10.28.09
The Reality of Malpractice Law Suits
In the third week after the first surgery I called two different malpractice lawyers. They both told me the same thing. In the state of Florida a plastic surgeon is only required to carry a minimum of $100,000 in malpractice insurance.
That amount would cover the investigative and legal fees and I would be left with very little. In all likelihood it would not be enough to pay for reconstructive surgery.
In the investigative part of the law suit they subpoena the records from the surgery. Once the records are subpoenaed, (or even before that) anyone can go in and change the records to indicate a more favorable position for the surgeon and the surgical team. So by the time the attorney gets them, there may be no evidence at all of malpractice.
It is also difficult to define what exactly constitutes malpractice. Who’s error was it? WAS there even an error?
Much later I spoke to a surgical nurse an another site who said that she thought, from the bruising I described, that something must have gone catastrophically wrong during surgery. But there wasn’t really a way to prove it.
So there you have it. Make sure you know what you’re getting into. Ask how much malpractice insurance your PS carries. You only get one body. Make sure it’s protected.
06.24.09
The Next Great Saga
Now the fun truly begins. Ken has started his negotiations with the hospital. Since my reconstruction had to be paid for out of pocket, he has made it his mission to make sure we don’t pay any more than we absolutely have to. At his request we have already gotten an itemized copy of the bill.
In the realm of ridiculous pricing, the hospital charged $10 for a multi-vitamin and $12 for a calcium pill. That’s right. ONE PILL! They also charged us $32 for an Oxycodone. Ken paid $20 for a 30 day supply of that AND a prescription muscle relaxer FROM THE HOSPITAL PHARMACY!! These are just a couple examples of inflated pricing from a major Atlanta hospital.
With billing and prices like this it really is no wonder that our medical system is in the shape its in. If it’s not the insurance companies looking for any reason to bilk the customer, it’s the hospitals screwing the insuance companies. Or the pharmaceutical companies screwing the inurance companies. And since shit rolls downhill, the insurance companies, in turn, screw the consumer.
Getting screwed USED to be FUN!
Originally we negotiated a cash price for the hospital stay. If we had been insured, our insurance company would have had to pay a little over $24,000. Our discounted cash price was$14,600 with an up front payment of $8,200 due 10 days before my surgical date. As far as we can see, there is PLENTY of room to negotiate.
As usual I’ll keep you all up to date as the situation develops.
06.23.09
9 1/2 Weeks
From the title of the post, it’s pretty obvious what today’s topic is.
Medical updates.
The spot on my back is still troublesome. It’s not really getting any better. I’m still not too worried about it though as no one else at Dr. Elliott’s office is overly concerned. Last night Ken said he thinks I should “be seen” by Dr. Elliott’s contemporary down here, Dr. Roxanne Guy. I have an appointment for Thursday.
Honestly, I am SICK of “being seen”. I am SO over all of this medical crap. I just want to get ON with my life. I think that’s part of the reason I’ve started doing Ta Ta Tuesday. Even though I may not be completely done with all of this, I want to start enjoying the completion of the major stage.
The nurse at Dr. Elliott’s office had suggested that I wait another month to take the tape off the suture line. I got tired of waiting so I went ahead and took the tapes off four days early. Really I could have taken the tapes off at 6 weeks but I tend to be overly cautious as far as suture lines go.
I haven’t taken any acetaminophen for pain in a few days. I’m happy about that. It’s definitely a few steps ahead of where I was. My endurance, however, is another matter all together. I used to be able to be at Disney for anywhere from 12 to 14 hours. Now I can’t walk around for more than a couple hours without getting worn out. It’s possible that the heat could be exacerbating the issue, but I just don’t think so.
Mobility is another issue. I can raise my left arm all the way up next to my head. The skin in my armpit is still a little tight. My right arm is another matter. I can only raise it at a 55 or 60 degree angle without tightness and pain. It HAS improved since surgery. It’s just improving more slowly.
