DAVE'S BREWERY OF THE MONTH-JULY

This month,I am featuring URTHEL's line of artisinal ales. All Urthel products will be $1 off for the month of July.

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URTHEL HOP-IT

One of very few Belgian IPA styles,

this ranks among the best. Strong hop

scent, with lemongrass and floral notes.Envelopes the entire palate in an interplay of bitterness and sweetness.

REG.$11.99+tx NOW $10.99+tx

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URTHEL TRIPLE

Vanilla, bubblegum, orchard fruits and spice on the nose. Brown sugar sweetness and biscuity malt mid-palate, with a peppery, spicy finish. Warming finish from the 9%ABV.

REG.$9.99+tx NOW $8.99+tx

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URTHEL VLAEMSE BOCK

This reddish-brown Belgian strong dark ale is somewhere in between a dopplebock and a bruin. Aromas of yeast and roasted malt. Hints of chocolate and coffee. Moderate carbonation. Very smooth and well balanced.

REG. $10.99+tx NOW $9.99+tx

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URTHEL SAMERANTH QUADRIUM ALE

Surprisingly light for a quaddruppel. Spicy, funky, and fruity combinations of citrus and cherries. Soft, chewy carbonation, and a lingering yeasty finish.

REG. $11.99+tx NOW $10.99+tx

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Cheers!

-Dave

Holiday road

We are about to load up the Family Truckster ...



... and head out on a road trip to northern Minnesota. This will be the first time in years that I've set foot in the state of Minnesota without getting poked with needles by medical professionals. It will be a welcome change. Our cabin is supposed to have high-speed Internet (Jay was in charge of picking the cabin, and he said Internet access was a requirement), so I might be able to post vacation updates on location.

In other news, I got my report from Dr. H at the Mayo Clinic. The summary of my last visit starts out like this: "Mrs. (my last name) is doing really quite well." If you have to get a report about your cancer, the words "doing really quite well" from a Mayo Clinic myeloma expert are good things to see. Thanks, Dr. H!

I suppose I should be doing something practical, such as doing laundry or packing up the Truckster. Instead I am blogging. As usual.

We Buy a House

We closed yesterday. We sat in the title company office and signed documents with their blue pens, because blue shows up better. Our lawyer, whom we had just met, advised us. She said we had to sign something saying that we would resign something. We went to the house and pulled up weeds and pulled down the ivy from the sides. We talked to our next-door neighbors, whose house is for sale and which we'd looked at twice. We met another neighbor who said that there was a block party the summer. L met a neighbor who lived about three houses down and does gardening. We found how terribly thick and unmoving the branches are that hold up ivy and weeds. I dug and dug to get at one tap root. For dinner we took the bottle of champagne our realtor C gave us and went to Tango Sur, a wildly successful restaurant around the corner from our new place, "on the Southport corridor"--a designation that sprang from the head of some realtor. L's lower back has been spasming so everything's been difficult for him. He can't sit very long and when he gets up to walk around he's still not entirely comfortable.

This morning I slept as long as I could despite disturbing dreams of getting to an appointment late and having my high school friends take me in a helicopter. I met with a client and then went to the new place, where L was meeting with our contractor J and his helper B. It still is so strange to think you can move walls and build in cabinets and add floor. We're opening up the wall between the living and dining rooms. Right now they're separated by a big doorway, and you can theoretically pull out dark pocket doors to close off the rooms from each other. We're going to take out the pocket doors. J said that he has a friend who used a door like that as a head board. I like that idea. I could use the other one as a desk but I don't know if I want one that has a pattern on it and isn't quite flat. I don't want to ravage the house. I want to respect it.

We have a head board already on the captain's bed that we were planning to sleep on. We could take off the headboard, which contains shelve inside it, but we'd lose the space. Suffer for beauty, I thought of saying, a quote of my mothers.

