A ^Retired Plastic Surgeon's Notebook

Seattle Plastic Surgeon goes back, way back to Match Day 1983.

I remember the excitement of MATCH DAY like it was yesterday.

Every March, fourth year medical students across the United States convene to receive and open a small white envelope that has a huge influence on their future.  The information contained in this white envelope is where they “matched” for post-graduate training.

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

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

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

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

And then there was Match Day for plastic surgery.  Again I snagged my 2nd choice, the University of Cincinnati.  I loved the program and training but it was a bit of culture and climate shock for me.  I even took up golfing which was about the only outdoor activity available.  I learned to love fireflies, the Ohio River, badass thunderstorms, cicadas and the way the humidity turned my naturally wavy hair into a Brillo Pad.  I never learned to love Skyline Chile which involves spaghetti noodles and cinnamon.

And now I am living in my home state, Washington in my dream city, Seattle.  But I so cherish those years away.  They expanded my world view while giving me great surgical training and some interesting ex-boyfriends.

So I hope every fourth year student matches at one of their top ranked programs and  some 36 years hence, looks back on their residency program with as much fondness as I do.

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

Seattle Plastic Surgeon blogs about how much surgery has changed in just a few decades.

Sometimes it just astounds me how much surgery has changed since my days as a medical student.  There was a time when hernia patients spent  an entire week in the hospital following surgery.  They were admitted the night before, a bazillion lab tests were done, they got an enema after dinner and a sleeping pill before bedtime.  After surgery, they were given morphine injections, Jello and broth and bed baths.  Their incisions were checked everyday and after a week their stitches came out and they finally went home.  Fast forward to today and a hernia patient checks into an outpatient surgery center in the morning and by lunch time is home eating a ham sandwich and watching Breaking Bad reruns.  How did all of this happen in just over twenty to thrity years?

Many of the changes have come about for economic reasons.  Keeping someone in the hospital for a week costs as much or more than a brand new Mini Cooper.  Insurance companies began to balk at these costs when I was a surgery resident in the 80’s.  I remember being shocked (shocked!) the first time some bozo from an insurance plan told me to discharge a hemorrhoid patient after just two days in the hospital.  I was used to waiting until those patients had managed to have their first bowel movement post op.  It was just, well, tradition.   So we started sending them home earlier and they did fine.  In fact, they did better than they if they were in the hospital being poked and prodded and woken up at midnight for vital signs.

Anesthesia has changed a lot too.  Back in the day, general anesthesia was almost guaranteed to leave a patient vomiting for a day or two after surgery.  These days, the anesthetic agents are much less nauseating and the anti-nausea medications much more effective.  And with spinal anesthesia, nausea is very rare.  I have not had to admit a patient to the hospital for nausea and vomiting and dehydration in at least ten years.

And surgical procedures have changed.  Take that hernia patient and his ham sandwich.  Thirty years ago he would have a six inch long incision in his groin and sutures tied so tightly that standing up straight would be difficult.  He would need a lot of narcotic pain meds which would make him nauseated.  He wouldn’t be able to keep the Jello down so he would need an intravenous line for a few more days.  He can’t go home until he can eat.  In contrast, these days the hernia is usually fixed from the inside out.  He has a couple of little incisions where the fiber optic scope was inserted to gently pull the hernia sac back into the abdomen when it belongs.  Then a plug of mesh is used to fill up the defect.  It’s slick and so much more gentle on the patient than fixing a hernia from the outside in.  Our patient is a little bit sore but will likely feel good enough to return to his desk job in a day or two, narcotic free.

So despite all the griping about our health care delivery system, it is actually getting better, more convenient and safer.   Now if someone could figure out how to make it less expensive.  But that’s another blog.

Thanks for reading!  Dr. Lisa Lynn Sowder

Seattle Plastic Surgery explains the importance of July 1st.

If you end up in the hospital this upcoming Sunday, you may notice that some of the doctors look young, really young.  That’s because this Sunday is July 1st and that is the first day of internship for all the doctors who finished medical school in June. 

I’ll never forget my first day of internship.  I was 27 years old but looked about 15.  I was assigned to the “Blue Team” at the University Hospital in Salt Lake City.  My chief resident (that’s a resident in their last year of training) was Dr. Karen Cartwright (now a pediatric surgeon in Arizona)  and the second year resident was Dr. Richard Barton (now a surgical critical care specialist in Utah).  We also had a couple of third year medical students on the team.  We were supervised by 4 attending surgeons. 

