Blog — Notes of a Plastic Surgeon

Welcome to my blog. I am a plastic surgeon in Seattle and have been in private practice since 1991. I've seen more than a few interesting faces and cases through my years spent in the exam room, the operating room and the emergency room. And I have an opinion on just about everything relating to plastic surgery (and a lot of unrelated stuff). If you like my blog, let me know. Thanks for reading! Lisa

Some suggestions for New Year’s Resolutions

December 31st, 2019 — 12:30pm

 

I cannot improve on this list of Woody Guthrie’s.

blog new yearsThanks for reading and Happy New Year!

And I would be honored if you followed me on Instagram @sowdermd and @breastimplantsanity.

Dr. Lisa Lynn Sowder

Uncategorized

Smash the Wellness Industry by Jessica Knoll

December 3rd, 2019 — 1:08pm

I am so pleased to share this opinion piece from the New York Times. My husband and I were celebrating our 25th anniversary in Paris last June when I came across it while paging through the International Edition of the New York Times while awaiting my Croque Monsieur at a tiny sidewalk cafe.

Croque Monsieur: 8 billion calories and totally worth it. Bon Appetit!

Smash the Wellness Industry

Why are so many smart women falling for its harmful, pseudoscientific claims?

By Jessica Knoll

New York Times

June 8, 2019

A few months ago, I had lunch with the writer behind one of my favorite movies of the year, the agent who made the deal and the producer who packaged the project. I wanted to hear all about the process and perhaps find an opportunity to collaborate. When the server came to take our order, I flashed to that scene in “Romy and Michele’s High School Reunion” when Mira Sorvino walks into a diner in a striped skirt suit and asks the waitress, “Do you have some sort of businesswomen’s special?”

Had there been any sort of businesswomen’s special that day, our group probably couldn’t have ordered it. Someone was slogging through the Whole30 program, someone had eliminated dairy, and someone else was simply trying to be “good” after a “bad” weekend. The producer said it didn’t matter how “good” she was. She had lost the baby weight and though she may look tolerable in clothes, under the Spanx her stomach was a horror show. The writer said she had so much cellulite on her thighs she looked diseased. I gazed around the restaurant, longingly, wondering what the men eating cheeseburgers were talking about.

At one time, I too would gleefully have torn myself apart. I despised my body, and my devotion to changing it amounted to years of unpaid labor, starting with a bout of bulimia in high school. In preparation for my wedding, I worked out twice a day on 800 calories. From there I moved on to counting macros, replacing rice with cauliflower pellets, 13-day cleanses, intermittent fasting and an elimination diet that barred sugar, dairy and nightshades like potatoes.

Every new regimen ended in the same violent binge. I’d wait for my husband to go to bed so that I could obliterate the pantry without him asking, “Are you O.K.?” For the next few days, I would throw myself on the altar of “clean eating,” only to start the cycle all over again.

I called this poisonous relationship between a body I was indoctrinated to hate and food I had been taught to fear “wellness.” This was before I could recognize wellness culture for what it was — a dangerous con that seduces smart women with pseudoscientific claims of increasing energy, reducing inflammation, lowering the risk of cancer and healing skin, gut and fertility problems. But at its core, “wellness” is about weight loss. It demonizes calorically dense and delicious foods, preserving a vicious fallacy: Thin is healthy and healthy is thin.

Almost three years ago, I moved to Los Angeles from New York. After death and divorce, moving is supposed to be the most stressful thing you can go through, and eating became my salve. I had a second book and a screenplay due, a new city to explore and friends to make, but I could hardly focus on any of that for how crazy I felt around food. So I did a desperate thing. I searched “intuitive eating” online.

Thanks to a stint at a health magazine, I had a glancing understanding of the philosophy, which encourages a return to the innate wisdom we had as babies — about when to stop eating, what tastes good and how it makes our bodies feel. I might have sought it out sooner if not for the part where you learn to accept how your body looks once you stop restricting food, even if that version of your body is larger than you would like.

The search led me to a nearby dietitian who is considered by some to be one of the founding mothers of intuitive eating. I picked up the phone.