A friend called today from Oregon. I hadn't heard from her in years. She'd just given my name to someone at a convention and when she Googled me to get my number she saw this blog. She told me she'd had a mastectomy about 20 years before. She didn't do anything to restore the breast until she realized she was wearing bigger and bigger clothes. She decided to buy a prosthesis.

We need to decide on color for the walls. I want to visit a friend's house to see what she's done with yellow. She's out of town but we have her keys. I'm afraid of color and always admire friends who use it. But I don't want the blue that's in the new house in the kitchen and two upstairs bedrooms. Make things look too small.

How utterly bourgeois and also to be reading a book called The Emotional House. I hate the Ikea ads that say that home is the most important building. It's not. It's the polis. We are a community who must band together. And yet, home is where we get the energy to go forth each day.

I am part of the Constellation!

Very cool thing, my daughter bought a star in my honor on the Stand Up For Cancer (SU2C) Constellation! I really wanted to be part of the constellation, but thought it would be wrong to buy a star for myself since stars are "in honor of" someone. I did start a Facebook page so I can be part of SU2C Stand, though.

I've donated money to Stand up for Cancer. I hope to donate more. I would love to honor every appendix cancer patient I've communicated with by buying him or her a star, but since I am a health care professional I am afraid of violating HIPPA regulations by identifying appendix cancer patients publicly in the constellation with out their permission. But I still hope to donate in honor of the people I know fighting this disease.

I am so excited about the potential Stand Up To Cancer has to make a difference. All of the money raised will go to fund research. Research has the potential to make cancer a disease like polio or small pox, the plague of a past generation. I so want people to only remember the past devastation of cancer, not to experience it in their own lives or the lives of those they love.

I want so much to see the end of cancer. This video from SU2C states much of what I've learned and have come to believe.....we can be a part of the generation that sees an end to cancer. Just like the 1960s had their grass roots movements, we can be the part of our own generation's grass roots movement. We can all be a part of the beginning of the end of cancer. We can make ourselves count in a way that matters and that will always be remembered. We can be a part of something really great.

I want to see a huge movement rally around Stand Up To Cancer. I want us all to know that we've made a difference that will outlive us for decades, for generations. I truly believe the stars ARE aligned. I truly believe cancer CAN be conquered. I believe that each one of us are part of the key. I believe we do stand on the precipice of greatness in conquering cancer. I do believe there IS a "perfect storm' brewing. I have met some of the people behind this movement. I know they are passionate about seeing cancer defeated, they want that to be their life's legacy.

More information about SU2C can be found on this link: Learn About SU2C

Please watch the video and believe with me. Please join the movement in any way you can. I believe with all my heart that we can make a difference. We can be part of the end of cancer.

Previous Abdominal Surgeries Increase Risk of Abdominal Complications following DIEP Flap Breast Reconstruction

A study published in the May edition of "Plastic and Reconstructive Surgery" has shown that patients who have had previous abdominal surgery are at an increased risk of suffering abdominal complications following DIEP flap breast reconstruction. Here is the abstract:

DIEP Flaps in Women with Abdominal Scars: Are Complication Rates Affected?

Plastic & Reconstructive Surgery. 121(5):1527-1531, May 2008.

Parrett, Brian M. M.D.; Caterson, Stephanie A. M.D.; Tobias, Adam M. M.D.; Lee, Bernard T. M.D.

Background: Previous abdominal surgery may affect perforator anatomy and complication rates in patients undergoing deep inferior epigastric perforator (DIEP) flap breast reconstruction. The purpose of this study was to determine whether abdominal scars in DIEP breast reconstruction have an effect on flap and donor-site complications.

Methods: Over a 3-year period, 168 DIEP flap patients were retrospectively divided into a control group with no previous abdominal operations and a scar group with previous abdominal procedures. Flap and abdominal wound complications were compared between the two groups.

