Head ache the day after surgery? It's probably a "coffee headache".

Seattle Plastic Surgeon advises coffee drinker patients to have a cup of coffee ASAP after surgery. 

I did surgery on a vigorously healthy middle aged lady yesterday and today she was doing fine except for a really, really bad headache.  My very astute nurse told her to drink two cups of coffee and see if that helped.  Sure enough, a little caffeine in the system and the headache disappeared. 

Coffee headaches are pretty common after surgery because patients cannot eat or drink anything the morning of surgery so regular coffee drinkers miss out on that dose of caffeine and they often don’t feel like a cup of coffee for a few days after surgery.

So, if you had a tummy tuck yesterday and your head hurts more than your tummy, you just may have a coffee headache and the cure is a nice hot cup of coffee.   Bottoms up!

Thanks for reading!   Dr. Lisa Lynn Sowder

My very first Botox patient. I injected her scowl lines and was met with great success.

I remember, years ago,  hearing about doctors injecting each other with Botox to reduce their scowl lines and thinking:  how crazy is that?????

But the anecdotal reports kept coming in and in 1992 a Canadian ophthalmologist, Dr. Jean Carruthers and her husband, Alastair, published their finding that Botox is effective in treating moderate of severe glabellar frown lines (those nasty vertical scowl creases right between the eyes).  Dr. Carruthers got the idea to try this because Botox had been used for years by ophthalmologists to treat involuntary squinting.    She and other astute opthalmologists noticed that the areas injected with Botox would loose their wrinkles. 

Botox quickly became one of the most widely researched pharaceuticals in the world with more than 2500 articles in scientific and medical  journals written about it.   Ten years after the paper by Drs. Carruthers and Carruthers, the FDA approved Botox for cosmetic use and well, the rest is history.  Botox is now approved for 25 unique indications in 85 countries.  In 2011, according to the American Society fo Plastic Surgeons’ procedural statistics, 5.6 million Americans opted for Botox treatment.  Some days when Botox is flying off my freezer shelf, I feel like I’m the one doing all those injections!

It is the scientific serendipity of the Botox story that I find so interesting.  It makes me wonder what other  discovery is just an astute observation away from being the NEXT BIG THING.

Thanks for reading!  Dr. Lisa Lynn Sowder

The pull of the operation will often pull up the medial thighs and really improve the contour.  This lady on the right is a great example of that.  I didn’t touch her thighs, honest!  You can try this at home.  Stand in front of a mirror and grab you lower abdominal fat pad and pull it up.  Cool, huh?

Another benefit of tummy tuck is reduction and lifting of the mons pubis which can be bulky and/or saggy.  I have to say that this is a benefit that many, many patients are thrilled with. 

Lastly, sometimes patients have a substantial improvement in their posture.  Many patients with abdominal laxity have lordosis, which is a fancy word for sway-back.  Once their abdominal muscles are tightened with a tummy tuck, their spinal support is improved.  Some women with back pain issues find their back pain much improved.

 When I am evaluating a patient for a tummy tuck, I make sure to take a look beyond their tummy and get a good look at their posture, their thighs and their mons pubis.

Oh, and these added benefits don’t cost a dime extra.  Now that is a nice twofer, threefer or even fourfer.  

Thanks for reading!  Dr. Lisa Lynn Sowder

For years it has been observed that obese patients with Type 2 diabetes have a dramatic improvement in their diabetes after gastric bypass surgery.   And this improvement is seen almost immediately after surgery, long before the patient loses significant weight.  Now there is something more that just anecdotal reports of this finding.

Recently the results of a randomized, prospective study of 150 obese, type 2 diabetic patients treated with  surgery or intensive medical therapy was released.  This study was carried out at the Cleaveland Clinic and took a look at the blood sugars of patients one year after surgery vs. one year after intensive medical treatment. 

The surgery patients blew the medical patients out of the water with their blood sugars going down, way down, despite stopping their diabetes medications. 

This study confirms the many anecdotal reports of the past decade or so.  Could it be that the first line of treatment for this devastating disease that afflicts so many obese patients will be major surgery?   It’s too soon to tell but as these types of surgical weight-loss procedures become safer and safer, that just may end up being the case. 

Now we just need a fix for obesity that triggers most cases of Type 2 diabetes.    Send me your ideas for this.  I’d love to be in on it. 

Thanks for reading!  Dr. Lisa Lynn Sowder

Recently a breast reduction patient told me that she felt like a part of her brain had been removed along with some of her excess breast tissue.

