Zouk Surgical

I am located in the East San Francisco Bay Area community of Walnut Creek (about 20 minutes for San Francisco). The majority of my patients live within a few hours of my office; however, thanks to the Internet, I get inquiries from around the world. Since it is difficult to be exact about any procedure without performing a focused history and physical examination, I usually recommend a consultation appointment for anything other than general information. At a consultation appointment you are provided specific answers to your questions. Initial consultations gives you time to get your questions answered and me time to formulate a plan tailored to your needs. In my practice there is a charge for the consultation, and this is applied toward the cost of surgery should we decide to proceed.

I am happy to be found, and my office can help make arrangements for out of town guests. However, if I am too far away, you might wonder how to find a Plastic Surgeon in your local area.

One way is to try asking your friends, family or family physician for a recommendation. Word-of-mouth referrals tend to quality recommendations, but this isn’t always an option.

If you are starting from scratch, the American Society for Aesthetic Plastic Surgery (ASAPS) at www.surgery.org and the American Society of Plastic Surgeons (ASPS) at www.plasticsurgery.org have doctor locators on their sites. The doctors on these sites must be Board Certified Plastic Surgeons and have had further credentialing.

When you are investigating a doctor you should check their Board Certification with the American Board of Medical Subspecialties (ABMS) at www.abms.org. If it does not say “Plastic Surgery” then they are not a Board Certified Plastic Surgeon. There are many “Boards” out there, but the ABMS is the recognized authority for subspecialties in medicine. Some boards may sound like plastic surgery (some even sound better) but they are not ABMS recognized boards.

You should also check the doctor’s license on you local states medical board web site. For example when you Google “California Medical Board” you will find: http://www.medbd.ca.gov/ listed in the number one slot. Click on the “Check Your Doctor Online” box to check the status for the doctors license. Any actions against the doctor’s California Medical License will be listed here. If none are found it’s a good thing.

I hope you find this information useful. There is no substitute for a face-to-face visit for both doctor and patient, but the above is a good starting point. For those of you in the greater San Francisco Bay Area or Northern San Joaquin Valley, if you would like to take the next step with me, the easiest way to schedule a consultation appointment is to call (925) 943-6353. We are open weekdays, 9 AM to noon and 2 PM to 5 PM.

Joseph A. Mele, III, M.D., F.A.C.S.
Certified by the American Board of Plastic Surgery
Walnut Creek, CA 94598
(925) 943-6353
www.DrMele.com

As 2006 draws to a close, there are many things to be thankful for. Since starting this blog in April of 2006, I have had a wonderful opportunity to interact with many of you who have commented and visited the blog. Hopefully, I have presented a fair and balanced approach to many of the topics discussed in joint replacement surgery. The field of orthopedics continues to grow with improved implants, better surgical techniques, and improved rehabilitation protocols. All of these have helped patients get back to activity with less pain and better function. I encourage all of you to educate yourselves about the various options available to treat conditions that adversely affect our joints. But, take a moment to appreciate all the good things in your lives and also take time and energy to help those less fortunate then us. Merry Christmas and Happy New Year. 

William P. Barrett, M.D.

WPB/mf 

I get many questions regarding what can I do to help prepare myself for hip or knee replacement surgery. Once the patient has reached a decision to undergo joint replacement surgery and has seen their orthopedic surgeon who concurs with the diagnosis and the need for surgery, several things can be done to prepare and optimize the outcome. These include beginning an exercise program if this is not already a part of the patient’s usual routine. Low-impact exercise such as riding a stationary bike, water aerobics, or swimming can be useful to tone muscles, burn calories, improve cardiovascular fitness, and not exacerbate the underlying joint inflammation. These types of aerobic exercises can improve the ability to use crutches or walker after surgery and also improve one’s overall health prior to the operation. 

