Seattle Plastic Surgeon comments on the results of a long running sunscreen use study from Austrailia. 

90% of this women’s skin aging is due to the sun. I hope her grandson uses sunscreen.

It’s that time of year when I must nag about tanning.  In rainy Seattle it is so tempting to soak up the sun once summer arrives (that is usually about July 5th).  But please, think before you rip off your clothes, don your thong and grab your beach towel.

A good study published by the Annals of Internal Medicine and reported in the Wall Street Journal  has shown that regular use of sunscreen reduces skin aging by 24%.  It had already been shown many times that sun protection prevents most types of skin cancer but now what seemed to be obvious has also got some scientific cred.   Now my nagging has some scientific backing!

I’m certain we are hardwired to love the feel of photons bombarding our skin but way back when we were being hardwired and learning to walk upright, we would die from an abscessed tooth or a ruptured appendix or (if we were lucky) a quick take down by a leopard long before we developed skin cancer or even a bad case of the wrinkles.

Fortunately, sun protection has finally caught up with our longer life spans.  We have really good sun screens and sun block, protective and comfortable clothing and don’t forget about umbrellas, cabanas and the most lovely shade of all, trees.   And lets hear it for staying indoors when the sun is at it’s strongest.  How about a nice glass of ice tea with some fresh mint leaves and a good book.  May I recommend The Storms of Denali by Nicholas O’Connell, or A Visit from the Goon Squad by Jennifer Egan, or I Remember Nothing by the late and great Norah Ephron?

And just to remind you, I nag because I care.  Thanks for reading.  Dr. Lisa Lynn Sowder

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

Anti-vaxers have been on my mind lately.  I recently had a nasty comment directed at my @breastimplantsanity Instagram telling me I should be ashamed of myself for promoting these “toxic bags of death”.  Those who follow @breastimplantsanity closely know that I am not a huge breast implant fan and much prefer other options for breast enhancement but I digress.  This particular detractor’s Instagram was militantly anti-vaccination   I just about choked on my Diet Coke.  So, breast implants are to be feared but not smallpox, polio, diphtheria, mumps, rubella, measles, chickenpox, meningitis, shingles, genital warts, cervical cancer, tetanus, pneumococcal pneumonia, etc?  Give me a break.

I am being generous here when I say anti-vaxers are misguided and so very coddled and sheltered from the reality of communicable diseases of childhood in and adulthood.  They don’t know what they don’t know but they don’t know even know that. 

Take a look at this photo.  This is from a book called Sleeping Beauty which consists of medical photos taken during photography’s earliest era and curated by Stanley B. Burns, M.D.  The book was published in 1990 and unfortunately is out of print.  This photo, “Mother With Her Dead Daughter”, was taken in the early 1900’s.  This may strike the modern reader as really sicko but most working class families of that era could not afford to have a photographs taken but would often splurge for a photo of a dead loved one.  Take a closer look at the photo.  Does the daughter look dead or even ill?  Doesn’t she just look like she is sleeping in her mother’s lap?  The real give away is this poor mother’s face.  It’s just haunting with its steely resolve. The daughter looks so normal because she died so fast.  Childhood mortality in this era ranged from 30 to 50 percent (!) with most children dying quickly from a wide variety of infectious diseases.  Those diseases so common then now make the news and are almost always associated with pockets of low vaccination rates.

It wasn’t so long ago that the whole world was a low, no really, a zero vaccination rate pocket.  Back in 1990, I was touring The Breakers, the mansion owned by transportation magnate Commodore Cornelius Vanderbilt (1794 –  1877) in Newport, Rhode Island.  Our little touring group was ushered into the mansion’s library to await our tour guide.  There were many family plaques hanging on the library walls and I was really moved to see how many family members, members of this rich and elite clan who could afford the best medical care of the time, died in early childhood.  But this was before the modern era of vaccination.

I am old enough to sport a smallpox vaccination scar on my upper arm and to remember lining up in a local grade school gym to receive one of the first oral polio vaccines.  These two scourges of humanity are all but wiped out thanks to world wide immunization.   And I am old enough to remember being sicker than a dog with red measles and I still see my faint chickenpox scars when I puck my eyebrows.  And I had a college dorm buddy, only one year older than me, with legs crippled by polio.  He missed the vaccine by a year.  These are real diseases that the young whipper snapper anti-vaxers have been spared because their neighbors do vaccinate themselves and their children thereby providing herd immunity.

