Dr. Greer hosts this episode of Carpools & Cannulas: Modern Motherhood and Plastic Surgery. She and Dr. Gallus talk about what it is like to recover from abdominoplasty, or tummy tuck. They discuss how long it may take you to get back to 100% after tummy tuck and things you can do to speed recovery.
Transcript
Dr. Greer: Hello, everyone. I’m gonna be joined by Dr. Gallus in a couple of minutes, and we will be talking about recovery after tummy tuck, which is one of our very favorite surgeries, both of us. We have similar practices, which is kind of funny because she is in San Diego and I am in Cleveland, Ohio. As soon as she pops on here… There she is. All right, should be coming on in a second.
Dr. Gallus: Hey.
Dr. Greer: Hello. How are you?
Dr. Gallus: How is it going? I’m good. Hanging in there. How about you?
Dr. Greer: Yeah. It’s been a month. We’ve had three people out for three weeks now, two with COVID, one on quarantine.
Dr. Gallus: And then, were they vaccinated, not vaccinated? No, can we not ask?
Dr. Greer: I mean, I’m not requiring it. I don’t think they were. But obviously, my patient care coordinator lost her dad last week from COVID, one of my receptionists/MA lost her dad earlier in the year from COVID, and my cousin died two days ago from COVID. She was 28.
Dr. Gallus: Your cousin?
Dr. Greer: Yeah. And otherwise healthy. I don’t think she was vaccinated. I don’t know for sure. But yeah, a healthy 28-year-old.
Dr. Gallus: That’s terrible. Yeah, there’s a little bump in San Diego. I saw the San Diego County put out a thing. Like, there’s, let’s say, 510 people hospitalized with COVID, and 500 of them are unvaccinated, and 10 of them are vaccinated. We’re over 70% vaccinated in San Diego.
Dr. Greer: Wow.
Dr. Gallus: Yeah.
Dr. Greer: That’s good.
Dr. Gallus: We’re doing okay, but it is really scary. And it’s a bummer because I feel like we’re at that point where everyone was like, “I’m going to Vegas. I’m traveling.” And I went to Hawaii. People are trying to travel. I know a lot of people who went to Europe, and I was like, “Oh.” And so you’re having to rethink all of that just when you got all excited about maybe going somewhere again.
Dr. Greer: True. Well, and the dad who just died, my patient care coordinator’s dad, he was vaccinated. He’s in Florida. My cousin’s also in Florida. I know numbers are higher there. Cleveland’s been okay, but Ohio is starting to come up.
Dr. Gallus: Oh, okay. Yeah, Florida’s pretty bad. My mom just left to go to Florida last night. It feels like she trying to be invincible.
Dr. Greer: Hopefully.
Dr. Gallus: And she’s vaccinated. She’s pretty sturdy. That’s like the third or fourth time she’s gone during this whole shenanigans.
Dr. Greer: Oh, my gosh. I know we’re scheduled to go in October, and I’m just gonna wait and see. See what’s happening.
Dr. Gallus: To Florida?
Dr. Greer: Yeah, yeah. I was like, “We gotta plan some trips so we have something to look forward to…”
Dr. Gallus: Yeah, absolutely.
Dr. Greer: “…and if we cancel, then we’ll cancel.”
Dr. Gallus: Yeah. I think that’s fair. Are you gonna go to the Plastic Surgery The Meeting in Atlanta, or no?
Dr. Greer: I am registered, yeah.
Dr. Gallus: Oh, okay.
Dr. Greer: I’m planning on going, but again, we’ll kinda see how things go. How about you?
Dr. Gallus: Yeah, I’m planning to go. I already have a bunch of commitments and whatnot there, so we’ll see.
Dr. Greer: Yeah, I’m on a panel and…pus, I would love to meet you in person.
Dr. Gallus: Yeah, I know. What panel are you on?
Dr. Greer: It’s about work-life balance, which will be extra hilarious as the kids come buzzing through here in their Captain America and astronaut costumes in a couple of minutes. So, balance is…
Dr. Gallus: What’s a balance? Yeah, no balance. I know.
Dr. Greer: I don’t know what that is. It’s fine.
Dr. Gallus: Cool. Very nice. My dog is sleeping in the background.
Dr. Greer: Aww.
