Posts by Jesse Sanchez90

Elizabeth Fox57 said:Betty Edwards22 — what does paying a private doctor out of pocket have to do with Medicare? I honestly don't see how I've "taken" anything from anyone by paying for private care, so I'm not quite sure who I'm supposed to be feeling sorry for here.

If you look at which post I'm actually responding to, you'll see I was addressing your point about ignoring shame and things like that, which feels even more morally questionable to me. I’m not one to go around calling people out, but if someone pulls my leg, I think it's perfectly fine to speak my mind and share my perspective.

It’s always easy to play the perfectionist when you're talking about taxpayers. A full septorhinoplasty isn't going to cost anything less just because Medicare picks up the tab. You take from one side and add to the other—the federal budget isn't some magic trick where money appears out of thin air or disappears into nothingness. It's not really about shame, though; it's more about having a little empathy for everyone else involved.

Michael Cruz9 said:When you guys talk about "cosmetic" aspects included in the surgery, are you referring to major changes to the shape and appearance of the nose, or does that also cover the bump caused by the initial fracture that started all this?
To be more specific, if the fracture led to breathing issues later on, and a small bump formed where the bone healed, would removing that bump be part of the procedure, or is that strictly considered cosmetic?

Actually, that kind of nasal kyphosis is a direct result of the trauma, and since it’s causing functional breathing difficulties, it can often be covered by insurance like Blue Cross Blue Shield. In cases like this, the primary issue is the impaired breathing—which is a legitimate medical concern—making it a clear indication for a full septorhinoplasty.

wanderingmason86 said:Thanks for the correction.

As for everything else, I actually have a little something to say about that. I have several specialist doctors in my family, so I know more than a little bit about how our medical system works—and it isn't just some "marketplace." It absolutely is a marketplace, just like pretty much everything else in this country. It’s just hidden from view, maybe for now, at least for you. You'll see. 😉

Anyway, I wanted to write this sooner, but the timing wasn't right... I was reading through your previous replies and, since I'm a bit older than you and—according to my psych tests—fairly intelligent, I'm going to take the liberty of giving you some well-meaning advice (I don't mean to be hurtful):

A great doctor isn't someone who acts like a walking medical encyclopedia, occasionally dropping knowledge in the form of sarcastic ego trips. Medicine is a bit more—or at least it ought to be more—than your perception of a "marketplace," or rather, a simple buyer-seller relationship (doctor vs. patient). You're young, yet you're already acting like a burnt-out professor who's seen it all and knows it all, as if that gives you the right to look down on ordinary, "worthless" mortals. Come back down to earth; anyone who has ever studied anything for even a second has been burned by that illusion of omnipotence—the idea that having knowledge somehow lifts you above the masses of average people. Slowly, the excitement will fade, and that cloud of idealism will burst. Don't let yourself be fooled; the day will come when you're treating patients like they're on an assembly line, and you'll be dying of boredom. What I'm trying to say is: don't be arrogant. Try your hardest to delay that day as long as possible because, believe me, it'll be better for both you and your patients.

Now, back to the topic...

Here is a specific challenge for you:
How can I get in touch with a doctor from the ENT department at Mount Sinai (I'll tell you the name if you're feeling generous)? A silly question, right? It's not!

During my two-minute exam, I didn't have time to discuss a very important issue—one that my decision regarding surgery depends on. Specifically, if I go through with the surgery, there is a chance I might end up with an iatrogenic version of atrophic rhinitis (I believe you've studied secondary atrophic rhinitis). On the other hand, if I don't go through with the surgery, it's a certainty that I'll be breathing through my throat for the rest of my life (that's a joke, I know people don't breathe through their throats 😉).

So... because I don't want to regret my nose or the surgery later, I'd really like to have a quick chat with the surgeon performing the procedure about one specific thing—just man to man, not like a pilgrim talking to God.
How can I pull this off without needing a new referral for an exam I've already completed, and without waiting another few months? They won't give me a phone number, I don't have an email, and I'm certainly not going to barge into the clinic like I'm a specialist myself.

Come on, please, be a sweetheart and help me out—it turns out I'm actually better at navigating the "marketplace" than I thought. 🙄

You can reach any doctor if you've got blue blood in your veins. Just show up and ask for the doctor who examined you; everyone has their good days in the clinic. As for the gods, I don't know much more than that.

coppertrucker13 said:To be totally honest, I don't mind paying more—I'll find a way to scrape the money together—but my real worry is whether everything will go smoothly. I just want to know there won't be complications and that the results will actually be what I'm hoping for.