So little miss smarty pants anti-vaxer Instagram diva, I could wish the pox on you, but I won’t.  I wouldn’t wish the pox on anyone, not even an anti-vaxer.

Boy, I feel better having written this and thanks for reading.  Dr. Lisa Lynn Sowder

I’d be honored if you followed me on Instagram @sowdermd and @breastimplantsanity.

Alison giving the elbow to one of our hard working nurses.

Yesterday we had a wonderful massage therapist come into the office to give our staff 30 minute massages in celebration of Nurses Week.  Oh yeah, I sneaked in and had one too and it was great.  While having my back, neck and shoulders, arms and hands kneaded, pulled, rubbed and elbowed, I had a very nice chat with Alison the therapist.  She is a weight lifter and I had a lot of questions about the mechanics of power lifting, what she thought of body builders, strength training for the over 60 crowd (me, for example), dwarf throwing contests and a bunch of other stuff.  I was so impressed with her knowledge and explanations of how strength isn’t just from muscle bulk but also from neurons in the neuromuscular junction acting in a coordinated fashion, from muscle memory for some actions, from bone strength and angle and from mechanical advantage.  This lady’s b.s. meter was set at zero, just where I like it.

It was particularly nice to have this encounter because a few days earlier there was an article in the Seattle Times about craniosacral therapy which had my b.s. meter red-lining.  Nicole Tsong, who is a yoga instructor, has a nice weekly column about exercise, nutrition and other self care and I usually enjoy reading it.  But this past Sunday, yikes did she go off the rails.  Nicole’s treatment, basically a massage, sounded pretty standard and pleasant but then the therapist started talking nonsense.

Cut and pasted from the article:  Craniosacral therapists observe your cerebrospinal fluid, which moves in roughly eight-, 20- and 100-second cycles, Christman said. My flow was good from my tailbone up until she got to my left shoulder, she said, where the flow contracted. She could work on my connective tissue to help the fluid move, or manipulate the fluid to move back into my shoulder, she said.

Yes, this is a head rub and it feels great but she’s not manipulating your skull and she is not observing your cerebrospinal fluid. Just sayin’.

Christman had asked me before the session about head injuries, and I told her about a concussion I had in college. After working on my spine and pelvis, she moved to my head and started gentle pressure around my skull to manipulate the tissue and bones. I was already relaxed, and when she started to work on my head, I succumbed and closed my eyes, nearly nodding off.

Since this is my blog, I’m just gonna get this off my chest.   Cerebrospinal fluid (CSF from now on) sort of circulates and sloshes around in the ventricles of the brain, between the brain and the skull and in the center of the spinal cord but ………………… 8, 20 and 100 second cycles?  Why not 34 seconds or 82?    Hmmm.  It has been awhile since I took neruoanatomy but that sounds like b.s. to me.  Oh, and the therapist observes the CSF?  I don’t think so.  CSF can be observed when doing a diagnostic spinal tap or doing a spinal anesthetic or during brain or spine surgery or in cases of a skull fracture when CSF can be observed dripping out of ears and nostrils.  Methinks Ms. Christman was not really observing CSF in a therapy session.  But why would she say she was?  Oh, and then CSF in the shoulder?  Nope.  Not there.  There is synovial fluid in the shoulder joint but not CSF.  If you have CSF in your shoulder you should report of the emergency room … stat.

Now lets deconstruct that head rub that Nicole got.  God, I love a good head rub, don’t you?  But I know that a head rub does not manipulate the skull.  The skull does have joints (called sutures) but they fuse in early childhood.  The only way to move a skull around is with power tools and preferably in the OR with a neurosurgeon.

Nicole almost dropped off to sleep and maybe would have been the best way to avoid listening to this balderdash which is fancy word for b.s.

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

You gotta read this from today’s Slate.com.  This will involve some heavy mental lifting so put on your thinking cap and take the time to read the entire article.

