The sun glints darkly off the boy who wears his umbrella on his head. The boy (almost man) in the tinker toy cage attached to his crown?shaven and shorn. I
do not know him. I know of him, and them, all of them I have seen. Born
of peril; fearless and foolish. These broken ones who live by speed and
are now crushed and crumbled.
I see him outside the rehab
center. Eyes staring ahead. Surrounded by fewer and fewer friends.
Trapped?body exiled from brain. A pretty blue ribbon on his chair
(cell).
What does he think? Am I king of the world? Has God abandoned me? Am I God?
What
does he say? Who will listen? Fed by staff and tired, frightened
family. At a distance. Who can stand the smell of spoiled fruit?
What
does he see? A future of torment? Of endless sad, stolen gazes and
reproachful stares. A victim of poor death perception.
Curiosity
conquers fear. Need meets want, and we visit. I need to know his
insight?need to hear the answers to my dark (devious) questions. He
only laughs and reminds me that he can wear his umbrella on his head.
Everything else is meaningless.
As I walk away, somewhat
ashamed, somewhat guilty, somewhat sad, he asks only one question:
?Will I ever again make a difference?? The tears come easily.
Poetry 2
Identity
By
Leon I Gilner, M.D., F.A.C.S.
Between morning rounds and evening report, between first cut and last stitch. From ancient wound to robotic laser ablation, from anxious failure to apathetic arrogance.
Here you will find me.
Between cautious optimism and raging nihilism, between quiet concern and coercive passion. From escalating awards to plummeting rewards, from increasing responsibility to declining self-worth.
Look for me there.
Between heart failure and heartache, between dogma and heresy. From symphonic dexterity to arthritic disability, from educated lie to outcome-biased myth.
You may chart my course.
Between innocence and indifference, between icon and actor. From healer to heathen, from me to you.
Meet me at the crossroads.
And when you seek me out (as you will), do not be surprised, or afraid, or discouraged. I
will have many faces, and many tongues, and many truths, and many lies.
But I will be as you have made me, and we will meet on a field that has
your name. And this will only be the beginning.
We will travel the rest of the way together, as friends.
Before
any operation, you should have a basic idea of what is going to be
done, how it is going to be done and why it is going to be done. Be
prepared. Read a book, search on the internet, or (last resort) ask the
surgeon. Show up on time, move with purpose, and act with confidence.
2. Strive to be helpful and cooperative.
There
are two types of people in an Operating Room; those that help and those
that hinder. Strive to be a helper. Take responsibility. It takes
practice to have a ?can do? attitude. Practice saying ?yes I can do
that? and then do it. Many jobs take more than one person?s skills and
abilities. Don?t be afraid to ask for help, or too timid to assist
someone.
3. Speak softly and minimize conversation.
Loud
conversations and noises are distracting to everyone and make it
difficult to pay attention to the task at hand. Sounds are amplified in
the close quarters of an Operating Room and even quiet conversations
may be too loud. Appropriate music may be acceptable as long as it does
not interfere with the anesthesiologist or the surgeon.
4. Cultivate body awareness.
The
more people enter and leave the OR, the more chances there are for
organism transfer, accidents, and distractions. Minimize traffic and
make your trips purposeful. The OR is a small space densely packed with
fragile equipment and people. Become ?body-conscious? and do not get in
the way.
5. Avoid problems by anticipating them.
Expect
problems and prepare for them. Learn from experience. Remember, the job
is often harder than it looks and commonly requires the only instrument
that is not in the room. Stay focused. Know the contents of the room
and where supplies are located.
6. Identify teachers and students.
If
you are a teacher, take charge of your student. Always introduce new
people to the surgeon and staff. If you are the student, pay attention
to your instructor and stay clear of the sterile field. If no one
introduces you, then you should introduce yourself and state why you
are in the OR. Wear a name badge.
7. Look professional.
The
Operating Room is no place for outlandish makeup, dangling jewelry,
long fingernails, or strong perfume or cologne. Patients are acutely
sensitive to sights, sounds and odors particularly when emerging from
anesthesia. It is best to be inconspicuous.
8. Avoid errors by confirming everything.
In
each and every procedure, there should be at least one ?time out? when
the team confirms the patient?s name, diagnosis, site, and side of
surgery. It is also appropriate to confirm that the imaging studies are
associated with the patient. Confirm all orders including the names and
quantities of drugs, the data on blood transfusion packs, and the
expiration dates of biological implants.
