Monthly Archives: April 2012

My friend Kelly called me in a panic Sunday morning.This is totally off the subject of plastic surgery–unless of course you were a Nip/Tuck fan and then you’d know who she is.

“My right arm is numb and I can’t use my fingers,” she said. “Do you think that’s okay?”

“Probably not. When did it start?”

“Since I woke up at six a.m.”

It was noon. And her speech was slightly slurred…but she was completely coherent.

I was on the treadmill. I paused my guilty-pleasure TV show and came to an abrupt stop to do an emergency over-the-phone consult. At first it sounded like she might have a cubital tunnel syndrome (compression of the ulnar nerve at the elbow–the “funnybone’) but as she described her symptoms, it started to sound like something else.

Normally when your arm or leg “goes to sleep,” when you’re sleeping, it wakes you up. We’ve all had that happen–you wake up and your arm feels dead, but you shake it out and it’s fine in a few minutes. But if you’ve had too much to drink, you may sleep harder than usual, and you could sleep through your body’s natural alarm system. This could cause a compromise of blood supply to the nerves and muscles in your arm, which could lead to temporary–or, depending on how long it lasts–permanent paralysis and tissue damage. This is called a compartment syndrome.

But that couldn’t be. That only happens to people who drink too much–I’ve known Kelly for six years and I’ve never seen her drink. She doesn’t even like the taste of alcohol and she’s allergic to the sulfites in wine. Actually, she’s one of the nerdiest people I know–nothing like her iconic character, “Kimber Henry.” Of course, I mean that in the nicest way 🙂

I told her to meet me in the office immediately. On my way driving in–still in my sweaty LuLu Lemons—I went through the differential diagnosis in my head, wondering how on earth I was going to tell my friend she might be having a stroke or possibly developing the first signs of Multiple Sclerosis. She’s so young and vibrant and talented–what a tragedy!

She walked in to my waiting room looking like a million bucks as usual, but she was in a panic. While I examined her arm, which was slightly swollen but otherwise fine, I noticed that she was still talking funny. Trying not to seem obvious because I didn’t want her to freak out, I checked for other classic stroke symptoms. Was one of her pupils more dilated than theother? Was the left corner of her mouth drooping?

The neurologic exam involves checking to make sure the patient’s tongue doesn’t deviate to one side when they stick it out because this would mean imbalance of muscle function, and possible nerve damage. All I noticed was that Kelly’s tongue was either very swollen, or I’d never before noticed how abnormally large it was. When I asked her about it, she said, “Yeah, I don’t drink wine because this is what happens. But I did go to a birthday party last night…”

Apparently, Kelly had decided to go crazy and drink to a toast the night before.

“So what was in the drink?”

“I don’t know…prosecco…”

I started laughing and when she asked me what was so funny, I said, “Why didn’t you tell me this morning that you decided for the first time in years to have a drink? And how did you not know prosecco is wine? That could explain the allergic reaction you’re having with your swollen tongue.”

I explained that the alcohol probably made her sleep deeper than usual, and that she had developed a mild compartment syndrome which appeared to be improving. I consulted with my colleagues at Cedars’ Emergency Room. (I didn’t want to tell her, but I’d never seen anything like this before.) The Emergency Room Physician laughed and said, “I wish I could tell you about all the rock stars that come in here with the same problem.”

But as all of her close friends know, Kelly is no partying rock star. She’s usually the parental supervisor, the designated driver. And the one time she decides to have a fruity island drink (we’re laughing as we write this) she winds up with a super-sized tongue and a compartment syndrome. That’ll teach her.

The ER Physician said that with the rate of improvement she’d been having, her symptoms should be completely resolved within the next twenty-four hours. First level treatment is high dose ibuprofen (600 mg., three times a day). But this is not medical advice! If you wake up with signs or symptoms of a compartment syndrome, you need to go to your nearest emergency room and be treated by a physician. But, like I said, I learned something…I didn’t realize that this could happen to someone who crashes out just a little too deeply, from drinking just a little more than their body is used to—in this case, drinking anything at all! Take note: You are especially prone to it happening if you sleep with your arm above your head.

 Fraxel update, day five: neck feels a bit dry, but looks back to normal, and the skin texture is definitely better…



That’s Christine and Karianne, the nurse practitioners at Ava MD who are helping to keep me looking under forty (it’s crazy how forty sounds so young these days…) Good thing neck Fraxel® is so easy to hide because my office staff surprised me with a new patient when I got back from my treatment. Fortunately I didn’t look too scary:

I do look a little more like E.T. than usual, but it’s easily camouflaged with a scarf or long hair. Besides, I know from the last time that this is as bad as it gets. Besides, Christine says after a few more treatments my skin will be less crepey. A neck lift won’t help someone like me. It’s the thin texture of my skin that’s the problem.

