Doctor808 Plastic Surgeon Honolulu Hawaii

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

Meet My Coach!! Or in Muay Thai language MY KRU—-

My Kru Doug Owens

My Muay Thai coach is a funny guy. It is 4:30 pm and I am on my way to my Japanese Language class and I see I have a voice mail on my iphone. I check that voice mail and its my coach. ….  “Give me a call”   -Ok I call him back and only a few words were said..”Doc I want you to fight next month”.  I answer : “Ok coach no problem” ,  that means I have 6 weeks to really turn on the training….6 weeks plenty of time.

Coach : ” how much you weigh now? “   “I weigh 190 lbs coach”- at 5 feet 10 inches…..not bad, but I fight at 180lbs. Next thing he says is  “ok doc lose ten pounds I want  you to fight at 180″ .

Thats easy I think,  ten pounds in 6 weeks not hard ?  Plenty of time , get ready for fight next month, June is 4 weeks away and the fight is about 6 weeks away. Right?

Now for the surprise. The inevitable twist in plot or the turn in events. I failed to notice one thing,  today is April 31st !!  So here it comes  ”Oh doc the fight is in 9 days , you know next month is May”–great great great—that is insane to get ready for a fight in 9 days. I mean when I was 20 maybe , but at my age now —-its going to be a challenge.  I have to lose ten punds in 6 or 7 days. @#$%^&*()_+!!

Let me think. What is ten poiunds?

Well here are two pictures. which come to mind.

Fighting weight of 180 lbs

The above picture is what I look like when I am in  fighting shape. The picture below is what  I look when I am fat like now–So I think the idea is to look like the guy above rather that the guy below—all in less than 9 days according to my Kru. He is a funny guy indeed!!

Me now at 190lbs

Coach being patient-Mr Nice

Swine Flu  is a serious disease and authorities are worried about its spread in the United States. The reason is that as of this writing there have been already reported 150 deaths in Mexico. Here in Hawaii there has not been a reported case yet.  However there has been at least one reported death in the USA.

A flu epidemic is caused by a virus which is spread typically by person to person contact. Sneezing, coughing and spread by air , are the usual methods.  It also can be picked up on door knobs if touched right after someone contagious has spread the droplets there for example. In the case of swine flu the virus has made the jump from pigs to humans and the DNA has become mixed up. There was not thought to be a spread of the virus beyond 3 successive people but now that has been dismissed. 

For a more detailed description of the swine flu check this out CDC SWINE FLU report from CDC.

As a Plastic Surgeon in Hawaii,  I do get reports from the local health department and there have not been any reported cases here,  but caution is advised. Hawaii has a lot of incoming visitors as it is a vacation paradise. At my clinic we come in contact with a lot of people and we take extreme precautions not to contribute to the spread of virus or any germs. I have not decided yet but I am considering carefully,  to mandate wearing of mask by staff when in contact with public. Its a balance of saftey and giving the appearance of friendliness that I try to maintain from my staff.

Any of my plastic surgery staff who is sneezing, coughing or shows signs of illness will either be sent home or at a minimum wear a surgical mask. We are tight knit group and everyone is concerned about saftey for our patients and ourselves. 

What can you do to prevent swine flu or any other cold or flu? Well common sense is the first order of business. That  is stay away from where there are reported cases if possible. Next when traveling especially by air or any other cramped condition wear a surgical mass. It may look funny or feel odd,  but better than being ill. Vitamin C of course is always a good overall immune system booster, I take 1 gram a day but that is not advice to you as that can cause diarrhea unless you build up to it slowly. Any medical suggestions here are not my advice to you as a doctor,as that would require a lot more knowledge of you , but you can ask your doctor his opinion. Wash your hands frequently , you may want to aquire a hand sanitation agent.

There are surgical mask commonly seen being worn by people in travel through airports and very common is Asia due to avian flu. I think now is the time to consider such precautions although it is not known how effective. Personally I think its a good step to take.

You can obtain surgical mask here:

Japanese Study

                     A quite morning of study  for Doctor808 ???

This morning I was up at the crack of dawn determined to get in my Japanese study time. I left the house early after  I spoke with my significant other and did the morning dog routine. I jumped  into  my hummer, drove to Starbucks and then sit down for an hour of study before work.  It was going very well, I had two pages of lesson completed both spoken and written. THEN THEY CAME……

A Gang Of Cantonese!!!

