2 Ways To Make Your Penis Bigger – 2 Of The Best Ways To Quickly Increase Your Penis Size Today!

Do you want to increase your penis size naturally? Or do you just have a small penis? In any case, I will discuss how to quickly and easily increase your penis size. So pay close attention!

The two best methods are: 1) The Penis Jelq and 2) The Penis Stretcher. They are discussed below:

1) The Penis Jelq – Penis Jelqing is the best technique for making your penis bigger! It is based on daily workouts of between 20 to 30 minutes. You first start with a warm-up.

1) To warm-up all you need to do is take a warm shower or bath. This increases the blood flow to the penis and makes it more pliable to the exercises so it can become stretchier.

2) Alternatively, if you don’t want to waste time taking a bath or you want to Jelq in the middle of the day, you can use another method to warm-up. Simply take a small towel and soak it in warm water. Wring out the excess water and wrap it around your penis for 5 minutes.

For the exercise, you need adequate lubrication on your penis (baby oil or lotion). Massage it on your penis to a 50-70% erection. Use the “OK” grip to circle the base of your penis gripping it firmly. This traps blood between the base and the head of your penis! You then ‘milk’ the penis from the base to the head slowly, when your first hand gets just below the head, alternate hands. Each stroke should last 3-5 seconds. The first session should be 100 jelqs. Stop if you see any bruising or it feels too uncomfortable, don’t sacrifice your functionality in the name of increasing your penis size!

Then you have to cool-down. To do this, just follow the routine of the warm bath or shower. Do this for at least 5 minutes to soothe your penis and prevent swelling and bruising.

2) The Penis Stretcher – Penis Stretching is the best technique to make your penis longer! It is based on daily workouts of between 10 to 20 minutes.

To warm-up, you follow the same routine as the warm-up above.

For the exercise, you need to be 100% flaccid. Grip just beneath the head of your penis with your forefinger and thumb. Pull it outwards directly in front of you. Keep pulling until you can’t pull it anymore without feeling any pain. Hold it at that position for 20 seconds and then relax for 5 seconds. Do 100 reps of this the first time. Cool down the same way you warmed up.

After one month of performing both exercises you would have increased your penis size by 2 inches! After 1 year, you would have increased in size by 4 inches!

What Will Happen During Your Gallbladder Operation?

If you are having gallbladder surgery, it is most likely because you have gallstones, or you are having bouts of cholecystitis (inflammation of the gallbladder). When you sign the consent for your gallbladder procedure, the consent may have the word cholecystectomy in it. This is the medical term for having your gallbladder removed. About 95% of all gallbladder surgeries are performed laparoscopically by use of a laparoscope and very small incisions. This is a minimally invasive procedure, therefore most people having this procedure can have it done at a same-day surgery center. If you have had several abdominal surgeries in the past and your surgeon feels that you may not be able to have your gallbladder surgery done laparoscopically, you will probably have your surgery done at a hospital.

Once you arrive in the operating room, the circulating nurse will have you transfer onto the operating room bed. The nurse should keep you covered with warm blankets as the operating room may be rather cold. The anesthesiologist or CRNA will begin placing monitors on you – EKG leads, oxygen saturation probe, and blood pressure cuff. The circulating nurse may place SCD’s (sequential compression device) on your legs or feet. The nurse may check your armband and have you recite your name, your birthdate, and what surgery you are having done. The anesthesiologist/CRNA will than place an oxygen mask over your nose and mouth. You will only be receiving oxygen through this mask, no anesthesia gasses. This is to make sure you are well oxygenated before receiving the IV anesthesia medication. You will then start receiving the anesthesia medication through your IV. This medication can sometimes sting or burn, this is normal and will go away very shortly. Only a few seconds after receiving the IV anesthesia, you will become unconscious.

After you are unconscious, the anesthesiologist or CRNA will place a breathing tube through your mouth and down into your trachea. Once the tube is secured in place, the nurse will start positioning and prepping you for the procedure. If you went to the bathroom while you were in the pre-op area, then you most likely will not have a urinary catheter placed. Your abdominal area (and your abdominal area ONLY) will then be exposed. If you are a male, your abdomen will most likely be shaved. The circulating nurse will “prep” your abdomen with a betadine solution or similar germ killing solution. After your belly has been cleaned with the solution, the sterile surgical team will begin placing sterile drapes on you. You will be completely covered with the sterile drapes except for your abdominal area where they will be making the incisions. The circulating nurse will hook up the equipment to specific machines that have been passed to her/him from the sterile surgical team. Once all equipment has been hooked up and operational, your surgery will begin.

The surgeon will start by making four small incisions and then place narrow tubes called ports into the incisions. These ports are used to place the laparoscopic camera and instruments through. CO2 gas is pumped into your abdomen to create more space inside your belly, this makes it mush easier for the surgeon to see. The laparoscopic camera is placed in one of the ports (the belly button port) and other laparoscopic instruments are placed through the other ports. The surgeon will be viewing a video monitor in which video from the laparoscopic camera is sent. The surgeon will use the laparoscopic instruments to place surgical clips on the cystic artery and the cystic duct. The cystic artery and cystic duct are attached to your gallbladder, the clips are placed in order to seal them off from the gallbladder. Once the clips are in place and the artery and duct have been divided from the gallbladder, the surgeon will begin to delicately separate your gallbladder from your liver.

Once the gallbladder is free, it is removed through one of the ports. Your gallbladder is passed to the circulating nurse who will place it in “formalin” (a formaldehyde solution) and send it to pathology. All of the ports are removed, the CO2 gas is released from within your abdomen and the small incisions are closed with either staples or suture. At this point, the anesthesiologist/CRNA will start waking you up. Once you are breathing on your own, the breathing tube will be removed.

The surgical team will transfer you from the operating room bed onto a stretcher and you will be wheeled to the recovery room or PACU (post anesthesia care unit). You will still be very sleepy, so you probably will not remember being wheeled to the recovery room. Once in PACU, a PACU nurse will be there to take care of you until you are discharged. The average time spent in the recovery room is around an hour.

How To Get Rid Of Angry Acne Overnight

Are there any actions you can do to get rid of acne overnight?

In this article you will discover some quick and easy steps on how to get rid of acne overnight!

We all know that acne can lead to depression and it is one of the most common skin problems so it is vital we find out how to cure it effectively. So here are some simple tips to help.

Depending on how severe a case is, acne can be cured overnight and sometimes easily within few days. There are already medications proven to be effective in removing acne within a day. However, some medications that are said to be effective are so strong, that they can lead to skin irritation, making your acne worse. So if you are new to curing acne, try some simple natural treatments to start with.

One of the simple steps you can use to get rid of acne overnight, is by washing your face regularly. Some people choose to use hand soap but a specialist facial wash is recommended. Remember not to touch the infected area with your hands before proper application of hand sanitizer. This will prevent the growth of acne. Cleanliness is very important. If we do not effectively wash our skin and get rid of all the built up dirt and grease, it will just clog pores and will result in acne. So keep clean!

To calm down an angry and painful infection, you can wrap some ice in a clean towel and apply to the sore area, to sooth irritation. Any acne redness should calm down within just a minutes.

Toothpaste can also help get rid of acne overnight because its menthol helps to reduce oils that block the pores on your skin. Interestingly white toothpaste is more effective than red toothpaste in curing acne. If you have big cystic spots that is driving you mad, just dab a little bit of toothpaste on it before bed and let it get to work whilst you sleep. By morning, the spot should have significantly reduced in size.

Avoid eating too much junk food and other oily foods because these produce oils that block the pores of the skin. Always make an effort to munch on healthy vegetables and fruit and they are packed full of acne busting vitamins.

Be sure that your face is free from oils because oily faces are prone to acne or pimples. You can prevent this by applying powder onto your face whenever you feel uncomfortable and shiny.

Remove toxic substance by drinking enough water regularly. Ski and health experts recommend we all drink at least “8 glasses of water a day.” Water is a great way to hydrate your skin and flush out bad toxins, eventually leading to healthy spot free skin. Also, don’t allow your skin to get dry because it can cause more irritation that can produce more acne. If, like me, you find this task a little too daunting, then just drink as much water as you can comfortably manage.

