Hugh Jackman: When Sunscreen Alone Will Not Keep The Skin Cancer Away

Hugh Jackman as of May of this year has had three skin cancers treated. He is realistic that he will have more.

Jackman, who plays Logan and Wolverine, wore a bandage on his nose after having a basal cell carcinoma removed last week. Basal cell carcinoma is a slow-growing form of skin cancer and Jackman was treated for the same disease last year.

He told The Associated Press: “I’m realistic about the future and it’s more than likely that I’ll have at least one more but probably many more, which is not uncommon for an Aussie particularly from English stock growing up in Australia where I don’t remember ever being told to put sunscreen on.”

Source: http://www.foxnews.com/entertainment/2014/05/13/hugh-jackman-expects-skin-cancer-will-return/

Don’t take it personally Hugh, my kids don’t listen much when I encourage their use of sunscreen. I am known to embarrass at baseball games, etc. :)

Jackman correctly attributes the skin cancer to sun exposure and his heritage. What is not mentioned in the Fox piece is that there are other preventative therapies for skin cancer useful in people who have had them already. When you have already had three skin cancers just wearing sunscreen is probably not enough to keep them from returning. Hopefully he is looking into some of the alternatives now.

Best Regards,

John Di Saia MD

Related:
Wanna See a Nodular Basal Cell Cancer?

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Plug Ear Lobe Repairs for Military and Police Academy Recruits

In the office, we have had an increase in military and police academy candidates with ear plugs for repair. It seems these men are being told to have the holes repaired before they apply.

Plug ear hole repairs are a bit more involved than standard ear lobe repairs due to the size of the holes and the degree to which the stretched ear lobe tissue has become lax, thinned and/or droopy. In most cases we are able to do them under local (numbing shots only) in the office. Complicated cases need to be done in portions over time and can have some deformity afterward.

Come to think of it, I can’t remember the last serviceman or policeman I saw with ear rings much less plugs.

Best Regards,

John Di Saia MD

Originally posted 2011-07-05 07:30:19.

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Repeal ObamaCare Petition Signing

Shopping this weekend we saw a “Repeal ObamaCare” petition. Gotta sign that one.

Best Regards,

John Di Saia MD

Originally posted 2010-09-20 10:00:36.

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Tanning Salon Owners Mislead Clients

Many tanning salons are downplaying the health risks associated with indoor tanning while claiming that time in a tanning bed offers an array of health benefits, according to an investigative report from Democrats on the House Energy and Commerce Committee. Committee investigators, posing as fair-skinned teenage girls, called 300 tanning salons across the country, and found that 90% said that the use of tanning beds did not pose a health risk. When pressed about skin cancer risks, some salon employees said the link to indoor tanning was “hype” or “a big myth.”
Source: skinandallergynews.com/newsletter/the-skinny/singleview40946
/tanning-salons-mislead-teens-congressional-probe-
finds/4aaea3a6b8.html

Studies showing tanning bed use is associated with increased risk of skin cancer and even melanoma skin cancer are now plentiful. It is funny though to expect businesses outside of medicine to discuss risk much. Does it really surprise anyone that tanning salon management downplays the risk of the services they provide?

As far as I am concerned tanning salons are cancer traps. They should have warnings similar to those on cigarette packages proclaiming the absolute foolishness their patrons have in using their services. I will even donate to the hypothetical copy of such a statement:

“To our Clients,
While we appreciate your patronage please be advised that tanning beds have been associated with increased risk of skin cancer and premature aging. The money you are pouring into our pockets might be better spent on sunscreens and sun avoidance clothing. By using these facilities you have decided to go against your better interest and as such the ownership takes no responsibility for the cavernous wrinkles, cancer and even death you might receive in the bargain.
Thank you.”

Best Regards,

John Di Saia MD

Originally posted 2012-02-09 07:30:06.

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Dr D’s “Cheap Plastic Surgery”

Most people looking into cosmetic surgery soon realize that it is not cheap, but why? Why is it so expensive? There are many reasons. Most of them have to do with overhead. The discussion below is meant to give you some insight into the way plastic surgery is practiced. It varies quite a bit. Bargain Basement plastic surgery may not be the best idea when you look at the big picture.

