In a nationwide cohort of patients with chronic pain, the use of medical cannabis was associated with a 64% risk increase of arrhythmias compared with no use. This poses a potential health concern and is vital knowledge for any physician prescribing medical cannabis. The use of medical cannabis was not associated with an elevated risk of ACS or HF.

Many cannabis users are familiar with trichomes. A tiny little crystal you’ll find on the leaves and buds of cannabis flower. Trichomes are minuscule in size, but they impact marijuana in a huge way. If you want your cannabis to have a lovely flavor and aroma– and a good amount of CBD or THC– you want your cannabis to have some well-tended trichomes.  Trichomes are tiny growths that can be found on certain plants, including algae, lichens, and cannabis plants. The word trichome comes from the Greek word “trichōma,” which means “growth of hair.” This is a fitting name for trichomes. As they look a bit like tiny, frosty, sparkly hairs that cover a plant. While cannabis trichomes are not hairs, they do grow out of the cannabis plant much like a hair would. Springing from the plant’s surface during the flowering phase.  

What do trichomes do?

In a nationwide cohort of patients with chronic pain, the use of medical cannabis was associated with a 64% risk increase of arrhythmias compared with no use. This poses a potential health concern and is vital knowledge for any physician prescribing medical cannabis. The use of medical cannabis was not associated with an elevated risk of ACS or HF.

As the stigma surrounding cannabis wanes and its potential medicinal value becomes more widely accepted, an increasing number of people are turning to the plant for both recreational and therapeutic purposes. However, despite its growing popularity, our understanding of how cannabis affects the human body is still limited. While a body of evidence points to the therapeutic potential of cannabis, it is important also to consider the potential risks associated with its use. A study by Holt et al. presented at the 43rd European Society of Cardiology Congress

Treatment with medical cannabis for chronic pain is in popular demand, and a rising number of countries allow physicians to prescribe medical cannabis for pain management. However, data on drug safety is scarce. Studies have shown a risk of cardiovascular side effects following the use of recreational cannabis warranting further investigations into the safety of prescribing medical cannabis.

last fall, for instance, suggested a possible link between cannabis use and an increased risk of cardiovascular events, bringing into question its safety.

About the Study 

Holt and colleagues conducted an observational study to examine the potential risk of cardiovascular events in 4,562 patients with chronic pain who were prescribed medical cannabis (cannabinoid, cannabidiol, or dronabinol) compared to a control group who weren’t taking the medication. Specifically, they looked at the risk of new-onset arrhythmias (abnormal heart rhythms), acute coronary syndrome (ACS, a condition caused by the sudden, reduced blood flow to the heart), and heart failure. The researchers used the Danish national registers to follow the cohort, who, importantly, did not have a history of arrhythmias, ACS, heart failure, or medical cannabis use prior to the study period (2018 to 2021). Patients from the exposed cohort were matched to controls in age group, sex, and chronic pain diagnosis. 

The study found that the risk of new-onset arrhythmias was higher in the group prescribed medical cannabis compared to the control group, with a risk ratio of 1.64 (95% CI: 1.04-2.23) – a 64% relative risk increase. The 180-day absolute risks were 0.71% (95% CI: 0.47%-0.94%) for exposed subjects vs. 0.43% (95% CI: 0.37%-0.49%) for controls, indicating an absolute risk increase of 0.28% with cannabis use. This 0.28% absolute risk increase translates to one case of arrhythmia for every 360 users. However, the risk of ACS or heart failure was not elevated in the group prescribed medical cannabis compared to the control group. 

A cause for alarm? 

Given the lack of human data on medical cannabis and potential cardiovascular risks, these findings are certainly noteworthy. However, upon closer examination, the limitations of the study suggest that there may not yet be cause for alarm.

One potential source of selection bias in this study is the difference in comorbidities between the exposed and control groups. Comorbidities refer to the presence of health conditions that an individual may be experiencing in addition to their “main” condition or the condition of interest within the study. In this study, the exposed group had more comorbidities, including hypertension, ischemic heart disease, chronic kidney disease, and diabetes mellitus, than the control group, which could potentially affect the results if the exposed group was more vulnerable to certain adverse events due to their overall health status. For example, in patients with hypertension, the heart muscle may enlarge (a condition known as cardiac hypertrophy), which can also involve the growth of fibrous tissue and a decrease in connectivity between cells. These changes can disrupt the normal electrical properties of the heart and increase the likelihood of arrhythmias. 

