AMY

[Guest guest]

Im so confused! It says theres no airport in Delano. How do people

> get there?!?!!??!!?? If you took/take a plane, where do you get

off

> at?!?!??! AND, how do you get from there to Dr.Keshishian?!?!?!?

=================================

Amy

Sorry it took me so long to answer this but I was waiting for

comfirmation from the office that the service was still being

provided.

You have already been told that you can fly into LA, Bakersfield,

Fresno and rent a car, then drive the rest of the way into Delano.

Bakersfield is about 30 min. from Delano. LA and Fresno are around

the 2 1/2 hour time frame from Delano...Fresno being a little closer

and does not have the traffic jam problems.

An option that is available for patients coming for SURGERY, NOT for

INITIAL visits, is a free of charge limo. The limo will pick you up

from the airport and take you to Delano. When your ready to fly back

home it will take you back to the airport. If patients need

transportation at other times Ed Berreth will provide it at a very

reasonable cost. His number is . He is also the one

that rents the recliners out.

As for your other questions about having someone with you for

surgery. You don't NEED someone with you BEFORE surgery or DURING

your hospital stay....BUT you DO need someone for the week after.

It just isn't safe to send you home (to the hotel) alone. I know it

can be really hard to find someone to take that much time to come

sit with you. If you have someone stay with you while your IN the

hospital they are provided a bed and three meals a day. This really

helps because you don't have to pay for a hotel and food during this

time.

Hope this helps answer some of your questions

Jo

[Guest guest]

In a message dated 9/13/2004 1:44:15 AM Central Standard Time,

amycakes04@... writes:

And as for my nose ring, even though theres the ENTIRE opening

because the " bar " thing curves on the roof of my nose, why would i

have to take it out when i can just have the naso-whatever-its-

called tube going in through my OTHER nostril? My left nostril is

pierced. Not my right. ANd i have questions. Why would i need to

take my earings out? When you go into surgery, dont you wear that

blue hat thing? Why cant i just cover my ears too? I just dont

understand.....

~Amy

__________________________________________________

Amy Honey,

Noone's trying to say your weird. Noone is trying to say anything bad about

you. I'm a nurse and Marta is a doc and may know more about local hospital

rules than I do. I just know what goes on around here.

I have read a lot the last few days about this. I have also read a lot of

people's opinions where they feel like they are being persecuted for thier

choices. This isn't about the jewelry, it is about saftey ....Yours and the

people taking care of you. There is a chance that Dr. K might say leave it is

and

then the hospital say get it out. People are trying to prepare you for

what " might " or more accurately " likely " to happen. Wouldn't you rather be

prepared

and then not have the shock of having to do it last minute when your not

prepared? you have the choice to say no. But then again The doc has the choice

like

with jo's SIL to say No also.

I will try to explain what I have learned the last few days from the

annesthesia links and journals and a few other sites.Maybe this will help you

understand why this might be a problem.

The surgeon frequently uses a cautery machine to stop bleeding. If this

machine arcs with metal then it can cause severe burns. Electrical type burns.

Think touching ghe positive and negattive posts of a battery. Have you ever

seen a battery arc? Same thing on a smaller area. It is a liability issue where

the machine's manufacturers says to remove all jewelry. If you don't and you

get burned, Lawsuit city. Some people in the past have been allowed to leave

them in after signing in a waiver if the area affected isn't to be used.

Once again, Your going to have a rather good sized tube(think pencil) in

your nose post op for a few days. This tube is to remove old blood acid and

all the yucky from your tummy and allow it to heal and not stretch out or get

distended and possibly pull sutures lose. You will need the NGT for your safety.

They will have a tube down your throat while your asleep. It is an

endotracheal intubation. The biggest problem her is snagging the jewelry on the

tongue and ripping your tongue...Wer're talking split it if it's hung up good.

The

annesthesia person isn't going to want ANYTHING in the way of the tube. An

obese person is hard enough to intubate, without anything causing problems.

As for the nose ring. Yes you have 2 sides. But I have inserted hundreds

of them. Do you know how often I have had to pull out and go down the other

side because of septal problems and things that just wont go?

