Dr. Moliver's Plastic Surgery Blog

Blog 2.0

Every once in a while I am at a meeting, talking with some one or reading something and I literally have a wow moment. About fifteen years ago I was at a meeting listening to a renowned occuloplastic surgeon. He shared that he always has his patients do a particular exercise after lower lid surgery and has never had an ectropion since that time. It made so much sense that I adopted it and it’s been a wonderful addition to that part of my practice. These ‘pearls of wisdom’ can be hard to find, particularly at medical meetings. I can sit and listen for an entire weekend and not find one pearl. Pearls are best found listening though. And the best way to find em is to listen to successful people in their trade that have been doing what they do for a while. So here is a great pearl.

I was out with a running friend, Dr. Mark Davis this past Saturday morning. My daughter Morgan came with us since she was in from college for the Thanksgiving break. Morgan has been suffering with an upper back stabbing ‘bone on bone’ pain for months, maybe a year on and off. Morgan describes it as along the posterior spine, mid line upper back lowest point of the back of the neck. Mark says yep, we see a lot of it. Here is his explanation. ‘The head weighs 25 – 35 lbs. And the posterior paraspinal muscles simply are not designed to support that kind of weight. They are designed for stabilising the weight as one turns one’s head this way and that. Apparently with the onset of the science of ergonomics body positioning was improved as it related to personal computers. College students that study either at lap tops (apparently the most recent culprit) or long hours over books with their heads bent over over fatigue these small muscles. Muscles such as the Multifidus (I didn’t remember that one from anatomy – he did). After they fatigue the stress transfers to the ligaments between the spinous processes and one winds up with chronic inflammation, sort of a tendinitis in the back of the lower neck. Answer, better ergonomics. get a separate screen and put it up so that you are looking at it instead of down. This plus resistance training with perhaps kettlebells that are great for the posterior chain.

What turned out to be interesting for me is that general surgeons that operate standing and looking straight down are at particularly high risk of cervical disk disease after years of flexing their necks forward and getting huge pressure on their disks. Fortunately I operate looking forward or up (under breasts, tummies or faces although I do have to twist my body which causes other issues, a different blog. When I turned about 48 presbyopia kicked in and I needed reading glasses for near work. luckily my optometrist suggested bifocals with an extra large lower part so that I had a large field of view. What it does is encourage me to keep my head up if I want to see close. Thinking back I use to have that same pain sometimes that resolved with bifocals! The other thing that happened this week was while running again (yeah I’m kinda into it) on a treadmill this time because the weather sucked I developed the same pain after a 45 minutes and realized that I had been looking down at the console too much. A trainer friend of mine told me that it is very important while running to not let your hips rock back and upper body fall forward while running, and keep your head up. Now I know why.

Dr. Mark Davis is a practicing Chiropractor in the Clear Lake area of Houston.

Ok so this is my first blog ever but about a topic I have been thinking about intensely for about a year. Two weeks ago while on a run an analogy came me that seems to perfectly describe the concept.

There were two towns along a river. One town was blessed by being much higher than the river and having naturally high stone cliffs. When the water would rise as it did from time to time this town never flooded. The second town however, was at the same level as the river. The town people long ago realized they had to build dikes. In addition they had to maintain the dikes. They did this buy using the hard wood from the local forest. Every two to three hours a group would come by and repair parts of the dikes that had been damaged by the force of the river. As long as they maintained the dikes would good healthy solid wood and did it often they never flooded either. After a while the second town’s people became complacent. They felt that every two hours was a bit much. They couldn’t be at work or in the fields and be efficient with their time so they started doing the repairs every six to eight hours. Also, no one would go out all night long. To make matters worse the quality of the wood was decreasing because they had such a large population that they started using inferior wood. They began to have floods. The floods were so devastating that they had to do something. It was killing many people every time it flooded. fact was it was practically killing off the town each time it flooded. So they petitioned the state to put in a dam upstream to control the amount of water coming down the river. Lo and behold by decreasing the amount of water in the river there were almost no more floods. In fact several of the learned people of the town were able to publish studies showing that over the ensuing fifty years lowering the water level had a absolute correlation with a reduction in floods and deaths. There was no doubt. A few people pointed out that perhaps just maintaining the dikes would have been better. No floods and plenty of water for the farms to be healthy. Since all readily admitted that water was necessary. But these folks ideas were drowned out by the dam owners who now charged a fee and were making a lot of money “protecting the town from flood and death.” High water causes flooding and death. The minority pointed to the town with naturally strong dikes as evidence that it was the dikes not the water, but alas no one was listening.

So that was my parable. Here are some facts.

Primates, guinea pigs and fruit bats all share an interesting commonality. They are the only mammals that do not produce their own Vitamin C. Care to guess which mammals develop coronary heart disease? Guinea pigs and primates are the only mammals that get coronary artery disease as defined as tears in the lining of their coronary arteries with accumulation of cholesterol plaques. In fact research scientists that study coronary artery disease and atherosclerotic vascular disease in general use guinea pigs preferentially for this reason. As it turns out if one lowers the level of cholesterol in the blood of guinea pigs or man (and there are tons of very good studies that prove this unequivocally) one will see a corresponding decrease in plaques, coronary artery disease, strokes – athersclerotic vascular disease in general. Just like the river water. But what about all the other mammals that make their own Vit. C and never get vascular disease? Bears run cholesterol levels of 500! They don’t have heart attacks. In fact half of all heart attacks occur in people with normal cholesterol levels. Fruit bats by the way do not get heart disease or vascular disease. They eat fruit all day! It is thought that somewhere way back in our evolution we lost the capacity to make Vit. C. But for most of mans’ evolution we have eaten every few hours, mostly nibbling and foraging as well as eating meat. Now we eat two to three times a day and whatever small amount of Vit. C we get isn’t enough and is gone in a couple of hours anyway.

There is ample evidence that the whole cholesterol business of the pharmaceutical industry is based on premises that are a bit misguided if not deceitful. There are pockets of people, notably in Italy where they have very high cholesterol levels and live into old age without heart attacks or strokes. Again, what about the bears? Read about cholesterol and you find that our bodies actually make the high cholesterol that our doctors warn us is so bad. I refer you to this article for more about the cholesterol lie.

So what to do? Many, including myself believe that number one the statins are probably really bad for you. We need cholesterol in our bodies. I recently heard that one company is now promoting chewable lipitor for children. Oh my god!! Rather, consider taking Vit. C on a regular basis. You can find tons of literature on the web describing what Vit. C does. It has many, many roles in our bodies but perhaps one of the most important is cross linking collagen or making collagen stronger so it doesn’t tear as easy. In fact there are studies that show those very same guinea pigs had substantially prolonged life spans when fed a constant source of Vit. C. There is one important caveat though. Vit. C is a water soluble vitamin so it washes out of your body in an hour or so. So my answer is either eat something high in Vit. C every two hours or take a timed release 1000 mg vitamin C capsule twice a day. Vitamin C repairs the ‘dikes’. It keeps the intima of our arteries healthy. Obviously there is a lot more to good health, but this is one more step in right direction. And for heavens sake, lets stop with the crazy obsession with cholesterol levels and bloods tests to measure it. I know it creates jobs and stimulates the economy but I just think we can be doing better things with our bodies than shoveling lipid lowering drugs into it.

Before I close I want to give credit to Dr. John Adams, a dear friend and the first person that told me about guinea pigs and Vitamin C.