Archive for the ‘Plastic surgery’ Category

Irritated

January 10, 2012

Back to work for me today. This morning I had to get an authorisation for a patient to have a breast reconstruction. She is a member of my favourite medical aid, Dico.very. I think I’ve explained this all before but cancer is what is known as a PMB condition and the medical aids have to pay for any procedures related to the cancer. Chris is contracted to Disc.overy which means he has to charge the rates they prescribe and the patients don’t have to pay any additional costs (such a nice guy). Anyway, I give the call centre lady all the codes and details and then can hear her discussing the case with whom I presume was her supervisor. The lady had her mastectomy last year and the plan is to do a muscle flap, an implant and then later on one does symmetrising surgery for the other breast and a nipple reconstruction. They are obviously querying the muscle flap part of the operation and going on about doctors charging for extra unnecessary things and not doing the op within 3 months, etc., etc. Now I’m clearly not a plastic surgeon but neither are they. The reconstruction is not always done within 3 months because often the patient is still having radiation and radiation can be catastrophic for wound healing so one needs to wait for the radiation to be completed. When they do the mastectomy (I’m sure you’ve all seen photos) they remove the breast with the skin and then stitch it closed. If you now come along and try to put in an implant, in a few patients with small breasts the skin can stretch, but for most women there is not enough skin and so they need to do a flap in order to get enough skin so that the implant can be put in. You need to take the skin with some underlying muscle tissue or else the skin will die and it all helps to give a more natural result. Bear in mind the other side doesn’t get an implant so even I can imagine how unnatural it would look if your one breast was just entirely implant and the other was a normal, middle-aged breast.

Chris had written a letter of motivation which I had to fax through but it just made me so irritated thinking that these people were chatting about whether the procedure was necessary or not. As soon as one hears the reasons or sees the photos it becomes blindingly obvious. Breast cancer is unfortunately very common so this can’t be the first breast reconstruction they are dealing with. Why are they always looking for reasons to say no?

It might be time

November 10, 2011

Summer is here, although no one seems to have mentioned it to whoever controls PE’s weather as today is rainy and rather chilly. Once a week or so we get a taste of what lies ahead and it’s a gorgeous day. PE is always like this, summer only really starts in late December/ January but then all the way up to June and July we have the most gorgeous weather.Ava doesn’t look like a girly girl – she’s a little chubby with a naughty face (does have blonde hair and blue eyes but not girly looking) and yet, she LOVES dresses and dressing up. She would happily wear a little strappy dress every day and every afternoon she insists on putting on her ballet outfit or fairy outfit (I’ve got an old photo of the ballet one but will still put one up of the girls in their fairy dresses). Zoe is tall and thin and has gorgeous long,curly blonde hair. She is a very pretty child I think and yet she would happily wear tights or skinny jeans and T-shirts with a jersey or fleece everyday!! I bought her the most beautiful skirts and dresses at Naartjie, Woolies Firefly stuff and other lovely summer dresses from Pick ‘n Pay (they have lovely cotton stuff) which she won’t wear. The only saving grace is that Ava will definitely wear them.

Precious ballerina - taken in January so a while ago

Zoe

Anyway, back to summer. I have strapless bra’s but they’re really old and uncomfortable and whenever I wear them, by the end of the day I’m going mad. Yesterday Ava and I popped into Woolies and I grabbed a strapless bra in my size and brought it home. I was about to throw my slip away when I remembered the bra and thought to quickly try it on. It is way too small, I mean seriously too small (the cup size). How devastating. Chris knows b.oo.bs, it’s his job and he keeps telling me that this or that bra is too big and doesn’t fit me properly but I’ve been living in denial. I have actually been a 32C (not even pregnancy/breastfeeding related) but was convinced I was still a 32B, I can’t actually cope with being a 32A. Thankfully despite breastfeeding they don’t sag at all – I know that for a fact because there are certain measurements (think it’s from your clavicle to the ni.pple) and mine are still within the normal range.Perhaps it’s just because there’s nothing much to sag!

Some may think, well lucky you you’re married to the right man but the right man is reluctant to operate on his wife. I obviously would like no one to even notice if I have it done. Chris has samples at work which I’ve tried and I lean towards the smallest size implant you get and he says that’s ridiculous. There are implants made for symmetrising surgery – so if you have a mastectomy on the one side then they adjust the size of your other breast to match – usually they do a reduction but sometimes one needs a very small implant.

There are a few problems – I will not be able to run for 6 weeks and that might actually kill me. I think I can cycle and swim after 2 weeks. There is a girl in our running club who had it done recently and she only stopped running for about 3-4 weeks but she isn’t married to the surgeon. She had absolutely nothing and is now a full B (small C) and she says she doesn’t notice it when running(something I’m nervous about, I certainly don’t want my running affected by my b.oo.b job). On so many levels I can’t even believe I’m contemplating it but Chris says that if you walk 100m in a shopping centre you will pass 10 women that have had it done. It would seriously cost very little – the cost of the implants and the theatre costs (and the hospital might not even charge because Chris works there and so generates lots of money for them) but still I’m almost too embarrassed to have it done and I’m scared one thing will lead to another.

