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Archives for August 2013

Chronic Pain After DIEP Flap Surgery–Can You Help?

August 30, 2013 by

This week, Dr. Richard Kline of The Center for Natural Breast Reconstruction answers your questions.

Q: After a double mastectomy in April 2010, my left expander was replaced in June 2010 due to leakage and became infected.

I was hospitalized and given vancomycin and oral antibiotics for almost 3 weeks. Infection spread to right breast and both expanders were removed the same month.

I had DIEP flap surgery in December 2010, but I have had severe pain and shocking sensations in chest, ribs and stomach. My surgeon says he does not know what is causing this pain. Is it the result of nerve damage? And is there any way to fix this?

A: So sorry to hear about your experience! Out of 1,011 flaps to date, we have very few patients with chronic pain, but unfortunately it does sometimes occur. We usually examine the areas in question with a CT and/or MRI, but usually this does not show any abnormalities other than normal post-surgical changes.

In this scenario, we then refer the patients to our pain therapists, who almost always are able to provide significant relief. Please let us know if we can provide additional information.

Dr. Richard M. Kline, Jr.

Center for Natural Breast Reconstruction

Have a question about breast reconstruction you’d like answered from our surgical team? Just ask us!

Filed Under: Ask the Doctor Tagged With: , , , ,

Gift of the Present: An Interview with Heidi Sermersheim

August 28, 2013 by

Heidi Sermersheim

Heidi Sermersheim is an absolute inspiration to our team at the Center for Natural Breast Reconstruction. Dr. James Craigie wrote a recommendation letter on behalf of Heidi for her Cancer for College scholarship application, and Heidi was selected as the recipient! She received funds to continue her education, and we are so proud of her! Take a few moments to read her inspiring interview, and feel free to share this story with the loved ones in your life.

Congrats on your recent scholarship! Tell us a little about your award and what it means to you personally.

Thank you!

In April  I received a generous regional ‘Carolina’ scholarship of a one-time $1000 donation through Cancer For College for the 2013-2014 academic year.  I am significantly humbled to receive this honorable scholarship award, and deeply appreciative for the financial support.  I plan to use this scholarship to help cover the additional expenses beyond the initial tuition costs, while continuing my education in Human Services at Southern Wesleyan University. Without the generosity of scholarship patrons like this, there would be many students, much like myself, struggling to meet various educational expenses. 

Tell us a little bit about your story and how you survived through breast cancer?

There were five children in our family, four girls and a boy. By birth order, Gail was second to the oldest and I was the youngest. Despite the age difference of 14 years, we were connected genetically, shared a spiritual bond, and had become the best of friends.

In 2004 Gail was diagnosed with breast cancer. At that time, she was forty-eight years old. Gail was a nurse, so she began to strongly encourage the women in her life to obtain a mammogram. Her persistent encouragement inspired me, and I, reluctantly, scheduled my first and consequently the last mammogram of my life. Two weeks later the results of my mammogram revealed suspicious spots in need of biopsy. Within three months further tests had revealed that I too, had the most aggressive form of what is classified as ‘triple negative’ (high grade – ER/PR-negative, HER2Neu negative) infiltrating ductile carcinoma breast cancer.

I found myself following behind my sister, stepping carefully in her footprints, mapping out my own cancer treatment and surgery. Soon, Gail and I were side-by-side in our journey, as our bi-weekly chemotherapy appointments were only offset by one week of each other. After six months of treatment, we were blessed to have 2 years of remission.

Unfortunately, her cancer returned with a vengeance in 2006 and sadly, Gail passed away. Gail’s compassion for life, desire to mentor, and willingness to share her experiences provided me with a heightened appreciation for the “gift of the present.”

Did you have breast reconstruction surgery? If so, what type of breast reconstruction did you have? Would you recommend it to other women who might be contemplating natural breast reconstruction?

