She opened her eyes from her restful state and asked, “Do you find this procedure challenging?”

I smiled, and reflected on my over 25 years of surgery.  “Well I have repaired ruptured aorta’s with patient’s close to death, and have performed heart bypass surgery on patients whom I brought to the operating room while doing CPR and had to “crash on the bypass machine” to save their life. I have reconstructed hearts that have been damaged by numerous heart attacks, so I would have to say that this procedure is actually not very challenging, but very enjoyable to me.”

“Oh,” she replied “How did you get from doing heart surgery on very sick patients to performing liposuction surgery?”

“I had performed over 4000 heart procedures but one procedure that most other heart surgeons didn’t like to do was to reconstruct chest walls after a patient developed a deep infection after heart surgery.” I replied. “I would reconstruct the chest wall with muscle flaps from the chest, and abdomen, as well as moving healthy tissue from inside the belly to fight the infection.  This was not a common procedure fortunately, but because I enjoyed the challenges of this procedure, many surgeons would send their complicated infections to me.”

“Now that sounds like a big surgery.”  She replied.

It is, and challenging as well, but the feeling of saving a patient’s life by repairing their chest wall and getting rid of a potential lethal infection made me appreciate the importance of what I did.”  She then asked, “Did heart surgery prepare you for liposuction surgery?”

I replied, “My in depth understanding of the muscles and fat layers in the chest and abdomen, helped me be a better surgeon to remove unwanted fat collections and to also perform this using minimally invasive procedures with small instruments and small holes that heal quickly.”

She was quiet for a moment and I thought our conversation was over and then she asked, “What is it called minimally invasive surgery?”

Minimally invasive surgery is performing a surgery through the smallest holes, and using smaller less traumatic instruments and incisions. This makes the surgery less painful, the recovery quicker and the procedure still successful.

I began doing minimally invasive surgeries in the early 90’s with removing many gall bladders and appendices, using laparoscopy instruments through very small holes. The procedure was more challenging and difficult than the standard procedures, but the patients recovered so quickly. I loved the challenge.

I later performed numerous lung surgeries through very small incisions, as well as aortic valve, mitral valve replacement, and bypass surgery. I enjoyed the minimally invasive approaches, and bring my extensive experience to using a minimally invasive approach to liposuction, helping achieve excellent results, with minimal down time and pain.

She closed her eyes for a moment and then opened them again asking, “How do you know where to remove fat and how much to remove?”

“I really enjoy performing liposuction and consider it art work with careful sculpting of the fat to achieve the most beautiful results.”  I replied. “ My experience sewing millimeter coronary arteries, bypass grafts that have to lay just perfectly on the heart, and the fine sutures placed exactly so that the bypass graft stays open for years. “

I believe creating a perfect bypass graft is an art form, and I challenge many plastic surgeons if they are able to perform such a meticulous procedure. It is truly fine  art when the graft lays so perfectly. And the patient’s life depends on it. It is my expertise in performing such meticulous operations that makes my ability to create a beautiful liposuction result possible.

“Thank you Dr. Carlson, “she said. “I feel so comforted and confident that I am in the best surgeon hands possible. So I’m not going to disturb your sculpting of my tummy anymore.”

“You never disturbed me. I enjoy talking with patients throughout the entire procedure.”

And she fell back asleep.

Menopause and peri-menopause are associated with the harmful loss of estrogen, progesterone, and testosterone in women and with the tremendous increase in total and abdominal obesity and hot flashes.

When a woman is having hot flashes, her brain is yelling at her ovaries to make the required estrogen her body needs to function properly. Unfortunately, the ovaries are no longer listening and the only structure in a women’s body that is listening is the fat cells in the belly, hips and thighs.

That’s because estrone, the estrogen of menopause is only made in fat tissue. So with hot flashes, your body is becoming dedicated to making more fat so that it can make more estrogen. I have seen weight gains exceeding 20 to 30 pounds over less than five years.

Regardless of what women do whether it’s exercising, eating less and eating smarter, they still gain weight. That’s because their body is primed to make more fat.  The good news is numerous reports have shown a dramatic improvement in stopping weight gain and abdominal obesity with balancing of hormones.

