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What is an MRA and What is it For?

June 10, 2011 by

Dr. Richard M. Kline, Jr.

The below question is answered by Richard M. Kline Jr., M.D., of The Center for Natural Breast Reconstruction.

Why am I scheduled to have a MRA prior to my DIEP surgery? What is it and what is it for?

Preoperative imaging of perforating vessels by CTA (computerized tomographic angiogram) or MRA (magnetic resonance angiogram) is probably the most significant development in perforator flap breast reconstruction in the last 5 – 10 years.

Some of the potential advantages of preoperative imaging (with CTA or MRA) include:

1. Shortened operating time, due to knowing in advance where the desired perforating vessels are located.

2. Decreased damage to the rectus muscle, due to being able to select perforating vessels with the shortest intramuscular course. This is particularly important because it can decrease the chance of a major motor nerve to the muscle being divided. A few fortunate patients have an unusual anatomic situation in which a large perforating vessel actually goes between the two muscles, which can allow harvest with no damage to the muscle at all; this is instantly recognizable on preoperative imaging.

3. Decreased fat necrosis, due to being able to select the largest perforator.

4. Advanced recognition of those few cases when the SIEA, not the DIEP, might actually be the preferred blood supply for the flap (the same tissue would still be used)

5. Advanced recognition of those very rare instances where the deep inferior epigastric system has been divided form past surgery, or where all usable perforating vessels have been damaged by previous abdominal liposuction.

CTA has the advantage of being most readily available, but also exposes the patient to radiation. MRA does not expose the patient to radiation, but we have found that only a very strong MRI (3 tesla, or 3T) can give us images with enough detail to be really useful for preoperative planning. MRA still requires the administration of intravenous contrast agents, which can rarely have undesirable side effects. On the horizon is MRA without the need for any injection—it’s not quite here yet, but its coming.

We are very fortunate to work with a very skilled group of radiologists with a 3T MRI who are very interested in and skilled at obtaining images for our breast flap patients. We obtain preoperative imaging on all patients preoperatively, whether they are scheduled for a DIEP or GAP flap. If a patient has a contraindication for an MRI / MRA (ferrous metal implanted in the body is the most common), then we obtain a CTA.

—Dr. Richard M. Kline, Jr.

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Healthy Brunch Ideas

June 8, 2011 by

healthy brunch ideasBrunch is the perfect time to eat healthy. From fruit to whole-grain muffins and Canadian bacon to turkey sausage, an endless variety of food works for brunch. We’ve come up with a dozen delicious options to help you stay on your healthy eating plan.

Multi-grain pancakes and waffles contain anything you want them to: oat, buckwheat, whole wheat, cornmeal, flax seed, or spelt. Use whole grains as much as possible, and don’t be afraid to add blueberries to those pancakes!

Whole-grain muffins give you the texture and taste you want in a healthier package. Use applesauce or mashed bananas to replace the fat during cooking, and use all-fruit spreads or nut butters on top.

Turkey bacon and sausage add low-fat protein and delicious flavor to quiches, casseroles, and scrambles.

Smoothies are the perfect way to blend your favorite fruits with protein powder, juice, yogurt, or even ice cream. Try several recipes, as there are hundreds of ways to make a tasty smoothie.

Tofu can replace meat in almost any dish. It can also be marinated and barbecued or used in place of cheese.

Canadian bacon has incredible flavor and one-third the calories of regular bacon. It’s also much lower in fat and sodium.

Vegetables of any kind add nutrition, color, and flavor to egg dishes, salads, and side items. Omelets and quiches are an ideal place for a variety of veggies. Try to eat as many different colors as possible to ensure you’re getting the full spectrum of antioxidants and nutrients.

Fruit is a brunch favorite and is used for everything from fresh-squeezed juice to tarts. Like vegetables, be sure to eat a variety to take advantage of the excellent nutrition fruit offers.

Nut and fruit butters and all-fruit spreads are healthy substitutes for butter and high-sugar jellies and jams. Choose from all-natural peanut butter, almond butter, cashew butter, apple butter, and spreadable fruit. All are available in stores, but read labels carefully: nut butters should have only one ingredient: the nut itself. Ingredients on the fruit butters and spreadable fruit will vary, but there should be only a few ingredients with no added syrup, sugar, or oils.

Quiche is a delicious, healthy main course, perfect for any type of food you want to put in it. Eggs, vegetables, meat, cheese, and tofu are common ingredients, and quiche invites experimentation with flavors, ingredients, and spices. A casserole is also a good option for a quick and easy brunch dish.

