Met with my not-so-hidden co-writer to go over our notes, and to start the editing process. Dr. Klein has written all of the drug content (he’s a clinical pharmacist), and much of the Bogotá city chapter. We’ll be getting together again this week to go over the book, in-depth and try to get a little closer to publication. It’s the first time I’ve seen him since leaving Bogotá, so it was great to get together again.. Now it will be a lot coffee (and sushi – our brain food) until the book is finally complete.
Author Archives: AL Press
Interview with Dr. Borraez, Bogota Bag: 27 years later
One of my new articles on Dr. Borraez has been published to Yahoo! (associated content section) – it’s shared content with the site.. I’ve also written two other articles, one of original content, so I’ll let you know if they get published. I thought it might get a little more exposure this way. I’ve written this trio of articles for Yahoo! as a trial run, so we’ll see how it goes..
Note: Due to recent changes at Yahoo! this article link has changed. I have updated the link to the new article link. Please let me know if you have difficulty accessing this article.
Goodbye Colombia!
fresh fruit at the market
My last today here – and I managed not to work my final day – until now.. Spent the day at the market, and spent the afternoon with friends…
Going to do one last post, before I finish packing up and getting ready to leave tomorrow morning.. Hard to believe leaving would be so difficult – but this has been an amazing time.. Writing this book has been a dream come true, even though at times it’s been frustrating, exhausting..
Making new friends here was an added bonus – but it makes it hard to leave..who would have guessed the girl from the itty bitty town in Virginia would enjoy the big city so much?
For everyone wh s daunted by the thought of a big city like Bogotá, in Colombia, no less.. Don’t be afraid – enjoy the vibrant life that is Bogotá.. the sophisticated mix of city, with quaint country traditions like bike riding on Sundays..
"the office" where I spent a lot of time writing, (and Victor, who looked out for me)
Now, it’s time to start editing.. Be back in August to present the book..
Images of Surgery in Colombia
I have published several Images of Surgery in Colombia to the web to give outsiders a glimpse into the operating rooms here in Bogota. But since Yahoo! has overhauled their site – I will publish images here for readers, including photos from some of my other travels (Mexico, Medellin).
However, please do not use/ copy/ alter these images without my express written permission. (All photos by K. Eckland)
Hospital San Carlos
Approaching Hospital San Carlos
So, I was really excited to head out to Hospital San Carlos.. It’s an older hospital – out in the south part of Bogotá, set apart from the city by verge of being in the midst of a park.. It’s where they film “A Corazon Abierto” which is one of my favorite programs here (or was, while I had a tv to watch.. along with RCN news – which is fantastically dramatic..)
But when I got out there, security informed me that no tours on the weekend, and no, I could not come in.. So I peeped in windows, and wandered the grounds. It’s an interesting place, several of the windows I peeked in looked like old storerooms and had equipment that must have dated from the originally opening.. It’s an art deco building, but it definitely has a gothic feel – great place to film one of those B movies about murderous patients in a haunted sanitorium.. (except of course, for all the pretty landscaped flowers, LOL) so much for my active imagination..
Hospital San Carlos
Wish I could tell you more – but unlike many of the security guards I’ve encountered – there was no charming this one..
Colombia as a medical tourism destination: my experiences & observations
I submitted an article on Colombia as a medical tourism destination to Yahoo! for publication. The article discusses several of the factors I’ve mentioned before, and includes my observations from the last several months. We’ll have to wait and see if they think it’s suitable for publication.. Of course, if they reject it – I’ll be sure to post it here, for all of you and your critiques..
Interview with ProExport
Update: 14 May 2011: I received a comment on the website from a Mr. Gabriel Amorocho (of ProExport) inviting questions – so I have sent him several.. Thank you for contacting me. I will update readers and let them know if I receive a reply..
Original Post
There’s nothing like a government agency to remind you of your own insignificance. In this case, it’s Colombia’s ProExport.. ProExport is the government tourism division and one of its specific aims is to promote medical tourism to Colombia.. and here I am, writing a guide to medical tourism in Colombia…hmmm.
So as a writer on medical tourism in Colombia – I thought it would be nice to meet with someone over there, just to hear more about ProExport, what they do, what they are doing to further medical tourism, what they thought the future of medical tourism was in Colombia, etc.. It was a pretty important interview for me – because I thought I would be able to get a lot of questions answered for potential medical travelers, from an official source… yeah – it would have been nice.. But..
Nope, Nada, Never. Not even after five months! of calling, emailing and trying to get an appointment with someone, anyone, over at ProExport. Everyone I’ve met here has tried to intercede, even my downstairs neighbor (who knows someone who knows someone etc..) to get me just twenty minutes with someone from ProExport.. I’ve emailed several people at ProExport directly, from the information they provided.. I even managed to navigate the operators, with multiple transfers only to be transferred to an endlessly ringing phone.. and called again, and again, and again.. Never even got a form response to my emails..
It was easier – to get a reply from the President himself, (President Juan Manual Santos), and he was exceeding gracious about it.. (I sent him a copy of my first book – silly, but I was excited – my very first book, and just a week or so later, I received a very nice thank you note..)
So it’s the last weekday, of my last week here in Bogota, so I guess this humble writer, has been humbled again – and I will accept defeat.. There will be no ProExport interview for this unknown writer..
Dr. Oswaldo Borraez, Trauma Surgeon
Most of you will never meet Dr. Borraez, a trauma surgeon at hospital San Blas, one of the public hospitals in the poorest neighborhood in Bogota, but now you will have heard about him. In March of 1984, when he was a second year surgical resident Dr. Borraez , training at San Juan de Dios, Dr. Borraez was assisting in a surgical case with a patient that had a serious infection preventing closure of the abdomen.
