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

Category: General Health


Driver’s side skin damage. Check this out!

June 8th, 2017 — 8:12am

Got sunscreen in your glove box?  You should!

 This is an ABC news report written by Serena Marsh and edited for length by me.  This was originally posted in 2012.

Sunny Side Old: Pic Reveals Sun’s Aging Effects

William (Bill) Edward McElligott is two different ages, 66 and 86 yeaars old. 

If you look at McElligott from the right, he looks like any 66-year-old would expect to, but from the left, wrinkles and sagging skin place him far beyond his years. He is a living demonstration of the importance of protecting your skin from the sun.

“It would take me an hour to drive to work and an hour to come home,” McElligott said. “It was a semi route, I’d have six to eight stops. … 6 a.m. to 3 p.m. on the road.”

For almost 30 years, McElligott drove a truck during prime sun hours throughout the city of Chicago delivering milk to stores and gas stations.

“My left arm was always more tan than my right, because a lot of the time I had the window open (since) we didn’t have A.C.,” McElligott said.

The 66-year-old truck driver suffers from unilateral dermatoheliosis or photo-aging, which was caused by repeated, long-term exposure to UVA rays of the sun.

It was 15 years before he noticed any difference between the two sides of his face, but McElligott ignored it, that is until his grandchildren’s questions got the best of him.

Dr. Jennifer Gordon a dermatology resident at UT Southwestern saw McElligott while on a rotation at Northwestern in Chicago and submitted his case study, which was featured in the April edition of the New England Journal of Medicine.

“It was very stark,” Gordon said. “We are used to seeing photo damage, photo aging every day, (but) for it to be so one sided? We were taken aback.”

Gordon explained that since McElligott spent so much time in his car, his left side was exposed to UVA rays that can penetrate glass and cause the majority of photo-aging, unlike UVB rays, which cause sunburns.

“We think its because it (UVA) can penetrate more deeply into the skin than UVB and affect your collagen and elasticity,” she said. “When you destroy those that’s what gives you the aging appearance that we see.”

Dr. Mitchell Chasin, a dermatologist who did not treat McElligott, says it is extremely common to see patients that come in with more damage to their left side than their right.

“Most people are completely unaware and most people who come in to have sun damage treated, they often times will point to their left side saying they see more spots, more wrinkles, more aging, but never put two and two together,” said Chasin.

Chasin says that whenever people are outdoors, even when covered from the sun directly or on a cloudy day, they should be aware they are not safe from the reflected rays of the sun and should wear sunscreen.

“Sun block is the answer, really, for someone 365 days a year, whether it’s cloudy whether it’s sunny, whether someone is outdoors, in the car, or at the beach,” Chasin said. “If someone wants to age as best they can, sun protection is a daily regimen no matter what you are doing. Put sun block on before you leave the house.”

With summer approaching and vacations and road trips, it’s important to make sure your sunblock has protection against both UVA and UVB rays.

Last year the FDA demanded sunscreen manufacturers update their labels to offer protection for both UVA and UVB, as well as to stop the use of misleading claims such as waterproof. The agency recently extended the deadline to December for manufacturers to comply.

For McElligott sunscreen with UVA and UVB protection has become a daily fixture.

“When I’m out in the sun, when I’m going to be driving, I have sunscreen on,” he said. “I always carry it with me.”

Thanks for reading.  And do you have a favorite sunscreen?  Send me an email and let me know. lsowder@madisonplasticsurgery.net

Dr. Lisa Lynn Sowder

Follow me on Instagram: @sowdermd and @breastimplantsanity

 

Aging Issues, General Health, Now That's a Little Weird, Skin Care, sun damage

Breast Implant Illness – a seasoned plastic surgeon’s humble opinion. Updated October, 2017.

February 28th, 2017 — 2:24pm
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“This stuff online just scares me to death.”

Warning:  This is a long one.  A really, really long one.

I recently counted up all of my operations for 2016 and I removed more breast implants than I put in.  Last year I removed implants from 44 women. Twenty-seven of those women had removal for the usual reasons:  “I don’t like them anymore, they make me look fat, they are too hard, I finally divorced that s.o.b., I’m becoming a nun, etc.”  But 17 women had breast implant removal because they believed their implants were ruining their health.  I have gotten to know these patients (and many more from prior years) and their families, have heard their concerns, looked at their medical histories, examined them and removed their implants.

