Being a doctor insurance was often one of the thorns in my side. Thankfully, since I’m retired I don’t have to deal with it any longer. Even moreso, I’m glad I won’t have to deal with the new health care law in the United States. Obamacare is the informal name for the Patient Protection and Affordable Care Act, which is also sometimes shortened to the Affordable Care Act. President Obama signed the statute into law on March 23, 2010. It is an attempt at sweeping health care reform in the United States, with the primary aim being to broaden access to affordable health insurance and reduce the rising costs of health care in the country. It includes requirements for uninsured individuals to buy health plans, for businesses with fifty or more full-time employees to provide health insurance to those workers, and it expands Medicaid eligibility for those states that choose to participate.Read More
One of the most confusing aspects of rhinoplasty for many prospective patients is the difference between the two primary techniques: open versus closed. These two possible approaches describe the method of access to the nasal structure. It’s important to understand this distinction because it has a direct impact on the quality of the outcome.
What is the Closed Approach?
The closed approach, also known as an endonasal rhinoplasty, requires that all incisions be made inside of the nostrils, with absolutely no incisions on the exterior of the nose. Parallel incisions usually encircle about half of the nostril lining, but no part of these incisions will be visible on the outside of the nose.
With this approach, the left and right incisions will not connect, with makes it very hard to reposition nasal skin. Surgery must also be performed through very narrow openings with very little visibility. This technique typically requires a great deal of stretching of the skin, so it can distort the cartilage.
This procedure will prevent any visible scarring, but the challenges and limitations mean that it is very rarely used except in certain cases. There are some other advantages to this technique, however. It does take less time in surgery, and there is less swelling and a shorter recovery. Still, the goal of a “nose job” is to reshape the nose, and most patients care more about their final result than how long they had to deal with swelling, and this is why surgeons and patients are increasingly turning to the open technique.
What is the Open Approach?
Most plastic surgeons today prefer the open approach, especially in the case of revision rhinoplasty like you see here, according to Dr. Robert A. Mounsey, MD, FRCSC, FACS. This technique requires a small incision at the base of the nose between the nostrils (or a trans-columellar incision) to connect the left and right nostril incisions. This will result in a very small, visible incision, but it offers the surgeon greater access to the nasal structure.
After this incision is made, the skin is folded upward and almost the entire framework of the nose will be visible. The surgeon can evaluate and correct each element of the nose individually. With this technique, there are many aspects of the nose that may be corrected. The resulting scar is very modest in exchange for greater accuracy, versatility, and results.
Many patients initially want a closed rhinoplasty, only because they fear the resulting visible scar from the alternative. The truth is, this scar will heal in time and become nearly invisible. It is almost never objectionable to patients, and most cannot even see the scar at all themselves after some time has passed.
If you are considering nose reshaping surgery, this is an important decision you will need to make with your surgeon. Be sure to discuss the pros and cons of each technique, but keep in mind that a closed nose job may not be a possibility, depending on what needs to be corrected or changed.Read More
I remember that it wasn’t so long ago when women would go to a dermatologist or plastic surgeon to get injected with collagen to plump up their lips or fill wrinkles. Times have changed dramatically over the last decade, however, as women no longer need to turn to bovine collagen to restore a more youthful appearance. New advances in fillers have brought better results, safer deliver and much longer-lasting results.
How Collagen and Restylane are Used
Bot of these products are injectable fillers that are used to fill depressed areas of the face, smooth out wrinkles, restore fullness or enhance the lips. In this way, they share some similarities. Both require a procedure that takes no more than thirty minutes, and both offer immediate results. The treatment itself is fairly easy either way. Injections are not generally painful, and the doctor can use a numbing agent to make it more comfortable.
How are They Different?
Collagen is made from sterile, processed bovine (cow) protein, whereas Restylane is made from hyaluronic acid, a compound that occurs naturally in our bodies but declines with age. Rather than injecting something that comes from a cow, Restylane is made in a lab and is a compound we already have in our bodies.