Dr. Gallus: So yeah, speaking of work-life balance, this morning, I got up early because I was getting ready for a case. We were doing facial surgery. And my dog was sick, and has been on and off sick for a few days, but, like, really looked bad. And then my youngest, it was her first day of school, so I was bringing her to school. And so there was just a lot going on. And I’m like, “I have to get my day going.” So, figured out a plan to get the dog to the vet and then drop my daughter off at school, and then went to the OR.
Dr. Greer: Yeah, we’ve all had it. I once had the OR bump up a case and I didn’t realize they hadn’t. And I got a call from them, and I was dropping my son off at his first day of kindergarten. They were like, “Oh, you’re scheduled to start.” So I called my patient. I was like, “Hey, I am dropping Wyatt off at kindergarten and I’ll be there.” She’s also a mom. She was totally fine with it.
Dr. Gallus: Yeah.
Dr. Greer: Just one of those things.
Dr. Gallus: I know. So I was like, “Yeah, we’ll get it off.” It was a little hectic, and then we figured it out. And luckily, my dog did not need surgery.
Dr. Greer: Oh, good. She’s just resting.
Dr. Gallus: Like, maybe if she could stop eating garbage off the street. But anyway.
Dr. Greer: That would probably help. Yeah. Oh, well.
Dr. Gallus: She loves it though. I don’t know why. She’ll see like a rotten banana and think that’s, like, awesome thought. I’m like, “No, don’t, don’t.”
Dr. Greer: Dogs are just weird that way.
Dr. Gallus: Urgh. Okay, yeah. And I’m supposed to be talking on a face show plastic surgery panel. So we should all be interested in that.
Dr. Greer: I will be there. I’ll be like, “Question.”
Dr. Gallus: Oh, yeah, “I have lots of questions.”
Dr. Greer: It will be fun. Well, I haven’t even been to a Plastic Surgery The Meeting since my chief here in residency, which was 10 years ago.
Dr. Gallus: Oh, my goodness.
Dr. Greer: Yeah. Well, I was having three kids, so I haven’t traveled. So I’m really excited to go now as an attending and knowing people, and, like, being on a panel. It’s really fun. I’m on committee now.
Dr. Gallus: It’s gonna be awesome.
Dr. Greer: Yeah.
Dr. Gallus: It’s gonna be so good. Yeah. There are so many things to do and see people in real life and… Hi, everybody that’s joining. And yes, garbage and raccoon poop are huge dog treats, for some reason.
Dr. Greer: Yeah, of course they are.
Dr. Gallus: She has four dogs, so she knows.
Dr. Greer: Oh my God.
Dr. Gallus: And she has one dog that’s like on a revolving door to the vet because he’s so old and frail.
Dr. Greer: Poor thing.
Dr. Gallus: It is. So anyway, so let’s talk. We’re talking tummy tuck recovery, right?
Dr. Greer: Tummy tuck, yeah. We were gonna talk about recovery after tummy tuck, and got, you know, sidetracked by COVID and dogs eating garbage, as we do. If you guys have any questions about tummy tuck or recovery after tummy tuck, or if my kid’s screaming is too loud and you need me to shut the door, just throw it in the comments. We’re keeping an eye on those. Yeah. So it’s interesting. When I was a resident, all of our tummy tuck patients stayed overnight.
Dr. Gallus: Same. It’s the hospital setting thing, I believe. I don’t know.
Dr. Greer: Yeah. I don’t know. It was so funny. Like, as a resident, our breast reductions stayed overnight, our tummy tucks stayed overnight. Like, everyone stayed overnight. And now I send everyone home. Although it’s kind of different patient populations too. My nanny is telling me to put the kids to bed. Bridget, you know that’s never gonna happen while I’m awake.
Dr. Gallus: Right. Yeah, I agree. It was a different…a lot of breast reduction patients stayed because it actually… A, it was not a cost that they were gonna incur, and it was just, I mean, something that they did. But yeah, currently in the “real world,” like, you go home. And it’s better for you to get up and move around, for starters, I think.
Dr. Greer: Yeah. And your own bed is more comfortable, and, yeah. And there aren’t a bunch of sick, contagious people around you, which is great.
