Dr. Bae:
Hey, Greg.

Greg:
What’s going on?

Dr. Bae:
Things are good. We are seeing patients regularly, busy. Everybody’s like kind of getting their COVID face on. They’re ready to get back out into the world, getting recovered so they can enjoy the summer.

Medical Tourism

Greg:
That’s true, absolutely. People are getting out and about and people want to look better. And that’s one reason to go see Dr. Bae. I have a friend and she just did one of your favorite procedures or one of your expertise procedures, the mommy makeover. But when she told me she was doing it, I was a little concerned because she went to a foreign country, medical tourism. I won’t say where. But she went to another country. It was a whole process when she was explaining it to me. She’s going to be down there for a couple of weeks and they’re moving her to another facility after. I mean, I’m concerned and I just wanted to talk to you about… Yeah, it’s cheaper, right? It’s cheaper maybe to go to another country. But what are the risks and how do you figure out? How to get a good person if you’re going to do that? And can somebody talk to you before they make a bad decision?

Don’t just focus on cost

Dr. Bae:
Absolutely. Unfortunately, people are really just focused on the cost. And of course, cost is a big part of everything, I know. We provide pricing on our website, so people can check pricing before they come in for a consultation. But you don’t want to boil everything down to cost. It’s like the ultimate decision. But you have to keep in mind that, yes, you’re going to save some money if you go to another country. And I’m not going to make a blanket statement that all surgeons in other countries are bad surgeons. But the thing that you have to realize is whether it’s a good surgeon or a bad surgeon, whether it’s in this country or out of this country, there’s always the risk of complications. And just because its cosmetic surgery doesn’t mean it’s not real surgery.

Dr. Bae:
So if you come to me and unfortunately you might have a complication like the wound doesn’t heal right, or the breast implant gets infect, or something like that, at least I’m here locally to take care of you and it won’t cost you anything else for me to take care of that complication or at least I’ll do everything I can to make sure it doesn’t cost you anything. Whereas if you get that procedure done in another country and then you come back home and then you start looking around for a doctor to help you when you’re having this complication, they’re going to charge you. That’s not your… They’re not your original doctor. You’re not their original patient. That’s what they do. They have to charge you to provide those services and it’s going to get really expensive. So whatever money you may have saved by going out of the country, you’re going to spend twice that treating a complication because you’re working with the doctor that’s not your original doctor.

Hope for the best, prepare for the worst

Dr. Bae:
So, I get it that you want to save some money. But for the peace of mind, and just put it out of your mind first of all that you might not get a complication, that certainly you have to go into it kind of preparing for the worst. I mean, that’s just kind of a good way to look at it because hopefully everything will be great. And yeah, so if you have a problem, you’re going to want to have your doctor there locally because you’re probably not going to be able to go back across the country even if it’s in the United States or go outside of the country to get that complication treated.

Greg:
Well. And of course, whatever decision anybody makes, it’s always so smart to do your research. But do realize if you go out of the country and you have a health problem and you’re having it there, it’s going to be difficult because you’re not at home with your insurance and stuff. And then again, it’s going to be hard if you have an issue with that doctor and you’re back here, what can you really do about it there?

Dr. Bae:
Another interesting thing is a lot of people will tell me like, oh, but when you go to another country, because it’s less expensive, you get more for your money. You get the operation that you’re going to get here. And you can then stay there and recover for two to three weeks or a month even. [crosstalk 00:03:49] hotel.

Greg:
Which is what my friend is doing. Yeah. She stayed in a hotel for two weeks.

Benefits of getting home as soon as possible

Dr. Bae:
And so you’re thinking, oh, that’s great. I get so much for my money. But the thing is, after you do your operation with us here in office operating room, you go home. And that’s, I don’t think there’s any better place to recover than at home. And if you’re staying at these hotels or these post recovery centers for an extended period of time, other patients are staying there also. So just like, there’s a risk of getting an infection from somebody else at a hospital, there’s a risk of getting infection in these long-term facilities and other places in other countries. So, it’s not so great that you have a place to stay for a long period of time. It actually increases your risk of infection potentially. So, that would be my opinion is get home as quickly as possible. And if you want a home health nurse to help you out, sure, no problem.