Another source of selection bias in this study is the fact that the exposed group had higher exposure to other medications compared to the control group. Other medications taken by the exposed group may interact with medical cannabis, altering the effects of both on the body and impacting susceptibility to CV concerns. It is also possible that other medications, if metabolized by the same enzymes in the body as CBD, could potentially interfere with the absorption, distribution, metabolism, and elimination of both substances. Notably, a significantly higher percentage of the exposed group (42.2%) were also taking opioid medications compared to the control group (12.3%). CBD has been shown to inhibit CYP2D6, an enzyme involved in the metabolism of opioids such as oxycodone, which may lead to an increase in the serum concentrations of these medications. In 2019, research by Dashi et al. revealed a link between opioid overdose and the occurrence of ischemic events, heart failure, and arrhythmias in patients hospitalized due to opioid overdose. Additionally, a review by Behzadi, Joukar, and Beik suggests that opioids can themselves trigger arrhythmias, and higher doses of these medications may exacerbate this effect.

The Bottom Line

Holt et al. showed that medical cannabis use was associated with a small increase in the risk of arrhythmias, but the presence of major confounds in this study stymies any meaningful interpretation of these findings with respect to the effects of cannabis per se. Those with pre-existing cardiovascular conditions may want to proceed with caution in light of the possibility that medical cannabis negatively impacts CV health, but ultimately, more research is needed.

FDA ‘remains unsatisfied’ with Philips’ handling of CPAP recall

We do not believe that the testing and analysis Philips has shared to date are adequate to fully evaluate the risks posed to users from the recalled devices,” the FDA's device center director, Jeff Shuren, said in an update this week. (Photo by Sarah Silbiger/Getty Images)

Since Philips began its recall of millions of respiratory devices in June 2021, the FDA hasn’t been shy about criticizing how the company has handled the recall.

Certain Philips Respironics ventilators, bilevel positive airway pressure (BiPAP) machines, and continuous positive airway pressure (CPAP) machines

And over two years in, despite Philips’ efforts, the agency “remains unsatisfied with the status of this recall,” according to an update it released Thursday and attributed to Jeff Shuren, M.D., director of the FDA’s Center for Devices and Radiological Health.

This time around, the FDA is taking issue with the independent testing Philips commissioned—on a post-recall request from the regulator—to assess the safety of the polyester-based polyurethane (PE-PUR) foam at the heart of the recall. The foam, which was added to many of Philips’ CPAP and BiPAP machines and ventilators to muffle sound and vibrations, was found to break down over time and possibly release debris and chemicals into a user’s airflow.

Philips reaches first settlement in class-action CPAP lawsuit

Since the start of the recall, the FDA has warned that inhaling particles released by the disintegrating foam could potentially lead to internal and external irritation, headaches, asthma, nausea or “toxic or carcinogenic effects to organs, such as kidneys and liver.”

Meanwhile, though Philips initially issued similar warnings, it has since changed its tune, touting instead the results of the independent testing, which concluded that exposure to materials released by the foam “is unlikely to result in an appreciable harm to health in patients.”

Is the FDA overreacting??  Many people no longer trust the FDAs judgment, since the COVID-19 mRNA EUA.  

Those findings clash with the FDA’s tally of more than 105,000 medical device reports (MDRs) related to the recalled devices that it received between April 2021 and the end of March of this year, including 385 reports of death—though both the FDA and Philips have been quick to note that MDRs are unvetted submissions and therefore their contents may not be directly linked to Philips’ devices.

Additionally, some experts have singled out the genotoxicity findings in the Philips-commissioned testing: The foam repeatedly tested positive for genotoxicity, and though the device maker said the results still fell within acceptable safety standards, experts interviewed in a recent ProPublica report argued that genotoxicity in any capacity is cause for “alarm,” since it denotes an ability to damage the genetic information within a cell, potentially leading to cancer-causing mutations.

It should be noted that genotoxicity was found in in vitro animal testing, not in a human Clinical Trial.

The FDA recall shows the inconsistency of the FDA's methodology as it approved an mRNA COVID-19 vaccine without a full approval process, yet recalled a previously approved device

FDA ‘remains unsatisfied’ with Philips’ handling of CPAP recall

Give Me some Attitude

Insurance Company Attitude

PTSD vs. PTSI — The Arguments for Changing the Name – It's PTSI

What's in a name?  Everything.