Yes, after my diagnosis and meeting with multiple physicians, oncologist and plastic surgeons along with a significant amount of research; I chose to have bi-lateral skin-sparing mastectomies, with immediate DIEP reconstruction. I was blessed to discover Dr. Craigie and Dr. Kline of the Center for Natural Breast Reconstruction. Their office staff graciously coordinated the details of my surgery. The overall attention to detail, kindness and care which I received from Dr. Craigie and his professional staff was absolutely priceless. I simply cannot express the impact this has made on my life, during treatment and my recovery. Not only would I recommend this procedure to other women, I have recommended it and will continue to do so.

What is the one thing you want all women to know about breast cancer?

First and foremost, aggressive breast cancer among young women is on the rise in America. One of the best ways for detection of breast cancer is through a mammogram, in my case, my first and last mammogram saved my life!

Upon receiving a breast cancer diagnosis, become your own best advocate by asking questions (remember there are no ‘dumb’ questions) and seeking out answers. Knowing all the surgical and reconstruction options is very important in making an informed decision.

I must add that, during this journey, I became significantly aware of the importance in human compassion during cancer diagnosis and treatment. When diagnosed with breast cancer, women often experience a feeling of their womanliness being robbed by breast cancer surgery and treatment. Flap reconstruction procedures are better than former surgical reconstruction options. However, in my opinion DIEP is the gold standard of reconstruction because it provides the least problems, offers a faster return to normal activities, and has a better long term surgical outcome than most other reconstruction options available.

 

You have achieved so much and given back since being diagnosed with cancer. What is next for you in life?

Surviving the diagnosis of breast cancer has helped to clarify my personal worldview and pinpoint my calling in life to serve others. In doing so, I am currently enrolled in a bachelor’s degree human services program, with aspirations to complete a graduate degree in social work, counselor education or youth development leadership. I plan to combine my degree with my life experience, in order to advocate, mentor, and assist people by teaching and helping with navigating higher education and oncology healthcare systems. By obtaining a bachelor’s degree in higher learning, I believe that my life will be enriched and I will be better prepared to fulfill this mission.

The journey of life and learning continue to propel us forward and provides opportunities to examine our mirrors of reflection introspectively and reflectively. All-the-while, our heart’s motive is revealed to us and becomes better illuminated and more transparent with time. I am forever grateful to live on my sister’s coattail, because my cancer diagnosis helped me blaze my life’s pathway. It is through her death and my battle with breast cancer that I have grown into a better person with an intimate knowledge of God’s grace, love and mercy. Overall, the ‘gift’ of breast cancer has bestowed upon me a ‘bucket list’ of goals, higher aspirations, and provided multiple opportunities to give back. Indeed, I am blessed.

For more information about me, please feel free to explore my website: www.heidiwalkersermersheim.webnode.com

 

Filed Under: In Her Words Tagged With: , , , , , ,

Push-Ups: Any Way You Want ‘Em

August 26, 2013 by

Did you have to do push-ups in school gym?

Did you hate them?

When starting out this exercise, push-ups can “feel” harder than other arm workouts–but they’re a simple and safe move that everyone should do.  Integrating push-ups into your workout every other day can quickly improve the strength and tone of your shoulders, arms and your chest, and put you on the path to a strong and sexy upper body.

Check out our three ways to get started with push-ups, followed by a couple of fun variations to challenge your workout!

Key Tips for Push-ups:

-If  you feel the muscle tiring and shaking a lot, stop. NEVER over-exert yourself on push-ups–this can lead to injury.

-Stop to rest any time you need to; we recommend 30-60 seconds of rest time between sets.

-Keep your neck and body straight.

-Remember to keep your core abs tight!

-Grab a friend and challenge each other to do push-ups! It will keep the rep numbers up where they need to be.

-Listening to a good music beat will keep you in push-up rhythm and complete your set.

Knee Push Ups are Easy Breezy

Push-up #1: The Easy Breezy

Step 1 Lower yourself to the ground facing the floor. Lift yourself up and position your hands shoulder-width apart. Keeping your legs together, bend the knees and cross your ankles in the air for extra support. Your body is now at a gentle angle to the floor.

Step 2 Keeping your abs tight and your body straight, lower yourself slowly, then push back up. Don’t bend at the waist or stick your, ahem, behind in the air.

