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The Changes Ahead – By Dr Farahmand

I have been elected to serve as the 81st President of the Lee County Medical
Society. I am the second female physician to be president and it is with great pleasure
and honor that I accept this position.

It is hard to imagine that Lee County Medical Society was formed 86 years ago in
1927 with only 11 members. Even then, the need for an organized medical association
was readily apparent. Compare that to today, we have 570 active members and 70
retired members and the need for organized medicine is greater today as we face
issues our predecessors could not imagine.

One of our biggest concerns is how the Affordable Care Act will affect our practices.
For example, the free annual exam promised by the Affordable Care Act puts
physicians in an awkward position with their patients. The free annual exam has its own
specific code that cannot be mixed with another code such as newly reported shortness
of breath. This annual visit covers the exam and “discussion about the status of
previously diagnosed stable conditions.” That’s the exact wording under that code —
insurance will not cover any new ailment under that code. Therefore, the patient will
need to be made aware that they are not financially covered under the free annual
exam if they want to discuss any new or unstable condition. Surely, this will leave the
patient feeling they have been “baited and switched” or leave the physician feeling they
need to provide those extra services for free to avoid committing fraud and to avoid the
angry patient phone calls. Also, patients wanting to discuss new symptoms with their
physician during this free annual exam might find it annoying that the physician is
mandated to redirect the discussion to cover questions such as weight loss, smoking,
seat belts, family life and sexual abuse. This is only one example of uncertainty under
ACA.

Another physician concern is the uncertainty of whether or when SGR cuts will occur
and how this will impact patient access to care. A large number of Lee County residents
already are uninsured. Those residents who are insured choose plans with lower monthly premiums but high deductibles, leaving them to choose to forgo medically necessary treatments because they cannot afford their out of pocket cost. Many of our physicians have voiced that if the cuts are implemented, they will be forced to not accept any new Medicare patients.

A third issue our physicians are facing is Information Technology. The financial
incentives offered to practices using Electronic Medical Records has been the driving
force behind many doctors switching to this technology. EMR has many positive
features such as prevention of drug interactions or medical ordering errors. However,
many physicians find EMR expensive, cumbersome and time-consuming. One may
argue that the use of EMR actually increases the cost of healthcare as it allows
physicians, at the click of a button, to document a normal comprehensive physical
exam, or review of systems on the record even though these have not been performed.
Of course, these should not be checked off or coded for if not performed; but physicians
are not saints, and they realize that they are reimbursed for what they document and
not necessarily what they perform.

A fourth looming transition will be conversion to ICD-10 in 2014. This system will
expand the number of diagnosis codes from 17,000 to 155,000 and affects both small
and large practices.

Indeed, the need for organized medicine is greater today than it ever was. LCMS’s
Board of Governors will be working hard this year to keep you updated on these
changes and we look forward to your participation and input.

 

DSC_4359Article provided by Dr Audrey Farahmand – visit her website or call 239-332-2388

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Liposuction Alternatives: Pending Drugs to Come

Liposuction is the only FDA approved method to permanently remove fat cells safely and effectively. The majority of people who undergo liposuction are highly satisfied with the results of the procedure. The procedure is less invasive than most other mainstream plastic surgery procedures. Yet, the plastic surgery community is always interested in exploring new ways to permanently remove fat. There are two alternatives on the horizon that involve fat reducing medications, including:
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Before and After Photo provided by Marc Mani MD

Lipodissolve
The plastic surgery community is taking steps to better understand the mechanisms of action behind certain fat reducing drugs that have been injected into individuals through lipodissolve. Lipodissolve is a procedure that has not obtained FDA approval yet. The procedure is not recommended by top plastic surgery organizations until FDA approval. Lipodissolve is currently under investigation by the Plastic Surgery Research foundation to study the safety and efficacy associated with this fat reducing drug.
Medicinal Herbs
Researchers are exploring the use of fat impacting Asian medicinal herbs such as Astragalus (milk vetch or huang chi) that have been used in Asia for centuries. Astragalus is being investigated for use as an anti-obesity and anti-diabetes drug in the U.S. Astragalus is “limited” at present, according to the U.S. National Center for Complementary and Alternative Medicine. This is partly because Astragalus may contain a large number of active pharmaceutical ingredients. Some researchers contend that a better understanding of fat cell interaction with Astragalus is required. Young-Cheul Kim, assistant nutrition professor at UMass Amherst, has a great understanding of how fat cells form in the body. He believes that testing Astragalus’ biological function is highly advantageous in identifying safety and efficacy of Astragalus as an anti-obesity herb. The research team combines professionals from the University of Massachusetts Amherst and Chungbuk Oriental Medicine Center in South Korea. Several compounds derived from plants will be tested for anti-obesity qualities. The use of these compounds is also being explored to prevent numerous diseases such as the many that Astragalus is used for in Asia. .