"Shell shocked". That is what PTSD was called after World War II and after the Korean War. 

We now realize PTSD occurs after any severe traumatic event, accident or emotional stress both acute and chronic.

The symptoms of PTSD are typically categorized into four main clusters:

1. Re-experiencing Symptoms: These symptoms involve reliving the traumatic event, often through distressing memories, nightmares, or flashbacks. Individuals with PTSD may experience intense emotional or physical reactions when reminded of the trauma.

2. Avoidance Symptoms: People with PTSD may try to avoid reminders of the traumatic event. This can include avoiding specific places, people, activities, or even thoughts and feelings associated with the trauma. They might also have a reduced interest in activities they once enjoyed.

3. Negative Changes in Mood and Thoughts: PTSD can lead to significant changes in a person's thoughts and feelings. They may experience persistent negative emotions, such as fear, guilt, or shame. They might have trouble recalling specific aspects of the traumatic event, feel detached from others, or have difficulty experiencing positive emotions.

4. Arousal and Reactivity Symptoms: These symptoms involve heightened arousal and reactivity, such as irritability, anger outbursts, difficulty sleeping, and being easily startled. Individuals with PTSD may also struggle with concentration and may become hypervigilant or overly alert to potential threats.

The American Psychiatric Association (APA) added PTSD —  coined in 1980 for severe, trauma-related symptoms among veterans of military engagement — to the third edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM). 

While the recognition was monumentally important then, a strong case can be made to think and talk differently about the condition today. More than 40 years later,  it’s clear that a shift from “disorder” to “injury” is necessary, if not overdue.

Post-Traumatic Stress Disorder (PTSD) is a complex mental health condition that can have various biochemical effects on the body. While I can provide some insights, please keep in mind that our understanding of the precise biochemical mechanisms of PTSD is still evolving. Here are some key biochemical effects and factors associated with PTSD:

PTSD or PTSI has associated biochemical dysfunction as well with the following features.

The technology can now detect physical changes in the brain following post-traumatic stress (PTS), but it was NOT available in 1980. These changes may include alterations in neural connectivity, activation patterns, or even structural changes in specific brain regions.

While it is understood, and even accepted, that terminology and conceptual frameworks within medicine often require time to adapt and incorporate advancements, like the ones mentioned above, the time has come to change the current classification/diagnosis of PTSD to PTSI. The once “invisible“ wounds of brain injury following psychological trauma can now be

1. **Hypothalamic-Pituitary-Adrenal (HPA) Axis Dysregulation:** One of the most well-documented biochemical effects of PTSD is the dysregulation of the HPA axis. This system controls the body's stress response. In individuals with PTSD, there can be alterations in the levels of stress hormones such as cortisol. Some may have elevated cortisol levels, while others may have reduced sensitivity to cortisol.

2. **Neurotransmitter Imbalances:** PTSD has been associated with disruptions in neurotransmitters, which are chemical messengers in the brain. There can be alterations in serotonin, norepinephrine, and dopamine levels. These imbalances can contribute to mood disturbances, anxiety, and other symptoms of PTSD.

3. **Inflammatory Response:** Chronic stress, which is often a part of PTSD, can lead to chronic inflammation in the body. Inflammation is associated with various physical and mental health issues. Elevated levels of inflammatory markers, such as C-reactive protein (CRP), have been observed in some individuals with PTSD.

4. **Alterations in Brain Structure and Function:** Neuroimaging studies have shown that PTSD can lead to changes in the structure and function of the brain. The amygdala, which plays a crucial role in the processing of emotions, can become hyperactive, leading to heightened emotional responses. Conversely, the prefrontal cortex, involved in emotional regulation, may show decreased activity.

5. **Epigenetic Changes:** There is emerging research suggesting that trauma, including that which leads to PTSD, can induce epigenetic changes. These changes can affect gene expression and may be passed down through generations. Epigenetic modifications can play a role in the long-lasting nature of PTSD symptoms.

6. **Sleep Disturbances:** Many individuals with PTSD experience sleep disturbances, which can further exacerbate biochemical imbalances. Sleep disruption can impact neurotransmitter function, stress hormone levels, and overall well-being.

