Pointing fingers: Taking the "easy out" with obesity

Dr. Ann Childers and I had an interesting twitter conversation (twonversation?) the other day. It went like this:

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AnnChildersMD I once saw a child who, at age 6 years, weighed more than 90 lbs. She ate a high carbohydrate diet, and drank a can of soda every day. 5 days, 22 hours ago from web

staticnrg @AnnChildersMD Lots of kids do that and don't weigh 90 lbs. Not healthy, but there is more at play than just food w/ a 6 y.o. 5 days, 22 hours ago from iTweet in reply to AnnChildersMD

AnnChildersMD re: prior tweet Her parents were poor, and soda is cheap (except for the medical bills). Children drinking soda is accepted in our society. 5 days, 22 hours ago from web

AnnChildersMD Nearly all my obese patients drink sweetened sodas. Ones that don't are ex-soda drinkers, looking for a substitute. 5 days, 22 hours ago from web

staticnrg @AnnChildersMD How many of your "non-obese" patients drink sweet soda? Have you asked? Your tweets sound biased to me...are they? 5 days ago from iTweet in reply to AnnChildersMD

AnnChildersMD @staticnrg Personally, I am "biased" against processed and refined carbs. But there is plenty of "bias" in the scientific lit against soda 5 days, 19 hours ago from HootSuite

AnnChildersMD @staticnrg Dietary Sugars Intake and Cardiovascular Health: A Scientific Statement From the American Heart Association http://ow.ly/pzDG 5 days, 19 hours ago from HootSuite

staticnrg @AnnChildersMD Yes, bad for all, but majority of those who do those "bad" behaviors are not obese. Why are we pointing at only the obese? 5 days, 10 hours ago from web in reply to AnnChildersMD

RT @staticnrg Why are we pointing at only the obese? {I was actually pointing at soft drinks <:-}1:36 PM Sep 16th from web

staticnrg @AnnChildersMD No, last night you first mentioned obese--I responded to that & asked if you asked slim patients about soft drink habits. :) 5 days, 7 hours ago from web in reply to AnnChildersMD

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I realize Dr. Childers was well-meaning. I just don't think she and other doctors see what they are really saying. This conversation looks like Dr. Childers assumes only obese children drink "sweetened sodas" and slim children do not. I wish it were that simple. Now, I don't have a study to prove it, but I have observed in my 52 years a lot of folks who drink sweetened soda and are slim. I've also observed a lot of folks who do not drink sweetened sodas and who are slim, and others who are not.

I never drink a sweetened soda unless I'm sick, and was only allowed to drink them as a child about once a year. Oh, and a ginger-ale when sick then, too. I think we are too quick to point at food and drink as a culprit but forget that Grandma fixed sweetened tea, fried everything, potatoes, and more for meals all the time.

Yes, I agree these foods and sweetened sodas are not healthy. My parents were health nuts before it was fashionable, and I grew up eating healthy and drinking non-sugared drinks. Milk was skim, and we had eggs only once a week. Salad was a treat to us in the winter, but we grew the vegetables and lettuce in the summer. My mother taught school and my dad was a corporate manager. We were literate and they were wise. I believe my mother is the reason I kept my weight down even with Cushing's much longer than most. Sadly, that is not the case now, but I still eat like I should, not like I look like I do. My HbA1c is 5.4, and I work hard to keep it that way with high cortisol. (Ask @sixuntilme how hard that is!)

As I drift along in this post, my point is: Why ask only obese patients about sweetened soda? Slim patients have a lot of terrible habits, too. The tweets highlighted above show the point I'm trying to make. Obesity isn't the only problem caused by sweetened sodas. And there must be a factor at play other than the sodas when some can drink them and not gain weight while others drink them and do gain. Or even DO NOT drink them and still gain.

Of course, I must point out endocrine factors. This blog is full of them. Just the posts about bariatric surgery not working for those with endocrine diseases attest for that.

@jensmccabe has tweeted some very interesting things on epigenetics. I've poste a couple of things. Those need to be considered, too.

But my MAIN point in all this (and forgive my tired rambling) is that we are quick to point at the "bad behavior" of the obese without looking to see if that same "bad behavior" is duplicated in the non-obese population. It's poor science. You know what they say about "assume"...

Research is what it is. It's easy to "prove" those who are obese drink a lot of sweet soda. It's not so easy to prove that those who drink sweet soda are obese. Not to mention drinking diet soda may make one obese. How 'bout them apples? Uh...sodas...?

I'm all for eating correctly. I work hard at it. But I think we need to be careful when attributing behaviors to obesity and make sure they are ONLY obesity related. That's what I was trying to say, Dr. Childers.

