Saving Smiles

Posted by The Editorial Desk / Tuesday, December 9th, 2008

Dentistry Patients Discuss Their Life-Changing Procedures

By Lindsay Holst

In a culture where plastic makes perfect, to cynics the word “cosmetic” conjures images of procedures representing one more costly indulgence, falling somewhere between “lip injections” and “eyebrow lifts.”
A winning smile has always been touted as the secret to many successes.

Studies have shown that an attractive smile can improve your self-confidence, get you a date and even help land you a job.

Why the obsession  with straight, shiny teeth?

Chalk it up to Darwinism. Blame society’s infatuation with the smiles of veneer-clad celebrities. But ultimately, it’s undeniable: The attractive smile is a coveted fixture, and the field of cosmetic dentistry has gained considerable popularity for its range of services, which include veneers, tooth implants, whitening and tooth restoration, in addition to other traditional dental procedures.

The cynics, as it turns out, are incredibly wrong.

The art of restoring a smile has far-reaching benefits, and the work of cosmetic dentists can drastically improve not only the physical appearance of their patients, but their confidence and sense of self-worth, as well.

No Bones About It
Though patients are ultimately taken by the change in their physical appearance, those who have been experiencing chronic pain can find dual relief in cosmetic dental procedures. Dr. Chong Lee, who practices at Galleria Dental Aesthetics in McLean and is a clinical instructor at the Las Vegas Institute for Advanced Dental Studies, emphasizes the need for cosmetic dentists to take care of the functional aspect of the patient’s problem before the cosmetic aspect. If pain exists, he advised, it must be addressed first.

“I have patients who have been to neurologists and ENT’s because of their headaches,” Lee said. “They can’t function due to migraine headaches, neck pain and back pain. Many times, it’s caused by their bite.” Often, the pain is a result of teeth grinding, which Lee said occurs when a patient’s bite is not in the proper place. The muscles and the jaw work overtime, causing fatigue and pain when they are at rest.

To assess the location of a patient’s bite, Lee uses a machine to measure the muscular activity. A computer helps him locate where the natural bite will be, and sonography—which uses the sound of the joint—helps him with jaw tracking. Once he restores the jaw to its natural position, Lee said patients are shocked that the pain “simply goes away.”

He can recall one patient who came into his office with two pages of medications that she had been taking for her head, neck and shoulder pain. “The pain was affecting her everyday. She couldn’t function; she was missing work, and had to sit in a dark room constantly for her migraines,” Lee recalled. “She took a second trust on her house just to get her teeth done, because she didn’t want to live with pain anymore.”

Meet The Dentist
CHONG LEE, DDS, received his Doctor of Dental Surgery from the Medical College of Virginia School of Dentistry in 1983. As a graduate of Las Vegas Institute for Advanced Dental Studies’ renowned post-graduate aesthetic and neuromuscular dentistry study program, Dr. Lee went on to become an LVI clinical instructor and regional director. He founded the LVI Study Club in the D.C. Metro area, and frequently gives lectures around the county to hundreds of dentists. Dr. Lee is a fellow of the International Academy for Dental Facial Esthetics and an active member of the Virginia Dental Association, American Academy of Cosmetic Dentistry, American Dental Association, Association of General Dentistry and Northern Virginia Dental Society. He practices at Galleria Dental Aesthetics in McLean, where he and fellow Drs. Oh and Mortazie were voted top dentists in the Metro area by several publications, including Washington Consumers’ Checkbook and Washingtonian Magazine. Visit www.smilesva.com.

Picture Perfect
Kellie, a 39-year-old mother of three, had had problems with her teeth for as long as she could remember. By the time she was in her late 20s, she found herself with only a few remaining teeth, and she was fighting to save even those.

“Every single tooth had multiple fillings,” she remembered. “I had had at least six root canals and a bridge in the front where one of my teeth had fallen out while I was eating. I have stories that could make your skin crawl.”

Kellie, who owns a well-drilling business with her husband in Christiansburg, Va., began having such difficulty eating that she lost nearly 45 pounds. Her teeth were decaying so quickly that she found herself at the dentist’s office at least once a week. When she went out to dinner, she could only order soft foods—what she began referring to as her “baby food diet.” And yes, her smile was unattractive, she said, but that was the least of her problems.

“When I decided to get cosmetic dental work done, the vanity aspect was only a perk of the procedure,” she said. “For me, it was, I have to eat again. I have to function again.”

After two consultations at nearby dentistry practices, Kellie remained unsatisfied with the institutions’ credentials. She extended her search to encompass the entire state and found Dr. H.R. Makarita, whose credentials impressed her and prompted her to drive three and a half hours to his Oakton practice for a consultation; later, she would return for a complete smile makeover.

“I now have—no exaggeration—perfectly colored, perfectly shaped Julia Roberts teeth,” she said gleefully, adding that before her dental work, she couldn’t find one picture where she was smiling with her teeth. “Over the years, I had major anxiety issues. Now, everything has changed; the way that I eat, the way that I look, the way that I photograph.” With her new teeth, Kelly is training herself to smile again, controlling her hand from flying to cover her mouth as it used to. “No way am I going to cover these beautiful teeth!” she exclaimed.

Meet The Dentist
H.R. MAKARITA, DDS, MAGD, LVIM, FICOI, FAACD, graduated from the Medical College of Virginia School of Dentistry in 1988. He has been a member of the American Academy of Cosmetic Dentistry since 1995, receiving his accreditation in 2001 and becoming the 39th member of the academy to receive its prestigious fellowship designation in 2006. He is a master of the Academy of General Dentistry, and was awarded mastership status from the Las Vegas Institute for Advanced Dental Studies in 2006; he is also an LVI clinical instructor and regional director. Dr. Makarita has received numerous AACD Smile Gallery awards, and received the AACD People’s Choice Award in 2003. His private practice in Oakton specializes in aesthetic reconstructive dentistry. Visit www.fixasmile.com.

Emergency Makeover
Not all dental damage is the result of gradual deterioration, and on-call dentists must be ready to immediately handle urgent cases as they arise. Dr. Lawrence Singer, who serves as assistant clinical professor of surgery at George Washington University and has practices in Alexandria and Washington, D.C., is on-call for facial fractures and dentoalveolar trauma, including avulsed teeth.

When traumas arise, he goes to the George Washington University hospital to assess the patients’ injuries, and has had many unique cosmetic and reconstructive surgery opportunities. “Often, we will go into the O.R. and reset broken jaw bones, and re-implant and stabilize loose teeth,” Singer said. “This initial treatment is critical to getting the best result so that the tissues are manipulated in the best possible way for ideal healing with little defect.”

He remembered when Tanya, an on-duty Arlington County police officer, came into the O.R. Tanya, who was on foot that night, had been struck by a car traveling at 55 miles per hour. In addition to broken hands and a badly broken leg, she had broken upper and lower jaws. She had lost six upper teeth and had three avulsed lower teeth. While orthopedics reconstructed Tanya’s broken hands and legs, Singer worked on her maxillofacial region with an ENT resident. He re-implanted and stabilized the lower teeth by connecting them to adjacent teeth, and began healing the upper and lower jaw by “reducing” the fractures; that is, putting the jaws back into place with plates, screws and sutures.

“The lower teeth were all treated with root canals and porcelain crowns,” Singer said. “We are replacing the upper teeth that were lost with zirconium implants and zirconium crowns, all porcelain.” Since the initial surgeries, Tanya has had several additional plastic surgeries for her gums. “It has been seven months since the accident, and we expect her to finish up in the next couple,” Singer predicted. “Tanya is a tough gal. She has a big smile, though, and restoring it has been rewarding as any.”

Meet The Dentist
LAWRENCE D. SINGER, DMD earned his Doctor of Medical Dentistry at the School of Dental Medicine: University of Pennsylvania, where he served as assistant professor of restorative dentistry from 1997 to 2000. He currently is the assistant clinical professor of surgery at George Washington University and maintains full admitting and ambulatory center privileges at the GWU hospital. He is a member of the Academy of Osseointegration, the American Academy of Cosmetic Dentistry and American Dental Association, among others. He is a also fellow of the Academy of General Dentistry, as well as the International Congress of Oral Implantologists. His practice, DC Smiles, has locations in Washington, D.C., and Alexandria, specializing in cosmetic, implant, and reconstructive dentistry. Visit www.novasmiles.com.

Best Face Forward
Broken teeth resulting from accidents or abusive relationships can cause emotional trauma that runs deep, and cosmetic dental procedures often serve as one significant step in the victim’s recovery process. Dr. Kevin Ryan is vice chairman of the board of Second Chance Employment Services, a Washington, D.C.-based nonprofit organization that places battered, abused and other at-risk women in jobs free of charge.

“Many of these women obviously need dental work because they have broken front teeth due to an abusive relationship,” Ryan said. “I use veneers to restore their smiles so that they are presentable enough to go and get a job, and I’ve also made temporary crowns so that they can go on job interviews. The main thing is to get them ready and give them enough confidence to go out into the workforce.”

The women, who are typically psychologically damaged, find it difficult to believe that they can actually get a job, and the cosmetic dental procedures often allow them to regain a sense of normalcy in their lives. Contrary to common assumptions, Ryan said that the organization sees women of all educational and social backgrounds. He remembers a marine biologist who had a front tooth knocked out.

“She was unbelievably well-educated,” he remembered, “but she just couldn’t get a job. I made her a temporary crown to improve her appearance, and she got a job right away.”

It seems that it isn’t just the women’s appearances that change with this dental work. Ryan remembered a young French woman whose teeth were incredibly damaged as result of an abusive relationship. He created an entire case of veneers for her, which he said made a dramatic change, not only in her looks, but also in her attitude. “She’s a completely different person now,” he remarked. “She’s remarried, has a baby on the way, and is happy and smiling every time she comes in.”

Although many of the procedures would ordinarily run up to $17,000, all of the dental work at Second Chance is done pro bono. Even so, it seems a small price to pay for a life change.

“We don’t just do dentistry [at Second Chance]. We get them clothes, help with their resumes, and you can always see the difference immediately in the way they hold their heads, the sparkle in their eyes. We have story after story of people who have made remarkable changes.”

Meet The Dentist
KEVIN A. RYAN, DDS graduated from the Medical College of Virginia School of Dentistry in 1981. Dr. Ryan was voted as “highly regarded for cosmetic work” by Washingtonian Magazine, and was voted by his peers as one of the “Best Dentists in America” for 2004-2005. He completed post-graduate training at the Las Vegas Institute for Advanced Dental Studies, where he put in 200-plus hours of continuous education a year. He is a member of the American Dental Association, Virginia Dental Association, Northern Virginia Dental Society and the American Academy of Cosmetic Dentistry. He started his own practice, the Springfield Esthetic Dental Center, in 1985, and has been practicing in the area for more than 19 years. Visit www.springfielddental.com.

(November 2007)

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Cutting Edge

Posted by The Editorial Desk / Monday, December 8th, 2008

The Real Deal in Cosmetic Surgery Advancements

By Marilyn Moss, M.D.

Ben Franklin astutely said, “All would live long, but none would be old.”