9. Be team minded and considerate of others.
A
good OR team is like a symphony orchestra with each person playing his
or her part. Be considerate of others and their jobs. Strive for
harmony and order. Rely on the team members and expect that they will
rely on you.
10. Think Safety.
The Operating Room is
filled with flammable liquids, heavy equipment, sharp points and edges,
and one defenseless human being. Remember to protect the patient,
protect yourself, and protect the surgeon (especially the surgeon).
Wear gloves, lead aprons, and safety glasses when indicated. Move and
lift patients as an organized group.
11. Be courteous and patient.
The
OR is a stressful environment and people are often anxious and
sensitive. It is best to be polite. If you have a smile on your face
(even behind a mask) your words will have a smile on them as well. Do
not shout. Leave your attitude outside. The corollary of this is to try
not to have too thin a skin. Although it is never appropriate for
anyone to be abusive, do not be overly sensitive to minor comments
uttered during times of stress. We are all human and deserve a break
from time to time.
12. Remember your goal.
Finally,
remember that you are in the Operating Room to provide the patient with
a safe, efficient, and successful operation. Treat the patient with
kindness--be gentle and genuinely concerned for their welfare. Take
your job seriously, take pride in your work, and enjoy the rewards of a
job well done.
DICOM Image Viewing Across Computer Platforms
DICOM Viewing and Image Manipulation across Computer Platforms
By
Leon I. Gilner, M.D., F.A.C.S.
Picture
Archiving and Communication Systems (PACS) are computers or networks
dedicated to the storage, retrieval, distribution, and presentation of
images. In the past few years hospitals have installed such systems to
reduce the cost of hard film acquisition and storage and to improve the
ability of staff to view images.
PACS systems ordinarily run on
proprietary software which may be accessed by stand- alone programs or
web-based browsers. Thus far, the stand alone programs run only on
Windows based PC?s but systems that can communicate through web
browsers may be accessed by both Macintosh computers and PC?s.
Digital
Imaging and Communications in Medicine (DICOM) is a comprehensive set
of standards for storing and transmitting medical imaging. It includes
a file format definition and a network communications protocol. DICOM
differs from other data formats in that it groups information together
into a data set. That is, each DICOM image contains patient
identification data and the image itself. The images in most PACS are
stored in DICOM format and must be read with a DICOM viewer. There are
quite a few DICOM viewers available and one of the most powerful is
OSIRIX. Osirix runs only on the Macintosh and is free and open source.
It is able to manipulate DICOM images at a level of sophistication and
speed that rivals the best PC programs.
I was recently faced
with a dilemma regarding my Macintosh computers interacting with a
hospital PACS. This particular PACS ran on a proprietary program that
could only be installed on a Windows PC, and could not run on a
Macintosh. Although there was a module to allow web browser based
viewing of the PACS, it was not installed in this hospital.
It
appeared that the only way I would be able to login to this PACS and
view DICOM images would be to purchase a Windows based PC but I would
not be able to use OSIRIX for image processing. After some time I came
up with a method that allowed me to use my Macintosh computers to login
to the hospital PACS and view the DICOM images with OSIRIX.
I
installed the program Parallels Desktop for Mac on my Macintosh MacPro
computer. Once Parallels was installed, I loaded a full version of
Windows XP Professional onto the virtual PC. Parallels allows Windows
XP to run on a Macintosh computer and permits the creation of folders
that permit file sharing between Windows XP and OS X on the same
computer. The proprietary PACS software was installed on the virtual PC
and permitted me to log on to the hospital system. DICOM folders
containing patient imaging data were copied and downloaded as saved
files. These DICOM files were saved on the primary drive of the virtual
PC in a folder labeled Images. They were then copied to the
Windows-Macintosh shared folder. Finally, this folder was opened in the
Macintosh environment using OSIRIX and the DICOM images viewed and
processed as needed. The final processed images were stored on the
Macintosh in a separate folder labeled with the patient?s name.
In
summary, a Windows based PACS was entered by a program running in a
virtual PC on a Macintosh computer and the DICOM images viewed and
manipulated by a program running in the OS X environment on the same
computer. The capacity for image processing of the OS X program OSIRIX
running on a MacPro computer with a high definition monitor rivals the
best software running on a PACS workstation and costs far less. This is
something to consider for Neurosurgeons and other specialists that must
integrate their office computers with a hospital PACS and for whom a
separate PACS workstation would be prohibitively expensive.
Furthermore, the Macintosh computer may be used for regular activities
such as word processing, and internet communications as well as for
PACS integration and image processing and archiving.