ACT1 Peptide to Reduce Silicone Breast Augmentation Risks?

Breast augmentation surgery is not typically associated with complications. However, there is always a risk for capsular contracture in breast augmentation procedures. Following the breast augmentation procedure, scar tissue will naturally form around the breast implant. Capsular contracture occurs when the scar tissue tightens and shrinks around the breast implant. Certain women that have capsular contracture must undergo revision breast surgery to remove excess scar tissue and replace the breast implant. The risk of capsular contracture is quite low and a recent scientific discovery has demonstrated the risk may be further reduced for silicone breast implant patients. A synthetic peptide, known as ACT1 peptide, may accelerate wound healing and reduce the rate of capsular contracture in silicone breast augmentation patients.

Peptide Action
Synthetic peptides consist of molecules that are composed of amino acid chains. South Carolina researchers implanted synthetic peptides that were wrapped around silicone disks in rats. The tissue surrounding the implant was removed for evaluation over a thirty day period. The results of the research demonstrated that treatment with the ACT 1 peptide resulted in the reduction of type 1 collagen and consequently, a reduction in the risk of capsular contracture. The results also demonstrated that wound healing was accelerated in this process. Though safety and effectiveness of ACT 1 treatment for humans must be further evaluated, the results of the research were significant. Research results were published in the May issue of Plastic and Reconstructive Surgery. According to the American Society of Plastic Surgeons, over 300,000 breast augmentation procedures were performed in 2008 and close to 50% were silicone breast implants cases.

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Peptide Science Expands
Synthetic peptides have been evaluated for use in the treatment of infection and disease as well. Dating back to 2001, researchers at the Scripps Research Institute in La Jolla, California had used synthesized cyclic peptides in mice to fight a deadly methicillin-resistant Staphylococcus aureus (MRSA) which requires 2 million people annually to be hospitalized. The researchers had identified that there are over 200 natural peptides with anti-microbiological qualities in plants and animals that may be used as a substitute for traditional antibiotic treatment. The researchers reengineered the peptides to create more of the rare D-amino acids and assembled six or eight-member ring structures. In the end, the peptides were able to penetrate the wall of the bacterial cell to kill the infection. The results of the study were published in Nature magazine. Synthetic peptides offer an appealing prospect for the treatment of a variety of medical conditions and diseases.

The Root behind Hyper-Pigmentation and Treatment Advancements

Hyper-pigmentation may be the result of the sun, medications, hormones or disease. The breakdown is, as follows:
Hormones: Unlevel hormones are a common reason for hyper-pigmentation. Hyper-pigmentation may occur as a result of pregnancy, estrogen imbalance, oral contraceptives, and hormone replacement therapy. Pregnancy caused hormone changes that may produce hyper-pigmentation may naturally improve following pregnancy. Hyper-pigmentation that does not naturally improve may otherwise improve with micro-dermabrasion, chemical peel and laser skin resurfacing treatments.
Sun: The sun can cause age spots that may be improved with laser skin resurfacing, micro-dermabrasion, and chemical peels.
Medical Conditions and Disease: Sexually transmitted diseases, diabetes, malaria, and Addison’s disease are some of the diseases that may produce hyper-pigmentation. Some types of hyper-pigmentation produced by disease may be treated with micro-dermabrasion, chemical peels and laser skin resurfacing.

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The Advancements
There are several types of micro-dermabrasion manufacturers which assist with minimal types of hyper-pigmentation imperfections. There are also a variety of chemical peels which may be mild, moderate or greater in strength.
The greatest advancements have come in lasers, including: the IPL to treat large areas of hyper-pigmentation, CO2 lasers for smaller areas and Fraxel’s Restore laser which was recently introduced as a laser that can provide optimal treatment for hyper-pigmentation. In fact, each laser serves a different type of imperfection so it is important to screen several doctors in order to determine if the physician has the particular laser for your need as well as the level of experience that the physician has with a specific laser.

