Story updates: Be care my friends, and Mexicali

Posted on October 13, 2014 by K Eckland

It may have been a while since my last post, but I haven’t been idle. In the last few weeks, I’ve traveled to Mexicali to check in, have some dental work done as well as attending professional conferences and working on my next locum tenens assignment.

First – some updates on Mexicali:

I don’t have photos to accompany these updates, but the new emergency department at Hospital General de Mexicali is big, beautiful and open for business.

I also met with both Carlo Bonfante and Dr. Carlos Ochoa to talk about some of the upcoming improvements to the Hospital de la Familia. Nothing has been completed yet, but they have some big plans to improve services for local residents and medical tourists alike. I’ll write more when I have the rest of the details.

I also had a chance to catch up with Dr. Horatio Ham (Bariatric surgeon) and Alejandro Ballestereos (Anesthesia). Dr. Ham reports that Dr. Abril’s radio show has been revived as an internet radio program.

Sadly, Dr. Alberto Aceves, a well-known Mexicali bariatric surgeon died in a private plane crash back in June.

My Mexicali dentist: Dr. Luis Israel Quintana

Dr. Israel Quintana with one of his American patients

I don’t have dental insurance but I have a history of bruxism (grinding my teeth) so I am pretty fanatical about taking care of my teeth. I’ve written before about the difficulties in reporting on dental tourism, as well as my previous experiences with Dr. Quintana, so when my dentist at my last locum assignment gave me a work estimate for almost eight thousand dollars!*, I knew I needed to plan a trip to Mexicali before my next assignment.

I ended up having 12 fillings (no cavities but plenty of damage from grinding), as well as a root canal and a partial crown. He also made me a new night guard since my old one obviously wasn’t preventing ongoing damage. While several days in the dentist’s chair was no picnic, I had minimal discomfort and little damage to my wallet. All told, the bill was less than 1300. I still need some additional work, but the majority of my teeth are now taken care of. I don’t have to worry about having a dental emergency while I am working a contract.

Dr. Quintana also reminded me that his office accepts most American insurance plans – with no co-pays or other payment required.

* My initial estimate in Dallas only covered work on four teeth. The additional surface fillings were not included.

Story Update: Please be careful my friends!

Baby making and Planet Hospital: Lots of money and no baby

Some readers may remember the sad story that I received from a childless couple last year. The couple had contracted with Planet Hospital for surrogacy services after receiving devastating news on the birth of their only child. The child had been born with a terminal disease (the child later died). The couple also learned that due to a rare (and previously undetected) genetic condition, it was likely that any future children would also contract this disease. The couple had started a blog to document their journey into surrogacy, but after several months, it devolved into a story of deception, with the couple being defrauded of thousands and thousands of dollars by one of Planet Hospital’s contracted facilities.

Recently, Planet Hospital and their surrogacy scams made the front page of the print edition of The New York Times. The story by Tamar Lewin rips the mask off of Rudy Rupak, the shyster I told you about previously. (I also wrote about his shady transplant tourism practices at the Examiner.com back in 2012).

Surprisingly, the “Medical Travel Quality Alliance,” a branch of the MTA that advocates for “self-regulation” of the medical tourism industry only seems to partially condemn the practice of tourism surrogacy and Rudy Rupak in their latest publications and newsletter. Of course, anyone with even a few years experience covering medical tourism remembers that Rudy Rupak was the poster child for the medical tourism industry for many years, even after the first rumors of shady business practices emerged in 2010. Mr. Rupak has since filed for bankrupcy, but knowing of some of the deals Planet Hospital was involved in, I think he should be in prison.

Medical tourism for pets?

Posted on December 14, 2013 by K Eckland

Hello everyone, and season’s greetings from Dallas, Texas!

I am on assignment as a locum tenens for the next several months, so I will be traveling around the United States quite a bit. In the meantime, this blog post by Marian Ruiz over at Borderzine caught my eye so I thought I would share.

In the article, Ms. Ruiz interviews Elva Lomas, a California resident who travels to Mexicali for her pet care. This article drew my attention for a couple of reasons:

1. I know Mexicali, MX.

Mexicali is one of my favorite cities. I guess it’s an occupational hazard; since Bogotá ranks pretty far up there on my list, as well.

But back to Mexicali –

After spending several months there writing my most recent book, this area of dusty and hard-packed, sun-scorched concrete, asphalt and dry dirt became near and dear to me.

2. I have pets.

The other reason this story caught my eye was the part about the animals. Mexicali was the first time I was able to bring my own pets on one of my writing projects. Both of our cats, 17 year-old Sid, and 4 year-old Cora came with us for the nine month stay in Mexico. (We previously transported the cats to the (U.S.)Virgin Islands, and on multiple cross-country car trips, so the cats were veteran travelers, but this was their first international trip.)

Our cats (at our home in Virginia), circa 2010.

Over the course of several months, both of our cats saw veterinarians in Mexicali – including two different ones – on Avenue Maduro and another office, closer to our apartment. We also went to the veterinary college in Mexicali.

Sid, prior to his final illness

But our experience was a little different from Ms. Lomas and her seven dogs, particularly for our geriatric cat.

In fact, at each clinic, the veterinarian expressed surprise at Sid’s age. In what turned out to be his final illness, we were forced to go across the border to El Centro, California to get Sid the aggressive, intensive care that he needed.

Sadly, he was too sick and too weak – so we brought him back to Mexicali to our apartment to die.

3. Many Americans have “close” relationships with their pets that maybe considered uncommon in other cultures.

What we found during this experience wasn’t that veterinarians on either side of the border were more or less qualified than the other. What we found is that the cultural expectations and the role of pets varied significantly by country. (I am certain that a case could be made that there were several other factors as well – such as our familial and socio-economic status).

For our vet in Mexicali – Sid was our beloved pet, and they were happy to offer compassionate and competent care. For our vet in El Centro – he understood that like many childless, middle-class couples, Sid was more than a pet – he was family. [Not everyone feels that way about their pets – but all of us know people who do.. However, not all cultures view this ‘child-pet’ attitude as indulgently as we do.] This meant that the vet offered more services and treatments (like emergency dialysis, and mechanical ventilation) for our ailing, long-term companion that they did at the vets’ offices in Mexicali.

