Your Second Visit: Medical Assessment Between your initial consultation and your actual surgery for liposuction, most physicians (myself included) will have you make at least one more visit to the office. This visit is an extensive and important one, because it provides the physician with the opportunity to assess your general state of health, and to learn about any medical conditions that may affect your surgery.
During your second visit, our physician will almost certainly do a complete medical evaluation of your condition. You may feel that you have answered a great many questions already, and wonder what else the doctor needs to know. However, during your initial consultation at least, at The Liposuction Institute you and your doctor will have discussed your history and related conditions as they apply to fat deposits, weight gain and loss, and eating behavior, rather than your total health background. Now it becomes important for your physician to know your complete medical record.
WHAT YOUR SURGEON WANTS TO KNOW
During the second visit to The Liposuction Institute, I review with the patient the information we have gathered during the first visit, to be sure it is complete and accurate, and that all facts have been recorded correctly. Next, I take an extremely detailed and comprehensive medical history.
1. Your doctor will review your case with you in detail.
2. Your personal and family history, including past illnesses and surgeries, and any medications you have taken should be carefully discussed.
Although physicians vary somewhat in the routine they follow, you will almost certainly be asked about your health history, your past surgical history, and any hospitalizations or anesthesia.
Your doctor will want to know about any chronic conditions for which you are being or have been treated, including high blood pressure, heart disease, kidney/urinary problems, or liver disease. Such conditions are not necessarily limited to physical problems. For instance, some medications given as antidepressants or blood thinners would affect your plans for liposuction surgery.
Consequently, it is extremely important that you be totally frank with your doctor. It is better to tell her or him what you consider "too much" information about your health than inadvertently to omit part of the story. Tell your doctor everything. He or she can then decide what information is significant.
You will be asked about present and past medications, allergies (including reactions to prescribed and over-the-counter drugs), and any anesthesia related reactions during previous surgeries. If you bruise easily, if you have a history of frequent nosebleeds, if you have lost significant amounts of blood during previous surgeries, be sure to tell your doctor.
If you are a woman, you will be asked questions about your menstrual cycle: how regular it is, how heavy your periods are, what pain medication, if any, you are accustomed to taking for premenstrual or menstrual discomfort. You will be asked about birth control pills, if they previously have been prescribed for you. Although liposuction can be and often is performed without regard to the time of your menstrual period, your doctor may wish to schedule surgery on a different date if your flow is customarily heavy, and if you are having liposuction in the abdominal or hip area. That is a decision for your physician to make.
It is important for you to tell your doctor exactly what over-the-counter drugs you take, as well as any medicines prescribed for physical or mental conditions. Do make sure he or she knows about everything you are taking, especially vitamins or supplements like calcium or iron. If you customarily take aspirin for headaches, antihistamine medications for relief of cold symptoms, over-the-counter drugs for premenstrual or menstrual pain or discomfort, be sure to tell your physician.
In fact, it is a good idea to bring along with you all your current medications, in the prescription bottles. Your doctor can review them with you. If you are taking vitamins or supplements, bring those along, too.
Sometimes, families or individuals get all their prescriptions filled at a certain pharmacy. If this is the case, your pharmacist may be able to run you a computer printout of all medications you have taken in the past year. You can ask to have that prepared--it's usually free of charge-and you can show the printout to the doctor.
Your doctor will also want to know something about your family's health history. Have your parents, brothers and sisters, or other close blood relatives had problems with heart disease, cancer, high blood pressure, diabetes, respiratory disease, liver problems, or other ailments?
It will help you and your doctor if you have jotted down this information before your second visit. That way, you can glance at your notes to be sure you do not leave out relevant information.
YOUR PHYSICAL EXAMINATION
At The Liposuction Institute, when the patient and I have completed and reviewed the comprehensive medical history, I then do a thorough physical examination. I recheck and record the patient's height, weight, pulse, and blood pressure. I examine the patient, paying particular attention to the cardiovascular system. I check the heart, lungs, and abdomen. I evaluate the blood flow in the patient's extremities, checking the arms and legs carefully for any indications of vascular insufficiency or impaired lymphatic flow. I will be looking for water retention, for bruises, or for previous scar tissue.