I have given this topic of breast implant illness a lot of investigation and thought.  This blog represents my opinion based of what I have read, what I have heard from patients and my colleagues, what I have seen in the exam room and OR in over 25+ years of practice.  I recently presented a paper on breast implant illness for the Northwest Society of Plastic Surgeons.

A very brief history:  Back in the early 1990’s, just when I was entering private practice, silicone gel breast implants came under intense fire for being linked with health problems, notably autoimmune diseases like lupus and rheumatoid arthritis.  This concern led to silicone gel implants being taken off the market in the United States for cosmetic purposes.  It also lead to large amounts of money finding its way into the pockets of trial attorneys, the bankruptcy of silicone supplier Dow Corning, and at least one case of a woman removing her own implants with a razor blade in a fit of anxiety.  This moratorium on gel implants lasted well over a decade.  For over ten years, the only gel implants I used were used in one of the several studies of gel implants in which I was an investigator.  Finally, in late 2006, after exhaustive analysis of many implant studies, gel implants were again approved by the F.D.A. for cosmetic use.  Interestingly gel implants remained available for post-mastectomy reconstructive use during the moratorium.  I always thought it was odd that the it was okay for patients with a history of breast cancer to have the same silicone gel implants that were deemed too risky for a healthy woman.  And I thought it was odd that the FDA was not recommending the removal of implants that were deemed unsafe for use.    So did breast cancer survivor and congresswoman Marilyn Lloyd who asked in 1992, “How scientific is the FDA’s decision that no woman should have implants put in, and no woman should have them removed?”  Good question.

Fast forward to the past few years and I start seeing women with implants who are convinced their implants are ruining their health.  About 1/3 of them have saline implants which were never taken off the market.  These breast implant illness ladies tend to be a little younger than my average breast implant removal patients.  They tend to embrace alternative medicine and distrust the medical establishment.  And they are all connected to the online breast implant illness community.  And another thing I find so odd – some ladies with all of these symptoms often look so healthy and they ask questions like “When can I go back to teaching Pilates?”,  “Can I hike the Appalachian trail two months after surgery?”, “Is it okay if I go snowboarding after a couple of weeks?”.

Many of the symptoms of breast implant illness are a vague and/or very common complaints.  Most of these symptoms have significant overlap with the most common complaints related to common health issues including menopause, hypothyroidism, depression, anxiety, general aging and the human condition.  And some patients blame conditions with very clear etiology on their implants.  A few examples include plantar fasciitis (an overuse injury of the foot seen in runners and dancers), chronic Epstein-Barr virus (cause by a ….. virus!), Lyme disease (a tick-borne bacterial infection) and dental cavities (caused by the acid produced by sugar loving bacteria).    And then there are the fringe disorders such as leaky bowel, chronic candidiasis, multiple chemical sensitivity, etc.  To quote the very smart Dr. Marcia Angell, former editor of The New England Journal of Medicine: “These much discussed but elusive disorders remain entirely speculative …. they are variously said to consist of just about every symptom imaginable in biologically improbable and shifting combinations.  Since they have yet to be objectively and consistently defined, it is impossible to study whether they have anything to do with breast implants.”  For some really good reading and a wonderful primer on the scientific method and statistical analysis by Dr. Angell, you should really check out her book:  Science on Trial:  The Clash of Medical Evidence and the Law in Breast Implant Cases by Dr. Marcia Angell This book is a decade old but its lessons are very timely.

If a patient goes to enough alternative health providers, they will eventually find one willing to take their money to tell them that they have one, two or more of these disorders and that it’s their implants that are at fault.  They may even offer $50,000 worth of testing and treatment (as reported by one of my plastic surgery colleagues). I have one patent who saw seven naturopaths before she found one who told her what she wanted to hear. Did she ever go at an actual rheumatologist for her autoimmune symptoms?  Of course not.  She could not trust a rheumatologist.  I have patients who pay hundreds of dollars for hyperbaric oxygen treatment that does not involved a pressurized capsule.  Ladies, if you are sitting in a room without an airlock you, are not getting hyperbaric oxygen!   Several months ago I saw a middle aged lady who after reading one of the breast implant illness websites was worried that her implants were causing her sleep disturbance, brain fog, low energy and general feeling of malaise.  Then she told me that those symptoms had recently resolved.  Upon further questioning, she told me her primary care doctor had diagnosed depression and had put her on an SSRI.  After a week or so on medication, she was feeling so much better.  And her implants not only looked fine, they looked great!  This lady did not have breast implant illness.  She had depression.  She needed medication and a boost in her seratonin, not an operation.  Oh, and then a few weeks ago my nurse took a call from a lady who was in a panic about needing her 10+ year old implants removed the next day before they killed her.  I was scrubbed in the OR and could not talk to her.  My nurse explained that she would need to come in for a consultation and that it may be a few weeks before I had the OR time to do her surgery.  She berated me, my nurse, the universe and then hung up before we could get contact information on her.  I have no idea what has happened to her but whoever in the BII community scared her silly about her breast implants did not do her a favor.

