More info in Mohs procedure.
Posted By: nm on 2008-01-16
In Reply to: Thank you very much. nm - trose
The reports I edit, the dr. does the procedure, inks and maps specimen for frozen section and sents to path with pt still on table. Based on path results, procedure either done or excise more tissue from area that still shows cancer cells. Sometimes takes 2-3 more specimens. When procedure done, that dr either does repair or if wound too big, a plastic surgeon is scheduled to do repair same day or day or 2 later.
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Slow-Mohs versus regular Mohs
I am a patient, not a doctor, but my understanding is this:
A regular Mohs procedure takes many hours but is finished the same day you start the procedure. The doctor cuts out the visible tumor, then makes either vertical or horizontal slices from what she has removed. Those slices are made into frozen slides (not literally frozen) and analyzed by the doctor while the patient waits in the office. This allows the doctor to "map" the tumor. If a part of a slide doesn't show a clear (tumor-free) margin, the patient is called back in to a little more tissue removed. Again, that tissue is made into frozen slides and the doctor looks for clear margins. The patient will keep being called back in to have more removed until all the slides show clear margins. This can take many hours, but once the margins are clear, the wound is closed and that is the end of it.
Slow-Mohs is when the wound is left open for a day or two (and up to a week) while the slides are analyzed. That is why it is called "slow" (the time you spend in the office on the first day of surgery should be about the same as if you had regular Mohs). The reason it takes so much longer to analyze the slow-Mohs slides is because the doctor uses paraffin-embedded slides instead of frozen slides. Paraffin-embedded slides are of much higher quality than frozen (my doctor said it's the difference between a huge HD TV and an old black and white TV with bunny-ear antennas).
For most of the malignant tumors treated by Mohs, frozen slides (and thus regular Mohs) is sufficient. But there are some types of tumors that have long, finger-like extensions (like roots) that are hard to see on frozen slides. If they are removed with regular Mohs than these roots could be missed and lead to a recurrance of the tumor. So that is when Slow-Mohs is usually used.
Sometimes Slow-Mohs is called Modified Mohs, but I have also heard Modified Mohs refer to a regular Mohs procedure with other variations. So if a doctor says they are going to do Modified Mohs, ask them exactly what they mean by that.
You should also ask if your doctor will be using vertical (bread-loafing) slices, or horizontal slices. I think vertical is the norm, but horizontal is better for tumors with irregular boarders.
Also, sometimes after doing regular Mohs with frozen slides, the doctor will take a final slice for paraffin-embedded slides to be analyzed just in case. This final paraffin-embedded slide isn't the same as Slow-Mohs. In the rare instance that the final slide comes back with a positive margin, the patient will be brought back in for another Mohs procedure, but usually regular Mohs is a one-day affair.
Overall, Mohs and Slow-Mohs are a great alternative to a wide surgical excision that could result in greater (and unnessesary) tissue loss. I think it is widely accepted for skin cancers, but more controvertial in other cancers like sarcomas.
I have a very rare sarcoma called Dermatofibrosarcoma protuberans (DFSP) and while most of the literature I read says Mohs is at least equal to or better than wide excision (but with less tissue loss), I have seen 2 sarcoma specialists that are strongly opposed to Mohs for DFSP. However, their reasons are that vertical slices and frozen slides are inadequate for DFSP. However, it doesn't seem like they are aware of the horizontal slicing options and the ability to do paraffin-embedded slides in Slow-Mohs (and doctors don't respond well to any implication that there is something they don't know). So I am trying to arm myself with as much knowledge as possible...and I suggest you do the same if you have one of the more controversial tumors.
Here is a good (technical) article about Mohs and DFSP that describes the different types of Mohs:
"Modified Mohs Micrographic Surgery in the Therapy of
Dermatofibrosarcoma Protuberans: Analysis of 22 Patients" http://www.annalssurgicaloncology.org/cgi/reprint/11/4/438
Mohs, not Moh's. nm
x
I had a "slow Mohs" in 12/00 after being diagnosed sm
with melanoma in situ on my left cheek near my eye. I had about 8 shots and I didn't feel a thing. I guess it was called a slow Mohs' because the procedure was about 4 hours long. The wound was open for 1 week until results came back that he got it all out. So for a week I was doped up, as I had a hole in my face that I could put my finger in. I barely have a scar there, he did an excellent job. And so far, no return of the cancer.