Wild or game meat adds unique flavor and healthy protein to any dish. Game is naturally low in fat, and does not receive antibiotics or hormones. Game meat includes venison, elk, bison, moose, alligator, and wild boar.

Real eggs are one of the healthiest foods you can eat and full of protein, vitamins, and minerals. Eggs are versatile and can be cooked a number of different ways: fried, scrambled, sunny side up, hard- and soft boiled, and poached.

Keep in mind that how you cook and serve is just as important as what you cook and serve. Stay away from partially hydrogenated oils, such as margarine. Coconut oil and olive oil are good choices for both cooking and serving. Real butter, low-sugar syrup, and cream cheese in moderation add a delightful taste to the table. And of course, stay away from high-fructose corn syrup.

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5 Ways to Improve Your Mental Health

June 6, 2011 by

mental healthYour mental health is a vital part of your overall health, yet we often ignore it. When you feel mentally alive, your physical health improves as well. Follow these five tips to improve your mental health and increase your happiness.

1. Address negative beliefs.

Most of us hold negative beliefs, and they have a detrimental effect on our mental and physical health. We choose to hold these beliefs for whatever reason, and some may be valid while others are outdated or simply incorrect. Negative beliefs lead to a negative attitude, which saps your energy and alienates family members, caregivers, and friends.

To change a negative belief, you must identify it. Ask a trusted friend for help with this. Once you have determined which are your negative beliefs, ask yourself three things: where they came from, whether they are true, and whether you still want to hold onto them. Letting go of negative beliefs can be difficult but tremendously freeing, and it must be your decision to move forward without them. No one can force you to release a negative belief.

2. Replace the negative with a positive.

Whenever a negative thought creeps into your mind, focus on the positive of the situation instead. The negative thought will float off, and you’ll be happier, more relaxed, and able to deal with the situation as a whole. This is not to say you don’t need to deal with negative thoughts or situations—sometimes you do—but often negative thoughts are holdovers from those negative beliefs you’re trying to lose.

For example, if you’ve lost 10 pounds and have a negative thought about your ability to continue losing, remind yourself that you’ve already lost 10. Tell yourself how good you feel, and encourage yourself to keep going. If you let a negative thought stay in your mind, you’ll fall into it and have a difficult time climbing out of it. Concentrate on the positive, and don’t dig yourself a negative hole.

3. Reduce stress.

Stress causes not only physical problems, but also mental blocks and issues. Reducing stress is one of the fastest ways to boost your mental health. One quick way to feel better is to take three deep breaths: inhale through your nose, close your eyes and hold it for two seconds, and then exhale through your mouth. Exhale as fully as you can, and feel the stress melt.

Several other ways to decrease stress include exercise, meditation, massage, and aromatherapy. Sometimes walking away and being alone for 5–10 minutes or listening to your favorite music is all you need to reduce anxiety. Experiment to find your best stress relief.

4. Take a break from your life.

A change of scenery is always good for your mental health. Take a week-long vacation at least once a year. You’re doing yourself and your family a disservice if you accrue vacation time and never use it. Find the time to do something for you. Get away and explore new places, or take a week off to work on a hobby you never seem to have time to enjoy. You’ll return refreshed, relaxed, and happier.

5. Exercise your mind as you do your body.

We move through each day doing what we must, but we don’t stimulate our minds as often or as deeply as we should. Your mind craves challenge and creativity, and you feel alive and alert when you give your mind a new job. Take a class, learn a new hobby, go to a symphony or museum, or do the crossword in the newspaper. Try something new and excite your brain, as well as improve your memory.

Your mental health is just as important as your physical health, and the more you take care of your mind and exercise it, the happier you’ll be. If you do it consistently, the benefits last long into old age.

What’s your favorite way to take care of your mental health?

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Does Radiation Affect My Options For Breast Reconstruction?

June 3, 2011 by
Dr. James Craigie

Dr. James Craigie

The question below is answered by Dr. James Craigie of The Center for Natural Breast Reconstruction.

I am not sure if I will need radiation after my mastectomy. What factors should I consider before going ahead with breast reconstruction?

Radiation therapy is part of the treatment for breast cancer for some but not all patients. To determine if it is necessary for any individual, the details of the cancer or the final path results must be known. The most common situation for radiation after mastectomy is based on the size of the cancer and the number of positive lymph nodes.