Dr. Gallus: Yeah, that also helps. And not some nurse coming and waking you up every 20 minutes to take your vital signs.
Dr. Greer: Oh my God. That was the worst after having kids. I was like, “Can you let me sleep, please?”
Dr. Gallus: I know.
Dr. Greer: Yeah. So I actually admitted patients, so for the first year or two as an attending, and then they would call me. They’d be like, “It’s 8:00, can I just go home?”
Dr. Gallus: You were like, “Okay.”
Dr. Greer: Yup. So it’s pretty much outpatient surgery for tummy tuck, which I think is one of those operations that people think is gonna be so much worse than it is most of the time.
Dr. Gallus: Yeah, I think so. I think the first one to two weeks can be rough, and I think it’s variable. I think some patients are really…I have some patients I have them come in the first day after day after surgery. Do you?
Dr. Greer: I don’t. I don’t see them for a week.
Dr. Gallus: Okay.
Dr. Greer: I call them that night…
Dr. Gallus: Yeah, I call them that night.
Dr. Greer: See if they’re worried about anything. But yeah, I usually wait for a week.
Dr. Gallus: I drag them in the next day because I want them to come in and walk. And so some people are great and hobble in no problem. Other people request a wheelchair and we bring them up with wheelchair just to make sure everything’s okay, drains are working. You don’t use drains though, right? So [inaudible 00:09:00] sometimes?
Dr. Greer: I do BMI over 30.
Dr. Gallus: Oh, okay.
Dr. Greer: And I do a lot of BMI over 30 as well. Like, I’ve done, honestly, even some BMI over 40 with really nice results.
Dr. Gallus: Oh, wow.
Dr. Greer: Yeah. I’m, like, straddling that weird dichotomy of I’ll do drainless tummy tucks, but I’ll also do a high BMI, which is actually pretty fun and something worth talking about. But yeah, so when I can do drainless, I love it. Patients are more comfortable. If I do need a drain, I only use one and then I end up leaving it in usually for two weeks, but that’s usually my higher BMI patients. And it’s a pain. They don’t love it.
Dr. Gallus: Nobody likes the drains. They’re brutal.
Dr. Greer: No.
Dr. Gallus: I had a drain…actually, I had a scar revision, my C-section scar from three C-sections. And I had it revised. And they didn’t put a drain in because it was a small area, but I am a doctor which makes me high risk for things. And so I got a fluid collection, and I tried to drain it, and it didn’t. So eventually had to have IR, interventional radiology, put in a drain after the fact, and dragged that around for a couple of weeks. And I was like, “These really suck.” Like, they’re terrible. Like, if you were to hide them, they’re just annoying.
Dr. Greer: Yeah. And they, like, tug and pull and are they’re uncomfortable. I know. Do you let people shower with the drain in? I do.
Dr. Gallus: Yeah, I do too.
Dr. Greer: Yeah.
Dr. Gallus: Yeah, there’s a lot of rules that were in place, I think, early on, either in residency or you did things…I think in residency I think the attendings are just super conservative because that’s what they can control. And then you get out into the real world, and you’re like, “No, you can totally shower. It’s fine.”
Dr. Greer: Yeah, it’s fine. It will be okay. You just have to hold the drain on something or land it around your neck. By the way, it works really, really well.
Dr. Gallus: Yeah. Okay, so speaking of recovery after tummy tuck, you go home that day. Do you send people home with little portable squeezers like SCDs?
Dr. Greer: I don’t. I tell them to get up and walk around. And if they’re laying in bed for a while, I tell them to point and flex their toes 10 times like every hour.
Dr. Gallus: Okay.
Dr. Greer: In my whole practice so far, I’ve had one DVT/PE in a massive skin removal patient. I do assess Caprini score in everybody, which assesses your risk of blood clots. Even with that, though, we know the risk is increased I think for a Caprini score of four or higher. I don’t anticoagulant until seven, which is kind of what I was taught. It’s not necessarily great-based data.
Dr. Gallus: I know.