Despite all the great training in medical school at the University of Washington with a lot of “hands on” experience, I was terrified that first day of really being a doctor.  I remember introducing myself the “Blue Team” patients and having many of them tell me that I could not possibly be old enough to be a doctor (or at least their doctor).  I remember Karen Cartwright being so kind and helpful and Dr. Richard Barton showing me ropes of “scut work”  which includes things like drawing blood, starting IVs, changing dressings, taking out stitches, etc.   And I remember that first night on call when I  ordered some Mylanta for a patient with an upset stomach.  I was so afraid that the patient would have a violent adverse reaction to this over-the-counter medication. Both the patient and I survived my first night of call.

So – if you are in the hospital on July 1st and a child in a white coat and stethascope introduces him or herself as your doctor, be assured that they have been training for years for this day and please don’t tell them how young they look.  It will just make them nervous.

Thanks for reading!  Dr. Lisa Lynn Sowder

Seattle Plastic Surgeon blogs about spitting stitches a.k.a stitch abscesses a.k.a. a real pain for both patient and surgeon

Healing after surgery in most cases is uneventful.  (Uneventful is a good thing when it comes to surgery and flying.)  But sometimes uneventful healing can be interrupted by a stitch abscess which always looks way worse than it actually is.

Spitting stitches can occur whenever stitches are left in after surgery.  In plastic surgery, we often close incisions just under the surface of the skin with stitches that dissolve over several months.  If one of these stitches is a little too close to the skin surface, or works its way up towards the surface, it can cause a stitch abscess which is the skin’s reaction to a foreign substance (in this case the stitch).  This is a lot like having a splinter in your foot or finger.  It won’t get better until the splinter is removed.  The same for a stitch abscess.  It won’t get better until the stitch is removed.   If you have had surgery and have a little area like in the photo above, give your surgeon a call and make an appointment to be seen.  In the meantime, put some warm, moist compresses on the area and don’t freak out!  It will be okay!

In most cases, a gentle probing with some sterile tweezers locates the offending stitch and it can be easily removed and the abscess resolves quickly.  Sometimes, I will put a patient on antibiotics for a week or so if the inflammation is pretty wide spread or the patient feels lousy and/or is running a fever. 

Back in the old days when silk and cotton sutures were used in the deep layers, patients could spit a stitch decades after surgery.  Fortunately that is really rare these days although I have had a few patients myself spit permanent stitches years after surgery.  It’s just one of those things that can happen but once the suture is removed, healing occurs quickly.  Learn more here.

Thanks for reading.  Dr. Lisa Lynn Sowder

Seattle Plastic Surgeon, Dr. Lisa Lynn Sowder wishes her Alma Mater a happy 150th birthday (sesquincentennial).

The University of Washington is celebrating its 150 birthday this year.   I drive or bike by the campus frequently and always feel a pang of nostalgia for the more simple times of my college and medical school years, all spent at the UW.

During my undergraduate years, I spent my time on “upper campus” shown in this photo.  The UW has one of the most beautiful campuses in the universe, thanks to some lovely old buildings, great landscape design and our mild, maritime climate that leaves most of the campus green even in the dark days of our northern winter.  Traipsing from German class to chemistry lab was just felt like a lovely 1/2 mile walk in the garden most days.

The medical school is located on “south campus” which is a collection of modern buildings that look like they were designed by Stalin or Mao Zedong.  I always felt I should be wearing a Chairman Mao hat and calling my med school buddies “comrade”.  The saving grace of the “south campus” is the fact that it is right on the shores of Lake Union.  There’s nothing like sitting by the lake to get a little mental clarity after 2 hours in the neuroanatomy lab trying to find then memorize the location the 12 cranial nerves.

So happy birthday University of Washington.  The times were great, the tuition cheap (really, it was) and the education was outstanding!

Thanks for reading!  Dr. Lisa Lynn Sowder

Seattle Plastic Surgery, Dr. Lisa Lynn Sowder gets picky and prickly about before and after photos.  You should be picky and prickly too!

I have blogged about this topic on many occasions but this example takes the cake!  Not because it is blatantly Photoshopped but because it comes from an advertisement insert in the latest edition of Plastic Surgery Practice and the “from the editor” editorial is on the topic of misleading before and after photos used by vendor reps promoting a product or device!  Hello Captain Irony.

The example above is a case of poor photographic technique where the lighting in the “before” photo is from above and in the “after” photo is more face on.  This makes the result of the nasolabial fold treatment much more dramatic than it likely is.  I know not if this is advertent or inadvertent.  Either way, it is misleading.

This sort of stuff drives me to blog about it and it makes me lose confidence in the products or devices that show these photos to doctors or to prospective patients.

GRRRRRRRRRRRRRRR.

Thanks for reading and send me any examples you have found of misleading photography.  I collect this stuff!  Dr. Lisa Lynn Sowder