Texas Medical Association Press Release
Physicians Champion Smoking Bans Across Texas
01 Apr 2008
Cities across Texas are going smoke-free, and physicians stand at the forefront of the movement. More than 20 cities have passed smoking ordinances, many since 2006. Texas Medical Association (TMA) physicians have led successful efforts to pass public smoking bans in Victoria, Abilene, Tyler, and Temple. Amarillo citizens are set to vote on a similar referendum this spring. Doctors involved in these efforts see championing the cause as a way to improve the health of their community.
"It's a health issue, it's always been a health issue, it's never been anything but a health issue," explains Leon Gilner, MD, about his involvement in the passage of Victoria's smoking ordinance in 2006. "Secondhand smoke is as fatal as firsthand smoke," adds Dr. Gilner, a neurosurgeon and a TMA physician leader. "As a neurosurgeon, I see the worst problems associated with smoking: Cancers in the spine and lung disease that prevent patients from getting even the simplest operation to help them."
Cigarette smoke carries thousands of chemicals, many of which cause cancer or are toxic when inhaled. Inhaling tobacco smoke causes short-term acute effects, like asthma attacks in children. It also causes long-term chronic diseases like lung cancer - the No. 1 killer in men and women.
Seeking to limit people's exposure to those dangers, the Victoria city council held a public vote to ban smoking in restaurants and other public places. Dr. Gilner decided to speak out in support and start his own grassroots campaign because no other ordinance supporters seemed to emerge. He designed a Web site, Smoke Free Victoria, and made buttons to pass out to voters. He feels it is his responsibility to act on behalf of public health. "As a physician I heal the sick, but even more, I should improve the health of our citizens," adds Dr. Gilner.
Ralph McCleskey, MD, an Abilene cardiovascular specialist, believes the same. He was equally active in his hometown's no-smoking movement. "As a physician, I had instant credibility. I could stand up and say that science has proven time and time again that secondhand smoke is harmful, and is at least as dangerous as firsthand smoke," TMA physician leader Dr. McCleskey says. "I've been telling my patients this for 30 years." Dr. McCleskey helped to create Smoke Free Abilene in 2006 in support of his town's proposed ordinance. The group included other local physician leaders plus people from various other professions. "I used my medical experience and joined with other people to have a much larger impact on the community than I ever could as an individual."
Though he credits the entire group for the local movement's success, Dr. McCleskey became the face and voice of the cause. He appeared in television ads and recorded a phone message that went to every Abilene voter. "It said something like, 'Hello, this is Dr. Ralph McCleskey. I've been practicing medicine in Abilene for the past 30 years, and I have seen firsthand the dangers of secondhand smoke and the harm that it can cause my patients,'" he recalls. In Abilene, 69 percent of voters passed the comprehensive smoking ban. "It really makes me feel good knowing that the community in general can pretty much go wherever they want and not
Dr. Gilner experienced a similar victory, as 70 percent of Victorians passed their measure in 2006. "I became the first [Victoria] physician to champion the cause in such a way that people could respond to it," he notes. "If I weren't a doctor, no one would have listened to me. People rallied, so in my 59 years, this is probably the thing I am most proud of."
Proponents of a statewide smoking ban were unsuccessful in their efforts to pass legislation in 2007. At the time, Joel Dunnington, MD, told legislators, "One of the easiest, simplest, and fastest public health interventions Texas can implement is to make Texas smoke-free." Dr. Dunnington, a TMA physician leader and radiologist at the M.D. Anderson Cancer Center in Houston, also told legislators that secondhand tobacco smoke causes around 50,000 deaths in the United States every year.
To date, 19 states have smoke-free restaurants and 13 states have smoke-free bars, while numerous cities have similar ordinances. Yet opponents of smoking bans cite infringement of smokers' rights, potential negative financial impact on affected businesses, and dislike of government intervention overall as reasons to oppose.
Dr. Dunnington notes that economic surveys show either there is no economic downturn in the community, or there is improvement after workplaces go smoke free. He also notes tourism in California and New York are booming following enactment of smoke-free legislation.
Dr. Gilner says Victoria restaurants and other businesses are booming with families enjoying smoke-free outings. "Even the smallest change can have big effects," he says. He hopes to see fewer heart attacks, less cancer, less hypertension, and less emphysema suffered in his community as a result.
