Tuesday, December 18, 2012


(CNN) -- She arrived on a suspicious flight. Her story didn't sound right. And then there was the blood ... under her breasts. An airport security check in Spain led to an operating table for a passenger -- where, authorities said, they found she had tucked packs of cocaine in her breast implants. The Panamanian citizen landed at Barcelona's Prat airport on a so-called "hot flight," one that came from a destination known for drug trafficking -- in this case Bogota, Colombia. Ninety percent of cocaine trafficked into the United States, for example, comes from Colombia, according to the U.S. Drug Enforcement Administration.
The passenger came under the scrutiny of security agents, who weren't satisfied with the vague answers she kept giving about why she was in town, Spain's interior ministry said. Her behavior aroused the suspicion of officers that she might be carrying drugs either in her luggage or on her. When a female officer patted down the woman, she found bloodied bandage material under the passenger's breasts. The gauze, the officer found, was covering incisions. And the breasts were hiding "a white foreign material."  Fresh breast implants, the suspect mustered an explanation. Must not have healed up right. The story didn't convince police, who hauled her off to a hospital. "There, a medical team extracted a bag-shaped prosthesis from each breast containing a white pasty substance," the ministry said. Cocaine. Nearly 1.4 kilograms (3 lbs) of it.
Pure cocaine goes for about $35,000 a pound, according to the DEA. The expensive implants landed her in jail.


"We are in our fifth straight year of trillion dollar annual deficits, and the president believes that – despite the Constitution – the power of deciding how much more debt the government can accumulate belongs to him instead of Congress. The president is asking for a blank check, and he wants Congress to abdicate power to him so he can raise the debt ceiling as he pleases. H.Res. 826 affirms the value of our three-part government, and the checks and balances that keep the pendulum from sticking in the liberal position. Giving the president the ability to raise the debt ceiling– without congressional authority– would be giving him power far beyond anything the Constitution intended. H. Res. 826 must be passed to remind the president that Congress will not surrender its power."  Introduced by John Fleming, M.D., U.S. Congressman

In addition, Congress needs to get its act together forcing the government to live within its means and abide by a balanced budget, just as we have to do in our personal and business activities.

Sunday, December 16, 2012


Early last year, Irma Carabajal LeCroy was a successful Dallas real estate broker who owned two homes, a luxury car, an SUV and a small office building. Today, she is out of work, uses a walker and wheelchair to get around and says she has nothing left to her name.And it's because of what she thought was a minor cosmetic surgery procedure.LeCroy is one of a growing number of women who have had liposuction, sometimes combined with fat-transfer surgery, in doctors' offices or med spas — salon-like medical facilities that have doctors on the premises and offer skin care treatments, such as Botox injections, facials and laser resurfacing. Some patients have found themselves disfigured or disabled. Others have died. Critics say the victims may not know that the rules that govern hospitals do not necessarily apply to the medical offices or spas popping up across the country. That's where a new breed of cosmetic surgeon now practices, often down the hall from where they do routine physicals, perform gynecological exams or pull wisdom teeth, according to state regulators, lawyers and plastic surgeons. USA TODAY reported last year that only half of states require licensing or accreditation of medical offices where surgery is performed. But even when there are office-based surgery rules or laws in place, they often aren't enough, critics say. For example, most accreditation or licensing rules cover surgeries only if the patient is fully anesthetized. Some rules apply only if private insurance or Medicare is billed, which typically isn't the case in cosmetic procedures.

