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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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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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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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How to Maximize Insurance Coverage and Discover the Full Range of Benefits

May 9, 2011 by

health insuranceHealth insurance coverage can be confusing, and often patients don’t know what is covered, which can lead to problems and extra expense. Following are three ways to maximize your insurance coverage and get the most for your money.

Premium cost isn’t the only consideration.

Many employers offer only one health insurance policy, but you do have the option to purchase coverage elsewhere. If you choose to purchase privately, look at more than the monthly premium before buying. Plans vary widely in their coverage and total cost, and some will be a better fit with your family’s health situation and desired coverage.

You should consider several things when buying health insurance:

  • Coverage should be adequate for any current health issues, including paying for prescriptions, medical equipment, and services such as physical therapy and nursing care.
  • Pre-existing condition coverage varies, but normally there is a waiting period before insurance will cover those health issues.
  • Deductible is the amount you pay each year before insurance goes into effect. This may be separate from your copayment.
  • Coinsurance is the percentage you pay after insurance kicks in. This typically varies from 10–50%.
  • Maximum out-of-pocket expense is the maximum dollar amount you will pay each year. Once you have reached that amount, insurance pays 100% up to the maximum plan dollar limit.
  • Maximum plan dollar limit is the most the policy will pay. Plans may have an annual and / or lifetime maximum dollar limit.
  • Copayment is the amount you pay at the time you visit the doctor, pick up a prescription, or enter the hospital. This payment may or may not count toward your deductible.

You will also want to check whether your doctors and pharmacies are listed in the insurance company’s network of providers. If they are, your visits and prescriptions will cost less. If they aren’t, you’ll pay considerably more—and some plans will not cover any care given out of network.

Read your policy thoroughly.

It’s not exciting reading, but familiarizing yourself with your policy will avoid nasty surprises and extra cost and hassle later. Speaking of surprises, you might find services and products are covered that you never thought of, such as alternative treatments and over-the-counter medicine.

Insurers send updated policies regularly, so be sure to read those as well, and keep the summary of benefits handy for quick reference.

Double-check your policy before, during, and after you receive care.

Make sure that everything you need is covered by your policy. Check whether you will need referrals from your physician or authorizations from the insurance company before you go in for care. Every insurance company has specific procedures they follow, and straying from them can cost money or time.

Any time you receive care, you need to be proactive about ensuring that your doctor’s office is coding and submitting your information correctly. Afterward, carefully check all bills to see that the insurance company is paying them. Don’t be afraid to talk to the insurance company directly and do what you can to maximize your coverage.

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How to Make Sure You and Your Doctor Communicate Effectively

May 6, 2011 by

breast reconstructionYour relationship with your doctor is a partnership, and one of the best ways you can help each other is to communicate effectively. You’ll avoid misunderstandings and hurt feelings, and the two of you can quickly move forward in your treatment. When it’s time for your next appointment, using the following tips can make a positive difference in your relationship.

Always be as honest and as specific as possible.

Even if you’re uncomfortable, tell the truth—your doctor can’t successfully treat you otherwise. If you’re not sure how to answer a question, say so instead of guessing. Your answers should be as specific as possible, even if you need to add more information or ask questions before replying.

Don’t be afraid to ask or tell your doctor anything—he or she has literally heard it all.

Listen, and then ask questions.

Sometimes while the doctor is talking, patients have an emotional reaction that prevents them from hearing the rest of what the doctor has to say. Listen to everything the doctor says, try not to react right away and let it process for a moment, and then ask questions.

Note anything unusual, and write down your questions before you go.

Keep a calendar or day planner with you, and jot down any symptom that is unusual for you. The night before you go to the doctor, make a note of these symptoms as well as questions you have. Often we go to the doctor with a list of questions in our head, and then forget what we wanted to ask. This step will save time for both of you during the appointment.

Never ignore unusual pain, discharge, or bleeding. Contact your doctor immediately.

Tell your doctor about everything you take.

Make a list of your medications and any dietary supplements you take, including vitamins and aspirin. Be sure to note dosage size and frequency. Give the list to your doctor for your file, and send a copy to your pharmacist. Update these lists at least once or twice a year.

Don’t be offended by non-medical questions.

Your doctor might ask about your job or what you do on weekends, and this is not to pry, but to evaluate how your lifestyle might be affecting your health. Stress, eating habits, and alcohol consumption may be factors in your condition.

Let your doctor know if he or she doesn’t communicate well with you.

Your doctor needs to know if his or her communication style isn’t effective. Think back on your last few appointments. Did he or she say anything that upset you, and was everything explained in a way you could understand? Were you comfortable talking with him or her?

Give your doctor specific suggestions to improve your partnership. If you’re not comfortable doing that in person, send an email or leave a voice mail after hours on the doctor’s private line.

Your doctor is there to help you—and he or she can do a much better job when you have built a relationship based on trust and good communication. This process can take a little time but is well worth the effort.

What do you and your doctor do to create effective communication?

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An Unforgettable Ladies’ Night: East Cooper Medical Center’s Garden Party

May 4, 2011 by

garden partyDon’t miss the East Cooper Medical Center’s exciting Garden Party Event happening Thursday, May 12 from 5:30 – 8:00 p.m. This wonderful event will take place in the front lobby and outdoor garden area of the East Cooper Medical Center, and will feature free wine tastings, cheese, appetizers, and chocolates, as well as great giveaways! In addition to yummy snacks and beverages, guests will also enjoy live music in the garden, a unique “Peace, Love, & Hip Hop” exercise performance, maternity floor tours, and will have the chance to enter to win great giveaways.

Event attendees will also have the opportunity to listen to 12 informational talks given by local doctors and health professionals and ask questions pertaining to healthcare. In fact, one of the information talks will be given by The Center for Natural Breast Reconstruction’s Dr. James Craigie and Dr. Richard Kline on Flappers Do the Charleston: The Free Flap Breast Reconstruction Method.

Some of the other talk topics of the night include:

  • How to Talk to Your Teenagers
  • Breast Screening and Diagnosis: It Could Save Your Life
  • Shining Light Where the Sun Don’t Shine: From Hemorrhoids to Colon Cancer
  • Face Lifts: Rejuvenate Your Look
  • And more!

The address of the event is East Cooper Medical Center Lobby & Garden, 2000 Hospital Drive, Mount Pleasant, SC.

Women are encouraged to register for this event so that the East Cooper Medical Center can purchase enough food and wine for all attendees to enjoy! To register for this free event, please call 843-884-7031.

All women are invited to this event, so share this post with your mothers, sisters, aunts, best friends, and grandmothers. We hope to see you there!

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