Too fat, too dumb, too selfish: a new year a new opportunity

It is now December 31 at 8:30 PM, the last day of the year. My wife and I have gone out the last 2 nights and decided to spend New Year's Eve alone with a quiet meal. We just got 2 movies and have finished watching the first, "Supersize Me". I am almost sorry this is my next to last movie of the year. My somewhat cynical and often disappointed self watched with resignation. A fat society where food is the number two addiction following alcohol is a sad realization. How much of this is ignorance and how much is depression and boredom I cannot say. I know that we prepared a healthy meal of pasta with a little olive oil, garlic, and parsley along with a small portion of apple sauce for our last dinner of 2006. This is only one side of the story. We are still the greatest nation in which to live. We are a land of opportunity. Last night I watched "The pursuit of Happiness". A story of hope and the rewards of perseverance. Still, also a story of unnecessary deprivation. I specialize in liposculpture. What percent of my patient population wants to make themselves thinner and continue their habits of eating too much and dieting too little. Today I ate at Red Lobster because I received a gift card to eat there. Lumps of butter and bowls of butter sauce and lumps of sour cream on my fried shrimp and sauteed shrimp. I balance this with more exercise than most and not enough for me. I go to a trainer because he knows more than I do and he forces me to do what is good for me. I had 1/2 of my colon and intestines and 1/3 of my stomach removed for treating pancreatic cancer. My anatomic realignment flushes out my fats and my blood tests are normal. I don't always practice what I preach. I will spend the new year , like the old, speaking my mind. I wish I followed my own advice more. I do wish our leaders- political, philosophical, educational, legal, and in general societal would also follow some of my advice. It isn't so much that I am always right. The abuses are so obvious and I judge much of my advice to be common sense and honestly from my heart. Mostly I hope we can meet on a spiritual level as we greet and live the new year.
Blessings to all and to all a good night.

The Gift of Cancer and the Gift of Life: Lessons to be Learned

"Cancer is not a death sentence, it is a life sentence", said Mary Mulcahy MD, my oncologist back in 2003. "It gives you an opportunity to plan the rest of your life." Such insight and clairvoyance is rarely expressed by anyone. I owe my life and much of my transformation to Mary.
In Sept. 2002 I was diagnosed with pancreatic cancer. Overall statistics gave me a 1% chance of survival and with early detection perhaps a 15% chance. I enrolled in a clinical trial under the guidance of Mary Mulcahy and Mark Talamonte. By virtue of their skill and divine intervention I am alive today, 52 months after my diagnosis. I lead a normal life and try to remember each day to give thanks for my many blessings. There are objective and subjective lessons I have learned about dealing with cancer.
First the objective: If you have cancer get into a clinical trial; you will get the best doctors and the best programs. If you have cancer go to a center of excellence; there are specific university medical centers where they have a particular interest in a particular kind of cancer. If you have cancer go to a support group. The Pancreatic Cancer Action Network (PanCan) is one of the best. So is the Gilda Radner Foundation. Learn Yoga, meditation, exercise, healthy eating. Find people who can relate to your life changing experience. Eat a steak every night and drink a glass of beer- no joke! This is the Talamonte diet and it should not be forgotten. Do not dwell on Internet sites like John's Hopkins site for pancreatic cancer which is full of pointless doom and gloom. None of us will live forever, so what's the beef. Experience gratitude in sharing the human experience with so many profoundly beautiful ancestors. Grieve only when you contemplate saying good-bye. Then find comfort in God's presence as your soul joins him, even if you don't believe in God or find the word offensive.
Now to the subjective: I listen better now. I empathize more. I have love in my heart and when I subject my patients to ridicule or playful put-downs such as if you don't like seeing a pimple on your face I could cut your head off, I do it with love and they laugh and are rarely offended. I thank God every day and if I don't, I apologize. I speak to cancer patients and their families as often as I can and I thank them for allowing me to be a part of their lives at such an intimate moment. After you read this please call someone you know who has cancer. You can't bother them. They are living today for that- for everything. Tomorrow is only theoretical. You will both feel better for the experience. If I don't show up tomorrow, thank you all for allowing me to share.
Happy Holidays and Good Health!

