We Asked A Plastic Surgeon The Questions Nobody Asks (Ft. Dr. Rick Green)

[0:00] Jason: Hey Kathy, I’m thinking about having some work done.

Kathy: Some work done. Did you hit 200,000 miles or something? Have you been keeping up with your oil changes?

Jason: No, seriously. Is there like a guy version of the mommy makeover?

Kathy: Oh, plastic surgery. Yeah, you could use some work. Today we have the perfect guest for you. He’s a board-certified plastic surgeon who’s been working with patients for three decades, helping them regain their confidence and health.

Jason: Yeah, this is going to be a really good one. Watch until the very end because we’re going to be talking about

[0:30] the history of plastic surgery, who needs it, who doesn’t, and everything in between. This is the PTCH. What happens when a chiropractor and a physical therapist get together to make a health and wellness podcast?

Chiropractors and physical therapists don’t like each other.

Oh, think again.

Kathy: I’m Dr. Kathy Lynch, physical therapist who likes to help people move and get stronger.

Jason: I’m Dr. Jason Young, an evidence-based chiropractor who uses humor just as much as adjustments to help people get better. Welcome to the PTCH Podcast.

Remember, there’s no I in PTCH.

[1:02] Jason: Oh, welcome back. We have a really good one for you today. I’m Dr. Jason Young.

Kathy: I’m Dr. Kathy Lynch.

Jason: And this is the PTCH Podcast.

Kathy: Yeah, pretty sure. I checked on the way in.

Jason: Yes, there it is. Okay. Today we have a very special guest. This is Dr. Rick Green, MD and plastic surgeon. So, welcome.

Dr. Rick Green: Thanks. It’s great to be here.

Jason: Yeah. Rick, tell us about yourself. Like where do you practice? We heard in the open that you’ve been

[1:32] practicing for three decades, which is longer than I’ve been alive.

Dr. Rick Green: We actually are in Vancouver, Washington. So which is the original Vancouver, by the way. People don’t know that, but really George stopped there first.

Oh, nice.

Dr. Rick Green: And then went up further north. So we are in the original Vancouver. I have a small private practice, plastic surgery, so I’m self-employed.

Jason: Okay.

Dr. Rick Green: And I have a partner who’s been wonderful, been working together for the last

[2:03] let’s see, eight years. This practice was started in 2007 with a different partner who is now happily retired and traveling the world but

Jason: warms my heart.

Dr. Rick Green: Yes. But life is good and I actually am proud of the fact that our practice has done well and we’re still self-employed which has been a lot of fun. And our practice actually does a large gamut of things. We’re about half cosmetic, half reconstructive. So we’ll do different things every day and a lot of

[2:33] Kathy: We’re going to talk about what that means because I don’t know what that means then.

Dr. Rick Green: You’ll find out.

Jason: Yeah. Well, a really important question that we always like to ask doctors that come on here is, did you become an MD because you couldn’t get into chiropractic school.

Dr. Rick Green: I didn’t know what a chiropractor was. You might have considered it, but you don’t know what you don’t know. That’s true. So, I couldn’t even ask the question.

Kathy: Yeah. Jason, you buried the lead.

Jason: I did.

Kathy: Yeah. This is a fellow Golden Dome.

Jason: Oh, that’s right. Oh, if we break

[3:05] out into like college football talk in the middle of the podcast

or the fight song or whatever. Is there a fight song? Do you guys know the fight song?

It’s the greatest of all college fight songs.

It is. Is it? Okay.

Dr. Rick Green: Yeah. And you might not know this looking at me, but I actually played for Notre Dame.

Jason: Did you really? What’d you play?

Dr. Rick Green: Clarinet. And I was in the marching band and honestly I got more field time than most of the players and it was great. At that time, the stadium was kind of its original size. 60,000 people cheering for you

[3:36] as you’re marching out. It was a lot of fun.

That’s sweet.

Dr. Rick Green: So, yeah, those guys put in a lot of time. I would hear them all week long practicing for football games on Fridays.

Jason: In the shadow of Touchdown Jesus.

Dr. Rick Green: In the shadow. Yeah. Yeah. We were three hours a day and then all day Saturday.

Yeah.

Dr. Rick Green: So, and it was totally worth it.

Jason: It’s like a full-time job for these guys.

Dr. Rick Green: Oh my goodness. They weren’t kidding. So,

Jason: I did not know that about you. That’s pretty cool.

Kathy: That is really impressive. You like this guy even better now.

Jason: Oh, yeah. He got way more play. He got

[4:07] more field time than Rudy.

Yeah. Well,

Dr. Rick Green: oh, that’s an interesting little historical tidbit. I was in the stadium the day they filmed the last scene of Rudy where Rudy gets in and then is carried on the shoulders of the players. They needed to film it in the stadium with a full stadium and it just happened to be the game where I was in the stadium. So theoretically I am in the Rudy movie.

Kathy: So we can hear you chanting Rudy. Rudy. Oh my god.

Jason: Why are you putting that guy in?

[4:37] Jason: Well, and I think this is good to talk about because you were actually referred to the show by a mutual friend and the only reason that you agreed to do it was because you knew about Kathy’s.

Yes.

Dr. Rick Green: And I do appreciate your shirt, wearing the shirt for me

showing out today.

Jason: Mhm. And it’s double layered, too. Like you show the Notre Dame t-shirt.

Dr. Rick Green: Yeah, she’s got a backup, you know, just I don’t know what would happen, but in case you lose the outer layer, she’s got a backup Notre Dame underneath. So,

Kathy: yes, you must. I mean, if I end up in

[5:08] the hospital, you know, and they got to take layers off. You’re like, “Wow, where’d she go to school? She’s going to be okay. She’s going to be okay.” Right.

Dr. Rick Green: I don’t know. I don’t think it means as much out here in the Northwest as it does in the Midwest or the East.

Kathy: It doesn’t. There’s not as much heat out here. Not as much. Not as much as we’re used to, right? Not as much. But the Pac-12 people do not love Notre Dame because

Well, we already beat you guys real bad in the festival. So,

that was like 1990. That’s true.

I think that was 2000 actually. Oh, was

[5:40] it? Yeah, I — I can’t remember.

Was it Y2K?

Yeah, something like that. There was probably a computer glitch.

So, plastic surgery. Now, this — I was really excited to talk about this because there — is it fair to say that there is some stigma in the world about plastic surgery?

Well, yeah, and here’s an interesting story relative to that. I grew up across the street from a surgeon and he was my adviser in medical school, and there were three of us actually

[6:11] from the same small town outside of Chicago, and he says, “I want one of you guys to be a surgeon.” And so after a year or so, I said — I was talking to him one day. I said, “I think I’d like to be a surgeon.” He says, “Oh, what kind of surgeon do you want to be?” I said, “I don’t know, but all I know is I don’t want to be a plastic surgeon.” And he said, “Why is that?” I said, “Well, it’s just foofoo stuff.”

Mhm.