This inherent desire in people for youthfulness has fueled the field of cosmetic surgery, which has continued to grow at a dizzying rate. According to statistics released by The American Society for Aesthetic Plastic Surgery (ASAPS), consumers spent $12.2 billion on plastic surgery in 2006 to pay for 11.5 million procedures. Although the number of women who undergo plastic surgery far outweighs the number of men, there has been a steady rise in the number of men who seek cosmetic procedures.

Non-surgical
Non-surgical procedures have proliferated in the cosmetic surgery field, making aesthetic surgery even more appealing. According to Dr. Foad Nahai, president of ASAPS, “What’s really new in the field is the tremendous growth in non-surgical treatments.”

Non-surgical cosmetic therapies are safe and fast, requiring very little downtime for the patient. The procedures can be done in an outpatient setting, commonly in the doctor’s office. Recovery time is much shorter, allowing patients to resume normal activities almost immediately, in many cases.

Fillers
Over the last few months, the FDA has approved several new non-surgical treatments for the face to add to the armament against aging. These newly sanctioned therapies involve the use of “fillers” for facial wrinkles. The injected substances add volume to reduce wrinkles and lines.

Most fillers are composed of a substance found in the body, such as hyaluronic acid, which reduces the risk of allergic reactions. In the past, collagen derived from animals was often used as the filler, and the incidence of allergic reactions was 3 to 4 percent. Nahai said, “These products are not permanent, but they are safe and free of side effects.”

Laser
Another relatively new procedure to reduce wrinkles or other signs of aging involves tightening the collagen underlying the skin. Tightening the sub-surface collagen gives the overlying skin a tighter, younger look. The treatment spares the overlying skin surface. Skin tightening procedures can be used on the face, the neck, the eyelid, the abdomen and the thighs.

The results of skin tightening, however, are less pronounced than surgical interventions, such as face lifts. “The changes are not that dramatic. But this is a promising technique that needs to be refined,” Nahai corroborated.

Surgical

Breast Augmentation
Breast augmentation surgery is the most popular cosmetic surgery among women. There are some new initiatives in use, as well as some on the horizon. To begin with, the FDA recently re-approved, again, the use of silicone breast implants, after withdrawing its approval because of health concerns.

Silicone is reportedly more “natural” appearing, but the implant can rupture without the patient noticing, allowing the silicone to seep out into the breast tissue. Medical texts have suggested that exposure to silicone may be associated with connective tissue diseases. Although that remains controversial, it is undisputed that the ruptured silicone can lead to hardening.

Saline implants have a safe health profile, and ruptures can be easily detected. These implants, however, are more prone to wrinkling or rippling at the edges. Dr. George Bitar, medical director of Bitar Cosmetic Surgery Institute in Virginia and a visiting lecturer at the plastic surgery department at the University of Virginia, said, “I like saline. And I insert the implant from the armpit and place it below the breast muscle to keep the implant separate from the breast tissue.”

According to Bitar, this method offers several advantages: no nipple nerve damage, no scarring of the breast tissue to confuse mammograms and little interference with breast-feeding.

At the cutting edge of breast augmentation is the promise of stem cells. Researchers are evaluating the use of stem cells derived from fat to increase the size of the breast. Dr. Adam Katz, an assistant professor in plastic surgery at the University of Virginia, explained that for years, fat transplants have been used in the cosmetic field, although not with breast surgery. Fat taken out by liposuction has been injected elsewhere to add volume. According to Katz, “This kind of transplant may have some beneficial effects for surrounding tissues.”

Those studying fat grafting feel that the stem cells within the adipose tissue are responsible for such additional benefits, along with the increased volume. Katz said, “There is emerging evidence that suggests the stem cells enhance vasculature [arrangement of blood vessels] and also affect the overlying skin.”

Blepharoplasty
Patients who seek eyelid surgery present different causes for their complaints. Some have loose skin, while others have a droopy brow. And others have experienced skin changes that make the eyelid surface look like crepe paper. Treatment for the individuals, therefore, must be tailored to their specific needs. According to Dr. Victoria Suh, a board-certified plastic surgeon at Victoria Plastic Surgery and Laser Skin Care Center in Fairfax, laser therapy may work well for crepe paper skin, but “sometimes you just have to do surgery.”
Brow and eye lifts can be done endoscopically, giving the surgeon visual access to the tissues. The fiber-optic scope is inserted through small incisions, rather than a large incision like that used in traditional lift procedures. Suh often uses a small, biodegradable device called an endotine. The endotine hooks the sagging skin from below the surface, lifting it up. The other end of the endotine is then anchored to the bone. Over time, the healing process causes the skin to adhere to this new position, and the device dissolves within seven to eight months. The anchored skin gives the face a younger, rejuvenated look. Suh said the endotine is an improvement over the use of threads, which do not dissolve. “The threads have not been all that successful,” Suh said.

Hair Transplantation
Cosmetic surgery offers micro-hair transplant surgery to treat baldness in individuals.

The micro transplant is a significant improvement over transplants offered 10 years ago. Hair follicles are harvested in mini-strips from the back of the neck. Individual hair follicles are prepared as follicular units for transplant, unlike the older method that transplanted multiple hair follicles together.

Dr. James Vogel, an associate professor in plastic surgery at the Johns Hopkins Hospital and a private practitioner with an office in Owings Mills, Md., said the new individual method produces a very natural appearance. Vogel commented that the procedure is much more demanding for the physician because of the size and number of the transplants. “This is very labor-intensive,” Vogel said.

He added that the effort was worth it, however, saying, “There should never be any physical evidence of a transplant.”

Liposuction
Although many modifications to the basic procedure have been introduced, none seem to have significantly improved on the old-fashioned method. According to Bitar, “These new devices are just a new twist on regular liposuction.”

Bitar, who has been performing plastic surgery for more than 13 years, remarked that the new approaches, such as liposuction with ultrasound or laser, had some advantages but also some downsides. The new procedures can often be done under local anesthesia, reduce blood loss and tighten skin. These benefits, however, are offset by a loss in precision, which might result in poorer outcomes.

Even the newest intervention, which involves injecting a fat dissolver under the skin, does not overly impress Bitar. He explained that the procedure causes fat cells to burst, and then the body absorbs and excretes the debris; no suctioning is required. The physician, however, cannot control which fat cells get targeted. Bitar said, “This can lead to lumps and bumps or require multiple treatments.”

Rhinoplasty
The most significant change to cosmetic nose surgery has been the use of an open technique instead of the former closed technique. Dr. George Weston, a partner with the Austin-Weston Center for Cosmetic Surgery in Reston, explained that the nose is opened at the junction with the upper lip. This allows the surgeon to open up the nasal area and view the structures. “It’s a huge advance,” Weston said.

Before any surgery occurs, Weston has the patient view a computer simulation of the result. This gives the patient a glimpse of an approximation of what to expect. “Every nose is different. You want to give the patient what they want, but you want to balance that with what is possible,” Weston said.

No matter what cosmetic procedure is done, Bitar cautioned patients to do their homework: Research both the procedure and the physician. To Bitar, the outcome depends largely on the provider. “It boils down to the operator. The procedure is only as good as the operator.”

Bitar advised consulting a board-certified plastic surgeon, saying, “These doctors are fully trained and have a lot of experience.”

Additionally, the best outcomes result when patient anticipations are well-matched with realistic expectations. Dr. Gary Price, a plastic surgeon affiliated with Yale University, stressed the need for communication about the different options and their expected results. He said, “Counseling the patient is very important. The patient needs to have realistic expectations.”

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Saline vs. Silicone
By Carissa Sutherland

Because of safety concerns, the Food and Drug Administration restricted the use of silicone breast implants 15 years ago, making saline implants the only option for American women. Then after years of research, in November 2006, the FDA lifted the ban to the cheer of plastic surgeons and patients nationwide. 
One has to wonder: If saline proved so safe and effective, and thousands of women continued to receive implants, why was the ban lifted? If silicone is the better type of implant, have thousands more women raced to their nearest surgeon now that the FDA changed its mind? Three Northern Virginia board-certified plastic surgeons—Drs. Anne Nickodem, Christopher Hess and David E. Berman—weigh in on which is better: saline or silicone.

Size Matters
Many surgeons and patients widely accept that silicone implants look and feel more natural than saline implants since silicone has texture similar to breast tissue.

Well, not necessarily, according to Nickodem. “It’s really based on the patient and how much tissue she has already. Saline can equally feel like a breast in a patient with more tissue. The more fat she has to start with, the more likely saline will feel just as natural.”

Hess echoed Nickodem’s remarks. “I recommend the silicone if women have smaller breasts to begin with. There is a point that saline and silicone will feel similar if the patient has a decent amount of tissue to start with.”

However, according to Berman, there is no question—silicone is better. He said, “It’s not even controversial; one feels like jelly, and one feels like water.”

Safety First
When it comes to safety, it would seem nothing rivals saline implants. Since water composes every human body, salt water causes no harm. But recent advances in the production of silicone implants make them safer than ever before.

“All implants get encapsulated naturally by the body, even pacemakers. Therefore, I could go in and easily remove ruptured silicone,” Hess said. Unlike their ancestors, newer silicone implants resemble Jell-O, are easier to remove and aren’t sticky or runny.

Cost Comparison
Aside from safety alone, patient concerns also lie in the differences in cost and post-op scarring when making the choice between silicone or saline implants. For example, silicone may cost twice as much as saline but won’t deflate if it has a leak. Hess said, “I offer both, but there is the cost factor. Silicone does cost more. But, when saline ruptures, it’s like a tire going flat.”

Leave a Mark
Berman added, “Silicone implants come pre-filled, so you have to make a bigger incision on the lower part of the breast and can’t hide the scar as well.” Alternatively, saline implants require a smaller incision and are filled once placed inside the body. Therefore, saline implants offer the least amount of scarring on the breast.

In the debate over silicone versus saline, weigh the costs, consider the starting breast size and ponder the issue of scarring. All the doctors agreed that each patient’s personal situation varies but that both options prove safe.

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Five After Five
Cosmetic Surgery Patients Share Their Reports Five Years Later
By Carissa Sutherland

Plastic surgery practices won’t be closing shop anytime soon.

The American Society of Plastic Surgeons (ASPS) reports that nearly 2.5 million people in this region of the country received surgical cosmetic procedures in 2006. In other words, 25 percent of all plastic surgeries throughout the nation happened on the East Coast last year between Delaware and Florida. The West Coast’s plastic surgery popularity may take the cake, but the numbers don’t lie—our area of the country holds a close second. And, perhaps even more shocking, that number has more than doubled from just a million patients in 2002.

Of those million people who went under the knife five years ago, five of them from our area share their stories.

Vanessa Marulli Baltimore, Md.
“I was always insecure about the size of my chest,” Vanessa Marulli, 25, remembered. She wasn’t alone; 42,000 other women in the region opted for breast implants in 2002 as well.

Marulli’s surgeon, Dr. Adam N. Summers of Glen Burnie, Md., required two consultations. “At the first consultation we talked about the incisions, risks and complications, the long-term effects and the eventual need for implant replacements,” Marulli said. At the next consultation, swept up in excitement, she scheduled her surgery date.