After the physical examination has been completed, the patient receives an electrocardiogram to check the heart. A sample of blood is drawn from a vein in the arm. Using the sample, automated equipment runs a battery of sophisticated blood tests that check many things, including the capability of your blood to coagulate, your liver and kidney function, your protein and albumin, and your blood sugar, to rule out diabetes.
Cholesterol and triglycerides are checked. A check of thyroid functioning, also done from this one blood sample, tells me how well your metabolism is working. The comprehensive tests measures red blood count, white blood count, hemoglobin, and hematocrit, all tests which evaluate your blood volume and possible anemia. A complete macro- and microscopic urinalysis is also done.
During this visit, I perform a skin impedance test, which helps evaluate the amount and percentage of fat, lean tissue, and water you have in your body. An electrode is placed on the surface of your wrist. Another electrode is placed on the surface of your foot. The test, which is painless, consists of passing a mild electric current between the two electrodes. Measurements from the test are placed into a computer, which already holds data about your weight, height, age, and sex.
The data from your test are compared by the computer to standard data for someone who corresponds to you on those criteria.
Then the computer calculates and prints out your values for fat, lean tissue, and water, as well as the standard "normal" values. If you are a woman, you would be expected, on the average, to have no more than 22 percent body fat if you had an "ideal" body composition. If you were a man, and your body composition showed you had no more than 18 percent of body fat, you would be in excellent shape. There are no "rights" or "wrongs" on the test. lt just measures your own body composition. But knowing the calculated percentages of fat, lean tissue, and body water is a help to the liposuction surgeon in planning your proposed operation. In some cases, underwater weighing is also done to determine the body's composition of fat and lean tissue.
It is at this visit, at least at The Liposuction Institute, that photographs are taken. You will undress so that the area of prospective surgery can be photographed, but your private parts will be covered.
We photograph a total frontal shot, and shots of your sides, and back. We take zoom-in closeup pictures of the body part(s) for which liposuction is planned. If you are going to have more than one part of your body done, even if the operations will be performed at different times, we will take all photographs at this second visit. They become "baseline" photographs, because they are used as a basis for assessing your progress after liposuction surgery.
DIET AND EXERCISE BEFORE SURGERY
Prior to the actual operation, I recommend a Pre-Liposuction Diet. I give patients a copy of the diet, which is also described in Chapter 21 of this book. The diet is designed to help prepare you for surgery. In addition, I recommend a special complete vitamin-and-mineral formula, to be taken before the operation along with the iron supplement I will prescribe.
Other doctors may have different recommendations on diet and vitamin supplements. Of course, since your own physician is familiar with your particular health history and medical records, you will want to follow her or his instructions exactly. Because of the particular way in which I perform liposuction, I never give my patients blood transfusions during the operation. Consequently, there is no need for a patient to donate blood for storage before the operation, so that he or she could receive it later, if needed.
If you are in good physical condition, and you almost certainly would be, if you are a candidate for liposuction surgery, there is no reason why you cannot exercise at will before the operation. Walking is an especially good exercise, and is highly recommended.
MEDICATIONS BEFORE SURGERY
It is extremely important that you thoroughly understand your doctorÕs orders about taking any medications including over-the-counter drugs, vitamins, or mineral supplements in the days or weeks before your surgery. You must follow these orders exactly with no deviation.
Your own physician will give you specific instructions, based on your medical condition, your health history, and the extent of the liposuction surgery he or she plans to do. I cannot stress enough that these are your instructions, planned carefully by your surgeon as part of her or his comprehensive involvement with your medical care.