Dr. Bae:
But most of the things you’re going to be dealing with after your surgery, you don’t really need a nurse. You just need a family member that’s there available to help you. You don’t really need somebody that’s got additional degrees. Because even if you get a home health nurse, they maybe mostly a cardiology nurse. They’re not necessarily a post-op cosmetic surgery recovery nurse. And that’s a big difference. Just like, you don’t come to me for your diabetes management, you don’t go to a internal medicine doctor for plastic surgery. So, same thing. Nurses are sort of specialized as well. So, they might not necessarily be perfectly suited to take care of you in your recovery. So, get home as soon as possible after your surgery. Try to avoid being around other people or other institutions where you could get additional infections. And so, that would be my argument why you should stay in the country.

How to get more information from Dr. Bae

Greg:
Well, whatever you decide, just make sure you do your research. Take your time. Don’t rush into anything. And if you have questions you want to reach out, you want to ask anything, you can always go to Dr. Bae social media. Ask him anything. And it is?

Dr. Bae:
@realdrbae, R-E-A-L-D-R-B-A-E, not B-A-Y, and realdrbae.com. You can always reach me there through website, social media. I’m always available to answer questions through direct messages.

Greg:
I’m going to test you now. I’m going to send you a message. See how long it takes you to answer me.

Dr. Bae:
Hopefully not asking me what’s the capital of North Dakota or something.

Greg:
You could look that up. All right. We’ll see you next time, Dr. Bae.

Dr. Bae:
Thank you so much, Greg.

Click here for the original blog post written by Dr. Kaplan for BuildMyBod.

The post Beware of Medical Tourism [video] first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

In the run up to the current vaccine approvals and post approval process, I’m blown away by what is making people worried about this vaccine. I’m not surprised they’re worried. Totally get that. But surprised by what they’re worried about!

Anxiety and fear are completely understandable for a vaccine that was developed in record time and with “newer” technology (mRNA (m = messenger)(RNA = ribonucleic acid). I say “newer” because while it’s the first vaccine coming to market using mRNA technology, the technology was actually developed decades ago. Yes, it was approved under an emergency use authorization so we don’t have years of follow up studies confirming its safety. However, with the millions of people who’ve received the vaccine either during trials or since release, severe reactions are very rare. Most side effects include short-term fatigue or headache. But with a greater than 94% effectiveness, these side effects are a reasonable tradeoff.

Of course we shouldn’t go into anything blindly. Of course we should have an idea of what we’re putting into our body. But the concerns people are bringing up suggest misinformation and rumors without a clear basis. My post below, along with this article and this article seek to allay some of those concerns.

Fertility

When someone expresses a concern, I don’t believe we should dismiss those concerns. I think we should be curious as to what is the underlying reasoning for their concern. Once we know, we can more accurately address that concern.

But in the case of fertility, it’s not clear where this fear is coming from. Do they think the vaccine causes a person to become sterile? Impotent? This article suggests the concern is a debunked cross reaction with placental proteins! I want to ask the people that cite this as the reason for not getting the vaccine, “what do you know about placental proteins?!”

An alternative reason for concerns about fertility may lie with the vaccine’s mechanism of action. The Pfizer and Moderna vaccines are messenger RNA-based vaccines. mRNA is genetic code that the cell uses as a blueprint for manufacturing proteins. In the case of the Pfizer and Moderna vaccine, the mRNA goes into the cell and stimulates the cell to create the coronavirus’ spike protein.

The spike protein then goes to the cell surface and stimulates the body’s immune system to create antibodies to that protein. Keep in mind the presence of these manufactured spike proteins on your cell surface don’t last forever. They degrade over time like any protein. They’re there just long enough for your body to stimulate antibodies to them. And if the real coronavirus with its spike proteins enters the body, your immune system is primed and ready to produce antibodies to neutralize the virus.