MEDICAL EXAMINER
Cuba’s Sonic Attacks Show Us Just How Susceptible Our Brains Are to Mass Hysteria
The symptoms so many Americans experienced were probably not caused by a secret weapon. That doesn’t mean they’re not real.

By FRANK BURES
FEB 01, 20185:43 AM

A few weeks after the 2016 presidential election of Donald Trump, several people working for the U.S. Embassy in Cuba fell mysteriously ill. Some lost their hearing. Some had headaches and a pain in one ear. Others reported feeling dizzy or nauseous, having trouble focusing, or feeling fatigued. Later, some would have a hard time concentrating, remembering things, sleeping, and even walking.

These symptoms were “medically confirmed,” as the State Department’s medical director Charles Rosenfarb put it, and brain scans were said to show abnormalities in the victims’ white matter, which transfers information between brain regions. The illnesses were believed by the government to be “health attacks,” carried out by a foreign power, though as Todd Brown, assistant director at the Bureau of Diplomatic Security, told the Senate Foreign Relations Committee, “investigative attempts and expert analysis failed to identify the cause or perpetrator.”

Nonetheless, investigators concluded the illnesses, which ultimately affected 24 people, were likely the result of a “sonic device.” This conclusion seems to be primarily due to the fact that some diplomats reported hearing a high-pitched noise in their homes and hotel rooms.

Despite a lack evidence for such a weapon, or any known way it could affect white matter, the sonic weapon theory proved irresistible for both media outlets and for Cuba hawks like Sens. Marco Rubio and Bob Menendez, both of whom immediately transformed the sonic weapon into a handy political weapon.

In the months following the “attacks,” new diplomats arriving in the country were warned of this sonic danger. Embassy employees were played a recording of what was thought to be the sound so they knew what to listen for. Soon, people at the Canadian Embassy in Cuba began reporting symptoms similar to what the Americans had experienced, as did a few tourists there. A husband and wife at the U.S. Embassy in Uzbekistan became ill as well. Whatever it was, it seemed to be spreading.

There is increasing recognition that these epidemics of hysteria, which usually mirror prominent social concerns, present real individual and public health problems.
With no details, no motive, and no plausible explanation for what kind of weapon this might be, doubts began to surface. The FBI investigated and reportedly found there had been no such attack (though it suggested maybe it was a “viral” weapon). Sen. Jeff Flake also cast doubts on the sonic version of events. A handful of skeptical stories began to appear amid the more alarming ones, suggesting this might be what in the past was known as, “mass hysteria,” but which is now referred to as “mass psychogenic illness,” or a “collective stress response.” (These include things like the twitching girls in Le Roy, New York, in 2011; the 600 paralyzed girls in Mexico in 2007; and the Belgian Coca-Cola scare of 1999, which affected 100 students with more than 900 others reporting a related symptom, and costing the company somewhere between $103 million and $250 million.)

Epidemics of this sort are well-known in the scientific literature. Robert Bartholomew, a New Zealand–based medical sociologist and the co-author of Outbreak! The Encyclopedia of Extraordinary Social Behavior, Mass Hysteria in Schools: A Worldwide History Since 1566, and other books on the subject, has collected a database of some 3,500 cases. While the precise mechanisms are difficult to pinpoint, and the diagnosis is always controversial, there is increasing recognition that these epidemics of hysteria, which usually mirror prominent social concerns, present real individual and public health problems.

Yet many people still assume victims of such phenomena are simply faking or imagining their symptoms. In the Senate hearings on the attacks, Sen. Rubio asked Rosenfarb whether he thought this was, “a case of mass hysteria, that a bunch of people are just being hypochondriacs and making it up?”

This was a loaded question, with Rubio deploying the term mass hysteria as a means of dismissing this possibility altogether. But Rubio’s assumption—that a mass psychogenic illness is the same as faking or hypochondria—is wrong, as was his dismissal of the idea that this might explain the illnesses in Cuba. Indeed, mass psychogenic illness is likely the best explanation for these illnesses. According to Bartholomew, if you removed the word concussion from discussion of what happened there (but left the “white matter tract” changes in its place), you’d have a “textbook case” of mass psychogenic illness, in everything from its symptoms to its spread.