Step 3 Repeat the move. Aim for 3 sets of 10 push-ups, but DON’T WORRY if you can’t meet this goal right away. You can build up with push-ups! These are fun and you can do them at home, in the office or at the gym.

A Little Elevation Stair Push ups

Push-up #2: A Little Elevation 

Step 1 Stand facing a staircase with both feet flat on the floor a few inches in front of the bottom step. Place your hands shoulder-width apart on the front edge of a step so your body is at roughly a 45-degree angle to the floor. Keeping your abs tight and your body straight, lower yourself slowly, then push back up. Do 1 set of 10.

Step 2 Position your feet about 6 inches away from the stairs and place your hands one step lower. Aim for 10-15 pushups, and take breaks as you need them. We recommend 30 seconds.

Step 3 Repeat the move, but this time back your feet a few more inches away from the stairs and lower your hands another step. Repeat until you run out of stairs and can do 10 on the floor.

Gimme Ten Standard Push-ups

Push-up #3: Gimme Ten! 

Step 1 Lie down on the floor face down with your feet close together. Place your hands shoulder-width apart.

Step 2 While maintaining a straight body–keep your abs tight!–lower yourself down until your chest touches the ground. Do not lock your elbows and let your weight go.

Step 3 Push yourself up. That’s one rep! Now repeat, going a little faster. Complete a set of 10 standard “military-style” push-ups, and aim for three sets.

Variations

  • The Diamond Push-up: Start in standard push-up “Gimme Ten” stance, but using your forefingers and thumbs, bring your hands together, palms flat on the floor, to form a diamond shape with the fingers. Lower per standard push-up. Aim for a set of 10.
  • The One-Handed Push-up: Cue the theme to Rocky and get ready to show the world what you’re made of! Starting in standard push-up position, place one hand behind your back and lower yourself to the ground. Raise your body back up. You can try a set of 5 on each side or alternate arms.
  • The Back Elevated Push-up: This requires lifting your legs higher off the ground on an elevated surface, such as a weightlifting bench. It adds a little more “oomph” to the standard push-up. Check out the instructional video at the bottom of this post!

You don’t have to follow these suggestions exactly—find the push-up stance and variation that works for you. There are plenty of instructional videos out there to show you ways to do push-ups indoors and outdoors. You’ll be on your way to a beautifully toned upper body in no time!

Filed Under: Health and Wellness Tagged With: , , , , , , ,

I Have Poland’s Syndrome–Am I Candidate for Reconstruction?

August 23, 2013 by

Natural Breast Reconstruction options

This week, Dr. James Craigie of The Center for Natural Breast Reconstruction answers your questions.

Q: I am a 56 year-old woman who has Poland’s Sydrome. I have no right breast tissue. Are any of your procedures appropriate for my condition? What is the cost? Because my condition is congenital, I will not be covered by insurance. 

A: I have seen many patients with Poland’s syndrome who we were able to help. As you know, there are many different problems–mild to severe–that can occur. All of our patients who have had reconstruction of their breast due to congenital (Poland’s) problems have been covered by insurance. So don’t give up on getting coverage. I will be glad to give you more information about your situation if you like. My office will be happy to contact you, too. Just let us know.

Dr. James Craigie

Center for Natural Breast Reconstruction

Have a question about breast reconstruction you’d like answered from our surgical team? Just ask us!

Filed Under: Ask the Doctor Tagged With: , , , , ,

Nature Walks in the Charleston Area

August 21, 2013 by

Charleston Area WalksThe beautiful Charleston area is home to a variety of natural settings and habitats. Explore the wonder of Charleston with two of our favorite nature walks and tours. And often the walking tours involve a boat ride too!

Morris Island Tours

If you enjoy hunting shells and exploring islands, this is the tour for you. Morris Island may look like a neglected shell of an island, but you’ll be fascinated by its rich history (including Blackbeard the Pirate and Civil War blockades).

