Ask A Doctor Questions and Answers Archive

Aug
2000

Q&A: Where is the best place and who is the best doctor to perform breast surgery and can I get insurance coverage?

Question:

Hi! I'd like to know if you could tell me how to choose the best place/doctor for having breast sugery. Is it best to go to a hospital, clinic, or elsewhere? Or does it not really make a difference. Are the fees more expensive with one than the other? Also, How do I find out if the doctor is "well-known" or the "right" doc for the job? I live in San Diego-- and have NOT a clue about anything here other than the Naval Hospital. If not mistaken, military insurance (TRICARE) doesn't cover this procedure, correct?? After child birth in Dec 97 I lost severel inches-- I've tried 2 different non-surgical ways (herbs) to get my size back, no such luck! I am scared to death of going to the doctor much less having surgery but will do it (after all I did have a child!) if I knew exactly how to go about finding all info needed, a great doc, and also depending on the final cost and if possible payment arrangements if they can be made and/or if my insurance covers any. Thank you for your time! I hope you can help. On another topic-- mole removal (if can be answered) What's the best procedue to remove them and the cost of removal. They are located on my stomach. Would there be a noticable scare left afterwards and/or would it leave a spot that woul no longer tan with the rest of my skin. (can ya tell me how painful/painless the procedure would be LOL) Thanks so much!

- Jamie

Answer:

 Gregory Caputy, MD, Chief Surgeon - LocateADoc.com

Dear Jamie, Insurance will not cover any portion of a breast augmentation or breast lift procedure since they are cosmetic in nature. I would suggest that you look on the web on this site as well as ebody.com for board-certified plastic surgeons in your area. Then I would suggest that you visit with at least three of them. This may cost you some additional money in terms of consultation fees but it is well spent. I would then ask them for a few patients that you could call and discuss the procedure with them. There are many choices to make including placement of the incision, size and placment below or on top of the mucsle. Each surgeon may give you a different answer on these subjects but go with the one that makes the most sense to you. I always suggest that you be conservative in terms of size. Leave the details to hospital vs clinic to your surgeon since he/she must be competietive in your market. Do not go with the cheapest surgeon just because of price. Hope this helps you

-- Gregory Caputy, MD, Chief Surgeon
Honolulu, Hawaii



Aug
2000

Q&A: Can I have Laser Vision Correction done if I have Keratonus (a cornea disease)?

Question:

I am 25 years old, my actual prescription is O.D. spherical -12.25 cylindrical +6.50 Axis 019 O.S spheircal -12.25 cylindrical +6.25 Axis 002 and I am Keratoconic eye can I get Laser vision correction?

- Litzy

Answer:

John D. Zdral, M.D. - LocateADoc.com

Dear Litzy, No. Keratoconus is a contra indiction to laser surgery and should not be done. The result may be very unpredictable, and the cornea may then need a transplant to restore the vision. For further information, or an evaluation, please schedule an medical appointment for an examination by calling 1-800-824-1073.

--John D. Zdral, M.D.
Fullerton, California



Aug
2000

Q&A: What should I do if I am experience pain, 5 years post-hysterectomy, where my ovaries use to be?

Question:

Im having a reacurring pain on my right side,the pain is on the lower side where my overies were,also through the back. Not sure if this is an OB problem or not,could you please give me advise on what the problem might be. I have had this problem for the past 5 years since my hysterectomy and I am not sure if it is related or not.

- Liz

Answer:

SCOTT ROSEFF, MD, FACOG, Director - LocateADoc.com

There are many causes of post-hysterectomy pain, and they should be investigated by an Ob/Gyn. Some causes may be adhesions (scar tissue), endometriosis, damage to a structure secondary to the surgery, and pain totally unrelated to the surgery.

--SCOTT ROSEFF, MD, FACOG, Director
West Orange, New Jersey



Jul
2000

Q&A: What should I do if my doctor performed LASIK (double carding) and now wants to performance more surgery?