Wait, seriously?!?!?!

P.S. The hump on my nose is actually from a fall I had when I was a kid, so maybe I could just head over to my primary care Doctor and tell her I'm struggling with mental health issues (like constant worrying, depression, feeling dissatisfied with myself, etc.). Maybe then she could give me a referral... I'm not sure if surgeries can be covered by Medicare or if there's any way to lower the cost.

So, if someone says money isn't an issue, they just "somehow" manage to save up??? That doesn't quite add up to me.

If those breaks are post-traumatic, you have every right to deal with breathing difficulties, and those should be covered by Medicare.

Betty Thompson45 said:I know I can't get a super narrow nose, but honestly, even the width isn't the main issue—it's more about the tip being way too large and my nasal bone looking uneven, where one side is flat while the other is just this bumpy, pitted mess. Since I have a pretty narrow face, I feel like my nose basically takes up half of it right now. 😁
Plus, if the light hits that bumpy side a certain way, it looks like my nose was snapped in two! 😲

Do you happen to know roughly what the prices are at Zambell's practice?

It sounds like you need to reduce the alar cartilages—an open septorhinoplasty would be the way to go.

wanderingmason86 said:Since nail color acts as an indicator of oxygen levels—meaning the color will shift if oxygen concentration in your body drops—it’s actually a great thing to keep an eye on.

Man, if only medicine were handled as casually as buying salad at a farmer's market...
If you actually hit a drop like that, you'd be in serious trouble...

Basically, the sensor just clips right onto your fingertip. Though, technically, you're introducing microbes into the mix when you handle the components—which isn't ideal, theoretically speaking.

Usually, it’s about 45 minutes after they get you under anesthesia, but honestly, it really just depends on what specific procedure they've decided to perform.

The nasal tip falls under the category of - septoplasty.

Elizabeth Fox57 said:Wait, what do you mean???

There’s one really straightforward, plain old reason for this that I bet will never even cross your mind.😂

restlessfox29 said:I don't want to write a whole novel here... but basically, I definitely have a deviated septum. My doctor mentioned that if it isn't causing me major issues, they wouldn't even touch it because, in most cases, the deviation just comes right back after a while. So, my question is: is that actually true? Has anyone else here dealt with a recurrence after surgery?
I mean, it’s not like it bothers me constantly—I've gotten used to it—but I can't tell if it's linked to the deviation. It feels like one nostril is always swollen on the inside; if it isn't the left side, then it's the right, and vice versa. It honestly feels like having tonsillitis inside my nose, leaving barely any room for air to pass through.🤷 ..

It’ll come back if the procedure isn't performed perfectly.

2. Are you dealing with allergies or chronic rhino-sinus issues? Either way, try sticking to a daily routine of rinsing your nose with saline solution three times a day, plus using Rhinocort Aqua Spray with two sprays on each side. Be consistent with it! That way, you'll be able to figure out how much of this is due to the physical deformity versus how much is just caused by hyper-reactive nasal lining.

Elizabeth Fox57 said:Me? Oh, nothing at all, I'm just asking because you clearly know a ton about this stuff.

It's not because of that... 😉

Elizabeth Fox57 said:@ Betty Edwards22 - did you have surgery too???

Wait, did I?

Everyone's got an opinion lately...😉

Alexander Mendoza21 said:I'm really curious about what the diet looks like after surgery—can you actually eat normally?

Honestly, I’d hate to lose 😁 this little bit of weight I managed to put on. Is it okay to eat things like chicken or other solid foods, rather than just being stuck with boring, tasteless soups all day?

Unless you're planning on stuffing your face constantly, I don't really see the issue with your question.)😉

Donna Johnson16 said:I’m not questioning your absolute expertise here—honestly, props to you, you know WAY more about nose surgeries than I ever will (and I’m being serious, not sarcastic).

But, can we try to get back to the spirit of this forum, where everyone actually gets a say? This isn't your private sandbox, sorry. You have to let other people participate too.

And just so we're clear, I didn't twist a single word of your posts when quoting them. Using Heparin cream on the face for massages after a nose job isn't "widespread," nor is it some crazy, unheard-of, dangerous, or expensive thing.

If I offer a specific piece of advice to someone asking a question, and you disagree with it, if we want us all to actually benefit and learn something together, you could just say something like:

- "Hey, don't use that cream for more than a week, and only apply it to the fatty areas under the eyes."

- Or: "Don't use that cream at all; you might as well just use... margarine, whatever."

- Or: "Maybe try this other method so the guy can speed up his recovery before he heads off to college."

