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DJP Update 2-15-2019 A MUST READ BOOK!  Childhood Abuse, Body Shame, and Addictive Plastic Surgery by Mark B. Constantian, MD

DJP Update 2-15-2019 A MUST READ BOOK!  Childhood Abuse, Body Shame, and Addictive Plastic Surgery by Mark B. Constantian, MD
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This book should be in every medical school curriculum.  It is a cautionary tale for physicians and patients.  It deserves to be a best seller.  Uncovering the cause of a problem is a critical step in the cure.  Read and admire Dr. Constantian’s research, discovery, and solution offering hope for the future.
 
Lagniappe:  Did you know that JAMA and the New England Journal of Medicine no longer do book reviews?  In my opinion, that is a loss.  Encourage your state and specialty societies to review this book.  
Mark B. Constantian, MD, FACS, has practiced plastic surgery in Nashua, New Hampshire, since 1978 and has faculty appointments at the University of Wisconsin and the University of Virginia. He is the author of more than 100 professional journal articles and book chapters and two previous textbooks, including Rhinoplasty: Craft and Magic.”
My review at Amazon:
Dr. Mark Constantian, a brilliant, accomplished surgeon, becomes a modern day Sherlock Holmes to uncover the causes of a grand theft of self-esteem in some patients and the never-ending quest for an illusory body perfection through plastic surgery. Meticulously researched and illustrated with evocative vignettes, readers will enjoy this as much as a suspense thriller. Highly recommended for physicians and patients.
Donald J. Palmisano, MD, JD, FACS, Former President of the American Medical Association, Clinical Professor of Surgery and Clinical Professor of Medical Jurisprudence at Tulane University School of Medicine
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Kirkus Review:
KIRKUS REVIEW
A plastic surgeon presents insights into patients’ motivations based on his practice and empirical research.
 
In this medical book, Constantian (Rhinoplasty, 2009) analyzes patients who have undergone multiple cosmetic surgeries and are unsatisfied with the results, finding that their reactions can often be connected to disturbing childhood experiences. The author combines anonymous anecdotes from his patients with peer-reviewed research into the lasting impacts of traumatic events in childhood to show that many cases are the result of patients’ reactions to family dysfunction or abuse. He argues that the pursuit of elective cosmetic surgery—rhinoplasties, or nose jobs, in Constantian’s practice—should be understood in that context. The deeply researched book (each chapter includes several pages of endnotes, and full credit is given to existing rubrics like the Mellody model) takes readers through existing literature on human psychology, including body dysmorphic disorder, an exploration of how behaviors related to body image can be a response to trauma, and the physiological effects of painful experiences. He concludes that patients can be best served by developing a sense of resilience and dealing with the underlying issues as opposed to going to surgeons who simply accede to requests to lengthen or shorten their nose tips by a few millimeters. The author urges physicians to understand the “intensity of emotion” that may be involved in a case and to acknowledge the connections between emotional state and physical health.
 
The writing here is strong, though certainly technical, and it is clear from the opening pages that the book is intended as a professional reference rather than casual reading material. The target audience is surgeons, and understanding that keeps the authoritative narrative tone from becoming overbearing (“Physicians see the effects of this neglect in patients who become childlike following surgery, or in Internet conversations where patients give medical advice to each other or pose questions that should be directed to their surgeons—or not even asked”). Although the patients who appear in the work’s many anecdotes may appear extreme (one’s “six-page letter read like the Unabomber Manifesto”), Constantian provides a level of detail and empathy that renders them entirely plausible, allowing readers to see how domineering parents, the lasting effects of physical abuse, or other childhood traumas can shape patients’ enduring unhealthy relationships with their bodies. The volume’s conclusions are based on solid science, and the author acknowledges socio-economic factors that may further shape patients’ responses. The occasional bits of humor (“If I were marooned with her for three days, she could probably turn me into Prufrock”) add a distinctive touch without detracting from the treatment of a serious subject. The concrete and actionable information provided gives readers useful takeaways, like comparisons of satisfaction rates between patients correcting real deformities and those having features that appear normal to a casual observer. There is some discussion of how patients can develop the resilience that seems to be the most effective way of managing these disorders, but the book remains focused on its readers, providing surgeons with guidance on improving their interactions with troublesome patients.
 
A solid, well-researched, and well-argued analysis of the behavior of plastic surgery patients.
 