On Monday I walked with Ava to the beach with the dogs (it was a glorious day) and she found a little friend at the tidal pool and they were having such a ball that we stayed much longer than I’d planned – I had sun screen and a hat for Ava but not myself (my moisturiser is SPF 15 though) and walking back I thought, oh well I’ll probably need a facelift when I’m 45 but that’s okay???? Chris could probably do a br.east aug.mentation in his sleep – he does them often and I think they’re fairly straight forward. A facelift is definitely trickier, he’s already reluctant to do my b.oo.bs there’s no way he’d agree to a facelift. Not because he can’t do it but because it’s not really ethical to operate on your own family. Not sure if I’ve mentioned this before but he keeps offering to do my mom’s eyes for her – he does it in his rooms and so it costs him nothing. She doesn’t want her eyes done, she wants a breast reduction but he flat-out refuses to do a breast reduction on his mother-in-law so he plays the family card very quickly!!

It’s almost like the decision to have a 3rd child or not, I can’t make up my mind. I just know I’ll chicken out at the last moment.

For now I just need to go and take the stupid bra back and buy my first 32A. Can you even take bra’s back to Woolies? If not, then my mind’s made up for sure, I’ll keep the bra and get my husband to organise the b.o.obs to fit into it!

Scary

November 8, 2011

This is going to be long because it’s got lots of bits.

There is absolutely no history of cancer in my family at all, none and so it’s something I didn’t really ever think about until Chris started specialising and then working as a plastic surgeon. People all think that plastic surgery is all about cosmetic surgery while the vast majority of his work is actually all to do with cancer – breast cancer, skin cancer, throat cancer, you name it wherever there is a tumour which needs to be removed, it leaves a hole (sometimes big and sometimes small) which needs to be sorted out and that’s where a plastic surgeon comes in. But before I get into all that please bear one thing in mind.

I know some doctors charge ridiculous fees and I do believe that’s wrong but please don’t ever complain about what your gynae charges. Do you know that their malpractice insurance is R18 000 per month? That is before they have even seen a patient, they need to pay R18 000. It went up R7 000 between last year and this year. Chris pays over R10 000 (even though he’s only part-time in private he has to pay the full amount) and I thought that was a lot. If gynaes don’t do obstetrics it drops way down to between R2 -R4000 I’m not sure but more and more gynaes are stopping obstetrics because it just isn’t worth it. Rant one over.

Chris saw a patient at the state hospital recently that has gone into debt to pay for a mastectomy privately. With a mastectomy the surgeon usually does what they call an axillary clearance which is when they remove some lymph nodes from the armpit to check those for any signs of cancer. The surgeon who did this lady’s mastectomy did that but when the pathologist analysed the sample, it only contained fat tissue, no lymph nodes. Chris saw the lady because she was being seen at the government hospital’s oncology breast clinic which he attends every week. The surgeon had told the lady her lymph nodes were clear, despite the fact that the pathology report clearly stated there was no evidence of any lymph nodes in the sample they received for analysis. She has a very obvious lump under her armpit which may be because of the mastectomy but could easily be a lymph node metastases. The right thing would’ve been for the doctor to admit his mistake, he could’ve even covered for his mistake by telling the lady that the pathology showed that not enough lymph nodes were taken out and he needs to go and remove more. To blatantly lie and tell the patient that everything was clear when you’ve made a mistake is just wrong on so many levels and is why a few incompetent, egotistical idiots give so many wonderful doctors a bad name. The sad thing is that Chris would’ve done the lady’s mastectomy for her and done a proper axillary clearance in the state hospital and it wouldn’t have cost her a cent. She is now in debt and needs to have another operation (Chris is doing this for her in the state). I was outraged when I heard. What does one do as the medical professional? PE is a small place, one can’t very well go bad-mouthing your fellow professionals. I told Chris that I think the best thing to do is to write a letter to the lady’s GP or whoever referred her to the useless surgeon in the first place. He actually has to anyway as when one does surgery on a patient one always needs to inform the person who referred them to you and the patient’s GP (if it’s not the same doctor) and let them know what is going on. At least then that GP will hopefully never refer patients to the idiot surgeon again. People make mistakes I accept that, but when a person’s life is at stake and you make a mistake, then you need to have the decency, guts, whatever to man up and admit to your mistake and make it right.