Hence the stigma that you’re referring to. He says, “Well, let me kind of show you what plastic surgeons really do.” Now, he was a surgical oncologist. He

[6:42] did a lot of abdominal cancer surgery, things like that, but he had a book in his office of all these flaps that plastic surgeons would use to close up holes that other surgeons had created. And I thought, “Oh, well, this looks sort of interesting.” And then right at the beginning of my third year in medical school, when we first go into the hospitals, two things happened. I was randomly assigned to surgery first and I was randomly assigned to two weeks of plastic surgery. The very first day I

[7:14] walk into the plastic surgery clinic at Cook County Hospital in Chicago, and the resident there says, “Okay, there’s this woman here who has a capsular contracture of her breast, and you’re going to put your hands at 12:00 and 6:00, and I’m going to put my hands at 9:00 and 3:00, and we’re both going to squeeze as hard as we can.” And this is like my very — I just walked into the third year.

Was she conscious?

She was absolutely conscious. So we put our hands there and we both squeeze it literally as hard as we can, and the scar around the implant pops.

[7:47] That’s called a closed capsulotomy, which is no longer allowed because it’ll void the warranty of an implant. But if I’m telling the story to my friends, I will say so I thought this wouldn’t be a bad way to make a living, but I don’t tell that to patients. The second day I walked into a craniofacial surgery, like a skull remodeling on an infant.

Wow.

That was being done with a neurosurgeon and it was a 13-hour operation and that 13 hours went by like nothing. And I’m

[8:19] thinking this is the coolest thing in the world.

You were hooked.

I cannot believe that people can do this. And I thought, “Oh, wow. I’m enjoying this so much. I can’t wait to find out what I really want to do.” And there was nothing even close to —

Nothing compared. Yeah, exactly.

Wow.

So that’s amazing.

Well, and it kind of makes me think — whenever we were talking about you coming on, you were telling me a little bit about the history of plastic surgery, which made me think, oh, there hasn’t

[8:49] just always been plastic surgery. Child of the 80s, and so I’m thinking like Michael Jackson — he was probably the first — but like how did this discipline even get started?

Well, plastic surgery, interestingly, goes back a long, long time. It actually goes back about 3,000 years. And in ancient India, a punishment for misbehavior of whatever kind would be to have your nose cut off. And so there were Indian surgeons back then who would lift a piece of skin

[9:20] off of the forearm, but leave it attached to the forearm, but then sew the other end of it to the nose. Come back three weeks later, detach it, and you could reconstruct a nose that way. That same technique was used in the 1500s, 1600s in Italy. There was a Dr. Tagliacozzi, and it’s called the Tagliacozzi flap, and a variant of that is still actually being used today. Okay, we actually will take skin from the forehead, detach it,

[9:52] sort of rotate it down and tie that to the end of the nose, come back and detach it — not get rid of it, detach it — three weeks later. And yes, you can recreate a nose that way. Where modern —

I was wondering about ways that I could recreate a nose. Like, I can do that at home.

Now, you know —

You can just do that at home.

Is there a YouTube video that —

I’m sure there is, but I wouldn’t follow it.

You want to watch it? I definitely don’t — come with me as I reconstruct a nose from a forearm.

[10:23] And you know you’re a social media person and digital person. I mean, there’s every single operation that you could ever imagine on YouTube, and that is how we learn. If we need to learn a new technique, which actually happened just earlier this year, we will go on YouTube and that’s how we learn it. But getting back to the history of plastic surgery, modern plastic surgery —

Real quick though, I think this is a great time for the disclaimer. This is entertainment only. We’re not giving

[10:53] medical advice or encouraging anybody to go out and do home plastic surgery.

No.

Okay. So —

Our insurance company has just a huge breath of relief.

Okay. So, back to the history — and I’m in full agreement with that.

Figured you would be. Yeah. So the modern plastic surgery started in World War I actually, and there was trench warfare, bombs being lobbed back and forth, and these

[11:23] soldiers would get these gruesome facial injuries, and there were no techniques described at the time as to how you would fix this. And so these soldiers were often left to just live out their lives in hiding basically —

Like missing a jaw or an eye?

Exactly. And or nose.

And there was a surgeon in England named Harold Gillies who was an ENT surgeon. There were also dentists at the time that were interested in this because a

[11:53] lot of the — a lot of the injuries were jaw injuries, but he single-handedly figured out techniques to fix these injuries. And so he was the very first modern plastic surgeon. No one was called a plastic surgeon at that time.

By the way, patients ask me all the time, like, what kind of plastic do you use?

Jason: I was waiting for you to ask that question.

Kathy: I was thinking that.

Jason: Well, I hear like you can just 3D print stuff, right?

So, you have to use the right kind of plastic. But where does it come from? It comes

[12:24] from the Greek word — the Greek word for molding or to mold is plasticky. I always thought it was plasticose, but I have a card-carrying Greek patient who was in the office three weeks ago, and I said, I have a question for you. I always wonder this — what is, you know, Greek for to mold? And she said, plasticy, is how she said it. So, the bottom line is it’s mold, malleable, that sort of — or to shape maybe would be another term for it. But that’s where the name comes from.

[12:55] But yeah, it was World War I. And if anyone’s ever interested in it, there’s a really cool book called The Face Maker that is about Harold Gillies. And not only was he a plastic surgeon, he was a champion amateur golfer in England.

Kathy: Yes. Perfect. I was going to ask if he was a champion golfer and he was. You probably just assumed that he —

Jason: probably. Yes.

Kathy: Always good to make sure.

But that’s — yeah, that’s where it came from. That’s where it all started.

Kathy: That’s funny because the PT profession

[13:25] also started after World War I.

Oh, I didn’t know that.

Kathy: Yeah. Mhm. That’s where it was born, for the same reason. You know, soldiers came back — well, they came back, first of all, alive because we had doctors on the scene. Yes. Right. And they came back alive, but also disabled. And so when they first came back, they needed — I think they started as nurses to help rehab them, rehab, or they were rehab specialists, I think. And so yeah, that’s when physical

[13:55] therapy started as well.

Jason: And chiropractic was about 20 years before both of those. And we probably caused World War II.

Yeah. Depending upon who you talk to. Yeah. Likely.

Yeah. I will tell you honestly, Jason, years ago, I read a book on the history of chiropractic just because I was curious. It’s interesting history, and I think you’ve evolved.

Jason: Definitely. Yeah. Some people don’t want us to, because it’s funner to have a cartoon caricature

[14:25] of what a chiropractor is, but definitely evolved. Definitely evolved.

So, you know, there was an interesting story in that book I mentioned, The Face Maker, where at this veterans hospital in England, huge hospital, there were benches that were painted blue. And the soldiers with the facial injuries were considered so unpleasant to look at by the average person that they were instructed, if you’re outside, you have to sit on these blue benches. And then the general public that’s walking by knew that the

[14:55] blue benches — you wouldn’t look, right?

Jason: And then they would, like, maybe charge, like, a dollar or something like that if you did want to look. Is that how they treated those guys? That’s terrible.

It was really — well, there’s even worse than that. There were lots of stories of fiancées running to — Dear John letters. Geez. People losing their jobs or having to work kind of in hiding. So, to be honest again, for Harold Gillies and then his students to figure out how to fix all this,

[15:25] and there are before and after pictures in this book of these original patients, and it is fascinating, and it’s really, really, really good work.

Kathy: Well, now, and plastic surgery though is not just about looks. It’s also about function, right? Because if you don’t have a functioning eyelid or jaw or nose, there’s other health issues that follow that, right?