While this may not sound like a big deal, collagen has a 3% risk of allergic reaction. That’s why skin testing is required before having collagen injections to make sure you will not have a serious and potentially life-threatening allergic reaction. You also need to wait a full 30 days before getting injections to rule out any reactions, which can be quite a lengthy commitment for such a short-lasting product. There is no skin test necessary for newer dermal fillers like this http://SkinByLovely.com/restylane/. I can guess by the comments on this Skin By Lovely Pinterest page for a dermatologist who offers these injections that Restylane has now far surpassed the popularity of collagen, which is rarely used any longer.
Another major difference is the amount of time that results last. While collagen results can last for one to three months, Restylane lasts up to twice as long. Because collagen lasts for such a short amount of time, you can find yourself in the dermatologist’s office all the time once you start reaching your late 30s and want to correct lines that are getting deeper.
Restylane was approved by the FDA a few years back, but it became so popular outside of the United States that it was not uncommon for women to travel to Mexico to get injections. This is just one of many recent developments in dermal fillers. Other new injections include Juvederm, Juvederm Voluma, Sculptra and Radiesse.
If you are considering Restylane, you may need to prepare yourself for a bit of sticker shock. The injections can cost around $500 to $750 per syringe, and most people will require several syringes depending on the treatment area and depth of the lines that will be treated. One syringe is often enough to fill smile lines, for example, but some people need two.Read More
Acne is by far one of the most common and frustrating skin problems, and it can range from breakouts as a teen to chronic problems that persist into adulthood. The American Academy of Dermatology says that acne is rthe result of hormonal shifts, such as those during puberty or during a menstrual cycle, according to Dr. Diane Walder, MD, who you can learn about by clicking here. When this happens, it blocks the openings of the pores and allows the follicle underneath to swell, where bacteria produce irritating chemicals that cause inflammation.
When I was young, we didn’t have many treatment options for acne. In fact, the best advice a doctor could give you was cleaning your skin regularly. I remember some girls back in the day even rubbed liquid vitamin E into their skin in the hopes of clearing it up. Today, teens and adults alike have a wide variety of treatment options.
The gold standard remains washing the face with a deep pore cleanser with ingredients like benzoyl peroxide to attack oil and topical antibiotics or sulfur compounds to fight bacteria. This tends to work well for mild to moderate acne. For some people, a dermatologist may also prescribe Retin-A, a topical medication that speeds the clearing of acne.
Many of us are now familiar with ProActiv, a series of acne treatments that contain lower percentages of ingredients found in prescription medications. The cost of this treatment can be pricey, however, at up to $40 for a month’s supply. For people who are not very sensitive to benzyl peroxide, other options include Oxy Balance with a 5% solution or Oxy Maximum with 10% benzyl peroxide.
One of the newer products available is Niomide-T, which is derived from vitamin B. Clinical trials found that is does reduce the inflammation and redness of acne, and it may be more effective than topical antibiotic treatments like clindamycin. Still, many dermatologists feel it only works well for mild acne.
Another recent and interesting development is something called Zeno, which is a tiny electronic device that “zaps” pimples. Zeno is FDA-approved and it’s supposed to work by applying a small amount of heat to the pimple for two or three minutes, which destroys the bacteria. The manufacturer says most pimples need a single treatment and are gone within hours, but others say it takes several treatments and up to a day to see results. If the pimple isn’t too large or very inflammed, this device can actually work but it’s not made for widespread acne but rather occasional breakouts. There’s also the cost factor, as the device costs more than $200.
Men and women who have moderate to severe acne may also consider new laser treatments that use laser energy to heat up the skin and destroy bacteria while stopping the production of excess oil. These treatments don’t hurt but they can cost anywhere from $500 to $800, with several treatments required.
Finally, there is also a new light treatment that may even offer permanent results. Photo dynamic therapy uses pulsed light or a laser along with a topical cream called Levulan. It not only clears acne, but may do so permanently. So far, they have found that people treated enjoy clear skin for three years, which is the longest-running study. The treatment works because the light activates properties in Levulan that destroy bacteria while simultaneously shrinking oil glands to restore normal oil production.Read More
Despite being retired, I do like to stay updated on current surgical techniques and the changes today’s surgeons incorporate into the practice. I recently read an interesting study that has found that modern rhinoplasty techniques offer patients improved function and quality of life compared to older techniques.
