Hand Surgery Questions and Answers

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Question:

My mom is 67 years old (a young one) she needs a hip replacement(now has a walker) 100 lbs overweight,can't exercise, they won't do a weight loss surgery, tried it all as far as diets. Doc says she is in a catch 22. She also has copd(lungs) any suggestions to help?

Answer:

Dear Misti, In this situation I would recommend a combination of two things. First of all, in place of a diet, I urge you to go to dietplate.com and sign on for a series of menues using real food and recipes which include a grocery list to help give your mother a healthy routine without deprivation or restriction. Secondly, there are books available that outline exercise for people who are handicapped in any way or unable to do regualr aerobics. These start with upper body workouts that will burn calories and facilitate her weight loss efforts and increase her energy and mobility. I have used these often with my clients. If she is unwilling to take these steps, a visit with a couselor to help motivate her may be another option. Don't give up. Small steps can really add up!!!

Question:

I have had two liposuctions of the abdomen areas, the first on Jan.31, and most recent on Oct. 24. I have some scar tissue buildup from the first surgery, and am battling it now from the second. Although I am going for twice-weekly half-hour massages of the area and trying to pinch it and break it up myself, is there anything else I can do? If there is a "pad" of scar tissue left in the lower abdomen area, can it be removed in any way? Are there any tools or massagers I could use to help?

Answer:

Dear Keli, The scarring from liposuction is usually very minimal. Pressure and massage help but will not break it down completely. Are you and your physician certain that there was no hematoma or blood build-up at the time of the procedure? This should be handled in a different way.

Gregory Caputy, MD, Chief Surgeon
Honolulu, HI

Question:

I have a couple of questions wrapped into one. When I was younger, I had pretty severe acne which left me with many scars on my face. Some of them are purplish, and others are what look like little "pits". Although they've faded quite a bit, I still find them hard to look at in the mirror each morning. What is my best bet to get rid of them? Also, I've noticed that I've been developing more facial hair (which I find disgusting) and it's to the point that I can't handle plucking and waxing anymore. I've heard of laser hair removal-what is this exactly? Is it painful? Is there any kind of miracle treatment that will cure me of my scars AND hair? If not, which should I try to clear up first? Approximately how expensive are the treatments? Any advice is greatly appreciated.

Answer:

3 of the best choices for the acne scars would be laser resurfacing with either a carbon dioxide or an erbium yag laser, surgically removing the scars and then having a more superficial laser such as photorejuvenation, mild peels or microdermabrasion, or having treatments with the Cool Touch Laser. You need to find a laser specialist and aesthetic dermatologist. I would go to the American Society for Laser Surgery and Medicine website www.aslms.com and they have listing of their members in all geographic locations. Your hair, if dark, would best be removed by a laser as well (unfortunately a different one than we use for scars). The most expensive option is laser resuracing which would probably run more than $2500 for a full face. Most of these solutions for scarring will probably run into the $1000 range. But it would be better to consult with an experienced aesthetic dermatologist and laser surgeon to determine what it best for you. Good luck!

Question:

Dr. Amy, you have been so helpful to me thus far and I cannot tell you how much I appreciate all your help. I would love to share all this info with my husband but he doesn't want to talk about it at all, so this really helps me. I am being as strong as I can be for him and abiding by his wishes by not discussing it, the children on the other hand are worried, especially my youngest son who has Obsessive compulsive disorder, he is very worried and I keep reassuring him that daddy will be fine. you said that the .8 and level 4 don't go together, what exactly do you mean? and as far as the scale are there 2 different ones and why? according to the first scale you explained, brian (my husband) would be stage 2? but according to the second he is stage 1 right? Just making sure I am understanding. Yes the melanoma is on the upper center of his back, between his shoulder blades, if that helps at all. he has several more he needs to get removed in 2 months, and I am not sure what they would do if any of those showed up melanoma? could he have it in more then one mole? I guess what makes it all so difficult is we took care of his grandmother just last year who died in our home from lung cancer and it is still so clear in our heads how she suffered so badly especially the last week and I think we are all seeing that so fresh in our minds. this is when I try to be the strong one and reassure everyone that brian is young, healthy, and in an early stage, where grammy was 80, sick and at stage 3 when they found it. big difference. thanks so much for all your help but if you can explain about why the melanoma on his back is .8 and level 4 and why this doesnt fit? thanks and God Bless. amy

Answer:

The best thing you can do is to reassure everyone and leave your husband alone. This is the way he is dealing with it- you are dealing with it by trying to understand, but he wants to forget, so give him some space. I wouldn't involve your children much at all, only to tell them concrete things like Dad is having surgery but he'll be fine. Then be strong! He is not a stage 2. This is the only thing that matters ultimately, that the cancer hasn't spread. Breathe a huge sigh of relief when the lymph node is negative. Write me back when you have the surgical results. PS Glad I could help.

Question:

Thanks for your immediate response. We have tried everything (i.e.Laser, Liquid Nitrogen, Aldara Cream, and Scraping) and nothing has worked. I am ready to go to the next level. Plastic Surgery. I want my face back. Please help!

Answer:

Dear Auntjuan, In my hands, I find that laser is the most effective treatment for these lesions. Surgery tends to cause their spread and, as you have noted, they are difficult to erradicate. I would suggest repeated treatments with either a KTP or FPTD (flashlamp pulsed tunable dye laser). Hope this is helpful to you.

Gregory Caputy, MD, Chief Surgeon
Honolulu, HI

Question:

I have a bad underbite. I had a surgery consult, and had been planning on having the surgery at the end of June. They planned on moving my upper jaw forward and possibly moving the lower one back also. They were also going to shorten my upper jaw. Then I found out my insurance doensn't cover the surgery and it is likely to cost 30-35,000 dollars. I can't afford that! I'm really insecure about my smile, and I have a lot of problems eating. Is there any way to get my insurance company to cover it? Do you know of any companies that do cover that kind of surgery?