Intuitive eating has been around for decades, but it’s suddenly receiving a lot of attention. Perhaps it’s because women are finally starting to interrogate the systems that hurt and exploit us. Perhaps it’s because we’re driven and ambitious and we need energy — not lightheaded, leafy-greens energy but real energy, the kind that comes from eating the hearty foods men eat.

I had paid a lot of money to see a dietitian once before, in New York. When I told her that I loved food, that I’d always had a big appetite, she had nodded sympathetically, as if I had a tough road ahead of me. “The thing is,” she said with a grimace, “you’re a small person and you don’t need a lot of food.”

The new dietitian had a different take. “What a gift,” she said, appreciatively, “to love food. It’s one of the greatest pleasures in life. Can you think of your appetite as a gift?” It took me a moment to wrap my head around such a radical suggestion. Then I began to cry.

Two years into my work with her, I feel lighter than I ever have. Food is a part of my life — a fun part — but it no longer tastes irresistible, the way it did when I told myself I couldn’t have it. My body looks as it always has when I’m not restricting or bingeing. I’m not “good” one day so that I can be “bad” another, which I once foolishly celebrated as balance.

Occasionally, when I’m stressed, I comfort myself with food, and my dietitian assures me that’s an acceptable kind of hunger too. Emotional eating is a coping mechanism. We’re told it is an unhealthy habit, one we must break, but that’s another wellness lie. It is not vodka in our morning coffee. My binges stopped once I stopped judging myself for wanting to eat the foods “wellness” vilified, sometimes for reasons other than physical hunger.

I no longer define food as whole or clean or sinful or a cheat. It has no moral value. Neither should my weight, though I’m still trying to separate my worth from my appearance. They are two necklaces that have gotten tangled over the course of my 35 years, their thin metal chains tied up in thin metal knots. Eventually, I will pry them apart.

Most days, I feel good in my skin. That said, I am probably never going to love my body, and that’s O.K. I think loving our bodies is not only an unrealistic goal in our appearance-obsessed society but also a limiting one. No one is telling men that they need to love their bodies to live full and meaningful lives. We don’t need to love our bodies to respect them.

The diet industry is a virus, and viruses are smart. It has survived all these decades by adapting, but it’s as dangerous as ever. In 2019, dieting presents itself as wellness and clean eating, duping modern feminists to participate under the guise of health. Wellness influencers attract sponsorships and hundreds of thousands of followers on Instagram by tying before and after selfies to inspiring narratives. Go from sluggish to vibrant, insecure to confident, foggy-brained to cleareyed. But when you have to deprive, punish and isolate yourself to look “good,” it is impossible to feel good. I was my sickest and loneliest when I appeared my healthiest.

If these wellness influencers really cared about health, they might tell you that yo-yo dieting in women may increase their risk for heart disease, according to a recent preliminary study presented to the American Heart Association. They might also promote behaviors that increase community and connection, like going out to a meal with a friend or joining a book club. These activities are sustainable and have been scientifically linked to improved health, yet are often at odds with the solitary, draining work of trying to micromanage every bite of food that goes into your mouth.

The wellness industry is the diet industry, and the diet industry is a function of the patriarchal beauty standard under which women either punish themselves to become smaller or are punished for failing to comply, and the stress of this hurts our health too. I am a thin white woman, and the shame and derision I have experienced for failing to be even thinner is nothing compared with what women in less compliant bodies bear. Wellness is a largely white, privileged enterprise catering to largely white, privileged, already thin and able-bodied women, promoting exercise only they have the time to do and Tuscan kale only they have the resources to buy.

Finally, wellness also contributes to the insulting cultural subtext that women cannot be trusted to make decisions when it comes to our own bodies, even when it comes to nourishing them. We must adhere to some sort of “program” or we will go off the rails.

We cannot push to eradicate the harassment, abuse and oppression of women while continuing to serve a system that demands we hurt ourselves to be more attractive and less threatening to men.

And yet that is exactly what we are doing when we sit around the lunch table and call our stomachs horror shows.

There is something called the Bechdel test for film. Developed by Alison Bechdel in 1985, an American cartoonist, the idea is that the film must satisfy three requirements to pass: (1) feature at least two women who (2) talk to each other about (3) something other than a man. Sounds simple, but a shocking number of films have failed to pass.

