Category Archives: Acupuncture

Lidocaine Info Important For My Surgical Practice – Maximums and Toxicity

lidocaine picture from


  • Also known as Xylocaine and sometimes Lignocaine
  • Local Anesthetic
  • Antiarrhythmic drug – for ventricular arrhythmias (but Amiodarone is mostly used for this)
  • The first Amino-Amide local anesthetic
  • First marketed in 1949
  • Alters signal conduction in neurons by blocking the fast voltage gated sodium channels in the neuronal cell membrane.  Thus prevents depolarization of the postsynaptic neuron.

Esters and Amide local anesthetics – way to remember which

  • Esters have only one “i” in the name: Procaine, Cocaine
  • Amides have over two “i”s in the name:  Lidocaine, Bupivicaine, Prilocaine.

Contraindications to using Lidocaine

  • Porphyria – rare inherited or aquired disorders of enzymes which produce porphyrins and heme resulting in neurological complications (abdominal pain, vomiting, neuropathy)  or skin problems.
  • Heme is one the best known porphyrin the pigment in red blood cells and cofactor of the protein hemoglobin.
  • Porphyrin means purple

Lidocaine overdose

  • can occur with topical creams
  • Treatment with IV lipid emulsions can reverse the effects of lidocaine toxicity.

Adverse Effects

  • Rare
  • Allergic reactions rare.
  • CNS (central nervous system) and cardiovascular effects
  • CNS at lower doses, cardiac at higher doses
  • CNS: nervousness, tingling around mouth, tinnitus, tremor, dizziness, blurred vision, seizures, depression, loss of consciousness
  • Cardiovascular effects: hypotension, bradycardia, arrhythmias

Insensitivity to Lidocaine

  • Genetic
  • Exists in some patients with ADHD and Ehlers-Danlos syndrome

Lidocaine Safety and Toxic doses

  • Particular care in calculating maximum safe dose for young children
  • Peak blood levels of lidocaine usually occur 10-25 minutes after injection – the point at which toxic effects are likely to be seen.
  • Maximum safe dose of lidocaine without vasoconstrictor (ie. epinephrine) is 3-4.5 mg/kg (duration of action 1 hour).  No more than 300 mg (30 cc’s of 1% Lidocaine) at once.
  • Maximum safe dose of lidocaine with vasoconstrictor is 5-7 mg/kg (duration of action 2-6 hours)

How to calculate Maximum safe doseage of Lidocaine

  • You need to know that 1% Lidocaine solution is 10 mg/mL
  • Example Calculation for a 70 Kg man:  Lido 1% with Epi:  keep under 7 mg/Kg.  7×70 = 490 mg for 70 kg man.  Divide 490 mg by 10 mg/ML = 49 ml.

How is this important to our Plastic Surgical and Acupuncture practice?

  • We use lidocaine in plastic surgical procedures – topical and subcutaneous – for removal of moles, injection of fillers such as Juvederm, and sometimes for Botox.
  • I also use injected  lidocaine as part of some trigger point deactivation practices in acupuncture.

Cosmetic Procedures at Surgical Artistry which may use Lidocaine

  • Liposuction – tumescent lidocaine
  • Mole removal – injected subcutaneous local lidocaine
  • Fillers – Juvederm – some formulations have lidocaine within the product
  • Fillers and Botox – sometimes we use topical lidocaine
  • Face Veins – sometimes we use topical lidocaine
  • Minor office surgeries – we use injected lidocaine in the subcutaneous level


What do we do at Surgical Artistry?


5 year patients choice     surgical artistry full page ad never boring

I get this question a good deal.  I think it’s probably somewhat confusing as to what we do and we offer a lot of procedures and products.  Basically we are a two surgeon medical group offering services in Veins, Acupuncture, Plastic Surgery, and General Surgery.  That can be quite a lot.  But even with that said, it’s somewhat confusing as to what each of these items involves.  So I thought I’d make a list which doesn’t include everything, but covers most of what we do:



  • Botox for cosmetic
  • Botox for headaches
  • Botox for hand and axillary sweating
  • Botox for TMJ (jaw pain)
  • Fillers (ie. Juvederm)
  • Lip Augmentation with Juvederm or other injectable fillers
  • Vein Laser
  • Vein Injections (ie. with Asclera)
  • Face Vein treatment
  • Acne Consultation
  • Skin Care Consultation
  • Cosmetic Mole Removal
  • Microdermabrasion
  • Chemical peels (ie. Obagi Blue Peel Radiance and Obagi Blue Peel)


  • Acupuncture trigger point deactivation for muscle pain
  • Acupuncture for back pain / neck pain
  • Acupuncture for buttock pain (ie. pyriformis syndrome)
  • Acupuncture for IT band pain (side of thighs wrapping to below knee)
  • Acupuncture for fertility
  • Acupuncture for TMJ (jaw pain)
  • Acupuncture for stress / anxiety
  • Acupuncture for allergies
  • Acupuncture for fibromyalgia
  • Acupuncture for depression
  • Acupuncture for hormones (hot flashes, acne, menstrual cycle)
  • Acupuncture for facial rejuvenation (cosmetic)
  • Acupuncture to boost the immune system
  • General wellness Acupuncture
  • Anti-nausea acupuncture for those undergoing chemotherapy or pregnancy


  • Obagi Line
  • NIA 24 Line
  • Various Skinceuticals


To recover faster from workouts, prevent varicose veins, and prevent injuries

  • Calf sleeves from Sigvaris and CEP brands
  • Full calf sleeves from Sigvaris and CEP brands
  • Dress socks from Sigvaris
  • Thigh high and Pantyhose compression from Sigvaris.