Emotionally I’m doing better, as the idea of TaTa Tuesday shows. I’m still trying to decide if I want to take a chance on nipple reconstruction. Some articles say that in experienced hands the failure rate is less than 2%. On other websites I’ve read women’s stories of how their nipples flattened out between six months to 2 years. There was also a fairly high incident of infection.
I have emailed Dr. Elliott and asked him to suggest someone who makes custom silicone nipples and write a letter of request. Every prosthetics maker I have found that does really good hand painted nipples requires a letter from a physician. Even if I decide to have the surgery later, I will still have the prosthetics in the mean time.
06.15.09
It’s More Complicated Than That
Something that isn’t really mentioned much is that eventually many breast implants may need to be replaced. An article released in 2005 by the New York Times reports that up to 93% of silicone implants fail within the first 10 years. http://www.nytimes.com/2005/04/07/politics/07breast.html .Those implants need to be removed and possibly replaced as soon as possible. This is another surgical expense that you will have to cover. Usually these costs must be paid out of pocket. In one study by the New England Journal of Medicine, the complication rate for augmentation was as high as nearly 25% http://content.nejm.org/cgi/content/abstract/336/10/677.
Other things surgeons are unlikely to tell you are that sometimes the skin thins and wrinkles and the silicone shell of the implant become visible. With saline implants, if you push on your breasts, you can hear the implant sloshing around. Ever fondle a breast with a saline implant? It feels like you’re fondling a water bottle. When it comes down to it, saline breast implants are really only good for looks. The other option is silicone implants. Although there is not a conclusive group of studies, it is widely believed that leaked silicone is responsible for, or at the very least, contributes to, autoimmune conditions such as fibromyalgia.
Sex may not be the same either. You have water bottles sloshing around in your chest that feel totally different from your natural breast tissue. Many women also report numbness or reduced feeling in their breasts and especially the nipples after augmentation. Sometimes it’s temporary. Sometimes it isn’t. This is surgery and it can cause permanent nerve damage just as with any other surgery.
Before you sign your paperwork for the surgery, someone in the doctor’s office will go over the list of possible complications. In my case the person stressed repeatedly that these complications were extremely rare. I’m sure that there are women out there who have gone through the procedure with no complications and no issues at all. I would LOVE to talk to one of these women.
The list of possible complications is as follows:
Seroma (pooling of serous fluid)
Hematoma (pooling of clotted blood; risk is 3-4%)
Symmastia
Double Bubble (also known as “double fold”, “snoopy effect”, or “snoopy breast”)
Mondor’s Cord
Bottoming Out
Deflation Photos (approximately 7%)
Capsule Contracture
Traction Rippling & Rippling Photos
Photos of these complications can be found here: http://tinyurl.com/5gz6mc
Other lesser complications include:
Asymmetry
Bleeding
Breast droop
Displacement
Implant leak
Infection (risk is less than 1%; always involves removal of implant)
Interference with mammography
Keloid (heavy scar)
Nerve Damage
Nipple numbness
Pain
Permanent numbness (risk is 15%)
Reactions to medications
Rippling
Rupture of the implant (often due to injury)
Skin irregularities
Sloshing
Slow healing
Swelling
Visible scar
The above are relatively MINOR complications, however. Seroma and hematoma can lead to necrosis because of the pressure on the small blood vessels reducing blood flow to the affected tissues.
Necrosis is the death of tissue. When necrosis occurs, the area must be debrided. This means that the dead tissue has to be clipped out and the remaining, new tissue cleaned. Debridement doesn’t hurt. That tissue is dead which mean there are no living nerve endings. To leave dead tissue is to invite infection. So even though the thought is terrifying (and believe me, it was TOTALLY terrifying when I went through it), it’s better to get it done and over with. Then the body has a clean bed of underlying tissue to grow from.