“There’s no evidence whatsoever that this was caused by a sonic device,” Bartholomew says. “It is physically impossible to have brain damage caused by an acoustical device. And most of those symptoms are not symptoms of sonic weaponry.” Anxiety and nausea, he notes, can be caused by both mass psychogenic illness and acoustic weapons, but the noise would have to be incapacitating and high volume. None of the other symptoms reported in Cuba are associated with an acoustic assault.

And what’s more: “This is a small, close-knit community in a foreign country that has a history of being hostile to the United States,” he says. “That is a classic setup for an outbreak of mass psychogenic illness.”

History is filled with cases of “sounds” making people ill. In Kokomo, Indiana, locals have been plagued since 1999 by a low frequency hum, which one resident said caused, “short-term memory loss, nausea, and hand tremors.” In Taos, New Mexico, a similar sound causes resident “sleep problems, earaches, irritability, and general discomfort,” by one account. Similar hums are reported in Bristol, England, and Windsor, Ontario. In 1989, a “Low Frequency Noise Sufferers Association” was formed in London. The people reporting illness from the noise produced by wind turbines have given the phenomenon its own name: wind turbine syndrome.

Unfortunately, it is also possible to lose your hearing without being attacked by a secret weapon. The Handbook of Clinical Neurology volume on Functional Neurological Disorders lists “nonorganic hearing loss” in its chapter on “Functional Auditory Disorders,” alongside conditions like musical hallucinations, misophonia (“hatred of sound”), “acoustic shock” from a sudden noise (symptoms include “pain in or close to the ear,” tinnitus, balance problems, hypervigilance, and sleep disturbance), and others. In Germany, there is a common condition called Hörsturz, which is a sudden loss of hearing related to stress. In 1973, at a nursing school in Papua New Guinea, there was an epidemic in which students were struck deaf, among other symptoms, with no apparent external cause.

“It’s very easy to manipulate people’s physical well-being through giving them expectations about sound,” says Keith Petrie, who researched the power of the mind in relation to wind turbine syndrome. When Petrie and colleagues exposed people to both infrasound and sham infrasound (silence), they found it wasn’t the sound itself, but their expectations—or what’s known as the nocebo effect—that produced adverse physiological reactions. Witnessing another person with symptoms can create an even stronger response, as can the perceived cause.

“When we gave them a plausible, biological explanation,” says Petrie, “it increased their symptoms the next time they were exposed to sound. When we gave them a nocebo explanation—and both explanations were equally credible—their symptoms decreased.”

On the surface, studies like this make it easy to agree with the Marco Rubio line of thinking that sufferers are just faking it. But the people who were told there was a medical reason for the hearing loss are not just imagining the resulting symptoms—they are physiologically real, “medically verifiable,” and cause deep distress, even if they resolve quickly, as most do.
“People suffering from mass psychogenic illness are not hypochondriacs and they’re not all making it up,” says Bartholomew. “It is a real condition with real symptoms. It could happen to anybody.”

There is real crossover between the condition’s mental origin and physical manifestation.
Research into the nocebo effect has been hampered by the ethics of subjecting people to it, but a picture of the mechanisms is emerging. And one important factor is “abnormally focused attention,” as neurologist Jon Stone puts it.

“As human beings, we’re more prone to these phenomena than we like to think,” says Stone, co-editor of Functional Neurological Disorders. “The rate of functional symptom experiences in the general population is very high. People have these symptoms a lot and just normalize them. We’re never very far from a functional disorder.”

What were once known as conversion disorders (meaning the conversion of a mental problem into a physical one) are now referred to as functional disorders. The old terms like psychosomatic or even psychogenic imply a purely mental origin, but the current parlance reflects the more complicated picture, that there is real crossover between the condition’s mental roots and physical manifestation. A “functional disorder means something has gone wrong with the network, the connections, the pathways, as opposed to the physical structure of the brain. And when these functions go wrong, normal sensations like tiredness, dizziness, or pain can grow much worse and become persistent.