100%. That’s exactly right. Yeah. So, you know, when I’m talking to my patients, I always say that, you know,

[15:55] first, our job number one is to keep you safe. That’s job number one. But number two is to restore normal. And so, to make people look different or odd — you mentioned Michael Jackson earlier, who probably just took it a little bit too far — but restoring normal is what we do every day. And I think that’s a really great goal. If we’re doing a breast reconstruction, for example, getting a woman to the point where she just doesn’t ever think about it anymore, or doesn’t think about the cancer,

[16:25] that is — that’s actually very satisfying to be able to do something like that.

Kathy: Well, and it’s interesting because I’ve had women who have had breast cancer and they forget that they’ve had a mastectomy, which I think is, like, wow, that’s good work, right? It’s part of a woman’s identity, you know, and they can grieve that loss if they don’t have that part of their body. So, I think it — well, it’s one of the gifts that medicine has given us.

Yeah. And I think it means different things to different people. There’s some

[16:55] people that are like, “Yeah, I never liked him anyway.” Right. And — but you’re absolutely right. It’s, you know, I think it comes down to stigma, because there’s stigma both ways, right? It’s like, oh, you’ve had plastic surgery, or oh, you need plastic surgery.

Jason: And so I imagine there’s so many kind of layers to what you do, from not just a technical standpoint, but also, like, psychologically and people’s mental health. I imagine the plastic surgery is really critical.

[17:26] It is. You know, people though still are judgy, and I’ll have patients that say, “Oh, you know, I ran into somebody today who said, I would never do something like that.” Or I had a patient who, you know, asked me why I’m doing that. I just — you don’t need that. And so you’re exactly right. But I think if we have that attitude that we’re not trying to do anything other than just restore normal, restore confidence, get rid of that self-consciousness that people

[17:57] can have about differences.

Jason: But there are some people who are like pathological with it, right? I mean, we’ve seen some of the examples of it’s like people that like they don’t look anything like they used to or anybody used to. Mhm. Um, so let me ask your opinion on that. I mean the surgeons who do it, how would they justify, yeah, I’m going to, you know, help you keep going down this road knowing that like they’re

[18:29] getting farther and farther from from normal. Are there people out there that are just like, “Hey, just as long as you pay me for a surgery,” or how does that happen?

Dr. Rick Green: I think that’s the only explanation honestly because I don’t understand it and I think there are surgeons, I’m sure, in different parts of the country that if you’re willing to pay X amount of dollars they’re willing to do, you know, whatever it is that you ask. We do spend time, I wouldn’t say every day, but you know, a couple times a month talking people out of something.

[19:01] Because they’ll look at pictures on social media or in magazines that are just completely unrealistic or not related to their body or just aren’t for them. So I actually, when people go overboard like that, I never think that that’s the patient’s fault. I always think it’s the doctor’s fault. Like just because you can do something doesn’t mean you should do something.

Jason: What a weird idea. You also have advanced training in

[19:31] hand surgery as well, right?

Dr. Rick Green: Yeah. A lot of people don’t know that in plastic surgery residency, 25% of our training is in surgery of the hand. And so we’ll work with orthopedic surgeons and plastic surgeons together. And people say, “Well, what cosmetic surgery do you do on the hand?” We don’t do cosmetic surgery in the hand. Hand is more in your realm in the sense of, you know, function, form and function. And we often don’t care how the hand looks. We care does it hurt and does it work. Yeah.

[20:02] And so, and actually physical therapy, occupational therapy is a big part of the treatment for hand. But in any case, I liked doing hand surgery. Why? Because when you do hand surgery, you sit down and it’s very relaxing. Yeah. You sit. It’s very relaxing. And when we do hand surgery, you have a tourniquet. So there’s no bleeding when you do hand.

Jason: Oh, really interesting.

Dr. Rick Green: So when we have medical students in, we work with Washington State

[20:33] medical school. I’ll give a shout out to them. We like our students there.

Jason: Cougars.

Dr. Rick Green: Yes.

Jason: Part of the pack, too.

Dr. Rick Green: Yes. Exactly. And they’re very proud of that. Yes. But in any case, that’s a great way to teach students because no bleeding, very easy to look at anatomy. Actually, hand anatomy is really cool. So, super cool. So yeah, there’s a lot of things that I like about hand. Early in my career when I first started, about two-thirds of what I did was surgery of the hand,

[21:03] like carpal tunnel, trigger finger, those kinds of things. Trigger finger, basal joint arthritis. So wrist arthritis. Dupuytren’s in the Northwest is huge.

Jason: Actually that’s in my family. I keep waiting to get it because my grandparents had it. My parents had it but I just looked this morning and I still don’t have it.

Dr. Rick Green: Good job.

Jason: Thanks.

Dr. Rick Green: For those you don’t know, it’s a contracture of the hand where you can’t straighten your fingers out. But, think you know, tendon injuries, tennis elbow,

[21:33] golfer’s elbow, any other sports-related elbows.

Jason: Do you want to know a weird fact? In the state of Oregon, chiropractors can do carpal tunnel surgery.

Dr. Rick Green: What?

Jason: Yes. Because it’s considered minor surgery and you’re not opening a major body cavity. So, all chiropractors have to pass a minor surgery test to get your license in Oregon. There’s maybe like five people that do it because there’s more stuff beyond that. So, my advice to everybody listening is don’t go to a chiropractor to get carpal tunnel surgery.

[22:03] We’re not doing a lot of them. I could maybe recommend an orthopedic surgeon or a plastic surgeon. How about that? Yeah.

Kathy: Yeah. But, um, yeah, go to chiropractors for adjustments, not carpal tunnel. The hand is, the hand’s so important. And this is, you know, one of the things they taught us in PT school because really it’s how we interact with the world a lot of times. And so if we don’t have that function with their hand, um, with people, when people don’t have that function

[22:33] with their hand, it affects everything that they do on a daily basis, right, from handing somebody their credit card, using, now you know, typing, being able to swipe the credit card or—

Jason: It’s weird, I usually do that with my teeth.

Kathy: Oh, but I get it because how do I get the card in my teeth? Yeah. Okay. All right. Yeah, you’re right.

Kathy: Yeah. I have a lot of patients that will tell me, you know, I use my hands every day. And who does that?

Jason: Yeah.

[23:03] I said, well, I do, too. We got that in common.

Kathy: Yeah.

Jason: Yeah. It’s just really important.

Dr. Rick Green: Yeah. Uh-huh. You mean you’re not using your teeth to do plastic surgery?

Jason: Not anymore. Not since the board complaint.

Dr. Rick Green: But, you know, so you mentioned teeth. The chief of plastic surgery where I trained, Loyola University in Chicago, was a dentist originally and most of the original plastic surgeons were dentists, and in our training we had

[23:34] to learn how to take out teeth, like broken teeth, jaw fractures and stuff. So I will brag that at least in Clark County, Washington, I’m the only MD that knows how the teeth are numbered.

Jason: Oh, okay.

Dr. Rick Green: Yeah. Yeah. And I can, it’s top to bottom, you know, here to here, here to here, 1 to 16, 17 to 32. So if you ever need to know which tooth, but it’s, and the only, you go to the dentist and he’s like, oh yeah, he’s talking to the dental assistant. It’s like, um, let’s see. 16. You’re like, I know.