I regularly visit some of these breast implant illness websites and Facebook groups and Instagram and to be very honest, I find so much of the content just outrageous.  Several of my patients noted the onset of their breast implant illness after stumbling into one of the breast implant illness communities.  Is this the nocebo effect (the placebo effect’s evil twin a.k.a. the power of negative thinking)?  Maybe.  One thing I find very interesting is the number of women who have their implants removed and still feel ill months and years later.   Do they think that maybe their problems were perhaps not related to their implants?  No, they are told that even after removal of the implants and scar tissue, the fact that they ever had implants condemns them to a life of ill health as if implants somehow have thrown a biological switch from healthy to sick.  Some of these posts are just heartbreaking to read. And most of the advice being given by non-physicians has no basis in reality based medicine.  And then there is the dismissal of surgeons like me who spent their youth training in medicine and surgery (I completed my residency training at the tender age of 35), took the Hippocratic Oath and devote most of their waking hours doing their best to provide competent and conscientious care to patients.  I take it a little personally when someone is more receptive to the advice or opinion of someone on Facebook who posts photos of themselves having a coffee enema that to the advice of a fully trained and experienced plastic surgeon.  And then there are those who feel that banning breast implants and denying their access to women who either want to enhance or rebuild their breasts is somehow empowering.  Give me a break.  I get cranky just thinking about it.

Do I think breast implants can cause problems?  Oh yeah.  For a small number of unlucky patients, breast implants can be a mess.  Although implant construction has improved over the years, implants can still get hard, they can become too loose, too tight, too low, too high, too medial, too lateral, too anything.  They can develop thick scar capsules that can cause distortion and cause pain in the breast, chest wall, upper extremities, neck and back.  Implants can leak which will deflate a saline implant.  A leak or rupture of a gel implant can result in silicone granulomas of the breast and even the chest and abdominal wall.  And then there is the more recent worry of ALCL which is looking like it occurs exclusively with textured implants but the jury is still out on that one.  I sometimes see patients who have had 3, 4 or more operations related to implant problems.  And yes, I am the original surgeon on a couple of them.  And yes, if a woman has breast implants she will likely need an implant related procedure sometime in the future.  And one more thing – IMO the bigger the implants, the bigger the problems.  That’s why you don’t see any large casaba melons in my photo gallery!  And you will also see a lot of non implant breast surgery in my photo gallery.  If I can make a breast look nice without an implant, I will encourage the no-implant route.

Do my implant removal patients feel better after removal?   Most, but not all of them, do feel better.  One interesting finding in almost all of my breast implant illness patients is a tight implant capsule.  Sometimes it is very thin and fragile and sometimes it is thick and even calcified but they are always really, really tight.  That tight scar tissue can cause discomfort that can include the entire upper extremity, chest, back and even the neck.  Removal of the scar tissue capsule (a procedure called a capsulectomy) will often result in a lot of relief.  Sometimes in surgery, I think I can hear the pectoralis major muscle breath a sigh of relief as I remove the tight scar tissue.   Also, capsule formation is an inflammatory process and we all know that inflammation is the new bogeyman.  And then there is the placebo effect.  I have a deep belief and deep respect for the mind–body connection.  Some patients fret every day about their implant’s effect on their health.  After removal, they often report just feeling better all over.  Is it that they don’t have the constant worry anymore or something else?  I really don’t know.  I can never guarantee what effect breast implant removal will have on a patient’s health.  I think many of my breast implant illness patients are worried sick and if the object of their worry – breast implants- can be removed, I am happy to do that.   I will also go after every bit of the scar tissue around the implants if it is safe to do so.  And, if the breast tissue is healthy enough, I will do a breast lift at the same time if it will improve the appearance of the breast.  And there’s more!  I will consider doing fat transfer a few months later if the patient wants a little volume back and has some good donor fat.  And I have to say, I just love sending patients on their way to an implant-free rest of their lives with no worries about the need for further implant related surgery. I call this “graduation” from breast implants.