Dr. Oswaldo Borraez, Trauma Surgeon, The Bogota Bag
(In cases of severe abdominal trauma, infection or necrosis closure of the abdomen can lead to the patient’s death due to compression of the abdominal compartment – leading to a sequelae of abdominal compartment syndrome —> internal organ hypoperfusion —-> organ failure —-> respiratory distress —> death. So basically all the swollen abdominal organs crush the blood vessels and other structures..)
During this case, the attending surgeon and the other operating room staff were looking for something to use to close the abdomen*. Sometimes surgeons used sterile operating room towels but that increased infection and allowed for massive fluid losses, and the synthetic films were prohibitively expensive (and not without their own problems.)
So while he was in the OR, Dr. Borraez spies the IV bag, and starts thinking.. He then took the largest bag made (a urology fluid bag – 3 liters) sterilized it, and placed it in the abdomen. And it worked – perfectly, as if it had been designed for that purpose.. It was clear, which allowed surgeons to monitor the wound, it was hypoallergenic, it prevented infection, it’s strong yet flexible and most of all – it was cheap (about 2 dollars) and available in any hospital – world-wide.
Since then, he has been recognized internationally for its use, especially after noted Atlanta trauma surgeon, Dr. David Feliciano came to Bogotá and saw this technique in use. He wrote about it in standard American trauma textbooks used worldwide, gaining some well deserved recognition for this kind Bogotá physician, who continues to work and innovate (for the last 27 years) in this humble hospital serving Bogotá’s neediest patients.
He now speaks at conferences world-wide, talking about the Bogotá bag – and different ways it is now being used. Hundreds of research studies and case reports have confirmed his findings. His contribution was recognized as one of Colombia’s top ten innovations in Medicine, along with the Hakim valve (which we mentioned in another post.)
He has successfully used the Bogotá bag as a permanently implanted internal closure device (placed between the muscle and the intestines) in 55 patients with no problems.
He continues to innovate for more affordable and practical wound closure devices. Currently, he has adapted a colostomy bag, along with a natural sponge and a suction canister as an effective wound-vacuum closure device, which mimics the success of the cost-prohibitive ‘wound vac’ (KCI) but only costs about a dollar to implement. (Wound vacs can be several hundred dollars per day of use.)
Yet, somehow, in between seeing patients, surgery, creating affordable solutions and teaching residents – he found time to sit down, explain all of this to me – and show me several patients with their “Borraez bag” in place.
* a temporary measure until swelling / infection subsides and allows for surgical closure.
In other news, I want to say hello to one of ‘my patients’ – (I know he is reading this) Cristian, a very nice thoracic surgery patient that I met during rounds one day. I tried to take a picture (he was very gracious and granted permission instantly) to show what a great guy he was – I met him as he was walking down the hall, chest tube canister in one hand, and puffing on his incentive spirometer in the other.)
He, too, made time for me, a strange American nurse, speaking bad Spanish – to answer my questions and tell me all about why he was walking the halls and puffing on this little box.. He gave me a tour of the hospital while we walked, and he puffed intermittently, as I thought about how everyone, doctors, nurses and patients have been so welcoming to me here. This kindness has certainly made this project not only possible, but a wonderful experience, that I will greatly miss when I return to the USA in a few days.
In the operating room with Dr. Rafael Beltran, Thoracic Surgeon
Dr. Rafael Beltran, Thoracic Surgeon
Spent the morning at the National Cancer Institute, which really is a pretty amazing place, with a pretty amazing guy – Dr. Rafael Beltran. He’s one of the many incredible people I’ve met here – that truly make the world a better place through their work. I could have spent all day with him, seeing patients, surgery, discussing his cases and research – (Heck – I’d love to work with him!) but unfortunately, I had to race across town after several hours for another interview..
Dr. Beltran (tall gentleman on the left) and his surgical team
I really like this picture here, I think it highlights one of the important aspects of surgery – the surgical team.. As you can see above, Dr. Beltran (left) certainly doesn’t work in isolation – and that’s his philosophy about cancer care – the surgeons from different specialties work together closely, along with oncologists, radiologists, hematologists, therapists and other specialties to give well-coordinated, and well-rounded care. While I was the operating room, I stood next to a shy young woman.. After I badgered her for a little bit – she told me her story. She’s a respiratory therapist – and she was watching the surgery, so she would better understand how to take care of her lung surgery patients – and to understand exactly what they had been through. Not often do surgeons find room in their ORs for respiratory therapists – but Dr. Beltran understands that by having this young woman here observing – she learned more today than she could ever glean from books.. By doing so – he’s integrated her into the surgical team, and that’s important when often today’s medicine is an exercise in fractured and fragmented care.
In the operating rooms all around us – the same thing was occurring, with orthopedics, plastic surgery, neurosurgery.. As you can tell – on all my visits to the National Cancer Center, I’ve been very impressed with the physician commitment and the level of care.
As I raced off – I received a text that the doctor I was next scheduled to meet had to go to another hospital – he offered to meet me there, but he had an emergency, so I thought it best to reschedule for when he had more time. I’m really looking forward to talking to him – so I didn’t want him to be too distracted.. I get the best interviews when we can just sit down and talk..
Then – a thoracic surgeon we’ve talked about before – texted me that he had 2 interesting cases – did I want to go? So I spent he remainder of the afternoon talking with Dr. Juan Carlos Garzon, thoracic surgeon. I’m glad I did – because I had lots of questions from our previous interviews, and between cases, he spent the time to answer my lingering questions; about his practice, about thoracic surgery in general, and about Colombian medicine so it was definitely a worthwhile trip..
