Category Archives: Statistics

Body Mass Index for Me, and my best so far in Modesto.

Body Mass Index

Regarding body flab, I’m going from Good to Great / from Overweight to Obese. My body mass index has got to stop increasing. It is currently at 27.6. Normal BMI is between 18.5 and 24.9. My BMI falls into the overweight range. A BMI of 30 or more is considered obese (I’m getting close?). 30 must be some sort of magic number because if I lose 30 lbs, I would be right in the middle of the “normal” range for BMI. Gosh this BMI scale is harsh.

My best Modesto recorded BMI was 24.5

Here’s a BMI calculator I found on the web:

http://www.nhlbi.nih.gov/guidelines/obesity/BMI/bmicalc.htm

180% increase in 1 year in the number of patients enrolled in Brilliant Distinctions in our Modesto Office: Surgical Artistry

botox bottles

New statistics! Compared to last year, we have a 180% increase in the number of patients taking advantage of rebates & coupons from Brilliant Distinctions.   In dollar amounts, we have more than a 235% increase.  As of 5/30/13 $47,085 has been redeemed by Surgical Artistry patients through this program.  I’d like to congratulate our staff, the Botox staff, and most of all thank our patients.  Actual numbers:

5/30/13 data reveals:

  • Total number of patients  573

  • They have redeemed a total of  $47,085  with Allergan’s Brilliant Distinction (BD) program

     

Brilliant Distinctions

5/20/12 data reveals:

  • Total number of patients  317

  • They have acquired a total of  $19,960  via Allergan’s Brilliant Distinction (BD) program

     

 

dr-wu-and-dr-lee

BRCA, Mastectomy, Angelina Jolie, and My Thoughts as a General Surgeon in Modesto, CA

I felt compelled to write a little bit on this subject.  I have been a breast cancer surgeon and have worked together with my wife, Dr. Tammy Wu on breast reconstruction after I had done the breast cancer operation.  In fact, part of my dream, which has somewhat died, was to create a breast cancer center.  The same kind that Angelina Jolie had gone to for her treatment.  It involves many breast cancer specialists under the same roof.

I had been one of the first surgeons in Modesto to bring sentinel lymph node technology to breast cancer surgeries.  I had helped certify my other surgical partners at a group which used to be called McHenry Medical Group.  We were a group of 6 surgeons at the time.  This was the group that brought me to Modesto, CA.  I also had been trained to perform skin sparing mastectomies.  Dr. Wu and I have performed several of these procedures together here in Modesto.  Dr. Wu would assist me in these procedures and then I would assist her in the reconstruction. However in 2006, we made a decision to move Surgical Artistry more toward a cosmetic surgery – only – focus.

Angelina Jolie’s surgery used sentinel lymph node technology, nipple sparing mastectomy techniques, and then followed up by breast reconstruction with tissue expanders and then with what I believe are anatomically shaped implants – possibly the implants that we have just been blogging about – the new gummy bear breast implants – approved in February of this year.  Dr. Wu has been familiar with all aspects of Angelina Jolie’s breast reconstruction with expanders and implants.

