Category Archives: Health Care Issues

Yoga Comes to the Rescue of Aging Joints and Loss of Running Buddy

A few weeks ago, we lost our wonderful springer spaniel at age 12 ½. No creature will love you unconditionally in the way that a good dog will.   Jenny was my running buddy for many years, and she also excelled at board games.

Jenny the Springer Spaniel

Jenny, the springer spaniel

As she started to slow down in the last couple of years, and as my knee started to swell with running, I needed to find another form of exercise that would be easier on middle-aged joints. My wife suggested that I try out a new yoga studio that had opened just across the new I-5 bridge near our office.

To be honest, I didn’t think that yoga was actually exercise. After all, my mother had gotten into yoga in the 1970s, but was not much of an athlete. I also wasn’t interested in chanting, gongs or anything that I might perceive as “strange.”

It has now been 20 months since I tried yoga for the first time and I continue to really enjoy the classes. They counteract all of the bad postures I find myself in during a long office or operating day. My flexibility continues to improve very slowly, but my balance is significantly better, and my shoulder, back and neck pain have entirely disappeared.

Any golfers reading this might be interested to know that I have increased my clubhead speed by five miles per hour (which means that I now hit my ball much further into the trees).

One of the things I like best about yoga is that people of all ages and all body types can practice together, regardless of ability or experience.

I would encourage everyone to consider trying something new like I did, especially if you find yourself with some nagging pain or stiffness that you just can’t shake. Jessie, the owner/instructor at Simply Yoga, has offered 10% off of an initial series of classes for any new student who mentions Salmon Creek Plastic Surgery.

Kidney Stone Teaches Me About Care and Healing

Green-smThree weeks ago, as I prepared to go to work I experienced a sudden, severe pain in my right flank.  Although I had never previously experienced anything like this in my life, I had a sneaking suspicion that a kidney stone had decided to change its location.  Since my wife was out of town, and my dog could only be so helpful, I called my partner Dr. Huang, who then drove me to the Emergency Department.  This began a two week journey from which I learned several things which I would like to share regarding our health and recovery.

First, you need to advocate for yourself. The Emergency Department had no empty beds when I showed up at 8 AM, and I was left to sit in a wheelchair in the lobby.  When a medical assistant walked by 15 minutes later, I asked if there was any way I could at least lay down on a gurney in the hallway because I was so uncomfortable.  She took pity on me and within a few minutes wheeled me into a room.  99% of health care workers are compassionate people who truly do want help you feel better. Be sure to let them know what you need.  Ask nicely and say thank you even if you don’t feel great and the staff will bend over backwards to help you.

Second, give yourself time to heal.  My kidney stone decided it did not want to move any further and I eventually had surgery to remove it on a Sunday afternoon five days later.  (Shout out to Dr. Jason Smith of Vancouver Clinic Urology, a kind, compassionate, competent surgeon who took time away from his young family to help me.)  I thought I would get that stone out and just go right back to work the next day.  Which I did. And which was a mistake.  I felt terrible that evening after work and ended up missing most of the rest of the week.  I would like to apologize to the many people that I (or maybe you could say my stone) inconvenienced, but our patients were incredibly understanding.

Third, be wary of antibiotics and take only when necessary.  We all are tempted to take antibiotics “just in case,” but that can potentially lead to unintended consequences.  In my case, some preventative antibiotics that I received at my initial emergency room visit destroyed all of the good bacteria in my digestive system, leading to much misery and discomfort.  Antibiotics certainly have their place, we need to use them cautiously and intentionally.

Finally, allow people to help you. None of us wish to feel like a burden to others, but my recovery really did not start until I started to listen to my wife, and my business partner, and my staff, and allowed them to “handle things” for me until I regained my strength. Helping others makes us all feel great, especially when those we are helping express gratitude and appreciation.

Oh by the way, be sure to drink plenty of water!

Skin Cancer 101: Three Main Types To Look For

People frequently ask what exactly I do as a plastic surgeon, and they are surprised to discover that I spend about 20% of my time treating skin cancer. Since most skin cancers are treated by surgically removing them, it makes perfect sense that a plastic surgeon would be involved in these cases.

Most patients who come in for a skin check actually have benign or pre-cancerous lesions rather than actual skin cancers. They have fancy medical names like actinic keratosis or seborrheic keratosis and are usually treated with freezing or topical creams. True skin cancers fall into three main categories:

  1. By

    Basal Cell Carcinoma. Photo By James Heilman, MD.

    Basal Cell Carcinoma is the most common skin cancer we see, and has a red, shiny appearance, often with a small central ulceration or depression. It has very clear borders typically. This cancer grows slowly and is seen on sun-exposed areas of the body. It essentially never spreads to other parts of the body but can come back in the same area if not completely removed.

  2. Squamous Cell Carcinoma looks more like a “sore” or “scrape” with irregular borders and often some scabbing. It usually appears relatively flat and is also on the sun-exposed areas of the body in most patients. Squamous Cell Carcinoma of the skin can spread to other organs although this is relatively rare. Again, the treatment involves complete surgical removal. To see photos, click here.
  3. Melanoma is the third major type of skin cancer and can show up anywhere on the body, not just the sun-exposed areas. It often looks like a flat or slightly raised mole with irregular borders and a mix of colors including brown, black or pink. We are very aggressive in removing melanoma because it most certainly can spread to other parts of the body, and proves rather resistant to treatment once it does. People with a family history of melanoma or a bad sunburn in childhood are at increased risk for developing a melanoma as compared to the general population. To see sample photos, go here or here.

If you have any questions about a particular mole or skin lesion, please do come in for a skin check. Insurance covers skin cancer screening and treatment, and sooner is definitely better than later in this case!

Health Care “Exchanges” Are a Reform We Can Support

bio-greenPeople are often surprised to hear that I care about the discussions going on in Washington DC and in Olympia regarding health care insurance reform. What difference does that make to a plastic surgeon?

Well, as it turns out, plastic surgeons care a great deal about access to health care coverage, as much of our work is reconstructive in nature rather than only cosmetic. Insurance companies and the federal government foot the bill for these types of services. For me personally, about 60% of my day is spent on reconstructive plastic surgery. This would include things like skin cancer screening and removal, hand surgery (carpal tunnel syndrome, arthritis, tendonitis and other injuries), breast reduction or reconstruction, scar revisions and wound management. This variety is, in fact, one of the things I like best about my job.

Most doctors in the United States remain unclear about what exactly heath insurance reform will
mean for them. Primary care doctors in many areas find themselves tremendously overworked and therefore unable to accept new patients, especially if they are covered by Medicare or Medicaid. Thus, problems with access to health care may continue to exist even after the health care “reforms” are fully implemented in 2014. Medicare and Medicaid simply do not reimburse hospitals and doctors enough to cover the actual cost of providing health care services to patients covered by this type of insurance. Washington State plans to greatly expand the number of its citizens covered by Medicaid. Will this increase access to care for these patients? That remains to be seen.

As an employer in a small business, I am looking forward to the ability to purchase health insurance for my family and for my employees on health insurance “exchanges” that may be available across state lines. Currently, we may only purchase coverage in the state of Washington and may not band together with other small businesses. This makes the cost of insurance very expensive, especially as we all age (I am “celebrating” one of those decade birthdays myself this year). This may be the one reform which truly helps the 70% of Americans who work in small business.