There are now about 4,500 med spas in the United States, up from about 800 five years ago, says Allan Share, executive director of the International Medical Spa Association. The growth of med spas has states scrambling to figure out how much legal oversight is needed. The Federation of State Medical Boards recently hosted a workshop for medical board attorneys that covered the regulatory oversight of med spas and office-based cosmetic surgery. State medical boards and the laws regulating the practice of medicine were "created 100 years ago when cosmetic procedures or surgeries weren't anything that anyone had contemplated," says Mari Robinson, executive director of the Texas Medical Board. "It was about treating illness and disease — not this idea of people personally pursuing medical procedures solely based on improving their appearance." In September, Maryland's health department shut down the Monarch Medspa in Timonium after three women contracted Group A Streptococcus infections during liposuction and one died. The department cited "deviations from standard infection control practices." The Group A Streptococci bacteria, which can cause strep throat, are often found in the throat and on the skin and are spread through direct contact with mucus from infected people or contaminated surfaces, according to the health department. Most of these infections are relatively mild, such as with strep throat, but they can cause serious and even life-threatening complications. Joshua Sharfstein, Maryland's secretary of Health and a pediatrician, sent a letter to three committee chairmen in the Maryland legislature last month asking them to tighten laws governing outpatient surgery. The existing law doesn't apply to outpatient surgery centers unless insurance companies are involved, according to a department press release. Health insurance typically covers only medically necessary or reconstructive plastic surgery after cancer. He also asked that the state Board of Physicians database include information on whether doctors perform cosmetic surgery and whether their facility is accredited. "We asked ourselves if more needs to be done to protect consumers from unsafe cosmetic surgery," says Sharfstein. "There are some protections that exist for bigger surgical centers, but gaps in regulation might put consumers at risk" because smaller operations, including med spas, can take advantage of loopholes. In Texas, doctors with office-based surgery centers or med spas that aren't accredited by one of three outside entities or licensed as ambulatory surgery centers, can register them for any level of anesthesia used that is above local anesthesia. It wasn't the anesthesia that harmed LeCroy, however. It was the surgery itself, according to a lawsuit filed on her behalf against internal medicine doctor Hector Molina and the company that sold him the liposuction machine. The suit charges that Sound Surgical Technologies should have known of the risks of a non-surgeon who was not adequately trained in liposuction using the machine. In its response to the suit, Sound Surgical denied the allegations and says it was not to blame for any of LeCroy's injuries. In a statement provided to USA TODAY, the company said LeCroy's attorneys aren't suggesting the liposuction machine was defective, so it "is confident that it will be dismissed from this lawsuit either before or during trial." LeCroy's attorney, Jim Mitchell, says it wasn't that the machine was defective, it was that "Dr. Molina simply didn't know how to use the system."
When they prohibited Molina from performing cosmetic surgery in April, a Texas Medical Board disciplinary panel found his "entire knowledge" of the procedure he performed on LeCroy (who it did not name) "consisted of reading a book provided by the manufacturer of the liposuction equipment, completing an online program over two weeks, passing an online exam and completing one procedure under the direct supervision of another surgeon." LeCroy was left permanently disabled by Molina due to problems including massive infection and the nerve and muscle condition known as "compartment syndrome," which causes body tissue to die, according to her lawsuit and an expert witness report by Miami plastic surgeon Alberto Gallerani. Molina denied the allegations in an answer to the lawsuit, and his lawyer declined to comment.
After LeCroy's more-than-nine-hour liposuction and fat-transfer surgery, Molina and a doctor assisting him abandoned her in his office "without any medical supervision or monitoring," according to Gallerani's report. Her friend, Marilyn Walker, found her "short of breath, unable to stand" and in severe pain in her legs and feet, the report said. She was rushed to the emergency room and transferred to a trauma center. So much fat was injected into the muscles in her buttocks, it caused the compartment syndrome, which Molina failed to diagnose, according to Gallerani's report. LeCroy needed 27 more surgeries to treat the compartment syndrome and related complications, according to Gallerani's statement. She spent a month and a half in the hospital. LeCroy, 49, now has a home health aide coming to her house three times a week. The money she earned selling real estate, which she did starting at age 25, went to pay medical bills, because complications from cosmetic surgery aren't covered by insurance. She says she is unable to walk without a walker and needs a wheelchair for long distances. "I have nothing," says LeCroy. "I'm down to $698 a month in disability benefits." Harlan Pollock, a Dallas plastic surgeon and past president of the American Association for Accreditation of Ambulatory Surgery Facilities, says Texas' law doesn't go far enough to protect patients. When offices register with the state of Texas, certain requirements kick in for the safe administration