Monday, September 28, 2015

Medical Mondays: I Am Titanium

(That's one of my favorite songs, by the way.)

Today, we've got a question from a friend and author, Elle Cosimano. She's the author of the YA thrillers Nearly Gone, the sequel Nearly Found, and the upcoming Holding Smoke.

Coming May 3, 2016 from Hyperion
Elle asked: Do hospitals still use metal plates for reconstructive surgery, or do they use some other type of material? Assuming his skull was damaged [during an assault], is it reasonable to mention that he had metal plates in his head?

The short answer? Yes.

Here's the longer answer. In a situation where someone had enough trauma to the skull to warrant surgery, it's possible that they would need titanium implants during the surgery. In one scenario, only titanium screws and thin, narrow plates would be used to put broken pieces of skull together. In a situation where the skull injury is too large to be covered by native skull pieces, a larger piece of plating or mesh might be used.

Photo Credit
I sort of have a fondness for titanium, so here are some more thoughts.

Why is titanium used in medical implants? Titanium is an inert metal that is biocompatible with the human body, so rejection isn't an issue. It's also able to osseointegrate, meaning that bone can grow right up to that metal, without having scar tissue in between.

Do they have to stay there forever? For the above scenario, yes. For things like artificial joints, those tend to have a more limited life span of 15-20 years (or more) due to the wear and tear of the components of the actual socket. Other life span factors include the health of the patient, bone health, and activity levels.

Will the patient stick to an MRI machine, or a giant junk yard magnet?
No. Titanium is non-ferromagnetic, so MRIs are safe (however, if it's near the area being examined, the implant can cause blurring or streaks, called "artifact," of the images.)

How about metal detectors? Depending on the detector or screening tool at the airport/school/building, titanium implants could set off an alarm.

Other bodily uses? Titanium dioxide, which is the most common form of titanium found naturally, is also the white stuff used in physical sunblocks. Lots of body piercing jewelry is also made with implant grade titanium.

I need to impress my friends. Really? Well okay, if you insist. Melting titanium will explode on contact with water. Also, in titanium polluted soil, Scotch Bonnet mushrooms will bio-decontaminate the soil. There you go.

On that note, here's a link to David Guetta and Sia's song, Titanium. Because it was in your head anyway, right? ;)

Monday, September 21, 2015

Book Giveaway! Last Night in the OR: A Transplant Surgeon's Odyssey, by Dr. Bud Shaw

Plume Books/Penguin Random House/2015
Many of you know I've lived in Omaha for almost a decade now, after being a home-grown East Coast girl. I also did my twenty-four years of schooling and training in the East too. (I had to add that up recently when a middle schooler asked me how many years of work it took to be a doctor. I think I scared him out of a future in medicine! Oops.)

What many don't know about Omaha is this: it is not, in fact, littered with cow pastures.
And also this: it possesses a prolific, supportive, and thoughtful contingent of artists.

Bud Shaw is one of them, and it's been wonderful working with him on the literature side of things these last several years.

Dr. Shaw is a writer, poet, and retired transplant surgeon who developed the liver transplant program at the University of Nebraska Medical Center. He's written over 300 journal articles, 50 book chapters, and was nominated for the prestigious Pushcart Prize in 2013 for his essay, My Night With Ellen Hutchinson. He also became a friend during the time that I joined a workshop called the Seven Doctor's Project back in 2009.

Yesterday, I attended his book reading and signing at The Bookworm Omaha for his debut book, a memoir about his career in surgery and the very human journey he experienced. Here he is, kindly crouching down for the photo because he's so damn tall. (Everyone in Nebraska seems so damn tall to me, at least.)

He recently wrote this wonderful article in the New York Times about a singular experience of watching two of his identities collide, being a physician and parent.

A few words about the book:

“This is just about the best book about surgery and a surgeon I have ever read—by surgeon or civilian alike. It is warm, honest, straightforward, sad, amusing and compelling from beginning to end.” —Lee Gutkind

"Shaw's lean prose offers insights into medical professionals' private perspectives as well as a sobering sense of human fragility and the scientific strides taken to counter it. A bracing, unusual personal narrative that should appeal to aspiring physicians as well as to those considering the "big questions" around high-risk surgery." —Kirkus

“Dr. Shaw's memoir is a uniquely human journey of a man who performed superhuman feats.  His written candor made me (a surgeon as well) cry, laugh, recoil, cheer, and ponder life's true meaning.  I could not put this book down.”—Paul A. Ruggieri, M.D., author of Confessions of a Surgeon

You can find Dr Shaw's book at our local indie bookstore, The Bookworm, and also at Barnes & Noble, IndieBound, and Amazon

And I'm giving away a signed copy!

a Rafflecopter giveaway

I hope you get a chance to read it!

Monday, September 14, 2015

Medical Mondays: Fluoride Toxicity and Saying No To That 100th Cup of Tea

I've been wanting to do a #MedMondays on this one for a while.

In the United States, pretty much everyone is familiar with fluoride. The element fluorine is the lightest halogen and exists as a highly toxic, yellow gas at room temperature. But we know it better in its anionic form, fluoride.

