Archive for November, 2009

Too many mammograms lead to unacceptable complication rate

November 22, 2009

There is an emotional outcry against the new guidelines for mammogram screening for breast cancer that recommend that  women between 40-49 years no longer obtain routine yearly mammograms, but instead consult with their physician at least every two years as to their risk and need for the test. The press is widely and inaccurately reporting that the guidelines recommend no mammograms between age 40-49.

This is an example of emotions being used to shield the facts and harm women, in addition to wasting money. The facts are that too many mammograms (yearly after several negative mammograms) are harming women by exposing them to unnecessary surgery (biopsies) and the complications associated with surgery such as emotional distress, infection, disfiguration, death, and cost.

These are NOT death panels. A panel of persons trained to understand risk verses benefits and medical issues, as well as trained to interpret statistical data has determined that more harm occurs with too many yearly unnecessary mammograms.

They have examined the facts and statistics and come up with a rational plan as to how many mammograms are necessary and at what interval to best balance the risks versus benefits. They are more in line with European and international recommendations.

Women are willing to put up with some unnecessary emotional distress, surgery, infections, costs, and even death as long as the benefits (numbers of cancers discovered early) outway the risks (numbers of complications including deaths). However irrational emotional statements that we have to do everything possible to uncover every cancer early are nonsense. Certain groups are at higher risks and patients should discuss this with their doctors. There is not a one size fits all answer here.

If we uncover one (1) cancer early for every two (2) deaths from complications due to unncecessary mammograms then the risk v. benefit calculation for the population, not the individual, suggests we are doing too many unnecessary mammograms. This is what the experts have found. This is why the overall general recommendations have been changed. This does NOT mean that those at incresed risk should follow these recommendations. Recommendations should be individualized by a person’s physician knowing their family history and risk factors.

Either way there are going to be deaths. The experts based their recommendations on reducing the OVERALL number of deaths to the minimum. When those that make decisions based on emotion instead of fact understand this, then the population will be informed. Until then, this discussion is total nonsense.

The new guidelines DO NOT apply to women with a family history of breast cancer. They should have yearly mammograms starting earlier in life, sometimes as early as age 20-30.

The bottom line is this: Do we want to make difficult decisions based on fact and risk versus benefit so that lines are drawn in favor of benefit, or do we want to make decisions based on emotions, feeling good, and with a total disregard to costs and available resources? 

The actual guidelines published in the Annals of Internal Medicine.

Opinions in favor of frequent mammograms for everyone over age 40 .

Recommendations of DHHS and Secretary Sebelius.

Medical News Today summary of reasons for new guidelines.

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Fort Hood massacre, the facts and commentary

November 7, 2009

Copied from author’s article first published on Examiner.com

by Dr. Linda Lorincz Shelton

From Chicago area:

Although the Army has yet to confirm the casualty list at yesterday’s horrific act of violence at Ft. Hood, Texas, it is now known through family members that two Chicago area soldiers are among the dead.

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UPDATE 11-7-09. The following are now confirmed dead. The deceased include five colleagues in mental health services working with the alleged shooter:

Lt. Col. Juanita L. Warman, 55, of Havre De Grace, Md. She was assigned to the 1908th Medical Company, Independence, Mo.

Maj. Libardo Caraveo, 52, of Woodbridge, Va. He was assigned to the 467th Medical Detachment, Madison, Wis.

Capt. John P. Gaffaney, 54, of San Diego, Calif. He was assigned to the 1908th Medical Company, Independence, Mo.

Capt. Russell Seager, 41, of Racine, Wis. He was assigned to the 467th Medical Company, Madison, Wis.

Staff Sgt. Justin Decrow, 32, of Plymouth, Ind. He was assigned to the 16th Signal Company, Fort Hood, Texas.

Sgt. Amy Krueger, 29, of Kiel, Wis. She was assigned to the 467th Medical Company, Madison, Wis.

Spc. Jason Hunt, 22, of Tillman, Okla. He was assigned to the 1st Brigade, Fort Hood, Texas.

Spc. Frederick Greene, 29, of Mountain City, Tenn. He was assigned to the 16th Signal Company, Fort Hood, Texas.

Pfc. Aaron Nemelka, 19, of West Jordan, Utah. He was assigned to the 510th Engineer Company, 20th Engineer Battalion, Fort Hood, Texas.

Pfc. Michael Pearson, 22, of Bolinbrook, Ill. He was assigned to the 510th Engineer Company, 20th Engineer Battalion, Fort Hood, Texas.

Spc. Kham Xiong, 23, of St. Paul, Minn. He was assigned to the 510th Engineer Company, 20th Engineer Battalion, Fort Hood, Texas.

Pvt. Francheska Velez, 21, of Chicago, Ill. She was assigned to the 15th Combat Support Battalion, Fort Hood, Texas.

Mr. Michael Cahill of Cameron, Texas. He was a civilian employee on Fort Hood.