And best of all, without hot flashes women will get a better night sleep which lead to more energy and helps them to think clearer.  With menopause and falling hormone levels, there is also an increase in the enzyme which causes fat development in the abdomen, hips, and thighs.

Estrogen therapy reduces this fat forming enzyme which will decrease the enlargement of the fat cell thus decreasing fat formation in the abdomen, hips and thighs. There is hope.  Unfortunately not all estrogens will reduce fat.

The topical bio-identical hormone therapies have been shown to dramatically reduce fat whereas the oral estrogen replacements, the synthetic horse urine derived estrogens and the synthetic progestins have all been shown to increase weight gain and inflammation.

So if you are having hot flashes and night sweats, don’t buy more fans, change your sheets every night or hide in the freezer. Get some help with bio-identical hormones and help your body stop fat forming in its tracks. Balancing your hormones will help you effectively lose weight, sleep better, think clearer, and feel more energized.

Maybe you’re taking sleeping pills that leave you spaced out in the morning as if moving in slow motion. Losing sleep is critical resulting in loss of memory, ineffective work habits and increasing irritability. Starting in their early 40’s, women are commonly plagued with sleeping problems.

The answer is really quite simple. About ten years before menopause, a woman’s progesterone levels start to plummet setting them up for sleepless nights. Progesterone, natural progesterone that is soy-based provides improvement in sleep, dramatic reduction in irritability, headaches and a generalized calmness free of anxiety.

Natural progesterone is amazing. It helps you feel better, lose weight and protects women from heart disease and breast cancer. Don’t be fooled by its synthetic chemical substitute, the evil twin progestins, Prempro, Provera, Medroxyprogesterone or the progestin components of birth control pills as they do the absolute opposite. They make you fat, wreck your sleep, dramatically increase your breast cancer risks as well as increase heart disease in women.

You may not have known that. It’s that extra tummy fat that keeps getting fluffier. Depositing extra fat into your tummy and hips is actually blocked by Progesterone. Restoring your natural progesterone levels, will help you sleep better and feel less irritable. An added benefit is losing your belly fat.

The bottom line is restoring progesterone in your body is going to make you feel better all over and it is very easy.

It’s just replacing what was so kind to you when you were in your 20’s and 30’s and is now so low you can barely measure it. Don’t waste another night without sleep. When treating women struggling with sleep issues in their 40’s and 50’s, sleep undoubtedly affected by progesterone levels, one of the most common responses I hear after starting progesterone is ‘This is the best sleep I’ve ever had’.

Ask your age management doctor about all the amazing benefits of progesterone.

A Caucasian wearing no sunscreen can sit in the summer sun with 40% of their body exposed for 20 minutes and produce about 10,000 units of vitamin D. If sunscreen is applied, Vitamin D drops to nothing.

A darker skinned person needs 45 minutes a day in the sun. If you live above 35 degrees latitude, the body is unable to produce adequate amounts of Vitamin D from the winter sun. The only adequate amount of sunshine in Boston occurs between May and September. Other than that period, there’s just not enough sunlight for Vitamin D metabolism.

The person working in Chicago during the middle of the winter will get absolutely no Vitamin D from sunlight and vitamin D fights the common cold better than Vitamin C. That’s why cold and flu season occurs during the winter season.

You won’t get enough Vitamin D by eating a balanced diet either because Vitamin D is present in small amounts in a handful of foods like oily fish and eggs. Vitamin D fortified foods such as Vitamin D fortified milk and orange juice are a joke containing a measly 50 units of Vitamin D2 which is the wrong kind and essentially worthless. You’d have to drink 5 gallons of milk and juice a day.

You need about 5000 units a day of Vitamin D3 to help your body fight the battle against cold viruses. That amount also reduces breast and colon cancer, diabetes, heart disease and even weight loss and obesity. Closely tied with the obesity epidemic, a high percentage of our population is grossly deficient in Vitamin D. We have been told that the sun is bad for us and processed foods have minimal Vitamin D.

Vitamin D has been shown to be critical in the creation of stored fat. Providing your body with sufficient levels of Vitamin D will signal fat cells to shrink. This makes weight loss much easier when calories or carbohydrates are restricted.