- Or you could just think to yourself, "Wow, look at the nonsense people post here; now this guy is going to rub this on his breakfast toast for the next two years and poison himself because silly old Donna Johnson16 wasn't clear enough," and then just stay quiet.

Anything else doesn't help anyone.

...

Ha, listen—stubbornly defending your own ignorance is one thing, and honestly, it doesn't bother me personally, but when you start giving advice that could be potentially dangerous, that's a problem. Like Lao Tzu said: He who knows does not speak, and he who speaks does not know—watch out, because that's dangerous!

If you had just stuck to what you started with—natural massage techniques without messing around with pharmacological agents—we wouldn't even be having this long conversation. But your stubbornness in the wrong direction has led you down a very avoidable path.

Second, don't act sweet to my face only to stab me in the back. Being "superior" has nothing to do with this; we aren't talking about playground hierarchies here, we're talking about health. Don't play the martyr.
Until you realize there’s a reason why you need qualifications—or at least the decency to listen when someone corrects you (first out of kindness, and then when they have to call you out)—you're going to struggle. It's like walking up to a cop on the street and saying, "Look, I know you went to academy and all, but bear with me while I cross this busy intersection illegally right in front of you"—just because it's *your* little playground. That's dangerous. It's relative, sure, but you know when was the last time someone...

Applying Heparin cream is NOT harmless, and I'm sure you won't find some random blog post online to tell you otherwise. You're insisting on your own ignorance by downplaying the effects of various substances (whose functions you don't even understand)—and you sleep just fine.
Personally, I'd be pretty worried about my own psychological profile.

So, do us all a favor and just pick an option:
a) "I'm sorry, I didn't mean to: my mistake, etc."

b) "I don't take responsibility; I take medicine and health lightly, so I don't really care about you guys."

As for me, dealing with you would be quite a chore, so expect more corrections if you keep insisting on amateur interpretations or twisting actual scientific knowledge (not mine, but established science).

Au revoir... 😍

Donna Johnson16 said:This has been going on long enough. Please, just take a second to re-read what I actually wrote. Do you honestly think the specific approach I’m suggesting could somehow hinder the recovery process?

...

Look, I specifically said that applying Heparin over large areas isn't recommended, which is exactly why I asked you to be more precise about what is being applied and how.
Instead of clarifying, you seem more interested in twisting my words.
Hypothetically speaking—and considering the physiological mechanism here, which seems to be escaping your understanding—applying it to much larger surface areas could potentially cause issues.

As for those Tanak massages, the instructions are perfectly clear and leave no room for doubt: just use a standard moisturizer.

Donna Johnson16 said:Yes, thanks for confirming. My original question was actually focused on speeding up the recovery from bruising and swelling, purely for aesthetic reasons.

...

On the contrary—I’m not "confirming" anything; I’m just pointing out how much you clearly don't understand this subject.

You still aren't getting it—you don't apply heparin to your nose.
There isn't any bruising there to fix, and heparin isn't going to do anything for swelling in that area.

So, please, stop messing around with medical advice when you don't even grasp how it works.

Donna Johnson16 said:😍 Or else...? Thanks so much for this opportunity!

Hey moderators, sorry if this feels a bit off-topic! I just figured that if anyone here is genuinely curious about whether Heparin cream actually does anything, we could just dive into the biochemistry or pharmacology side of things. If you want to get into the nitty-gritty details like molecular weights and all that technical stuff, there’s plenty of data available in various medical PDFs out there to fuel the discussion!

Topical heparins for treating vascular issues: a deep dive.
Old C, Frisinghelli A. source
Source
The Vascular Rehabilitation Center at Passirana Hospital, located in Garbagnate Milanese within the greater Milan area, Italy. cesarevecchio@fastwebnet.it

Abstract Effective treatment of peripheral vascular disorders is important not only for resolution of local symptoms but also for preventing the development of systemic conditions such as Deep Vein Thrombosis. Topical heparins are widely used in Europe for the prevention and treatment of local symptoms associated with peripheral vascular disorders. This comprehensive review of the literature evaluated the efficacy and safety of topically applied heparins for the treatment of vascular disorders.

