Medical Clearance – Dr D’s Concept

As some of you may know I perform medically necessary as well as cosmetic surgery. Not infrequently medically-complicated patients are assessed for the possibility of surgery for wounds and patients and their families do not understand the concept. So let’s explore it a bit:

What is Medical Clearance?

Medical Clearance is a assessment requested usually by a surgeon and performed by internists. It looks into a patient’s ability to withstand anesthesia and the relative risk of the stress of surgery in such a patient. Internists will clear a patient for the surgery, but the exact meaning of that “approval” varies. Many internists provide a risk assessment usually for problems like heart attack or stroke following the surgery or even during the surgery. So a patient could be “cleared” for surgery and assessed as “high risk” at the same time.

What determines a Good Surgical Candidate?

There are surgeons who will operate upon any patient who has been cleared for surgery. I am not one of them. As far as I am concerned the “fitness” for surgery is more complicated than a “yes” or “no” answer. I look at each patient in a “Risk versus Benefit” paradigm. I look at their nutritional status as well as their medical clearance and the nature of their wound(s) to determine the probability of healing versus the possibility of catastrophe. If the possibility of a poor outcome is high relative to the possibility of a good healed wound, I may not choose to operate.

So not all medically cleared patients get surgery by Dr D.

Best Regards,

John Di Saia MD

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How to Get Dr D To Not Operate On You

People sometimes surprise me. A lady e-mailed me recently after I had seen her a year or so ago. There are good things and bad things about seeking care at a small practice. We remember you.

This lady originally came for a reconstructive operation that her insurance would not cover. Plastic surgeons cannot guarantee that an insurance company will approve surgery or pay for what you want. When we were unable to get her operation pre-approved, we lost contact with her.

Later on, she became angry when her insurance assigned her consultation bill to her. She had an unmet deductible. She proceeded to drag her feet and not pay this bill. Eventually she mailed partial payment with a nasty letter basically saying “this is all he is worth.” We left it alone even though we did not collect the amount we billed.

Now more than a year later, she is e-mailing asking if we can do her operation. Now why would I want to do that?

Understand that surgeons are people too. If you treat yours with disrespect, why would he want to take care of you?

Best Regards,

John Di Saia MD

Originally posted 2012-09-10 07:30:41.

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Expressions Dermal Filler Recalled – Dr D’s Experience

These days I do very little dermal filler business but go to a friend’s office in the Inland Empire (Upland) a few times a year to offer some. It was there a year or so that a product representative offered a few samples of a new dermal filler called Expressions. We gave away a few sample injections and heard nothing more of it until recently. I did not order the product as I have been happy with the Prevelle I have been using.

A year or so later my office gets a call from a representative of the company that was selling Expressions saying it had been recalled and asking if we had any. Rumor has it that the material was never approved for injection by the FDA.

Live and Learn:

Soft tissue fillers are good in limited amounts to lessen but not eliminate the signs of aging. They can be used effectively in this regard but the safer products are very temporary. Newer products should be looked at with suspicion even by the doctors who are being encouraged to use them.

Best Regards,

John Di Saia MD

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Sclerotherapy – The Truth

Small procedures are on the rise with the economy being depressed. Sclerotherapy (injections to improve spider veins) are pretty common.

The concept is pretty simple: inject a fluid into the vein causing it to clot and scar (and eventually go away.)

This works pretty well for small veins but frequently can leave a bruised vein for several weeks. You really should keep the treated area out of the sun while this bruise resolves or it can be permanent.

The veins can come back. They usually do to some extent so this is a maintenance therapy.

Best Regards,

John Di Saia MD

Related:

Originally posted 2009-12-25 07:30:27.

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Reader Question: Acne Scarring Treatment

Hello, Dr Di Saia,

I’ve had acne for a few years (it is now almost completely gone) and I am now left with a few but noticeable facial scars. What is the best way to deal with them? What fillers would you recommend? Would a chemical peel or microdermobrasion be enough?? (I personally don’t think it would be). I am 19, by the way. Thank you for your professional advice!

Acne scarring is an extremely variable problem. The treatment depends upon severity and skin type. A single facial peel will likely not be enough to improve any, but the lightest of cases. You really need an individual professional evaluation regarding peels, fillers, and other surgical options as they pertain to your specific case.

Best Regards,

John Di Saia MD

Related:

Basic Skin Care

Originally posted 2005-07-24 15:35:00.

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When to Fire the Patient

There are good and bad aspects to running a small practice like mine. Information containment for example is easier when fewer people handle that information. But there are limits to what any practice can or will provide.