If the idea of spending your days drinking buckets of water is too boring, why not jazz the drink up with a few drops of freshly squeezed lemon or lime juice. Not only will this tip add excitement to the drink, it also adds plenty of acne busting goodness too.

Citrus fruit juice such as lemon and limes are fantastic for treating acne. Alongside the fresh water flushing out your system and getting rid of nasty toxins polluting your body and skin, the citrus juice will help speed up the healing process.

You don’t just have to consume citrus juice for it to be effective on your skin either. You can use it as a topical acne treatment as well. Lemon and lime juice are said to not only be excellent at preventing the signs of spots, but they are great for calming down facial redness and healing unsightly scars left behind from painful cystic spots.

My Penis Skin Is Kind of Itchy – Please Help

An itchy penis is embarrassing, especially when it is constant. This can not only be frustrating and intrusive on life; it can also slowly erode sexual confidence and the prowess of the sufferer. It’s important to find out what is causing the problem and treat it before it becomes a major issue and sex stops being fun.

What Causes an Itchy Penis?

There are many reasons why a penis itches. Some of the most common causes are as follows and account for the bulk of penis skin issues caused by itching.

Skin Irritations

Factors such as poor hygiene, washing with a harsh soap or shampoo, using concentrated clothing washing powder or detergent, or even using latex condoms may be causing an irritation to the skin of the penis.

To rectify the problem consider bathing more frequently, using a milder soap, shampoo or clothing detergent, and changing the brand of condom used. This may reduce the irritation and the penile itch should cease. If this is not the case, it is advised that the condition may be more serious and it is recommended that medical advice is sought.

Skin Conditions

There are a number of skin conditions, such as dermatitis, eczema, and psoriasis that can cause penis itch. These conditions can cause the penis to become inflamed, red, swollen, and/or itchy, with flaky skin or take on one of numerous red and itchy skin symptoms..

Dermatitis and eczema are frequent culprits as a cause of penis skin itching and are typically caused by a compromised immune system, stress or exposure to skin irritants. Psoriasis is caused by the skin’s over-production of cells. This means that the skin is reproducing new cells faster than the penis is shedding old cells. Over time the cells build up on the skin of the penis which results in the skin’s irritation and penile itch.

Treatment for these conditions entails lifestyle changes: diet, emotional wellbeing and exposure to irritants are considered and altered to reduce inflammation of the penis skin. In addition, a doctor may prescribe medications and creams to reduce the itchiness and inflammation of the penis.

Penile Infections

Candida, scabies, pubic lice, trichomoniasis and tinea are each either fungal or parasitic in nature and can cause extreme penile itch and discomfort if not treated.

Candida is a fungal condition that is caused by an overgrowth of yeast, which then causes inflammation, itchiness, and a yellowish discharge. The best way to treat candida is to cleanse the infected area with water (no soap) and apply an antifungal skin cream for candida (thrush). In extreme cases, a doctor may prescribe an antibiotic, which can be taken to eliminate the yeast infection. Tinea is another fungal infection which causes irritation, inflammation, and itchiness. It can usually be treated with topical antifungaams. In severe or resistant cases, physicians may prescribe antibiotics.

Scabies, pubic lice, and trichomonasis are all parasitic infections in which a micro-organism invades the penile skin and causes irritation. These conditions are typically treated with lotions and specific topical solutions that kill the micro-organisms and allow the skin to heal. For more information about these conditions, please visit a health care professional or their website.

Once the penile itch ceases and the skin of the penis begins to heal the regular use of a penis specific creme(health professionals often recommend Man1 Man Oil) should occur daily. A penis skin creme enables the skin of the penis to repair itself faster and more efficiently, as it is rich in essential vitamins, minerals, and amino acids. In addition, a good penis skin product also increases skin appearance and the function of capillaries so that the penis sensation and performance are improved.

Can You Find a Sleep Aid That Does Not Cause Brain and Liver Damage?

New research reveals that repeated use of some commonly known over-the-counter sleep aids can be very dangerous to your long term health. This may strengthen the trend towards the use of natural sleep aids instead. According to a new study by Indiana University School of Medicine, traditional over-the-counter sleep aids are negatively affecting the brain, causing long-term cognitive impairment. In a six-year study, over 1600 African-Americans over the age of 70 were evaluated. Their over-the-counter and prescription medications were tracked.

The results were stunning. They found that taking one anticholinergic drug increased a person’s risk of developing mild cognitive impairment, which include gradual memory loss. Taking two of them doubled the risk! In other words, if you are consuming these drugs, you are literally destroying your brain. The researchers are next going to focus on finding out whether the impairment might be reversible, or whether the damage remains permanent.

What exactly are anticholinergic drugs? You can find them in your local drug store under the brands of Benadryl, Dramamine, Excedrin PM, Nytol, Sominex, Tylenol PM, and Unisom. Prescription versions include Paxil, Detro, Demerol and Elavil.

Even the most common side effect, memory loss, is not the only danger. In fact, the other active ingredient in Tylenol PM, acetaminophen (a widely used non-steroidal anti-inflammatory analgesic or NSAID) is said to be the leading cause of liver failure in the U.S. Acetaminophen is responsible for 56,000 emergency room visits and 456 deaths annually, according to studies done between 1990 and 1998.

Acetaminophen is one of the most common pharmaceutical agents involved in overdose, as reported to the American Association of Poison Control Centers. In the United States, acetaminophen toxicity has replaced viral hepatitis as the most common cause of acute hepatic failure, and it is the second most common cause of liver failure requiring transplantation in the United States.

Obviously, acetaminophen is not a bad drug. Most emergency room visits are due to overdose issues. People have the tendency to combine various drugs containing the same active ingredient, without realizing that it can lead to a life-threatening situation.

Are natural sleep aids safe? Categorically, yes. None of the commonly used ingredients in natural sleep aids made it to the recently published list of dangerous dietary supplements compiled by Consumer Reports. It is no wonder that people are turning to natural sleep aids to find a permanent and healthy solution to their occasional sleep problems.

The most common natural sleep aid is melatonin, a naturally occurring hormone. Circulating levels of melatonin vary during the course of the day. When it gets dark, the pineal gland of your brain starts secreting melatonin, and this helps you to become tired and fall asleep. Melatonin has very few potential side effects, but they are rare and minor compared to memory loss or liver damage. In various scientific studies, melatonin has been proven to cause very few, if any side effects in the short run (three months or less). In larger doses of more than three milligrams, some people get mild side effects such as headaches or morning grogginess.

But melatonin is not the only natural sleep aid available. In fact, you should find a natural sleep aid product that contains at least ten active ingredients. Why? If you take melatonin only, you may find it easier to fall asleep, but melatonin quickly wears off and does very little to help you stay asleep.

Similarly, chamomile extract contains a flavonoid called chrysin, which has been commonly attributed to chamomile’s ability to relieve anxiety. In other words, each natural component targets only one part of your sleep process. The more ingredients, the more synergistic and effective solution you have for your individual sleep problem and a complete good night’s sleep.

When choosing a natural sleep aid, make sure you find one with indium sulphate. It is a rare, but powerful trace mineral that appears to work with your brain’s HPA-complex, the sleep center. This is where indium sulphate regulates hormones that potentially interfere with sleep such as epinephine, adrenaline and cortisol. It puts the HPA-complex into a state of homeostatis or perfect balance, allowing complete relaxation and promoting deep and restful sleep.

Common Complaints About Nutrisystem

If this is a wonderful dieting program, so why so many complaints about Nutrisystem?

Horrible taste, horrible smell, food costs, and poor customer service are all concerns that seem to come to the top time and time again.

“This looks and smells like vomit” one nurse writes on the consumer affairs website. I’m sure most of us don’t think of diet food to be the best looking or tasting food on the planet, and may even make references to cardboard when explaining the taste, but vomit? Well, she is not alone in her assessment of the food that Nutrisystem offers. There were many letters posted at the consumer affairs website regarding the food, many calling it inedible. There were however some letters that stated the food “wasn’t that bad” and “what do you expect, it’s ‘diet food'”. There were also a few letters there about successes people have had on the diet.

The cost was another concern that was brought up a few times. On average you can expect to pay from $270-$380 for a months order. On the surface that doesn’t sound that bad considering a lunch at the local fast food restraint will run you $5-$7 anyway. But what wasn’t shared is that the meals that you buy from Nutrisystem also need to be augmented with salad and vegetables, which we all know aren’t the most inexpensive commodities right now, so your over all cost does go up. But maybe you can justify the extra food cost by the fact that you’re actually losing weight, which isn’t the easiest thing to do in the first place.