But after the procedure, Marulli wasn’t out of the woods. Her left breast healed properly while her right breast stayed hard and high. Marulli had developed scar tissue under the implant. Three months after her original surgery, she had another surgery to remove the scar tissue. Though she was numb from local anesthesia, Marulli could feel the tugging, scraping and pulling. “It was very uncomfortable and at times painful, but in the end it was worth it because my breast healed correctly, and now it looks and feels great,” she said.

For others considering breast implants, Marulli advised, “Think about every complication possible and ask yourself if it’s worth the risk.”

Vicky Decker Sterling
The number of people receiving Botox nationwide quadrupled since 2002. Like millions of other women, Vicky Decker, 44, seized the opportunity to look younger. She hated maintaining her body with exercise while her face revealed her age.

After researching online and talking to friends, Decker chose to treat her brow furrow and horizontal forehead lines. She felt pleased with her results, which took only a day to kick in. “There’s a joke about Botox—that you become expressionless. I still make facial expressions, but they don’t involve my forehead. And that’s just fine with me!”

The effects of Botox eventually fade, requiring ongoing injections. Though many people swear by Botox, Dr. Christopher Hess, a board-certified plastic surgeon in Northern Virginia, warned against using Botox as a substitute for face or brow lifts. He said, “Injectables do good for a lot people, but they’re no replacement.” Future face lift or not, Decker intends to continue her quick Botox injections. “I look younger and I feel better,” she concluded.

Dylan Scholinksi Washington, D.C.
Since Dylan Scholinski’s childhood, he felt uncomfortable in his own body. Scholinski, 40, was born a female and endured years of agony for having masculine traits. At 18, he decided to begin living as a man. However, his breasts made this transformation difficult.  “Every time I looked at my body in the mirror, nothing fit or made sense,” he remembered. After years of hunching his back and wearing several layers of clothes, Scholinski chose to undergo chest reconstruction surgery.

Scholinski picked his surgeon, Dr. Michael L. Brownstein, based on reputation. “Dr. Brownstein is one of the best in the country,” he said. “He’d done this type of surgery many times and understood what I wanted.” Within an hour of flying from Washington, D.C. to San Francisco, Calif., where Brownstein is based, , Scholinski completed his initial consultation and had the procedure the next day. During the two weeks he spent healing in San Francisco, Brownstein addressed all of Scholinski’s concerns. His lengthy healing process prevented Scholinski from raising his arms over his head for over a month.

Looking back, Scholinski wished he’d dedicated himself to fitness before surgery to expedite his healing. In addition to exercise, he recommended “having a support system in place for physical and emotional recovery.”

Five years later, Scholinski remains pleased with the results of his surgery. “When I hug people, all of a sudden I can feel myself touching another person without all the layers covering up my body. That’s nice,” he said.

Jill Russell Alexandria
“I had heavy bat wings, like most of the women on my mother’s side of the family, and it was difficult to find clothes to fit over them,” said Jill Russell*. Both men and women have difficulty defeating upper-arm fat. Since diet and exercise sometimes aren’t enough, some people opt for an upper arm lift, called brachioplasty.

Russell and only about 1,000 other people in this area chose to have brachioplasty in 2002. Fed up with how she looked and felt, Russell, 50, surveyed several area doctors and chose Dr. Dean Kane. Kane’s high ratings in Baltimore Magazine as well as the size of his practice sealed the deal.

At her initial consultation, Russell and Kane discussed options for the best possible results. Russell already knew the traditional way to have the procedure, along the underside of the upper arm. However, Kane suggested a different way, through the armpit. “By coincidence, his wife had the same surgery and showed me her results,” Russell said. She was immediately pleased with what she saw and scheduled her surgery.

Though Russell remains pleased with Kane’s work, looking back, she might have done things differently. “Everyone should consider both the traditional and the armpit procedure. I might have had the traditional, even with the long suture, because the results are more even,” she said.

Elizabeth Gunthert Washington, D.C.
“I hated it when I smiled because one of my eyes would completely close,” Elizabeth Gunthert remembered. Gunthert, 25, suffered from a weakened eyelid muscle, and it not only affected her looks and self-confidence, but also her sight. “My eye drooped so much at the point of the surgery that it was affecting my vision.”

Gunthert’s eye especially drooped when she was tired. “My eyelid would become very heavy and uncomfortable,” she said. A specialist identified her issue immediately. Luckily, since Gunthert’s drooping eyelid affected her sight, her insurance company covered the costs of her procedure.

After the surgery, her sight immediately improved. “My eye no longer bothered me when I got tired, and I noticed a difference in pictures immediately.”

Now, five years later, she reflects upon the extended follow-up required for her particular situation. “For medical reasons, I couldn’t have waited any longer.  In a few years, I will probably have to do it again.”

Hess recommended visiting a few surgeons before selecting one. And, he noted, ensure the surgeon is a board-certified plastic surgeon. Dr. David E. Berman, a board-certified plastic surgeon in Northern Virginia, also noted that the best candidates for any type of plastic surgery maintain emotional stability, good health and realistic expectations. Dr. Anne M. Nickodem, another board-certified Northern Virginian surgeon, agreed. “It’s still a body image change, even if you’ve wanted it for years. What I do will make you feel more confident, and then you’ll feel stronger overall.”

(October 2007)

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It’s a Spa World, After All

Posted by The Editorial Desk / Monday, December 8th, 2008

By Sarah Markel

Day spas, those havens from the stresses of modernity, are no longer the preserve of the pampered few. Yet with new spas opening weekly in Northern Virginia, it is easy to become overwhelmed by selection. So we waded through the spas, non-spas and wannabe spas to find places where we would send our girlfriends, our mothers, our daughters and even the guys in our lives—Who knew research could be so relaxing?

The criteria were two-fold: the spas had to offer full-service facials, massage and waxing, and also be hip to the latest trends in detoxification, anti-aging and wellness. So here is the run down on the rub down: Twenty great spas. You choose which is right for you.

Healthy Aging
More than wrinkles come with age. As collagen in the skin breaks down, cells regenerate more slowly and the result is dull, sagging, often mottled skin. All spas provide anti-aging treatments these days, but these spas elevate growing old gracefully to an art form.

Fountains Day Spa
422 South Washington St., Alexandria
703-549-1990; www.fountainsdayspa.net
This Old Town spa is easy to miss if you are not looking—and their high-profile clientele prefers it that way. Owner Susanne Olsen keeps the faces of area celebrities camera-ready and advises on everything from nutrition to relaxation techniques. The Guinot Hydradermie facials are often combined with reflexology for what amounts to a full body intervention. Loyal customers bring their teens for skin care education and treatment. Boys have been known to sneak in the back door for their facials. They know Susanne won’t exfoliate and tell. Acupuncture and craniosacral therapy are also available.

Circe
123 North Washington St., Alexandria
703-519-8528; www.circedayspa.com
If you can’t get what you need at Circe, it is because you haven’t asked. Circe is a gem of a spa with a hip, but attitude-free, staff. The atmosphere is sociable. Owner Sheila McGurk is hugely into building relationships and teaching clients about the importance of mind/body wellness. The spa offers just about every form of massage therapy, including osteopathy, in addition to a full menu of anti-aging facials. Circe also provides creative extras such as a mobile spa for brides. This is the only area spa that uses the KineLase Non-Surgical Facelift, the photo-rejuvenation system that keeps Oprah and Jennifer Anniston looking gorgeous.

Sugar House
111 N Alfred St., Alexandria
703-549-9940; www.sugarhousedayspa.com
You feel noble just walking through the heavy doors of this breathtaking 1795 mansion. The Sugar House provides all the amenities of a large spa in a friendly, intimate atmosphere. Clients trust Sugar House to keep them looking polished and feeling peaceful. It is the home away from home for hundreds of women who book standing appointments up to a year in advance. On Mondays and Tuesdays Sugar House holds a medi-spa clinic with Gerrish & Associates, PC. Medi-spa services include Botox, Restylane, Fraxel, laser hair removal and Thermage skin tightening treatments. Sugar House also sells Obaji (by prescription only) and Philip B products.

PR at Partners
2900 South Quincy St., Arlington
703-998-6500; www.pratpartners.com
Need expert skin care—fast? Head to PR at Partners in Shirlington. This salon has two treatment rooms for facials and massages. Lots of salons do that, right? But two things make Partners special: They give lavish G.M. Collin facials, those pudding-like collagen masks that leave your skin baby-plump, and for hair removal they offer sugaring. Sugaring is your only option for last-minute hair removal because it doesn’t leave those embarrassing red streaks on your face (or worse). This friendly spa is a no-brainer for high-quality beauty reparations that won’t take all day.

Medical Spas
These days medi-spas offer a whole lot more than doctor-supervised injectables and peels. They combine compassionate support with centuries-old natural medicine in a soothing setting. Take control of your well-being.

The Medical Spa at Nova
21785 Filigree Court, Suite 100, Ashburn
703-554-1130; www.novamedspa.com
This is what a medical spa should be: Traditional medicine meets alternative therapy in a doctor-owned day spa. Because this beautiful spa is housed adjacent to a medical practice, patients can book services their doctors recommend without having to independently search for a therapist. Physicians and wellness practitioners collaborate in an effort to help patients improve their wellness. What could be more soothing than that? In addition to the usual medi-spa menu, Nova offers acupuncture, photo-rejuvenation and houses a naturopathic pharmacy.

Lofty Salon and Wellness Center
354 Maple Ave., Vienna
703-242-0609; www.loftysalon.com
Thinking of having a little work done, but don’t know where to start? Call Lofty. Owner Mona Harb has partnered with the Bitar Cosmetic Surgery Institute, to create a medi-spa/salon that provides everything from hair styling to massage therapy to surgical consultations. But beauty is more than skin deep at Lofty. This warm-hearted spa has a whole host of wellness services designed to help clients feel happy and healthy, including personal trainers, yoga classes, belly dancing, and life-coach consultations. The hand-holding is free.

Girls Night In—Brides and Showers, Too!
Spas are fun—and what better way to relax than to reconnect with the people you love? One of the biggest trends in the spa industry is the spa party. Most spas accommodate groups, but these spas make it their business to help you party pretty.

Elizabeth Arden Red Door
1101 South Joyce St., Arlington
703-373-5888; www.reddoorspas.com
Now that Tiffany & Co. sells affordable silver, the Holly Golightlys of the world go to Elizabeth Arden for that princess buzz. When they do, they bring their girlfriends. Arden does more spa parties than anyone and they have it down to a fine art. These “sparties” are so seamless that even the hostess can relax. The Red Door in Arlington, a relatively small spa for Elizabeth Arden, has hosted corporate sparties for up to 80 (using mini-treatments). For full-service treatment parties, consider eight to 10 guests. On Monday evenings at this location, sparty guests can have the spa to themselves at no additional charge.

Modern Day Spa
7856 Tysons Corner Center, McLean
703-356-6995; www.modernco.net
For a spa with numerous locations, the customer care at Modern Day Spa is second to none. Don’t let the waiting area deceive you—this is an expansive spa with a huge pedicure treatment room designed to host large groups. Modern serves wine and champagne to guests as they get pretty in comfort and style. They have an equally large relaxation room where tired mall shoppers are invited to sample products, drink tea and relax even without booking a spa appointment. You’ll come out smiling since Modern offers Zoom teeth whitening performed by a dentist in the spa.