You can help your body burn abdominal fat and lose weight naturally by incorporating adequate amounts of vitamin D in your diet primarily through extremely inexpensive Vitamin D3 supplements.

Vitamin D is critical in regulating weight. The dramatic impact on thyroid function, optimizing metabolism, the correlation between rising rates of obesity and vitamin D deficiency aren’t a surprise. Focus on optimizing your vitamin D levels and a healthy and active lifestyle will be in your future.

Dr. Robert Carlson, MD, FACS

Our body may create various substances to help counteract the effects of these harmful toxins. One of the most potent substance our body produces to neutralize these toxins is Glutathione or GSH. The effects of glutathione as the body’s defender are unparalleled. When our levels of GHS are depleted, there is an increased susceptibility to chronic illness, and the level of glutathione complex within an individual serves as an indicator to reflect overall health and longevity.

Within the human body, there are three critical functions of glutathione:

• Acts as an immune system booster
• It aids in systemic detoxification
• It possesses an amazing antioxidant capacity.

Glutathione has the ability to naturally shield our body from the long-term dangers posed by dangerous disease causing free radicals, while simultaneously removing hazardous waste and toxins from our body. So maximizing Glutathione levels seems to be of critical importance, however our body’s ability to produce GHS decreases incrementally as we age.

The benefits of Glutathione to the body cannot be questioned. It is called the Master Antioxidant because it helps boost the immune system as it removes excess free radicals thus gives resistance in fighting common diseases and even cancer. Intravenous administration of Glutathione has demonstrated numerous beneficial roles including the maximization of a powerful anti-oxidant, binding of toxins that accumulate in the body like mercury and lead, and it aids in rapid expulsion through the urine and feces.

But what has made Glutathione famous is its positive side effects on the skin. Glutathione when given intravenously causes whitening of the skin all over, reduction in acne, age spots and other skin blemishes — resulting in flawless, radiant and youthful looking skin. Truly a no downtime procedure, injectable glutathione only takes 30 minutes or less to perform and you can go back to your usual activities after the session. The effects of injectable glutathione are a lot faster compared to the oral one.

The procedure is relatively simple and involves injection of pure injectable glutathione directly into your system via the intravenous route. Each session takes about 30 minutes and there is no downtime. To achieve maximum results, Glutathione should be administered at one or two week intervals, although some request it be performed every 3 days to speed the results. To achieve the objectives of skin whitening, we recommend at least 5 to 10 sessions to achieve optimal results.

Benefits of Glutathione on Neurologic Disorders

Intravenous administration of Glutathione has demonstrated numerous beneficial roles associated with its amazingly powerful anti-oxidant properties. We now know that one of the most prominent features in Parkinson’s Disease or most neurologic disorders is the destruction of neurons by free radicals.

So using Glutathione to neutralize and reduce these free-radicals has been shown by Dr. Perlmutter to have significant benefits in managing neurologic conditions associated with inflammatory disease processes promoted by excessive free radical activity. The primary role of glutathione is not necessarily in preventing symptoms, but in slowing the disease by limiting free radical activity.

Doses higher than RDA of vitamin C have been associated with increases in HDL cholesterol, decreases in LDL cholesterol oxidation, decreased blood pressure, and decreased cardiovascular mortality. It has also been described as very effective in reducing symptoms of a “hang-over” after drinking too much alcohol, improvement in your immune system, and reduction in symptoms and the duration of the flu or common cold. Vitamin C is a powerful anti-oxidant, reducing damaging free radicals in your body. Often Vitamin C infusions are given in conjunction with B-vitamin infusions and the Myers cocktail.

This often reduces the actual vitamins and nutrients entering your system to miniscule amounts, versus the intravenous, intramuscular, or subcutaneous administration routes, where the veins bring the vitamins and nutrients immediately back to your heart, where they are evenly distributed throughout your body, without having to pass through the liver initially. The amount you administer is actually the amount your body REALLY gets.

Intravenous Vitamin C has been used extensively, and has been shown to be very safe at dose up to 50 -150 grams ( 50,000- 150,000 mg) a day. I very seldom exceed 100,000 mg at one administration, more commonly infusing 25,000- 50,000 mg. The benefits of intravenous Vitamin C administration include reduced risks of cancer, cardiovascular disease, and cataracts.

