long island plastic surgery

2006-01-21T18:32:00.000-05:00

Las Vegas -- Coumadin and other blood thinners should not be discontinued pre- or postoperatively in patients who are having skin surgery, says a professor of dermatology at the University of Rochester School of Medicine.

Speaking at the Fall and Winter Dermatology Conference in October, Dr. Marc Brown says dermatologists should be more concerned with the risk in taking patients off a blood thinner.

"A lot of us (dermatologists) now are keeping our patients on blood thinners like coumadin," Dr. Brown says. "There is a small but significant risk that they could have a stroke or heart attack. Similarly, if a patient were on aspirin for serious reasons, we would keep them on it. There is a greater concern of a serious problem occurring because the patient is not on a blood thinner like coumadin or warfarin than of extensive postoperative bleeding or extensive intra-operative bleeding."

He adds, however, that patients on aspirin who do not have cardiac or cerebral history should be taken off the medication.

Dr. Brown refers to a study published in Plastic Reconstructive Surgery in 2002 that found that cutaneous surgeons were unable to identify, through visual inspection, that patients had taken antithrombotics, based on the amount of intra- operative bleeding.

Dr. Brown estimates that most practicing dermatologists are taking their patients off blood thinners to avoid intra- operative bleeding and postoperative bleeding. Effective counseling, such as advising patients that they need to behave like couch potatoes in the 48 hours following surgery, needs to take place to avoid postoperative bleeding, Dr. Brown stresses.

"They can't undergo the surgery on a Friday and then go ahead and play tennis or golf over the weekend," Dr. Brown says. "They should also avoid bending over or lifting if they have had major excisional procedures performed, such as removal of skin cancers on the face."

Apart from rest, the application of ice packs to the surgical site, and an effective pressure dressing will contribute to minimizing post-operative bleeding, and minimizing ethanol.

In addition to bleeding, major areas of concern in terms of surgical complications are infection, wound dehiscence, and necrosis, Dr. Brown explains. Outpatient surgery is quite safe, with the incidence of complications at 1.6 percent in Mohs micrographic surgery, according to a study published in the Archives of Dermatology in 2003. The complication rate is comparable to complication rates in other surgical specialties, Dr. Brown notes.

If infections do develop following skin surgery, for instance following the removal of a cyst, they would typically occur within a week of surgery. Patients would experience tenderness and pain at the surgical site, as well as redness if an infection develops.

Typically outpatient skin surgery results in an infection rate of between 2 percent and 3 percent. Dermatologic surgeons who perform Mohs surgery and routinely prescribe prophylactic antibiotics to prevent infection should be questioned, Dr. Brown says. About a third of plastic surgeons prescribe antibiotics for graft and flap surgery.

"It's a controversial issue in terms of which patients you should place on antibiotics and which you should not," Dr. Brown says. "If you are performing complex reconstruction, or the patient is immunosuppressed, or the surgical site is around the nose and the ears, I would recommend antibiotics to be prescribed as prophylaxis."

Since the rate of infection is fairly low, Dr. Brown says data do not substantiate prescription of antibiotics as a matter of course in skin surgery.

Proper surgical procedure is one way to avoid possible infection. Taking a nasal swab of medical personnel to ensure there are no asymptomatic carriers of Staph aureus is a judicious measure, Dr. Brown adds. Just as patients should avoid too much activity to prevent infection or postoperative bleeding following skin surgery, minimal activity is recommended to prevent wound dehiscence. Surgeons need to ensure adequate deep closure to avoid wound dehiscence.

2006-01-20T17:32:00.000-05:00

Dermatologists are among the physicians cited by name in federal court documents exposing an underground network to distribute cutrate botulinum toxin type A to physicians suspected of using it on patients who may have assumed it was Botox.

Four doctors, including the director of oculofacial plastic surgery at University of Kentucky, have been indicted on federal conspiracy charges involving mail and wire fraud and misbranding a drug in connection with what the federal government is calling "a scheme to distribute fake Botox for use on humans."

At least 10 Florida physicians, including several dermatologists, have also had their licenses suspended or restricted because they purchased the unapproved drug, said Lindsay Hodges, a spokeswoman for the Florida Department of Health.

The network was discovered after four South Florida residents were hospitalized in critical condition with botulism, having received catastrophic amounts of improperly diluted raw botulinum toxin purchased from a California laboratory.

The same laboratory also supplied a Tucson, Ariz., company, Toxin Research International (TRI), with 3,081 vials containing botulinum toxin type A, "in a formulation designed to imitate Allergan's Botox" Cosmetic, according to an indictment issued by the U.S. Attorney's Office in the Southern District of Florida.

Botox is the only botulinum toxin type A approved for use in humans in the United States. At least 219 physicians and other health professionals purchased $1.5 million worth of the knockoff botulinum product at about half the price of Botox from TRI, after attending a weekend workshop or being sent promotional postcards or faxes advertising "A Very Stable Clostridium Botulinum Toxin Type A."

In very small print, the $1,250 vials containing 500 IU of toxin noted, "For Research Purposes Only Not for Human Use," according to federal documents.

Assistant U.S. Attorney Carlos B. Castillo said in an interview that physicians who ordered the fake Botox are being investigated by the Centers for Disease Control and Prevention and the Office of Criminal Investigations of the Food and Drug Administration in conjunction with numerous state medical boards.

"This deadly toxin packaged in harmless looking vials, wrapped in the guise of medicine, and used on unsuspecting members of our community, represents a grave threat," said Marcos Daniel Jimenez, U.S. Attorney for the Southern District of Florida in a statement.

A preliminary injunction halted further distribution of the mock Botox in January 2005.

The scandal came to light in late November 2004, when Bach McComb, a 47-year-old Florida osteopath with a suspended medical license, injected himself and three others with improperly diluted amounts of raw toxin obtained directly from List Biological Laboratories, a Northern California research laboratory.

Federal investigators believe the vial contained 20,000 units of botulinum toxin; however, a spokesperson for Allergan said the company's scientists have calculated that the vial may have contained up to 10 million units of botulinum toxin. It is unclear whether Dr. McComb used saline to dilute the product, and if so, by how much.

He and his three patients were hospitalized on ventilators with botulinum poisoning and, months later, are in various stages of recovery. Dr. McComb's girlfriend. Alma "A.J." Hall, remains hospitalized in New Jersey; a Palm Beach County, Fla., couple, Bonnie and Eric Kaplan, are recovering at home, having spent months in the hospital and a rehabilitation center.

Dr. McComb had to use a walker during his arraignment in federal court in Fort Lauderdale in late February 2005, according to the Palm Beach Post.

Also indicted in the case were Chad Livdahl, N.D., and Zarah Karim, N.D., of TRI, and Robert Baker, M.D., professor of ophthalmology, neurology, and pediatrics at the University of Kentucky in Lexington.

The Tucson naturopaths are accused of purchasing thousands of vials of botulinum toxin that were intended for research and then marketing them to physicians, presumably for human use in spite of labeling noting they were research products.

A fax found during a search of TRI headquarters explained to one customer that she could not receive a refund for the botulinum toxin A she returned to the company after she discovered the notation on the vials stating it was not meant for human use. "We must state that for legal purposes to protect ourselves," the fax said. "Our product is simply Botulinum Toxin Type A, which is exactly the same as any Botulinum Toxin Type A that you used in the past."

Federal prosecutors say Dr. Baker promoted and demonstrated the product to physicians at a 2-day workshop in Scottsdale, Ariz., in July 2003. A testimonial letter distributed to physicians bears his name; however, his attorney has told reporters the case is one of identity theft.

A December 2004 affidavit from a special agent for the FDA's Office of Criminal Investigations quotes attendees of the workshop as saying that Dr. McComb injected volunteers with hyaluronic acid, whereas Dr. Baker demonstrated botulinum toxin injections using the TRI product.

A nurse who attended was quoted as saying that Dr. Baker made it a point never to use the word "patients," as if he were avoiding it. Instead, he used the words, "When you inject your specimens."

The affidavit included comments from many physicians who attended the workshop, bought the product, or both.

In Florida, dermatologists, plastic surgeons, family physicians, and a pathologist who performs cosmetic procedures are being investigated by state medical board authorities for allegedly purchasing unapproved product and using it on their patients.

To read the complaint field in U.S. District Court, Southern District of Florida, visit www.usdoj.gov/usao/fls. Use search word Botox.

RELATED ARTICLE: 'Fake Botox' Timeline

2003

Early 2003: Dr. Livdahl and Dr. Karim order 3,081 vials of full-strength, raw botulinum toxin from a California laboratory.

April 14, 2003: Dr. McComb's medical license is suspended in Florida for reasons relating to the prescribing of narcotics.

May 2003: Dr. Livdahl and Dr. Karim incorporate TRI in Tucson.

July 19-20, 2003: Health professionals attend TRI-sponsored workshop where botulinum toxin type A is promoted and allegedly demonstrated.

2004

October 2004: Cosmetic surgeon in Tennessee notifies FDA about possible fraudulent TRI business scheme to market a Botox-like product; FDA investigation begins.

Nov. 26, 2004: Dr. McComb injects himself and three others with raw botulinum toxin from the same lab. All are hospitalized on ventilators within days.

Dec. 4, 2004: Federal agents search TRI offices in Tucson, finding marketing materials and 134 vials of botulinum toxin.

Dec. 15, 2004: Federal agents begin contacting physicians listed in TRI files.

2005

Feb. 3, 2005: Federal grand jury in Florida indicts Dr. McComb, Dr. Livdahl, and Dr. Karim. All later plead not guilty and Dr. McComb is freed on bond.

Feb. 24, 2005: Federal magistrate in Florida denies bond to Dr. Livdahl and Dr. Karim.

March 22, 2005: Dr. Baker is indicted.

March 29, 2005: Dr. Baker pleads not guilty and is released on bond.

Sources: Media reports and documents from U.S. District Court, Southern District of Florida

BY BETSY BATES

Los Angeles Bureau

2006-01-19T14:32:00.000-05:00

Denver Rocky Mountain News

10-18-2005

PLASTIC FANTASTIC? IN QUEST FOR CONFIDENCE, AMERICANS NIP AND TUCK AWAY

Nothing hurts more than a broken nose - not even having a baby.

This from someone who has had two unmedicated births and three unmedicated broken noses.

The first time, my nose and I smacked into a concrete floor after a fall from a cabinet I mistakenly thought was anchored to the wall. The second time, I ran nose-first into a plate-glass window that I mistook for a door. The third time, I jumped from a runaway horse I thought I could control, despite the fact that it had no saddle or bridle. My choice: either leap onto my nose or be decapitated when Zippy finally blasted into his stall.

By the time I turned 13, my nose made me look as if I'd had a long but unfortunate boxing career, and it no longer functioned as an airway. Finally getting my septum undeviated was like a revelation - I can breathe! It's a miracle!

Praise the Lord for 19th century German surgeons Carl Von Graefe, father of modern facial reconstruction - who coined the term plastic surgery - and Jacques Joseph, father of the modern nose job.

Last year, Americans spent $8.4 billion for 9.2 million procedures to enlarge their assets, reshape their schnozzes, tuck their tums, unload their saddlebags and fill in their wrinkles, according to the American Society of Plastic Surgeons.

Liposuction is the top surgical seller, followed by noses, breasts, eyelids and face-lifts. So-called "lunchtime" procedures - Botox, cellulite treatments and the like - have exploded in popularity, ASPS spokeswoman LaSandra Cooper says.

The number of Botox treatments, for example, has increased 280 percent in the past five years, with most done in people younger than 50.

While such procedures are strictly cosmetic, some surgeries qualify as both cosmetic and reconstructive, the two subsets of plastic surgery.

Consider the mangled nose: It's not normal-looking (or in my case, functioning) because it's been broken three times. So fixing it - bringing it back to the way it's supposed to be - qualifies as reconstructive. On the other hand, making it look better is also cosmetic.

Breasts can be the same way. A woman might have lost one or both to cancer, and reconstruction can give back what disease took away.

Or there may be absolutely nothing wrong with a woman's breasts: They're the ones she was born with. But maybe they haven't gotten much bigger since then.

From a surgical standpoint, breasts are much simpler to improve than facial features.

"I can make a far more beautiful breast starting with an average or sub-average breast," says Denver plastic surgeon John Grossman. "A face is far more complex."

So forget looking like Catherine Zeta-Jones. But leafing through a Victoria's Secret catalog or a Sports Illustrated swimsuit issue for the kind of cleavage you crave isn't necessarily far-fetched. It's a safe bet much of what you're looking at has been surgically enhanced, because there's no way a 5-foot-10-inch woman who weighs 110 pounds has a 36-D bust. Breasts, after all, are mostly fatty tissue. On the other hand, supermodel Tyra Banks recently went to the extreme of having a doctor feel her up on national television to prove she's the real deal. But then, she's no size 2, either.