Dr. Greer: You know, there’s not super strong data behind that. This is something plastic surgeons talk a lot about. Oh, DVT and PE. Thank you, Erin, for making me translate. So DVT is deep vein thrombosis, PE is pulmonary embolism. So when you get a clot in the deeper veins of your legs, a clot is a thrombosis, it can break off and travel to your lungs, which is called a pulmonary embolus, which can damage lung tissue or even be fatal in rare cases. And having a blood clot is higher risk anytime you have surgery because your blood is in clotting mode. And often, you’ll have the additional factor of being kind of immobile, which, you know, after your knee surgery, you get put on anticoagulants because you’re not up and walking around. With most of the operations we do as plastic surgeons, people are up and moving but kind of to varying degrees. And also with tummy tuck, if you’re tightening the muscles, there’s theories that it does decrease the venous return from your legs and maybe make you a little more prone to clotting.
Dr. Gallus: Yeah, again, not great literature to support that. But certainly if you’ve had a risk factor from something else, like you’ve had a clot before in your legs documented for whatever reason, or you have a history of easy bruising and bleeding, those are, like, kind of things we screen for. If you’ve had a history of a lot of miscarriages, those are things that…
Dr. Greer: History of cancer. Not skin cancer, but any type of cancer. Being on hormone replacement or contraceptives increases your risk a little bit, and higher BMI and higher age do as well as well.
Dr. Gallus: Right. And, like, the surgery. But it’s over 45 minutes, so pretty much everyone gets points for that.
Dr. Greer: Everything. Yeah.
Dr. Gallus: So it is a point system. That has been delineated. And then you get however many points you are, and then that tells us a little bit about whether we should prescribe you a blood-thinning medication for after surgery. Most people, it’s just having little squeezers on on their legs when they’re in surgery to help your circulation through your legs, keeping their body temperature normal and not too cold, and then early moving around. So early walking is helpful. Those things are all known entities. And so, I do send people home on…they’re called Circul8s, spelled C-I-R-C-U-L-8, because it’s like a band or something. I don’t know. It’s a funny…
Dr. Greer: Like a license plate.
Dr. Gallus: Yes, like a license plate. Yeah, so circul8s. And they are battery-powered and they go home on those and they stay on for a handful of days. So, if for some reason they’re not walking around, I know at least things are squeezing. But I do have them come in the next day. I most often leave drains, and then they come out the next week. But I do tell patients, right, “When you get home…” You know, I tell patients to be really well hydrated before surgery. So push fluids, push water a couple of days before surgery. And then when you go home…I mean, a lot of questions I get are related to “How do I sleep?” You know, you can put some pillows under your knees, propped up on some pillows under your back so that you’re kind of in a V, because that’ll be more comfortable, certainly. And I do put people a garment a, so…
Dr. Greer: I do as well. I will use compression foam as well. And I’ve been doing binder over the garment.
Dr. Gallus: Oh, wow.
Dr. Greer: Yeah. Well, you know, I’ve had some seromas, which is annoying. That’s probably one of the biggest annoyances of tummy tuck. And that has seemed to help. I do a lot of internal plication sutures. I probably do more. Everybody could always do more. But yeah, I do like the type of foam in the garment. The binder just stays on over for one week and then they drop back to one of them.
Dr. Gallus: Okay. Yeah. Yeah, so fluid collections are probably the most common complication of tummy tuck. And maybe, like, a little bit of a wound breakdown or healing issues at the incision, is probably the other one.
Dr. Greer: Yeah. We get like a little rim. I mean, you can have big areas of wound healing problems. And we’ve all, unfortunately, seen that as well. But yeah, the seromas are kind of the big nuisance because then you have to get them drained a lot. A lot of it, I think, is just patients feel deceptively well after. Actually, I had a tummy tuck patient text me on Saturday. She’s like, “So if I were developing a seroma, it would kind of feel sloshy, right?” She was a nurse. She’d gone back to work. I said, “Were you doing a lot of bending and twisting?” She’s like, “Yeah, the entire shift.” I’m like, “Okay, well, we’ll drain it. We’ll do your binder on over your garment again.” Because when you’re moving like that, your skin just can’t stick back down.
Dr. Gallus: Right. Which is probably how I got my seroma. I could never slow down. Doctors and nurses are the worst patients, hands down.
Dr. Greer: We are. But seromas at least are fairly easy to deal with. They’re a nuisance. You drain them several times, get some good compression, and then they seal up.
Dr. Gallus: Yeah. And then they go away. Okay, so any other tips? Do you have patients take Arnica or Bromelain after?