Natural Spas
The trend these days is toward natural healing using essential oils, organic products, recycled materials and detoxification. Here are two spas that offer all that and then some:

Natural Body Spa + Shoppe
4100 Wilson Blvd., Arlington
703-243-4015; www.naturalbody.com
Relax with a clear conscience at these earth-friendly spas in Ashburn and Arlington. The Ashburn shop has only been open two months, but is already generating buzz because of its environmentally conscious building design (they’ve applied for LEEDS certification). Everything is recycled. The floors in the treatment rooms were school bus tires in a former life, which keeps the rooms warm and quiet. It’s the only wind-powered spa in the area. The retail shop sells an array of natural beauty products including Jurlique, the bio-dynamic line of rose-infused products from Australia.

Comfort and Joy
9514 A Main St., Fairfax
703-425-8800; www.comfortjoy.com
Open the door to Comfort and Joy and enter a restful world of chemical-free beauty. Owner Julie Smalfelt has created a spa that appeals to the general public and is safe for those with immunological issues or severe allergies. Even the water is triple-filtered. This is the place to go for formaldehyde-free manicures (that actually last), henna dyes and detoxifying wraps. Comfort and Joy also offers energy medicine, Thai yoga massage and Ayurvedic healing. Shop here for Suki products, and Amrita essential oils.

Creative Spa Experiences
Experienced spa-goers are always looking for novelty in their relaxation experience. While we didn’t uncover anything as weird as barbecue sauce massage—you’ll have to head out West for that one—there are plenty of local day spas offering unique services. Here are two that wowed us.

Ritz-Carlton
1700 Tysons Boulevard, McLean
703-506-4300; www.ritzcarlton.com
What isn’t great about the Ritz? The decor is stunning, everyone from the doorman up is gracious and the food is terrific. The Ritz-Carlton has long been a destination for brides thanks to their inimitable multi-day bridal packages. But they also have a marvelous spa luncheon. It includes a half-hour relaxation treatment, usually something that won’t ruin your hair, and a gourmet lunch served poolside. Just think how productive you’ll be after that heavenly experience. Members of the Ritz’s new fitness club receive discounts in the spa. On weekends and school holidays, teens love to come to the Ritz for their ice cream pedicures using Me! products.

McLean Face + Body
6707 Old Dominion Drive, McLean
703-761-0100; www.mcleanfaceandbodyspa.com
While most spas are growing, Maria and Randy Gould have decided to take theirs in the opposite direction. This sweet spa is two treatment rooms and a relaxation lounge decorated with Mark Mentzer originals—Mentzer is Maria’s brother. Book the Signature Three Hour Vacation with a friend or loved one and the spa becomes your own private oasis. Bring wine, order a meal—this is a place to uninhibitedly relax and reconnect. The treatments are completely customized. Athletes love Randy’s “tune-up massage,” a combination of Swedish, deep tissue, trigger point and hot stone. Maria’s signature facial is 70 minutes of “pampering with top of the line skin care.”

(May 2007)

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Local Heroes

Posted by The Editorial Desk / Monday, December 8th, 2008

Dentists Who Make a Difference

By Jan Maxwell

While most of us don’t look forward to visiting the dentist, there are millions of people around the world who would give anything to sit down in a dental chair. Coping with infected teeth and aching jaws, these people live in remote areas where the word “toothbrush” is not in their vocabulary. Many must wait for months, if not years, to get even the most basic dental care.

Fortunately, some of the most poverty-stricken areas of the world are beginning to get help as an increasing number of dental professionals step up and volunteer. From pulling teeth to providing much-needed dentures, volunteer dentists often work in primitive conditions to bring smiles to people who haven’t smiled in a long time.

Northern Virginia boasts a number of professionals who have reached out to help those in desperate need of dental assistance. From the water-logged streets of New Orleans to the mountain villages of Haiti to the under-served areas of our own state, dental volunteers from Northern Virginia have given up vacations and paid their own way to travel to places where the need is the greatest.

“I Just Want to Try and Make the World a Better Place.”

Dr. Michael Morch of Woodbridge has been providing volunteer dental services for over 10 years. Working primarily through Medical Missionaries, a group of physicians and dental professionals who travel to Haiti and the Dominican Republic each year, Morch has seen firsthand how poverty affects basic dental care.

Carrying portable dental units, Morch and his companions hike into the mountains, find a village and set up shop. Word spreads quickly that they have arrived and long lines rapidly form. One by one, patients take their place in the makeshift dental chair and have their aching teeth removed. On some trips, Dr. Morch and his companions extract over 1,500 teeth.

Preventative care is not an option in most third-world countries, since toothbrushes are virtually non-existent. Even fillings are rarely done.

“It’s too time consuming,” Morch said. “We see over 100 people a day, so all we have time to do is pull teeth.”

Dr. Gilbert Irwin, a Manassas physician who started Medical Missionaries over 10 years ago with a handful of doctors, was delighted to add dentists to his group.
“Before Dr. Morch and others came along, we had a urologist pulling teeth,” Irwin said.

In response to the increasing demand for help and to build continuity, Medical Missionaries has just finished building a permanent clinic in Haiti. In addition to providing much-needed medical assistance, the clinic will be able to provide both emergency and preventative dental care in a dedicated suite. 
“For the Few You Touch, it’s Everything”
Dr. Jeff Massie of Marshall wanted to provide volunteer assistance since dental school, and he finally got the opportunity with Medical Missionaries. In addition to the group’s annual trip to Haiti, Massie also tries to make a church-sponsored trip to Kenya each year. He relishes every moment that he is able to help someone, like the villager who got his first good night’s sleep in 10 years after he had a bad tooth extracted.

Like Dr. Morch, Dr. Massie finds that emergency care is all he can provide in remote locations.

“There is very limited electricity,” Massie said. “Even if I wanted to drill, I couldn’t.”

Once it is known that dentists are on their way, word-of-mouth advertising insures a steady stream of patients, including some who walk days for treatment.

“When we show up, there are already long lines of people waiting for help,” Massie said.

Because of the lack of trained dental professionals in third-world countries, Massie and others like him provide the only dental care that most of the villagers will see for some time. Getting equipment and supplies into some of the most remote regions is difficult, so Massie and his volunteer partners carry everything they need with them, and they use up all of their supplies before they leave.

Volunteering has become a very important part of Dr. Massie’s life. “I love it,” he said, “and I hope to continue as long as I can.”

Closer to Home
It’s not only third-world villagers who are in desperate need of dental care. Many Virginia residents often go without even the most basic services. That’s where organizations like the Virginia Dental Association step in. Through a variety of programs, the Association reaches out to the under-served population of the state, providing them with much-needed dental care.

Since its inception, the Mission of Mercy, or MOM project, has provided dental services to over 20,000 patients in under-served areas of the state. This outreach has broken records for the largest short-term dental clinics ever conducted in the United States.

Volunteer dentists also participate in “Give Kids a Smile,” a once-a-year opportunity for low-income children across the state to receive free dental services and Donated Dental Services, a program that allows qualified individuals to visit local dentist offices and receive treatment at substantially reduced rates.

The Virginia Dental Association reached out to a sister state last year. Over 40 dental professionals joined together to set up temporary clinics in Louisiana for the victims of Hurricane Katrina.

Information about all of these programs, and how to receive volunteer treatment, can be found at the Virginia Dental Association’s Web site, www.vadental.org.

Volunteer Clinic
Area residents who qualify can receive quality dental treatments at the Northern Virginia Dental Clinic in Falls Church. Although not all services are available, eligible patients can receive basic dental care at substantially reduced prices. The clinic is open to residents of Arlington, Fairfax, Loudoun and Prince William Counties, as well as the cities of Alexandria, Fairfax and Falls Church. Information about the volunteer clinic can be found at the Web site of the Northern Virginia Dental Society; www.nvds.org.

If you would like to volunteer your professional services, provide equipment and supplies, or make a cash contribution to one of these excellent organizations, please contact them directly.

Medical Missionaries
9590 Surveyor Court, Manassas; 703-361-5116; www.medicalmissionaries.info

Northern Virginia Dental Clinic
5827 Columbia Pike, Suite # 405, Falls Church; 703-820-7170; www.nvds.org

Virginia Dental Association
7525 Staples Mill Road, Richmond; 804-261-1610; www.vadental.org
Needs “gently-used” teddy bears/stuffed animals to distribute to children receiving dental care, equipment and supplies, or monetary contributions. Checks should be made out to the Virginia Dental Health Foundation.

(May 2007)

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A Frown Turned Upside Down

Posted by The Editorial Desk / Monday, December 8th, 2008

One Woman’s Adventure in Plastic Surgery

By Elizabeth Weiss McGolerick

On the corner of Dr. Csaba Magassy’s desk in his McLean office stands a miniature statue of Venus. The plump, fleshy icon, Roman goddess of beauty and love, is an anachronism in today’s Barbie-doll slim ideal of proportion and beauty. For Ann Boyer, neither the mythological nor societal vision of beauty makes any difference to her. “I want to be who I am,” she says.

The Mind’s Reflection
And who is Ann Boyer? Originally from Britain, she is a 59-year-old educational consultant who lives and works in McLean. She is also a devoted patient of Dr. Magassy, one of the region’s most highly-regarded plastic surgeons.

On the first of November, Boyer indulged in an $11,000 birthday gift from her husband. Her elected surgeries included liposuction of the arms, a facelift, an endobrow midface lift, and a neck lift. As daunting as her adventure may seem, this would not be Boyer’s first time under Dr. Magassy’s precise knife. “My first procedure was in February 2004. I had my breasts lifted and lower eyelids done,” she says. One year later she had liposuction to the tummy, hips, and thighs. “It changed my life completely.”

Boyer says she’s not one of those serial surgery people. “I think there comes a time when you have to say, ‘That’s enough’,” she says. “I knew what I wanted. It was really in order of importance for me. I lost a lot of weight at one point quite quickly and I had really saggy breasts. Very uncomfortable.”

Boyer wasn’t looking to conform to an ideal or to stand out from a crowd, she says. She simply wanted to feel better about herself. “I’m very tall and I’m never going to be stick thin and I don’t want to be,” she says, describing the level of confidence her surgeries have given her. “I know I’m nicely in proportion now. I want to wear what I want and know that I look nice. That’s really what it is.”

Boyer had her lower eyelids done because “everyone kept telling me I had bags under my eyes, and that I looked tired.” And then she decided to undergo facial surgery, because “when I catch myself in a photograph, if I’m not smiling the corners of my mouth go down. People mentioned that I looked so sad and I hate that.”

Under the Knife
Simon & Garfunkel wafts through the O.R. It’s 9:00 a.m. on a gloriously mild November morning when a not-at-all nervous Boyer enters Dr. Magassy’s surgery center for the third time. For the next five hours, to the tunes of Bob Denver and Frank Sinatra, and with a scrubs-garbed reporter in observance, Boyer gets sliced, injected, suctioned, scraped, compressed, sewn, stapled, and bandaged.

Very few instructions are given during the marathon surgery. Each person knows their role before, during, and after the procedure. An intervenous anesthetic puts Boyer under and the journey begins with liposuction of the arms. A new combination of laser and ultrasound techniques “melt away the superficial fat as well as the deep layer [of fat],” Magassy explains. This breaking up of tiers allows for easier suctioning during the procedure. Together, the laser and ultrasound also shrink the excess skin. Astonishingly, the desired smooth, tightened surface is already visible as recovery nurses work efficiently and with great care to clean and wrap Boyer’s arms after the procedure.