Who's getting plastic surgery, besides everybody on television? If you guessed wealthy middle-age white women, you're only partly right.

Yes, they're mostly white, and they're mostly women, but a study found that of 644 people considering having plastic surgery in the next two years, 70 percent have household incomes of $60,000 or less, and nearly 30 percent make less than $30,000. Nearly 65 percent are younger than 50, and 26 percent are from 18 to 29.

I was 17 at the time of my surgery. I remember a conversation with my father where I pointed out that my nose didn't work and it didn't look so hot, either.

"I like your nose," he said. "It looks just like mine."

"A 17-year-old girl should not have the nose of a 57-year-old man," I said.

Like me, most of the people in the study aren't trying to make themselves look like someone else. They're simply trying to feel better about looking in the mirror or to stop mouth-breathing. Most think plastic surgery will make them physically healthier and more self-confident, and men in particular expect surgery with benefits. Yes, those benefits.

But beware of unrealistic expectations: All surgery has risks and involves pain and weeks of recovery. And at the end of the day, you're still you.

"Cosmetic surgery isn't going to make you more talented than you are," Grossman says. "It's not going to repair a failing or broken marriage or make you qualified for a job for which you're not qualified. And it's not a transformation from a troll that crawled out from under a bridge into a Prince Charming."

Where you can go with plastic surgery depends a lot on where you are to begin with. Grossman mentions a patient who wanted her face-lift to make her look as good as Dolly Parton. That's not going to happen, he says, because there are just some people who are naturally more beautiful than the rest of us.

"I can do a fabulous job with you and what you have to work with," Grossman says. "But you're not just a lump of clay. There are limitations."

Unreal reality TV has skewed the public perception of what plastic surgery is. A survey of 220 adults found that many thought cosmetic surgery was less painful, less risky and easier to do and undo than procedures called "plastic surgery" or "reconstructive surgery." The study, which appeared in the Archives of Facial and Plastic Surgery, found that people also thought cosmetic surgeons require less training than those who do "plastic" surgery.

Some of them have less training - there are doctors who call themselves cosmetic surgeons who have none whatsoever, Grossman says. Look for a surgeon who has been certified by the American Board of Plastic Surgery, and look for someone who regularly does the procedure you want.

He recommends examining pictures of results and talking to someone who has had the same operation - someone besides the doctor's employees.

And don't shop price - going to Indonesia to have plastic surgery with a doctor of unknown skill is nuts. If saving money is the object, skip the surgery and try therapy.

"In some ways, those (makeover) shows are good for plastic surgery because they showcase just how much we can do," Grossman says. "But they're also very bad in that they deal with pitiable people whose self-esteem is in the toilet. They should be seeing a psychiatrist, not a plastic surgeon."

INFOBOX 1

Top 5 cosmetic procedures in 2004

* Liposuction 324,891

* Rhinoplasty (nose) 305,475

* Breast augmentation 264,041

* Eyelids 233,334

* Face-lift 114,279

Source: American Society Of Plastic Surgeons

INFOBOX 2

Handling your case with care

Steps to take if you're considering plastic surgery

Find a surgeon

Ask your physician, get referrals from friends or family, or call hospitals and ask who's on staff. The American Society of Plastic Surgeons has a referral service: www.plasicsurgery.orgor call 1-888-4-PLASTIC (1-888-475-2784).

Check your doctor's credentials

What type of training has he had? Be sure the surgeon completed an accredited residency program in plastic surgery. The American Medical Association lists what type of training a physician has had and where it took place. A physician performing plastic surgery also should be certified by the American Board of Plastic Surgery, the only plastic surgery board recognized by the American Board of Medical Specialties.

Schedule a consultation

This is a chance to discuss your goals and to get advice on the best procedure to achieve your desired results. Your plastic surgeon should:

* Answer all your questions thoroughly and clearly.

* Offer alternatives, where appropriate, without pressuring you to consider unneeded or additional procedures.

* Welcome questions about your procedure and his or her professional qualifications, experience, costs and payment policies.

* Make clear the risks of surgery and possible outcomes.

* Give you information about the procedure you want.

* Leave the final decision to you.

Your plastic surgeon should also ask lots of questions, including:

* Are you certified by the American Board of Plastic Surgery?

* Do you have hospital privileges to perform this procedure? If so, at which hospitals?

* How many procedures of this type have you performed?

* Am I a good candidate for this procedure? What will be expected of me to get optimal results?

* Where and how will you perform my procedure?

* Is the surgical facility accredited?

* What are the risks involved with my procedure?

* How long a recovery period can I expect, and what kind of help will I need during my recovery?

* Will I need to take time off work? If so, how long?

* How much will my procedure cost? Are financing options

available?

* How are complications handled?

Source: American Society Of Plastic Surgeons

INFOBOX 3

Most common nips and tucks

Here are descriptions of the top five cosmetic surgical procedures performed last year, in order. All the operations take at least two hours and usually don't require a hospital stay. The average cost listed is only the surgeon's fee and doesn't cover anesthesia or hospitalization:

Liposuction (suction-assisted lipectomy)

Improve body shape by removing exercise-resistant fat deposits with a tube and vacuum device. Common locations include chin, cheeks, neck, upper arms, above breasts, abdomen, buttocks, hips, thighs, knees.

* Side effects: temporary bruising, swelling, numbness, soreness, burning sensation

* Risks: asymmetry, rippling or bagginess of skin, pigmentation changes, skin injury, fluid retention, excessive fluid loss leading to shock, infection

* Recovery: Back to work: 1 to 2 weeks. More strenuous activity: 2 to 4 weeks. Full recovery from swelling and bruising: 1 to 6 months or more

* Results: Permanent, with sensible diet and exercise

* Average cost: $2,200

Nose surgery (rhinoplasty)

Reshape nose by reducing or increasing size, removing hump, changing shape of tip or bridge, narrowing span of nostrils, or changing angle between nose and upper lip. May also relieve some breathing problems, so may be covered by insurance.

* Side effects: temporary swelling, bruising around eyes and nose, headaches; some bleeding and stiffness

* Risks: infection; bursting of small blood vessels, resulting in tiny, permanent red spots; incomplete improvement, requiring additional surgery

* Recovery: Back to work: 1 to 2 weeks. More strenuous activities: 2 to 3 weeks.

Final appearance: 1 year or more

Results: permanent.

Average cost: $3,300

Breast enlargement (augmentation mammaplasty)

Enhance the size of breasts using inflatable implants filled with saline.

* Procedure: 1 to 2 hours, local anesthesia with sedation, or general anesthesia, usually outpatient.

* Side effects: temporary soreness, swelling, change in nipple sensation, bruising

* Risks: Lack of implant permanence - surgical removal or replacement of the implants may be required to treat problems such as scar tissue or deflation. Mammography requires a special technique.

* Recovery: Back to work: a few days. Physical contact with breasts: 3 to 4 weeks. Fading of scars: several months to a year or more.

* Results: Variable. Implants may require removal or replacement.

* Average cost: $3,400

Eyelid surgery (blepharoplasty)

Correct drooping upper eyelids and puffy bags below the eyes by removing excess fat, skin and muscle. Upper-eyelid surgery may be covered by insurance if used to correct visual problems.

* Side effects: temporary discomfort, tightness of lids, swelling, bruising, dryness, burning, itching; excessive tearing; sensitivity to light for first few weeks.

* Risks: infection, bleeding, swelling at the corners of the eyelids, dry eyes, temporary blurred or double vision, formation of whiteheads, slight asymmetry in healing or scarring

* Recovery: Reading: 2 or 3 days. Back to work: 7 to 10 days. Contact lenses: two weeks or more. Strenuous activities, alcohol: about 3 weeks. Bruising and swelling gone: several weeks.

* Results: Several years. Sometimes permanent.

* Average cost: $2,500

Face-lift (rhytidectomy)

Improves sagging facial skin, jowls and loose neck skin by removing excess fat, tightening muscles, re-draping skin. Most often done on men and women over 40.

* Side effects: temporary bruising, swelling, numbness and tenderness of skin; tight feeling; dry skin. For men, permanent need to shave behind ears, where beard-growing skin is repositioned.

* Risks: injury to the nerves that control facial muscles or feeling (usually temporary but may be permanent), infection, bleeding, poor healing, excessive scarring, asymmetry or change in hairline.

* Recovery: Back to work: 10 to 14 days. More strenuous activity: 2 weeks or more. Bruising: 2 to 3 weeks. Must limit exposure to sun for several months.

* Results: usually 5 to 10 years

* Average cost: $4,800

Techniques on the horizon

* Focused ultrasound: A noninvasive body-sculpting technique, it can give patients the benefits of minimal to mild liposuction without the downtime. Three studies have shown a single treatment to significantly reduce the circumference of the targeted area.

* Suture suspension techniques: The use of barbed or trumpet sutures might offer a face-lift alternative that gives fast results and recovery.

For more information or to find a physician, go to " class="emaillink" target="window">www.plasticsurgery.org

Source: American Society Of Plastic Surgeons

Copyright © 2005, Denver Publishing Co.

2006-01-18T07:32:00.000-05:00

AP Online

08-31-2005

Dateline: ST. LOUIS

Fourteen-month-old Quinn Sliment, is shown in a photo before his cleft palate surgery, left, and after the procedure, right. Quinn is the first child in the world to have his cleft palate repaired using the bone morphogenetic protien procedure. The procedure was performed by plastic surgeon Dr. Michael Carstens. (AP Photo/Tom Gannam)

Quinn Sliment was born with a cleft palate, a defect that caused his lip to merge into his nostril on the right side of his face. But on Tuesday, the 14-month-old was all smiles at SSM Cardinal Glennon Children's Hospital in St. Louis, showing just a ghost of a scar.

He is the first child in the world to undergo a new type of surgery for his cleft palate and lip repair, the hospital said.

The plastic surgeon who performed the surgery, Dr. Michael Carstens, was born with a cleft lip and palate himself. He used a new technique on the child from Waterloo, Ill., requiring two surgeries, rather than the normal five to seven over several years.

Unlike the traditional surgery, no bone graft was used to repair the gap. And the new technique should allow a child such as Quinn to be done with treatment before beginning kindergarten.

"It's amazing. It's wonderful," Quinn's mother Judee Sliment, 36, said of the surgery results.

Quinn's father, Tom, 34, said the family had expected it would take years for surgery and healing, based on other children's experiences.

The parents were thrilled that most of their son's defect seems repaired. "We almost feel guilty, but not too guilty," Judee Sliment said.

Carstens performed a surgery in November focusing on Quinn's lip and another in March to repair the palate. In the months since, the boy has been able to heal and his growth has helped improve his appearance.

Carstens used a type of genetically engineered protein, called bone morphogenetic protein, that was placed on a collagen sponge and inserted into a gap that Quinn had between his nose and gum line. "It's like putting a keystone in an arch," Carstens said.

Cells migrate to the sponge and grow into new bone.

"Bone doesn't grow itself. It is produced by the soft tissue around it," he explained.

A plastic surgeon in Charlotte, N.C., Dr. David Matthews, said the technique could lead to "improved appearance, improved bone structure, fewer surgeries and better growth" in patients. He also said the surgery will help children regain a normal appearance.

Carstens will be the keynote speaker at upcoming cleft palate medical conferences in Mexico, Brazil and India.

___

On the Net:

Cardinal Glennon Children's Hospital: http://www.cardinalglennon.com

Copyright 2005, AP News All Rights Reserved

2006-01-17T06:07:00.000-05:00

Byline: LAUREN BECKHAM FALCONE

Furrowed foreheads, relax. A new trend is surfacing in skin care, much to the delight of the wrinkled yet squeamish, who swoon at the thought of getting toxins injected into their face just to look smoother:

Just say no. To needles.

"I think women my age (52) and younger have seen so many people who have that look of surgery or Botox and they hate it," said Dr. Gregory Bays Brown, author of "About Face: A Plastic Surgeon's Four-Step Non-Surgical Program for Younger, Beautiful Skin (Ballantine Books, $24.95). "When you want to say to someone `My, you've had a face lift!,' that's not a compliment. And women in my generation and younger don't want that."

And companies are delivering.

At www.sephora.com, there's a whole marketing movement afoot:

** "Lipfusion: No needles. No waiting. No kidding."

** "Protox Wrinkle Treatment: No needles. No surgery. No acid peels."

** "Bye-bye Botox. OHT Peptide-3."

Bliss Spa is offering No-Motion Lotion, which promises a "painless, nonprescription wrinkle-reducing alternative to the dreaded needle."