The most disturbing complaints about Nutrisystem, to me, are the ones about customer service. There is just no excuse for bad customer service in my opinion. When you run a huge company that people count on, and pay for your service, by giving them bad customer service you jeopardize your whole company. I have worked in customer service for over 12 years and I strive to give every single customer the best service I possibly can. That’s not to say that I have made everyone happy, but I did try. Many of the letters that I read were horror stories about how cancellations were difficult, refunds were very slow, and that the person on the other end of the phone just didn’t care.

There is no doubt that Nutrisystem works; in fact many thousands of people have had great success on this program. As long as you understand that Nutrisystem isn’t Dairy Queen, then you can probably get over the food not being the greatest. If you understand that yes you are paying a company to help you lose weight, and customer service isn’t a higher priority that the actual weight loss than Nutrisystem can work for you too.

Cross Examination of the Defense Medical Doctor: Nine Keys for Success

1. Cross examination: one fact one question.

The only way to keep control of the doctor on cross examination is to ask questions with one fact that calls for a yes or no answer. You are giving a speech in the form of questions. The facts in your questions should stand on their own and not depend on any information the witness has in their head. When deposing the defense doctor, there are plenty of facts to pull from. Here are some sources to pull facts to put in to your leading questions. The defense doctors report, plaintiff’s medical records, the doctor’s deposition in your case, depositions the doctor has given in other cases, journal articles written by the defense doctor.

2. Summarize the important admissions with leading questions.

Many times a defense doctor will admit a few things in deposition that help your client’s case. We should all confirm those facts with leading questions on cross examination. For example in most cases defense doctors will admit that a traumatic event can result in an injury that is appropriate to treat with physician supervised physical therapy or chiropractic care within six weeks of the injury. Confirm the amount of the bills he or she agrees the collision was a substantial factor in causing.

At deposition get the defense doctor to admit that your client experienced pain following the injury and that patients of theirs have complained of pain for varying periods after an event like the one your client went through. Most defense doctors will admit that a certain segment of the population is predisposed to injury and that prior injury can make people more susceptible to greater harm from a later injury. Here are some questions to try at the defense doctor’s deposition. These are not cross examination questions for trial.

Q. Would you agree that some people are more fragile than others?

Q. Would you agree that fragile people are often predisposed to greater injury or pain from an injury-producing event?

Q. Do people experience pain differently?

Q. Some people have a greater threshold for pain than others?

Q. Is there a precise way to measure pain?

Doctors understand that a person’s body can be “healed” but they can still have pain. A defense doctor may be using the work “healed” to mean that, architecturally, the body has reached maximum medical improvement. Some defense doctors will admit that symptoms, such as pain, last long after the body has “healed.” Focus on symptoms rather than injuries or healing.

3. If the defense doctor’s file is incomplete…

Often defense doctor’s files will be incomplete. They may not have all of the prior medical records and most commonly defense doctors will not look at the radiology images themselves. Typically their review will rely on the written report of the radiologist who interpreted the images. This is a good opportunity to point out where the defense doctor got his information. Walk through with the defense doctor how he got the records of plaintiff. Ask, “All the records you got were provided by the defense attorney, correct doctor? Confirm the defense attorney did not provide the images of plaintiff’s spine from her X-ray, MRI or CT scans. Most doctors will admit that it is their general practice to review MRI images themselves before making a decision on whether or not to perform surgery.

Remember this issue applies with equal vigor to the plaintiff’s treating doctors and testifying healthcare providers. Beware, treating doctors who are not made aware of important medical records, or information about prior trauma are just as susceptible to this type of cross examination.

4. Some symptoms improved: You believed my client when she said her headaches went away?

Keep an eye out for symptoms or pain the plaintiff has that get better. For example it is common for injured people to have multiple locations of pain early on, some of which resolve, only to be left with one or two chronic conditions that are significantly affecting their lives. If this is the case, you can employ the following cross examination.

Q. Did Ms. Jones’s say her headaches went away?

A. Yes.

Q. Did Ms. Jones’s say her low back pain went away?

A. Yes.

Q. Did you believe Ms. Jones when she said her headaches went away?

A. I did.

Q. Did you believe Ms. Jones when she said her low back pain went away?

A. I did.

Q. She was honest with you about that.

A. Yes she was.

Q. Did she have any complaints in any other part of her body when you examined her?

A. Well, yes she said her neck was still hurting?

Q. Did you believe her when she said her neck was still hurting?

A. Well No or Yes I did. [Either answer is good here.]

Q. [If they Say no.] You do not state anywhere in your report that you did not believe her, true?

Q. Did you label Ms. Jones as a malinger in your report?

A. No.

5. Show that the defense doctor is more familiar with law firms in town than the names of the people he has testified against in court.

You may be able to make the point on cross-examination that the defense doctor is very familiar with the names of the defense law firms that refer him defense medical exams, but less familiar with all of the individuals he has testified against. At the doctors deposition see how familiar the doctor is with the names of the more prominent firms that send him cases. Ask which firms refer him the most defense medical examinations. If he says he does not remember, provide the names of some firms you know have referred business his way. He will remember some.

Q. Do you know the law firm of Smith, Jones and Johnson?

A. Yes.

Q. Do you know the law firm of Levi & Louis?

A. Yes.

Q. These are law firms who have referred you business?

A. Yes.

Q. Doctor do you know Javier Martinez?

A. No.

Q. Do you know Tom Jones?

A. No.

Q. Do you know James Lee?

A. No.

Q. Do you know Sally Smith?

A. No.

[Make sure you get real names from real people, and have the old reports ready to back it up.]

Q. You know the law firms I asked you about, true?

Q. You don’t know the names of any of the people you have testified against in Superior Court?

Q. You don’t remember any of them do you?

Q. You don’t have any responsibility for these people do you?

Q. You don’t care for them as their doctor do you?

Q. You don’t treat them?

Q. You don’t have to worry about them at all

Q. You just have to produce a report that says they are not hurt?

Q. You just have to produce a report for the law firm that hired you?

6. Doctor do you have any private patient’s that you’re responsible for?

Many defense doctors still have a few private patients that they see. Here is a line of questions that exposes that absurdity that everyone gets better at the same rate, all within six weeks time, all with a short course of physical therapy and some home exercises.

Q. Dr. Do you have any private patient’s that you’re responsible for?

A. Yes.

Q. Do some of them get hurt in accidents?

A. Yes.

Q. Do some of them get hurt swinging a golf club?

A. Yes.

Q. Playing tennis?

A. Yes.

Q. Jogging down the street?

A. Yes.

Q. Stepping of a curbing

A. Yes.

Q. Bending over the counter to shave?

A. Yes.

Q. Changing a baby’s diaper?

A. Yes.

Q. Any impacts in any of those incidents?

A. No.

Q. Any property damage?

A. No

Q. Do you ask for pictures of golf clubs, or baseball bats, or tennis racquets?

A. No.

Q. Do you have any pictures inside your private patient’s charts?

A. No.

Q. Have you ever taken care of anyone who was ever hurt in an auto accident?

A. Yes I have.

Q. Have any of them had neck injuries?

A. Yes some of them.

Q. Have any of them had back injuries?

A. Some of them have.

Q. Do you actually treat them for this?

A. Yes I do.

Q. Some of them get well right away.

A. Yes.

Q. Have you ever heard of the word chronic?

A. Yes.

Q. What does that mean?

A. Well it means something that long lasting and long standing.

Q. Over the years have any of your patients had chronic back problems?

A. I am sure there have been a few of them.

Q. Do any of them have chronic neck problems?

A. Occasionally that will happen.

Q. Well if they say they are still hurting do you still take care of them?

A. Yes.

Q. Do you send some of them out for MRI’s, PT, or pain management?

A. Yes.

Q. My client told you the truth. Her headaches got better, her neck got better, and her back is not better?

Q. And she was in an auto accident just like some of your private patients.

A. Yes.

Q. Don’t you think doctor that she could have been hurt to in this accident?

A. [There is not a lot he can say.]

7. Doctor do you have pictures of vehicle damage in any of your private patients charts?

Here is a line of questions to point out the absurdity of basing a medical diagnosis on property damage estimates or photographs of car bumpers. Typically you can get these admissions during the deposition of a doctor. Many medical doctors will admit at deposition that there is little correlation between the extent of injury to the amount of damage to a vehicle.