I have seen other post-treatment Fraxel®  patients from Ava’s whose necks definitely look better than mine, so there is still hope. But if the Fraxel doesn’t work…there is this thing called a “Vampire Facelift®” that I am going to check out. It’s the first time I’ve found anything related to vampires remotely interesting (I think I’m the only person I know who didn’t read Twilight or watch Trueblood or The Vampire Diaries.) I’ve heard a few people talking about it—including one of my colleagues–so I decided to look into it. Basically, it’s along the same lines as a Stem Cell Facelift or Breast Augmentation, but without the fat. The reason they’re able to throw the catchy term “vampire” in there is because the procedure involves drawing your own blood, and then injecting it back under your skin. First, it’s spun down to get a layer of “platelet rich plasma” (PRP) which contains growth factors like the ones in stem cells. Since some of these growth factors have been shown to improve wound healing, the thought is that they may also rejuvenate unwounded tissue (ie, make skin look younger.) Again, there is no scientific evidence supporting the use of concentrated growth factors in enhancing cosmetic procedures(see Stem Cell Facelift Post), but I don’t see much downside to it, except the expense, which shouldn’t be outrageous since the physician’s cost for the PRP isolation kit is fairly low  (as a reference for price-shopping, in most neighborhoods, a single vial Vampire Facelift® shouldn’t be $10 G.)

And as far as those two “bands” under my chin that everyone swears “you can’t even see them! I don’t know what you’re talking about!”–well, here they are (in this side view under the chin):

Although they really don’t look this bad in real life—the area under the chin is what gets most noticeably swollen with the Fraxel. Anyway, anatomically, these are the edges of the platysma muscle that sag over time, and they are especially evident in a thin-skinned neck like mine. The first step of treatment is to Botox® them to relax the muscle. This works in most of my patients, though for some reason I can’t get it to work on myself. I’m going to let Christine give it a try, and if she can’t get it to work, I’m going to have a submental plication (a mini-neck lift that involves an incision hidden under the chin, and tightening of the muscles and redraping of the skin. For before and after pictures, check out

Okay, this is getting a little absurd. I really need to get out of here and start thinking about something else besides my neck. Though I know everyone is waiting with bated breath on these Fraxel results so I’ll keep you posted! 🙂



Even worse, she probably just pretends not to because she’s trying to be intellectually above it. No, I wasn’t in the supermarket. And obviously I wasn’t in L.A

I don’t trust people who don’t admit to enjoying mindless pop culture. I’m not talking about devouring tabloids for hours on end–just glancing through one if someone drops it in your lap and you have nothing to do. Because anyone who says they’re not the tiniest bit interested in whether or not Jen is really pregnant, or whether Brad and Angie are really fighting, or what Jessica Simpson really looks like going into her seventh month, they’re lying. At least to themselves.

How do I know? Because I could do a Candid Camera episode on this subject right in my office waiting room. (Those of you who are too young for this reference can check out the link.) It might actually be a landmark sociologic study. I have an entire upscale Conde Nast corporate subscription to all of the high-brow magazines—Vogue, Elle, GQ, Travel this and Wine that–and yet if I have one tattered old Star lying around, that’s the one everyone picks up when they walk in. And I’m talking about even the most educated, sophisticated, professional career women and homemakers with strong family values. I soon figured it all out;  as long as they have trashy magazines to browse through, my patients don’t seem to mind when I’m running late. In fact, I usually come into the exam room to find them curled up in the chair with a stack of tabloids on their lap, completely engrossed. It’s like I’m interrupting them. Sometimes they don’t even notice I’m there until I ask, “Is that the new one?” “No, it’s old,” they’ll say, still frantically flipping pages without looking up. Of course it’s old. Because I haven’t yet retrieved the new ones from the staff break room. (“How many times do I have to tell you guys–these are for the patients!”) Yesterday I had to pry the Us Weekly out of someone’s hand to get her to look up so I could do her injections.

Why all of this tabloid power reading in my office? Because there’s never enough time to catch up on the checkout line. And nobody actually buys them in the store. Even the guy ringing you up knows that. Haven’t you noticed that he never points at the magazine and asks if you want it,  even after he’s given you the total and waiting for you to swipe your Ralph’s Rewards card? He never even seems concerned that you might steal it, or take it by accident. Because he knows you wouldn’t be caught dead walking out of the store with it. And he never gets nasty or impatient about it–it’s almost like the cashiers feel sorry for us, like reading tabloids on the checkout line is some affliction that they’ve been  trained to overlook.

I’m positive that supermarkets have an entire protocol in their new employee manuals for how to handle the shopper reading tabloids on the checkout line. And it goes something like this: “They’re not going to buy it. Don’t even ask them if they want it. Pretend you don’t even see it. But if they’re still standing in the way flipping through it when you’re trying to ring up the next customer, you can kindly ask them to just step to the side. And whenever you have a break, please tidy up the racks, because they always shove them back upside-down in the wrong ones.”

So, in addition to de-bunking nasty myths about plastic surgery, today I’d like to use this blog to de-stigmatize everyone’s favorite guilty pleasure–tabloid reading.

I mean, really. What’s wrong with admitting that our society has succumbed to pop culture?  Most of us have to deal with so much physical and emotional stress and politics at work all day–what’s so terrible about enjoying mindless entertainment when we’re “off-duty?” I personally have found an exponentially indirect correlation between the number of diplomas I’ve acquired over the years and the number of intellectually challenging activities I choose to strain my brain with on my downtime. And I’m not the only one. There’s a reason that young adult fiction is morphing into the next wave of movie blockbusters—because it’s not just being read by young adults. Wizards, vampires, futuristic teenagers battling for their lives on reality television…it’s fun and easy! And it’s all written on a fifth-grade level. And so what?

So go ahead…pick up that Star magazine on the checkout line. Or you can always come to my office and read it. Everyone else does. If the National Enquirer would change to a magazine format I’d get that one too. It’s just that there is still something about a trashy “newspaper” that crosses the line…

Okay, that’s all for today. I have to go to work.