But at no time does the mRNA ever enter the “inner sanctum” of the cell, the nucleus. This is where our genetic code is kept. Our genome, our DNA. By remaining outside of the nucleus when creating the spike protein, the mRNA never incorporates into our DNA. Therefore it is not passed on to your kids and does not affect fertility.

If additional reassurance is necessary in regards to fertility, keep in mind that The American College of Obstetrics and Gynecology are very clear about vaccination during pregnancy and lactation. They’re for it!

Ultimately, the attempt to dispel a myth regarding fertility is the difficulty in addressing the underlying source of the concern (since it’s not always clear).

So imagine yourself listening to the news during this pandemic and the news anchor says, “Breaking News! Two companies have developed new vaccines for the coronavirus. They work by injecting the actual coronavirus into your bloodstream.”

Concerns over the vaccine technology

Back to the technology used in these first two vaccines. They use mRNA as a way to stimulate the body’s immune response as explained previously. Whether people are concerned that it’s the first vaccine using this technique or because of fear that it interacts with our own DNA (again, it doesn’t), I think it’s important for concerned citizens to consider the alternative types of vaccines.

Keep in mind that all of the vaccines you’ve ever received, stimulated your immune response by using 1) a live, weakened (attenuated) virus (eg MMR or measles vaccine), or 2) a dead virus (eg polio, hepatitis A, most flu vaccines). So imagine yourself listening to the news during this pandemic and the news anchor says, “Breaking News! Two companies have developed new vaccines for the coronavirus. They work by injecting the actual coronavirus into your bloodstream.” It wouldn’t matter that the vaccine contained weakened or dead viral particles. You’d run for the hills!

Therefore, a vaccine that produces a protein that allows your body to produce antibodies to the virus, without ever interacting with the virus itself, is progress. Consider yourself lucky to be living in a time where this technology is available. Now go out and get vaccinated!

Click here for the original blog post written by Dr. Kaplan for BuildMyBod.

The post You’re worried about this vaccine?! And other myths! first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

The Vice Presidential debate last week may seem like forever ago. But who can forget Kamala Harris’ statement that she would accept a vaccine from the FDA but not from President Trump. Whether you heard it or not, it’s still nonsense. This has nothing to do with politics and everything to do with the scientific method and science in general. So don’t let Kamala scare you.

Don’t let Kamala scare you from taking a vaccine

The development and approval of a vaccine is not, nor has it ever been, solely under the discretion of the President. There is a cacophony of public and private partnerships involved. Currently there are four drug companies that are in the final Phase 3 trials of a COVID-19 vaccine. Translation: they’re providing the vaccine to tens of thousands of volunteers throughout the world to ensure the vaccine is both safe and effective.

After each phase of any drug trial, the FDA reviews the data to determine if the drug company can proceed to the next phase and final approval after the third phase. Consider all of the researchers, doctors, nurses, statisticians that take part in these studies. If there were any shortcuts, someone within this entire process would blow the whistle.

And with so many involved, there are simply too many people standing in the way of a President imposing their will to magically approve a vaccine over everyone’s objections. While Vladimir Putin did that in Russia, this isn’t Russia. So for Kamala to say she would accept a vaccine from the FDA but not from the President is ridiculous. The truth is that approval is predicated on the drug companies, the FDA and the President signing off on it. Does that mean she won’t take the vaccine because the President was ultimately involved? Actually, what she does personally is immaterial.

Why her comments are so irresponsible

The real issue, the real harm is that she has lent credence to the thousands (or millions?) of Americans that have reservations about taking the vaccine. For either founded or unfounded reasons, some have concerns about the safety of the vaccine. With her irresponsible comments, they can now follow their instincts to forego the vaccine. Albeit for completely unscientific, nonsensical reasons.

By promoting a conspiracy that Trump will single-handedly approve the vaccine, she is no better than anti-vaxxers that believe vaccines lead to autism, a widely debunked theory. Some may believe her comments were hyperbole. That she didn’t really mean it. Unfortunately, being the Jenny McCarthy of the Democratic Party and scaring the populace from getting the vaccine, and producing herd immunity, is unforgivable.

