Doctor808 Plastic Surgeon Honolulu Hawaii

Few Speak English here

There is something very special about Thailand.  To me its my retreat, an inner sanctum of self inspection and evaluation of my life and simply an escape. When I get off the plane here I am surrounded by people who I cannot communicate with due to the fact I do not speak Thai and few speak English. Yet I have  misspoken in that we do communicate the basics–go here, buy this, how much is that etc etc. Yet there is no substantive conversations. This is good for me. I don’t have to talk or think about others much.

In my real world that is all I do is think about others and put a lot of effort into communication. “What do you mean you want a natural looking breast”  I have to ask when a patient tells me they want that. Its all about communication. Thats what we in plastic surgery must do if we are to have a happy patient. What one lady thinks is a “natural breast” is another ladies vision of saggy breast. Again its all about communication and Thailand to me is a place of little communication and lack of need to communicate for me. So its a good thing.

Pool at Condo-no talking here

I recall the first time I came here and found the Muay Thai Gym and how no instructor spoke English. Yet they taught me with hand signs, grunts and other noises with many facial expressions thrown in. If I did something wrong they had no difficulty in letting me know. They did this by making an angry face and when I did good they showed a happy face. To instruct me the right way they simply did a demonstration using themselves and I copied their movements. Simple. practical and it worked. I think in plastic surgery the same applies. Words are inadequate so we allow the patients to demonstrate to us with pictures what they consider a natural breast. Simple and practical with few words.

It is also a good place for me to think about people I know as I seem so far away from them. My wife is here but we dont talk so much after 20 years of marriage. Of course we talk about what we need to. Yet after that time of being around each other for well over 20 years,  we know what each other will say, like it or not. We know. So relationships with workers or friends– is a good time to revaluate. I am not in the middle of things and can see much more clearly—is this person really a good worker? Should I stay in a business relationship with this person or that person? These type of things are always resolved by the time I leave Thailand. I think about what I should do then I decide and then do it.

River Taxi no talking here either

What I actually do in Thailand is pretty basic. On this trip our company Thaidox LTD is getting ready to launch and I am going through the business process and set up. That is my web development company which is based here in Bangkok. So I take care of that. Doing business in Thailand is not easy nor is it as crazy as some would have you believe. One must get used to the Thai way of doing things. This is not different from getting used to doing things the Hawaii way. I came out of New York City so adapting to the Thai way is certainly easier than adapting from New York to Hawaii. 

The other thing I concentrate on here in Thailand is training in Muay Thai. Every afternoon around 2pm I get on a river taxi, which is a long boat made to run in the canals for a 15 minute ride to my Muay Thai gym. I usually spend about three hours a day with this. I also go down to my gym in the Condo here and work out as well in early morning. I do this pretty much everyday.

In the evening I may go to a movie or simply sit on the Balcony working on the computer. This is easy life for me. Its an escape and a place to make life decisions.

I suppose I wanted you to just see why I come to Thailand in this post. Next post I will show you my world here in more detail about this place instead of about me.

Doctor 808

I wanted to tell you about Japan from my perspective. I have been there often,  as an invited  teacher and lecture of Plastic Surgery and just for fun. Other times I have passed through on the way to another part of Asia and stayed just one or two nights like on this trip. 

Japan is one of the most interesting places to visit as its people and its culture are far different than any other culture I have known. The Koreans and even the Chinese are somewhat less confusing to the western mind I think. I have had friends from Vietnam , Thailand , Cambodia both Korea’s as well as Taiwan. These were not casual acquaintances but people I have known for years and very well and at least to my thinking I believe these cultures are very close to the American way of thinking. I am sure many of you will disagree but it will take a lot of convincing for me to change my mind. I will simply say that the Japanese are the most detailed and type A personalities I have ever known.  If you study the Japanese tea ceremony and understand  that , you will agree and understand what I am saying. 

Now back to the trip, as we can discuss  Japan as a culture forever and write an entire book on the smallest aspect of that. Once we arrive in Shinjuku station we have to find the Hotel. It was the Hotel Star (Hoteru Star). A pleasant but inexpensive place only 122 US dollars per night  for a large room by Japanese standards. I have stayed at the Southern Tower a much nicer hotel but at over twice the price but since I am only there as a stop over why waste the money?  The reason i like Shinjuku area is its central to many things and easy to get around Tokyo. There are trains leaving Shinjuku station to everywhere.  

The first thing to do in Japan is for me to find the most hole in the wall ramen place I can. There I have found the best ramen noodles as opposed to a fancy looking place. You have to listen to slurps of Japanese men sucking up these noodles. The louder the sounds the better the noodles I suppose.

