A Surgeon's Sojourn - into Zanskar Valley, Ladakh

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Do professionals need a break?

A recent legal document reminded me of the definition of a professional person – in the eyes of the law - Someone who works in an area where ordinary men do not venture.

Thus, whatever the sphere of life may be, the services of a professional person are always highly sought. In this background, there are a couple colleagues I am aware of, for whom taking a break from his/her highly successful professional life is something they cannot imagine. Will society not be deprived of the services of the professional – for the period of his unavailability?

Well, I belong to the breed of professionals who think it is essential to take a break – indulging in something that borders the wild, allows you to let your hair down (or up as seen in my example further ahead), that disconnects you completely from your existing world. My forays in this context have been in the field of Mountaineering and Hiking.

My exposure to this field began right from my days as a professional ‘in training’ – read medical school… the experiences gained have changed my life to such an extent that I would not hesitate to dedicate a large part of my professional achievements to the lessons learnt during the breaks I took.

Having reasonably settled down in the last (and the longest) phase of my Medical Career since a few years – my Medical Practice – I finally felt it was time to come out of my self-imposed exile from the Mountains.

With this in mind, three of us college friends set off on a venture to experience the harsh environment and physical challenges in the heart of the Zanskar Valley – a trek up a river of ice, on the frozen Zanskar river -  in Ladakh Province at the northern limits of our country. Thanks to our young but supportive families, we set to explore not just the mountains, but new limits to physical endurance and boundaries of our inner self.

As we set off on the venture, the thought did play in our minds -Why would someone ‘taking a break’ give up a life of comforts and take on new challenges and face difficult times?

The obvious answer is “You must be off your rocker...”  However, with our past experience to support us, we went on…

We faced temperatures of upto -30^OC on a regular basis, but beyond a point it did not really matter. The presence of a colleague who will support – no matter what – was enough to take on the challenge. 

Ice formed on eyelashes and face of the author - from condensation of body vapour in the breath and discharge from the eyes...

Cut off from all forms of modern communication with the outside world, the entire duration of the venture was a unique experience. Finishing dinner 7PM daily, we had ample time to reflect till 7AM next morning, while we fought off the cold, within our tents and sleeping bags. Though we left behind worried families, without any idea of our progress, it gave each of us an opportunity to introspect and reorganize our priorities, on our roles in the fast paced life and materialistic world.

The group of friends in front of a …frozen waterfall...

Standing water has the least kinetic energy, flowing water some more, while falling water has the most. The ability of the environment to freeze flowing water speaks of it's intensity...

The knowledge that our soldiers, guarding the country a few kilometres away, on the icy tops of the Siachen... at 24,000ft and – 70⁰C...  was enough to make our effort seem insignificant. While our experience made us realize the enormity of their sacrifice, it also gave us the confidence that we low-landers coming from sea level did have it in us to cope with challenges thrown at us from 11,000.

 

With Sepoy Ravi Pandey at Rohtang La - 18,350ft altitude. He was returning from Siachen after his 5 month stint at 24,000 ft.

 

                                             Negotiating a rocky mountain stretch
                                                  to bypass a stretch of tricky ice









As in the life of a Surgeon, a Plastic & Cosmetic Surgeon in my case,  there is no end to how much an outcome can be improved, by meticulous planning and attention to the details. These attributes were immensely useful on the mountains as well. While in the former scenario, it had an impact on someone else’s life; here it was our own!

We three pals had been fortunate to have been exposed to the mountains way back in our teens, while we began our stint at Medical School at Pune. Looking at few of our colleagues on the venture, one with a post-polio leg shortening, one with a traumatic ankle deformity and others who were well into their sixth decade – one even hitting the seventh decade of life -  made us value the opportunities that our short life had given us so far!

The rarefied atmosphere and unconventional terrain converted even the daily tasks of life into a huge effort – whether it was performing the morning ablutions, or maintaining body hygiene. Coming out of and re-entering the multi layered sleeping bag to attend nature’s call at night was such a drudgery, we had one colleague even remark – “never again shall i ever complain about making my bed every morning at home”.