Answer:

Kelly, Unfortunate for many, insurance companies often apply the cosmetic surgery rules to orthognathic surgery. They feel the establishment of a functional bite is nothing more than cosmetic surgery, and most companies will not cover cosmetic surgery. It may take a number of appeal and review letters to get the company to assist you. You may need to make a number of calls to the company, and have both your doctor's office and your employee benefits rep make calls, too. If it can be a benefit to any medical problems you have, e.g.TMJ, gastric problems, air way problems you might get a favorable responce. Check also that your benefit handbook excludes or does not exclude corrective jaw surgery. It may mean changing docs, but if they do cover it it may mean you have to see a new provider. Good luck

Question:

What information can you give me for breast reductive surgery due to health problems? Back Pain

Answer:

Dear Mary Jane, Breast reduction surgery is a very effective means of helping not only back pain but also bra strap furrows, intertrigo (infection of the skin under very heavy breasts) as well as occasional women with numbness and tingling in the hands and arms due to the weight of the breasts and resultant nerve problems. If your back pain is due to very heavy breasts and it is a functional problem, your insurance carrier will be able to help with the cost of the procedure. Many of my happiest patients are those who have undergone this procedure with only the drawback of scarring as the main unfortunate sequela of the surgery. Contact your local plastic surgeon for more information.

Gregory Caputy, MD, Chief Surgeon
Honolulu, HI

Question:

I have very "nervous" eyes which is why I have a hard time with contacts. It is hard for either myself or the eye doctor to handle my eyes. They want to shut up tight! Would this be a problem in the laser surgery or is there a way to keep them open? Thank you for your time.

Answer:

During the laser procedure, the eyes are held open with a lid retractor. For most people, it is not a problem. Andrew Caster, MD www.castervision.com

Question:

I have lost 65 lbs , and I am seriously looking at getting some plastic surgery done on my belly , and my love handles.How much would it cost , and am I crazy for thinking of it , I REALLY want this junk gone FOR GOOD. thank-you.I live in New Brunswick , Canada

Answer:

I performed my plastic surgery residency in Halifax, Nova Scotia. Congratulations on the weight loss!! I would suggest that you likely need a tummy tuck - perhaps extended in order to remove all of the extra skin from your weight loss. It may be possible for the medical system to pick up some of the costs. I would suggest that you visit with some of surgeons in either NB (Dr. Lalonde) or some of the surgeons in Halifax for details on what will and won't be covered.

Gregory Caputy, MD, Chief Surgeon
Honolulu, HI

Question:

I have some problems with my #1,#16,#17,#32 teeth and my dentist recomends a surgery. H wants to use IV anesthesia. I would like to know if are any risks or are there options for a diferent kind sedative?

Answer:

If your wisdom teeth are giving you trouble, see an Oral and Maxillofacial Surgeon in your area for treatment. They are trained in anesthesia and are more capible of handling any complications that may occur as a result of the anesthesia or surgery. He or she can discuss with you the techniques of anesthesia that are available, and inform you of the risks and benefits of the surgery far and away better than a general dentist can. Nothiing against general dentists, but they should stick to drilling and filling and leave the more complicated treatments to specialists.You are fortunate that Denver has many excellent surgeons in town and in the surrounding area(Lakewood etc...). I would no more let a general dentist sedate me or a member of my family than I would let a podiatrist treat a cardiac problem. Good luck.

Question:

My husband has major back pain & spasms. When he was 18, he broke his back. The doctor said that if he did walk again, by age 35 he would be in a wheelchair. He is now 33 and his back pain is getting worse. Now, he is a big man (6'4" and approx. 400lbs.) We know that is part of it, but, he has been big his whole life so we know that's not the cause. Could you give us an idea if what the doc. said is true or what it might be? thank you.

Answer:

Dear Melissa, This is a very difficult question to answer without your husband being right infront of me. But I will try to help you. First of all. Breaking your back is not uncommon. But how badly he broke his back may determine if future care can help him. For example did they have to perform major surgery in that he has a lot of "hardware" inside. Did he have any fusion performed. If the answers are no then you may have some options. First of all he has to lose atleast 150 pounds. This is important to slow down the degenerative process. Just because he has been big his whole life doesn't mean as he gets older his body will handle it easily especially with this type of previous history. Have you seen a chiropractor? If there has been no fusion performed and no hardware inserted and after viewing a possible MRI to determine if there is no spinal cord compression of any nature then this should be your next step. if you have already tried chiropractic and it did not work then you may want to consider giving another chiropractor a chance. Many practice differently. If you have not seen a chiropractor and you have followed all of these steps to make sure that manipulation is ok then i would go for it. I have changed peoples lives who felt that there was no hope. This is not a guarantee that it will work. I have not examined your husband therefore I can not assure you that it will work. But give it a try. There are alot of factors. First start losing the weight. Second Consult a chiropractor as well as see what the orthopedic surgeon says. Just be aware that it is unlikely that the orthopedic surgeon is going to give you the green light. As i stated before as long as there are no contraindications to manipulation this may be your next step. good luck.

Question:

I have been diagnosed with DJD left TMJ. I have had surgery to correct but now the right side is popping and clicking. I don't seem to be able to find a way to chew that I can control or eliminate the popping. The closest I come is placing the food in my mouth then placing my hands on both sides of my jaw and chewing then repeating until my meal is finished. Any suggestions?

Answer:

My first recommendation would be to follow-up with the surgeon that treated the other joint to re-eval both sides. These symptoms may be early changes that could be managed conservatively ie: soft non-chewing diet, physical therapy, bite splints etc.

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