[Histonet] What is a level?

[Bruce Gapinski]

What is a level?
Levels, deepers, we all call it something different, but what exactly is a 
level?  I know it is all relative. One would never cut into a prostate needle 
biopsy the same way they'd cut into a skin.
But if we suppose are tissue sample is 3mm thick (don't laugh). How deeply 
would you cut when the pathologist asks for a level? I guess I'm talking to 
those of us with automated microtomes where we can set the trim to 10, 20, 30 
microns. I started on a manual microtome where it's impossible to gauge this 
altogether.
So let's say I have a nicely processed ellipse of skin grossed 3mm thick.  The 
pathologist asks me for a level. If we assume I gave them a full face on the 
first slide, how much deeper should I go to get the level? 60-80 microns? 
Deeper? Less?
Your thoughts please,


Respectfully,
Bruce Gapinski HT (ASCP)




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[Histonet] Re: wax on the floors

[Bruce Gapinski]

I beg your pardon!?!
Just joking. Bruce is a brand name. And I don't strip. (Certainly not at my age)

Respectfully,
Bruce Gapinski HT (ASCP)
Chief Histologist
Marin Medical Laboratories
PathGroup SF
(415) 209-6076




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[Histonet] Microtomes

[Bruce Gapinski]

Dear Histonians
I'm in the market (please, no vendors) for a new microtome. I'd 
like an automated/manual type. What is on the market these days that is worthy? 
I know about Leica, but it's been many years since I've looked for these 
instruments and would love to know what you like and don't like about your 
microtomes?
Respectfully,

Bruce Gapinsk HT (ASCP)
Chief Histologist
Marin Medical Laboratories
PathGroup SF




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[Histonet] Employment in Bay Area

[Bruce Gapinski]

I have two full-time openings in my Histology Lab in beautiful Marin County 
California just north of SF. Full benefit positions including health, dental, 
vision plans and 401k etc. Please call me at (415) 209-6076 and or send résumé 
to bgapin...@pathgroup.com

Bruce Gapinsk HT (ASCP)
Chief Histologist
Marin Medical Laboratories
PathGroup SF




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[Histonet] AM HT

[Bruce Gapinski]

Early shift available. We are looking for someone to embed starting at 2:30 AM 
in gorgeous Marin County California. HT preferred, but will train if necessary.
To apply contact
Bruce Gapinski
bgapin...@pathgroup.com
(415) 209-6076
Fax resumes to (415) 898-0870

Bruce Gapinsk HT (ASCP)
Chief Histologist
Marin Medical Laboratories
PathGroup SF




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[Histonet] phobic slides

[Bruce Gapinski]

Histonians!
Has anyone else had incorrect  IHC  staining due to overly 
charged slides that are hydrophobic? My Ventana service department was out 
because I kept complaining about incomplete staining. For instance, the control 
at the top of the slide stained with  both DAB and hematoxylin. But on the very 
same slide the hematoxylin was missing from the patient tissue.
I told them how this unnerved me. If the same thing happens but 
the hematoxylin stains and the DAB does not...I could be looking at a false 
negative. This may have happened already as far as I know.
The solution according to Ventana is to take 4 slides from each 
new box of slides (1/2 gross) and do a vortex mix on each of them one at a 
time. Then you know you have valid slides to stain patient tissues! I have no 
time for this. And I'm trying to believe it but it's just not scientific. How 
is it that my results have been free of this "phobia" for over a year? Why 
didn't I get this (EVER) with Dako instrumentation? The answer, I was told, was 
that the humidity was a problem. If I were to take this to it's ridiculous 
conclusion, I would need to inform oncologists not to operate during these 
incorrectly humidified days. It IS summer so I'm not sure how much humidity is 
required.

1.   What brand of slides do you use?

2.   Have you had the "slide phobia" so that it compromised the results? 
(Slide-phobia is for retired Histologists, no?)

3.   (I think I know the answer but I just have to ask) Do you validate 
slides?

