It’s a Boy!

I completed medical school more than 30 years ago. Medical education, like most aspects of life, has changed drastically in the past several decades with the advent of the Internet and electronic education programs and modules.  I come from the pre-cellular telephone and personal computer era when dinosaurs like me carried loads of textbooks and sat dutifully through hours of classroom lectures taking copious notes.  Frighteningly, I even recall college chemistry and physics classes where we were required to use a slide rule for mathematical calculations.  Oh, the humanity!

At the time I was a medical student, most medical school curricula required you to spend your first two years in lectures and in laboratories learning anatomy, normal body functions, biochemistry, disease pathophysiology, pharmacology, diagnostic studies, and treatment options. All of us were excited and nervous in the summer of our third year because we were beginning our clinical rotations.  The third year was comprised of three months of internal medicine, three months of surgery, and two months each of pediatrics, obstetrics/gynecology, and psychiatry.  The fourth year of medical school had few required rotations and provided an opportunity to take electives specific or helpful in whichever career field a student had chosen.  I enjoyed all of my third year rotations, despite realizing by fall of my third year that surgery was the career path making the most sense for me.

In the spring of my third year of medical school, I did a four-week rotation on a busy obstetrics service. It was great fun because the obstetrics faculty and residents allowed us to assist during normal deliveries, and then actually allowed students to deliver a few babies.  The experience was certain to cause some tachycardia in the medical students, but after delivering the baby, clamping and cutting the umbilical cord, and handing the child to the mother, a sense of great accomplishment was assured.  It was exhilarating and satisfying.  I was glad I had played lots of sports like baseball, basketball, and football growing up; you need a sure set of hands as those new babies are slippery.

Over three decades later, I had not thought about delivering babies or anything to do with obstetrics. I am a surgical oncologist.  The malignant or benign tumors I remove are a source of pain, angst, aggravation, and fear for my patients.   After providing care for thousands of patients over the course of my career it is rare to encounter something that startles me.  But I can still be surprised and I enjoy a good practical joke, even when played on me.

Several years ago a young woman not yet 30 years old was referred to me with a very large liver tumor. The patient had seen her local physician and reported she felt bloated and unable to eat a normal size meal.  The referring physician examined her and was astonished to palpate a large abdominal mass. When I first walked in to the examination room to meet her and her husband, when she stood I wondered if she was pregnant.  She had an obviously protuberant belly and I had not yet seen her magnetic resonance imaging (MRI) scans.

We spoke for ten or fifteen minutes and then I performed an abdominal examination. With her lying supine on the examination room table, it was possible to palpate a mass originating in her upper abdomen and extending well below her umbilicus.  The mass was not tender but was firm.  After completing the evaluation, I walked out and loaded the disk with her MRI scans onto my computer workstation.  When I opened the abdominal images, I let out a low whistle.  Quickly, every physician, resident, nurse, and student in clinic was clustered around the computer screen.  A couple of representative images explaining their interest and excitement are seen in the two images below.



Almost the entire right lobe and the medial segment of the left lobe of her liver was occupied by an enormous tumor. There were areas of necrosis, or dead tissue, and other regions demonstrating recent hemorrhage, or bleeding into this tumor.  The characteristics and MRI appearance were all consistent with a benign type of liver tumor called a giant cavernous hemangioma. The term giant was an understatement in this young lady. Hemangiomas are abnormal, but not malignant, spongy collections of blood vessels which can occur in many solid organs in the body. A familiar type of hemangioma is one arising in the skin (which is a large solid organ), known by the common vernacular name as a port wine stain.

This tumor was massive and clearly causing symptoms, so even though benign, I recommended surgical removal. I knew the operation would be a hepatobiliary surgery tour de force because the right and middle hepatic veins were compressed and the tumor abutted and bowed the main, left, and right portal veins.

Liver surgeons use a variety of specialized pieces of equipment to dissect through the liver and expose blood vessels and bile ducts that can be clipped, tied, or stapled to prevent bleeding or bile leakage. I was forced to make a larger abdominal wall incision than usual in this young woman once I recognized it would be necessary simply to remove the impressive tumor.  The resident and I were able to mobilize the right side of the liver and take down its attachments to the tissue behind the liver and to the diaphragm.  We used a special dissecting instrument with a rapidly vibrating tip to push aside the soft liver tissue while leaving blood vessels and bile ducts intact.  The visualized vessels and ducts were then ligated, clipped, or if tiny, cauterized.  We slowly and meticulously dissected through the liver and began the tedious process of dissecting the tumor free from the main and left portal veins, hepatic artery branches, and bile duct.  We had to maintain normal blood supply to the remaining left liver and intact bile ducts to drain bile from the liver into the intestine.  The numerous blood vessel branches running into the tumor were clipped or tied and divided.  Once we had preserved the left sided blood vessels and bile ducts, I was able to staple and divide the blood vessels and the bile duct to the tumor-bearing right liver.  We continued the careful dissection through the liver until we identified both the middle and right hepatic veins, and again it was possible to staple and divide these vessels.  In a moment reminding me of some of the caesarean sections I had witnessed as a medical student, the resident and I gently wrestled the tumor mass out of the abdominal cavity, but, unlike the gentle swaddling of a newborn infant into a warm blanket, we indecorously plopped it into a very large basin we requested just for this purpose.