There’s more though. Yesterday he saw a 31 year old man with a melanoma (the bad skin cancer) on his leg and a big lump in his armpit, a sure sign it has metastasized. That gives this 31 year old man a 20% 5 year survival rate which means he has an 80% chance of being dead within 5 years. This young guy had a thing on his leg and went to have it cut out, he can’t remember which doctor did it – GP/surgeon/dermatologist but lets guess it was probably a GP. I asked Chris, and he said that a melanoma is pretty obvious to a trained eye. He (this other doctor) cut it out and then asked the patient if he wanted it sent away for analysis warning the patient that it would cost him more money. On the advice of the doctor and let’s be realistic here, if a doctor asks you, “Do you want it sent away, it’s going to cost you extra money?” you probably won’t choose that option. But if the doctor says, “Listen this might be nothing, but there’s always the chance that it’s something sinister, we’ve cut it out so let’s be on the safe side and have it sent away for analysis, it will cost you XYZ” you’ll probably have it sent away. Chris sends away absolutely everything that he cuts out for analysis. So, the patient was given his melanoma in a jar to take home!!

What usually happens is that if something turns out to be cancerous the pathologist checks whether it has been cut out completely and there needs to be certain clear margins as well (that means a few mm beyond the cancer on every side needs to be removed and clear of any cancerous cells). Often, if Chris thinks something is cancerous he’ll take out as much as he can (but also as small as possible for scarring) but if it turns out to be cancer then sometimes he has to see the patient again and cut out a bit more to make sure it’s removed fully with wide enough clear margins. By not having the original melanoma analysed one had no idea that it hadn’t been fully removed and/or with wide enough clear margins. Not only did the melanoma recur but it has now metastasized to this young man’s lymph nodes and now at the age of 31 he has a very good chance of being dead before he reaches 36. A good friend of ours (actually the one expecting the twins) found a melanoma after having her second little girl. She found a funny looking mole and went to have it removed, it was analysed and when it was found to be a melanoma she had it cut out further and chose to have some lymph nodes removed as a precautionary measure. She has a 100% 5 year survival rate and never has to think about the melanoma again. She was also 31 at the time and instead of staring death in the face, she is now expecting twins. Melanomas are scary things and there is always the chance that this man’s particular melanoma had already spread before he had it removed the first time but the earlier you start treating cancer, the better and the better one’s chance of beating it. If you don’t know you even have it, you certainly can’t start fighting it.

What’s my advice – never ever have anything burnt off, if it’s burnt you can’t ever analyse it so I know I’m biased but rather see a plastic surgeon not a dermatologist – they have no surgical training whatsoever and are more likely to burn things off and always, always have things analysed. I’m not sure how much it costs but even if it’s R1000, your life is surely worth more than R1000.

Dilemnas

May 10, 2011

Chris is about to have a Smi.le Week here in PE. There is a NPO called the Smil.e Foundation which help fund a week of operations for children with facial deformities – mostly they have cleft lips and palates but also other more complex problems or other issues such as needing reconstructions following burn wounds or whatever. As you all know the Health Dept doesn’t get a lot of good press and the Eastern Cape is no exception. Smi.le are a big, highly organised organisation that hold a few of these weeks in different places in South Africa every year. This will be the first one in PE as Chris has taken part in Smi.le Weeks before (while at Tyg.erberg) and he has managed to convince Sm.ile that PE is able to hold such a week. Everything was going really well until the CEO’s and other incompetent idiots that run the hospitals in PE got wind of it and started trying to get involved. They are absolutely terrified of any negative publicity??? WTF, this is the ideal opportunity for some much needed positive publicity – 35 children all getting operated on in 1 single week. 2 other plastic surgeons are coming to help Chris and as I mentioned – Smil.e have done this so many times before that they know how to make sure that everything runs like clockwork.

The kind of stuff that they are worried about – the Wednseday happens to be a public holiday (because of the voting) and this was only declared after they’d organised the dates for the week. The doctors are obviously all happy to work despite it being a holiday but Chris asked for a list of all the nurses scheduled to work on that day so that Smi.le could pay them for their time. No, according to the bright sparks in charge that isn’t fair as how could one fairly decide who gets to work and who doesn’t??? So any nurses that work that day can’t get paid thanks to the CEO and his cronies. They have consulted 3 different labour unions about the whole week (WHY??? Maybe they are terrified that someone might complain if they have to do any extra work??? Again, WTF this is a charitable thing for children – who on earth is going to complain about working a bit extra (which they won’t have to as it’s all been carefully planned). Oh dear maybe the answer to that question isn’t as onbvious as one would imagine.

They (the doctors) MAY NOT speak to the media. Have you ever heard such crap? They would rather have their own highly efficient PR department that have no clue about the first thing about plastic surgery and have made no effort to find out anything about what is going to happen speak to the TV and radio and newspapers about the week. They are so scared that the doctors might say something negative about the hospital (Why would they do that, this is about helping children not a platform to complain). They are suddenly worried about what the hospital looks like. A car crashed into the outside wall of the hospital months ago and a piece of the wall fell down and that is now a huge issue??? Nevermind the paint is all peeling off the walls and the grass is never cut. They were quite surprised that Smi.le said that the ward and hospital looked good. Surely if whoever is high up in government happens to see the hospital on TV and sees that it doesn’t look good then they might be more inclined to throw some money their direction to make things look better. If there’s no money for maintenance then why make everything look perfect or maybe it’s because there is enough money budgeted for maintenance and they’ve just wasted it all.

