Surgical protocol reduces opioid use for breast reconstruction patients

Breast cancer surgeries can be quite painful, so a team at Houston Methodist West Hospital has worked to develop pain management protocols that help some patients while reducing the use of narcotics.

Dr. Candy Arentz, a breast surgical oncologist, and Dr. Warren Ellsworth, a plastic surgeon, have been using an enhanced recovery after surgery (ERAS) protocol with non-narcotic medications and nerve blocks to lessen pain and the need for narcotics in reconstructive surgeries.


A DIEP flap reconstruction uses tissue and fat from the abdomen and other areas to reconstruct the breast after a lumpectomy or a mastectomy. Ellsworth said the reconstruction can be beneficial because it can look more natural than implants and can last the rest of a patient’s life. But it can be more painful because of the extra incisions. He recognizes that opioid overuse is an issue and said that is just one reason why he and Arentz are working to reduce opioid use.

“We have also, I would say, across the entire house of medicine known about this opioid overuse, opioid dependence and all these challenges that our narcotics impose on our patients, not only the basic side effects of narcotics like nausea, vomiting, constipation, but of course, the dependency,” Ellsworth said.

The ERAS protocol helps patients with pain starting the day before the surgery. “So it prepares their body for the surgery and the pain that could occur, and then we continue the pain control throughout the surgery and then of course postoperatively and have found a significant reduction in the use of narcotics because of this protocol,” Ellsworth said.

As Arentz and Ellsworth were coming up with the protocol, Ellsworth consulted with plastic surgeons at the University of Pennsylvania and Stanford University, modeling the Methodist West protocol after their programs. But according to Ellsworth, Methodist West is the first in the Houston area to make the non-narcotic protocols a priority with their patients in the area of DIEP flap reconstructions.

Ellsworth said starting ERAS required bringing in others in the hospital on board, including the head of anesthesiology so that anesthesiologists could administer nerve blocks, or long-lasting numbing injections into patients’ nerves, and the head of the ICU (intensive care unit) because the new protocols were a big change in pain management. Arentz said it required patient buy-in as well.

“It starts with our conversations in clinic and assuring the patients that they will have decreased pain afterwards than probably what they were expecting,” Arentz said, adding that the protocol is done without using IV medications, which is what most people expect when they are going to have surgery.

Arentz and Ellsworth had planned to start using ERAS in February or March, but COVID-19 shifted it back some. So they started in April. Ellsworth said that all

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MD Anderson’s hurricane checklist for breast cancer patients

Many Houston-area residents experienced at preparing for hurricane season have likely already stocked their home with basic supplies such as extra batteries, a first-aid kit, rain gear and a 7-day supply of non-perishable food and water among other essentials needed to weather a severe storm and its aftermath. But breast cancer patients should be aware to also have additional supplies on hand, especially as Texas continues to face new challenges created by the COVID-19 pandemic, making it more important than ever to plan ahead.



a person riding a wave on a surfboard in the water: In this file image, a GOES-16 GeoColor satellite image taken Saturday, Sept. 19, 2020, and provided by NOAA, shows Tropical Storm Beta, center, in the Gulf of Mexico. A hurricane watch is in effect Saturday for coastal Texas as Tropical Storm Beta gains strength. A storm surge watch and a tropical storm watch are also in effect for the area during an exceptionally busy Atlantic hurricane season. (NOAA via AP)


© Associated Press

In this file image, a GOES-16 GeoColor satellite image taken Saturday, Sept. 19, 2020, and provided by NOAA, shows Tropical Storm Beta, center, in the Gulf of Mexico. A hurricane watch is in effect Saturday for coastal Texas as Tropical Storm Beta gains strength. A storm surge watch and a tropical storm watch are also in effect for the area during an exceptionally busy Atlantic hurricane season. (NOAA via AP)


“Cancer patients are often at greater risk of contracting an infection. So, try to get everything you need early on, to avoid the last-minute crowds in stores,” Marian Von-Maszewski, M.D., associate medical director of Critical Care at MD Anderson said. “It’s almost impossible to maintain adequate social distancing in those situations. And that could prove to be more dangerous than the storm itself.”

Von-Maszewski shared recommended hurricane preparation measures for cancer patients in a recent article published by the MD Anderson Communication Department. First off, breast cancer patients are advised to include an adequate supply of face masks, gloves and hand sanitizer.

“Evacuation could pose a risk,” Von-Maszewski said. “Face masks will be especially important if patients have to stay in crowded shelters.”

Flood water and other standing water are also a potential source of infection and breast cancer patients are advised to add mosquito spray to guard against insect bites, and antibiotic cream and bandages to cover any open wounds to their hurricane supplies.