I think you have the right procedure;
it's just that the results vary from patient to patient. My boss had an ablation, but after just a few months had to have a hysterectomy anyway; it didn't help at all. Others, like the person you mentioned, have great success. I think it's worth it to try an ablation to begin with, if you could be one of the lucky ones. Good luck!
Want to know more about your procedure
I, like so many others, am overweight and would love to be able to take it off. I have some feet issues so the part about walking is totally out for me other than what is necessary. What part of the country are you in, the cost, does insurance cover, time of hospital stay, recovery period and I know about possible complications from gastric bypass, but what about on your end? Thanks for any information.
NovaSure Procedure
I had the NovaSure procedure in February of 2007. It was the best decision of my life!! I was extremely anemic and was on IV iron supplementation for several years before I went searching for an OB/GYN for options for my heavy cycle. I was introduced to this procedure by my OB/GYN and did lots of research online. Basically, it is a minimally invasive endometrial ablation that burns the lining of the uterus to destroy the endometrium. The procedure only lasts a few minutes, but you are put under general anesthesia. My doctor told me it should last approximately 5 years, maybe longer (no guarantees). She told me some patients have much lighter cycles and some have no cycles afterward. I was a lucky one....I have had no cycle since I recovered from my procedure, and also no more IV iron supplementation. This has been great!!!!
She is going to have the procedure performed
on a Thursday by the doctor that, we have been told, invented it. Then the next day she is going to have the plastic surgery done to repair the hole. You waited a week for results...is this something we should be looking into? Still haven't googled it yet. Asked the question yesterday and just got back on the computer today and started reading the answers. Thanks for the info!
I'd certainly wanna see the procedure note
They should have some documentation of what happened. If not, I'd REALLY wanna know exactly what was so minor they'd not document it, but left marks on your body!
It is a MEDICAL procedure. I suppose
spaying is mutilation to you too, right? I don't know if vets tell people....but they remove their ovaries for that. The horror!
If you don't want it done to your cat, don't do it, but leave others alone that need/want to have this done!
LEEP procedure, google it
NM
Go to their web site and follow their procedure - sm
they have it all there how to report problems, etc.
Anyone familar with Mohr procedure?
My MIL is having this procedure (not exactly sure about the spelling) done to remove a skin cancer. It is supposed to have a 99% rate of the cancer not returning. Just wondering if anyone has any info on this.
Moh's procedure for skin cancer
It's cruel. It's a very painful procedure for the cat - sm
as their paws are very sensitive. They don't just remove the claw - they remove the entire terminal phalanx. They lose their first line of defense against attack, or their ability to climb, though they can still jump.
It can also lead to litter box problems due to sore feet, and other behavioral problems.
Instead, buy a little animal toenail-clipper and clip the nails every few weeks. Cheaper, and MUCH more humane.
If I cared about the chair, I'd just put a cover over it for everyday use, so it'll be nice for company. But my cat's health & well-being is worth more than any piece of furniture.
I know someone who had a procedure because it became extremely painful -nm
:)
Period pain after LEEP procedure
 I had LEEP for cervical cancer a few years back. Cancer is gone now, but I have horrible periods. Am I alone? Does anyone else suffer since LEEP surgery? I also have fibromyalgia which only adds to the discomfort.
I agree with you on declawing - it's a painful procedure -sm
and can lead to other behavioral problems. I think the scratching has less to do with the claws than their instinct to scratch. One of my cats is a front-declaw (she came that way, unfortunately) and I feel SO sorry for her. She gets so frustrated when she can't pick anything up with her front paws. She still 'scratches', too, but always uses the scratching post. They do seem to prefer that to anything. My other cat sometimes uses the rug, but it seems to be more as a precursor to a game of chase between them. I trim my clawed cat's nails frequently. The only furniture she tries to scratch on is the bedpost, which is sort of a wicker-type material I got at Ikea. But she does it rarely, and if I really cared about it, I'd protect it somehow.