In 2019, I want to propose a new kind of test. Women, can two or more of us get together without mentioning our bodies and diets? It would be a small act of resistance and a kindness to ourselves.

When men sit down to a business lunch, they don’t waste it pointing out every flaw on their bodies. They discuss ideas, strategies, their plans to take up more space than they already do. Let’s lunch like that. Who’s eating with me?

Jessica Knoll is the author of the novels “Luckiest Girl Alive” and “The Favorite Sister.”

Thanks for reading and I would be honored if you followed me on Instagram @sowdermd and @breastimplantsanity.  Dr. Lisa Lynn Sowder.  And…….you gotta eat at least one Croque Monsieur before you die.

 

General Health, Highly Recommended Reading, Stuff I love

En Bloc Capsulectomy: A Skillful Dissection by Investigative Reporter Jolene Edgar for RealSelf

November 26th, 2019 — 10:56am

I do a lot of breast implant removals and the topic of en bloc capsulectomy often comes up.  I am so glad to see this this very well researched and well written article by Jolene Edgar.  She has interviewed me and several other plastic surgeons regarding our approach to the breast implant illness patient.  If you are considering breast implant removal for any reason, be sure to check out this article.  https://www.realself.com/news/breast-implant-illness-en-bloc-implant-removal

Thanks for reading and I would be honored if you followed me on Instagram @sowdermd and @breastimplantsanity.

Dr. Lisa Lynn Sowder

Breast Implant Illness, Breast Implant Removal, Breast Implants, Patient Beware, Patient Safety

Halloween Owl is a Mother’s Friend

October 29th, 2019 — 12:20pm

Happy Halloween!

blog halloween owl

“I’ve come for my candy.”

If you have young kids at home, you need to meet the Halloween Owl.  He is your best friend this time of year.

This is how he operates.   You help your  children set aside at least half of their sugary treasure to donate to the Halloween Owl.  They put their donation into a nice decorated paper bag with “Halloween Owl Only” written on it with big black letters.   After the children are in bed, their tummies aching from all of that crappy candy, the Halloween Owl taps on the window to claim his share of the bounty which he shares  with all of his woodland friends.    There is little pushback from the children as they imagine the owls and raccoons and possums enjoying their once a year treat.  And in Seattle, where I live, there are occasionally reports of coyotes in the city limits and once a report of a cougar in one of our city parks.   Those are big critters and they need lots of candy and the children may be even more generous with their donation.

My children are young adults now and they are wise to the Halloween Owl but it worked great for years.  So if your kids are young, give it a try.  Just make sure that you put the candy at the very bottom of the garbage can.

Thanks for reading and i would be honored if you followed me on Instagram @sowdermd and @breastimplantsanity.   Dr. Lisa Lynn Sowder

Children, Now That's Cool

“It’s All in Your Head”—Medicine’s Silent Epidemic

October 11th, 2019 — 8:18am

A fascinating article about the mind-body connection.  This is from a recent Journal of the American Medical Association.  

 

Viewpoint

September 16, 2019

“It’s All in Your Head”—Medicine’s Silent Epidemic

Matthew J. Burke, MD, FRCPC1,2

Author Affiliations Article Information

JAMA Neurol. Published online September 16, 2019. doi:10.1001/jamaneurol.2019.3043

It’s all in your head” is a phrase sometimes said by physicians to patients presenting with symptoms unexplained by medical disease. As a neurologist specializing in neuropsychiatry, nothing bothers me more than overhearing medical colleagues proclaim this one-liner at the bedside or snicker about these patients during rounds. Unbeknownst to them, I also hear my patients’ version of being on the other end of this phrase and find myself constantly trying to repair the damage that these words can cause. Whether physicians like to admit it or not, medically unexplained symptoms encompass a vast terrain of clinical practice. In neurology, these symptoms fall under functional neurological disorder, but every specialty has their own variants and favored terminologies (eg, chronic fatigue syndrome, fibromyalgia). The inadequate management of this segment of medicine represents a silent epidemic that is slowly eroding patient-physician relationships, perpetuating unnecessary disability, and straining health care resources.

