You’ve come a long way, baby!

Wow..  a long couple of days – but I am sure not complaining!  Still having a blast – and as they teased me in the operating room, “Cristina, Cristina, Cristina!” I felt more like I belonged – instead of as a student, often lost/ confused.  Even more so – when I found myself irritated on rounds – irritated when the answers were obvious!!  Obvious – that’s certainly making progress..  (Irritated is such an improvement over clueless, I must say..) But the interns are a good bunch, even if they don’t love surgery like I do!

Residents at Mexicali General

The good doc gave me some homework – as we work on a ‘mystery diagnosis’ which I am enjoying.  Of course, it won’t be a mystery as soon as the pathology comes back, but I am surely enjoying the intellectual challenge (and kind of hoping that my preliminary leaps aren’t completely off-base..)  Of course – the doc is so smart – he probably already has it all figured out, and is just checking on the faculties of his student.  (He is secretly brilliant, and just hides it behind his braces and freckles.. Kind of scares me sometimes..)

Deceptively normal looking..

Bumped into Dr. Ramirez and Dr. Perez (the anesthesiologist) this morning, which reminds me that I still need to write about my visits to his operating room last week.  So I haven’t forgotten – expect it in just a couple of days..

It’s nice too when we run into people I know as we round at different hospitals around the city..  But then – as I glance at the calendar and realize that time is passing – I get a little sad.  Just as I am starting to understand things (Spanish, the hospital systems etc..) and I am enjoying it here so much, learning so much, yet time is flying, and before you know it – I will be returning home again (wherever that is!)

In the OR (and back again!)

It sounds awful to say but it’s a good thing my husband has been out-of-town this week – after all, considering my week in the operating room, he wouldn’t have seen much of me anyway!  But it always drives him a little crazy to see me racing from interviews to operating rooms – stumbling home late, with aching legs and a rumbling tummy, only to climb out of bed and the crack of dawn just to do it again.. then worry that I somehow won’t have time to write it all down – and round and round..  (That being said – he is phenomenal about understanding this driving motivation I have to interview, and to write – even when I’m not quite sure I understand myself.)

So he wouldn’t have complained about my whirlwind tours of the operating rooms this week – or the long days of back-to-back surgery but I would have felt bad about not seeing him all the same..

Instead with my husband thousands of miles away, I hear him smiling in the phone, laughing at my exploits, though I sometimes picture the wrinkle he gets in his brow when he thinks I’m not eating right, or getting enough sleep.. He currently serves as my remote editor for my articles at – calling to give feedback before submission.  He’ll be home soon – and he’ll be patient with me, as always.

Dr. Victor Ramirez, plastic surgeon

Had some great interviews and operating visits this week – including Dr. Victor Ramirez, and most of the plastic surgery community here in Mexicali – but to be fair, I will break it all up into a couple of posts.

Demonstration of techniques for breast reconstruction at Mexicali General

Back in my ‘home’ OR in thoracic surgery – which felt good.  I love meeting and seeing all the different specialties like bariatrics, urology and plastics, but it sure does feel good to come back home again..

back in thoracics (and trying to hang from the rafters)

I could wax some eloquent nonsense about the beauty of a muscle-sparing thoracotomy but then again – the good doc does almost everything minimally invasive, so I never see any.. (and you’ve heard me crow about dual port thoracoscopy.)

with more to come..

Kim Kardashian’s Mexicali secret.. (ads, that is)

Kim Kardashian on the red carpet – photo credit unknown

Looks like Dr. Victor Ramirez, the plastic surgeon in Mexicali that we previously interviewed here has ignited a firestorm of controversy by using the unauthorized likeness of Kim Kardashian (of reality television fame) to advertise his surgical skills.

While I don’t condone this behavior – the irony of the situation is unmistakable since Ms. Kardashian first shot to fame (and public attention) through public exposure of another sort entirelyIn fact, she along with Paris Hilton are two of the very ‘celebutards’ that popular media love to exploit while simultaneously decrying their actions.

Mexicali ad courtesy of Perez

Is the outrage against Dr. Ramirez, expressed by Kim Kardashian based on true or genuine anger or frustration against unwanted (and unpaid!) advertising, or just another slick publicity stunt in the wake of negative public sentiments regarding her highly profitable (yet amazing brief) marriage?  Even now, tales of her bickering and fighting over money with her ex still dominate the internet, tv and gossip columns..

Especially since the timing coincides nicely with the opening of her new lingerie line, the Kardashian Kollection..

Ms. Kardashian’s recent twitter pix,

Now, I’ve never met Ms. Kardashian, and I’m sure this situation might be aggravating, but at the same time – isn’t it just a bit flattering too?  That other people might choose to have a surgical procedure so that they can attempt to mimic your beauty?  If I were Kim – I’d sit down with Dr. Ramirez and work out some sort of agreement – for advertisements and endorsements..  But, wait..

Isn’t this the same woman who sued Old Navy for hiring a model for looking “too much” like her?

But then again – I’m just a nurse.

I’ve emailed Dr. Ramirez for his side of the story, (for more about the real Dr. Victor Ramirez – read our post here).