[24:04] I know. Okay, guys. Guys, I know which one. You don’t need to use the code. I know. 16. You should look at 14. Yeah, it feels a lot more like 15 to me. I do, I do say that. I said I’m— I have gotten a little. Can you just check, you know, between 19 and 20? And they never— Oh, how do you know? They never say, “How do you know?” They just— Okay. Yeah. Well, you guys have had that experience, too, right? When you have that patient that knows a little too much, right? Like I’ll have somebody comes in, they’re like, “Yeah, it feels like it’s the L4-L5 disc.” You know, it’s like—

[24:34] I always side-eye them. What are you? What are you? That’s— I’ve watched Dexter. That’s right. Or in your case, Nip/Tuck, right? People come in, they’re like, “I want this procedure.” It’s like, “Oh my gosh, I never watched that, but it seems like a crazy show.” Not my style. Yeah. Yeah. I didn’t watch that. I— I’ve also never watched Dr. Pimple Popper. I just don’t know why people would find that interesting. Not for me. No thanks. Well, tell us more about your training besides Notre Dame. We can—

[25:05] Yeah. Yeah. Obviously not. Yes, that was excellent. So there’s, after college, there’s four— I actually went straight to medical school from college. That’s not as common these days, but it was reasonably common back then. So I went to the University of Illinois medical school, right in downtown Chicago. Fighting Illini. Fighting Illini, but you know, I have— sorry, I have no loyalty to Illinois because the main Illinois campus, where the football was played, was 200 miles away

[25:35] from Chicago. So that really didn’t affect us. But a great experience, you know, real melting pot of people and conditions, and I really loved my medical school experience. I have great friends that I still stay in touch with, and that was wonderful. And then I matched into the five-year general surgery program at Loyola, knowing that I wanted to be a plastic surgeon. But then you had to go to— you had to finish a general surgery program and then apply to a plastic surgery residency after five years of general surgery. I was very fortunate at Loyola, they would occasionally take

[26:05] a resident into plastic surgery after three years of general surgery. Nice. And so that’s what I was able to do. The general surgery residency director was not happy about it. But I will just tell a little story about my learning experience.

[26:36] Back then there were no residency work restriction hours. So as an intern I was working about 110 hours a week. It was a lot. Impossible. Yeah. For people who are trying to do the math, there’s only 100 hours in the week. There’s 168 as it turns out. How is that? But it was really crazy. And so I was scrubbing one time preparing to go into surgery with the program chair of our general surgery residency who was a vascular surgeon. And he asked me a question about a carotid endarterectomy,

[27:08] cleaning out an artery in the neck. Mhm. And I said, “I’m sorry, Dr. Baker, I don’t know.” Because I was just exhausted. I was trying to survive. I don’t know. Says, “Damn it, Green. If you think we’re going to spoon feed you this stuff, you can take that spoon and shove it up your ass.” And I’m thinking, “Well, this is a really nurturing environment. Nurturing learning environment.” Lovely. Yeah. Yeah. And then so the next year I, you know, applied to this program to go into plastics. And fortunately, I had a

[27:39] mentor. I always feel like I was the luckiest person in the world because I had somebody that paid attention to me when I was young. When I was a young first-year surgeon, and it was a guy named Juan Angelott, a plastic surgeon originally from Lima, Peru, but who had trained in Chicago, and at the time the plastic surgery department was running the burn unit at Loyola. It was a busy burn unit, and I went into the operating room one day with him and I said, “Dr. Angel, I’m I’m interested in plastic surgery.” And for whatever reason, he took me under

[28:10] his wing and basically gave me my career. Wow. Cool. So, he was just great. And we had a lifelong relationship. He passed away just last year, but he was sort of like my second dad really. And that was wonderful. But I did ultimately three years of general surgery, three years of plastic surgery training, which was super fun. In plastic surgery, there’s so much to learn, so much to do. Yeah. One of my favorite parts of plastic surgery training was actually pediatric plastic surgery. And again, what do

[28:40] people do— what cosmetic surgery are they doing on kids? We’re not doing— it’s like babies who want the— what is it? The Brazilian butt neck. Is that what it is? Yeah. It’s a very quick operation though. And normally it’s not. And they’re just easier to flip over back and forth. Yeah. But no, like, you know, pediatric plastic surgery. Cleft lip, cleft palate, ears, ear reconstruction. Sometimes people are born without an ear, and that

[29:10] stuff is so amazing. Like the technology is just so far beyond— like I remember as a kid, like it was not hard to spot kids who had a cleft palate, and like now, um, yeah, you hardly see children that— like you would have to look really hard. Yeah, the technology is amazing. Yeah. Well, you know, with that, what you have to really look for is the nose. That’s how you know if it’s a really great— oh, cleft repair, because whenever there’s

[29:40] a cleft lip, the nostril on the involved side will flatten. And so a big part of cleft lip repair is actually a cleft lip nose repair. Yeah. So that’s interesting. Another thing that we would do would be, like I mentioned at the very beginning of this conversation, remodeling the skull. There’s little lines in the skull, like the soft spot. When you hear that soft spot, that’s actually called a suture. And these sutures have cartilage but not calcium when we’re born. So we can get through the birth

[30:10] canal. And sometimes they fuse too soon. And if that’s the case, the head can be misshapen, and so we plastic surgeons will fix that. There’s a lot of pediatric hand surgery to be done. There was a drug back in the 1960s that women were taking for morning sickness called— and that created all sorts of abnormalities in the extremities, but especially the hands. And so there

[30:40] are many young children that were born without thumbs, and so there’s a way to recreate a thumb using an index finger that you’re rotating. Just super super clever stuff. So sometimes people ask me like, “What is your favorite operation to do?” And I would say that my favorite operation to do is an operation I never get to do unless I go and do a medical mission trip, and that’s a cleft lip repair.

Kathy: Mhm.

And the last one I did was actually on a 22-year-old woman in Peru who had

[31:11] an unrepaired cleft lip. And what I remember about her is that she would not smile. I wanted her to smile in the pre-picture because I wanted to see the basically the extent of the cleft. But she wouldn’t do it. The next day after her lip was repaired under local anesthesia, she smiled and that was really cool.

Kathy: That’s really cool.

Jason: Oh man, that’s awesome. So you’ve done these medical missions.

Yeah. When again, my mentor Dr. Angelots, every year he would invite

[31:41] the senior residents to go on a trip to Peru with him. And so I am now a member of the Peruvian American Medical Society. We went to different places, and this—you might appreciate this story—but it was February of 1995 and it’s winter in Chicago and we went on this trip. On this trip I met that woman that I just described. We were doing other cleft palates and other things like that on the trip. But after

[32:12] we finished, we actually went back to Peru and I got to meet some of Dr. Angelots’s family, and there was this beach club that they liked to go to. And of course the seasons are reversed. It’s South America.

So February is summer there.

We’re sitting at the beach club and we have our swimsuits on, and I noticed Dr. Angelots’s brother-in-law is staring at me, and he’s staring and staring, and finally I just said, “What are you looking at?” And he said, “You are so white.”

