The newest 'hot' diagnosis on the block is abdominal Anterior Cutaneous Nerve Entrapment Syndrome (or ACNES as the acronym goes) - on the web, in the office, on the soccer field. The diagnostic test for it - Carnett's test - gets only about 4,750 results (in 0.15 seconds) if you GOOGLE. Images for Carnett's test get about 10,800 results (0.44 seconds) if you GOOGLE - so patients are aware of the diagnosis, and want it made correctly - at Mayo Clinic or University Suburban Medical Center. And they see the pictures, images, of how to do the test on the web if they look.
No Suburban Green Road Medical Center (in Cleveland or anywhere else), or Medical Director, can afford not to handle this well and daily - the diagnosis is there in every waiting room that sees abdominal wall pain. Physicians, or professionals, presenting with it are not exaggerating or 'standing a surgeon up,' they are trying to get the right diagnosis and avoid unnecessary surgery IF THAT IS POSSIBLE in a world that overuses SURGERY. Stellato wants to say 3 words and CUT, and that's not always the ANSWER. This is a diagnosis that is misinterpreted, misdiagnosed and misunderstood - and unnecessarily taken to surgery and made a mess of - a diagnosis that every Medical Director needs to do right or be able to repair.
And if the surgeon did the incision that caused this, the patient will go to the surgeon instead of the Family Practitioner, if they get hit in sports the patients will show in the Sports Medicine Office. But University Suburban Medical Center can designate a Family Practitioner, Internist or Pain Expert to work with Dr. Stellato - so that patients don't have to get stuck trying to get this across to Carol - who doesn't get the problem AT ALL - the words Carnett's test or ACNES will not come spontaneously from Carol. This problem can occur in ANY surgical incision, at any LATE DATE - it usually does not occur immediately after surgery.
The injecting for it is a Kaiser code number for reimbursement - no one is making this diagnosis up - it's too painful. The 2% lidocaine injection is therapeutic & diagnostic, and pays without an argument.
Dr. Stellato should quit being mad at the woman MD who tried to say to him that she had it, and realize that it is just amazingly common; it's rather too popular to be missed if you are in the Medical Center business. Problems always have GIFTS per Richard Bach in Illusions.
If you GOOGLE anterior cutaneous nerve entrapment you get only about 463,000 results (0.42 seconds). That's a lot of business out the door if you alienate every woman that has this, needs an injection, and some understanding, after a positive Carnett's test - and you have to do a Carnett's test for well-localized abdominal wall pain - before putting it on the Wright Surgery Schedule or cutting all the abdominal muscles and making a common mass closure mess.
Doing unnecessary surgery, arguing, is not cost effective. It's the diagnosis of the day in an ambulatory care center. Coming in tired doesn't cut it. Blaming the woman MD that left the articles doesn't cut it, maturity does. No one wants the wrong diagnosis, or an unnecessary surgery that requires endless repairs; neurectomies are not the answer - at Mayo Clinic or Green Road University Hospitals.
Surgery for refractory ACNES gets about 2,220,000 results (0.51 seconds) - it's an up-and-coming diagnosis in the surgical repair repertoire - a diagnosis that has been in the Surgical Literature since 1926, but overlooked. And it's overlooked because, almost everyone who has written about abdominal wall pain overlooks the diagnosis - including Dr. Stellato in his publications.
Wrong surgeries for this condition need repair. Wrong or right - the diagnosis is a no-brainer money-maker. Dr. Stellato should have been recognizing it for the last 20 years. It's not a Carol diagnosis however; no BP required. But it is an interdisciplinary medical problem, and Pain Management Offices can get huge business from this diagnosis correctly made. But it is painful, and only complete relief of pain by the anesthetic agent establishes the diagnosis - not another surgery, not Advil.
University Suburban Medical Center, and it's Medical Director, need to develop a way to handle nerve entrapments - it's also a common sports injury (for the guys) after cracked ribs, abdominal impact in football. Tim Tebow's probably got it, but no one is diagnosing - and you can meet some Cleveland Browns this way if anyone's interested.