No matter what you may have heard or read, no matter what instructions your friends or acquaintances who have had liposuction surgery may have been given, you must for your own safety and for the best possible results, comply with your physicianÕs specific directions. If you do not understand them, or if you have any questions about what you should be doing, I urge you strongly to discuss your concerns with your doctor at once.
In general, though, certain principles apply and I will talk about them here.
DISCONTINUING CERTAIN DRUGS BEFORE SURGERY
Aspirin, and medications containing aspirin or anti-inflammatory substances that act in a similar manner, are not good for you to take shortly before surgery, or during your recovery period, since they tend to cause bleeding or affect blood clotting. Some of the medications are sold as over-the-counter drugs. Others are available only by prescription.
Pain relief compounds, (Anacin, Vanquish, or others), menstrual pain relievers, and over-the-counter cold remedies often contain aspirin or one of its closely-related compounds. So do certain anti-inflammatory agents, such as ibuprofen (the generic name for Advil or Nuprin.)
Frequently aspirin is an ingredient in these medications, even though its presence is not prominently advertised. You must read labels or check with your pharmacist. Better yet, call your doctor. He or she would far rather have a phone call asking for advice than to have you be in less than ideal condition for the surgery.
How long before liposuction surgery should you discontinue taking aspirin and related medicines? That will be up to your doctor. At The Liposuction Institute, however, we advise patients to stop taking any such medications at least a week before the date of the operation. Another medicine we advise patients to discontinue two weeks or more before surgery is Vitamin E in high doses. The Vitamin E you receive in a balanced multi-vitamin, mineral formula is all right to take...that is, unless your own physician advises you against it, you will be able to continue your daily vitamin pill.
Vitamin E, taken in a separate capsule by itself, however, is generally too high a dose for you to take safely before surgery, since it can affect your blood.
That is why I advise my patients to discontinue it until after surgery and their convalescent period.
VITAMIN K SUPPLEMENTS
When a patient has made the decision to have liposuction surgery, 1, and a number of other physicians who perform liposuction, will frequently prescribe a special Vitamin K supplement-usually Synkavite. I generally instruct patients to take one pill two times a day, starting two to four weeks before liposuction. Vitamin K helps the body to manufacture factors in the blood that help coagulation and clotting. Therefore, making sure your body has an adequate supply of this important vitamin before surgery helps prevent or lessen bleeding and bruising. I feet it is especially important to take Vitamin K if you have a history of using aspirin or anti-inflammatory drugs.
OTHER VITAMINS AND MINERALS BEFORE SURGERY
At The Liposuction Institute, the special Pre-Liposuction Diet and comprehensive vitamin-mineral supplement (Complete Osteocal Hemoplex) I have Prescribed for my patients before they have the surgery meets all their nutritional needs. This Pre-Liposuction Diet and comprehensive supplement replace any other vitamins they have been taking.
BIRTH CONTROL PILLS AND OTHER MEDICATIONS
You may be relieved to know that taking birth control pills does not affect any plans for liposuction. If you are on "the pill,"you may continue taking this medication as you normally do. You will not have to stop it before or after surgery. Of course, you will discuss contraception practices with your doctor, as part of your comprehensive medical assessment.
Certain prescription drugs, however, should not be taken before the liposuction surgery. You will need to discontinue them before the operation. In general, anti-depressant drugs react unfavorably with the anesthetic used in surgery. If you are taking drugs of this type, the date of your surgery will be carefully scheduled to be sure all traces of them are eliminated from your system before you receive an anesthetic.
That is why it is so important to discuss all medications with your liposuction surgeon, and even to bring the prescription bottles of any drugs you may be taking or that may have recently been prescribed for you.
If it appears that there is the possibility of a drug induced reaction, your surgeon will ask your permission to contact your primary care physician who has prescribed the drugs. Together, the two doctors will work out a coordinated plan for your treatment and medications--before and after surgery. You should not just decide on your own to discontinue taking the drugs.