[32:42]

Jason: I was thinking that same thing a few times. No, just

And I said, “Hey, it’s February. I’m from Chicago.”

Kathy: Uh-huh.

So, but it was lovely. And I’ve had the opportunity to go back there a few more times.

Jason: Awesome. Super cool.

It’s kind of like—I don’t know if either of you have had the experience of just medicine without attorneys, without consent forms, without bills—and the only payment is a hug or a smile or just watching a mom,

right?

You know, look at her baby that you just

[33:13] had the privilege of helping. So yeah, that was really neat.

Jason: Wow, that’s amazing.

Kathy: Gosh, that’s so cool. So in preparing for this, I saw a statistic. I don’t know if it’s true because I got it from the internet.

Wikipedia, our main source,

but it said that plastic surgeries are up 40% since the pandemic. Is that true? And why?

It was very true. I tell you, I don’t know about your business, but the pandemic was great for our business.

[33:45] A lot of it is Zoom. Yeah. You know, especially for the some of the facial things we do.

Zoom face. Is that what they call it? I haven’t heard that term, but I completely understand that term. Usually it says it’s like—

I should have gotten a ring light. Face is what it should be, because a lot of times it’s the lighting that creates the problem. But people all of a sudden had lots of time to look at themselves and they were seeing themselves like they never had before, and they weren’t going anywhere. Yeah. So if they

[34:15] did have some discretionary income, they were doing things like laser, or might as well get some work, or you know, surgery or eyelids or whatever. And so yeah, it has gone up. And you know, we get these little surveys. Do you feel the economy is affecting your business? And I’ve never really felt like the economy, better or for worse, is affecting the business, because this is a priority for certain people, and if it’s enough of a priority, they’ll

[34:46] make it happen.

Yeah.

But yeah, I think there’s no question. The other reason I think actually why procedures are up—and I mean surgical and non-surgical procedures are up—is because I think things have been destigmatized a little bit because it’s now so commonplace. One thing I personally tend to be a little bit uncomfortable with still is posting a bunch of pictures of my patients on the internet, on the website. But you get a young surgeon in there,

[35:17] everything goes on the website. We have a—

Kathy: Well, and I was looking through your website and you don’t have a ton of before and after.

No, but I’m happy to show them in the office.

Kathy: Sure. Yeah. But I just—I actually thought that was kind of cool because it’s like, I don’t know, patients are patients. They’re not posters or advertisements. And yeah, I think that’s really—

For some reason in this day of, you know, posting your entire life on the internet, people have this expectation that you’re

[35:49] going to be able to see all these pictures. And we have an associate now who does a good job of posting pictures, but she will literally ask every single patient, can I post your picture? And obviously we’ll never post anything unless people give their permission. But even with permission, I still—I guess I’m just at the end part of my career where I’m just a little bit uncomfortable with that, because we didn’t in the past share as much as we share.

Kathy: We overshare.

[36:19] So, yeah, but that being said, I have lots and lots of patients who have given permission to — oh yeah, you want to show other patients my picture, be happy to do that.

And I think that is super helpful. We had a wonderful patient recently who was having a tummy tuck, you know, after having kids and so forth. And she actually documented her whole experience. We didn’t ask her to do it. She just wanted to do it. And I think she wanted to serve as a kind of an

[36:50] education source for people that were considering the same thing. So I think done right, there is a lot of value in that. But just for whatever reason — and I just think it’s, you know, the era in which I grew up — I’m just still a little bit uncomfortable with all that.

Respect that. Are you starting to see, because of the GLPs trending, are you starting to see more like skin removal requests?

Yes, there’s — GLPs are really amazing, and I was very interested in listening to your show on peptides, by

[37:20] the way, because people would come in and ask about all these peptides. I was just so —

Jason: It’s like the one peptide we didn’t talk about. Yeah, which is the most —

But the one peptide you should have talked about. But we will.

But I’m thinking, because people talk about peptides and I think, well, everything’s a peptide. But if you haven’t seen that episode, I would recommend it because it was really well done and it’s evidence-based. How about that?

Crazy.

Who would have thought?

A win for the PTCH. But originally bariatric surgery was the

[37:50] thing that really got a lot of people coming in, because insurance would pay for the bariatric surgery. Insurance would not pay for the aftermath of the bariatric surgery. And what I noticed in some, but not all bariatric surgery patients, is that especially if they had a true gastric bypass, they would lose weight so rapidly that it would change the shape of their face, and you could just tell by somebody walking in the door that they had had this done.

Wearing like a skin suit is what I’ve had patients describe it as. I feel like

[38:21] I’m walking around in a parachute or something like that.

Yeah. And, you know, they’ve done really good work to get to this point where they’re at a healthy weight and feeling good, but then they’re left with this reminder of what they’ve been through. And so, again, getting back to the restoring normal idea, we were seeing more and more and more of those patients. What I have found interesting though — I actually just asked a medical student this the other day, because they had done a two-week rotation in bariatric surgery. I said, “Are they still busy? Are they still doing stuff?”

[38:51] Yeah. And she said, “Yep, yep. Their schedule’s full, and there’s just a lot of people that — still, that is the right choice for them.”

What I have noticed about the GLP-1s — and we’ve had them in our practice for about a year and a half now — what I’ve noticed is that you tend to lose weight a little bit more slowly. At least done properly, and you tend not to have that sort of melted appearance that some people can have. I keep waiting — and I don’t know if you two feel the same way — but I keep waiting to —

[39:22] what is the complication going to be? What is the side effect going to be? Other than nausea or constipation, people just don’t have problems with these things, and it really works. And it’s almost — you know, you keep thinking it’s too good to be true, but it’s really, it’s really good. It’s really good.

Seems too good to be true. It’s really interesting though, and we probably will do a full episode on it. But I think that you look at where some of the backlash comes from, and a lot of times

[39:52] it’s people who have something to sell. It’s people who have something else to sell other than like a GLP. And then there’s always a subset of people that are just very vulnerable to inaccurate information, conspiracy theories, just because they have a low level of trust for establishment. And so they see that, and they see that it’s working, and then they automatically just don’t want to trust it. But there’s some of these things too where

[40:22] it’s like, some things are too good to be true and some things are just good, right? And I think this is just a good thing, probably.

Well, what is your response when somebody comes to you and the statement is, “I’ve done my research”?

Yeah.

And we hear this all the time, and typically that means they’ve been on TikTok and they’ve seen somebody, an influencer of some kind, you know, talk about something. I just think it’s hard — I’m sure you have patients — I think it’s hard

[40:52] for people to know what is accurate information and what is not, because you don’t know what you don’t know.

Yes, correct. I had this experience very early on when I was actually just finishing chiropractic school, and I was talking with my mom about something. I can’t even remember what the topic was, but I was like, “Yeah, Mom, that’s not a real thing.” Like, I don’t even remember what it was. And so she’s like, “It is. There’s a lot of research on it.” And I was like, “I’ve read it, and

[41:22] that’s not a real thing.” And so I was like, “Well, show me what you’ve got.” And so my mom believed — this was earlier on — she believed in printing out the internet. Like, there was what was on the internet, but when you printed it, it became real, right? And so she came and she had just pages and pages of stuff that was printed out from like messaging boards and stuff. She’s like, “Look, here’s the data. Here’s the research.” And I was like, “Oh, wow. How do I explain this to somebody that I really care about that

[41:52] this isn’t data or research?” So that’s a real — it is a real challenge, especially with patients.