Question:

DEAR DOCTORS I HAD LASIK SURGERY 4 MONTHS AGO AND MY PRESCRIPTION WAS OD -2.00 +3.00 X 95 OS -1.75 +3.25 X 85 HYPEROPIC ASTIG? OR MIXED ASTIG? MY DOCTOR PERFORMED A DOUBLE PROCEDURE ON MY EYES (DOUBLE CARDING)WITH THE SUMMIT APEX PLUS) I AM CURRENTLY SEEING 20/50 AND MY DOCTOR IS CONSIDERING AN ENHANCEMENT (VERY SCARED) MY QUESTION IS WHY ARE SOME DOCS PEROFORMING DOUBLE CARDING AND SOME DOCS ARE WAITING FOR THE FDA APPROVAL OF HYP ASTIG TREATMENT? I FEEL LIKE I HAVE JUMPED THE GUN AND MADE A MISTAKE. I HAVE SOME ASTIG LEFT WITH SOME MYOPIA NOW. MY DOCTOR TO DATE HAS NOT PERFORMED A TOPO ON ME. ANY TYPE OF RESPONSE WOULD BE APPRECIATED. THANKS JO ANN CISSELL

Answer:

Byron Stratas, M.D., F.A.C.S. - LocateADoc.com

It is hard for me to believe that there are ophthalmologists who do not know that the bitoric treatments give a far superior visual result than "double carding." There are some cases when double carding may be appropriate, but this is the exception. In our practice the patient's best interest is our chief motivation for recomending procedure(s). We place patients with your refractive error on a list so we can treat them the way we would want to be treated. We are not desperate for surgery to do, and we are not motivated by our own economic considerations. I am sorry you are having an outcome that is less than what you could have had. I would go to another surgeon for the rest of your care.

--Byron Stratas, M.D., F.A.C.S.
Wilmington, North Carolina



Jul
2000

Q&A: Is it possible to increase breast size without surgery?

Question:

Unfortunatly, I don't know if I'm asking the right person, but here goes anyway. Is it REALLY possible to increse breast size without sugery? As in, do products like "Busting Out" work like they say they do?

- Kate

Answer:

Gregory Caputy, MD, Chief Surgeon - LocateADoc.com

Yes, they do. They are an excellent way of externally increasing your bust size without undergoing surgery. They do, however, have all of the drawbacks of not being a part of you and there are many instances where they cannot be worn. I would suggest a modest increase in size only so that it does not appear as though your breast size is varying by too much. Hope this helps.

--Gregory Caputy, MD, Chief Surgeon
Honolulu, Hawaii



Jun
2000

Q&A: What should I do to address my pain when my dentist nor my oral surgeon can find anything wrong?

Question:

One year ago, pain in the right side of my face was misdiagnosed by several doctors (as osteoarthritis, trigeminal neuralgia, and TMJ). About 6 months later, it was correctly diagnosed as a severe absess of a lower right molar, and an oral surgeon extracted the tooth and debrided the cyst of infection. Since surgery, I have had constant pain in the crown immediately in front of the extracted molar (which crown had a root canal many years ago).The pain has intensified and now radiates toward the right ear and down into the chin, with very tender spots along the right jaw bone. Neither my dentist nor my oral surgeon can find anything on recent x-rays/panoramics to explain the pain, and both say there is nothing more they can do. The oral surgeon did say that the cyst of infection was severe enough to have affected the bone and mentioned the necessity in some cases for a hyperbaric chamber. To whom can I go now? I cannot endure the constant pain, and I am concerned about the consequences to my health if left untreated. What should my next step be? Is there some discipline or test which can determine whether or not there is infection in the bone? I would appreciate your response. Thanks.

Answer:

I cannot give you an opinion based upon the information you have given. i.e. your age, sex, general health, occupation, past medical history, etc... may or may not be important with regard to the symptoms you express. I might suggest the following: 1) Make an appointment with the nearest University Medical Center for a complete physical examination. 2) be sure the Medical Center has an Oral and Maxillofacial Surgery department for consultation 3) helpful tests would be a complete blood work up, a bone scan, chest xray, etc... Your pain could be any number of things, from fracture of the roots of the tooth next to the cystic area to osteomyelitis(bone infection), to tumor metastasis from another location, and ANYTHING in between. Without more information and a complete exam I can't be of any more help.

--Charles R. McNamara, DMD
Winter Park, Florida



Jun
2000

Q&A: What should I do if I have pain in both jaws, neck and shoulders and sever headaches and was diagnosed with TMJ?

Question:

I have been diagnosed with tmj with degenerative joint disease for the past 8 years. Over the past year my symtoms, pain in both jaws, neck and shoulders and sever headaches have increased greatly. I am also diagnosed with fibromylgia. I am almost always taking antiflamitories, muscle relaxers and pain pills. In addition I take accupuncture tx. and occasionally physical therapy. I also do several other things for relaxation. My job requirs me to talk all day and this seems to be causing me increase symptoms. Is my only other option surgery or stop talking?

- Rhonda

Answer:

Can't make an opinion based on what you're stating. Surgery is usually a last option, have you had other opinions? If not, you should.