SMOKING AND DRINKING
If you are a smoker, your doctor will almost certainly advise you to cut down as much as possible before and after surgery, or even to stop smoking altogether. Follow his specific instructions.
1. It is essential for the patient to be absolutely frank with the doctor in describing all drugs or medications, even vitamin pills and over-the-counter medications that are being used.
There is no medical reason to prohibit alcohol totally in the time between your medical assessment visit and 24 hours before your surgery. Nevertheless, alcohol is unnecessary and adds extra calories. You are far better off following the Pre-Liposuction Diet, with its emphasis on fruits and vegetables. if you are in a social situation where you feel you must drink, try to limit your consumption during the evening to a single glass of white wine. Better, yet, stick with club diet beverages, or even plain water. You can drink a glass of tomato juice during the evening, and your friends will assume it's a Bloody Mary. Alcohol will do almost nothing to help you medically, and will certainly add calories you don't need. Most doctors would agree that it's far better to "spend" those calories on nutritious fruits and vegetables.
STOPPING ALCOHOL CONSUMPTION
Do not drink alcohol at all during the 24 hours before your liposuction surgery. This includes beer, wine, and even the popular "wine cooler" drinks.
Although you can discuss your alcohol consumption with your individual surgeon, most doctors agree that drinking alcohol retards wound-healing. Consequently, it is probably best if you eliminate alcohol completely for six weeks after surgery. If this is not possible, then certainly minimize your drinking.
NO "RECREATIONAL DRUGS" BEFORE SURGERY
Years ago, the use of certain drugs for "recreation" was not something doctors expected to be discussing with patients-especially those who were planning surgery. Today, however, there are a number of people who routinely or occasionally use such drugs as marijuana (pot), amphetamines, or even cocaine. If you are one of them, I urge you to be totally frank in talking about your lifestyle and use with your surgeon. Certainly, it has a bearing on your surgery.
It is extremely important-crucial, in fact--that you do not take any such drugs for a period of at least seven days before surgery. You can talk with your surgeon about post-surgical conduct, but most responsible physicians will urge you to do everything possible after surgery to aid the healing process.
NO APPETITE-DEPRESSANTS BEFORE SURGERY
Since you have discussed our medications, including over-the-counter drugs, with your surgeon, you will have told her or him whether you're taking appetite-depressants. Most likely, your surgeon will instruct you to discontinue them, believing that a well-balanced nutritional diet is more beneficial. However, it is extremely important not to take any drugs of this type (including any pills you buy over-the-counter, or even weight-control candies) in the 24 hours before surgery.
PLANNING YOUR SURGERY
The date your liposuction surgery will be scheduled depends on a number of factors, including your plans and those of your physician. One major factor will be the length of time necessary for such drugs as anti-depressant medications to be eliminated completely from your body. Of course this will depend on your individual case. Another factor may be the length of time your surgeon wants you to take special Vitamin K supplement.
1. A comprehensive approach to liposuction involves far more than surgery. The pre-operative consultation between patient, doctor, and nurse offers a chance for extensive medical assessment, as well as instructions the patient will follow before the operation.
Now that you have decided to have the surgery, you are eager to get on with the process, and eager to see your new image. Rest assured, your physician will schedule your surgery as soon as he or she feels it is medically appropriate for you.
Although liposuction surgery can be done in a hospital, it is almost always performed in the doctor's clinic, operating rooms, or a surgical facility he or she uses.
DISCUSS QUESTIONS WITH YOUR DOCTOR
If there is anything you do not understand, or any questions you have, I urge you to discuss them with your doctor. No matter how well-meaning your friends or relatives can be, it is your doctor who, by this time, knows your complete medical history and has reviewed your case and problems in detail. If any situation arises that concerns or worries you as you wait for surgery, do not hesitate to phone your physician and talk it over.
The reputable, experienced liposuction surgeon welcomes this close relationship with patients. It makes it easier for your doctor to provide the total comprehensive care that helps ensure the best possible results from your surgery. Previous Chapter | Next Chapter