Considering rev.surgery w/ Bermant in nxt 12 months - MANY LOGISTICAL CONCERNS.

[tonysoprano]

So..I have just started planning (in my head) for the idea of travelling very,very far for possible revision surgery with Dr Bermant in VA.
Even though it's really early days still, I am finding myself worrying about A LOT OF THINGS right now. Least of all in fact is the actual operation.

I have had surgeries before (original gyne op + wisdom teeth, adenoids, knee reconstruction hernia,etc) and as this is going to be my second gyne op, that is not what is concerning to me. All of my main concerns right now mostly focus on all the logistical considerations and minor costs here and there and there and there adding up, and just how exactly the whole thing would be planned out...

My main concerns are mostly based around the fact that I will be travelling down from Canada TWICE - for the consult and the surgery ( It's for a revision and I just don;t think the remote discussion will adequately allow for me to express my concerns and desired outcomes of the surgery). I am also concerned about a bunch of things that will need to occur while I am staying in Chester/Richmond for the week of the surgery. I'm assuming I will have to remain in Richmond for 6 days to a week after my op...


Here are the biggest concerns I have at this initial stage:

1* Explanations to homeland security. I need to get 2 separate return flights from Toronto (or possibly Buffalo,NY) to VA and back - one on each occasion- for both the consult and the op.
i WILL have to cross the US border on TWO separate occasions, and as I am not even a citizen of Canada, this generally brings up many questions and obstacles - in this hysterical day and age. I will need to provide a good reason why I am coming into the country and they always want a name of a person, proof of where you will be staying, how long, how you know the person,etc.
What could I possibly say? I don't want to go through the embarrassment of disclosing that it's for a P.SURGERY consult the first time, and then SURGERY the second time... Any suggestions? Particularly, how will I explain the first visit where I will likely  have a return plane ticket for a few hours later that same day ?? That can look very suspicious to the border guards.

2*  Travel Logistics in VA. Getting from the airport to Bermant's office and back to the airport for the consult on the first occasion visit is NOT the issue. The issue on this trip will be explaining to homeland security why I am flying to VA from Canada for the afternoon?
It's the week of surgery that I can't fathom logistically. I will have to get from the airport to the hotel >Bermant's office > the hotel > Bermant's office again for the surgery > back to the hotel > back to Bermant's office for the 5-6 days-later follow-up > back to the hotel > back to the airport. That's not even accounting for taxi rides to go to a restaurant or a grocery store or anything in the middle of the week...I mean, how many trips is all this going to add up to, and how much is this gonna cost in taxi fares in the end ?

3* FOOD for A WEEK. What/where/how the hell am I going to be eating the whole week of surgery? I am going to be on my own in a hotel somewhere, laid up on a bed, unable to move about or get around or cook or anything? Is it going to be all room service and take-out? I get migraines if I don't eat every 4 hours. How much is a week of room service and take-out going to add up to in the end? This could equate to hundreds of $$ too..

4* ZERO HELP.I am coming down to Richmond ALONE, and NO ONE will know where I am going that week or what for (I am even planning to tell work colleagues and friends that I was sick with flu for a week). Who is going to help me after surgery, who is going to help me get back to the hotel safely? Won't I need to stay in the operating theatre's hospital rooms for some hours after a general anaesthetic to monitor my vitals/observation ?? Surely I won't be woken up from the operation and sent to a hotel right away?
Who is going to help me with things back at the hotel on that first day? Who is going to help me carry my stuff back to the airport with me? And on the plane? Back into Canada from the airport,buses,etc ?  I'm not planning on taking much at all - just my laptop and 1 or 2 changes of clothes, but as I can recall a few days after my first surgery, I still couldn't even move my arms away from my sides, let alone carry ANYTHING!!

5* Accommodation.Which hotel would I choose? I know Bermant has corporate discounts with some, but which one is the closest to Bermant? And proximity to the airport ? Equally close to Bermant's office AND the airport ?Do they all have room service? Wi-fi? Cable tv? security? AAAAAAAAHH!!! so much to think about?