of anesthesia, according to Texas Medical Board spokeswoman Leigh Hopper. These include the presence of a doctor and another person certified in treating cardiac arrest and a "crash cart" containing life-saving equipment. But Pollock says these requirements apply only to anesthesia and have little to do with the safety of the surgery itself. Accreditation, on the other hand, would require sterile procedures, physical requirements for the operating room, safety equipment and thorough record-keeping procedures, Pollock says. Sterile procedures are key for infection control, which was what Maryland officials found lacking at Monarch Medspa, medical experts say. This kind of "an out," in Pollock's words, means "The public has no real assurance that the facility is an adequate facility, and that is disturbing and a real concern," he says. On Nov. 30, the Texas Medical Board barred Molina from ever performing surgery or dispensing controlled substances, a category that includes some pain medications, such as those with codeine. But Texas has done little to crack down on the offices and med spas where doctors like Molina practice cosmetic surgery, say plaintiff attorneys and plastic surgeons. Hopper emphasizes that Texas' medical board "rigorously screens" doctors who apply for medical licenses. And once they have these licenses, doctors are required to meet what's known as the generally accepted standard of care no matter what area they practice in, she says. Still, if Texas' state Legislature wanted to address office-based surgery, Robinson says, the board would "be happy" to implement any new rules. LeCroy isn't the only Texas patient to suffer after cosmetic surgery in a doctor's office or med spa. The Texas Medical Board also found OB/GYN Barbara Marino didn't meet the "standard of care," have emergency procedures in place or maintain a sterile operative facility during liposuction on patients at Medspa 21 in Houston. One died two days after his liposuction, and an autopsy report said the cause of death was "acute toxicity" from the combined effects of four medications, including a patch for the pain medication Fentanyl, according to the medical board's records. Another patient had excessive levels of pain medicine, the board said. Late last month, Marino was ordered to observe at least 30 hours of cosmetic surgery by a board-certified plastic surgeon and document other procedures for treating at-risk patients and dealing with emergencies. She did not espond to calls seeking comment. In November 2011, Laura Bennack, an emergency room doctor who owns Radiance MedSpa in San Antonio, had her practice put under the supervision of another physician by the Texas Medical Board. It had investigated the treatment of 10 cosmetic surgery patients and found she didn't meet what it considers the appropriate "standard of care" or keep adequate surgery records. According to the board's disciplinary order, Bennack performs tummy tucks, liposuction and breast augmentation while patients are awake. The board said in an order in February 2010 that Bennack acknowledged her medical recordkeeping was "sparse at best." Bennack did not respond to calls seeking comment. Med spas typically offer only procedures without anesthesia or under local anesthesia, which isn't regulated in Texas or many other states. "There is absolutely no regulation of med spas," Pollock says. "That's something that to me is very frightening." Some doctors, including Marino and Molina, register their facilities for higher levels of anesthesia. Several states require accreditation for offices intending to use deep sedation or general anesthesia, since it is the type used for the most serious procedures, says Tampa anesthesiologist Hector Vila. But doctors can get around the law by registering for a lower level of anesthesia or using large volumes of local anesthesia, says Vila. Vila says existing laws need to be more strictly enforced to ensure people don't continue to skirt them. Performing surprise inspections and more frequent inspections could be one way to accomplish this, he says.   In Florida, the state changed its law early this year to authorize the state to inspect any facility, including med spas, that remove more than 1,000 cc's of fat during liposuction. That would cover all but the most minor procedures, says Democratic state Sen. Eleanor Sobel, who introduced the bill. Previously, the inspection authority existed only for facilities that accepted Medicare or other insurance. The law was passed after two women died of an overdose of lidocaine, a local anesthetic similar to novocaine, after liposuction. In California, under a law passed in January, California's medical board keeps a list of accredited outpatient surgery settings. The board approved four accreditation agencies that inspect and accredit outpatient surgery settings, including medical offices and spas. These agencies can reject, revoke, or otherwise restrict a facility's accreditation. If that happens, the medical board is notified and alerts the public on its website. In New York, any office-based surgery facility that removes more than 500 cc's of fat during liposuction or uses anything more than minimal sedation must be accredited. Still, even though New York has some of the most stringent regulation of office-based surgery, any licensed physician can perform cosmetic surgery under a local anesthetic in an unaccredited facility, says Manhattan plastic surgeon Adam Schaffner. "My hope is that they will require that physicians who perform such procedures perform them in accredited facilities (and) that they have hospital privileges for any procedure they perform outside the hospital," says Schaffner. The issue of med-spa regulation is "absolutely rising to a national level ... everyone is really looking at it right now," says Robinson.