Q. Dr. Did you get a copy of the repair estimate in this case?

A. No.

Q. Did you put a copy of the repair estimate in the plaintiff’s file?

A. No.

Q. Have you ever asked any of your own patients for a repair estimate from a body shop?

A. No.

Q. Don’t you just ask your patients if they were hurt?

A. Yes.

Q. Don’t you listen to their subjective symptoms?

A. Yes.

Q. Aren’t their subjective complaints the best tool you have to diagnose their problems?

A. Yes.

Q. Do you have any pictures of a fender or a bumper in any of your private patient’s file?

A. No.

Q. Have you ever made a diagnosis of any spinal condition bases on a photograph of a bumper?

A. No.

This is a good rebuttal to the common defense in the low impact case of just use your “common sense”. The trial that starts with a big picture of a bumper and the refrain, “use your common sense.” We need to turn that around and say, “Yes, use your common sense. Members of the jury, when you want to know why your back hurts do you look at your golf club, or your tennis racquet or your bumper? No, you feel the pain and you tell your doctor.”

Jurors don’t try to figure out if their back hurts based on a physics formula, they cannot understand. Pose the thought, “Has anyone in this courtroom ever gone up to the black board to figure out their injuries?”

8. Create leading questions with facts lifted from the medical records.

We should take some pointers from defense lawyers from their cross examinations of plaintiffs. The best cross examinations of an injured plaintiff uses leading questions with facts taken from the subjective complaints lifted from the medical records. A similar strategy can be used when cross examining the defense medical doctor. Here is a line of leading questions using facts lifted from medical records.

Q. You reviewed the medical records of Ms. Smith’s treating doctor, Dr. Jones?

A. Yes.

Q. You are aware on May 1st Ms. Smith reported to Dr. Jones that her right thumb was numb?

A. Yes.

Q. Again on May 15th she reported that her right thumb was numb?

A. Yes.

Q. And that right thumb numbness was documented by Dr. Jones in her chart on that same day May 15th.

A. Yes.

Q. Again on May 22nd Ms. Smith reported to Dr. Jones that her right thumb was numb?

A. Yes.

Q. And again that symptom of right thumb numbness was documented by Dr. Jones on May 22nd.

A. Yes.

Q. These facts are documented in Ms. Smith’s medical records.

A. Yes.

Q. You do not dispute the truth of these facts do you?

A. No.

9. Limit the defense doctor who wants to testify about malingering.

Defense doctors will often testify on matters on which they are simply not qualified to offer testimony. A common one is testimony about malingering or secondary gain. If the physician starts stating that the client is a malingerer, or advancing secondary gain, get them to admit that these are diagnoses under the DSM IV or DSM IV-R. Have a copy of the DSM criteria for malingerer and ask the doctor to tell you what they are. Typically they cannot. Get them to admit that they are not licensed to do psychology, that they are not practicing as psychologists or psychiatrists and they refer their patients to professionals in psychology / psychiatry if they think that they need such treatment. This demonstrates that they are not licensed in that field and, therefore, lack the qualifications to provide testimony on those subjects. Have them admit that they did not preform a psychological examination, psycho-social history and/or did not conduct the battery of psychological tests such as the MMPI or MMCI. This shows that they lack a foundation upon which to provide testimony as to a psychological diagnosis. Remember your deposition is as much about limiting the scope of testimony as it is about knowing what that testimony might be. File a motion in limine to preclude that testimony.

Conclusion:

When preparing for your cross examination of the defense doctor keep in mind that each case is unique. Trying to use cookie cutter cross examination techniques many not serve you well. Practice your cross examination on your colleagues and friends. Have them read the DME report and deposition and see how well your leading questions work. Does each question truly stand on its own and call for a yes or no answer? Does each of your leading questions call for facts and not characterizations or opinions? After your preparation is complete, remember the jurors expect the plaintiff to take some hits from the defense doctor during the direct examination. Your job is to not make it worse on cross. Make some points using the powerful tool of the leading question and sit down. Remember the words of Voltaire: “The perfect is the enemy of the good.”

7 Complications Leading to Barretts Esophagus

If GERD is not controlled by lifestyle changes and diet modifications, acid reflux disease could lead to serious problems for the sufferer.

In extreme cases, complications cause by the continuous presence of acid in the food pipe could eventually become the life-threatening condition known as Barretts Esophagus.

Constant burning and erosion of the walls of the esophagus is a chronic disease which might create a domino effect leading to a number of painful malady’s.

Complications leading to Barrett’s Esophagus

The first sign of this life-threatening cycle is a condition known as “esophagitis”.

If this condition is not accurately diagnosed and treated, multiple problems could develop, including Barretts esophagus.

Here is a list of possible complications:

  • Pain.

    Esophagitis is a painful condition that could lead to dysphagia. This condition makes it almost impossible to swallow.

  • Scarring.

    Continuous onslaught of acids causes longitudinal scarring to the walls of the esophagus, particularly where it joins the stomach. This could cause the opening to pucker and shrink. This shrinkage creates a srticture thereby blocking the passage of food and making it difficult to swallow.

  • Ulcers.

    Lesions known as ulcers form on the weakened walls of the esophagus causing further scarring. These scars also pucker and tend to shrink the lining, leading to the same condition described above.

  • Bleeding.

    Ruptured ulcers can bleed profusely. On many occasions this bleeding has necessitated hospitalization followed by emergency blood transfusion.

  • Asthma.

    Acid invasion triggers a nerve impulse that causes the airways to dilate. This can induce an asthma attack, which, if left unchecked, could result in ongoing chronic asthma.

  • Lung damage.

    At the back of the throat, the gullet forks into two tubes; the trachea, which is the air-pipe leading to the lungs, and the esophagus, which is the food-pipe leading to the stomach.

    If the acid washes high enough, it could be aspirated into the trachea, reach the lungs, and cause inflammation and permanent damage.

    This could result in hoarseness, laryngitis, choking, coughing and difficulty in breathing.

  • Barrett’s esophagus.

    Finally, barretts esophagus. Due to the ongoing invasion of digestive fluids in the lower esophagus, the body might attempt a system of damage control, which could lead to the onset of cancer.

Dysplasia – The Seeds of Cancer

In order to withstand the onslaught of acid, the walls of the esophagus undergo a cellular change know as dysplasia, (sometimes referred to as metaplasia).

This is where the body replaces normal cells with precancerous abnormal cells resembling those of the stomach and intestinal lining.

This stage is known as ‘low grade dysplasia’.

Although these rogue cells are more resistant to acid attack, in five to ten percent of patients, they eventually lose their tissue identity and revert back to a primitive form that grows rapidly without regulation.

The final stage is is ‘high grade dysplasia’, a condition known as ‘carcinoma in situe’.

This particular form of cancer remains localized and does not invade past the basement membrane into tissue below the surface.

As a result, it can still be treated surgically, with few risks of it spreading to other parts of the body via a process known as “metastasis”.

However, if left untreated, it eventually develops into a deadly form of invasive esophageal cancer that is almost always fatal.

We cannot overstress the following: Every one of these complications can easily be avoided by sensible and timely changes to your diet and lifestyle.

To Heal Varicose Veins You First Need to Know Why You Have Them

When ever one comes across a text of an article that, its headline mentions anything even remotely promising in curing varicose veins, curiosity kicks in instantly in most people. It is not very hard to figure out why. They are unsightly, they are extremely painful, and most of all, they are very dangerous for your health, because, if left untreated they can lead to other serious cardiovascular diseases.

You may think that I mistakenly put these three reasons into reverse order, but you would be wrong. Although, your health is most important thing in your life,”looks” are here mentioned first, because vast majority of the varicose veins sufferers are women, and most of the procedures undertaken are for that reason only.

Several procedures are offered today by western medicine. Basically all of them are about the same thing, vein stripping or vein collapsing. This is to say that, veins are injected with drugs so they are destroyed, they collapse and stop functioning. Seemingly they disappear. The same effect is produced when varicose veins are exposed to laser light. Surgical procedure, called vein stripping is another choice. Along with it, whole branch of pharmaceutical industry is built around this ailment alone. And this brings in huge profits, based on the simple premise that, it is in human nature to believe that there is always quick fix, magic bullet, to what ever the disease.

