Doug Fister Skin Cancer

Washington Nationals pitcher Doug Fister recently had a skin cancer removed from his neck. Details are slim. The surgery sounds like a minor office operation as it did not delay his start on the Nationals pitching schedule. He appears with some sutures over a small incision on his neck in the link below reportedly two days after the operation. If the cancer was of the Basal Cell type (likely as 80% of skin cancers are of this “low strength” type,) then Doug is likely complete with his therapy for this cancer. That doesn’t mean his story with skin cancer is over though.

He does mention in his media coverage on the topic that baseball involves an occupational exposure to the sun and sun exposure is the main culprit in skin cancer formation. Baseball players should be disciplined in the use of sun screens and prophylactic therapy even though many prophylactic treatments are often not covered well (or at all) by insurance. They can certainly afford it. :)

Best Regards,

John Di Saia MD

Story Source: cbssports.com/mlb/eye-on-baseball/24676739/doug-fister-had-skin-cancer-removed-from-neck-before-fridays-start

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Blue Cross Breast Reduction Denial After Pre-approval

Healthcare insurance companies are on my short list for contempt.

They underpay, take forever to pay, deny after approval and rescind for fun. Why should I not pitch them the BS they deserve in return?

Today I received a particularly funny (and O-So-Typical) letter concerning a woman for whom I performed breast reduction a few weeks ago. This case was the largest I have done this year with over 4 pounds of breast tissue in the removed specimen. Her back pain is gone. She can stand up straight. And her husband looks like an worked-up fiancé (amongst the best compliments in my book).

Bottom Line: This case was medically-indicated and I did a great job. Sorry Blue Cross.

Nevertheless, Blue Cross via letter issued a denial/delay of payment after the surgery had been performed (and after their own pre-operative approval). They are trying to make payment the responsibility of the HMO arm of her insurance plan. I am not an HMO provider. They know it won’t work, but it will delay payment.

This is Health care Insurance Company B.S. Maneuver #1 from the “We’re Cornered But We Can Still Delay The Payment” chapter.

They know this abuse is amongst the reasons doctors drop insurers. I can certainly see why many of my friends have done so.

More of that wonderful treatment from your insurance industry.

Best Regards,

John Di Saia MD

Originally posted 2005-06-30 20:09:00.

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Skin cancer arm after removal and 1 month after #plasticsurgery #goodplasticsurgery

Skin cancer arm after removal and 1 month after <a href='http://twitter.com/search?q=plasticsurgery'>#plasticsurgery</a> <a href='http://twitter.com/search?q=goodplasticsurgery'>#goodplasticsurgery</a>

Originally posted 2013-09-18 15:30:47.

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Good (but Ugly) Plastic Surgery in the OC – Good Skin Graft


“Not all plastic surgery is cosmetic surgery, but cosmetic surgery pays the bills.”
This is a plastic surgery truism. There are plastic surgeons (like me!) who split their work between the things you need (that don’t pay your surgeon so well) and the things you want (that do.) In this sense cosmetic surgery is the subsidy upon which the needed (but less well reimbursed) work is supported.

Here is an ugly plastic surgery case of an ankle wound that needed some skin to close. The patient had had an operation by an orthopedist that got complicated. The skin graft surgery will leave a scar, but the wound that would have healed slowly if at all without it healed quickly afterward. This is an aspect of good plastic surgery rarely featured on your local news program.

Something to think about when you are considering cosmetic plastic surgery:

If you support a reconstructive plastic surgeon, he may be able to stay in business to be able to help you when you might need him. That cosmetic guy won’t be.

Best Regards,

John Di Saia MD

Originally posted 2012-10-10 07:30:20.

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Pressure Wound Surgery in Orange County

When I tell people I have a hybrid plastic surgery practice, I am not talking about a fuel efficient car. I am talking about the fact that I do both cosmetic surgery and medically-necessary surgery. Part of the medically-necessary surgery includes the repair of pressure wounds (also called decubitus ulcers.)

Not only is this type of surgery not cosmetic, it can be pretty ugly. It is surgery to assist often long standing wounds in healing in often significantly ill patients. If possible such a wound is repaired using tissue from adjoining areas of the body called fasciocutaneous and musculocutaneous flaps after scar and debris is cut away. This isn’t pretty, but the patient was pretty happy to not have an open wound afterward.

I do these at an LTAC in Santa Ana at which good wound care nursing services are available before and after surgery. Not all patients are candidates for surgical correction. Often these patients have had these wounds for months or years at the time they are referred for possible surgery.

Below are images showing an example case I did years ago (after “Page 2″ so those who don’t like pictures of wounds can pass.)

Originally posted 2011-07-13 07:30:57.

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Mohs Surgery and Plastic Surgery – How Does This Work in Orange County?

Mohs surgery is surgery for the removal of skin cancer which is common in Orange County due to our “sun sitting tendencies.” It is mostly offered by dermatologists and is specifically designed to remove the cancer with a low recurrence rate. Derms generally perform it under straight local (numbing shots in the office) and it is quite profitable for them. In this case the procedure to make the hole (that is what Mohs does) pays much better than the surgery to repair that hole. Some Derms in Orange County try to use Moh’s for nearly everything as it is profitable. This is not always in the best interests of the patient.

At times a dermatologist will refer the patient to a plastic surgeon for the closure after the Mohs is complete. This can be upsetting to the patient because unless it is arranged ahead of time, the plastic surgeon may not be able to get the patient scheduled for a few days.