In the end, it didn’t make a difference, after 17 years, my cat was at the end of his life. We didn’t put him on dialysis, or advanced life support. Instead, we made him as comfortable as possible and watched him slip away from us, surrounded by people who loved him (my husband and my dear friend).

The cultural context of care

But the focus of this story isn’t about pets, veterinary care or Mexico at all. It’s more about the importance of cultural context and cultural values related to health care. In fact, one of the reasons that I focus on health care / medical tourism in Latin America is due to concerns over differences in cultural expectations related to health care.

Life support despite medical futility as a cultural expectation*

In general, these differences are minimized for people from the United States when they receive care from Latin American providers due to similar cultural backgrounds and cultural expectations. (A good example that highlights the differences in healthcare related to culture that is often cited in the literature has to do with end-of-life and ‘futile care‘.) This is care that may be very expensive to provide – and may actually do nothing to prolong life. It’s one of the hallmarks (or pitfalls) of American healthcare. But then again, it’s only a pitfall, or ‘wasteful spending’ when it’s not your family member.

Translated this ‘futile care’ means that in most parts of Northern America, metropolitan areas of Latin America, people may receive treatments (like dialysis, prolonged mechanical ventilation/ or other artificial ‘life support’) despite having minimal or a low or no chance of survival. Ethicists can debate the issues related to the use of limited or scarce resources to keep someone’s elderly grandmother, or extreme ‘preemie” baby alive, but for the most part – doctors (and patients) in Bogotá, Mexico City, Dallas, Texas or Washington, D.C. all want the same level of care and are willing to provide some level of this care, even when doctors feel it may be futile in nature. It is part of the culture, and the cultural expectation shared by most patients.

However, if you contrast that with other common medical destinations (by country, not facility), the answer is not always the same. If the average life expectancy/ infant mortality / or level of available technology is dramatically different, than the cultural expectation of “appropriate care” may be very different. That isn’t to say that the doctors or families of patients in these countries care about their patients any less. However, it may translate to a very different level of care in similar circumstances.

For example, I currently work in a surgical program that specializes in providing valve replacement (cardiac) surgery to the extreme elderly (patients in their late 80’s and early 90’s). In other cultures and societies, expensive and scarce medical resources would not be allotted as freely to this group of patients. It’s one of the concerns in our own country with the advent of ‘Obamacare’ or a socialized medicine schemata, and it is a legitimate one.

Whether or not we consider it right or appropriate to offer this level of care to high risk groups is often debatable, but as Americans we take it for granted – that we have the right to decide this for ourselves. We might not be as happy if it’s not offered (or available) to us as medical tourists somewhere else.

*This field of study is a subspecialty of Sociology – while it’s not scientific, the linked description on wikipedia may be helpful for readers who want a basic overview on some of the ways culture affects health beliefs and behaviors.

Health insurance and medical tourism

Posted on November 2, 2013 by K Eckland

Medical tourism is for boob jobs, liposuction and poor people without insurance

Many people think medical tourism is only for people without health insurance.. Or people seeking treatments or procedures that aren’t covered by the typical health insurance policy (like some types of plastic surgery.)

But that’s not true.

While medical tourism is often a ‘saving grace’ for the uninsured and underinsured patients in the United States, other medical tourists are often referred to overseas practices by their insurance companies.

Insurance companies want to save money too..

Insurance companies collect premiums from their subscribers. When subscribers need care, the companies pay out claims at pre-set rates for services. Companies negotiate for ‘volume discounts’ for many services but use several other strategies to make a profit while meeting their commitments to subscribers.

Paying for services while balancing the bottom line

They balance claim payout with profit-making several ways;

1. Deny claims. One of the ways insurance companies can save money on claims – is to not pay them… So companies may deny certain claims or by limit access to care for subscribers with expensive pre-existing conditions. (The New ‘Obamacare’ legislation is aimed at preventing this practice, but we won’t know how effective it is for a couple of years).

2. Promote health ..Many insurance companies also offer incentives to their subscribers for health promotion activities. Quit smoking? Lose weight? Exercising daily? Then the insurance company might even lower your premium a bit – since these activities may reduce their future payouts.

3. Use less costly services. Another way insurance companies can reduce their payouts is through medical tourism. Since surgery is significantly less expensive outside of the United States, it benefits the insurance company to have patients travel for services. So – even if your insurance company doesn’t advertise (loudly) its medical tourism division, it probably has one.

If you aren’t sure – do a little on-line research and call your insurer. Sometimes the insurer will even offer subscribers an incentive for traveling.

and even if your insurance wants to send you to India – they will probably pay for you to go to Mexico, Colombia, Costa Rica or wherever you chose.

But, if you are like me, you still have some questions.. How difficult is it to file a claim internationally? Is it more difficult for Americans to have their claims processed in other countries? How long does it take for claims to be processed and paid? Do patients need to start researching and preparing their claim ahead of time?

Meet Myriam

While I was in Mexicali – I took advantage of the opportunity to interview someone who negotiates with American insurance companies every day. Myriam is an insurance billing specialist for a bariatric surgeon in Puerto Vallarta, Mexico.

Meet Myriam.

The bilingual Myriam has been processing international health insurance claims for over 12 years now. She laughs out loud when I ask about processing claims for American patients. “Those are the easiest,” she said. “The companies are happy to pay. They never give us any problems.”

As part of her job, Myriam helps patients with information and files their insurance claims. Myriam explains that as part of the claims process for bariatric surgery, for example, claims must be filed when the patient is actually in the hospital. “The insurance company requires us to submit the claim at the time of service, not before.”

[So in this practice],” we have the patient provide us with a credit card prior to the procedure. We don’t bill it without speaking to the patient but that way we can use the credit card for the deductible or co-pay. Insurance usually pays within 60 days of the procedure, Myriam explains. If you aren’t sure if your insurance carrier will cover the claim, call them ahead of time.

Mexicali updates: October 2013

Posted on October 27, 2013 by K Eckland

Here is some updated information from my recent visit to Mexicali for the Mexicali Summit (Cumbre de turismo Medico):

New Cath facility

Hospital Almater opened their new cardiac catheterization laboratory as part of their long-standing plans to build a ‘chest pain’ center. The first cardiac cath in the new facility was scheduled to be performed October 18th, 2013.