Some of you out there are thinking: “Gimme a break! I have this ad right here saying that breast implants are only $3000. How can this be?”

You are correct. There are those that do this operation for less than it costs me to render the service. Then there are those who use ads to get you into the office and the story changes when you get there. How can they do this? Below we will lay out some possibilities. These may seem quite familiar to some of you:

Say you walk with ad in hand to see the doctor. You notice that the doctor’s name doesn’t seem to be listed in the advertisement. This is called a Bait and Switch Scam.

SCENARIO 1: “All things are not as they seem”

You find yourself in an examination room with a nurse who tells you that the doctor only meets with patients after they have signed up for surgery. This saves the practice money, but wouldn’t you rather meet your surgeon before you decide to make him your surgeon? She then explains that the price you saw in the advertisement is just the surgeon’s fee. The full price with anesthesia, the facility fee and implants is several thousand dollars more.

SCENARIO 2: “The surgeon and facility are not as they seem”

You meet the doctor and ask him about his training. You find that he trained as an Obstetrician or Head and Neck Surgeon. He started doing cosmetic surgery years ago. He is not board eligible or board certified in Plastic Surgery, but he is board certified in “Cosmetic Surgery.” He operates in his office, but hasn’t bothered to have it certified by any ambulatory care agency, so there is no facility fee. He does the procedure under “twilight sleep,” so there is no anesthesia fee.

I am not trying to say that you have to pay a fortune to have cosmetic surgery, but contrary to popular belief most plastic surgeons are not trying to rip you off. They have legitimate costs of doing business and pass these on to their clientele. By the same token if you see a few doctors and one has a “sky-high” fee, don’t think that an operation here is a guaranteed success. My suggestion is that you consider seeing a few surgeons. Take your cosmetic surgery fee quotations and throw out the really high and really low ones. Then choose one of the remaining surgeons.

When you go to have a cosmetic operation, you are paying for the expertise of your surgeon. You are also paying for every patient who has ever sued a plastic surgeon in Southern California, because this is how malpractice insurance premiums are charged. Malpractice insurance is one of the highest overhead items that plastic surgeons pay. Non-plastic surgeons who perform cosmetic surgery often do so without specific malpractice coverage meaning they pay cheaper malpractice premiums than I do. Finally, in choosing cosmetic surgery with a particular surgeon you are choosing a Level of Service. This often changes dramatically with the price tag.

Best Regards,

John Di Saia MD

I originally wrote this for my web site a few years ago. It still applies to this day however. :)

Originally posted 2013-04-22 07:30:37.

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Dr D Writes for Medical Economics

Dr D’s “Liability Call For Your Plastic Surgeon” was published.

I am doing a bit more Op Ed writing these days. This is a piece that was written for Medical Economics regarding liability in a surgeon’s practice. This post was originally linked to the piece on their site but they took it offline. :(

Best Regards,

John Di Saia MD

Originally posted 2012-02-07 07:30:45.

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A Fixin’ Your Thighs – Inner Thigh Lift

Body Lift Surgery

After reading a post at a forum that I occasionally visit, I figured an explanation of what thigh lifts can (and cannot) do was appropriate. Many plastic surgeons look at thigh lifts with a degree of exasperation. They not infrequently require revision. Those in large weight loss or gastric bypass patients can be a big job.

The amount of excess skin that so unattractively jiggles in the inner thigh is the question. To reduce said jiggling requires incisions. If the excess is mild to moderate, we can usually get away with just an incision in the crease between the thigh and groin. Gastric bypass and extreme weight loss patients often require an additional incision vertically down the leg. These incisions heal with variable scarring. The scars can migrate down the leg although this is less frequent than it was years ago.

We pull and often liposuction to make the tissues as tight as we can. Then to an extent they loosen over a year or so then we see how we did.

Best Regards,

John Di Saia MD

Originally posted 2005-10-24 09:56:00.

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Plastic Surgery at Medi-Cal Rates – How Glamorous.

Plastic surgery is not always as glamorous as you see on television. Part of my practice has been the repair of wounds. Recently a wound care hospital at which I have seen patients called asking if I would see a patient. The patient’s HMO pays at Medi-Cal rates. For those of you who don’t know, Medi-Cal is California’s Medicaid program.

