If you’ve had surgery or planning on surgery, you may need a JP drain. JP stands for Jackson-Pratt, ostensibly the inventors that probably didn’t sign a very good deal for royalties! Anyway, a drain is useful to remove any fluid that builds up after an operation.

When a JP drain may be used

Basically, anytime you have an operation that requires the undermining of skin or the removal of tissue that leaves “dead space” behind, you’re at risk of developing a fluid collection, called a seroma. Examples includes arthroscopic surgery, heart surgery, extensive liposuction or a tummy tuck. Using a drain can evacuate this fluid so that the “dead space” collapses and closes off. Once the cavity closes off, fluid no longer collects and the drain can be removed.

But while the drain is in, certain things need to be done to ensure it’s working properly. The video below explains the following two principles: 1) stripping/milking the drain and 2) charging the drain.

Stripping or milking the drain means that you’re squeezing and sliding your fingers along the drain to move the fluid along. This helps avoid clots from clogging up the drain. And if the drain is clogged, it’s not draining and therefore doing you no good.

Also make sure that after you empty the drain, you “charge” it again. This means that you squeeze down on the bulb and then put the stopper in so it holds suction. If these descriptions aren’t clear, the video below will definitely help.

Video of how to take care of your JP drain

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

The post Taking care of your JP drain [video] first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

Once they pull over, Tommy Boy jumps out of the car, while encouraging Spade’s character to follow his lead, screaming, “Bees! Bees! Bees!” At the same time, they’re miming their attempt to bat away killer bees that aren’t there. The police, concerned for their own safety, encourage the two young men to roll around in the grass as the police quickly flee the scene. Tommy Boy, in disbelief, exclaims, “Holy schnikes, it worked!”

What bees have to do with my surgery “origin story”

That scene from Tommy Boy, released in 1994, reminded me of something I had forgotten. Ten years before, when I was 11 years old, I went with my Dad to the emergency room for the first time. He was called to evaluate a woman with an open scalp wound.

Before we entered the exam room in the ER, I could hear my Dad asking the patient if it was alright for his son to come in, which she very generously agreed. Upon exam, I could see the patient’s scalp wide open from the top of her right ear, over the middle of her head, to the top of her left ear. It was a clean separation of the scalp, exposing this glistening red layer of tissue. I learned 10 years later in my first year of medical school that this layer of tissue is the galea aponeurotica,

So how did this woman split her scalp? As alluded to in the introduction, she was attacked by a swarm of bees! She started running from the bees and absent-mindedly ran into her garage where her husband had a boat hoisted up to the ceiling. As she ran away, she ran underneath the back edge of the boat. In the process, she hit the top of her head, splitting her scalp from ear to ear. Understandably, she drove to the ER.

The Moment

While standing there, looking at her injury, I realized two things. The first was that this grotesque trauma didn’t freak me out. I mean, I was sorry for the patient. But she was awake and talking, and clearly going to live, so the experience was actually reassuring. Secondly, I knew this is what I wanted to do the rest of my life (be a surgeon).

But I always wanted to be a surgeon, right? Ever since I was four years old, a family friend always reminded me that when he asked what I was going to be when I grew up, I said, “I’m gonna be a surgeon,” (said with a very thick Louisiana accent). I didn’t know what I was talking about; I was just copying what my father did. Not an unusual thing for a child to want to emulate their parents, regardless of what their vocation was.

Until I saw Tommy Boy, I had forgotten about this pivotal moment. Again, I just figured I always wanted to be a surgeon. However, Tommy Boy made me realize that meeting this woman running from bees was “the moment.”  It was the point at which child-like imitation turned into a deliberate career choice.

Not to give myself too much credit, but I bet no one was so genuinely affected by one of the greatest films of the 20th century as I was! Rest in peace Chris Farley.

Video of Bees, bees, bees! from Tommy Boy

That’s my story of what influenced me to become a surgeon. The decision to become a plastic surgeon? Well, that’s another story…

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

The post Bees and my surgery origin story [video] first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

Why do surgeons hate fingernail polish for surgery?!

One of the least invasive ways to monitor the oxygen level in your blood is with a pulse oximeter. See the photo above. A pulse oximeter, or ‘pulse ox’ for short, lightly clamps onto the finger tip and monitors the level of oxygen in your blood in real time. This is certainly easier than drawing blood from the patient’s artery every time the anesthesiologist wants to check the level of oxygen.

The pulse ox needs clear access to the blood vessels in the fingertip and nail polish can affect the readings. This study set out to assess how these 10 different colors affect pulse ox readings:

“Ten different colors of Wet ‘n’ Wild (Pavion; Nyack-on-the-Hudson, NY) fingernail polish were used: red, yellow, dark blue, green, black, purple, fuchsia, light blue, brown, and white.”

According to the study, black and brown were the only colors to alter the readings to a statistically significant degree. However, even in those circumstances, if the pulse ox was placed on the finger in the ‘side-to-side’ direction rather than the normal ‘top-to-bottom’ direction of the finger, the readings were again accurate.

So next time you go to surgery, you have 3 options:

1. 1. don’t wear any nail polish.
2. 2. allow the OR staff to remove your nail polish.
3. 3. argue with the staff and cite this article and tell them to place the pulse ox in the side-to-side position if you’re wearing black or brown nail polish. Or the top-to-bottom position if wearing any of the other 8 colors above.

 
I would recommend against the 3rd option. Arguing with OR staff before your operation is bad karma!

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

The post Do you really need to remove fingernail polish for surgery? first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.

What to wear for surgery

Determining what to wear for surgery requires knowledge of what happens in the operating room. Obviously the surgeon needs access to the area where the operation is occurring. Is it the chest, arms or abdomen? Maybe the face. So you want to make it as easy as possible to get out of your clothes upon arrival. But more importantly, you want to wear clothes that are easy to get back into after surgery.

For example, if you’re having facial surgery, you should wear a button down shirt so you don’t have to pull a shirt over your head. If you’re having breast surgery, there’s no reason to bring a bra because your surgeon will probably place a postop garment on you after surgery. There’s no need to wear tight jeans because you don’t want to put yourself in the situation where you have to struggle to put your pants back on. In light of these situations, you should focus on baggy clothing. That includes a button down shirt for the reasons mentioned above and sweat pants. Slip on shoes are best so it’s easy to get back on after surgery.

But what about accessories?

I know you want to look as pretty as possible for surgery but you really don’t need to wear any makeup or jewelry. It’s best if piercings are removed but I understand non-traditional piercings can be difficult to remove. For patients that have nipple rings, we cover these with a sterile dressing during surgery if we’re not making incisions around the areola. By allowing the patient to keep those piercings in place, there’s less frustration for the patient and it avoids a delay in surgery trying to get them out!

Don’t forget to wear similar loose-fitting clothing for your postop appointment so it’s easy for your doctor to examine your surgical site. Best of luck!

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

The post What should I wear for surgery? first appeared on Plastic Surgeon San Francisco | Pacific Heights Plastic Surgery.