Thursday, November 15, 2007

Fatal Attraction (Death)

When and why does cosmetic surgery prove fatal? Rapper Kanye West's mother arrived in the emergency room DOA Saturday night, subsequent to undergoing an outpatient abdominoplasty (tummy tuck) and breast reduction on Friday. Of course the American Society of Plastic Surgeons (ASPS) has immediately issued press releases to say how rare this is– they don't actually keep statistics on all who die during or as a result of undergoing elective aesthetic surgery– but who wants to die?

Is it always the doctor's fault? Yes and no. Many variables are outside the control of the surgeon– from anesthesia to the vagaries of healing to patient non-compliance. In general, though, there is one personal variable that has tripped up the established, credentialed plastic surgeon more than any other. That liability is his own ego. Operating on a patient who shouldn't be operated on, deluding oneself about one's surgical omnipotence, can lead to disaster. Sometimes this is compounded by poor judgment and/or skill set.

That may indeed be the case with this death.

The surgeon, Dr. Jan Adams (53), has two previous malpractice suits under his surgical scrubs and three more in gestation (one of which also involves a co-morbidity: diabetes). Shown here in his booking photo, his most recent convictions for DUI in March and April of 2006 led the California Medical Board to consider suspending his license (it's pending with the State). Of the 60 ASPS board certified plastic surgeons listing Beverly Hills as their venue, Adams isn't one of them. When it comes to checking out a physician, Google is your friend.

Dr. Jan Adams considers himself a top plastic surgeon in Beverly Hills, despite his lack of board credentials. He authored Everything Women of Color Should Know About Cosmetic Surgery. He hosted Discovery Health's Plastic Surgery: Before and After show and has been featured pretty much everywhere on the talk circuit. Check out the OprahAftertheShow chat. He's a showman. Is he the most articulate spokesman for plastic surgery? Nope. Was his handiwork on display lovely? Nope. But he is a rare commodity: a black surgeon marketing to women of color.

Donda West (58) also consulted with another Beverly Hills surgeon, Dr. Andre Aboolian. This board certified plastic surgeon insisted on a preoperative clearance from an internist because of an underlying condition. "I always insist on a medical clearance for women over 40, and in this instance, it was particularly important because of a condition she had I felt could have led to a heart attack."

The operating surgeon's response? Adams claims that he did nothing wrong and shared his opinion of his colleague Dr. Aboolian: “[h]e is sleazy and manipulating the truth to elevate his own importance.” That's not generally anything a reputable plastic surgeon would publicly say.

Using a board-certified surgeon at an accredited facility and operating on a healthy person with medical clearance is the prudent route. It isn't possible eliminate all risks in elective aesthetic surgery, but it can really reduce them by not doing too many procedures at one time and by screening for medical conditions beforehand.

Dr. Aboolian didn't specify the underlying morbidity due to patient confidentiality, but the autopsy results will be out in 6-8 weeks. It could very well be that Donda West had an abnormal heartbeat. Arrhythmias (irregular heart rhythms) can result from coronary artery disease, but also occur in normal, healthy hearts particularly as we age. Many don't require any treatment at all, but do pose an additional risk when having surgery. Electrolyte imbalances in the blood (such as low sodium or potassium) brought on by excessive postoperative vomiting can precipitate a heart attack.

Is it safe? The real question to ask is how to make it safer, relative to the risks of any surgery. Once you, the prospective patient, have done your due diligence and selected a physician, here is what you can and should do to protect yourself:

• Don't lie to your surgeon. Devulge everything, everything, truthfully: the smoking, the drugs, the OTC, the supplements, that "baby heart attack" you had 10 years really does make a difference.

• Involve the primary care physician who knows you top to bottom by getting him/her to medically clear you for surgery. Elective aesthetic surgery should carry the same standard of clinical medicine as any other surgery: it's not fluffy spa medicine.

• Stick with 6 hours or less of anesthesia; you can always come back for more.

• And last, but not least, know how to reach your surgeon that first night. You want– and s/he will give you– all the secret numbers, so you can phone about anything untoward. Before you crash, call your surgeon. Really. Wake them up! Your surgeon wants you to live.


binu said...

Operating on a patient who shouldn't be operated on, deluding oneself about one's surgical omnipotence, can lead to disaster.

Dui In California

binu said...

That liability is his own ego. Operating on a patient who shouldn't be operated on,

Dui In California