The South as a whole seems to have a real problem with obesity. Ten of the eleven states with the highest obesity rates are in the South. This problem truly deserves all of our attention because with high obesity rates come high rates of high blood pressure, diabetes, and heart disease just to name a few.

Start With Kids
The best place to fixing this problem is with our kids. Let’s get them outside playing. Let’s throw some chicken on the grill rather than stopping for deep fried chicken nuggets. Understand, I am not an anti-fried food fanatic. I will splurge every once in a while, but we all need to exercise and be mindful of what we eat.

I’m heading down to my erg (my rowing machine) for exercise. You can help us too because we really need to lose this one to Alabama!

Lung Cancer Isn’t The Only Problem
Most people know that smoking is bad for you. And most people know that this can affect your lungs by making you susceptible to lung cancer and emphysema. But what many people don’t know is the other more important side effect of smoking: circulation problems. Not everyone who smokes will develop lung cancer, but everyone who smokes will have their circulation negatively effected.

The culprit here is nicotine. Nicotine is a very potent vasoconstrictor. This means that it causes the blood vessels to squeeze down so that blood will get through. This is not good for your heart, your brain, or even your skin. Healing after surgery depends upon the blood getting to and through the blood vessels in your skin. If the blood vessels are constricted, there is diminished blood flow. This can cause wounds not to heal, and for segments of the skin to die. This, then, creates a big problem which can lead to permanent scarring, prolonged recovery, and the need for other operations.

At Least Quit Smoking Temporarily
The next question is how long should one stop smoking if surgery is planned. There is no real good answer to this, but three to four weeks seems to be a minimum. This will not remove all the effects of smoking, but it will improve the situation. Ultimately it’s best not to smoke at all, or to have quit for several months or years.

Gum, Patches, And Second-Hand Smoke
There are two other considerations. Remember, it’s nicotine that is the problem. So using a nicotine patch or chewing nicotine gum may help you to quit smoking, but you are still introducing nicotine into your system. And, second-hand smoke can also deliver nicotine to your body. It’s best to be in a smoke free environment.

When you are considering elective surgery you should do everything to insure a good outcome and limit complications. Smoking cessation is a very important step to take to make sure we have the best result.

All the best,

David B.

Fans = Funds For Food

Fish Hospitality Pantry on Scott Street

FISH Hospitality Pantry is a local hunger ministry and a favorite charity of mine. They have several distribution centers that provide food for those in need. Over fifty local churches are involved and together FISH feeds about 11,000 hungry families each month. And they do this with great economic efficiency. Through bulk buying and gifts of food, five dollars will feed a family of four for three days. So today’s donation will feed one hundred families, making a real difference right here in Knoxville.

Recently, our entire office staff spent a morning helping to distribute healthy food to those in need. Here is a link to their website. We’d be honored to tell you more about the good work FISH is doing here in Knoxville, and how you can help.

Have a great weekend,

David B.

Stuffed Chicken with Roasted Red Pepper Sauce

(Serves 2 with extra sauce leftover)

3 red bell peppers, roasted and peeled*
1 T. Extra virgin olive oil
1 T. balsamic vinegar
1 cup low-sodium chicken broth
3 cloves garlic, chopped
1/2 jalapeno pepper, seeded and minced
1/2 tsp Italian Seasoning
Kosher salt and freshly ground black pepper
2 boneless, skinless chicken breasts, pounded thin
2 T. goat cheese
6 to 8 thin asparagus spears (If thick, half lengthwise)
Butcher’s Twine (if you don’t have any, ask the meat department to give you some)

Preheat oven to 400 degrees.

Slice one of the roasted peppers into strips and set aside to use to stuff the chicken breasts.

Take the other two peppers and add to blender along with the oil, vinegar, broth garlic and jalapeno pepper. Blend until smooth. Pour into small saucepan and add Italian Seasoning, salt and pepper. Cook on low heat for 10 minutes.

Meanwhile, assemble the chicken breasts. Lay the chicken breasts on a cutting board and spread 1 T. of goat cheese on each breast. Add the roasted red pepper strips and asparagus and roll them carefully to surround the peppers and asparagus. Tie a couple of pieces of butcher’s twine around each stuffed breast to hold them in place. (You can also use toothpicks if you wish, but twine works better.)

Transfer the chicken breast to a casserole dish and pour about 1/2 cup of the sauce over the breast. Bake for 35 to 40 minutes until the chicken is done. Pour additional warmed sauce over each breast and serve.

Recipe Note: This is another example of really flavorful low-calorie and healthy cooking. Each breast with sauce is low on calories (323) but high on antioxidants from the red peppers and the asparagus. It comes from Clean Eating Magazine, which we highly recommend.

* Roasting whole bell peppers is easy on a gas cook top or grill. Just place them directly on the burner or grill and turn until they are completely black on all sides. You can also use your oven broiler. Once they are completely black, put them in a paper bag or Tupperware container and let them sit for 10 minutes. Then take off the stems and seeds and peel them.

We had some fun with this week’s Truth-O-Meter Tuesday question. Here is the video:

Essentially, when the glaucoma eyedrop known as Lumigan entered its third phase of clinical studies, Allergan researchers noticed that it was making people’s eyelashes grow. Encouraged by the drug’s eyelash-enhancing effects, the company soon started considering the cosmetic applications that could be derived from it’s active ingredient, bimatoprost.

