Could plastic surgery affect future medicals?

[gmeehan]

I passed my initial JAA Class I medicial in March 2009 but the doctor recommended I try lose some weight as I would be better off in the long run.

For the last 8 months, while completing my PPL, I have made massive changes to my diet and lifestyle. I have worked hard in the gym and have lost 3 stone and have reached my target weight, however, I now have unsightly saggy skin around my abdomen and am considering having surgery to have this removed.

My question is could this surgery cause me not to pass the medicial again next March? I am otherwise perfectly healthy, take care of what I eat and drink, regularly exercise, do not smoke, am not on any medication.

[kui2324]

Having a surgical procedure would mean you would have to inform IAA/CAA and it is likely you would be temporarily unfit until you had recovered from the surgery.

Do lots of research. Surgery of this type is not pleasant and the recovery can be dogged by complications. If those complications were severe or took a long time to recover from then yes, that may well affect your medical. Think very carefully about this!

[gmeehan]

Thanks Kui, I will not be rushing into anything like this lightly.

[gingernut]

I have made massive changes to my diet and lifestyle. I have worked hard in the gym and have lost 3 stone and have reached my target weight

Well done you.

In all honesty, surgery of this type is unlikely to make a difference.

Check how many the surgeon has done, and ask if he's audited his success rate. If he hasn't, walk away and find one who has:bored:

[Mac the Knife]

"......unsightly saggy skin around my abdomen and am considering having surgery to have this removed....."

OK. An abdominoplasty. Plastic surgeons do 'em all the time. I've done hundreds.

".....Surgery of this type is not pleasant and the recovery can be dogged by complications....."

It is not particularly unpleasant as surgeries go (better than a hysterectomy), patients are encouraged to be up and about the next day and spend 2 to 3 days in hospital.

All surgery CAN have complications but for abdominoplasty these are usually limited to minor problems of wound healing. Deep venous thrombosis and pulmonary embolism are no commoner than for a hysterectomy and we take steps to reduce the risks (subcutaneous heparin and sequential compression stockings).

REALLY nasty complications like necrotising fasciitis are excessively rare and anyway can occur with any surgery.

"...In all honesty, surgery of this type is unlikely to make a difference...."

Oh really Gingernut! It makes a great deal of difference. The repaired abdominal musculature is trimmer and more efficient and losing that hanging abdominal pannus makes patients look and feel better. The scar runs from hip to hip, just above the pubic hairline and is near invisible.

"....Check how many the surgeon has done, and ask if he's audited his success rate...."

Not a bad idea, but I've never troubled to "audited my success rate" because it is effectively 100%

:ok:

Mac

Edited to add: The OP asks, "...could this surgery cause me not to pass the medical again next March?" and the answer is that I would advise 6 weeks off before returning to flying duties.

[gingernut]

In all honesty, surgery of this type is unlikely to make a difference.

Apologies, my post was unclear. Unlikely to make a difference to your medical. (I wasn't referring to the clinical outcome.)

Never a bad idea to question your surgeons expertise. We did have a situation in the UK, where some surgeons were only performing some (cancer) procedures rarely, resulting in unsatisfactory outcomes.

[gmeehan]

Thanks alot for your comments guys. Mac The Knife, it's hear to hear a surgeon's POV.

[homonculus]

I am not an attractive little anaesthetist but I have anaesthetised hundreds of these

The advice you have been given is very good - check the surgeon - I wouldnt go anywhere near a surgeon who has not been a substantive NHS consultant in the UK for many years. He must have done at least 50, and 6 in the past 2 years.

Check the anaesthetist - sadly you are more likely to die from the anesthetic than the surgery - I would insist he is an NHS consultant, works at least weekly with that surgeon, and commonly does large operations (not just eyelids etc)

Finally check the hospital. It must have overnight stay and ITU backup.

However, despite Mac the Knight's accurate comments please be aware this is a major operation involving a general anaesthetic. The only benefit is cosmetic. The risks are DVT, pulmonary embolism plus infection. Rarer risks such as stroke and heart attacks (1 in 10000) lung problems (1 in 3000) deafness (1 in 10000) and peripheral nerve injury (1 in 300) do occur. These are all quite rare, and we often point out that it is more dangerous to walk around the streets of London than to have a general anaesthetic. BUT in cosmetic anaesthesia the risk benefit ratio is different to surgery for organic disease, and as a pilot there is the added consideration that what might be a short term issue for the rest of the population which is self limiting might in your case stop your career.

Sorry to be a doom merchant, and I may well be shot down in flames, but cosmetic anaesthesia is not risk free and only you can decide if it is worth it.