An example:

A potential client e-mailed inquiring about a procedure upon which I have good online reviews. :) This person e-mailed four times in a few minutes. The same message was sent so I figured it was an honest mistake and thought nothing of it. Then I started getting a number of phone calls from the same number that left no messages. The first day I received about eight of these phone calls. These calls were made to our “urgent phone line.” The latest was at 9:00 PM. I do not make it a habit of calling back unknown numbers from my urgent phone line particularly when no message is left. Time has taught me this is a safe plan of action.

The next day the multiple calls from that same number continued sans messages. I called my office gal to find that a patient called that first day for an appointment and complained that his call was not returned for a few hours. My office gal herself had had surgery that day. As I said before, we are a small outfit.

A light went on in my head. I asked her: “From what number did that person call?” Of course it was the frequent urgent phone line caller’s number. Even after getting that appointment, the caller continued to call multiple times on the urgent line without leaving messages the second day.

See the problem?

A doctor’s office is geared to answer urgent calls urgently, but calling to the point of harassment to schedule an appointment and/or getting testy about a reasonable delay in calling you back is a good way to become a fired patient.

In this kind of case, your doctor looks at an unreasonably high potential for an unhappy client and avoids it before it happens. We only have so much time in the day to handle quite a few patients. When they are reasonable we do it gladly. When they are not, some of them have to go.

Best Regards,

John Di Saia MD

Originally posted 2013-08-05 07:30:34.

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CPR Denied California Nursing Home Death – Dr D Comments

CPR denied California?

A 911 dispatcher pleaded with a nurse at a Bakersfield, Calif., senior living facility to save the life of an elderly woman by giving her CPR, but the nurse said policy did not allow her to, according to a newly released audiotape of the call.

“Is there anybody there that’s willing to help this lady and not let her die?” the dispatcher asked in a recording of the 911 call released by the Bakersfield Fire Department.

“Not at this time,” the nurse said.

After several minutes, an ambulance arrived and took Bayless to Mercy Southwest Hospital, where she died.
Source: http://abcnews.go.com/blogs/headlines/2013/03/elderly-woman-dies-after-nurse-refuses-to-give-her-cpr/

In today’s medical legal marketplace, this is really not surprising. There is no liability for not performing CPR. There is liability however if CPR is provided and the patient does poorly. In the balance of the equation, you cannot have such a medical legal environment without facilities doing that which is possible to protect themselves.

When I was in residency, a guest legal defense expert lectured on the “facts of life.” He provided a scenario in which we were driving along and saw an injured individual on the side of the road ahead. He asked what we would do. Answers were given.

He then advised we not stop but call “911” and keep driving.

Why?

Because we would be help liable if we stopped and would not if we did not. For the medical ethicists safely tucked away in their academic salaried jobs, most physicians need to keep working to support themselves. Legal entanglements are avoided at all costs. You can say it is unethical, but it is the nature of the current malpractice market. The public pays the price.

Best Regards,

John Di Saia MD

Originally posted 2013-03-05 07:30:37.

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Good Liposuction Results – Woman Minus Baby Weight

Good liposuction results are nice smooth contours in the right client. Here is a young OC mom who wanted to get a few post-baby areas trimmed.

 

Good Liposuction Results

Good Liposuction Results Orange County California

She works out several times a week and is not fat by any means, but had some small problem areas that would not get better with exercise. Her biggest problem area was her tummy bulge and part of that was fatty. Here she is in the image before and 6 weeks after tumescent tummy liposuction with a nice result. Remember liposuction just trims the fat, but doesn’t do much to the skin or muscle wall. This is a good liposuction result showing not lumps or surface irregularities.

Best Regards,

John Di Saia MD

Originally posted 2012-11-01 07:30:57.

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Reader Question: Did You Do Labiaplasty on Stacie Halas?

Stacie Halas is a science teacher in an Oxnard middle school who was put on administrative leave while her bosses looked into the allegations that she was moonlighting as a porn star.

The question was probably put to me in jest, but I couldn’t tell you if I had operated upon her without her permission anyway. Have you ever heard of HIPAA? Patients have their privacy on health care information whether they are accused on moonlighting in the adult industry or not. It is not like most labiaplasty patients volunteer much private information about themselves. Their operations are pretty private in the vast majority of cases anyway.

Another equally important point is that I haven’t seen a single image identifying Ms Halas, so I wouldn’t know if I had operated upon her or not.

Best Regards,

John Di Saia MD

Originally posted 2012-03-09 07:30:29.

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Giveaway Patient #1 – Facial Chemical Treatment

Well we have been talking about a giveaway so here’s the first recipient, Allison. Allison has pretty green eyes and Northern European skin, so skin care is a good idea particularly because she likes the sun quite a bit. :)

Dr D gave her a facial chemical treatment (his own little blend :) ) and we walk you all through it:

Best Regards,

John Di Saia MD

P.S. Keep an eye on the Giveaways Page to comment your way to some free goodies too. :)

Originally posted 2012-12-17 07:30:53.

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