The complication percentages listed above are reported to be low. Most are under 10 percent according to the statistics I have found. This does NOT mean that surgery of any kind is completely safe. Do not believe that just because your friend had a boob job that went perfectly that you would have the same experience.
Your surgeon and his or her skill level play a big part. So does your body and how it heals. Even though I got a clean bill of health from my pre-surgical physical and blood test, I developed several complications. I had seroma and hematoma that were NOT addressed by my surgeon. I believe those contributed to the development of necrosis. I also talked to a nurse about a year after my complications. From the description of my waist to collarbone bruising, the nurse was completely convinced that something had gone wrong during the surgery that led to the development of the necrosis.
I’d like to stress again that you should be educated about your choice of surgeons. He or she MUST be board certified by a plastic surgery association. ANY doctors can call themselves a plastic surgeon but the ones who are actually educated for that specialty are board certified.
Do NOT try to find a deal. Trust me when I say that cheaper is NOT better. I learned this lesson the hard way. It cost me more than money to learn this.
If something does go wrong, you may not be able to sue. In the state of Florida a plastic surgeon is only required to carry $100000 in malpractice insurance unless they are affiliated with a hospital. By the time your lawyer proves malpractice, most of that $100K will be gone to lawyer’s fees. You will, in all likelihood have little to nothing left for any repair procedures.
Use my story as a cautionary tale. Know your body, know your family medical history, know your surgeon, and know the risks.
06.14.09
The Adjustment
Something I’ve been meaning to talk about for some time now is my process of making the adjustment from having a mangled A- cup to what I now know to be an F Cup. This has been a tremendous adjustment for me <no pun intended>. Not only have I had to make mental adjustments, but I’ve also had to make emotional AND physical adjustments. As I type this, I am tearing up because I STILL can’t believe that not only do I have natural, implant-free breasts, but I have HUGE, all-natural breasts. They’re mine. Not because I bought them but because the tissue is mine. They are a part of me.
Granted, those parts used to be elsewhere on me. The Latissimus Flap procedure, as I’ve mentioned before, takes a piece of muscle from the back, as well as fat and skin which is left attached to the blood supply on one end and pulled through under the skin to the front and molded to create a new breast. After the complications from my initial augmentation, I have been adamant about not having implants. I will explain why in a future installment.
Mentally I’ve had to slowly coax myself into the realization that I am no longer a mangled thing. Yes, there are small scars but in comparison, that is so completely inconsequential now that it really boggles my mind. The first time I looked in the mirror and realized that what I was seeing was real, it shoved me headlong down the path towards feeling whole again.
Emotionally, blogging my journey has helped imensely. Knowing that I might one day make a difference in someone’s life has been a major motivating factor. One of my long-time Twitter followers, QueerCincinatti, actually linked to my blog and told me how much of a difference I’ve made. Check out that post here and susbscribe to the blog. It’s chock full of fantastic information. http://tinyurl.com/kldzgs
I have tried for several weeks to write this particular post. It has been very difficult for me to find the right words. I’ve spent SO much time trying not to think about the wreckage that was my chest. Now that I am focusing on it, I find that I’m easily distracted. It’s like trying to drill glass. My mind skates over the surface of the topic and skitters off in a different direction before I can stop it.
Right now, for instance, I’m wondering if Ken needs help in the office or when we’re going to leave to run the couple errands I’d like to get done today. I’m also gauging how much pain I’m in and wondering if I should get up to take acetominophen or do I need a 1/2 Darvocet?
No, I don’t have ADD. I’ve just trained myself for the last two years to avoid thinking deeply and seriously about the situation surrounding my breasts or, until 6 weeks ago, the lack thereof. So please bear with me while I…oh look! A butterfly!
No. Seriously. I have to work on retraining myself now. I have to remind myself that it IS okay to look in the mirror. It IS okay to look down at my chest because I actually have something there to look at now that isn’t mutilated or damaged in some horrible way. It’s going to take time to make that adjustment, too.