When a patient would benefit from radiation the treatment may affect the options for breast reconstruction as well as the timing of the reconstruction. There are several advantages to starting the breast reconstruction at the time of the mastectomy. These include: the breast surgeon can save more of the breast skin or even the nipple and this can set the stage for the best possible result, and avoiding an extra step and an extra recovery period.

If radiation will definitely be needed after mastectomy then I do not recommend immediate natural breast reconstruction because the radiation can possibly damage the new breast. In this situation the reconstruction would start approximately 6 months following radiation. These decisions are best made following the advice of your oncologist, breast surgeon, and plastic surgeon all working together. For this reason I am a strong advocate of the multi-specialty breast conference where each patient can be presented to all the specialists at once so they can share their opinions right away. Cooperation between experts can ensure better results and more options for each patient.

It is important to remember that if you need radiation for the treatment of breast cancer it does not mean you cannot have a very good result with natural breast reconstruction. It may however determine the order and timing of when the breast reconstruction should begin.

—James E. Craigie, MD

 

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Important Self-Exams Every Woman Should Perform

June 1, 2011 by

Image to the left taken from Cancer.org.

 

Self-exams help you to detect changes in your body between visits to your doctor. Many lives have been saved due to diligent self-examination, and following are two self-exams you’ll want to perform regularly.

BSE or breast self-exam

Each woman has her own method of examining her breasts. Some do a systematic BSE monthly or bimonthly, while others keep an eye on their breasts by regularly feeling them in the shower or while lying in bed. Often, women ask their significant others to help them check, or they visit the doctor several times a year for a clinical exam.

While a regular BSE with a consistent technique is best, perfect technique is not as important as frequency and diligence. Sometimes, women stress needlessly about doing it correctly. As long as you feel the entire breast and overlap your motions, you’re doing it right. The goal of a BSE is to know what is normal for you and check for changes.

If you’re not sure whether you’re feeling the entire breast, cancer.org suggests the following BSE routine:

  • Lie down and bend your arm behind your head to spread the breast tissue evenly over your chest, making it easier to examine.
  • Imagine your breast is divided in vertical lines from your underarm to breastbone, and use the finger pads of your other hand to feel for lumps in an up-and-down pattern along those lines. Move in dime-sized circles, slightly overlapping the previous line as you move up and down.
  • Use different levels of pressure at each spot so you feel all the breast tissue, especially if you have large breasts. You can feel the tissue close to the skin with light pressure, tissue in the upper half of the breast with medium pressure, and lower breast tissue with deeper pressure. There will be a ridge at the bottom of each breast, which is normal. If you have questions about pressure, talk with your doctor or nurse.
  • Examine the entire breast area, and then repeat the exam on your other breast.
  • Stand in front of a mirror, press your hands on your hips, and look at your breasts for changes in shape or size. Also look for rashes, redness, or dimpling.
  • Raise each arm slightly, and feel the underarm for lumps.

Some women may find it easier to examine their breasts in the shower, which is fine, as long as you are thorough—or add this routine to your shower exam. Current medical literature suggests that the above procedure is the most effective for finding lumps as soon as possible.

Skin exam

A regular skin exam will help you keep an eye on moles, freckles, and other spots that could become cancerous. It should be done at least once a month, and if you ask your doctor to do a full-body exam first, you’ll have a baseline. While it may sound daunting, after you’ve done a full skin exam a couple of times, it shouldn’t take more than 10–15 minutes.

Warning signs of skin cancer include a change in an existing mole or spot, or any growth or spot that . . .

  • Appears during adulthood.
  • Increases in size or thickness.
  • Changes in texture or in color—especially if it turns pearly, multicolored, brown, or black.
  • Has an irregular shape or outline.
  • Is bigger than a pencil eraser.
  • Continues to hurt, itch, scab, or bleed longer than three weeks.

If you see any of these signs, don’t wait or hope it goes away. See a doctor, preferably a dermatologist.

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7 Ways to Beat Stress

May 30, 2011 by

stress reliefStress adversely affects every aspect of your life, from your health to your relationships. Many people don’t realize how stressful their lives are, and they don’t know how to deal with or reduce their stress. Let’s explore seven ways to improve your life by beating stress.

Determine your stressors.

We all have different areas of our lives that cause stress. While you may not be able to change stressful situations, by identifying your stressors, you can develop a plan to deal with them as effectively as possible. For example, if work causes stress, you can go to the gym after work to release tension with a workout, or leave the building for lunch to get away from your desk for a few minutes.