During a discussion with the owner of Hospital Almater, at the Cumbre, I asked for permission for an ‘official’ tour of the new cath facility so I will have additional details for readers. My request was denied.

Hopefully, I will be able to provide more information about the cath lab as well as the continued development of the ‘chest pain’ on a future visit to Mexicali.

Loss of full-time heart surgeon/ heart surgery program

Mexicali has lost its only full-time cardiac surgeon.

Several local physicians have reported that Dr. Cuauhtemoc Vasquez is no longer functioning as Mexicali’s only full-time cardiovascular surgeon. His cardiac surgery program at Issstecali has closed (due to financial reasons), and he is no longer operating at the various facilities in town. It is a huge loss of the city of a million residents. Baja California residents will have to travel to Tijuana for surgery – while Imperial Valley residents will continue to travel to San Diego or Los Angeles for cardiac surgery services.

Salud Longevidad

During my visit, I was also invited to visit Salud Longevidad, a new clinic that is the brainchild of Dr. Jorge Gallegos. He created the clinic as a place for many of the local therapists and alternative/ complementary medicine practitioners to provide their services. He likes to joke that he created the centro de medicina alternativa as a way to personally fight of the aging process, so “I will be young forever,” he explains with a smile.

The unassuming, nondescript exterior hides a spacious and elegant interior. The clinic offers multiple treatments including various types of massage (and couples massage), water therapy, high colonics, magnetic therapies – and other varieties of “alternative” therapies.

The fifteen suite clinic also features a hyperbaric chamber. Now, this is a treatment I can appreciate since there is a large volume of research on the benefits of hyperbaric oxygen therapy for wound healing and other medical applications outside of the ‘bends’ or complications from scuba diving for which the therapy is best known for*. It also happens to be one of the nicest, most modern chambers that I have ever seen. The majority of other chambers I have visited are either former military equipment or vintage models.

Dr. Juan Fernando Medrano, a medical doctor who also serves as the head of medical tourism at the Hospital de la Familia was gracious enough to invite me for a tour, and to watch one of his sessions at the new clinic. He recently finished training as a medical aesthetic physician, and now performs platelet rich plasma (PRP) treatments (among other procedures).

Salud Longevidad is located on Av. Francisco Javier Mina #200 in Zona Centro (across the street from the parque de Mariachis).

For more information about Dr. Medrano and the PRP – please read my recent article at Examiner.com.

* Hyperbaric oxygen is best known for its use in treating ‘the bends” or complications from rapid decompression (rising to the surface too quickly) in scuba divers.

I have included a limited selection of medical literature on hyperbaric therapy. However, I also want to caution readers when researching medical information, particularly when reading Chinese journals which have been recently discredited for widescale/ widespread fraud.

References

Egito JG, Abboud CS, Oliveira AP, Máximo CA, Montenegro CM, Amato VL, Bammann R, Farsky PS. (2013). Clinical evolution of mediastinitis in patients undergoing adjuvant hyperbaric oxygen therapy after coronary artery bypass surgery. Einstein (Sao Paulo). 2013 Sep;11(3):345-349. English, Portuguese.

While many readers know that I have a background in cardiac surgery – where mediastinitis is a serious/ dreaded complication – I hesitate to embrace these findings too enthusiastically due to the very small sample size (of 18 patients over 2 years).

Cao H, Ju K, Zhong L, Meng T. (2013). Efficacy of hyperbaric oxygen treatment for depression in the convalescent stage following cerebral hemorrhage. Exp Ther Med. 2013 Jun;5(6):1609-1612. Epub 2013 Apr 2. A small (60 patient) study looking at the effects of hyperbaric oxygen on depression in patients following cerebral hemmorhage (hemorrhagic stroke).

de Nadai TR, Daniel RF, de Nadai MN, da Rocha JJ, Féres O. (2013). Hyperbaric oxygen therapy for primary sternal osteomyelitis: a case report. J Med Case Rep. 2013 Jun 27;7(1):167. doi: 10.1186/1752-1947-7-167. Did hyperbaric oxygen help?

Delasotta LA, Hanflik A, Bicking G, Mannella WJ. (2013). Hyperbaric oxygen for osteomyelitis in a compromised host. Open Orthop J. 2013 May 3;7:114-7. Research suggesting hyperbaric oxygen may be helpful in treating serious orthopedic infections in patients with impaired wound healing.

Recommended reading:

Chantelau EA. (2013) Benefits of hyperbaric oxygen still doubtful. Dtsch Arztebl Int. 2013 May;110(21):372. doi: 10.3238/arz9tebl.2013.0372a. No abstract available. A letter in which the author presents evidence suggesting that any attempt to conclusively state the benefits of hyperbaric oxygen therapy is premature/ misguided (at best.)

In the operating room with Dr. Gustavo Gaspar Blanco

Posted on September 9, 2013 by K Eckland

Dr. Gustavo Gaspar, plastic surgeon

In the operating room with Dr. Gustavo Gaspar Blanco

Hospital de la Familia,

Mexicali, B.C.

Mexico

After interviewing Dr. Gaspar, he graciously invited me to join him in the operating room as an observer for several cases during the week.

Hospital de la Familia

As reviewed in the Mexicali! mini-guide to medical tourism, Hospital de la Familia is widely acknowledged as “the second best hospital in Mexicali.” Much like the Hertz automobile rental campaign “We try harder,” the directors of Hospital de la Familia have embarked on an aggressive publicity campaign to attract patients and physicians to their facility. This includes medical tourism – as Hospital de la Familia has partnerships with multiple brokers including PlacidWay and Planet Hospital.

Dr. Gaspar exclusively operates at Hospital de la Familia.

In the ORs at Hospital de la Familia

OR #3 is the plastic surgery suite. It is spacious and well-lit with modern and functional equipment. Along with a designated OR, Dr. Gaspar has an operating room team consisting of an anesthesiologist, an assistant surgeon, scrub nurse and circulating nurse.