Pub Date: Dec. 13th, 2018
ISBN: 978-1-138-10030-5
Page count: 342pp
Publisher: Routledge
Program: Kirkus Indie
Review Posted Online: Feb. 13th, 2019
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Stay well,
 Donald

Donald J. Palmisano, MD, JD, FACS

Donald J Palmisano Consulting
Intrepid Resources® 
5000 West Esplanade Ave., #432
Metairie, LA 70006
USA
504-455-5895 office
 
(Author of ON LEADERSHIP (2008, 2011 2nd edition) and THE LITTLE RED BOOK OF LEADERSHIP LESSONS (2012 in bookstores and AMAZON)
DJP Updates: 
Twitter: @DJPNEWS  https://twitter.com/DJPNEWS
This DJP Update started out going to leaders in Medicine representing all of the State Medical Associations and over 100 Specialty Societies plus some other friends; and now around the globe via Twitter followers.
You can share it with your members and it has the potential to reach 800,000 physicians.
To join the list, send me an email stating “Join DJP Update”
To get off the list, state ” Remove DJP Update” in subject line.
NOTE:  IF YOU ELECT TO GET OFF OF THIS MAILING, PLEASE SEND ME ALL EMAIL ADDRESSES YOU USE IF YOUR OLD EMAIL IS FORWARDING TO YOUR NEW EMAIL BECAUSE THE LIST IS BY EMAIL AND NOT NAME.  IF YOU SEND ME ONLY YOUR NEW EMAIL, I WON’T FIND YOU TO REMOVE.  THANKS!

 

 

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DJP Update 10-5-2014 Gadgets and Lagniappe (articles)

DJP Update 10-5-2014 Gadgets and Lagniappe (articles)

If you are not into tech stuff and do it yourself projects, you can skip this item and go directly to Lagniappe.  The Gadget section is about modifying old computers so you can use longer plus info re new iPhones.

 GADGETS A) Computer upgrade B) iPhones

A) Upgrading your old computer with larger hard drive (SSD) and more RAM

I decided to upgrade my Apple mid-2009 MacBook Pro with 4 GB RAM and 250 SSD (Solid State Drive rather than a spinning hard drive) GB hard drive that I use as my desktop computer for writing. The 250 GB hard drive was full despite moving most data off.  Lots of programs!

With the availability of excellent YouTube videos online free for viewing via Internet for viewing options and techniques for changes the insides of my computer, I ordered 8 GB of RAM and the new Samsung SSD 850 Pro SATA III (512 GB) from Amazon.

I also bought special screwdrivers (T6 Torx and Phillips PH00) made by Boxer to remove back of computer and the internal screws.  In addition I got an anti-static wristband with clip to attach to computer at the advice of my younger brother who knows much more than I do about computer insides.

I cloned my original 256 GB SSD to the new 512 GB SSD (solid state drive) before removing using “Carbon Copy Cloner” program and connecting new SSD to USB port before the swap.

No problems at all with transplant or data transfer including clone of operating system. Computer worked immediately when I turned it back on.  All items were bought from Amazon. As a PRIME member, I received items in 2 days at no extra mailing costs.  The Carbon Copy Cloner was free for 30 days and worked smoothly.  It was downloaded from the maker of the program:

https://www.bombich.com/

I then purchased the Carbon Copy Cloner program ($39.99) to encourage the developer of the program plus the program is a good way to back up frequently so that you have a bootable external hard drive if the internal drive crashes. The advantage of this is if the computer hard drive crashes and remains broke, you can put in new hard drive or take it to a computer store to remove broken drive and add new one. Then the new internal hard drive with everything you saved on external drive is cloned using Carbon Copy Cloner.  In other words, no need to reinstall the Operating System from original discs that came with your computer.  Remember, ALWAYS back up!  (Some people use the “Cloud” to store data but I don’t as I worry about security at those sites.  I believe it best to control your own backups and keep one backup at another location in a waterproof container such as a Pelican 1200 case made by Pelican Products in Torrance, California. Light enough to carry with you in an evacuation. Those who suffered through Hurricane Katrina know the value of backup and alternative safe locations to store one additional backup!)

This Carbon Copy program copies booting files, all programs, and all data. I have two external hard drives for back up.  One backs up with Apple’s TIME MACHINE, the other with CARBON COPY CLONER. Both external hard drives are Lacie 500 GB 7200 RPM with option for Firewire 800 or USB 3.0.  I have Firewire 800 on my old mid-2009 as well as the slower USB 2.0. Using Firewire 800 with the 7200 RPM makes the back up very fast.  Most external hard drives at stores are 5000 RPM.  7200 RPM drives are faster and give better result with transferring and modifying video.

I am impressed with educational info on YouTube!  The swap reminded me of my first short wave radio I built from a Heath Kit when I was a teenager.  Lots of fun.

Here is some info re the revolutionary Samsung 850 Pro 512 GB SSD that I inserted into computer:

http://www.samsung.com/global/business/semiconductor/minisite/SSD/global/html/ssd850pro/overview.html

This adventure give me a functional writing computer for some additional years rather that spending thousands on a new computer.  The speed increase in the computer is noticeable!

Here are examples of the YouTube educational videos reviewed before attempting this transplant and more specs on my Mac:

Larger Samsung SSD into MacBook Pro and also cloning in this YouTube video:

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Cloning hard drive to swap hard drives in MacBook Pro (to back up all programs, data, etc.)

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Upgrade RAM in MacBook Pro – YouTube



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Specs on my mid-2009 MacBook Pro

Core 2 Duo 3.06 15″ Model Identifier 1066 PX3-8500 with 4 GB RAM.

