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What the Dermatologist Did Right

Kudos to my newest doctor, a der­ma­tol­ogist whom I met yes­terday for eval­u­ation of a small, benign-​​​​appearing mole I recently noted on my right leg. What she did right:

1. She saw me promptly, at the time of my scheduled appointment.

(Thank you, you seem to value my time, as I do yours.)

2. In her initial clipboard-​​​​bound paperwork, along with the usual forms about my history (always with insuf­fi­cient space for my case and, unfor­tu­nately, still non-​​​​electronic) she asked not only for emer­gency contact infor­mation, a standard, but for the name and rela­tionship of someone besides me – such as a family member or close friend — with whom she might discuss my con­dition, if I permitted.

(Thank you for asking this and really, I’d prefer that you not speak with my parents about my results. I’ll be turning 50 next month.)

3. In the same short set of

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The Traveler’s Dilemna

Yes­terday my husband and I took a short tour of Jericho, one of the world’s most ancient cities. I’d been there once before, sometime around 1972. My firmest memory of the place, stronger than my rec­ol­lection of the ruins, is of drinking warm soda straight from the bottle with a plastic straw. It was hot then, like yes­terday. While we poked around the rem­nants of a curved, tall stone tower said to stem from the Natufian period (~ 9,000 BCE), our driver took a seat in a nearby cafe. He ordered a pitcher of lemonade. “It’s the best here,” he said as we reached the shaded table. He poured some of the slightly-​​sweetened, fresh juice into each of our glasses. This was a familiar dilemna…

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Suggestions to Reduce Errors in Breast Cancer Pathology

A prominent article in yesterday’s New York Times con­siders some trou­bling problems regarding inac­curacy in breast cancer diag­nosis and pathology. The main point is that some women get needless, dis­fig­uring and toxic treat­ments after being told they have breast cancer when, it turns out, their con­dition was benign.

My main take on this sit­u­ation – which doesn’t just apply to breast cancer – is that, whenever pos­sible, patients should get a second opinion on biopsy results before under­going major treatment. The costs of a second pathology review is some­times covered by insurance, but some­times it’s not; either way, that’s money well-​​​​spent, espe­cially if the opinion is ren­dered by an appropriately-​​​​credentialed, expert pathol­ogist who works in a state-​​​​of-​​​​the-​​​​art facility.

From the doctor’s per­spective there’s respon­si­bility, too. Sur­geons shouldn’t lop off a woman’s breast without knowing that the pathology is real. Well-​​​​trained oncol­o­gists know they’re sup­posed to review the pathology, to make

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Staying Healthy in Hot Summer Travel

Hiking, or even just walking, in the hot summer heat to see ancient ruins, national mon­u­ments or spec­tacular vistas can sap the energy of healthy people. For someone who’s got a health issue – like chronic lung disease, reduced heart function or anemia – or anyone who’s pregnant, elderly or just frail, summer travel can knock you out in the wrong sort of way.…Don’t plan

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Avoiding Blood Clots During Long-​​Distance Travel

A few years ago my family took a trip to China. Even before we arrived, I learned some­thing about an unfa­miliar health care culture. What I observed en route was that many of the older pas­sengers on that long flight to Beijing were getting up from their seats and stretching. Not just once, but reg­u­larly and sys­tem­at­i­cally – they were doing slow motion, iso­metric cal­is­thenics on the airplane.

I took notice of their behavior first because it seemed a simple and inex­pensive, albeit strange example of pre­ventive med­icine. Second, as a hema­tol­ogist who cared for patients with blood clots upon trav­eling, I pon­dered the risks and ben­efits of their on-​​​​board exer­cises. Third, as a patient who’s had a blood clot, or deep venous throm­bosis (DVT), I thought maybe I should follow their example.

Throm­bophlebitis — the old term for DVT – happens when a vein (as opposed to an artery)

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ML Travel Advisory

Exotic cuisines, sun-​​lit visits to ancient ruins and long air­plane flights — these all provide health chal­lenges, espe­cially to the elderly and others with chronic ill­nesses. So I thought I’d take these weeks as an oppor­tunity to review some of the ways I’ve learned to take care of myself while exploring places far from home. Because I’m a hematologist…

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On Sergey’s Search (for a Cure for Parkinson’s Disease)

…This goes well beyond a new approach to finding a cure for Parkinson’s disease. This story, largely based in genomics and com­pu­ta­tional advances, reflects the power of the human mind, how the gifted son of two math­e­mati­cians who fell into a par­ticular medical sit­u­ation, can use his brains, intel­lectual and financial resources, and cre­ativity, to at least try to make a difference.

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About the Concert

Madison Square Garden, June 30, 2010

I had the pleasure of seeing and hearing Carole King and James Taylor in concert on Wednesday night at Madison Square Garden. Some high­lights — Carole King picking up the guitar for a dueling ren­dition of Smack Water Jack, a sur­prise and rol­licking re-​​take of Little Eva’s Loco­motion, and her dancing like a happy teenager to I Feel the Earth Move. Taylor played well and gra­ciously, with wit to boot. They made me feel like life gets better with age. Who knows? This

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Some Notes after Grand Rounds, and Questions for Medical Blogs and the Internet

…the Internet as a source of medical infor­mation is a complex, evolving, pow­erful and largely unreg­u­lated instrument. Some key ques­tions for the future: 1. How do we define a blog and dis­tin­guish that from, say, a website with ads and text, or from a news­paper or mul­ti­media con­glom­erate with an engaging on-​​line section? 2. How do we dis­tin­guish a medical blog…

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