If you are looking for a careful and conscientious surgeon who will remove your implants and capsules and offer non-implant options to enhance your breast appearance, I’m your gal.  Come see me!  If you are looking for a surgeon who believes that breast implant surgery destroys women’s health, I am not your gal.  And really, would I use breast implants if my implant patients came crawling back to my office sick?

So, if you want your implants out for any reason, come on in.  I will  listen to your concerns and answer your questions to the best of my ability.  I’m not Marcus Welby but for a surgeon, I am really pretty nice (at least that what I have heard).

Wow, this was a long one.  Thanks for reading!   Dr. Lisa Lynn Sowder

If you want to follow me on Instagram, I would be honored.  Look for me at @breastimplantsanity. and @sowdermd.

 

 

Breast Implant Illness, Breast Implant Removal, Breast Implants, General Health, This Makes Me Cranky.

Placebo and Nocebo Effect : The Power of Positive and Negative Thinking

February 6th, 2017 — 12:18pm

The Placebo Effect and its evil twin, the Nocebo Effect.

I’ve been doing some interesting reading lately on the mind/body connection in preparation for a presentation I am giving at the annual meeting of the Northwest Society of Plastic Surgeons this month.  I have been reading up on the “Nocebo Effect” which is the evil twin of the much studied and celebrated “Placebo Effect.”  Any one who has kissed a child’s owie is well acquainted with the placebo effect.

The nocebo effect is a more recently studied phenomenon.  One nocebo effect study involved giving a fake lactose solution to a group of participants which included lactose tolerant and lactose intolerant individuals.  44% of the lactose intolerant and 26% of the lactose tolerant reported gastrointestinal distress after ingesting the sham lactose.  The study participants were told that the solution was know to cause gastrointestinal symptoms.   The nocebo effect can be disruptive when it comes to new drug trials.  In some cases almost 10% of the participants in the placebo arms of clinical trials have to drop the study because of adverse effects.  I have come to view the nocebo effect as the Power of Negative Thinking.  We humans are very susceptible to suggestion.

I had a patient recently who came in for removal of her surgical drains after a breast reduction.  She was just a nervous wreck and was clearly bracing herself for the most painful thing ever.  I asked her about her anxiety and she told me she had seen a YouTube video of a young man who had had a gynecomastia procedure getting his drains removed.  He apparently was howling like an injured wolf.  He must have either had a very low pain threshold or maybe he was a drama student?   Anyway, while chatting with my patient, I slipped out her first drain in about 3 seconds.   Then I slipped out the other one.  She was pleasantly surprised at how quick and easy it was.  Yes, it stung a little but no need for howling.  The howling wolf video she saw was the nocebo effect at work.  The nocebo effect is one reason I implore my patient to avoid surgery horror stories before and after their procedures.  For every horror story out there are likely 10,000 undocumented stories of uneventful surgery and recovery.  But uneventful isn’t nearly as interesting as a howling wolf.

Thanks for reading and beware the nocebo effect.   Dr. Lisa Lynn Sowder.

 

 

Breast Implant Illness, General Health, Now That's a Little Weird, Postoperative Care

Seattle Plastic Surgeon Saves Resusianne (for the umpteenth time).

March 14th, 2016 — 12:16pm

Resusianne saved once again by Seattle Plastic Surgeon. 

Last Saturday I had my biyearly Advanced Cardiac Life Support review and examination.  After an excellent review of heart rhythms, various resuscitation drugs,  much studying and fretting and sweating bullets while taking the written exam, I was taken into a small room by a seasoned and tough-as-nails intensive care unit nurse.  There, on the table, lay Resusianne.  After many years of saving her life, I just call her Anne for short.  I don’t really care for her much but only because she makes me so nervous.  You see, she is always trying to die on me.

Resusianne lives yet again.

Resusianne lives yet again.

My nurse examiner starts with the scenario that I’m in Nordstrom’s and come across a woman who is laying, unmoving on the floor.  My first thought is sticker shock at the price of this bikini but I keep that to myself.  I automatically go though the drill that has been beat into me over three decades.