California affirms equivalency of The American Board of Cosmetic Surgery

Once again the Superior Court of California affirmed the equivalency of the American Board of Cosmetic Surgery to the American Board of Plastic and Reconstructive Surgery in the State of California. I would hope this will end the dispute once and for all and stop the needless waste of money and time over what is only a turf battle. As the number of board certified plastic surgeons who join the American Academy of Cosmetic Surgery and take board exams from the American Board of Cosmetic Surgery increases, the obstructionists who often hide their identities in the American Society of Plastic Surgery will lose more and more prestige as the public views them as the self-seeking propagandists that they are. As acknowledged by the American Board of Cosmetic Surgery and affirmed by the Superior Court of California, cosmetic surgeons include qualified physicians from the fields of Dermatololgy, Facial Plastic-ENT surgery, Oculoplastic surgery, General Plastic Surgery, Oral Maxillo-Facial Surgery, and General Surgery. By sharing our knowledge and our insights we provide a forum and a constellation for the American public to receive the safest, most up-to-date, and most accomplished cosmetic surgery in the world.
Kudos to the courts of California. Were it only true in the rest of the United States.

Do Not Be the First on Your Block to Try Artefill

Artefill is the newest FDA approved kid on the block for skin fillers. These products can erase static wrinkles, facial lines, and scars. This new product is supposed to be nonresorbable. It has been on the market in Europe for many years and there is a litany of bad results such as nodules, sores, and redness which are difficult or impossible to erase. The product was changed slightly for the US but it is still polymethylmethacrylate microspheres suspended in a collagen and water matrix. The collagen and water matrix are absorbed, leaving the microspheres in the skin. These spheres are then surrounded with fibrous tissue from the body, much like silicone is after injections. The results have been noted to last at least one year. Again they warn recipients of lumpiness, persistent swelling or redness, and increased sensitivity at the injection site. The product requires a kin test to be sure the patient is not allergic to the material and can worsen hypertrophic or keloid scars. The biggest draw-back is that unlike resorbable fillers like Restylane this will not go away after a bad reaction. Seeing the permanent deformities of so many self-indulgent movie stars this is not the time to test-try the newest product on the block. I am not sure how long I will wait before trying this product. I am sure I will use the silicone microinjection technique as we do with silicone and I will insist on multiple very small treatments to prevent permanent unsightly nodules.
Buyer Beware!

Abdominoplasty (tummy tuck) vs liposuction

Many people are confused when is abdominoplasty (tummy tuck) the right procedure and when is liposuction (liposculpture) the correct procedure. Some years ago a study at NYU medical center looked at abdominoplasty patients done at their institution from 1981-1990. They found that only 15% of patients fit the criteria for abdominoplasty. That is still a lot of necessary abdominoplasties, but even more unnecessary abdominoplasties. These patients should have had liposculpture.
Abdominoplasty or tummy tuck is the surgical removal of the bottom half of the abdominal fat and skin, the tightening of the underlying abdominal muscles, the repositioning of the umbilicus (belly button) and the reattachment of the upper abdominal skin to that of the pelvis. The purpose is to treat patients with excess fat above and below the umbilicus, excess loose hanging skin above and below the umbilicus, and stretched abdominal muscles. While you can judge loose skin and fat a physical exam is needed to diagnose stretched muscles.
Since fat can be removed with liposculpture and skin is elastic and will shrink after liposculpture, most patients do not need abdominoplasty.
Recovery from liposculpture is almost immediate and patients resume exercise by walking for an hour each morning and night beginning the evening of or the morning after liposculpture. Pain is minimal and can be controlled with tylenol or alleve. Abdominoplasty, on the other hand, is painful because muscles are sewn and skin is cut and sewn and often a drain is in place for 3-4 days. Patients complain of pain and soreness and while we do walk the next day it is usually 1/2 the distance or less of liposculpture patients.
Healthy lifestyle may be the best body shaping method, however liposculpture and abdominoplasty are valuable tools when they are selected correctly.