(After addition of new RAM, I now have 8 GB RAM.)

 Conclusion:  For most purposes, one doesn’t have to upgrade to a new computer when you run out of space on hard drive or need more RAM for running multiple programs at once.  Simple transplants can keep the computer sufficient for most needs, especially writing.  Educational info on YouTube makes the swaps easy and instills confidence.

B) iPhones: Robin and have used iPhone 4S for several years.  But there are problems with these phones in our hands with the updated software that brings new features for iPhone 6.  Freezing of program, inability to use some of apps, etc.  We decided to get the new iPhone 6.  We chose different versions:  Robin iPhone 6 and DJP iPhone 6+.  Her phone arrived in a few days.  Mine won’t get to me until the end of this month.  Her phone works well!  Great detail.  We also switched carriers to Verizon as we get good Verizon signal at our home but a poor signal with ATT on old iPhones.  We have had the Verizon Jetpack for portable hotspot for computers and we have used these Verizon portable devices with great success.  Good signal strength where we travel in USA.

Good YouTube video showing how to transfer all data and apps from old iPhone to new iPhone.  This is method I used and it works well.

LAGNIAPPE:

A) Dr. Stormy Johnson forwarded this link for me to share re health system reform.  It is an article by James C. Capretta in National Review Online:

http://www.nationalreview.com/article/388386/replacing-obamacare-saves-lot-money-james-c-capretta

B) Mark B. Constantian, MD, FACS and co-author Chee Paul Lin, M.A. have new articles re unhappy patients and plastic surgery in Plastic and Reconstructive Surgery, The Journal of the American Society of Plastic Surgeons.

Journal cite: Plastic & Reconstructive Surgery. 134(4):823-835, October 2014.

Why Some Patients Are Unhappy: Part 1.

Relationship of Preoperative Nasal Deformity toNumber of Operations and a History of Abuse or Neglect

Why Some Patients Are Unhappy: Part 2.

Relationship of Nasal Shape and Trauma History to Surgical Success

Journal cite: Plastic & Reconstructive Surgery. 134(4):836-851, October 2014.

Both can be found in medical library or at: http://journals.lww.com/plasreconsurg/pages/results.aspx?txtKeywords=constantian

Summaries can be seen at link:  e.g. Part 1:

Background: Trauma (neglect or abuse) can create body shame (different from body dissatisfaction), driving some patients to seek aesthetic surgery. We hypothesized that a trauma history would be related to the severity of the original deformity and the drive to undergo repeated operations.

Methods: Descriptive statistics were computed for 100 secondary rhinoplasty patients, 50 of whom originally had dorsal humps, 21 of whom had straight, functional noses, and 29 of whom had subjectively normal noses but underwent multiple rhinoplasties. This latter group fulfills criteria for body dysmorphic disorder.

Results: Compared with patients with hump noses, patients with normal primary noses were 2.9 times more likely to be demanding 2.5 times more likely to be depressed, had undergone 3.0 times more rhinoplasties and other aesthetic operations, and were 3.8 times more likely to have confirmed trauma histories. Patients who had undergone more than three operations were 92.7 percent women; 85 percent originally had straight noses and had undergone an average of 7.56 rhinoplasties and 5.78 aesthetic operations; 85.4 percent had histories of abuse or neglect.

Conclusions: Secondary rhinoplasty patients with normal preoperative noses, who fulfill the criteria for body dysmorphic disorder, had significantly higher prevalences of depression, demanding conduct, previous rhinoplasties and other aesthetic operations, and confirmed trauma histories than patients who originally had dorsal deformities or straight noses with functional symptoms. To the authors’ knowledge, this is the first report of such associations. A history of childhood trauma may impact adult patient behavior and therefore the surgical experience.

Mark also has an editorial in Plastic & Reconstructive Surgery (December 2013)

The New Criteria for Body Dysmorphic Disorder: Who Makes the Diagnosis?

These articles and the editorial are very interesting.  Risk managers and medical liability companies especially may find the information of value.

Stay well.
Donald

Donald J. Palmisano, MD, JD, FACS

Intrepid Resources® / The Medical Risk Manager Company

5000 West Esplanade Ave., #432

Metairie, LA 70006

USA

504-455-5895 office

DJP@donaldpalmisano.com

www.donaldpalmisano.com

www.onleadership.us

(Author of ON LEADERSHIP (2008, 2011 2nd edition) and THE LITTLE RED BOOK OF LEADERSHIP LESSONS (2012 & in bookstores and AMAZON now!)

DJP Updates:  www.DJPupdate.com

Twitter:  www.twitter.com/DJPNEWS

YouTube: http://www.youtube.com/user/IntrepidResources/videos  Check out the videos.

This DJP Update goes to over 2300 leaders in Medicine representing all of the State Medical Associations and over 100 Specialty Societies plus some other friends.

You can share it with your members and it has the potential to reach 800,000 physicians.

To join the list, send me an email stating “Join DJP Update”

To get off the list, state ” Remove DJP Update” in subject line.

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