confirms the utility of using an incentive spirometer (IS) and performing ‘pulmonary toileting’ prior to surgery.  The study, re-posted below looks at the rate of post-operative pneumonia in cardiac surgery patients.

Patients were stratified into two groups; one group received pre-operative IS teaching several weeks before surgery and the other didn’t.  Results: a dramatic reduction in post-operative respiratory complications – confirming what we know (and taught our patients about).

If you don’t have your incentive spirometer – take the deepest breath you can (inhale slowly.. over 2-3 seconds), hold for ten seconds, slowly exhale.  Repeat ten times, then rest..  Do this several times a day – along with coughing exercises.. and WALK frequently.

Article Re-post:

Preop Deep-Breathing Exercises Cut Pneumonia Risk After Cardiac Surgery

By Anne Harding

NEW YORK (Reuters Health) Jun 03 – Using an incentive inspirometer for a few weeks before cardiac surgery can help high-risk patients avoid pneumonia, new research confirms.

“The idea of the inspiratory muscle training before surgery is that if you increase your inspiratory muscle function before surgery, you can do your deep breathing exercises after surgery better and therefore the pulmonary complications can decrease after surgery,” researcher Karin Valkenet of the University Medical Centre Utrecht in the Netherlands told Reuters Health.

On Wednesday at the American College of Sports Medicine’s annual meeting in Denver, she reported that cardiac surgery patients in her study who did not receive at least two weeks of preop inspiratory muscle training (IMT) were three times as likely to develop pneumonia.

Valkenet’s study follows a 2006 paper in the Journal of the American Medical Association by another team from her center, which reported on 279 high-risk patients undergoing coronary artery bypass grafting (CABG) In that study, 6.5% of the IMT group developed pneumonia, compared to 16.1% of controls. Overall, 18% of the IMT group had postoperative pulmonary complications, compared to 35% of controls.

In the new study, Valkenet and her colleagues enrolled patients with diabetes, productive coughing in the previous five days, or impaired pulmonary function. Ninety-four such high-risk patients were given incentive inspirometers, trained to use them, and told to practice for 20 minutes a day at home. Their starting load was 30% of maximal inspiratory pressure, which they increased based on their perceived exertion.

Another 252 high-risk patients served as controls.

One patient in the IMT group developed pneumonia, compared to eight patients in the control group. While the difference was not statistically significant given the low number of events, Valkenet and her colleagues were able to show a relative risk of 2.9 for the patients who didn’t undergo the training, based on a propensity score analysis.

“The data confirms the randomized, controlled data that was published earlier so that’s very good news for us,” Valkenet said”.  [end of re-post]

Remember – this advice goes for all surgical patients – especially lung surgery patients, in addition to heart (cardiac surgery) patients.

Update: February 2012

Another reason to walk as if your life depends on it after surgery – it does!

The latest study on post-operative pneumonia after CABG confirms what we’ve always known – patients who develop pneumonia after cardiac surgery are much more likely to die than people who don’t..

One of the things I often tell my patients is – heart surgery is actually pretty safe (most of the time) and people rarely die from surgery – but LOTS of people die from pneumonia..  So find that inner drive/ strength/ determination to get out of bed and WALK..

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