at Universidad Nacional – Medellin open air auditorium (The medellin campus is famed for the lush greenery)
So I am back in Medellin, Colombia for several weeks – but this trip is different from all of my previous visits. It’s the first time I have come here without a specific purpose. I’m not here to interview surgeons, attend surgical conferences or even ColombiaModa.
No Colombia Moda this year for me. 😦
Medellin has become so familiar to me, that when I needed a nice tranquil space to work on a non-Colombia related project – I headed here to get away from the thousands of distractions of my stateside life. While I am here, I am also determined to enjoy and explore more of Colombia since I have just seen the bare minimum of life and locales. So next week, I heading off to one of Colombia’s best known natural wonders, Cano Cristales.
I’m going as part of a group (which is something I’ve never done before). It’s sounds like it will be a great trip – flying to Meta, Colombia in a small plane – to a community with limited electricity and no cellphone or internet service. That doesn’t sound like a big deal, but as I writer, I have gotten used to almost always having computer access – almost anywhere in the world. So this will be a nice break from the ordinary for me.
I don’t have my trusty Nikon this time around, which is a shame since Cano Cristales is famed for its beauty but I will attempt to take some pictures with a tiny camera (that packs well). It’s weird because I tend to lose my confidence when I don’t have my big, heavy camera.
Naked without my Nikon? Not a great visual, is it?
La Tierra del Olvido (2015 version)
In the meantime, I will continue to work on my current projects, relax a bit and enjoy Colombia. Carlos Vives, one of my favorite Colombian singers, along with Medellin natives Maluma and J. Balvin, have re-made one of Carlos Vives most popular songs as part of a Colombia tourism promotion. It’s lovely, lively and catching – and features several other well-known Colombian entertainers and Colombian landscapes – so I hope you enjoy.. (Thankfully, no Sofia Vergara!)
My apologies to my dear readers for this late post. I usually write about surgery and surgeons, but occasionally drift into other things.. I visited the new Clinica de Medellin facility in late July, but didn’t have time to write about it before now.
Dermatology
Just before travelling to Medellin to cover Colombia Moda and the ALAT conference, I developed a dermatology problem. As my American readers know, getting an appointment with a specialist in the USA can often take several months. In fact, I was given an appointment in early July for later this fall.
However, during my stay in Medellin, my dermatology condition continued, so I decided to give the Clinica de Medellin another try. I had heard rumors about some re-organization of the medical travel division so I decided to use this as an opportunity to verify those rumors. I am very pleased to report that after sending my initial email to the Clinica de Medellin requesting a consultation with a dermatologist that I received a reply that same day (from Adriana Henao – email: ahenao@correo.clinicamedellin.com.co).
The coördinator called me back to confirm my availability and to ask if I would be willing to go to a clinic at one of the other Clinica de Medellin campuses. (She also asked about my level of Spanish fluency so she could direct me to the appropriate physician.)
By the next day, an appointment had been scheduled for the end of the week.
New clinic
The clinic was so new that when I gave the address to the cab driver, he merely raised an eyebrow before starting the car. On arrival, he expressed surprise – and said, “This wasn’t there before.” The Clinica de Medellin Sede Occidental is divided into a hospital and an outpatient clinic area. The smell of fresh paint was still evident in the immaculate, and sparkling facility.
The officer at the information desk had me personally escorted to the correct clinic when he heard my American accent (and hesitant Spanish). I waited about fifteen minutes before being escorted into the private office of Dra. Sara Gonzalez Trujillo. She was very friendly and pleasant. We reviewed my past medical history and current treatments before she examined me. She explained the condition in-depth before writing several prescriptions and requesting a lab test.
She provided me with a full copy of my medical records to take to my upcoming appointment and gave me her contact information.
Total cost of consultation: less than $50.00
Lab:
The labs cost about 25.00. After a quick lab draw, I was given a lab slip with my record number on it. I later received an email with my login to access my results. Since I was headed back to the states, I emailed my results to Dr. Gonzalez, who called me with additional treatment recommendations and an explanation of the results.
Since seeing Dr. Gonzalez, I have been using the medications as prescribed – and my condition has improved dramatically.
Follow-up:
I have been taking the medications as prescribed and it is getting better. I will email Dr. Gonzalez after seeing the dermatologist here to give her an update.
To make an appointment with Clinica Medellin, click here.
el centro map with shopping districts outlined -high resolution
During Colombia Moda, I met several American business people looking for more information about fabric and textiles than the small booths could provide. Many of them wanted to go out and see the fabrics, some of the shops and the factories but no one thought to take them to see any of these things. All of the people I met were first-time visitors to Medellin (and some may never be back). I can’t help with factory tours (I’d like to see those myself) but I do live nearby, so I thought maybe I could help provide some information for future visitors to this fair city. Since I thought wandering around El Centro as a first-time visitor without a guide might be a little daunting, this post might help people feel more comfortable. So I spent all day Saturday wandering around the district – to take pictures and be able to provide more information to people interested in finding fabrics and materials while in Medellin.
A note about Fabric shopping in Medellin: If you are looking for super cheap – crazy bargains, you probably won’t find them here. But you will find a huge array of all kinds of fabric – most of it made right here in the city. For someone like myself who is sometimes (okay, frequently) frustrated by the lack of floor space given to apparel fabrics in the United States – (where it seems like 90% of fabric is for quilting and such), it’s still a bonanza.
Also, while it isn’t made in the USA (which is increasingly rare, I know) – I still feel a bit of loyalty towards buying locally sourced items – even if Medellin is that source. Still interested? Good.
How to get here – the real Medellin
The best fabric and general shopping in Medellin isn’t in the fancy malls of El Poblado and Enviagado. It’s in the busy, teeming streets of El Centro. El Centro is also where many of the most famous tourist attractions are, so if you are interested in seeing some of the famous architecture, the Botero collection (at the Museo de Antioquia) – you can do that too. El Poblado and Enviagado are the rich, sanitized versions of Medellin – so if you have friends that aren’t interested in shopping but would like to see more of Medellin – this is a trip to take them on…
1. Taxi – if you want to take a taxi, ask him to take you to the Plaza Botero. It’s a few streets away from your destination, but it’s a nice central space – especially good if you are meeting friends or other visitors.
2. Metro Train – the metro train is cheap, clean and quite reliable. It’s also a good way to see a bit of the city. Take the (blue line) train to either Parque Berrio station or the San Antonio station. San Antonio is closer to shopping, but Parque Berrio puts you right at the Plaza. (For more information about the Metro, see this helpful article at Medellin Living).
Get a map – Now, I know this is a digital age, but sometimes a paper map is just easier.. Safer too because it makes you less of a target for thieves who prey on upscale tourists for all of our fancy electronic devices.
tourist kiosk with maps
There are several of these kiosks located in/ around Plaza Botero and around the Parque Berrio station. Just ask for a map “Mapa, por favor” and they will be happy to provide you with a free map of Medellin. I used this same map for reference for the shopping areas, to make it easy for visitors to recognize where to go.
Navigating the city Places like Medellin and Bogotá are particularly easy to navigate because streets use numbers, not names for the most part. (Once you get used to the system – our system of street naming in the USA seems needlessly confusing.) Everything is basically on a grid – Calles run in one direction and are abbreviated as Cll. Carreras run in a perpendicular direction and are often abbreviated as Cr. It makes locating a business very easy. For example, my favorite fabric store in Medellin is Textiles El Faison – and their address is Calle 49 #53 – 101. This means that they are located on Calle 49, about 101 meters from the cross-street, Carerra 53.
Now that you are here – with your map Walk south towards Calle 49. (To orient yourself – remember that Medellin is set in the foothills. If you start walking uphill, you are heading East (the wrong direction) – towards the financial center of Medellin (near where I usually stay). On Calle 49 – turn West (or downwards on a very slight grade) The next several streets will be crammed with shops filled with all kinds of sewing related items – thread stores, fabric stores, sewing machine repair etc.
Sewing machine repair and sales
Many of the shops look tiny compared to JoAnn’s or the big craft stores you may be used to. Sometimes they are tiny – but sometimes, it’s just the entrance to a larger indoor mall.
Entrance to one of the small fabric markets
Fabric
Now, the fabric stores line Calle 49 and many of the cross-streets.. But sometimes notions can be a bit trickier to track down. A lot of tiny shops sell just one product – like elastic or ribbon trims, buttons and the like.
small shop in an indoor fabric mini-mall (Shanghai) off calle 49 selling thread
elastics and trims
As I mentioned before, my favorite fabric store from my wandering on Saturday – is Textiles El Faison. It’s a big store, and not quite as claustrophobic feeling as some of the smaller shops. (When the shops are crowded, and the fabric piled to the ceilings, I get a bit closed in feeling in some of the smaller shops..) Not that this would prevent me – if I saw ‘the fabric’ there.
many shops are small but piled high with fabric
Lots of great stuff- but limited luggage space, so I move on to the next ones.
as you can see – the width of the store is pretty narrow, maybe 12 feet in total. Now add ten customers and I get a bit ‘crowded’ feeling
But for general browsing, or to see fabric in a shop more like what most of us are used to – Textiles El Faison is a well-lit two story shop. Jaime Sosa is the manager there – and he is very nice and helpful. My photos are a bit blurry because I was relying on my small phone (an older model) because I don’t like lugging my fancy Nikon down to El Centro).
Jaiime Sosa
Here’s the address for people who want to skip the adventures and go straight to his shop:
Textiles El FaisonCalle 49 No 53 – 101Medellin
displays piled high with fabric
But that’s not the only great place.. I really liked Portofino Textil too.. It’s located on the ground floor of a little textile mall. (It’s a very interesting mall – about half the shops sell custom printed fabrics).
One of the malls for custom printed fabric
I was trying to cover a lot of ground, so I didn’t stop in and get all the details on custom printing – even though I saw little storefronts printing the fabric during my wandering. (Maybe I will get a chance to go back and ask some questions.) Custom may be the wrong word since most of it seems to be more like “Small lot pop prints” but at one shop, I did see a customer hand over a jump drive filled with images for printing). But some of the other shops / kiosks didn’t look to have computers just their own style of pop prints (justin beiber, popular artists, other cool designs).
small storefront.. the lady in the blue tank is printing custom fabric
Portofino Portofino has more of a warehouse feel – and a two meter minimum. Fabric is priced by the kilogram. I couldn’t resist one of the fabrics there – and my two meters of this lightweight lycra was 0.7kg in total. For an example on prices – the tag on the bolt said 45,000 per kilogram but advertised a discount.. After the discount, my fabric total 27,156. tax added a bit – for a total of 28,350 for my two meters of a 60 inch (or there about width). According to today’s exchange rate – that’s about $15.35 (or around 7.50 a yard since a meter is a couple of inches more.) So, like I said – not a crazy, amazing deal – except that I love the fabric, it was made right here, and it’s certainly not something I’d find at Hancocks or Joanns (if we even had one in my town). It’s actually located under another fabric store but I found it to have better selection, and salespeople that were very helpful and friendly. (Fabien was particularly nice – and patient with my limited Spanish).
I just couldn’t resist..
Portfino Textil #162 Carrera 53 No. 49 – 68Medellin There were quite a few other shops – so you will just have to make you way down Calle 49 and find your own favorites. Patterns Pattern magazines can be especially hard to find – but when you do find them – they are a great deal.. Most pattern books contain anywhere from 20 to 200 patterns. It depends on the magazine. My favorites are Bianca, Quili and the more simply named Patrones. Bianca has a lot of the patterns that are hard to find in the United States – like an extended variety of swimwear, lingerie and exercise apparel. They also have a great assortment of patterns made for the new stretchy fabrics; lycra blends and modal.
Magazines containing 10 – 40 different patterns
Patrones is a grand brand because it has copies of a lot of the designs by major labels. Want to wear your own Dolce & Gabbana? Then patrones is the magazine for you. Sometimes you can find the magazines at larger newsstands or bookstores like Panoamericano. Some of the patterns in Patrones are pretty intricate and instructions are limited (and in Spanish) but at 4,000 to 10,000 pesos (2.25 to about 6 dollars) a book – if you are an experienced sewer it is still quite the find.) Now – for patterns on Calle 49 – the best place to go is – this little shop..
the place to buy patterns Calle 49 #53 – 14
The place is tiny, so you have to ask to see the pattern books (or point, if necessary.) They don’t have long aisles to browse like some of the bigger bookstores. But the owner is very sweet – and they have a large array of titles available.
some of the patterns available at this small shop
Yarns
Now, Medellin has that ‘perpetual spring’ climate we have been talking about, so I didn’t find as many places offering the bulky and superbulky yarns that I love. Quite a few thread stores offered the smaller crochet threads and yarns similar to Lily’s Sugar N’ Cream but since I am on a superbulky yarn kick – I will keep looking.. I did see a couple, but shame on me because I didn’t write down exact addresses or take pictures (but since one of them is on a street close to home, I may venture out later this week – when I’ve exhausted my current supply and get some pics.)
yarns
Now before you head out for your shopping adventure – review a few things to make your shopping more enjoyable and safe.
In Medellin – alone or not quite ready to venture into El Centro by yourself?
I am always up and willing to lend a hand – if I am in the city. (It’s a good guess if I am blogging about Medellin, then you can find me here.) You can always call me/ text me at 301-706-3929 (If I am not in Colombia, I won’t answer) or email me at k.eckland@gmail.com I’d be happy to arrange to get together for a day tour of the shopping areas. We can check out museums, eat some tasty street food, buy local produce, window shop – or hunt down that one special piece of fabric you’ve been waiting for..
If you don’t catch me on this trip – I’ll be back.. I’ll definitely be back for Colombia Moda 2015, so if you come a few days early (in July) we can have some fun.
Now that it’s over, I can say it’s been another wonderful week at Colombia Moda: I met Miss Colombia (she seems sweet) and took a picture of the President of the Republic..
Didn’t get to meet President Santos, but maybe someday. (I promise not to talk politics.)
Miss Colombia, Paula Vega of Atlantico region (Barranquilla)
Luis Martin
I even say hello to one of the models (since we were heading down the hallway) and we had a nice conversation. It’s funny – I guess I always get intimidated by people taller than me, etc.. and I guess sometimes the expectation is just that models aren’t that nice.. But nothing could be farther from the truth. Luis Martin – a local model from a neighborhood here in Medellin was very nice, sweet and pleasant. It must be weird for him – I mean, his face is really familiar to me – after two years of seeing it thru my lens..
Luis Martin, model and a nice kid
I wish we hadn’t be racing down a hallway – I would have liked to get a photo because he looks better in his own clothes..(Better sense of style). Anyway, I thought it was nice of him to make conversation with a random gringa.. (We talked about Virginia of all things). So – I wish him the best luck, and hope he makes the cover of Vogue one of these days.
Last day of Moda
Yesterday was the last day at Colombia Moda, and I don’t have enough nice things to say about all of the photographers and videographers there. They are the reason I came back this year. Instead of treating me as an outsider, they have always been welcoming and kind.
the orange backpack shows where I sit during the runways
This year it was great to be back and see old friends like Stiven and Fredrico. I didn’t see some of the wonderful people from last year, like Estaban who kept me in laughter and good humor even when every bone in my body ached from long hours in contorted positions.
Always great to see Stiven
This year, I have to give special thanks and words of gratitude to the videographers of Une Canal (Channel One) of Medellin. Une Canal is the public television station for the city and during fashion week, they record live from the runway so it can be seen on big screens outside (so people without access to the runway itself can see it as it happens.) That means they are at every single catwalk – always smiling, joking and being friendly even while setting up cameras, untangling cables etc…
The Videographers of Une Canal
That’s the handsome Juan Carlos, the charming Danilo Gallego and the ever kind Hernan. For the entire fashion week, they allowed (and encouraged) me to take one of the plum floor positions beneath their cameras – in the dead center position of the runway.
Danilo Gallego of Une Canal
People with better equipment than my starter Nikon can take sitting positions and even rise up on the press bleachers, but without this prime spot on the floor – I’d have been toast. I never would have been able to capture 1/10th of the images that I’ve used in my recent articles.
I’d love to do a real (in-depth) articles on the videographers and photographers here at Moda, but it looks like I’ve already been scooped which I think it really cool. Yesterday, the reporter from Une canal turned the tables of the videographers and interviewed them before one of the runways.
Danilo is interviewed for a segment on Une Canal
I am hoping to see Juan Carlos, Danilo and Stiven at some future events here in Medellin before I leave in August.. If not – I’ll see you next year!