Ramen at Hole in wall

There are many of these places around Tokyo and they are great eats. Probably some secret recipe that has been in the family for years or maybe not. Yet i like to pretend it is so it taste more exotic.  There is the type where you buy a ticket from a machine and then hand it to the staff or  the other type and which you simply pay the cashier. I am not sure why the difference. Yet its interesting when you try to figure out by comparing Japanese written language to picture of the food so you get what you want. The machine you order does not have a picture and the only way is to compare written language which I cant read or write yet. So I say to myself, ok this first character is the same as this one on the machine, then down the line comapring characters from the menu with pictures to the machine buttons with only written japanese. So far I have always been right. I cant wait until I actually can read Japanese so I dont have to do that anymore. Then it will be a simple , Ok this says beef with ramen noodles–very simple right?

Now remember I said you have to look for a hole in the wall type place and there you will find the best I think. You can see the alley I found which has good ramen. This alley looks like it has been there about 100 years but the building surrounding it are all modern which is one reason I like Japan , it mixes the old and the new very well.

A great alley with Ramen hole in the wall

This alley like I said,  looks like it has not changed in 100 years. Right next to it is a very modern building which I will show you in a picture as well. 

The other thing I really like from Japan is electronic music. The Atom Club in Shinbuyu I visted this trip. Its a little young crowd but what do you expect for trance crowd. I had a great time and the young jet set Japanese dont seem to mind an old guy party along with them when I was the only foreigner in the crowd. I will post one picture here but you can find out more about Atom Club by searching on Youtube. Well that is all I will write now. I will continue about this later. There is much to write about the Japanese Muay Thai scene and kick boxing gyms there. I have been to many and actually met some friends from my Muay Thai Gym in Thailand there. Well until next time.

Atom Club In Shinbuya great electronic music

As is typical I had last minute patients to see exactly 20 minutes before I had to be at the airport. I stopped by the office quickly before I went to the plane. Understand plastic surgery patients for the most apart are not emergency type patients so my last minute having to see a patient is nothing more than my staff causing me a headache. Certainly they could see the RED -DOCTOR LEAVNG DO NOT SCHEDULE on our computerized scheduling program. Yes this staff member who scheduled saw that but choose to ignore it I suppose.  It never ends the schedule. 

First let me review the first leg of the journey and share with you how I do these trips and maybe you can learn from my misadventures. Well I like Japan Airlines, service is good, movies are good and I have never had a problem in  the years I have flown with them. My wife likes them as well and since she makes most travel arrangements we do that one. In trips where she does not go she still does that one for me. 

When I travel I always wear shoes that can come on and off quickly because of security here in the USA. They always make us take off ours shoes. So I have serveral sets of shoes which are like slippers designed much like operating room shoes. These are pictured below. These shoes are made in Italy. I use them in the operating room as well for my plastic surgery cases.

Shoes in TSA basket for X-Ray

These are easy to slip on and off.  They are comfortable to wear and you can take them off easy during the plane ride easy as well. These surgeon shoes can be ordered online. Then  we get inspected by the TSA guy as shown looking at my stuff with blue gloves on. The line went quickly and then on to Japan. I fall asleep or watch movies is how I kill time. I like to stay over at least a night or two in Japan to break up the long flight to Thailand. I like Japan for the food and culture so I soak that up when there. I have very good plastic surgery buddy in Tokyo as well, so we usually visit.

The Narita express is the train from Narita airport to Shinjuku Station as I like to stay near there. Easy access to many places from Shinjuku. It takes about 90 minutes to get to Shinjuku. When you leave the Shinjuku station the sounds are city and rush of people all around. I like that!

sign in Japan

Well Japan is excellent place for observing people trying new food and looking at a culture which is really different than the west. One minute you will see kimono clad woman and the next thing you will see a Obama Costume hanging in store. I could write about Japan for ever as its so Henano!

Obama Costume in Shinjuku Store

I will board a plane for two days in Japan and then on to Thailand,  tomorrow. First , is the night of panic before I go, this is routine before I leave, according to my spouse. Did I make sure I have a doctor to cover my patients? Yes. Did I make sure I have no other obligations to take care of like some last minute paperwork? Yes. Do I have all my patient care duties taken care of and no one needs me?  Yes. What about staff –does everyone know what they are suppose to do while I am gone? hmmmm  maybe.

Muay Thai Fight Thailand

I have tickets , passport and laptop. I have clothes clean underwear and what I need for living. Ok i think I am ready .

Well what I need to do when I travel is three things

1. Learn new techniques or discuss old ones with plastic surgery colleagues in other parts of the world.

2. Spend time working online with my web development company, serveral meetings planned in Thailand to hire some new employees. 

3. Check out some new gyms for Muay Thai training and attend my regular gym in Thailand.

A cosmetic surgeon in Korea who does botox in chin "a chemical chin implant?"