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PVT Francheska Velez, 21, a graduate of Kelvyn Park High School in 2006, recently returned from Afghanistan due to a pregnancy, was killed in the assault as was PFC Michael Pearson, 21, of Bolingbrook. She had enjoyed traveling the world, decided to make the military her career, and was planning on training to be a psychologist. Surgeons worked valiantly to save Pearson who was shot three times, reportedly bringing him back to life several times but tragically he died in surgery 10:00 pm Thursday night. He was expecting to be deployed to Iraq in January. An avid musician, he had hoped to make a career in music. For more extensive profiles of these two fine young soldiers see Chicago Tribune article.

The suspected shooter in the attack, Maj. Nidal Malik Hasan, remains hospitalized, on a ventilator, after being shot four times. He is an Army Psychiatrist, who was trained at the Military Medical School in Bethesda and received specialty training at Walter Reed Army Hospital. He was scheduled to be deployed and recently had been in arguments with others about the war, expressing views against the war. His family has expressed that he was feeling increasingly harassed by fellow soldiers for being a devout Muslim and had expressed interest in leaving the military. He also was increasingly distressed over his coming deployment to Afghanistan. At first believed to have died, it is now known he survived and is in serious condition under military guard.

The massacre occurred in a crowded processing center at Fort Hood where soldiers are processed to go to or return from Afghanistan and Iraq. Soldiers are not armed during processing and mainly fill out paperwork and obtain medical and dental treatment and examination. Only military police and armed civilian police, as first responders were able to respond with fire power to bring down the alleged assailant. The alleged shooter is said to have used an automatic pistol with a clip containing at least 20 bullets, and with numerous spent clips found on the floor. The alleged assailant was able to fire off over a hundred rounds, with careful aim, reportedly from two handguns in a matter of less than a couple of minutes, before first responders arrived. All killed and wounded were reported to be adults, mainly military personnel and civilian police. Most had multiple deadly wounds due to the methodical and deadly aim of the shooter.

Ft. Hood Police Department Officer Kimberly Munley and her partner responded within three minutes. Ofc. Munley was first on the scene and as she rounded a corner came face to face with the shooter and dropped to the ground as he took aim and shot her three times while she fired at him. She quickly and valiantly placed herself in harms way, shooting alleged assailant Maj. Hasan in the chest, dropping him to the floor as other responders converged on the scene. Her quick, focused, and decisive action under crowded,confusing, and volatile circumstances may have saved many others, and is cited as the act that brought down the alleged shooter. Lt. Gen. Bob Cone, Fort Hood’s commanding general is quoted as describing Ofc. Munley’s actions as, “really a pretty amazing and aggressive performance by this police officer.” She is reported in stable condition after treatment of her wounds to both thighs and a wrist.

Reports are coming out that the scene was a crowded processing center, where many were wounded by ricocheting bullets, it was hard to identify exactly what was going on and the aftermath was a chaotic and horrific scene of pools of blood, spent shells, and frantic attempts to save the 58 wounded (43) and dying (13) victims with soldiers ripping up their clothing to make tourniquets. Conflicting reports put the number of wounded at 31 to 43. Seven remain in intensive care.

Military officials say they are still piecing together what may have pushed alleged assailant Hasan, an Army psychiatrist trained to help soldiers in distress, to turn on his comrades. There are also reports that some of the victims might have died in friendly fire during the fire fight under crowded conditions. Search warrants have been issued for Hasan’s computer and apartment.

Please remember Major/Doctor. Hasan is the alleged assailant and has not yet been convicted. Army sources now state that they believe there was only one shooter.

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Personal commentary:  I am a physician who has practiced psychiatry.  I also have many relatives and friends who are in or who have served patriotically in the military. This incident deeply saddens me. Trying to  put aside my feelings, I will try to answer many people’s questions as to how something like this may happen. Do NOT jump to ANY conclusions until the facts are all in. 

Doctor/Major Hasan, the alleged shooter, apparently had no history of violence or extremist views. He was reportedly very dedicated to serving his country even wearing his uniform to prayers at the Mosque. He reportedly was a talented and devoted psychiatrist who had helped many patients. There was some suggestion that recently he was turning against the war and began to have some strange views.

Therefore, it is possible he suffered some kind of recent mental deterioration. The doctors are going to have to consider the possibility of medical problems like hyperthyroidism that can cause a sudden change into a paranoid, violent and delusional state. This is treatable. There are other medical reasons people become crazy also that will have to be looked into. Then there are mental illnesses that may develop for unknown reasons. If this turns out to be the case, then it will be necessary to examine why the Army failed to screen for this. Finally there are points when people crack from pressure.

Being a devout Muslim may have brought criticism and stress while in the military to Doctor/Major Hasan as would treating for 10 or more years numerous soldiers who suffered from post-traumatic-stress and trauma from war. All of us have a breaking point and if he began to internalize their suffering and turn against the war psychologically, without obtaining his own mental health counseling, it is possible that this stress could make him crack.