Yeah, exactly. Well, one thing that has evolved over my career — it used to be that if you came into the plastic surgery office, you were pretty likely to be interested in surgery of some kind.

Yeah. Yeah.

And so there were times where we had really short conversations, because either there was a procedure we didn’t offer or

[42:22] they just weren’t a candidate for surgery for whatever reason. And that has completely flipped on its head, to where throughout the day probably three-fourths of what we do is non-surgical. And it might be, you know, injectables like Botox or fillers. It might be we do a lot of laser in our office. In the year 2000 I became interested — way back when. Remember that?

Rick: Why two? Way back when, I became interested in just the

[42:53] concept of laser. And I was with a multi-specialty group at that time that had general surgeons and vascular surgeons, and I thought, well, you know, people have spider veins and people have interest in hair removal, let’s see if we can find a laser to do that. And we got our first laser in 2002, and we’ve had various lasers in our practice ever since then, and there’s a lot we can do with that.

Yeah. And so, you and I would never have imagined in the middle of my

[43:23] surgery residency that I’d be talking about skincare or talking about laser or these injectables, because I just couldn’t even imagine it. But so there is a lot. One thing I like about being a plastic surgeon though is we never really have to talk anybody into anything, because we effectively have all the tools.

Yeah. And so if you want something non-surgical, great. Something else that you want surgery, great. We can do that. And both are fun. Both, I really

[43:53] enjoy talking to people. I enjoy my clinic days. We enjoy our — the most common sound in the clinic is, “Yeah, we can do that.”

Jason: Yeah. Well, so that conversation with patients, it kind of leads me — I was talking to a patient today, and she was appreciating the PTCH Podcast. I think she’s also a patient of yours, and she saw your picture on the board and she’s like, “Why do you have a picture of my physical therapist?”

She’s so —

Yeah, that’s exactly what she said. Were you there?

[44:23] So we got talking about the podcast and I was like, “Actually, today we’re having on a plastic surgeon.” I said, “So, is there a question that you would want me to ask a plastic surgeon?” And so she said that she had had a double mastectomy and she described it as being a really important and good experience for her. She really appreciated her doctors. But she said she wanted me to ask you what advice you would give a patient in terms of, like, what they should do to

[44:54] advocate for themselves, especially if they’re in the presence of a doctor who is just very confident about what they’re doing to the point where it maybe feels a little overbearing, and it’s like they don’t have choices and things like that. What kind of advice would you give a patient about advocating for themselves in that realm of plastic surgery?

Rick: I think this is a hugely important question to ask, because this is something that almost everybody struggles with when they’re going through very scary experiences

[45:24] like this. And first of all, what I would say is that there’s no one way to do anything. Secondly, I would say that in the breast cancer world especially, it’s really intimidating. And I always tell breast cancer patients, it’s a journey. It’s not like getting your appendix out. And there’s going to be a bunch of doctors that are going to be talking at you with statistics and you will not understand them. Frankly, I don’t understand because I’m not an oncologist, but

[45:54] it’s very intimidating and it’s hard to know. And with not having that knowledge, it can be difficult to advocate for yourself. But sometimes you’ll, as a patient, connect with a particular doctor and sometimes you won’t. And there is nothing wrong with getting a second opinion. There’s also nothing wrong with, you know, talking to friends or other people that have gone through this and say, “Who did you see? What was your experience like?” Interestingly, funny you mentioned that, but just this week, my lovely

[46:25] first cousin just underwent a double mastectomy. And she had the advantage, I think she realizes now — hopefully she realizes — of having a cousin who’s a plastic surgeon. I said, “Oh, wait a minute. I know who you should see.” And so I just texted two surgeons that I really respect. One is a general surgeon who specializes in breast cancer and another is a reconstructive surgeon that does the particular kind of reconstruction that my cousin might be interested in. And I

[46:56] was able to say, “Hey, would you mind — would you be able to see my cousin?” And, oh yeah, yeah, yeah, of course. But not everyone can do that. So how do we do that? I think talking with your primary care doctor is not a bad idea, because they will often know who patients like and who patients have had a good experience with. But we have to advocate for ourselves, and it’s true in every part of medicine. Somebody’s had back pain for a long time and their insurance carrier won’t allow them to see this

[47:27] person or that person. Well, you got to rattle the cage and make a fuss. And don’t ever feel like, as a patient, that you are insulting a doctor by saying, you know, “I think I’m going to go get a second opinion.” I think any doctor that bristles at that, they’re not somebody who you should see. And in fact, that is your second opinion. I encourage people, hey, go talk to somebody else. And if they’re saying the same thing I’m saying, then that’s great. And if you’re more comfortable with them, absolutely, you know, go with them.

[47:59] But we want you to feel comfortable, and we’re not trying to make a sale. We’re trying to educate people. But I think it’s very difficult to advocate for yourself, because, at least traditionally, you look at the doctor as being some sort of, you know, infallible authority.

Yeah.

But again, there’s lots of paths to get to every destination.

Jason: Well, I think one thing that kind of fits in with this, and it’s just

[48:29] it’s really sad to see. I’ve had two patients who have said this, but they had like a single mastectomy and then down the road — and I don’t really ask about those things because I don’t know that everybody wants to talk with their chiropractor about that. But down the road, what they found out was that they had the option of getting a reconstruction. And of course they have the option, but I think that there are some people that think that you only have that

[49:00] option if you’re rich, right? Or you have really good insurance coverage and things like that, which really kind of made me sad, because both of them kind of expressed that they didn’t feel like they were as good as other people, and it was really kind of a badge of this is my poverty — I can’t afford to get a reconstruction. So —

you want to know something interesting about that?

What’s that?

Clinton administration, 1998, federal law requiring insurance companies to cover reconstruction of a

[49:32] of lumpectomy or mastectomy, and they’re required to cover a procedure on the opposite breast for purposes of symmetry. Federal law. And so a lot of people don’t know that, and they think, well, I can’t afford that, or that’s cosmetic so my insurance would never cover it. No. If somebody has a diagnosis of breast cancer, then by federal law their insurance is required to cover that, including government insurance — Medicare, Medicaid — required to cover that.

Yes. If you are listening and that is

[50:03] you and you think that you cannot afford it, you heard it on the PTCH Podcast, the ultimate source of truth

on the internet, at least. You know what’s really helpful too, is that if patients have the opportunity while they’re, you know, before they even have their surgery, ask for an appointment with a plastic surgeon — doesn’t necessarily mean you’re going to have plastic surgery, but at least you have the opportunity to make an informed decision. Yes.

The other thing that’s relatively new,

[50:34] it’s been around for a few years now, but there’s a term called oncoplastic surgery. And oncoplastic surgery is using plastic surgery techniques, often at the same time as a lumpectomy or mastectomy, to take care of a deformity preemptively that could be caused by the breast cancer surgery. And so that’s

that’s something we do quite frequently, and it’s actually fun. We get to

[51:04] work with the breast surgeons, and we might do, you know, a bilateral breast reduction, for example, in somebody that could benefit from that. But where the lumpectomy was, we’ll take a little flap of breast tissue and kind of plug the hole, and so people come out basically with just having had a breast reduction, which they benefit from. As a chiropractor and PT, you know that.