Plan ahead for a hurricane during the COVID-19 pandemic

Plan ahead and be sure to maintain at least a two-week supply of any current medications. Make a list of all your current medications and their dosages, and talk to your doctor about what to do if you have to miss a dose or treatment. In addition, prepare a dedicated cooler with ice packs or frozen water bottles for medications that need to be kept refrigerated. Research the location of the nearest emergency room and how to get there. Call your insurance company in advance to be sure which ones are covered by your policy. Remember to keep your car’s gas tank full, too, in case you need to seek medical attention or quickly evacuate.

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Please consult our important notice to patients before visiting our clinics.

Dental student with patient

“I highly urge people to go there. The treatment you get is superb. [The student clinician] is very meticulous. The teacher will talk to the student right in front of me, which I enjoy. It’s a tremendous learning experience for me. You’re going to go there, and you’re going to walk out and go ‘Wow.’ ”

Welcome to the UW School of Dentistry where we have several options available to manage your oral health care. Please contact us by choosing one of the options below.

New Patients

Please call 206.616.6996 to make an appointment for a new patient screening appointment. This appointment will determine which clinic best meets your treatment needs. 

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Type of clinic

UW Dentistry

UW School of Dentistry

Campus Dental Center 

Teaching Clinics

Specialty Clinics

How care is delivered Highly skilled, experienced faculty providers from the UW School of Dentistry deliver general and specialty care. Dental students working toward their DDS degree, under close UW School of Dentistry faculty supervision, deliver care. Dentists studying an advanced specialty, under UW School of Dentistry faculty supervision, deliver care.
Time required for care The same time as a private dental office. Approximately two to three times longer than in a private dental office. Varies by procedure; generally, somewhat longer than in a private dental office, but not as long as a teaching clinic.
Fees charged Prices are competitive with local private dental practices. Approximately 30-40 percent less than private practice. Generally, less than private specialty practice.

During your screening appointment, a brief oral evaluation and assessment of your dental needs and concerns will be completed to determine if your dental needs are appropriate for our teaching mission.  This screening is not a complete examination and during this visit we will not be providing a definitive diagnosis, treatment plan, or cost estimates. 

If accepted as a patient, and you decide to receive dental care at the School of Dentistry, a Comprehensive Examination appointment will be scheduled for a fee of $70.00 – $100.00 plus an additional $75.00 – $140.00 for x-rays.

Please visit our Dental Student Clinic page for more information about becoming a patient at the School of Dentistry. If you already have a referral to one of our clinics, please visit our Clinics page.

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If you need to make a follow-up appointment, cancel, or reschedule an appointment, please call 206.616.6996 option 2.

If you need urgent care

If you need urgent care, please call 206.543.5850 between 8:30 and 4:30 Monday through Friday. For after hours emergencies, if you are an existing patient, please call 206.616.6996, otherwise you can call the University of Washington emergency department at 206.598.4000.

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Letter: Dentist offices will pose risks to patients and staff – Opinion – The Columbus Dispatch

I am writing out of concern for Gov. Mike DeWine’s decision, announced on Monday, to allow dentist offices to go full speed ahead. From a health standpoint, this is incredibly irresponsible.

For over two months we have listened to all of the dangers of this elusive and deadly pandemic to now suddenly announce it’s OK to ask dental hygienists to work inside a possibly asymptomatic patient’s wide-open mouth for 45 minutes while only being about 6 inches away is ridiculous.

It’s a known health fact that the spread of COVID-19 is by air droplets that can stay in the air for up to three hours, which means the next three to four patients will be breathing the potentially deadly germs the previous patient exhaled since they were not wearing masks. Is this worth the risks just to get a nonemergency teeth cleaning or whitening?

Many people get their teeth cleaned every six months, so some might have missed one appointment while dental offices have been closed, which is not a life-or-death matter. The governor’s protocols of wearing masks, social distancing and putting up partitions cannot be applied to typical dentistry.

Dental hygienists usually don’t have access to all of the protective equipment doctors in hospitals have (who can now perform elective surgeries), so they should not be grouped in the same proclamation from the governor.

The governor now allows elective surgeries to reduce a patient’s pain or life-altering health condition, which I applaud, but teeth cleaning and whitening does not fall into these categories.

To allow these nonemergency dental procedures to proceed while not even knowing when a decision will be made for it to be OK to get a haircut is totally irresponsible! Let’s get Ohioans tested first!

Larry Pogue, Blacklick

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Coronavirus NYC: Dentist handing out free face masks to patient’s caregivers, others in Manhattan

NEW YORK CITY (WABC) — It may look like she is jousting, but in fact, Dr. Alisa Kauffman is fighting to keep people healthy.

She is a dentist who usually makes house calls to the homebound elderly in Manhattan, but these days, it’s all about tele-dentistry and giving out masks.

“It’s just a simple surgical mask,” she said, “The ones all dentists use commonly.”

She was proactive when it came to her patients and their caregivers.