Many of my staff say well the doctor is on “vacation”. This is certainly not true , as all my travel is working time away from the office. I own a web development company so I spend much of my time meeting with people about this. I spend  time planning , catching up on company emails, with clients and our company employees around the world.  The techniques I learn about I bring back to my practice such as the one I learned from the above Korean cosmetic surgeon which is to place a small amount of botox in the mentalis muscles which relaxes it can gives the appearance of a larger chin. Thus a “chemical chin implant” . So these journeys are always helpful to my patients here in Hawaii.

Crowded Streets from High Rise View

This journey will be a little different in that I will write about my travel in detail on this blog and perhaps it can be if some use to other travelers. The secret to good travel in my mind is to continue learning and what i do most days here in Hawaii only in a different location. You become refreshed and your mind is stimulated. I suppose others take the complete vacation , get away approach to travel but somehow I have never been able to do that, I start to feel guilty i suppose. My way to travel works for me. 

Well now I have last minute things to get done as I leave in less than 15 hours. I will let you know as I go along.

doctor 808

The swine flu has hit Hawaii as many of you know with the center for disease control reporting 26 confirmed cases. There have been no deaths in Hawaii but nation wide they report a total of 8 deaths. The world health organization reports a total of 80 deaths world wide and over 10,000 cases world wide. The disease appears to have lost most of its mortality as it becomes further remove by transmission from Mexico where 72 deaths were reported. 

I will traveling to Thailand which reported two cases, no mortality so I am not concerned. However the plane ride over is always a concern. I always get sick after breathing in plane air it seems. I think it my contamination by being in cramped quarters. So this trip I will be wearing a respirator style surgical mask. I am determined not to get sick.

I believe these will cut down on my catching every germ on the plane as usual. The mask are not too expensive and may prevent some down time , If you are around people who are sick or going to travel you may consider a small purchase of these which you can order online as seen in my earlier post. click here and scroll down for purchase of these mask— Swine Flu Update Hawaii

I usually work most Saturdays for one half a day.  Saturdays in Hawaii are good days. Mostly family day,  where the locals go to da beach and hang out eating lau lau or eating something else I do not like. After over 20 years here I am still such a Haole Boy.

So typically on Saturday,  as far as plastic surgery goes I see a few patients who are post procedure, and maybe a few new consults. Mainly Saturday is my catch up day from the busy week. I will look over patient charts, troubleshoot management issues. I will spend special time with staff to go over issues or train them the way I want. They learn from others many times in the practice and sometimes that means the wrong way. So Saturday is a good day to directly interact with my staff as their is less business to take care of and I have time.

A plastic surgeons office in Hawaii is a very interesting thing in that such a wide range of cultures and ethinic issues arise. We have Japanese from Japan, local Japanese, military from Texas , Vietnamese, Korean, British , Russian and on and on. Hawaii is like that and we as plastic surgeons we learn all the nuances of a multiplicity of cultures. This Saturday my receptionist was from main land china, other days my tech is from Japan, my other tech is Filipino and my other receptionist is Korean. This is required to deal with all the languages and cultural issues.

Today I spent teaching my newest receptionist who is from mainland china, she is smart so its easy. Saturday is generally a no surgery day so its easy., I saw all the patients myself and corrected some documentation. It was really a boring day…..but thats ok. I need that by Saturday in my plastic surgery office—now off to the gym.

Doctor808 Red trunks May 9 fight Tiger

This was my first fighting in over two years, so in that respect  I felt I “did ok”. I had a bad injury discussed elsewhere so I was out of muay thai  for a while.  It was at my gym at one of the now famous Muay Thai Smokers at TigerMuaythai.

My opponent was  equally matched, neither of us in ideal cardio- shape that would have made the fight  more interesting and both of us a  bit heavy. He the brawler, me with perhaps better technique. The referee judge awarded  the fight to my opponent.

I reviewed the tapes after my Kru Doug Owens told me where my big error was and as usual he was correct,  which I could easily see from the replay.

My opponent a very nice guy , local boy (twentyfive to thirty years younger than I ?) fought a very eclectic style. Spin fist, some power punches and some type of kicks which were not technically well done. As I predicted, he was using the Hawaii Style of a onslaught of barrage. I always have trouble with these barrages,  because frankly they wear me out quickly.  No damage or pain involved but just tiresome to defend. Then when I try to analyze how to counter another irritating barrage comes my way. The bottom line is I was not in shape for an onslaught Hawaiian style.  This means I will be working on my cardio more intensely. My coach said it best , you looked good the first round, but you were out of it by the second as far as energy goes.

Well he is right in that I did not have the energy to move my tree trunk legs for good kicks and relied on hands– but with a barrage there is no time to set up.  I saw so many openings for a good kicks,  but could not take advantage of that due to lack of juice in the latter part of the second and third rounds. 