Freeze 24.7's tagline is "Nature. Not Needles."

"I think all of us fall into two camps," said Eden Grimaldi, spokeswoman for Freeze 24.7. "There are those who will do anything and risk anything to look younger. And then there are the rest of us, who are looking for an alternative."

Freeze 24.7's Anti Wrinkle Cream is one. It claims to work immediately, relaxing wrinkled zones with its Gamma Aminobutyric Acid, which is produced in the body as a natural muscle relaxant, much like melatonin works as a natural sleep agent.

"The reason it's so popular is that it works on contact, so once you try it in the store, you know you're going to get results," Grimaldi said.

If the Botox and topical creams have anything in common, it's the price. A few shots might cost you $500, an ounce of Freeze 24.7's Anti-Wrinkle Cream will put you back $115.

Dr. Brown, who also has a line of skin-care products, said the skin-care industry is much different than it was a decade ago.

"Until AHAs came out in the '80s, every wrinkle cream was essentially a moisturizer," he said. "But since then, there have been a lot of advances in skin care and people want it. I think people are also turned off by the over-the-top plastic surgery marketing and advertising. It's truly not health care anymore. It's product. Which has changed the face of plastic surgery. The pendulum is swinging back."

2006-01-17T06:06:00.000-05:00

The Atlanta Journal and Constitution

11-12-2004

What DO you get for $9,300?

Byline: MARLON MANUEL STAFF

Edition: Home

Section: Living

Politics, at times, is about saving face --- not paying for one.

Linda Schrenko may be confronted with both.

On Wednesday, a federal indictment charged that the former Georgia school superintendent and past gubernatorial candidate stole $500,000 in taxpayer money.

The 18-count indictment contends that Schrenko, who acknowledged two years ago that she had a face-lift, spent $9,300 of the money on cosmetic surgery.

But for anyone with $9,300 to spend on a nip and tuck, how far will her dollar --- let alone her face --- stretch? Plastic surgeons provided us with a buyers guide to surgical makeover.

--- Marlon Manuel

UPPER

$9,300: Could spend the whole kitty tightening the eyebrows and lifting the eyelids, upper and lower. If you wanted to spread your $9,300 out, consider skipping the browlift and fork over about $5,000 for a lid lift, saving the rest for the lower part of the face. Could also spend $300 per Botox treatment.

MIDDLE

$5,000: Adjusting the honker blows a lot of dough. Unlikely that a 54-year-old woman would get a nose job. Advice: Save your cash.

LOWER

$8,000: Resculpting or removing fat pads in the cheeks and reducing rooster neck constitutes the basic face-lift. Quotes across the country could range from $5,000 (new surgeon trying to get business) to $40,000 (name brand doc). Surgery with a hospital visit costs more.

Sources: Atlanta plastic surgeons Drs. Diane Alexander, Sheldon M. Lincenberg and Arthur Simon

Illustrations/Photos:

Photo

Mannequin

Photo

2002 Schrenko cosmetic surgery

Photo

1998 Schrenko

(Copyright, The Atlanta Journal and Constitution - 2004)

2006-01-04T09:16:00.000-05:00

The browlift procedure can be a tough sell. Patients might shy away om having the necessary hardware implanted and the hardware fixation devices that are available can add hundreds of dollars to the final tab.

Gregory Chernoff, M.D., a facial plastic surgeon in practice in Indianapolis, Ind. and Santa Rosa, Calif., has found a way to get around having to use hardware fixation in the browlift, without sacrificing outcome quality or longevity.

Dr. Chernoff, an assistant clinical professor at Indiana University, Indianapolis, has been performing browlift procedures without hardware fixation devices for seven years.

"You can substitute hardware with permanent stitches on anyone wanting the results of a browlift," says Dr. Chernoff. "It is quicker, there is no hardware required and, for the patient's benefit, there is an average $500 savings."

Patients not comfortable

Dr. Chernoff consulted for many endoscopic and hardware companies when the endoscopic browlift first became mainstream. He says despite the many hardware choices, including absorbable options, patients would hesitate when it got to the hardware part of the surgery, and the extra hardware expense would add salt to the wound.

But in developing a browlift procedure using sutures rather than hardware, Dr. Chernoff was concerned with the longevity of results.

For the sake of research, 20 patients allowed Dr. Chernoff to use conventional hardware fixation techniques on one side of their faces and the suture technique he describes on the other. He did not tell the patients which side was which, to avoid bias.

Dr. Chernoff has found, after nearly six years of follow-up, that uniformly--within a millimeter--there was no differences in procedure outcomes or longevity.

"The suture alternative is a much easier procedure to teach because the hardware, placed endoscopically, requires hand-eye coordination. This aspect of the surgery can be hard for doctors who are not comfortable using the endoscope to grasp," he says.

Suture browlift: step by step

Dr. Chernoff does a subperiosteal elevation through either a combination of a 2.5 cm or an inch-long single horizontal central incision.

"When you evaluate a patient, the patient either has ptosis at the head of the eyebrows, which gives the person an angry look, or ptosis of the lateral brow, which gives the patient a sad or tired look," Dr. Chernoff explains. "If the arch of the patient's brow is fine and the patient just needs elevation of the head of the brow, then I just make a single, central incision horizontally, a few millimeters into the hairline."

The facial plastic surgeon enters subperiosteally, as he or she would in the traditional endoscopic browlift, and identifies the supraorbital bundle to preserve it. He or she then uses a suction cautery or laser to divide the corrugator and procerus muscles.

The connection around the tail of the brow is divided, between the frontalis muscle and periorbititis muscle. This loosens up the entire brow complex, as it does in the traditional procedure.

"This is the point then that you would typically put in whatever hardware you were going to use to fixate," he says. "What we do instead, is we have elevated the periosteum anteriorly and now can take advantage of the fact that the rest of the patient's periosteum is still attached. We can now sew the area of elevation."

If elevating 1 cm of the head of the brow, he does a posterior cutout of some of the posterior scalp, as the back part of the incision, and cuts out whatever portion he needs.

"This gives you the amount of elevation that you will get" he says.

Dr. Chernoff then sews the periosteum together with a permanent stitch, using a 3-0 Proline. If he is using one horizontal incision in the central region, he usually would put in four to five permanent stitches.

"That is what gives you the elevation and permanent fixation" Dr. Chernoff says."Those stitches are nonabsorbable and buried, so they do not go anywhere."

Lateral brows

For patients who have ptosis of their lateral brows, Dr. Chernoff would make three incisions horizontally--one in the midline and one on either side--probably along the vector of the lateral corner of the eye.

The technique is the same, according to Dr. Chernoff, except that he would do three cutouts of scalp as opposed to the one.

Different take on old procedure

Cosmetic surgeons can use the suture alternative on any patient who wants a browlift, according to Dr. Chernoff.

Doctors have written previously in the literature about browlift procedures that have involved sewing periosteum to periosteum, and most procedures now are using some form of hardware, according to Dr. Chernoff.

"Other doctors who have sewn tissue, have drilled little holes into the bone and sewn those stitches into the bone," he says. "This procedure allows you to do the browlift without entering the bone at all."

Words of advice

Surgeons should remember not to make their bites too close to the actual epidermis when putting in the permanent stitches.

"The bites of the needle must be in the dermis and not make contact with the epidermis; otherwise, the Proline stitch could extrude," Dr. Chernoff says. "I have seen a 1 percent to 2 percent incidence of that, where at two to three months, a patient will come in with a visible stitch. I inject it with a local anesthetic in the office and cut out the one stitch. There are still four or so others holding things in place."

Added benefit

An added benefit of using the suture versus the traditional hardware browlift approach is that surgeons can simultaneously lower receding hairlines.

"We make the incision along the existing hairline, elevate the tissue and instead of excising the hair-bearing tissue posteriorly, I cut out the balding scalp," Dr. Chernoff says. "I just took the bandage off this morning of a gentleman on which I did this procedure yesterday, and when he looked in the mirror he said the nicest thing I did for him was to lower his hairline."

Disclosure: Dr. Chernoff reports no conflicts of interest related to products/companies named this article.

2006-01-04T01:07:00.000-05:00

LA JOLLA, Calif. -- A new website will help consumers make educated decisions about a variety of cosmetic plastic surgery procedures. The Consumer Guide to Plastic Surgery (http://www.yourplasticsurgeryguide.com), launching in January 2006, will provide comprehensive, unbiased articles about all facets of plastic surgery and skin care. Each article will be reviewed by an advisory panel of leading, board-certified plastic surgeons, assuring consumers of the highest-quality, most trustworthy content on the Web.

The Consumer Guide to Plastic Surgery will offer in-depth information on procedures, candidacy, expectations, techniques, risks and cost for each of these content areas:

--Breast augmentation: http://www.yourplasticsurgeryguide.com/breast/

--Breast implants: http://www.yourplasticsurgeryguide.com/breast-implants/

--Breast lift: http://www.yourplasticsurgeryguide.com/breast-lift/

--Breast reduction: http://www.yourplasticsurgeryguide.com/breast-reduction/

--Face-lift: http://www.yourplasticsurgeryguide.com/face-lift/

--Liposuction: http://www.yourplasticsurgeryguide.com/liposuction/

--Rhinoplasty: http://www.yourplasticsurgeryguide.com/rhinoplasty/

--Tummy tuck: http://www.yourplasticsurgeryguide.com/tummy-tuck/

The Consumer Guide to Plastic Surgery will be the only consumer information portal to provide both surgical procedure information and broad coverage of non-surgical topics, including:

--Anti-aging treatments such as antioxidants, hair transplants, moisturizers and stretch mark reduction

--Facial rejuvenation, including chemical peels, exfoliants, implants and microdermabrasion

--Injectables and fillers such as Botox and Restylane

--Laser skin procedures for hair removal, scar reduction and skin resurfacing

Also in development are a before-and-after photo gallery and reference database, and a special section on reconstructive plastic surgery.

The Consumer Guide to Plastic Surgery is published by Ceatus Media Group LLC, an online provider of health information and physician directories.

2006-01-02T03:07:00.000-05:00

Byline: Compiled by: Lynne Michelle

WhatOs the most youOve ever spent on a face cream? Not much. I donOt think price matters, youOve just got to find something that suits your skin and stick to it. How can a face cream be worth pounds 1,000? ItOs ridiculous. For that, IOd want a face lift.

WhatOs your beauty extravagance? Spas. I love to try out new treatments I the last one was a dry float which involved being wrapped in detoxing seaweed and put on a water bed. It was all warm, dark and squishy, but lovely I the closest thing to being back in the womb.

And your idea of beauty heaven? My last pampering holiday in the Maldives. The hotel spa was right on the water and had a glass floor, so I could see the fish swimming while I was being massaged.

WhatOs your worst beauty crime? IOm very hairy and often forget to pluck my eyebrows and look like a monster. My make-up artist will take one look at me and attack me with her tweezers.

Are you high-maintenance? No. LifeOs too short to cleanse, tone and moisturise every single night, so I donOt give myself a hard time if I forget. When IOm on holiday, IOm especially lazy. My hair grows so fast in the sun and I donOt bother shaving my legs. But youOve got to let things be natural sometimes.

YouOre 34 now I how do you feel about ageing? IOd like to think IOll grow old gracefully, and I hope every single wrinkle on my face tells a story. IOm not going to get paranoid about getting older because IOve still got lots to do with my life.

Would you ever have plastic surgery? I think weOre in a phase where itOs acceptable, but personally IOm scared about going under the knife for something that isnOt medically necessary. But in 20 years I might say, OGosh I look awful, surgery would really make me happy.O

Are you careful about the sun? People say, ODonOt go in the sunO, but I think it makes you feel great, and if youOre sensible, why not enjoy it? I like to tan, but I donOt burn and I get my moles checked. I donOt think thereOs anything wrong with ending up looking a bit weathered I you look like youOve spent your whole life on holiday. What could be better than that?

How do you cope with a bad face day? I exfoliate to scrub away the greyness, then I slap on an intensive moisturising mask and drink loads of water.

How do you stay in shape? IOve got a personal trainer three times a week. If I stop exercising, I soon know about it I IOm low on energy and feeling untoned and podgy. Especially here (prods stomach). My mumOs just like me I if she puts on weight, her arms and legs stay the same, but her middle goes like a barrel.

Is there anything you would like to change about your body? Without wanting to sound smug, IOm pretty happy with myself at the moment.