You might be able to protect the furniture, at the same time enhancing the look, by getting several throws to put over vulnerable areas. Or, if it really only matters if they look good for company, I'd cover the entire piece. That way you wouldn't have to vacuum cat hair, either.
Finally, another option is a product called 'Soft Paws' - a plastic 'fake nail', basically, that is glued on over the existing claw. Kind of a pain to apply, and they do shed off when the outer nail sheds. But they look cute, come in lots of pretty colors (including clear), and they can save the furniture without traumatizing the cat.
dental procedure: root planing
dentist says i need this because of moderate periodontal disease. $200 a quadrant x4 = $800 for what sounds like a horrible, bloody procedure. they say they only do two quadrants at a time. does anyone know anything about this, had it done? please let me know what to expect.... thanxabuncha
Thanks! That was enough info for
me to find the sheet music :)
Some info for you
http://www.ldonline.org/article/8023
LOL! I did not know that! Thanks for the info!! nm
m
Thank you for the info.
I just registered and I appreciate your response. I'm sure my husband would love for me to have more of a sex drive. ;)
Gee. thanks for the info! I appreciate it! nm
nm
info
Needing this information depends on if you need to use both of your incomes. If not, i would not worry about getting this letter. All mortgage companies are different in what they require. I would just try to use your previous 1099. I am sure the company would not have a problem writing this letter though if needed. If you just explain to them what it is needed for. I am sure you would not be the first person to ask of this.
I don't own a TV but get info from the net
x
Thanks for the info but not really getting that much
No matter what the cost of the property sold, the rate I am paying (as others would do) is less than $3,000.00! When you take into consider the previous realtor I had was charging 10% of the total amount, I am coming out smelling like a rose. I tried to tell my relative the earnest money was like down payment but apparently not being believed. Their son was selling some property without a realtor and they got up front and got to keep around $500.00 from a sale that did not go through but mine, I told her, was different. Thanks!
Thanks so much for the info!!
x
Thanks so much for this info..
am sitting here wondering why did I not think of that! I think there is a new walk in really close to me, in fact. I have fibro, like I said and I am 1 big ache to start with with pain in the legs, arms, shoulders but this most excruciating pain right now is in the ribs, not more 1 side than the other, almost unbearable. I once again appreciate so much the helpful thought!
Thanks for the info!
nm
Thanks for the info..
Going to try it out.
more info
She's been on BCP for around a year now...not for contraception initially...for dysfunctional bleeding. Thankfully though, she's somewhat protected. But you know, pregnancy isn't what scares me the most, it's a deadly disease that she could contract...it's a disease that could leave her unable to have a child when she does meet the man she wants to marry. I just feel like crying, she's my little girl...
You don't need a cop to get that info. - sm
It can be found on the internet (for a price) if you know where (Florida) and how to look.
Hey, thanks for all the info
I especially like the part where you say, "I'll be firing AT&T for the phone service." . . . sounds REALLY good about now. Have had a few problems since "the change", and seems they always want to have me try to discuss the issues they are causing with their employees overseas. All I got ta say about dat is . . . taint gonna happen.
Huh? What was that? I need you to transfer me to someone in the United States! LOL!
Thanks again!
more info...
My son is 8, he's in 3rd grade.
He can concentrate for hours on videogames. We spend all of our time together, except for the hours he is in school. Of course, I'm a SAHM MT, so that makes for more time for us. He talks nonstop to everyone, everywhere, all the time. However, my dad and my DH's dad do the same thing, so that could be inherited!