Click here for the original blog post written by Dr. Kaplan for BuildMyBod.

The post If a vaccine is approved, don’t let Kamala scare you from taking it! first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

Why San Francisco is ready to reopen for business

As I discussed here previously, San Francisco has had fewer COVID-19 deaths than most large cities in the country. The city benefited from the early institution of shelter-in-place orders. Additionally, the large number of tech workers in the area began working remotely even earlier in the month of March. These early social distancing recommendations are having far reaching benefits in San Francisco.

There were only 12 COVID-19+ inpatients at all three Sutter Health CPMC San Francisco  hospitals as of Friday, April 10th. Clearly, not every city has these same low rates of inpatient admissions for patients with the coronavirus. And that’s why the decision to reopen for business or relax the shelter-in-place orders are not a national-level decision. These decisions are necessary on a local and regional basis, when appropriate, in coordination with state decision makers.

Because there are so few COVID-19+ inpatients in San Francisco, that means the hospital has the capacity to accept more of these patients if necessary. But it also means hospitals can start performing elective procedures again. With beds available, we can reassure every patient they will have a bed if needed.

Concerning news for San Francisco

While San Francisco is controlling the outbreak with social distancing, there is a potential problem on the horizon. On April 10th, public health officials announced that 70 people at San Francisco’s largest homeless shelter were found to be COVID-19 positive.

At this time, it remains to be seen if this will lead to the surge that has yet to materialize.

Benchmarks before reopening businesses

Based on the roadmap to reopening issued by former FDA commissioner Scott Gottlieb, there are four benchmarks before we can move to the next phase (Phase II) of this crisis. In his words, the current quarantine and shelter at home is Phase I. Now that we have 1) a reduction of patients needing inpatient medical care over the course of 14 days (one incubation period) and 2) hospitals in the area can safely treat all patients requiring hospitalization, San Francsico satisfies two of his four milestones at this moment.

The third and fourth benchmarks include widespread testing along with active monitoring and tracing of all confirmed cases. This is possible to implement over the remaining days in April.

On a case by case basis, doctor’s offices can join the city and other lab testing facilities in providing rapid testing capabilities to our citizens. My office is receiving delivery this week of antibody testing kits. These rapid blood testing kits can determine if one of my patients has 1) not been exposed to the virus, 2) was recently exposed and does not have full immunity yet or 3) they’ve been exposed and now has full immunity. If any patients test positive, but not yet immune, in our office, they will be sent home or to the hospital depending on symptomatology and they will be reported to the CDC.

The last requirement to move on to Phase II, contact tracing, will be available by the end of April. This includes the notification of an individual via smartphone if they’ve been near someone else that has since tested positive for the virus. By tracking this information, affected individuals can be monitored, sent home, isolated or seek out treatment. The technology to accomplish this is being provided by both Apple and Google. The software or API (application programming interface) they’re building for health department apps will have interoperability between both iPhone and Android.

Guidelines when reopening businesses

According to Gottlieb, in Phase II, the majority of schools, universities, and businesses can reopen. The truth is, many governors are leaning towards leaving schools closed for the rest of the school year. But working from home, when feasible, should continue. And he suggests gatherings be no more than 50 people at a time.

While grocery stores and convenience stores can limit the number of people that come in at once, this is a more complicated decision for restaurants and bars. Many restaurants can continue delivery through DoorDash, Caviar, Postmates and UberEats. And I suppose dine-in restaurants can operate at 50% capacity where some social distancing is possible.

However, most restaurants operate on a thin margin. Being in a situation wherein their expenses/payroll are at pre-pandemic levels, but the restaurant is generating half the revenue may be untenable and impractical. It will also be interesting to review the numbers, when available, if restaurants whose business model is not meant for delivery and take out only, are generating enough revenue.

When it comes to bars, is there any scenario where they can reopen during Phase II? Bars seem to be less conducive to social distancing and more likely for patrons to be in close proximity to one another. Can a bar operate at 50% capacity? This may be a decision for a later phase.