As a young woman, she watched in horror as her breasts became larger and larger and then in middle age became saggier and saggier.  Her breasts tormented her every single day of her adult life.  They dictated the sports she played (or didn’t), the clothes she wore (or didn’t), and in some cases, how others (particularly dudes) percieved her.

Finally, she overcame her fear of surgery and came in for a breast reduction.  During her initial consultation I told her that a pair of smaller, shapelier  breasts (that would match her slender build) were lurking inside those big, saggy breasts and it was my job to liberate them.  And indeed, when her surgery day arrived, I did.  It took me three hours to fix something that had tormented her for thirty years.  Despite the usual early postoperative bruising, swelling and discomfort, I could not wipe the smile off her face from the minute she woke up from the anesthetic and took a peak into her postoperative bra.

All of that mental (and physical) effort she had been putting into her breasts was now freed up for something else.    This particular patient’s “something else” is  lessons in the aerial arts -  twisting, turning, and slinking up, on, in and around a large silky ribbon suspended from her ceiling.  Talk about a change and just not a change in her bra size.

Thanks for reading!  Dr. Lisa Lynn Sowder

Today I saw a patient in my office for a cosmetic procedure.  I couldn’t help but notice in his health history that he had had colon surgery.  I asked him about the details and here’s his story.

He knew he should get a screening colonoscopy at age 50 but he kept putting it off – and off – and off.  Finally at age 54 he succumbed to his wife’s “nagging” and finally went in.  Guess what the doctor found?  A couple dozen polyps and a rectal cancer.  He had been totally without symptoms despite having a half dollar sized cancer just beyond the reach of a finger during his yearly rectal exam. 

He had part of his rectum removed but did not need a colostomy and now 5 years later is disease free.  Had he procrastinated another year or two, his outcome could have been much, much worse. 

I’m here to tell you, it’s not that bad.  The preparation is a little unpleasant and I was famished by the time they were starting my IV to knock me out but really, it was just one day off of work and a full ten years of peace of mind.  I also had several weeks of basking in my handsome doctor’s praise of my  ”absolutely pristine”  colon.

Read more here about early dectection of colorectal cancer and fear not the big black snake (my term of endearment for the colonoscope).  There are things you should fear a whole lot more – colorectal cancer come to my mind.

Thanks for reading!   Dr. Lisa Lynn Sowder

American Humorist David Sedaris

This week’s New Yorker Magazine has a hilarious piece by humorist David Sedaris.  Mr. Sedaris now lives in Paris and I squeal with delight every time I read one of his essays on his French experiences.   Here is his take on French medicine.  This is just an excerpt and you  should really pick up the April 2, 2012 New Yorker to read the entire essay. 

I was lying in bed and found a lump on my right side, just below my rib cage.  It was like a devilled egg tucked beneath my skin.  Cancer, I thought.  A phone call and twenty minutes later, I was stretched out on the examining table with my shirt raised. 

 ”Oh, that’s nothing,” Dr. Medioni said.  “A little fatty tumor.  Dogs get them all the time.”

I thought of other things dogs have that I don’t want:  Dewclaws, for example.  Hookworms.  “Can I have it removed?”

“I guess you could , but why would you want to?”

He made me feel vain and frivolous for even thinking about it.  “Your right,” I told him.  “I’ll just pull my bathing suit up a little higher.”

When I asked him if the tumor would get any bigger, the doctor gave it a little squeeze.  “Bigger?  Sure, probably.”

“Will it get a lot bigger?”

“No.”

“Why not?” I asked.

And he said, sounding suddenly weary, “I don’t know.  Why don’t trees touch the sky?”

This conversation would never happen in my office.  The conversation would go something like this.

Me:  It’s probably a lipoma, a fatty tumor.  They are very common.  (I’d leave the dog reference out).  It could be something else but I am almost certain it’s a lipoma.

David:  Can I have it removed?

Me:  Sure.  I would send it to pathology to make sure it wasn’t something more serious and that would take care of it.  These lipomas can get pretty big.  I could remove it next week in the office.  I would inject some local anesthetic and remove it though a small incision.  You could drive yourself home.  It will leave a scar but the scar won’t be as noticable as the lipoma.

David:  Will my insurance pay for it?

Me:  Maybe, it depends on your insurance.  I’ll have you pay me, then I will send the information to your insurance company and they might reimburse you. 

David:  How much will it cost?

Me:  I’ll have my patient care coordinator give you a price quote and get you on my schedule.  Make sure you don’t take any aspirin between now and next week. 