Are you one of these who believe that there is a medical procedure that can rid you your varicose veins? If you are, please continue reading because I’m just about to save you money. If you are not decided, and still don’t have an opinion, you should easily deduct the truth about it when you finish this read.

All of our cells are submerged in our lymphatic fluids. When, because of the bad diet choices we made, our lymphatic fluids become too acidic, and the acidic tissue can not hold on to oxygen, that tissue slowly starts to decay. It starts to dye. No human cell can live without oxygen.

Our veins, that do their proper work against gravity and rely on muscles to move the blood in them, are much like elastic band. They expand, and they contract and the blood moves up.

Our veins like any other cell in our body, are floating in our lymphatic fluids. When these lymphatic fluids become too acidic, they start to burn walls of our veins. Veins when burnt loose their elasticity and they start to harden. Pretty much the same thing would happen if you dropped battery acid (sulphuric acid) on your bare skin. The way your skin would look all burnt, is the way your veins look. When our vein walls become hard and rigid they cannot react to increased blood pressure, and they break. Garden hose full of water sitting in the hot sun all afternoon that gets run over by a 4X4, describes it almost to a letter.

Now you know what is the exact cause of condition called varicose veins. Bad, over acidic diet. So to cure varicose veins we must change our diet. We must choose to eat diet that is going to be more alkaline, so that these acids eating us from inside, get buffered. Alkaline diet will supply needed alkaline minerals that are going to repair damage done by over acidity, and the healing will commence. Until the final cure.

It is quite obvious now why this condition cannot be fix by drugs or by surgery. They do not address the cause of the problem but rather deal with the effect of it. Since the same amount of blood still circulates in our body, other healthier veins that took over the job of collapsed veins, are now under more stress and more pressure. Simple question of time when it’s going to be their turn, and when we are going to need another surgery.

Good for the business, but not good for you.

Always remember that our body has that magnificent ability to recover, to self cure, but just if you give it an opportunity and time.

Surprising Health Benefits of Quilting

You know that quilting makes you feel good, but now there’s scientific evidence to back up what you’ve always suspected-not only does quilting make you happy, it’s actually good for your health. Researchers at the University of Glasgow published their findings in the peer-reviewed Journal of Public Health after conducting qualitative research using a local quilting group as their source. The end result? “Quilting seemed to possess some distinct properties for enhancing well-being that would not be replicable through outdoor/physical activity.” In other words, that’s dry research speak for saying quilting gives you a workout you’re not going to find in your local step class.

The biggest perk? When you’re happy and doing something you love, your brain gets saturated with dopamine and serotonin, otherwise known as happy chemicals-especially when you’re doing “meaningful work” using your hands. According to Kelly Lambert, PhD and a member of the neuroscience department at Randolph-Macon College, quilting complements these conditions perfectly.

Get Healthy and a Stunning Quilt

Next on the health benefits list is a decrease in stress levels. Dr. Lambert says quilters “feel a sense of accomplishment that increases your ‘reward chemicals’ and decreases the chemicals related to stress or anxiety.” Of course, lower stress levels are linked to a variety of good things from a lower risk of heart attack and stroke to lower body fat. In a time when stress levels are breaking through the roof for most people, who wouldn’t benefit from a little cultivation of mindfulness?

If you’re more into quantitative proof, a clinical psychologist published research in the Journal of the American Medical Association showing evidence that quilting leads to decreased blood pressure, heart rate and respiration. Finally, according to Harvard neurologist Marie Pasinski, MD, quilting is a soother for the brain. The Glasgow research echoes these sentiments, with the participants saying that quilting was a (relatively) easy way to embrace creativity, and the use of different colors and textures gave them a “sense of wellbeing.”

Straight from the Source

The Glasgow participants specifically cited, time and again, bright colors and how they elevated their moods-particularly during those dreary British winters. Most of the group also said there was something captivating about quilting and that they got into a flow, much like a runner’s high. It’s relaxing and at least for a little while, their anxieties were put on the back burner. However, quilting also requires problem solving skills, like when new patterns and shapes are required. From newbies to quilt masters, everyone said that at some point they always find a new challenge.

Finally, getting that tangible end result is a built-in reward that offers plenty of satisfaction and the feeling of achievement. During the social aspect of quilting as a group, the women said they felt inspired and all those compliments don’t hurt when it comes to getting a self-esteem boost. Quilting is “uniquely good for you” concluded researchers-a sentiment that’s obvious for quilters, but it’s quite the rush to get a nod from the world of academe (kind of like nailing that tumbling blocks pattern on your first try).

Natural Cure For High Cholesterol and Triglycerides

Cholesterol is found throughout your cells and in your bloodstream. Your body needs a certain amount of cholesterol to function properly, but it is when you have too much that your health can begin to suffer. There is good cholesterol and bad cholesterol. HDL is the identifier for good cholesterol and LDL identifies your bad cholesterol number. A natural cure for high cholesterol and triglycerides can help.

Excess LDL can build up in the inner lining of your artery walls and cause blockages that don’t let blood flow through easily. A level of less than 100 mg/dL is considered a most favorable number in LDL. Levels of HDL are considered good when they are above the number 40 mg/dL. These two numbers combined are often used to assess the capacity for risk of a heart attack or stroke. Both good and bad cholesterol are made in your body and come from the foods you eat. Your total blood cholesterol level should be below 200 mg/dL.

Triglycerides are another form of fat. They are also made in your body and they come from the foods you eat. High cholesterol and high triglycerides often go hand-in-hand and are a determinant of heart disease. Your triglyceride level should be less than 150 mg/dL.

To combat high levels of cholesterol and triglycerides, doctors will often prescribe medications. For a lot of people, these medications either don’t work or they bring about way too many side effects to make it worthwhile for them to use.

Natural cures are available to help with these conditions. A product named Resterol focuses on adding nutrients to your system to help fight cholesterol build-up. Nutrients in Resterol have been compared to eating as much as two pounds of almonds, seven cups of sunflower seeds, half a garlic bulb, a turmeric plant root, 1 1/2 cups of brown rice, and the resin of a Commiphora mukul herb.

Another supplement choice is Cholesto-rite, which combines herbal ingredients that have been well-researched to provide the nutritional requirements to fight the build-up of cholesterol and triglycerides.

D-Herbs Cholesterol Buster supplement pills contain such natural ingredients as Apple Fiber, Alfalfa, Cayenne, Green Tea, Devil’s Claw, Glucommanon, Calamus, Fenugreek, Guggal Gum, and Yunnan Toucha. This is a vegetarian formula that provides supplements your body needs, especially if you eat a lot of meat products. When your cholesterol and triglyceride levels are high, you should reduce the amount of fatty meat you consume as well.

Alfalfa is known as one of the good grains because alfalfa leaves have been known to reduce cholesterol levels and shrink plaque along your artery walls. Oats are another grain source that are given a lot of credit in reducing cholesterol. Oatmeal has long been a favored food in reducing overall cholesterol numbers.

As always, along with any natural aid or prescription aid, for that matter, you should watch what you eat and get regular exercise. Try a natural cure for your high cholesterol and triglycerides problem numbers. A natural cure using organic ingredients is always the best way to treat your body.

Beating Gout By Eating Citrus

What is gout? Gout is a type of arthritis that causes very painful swelling in one or more joints. It typically affects the big toe joint, but it can also cause painful inflammation in other joints such as the elbows, knees, wrist or fingers. Thankfully, although gout is a very painful condition, it is possible to beat gout by eating citrus fruit.

What causes gout?

The painful symptoms of gout are caused by a build up of uric acid crystals. Uric acid is a by-product of the breakdown of purines, a type of protein found in various foods, including shellfish, offal, and red meat. If levels of uric acid are too high, the kidneys are unable to excrete the excess and uric acid crystals accumulate in the joints, causing inflammation and painful swelling.

There are many reasons why people suffer from gout. In some cases, gout is caused by a protein rich diet: eating too much shellfish, red meat and other rich foods is a known risk factor for gout. It can also be caused by a heavy consumption of yeast rich products such as beer and red wine. But apart from lifestyle factors, gout is also a side effect of certain health problems including kidney disease, diabetes, and obesity.