I'm not sure if ADD is the right word here, but don't know how else to describe it. He's not behind by any means in school, however the thing is, it takes him twice as long to complete *jobs*, as his teacher puts it, than the other kids. I know from my experience with him and homework, and it's like pulling teeth sometimes to get one worksheet done. He's just extremely social, I guess. He can't sit still. He has a hard time focusing, I do know that much.
Medication is the last thing we want to do (yes, his father is VERY involved in his life...we are an intact family). I'm thinking about taking him to his ped's office just to talk about some things we can try. I don't want him labeled with anything unless we know for sure he has it. I'm just exploring options right now.
Thanks for the advice and responses y'all, keep 'em coming!
Thanks for the info.
xx
Thanks for the info!
I thought there would be more restrictions but I guess it is more or less common sense.
Thank you for this info!
We have been tangling with FAFSA since my daughter graduated high school in 2004 but the school that she goes to is less than helpful in giving out information. I have learned more from you than all of the financial "experts" we have spoken to. Thank you for posting!
More info...
He's worked for this company for 11-12 years, however they just moved across town in July, so he's been driving since then. He absolutely hates the drive, comes home tired and cranky every night. And by apartment, I did mean one of those weekly hotel-thingies.
thanks for the info
Thanks a lot - I am kind of leaning toward the Monte Carlo but will do a lot more checking before deciding. . I do think it would be best to stay on the strip.
thanks for the info
Thanks guys. Glad to hear there are some happy people out there. I'm looking forward to knowing all there is to know and getting on with the every day stuff. Happy New Year.
Some info
http://altmedicine.about.com/cs/womenshealth/a/PMS.htm
Thanks for the info sm
I definitely need to lose the plastic hamster cage. It has metal slats on the sides and all of their bedding gets pushed out all over the floor. Who ever thought that was a good idea. I wish they would have warned me at the pet store.
BTW, three days after we got them, one of them chewed its tail off or one of the others possibly did it. Ever heard of that?
More info...
The dinner is going to be at a 5-star resort in CA. Of course, he hasn't gotten me much info yet. He'll wait til the last minute, as usual. I don't know anyone else to call that may know for sure what this event is like, but it sounds maybe *swanky* but not black tie...thanks for your response though!
Thank you for the info...
Her mom called me again a little while ago. Just wanted to chat. I know she will come around on her own. I will respect her wishes to be left alone. It just baffles the heck out of me.
more egg info
I had a friend from England and she always stored her eggs in an egg basket on the kitchen counter! She said that's always been the way they did it in England. I was amazed she wasn't dead of some kind of horrible egg bacteria poisoning.
Thanks for the info!
xx
Thank you so much for the info..sm
This little one is just a sweetheart! She is an absolute doll. I just feel so bad for her when she cries and cries. When we first brought her home she was given an anxiety medication to help her calm down and to help her deal with the coughing. She would cough so much she would get out of breath and then couldnt get enough air in. At one point she was in ICU for respiratory distress. We have a Cavalier King Charles Spaniel and he just loves his basset sister! He is always trying to love her and make her feel beter and they sleep together all the time. My daughter made a sign over their pet bed that says King Monroe and Queen Zoey sleeps here!
Anyway, thanks for the info. I appreciate it!!
Thanks for all the info cat, unfortunately
it is snowing here and the entire sky is gray. I doubt we will get to see anything but we are certainly going to try.
thanks for this info! nm
nm
Thanks for the info sm
I think my husband could probably change those too, but $100 each bearing, and it's happened several times to you, that would get really aggravating. I'm considering a different vehicle, possibly. I like my car alot, but if this is something that could be ongoing, i don't want the headache. we have a 1994 dodge dakota that we bought brand new and he maintains it and we never have problems with it. i just think some of this new technology on the cars isn't so great.
thanks for your info! it helps to know what other people have done. there is a website i found topix.com that have a whole bunch of people on there that have had this problem and some of them said what they did to help the problem.
thanks for info sm
i don't even have credit cards to some of these accounts that are open. i think i will end up closing some of them. i think there are at least 10 or so of these credit card accounts that are open on my credit report that i don't use at all and haven't used for many years.
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