So you donOt have any weight worries then? Oh, I have to work at it. IOve had fat times where IOve thought, OGod IOm never going to shift this before I start filmingO, but if I put my mind to it, I always can. My attitude is, donOt moan about it, be proactive and sort it.

Do you have cellulite? Everyone has some cellulite somewhere. If I clench my bum I can definitely find some, donOt you worry.

Have you ever done a detox? Every few months I do a detox where I drink a horrible tea that smells like camel poo, but itOs good to give my insides a rest every now and again. I do believe in a good clear-out. IOd love to go to one of those detox places in Thailand where they flush you right out with a week of colonics.

Are you shocked by how thin some celebs are? Being onscreen really does put pounds on you, so celebrities who look OK on TV often look horribly skinny when you see them in real life. ItOs all good for your work, but then youOve got to walk round all day looking that spindly and unhealthy.

So would you turn into an LA lollipop for your dream role? If the role was right, yes, but IOd always come back to the real me afterwards. But IOd slim down through exercise, not through some dangerous extreme diet.

WhatOs your diet like? Pretty healthy I I eat lots of salad, fruit, vegetables, fish, chicken and pasta. I donOt really eat desserts because I donOt have a sweet tooth I IOd rather eat a bowl of garlic-marinated olives than a Toblerone.

YouOre involved in AvonOs new breast cancer campaign I has it made you more health-conscious? ItOs made me realise how important early detection is, so IOm making the effort to check my breasts regularly. Kate Thornton actually showed me how to do it properly I she interviewed me for a programme she was making on breast cancer and she taught me which bits I had to feel.

The campaignOs called Shake It I whenOs the last time you had a good old boogie? IOm always dancing I itOs my way of throwing off a bad day. When IOm out, IOm always the first on the dance floor. IOll be up on the table if thereOs no other room. IOm very embarrassing. When IOm 80, IOm going to be the awful old granny who turns up to weddings and grinds away with all the young men.

To find out about Avon products, call 0845 601 4040 or log on to www.avon.uk.com. The Shake It! CD is a compilation of celebritiesO favourite dance tracks and costs pounds 6.99 I proceeds go to the Avon Breast Cancer Crusade. See www.avoncrusadeshakeit.co.uk

MY FIVE BEAUTY ESSENTIALS

Dermalogica Multivitamin Power Firm Lip & Eye Cream, pounds 22.75 This makes my skin feel really smooth and instantly softens lines. If my skinOs feeling tired, IOll treat myself to a Dermalogica facial.

Jo Malone Orange Blossom Bath Oil, pounds 35 If IOm relaxing at home, thereOs nothing nicer than a long soak in a bath full of this.

Acqua Di Parma Colonia, pounds 49.95 My signature scent I a gorgeous mix of citrusy and herby smells.

Avon Planet Spa Shea Butter Foot & Elbow Cream, pounds 4 So moisturising, and it smells gorgeous I like butterscotch. People always tell me, OMmm, you smell like a sweetie.O

Avon Face Pearls, pounds 7 These catch the light beautifully and are great for sweeping over cheekbones.

2005-12-24T20:55:00.000-05:00

Byline: ADRIENNE MCGILL

Bending the plastic and buying goods or services abroad may end up costing consumers a lot more than they bargained for. ADRIENNE MCGILL reports

ONE of the main benefits of using a credit card is being able to buy goods abroad.

But what happens when the quality of the goods or services purchased falls below the expected standard? Can consumers in the UK who use their credit cards abroad expect the same level of protection they would get if the purchase was made in the UK?

Card issuers and consumer associations have been arguing about this for decades. The level of protection offered to UK consumers on domestic transactions is in fact very high and exposes card issuers to liabilities which many consumers are unaware of.

In particular, if the goods or services paid for are defective and the consumer has a claim for misrepresentation or breach of contract against the supplier, then, provided that the consumer paid more than pounds 100 and less than pounds 30,000 for the goods or services, section 75 of the Consumer Credit Act 1974 gives them the option of suing the card issuer instead of the supplier.

But do these provisions apply with equal force to foreign transactions? It is never easy to pursue a foreign supplier. If section 75 were held to apply to foreign transactions then suing the UK card issuer would be a much easier option for consumers than pursuing the foreign supplier.

But would that place an unacceptable burden on the card issuers? They would effectively become insurers for millions of foreign supplies in situations where they would not know the supplier at all, would not have direct knowledge of the facts and would not be in a position to assess the merits of any claims.

Section 75 does not limit the liability of the cardholder to the amount spent on the card. If a consumer spends pounds 1,000 on plastic surgery abroad which then goes horribly wrong the card issuer could then be liable for the much larger sum needed to compensate the victim.

Against that background it is easy to see why card issuers have been concerned about their potential exposure to foreign claims, particularly given the exponential growth in foreign internet transactions.

In the absence of any clear authority from the courts, and under considerable pressure from consumer associations, some card issuers have in the past agreed to compensate consumers for foreign transactions on a voluntary basis, limiting the amount of compensation paid to the amount actually spent on the card.

Earlier this year though the Office of Fair Trading (OFT) took more formal steps to bring matters to a head by bringing a test case in the High Court. The case was finally decided on November 12 and, in a decision which is likely to be greeted with joy by the card issuers and dismay by consumer groups, the court ruled that consumers entering into foreign transactions are not afforded the same degree of protection as they are for domestic transactions.

In reaching her decision the judge explored the historical context in which the legislation had been drafted and concluded that it was a different world from the modern market place. The rights afforded to the consumer had been granted on the basis that the credit card issuer would have a right of indemnity from the supplier.

At that time it had been envisaged that the relationship between the credit card issuer and the supplier would be such that the credit card issuer would be able to put pressure on the supplier to deal with the customer complaint or face withdrawal of financing facilities.

However, in the modern market place, and particularly in the context of a foreign transaction, the card issuer would be unlikely to have such a relationship with the supplier. There was nothing either explicit or implicit in the Act which suggested that it should have extra-territorial effect.

Kevin McNamara of the Trading Standards Service in Northern Ireland said: "This ruling removes a very useful form of protection, which has been used by consumers in the past to obtain redress in situations where it would otherwise not have been available. We have had cases where consumers who had used their credit card to pay a deposit on a timeshare or holiday club, which they had bought while on holiday in Spain, had been able to claim back off the credit card company when they found on their return to Northern Ireland that the deal had been misrepresented to them, or their contract had been breached. It means that holiday makers in these situations will just have to be that little bit more careful in the future when entering onto contracts abroad." * Consumers who want further advice about this subject should contact Consumerline on 0845 600 6262.

2005-12-22T18:37:00.000-05:00

In order to counsel the surgical patient, the nurse needs to have a clear picture of home recovery based on the patient's biophysiologic health problems. The purpose of this study was to examine short-stay surgery patients' experiences of pain, nausea, vomiting, fatigue, and problems with elimination and wound healing during a 1-week recovery phase at home.

Advances in medical technology and the drive to cost-effectiveness in health care have provided a major boost to short-stay surgery. In Finland, the goal was to have 50% of all elective surgeries done on an ambulatory basis by 2003. Elective surgery includes surgical procedures which are planned and organized beforehand; those procedures coming via emergency room are excluded. This figure currently varies in different hospitals from 28% to 59% (Punnonen, 2001). In many countries, however, outpatient services and follow-up procedures have failed to keep up with the rapid development in ambulatory surgery (Bruce, Russell, Mollison, & Krukowski, 2001). During recovery at home, the short-stay patient has to manage alone or rely on help from significant others. To provide support for the patient returning home, the nurse needs a clear picture of the patient's condition and possible health problems. The patient also needs to know what to expect, and how long any biophysiologic health problems will continue. Furthermore, the patient needs concrete advice on how to prevent and manage these problems in everyday life.

This study was concerned with the biophysiologic health problems of two groups of short-stay patients: day surgery patients (24 hours), and patients hospitalized for no more than 3 days. Its aim was to increase awareness of the biophysiologic health problems that short-stay patients may experience at home. With this knowledge and understanding, the nurse will be able to provide better counseling services and appropriate interventions. Ultimately this will help to raise the quality standards of patient care and nursing, both in the hospital and in home nursing contexts.

Review of the Literature

Earlier nursing and medical studies of pain, nausea and vomiting, fatigue, and problems with elimination and wound healing in short-stay surgery patients have different philosophical underpinnings and have been conducted in different cultural environments. They also vary widely in terms of their sample sizes, methods of data collection, anesthetic techniques, and surgical procedures. However, all these studies have shown that short-stay patients have difficulties managing their biophysiologic health problems sufficiently during recovery time at home. These problems should be studied in the Finnish context as well.

Pain

In the current study, acute postoperative pain was measured on the single dimension of intensity with five items on a 5-point Likert scale as described by the individual patient. The measurement of chronic pain was excluded in this study by asking patients to evaluate contemporary acute postoperative pain caused by the surgical procedure. Measurements of pain experienced by short-stay patients on the first day at home have yielded different results depending on the surgical procedures and the methods of measurement. Cason, Seidel, and Bushmaier (1996) reported that 81% of patients who underwent laparoscopic cholecystectomy had pain on the 2nd day at home. However, by the 7th postoperative day, 50% of the patients still had pain and 31% used pain medication. Other studies have also seen a progressive decrease in experiences of pain (Keulemans, Eshuis, de Haes, de Wit, & Gouma, 1998; Young & O'Connell, 2001). Some patients undergoing different kinds of surgical procedures have complained that pain relief was inadequate (Aasboe, Raeder, & Grogaard, 1998; McHugh & Thoms, 2002; Rawal, Hylander, Nydahl, & Gupta, 1997; Waterman, Leatherbarrow, Slater, & Waterman, 1999), and that instructions about pain control were unclear or nonexistent during the recovery phase at home (Beauregard, Pomp, & Choiniere, 1998; Young & O'Connell, 2001).

Upper Gastrointestinal Distress

In the current study, upper gastrointestinal distress included nausea and vomiting. The proportion of short-stay patients who vomit or feel nauseated after surgery varies considerably, even when the operations and anesthetic techniques are very similar (McQuay & Moore, 1998). According to some studies, general anesthesia is associated more with higher rates of nausea and vomiting than face-mask anesthesia or regional blocks (Thompson 1999). Patients undergoing orthopedic and certain other operations, such as hemorrhoidectomy, have reported nausea and vomiting at home during the first day (Claxton, McGuire, Chung, & Cruise, 1997) and the first week (Aasboe et al., 1998) after their operation. Rawal et al. (1997) found that 20% (n=1,035) of patients from various operations suffered from nausea during the first 48 hours after surgery. According to Cason et al. (1996), 17% of laparoscopic cholecystectomy patients had nausea even on the 7th postoperative day. These biophysiologic health problems decreased considerably in different patient groups during the first week (Hunt, Luck, Rudkin, & Hewett, 1999; Young & O'Connell, 2001). Very few patients suffered from vomiting, particularly for extended periods after the operation (Ashworth & Smith, 1998).

Fatigue

Fatigue is used by patients themselves to assess their postoperative recovery (Kleinbeck, 2000). In the current study, fatigue as well as pain were measured with five items on the single dimension of intensity as described by the individual patient on a 5-point Likert scale. Short-stay patients undergoing different surgical procedures are usually fatigued to some extent (Rawal et al., 1997). Fatigue may last longer than expected, and it may also hinder normal daily activities (Young & O'Connel, 2001). In some cases patients needed to contact a health care provider or significant others to get help (Ruuth-Setala, LeinoKilpi, & Suominen, 2000).

Problems in Elimination

Problems include both bladder and bowel elimination. Patients who undergo spinal or epidural anesthesia and pelvic surgery may be unable to control their bladder (Korttila, 1991, 1995; Rawal et al., 1997) and bowel function (Campanelli et al., 1998). Some patients undergoing hydrocelectomy and varicocelectomy have reported difficulties in urinating (Twersky, Fishman, & Homel, 1997). Opioid analgesics can decrease the motility of the alimentary tract (Pasero, Paice, & McCaffery, 1999). On the other hand, pain itself can make it difficult to urinate and defecate after a surgical procedure. Furthermore, patients may avoid moving because of pain, and refrain from drinking and eating to avoid nausea and vomiting (Waterman et al., 1999). This increases the risk of constipation. Campanelli et al. (1998) found that 90% of patients had normal bowel peristalsis within 24 hours of laparoscopic cholecystectomy. Young and O'Connell (2001) indicated that by day 4 after laparoscopic cholecystectomy, most patients had returned to normal bowel habits.