Dr. Greer: We can do the Silagen-Arnica Bromelain supplements. I like the Bromelain. I know there’s good clinical studies showing improvement in bruising and swelling. I don’t believe in Arnica because it’s homeopathy and I don’t believe in homeopathy, which, I don’t know. Do know much about homeopathy? I did like an entire podcast episode on this one, so I get weird about it. But homeopathy is based on this theory that the more you dilute something, the more potent it is. So the dilutions are like one in a million, to the point where there’s like not a single molecule of the active substance. So, most Arnica is just a sugar pill.
Dr. Gallus: Okay.
Dr. Greer: Same thing with the tablets. There’s not anything actually in them. So, scientifically, it doesn’t make a lot of sense to me, but it comes with the Bromelain, and I like the Bromelain, so there we go. No, Bromelain is not homeopathy. I don’t think, Erin. It’s an actual supplement like vitamin C or zinc. The homeopathic preparations are severely diluted to like one part in one million, whereas Bromelain is just like taking a vitamin C supplement.
Dr. Gallus: Right. Or eating a ton of pineapple.
Dr. Greer: Yes. Which you can also do. And if that burns your tongue, it’s not the vitamin C. There’s an enzyme in the pineapple. And you can denature the enzyme by soaking it in saltwater and then rinsing it off.
Dr. Gallus: Oh, I didn’t know that.
Dr. Greer: I mean, if you needed more random facts from me.
Dr. Gallus: More random facts. Well, here’s a random fact. Did you ever read that book “Educated”? The one…
Dr. Greer: Tara Westover?
Dr. Gallus: Yes.
Dr. Greer: Oh my gosh, I just read about her.
Dr. Gallus: Her parents, or her mom, went from being a midwife to offering homeopathic medicines or essential oils, or something, and had that hold. And it still exists, and you can buy them. So it’s, you know, one part per million of lavender oil or something.
Dr. Greer: I can sell that. I mean, I have tap water. I can… Yeah, homeopathy is really fascinating because there have been several, like, randomized trials on whether Arnica works. And I think most people don’t really understand what homeopathy is. And I don’t remember why I ever looked it up, but I read it, and I was like, “This is not science in any meaningful way.” It’s like some random theory from this German guy in the 1800s, kind of, like chiropractic. Don’t get me on that one either.
Dr. Gallus: Oh-oh. We’ve found a difference.
Dr. Greer: Yeah, I have lots of weird esoteric knowledge. Well, chiropractic is the idea that you can cure anything by manipulating the spine. And the guy who created it claimed to have cured deafness by doing a spinal manipulation. I think, like, more mainstream chiropractors just do muscular scouts manipulations, so that’s cool. But the real hardcore guys will say like, “Well, I can cure diabetes by addressing your neck.” It’s fascinating.
Dr. Gallus: Yeah. No. Yes. I agree. I agree, yeah. But I do like to have my back cracked because…
Dr. Greer: Oh, it feels good, yeah.
Dr. Gallus: Yeah, it feels amazing. All right. Okay, so Bromelain, you’re a fan of.
Dr. Greer: I am.
Dr. Gallus: Do you have them take any other supplements, like zinc or vitamin C, or only if they want to?
Dr. Greer: The Silagen. That company makes this very convenient Arnica-Bromelain-vitamin C-zinc, and we just include it with all the surgery packages. So they take it twice a day starting two days before surgery. Vitamin C and zinc have been shown to help with wound healing if you’re deficient at all. And you can’t overdose in the short term on those, so, I just figured it does cover bases nicely.
Dr. Gallus: Cool. I’m writing this down.
Dr. Greer: It’s called Silagen, S-I-L-A-G-E-N. It’s from New Medical.
Dr. Gallus: I know their scar cream.
Dr. Greer: Yeah.
Dr. Gallus: So I know the company, I just didn’t realize they made a… Because we just give people a list. And then by the time you go to Sprouts or Whole Foods, you have like 18 things that you need to take.
Dr. Greer: Yeah. So we just give them that, and then there we actually give them the scar gel at their one-month postop. It’s just included in the surgery package. They don’t have to worry about it. They have to buy it. Same with their garments, they get two.