Colombia Moda is over, and I am exhausted.. Sorting through several thousands of photos while writing articles about fashion collections has to be done in as timely a manner as possible, which doesn’t leave much time for sleep!
The good thing about writing for the Examiner.com is that they don’t give me any deadlines or article requirements. I write about what I want – and submit it as fast as I can. But there is no editor to nag me for specific lines so I feel free to focus on writing about the fashion that I like, or that I think is important.
I don’t write about Gef France because I think it’s boring. I do cover Studio F if only because it is so immensely popular here – though I prefer the more daring and creative (and often smaller) lines.
But while I continue to gulp coffee and sort photos (even though my eyes are so tired I’m not sure if the photo is blurry or it’s just me, I wanted to give my readers links to my most recent articles (and photos) at Examiner.com
Agua Bandita and Onda de Mar – the Agua bandita photos are disappointing – the lighting was terrible. (I thought that was me too – but then several photographers grumbled about substandard lighting and showed me their photos..) They even called out during the runway to get better light..
I also talked to some Americans I met at the expo. They seemed a little overwhelmed and lost – as they looked for textile manufacturers to produce fabric samples for use in their designs. I bet they would have liked my textile/ fabric city tour idea.
I have a couple of articles I am still working on – and then it will be back to normal here at Latin American Surgery. The ALAT conference (thoracic surgeons from all over Latin America) will be here in Medellin next week, so we will be back to some surgical topics soon.
I’ll be heading home again at the beginning of next week via a bit of a meandering journey. (The protests haven’t been as much of a disruption as anticipated in most of the bigger cities).,
First I am headed to Bogota to cover an upcoming conference before making my way to Northern Nevada. From there – it’s a brief trip to Baja California (Mexico) before starting the slow eastward caravan to my home in Southern Virginia. I hope to post something along the way – but first – a thank you to Medellin, a gracious city and wonderful host.
Colombia’s second city: Medellin
Medellin as seen from Metrocable
I’ve had an interesting time in Medellin, even if it didn’t turn out to be as productive as I would have hoped. I’ve come to better appreciate and enjoy a city that I had previously only known on a very superficial level.
public fountain for cooling off – parque de los pies descalzos
Medellin holds an endearing charm despite its rough edges: From the public parks, to the bustling life of the different barrios (like Aran Juez), to the upscale glamour of Poblado, El Tesoro mall and the high fashion excitement of Colombia Moda, it’s a vibrant life – lived in real-time and Technicolor.
indoor flower garden at upscale mall in Medellin
photo by Thor Gustafson kids in the park
But whether I am in Poblado, El Centro, on the metro, or on the street – the one thing that really brings Medellin to life are it’s people.
my models help advertise the city of Medellin for it’s fashion-forwardness
Whether it’s Linda, offering me fresh fruit, or a cab driver watching to make sure I am safely inside before heading to the next destination – or the girl on the train who wants to practice her English, people in Medellin are genuine, down to earth and friendly.
selling fruit in the park (photo enhanced)
People, from all walks of life – surgeons, friends, professional photographers and even my hairdresser (Carmen) have embraced me like a long-lost friend.
rides for tots
So while Bogotá will always be my home away from home (in Colombia), the people of Medellin have captured a piece of my heart..
What’s next in Colombia? Sincelejo, more Barranquilla or maybe even Bucaramanga? Who knows…
I met Dr. Betancourt Parra at IQ interquirofanos while observing surgery with Dr. Luis Botero,. Dr. Betancourt was friendly, and immediately amendable to an interview but it took a little while to coördinate our schedules.
In person, he reminds me a bit of Dr.Carlos Ochoa Gaxiola, the kind and talented Mexican surgeon who graciously permitted me to study with him at Hospital General de Mexicali for several months while writing the Mexicali book.
Maybe it was his laid-back and open conversational style, or the braces on his teeth, giving him a bit of boyish charm that belies his years of experience. Maybe it was his enthusiasm for his work, but whatever it was, I found the discussion to be especially informative and interesting.
Aesthetic plastic and reconstructive surgery
Dr. Betancourt is a plastic surgeon in Medellin. He performs a wide range of aesthetic and reconstructive plastic surgery including corporal (body) and facial procedures such as rhinoplasty (nose), face-lifts, blepharoplasty (eyelid lift), breast augmentation, liposuction etc. but his true love is post-bariatric surgery procedures.
He also performs reconstructive surgery such as breast reconstruction after breast cancer.
Post-bariatric surgery is a subspecialty area of plastic surgery (reconstructive surgery). Many of these patients have lost very large amounts of weight (100+ pounds) and have large amounts of sagging, drooping and excess skin.
This skin is more than aesthetically displeasing – it can also contribute to the development of skin irritations such as intertriginous dermatitis and infections. It is particularly prone to causing problems for females – due to an excess build up of moisture, and friction in the genital areas. It can also make simple tasks like showering, getting dressed and cleaning after using the bathroom difficult. Patients sometimes have to “tuck” loose skin from the abdomen into support garments to prevent this skin from slipping down to their thighs. This excess of skin (and the resultant movement/ friction) can prevent people from participating in normal activities like exercise.
The psychological impact of the appearance of, and the challenges of daily living can be extremely distressing – especially for someone who have spent months or years trying to lose weight.
The group of procedures used to treat this problem is called “Body contouring”. For the majority of patients – this body contouring process will require several months and several separate surgeries.
Body Contouring
One of the primary procedures for body contouring is called a “lower body lift/ /belt lipectomy/ torsoplasty”. This is actually two separate but very similar techniques; with the belt lipectomy being a modified lower body lift procedure. However, they are often grouped together to simplify discussions about body contouring procedures. The lower body lift or belt lipectomy is usually one of the first procedures as part of the reconstructive process after massive weight loss.
This procedure is the core procedure – which removes the majority of excess skin and tissue which is usually in the abdominal/ torso area. This is a dramatic and large surgical procedure which I liken to “the open heart surgery of plastic surgery.” This procedure can take 2 to 6 hours, and often requires a 1 to 2 night hospital stay.
The remaining procedures are more of a ‘fine tuning;, as they are smaller procedures with lesser effects as they are aimed at smaller, more specific areas of the body. These procedures include brachioplexy to remove excess skin (aka “batwings”) from the upper arm/ bicep area, reduction mammoplasty to remove excess skin and drooping from the breast area, or a thighoplasty, to remove excess skin from the thighs/ upper legs.
One year minimum wait after bariatric surgery
Dr. Betancourt requires a minimum of one year after bariatric surgery before patients begin considering body contouring procedures.
This is important for two reasons:
1. Patient’s weight should be stable prior to performing surgical procedures.
2. This period gives patients a chance to adjust to their new weight. Several studies have demonstrated that it may take months to years to adjust the mind’s eye (mental image) to a person’s actual appearance.
For an excellent article by Salwar & Fabricatore (2008) on the psychological considerations for patients after massive weight loss – click here.
Mirror versus mind’s eye
This is why many people literally “do not see” recent changes in our weight / appearance (particularly subtle/ small changes) when looking in the mirror. However, as time passes, the mind’s perception of our image/ appearance usually changes to accommodate changes in our ‘real’ appearance – whether weight loss/ gain, signs of aging (fine lines, wrinkles) or even the loss of a limb or appendage.
photo from uhs.uk
When the mental / mirror image “mismatch” is dramatic, long-lasting, accompanied by depression/ anxiety or leads to dangerous practices like anorexia, hypergymnasia or self-mutilation – it is called body dismorphic disorder (BDD). Patients who have successfully adjusted to their new size and appearance are much more likely to have realistic expectations, be satisfied with surgical outcomes and be able to maintain their weight over the long-term.
Dr. Betancourt explained that he enjoys the intellectual challenges of caring for post-bariatric surgery patients for several reasons. These patients, often differ greatly from the majority of plastic surgery patients due to the presence of multiple co-morbid conditions relating to their previous obesity. Patients may also have body image issues following the initial bariatric surgery as they adjust to their new bodies. These patients may require multiple procedures for a complete reconstruction, making treatment a somewhat lengthy process.
Dr. Betancourt states that this is what makes it so gratifying; to be able to provide patients with dramatic body changes, help improve their self-image and enable patients to successfully adjust to their new lives. He also finds it very rewarding because of the high level of patient satisfaction after these procedures.
These patients account for approximately 1/3 of his practice.
Education and Training
Dr. Betancourt has been a plastic surgeon for twelve years. For eleven years, he worked in a public hospital, Manuel Uribe Angel in Enviagado, providing reconstructive surgery services to all patients at all socio-economic levels in Antioquia, Colombia . For the last several years, he has devoted a significant portion of his practice to the sub-specialty of post-bariatric surgery. He has attended several post-bariatric surgery conferences to learn new techniques and exchange ideas with many of the leaders in the field including Dr. Alaly (USA), Jean François Pascal (France) and Dr. Ricardo Baroudi (Brazil).
Dr. Betancourt attended medical school at Universidad CES (University of Health Sciences) and graduated in 1993. He is currently a professor at CES.
He competed in general surgical residency at the public hospital, Hospital Ipiranga in Sao Paulo, Brazil before completing his plastic surgery fellowship at the Universidad Santo Amaro, (in Sao Paulo, Brazil).
He is a member of the Colombian Society of Plastic Surgery (SCCP), as well as the Brazilian Society of Plastic Surgery.
Dr. Betancourt speaks Portuguese and English in addition to his native Spanish. He reports some trepidation with his English but was readily able to communicate with me without difficulties.
While the majority of Dr.Betancourt’s patients are from the local area, he does see international patients. After an initial contact by email, or via his internet page, Dr.Betancourt solicits a complete medical history including previous surgical reports (from previous bariatric or plastic surgery procedures) and current photos. Patients will also need to have blood work, and EKG as part of the pre-operative evaluation. Additional studies may be needed depending on the individual’s history and diagnostic test results. (Patients may be referred to Internal Medicine specialist, as needed).
Following the on-line/ email communications, patients will be seen, for an in-person consultation and full physical examination. Dr. Betancourt’s office will make arrangements for a translator and companion to accompany the patient, as needed. With the patient’s assistance, a full surgical treatment plan will be designed at that time – which discusses how many surgeries and what the anticipated timeline and recovery will be.
As discussed above, the torsoplasty/ belt lipectomy is usually the first procedure performed, often followed by reduction mammoplasty/ mammoplexy.
With the torsoplasty, patients are usually hospitalized for 1 to 2 nights. They are encouraged to be active and ambulatory as soon as possible after surgery to prevent post-operative complications such as thrombosis and pneumonia. Dr.Betancourt usually engages private nurses to assist patients following their discharge from the hospital.
Sufficient recovery from return travel usually requires 3 weeks, and is monitored by Dr.Betancourt.
Dr. Betancourt also provides psychological / counselling referrals as needed for patients.
Additional References / Reading and Resources on post-bariatric surgery
* Recommended reading: Langer V, Singh A, Aly AS, Cram AE. (2011). Body contouring following massive weight loss. Indian J Plast Surg [serial online] 2011 [cited 2013 Aug 11];44:14-20. Available from: http://www.ijps.org/text.asp?2011/44/1/14/81439
Excellent article with general overview of the issues and procedures with before and after photographs.
* Recommended reading: Shrivastava P, Aggarwal A, Khazanchi RK. Body contouring surgery in a massive weight loss patient: An overview. Indian J Plast Surg [serial online] 2008 [cited 2013 Aug 11];41:114-29. Available from: http://www.ijps.org/text.asp?2008/41/3/114/43607
Additional Readings
“Distressing skin problems” – a 2011 first person story about skin problems after massive weight loss from the UK paper, Daily Mail.
Giordano S, Victorzon M, Koskivuo I, Suominen E. (2013). Physical discomfort due to redundant skin in post-bariatric surgery patients. Plast Reconstr Aesthet Surg. 2013 Jul;66(7):950-5. doi: 10.1016/j.bjps.2013.03.016. Epub 2013 Apr 9. [free full text not available].
Song AY, Rubin JP, Thomas V, Dudas JR, Marra KG, Fernstrom MH. (2006). Body image and quality of life in post massive weight loss body contouring patients. Obesity (Silver Spring). 2006 Sep;14(9):1626-36. [no free full text available].
Dr. Rodrigo Diaz is a plastic surgeon at the Clinicas de Las Americas in Medellin. He primarily specializes in facial plastic surgery (rhinoplasty, blepharoplasty, forehead surgery, facial endoscopy, face-lifts and fillers) and breast surgery (augmentation/ reduction). He reports that he receives most of his clients by work of mouth but does see a significant percentage of medical tourists.
The majority of his patients are private practice (self-pay) patients but he does see patients from many of the major Colombian health care insurance plans such as Colseguro, Liberty, Sur America, Colsanitas. While American insurance companies do not traditionally cover elective cosmetic procedures, it is worth investigating with your insurer as many of the larger plans such as Blue Cross/ Anthem now have ancillary plans for cosmetic procedures.
Dr. Diaz has been a practicing plastic surgeon for thirty years, and a professor of plastic surgery at the Universidad de Antioquia for the past 12 years. He attended the Universidad de Antioquia medical school and completed his plastic surgery residency there as well.
Like all Colombian surgeons profiled here at Latin American Surgery.com, he is a member of the Colombian Society of Plastic, Aesthetic and Reconstructive Surgery. He is also a member of the American Society of Plastic Surgeons (ASPS) and the International Society of Plastic, Reconstructive and Aesthetic surgery.
Pre-operative process
As we talk, he reviews the pre-operative process for his patients. “It usually starts with an email from the patient,”he states. Then he solicits a complete medical history from the patient, including medications, past surgeries, social habits (smoking, drinking etc), current and past medical problems (like hypertension) and family history. This also includes photographs so he can best determine exactly what procedure(s) they will need, plan the procedure and discuss anticipated results.
If they have a single problem (like high blood pressure), then he sends the patient for a complete medical evaluation.
All smokers are required to quit at least 2 months before the procedure, and Aspirin (and other anti-platelets) must be discontinued 8 days before the scheduled procedure.
Out-of-town patients are encouraged to bring another adult with them, and additional translators are provided as needed.
Plan for adequate recovery time
One of the things he stresses heavily during our interview is the need for medical tourists to allocate adequate time to the recovery process before returning to their home country. This is something that has been brought up in previous interviews with other surgeons, as well but bears repeating. Even smaller surgeries require adequate healing time, so the idea of a ‘weekend surgical makeover’ should be dismissed from the minds of potential clients.
Most important aspect is post-operative care
The time necessary for adequate healing is usually 15 days to three weeks depending on the procedures. This period is also important for surgeons to be able to detect small problems such as delayed healing before it becomes a bigger problem. “It is better for me to see an incision that isn’t healing right away so I can treat it immediately, then for the patient to put it off – and then seek treatment weeks later when it is a much larger problem.”
Another reason he encourages patients to not to rush home, is that surgeons in their home countries may be unwilling to care for patients who have surgery elsewhere.
Patients take priority
Dr. Diaz prides himself in providing excellent post-operative care. All patients have his cell phone, and he encourages them to use it for all and every question or concern – day or night. “If they need me, I am here.”
And – don’t worry, if you are hesitant to call him – he is going to call you anyway, just to check in and make sure you are doing well, and your pain is controlled. He calls all of his patients the day after surgery, and continues to check-in and see patients frequently during the first weeks after surgery.
“My patients always take priority, even after they return home. If I have a patient Skyping me in the office – well, that takes priority over other things because I know what a hassle it is for them.”
He speaks English fluently but reports he continues to take weekly classes in English and American culture. He feels that it is impossible to have a complete understanding and good communication of his clients without understanding the culture.
Trends in facial plastic surgery
During his lengthy plastic surgery career, Dr. Diaz has seen a lot of trends come and go in aesthetics. He reports that one of the main trends he has seen over the last few years, is a trend for lesser facial procedures such as facial endoscopy, eyelid surgery or use of fillers by his clients versus a full face-lift. He states the reasons are multiple. Patients want to avoid the dreaded “plasticized / surgerized” artifical appearance that has been highly visible in popular media such as American reality shows, and prefer more subtle results, so his patients tend to seek treatment earlier, just a lines and folds appear. While many of these treatments are temporary like fillers or laser re-surfacing, the results are more natural and aesthetically pleasing.
Secondly, patients want to avoid the longer downtown involved with a larger procedure like a face-lift which may have residual bruising, or swelling for several weeks. These patients want to be refreshed and back in the office quickly.
