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Skeptical Scalpel said...

But not in that order.

If you don't like what I have to say, don't read it.

Anonymous said...

I like that you have a spammers link. Is it that much of a problem?

Skeptical Scalpel said...

Not really a problem. They apparently can't read so they ignore the notice. I block all of their comments but they spam away.

The best part is the bogus online medical assistant school spammers who try to put spam comments on my post that describes the worst online scam school of all. Even the school I wrote about still does it.

Anonymous said...

Of course they can't read... they're bots! They're not really wasting their time; they're just mindless computer slaves doing their master's bidding.

Skeptical Scalpel said...

So I've been told. I wish they would stop thoough. They are a real nuisance.

The spam from the medical assistant school has decreased significantly. Who knows? Maybe someone did read that post.

Unknown said...

You realize they aren't going to hear you by making posts like this right? I'm a web designer, these spammers are not actually viewing your website, they are just using a program that finds blogspot blogs and comments on them. You use blogspot, blogspot can automatically be spammed.

Skeptical Scalpel said...

Steven, thanks for the comment. Others have told me this too. So how do you explain this spam comment that I received just before yours?

"Lawyers are hardworking people. That's for sure. Take this lawyer from Ohio who billed long hours for court-appointed cases. For instance, he billed for 21, 21.5, 23 and 29 hours of work for 4 different days. criminal defense attorney orange county"

Are you telling me that a bot extracted a pertinent quote from my post so that an Orange County lawyer's link could be posted? i find that hard to believe.

Anonymous said...

Regarding the Orange County link, spambots look for keywords (in this case "lawyer", "court", "attorney", "criminal") to decide who to spam.

Skeptical Scalpel said...

I'm not sure you got my last response. The spam comment quoted specific lines from my post. I don't think a bot could do that. Anyway, I don't see what harm this announcement is doing.

Anonymous said...

A bot can definitely do that--in fact, it's a common tactic. It has zero SEO benefits and hasn't had for many years, specifically because Google is on to these operations. But there are shady operations selling their shady services to equally sketchy customers. You can be happy that they are wasting a lot of their ill-gotten money getting scammed themselves!

Skeptical Scalpel said...

Christina, thanks for the information. I will just keep deleting their attempts.

Anonymous said...

In reference to your post on '' about society not clearly understanding 'brain death' - In my practice as an ICU physician, I also find difficulty explaining this concept to patients' families. Several things have helped:
1) A neurology consultant able to explain this concept and demonstrate neurologic findings at the bedside with the family members in attendance.
2) Having the family at the bedside during an apnea test (after showing them the MAR (medication administration record), awaiting the post-apnea test arterial blood gas results, and discussing the implications of test results (with their own observations of no respiratory efforts.
3) At times, a brain nuclear scan which demonstrates zero cortical blood flow. An addendum to "A picture is worth a thousand words" is:
"The BEST picture is worth over ten thousand words."

Skeptical Scalpel said...

Anon, Thanks.

These are very good suggestions. I wish you had posted them on the comments section of the post itself so others could read them.

Anonymous said...

The Crile script was used at The Hertzler Clinic for many years. As late as 1968, senior Kansas University medical students were sent out into the state on a one-month externship program. I was sent to Halstead, home of the Hertzler Clinic and Hospital (1902). Like the Mayo experience, Dr. Arthur Emanuel Hertzler (1870-1946) came to Halstead to assist after the town had been hit by a tornado and styed there until his death..
One of the older nurses pointed out where the beautiful woodwork in the former hospital "thyroid wing" still had the dents and gouges left when a thyroid storm occurred.
It was an excellent, although somewhat usual externship - during my month, the town went from a telephone operator assisted system to "real dial phones." Before the change, you would just pick up any phone and let the operator know where you were. If you had left when she called back, she would next call to the place you usually went! Worked great!
My preceptor was the clinic cardiologist. We would meet patients with soft heart murmurs at the clinic after the 8:05pm train. Even I could discern the difference between a grade i and grade ii “dove-coo” in aortic regurgitation..
If you can locate a copy of Dr. Hertzler’s autiobiography ‘The Horse and Buggy Doctor’ I think you will enjoy his perspective on The Art, the medicine of the late 1890’s and early 20th Century, and, particularly, his opinion of two types of medical lecturers (page 53).
Roy D. Clark, Jr, MD

Skeptical Scalpel said...

Roy, thanks for commenting. I will see if I can find that book.

Emily said...

I'm having trouble getting e-mail updates to your blog. For some reason I stopped getting consistent e-mail notifications for several weeks. I even tried subscribing on my other e-mail accounts (2 yahoo and hotmail) and only once in a great while do I get a notice. (no, they're not in spam folder) I thought to try unsubscribing, then re subscribing to see if that might work, but can't find any way to unsubscribe.