...and coming back to the question posed at the beginning...do professionals need a break – that too indulging in something which involves such hardships? Well, we realized that taking on new challenges and difficulties is a requisite for progress in life... the experience gained and endurance achieved, in solving problems in a field of one’s choice, can be fruitfully used to address issues in daily life, in less pleasant circumstances... as some wise man has said, “The only constant thing in life is Change”. I believe such experiences leave us better placed to bring about this change!

The author at 18,000 ft above sea level...

in the wilderness of the Ladakh province

We returned to the plains, having strengthened old bonds and made newer plans, to return back to the mountains another time!

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             Cosmetic Surgery - Is it really worth the Risk?

Medical reviews have proved beyond doubt the rising popularity of Cosmetic Medical Services, especially Cosmetic Surgery. It is a fact that a physically attractive or smart person has better opportunities in life, is judged more positively and gets preferential treatment in situations such as marriage and employment. This can significantly impact the person's life as a whole.

At the same time, there are reports in media of complications after Cosmetic surgery procedures – “Patient dies after Liposuction surgery”. This has led to a confusion among the layman about whether to consider Cosmetic Surgery at all . The man on the street hears of either stories of cosmetic surgery involving glamorous people, OR ‘horror’ stories of Cosmetic Surgery gone wrong. Neither of these is something the common man can relate to. Is there nothing in between these two extremes? Can Cosmetic Surgery or procedures not be done safely for the layman?

Cosmetic procedures can certainly be done safely, ensuring both cost effectiveness and patient satisfaction, very often giving a new lease of life to the person concerned. All that is needed is to take care of a few issues. Let us see what they are.

1. Patient expectations

2. Procedure related risk

3. Procedure benefits – extent and duration

4. Health care facility

5. Surgeon involved

6. Procedure Costs

7. Decision making

What is a reasonable expectation? Reasonable is one that matches with common opinion. In case of a Cosmetic problem, there exists a consensus opinion (scientific impression) about what is beautiful and what is not, which also has a scientific basis. This can be confirmed by the surgeon, who will accurately tell how different from the normal the present condition is.

When the opinion of the surgeon and the patient match each other, the expectation is considered reasonable. Sometimes, this does not match-seen usually as the patient referring to a minor problem (minor in the Surgeon’s opinion) as very severe, enough to upset the person significantly and interfere in their daily life. This is called an unreasonable expectation. This is a tricky situation, with high chances that the patient is unhappy even when the cosmetic treatment is successful.

In such a situation, the surgeon will discuss frankly with the patient the amount of correction possible, most importantly whether complete correction is possible or not. This varies with each different type of problem; based on his personal experience with similar cases, the surgeon will explain the likely result by keeping the procedure risks low.

A reasonable person is usually willing to accept that in certain situations, a minor problem may be very difficult to correct perfectly OR that complete correction of a major problem is difficult. If the person still refuses to understand, the surgeon should realize that chances of an unhappy patient or complications are high.

How does the risk severity change with the procedure? Usually, the less invasive (deeper) the procedure, lesser are the risk of complications. However, long lasting and better corrections can be achieved only with invasive procedures, for problems that have more than one treatment option. Thus, a balance has to be kept between the amount of correction desired and it’s longevity to keep the risk reasonable.

Further, there is an inherent risk in every procedure that a surgeon usually will explain to the patient. This risk depends how well established the procedure is worldwide and how familiar the surgeon is with the procedure.

To illustrate, liposuction procedure for body reshaping is extremely safe when done to a reasonable extent. However, If extensive liposuction is planned-called Mega liposuction-the risk of complications increase - depending on the patient’s general health, the surgeon’s experience, the availability of intensive post op care, etc.

Similarly, when correction for a sagging face is planned, it can be done as a minimally invasive procedure called thread lift with minimal risks as an office procedure. Alternatively, a face lift procedure is a major surgery under general anaesthesia with definite risks of nerve injury, face swelling-bruising and needs a few days to recover both in hospital and at home. Also, the surgery needs a skilled and experienced person to keep risks low. However, with severe sagging problem, thread lift cannot help; face lift surgery is needed.