Lastly, as he reflects on his career and the ‘style’ of plastic surgery – he reports that for many of his clients (particularly Colombian client), the focus is so heavily on the body (breast and buttock augmentation) that the face is secondary in consideration.
Dr. Juan David Londoño, plastic surgeon (photo provided)
Dr. Juan David Londoño is a plastic surgeon here in Medellin who specializes in body procedures such as liposuction, abdominoplasties and breast augmentation.
He shares an office with Dr. Jorge Aliro Mejia Canas in the Forum building, next to the Santa Fe shopping mall in the upscale Poblado neighborhood.
He is also one of just a handful of surgeons here who specialize in hair restoration.
Dr. Londoño attended medical school at the Universidad de Antioquia, graduating in 1995. He completed his plastic surgery residency at the same institution and completed his training in 2003. While he trained in both reconstructive and aesthesthic plastic surgery, he states that he prefers aesthetic surgery because of the close relationship it entails with patients.
Today we talked primarily about Hair Restoration procedures because it’s his favorite procedure, and one I don’t know much about.
Patience is the key, he states as he explains the ins and outs of hair restoration treatments. Patience was certainly the order of the day as he carefully and graciously explained the principles of hair transplantation to me. Patience is necessary he explains, as in, there is no ‘quick fix’. Hair restoration techniques have evolved with the development of newer procedures but it remains a painstaking process.
Not just for male pattern baldness
While people traditionally think of this treatment as exclusively for male pattern baldness, women also undergo hair restoration in cases of thinning hair. People can also use this treatment to restore hair to other areas of the body such as the eyebrows (or as commonly publicized in Turkey) for beard restoration.
Treatment options
As Dr. Londoño explains, there are a range of treatments available for the treatment of hair loss, such as male pattern baldness, or thinning hair. While these treatments run along a continium of scalp massage –> medications –> surgery; these treatments can also be used to compliment each other.
Probably the best well-known treatments are the medications such as topical applications of minoxidil (Rogaine) or oral (finesteride) Propecia tablets. Many people are familiar with these medications due to long-standing and widely viewed pharmaceutical advertisements in the early and late 1990’s. Both of these medications were originally developed to treat other conditions (hypertension and BPH) and hair growth was quickly noted to be a frequently occurring side effect. These medications underwent additional clinical trials and study by the FDA before being re-formulated (as a topical spray), in the case of minoxidil, and re-marketed to treat hair loss.
However, these medications are less than ideal for treating a long-term problem like hair loss. While the medications can prevent additional hair loss, in most cases – additional hair growth is modest and requires continued medical therapy (pills) to maintain.
Scalp massage, is believed to stimulate blood circulation in the scalp and improve the health of the scalp and hair. It is also quite pleasant for most people. However, the results of scalp massage as a sole treatment are minimal at best when it comes to the treatment of alopecia.
Surgical methods of hair restoration
The original surgical methods of hair transplantation (or hair restoration) are more widely known for their limited results. “Hair plugs” refer to the artificial appearance due to the technique of implanting a group of hair in one area, with the finished results often having a row-like appearance (like a doll).
More modern techniques include the strip method, and the most recent technique called Follicular Unit Extraction (FUE).
With the strip method a small area of scalp on the back of the head (where hair is usually the densest, and has the greatest longevity) is surgically removed in a long strip. The scalp is then sutured closed, leaving a small linear scar. The area of scalp, and hair follicules are then used for implantation. By taking a portion of the scalp, the surgeons are able to ensure that the critical portion of the hair shaft – the root is preserved. This root is needed for hair to survive and grow after implantation.
With the newer Follicular Unit Extraction, each hair, including the root is extracted using a 1mm punch biopsy technique. (This is like a skin biopsy punch but much smaller.) Since each root is extracted individually, this is a painstaking and time consuming process. He reports that depending on the degree of hair loss, the length of the sessions and the results desired by the patient – determines the number of sessions a person will need. Since this procedure requires multiple sessions, some patients elect for shorter sessions but require a higher number of sessions since this is often more convenient for the schedules of working people.
The first treatment is usually done to re-establish the natural hairline. Subsequent treatments are needed to fill in areas of hair loss.
For patients who have very little remaining head hair, hair can be taken from other parts of the body. In general, surgeons use hair from areas (like the so-called “fringe area”) where hair persists despite months or years of hair loss. These areas are less likely to have hair that will succumb to the processes that caused alopecia in these individuals.
There are newer methods of FUE which use a more automated process, but as Dr. Londoño explains this often incurs a higher cost – and does not improve the outcomes (but does shorten the process somewhat.) He has the Artas Robot to assist him with the process, (if needed), but cautions readers not to be fooled by surgeons advertising the latest and greatest machinery. We digress into a conversation about general plastic surgery and the widespread advertising of specifically trademarked (and very expensive) equipment such as SlimLipo, Ultrasound and Vaser.
It’s more about the surgeon than the tools
He cautions consumers not to be fooled into thinking that having the most expensive equipment equals the best surgeon as often these devices are employed only to attract customers and command more expensive prices. As we discussed in a previous post, these devices were designed for specific uses that may not even be needed for many clients.
Why should patients pay for ultrasound-assisted liposuction when standard liposuction will be equally effective in their case? That’s kind of how he feels about the hair transplant robot. He has it – and he will use it if he needs it, but it isn’t for everyone.
Results take time
Results of this procedure are not immediate. The scalp takes time to heal from the transplant procedure, and the newly implanted follicules need to adjust to the transplantation process. Usually, the initially transplanted hair sheds – leaving living, hair producing roots behind. These hair roots will then grow new hair as part of the normal hair growth cycle. But hair takes time to grow – so many patients won’t see the full results of their procedure for up to six months afterwards as the hair grows in to the patient’s normal length.
Costs of the procedure
The near universal standard for hair restoration at many facilities is a dollar a hair. When you consider that the average (full) head of hair contains 100,000 hairs – the potential costs of this procedure* can be daunting. However, Dr. Londoño does not apply a “one price fits all” approach to his patients. Instead his assesses the client, their restoration needs (a small area versus the entire coronal area), the amount (and type) of treatments involved, and the expected results before determining a price. It is a more personalized and individualized accounting that may not suit some medical tourists who are looking for bargain basement prices however, it seems a better practice.
*Generally patients would only need a small fraction of this number for hair restoration.
References and Resources
Khanna M. (2008). Hair transplantation surgery. Indian J Plast Surg. 2008 Oct;41(Suppl):S56-63. An excellent overview of the procedures used in hair transplantation with photographs depicting these techniques and results.
Note: the feature photograph(on the front page) has been heavily edited (by me) to depict a gentleman with a receding hairline. This model actually has a lovely head of hair, but I did not want to use the photo of a real person without permission. (This photo is open source). This photo is for article art only and is not an attempt to dupe or trick readers. It is my policy to always disclose when photos have been altered from the original image.
Security on a street corner in an upscale Bogota neighborhood
Stories from the Front
Anyone want to hear about the summer I spent living with a group of young journalists, in a South American country in the midst of a civil war? Oh, wait – that’s this summer – and it’s not as dramatic as all that. While everything I said in the first sentence is factually correct; it’s also horribly misleading.
I live in an exciting, wealthy cosmopolitan city where the murmurs of FARC and continuing peace talks garner little notice – unless, of course, you are living in the corporate offices of Colombia Reports. But otherwise, paramilitaries are not a big part of my daily life with the exception of the occasional amputee in the park.
(This is not to minimize the horrors faced by the populace for the last fifty years, but to avoid over-sensationalizing daily life here.)
lost his leg due to a landmine
Daily concerns
A bigger concern is a more basic one – for any woman alone in any major city, particularly as a traveler navigating a foreign city, and foreign language: the usual safety concerns to avoid being victimized. So, I worry more about being mugged for my purse than being kidnapped and held by gangs or para-military groups. Living here is like living in Chicago, Detroit, and Washington D.C in that respect. But that’s not always what people want to hear.
Flashy Headlines
Big headlines attract readers, but substance and content are what’s really important. So instead of trading in on ‘war stories’ with my readers, I try to bring portraits of daily life in Colombia and other parts of Latin America. It’s not as flashy; and exciting – but it’s worthwhile reading all the same. So with that in mind, I hope you enjoy reading about the lives of some of the people I encounter in my travels.
Please note that some of the images in this article have been edited to preserve patient privacy.
Today, Dr. Luis Botero has invited me to observe surgery at IQ Interquirofanos in the Poblado section of Medellin. He is performing full-body liposuction and fat grafting of the buttocks.
Dr. Luis Botero, in the operating room
The facility: IQ Interquirofanos
Interquirofanos is located on the second floor
IQ Interquirofanos is an ambulatory surgery center located on the second floor of the Intermedica Building across the street from the Clinica de Medellin (sede Poblado). The close proximity of this clinic to a hospital is an important consideration for patients in case of a medical emergency.
The anesthesiologists estimate that 90% of the procedures performed here are cosmetic surgeries but surgeons also perform gynecology, and some orthopedic procedures at this facility.
The are seven operating rooms that are well-lit, and feature modern and functional equipment including hemodynamic monitoring, anesthesia / ventilatory equipment/ medications. There are crash carts available for the operating rooms and the patient recovery areas.
There are fourteen monitored recovery room beds, while the facility currently plans for expansion. Next door, an additional three floors are being built along with six more operating rooms.
Sterile processing is located within the facility with several large sterilization units. There is also a pharmacy on-site. The pharmacy dispenses prosthetics such as breast implants in addition to medications.
The only breast prosthetics offered at this facility are Mentor (Johnson & Johnson) and Natrelle brand silicone implants (Allergan). In light of the problems with PIP implants in the past – it is important for patients to ensure their implants are FDA approved, like Mentor implants.
In the past seven years, over 31,000 procedures have been performed at Interquirofanos. The nurses tell me that during the week, there are usually 30 to 35 surgeries a day, and around 15 procedures on Saturdays.
Prior to heading to the Operating Room:
Prior to surgery, patients undergo a full consultation with Dr. Botero and further medical evaluation (as needed). Patients are also instructed to avoid aspirin, ibuprofen and all antiplatets (clopidogrel, prasugrel, etc) and anti-coagulants (warfarin, dabigatran, etc.) for several days. Patients should not resume these medications until approved by their surgeon.
Complication Insurance
All patients are required to purchase complication insurance. This insurance costs between 75.00 and 120.00 dollars and covers the cost of any treatment needed (in the first 30 days) for post-operative complications for amounts ranging from 15,000 dollars to 30,000 dollars, depending on the policy. All of his clients who undergo surgery at IQ Interquirofanos are encouraged to buy a policy from Pan American Life de Colombia as part of the policies for patient safety at this facility. International patients may also be interested in purchasing a policy from ISPAS, which covers any visits to an ISPAS-affiliated surgeon in their home country.
Today’s Procedures: Liposuction & Fat Grafting
Liposuction –Liposuction (lipoplasty or lipectomy) accounts for 50% of all plastic surgery procedures. First the surgeon makes several very small slits in the skin. Then a saline – lidocaine solution is infiltrated in to the fat (adipose) tissue that is to removed. This solution serves several purposes – the solution helps emulsify the fat for removal while the lidocaine-epinephrine additives help provide post-operative analgesic and limit intra-operative bleeding. After the solution dwells (sits in the tissue) for ten to twenty minutes, the surgeon can begin the liposuction procedure. For this procedure, instruments are introduced to the area beneath the skin and above the muscle layer.
During this procedure, the surgeon introduces different canulas (long hollow tubes). These tubes are used to break up the adipose tissue and remove the fat using an attached suctioning canister. To break up the fat, the surgeon uses a back and forth motion. During this process – one hand is on the canula. The other hand remains on the patient to guide the canulas and prevent inadvertent injury to the patient.
fat being removed by liposuction
Due to the nature of this procedure, extensive bruising and swelling after this procedure is normal. Swelling may last up to a month. Patients will need to wear support garments (such as a girdle) after this procedure for several weeks.
Types of liposuction:
In recent years, surgeons have developed different techniques and specialized canulas to address specific purposes during surgery.
Standard liposuction canulas come in a variety of lengths and bore sizes (the bore size is the size of the hole at the end of the canister for the suction removal of fat tissue.) Some of these canulas have serrated bores for easier fat removal.
Ultrasound-assisted liposuction uses the canulas to deliver sound waves to help break up fat tissue. These canulas are designed for patients who have had repeated liposuction. This is needed to break up adhesions (scar tissue) that forms after the initial procedure during the healing process.
Laser liposuction is another type of liposuction aimed at specifically improving skin contraction. This is important in older patients or in patients who have excessive loose skin due to recent weight loss or post-pregnancy. However, for very large amounts of loose skin or poor skin tone in areas such as the abdomen, a larger procedure such as abdominoplasty may be needed.
During laser liposuction, a small wire laser is placed inside a canula to deliver a specific amount of heat energy to the area (around 40 degrees centrigrade). The application of heat is believed to stimulate collagen production (for skin tightening). Bleeding is reduced because of the cautery effect of the heat – but post-operative pain is increased due to increased inflammatory effects. There is also a risk of burn trauma during this procedure.
There have been several other liposuction techniques that have gone in and out of fashion, and many of the variations mentioned are often referred to by trademark names such as “Vaser”, “SmartLipo”, “SlimLipo” which can be confusing for people seeking information on these procedures.
Fat Grafting
Fat from liposuction procedure to be used for buttock augmentation
Fat grafting is a procedure used in combination with liposuction. With this procedure, fat that was removed during liposuction is relocated to another area of the body such as the buttocks, hands or face.
In this patient, Dr. Botero injects the fat using a large bore needle deep into the gluteal muscles to prevent a sloppy, or dimpled appearance. Injecting into the muscle tissue also helps to preserve the longevity of the procedure. However, care must be taken to prevent fat embolism*, a rare but potentially fatal complication – where globules of fat enter the bloodstream. To prevent this complication, Dr. Botero carefully confirms the placement of his needle in the muscle tissue before injecting.
Results are immediately appreciable.
fat being injected for buttock augmentation. (Photo edited for patient privacy).
The Surgery:
Patient was appropriately marked prior to the procedure. The patient was correctly prepped, drapped and positioned to prevent injury or infection. Ted hose and sequential stockings were applied to lessen the risk of developing deep vein thrombosis. Pre-operative procedures were performed according to internationally recognized standards.
Sterility was maintained during the case. Dr. Botero appeared knowledgeable and skilled regarding the techniques and procedures performed.
His instrumentadora (First assistant), Liliana Moreno was extremely knowledgeable and able to anticipate Dr. Botero’s needs.
Circulating nurse: Anais Perez maintained accurate and up-to-date intra-operative records during the case. Ms. Perez was readily available to obtain instruments and supplies as needed.
Overall – the team worked well together and communicated effectively before, during and after the case.
Anesthesia was managed by Dr. Julio Arango. He was using an anesthesia technique called “controlled hypotension”. (Since readers have heard me rail about uncontrolled hypotension in the past – I will write another post on this topic soon.)
Controlled Hypotension
However, as the name inplies – controlled hypotension is a tightly regulated process, where blood pressure is lowered to a very specific range. This range is just slightly lower than normal (Systolic BP of around 80) – and the anesthesiologist is in constant attendance. This is very different from cases with profound hypotension which is ignored due to an anesthesia provider being distracted – or completely absent.
With hypotensive anesthesia – blood pressure is maintained with a MAP (or mean) of 50 – 60mmHg with a HR of 50 – 60. This reduces the incidence of bleeding.
However, this technique is not safe for everyone. Only young healthy patients are good candidates for this anesthesia technique. Basically, if you have any stiffening of your arteries due to age (40+), smoking, cholesterol or family history – this technique is NOT for you. People with high blood pressure, any degree of kidney disease, heart disease, peripheral vascular disease or diabetes are not good candidates for this type of anesthesia. People with these kinds of medical conditions do not tolerate even mild hypotension very well, and are at increased risk of serious complications such as renal injury/ failure or cardiovascular complications such as a heart attack or stroke. Particularly since this is an elective procedure – this is something to discuss with your surgeon and anesthesiologist before surgery.
The patient today is young (low 20’s), physically fit, active with no medical conditions so this anesthesia poses little risk during this procedure. Also the surgery itself is fairly short – which is important. Long/ marathon surgeries such as ‘mega-makeovers‘ are not ideal for this type of anesthesia.