7. **Altered Immune Function:** Prolonged stress associated with PTSD can weaken the immune system, making individuals more susceptible to infections and other health issues.

It's important to note that not all individuals with PTSD will experience the same biochemical effects, and there is significant variability in how PTSD manifests. Additionally, the relationship between biochemical changes and the development or persistence of PTSD is complex and not fully understood.

Treatment for PTSD often involves a combination of psychotherapy, medication (such as antidepressants or anti-anxiety drugs), and lifestyle changes to address these biochemical imbalances and their associated symptoms. Early intervention and a comprehensive approach to treatment are key to helping individuals with PTSD manage their condition and improve their overall well-being. 

 observed in the brains of people diagnosed with post-traumatic stress and, thus, should be considered “injured.”

The efficacy of diagnostic imaging, and the importance of its role in determining treatment for the injured, should not be ignored when considering the effects — and the survivors — of severe trauma. The current model of a “disorder” does not consider the latest, widely accepted neuroscience developments and, thus, renders the “D” in PTSD to be clearly outdated, from a scientific perspective.

The use of brain scans to diagnose PTS has proved inconclusive, yet there is abundant evidence for changes in the structure and function of different areas of the brain involved in fear response and anxiety, regulation of emotions, cognitive processing, and memory. For example, Michael T. Alkire, M.D. — featured in a 60 Minutes segment about the use of SGB to treat PTSD — has demonstrated over-activation of the amygdala in patients with PTS as far back as 2015 in his work for VA Long Beach Healthcare System.

From a scientific perspective, the “D” in PTSD is outdated. Seeing is believing.

Stigma is a barrier to seeking help.

PTSD vs. PTSI — The Arguments for Changing the Name – It's PTSI

Read About the Study

Costco announces new $29 perk for shoppers after membership - and customers call it 'awesome' | The US Sun

New scam ??

COSTCO announces new $29 perk for shoppers after membership

Costco enters the digital telehealth market by aligning with Sesame, a telehealth network.  Especially interesting is the telehealth mental health perk, for $72.00

You get what you pay for.  Costco has entered a slippery slope, one which will backfire for them and their intended Costco Members.  Costco has a reputation for quality products, such as tires, food, and other specialty items. and exceptional guarantees and this flies in the face of its credibility.  Will COSTCO offer a refund if your are dissatisfied?

This is nothing but a ploy to bring business into the COSTCO PHARMACY, which is an established and credible pharmacy.  Why not get your prescription at COSTCO PHARMACY. After all you are there already.

However, why pay $29 to get the prescription from an unknown person from Sesame who may not even be an M.D. doctor.  Many of Sesame's providers are unsupervised Physician assistants or Nurse practitioners. It's important to note that both PAs and NPs are mid-level medical professionals. They're basically at the same level. However, NPs can work independently in many states that PAs can't. So, it places nurse practitioners above physical assistants in terms of practice independence. 

In order to make an appointment on the Sesame Telehealth Platform, you must enter. your credit card information and add several personal identifying information data. Is Sesame telehealth HIPAA compliant?

CAVEAT EMPTOR !!!

 

Costco announces new $29 perk for shoppers after membership - and customers call it 'awesome' | says  The US Sun, an online newspaper.