This kind of mentality makes me rather concerned about the future of SA. How can you see a wonderfully postive initiative as a threat and merely as an oppurtunity for things to go wrong which will then put you in a bad light. Are you that sceptical of your own abilities to manage that you’d rather the children went untreated. Why not see this for what it is – a chance to help children in a profoundly significant way and at no cost to your precious budget. Wonderful free publicity, who in their right mind would try and turn that down? They are getting themselves in such a tizz that they are just causing havoc left right and centre, including scheduling meetings without telling Chris (who is the main organiser) or any other doctors – rather making sure the cleaners, porters, 3 labour representatives, nursing staff,etc. are there but none of those (except some nurses not told about the meeting either) know anything about what is happening. Interesting meeting that must have been. No wonder they are now terrified and think that nothing has been organised. It’s actually quite funny but also unbelievably sad. How did such incompetent people get to be in such powerful positions? No wonder the hospitals are all falling apart. The really sad thing is that it’s driving Chris nuts and he is getting more and more keen to leave government as he just can’t stand working with people that are so incompetent and that’s really sad as the people that would suffer would be the patients that would no longer have access to any plastic surgery in the entire Eastern Cape.

If Chris reads this I know he’ll ask me to delete it as obviously he’d be in huge Sh1t if any of the bigwigs read this but it’s making me really mad.

Today

December 12, 2010

Today is the first day that I’m feeling ever so slightly better and not absolutely consumed by overwhelming sadness. I’m not going to talk about Rolo anymore as it’s far too painful.

We have ordered a chocolate lab puppy. Why so soon? Olive was so withdrawn and wouldn’t touch her food until Kohl came to stay yesterday. She needs a friend. She is an absolutely useless watch dog and I’m not saying that labradors are the best watch dogs but a big, brown dog is better than nothing. My conscience tells me to go and rescue a dog, but my heart tells me otherwise. I won’t take a chance on a rescue dog when I have small children of my own, many that come and visit and our dogs are inside dogs. I know what I’m getting when we get a labrador and I want what a labrador can give me. Whether I’m ready for a puppy and all that comes along with that is another story. I’ve also found a dog school and will try and persuade my parents to take Kohl along every Saturday afternoon.

Don’t for 1 minute think that I’m not utterly devastated or trying to replace Rolo, I’m constantly reminded of him. Last night I logged onto Investec (to pay for the new puppy) and are pass phrase or whatever it’s called is “Olive and Rolo”, it’s stuff like that that breaks my heart. Anyway, I’m not talking about him anymore.

Friends of ours (they’re in our home group at church) bought a new house recently and on Wednesday myself and 2 of the other moms in our home group went to visit. I was shocked to say the least. I had an idea the house was big because they’d told us so but hearing about a house and seeing a house are 2 different things completely. I grew up in a pretty standard-sized middle class house – 4 beds,3 baths, study, 3 livingrooms, 1800 square metre plot, double garage, domestic quarters, you get the picture. Most of my friends’ houses were pretty much the same. Two of Chris’s sisters live in Joburg, 1 is in Saxonwold and 1 in Bryanston. Both of their houses are big but still within reason (kind of). This house (of our friends) is on a biggish plot 2000 square metres I think and the house is 660 square metres (EXCLUDING the garages and “cottage”). Do you have any idea how enormous that is. There are 6 LARGE (I am not kidding) living rooms, 5 ENORMOUS bedrooms, a study, etc.,etc.,etc. They have one son and another on the way. You could easily lose your children in this house, for hours, I am convinced of that. It’s an old house so it has doors and passages and and and many hiding places. It’s the usual story where each subsequent owner has done “something” and it needs quite a bit of work. Not building on (ha ha) but just updating the bathrooms and removing a lot of what people thought was nice and making it a bit more modern and suitable for their needs. The paving outside is outdated (all 200 square meters of it). They’ve already had to put on a whole new roof!!! (330 square metres of roof). Upstairs had balconies wrapping around most of the bedrooms which at some point were enclosed and they want to open up again, stuff like that. It may not seem like a lot but when you consider the scale of the house, the job is massive. They plan to have it all done in 3 months for about R1 million. No way, I think but I can’t wait to see the finished product, sure it’s going to be incredible. My point is that I would absolutely hate to live in such a big house. When we were upstairs looking around, the kids were downstairs (with the nanny) but we couldn’t hear them at all. What does one do with 6 living rooms (and remember there’s a study upstairs)? I can’t begin to describe the sheer vastness of all the rooms. Zoe has what I thought was a big bedroom for a child, think it’s about 30 square metres. All of their bedrooms were at least 2 -3 times the size of her room, easily, except for one of the bedrooms.