More on this story – elsewhere on the net

Fox News

Orange County Register

Interview with Dr. Victor Ramirez, Plastic Surgeon

Read about my visits to the OR with Dr. Ramirez here.)

Today, I interviewed the charming young plastic surgeon, Dr. Victor Manuel Ramirez Hernandez, 37.   Dr. Ramirez is well-versed in medical tourism – he tells me that 90% of his current practice are American patients.  He reports that many of these patients are from nearby areas in California and Arizona but that he has patients from across the United States.

Undoubtedly, these patients found Dr. Ramirez the same way I did – via the internet, thru his well-designed and attractive website,   Parts of the bilingual site are still under construction, so I contacted Dr. Ramirez directly to arrange for an in-person interview.  He also offers his services thru Costuco, a medical tourism agency that published their own medical tourism guide.  He is one of four local plastic surgeons listed in their recent publication advertising surgical services in the city called guia de cirugia en Mexicali.)

His office is located just a short walk from FCO (Francisco) Maduro, on Calle B – between Reforma and Obregon and across the street from Hospital Hispanol Americano.   (Interestingly enough – and coincidentally, his office is next to one of the thoracic surgeons I had previously contacted.)

He readily agreed – and with a minimum of fuss, we sat down together to discuss his practice.  He is friendly, polite and patient.  (I, myself, am surprisingly nervous – as much of my Spanish deserts me, the usually smoothly phrased questions becoming a jumbled, hurly burly mix.)  Luckily for me, Dr. Ramirez has arranged for his nephew, an Arizona native* to stand by and assist with translation as I try and gather my wits and compose myself.  Dr. Ramirez, who primarily speaks Spanish tells me that he often does this in order to facilitate communication with his English-speaking clientele.

As we talk, one of the things Dr. Ramirez and his nephew touch on is the importance of medical training and education, and the importance of being able to quantify the validity of this training in Mexico, where training standards and requirements are not standardized.

Dr. Ramirez himself received his medical education** in Morelia, which is the capital of the Mexican state of Michoacan (de Ocampo).  He attended the well- respected, and well-reputed Universidad de Michoacana de San Nicolas de Hidalgo***.  After graduating in 1997, he completed his general surgery residency (1997 – 2002) at Hospital Central Militar (which is a large military hospital – similar to Bethesda or other American VA facilities, located in Mexico City.)

He completed his plastic and reconstructive specialty surgery at the same facility in 2007 – 2008.   During his fellowship, he published several papers in a national medical journal, Revista Sanidad Militar (Military Health Magazine).

He completed additional training in microsurgery and breast reconstruction and received his board certification in plastic, esthetic and reconstructive surgery.

(As we’ve mentioned in previous posts, and in prior publications – not all countries require specialty surgeons such as plastic surgeons, cardiac surgeons etc. to have general surgery training.)

Since then, he has presented, and lectured at several national conferences (Mexican Association of Plastic, Esthetic and Reconstructive Surgery as an active member of this organization.)

He currently performs (on average of) four surgeries a week.   He performs a wide range of facial and body procedures including injectables, face-lifts, breast augmentation, abdominoplasties, and liposuction. (This is not an all-inclusive list.)  During his initial consultation, Dr. Ramirez performs a full medical evaluation.  If patients have uncontrolled diseases (such as diabetes) or are at high rick for surgical complications, Dr. Ramirez will refer patients for further medical evaluation and treatment before undergoing surgery.

For patients who live nearby (but outside Mexicali), Dr. Ramirez recommends a three-day stay with a return to Mexicali for a one week post-operative follow-up.  For medical tourists from greater distances, Dr. Ramirez recommends a one week stay in Mexicali.  He and his staff will assist in making hotel arrangements, and Dr. Ramirez has nurses that make house calls after surgery.

During my visit today, we also reviewed several of his cases – including before and after photographs.  Notably, in the photos viewed, post-operative photos, while showing dramatic differences, also showed natural appearing results.  The post-operative breast augmentation photos were particularly interesting – in all of the photos reviewed, the patients had elected for cosmetically appealing, natural looking results [versus dramatically endowed, ‘porn star’ breast implants].  (As discussed in Bogotá! – styles and fashions of plastic surgery may vary among cultures, geographic regions and the general public.)

*It turns out that his nephew, who is currently studying medicine is practically my neighbor, having been raised and attending school in Williams, AZ which is near Flagstaff (my current home.)

** In Mexico, like many countries, students do not attend a separate undergraduate program prior to medical school.  Instead, students undertake a six or seven year program that encompasses medicine and general studies.

*** This is one of the oldest universities in Mexico, originally founded as the colegio de San Nicolas de Higaldo in 1540. It became a university in 1917. It is also one of the largest public universities in Mexico. At the Universidad Michoacana – students may apply for the five-year medicine program after completing two years of general study.

Publications: (selected sample, not a full listing)

Percutaneous tracheostomy: Experience in the intensive care unit of the regional military hospital in irapuato, guanajuato.  (2005) full-text pdf download.

Ring injuries: case report and review of the literature. (2006).  full text pdf download

Clinical experiences in burns at Hospital Central Militar. (2007) full text pdf.