Legislators Do Not Support Cancer Research

Skin care and cosmetic enhancement/cosmetic surgery
Edward B. Lack MD
President, MetropolitanMD
Chicago’s Cosmetic Surgery Center

Two weeks ago a report from the National Cancer Institute described the cure of 2 patients with metastatic malignant melanoma using gene therapy. 15 other patients in the study died. The results were heralded as a potential break-through. At the same time scientists cautioned people not to get too excited as studies have a long way to go. Gene therapy is purported to work by stimulating lymphocytes in the body to attack the cancer.
I am a 4-year survivor of pancreatic cancer. I also participated in a clinical study and out of an initial group of 20 cohorts with pancreatic cancer, 10 of us are still alive and 4 of us have not had a recurrence. While these figures are not good enough, they represent progress in a devastating cancer and reports of similar trials are supportive.
These studies need funding to be effective. The men and women who do these studies need funding to be effective. At a time of international terrorism cancer research doesn’t get much press. Our legislators piously spend billions of dollars for national defense and then withhold appropriations for cancer research. The hypocrisy of senators and congressmen in funding their own pork barrel projects to the detriment of cancer research is appalling. It behooves each citizen to ask each candidate for federal office if he supported the cuts in NIH and NCI (National Cancer Institute) and if so he or she should not be re-elected. Federal office has become a career for these people and a great deal of time and money is spent on their retaining their office. Fully 98% of incumbents have been re-elected in the past. It is time for this to stop. If citizens won’t vote for health care, we will simply get less and less of it.
CANCER RESEARCH REQUIRES GOVERNMENT SUPPORT

Pain and Compassion After Surgery

Skin care and cosmetic enhancement/cosmetic surgery 09/09/06
Edward B. Lack MD
President, MetropolitanMD
Chicago’s Cosmetic Surgery Center

For the past 2 weeks I have had a toothache. Of course that does not take into account the many months that passed when my tooth would hurt periodically and I did not take the time to go to my dentist. For the past 2 weeks I did take care of it and after waiting 5 days in moderate pain to see an endodontist I finally got an appointment. After working on me for about an hour he found that the tooth had fractured and was infected and could not be saved. He offered to send me to an oral surgeon immediately (3:30PM on a Friday afternoon) and I agreed. Fortunately, a former colleague offered to wait until I could arrive and he pulled the tooth. My maxilla (the upper teeth containing bone) was throbbing before the procedure and became worse after. I received a prescription for vicodin and antibiotic and went to the pharmacy where the Osco pharmacist told me there would be a 20-45 minute wait. Persisting in his presence for immediate care he relented and gave me my medicines 5 minutes later. Once home I took the vicodin and put ice on my cheek and after 2 hours the pain subsided.

The real story is the next day when I felt worn out, sad, and depressed. I am a cancer survivor who so far has beaten the odds so I am no stranger to pain and surgery and medication. I also have had to take vicodin before and noted its profound emotional depressant effect. I operate on skin and fat and I routinely recommend patients walk to dampen pain and avoid the depressant effects of narcotics. So I need to be reminded form time to time how our emotions are affected by illness, drugs, and surgery. I know of nothing that makes me feel more helpless than being ill- especially ill and taking narcotics. I suggest that I need to remember this when I am ill or when one of my loved ones is ill or when one of my patients feels ill or in pain. Maybe we all need to remember. Understanding is powerful medicine that leads to forgiveness and caring.

American Board of Cosmetic Surgery is Legally Equivalent to All ABMS Boards

Skin care and cosmetic enhancement/cosmetic surgery
Edward B. Lack MD
President, MetropolitanMD
Chicago’s Cosmetic Surgery Center

Two days ago the Superior Court of California handed down a ruling that ordered the Medical Board of the State of California to recognize the American Board of Cosmetic Surgery as equivalent to any board certification in that state. As I wrote in a previous blog the American Board of Cosmetic Surgery is the only board which certifies the competence of cosmetic surgeons. In the battle with The American Society of Plastic Surgery, that organization had asserted that they comprise the only organization of board certified surgeons who are qualified to perform cosmetic surgery. Furthermore they asserted that only boards certified by the American Board of Medical Specialists are legitimate. I further asserted that the ABMS is an old boys club whose function is promote their own members at the expense of everyone else in American medicine and that the ABMS is an archaic if not effete organization. The ruling by the Superior Court of California now upholds my assertion and sets a precedent establishing the American Board of Cosmetic Surgery as equivalent to any medical certifying board in the United States by virtue of the fact that the requirements for board certification of the American Board of Cosmetic Surgery “are equivalent to or exceed the requirements of the American Board of Medical Specialties”. This is a landmark ruling and will be pursued in all 50 states so that consumers will not be misled when they examine a physician’s credentials. They can rely upon certification by the American Board of Cosmetic Surgery as one criteria of competence in choosing a cosmetic surgeon.