Not even sure why I’m telling you all of this, except that it made me feel a whole lot better about our renovations, they seem positively minuscule in comparison. Unfortunately our budget is also a bit smaller than theirs at this stage and we’ve made some decisions. A few things have prompted our decision.

There are 6 plastic surgeons in PE. Two of them are basically retired and just help Chris in the state on a part-time basis, then there’s Chris that does private and state and then 3 others that are fully private. One of the private guys is older (in his 50’s), one started in PE about 6 months before Chris started and the other one has been here about 8 years. We know the other new guy through mutual friends, he’s a very nice guy but works very long hours. The other guy also works unbelievably hard. We just found out that he’s recently got divorced for the second time. He has 2 young children (and 3 older ones from his first marriage as well). How very sad. Obviously we don’t know the story but it’s tragic and I can only guess that his long hours away from home possibly played a part in what happened. In order to pay for massive renovations, Chris will obviously have to work much harder. If Rolo’s death has taught us anything it’s that you never know what’s going to happen and one needs to appreciate and enjoy what you’ve got right now. You need to spend time together, enjoying your family while you can because one just never knows. What’s the point of making huge amounts of money only to find your children hardly know you, you never enjoy life, you’re unfit and your wife’s left you?

We want to go on lots of holidays and do stuff to our house that will make our lives more enjoyable. We also don’t want to spend every last cent on our house and not have money left to do other fun (or even necessary) stuff. My dad has done a very rough estimate and based on that we will probably only do the patio (it’s an expensive patio as it’s having a new, proper pitched roof and ceilings), the deck, pool (with solar heating and Chris’s own automatic pool cover), removing the flat in the garden and re-doing the garden(where necessary), the roof over the guest room (which leaks), installing air-cons in the bedrooms and raising part of the wall. We will more than likely not extend the garage and do the front boundary wall at this stage. We only have 2 cars so at this stage we don’t need a garage big enough for 4. Chris can easily park one of the cars inside the gate (and not in the garage) when he’s working in the garage. We do plan to do the rest of the stuff but at this stage the pool and patio will improve our quality of living in our house much more than a bigger garage and a higher front wall will. While I’ll probably change my story entirely after having had to deal with builders, our plan at this stage is to add an extra phase or even do 1 smaller project a year and keep trying to pay off our house as soon as possible. We are planning to live here forever, at the moment this house satisfies all our needs, so why try and do everything all at once and possibly skimp on quality. This isn’t easy for me to accept as I’m an extremely impatient person and usually want everything done yesterday but I’m slowly trying to change.

Watch this space. Our builder is busy doing the PE to East London Surfski race ( I know phenomenal) which ends today so later in the week we’ll hopefully get together and start really getting the ball rolling for January.

Everything in perspective

October 24, 2010

Chris arrived back from doing his op as we were reversing out the driveway at 13.05. He’d done the 27km run (finished just before 8.30am) and then gone straight to the hospital where he showered and started the op. I’d had a long morning getting both girls up, dressed, fed and then done the solo-church thing, which is basically joining in on a bit of the worship and then taking them to Children’s Church. Ava actually now stays in Zoe’s class at Children’s Church as there are other siblings her age that potter around, scribbling and playing with the toys, while the bigger ones sing, listen to a story and do the craft activity. Anyway, I’m seriously off the topic. Got home and quickly made the malva pudding to take along to the lunch, gave Ava her snack, put her down for a nap,etc.,etc.

Chris had mentioned that the op might take 2 hours, always a dangerous thing to do as I’m always on time and if he says 2 hours then I expect 2 hours. I worked out that he’d started the op sometime after 9am and 2 hours would mean 11am. When both 11am and 12pm came and went without any sign of him, I started to get a bit cross. It’s not as if he’s playing golf or fishing or anything like that, the poor thing was working so I know I’m being very unreasonable.

So, he hopped into the car and off we went. Turns out the girl had managed to severe 11 tendons and 2 nerves (of her dominant hand). She’s 16 and goes to the high school right near our house. The mom asked about her writing her exams and Chris said no, not for 3 months minimum. The mom asked about playing the piano, Chris said not for 6 months at least. She plays waterpolo and again it’s 6 months minimum. Your ulnar nerve controls a lot of your finger movement. More than likely she will never use her hand normally ever again. She’s 16. She was arguing with her sister and lost her balance and stuck her hand through a cottage-pane window accidently. A completely freak accident that’s probably changed her life forever. Scary and made my little issue seem completely non-existent. We had a divine lunch, the kids all played like superstars and I even got to go for a lovely long run. Yes, my husband is that incredible. He was up at 5am this morning but as soon as we got back from lunch he took the girls and the dogs down to the beach while I lay and read my book for 30 minutes (heaven I tell you) and then I went for an hour’s run while he gave them supper and got them ready for their bath.