The irony of “it’s all in your head” is that although this phrase is often used inappropriately and dismissively, it is technically correct. The problem does indeed lie within the head. More specifically, it lies within the brain and its complex networks that we are just beginning to understand. Over the past 10 years, neuroimaging research studies have consistently identified brain abnormalities in patients with medically unexplained symptoms—yes, biologically based changes in the activity and connections of brain regions, such as the amygdala, prefrontal cortex, temporal-parietal junction, and other structures.1 These brain circuit abnormalities provide physiological explanations for once mysterious links between regions implicated in emotional processing and the generation of “physical” symptoms (eg, pain, fatigue, weakness). Jean-Martin Charcot, MD, a famous 19th century French neurologist and early pioneer of this field, reportedly insisted that a “functional lesion” would be found when microscopes were sufficiently powerful.2 Well, our microscopes are getting better, and we are now starting to see evidence of the predicted functional or software disruptions in the brain. We still do not fully understand what causes these software problems; however, recent research suggests a multifactorial etiology, including genetic predisposition, environmental risk factors (eg, childhood adverse events), and psychological stressors.3

Despite the growing scientific literature, there has been minimal shift in physician attitudes toward these patients. Physicians seem quite comfortable with the idea of structural brain lesions causing psychological symptoms, such as a frontal lobe stroke causing depression or a temporal lobe tumor causing delusions. However, the reverse causality of psychological factors (borne of the same substrates—neurotransmitters, neurons, and synaptic connections) leading to neurological or systemic symptoms is often hastily dismissed and remains highly stigmatized. Thus, many physicians either simply ignore these kinds of symptoms or wrongfully assume that patients are malingering.

Based on such attitudes, a typical physician-patient interaction may proceed as follows: (1) the physician provides a rundown of normal investigations, (2) the patient is told they have no known medical diagnoses, (3) a brief awkward exchange occurs, and (4) little further explanation, guidance, resources, or facilitation of an appropriate referral process is given. Even if the infamous phrase is not explicitly stated, this sequence leaves the patient to infer for themselves that it must be all in their head. Unfortunately, they do not perceive this as, “I have a real dysfunction of networks in my brain,” but instead understandably conclude that, “they think I’m crazy” or “faking it.”4 Sometimes, patients may hear the distant utterance of, “Maybe you should see a psychiatrist,” as they exit the office door, but in this context, such advice is rarely productive.

Many of these patients can be so offended by this encounter that they quickly seek multiple second opinions and subsequent rounds of pricey and unnecessary investigations. Depending on the jurisdiction and medical record system, the original physician may be completely unaware of these additional rounds of care. Mounting negative and invalidating clinical interactions can become a source of distress and cause medical trauma. At this point, patients often either fall through the cracks or stumble on a fringe medical specialist or alternative medicine practitioner who may offer the “physical” diagnosis they’ve been yearning for. This could include a growing list of unsubstantiated metabolic deficiencies, infectious disorders, or autoimmune hypersensitivities. Anecdotally, the most common current example seems to be the diagnosis of chronic Lyme disease by unvalidated assays.5 Let me be clear that many of these practitioners are well intentioned and can offer holistic approaches that medicine could learn a lot from. However, there appears to be a subset that take advantage of these patients’ desire for a “physical” diagnosis and exploit their vulnerabilities.

For the patient, receiving such a concrete, “organic” diagnosis often quells mounting anxiety, which in itself could be partially therapeutic. However, now wedded to their given diagnosis with no knowledge of their actual software problem, patients do not see a need to address underlying factors that may be contributing to their disorder nor do they receive the multidisciplinary care that they may so badly need. The saddest part of this epidemic is that if addressed early, these symptoms may be reversible; however, with delays to proper diagnosis and management, prognosis worsens considerably.6

So how can we prevent or interrupt this concerning trend? Often, the first step to addressing a problem in medicine is providing data to prove that the problem exists. This is where the challenge begins and what makes this a silent epidemic. The magnitude of this crisis is difficult to demonstrate because these patients largely elude the billing codes used for case ascertainment in large population-based studies. This is because of a combination of gaps in current billing and diagnostic codes (country specific) and because of the fact that codes are not being used appropriately by many physicians. The latter may happen for multiple reasons, including lack of comfort with these diagnoses and concerns of medicolegal ramifications.