I thought I had made it to some extent. I was wrong. There are still parts of this that make me cry if I think about it. That’s just normal, human feeling. Recovering from major trauma takes time. Having breasts again goes a long way, but it doesn’t magically repair the emotional damage that watching the necrosis steadily eat away my breasts or not really understanding why it happened or even the emotional damage of having my concerns blatantly ignored by the first surgeon.
When I first started this post, I thought I would be talking about how I’m still adjusting to the size of the Twins. Really they still get in the way sometimes. The other day I actually whacked one against the doorjamb as I was exiting the bathroom!
It turns out though that after eight weeks the mental adjustment has gotten easier. I do occasionaly wake up in the morning feeling angry over what happened. Because this was the result of plastic surgery gone awry, we had to pay for the reconstruction ourselves. That really pisses me off to no end that people like me have no other option because cosmetic surgery is looked on as vanity-based or superfluous.
No one’s health issue, regardless of the initial reason, should be marginalized like that.
But again, I digress.
SEE??? It’s hard to actually stay focued on the mental adjustments I’m making. I’m thinking that I am probably not alone here.
Clothes shopping last week actually helped. I bough some new, sexy tops that showcase the Twins. Those really make me smile because I haven’t felt sexy is a VERY long time. Not because my Hubby hasn’t been supportive. He HAS been, telling me I’m beautiful no matter what. It’s just hard to believe that when I felt so mangled and sub-human.
I’m starting to come back from that though. I actually got called “gorgious” this morning by someone I’d just met yesterday. Yes, I got hit on 
That helps, though after all I’ve been through, it’s still pretty weird.
This post is running long so I’m going to wrap up this episode. I WILL be talking more about these adjustments though. And remember, dear reader, you are NOT alone. Email me. I am happy to talk to you any time.
05.12.09
Turning A Corner?
Two days ago I was talking to my mother, who has been through MUCH more medical crap that any human being should EVER have to endure. She said that soon I would have to start learning to differantiate between pain and stiffness. There IS a difference. Pain does not improve with movement. In fact movement simply makes pain worse. Stiffness, however, is eased with movement until the body feels nearly normal again.
This morning I woke after only about four hours of sleep feeling very sore and stiff. I went to use my usual method of rolling out of bed only to discover that it was MUCH easier to get up. I was really surprised. It’s actually a bit of a shock at how quickly I seem to have started turning a corner. There are still spots, like my triceps, that hurt but don’t top out at more than a 1 on the pain scale. Of course the spot where I ripped the stitch is still a but tender. All in all things are getting easier though.
I am by no means totally there and I’m going to have to take things slow still to make sure that I don’t overdo and really hurt myself. I still have muscle relaxers for when I need them and two different types of pain meds if and/or when I should need those.
I think the thing that’s the worst right now is the lack of sleep. I’m so very tired right now but I can’t really sleep. I just got up. I need to eat because I’m nauseous from lack of sleep and I’ve GOT to move around more. Plus there is morning maintainence to be done. I’m just so tired. I’ll probably take a nap in a bit after everything else has been accomplished.
In the mean time, I’m relieved that it looks like I may finally be turning a corner.
05.06.09
Your Wake Up Call
2 am is becoming some kind of freaking magic number I’m starting to dread. I woke up slowly this time though. I had hoped that a dose of Darvocet would put me back to sleep. No such luck. So I got SLOWLY out of bed. Rolling is a GREAT way to get up but I was starting to feel like hundreds of tiny people were raising me as an Egyptian monolith. Once upright I felt loads better, so I went for a breif walk. I hadn’t realized that our sprinkler system is set for that early hour. I almost got a nasty surprise but heard the hissing spitting sound before I ran into the jet of water.