Dr. Julio Arango keeps a close eye on his patient
However, Dr. Arango does an excellent job during this procedure, which is performed under general anesthesia. After intubating the patient, he maintained a close eye on vital signs and oxygenation. The patient is hemodynamically stable with no desaturations or hypoxia during the case. Dr. Arango remains alert and attentive during the case, and remains present for the entire surgery. Following surgery, anesthesia was lightened, and the patient was extubated prior to transfer to the recovery room.
He also demonstrated excellent knowledge of international protocols regarding DVT/ Travel risk, WHO safety protocols and intra-operative management.
Surgical apgar score: 9 (however, there is a point lost due to MAP of 50 – 60 as discussed above).
Results of the surgery were cosmetically pleasing.
Post -operative care:
Prior to discharge from the ambulatory care center after recovery from anesthesia the patient (and family) receives discharge instructions from the nurses.
The patient also receives prescriptions for several medications including:
1. Oral antibiotics for a five-day course**. Dr. Botero uses this duration for fat grafting cases only.
2. Non-narcotic analgesia (pain medications).
3. Lyrica ( a gabapentin-like compound) to prevent neuralgias during the healing period.
The patient will wear a support garment for several weeks. She is to call Dr. Botero to report any problems such as unrelieved pain, drainage or fever.
Note: after some surgeries like abdominoplasty, patients also receive DVT prophylaxis with either Arixtra or enoxaparin (Lovenox).
Follow-up appointments:
Dr. Botero will see her for her first follow-up visit in two days (surgery was on a Saturday). He will see twice a week the first week, and then weekly for three weeks (and additionally as needed.)
* Fat embolism is a risk with any liposuction procedure.
**This is contrary to American recommendations as per the National Surgical Care Improvement Project (SCIP) which recommends discontinuation within the first 24 hours to prevent the development of antibiotic resistance.
Dr. Sergio Franco wrote the book on heart surgery.
It was exciting and illuminating to talk to Dr. Sergio Franco, who is one of Colombia’s most prolific writers and professors of cardiac surgery. The 50 year-old cardiac surgeon has authored multiple textbooks for surgeons and edited ten others, making him one of the nation’s definitive experts on cardiac surgery.
Dr. Franco stands near a collection of his textbooks
Currently he is the Medical Director of the Cardiopulmonary and Peripheral Vascular Center of the Fundacion San Vicente in Rio Negro, as well as Chief of Cardiothoracic Surgery at the Clinica de Medellin. For the last 12 years, he has also been the program director for post-graduate studies at the Universidad CES medical school. Between the two clinics, and the five other surgeons he works with (2 at Clinica de Medellin and 2 at Rionegro), he estimates that the cardiac programs see volumes of 700 – 750 cases per year.
For our first interview, we meet at the Clinica de Medellin to talk. He later invites me to see the hospital at Rionegro.
Education/ Training / Experience
Dr. Franco attended medical school, general surgery residency and cardiac surgery fellowship at the Universidad Pontifica Boliviarana. He finished his fellowship in 1996. As part of his fellowship, he spent nine months training in heart and lung transplantation at Loyola University Medical Center in Chicago, Il. During his heart and lung tranplantation training, he received an award as “Best Foreign Medical Fellow.” He graduated with high honors due to his exemplary grade point average.
He has additional training in thoracic and thoracoabdominal aortic surgery (Missouri Baptist, 1998), and minimally invasive valvular surgery (Cleveland Clinic).
Selected awards and special recognition
He was also the first surgeon to perform endovascular harvesting of the saphenous vein in Colombia in 1997. He received second place for a poster presentation based on this technique at the Colombian Congress of Cardiology and Cardiovascular Surgery, Cartagena, 8 to 11 February 2006.
He received the Cesar Uribe Piedrahita Medal from the Colombian Medical Federation and the Antioquia Medical College in 2003 for academic and clinical excellence, in addition to several other awards for academic achievement.
He was the chapter president of the Colombian Society of Cardiovascular Surgery and the Colombian Surgical Consensus for multiple terms. He was also the Chairman, and Medical Advisory of the first Latin American Forums on cardiovascular surgery.
He has received several awards including “The best of 2006” from Hospital General de Medellin for his assistance in the development, creation and commissioning of the cardiovascular services unit at that facility. He has also presented his work at numerous national and international conferences.
He speaks English in addition to his native Spanish.
Dr Sergio Franco
San Vicente Fundacion
Cardiovascular Surgery
Medical Director, Cardiopulmonary and Vascular Surgery
While I requested a visit to the operating room, an invitation was not forthcoming.
Selected writings of Dr. Sergio Franco
Book chapters:
1. Franco S., Restrepo G. Momento Quirúrgico óptimo en el paciente con enfermedad valvular cardiaca. Libro Tópicos selectos en enfermedades cardiovasculares 2000. Unidad cardiovascular Clínica Medellín. 1 Edición. Página. 101-112. ISBN 958-33-1541-9
2. Franco S. Endocarditis Infecciosa: Visión Quirúrgica – Indicaciones de Cirugía. Libro Tópicos selectos en enfermedades cardiovasculares 2000. Unidad cardiovascular Clínica Medellín. 1 Edición. Páginas 201-211. ISBN 958-33-1541-9
3. Franco, S. Estenosis Mitral – Tratamiento Quirúrgico. En: Franco, S. (Ed) Enfermedad valvular cardiaca. Sociedad Colombiana de Cardiología. Editorial Colina, 1 edición, Pgnas 111-116 Abril 2001. ISBN : 958-33-2244-X
4. Franco, S., Giraldo, N. , Vélez JF. Uso e Indicaciones deHomoinjertos – Cirugía de Ross. En: Franco, S (Ed) Enfermedad Valvular Cardiaca. Sociedad Colombiana de Cardiología. Editorial Colina, 1 edición, Pgnas 70 – 77, Abril 2001. ISBN : 958-33-2244-X
5. Alzate L., Franco S. Factores hemodinámicos y físicos de las válvulas cardiacas artificiales. En: Franco, S. (Ed) Enfermedad Valvular Cardiaca – Sociedad Colombiana de Cardiología. Editorial Colina, 1 edición, Pgnas 222 – 228 Abril 2001. ISBN : 958-33-2244-X
6. Franco, S., Vélez, J. Revascularización Quirúrgica del Miocardio: Estado actual. En: Tópicos selectos en terapéutica cardiaca y vascular 2001. Cardiología Clínica Medellín. P: 108 –120. Primera edición, Octubre 2001. ISBN : 958-33-2607-0
7. Vélez, JF, Franco, S., Tamayo L. Tratamiento quirúrgico de la enfermedad coronaria. En: Enfermedad Coronaria. Pineda M, Matiz H, Rozo R. (Ed), septiembre 2002. Capitulo 36, pgnas 609-630. ISBN : 958-33-3945-8
8. Franco, S.Intervencion Quirúrgica de los síndromes coronarios agudos. En: Tópicos selectos en enfermedades cardiovasculares, 2002. Pgna 177-192 (Velásquez D, Uribe W, editores) Ed. Colina, Departamento de Cardiología Clínica Medellín 2002. ISBN 958-33-3663-7
9. Franco, S.Cardiopatías Congénitas del Adulto. En: Tópicos selectos en cardiología de consultorio 2003. Pgnas 193-211. (Restrepo G., Uribe W., Velásquez D., editores). Ed. Colina, Cardiología Clínica Medellín, 2003. ISBN : 958-33-4858-9
10. Franco, S.Enfermedad Valvular Cardiaca: Indicaciones de Cirugía. En: Libro II Congreso medicina cardiovascular y torácica. . Hospital Departamental Santa Sofía de Caldas, 2003 (Jaramillo O., Editor) Editorial Tizan. Pgnas 87-104
11. Franco, S.Tratamiento Quirúrgico de la Fibrilación Atrial. En: Libro II Congreso medicina cardiovascular y torácica. Hospital Departamental Santa Sofía de Caldas, 2003. (Jaramillo O., Editor) Editorial Tizan. Pgnas 123-131
14. Franco, S., Giraldo, N. Tratamiento Quirúrgico del Paciente Valvular en Falla Cardiaca. En: Enfermedad Valvular Cardiaca. Paginas 169 – 176. (Franco, S., Editor). Editorial Colina. Primera Edición 2004. 227 paginas. ISBN 958-33-6218-2
15. Franco, S. Jiménez A. Factores Físicos y Hemodinámicos de las Prótesis Valvulares Cardiacas. En: Enfermedad Valvular Cardiaca. Pgnas 223-227. (Franco, S., Editor). Editorial Colina. Primera Edición 2004. 227 paginas. ISBN 958-33-6218-2
16. Franco, S.Guías de manejo de las valvulopatias aorticas. En: Tópicos Selectos en Guías de Manejo en Enfermedades Cardiacas y Vasculares 2004. Pgnas 143-149. (Uribe, W, Velásquez D, Restrepo G., Editores). Editorial Colina. Primera edición, 2004. 195 paginas. ISBN 958-33-6285-9
17. Franco, S.Guías de manejo de las valvulopatias mitrales. En: Tópicos Selectos en Guías de Manejo en Enfermedades Cardiacas y Vasculares 2004. Pgnas 149-155. (Uribe, W, Velásquez D, Restrepo G., Editores). Editorial Colina. Primera edición, 2004. 195 paginas. ISBN 958-33-6285-9
18. Franco, S.Tratamiento Quirúrgico de la Fibrilación Atrial. En: Falla Cardiaca, Diagnostico y manejo Actual. 2004. Pgnas 271- 287.. (Castro, H; Cubides, C. Editores) Editorial Blanecolor, Primera edición, 2004. 431 pgnas. ISBN 33-6689-7
19. Escobar, A. Franco, S. Trauma de grandes vasos torácicos. En: Tópicos Selectos en guías de manejo en enfermedades cardiacas y vasculares – 2005. (Velásquez D., Uribe W. editores) 1 Edición, editorial colina, 2005. pgnas 160- 169. 193 paginas. ISBN : 958-33-7698-1
20. Franco, S., Vélez, A. Trauma cardiaco. En: Tópicos Selectos en guías de manejo en enfermedades cardiacas y vasculares – 2005. (Velásquez D., Uribe W. editores) 1 Edición, editorial colina, 2005. pgnas 154- 159. ISBN : 958-33-7698-1
21. Franco, S., Jaramillo, J. Tumores cardiacos. En: Tópicos Selectos en guías de manejo en enfermedades cardiacas y vasculares – 2005. (Velásquez D., Uribe W. editores) 1 Edición, editorial colina, 2005. pgnas 117 – 123. 193 paginas. ISBN : 958-33-7698-1
22. Franco, S., Vélez, A. Trauma cardiaco. En: Tópicos Selectos en guías de manejo en enfermedades cardiacas y vasculares – 2005. Manual Condensado. (Velásquez D., Uribe W. editores) 1 Edición, editorial colina, 2005. pgnas 362- 366. 388 paginas. ISBN : 958-33-7698-1
23. Franco, S.Guías de manejo de las valvulopatias aorticas. En: Tópicos Selectos en Guías de Manejo en Enfermedades Cardiacas y Vasculares 2005. Manual condensado. Pgnas 177-182. (Uribe, W, Velásquez D, Restrepo G., Editores). Editorial Colina. Primera edición, 2005. 388 paginas. ISBN : 958-33-7698-1
24. Franco, S.Guías de manejo de las valvulopatias mitrales. En: Tópicos Selectos en Guías de Manejo en Enfermedades Cardiacas y Vasculares 2005. Manual condensado. Pgnas 183-188. (Uribe, W, Velásquez D, Restrepo G., Editores). Editorial Colina. Primera edición, 2005. 388 paginas. ISBN : 958-33-7698-1
25. Jaramillo, J.S., Franco, S.Implante Quirúrgico del Electrodo Epicárdico en el Ventrículo Izquierdo Mediante Cirugía. En: Duque, M., Franco, S. Editores. Tratamiento no Farmacológico de la Falla Cardiaca. Sociedad Colombiana de Cardiología y Cirugía Cardiovascular. Primera Edición, Editorial Colina, Pgnas 89-92, Abril 2006. ISBN : 958-33-8661-8
26. Franco, S.Cirugía de Remodelación Ventricular en Falla Cardiaca. En: Duque, M., Franco, S. Editores. Tratamiento no Farmacológico de la Falla Cardiaca. Sociedad Colombiana de Cardiología y Cirugía Cardiovascular. Primera Edición, Editorial Colina, Pgnas 168 – 182, Abril 2006. ISBN : 958-33-8661-8
27. Jaramillo, JS., Franco, S., Vélez, JF. Revascularización Coronaria Quirúrgica. En: Velásquez, D., Restrepo, G., Duque, M., Uribe, W., Franco, S. Editores. Tópicos Selectos En Enfermedades Cardiacas y Vasculares – 2006, Estado del Arte. Primera Ed, 2006, Editorial Colina. Pgnas 559-576. ISBN : 958-33-9493-9
28. Franco, S., Vélez, JF, Jaramillo, JS., Cirugía en Enfermedad Valvular Aortica. En: Velásquez, D., Restrepo, G., Duque, M., Uribe, W., Franco, S. Editores. Tópicos Selectos En Enfermedades Cardiacas y Vasculares – 2006, Estado del Arte. Primera Ed, 2006, Editorial Colina. Pgnas 588 – 595. ISBN : 958-33-9493-9
29. Franco, S., Vélez, JF, Jaramillo, JS., Valvulopatia Mitral. En: Velásquez, D., Restrepo, G., Duque, M., Uribe, W., Franco, S. Editores. Tópicos Selectos En Enfermedades Cardiacas y Vasculares – 2006, Estado del Arte. Primera Ed, 2006, Editorial Colina. Pgnas 596 – 603. ISBN : 958-33-9493-9
30. Franco, S., Vélez, JF, Jaramillo, JS., Cirugía en Enfermedad Valvular Pulmonar y Tricúspidea. En: Velásquez, D., Restrepo, G., Duque, M., Uribe, W., Franco, S. Editores. Tópicos Selectos En Enfermedades Cardiacas y Vasculares – 2006, Estado del Arte. Primera Ed, 2006, Editorial Colina. Pgnas 604 – 606. ISBN : 958-33-9493-9
31. Jaramillo, JS., Franco, S., Vélez, JF, Disección Aortica. En: Velásquez, D., Restrepo, G., Duque, M., Uribe, W., Franco, S. Editores. Tópicos Selectos En Enfermedades Cardiacas y Vasculares – 2006, Estado del Arte. Primera Ed, 2006, Editorial Colina. Pgnas 607 – 617. ISBN : 958-33-9493-9
32. Franco, S., Vélez, A., Trauma de Corazón y Grandes Vasos. En: Velásquez, D., Restrepo, G., Duque, M., Uribe, W., Franco, S. Editores. Tópicos Selectos En Enfermedades Cardiacas y Vasculares – 2006, Estado del Arte. Primera Ed, 2006, Editorial Colina. Pgnas 618 – 625. ISBN : 958-33-9493-9
33. Franco, S., Jaramillo, JS., Vélez, JF., Tumores Cardiacos. En: Velásquez, D., Restrepo, G., Duque, M., Uribe, W., Franco, S. Editores. Tópicos Selectos En Enfermedades Cardiacas y Vasculares – 2006, Estado del Arte. Primera Ed, 2006, Editorial Colina. Pgnas 626 – 635. ISBN : 958-33-9493-9