Despite a few isolated efforts to estimate prevalence7 and health care costs,8 the evidence base needed to sway research granting organizations, government policy makers, and health care and insurance systems has been largely elusive. I am optimistic that it is only a matter of time until the scope of this crisis is fully appreciated. I see firsthand the high patient volumes and health care resource utilization that currently escape record keeping. I raise these concerns to my colleagues, who wholeheartedly agree, but the conversation ends there and the silence continues. I am hopeful that new research technologies, such as natural language processing, could identify these patients in medical records despite the lack of adequate billing code data and that improved records systems will better track these patients through different health care pathways.

To address the epidemic itself, we desperately need more clinicians and researchers dedicated to interrogating the complex interfaces of mind, brain, and health. Currently, there are small pockets in different specialties, but these are not nearly commensurate with the volume and impact of these disorders. Second, and arguably more importantly, we need to fundamentally change the culture within the medical community to eliminate the negative connotations associated with these disorders. This change requires buy-in from hospital and health care leadership and a supportive infrastructure. These patients have complex conditions and require additional upfront consultation time, resources, and collaborative care. To prevent the cycles described previously, physicians need to be incentivized to take the time necessary to optimize the initial patient encounter. This includes delivering and explaining the diagnosis in a transparent and supportive context,9 providing patient-friendly resources (eg, https://www.neurosymptoms.org/), and referring appropriately for interdisciplinary management (eg, physical therapy, occupational therapy, psychotherapy). New educational and training initiatives across medical and allied health professions will be critical for enabling a successful transition.

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Article Information

Corresponding Author: Matthew J. Burke, MD, FRCPC, Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, KS-274, Boston, MA 02215 (mburke11@bidmc.harvard.edu).

Published Online: September 16, 2019. doi:10.1001/jamaneurol.2019.3043

Conflict of Interest Disclosures: Dr Burke is supported by funding from the Sidney R. Baer Jr Foundation.

Disclaimer: The content of this article is the opinion of the author and does not necessarily represent the official views of Harvard University or the University of Toronto (and their affiliated academic health care centers) nor the Sidney R. Baer Jr Foundation.

Additional Contributions: I thank Saadia Sediqzadah, MD, SM (Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada), for her helpful comments and review of the manuscript. Dr Sediqzadah did not receive compensation for her contributions.

Thanks so much for reading and I would be honored if you followed me on Instagram @sowdermd and @breastimplantsanity.  

Dr. Lisa Lynn Sowder

General Health, Highly Recommended Reading

A craaaaazy breast implant complication.

September 25th, 2019 — 3:19pm

I use my blog to share some of the interesting stuff I see in medical journals and this is one of weirdest case reports I have ever seen.  This is from PRS Global Open (from about a year ago) which is the International Open Access Journal of the American Society of Plastic Surgeons. See the original article here.

This is a 65 year old lady with 31 year old silicone gel breast implants.  She presented with massive swelling of her left breast. She first noted the three years previously following a car accident.  Apparently she initially sought treatment but because of insurance issues did not receive definitive care.  Her MRI scan showed rupture of her implant with extrusion of implant material outside the scar capsule (a so-called extracapsular rupture) and fluid and a mass.  Since this looked so creepy and suspicious for cancer, a biopsy was done with came back consistent with organized hematoma which is a benign collection of old blood usually secondary to trauma.

She was taken to the OR and she was found to have ruptured breast implants (not unexpected given their age) and a large blob of old partially solidified blood on the left side.  She had removal of the implants and blood blob and also had some skin reduction done on the left side.  From this seasoned plastic surgeon point of view, she has an absolutely stellar result.  She also had some silicone removed from her left upper arm.  It no doubt migrated there either during or shortly after the car accident.  It had not caused any problems but was a palpable mass.  It hard to believe that this lady had to live with for 3 years because of her insurance company dragging their feet!

Anyway, it’s always something and I’m grateful to the plastic surgery department from Duke University for sharing this really weird and really interesting case with a very happy ending!

Thanks for reading and I would be so happy for you to follow me on Instagram @sowdermd and @breastimplantsanity.  Dr. Lisa Lynn Sowder

Breast Implant Removal, Breast Implants, Now That's a Little Weird

Should you travel for breast explant surgery ?????

August 29th, 2019 — 2:00pm

This post is based on a phone consultation from earlier this week.  I’ve changed a few unimportant details to protect patient privacy.