Rhinoplasty like you see here performed by Kyle S. Choe, MD actually has a very long history. The nose job is the oldest cosmetic surgery procedure with a history going back to ancient India, although it has come a long way since then. Today’s surgeons can do everything from changing the size and shape of the nose to correcting functional problems or reconstructing the nose by manipulating the skin, bones, cartilage and nasal passages.
While we all read stories of celebrities who have had work done — and sometimes have gone overboard in their zeal for perfection — this procedure is now very common and performed more than 240,000 times every year in the United States on everyone from the rich and famous to the middle class. Changes in technology and technique have come rapidly, especially over the last three decades.
In the past, now out-dated techniques focused too much on the cosmetic, sculpting noses that looked great for awhile but began to degrade both aesthetically and functionally over the years to come. Today, surgeons strive to make changes that are functionally sound and will not harm the integrity of the nose for lifelong, beautiful results.
In the study I mentioned, which was published in Laryngoscope, Dr. Oren Friedman examined rhinoplasty techniques and how they impacted patient outcomes. Dr. Friedman reviewed surgery performed on patients and asked each patient to complete a survey. The survey asked patients to score nasal breathing, nose shape and other factors.
He found that with newer nasal surgery techniques, patients had a much higher cosmetic improvement, with 90% reporting satisfaction with the shape of their nose, and 90% reporting improved breathing after surgery. He’s also conducting research now into possible improvements that can be made in techniques, particularly in customizing and refining these techniques for each patient.
“It’s all about being able to select the right patient for the right technique,” he said.
It’s interesting to see how far this surgery has come. I can still remember how common it was for patients to suffer from collapsed nasal structures and other horrendous procedures, despite being very happy with the appearance of their nose for the first year or two. There has been a major shift in recent years toward open rhinoplasty versus the closed technique. There have also been many new types of cartilage grafts that have been made available to support the structure of the nose and the structural tip during surgery, including spreader grafts, alar batten grafts and tip projection grafts. The spreader graft in particular is very common now and is used to straighten the lower third of the nose.
While overdone noses can still be seen today, they are becoming much less common, and I for one think that is a great thing. I can only imagine what they will be capable of going in the next decade or so!Read More
There are a lot of questions surrounding what could really be responsible for people developing antisocial personality disorder. Is it hereditary? Can one avoid developing it? These and many other questions are answered in the following discussion.
Researchers have established a strong link between personality or affective disorders like antisocial disorder and genetics. A child born in a family where one of the parents has this condition is likely to develop it too in later life.
However, the presence of a close relative with the disease does not on its own mean that a child will develop the disorder. Other factors must also play a role before the condition makes its presence felt.
The Role of the Brain Structures
There is a part of the brain that is responsible for how we react to fearful, happy or sad facial expressions of those we are looking at. This part is called the amygdala.
For people having antisocial personality disorder, this part of the brain is markedly small and it responds in less robust ways when compared to that in people without the disorder. This limited response could be the reason why those with antisocial personality disorder are noticeably devoid of empathy towards those that are in distress. There is therefore a biologic factor that plays a role in the onset of this disorder.
Excessive use of alcohol and drugs is emerging as another possible causative factor in the development of antisocial personality disorder. This is because the substances used by the individual affect cognition and over time, brain function can be irreparably damaged.
Presence of Other Mental Disorders
Having a history of conditions like attention deficit hyperactivity disorder (ADHD) and reading disorders diagnosed in children is also believed to play a role in predisposing an individual to antisocial personality disorder.
The experiences that a child goes through while growing up can have an adverse effect on their health later on. It has been found that if a child was abused physically, emotionally or even sexually, they stand a very high chance of developing antisocial personality disorder later on in life.