Having realistic expectations

It’s critically important the public understands it’s not realistic to expect no one to get sick during the process of relaxing social distancing protocols. We just have to minimize the number of people that get sick at any one time. That’s what flattening the curve is all about.

We should not frame the question as, if we stop social distancing too soon, will people die? Unfortunately, it’s inevitable that as home quarantines are lifted, more people will die. More people will contract COVID-19, some will require admission to the hospital, and a few of those people will then go to the ICU and succumb to the virus. That’s unavoidable to some extent.

The right question is, how to do we relax social distancing, lockdowns and quarantines in such a way as to reduce the possibility of a spike in new infections that overwhelms the healthcare system? Just as flattening the curve was the goal at the beginning and in the midst of this crisis, flattening the curve is still the goal as we start to return to a more normal (but definitely not normal) way of life.

A phased return to “business as usual” is necessary. But only in areas that are ready based on the four benchmarks above. With contact tracing and rapid immunity testing, businesses can reopen. And as time goes on and new data becomes available, more test-proven immune employees will be able to return to work. We can eventually gather in successive waves of 50, 100, or a 1000 people. And then one day, we’ll be able to attend an NFL game. One day.

Click here for the original blog post written by Dr. Kaplan for BuildMyBod.

The post America has to reopen for business… but not at the same time first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

The Gold Standard of what to look for in a doctor by Kelsey Kaplan Fashion

1. Board certified in the specialty they’re treating you for

Seems obvious but you want a doctor that’s actually board certified in the field of medicine they’re practicing. For example, if they’re performing a plastic surgery procedure on you, they should be board certified in plastic surgery.

2. Transparent with their pricing

It’s insane that you can’t find out how much a healthcare procedure or service costs ahead of time. In the future, we’ll look back on this lack of price transparency and wonder how it was ever like that. We need Price TransCAREncy! Doctors that are pro-price transparency are on the the right side of history. The future will prove it!

3. Has their own operating room

A Harvard study showed that doctors who consistently operate with the same team have fewer complications. That doesn’t mean you have to have your own operating room, just the same team. But if you have your own operating room, you’ll have the same team!

4. Posts on Instagram Stories and Snapchat

You should be able to get to know your doctor. They’re attitude, personality and surgical acumen. There’s no better way to learn this than through their very own “reality show” on Instagram Stories or Snapchat.

5. Has some non-5 star reviews

You can’t please everyone. So if someone has no non-5 star reviews, they’re paying for them. Ask anyone that specializes in online reputation. All 5-star reviews is a charade, a facade. You can’t legitimately have 100% 5-star reviews. Now, you shouldn’t have too many non-5 star reviews but where that line is drawn is up for discussion.

Video of Kelsey Kaplan Fashion on The Gold Standard when looking for a doctor

Be prepared, it’s pretty funny!

Click here for the original blog post written by Dr. Kaplan for BuildMyBod.

The post Kelsey’s rant (kelseykaplanfashion on IG): What to look for in your doctor [video] first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

Maintenance of Certification (MOC) is a program put forth by specialty medical boards like the American Board of Internal Medicine (ABIM), American Board of Surgery (ABS) and American Board of Plastic Surgery (ABPS) to name just a few examples. The idea is for these programs to ensure that currently practicing physicians are up to date on the latest clinical data on the practice of medicine within their specialty. By keeping doctors well-informed, the hope is that this leads to greater patient safety. There is much dissension among physicians as to whether the formal MOC programs administered by the various specialty medical boards succeed in that goal.

Many argue this is just a way for specialty medical boards – when combined, make up the American Board of Medial Specialties (ABMS) or the American Osteopathic Association (AOA) – to increase revenue with annual MOC dues, tasks and exams.

These specialty boards require MOC as a prerequisite towards continued board certification. So rather than intermittent revenue only during the physician’s year of board recertification (approximately every 7-10 years), they can generate revenue on a continuous basis with MOC programs. For this reason, it is very easy to abhor the MOC programs along with their annual dues and busy-work.

