My Physician Assistant (PA) Elective experience with Dr. Bryan Michelow

The past six weeks spent with Dr. Michelow and his staff has been an absolute blessing.

I had the pleasure of meeting and assisting Dr. Michelow on my General Surgery rotation earlier in the year and had such a pleasant experience that I was elated to have the opportunity to do my elective with him in Plastic Surgery. Not only is he a fabulous surgeon and teacher, but he is a wonderful person.  He takes an interest in each and every person he comes in contact with and is never too busy to lend a helping hand.

I have learned so much throughout this elective rotation.  I was encouraged to think abstractly and apply my knowledge and skills while in the office and in the operating room.  I was given the chance to assist on the majority of the cases that were encountered during my time here including: skin grafting, skin cancer excisions, panniculectomy, blepharoplasty, breast augmentation, mastopexy, incision and drainage, breast reduction, and various hand surgeries.

In addition to assisting in surgery and seeing patients in the office, Dr. Michelow took me to a conference on Pediatric Emergency Medicine, and arranged for me to take a private suturing class.  I was also able to attend his monthly hand clinic and gain insight into the management of debilitating hand injuries.

I am so thankful to have had this opportunity and to have met such wonderful people.  The information and skills that I have learned here are invaluable.  I have no doubt that my experiences here have given me perspective and have solidified my interest in the extraordinary and challenging world of surgery.

Thank you Dr. Michelow, Cheryl, Roxanne, Andrea, and Jill for such a welcoming and rewarding experience!

Alexandra Messmer
Physician Assistant Student – University of Findlay

Calciphylaxis - an unusual but interesting condition

During my elective rotation at Dr. Michelow’s office, I was able to see a large amount of patients with a vast array of conditions.

One particular case that sparked my attention was a woman with presumed calciphylaxis of the lower abdomen. I was so intrigued by this condition that I decided to do my end of rotation presentation on calciphylaxis. 

Here is what I found:

Calciphylaxis is a condition where calcium is deposited in the subcutaneous and cutaneous tissue, as well as in the vessel walls. The continued calcification leads to vascular occlusion which impedes blood flow and ultimately leads to necrosis of the tissue. 

The exact etiology of calciphylaxis is unknown, however there are many risk factors that predispose a patient to this condition. The most noteable risk factor is chronic kidney disease, especially those patients requiring dialysis. The kidney does not properly excrete calcium and phosphate and often the dialysate utilized is high in phosphate and/or calcium. The calcium and phosphate then bind and precipitate, thus causing vascular occlusion. 

Another risk factor includes uncontrolled Warfarin levels. Warfarin inhibits a vitamin-K dependent factor that is responsible for inhibiting vascular calcification. 

Additional risk factors for calciphylaxis include alcoholic liver disease, diabetes mellitus, connective tissue disorders, glucocorticoid use, chronic inflammatory conditions, and clotting disorders.

Calciphylaxis typically presents as a tender, erythematous areas of skin. The lower extremities are most commonly affected (90%). Other areas that may be involved include the abdomen and the buttocks. These lesions progress to reddish-purple plaques and ultimately end up as a black stellate eschar overlying gangrenous ulcers and patches of ischemic necrosis.

Diagnosis is typically made by deep tissue biopsy. Incisional biopsy of the skin could result in a non-healing ulcer which increases risk of mortality 2-fold. Additional diagnostic tests that may help include plain films showing calcium deposits in the vessels.

The goal of treatment of calciphylaxis  is to lower calcium and phosphate in the blood. This is accomplished by Cinacalcet, which makes receptors more sensitive to calcium, and Sodium Thiosulfate which increases the solubility of calcium deposits. A non-calcium phosphate binder such as Sevelamer will decrease phosphate levels. Wound management should be optimized and prophylactic antibiotics may be necessary to prevent secondary infection. Surgery may be considered to excise the areas of vascular compromise if the patient is fit for surgery.

Unfortunately, the mortality rate for calciphylaxis is 85%. The 1-year survival rate is 45% while the 5-year survival rate is only 35%. The most common reason for mortality is sepsis. Factors that increase mortality rate include proximal lesions and ulceration.

The plan for the patient that I saw was to undergo a deep tissue biopsy to confirm the diagnosis. Once confirmed, she will be started on Cinacalcet or Sodium Thiosulfate. Wound management will be optimized with a multi-disciplinary approach and strict adherence to the medical regimen. Her prognosis is guarded.

Julie Shawver PA-S

Mount Union Physician Assistant Program

Beautiful, Natural, Noticeable

Breast Augmentation so naturally attractive you will forget that you have implants.

Dr. Michelow's "Hidden Incision" combined with the new tear-drop shaped, high-strength, cohesive silicone gel implants add volume and fullness where these should be...for natural breast enhancement.
Tighten, lift and achieve the silhouette you want and an appearance that will turn heads

www.DrMichelow.com


3733 Park East Drive Suite 107
Beachwood, OH 44122
216 595 6800

Best Results Obtained When Your Surgeon is Certified by the American Board of Plastic Surgery

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Scary Scars - Simple Solutions!

Jennifer Kish, DO, FACEP  Seriously Skin 

Bryan J. Michelow, MD  Contemporary Cosmetic Surgery

Dr. Jennifer Kish (Seriously Skin) and Dr. Bryan Michelow (Contemporary Cosmetic Surgery) have teamed up to treat those tough, thick scars that can be unsightly.

What are scars?
Healthy skin consists of two layers (Epidermis and Dermis). However, after an injury to the skin, be it a cut, a burn or an operation, the skin will heal with a scar. Scar tissue consists of collagen fibers.
Because of this difference, scars are visible.

Why do I get scars?
If the injury to the skin is superficial, like an abrasion or a "road rash" following a fall, the skin will heal from the uninjured deeper dermal cells.  A scab may initially form. As the wound heals, the scab falls off leaving healthy skin.

If, however, the wound in the skin is deep (full thickness) then the natural healing is with scar tissue. Scars are pink when they are healing (immature scar) and turn lighter in color when fully healed (mature scar).

Unfortunately, scars can be unsightly. Some scars thicken (hypertrophic scar or keloid).  Other scars widen or develop spider veins within them.

Will my scars disappear?
Fortunately, the majority of scars heal well and fade over time, becoming less noticeable. Because scars and natural skin differ, they will never disappear completely.  Cover up cosmetics can help hide a scar.

What can I do about my unsightly scars?
Dr. Bryan Michelow cautions about treating your scar with surgical excision alone. "This may lead to a new, thicker, more unsightly scar then before."

The solution is to combine the expertise of the Plastic Surgeon with that of a "Seriously Skin" Specialist. Dr. Jennifer Kish offers additional specialized services with the aid of lasers, topicals and injectibles to manage those scars.

Some options available to clients include BBL (broad band light) treatment which allows for reduction of the scar’s pigment and brown hues.

Another option, the Micro Laser Peel, is used to reduce the raised effect of a scar and smooth out any Keloid scarring that may be present.

Finally, a Profractional treatment may be considered as the Profractional treatment allows the scar to heal in a more even fashion than a surgical procedure, reducing the size of the scar, and assisting the scar in replicating skin cells in a “non scarred” fashion.  

Ask about these special options:

Jennifer Kish, DO, FACEP  Seriously Skin, Chagrin Falls, Phone 440-247-3111
Bryan J. Michelow, MD,  Contemporary Cosmetic Surgery, Beachwood. Phone: 216-595-6800

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