Problems in Wound Healing

Wound healing can be divided into three distinct phases--inflammation, proliferation, and maturation--each showing its own characteristic biophysiologic features. The common features of a healing wound in the first few days after surgery are redness, swelling, incision pain, and localized heat (Dealey, 1994). Other complications include incision ache, swelling, bleeding, serous exudate, bruises, wound hematoma, and wound disruption. Surgical wound infection can cause scar tissue to develop and further give rise to scar pain (Stotts, 1993). Evaluation of surgical wound healing is problematic because the normal phases show the exact same symptoms as complications: ache, swelling, and redness.

In Finland, no records are kept of the exact rate of wound complications. Studies in other countries have shown that wound infection rates vary from 3.5% to 15.9% (Twersky et al., 1997; Zoutman, Pearce, McKenzie, & Taylor, 1990). In a study comprising gastroenterologic, orthopedic, vascular, plastic, and urologic day surgery, Grogaard, Kimsas, and Raeder (2001) reported a wound infection rate of 3.5%. Direct comparison of these wound infection results is not, however, possible because of the culture, definitions, and methods of measurement (Bruce et al., 2001), and their nature, sample sizes, surgical procedures, and methods of data collection. In the current study, problems in wound healing included redness, swelling, ache, bleeding, discharge and odor of the pus, disruption of the incision wound, and wound infection, which is considered if antibiotics were prescribed for the infection of the incision wound.

Purpose of the Study and Research Questions

The purpose of this study was to describe short-stay surgery patients' perceptions at home after discharge, of pain, nausea, vomiting, fatigue, and problems in elimination and wound healing caused by surgical procedure. The authors had three specific interests: (a) the incidence; (b) intensity of the experiences of pain, nausea, vomiting, fatigue, and problems in elimination and wound healing in the recovery phase at home; and (c) the change in the incidence and intensity of these biophysiologic health problems during the first week of recovery.

Sample and Questionnaire

The study was conducted on six surgical wards of four district hospitals performing short-stay surgery in southern Finland. The country has a total of 26 district hospitals; the four selected for this study were chosen because they perform identical surgical operations with the same types of patient groups. The study protocol was approved by the institutional review board of each participating hospital. The convenience sample of 200 voluntary informants recruited for the first measurement (1-2 days postoperatively) included short-stay patients who had undergone an orthopedic, general surgical, or urologic procedure at the time of data collection, who were at least 16 years of age, who were Finnish-speaking, and who were independently able to complete the questionnaire. Gynecologic patients were excluded to avoid gender bias; ear, nose, and throat surgical patients were excluded because they were mainly under 16. The cover letter attached to the questionnaire informed the respondents of the purpose of the study and stressed that participation was voluntary.

Fifty questionnaires were distributed at each of the four hospitals (N=200). The sample for the second measurement (1 week after the operation) consisted of those patients (n=73) who in the first measurement indicated they were willing to take part in the second stage and who gave their contact address for the next questionnaire. The response rate in the first measurement was 54%, with 107 patients returning the questionnaire; the corresponding figure for the second measurement was 32% (64).

Instruments

No tools are available for measuring all the previously mentioned biophysiologic health problems. Most existing tools are not suited for measuring the intensity of biophysiologic health problems unidimensionally (Frank-Stromborg & Olsen, 1997) and subjectively from the patients' point of view. The authors therefore designed a new 27-item, structured questionnaire for purposes of collecting the required data. The main items concerning biophysiologic health problems were identical in questionnaires 1 (1 to 2 days postoperatively) and 2 (1 week after the operation). The development of questionnaires was based on the literature and earlier studies in medicine and nursing science. Pain and fatigue were measured with five items, upper gastrointestinal distress with four, and problems in elimination with three items on a 5-point Likert scale. Five items to address problems in wound healing were measured with a dichotomic scale (yes--no). The biophysiologic health problems measured in this study varied in terms of the extent; therefore, the operationalization and number of items measuring these problems varied as well. Before pilot-testing, the questionnaires were reviewed by lay people (2), nurses (2) working in a short-stay surgery ward, and an expert panel that included professors (2) and students (10) of nursing science. The questionnaires were pilot-tested with six patients on a surgical ward. Only a few minor adjustments were made on the basis of the feedback.

The demographic data showed that most respondents to questionnaire 1 were ages 30 to 60 and had completed upper secondary school or less. In this population, the majority of patients had been hospitalized for more than 1 day but no more than 3 days. Daysurgery patients accounted for 35% of all subjects. The recruited patients had been admitted for orthopedic surgery, general surgery, or urologic procedures. The majority underwent the operation under local anesthesia and had prior surgical experience (see Table 1).

Analysis

Statistical data analysis was conducted using Statistica software 5.1. Descriptions of pain, upper gastrointestinal distress, and fatigue, as well as problems in elimination and wound healing, were based on frequency and percentage distributions. In addition, sum variables were constructed on the basis of the responses to statements concerning pain, fatigue, and problems in elimination. If at least half of the respondents had answered the items, the sum variables were constructed by adding up the response scores. The nonrespondents were coded by using zero. In the case of upper gastrointestinal distress, only 44 of the 107 respondents answered the question concerning the amount of emesis in conformity with the instructions; therefore, it was not possible to construct a sum variable. Problems in wound healing were addressed by a number of different items and therefore could not be reduced into a sum variable. Cronbach's alpha values of 0.70 or higher were considered desirable in pain and fatigue items (Polit & Hungler, 1997). Items which considerably reduced the Cronbach's alpha were excluded from the sum variable, but not from the questionnaire. Lower Cronbach's alpha levels were accepted in the measurement of problems in elimination, which included two different items (urinating and constipation) (see Table 2).

In the items measuring pain, nausea and vomiting, and problems in elimination, the lowest scores were recorded for the no/not at all response options and the highest scores for the other extreme of to a great extent (1 = no/not at all, 2 = to some extent, 3 = don't know, 4 = to a great extent, 5 = to a very great extent). All fatigue items were translated into positive items for the sum variable, which made a high score indicative of a nonsignificant problem. The items measuring wound healing were dichotomic. Results reflecting no problems got a value of zero, and those reflecting problems got a value of one.

Five different tests were used in the statistical analyses. The Mann-Whitney U-test was used in analyzing the association of background variables (gender, basic education, day surgery, and short-stay surgery patients) with sum variables. Kruskall-Wallis ANOVA and the Median test respectively were used in analyzing the association of vocational education background variables (no vocational education, school-level vocational education, postsecondary vocational education, academic degree) with sum variables. Spearman rank correlation test and Analysis of Variance were used for analyzing the association with age. The associations of background variables with other individual items remaining outside the sum variables were examined by cross-tabulation. The statistical significance of differences between groups was measured by Pearson's Chi Square Test. P-values of 0.05 or less were interpreted as statistically significant. Differences in the incidence and intensity of biophysiologic health problems between the two measurements were determined on the basis of sum variables by using the Wilcoxon Signed-Rank Test.

Results

Pain. Pain was the most common health problem among the short-stay surgery patients in this study. One or 2 days after discharge (questionnaire 1), more than half of the respondents reported some pain with movement (57%) and also at rest (52%). Almost one-fifth had pain while moving (19%) and sitting (19%). Most of the respondents used analgesics (63%) and noted that they reduced pain. However, 13% were of the opinion that analgesics had little effect (see Table 3).

Comparison of the sum variables for patients who took part in both measurements indicated a clear decrease in the intensity of experiences of pain during the first week after discharge (Wilcoxon Signed-Rank Test, p=0.000). Nonetheless, 63% of the respondents still had at least some pain while moving, and about 40% while sitting and resting. No one reported severe pain at this stage. The use of analgesia was reduced by more than one-third. Five respondents stated that analgesics gave them no relief at all. In these two measurements, no statistical significant differences existed (Kruskal-Wallis ANOVA) among the general surgical, orthopedic, and urologic patients groups, which may be due to the small sample sizes.

Upper gastrointestinal distress (nausea and vomiting). The clear majority of respondents (82%) had not vomited during their first days at home, and vomiting had not prevented them from doing daily activities. Less than one in five (17%) reported some nausea, and five stated nausea had to some extent prevented them from doing daily activities. One week after discharge (questionnaire 2), one respondent reported having vomited and four (6.5%) still had nausea. Type of anesthesia correlated with upper gastrointestinal distress; 1 to 2 days after surgery, those who had undergone general anesthesia suffered from nausea more often than those who required local or regional anesthesia (Kruskal-Wallis test, p=0.003). Upper gastrointestinal distress was not a major problem for the short-stay patients in this study.

Fatigue. Almost all informants reported experiences of fatigue, but very few said that it had been severe. One to 2 days postoperatively, most respondents (77%) had to rest during the daytime, but the majority could still cope with their daily activities (97%). Experiences of fatigue decreased considerably between the two points of measurement (p=0.000). However, the proportion actually increased of those who were too tired to cope with daily activities and who felt that resting did not help to reduce fatigue. Over half of the respondents (53%) felt very or extremely energetic, and 56% reported that they could cope with their daily activities to a great extent. Four respondents (6.5%) could not cope with their daily activities at all, while 54% still had to rest during the daytime. For five respondents (9.6%), resting did not help to reduce the feeling of fatigue.

Problems in elimination. Constipation was the main concern (27%), and it decreased between the two points of measurement (14%). At the first point of measurement, some respondents had difficulties in getting urine to flow (11%) or in controlling the flow of urine (9%) (see Table 3). At the second point of measurement, the percents were the same.

Problems in wound healing. More than half of the respondents (54%) experienced aching in the incision wound, and 7% also reported bleeding. Four percent received an antibiotic prescription for the surgical wound infection. The problems of redness, swelling, and bleeding did not change to any significant extent during 1 week at home. The incision wound caused less aching, hut the incidence of aching was still 33% (see Table 4).

Reliability and Validity

The reliability of the instrument was tested for internal consistency by Cronbach's alpha. The alpha value for the sum variable measuring pain was 0.82 in questionnaire 1 and 0.86 in questionnaire 2; the corresponding figures for the sum variable measuring fatigue were 0.77 and 0.71, and measuring problems in elimination 0.56 and 0.51 (see Table 2). A coefficient of reliability in excess of 0.70 is considered desirable in a new instrument that has not been used before (Nunnally & Bernstein, 1994), especially when the researcher is interested in making group-level comparisons, as is the case in this study (Polit & Hungler, 1997).

The upper gastrointestinal distress item caused some problems due to missing responses to the question concerning the number of times the respondents had vomited ("I have vomited about ... times"). The informants were expected to indicate the appropriate number from 0 upward. However, three different methods were used in responding to this question. Another point that should be made clearer in the instructions is the time span that the measurement covers.

The validity of the instrument was assessed in terms of content validity and construct validity. Content validity was supported by the literature review (LoBiondo-Wood & Haber, 1994). Furthermore, content of the new instrument was assessed by a group of nurses (10) and patients (2) as well as by a specialist in statistical methods (1). The feedback received was used in further developing the instrument. Construct validity was also supported by Cronbach's alpha.

Limitations

The credibility of the research procedure can be assessed in terms of internal and external validity and in terms of statistical conclusion validity. The primary concern has to be with internal validity, because that will also determine external validity. One threat to internal validity is represented by selection bias (Polit & Hungler, 1997). In this study, the selection of respondents could have been influenced by the fact that the questionnaires were handed out on the wards by nurses. Their efforts to motivate all the patients similarly were guided and supervised personally by the researcher with verbal and written instructions. However, the researcher was not able to control how nurses actually distributed questionnaires and how they motivated patients to take part to the study.

The study was carried out in two phases, which itself may give rise to response fatigue (Burns & Grove, 2001). One indication of this is that, contrary to the instructions, some informants mentioned experiences of nausea outside the period of measurement; however, they always clearly indicated when this was the case. It is possible that response fatigue may have undermined the reliability of the results and reduced the response rate to some extent, which would affect external validity as well (Burns & Grove, 2001). Any generalizations beyond the study's population have to be made with extreme caution because the nonresponse rate 1 to 2 days postoperatively was relatively high at 46%. Reminders could not be used in this study because the names and addresses of the respondents were destroyed immediately after the questionnaires had been mailed. Analysis of nonresponse by demographic background variables revealed no systematic patterns.

The study has some limitations that need to be noted. The number of patients was relatively small, and the lack of significant differences between the patient groups (or other variables) may be due to low statistical power. The study has demonstrated to what extent short-stay patients who have had a surgical procedure in a district hospital in Finland suffer from pain, nausea and vomiting, fatigue, and problems in elimination and wound healing 1 to 2 days and about a week after the operation. These results do not indicate how patients manage these problems and what the problems mean to them. Because the patients' health conditions were not measured prior to the ambulatory surgical procedure, it is possible that some of these patients suffered from chronic pain, fatigue, or constipation. However, the instructions in the questionnaire did make it clear that the statements concerned biophysiologic health problems specifically caused by the surgical procedure.