Bruce Gapinsk HT (ASCP)
Chief Histologist
Marin Medical Laboratories
PathGroup SF




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[Histonet] Leica CV5030

[Bruce Gapinski]

This coverslipper is over engineered. No self respecting histologist would 
design something that holds the slide a foot in the air by two "v" shaped 
grippers. Gravity sucks and the slide falls. I have a box of DISTROYED slides 
that I show the repairman. Can you imagine "Sorry Mr. Smith we can't read your 
biopsy because it splintered into pieces AFTER we did all the hard work." "Good 
luck with that health of yours."
It is NOT compatible with Ventana labels, as the gum sticks to those grippers 
and the slide falls, or jams in the output rack.
To tell you the truth, I loved the old Leica coverslipper. It had a "walking 
beam" and never broke a slide.
I'm in the mood for a Sakaura.

Bruce Gapinsk HT (ASCP)
Chief Histologist
Marin Medical Laboratories
PathGroup SF




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[Histonet] Microtome repair

[Bruce Gapinski]

Jeff Myers is the best I've seen in my 35 years. This guy will cut beautiful 
sections as his final test after repair. He's one of "us".
(408) 469-0957

Bruce Gapinsk HT (ASCP)
Chief Histologist
Marin Medical Laboratories
PathGroup SF




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[Histonet] grossing tools

[Bruce Gapinski]

Histonians,
I'm sure we are not the only histology lab that deals with 
thick grossed specimens. Has anyone tried the new gross tools by Sakura? Or 
anything else that can cut ONE nickel thick.

Tired of reprocessing.
Bruce Gapinsk HT (ASCP)
Chief Histologist
Marin Medical Laboratories
PathGroup SF




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histonet@lists.utsouthwestern.edu

[Bruce Gapinski]

Dear Histonians,
How many sections do put on a slide from a block cast in a 
small embedding mold? Do you automatically include any levels?  Then please 
tell me how many slides your techs cut per hour?
The problem is (may be) that we put 4 levels on a slide with 
two sections per level. That is:

  1.  Full face (or pretty close) 2 sections
  2.  Level 2 sections
  3.  Level 2 sections
  4.  Level 2 sections
So I have 8 sections on my H&E. This takes me some time, and I understand all 
histologists may not be doing things this way. But the problem is, when we 
discuss output and my techs appear slow I find that other labs put much less 
tissue on a slide. Some labs give a fatty string of serial sections in two 
rows, and that appears to be just like my slide. But only on the surface 
(pardon the pun).
My pathologists just renegotiated the contracts for all our dermatologists 
after the new 88305TC pricing, and those doctors say "Oh, we can get slides 
cheaper than that." Maybe they can but what would they see on the H&E, and 
would they care?
So now I'm faced with doing things as we have or stop giving those 
levels. I understand my job as a Histologist is to demonstrate the tissue. So 
I'll stick to the levels, because  I:

1.   Work for the patient

2.   Am supervised by the Pathologists

3.   Am reimbursed by our company
Tell me what you do in you lab, please

Bruce Gapinsk HT (ASCP)
Chief Histologist
Marin Medical Laboratories
PathGroup SF




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RE: [Histonet] Re: Basis for Quality Work in a Histotech

[Bruce Gapinski]

I agree with most everything said here. I'd like to add that I ask my staff to 
visualize the patient getting "accurate results in a timely fashion". In that 
order of importance. We really work for the patient, not the Pathologist or the 
company. If I don't tell them the good stuff, I can never address the bad.
Another mistake is using fear to motivate. In other words, I've messed up 2 
times this month one more and I'm out of a job. There has to be little risk for 
mistakes. And an environment of working together to change should help people 
with Histological pride.
Here's how I do it. I call a meeting. I describe the problem, and give the 
person who did it, an "out". An out is an admission by me that the system needs 
tweaking. Blame is not going to get us the information we need. I say we, 
because my job is to exclude the ridiculous ideas, and choose the first one to 
try. It is a mistake for me to assume I have the answer. They do, the people 
doing the work. Now I observe and LISTEN. And as a group we agree on how to 
move forward. Sure they'll suggest stupid things, and I brush them aside. But 
if they make the rule, they will most likely follow it.
Yes, you're right this is very Pollyanna of me and  I know there are people we 
just can not reach. Problem people need extra prodding sometimes. But there 
comes a point when we just have to let them go. Documentation will help you 
move them on to another job that better suits their skill-set.
Good reading is the American Samurai  by William 
Lareau

Bruce Gapinsk HT (ASCP)
Chief Histologist
Marin Medical Laboratories
PathGroup SF