One last thing, I came 10th out of the ladies in yesterday’s race. 10th!!! Chris came 73rd (I was 90th overall), I love being a girl!!!

21.53

September 8, 2010

Yes, everyone that was my 5km time trial time, 21 minutes 53 seconds. My chest was burning a touch when I finished but I’m thrilled. The 1st lady did a 20.03 and I was 2nd. Think it will be a while before I’ll get close to her time. I went for a run this morning and my legs felt rather leaden eventhough the time trial was only 5km.

Chris did a free flap yesterday for a breast reconstruction and only got home at 11pm, I think as I was busy dealing with a vomiting child, yay. A free flap is when they take a muscle from a completely different part of the body, cut off the artery and vein and then re-attach it again to replace the breast tissue (or any other tissue) that was removed. It involves a lot of micro-surgery and it didn’t all go smoothly. Once he’d re-attached everything the flap stayed white which usuallly means that the artery isn’t working as no blood is getting into the flap so he re-did that anastomosis (what they call the join in the artery), it still didn’t work so he redid it again and it was still white. He then checked the vein and it was twisted, so he redid that and all was fine. He’s still not sure what happened as usually if it’s the vein then the flap will be blue not pink (as it should be) or white (as it was). The reason it goes blue is because blood is getting into the flap but not going out, so it gets engorged with de-oxygenated blood. The first time the anastomosis took 1 hour 20 minutes, the next time 40 minutes and the last time 30 minutes, so the Anaesthetist joked that at least he was getting good practice!! Each time he redid it, he had to cut out the previous anastomosis and start from scratch. The op started just before 3 and he eventually finished at about 9.30pm but kept the lady under anaesthetic a little bit just to check that the flap was okay. This morning he says that the flap looks okay and the patient is also doing well so fingers crossed it’ll continue to go well. He has another one tomorrow but he tells me that this flap isn’t quite as difficult as the one yesterday. Why, I have no idea. As far as reconstructive surgery goes, a free flap is about the most difficult thing you can do and although he’s done a lot over the years, it’s always rather nerve-wrecking stuff. He is a very calm person that never gets stressed but free flaps do make him a little nervous I’ve come to realise.

Here’s for the ironic bit. There’s another newish plastic surgeon in PE that is good but he works very slowly. Chris operates quite quickly (well so I’ve been told). This guy took over 8 hours to do a pedicled flap the other day (that’s when you don’t cut through the vein and artery, just reposition everything). If all goes well that would normally take Chris less than 3 hours but he says at the end of the day it really doesn’t matter how long you take to do an op, as long as it is successful, that’s what’s important. Next time we won’t make any comments about how long other surgeons take, although even with the couple of redo’s it still only took him just under 7 hours. Can you imagine standing operating for 7 hours with quite a large proportion of that time spent looking through a microscope while you’re operating, rather him than me. The main issue with a slow plastic surgeon is that it has a big influence on their cosmetic work. The hospital charges per minute for the theatre and so because the patient and not the medical aid is paying, time is money. Usually one charges a set price for a particular procedure, so if you operate quickly then you (as the surgeon) will get more money as the hospital fee will be less. If you are a slower surgeon then you could charge more for the procedure but you might not get so many people coming to you if you are way more expensive than everyone else.

The other side of plastic surgery

July 18, 2010

Mention the words plastic surgery and everyone immediatly thinks of the cosmetic side of things – the boob jobs, tummy tucks, liposuction, facelift, botox, whatever. The other side is of course the reconstructive side of things. Because Chris works for the state he gets to do a lot of reconstructive work and it is the part of his job which he finds more interesting and challenging I think and one of the main reasons that he chooses to work in the state system. If one is missing a bit of skin, muscle, bone or any combination of those bits, anywhere on your body, then it is a plastic surgeon’s job to reconstruct that defect by getting skin, muscle, bone, etc. from another part of you and making you look just like you did before or as close as one can. Sometimes it means just rearranging bits, so they’d take a piece of muscle, leaving the skin and blood vessels (artery and vein/s) still attached and swing it around to another position (often done during breast reconstruction following a mastectomy). If that is not possible then they must detach the muscle or piece of muscle making sure they take the few millimetre thick artery and veins with and then re-attach it at another place on the body. They often have to take a piece of bone along.For example, if you had a tumour that’s eaten through your mouth, jaw,etc, then they take a piece of bone from your leg (with muscle and vessels) and cover the hole that is left once the tumour is removed. These kind of ops take many,many hours as one has to do microscopic surgery to reattach the minute vessels. Arteries are actually more resilient than veins, so often the “flap” (as it’s called) will have blood flowing into it but the veins aren’t working so well yet and it gets engorged. Then one sometimes has to use leeches, yes leeches, to get rid of some of the blood while the veins recover. It’s all pretty fascinating stuff but time-consuming, stressful and requires amazing skill. They need to work out which particular muscle in the body would work best at closing the particular defect and so one must know one’s anatomy very well as you need to know where the blood vessels are and the size of all the various muscles. I would be absolutely useless, I have useless spatial awareness. I can’t even judge which size of container I need to put a particular amount of leftovers into.