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Patients First: Twitter Transcript

From the first tweet by Dr. Val...

Medbloggers and congressman discuss healthcare reform at the National Press Club today 9am-12pm ET. Follow #patientsfirst for live coverage.

....to the multitude of tweets from participants and the audience, it was an intense and vibrant conversation. The tweets of those on Twitter were in the background as those on the panel gave their responses.

I missed it. I was working and couldn't watch. But I wanted to read the thread as it happened, in the order it happened. So I compiled it and here it is for those of you who missed it or want to read what others had to say.

To those who participated and/or tweeted, I want to say a great big "THANK YOU!!"

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UPDATE: Here are some blog posts/links that are pertinent to this discussion. Feel free to email or comment below if there are others which I've missed:

Someone who actually knows how to put patients first

Congressman Paul Ryan's speech

Media piece about Patient's First

Dr. Rob's post about his experience

Dr. Wes' speech

Dr.Wes' wrap-up

When "Putting Patients First" is a matter of perspective

An interesting, vibrant, and on-target discussion took place on Twitter today. Dr. Rob (@doc_rob) and Dave (@ePatientDave) started discussing the event "Putting Patients First" at the National Press, hosted by Dr. Val Jones (@drval).

1. 
   ePatientDave What's wrong w this picture? The event "Putting patients first" has no patients on the panels http://bit.ly/3wc2vh 12 Jul 2009 from TweetDeck
2. 
   ePatientDave Clue: talking *about* pt-centered, w/o pts in the talks, is like Congress talking about suffrage w/o women in the talks 12 Jul 2009 from TweetDeck
3. 
   ePatientDave To be blunt about it, that approach to suffrage took nearly a century (Superb Ken Burns film http://bit.ly/PjuIH) 12 Jul 2009 from TweetDeck
4. 
   doc_rob @ePatientDave What do you want said? 12 Jul 2009 from Tweetie in reply to ePatientDave
5. 
   doc_rob re: Putting Patients First - Women's suffrage is not analogous. People who work with poor and know plight of them are worth listening to. 12 Jul 2009 from Tweetie
6. 
   doc_rob Plus, we are ALL patients in this system. I am a doctor AND a patient. I know MANY patients' hardships, not just one. I love my patients. 12 Jul 2009 from Tweetie
7. 
   ePatientDave @doc_rob Oo oo, the well clued @Doc_Rob is one of the panelists at the (impatient) Putting Pts First! Let's have a blogchat! 12 Jul 2009 from TweetDeck in reply to doc_rob
8. 
   doc_rob Healthcare workers who give a damn and ACTUALLY care for patients have had no voice up to now. I plan on advocating for them. 12 Jul 2009 from Tweetie
9. 
   ePatientDave @doc_rob Seriously, will you host that? Or should e-patients.net host it? You rock! 12 Jul 2009 from TweetDeck in reply to doc_rob

-- this quote was brought to you by quoteurl
Dr. Rob is one of the members of the panel at the event. He has been and still is taking an active interest in representing patients. As you can see below, he continues that.

1. 
   doc_rob @ePatientDave It's what I try to do all the time. I'd love to host a real discussion. Understand that not all docs are deaf to their pts. 12 Jul 2009 from Tweetie in reply to ePatientDave
2. 
   ePatientDave Thinking out loud...continuing suffrage thought: imagine male Congress discussing "impact on our process if women vote" 12 Jul 2009 from TweetDeck
3. 
   doc_rob Read http://bit.ly/MdRZQ
   to understand where I come from and what I will say. 12 Jul 2009 from Tweetie
4. 
   ePatientDave @doc_rob I do understand that. It's the "is a proxy sufficient" question. So, dude, git the party started! I'll bring some peeps. 12 Jul 2009 from TweetDeck in reply to doc_rob
5. 
   doc_rob I'll put up a post on the subject tomorrow with the intent on getting discussion and hearing opinions. 12 Jul 2009 from Tweetie
6. 
   doc_rob Nah. I'll do it today. 12 Jul 2009 from Tweetie
7. 
   ePatientDave @doc_rob btw, since the point is to contribute not rant, in our pre-talk we should include finding out what the audience thinks about 12 Jul 2009 from TweetDeck in reply to doc_rob
8. 
   doc_rob @ePatientDave How about me writing a post that says: "Tell me what you think I should talk about in Washington?" 12 Jul 2009 from Tweetie in reply to ePatientDave

-- this quote was brought to you by quoteurl
As the discussion continued, others became involved also. For the sake of brevity, I didn't include all the tweets that resulted. Dr. Bryan Vartabedian (@doctor_V) posted "We're All Patients" as a response to the tweets.