Am I the only one complaining or have I been blacklisted? ;-)

Skeptical Scalpel said...

Emily, I'm sorry about this. I have no idea what is going on. I will say the Blogger, the platform I use, has been acting strangely for a few months. The search function stopped working. I had to add a third-party search widget. Sometimes when I try to comment, what I have written mysteriously disappears. The is no tech support, no number to call. The service is free. You get what you pay for.

Emily said...

I'm a bit relieved that the problem might not be on my end. I will log in daily to see if there's anything new. I think what was frustrating to discover a column of interest to me and the discussion had ended days ago discouraging me from commenting. Oh, well.

Skeptical Scalpel said...

Emily, I see all comments. There's no time limit. You can comment whenever you like.

Anonymous said...

I am an board certified surgeon specialized in minimally invasive surgery.
( 20 years out) I appreciate your perspective. In my practice , I dont use SILS as a routine only for younger females for its potential cosmetic benefits. I concede it is no better and in reality micro instrument cosmesis is similar in my experience.

Skeptical Scalpel said...

Anon, thanks. I agree with you.

Anonymous said...

Sorry I posted a few minutes ago.
Forgot to say but I have also lost approx 1 stone in weight but am eating normally.
Have always been 11st now 10st but not loosing anymore.
Think ive covered all symptoms I have and still have.
Thanks for reading.

Jenny B said...

Reading over your page - very impressed. Wanted to thank you for being a brave voice. Your work is appreciated. - a fellow Doc

Skeptical Scalpel said...

Jenny, thanks. I hope you will keep reading.

Unknown said...

Outliers DO NOT MEAN BAD, just not average.
However, does normal mean good or just average, as defined by the disease industry, to include the central 4 Standard Deviations of whatever variable.
But what does the central 95.8% of any given variable have to do with excellence, health or anything else?
Answer: Absolutely NOTHING!

How about reading Malcolm Gladwell's book: Outliers
thinking about excellence,
as opposed to mediocrity, and the medium of exchange called money (increasingly worthless thanks to our politicians, government bureaucracy, public greed/stupidity)

Unknown said...

Cholesterol has nothing to do with Cardiovascular Disease, as I have publicly written about on the web for many years, e.g. some on wikipedia, some on healthtap.
As you stated, it is part of every single animal cell membrane, thus made by every single animal cell, a complex 37-step biochemical manufacture pathway with multiple modulators.

What is the function of cholesterol?
Answer: Added to the phospholipids of animal cell membranes, the membrane is both far more flexible and durable, thus animal cells do not need a cell wall (like plants and bacteria - which do not make cholesterol; only using phospholipids for their membranes) and thus animal cells are not trapped with cell walls:
a. animal cells can change shape, animals can move,
b. RBCs can fold up to fit 7μm diameter cells through 5ìm capillary openings and despite all this flexing, 2-3 or more cycles every minute, still live about 3 months.
3. etc.
Thus cholesterol is about motion, flexibility, a big advantage of animal engineering.
It has nothing to do with cardiovascular disease.

Then why the decades of promotion of non-sense that cholesterol and CVDs are related and by whom?
The in the early 1970s, chose cholesterol as a surrogate marker for LDL particles.
Why? Four reasons:
1. Money (lipoprotein fractionation at the time was about $5K/sample; though now <$80/sample including bulk rate FedEx overnight shipping)
2. Public health viewpoint: just decrease the "risk" for those at highest risk, not CVDs in general
3. Cholesterol measurements, if fasting >14 hours (IDL, VLDL & ULDL particles presumed no longer present) and total cholesterol was >350 mg/dL was a reasonable surrogate marker for LDL particle concentrations.
4. Arrogance: Physicians and the public were too uneducated (and stupid) to deal with reality/science.

Later this was slightly refined to include Estimated LDL-C (a guess of how many cholesterol molecules are within all LDL particles) = Total cholesterol - HDL-C - 1/5 triglycerides.
However, is LDL-C a good surrogate for LDL particles?
Answer: No, highly unreliable, thus lots of clinical misleads, as I have seen for 1.5 decades in clinical practice since NMR lipoprotein methods brought the prices way down and accuracy way up.

Example: What, from multiple surveys, is the typical total cholesterol for US citizens just prior to having an obvious ST-elevation MI?
Answer: ~170 mg/dL.
So what good is having a total cholesterol value of <200 mg/dL?
Answer: Not much.