It's in our drinking water and toothpaste, and helps to prevent tooth decay and keep our teeth strong. (But did you know that several countries have chosen to no longer fluoridate their water? The CDC says it's one of the top ten greatest public health achievements. Others have argued that it's a compulsory, mass medication in our drinking water. Thoughts?)

A little too much fluoride in your drinking water (or swallowing too much toothpaste) can cause dental fluorosis, which is harmless but causes cosmetic changes to the enamel in the form of stained and pitted teeth.

What about more severe toxicity? Well, it turns out that not only your teeth are affected by fluoride, but your bones. In some areas of the world, particularly where the fluoride levels in the water are high due to contaminated water supplies or geological sources, fluorosis can occur.

Chronic fluorosis, which is from consuming too much fluoride over time, can result in denser but brittle bones, calcified ligaments, stiffness and joint pain.
The arrows are pointing to excessive calcium deposits on the forearms and spine. Source: NEJM
Acute fluoride toxicity can occur in areas after industrial explosions or accidents (like from a hydrofluoric acid spill), or more commonly by ingestion of too way much fluoride-containing dental products. Symptoms can include nausea, vomiting and diarrhea (the trifecta of GI distress! In doctor's notes, we write that as N/V/D, in case you were wondering), kidney damage, heart damage, and possibly even death.

And guess what? You can get it from tea, too. Tea plants tend to accumulate fluoride from the soil. See those x-rays up there? They were from a woman who drank >100 tea bags worth of tea every day for 17 years (read here for the New England Journal of Medicine article.)

People who drink a lot of brick tea are at risk, too. What is brick tea? I actually snapped this photo at one of my favorite tea shops, thinking it looked just like an ink stone for Asian calligraphy.

Apparently, this type of tea can be made from older tea plants, and so they accumulate more fluoride than your usual cup of tea.

For more information, check out the CDC page on dental fluorosis and the WHO page on fluorosis due to drinking water. For parents, here's the info page on dental fluorosis by

Have fun brushing your teeth and overthinking the entire process! :D


It's here! So excited to be part of this dark YA anthology with some of my favorite authors!

About the book:

You’ve been there.

It’s dark and you’re comfortable. You’re just about to fall asleep when you can’t help but wonder if maybe tonight the thing you’ve always been sure exists will finally find you.

The best short stories stick with you, and the stories in this book especially, are meant to cast long shadows. The authors who contributed to this anthology are not only familiar with what lurks among the shadows, we choose to spend time there. Our monsters all live in different places—under beds, beside peaceful streams, inside ourselves, down mine shafts, in the sky. The darkness you’ll find in these pages knows no boundaries, so it’s only fitting that these stories cover many genres.

Reality can be just as terrifying as anything our imaginations conjure, which is why the darkness in these pages isn’t relegated just to flights of fancy or the paranormal. In choosing such a wide range of stories, our hope is that everyone will find something to make them clutch their bedcovers a little closer.

In realistic contemporary stories from Joelle Charbonneau and Kelly Fiore, depression, addiction, obsession, and isolation are all the stuff of nightmares. Other stories by Justina Ireland, Phoebe North, and Geoffrey Girard straddle the line, making us question what is real and what is false. Mindy McGinnis explores the question of not knowing yourself, while Kate Karyus Quinn speculates on the effect of learning that every terrible thing that’s ever happened to you has been manufactured for the entertainment of others.

Demitria Lunetta and Gretchen McNeil each take a closer, horrific look at human nature. Lenore Applehans delves into a post-apocalyptic future, while R.C. Lewis discovers the darkness that lurks on another planet in her science fiction narrative. Then of course there are the paranormal stories from Beth Revis and Lydia Kang, each digging into the many types of monsters that might wait for us in the dark.
Overall, you’ll find a wide range of horrors represented, including demons, aliens, and one of the most frightening creatures ever—human beings.

So set aside an hour or two, switch on some lights and come join us… among the shadows.

Monday, September 7, 2015


So excited that this book is coming out soon! We have lots of blog tour stops scheduled and there will be excerpts from the book at each stop.

Read some choice bits from this dark YA anthology--there is something there for every reader. :)

9/7/2015A Backwards StoryExcerpt- Lenore Appelhans

9/7/2015Bookhounds yaExcerpt- Beth Revis
9/8/2015The Book CellarExcerpt- Joelle Charbonneau
9/9/2015The Cover ContessaExcerpt- Kelly Fiore
9/10/2015Fiction FareExcerpt- Lydia Kang
9/11/2015Ohana ReadsExcerpt- Demitria Lunetta
9/12/2015It Starts At Midnight - Excerpt-Geoffrey Girard
9/13/2015The Bibliophile ChroniclesExcerpt- R.C. Lewis
9/14/2015CreatyvebooksExcerpt- Justina Ireland
9/15/2015Please Feed The BookwormExcerpt- Mindy McGinnis
9/16/2015Seeing Double In NeverlandExcerpt- Phoebe North
9/17/2015She Dreams in FictionExcerpt- Gretchen McNeil
9/18/2015Curling Up With A Good Book- Excerpt- Kate Karyus Quinn

See you on the tour! The book releases September 15th and is available for pre-order on Amazon. :)