You may have seen people walking around with large bandages on their ears or noses. They may not have had accidents as you might have thought.

An alternative is to have the skin cancer surgery performed entirely by a plastic surgeon which can decrease the patient’s total expense and allow for anesthesia and completion of surgery in one day. The plastic surgeon may order a frozen preparation of the removed tissue in the operating room (called frozen section) and the results have a similar cure rate and often look a whole lot better. Many plastic surgeons will take cases like these as long as the cancer isn’t too small because we are paid less to remove the cancer with conventional surgery than the Derms get with Mohs.

Best Regards,

John Di Saia MD

Originally posted 2011-03-04 07:30:28.

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Tummy Tuck Redo – Orange County, California

Previously I discussed the relative reluctance of plastic surgeons to post images of revisions. Tummy Tuck Redo surgery can offer good results when the patients are properly chosen and the surgery is carefully focused. Not everything can be easily fixed of course.

tummy tuck redo

“M” is a lady who had had a tummy tuck twenty years prior. After she visited another surgeon she had additional upper abdominal liposuction some years later. She never got the tightness she had wanted from that liposuction so later she considered revision of her tummy tuck. She did very well with her redo tummy tuck. Her pre-operative skin excess was greatly improved and the hollows created by the prior liposuction were also corrected in part. Not seen well in these images is the “puffy pubis” (commonly called a Ken Doll) she had following her original surgery. This was also nicely improved via her revision.

She is quite pleased with her smoother sexier appearance.

Best Regards,

John Di Saia MD

Related:

Dr D’s Standard of Care for the Best Tummy Tuck

Originally posted 2011-12-16 07:30:06.

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Scan, Secure Horizons and the Medicare HMO Compromise

It is change your Medicare season so the advertisements are blaring for Scan, Secure Horizons and the other Medicare HMOS. Many Medicare patients do not understand how things change when they sign with a Medicare HMO. Regular Medicare patients have choices and do not need to wait for approval before receiving care.

I saw a Medicare HMO patient this month with a wound on his foot. The wound looked ready for skin grafting. As his HMO does not have a plastic surgeon under contract at the hospital where this patient was admitted, I was told he would have to wait for evaluation by their podiatry doctor. An operation I could have offered him in days waits weeks or longer. That is the HMO compromise. You wait for them to decide what you need.

Ultimately the podiatrist saw him and decided the wound would heal without surgery. It might, but it will take longer…maybe months longer. Then again passing on surgery will cost the IPA (HMOs usually contract with other health care companies called IPAs) less money and that is often the name of the game in health care.

When you change your health insurance you really don’t see the big picture unless you come to really need it.

Best Regards,

John Di Saia MD

Originally posted 2010-12-22 07:30:57.

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Leighton Meester Sues Mom Over Plastic Surgery

Leighton Meester just won her legal war against her mom — after the “Gossip Girl” star sued her last year … claiming the woman diverted money Leighton had sent to her little brother … and she spent it on things like plastic surgery, Botox, and hair extensions.

Leighton filed the lawsuit claiming her little brother has serious medical problems … so she sent home $7,500 a month to help cover his expenses. Leighton actually didn’t sue to recover any money from her mom.

Source: http://www.tmz.com/2012/06/06/leighton-meester-mother-
constance-lawsuit/

So mom takes the money sent home for a sick sibling and spends it on cosmetic work for herself. Kinda cold.

Best Regards,

John Di Saia MD

Originally posted 2012-07-09 07:30:36.

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Breast Implant Massage to Prevent Hardening Contracture : When, Where and How?

On one of the forums at which I occasionally contribute the question came up of breast implant massage for textured implants as a preventative measure to avoid hardening (Capsular Contracture.) The question was under what circumstances does it make sense to massage textured implants within breasts to prevent hardening. As is frequently the case, the answer relates to the history of breast implants and hardening:

To make a long story short, one of the most frustrating issues when working with breast implants is the tendency over time for them to harden within the breast. To be more correct, the breast tends to harden around the implant. This is more often the case with silicone gel breast implants, implants with relatively little soft tissue coverage, in smokers, and in cases in which infection, radiation treatment or bleeding have been involved. Back in the seventies and eighties, there were studies with differing methods of decreasing these tendencies. The studies had varying results (unfortunately) showing loose associations with implants with textured surfaces and patients in whom breast massage was used showing inconsistently favorable results.

Surgeons do not all do things exactly the same and frequently a surgeon’s experience affects his or her practice. Breast implant surgery is no exception to the case. Some surgeons will tell you that there is no need to massage textured implants. Others will tell you the opposite. There is no consensus here.

Many surgeons will look at issues with a particular patient to determine what to advise. If patients have had more issues with capsular contracture, then massage and/or textured implants might be advised. Many of us rarely if ever use textured implants for other reasons (for example they are more often associated with rippling.) Suffice it to say following your surgeon’s advice and having follow-up visits with that surgeon is probably the best strategy to try to avoid capsular contracture. I tend to use more saline filled implants and moderate sizes and have had very low contracture rates over the years in my practice. If you are going to massage your implanted breasts, have your surgeon show you how he or she would like you to do it. The method is debatable as well.

Best Regards,

John Di Saia MD

Related:

Your Options With Capsular Contracture / Rock Hard Breasts

“I Have Hard 20 Year Old Breast Implants?”

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