You might be able to change your response to stressors by altering the situation to make it easier to bear. For example, if visiting the doctor during the day is stressful because you need to go to work afterward, perhaps you can meet the doctor in the evening or on a weekend day. If you become agitated during rush hour traffic, try a new route or travel at a different time.

Avoid people, places, and things that upset you.

We all have people who make us uncomfortable or tasks we dislike doing. When those aggravations become stressful, it’s time to take matters into your own hands. Rethink whether it’s necessary to have dinner with the neighbor who criticizes your cooking. Perhaps it makes sense to find an accountant to do your taxes or a detailer to wash your car. Delegating tasks and avoiding stressful people not only reduce your stress, but they also give you a marvelous feeling of freedom.

Know your limits.

Be realistic about your time and what you can do, and say no when you need to. When you’re at your limit, additional items on your to-do list become stressors. Stand your ground and be assertive when you need or want to say no.

Give yourself a treat.

Integrative therapies such as massage, reflexology, and aromatherapy help to reduce stress, lower blood pressure, and relax you. They’re also fun and rejuvenating. Find a certified practitioner or visit a spa, keep an open mind, and give it a try.

Turn off the noise.

Unplug and spend at least 30 minutes alone and quiet every day. We’re all bombarded by technology and advertising, and it’s overwhelming. When you get away from the constant noise, you’ll feel your stress melt away. Spend that time doing what you enjoy, whether it’s a walk or a hot bubble bath. Unwind and enjoy.

Tune out negativity.

Do you really need to watch the 10 pm newscast each night or read the paper every day?  The news is mostly negative, which raises your stress levels. Your mind doesn’t need any more input on weather disasters or the latest political upheavals around the world. Don’t take on the world’s problems as your own. Rather than watch the news, find a comedy or cartoon to watch. Better yet, turn off the TV and read a book.

Experiment to find your best release.

Some women relieve stress by laughing or crying, and others find exercise or art to be their release valve. You may need to try a few different outlets to relieve stress, such as watching classic TV comedies, renting a movie that makes you cry, painting, or going to the gym. You may find one perfect stress reliever, or you may decide a combination of activities helps.

As you work through your stress, stay positive. Negativity is an unhealthy stressor and can creep into areas of your life that aren’t stressful. An upbeat attitude will do wonders to combat stress and help you feel healthy and at your best.

What do you do to combat stress?

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Are Implant Problems Affecting Your Life?

May 25, 2011 by

implant problemsBelow is an In Her Words post from one of our patients who came to us with implant problems. Read her story below:

I am so thankful to Dr. Craigie and Dr. Kline and Christina for making me feel at ease. Meeting someone for the first time and having surgery the same week was a lot to take in, but thanks to everyone, including The Center for Natural Breast Reconstruction staff, Christine, and Gillian. And a special, big thank you to Gail for helping me with my insurance and all the conversations we had prior to my office visit with Dr. Craigie. Gail, thank you for making me feel like a person not a number, you are wonderful!

I cannot say enough about the results from my surgery! It was absolutely fantastic to say the least! I am amazed how natural I look! I really am excited to have my follow-up. Can it get any better? I do not have the pain in my breasts or the hardness and pulling from the implant anymore. I can lift my arms straight up over my head now! I noticed that I don’t have the flu-like feeling anymore—it’s gone!

Before coming to Dr. Craigie’s office, I have had five painful surgeries with implants and expanders going wrong with infections, plus lengthy hospital stays and home care. This was over a period of four years—four years taken out of not only my life but also my family’s life. Just think of how much time and money was wasted on paying insurance companies when I could have had only one surgery and a follow-up! If I only knew there was an alternative option before having my first implants.

My goal is to get the word out. Women need to know that you do have an alternative, besides using implants. Utilizing the body’s own tissue! Again, I was never given this option.

I cannot thank you enough Dr. Craigie and Dr. Kline for your skilled surgical talents and dedication in this field that made me look and feel like a women again!

Sincerely,
D.N South Amherst, Ohio

Do you know of someone whose life is affected by implant problems? Share this story with them.

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The Importance of Sleep and How to Get More of It

May 23, 2011 by

sleep apneaWe know we need it, but we don’t get enough. Sleep can be elusive, and most of us have problems sleeping occasionally. According to the National Sleep Foundation (NSF), at least 40 million Americans suffer from sleep disorders, and 60 percent of adults report having insomnia at least a few times a week.