Times are good in Abilene too, according to Dr. McCleskey, who points to a bowler friend who laments the effects of the new ordinance. "He said, 'I used to get a lane easily. Now since there's no smoking, there's all these families with kids running around and the bowling alley's full; so I can hardly get a lane!" he recalls.
"Physicians and citizens have to take an active role in public health; neither side is capable of making this happen without the other side's support," says Dr. Gilner. Not only do Victorians face less secondhand smoke but also some patients have told Dr. Gilner they quit smoking altogether as a result of the ban. "It became such a pain in the 'tuchis' to have to try and find a place to smoke, they said it wasn't worth it."
TMA is the largest state medical society in the nation, representing more than 43,000 physician and medical student members. It is located in Austin and has 120 component county medical societies around the state. Organized in 1853, TMA's key objective is to improve the health of all Texans.
Texas Medical Association Article URL: http://www.medicalnewstoday.com/articles/ 102341.php
Main News Category: Smoking / Quit Smoking
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Biographical Sketch
Leon I. Gilner, M.D., F.A.C.S. Neurological & Spinal Surgery
Leon I. Gilner, M.D., F.A.C.S., earned his medical degree with honors from Upstate Medical Center in Syracuse New York in 1974. He completed his internship in General Surgery at the University of Miami-Jackson Memorial Hospital in 1975 and his residency in Neurosurgery at the Albert Einstein College of Medicine in New York in 1980. Afterwards, he served as Assistant Professor of Neurosurgery and Director of the Residency Training Program at the Medical College of Pennsylvania in Philadelphia, Pennsylvania from 1982 to 1984 and Chairman of Neurosurgery at Valley Medical Center in Fresno, California from 1984 to 1987.
He has been in the private practice of Neurosurgery since 1987, and with the exception of only a few months, has practiced in Victoria since 1994. In Victoria, he introduced outpatient lumbar microdiscectomy, anterior cervical fusion, posterior cervical microforaminotomy and vertebroplasty and was the first Neurosurgeon in Victoria to perform posterior and anterior lumbar interbody cage fusion. Dr. Gilner is certified by the American Board of Neurological Surgery and is a Fellow of the American College of Surgeons. He is also a member of the American Association of Neurological Surgeons, the North American Spine Society, and the Texas Association of Neurological Surgeons.
Dr. Gilner is on the consulting staff of Krames Publications and has contributed to many of their publications including, Lumbar Microsurgery, and Cervical Disc Surgery among others. Most recently he contributed to the Krames patient education manual Vertebroplasty and Kyphoplasty. He is also the inventor of the Cordis Intraventricular Pressure Monitoring Catheter.
He has held many hospital positions, both elected and appointed including Chief of Staff at two hospitals, Chief of Surgery, Chairman of the Bylaws Committee, Chairman of the Pharmacy and Therapeutics Committee, and Chairman of the Credentials Committee. He formerly sat on the Executive Board of Health First, the physician IPA in Victoria and served as its Treasurer from 2004 to 2006. He was also on the teaching staff of Spinetech, Inc..
On a more personal note, Dr. Gilner is a published poet and author and twice past President of Temple B'nai Israel in Victoria. In 2006, he was honored by the American Cancer Society as Founder and Chairman of Smokefree Victoria, a grassroots organization which successfully advocated for the passage of the Victoria Smokefree Ordinance. This ordinance eliminated smoking from all restaurants, bars, and public buildings in Victoria and was passed by the electorate with the largest majority of any similar election in Texas.
Dr.Gilner accepted the position of Chief of The Division of Neurological Surgery at Berkshire Medical Center and began his appointment on November 1, 2008.
What Questions Should I Ask Before I have Surgery?
Ask Dr. Gilner What Questions Should I Ask Before I Have Surgery?
We know that you may be facing surgery and you may be nervous, anxious, and perhaps even afraid. Most operations are not emergencies and you will have time to ask your surgeon questions about the operation and time to decide whether to have it. Our surgeons invite such questions since we believe that a well-informed patient will make better decisions, cooperate with the surgeon, and in the end have a better surgical experience. The questions we have listed are a good starting point but you may have other questions you want to ask. We suggest you write those other questions and all the answers you receive on the back of this handout so you may refer to them when you leave our office.
Your Surgeons Qualifications
You will want to know that your surgeon is experienced and qualified to perform the operation. Most Neurosurgeons have taken special training and passed exams given by a national board of surgeons. Ask if your surgeon is board certified in Neurosurgery.
Some surgeons have the letters F.A.C.S. after their name. This means they are Fellows of the American College of Surgeons and have passed another review by surgeons of their surgical qualifications and practices.