34. Vélez, JF, Franco, S., Jaramillo, JS., Cardiopatías Congénitas del Adulto. En: Velásquez, D., Restrepo, G., Duque, M., Uribe, W., Franco, S. Editores. Tópicos Selectos En Enfermedades Cardiacas y Vasculares – 2006, Estado del Arte. Primera Ed, 2006, Editorial Colina. Pgnas 649 – 659. ISBN : 958-33-9493-9
35. Uribe, W., Franco, S., Gil, E. Fibrilacion Auricular. En: Velásquez, D., Restrepo, G., Duque, M., Uribe, W., Franco, S. Editores. Tópicos Selectos En Enfermedades Cardiacas y Vasculares – 2006, Estado del Arte. Primera Ed, 2006, Editorial Colina. Pgnas 441 – 466. ISBN : 958-33-9493-9
36. Restrepo, G., Franco, S.Endocarditis Infecciosa. En : Texto de Cardiologia. Sociedad Colombiana de Cardiologia y Cirugia Cardiovascular. Legis, S.A. 1 Ed, 2007; Capitulo VI, pgnas 614-30. ISBN : 958-97065-7-6
37. Franco, S., Sandoval, N. Tratamiento Quirurgico de la Fibrilacion Atrial. En : Texto de Cardiologia. Sociedad Colombiana de Cardiologia y Cirugia Cardiovascular. Legis, S.A. 1 Ed, 2007; Capitulo IX, pgnas 835-842. ISBN : 958-97065-7-6
38. Franco, S., Jaramillo JS. Trauma Cardiaco. En : Texto de Cardiologia. Sociedad Colombiana de Cardiologia y Cirugia Cardiovascular. Legis, S.A. 1 Ed, 2007; Capitulo XVI, pgnas 1442-49. ISBN : 958-97065-7-6
39. Franco, S., Velez, A. Trauma Vascular Cervical. En : Guias de Manejo en Enfermedades Cardiacas y Vasculares 2007. Manual Condensado, 3 Edicion, Cardiologia Clinica Medellin; 2007. Capitulo 31, P 425 – 433. ISBN : 979-958-98111-9-1
40. Franco, S., Velez, A., Jaramillo JS. Trauma Cardiaco. En : Guias de Manejo en Enfermedades Cardiacas y Vasculares 2007. Manual Condensado, 3 Edicion, Cardiologia Clinica Medellin; 2007. Capitulo 30, P 419 – 423. ISBN : 979-958-98111-9-1
41. Franco, S.Guias de Manejo de las Valvulopatias Aorticas. En : Guias de Manejo en Enfermedades Cardiacas y Vasculares 2007. Manual Condensado, 3 Edicion, Cardiologia Clinica Medellin; 2007. Capitulo 25, P 379 – 385. ISBN 978-958-98111-9-1
42. Franco, S.Guias de Manejo de las Valvulopatias Mitrales. En : Guias de Manejo en Enfermedades Cardiacas y Vasculares 2007. Manual Condensado, 3 Edicion, Cardiologia Clinica Medellin; 2007. Capitulo 26, P 387 – 392. ISBN : 979-958-98111-9-1
43. Jaramillo, J.S., Franco, S.Guias de Manejo de la Revascularizacion Coronaria Quirurgica. En : Guias de Manejo en Enfermedades Cardiacas y Vasculares 2007. Manual Condensado, 3 Edicion, Cardiologia Clinica Medellin. Capitulo 24, P 369 – 377. ISBN : 979-958-98111-9-1
44. Franco, S.; Velez, JF.; Jaramillo,JS. Complicaciones mecanicas del infarto agudo del miocardio. En : Topicos Selectos en Enfermedad Coronaria – 2008. Velasquez, D. ed; Distribuna Ed, Cardiologia Clinica Medellin, 2008. P. 115-126. ISBN 978-958-8379-09-8
45. Jaramillo,JS.; Franco, S.; Velez, JF. Guias de manejo de la revascularizacion coronaria quirurgica. En : Topicos Selectos en Enfermedad Coronaria – 2008. Velasquez, D. ed; Distribuna Ed, Cardiologia Clinica Medellin, 2008. P. 197- 218. ISBN 978-958-8379-09-8
46. Franco, S.; Jaramillo, J.S. Guías de Manejo de la revascularización Coronaria Quirúrgica. En: Guias de manejo en enfermedades cardiacas y vasculares. Manual Condensado 2009. Velásquez, D. Ed. Editorial Distribuna, 1 edicion 2009, 503 paginas. P. 429-440. ISBN : 978-958-8379-19-7
47. Franco, S.; Jaramillo, J.S. Guias de Manejo de las valvulopatias aorticas. En: Guias de manejo en enfermedades cardiacas y vasculares. Manual Condensado 2009. Velásquez, D. Ed. Editorial Distribuna, 1 edicion 2009, 503 paginas. P. 441-448. ISBN : 978-958-8379-19-7
48. Franco, S.; Jaramillo, J.S. Guias de Manejo de las valvulopatias mitrales. En: Guias de manejo en enfermedades cardiacas y vasculares. Manual Condensado 2009. Velásquez, D. Ed. Editorial Distribuna, 1 edicion 2009, 503 paginas. P. 449-456. ISBN : 978-958-8379-19-7
49. Franco, S.; Jaramillo, J.S. Trauma Cardiaco. En: Guías de manejo en enfermedades cardiacas y vasculares. Manual Condensado 2009. Velásquez, D. Ed. Editorial Distribuna, 1 edición 2009, 503 paginas. P. 487-492. ISBN : 978-958-8379-19-7
50. Franco, S.; Jaramillo, J.S. Trauma Vascular Cervical. En: Guías de manejo en enfermedades cardiacas y vasculares. Manual Condensado 2009. Velásquez, D. Ed. Editorial Distribuna, 1 edición 2009, 503 paginas. P. 493 – 503. ISBN : 978-958-8379-19-7
51. Franco, S.; Jaramillo, J.S. Trauma Vascular Cervical. En: Guías de manejo en enfermedades cardiacas y vasculares. Manual Condensado 2010. Velásquez, D. Ed. Editorial Distribuna, 2 edición 2010, 511 paginas. P. 501 – 511. ISBN : 978-958-8379-29-6
52. Franco, S.; Jaramillo, J.S. Trauma Cardiaco. En: Guías de manejo en enfermedades cardiacas y vasculares. Manual Condensado 2010. Velásquez, D. Ed. Editorial Distribuna, 2 edicion 2010, 511 paginas. P. 495 – 500. ISBN : 978-958-8379-29-6
53. Franco, S.; Jaramillo, J.S. Guías de Manejo de las Valvulopatias Mitrales. En: Guías de manejo en enfermedades cardiacas y vasculares. Manual Condensado 2010. Velásquez, D. Ed. Editorial Distribuna, 2 edición 2010, 511 paginas. P. 457 – 463. ISBN : 978-958-8379-29-6
54. Franco, S.; Jaramillo, J.S. Guías de Manejo de las Valvulopatias Aorticas. En: Guías de manejo en enfermedades cardiacas y vasculares. Manual Condensado 2010. Velásquez, D. Ed. Editorial Distribuna, 2 edición 2010, 511 paginas. P. 449 – 456. ISBN : 978-958-8379-29-6
55. Franco, S.; Jaramillo, J.S. Guías de Manejo de la Revascularización Coronaria Quirúrgica. En: Guías de manejo en enfermedades cardiacas y vasculares. Manual Condensado 2010. Velásquez, D. Ed. Editorial Distribuna, 2 edición 2010, 511 paginas. P. 437 – 447. ISBN : 978-958-8379-29-6
56. Franco, S.; Bucheli, V. Anatomía Quirúrgica de la Válvula Mitral. En : Enfermedad Valvular Cardiaca. Franco, S. Ed., Editorial Colina, Primera Edición 2010, 440 paginas. P. 26 – 31. ISBN : 978-958-44-7706-4
57. Franco, S.; Bucheli, V. Anatomía Quirúrgica de la Válvula Aortica. En : Enfermedad Valvular Cardiaca. Franco, S. Ed., Editorial Colina, Primera Edición 2010, 440 paginas. P. 33 – 38. ISBN : 978-958-44-7706-4
58. Franco, S. Endocarditis Infecciosa. En : Enfermedad Valvular Cardiaca. Franco, S. Ed., Editorial Colina, Primera Edición 2010, 440 paginas. P. 85 – 113. ISBN : 978-958-44-7706-4
59. Franco, S. Criterios para la Selección de una Prótesis Cardiaca. En : Enfermedad Valvular Cardiaca. Franco, S. Ed., Editorial Colina, Primera Edición 2010, 440 paginas. P. 433 – 440. ISBN : 978-958-44-7706-4
60. Franco, S., Atehortua, M. Endocarditis Infecciosa. En : Estado Actual en Enfermedades Cardiacas y Vasculares 2011. Ed. Editorial Distribuna, 1 Edición 2011, 744 pnas. Pgna 153 – 184. ISBN : 978-958-8379-46-3
61. Franco, S., Atehortua, M. Valvulopatia Mitral. En : Estado Actual en Enfermedades Cardiacas y Vasculares 2011. Ed. Editorial Distribuna, 1 Edición 2011, 744 pnas. Pgna 717 – 727. ISBN : 978-958-8379-46-3
62. Franco, S., Atehortua, M. Cirugía Valvular Aortica. En : Estado Actual en Enfermedades Cardiacas y Vasculares 2011. Ed. Editorial Distribuna, 1 Edición 2011, 744 pnas. Pgna 707 – 717. ISBN : 978-958-8379-46-3
63. Atehortua, M., Franco, S. Revascularización Coronaria Quirúrgica. En : Estado Actual en Enfermedades Cardiacas y Vasculares 2011. Ed. Editorial Distribuna, 1 Edición 2011, 744 pnas. Pgna 675 – 690. ISBN : 978-958-8379-46-3
64. Atehortua, M., Franco, S. Evaluación y Momento Optimo de Intervención en el Paciente con Enfermedad Valvular Cardiaca. En : Estado Actual en Enfermedades Cardiacas y Vasculares 2011. Ed. Editorial Distribuna, 1 Edición 2011, 744 pnas. Pgna 691 – 707. ISBN : 978-958-8379-46-3
65. Atehortua, M., Franco, S. Cirugía en Enfermedad Valvular y Tricuspidea. En : Estado Actual en Enfermedades Cardiacas y Vasculares 2011. Ed. Editorial Distribuna, 1 Edición 2011, 744 pnas. Pgna 727 – 744. ISBN : 978-958-8379-46-3
66. Atehortua, M., Franco, S., Velez, L.A. Guias de Manejo de Revascularizacion Coronaria. En : Guias de Manejo en Enfermedades Cardiacas y Vasculares Estado Actual – 2012. Ed. Editorial Distribuna, 3 Edición 2012, 708 pnas. Pgna 619 – 630. ISBN : 978-958-8379-60-9
67. Velez, L.A., Franco, S., Atehortua, M. Guias de Manejo de las Valvulopatias Aorticas. En : Guias de Manejo en Enfermedades Cardiacas y Vasculares Estado Actual – 2012. Ed. Editorial Distribuna, 3 Edición 2012, 708 pnas. Pgna 631 – 642. ISBN : 978-958-8379-60-9
68. Atehortua, M., Franco, S., Velez, L.A. Guias de Manejo de las Valvulopatias Mitrales. En : Guias de Manejo en Enfermedades Cardiacas y Vasculares Estado Actual – 2012. Ed. Editorial Distribuna, 3 Edición 2012, 708 pnas. Pgna 643 – 653. ISBN : 978-958-8379-60-9
69. Velez, L.A., Atehortua, M., Franco, S. Cirugia en Enfermedad Valvular Pulmonar y Tricuspidea. En : Guias de Manejo en Enfermedades Cardiacas y Vasculares Estado Actual – 2012. Ed. Editorial Distribuna, 3 Edición 2012, 708 pnas. Pgna 655 – 661. ISBN : 978-958-8379-60-9
70. Franco, S., Bucheli, V., Atehortua, M., Velez, L.A. Guias de Manejo en Endocarditis Infecciosa En : Guias de Manejo en Enfermedades Cardiacas y Vasculares Estado Actual – 2012. Ed. Editorial Distribuna, 3 Edición 2012, 708 pnas. Pgna 671 – 690. ISBN : 978-958-8379-60-9
71. Franco, S., Bucheli, V., Atehortua, M., Velez, L.A. Guias de Manejo de los Sindromes Aorticos Agudos. En : Guias de Manejo en Enfermedades Cardiacas y Vasculares Estado Actual – 2012. Ed. Editorial Distribuna, 3 Edición 2012, 708 pnas. Pgna 691 – 702. ISBN : 978-958-8379-60-9
72. Franco, S., Atehortua, M., Velez, L.A. Trauma Cardiaco. En : Guias de Manejo en Enfermedades Cardiacas y Vasculares Estado Actual – 2012. Ed. Editorial Distribuna, 3 Edición 2012, 708 pnas. Pgna 703 – 708. ISBN : 978-958-8379-60-9
Journal articles
1. Franco Sergio, Hincapié Miriam, Mejía Olga. Estudio Epidemiológico de Teníasis. Cisticercosis, San Vicente Antioquia – Colombia, 1985-1986. En: Medicina Tropical y Parasitología Vol. 2 No 1, Ecuador, Diciembre 1985.
2. Franco Sergio, Hincapié Miriam, Mejía Olga. Estudio Epidemiológico de Epilepsia y Neurocisticercosis. En: “Revista Universidad Industrial de Santander – Medicina¨ Vol. 14 No 1, Mayo 1986, p 143- 74.
3. Botero D., Franco S., Hincapié M., Mejía O. Investigaciones Colombianas Sobre Cisticercosis. En: Acta Neurológica. Vol. 2 No 2 Septiembre 1986, p. 3-6.
4. Franco Sergio; Londoño Juan. Dermatopoliomiositis – Reporte de un caso – Revisión del Tema. En: Medicina – U.P.B. Vol. 7 No 2, Noviembre 1988. p. 115.
5. Franco Sergio; Vásquez Jesús; Ortiz Jorge. Infarto Segmentario Idiopático del Epiplón Mayor – Presentación de dos casos y revisión del tema. En: Medicina – U.P.B. Vol. 10 No 2. Octubre. 1991, p. 109.
6. Franco Sergio. Choque Hipovolémico. Medicina U.P.B., Vol. 13 No 2, Octubre, 1994. P. 139-160.
7. Montoya A., Franco S.,. Lung Transplantation for Bronchoalveolar Cell Carcinoma. First Case Report in the Word Literature. 1996 – Loyola University Chicago Annual Report Magazine.
8. Franco S. Autopsy Results in Patients Following Lung Transplantation. Department of Pathology at Loyola University Medical Center. 1996 – Loyola University Chicago Annual Report Magazine.
9. Franco S., Giraldo N., Flórez M. Tratamiento Quirúrgico de la Coartación Aórtica Seguimiento a Largo Plazo – 8 años. Revista Colombiana de Cardiología. Vol. 5 No 5, Diciembre 1996.
10. Franco S, Giraldo N. Trauma Cardíaco: Revisión del Tema. Revista Colombiana de Cardiología. Marzo de 1997.
11. Franco S., Giraldo N., Ramírez C., Vallejo C., Castro H. Revascularización Miocárdica en pacientes con fracción de eyección menor del 30%. Departamento de Cirugía Cardiovascular. Unidad Cardiovascular Clínica Medellín. XVIII Congreso Colombiano de Cardiología. Medellín, 1999. Revista Colombiana de Cardiología, 1999, Vol. 7(6): 301.
12. Franco S., Giraldo N., Fernández H., Ramírez C., Vallejo C., Castro H. Transección Aórtica Traumática: Presentación de tres casos, revisión de la literatura. Departamento de Cirugía Cardiovascular. Unidad Cardiovascular Clínica Medellín. XVIII Congreso Colombiano de Cardiología. Medellín, 1999. Revista Colombiana de Cardiología, 1999, Vol. 7(6): 330.
13. Franco S., Giraldo N., Vélez S. et al. Fístula de la arteria coronaria derecha al tracto de salida del ventrículo derecho. Reporte de un caso – revisión del tema. Departamento de Cirugía Cardiovascular. Unidad Cardiovascular Clínica Medellín. XVIII Congreso Colombiano de Cardiología. Medellín, 1999. Revista Colombiana de Cardiología, 1999, Vol. 7(6): 319.
14. Giraldo N., Franco S., Ramírez C., Vallejo C., Castro H. CIV y Banding de la arteria pulmonar en un paciente adulto. Departamento de Cirugía Cardiovascular. Unidad Cardiovascular Clínica Medellín. XVIII Congreso Colombiano de Cardiología. Medellín, 1999. Revista Colombiana de Cardiología, 1999, Vol. 7(6): 333.
15. Giraldo N., Franco S., Ramírez C., Vallejo C., Castro H. Ruptura Ventricular post implantación de válvula mitral. Departamento de Cirugía Cardiovascular. Unidad Cardiovascular Clínica Medellín. XVIII Congreso Colombiano de Cardiología. Medellín, 1999. Revista Colombiana de Cardiología, 1999, Vol. 7(6): 340.
16. Castro H., Ramírez C., Franco S., Mesa J. et al. Anestesia y técnica quirúrgica en pacientes sometidos a implantación percutánea de endoprótesis en aneurismas de la aorta abdominal. Reporte de tres casos y revisión de la literatura. Departamento de Cirugía y Anestesia Cardiovascular. Departamento de Hemodinámica. Unidad Cardiovascular Clínica Medellín. XVIII Congreso Colombiano de Cardiología. Medellín, 1999. Revista Colombiana de Cardiología, 1999, Vol. 7(6): 331.