Facing Change
The bulk of surgery time—more than four hours—is dedicated to Boyer’s endobrow midface lift, face lift, and neck lift. Board certified as a general surgeon as well as a plastic surgeon, Magassy says, “I actually pioneered [the endobrow midface lift] here in the D.C. [area]. I’ve done a little over 1,200 so far.”

After injecting local anesthesia into Boyer’s scalp, brow, temples, cheeks, and under her eyes, several small incisions are made in her hairline. Magassy’s intricate endoscopic techniques—meaning minimal-incision surgery done while using a tiny fiberoptic lens for visualization—allow him to separate the skin of Boyer’s face from the skull, muscle, fat, and capillaries, and slide it up and back. This procedure lifts the face vertically rather than pulling the skin to the sides. “The endobrow midface brings out the artistic qualities [of cosmetic surgery],” Magassy says. “You can truly see what the difference is—the hollows are filled in and the whole face is pulled up. Very dramatic results.”

During the surgery, Magassy sears capillaries to reduce blood loss, removes the frown muscles between Boyer’s eyes, separates the periosteum from the skull (making a scraping sound no kinder than fork tines on a plate), and inserts dissolvable implants in the cheek to pull the face up.

Before Boyer’s neck lift, Magassy administers local anesthesia around her chin and ears. He liposuctions her neck and removes extra skin and parts of her lower earlobes, tightening the understructure as well as the exterior. Boyer’s profile is magically altered as Magassy’s quick, exact stitches are set in place.

The difference in Boyer’s face from the start of surgery to the finish is quite distinct. Her cheeks are higher, her forehead smooth, the corners of her mouth turned up, her neck an easy curve. There is no stretching of the skin or strained features. She comes out of surgery well-wrapped and looking a little rough, but Boyer’s procedures have already changed her dramatically.

Handled with Care
For Magassy’s bigger surgeries—and Boyer’s makes the grade—RN Connie Worley visits patients the following day at their home, checks their dressings, reviews instructions, and removes draining tubes. Worley likes to call herself the “Reassurance Agent.” She is the right-hand woman for Magassy’s patients, interviewing them before surgery and seeing them through recovery. “If a patient is going to develop a complication, it happens in the first 24 hours,” Worley says. The home visits are unique to Magassy’s practice and a terrific perk for patients, eliminating the painful step of visiting the doctor’s office a day after surgery.

Recovering the Self
“I feel like an Egyptian mummy,” Boyer says, five days after her surgeries. “My neck is incredibly tight and quite uncomfortable but I’m not complaining. I’m so grateful to Magassy. This is going to give me a new lease on life.”

Magassy keeps close tabs on Boyer over the next few weeks, removing the staples from her hairline and behind her ears, giving her a compression garment for her arms to replace the bandages, and even re-piercing her ears since the original holes were sliced away during surgery.

“They never know how painful [recovery] is going to be because everyone’s different,” Boyer says. One month after the surgery, all the bruising on her face had disappeared, some slight swelling remains on her chin and neck, and she is still experiencing a burning sensation in her arms. “The experience has not been without pain and some days have been easier than others,” she says, “but I believe I have made an excellent recovery and it’s been more than worth it. I am delighted with the changes I see. Very subtle and natural. I have a more youthful neckline suddenly. I can actually see better now that my brows have been lifted.”

Boyer’s advice for potential plastic surgery candidates? “The most important thing is having confidence in your plastic surgeon and knowing that person is going to make you look the way you want to look. You hear about places that give special prices and sales—you get what you pay for. I’ve read about disasters but, if you look into it, you’ll find [the patients] didn’t do their homework. You’ve got to go to someone who is board certified and very experienced. Even if they’re not as experienced as Magassy, you want somebody who has a good reputation. It all sounds obvious, but it’s amazing what people don’t do.”

Magassy’s Nurse Anesthetist Debbie Richardson echoes Boyer and encourages patients to investigate their plastic surgeon. “Ask a lot of questions, make sure they have a staff that have been working together for some time, and look for a doctor who does a lot of the procedure that you want to have done.”

A Chat with Dr. Csaba Magassy

Equestrian imagery and memorabilia from Dr. Csaba Magassy’s days as an Air Force Thunderbird decorate his spacious McLean office. The initial consultation begins here, doctor and patient sitting side by side, discussing what bothersome feature brought the patient in.  “I usually draw for them,” Dr. Magassy says. Using only pencil and paper, he’ll demonstrate how he can change the shape of a person’s face or body. Watching him, one realizes the man is an artist at work.

Board certified by the American Board of Plastic Surgery and in practice for 32 years, Dr. Magassy exudes confidence and possesses a gentle demeanor. “It’s a luxury service, cosmetic surgery,” Dr. Magassy says. Even so, “It takes a great deal of courage for a patient to come and see a plastic surgeon. I’m not here to destroy their ego.”

However, Dr. Magassy will tell a patient if his or her wishes are unrealistic, oftentimes suggesting an alternate course of action that, ultimately, gives the patient more “bang for their buck.” There are occasions when he is forced to turn people down. “Someone who is trying to look for nirvana—I know I won’t be able to accomplish that. They’re looking for something that’s unattainable,” he says. “But I would say 90 percent of the patients are fairly realistic in their approach.”

This solid patient base, from teenagers (mostly nose jobs) to the elderly, has helped to build Dr. Magassy’s sound reputation. The majority of his patients come from referrals and 30 to 40 percent are repeat patients. “I have a pretty good feel about what’s going on and a very good rapport with most patients. You just see them through and do the best you can.”

Surgeries begin in early morning—usually one or two majors a day—and take Dr. Magassy into the afternoon when he meets with patients. “After that,” he says, “I usually go and ride. I still compete in horseback riding. That’s my therapy.”

Don’t be Afraid to Ask Your Doctor

We’ve all been there: overwhelmed, in the doctor’s office, thinking we’d remember everything we wanted to ask. Meeting with a plastic surgeon is no time to skimp on questions. Take this list with you to your appointment and realize there is no query too big or too small when it comes to physically altering your body.

Are you certified by the American Board of Plastic Surgery (ABPS)?
What are your hospital privileges?
Is your facility accredited?
What experience do you have in performing this procedure?
What are the possible risks?
What is the expected recovery for the procedure?
What is your policy on surgical revisions?
How much will the surgery cost?

Nonsurgical Procedures

The definition of cosmetic surgery has broadened.  Find out what it takes to shave off a few years and reclaim a more youthful look—without surgery—and how it’ll affect your budget. Here are some of the most popular skincare and nonsurgical procedures available today.

BOTOX (AVERAGE COST: $382 PER PROCEDURE)
Temporarily paralyzes facial muscles and flattens wrinkles, particularly frown lines around eyes and on the forehead. Results: temporary; repeat treatments every 4 to 6 months

CHEMICAL PEEL (AVERAGE COST: $848)
Removes damaged outer layers of skin; smoothes and improves skin’s texture due to uneven pigmentation and damage from sun-exposure, acne, and aging. Results: long-lasting; may require more than one peel

COLLAGEN (AVERAGE COST: $398-488)
Treats fine lines and wrinkles, often around the mouth; creates fuller lips and softens scar tissue. Results:
temporary; repeat treatments every 3 to 6 months

LASER HAIR REMOVAL (AVERAGE COST: $347)
Disables hair follicles while sparing surrounding tissues; light-skinned, dark-haired candidates often fare best. Permanent hair reduction is possible. Results: ongoing; usually requires multiple sessions

LASER SKIN RESURFACING (AVERAGE COST: $2,484)
Minimizes appearance of fine lines and wrinkles; treats skin damaged by sun, acne, and age spots. Superficial burns allow new, smooth, wrinkle-free, living cells to replace dead skin cells. RESULTS: long-lasting; may require more than one treatment

MICRODERMABRASION (AVERAGE COST: $149)
Polishes away dead skin cells; promotes new growth and exposes healthier skin. Can diminish fine lines and wrinkles, unwanted skin pigmentation, sun damage, and acne scars. Results: temporary after multiple sessions in 2 to 3 week intervals

RESTYLANE (AVERAGE COST: $527)
Restores volume and fullness to skin to correct facial wrinkles and folds. Results: temporary; repeat treatments every 4 to 12 months

SCLEROTHERAPY (AVERAGE COST: $326)
Eliminates varicose veins; may remedy symptoms associated with spider veins—aching, burning, swelling, and nigh cramps.  Results: permanent; requires multiple treatments.

(April 2007)

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Migraines

Posted by The Editorial Desk / Monday, December 8th, 2008

More Than One Road to Relief

By Brenda M. Melvin / Illustration By Holly Camp

Like clockwork, the warning signs reappeared each spring—the intense pain on the side of her head, the muscle tightness in her neck, the waves of nausea that stopped her cold. Maria Hartnett winces as she thinks back to those dark days that comprised much of her adolescence and young adulthood—years marked by a desperate struggle with a chronic, disabling condition that afflicts millions on a daily basis. The usual symptoms: sharp, incessant throbbing on one or both sides of the head, nausea, vomiting, visual disturbances—called auras—and heightened sensitivity to noise and light. The culprit: migraine.

A 29 year old Crofton, Maryland mother of two, Maria Hartnett had her first encounter at age fourteen. Initially her headaches were limited to the spring. As she entered her twenties, however, both the severity and the frequency increased. For years, she endured multiple, often frightening, treatments and procedures in an effort to control the pain. She tried numerous pills, sprays, intravenous medications, even acupuncture. Nothing seemed to work for long. “I reached a point where the constant pain was so intolerable that I could not take care of my oldest child for several months,” she recalls. “As a mother, that just broke my heart.”

The Drug Debate: Just Say No?
Hartnett’s story is all too familiar to the more than thirty million migraineurs, mostly women, who regularly suffer from these crippling headaches and their debilitating side effects. While there is no universal cure, some find relief in varying degrees from medications, non-traditional or holistic remedies, or some combination of treatment options. After following the advice of four specialists with minimal success, Hartnett’s ultimate salvation was Dr. David Buchholz, Johns Hopkins University neurologist and author of Heal Your Headache: The 1-2-3 Method for Taking Charge of Your Pain. Hartnett recalls her surprise at Buchholz’ theory on migraine treatment: “He helped me understand that many frequently prescribed migraine drugs, all of which I had taken, actually cause headaches. He literally suggested that I flush those medications down the toilet!” The medications in question were triptans, a class of drug that is intended to reduce the swelling of blood vessels surrounding the brain during a migraine attack as well as block the release of substances from nerve endings in the brain that are thought to play a role in pain and other migraine symptoms, such as nausea. While Hartnett had experienced short-term relief with these drugs, as do other sufferers, Buchholz explained that their overuse can lead to “rebound headaches”—hence, a never-ending cycle of pain. Hartnett stopped taking the medications immediately.