The other energy I had lost was with the what appeared to be a continuing , almost mma grappling  thing , we ended up in. I am simply a stand up guy and we spent as much time on the ground or tangled up in the ropes as we did exchanging blows. This is simply not my style and I have to expend a lot of energy with this. Energy I did not have to spare. There is actually one point in the fight where he does a “piledriver”,  thats when he falls down backward grabbing me and drives my head into the ring  like seen on wild world  of wrestling (my god I am not a wrestler). 

The bottom line is my heavy weight and cardio endurance if better I could have taken advantage of  his wide open gaps for kicks but seeing them easily does no good if you no energy to take advantage does it?

Bottom line I lost , not by any slaughter  or significant gap. It was good,  but sloppy match. He landed more punches and some kicks , mostly blocked, but none had any power to do damage, I landed more powerfull blows,  but less of them. The fight may be  equally matched,  but I am too out of shape to endure his style of Hawaiian brawling. That will be taken care of , as I realize my coach is right. I am still not sure what to make of the piledriver move where he bounced me on my head—Yet this  is standup Hawaian style.

I will try to review some of the other fights in the next segment. I must say that these “smokers” at  Tiger Muay Thai are fun exciting and some great fighters and their skill are seen. I hope this will continue with support from other gyms. You should come to next one. 

Doctor808

Well its friday and my weight is down to 180Lbs!!  I feel good and ready to take on my opponent who will be a kick boxer from another gym. Muay Thai style verses American Kickboxing is what the fight will be about I believe,  but who knows.  These series of fights at Tiger Muay Thai gym are to raise money for the Tiger Muay Thai Team to travel to the world championship in the fall. The events are held once a month and really rather exciting. This will be my first fight at this gym,  but the ones I have seen are exciting, and intense.  The action starts at 6pm at the Tiger Muay Thai gym about 1/2 mile down Sand Island access road, but see the webs site for directions.  The web site is TigerMuayThaiHawaii.com.

180 lbs finally

Hawaii has its three possible cases reported of the swine flu. The governor announced this yesterday stating that the CDC has been sent samples so its not confirmed. This means they are not 100% sure yet. Stay tuned …as of this writing the Center for Disease Control has not listed Hawaii among the States with confirmed cases. Lets hope its a false alarm.

Doctor808

What to wear???

In surgery some times surgeons and other members of the team have some interesting conversations. We commonly talk about music, local events , and each others lives. I mentioned to the anesthesiologist who has been working with me that I had a Muay Thai fight coming up soon. The first question he had for me was “do you know what you want to wear yet?”  he said with a sarcastic chuckle. It seems that there is a running joke in the plastic surgery office about my Muay Thai avocation in that I am allegedly over concerned with my kick boxing fashion and fight music.

I don’t think I am. It is important to look well dressed in a Muay Thai ring. The music which is played when you first appear is also important. I mean what would it look like if I just showed up in any old shorts. People would think I was an MMA fighter which is a sin. Even if they knew my discipline was Muay Thai,  I have pride and want to look nice. As all plastic surgeons know appearance means a lot. If my opponent noticed that my Muay Thai shorts were not properly pressed , he may get the idea that I am someone not up to par.  Nothing could be more damaging to the all important psychological aspects of a fight than show up with dirty or or unpressed shorts. The color one chooses is a also important and should reflect your mood as well.  If I am feeling aggressive and want to be on the offensive I prefer black or a dark color. If I am in a sneaky mood , I prefer blue or white as I think it distracts my opponent. One of my favorite colors is pink, a soft pink almost pastel. This lulls my opponent into a calm which amy make him less attentive to  details. 

Music is equally important. One can choose  heavy death metal sound, rock and roll or  or something different.  Again this is all designed for how I want to appear at the ring. Perhaps if my mood is aggressive,  I would choose something like “bodies” by drowning Pool  This has a nice effect sorta of a “I am going to kill you type theme”.  If you really want to confuse your opponent perhaps  Japanese techno or pop may be interesting though I have not fought with this music yet.  I was thinking it might be fun. Here since most Americans are unfamiliar with this genera of music it may give your opponent the idea that I am some kinda of  science fiction type fighter with far advanced futuristic skills,  rather than a brutal killer. I like this in that the futuristic fighter has a nice appeal and would go really well with pink Muay Thai shorts. I think Dream Fighter or Electroworld by Perfume is a good choice.

I have  a few days to decide about these issues , but I will put considerable thought into this. It is very hard decision and I certainly think my office staff and that anesthesiologist who made such comments are simply rude and have no fashion or style , what so ever. Really !  What would doctor 9o210 say?

I will be consulting with one of my favorite fighters Mayhem Miller over this as I am sure he will understand,  as well as some other local fighters and friends who will be more understanding of me than  my staff. I am not sure such an important decision can be made alone. Please make your comments known and help me decide!

doctor 808