1. What operation are you recommending? Ask your surgeon to explain the surgical procedure step by step in as simple terms as you think are necessary to understand it. Ask your surgeon to draw a diagram, show you a picture, or even a video. Ask your surgeon if there is more than one way to do the operation or if there are different approaches. Ask you surgeon why he wants to do the operation one way or another. Ask the surgeon about anesthesia and the options you have regarding the type of anesthesia and the anesthesiologist. Ask your surgeon if any devices will be implanted in your body, what materials they are made of, will they have any effects on future imaging studies, and will they need to be removed at a later date.
2. Why do I need the operation?
There are many reasons to have surgery.
Some operations can relieve pain while others may reduce a symptom or improve function. Some operations are performed to diagnose a problem and some may save your life. Your surgeon will tell you the purpose of the procedure. Make sure you understand how the proposed surgery fits in with the diagnosis and what you can expect as a result of the operation.
3. Are there alternatives to surgery?
Sometimes surgery is not the only way to treat a problem. Medication and other non-surgical treatments may be safe and effective alternatives to surgery. Also, watchful waiting may be appropriate in some situations?to see if your condition gets better or worse. Ask your surgeon about the benefits and risks of these other treatment options.
4. What are the benefits of the operation?
Ask your surgeon what you can expect to gain from the operation. Ask how long the benefits are likely to last. When asking these questions, try to be realistic and specific. Some patients may expect too much from an operation and are disappointed with the outcome. Also, some problems you have may have nothing to do with the problem that the operation will treat and you should not expect these problems to respond to the operation.
5. What are the risks of having the surgery?
All operations have some risk. When deciding on whether or not to have surgery, you need to weigh the benefits of the operation against the possible complications or side effects. Complications are unplanned events that can occur around the time of the operation. Examples of complications are infection, too much bleeding, reactions to anesthesia, and nerve injury. Some people are at greater risk of complications because they have other medical conditions such as heart disease, lung disease, bleeding disorders, and diabetes. Side effects of surgery are reactions that are common such as pain and swelling at the incision site. For the most part, side effects can be anticipated and treated. Ask your surgeon about the possible complications and side effects of the operation. In particular, ask about how much pain you may expect and how your doctor plans to treat it.
6. What if I don't have this operation?
Ask your surgeon what you will gain or lose by not having the operation now. In most cases, there is time for you to think about your options and consider what you want to do.
7. Should I get a second opinion?
Getting a second opinion from another doctor may be a way for you to decide if the operation is the best alternative for you. Ask your doctor if he or she thinks it is necessary for you to have a second opinion. Check with your insurance company if they will pay for a second opinion.
8. What has been your experience in doing this operation?
It is a good idea to choose a surgeon who has been thoroughly trained to do the procedure and has experience doing it. You should ask your surgeon about his or her recent record of successes and complications with this procedure. Remember, there is no procedure that is without risk or any surgeon who has not had any complications.
9. Where will the operation be done?
Your surgeon may practices at several places and you should ask where your surgery will take place. Ask your surgeon if the operation is a routine procedure done at the hospital and how often has he or she performed that surgery there. Until recently, most surgery was performed on an inpatient basis and patients stayed in the hospital for one or more days. Today, a lot of surgery is done on an outpatient basis and you may go home the same day. The operation is still performed in the standard operating room in most cases.
10. What kind of anesthesia will I need?
Anesthesia is used so that surgery may be performed without unnecessary pain. Your surgeon will tell you whether the operation calls for local, regional, or general anesthesia. Anesthesia is quite safe for most patients and is usually administered by a specialized physician (anesthesiologist) or nurse anesthetist. Both are highly skilled professionals and have been trained to give anesthesia.
11. How long will it take for me to recover?
Your surgeon can tell you how you might feel and what you will be able to do or not do the first few days, weeks, or months after surgery. Ask how long you will be in the hospital. Find out what kind of supplies, equipment, and other help you will need when you go home. Knowing what to expect can help you cope better with recovery. Make sure you ask when you can start regular exercise and go back to work.
12. How much will the operation cost?
Health insurance coverage for surgery may vary, and there may be some costs you will have to pay. Ask what your surgeon's fee is and what it covers. Surgical fees usually include a number of postoperative visits or postoperative care for a specific time period?usually three months for most procedures. You will also be billed by the hospital for inpatient or outpatient care and by the anesthesiologist and others providing care related to your operation.