Wednesday, December 5, 2012


Arlington Heights, Ill. - The risk of hair loss in women is affected by genetics, but also by a wide range of health and lifestyle factors-notably factors related to high stress levels, reports a study in the December issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).
"Increased stress, smoking, having more children and having a history of hypertension and cancer were all associated with increased hair thinning," writes ASPS Member Surgeon Dr. Bahman Guyuron and colleagues of Case Western Reserve University School of Medicine, Cleveland. They believe that modifying these factors might help reduce risk in women concerned about hair loss.
Stress and Other Factors Affect Hair Loss-Not Just Testosterone
The researchers studied risk factors for hair thinning in a series of 98 identical female twins, average age 54 years. Studying identical twins-who share 100 percent of genes-provided an opportunity to separate out the genetic and social/environmental factors associated with any disease or condition.
The twins posed for standard photographs, which the researchers used to measure hair loss or thinning at specific locations: the front, sides and top of the head. Testosterone levels were measured, reflecting hormonal causes of hair loss.
The women also completed detailed questionnaires assessing a wide range of possible environmental, lifestyle and health-related factors-from diet and marital history to common diseases. Differences in these factors could help to explain differences in hair loss risk between genetically identical twins.
As expected, higher testosterone levels were associated with increased hair loss, particularly at the sides and top of the head. This was consistent with the hormonal causes of female pattern hair loss.
But the study also identified a wide range of environmental risk factors for hair loss. Although associations differed by site, women reporting higher levels of stress had more hair loss and thinning. Life situations related to higher stress-including being separated or divorced, multiple marriages and more children-were also linked to hair loss.
Other risk factors potentially related to high stress levels included higher income. Prolonged sleep was another risk factor, possibly related to depression/anxiety as well as stress.
Modifying Risk Factors May Help Prevent Hair Loss
Several medical risk factors for hair loss were identified as well, including cancer, high blood pressure and diabetes. Smoking, not exercising, and not using sun protection also increased risk. Women with higher caffeine intake were actually at lower risk of alopecia, possibly because caffeine counters the hormonal effects leading to hair loss.
Although typically regarded as a male problem, hair loss can also occur in women, in whom it causes even greater psychological distress. Hormonal and genetic factors contribute to female alopecia, but do not fully explain the risk. Studying twins allowed the researchers to evaluate other, nongenetically determined risk factors for female alopecia.
The study confirms the impact of hormonal causes for female hair loss, while also highlighting the contribution of various health and lifestyle-related risk factors-many of them related to high stress levels. The good news is that at least some of the identified risk factors are potentially modifiable. Dr Guyuron and coauthors conclude, "Many of the environmental factors discussed in this study such as smoking, sun exposure and excessive stress can be targeted by both patients and physicians as potential ways to augment hair loss prevention strategies."

