~ Losing Face ~

Boston Medical Center                      Lucille M Iacovelli                    July 2, 2003

History of Present Illness: 53 yr old female pt here to consult previous face-lift surgery and complications with swallowing………………………………. Angelina Jones

Past History: Long standing history of neck “tightness” inability to move neck well, breathing difficulties swallowing difficulties, ear pain, tinnitus. Partially relieved by pulling forcefully up on neck skin and under angle of mandible

Constitutional: Reports change in energy level. Depressed, not pursuing Yoga/exercise because of neck concerns

Ears/Nose/Throat/Mouth:  Reports otalgia/earache, tinnitus/ringing in ears, globus sensation, dysphonia/hoarseness, difficulty/trouble swallowing.
Neck:  c/o abnormal “tightness”
Respiratory: Reports dyspnea, shortness of breath, trouble breathing.
Musculoskeletal:  Reports muscle aches, muscle cramps. Neck muscle tightness
Integumentary:  scarring of skin and underlying SMAS subjectively
Psychiatric:  Reports depression, excessive stress, fatigue.
Chronic Pain Assessment:
Do you experience Chronic Pain? Yes
Location of Pain:  ears, neck
Duration of Pain: Constant   -  Type: Pressure, Cramping
Physical Exam:
General: frail appearing, depressed, tearful
Eyes: sip blepharoplasty
Head and Face:        Comments: sip facelift with preauricular and postauricular incisions
External Ears: normal
Otoscopic Exam - Bilateral: Normal external auditory canal bilaterally         Skin: Comments: moderate laxity of facial/neck skin.

Assessment

Impression:   pt with chronic neck/tongue base/jaw problems after secondary facelift surgery. Very tearful and sad today. Has asked if I would be willing to “dissect” her body if she donated herself to science after her death. No real anatomic abnormality noted to help explain her symptoms.

Plan:   I have reassured Ms. Iacovelli that there is nothing tangible upon which I can operate or recommend other forms of tx  [treatment] to address her symptoms. I have advised her to consider seeking an opinion(s) from physical therapy and/or alternative medicine (acupuncture etc) to determine if any non-surgical maneuvers might help with her symptoms.

Signed by Raffi DerSarkissian MD (4901) on 07/02/2003 at 6:03 PM
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This is  a change of tune from his initial report in April 2002. He also had the report from my ENT doc regarding the abnormal findings from the first  MBS (modified barium swallow) study performed in May 2003. My ENT encouraged me to return to Dr. der-Sarkissian because he felt this study was a significant finding.  The second MBS in December 2003 was also sent to Dr. D.  This study indicates the tension in the platysma muscle is the cause of my swallowing problems.  Dr. D ignored this study as well.

Any doctor can claim they did not find any anatomical abnormality when they purposefully avoid performing an adequate physical examination and diagnostics appropriate to the patient’s problem. Before my MBS studies, I was told I  only felt as if I could not swallow.  I was told the same thing about breathing.. that I only felt as if I could not breathe.  Yet my  PFT (pulmonary function test) indicates an airway obstruction above the larynx. The diagnosis of positional airway obstruction by my pulmonologist indicated the problem was related to my surgery.  This, too was IGNORED.