Can natural remedies be used to treat gout?

There are lots of natural remedies that can help the sufferer find relief from the painful symptoms of gout. Vitamin C is a well-known natural remedy for gout and many studies have indicated that taking a vitamin C supplement regularly can help to prevent a recurrence of gout attacks. If you are already suffering with gout, vitamin C can also help to alleviate the symptoms.

Can citrus fruits help alleviate the symptoms of gout?

Citrus fruits are a natural source of vitamin C, so including plenty of citrus fruits in your diet can also help you find relief during an attack of gout. Try eating oranges, clementines, satsumas and tangerines. Alternatively, infuse slices of lemon and lime in a glass of hot water twice per day or drink some freshly squeezed orange juice.

How does citrus fruit help you to beat gout?

Citrus fruits contain high levels of citric acid. Scientific studies have shown that citric acid can help to dissolve uric acid, so consuming plenty of citrus fruit can reduce your levels of citric acid and provide you with fast relief from the symptoms of gout. If eaten regularly, it can also help to keep your residual levels of uric acid in the blood lower, which will prevent frequent attacks of gout.

Although gout is a painful and debilitating condition, it does not have to ruin your life. Avoid the foods known to increase your risk of developing gout and eat plenty of vitamin C rich citrus fruit: this will help you to avoid future bouts of gout. You should also try to maintain a healthy diet, avoid too much beer and red wine, and take regular exercise, as these factors all play a part in causing painful attacks of gout.

Power Napping For Powerlifters (and Bodybuilders Too!)

Look at everything you do in the gym right now. Think about the tough, brutal and long workouts you endure on a daily basis. Then, look at the foods you shovel down the hatch on a daily basis. Now, look at your results. Think about the gains you’ve made in the gym in the last year. Are they satisfactory? Now, consider what kind of rest you would have seen if you had given your body a separate and individual ‘growth period’ each day in which new muscle was formed!

Plan your next year. Will you continue plodding along at the same slow rate? Are you intrigued to see what kind of powerlifting or bodybuilding gains you can make with a daily ‘power nap’? Naps are a great way to provide your body energy for the second half of the day, as well as to give your body a brief ‘growth period’ in which new muscle growth can occur outside of the normal 8-hour sleep window at night. Bodybuilders grow when we rest, and a mid-day rest is awesome for delivering more new muscle growth.

Before of after? Which time is the best time to nap? Do you wish to sleep before your workout, providing a fresh and well-rested body for the gym? Or is it better to complete your workout and immediately enjoy a big meal rich in intelligent carbs and slow-digesting carbohydrates, and then hit the hay? This question may be answered based upon your available options with work, school, family, etc. However, if you do have the ability to sleep at either time, then you should give both of them a shot. Record your results and decide which time period delivers the best results in the gym!

Making time for a nap may be difficult. If you’re a stay-at-home parent, this should be fairly simple. When the kid sleeps, YOU SLEEP! Granted, you might already be sleeping at the same time out of exhaustion. Use this time to grow, because as you know, your child is already using this time to grow! Just don’t forget to eat before crashing. If you run your own business, as many young bodybuilders do (must be something about that Type-A personality and work ethic), then you should be able to schedule a ‘meeting’ each day around 12:30 and give yourself adequate time to recover from the morning’s

Length of nap-time will depend upon the individual. Some lifters will benefit from 20 minutes, and some will enjoy a full 90 minutes. If you use anabolic steroids, you already recover faster from your workouts, so you may be under the impression that a nap will not do you all that much good. However, you grow more when using steroids, and another growth period during the day can be ideal for this!

Whether you are a natural or a steroid user, a bodybuilder or a powerlifter, the use of power naps will make you bigger and stronger faster than you can imagine!

It’s Only A Small Whitehead

As I was growing up, I was nurtured by the sun just like plants are. I was outside in the sun every day. When I was a teenager, we used baby oil and iodine to help us get that tan look. (Fry-Baby-Fry)

I became involved in the city recreation age group swimming and diving teams for many years. As I grew older I worked out in the fields for farmers, as a lifeguard, pool manager, and swimming and diving coach during my summers. I also coached football, track, and had outside lunch duty while I was a teacher.

According to the specialists in the field of skin cancer, “…much of the damage that leads to skin cancer occurs in young children and adolescents…”

We did not know what sunscreen was except for the cute Coppertone commercials on the television. I guess you could say I have been a devout “Sun” worshipper all of my life. I had my share of very bad sunburns throughout my lifetime.

The very first time I went to see a Dermatologist he asked me to remove my shirt. The first words he stated were, ” My you have really enjoyed the sun throughout your lifetime.”

On November 22nd of 2010, I went and had my yearly Dermatology exam. The doctor did a thorough exam and then he asked if there was anything I would like to have checked out. I said”, Yes there was a very little spot like a white head on the left center part of my forehead that always bothered me when I wiped sweat off. It didn’t hurt or anything it was just bothersome.”

The Doctor took a look at it and said that it was nothing to be worried about but he would do a punch biopsy to make sure. He numbed the area with a local anesthetic and did the biopsy. He didn’t have to use any stitches; just a band-aid.

Since it was the week of Thanksgiving, he told me he would have his staff call me the next week with the results. I told him that would not be a problem.

The next week passed by without a call from his office. Then the second week passed by also. I had forgotten about the test and continued on with my daily life of running, substitute teaching, and just enjoying life since I had retired from the teaching field.

During the third week, on a Thursday evening about 8:30 p.m., my doctor called me at home and told me that my biopsy had been sent back to Boston because the Pathologists here were having a tough time defining and diagnosing it. They thought it was a grouping of nerve cells that had intertwined but they weren’t sure. They wanted other pathologists to confirm their diagnosis.

The pathologists back in Boston had also agreed to disagree. Finally they came up with the correct definition and diagnosis for this grouping of cells. On December 8th of last year, the bump on my forehead was positively diagnosed as a spot of Desmoplastic Melanoma.

I was told this type of cancer is very aggressive and devastating. It is a type of cancer that doesn’t play by designated rules; like other cancers did.

The doctor told me he had already made an appointment for me with a surgeon. I was to meet with the surgeon on the following Tuesday morning.

After I hung up the telephone, my wife asked who had called. I told her the entire story. I was absolutely numb and in shock. The more it sunk in that evening the more concerned I became.

I worried about it all weekend. I researched this type of skin cancer on the internet. The more I found out about it the more concerned I became. I talked with my sister- in- law and brother- in- law in Salt Lake City, Utah. They are both in the medical field. They suggested I come down there and get into the Huntsman Cancer Institute. It treats nothing but Melanoma type cancers. I said we would have to wait and see what my doctors were prescribing. They told me not to wait too long because of the type of cancer this was.

Upon further research at the Huntsman Institute site, I found that Melanoma is ” The deadliest form of skin cancer, has reached epidemic proportions worldwide, and is the most rapidly increasing cancer in the United States of America.”

On Tuesday morning, I met with the surgeon. He began by looking at this small white head of a bump and then he began relating medical terminology to his nurse. He then said if I had any questions I could ask his nurse and he left the room. His nurse told me that she couldn’t schedule the surgery any sooner than January 3rd.

I told her I could not have surgery until after January 10th because I had committed to some substitute teaching jobs for some dear friends. She said that was okay but I needed to call the hospital and go in for a pre-surgery screening. She said she would send in the orders to the hospital.

I called the hospital that afternoon and set up an appointment for the morning of January 7th.

On the morning of January 7th, I went to the hospital and told them why I was there. We went through the basic paperwork, and the pre-lab exam. They told me that we couldn’t do the lab tests or the EKG because there weren’t any orders from the doctor.

The nurse was kind enough to call the doctor and ask for the order to be faxed to her. We waited for about twenty minutes but no fax arrived. The nurse said she was sorry but there wasn’t anything she could do. So she sent me home.

When I arrived home I called the doctor’s office and the receptionist said that everyone was out to lunch. She would have the nurse call me when she arrived back at the office.

After two hours the nurse called me at home and told me she had just faxed the orders. I asked her what I needed to do now. She told me to call and make another appointment with the hospital but I needed to have it completed before I could check in for the surgery.

