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Getting Over Getting Under by Dr. Barry Friedberg

Five reasons why Dr. Barry Friedberg, a 36-year private practice, Board certified anesthesiologist and the founder and president of the 501c3, non-profit Goldilocks Anesthesia Foundation wrote Getting Over Going Under, 5 things you MUST know before anesthesia

Let no one ever kid you, being an advocate for change, especially in anesthesia, is about the most difficult task one could ever attempt to shoulder.

Hercules

     Hercules should have had it so easy.

 

 

In 1992-3, after seeing my first 50 cases of propofol ketamine (PK) sedation emerge without PONV or need for postoperative opioids, I felt much like Archimedes, “Eureka. I’ve found it.” PK numerical reproducibility was established with the addition of BIS/EMG monitoring in 1998.

I have published 5 peer reviewed papers, 15 letters to the editor in Outpatient Surgeon Magazine, more letters to the editor in Anesthesia & Analgesia, British Journal of Anaesthesia, Anesthesia Patient Safety Foundation, Plastic & Reconstructive Surgery, & Aesthetic Plastic Surgery, a landmark textbook ‘Anesthesia In Cosmetic Surgery,’ and 51 lectures in the US, Canada, Mexico, Dominican Republic, Israel, Malaysia & Singapore.

Many people publish papers. However, half of all published papers are never subsequently referenced. My papers have been subsequently referenced in 144 papers and in 50 textbooks.

Despite my Herculean effort to change the minds of my fellow dedicated anesthesia providers (DAPs), the subjects of postoperative pain management and PONV continue to appear in the literature as if the solution had yet to be discovered (or worse if my efforts had never occurred.)

As Aspect’s Dr. Paul Manberg often opined, ‘Change is glacial.’ When presented with my thoughts about getting better patient outcomes, most of my colleagues attitudes were essentially, ‘We’re not killing anyone, why should we change?’ Somewhere Semmelweis’ corpse is turning over in his grave.

Actually, as Li reported in 2009 Anesthesiology (110, 759-765), we are killing one American patient every day from anesthesia over medication, the natural result of not directly measuring anesthetic effect on the cerebral cortex. Even more saddening was that the editors of Anesthesiology did not deem this mortality study worthy of being an article of special interest.

Part of the human condition is that all people regardless of their profession resist change. Physicians as a sub-set are notoriously resistant to change. DAPs as a sub-set of physicians are virtually impossible to change. Unless presented with this simple paradigm in training, most DAPs will not even consider the notion of a differing paradigm.

The DAP syllogism goes like, ‘All surgery is painful. Opioids (narcotics) are painkillers. Therefore, all surgery requires the judicious use of some opioids.’ Having successfully practiced for the past 16 years without intra- or postoperative opioids, I would beg to differ.

Postoperative pain is a function of intra-operative pain.

Only by midbrain NMDA saturation prior to incision (or injection) does one avoid entrance of pain signals to the brain. NMDA saturation is accomplished in 98-99% of patients with a 50 mg dose of intravenous ketamine 3 minutes prior to stimulation. Hallucination free use of ketamine is accomplished by incrementally titrating propofol to BIS <75 with baseline EMG; i.e. tinyurl.com/n98x86k

Instead of being frustrated with my apparent inability to produce change in my fellow DAPs’ intra-operative conduct, I considered using the same paradigm for change that got fathers in the delivery rooms for the births of their children; i.e. public knowledge leading to public demand.

What are the 5 reasons I wrote ‘Getting Over Going Under, 5 things you MUST know before anesthesia?’

Reason #1: How can a pre-surgery patient know to ask for the best available technology, a brain monitor, if they do not even know that such as thing exists?

Reason #2: Why would they ask for one without the knowledge that over medication can lead to delirium, dementia and even death, especially in those over 50?

Reason #3: Why would the general public not assume they would receive the best available technology for their anesthesia care, especially if it might improve their chance of waking up without brain fog?