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[Histonet] Ultra

[Bruce Gapinski]

I too have had problems with my Ultra. I am so glad I place a control at the 
top of every slide. Sometimes no Hematoxylin, sometimes no positive staining. 
I've documented half a dozen cases.
One thing we noticed is that the antibody vials get plugged up 
from the protein in the antibody. We inspect every vial before we place it on 
the instrument. The other thing we look for is antibody in the spout of the 
vial. It will recede. Called Ventana, and they said " There are plenty of extra 
drops in the vial, so prime the vial. Bad advise, here's why. The instrument 
has no idea how many drops are disposed of during priming. So we ended up with 
another bunch of primaries with no drops left. Now we prime without expelling 
any reagent and how that works better.
With this problem I feel Ventana owes us URA (Ultimate Reagent 
Access) then we can prime as we go.

Bruce Gapinsk HT (ASCP)
Chief Histologist
Marin Medical Laboratories
PathGroup SF




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RE: [Histonet] Pa Leeeze

[Bruce Gapinski]

Dear Histonians,
I am sorry. I wish I felt as you do. "We were looking at this for some 
time, and it was inevitable." "Histology has enjoyed a fairly long period of 
great reimbursement."" what we had been doing overall in healthcare could not 
be sustained"" The only thing that may cost a few jobs is if   over-utilization 
is curbed."
I don't get it. I don't run my lab that way. Or my Pathologists are 
real fat-cats who've been pulling the wool over my eyes for almost 40 years. 
How is it you all can post to HistoNet if you're so flippin lean? I don't have 
time to do this during work hours. I'M BUSY. Did you get rich in Histology? I 
didn't.
Loosing a job is painful, and we in mid management loathe letting our 
staff go. The notion that I'm in panic mode is baiting at best. I asked for 
help from my colleagues and got a plate full of Rush Limbaugh.
    Untill HistoNet has CONSTRUCTIVE information, I will stay unsubscribed.
Bruce Gapinski

-Original Message-
From: Boyd, Debbie M [mailto:dkb...@chs.net]
Sent: Wednesday, November 21, 2012 6:12 AM
To: O'Donnell, Bill; Bruce Gapinski; histonet@lists.utsouthwestern.edu
Subject: RE: [Histonet] Pa Leeeze

Thank you Bill, well stated!

-Original Message-
From: histonet-boun...@lists.utsouthwestern.edu 
[mailto:histonet-boun...@lists.utsouthwestern.edu] On Behalf Of O'Donnell, Bill
Sent: Tuesday, November 20, 2012 3:25 PM
To: Bruce Gapinski; histonet@lists.utsouthwestern.edu
Subject: RE: [Histonet] Pa Leeeze

Like it or not, politics played a part in the cut of 88305. So did POLs, CAP 
and a host of other factors. Finger pointing in time of uncertainty somehow 
makes us all feel better, but  it doesn't give us concrete ways of addressing 
the problem. Histology has enjoyed a fairly long period of great reimbursement, 
reasonable per-test costs, and a certain amount of security in that what we do 
is unique.

That is all changing, but was likely to change at least some no matter who was 
elected to do whatever. Remember the panic when DRG's first arrived?

There is no doubt that labs are going to have to get leaner, but this was 
already a trend. Find reasonable ways to cut costs. I know. We've been doing 
this for years But it needs to go further.

Some people will lose their jobs. I may well be one of them and I don't like 
it, but it is a reality. If I go down, it will not be for lack of trying to 
maintain.

88305 cuts are big but there are a lot of clinical services getting cuts as 
well. Hospitals need to do what they can to keep the doors open for the benefit 
of the patient. Pay cuts, bonuses+/-, benefits, hiring freezes, capital freezes 
are all looming on the horizon. If at all possible, fight them, but do not 
exhaust yourselves. It's a new world - and it will sometimes be ugly. Blame the 
Democrats or the Republicans, Wall Street or Main Street, but figure out how to 
adapt.

OK. So What can we do to ride out the storm?

1. Find a marketing advantage. POLs and certain smaller private labs cannot 
remain the "bargain" they once were. My lab is expectiing to get back some of 
what we lost to them a few years back. We are the only game in our town Why 
are we losing business to labs in other areas? It should all be staying here.