Saturday, December 1, 2012


With all the plastic surgery nightmare stories circulating around the web, you'd think the dangers would be self-evident by now, and people would be cautious as to who is performing their surgery.But the recent arrest of an Ontario woman reveals that many people are still risking their lives by submitting to surgical procedures at the hands of unqualified practitioners.The Toronto Sun reports that police charged Marilyn Ely Reid with criminal negligence causing bodily harm last week after a 28-year-old woman suffered debilitating side effects from a series of Reid-administered butt injections last August.Police say the woman felt ill with a high fever immediately afterward, and three days later she'd deteriorated to the point where she required hospitalization.ER. "She was treated for several days with antibiotics but the woman's condition continued to deteriorate and she received surgery," Toronto Police Det. Louise Farrugia tells reporters, adding that the surgery was necessary to remove the substance from her rear. Although the woman is expected to make improvement over time, Farrugia says that she can "barely walk," is still hooked up to IV and has trouble sitting down.Reid -- who shilled her injectable wares on the website pmmainjection.com -- advertised "lip, muscle and buttock injections" and would meet her clients at their private homes or hotel rooms.As the National Post notes, PMMA stands for polymethyl methacrylate, and it's an expensive thermoplastic once commonly used as bone cement in cosmetic surgery procedures. By the 90s, PMMA got mixed with bovine collagen to create a long-term injectable that helped kick off the Botox craze.
The problem, as Julie Khanna of The Institute of Cosmetic & Laser Surgery tells the Post, is that the product was easy for unlicensed people to get their hands on. "People are downplaying these injectables — 'Oh yeah, your hairdresser can do it for you, anyone can do it for you.' And that's pretty scary to me," she says.



Nobel laureate and renowned plastic surgeon Joseph Murray, MD, passed away Monday, Nov. 26, at Brigham and Women's Hospital, Boston, after suffering a stroke at his home on Thanksgiving Day. He was 93.Dr. Murray is credited for performing the world's first organ transplant in December 1954. The recipient was 23-year-old Richard Herrick, who received a functional kidney from his twin brother, Ronald. Since that time, more than 600,000 people have received life-saving organ transplants as a result of Dr. Murray's groundbreaking work, for which he awarded the Nobel Prize in Medicine in 1990."Kidney transplants seem so routine now," Dr. Murray told The New York Times after he won the Nobel. "But the first one was like Lindbergh's flight across the ocean.""He brought comfort to thousands of patients and families with his compassion and the exquisite care he provided," wrote Betsy Nabel, MD, president of Brigham and Women's Hospital, in an e-mail sent to the hospital community upon hearing of Dr. Murray's passing. "He selflessly sought to share his knowledge with his colleagues and to teach and mentor younger physicians." Dr. Nabel was among those who honored Dr. Murray as a Special Guest during a Veterans Day celebration at the hospital on Nov. 12.A 1943 graduate of Harvard Medical School in Boston, Dr. Murray was commissioned by the U.S. Army Medical Corps in 1944 and served at Valley Forge General Hospital in Phoenixville, Pa., treating wounded soldiers - many badly burned - returning from the battlefields of World War II.One of his first and most memorable patients was a pilot named Charles Woods who survived extensive burns to his face and hands. The skin grafts required to treat his injuries provided Dr. Murray a fascinating view into the budding study of immunology and rejection of transplanted tissue. After his military discharge in 1947, Dr. Murray completed his surgical residency at Boston's Peter Bent Brigham Hospital (where he would retire from in 1986 as chief of plastic surgery) and then moved to New York for plastic surgery training.
"I consider myself a plastic reconstructive surgeon," Dr. Murray told PSN in 2006. "Transplantation was merely a side issue and it really is a form of reconstruction. I never considered it competitive. They're both the same - taking care of patients." Dr. Murray's interest in reconstructive surgery was sparked primarily as a means of treating children with deformities, but he also enjoyed doing purely cosmetic surgery.
Dr. Murray's surgical DNA could also be traced to the first partial face transplant, which was performed in 2005 on Isabelle Dinoire in Amiens, France. "The surgeon who did that face transplant (Jean-Michel "Max" Dubernard, MD) was one of my former research Fellows," Dr. Murray told PSN. "They've done a great job on a partial facial transplant. It's been a great success." Advances in hand and limb transplantation were also gratifying for the ASPS Life Member."The whole field of transplantation continues to expand far beyond the simple replacement of skin or kidney," Dr. Murray told PSN. "It's been a glorious experience to be a part of."