If you are overweight, attempting to decrease your calorie consumption while increasing your exercise will help drop a few pounds which not only makes your recovery easier but also makes the surgery technically easier to perform. Optimizing your medical status is also important making sure that any underlying medical condition is evaluated and updated and that your medications are in order. It is important to check with your internist or family physician to make sure that there are no “loose ends” in your healthcare history prior to an elective operation. Rearranging your home to make sure that there is easy access to essential items and avoiding throw rugs and other things that can be hazardous after surgery is important. Stocking up on food that is easy to prepare will help in the first few days after you return home from surgery. Arranging for assistance in the form of family members or friends to help you your first week home can be very important. These are things that should be taken care of ahead of surgery so that you do not have to scramble while you are in the hospital arranging for someone to give you assistance following your operation. Arranging for transportation to and from a physical therapy after surgery is also helpful as often outpatient physical therapy will be required. 

It is an investment in your future health and important that you become an active participant in the recovery from your operation. Most people will be in and out of the hospital in just a few days after a hip or knee replacement so it is important to make sure that these things are taken care of ahead of time. 

AMD is associated with a slowly progressive deterioration of central vision for which there is no cure. It is the leading cause of irreversible vision loss among the elderly. The condition may lead to severe loss of central acuity, such that the affected may lose ability read, drive a vehicle, or recognize familiar faces. However, as in many disease states, prevention may be possible and every person with AMD or at risk for AMD should understand the basic principles.

There are a number of risk factors for AMD, including genetic inheritance, advancing age, smoking, and high blood pressure. Unfortunately, many people that get AMD or are at risk for the disease don’t have any risk factors that are under their control, except possibly one: nutrition. In this article, we’ll review two landmark studies linking nutrition to AMD and we’ll provide specific nutritional advice to those with AMD as well as those at risk for the disease.

Ophthalmologists and vision scientists at the Massachusetts Eye and Ear Infirmary published the results of a study investigating the relationship between dietary factors and AMD in the Journal of the American Medical Association in November, 1994. This study found that individuals who had the highest consumption of vegetables rich in carotenoids (lutein and zeaxanthin) had a 43% lower risk of developing AMD than those who ate these foods the least. Vegetables rich in carotenoids include dark, leafy green vegetables, especially raw spinach, kale, and collard greens. As stated by the investigators in this study, “in particular, a higher frequency of intake of spinach or collard greens was associated with a substantially lower risk for AMD”. The authors stated, at the conclusion of the study, that “consumption of foods rich in certain carotenoids, in particular dark green, leafy vegetables, may decrease the risk of developing advanced or exudative (“wet”) AMD, the most visually disabling form of macular degeneration among older people”.

A second study investigating nutritional factors and AMD, supported by the National Institutes of Health/National Eye Institute, showed that high levels of antioxidant vitamins and zinc significantly reduced the risk of advanced age-related macular degeneration and its associated vision loss. This study, known as the Age Related Eye Disease Study (AREDS), was truly another landmark study for patients with AMD. The investigators state, “people at high risk of developing advanced stages of AMD, a leading cause of vision loss, lowered their risk by about 25 percent when treated with a high-dose combination of vitamin C, vitamin E, beta-carotene, and zinc”. Interestingly, the participants in the study who had either early AMD or no AMD did not appear to benefit from this antioxidant and zinc regimen.

“This is an exciting discovery because, for people at high risk for developing advanced AMD, these nutrients are the first effective treatment to slow the progression of the disease,” said Paul A. Sieving, M.D., Ph.D., director of the National Eye Institute. “AMD is a leading cause of visual impairment and blindness in American 65 years of age and older. Currently, treatment for advanced AMD is quite limited. These nutrients will delay the progression to advanced AMD in people who are at high risk – those with intermediate AMD in one or both eyes, or those with advanced AMD in one eye already”. Dr. Sieving further states that patients with AMD should understand that there isn’t a cure for AMD and that proper nutrition will not restore vision that is already lost. However, the study results also clearly demonstrate that nutrients play a key role in helping to maintain vision in people at high risk for developing advanced AMD.