Next, Buchholz encouraged Hartnett to modify her diet to avoid foods that can trigger headaches. This step required a radical lifestyle shift, as Hartnett set out to eliminate caffeine, processed deli meats, citrus fruits, nuts, cheeses and any foods containing monosodium glutamate (MSG) and other nitrates. “I had to learn how to read labels and cook from scratch,” she laughs, relying on staples from Whole Foods and Trader Joe’s to come up with safe, enjoyable meals. Buchholz also stressed regular exercise and at least eight hours of sleep every night.

For Hartnett, the prescription worked. With her “headache diet” and sleep and exercise program in place, she began to notice positive results within a few months. Today, her migraines are many fewer and far less severe. In consultation with Buchholz, she will determine whether or when preventive non-triptan medications are appropriate to sustain her progress. In the meantime, she is thrilled with her happy ending: “I was recently able to have a second child—something I previously would not have considered due to massive headaches during my first pregnancy and frequent struggles thereafter. It has finally been brought under control!”

While Hartnett’s success is tied to major lifestyle changes, there is no doubt that many migraine specialists and their patients continue to rely on drug therapy for headache relief. “I find that rescue medications (triptans) work well for about 80 percent of migraine sufferers, particularly if taken at the onset of the headache,” says Dr. Stuart Stark of the Neurology and Headache Treatment Center in Alexandria. He adds that early action generally results in relief within two hours, and medications taken in injectable form tend to work even quicker than pills and nasal sprays.

Alternative Techniques: Is Tapping the Answer?
Emotional Freedom Techniques, or EFT, have been utilized by certified practitioners to help individuals achieve holistic wellness in a number of areas. The techniques help users eliminate undesirable habits like smoking and overeating, reduce fears and manage pain and stress. “The theory behind EFT is that negative emotions are caused by disruptions in the body’s energy system,” explains Mary Bonnet of Bonnet Unlimited Potential in Herndon. The process involves using two fingers to tap fourteen points on the body—usually on the head, the upper torso and the hand. The tapping sequence is based on the issue the individual is trying to resolve and is intended to move energy, or chi, through the body. To help focus, the individual also repeats a set of phrases as they are tapping. For example, a migraine sufferer might say: “Even though I have a sharp pain behind my right eye, I love and accept myself.” If the pain shifts, a different phrase is used. Bonnet is able to teach her clients the process in about three sessions of 60 to 90 minutes each, either in person or by phone. Depending on the severity of the case, clients can experience some relief immediately and see more sustained results in a matter of weeks. As a preventative measure, she encourages them to do at least a couple of rounds of the technique each day to maintain progress. For clients who begin tapping while they are on migraine medication and experience relief, she advises that they consult their doctor before stopping the medication. Sound unbelievable? Bonnet has heard it all, and encourages naysayers to give it a chance. “You don’t have to believe up front that EFT is going to work, but you have to be open to the possibility.”

Jan Williams is a believer. A migraineur for several years, the Vienna resident had tried many of the usual strategies—medications, lying quietly in a dark room, chiropractic treatments—to no avail. Her daughter consulted Bonnet on her behalf. “I really wasn’t aware of EFT before Mary introduced the technique to me, and I was a bit skeptical but willing to try,” Williams recalls. In the midst of a headache one day, Williams was unable to leave her work station but craved relief. Bonnet, who worked nearby, arrived and worked with her at her job site. “I still wasn’t seeing how tapping could relieve my nausea and migraine pain, but I started feeling results within ten minutes. It was amazing!” Today, Williams rarely experiences migraines, but at the slightest hint of a headache she starts tapping the designated points while repeating her statements in her head, and she is usually able to stop the symptoms right away. “I really don’t want to be on any prescriptions for migraines and I am very grateful that such a simple exercise can work for me. More people could really benefit from this technique if they were just willing to try something a little different. Relief is just a tap away!”

What’s New?
Stark is encouraged by studies of the drug Trexima, which proposes to combine sumatriptan succinate (marketed as Imitrex) and naproxen sodium in a single pill with the hope that migraineurs will experience better, quicker results than they would achieve from taking either drug separately. (Note: final FDA approval of Trexima was still pending at publication date.)

There are a number of nerve stimulators, or implants, currently being studied to determine their effectiveness in treating migraines. The website ScienceDaily.com reports that occipital nerve stimulation (ONS) has shown to be a safe and effective treatment for chronic headaches in clinical trials. The treatment involves implanting a neurostimulator under the skin at the base of the head. The device delivers electric impulses near the occipital nerves through insulated lead wires tunneled under the skin.

Stark adds that the Vegas Nerve Stimulator, originally designed to treat epilepsy, is also being studied for potential use among migraineurs.

Surprisingly, there may be a role for Botox in the fight against migraines. The popular cosmetic quick-fix has been tested on sufferers with varying degrees of success, and continues to be the focus of clinical trials related to migraine prevention. Last fall, research funded by the American Society of Plastic Surgeons further advanced the Botox connection and made a case for surgery as a route to migraine relief. Study patients were given Botox injections to pinpoint the muscular source of their migraine triggers. Those who experienced an improvement in their symptoms post-Botox were selected for surgery to remove portions of muscle or minor nerves in the targeted areas in an effort to relieve the nerve compression and inflammation that generally accompanies migraine episodes. One year after surgery, a remarkable ninety percent of the patients reported a significant decrease in frequency and intensity, and in some cases complete elimination, of migraines. Sufferers who experience severe headaches at least three times per month and those who do not respond to or cannot take medication are potentially ideal candidates for surgical intervention.

For adolescents aged 12 to 17 who suffer from migraines, treatment options have been somewhat limited as most triptan medications are FDA-approved only for use by adults over 18. Imitrex nasal spray has been the sole exception. However, the National Migraine Association has reported that clinical trials are underway to test the tolerability and effectiveness of other triptans in this age group. In a recent study of the drug Axert, participants experienced significant pain relief and a reduction in two out of three migraine-associated symptoms two hours after dosing, and the medication was well tolerated. Additional trials aimed at this patient population are planned.

Self-Care: A Refresher
No matter what path a migraineur chooses to follow in search of relief, experts agree that there are a number of “back to basics” self care strategies that can help: Keep a diary of your triggers. Identify and track the conditions (foods, events) that most often precede migraines and what relieves them. “You may encounter a trigger up to 48 hours before a headache begins. Your diary may reveal patterns that hadn’t been spotted before,” explains Teri Robert, Support Advisor for the National Migraine Association. In women, hormonal fluctuations have been shown to trigger migraines. These include changes in estrogen levels that occur around the menstrual cycle and during pregnancy, as well as effects associated with the use of birth control pills or other hormonal therapies. Female “menstrual migraine” sufferers will generally see a progressive improvement, in terms of a decrease in the frequency and severity of migraines, at or near menopause.

Learn stress management and relax to a headache. Consider meditating, light stretching, or sitting quietly to recharge and center yourself. Watch what you eat and drink. Avoid foods that trigger migraines.

Eat small meals more often to moderate blood sugar levels, and stay hydrated. And stick to a regular sleep pattern. “Too much, too little, or disrupted sleep is a very common trigger of headache,” Robert warns.

He recommends limiting stimuli during an attack. Apply cold compresses to painful areas. Lie in a dark, quiet room.

Massage your scalp and temples and try to fall asleep. Staying educated is extremely important.

“We need to understand our condition to be able to care for ourselves. We need to avoid episodes when possible, and to try and lessen their impact when they can’t be avoided.

We live with these bodies 24/7, so it’s very much up to us to make our own treatment decisions.”

Where to Turn for Help

Northern Virginia Treatment Facilities:

The Neurology & Headache Treatment Center
4600 Kenmore Avenue, Suite 900, Alexandria
703-212-0700; www.neurologychannel.com/neuroheadache

Kaplan Clinic
5275 Lee Highway, Suite 200, Arlington
703.532.4892; www.kaplanclinic.com

Neurology Center of Fairfax
3020 Hamaker Court, Suite 400, Fairfax
703-876-0800

Additional Resources:

MAGNUM
The National Migraine Association
113 South Saint Asaph Street, Suite 100, Alexandria
703-349-1929; www.migraines.org

American Council for Headache Education
19 Mantua Road, Mt. Royal, NJ
856-423-0258; www.achenet.org

National Headache Foundation
428 West St. James Place, Chicago, IL
1-888-NHF-5552; www.headaches.org

World Headache Alliance
www.w-h-a.org

(March 2007)

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Top Doctors 2007

Posted by The Editorial Desk / Monday, December 8th, 2008

Northern Virginia and environs could be considered an embarrassment of riches in terms of excellent medical care, yet one can be at a loss to identify physicians with superb credentials, experience and reputation when such things really matter. On these pages you’ll find 100 practitioners who excel in 33 fields of specialty. We profile seven of them. Culled by independent, physician-led research firm Castle Connolly, these physicians are not only highly regarded by their peers, but carefully vetted and selected. Come meet our top doctors. They are among the best in the nation.

By Sarah Hamaker, Sarah Markel, Brenda M. Melvin and Jan Maxwell
Photography by Anastasia Chernyavsky and Morgan Howarth

At The Top of His Game
Dr. Gary C. Dennis

Surgeon. Teacher. Researcher. Policy Advocate. Dr. Gary Dennis is a veritable renaissance man. “I like to perform surgery that makes a dramatic difference for the patient,” says Dennis, Chief of the Division of Neurosurgery at Howard University Hospital and Associate Professor of Neurological Surgery at Howard University College of Medicine.

One need only peruse Dennis’s case files to see a man at the top of his game. There’s the case of the 17-year-old who, crop dusting with his father, disembarked from their helicopter, whence its propeller lopped off a third of the back of his head. Dennis and his team worked all night on delicate reconstruction of the blood vessels and cranium. The patient walked out of the hospital three weeks later.     There was the bedridden octogenarian who wanted to regain mobility, and though surgery at her advanced age is considered risky, Dennis agreed to perform the spinal procedure. The plucky 96-year-old poker wiz is eternally grateful. Then there was the man with tuberculosis of the spine who was almost completely paraplegic. Dennis operated to de-compress the spinal cord, and today the patient is fully mobile with no neurological impairment.

The list goes on.

Early Influences
Dennis’s exposure to neuroscience began with a motorcycle accident when he was 17 years old and treated by a neurosurgeon for head injury. “The tests were impressive yet rudimentary compared to today’s technology, but it was enough to pique my interest.” As a student at Boston University, Dennis participated in research involving Rhesus monkeys, where electrodes were neurosurgically implanted into monkeys to stimulate their brains. Researchers would record their responses and evaluate their ability to learn and perform tasks. The neurosurgeon made a major impact on the students, Dennis says. “When he came in, it was like Moses parting the Red Sea. I said to myself, ‘that is the person I want to be.’” Dennis chose Howard for medical school, thinking he would pursue a career in psychiatry. He delved into Freud’s Interpretation of Dreams and even learned hypnosis. In the end, though, his affinity for neuroscience won out. “I found clinical work fascinating and I decided that I no longer wanted to be a bookworm. I wanted to be a clinician.”

Dennis completed a general surgery internship at Johns Hopkins and trained in neurosurgery at Baylor University, in one of the nation’s busiest trauma centers. A few years later, he was lured west for a faculty position at the University of California, San Diego.

Coming Home
Born in Washington, D.C. Dennis retained a soft spot for his hometown. When presented with the opportunity to become Chief of Neurosurgery at Howard, he says he couldn’t refuse. He moved back in 1984.