But what is new to me, as a general surgeon who backed off from breast cancer surgery in 2006 is: The nipple delay procedure – I think this is genius!.  This procedure is usually done when patients have had previous augmentation or when there is fear of cancer hiding underneath the nipple area, and also for improving nipple/areolar survival after mastectomies.  The blood supply is improved.  Dr. Tammy Wu explained to me that this idea is also done in plastic surgery procedures such as TRAM flaps – where a extraneous blood supply is cut off first and then a waiting period is done to have the rest of the blood supply improve – before performing the full surgery.  And I have never performed a double mastectomy.  I have received three requests (that I can remember) for this in my breast cancer surgery career, but I have turned all three of them down, but recognizing that it is a patient’s choice.  I have hooked them up with other surgeons.  I felt somewhat uncomfortable removing the mastectomies.  Not all of these patients has had definitive BRCA testing and at the time, and I would say that BRCA testing was newer back in the early 2000’s.  Thus some of these requests were based on just “disliking breast cancer” and wanting to “reduce breast cancer risk.”  But I know that breast cancer risk is present even after I do a mastecomy (meaning breast removal).  Why?  Because inevitably, I will leave some breast tissue behind, and much of the breast tissue left behind is in the nipple/areolar complex.  And even if I take the nipple/areolar complex (which is the standard mastectomy), I would leave some tissue and cells behind – especially on the skin flap.  If I made it too thin, the skin flap above could die.  Thus, I felt uncomfortable, personally, removing normal breasts – even though I knew I was married to someone who could reconstruct them very well.  So even if I removed them, the risk of cancer was still there.  Essentially I was thinking that I would reduce a woman’s general risk of breast cancer from 10% (this was the figure I used back then), down to about 5%.  It wasn’t worth it for me.  But with BRCA testing, it is a different story as you read below (the risk reduction is greater because you start at a higher number BRCA mutation positive risk – 87% per Angelina Jolie’s doctors).  So perhaps if I was practicing breast cancer surgeries today, I would be more “comfortable” with performing prophylactic double mastectomy (which is what Angelina Jolie received).

Angelina’s surgery – is public – as she wanted it, and in this blog I paraphrase highlights from Angelina’s general surgeon (breast surgeon).  I think it is wonderful that she is sharing and I think she made a good decision based on the knowledge that is available.

In Summary of Angelina’s surgery:

My one sentence summary of her recent breast surgeries from February 2013 to May 2013:

With a known BRCA1 genetic mutation, Angelina Jolie underwent a prophylactic nipple sparing double mastectomy with sentinel lymph node marking after passing a nipple delay surgery procedure, and then had a staged plastic surgery breast reconstruction procedure involving breast expanders and implants.

  • She underwent genetic testing.
  • She was diagnosed as being BRCA1 mutation positive.
  • She had her surgery done in California at a breast center / surgery center.
  • She had a technique done callled nipple delay.
  • She then underwent prophylactic double mastectomy with nipple sparing surgery
  • She had sentinel lymph node identification done, but not removed – this is in case she gets cancer in the area of her mastecomies in the future.
  • She had breast reconstruction with her plastic surgeon, first with expanders to stretch the skin envelope then with breast implants.

BRCA – a part of overall Breast Health

5/18/13

First, what does BRCA stand for?

BRCA stands for BReast CAncer susceptibility gene.  There are two of these genes identified #1 and #2.  thus the designation BRCA1 and BRCA2

What is BRCA?

  • BRCA1 and BRCA2 are tumor suppressor genes.
  • In normal cells, BRCA1 and BRCA2 help stabilize DNA and prevent uncontrolled cell growth.
  • Mutation of BRCA1 and BRCA2 has been linked to hereditary breast and ovarian cancer.
  • A woman’s risk over her lifetime of developing breast and/or ovarian cancer is much increased if she inherits a harmful mutation in BRCA1 or BRCA2.
  • the percentage of people in the general U.S. population that have any mutation in BRCA1 has been estimated to be between 0.1 – 0.6 percent.

Mutations of BRCA1 vs BRCA2

In addition to risk of breast and ovarian cancer BRCA1 and BRCA2 have additional cancer risks to other organs see list below.

BRCA1 mutations may have additional risk of these cancers

  • cervical
  • uterine
  • pancreatic
  • colon cancer

BRCA2 mutations may have additional risk of these cancers

  • pancreatic
  • stomach
  • gallbladder
  • bile duct
  • melanoma

 Angelina Jolie’s Mastectomy and her article in NY times.