Discussion

This study was concerned with the biophysiologic health problems experienced by short-stay surgery patients. In line with earlier findings (Beauregard et al., 1998; Waterman et al., 1999; Young & O'Connell, 2001), the most common reported problem in this study was pain. It is notable that 1 to 2 days after surgery, 36 out of 104 patients were not using analgesia; 1 week after surgery, the figures were 44 out of 64, respectively. Experiences of pain decreased during the first week, but some patients complained that their analgesic provided no real relief; Cason et al. (1996) made the same observation in their study. It seems that at least some of the patients who reported pain were not making proper use of the pain management methods available, but it was not possible within the confines of this study to look into this question in closer detail.

It is possible that patients are unaware of the adverse affects of inadequate pain control upon recovery after surgery. They should be taught that the physiologic stress response triggered by surgery and unrelieved pain can adversely affect circulation and suppress immune functions, while the use of analgesics even in advance can help to inhibit the stress response and so contribute to the healing process (Pasero et al., 1999; Pavlin, Chen, Penaloza, Polissar, & Buckley, 2002). Patient counseling should consider all these issues and additionally give patients the opportunity to ask questions (Beauregard et al., 1998; McHugh & Thoms, 2002). Patients also should be informed about the purpose and different types of analgesics, as well as the additional use of nonpharmacologic treatments such as cold packs and relaxation techniques (for example, music, massage) according to patients' preferences. These interventions may have benefits such as making pain more bearable, reducing distress and muscle tension, and providing a sense of control (McCaffery & Pasero 1999).

Upper gastrointestinal distress was not a major problem for short-stay patients in this study. The severity and duration of upper gastrointestinal distress depends, among other things, on the type of anesthesia employed (Apfelbaum et al., 2002) and on the surgical procedure. The absence of severe nausea in this study is explained in part by the fact that most patients (approximately 80%) received regional anesthesia. Those who had their operation under general anesthesia suffered from nausea more often 1 to 2 days after the operation. Because regional anesthesia is generally favored for short-stay surgical procedures in Finland, this study's results on the incidence and intensity of upper gastrointestinal distress may reflect the national situation.

Although rarely severe, fatigue was a common health problem shared by almost all short-stay patients. Almost all patients were able to manage their daily activities, but they needed to rest. Most patients said they were feeling less fatigued by the 7th postoperative day, although some patients still had to rest during the daytime even when they felt energetic. Cason et al. (1996) and Kleinbeck and Hoffart (1994) reported similar results. Patients should know that they will need time to rest for at least 1 week after the operation. This may mean they will need to make special arrangements for housework and child care during recovery. Young and O'Connell (2001) made the same observation.

Almost one in three patients had constipation during the first days at home; this problem was more persistent than the other biophysiologic health problems. Pain can restrict patients' mobility and cause decreased bowel elimination. On the other hand, constipation may be due to the use of opioid analgesics, which decrease the motility of the bowel (Pasero et al., 1999). For proper prevention and management of constipation, patients need to be informed before surgery about the possible side effect of the use of opioids. This will allow them to plan their diet and the use of laxatives and stool softeners. Patients also need to be aware of the importance of physical activity after the operation.

This study found no threats to the healing process of the incision wound. However, every other patient (53 of 99) suffered from incision ache during the first days after the operation; by the 7th day, one-third still complained of aching. This result clearly underscores the need for improved pain management. Four patients out of 99 (4%) received an antibiotic prescription for surgical wound infection soon after the operation. This result reflects the findings of Zoutman et al. (1990), who reported an infection rate of 5.05%. This study was unable to produce final figures on surgical wound infection, which may take up to 30 days from the operation to develop (Fanning, Johnston, MacDonald, LeFort-Jost, & Docerty, 1995). Because many monitoring programs exclude patients undergoing day surgery, there is no evidence on the infection rate universally (Bruce et al., 2001).

How can nurses put these results to good use with the ambulatory surgery population? The findings clearly underline the importance of increasing efforts in patient counseling concerning the prevention and management of pain, fatigue, constipation, and incision wound aching. The timing of counseling is particularly crucial so that patients are aware of potential problems in advance and can make arrangements for the recovery phase at home. Before discharge, they need concrete advice on how to prevent and manage potential biophysiologic health problems in their everyday lives. Nurses may not have the tools they need to make sure that patients really understand and accept the instructions they are given; indeed, there is an urgent need to develop methods for assessing the effectiveness of counseling and for monitoring short-stay surgery patients' recovery at home.

Further research with larger sample sizes should look separately at the distinctive biophysiologic health problems of patients undergoing certain types of short-stay surgical procedures with certain anesthesia techniques. The results should provide important clues about targeting counseling efforts and developing their content and methods. By extending the time span to 1 month after the operation, studies could gain useful information about how long patients' biophysiologic health problems continue and how long the recovery phase lasts at home. Current literature does not identify the meaning of these biophysiologic health problems to short-stay patients or how they cope with them. Qualitative research is needed to fill in this gap.

Ethical Considerations

A basic requirement in any scientific research is that participation is genuinely voluntary. During the first measurement for this study, the patients were recovering at home and therefore were unlikely to feel any dependence on the hospital and its staff; this may have contributed to creating a genuine sense of voluntary participation. By contrast in the second stage, the respondents who volunteered to take part had to give their names and addresses to the researcher, which may create some sense of commitment (Thompson, Melia, & Boyd, 1994). The requirements of privacy and dignity are obviously easy to meet when the respondents can fill in the questionnaires at home (Burns & Grove, 2001).

A potential source of emotional discomfort is that the questionnaire required the participants to concentrate on unpleasant responses and to disclose personal feelings to the researcher. The decision by the respondents to return the questionnaire was regarded as a sign of their informed consent (Burns & Grove, 2001).

Conclusion

Given the rapid growth and expansion of short-stay surgery, especially day surgery, the nursing knowledge and practical care of these patients may need to be refocused. More research is needed into the knowledge of nurses taking care of day-surgery patients in hospitals as well as in home care settings.

Table 1. 
Demographic Data 1 to 2 Days (Q1) 
and 1 week (Q2) after surgery 
 
Demographic Variable                               Q1        Q2 
 
                                               n    %    n    % 
Gender 
Male                                           53   50   32   50 
Female                                         53   50   32   50 
 
Basic education 
Middle school/comprehensive school or less     85   82   49   78 
Senior secondary school                        19   18   14   22 
 
Vocational education 
No vocational education                        35   35   19   32 
School-level vocational education              39   39   20   34 
Post-secondary vocational education            23   24   18   31 
Academic degree                                2    2    2    3 
 
Duration of hospitalization 
Over 1, but not more than 3 days               68   65   43   67 
24 hours or less, no overnight (day surgery)   36   35   21   33 
 
Surgical specialization 
Orthopedic                                     51   52   32   52 
General surgery                                45   45   29   47 
Urology                                        3    3    1    1 
 
First procedure for patient 
Yes                                            17   16   10   16 
No                                             88   84   54   84 
 
Type of anesthesia 
Local or regional                              87   83   50   78 
General                                        18   17   14   22 
 
Table 2. 
Sum Variables and Statistical Measures of Biophysiologic 
Health Problems 1 to 2 Days (Q1) and 1 Week (Q2) After 
Surgery 
 
Biophysiologic   Items Included 
Health           in Sum                         SD             M 
Problem          Variables                 Q1     Q2     Q1     Q2 
 
Pain             I feel pain               3.5    2.8    8.3    6.4 
                   while moving. 
                 I feel pain 
                   while sitting. 
                 I feel pain 
                   while resting. 
                 I use pain medication 
                   to relieve 
                   pain caused by 
                   the operation. 
 
Fatigue          I feel energetic. 
                 I feel I have             3.4    3.0    13.8   15.5 
                   no energy left. * 
                 I can cope with my 
                   everyday chores. 
                 I have to rest during 
                   the daytime (because 
                   I get so tired). 
Problems in      I have difficulties       1.3    1.2    3.7    3.5 
elimination        getting urine 
                   to flow. 
                 I have difficulties 
                   controlling the 
                   flow of urine. 
                 I have constipation. 
 
Biophysiologic   Items Included 
Health           in Sum                    Alpha 
Problem          Variables                 Q1     Q2 
 
Pain             I feel pain               0.82   0.86 
                   while moving. 
                 I feel pain 
                   while sitting. 
                 I feel pain 
                   while resting. 
                 I use pain medication 
                   to relieve 
                   pain caused by 
                   the operation. 
 
Fatigue          I feel energetic. 
                 I feel I have             0.77   0.71 
                   no energy left. * 
                 I can cope with my 
                   everyday chores. 
                 I have to rest during 
                   the daytime (because 
                   I get so tired). 
Problems in      I have difficulties       0.56   0.51 
elimination        getting urine 
                   to flow. 
                 I have difficulties 
                   controlling the 
                   flow of urine. 
                 I have constipation. 
 
* The Likert-scale reversed (5-1) before statistical analysis 
(SD = standard deviation, M = mean, Alpha = Cronbach's alpha) 
 
Table 3. 
Responses to Items Concerning Pain, Fatigue, Problems in Elimination 
and Upper Gastrointestinal Distress 1 to 2 Days after the Operation 
(Q1) (Numbers Rounded to the Nearest Whole Number) 
 
                                            No/Not   To Some   Don't 
Items                                       at All   Extent    Know 
 
Pain 
 
I feel pain while moving. 
n=103                                Freq     18       59        2 
100%                                  %       18       57        2 
 
I feel pain while sitting. 
n=102                                Freq     42       39        2 
100%                                  %       41       38        2 
 
I feel pain while resting. 
n=102                                Freq     36       53        0 
100%                                  %       35       52        0 
 
I use pain medication to relieve 
pain caused by the operation. 
n=104                                Freq     36       48        3 
100%                                  %       35       46        3 
 
Pain medication alleviates pain.     Freq     1        11       12 
n=84                                  %       1        13       15 
100% 
 
Upper Gastrointestinal Distress 
 
Vomiting prevents me from doing my 
daily activities.                             89        0        0 
n=89                                 Freq    100        0        0 
100%                                  % 
 
I feel nauseous (sick). 
n=102                                Freq     85       17        0 
100%                                  %       83       17        0 
 
Nausea prevents me from doing my 
daily activities. 
n=99                                 Freq     94        5        0 
100%                                  %       95        5        0 
 
Fatigue 
 
I feel energetic. 
n=101                                Freq     22       42        9 
100%                                  %       22       41        9 
 
I feel I have no energy left. 
n=100                                Freq     59       28        7 
100%                                  %       59       28        7 
 
I can cope with my daily activities. 
n=101                                Freq     3        39        4 
100%                                  %       3        38        4 
 
I have to rest during the daytime 
(because I get so tired). * 
n=98                                 Freq     22       52        6 
100%                                  %       23       53        6 
 
Resting alleviates fatigue. 
n=91                                 Freq     2        26       15 
100%                                  %       2        29       16 
 
* Likert-scale reversed (5-1) before statistical analysis 
 
Problem in Elimination 
 
I have difficulties getting urine to flow. 
n=104                                Freq     93       10        0 
100%                                  %       89       10        0 
 
I have difficulties controlling the flow 
of urine. 
n=104                                Freq     95        6        1 
100%                                  %       91        6        1 
 
I have constipation. 
n=103                                Freq     75       20        3 
100%                                  %       73       19        3 
 
                                              To     a Very 
                                            Great     Great 
Items                                       Extent   Extent 
 
Pain 
 
I feel pain while moving. 
n=103                                Freq     20        4 
100%                                  %       19        4 
 
I feel pain while sitting. 
n=102                                Freq     19        0 
100%                                  %       19        0 
 
I feel pain while resting. 
n=102                                Freq     10        3 
100%                                  %       10        3 
 
I use pain medication to relieve 
pain caused by the operation. 
n=104                                Freq     14        3 
100%                                  %       13        3 
 
Pain medication alleviates pain.     Freq     44       16 
n=84                                  %       52       19 
100% 
 
Upper Gastrointestinal Distress 
 
Vomiting prevents me from doing my 
daily activities.                             0         0 
n=89                                 Freq     0         0 
100%                                  % 
 
I feel nauseous (sick). 
n=102                                Freq     0         0 
100%                                  %       0         0 
 
Nausea prevents me from doing my 
daily activities. 
n=99                                 Freq     0         0 
100%                                  %       0         0 
 