Dr. Juan Carlos Garzon, Thoracic Surgeon..
The Future of Thoracic Surgery
Dr. Juan Carlos Varon in the bronchoscopy suite
Actually, this title sounds way too dire for the pleasant and relaxed day I spent over at Hospital Santa Clara, interviewing Dr. Barrios, Thoracic Surgeon and two Thoracic residents, Dr. Juan Carlos Veron and Dr. Carlos Carvajal.. But it’s essentially true as I talked to the up and coming Dr. Barrios, and the future thoracic surgeons… Dr. Barrios is currently involved in some very interesting treatments for metastatic cancer.
Dr. Juan Carlos Varon, unmasked
Dr. Carlos Carvajal
I also interviewed Dr. Juan Manuel Troncoso and his partner, Dr. Elena Facundo, two general surgeons who are currently involved in some interesting projects..
Last week in Bogota
well, everyone – my visa is expiring, I’ve spent my retirement, I’m physically exhausted, and I need a job – it’s come time for me to return home to the United States. But not before I cram in as many last-minute interviews as possible before my plane takes off in the early morning hours of May 16th.
My only regret is despite interviewing as many surgeons as I was physically able, it just wasn’t possible to meet and talk to all of the thousands (literally thousands) of surgeons here in Bogota.
For my last week, I have some great interviews lined up – going to meet with several more surgeons at Hospital Santa Clara, going to the operating room with Dr. Beltran from the National Cancer Institute and interviewing with the amazing trauma surgeon, Dr. Borraez, inventor of the ‘Bogota Bag’ aka the ‘Borraez Bag.’ I’ll be seeing Dr. Holguin, as well, from the first edition – to catch up as he now lives in Bogota part-time.
I’m still hopeful I’ll be able to slip in and see a few more surgeons – waiting to hear back now..
But I won’t be away from Colombia for too long! I plan to be back in August, once I’ve completed the arduous task of editing the hundreds of pages of notes, and thousands of pages of additional materials – to present my book, here in Bogota, first – to all the people who have assisted me, took time out of their busy schedules to talk to an unknown nurse, and budding writer.
Even if I never sell a large amount of copies, I feel like I have accomplished a lot – I have brought some well deserved attention to some great physicians. Many of these people do things, ever single day that would be considered extraordinary at home. Others have invented or performed procedures that are used around the world to help others. Others make the world, and Bogota, a better place, just by listening to their patients, giving freely of their time and caring. That’s no small feat in today’s world of medicine, and for me, no small feat to write about.
I hope that the readers of this book are able to get a sense of the information I am trying to convey, and that it helps them with their healthcare decisions. If I have done that, and sell ten copies – then I have succeeded beyond my wildest dreams.
Thank you to everyone following my blog, and I hope you’ve enjoyed reading it as much as I have enjoyed writing it!
Interview with Dr. Catalina Morales, Plastic & Hand Surgeon
Met with the very nice Dr. Catalina Morales yesterday evening to talk about Plastic, Aesthetic and Reconstructive Surgery.. Oh – and did I mention hand and maxillofacial surgery..
She’s very enjoyable to interview because she’s one of those people who really finds pleasure in what she does.. She likes to help people with reconstructive surgery, and she enjoys the satisfaction her aesthetic practice gives her patients..
Planning to go to the OR with her today – so we will re-visit the smiling, talented Dr. Morales later this afternoon..
Update: In the operating room with Dr. Catalina Morales, at Clinica de Marly 7 May 2011
Dr. Catalina Morales at Clinica de Marly
Dr. Morales at Clinica de Marly during hand surgery
I also interviewed Dr. Casallas Gomez over at Santa Fe de Bogota, read about it in another post..
A tribute to Dr. Salomon Hakim
Dr. Salomon Hakim, the Father of Modern Neurosurgery died yesterday here in Bogota. I never had the privilege of meeting Dr. Hakim, and I was not an ardent follower of his work.
But I did have the pleasure of interviewing his son, Dr. Fernando Hakim . I had heard Dr. Salomon Hakim’s name mentioned in passing, so I had familiarized myself with him prior to meeting Dr. Fernando Hakim, thus I knew of his contributions to the treatment of hydrocephalus, and the field of neurosurgery, and the development of the Hakim valve. I had even gone by San Juan de Dios in downtown Bogota, and tried to imagine him, hard at work, in the now deserted halls.
I remember upon my first meeting with Dr. Hakim being daunted by his accomplishments, and then thinking, if I felt daunted by his achievements, what was it like to be the son of Salomon Hakim?
But, Dr. Fernando Hakim – he didn’t follow in his father’s footsteps.. He tread through them, and past them to build upon his father’s body of work, and create new innovations. That is the greatest tribute anyone could ever give Dr. Salomon Hakim, a man who dedicated his life to helping others.
New short on YouTube : The Thoracic Surgeons
New short film on YouTube featuring many of the thoracic surgeons you’ve seen profiled here on BogotaSurgery.org – Dr. Nelson Renteria, Dr. Stella Martinez, Dr. Andres Jimenez, Dr. Mario Lopez, Dr. Juan Carlos Garzon, and Dr. Ricardo Buitrago.
Hoping the next film is ‘live action’.
General surgery M & M
Attended the general surgery case review at Clinica Reina Sofia today. No pictures to post here today, but several interesting cases presented.