6*PAYMENT methods. my finances (or the ones I plan to save) will be spread out across savings accounts in Canada and another country, as well as 2 credit cards. How will I pay for the surgery exactly? I think each account has a daily limit, the cheques are not international cheques, the money is spread across a number of accounts, NONE OF IT IS IN US INSTITUTIONS OR US CURRENCY. Would it work to put it all into a paypal account and paypal the surgery ??
Should I transfer it all onto one (foreign) Visa and swipe that visa for the surgery (despite the associated surcharges,overseas usage charges, international currency exchange charges, INTEREST charges,etc) ??
If I use a Visa, what 'description' will be showing up on the visa statement for a transaction worth thousands of US Dollars ? Gynecomastia surgery? Dr bermant-plastic surgeon? AAAAAAAAAHHH!!!
What have other people done regarding paying in US currency, with one single method?


If anyone here has any great suggestions or recommendations/anecdotes from their own experiences of travelling to VA to see Bermant (or any other doctor at any other great distance) I would love to hear them.  Especially those that have travelled far for REVISIONS and especially those that have travelled FROM OVERSEAS or CANADA, HAVING NOT BEEN US residents ( Or even a Canadian citizen, as is my case), and especially those that DID IT ALL ALONE.... I could really use any advice that anyone has right now, as I continue making thorough plans in my head, so that I can schedule surgery for next fall/winter, once I have everything figured out logistically, and all the cash saved. I just recently set my mind on this option for a revision, just a few weeks ago, and the more I think about it, the more it seems like there might be no turning back now...

So anyone with anything to offer/advise/suggest, especially those that have done the exact same thing I am proposing, in the same way that I am proposing it, I would love to hear it all, and would be ever ever so grateful...

And if you, Dr Bermant have any answers for me,advice or suggestions pertaining to any or all of these initial concerns I have, your thoughts would be equally appreciated, if not more...

Thanks people. 

[DrBermant]

So..I have just started planning (in my head) for the idea of travelling very,very far for possible revision surgery with Dr Bermant in VA.
Even though it's really early days still, I am finding myself worrying about A LOT OF THINGS right now. Least of all in fact is the actual operation.

I have had surgeries before (original gyne op + wisdom teeth, adenoids, knee reconstruction hernia,etc) and as this is going to be my second gyne op, that is not what is concerning to me. All of my main concerns right now mostly focus on all the logistical considerations and minor costs here and there and there and there adding up, and just how exactly the whole thing would be planned out...

My main concerns are mostly based around the fact that I will be travelling down from Canada TWICE - for the consult and the surgery ( It's for a revision and I just don;t think the remote discussion will adequately allow for me to express my concerns and desired outcomes of the surgery). I am also concerned about a bunch of things that will need to occur while I am staying in Chester/Richmond for the week of the surgery. I'm assuming I will have to remain in Richmond for 6 days to a week after my op...


Here are the biggest concerns I have at this initial stage:

1* Explanations to homeland security. I need to get 2 separate return flights from Toronto (or possibly Buffalo,NY) to VA and back - one on each occasion- for both the consult and the op.
i WILL have to cross the US border on TWO separate occasions, and as I am not even a citizen of Canada, this generally brings up many questions and obstacles - in this hysterical day and age. I will need to provide a good reason why I am coming into the country and they always want a name of a person, proof of where you will be staying, how long, how you know the person,etc.
What could I possibly say? I don't want to go through the embarrassment of disclosing that it's for a P.SURGERY consult the first time, and then SURGERY the second time... Any suggestions? Particularly, how will I explain the first visit where I will likely  have a return plane ticket for a few hours later that same day ?? That can look very suspicious to the border guards.

Most of our Revision Gynecomastia Surgery patients start out with our Preliminary Remote Discussion to minimize travel to Virginia. Of these the vast majority can then set up tentative surgery the day after the in office consultation. For more severe problems or issues that just do not show up well on pictures, there is no additional charge from us to continue the exam in the office within a reasonable time limit. We have had many patients traveling from Canada and around the world for our consults and none have complained about homeland security or border guard issues.