Emergency Message System

Motor Vehicle Crashes: A Leading Cause of Death for Children. Of the children who were killed in a crash, 36% were not buckled up. Parents and caregivers can make a lifesaving difference by ensuring that their children are properly buckled on every trip. Risk Factors for Child Passengers   Age Restraint use (like car seat, booster seat, or seat belt use) varies by age. Restraint use typically decreases as children get older. In a study from 2021 where researchers observed children riding in cars, they found: <1% of children under age 1 were not buckled up, 6% of children 1–3 years old were not buckled up, 11% of children 4–7 years old were not buckled up, and 13% of children 8–12 years old were not buckled up.3   Being unrestrained in a vehicle increases the risk of being killed in a crash. In a study from 2023 using fatal crash data, researchers found: 30% of 0–3-year-olds killed in crashes were not buckled up and 36%§ of 8–12-year-olds killed in crashes were not buckled up.   Also, among children who are buckled up in child restraints, many graduate too soon to the next stage of child passenger safety. An example is when children stop using a booster seat before the seat belt fits them correctly. Age-appropriate restraint use typically decreases as children get older. Race and ethnicity American Indian and Alaska Native children and Black children are more likely to be killed in a crash than White children. Child passenger death rates were highest among American Indian and Alaska Native children (2.67 per 100,000 population), followed by Black children (1.96), according to combined data from 2015–2019. Several studies also indicate that it is more common for Black children, Hispanic children and American Indian and Alaska Native children to travel unrestrained or improperly restrained when compared with White children. 21% of Black children, 15% of Hispanic children, and 7% of White children ages 4–7 years were not buckled up, according to a study in 2021 where researchers observed children riding in cars. There are likely many reasons for these differences, including access to affordable car seats and booster seats and differences in culture and perceptions related to car seat and booster seat use. Rural versus urban location Children in rural areas are typically at higher risk of being killed in a crash. According to combined data from 2015–2019: Child passenger death rates were highest in the most rural counties (4.5 per 100,000 population) and lowest in the most urban counties (0.9). Death rates among children who were not using age-appropriate restraints were highest in the most rural counties (2.9 per 100,000 population) and lowest in the most urban counties (0.5). Studies also indicate that children in rural areas are more likely to be incorrectly restrained than children in urban areas. A multistate study using data from car seat check events found that child restraint misuse was more common in rural locations (91%) than in urban locations (83%).Similar to racial and ethnic disparities, there are likely several factors for these differences. Alcohol-impaired driving Alcohol-impaired driving is a major threat to all road users, including child passengers. In 2021, 25% of deaths among child passengers (ages 14 and younger) involved an alcohol-impaired driver. Among all child passengers (ages 14 and younger) who were killed in crashes, a higher proportion of those riding with alcohol-impaired drivers were unrestrained (43%) compared with children riding with drivers who had no alcohol in their system (38%).   Driver seat belt use Restraint use among children is associated with their driver’s seat belt use. In 2021, 69% of child passengers ages 14 and younger killed in crashes who rode with unbuckled drivers were also not buckled up, compared with 26% of children riding with buckled drivers. Researchers who observed adults and children riding in cars in 2021 found that 95% of children ages 7 and younger who were driven by a buckled driver were restrained, compared with 77% of children driven by an unbuckled driver. Many other studies assessing different child age groups or specific geographic locations have also found strong associations between unrestrained drivers and unrestrained child passengers. Car seat and booster seat misuse Car seats and booster seats are often used incorrectly, which can make them less effective. Researchers who observed children riding in cars in a 2011 study estimated that 46% of car seats and booster seats are used incorrectly in a way that could reduce their effectiveness.22–24 Car seat misuse estimates are even higher at 59% when booster seats are excluded. More

The average doctor in the U.S. makes $350,000 a year. Why? - The Washington Post

The average doctor in the U.S. makes $350,000 a year. Why? - The Washington Post

Compensium of Unpublished Health Train Express Articles

 These are previously unpublished articles from September 2016 until current (September 22, 2023)

I unknowingly accumulated these drafts during the past years.  Sometimes I will look at them and don't even remember writing them...   Does anyone else have this experience?  Am I brain-damaged?

https://draft.blogger.com/blog/post/edit/1928170677546195443/7695180941023409286

https://draft.blogger.com/blog/post/edit/1928170677546195443/2985923747823633413

https://draft.blogger.com/blog/post/edit/1928170677546195443/6864373290720454374

https://draft.blogger.com/blog/post/edit/1928170677546195443/451197192291627646

https://draft.blogger.com/blog/post/edit/1928170677546195443/4723515906286209104

https://draft.blogger.com/blog/post/edit/1928170677546195443/6352283569341904365

https://draft.blogger.com/blog/post/edit/1928170677546195443/8563191770624462465

https://draft.blogger.com/blog/post/edit/1928170677546195443/3426109235947992328

https://draft.blogger.com/blog/post/edit/1928170677546195443/8154004737906066492#

I will be posting additional memories.  Stay tuned

Giving up the knife: Saying goodbye to surgery

Words from a retiring surgeon.

RANDALL S. FONG, MD 

PHYSICIAN  

SEPTEMBER 20, 2022 

This year, I stopped doing surgery — giving up the knife, so to speak. It wasn’t an easy decision to make. I’ve been a surgeon for 32 years since graduating from medical school. It’s been a distinct part of who I am for most of my life.