1. 
   ePatientDave Yikes: @ "Putting pts first" http://bit.ly/3wc2vh, not only no pt spkrs; Policy Expert=pharma front CMPI http://is.gd/1wbok 12 Jul 2009 from TweetDeck
2. 
   ePatientDave YikesX2: The CMPI "policy expert" warned 1/08 "Internet health searches are dangerous to public health" http://is.gd/1waKh 12 Jul 2009 from TweetDeck
3. 
   ePatientDave He's wrong - @Eysenbach did multi-year study to find "death by googling" and found ZERO cases. http://is.gd/1wbJG 12 Jul 2009 from TweetDeck
4. 
   doc_rob @ePatientDave I was nervous about that as well. Made sure we were free to say what WE felt. 12 Jul 2009 from Tweetie in reply to ePatientDave
5. 
   Doctor_V My thoughts for those who feel @drval 's Washington panel doesn't represent patients http://bit.ly/XjDo8 12 Jul 2009 from TweetDeck
6. 
   Doctor_V Hate it when patients feel we're not on their page http://bit.ly/XjDo8 12 Jul 2009 from TweetDeck
7. 
   doc_rob RT: My thoughts for those who feel @drval 's Washington panel doesn't represent patients http://bit.ly/XjDo8 (via @Doctor_V) - Agree. 12 Jul 2009 from Tweetie

Dr. Rob was true to his word, and posted his response, "Speak to Me" .

I posted one comment in Dr. V's post, and will on Dr. Rob's as soon as I have time. Trisha Torrey, a patient advocate, also posted “Putting Patients First” = No Patients (Time to go clean my room now.)". Mary Shomon (@ThyroidMary) had an excellent comment there. And Dr. Val (@drval) responded very honestly about the good intents of her efforts with this panel. (Thank you, Dr. Val).

Now is your time to respond. Go tell Dr. Rob what you want heard. Speak to him. What do you have to say about this? Do you think patients should be represented by patients? Do doctors count since at some point in their lives they will/are patients, too? Should we work as a team, not as antagonists?

What do you think? Say it. Now is the time.

(I will update with other posts on this topic as they occur. I'm sure there will be more.)

Reporter Tweets Removal of Pituitary Adenoma

A couple of weeks ago I blogged about the reporter who tweeted during a surgery to remove a pituitary adenoma, the cause of Cushing's Disease. Last night, her station ran a segment on the event and posted an article complete with uploaded video. Thanks to KSDK and Kay Quinn, the video may be viewed at their site or below:




To read more: St. Louis medical milestone: Twittering from Barnes-Jewish Hospital operating room

Twittering Live! Pituitary Adenoma Removal

On Monday, 09-April-27, Erin Marie Kelley had a pituitary microadenoma removed to hopefully cure the Cushing's Disease it caused. Kay Quinn, a local reporter, was at Barnes-Jewish Hospital in St. Louis observing the whole procedure and twittering it live via the social media called Twitter. Below is the thread of her tweets in my timeline, along with a few others interspersed. I've bolded her input for easier reading.