17. Vallejo C., Castro H., Ramírez C., Franco S., Duque M. et al. Anestesia y técnica quirúrgica en pacientes sometidos a implante de cardiodesfibrilador automático. Reporte de 20 casos. Departamento de Cirugía y Anestesia Cardiovascular. Departamento de Electrofisiología y Arritmias. Unidad Cardiovascular Clínica Medellín. XVIII Congreso Colombiano de Cardiología. Medellín, 1999. Revista Colombiana de Cardiología, 1999, Vol. 7(6): 336.
18. Ramírez C., Vallejo C., Castro H., Franco S., Giraldo N. et al. Protección Miocárdica: Solución de HTK en Cirugía Cardiaca. Departamento de Cirugía y Anestesia Cardiovascular. Unidad Cardiovascular Clínica Medellín. XVIII Congreso Colombiano de Cardiología. Medellín, 1999. Revista Colombiana de Cardiología, 1999, Vol. 7(6): 336.
19. Ramírez C., Vallejo C., Castro H., Franco S., Giraldo N. et al. Protección Miocárdica: Comparación entre la Solución de HTK y la Solución de Buckberg en Cirugía Cardiaca. Departamento de Cirugía y Anestesia Cardiovascular. Unidad Cardiovascular Clínica Medellín. XVIII Congreso Colombiano de Cardiología. Medellín, 1999. Revista Colombiana de Cardiología, 1999, Vol. 7(6): 336.
20. Vallejo C., Ramírez C., Castro H., Giraldo N., Franco S. Hipotiroidismo y enfermedad cardiaca: Administración de hormona tiroidea vía oral en pacientes sometidos a cirugía cardiaca. Departamento de Cirugía y Anestesia Cardiovascular. Unidad Cardiovascular Clínica Medellín. XVIII Congreso Colombiano de Cardiología. Medellín, 1999. Revista Colombiana de Cardiología, 1999, Vol. 7(6): 334.
21. Franco, S., Giraldo, N., Fernández H., Escobar A., Ramírez, C., Vallejo, C., Castro H. Revascularización miocárdica con arteria radial: Estudio de Casos y Controles. Departamento de Cirugía Cardiotorácica, Clínica Medellín. XIX Congreso Colombiano de Cardiología. Noviembre 27 – Diciembre 1, 2001. Revista Colombiana de Cardiología, 2001, Vol. 9(2): 197.
22. Giraldo, N., Franco, S., Fernández H., Escobar A., Ramírez, C., Vallejo, C., Castro H. Revascularización miocárdica Off Pump: Requerimiento de derivados sanguíneos. Departamento de Cirugía Cardiotorácica, Clínica Medellín. XIX Congreso Colombiano de Cardiología. Noviembre 27 – Diciembre 1, 2001. Revista Colombiana de Cardiología, 2001, Vol. 9(2): 238.
23. Giraldo, N., Franco, S. Fernández H., Escobar A., Ramírez, C., Vallejo, C., Castro H. Endarterectomia Coronaria del tronco principal izquierdo. Departamento de Cirugía Cardiotorácica, Clínica Medellín. CES Medicina Vol. 16 # 1, página 39-44. Enero-Marzo 2002.
24. Franco, S., Giraldo, N., Fernández H., Escobar A., Ramírez, C., Vallejo, C., Castro H. Cierre tardío del esternón en el manejo del sangrado mediastinal post cirugía cardiaca. Departamento de Cirugía Cardiotorácica, Clínica Medellín. CES – Medicina. Vol. 16 # 1, página 27-34. Enero-Marzo 2002.
25. Franco, S., Giraldo, N., Fernández H., Escobar A., Ramírez, C., Vallejo, C., Castro H. Cambio valvular mitral con preservación total del aparato valvular: Técnica quirúrgica, resultados y seguimiento. Departamento de Cirugía Cardiotorácica, Clínica Medellín. CES Medicina. Volumen 16 # 1, página 9-18. Enero-Marzo 2002.
26. Franco S, Giraldo N, Escobar A, Fernández H, Vallejo C, Ramírez C. Cambio valvular mitral con preservación total del aparato valvular: técnica quirúrgica, resultados y seguimiento. Revista Colombiana De Cardiología. 2003. pp. 368 – 74
27. Giraldo N, Franco S, Escobar A, Fernández H, Vallejo C, Ramírez C. Cierre tardío del esternón en el manejo del sangrado mediastinal post cirugía cardiaca. Revista Colombiana De Cardiología 2003. pp. 95 – 99
28. Escobar A., Giraldo N., Franco S., Jaramillo J., Orozco A. Taquiarritmias supraventriculares postcirugia cardiaca con y sin el uso de circulación extracorpórea. En : CES Medicina Volumen 17 # 1, Enero-julio 2003, Pgnas 23-31
29. Echeverri JL, Gonzáles M, Franco S., Vélez LA. Ruptura traumática de la aorta. Reporte de dos casos y revisión de la literatura. Medicina Crítica y Cuidados Intensivos. Enero – Junio 2004, 2 (1) : 31-35
30. Franco, S. Giraldo, N., Gaviria, A. et al. Aneurismas y seudoaneurismas de injertos venosos coronarios. Revista Colombiana de cardiología, Vol. 11 # 8, Abril 2005. Pgna 401- 404.
31. Franco, S.; Uribe, W.; Velez, JF. et al. Tratamiento quirurgico curativo de la fibrilacion atrial mediante tecnica de ablacion con radiofrecuencia monopolar irrigada : resultados a corto y mediano plazo. Revista Colombiana de Cardiologia. 2007. Vol 14, # 1. Pnas 43 – 55.
32. Escobar, A., Franco,S., Giraldo,N., et al. Tecnica de perfusion selectiva cerebral via subclavia para la correccion de patologias del arco aortico. Revista Colombiana de Cardiologia Volumen 14, numero 4, agosto 2007. P 232-237
33. Franco, S.Tratamiento quirurgico de la fibrilacion atrial. Revista Colombiana de Cardiologia – Guias de Diagnostico y Tratamiento de la Fibrilacion Auricular. Vol 14, Suplemento 3, Octubre 2007. P. 133 – 143.
34. Franco, S. Velez, A., Uribe, W., Duque, M., Velez, JF, et al. Tratamiento quirurgico de la fibrilacion atrial mediante radiofrecuencia. Revista Medica Sanitas 2008, Volumen 11, Numero 1, pgnas 8 – 20. Febrero – Abril, 2008.
35. Franco,S., Herrera, AM., Atehortua, M. et al. Use of Steel bands in sternotomy closure : implications in high-risk cardiac surgical population. Interactive CardioVascular and Thoracic Surgery 8 (2009) : 200-205.
36. Franco, S.Tratamiento Quirurgico para el manejo de las arritmias ventriculares. Guias Colombianas de Cardiologia. Artitmias Ventriculares y Muerte Subita. Revista Colombiana de Cardiologia. Volumen 18, Suplemento 1. Pgnas 160 – 163. Febrero 2011.
37. Miranda, A. ; Franco, S.,; Uribe, W. et al. Tromboembolismo Pulmonar Masivo de Alto Riesgo. Medicina ( Buenos Aires), 72 : 2012; Pgnas 128-130.
38. Miranda, A., Duque, M., Franco, S., Velasquez, J. et al. Tromboembolismo Pulmonar Masivo. Indicaciones de Cirugia – Reporte de caso. Revista Colombiana de Cardiologia. Volumen 19, Suplemento 1. Marzo de 2012.
39. Franco, S.; Eusse, A.; Atehortua, M., Vélez, L., et al. Endocarditis Infecciosa : Análisis de Resultados del Manejo Quirúrgico Temprano. Revista Colombiana de Cardiologia. Volumen 19, Suplemento 1, pgna 66. Marzo de 2012.
40. Franco, S.; Bucheli, V.; Atehortua, M., Vélez, L.; Eusse, A et al. Tratamiento Quirurgico : El “Gold Estándar” en el manejo de los defectos del septum interauricular. Revista Colombiana de Cardiologia. Volumen 19, Suplemento 1. Marzo de 2012.
41. Franco, S.; Atehortua, M., Vélez, L.; Castro, H., et al. Anomalías coronarias del Adulto. Origen anómalo de la arteria coronaria izquierda de la arteria pulmonar (ALCAPA). Reporte de caso. Revista Colombiana de Cardiologia. Volumen 19, Suplemento 1, pgna 61. Marzo de 2012.
42. Franco, S.; Atehortua, M., Vélez, L.; Castro, H., et al. Metástasis cardiaca de carcinoma anaplasico de tiroides. Reporte de caso. Revista Colombiana de Cardiologia. Volumen 19, Suplemento 1, pgna 70. Marzo de 2012.
43. Franco, S.; Giraldo, N.; Atehortua, M., Vélez, L.; Castro, H., et al. Endarterectomia coronaria del tronco principal izquierdo : Seguimiento a 15 años. Reporte de caso. Revista Colombiana de Cardiologia. Volumen 19, Suplemento 1, pgna 66. Marzo de 2012.
44. Franco, S.; Atehortua, M., Vélez, L.; Castro, H., Bucheli, V.; et al. Implante de válvulas biológicas : evaluación de libertad de reoperación por deterioro valvular estructural. Revista Colombiana de Cardiologia. Volumen 19, Suplemento 1, pgna 69. Marzo de 2012.
45. Miranda, A. Franco, S. Uribe, W., Duque, M. et al. Tromboembolismo Pulmonar Masivo de Alto Riesgo Asociado a Foramen Ovale Permeable. Medicina (Buenos Aires) 72 : 128 – 130. 2012.
46. Franco, S.Criterios Para la Selección de Una Protesis Cardiaca. Rev Fed Arg Cardiol. 2012; 41(3): 156 – 160.
Special topics in Cardiac Surgery: (Monographs)
1. Franco Sergio. Manejo Básico Inicial del Paciente Con Trauma CortoPunzante En: Monografía. Hospital San Vicente de Paúl – Prado (Tolima) 1989.
2. Franco S; Montoya A. Transplante Pulmonar: Indicaciones, Criterios de Selección y rechazo, Técnica Quirúrgica, Manejo de Donante y receptor, Complicaciones. Protocolo para la realización de transplante pulmonar en nuestro medio. Comité de transplantes de corazón y pulmón. 1996. Clínica Cardiovascular Santa María, Biblioteca Médica – Facultad de Medicina, Universidad Pontificia Bolivariana
3. Giraldo N., Franco S., Estudiantes X Semestre Instituto de Ciencias de la Salud – CES. Tratamiento Quirúrgico de la Endocarditis Infecciosa. Monografía. Investigación realizada en la Clínica Cardiovascular Santa Maria. Publicación Monográfica. Enero 1997.
4. Franco S. Safenectomía Videoendoscópica. Realización de video con descripción de la técnica quirúrgica. Descripción Monográfica. Departamento de Cirugía Cardiovascular. Unidad Cardiovascular Clínica Medellín. Diciembre de 1997.
5. Franco S., Giraldo N., Fernández H. Tratamiento Quirúrgico de la Enfermedad Pulmonar Obstructiva Crónica. Cirugía de Reducción de Volumen Pulmonar. Monografía, Departamento de Cirugía Cardiovascular – Unidad Cardiovascular Clínica Medellín. Octubre 1999.
6. Franco S., Escobar A. Trauma de Tórax. Revisión del tema. Monografía. Departamento de Cirugía Cardiovascular / Unidad Cardiovascular Clínica Medellín. Octubre de 1999.
7. Franco S., Jaramillo J.C. Cirugía en el paciente con Angina. Consenso Nacional sobre el Manejo de la Angina de Pecho. Sociedad Colombiana de Cardiología. Bogota, 11-12 agosto 2000.
8. Franco, S. Fibrilación Atrial: Tratamiento Quirúrgico. I Actualización del Consenso Nacional Sobre Fibrilación Atrial. Capitulo de Electrofisiología, Sociedad Colombiana De Cardiología. Abril 2002.
9. Franco, S, Jaramillo JS, Vélez JF, Castro H. Infecciones Mediastinales. Monografía. Departamento de Cirugía Cardiovascular. Hospital Departamental Santa Sofía de Caldas, Manizales. Mayo de 2003.
10. Guias Colombianas de Cardiologia. Fibrilacion Atrial – Guias de bolsillo.
Duque, M, Marin, J, ed. Franco, S. Cirugia de fibrilacion atrial. Sociedad Colombiana de Cardiologia y Cirugia Cardiovascular. 2008.
11. Franco, S. Long-Term Effectiveness of HIFU on Atrial Fibrillation in High Risk Valvular Surgery Patients. A Clinical Interview from Epicor- Cardiac Ablation System – St Jude Medical. March 2009.
What is the difference between a medico estetico and a cirujano plastico? The answer is more than just an issue of translation and semantics. We discussed this and several other issues during a visit to Clinica Plastic & Estetica Nova with Julio Casadiego, who works in the medical tourism sector here in Medellin at Colombia Travel Operator. Mr. Casadiego works with many of the healthcare professionals here in Colombia to assist overseas traveler in making arrangements for medical travel and has done so since 2009.
The Clinica Plastica & Estetica NOVA
Carrera 48 #32B sur 30
Envigado, Antioquia
Tele: (4) 339 2300 EXT 125
Email: gerencia@clinicanova.com.co
Nova is an ambulatory surgery center and a center for aesthetics. (Aesthetics is an umbrella term that encompasses other treatments outside of plastic surgery.) This five-story facility houses several doctors offices, aesthetic treatment facilities (laser treatment area) other nonsurgical treatment areas (cellulite treatment, botox/ injectables etc.), a cosmetic dentist (Dr. Jorge Ivan Echavarria) specializing in crowns, dental implants, maxiofacial surgery, and orthodontics along with other cosmetic services such as teeth-whitening.
There is a small pharmacy as well as a full lab (for development of gel matrix in addition to performing blood analysis), and sterilization facilities along with an operating theatre and recovery unit.
There are three operating rooms; all of which are spacious and well-lit. Each operating room has a full complement of fully functional and modern equipment and hemodynamic monitoring devices. There are also several well placed ‘crash carts’ for potential emergencies. The recovery room contains hemodynamic monitoring equipment with additional emergency equipment (just in case.) Dr. Diego Correa was my guide for a tour of the operating facilities and was happy to answer all of my questions.
He also reported that in the last year there have been just three cases of minor skin infections (the causative agent was normal skin flora). He reports no serious infections or complications after surgery, and states that have been no instances of resistant bacteria or MRSA.
What is a Medico Estetico?
The literal translation of medico esthetico is aesthetics doctor, but a more accurate description would be a doctor who serves as an Aesthetics Consultant, or a doctor who performs nonsurgical aesthetics treatments. For a better understanding of this specialty, I spoke with Dr. John Jairo Monsalve Bedoya, a medico estetico and general director at the Nova clinca.
A cirujano plastico is a ‘plastic surgeon’. This is the surgeon who is trained to perform surgical procedures such as abdominoplasties, breast augmentation and similar types of procedures.
As he explained, the Aesthetics Doctor is a physician who specializes in the study of Aesthetic procedures. Patients consult with this physicians as part of the initial consultation to help patients determine what procedures the patient needs or wants to achieve a desired result. This is important in many cases when the patient knows what type of result they want (“I want to look younger”, for example) but may not know exactly what procedure is best to accomplish the results they want.
During the consultation, the doctor listens to the patient describe what they are looking for, collections medical history and other medical information as well as preferences. Then the doctor discusses a range of procedures from injectables (botox, restalyne, gel matrix), and other non-surgical treatments (laser/ light therapies, mini-lift procedures) to larger, more invasive surgical procedures such as facial endoscopy, traditional face-lifts, eye lifts and other related procedures.
Finally, based on the information provided and the discussion with the patient and their family – the doctor recommends the procedures to accomplish the results the patients are seeking.
Once the patient has decided on their options, Dr. Monsalve, and his associate Dr. Correa begin the pre and post-operative treatment plan. This plan is more than discussing payment, arranging a date for surgery, and a follow-up visit. As Dr. Monsalve explains – it’s a process that encompasses the entire pre-operative period, surgery and recovery.