Back in the OR with Dr. Renteria
Went back to the operating room for several vascular cases today with Dr. Renteria at Compensar. Everything went well – I’ll upload photos later…
Update: Photo from 3 May 2011 – Vascular Surgery, Dr. Renteria
Dr. Renteria, Vascular Surgery
Dr. Beltran and Dr. Renteria, Thoracic Surgeons
Spent a fascinating morning over at the National Cancer Insitute with Dr. Rafael Beltran, the Chief of Thoracic Surgery. Since the cancer institute is the biggest hospital specializing in cancer treatment – Dr. Beltran sees most of the rare and unusual cancers affecting the chest. He also have a keen interest in tracheal surgery, and has published (in collaboration with Dr. Barrios) several articles on the topic recently. (Guess we’ll have to tap into his expertise for a guest publication over at CirugiadeTorax.org)
Hoping to follow him to the OR next week.
Then I spent the afternoon over at Hospital de Kennedy with Dr. Nelson Renteria.
Dr. Nelson Renteria, Thoracic & Vascular Surgeon
Today he performed a VATs decortication for a stage III empyema (which is one of my favorite cases – but that’s another discussion entirely.) Going back tomorrow to see some of his vascular cases.
Dr. Renteria in the operating room
Meeting of the minds – thoracic surgery
Attended the monthly thoracic surgery meeting led by Dr. Juan Carlos Garzon yesterday for case discussions.. Several interesting cases presented. More importantly, I met and set up interviews with the last few thoracic surgeons; Dr. Beltran and Dr. Rodolfo Barrios (that I hadn’t met previously). Should be an interesting week in the south end of the city..
On the topic of thoracic surgery – I am soliciting articles from thoracic surgeons, and other practitioners on the site – not just here in Bogota, but from around the world as part of the mission of the site. I’ve already had some great feedback from some American surgeons.
Over at cartagena surgery we are talking about the recent announcement by the International Diabetes Federation on treatment recommendations for diabetes including the endorsement of Bariatric Surgery.
International Diabetes Federation supports Bariatric Surgery for treatment of Diabetes
In a 180 shift from the position adopted by the American Heart Association who remains firmly rooted in the idea of bariatric surgery as a ‘last resort when all options have been exhausted’ the International Diabetes Federation (IDF) has taken the unprecedented and progressive step forward to recommend bariatric surgery as a form of aggressive treatment for Diabetes, (which is now only suboptimally controlled with multiple medications in the majority of people.)
In a re-post from Medscape, an article by Robert Lowes “Bariatric Surgery Recommended for Obese Patients With Type 2 Diabetes” reports that surgery is now being endorsed to prevent the devastating complications of this disease.
In this ground-breaking move, hope is being offered to the millions of people diagnosed with this disease.
Article re-post below:
March 28, 2011 — Bariatric surgery is an appropriate treatment for people with type 2 diabetes who are obese, the International Diabetes Federation (IDF) announced today.
Although such operations cost anywhere from $20,000 to $30,000, they will reduce healthcare expenditures in the long run, according to a new IDF position paper on the subject. The surgery, the IDF explains, often normalizes blood glucose levels and reduces or avoids the need for medication.
 |
| Dr. Francesco Rubino |
In addition, curbing diabetes can stave off costly complications such as blindness, limb amputations, and dialysis, said Francesco Rubino, MD, director of the IDF’s 2nd World Congress on Interventional Therapies for Type 2 Diabetes, meeting today in New York City.
“When we talk about whether we can afford bariatric surgery, we have to ask what will be the cost if we don’t treat the patient,” Dr. Rubino told Medscape Medical News. “Studies have shown the surgery to be cost-effective. So there is a return on investment.”
The IDF puts the lifetime cost of diabetes in the United States at $172,000 for a person diagnosed at age 50 years and $305,000 at age 30 years. More than 60% of this amount is incurred in the first 10 years after diagnosis.
Under the new IDF guidelines, patients with type 2 diabetes warrant bariatric surgery when their body mass index is 35 kg/m2 or higher, or when it is between 30 and 35 kg/m2 and their diabetes cannot be controlled by medicine and lifestyle changes. This latter indication is even stronger when there are other major cardiovascular risk factors, including hypertension, hyperlipidemia, and a history of heart attacks, said Dr. Rubino, chief of the Gastrointestinal Metabolic Surgery Program at New York-Presbyterian Hospital/Weill Cornell Medical Center.
The body mass index action points can be reduced by 2.5 kg/m2 for Asians.
The guidelines were drawn up by an IDF taskforce of diabetologists, endocrinologists, surgeons, and public health experts who met in December 2010.
Trials Needed to Compare Surgical Procedures
The new recommended indications for performing bariatric surgery on patients who are both diabetic and obese match those announced last month by the US Food and Drug Administration for expanded use of the Lap-Band Adjustable Gastric Banding System (Allergan) to treat obesity.
The US Food and Drug Administration originally approved the product, designed for laparoscopic adjustable gastric banding (LAGB), for adults with a BMI of 40 kg/m2 or higher and those with a BMI of 35 kg/m2 or higher who have additional risk factors. Under the expanded indications, the LAGB system also can be used for adults with a BMI of 30 to 40 kg/m2 and 1 additional obesity-related condition who have failed to lose weight despite diet, exercise, and pharmacotherapy.
The use of bariatric surgery to treat diabetes has sparked controversy in healthcare circles. Critics question the wisdom of wielding a scalpel to solve a medical problem, especially when clinicians have more drugs at their disposal to deal with diabetes.
At the same time, a study published online last week in the Archives of Surgery has raised doubts about the efficacy of LAGB. Researchers following 151 patients who underwent LAGB for obesity concluded that the procedure yielded “relatively poor long-term outcomes,” with nearly half the patients needing their bands removed and 60% overall requiring some kind of reoperation. The authors, who performed the surgeries in question during the mid-1990s, added a caveat: they had used an older dissection technique.