I called the hospital and luckily the nurse I had talked to that morning answered the telephone. I explained what the doctor’s office had said. She told me to get myself down there right away and we would finish the exam then. Thank goodness for her because I was not getting any help or information from my surgeon’s nurse.

On January 12, I checked into the hospital. I was a basket full of nerves because I really had no idea of what was going to happen. The first thing that I had to experience was the Radiation Doctor injected the “white head” with lidocaine. Then he injected the north, west, south, and east points of the spot with a radioactive element that stung like acid even though it had been numbed. I had to lie perfectly still for 40 minutes for the elements to travel to certain sentinel lymph nodes. My wife and the Radiation Doctor watched on a monitor as the radioactive element traveled from my forehead down to my left ear and neck. The surgeon would remove these marked nodes because that is where cancer cells had traveled to.

After this procedure was completed, I was directed to the pre-surgery department. I had an IV hooked up to my arm. I was asked more questions for the hospital records. Actually these were the same questions I had answered during my first visit. I guess different departments don’t communicate with each other, even in this day and age of technology.

The Anesthesia Doctor came in and talked with me while he injected the IV with a mild sedative. This was fine because I was really starting to get stressed out. This doctor actually answered some of my questions and gave me some information about the procedure.

The surgeon had gotten behind on his surgery schedule so my surgery was pushed back by two hours. I think I was given the mild sedative two more times before I was wheeled into the surgery area.At this point all I knew or should I say all I was told was that he was going to remove that spot. Oh, was I wrong.

During the surgery that afternoon, the doctor made an incision from inside my hairline to just below my left eyebrow. He removed a section as round as the bottom of a yogurt container from my forehead and went in as deep as the skull. He also removed a sentinel lymph node beside my left ear and two nodes from deep in my neck. He told my wife that he had to go in an inch and a half to get these nodes.

The node incisions he closed and sutured. The forehead opening was packed with cotton balls and compression bandaged to prevent any bleeding. The bandages were actually sutured to the skin to prevent them from shifting.

When I was relatively awake from the anesthesia and given the okay by the recovery room doctor, I was sent home with my wife and told to come back to the doctor’s office on Tuesday morning of the next week.When I arrived home, I looked in the mirror and saw someone who had bandages all over his face. I had a huge bandage on my forehead that looked like the beginning of a Unicorn’s horn. I also had a bandage by my left ear and one on my neck just below the ear.

The pain pills, which had been given to my wife to help alleviate my pain until she could fill my prescription, were very welcome at this point. This had been a very long day for my wife and I. We had arrived at the hospital at 6:30 a.m. and returned to our house at 8:10 p.m.

The weekend went fairly well except for the throbbing in my forehead, my left ear area, and my neck. I used ice on a regular basis to help control the swelling.

On Tuesday morning, I was allowed the luxury of finally becoming privileged to some information involving my case. My wife and I knew nothing about this information beforehand.

They were going to put me back in the hospital again the next day and this time it was going to be for overnight. This was because all of the maneuvering the doctor was going to have to do under the skin would leave me very sore and actually very sick to my stomach. He was very correct about that!

He said they were going to loosen the skin up under the hairline about two and a half inches and then pull it, tuck it under and then stitch it back together leaving as small of a scar as possible. I looked into the mirror and saw the incision they had previously made. The incision went from 1/2 inch below my eyebrow up and across my forehead and into my hairline by 1/2 an inch.

It was basically a partial face-lift that plastic surgeons might do.

The nurse packed and re-bandaged the incision and we headed back home. As we were driving home, my wife and I both questioned each other about knowing any of this information before today. We both came to the same conclusion. We had not been given any of this information prior to today.

We arrived back at the hospital the next day around noon. I was checked into the pre-surgery area again. I actually had the same pre-surgery nurses as I did for the first surgery. We went through the same procedures as before with the IV and the questions. Today the surgeon was not behind and it looked like we were going ahead as scheduled.

The Anesthesia doctor came in to my cubby hole and gave me the pre-sedation. As he was doing this I happened to look across the aisle from me. There was a pretty fifteen year old girl and her father in the cubby hole across the aisle. Just as my bed was being wheeled out of my cubby hole, her doctor had told her they were going to have to remove her nose and upper lip because of a spot on her nose. The scream that came from her was a blood curdling scream that I had only heard in the movies.

I was later told by my nurse that the parents could not bring themselves to tell her about her surgery. They had only told her that her dermatologist was going to remove some acne bumps. They figured the doctor could let her in on the secret after she had been partially sedated.

I am glad that I was being wheeled into the operating room and out of that area.

As I was going into the operating room, where my surgery was going to be done, I remember thinking “Oh Crap, what are they going to do to me this time?”

When I woke up in my hospital room the pain started immediately. The remainder of the night I tried to listen to music to block out the pain-No help or very little. We, the nurse and I, then tried Norco tablets every four hours….took a little edge off but when the pain wanted to scream it would get its own way.

The nurse finally said, “that’s it” and gave me an injection of morphine. She told me that the pain was making my blood pressure raise to a level she did not want to see. The morphine brought the pain down to a low to medium migraine. So we continued this routine, Norco tablets every four hours followed by injections every hour, all night until I was released the next morning at 9:30 a.m. I did not get any sleep at all that night.

When I was released from the hospital the next morning, I was told to keep the bandages dry and clean and the doctor would see me in three days to take out the stitches.

I loaded up on some Norco tablets and eventually slept like a rock when I returned home.

My wife told me that the doctor had come and talked with her after the surgery. She said he was very informative and actually very nice.

When I went to the surgeon’s office to have my stitches removed, I had a new nurse take them out. The stitches came out very easily. I looked like I had a small irrigation ditch running through my forehead but I felt fortunate to this point.

The doctor told me there would be a few radiation treatments to clean up any debris that was left but it would nothing to stress out about. He told me the headaches, the soreness, and the itching under the skin would go away with time.

He had set up an appointment for me to meet with a Radiation Oncologist at St. Luke’s Hospital in the Mountain States Tumor Institute or MSTI department. This appointment would be scheduled in about two weeks. This would give the incision time to heal.

When I went to my appointment to meet the Radiology Oncologist and the Chemical Oncologist at the Mountain States Tumor Institute, I was under the impression that I would have a few radiation treatments and that would be it.

Everyone that I met at MSTI, from the receptionists all the way to the doctors were very sweet and compassionate. The compassion the doctors, nurses, and everyone that worked there had for their patients was truly immense and heartwarming.

The doctors were compassionate but were very matter of fact when it came to this disease. The first doctor, who was a Radiation Oncologist, looked at the incisions I had and said, “Your other doctor did a very good job on your fore head, and neck but I want you to know something-He is a surgeon, a very good one, but still just a surgeon. I am the Radiology Oncologist and you are now mine.

I am setting you up for a brain MRI, a full body PET scan, and a meeting with the Chemo Oncology doctor and the radiation tech staff.”

I met with the Chemo Oncologist right away. I could tell from what she said that she was a very intelligent person. She asked me what stage I was in? I told her I didn’t know because no one had offered me that information. She looked at my file and said that I had stage two. I was one cell away from being in stage three. She said the difference being stage two-NO chemotherapy, stage three FULL interferon chemotherapy. She explained what would happen to me physically and mentally if I would have gone through the Interferon therapy.

She told me that if I had not asked for my dermatologist to check this “white head” out by this time next year at my annual dermatology check there would have been nothing they could have done for me. She said I was very, very lucky.

I was then taken into the radiation room where they were going to fit me with a very tight plastic mask that clicked to the table. It was designed so that for the next five weeks I would be in the same position every day. They told me my eyebrow hairs would fall out, parts of my hairline would fall out, my skin would burn like a sunburn, then blister and peel. They said I could only use the lotions that they gave me because the commercial products were too strong. They also told me I could not use sunscreen for the first year due to the harm it would cause the skin.

The radiation tech person asked, “Have you ever been claustrophobic?” I told them no and asked why. They told me the mask was to be placed in very warm water and then pushed down over my face and clicked to the table. Then the techs would form it to my face with their hands. Once this was completed they would place cold towels over it to solidify its shape.

Then they would take the mask off, draw on my face with a Sharpie pen for future reference points, place the mask back on my face, and make some marks on the mask.