Reason #4: Why does PONV still exist and is there is an established way to avoid it?

Reason #5: Why does postoperative pain still exist and is there an established way to avoid it?

The answers to these reasons are easily digested in his 2010 book for which a free Kindle giveaway this summer was very successful and another is planned for this fall.

All proceeds from the sale of this book support the education message of Dr. Friedberg’s non-profit Goldilocks Anesthesia Foundation, “No major surgery under anesthesia without a brain monitor.”

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For further information, contact Dr. Friedberg @drfriedberg@drfriedberg.com

ANTI-AGING WITH NEW DERMAL FILLER

voluma2 Juvederm’s  new dermal filler is getting raves from patients and surgeons alike. It’s thicker constancy is said to get better, more long lasting results. Is the result the same as a facelift? Not on your life. It’s not as long lasting, nor is the result as dramatic. But if you are surgery adverse, it might just be enough. 

Check out this video @http://www.realself.com/question/does-voluma-cost

FREE – 10 Beauty Secrets That Won’t Break the Bank

Sign up for this monthly Beauty and Anti-aging Newsletter and Learn From the experts.

Click here.

Addendum:

Cosmetic Surgery consultant, Denise Thomas, just sent me her thoughts on the dermal filler, Belotero. Since I have never tried any of these fillers, I was interested in her experience.
“I am going to share my experience with you after trying, Belotero, as a filler.
Juvederm has been my favorite, but noticing many good reviews on Belotero, I tried it.
To my dismay, after three months the line between my brows has returned. Also, my sister immediately noticed a very slight puff in that area plus a slight darkness.
This is not to say others have not be pleased. I will stick to Juvederm, Belotero is less expensive, but not for me.”

 

WHAT IS BEAUTY? – Another Thought on Ageless Beauty by Lois W. Stern

I wrote an article some time ago that created quite a stir titled Step Aside Mother NatureHanna Mae Salcedo’s artcle in the Sun Star this morning brought it back to mind, nudging me to post it once again. Just click on the image below to read this thought provoking article . . .

mother_nature

or  click here, or copy and paste the following URL into your browser. http://www.sexliesandcosmeticsurgery.com/Articles/mnature.html

But one way or another, just read it! Then let me know your thoughts.

What is your notion of beauty? What do physically beautiful people have that others do not? And why aren’t traits like being strong, smart, compassionate, honest, creative, trustworthy, funny and kind-hearted considered beautiful? These are the questions Hanna Mae Salcedo addresses in her Sun Star article.

My question to Hanna Mae is this: Why do we have to take sides on this issue? Can’t we strive for both? And in achieving some degree of physical beauty, don’t we feel better and project a more positive image, inside and out? To my mind, it’s a matter of balance and degree.

Your comments, please?

AGELESS BEAUTY – GETTING A LITTLE WORK DONE . . .

Autumn is just around the corner – the time women begin to seriously consider (or reconsider)  “Getting s little work done”.  With this professional courtesy offer, you can purchase copies @ $8.95 while supplies last – and at this price they are going to go fast!. 

slcs_cover_gold_med

Your order will include 12 copies of Sex, Lies and Cosmetic Surgery plus a FREE 5.5 X 8 inch laminated sign to post in your office. 

Learn more about this award winning book at: www.sexliesandcosmeticsurgery.com. Read the reviews – even written up in the Style section of the NYTimes.

 Want to offer patients some great encouragement and calming advice coming from over 100 women who have been there, done that? Sex, Lies and Cosmetic Surgery has received glowing reviews from several top board certified plastic surgeons, read and endorsed by three members of the ASPS before being placed in first position on their online bookstore (until their bookstore feature was removed from their website.) 

 

Click here to  place your secure order.

And here is a picture of the laminated sign that will be included with your order.

buy_now_poster

A PRESCRIPTION FOR BEAUTY – PUT A SMILE ON YOUR FACE

How Do Court Reporters Keep Straight Faces?