Dr. Gallus: Right.
Dr. Greer: Yeah.
Dr. Gallus: Nice.
Dr. Greer: Keep it simple.
Dr. Gallus: So here’s another topic, Erin, because she’s interacting. Garments. What brand of garments? So I feel like…she just recently had liposuction, and she’s probably…she’s gone through like 800 garments in terms of trying. Like, we trial them all. And we have trials with our patients. We’ll find one we really like, and then somebody will point out, “Oh, it doesn’t zip right,” or whatever. “The torsos are too long.” And then we’ll switch again. Or because of the last two years, it’s been so hard for shipping and distribution that, you know, we’ll have a company that we like working with. Their garments are great, but then we’re like, “Where’s the stuff we ordered?”
Dr. Greer: You can’t get them.
Dr. Gallus: Yeah. So, we use Marena, Isavela, Clearpoint Medical.
Dr. Greer: That’s who I use now.
Dr. Gallus: Okay. That’s who we mostly use now.
Dr. Greer: They fit most people pretty well. There are always people who it doesn’t fit right. And I’m like, “Go to Kohl’s, get some Spanx. It’s better than nothing.” Yeah, those hook-and-eye closures in the groin area are a little tricky. I wore Clearpoint Medical. Well, when I had lipo, I wore an Isavela, and then I got a Clearpoint Medical for my office. And, like, it’s not bad. It’s pretty comfy.
Dr. Gallus: Yeah. So yeah, there are so many versions of garments. So yeah, I think we used Isavela, and then we had shipping issues and switched to Clearpoint, which has been mostly okay.
Dr. Greer: And the funny thing is, like, I’ve always called it a garment, but I have so many patients who call it a faja.
Dr. Gallus: Oh, yeah. Yes, they call it a faja, or a faja board. So that board that you can sit in.
Dr. Greer: Yes, there’s a board that goes in. This is a whole thing that, like, I’ve learned about from patients.
Dr. Gallus: Yeah, a whole niche of, like, garments. I know. And then people are like, “You should just design one that has…” I’m like, “No, no.”
Dr. Greer: Right. There are people better skilled than me doing this.
Dr. Gallus: Right, right.
Dr. Greer: I mean, it’s never gonna be perfect. Sometimes people just end up in a binder because they’re very short-waisted or the garment’s a pain in the butt. I know there are many surgeons who don’t use garments at all, and that still boggles my mind. I just feel like everything will be sliding around and uncomfortable.
Dr. Gallus: I feel like that would be, yes, frightening. But yes, people sometimes choose not to wear them because of all the things we just described. It’s a hassle. Who knows? It’s funny. When I did… I’ve done a lot of burn surgery in my day. I did some as a general surgery resident and some as a plastic surgery resident. And compression garments are useful for patients who had burns for flattening the scar. Yeah. And UCSD actually had… and I don’t know if this is still true. They had seamstresses that would custom make the burn patients’ garments. And there was, like, a room with sewing machines, and they would come and get fitted. And it was unique in that way. It was one of the few places that did that. But it was super effective. It’s just, you know, manpower, and expensive, and all those things, but…
Dr. Greer: Pretty amazing though.
Dr. Gallus: Could you imagine, though, if you’re, like, “Oh, yeah, so after your tummy tuck, you’re just gonna go meet the seamstresses and they will custom-make a garment for you?”
Dr. Greer: They will make a bespoke, which is my favorite word. I mean, it’s so fancy. Maybe I should hook up with a tailor, yeah, and just be like, “Okay…”
Dr. Gallus: Yeah, we should do that.
Dr. Greer: “Will you alter garments?”
Dr. Gallus: We should create bespoke garments.
Dr. Greer: There we go. Oh my gosh, it would be so ridiculously expensive. And by the time they got shipped to you, you’ll be all healed. Which reminds me of another thing. Do you recommend lymphatic massage? Because that’s another thing people read about and they wonder like, “How important is this?”
Dr. Gallus: So early on, I didn’t really recommend it. I sort of moved in that direction because I do think it helps. It’s funny. I was on Clubhouse. I don’t know if that’s still a thing. Are you on that platform?
Dr. Greer: I have an account. I never logged on.