Fatigue 
 
I feel energetic. 
n=101                                Freq     20        8 
100%                                  %       20        8 
 
I feel I have no energy left. 
n=100                                Freq     4         2 
100%                                  %       4         2 
 
I can cope with my daily activities. 
n=101                                Freq     44       11 
100%                                  %       44       11 
 
I have to rest during the daytime 
(because I get so tired). * 
n=98                                 Freq     16        2 
100%                                  %       16        2 
 
Resting alleviates fatigue. 
n=91                                 Freq     32       16 
100%                                  %       35       18 
 
* Likert-scale reversed (5-1) before statistical analysis 
 
Problem in Elimination 
 
I have difficulties getting urine to flow. 
n=104                                Freq     1         0 
100%                                  %       1         0 
 
I have difficulties controlling the flow 
of urine. 
n=104                                Freq     2         0 
100%                                  %       2         0 
 
I have constipation. 
n=103                                Freq     4         1 
100%                                  %       4         1 
 
Table 4. 
Frequencies and Percentages of Responses to Items Concerning 
Problems in Wound Healing 1 Week after the Operation (Q2) 
(Numbers Rounded to the Nearest Whole Number) 
 
Items                                              Yes   No 
 
Is there any redness in the incisional 
wound (operation area)? 
n=63                                        Freq   10    53 
100%                                         %     16    84 
 
Is there any swelling in the incisional 
wound (operation area)? 
n=63                                        Freq   22    42 
100%                                         %     33    67 
 
Is there any ache in the incisional 
wound (operation area)? 
n=63                                        Freq   21    42 
100%                                         %     33    67 
 
Is there any bleeding in the incisional 
wound (operation area)? 
n=63                                        Freq    2    61 
100%                                         %      3    97 
 
Is there any discharge of pus in the 
incisional wound (operation area)? 
n=63                                        Freq    1    62 
100%                                         %      2    98 
 
Does the pus have an odor? 
n=60                                        Freq    1    59 
100%                                         %      2    98 
 
Did the doctor prescribe antibiotics for 
you for the infection of the incisional 
wound (operation area)? 
n=63                                        Freq    3    60 
100%                                         %      5    95 
 
Has the incisional wound (operation 
area) disrupted? 
n=63                                        Freq    2    61 
100%                                         %      3    97

References

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Helena Susilahti, MNSe, RN, PhD(c), is a Clinical Nurse Specialist, District Hospital of Rauma, Rauma, Finland.

Tarja Suominen, PhD, RN, is a Professor, University of Turku, Department of Nursing, Finland.

Helena Leino-Kilpi, PhD, RN, is a Professor, University of Turku, Department of Nursing, Finland.

2005-12-20T10:27:00.000-05:00

Byline: Adrian Walker

Mar. 31--Fadhil Muammar is 17 months old, and yesterday he was screaming his lungs out in a crowded room at Massachusetts General Hospital. His company included his happy parents and a television crew, but his main interest seemed to be in playing with a plastic thermometer that he had discovered he could launch halfway across the room.

Fadhil is one of the few people whose life was saved by the tsunami that devastated his native Indonesia in December. The head injury he suffered while escaping the killer waves got him the medical attention he needed to solve a much more urgent problem.

As his mother Miswar put it, speaking through an interpreter, "It's like a dream, even better than a dream."

In escaping the tsunami, the baby had suffered a head wound. After his family was reunited, infection set in. The local doctors bandaged the cut and told his mother he would be fine.

But he wasn't fine, and she knew it. It wasn't just the head wound. For some time, she had noticed a swelling in his abdomen. It was big and growing. She had taken him to doctor after doctor, and none had been able to diagnose it.

The tsunami had brought one good thing to Banda Aceh: the USS Mercy, a US Navy ship that is, essentially, a floating 800-bed hospital. Along with the Navy personnel who typically staff it was a large group of volunteer doctors who had come in to help provide relief.

Miswar Muammar heard about the Mercy and the foreign doctors aboard and managed to get a referral from an Indonesian doctor, even though the doctor didn't see why she needed to go elsewhere for help.

The growth turned out to be a huge tumor on the baby's liver. Though benign, its sheer mass posed a danger to the organs around it and to Fadhil's life.

One of the doctors on the ship was Vicki Noble, an emergency room physician at Mass. General. Noble immediately recognized the severity of Fadhil's condition and the difficulty of treating it aboard the USS Mercy.

"The problem was that, given the surgical capabilities of the ship and the pediatric ICU capabilities, people didn't feel quite comfortable that it would go as smoothly as if we were back in the United States," Noble said yesterday.

Enter A. Raymond Tye.

To celebrate his 80th birthday a couple of years back, Tye, the chairman of United Liquors, one of the state's largest liquor distributors, had founded a medical foundation. After doctors and nurses were dispatched from MGH for tsunami relief, he made it known that he would be willing to contribute to medical costs, especially in a case that involved children. He was approached and agreed to pay for the liver surgery Fadhil needed, at a cost in the vicinity of $75,000.

Before the surgery could take place, there was one other complication to be negotiated, getting Fadhil and his parents out of Indonesia. There was no time to waste, because the ship was scheduled to leave in a matter of days. Through the efforts of Noble, a translator, and some compliant Indonesian and American bureaucrats, enough rules were bent to issue passports and visas in two days, and the group was ready to travel.

Fadhil's surgery took place at MGH on Monday, and where there was once a tumor the size of his head, now there is only a bandage. His prognosis, according to Noble, is excellent. His survival had been made possible by a mother's persistence and American generosity.

"I cannot repay with anything," Miswar said yesterday. "I hope God will pay a good deed, and all I can do is pray for all of you. I cannot express how grateful I feel."

There's a party planned in Fadhil's honor tomorrow, courtesy of the local Indonesian community. If all continues to go well, he could be out of the hospital in a week.

"I think he's going to grow into a troublesome teen who'll cause all kinds of havoc," Noble said yesterday. "Which is the point, I suppose, of all children."

Adrian Walker is a Globe columnist. He can be reached at walker@globe.com.

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2005-12-11T19:01:00.000-05:00

BURT REYNOLDS would no doubt give anything to return to the days when he was a fresh-faced sex symbol.

Anything including, it seems, large sums of money for plastic surgery.

The 1970s heartthrob appears to have had an extensive and expensive series of operations on his once-chiselled features.

But whether or not the result is an improvement is open to debate.

Reynolds, 69 next month, made his latest public appearance at the festivities surrounding this weekend's Superbowl event in Jacksonville, Florida. From a distance he looked in remarkable shape for his age. Close up, however, his appearance was less impressive.

'Burt's face has been pulled and stretched so much, it actually looks painful,' said one partygoer.

'His eyes looked incredibly tight and they appeared to be quite sunken. The eyebrows looked as if they were being pulled upwards by a piece of string.'

Plastic surgeon Alex Karidis, who regularly treats celebrity clients at his central London practice, said: 'The problem with Burt is that his skin has suffered an awful lot of sun damage, which has made it look crepey and lined.

'If a surgeon is trying to perform some sort of lift on sun-damaged skin they would have to work very carefully to avoid a bunching effect around the cheek area, which can happen when the patient has been overexposed to the sun. This is what appears to have happened in Burt's case.' Although the fact that he wears a wig is beyond dispute, Reynolds has always denied having plastic surgery. But he is thought to have undergone his first procedure - on his eyes - when he broke up with wife Loni Anderson in 1993, leading to a bitter and ruinous court battle.

According to Dr Karidis, he has probably spent at least [pounds sterling]20,000 on his appearance.

'It seems as if Burt has undergone a brow, mid-face and eye lift but the overall effect, coupled with his crepey skin, means he looks too stretched,' added the surgeon.

'He used to look cuddly and now, after all this work, he has a much harsher look to him.' Reynolds worked mainly as a TV actor until 1972, when his role in the film Deliverance established him as a star. He became the first male nude centrefold in Cosmopolitan magazine and over the next few years was Hollywood's biggest box-office attraction, starring in hits such as Hustle, and Smokey and the Bandit.

But his career began to decline following a 1984 jaw injury which left him addicted to painkillers - at one point he took 50 a day.

While struggling to beat his addiction - and beset by false rumours that his haggard appearance was the result of Aids - he starred in a series of flop films.

However, he made a successful comeback in the 1990s, in such films as Striptease and Boogie Nights.

l.benjamin@dailymail.co.uk

HAIR

A long-time wig wearer, Reynolds now prefers the natural cropped look, peppered with grey hairs

COST: [pounds sterling]1,000

FOREHEAD

Has brow lift helped remove telltale wrinkles?

COST: [pounds sterling]3,000

EYES

The actor appears to have undergone at least one upper and lower eye lift.

Excess skin is trimmed away, removing bags and wrinkles COST: [pounds sterling]5,000

CHEEKS

Muscles under Reynolds's cheeks appear to have been lifted to tighten central part of face

COST: [pounds sterling]4,000

CHIN AND NECK

Skin and muscle apparently tightened in lower facelift to eradicate jowls COST: [pounds sterling]7,000

2005-12-08T11:53:00.000-05:00

Byline: Allison Adato Adrienne Bard in Mexico City; Cary Cardwell in Nuevo Laredo; Maureen Harrington in Los Angeles; Andrea Orr in San Francisco; Tracie Powell in Dallas; Charlotte Triggs; Jennifer Wulff in New York City

Lots of people come back from a Mexican vacation with a tan. Suzanne Jacobson hoped for something even more dramatic. Friends had boasted to her of going over the border for a little R&R, a few margaritas--and an inexpensive tummy tuck or face-lift. "A group would go for the weekend, go to the clubs, sleep in the clinic, and someone would have a procedure," she says. "Then they'd drive back in time for work."

Jacobson, 50, learned about a favored Nuevo Laredo clinic, about 140 miles from her home in San Antonio, and headed there in February 2002 for a tummy tuck. She did return transformed, but not in the way she'd planned. When she got home, she says, her stitches burst, leaving an oozing hole the size of a fist in her abdomen. Today she is still disfigured. "I have really bad scars," she says. But costly reconstruction is out of the question: "I can't afford more surgery."

A growing number of Americans are discovering that they can save thousands of dollars by going to Mexico for cosmetic procedures and weight-loss surgery. While many return home with outstanding results, the bargains may come at a steep price for others. For Americans familiar with U.S. health care oversight, checking surgeons' credentials and the quality of facilities in a foreign country can be difficult. And many patients who travel to Mexico for procedures receive little or no follow-up care, leaving them at risk.

"There are first-class clinics in Mexico where people can feel totally assured they are getting the best care," says Dr. Sergio Maltus, Mexico's director of federal health inspectors. But not necessarily "if you go to a clinic hidden on a backstreet." Such clinics, which can charge a fraction of the cost of similar procedures in the U.S., may not be licensed by Mexican authorities. "Our work is not easy," says Maltus. "Some of these places don't even have signs."

"Mexico is well regarded as a plastic surgery center," agrees Dr. Sebastian Padron, an emergency room doctor in neighboring Laredo, Texas. Problems for foreigners arise, he says, when people fail to verify their surgeon's credentials. (See box, p. 119.)

While neither country keeps count of Americans seeking surgery in Mexico, one indicator of the rising trend is the uptick in those heading home to U.S. doctors for repairs--or simply the follow-up care they've failed to receive at the border clinics, where so-called "weekend warrior" doctors drop in briefly from other parts of Mexico to operate on Americans. "If the patient has complications and goes back," says Dr. Khalid Soleja, a surgeon in Harlingen, Texas, near the border, "9 times out of 10 the doctor who operated on them isn't there."

Due to liability risks, Dr. Soleja no longer takes repair cases. But he recounts a list of horrifying complications he has seen from botched over-the-border surgeries: holes left in a woman's ears after a face-lift; nipples missing after breast reduction; a woman in her 30s who died from organ failure after a severe infection following liposuction. "She went into shock," he says, "most likely from too much surgery."

Travel agencies are even getting in on the act, arranging airfare, accommodations and a clinic. And a growing number of facilitators, who receive commissions to direct patients to clinics over the border, advertise in the U.S. on TV, billboards and the Internet. One of the most ubiquitous is San Antonio businessman David Hernandez, known as Dr. Dave. He's not a doctor--though several patients, including Suzanne Jacobson, say he has been decidedly vague on that point--but the Texas-based promoter of a Nuevo Laredo clinic catering almost exclusively to Americans. In April, federal health inspectors temporarily barred the clinic from performing surgery. (See box below.)

Jacobson's journey began with a visit to Hernandez's San Antonio office, where, she says, despite his lack of medical training he assessed her as a good candidate for surgery. She had lost 120 lbs. after a gastric bypass. "He told me I needed lipo and a tummy tuck," and said the surgeries would cost $2,800. She agreed and, with her ex-husband, drove to Nuevo Laredo for the procedure in February 2002.