What are LDL particles?
They are complex protein particles, 90-100 proteins/particle, proteins made & excreted into the extracellular water by both liver and intestinal cells, which self assemble into water-soluble particles, charged amino acids turned to the outside, hydrophobic amino acids turned inside.
In general, lipoproteins (ULDL, VLDL, IDL, LDL and HDL) carry all fat molecules in the water outside cells around the body.

I have attached 2 files which I routinely send to clients to help them get past the usual nonsense long promoted by the government, including why stress tests do not work.

Do I do much interventional cardiology any more?
Answer: Rarely. I instead work to help clients understand reality, avoid symptomatic disease as much as possible & I rarely have clients who end up in disease buildings (aka hospitals).

Does this activity pay well?
Answer: Of course not, "insurance" and the public mostly pay some only for treating the symptoms of advanced disease and/or their fears.

Skeptical Scalpel said...

Milton, some outliers are bad. Elon Musk may be an exception.

I agree with much of what you say about cholesterol. Thanks.

Anonymous said...

Dear Dr Scalpel:

Thank you for all these blogs. I had a question for the older IMG. I am a recent foreign medical graduate, will be obtaining my degree by the end of this year, age 44y, multiple publications (9), conferences (14), and research experience. Currently studying for USMLEs and planning to have up to step III written by March. I have started applying for 2015 for prelim surgery positions. I am hopeful to get a prelim for march. What do you think my chances are for prelim and for categorical general surgery?

Thank you.

Skeptical Scalpel said...

Your chances of getting a prelim position are probably pretty good since there are usually about 400 open positions after the match. For categorical, your first hurdle is which school did you attend? Some foreign schools are more highly regarded than others. The publications, if they are clinical and in journals that people have heard of, may help a little. I'm afraid your age is a big negative. No one would admit it, but to take a categorical resident who will be 50 when he finishes his 5 years of training is not appealing to many program directors.

It costs you nothing but time to apply, so you might as well go for it, but have a back-up plan in mind.

Morten Tolboll said...
This comment has been removed by the author.
Skeptical Scalpel said...

Morten, thank you for commenting. I agree that anonymous comments can be annoying. However, I think it would be difficult for me, an anonymous blogger, to deny anonymous comments.

Morten Tolboll said...
This comment has been removed by the author.
Anonymous said...

Published on Jul 6, 2014
An underreported Robotic instrument malfunction.
It is difficult to recognize and it might add to the risk of Insulation Failure.

Here is another video showing the the Insulation failure. Notice they even have to remove it... This is where the electricity arcs from.

Well after the recall and redesign. do you need more ? do you need too see more of a smoking gun?

Subject: Re: Video documented insulation failure of Robotic monopolar hot shear instrument dated Jul 5, 2014

Published on Jul 5, 2014
Uterine Perforation of Colpotomizer is shown. It is an underestimated & underreported complication of Laparoscopic and Robotic Gynecologic Surgery. Question is : DOES THIS COMPLICATION AFFECT STAGING OF ENDOMETRIAL CANCER ? AND DOES IT AFFECT THE MANAGEMENT/PROGNOSIS. Insulation Failure is showed at the end of the Video clip.

This next video is well after the recall and well after the sleeve fix and it is still burning patents. Why ?

Sent: Sat, Jan 31, 2015 9:32 pm
Subject: Video documented insulation failure of Robotic monopolar hot shear instrument

Video documented insulation failure of Robotic monopolar hot shear instrument, during Robotic assisted hysterectomy procedure. Insulation failure seen as sparks, firing against the posterior wall serosa of the uterine corpus. This is related to malfunction of the monopolar instrument (hot shear) sleeve. Carful handling of the instrument (and it's shortcomings) is a must , to avoid injury to surrounding structures in the operative field (such as bowel). Frequent change, as needed, of the hot shear monoplar instrument is need to avoid such failure.

Anonymous said...

It's called insulation failure of Robotic monopolar hot shear instrument, during Robotic assisted hysterectomy procedure. And according to the FDA Mauda report it has happened over 4000 times.

When you see the videos of your robot failing and you read the reports from the FDA about your robot failing, and when you read reputable news reports about your robot failing. You then read outside independent medical reviews about your robot failing and then you read about your robots recalls... Then you see over 9000 medical adverse events reported to the maude report ( no way all those doctors are incompetent, there is no way all those doctors are all making the same mistakes ). It's easy to come to a conclusion that your robot has a very dangerous defect!

You should not be surprised to hear, "If is looks like a duck and sounds like it's a duck. It's probably a duck".

You should be aware of: res ipsa loquitur

Latin for "the thing speaks for itself," a doctrine of law that one is presumed to be negligent even though there is no specific evidence of an act of negligence, and without negligence the accident would not have happened.