One of the findings in Cuba that reporters seized on was the assertion that victims had suffered some kind of head trauma. As Rosenfarb put it, there were “clinical findings of some combination similar to what might be seen in patients following mild traumatic brain injury or concussion.” Here, he appears to be talking about abnormalities in the patients’ white matter, but a concussion isn’t the only thing that can have that effect. White matter changes with experience and learning, and becomes more robust in response to using a given pathway repeatedly. If those pathways are related to a disorder, it may appear in “diffusion tensor imaging” scans as anomalies.

“Diffusion tensor imaging,” says Stone, “is a technique that shows abnormalities in patients not only with minor brain injuries, but also with chronic pain, anxiety, depression, you name it. This is not a mark of brain injury. It’s a mark of brain dysfunction. It’s evidence that they’re ill.”

One problem in understanding the reality of a functional disorder is that most of us, when we are ill, look for a single cause, a simple chain of events that starts with an event, or a germ, and ends with our own misery. But functional disorders don’t work in this linear fashion. They are recursive and multifactorial, a feedback loop between our expectations, emotions, and physiology. According to Mark Hallett, a senior investigator at the National Institute of Neurological Disorders and Stroke, a picture of how they work is beginning to emerge, in a sense that, “when the so-called limbic system of the brain [the part of the brain that drives instinct, mood, and emotion] is overactive, it might induce the different symptoms that arise.”

Which is to say that if we fixate on our naturally occurring experiences and feelings, they can become amplified, particularly if the limbic system is overactivated by fear and anxiety. This creates a kind of loop between mind and body that it can be difficult to get out of, and which can make these conditions difficult to treat.

“It’s very powerful,” says Petrie. And often underestimated. “From the comments I read by the physician associated with the [embassy attacks], it was interesting how he dismissed this explanation” Petrie says. “He didn’t seem to understand how easily this can happen.”

Most people don’t. That includes just about everyone involved in the Cuban attacks. Mass psychogenic illnesses are not as intuitive to grasp as cold or a flu, but they are just as serious, and should be treated as such. In Cuba, they have not been. Instead, a fixation on secret weapons has obscured a real illness with real consequences, one which can not only be “medically verified,” but which regularly afflicts people across the world, and to which anyone with a functioning brain is vulnerable.

Thank you for reading!  Dr. Lisa Lynn Sowder

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

I participate in a few doctor only on line message boards and forums.  A topic that has been front and center the past few months has been the #METOO movement and some of the challenges women in medicine face.  I’d like to share a few of my own stories.  Fortunately none of them include Harvey Weinstein.

I finished medical school in 1983.  1/3 of my graduating class were women.  These days women comprise more than 50% of most medical school classes.  I did my general surgery residence at the University of Utah, not exactly a bastion of progressive ideas.  Surprisingly about 20% of the surgery residents were women.  I felt very little discrimination but maybe I was just to busy and exhausted to notice?  I did get a couple of evaluations that I thought were just hilarious and still do. They were both from the Latter Day Saints (Mormon) Hospital.  One described me as “defensive, argumentative and with a chip on my shoulder”.  The other described me as “a sharp little gal”.  My boyfriend at the time just about split a gut laughing when he saw these. He was also a general surgery resident and never got such amusing reviews.

I had a few interesting experiences with male patients.  When I was doing an Intensive Care Unit rotation as a wet behind the ears intern at the University Hospital, I helped with a middle aged Mormon Elder who was crashing badly from acute pancreatitis.  (If you have never heard of this disease, count yourself lucky).  I was cleaning his penis in preparation to place a catheter so we could monitor his urinary output.  This man was very ill and a little delirious.  He looked at me and said “Doc, I’ll give you 10 minutes to stop that”.  It never crossed my mind to take offense at this.  It added a bit of levity (ha, ha) to a very serious situation.  I got to know this gentleman quite well during his ICU stay and he was a totally stand up guy.  On the gastroenterology rotation during my third year, I was doing a colonoscopy on an elderly man and he twisted his torso and neck to look me right in the eye and asked “What is a pretty little thing like you doing here?”  At the time, I thought that was actually a very good question!  This fellow grew up in a time where women rarely worked outside the home and certainly did not become surgeons.  Again, since I was the one with the scope, I felt no animosity towards him.