During his remarkable career, however, Dr. Murray also focused on developing treatments for congenital facial deformities in children, and he served as chair of the American Board of Plastic Surgery and president of the American Association of Plastic Surgeons. He was also a professor of surgery at Harvard.

Perhaps more than anything, Dr. Murray simply enjoyed caring for people.

"Each person is intrinsically valuable. Whether you're repairing a small blemish of the cheek or a major facial reconstruction, for the patient, it's 100 percent," Dr. Murray said. "You're putting them back into the mainstream - improving the quality of their life.

"Life goes on, and it's a very rich life, but it's all one theme: taking care of patients," he said.

"Enjoy everything about living," he added. "Even how a spider spins its web."


Women seeking information about genital cosmetic plastic surgery are ill served by Web sites purporting to provide expert advice and guidance about such procedures, a new study finds.Researchers at the UCL Elizabeth Garrett Anderson Institute of Women’s Health, University College Hospital in London, England wanted to assess the quality of information available online to women considering surgical alteration of their genitals – a practice that, for the record, the American College of Obstetricians and Gynecologists advises against. To that end, they Googled the term “designer vagina,” which they report is commonly used to describe procedures aimed at improving the appearance of women’s genital areas.The team of researchers reviewed the first five U.S. and the first five British Web sites that search yielded, analyzing content according to 16 criteria they developed, including accuracy, the kinds of procedures offered, and representations of success rates and potential risks of those surgeries.What they found was a mishmash of confusing information, the study said. Common procedures – 72 of them -- were identified by a baffling number of terms, from "labioplasty" and "liposculpting" to "hoodectomy" and "hymenoplasty." Though all 10 sites mentioned risks related to surgery, only six spelled out what those risks were. Hardly any mentioned that women’s vulvas naturally differ from one another in size and appearance and that a broad variety of appearances are normal. Worst of all, according to the authors, none of the sites mentioned an age below which such surgery is inappropriate. According to the study, women typically seek genital cosmetic surgery because they’re not happy with the way they look in that area or because they think surgery might help them or their partners achieve greater sexual satisfaction. It’s unclear how many such surgeries are performed in the U.S.; the American Society of Plastic Surgeons doesn’t keep track because the numbers are so small, according to that organization’s media relations office. But the new study suggests these procedures are increasingly popular. “The quality and quantity of clinical information in [female genital cosmetic surgery (FGCS)] provider sites is poor, with erroneous information in some instances,” the study concludes. “Impeccable professionalism and ethical integrity is crucial for this controversial practice. Clear and detailed guidelines on how to raise the standard of information to women on all aspects of FGCS are urgently needed.

Their work appears in the "Obstetrics & Gynaecology" edition of the on-line journal BMJ Open.


Card players who don’t want to give themselves away and tip their hand can turn to a Manhattan doctor who says bet on him — and “Pokertox.”Dr. Jack Berdy, an East Side doctor of aesthetic medicine, just launched the idea of using Botox to “allow people to gain a poker face’’ in a service he calls Pokertox.
“Very few people can maintain a real poker face,’’ said Berdy. “They have some ‘tells,’ some expression that gives away that they have a good hand or a bad hand’’ to an opponent.
He said he and his patients would go over those ‘‘tells’’ and the expressions that would give away a hand.
Some players look at their cards and ‘‘might raise their eyebrows or raise one eyebrow’’ if they do or don’t like what they see.“Some squint, or furrow their brows,’’ Berdy said.“We can inject Botox appropriately’’ so the other player doesn’t get the message that they’re angry, disappointed or happy.“What someone sees across the table is no movement,’’ he said.Pokertox costs an average $600 to $800 and lasts three to four months, he says.The idea came to Berdy because he used to be a gambler and his specialty is Botox — “and they go together.’’