I have nothing against Chinese people , in fact my significant other is Chinese. Yet here I am trying to study,  enjoy in a  nice tropical breeze, the peaceful quite with my favorite coffee. This is all  very  conducive to study. All of sudden an Asian man walks up and starts pulling outside tables together near me.  He not only pulled one but then two and then a total of five tables and 15 chairs.   He lined them up all in nice neat row , next to me.  A t first I thought he was crazy as sometimes homeless people come around there and do strange meaningless things such as that. Then I realized —OH MY GOD –NO NO NO, it was evident he was preparing for a crowd and getting chairs and tables together for THEM. 

 I am not against Chinese per se,  but when you are trying to study a gang of Chinese having  social event next to you  is not a great idea. To make matters worse they were not just any Chinese,  but CANTONESE speakers. The difference is huge when compared to the  main land Chinese who speak Mandarin. Cantonese speakers when in a group sound like a major fight is going on as they talk. Its not that they are fighting , but it is the nature of the dialect. This is much different than Chinese Mandarin dialect which actually  is very calm , sweet and like a song. Chinese are much like Italians, my ancestry, they are very loud when being social.

I had to end my study as the loud sound of Cantonese chatter was overwhelming. First one person yakking then another  then all talking at the same time. It appears as if there is strong competition for talking!! I found  myself thinking back when I worked in China Town in New York City and the words I had learned in Catonese  from those days were entering my head without permission.

No longer could I think to myself “Genki Desu KA? ” but now I was thinking ” Ne Ho Ma ?“  My thoughts were taking a beating , my blocks to the environmental distraction were failing and had failed. As the cloud of asian languages were confusing, overwhelming and non stop swirling about in my brain—I was having second thoughts about learning Japanese , maybe I should learn french.

drmap

Well the recent troubles with Ushers wife going to Brazil and having a cardiac arrest make this a very topical topic. Many people travel to places other than their home towns to have  procedures. Here in Hawaii I have spoken to many patients who come to my office after travel for cosmetic procdures. Some go to Korea, Thailand and other parts of Asia. Recently a woman told me she was going to Mexico to have the procedure we discussed at half the cost. 

Basically there are good plastic surgeons all over the world which is not the problem. You can find good surgeons in Mexico or in any of the other countries I mention no doubt. The problem is when there is some difficulty. Not only are you miles away from family or any support, but the money you would have saved now is lost  and most likely has become so much more than the original cost quoted locally.

What comes to mind was doctor and her husband who went to Brazil to have the LASIk procedure done to correct some vision problem. She and her husband both had the procedure at a substantially reduced cost,  than they would have in the States. Yet she had a problem after surgery which she had to travel to London eventually to correct. As london indeed had the only expert in her problem. Although she saved money with the initial surgery it cost her over 8 times more and she is still receiving treatment.

This story has been repeated many times in my practice a girl who traveled to Thailand who had some rubber unknown sack used as a breast implant which I took out for example. She wasted her money. Even when people have quality plastic surgery done away from home if they have a problem they have to fly back to the place which cost additional money.  It can work but dont think you will save in long run , the numbers do not work out.

I have patients fly in to see me as well. Yet we require them to stay till everything is ok. Even then we tell them that if they are from Japan for example  we may have a doctor they can see there,  but it may require a plane trip back to Hawaii. Its not that I condemn the practice,  but I want to make sure they are appraised of the risk and know that in long run saving money will not be one of the benefits.

Well these are some of my thoughts Summary: You can fly far away to have plastic surgery and it may be good idea if you find the right surgeon. Yet do not think you will save money and you best be able to be prepared if something goes wrong to pay extra. The only reason I can see to take this risk is that you are traveling for special expertise. You pay for that, so going for cheap is not a good reason.

Doctor808

This is a rather personal writing not too much exciting but gives the reader a little insight.

What is Monday ?