Yes.

Hopefully you know that. Hopefully you admit it 100%. Yeah.

Is that still like the most common elective surgery, a breast reduction?

[51:34] It is. And if you ask every single plastic surgeon who are their happiest patients — breast reduction patients, 100% of the time.

Insurance doesn’t always cover that.

No, there’s so many hoops that we have.

That is the hardest thing for our staff, our wonderful staff, to —

Shout out to the wonderful staff

at San Creek Plastic Surgery. Thank you for your help. Yes.

In getting insurance authorization for breast reduction.

Yeah.

Because it’s just so easy to um, you know, deny, deny, deny, right?

[52:07] And there was a time a few years ago where there was a certain insurance company in the greater Portland area. I won’t mention any names because I don’t want Regions Blue Cross to be embarrassed.

But they, uh —

if it were them —

if it were them.

Yes. Which it is. Or if they knew who it was.

Yeah.

But the problem is, they would deny every single authorization we sent in.

Wow.

Every single one for a period of about a year and a half.

And see, it doesn’t just happen to us.

It’s not just us.

[52:38] And so what happened was, then we’d have to go through the process of, you know, appeal and this sort of thing, which we do for our patients, and which you do, because we’re patient

advocates. But you know what patients often — Here’s another piece of information. How do insurance companies make money? Do they make money from your premium dollars? No,

they make money from investing your premium dollars. So when the stock market is good, the denials seem to

become more frequent, because the longer they can hold on to the dollar,

the more successful they are. And I’m

[53:08] not criticizing, other than this one instance with Blue Cross, but uh —

you’re not criticizing insurance companies, like you wouldn’t criticize another insurance company that’s owned by what? Berkshire Hathaway.

And, you know, their little lizard is investing all the money,

and so they’re delaying payments and stuff. You wouldn’t do that. I would —

but okay.

Okay. Well, it’s your podcast.

Yeah.

Yeah. I don’t know. It’s frustrating, and it’s frustrating for patients, and they

[53:38] don’t understand. They say, “I have good insurance. I don’t understand what the problem is.”

But it’s difficult, and just know that whatever medical office or surgical office or chiropractor, PT — everyone’s advocating for you, but it’s just difficult.

It’s difficult. And I’d like to —

There was something recently in the news about, uh, there was an insurance company, I think it was United Healthcare actually, that they were going to get rid of pre-authorization.

Yes. For 30% of medical —

just happened this week, I think.

Right.

[54:08] That doesn’t mean that they get rid of not paying you, though. And exactly —

and so, you know, patients can still get stuck with bills if insurance companies, after the fact,

do that. So that’s a whole other podcast.

We’ll have to have you back for that one.

We can rant. We can rant together.

Can we go back to the breast reconstruction, when you’re talking about your cousin? If a patient doesn’t want an implant, which one do you recommend? Like which one would you have

[54:39] recommended for your cousin in that sense?

Rick: Well, my cousin did her research.

Kathy: Yeah.

Rick: Um,

Jason: real research.

Rick: I don’t think she’s on the message boards. No, she’s just super smart, and so she knew some questions to ask, and what she was interested in is what’s called an autologous reconstruction, where you take tissue from one part of the body, disconnect it from its blood supply, transfer it to another part of the body, reconnect it to its blood supply, and so you’re using the patient’s own

[55:10] tissue to reconstruct a breast. Now, that’s not a procedure I offer, so that’s exactly where with her, I was kind of inferring that she was interested in that type of procedure, and I happened to know a surgeon in Portland who I think is the best at that procedure and so texted her and said, you know, would you be willing to see my cousin for that? Again, insurance will cover these procedures, and if it’s appropriate for the patient, insurance will cover that. So

[55:40] again, there’s lots of different things that can be done. Another thing that we’ve done a lot lately for people that aren’t interested in implants is fat transfer.

Kathy: Yeah.

Rick: And you can take fat from one part of the body.

Jason: I’m happy to be a donor. Like, is that a service I could provide? Like, I give blood.

Rick: You can, but you would be rejected. Yes. You’re rejected, and it’s not just because of your occupation. It’s No, it’s, you know, it’s living tissue. So if you have an identical twin, it would work.

[56:10] Oh, okay. Yeah, a genetically identical twin, no problemo, but otherwise, yeah, it has to be your own fatty tissue.

Kathy: Body would reject it, right?

Rick: So, for example, this comes up sometimes where somebody’s had a lumpectomy and radiation. I don’t know if you’ve seen radiated tissues. I’m sure you have, but it creates scarring, stiffness, contraction under the skin even.

Kathy: Yes. Yes. Within the tissues of, you know, whatever you’re dealing with.

Rick: But you can take fat, you can inject fat

[56:40] into radiated tissues and make them soft again, because it’ll stimulate new blood vessel growth, and so it’s a way of counteracting the effects of radiation and then filling in divots or defects from that. So that’s something we do a lot. But getting back to the operation that my cousin was potentially thinking about, that has not been around forever, but it has gotten really good. The people that do that operation are really, really good. And there are some centers in the

[57:10] country that are excellent at that. And New Orleans, for example, has a group of nine plastic surgeons. And that’s all they do. Wow.

Kathy: Is autologous breast reconstruction. And they’re—

Jason: What tissue are they taking?

Rick: You can take the lower abdomen, lower abdominal tissue, tissue you use for a tummy or get rid of for a tummy tuck. You can take the upper part of the gluteal area.

Kathy: Oh, so you’re taking muscle.

Rick: Not always. Well, yes and no. You’re not taking functional muscle, but often the

[57:40] muscle is where the blood supply is going through. So you might take a piece of muscle.

Kathy: Okay.

Rick: You can also take tissue from the back. We’ll use latissimus and the skin over latissimus to reconstruct breast, and so those, you can take thigh actually is another place where they can go for that. So a lot of it just depends on sort of the quality of tissues in different areas and how much volume somebody needs, right? And you can create, using their own tissue, autologous tissue, really

[58:10] natural looking breast. That being said, one thing I tell my patients always is a reconstructed breast is a reconstructed breast. It’s not exactly the same as the original breast. But, you know, you’ve had a win where people are, you know, step out of the shower, they’re toweling off, and they just don’t notice anything weird in the mirror anymore. That’s huge. And that’s a win.

Kathy: That’s huge.

Rick: And these breast reconstructions can do that.

Jason: That’s outstanding. Do you send your patients to PT after

[58:40] they’ve had the lats moved?

Rick: We do, because they sort of have to learn to use their body again.

Kathy: Yeah.

Rick: We actually would, really, enough, would send—we haven’t done this recently, but in the past we’ve sent people to PT after abdominal plastics. Every once in a while somebody gets almost like a—turn to like a—you know, the muscle’s too relaxed. It just

[59:10] doesn’t seem to contract in the proper way, it’s flaccid. I was going—I didn’t want to say the word flaccid. I don’t like that word, but—

Kathy: except that that’s the word for it. That’s what it is. That’s the word for it.

Rick: Sorry. Flaccidity.