Dr. Gallus: Yes, I haven’t been on there. So, I was on a Clubhouse panel about plastic surgery recovery or lipo. I can’t even remember. And I remember because they had one of the local massage therapists. She’s local to San Diego. And I was like, “Oh, cool. Kathleen’s on this call.” And she does manual lymphatic drainage. And I remember her also from when I did a lot of breast reconstruction at the Navy hospital. We would refer patients to her for that too, after having node biopsies and had arm swelling. So anyway. So I’m excited to see her on there. And then I also see Karen Horton, who is another friend of mine from San Francisco. And the panel moderator asked a question about lymphatic drainage. And Karen’s like, “I don’t know anything about it except what my massage therapist told me, which was that it’s nonsense.” And I was like, “Do you see who else is on the call?”
Dr. Greer: There’s a massage therapist.
Dr. Gallus: She doesn’t care. So then Kathleen was talking about it. And I do think it’s helpful. And the patient feedback is…you know, I recommend it. I don’t require it, obviously. And the ones that go really, really feel like it makes a difference. And it makes sense. It’s more like manual compression, right?
Dr. Greer: I love it. I wish I could find a massage therapist in Cleveland who offers lymphatic massage because my patients have looked too and haven’t had any success.
Dr. Gallus: Oh, really?
Dr. Greer: I have a friend who’s a massage therapist. I’m like, “Get certified in lymphatics.”
Dr. Gallus: Yeah. You don’t want just somebody who’s gonna, you know…
Dr. Greer: Yeah.
Dr. Gallus: They need to know what they’re doing.
Dr. Greer: And I have told patients, though. If they’re really concerned about a swelling, I’m like “You know what? Look up a YouTube video.” It’s not something you’re gonna hurt yourself with. It’s very light massage. And you just kinda need to be going in the direction of the lymphatics.” So, if anyone knows a good lymphatic massage therapist in Cleveland, give me a shoutout.
Dr. Gallus: Yeah, yeah. I know. That would be helpful. Yeah, we have more than one, so…
Dr. Greer: You’re in the big city. I’m in the midwest.
Dr. Gallus: Yes. It’s great. I know. We can probably get somebody who would do it for your dog, to be honest.
Dr. Greer: It’s true. Yeah, I bet you could.
Dr. Gallus: Okay. So, lymphatic massage, we talked about supplements, compression garments, staying hydrated, sleeping properly.
Dr. Greer: Yeah.
Dr. Gallus: What else do you…
Dr. Greer: Activity restrictions. I feel like I’m always reigning my patients in. I had one lovely lady, Seroma. And I was like, “What have you been doing this week?” She said like, “Well, let’s see. On Tuesday, I delivered a bunch of Avon.” I’m like, “You had surgery on Monday, why are you delivering Avon?”
Dr. Gallus: No.
Dr. Greer: “Go home and sleep.”
Dr. Gallus: Yeah, so taking it easy. Yes.
Dr. Greer: Yes. I’ve been telling people, “Stay home. Take naps. Have someone watch your children. Don’t be doing a lot. And then once the drain is out, or week one to two, then you can, like, start doing some short walks, but not like 10-mile hikes.”
Dr. Gallus: Right. Because usually, again, sometimes at the two-week mark, I get, “So, Peloton okay?” No.
Dr. Greer: No.
Dr. Gallus: Or actually, I don’t if I’ll remember. One of my patients, she was probably three weeks out, and I knew she had a planned trip to Hawaii after surgery at like four to six weeks, which we had talked about in advance and that. “I promise I’m not gonna do anything. You know, I’m just gonna lay by the pool.” If I know someone’s going out of town, I see them kind of right before they go out of town. So I’m like, “Oh, are you so excited for your trip? And she’s like, “Yeah. So scuba diving?” I’m like, “No.”
Dr. Greer: No. I really think not.
Dr. Gallus: I was like, “Do you scuba dive?” She was like, “No, but I thought I’d learn.” “No. No, this is not the time to learn. Put it on pause.”‘
Dr. Greer: I know. What a terrible…
Dr. Gallus: She said, “I thought I’d ask.” She just wanted to ask.
Dr. Greer: At four weeks I will let people, like, get back to more activity. But still even like core exercises, like, hold off on that. We just repaired some muscles.