Monday Hair

What is Monday? It is the start of the week after Sunday, family day. As a plastic surgeon who also CEO of a web development firm and one who trains in a the sport of Muay Thai almost everyday my time is limited. Thus, I usually divide my day up in sections, of what to get accomplished. Each day of the week I have also designated for particular things to get done. Monday is revision surgery and small cases with staff a meeting, tuesday is big case day , Sunday is family day and so on……. Let me dissect Mondays for you to see if you find it interesting. Monday I am up at 5 or 6 am as most days and I go to computer, check emails. look at schedule and fool around with my three dogs. Samantha is my oldest dog who is 12 years old and needs the most attention. I try to do stretching every morning although when I am training hard I go to the gym. So after taking care of Dogs , computer work , planning some things I go to pick up one of my employees on the way to work before 8 am. We discuss our web business , google news, SEO stuff , our clients etc. I get to office and my nurse will have the first patient ready along with my operating assistant. I check the patient and do what ever was required. Today for example we did a scar revision, a liposuction touch up and lower lid blepharoplasty ( lower eye lid surgery). Everything went smoothly this morning as usual. After 20 years of doing this stuff, it better go smoothly one would think and it does. Then the fun starts–the mandatory staff meeting at lunch. This occurs every monday and even though its mandatory I spend an inordinate amount of time being irritated because certain people dont feel the same way I do about it. Yet with legitamate excuses what can I say. Every monday we go through the same thing….where is so and so. “Dont you recall Doctor she has school or her child is sick or bla bla bla”. Anyway that is always an irritation. So Monday is irritation time at least for few minutes, regular, steadfast and like clockwork every monday i get irritated at the start of the staff meeting.

The dreaded staff meeting.

Some Staff

Next we have our staff meeting, we review new patient statistics, we talk about supplies which are needed and not in yet, we discuss any issues at hand and finally we review how to make things better for our patients, staff and all concerned. The staff meeting usually ends around 1 pm and the rest of the day is spent seeing a few patients and taking care of the important things that cant wait. I try usually unsuccessfully to take Monday afternoon off. Today for example I left at 3:30 pm which is early for me. If I am lucky as I was today I can make it to Muay Thai training on time 5pm or so. I train for minamum two hours and by then its usually 8pm. I travel home , say hello to my other half who inevitably makes a nasty comment about how I am getting too old and will hurt myself about full contact Muay thai. Its hard to argue with the truth, but I pretend to even though she is probally right I don want to admit that I am getting older and few people my age do such a sport. I take a shower and then head to the computer again getting my web work done. Oh I usually don’t eat much after training, but a small meal and plenty of fluids. After this I checked some search terms on google analystics tonight, answered some emails and then worked on my latest web site. Monday is never that exciting and I am glad really. I work on the internet to about midnight and then off to sleep. When I look at this I think I am rather simple guy. Not exactly 9-5 but kinda, as my internet work is play as much as it is work. I enjoy it that much designing , content writing and even thinking how I can take over the internet world of plastic surgery web site design and marketing……

Oh I forgot to tell you I always try to listen to my Japanese language disk to and from work and Muay Thai. I have listened to them so many times that I am sure I speak like a japanese female as opposed to a male since the voice is female on the disk.

Future Monday?

Future of Monday

I think in a few years I will change my Monday’s I look forward to that. Yet after many years of these Monday routines I may become confused or something. How is your Monday dear reader ?

Dr. Pasquale

Welcome to Doctor808  my blog about many of my interest and helpful information I hope to share with you. I hope to make this entertaining as well and most of all we hope you will contribute. Our friends are from around the world and this blog will be in English and hopefully translated to Japanese and Chinese and other languages as we go along.

Allow me first the privilege of introducing myself . My name is Michael Anthony Pasquale and I am Plastic Surgeon located in Honolulu , Hawaii. I have been in practice about 20 years , first with microsurgery, facial and extremity reconstruction now exclusively in cosmetic surgery ( beautification procedures).  I was also a trauma surgeon as well at one point in my career, in New York and Hawaii with some time spent with Army. I have had intense interest in the Internet for years. I was one of the original compuserv members over 27 years ago. I have watched the Internet grow from nothing. As this interest as grown , I started  web design/marketing company was well which specializes in cosmetic surgery and beauty industry known as 3D-plasticsurgery.com.  There will be more information on this endeavor as we go along. Our company does  virtual world design , traditional web design and marketing functions such as SEO.

We hope you will find this usefull and be patient with us as we learn as we go along. Comments will be welcome.