Doses higher than RDA of vitamin C have been associated with increases in HDL cholesterol, decreases in LDL cholesterol oxidation, decreased blood pressure, and decreased cardiovascular mortality. It has also been described as very effective in reducing symptoms of a “hang-over” after drinking too much alcohol, improvement in your immune system, and reduction in symptoms and the duration of the flu or common cold. Vitamin C is a powerful anti-oxidant, reducing damaging free radicals in your body. Often Vitamin C infusions are given in conjunction with B-vitamin infusions and the Myers cocktail.

Myers Cocktail Infusions promote healing and replenishes energy – The Myers’ cocktail is composed of nutrients that are recognized to be deficient or involved in a variety of pathologies. This potent solution contains a specially balanced combination of vitamin and minerals and is administer intravenously to help the treatment of a range of ailments and increase energy. Ingredients in the Myers’ Cocktail include: Magnesium, Calcium, Vitamin B-12, Vitamin B-6, Vitamin B-5, Vitamin B-Complex, and Vitamin C. Myers’ cocktail has been used to relieve respiratory symptoms of upper respiratory tract infections, chronic sinusitis, and seasonal allergies, migraines headaches, fibromyalgia and the chronic fatigue syndrome.

Intravenous Glutathione

Our body is constantly fighting the insult caused by toxins and chemicals that we are exposed to through the environment, our diets, our personal care products and the overall lifestyles that we live. Unfortunately these toxins will accelerate the aging process; increase our vulnerability toward sickness, and will disrupt our bodies ability to function optimally.

Our body may create various substances to help counteract the effects of these harmful toxins. One of the most potent substance our body produces to neutralize these toxins is Glutathione or GSH. The effects of glutathione as the body’s defender are unparalleled. When our levels of GHS are depleted, there is an increased susceptibility to chronic illness, and the level of glutathione complex within an individual serves as an indicator to reflect overall health and longevity.

Within the human body, there are three critical functions of glutathione:

1. Acts as an immune system booster
2. It aids in systemic detoxification
3. It possesses an amazing antioxidant capacity.

Glutathione has the ability to naturally shield our body from the long-term dangers posed by dangerous disease causing free radicals, while simultaneously removing hazardous waste and toxins from our body. So maximizing Glutathione levels seems to be of critical importance, however our body’s ability to produce GHS decreases incrementally as we age.

The benefits of Glutathione to the body cannot be questioned. It is called the Master Antioxidant because it helps boost the immune system as it removes excess free radicals thus gives resistance in fighting common diseases and even cancer. Intravenous administration of Glutathione has demonstrated numerous beneficial roles including the maximization of a powerful anti-oxidant, binding of toxins that accumulate in the body like mercury and lead, and it aids in rapid expulsion through the urine and feces.

But what has made Glutathione famous is its positive side effects on the skin. Glutathione when given intravenously causes whitening of the skin all over, reduction in acne, age spots and other skin blemishes — resulting in flawless, radiant and youthful looking skin. Truly a no downtime procedure, injectable glutathione only takes 30 minutes or less to perform and you can go back to your usual activities after the session. The effects of injectable glutathione are a lot faster compared to the oral one.

The procedure is relatively simple and involves injection of pure injectable glutathione directly into your system via the intravenous route. Each session takes about 30 minutes and there is no downtime. To achieve maximum results, Glutathione should be administered at one or two week intervals, although some request it be performed every 3 days to speed the results. To achieve the objectives of skin whitening, we recommend at least 5 to 10 sessions to achieve optimal results.

Benefits of Glutathione on Neurologic Disorders

Intravenous administration of Glutathione has demonstrated numerous beneficial roles associated with its amazingly powerful anti-oxidant properties. We now know that one of the most prominent features in Parkinson’s Disease or most neurologic disorders is the destruction of neurons by free radicals.

So using Glutathione to neutralize and reduce these free-radicals has been shown by Dr. Perlmutter to have significant benefits in managing neurologic conditions associated with inflammatory disease processes promoted by excessive free radical activity. The primary role of glutathione is not necessarily in preventing symptoms, but in slowing the disease by limiting free radical activity.