Kathy: Yeah.

Rick: It’s like a depressing word. It really is. Yes.

Kathy: Yeah.

Rick: But anyhow, and I do think I send people to chiropractic, too, because, you know, we’ll have patients. It’s actually more in the hand surgery world where I have patients with chronic pain. I even like acupuncture.

[59:41] And if somebody knows what the heck they’re doing, it is all one of those things. How does it work? Why does it work? I don’t know. It’s magic. It’s magical. Yeah.

Jason: Yeah.

Rick: So, no, we like having relationships with people in the community like that.

Kathy: Yes.

Jason: Outstanding.

Rick: We appreciate those surgeons.

Jason: Well, you talked about a win, and you’ve listened to the podcast enough to know that we play a game every single time.

Kathy: Sometimes they just skip to the game.

Jason: Yeah, exactly. Make the podcast better.

[60:12] It’s true.

Kathy: I know. Basically, if this is your first time listening to the PTCH Podcast, we torture you for about 45 minutes so that we can play a game.

Rick: Definitely not today. This has been so good.

Kathy: Yeah. I think that we should come back for part two. But I think that this is a really, really good time to do a PTCH Podcast Mad Libs. Okay. So you’ve done Mad Libs before, I’m guessing. Okay. Are you good at them?

[60:42] There’s no particular skill.

No.

Yeah. So, I hope you are.

I’m not bad at them.

Okay. You know your parts of speech like adjectives. Now,

you probably had to take Latin. Did you have to take Latin in high school?

You learn in medical school, you learn Latin. Greek by default.

You know that the lumbrical muscle in the hand is a lumbrical muscle because that’s Greek or Latin for worm. It looks like a worm. So, there you go. It’s not a part of speech, but

I’ll use worm at some point in this game.

Well, okay. Well, perfect. The first kind of word I’m going to need is an

[61:12] adjective.

That’s a description word.

Placid.

Yes.

Okay. Oh, hang on a second. I got to restart this. Oh, let’s see. All right, there we go. And give me—oh, I’m gonna have to write this somewhere else. Okay, I got this. So, sorry. On the fly. My little program that I wrote to do

[61:42] this. All right. Give me an animal.

Echidna.

You’re not going to do a worm. What is echidna?

How do you spell that?

Echidna. E-C-H-I-D-N-A. It looks like a hedgehog.

A big hedgehog. Super cute.

And we met one in Australia recently.

Raul’s nodding because he knows what that is. All right. Okay.

All right. How about this? A body part. The little finger.

Little finger.

[62:12] All right. How about a noun?

Comb.

Comb. Okay. Give me the name of a medical business.

Medical business. Salmon Creek Plastic Surgery.

Oh, okay. Okay. Like it.

All right. Another adjective, please. Happy.

[62:42] Happy and a noun.

Did we already say worm?

Not yet.

So worm.

Okay. Another body part.

Let’s do the left nostril.

Okay. And a number.

And then a plural noun.

Eyelashes.

Okay. And we’re going to need a

[63:12] celebrity.

Jason Young.

Oh jeez. A minor celebrity. Okay. And a number. How many words are there?

I thought I told it 10. Okay. Another plural noun.

Footballs.

Okay. And let’s see, we’re almost there. A noun.

Measuring cup.

[63:42] Okay. This is going to be a good one.

And we’re at an adjective and then a verb ending in -ing.

Okay. Silly and thundering. Thundering. And the final one is a noun.

Dog.

Dog. Got it. All right. This is an advertisement for a plastic surgery

[64:14] practice. Okay. Here we go. Are you tired of looking like a flaccid echidna? Do you wish your little finger looked more like a comb?

Come to Salmon Creek Plastic Surgery where Dr. Rick Green, a board-certified surgeon and happy worm, will transform your left nostril in just 13 eyelashes.

Yes. Our most requested procedure, the

[64:44] Jason Young attack, where Rick uses 44 footballs and a single measuring cup to sculpt your dream silhouette. After surgery, relax in our silly recovery suite while our staff—while our staff thundering you back. Oh, while our staff is thundering you back to confidence. Salmon Creek Plastic Surgery because

[65:15] beauty is just a dog away.

All right.

It doesn’t get any better than that.

Nice. No, we’ll use that. Quank, can I use that?

I’m going to send that to you. Thank you. Yes. Yes. And we’re also going to send you a PTCH Podcast shirt because winning tradition, you know, you won the game, so we’re going to get you a shirt. We have several to choose from. I kind of think you should get the nard shirt, although you can’t really wear it because you are a real doctor. So,

[65:46] but some people don’t. They think

that plastic surgeons aren’t real doctors. I think we have that in common.

Okay,

sweet. Great. We could all start a group practice. Excellent.

Sold.

Yeah. Well, thank you so much.

Now, we’re going to do takeaways. Kathy, you want to start us out?

I don’t even know where to start with this. I’m going to let you start.

Okay, ‘cause I should have thought about this.

I think one of the biggest—I never want to have

a patient tell me that they didn’t

[66:17] think that they could get

a reconstruction again. That was

very valuable knowledge, and I am going to be telling women confidently you are entitled to that under the law. So, because that’s life-changing. I think that what you do is really life-changing and really appreciate you being here. So

yeah, hopefully this helps lift the stigma

because, like Jason said, I think what you do is life-changing. It’s—yes, some of it obviously is cosmetic.

But

[66:47] which also isn’t bad.

No, no, no stigma to that. But restoring function and restoring people’s identity is huge. And so yeah, thanks for the gifts that you give people.

Yeah. Thanks.

And Rick, your turn. Takeaways. What did you learn from Kathy?

That it’s okay to wear a Notre Dame shirt in public. Sorry.

I didn’t know that.

People usually think this is North Dakota.

Not going to lie.

[67:17] You did your research, huh?

That’s right. Now, I think takeaways for me that sometimes people ask me, am I too old to do this? And the oldest patient I operated on was 101.

He had a big skin cancer on his nose and took that out and did a little flap to kind of

fix the nasal tip. But

afterwards I went out to talk to his kids, and the

the 80-year-old kids.

[67:47] 80-year-old kids. They were 80.

Wow.

And I said, “Your dad did great. Just have him take it easy over the weekend and I’ll see him next week and we get his stitches out.” Well, did you tell him to take it easy? I said, “No.” Why? Well, he has a new chainsaw and he’s—I got cutting a bunch of brush this weekend.

I said, “Well, don’t let him cut brushes.”

Oh my gosh. So, what kind of warranty do you offer on a repair on a 101-year-old?

Not extended.

[68:20] Not extended. But — especially with a chainsaw.

This is going to last longer than your roof, sir. I love patients like that. You know, sometimes the older the patient, just the more stories they have, the more open it is. And you know, one thing the three of us do have in common is that we have plenty of time to talk to patients and get to know them, and everyone has a story. And sometimes what you anticipate will happen, it’s just the opposite. And

[68:50] people are wonderful. So we’re very lucky to do what we do, I think.

Fantastic.

Oh sorry, I got one more. Rick had more field time than Rudy.

Yes. Very important.

Got it.

Suck it, Rudy.

Yeah.

All right. And I guess there is one more thing, right? And that’s there’s no I in pitch.

[69:32]