The Doctor Wars Are Heating Up Again

The economy is tight and people are watching how they spend their money more carefully. That's the cue, it always is, to resume The Doctor Wars. Ever had a carpenter come to your house to do a remodeling job and he looks around the room and invariably asks: "What guy messed up the work on this house?" It seems the last guy always did it wrong.
Well, it's the same with doctors. A former employee of mine called to tell me she had applied for a job at a neighboring plastic surgeon's office and when the doctor found out she had worked for me he harangued her for a full half hour on what a bad surgeon I am and how he fixes all my bad results. He must be hurting! Which reminds me of another plastic surgeon on the north shore who found one of his patients was consulting me and he told her "Why he's ... he's... a dermatologist!" Oh my goodness. The word is out.
The anesthesiologists disparage the anesthetists, the orthopedic surgeons disparage the podiatrists, the internists disparage the family practice docs, cosmetic surgeons disparage gynecologists who perform cosmetic techniques, we all complain about the salons and spas, and the plastic surgeons disparage everyone who is not a plastic surgeon and most of the others who are. This feels like the plight of a Christian Scientist with appendicitis. The problem is all of this complaining is done under the guise of advising patients of the risks and benefits of medical and surgical care. It is, of course, self-serving and debasing. And ultimately, as more and more patients tell me stories of doctors who disparage their fellow physicians, what comes through is that no one is fooled. Certainly the patients hear the defensiveness in these attacks. Certainly patients use this information to decide if this is the kind of doctor with whom they wish to entrust their care. For if a doctor will disparage his own in the privacy of his office, what does he say about his patients in the privacy of his other life.
So, I am going to suggest 5 rules by which to judge the ethical conduct of doctors as you evaluate who you trust to care for you and your family:
1. Doctors who spend time disparaging doctors are not focusing on their patient's needs.
2. Doctors who do not reveal their own work ( as in before and after photos or their experience with a given condition) are protecting themselves.
3. Doctors who do not refer to other doctors when they are unclear of a diagnosis or when the patient is not progressing as well as anticipated are not serving the best interests of their patients
4. Doctors who promise perfect results are not perfect.
5. Doctors who do not touch or examine their patients before surgery should not be touching them during surgery.
Be an educated consumer. Stay healthy.
Dr. Lack www.metropolitanmds.com

The Botox Scare: Much More Fiction Than Fact

Aspirin has caused death from bleeding and allergic reactions. Some people should not take aspirin. Water has caused death by excessive water ingestion called water intoxication. All people should not drink too much water at one time. Now we learn of 16 deaths apparently due to botox. We learn that in most cases this was due to massive doses of botox given to children with cerebral palsy. Some others died because of injections in the neck which caused difficulty in swallowing and/or breathing and led to aspiration.
Most patients receive about 30 units at one treatment session in our practice. The doses used in the reports varied from 600 units to 1000 units. Our migraine headache patients receive up to 100-130 units at one treatment session. That is still 1/6 the dose reported in these studies. Many thousands of children have been treated with doses of 600 units and they did not die or suffer. This speaks to the fact that all drugs must be calculated on a case by case basis. They must be administered in a physician’s office by a physician. OK, OK. So your doctor uses a nurse or nurse practitioner or physician assistant. I wonder why. Could it be to improve patient care? I doubt it. And botox parties. There’s a fun idea! Let’s inject drugs into our faces while drinking alcohol with no medical records and no screening of patients. All of our patients fill out a health history form and all are interviewed by Dr. Rachel or myself before they can receive botox. And while I am naming names, what about the salons that are injecting botox. “Don’t worry,” they say. “We have a medical director.” Of course he happens to be an ER doctor on retainer some 10-20 miles away. When we dumb down the administration of drugs, when we eschew physician competence for convenience and price, when we lump all health care providers as equal then we sow the seeds of incompetence and we reap the consequences. The irony here is that these cases of botox injury were probably administered by physicians who are the best in our profession and even they are still vulnerable to human adverse consequences.
I have said and I maintain that botox is one of the miracle drugs of the 20th century. I know it treats wrinkles- you say “big deal”. It is the most effective drug for the spasticity of cerebral palsy; it is very effective in both migraine headache patients and tension headache patients; it is the most effective drug for excessive sweating; it is the most effective drug to balance the face and promote normal chewing after bell’s palsy or stroke; and it is the most effective drug we have for severe muscle spasticity. Put yourselves in the shoes of all of these patients whose lives are compromised by their health impairments. And if you are one of those people who needs a minimally invasive face lift and does not want cutting surgery, the botox non-surgical facelift is a relatively painless and effective treatment to buy 5 years or more of non-surgical facial enhancement.
Let us continue our vigilance with adverse drug reactions. But let us not over-react to the reactions. Let’s not have another law-suit induced silicone scare that torments patients and bankrupts companies.

The Brazilian Butt Lift

I find the term Brazilian Butt Lift to be both titillating and euphemistic. For me it conjures up visions of nubile sun tanned young females clad in scant bikini's cavorting in the Latin sun. To be sure there is considerable historical precedent for regarding the shape of the buttocks as a most sensuous part of the female anatomy, and sometimes the male anatomy. Has anyone failed to note the allure of historical pictures of travel shows to Africa showing minimally clad beautiful African women, or the vision of Latin women conjured up by Girls from Ipanema, or even the then fashionable look of Twiggy.
I first wrote about the contour of the female buttocks about 10 years ago as I was developing liposculpture of the buttocks and I found that women who wanted their buttocks made smaller and/or more shapely were asking for different things depending on their racial preference. The African American female buttocks tends to have a higher rise (the pelvis is tilted anteriorly) and a higher origin with a decided posterior projection (which must be balanced by her breasts); the Hispanic female tends to have a higher rise (the pelvis is tilted anteriorly) with a slightly lower origin and a decided posterior projection (which must be balanced by her breasts); and the Caucasian woman has a still lower origin and little rise (her pelvis tends to be perpendicular to the ground), and is often (in my judgement erroneously) preferred to be relatively flat.
So it is not surprising that with a greater appreciation of ethnic differences and beauty that many women of all races want their buttocks to resemble the Latin or African shape to their buttocks. This accounts for the poplularity of the Brazilian Butt Lift. Essentially, fat is taken from one area, usually the hips, and transferred to the buttocks. My own preference is to transfer about half of the desired fat on the day of surgery and then save an additional half which can be strored frozen or removed anew at a later date and then injected 1-2 months later. The results are usually excellent and patient satisfaction is very high. While there is a dramatic difference in a bikini, I think most women want a better butt line to show off their clothes and their shapely figure. When this is combined with liposculpture of the hips and thighs, the results are very dramatic.
Check out our website www.metropolitanmds.com and click on Body/Brazilian Butt lift to see before and after pictures of some of my patients.