The nutrients evaluated in the AREDS study contained 500 milligrams of vitamin C, 400 international units of vitamin E, 15 milligrams of beta-carotene, 80 milligrams of zinc as zinc oxide, and two milligrams of copper as cupric oxide. In this study, the NEI was supported by and collaborated with Bausch and Lomb, an ophthalmic products and pharmaceuticals company that provided the nutritional supplements, financial support for laboratory testing, and distribution of the supplements themselves. Today, these supplements can be found in a formulation called Ocuvite® Preservision™.

What Supplements Should One Take to Prevent AMD Progression?

Given the findings of these studies, most ophthalmologists have begun to recommend that patients with AMD include an abundance of leafy green vegetables in their diet.

Bausch and Lomb, the maker of Ocuvite®, produces other supplements specific for patients with macular degeneration, including Ocuvite Extra®, and Ocuvite® Lutein. These products are found in retail stores and pharmacies everywhere. Macular Protect Complete® from Science Based Health, Alcon laboratories ICaps™, and other supplements also contain antioxidant vitamins and zinc in dosages supported by the AREDS study group, along with various doses of other vitamins and minerals, which are beyond the scope of this article.

It should be pointed out that supplementation with beta-carotene, a vitamin A precursor, has been shown to increase the risk of lung cancer among smokers. However, whole food based supplementation has not been shown to increase the risk of lung cancer among smokers and, in fact, there is some evidence that whole food based nutrition may decrease the risk of lung cancer in smokers. One study showed that a higher intake of green and yellow vegetables or other food sources of beta-carotene decreased the risk of lung cancer. As such, smokers should exercise caution in consuming any non whole-food based supplement that contains beta-carotene or Vitamin A.

Conclusions

It is clear from the studies to date that a diet rich in dark, leafy green vegetables will help to decrease an individual’s risk of developing age-related macular degeneration (AMD). It would be wise to include a serving or two of raw spinach, kale, or collard greens in your diet every day to help prevent macular degeneration and/or to help delay progression of the disease once it has begun.

If an intermediate degree of AMD has already developed, or an advanced degree of AMD has developed in one eye, studies clearly indicate that dietary supplementation with vitamins E and C, beta-carotene, zinc and copper, in the doses previously mentioned, will help to delay progression of the disease. These antioxidant vitamins are readily available in a number of over-the-counter products including Ocuvite®, ICaps™, and many others.

AMD may not be an entirely preventable disease, however, it is certainly prudent for all of us to minimize our risk. How do we do this? Don’t smoke. Be sure your blood pressure is controlled. Consume plenty of dark, leafy green vegetables along with antioxidant vitamins and zinc.

I am frequently asked by patients, reporters and market researchers about the latest trends in plastic surgery. Most new technologies promise surgical results with no recovery time. I like to keep up with what’s new, but listen with a critical ear. At the recent American Society of Plastic Surgery Meeting I had the opportunity to speak with several vendors of new technology, and it struck me that many plastic surgery procedures are hard to beat in terms of efficacy.

For example, there are several new(ish) technologies claiming to provide liposuction results without the need for surgery. A few have clinical research to show that the technology is safe and effective. When comparing to surgical liposuction, these alternative procedures have a shorter recovery and lower cost per treatment; however the degree of effectiveness is debatable and the number of treatments required can outstrip the lower cost per treatment advantage. The clinical studies that do exist show that noninvasive methods can result in hundreds of cc’s of fat reduction (up to a pound of fat) and repeated treatments are common to achieve the desired results. Compare this to surgery which can remove thousands of cc’s at one time (up to eleven pounds). Upper limits depend on the amount of fat available to be removed.

This is not to say that there is no roll for these types of more limited procedures, and if they improve, one day they may indeed replace liposuction. I am excited about being able to move in this direction, but more effective treatments are needed before they can truly compare to liposuction. There is a reason that liposuction is the most frequently performed cosmetic plastic surgery procedure — it works. Like with any procedure, careful patient selection is key.

No matter what the topic, it pays to ask critical questions. I am always suspicious of oranges that claim to be as good as apples. New procedures have the connotation of better, but old procedures that persist have withstood the test of time. The strengths and weaknesses have been defined leading to increased safety and predictability. We can’t make progress without change, but if something sounds too good to be true…it probably is.