Applied directly to the base of the lashes, Latisse keeps hairs in their growth phase, producing longer, darker and thicker eyelashes. It contains a much smaller amount of bimatoprost than Lumigan, as it is intended for daily use.

Many medical breakthroughs have been made in a similar way. Alexander Fleming’s unexpected discovery of penicillin is the most famous example. Fleming was conducting research on the flu and noticed that mold was growing in one of his petri dishes. Upon closer inspection, he realized that the area with the mold had no bacteria and proceeded to develop our very first antibiotic.

The more recent accidental breakthrough is Viagra. Most people don’t realize that Viagra was originally intended as a cardiovascular drug. Early in the clinical trials, scientists at Pfizer realized that it was not effective in treating heart ailments, but they decided to continue to study one of the drug’s unexpected side effects.

Should Doctors Upsell?
In business and sales the art of “up-selling” is an accepted practice. The more goods and services that are sold, the more income to the company and to the sales person. While there are some similarities between medicine and business, there are some huge differences. If someone is trying to “up-sell” you on surgery or a procedure, be very careful.

Anytime there is an encounter with a new patient, a physician will take a history which defines the concerns of that patient. The same is true of plastic surgery, even if it is cosmetic and totally elective. I start out by asking the patient what his or her concerns are. Our discussion is then focused on this and the possible ways to taking care of this. So, if a women comes in for a tummy tuck, I don’t tell her that she should really consider a facelift, or perhaps some Botox. If I were to do this, I would not be truly addressing her concerns. Certainly if a patient inquires about other procedures we will discuss them. However I really try hard not to talk to a patient about a particular operation or treatment if they have not asked about it, or if it is not appropriate to the treatment of their concerns.

Managing Expectations And Professional Recommendations
I should point out here, somewhat parenthetically, that sometimes a patient will want a result that can not be achieved by the operation they desire. In the example above, if a women comes in with troubles with her abdomen after having children, and only wants liposuction, I have to tell her that this may not be the right option for her. While the tummy tuck that she needs is a bigger operation than liposuction alone, this is the right choice for her to treat the problem that she is concerned about.

Take Note: Non-Plastic Surgeons Doing Plastic Surgery
The other issue that this article points out is one that I have written about often: non-plastic surgeons doing plastic surgery. Usually the training of these physicians is not adequate, there is no oversight of their practice, and they are not Board-certified in the area of medicine they are practicing. Also, if they are only trained in one operation, this will be their solution to all problems, whether or not it is the right solution (if all you have is a hammer, the whole world is a nail).

The simple solution here is this: see an ASPS (American Society of Plastic Surgeons) member.

So be careful. If you are feeling pressured about your decision to have an operation, or if you are be pressured into considering something you don’t want, think twice about who you are seeing.

All the best,

David B.

Spicy Sichuan Cucumbers

2 lbs. cucumbers
1T. Kosher Salt
1 jalapeno pepper, seeded, deveined and minced
1T. julienned ginger root
1 1/2 T. white wine vinegar
1 T. dark sesame oil
1 T. sugar
2 tsp. Sambal Oelek or Siracha (spicy chili paste found in the Oriental aisle)

Peel cucumbers. Cut in half lengthwise. Scoop out seeds with a small spoon. Cut into 1/2 inch slices. Place in colander with the Kosher salt and mix well. Let sit in the sink for 30 minutes and then rinse very, very well. Now you are ready to season them. Put cucumbers in a bowl and add the rest of the ingredients. Stir well. Taste and adjust the seasonings. If they are too tart, add salt, a bit of sugar or even soy sauce. If you want them spicier, add more chili paste. You may also like more sesame oil. Chill and serve.

Recipe Note: It’s very strange to have everyone fighting over cucumbers, but I promise…that’s what happens with these. It wouldn’t be Chinese Feast Night without them.

The story behind “Reath Eats” : Dr. Reath and his family love to cook. So when he is not working or rowing, it’s likely you’ll find him in the kitchen or manning the grill. In fact, the fourth edition of their family cookbook is being published later this year. Most weekends Dr. Reath has started sharing a favorite family recipe here and on facebook. Bon Appetit!

We are the only plastic surgeon’s office in the Knoxville area to provide this important insurance to cosmetic surgery patients. I explain why on the video and announce the winner of this week’s Truth-O-Meter Tuesday question:

Part of this comes from respecting our patients: their time, their trust, and their needs and desires. And to respect these concerns, we must first understand them (seek first to understand, and then to be understood). Like everyone in this world, occasionally I come up short (like when someone has to wait longer than I would like to see me). But the goal remains the same.

I once read a book called “The Disney Way“, which talked about the practices of Walt Disney. Perhaps the most important chapter was called “Never a Customer, Always a Guest.” This was a wonderful discussion of how Disney treated the visitors to his parks. They were not visitors, or even valued customers, but guests. So the considerations that he inspired his employees to show his guests, rise above what many other businesses aspire to. And while this analogy is not completely applicable to my medical practice, it has a lot to offer me in my interactions with patients.

Over the years I have come to realize that no one has to come to see me. They are here by choice. And, if I am fortunate to have you come to me as a patient, I will do my best to treat you like I want to be treated.

All the best,

David B.