2*  Travel Logistics in VA. Getting from the airport to Bermant's office and back to the airport for the consult on the first occasion visit is NOT the issue. The issue on this trip will be explaining to homeland security why I am flying to VA from Canada for the afternoon?
It's the week of surgery that I can't fathom logistically. I will have to get from the airport to the hotel >Bermant's office > the hotel > Bermant's office again for the surgery > back to the hotel > back to Bermant's office for the 5-6 days-later follow-up > back to the hotel > back to the airport. That's not even accounting for taxi rides to go to a restaurant or a grocery store or anything in the middle of the week...I mean, how many trips is all this going to add up to, and how much is this gonna cost in taxi fares in the end ?

Many of our patients who travel to Virginia find that Richmond car rentals are much less expensive than Richmond cabs / taxi fares. Just check ahead to see that your driving license can be used in the U.S.. Jane is my office manager and can discuss typical costs of cab fares.  She can normally be reached at our office by phone Monday - Friday 9-5 Eastern Time at (804) 748-7737.

3* FOOD for A WEEK. What/where/how the hell am I going to be eating the whole week of surgery? I am going to be on my own in a hotel somewhere, laid up on a bed, unable to move about or get around or cook or anything? Is it going to be all room service and take-out? I get migraines if I don't eat every 4 hours. How much is a week of room service and take-out going to add up to in the end? This could equate to hundreds of $$ too..

One of the hallmarks of my patients' recovery is the comfort they have after surgery. Almost all are up and about the day of the operation. Many chose to take the time here to travel about vacationing and enjoying the region. Richmond Virginia has much to offer. Others actually visit Washington D.C., N.Y, or Florida for sightseeing once they have been cleared after surgery. Some of our patients choose to stay in Extended Stay Lodging with kitchen facilities in the room. They go grocery shopping and eat there. Others choose to stay in a hotel with room service and yet others travel about for an eating adventure that the region offers.

4* ZERO HELP.I am coming down to Richmond ALONE, and NO ONE will know where I am going that week or what for (I am even planning to tell work colleagues and friends that I was sick with flu for a week). Who is going to help me after surgery, who is going to help me get back to the hotel safely? Won't I need to stay in the operating theatre's hospital rooms for some hours after a general anaesthetic to monitor my vitals/observation ?? Surely I won't be woken up from the operation and sent to a hotel right away?
Who is going to help me with things back at the hotel on that first day? Who is going to help me carry my stuff back to the airport with me? And on the plane? Back into Canada from the airport,buses,etc ?  I'm not planning on taking much at all - just my laptop and 1 or 2 changes of clothes, but as I can recall a few days after my first surgery, I still couldn't even move my arms away from my sides, let alone carry ANYTHING!!

Plastic Surgery Anesthesia has evolved quite some way. We do not use general, but local with sedation. For those traveling alone, Jane can help organize a nurse for a few hours after the operation. Our patients do not seem to need that much extra help after that time except for putting things overhead such as in the overhead compartment in the jet.

5* Accommodation.Which hotel would I choose? I know Bermant has corporate discounts with some, but which one is the closest to Bermant? And proximity to the airport ? Equally close to Bermant's office AND the airport ?Do they all have room service? Wi-fi? Cable tv? security? AAAAAAAAHH!!! so much to think about?

Richmond Hotels nearby are no issue. Most of the chain hotels are within a 5 mile radius of our office. Again a Jane issue. She keeps tracks of the current patients' feedback about the local lodging.

6*PAYMENT methods. my finances (or the ones I plan to save) will be spread out across savings accounts in Canada and another country, as well as 2 credit cards. How will I pay for the surgery exactly? I think each account has a daily limit, the cheques are not international cheques, the money is spread across a number of accounts, NONE OF IT IS IN US INSTITUTIONS OR US CURRENCY. Would it work to put it all into a paypal account and paypal the surgery ??
Should I transfer it all onto one (foreign) Visa and swipe that visa for the surgery (despite the associated surcharges,overseas usage charges, international currency exchange charges, INTEREST charges,etc) ??
If I use a Visa, what 'description' will be showing up on the visa statement for a transaction worth thousands of US Dollars ? Gynecomastia surgery? Dr bermant-plastic surgeon? AAAAAAAAAHHH!!!
What have other people done regarding paying in US currency, with one single method?