 Contact Us:

Surgical Artistry - Calvin Lee, MD / Tammy Wu, MD


What is Stage 4 Colon Cancer

These are just educational notes on stage 4 colon cancer – no personalized medical advice is given here.  In my Modesto surgical experience, I have had the privilege of participating in the care of several patients with stage 4 colon cancer.  Some of these surgical patients have also become my acupuncture patients.

colon cancer diagram of stages

Colon Cancer Stages with TNM designation

Stage IV Colon Cancer

  • Cancer spread from the colon to other organs and tissues, ie. liver, lungs, peritoneum (in the abdomen surrounding), or ovaries.
  • Considered the most advanced cancer stage
  • Stage IV A: spread to one organ not near the colon, such as the liver, lung, ovary, or to a distant lymph node.
  • Stage IV B: spread to more than one organ not near the colon or into the lining of the abdominal wall (peritoneum)

Stage IVA

Any T, Any N, M1a: The cancer may or may not have grown through the wall of the colon or rectum, and it may or may not have spread to nearby lymph nodes. It has spread to 1 distant organ (such as the liver or lung) or set of lymph nodes (M1a).

Stage IVB

Any T, Any N, M1b: The cancer may or may not have grown through the wall of the colon or rectum, and it may or may not have spread to nearby lymph nodes. It has spread to more than 1 distant organ (such as the liver or lung) or set of lymph nodes, or it has spread to distant parts of the peritoneum (the lining of the abdominal cavity) (M1b).

TNM designation

T categories of colorectal cancer describe the extent of spread through the layers that form the wall of the colon and rectum.

categories indicate whether or not the cancer has spread to nearby lymph nodes

M0: No distant spread is seen.

M1a: The cancer has spread to 1 distant organ or set of distant lymph nodes.

M1b: The cancer has spread to more than 1 distant organ or set of distant lymph nodes, or it has spread to distant parts of the peritoneum (the lining of the abdominal cavity).

Reviewing my Personal Experience with Stage IV colon cancer

  • I’ve operated on several patients with Stave IV colon cancer
  • I’ve also done wedge resections on the liver for areas of cancer spread (metastases)
  • In some patients I’ve made diverting colostomies.
  • Some patients I’ve had receive chemotherapy before surgery to shrink down the size of the  tumor load.  The is called Neoadjuvant therapy.
  • Most of the patients after surgery with Stage 4 colon cancer have received chemo therapy after surgery – and the chemotherapy is decided up and performed by the oncologist.
  • Some get radiation afterwards to relieve symptoms
  • There are clinical trials
  • Re-operations are done for recurrences.

Web sources of info regarding the stages of Colon Cancer

Inspirational Story in Modesto, CA of Kelly with Stage IV Colon



1 hour Lecture by Grace Nadolny, MD on 4/20/13 in Modesto, CA, CME provided by Sutter Gould Medical Foundation as part of it’s Subspecialty Lecture Series.  4 hours total of CME was provided.  Part of the 4 hours of CME included discussion about back pain and ovarian cancer.

Why this is interesting to me

  • I have learned some of this before in my NeuroScience years at Brown University.  It was good to review.
  • I have an acupuncture practice which has a good number of patients with depression.

Learning points (not all points were made in the lecture, but they were learning points for me):

Evidence Based medicine supported treatment of depression

  • includes the use of methylphenidate, exercise, and sertraline


  • Ritalin
  • NE and DA reuptake inhibitor.  (Norepinephrine adn Dopamine)
  • Psychostimulant
  • Used for ADHD, Narcolepsy, and Depression


  • Also known as Zoloft, Lustral
  • SSRI – selective serotonin reuptake inhibitor


  • Population affected: 20%
  • Depression is a state of chronic stress
  • CV risk
  • Diabetes risk
  • Anatomically there is decreased amount of gray matter in the brain.  Decreased size of  Cortex and Hippocampus has been found.


The hippocampus is involved in several functions of the body including:

  • Consolidation of New Memories
  • Emotional Responses
  • Navigation
  • Spatial Orientation

Current concepts of depression

  • glutamatergic theory of depression: exposition to stressful stimuli increases hippocampal glutamatergic neurotransmission and triggers excitotoxic changes.
  • Another theory: depression is closly correlated with neuronal atrophy due to a decrease in BDNF (Brain Derived Neurotrophic Factor)
  • Monoamine hypothesis is considered old school:  deficiency in monoaminergic neurotransmission.  Monoamines being Catecholamines (NE, DA) and Indolamines (5-HT).

Results of Star*D Trials

Sequenced Treatment Alternatives to Relieve Depression

  • Officed based – what is done after a patient fails first line treatment for depression?
  • Level 1 through Level 3 choices in medication to switch to.

After the lecture:  What about Acupuncture for Depression?

I asked Dr. Nadolny about what she thought of acupuncture for depression.  And she seemed very excited.  She said that she didn’t know that acupuncture was readily available in Modesto, CA.  I do hope to recommend some of my patients to Dr. Grace Nadolny in the future and other psychiatrists too, because I feel that at times combination treatment with acupuncture and excellent psychiatric care would be of greatest benefit.

Disclaimer:  I am not an expert on the topic of Depression.  These are notes from a lecture that I took and feel free to use this as a springboard for your own studies.