You’ll be surprised by how few people wander around the island, so you’ll feel like you have it all to yourself. Expect to find sand dollars and conch shells, and if you’re lucky, you might find a piece of Morris Island history. Wildlife abounds, and you’ll feel as if you’ve gone back in time.

Bulls Island Ferry and Eco Tour

Join Captain William Christianson on board one of three ferries to Bulls Island. The Captain is a marine biologist, so during the half-hour trip to the island, you’ll discover the beauty of turtles, a variety of sea birds, and dolphins, among other species. You’ll gather round the touch table and hear about the artifacts, which typically include skulls and bones of the native animals.

When you arrive at Bulls Island, you’ll be greeted by miles of beach and trails, just waiting for you to explore. Take your time and enjoy the walk, or bike along the paths. Turkey Walk Trail is a particular favorite of guests. Don’t forget to check out the observatories throughout the island.

Have you been on either of these tours, and what did you enjoy most?

 

Filed Under: All Things Charleston Tagged With: , , ,

The Five-Minute Office Stretch Break

August 19, 2013 by

Stretch Break

Have you ever left work feeling hunched over and cramped up?

Time to start stretching throughout the day!

You’ll feel better—and be healthier too—if you can get up from your desk and stretch at least once an hour. To remember to do it, schedule it on your calendar just like you would a work-related task. Taking a break once an hour will get the blood flowing, release stress and tension, and maintain health and productivity. Stretching also gets your eyes off the computer screen and gives them a rest.

Any kind of stretch you can do will be helpful, but here are a few ideas.

  • Stand up and pretend you’re reaching for the ceiling. When you think you’ve stretched as far as you can, try for one more inch and hold for a count of three. Interlock your hands and lean back as far as you can without falling over and hold again for a count of three. Lean left, then right, then forward—holding all for that same three-count.
  • Spread your legs a little bit and see if you can touch the floor. Go limp like a rag doll and feel the stretch in your back.
  • Stretch out one arm and turn the hand so fingers are pointing down. Use the other hand to gently pull the fingers up and towards you, stretching the forearm. Hold for 10–15 seconds and repeat on the other hand.
  • Move your head gently from left to right ten times, and then slowly move your head up and down ten times. Shrug your shoulders ten times, and make a fist and roll your wrists ten times clockwise and counter-clockwise. Finally, open and close your hands ten times, spreading fingers wide.

If you’re stuck sitting in a meeting, you can still stretch…

  • The third and fourth set of stretches above can be done while sitting, but you may need to do them extra slowly so you don’t call undue attention to yourself!
  • Sit up as straight as you can and stretch your body as tall as possible. Roll your shoulders back and enjoy the stretch.
  • Twist your upper body to the left five times and to the right five times.
  • Flex your feet slowly ten times, then quickly ten times.

You don’t have to follow these suggestions exactly—find the stretches that make you feel better. We all hold tension in different places. One last idea for your eyes, which should be done as often as possible: focus on something at least 10 feet away for 10 seconds, and then focus on something closer than your computer screen for 10 seconds. Repeat five times at least once an hour.

Filed Under: Health and Wellness Tagged With: , , ,

Experiencing Cosmetic Problems After Breast Reconstruction?

August 16, 2013 by

This week, Dr. Richard Kline of The Center for Natural Breast Reconstruction answers your questions.

Q: I recently had breast surgery. I think my nipples are positioned too high up, and one breast is harder than the other. What can I do? 

A: Usually asymmetries in this situation can at least be improved, although it is often best let a few months (at least) pass first for the tissues to heal. If one breast is hard, it could mean that you have a significant fat necrosis under the skin, although there could be other reasons. I would strongly urge you to see your surgeon and share your concerns with him or her.

Q: In December 2011 I had a bilateral mastectomy with immediate tissue expanders, followed by silicone implant and nipple tattoo. My problem is that I have developed the “double bubble” look, rippling and contractors bilaterally.

I am 63 and realize that my age does reflect my outcome, however, I just need to know if I am alone or if you have patients that experience this? All of the pics I have seen have really great results and none of them look like me!