Nose Surgery Revision

Nose surgery to revision the outcome of an initial surgery is not often required, but there are exceptions in some cases. Revision nose surgery may be required to improve an aging result. Revision nose surgery may be necessary to revise a complication. Complications that may be improved through revision nose surgery might be slight asymmetries of the nose, mal-positioning of a specific feature of the nose, and difficulty breathing through the nose. There are many types of approaches and techniques available to provide improvements. However, women and men are cautioned that not all nose surgeons are equipped to provide such improvements. When seeking a revision to nose surgery, the following inquires should be made:
1. Inquire about the number of secondary procedures that the plastic surgeon has performed.
2. Inquire about the number of techniques that the plastic surgeon is skilled in as well as the number of times that the plastic surgeon has performed each technique.
3. Inquire about why the plastic surgeon has selected the proposed technique.
4. Inquire about the risks involved with the proposed technique.
5. Inquire about alternatives to the proposed technique and request a comparison between the techniques.
6. Inquire about the expectation for long term results from the nose revision surgery.
7. Inquire about the advancements that have been made when compared to the initial nose surgery.
8. Inquire about the length of recovery period, including the length of recovery time period should a complication arise.
9. Inquire about the type of facility that the procedure will be performed in such as an office based facility or a hospital.
10. Inquire about the type of anesthesia that may be used in the procedure, including sedation, local anesthesia or general anesthesia.
11. Inquire about the requirement to cease or take select medications prior to the procedure.

Dr. Bain focuses on all aspects of plastic surgery and cosmetic surgery including rhinoplasty in Newport Beach, California. To learn more about these procedures click here or call us at 949-720-0270.

Breast Lift Information

A breast lift (also known as a mastopexy) is a procedure designed to enhance the appearance of breasts.

Many women find that aging, weight loss, or child birth leave them with a loss of tone and volume in the breast area. This leads to sagging and drooping of the breasts. Mastopexy is a surgical option that restores breasts to a more “perky” state.

How is a Breast Lift Performed?

There are several types of breast lift procedures, which are divided into the categories of full and modified breast lifts.

Full breast lifts are the most common, and are known for pleasing, lifting results. This procedure involves a horizontal incision along the bottom of the breasts, an incision around the areola, and a vertical incision that connects the two. Excess skin is removed and the areolas are repositioned to their proper place on the breasts.

Modified breast lifts involve fewer incisions. There are several different types of modified breast lift procedures like breast augmentation.

Commonly known as the “doughnut” method, the most popular modified breast lift involves removing a ring of skin from around the areola. Other modified breast lifts are variations on this technique.

What are the Risks Involved in Having a Breast Lift?

As with any surgery that involves incisions, there will be some scarring. The placement of the incisions helps to reduce their visibility, and most patients find that their scars heal and fade nicely over time. However all people heal and react to surgery differently, so individual results may vary.

Any surgery also comes with the risk of infection. Open wounds like those from surgical incisions always have the potential to become infected if not properly cared for or if the patient has a weak immune system. Severe infections can result in loss of tissue or even death.

Choosing the Right Plastic Surgeon for Your Mastopexy

Asking around for word-of-mouth recommendations is one of the best ways to get honest feedback about surgeons in your area. Inquire with friends and family members to see if anyone has had any experiences good or bad, with any doctors you are considering.

If you visit a family doctor or general practitioner, don’t be afraid to as them if there is a surgeon they would recommend. People in different areas of the medical field tend to know each other, and your doctor should be able to offer sound advice.

When having an operation, it is important to find a surgeon that you trust and are comfortable with. Be sure you are personally comfortable with your doctor before committing to the procedure. If you feel uncomfortable at all, do not be afraid to walk away! Contact a plastic surgeon today.

Choosing the Right Plastic Surgeon for Your Mastopexy

Asking around for word-of-mouth recommendations is one of the best ways to get honest feedback about surgeons in your area. Inquire with friends and family members to see if anyone has had any experiences good or bad, with any doctors you are considering.

If you visit a family doctor or general practitioner, don’t be afraid to as them if there is a surgeon they would recommend. People in different areas of the medical field tend to know each other, and your doctor should be able to offer sound advice.

When having an operation, it is important to find a surgeon that you trust and are comfortable with. Be sure you are personally comfortable with your doctor before committing to the procedure. If you feel uncomfortable at all, do not be afraid to walk away! Contact a plastic surgeon today.