Returning our attention to the patient and the remaining portion of the left liver, we confirmed there was no bleeding or bile leak from the cut edge of the liver. Our blood loss for the operation was minimal.  We checked the blood flow into and out of the liver using color flow ultrasonography.  The liver was re-suspended to the diaphragm and the abdominal wall at the falciform ligament with a couple of sutures, and a drain was placed along the liver edge into the large empty space now present in the upper abdomen once occupied by a relatively gargantuan tumor.  The patient recovered rapidly and without problems after her operation.  She was young and in excellent health so she was walking the day after surgery and quickly developed a ravenous appetite.  Nothing like having a large tumor compressing your stomach and intestine removed to improve your interest in food again.  The patient was discharged from the hospital four days after the operation.  Her drain tube was removed prior to discharge, and at her first post-operative visit she was recovering well and doing her best to ingest enough protein to permit liver regeneration.  She succeeded well, and now has a large hypertrophied left lateral liver occupying her upper abdomen (see the representative image below).


On final pathology the patient did have a giant cavernous hemangioma, but the pathologist noted a few areas were worrisome for possible deterioration into a sarcoma-like situation. Her pathology slides were sent to multiple institutions and nobody was convinced she had an actual malignant tumor, but enough concern was raised I decided to follow her routinely for a few years to be certain no new tumors developed in the liver or at other sites.  I saw her at six-month intervals with repeat MRI scans which confirmed there was no evidence of recurrent tumor.  After about three years, I told her I was comfortable seeing her back on an annual basis.  We did an annual visit and scans and blood tests were again completely normal.  I had a social chat with the patient and her husband and learned she was involved in several new hobbies and activities.  We ended the conversation with a pleasant goodbye and made plans for a visit a year later.

Seven months later I received an email from the patient requesting an urgent follow up appointment. Immediately alarmed and worried, I called my clinic staff to contact her for an appointment a few days later.  When she arrived, I entered the examination room and was met by a somber-faced patient and her husband.  She looked well but told me she was there to inform me of a new tumor.  I asked if she was having symptoms to suggest the tumor had regrown.  She solemnly shook her head no.  I inquired if she had a disk with MRI scans for me to see.  Another shake of the head no, and then she said, “All I have is this.”  She handed me a black and white ultrasound image.

I’ve been a surgical oncologist for a long time, but thankfully my physical and mental facilities have not slowed yet. I studied the image for a few seconds, and by the time I looked up both my patient and her husband were grinning widely, and then openly laughing.  She gleefully exclaimed, “I got you, didn’t I?”

Yes, yes you did. The ultrasound image revealed a normal human fetus of fourteen weeks gestation.  I’ve performed thousands of ultrasounds of the liver, pancreas, and other upper abdominal organs or structures, but even though I’m not an obstetrician, I was quickly able to recognize the image of a human fetus.  After the laughter and general hilarity waned and I congratulated them for playing the scene (and me) perfectly, we had an excited discussion about the elation and tribulations of parenthood.  I shared stories from the time when my own children were small.  I was thrilled for this young couple and this was not a conversation I had previously experienced in my practice.  We agreed we would push the date of her next MRI scan to slightly longer than the originally planned one-year visit to allow her to complete her pregnancy.

A few weeks ago I noticed the patient’s name on my clinic schedule. I opened her MRI images and saw her enlarged left liver and no evidence of tumor recurrence.  The scan also included the pelvic region and I noted a normal, non-pregnant uterus.  I knocked once on the door, entered the room, and was immediately introduced to her new son.  I have delivered lots of tumors out of patients’ bodies over the course of my career, but this remarkable, alert, healthy delivery brought a smile of pure happiness to my face.  Removing malignant tumors from patients is rewarding, challenging, and often provides the best chance for a patient to be cured of this dread disease.  I derive great satisfaction from the blessing of helping cancer patients, but holding this infant was a feeling of deep gratification surpassed only by the times years ago when I was embracing my own children.  I hugged my patient and her husband and quickly reported everything was fine with her blood tests and scans.  We spent the next twenty minutes watching her newborn son while talking about the fatigue, sleeplessness, and fulfillment associated with an infant.  She was tired, but triumphant.  As she left, she waved goodbye and stated, “I could have never had him with that huge tumor inside me.”

