Dr D an Aging Athlete and the Statin Question – Statin Every Other Day? III

Statins are so positively heralded in the medical literature and had kept my LDL cholesterol low for eight years, it seemed that it made sense to try to stay on them. So one of my first manipulations to get rid of the muscle pain was to try to alternate a every other day Statin with an alternative drug:

So 20 mg of Atrovastatin every other day with alternative days on fenofibrate at 145 mg:

Total Cholesterol: 155
LDL Cholesterol: 86
Triglycerides: 140

HDL Cholesterol: 41

My Creatinine Kinase bumped to 222 (44-196) on this regimen though and my muscle pain was intermittent, but still present so the equation was not quite right yet.

Best Regards,

John Di Saia MD

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Reader – “Help Dr D, My Plastic Surgeon is an ahole!”

Reader Question:

I know you can’t fix this but can you help me cope? My plastic surgeon is an ahole. He has no time for me now that he has operated. He just ignores my concerns. I look OK but I want to do what I can to get the best result possible. He doesn’t care about me.

I am in Orange County. I so wish I knew you before I let this toad touch me! He is a short arrogant little twit though in Laguna Hills. I don’t regret my plastic surgery just my choice of a plastic surgeon.

I frequently remind people to choose carefully when they are in the market for a plastic surgeon. Once surgery has been performed it is hard to switch. Many docs will not accept patients who present liability challenges from the onset. This includes fresh post-ops and people who look like they might sue someone.

The first thing is to try to deal with the surgeon you have. Try to get through to him. How was he when you first met? Docs who never have time for their patients before surgery frequently don’t afterward.

Maybe you can develop a relationship with a contact person in the office and get what you need from that person? Otherwise you can try to call around and find another local surgeon who can help you. Try to choose better this time.

Best Regards,

John Di Saia MD

P.S. I think I know who you might be writing about, but I can’t put his name here for obvious reasons.

Originally posted 2011-03-17 07:30:34.

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Dr D’s “Kim Kardashian – 3 Plastic Surgery Stories”

Kim Kardashian – 3 Plastic Surgery Stories Mp3

Kim Kardashian has been doing a media tour and her story on plastic surgery keeps changing. A little comedy seemed only fair.

Best Regards,

John Di Saia MD

Originally posted 2010-05-28 07:30:04.

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Dr D versus the V-Loc: A Patient Story

I had a patient come for scar revision surgery who had previously some scars revised by another surgeon using the V-Loc suture device. This resulted in wide (nearly 2 cm wide) wounds at the site of groin scar revisions. I do not use these contraptions as I do not see them making me better than I am already. :)

What is the V-Loc?

The V-Loc is a barbed suturing device made to save the surgeon time in closing wounds. Barbed sutures have been popular developments in the past five or so years. I have been reluctant as I have said in using them. Why change things that are working well? The V-Loc uses polyglyconate suture material (Maxon TM) which is actually a pretty good material when used properly.

I revised one of the patient’s scars using my own technique. We will see how the wound heals. Maybe the patient will allow me to share his images as his scar matures.

Best Regards,

John Di Saia MD

Originally posted 2012-01-27 07:30:13.

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Non Provider Non Elective Plastic Surgery – Your Health Insurance May Pay

The games that many health insurance companies play make doctors wary of becoming a “Provider.” Provider status is nothing more than a contract in which the doctor relinquishes quite a few rights, for example the right to determine what a service should be paid. I am selective about contracting with health insurance companies for this reason. And I still do some work for insurers to which I am not contracted.

How can this work?

Some of the surgery I perform is not elective. It involves hospitalized patients who have wounds that won’t heal (or haven’t healed) without surgical help. In some of these hospitals I am the only plastic surgeon on staff.

Why does this make a difference?

If you need surgery and the only available surgeon is not a provider for your insurer, you will find your insurer may be willing to make an agreement with the surgeon for that one case. My office interfaces with the insurer and often we come to an agreement and are able to do the operation as a covered benefit. Some insurers are more receptive than others. Others simply offer an unacceptably low rate knowing no good surgeon will take it.

This is not 100%, but can work. Some patients have actually called their human resource departments at work and helped the process along too. The fact is that surgery costs your insurer money and without some pushing you might not get it. Be prepared to get involved if you want better care.

Best Regards,

John Di Saia MD

Originally posted 2011-05-05 07:30:55.

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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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Safe Breast Augmentation – How To Get Yours.

Safe Breast Augmentation?

The level of confusion regarding breast implant surgery is enormous. Can you get implant surgery without the drama?

safe breast augmentation

There are sites with scary stories of women (including this one) who went to horrifying B movie type doctors and had horrendous results. There are also stories of women who went bigger and bigger and bigger until their breast tissue just gave out and failed.