Further, with mild to moderate problems, risks may be kept low by choosing a minimally invasive procedure if available, such as thread lift; but keeping in mind that results will last only about half as long as a face lift surgery where results will last about 12-15yrs or more.

Does the choice of the health care facility really matter while opting for Cosmetic Surgery? Usually those undergoing major Cosmetic Surgery are healthy or have minor medical problems that are under good control; the stay after surgery in hospital lasts about 2-3 days. A health care setup with basic safety facilities in the Surgical Suite will suffice, more so if no major anaesthesia is involved and patient will not stay overnight. Sometimes, a setup with an ICU facility is essential, as when doing a Megaliposuction procedure, OR when doing a regular procedure but for a person with definite medical problems.

Training and experience of the Physician (Surgeon) are very essential. With the presence of self proclaimed experts in Cosmetic Medical Care, how does one choose/identify the right Physician?

Basic considerations in choosing a Surgeon include

1. Qualification

2. Association/professional body memberships

3. Experience of the surgeon with the procedure

4. Approval by Hospital to surgeon

5. Hospital approval

A trained Plastic Surgeon completes at least 6 years of surgical training with at least 3 years intensive training in Reconstructive & Plastic Surgery. In India , this earns the qualification of either a M.Ch. or a DNB in Plastic Surgery and the membership of the Specialty Association – association Plastic Surgeons of India – www.apsi.org.in . Similar qualification in the UK is a FRCS in Plastic Surgery and in US the person will be a Board Certified Plastic Surgeon.

What makes a Plastic Surgeon competent to handle Cosmetic Medical Care?

Plastic surgeons work with patients at all stages of life, evaluating health, medical, psychological history, and body type to provide comprehensive advice according to their personal cosmetic medicine goals. They help explain the specific results a procedure can and cannot deliver and its associated risks; how to choose the right course of action depending on our age, needs, and wishes; and what we can expect to look like after the procedure.

Unlike others who may be trained in only a few cosmetic procedures, plastic surgeons are educated in the full spectrum of cosmetic surgical and non-surgical care. They hone their skills and techniques through one of the lengthiest and most comprehensive training programs in all of medicine.Besides delivering great results for patients through comprehensive cosmetic procedures, our focus as plastic surgeons is on patient safety. We believe that patients deserve the highest quality of care and safety, which is delivered in our accredited facilities. Also, Plastic surgeons are actively involved in research to develop new techniques and improve existing procedures that will deliver scientifically proven outcomes for patients undergoing cosmetic or reconstructive procedures.

Are procedure costs related to risks or outcomes in any way?

With increasing demand for Cosmetic Surgery, patients and physicians look for cheaper services.However, cutting costs beyond a point can compromise safety . Practical ways to keep costs less include choosing a non-Metro city (such as Mangalore) OR choosing a surgeon who is less busy, provided he meets your satisfaction and gives you time.Chances of complications are high with physician or others who undertake procedures without the suitable training, knowledge or experience. It leads to disappointment, loss of time and money besides bringing disrepute to the specialty

How quickly can a decision for Surgery be made?

Though a quick decision can be made about treatment for a common problem, a second consultation is usually helpful – whether with the same or another surgeon. Collecting information on the matter from websites and discussion forums will give you a better idea of what to expect with the procedure. Popular stories of disasters after cosmetic surgery result from inappropriate/hasty decisions or poor surgical technique. examples of inappropriate decisions include agreeing for an over-sized breast implant (high risk of wound breakdown and implant removal) OR excess liposuction (leading to skin necrosis, fat embolism or death). A popular quote among physicians says “A Good Surgeon knows how to operate, The Better one knows When to operate, The Best one knows when not to operate” A competent surgeon knows the shortcomings of a procedure well.

Keeping these issues in mind will ensure Cosmetic procedures stay safe and cost effective, while more people avail these benefits and improve their lives.