Medical Advances: The Best PR Money Can Buy

Skin care and cosmetic enhancement/cosmetic surgery
Edward B. Lack MD
President, MetropolitanMD
Chicago’s Cosmetic Surgery Center

Are news articles about scientific advances in skin care hyped?
I am struck by the need for physicians to make headlines by writing articles of questionable merit in medical journals and the thirst of the media to pick up these articles as grist for their voyeuristic publications in order to sell more advertising.
Two cases in point: Newsweek picked up the ridiculous article by a dermatologist who gave anecdotal evidence that botox could be used to treat depression. He theorized that the absence of frowning produced a happier outlook in the patient. His own published pictures showed patients with depressed eyebrows staring in what might be interpreted as angry poses. How he connects the appearance of sadness to the appearance of anger as a sign of a more positive affect is puzzling. Since he has frozen the patient’s brows, why not do that to the whole face and he can simulate stroke- certainly no cause for depression. Today I read about an article that purports to show skin resurfacing with peels or lasers reduces skin cancer. The sample size was small, the control group was different from the trial group, and peels have been used for over 2000 years and no one has asserted that they saw a reduction in skin cancer in such patients. Also, for almost 30 years we have known that tretinoin (Retin A, Retinol, etc) can prevent up to 90+% of new skin cancers in patients who have had previous skin cancers. My patient’s have been doing that since 1980 and to my knowledge compliance is high as is patient satisfaction. I think most of us would prefer applying a drop of cream to our face each night as opposed to having our skin resurfaced.
If writers are having trouble using common sense, then readers need to do it for themselves.

Liposuction/Liposculpture Rapid Healing

Skin care and cosmetic enhancement/cosmetic surgery

Edward B. Lack MD
President, MetropolitanMD
Chicago’s Cosmetic Surgery Center

I have been performing liposuction surgery, which I call liposculpture, since 1992 and was fortunate to have worked with many of the most famous developers of the concept of body sculpting. We have since called it liposculpture. Over the years we have been able to create incredibly pleasant results with these techniques.

Today I have 2 bones to pick with medical advertising and information distribution by doctors concerning liposculpture.

The first is telling patients that they have to restrict their activities after a procedure and that they will need pain medication. I have been doing this procedure for almost 15 years and my patients have always exercised the next morning and I have never used any pain medication stronger than Tylenol. Since this procedure involves only skin and fat there is little reason for pain and disability afterward. The only reason I can imagine there is a problem is if the surgeon is too rough with the patient. With the tumescent technique of local anesthesia which is the standard for liposuction in the United States, the numbing medicine, lidocaine, stays in the tissue for up to 18 hours. Also, we have a lot of experience with all sorts of surgery that early ambulation, walking, leads to rapid healing. So I have my patients take a 1 hour walk the next morning and another hour walk the next night and then repeat that for three days. Thereafter patients walk one hour daily. Since an average adult can walk 4 miles in 1 hour that is a total of 8 miles per day starting the morning after surgery. Many patients start walking the evening of surgery. Even patients who say they had pain, agree that walking diminishes their discomfort. And with no narcotics they are clear-headed. And they can return to almost all activities (no soaking in water!) within a few days.

The second is all the “new-advances” in technique with specialized instrumentation. From ultrasonic assisted liposuction, to Vaser, to laser liposculpture, to laser assisted liposculpture, to non-invasive laser lipolysis and so on these “advances” are only marketing gimmicks to sell products. They are hyped by manufacturers and doctors alike. I use laser assisted liposculpture and I think it leads to faster healing. I don’t believe it produces better results. I think liposculpture is more of an art than a science. How come 21st century artists don’t sell their work by claiming better results because of better technology or better paint or better canvases than 20th or 19th or 18th century artists? Because it isn’t so! And a surgeon who is gentle and has a good “eye” for his work will produce excellent results regardless of which liposculpture tool you give him. (And beware of the after-photos of patients with their arms raised. Raise your arms while looking in the mirror and see how much thinner you look.)

