LawPlasticSurgery231 karma2021-02-13 17:25:54 UTC
That's an interesting question. Certainly we know genetics can play a role, and we see generations of patients come through with grandparents, parents, and now the children with a cleft.
At the same time, we see plenty of patients with zero family history, nothing abnormal with the pregnancy, and everybody is surprised at birth.
In one way, it's a bit like cancer - there are a lot of different cleft types and causes, so narrowing it down to a handful of causes is difficult.
There's great research being done at multiple centers, including UPenn and Seattle Children's. Here are a few pages with more information: CLAPA, CDC, ACPA, Pubmed article.
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LawPlasticSurgery144 karma2021-02-13 18:12:49 UTC
Hahaha, yes. Band was awesome, and some of the best times of my life.
An anesthesiologist I work with is part of a clarinet choir, and I've considered trying to pick it back up to join them for fun. It would be like my time in an a capella group - quietly in the background.
LawPlasticSurgery133 karma2021-02-13 19:29:11 UTC
You're welcome. Mom/dad guilt is already such a tough thing at baseline.
Overall, we spend more time with our children than our parents did (https://ourworldindata.org/parents-time-with-kids), working more (https://www.bls.gov/opub/mlr/2002/05/art2full.pdf), and even doing more housework (https://www.bls.gov/news.release/pdf/atus.pdf).
I see families where it feels like the mom has also taken the brunt of any issues with conception or problems with a baby's health, when there's more research coming out that paternal factors also play a large role.
Most often, though, it does just seem like random chance. A random ray of radiation from the sun that happened to tick an A to a T somewhere.
Genetic counseling can be helpful for some families, especially if you're thinking about having more kids, or for your kiddo before they go on to have kids themselves one day.
LawPlasticSurgery126 karma2021-02-13 18:42:24 UTC
Brow lift and a straightforward breast augmentation immediately come to mind.
We have a tendency in medicine to sometimes overcomplicate things with jargon and people publishing papers for a variety of reasons (publish or perish academics, trying to make a name for themselves, etc.).
A lot of surgical procedures do distill down to simple steps and principles quite a bit. But sometimes when you least expect it, surgery will humble you. Some people with lots of grey hair will tell you that the only surgeons with no complications are those that are not operating.
LawPlasticSurgery81 karma2021-02-13 17:51:33 UTC
It's been a journey. I didn't consider medical school until I did a summer program after my junior year of college. This was set up through the UT Biomedical Engineering program. We were at MD Anderson Cancer Center / UT-Houston, and it was a bit of an immersion in different paths an MD can open up.
We did 2 weeks of gross anatomy with human cadavers, and then 8 weeks of rotations shadowing in the mornings in the hospital (OB, ER, pediatrics, general surgery, etc), and research in the afternoons. My research was on isolating fat stem cells to be able to grow them outside of the body, like for breast reconstruction. Throughout, we also had lectures in the morning that started at 630am, covering ethics, leadership, etc. It was intense, interesting, and eye-opening.
Then during medical school, we had a chance to rotate with orthopaedics or plastic surgery for a musculoskeletal focus. I ended up with plastic surgery, and got to see the crazy range of things the specialty has swallowed up. My first memory was of a guy who fell from a ladder and cut a tendon and couldn't straighten his finger. After he was numbed up, he watched Bad Boys 2 on the TV while the resident repaired the tendon and skin. And immediately he had full function again. So immediately gratifying.
After that, there were further rotations at WashU, and some visiting rotations I took to Taiwan, Irvine (CA), and Dallas. Tons of interesting problems and surgeries to try to fix the problem.
I'd say I have had many mentors who I have learned from, and continue to learn from. We certainly stand on the shoulders of giants, and I'm always humbled by how much I have learned from a lot of selfless teachers.
Most recently I'd say I lean on my partners the most - Drs. David Genecov and Carlos Raul Barcelo. Dr. Jeff Fearon is across the hall and has an open door, and I've called Drs. Steve Byrd, Craig Hobar, Richard Ha, and Jason Potter probably within the past year. I also learned a lot in residency from the amazing team there - truly more mentors than I could list out.
And then you look back at all those other steps along the way - Michele Follen from the mini-medical school experience, David Callahan and Denise Koo at the CDC, Will Ross, Alison Whelan and many more at WashU.
I haven't read it yet, but I'm always looking for more book recommendations! The tough part is carving out time to read it all. My bookshelf is like my whiskey collection - definitely grows at a faster rate than I can consume.
Current open books on the bedside table:
- Brandon Sanderson, Rhythms of War
- Michael Lewis, The Big Short
- Emily Oster, Cribsheet
Underneath those - waiting to be opened - are Jonathan Haidt's The Righteous Mind, and Kahneman's Thinking, Fast and Slow.
Sure, always happy to chat.
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