The Role of Peers
It has been known for a long time that peer pressure can lead young people astray. A lot of the antisocial behavior that children exhibit is picked up from the people that they associate with, or look up to. Antisocial parents are therefore doing a lot of harm to their children.
A teenage daughter of a friend found Dr. Andrew Campbell on Tumblr after browsing through the site http://www.campbellplastics.com/ and was insisting on undergoing a complex cosmetic procedure that isn’t suitable for teens her age. Her reason? She wanted to copy what her peers had done! That is how influential peers can be in a youngster’s life.
A cocktail of factors have to be present at the same time for an individual to develop antisocial personality disorder. The presence of any one factor should not on its own be a cause for alarm. If you suspect that you have the risk factors for this condition, talk to your doctor and they will advise you as to what steps to take next.
Medicine is meant to make us get better when we are suffering from a given illness. But, did you know that many of the medications that people commonly take can end up making them feel much worse than they felt before they took them?
The following are just some examples of how common medicines make people feel or get worse over time.
Without naming any specific brands, all sleep medications have an adverse effect on the user since they interfere with the body’s normal processes.
The body normally carries out repairs during deep REM sleep but when you take medications to make you sleep, your body keeps battling to get that medicine out of your system. The result is that you will get up feeling groggy and un-rested.
Plastic surgeon Dr. Miller in New York prescribes a limited amount of sleep medications for patients who undergo a procedure like the one on this page http://drphilipmiller.com/procedures/rhinoplasty.asp due to the side-effects that can be brought on by prolonged use of sleep medications.
Many doctors discourage the use of drugs to combat constipation or diarrhea because there is a real danger that the patient will become dependent on them for normal gastric function.
The body eventually stops working without those medications being taken and that is a counteractive effect contrary to what was desired.
Many people get splitting headaches because of, hold your breath, overdosing on painkillers. It has also been found that prolonged use of painkillers makes one’s brain very sensitive to pain so you will acutely feel every little prick that other people hardly notice.
It gets even worse for people that take aspirin because that opens another can of worms since it can even hinder blood from clotting.
Very many people are on prescriptions of vitamins not knowing that some of them may be causing them lots of problems. High levels of Vitamin B3 can for instance result in elevated blood glucose levels and diabetics will be in trouble if that happened to them. If you are on antibiotics for stomach ulcers, Vitamin A can cause you very severe headaches. You should therefore talk to your doctor before you start taking these vitamin supplements.
Many topical antibiotics have been reported to cause allergic reactions in as many as 25% of all the people that use them. That allergy you may be suffering from could be a result of the antibiotics you use on your skin.
Summing it up…
All medicines are poisons and it is only a limited intake that has therapeutic value. If you have this in mind, you will avoid many of the problems that come from excessive drug use since you will only take them as, and when directed by a physician.
The examples above are just to illustrate how simple over the counter medications can have very adverse effects yet many people routinely buy and use them without a care in the world. Be on the lookout!Read More
By and large, your bones are hidden from view. That doesn’t mean that the role they play is of no significance; far from it. Bones are very crucial in our lives and if they are not in good health a lot could go wrong, such as getting frequent fractures.
Since they are invisible, how can you know their state of health? Well, your nails are a part of your bones and there is a lot that you can learn about the state of your bones by looking at your nails.
The following are some of the things that you can learn from observing your nails.
White Lines (Vertical)
When you observe these white lines on more than one nail and the nails proceed to split along those white lines that is a red flag indicating to you that you have a calcium shortage in the body.
Just look at your nails. When you see that they have taken on the shape of a spoon and the end of the nails curves upwards, that is an indicator that you could be suffering from a deficiency of iron in your diet and the nails are showing that shortage.
When you see white spots on a nail or two, don’t sound the alarm. It could be that you suffered some trauma that caused those spots and you now can’t remember what really happened.
If the spots appear on most of your nails, chances are very high that you have a zinc deficiency that is making its presence known via those white spots.
Dry, Brittle Nails.
Your fingernails and toenails are not supposed to be noticeably dry, or brittle. The moment these characteristics make their presence felt, it is highly likely that you could have two issues; poor hydration as well as a shortage of calcium in the body.