I am facing another surgery now to remove these implants and replace them with a different shape. I forgot to mention the cleft/ledge above each implant. They tried fat grafting but it was minorly successful. I need advice and have searched the internet with no success. Can you help?

A: Your situation is far from unique, especially if you don’t have much thickness of soft tissue cover over the implants. Rippling, implant malposition (double-bubble), and contracture are unfortunately fairly common problems even after cosmetic breast augmentation, and can be yet more common after reconstruction.

Our practice is limited to fully autologous breast reconstruction using perforator flaps (DIEP, sGAP, PAP). The surgery to replace the implants with your own tissue is long (6-8 hrs), and carries risks not associated with implant reconstruction alone, so it is not for everyone. Having said that, we have successfully removed implants and replaced them with flaps hundreds of times, and it can work very well indeed (especially if you have a good flap donor area).

There are some additional options your surgeons might consider, if you don’t want to pursue complete implant removal and replacement with your own tissue. These include the addition of latissimus flaps to the implant reconstruction, or potentially the addition of acellular dermal matrix (Alloderm, etc.) to cover the implants. We don’t perform these procedures, but they are commonly available in almost all areas, and can bring extra “cover” over the implants.

 

 

 Dr. Richard M. Kline, Jr

Center for Natural Breast Reconstruction

Have a question about breast reconstruction you’d like answered from our surgical team? Just ask us!

Filed Under: Ask the Doctor Tagged With: , , ,

Charleston’s Five Beach Towns

August 14, 2013 by

Whether you’re taking the kids out for sandcastles and swimming lessons, or your friends need a day suntanning with gossip and a good book, Charleston beaches have something for everyone. We’re known for gentle waves, fun beachside events and friendly neighborhoods, but how do you choose which one to visit?

Check out our short guide to plan a day-trip on the coast:

Kiawah Island: Known as one of the most popular southeast wedding destinations, Kiawah Island is all about Southern comfort and luxury. Not only can you enjoy ten miles of untouched beaches, the family can explore forests, sand dunes and enjoy wildlife. The Island is mainly known for its impressive golf course and resort, so if you get sick of the surf, you can trade it for turf. Coastal Living Magazine recently voted Kiawah the “Happiest Seaside Town.”

Isle of Palms: Six of the seven miles that make up Isle of Palms are accessible beaches, which are used by a number of year-round residents as well as thousands of visitors and guests. Many of the beach houses on the island are available for rent. It’s quiet and perfect for families who want a subdued getaway. Rent or bring some bikes and explore the island through its many bike paths!

Folly Beach: Folly Beach is where the action is! Catch some waves at the most popular surfing spot in the area. But note: From May 15th to Sept. 15th surfing is prohibited from 10 am to 6 pm from 2nd Street East to 3rd Street West, known as the swimming zone. From September 16th to May 14th, surfing is allowed in any area except surfing is always prohibited 200′ from the fishing pier. Build sandcastles and enjoy the sun on these wide beaches. If you want to escape the coastline for lunch, break with a picnic and check out the pier or gaze at the Morris Island Lighthouse in the late afternoon.

Seabrook Island: Exclusive and serene, Seabrook is a privately-owned island for members and their guests to enjoy. That’s right, you have to join the Seabrook Island Club to gain access to its amenities, but it’s worth it. Miles of pristine beaches, gorgeous dunes, old live oaks and more await. You can enjoy ultimate comfort, plus switch between playing in the waves and playing in the pool.

Sullivan’s Island: Sullivan’s Island is a truly day-trip spot, with hardly any vacation rentals and no hotels available. A serene and casual neighborhood, it offers the best in family-oriented activities. Bring your buckets, bikes and blankets for an all-day sun fest! Be sure to pack a cooler, too. This island is so quiet, it only offers a handful of restaurants. You’ll feel like you live there!

Remember to check beach guidelines and rules before you travel!

Filed Under: All Things Charleston Tagged With: , , , , , , ,

What is THAT? Skin Mysteries Solved

August 12, 2013 by

Skin cancer is the most common type of cancer in the United States, and it’s easy to overlook. We’re all told to inspect our skin regularly for moles, bumps, and discolorations, and go to the doctor if we suspect anything out of the ordinary. Sound advice.