“Neurosurgery is an area that is very intricate. Many medical students shy away from it because they think it’s too hard. I wanted to give back to the community by teaching students and residents how to become successful neurosurgeons.”

Dennis is proud of his involvement in a mentoring project for gifted students at D.C.’s Benjamin Banneker High School. Those considering a career in medicine, students are paired with doctors to learn more about their fields; they sit in on medical school lectures and observe surgical procedures.

The Wonders of Technology
Dennis marvels at recent years’ major advances in neuroscience. “Neuro-imaging has improved astronomically.” We can see very clear pictures of the brain using sophisticated new diagnostic tools, and MRIs and CAT scans generate images of the nervous system that can be viewed remotely, by email, he says. “A doctor can see the problems a patient might have without actually being present.” Techniques such as real-time visualization allow operating surgeons to determine where they are in a patient’s brain compared to where they think a tumor is located.

Dennis hopes neurosurgeons will soon be able to employ three dimensional imaging technology to perform surgery remotely using controlled robotics.

With such advances, surgical procedures will become less invasive, he says, resulting in a safer patient experience, less hospital time and shorter recovery period. “It will be possible to perform major miracles without having to do extensive operations. This will be true for both brain work and spinal work,” he predicts.

Ongoing Research
Though he has taught and practiced neurosurgery for years, Dennis hasn’t lost his passion for research. Partnering with a neurophysiologist colleague, he is studying the respiratory center of the brain stem. Together they have looked at things such as the effect of cocaine use on the brain—in an effort to develop treatment that can prevent patients from dying from overdoses.

The improvement of patients with spinal cord conditions is another project to which Dennis devotes significant time and attention.

Dennis writes and speaks widely about health care disparities—the unequal access to health care experienced by various ethnic groups, minorities and social stratum.

He has secured funding for a comprehensive study on the issue; has chaired various political action committees, and has testified before the D.C. City Council on matters related to the health of city residents.

A Day In The Life
Dennis walks the talk when it comes to diet and exercise issues. The doctor’s day begins with a 5:30 a.m. workout followed by a light breakfast where he tries to fit in the first of nine daily servings of fruits and vegetables. In his office by 7:00, he operates two days a week and sees patients three days a week.

On the days he’s not scheduled for surgery, Dennis tries to spend the first two hours of his work day reading. To hear him speak of it, these hours are sacred. “I like to read when I can see the sun when it rises and hear the birds sing. I get a lot of work done during this period.”

Dennis starts seeing patients at around 9:00; a full day may consist of 25 appointments. Then it’s on to student lectures, “consults,”  committee obligations and the inevitable emergencies that arise. Dennis tries not to operate for more than eight hours and handle no more than three cases in a day. “On a good day, I’m home by six.”

So, what does the good doctor do to unwind and stay sane? “I have a strong belief in God, I love my wife, and I love music. A good jazz concert usually makes my day.” Dennis is an accomplished violin player, part of a group of doctors and other healthcare professionals who perform regular gigs at the University of Maryland in Baltimore. —Brenda M. Melvin

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Steady Hand, Warm Heart
Dr. Alan Egge

In the highly unlikely event that ophthalmology doesn’t workout for Dr. Alan Egge of Dominion Eye Care in Manassas, he may well have a future in journalism. It was only when I was well into the not inherently interesting story of how I financed my education that I realized how skillful he is at putting people at ease.

Sure, Egge (pronounced Eggy) has performed over 7000 successful eye surgeries using both laser and microscopic technologies. But his real gift is in getting his patients to relax enough to forget that he is about to operate on their eyeballs.

Despite the ubiquity of modern eye surgery, Egge practices a difficult art. During microsurgery, he operates within a tiny field, using even tinier instruments, while looking through a microscope. He cuts open the cornea. Egge’s work requires tremendous concentration, which he describes as “being mentally in the room with the patient at all times.”

This intense concentration is something he honed as a coping mechanism during an emotionally brutal pediatrics residency at the University of Chicago during the late 70s.

During a subsequent ophthalmology residency at the Doheny Eye Institute at the University of Southern California, Egge found that concentration equally useful in microsurgery.

Today Egge is a board-certified pediatrician and an ophthalmologist with a 20-year-old practice in Manassas and Warrenton.

Although he doesn’t practice pediatric ophthalmology, an advanced sub-specialty, Egge often treats children at Dominion Eye Care because the population of children in Northern Virginia is growing faster than the number of local pediatric ophthalmologists, he says.

Egge also treats uninsured children at the Manassas Free Clinic where he volunteers on Thursdays as a pediatrician. Most of his patients are there for basic primary care such as colds, rashes and flu.

The best part of his work, Egge says, is the ability to provide both ends of the spectrum of medical care. Egge relishes the opportunity to practice advanced surgery, and he clearly enjoys the patient interaction involved in primary care.

“It’s a good mix.”

He smiles easily.

Dominion Eye care has grown with the region. Egge credits his local success to the fact that two decades ago, Manassas was similar in feel to his native town of Sumner, Washington (pop. 3000). “I don’t know that I could have made it in a city,” he muses.

Alan Egge is married to Kathleen Cox, the former head of the Corporation for Public Broadcasting.

They live in Fairfax and have four children. —Sarah Markel

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When Knowing is Strong Medicine
Dr. Claudine Isaacs

Women at high risk of breast cancer used to live under a black cloud of dread. Today, doctors are using the knowledge gained from genetic testing to fight breast cancer. And the clouds are lifting.

In my experience, cancer centers are not pleasant places. They are whispering, metallic-smelling other
worlds where fear lurks and mothers grow old before your eyes.

But the Lombardi Comprehensive Cancer Center at Georgetown University seems different somehow. Teeming with doctors and students, it seemed brighter; less a place of darkness than of possibility.

“Call me Claudine,” is the first thing the director of the Clinical Breast Cancer Program, Dr. Claudine Isaacs, says as she appears, smiling, through a passing throng of students.

Isaacs is one of those super doctors; besides being a pioneer in clinical research, she teaches medicine and oncology and sees cancer patients in the clinic two days a week.

Her office is what you would expect of an academic. Piles of documents are neatly stacked on desks and tables. An incongruous calendar of European castles hangs on the wall—a gift from her two sons, eight and eleven.

Isaacs’ work at the Lombardi Center involves using clinical trials both to study the genetics of breast cancer and to learn more about ways of treating it. She is changing the way others look at the disease.

In the 14 years since coming to Georgetown Hospital from her native Montreal, she has published over a hundred articles and papers on breast cancer, genetics testing, and counseling.

Isaacs is a tireless speaker on issues of hereditary breast cancer, and an irrepressible advocate for the power of genetic testing to transform lives.

Much has changed since the genetic abnormalities that predispose a person to breast cancer, BRCA1 and BRCA2, were identified in the early nineties. “We used to sit across from high-risk patients and we had so little in the way of data to offer them,” she recalls, speaking of the close team of
genetic counselors and behavioral scientists with whom she works.

Isaacs describes the worry that high risk patients used to live with.

I know that black cloud of dread well.

Today people who are found to be BRCA carriers have a handful of good options for reducing their risk of actually getting cancer. And if they do get cancer, better screening has increased the chance that it will be found early and successfully treated. During those years of assessment and evaluation, relationships form. Friendships grow.

Isaacs tells the story of “Sue,” who came in for a consultation a decade ago because her sister had tested positive for BRCA1. As a young mother of three, Sue was scared, although less for herself than for her daughters’ future.

Isaacs encouraged her to undergo genetic testing. And when the tests showed that she too had the genetic mutation, Isaacs recommended removal of her ovaries, which has been found to be an effective option for reducing the risk of developing breast cancer.

Sue agreed to the surgery. Years passed. She continued to see Isaacs for follow-up and to take part in cancer studies. One such study compared the relative effectiveness of mammogram, ultrasound and MRI as screening tools for cancer.

No one expected to find anything. Sue’s chances of getting breast cancer had been reduced 50 percent by the surgery. Plus she was still young. The mammogram and ultrasound came back clear, but the MRI showed a tiny irregularity.

It was cancer. She had her chemotherapy at the Lombardi Center. Today, Sue has had five cancer-free years. To her daughters, now teenagers, and with the help of Isaacs, Sue is passing on some hard-won knowledge.

According to Isaacs, genetic testing can provide information that makes a huge difference in the types of care available to patients. And it changes families.

Sue still participates in cancer studies. She looks upon her involvement in the MRI study as life saving. “You are my guardian angels,” she tells Isaacs and her colleagues.

“A good day,” says Isaacs, “is when you make a difference in some else’s life. That was a good day.”

Near the end of the interview I tell Isaacs that my mother has breast cancer, her second relapse.

She nods thoughtfully and asks several questions about our family history. She doesn’t say “oh-my-God-I’m-so-sorry” and look at me with pity the way most people do.

Instead, she encourages me to talk with my mother about genetic testing, and to be honest with her about my fear. Basic stuff, really.

As I leave the interview and walk across the campus, my step is lighter. I kick at the fallen leaves, not just because the interview has gone well, but because she made me see that breast cancer is just a disease. It isn’t a death sentence. —Sarah Markel

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Breathing Lessons
Dr. Steven T. Kariya

Trying desperately to save patients while tuning out the constant ringing of gunfire can be a real challenge for a young doctor, a lesson learned by pulmonologist Steven Kariya during his days as a volunteer assigned to tend to Cambodian refugees. Indeed, the road from Thailand to Silver Spring, Maryland has been a storied one for this lung and respiratory disease specialist, who now runs Pulmonologists, PC, and serves as Medical Director of Respiratory Therapy at Holy Cross Hospital in Silver Spring.

Kariya received his Bachelors degree from Harvard College and his M.D. from Cornell University Medical College. “I think of myself as an applied physiologist, one who thinks about how the body works overall and uses this insight to educate and treat patients,” says Kariya. His decision to specialize in pulmonary care was the result of having asthma as a child and having mentors during his training years who were pulmonologists. “The practice of medicine is an honorable profession that allows me to help people in spite of the bureaucracy that is often involved. Sadly, [respiratory disease] is a growing problem. People are sicker, smoking is on the rise among many groups, and patients often suffer from chronic illnesses as they age.”

Kariya’s cases run the gamut from common sleep disorders to some of the rarest forms of lung cancer. While many of us take a good night’s sleep for granted, people who suffer from a condition known as sleep apnea actually stop breathing, or underbreathe, in their sleep several times in a night.

Kariya has apnea patients go through a lab-based sleep study to observe their sleep patterns and confirm the diagnosis. A typical treatment requires the individual to wear a continuous positive airway pressure (CPAP) mask that blows air into the nose to keep the windpipe open—an effective, fairly simple remedy for a serious problem. Non-treatment of sleep apnea can lead to high blood pressure, heart failure or stroke.

One of Kariya’s more complex cases involved the decade-long journey of a patient to whom he recently had to bid farewell—in a good way. Kariya met the woman ten years ago and diagnosed her with cancer of the windpipe, right where the right and left lungs divide. He consulted with a thoracic surgeon who performed a unique operation to remove the cancer and repair the windpipe. Following surgery, the patient literally had her chin sewed to her neck for a week to restrict movement and ensure proper healing. Thereafter, Kariya saw the patient annually for ten years to perform a broncoscopy, a procedure in which a fiber optic tube the diameter of a pencil is inserted into the windpipe to look for signs of cancer. Happily, the patient reached her ten year mark with no signs of cancer, and she was officially “fired” by Kariya.