I didn’t start this entry until about 5:15 am and I just took another dose of Darvocet. It’s already starting to make me sleepy. That’s the thing I’ve noticed so far. I was loopy but a bit more coherent on the Oxycodone. The Darvocet just makes me sleepy as it kicks in and kills the pain. Either that or it’s the fact that I only slept about 2 and 1/2 hours. Who knows? But that was an hour more than I had slept on previous nights when I’ve woken up at this hour.
As I take more of the Darvocet I’ll be able to do more of a compare-and-contrast as time goes on.. In the mean time I think I might actually get back to sleep before 7 am.
The realtor is coming over tomorrow morning around 11:30 so that we can officially take the house off the market. With the national credit situation the way it is and the fact that we’ve had to pay for this surgery completely out of pocket we’re not going anywhere any time soon.
04.28.09
Infection- Part 1
It’s 1:18 am Tuesday April 28th. That smell I thought was my armpits…isn’t.
There is a thick yellow discharge from the suture line on the underside of my right breast. And it smells awful.
The area is also red.
Classic signs of infection
The plus side? I’m not running a fever.
Right now we’re waiting for the on-call person from Doctor Elliott’s office to call back and advise us on what to do.
I’ll post updates as they occur.
Right now? I’m freaking the fuck out.
The Curse Of The Pre-Existing Condition
Northside Hospital wasted no time at all in sending their bill. It was, of course, not itemized. It was also for more than the initial estimate.
Yes, I know that “estimate” means it could be more or it could be less. Considering I was only in there for two full days I’m surprised that it turned out to be over $32,000.
Ken is going to be contacting them for an itemized bill and negotiating it down further. He’ll also be negotiating a payment plan, I’m sure because there is NO WAY we can afford to pay that kind of money all at once.
Our income is further limited because right now there’s no way I can work. I can’t pour oils from one bottle into another. I’m not steady enough. I don’t trust myself to reliably fill even 10 ml bottles. I can’t even lift hydrosol bottles because they are far too heavy. Right now I can’t even really stand upright for very long. The pain meds, especially the muscle relaxer, makes me sleepy. So I’m doing duty as two of the seven dwarfs: Sleepy and Dopey. I also don’t have the mental capability of taking orders because I can’t focus for very long. It’s unbelievable how long it takes me to do one of these posts so you can imagine what I’d be like on the phone with a customer.
Not only did the surgeon’s fee have to come out of pocket, but so do the hospital fees. I’m one of the fortunate few. Many women who are uninsured never have this kind of opportunity and are forced to live their lives feeling the way I felt just a few short weeks ago. My heart goes out to each and every one of you who continue to live without the benefit of reconstructive surgery. I may complain about the expense, but I want to acknowledge here that I know how very fortunate I am.
It is for women in this position that I support an overhaul of the insurance and medical system. When we are in the financial position to do it, we will be starting a foundation that will help to pay the medical costs of women who have gone through things similar to what I have had to endure. NO woman should have to be put in a position where she has to choose between being whole and keeping a roof over her head.
Unfortunately, insurance companies keep putting people in just that position. Cosmetic surgery snafus that cause these tragic circumstances lead insurance companies to deny claims because any new claim filed in conjunction with those complications are considered a preexisting condition. Even if you go into cosmetic surgery like I did with a clean bill of health, insurance companies will find ANY excuse at all, including old medical test results that were a little iffy to either deny the claim OR yank your coverage.
Once you’ve been denied coverage, good luck getting anything remotely resembling decent medical insurance after that. These unscrupulous practices are ruining people’s lives. All in the name of the AllMighty Profit.
In my particular instance, the insurance company dug up a urine test that had a high number of epithallial cells. These are the cells that line internal organs and are sloughed off as a regular biological process. In higher levels they CAN also indicate a pre-cancerous condition.
I do not have cancer nor was I told about this result by my doctor because there was nothing to worry about. When I told the insurance company all of this, they just reiterated their stance and continued to deny me coverage.
This sort of practice has GOT to stop.