“The band is only one option,” Dr. Rubino told Medscape Medical News, noting that gastric bypass procedures have demonstrated a greater endocrine effect than LAGB. “We are learning that some types of diabetes are well treated by lap-banding early in the disease process. The answer is in patient selection.”
The IDF taskforce calls for randomized controlled trials to compare different bariatric procedures for diabetes between themselves, “as well as emerging non-surgical therapies.”
Dr. Nelson Renteria, Thoracic and Vascular Surgeon
What a delightful afternoon with Dr. Renteria and Dr. Cecilia Villasante (Radiology)! Dr. Renteria works at the Centro Vascular del Country, which led me to suspect that he may no longer practice thoracic surgery.. But, happily, I was wrong.
While I enjoy meeting all the wonderful and interesting people from all surgical specialties (like the orthopedic surgeons I met with today), I can never deny how much I enjoy talking to people from my home specialties. Maybe it makes me a little less homesick for my patients because it’s all so familiar.. And it’s always thrilling to meet people who find empyemas, VATS and all these other things thoracic as interesting and engrossing as I do, especially when you meet people like Dr. Renteria, who still loves what he does as much as I do. He still enjoys discussing cases, and has a real enthusiasm for his patients.
And – He does esophagectomies! (Not many thoracic surgeons in Colombia perform esophageal surgery which is kind of like the ‘open heart’ surgery of thoracics*.) He completed his fellowship training in esophageal surgery at Toronto General Hospital with Dr. Pearson (Dr. F. Griffith Pearson of Pearson’s Thoracic and Esophageal Surgery) and currently does esophagectomies here in Bogota. (This is much bigger news than it sounds – finding qualified thoracic surgeons that perform an adequate number of esophagectomies can be difficult even in large centers. Currently, in my home state of Virginia – University of Virginia is home to the largest esophageal surgery center with three dedicated thoracic surgeons. Even my beloved Duke only does about 75-76 cases a year.)
So, I admit I lost a bit of my professional cool (if I ever had any). I was like a kid in a candy store – talking about pre-operative optimization, Ivor -Lewis versus Transhiatal approaches, node dissection and other minutiae that I enjoy.
I must say – I am looking forward to following him to the operating room soon!
** Studies show a significant decrease in morbidity and mortality when esophagectomies are performed by thoracic surgeons (versus general surgeons).
The Department of Orthopedics at Clinica San Rafael
Dr. Victor Lizcano, Chief of Orthopedics
Spent the day with several surgeons from the Department of Orthopedics at Clinica San Rafael – which has a city-wide reputation for excellence.
Dr. Victor Lizcano, MD is the charming Chief of Orthopedics who opened his busy, 11 surgeon department to me. I watched surgeries, talked to patients, reviewed films, and interviewed the surgeons in his department, with free rein.
Orthopedics surgical team; two instrumentadors and 4th year resident (center)
Dr. Maria Angela Gomez, MD, a busy surgeon who nevertheless took the time to talk to me; manages dual practices; both as a plastic surgeon (at Clinica de Marly) and an orthopedic (hand) surgeon. She’s currently involved in a very interesting research project – tell you more about it later… A very fascinating lady.
Dr. Martha Pincon, MD an orthopedic surgeon specializing in foot and ankle surgery, also a very interesting and enjoyable surgeon.
Dr. Martha Pincon, during a complex case at Clinica San Rafael
There’s a lot more to tell – but I have another interview in a few minutes..
The Latest Compilation
Enjoy – a short ad for the Bogota Guide to Medical Tourism featuring Bogota’s Hottest Young Surgeons – including Dr. Juan Pablo Umana, Dr. Ivan Adolfo Santos, Dr. Juan Carlos Garzon, Dr. Freddy Sanabria and Dr. Felix Castro. If you haven’t heard about Bogota’s best and brightest – you haven’t heard anything yet.
In the OR with Dr. Diego Pineros, cardiac surgeon
Dr. Diego Pineros, cardiac surgeon
Spent an enjoyable morning with Dr. Diego Pineros in the operating room at Clinica San Rafael, watching him operate on a four-month old girl. Surgery went well, with no intra-operative or post-operative problems.
Spent the remainder of the morning talking about cases, the history of cardiac surgery and seeing patients.
Like many of his counterparts here in Bogota, Dr. Pineros spends his “leisure time” in ways we might not expect. Right now, he is coordinating and arranging for his surgical team to fly to Tolima (300 miles away) to perform several pediatric cases over the weekend. The team will spend several days to make sure their little patients are well on the road to recovery before returning to Bogota, and to another full week of surgery. When asked about this, Dr. Pineros quickly shrugs off any praise – stating, “they need surgery, and there is no one [at that hospital] to do it. It’s hard on the families that travel to Tolima [from outlying rural communities] for care.”
Dr. Diego Pineros
Cardiac Surgeon, Clinica San Rafael
Book Advertisement
Created a new advertisement for the book. Now, obviously for reasons of patient privacy, HIPAA and all of that – we’ve changed the names, and pictures of the people involved. (I did obtain permission from the patient to use surgery photos in print, video and other media).
This is the first in a series of ads for the book, so let me know what you think.
Does it get any better than this?
Going to heart surgery tomorrow – with one of the nicest people I’ve met since I’ve been here.. (Don’t worry, I’ll tell you all about it.)
Then, later this week, I have an appointment for an interview with a thoracic and vascular surgeon – I always said those two specialties combined are like dynamite..
Does it get any better than this? I’ll let you know.