The military needs to consider that pathologists, morgue workers, mental health professionals, and medical personnel on the front lines in treating soldiers may need mental health care and screening as they can also suffer from post-traumatic-stress and other types of mental deterioration if constantly exposed to the horrors of war and its consequences, mental and physical.

I can testify from my own experience that treating gunshot wounds in children in inner city hospitals, drug withdrawal in large numbers of babies, abused and battered children, as well as treating rape victims and victims of war overseas took its toll on me. Then when I was battered by corrupt police officers the stress of hearing so many details of horrific trauma came out and I suffered from post-traumatic-stress disorder. It takes counseling and constant vigilance, when one is on the front lines so to speak of being the sounding board for so many troubled souls, to avoid falling victim to the same mental health consequences that one is treating. None of us are so mentally strong that we are immune to that kind of stress. It should be talked about and not ignored or dismissed. One should not forever wear a scarlet letter for having the courage to address these possibilities in oneself before they get out of hand. Mental health treatment should be more readily available to all and not in itself be a disability.

I will pray for the victims and their families, but also for Doctor/Major Hasan and his family. Our society failed Doctor/Major Hasan if he is the alleged shooter for not recognizing his deterioration and dangerousness earlier and failed all the victims in not preventing this horrific disaster. United We Stand, Divided We Fall. We should stand together to honestly and rationally discover what caused this massacre and see that it does not happen again, from a viewpoint of careful and systematic analysis of facts and evidence, not emotions or hatred towards any ethnic or religious group.

For more information:

See the article in New York Times on No one Treating the Therapists

Evergreen Park, IL soldier dies in Afghanistan – Presidential salute

November 1, 2009

In the early morning hours of October 29, 2009, President Obama, in an unannounced tribute, along with a small group of dignitaries and family members honored Cook County’s son, Spc. Jared D. Stanker, 22, of Evergreen Park, by attending his dignified transfer event back to the United States by transport plane at Dover Air Force Base, Delaware. Spc. Stanker and all 18 returning heroes who perished this past week were each honored with a dignified silent salute by President Obama, high ranking officers and government officials. The President met with family members privately before the dignified transfer event, including Mr. and Mrs. Kevin Stanker.

Spc. Stanker is a 2006 graduate of Brother Rice High School. He enlisted shortly after graduation. This was his first deployment. He had just celebrated his 22nd birthday. He is the first military casualty from Evergreen Park in the last 20 or more years.

Defensive Department spokesman related that Spc. Jared D. Stanker, was one of seven soldiers who died Tuesday, October 27, 2009, in Arghandab Valley, Afghanistan, after enemy forces attacked their vehicle with an improvised explosive device. The troops were assigned to the 1st Battalion, 17th Infantry Regiment, 5th Stryker Brigade Combat Team, 2nd Infantry Division, Fort Lewis, Wash.

He is survived by his parents, Mr. and Mrs. Keith Stanker and an older sister. Arrangements for return of his remains to Cook County and his family, as well as burial arrangements are pending.

United We Stand. Divided We Fall, is a well known statement, but few actually stand up for freedom. Most of us just talk the talk and feel good. A very few walk the walk and put themselves in harm’s way. Spc. Stanker chose to walk the walk, as a patriot in order to protect us all from terrorists, and paid the ultimate sacrifice. One of his favorite quotes from his web site: “The only thing necessary for evil to triumph is for good men to do nothing. ” Edmund Burke 1729-1797

Please prepare to honor our son, our brother, our neighbor, our countryman, who made the ultimate sacrifice for freedom thousands of miles from home. Please unite in prayer and remembrance, in comfort for his family, and in greater determination to support our troops and support our government in its efforts to bring an end to this war, an end to the era of terrorism instead of dialogue in the world, and an end to the fear that is pervasive not just in the United States, but around the world as a result of decades of failed diplomacy. _________________________________________________________________________ The following are the writer’s personal thoughts: In memory of Spc. Stanker and his patriotic devotion to his country, because I believe he would have understood the meaning of these famous remarks, I offer the following quotes:

“There are a thousand hacking at the branches of evil to one who is striking at the root.” — Henry David Thoreau

“It is in vain, sir, to extenuate the matter. Gentlemen may cry, Peace, Peace– but there is no peace. The war is actually begun! The next gale that sweeps from the north will bring to our ears the clash of resounding arms! Our brethren are already in the field! Why stand we here idle? What is it that gentlemen wish? What would they have? Is life so dear, or peace so sweet, as to be purchased at the price of chains and slavery? Forbid it, Almighty God! I know not what course others may take; but as for me, give me liberty or give me death!” – Patrick Henry, March 23, 1775

 “God grants liberty only to those who love it, and are always ready to guard and defend it.” – Daniel Webster

If a man hasn’t discovered something he will die for, he isn’t fit to live. – Martin Luther King

I only regret that I have but one life to lose for my country. – Nathan Hale, age 21, last words before being hung by the British September 22, 1776


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