kayquinn (kay quinn)	Good morning from the second floor, West pavilion at Barnes-Jewish Hospital!
kayquinn (kay quinn)	I'm in the IMRI, room 217, and Erin is on the operating table. Everything looks great!
kayquinn (kay quinn)	I'm going to spend the next few hours sending Twitter messages from the O.R., reporting on Erin Kelley's neurosurgery.
kayquinn (kay quinn)	As we get started, let me say that out of respect for Erin and her family, should something unplanned occur, I will stop my Tweets.
kayquinn (kay quinn)	Erin has Cushing's disease, which is an endocrine disorder that means her body produces too much cortisol.
kayquinn (kay quinn)	These high cortisol levels in the blood can cause a host of unpleasant symptoms, from weight gain to excessive sweating to fertility trouble
staticnrg (Robin)	RT @kayquinn: I'm going to spend the next few hours sending Twitter messages from the O.R., reporting on Erin Kelley's neurosurgery.
kayquinn (kay quinn)	Erin's Cushing's disease has been traced to a tiny tumor on her pituitary gland. She's having that tumor removed this morning.
kayquinn (kay quinn)	The hope is, the removal of the tumor will reduce or eliminate her symptoms.
marsmi (Martin)	@kayquinn is live tweeting Erin Kelley's neurosurgery at @barnesjewish. Erin has Cushing's disease. She'll halt tweets if problems arise.
kayquinn (kay quinn)	Erin's been mostly troubled by the excessive weight gain.
kayquinn (kay quinn)	She also gets sick a lot and is tired too much of the time.
kayquinn (kay quinn)	Here's what I'm seeing now: Erin's draped on table, and until just a few seconds ago, her face was exposed.
kayquinn (kay quinn)	She has fiducials all over her face. They allow doctors to use an MRI to get a 3-D GPS of her brain.
kayquinn (kay quinn)	These little markers allow surgeons to locate her tumor exactly. The tumor is so small, it can't be seen on regular imaging.
cushings (MaryO)	@staticnrg You're saving these tweets from kayquinn? I have to go to work :(
kayquinn (kay quinn)	Erin's face is covered now. Only her nose exposed. Surgeons will go in through her right nostril, through the spenoid sinus to pituitary.
kayquinn (kay quinn)	Using an endoscope, they'll travel through this "tunnel" in the nose and sinus, right to the left side of her pituitary.
kayquinn (kay quinn)	That's the side making too much cortisol. The tumor us called a microadenoma.
shygirlxoxo (anna henderson)	Watching kayquinn twitter away during a fellow Cushie's pituitary surgery!
kayquinn (kay quinn)	Sorry...sphenoid is correct spelling of the sinus. I'll have to brush up on my medical terminology. Sorry for the other typos.
cushings (MaryO)	Check out kayquinn tweeting pituitary Cushing's surgery http://www.twazzup.com/search?q=kayquinn
ItWasntADream (Natalie)	follow @kayquinn for a play by play of pituitary surgery on a Cushing's patient taking place right now at Barnes-Jewish Hosp! Amazing!
kayquinn (kay quinn)	Surgeons are now starting to insert the endoscope through the nose to access the pituitary. This process should take 30 mins.
EmergencyHealth (EmergencyHealth)	Following very interesting tweets from @kayquinn from the O.R. at Barnes Jewish Hospital in St. Louis
llama_3234 (Jessica)	follow @kayquinn this morning to watch a "play-by-play" of a pituitary surgery (same one I had last May)
kayquinn (kay quinn)	All is well in the OR. The room is dark now. Surgeons are tracking their progress on monitors.
kayquinn (kay quinn)	I just spoke with Dr. Ralph Dacey, the neurosurgeon who will remove the tumor. He says all is going well.
kayquinn (kay quinn)	He also told me, what makes this operation so different from others of its kind is the MRI machine that is located right in the room.
kayquinn (kay quinn)	There are only 7 or 8 hospitals in the country with this kind of MRI capability.
kayquinn (kay quinn)	The advantage is that surgeons can ensure they've removed all they need in one operation.
kayquinn (kay quinn)	Without this intraoperative MRI, Erin might have had to come back for a second operation if there was any tumor left behind.
michelleimason (michelleimason)	Check out @kayquinn tweeting live from a surgery!
kayquinn (kay quinn)	Dr. Richard Chole is the otolaryngologist working on acessing the pituitary right now. Still dark in the OR.
BarnesJewish (Barnes Jewish)	KSDK @kayquinn is twittering a live nuerosurgery @barnesjewish
kayquinn (kay quinn)	Dr. Jim Johnston is the chief resident helping coach me through this. He says it's dark so surgeons can see the monitors better.
kayquinn (kay quinn)	It helps him place the endoscope, as they make their way back to the sinus.