For payment, any bank can generate a cashier's check. Others seem to prefer a bank wire transfer. Again something to discuss with Jane.

If anyone here has any great suggestions or recommendations/anecdotes from their own experiences of travelling to VA to see Bermant (or any other doctor at any other great distance) I would love to hear them.  Especially those that have travelled far for REVISIONS and especially those that have travelled FROM OVERSEAS or CANADA, HAVING NOT BEEN US residents ( Or even a Canadian citizen, as is my case), and especially those that DID IT ALL ALONE.... I could really use any advice that anyone has right now, as I continue making thorough plans in my head, so that I can schedule surgery for next fall/winter, once I have everything figured out logistically, and all the cash saved. I just recently set my mind on this option for a revision, just a few weeks ago, and the more I think about it, the more it seems like there might be no turning back now...

So anyone with anything to offer/advise/suggest, especially those that have done the exact same thing I am proposing, in the same way that I am proposing it, I would love to hear it all, and would be ever ever so grateful...

And if you, Dr Bermant have any answers for me,advice or suggestions pertaining to any or all of these initial concerns I have, your thoughts would be equally appreciated, if not more...

Most of my patients move on with their lives and them finding your questions here is less likely. Having your questions answered before traveling to Virginia is part of the reason of having my website and our remote discussions. That is how our system has been set up over the years and it works for the vast majority of our patients. Yet other patients choose to travel to see me before considering surgery. Read the experiences from this Hong Kong revision gynecomastia patientwho chose to travel for his initial consult and then back for his surgery!

Thanks people. 

Hope this helps,

Michael Bermant, MD
Learn More About Revision Gynecomastia and Chest Surgery

[tonysoprano]

Thanks Dr. B. ,

As far as those things you have addressed go:

1*I do not think that pictures or a "remote discussion" would accurately illustrate the extent of my chest situation, as I find it very hard to demonstrate the concerning issues through pics alone. I really believe that the specific issues at hand would appear much more obvious to you, and be much easier for you to assess in-person.
I would definitely like to avoid scheduling the two trips if possible (especially since A.> it would be less costly, less time-consuming, less hassle, less wait-time in between consult and surgery for me and B) it is much easier to make up a story for coming to VA for a week, than it would be to explain "an afternoon in Richmond VA, and then I'm flying home...I promise Mr.border guard!".) Having been across the border to the US many times now by bus, I have many,many experiences with homeland security's intensive interrogations and in-depth sniffing around. I have never been allowed into the US without providing a "friend"'s name that I'm visiting, their occupation, address, details of how I know that person, details of where I will be staying and how long,etc. Just saying... that I WILL NEED to have CONTACT Names/addresses, accommodation booked and a story concocted before I encounter homeland security, as a non-American. Past experience has taught me so.

Now, if we have the remote discussion (to try to cover as much of the physical issues as 2-D allows for), and then a month or 2 later I fly down to Richmond for an in-person office consultation with a "tentative" surgery booked the next day, how tentative would that surgery actually be? I mean, if I saw you in-person and we figured out a surgical plan and you assessed the condition with a physical examination, then we would just go ahead and have the surgery the very following day? And should I have a week's hotel accommodation "tentatively booked" too? And if for some reason we decided not to proceed with the surgery, then we would just decide that there and then? And I would cancel the week's hotel booking then? (probably losing a night's payment)? And what about the return leg of the flight? Just trying to cover all my bases here.
But yes, ideally we could have the remote discussion (although I truly don't believe it would be able to paint more than 25% of the picture here in this case), and then I could come down to Richmond at a later date for the in-person consult as the first day of a "surgery week" (tentatively). In fact, just the one trip down would be ideal for me if possible, however my number one priority is doing whatever is best to give you the most accurate illustration of my problem and whatever is the best approach for the problem, rather than doing what works best in saving me 2 trips.