• Remove the protective caps from the two vials. With one alcohol swab, clean both the rubber top of the vial that contains the powder and the rubber top of the vial that contains diluent.
• Use next the sterile diluent vial, the disposable 3 mL syringe and a needle.
• Attach the needle to the syringe (if not attached already).
• Pull back the syringe plunger and fill the syringe with air. Push the needle fitted to the syringe through the rubber top of the diluent vial, push all the air from the syringe into the vial, turn the vial upside down, and withdraw all the diluent from the vial into the syringe.
• Remove the syringe and needle. You will draw about 1.14 cc of sterile water.(most vials have a little more) This will allow you to inject .07 cc of fluid each time for a total of approx 17 injections. Regardless, once the vial is empty you will have given yourself 17.4 units of HGH.
• Next take the syringe with the diluent in it and push the needle through the rubber stopper of the vial that contains the white powder.
• Inject the diluent slowly. Aim the stream of liquid against the glass wall in order to avoid foam. Remove the syringe and needle and dispose of them.
• Gently swirl the vial until the content is completely dissolved. Do not shake

MEASURING THE DOSE OF OMNITROPETM 5.8 mg TO BE INJECTED

• Next use the sterile, disposable 1 mL (or similar) syringe and needle for subcutaneous injection. Push the needle through the rubber top of the vial that contains the medicine that you have just mixed.
• Turn the vial and the syringe upside down.
• Be sure the tip of the syringe is in the OMNITROPE™ mixed medicine.
• Pull back on the plunger slowly and withdraw the dose prescribed by your doctor into the syringe. Should Start at one unit or .07 cc on your TB syringe. So that is between the 10 unit mark on the syringe and the hub(towards the needle part)
• Hold the syringe with the needle in the vial pointing up and remove the syringe from the vial.
• Check for air bubbles in the syringe. If you see any bubbles, pull the plunger slightly back; tap the syringe gently, with the needle pointing upwards, until the bubble disappears.
• Push the plunger slowly back up to the correct dose. If there is not enough medicine in the syringe after removing the air bubbles, draw more medicine into the syringe from the mixed medicine vial and repeat checking for bubbles.
• Look at the mixed medicine in the syringe before using. Do not use if discolored or particles are present. You are
  now ready to inject the dose.

4. INJECTING OMNITROPETM 5.8 mg

• Choose the site of injection on your body. The best sites for injection are tissues with a layer of fat between skin and muscle such as the upper leg (thigh), buttocks, or stomach area (abdomen) as in the picture shown to the left. Do not inject near your belly button (navel) or waistline.
• Make sure you rotate the injection sites on your body. Inject at least 1/2 inch from the last injection. Change the places on your body where you inject, as you have been taught.
• Before you make an injection, clean your skin well with an alcohol swab. Wait for the area to air dry.
• With one hand, pinch a fold of loose skin at the injection site. With your other hand, hold the syringe as you would a pencil. Insert the needle into the pinched skin straight in or at a slight angle (an angle of 45° to 90°).
• Inject the solution by pushing the plunger all the way down gently.
• Pull the needle straight out of the skin. After injection, press the injection site with a small bandage or sterile gauze if needed for bleeding, for several seconds. Do not massage or rub the injection site.
• Discard the injection materials.
• Dispose of the syringes safely in a closed container. You can ask your health care provider or pharmacist for a “sharps” container. A sharps container is a special container to put used needles and syringes in. You can return a full sharps container to your pharmacist or health care provider for disposal.
• The vial of mixed medicine must be stored in the refrigerator in its carton at 36° to 46°F (2° to 8°C) and used within 3 1/2 weeks.
• The solution should be clear after removal from the refrigerator. If the solution is cloudy or contains particles, discard the vial. Do not inject the medicine from this vial. Start over with a new vial of OMNITROPE™ 5.8 mg. Call your pharmacist if you need a replacement.
• Before each use disinfect the rubber top of the reconstituted vial with an alcohol swab. You must use a new disposable 1 mL syringe and needle for each injection.

Figure 1: Schematic amino acid sequence of human growth hormone
including the disulfide bonds