Donda West Death Results in New Law
December 10th, 2009
In response to the death of Donda West, Kanye West’s mother, the California State Senate recently approved a requirement that patients must be given a physical exam before elective surgery, according to the Los Angeles Times. The new law, AB 252, passed by an overwhelming margin. The vote was 37 to 1. This new California statute requires a history and physical examination be done prior to any elective cosmetic surgery or cosmetic medicine procedure that is performed in physician offices. The goal, of course, is to reduce the risk of death or serious impairment associated with surgery. Unfortunately the law does not address cosmetic surgery done in dentist offices or surgery related to body modifications carried out in non-medical facilities or surgery done by unqualified personnel.
I have always insisted that my patients have a History and Physical completed by their primary physician before having elective surgery. The most important philosophy guiding most surgeons, in an effort to avoid complications from cosmetic surgery, directly relates to patient safety. Risks are present in all medical procedures and surgical treatments, but certain steps minimize this risk. Yet complications occur and cannot be eliminated entirely. It is important to know that your surgeon has made every effort to reduce the risks and incidence of complications for any cosmetic surgery.
One of the cornerstones making cosmetic surgery safer is the pre-operative History and Physical. This medical evaluation is usually completed in advance of having cosmetic surgery. I require this evaluation to be done within two weeks prior to a patient’s surgery date. It was my practice as I began my career as a surgeon and it is a policy that I have continued for the past twenty-five years. However, I do not do pre-operative history and physicals on my own patients. I prefer that an independent, unbiased physician complete the examination, order necessary laboratory tests and finally interpret the results and confirm that the patient is healthy enough for surgery. I like to think of this division of patient care as an effective tool used to uncover any underlying medical condition that might lessen the safety of having elective surgery.
Whether or not your state requires this extra step, please consider having a pre-operative medical examination before all elective surgery.
Complications of the Flu
December 7th, 2009
Getting H1N1 while recovering from Cosmetic Surgery
Patients recovering from cosmetic surgery have a similar chance of being exposed to the flu as the rest of the population. Therefore, H1N1-Swine Flu or seasonal influenza can and does occur sometimes following cosmetic surgery if the patient is exposed and does not have sufficient immunity. The symptoms of the flu can be accentuated during the normal course of recovery after surgery. Depending on the cosmetic surgery procedure, hospitalization may even be necessary to treat the flu.
What should you do if you think you have the flu after cosmetic surgery? First, call your plastic surgeon. They need to be notified of your symptoms, so they can help guide you through the recovery process. An additional consultation with you primary care physician will most likely be necessary and recommended by your surgeon.
Secondly, coughing is one of the most common symptoms of influenza. After surgery, coughing may cause bleeding beneath the skin or around implants. Bleeding after tummy tucks and facelifts can lead to skin death and loss. If the bleeding is significant, emergency surgery might become necessary. When bleeding occurs around breast implants, the risk of firmness or capsular contracture is dramatically increased, so surgery might be necessary in this situation, as well.
Avoid dehydration. It is normal to experience mild dehydration after surgery, however, the flu can compound the problem and lead to hypovolemia problems like dizziness, fainting and nausea.
Finally, the CDC does not specifically recommend anti-viral therapy (Tamiflu) for post-operative patients at this time. Tummy tucks and breast surgery often makes taking a deep breath more difficult. The reduced inspiratory volume or inhale capacity in these cases significantly increases the risk of serious pneumonia. This increased risk warrants consideration of such drugs only if the symptoms are caught within 24 to 48 hours after they begin. Careful periodic medical evaluation during the course of the influenza is also important in detecting and treating pneumonia early.
Minimize your risk. Using the standard precautions issued by the CDC (http://www.cdc.gov/flu/protect/preventing.htm) during flu season is an effective way to reduce your chances of catching the flu.
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