Medi-Cal rates amount to about half of Medicare rates which is essentially nothing. The practice barely squeaks through any profit on most Medicare business. I am always conflicted as to whether or not to see such a patient.

On one hand, I’d like to be of help. On the other hand, starting a trend at which doctors care for patients at less than overhead is part of what brought us to where we are today.

Best Regards,

John Di Saia MD

Originally posted 2011-04-27 07:30:57.

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Dr D in a Prius Poll?

Initial Post 11/3/11 7:30 AM

Hello all,

I am thinking of changing my ride. The idea of driving a Prius appeals to me. I get to use less gas which makes me feel a bit better about not contributing so much to our pollution and gas industry problems. There are a few environmentalist quirks I picked up as a Berkeley undergrad. :) The nerd in me likes efficiency and with the miles I drive I might need to stop less frequently. Some of the docs around me have commented that they are not so sure my clients will take well to their plastic surgeon driving a more green machine however.

So you can vote on it:

<a href="http://www.sodahead.com/fun/should-a-plastic-surgeon-like-dr-d-drive-a-prius/question-2259327/" title="Should a Plastic Surgeon Like Dr D drive a Prius?">Should a Plastic Surgeon Like Dr D drive a Prius?</a>

Update 9/26/12 – I have had my Prius for nearly a year and really love it. It is not a really sexy ride but I have been over that for years. It has been reliable and not stopping for gasoline so much has been pretty cool. The AC could be a bit stronger, but otherwise I am happy.

Best Regards,

John Di Saia MD

Originally posted 2011-11-03 07:30:41.

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Emergency Plastic Surgery – Why Plastic Surgeons are Not So Interested

I have been less available for emergencies as of late, but got caught up in one recently. A young lady had been bitten by a pit bull and a portion of her nose had been removed. What followed was a three day run around partially due to the nature of the law and the health care system. Let me explain…..

Specialists like Plastic Surgeons are at times hesitant to see emergency patients as they represent poorly compensated or uncompensated liability. When we are even called to see emergencies our names are added to the medical record which immediately puts us in line for a lawsuit. If the care of that patient goes poorly, the law permits a lawyer to sue essentially any doctor’s name who appears on that patient’s chart. In addition, there are laws regarding the care of emergency patients that forbid a doctor from inquiring as to a prospective patient’s health insurance status when being called for an emergency. Essentially we cannot even try to insure we get paid for whatever care we render. And many emergency room patients are uninsured and do not pay their bills.

Even when patients do have health insurance, the nature of that health insurance and additional laws again slant the deck against the doctor. In California former Governor Arnold Schwarzenegger signed an executive order that a doctor could not balance bill a patient for anything an insurer did not pay on an emergency bill. So even if the patient is insured the doctor has no assurance of being able to get paid anything reasonable. The insurance plan pays what they want pretty much knowing that the doctor has little recourse. Thanks Arnold.

Back to my dog bite consultation: a 20 year old woman had a portion of her nose gnawed off by a dog. She needed surgery after the wound was allowed to heal for a few days and was discharged with wound care and follow-up instructions. My office interfaced with her insurer. It turns out that she had “Health Net administered Medi Cal.” Nearly a dozen phone calls from my office to her provider doctor were made. I had to write a letter to fax to them to indicate what she needed. We did this the day after her injury. The following day we received a phone call and a fax indicating that the patient had been re-routed to a provider doctor meaning one who takes her insurance. So at that point we had spent hours on the care of a patient who was sent to another surgeon by her insurer for her surgery. This work was all done without compensation of any sort.

This amounts up to a colossal waste of time and more potential liability: Would the patient get her surgery in time to minimize her deformity? Would I be liable for any deformity she might have even though her plan essentially took her away from me? I was not really interested about the amount that Health Net was going to pay anyway, but to receive any liability on a case like this is kinda ridiculous.

These are amongst the reasons that I like many other Plastic Surgeons have greatly curtailed my willingness to become involved in emergency cases. As my Grandfather used to say, everybody has to make a living.

Best Regards,

John Di Saia MD

Originally posted 2011-11-24 07:30:15.

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