These marks on the mask would help align the laser markings for the radiation treatments. This way the placement of the markers would be exact every single treatment. I was also going to wear a lead eyepiece over my left eye so the radiation would not affect my eye.

From the radiation room, I was sent to the Imagery department. Here they would do the PET scan and the MRI.

I was first given an injection of a radioactive element, placed in a dark room, and told to be as quiet as possible for forty minutes. I couldn’t even talk. When the time period was up, I was led to a restroom. The sign on the outside of the door read “For Nuclear Patients Only”. I highly expected my urine to glow if I turned out the lights. I was then escorted back to the Imagery room and they did the full body scan.

I was then taken to an MRI room, where the technician did an MRI of my brain. Other than a lot of noise this was an easy exam. I was told my doctor would go over the results of the tests on Monday and I was then sent home. I was extremely exhausted after all of this. This was not the few radiation treatments to clean up any debris left from the surgery that my surgeon had indicated.

Once we started the radiation treatments, I was to meet with the doctor every Monday. On the first Monday she told me that the results of the MRI and PET Scans were back and that I had Nodules in my lungs. Oh great some more good news!

She said most people do have them from the air we breathe but she ordered a DEDICATED CAT SCAN of my lungs. This scan was scheduled to take place the next morning. This exam would look at the nodules more closely.

My doctor then guided me back to the radiation treatment room. They handed me a schedule for the next five weeks. I was going to have a radiation treatment every week day at 3 p.m. for the next five weeks.

The technicians had me lay down on a skinny table. They put a pillow under my knees to relieve any back pressure. They then took the mask they had made for me, placed it over my face, pushed it down towards the table until I heard four clicks. This was the mask clicking into its proper position. They placed a lead shield over my left eye.

The technicians then told me they were ready and that they were going to leave the room. They told me not to move. I had my eyes closed but when the machine came on I could see a white light pass over my face. I asked the technician about this and she told me there wasn’t any white light. It could have been the radiation playing with my optic nerve.

As the weeks passed by I developed a sun burn on my fore head, I lost the hair from my left eyebrow and up into my hairline about an inch and a half. During the third week of treatment, when the radiation came on, I could feel a bubbling sensation just under the skin. The technicians said this was a normal occurrence and to make sure I used the lotion they had given to me.

If you ever want your life totally scheduled out, this is one way to do it. You have Radiation treatments every day at 3 p.m., Doctors appointments every Monday at 11 a.m., and then any scheduled tests in between those two. I have seen patients at MSTI spend all day there. First they have their chemo treatment and then they go and have their radiation treatment.

One day while I was sitting in the radiation waiting room and a young man about 22 years of age walked in and sat down. I knew he had just had his chemo treatment because of the bandage on his arm.

As we sat there he began to cry. He kept repeating that he wasn’t going to make it. I was just about to talk with him when the nurse called me back for my treatment. I told her about him, what he was saying, and suggested that he needed to talk to someone. After my treatment was completed, the nurse came up to me and thanked me for saying something. This young man was in a very depressed state and they had checked him into the hospital.

When I went in for my first CAT scan they told me they were going to use a warm iodine solution as a contrast material. I am allergic to Iodine. The radiation technician gave me some medications to take to stop any allergic reactions.

The technician told me when they injected the warm Iodine it would make you feel like you were getting warm all over, and then suddenly you would feel like you are wetting your pants….She didn’t lie. That’s exactly how it felt. She told me she would warn some of her older patients that feeling was going to happen but they still would grab their crotch when it did occur.

The nodule results were fine but as we were walking out the tech told me I probably would have two more CAT Scans about six months apart. About this time, my nose and upper lip had become itchy. It was a slight reaction. I had to sit down for ten minutes with a nurse and an IV in my arm so I could be monitored for anymore reactions.

The second CAT scan went according to plan with no changes in the nodules and no reactions from the iodine.

The third CAT scan results were okay except the nurse was behind schedule and decided the best way to put in a needle is by the perpendicular-vertical method over the parallel-horizontal method. This was to be my last CAT scan but the doctors found a new nodule. So now I have one more to make sure this one has not changed.

Just about the time I feel like everything is coming to an end a new surprise hits the fan.

I finished my radiation treatments and I am still in the process of recovery; both physically and mentally. The doctors said about two years to recover from the surgeries and radiation treatments. My forehead is still sore where the surgeries had taken place. I did have a few chats with the MSTI Social Worker to vent a few anxieties. What a wonderful and caring person she is and will always be a dear friend

When my radiation treatments were over, the radiation tech gave me my mask and told me I could paint it for Halloween to scare kids away from my door or I could paint it in orange and blue colors and wear it to a home Boise State football game. He was a great guy during this time period.

So I have another Cat Scan in August and at the present time I am 15 months clean; with dermatologist, radiation oncologist, and M.D. Doctor appointments set every three months; hopefully all not on the same day. I do not want any more surprises; although the last dermatology checkup I had the doctor asked me if there was anything I wanted checked. I mentioned an area on the back of my left arm, in the middle of the Tricep area.

He looked at it, did a biopsy, and then called me two days later. He told me it was a squamous carcinoma cell that needed to be removed.

Luckily that was an office visit that took very little time. It did cause me some stress because I don’t like needles and to hear him cutting and scraping with the scalpel was not a treat. So I went out on a run to relieve that feeling and to get my head back into my zone that happens during a “runners high”.

These types of occurrences really interrupt my running schedule, my family schedule, and my living schedule.

But because I had my dermatologist check a small white head I am still here, fighting back, and enjoying life.

Steve McCain

“Hug Life Like Your Favorite Teddy Bear”

Chemotherapy and Bloodletting

The goal of chemotherapy is to kill part of a cancer patient’s body without killing the patient. It involves lethal drugs that do serious damage, hence the side effects. The drugs work by damaging the RNA or DNA that controls cell division. If cells are unable to divide, they die. Healthy cells grow back; hopefully the cancer cells won’t.

Pharmaceuticals are risky business. Having them prescribed and monitored by a doctor is a safeguard, but it doesn’t make them safe. In her book, Another Day in the Frontal Lobe, neurosurgeon Katrina Firkin notes that,

Anything strong enough to help you is strong enough to hurt you. No treatment, at least no worthwhile treatment, comes without risk. Even natural supplements, if you take unnaturally large amounts, can have untoward effects… There are plenty of medications that work wonders without us having a clear idea as to how or why they work. To me, that means there are probably other things those drugs are doing that we may not expect. It would be unlikely for a drug to have one and only one effect on the body. That’s not how the body works. One physiological mechanism can mediate numerous different functions. One natural chemical, blocked or enhanced by a certain drug, may have dozens of different targets. Those targets are probably not all figured out yet.

It’s a Faustian bargain, but I’ve adopted Dr. Firkin’s approach, “I’ll take a medication when I need it, when the time comes, if the benefits clearly outweigh the risks. But I won’t expect to get something for nothing.”

Bloodletting

A hundred years from now chemotherapy may be looked back upon with the same aversion we have to bloodletting today as a barbarous rite of pre-enlightened medicine. For almost 2,000 years sincere physicians drained copious amounts of the vital fluid to relieve their patients of “bad blood.”

The practice was supported by the best scientific minds of the time and based on observation of the body itself, specifically menstruation. None other than the father of medicine, Hippocrates-who gave us the word “cancer”-believed menstruation purged women of bad humors. His most famous student, Galen, began physician-initiated bloodletting in the second century.

Bloodletting was once used to treat cancer, along with everything else from cholera to diabetes, herpes to leprosy, plague to pneumonia, and scurvy to smallpox. The earliest recorded cancer treatment comes from the Egyptians, who used a “fire drill” to cauterize tumors. Medical science lurches forward by trial and error.

Even great advances sometimes have unforeseen consequences. A popular theory regarding how AIDS entered the human population posits that it came from chimps whose organs and fluids were used in culturing a strand of oral polio vaccine used in the Congo, the epicenter of the pandemic.

Never mind inadvertent danger, modern chemo causes lots of collateral damage. It is a shotgun that indiscriminately kills both terrorists and hostages. But for many forms of cancer, it’s the best weapon we have right now.

Chemo is one of those things in life for which a stunt double would be absolutely great. Other experiences where a stand-in would be wonderful are:

  • childbirth
  • IRS audits
  • root canals
  • prostate exams
  • (add your least favorite activity here)