kayquinn (kay quinn)	No music in the OR. Dr. Dacey says he doesn't like to listen to much music as he works. OK, sometimes he does.
kayquinn (kay quinn)	He says the residents usually hook up and i-pod and force him to listen to U2....
kayquinn (kay quinn)	Sorry again for the typos.
jaelithe (jaelithe)	@kayquinn Good account you have going on.
kayquinn (kay quinn)	Dr. Dacey says not a lot of drama in the OR. Nurses and support staff are very professional. Not like TV show ER.
kemperartmuseum (Kemper Art Museum)	RT @barnesjewish: KSDK @kayquinn is twittering a live neurosurgery
valeriehoven (valerie hoven)	RT @BarnesJewish KSDK @kayquinn is twittering a live nuerosurgery @barnesjewish [hehe i just retweeted my own tweet]
kayquinn (kay quinn)	Dr. Dacey tells me the whole operation should take three-and-a-half hours.
kayquinn (kay quinn)	Going through the nose is a new approach. Surgeons used to go up under the lip. Dacey says this technique means less post-op pain/scars
kayquinn (kay quinn)	Pituitary Gland Fact: 1 to 3% of adult population has a pituitary tumor. Very common. Most have no symptoms.
kayquinn (kay quinn)	Dr. Chole is in the sphenoid sinus now, getting closer to pituitary.
kayquinn (kay quinn)	He just took out a piece of bone in the rostrum, which is the outer shell of the sphenoid.
kayquinn (kay quinn)	Pituitary Gland Fact: While tumors in the pituitary are common, only a very small number of people will develop Cushing's disease.
kayquinn (kay quinn)	Amazing images on the monitor in the OR: we can see images being sent back by the small camera in Erin's sinus.
kayquinn (kay quinn)	We can see Dr. Chole removing tissue as he goes deeper into the sinus.
kayquinn (kay quinn)	I look very attractive in my scrubs and surgical bonnet.
kayquinn (kay quinn)	I'll send a photo later. Cell phones don't work in here.
kayquinn (kay quinn)	For the squeamish: This is not bloody at all. Very clean looking.
advantechmedia (advantechmedia)	@kayquinn thanks for sharing, we do a lot of work for science publishers and all of this sound familiar although we're not doctors
kayquinn (kay quinn)	I've got a Newschannel Five photographer by my side today. Joe Young is the best in the business. He's been at 5 for 25 years.
kayquinn (kay quinn)	We'll shoot the operation and my Tweets and show the story sometime in May.
kayquinn (kay quinn)	@advantechmedia Glad you're following!
kayquinn (kay quinn)	@valeriehoven Thanks for the follow.
clairecg (Claire Goldfarb)	Very cool....RT @michelleimason: Check out @kayquinn tweeting live from a surgery!
kayquinn (kay quinn)	I'm making this sound easy, but Dr. Chole has to be very precise as he tunnels his way to the pituitary.
kayquinn (kay quinn)	The carotid arteries run along either side of his "tunnel," so he can't veer off course at all.
kayquinn (kay quinn)	We've reached the bone that separates the sinus from the pituitary. Soon, Dr. Dacey will cut a window in that bone to get to the pituitary.
kayquinn (kay quinn)	All is well, all is going as planned.
ScrubsAndBeyond (Scrubs & Beyond)	@kayquinn Will you be wearing them on-air?
kayquinn (kay quinn)	Big thanks to Dr. Jim Johnston. He's my John Madden...providing important medical background.
kayquinn (kay quinn)	Barnes-Jewish, thanks for making this possible. This is an incredible opportunity.
kayquinn (kay quinn)	@lzigman Oh, Leisa, I'm so sorry! I had a vicious turn-around this morning. At Barnes by 8:30 after working late last night.
marsmi (Martin)	@kayquinn The tweets are great! Why the formal story delay until May? Are you waiting to add Erin's input post surgery?
kayquinn (kay quinn)	@ScrubsAndBeyond Uh, no.
lzigman (lzigman)	@kayquinn-no worries...
kayquinn (kay quinn)	@marsmi I'll turn it into a longer story. Our Cover Stories are three or more minutes, so I'll get extra time to put it together.
kayquinn (kay quinn)	@WthrmnSlaughter Keep up the great work Anthony!
kayquinn (kay quinn)	Surgeons never actually reach the brain, but they're very close. The pituitary is right behind the sinus at the base of the brain.
annmarierussell (Ann-Marie Russell)	@kayquinn I know many of us (Erin's friends and family) are following you today, thanks for doing this.
staticnrg (Robin)	Thanks to @llama_3234 there is a great "twazzup" for the pituitary surgery of @erinmariekelley covered by @kayquinn http://bit.ly/W9rnx
kayquinn (kay quinn)	Dr. Chole has done his work. Now Dr. Dacey will take over. First up, he'll make the window in the bone that's between sinus and pituitary.
kayquinn (kay quinn)	Then, he'll be able to go into the gland itself.
kayquinn (kay quinn)	@annmarierussell Thank you all for allowing us in! She's doing great! It's really amazing.