Dr. Gaspar and his OR team

Anesthesia is managed by Dr. Armando Gonzalez Alvarez. He monitors the patient with due diligence and remains in attendance at all times. He avoids distractions during surgery (like texting or excessive cell phone use) and remains patient-focused.

Dr. Gonzalez Alvarez, Anesthesiologist

Dr. Binicio Leon Cruz, is a general surgeon who serves as Dr. Gaspar’s assistant surgeon during the case. Monica Petrix Bustamante is the instrumentadora (scrub nurse), and she is excellent, as always*. She knows the surgeries, easily anticipates the doctors’ needs while maintaining surgical sterility and ensuring patient safety.

Monica prepares a prosthesis for implantation

Adherence to international protocols

The majority of procedures are under an hour in length, which means that patients do not need deep vein prophylaxis during surgery. The procedure (including site) and patient identity are confirmed prior to surgery with active patient participation before the patient receives anesthesia with both surgeons, nursing staff and the anesthesiologist in attendance. Patients are then prepped and draped in sterile fashion, with care taken to prevent patient injury.

As with many plastic surgeons, Dr. Gaspar does not administer IV antibiotics for infection prophylaxis prior to the first incision. Instead, all patients receive a course of oral antibiotics after surgery***.

Surgical sterility is maintained throughout surgery. For the first case, after receiving adequate tissue preparation, since only limited liposuction is needed (for very specific sculpting), the patient receives manual liposuction (without suction) to prevent overcorrection or excess fat removal. Despite having significant adhesions due to previous liposuction procedures, there is very minimal bleeding during the procedure.

Following the procedure, the patient is awakened, extubated and transferred to the recovery room for hemodynamic monitoring and adequate recovery prior to discharge.

Throughout the case, (and during all subsequent checks in the PACU), the patient is hemodynamically stable, and maintains excellent oxygenation.

The second case, is a breast augmentation revision – in a patient with a previous breast reconstruction after mastectomy for breast cancer. The patient developed a capsular contracture which required surgical revision**.

Abdominoplasty

On a separate occasion, Dr. Gustavo Gaspar performed an abdominoplasty with minor liposuction of the “saddle bag” area at the top of the thighs. For the abdominoplasty case, the patient received conscious sedation with spinal anesthesia.

While an abdominoplasty, “tummy tuck” is a much larger procedure, the case proceeded quickly (1 hour 15 minutes), and uneventfully. There was very minimal bleeding, and excellent cosmetic results.

skin, and adipose tissue removed during abdominoplasty.

skin, and adipose tissue removed during an abdominoplasty

Gluteal augmentation (Gluteoplasty)

However, it was the gluteal augmentation case that attracted the most interest. As mentioned during a previous interview, Dr. Gaspar is well-known throughout Mexico for his gluteal implantation technique.

Pre-surgical planning

Due to the proximity to the anus, and potential for wound infection and contamination, the area is prepped in a multi-step process, in addition to the standard surgical scrub. A Xoban (iodine impregnated dressing) is applied to the area to prevent bacterial migration to the area around the incision.

For this procedure, Dr. Gaspar uses gluteal prostheses for intramuscular implantation. Using one, small 3 cm incision, Dr. Gaspar dissects through the gluteal tissue to the muscle plane. He then inserts the prosthesis and adjusts it into its final position. When he has finished placing the implant, it is buried deep in the tissue and invisible.

after the implant is placed within the muscle it is invisible to the eye

He explains that by placing the prostheses in the intramuscular layer, the implants remain in a stable position, and are invisible to the eye and imperceptible to the touch. (Even with movement and manipulation – there is no edge or pocket seen or felt after the gluteal prosthesis is placed).

The procedure is repeated on the opposite side. Two small drains are placed, and the incision is closed. The entire procedure has taken just 18 minutes.

incision and drains at the conclusion of surgery

Despite the speed by which Dr. Gaspar operates, he is meticulous in his approach. He frequently re-assesses during the procedure (particularly during bilateral procedures) to ensure symmetry of results.

*I frequently encountered Ms. Petrix during previous visits to the operating rooms at Hospital de la Familia during research and writing of the Mexicali book).

** Capsular contraction is one of the most frequently occurring complications of breast augmentation using breast prosthesis (implants).

*** this practice is somewhat controversial but the most recent surgical guidelines and literature on antibiotic stewardship suggest that pre-operative antibiotics may be unnecessary for some surgical procedures.

Thank you to the kind patient who graciously gave permission for publication of pre-operative, intra-operative and post-operative photographs on this site.

Additional readings: Gluteoplasty

The majority of publications originate in Latin America and Latin American journals (and are written in Spanish and Portuguese.) Here is a small selection of open-access, English language journals.

Bruner, T. W., Roberts, T. L. & Nguyen, K. (2006). Complications of buttocks augmentation: Diagnosis, management and prevention. Clin Plastic Surg 33: 449 – 466.

Cardenas – Camarena, L. (2005). Various surgical techniques for improving body contour. Aesth. Plast. Surg. 29:446-455.

Cardenas- Camerena, L. & Palliet, J. C. (2007). Combined gluteoplasty: Liposuction and gluteal implants. PRS Journal, 119(3): 1067 – 1074. Part of a series on gluteal augmentation.

Harrison, D. & Selvaggi, G. (2006). Gluteal augmentation surgery: indications and surgical management. JPRAS 60:922-928.

Talking with Dr. Gustavo Gaspar Blanco, plastic surgeon

Posted on September 6, 2013 by K Eckland

Dr. Gustavo Gaspar Blanco, plastic surgeon

Dr. Gustavo Gaspar Blanco is a plastic surgeon in Mexicali (Baja California) Mexico. He is well-known throughout Baja and Northern Mexico for his gluteal augmentation techniques using gluteal implants. While this is one of the procedures he is most famous for, he also performs the complete range of body, facial plastic surgery procedures, and post-bariatric reconstructive surgery.

It was an engaging series of interviews as Dr. Gaspar is extremely knowledgeable and passionate about his craft. “Plastic surgery is different from other specialties, it is an art. The surgeon needs to have an eye for beauty and symmetry in addition to surgical skill.”

To read more about Dr. Gaspar in the operating room.