Other times they need to make new ears or noses or other bits and pieces if the person is born without or the bit is bitten off, burnt, ripped off, whatever. I won’t go into all that. Why am I talking about flaps? Well, Chris has some registrars working under him. They are training to become plastic surgeons and as part of their training they must publish articles in medical journals. The study that they’ve chosen to do is about a calf muscle flap. They measured 300 peoples’ calves (black, white and Indian men and women) and I think it’s just Black men and women (might be Indian as well but I can’t remember) that have statistically shorter calf muscles. This would mean that if they need to use your calf muscle as a flap to cover a hole left by a tumour or if you’ve badly injured your leg in an accident or whatever, if you are black, then the amount of muscle available to use, is less than if you are white or Indian. Nothing really ground-breaking but as part of the study they must dissect the calf muscle from cadavers (dead bodies) and because the registrars have no experience in doing this flap, Chris must fly with them to Cape Town to go and dissect cadavers’ calf muscles at Tygerberg. Rather him than me. I did Anatomy in my 2nd year and hated it. Our cadaver was this ancient old lady who obviously thought she was being a real hero by donating her body to science. She was so skinny that we couldn’t really see where the muscles started and the tendons ended. We spent most of our time looking at the cadaver of the group next to us, who had one of a young, muscular man. The cadavers are either donated or they use unclaimed bodies I think. The smell was the worst, one just couldn’t get rid of that Formaldehyde smell and then you had to wrap it all up afterwards with wet cloths soaked in Formaldehyde. Our practical exams also gave me the creeps. You’d have all these stations in a room and when a buzzer sounded one moved to the next station. At each station one was confronted with some bit of anatomy ( a real bit, not a picture or a model), with a little flag pointing/stuck somewhere and you’d have to say what it was. I wasn’t very good, sometimes I didn’t even know what bit of the body it was, let alone what the darn flag was pointing at. So, imagine flying down to Cape Town to go and cut up bodies for the day. Not quite the stuff you thought Plastic Surgeons did I bet.

In kiddie news. Ava is actually better, YAY!!!! We suspect that she actually got another cold immediatly after the original one. Well, that’s what we hope and pray as Zoe is now pretty ill (with Ava’s cold). If that’s not the case and it’s actually her with the new cold that Ava is still going to catch in 3 days time then I think I’ll just run away and come back when summer is here. Once again thank goodness for grandparents. Chris and I went out last night and left my parents with Zoe with a fever and a terrible cough. I really wouldn’t have felt happy about leaving her with anyone else. By the time we got home at about 23h45 (again, thank goodness for grandparents that do it all with a smile) she was sleeping peacefully and both girls only woke well after 7am, what little superstars. Zoe was quite a bit better today thank goodness, so maybe the end is in sight (till the next wave I presume).

The tooth fairy

June 1, 2010

Ava slept like a dream till 5.20am and then when she cried I rushed in, gave her her taglet and she went back to sleep straight away and woke at 7am. Think we may go with that option as opposed to the leaving to cry for 5 minutes first (and obviously wake herself up totally). A top tooth and possibly a bottom tooth seems to have finally cut through, so perhaps that’s what all the fuss was about. Only time will tell.

The lady that I fought so hard with the medical aid to get them to authorise her breast reconstruction had her op today and it went well. She did start to cry when Chris told her that they’d finally approved the op, so that did make all my hard work and frustration worth it. Just thought I’d mention that Chris would’ve actually done exactly the same op at the government hospital, if they hadn’t have approved it, but the government will only pay for a certain number of breast reconstructions a year so it means an extra person (that doesn’t have medical aid) can now have a breast reconstruction. I feel this is only right as who knows how many thousands of rands this lady¬† has paid out in premiums over the years.

One last thing. I really need a new car. I have a Renault Scenic (1.9 diesel) that has 110 000km on the clock. Every flipping 10 000km it must go for a service and Renault services are just astronomical, as they seem to find such a lot of things wrong and my car was drively brilliantly. They wanted to replace the wiper blades (like I need those in PE and I hadn’t noticed a problem) for R500 – I said no. But then it was rear brake pads or shoes or something and the gear box mounting which I thought sounded essential, so said yes to those. That will be R1700, never mind the service and Vat and as I said, the car was driving perfectly. I presume a new car will cost a bit more but at least it won’t make me so mad. We’re thinking at a Charcoal 4X4 Toyota Fortuner – can’t quite believe it as I always said I’d never have a big car. I have a very good friend that has one and absolutely loves and says that I must test drive hers as I’m always too scared to test drive cars at the dealers. Chris would love a Toyota Land Cruiser but I seriously threw my toys about that big monster. Besides the fact that he would never pay off a car and he fortunately can’t afford to pay cash for a Land Cruiser. Thank goodness.