While the occasional sleepless night is nothing to worry about, the Harvard Women’s Health Watch reported that chronic insomnia decreases the immune system and leads to health problems such as weight gain and hypertension. These health issues, as well as medication and painful disorders such as arthritis, often result in continued insomnia, creating a vicious cycle.

Other health issues linked to sleep loss include:

  • Impaired memory and learning problems.
  • Less effective decision-making.
  • Daytime drowsiness, thought to affect some 40% of adults per the NSF.
  • Irritability, anxiety, and impatience.
  • Mood swings.
  • Higher stress levels.
  • Diabetes.

The need for sleep varies, with an average of eight hours being the ideal for most adults. Shift workers, truck drivers, medical professionals, and teens and young adults tend to live on less sleep than they truly need, causing problems for themselves and others.

While quantity of sleep is important, quality of sleep is vital to your health. You’re better off sleeping soundly for 7 hours than sleeping restlessly for 9 hours. You can take some simple steps to improve both the quality and quantity of your sleep:

  • Avoid strenuous exercise, alcohol, and caffeine at least four hours before bed.
  • Keep a regular sleeping and waking schedule, even on weekends.
  • Reconsider keeping a television or computer in your bedroom. The light from the screen can disrupt sleep.
  • Make sure your mattress is comfortable, turn it regularly, and replace it after 5–7 years.
  • Keep your room as dark as possible and slightly cool.
  • If your sleep partner tends to toss and turn, consider a larger bed or one of the newer beds that has dual controls for firmness. These modern beds tend to minimize disruption of your sleep if your partner is restless.

While short-term insomnia is usually not an issue, continued sleeplessness may indicate a problem such as sleep apnea or narcolepsy. Most sleep disorders go undiagnosed, and could be discovered and treated with a simple test at your local hospital or sleep center. If you have insomnia more than once a week, talk to your doctor about a referral for sleep testing.

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Can I Have My Current Implant Removed to Receive a Muscle-Sparing Free Flap Breast Reconstruction?

May 20, 2011 by

dr. richard kline

Dr. Richard M. Kline, Jr.

The below question is answered by Richard M. Kline Jr., M.D., of The Center for Natural Breast Reconstruction.

I had reconstruction with implants after my breast cancer diagnosis in 2009. How hard is it to go back and do breast reconstruction with a flap? What would the recovery time be?  Also, does insurance give you a hard time about taking out the implants and revising having a flap?

It’s no trouble at all to remove implants and replace them with a muscle sparing free flap breast reconstruction. We’ve done it successfully hundreds of times. Unfortunately, roughly 30% of women who come to us are seeking conversion from a failed or unsatisfactory implant based reconstruction. Recovery time after flaps is usually 6 – 8 weeks, although some ladies recover much faster. I don’t think insurance usually gives you a hard time—once you’ve started the reconstruction process, they seem to follow through until you are finally content with your reconstructed breast.

—Richard M. Kline Jr., M.D

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Fashion Feminar: What to Wear to a Wedding

May 18, 2011 by

 

what to wear to a weddingJoin Lee Heyward, style coach and owner of Charleston Style Concierge, and Kathryn Poe, owner of Mary Mojo Boutique, as they discuss tips for planning your wardrobe for a wedding. The live event, What to Wear to a Wedding, happening on Wednesday, May 25th at 6:30 p.m. at Mary Mojo Boutique in Mount Pleasant, SC, will benefit the Warriors Wear Pink organization.

Warriors Wear Pink lends assistance both financially and mentally to families fighting breast cancer. A portion of the proceeds from ticket sales and shopping at Mary Mojo Boutique during the evening of the event will be donated to Warriors Wear Pink. (Click here to register!)

In an effort to eradicate wedding attire confusion, Lee and Mary will host this exciting and highly informative Feminar, dedicated to helping women eliminate frustration and quickly and easily dress for a wedding.

During this event at Mary Mojo Boutique (1405 Ben Sawyer Blvd., Mount Pleasant, SC), you’ll learn . . .

  • How to make one dress work for both a casual and dressy wedding.
  • What to wear according to the time of a wedding.
  • How to know the dress code when it isn’t specified.
  • What colors you should NEVER wear.
  • Which accessories are must-haves for the next wedding you attend.

Once Lee and Mary have finished their Feminar, you’ll be invited to delight in refreshments and shopping. Tickets to the event cost $20, but remember, part of the proceeds go to a great cause!

Since space is limited, you must register for this live event. Click here for more information or to register for this exclusive Feminar.

 

 

 

Share this event with your friends and bring your girlfriends along for a fun night of refreshments and shopping!

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