If you do go ahead, good luck

[Mac the Knife]

With the greatest respect to homonculus (homunculus?) I think s/he is a tiny bit erring on the side of caution.

If one wants to avoid a GA then it is quite possible to do an abdomino under epidural and sedation (indeed, this is my preferred technique because there seem to be fewer pulmonary hiccoughs and analgesia is better). Yes, I know that epidurals have their own potential problems.

So long as your surgeon is a member of the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) you really should be OK - by the time you are eligible for membership you will have done dozens of abdominos and it is such a common procedure that most active surgeons will have done 60 rather than 6 in the past 2 years.

Anaesthesia is, as you say, a different matter, but reputable plastic surgeons are very careful about their anaesthetists and for very good reasons, wouldn't dream of operating with an anaesthetist who didn't have their full confidence.

Minor "complications" are not uncommon but rarely significantly affect either recovery or the eventual aesthetic result. The chances of meeting with a complication so severe as to "stop your career" must really be extremely small.

:ok:

Mac

PS: You can find plenty of ghastly horror stories of abdominoplasties gone wrong but almost all of these were performed by untrained (and often unlicensed) "surgeons" in unsuitable (and often unlicensed) premises. It is remarkable what people will subject themselves to in order to save a few bucks.

[Mac the Knife]

"Be aware of Certificates on the Wall."

???? To what end? Do you mean look for 'em (and count 'em?) or discount 'em or question 'em?

"Being a member of an association itself won't guarantee best outcomes."

Of course not, but you're probably better off than with someone who is NOT a member of their professional association.

If you want the 'best of the best" (or at least someone who has the reputation of being the best of the best, which is not the same thing) then be prepared to pay top dollar and wait a long time.

"If the surgeon (and his team) is unwilling to express his results, or seems more reactive than proactive, walk away. Don't settle for "I've done hundred's of these." Ask to see the evidence."

I'm a member in good standing of my association. I've done hundreds of these procedures. My results are on a par with any experienced professional who does these procedures. If you believe that I am lying then the trust that is necessary between patient and surgeon is not there and I won't treat you.

You trust ME to know what I am doing and do it well.

I trust YOU to not disconnect your drains, not fiddle with your wound, not turn off your drip, to refrain from smoking for six weeks before and six weeks after the procedure, to take the medicines prescribed for you, to give me a truthful medical history, not to conceal any relevant medical conditions, to cooperate with the nurses and physiotherapists, and to inform me of any concerns that you may have in a timely fashion. And I trust you to pay your account without me having to badger you about it for six months.

If I cannot trust you to work with me then please, with my blessing, take your custom elsewhere.

"Ask your referrer about reflective practitioners."

"Reflective practice is a continuous process and involves the learner considering critical incidents in his or her life's experiences. As defined by Schön, reflective practice involves thoughtfully considering one's own experiences in applying knowledge to practice while being coached by professionals in the discipline. It has been described as an unstructured approach directing understanding and learning, a self regulated process, commonly used in Health and Teaching professions, though applicable to all. (R.Gregory)

Reflective practice is associated with learning from experience, and is viewed as an important strategy for health professionals who embrace lifelong learning. The act of reflection is seen as a way of promoting the development of autonomous, qualified and self-directed professionals. Engaging in reflective practice is associated with the improvement of the quality of care, stimulating personal and professional growth and closing the gap between theory and practice, (Jasper, 2003)."

In other words, a "reflective practitioner" is someone who thinks about what they are doing and tries to do it better - new to you perhaps, but my teachers (and their teachers before them) and I (and my students) have been doing this all their lives without putting a fancy name and fancier definition to it.

"Beware of dinosaurs' there are plenty out there."

Thank goodness! At least we have actually performed the procedure many many times, often under adverse conditions, as opposed to today's young lions who have done a few and theorised a lot.

"They're unlikely to ever change."

:E


Hmmm. Seems like the posting that led to this reply has been deleted.

[gingernut]

I reflected:)

[gingernut]

Mac, it does concern me slightly that our debates are sometimes latched onto a patients query, but hopefully gmeehan can be somewhat reassured by the advice given so far.

And the fact that we are in debate, is healthy.

I 'fess up. My original last (deleted) post was designed to wind you up. It was made in mischief, which is why I deleted it. It just wasn't the right thing to do. I deleted it before your response, but it's now obvious that you've read it- I guess you were dusting off a copy of "Clever quotations to make in response to gingernut," which may explain the reason for your delay in responding.

The post did, however, have a serious point. We can dress the language up as much as we like, but patients have come to harm as a result of health care professionals (not just surgeons) who seem to take a "gung ho" approach to their practice: refusing to learn from a changing evidence base, not learning from mistakes and not learning from tools such as clinical audit. The fact that someone has been practicing for 20 years doesn't reassure me, if they've been practicing wrongly each year of those 20.