Dr. Henry Neal in 1990 with his girl residents, me, Sue Wermerling and Kimberley Goh. Can you tell that he secretly loves us?

My first year of my plastic surgery residency (after 6 years of general surgery) three of the four residents were women.  This was a fluke of the computer based residency matching system.  The chairman of plastic surgery, Dr. Henry Neale was a good old boy from the south.  He kept a bull whip in his desk drawer.  Really.  He was a great surgeon and ran a powerful department.  We operated our brains out and he had our back every day.  Dr. Neale was very, very politically incorrect.  He pondered if Sue, Kim and I would start cycling together and once stated he should put a Kotex machine in the resident’s office.  Well, the three of us just dished it right back at him and we did end up cycling together.

There was one occasion where I really felt harassed.  I was a 4th year general surgery resident on call at a private hospital in Ogden, Utah.  Late one night there was knock on my call room door.  I opened it to find an elderly staff surgeon with alcohol on his breath with a fifth of Southern Comfort (yuck!) in his hand.  He wanted to know if I wanted to party.  This scene was so ludicrous that I laugh out loud just thinking about it.  Most residents given the choice of sleep vs. party would pick sleep no matter whom was holding the bottle.  This man’s son was a medical student who had rotated on my service a few months previously.  I told the party hound horn dog that he had three seconds to leave or I would tell his son.  I think he was gone before I hit “two”.  I never assisted him on a case again which was no loss on my part because he was a lousy surgeon.  No, I did not file a complaint or make a fuss of this.  Again, he grew up in a different time.

I’ve had a few really weird patient encounters in private practice related to my gender.  Years ago when I was pregnant with my twin sons and could barely fit through a door, I had a mentally unstable older man with a skin cancer on his scalp the size of a poker chip.  This, gentle readers, is what we surgeons call a GREAT CASE.  The mentally unstable older man was quite the cad with many comments about my huge belly and the certain studhood of my husband.  He also had many bizarre ideas about selenium deficinecy and sexual function.  I was not sad to send him on his way once he had healed.  A few years later I had an elderly woman come in with another neglected and ginormous skin cancer who shrieked when she saw me and declared that “women are stupid and I won’t have one for my doctor”.  Oh well, that great case went to my partner who has a Y chromosome.  She was nasty to him too.

As I write this blog, I can’t really think of any weird encounters in recent years.  I think in the 26(!) years since I started practice that being a woman surgeon or woman astronaut or woman programmer or even race car driver has become sort of a no big deal which suits me just fine.  Recently my 17 year-old daughter took a field trip with her computer science class to the Microsoft campus just outside of Seattle.  She attends an all girl high school and they were given a tour by an all female coding team.  The advice given to these bright young students by these bright young and not-so-young techies was to work hard, advocate for yourself and don’t take things too personally.  I think that is good advice regardless of your gender or your workplace.

Thanks for reading and follow me on Instagram @sowdermd and @breastimplantsanity.  Dr. Lisa Lynn Sowder, girl surgeon.  And there will be an upcoming blog about delayed childbearing which is something I don’t recommend but sure worked for me.

Not a good time to be having that eyelid lift.

Seattle Plastic Surgeon nags because she cares.

It’s that time of year again.  Roll up your sleeve and get your flu shot already.  Why should a “surgical sub-specialist” like me care about whether or not you’ve had your flu shot?  First of all, I’m a physician and it is my duty promote good health.  Second of all, I don’t want any of my patients coming down with the flu.  If a patient falls sick before surgery, we have to cancel and then reschedule the case which is hard on us meaning surgeons, anesthesiologists, surgical techs and nurses and it is also really hard on the patient because he/she has to carve more time out of a busy schedule and many times arrange for child care,  not only for surgery but for recovery.

If a patient comes down with the flu in the early postoperative period, he/she may end up wishing they had never been born.  That would make for a less than excellent plastic surgery experience and could also be down right dangerous.

And we tend to think of the flu as just an inconvenience with a little misery added but really, the flu can be very, very serious.  I am old enough to remember the Hong Kong Flu of 1968.  I was sicker than a dog and missed a week of school but was not one of unlucky million or so who died.  And then there was a Spanish Flu of 1918 that killed 50 (!) million mostly healthy, young people.  Sorry to be such a fear monger but I really want you to get a flu shot.