2*I'm not really too interested in incorporating any kind of sight-seeing or "vacation" into this trip. I just want to fly down, have the surgery, lie in front of a tv in a hotel resting up for the next week, see you again for a follow-up, and fly back.
I am just wondering where these hotels that you have corporate discounts are situated, and if they are right near the Richmond airport, or mid-way between your office and the airport? I guess it would be good to stay in a hotel right near the airport, so that the airport >hotel commuting is minimal to zero, and so the only commuting would really be taking taxis from the hotel to your office. I guess I could live on room service for the week, and take-out food from places close-by any hotel I am staying at. And I'm sure Richmond and the surrounds are lovely, though I am only really focused on coming for the surgery and not much else. Another time I will maybe sightsee 

3*As far as coming alone, I guess I will at least need a nurse to help me back to the hotel following the operation. I could probably take it from there by myself, especially since I won't have to be back at your room's for a few more days. Though I am wondering about drains. Do you use drains? If I need to have drains, when would those come out? Surely they couldn;t stay in for 5/6 days?
Would I see you again the day after surgery? or would it just be once more, a few days later? And how many days after surgery will I need to wait to see you for that last time before i leave Richmond - 5,6,7 ?

4* I guess I will discuss things like hotels, a nurse, room-service, cabs, payment,etc with Jane... thanks for the other suggestions though. I am also just wondering, if I used a VISA for everything, what would the "description" be labelled as on my bank statement? A Jane issue too?

I mean ultimately I am wondering (because I am concerned about the inability to convey the aspects of my situation accurately and clearly enough through the remote discussion) whether there would be any difference between arranging two separate trips to see you for the consult and then a surgery trip, and arranging just the one trip, where there is a consult followed by a tentative surgery the next day? If it's all the same, then I would certainly be much keener to go with the latter option and save myself doing 2 trips... As long as there is enough time in that 24 hrs for you to evaluate my condition and decide on a surgery plan between that consultation and a surgery scheduled for the very next day?


Thanks again for all the great feedback Dr.B!



And if anyone else here can share similar experiences of their's travelling from far, ALONE for surgery, I'd sure love to hear some details. My peace of mind seems could really use some personal accounts right now...

[DrBermant]

Thanks Dr. B. ,

As far as those things you have addressed go:

1*I do not think that pictures or a "remote discussion" would accurately illustrate the extent of my chest situation, as I find it very hard to demonstrate the concerning issues through pics alone. I really believe that the specific issues at hand would appear much more obvious to you, and be much easier for you to assess in-person.
I would definitely like to avoid scheduling the two trips if possible (especially since A.> it would be less costly, less time-consuming, less hassle, less wait-time in between consult and surgery for me and B) it is much easier to make up a story for coming to VA for a week, than it would be to explain "an afternoon in Richmond VA, and then I'm flying home...I promise Mr.border guard!".) Having been across the border to the US many times now by bus, I have many,many experiences with homeland security's intensive interrogations and in-depth sniffing around. I have never been allowed into the US without providing a "friend"'s name that I'm visiting, their occupation, address, details of how I know that person, details of where I will be staying and how long,etc. Just saying... that I WILL NEED to have CONTACT Names/addresses, accommodation booked and a story concocted before I encounter homeland security, as a non-American. Past experience has taught me so.

Now, if we have the remote discussion (to try to cover as much of the physical issues as 2-D allows for), and then a month or 2 later I fly down to Richmond for an in-person office consultation with a "tentative" surgery booked the next day, how tentative would that surgery actually be? I mean, if I saw you in-person and we figured out a surgical plan and you assessed the condition with a physical examination, then we would just go ahead and have the surgery the very following day? And should I have a week's hotel accommodation "tentatively booked" too? And if for some reason we decided not to proceed with the surgery, then we would just decide that there and then? And I would cancel the week's hotel booking then? (probably losing a night's payment)? And what about the return leg of the flight? Just trying to cover all my bases here.
But yes, ideally we could have the remote discussion (although I truly don't believe it would be able to paint more than 25% of the picture here in this case), and then I could come down to Richmond at a later date for the in-person consult as the first day of a "surgery week" (tentatively). In fact, just the one trip down would be ideal for me if possible, however my number one priority is doing whatever is best to give you the most accurate illustration of my problem and whatever is the best approach for the problem, rather than doing what works best in saving me 2 trips.

