Complaint Review: University Suburban Health Center Cleveland - South Euclid Ohio

Dr. Stellato is allowed to call the South Euclid Police for patient complications of his surgeries.  The one problem that he can't handle is the most common cause of chronic abdominal wall pain - and Dr. Stellato is a General Surgeon.  Dr. Stellato is a former Chief of General Surgery at University Hospitals, the former Hubay Professor of Surgery, a former Chief of Bariatric Surgery, and the writer of the General Surgery Board Review Materials for the American College of Surgeons.  But in regards to abdominal wall pain, Dr. Stellato needs to return to General Abdominal Wall Exam 101.   

A more educated male surgeon, with a more glaring surgical repertoire 'hole' can't be found.  Dr. Stellato is to Chronic Abdominal Wall Pain as Obama is to Christianity.   

The chronic abdominal wall pain problem is huge - and the money is huge - and General Surgeons, Family Practice, and ER see this problem as well as Obstetrics & Gynecology physicians - if they recognize it.  Peds surgeons, and Pediatricians, also see this problem if they look.   

This problem occurs all too commonly after any abdominal procedure, after pregnancy or a C-section, after sports injuries, and just happens = Abdominal Cutaneous Nerve Entrapment Syndrome (=ACNES, that is not acne).  If anyone has ever heard Dr. Tom Stellato say it, they should get $5 or maybe $50.  

Not only has Dr. Stellato never said it, but he has never written about it - never considered it part of the Surgical Literature or a General Surgery Board Review item.  Chronic abdominal wall pain is not part of Surgery for Dr. Stellato - it's the scope of the South Euclid Police Department.  Almost everyone who has written about abdominal wall pain overlooks the diagnosis of ACNES in the writing - Dr. Stellato, and University Suburban physicians & management - are not exceptions to that rule.  The Rule of ACNES is that General Surgeons goof the diagnosis like no other - they don't know what the acronym stands for, they can't find the 10 nerve exit foramen spots on an abdominal wall exam.     

Dr. Stellato can't diagnose, handle, or correctly treat anterior cutaneous nerve entrapment - an extremely common complication of any abdominal procedure, sports injuries to the abdominal wall, sports over-exertions, pregnancy, and anything that stresses or injures the abdominal wall.   Yet he is now a Medical Director.  There are 10 neuromuscular 'foramen,' where the nerve exits anteriorly at an acute angle, and where the nerve is able to be palpated & injured - creating 'trigger points' for inflammation & injury.  But Dr. Stellato never examines these openings/nerve exits - and they are not hard to find - the physical exam is in the paper cited below and the diagrams are cartoons - patients can examine themselves the T-8, T-9,T-10, T-11 and T-12 areas along the lateral border of the rectus muscle.  Suggestion: mark these with a surgical marker for Dr. Stellato and have him ask what's going on.  It's an anatomical diagnosis - no scope required. 

Some patients have this nerve entrapment in an abdominal scar.  These patients can be helped with excising this part of the scar, or removing the retained suture - or the inflammatory tissue/granuloma - from around the nerve.  But not by removing the nerve - a move that Mayo Clinic likes to do because of the $-charge of a neurectomy.  Neurectomy does not treat this, more surgery does not treat this, an injection of a 2% lidocaine does - and the how-to is in the article cited below.  This is a separate procedure, billing-wise, than what caused the original scar - even if you hand the paper to Dr. Stellato.   

The diagnosis of nerve entrapment in a scar is suggested by exacerbation of the pain from pinching the scar, or by moving the scar across the underlying muscle - moves that Dr. Stellato doesn't do - he wants you to schedule time in the OR with Carol - which is a real upper - another scar that can get ACNES.  And the Administration at University Suburban is equally oblivious to this scar-problem that you can charge to treat separately of the surgery that caused the scar - but 2 scars is not the treatment.  

Articles on this problem even include the question to ask the patient,"Where exactly is the pain?"  Stellato will not do this, will not ask the questions, will not offer an injection, and there is associated muscle spasm that can then lead to more misdiagnosis, more surgery, and more scars.  Patients are encouraged to bring the article from: Abdominal Cutaneous Nerve Entrapment Syndrom (ACNES):www.thepermanentejournal.org/files/Summer2002/acnes.pdf 

And has anyone ever heard Dr. Stellato ask an open-ended question?  He tells you what to do, or asks about your bowel movements.  Where exactly is the pain, would let the patient speak without a rectal.  Communication is not a strong point of Dr. Stellato, Carol, or University Suburban - cash is the only language.  But the article has PRACTICE TIPS - which the patient can then read to Dr. Stellato.     

The South Euclid Police do not examine, or read, anything either - they just let Dr. Stellato and Carol, his office manager, do what they want with patients.  The treatment is a 2% lidocaine injection - which University Suburban doesn't appear to stock - but they could bill for this if they checked with Kaiser Permanente. 

NERVE ENTRAPMENT SYNDROME: The exam and treatment is missing in offices at University Suburban - so Cleveland Kaiser cleans up on this diagnosis.  Certain Kaiser docs see one or two patients with this diagnosis for every 150 patients overall - but Dr. Stellato never sees any.  Certain Family Practitioner Kaiser docs have seen as many as 3 such patients per consultation session in a busy evening clinic with 15 physicians on duty screening abdominal & other pains.  So University Suburban should have at least 3 patients/day with this diagnosis.  

Anterior Cutaneous Nerve Entrapment Syndrome (ACNES) is a clean-up diagnosis (quick diagnosis, Carnett's test is cost free as to radiology staff/machines, easy treatment, and billing can be over $250 with followup for the local Pain Clinic physicians).  Or patients can be so happy that they give you their credit card - instant payments are known with the proper treatment of this problem.   Acute cases are seen in the evenings, but it is a bet that the Urgent Care at University Suburban never sees any ACNES = the most commonly overlooked cause of abdominal pain.  No stats are ever available, from Dr. Stellato, or University Suburban.  Isn't that what Medical Directors do ie stats?

But if Stellato can't handle abdominal wall pain - and the most common cause of it - a problem that he commonly causes with a procedure - then he should get out of abdominal surgery.  It's not the purview of the South Euclid Police to clean up the messes of University Suburban Health Center & Carol.  And no patient deserves this.  It's been around since 1926 as 'intercostal neuralgia,' but this blind spot of Dr. Stellato is a huge bummer of a miss in an academic surgeon otherwise capable and well-qualified - but he's not capable of admitting a mistake, or that he mishandled a patient with this - he wants to beat up on the woman MD who told him about this condition and she was just the messenger.