--Charles R. McNamara, DMD
Winter Park, Florida



Nov
2000

Q&A: What should I do if I had a hysterectomy as a result of a prolapsed uterus, a cystocele and a rectocele and now having reoccurring problems?

Question:

I am 60 years old and had a hysterectomy 9 years ago. I had the hysterectomy because I had a prolapsed uterus, a cystocele and a rectocele. Six months ago I had recurring problems again with the cystocele and rectocele and am now wearing a pessery. I wanted to know what other options there are for this problem, if any. Thank You

- wilma

Answer:

Daniel Potter, MD, FACOG - LocateADoc.com

Surgery done by a specialist in pelvic reconstruction should cure you.

--Daniel Potter, MD, FACOG
Fullerton, California



Mar
2000

Q&A: What is the cause of and timing for the loss of a large lump in my cheek following 4 wisdom teeth extractions?

Question:

I am a 23 yr old otherwise healthy female, and I just had all 4 wisdom teeth extracted 5 days ago. The two on my left side were both vertically impacted. They gave me IV sedation, and my teeth came out easily, so the surgery itself was painless and the rest of that day wasn't too bad except for the bleeding. The next day, however, my left cheek had become massively swollen. It is now still very swollen and moderately painful, with little sign of subsiding, making it very hard to smile or to open my mouth wide enough to fit small bites of food. My left cheek continues to be very tight and painful, but my main problem is that there is a half-walnut-sized lump in my cheek, a bit above the level of my mandible. It is extremely hard, seems like its located in the muscle, and doesn't appear to be getting smaller. I called the resident who performed my surgery, and he said that it just happens in some cases, and it might take 3 weeks to go away. Is that true? What causes it? Will exercising my jaw help, or should I try to keep it still? I'm a vet school student, and would like to know some of the medical details also. Thank you very much for your help!

- Kristen

Answer:

Dear Kristen, As you will no doubt learn in your orthopedic rotation what your are experiencing in a bony callus formation over the area where the bone was removed during the wisdom tooth extraction. As the natural underlying bone heals it will lay down a protective layer. As the socket fills the callus will disappear. It may last three weeks, but usually by the second week, baring any inflammation or infection, it should be quite small, and only perceptable with palpation. The pain in the more swollen side is most likely muscle inflammation which is best treated by ASA or NSAID and moist heat. Use the heat as you did the first day or two with the ice packs. You will have beter pain relief if you take the OTC meds on a regular schedule, just don't exceed the daily recommended dose ( prevent GI upset). You trismus, tight jaw will resolve faster as well with consistent use of the moist heat when you can do so. Do not attempt to over do jaw motion, as it will just further inflame the tissue. Stick to a softer diet and be protective of yawning and sneezing( I know sounds odd, but think about it) Also, as your resident will learn as time goes by...young women will swell more at your age for a number of reasons (big teeth, small mouth, his inexperience, length of time it takes to complete treatment etc...)but one he won't realize for a while is if he is right handed, all his patients will swell slightly more on the left because access and visibility are more difficult on that side for a right handed operator, especially if he was sitting down for the surgery! Us old guys still stand up for everything! Good luck with school and don't worry about your cheek, it will be very self limiting.

--Charles R. McNamara, DMD
Winter Park, Florida



Mar
2000

Q&A: What is the cost of an implant on a front tooth?

Question:

I am trying to find out what the cost of an implant on a front tooth will cost on average.

- Kelly

Answer:

Your best bet is to call around to your local Oral Surgeons and ask or search for them right here on locateadoc.com Professional fees vary from area to area, and state to state. Beware of "clinics" and GP's who do both the surgery and the final prosthetic work. Stick with a Surgeon who has had additional training in this type of treatment. We refer to GP's and periodontists who do implannts as "weekend warriors", that is they go to a twoday class, and then back to their office on Mondays to start putting in implants...not a good idea.

--Charles R. McNamara, DMD
Winter Park, Florida



Feb
2000

Q&A: Can laser eye surgery and / or methods developed by William Bates correct and prevent further change with nearsightedness?

Question:

I am nearsighted (-1.25;-1.25) and I would like to find out how to prevent worsening of my eye-sight (I am willing to try anything) or perhaps even try to make it better. I have heard of some methods developed by William Bates - could you please give me some more information on that. I am also interested in laser surgery - are there any conditions for patients who want to be operated? Regards. Jernej Kos

Answer:

John D. Zdral, M.D. - LocateADoc.com

Dear Jernej Kos, The laser treatment is a permanent correction of your near sightedness and your best option. If you would like to schedule a consultation, call Annette at 714-879-737

--John D. Zdral, M.D.
Fullerton, California