Skeptical Scalpel said...

Thanks for the comments and the interesting links. This may be worthy of a full blog post. I will think it over.

Unknown said...

I went to the hospital in the ER department is February the past with stomach pain just paying the bill kind of scans and did a CT scan with contrast and came back saying that there was a little long line near either inside or outside my pendix and that the contrast only sold my pendix half way they work they admit me and they're going to do surgery to remove it I was there for about 5 be on the 4th day on the weekend there was different surgeon doctors and they said everything looks fine a global work is coming back better we don't think we need to surgery and they sent me home I just left for a second opinion just now for another started office and he wants me to get another CT scan with contrast I'm not sure what's going on I'm still having the symptoms I don't have fever but I have everything else with a pain in stomach pain in your right side any advice it could be I don't understand what it means when they do a CT scan and it still. Halfway your appendix with I guess the contrast with a mean I'm type of wine near it and might be bacterial infection something like that all they did was not feed me when I was at the hospital admit it and just give me fluids and pain medication for the pain and they're going to schedule me you know after the weekend to do the surgery and then other surgeons came in and change their mind send me home now I've been dealing with this and other issues that I have health wise what is his only need any advice would be appreciated thank you

Skeptical Scalpel said...

As you will note from the disclaimer above, it is impossible to give you medical advice over the Internet nor should you need any advice you get over the Internet.

It's not exactly clear to me what is going on. It sounds like you have had a problem for five or six weeks. If it had been appendicitis, you would probably be sicker by now. Information that would be helpful would be things like do you have a fever, are you eating and moving bowels, does the pain keep you up at night, how old are you, is the pain constant or do you have periods of time when there is no pain, does it hurt when you move or cough.

You didn't say what the second opinion doctor thought it was.

I'm sorry I cannot be of more help..

Anonymous said...

Just came across your entertaining and honest blog page.Very interesting and timely reading.Hope to be able to add some worthwhile comments....Gabe MD,retired urologist and musician

Skeptical Scalpel said...

Gabe, thank you. Please comment whenever you want to.

Todd Gabrielson said...

Glad I came upon this website. First, I have to say I will always admire the men and woman who pursue the medical professions, including surgery. It is much needed skill. Secondly, in June 2007 my daughter had successful orthopedic surgery for her mild spastic cerebral palsy condition. She had it done at the world known Gillett children's hospital in St. Paul, Mn. She died the first night home upon discharged. As her parents we did the very best for her, always reading the discharge instructions and even having a medically trained professional stay with us for what was to be a month for her recovery. Her cause of death was from Narcotic toxicity when the small amount of pain medicine that was prescribed failed to metabolize in her blood stream leading to severe respiratory suppression which caused the cessation of her breathing. Over the course of the next several years I, as her dad, ran the full range of emotions, second guessing all of my previous decisions and being angry at the medical system. At the time of her surgery the provision of narcotics was considered the standard of care used by the AMA. Today, the AMA is revisiting that standard and looking for safer alternatives of pain management such as Europe has done years ago. Several years after her death, my wife and I sat down with Maria's surgeon where we had a heart rendering conversation, filled with tears, lots of Kleen-ex's and at the end we exchanged hugs. We knew at that point that he was human and most vulnerable to depression and our ability to forgive this man was the beginning to his healing from this tragic death. You see, it wasn't his intent for Maria to die and it was his intent to see her live, to thrive, and expand her abilities beyond what her disability presented her when she entered the world. Today, I manage my own blogger account to help grieving families who have lost children. and I manage the website I created to give support to grieving families I am also having my manuscript professionally edited and published which I hope will inspire others that it is possible to heal from loss.

Skeptical Scalpel said...

Thank you very much for sharing your story. I cannot imagine what you went through or what you are still feeling. Let me know when the book comes out, and I'll give you a mention on Twitter.

Anonymous said...

Hi scalpel, I am a foreign national graduate, my recent step 1 score is 204, can I get General Surgery or vascular surgery ?
Will Improving my step 2 score would help ?

Skeptical Scalpel said...

Sorry for the delayed response. I was out of the country. I have blogged about that question. If you read it, you will see how I feel about it. Here is the link:

Anonymous said...

I got sexually assaulted by a new doc around 32 years ago and since then I only get bad care, real bad care or no care at all.

Skeptical Scalpel said...

Very sorry to hear about your experience. I'm not sure why that should lead to bad care over 32 years though.

Bill S. said...

Your last two posts here have links that don't work. Are you aware of that?

Skeptical Scalpel said...

Thanks for pointing these errors on my part. I fixed links on the last post on January 11 and the first post on February 17. I hope there aren't any more.