“Anne! Anne! Are you okay?”  Of course she’s not okay.  Resusianne is never okay but it seems polite to ask.  “I need help!  Someone call 911 and someone bring an AED.”  And then I start CPR.  Now the fun starts when the AED arrives.  I have to fumble for the on switch, rip open Anne’s shirt (fun!) and put on the paddles and then start CPR again until the AED tells me to stop.  And then it seems like an hour before the AED decides to shock Anne.  As soon as the shock is completed, I start in on CPR again until the nurse has mercy on me and tells me I can stop.  Good CPR is really, really physical, especially for a petite little gal like me.  By this time, I am a nervous wreck.  I take Anne’s problems way too personally.

Normal Sinus Rhythm is a beautiful thing.

Normal Sinus Rhythm is a beautiful thing.

Next, my examiner gives me this scenario:  I’m in the operating room with a patient and her EKG shows a heart rate that suddenly goes from 68 to 135 and her blood pressure starts to drop.  This is the arrhythmia part of the test.  You know that nice normal EKG pattern we always see with a spike between two humps? That is called normal sinus rhythm and that is what we love to see on an EKG but Anne is such a drama queen.  She’s never in that rhythm for long.  There are a dozen or so aberrant rhythms that range from kind of ugly to downright terrifying.  Her current rhythm is somewhere in the middle and responds to a nice dose of Adenosine.  She converts to normal sinus rhythm.  Woo Hoo!   But there she goes again.  Fie on her.  I give her a second and larger dose of Adenosine which really works this time.  After Anne is conscious, I tell her that I will never, ever operate on her again and that she needs to find another plastic surgeon with larger cajones than mine.

And then my examiner raises the bar.  This time Anne has just walked into my office to get her tummy tuck stitches out and she goes to ground right in the middle of my really nice waiting room!  How rude.  I go through all the steps of CPR and get EKG monitoring set up  which shows normal sinus rhythm but Anne has no, nada, zero, zilch pulse.  So now while I’m doing CPR and getting an IV started and pushing epinephrine I have to figure out why it is that Anne’s heart has electrical activity but is not pumping blood.  There are about 12 reasons this can happen and I start with the most common in this scenario which is a pulmonary embolus (a blood clot to the lung).  Now, after some IV fluid and epinephrine,  Anne has a little bit of a blood pressure and I am ready to inset a breathing tube and get her over to Swedish Hospital for a diagnostic CAT scan and treatment and I’m about to have a cardiac arrest myself with my nurse examiner tells me that my exam is over and I passed!   WOO HOO!  I’m good for two more years and now I get to go change my scrubs which are soaked with sweat.  I really, really hope I never have to use these skills.  But I’m glad to keep up to date …..just in case.  I say goodbye to the examiner but not to Anne.  I may have a different examiner in two years but I know Anne will be back.  She always is.

Thanks for reading and if you don’t know CPR, get thee to a class.  The life you save my be of someone you love!  Dr. Lisa Lynn Sowder

General Health, Patient Safety

Do I have to cancel my surgery because of a common cold?

October 8th, 2015 — 9:14am

Fall is the time of year when we get a lot of questions about the common cold.  Murphy’s law dictates that about week before surgery, patients wake up with a sore throat and a runny nose and a sinking feeling that we will cancel their upcoming surgery.  Here are the guidelines my anesthesia and nursing staff and I use:blog common cold

A significant cough will probably require rescheduling of most surgical procedures, especially those done with a general anesthetic.  General anesthesia can irritate the airway and make a cough worse.  Also, some procedures, tummy tuck for instance, does not go well with a cough.  If the cough is minor and is likely secondary to post nasal drip, it may be okay to go ahead with surgery.  Most of the narcotic pain meds we prescribe after surgery are also powerful cough suppressants.

A mild sore throat with no other symptoms is probably not a reason to cancel surgery.  The anesthetic may make your sore throat a little worse for a day or two.   A raging sore throat with swollen, nasty tonsils is a reason to cancel surgery.

A runny nose without other symptoms is not likely to interfere with anesthesia or recovery but a nasty sinus infection, either viral or bacterial, should be resolved prior to surgery.

A fever will require rescheduling your surgery.  Fever is indicative of something bad enough to get your body fighting back.  You don’t want to pile on with surgery.