"As soon as I walked through the door, I knew it wasn't right," says Jacobson, who met her surgeon, Dr. Jose Luis Villareal, who is certified by the Mexican Council of Plastic Surgery, only after she was on the gurney. She claims she saw blood from previous patients pooled on the floor. Yet she went ahead, she says, because "I was desperate to change my appearance." After the surgery, she stayed three days before heading home. Two weeks later, she says, her sutures gave out and she returned to Nuevo Laredo twice for repairs.

Hernandez disputes much of her account, including the alleged bloody floor. Jacobson, he says, didn't follow post-op protocol of walking bent over for a week, which is why her stitches split. After the second restitching, he told her that he would charge her for another procedure. At that point, says Hernandez, "the complaints started."

Victoria Bray, 36, also went to the Nuevo Laredo clinic for multiple procedures. Though she had a life-threatening scare during her trip home, the manicurist, who lives in a suburb of Ft. Worth, is very happy with the results of her liposuction, tummy tuck, breast augmentation and underarm skin removal, all of which cost her $9000, an extraordinary saving over the $40,000 quote she got at home. (Despite the lower prices, the clinics are a boon for Mexican doctors, who make far less than their American counterparts. At a public hospital, a surgeon earns only $1,800 a month, says Hernandez. "He can earn that much in a weekend at the clinic.")

Bray flew home with her husband, LaRay, just three days after her 5 1/2-hour operation. Bleeding and fevered, she became disoriented on the plane. The pilot radioed ahead and she was rushed by ambulance to an E.R. in Grapevine, Texas. "I was very unhappy when her care fell into my lap," says the surgeon on duty, Dr. Randall Wright. "I saw her as a huge liability risk." Bray, he says, "had lost a great deal of blood," due to having so many procedures at once. And traveling after three days was "ill-advised. She had ongoing needs."

The clinic's owner, Dr. Luis Trevino-Cisneros, says that his facility has not had any complaints, does not discharge anyone if they are at risk, and patients are free to return if complications arise.

Bray, who is planning to have lower-body-lift surgery in Brazil, doesn't link the bargain prices to her complications. "What happened to me in Mexico could have easily happened here," she says. Dr. Wright isn't sure he agrees. "What she received is certainly not the typical standard of care here," he said. "Yes, it could happen in the U.S., but it's certainly less likely to happen."

Even going well beyond the border, to more southerly cities like Monterrey, doesn't always ensure a good result, unless prospective patients carefully research doctors, their facilities and surgical materials. Marlena Perkins, a Fremont, Calif., bus driver, was quoted $25,000 in the U.S. for a lap-band procedure, which aids weight loss by constricting the stomach and limiting the amount of food a person can eat. A doctor at a hospital in Monterrey, whom she had found online, said she could get one for $10,850. "That was my whole savings," she says. In September 2003 Perkins, now 28, was on a plane with her father.

She met her doctor, Rodolfo Sanchez, not long before the surgery. "He had a good bedside manner," says Perkins. After the procedure, which she believed went well, they hugged and took photos together. At home she began a diet of liquids and restricted foods prescribed by Dr. Sanchez. She took with her a list of local doctors who could offer follow-up care.

In the first month she lost 25 lbs. But then she started to feel very hungry, and saw a doctor to have the band tightened. Perkins reports that tests showed no band around her stomach at all. "I started crying," she says. "I spent all that money and it didn't do anything." Dr. Sanchez declines to comment on specific cases, but notes that "all surgeons make mistakes. Those things can and will happen even in the U.S."

Rather than return to Sanchez, in July of last year Perkins underwent lap-band surgery in San Francisco, at a cost of $14,000. During that operation, her surgeon, Dr. Paul Cirangle, found the Mexican lap-band below her stomach. "It was not an [FDA-approved] lap-band," he says. "And it had been put on improperly. It wasn't dangerous, but it obviously wasn't working." He put a new one in, and Perkins has since lost about 40 lbs. With a sigh she says, "I should have just had it done here in the first place."

By Allison Adato. Adrienne Bard in Mexico City, Cary Cardwell in Nuevo Laredo, Maureen Harrington in Los Angeles, Andrea Orr in San Francisco, Tracie Powell in Dallas and Charlotte Triggs and Jennifer Wulff in New York City

[BOX:]

FINDING A FOREIGN DOCTOR

You can get safe procedures outside the U.S., says Wendy Lewis, author of America's Cosmetic Doctors and Dentists, if you do some legwork:

(1) Use a doctor recognized by the International Society of Aesthetic Plastic Surgery (www.isaps.org). For Mexico, www.cirugiaplastica.org.mx lists board-certified plastic surgeons. Check that the clinic has an up-to-date license.

(2) Ask: Are there registered nurses? Do the staff speak English? If the procedure is to be done in a doctor's office, is there a nearby hospital, and what is done in the event of an emergency? What follow-up care is offered?

(3) The American Society of Plastic Surgeons says a reputable doctor will begin by taking a full medical history to determine if you're a good candidate for surgery.

(4) Be willing to walk away, says Lewis, if you don't have a good feeling about the facility.

[BOX:]

OPERATING UNDER THE RADAR

Two of the subjects interviewed for this story encountered problems after surgery at the same clinic, Centro de Ginecologia y Obstetricia in Nuevo Laredo, where Texas-based marketer David Hernandez had been steering American patients. So PEOPLE called the Mexican agency that licenses hospitals to inquire about the facility. Shortly after that call, the agency ordered an inspection of the clinic--owned by Mexican doctor Dr. Luis Trevino-Cisneros--which was unlicensed and therefore had never been monitored. While Centro's doctors are board-certified specialists, inspectors found several problems with the facility itself: inadequate barriers between surgical and nonsurgical areas, improperly calibrated anesthesia equipment, no backup power generator and expired vaccines. On April 22 authorities shut down the clinic's operating room. The closing came as a shock to Trevino-Cisneros, who says, "I've not had any problems, lawsuits, complaints. No clinic complies with all the articles in the Mexican health laws--there are too many demands." A few weeks later, Hernandez claimed the clinic's O.R. was back in business, after a May 4 visit by the local Tamaulipas state health department. "We made changes," he says. "We're allowed to operate." No, say federal authorities, which have yet to lift their sanctions. Mexico's director of federal health inspectors Dr. Sergio Maltus insists, "As long as they do not correct the problems, they cannot operate, you can be sure of it." But on June 6 a caller to Hernandez's San Antonio 800 number requesting a breast augmentation received an appointment for later this month.

[BOX:]

NO FOUNTAIN OF YOUTH

Four years ago Martha Ponce de Leon, 49, went to a doctor in Tijuana for injections to fill out her thinning lips and paid $100. (It could cost up to $1,000 in L.A., where she lives.) Pleased with the results, she returned when she needed re-plumping 18 months ago--but not to the same doctor. "Now I have a monkey lip," says Ponce de Leon, a marketing exec. She is seeing Beverly Hills plastic surgeon Dr. Paul Nassif about repairs. Would she go back to Tijuana for a procedure? "No. It is not worth it to save money."

2005-12-07T23:12:00.000-05:00

Byline: ROBIN YAPP

PLASTIC surgery boom is changing the face of Britain.

Those dissatisfied with their looks are no longer simply dreaming of transformation.

Instead, increasing numbers are choosing to go under the knife.

Latest figures show a 52 per cent increase in the number of operations carried out in a single year.

Members of the British Association of Aesthetic Plastic Surgeons performed 16,367 operations in the year to April 2004 - up from 10,738 in the previous 12 months. Most will have been done privately.

Although the rise can be partly attributed to an increase in those registering with the association - part of the Royal College of Surgeons - there is no doubt that more patients are opting for surgery. Less invasive procedures are even more popular. Those baulking at operations are opting for non-surgical procedures such as Botox and collagen injections.

More than 72,000 such ' beautyenhancing' cosmetic treatments are thought to be carried out each year.

The Healthcare Commission - the government watchdog monitoring many non-surgical procedures - and the Department of Health are preparing to demand better regulation of the cosmetic treatments industry.

But with celebrities showing off their implants and facelifts, and programmes such as Plastic Surgery Live, Nip/Tuck and I Want A Famous Face on TV, calls for caution may be hard to hear.

More than nine out of ten operations are performed on women but demand is growing fastest among men.

In the 12-month period, surgeons from the association carried out 1,348 procedures on men - up from 822 in the previous year.

Breast enlargement is the most popular operation for women while men tend to ask for work on their noses.

The figures, based on an annual audit of the 151 members of the association, follow warnings that many prospective patients have unrealistic expectations of what cosmetic surgery can achieve.

A spokesman for the Healthcare Commission said: 'Both the Department of Health and the Healthcare Commission want to ensure that there are some minimum standards that all these providers need to adhere to in the interest of patients.' Douglas McGeorge, a consultant plastic surgeon at the Grosvenor Nuffield Hospital in Chester and president elect of BAAPS, believes demand for surgery is driven by more than TV shows and celebrities.

He said wealthy couples in their fifties taking early retirement were often keen to change their looks.

'We live in a society where men generally grow old gracefully and women do a lot to look after their looks,' he said.

'Now people are retiring earlier to start new lives and find a place in the sun and plastic surgery generally is becoming more acceptable for men as well as for women.' r.yapp@dailymail.co.uk

2005-12-03T04:12:00.000-05:00

MINNEAPOLIS, Sept. 27 /PRNewswire-FirstCall/ -- Uroplasty, Inc. (BULLETIN BOARD: UPST) announced today that it has been approved for listing on the American Stock Exchange. The listing will begin on Monday, October 3rd, 2005 under the symbol UPI.

This approval is contingent upon the Company being in compliance with all applicable listing standards on the date it begins trading on the Exchange, and may be rescinded if the Company is not in compliance with such standards.

Uroplasty, Inc., headquartered in Minneapolis, Minnesota, with wholly- owned subsidiaries in The Netherlands and the United Kingdom, is a medical device company developing, manufacturing and marketing products and procedures to improve patient quality of life for specific indications in urology, urogynecology, colon and rectal, otolaryngology and plastic surgery markets. The Company's products offer physicians and their patient's minimally invasive treatment options for urinary incontinence, fecal incontinence, vesicoureteral reflux, vocal cord rehabilitation and dermal augmentation. Uroplasty's products are CE marked for these indications and sold only in markets outside the United States.

The company is currently conducting an FDA IDE clinical study with Macroplastique(R) for the treatment of adult female stress urinary incontinence. Upon completion of the study, a PMA submission and clearance by the FDA is required prior to market introduction into the United States.

The Private Securities Litigation Reform Act of 1995 provides a "safe harbor" for certain forward-looking statements. This press release contains forward-looking statements, which reflect our views regarding future events and financial performance. These forward-looking statements are subject to certain risks and uncertainties, including those identified below, which could cause actual results to differ materially from historical results or those, anticipated. The words "aim," "believe," "expect," "anticipate," "intend," "estimate" and other expressions, which indicate future events and trends, identify forward-looking statements. Actual future results and trends may differ materially from historical results or those anticipated depending upon a variety of factors, including, but not limited to: the effect of government regulation, including when and if we receive approval for marketing of our products (including the I-Stop tape product line) in the United States; the impact of international currency fluctuations on our cash flows and operating results; the impact of technological innovation and competition; acceptance of our products by physicians and patients, our reliance on a single product for most of our current sales; our intellectual property and the ability to prevent competitors from infringing our rights; the ability to receive third party reimbursement for our products; the results of our current human clinical trial; our continued losses and the possible need to raise additional capital in the future; our ability to manage our international operations; our ability to hire and retain key technical and sales personnel; our dependence on key suppliers; future changes in applicable accounting rules; and volatility in our stock price.

Uroplasty, Inc. stock is presently traded on the OTC Bulletin Board system under the symbol "UPST.OB."

FOR FURTHER INFORMATION, CONTACT MR. HUMPHRIES OR VISIT UROPLASTY'S WEB PAGE AT http://www.uroplasty.com/ .

 
  UROPLASTY, INC. 
  Sam B. Humphries, President / CEO 
  2718 Summer Street NE 
  Minneapolis, MN  55413-2820 
  Tel:  612-378-1180 
  Fax:  612-378-2027 
  E-mail:  samh@uroplasty.com

CONTACT: Sam B. Humphries, President - CEO of Uroplasty, Inc., +1-612-378-1180, Fax, +1-612-378-2027, samh@uroplasty.com

Web site: http://www.uroplasty.com/