So here’s the difference:  I’m happy to take the lipoma out.  I like doing surgery and that’s how I pay my bills.  Also, I want to make sure it is a lipoma.  If it is something horrible like a fibro-fatty cancerous horrindoma and Mr. Sedaris has a delayed diagnosis because of me, he will sue me for a bazillion dollars.   I, like all American doctors, practice defensive medicine.   In America, defensive medicine is the standard of care.  Also, this conversation takes place between two Americans.  American patients  like to get things fixed and American doctors like to fix things.   Even minor things.  So there will be about $500 changing hands because of Mr. Sedaris’  lipoma, $250 for the use of the operating room and $250 for my time and skill.    In France, $50 changes hands because  Dr. Medioni is dismissive about Mr. Sedris’ lipoma and is not worried about being sued even with the 0.1% chance his clinical impression is wrong.  And  Mr. Sedaris lives with his lipoma and pulls his bathing suit up a little higher. 

This, folks, is why American Health care is so expensive.

Thanks for reading!  Dr. Lisa Lynn Sowder

The Bee Gees' "Stayin' Alive" is about 100 beats per minute. Perfect for CPR.

Last weekend I spent the better part of a beautiful spring day indoor taking my ACLS provide course.  I take this class every two years and every year there is something new.   This year my take away was to forget about the mouth-to-mouth resuscitation and just do chest compressions really strong and really fast and be sure to hum “Stayin’ Alive” while doing so.   This keeps the patient “alive” while waiting for help to arrive. 

• The compression tempo needs to be at least 100 per minute – that same tempo as “Stayin’ Alive”!
• The depth of compression needs to be two inches.
• You must allow for full recoil of the chest.
• If possible, switch out the person doing the chest compressions every 2 minutes because doing it right is very, very tiring. 

If you have not had training in CPR, get thee to the nearest class.  They are held frequently and the life you save may be someone you love. 

Thanks for reading!  Dr. Lisa Lynn Sowder

Every late winter/early spring, when the city of Seattle is just about ready to move to Phoenix the Moisture Festival saves the day.

This quirky vaudevillian celebration of human weirdness runs for several weeks at various venues in Seattle.  It showcases jugglers, comedians, contortionists (my husband’s favorites), aerialists, musicians, unicyclists, bubble masters and even a guy who makes sandwiches with his feet and then gets members of the audience to eat them.   What is not to loooooove?   All of this for $20!!!

Soooo, if you need a few laughs, check out a show.  The Comedy/Variety shows are PG rated and fine for the kids.   (My daughter loves the Moisture Festival and wants to be an contortionist when she grows up).  The over 18 shows are for adults only and showcase Seattle healthy burlesque scene and, although I do not have proof, probably some nice plastic surgery work!

Thanks for reading.  Dr. Lisa Lynn Sowder

The Match System works like this:  As a fourth year student, you apply to a dozen or so residency programs and if asked, go for an interviews at these programs.  Then you rank the programs in decending order of fabulous to surely miserable and everything in between.  And the residency directors rank all of the applicants in decending order of incredible to surely a disaster.  An all knowing computer takes these rankings and matches the applicants with the programs.  Supposedly, the applicants’ wish list has more weight than the residency programs’  but I bet that students are still advised NOT to list any program that makes them want to chew glass instead of go there.

This is a momentous day.  This Match determines where you will live and train for anywhere from 3 – 8 years, who will become your BFFs, often whom you will marry, where you will eventually live and how you will practice your specialty.  Every fourth year medical student wants a great residency experience both academically and socially.

Okay, enough about that and more about me.  I matched at my 2nd of 10 choices, the University of Utah and, as a skiier and a woman, was thrilled.  Of course Utah has the BEST SNOW ON EARTH and the University of Utah had a lot of women in their general surgery program, even back then. 

I ended up spending 6 years in Salt Lake City, 5 years as a general surgery resident and 1 year working in the Intermountain Burn Unit.  My years there made a man out of me (even though I’m a girl).  I came away from Utah feeling I could handle just about anything that walked in through the emergency room door.  I also came away from Utah in fantastic physical condition (the altitude makes for a strong cardio-pulmonay system), with many, many lifelong friends and a deep love and appreciation for deep, dry powder snow and Mormons (really). 

So I hope every fourth year student matches at one of their top ranked programs and  some 29 years hence, looks back on their residency program with as much fondness as I do. 

Thanks for reading.  Dr. Lisa Lynn Sowder