Thanks for reading!  Dr. Lisa Lynn Sowder

P.S.  Get your flu shot.  Today.

Seattle Plastic Surgeon implores patients not to fall for “Botox on Sale”.

Occasionally I have patients come in for Botox or fillers who have flitted around from doctor to doctor looking for the “best price”.   I hear statements like  “the last Botox didn’t work” , “the Restylane didn’t last”, “I’m not sure what she used but I didn’t like it”, and this is my favorite, “it was on sale but it didn’t last”.

This flitting around in search of a “deal” makes it very hard for a hardworking plastic surgeon (moi, for example) to figure out what, where and how much injectable to inject.  In my practice, we keep very accurate records of all of the above so I can judge what works best for any given patient.   And believe me, every patient is different.

Sometimes I think just because it is “cosmetic”,  patients don’t take these treatments seriously enough.  I cannot imagine anyone shopping around for the “best” price on, say, steroid injections into a bum shoulder or the “best” price for an hour of psychotherapy!

Usually continuity of care provides the best value of all, even if the prices are not bargain basement.  So for injectables, find a good doctor and stick (nice pun, huh?) with him/her.

Thanks for reading and follow me on Instagram @sowdermd and @breastimplantsanity.  Dr. Lisa Lynn Sowder

Seattle Plastic Surgeon (and mother of three) Dr. Lisa Lynn Sowder nags her children and you about lawn mower safety.

It is such a wonderful thing to get some yard work out of my offspring now that they are old enough to mow, rake, sweep, weed, water, trim, edge, poop scoop, etc.  As much as I love the smell of newly mown grass and the thought of them working (instead of me), I worry.  I worry about the lawn mower thus the little nag session each and every time one of my boys has been nagged into mowing the lawn.

Here is my list of lawn mower safety tips.

• • • • Only children over 13 should mow a lawn.
      • One person only should be on the lawn being mowed.  That would be the person behind or on the mower.
      • NO PETS unless it’s a rabbit you really wish you had never adopted.
      • Always wear socks and heavy shoes and gloves.
      • Always wear eye protection.
      • Ear plugs okay but not no ipod listening.  They need to hear you yell, “Watch out for the dog!”
      • No mowing until the offspring has cooled down from his/her rage at having to actually perform agreed upon chores for agreed upon bennies.  Rage and lawn mowers should never coexist.
      • If the mower malfunctions, turn it off and don’t even think about flipping it over unless a knowledgeable and responsible adult is present.
      • Leave sharpening to the experts.  Oh, unless you work in a lawn mover sharpening shop, you are not an expert.
      • No using the lawn mover for anything other than mowing the lawn.  This calls for a cautionary (and I swear to God true) tale.  Two patients in the same day present with nearly identical lawn mower injuries sustained while attempting to trim a hedge with a lawn mower.  Patient #2  happen to see patient #1 (prior to his mishap) trimming his hedge with the lawn mower while Patient #2 was driving to get gas for his lawn mower and thought “Hey, what a great idea.” Not.

Stay tuned.  One of these blogs I will tell you about my dad’s snowblower injury.  His bloody glove is still nailed to the wall of his shop some 30 years later.

Thanks for reading.  Dr. Lisa Lynn Sowder

In a perfect world, women would wait until they were done childbearing and breast feeding prior to having breast implants, mostly because pregnancy and breast feeding can really change the breast.  In the real world, many young women opt for breast enhancement long before having children. I am often asked what effect childbearing will have on an implanted breast.  My answer?  Some ladies do great and some don’t.  I don’t have a crystal ball.  I do tell patients that whatever happens to their breasts, I can likely fix it!

I am also often asked about the effect implants have on breast feeding and if feeding a baby from an augmented breast is safe for the baby.  Here is what I know based on reading the literature and listening to patients for 25+ years.