WthrmnSlaughter (Anthony Slaughter)	@kayquinn just trying to keep up with you! If anyone's the tweet master, it's you!!!!
staticnrg (Robin)	RT @cushings: Check out kayquinn tweeting pituitary Cushing's surgery http://www.twazzup.com/search?q=kayquinn
llama_3234 (Jessica)	@kayquinn Thank you for doing this. This can really raise some awareness of Cushing's (from one of Erin's fellow Cushie buddies)
kayquinn (kay quinn)	Just to recap if you've just logged on: I'm reporting via Twitter from a Barnes-Jewish Hospital OR.
kayquinn (kay quinn)	Erin Kelley is having a tumor removed from her pituitary gland, a small gland behind the nasal sinus, at the base of the brain.
staticnrg (Robin)	RT @llama_3234: @kayquinn Thank you for doing this. This can really raise some awareness of Cushing's Amen...from another Cushie buddy.
ItWasntADream (Natalie)	skull base pituitary surgery to remove tumor at Barnes-Jewish hosp. tweeted live by @kayquinn now. Good luck to patient @erinmariekelley!
kayquinn (kay quinn)	She's hoping the operation will control or eliminate symptoms of her Cushing's disease.
marsmi (Martin)	The @barnesjewish surgery @kayquinn is covering is on @erinmariekelley.
kayquinn (kay quinn)	Temperature is very cool in here.
kayquinn (kay quinn)	Dr. Dacey is now working at the base of the skull. Very vascular area. Seeing a little more blood, which is normal.
isserman (David Isserman)	Wow, TV news anchor - @kayquinn - is Tweeting about a surgery going on right now. This may be a first for Twitter.
llama_3234 (Jessica)	@erinmariekelley is practically a celebrity with @kayquinn tweeting her surgery=).
cushings (MaryO)	I put a link on the top of the boards, too... pituitary Cushing's surgery http://www.twazzup.com/search?q=kayquinn
ItWasntADream (Natalie)	@kayquinn if any would like more information about Cushing's Disease they can visit www.cushings-help.com
cushings (MaryO)	Many thanks to @kayquinn for doing this. It will really help with Cushing's awareness and pituitary, too!
ItWasntADream (Natalie)	follow entire thread on twazzup RT @cushings: Check kayquinn tweeting pituitary Cushing's surgery http://www.twazzup.com/search?q=kayquinn
chzmongerswife (CheesemongersWife)	@kayquinn jim is the best. Super nice guy
kayquinn (kay quinn)	Just got an update from Dr. Chole, the otolaryngologist. He says Erin's tissue is more fragile because of her disease.
kayquinn (kay quinn)	They're going slower than normal because of this. The tissue bleeds more easily, so they're moving cautiously.
kayquinn (kay quinn)	Dr. Dacey is operating now. He's through the bone and didn't have to drill to get through. This is good. Less traumatic for Erin.
kayquinn (kay quinn)	Dr. Dacey is at the dura, the covering of the brain that also encompasses the pituitary. He'll go through that now to gland.
ScrubsAndBeyond (Scrubs & Beyond)	@kayquinn Well, not on-air (obviously), but maybe in a news segment? Just wanted to encourage local viewers to tune-in if so.
llama_3234 (Jessica)	@kayquinn Yep that's very common with most Cushing's patients. That's one of the reasons why you want to have an experienced neurosurgeon.
kayquinn (kay quinn)	Cushing's is named after Harvey Cushing, the father of modern neurosugeron. He did basic research on role of pituitary, how to treat it.
sahah86 (sahah86)	@kayquinn while I was taking photos, a strange noise (maybe scraping?) was happening in the OR.
kayquinn (kay quinn)	@cushings It's a privilege to do it!
kayquinn (kay quinn)	@ScrubsAndBeyond I'll find out and let you know. Not a decision I get to make. :)
debdobson (DebDobson)	@kayquinn Wow, you are doing a great job tweeting this surgery.
kayquinn (kay quinn)	@isserman Hi David. There've been others before this. But not many!
isserman (David Isserman)	@kayquinn - I just added a link to your Twitter on the Cushing's Syndrome community on RareShare - http://tinyurl.com/ch8v52
kayquinn (kay quinn)	@debdobson Thanks for the kind words!
ahawkcollinger (ahawkcollinger)	@kayquinn Wow, the detail on the surgery is amazing. Are you in some kind of sterilized area to do the tweets??
kayquinn (kay quinn)	@ahawkcollinger I'm not in a sterile area. I'm in a control room with a window into the OR.
kayquinn (kay quinn)	@ahawkcollinger But I do have scrubs and a surgical bonnet on! Adorable blue color.
kayquinn (kay quinn)	@isserman Thanks David!
cushings (MaryO)	@kayquinn Cushing's community members can discuss this surgery here http://cushings.invisionzone.com/index.php?showtopic=40930
kayquinn (kay quinn)	Hello to Erin's family on the 10th floor. Dr. Chole just came by to tell me where you are. All is well! Hope to catch up with you later.