But how do you know what “out of the ordinary” means?

It’s not always easy to tell, and it does help to have a family member or friend serve as a second set of eyes on moles, skin tags, and bumps. Here are some tips and pictures to help you decide when it’s time for a trip to the doctor. A good website to visit is http://www.cancer.gov/cancertopics/types/skin

There are three types of skin cancer: basal cell carcinoma, squamous cell carcinoma, and melanoma. The first two are relatively easy to cure, but melanoma is much more difficult to treat. The carcinomas are typically found on skin that has been exposed to the sun, while melanoma may occur on any skin surface.

Sometimes it can be difficult to tell whether a bump or mole needs to be checked by a doctor, but there are several telltale signs. The following information is from the National Cancer Institute website, cancer.gov:

Often the first sign of melanoma is a change in the shape, color, size, or feel of an existing mole.

Melanoma may also appear as a new mole. Thinking of “ABCDE” can help you remember what to look for:

  • Asymmetry: The shape of one half does not match the other half.
  • Border that is irregular: The edges are often ragged, notched, or blurred in outline. The pigment may spread into the surrounding skin.
  • Color that is uneven: Shades of black, brown, and tan may be present. Areas of white, gray, red, pink, or blue may also be seen.
  • Diameter: There is a change in size, usually an increase. Melanomas can be tiny, but most are larger than the size of a pea (larger than 6 millimeters or about 1/4 inch).
  • Evolving: The mole has changed over the past few weeks or months.

Melanomas can vary greatly in how they look. Many show all of the ABCDE features. However, some may show changes or abnormal areas in only one or two of the ABCDE features.

In more advanced melanoma, the texture of the mole may change. The skin on the surface may break down and look scraped. It may become hard or lumpy. The surface may ooze or bleed. Sometimes the melanoma is itchy, tender, or painful.

The National Cancer Institute recommends that when you do a skin self-exam, take your time and inspect every inch of your skin, looking for anything new:

  • A new mole (that looks different from your other moles)
  • A new red or darker color flaky patch that may be a little raised
  • A new flesh-colored firm bump
  • A change in the size, shape, color, or feel of a mole
  • A sore that doesn’t heal

For photos of skin cancer examples, visit the following websites:

http://www.cbsnews.com/2300-204_162-10006772.html

http://cancer.about.com/od/skincancermelanoma/ig/Skin-Cancer-Photo-Gallery/

http://www.webmd.com/melanoma-skin-cancer/ss/slideshow-skin-lesions-and-cancer

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I Found Lumps After Reconstruction Surgery–Could I Possibly Have Breast Cancer Again?

August 9, 2013 by

Ask the DoctorThis week, Dr. Richard Kline of The Center for Natural Breast Reconstruction answers your questions.

Q: I had breast reconstruction surgery 5 years ago.

Upon my 5-year check up, three lumps were found on my left breast. I had an ultrasound, then an MRI. I just received a call from my general physician informing me that I need a biopsy done due to fat necrosis on my left breast. Meanwhile, I have found many more lumps on both breasts. I’m waiting for my plastic surgeon to return from vacation to schedule a biopsy. I’m extremely nervous. Could I possibly have breast cancer again? Why do they need to do a biopsy? 

A: Although I don’t know what type of mastectomy or reconstruction you had, at least microscopic amounts of breast tissue are left after any mastectomy, so it’s still theoretically possible to develop  cancer. This is very unlikely in most cases, however. If you just had lumpectomy with radiation, it’s much more common. Fat necrosis after reconstruction with your own tissue is pretty common, but it’s unusual to have it show up after five years. If you had radiation after your reconstruction, however, that could help explain the late changes you note.

 Dr. Richard M. Kline, Jr

Center for Natural Breast Reconstruction

Have a question about breast reconstruction you’d like answered from our surgical team? Just ask us!

Filed Under: Ask the Doctor Tagged With: , , , ,
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