It certainly would have been crowded in her abdominal cavity with both a giant liver tumor and a full term infant present. I’m glad the removal of the liver tumor went so well and she is fully living and enjoying life.  And more importantly, she has now created new life and will experience all of the joy, pleasure, fatigue, frustration, and induction of gray hair associated with this phenomenon.


A Healthy Lifestyle Helps Prevent Cancer

Remember those old black and white movies when most of the actors and actresses smoked their way through countless roles?  Back then, smoking was a way of life for the famous and the not-so-famous alike.  So, it’s no surprise that John Wayne, Humphrey Bogart, Lana Turner and numerous other Hollywood stars shared two things in common with millions of their fans:  they were heavy smokers and they died from cancer.

It’s been a half century since the Surgeon General’s Report linked tobacco with cancer and other deadly diseases.  Today, smoking cigarettes or cigars is no longer part of the lifestyle for a majority of Americans.  Yet, according to the American Cancer Society (ACS), one-third of all cancer deaths in the United States can be blamed on tobacco.   An estimated 160,000 Americans died from lung cancer in 2014 and most of them were smokers.  Those who believe they can chew tobacco and escape the risk of cancer are fooling themselves.  The chewing habit leads to numerous cancers, including those of the mouth, throat, voice box and esophagus.

Smoking is the most obvious lifestyle choice linked to cancer, but hardly the only one.  Even if you don’t use tobacco, you could be leading a lifestyle that increases your risk of cancer.   Obesity, a poor diet and inactivity also play significant roles in the incidence of various types of cancer.

The ACS says obesity may be linked to cancers of the pancreas, kidney, colon stomach and uterus.   Women who gain excess weight after menopause increase their risk of breast cancer.  Obese men may be more likely to be diagnosed with a deadly type of prostate cancer than men of normal weight.  Studies cited by the ACS also indicate that obese men and women are at greater risk for pancreatic cancer.

Many studies also show a healthy lifestyle that includes proper nutrition and regular exercise lower your risk of cancer.  A steady diet of vegetables, fruit, poultry, fish and low-fat dairy products has been linked to a lower risk of breast, colon and other cancers.  Limiting the consumption of processed meats and alcohol may also reduce the risk of various types of the disease.

Of course, even the healthiest among us can’t totally eliminate the risk of cancer.   No one can control family histories and other medical factors that increase the risk.  However, for most of us, a tobacco-free healthy lifestyle that includes a healthy diet and regular exercise can help reduce the chances that cancer will strike.

Homeless and Unhealthy

We’ve all witnessed it at major intersections: a homeless man or woman with a cardboard sign trying to coax a few dollars from motorists stopped at red lights.  When the light turns green and we hit the accelerator, we leave behind an individual who not only has no place to live, but may have no health care of any kind.

It’s well known that mental health and addiction issues are rampant among the homeless and drive many of them to the streets in the first place.  But many are physically unhealthy as well.  The diseases they often suffer from include:

*Substance abuse and addiction



*Wound & skin infections


*High blood pressure and heart disease

According to the National Health Care for the Homeless Council (NHCHC), the homeless are also at higher risk of communicable diseases from living on the streets or spending time in crowded shelters.  Even if seen by a shelter medical professional, there’s not much opportunity for treatment follow-up for high blood pressure, diabetes, and other ailments.  The NHCHC says the homeless are three to four times more likely to die prematurely than people who live in traditional housing.

Homeless children face a dire health care situation as well.  A recent study by North Carolina State University found that 25 percent of homeless boys and girls have mental health issues.  That adds up to an estimated 625,000 homeless children who need, but often don’t receive, mental health treatment.

In addition to inadequate health care, the study notes that homeless children are more likely to be exposed to domestic and neighborhood violence, which leads to developmental delays and social and emotional problems.

So, how do we do a better job of providing health care services to homeless adults and children?  I suggest you start small. What does that mean? Consider these statistics from 2014:

In January 2014, there were 578,424 people experiencing homelessness on any given night in the United States.

  • Of that number, 216,197 are people in families, and

362,163 are individuals.

  • About 15 percent of the homeless population – 84,291 – are considered “chronically homeless” individuals, and
  • About 9 percent of homeless people- 49,933 – are veterans (many of whom have given much for us, how can we now help them?).

The numbers have only increased since January 2014, with now more than 650,000 people homeless in America on any given night. That’s a lot of people, and a seemingly big, daunting problem. Starting small doesn’t mean giving some change or a few bucks to somebody on a street corner, it means getting involved at shelters and addiction treatment programs in your town or city. For medical professionals, it means volunteering time and using your contacts to evaluate and treat people with acute or chronic conditions. For everyone, it means finding out what programs or services are available in your community, and then volunteering with your time, your talents, or your resources to promote and aid those programs.