What about CME’s

No one argues that doctors should remain current with the latest data in their field. But it’s unclear if MOC (with all of it’s unproven requirements) does this. Moreover, for a doctor to maintain their privileges or ability to remain on staff at a hospital or to renew their medical license from their respective state medical board, the physician must accumulate a minimum number of continuing medical education credits (CME).

But why aren’t CME’s enough? The Maintenance of Certification program has a CME requirement along with many other tasks but why not only require CME’s? Why all of the other tasks? In other words, if MOC and CME are both vehicles towards maintaining continuous education, then they’re duplicative of one another. So which is more critical?

The sine qua non (that without which is not) of practicing medicine is to maintain your state medical license. So if you MUST attend annual meetings and lectures to accumulate enough CME’s to maintain your MANDATORY medical license, then why must a physician also pay annual dues and complete tasks from their specialty medical board for MOC? The state medical boards aren’t requiring MOC. They only inquire about your board certification status.

If the specialty boards had the physician and the patient’s well being as a priority, they would recognize that the CME’s required to achieve continuous education and satisfy the state medical boards are enough. Does this prove that by continuing the onerous requirements of MOC, the specialty boards are simply maintaining their portfolio of cash and real estate?

Throw MOC out?

If you didn’t already strongly dislike MOC, do you now?! So if legislation was making its way through state houses across the country to abolish MOC, would you vote for it? Not so fast!

While the ridiculousness of MOC is clear in many circles, there is a trojan horse of sorts when attempting to throw them out legislatively. When abolishing Maintenance of Certification programs, but still maintaining requirements for continuing education by other methods, legislation can simultaneously weaken the meaning of board certification.

Board Certification

A physician’s board certification refers to the accomplishment of finishing training, passing many exams and “checking off many boxes” that show a doctor has seen a wide variety of disease processes and performed a minimum number of procedures within that specialty. As stated previously, these individual specialty boards compose the largest physician specialty certification organization of the ABMS and the AOA.

Physicians who are board certified in this “traditional” manner are understandably protective of their training and what it stands for. Whether it be out of principal or financial survival, these physicians resent other physicians who do not undergo this same level of training and then go on to practice outside of their primary field of medicine. A classic example in the realm of plastic surgery is a non-plastic surgeon (say, an emergency medicine physician) performing cosmetic procedures.

Surprisingly, there are no laws that forbid an ER physician from providing Botox or offering liposuction in their office. To be sure, a hospital won’t let an ER physician have privileges to offer liposuction within the confines of the hospital. But out of the hospital? In the doctor’s own office? State and Federal law will allow it.

Why anti-MOC legislation could weaken the meaning of Board Certification

Part of the anti-MOC laws that are being passed in state houses across the country have the intended or un-intended consequence of weakening what it traditionally means to be board certified. Put another way, if legislation is put forth that requires physicians to maintain continuous education, but not necessarily MOC programs required by specialty boards of the ASMS or AOA, then that opens the door for an alternative means of education by boards outside of the board-certification-duopoly of the ASMS and AOA. If alternative boards can administer continuing education programs without the same rigorous board certification process as the ASMS and AOA, then the credibility of the entire system is undermined. In other words, the appearance of alternative boards could “water down” what it means to be board certified. So you have a choice to make: down with MOC or up with board certification. Unfortunately it can’t be both.

Click here for the original blog post written by Dr. Kaplan for BuildMyBod.

The post MOC vs Board Certification first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

The knowledge gap in healthcare

The article above tells the story of a family taking their 3-year old to get an MRI for a new-onset illness. They did some cursory work to determine their out-of-pocket cost for this service. They thought they had a general idea of the cost beforehand. A few thousand dollars probably. Their bill ended up being $25,000. This was partly because they chose to go outside of their Obamacare-exchange insurance network.

Yes, this is expensive and yes, there are hidden fees at some facilities. That was the point of the article. But there is an underlying knowledge gap that led to the decisions on the part of the family, and even the facility, where the MRI was done. That was not the intent of the Vox article. Let me explain.