llama_3234 (Jessica)	I wonder what it would be like to be family of @erinmariekelley and watching the tweets of @kayquinn - nervous or relieving?
kayquinn (kay quinn)	Dr. Dacey is putting a needle into the area where the pituitary is now to make sure it's the gland he's reached and not a blood vessel.
kayquinn (kay quinn)	Dr. D about to make an incision in the dura to get to the gland.
kayquinn (kay quinn)	Joe Young took the camera back in the OR to get more shots of the operation. He's also been shooting me in the observation room on Twitter
kayquinn (kay quinn)	@llama_3234 Good question! Apparently, they can read our Tweets, but the hospital's system has blocked them from sending messages out.
kayquinn (kay quinn)	Dr. Chole says they're anxious to send messages out but can't.
ItWasntADream (Natalie)	@llama re: family feelings about surgery tweets by @kayquinn.i think relieving, 3-4hrs is a long time to wait, helps to know whats going on.
kayquinn (kay quinn)	Dr. D has opened up the dura and is trying to visualize the pituitary gland.
kayquinn (kay quinn)	Apparently the gland is an orange-brownish colored gland, shaped like a Hershey's kiss. Very firm. (dr. j's description. love it!)
kayquinn (kay quinn)	Dr. D is using a blunt instrument to feel around the pituitary now for any unusual tissue.
kayquinn (kay quinn)	The hope is that by taking the left side of the pituitary, disease symptoms will go away. Remaining right side should function normally.
BillRomer (Bill Romer)	#STL local NBC anchor/reporter @kayquinn is tweeting from the operating room viewing area while watching brain surgery!
mykscholze (mykscholze)	> @BillRomer: #STL local NBC anchor/reporter @kayquinn is tweeting from the operating room viewing area while watching brain surgery!
eddherwig (edward herwig)	@kayquinn
kayquinn (kay quinn)	Dr. Dacey says he's in the pituitary and can see a milk nodule on the left hand side that he's removed and sent off to pathology.
kayquinn (kay quinn)	Now, he's going to remove the left portion of the gland.
kayquinn (kay quinn)	This is great news! Dr. D got what he was looking for!
kayquinn (kay quinn)	Now waiting for lab to call back with a preliminary report on what that nodule was. Takes five days for the full report on it tho.
cushings (MaryO)	#kayquinn Follow Erin's pituitary Cushing's surgery Live! http://ping.fm/OWQ3S
supportsurfaces (Chuck Beye)	rt@kayquinn This is awesome.
kayquinn (kay quinn)	There has been some bleeding, but Dr. Jim tells me its completely normal. Dr. D's been working around it all, which has taken some time.
RPMaus (Ryan Maus)	STL TV reporter @kayquinn is Tweeting from some kind of surgery... Bizarre
cushings (MaryO)	@kayquinn great news!!!
kayquinn (kay quinn)	Not planning to do intraoperative MRI because her pre-op scans were normal.
kayquinn (kay quinn)	@RPMaus 28 year old Erin Kelley, mother and wife, is having the left part of her pituitary removed to alleviate symptoms of her Cushing's.
kayquinn (kay quinn)	@RPMaus She had a tumor or nodule on it. The neurosurgeon just removed it and sent it to the lab.
kayquinn (kay quinn)	@RPMaus All happening on a second-floor operating room at Barnes-Jewish Hospital in St.Louis
kayquinn (kay quinn)	Dr. Jim tells me the pituitary sits in a "web of veins" and that's why there can be bleeding during surgery.
kayquinn (kay quinn)	It's very normal. Also, because of all of the excess cortisol in Erin's blood stream, those veins have become very fragile.
kayquinn (kay quinn)	A lot of the left side of the gland is out now.
kayquinn (kay quinn)	Dr. D now looking at the bone fragments Dr. Chole took out. Looking at closing the "window" or hole already!
kayquinn (kay quinn)	Left side of the gland completely out. Peeled it off. Tofu-like substance.
kayquinn (kay quinn)	Now, surgeons will take a little fat pad from the abdomen to also use to seal the hole.
brianarygg (Briana Rygg )	RT @RPMaus: STL TV reporter @kayquinn is Tweeting from some kind of surgery... Bizarre
llama_3234 (Jessica)	@kayquinn Usually this is done because of a CSF leak, is that what happened here, or do you know?
kayquinn (kay quinn)	Dr. D placing gel foam used to minimize bleeding. This is all part of the process of finishing the operation.
kayquinn (kay quinn)	I'll be away from the computer for several minutes. Going to grab a quick interview. I'll be back to wrap it all up. Awesome experience!
supportsurfaces (Chuck Beye)	@kayquinn Ask Dr D what kinfd of pad is on the OR table. I provide BJC with the Roho pads.
RPMaus (Ryan Maus)	@kayquinn Wow, sounds really interesting! Cool thing to Tweet... What has the response been like so far?
kayquinn (kay quinn)	Erin's surgery is complete! She'll leave any moment for the recovery room.
