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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Fish Oil vs Flax Seed Oil – Dr D’s Take

Being that heart disease is in my genes, I try to keep the cholesterol and fats down. Over the last ten years this has led me through Mevacor, Zocor and Lipator to Tri Cor.

Well Niacin has improved over the last twenty years. I remember the nasty flushing and itching when I tried even tiny amounts as a college student. Well now the flushless stuff seems to work pretty well. I have added two to three grams a day to my regimen.

At some point, any health conscious person is going to run into the consideration of Omega 3s, and that pretty much translates to Flax Seed oil versus Fish Oil. So I tried a bit of each…a few different formulations.

Well Fish Oil farts are pretty nasty. I got them with enteric and non enteric coated fish oil. Flax Seed oil gives you enough of one Omega 3 for you to make the others you need. So I think for the most part Flax wins the debate there.

Best Regards,

John Di Saia MD

Originally posted 2013-06-17 07:30:16.

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Dr D’s No Bull Blog Magnets

I have been designing some new blog-related swag and came up with this magnet. Over the top maybe?

Best Regards,

John Di Saia MD

Originally posted 2012-06-25 07:30:22.

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Why Dr D Dropped Saddleback Memorial Hospital

Those of you who know me know that I practice both cosmetic and reconstructive surgery and have done so for years. For about a decade I have maintained an office and a relationship with the hospital in San Clemente, now a Memorial hospital. Part of that relationship has been covering their emergency room and repairing what I believed to be my fair share of wounds in that environment. The hospital has had a mandatory call policy for plastics and a few other surgical specialties such as orthopedics and ENT. The hospital had not paid for this privilege or at least had not disclosed that they had.

Several things have changed in the last few years:

(1) Memorial bought the hospital. Their administration has a poor relationship with the majority of the medical staff to say the least.

(2) I moved to Long Beach, fifty miles away.

(3) I became aware that “under the table,” the hospital had been paying orthopedics to take call from 15 minutes away. (The two pods live closer to the hospital than I do.)

(4) A staff member from ENT was released from call after he made a request a few years ago.

So I made a request to be released from call and was told….if you want to keep privileges at the hospital you will take emergency room call. I informed the ever so considerate (note: sarcasm) medical staff that I would be dropping their hospital effective January 1 2011. Taking call from fifty miles away for free is BS, no matter how you slice it.

My belief is and has been that doctors accept way too much bull and rarely if ever do anything about it. Time to put my money where my mouth is. I will still maintain my San Clemente office, but not see patients at the hospital. If you are a physician considering privileges at this hospital, don’t expect them to be either forthright or honest. If you are looking to see Dr D, don’t go to Saddleback to do it.

Best Regards,

John Di Saia MD

Originally posted 2011-01-05 07:30:48.

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Tummy Tuck and the Totally Flat Tummy

At an online forum, I responded to a post by a woman who had had tummy tuck surgery elsewhere (the famous Dr “X”) and was unhappy that her tummy was not “totally flat” afterward. She was asking whether this might represent fat that her doctor hadn’t removed. At this forum they refer to the after tummy tuck appearance as the “flatlands.” Kinda cute.

Tummy Tuck surgery results vary between surgeons and patients. The reasons for this are multiple:

(1) Different surgeons work with different techniques and spend more or less effort than others to get their best result.

(2) Some patient’s tissues stretch more after being placed upon tension than others. We see this over the weeks and months after an operation.

(3) Some people are more successful than others at pushing away from the buffet.

Is has been true for as long as there has been cosmetic surgery that the most important issue for a patient to comprehend relates to reasonable expectations.

Expecting “absolutes” in a world of “relatives” is an invitation to disappointment. “Totally flat” sounds great but might be off the charts for some patients. Some surgeons are going to make more of an effort to get you there though. And what is “Totally flat” for one patient might not be flat enough for another anyway. When plastic surgery doesn’t get you where you want to be there are several issues to address regarding the cause.

It is far more productive to look at degrees of improvement and focus your pre-op conversation on what you might be able to achieve. Picking the right surgical talent never hurts either. :)

Best Regards,

John Di Saia MD

Related:

Dr D’s Practice Web Site Tummy Tuck Section

Originally posted 2011-07-25 07:30:16.

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Reader Question: Breast Implants Under Local?

Reader Question:

A surgeon I’m thinking about seeing said on his site that breast implants were able to be done under local + intravenous anesthetic (like twilight). Can this really be done? I always thought it was too invasive for just twilight, especially if it is under the muscle. Is there an advantage to using twilight? After looking it up there are lots of differing opinions out there but I think that this may just be a way for the surgeon to cut costs. What is the cosmetic surgery truth here, Dr. D?

I am not a fan of local or twilight sleep for breast implant surgery except in rare cases (simple redos and such.) The reasons are patient comfort and practicality. I place most of my breast implants under the pectoral muscles and these muscles need to be relaxed for this to work out. That relaxation is suboptimal under less than a general anesthetic.

An interesting aside to the argument of sedation versus general anesthesia is the fact that under less than a general patients often need more medication to maintain them in a narrow range of alertness. This translates to more drugs for twilight sleep which is contrary to the reason many of these patients wanted less than a general anesthetic in the first place.