Despite the long hours required by his critical care practice, Kariya manages to find time for community involvement. He helped establish the nonprofit Northern Virginia-based Campbell Hoffman Foundation, which seeks to increase access to healthcare for the underserved.

When he’s not on call, look for him on the soccer field where he is likely putting his son’s team through the paces for their next big match: “It’s hard work, and I can’t bill the hours, but I enjoy it!” —Brenda M. Melvin

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Guts and Glory
Dr. Fredrick Brody

If Top Gun had been about gastrointestinal surgery, it would be easy to see Dr. Fredrick Brody of George Washington University in the role of Maverick.

Brody’s handsome, self-confident and smart as, well, you know.

At 40, he has already published a mountain of articles on gastrointestinal surgical procedure. He has contributed to books, starred in educational films, and is at the forefront of cutting edge research to unravel the science behind chronic obesity. He doesn’t go in for small talk.

“I have four favorite types of surgery,” he says at a clip, as soon as we begin the interview, “but I really like to do foregut.”

It’s late afternoon and Brody’s been in surgery since dawn. He’s blowing on a cup of tea and talking fast.

Foregut is stomach and esophagus, he explains.
Now he’s describing his other favorite surgical procedures: “Achalasia, esophageal or GERD, and gastric, especially when it’s gastro-peresis and we have to use electrical stimulation.”

I can’t spell half of what he’s talking about and he knows it. He slows down and explains that 75 percent of his work involves laparoscopic surgery: “Big surgery, small incision.” The benefits of laparoscopy are less pain for the patient and faster recovery time. The rest of his surgical time is divided between big incision gastrointestinal surgeries, and bariatric work, which includes any kind of surgery to treat obesity.

The bariatric work, he says, is a very small part of any given day, but it’s hugely important because of a project he’s spearheading. It’s called the Bariatric Surgery Program.

Brody isn’t just interested in solving obesity problems, he and a close team of three surgeons, several nurse practitioners, plus a host of other physicians, including cardiologists and pulmonologists, are working together to try to figure out the genetic mechanisms behind the condition.

This intersection of the academic and the clinical is called Translational Medicine. But call it what you will, it is a tough business—fighting for funding, collecting and analyzing data, and publishing findings.

This is in addition to seeing patients, teaching, surgery, and managing a practice. Members of the medical faculty are not employed by the university and are essentially independent contractors. That’s why Brody has an MBA and no time for hobbies.

There’s a set of tiny pink albums on his desk. I ask if he gets tired during surgery.

Nope.

Lose your concentration?

Nope.

He follows my gaze to the albums. “She’s a good baby.”

He describes how during surgery the adrenaline surges through you with such force that no matter how tired you may be, concentration is not a problem. Then when you go home, you crash.

So surgery is a Zen-like experience?

His eyes roll upward behind the still steaming tea. Nope.

For crying out loud, Maverick, help me out here, I wail inwardly.

And at this point, Brody seems to understand that I am just not getting it. How can he lead such a grueling and intellectually demanding professional life and remain so cool?

Leaning forward, he says, “to excel at anything, you have to love what you do. Sure, it’s a constant juggling process—the phones, the papers, pre-op, post-op, patients, residents, students…. But, it’s a dynamic field. There is always something to learn.” He gives the tiniest of shrugs and grins. “And it’s really fun.” —Sarah Markel

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The Art of Neurology
Dr. Ruben Cintron

The mysteries of the human brain have fascinated scientists for centuries.  Although it weighs only a few pounds, the brain contains over 100 billion cells that process and transmit information, controlling everything from breathing to vision to thought. Unlocking its secrets can lead to medical breakthroughs, and one of the people most interested in doing that is Dr. Ruben Cintron of Reston.

Cintron is a neurologist, a doctor who diagnoses and treats nervous system disorders, including diseases of the brain, nerves, muscles, and spinal cord.  As part of his daily practice, Cintron tests muscle strength, balance, speech, and other cognitive abilities in patients who suffer from a wide variety of these disorders. Once a diagnosis is made, he sets about finding the right mix of drugs and therapy for each situation.

A normal day may find Cintron treating patients with a range of illnesses, from migraines to brain tumors to degenerative disorders such as Lou Gehrig’s disease and Parkinson’s.  Although multiple patients may suffer from the same disease, each case is unique.  “You can’t write a computer program to evaluate a neuro case,” says Cintron. “They are all different.”

Cintron received his B.S. degree from Wake Forest University in Winston-Salem, North Carolina in 1986. He went on to Wake Forest’s Bowman Gray School of Medicine, where he graduated in 1990. It was during those four years of medical school that Cintron developed interest in neurology.

“I read the book, The Man Who Mistook His Wife for a Hat, which was written by a neurologist named Oliver Sacks. In the book, Sacks described some very interesting cases, and I became absorbed by the unknown territory of the brain.” Cintron began to pay close attention to the neurosciences and realized he had found his niche. “It’s a great specialty, as we see a large variety of disorders and no two patients are the same.”

When he completed his internship at Washington Hospital Center in D.C., Cintron moved to Georgetown University Hospital, where he began a three-year residency in the Department of Neurology. There he was involved in Parkinson research, testing a new synthetic drug that gave extended relief to patients. The study was a success, the drug received FDA approval, and it has been on the market for several years.

After completing his residency, Cintron felt that he had not had sufficient exposure to neuromuscular disorders, so he stayed at Georgetown for another year as a Fellow in Neuromuscular/EMG medicine. One of the neuromuscular diseases that fascinates him is Myasthenia Gravis, an autoimmune disease that attacks muscles and creates weakness. It can be hard to detect since screening tests are often normal.

“Sometimes you have to treat the patient to make a diagnosis,” says Cintron. A woman suffering from Myasthenia Gravis came to see him after a major university program had told her that her symptoms were psychological, rather than physical. After examining her, Cintron disagreed and treated her with a therapy that slowed down her immune system. She had dramatic improvement.

Cintron sees many patients who have chronic, ongoing diseases. These illnesses take a toll on the whole family, not just the patient and Cintron sees his role as supporting the entire group. “When people develop a chronic neurological problem, I get to know the families as well as the patients. I have the opportunity to help them all as they struggle over many years.”

Carol Welsh is one such patient. She is a six-year survivor of an adult ependymoma, a rare brain tumor, and has been with Cintron throughout most of her disease. “Dr. Cintron is terrific, kind and generous. I wish all doctors could be like him,” she says.

Raised in Northern Virginia, Welsh was looking toward a bright future until the day in 2000 that doctors discovered her brain tumor. Unfortunately, the tumor was attached to several cranial nerves on her brainstem. These nerves are the source of a person’s ability to see, chew, move and hear, among other vital processes. Three brain surgeries left her cranial nerves damaged. She now faces problems with headaches, balance, swallowing, double vision, and debilitating pain.

Cintron helps her make it through each difficult day. At a typical appointment he will do neurological testing and then decide on the optimal blend of drugs that will make Carol the most comfortable and give her the highest level of functionality. He also helps her translate the highly technical reports she gets from her neurosurgeons. Welsh appreciates the fact that Cintron does not sugar-coat the truth. “He is low-key and realistic about things. I really appreciate his empathy and good sense of humor.”

As we begin the 21st century, Ruben Cintron sees breakthroughs ahead in neurology. He is impressed with the work being done in genetic engineering, where infusions could help genes make proteins that might correct a variety of disorders. Cintron is also an advocate of stem cell research, where healthy stem cells could be programmed to replace diseased cells in patients who suffer from diseases such as Parkinson’s. In both areas, critical work is now underway in research centers around the world. “The future is already here,” says Cintron, and he’s excited to be a part of it. —Jan Maxwell

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Nurturing the All of Them
Dr. Elizabeth Anderson

Dr. Elizabeth “Beth” Anderson is so well-liked in her internal medicine practice that a patient once wrote a poem for her. “I’ve been very fortunate to have lots of patients who have touched my life,” she says.

“I’ve wanted to be a doctor for as long as I can remember,” says Anderson. “I simply never wanted to do anything else. That single-minded desire and true passion for caring for the sick has sustained me through many obstacles—be it histology lab, which I hated, or managed-care restrictions, which drive me nuts!”

Her background includes degrees from Emory University (BA) and East Carolina University School of Medicine (MD), as well as residencies at both Georgetown University Medical Center and George Washington University Medical Center in Washington, D.C, and a research fellowship at the Veterans Administration Medical Center in Washington, D.C. Anderson first had a surgical residency and then transitioned to an internal medicine residency for a total of seven years’ worth of post-medical school training. She met her husband, got married and gave birth to her two children while doing her residencies. “Residency was probably the toughest part of my preparation,” she says.

Anderson’s medical focus these days involves the development of atherosclerotic [a degenerative disease of the arteries] complications affecting two specific patient populations: individuals affected by diabetes mellitus, and women. In particular, she focuses on how cardiovascular risk factors are different in a female population, how that difference puts women at risk and what needs to be done to assess and to reduce risk to women’s health.

“When I first started in medicine, I did two years of bench research looking at why specific complications develop in patients with diabetes,” she says. “That, and seeing women with risk factors for heart disease that remained unrecognized and under-diagnosed, sparked my interest in this area.”

Most studies done in this area were conducted on a male population, and some of the guidelines and risk factors that contribute to the development of heart disease and diabetes that came out of these studies may not apply to women, she says. “Our bodies just work differently than the typical male pattern. For example, the typical risk factors are high blood pressure, diabetes and cholesterol problems, and those are very important problems for women as well, but there’s also something called syndrome X. That means, because of estrogen loss, there’s a change in the character of blood vessels that puts women more at risk. That’s why you see women develop heart disease a few years after men.”

In her current practice at Internal Medicine Associates in Centreville, Va., Anderson strives to catch potential problems in patients before they can develop into established diseases.

Her physician philosophy revolves around her desire to create relationships with her patients. “If you establish a relationship with people, you have a shared partnership working toward a specific goal. That’s much more effective in the doctor/patient relationship because you can work together to accomplish things,” says Anderson. “Some of that has been lost with the way that managed healthcare has developed. I have a very stable patient population—I know them, I know their kids, their jobs, etc…I think patients respond much better to a relationship approach than to the old paternalistic model.”

This has led Anderson to consider many of her patients as friends as well as clients. Two of her patients—a retired husband and wife—ended up with various illnesses that required one or the other to see her once a week for an entire year.

“The thing that so impressed me was they never got depressed about their situation,” she says. “We got to be very good friends throughout that year.” Anderson even ran interference for them to get a test scheduled when the couple encountered roadblocks with their insurance company and the testing facility. The husband, who writes poetry for fun, penned her a poem entitled “Don’t Mess With Beth” in gratitude for her assistance. “It was all about if you ever needed anything, I was the one you could go to,” she says, and smiles.

She says when she addresses residents, she tells them: “Remember, you are the patient’s advocate. You have a huge gift and responsibility in terms of their most basic needs. It doesn’t take that much time to help them out and people are so grateful when you do.” —Sarah Hamaker

(February 2007)

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