When you're dealing with peripheral vascular issues, getting the treatment right isn't just about fixing the immediate discomfort—it’s about playing defense against much bigger systemic problems, like Deep Vein Thrombosis. It turns out that using topical heparins is actually quite common in many parts of the world for managing those localized symptoms. I was recently looking into a comprehensive review of the literature that took a deep dive into how safe and effective these topical applications really are for vascular disorders. The scope of this review was pretty impressive: they looked at 20 different studies involving a total of 1,055 patients. These studies compared various topical heparin formulations against placebos, no treatment at all, subcutaneous injections, or even pitted them against one another to see which worked best for things like superficial thrombophlebitis or venous insufficiency. Here is the breakdown of what they found: First off, when it comes to easing the signs and symptoms of superficial thrombophlebitis, the 1000 IU/g heparin gels (like Lioton 1000 or Menaven 1000) were significantly more effective than a placebo. Interestingly, the liposomal heparin gel at 2400 IU/g (LipoHep Forte) performed just as well as subcutaneous low-molecular-weight heparin when it came to relieving those local symptoms of superficial venous thrombosis. That’s actually quite encouraging! When researchers did head-to-head comparisons between different topical brands, almost all of them showed effectiveness. However, the 1000 IU/g heparin gel really stood out as being superior to heparinoid mucopolysaccharide creams (like Hirudoid) for helping patients deal with spontaneous pain, pain triggered by movement, swelling, and that heavy feeling in the limbs. Another study also pointed out that the 1000 IU/g gel outperformed a formulation containing a lower dose of heparin (100 IU/g) mixed with aescinate and essential phospholipids (like Essaven). On the safety side, everything seemed to go smoothly. The treatments were generally well-tolerated, with very few reports of skin irritation or local reactions. To wrap it all up, topical heparin preparations seem to be a really useful tool for relieving vascular symptoms and helping to improve microcirculation. There is a strong suggestion in the data that the 1000 IU/g heparin gel might have the edge over other topical options, likely because it carries a higher concentration of heparin. Of course, we still need some larger, more strictly controlled clinical trials to confirm these findings definitively, but it looks very promising!

Here's the full study at this link: I was just digging through some medical literature on PubMed and stumbled upon this study regarding how we handle peripheral vascular issues. It’s actually a pretty fascinating read if you're interested in the science behind it! The abstract basically highlights why treating these vascular problems effectively is such a big deal. It isn't just about fixing the immediate, localized symptoms that people feel; it's also a critical step in preventing much more serious systemic complications, like Deep Vein Thrombosis. It also mentions how topical Heparin is a go-to method used across various parts of the world to manage those local symptoms associated with vascular disorders. This particular review was a deep dive into the existing literature to really nail down just how safe and effective applying Heparin topically actually is when you're trying to treat these types of vascular issues. It's always interesting to see how these clinical reviews consolidate everything we know to make sure treatments are actually doing what they claim to do!

...

Actually, I’d argue the exact opposite! If you're going to go out of your way to recommend something here, you really ought to back it up with some solid reasoning. Otherwise, it shouldn't be labeled as off-topic material.

That's great!
You still haven't explained the actual mechanism behind it, which tells me you don't quite have a full handle on the subject matter yet.

So, what you're really saying is:
When you see researchers toss out a phrase like "may be" in their conclusions, it’s usually a bit of a red flag in academic circles. It often feels like they're just hoping to eventually prove a point, especially when there isn't a single shred of hard data in the abstract to back it up. Without any actual computer-generated data or solid evidence presented, the whole thing essentially boils down to nothing more than a hypothetical guess that hasn't even been statistically validated.

I don't really feel like listing everything out, but the text clearly explains that it’s meant to treat superficial thrombophlebitis—where the leg swelling is actually a byproduct of poor circulation. At no point does it suggest that Heparin directly reduces swelling caused by other issues stemming from tissue damage rather than thrombophlebitis itself.
The kind of swelling you get after nasal reconstruction isn't what they're talking about here.

Do you think you could just stop nitpicking for a second and realize that Heparin gel is prescribed in rhinological cases exclusively during full septorhinoplasty? In those procedures, the osteotomies performed can lead to hematomas or blood clots that the body eventually breaks down on its own over a longer period—it's used mainly for purely aesthetic reasons. If that doesn't make sense to you, maybe it's best to step back from debating pharmacological recommendations, which are handled by professionals for a very good reason.

Donna Johnson16 said:Hey @Betty Edwards22/">@@Betty Edwards22 - honestly, Google is your best friend here!

...

Look, I’m asking you nicely to please explain yourself here publicly. I want to understand what exactly you're trying to achieve with this, because I am honestly convinced that you either haven't realized you made a mistake, or you're just typing things out incorrectly and thinking they mean something else entirely. I’m giving you one more chance to either clarify your position or set the record straight.

So, how exactly does Heparin work to take down that swelling? 🙂
Mechanism.