Gluteal Implants versus Fat Grafting

There are multiple methods of gluteal augmentation (or buttock enhancement). Dr. Gaspar performs both fat grafting and gluteal implantation procedures. He prefers gluteal implantation for patients who are very thin (and have limited fat tissue available for grafting) or for patients who want longer-lasting, more noticeable enhancements. (With all fat injection procedures, a portion of the fat is re-absorbed).

He recommends fat grafting procedures to patients who want a more subtle shaping, particularly as part of a body sculpting plan in conjunction to liposuction.

Breast Implants and attention to detail

Like most plastic surgeons, breast augmentation is one of the more popular procedures among his patients. The vast majority of his patients receive silicone implants (by patient request), and Dr. Gaspar reports improved patient satisfaction with appearance and feel with silicone versus saline implants. He uses Mentor and Natrelle brand implants, and is very familiar with these products. In fact, he reports that he has visited the factories that create breast implants in Ireland and Costa Rica. He says he visited these factories due to his own curiosity and questions about breast implants**.

Once he arrived, he found that each implant is made by a time-consuming one at a time process versus a vast assembly line as he had envisioned. He was able to see the quality of the different types of implants during the manufacturing process. These implants, which range from $800.00 to $1200.00 a piece, go through several stages of preparation before being completed and processed for shipping. He also watched much of the testing process which he found very interesting in light of the history of controversy and concern over previous silicone implant leakage in the United States (during the 1960’s – 1970’s).

Another aspect of breast augmentation that Dr. Gaspar discusses during my visits is the breast implantation technique itself. While there are several techniques, in general, he uses the over-the-muscle technique for the majority of breast implantation procedures. He explains why, and demonstrates with one of his patients (who had the under-the-muscle technique with another surgeon, and now presents for revision).

“While the under-the-muscle technique remains very popular with many surgeons, the results are often less than optimal. Due to the position of the muscle itself, and normal body movements (of the shoulders/ arms), this technique can cause unattractive rippling and dimpling of the breast. In active women, it can actually displace the implant downward from pressure caused by normal muscle movements during daily activities. This may permanently damage, displace or even rupture the implant.”

Instead, he reserves the under-the-muscle implant for specific cases, like post-mastectomy reconstruction. In these patients (particularly after radiation to the chest), the skin around the original mastectomy incision is permanently weakened, so these patients need the additional support of the underlying muscle to prevent further skin damage.

Not just about outcomes

While his clients, from all over North America, are familiar with his plastic surgery results, few of them are aware of his deep commitment to maintaining the highest ethical and medical standards while pursing excellence in surgery.

Commitment to ethical care of patients crosses language barriers

While Dr. Gaspar is primarily Spanish-speaking, his commitment to ethical practice is crystal clear in any language. He explains these ethical principles while offering general guidelines for patients that I will share here (the principles are his, the writing style is my own).

Advice for patients seeking plastic surgery

Be appropriate:

– Patients need to be appropriate candidates for surgery:

Around fifty percent all of the people who walk into the office are not appropriate candidates for plastic surgery, for a variety of reasons. Dr. Gaspar feels very strongly about this saying, “Unnecessary or inappropriate surgery is abusive.”

– Plastic surgery is not a weight-loss procedure. Liposuction/ Abdominoplasty is not a weight loss procedure. Plastic surgery can refine, but not remake the physique. Obese or overweight patients should lose weight prior to considering refining techniques like abdominoplasty which can be used to remove excess or sagging skin after large-scale weight loss.

fat removed during liposuction procedure

– Have surgery for appropriate reasons. Plastic surgery will not make someone love you. It won’t fix troubled relationships, serious depression or illness. Plastic surgery, when approached with realistic expectations (#3) can improve self-esteem and self-confidence.

– Realistic expectations – just as plastic surgery won’t result in a 25 pound weight loss, or bring back a wayward spouse, it can’t turn back the clock completely, or radically remake someone’s appearance. There is a limit to what procedures can do; for the majority people, no amount of surgery is going to make them into supermodels.

– Know the limitations

Not only are there limits to what surgery itself can do, there are limits to the amounts of procedures that people should have, particularly during one session. “Marathon/ Extreme Makeovers” make for exciting television but are a dangerous practice.

Stay Safe:

Just as patients should avoid marathon or multi-hour, multiple procedure surgeries, patients should stay safe.

– Avoid office procedures

As Dr. Gaspar says, “The safest place for patients is in the operating room.” With the exception of Botox, all plastic surgery procedures should be performing the operating room, not the doctor’s office. This is because the operating room is a sterile, well-prepared environment with adequate supplies and support staff. There are monitors to help surgeons detect the development of potential problems, life-saving drugs and resuscitation (rescue) equipment on hand. Should a patient stop breathing, start bleeding or develop a life-threatening allergic reaction (among other things), the operating room (and operating room staff) are well prepared to take care of the patient.

Communicate with your surgeon –

Give your surgeon all the details s/he needs to keep you safe, and have a successful surgery. Talk about more than the surgeries you are interested in –

– bring a list of all of your medications

– know a detailed history including all past medical problems/ conditions and surgeries.

If you had heart surgery ten years ago – that’s relevant, even if you feel fine now. Have a history of previous blood transfusions/ radiation therapy/ medication reactions? Be sure to tell the doctor all about it.

Even if you aren’t sure if it matters, “My sister had a blood clot after liposuction” – go ahead and mention it.. It might just be a critical piece of information such as a family predisposition to thromboembolism (like the example above).

Lastly

Surgical complications are a part of surgery. All surgeons have them – and having a surgical complication in and of itself is no indication of the quality or skill of the surgeon. Complications can occur for a variety of reasons.

However, how efficiently and effectively the surgeon treats that complication is a good indicator of skill, experience and expertise.

As part of this, Dr. Gaspar stresses that medical tourism patients need to prepare to stay until they have reached an adequate stage of recovery. This prevents the development of complications and allows the surgeon to rapidly treat a problem if it develops; before it become more serious.