Best Regards,

John Di Saia MD

Related:

Dr D’s “Breast Surgery Index”

Originally posted 2010-12-09 07:30:25.

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Boob Job Cost – What Should A Good Breast Augmentation Cost Anyway?

Cleavage can Cost $$$$

Cleavage can Cost $$$$

Boob Job Cost

Recently a nurse at one of the hospitals in which I do wound work asked me what a boob job costs.

This is a question without a simple answer so let’s share:

A “boob job” is a generic term for cosmetic breast surgery. Cosmetic breast surgery can have a number of different operations involved. The main items that are associated with expense in cosmetic breast surgery are degree of work, the location and who is doing that work.

I have made light of the cheapie boob job bulletin board ads we see in areas of Southern California. The quotation of a price without knowing who will be doing the surgery or what exactly will be the nature of that surgery is an invitation to misunderstanding. Some of these cheapie boobjobs end up looking like novice surgeons indeed were involved. Take my word on that. :)

The simplest of all boob jobs is solely the placement of breast implants. If this is done by a reasonably experienced surgeon using saline filled implants, an average cost in Southern California is about $5000-6000; yes, roughly twice the cost quoted on that cheapie plastic surgery sign. If the implants are silicone gel types add another $1000.

Breast lift surgery can be simple or complicated. Some women have significant degrees of breast droop that putting implants in alone may not improve. Breast lift surgery in addition to breast implants can double the price of the surgery.

So you see the cost of a boob job requires a visit to a surgeon’s office for an examination to be followed by a quote for the work you might want performed. You would do this for your car before repair work. Why not do at least the same for your body? :)

Decide before you go if you want a bargain basement job or custom work.

Caveat Emptor.

Best Regards,

John Di Saia MD

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

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Why Celebrities Deny Plastic Surgery

Many people deny having had plastic surgery. Celebrities are only different in that there are multitudes of photographs publicly available to debunk their statements. Smart celebrities (in my opinion) simply admit to considering it and leave people wondering. Maintaining public interest is always in a celebrity’s best interest.

Probably the most important issue for entertainers is that their image is their livelihood. They need the availability of good plastic surgery in many cases to stay marketable. Of course, that which is “good” is very much a matter of opinion.

Best Regards,

John Di Saia MD

Originally posted 2005-06-22 19:49:00.

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Off Label Drug Use – More on Botox Cosmetic

Looking into some articles in the press on Botox and “Bad Drugs,” there is a misconception that warrants explanation. Allergan and other drug companies have a significant market interest in their products. Their marketing will of course imply that their drug is superior or that alternate drugs are unsafe. For better or worse, this is the nature of advertising.

Let’s look at the history of Botox Cosmetic TM:

Botulinium Toxin A (at the time named Botox TM) was approved by the FDA for use in blepharospasm (to decrease spastic movements of the muscles of the eye) in 1989. It was used “Off-label” soon thereafter by plastic surgeons and other physicians to effect cosmetic muscle paralysis.

What is “Off-Label?”

The “Off-label” use of a drug is utilization of a drug for a purpose for which is not FDA-approved. Between 1989 and 2002, Botox TM was used “Off-label” by a number of physicians essentially every time it was used for cosmetic purposes prior to being FDA-approved.

Since Botox TM was FDA-approved for cosmetic use in 2002, Allergan has promoted it over other competing products as the “only FDA-approved” Botulinium toxin for cosmetic use. The inference is that other products are unsafe. To berate non-FDA-approved Botulinium products ignores the history of Botox Cosmetic TM.

Myobloc TM is Botulinium toxin B. It is currently FDA-approved for cervical dystonia (to diminish neck spasms). It is currently being used “Off-label” for cosmetic purposes just as Botox TM was for years. It is as safe now as Botox was when it was being used “Off-label.”

Best Regards,

John Di Saia MD

Related:
My 2002 Botox FDA Approval Newspaper Editorial

Originally posted 2005-06-19 07:25:00.

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Will You Remove My Mole Under Health Insurance?

In years gone by, I spent far too much time removing small skin bumps in the office. At the time, I was sharing space with another doctor who was profiting by any service I provided. His staff scheduled me with tons of things that simply made me no money. [Meanwhile his stuff diverted some of my better business into his schedule as opposed to mine.]

The facts of life are that medicine is a business and when I am paying a huge chunk of change to overhead, I need to make that back or I operate at a loss.

Patients frequently don’t understand why I cannot remove their moles for what their insurance pays and make a profit. Well when your insurance pays for a janitor, you can’t always have a surgeon.

The materials used in the office for surgery (drapes, medications, needle, sutures, blades, instruments, instrument maintenance and sterilization, etc.) are not reimbursed by insurance companies.

A year or two ago, I removed a cyst from a patient’s eyebrow. My costs in materials alone (not counting rent, employees, insurance, etc) were about $65. The insurance company paid $93 and 8% of that went to my billing company. This is no joke.

This is a reason why you won’t see me doing cosmetic dermatology anymore; not at insurance rates anyway.

Best Regards,

John Di Saia MD

Originally posted 2005-09-11 08:30:00.

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