(Cartagena Surgery News) But it certainly gets worse: over at our sister site we are talking about the financial and emotional burdens placed on Americans due to our failing healthcare system..
(Thoracic Surgery News) We’re discussing robotic surgery at our new Thoracic Surgery Portal:
Saw this on a neighboring blog, talking about robotic lung surgery – but my readers here know that Dr. Buitrago has been training with an American surgeon to offer that treatment here – at Clinica de Marly.
Thoracic Surgery portal
Over at our sister site – we’ve published the first few discussions on lung surgery, and lung diseases as part of our new lung surgery portal.
It is the first tentative steps towards a fully integrated lung surgery site – CirugiadeTorax.org
which I hope to one build into a one stop site for patients looking for information, the latest treatment and facilities for lung surgery, and lung cancer. I envision a site eventually filled with articles, links to treatment options/ and facilities along with physician profiles from different surgeons around the world, so patients have access to the newest, and most effective treatments possible.
It’s a big task to take on – but it all starts somewhere, and who better than I, a practicing acute care nurse practitioner, in cardiothoracic surgery?
I am already travelling, meeting thoracic surgeons, learning about new and different treatments at every opportunity..
Just posted new articles on Malignant effusions and Preventing post-operative atrial fibrillation..
Dr. Diego Pineros, cardiac surgeon, (revisited)
Clinica San Rafael – Bogota, Colombia
Most of you haven’t heard of Dr. Diego Pineros but I originally interviewed him about three months ago, (long before I set up this website.) He is one the many genuinely nice people I have had the fortune to meet during this trip (and a great tour guide since he knows quite a bit about the history of Bogota). Today, I went back to visit him, at Clinica San Rafael, which is one of several facilities where he operates.
The case for this morning was cancelled, but it was nice to catch up with Dr. Pineros, meet his residents (young future surgeons) and see the clinic itself.
While we were there – we ran into Dr. Mario Lopez (thoracic surgeon) who has now added Clinica San Rafael to his roster. If you remember, we last saw him in the operating room at Mederi.
I tried to get a picture of him (without his mask) but it’s a bit blurry..
Hope to be back at Clinica San Rafael soon, so I will be able to tell you more.
Wrapping up!
Leaving Bogota in three weeks – then completing the rest of my writing stateside.. Trying to cram in as many interviews and surgeries as possible before I leave, but playing email/ phone tag with far too many people..
In the OR with Dr. Mauricio Largacha, Orthopedic Surgeon
The rest of Bogota may be quiet for the Easter holidays (la semana santa) but the operating rooms were busy at Unidad Medica Cecimin.
Dr. Mauricio Largacha, Shoulder and Elbow surgeon
I spent an interesting and enjoyable morning in the operating room with Dr. Mauricio Largacha, MD for an arthroscopic Rotator Cuff Repair. Dr. Largacha is a natural teacher, and did an excellent job at explaining different aspects of the procedure, expected post operative outcomes, and specialized equipment – since I am less familiar with shoulder and elbow surgery than other surgical procedures. (Unsurprising since as I mentioned previously, he is an expert in this area, and the author of several chapters in multiple orthopedic surgery textbooks on elbow, shoulder and ankle surgery).
Dr. Mauricio Largacha (left) and author
Surgery went beautifully, and surprisingly quick.. No intraoperative complications.
Dr. Celso Bohorquez, plastic surgeon
When we first met Dr. Celso Bohorquez, he was donating his time and surgical skills for the repair of congenital facial malformations in Chia, Colombia as part of Operacion Sonrisa.
I went back, yesterday, to Clinica Shaio, to learn more about the man, and the surgeon that so generously contributes to improving the lives of the less fortunate.
Dr. Celso Bohorquez, plastic surgeon
We spent the day in the operating room, watching Dr. Bohorquez perform several techniques including a case with facial endoscopy as part of a face-lift. The results of the cases were striking.
In other news, we are discussing pre-operative and intraoperative risk reduction for peri-operative/ post operative MI (along with the high incidence of missed diagnosis) over at our sister site.
Dr. Ernesto Andrade, plastic surgeon
Dr. Ernesto Andrade is another one of Bogota’s celebrity plastic surgeons, of “Cambrio Extremo” fame. (A latin television version of ‘Extreme Makeover’ that was popular here several years ago.) Unfortunately, he was delayed today so I was unable to meet with him, but I did speak with a young doctor in his office, Dr. Eliana Garces. She filled in a bit of Dr. Andrade’s biography.
I’m hoping to meet with Dr. Andrade himself tomorrow after I get out of the operating room with Dr. Celso Bohorquez. If you remember, I met Dr. Bohorquez out in Chia while he was volunteering his surgical skills as part of Operacion Sonrisa (Operation Smile.)
Dr. Mauricio Largacha, orthopedic surgeon
Dr. Mauricio Largacha is an orthopedic surgeon specializing in shoulder and elbow surgery including arthroscopy, rotator cuff repair and joint replacement. I’ll be following him to the operating room this weekend – so check back in for more details..
For readers unfamiliar with orthopedic surgery – ankle and shoulder joint surgeries are a particular sub-specialty only practiced by a few orthopedic surgeons. Luckily for readers here – Dr. Largacha is the author of several of the most heavily used textbooks (and chapters in American medical textbooks) on both ankle and shoulder surgery.
Dr. Fabian Emura, of the EmuraCenter
Dr. Fabian Emura, of the EmuraCenter
is a gastroenterologist and general surgeon here in Bogota, who specializes in the detection and treatment of digestive cancers. Along with his clinic, he has also created two separate divisions; a foundation for promote the prevention and detection of digestive cancers, and a medical education division – which supports training physicians world-wide in the endoscopy techniques he currently uses.