“There is no set time limit for my patients after surgery, everyone is different. But none of my patients can go [return home] until I give my approval.” This philosophy applies to more than just medical tourists from far off destinations. It also applies to any patients have large procedures and their hospitalizations. While many surgeons race to discharge clients as same-day surgery patients, Dr. Gaspar has no hesitation in keeping a patient hospitalized if he has any concerns regarding their recovery. “Hospitals are the best places for my patients, if I am concerned about their recovery.”

About Dr. Gustavo Gaspar Blanco, MD

Plastic and reconstructive surgeon

Av. Madero 1290 y Calle E

Plaza de Espana, suite 17 (second floor)

Mexicali, B.C

Tele: (686) 552 – 9266

If calling from the USA: 1 (877) 268 4868

Email: gustavo@drgaspar.com

Dr. Gaspar attended medical school at the Universidad Autonoma de Guadalajara. He completed both his general surgery residency and plastic surgery fellowship in Mexico City at the Hospital de Especialidades Centro Medico La Raza.

He is a board certified plastic surgeon by the Mexican Society of Plastic and Reconstructive Surgery, license number #601. He has been performing plastic surgery for over 20 years. Surgeons from areas all over Mexico train with Dr. Gaspar to learn his gluteal implantation techniques.

** He has also visited the facilities in Germany where the Botulism toxin is prepared for cosmetic/ and medical use.

Spending the day with Dr. Gabriel Ramos, Oncology Surgeon

Posted on September 1, 2013 by K Eckland

Spent the day in the operating rooms with one of my favorite Mexican surgeons, Dr. Gabriel Ramos Orozco. Dr. Ramos is an oncology surgeon with offices in Mexicali (Baja California) and his hometown of San Luis Rio del Colorado in Sonora, Mexico.

Dr. Gabriel Ramos Orozco, Oncology Surgeon

In the operating room with Dr. Gabriel Ramos

We spent the day in his hometown – first at the Hospital Santa Margarita, where he performed a laparoscopic cholecystectomy, and then in his offices seeing patients.

In the operating room – photos edited to preserve patient privacy

Hospital Santa Marta

The hospital itself was a small intimate clinic. The operating rooms were small but well-equipped. We were joined by Dr. Campa, an excellent anesthesiologist and another general surgeon. While the anesthesia equipment was dated, all of the equipment was functional. At one point, the sensors for cardiac monitoring and oxymetry readings malfunctioned but within seconds a backup monitor was attached. (This is a frequent occurrence in most hospitals around the world and the USA because the sensors that connect to the patient with gel are cheap disposable and somewhat fragile.)

There were several monitors dedicated to laparoscopy with good display quality. The operating rooms had ample light and functioned well. Overall the clinic was very clean.

The surgery itself proceeded in classic fashion. The patient was positioned appropriately and safely before being prepped and draped in sterile fashion. Since the surgery itself was of short duration, anti-embolic / DVT prophylaxis was not required but was still applied. (Note: in Mexico, these stockings are of limited utility – and for more lengthy procedures, TEDS or electronic squeezing devices are usually applied.)

The surgery itself was under an hour, with no bleeding or other complications. The patient was then transferred to the post-operative care area for monitored recovery from general anesthesia.

Dr. Ramos performs laparoscopic surgery

In the clinic

It was an interesting day – because he sees a diverse mix of patients. As a general surgeon, he also operates for many of the classic indications, so there were several patients who saw Dr. Ramos for post-operative visits after appendectomies, cholecystomies (gallbladder removal) and the like. There was also a mix of patients with more serious conditions like colon, testicular and breast cancers. His patients were a cross section of people, from the United States and Mexico alike.

International patients

Some of these patients came for the lower cost of treatment here in Mexico, but others came due to the dearth of specialty physicians like oncology surgeons in places like Yuma and Las Vegas. Many of these international patients spoke Spanish, or brought translators with them since Dr. Ramos is primarily Spanish speaking.

Since D. Ramos is not well-known outside of Mexico, many of these patients were referred by word-of-mouth, by former patients, friends and family.

Then it was back to the hospital twice to visit his patient post-operative. She was resting comfortably and doing well. It is this level of service that draws patients to his clinic both here and in central Mexicali.

This winter, Dr. Ramos returns to school so to speak – as he will be spending several months in Barcelona, Spain and Colombia learning new techniques such as uni-port laparoscopy. He will then be able to offer these state-of-the-art treatments to his patients back here at home; whether these patients come from northern Mexico or other parts of the globe.

Highly Recommended: Excellent surgeon with well-coordinated team. However, patients requiring more extensive surgery (large tumor surgeries/ cytoreductive surgery) should request Dr. Ramos perform surgery in the larger Mexicali facilities for better access to advanced and specialized support services like hemodialysis etc. for sicker/ higher risk patients.

However, the level of care was appropriate at this facility for this procedure, which is rated as low-risk. (i.e. generally healthy patient, with straight-forward procedure)

Memories of Mexicali

Posted on September 10, 2012 by K Eckland

As I get ready to leave Mexicali, I am posting several old postcards of the city. Today’s post is more reflective of the many changes going on now – but we’ll be back to our usual topics soon..

this one is just a few years old

I’m sure that my regular readers can tell that parting is ‘such bittersweet sorrow’.. How could it not be – when I have met such wonderful people, learned so much and made some great friends?

Mexicali – Av..Revolucion – circa 1960’s

At the same time, I am excited about moving forward – school, studying in Bogotá, and working on my research.

Governmental Palace (now part of UABC) circa 1960’s

Hard to leave the hospital in particular. I went back there yesterday and got to see some of the people who were so welcoming, starting on my very first day. (When I was still struggling – particularly with the regional accent here – which differs from the Spanish I was used to hearing.)

Av. Lopez Mateos

It was great to be back in the operating room with Dr. Ochoa. With classes in Nashville, and my homework assignments, I hadn’t seen him for a couple of weeks.

I know I will miss him most of all even if I am embarrassed to admit it. He will always rank up there as one of the world’s great “bosses”; he was great to be around; day after day after day- which is not something you can say about most people. I know I’ve talked about what a good (and patient!) professor he has been, but this last month, when we’ve been collaborating on the book, has changed the dynamic a bit. He’ll still always be ‘my professor’ and a surgical colleague – but now that we have worked together in a different capacity – he is more of a friend too. (I’ve actually called him by his first name a couple of times, which is a hard thing for me to do..)