The ears are not an infections source it is due to the burn potential.

Plus Somewhere somehow someone has had an earring lost in linnens. Do you know

how often that happens? even with studs? Change a bed and then find all kinds

of things. The other risk with the ears is snagging them accidently and ripping

the earlobe. Even studs can hang on stuff. I have had patients coming from

the ER slide to bed and have rings, Earrings and other stuff get caught on my

Skin and scratch it. Do you know how much paperwork is involved with a little

scratch? Not to mention Hiv and hepatitis testing.

Back to the nose and the tongue. This is an aspiration(Choking) risk. The

balls of the tongue ring can work loose, Not very often, but somewhere

somehow it has happened. And the nose ring can get loose. You sure don't need

any

unexpected metal objects sucked down your windpipe, you lungs or anywhere else

they might come lose.

Frequently (VERY) there is swelling after surgery. If the tongue ring

becomes imbedded in the tissues, Then circulation to parts of the tongue could

be

cut off. Can you see the docs and nurses in an emergency trying to take all

the body jewelry off before any lifesaving measures can happen? How many people

do you think could take it out if your unconcious in the OR and it has to be?

One survey of 28 docs showed only 6 of them knew how, several wanted to " cut

it out " .....I knew better than this...LOL

Then if there is trouble needing an MRI or XRAY then the jewelry can

affect or interferre with the pictures. One site speaking of this talked about a

non magnetic place keeper that is able to be seen on xrays. Is this a

possibility?

Amy, I have tried to explain the possible reasoning that might be used.. If

you have any more questions ask. I think I pretty much explained what might be

said. I'm sure I missed some things.

AGAIN...DR.K and the hospital have the final word. No one here can say

what will be said, just us who have an idea how the rules go in these

situations, can suggest the possible outcome. I sat here 2 years ago and

listened to

another of Dr. K's patients cry on my shoulder about having to remove her tongue

ring and her belly button ring. i looked for her post and never could find it.

I knew what happened in this case, And think you should be prepeared incase

he says no. Please let me know if this helps you understand....

Here is a few of the sites and articles I read. Maybe they will help......

Question: Recently, we have seen more patients coming into our surgery center

with various pieces of jewelry in various parts of their body. Our policy

states that patients must remove all jewelry before surgery, but we are

encountering a lot of resistance from these patients. They claim that the body

piercing

is permanent and the jewelry cannot be removed. Others claim that it will be

too painful to remove and then reinsert the jewelry. Should we continue to

maintain a policy of having patients remove all jewelry before surgery, or

should

we accommodate these patients with some other policy?

Answer: Your policy for removing jewelry should be maintained. In addition to

the possibility of injury should the patient's jewelry become trapped in some

portion of the drape or on the OR bed itself, there is the possibility the

patient will be burned if the electrosurgical unit (ESU) is used.

Electrosurgical units with ground-referenced generators may seek alternate paths

to ground

through the patient's jewelry. Newer models of ESUs have isolated generators

that eliminate the occurrence of alternate-site tissue burns, but many health

care facilities across the country still use ESUs with ground-referenced

generators. Manufacturers of electrosurgery systems continue to advocate for

removal

of all jewelry.

Most body jewelry is removable, and many of the jewelry items work on a

threading principle. In some cases, ring spreaders and closers are needed to

remove

the jewelry. If you are dealing with this specific type of ring, you may want

to purchase ring spreaders and closers in an assortment of sizes for your

facility. Using a cutting tool to cut the rings off is not recommended. By

consulting a body-piercing establishment and becoming familiar with various

types of

body jewelry, you can be prepared for any jewelry you encounter on patients

who come to your facility for surgery.

Some health care facilities have written policies that state surgical

procedures will be cancelled if jewelry is not removed. You may want to include

a

question about body piercing in your telephone preoperative interview and inform

patients that they are responsible for having the jewelry removed before the

date of surgery. Patients have the option of removing the jewelry themselves or

returning to the body-piercing establishment to have the jewelry temporarily

removed. If you do not conduct a telephone preoperative interview, educate the

physician's office staff members to discuss jewelry removal with the patient

before scheduling the surgery. Be sure to verify with the scheduling person in

the physician's office that the jewelry issue is resolved before the

procedure is scheduled.