Not always the Third World

May 6, 2010

My husband is a Plastic Surgeon and we do watch Dr 90210 from time to time and are amazed at how differently things are done in the USA. Firstly, the most obvious difference is the fact that they use so much larger breast implants. Whether it’s something to do with their culture or just fashion I don’t know but they obviously want everyone to know that they’ve had their boobs done and so it is a fairly unnatural look. It is also not legal to use silicone implants, unless it is for a revision augmentation (second time one is doing the op) or reconstruction (in the case of breast cancer). I could easily be incorrect as to the circumstances under which silicone implants may be used but I think those are the reasons when it’s allowed. Silicone is much better from what I understand. I’m also not going to get into all the reasons why they don’t allow silicone for primary (first) breast enlargements. The other thing is that the poor patients are sent home immediatly following major surgery. A tummy tuck and breast reduction are major surgical procedures and liposuctuion can also have a pretty major effect on the body because by removing large amounts of fluid (fat included), it can be like losing a lot of blood, being dehydrated or whatever and one can react badly and so should be monitored. On Dr 90210 you see these half-groggy people getting wheeled out in a wheelchair and often being sent home or to a hotel. This is rather alarming but the astronomical cost of healthcare in the USA means that most cosmetic procedures are not performed at a hospital but rather at the doctor’s rooms or clinic. Now, this does happen in SA as well, but it’s usually the smaller, less invasive and the less painful procedures which are done in the doctor’s rooms but all the bigger stuff is done at a hospital and the patient stays 1 or 2 nights while they recover. With a tummy tuck, your scar is quite a bit longer than for a c/section, so that would be like having an op bigger than c/section and then pretty much as soon as you’re awake, you get sent home. Often the First World is not really the First World at all. Another example of this is ante-natal care. In South Africa we really are spoilt and incredibly blessed with the private ante-natal care that is available. Friends of ours live in Canada. He is a doctor and she is a physio, although she is now a mom. They have just had their 4th baby, a 4th boy. They were pretty sure it was another boy, but also not 100% (that’s unheard of here, if you want to know what you’re having you will definitely know by the time you give birth). That’s not the issue I want to tackle though. The baby was born without a left hand and they had no idea. Now, there isn’t obviously anything that one could have done about it, but at least they would have been prepared. At both of my 13 week scans and again at the 22 week scans, they checked every bone, organ, etc of my babies in the finest detail and for all sorts of abnormalities such as cleft lip and palate,etc.. There is no way we wouldn’t have known if one of our girls was missing a hand. Some people might not want to know but I really do think it helps to prepare oneself.

Getting back to Dr 90210 though, there was once an episode where the patient had a nose job. When the doctor started doing the op he discovered that the guy had had a previous nose job and it made the op far more complicated. I obviously am not in the position to explain why it makes the operation so much harder but it does. In fact, it doesn’t really matter for most other cosmetic procedures whether one has had the same procedure done previously but when it comes to a nose job, it makes a massive difference. One obviously gets various kinds of nose jobs, depending on the problem (removing a hump, straightening a broken nose, making it thinner, whatever). The most difficult one (I’m told) is to make a long nose shorter. So, the other day Chris had this type of nose job, so he was already a bit apprehensive about the op and despite denying having had a previous nose job, once he started with the op it became obvious the person had had a previous one done and this made for a very difficult operation indeed. When he questioned the patient as to why they hadn’t told him, when he’d asked them, they said they were scared he’d refuse to do the op, which ironically is probably what would have happened. The reason is, I think, that one can’t really make enough of a difference to justify the money spent so it’s actually that one has the patient’s best interests at heart. So, as always honesty is always the best policy. Not too sure why I’m telling you all of this today but I can’t stop thinking about our friends’ baby and how they are learning to accept a shock like this. I know when one compares it to the innumerable birth defects, syndromes, diseases,etc that could have happened, then life without a hand is not really too bad, but it still isn’t nice and I’m glad I live in a country where I can afford the type of medical care that I feel should be available to those living in much “wealthier” countries but because of whatever reason, it isn’t.

Just to add that all the plastic surgery related stuff is purely my opinion and what I think are the facts, based on me listening to my husband telling me stuff and what I’ve picked up over the years of being married to someone whose been studying to become (and now is) a plastic surgeon. What I’m trying to say is that I could easily have got the wrong end of the stick with regards to a lot of the facts so don’t hold that against him!