Extending bad insurance to more people isn’t the answer

First, Obamacare exchanges provide insurance for more of the population that what was available pre-ACA. The article correctly points out that it made insurance more affordable to the consumer. But did didn’t change the underlying cost of healthcare. But what is also missed by the consumer is that you can’t solve the healthcare crisis by extending bad insurance to more consumers. Not everyone takes these Obamacare exchange insurance plans because they reimburse so poorly. As in this example, Stanford Hospital didn’t accept the family’s plan because of low reimbursement from the insurance company. So the family was forced to pay the costs out of pocket. This leads to another example of a knowledge gap.

Don’t go out of network for standard procedures

While the family was forced to pay out of pocket because they went out of network, going out of network wasn’t necessary in the first place! The family thought that they should get the MRI at a hospital that specializes in that particular disease process. What they didn’t understand is that an MRI is an MRI is an MRI. No matter where you get it. An MRI is a commodity which means it’s essentially the same test no matter where it is performed. So best to get it in-network and avoid the costly out-of-network rate.

Sometimes, even the facility doesn’t know what they’re talking about

The next example of a knowledge gap was on the part of the facility. When the family called around asking about pricing, my guess is they “simply” asked about the cost of an MRI or more specifically, the cost of an MRI for a 3-year old. The distinction is critical and I would argue the facility didn’t appreciate this distinction when providing an estimate beforehand. You see, an MRI requires the patient to stay perfectly still for the better part of an hour. While some adults may be able to do this, clearly a 3-year old child can not. So part of the $25,000 bill from Stanford was for an anesthesiologist and placing the child under general anesthesia for the MRI. Placing a child under general anesthesia for an MRI may sound unusual but it is necessary for a study (MRI) of this nature.

Yes, the cost of healthcare is critically important. While checking pricing on healthcare services is easier than ever, it can’t completely fill the knowledge gap. Parents will continue to think they’re doing the right thing by getting insurance, even if, unbeknownst to them, few facilities will accept it due to poor reimbursement. Consumers will still think they have to go to the most well known institution for a test that can be done anywhere (and probably for less). And ultimately, the consumer’s knowledge gap is no match for knowledge gap exhibited by the facility for their own services!

Click here for the original blog post written by Dr. Kaplan for BuildMyBod.

The post The knowledge gap in healthcare is wider than I realized first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

Cleveland Clinic Alumni Board of Directors

Dr. Kaplan will serve on the Cleveland Clinic Alumni Board of Directors for a three year term. During that time, he will serve as a liaison between the alumni board and alumni of the Department of Plastic Surgery. Dr. Kaplan finished his plastic surgery training at the Cleveland Clinic in 2007.

In this capacity, Dr. Kaplan will facilitate alumni events throughout the year at various plastic surgery meetings. Additionally, he will attend twice-yearly meetings at the main campus in Cleveland, OH. For more information about the Cleveland Clinic, click here.

As many readers know, BuildMyBod Health provides pricing information on healthcare services typically paid out of pocket. BuildMyBod Health offers pricing across the US, including the Cleveland Clinic Department of Plastic Surgery. To check their pricing, click here.

Click here for the original blog post written by Dr. Kaplan for BuildMyBod.

The post Dr. Kaplan appointed to Cleveland Clinic Alumni Board of Directors first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

1. Avoid opioid overdose and addiction

The current opioid crisis has contributed to over $55 billion in health and social costs. Could marijuana use after surgery ironically be the answer to the opioid crisis in America?  When you consider the following facts, it’s not such an unreasonable conclusion. In this recent study, most consumers try opioids (Percocet, Vicodin, etc) for the first time after undergoing surgery. Of those, 6% continue using opioids for at least three months after surgery. So what if those patients were never offered opioids in the first place? What if they were given a pain prescription for marijuana instead?