We always appreciate a “heads up” if a patient thinks there is something brewing that may affect their surgery.  Don’t hesitate to give us a call!

Thanks for reading!  Dr. Lisa Lynn Sowder

 

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Anesthesia, General Health, Patient Safety, Preoperative Care

Correct diagnosis is the cornerstone of proper treatment.

June 15th, 2015 — 1:27pm

blog correct diagnosisI saw a patient this week that really drove home the importance of diagnosis before treatment.  In plastic surgery, diagnosis is usually very straight forward and can be made from across the exam room or sometimes even from across the street.  Common diagnoses in my practice include large breasts, saggy breasts, small breasts, asymmetrical breasts, saggy abdomen, big saddlebags, jowls, saggy eyelids …… you get the idea.  But sometimes I will see a patient whose diagnosis requires something more than a history and physical examination.

This particular patient was a lady in her early 60’s who had a breast lift some 15 years previously.  She presented with an ulcerated area on her right nipple that had been present for over 6 months.  She was convinced it had something to do with her breast lift surgery although the ulcerated area was well away from any of her well healed and almost invisible breast lift scars.  I am convinced that her ulceration is a rare and treatable form of breast cancer called Paget’s disease.

She had seen a half dozen alternative provides who all offered some sort of treatment be it supplements, special salt baths or special ointments.  Guess what?  Nothing worked and none of these providers had a diagnosis.  They were treating an unknown problem with ineffective therapy.  If you know me well, you know that this sort of thing makes me really, really cranky.  This lady had spent a lot of money and delayed a definitive diagnosis by 6 months.

I referred this patient to a breast cancer surgeon for a biopsy which will reveal her diagnosis and allow her to get proper treatment.  I never cease to be amazed by the hubris of some members of the “alternative” medical community.  They don’t know what they don’t know.

Thanks for reading.  Dr. Lisa Lynn Sowder

General Health, Ineffective, My Plastic Surgery Philosophy, This Makes Me Cranky.

Very effective sunblock blocked by the FDA.

June 10th, 2015 — 11:33am

 

Border patrol K-9 unit trained to sniff out illegal sunscreen.

Sparky is especially trained to sniff out illegal sunscreen. Woof.

This is an article from the May/June 2015 King County Medical Society Bulletin.  It’s a little long and technical but just hang onto that attention span and read it!

Packing a Sunscreen Souvenir

Tourists Grab UVA Treatments Common Elsewhere, Illegal Here

By Barbara K. Gehrett, M.D.

Some international travelers are returning with pharmaceutical souvenirs – new UVA sunscreens available in Europe, Canada, Mexico, and other countries and not yet approved in the United States.

Ninety-five percent of the solar UV radiation that reaches earth is UVA.  It has a wavelength between 320 and 400 nanometers and is present during all daylight hours, summer or winter, cloudy or clear.  UVA passes through glass and penetrates deep into skin.  It is responsible for more damage to basal keratinocytes in the epidermis than UVB.

Most UVB damage occurs in the superficial layer of the epidermis, producing suntan, sunburn, and aging skin.  Protection from UVB with sunscreens reduces the risk of non-melanoma skin cancers.

Two short-acting, barrier-type UVA sunscreens have been approved for use in the U.S.  These are zinc oxide and oxybenzone.  Dermatologists argue that their protection is limited and requires repeated application because they break down quickly.

Ecamsule is a longer-acting “chemical filter” made by L’Oreal and is one component of a U.S. approved lotion, Mexoryl.  The FDA turned down the application to release ecamsule as an over-the-counter UVA sunscreen, although it has been available in Europe since the late 1990s.  It is regulated there as a cosmetic, which has a different standard than the drug category it falls into in the U.S.  All sunscreens in Europe must give both UVA and UVB protection.

Eight UVA sunscreen products have been languishing in line (one since 2003) for FDA consideration.  Congress and President Barack Obama attempted to pressure the FDA by passing the Sunscreen Innovation Act in December of 2014.  This new law requires the FDA to issue an approval or disapproval ruling within 60 days of receiving a complete application for sunscreen.   All eight of the new UVA sunscreens were expeditiously disapproved by the FDA early in 2015.