These are things people actually said in court, word for word, taken down and published by court reporters. They couldn’t laugh while the exchanges were taking place, but you can – and will!

Remember, nothing makes a face more beautiful than a smile.

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ATTORNEY: What was the first thing your husband said to you that morning?

WITNESS: He said, ‘Where am I, Cathy?’

ATTORNEY: And why did that upset you?

WITNESS: My name is Susan!

_______________________________

ATTORNEY: What gear were you in at the moment of the impact?

WITNESS: Gucci sweats and Reeboks.

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ATTORNEY: Are you sexually active?

WITNESS: No, I just lie there.

pills____________________________________________

ATTORNEY: What is your date of birth?

WITNESS: July 18th.

ATTORNEY: What year?

WITNESS: Every year.

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ATTORNEY: How old is your son, the one living with you?

WITNESS: Thirty-eight or thirty-five, I can’t remember which.

ATTORNEY: How long has he lived with you?

WITNESS: Forty-five years.

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ATTORNEY: This myasthenia gravis, does it affect your memory at all?

WITNESS: Yes.

ATTORNEY: And in what ways does it affect your memory?

WITNESS: I forget..

ATTORNEY: You forget? Can you give us an example of something you forgot?

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ATTORNEY: Now doctor, isn’t it true that when a person dies in his sleep, he doesn’t know about it until the next morning?

WITNESS: Did you actually pass the bar exam?

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ATTORNEY: The youngest son, the 20-year-old, how old is he?

WITNESS: He’s 20, much like your IQ.

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ATTORNEY: Were you present when your picture was taken?

WITNESS: Are you shitting me?

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ATTORNEY: So the date of conception (of the baby) was August 8th?

WITNESS: Yes.

ATTORNEY: And what were you doing at that time?

WITNESS: Getting laid

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ATTORNEY: She had three children , right?

WITNESS: Yes.

ATTORNEY: How many were boys?

WITNESS: None.

ATTORNEY: Were there any girls?

WITNESS: Your Honor, I think I need a different attorney. Can I get a new attorney?

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071-lawyer-cartoon

ATTORNEY: How was your first marriage terminated?

WITNESS: By death..

ATTORNEY: And by whose death was it terminated?

WITNESS: Take a guess.

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ATTORNEY: Can you describe the individual?

WITNESS: He was about medium height and had a beard

ATTORNEY: Was this a male or a female?

WITNESS: Unless the Circus was in town I’m going with male.

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ATTORNEY: Is your appearance here this morning pursuant to a deposition notice which I sent to your attorney?

WITNESS: No, this is how I dress when I go to work.

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ATTORNEY: Doctor , how many of your autopsies have you performed on dead people?

WITNESS: All of them. The live ones put up too much of a fight.

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ATTORNEY: ALL your responses MUST be oral, OK? What school did you go to?

WITNESS: Oral…

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ATTORNEY: Do you recall the time that you examined the body?

WITNESS: The autopsy started around 8:30 PM

ATTORNEY: And Mr. Denton was dead at the time?

WITNESS: If not, he was by the time I finished.

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ATTORNEY: Are you qualified to give a urine sample?

WITNESS: Are you qualified to ask that question?

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And last:

ATTORNEY: Doctor, before you performed the autopsy, did you check for a pulse?

WITNESS: No.

ATTORNEY: Did you check for blood pressure?

WITNESS: No.

ATTORNEY: Did you check for breathing?

WITNESS: No..

ATTORNEY: So, then it is possible that the patient was alive when you began the autopsy?

WITNESS: No.

ATTORNEY: How can you be so sure, Doctor?

WITNESS: Because his brain was sitting on my desk in a jar.

ATTORNEY: I see, but could the patient have still been alive, nevertheless?

WITNESS: Yes, it is possible that he could have been alive and practicing law.

Remember my motto:

Beauty Within . . . Beauty Without . . . What’s Your Passion?

Explore the Many Dimensions of Beauty

and laughter is surely one of them!