Vertical and Horizontal Ridges.
When you observe these ridges on your nails and they are coming at a time when the nails are brittle, you should suspect that your body isn’t getting as much Vitamin B as it should be receiving and that is why the nails are exhibiting those characteristics.
When your nails are pale and are very white in color, the problem is much broader than just your bones. You could be anemic and that is why your nails are taking on that unnatural color and appearance.
Bones are very important and we should do everything we can to keep them healthy. When we have other ailments or undergo certain treatments like plastic surgery, chances of an event-free recovery are higher when your bones are in good health, says Dr. George T. Moynihan, a plastic surgeon of http://www.goldcoastplasticsurgery.com/rhinoplasty.aspx.
If you talked to any surgeon, you would still be told the same thing, and that the effects of bone health go even beyond plastic surgery and impact on other organs since the skeletal system houses and protects all other body systems.
The signs above should therefore be seen as a call to action so that further investigations are carried out to confirm or rule out your suspicions. Forewarned is forearmed!Read More
It’s hard to believe how many years have passed since I finally accomplished my life long dream of becoming an orthopedic surgeon. Today, many friends that I have the chance to reacquaint with seem like strangers from a distant land. But I can’t forget how many of these very same people influenced me in my life and propelled me in my quest for knowledge and pursuit of excellence.
In some ways, my oldest companions are the books I still have with me that have also served as a source of inspiration from as early as my pre-college days. I need them back then as not everyone was as encouraging as young boy might want them to be.
One particular book had a major impact on me in my earlier years. It was a book of philosophy built around the concepts of Greek and Roman wisdom which included the brief, yet astute saying, “Qui docet, discit” which translated means “he who teaches, learns.”
Using this simple saying really helped my skills as a surgeon to evolve to a lever that I hadn’t previously thought possible. Any surgical procedure I learned, any medical concept I studied, and any statistical analysis that I worked on grasping, I always made sure that I was able to explain it myself.
Unfortunately, it seems that these days more and more time is being spent preparing students for passing test than actually helping them to improve their skills. And even some of the skill training seems quite questionable to me. I’m thoroughly that robotic surgery is any better than traditional surgery – in fact, I’m quite convinced it’s not. Not only that, but it’s a certain that such so-called “state of the art” devices add additional costs to already mounting Medical Tuition hikes.
And that’s the last thing today’s future doctors need. I’ve seen too many young doctors file for bankruptcy, run up huge credit card bills, take out loans for people with poor credit, or take out second mortgages on their homes. I’m pretty sure the Affordable Health Care Act isn’t going to help their situation out either. I wouldn’t be surprised if the whole thing gets repealed soon.
I suppose I probably am coming off as a bit pompous in my post here, but nothing could be further from the truth. My years in government service provided me with more than my share of humility. I won’t go into much detail right now, but it was inside of that environment that a person who I had initially scorned and thought inferior to me eventually ended up saving my life.
And that takes me back full circle to how I started out this post. My friends, my books, and my life have changed in ways that I never could have imagined when first starting out my quest to be an orthopedic surgeon. I was brought up in a family where I was taught that work has value and to value my work. Unfortunately, the value of friendship was discussed less, but as I made it through the maze that was my career I learned that sometimes both work and friendship are inseparable things.Read More
Spider veins are the common term used to refer to visible veins through the skin. Spider veins are usually blue or purple in color and are concentrated around a center spot that often gives off the look of a spider web. Spider veins are signs of not taking care of your body, but are common and do not directly expose the person to any health risks. Spider veins are caused by not giving your feet enough rest and often appear in women because of wearing heels too often. Spider veins are just a cosmetic issue and treatment is just for cosmetic purposes. There are various treatments to reducing and hiding spider veins through laser treatments that are quick, relatively painless, and high success rate.