In an emergency situation, anesthesia care providers and surgeons may choose

to remove the jewelry after the patient has been induced and replace it before

the patient emerges from the effects of the anesthetic agent. Of course, the

necessary tools for removal and reinsertion of the jewelry need to be

available.

QUESTION 3:

What do you do about body jewelry? I've always had patients remove tongue

rings and nose rings because they're in our field. But patients frequently

object

strongly to eyebrow rings and naval rings being removed. Historically, we've

always said electrocautery and burns are an issue. But is this really true?

-- From S. Rapkin, M.D., Richmond Heights, OH

REPLY:

This is an increasingly common problem. Our head of ambulatory anesthesia,

Dr. Sivashankaran, does not think that electrocautery-induced burns are an

issue. Another colleague, Dr. Mark Boswell, notes that the risk of a burn

applies

only to electrocautery applied " near " the jewelry. He suggests that the

decision about removal be left to the surgeon and that this be documented. Dr.

Boswell also says that tongue jewelry should come out.

It appears that there are at least 3 distinct problems here. Firstly, there

is the risk of tissue burn. Jewelry may provide an alternate path to ground for

electrocautery units. Although newer units have ground-referenced generators

that should prevent burns, manufacturers of electrosurgery systems continue to

advocate for removal of all jewelry. Certainly, if jewelry is to be retained,

electrocautery should not be used in close proximity. Secondly, there is the

risk that jewelry may become snagged on bedding or other items, causing damage

to tissue or to the jewelry itself. Third, oral jewelry and piercings can

impede airway management - there seems to be a consensus that these decorations

should be removed before surgery.

It would be interesting to know what the policy is in different institutions.

-- From Kantor, M.D., Cleveland, OH

Body Piercing Causing

Trouble For Doctors

By Reaney

http://dailynews.yahoo.com/h/nm/19991026/sc/health_bodypiercing_2.html

10-26-99

LONDON (Reuters) - Body piercing may be a fashion statement for some but the

studs and rings in tongues, navels, eyebrows and more private parts are

causing problems for British doctors -- they don't know how to remove them.

``Doctors have very little idea about how to take these wretched things off

or how to do anything about them unless the doctor has one himself,'' Dr Rakesh

Khanna told Reuters.

The emergency room physician at Manor Hospital in the central English city of

Birmingham said it is not a problem doctors encounter every day but that when

it does occur many are helpless to remove the jewelry, particularly if the

patient is unconscious.

``It is a problem doctors have to deal with,'' he said.

In a study in the Journal of Accident and Emergency Medicine, Khanna and his

colleagues said only six of 28 emergency room doctors they questioned knew how

to open the most common types of body piercing jewelry.

These include the barbell stud used in the lip, tongue and male and female

genitalia, the labret stud found most often in the nose, navel and eyebrow and

the captive bead which resembles a loop earring.

``If you know how to do it, it's no problem at all. It's just a question of

unscrewing something. The problem is if you don't you may spend an hour of your

time trying to get it out,'' said Khanna.

Doctors often have to remove the jewelry when bleeding, swelling or an

infection develops, or when patients have to be treated for other medical

conditions

or emergencies.

Tongue piercing can be particularly troublesome for X-rays of the head

because the stud or ring can get in the way. Body piercing jewelry also has to

be

removed for whole body or brain scans.

Infections resulting from piercing could lead to blood poisoning, although

Khanna said he has found no reports of deaths due to body piercing in medical

studies.

``Even a small infection can lead to blood poisoning,'' he told Reuters.

People with congenital heart diseases may also develop

in Bama

Web site- http://hometown.aol.com/mdl1031/

[Guest guest]

NO. Its just a solid barbell. Its so big because i keep buying

bigger barbells and sticking it through(stretching it). Its just a

myth that people with their tongue pierced talk funny. I talk

exactly like ive always talked. ABSOLUTLY nothing different about

it. Just because its there on your tongue doesnt mean theres a lisp

or whatever everyone's thinking. Tongue piercings do NOT hurt when

you first get it pierced. Just because SOUNDS werid and painful

doesnt mean it acually is. I didnt even feel it go through. When

people use to tell me that,i thought they were just trying to act

all macho and tough, but you really barely feel anything.I eat

exactly the same. Nothing different about that either. I wanted it

pierced because i LOVE the way it looks. I did NOT get for

nasty " sexual " purposes like every older person thinks. I just love

how it looks. I love it being there. Its a part of me. I just love

it!!! Im trying to think of anything i can do besides taking it out.

