Friday, May 21, 2010

I had my "Tummy Tuck" Consultation

So, I met with the cosmetic surgeon on Wednesday afternoon, and what an interesting consultation it was!
This surgeon has been in practice since 1973 so he has lots of years of experience under his belt.
His office staff was friendly and courteous, and the doctor himself was extremely personable (I guess that's why my doctor was so comfortable making the referral -- he knows me well and knew what kind of match would work for me).
AND, my 2:00pm appointment was precisely that -- I was actually called into the doctors' inner sanctum, by the doctor himself, at 2:00pm!
He was a most delightful man indeed (not something you hear often, when describing a specialist -- they are usually such stuffed-shirt, "I know everything and you know nothing" type ass-holes, I find).
We first sat and discussed my history (I had filled out the initial in-take form in the waiting room when I had arrived) and he questioned my desire for a tummy tuck since, as he put it, "I clearly didn't 'need' one." 
"No, I want one," I explained, "and I have wanted one for 30 years."
His obvious next question was to wonder why, if I had been wanting one for 30 years, I was only pursuing it now.
"Economics," I replied, "Until now, I was not in a financial position to indulge myself.  Plus, in the intervening years, when twice my weight ballooned as a result of taking various medications, I wasn't much interested while I was 40 pounds overweight.  But those days are over now, if I have any say about it."
Ever the flatterer, he assured me that I am, according to his chart, at exactly the perfect weight for my height.
He had a series of questions that he asks all his patients, and I guess I passed (cosmetic surgeons have to ensure that patients are "suitable candidates" for the surgery being undertaken).
I had a set of questions for him, and he clearly passed. 
More importantly, I trusted him and what he was telling me.  It was almost like we had known each other for many years, he was that easy to talk to.
One of my questions, of course, was whether or not he had performed this procedure on fibromyalgic patients and he said yes, he had, and there had not been any repercussions.  If the fibro was controlled (ie many were taking Lyrica, as I am), none had flare-ups as a result of having had the procedure.
He expressed concern about the fact that I am not using anything for my additional hip pain and I assured him that I have several non-invasive tools at my disposal (TENs, acupen, massage tub etc).  He was intrigued.  I also explained that I will use Codeine Contin on an "as needed" basis if the pain becomes too intense.  He seemed happy with that approach.
We discussed my concerns about anaesthetic and he respected what I was telling him; he in fact validated my experience.  He was actually quick to explain that the previous use of cortisone to control my allergies would have affected my adrenal glands, which is why my response to anaesthetic was so dramatic (very close to the explanation I had been given some 25 years earlier, I just don't understand all the medical nuances).
He operates out of a major hospital in Ottawa as well as the Carleton Place hospital, which is much closer to where I live. We decided that, should I give this procedure a green light, it should be done in the Ottawa hospital where all the specialists were in-house, rather than in the local hospital where those specialists would have to be called in, should a problem occur. (This was the same reasoning used two years ago for John's gall bladder surgery being done in Ottawa rather than in Almonte.)
As we were moving into the examination room so that he could assess whether or not I was even a candidate for a tummy tuck, I assured him that once he "saw me," he would understand exactly why I wanted the procedure.  We were both giggling (like I said, our rapport was like two old friends chatting).
His examination involved his first assessing that there was excess skin that required removal, and then he had me do various things to help him assess my abdominal muscle wall, which he determined to be in excellent condition (must be from 30 years of "sucking it in," I offered). 
He determined that my problem has nothing to do with muscles and everything to do with excess fat, perhaps from years of fluctuating weight.  He said that I basically have the fat and skin of a size 14 woman in the body of a size 6-8 woman (I think he understated the body size but perhaps he's not very familiar with women's clothing sizes?).   At my largest, I was a size 18, but I've never been as small as a size 6-8.
He agreed with the advice I had been given 25 years ago that the only way I would lose my "tummy" was by cosmetic surgery; no amount of sit-ups was going to rid me of it (don't I know it!).
We then returned to his office where he showed me detailed diagrams of the procedure (gross me out!) and we got back to the discussion of my issue with anaesthetia.
I voiced my concern about the fact that in 1978 I woke in recovery unable to breathe (a "delayed response" to the anaesthetic) and then in 1982 I was "almost lost on the table."  How can we be sure that the next administration of anaesthetic won't be even more catastrophic (ie will the trouble occur even before it's administered )?
He understood the sentiment of my concern and suggested that the only way to get answers was to have a consultation with the anaesthetist before making a decision.
We left it that his office will book a consultation with the anaesthetist and depending on what I learn from that visit, I will then decide whether or not I want to proceed.
His parting words to me were, "Fortunately for you, this is definitely something you don't really need, it's something you want.  So if in the end it turns out that you shouldn't do it, it won't really be the end of the world for you.  It will simply be something you can't have, for your own safety."
He obviously is not looking at this only in terms of how much money he could make.  He truly cares about the patients who walk through his door.  That philosophy so closely matches my own doctor's approach to health care.  Such doctors are few and far between today.
How can you not trust and respect a plastic surgeon who takes that kind of position with your care?

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