Here in Houston we have many great organizations to assist people struggling with homelessness, mental illness, and addiction. I volunteer at several of them, but The Women’s Home is my favorite group because they are fully committed to changing the lives of the women they take in and treat. This means treating addicted and mentally ill women in a safe, supportive inpatient facility for months or years instead of a few weeks. It means providing the clients (as they call them!) with treatment, counseling, and real life job skills. The Cottage Shop at The Women’s Home is a resale boutique that helps fund the programs and which gives the women a chance to develop productive skills. Most impressively, The Women’s Home includes an affordable housing facility, the Jane Cizik Garden Place, that provides permanent housing to women, including their children, that allows them to maintain sobriety, receive ongoing treatment and counseling, and to develop long-term, successful employment. I was amazed when I learned we had this program in Houston. Does your community have similar programs?  Whether they do or not, the programs that are available need your help and support (financial and otherwise). Start by helping one organization or one person; whatever you do will be a small step in providing help to someone in need. Seeing the lives that are changed one person at a time will change your life!

A Houston Treasure: The Cottage Shop

In 1971 The Women’s Home established a resale store in the Montrose neighborhood that now shines as one of Houston’s brightest lights.  The Cottage Shop is one of our community’s premier resale stores.  It also serves as a training center for residents of The Women’s Home as they conquer the crises in their lives that led them to the agency.

My wife, Natalie, and I were so impressed with The Cottage Shop that we commissioned paintings to be placed on the exterior front and rear of the store.  We wanted the artwork to be a symbol of The Cottage Shop’s vibrant programs and to help raise the visibility of the building.

We asked artist Homer Allen to create the paintings and he came through with works of art that perfectly illustrate the Shop’s impressive record of success.  The paintings feature monarch butterflies rising from orange chrysanthemums.  Homer used the butterfly to symbolize the evolving nature of The Women’s Home over the past half century.  The butterfly’s flight from the flower also symbolizes residents graduating from the Home’s programs.

Homer’s brilliant paintings are done with waterproof enamel on recycled billboards.  The works can be displayed indoors or outdoors and will remain a permanent part of The Cottage Shop’s exterior.

Natalie and I couldn’t be more pleased with the paintings.  The Cottage Shop generates 20% of The Women’s Home revenues.  We believe the paintings will draw more people into the Shop and perhaps help increase revenues to fund the Home’s programs for women in crisis.

As volunteers at The Women’s Home, Natalie and I invite you an exciting fundraiser with a best-selling author.  The Afternoon Tea with Barbara Taylor Bradford will be held April 8th.  You can learn more about the event and services offered by The Women’s Home at the agency’s website:

The welcoming front door of the Cottage Shop,  811 Westheimer, Houston, TX 77006. Open Monday through Saturday, 10:00 am – 4:00 pm. Donations accepted Monday through Saturday, 10:00 am – 4:00 pm.

The welcoming front door of the Cottage Shop, 811 Westheimer, Houston, TX 77006.
Open Monday through Saturday, 10:00 am – 4:00 pm.
Donations accepted Monday through Saturday, 10:00 am – 4:00 pm.

Artist Homer Allen and Dr. Steven Curley pose with one of the photos donated by Dr. Curley to hang on the Cottage Shop exterior.

Artist Homer Allen and Dr. Steven Curley pose with one of the photos donated by Dr. Curley to hang on the Cottage Shop exterior.

One of the photos by Homer Allen donated by Dr. Steven Curley

One of the photos by Homer Allen donated by Dr. Steven Curley

Exercise Your Way to a Lower Colon Cancer Risk

It’s no secret that exercise reduces your risk of heart and respiratory diseases.  But did you know that running, walking, playing tennis, swimming or whatever exercise you prefer can help prevent colon cancer?

Numerous studies indicate that regular exercise can reduce your risk of colon cancer by as much as 40 per cent.  One study at the Dana-Farber Cancer Institute in Boston included the collection of data from more than 150,000 men and women over a period of three decades.  Researchers found that cancer of the colon or rectum was far less common among people who exercised for 30 minutes several times a week, compared to those who led a sedentary lifestyle.

Another study, this one at the University of Vermont, also concluded that exercise lowers the risk of colon cancer.  Researchers studied 17,000 middle age men and found that those who exercise regularly and kept their weight down were 38 per cent less likely to be diagnosed with the disease.

It’s unclear why exercise lowers the risk of colon cancer, but these two studies and many others indicate the connection is unmistakable.  Research also shows that cancer patients who exercise regularly are less likely to die from several types of the disease.

As we come to the end of March, designated as Colon Cancer Awareness Month, it’s vital to remember that nothing can eliminate the risk of coming down with the disease.  So, even if you live a physically active lifestyle, you shouldn’t run away from colonoscopies and other forms of colon cancer screenings.  They can lead to prevention and early detection of the disease and make it much more likely that your healthy lifestyle will continue for many years to come.