Patients undergo a compete physical examination, with blood work and cardiac testing as appropriate (usually EKG). Patients are evaluated and treated by internal medicine physicians for any co-morbid conditions before meeting with the anesthesiologist for further evaluation. (This is done to reduce risk of peri-operative and post-operative complications). The degree of pre-surgical evaluation is related to the type of treatment – with more comprehensive evaluations for patients who elect to have surgical procedures with general anesthesia.
Intra-operative care is provided by the attending anesthesiologist with the initial post-operative recovery under monitored care in the recovery room. But after the immediate recovery, patients aren’t simply discharged home.
The discharge planning / recovery phase is also governed by Dr. Monsalve and his team. This includes a 24 hour call line, and home visits, as needed. In fact, Dr. Monsalve encourages patients to call, saying, If a patient is having pain – they should call.. If they have questions or concerns, they should call. It doesn’t matter what time it is.
Dr. Monsalve also encourages patients to consider aesthetics “a process- not just a surgery”. He states that this treatment is a part of a patient’s life, and that using a philosophy of a process-based approach (rather than an episodic experience of pay – surgery – follow-up visit) results in a better patient experience, better outcomes and greater satisfaction/ happiness with the outcomes. He believes that successful aesthetic procedures aren’t about making people prettier, it’s about making people happier with themselves.
Medellin surgeons serving their community
During our discussion, we also talked about the many ways that local surgeons give back to their communities. While this includes the more widely known programs such as Operacion Sonrisa, it also includes programs such as Gorditis de Corazon for post-bariatric procedures, Angeles por Colombia , a more generalized organization that recruits volunteers from all professions and areas of society (which operates under a philosophy of each one recipient then helps three others) as well as several other programs aimed at providing reconstructive surgery procedures to low-income Colombians.
Gel Matrix for skin rejuvenation
During our visit we also talked to Dr. Maria del Pilar Sanin, another medica estetica, who performs many of the non-surgical procedures offered at Nova. She talked about Recombinant Plasma (approximate translation) which uses a gel matrix made for the patient’s own blood to improve the appearance and condition of the skin.
The origins of gel matrix: cardiac surgery
Having worked in cardiac surgery, this concept is not new – our perfusionist in Virginia often used the patient’s shed blood in orthopedic surgery to make a similar gel matrix that enhanced healing and reduced inflammation – particularly in patients with a history of poor wound healing.
Here at the clinica Nova, no major surgery is required. Blood is taken, (by syringe) and placed into a centrifuge. Now if you can remember back to high school biology – this causes the blood to separate into its components, buffy coat, platelets and red cell matter. Then the doctor uses the platelet rich portion (which also contains fibroblasts, collagen, and other nutrients important to skin elasticity and wound healing). This formula is then injected in small increments into the patient’s face to promote skin health and rejuvenation. Since the material is made for the patient’s own body, (and unadulterated with preservatives or other chemicals) there is no possibility for allergic reactions or sensitivities to the ingredients.
Dr. Maria del Pilar Sanin reports that the healing time for this procedure is approximately four days, and that redness and inflammation at the sites of injections are common immediately after this procedure. She states that the duration of the effects depend on the patient’s underlying skin condition, general health and age. On average it lasts 1.5 to 2.0 years in most patients, but may not last as long in patients with extensive sun damage or deteriorated skin condition.
She recommends this procedure as a complimentary treatment to other non-surgical treatments for better overall skin condition/ health and a reduction in the appearance of wrinkles and fine lines. She reports it is frequently used to treat the deepening of the naso-labial fold (the line that stretches from the nose to the corners of the mouth.)
Clinica Nova offers a wide-range of patient-centered aesthetic procedures and plastic surgery – all under one roof.
Medellensa (or women from Medellin) are considered some of the most beautiful women in the world. However, they often have had some help. Plastic surgery is wildly popular in Medellin, Colombia and much of Latin America, and standards of beauty are based on a voluptuous physique with large breasts, small waist and an (often) exaggerated caboose. Actress Sofia Vergara, of Barranquilla is a classic example of Colombian beauty ideals, which have spread into popularity to the United States. Many North Americans and Europeans seeking this look come to Medellin for the city’s famed plastic surgeons.
Of the 650 members of the Colombian Society of Plastic, Aesthetic and Reconstructive Surgery, 98 members are located in the Medellin area. Using this directory, I attempted to contact surgeons for interviews. When e-mail addresses were not available, I contacted surgeons thru the Colombian Society website, when that option was available*. If the surgeons listed a website, contact was also attempted via website.
Alphabetical listing – compilation is ongoing as I continue efforts to contact and interview plastic surgeons in the city.
Lists English and French in addition to Spanish. Following correspondence, I interviewed Dr. Botero at his office. The interview with Dr. Botero can be seen here. You can read about my visit to the operating room here.
No email listed, emailed through society website on 7/8*.
Profile states he speaks English and Portuguese in addition to Spanish.
Lists plastic surgery education at Hospital Barata Riverio – Rio de Janiero, Brazil.
Martha Elena Gomez Botero
Calle 2 Sur # 46 -55
Clinica Las Vegas
Medellin
Tele: 268-3818
Email: megomezbotero@hotmail.com
Emailed 7/8.
Dr. Gomez specializes in maxiofacial surgery and hand surgery.
** the website email form for the Colombian society of plastic surgeons does not appear to be working. I have contacted the society regarding this issue.
Sundays in Colombia are special to me. The tradition family day of relaxation and enjoyment has existed for centuries but somehow managed to pass me by for most of my adult life. In hospitals, patients need care every single day; on Christmas, on Thanksgiving, the fourth of July and on Sundays.. Usually I am first in line to volunteer to work these days.
I know that these days are important for my co-workers with small children and local family, and I don’t mind working during the holidays; the operating rooms are closed – everything slows down, so it’s a chance to spend some extra time with my patients.
But here in Colombia, I am a writer first, nurse second – so my schedule is very different. No more Sunday rounds, and bedside visits..
Sundays have become a ‘family day’ for me at this late date. A day to enjoy my surroundings, time with family and friends and to experience the food of Colombia.
Today we spent most of the day just outside the city in Parque Arvi. Just the trip to the park is fun – on the metrocable (the city’s tram system) up into the hills of Medellin..
on the metrocable, climbing the hills of Medellin
Then another tram ride across the mountains to the park.
some friends we made on the tram up
The view is glimpse down at a tiny slice of Medellin life..
kids enjoying the pool in the barrio beneath the metrocable
In general, the higher into the hills of Medellin, the poorer the settlements (but not always – some of the nicer estates in Poblado hug the hills on the way to Envigado).
houses hugging the hills of Medellin
But the views of the city itself are spectacular.
the city of Medellin as seen from the tram
It wasn’t a long ride – just long enough to meet our fellow tram riders (each tram holds eight people) including a newly wed couple from Bogotá..
The park itself is lovely, and the temperature just a wee cooler. Lots of families were out enjoying the park and the numerous restaurants selling regional Colombian cuisine. The trip is one of the most popular tourist activities for visitors to Medellin – and I am glad I finally took the time to see for myself.
If you want to understand and to really know life in Medellin, than you need to see the richness and complexities of life here. It’s simplistic to say that life here is more than black and white. It isn’t varieties of grey either.. There are so many levels, and sublevels and little pockets / slices of life here. Every barrio has its own personality; community, strengths and weaknesses.
Never has that been more apparent than during my visit to El Tesoro yesterday to interview Dr. Botero. Even so, I would be selling the city short if I pretended that I truly understood Medellin in my brief time here. My friend, Adriaan has lived here since 2008 and he would be the first person to admit – that it takes much of that time just to scratch beneath the surface.
One of the reasons I write about Colombian life so frequently, in addition to medical issues is to better understand life here – and to share that with my readers. It’s not just another language, or another Latin American country. Superficial differences are great for picture postcards and brief visits – but if you spend any real time here, or want to have lasting business relationships or friendships with people here, than you have to dig deeper (not just into Colombia, but in yourself).
One of the lessons has to do to with what we bring to other countries. A lecturer at the Global Health Conference in Duke one year explained it best. He went on a ‘medical mission’ to Mongolia.. And he thought he should teach them American principles of surgery. But when he got there he talked to the surgeons there and realized they didn’t want or need this. They wanted to learn more about laparoscopic surgery. So he changed his project entirely, and taught laparoscopic surgery. (Notably, he was the only speaker at this three-day conference who listened – and taught what the hosts wanted to learn.)
This is not a medical mission, it’s the anti-thesis to what I do. But I still have to listen, and to consider Colombians and Colombia as a big part of what I do. I am not an imperialist, and I am not a big multi-national organization. But if I am going to encourage people to see Colombia as a viable option to affordable surgery, then I need to consider the Colombians that will be impacted by this.
I have to take time to make sure that my efforts don’t undermine the needs of Colombian citizens – that they don’t lose access to health care providers in favor of the ‘wealthy gringos’ with cold hard cash in hand. I have to try to encourage others in this industry to do the same; to work within the existing framework to try to ensure services for all.
This means that I tend to steer clear of facilities created only for ‘rich gringos’ and send people to the excellent public and private facilities that also serve Colombian citizens. This prevents the diversion of resources away from the very people who live here and rely on these services for everyday life. It means sending people to Fundacion Cardioinfantil, Clinica San Rafael or the National Cancer Institute for the wonderful doctors who work there, instead of the ‘Medical Cities” that are popping up almost daily. That way, these excellent providers continue to serve their communities and the money from medical tourism enriches these same communities instead of the pockets of a very few. These facilities then add services – for everyone. There are enough excellent facilities here that it’s an easy choice – but people traveling to other countries like Thailand and India need to think about this. These countries already suffer from a “brain drain” as their most talented health care providers flock to the ultra-expensive and ultra-elite facilities for wealthy travelers (and leave their own citizens out in the cold.)
There is talk of building several of these tourist hospitals in the coastal cities (Cartagena, Barranquilla and Santa Marta) and I hope it doesn’t come to pass. It would change, and damage this country which I have come to love so much.
This is also why I steer clear of transplant tourism – which is inherently unfair.
Being in Colombia has changed me, because it makes me question a lot of the things that I held as ‘facts’ merely due to my upbringing and geographic orientation. But I feel this is essential for becoming a more intelligent and informed person and citizen of the world. Sometimes it is just noticing the obvious – like the view from the mall at El Tesoro.. Sometimes its taking a minute to talk to the vendors in the park; to listen to their dreams, hopes, worries as well as get their perspectives on life, global and local events. But sometimes its just being here.
All plastic surgeons listed (for Colombia) are members of the Colombian Society of Plastic, Aesthetic and Reconstructive Surgery.
Dr. Luis Botero during a tour of the new El Tesero ambulatory surgery clinic
Dr. Luis Fernando Botero Gutierrez
Carrera 25A #1 -31
Edificio Parque emp. El Tesoro
Office # 907
Medellin, Colombia
Tele: 448 – 6030
Email: luchobot@gmail.com
Website:currently under revision
It is fitting that one of Medellin’s most prominent plastic surgeons shares the same last name as one of Colombia’s most (but not related) famous artists – since plastic surgery requires considerable artistic vision from its practitioners. While Fernando Botero’s classic works depict a more fleshy, voluptuous and sumptuous view of the world, Dr. Luis Botero spends much of his time doing the opposite: slimming and smoothing his clients with the judicious application of the latest liposuction techniques.
Quirofanos El Tesoro
His office is located next to the El Tesoro mall, in one of the most affluent parts of the city, but that will soon change with the August opening of a large ambulatory surgery clinic within the upscale shopping center. Dr. Botero is a large part of the vision behind the 15-million dollar surgery center, which will also house the 150 physician offices from multiple specialties (including 21 plastic surgeons).
Trilingual surgeon
Dr. Botero speaks English and French fluently in addition to his native Spanish. Much of this is due to his training. After attending medical school at the Universidad de Antioquia here in Medellin and practicing as a general medicine physician for four years – he headed to Europe for specialty training in plastic surgery.
He attended the Free University of Brussels (Universite Libre de Bruxelles) in Belgium for his plastic surgery residency before moving to the University Henri Poincare (now University of Lorraine) in Nancy, France for four years to complete fellowships in maxiofacial surgery, plastic surgery of the face and separate training in hand and microsurgery and upper limb surgery. He spent an additional year working as a plastic surgeon in France. He also spent time in Singapore (National University Hospital) with Dr. Robert Pho and Taipei, Taiwan (Chang Gung Memorial Hospital) as a visiting fellow.
He returned to Colombia 12 years ago, and has been working as a plastic surgeon in Medellin ever since.
He is currently the president of the Antioquia chapter of the Colombian Society of Plastic, Aesthetic and Reconstructive surgery as well as holding memberships in Belgian Society of Plastic Surgery and the Group for the Advancement of Microsurgery (GAM). He is also a member of the International Society of Aesthetic Plastic Surgery (ISAPS) and the Latin American Federation of Plastic Surgery (FILACP).
He is the official physician for the French Embassy office in Medellin.
Current practice in Medellin
Despite his extensive training, his current practice is almost exclusively aesthetic surgery (rather than reconstructive, micro or hand surgery). He performs a combination of facial and body procedures including facial endoscopy, and reports that like almost all plastic surgeons, around fifty percent of his practice is liposuction.
While the majority of his practice are women, he estimates that around 15% are male clients. The most popular procedure for his male patients are blepharoplasty (eye-lid lift), mandibular liposuction (chin) and corporal liposuction (body).
He is patient, pleasant and very likeable. We talk about current trends in plastic surgery, cultural attitudes regarding plastic surgery and the anticipated opening of the new clinic. During our walk through the mall after a tour of the new clinic – we are greeted by two of his former patients who are pleased to see him. One young lady ruefully shrugs with a shy smile while showing off her advanced pregnancy, as if acknowledging that she will be back soon.
Hopefully, we will follow Dr. Botero to the operating soon.
the crowd at the Botanical Gardens enjoys a free show during the International Tango Festival
While salsa dancing is a Colombian original (from Cali), the Argentine tango is alive and well here in Medellin. At this week’s festival, several musicians and dancers from Medellin are being showcased for their skills – along with Buenos Aires legends.. Local schoolchildren are also participating in a series of concerts and dance demonstrations. It’s quite a bit of fun – and showcases some of the things the city of Medellin really excels at.
After attending a Tango performance last weekend, and numerous other public events and outings – one of the things that it really noticeable is how well the city manages these events.
Fun and family friendly
There has been no trash or litter, no displays of public drunkenness (despite the fact that there is plenty of alcohol at these events), and no disturbances at any of our outings (and several were free).
Roaming the city
During the weekend, we roam the city – taking pictures, enjoying the endlessly lovely weather – and riding on the metro (train). The trains are affordable, quick (and if you avoid peak traveling times during the week) not too overly crowded.
above ground metro train
Universidad Station
Several parks and museums are located close to the Universidad Station including the Planetarium, Parque Explora (for kids) and the Botanical Gardens.
the planetarium
The Botanical Gardens
The ‘Joaquin Antonio Uribe’ Botanical Gardens were a delightfully relaxing place to spend a gorgeously sunny Sunday afternoon in the midst of the city, but away from the hustle and bustle of El Centro (where I live).
Admission is free.
There was live music to listen to, plenty of flowers, and wildlife to enjoy (iguanas roam the grounds), and assortment of snacks (ice cream, juice drinks, and other regional treats).
Iguanas roam the park
But the park isn’t just there to enjoy nature.. It’s a great place to people watch.. Also the people of Medellin are very kind and friendly, so they are happy to talk – even to gringas with bad Spanish, like myself.
using his camera to meet girls
We watched this photographer use his camera to meet girls as he roamed the park..
A group of young people singing…
Then we met a lovely princess..
and a local vendor selling gum in the park..
lost his leg due to a landmine
This very nice gentleman is a reminder that as sunny and lovely as Medellin is – there is still an ongoing war to remember.. One that has devastated thousands of young men, and displaced millions of people.
jumping rope
Wholesome
As a visitor (and temporary resident) of Medellin – the wholesomeness of the park is enchanting.. It’s a reminder of one of the reasons, I do enjoy Colombia so very much.. Just like my “Sundays in Bogotá” – the city slows down during the weekends, and people spent time with their loved ones.. No gameboys in evidence, and phones used mainly to take pictures.. It’s a gracious illusion that reminds me of my own childhood in a small town..
I apologize for the wordiness of this post – but much of what we discuss below is covered in the Bogotá, Cartagena and Mexicali books – the essential mechanisms of cardiac surgery; how procedures work, what is off-pump surgery, when do we use the bypass pump and other explanatory information. But since I have am not writing a full book on Medellin, I wanted to offer a bit of a primer for my new internet readers here.