There have been a collection of notorious cases in the UK recently, where a lack of reflection, has resulted in poor outcomes for patients.

Anyway, good health, may the debates continue.:)

[Mac the Knife]

Well that's decent, but I'm sorry I got suckered in.

This isn't a debate, this is just Gingernut banging on again about how most medical professionals are either venal or lazy or both and really can't be trusted to treat people properly without constant surveillance.

The sooner we all :mad: off and leave it all to him and his ilk the better I reckon!

Mac

(The "clever quote" was from Wikipedia, Google's first hit on "reflective practice")

[mad_jock]

Back to the chap in question.

From a personal view as a line pilot who is also a fat bastard.

Its hard to explain the life style change when you get that first job.

Nothing in your life ever has any rhythm again. Your body clock is mucked about on a weekly bias 4 am wake up for a few days then 11am for a few days finishing at anywhere between 9pm and early hours of the morning. A couple of days off and then repeat. Eating is again very hit and miss. You try and be good and then something happens and it all goes to pot.

You have done a cracking job at getting rid of the weight but I would leave it a few years until you go under the knife. My weight goes up and down depending what roster I am on you may be saggy just now but a couple of years down the line you might need that extra slack.

[gmeehan]

I've decided to leave it for a year or so, continue to work in the gym and eat right, will assess my situation then.

Thaks for all the advice and healthy debate.

gmeehan

[jollyrog]

This is a very interesting debate. I'm curious to know if all my excess skin can be cut off with the fat still in it?

[Flyin'Dutch']

Lively debate!

An apronectomy is usually a purely cosmetic procedure and as such has limited benefits in general.

It has risks and they need to be weighed up carefully before you sign on the dotted line.

As per usual the surgeon will tell you a slightly positive story and the medics a slightly negative one; the truth will lie somewhere in the middle.

Caveat emptor!

[Mac the Knife]

Dutch, an apronectomy is not the same as an abdominoplasty.

And it depends whether you prefer the comments of a very experienced plastic surgeon who has done hundreds of abdominoplasties (me) or Nurse Gingernut.

Caveat emptor indeed!

Mac

[gingernut]

Unfortunately, we still do see examples of such arrogance in our health care system, with the resulting detriment to patient care. I'm sure parallels can be drawn in the aviation industry, but I suspect that developments in team management, have improved things dramitically over the years.

An example of where we can get if spectacularly wrong, can be seen in the Bristol Babies Scandal.

Whilst it's tempting to use sources such as Wickipedia to find one's own quotes, it's sometimes preferable to gain information from more robust sources.


I've quoted this from the Inquiry into Bristol Heart Babies Inquiry Team, who suggested these recommendations:

Keeping patients informed about care and treatment, with better communication and support.
Better consent procedures.
A Council for the Quality of Healthcare which brings together the Commission for Health Improvement, the National Institute for Clinical Excellence and the proposed national patient safety agency.
Improvements to the management of NHS services.
Doctors must keep up to date with clinical practice and must be appraised regularly.
Each of the professional bodies, such as the GMC for doctors must continue to oversee professionals, but there should be an overarching body called the Council for the Regulation of healthcare Professionals above them.
There must be an environment in which errors can be reported and learnt from.
The clinical negligence system should be abolished and in its place should be an alternative system for compensating patients.
NICE should co-ordinate all action and monitoring of clinical standards nationally.
The Department of Health should not be able to change those standards when it issues other guidance.
There must be a coherent set of standards for the NHS, which all bodies must comply with.
The Commission for Health Improvement should ensure those standards are met.
Assessments should be made public and if a an organisation fails to meet the targets, it should lose its validation to provide care.
In time, specialised services, such as children's acute hospital services and children's heart surgery should be included, and be able to show it can deliver all aspects of the service.
Information on how trusts, and doctors and services within them, perform compared to others should be available to the public.
Trusts should also demonstrate how well they comply with national clinical standards.
The public should be more involved in the running of the NHS.



In the report's conclusion,


The official report into the Bristol Royal Infirmary tragedy blames a "club culture" among surgeons and warns it could be repeated elsewhere.

And boy oh boy, if ever there is an example that somethings are slow to change (and why), here we have it.

caveat emptor indeed.

[Mac the Knife]

Quite what a nearly 20 year old cardiac surgery "scandal" has to do with abdominoplasties today is hard to fathom, apart from Gingernut's preoccupation with medical incompetence.