Currently, Dr. Emura is the only physician outside of China, Korea and Japan (where gastric cancer is endemic, and accounts for 20% of all cancers) who is treating early stage (stage I) cancers with endoscopic surgery versus a more radical gastrectomy. This procedure has already been well validated in Asia, where it has been used for over a decade.
Dr. Emura has also created and implemented a classification system for the grading and staging of digestive lesions.
By using chromography endoscopy (or chromoendoscopy) and a wax dye, doctors such as Dr. Emura are better able to visualize lesions that might otherwise be missed.
His research has also focused on differentiating colon lesions endoscopically, (to prevent unnecessary surgery for benign lesions).
He is currently working on screening guidelines (particularly for populations with higher incidence of gastric cancers such as in Colombia) because one of the main problems that still exists – is that the majority of patients with stomach cancer – are diagnosed late – when treatment options are limited and noncurative.
The Doctors Luna at Clinica Shaio
Interviewed the father and son, Dr. Ruben Francisco Luna Romero and Dr. Ruben Daniel Luna Alvaro this morning, before following Dr. Luna (Alvaro) to the operating room. Dr. Luna was joined by the remaining doctor in the Grammo practice, Dr. Cesar Guevara.
Due to some technical issues – i will post photos later.
Update: 21 April 2011: Photos
Dr. Luna, general and transplant surgeon
Dr. Guevara (left) and Dr. Luna (right) during laparoscopic surgery
Dr. Cesar Guevara, Grammo
Hospital San Juan de Dios
Hospital San Juan de Dios, front view
from first glance – the majesty and history of this place is lost.. The newer 70’s era concrete edifice overshadows the older, more classic church and other buildings in this sprawling campus.. An iron fence, scattered trash, dirty, stained mattresses laying on the ground, broken windows, and overgrown grass keep the casual viewer from ever knowing what’s really inside. The lost letters on the tower building, add to the forlorn air that hangs around the old hospital.. A few bored looking guards patrol lazily, mainly smoking and chatting behind one of the buildings – not enough to keep out the many vagrants that are rumors to have taken up residence here.
It’s a sad and undignified end to a place that has given much to Colombia, and it’s capital city. For a facility with such a long and proud history (it was founded in 1723) – it seems unfair that is should be so unkept and unloved. While it was designated a national landmark in 2000, now it is more of an eyesore. For a place that witnessed the first surgery in Colombia (in 1926) and the development of the first malaria vaccine, and was home to much of the medical research of the 19th and 20th centuries – this is a tragedy indeed. I can almost picture Dr. Salomon Hakim, inside these halls, hard at work. Entire generations of physicians trained here, practiced here and retired from here before it’s closure in 1999. Inside this fence, these buildings are silent witness to hundreds of years of suffering, sickness, hope, faith and health.
But there are no plaques, no tour guides**, no monument or museum to mark its contributions.
Previous attempts have been made to re-open the hospital (200,000 besos campaign in 2008), and several local books and articles, but little to show the world, and outsiders like myself, all the wonderful contributions and history, behind the locked gates.
While this is quite the departure from my usual writing, I couldn’t help pondering all of this as I walked past the hospital the other day.
** There is an old article stating there are free tours on the last sunday of every month, by former nurses, so I’ll go by and see if that is still the case.
Back in the OR with Dr. Buitrago, and a visit with Dr. Andres Franco
National Cancer Institute –
Dont judge a hospital by the exterior sign..
The view from the fifth floor is less than inspiring – with the Bogota prison from one angle and the now decrepid Hospital San Juan de Dios from another..
The view from the operating room window, the now defunct Hospital San Juan de Dios
But the view from within the operating room is impressive! Large operating rooms, in an all new facility, with brand new equipment.. This is a first class surgery facility..
– and the surgery itself was wonderful. I can’t divulge too many specifics other than it was a huge surgical resection that was the last chance for a heart-breaking patient..
- Dr. Buitrago, Thoracic surgeon
But the case went beautifully.
After spending all morning and part of the afternoon with Dr. Buitrago and his team – I went over to Hospital Santa Clara to interview a nice young thoracic surgeon, Dr. Jaime Andres Franco. Dr. Franco is actually dually trained as both an Critical Care Medicine specialist and a thoracic surgeon – which is ideal because it means he is even more capable of handling any sort of crisis that may affect his surgical patients.
I’m hoping to follow him to the operating room soon, so I can give you even more details..
In the OR with Dr. Martinez, Thoracic Surgery
Spent most of the day over at Hospital Santa Clara with Dr. Stella Martinez, thoracic surgeon.. Despite having three cases, Dr. Martinez apologized for the paucity of scheduled OR surgeries due to the upcoming religious holidays.. (Despite Bogota’s booming population – this is a familiar scene, repeated around the city – kind of like people putting off surgery until after Christmas..)
Dr. Martinez, in the OR
I’d been warned by several people about Hospital Santa Clara – it’s one of the poorer public facilities, but to be frank, despite the aging exterior, it beat out some of the homegrown facilities I’ve been to.. While it was obviously a less affluent facility; with a campus style layout, no CT scan, and a 1950’s feel; the hospital was clean, all of the equipment worked, much of it was new – courtesy of a new administration..
Dr. Stella MArtinez, Thoracic surgeon
Dr. Martinez is impressive, both in and out of the operating room – with an extensive resume, and skill set. She’s currently the Director of the thoracic surgery residency program at Hospital Santa Clara, and she takes resident training seriously. She’s also interested, and active in research, and maintains a busy surgery practice at several facilities. There’s a lot more to say about this talented surgeon , but you’ll have to wait to read the rest.