If you have spider veins on your ankles or legs, you can rest assured that they are just a cosmetic issue and can be treated whenever you like. Treatment of spider veins, or sclerotherapy, is a specialty treatment and not often covered under most health insurances. You will also have to see a specialty doctor get treatment, such as Sclerotherapy Los Angeles. Typically, costs of spider veins treatment depend on the severity of the case. For small area treatments, costs can range from a few hundred dollars to $600. For larger cases however, treatment can cost from $1,000 to $4,000 for severe cases. Most people who get treated can expect to spend somewhere close to $500 per treatment. Once your spider veins have received the laser treatment, you can expect to not have to get treated again in the same spot for at least another 15 years.
Depending on your case, you might also need additional treatment to treat swollen ankles, blood clots, or discolored feet due to a build up of blood. You will need to ensure you go to a practice that can treat your exact problems. For example, vein treatment Aventura treats many different kinds of vein irregularities including spider veins. Your consultation with the doctor will determine whether you need to go to a spider vein treatment center or a more specialty doctor that can really help with your case. If you need to go to a specialty doctor, then you can expect to be billed for more amount of money as the treatment you need will be increased.
To prevent spider veins occurring in the future, ensure that you give your feet ample rest. If you are working and on your feet all day, ensuring you have good shoes and give your feet rest at the end of the day will significantly reduce your chances of spider veins appearing on your feet, ankles, and legs. Additionally, drink lots of water for better circulation and health. The amount of water you need to drink daily is 6 cups at least. Water will help the blood in your veins flow much more smoothly and interrupted decreasing your risk of spider veins appearing. As a final tip, eating healthy foods and less sugar also decreases your risk of getting spider veins. What do you do to prevent spider veins appearing?Read More
So although I like to write about a lot of different topics, one of the ones that is near and dear to my heart is medicine. Let’s face it….I was a doctor for the bulk of my life. The only other job I have had longer than a physician is being a spouse and that really hasn’t been to difficult. I thought I would share here one of the difficult cases I dealt with back in 1993. At that time I was doing a shift at our local emergency room. If you ever want to become a physician I actually recommend that you spend some time in the emergency room as you really do see a little bit of everything. On that day I saw one of the worst non-fatal accidents I had seen…
It was actually a Tuesday as I remember it quite clear. The ambulance brought in a gentleman whose leg was just crushed beyond belief. One of the charge nurses on duty actually seemed quite surprised at the patient has he was wheeled in. There was blood everywhere and this man was just screaming his head off in agony. We immediately gave him some pain medicine and got to work. Being an orthopedic surgeon I very quickly realized that the man’s leg would need an immediate open reduction with internal fixation or ORIF as it’s called. This basically means that since the man’s leg was broken so badly, in fact the exposed broken bone was sticking out of his skin, that he would need surgery to correct this. The procedure involves opening the leg up, putting the bones back to together, and placing a rod to hold them in place. Not really fun for the patient but sort of routine for me.
Without getting into details the surgery itself went quite well. However, it wasn’t until he was in the recovery room that things started getting really bad. Unfortunately the man started to go into cardiac arrest and it was all hands on deck to save his life. The doctor who had taken over had to use the paddles to get his heart going (thank goodness I’m an orthopedist as those paddles scare me). Anyway, the man ultimately recovered just fine and all was well.
So, where is the “horror story” in all of this? You might not believe it but a year later my daughter married him! Oddly enough she had known the patient, who’s name is Seth, and they became boyfriend and girlfriend and ultimately husband and wife. The “horror story” part of this is that he is now my son in law and I wouldn’t wish that surgery on anyone. It is in a whole new way you look at someone when they are family versus when they are patient. At the time he was my patient, but when he became my son-in-law my perspective changed.
Another interesting side note you might be wondering is how he got his leg crushed in the first place. Unfortunately accidents like these aren’t exactly rare, he got it crushed by a forklift on the job where he works. Seth got his forklift license years ago and he is a very hard working man. He always jokes that he should have paid more attention during forklift safety training watching videos like these, when instead he was actually sleeping in safety training class. Oh Seth, if you are reading this, I hope you are now paying attention to those videos when they show them to you at work!!Read More