In the recent “Cohort Study to Assess the Impact of Breast Implants on Breastfeeding” conducted by lactation specialists and doctors in Argentina published in the December 2016 Plastic and Reconstructive Surgery Journal (PRS Vol. 138, 1152-1159, 2016) 100 women with breast implants and 100 women without breast implants were followed from the time of childbirth through about 3 months.  All of these women received instruction and encouragement to breast feed by lactation specialists. Here’s what was found:  99 of the 100 women without implants were able to breast feed.  93 of the 100 women with breast implants were able to breast feed.  This was not found to be statistically significant.  At 3 months, more women without breast implants were breast feeding exclusively than the women with breast implants.  This was statistically significant.   The study showed no correlation in the type of implant or incision location as to the ability or inability to breast feed.  Sooo…it would appear that breast implants may impact the quantity of milk production and it may be necessary to supplement.  I have been telling my young patients for years if they will feel like a terrible mother if they are unable to breast feed, they may want to wait on that breast augmentation. I think based on this study I will change that to breast feed exclusively. I also over share with these patients that I am a lactational failure and my children (now 20, 20 and 16) have had one ear infection, 2 broken bones, one cavity, one torn thumb ligament between them and all are healthy and happy.  And I felt like a horrible mother for awhile but got over it. I also refer them to a article that appeared in the Atlantic in 2009: The Case Against Breast Feeding written by Hanna Rosen, the mother of three breast fed children.  It’s an fact filled and thoughtful look at this very prickly topic. It made this lactational failure feel a little better!

Is it dinner time?

And lately I have been questions about the safety of breast milk from an implanted breast.  I think some of this is being stirred up by the breast implant illness community which is doing its best to have breast implants banned.  One of the breast implant illness web sites has an extensive diatribe about this and there is also a recent alarmist Instagram post on this topic.  In doing a little research of the peer reviewed literature, I did come up with a paper regarding silicone gel implants and breast milk.  This paper (PRS Vol. 102, 528-522, 1998) looked at silicon levels (silicon is the element that silicone is made of) in breast milk in patients with and without breast implants and also in cow’s milk and various formulas. This study was done way back in 1997 at the University of Toronto.  The researchers looked at the milk of 15 mothers of newborns with silicone gel implants and 34 mothers of newborns without implants.  The silicon levels in the implant group was lower than the non-implant group although the difference was not statistically significant.  Now here’s the kicker. The silicon levels in cow’s milk (presumably the cows did not have breast implants although that is not stated in the paper) was over 13 times that of the mother’s milk!  Twenty six formulas were tested and they ranged from 13 times to 433 times that of mother’s mild.  The soy-based formulas had some of the highest levels!

How can this be????  Again this study did not measure silicone (the rubbery stuff made from elemental silicon).  Silicone is a big fat molecule and cannot be dissolved in solution and therefore cannot be measured.  Silicon, the element, can be measured.  And silicon is everywhere.  Silicon is the second most abundant element on  the earth’s crust, second only to oxygen.  Silicone, the man made rubbery stuff, is also very abundant in medical devices, prosthetics, pharmaceuticals and many consumer products (I love my silicone oven glove). Oh, and it’s used to make nipple shields for breast feeding moms and bottle nipples for bambino.

The other issue is the location of breast implants in relation to the milk producing glands and the lactiferous (great word) ducts.  Implants on top of the muscle sit under the breast tissue and are in contact with some of the milk producing gland but are well away from the ducts.   Implants under the muscle are not really in contact with the breast much at all.  I don’t have the imagination to visualize big gooey silicone blobs getting though the wall of an intact implant, thorough the fibrous scar capsule and into the milk producing glands and travelling out of the ducts.  I have removed a bajillion ruptured gel implants and have never seen or heard of leakage of gel from one of my patient’s nipples.

Based on this information and my intimate knowledge of the location of breast implants in relation to the milk glands and milk ducts, I would not advise patients with intact silicone gel implants to forego breastfeeding because of fear of some sort of contamination of their breast milk.  If an implant is ruptured, I think it would be prudent to bottle feed.

So there you have it, my take on breast feeding and breast implants.  Mothering is a wonderful, mysterious and complex task and sometimes doesn’t include lactation (and sometimes doesn’t even include giving birth).  I think most patients are very capable of making up their own minds about if and when they desire breast enhancement with breast implants.

Thanks for reading!  Dr. Lisa Lynn Sowder