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September '10

Tuesday 28 August 2010

Changes in Practice of Medicine –

Part 3

Dr. Bert Grapes

Bert Grapes continued with a third part on changes in medicine over the past 50 years.


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Surgery is no longer done for many conditions including acid reflux, bleeding of the esophagus, stomach ulcers and duodenal ulcers.  Appendectomies are not as common as coronary bypass surgery.  Diagnostic techniques have reduced the number of appendectomies.


Fiber optics have contributed to surgery being less invasive and patients are able to recover more quickly.  Fiber optics are used when operating for diseases of the colon thus avoiding large muscle damage.  For many issues related to the colon, where surgery is required, appliances are much better and almost invisible.  Some conditions of the bowel like diverticulitis can be helped by avoiding laxatives and ensuring one eats a good diet.

Cancer of the rectum can be best managed by early detection.  It is important to have regular digital examinations by your doctor and watch for signs of blood in your stool.

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Treatment for breast cancer is still evolving.  50 years ago the standard treatment was a radical mastectomy.  Through research it has been determined that segmental resection is a better approach.  This means removing the section of the breast where the cancer is located and then treating the patient with radiation. 

If there is no recurrence after 5 years the patient is considered cured.  Current research related to breast cancer is looking at the DNA of the cancer cells to determine what happened to the DNA chain.  The idea of this is find what is changing the genes and then stopping that from happening.  If successful this approach could likely be used with other forms of cancer.


Orthopedics have seen great improvements over the past 50 years.  Surgical steel has been a big contributor.  It is harder and non-corrosive.  This has resulted in significant improvement in plates, appliances and joints.  Very hard plastic is also being used now.  The result is fractures heal more quickly and one is able to put weight on the joint sooner.


Kidney stones are now most often treated with blast of ultrasound to disintegrate them (lithotripsy).


The bottom line is that in spite of the improvements, you should always ask for a second opinion when dealing with a difficult health issue.

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