The FDA wants long-term data on safety before approval will be given.  Typically this means two Phase 3 clinical trials, which are expensive and time-consuming.  It is possible ;that future data on skin cancer protection from other countries would move the agency.  Or perhaps ;the procedural review taking place at the agency will result in a different set of criteria for sunscreens.

In the meantime, U.S. travelers stocking up on sunscreen  when they are outside the country are violating the Food, Drug and Cosmetics Act by importing unapproved drugs.  According to WebMD, the FDA does not generally pursue violators, unless the quantities involved are egregious.  One other work of warning:  online purchases should be made with caution, because of international counterfeiting of drugs.

Thanks for reading!  And keep using that lousy U.S. approved sun creen.  It’s better than nothing.   Dr. Lisa Lynn Sowder

General Health, Government and Politics, Skin Cancer, Skin Care, This Makes Me Cranky.

It’s open season for celebrities in swimsuits.

May 28th, 2015 — 12:49pm

Scans,   (20140304095238874) 20140722133849781Recently I found myself waiting in a long line at the grocery store so I reached for the National Enquirer to catch up on the latest case of Spontaneous Human Combustion and Lizard Boy but alas, about half of the issue was devoted to mostly unflattering photos of celebrities in swimsuits.  It was a potpourri of bulges, sags, bags, cellulite, stretch marks and other bodily imperfections.  After a few pages, I just had to put it down.  Maybe it’s the Catholic in me but I just felt kind of guilty looking.  But before putting in back in the rack, I did get a glimpse  of Bruce Springsteen frolicking in the surf.  He’s in his sixties and he is still The Boss.

I am so thankful that nobody follows me around with a camera!

Thanks for reading.  Dr. Lisa Lynn Sowder

General Health, Wardrobe Observations

Modern Day Snake Oil

February 4th, 2015 — 10:29am

Modern Day Snake Oil

blog snake oil

Hey Darlin’. How about a little St. John’s Wort for those post-partum blues?

I was shocked, shocked! to read the recent New York Times article about the “health” supplement industry.  Check out the article here if you want to but here is the abbreviated version:

The New York State attorney general had an independent agency test the ingredients of a variety of supplements sold by large retailers like Target, GNC, Walgreens and Wal-Mart.  The results are almost unbelievable.  Eighty percent (80%!!!!!!!!!) of the supplements tested had zero, nada, zilch of the ingredient on the product label.  They did have a bunch of other stuff like grass, compost and rice in them.

You ask, “how can this be?”   Since these products are labeled as supplements, they are not under the scrutiny of the F.D.A.  They require no scientific trials or testing or proof of safety or efficacy.  Crazy, huh?  People are spending a bajillion dollars on this crap.  In fact, most of my patients take supplements of one sort or another.  And that really rips me because they could have saved their money for plastic surgery!

Thanks for reading and if you have any of this stuff in your medicine cabinet, I would take it back to the place of purchase and demand a refund.   Dr. Lisa Lynn Sowder

General Health, Patient Beware

Agressive treatment for acne

January 22nd, 2015 — 1:44pm

Treat acne now to avoid scars later.

blog acne scarsIf, like me, you are a fan of the cable T.V. show “Justified” you recognize this man as Johnny Crowder.   I find him very attractive despite his really severe acne scarring.  Maybe it’s because he is the quintessential bad boy or maybe it’s because he has such a soft heart despite being a total sociopath.  Anyway, he was killed last season by his even more bad ass cousin, Boyd Crowder so I won’t be able to enjoy his handsome mug anymore.  But this post is not about my taste in men but about acne scars.

Acne is often thought of as just one of the many challenges of adolescence and in many cases it is.  Mild cases can often be controlled with over-the-counter treatments and usually the acne subsides once the hormones have leveled off.  But for some, acne can be a devastating disease.  When the acne lesions are deep and cystic, they can destroy the normal fat layer under the skin and cause deep permanent scars as in David Meunier, the actor who plays Johnny.   Acne scars have not kept Mr. Meunier from  finding success but they may limit his roles somewhat.  He may find himself cast more frequently as a bad guy.

So if you or someone you know has out of control acne, get thee to a dermatologist.  Those pesky “zits” of today can turn into the life long scars of tomorrow.  Oh, one more thing – treating acne scars is really difficult and only partially effective.  It’s much better to prevent them in the first place.

Thanks for reading!  And Johnny, I miss you!  Dr. Lisa Lynn Sowder

 

Acne, General Health, Scar, Skin Care

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