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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OC Weekly $3000 Breast Implant Ads – and a Story

As some of you might know I serve as an expert witness for the California Medical Board in cases of suspected negligence and malpractice. Not long ago I testified in a case of a not-so-qualified doctor (my opinion) in a liposuction death. Remember as the medical expert in this case, I reviewed the doctor’s training and experience. It was so weak that he would have failed a hospital credentials committee evaluation for sure. Unfortunately, these cases are confidential and I can’t divulge the name.

What I can divulge is that leafing through the OC Weekly recently I saw an advertisement by the aforementioned doctor offering incredibly inexpensive breast implant and liposuction work. I wonder if his dead former patient found him in these ads. Be careful when you select a surgeon this way.

Really.

Best Regards,

John Di Saia MD

Originally posted 2011-03-16 07:30:57.

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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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Dr D and a Botched Thigh Liposuction Repair Patient

I have a soft spot for attractive women who have suffered poor results with plastic surgery. Not infrequently I am asked to consult on such patients. Recently a nice forty something year old lady came in after having had pretty much botched liposuction by another surgeon nearly ten years prior.

Her right thigh has a pretty profound dent in it about one centimeter in depth and five or so in diameter. She had already had four attempts at surgical correction using fat grafts. She indicated that at best the results with the revisions lasted weeks in duration.

Botched liposuction can be improved at times. The main treatments are additional liposuction at the margins and fat grafting. Deep defects are very difficult if not impossible to repair with fat grafting as the grafts do not tend to heal completely or consistently.

I will look into alternatives in the surgical literature, but the main point of this post is to encourage patients to check into their prospective surgeons carefully. When you go to the unqualified these complications are more prone to happening. Try to keep unqualified surgeons from operating on you and your chances of problems go down markedly.

Best Regards,

John Di Saia MD

Originally posted 2012-08-27 07:30:33.

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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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Dr D’s Top Ten Celebrity Boob Jobs Comedy – Tori Spelling and Tara Reid

Tori Spelling / Tara Reid Top Ten Celebrity Boob Jobs Bit Mp3

This is part II of a series of Dr D comedy bits. Here we poke a little fun at Tori Spelling and Tara Reid.

Best Regards,

John Di Saia MD

Originally posted 2010-05-14 07:30:41.

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Dr D’s “America Doesn’t Know Natural Boobs” Comedy

“America Doesn’t Know Natural Boobs” Bit Mp3

Here’s a follow-up mini-rant to my Aly Michalka doesn’t have breast implants post.

Best Regards,

John Di Saia MD

Originally posted 2010-06-18 07:30:26.

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Reader Request: Pressure Ulcer Surgery

“My mother has been paralyzed for many years and needed many surgeries. She has had a problem after a recent pressure ulcer surgery. The wounds have opened. Can you help her out? Her recent pressure wounds had been there for over a year and weren’t healing.”

Occasionally this blog connects me with potential patients who live locally in Orange County. I rarely meet this kind of person via the blog however and am not always able to help patients after recent surgery by another surgeon. With pressure ulcer surgery on large open wounds there are periods of opportunity during which surgery has the best potential. Right after an operation complicated by wound disruption, the wounds are frequently fragile and need to heal for a while before surgery can be performed successfully.

Pressure ulcer surgery is difficult in that it requires a protracted period of care after the operation itself. Medicare restricts how long a patient can be kept in an acute care hospital, so I do these cases in a long term acute environment (LTAC.) I specifically do the cases in an LTAC that I frequent. Other surgeons deal with these cases differently. Not many plastic surgeons spend much time doing decubitus ulcer surgery. These cases take time and are not infrequently complicated even when everything is optimal.

Pressure ulcer surgery is also best accomplished with a motivated patient who is ready and able to restrict pressure to the newly operated wound. Patients who sit on their newly-operated wounds shortly after surgery have poor success rates.

Best Regards,

John Di Saia MD

Related Posts:

Pressure Wound Surgery in Orange County

Originally posted 2011-11-09 07:30:11.

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Covered California – A Soft White Underbelly Of ObamaCare?

Covered California is a health care exchange like those touted by representatives of ObamaCare. As their website states:

“Covered California is a part of the state of California and was created to help you and your family get health coverage to protect yourself and your loved ones.”

When people sign up for insurance through this system there can be interesting consequences however and not just for these newly insured.

Some of the doctors with whom I have spoken have reported an unusual hole in the system and it has to do with being paid, a sore spot for physicians: the insured under Covered California can have coverage for three months without paying their premiums. And this can bite your local doctor in his bottom line.

Case and Point:

Three separate doctors (Two primary care doctors and one Podiatrist) with whom I have actually spoken who have seen Covered California patients have been paid for their services only to have the insurers later demand repayment of the monies for lack of premium payment months later.

Apparently Covered California patients can receive services for three months without paying premiums. Once they fail to pay their premiums after this time, their insurance lapses and all services rendered become non-payable meaning the doctors, hospitals, etc must refund their original payments.

So these doctors with whom I have spoken are planning to not provide services to these patients for at least three months after they have joined to allow for the non paying members to fall “through the cracks” and decrease the potential to not be paid for services.

Great system.

Best Regards,

John Di Saia MD

Originally posted 2014-06-09 07:30:54.

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Dr D on the “Mother: Daughter Plastic Surgery” Trend

As plastic surgery becomes increasingly common in our society, more and more individuals are electing to have cosmetic surgery to turn back the clock, eliminate unwanted fat and enhance their figures. Some couples have begun having plastic surgery together; and now, it seems that mother daughter plastic surgery may be the latest trend among prospective patients. Plastic surgeons throughout the country are seeing more and more mother-and-daughter pairs coming in together as a team – and helping one another through the healing process by providing support through shared experience.

Source: lajollalight.com/2012/12/31/mother-daughter-plastic-surgery-
new-trend-provides-support-bonding-experience-for-plastic-surgery-
patients

I wonder when I read “stories” like this one as to whether even the writers believe them to be truthful or not. There is no great trend to mother and daughter plastic surgery. It is an occasional issue. This is a fluff piece as far as I am concerned. Not being familiar with the online source, maybe it is a spam farm.

Then again we have seen similar fluff pieces from larger media whenever a plastic surgery society puts out statistics in which someone tries to infer something larger from relatively small numbers. I have made my personal position statement of sorts on these. OK, just call me jaded. :)

Best Regards,

John Di Saia MD

Originally posted 2013-01-21 07:30:35.

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