  • She had a positive test for the BRCA1 mutation
  • She underwent double prophylactic mastectomy
  • Angelina Jolie’s Op-Ed contribution to the New York Times on May 14, 2013.
  • She explains that, she had a 87% risk of breast cancer and a 50% risk of ovarian cancer, according to her doctors.
  • Only a fraction of breast cancers have the BRCA1 gene mutation.
  • Those with the BRCA1 gene have a 65% risk of getting breast cancer on average.
  • On April 27, 2013 she finished three months of medical procedures which involved the mastectomies.
  • She chose to have bilateral prophylactic mastectomies, meaning removal of both breasts, preventative – without having the disease yet.
  • On Feb 2, 2013, she did a procedure known as “nipple delay” which rules out disease in the breast ducts behind the nipple and draws extra blood to the area.  It is a study which can increase the chances of saving the nipple.
  • 9 weeks later, she had mastectomy with implant reconstruction.
  • She says that her risk of developing breast cancer drops from 87% to under 5%.
  • A primary motivator for her surgery, she says, is so that her children don’t have to fear losing her to breast cancer.
  • The cost of testing for BRCA1 and BRCA2 is more than $3000 in the USA.
  • She chose not to keep her story private.

Angelina Jolie’s Surgeon, Dr. Kristi Funk Blogs on May 14, 2013:

  • Emphasizes that each woman’s case is different.  Surgery will not necessarily be the right choice for everyone.  The important thing is to be aware of your options.
  • Approximately 5-10% of all breast cancers and 14% of ovarian cancers occur from a BRCA1 or BRCA2 genetic mutation that is inherited from either parent.
  • Women carrying either a BRCA1 or BRCA2 mutation have up to a 87% lifetime chance of breast cacer and a 54% chance of Ovarian cancer.
  • General population (all comers), there is a 12% risk of breast cancer and less than 1% risk for ovarian cancer.
  • In the general population the risk for a BRCA mutation is 1-500 (.2%) people but those of Ashkenazi Jewish heritage it is 1 in 40.
  • In those who BRCA-1 carriers who get breast cancer, 85% will have a more aggressive “triple negative” subtype (vs. 15% of general population).  Triple negative breast cancers mean ER/PR negative and Her2 – normal.
  • 8 red flags that indication a possible BRCA mutation:
  1. 1st, 2nd, or 3rd degree relatives from mother or father, with breast cancer before age 50 or ovarian cancer at any age
  2. Ashenazi Jewish Heritage (Easter European)
  3. Male relative with breast cancer
  4. Any relative who is a known BRCA mutation carrier
  5. Breast cancer in self before age 50 – early onset.
  6. Two breast cancers in self, at any age
  7. “Triple negative” breast cancer in self.
  8. 2 or more family members with Breast, Ovarian, Pancreas, Prostate, Melanoma, Uterine, Colon, and Stomach Cancers.
  • There exists non-BRCA inherited genetic mutations associated with breast and ovarian cancer as well.
  • Feb 2, 2013, Angelina had her first operation, the nipple delay.
  • Feb 16, 2013, Mastectomy with Sentinel Nodes Identification – not removed – but dyed.
  • Her plastic surgeon was Dr. Jay Orringer, assisted by her breast cancer surgeon Dr. Kristi Funk – the writer of the blog which I’m paraphrasing from in this section.
  • April 27, 2013, 10 weeks after the mastectomies, she received reconstruction of the breasts with implants.

What is Nipple Delay Surgery?

  •  Considered when the nipple is thought to be at risk for either cancer disease or inadequate blood supply.
  • This is performed 1-2 weeks before the mastectomies.
  • The incision used is the planned mastecomy incision.
  • The small disc of tissue behind the nipple and areola is removed and sent for pathologic diagnosis – to rule out the presence of cancer.  If cancer is present in this area, then nipple sparing/areolar sparing mastecomy would be contraindicated.
  • This procedure could bring extra blood flow to the nipple aream lessening the chances of nipple and skin loss after nipple sparing/areolar sparing mastecomy.
  • This is similar to the delay procedure performed by plastic surgeons :  My wife says: “In Tram Flaps we cut off the inferior blood supply to the rectus muscle to allow the remaining blood supply to get used to taking over – this strengthens the remaining blood supply and in about 2 weeks the remainder of the surgery is done for breast reconstruction.”