2. Become politically active. Demand better from your elected officials and 
from your professional organizations that are lobbyists(sp). If they can't do 
the job, use your vote or your membership fees to fire them OR run for office 
yourself. Become an activist in your professional organization.

3. Maintain high standards. Cut-backs and performance improvement need not 
automatically equate to less quality. I hate it when people assume that shaving 
a couple of minutes must necessitate poor cutting. How close to borderline is 
your current quality if this is your attitude.
Yes, that was snarky, but think about it.

4. Remember the mantra of the Hitchhikers Guide to the Universe: DON'T PANIC. 
When you are caught up in a panic mentality, thinking and problem solving 
suffer. We need our heads in the game if we are going to come out on top.
(How's that for my best Zig Zigler impersonation)?

Above all - have a nice day and thank you for letting me vent a bit.

Bill



-Original Message-
From: histonet-boun...@lists.utsouthwestern.edu
[mailto:histonet-boun...@lists.utsouthwestern.edu] On Behalf Of Bruce Gapinski
Sent: Tuesday, November 20, 2012 10:37 AM
To: 'histonet@lists.utsouthwestern.edu'
Subject: [Histonet] Pa Leeeze

Wow,
How disappointing. Looking for constructive ways to keep my lab 
open and I get political stuff. Did you all go crazy in the 80's with Ronald 
Ray-gun and the DRG's? Too young?


Bruce Gapinsk HT (ASCP)
Chief Histologist
Marin Medical Laboratories
PathGroup SF


__

[Histonet] Pa Leeeze

[Bruce Gapinski]

Wow,
How disappointing. Looking for constructive ways to keep my lab 
open and I get political stuff. Did you all go crazy in the 80's with Ronald 
Ray-gun and the DRG's? Too young?


Bruce Gapinsk HT (ASCP)
Chief Histologist
Marin Medical Laboratories
PathGroup SF




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[Histonet] 88305

[Bruce Gapinski]

I am in the middle of the biggest cost study because we need to reevaluate the 
cost of our work. We have no expectation of keeping any derm clients after the 
change in the 88305. They will go elsewhere to get a slightly better price than 
here in California.
This is depressing on many levels.

1.   Lay-offs

2.   Inferior quality (we are VERY proud of our work)

3.   TAT nightmares.

4.   Where does that leave our true client ( THE PATIENT)?
Furthermore I may be out of a job (last 35 years) and the pathologists may farm 
out our surgical work too.  How does this impact your Histology laboratory?
Respectfully,
Bruce Gapinski


Bruce Gapinsk HT (ASCP)
Chief Histologist
Marin Medical Laboratories
PathGroup SF




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[Histonet] CLIA qualified

[Bruce Gapinski]

Dear Histonians,
I need a CLIA qualified HT to gross full time at our hospital. 
The problem is. the money game. We need to create a new job, and we have no 
idea where to start with $/hr.
A PA would be overkill for our job. Can anyone help us figure out what is fair 
compensation for a CLIA qualified technician?
Respectfully,
Bruce Gapinski HT(ASCP)


Bruce Gapinsk HT (ASCP)
Chief Histologist
Marin Medical Laboratories
PathGroup SF



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[Histonet] Grossing techs

[Bruce Gapinski]

We are looking for help with our grossing. Can you help? You must be CLIA 
qualified to do the high complexity testing we know as grossing. Times have 
changed as we used to do this work ourselves, but no more. Two of my staff 
qualify but I need another.
We are a small laboratory in Marin County, just north of SF.
Respectfully,

Bruce Gapinsk HT (ASCP)
Chief Histologist
Marin Medical Laboratories
PathGroup SF



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[Histonet] "grossing" again...

[Bruce Gapinski]

Is anyone anticipating new CAP changes this year in their lab with 
respect to "grossing" tissue. We are not in the same site as the doctors and 
we've been submitting specific surgical specimens for the Pathologist for 20 
years. GI bxs, prostate needle bxs, etc. We've also been grossing dermatology 
specimens since 1970. Cutting skin ellipses, submitting punch bxs, and on and 
on. All off site. 
Our Pathologist thinks it is more technical to embed the punch bx, than 
to place it in a cassette.
Is it true, we can't gross anything with just an HT certificate? How 
about if we use cameras to watch our grossing from the hospital?
Your thoughts please
Respectfully,
Bruce Gapinski HT (ASCP)






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