Results: Ninety patients (54 percent) underwent 114 flaps in the control group and 78 patients (46 percent) underwent 104 flaps in the scar group. The most common previous incisions were Pfannenstiel, laparoscopic, and midline. There was no significant difference between the groups in age, body mass index (mean 27 kg/m2 in both groups), smoking history, or radiation status. There were no significant differences between the control and scar groups in DIEP flap loss (1.8 percent versus 2.9 percent), partial flap loss (1.8 percent versus 1.0 percent), or fat necrosis (15 percent versus 14 percent, respectively). However, the scar group had a significantly higher rate of abdominal donor-site complications (24 percent) compared with the control group (6.7 percent; p = 0.003). The most common complications were abdominal wound breakdown (12 percent), seroma requiring operative drainage (6.4 percent), and abdominal laxity or bulge (5.1 percent).

Conclusions: With minor technical modifications, DIEP flaps can be performed successfully without increased flap complications in patients with preexisting abdominal incisions. Despite these design modifications, patients should be informed of an increased risk for donor-site complications.

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Here's my take...

While we have not seen such a high rate of complications in our practice, I agree with the conclusions of this study completely. There is no question that the DIEP flap procedure is associated with far fewer abdominal complications than the TRAM flap. However, that does not mean that DIEP surgery is free of risk.

The complexity of any surgery and the potential complications increase when operating on parts of the body that have undergone previous surgeries. The abdomen is no different to any other part of the body. Patients undergoing DIEP flap breast reconstruction must be aware that they are facing increased risk in terms of abdominal complications compared to patients that have never had abdominal surgery. This study has underlined this. As a general rule of thumb, the more scars on your belly the higher your risk probably is.

I personally would have liked this study to have included a second group of patients that had undergone TRAM flaps (instead of DIEP flaps) for comparison of complication rates between the 2 groups. If the complication rate is 24% for a DIEP patient, what is it for a TRAM patient that has had multiple previous surgeries? Results of previous studies suggest that it would be even higher in TRAM patients.

It is also important to remember however that just because a patient has had previous abdominal surgery does not mean they are not a DIEP candidate. While the patient must be informed of the increased risks, previous abdominal surgery is not a reason to deprive her of what is very likely still her best reconstructive option.

Dr C

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Dr Chrysopoulo is board certified in Plastic and Reconstructive Surgery and specializes in breast reconstruction surgery after mastectomy for breast cancer. He and his partners perform hundreds of microsurgical breast reconstructions with perforator flaps each year including the DIEP flap procedure. PRMA Plastic Surgery, San Antonio, Texas. Toll Free: (800) 692-5565. Keep up to date with the latest breast reconstruction news by following Dr Chrysopoulo's Breast Reconstruction Blog.

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Tag Team

My wife is home, normalcy will soon follow, we will wear clean clothes no more hole is our socks, our hair will be done, I will shave, oh yea and we will have cooked food (no more raw meat survival of the fittest) this was a ha ha joke please don't report any of the above fiction to Texas CPS as they have meet their mistake quote for the year.

I made it staying alive, no hospital, knock on wood, my throat hurts but the girls and I survived her long business trip.

More Vita Interruptus

One year after a cord blood stem cell transplant, my friend Ann just discovered that she has relapsed with ALL (acute lymphoblasic leukemia). She and her husband Chris were scheduled to close escrow on a new house yesterday. Instead they're at MD Anderson (MD INNderson?) where they're waiting to find out the treatment plan.

Two years after a donor stem cell transplant, my friend Nancy developed pneumonia and is waiting to find out today if she'll be hospitalized at Hotel Hope.

I keep telling myself that these are just examples of life interrupted, not life ended. Just the same, I obsessively check the blogs of Ann, Nancy and Brad for updates. I hope you'll join me with your good thoughts and prayers.

At the same time, I'm dealing with the continued deterioration of my dear friend Bob in SF. His condition is not improving with treatment. He just turned 81, and I wonder if, at this stage, we are talking about a permanent interruption of life.