There’s reason to believe the replacement of opioids with marijuana can reduce dependency on opioids. According to this study in JAMA Internal Medicine, “Medical cannabis laws are associated with significantly lower state-level opioid overdose mortality rates.” The article goes on to say, “In states with a medical marijuana law, overdose deaths from opioids like morphine, oxycodone and heroin decreased by an average of 20 percent after one year, 25 percent by two years and up to 33 percent by years five and six compared to what would have been expected…”

And it’s not just the risk of dependency that’s concerning. There’s also the risk of an accidental overdose. I prescribe Percocet for all of my postop patients. Usually there’s not a problem with dependency or overdose but an overdose occurred once, and once is enough. Instead of taking their Percocet “prn pain,” the patient took their pain medication around the clock. When combined with the fact that the patient was opioid naive, their respiratory rate dropped and had to go to the hospital. The patient recovered without any need for reversal medications like Narcan but obviously it was a scary, avoidable situation for the patient and family (and me).

In contrast to opioids, the risk of overdose with marijuana is impossible because according to the National Cancer Institute, “cannabinoid receptors, unlike opioid receptors, are not located in the brainstem areas controlling respiration.” In other words, my patient whose respirations slowed from Percocet would not have had the same experience with marijuana.

Additionally, opioid addiction can be evident in other ways. As I wrote in this post, opioid addicted patients can skewer their doctor with a negative Yelp review if they don’t receive the meds they demand. While this could also occur if a doctor doesn’t refill a patient’s marijuana prescription, that is less of a problem since recreational marijuana use is becoming more prevalent in several states (Oregon, Washington, California and Colorado to name a few).

2. Decrease pain and increase appetite

In addition to the benefit of avoiding an overdose, marijuana decreases pain and increases the appetite. Increasing appetite for chemotherapy patients is well documented but the importance of eating after any major operation can’t be overstated. Consuming foods high in protein contributes to wound healing. Marijuana clearly reduces pain, nausea and vomiting whereas opioids can actually increase nausea and vomiting.

For those of you worried about prescribing a medication that will make patients “high,” there’s an alternative that can avoid that stigma.

3. CBD vs THC

Cannabidiol, also known as CBD, is one of many active ingredients in marijuana. The more commonly known chemical compound is THC – tetrahydrocannabinol – the psychoactive ingredient in marijuana. As explained in this article here, CBD, in appropriate ratios can actually counteract the negative effects of THC. So by using a marijuana strain that is relatively higher in CBD than THC, the typical paranoia and euphoric effects of the marijuana high are less. At the same time, the beneficial effects of less pain, nausea and vomiting are still present.

4. Lack of nicotine avoids issues of wound healing associated with cigarettes and other tobacco products

As noted here, nicotine before or after surgery can constrict blood vessels and adversely affect wound healing. Marijuana on the other hand does not contain nicotine. Additionally, the risk of lung cancer seen with tobacco products doesn’t translate to marijuana either. According to this article,

“Marijuana use also was not associated with tobacco-related cancers or with cancer of the following sites: colorectal, lung, melanoma, prostate, breast, cervix. Among nonsmokers of tobacco cigarettes, ever having used marijuana was associated with increased risk of prostate cancer (RR = 3.1, CI = 1.0-9.5) and nearly significantly increased risk of cervical cancer (RR = 1.4, CI = 1.0-2.1).”

5. No constipation

With either short or prolonged use of opioids, patients complain of constipation. This is a vicious cycle. As patients take more opioids for pain, the resulting constipation can cause more pain and the cycle begins anew. That is not an issue with marijuana.

Conclusion

Granted, the use of marijuana to control pain postoperatively only pertains to the states where it is legal. In a situation where there is a process for obtaining marijuana, the stigma is less. Whereas, in states where medical marijuana is not approved, going to a drug dealer to fill your prescription is obviously a non-starter for most consumers. And exceedingly awkward for law-abiding citizens.

So, should you use medical marijuana postop instead of opioids? That’s a decision for you and your doctor. However, the point is that this is a legally viable option in many states and no longer on the fringes of society.

Click here for the original blog post written by Dr. Jonathan Kaplan for BuildMyBod.

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