kayquinn (kay quinn)	Thanks to all who made this possible: Erin, BJ Hospital, KSDK. It was an incredible experience!
cushings (MaryO)	RT @cushings: @kayquinn Cushing's community members discuss this surgery here http://cushings.invisionzone.com/index.php?showtopic=40930
kayquinn (kay quinn)	Funny to see all the lights on in the OR. It was dark for 99% of the operation.
kayquinn (kay quinn)	I'll keep you posted on when you can watch the story on Newschannel 5!
kayquinn (kay quinn)	@RPMaus Response has been great! Lots of interest!
agoodeye (lisa jennings)	@kayquinn That's good to know. Is she a friend or someone you're covering for KSDK?
kayquinn (kay quinn)	@llama_3234 Erin has Cushing's disease and docs think the tumor on her pituitary was causing it and all of her symptoms.
cushings (MaryO)	Great news! Thanks for the tweets. @kayquinn Erin's surgery is complete! She'll leave any moment for the recovery room.
ItWasntADream (Natalie)	@kayquinn Thanks Kay! Can't wait to see the story. Hoping for a quick recovery for @erinmariekelley.
kayquinn (kay quinn)	@supportsurfaces It's not a Roho pad. Just a foam rubber egg crate.
cushings (MaryO)	@kayquinn A lot of us "Cushies" are out of area. Will the story be online?
kayquinn (kay quinn)	@cushings It will be on-line the day it airs. I'll let you know!
cushings (MaryO)	@kayquinn Fantastic! Thanks
cushings (MaryO)	@kayquinn Thanks again for doing this. Lots of Cushing's patients are following this story. Thanks to @erinmariekelley for sharing, too!
llama_3234 (Jessica)	@kayquinn right I have/had it, but when a fat patch is used in a pit surgery it is because of a CSF leak, jw if that was the case here
kholleman (kholleman)	Just got done with KayQuinn Twittering brain surgery. Terrific experience. They went through the nose to get to the pituitary glad.
supportsurfaces (Chuck Beye)	rt @kayquinn Thanks for thi info. How long was the patient on the table,
cushings (MaryO)	Check out kayquinn tweeting Erin's cushing's pituitary surgery! http://www.twazzup.com/search?q=kayquinn
kayquinn (kay quinn)	@llama_3234 The fat pad was to ensure there would be no leak. But surgeons said they didn't detect csf on the table.
kayquinn (kay quinn)	@supportsurfaces Five hours or so.
kayquinn (kay quinn)	@cushings Thanks for following me! I was honored to do it.
valeriehoven (valerie hoven)	@erinmariekelley congrats on a successful surgery @barnesjewish (covered by @kayquinn via twitter)
kayquinn (kay quinn)	@agoodeye No, just a internet saavy patient who has been blogging about her disease and was excited I would Twitter from the OR.
kayquinn (kay quinn)	@agoodeye It was actually the hospital's idea.
debdobson (DebDobson)	@kayquinn You are welcome.
supportsurfaces (Chuck Beye)	@kayquinn Thank you.
valeriehoven (valerie hoven)	RT @RPMaus STL TV reporter @kayquinn is Tweeting from some kind of surgery... Bizarre
supportsurfaces (Chuck Beye)	@kayquinn @barnes-jewish Just read throuh all tweets. It was fascinating. Thanks
BarnesJewish (Barnes Jewish)	KSDK's Kay Quinn's "Tweets" of the live neurosurgery are complete and can be read @ kayquinn
BarnesJewish (Barnes Jewish)	KSDK's Kay Quinn's "Tweets" of the live neurosurgery are complete and can be read @kayquinn
stephaniethum (Stephanie Thum)	A St. Louis TV reporter Tweeted from a live surgery today at @BarnesJewish. Follow @kayquinn to see the Tweets. #hcsm
Tojosan (Todd R Jordan)	#STL local NBC anchor/reporter @kayquinn is tweeting from the operating room viewing area while watching brain surgery! (via @BillRomer)
BarnesJewish (Barnes Jewish)	Complete chronology of kayquinn tweets from the OR http://cushingshelp.blogspot.com/2009/04/pituitary-cushing-surgery-twittered.html
ImBFC (Belinda)	@kayquinn cool Twitter stream! I learned a lot and I'm looking forward to seeing your story. Best wishes to Erin in her recovery :-)
CAMURPHY (Craig Murphy)	@kayquinn excellent tweets yesterday; amazed that they are able to go after something so small-my wife's tumour was the size of a fingernail
CAMURPHY (Craig Murphy)	http://url.ie/1i6o @kayquinn coverage of @erinmariekelley operation - similar to my wife's treatment - amazing what can be done these days
kayquinn (kay quinn)	@CAMURPHY Thanks for the Tweet! It was very exciting, and I'm glad you would follow along.
kayquinn (kay quinn)	@staticnrg Thanks for the Tweet and thanks for following the surgery. It was amazing!

The whole process took a little over 3.5 hours. Erin is recovering and she tweets as @erinmariekelley.

To read more about it:

St. Louis Reporter Twitters Live Surgery at Barnes-Jewish
Cushing's Help Website and Message Boards