How does this relate to us at Surgical Artistry?

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  • As a general surgeon, I (Calvin Lee, MD) am a breast cancer surgeon, and I have performed many breast cancer operations in the past including mastectomies.  In 2006, my practice changed and I focused less on breast cancer surgeries.  It is good for me to continue following trends and different thinking regarding breast cancer.
  • I was one of the first surgeons to bring Sentinel Lymph Node biopsy for breast cancer to Modesto, CA.  I helped certify the rest of the other surgeons whom I worked with (at the McHenry Medical Group) for this procedure, since this procedure was part of my residency.
  • I was one of the first to create an online support group for breast cancer.  It was founded in 1997.  And several national publications thought it was the most effective group on the internet at the time.  It is still active on the internet and has been since moved over to Yahoo for management and software run by Yahoo which is tons more stable than what I could have offered.  I also let members of the group run the breast cancer support group and I’ve stepped away for fear of malpractice issues of having a doctor be part of the group – patients there have their own doctors and I was afraid that they would start to look to me for answers and medicine as an art form is practice different and surgery/medicine should be very personalized as it had been for Angelina Jolie.
  • Dr. Wu and I have done several nipple sparing, areolar sparing, skin sparing breast mastectomies with implants together, along with sentinel lymph node biopsy.
  • A huge part of Dr. Tammy Wu’s practice is breast reconstruction after breast surgeries such as mastectomies.  She uses many different breast reconstruction techniques – including implants and expanders (as in Angelina Jolie’s case) or with the patients own tissue either from the back or from the abdomen.
  • We also use the anatomic teardrop shaped breast implants newly approved by the FDA.  I am not certain that these are the ones that Angelina Jolie received, but it is possible and Dr. Wu is the first surgeon in our area to be certified to use these implants.  There are choices other than the 410 Natrelles, there’s the Sientra shaped breast implants.

A great source of info:  Position paper by American Society of Breast Surgeons:

https://www.breastsurgeons.org/statements/PDF_Statements/BRCA_Testing.pdf updated September 2012.

  • The position statement on BRCA genetic testing for patients with and without breast cancer, above also talks about prophylactic oophorectomy (preventative ovary removal without the presence of cancer).
  • The American Society of Breast Surgeons say that patients without cancer but with a positive BRCA1 and/or BRCA2 deleterious mutation can achieve a greater than 90% reduction in breast cancer risk if they choose to have a bilateral prophylactic mastectomy (as Angelina Jolie did).

dr-wu-and-dr-lee

Free SEO tools online

My SEO history

Search Engine Optimization (SEO) has been a hobby of mine.  I was pretty good at it.  Good enough that I got swatted by Google’s protocol change – code name Panda