Safe Breast Augmentation is possible as long as you exercise proper judgement. Suffice it to say there are plenty of women who have had safe breast augmentation:

“Dr. D!!! They are still so awesome! They aren’t hard or sagging, almost 16 years later. Unbelievable! They look great and feel like a part of my body. You are the best and you can tell everyone I think so!!”
-G: Los Angeles, Ca. – Breast augmentation patient 2013

This woman had her breast implants placed in 1997 by yours truly. They were placed in an operating facility under her pectoral muscles and were saline-filled models of a moderate size. Now fifteen years later, she has needed no additional surgery and feels and looks great.

Beware advertising gimmicks and promises of the extreme. Choose a qualifed board certified plastic surgeon and moderate enhancement guided by his or her advice. That “happy medium” might just last you ten or more years. :)

Best Regards,

John Di Saia MD

Originally posted 2013-04-01 07:30:53.

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WoundsCare.org & Dog Bite Plastic Surgery

It has been mentioned to me more than once that my blog covers a good deal that is not cosmetic surgery despite the name. My practice site has also straddled the boundary between cosmetic plastic surgery and the less attractive reconstructive surgery.

To address the issue I am starting a new site WoundsCare.org:

WoundsCare.org logo

This site (which at present is just a tack on to my practice site) will center upon the wound patients I see and the surgery that often follows. The images will be somewhat graphic but will go to illustrate important points for those faced with less than cosmetic reconstructive plastic surgery. The first image will be placed after the page break for those who would rather not go there. :)

Best Regards,

John Di Saia MD

Originally posted 2014-01-07 07:30:08.

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Dr D an Aging Athlete and the Statin Question – The Muscle Pain II

Statin Muscle Pain

On researching the internet on muscle pain with Statins I found that it was being down played by many (including the drug companies) and hyped by others. Some studies indicated muscle pain only occurred in a few percent of Statin users. This seemed implausible to me as back pain is exceedingly common. It is probably difficult to talk about back pain relating to any drug as back pain is so common. But I noticed when I was on Statins (several different Statins) that certain muscular pains were more common and seemed to go away entirely with removal of the drug for a week or two. They may not be causing the pain but who is to say they may not make existing pain worse?

My muscle pains seemed to be more prominent at night. At first I noticed tingling cramping type pain in my feet. Later I had low back pain which I figured was just over exertion and in addition on occasion I had forearm pain and lower leg cramping pain especially with exertion. I cheeked my Creatinine Kinase (CK) a few times and it was either normal or a little above normal. So the feared rhabdomyolysis was not going on. It was the more mundane myositis (muscle inflammation) or so I ascertained. I do workout 3-4 days a week mostly swimming between 1000-1400 yards a day.

Statin muscle pain in my experience seemed to be more of a sensitivity to pain from this exercise. Hydration helps it a bit. I was later to find that other things could decrease it as well. Stopping the Statin for a week or two made each of these pains go away. I did this several times before concluding that the Statins were involved with the pain.

It seemed reasonable to play with the doses and the exact drugs a bit to try to find a tolerable medium ground.

My baseline cholesterol over the years on Statins (before the pains became a problem) had been pretty good:

In 2011 on Simvastatin 80 mg a day:

Total Cholesterol: 143
LDL Cholesterol: 67
Triglycerides: 170

HDL Cholesterol: 42

I did notice reviewing these labs that even in 2011, the Statin may have started to irritate my liver as my ALT was 62 a tad bit above the normal range of 60.

Best Regards,

John Di Saia MD

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Allergy, Pain and Liability

Sometimes the nature of liability forces medical care that does not seem all that compassionate. Not long ago I had a patient with a charted allergy to lidocaine, a drug that numbs the sensation of pain at surgery.

Dangerous allergies to drugs are far more common with some drugs that others. Most good plastic surgeons use a lot of lidocaine and related drugs to make surgery a less uncomfortable experience. This patient needed a pretty large skin graft and could have used that pain relief.

Almost invariably when patients are documented to have allergy to lidocaine, it is a mistake. Allergy is not the same as a less dangerous drug reaction. A common scenario is a trip to the dentist at which time a closely related drug novacaine is injected. The drug is applied too closely to a blood vessel and the patient experiences a few heart palpitations. This is a drug reaction. Most often it is documented as an allergy however.

All it would have taken to prove this would have been a small injection of lidocaine at surgery. Such a trial might indeed have been performed twenty years ago, but the medical malpractice landscape is different now. A mistake like this could easily be a slam dunk malpractice lawsuit, so a test like this is not advisable. It is simply not worth the liability to even bother.

While I have never seen a true allergy to lidocaine, any additional risk in an operation is not something a smart doctor entertains. We have enough uncompensated liability in medicine as it is. So practically-speaking the patient needed more narcotics during his post-operative period. He needed more during surgery. Thank a lawyer.

Best Regards,

John Di Saia MD

Originally posted 2012-04-17 07:30:35.

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