This doesn’t mean I’ve retired. I’m still practicing in a clinic-based setting and still do procedures in the office. I just no longer operate in hospitals or ambulatory surgery centers. And because of this, I no longer must take call for the hospitals and their emergency rooms (which are required to have surgical privileges at a hospital). In the past few years, seeing patients in the office occupied most of my work week anyway.

And yet now, the time spent in the office is less harried and more engaging. I’m more in the moment with the person in front of me, without that overhanging sense of dread that comes with the unknown — an unexpected complication in a post-op patient, a call from one of the ERs, the hospital or the transfer center.

Office encounters have been more rewarding. Besides a patient’s medical problems, I’m more inclined to see their intangible qualities, aspects of their nature that can be intensely interesting or downright humorous.

I do miss the OR. I miss the people in the OR. Though we’ve faced a torrent of scary, pee-in-the-pants situations as any surgical team is bound to face, much of the time was quite pleasant and fun. Yeah, surgery can be a real kick-in-the-pants. That’s the reason I became a surgeon.

I miss some of the more challenging surgeries when actively treating a patient with cancer was the ultimate high of my surgical profession. But I gradually gave up some of the more complicated and lengthy surgeries some years ago. Part of this was the stamina of my youth had dwindled– some of those cases took six to eight or more hours of continuous operating with no break. More importantly, more fellowship-trained surgeons nowadays are sub-specialized with more experience. It was best for the patient to be treated by these folks, even if it meant traveling three or more hours to get there. All the other ENTs in our area have done the same.

I was the sole “old-timer” still in private practice. All the other ENT doctors in our area are employed by a large hospital system with a huge referral base. My surgical volume was far lower than my hospital-employed colleagues, which didn’t bother me since I was getting older. Yet last year, I was the only ENT taking call for all three of our area hospitals. I could’ve been employed by a hospital, earning much more while relinquishing the business of running a practice, but the loss of autonomy wasn’t worth the trade-off.

I wasn’t unhappy about making less than my peers. There was no dire need for more money. What’s the endpoint with money anyway? How much annual income is really enough? My wife and I always budgeted our expenses and were able to save each year while regularly contributing to our kids’ college funds, even during the leanest years. We stuck by a strategic plan for savings and investing and nearly met our financial retirement goals before I decided to stop doing surgery. Our quality of life was not adversely affected. Additional money would not have changed our lifestyle.

Stopping surgery and no longer taking calls from the hospitals was the right thing to do at the right time. I eventually felt the stress evaporate, replaced by an enhanced peace of mind. I see this not as an end but as another stage in life’s journey. But I’m not ready to retire yet.

After giving a lecture earlier this month, a third-year medical student came up to me. He was interested in pursuing ENT, his reasons being a good blend of clinic and surgery — some of the same reasons I chose this calling. He said that aside from tonsillectomies, and nasal and ear procedures, he wasn’t aware we did surgeries such as thyroidectomies, parotidectomies, neck dissections, and the like, which fascinated him even more.

He asked how one gets to that point doing such intricate surgery. I had that same fascination back when I was a lost third-year med student, not knowing what field of medicine to choose. The epiphany came during a series of lectures from a few of the ENT attendings, one of whom was a head and neck surgeon who later became my mentor (Bruce Campbell, MD). Like a slobbering, tail-wagging dog, I approached him and asked the same questions. I chose ENT and never looked back. It has been — and continues to be — a most fascinating and rewarding career.

Saying goodbye to surgery is a pivotal and bittersweet milestone, but I look back at my surgical career with fondness and satisfaction. And despite no longer performing surgery in the OR, I still want to treat patients until I am unable to do so.

Following are a few lines from a speech to the graduating class of residents I was asked to give this year, which speaks to this very point:

At this stage in my career, I still want to keep going. I still think of medicine as an adventure. I still find joy in our profession. I still learn; I learn from all of you. It’s been 27 years since I finished my residency, and I reflect back with a sense of satisfaction and pride and no regrets. Though I look forward to one day retiring, I’m hesitant to do so since what we do is so meaningful, absorbing, and worthwhile that I don’t want my professional journey to end. That’s by choice. Being a doctor is a part of who I am, embedded in my DNA. And hopefully, it is with you.

Giving up the knife: Saying goodbye to surgery