In the OR with Dr. Hakim
Had an interesting day with Dr. Fernando Hakim, Neurosurgeon, over at Santa Fe de Bogota, for a tumor resection. A lot of the stereotypes are true; neurosurgery is a precision-based specialty (not that the other specialties aren’t – but at least in most cases, there is a margin to work with**.) but some of them aren’t.. In this case, with a tumor pressing against the spinal cord – there is no margin to work with, no border area around the tumor, so to speak.. but then again this petty much describes a lot of neurosurgery.. requiring careful, painstaking process..something I would find inherently, and incredibly stressful – but Dr. Hakim and his team didn’t; they were focused, precise, but relaxed and well-coordinated with each other.. Definitely not the uptight, high stress stereotype.. (You’d think I would have known better – I’ve seen plenty of surgery, and some spine cases# before – but nothing of this magnitude, and as I’ve said before; neurosurgery is a bit of a final frontier)
(not to give you the wrong impression – surgery is always serious, this just wasn’t the melodrama that stereotypes/ stories sometimes suggest)
Dr. Fernando Hakim Daccach (left), neurosurgery
** ‘margin of tissue’ or area surrounding the tumor, not ‘margin of error’
# cartagena neuro cases were ‘back cases’ or spinal cases for chronic back problems..
Dr. Hakim, neurosurgeon using the OR microscope for precision work
To switch gears a bit, I met with Dr. Fabio Andres Mejia, a plastic surgeon specializing in rhinoplasty and breast procedures (augmentation/ reduction). He’s a former fellow (and current member of the) Dr. Ralph Millard (Society) and has been in practice since 1998.
He’s no longer working three jobs or taking emergency plastic surgery calls all over the city – and is now focused solely on private practice (and having a livable schedule)
Gastric banding versus gastric bypass: Easy?
Another example in the realm of surgery where easiest doesn’t equal most effective: gastric banding (lap-band). This is one of those procedures highly touted in American medicine – and heavily advertised on television as an ‘easy’ way to lose weight..
First, let’s get some things clear – the ‘easy’ mentality needs to go away in medicine, and so does the pushing of this concept with patients.. None of this; not surgery, weight loss drugs, or conventional treatment is easy for the patient..It’s all hard work, so don’t mislead your patients – that sets them up for failure..
In the article linked here (from the LA times, February 2011) the two doctors interviewed do their best to avoid answering the easy/ effective question. “I let the patient decide,” which is a royal cop-out. Patients come to doctors for expert opinions and recommendations not wishy-washy information that doesn’t present the facts and evidence. The picture accompanying the article is disturbing as well, since it’s captioned as a patient awaiting lap-band.. The patient is clearly morbidly obese – yet is undergoing the least effective option available!
What makes this frustrating to me – is that in talking to patients – is that it’s usually such a long road to even get to bariatric surgery.. Contrary to popular belief and tabloid reporting, the majority of overweight people don’t jump to bariatric surgery.. These patients spend years (sometimes decades) dieting, gaining and losing weight..
This isn’t always the case in other countries where surgery is more readily available – but in the USA where insurance coverage or lack there of, usually dictates care – bariatric surgery is usually the end of a long, frustrating road..
I know I’ve discussed this before on the site – but I feel that there needs to be transparency in treatment options – and that we need to do away with the ‘easy’ concept whether it’s bariatric surgery, stents or even medications.. Don’t sell people easy – give them safe, proven and effective.
I’ll be updating the article over the next few days with links for more information – and hard facts about surgical options and obesity surgery.
Related Articles: Free full-text links: (my titles, the actual titles are a bit longer)
1. It’s Not Easy – a study looking at the patients perspective, and perceptions before and 2 years after bariatric surgery.
2. Current treatment guidelines and limitations – a discussion of current treatment guidelines in the USA and Canada
3. German study with 14 year outcomes after gastric banding – this is a nice study because they use terms that are easily understood for laypeople – and shows decent outcomes for patients with this procedure
4. Single port bariatric surgery – this has been a hot topic over at the sister site. This article discusses the most recent innovations in surgical techniques for bariatric surgery.
5. A review of the current data (2008) surrounding bariatric surgery, obesity, and diabetes and the cost of care.
This is a particularly good article (reviews often are) because it gives a nice summary of multiple other studies – so intead of reading about eight patients in Lebanon or some other small group – you are getting a good general overview..also it gives a good idea the scope of the problem..
I’m trying to collect a wide range of articles for patient education; unfortunately, since surgeons in Latin America are on the forefront of bariatric surgery – a lot of the most interesting articles are in Spanish and Portuguese (or paid articles). i haven’t posted the translations since they are secondary source and all of the other citations are primary source.
In the OR with Dr. Javier Maldonado
Dr. Javier Maldonado, cardiac surgeon
No southern accent, per say, just a gentle, relaxed way of speaking that reminds me of home.. Went to the operating room with Dr. Javier Maldonado at Clinica Colombia this morning, for a three vessel off-pump CABG. Everything went smooth – textbook perfect..
I followed him to the Cardiovascular ICU and then to his cardiac clinic to see patients..
After a productive and pleasant morning (and afternoon), I raced over to Clinica Shaio to catch the end of the minimally invasive cardiac surgery symposium, and to interview Dr. Barbosa, one of the first surgeons I interviewed for the Cartagena book..
Dr. Javier Maldonado
Cardiac surgeon, Fundacion Santa Fe de Bogota, Clinica Colombia
Colombian Culture & Cuisine 