breast augmentation before and after 700cc

ten years ago, i got a phone call thatchanged my life. at the time, i wascardiologist at ucla, specializing in cardiacimaging techniques. the call came from a veterinarianat the los angeles zoo. an elderly female chimpanzee had woken up with a facial droop and the veterinarians were worriedthat she'd had a stroke. they asked if i'dcome to the zoo

and image the animal's heart to look for a possiblecardiac cause. now, to be clear, north americanzoos are staffed by highly qualified,board-certified veterinarians who take outstandingcare of their animal patients. but occasionally, they do reach intothe human medical community, particularly for somespeciality consultation, and i was one of the lucky physicianswho was invited in to help. i had a chance to rule outa stroke in this chimpanzee

and make sure that this gorilladidn't have a torn aorta, evaluate this macawfor a heart murmur, make sure that this california sea lion'sparicardium wasn't inflamed, and in this picture, i'm listeningto the heart of a lion after a lifesaving,collaborative procedure with veterinarians and physicians where we drained 700 cc's offluid from the sac in which this lion'sheart was contained. and this procedure, which i havedone on many human patients,

was identical, with the exceptionof that paw and that tail. now most of the time, i was workingat ucla medical center with physicians, discussing symptomsand diagnoses and treatments for my human patients, but some of the time,i was working at the los angeles zoo with veterinarians, discussingsymptoms and diagnoses and treatments for their animal patients. and occasionally, onthe very same day, i went on rounds atucla medical center

and at the los angeles zoo. and here's what started cominginto very clear focus for me. physicians and veterinarianswere essentially taking care of the same disorders in theiranimal and human patients: congestive heart failure, brain tumors, leukemia, diabetes,arthritis, als, breast cancer, even psychiatric syndromeslike depression, anxiety, compulsions, eating disordersand self-injury. now, i've got a confession to make.

even though i studied comparativephysiology and evolutionary biology as an undergrad -- i had even written my seniorthesis on darwinian theory -- learning about thesignificant overlap between the disorders ofanimals and humans, it came as a much neededwake-up call for me. so i started wondering,with all of these overlaps, how was it that i had neverthought to ask a veterinarian, or consult the veterinary literature,

for insights into oneof my human patients? why had i never, nor had any of myphysician friends and colleagues whom i asked, ever attendeda veterinary conference? for that matter, why wasany of this a surprise? i mean, look, every single physicianaccepts some biological connection between animals and humans. every medication that we prescribeor that we've taken ourselves or we've given to our families has first been tested on an animal.

but there's something very different about giving an animal amedication or a human disease and the animal developingcongestive heart failure or diabetes or breast canceron their own. now, maybe some of the surprise comes from the increasingseparation in our world between the urban and the nonurban. you know, we hear about these city kids who think that wool grows on trees

or that cheese comes from a plant. well, today's human hospitals, increasingly, are turning into thesegleaming cathedrals of technology. and this creates a psychologicaldistance between the human patients who are being treated there and animal patients whoare living in oceans and farms and jungles. but i think there's aneven deeper reason. physicians and scientists, we acceptintellectually that our species,

homo sapiens, is merelyone species, no more unique orspecial than any other. but in our hearts, we don'tcompletely believe that. i feel it myself when i'mlistening to mozart or looking at pictures of themars rover on my macbook. i feel that tug ofhuman exceptionalism, even as i recognize thescientifically isolating cost of seeing ourselves as asuperior species, apart. well, i'm trying these days.

when i see a human patientnow, i always ask, what do the animal doctors knowabout this problem that i don't know? and, might i be taking bettercare of my human patient if i saw them as a humananimal patient? here are a few examples of thekind of exciting connections that this kind ofthinking has led me to. fear-induced heart failure. around the year 2000, human cardiologists "discovered"emotionally induced heart failure.

it was described in a gambling fatherwho had lost his life's savings with a roll of the dice, in a bride who'dbeen left at the alter. but it turns out, this"new" human diagnosis was neither new, norwas it uniquely human. veterinarians had been diagnosing,treating and even preventing emotionally inducedsymptoms in animals ranging from monkeys to flamingos,from to deer to rabbits, since the 1970s.

how many human livesmight have been saved if this veterinary knowledgehad been put into the hands of e.r. docs and cardiologists? self-injury. some human patientsharm themselves. some pluck out patches of hair, others actually cut themselves. some animal patientsalso harm themselves. there are birds thatpluck out feathers.

there are stallions that repetitivelybite their flanks until they bleed. but veterinarians have very specificand very effective ways of treating and evenpreventing self-injury in their self-injuring animals. shouldn't this veterinary knowledgebe put into the hands of psychotherapists andparents and patients struggling with self-injury? postpartum depression andpostpartum psychosis. sometimes, soon after giving birth,

some women become depressed, and sometimes they become seriouslydepressed and even psychotic. they may neglect their newborn, and in some extreme cases, even harm the child. equine veterinarians alsoknow that occasionally, a mare, soon after giving birth, will neglect the foal,refusing to nurse, and in some instances,kick the foal, even to death.

but veterinarians have devised an intervention to deal withthis foal rejection syndrome that involves increasingoxytocin in the mare. oxytocin is the bonding hormone, and this leads to renewed interest, on the part of the mare, in her foal. shouldn't this information be put into the hands of ob/gyn's and family doctors and patients

who are struggling with postpartumdepression and psychosis? well, despite all of this promise, unfortunately the gulf betweenour fields remains large. to explain it, i'm afraid i'm goingto have to air some dirty laundry. some physicians can be real snobs about doctors who are not m.d.'s. i'm talking about dentists andoptometrists and psychologists, but maybe especially animal doctors. of course, most physiciansdon't realize that it is harder

to get into vet school thesedays than medical school, and that when we goto medical school, we learn everythingthere is to know about one species, homo sapiens, but veterinarians need to learnabout health and disease in mammals, amphibians,reptiles, fish and birds. so i don't blame the vetsfor feeling annoyed by my profession'scondescension and ignorance. but here's one from the vets:

what do you call a veterinarian who can only takecare of one species? a physician. (laughter) closing the gap has becomea passion for me, and i'm doing thisthrough programs like darwin on rounds at ucla, where we're bringing animal expertsand evolutionary biologists and embedding themon our medical teams with our interns and our residents.

and through zoobiquity conferences, where we bring medical schoolstogether with veterinary schools for collabortive discussions of the shared diseases and disorders of animal and human patients. at zoobiquity conferences, participants learn how treatingbreast cancer in a tiger can help us better treat breast cancer in a kindergarten teacher;

how understanding polycysticoveries in a holstein cow can help us better take care of a dance instructorwith painful periods; and how better understanding thetreatment of separation anxiety in a high-strung sheltie can help an anxious young childstruggling with his first days of school. in the united states and nowinternationally, at zoobiquity conferences physicians and veterinarians checktheir attitudes and their preconceptions at the door and cometogether as colleagues,

as peers, as doctors. after all, we humansare animals, too, and it's time for us physicians to embrace our patients' and our own animal natures and join veterinarians in a species-spanning approach to health. because it turns out, some of the best andmost humanistic medicine is being practiced by doctorswhose patients aren't human.

and one of the best wayswe can take care of the human patient is bypaying close attention to how all the otherpatients on the planet live, grow, get sick and heal. thank you. (applause).