That bag is gonna be a killer to get into the overhead bin after surgery!

This lady has smooth, saline implants that are about 10 years old.  She is part of the Pacific Northwest Breast Implant Illness (BII) Facebook group and she thinks her implants are making her ill.  Her augmentation was done by the (IMHO) very best plastic surgeon in her state who lives and practices in the patient’s hometown.  She has seen her plastic surgeon for explant and her plastic surgeon has agreed to do her explant and remove as much capsule as can be safely done.  So why, I ask, does this patient want to come see me???  Am I an explant expert?   Well, sort of in that I have done about a bajillion explants (mostly reasons other than BII) over the 28+ years I’ve been in practice.

But……………….explant and capsulectomy is not specialized surgery.  This is a procedure that just about any plastic surgeon who does a lot of breast surgery is capable of doing.  Now, I would not expect, say, a craniofacial surgeon to have any great expertise (or interest) in this but most “general” plastic surgeons are very capable of doing this.  Promoting myself for explant and capsulectomy is sort of like Gordon Ramsey promoting himself as the ultimate chef for grilled cheese sandwiches.

So how about the fabulous explant experts who can guarantee an “en bloc” and offer “detox” products?  Well…………………………….I’m not gonna throw anyone whom I have never met under the bus.  But I will say this:  There is zero, nada, zilch, nichts, niet, nula, noll, odo evidence that an en bloc resection is absolutely necessary or that detox does anything other than slim down your bank account.  It’s super nice (and sort of fun) to do an en bloc in cases of silicone gel rupture but there is no evidence in peer reviewed surgical literature that there is any difference in clinical outcome.  The same goes for cases of BIA-ALCL.  Would I recommend a careless surgeon who is not thorough or does not endeavor to keep things as clean as possible?  Of course not but I must say the vast majority of plastic surgeons are pretty damn thorough and meticulous.  It’s in our DNA.

We plastic surgeons are always ragging on surgical tourism and espousing the danger of going to a distant land for el cheapo plastic surgery but we should also be ragging on traveling within the United States for routine procedures.  Travelling adds a lot of complexity to the whole surgical process from initial evaluation to final follow up.

There are plastic surgeons being promoted as some sort of super experts by the breast implant illness activists.  I have zero evidence that money is changing hands but isn’t it a little weird that this sisterhood, who should want what is best for other women, to recommend traveling hundreds and sometimes thousands of miles for a routine surgical procedure?  Oh, and waiting sometimes up to a year to have their toxic bags of death removed?  And as for detox?  Zero evidence of necessity or efficacy. You can get your detox package from your local woo woo health provider who is happy to lighten your wallet.

So think global, buy local and support your probably very capable local plastic surgeon!  Just make sure your plastic surgeon is the real meal deal and certified by the American Board of Plastic Surgery.

Thanks for reading and I would be thrilled if you followed me on Instagram @sowdermd and @breastimplantsanity.

Dr. Lisa Lynn Sowder

Breast Implant Illness, Breast Implant Removal, Breast Implants, My Plastic Surgery Philosophy, Patient Safety, Plastic Surgery

Off to college? Words of wisdom.

August 26th, 2019 — 9:35am

Four years ago I sent my twin sons off to college. Last Saturday I help their little sister move into her dorm.  And then I cried.  A lot. 

For those parents doing this for the first time, second, third or fourth time,  and for all those lucky youngsters heading off to college, let me share this wonderful essay with you.

blog off to collegeCoping with the angst of dropping off your child at college by Kent Hickey.

From the Seattle Times, August 29, 2014.

All around the country freshmen are filling up suitcases for college. Their parents’ heads are filling up too, mostly with “remember when.”

As we prepared to send our first off to college, my mind kept revisiting all those Saturday mornings in parks when our kids were little. They loved to sneak acorns into my pockets and run away laughing as if they had pulled off some grand caper. One day I caught the eye of an older gentleman as he walked by. “Enjoy it while you can,” he said. “This passes fast.”

It has. And that first college drop-off was a big moment for all of us, especially for our daughter, though one likely eclipsed by that even bigger moment when she finally received the highly anticipated and much practiced “Dad’s Wisdom for College” talk.