Dr. Luis Meza
Cardiac surgeon, Hospital General de Medellin
After interviewing Dr. Meza and meeting many of the staff at Hospital General de Medellin, it was a pleasure to be invited to observe Dr. Meza and Dr. Urequi , the head of the cardiac surgery department in the operating room. Despite the patient’s young age, the surgery (for me as an observer) was knuckle-biting. While the surgery itself was a fast, straight-forward and uncomplicated repair of an interauricular septal defect – it was the patient’s fragile condition that had me on the edge of my seat.
Complex patients The case was typical of many of the cases they see at public hospitals. It was a young patient with newly diagnosed right-sided heart failure due to an uncorrected congenital defect. The patient had traveled from another part of Colombia (one of the poorer regions) to have surgery. The patient had initially presented to a local doctor after a syncopal event (passing out) and was found to have an enlarged heart, with a moderate sized pericardial effusion (fluid in the sac around the heart.) After arriving at HGM, the patient was also diagnosed with a serious acquired coagulopathy (bleeding disorder).
drawing courtesy of Wikipedia (Creative Commons licensing)
Since the patient had a hole between the left atrium leading into the right atrium, blood was being pushed from the left atrium (which is under higher pressure) to the low pressure right atrium. Over the course of many years, this had caused the right atrium to enlarge massively. As the right atrium was continuously being overfilled (from blood from the left side), the right side of the heart was being forced to work harder, and harder. As the atrium continued to be overstretched, and enlarged – it also caused blood to be forced back into the pulmonary arteries – causing pulmonary hypertension. While pre-surgical tests (echocardiogram, and cardiac catheterization) showed the patient to have (only) moderate pulmonary hypertension (with PA systolic pressures of 65mmHg).
Pre-operative testing is only part of the story
However, when we looked down, into the patient’s chest – it was obvious that the patient’s pulmonary vasculature was engorged and enlarged. The patient’s heart was massive, and floppy (which is a sign the heart is working way too hard). The patient also had peripheral edema which is another sign that the heart was not working well.
Potential for badness*
So even though, the surgery itself (described below) is not terribly technically challenging (‘like darning socks’ one surgeon used to say) – a lot can go wrong because the patient’s heart just doesn’t work that well to begin with.
* a not-so-scientific term to describe the likelihood of potential complications, problems or adverse outcomes. These may be unavoidable circumstances in many cases – but the term is a reminder to remain vigilant even during so-called “simple” procedures.
Nitric oxide on hand
This OR does have nitric oxide – (which we didn’t need), but was available nearby, just in case. Nitric oxide, milrinone and other medications are critical to have on hand in patients with pulmonary hypertension. Some patients will never need it – others can’t survive without it – and sadly, (in patients with severe fixed pulmonary hypertension), nothing – not even an assist device is going to make much difference. While we can try to predict which patients are going to tolerate surgery, it’s not always clear-cut. Tests (echocardiograms, right heart caths) can predict, tests can give probabilities – but sometimes tests are wrong, and patients who appear to have only ‘mild’ disease do very poorly (and visa versa). Sometimes, we just have to hold our breath as the patient comes off bypass and see.
canisters of nitric oxide in OR #1
As I mentioned in a previous post – cardiac surgery procedures can be a bit more complicated than many other surgical procedures, and while having something like nitric oxide on hand doesn’t seem like a big deal – it is. (I have worked in several facilities without these capabilities). It also speaks to the general preparedness of the staff. But despite the ‘potential for badness’ everything proceeded beautifully with Drs. Urequi and Meza. The case seemed to speed by despite the patient’s fragile health. The entire CPB (cardiopulmonary bypass run) was just 26 minutes with a total cross-clamp time of 31 minutes.)
A little bit about cardiopulmonary bypass – the “heart-lung machine”
In comparison to the congenital repair above, average CPB times for valve replacement run around 100 minutes, 60 to 90 minutes for bypass surgery. Patients have a higher risk of CPB related complications from hypo/ altered perfusion after long pump runs . As the clock begins to exceed 120 minutes, the risk of renal failure, cognitive changes and bleeding problems (as blood cells are continuous smashed/ broken / damaged within the pump) increase.
What is “Off-pump surgery”? Nowadays, lots of people get real excited about “off-pump” surgery because they think that by not using the heart-lung machine, they can avoid a lot of the problems we mentioned above. But that’s oversimplifying the entire scenario – and one that I find is often used to “sell” a particular surgeon or surgical program. Off-pump can be safer than CPB cases, for some patients. But these are usually not the patients that the surgery is sold to.. So it’s important to know what some of the terminology really means. Just because Hospital X has billboards announcing that they now perform off pump surgery – doesn’t mean that it’s something you may even need or want.
Off pump is not for everyone
Patients have to be fairly healthy to tolerate cardiac surgery without the pump. People with a lot of the problems that we thought were worsened by the pump, actually fare worse when we try to do surgery without the heart-lung machine. For example, we initially thought that Off-pump surgery would be great for people with renal insufficiency or ‘bad kidneys’ – particularly people who have kidney problems but aren’t quite sick enough to be on dialysis yet. The hope was that by avoiding the bypass pump we could avoid any damage to the kidneys from artificial flow/hypoperfusion because one of the biggest risks of cardiac surgery in patients with bad kidneys is that surgery will cause their kidneys to fail entirely, and make patients dialysis dependent. Unfortunately, the research from all of the off-pump surgeries being done hasn’t really shown the benefits that we thought it would. So like most things in medicine, it’s not quite the panacea we had hoped it was. But we did learn an incredible amount of information once surgeons started trying off pump surgeries for coronary bypass. Surprisingly, we learned that many of the complications, and conditions that we had long blamed on the CPB pump – weren’t related to the machine at all. But much of this is still being argued by cardiac surgeons every single day – each with different research studies giving different results..
More importantly, Off-pump not possible for many types of cardiac surgery
It’s technically impossible to do some types of cases without the bypass pump. Coronary bypass surgery (CABG) is very different from other types of surgery, for example. During bypass, the surgeon is only operating on the outside of the heart – attaching new conduit (arteries and veins) to arteries on the surface of the heart. So – it isn’t absolutely essential to have the pump circulating blood for him while he’s operating – in some patients – we can let their body do it for us during surgery.
But replacing diseased heart valves, or the great vessels (aortic aneurysms etc) is a completely different entity. In those surgeries – the surgeon is cutting into the heart or great vessels themselves. It’s not possible to lop off the top of the aorta, operate on the aortic valve and not have blood being re-directed mechanically during this process. Otherwise blood would just literally spill out into the chest and never oxygenate the brain and the rest of the body. (The only time we ever do this kind of procedure without a pump is during organ retrieval – for obvious reasons). It’s important to know these distinctions so people understand how the surgery actually proceeds.
For the case today – the surgeon has to make an incision through the side of the atria (wall of the heart chamber) to get to the hole on the inside wall of the heart.) The surgeon then closes the hole with suture (and a patch, in some cases). Some doctors do this in the cath lab without surgery – but that’s also controversal because the patch used in the cath procedures in the past has caused a high incidence of stroke. In a young patient like the one here – you certainly wouldn’t want to risk it – particularly since we don’t know how well those patches hold up in the long term.
Cardiac surgeons operate at Hospital General de Medellin (HGM)
Overall evaluation of today’s case:
Safety checklists, and all pre-operative procedures were completed. Patient was prepped and draped in an appropriate sterile fashion. Antibiotics were administered within the recommended window (of time). Appropriate records were maintained during the case.
Surgery proceeded normally and without incident.
Due to an underlying coagulopathy the patient did require administration of nonautologous blood products (4 units of packed red blood cells, 3 packets of platelets, and abumin) while on pump. While the facility does not have a ‘cell-saver’ for washing and re-infusing shed blood, patient did receive autologous(their own) transfusion from the CPB pump. This blood, from the CPB circuit was returned to the patient to limit the amount of blood needed after surgery. Hemoglobin at the conclusion of surgery was 9.6mg/dl, which is within acceptable parameters.
Hemostasis was obtained prior to chest closure, with only a small amount of chest tube drainage in the collection chamber at the time of transfer to the intensive care unit.
Surgical Apgars – do not apply for cardiac cases due to the nature of the case, and use of CPB. Mean pressure while on CPB was within an acceptable range. Patient’s urinary output was less than anticipated during the case (150cc) despite the use of mannitol while on pump, but the patient responded well (1000+) with volume infusion and the addition of furosemide.
The patient was hemodynamically stable during the entire case. The was a very brief transitory period of hypotension (less than 5 minutes) near the conclusion of the case, which was immediately noted by anesthesia and treated with no recurrence.
On transfer to the unit, the patient was accompanied by several members of the OR staff, including Dr. Meza, the anesthesiologist, and the perfusionist, each of which did a face-to-face “hand-off” report of the patient (and medical history) including the course of the surgical procedure (including medications given, lab values, procedural details) to the Intensivist (physician), with ICU nursing staff attending to the patient.
Transesophageal echo (TEE) was not performed during this case, but was available if needed.
Also, I am happy to report there were no smartphones or “facebooking” in sight. No one appeared engaged in anything other than the surgery at hand.
Dr. Luis Fernando Meza Valencia, cardiac surgeon and his wife, Dra. Elaine Suarez Gomez, anesthesiologist have a terrific partnership as part of the Cardiac Surgery program at Hospital General de Medellin (HGM). (Hospital General de Medellin is one of just a few public hospitals that have heart surgery programs.)
Dr. Meza, a Cali native who trained at Fundacion Cardioinfantil under the instruction of Dr. Pablo Umana, Dr. Nestor Sandoval along with Dr. Maldonado now performs coronary bypass, valve replacement, surgery on the great vessels (such as ascending arch replacement, aortic aneurysm repair) at the Hospital General de Medellin as well as several smaller, private facilities like Clinica Las Vegas.
He has worked at HGM for 2 1/2 years since he moved from the public hospital in Manizales (in the coffee-growing region of central Colombia).
Dra. Elaine Suarez is a anesthesiologist who has specializes in cardiothoracic anesthesia. She has been practicing for five years and is fluent in English and German in addition to her native Spanish.
High risk patients
Because HGM serves the public and many of their patients are impoverished, Dr. Meza and Dra. Suarez see a large number of rheumatic heart disease and endocarditis patients. Many of these patients have had very limited preventative care or medical management of their underlying chronic health conditions. A large number of these patients have significant co-morbid conditions such as diabetes, chroic pulmonary disease, hypertension, hyperlipidemia, and nephropathies (kidney damage). This subset of patients almost always presents in the midst of a cardiac emergency.
In the Consulta Externa
Dr. Meza reports that he usually spends at least an hour with his patients during the initial consultation, gathering information, examining the patient and explaining the necessary tests and treatments.
In the Operating Room
Haven’t had an opportunity to follow Dr. Meza to the operating room yet, but we did get to see Dra. Suarez in action.
I am still working on several posts – but in the meantime, I wanted to post some photos from my visit to the operating room with Dr. Wilfredy Castaño Ruiz, one of the thoracic surgeons at Hospital General de Medellin.
Readers may notice that some of the content of my observations of the operating room have changed.. In reality, the reports haven’t changed – I have just chosen to share more of the information that I usually reserve for the books since I probably won’t get time for a “Medellin book”. So, if you are squeamish, or if you don’t want to know – quit reading right about now…
It was a surprise to meet Dr. Wilfredy Castaño Ruiz because it turns out we’ve already met. He was one of the fellows I encountered during one of my early interviews in Bogota, with Dr. Juan Carlos Garzon Ramirez at Fundacion Cardioinfantil.
Since then (which was actually back in the early spring of 2011), Dr. Castaño has completed his fellowship and come to Medellin.
Dr. Wilfredy Castaño Ruiz, thoracic surgeon at Hospital General de Medellin
Yesterday, I joined him in the operating room to observe a VATS decortication. The case went beautifully.
Dra. Elaine Suarez Gomez, an anesthesiologist who specializes in cardiothoracic anesthesia managed the patient’s anesthesia during the case. (This is important because anesthesia is more complicated in thoracic surgery because of such factors as double lumen intubation and selective uni-lung ventilation during surgery).
Anesthesia was well-managed during the case, with continuous hemodynamic monitoring. There was no hypotension (low blood pressure) during the case, or hemodynamic instability. Pulse oxymetry was maintained at 98% or above for the entire case. Surgical Apgar: 8 (due to blood loss**)
Monitors at HGM are large and easily seen from all areas of the OR
Dr. Wilfredy Castaño Ruiz was assisted by Luz Marcela Echaverria Cifuentes, (RN, first assist*). The circulating nurse was a very nice fellow named Mauricio Lotero Lopez.
Enf. Luz Echaverria assists Dr. Wilfredy Castaño Ruiz during surgery.
*”Registered nurse” is not terminology common to Colombia, but this is the equivalent position in Colombia, which requires about six years of training.)
** In this particular case, the surgical apgar of 8 is misleading. The anesthesia was excellent, and the surgery proceeded very well. However, due to the nature of surgical decortication (for a loculated pleural effusion/ empyema) there is always some bleeding as the thick, infected material is pulled from the lung’s surface. This bleeding was not excessive for this type of surgery, nor was it life-threatening in nature.
I spent the day yesterday at Hospital General de Medellin, and I am going back today for another visit. I’ll be revising and updating this post as I go along. I spend most of the day with Dr. Luis Fernando Meza Valencia and Dra. Elaine Suarez Gomez, but we will talk more about these two doctors in another post.
Quite frankly, it is the nicest public facility I have ever been in, anywhere. The entire facility (and I was peeking in corners and closets) was spotless – and that included the operating rooms.
It’s the main trauma center for Medellin, and the largest public facility with a large well-coordinated ER. (The ER was quiet and orderly during my visit – despite being about half-full.
The hospital is well-equipped with 3 mixed ICUs, a step-down unit, a large neonatal ward and NICU, pediatric ICU along with multiple wards for medical patients. There are nine operating rooms, including a dedicated cardiac operating room (quirofano #1), and a separate cath lab with OR capabilities (for endovascular and hybrid procedures.)
Attached to the hospital is the ‘Consulta Externa’ where the doctors see their patients, along with a non-invasive cardiology clinic (echocardiograms, stress tests and the like, and laboratory. I have certainly missed several departments – as I passed auditoriums and several other departments during my visit, but all of the major elements are included above.
They do not have a PET scanner at Hospital General de Medellin (but given the expense of this machinery, there are only a few PET scanners in Colombia. There are only two in Bogotá – one at the Fundacion Santa Fe de Bogotá, and one at the National Cancer Institute.)
There is no international patient division or department, but the website has a full English version, many of the physicians speak English (about half of the physicians I met), and they are very welcoming.
Mural at Hospital General de Medellin
The hospital, while busy was not as hectic or crowded as some of the other facilities I have seen in the past. I’ll be at Hospital General for multiple visits, so I will have plenty of opportunities to see if that changes.
High-risk Obstetrics Program
During my visit – Dr. Carlos Garcia, the Chief of Surgery was talking about the new obstetrics outpatient monitoring program along with several other services that are fairly uncommon for publicly funded hospital facilities.
I only received the basics of the OB program (because OB is not really my area of expertise) but as Dr. Garcia explained – it’s an out-patient monitoring program for high-risk obstetrics patients. Patients are equipped with fetal monitors so that they can be in their own homes during much of their gestational period, instead of confined to the hospital. The monitors are reviewed continuously by the staff at Hospital General – and if there are any serious abnormalities or evidence of fetal distress, not only is the patient contacted – but an ambulance is automatically sent to bring in the patient for urgent/ emergent evaluation and treatment.
I was hoping to collect information on surgeons and surgery here in Medellin for publication in a series of articles as well as a potential collection(another book, perhaps) but so far – the surgeons of Medellin have proven to be quite elusive to my attempts to contact them.
Hopefully my luck will change, so I am able to bring all of you news about what’s new, innovative, or simply outstanding in medicine here in Medellin..
I don’t know how it always happens.. I set out on one kind of expedition and (frequently) it turns into something else. So we have it.. I was planning to write extensively on Panama City, but looky, looky – here I am again, living in the fantastic, tragic beauty of Medellin.
As I wrote once before, Medellin is a city of great loveliness, but somehow Bogotá always blinded me to Medellin’s charms.. But it’s time to give Medellin a fair shake, so here I am..
Colombian Culture & Cuisine 