The responsibility of creating this awareness lies with the Plastic Surgery Fraternity.

http://www.plasticsurgerymangalore.com

Health benefits of Modern Cosmetic Medical Care - The Healthy and The Beautiful

The Healthy and The Beautiful –

Health benefits of Modern Cosmetic Medical Care

Beauty Enhancement by Cosmetic Medical Care is rapidly gaining popularity over the last few decades. Skeptics view this as purely an exercise to cater to a person’s vanity, to satisfy their whim and fancy. Is this true or is there some scientific basis behind the purpose of trying to look more beautiful? Let us see.

Beauty lies in the eyes of the Beholder. 

In reality, beauty is not a personal opinion alone; there is a consensus opinion about beauty as well. Scientific research has proved and identified the physical features in a person that are universally accepted as attractive or beautiful. What is not so well known is that most of these features when present actually reflect a healthy status of the person. Nature has gifted the healthy person with features that the human mind perceives as attractive; thus beauty is the parameter to identify a healthy person. Identifying beautiful/attractive features is Nature’s way of identifying the person with the best health

This is why humans are naturally attracted to beautiful persons, whether we are looking for partners or colleagues. Following Nature’s policy of ‘survival of the fittest’, a beautiful person the best chance of finding a partner, thus ensuring that the best of qualities in the species are passed on to the next generation.

The best example of this is the female figure. A hip to waist circumference ratio of less than 1.1 is associated with an appropriate body fat content and healthy fertility (reproductive health). A ratio greater than this is associated with overweight problems, menstrual irregularities; when the ratio is significantly high, the person will have or is likely to develop problems such as Diabetes, Hypertension, Heart problems and stroke.

Does it mean that a person who is not beautiful is unhealthy? To an extent this is true. Also, it is well known that Cosmetic Medical Care can significantly enhance/restore beauty of the individual. Does it mean that the person’s health also improves at the same time? This is also true, though partly. Let me explain both the points: people who are significantly unattractive (eg. out of shape) are at very high risk of having health problems (if they do not already have), while those who are minimally unattractive may very well be healthy. Once Cosmetic treatment restores beauty to both these groups of people, the latter group will have both beauty and health. What about the people who did not have sound health to begin with? Does the cosmetic Surgery procedure improve their health as well? This is likely to be true and is in fact the focus of medical research at present. 

Certain Cosmetic Surgery procedures certainly result in improved health. Reduction in body fat by Body Contouring Surgery or Bariatric Surgery has beyond doubt been proven to control or even eliminate the same problems seen with excess fat-Diabetes, Hypertension, Heart Disorders, Stroke, etc. classic examples are people with diabetes who undergo surgery – after surgery they dramatically manage sugar control without medicines. Another example is people with hypertension with irregular control of Blood Pressure OR needing multiple drugs for control; after surgery, in addition to the surgical benefit, their Blood Pressure stays under control with fewer/single drugs or rarely without medicines as well.

Certain other cosmetic issues, associated with local health problems, can be corrected permanently by Cosmetic Surgery with significant benefit to the associated health problem. One Classic example is excessively large breasts causing skin, shoulder and neck problems. Large breasts (for the person’s frame) may occur developmentally (in teenage) or after childbirth (the breast that enlarges at time of breast feeding fails to go back to the original size) or oven after menopause. Obvious problems include the embarrassment caused, the limitation in the choice of clothes and the problems due to undue sweating in the skin crease beneath the breasts. If uncorrected, over time other serious problems that develop include strap marks on the shoulder due to the brassiere, arthritis of the shoulder or neck joints even leading to neck disc problems. Successful surgery has been proven to correct all the obvious problems immediately and will stop or even reverse the serious problems in the neck and shoulder over a period of time.