I found the perfect setting a few days before departure: a car ride to the grocery store, doors locked and vehicle in motion to guard against the inevitable triggering of the daughter’s flight response.

Here it is:

“Introverts draw energy from solitude. Extroverts draw it from company. Know who you are and find your balance.

“Dads are awesome; boys are not. Always do what Dad would think is right. Never do what a boy thinks is right.

“The single most stupid thing done in college is almost always done while drunk. And, while getting high on marijuana may not necessarily lead to doing equally stupid things, it will lead to doing fewer things. Don’t be stupid.

“God has been a friend in your life every day, whether you’ve known it or not. Bring your friend to college with you and spend time with your friend every day.

“You will never really leave your home.”

It’s hard to say what the daughter took from these pearls, especially with all the other messages, often mixed, that young people hear as they prepare to head off for college:

Explore, find yourself; just make sure you earn a marketable degree that guarantees high lifetime earnings. Don’t be afraid to meet new people, but be wary given all those sexual assaults on campuses. Become a lover of learning without obsessing over grades, though they will likely decide your future.

Colleges are now keenly aware of how hard the drop-off is on my generation, the baby boomers. Upon our arrival on campus the daughter was quickly immersed in her orientation. The same experience awaited parents. I’ve never felt so nurtured, or exhausted.

There were days of parent orientation, each session starting with a “Relax, it will all be fine.” Heck, the school’s president even gave out his personal cell number, just in case we needed to chat, and I don’t even think it was fake. When did we become so needy?

My folks, who were of the World War II and Korean War generation, drove me from our home in Kalamazoo, Mich., to Marquette University in Milwaukee 35 years ago. We had one stop along the way, at the Mars Cheese Castle in Kenosha, went straight to my dorm upon arrival and quickly deposited the contents of one suitcase in my room.

Then Mom gave me a tearful hug, Dad an awkward handshake. Right after I moved in, they moved on. No dayslong orientation for them, and hardly one for me. My first lesson was given that very night by two sailors who tried to mug me when I got lost in an alley behind some dorms. I ran away and hid in a dumpster. A passing grade, if not a very courageous one.

Yes, a lot has changed, but one thing hasn’t. That drop-off moment is just really hard.

Right after the final goodbye the daughter gently slipped an acorn into my hand. I’m glad I had already said all that I wanted to say. I couldn’t talk anymore.

Kent Hickey is president of Seattle Preparatory School.

Thanks for reading!  Dr. Lisa Lynn Sowder

i would be honored if you followed me on Instagram @sowdermd and @breastimplantsanity.

 

Children, Highly Recommended Reading

Should I have my Biocell textured breast implants removed???

June 17th, 2019 — 11:50am

Looking pretty awesome after all these years.

This is a question posted by a patient on RealSelf.  She’s a lady in her 50’s with 11 year old anatomic Allergan Style 410 implants.  She has typical menopausal symptoms and does not think her implants are causing her night sweats, mild brain fog or hot flashes.  She’s heard about BIA-ALCL and wants to know if she should have her implants removed.  The photos she submitted show an absolutely beautiful long term result and the rest of her looks pretty awesome too.  She’s obviously either biologically privileged or she’s a gym rat or maybe both.  She’s very lean.  She doesn’t have enough fat for a meaningful fat transfer. Her breast volume is mostly implant. She loves her implants but she is scared.  What should she do?

So let’s be rational about the advice we give her based on what we know about BIA-ALCL.  First of all, she cares about her appearance.  Will she look good after explant?  IMHO, no.  She will be very, very small breasted.  If she’s okay with that, fine.  But I don’t think she will be okay with it.

What are the odds that she will get BIA-ALCL?  The latest numbers coming out of Dr. Mark Clemen’s work at MD Anderson estimate the chance of her developing BIA-ALCL is about 1 in 3000.  What about the chances of her DYING from BIA-ALCL?   Well, with increased awareness, early diagnosis and proper treatment, those chances are approaching ZERO.  I cannot rationally recommend she part ways with her awesome and great looking implants for those odds.