Dr. Gallus: Yeah. Take it easy, four weeks. Two weeks you can start moving around, but I tell them it’s four to six weeks. So protecting that diastasis repair. So bringing your core muscles together and suturing them down, and you really want to not pressure that and, like, have that stick. So, you’re right, it’s hard. I feel like the first two weeks, people are a little sore and kind of, you know, slow down a little bit. And then it’s the next two weeks, so weeks two to four, where, like, you know, pump your breaks, take a little time off.
Dr. Greer: Yes, yes.
Dr. Gallus: Maybe that’s not the time to, like, deep clean the house or whatever.
Dr. Greer: No. I know you’re off. It seems like a good idea. It’s not.
Dr. Gallus: Right, right. Cool.
Dr. Greer: Yeah.
Dr. Gallus: So wow, that went fast, I think.
Dr. Greer: I know.
Dr. Gallus: Like, we talked about sick dogs. When do your kids start school?
Dr. Greer: Let’s see. My son starts second grade on Monday. My daughter’s kindergarten, so her first day is not till Thursday because she’s to go to meet her teacher and everything.
Dr. Gallus: Oh, that’s super cute. Yay.
Dr. Greer: Yeah. How about yours?
Dr. Gallus: So my fourth-grader started today, and my eighth and my tenth grader start mañana.
Dr. Greer: It’s so early.
Dr. Gallus: I know. They got out. The [inaudible 00:29:47] were done by, like, Memorial Day. They were like, “Summer was so short.” I’m like, “Oh, it’s fine. [inaudible 00:29:54].
Dr. Greer: I know. It’s good when they’re back.
Dr. Gallus: Yeah.
Dr. Greer: We are totally losing our internet connection.
Dr. Gallus: Oh, okay. Well, we’ll figure out…
Dr. Greer: We could give it a few seconds, see it comes back.
Dr. Gallus: Oh-oh.
Dr. Greer: Yeah, we’ll have to figure out our topic for next time. Probably two weeks or so, usually.
Dr. Gallus: Yeah.
Dr. Greer: We can look at calendars.
Dr. Gallus: Two weeks.
Dr. Greer: Yeah. Any requests for topics for next time, guys?
Dr. Gallus: I guess no. Erin says they start on a Thursday. Yes, that is true because their last day of school was a Wednesday, whatever logic that is.
Dr. Greer: That’s right. Yeah.
Dr. Gallus: So, whatever. I long stopped caring about when school starts and stops because it makes no sense ever.
Dr. Greer: Fair enough. Supplements. Erin, have you been checking out my podcast topics? I stopped my podcasts, like, over a year…two years ago. But yes, supplements are a fun topic. I actually took a class in med school on food, drug, and biotech law.
Dr. Gallus: Oh, wow.
Dr. Greer: Which was entertaining. Yeah. So interesting stuff there.
Dr. Gallus: Let’s talk about that. I think that’ll be good.
Dr. Greer: That’ll be a good topic. Cool. And whether, you know, collagen actually helps healing or not.
Dr. Gallus: Yeah, yes. Yeah.
Dr. Greer: Those are good things. Cool.
Dr. Gallus: Yeah. All right, I’ll have to do a little research probably before, but it sounds good.
Dr. Greer: Yeah. Awesome.
Dr. Gallus: All right. Have a good evening.
Dr. Greer: You too. Stay healthy.
Dr. Gallus: Yeah. You too. Bye.
Dr. Greer: Bye.
About Restore SD & Dr. Katerina Gallus
As the Director of Restore SD Plastic Surgery, board certified female plastic surgeon Dr. Katerina Gallus has over 15 years of experience helping San Diego women enjoy head to toe rejuvenation with face, breast and body procedures. After a successful career as a Navy plastic surgeon, Dr. Gallus founded Restore SD Plastic Surgery with the intention of creating a welcoming space for anyone seeking cosmetic enhancement.
Restore SD Plastic Surgery offers popular facial rejuvenation procedures like facelift & neck lift, facial fat grafting, and eyelid lift; breast augmentation with implants, breast lifts or breast reduction; body contouring procedures such as tummy tuck, liposuction, mommy makeover, and Brazilian butt lift (BBL), as well as aesthetician services, BOTOX, injectable fillers, and laser treatments.