FREE SEO TOOLS

  • http://smallseotools.com/keyword-position/ – my favorite tool!  You do have to find the “Check Position” button mixed in the middle of the ads.  It tells you your position on the search results!  See below, it’s part of a website with a suite of tools.
  • http://www.metatags.org/ – might be a bit out dated but still a useful tool – click on Free Website Analyzer: http://analyzer.metatags.org/.  Tells you about Tags ie. Title (not really a tag), Description, Keywords, Robots, Author.  But it tells you how many urls you have linked to it and most cool: it tell you page load time (this is a user experience variable that is now used in SEO)
  • http://www.smallseotools.com  – my favorite here is keyword position (you can see what position you have in a search result based on key search phrases).  It also has a page rank checker.  This is a slightly tricky site in that you might click on the ads by accident.  There’s enough here to keep on happy for awhile in SEO, including: Ping Tool (to notify search engines of changes to a website).  I tried the Reverse IP Domain checker, and it didn’t seem to work today.  The backlink checker is a bit awkward to use because you only see 10 backlinks at a time.  For example a page such as one of mine has 1820 backlinks.  There is a page rank checker here and it claims to have the ability to find fake page ranks, but I didn’t find this to be useful to me at this point, and can’t figure out whether it’s faking me out about the fakeness.
  • http://www.prchecker.info – I’ve used this for awhile to check Google Page Ranks
  • http://www.backlinkwatch.com/ – I’ve also used this free seo tool for awhile to check back links to a particular page.
  • http://www.google.com typing in “site:http://www.whatever.com” – gives you a list of indexed websites of a page.  This is a very important tool for me – especially to see if a page that I made had been indexed or not.
  • http://www.ismyblogworking.com – it gives you some information regarding load time and most importantly it reports any CMS editor that you are using.  This way you can see if it is wordpress, drupal, joomla, symphony, squarespace, etc.
  • Google Rich Snippet testing tool – get that picture next to your Google search.

There are more tools that use, but these are the best ones on my list so far.

My stuff

My page (www.SurgeryToday.com) load time: not too bad:  6.4 seconds

My SEO.  But my attempts have been spotty.  I’ve learned a whole bunch of things in the process, and will hopefully be implementing more of what I learned.  Much of this takes a good chuck of time which I’m not entirely willing to do.  But I do enjoy doing it myself, so I’m also not willing to farm out the SEO process.

Search Phrase May 14, 2013 June 2012 Previous 2011
modesto plastic surgery #2 Local #2 Local #1
modesto plastic surgeon #2 Local #1 Organic #1
modesto botox #1 #3 #1
modesto breast augmentation #3 #4 #1
modesto tummy tuck #5 #3 #1
modesto veins #3 #2 #2
modesto spider veins #3 #5 #2
modesto acupuncture #1 #2 #1
modesto skin care #1 #2 #1
ask dr wu #11 can’t find #1
big veins can’t find can’t find #1

My main personal activities in my medical practice is Botox and Acupuncture, so I mainly focused on these.  I’ve briefly touched Dr. Wu’s practice but perhaps it will be more of a project for the next few months.

How’s this educational for a doctor?

I think all doctors should understand the basics of the internet. When I was in high school, I felt that doctors should know how to type well. When I was in college, I felt that all doctors should be able to make web pages. When I was in medical school, I had no thoughts. When I was in Surgery Residency, I thought bad thoughts. Then when I realized there was life after Surgery Residency, I thought that doctors should understand SEO (Search Engine Optimization). This allows us to share information responsibly and effectively. For me at Surgical Artistry, my world is General Surgery, Plastic Surgery, Acupuncture, Skin Care, Botox, Juvederm, Fillers, Latisse, Veins, and Lasers.

Modesto Pollen and Weather Recording

Modesto Pollen Count & Weather Diary

Purpose: To keep track of what weather patterns we’ve lived through in Modesto, CA – to help planning for the next year for issues such as outdoor events – perhaps even related to Plastic Surgical events or for  dates for the Surgical Artistry Modesto Marathon and of course this may be useful for others too.

Sources: www.pollen.com

Zip code used:  95355

Relevance to Plastic Surgery and Surgical Artistry

it’s hard to see how Pollen Counts in Modesto could be related to plastic surgery.  But a part of our plastic surgery practice with Dr. Tammy Wu is Acupuncture – which has some direct relevance to anti-allergy treatments with acupuncture treatments and acupuncture protocols with Dr. Calvin Lee.

However there is a direct relationship with plastic surgery.  There has been some anecdotal reports that Botox injections into the forehead and glabellar area of the face has helped some of our patients with their allergy suffering.  I have seen more than 3 botox patients who are fairly confident that this is the case and these are patients who normally have year round suffering for their allergies.  This correlation with Botox is purely anectdotal.  But perhaps the future will tell us if there is a true scientific correlation, as there is with Botox and headaches; and Botox’s relationship with muscle tension.