Similarly, tummy tuck surgery to correct the pot belly problem will correct the obvious problems of a ugly/awkward looking tummy, and problems due to the skin fold. Studies have proven the favourable benefit of muscle tightening (done in the tummy tuck procedure) on the problem of disc prolapse and nerve compression in the lower back. Improved muscle tone on the front of the trunk helps increase the intervertebral space on the back of the trunk and relieves pressure on the damaged disc-this leads to an improvement in the symptoms.

Finally, there are distinct psychological benefits from successful Cosmetic Surgery. even when cosmetic problems are not associated with health problems, such as bulky nose without breathing difficulty OR small/underdeveloped breasts in a teenage girl OR feminine chest in an adolescent boy, permanent safe surgical correction of the problem leads to a significant improvement in the person’s body image, self-esteem and self-confidence. In today’s competitive world, smart looks are likely to open new doors of opportunity, to give a person the edge over others and help a person achieve one’s goals in personal or professional life. It has the potential to be the turning point in a person’s life, the break that one seeks for in difficult times to tackle life with renewed vigour and enthusiasm.

The biggest gain from these psychological benefits is a remarkable decrease in the risk of depression problems. People with Depression have a higher risk of Cardiovascular Diseases, stroke and high Blood Pressure. Also, a successful procedure has an overall positive impact on the person’s health by making him/her more likely to exercise. 

 

Along with these potential benefits lurks the danger from the risks of associated complications. Risks are an inevitable part of every action that we do in life, but are kept low by doing it the recommended way. Just to illustrate, there is a risk even in crossing a road; if we stick to the rules, the chances of a problem are negligible. In fact, we don't realize the risk exists unless brought to our notice. Similarly, the trained physician, with his knowledge and experience, is able to identify the risks specific to the person, procedure, and either take steps to minimize them or clearly decide that benefits from the procedure are not worth the risk. He will also disapprove of unjustified expectations. The Trained Surgeon will thus keep the risk very low. Risk of Surgical complications becomes high when such Risks have not been anticipated by the surgeon. A common cause for this is a physician who undertakes procedures without the suitable training, knowledge or experience. It leads to disappointment, loss of time and money besides bringing disrepute to the procedure and specialty.

Instances of such Complications, that result from inappropriate decisions or poor surgical technique, lead upto disasters stories in media. Inappropriate decisions include agreeing for an over sized breast implant (high risk of wound breakdown and implant removal) OR excess liposuction (leading to skin necrosis, fat embolism or death).

Thus, improved awareness among the common man will help in choosing the suitable Physician, thereby avoiding complications and keeping Risks low. This will ensure the health benefits of the procedure in addition to the benefits of Beauty Enhancement can be enjoyed by a greater number of people.

More information can be found online at http://www.plasticsurgerymangalore.com

Plastic Surgery-Common Myths busted - An Enigma of Modern Medicine

An Enigma of Modern Medicine-Plastic Surgery-

Common Myths busted 

Plastic surgery is a very young specialty in modern medicine. Just as most fields in modern science, recent developments have been phenomenal; when used suitably, they make a tremendous difference to the life of the person concerned. Effective benefit to society is very often prevented by lack of awareness or prevalence of wrong notions; Plastic surgery is a classic example. Knowing the story of the growth of Plastic surgery across the world will clear most of these issues.

As a recent branch of modern medicine, awareness about Plastic Surgery is still inadequate among common man, leading to loss of benefit to society. Few false notions compound this problem. Many recent developments, by simple techniques, can make dramatic changes to live of average person.

The foremost false notion is when Plastic Surgery is equated to Cosmetic surgery. Though cosmetic surgery issues/news are more glamorous/attention catching, though it’s demand often portrayed as rapidly increasing, the fact is that cosmetic surgery procedures are still just a fraction of the entire spectrum of Reconstructive & Plastic surgery, more so in a country such as India. 

Modern Plastic Surgery has it’s origin in treating complex gunshot wounds, deformities & disabilities that occurred during the first world war. Since then, surgeons began increasingly applying Plastic Surgery principles to improve results in existing procedures or treat problems without any existing treatment.