Now let’s look at breast cancer.  What are the odds?  Well, about 1 in 8 or 9 women will be diagnosed with breast cancer. The cure rate for breast cancer is much lower that the 90% plus cure rate for early diagnosed and properly treated BIA-ALCL.  Do we recommend bilateral prophylactic mastectomy for your average patient with average breast cancer odds?  Of course we don’t.  Women should be freaking out about the fact that they have breasts instead of the fact that they have textured breast implants!  And this post is in no way dismissing the suffering and, yes, death of patients with delayed diagnosis and/or treatment of BIA-ALCL.  These numbers mean nothing to someone who has died or lost a loved one BIA-ALCL.  We now know so much more about the etiology, diagnosis, prevention and treatment of this really weird malignancy.

So this is what I would advise this lady if she were my best friend or sister:  Her implants are getting up there in years.  I would get them removed and replaced with smooth, round cohesive gel implants.   With her anatomy she will look fine with round implants.  It’s been demonstrated very well that anatomic implants offer almost zero benefit over round implants in patients with normal anatomy.  If her surgeon finds seroma fluid or capsule nodules, he/she should do a capsulectomy and send the fluid and capsules for examination.  If the capsule is smooth and thin and unremarkable, he/she can just adjust the implant pocket if necessary to accommodate the new implant and leave the existing capsule in place.

And then she needs yearly exams and regular mammograms based on her breast cancer risk.

Thanks for reading and I would be honored if you followed me on Instagram @sowdermd and @breastimplantsanity.  Dr. Lisa Lynn Sowder

Breast Implant Illness, Breast Implant Removal, Breast Implants

Opioid Free Surgery

May 20th, 2019 — 9:08am

I am very pleased to introduce our new opioid free surgery protocol.  This has been in the works for several months and we launched it 3 weeks ago with very good feedback from our patients.  Here’s just about everything you need to know.

Why?    The use and abuse of opioids cause a lot of problems not just for patient but society at large.  On the patient level, opioids often cause side effects such as itching, nausea, constipation, fuzzy head, bad dreams and the list goes on.  Having been on opioids myself for various surgical procedures, I personally think they don’t do a very good job at controlling pain but just get you so fuzzy in the head that you just don’t care.   On a societal level, have you heard of the opioid crisis?  The fewer pills out there in people’s medicine cabinet will mean less abuse.

How?   By approaching anesthesia and post operative pain in a different way, pain control can actually be better than what we have achieved in the past with opioids.  The non-opioid medications are started pre-operatively to provide a preemptive strike against the pain cycle.

What?  Here are the medications we use.  Acetaminophen a.k.a. Tylenol:  It’s good for head aches and post op pain.  Celecoxib a.k.a. Celebrex:  this is a non-steroid anti-inflammatory but does not have the blood thinning effects of other NSAIDs such as ibuprofen.  Inflammation is a major factor in pain.  Gabapentin a.k.a. Neurotin:  This is a medication used commonly for nerve pain.  It has a mild sedating effect in some individuals but does not fuzz your head nearly as much as an opioid.  Marcaine and/or Exparel:  These are long acting local anesthetics that are injected into the operative sites that can render the injected area numb for hours or days.  Ice: Oh, yeah, ice packs can help a lot.  My husband got through a gnarly knee operation with virtually nothing more than Tylenol and a gizmo that surrounded his knee with ice slush, provided by his awesome caregiver (that would be me).

When?  We have out patients take a dose of Tylenol, Celebrex and Gabapentin a couple of hours before surgery with a sip of water.  During surgery, the surgeon injects the operative area with local anesthetic.  After surgery, the patient continues with the medication combination.  Ice packs can be added for most types of surgery but check with us first.

Who?  All of us – surgeons, anesthesiologist, nurses, patients and their caregivers.  This protocol requires that we all work together.  The patients must make sure to take their medication before surgery, anesthesia must minimize or eliminate the use of opioids during surgery, the surgeon must be thorough with injection of the local anesthetics, the nurses must be sure the patients and their caregivers understand the pre and post-operative instructions.

So, how’s it working?  So far I have had a dozen patients on this protocol including a tummy tuck patient with very, very favorable results. I am very excited about this plan.  I’m sure we will tweak it here and there a bit but thus far I’m a total fan.

Thanks for reading and I would be honored if you followed me on Instagram @sowdermd and @ breastimplantsanity.

Dr. Lisa Lynn Sowder

 

 

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