“In early March I was telling all of the caregivers, ‘You need to start wearing a mask, you’re traveling on public transportation, you’re taking care of sick people,'” Dr. Kauffman said.

And then she started giving them away.

She has given out hundreds; each bagged, to minimize germs, dangling at the end of a long pole.

Dr. Kauffman has asthma, which puts her at high risk for complications from the new coronavirus, but she’s compelled to do this.

She says they are free and she will give them out until she has none left.

And as for her patients, she can’t wait to get back to them in person.

“To be honest, maybe someone is watching out for my older patients because they’re not really having a lot of emergencies,” Dr. Kauffman said. “I’m really fortunate my housecall patients are okay.”

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Project Home Dental Clinic Helps Philly Patients

project home dental clinic janine musheno burkhardt

Duck into the concourse under Suburban Station and you’ll find more than just the usual snack stalls and shops. A nonprofit dental clinic located within the underground network provides free or reduced cost healthcare to Medicaid or uninsured patients that walk in its doors. It’s just one of many services offered by Project HOME, a Philadelphia organization serving people experiencing homelessness.

“There aren’t a lot of private practices that accept Medicaid because the reimbursement isn’t really that high,” explains Janine Musheno Burkhardt, DMD, Project HOME’s dental director and recent Temple University 30 Under 30 honoree. “Because it might be hard for somebody to find a dentist where they can actually get in for treatment, they might go for years and years without ever seeing one.”

Insufficient dental care affects homelessness in more ways than one. Intense tooth pain can push people toward opioids or other substances, Dr. Burkhardt explains. Tooth loss or decay can also affect patients’ confidence, holding them back in an employment search or day-to-day job performance.

At Project HOME, no client is turned away due to an inability to pay, no matter how much work is required. “Some people might come in once for the exam and only need a cleaning or one cavity filled,” Dr. Burkhardt says. “Then there are other patients that I am almost working on every tooth in their mouth.” To meet the extensive demand, the program now operates across two Philadelphia locations and will soon include three dentists. The clinics provide a wide range of procedures, such as cleanings, fillings, X-rays, extractions, crowns, bridges and root canals.

janine musheno burkhardt

Many patients come to form a close rapport with the nonprofit’s staff. In addition to receiving medical, dental and behavioral healthcare, clients may stop by for a hot shower, warm meal or access to laundry facilities. Project HOME—which stands for Housing, Opportunities for Employment, Medical Care and Education—aims to supply comprehensive services. It launched the dental program nearly five years ago at the Stephen Klein Wellness Center in North Philly before expanding to the Hub of Hope location at Suburban Station in December 2018.

Dr. Burkhardt’s work to grow the dental clinic recently earned her recognition as one of Temple University’s inaugural class 30 Under 30 honorees in 2019. After a brief stint at a private practice following graduation, the Kornberg School of Dentistry alumna has now found her niche helping underserved Philadelphians.

“You kind of become their family, especially with some people who are coming to see you pretty frequently,” she says. “Or it might just be an emergency walk-in and you’re able to take care of their pain … The most rewarding part is just knowing that you’ve been able to help them in some way and provide some relief for the day.”

Create change in our community at Temple University, an innovative institution committed to making a real, positive impact in Philadelphia and beyond.


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Rabbit virus improves bone marrow transplants

Rabbit virus improves bone marrow transplants

University of Florida Health researchers have discovered that a rabbit virus can deliver a one-two punch, killing some kinds of cancer cells while eliminating a common and dangerous complication of bone marrow transplants. For patients with blood cancers such as leukemia and multiple myeloma, a bone marrow transplant can be both curative and perilous………Go to Health news blog (Added on 6/05/2015 2:18:18 PM)

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A fundamental malaria discovery

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Diet, nutrient levels linked to cognitive ability, brain shrinkage

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New research has observed that elderly people with higher levels of several vitamins and omega 3 fatty acids in their blood had better performance on mental acuity tests and less of the brain shrinkage typical of Alzheimer’s disease � while “junk food” diets produced just the opposite result.

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Read infant acetaminophen labels carefully

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Acetaminophen is one of the most usually used pain and fever relievers for infants and children and is safe and effective when used as directed. However, with recent dosing changes to liquid acetaminophen products for infants, the FDA last week issued a press release urging parents to know the concentration and read the label as the new, less concentrated form of the popular pain reliever arrives on store shelves.

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Turn Down the iPod to Save Your Hearing

Turn Down the iPod to Save Your Hearing

Today’s ubiquitous MP3 players permit users to listen to crystal-clear tunes at high volume for hours on end – a marked improvement on the days of the Walkman. But as per Tel Aviv University research, these advances have also turned personal listening devices into a serious health hazard, with teenagers as the most at-risk group.

One in four teens is in danger of early hearing loss as

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