Smart Lipo All Over Again

Aha! Now I found "smart lipo" on the internet. This time the search revealed the term is trade-marked by Cynosure, one of the premier laser companies in the world. This new marketing initiative involves using a KTP laser which delivers energy through a fiber optic flexible cable. The cable is introduced to the fat through the skin and heats the fat until it destroys the cells. They claim for small areas they do not have to suction the soupy remains and for large areas they do. I did not see any studies to support their claims nor any reports of side effects. I will need to go through the literature that they site. In the meantime this is the same technology with a laser twist that I and others investigated and reported on using low frequency ultrasound in the mid 1990's. In addition I and colleagues reported on laser assisted liposuction in 2000 in peer reviewed literature. Once again we have a me-too product with no proof of superiority being hyped through the lay press so that patients are calling to find someone who pracitices this new revolutionary procedure. As I previously stated the only breakthroughs in liposculpting came in 1987 when Jeffrey Klein developed the tumescent technique of local anesthesia and microinstrumentation. All the rest has been introduction of different kinds of screw drivers to make the procedure better in someone's (usually the inventor's) hands. Ultimately liposculpting is an art and when a machine is developed to do the work there will be no need for a physician.
Perish the thought!

Who is a Cosmetic Surgeon Part II

For the second time I am writing a brief on who is a cosmetic surgeon. I am stimulated to address this issue again by a clearly biased editorial written in the last Plastic and Reconstructive Surgery journal. From the point of view of training, contributions, and board qualifications of the American Board of Cosmetic Surgery: general surgeons, facial plastic surgeons, dermatologic surgeons, oral maxillofacial surgeons, oculoplastic surgeons and general plastic surgeons are all qualified to be cosmetic surgeons. Whether members of these groups choose to practice cosmetic surgery depends on their interests, continuing education, and the amount of practice time they devote to cosmetic surgery. None of these primary fields teach cosmetic surgery in residency. All of them must have post graduate education to gain knowledge and subsequently to gain experience. Despite the protestations of some physicians in any one of these groups none have special expertise in our field and none have made such a contribution that they can dominate the field. The wonderful thing about cosmetic surgery is its codependence on each of the contributing fields to its whole.
That said, a would-be consumer should: interview several surgeons in the field, look at before and after photos, check credentials and training, verify the reputation of the physician from internet searches and from hospital and medical society sources, and speak with a previous patient when it is appropriate. Ultimately, you will live with your cosmetic surgeon for a year after the procedure so if you are not pleased with the person before you have the procedure, summer may look like winter to you.

Acne Patients Get Short Shrift From Government

Last March the federal government implemented what is known as the i-Pledge program for acne patients needing the drug Acutane. The premise is that this drug is so dangerous that only federal beurocrats and not doctors can monitor use of the drug. The concern is for fetal malformations in patients becoming pregnant while taking Acutane. I treated more than 1000 young patients during the 1990's with this drug and never had a single pregnancy occur. Nevertheless, this is an important concern and one left best to the management of physicians. Interestingly this was not an issue of government concern until a United States Senator lost a child to suicide after taking Acutane. The Senator blames the drug Acutane, ignoring familial, social, and genetic causes for his son's untimely demise. Somehow this reminds me of throwing the baby out with the bath water. Acutane has saved thousands of people with disabling and scarring acne from a life of shame and untold costs in trying to remedy their scars. It is a life saving drug when one considers quality of life and mental health important. Attorneys in general and beurocrats specifically are not competent nor qualified to monitor drugs. The program is onerous and inhibitory. Physicans are trained to monitor the use of dangerous drugs. If we find an incompetent physician do not punish patients. Get rid of the physician's license. And while we are at it, let's get rid of incompentent government beaurocrats. Oh, Oh. That can't happen. There would be virtually no one left to run the government.