As far as 99% of the people who read M&H are concerned, Gingernut IS a doctor (typical ppruner quote "Never trust doctors (unless it's Gingernut or <redacted>)". The tone and variety of his posts, his references to "my waiting room" and "my patients", lead one to believe that he is a GP (as I did at first). He regularly (and sometimes sensibly) advises on everything from epilepsy to electrocardiograms, giving the definite impression that he is a doctor (although to his credit, he has never actually claimed to be one).

Only in two obscure threads has he ever conceded that he is not (his profile gives his occupation as "professional disco dancer") . Perhaps more tellingly, he has never to my knowledge told us what he really is (probably a nurse-practitioner). A Walt, second class, I'd say.

As to his views on medical practice and medical practitioners, these must be well known to readers of M&H. He believes that much current medical practice is misguided and that the majority of medical practitioners deliberately or thoughtlessly follow unproven and often harmful therapies. He (and New Labour) believe that medical professionals are intrinsically unreliable (look at Shipman!) and that only careful monitoring by lay persons can adequately protect the public from them.

Now only a fool would maintain that doctors do not have their share of the overdogmatic and uncritical, Gingernut is hardly unique in being able to perceive this. Doctors themselves are uncomfortably aware that there are those of us who bring little credit to the profession.

But Gingernut's conviction is that the MAJORITY are overdogmatic and uncritical and it is there that we part company. The vast majority of doctors (how many has Gingernut REALLY talked to in depth?) are very acutely aware of their results and limitations, worry about them and work hard to try and improve their practice.

From his posts it is evident that Ginge believes that he is as well or better qualified to advise and treat patients than a GP and, given the very limited scope of UK general practice these days, he may well be right. But I would venture that he might find himself alarmingly out of his depth in a wider practice or one of the postgraduate specialties that he treats so lightly.

Ginge normally uses the word "quack" to refer to doctors (over 60 times so far, and the words "doctor" or "doctors" only 4 times). And, lest he protest, "quack" is not an affectionate idiom for a doctor, it is an expression of disbelief and contempt.

He believes that the nurse-practitioners and the OR-technicians whom he would have take over from us "dinosaurs", will somehow be immune to the sins of pride and complacency that beset us all from time to time, but this extraordinary hubris seems improbable.

I think Ginge is sincere in wanting to improve healthcare and its delivery, but he also has a large personal axe to grind. Whether his policy of continuously running down doctors on a public forum or elsewhere is constructive is a matter that you must decide for yourselves.

Mac

[gingernut]

And did you find any specific innapropriate or dangerous advice I've given during your stalking exercise? If you did, I'd gladly walk away from this forum.

I'm not a doctor, and I'm the first to set the record straight when that assumption is made. However, I do feel the advice I give is qualified. (And so does the Department of Health.)

I'm not a specialist. (Can you be a specialist generalist??). I do have a caseload, but perhaps it's a little paternalistic to refer to "my patients,"-it's a reference to my care for them, rather than an attempt to decieve.

Do I talk to doctors? too right, all the time, and most are as brassed off with the system as I am. (And want to change it.)

Most:)

PS I'm not really a professional disco dancer, just as I doubt you are made of plastic, my occupation is a nurse, and I work in primary care. (Part time).

[7120]

"Do I talk to doctors? too right, all the time, and most are as brassed off with the system as I am"

I'm a doctor in the NHS. Tell me how am I brassed off and who do you talk to?

[gingernut]

My work involves talking to those involved in "the system," which we use to deliver health care. Mostly (but not always) in the NHS and the UK.

My current work involves talking to patients, their carers/relatives, the primary care team, secondary (and sometimes tertiary) care staff amongst others. PM me if you wish, and I'd be happy to discuss my work in more detail.

I'm not into bashing the NHS-I'm very proud of the NHS as an organisation. And I'm not into doctor bashing- (Mac and I are old adversaries, although lately he seems less inclined for debate.) Most doctors I've met are neither lazy nor incompetent.

As I've said in numerous other posts, I don't think I've met many people in the organisation (NHS) who don't want to improve the quality of care they give to their patients- I can, and do, say that with hand on heart. And, I must say, in terms of outcomes, I reckon the NHS has, and continues to, improve the care we give to our patients, in most areas.

But there are still issues, sometimes only small issues to us, but sometimes with massive implications for the patients, that need fixing. As a doctor with the NHS I suspect that you know that already. I don't know your area of work, so it's hard to be specific.

I enjoy the challenge of trying to identify the gaps, and make the fixes, unfortunately that seems to upset those who think things are perfect. (and they 'aint.)

I can't tell you if or how you are brassed off, I don't know you.

[Bad medicine]

OK, I think we are well beyond the topic of the thread now. Play the ball not the man - both of you.