I think, too, that is was a little-bit eye-opening for him to be more involved on the writing (and researching) side of things. I hope he enjoyed it as much as I have. (He should – he did all the research on Mexicali’s nightlife.. )

and Joanna – who has become one of my best friends.. (Not just my best friend in Mexicali – but someone I consider a really close friend – anytime, anywhere..) It just seems like we connect and communicate on that level that only really close friends ever do.. Despite different backgrounds, I feel like I’ve known her my whole life.. So it’s hard to say “see you later” to Joanna.. (“See you later” is so much better than goodbye, don’t you think?)

So of course, as you can imagine – I spent my last day at the hospital – in the place I love the most: the operating room.

Dr. Rivera (left) and Dr. Ochoa

I’m going to miss my ‘movie star’ surgeon too – Dr. Rivera has been great about being in all my pictures and film clips.. He’s a nice young resident – (still grounded) and I think he’s be a great surgeon when he finishes his training.. He’s interested in surgical oncology – so we might be writing about him again in a few years..

Kim Kardashian: Better call your lawyers..

Posted on August 18, 2012 by K Eckland

As I mentioned previously – the ‘unauthorized’ use of celebrity images is pretty common around here. We talked about this before in conjunction to Kim Kardashian and Rhianna – and today, while driving around Mexicali taking pictures for a section of the book on architecture, we saw yet another example of this. (Sorry, Kim – we were in traffic, and seeing it was unexpected, so the photo is blurry – and I know, my window is filthy) – but it’s undeniably you hawking clothing up on a sign outside a clothing store on Blvd Anahuac.. Just thought you should know..

Kim Kardashian hawking cheap clothing in Mexico

In other news – spent the day trying to find the elusive “casa de Louis Vuitton” which is a house of the outskirts of Mexicali painted brown with symbols to look like a Louis Vuitton bag. I know the house is still there – yesterday one of the people who lived near the house was lamenting being a neighbor – but the address and directions were far from correct..

I did get some more great photos of Mexicali.. including one of the fancy car dealerships down here.. (I like to remind people that Mexicali has one of the highest standards of living, and income in all of Baja).. There is a growing middle-class here (and just like most of us), they like nice things.. It’s another side of the road photos since I wasn’t planning on taking pictures of car dealerships..

Mercedes Benz dealership

A lot more photos but I haven’t gotten around to sorting of all them yet..More architectural adventures tomorrow..

as the mercury soars..

Posted on August 16, 2012 by K Eckland

into the 110’s (and higher) it’s been an interesting week in Mexicali. I’ve definitely entered new territory in my book writing venture. In the last books, I basically didn’t see the forest for the trees – meaning that even as I raced around, and enjoyed the cities I was living in – I didn’t include any of the information about the cities themselves.. Just the surgeons, and surgery.

In retrospect – I think that was a mistake. While I know the beautiful multifaceted Bogotá, my readers don’t. At the time, I didn’t want to duplicate the efforts of the many talented travel writers out there. But on consideration – living in a city is so much different from visiting one. It takes months to see and fully appreciate the nuance of many locations – especially cities.. Anyone can talk about the historic church built in 19 whatever, but it takes time and familiarity to see the beauty of Mexicali’s Graceland, or the changing canvas of the UABC museum. It takes time to collect the stories that bring the city to life. So now, I am trying to do that – in a small fashion with everything I’ve collected since coming here in March.

I am not Frommer’s.. I am more like his awkward, quirky little cousin. I don’t have the manpower or the resources to talk about the hundreds of restaurants here (more than 100 Chinese restaurants alone!) but I can tell you some of my favorite places; for a casual lunch with friends, or a night on the town. I can’t give exhaustive listings on all there is to see and do in this thriving city, but I can show you the heart of it. I can tell you about the things that make Mexicali more than just spot in the hard-baked earth; the things that make this city real, and make it a fascinating place to be. I can make your stay; whether just a few days, weeks or months; interesting and informative.

It’s been a fascinating and amazing journey to discover these ‘pockets of life’ and living history – and now that I am outside my realm (of medicine and surgery) one that would have been impossible without the numerous people who have embraced me, and shared their wisdom. (It’s becoming quite the list – and I’ll share it with you all soon.)

But I certainly hope that my future readers enjoy the journey as much as I have.

How’s the book coming?

Posted on August 8, 2012 by K Eckland

I was in the United States most of last week (at my reunion) but I didn’t stop working. While a reunion may not seem like the most ideal situation for a medical writer – it’s actually a great opportunity to talk to people and get their opinions about health care, medicine and surgery. After the first few minutes of catching up – talk naturally turns to everyday life, and for many of us – ‘everyday life’ involves worrying about the health of our families.. Also, many of my classmates – and old friends have been some of my biggest supporters of the blog (and my other work) so it was good to get some critical feedback.

Bret Harte class reunion

The book is coming along – almost continuous writing at this point. While I (always!) want more interviews with more surgeons, I am now at the point where I am filling in some gaps – talking about the city of Mexicali itself. So I am visiting museums, archives, and talking to residents about Mexicali so I can provide a more complete picture to readers. Right now, I would really like some information about 1920’s -30’s Mexicali – I can find a lot of interesting stuff about Tijuana, but Mexicali is proving more elusive.

It’s a bit of a change from my usual research – finding out about decades old scandals (even local haunted houses), visiting restaurants and nightclubs, but it’s been a lot of fun., even if it seems frivolous or silly at times. I hope readers enjoy this glimpse into Mexicali’s rich history as much as I have.

Finished the cover – which to me, is critical at this point. (I use the cover to inspire me when it comes to the less than thrilling stage of copy editing) so I am posting an image here.

cover for the new book

Meeting with an architect later this week – to learn about, and write about some of the variety of styles here in Mexicali. (There is such a surprising array – I thought it would be nice for readers to have a chance to know a bit more.)

Now there’s one house I’ve dubbed “Mexicali’s Graceland.” I don’t know why Graceland comes to mind every time I go past this home (it looks nothing like Elvis’ home in Memphis) but the term has stuck. I am hoping to get some of the history on this house because it just looks like a place where even the walls have stories to tell.