With the development of Microvascular Surgery in the 1960s, a Plastic Surgeon was able to give dramatic results by means of Re-implantation procedures & Microsurgical tissue transfer. The former allowed successful reattachment of a body part that is detached completely due to injury - amputated- hand, foot, digits, even ear, nose and scalp have be successfully reattached; the latter allows use of body tissues from one area (where they can be spared) to an area where tissue/body part has been damaged by injury, infection or even cancer. The most recent application of this has been Hand transplant and Face Transplant Surgery.

The field of Plastic Surgery expanded to include Burns Care, Craniofacial Surgery, Hand Surgery and Deformity & Disability correction for externally visible problems. Benefits of these principles are best appreciated in procedures of the hand, face and genitals, by making a dramatic difference to the outcome; very often as the critical difference in success & failure of the procedure.

Every Indian Plastic Surgeon takes pride from the fact that worldwide, the roots of Plastic Surgery is traced to the ‘Sushruta Samhita’. This text was written by a Indian Physician ‘Sushruta’ in700BC. Of late, worldwide developments in Plastic surgery are coming from many Indian institutes; and both overseas surgeons (from ‘developed’ countries) and patients are visiting India to benefit from these advances.

Over the last decade, Cosmetic Surgery has caught the attention of both media and common man. As the glamour industy demanded enhancement of beauty, Plastic Surgery techniques came to their rescue. This led to a wrong notion that Cosmetic Surgery is meant only for the upper class in society. Cosmetic (Beauty/Appearance) problems in the rich & affluent have one fundamental difference in similar problems among the average/lower economic class. While the former seek to enhance beauty that is presently normal, the latter seek to restore to normal what is presently lost /damaged and is often a social need, especially when beauty/appearance is severely abnormal/distorted. Usually a person without smart looks in not considered approachable; consequently correcting this appearance can have dramatic benefits in their job or personal life.

Correcting a crooked nose of a young lady or balding scalp in a young male can help in a marriage alliance OR improve personal relationships; reducing oversized breasts of an old lady/young girl can relieve her of the daily embarrassment in addition to the shoulder or neck joint problems. Simple correction of a face scar can restore self-confidence in a person and give new meaning to life. This and other applications are unfortunately not illustrated to the general public, adding to the notion that these procedures are not meant for the common man. Matters cannot be farther from the truth.

Though initially available only in the Metro cities, obviously at a high cost-by Indian standards- these procedures are now increasingly available in smaller cities such as Mangalore, Baroda or Cuttack. This has resulted in a decrease in the treatment costs, but at the same quality that Indian healthcare is known for. Also, Cosmetic or Plastic Surgery procedures make a far greater impact on the lives of the less affluent section of society; correcting a hand deformity in the sole earning member can feed an entire family, correcting face deformity of a person cured of Leprosy can remove the disease stigma and help his/her integration into society. Both these facts make the need for Plastic and Reconstructive surgery far greater in smaller cities.

However, society is deprived of this benefit due to the false notion that Plastic or Cosmetic Surgery is available only in big cities, that too at a prohibitive cost.

In spite of all these benefits, there are the darker issues too. With a rapidly spiraling demand, facilities offering cosmetic services are coming up at every street corner in larger cities. Unfortunately, many of these centers are run by people with inadequate or poor training; if the average person is lured by the aggressive publicity pursued by such centres they entail a high risk of complications or poor results. It takes about 12-13 years of rigorous medical training to qualify as a Plastic Surgeon, similar to that needed to be a Cardiac or Neurosurgeon- this alone guides the surgeon to make a sound decision by balancing the patient’s expectations with the problem severity. Thus, approaching the right person is essential for a treatment with predictable, safe results and thus and a new lease to life. Qualified Plastic surgeons in India are members of the national association as seen in at www.apsi.org.in

Thus, improved awareness is essential among the average person, to ensure society at large benefits from this medical specialty, while avoiding permanent scarring of a person’s body by falling into the wrong hands. This insight has been compiled to clarify the role of Reconstructive and Plastic Surgery, with improved benefits to society.

For further details, visit www.plasticsurgerymangalore.com