Edward Lack, MD

Who is a cosmetic surgeon

Skin care and cosmetic enhancement/cosmetic surgery
9/18/06

Edward B. Lack MD
President, MetropolitanMD
Chicago’s Cosmetic Surgery Center

Welcome back. After 30+ years in practice I have many experiences I would like to share. Some are funny and some are not. I hope that at the least they will all be interesting.

Today, I would like to address the issue of what is cosmetic surgery and who is a cosmetic surgeon. Unfortunately we have a turf war going on between the American Academy of Plastic Surgery and whoever they feel is encroaching on their wish to control cosmetic surgery. Cosmetic Surgery is surgery performed for the purpose of enhancing appearance- no more and no less. In fact, there is no specialty of medicine or surgery that teaches this field to any significant extent in any residency training program. All cosmetic surgeons, all, have to acquire post graduate training following their residency programs. I do not want to belabor the inadequacy of cosmetic surgical training in residency except to say that a good cosmetic surgeon is a good doctor first and foremost and there is so much to learn in a residency program that it is all we can do to acquire basic knowledge at that time.

Another issue of debate in the campaign for misinformation is that only ABMS (American Board of Medical Specialists) certified boards are legitimate. In fact while ABMS served an important function 20 years ago it has frozen its accreditation process for as long as the past 20 years. Since then, some 60 boards of specialization and sub-specialization have come into existence and to deny them their deserved competency because an old fraternity wishes to protect its club is absurd.

So who or what is a cosmetic surgeon? The discipline of cosmetic surgery is made up of surgeons who have dedicated their training and their careers to the field of cosmetic surgery. Very few cosmetic surgeons practice cosmetic surgery to the exclusion of all surgery in their primary field of training. Therefore, the field of cosmetic surgery is made up of dermatologists, facial plastic surgeons (originally board certified head and neck surgeons), general plastic surgeons, general surgeons, oculoplastic surgeons (originally board certified in ophthalmology), and oral-maxillofacial surgeons. To these I am sure OB-GYN will soon be added. In addition there are many physicians board certified in internal medicine, family practice, and emergency medicine who have added to their training to perform some types of cosmetic surgery.

The only medical organization which embraces all of these specialties and which promotes interdisciplinary education is The American Academy of Cosmetic Surgery and the only board which certifies cosmetic surgeons is The American Board of Cosmetic Surgery. Both of these can be researched on their websites. However, that is not to say that a well qualified cosmetic surgeon may prefer for his or her own reasons not to participate in either organization.

In coming reports I will discuss the contributions to different aspects of cosmetic surgery and cosmetic enhancement.

Edward B. Lack, MD

Welcome

When my partner, John Rachel, MD, and I founded MetropolitanMD (www.metropolitanmds.com) it was an idea I had had for several decades. Imagine an institution with multiple physicians and surgeons with special and different training in cosmetic surgery and cosmetic enhancement and skin care, where a patient could get an expert evaluation and treatment program no matter what their presenting problem would be. As a fellow of The American Academy of Cosmetic Surgery I already knew that many different fields of medicine and surgery had contributed to the creation of what we now know as cosmetic surgery and that no one specialty had the knowledge to address all patient’s problems. Hence, the idea of a multispecialty cosmetic surgery center was formed. And to make it even more unique, having specialists from different disciplines allows us to practice necessary medical care for patients as well as cosmetic care at the highest skill levels now available.

I am creating this blog with patient information as a goal. Over the coming months (years?) I will address problems in skin care, skin disease, cosmetic enhancement, facial plastic surgery, general plastic surgery, ear nose and throat medicine, head and neck surgery. I may also address concerns in primary care and family medicine, internal medicine, OB-GYN as well as the cadres of specialty medicine which have become invaluable keeping us healthy. As a cancer survivor I will also address cancer issues including cause, prevention, treatment, and issues of being a survivor and the grieving over a lost loved one.

I hope you will join me in what I anticipate to be an exciting adventure in health care communication. Your comments are welcome.

Edward Lack MD