That is the whole reason we suggest our patients start out with the remote discussion. There are limitations with any process. When the problem is not well demonstrated by images, then they need the in office exam before the tentative surgery can be scheduled. It has been quite rare for our tentative surgeries to need to be canceled because what we found on examination did not match what was shown on the initial discussions. When a patient does not feel that the remote will work, then they should start with the in office exam. For some complex cases, I advise that patient that they will need the in office exam before surgery can be offered. When patients do not start with the remote, surgery can not be reserved for the next day. There is no reasonable way to save a spot like that wasting the time for others or for that matter having that patient pay for surgery that then is not done.

2*I'm not really too interested in incorporating any kind of sight-seeing or "vacation" into this trip. I just want to fly down, have the surgery, lie in front of a tv in a hotel resting up for the next week, see you again for a follow-up, and fly back.
I am just wondering where these hotels that you have corporate discounts are situated, and if they are right near the Richmond airport, or mid-way between your office and the airport? I guess it would be good to stay in a hotel right near the airport, so that the airport >hotel commuting is minimal to zero, and so the only commuting would really be taking taxis from the hotel to your office. I guess I could live on room service for the week, and take-out food from places close-by any hotel I am staying at. And I'm sure Richmond and the surrounds are lovely, though I am only really focused on coming for the surgery and not much else. Another time I will maybe sightsee 

There are hotels all over the Richmond region as mentioned before. Jane is my office manager can discuss current feedback about the lodging.  She can normally be reached at our office by phone Monday - Friday 9-5 Eastern Time at (804) 748-7737.

3*As far as coming alone, I guess I will at least need a nurse to help me back to the hotel following the operation. I could probably take it from there by myself, especially since I won't have to be back at your room's for a few more days. Though I am wondering about drains. Do you use drains? If I need to have drains, when would those come out? Surely they couldn;t stay in for 5/6 days?
Would I see you again the day after surgery? or would it just be once more, a few days later? And how many days after surgery will I need to wait to see you for that last time before i leave Richmond - 5,6,7 ?

I rarely need drains, but they are a risk of any surgery. Time for removal of the drain depends on the drainage and is not predictable. That is why I worked so hard evolving my techniques to minimize the need for drains.

4* I guess I will discuss things like hotels, a nurse, room-service, cabs, payment,etc with Jane... thanks for the other suggestions though. I am also just wondering, if I used a VISA for everything, what would the "description" be labelled as on my bank statement? A Jane issue too?

I mean ultimately I am wondering (because I am concerned about the inability to convey the aspects of my situation accurately and clearly enough through the remote discussion) whether there would be any difference between arranging two separate trips to see you for the consult and then a surgery trip, and arranging just the one trip, where there is a consult followed by a tentative surgery the next day? If it's all the same, then I would certainly be much keener to go with the latter option and save myself doing 2 trips... As long as there is enough time in that 24 hrs for you to evaluate my condition and decide on a surgery plan between that consultation and a surgery scheduled for the very next day?


Thanks again for all the great feedback Dr.B!



And if anyone else here can share similar experiences of their's travelling from far, ALONE for surgery, I'd sure love to hear some details. My peace of mind seems could really use some personal accounts right now...

You can find many patient traveling experiences posted on my website starting on that page. Then follow the arrows at the bottom of the page or the link menus to see many pages of such experiences. My patients tend to not stay and hang around on forums. Those that do are appreciated helping others, but most move on with their lives. That is why I posted their experiences on the forums there.

When a patient sees us without the remote discussion, they need to wait for the next available surgery slot. Jane can best advise what our current waiting times are.

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia and Male Breast Reduction