The pictures aren’t the most flattering – but I’ll post one so you can tell me what you think. (It’s actually far more lovely in person – with the contrast between the pink walls and the white scrollwork, as well as some of the more classic design features.) I guess my imagination tends to run away with me – with images of grandeur and elegant ladies sipping champagne in the marbled halls of the past – but then – most of my usual writing is technical in nature, so I have few outlets for my creativity.

Mexicali’s Graceland

Meeting with my co-writer today to go back to the archives..

In the operating room with Dr. Enrique Davalos Ruiz, Neurosurgeon

Posted on July 26, 2012 by K Eckland

Dr. Enrique Davalos Ruiz, Neurosurgeon

Spent the morning in the operating room with Dr. Davalos. As we discussed in a previous post, Dr. Davalos is one of just a few neurosurgeons here in Mexico to specialize in both adult and pediatric neurosurgery procedures. He performs a wide range of procedures such surgery for cerebral tumors, spinal bifida, hydrocephalus, trauma, spinal surgery and epilepsy. But one of the procedures he is best-known for here in Mexicali is the surgical repair of craniosynostosis. However, if you’ve ever watched this intricate procedure – ‘repair’ really isn’t the word that comes to mind to describe the procedure. ‘Rebuild’ is much more appropriate.

Craniosynostosis is a congenital cranial deformity caused by the premature fusion of the cranial sutures. (These sutures allow for the babies head to be slightly compressed during natural childbirth). Many new moms can attest that their neonate’s head was temporarily ‘squashed’ looking at birth, but normalize over the first few days as the bones relax into their natural position. In normal development, these sutures (or ridges where the bones come together) are not yet fused – and fuse over the first few months of life.

When the bones that comprise the skull fuse early, it can result in a significant cranial abnormality. (Luckily, in most cases of [primary] craniosynostosis – the patient’s brain functions normally despite this.)

To treat this surgically, Dr. Davalos had to essentially rebuild part of the skull (the coronal sections of the parietal and frontal bones). He did this by removing and reshaping the skull in separate sections and then rejoining the pieces to conform to a more natural shape. (As a someone who sews, it reminded me of lacing a corset to get curved shaping). In a child of this age – the bones should fuse/ heal within approximately six weeks – with no long term limitations for activities.

Sterility was maintained during the case, and everything proceeded in a rapid and appropriate fashion. Anesthesia was proficient during the case, with excellent hemodynamic stability and oxygenation.

Dr. Davalos beveling a portion of the skull

Dr. Enrique Davalos Ruiz, MD

Pediatric and Adult Neurosurgery specialist

Calle B No 248

entre Av. Reforma and Obregon

Zona Centro

Mexicali, B. C.

In the OR with Dr. Ramos & Talking with Dr. Enrique Davalos Ruiz, Neurosurgeon

Posted on July 20, 2012 by K Eckland

Interesting day today – as I travelled across a wide range of specialties in just a few short blocks. I started out this afternoon in thoracic surgery with the good doc seeing patients in clinic, then off to IMSS to watch a Whipple procedure (pancreatoduodenectomy) with Dr. Gabriel Ramos. (The Whipple procedure would be the ‘open heart’ surgery of the general/ oncology surgery specialty – it’s a complex, complicated and involved procedure – so, naturally, I loved every minute of it!)

Dr. Gabriel Ramos & Dr. Maria Rivera

Some of you will recognize the absolutely delightful Dr. Maria Rivera from one of our pictures last week (on facebook) – in which she was an absolute stunner.

Not an everyday photo – but then that case was pretty breathtaking too – (when I finish writing about it, I will post a link.)

Dr. Elias Garcia Flores, who I met briefly last week was there too.. (Of course, I didn’t recognize him since he had a mask on this time.)

Unfortunately, I couldn’t stay because I had a previous appointment to interview Dr. Enrique Davalos Ruiz, a local neurosurgeon. He turned out to very charming and interesting..

He’s the only neurosurgeon specializing in pediatric and adult neurosurgeon for all of Baja California and Sonora. (I’ll write more about him soon – I am hoping to head to the operating room with him next week.) He’s pretty busy working at IMSS and Hospital General de Mexicali, in addition to private practice but he didn’t seem to mind taking time to talk to me.

Mexicali book: New co-author

Posted on July 19, 2012 by K Eckland

As much as I have adored working with my previous co-author, Dr. Albert Klein, PharmD on two previous editions – it just wasn’t practical for this title. He’s now living and working in North Carolina, whereas – I don’t know when (and if) I’ll be returning to my beloved southern Virginia, which makes this sort of collaboration more difficult. Also, Dr. Klein, (by the nature of his background) is more of an expert on Colombian history, culture and Bogotá life than the rest of Latin America. (I always feel that the best way to get a glimpse of life is through the eyes of those who have lived it.)

But I do want to sincerely thank Albert for everything – (without him, I might not have been brave enough to publish at all!) It’s been a pleasure working with him – both on the books and in the hospital, so hopefully we can collaborate again in the future (Medellin, perhaps?)

In the meantime, I have a new co-author for the latest book, the ‘mini-gem’ guide to Mexicali. While it’s a more breezy style book compared to my other offerings, I still feel very fortunate to have enlisted some local assistance for the sections on culture, Mexicali life and local color. The input has been invaluable for me during the writing process – and will prove to be the same for readers, (I hope!)

I am also hoping to get a few additional contributors for other sections of the book to talk about issues in their respective areas of expertise. (It may be free but that doesn’t mean it shouldn’t be a quality product and a good read.) It’s not a done deal – and it may be difficult due to everyone’s busy schedules etc – but I am hoping it all comes together.

Once I get all of the specifics nailed down – I’ll post more about it here.

The rest of the book is going well – I am probably about 75% complete (and then the dreaded editing process!!) Depending on how horrible editing is – and time limitations – determines whether or not the Mexicali book becomes a e-book. (I find the e-book conversion process endlessly frustrating, particularly for a die-hard fan of footnotes like myself.)

Love, Life and Surgery in Latin America is now Colombian Culture & Cuisine

Category Archives: Mexico