And as for my nose ring, even though theres the ENTIRE opening

because the " bar " thing curves on the roof of my nose, why would i

have to take it out when i can just have the naso-whatever-its-

called tube going in through my OTHER nostril? My left nostril is

pierced. Not my right. ANd i have questions. Why would i need to

take my earings out? When you go into surgery, dont you wear that

blue hat thing? Why cant i just cover my ears too? I just dont

understand.....

~Amy

> Amy

>

> If I understand correctly, your tongue piercing is not the

> standard. But rather you have worked to enlarge the hole. Does

> this look like the ears with the large holes? Or is the device in

> your tongue solid?

>

> How about educating me, this whole thing is beyond my safe boring

> little world. Tell me all about it...did it hurt, how do you

expand

> it, does it change the way you talk, eat...why did you want it?

I'm

> not judging but truely wish to understand something and someone

that

> is beyond my little world.

>

> I hope that you and Dr. K can work something out that is " safe "

for

> you, yet disrupts the efforts you have put into your piercings as

> little as possible.

>

> Good luck at your consult!

> Jo

[Guest guest]

Amy,

Have to warn you, this may not be the nicest of replies... I can't

believe you're going to sit there and b*tch and moan about having to

remove your piercings in order to improve your health. People all

over the world would give their right arm to have this surgery.

Hell I self paid $25,500 because my insurance wouldn't pay. That's

how much having this surgery meant to me. I have my nose pierced

and my ears pierced. I removed all of them in the morning, before I

went to the hospital. If your tongue ring is more important to you

than saving your life, then maybe you don't deserve to be approved

by your insurance company and maybe you don't deserve to have this

surgery at all. Like others have said.. you need to get your

priorities straight girl. Tongue ring (which can be RE-pierced and

re-stretched) or life saving procedure (which you may never get

another opportunity at getting approved by insurance)... take your

pick.

Sincerely,

> > Amy

> >

> > If I understand correctly, your tongue piercing is not the

> > standard. But rather you have worked to enlarge the hole. Does

> > this look like the ears with the large holes? Or is the device

in

> > your tongue solid?

> >

> > How about educating me, this whole thing is beyond my safe

boring

> > little world. Tell me all about it...did it hurt, how do you

> expand

> > it, does it change the way you talk, eat...why did you want it?

> I'm

> > not judging but truely wish to understand something and someone

> that

> > is beyond my little world.

> >

> > I hope that you and Dr. K can work something out that is " safe "

> for

> > you, yet disrupts the efforts you have put into your piercings

as

> > little as possible.

> >

> > Good luck at your consult!

> > Jo

[Guest guest]

Dont sit there thinking your all cool just because you THINK you can

talk to me like that. I think YOU need to get your priorities

straight, and YOU need to stop b*tching and moaning in your little

opinions because it doesnt matter anyways.....

~Amy

> > > Amy

> > >

> > > If I understand correctly, your tongue piercing is not the

> > > standard. But rather you have worked to enlarge the hole.

Does

> > > this look like the ears with the large holes? Or is the

device

> in

> > > your tongue solid?

> > >

> > > How about educating me, this whole thing is beyond my safe

> boring

> > > little world. Tell me all about it...did it hurt, how do you

> > expand

> > > it, does it change the way you talk, eat...why did you want

it?

> > I'm

> > > not judging but truely wish to understand something and

someone

> > that

> > > is beyond my little world.

> > >

> > > I hope that you and Dr. K can work something out that

is " safe "

> > for

> > > you, yet disrupts the efforts you have put into your piercings

> as

> > > little as possible.

> > >

> > > Good luck at your consult!

> > > Jo