Pollen Count History for Modesto, CA

Rating is from 0-12.  12 being the highest.

  • High 9.7-12
  • Med-High 7.3-9.6
  • Medium 4.9-7.2
  • Low-Medium 2.5-4.8
  • Low 0-2.4

2013:  Here’s the Pollen Counts Log and Weather too

5/14/13 Pollen 7.7, Predominant: Mulberry, Walnut, Grasses.  Temperature 90 F – 61 F.  May 8, 2013, I had a particularly bad day with my personal allergies to pollen, but these numbers didn’t register so high for the pollen count.  I think wind has something to do with it.

5/15/13 Pollen 7.5, Predominant: Mulberry, Walnut, Grasses.  Temperature 83 F – 55 F.

5/19/13 Pollen 8.1, Predominant: Grasses, Juniper, Walnut.  Temperature 87-55

5/24/13 Pollen 6.7, Predominant: Grasses, Amaranth, Oak.  Temperature 80-51

5/27/13 Pollen 6.5, Predominant: Grasses, Amaranth, Oak.  Temperature 81-54

<My own allergies started getting better at this point in the year>

6/9/13 Pollen 7.2, Predominant: Grasses, Sagebrush, Olive. Temperature 95-69

6/23/13 Pollen 5.7, Predominant Pollen: Grasses, Sagebrush, Chenopods.  Temperature 88-60

Around July 4th 2013, the temperature in Modesto, CA hit over 100 degrees Fahrenheit.  Now that the sun is dominant – please consider wearing your sunscreen with zinc all year round – even if it’s snowing or raining outside.

7/7/13 Pollen 4.0, Predominant Pollen: Grasses, Dock Chenopods.  Temperature 94-61

a purple flower IMG_4809

Most of our pollen allergies aren’t to these nice visible looking flowers. (In April/May).

 

2014 Modesto Pollen Counts Log and Weather History for Modesto:

My own personal allergies started acting up around the middle of March this year.  Specifically acted up on 3/16/14, although several weeks earlier there were indications of allergy irritations for myself.  This acted as a trigger for me to continue posting to this pollen blog for Modesto, CA.  I’m copying data down from pollen.com (source).

3/16/14 Pollen 8.8 mulberry, ash, oak.   81/47 F

3/25/14 Pollen 7.5 alder, ash, poplar.  69/51 F

3/30/14 Pollen 8.5 oak, alder, juniper 69/49 F

4/4/14 Pollen 7.9 oak, mulberry, ash.  68/47 F

4/21/14 Pollen 7.6 oak, grasses, mulberry.  80/54 F

5/21/14 Pollen 6.4 grasses, juniper, walnut.  81/54 F

5/27/14 Pollen 7.4 grasses, amaranth, oak.  94/60 F

7/4/14 Pollen 4.4 grasses, dock, chenopods.  98/65 F

8/24/14 Pollen 7.7 chenopods, elm, grasses. 91/61 F

11/16/14 Pollen 2.3 sagebrush, elm.  61/43 F

2015 Modesto Pollen Counts Log and Weather History for Modesto:

1/25/15 Pollen 5.7 alder, juniper.  68/42 F

2/1/15 Pollen 7.3 alder, juniper. 70/38 F

6/9/15 Pollen 7.4 grasses, juniper, hickory 90/70 F

6/13/15 Pollen 7.4 grasses, sagebrush, olive 90/60 F


2016 Modesto Pollen Counts Log

4/16/16 Pollen 9.6 Mulberry, Oak, Walnut.

This is a work in progress.  Every consider acupuncture for your allergies?  We frequently perform anti-allergy acupuncture at our Surgical Artistry office in Modesto, CA.

If you need a Converter for Fahrenheit to Celsius, consider this Google link.  Or consider this conversion link.