Behind the Mask, Beneath the Glitter: The Deeper Truths About Safe, Smart Cosmetic Surgery
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What medication can help me? Has this medication been proven to lower risk of fractures of spine and hip?
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What are the side effects? Do I need special instructions for taking my bone medication? Will the medications affect other drugs that I'm taking for other conditions? How will I know if the treatment is working? How soon will I see a change? How long will I take this medication? Am I taking any medications that put me at risk for a fall? What exercise is safest for me?
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Are there exercises I should not do? How can I know if I've fractured a bone in my spine? Tricyclic antidepressants, for example, may cause dizziness — which increases the risk of falling and could explain an increase in bone fractures. In the past few years, however, better-designed studies have not only strengthened the case for a biological link between bone and brain, but also suggested something previously unsuspected — that SSRIs may be particularly harmful to bone.
Researchers began investigating the link between depression and bone loss in the late s. Although multiple factors may contribute to bone loss, growing evidence implicates SSRI use. Clinicians prescribing SSRIs and patients taking these drugs may want to address bone health during office visits. Although typically depicted as something solid, bone is actually a dynamic, living tissue undergoing constant remodeling see illustration.
During a stage called resorption, cells known as osteoclasts break bone down into calcium and other constituent components that are returned to the bloodstream for use elsewhere in the body. During bone formation, other cells known as osteoblasts assemble calcium and other biological materials to rebuild the harvested area. Nutrient intake, exercise, and cigarette smoking all affect this remodeling process, and likely contribute to findings of low bone mineral density in patients with depression.
For example, a severely depressed patient who stays indoors for extended periods may not get enough sunlight exposure to produce vitamin D, which helps the body convert calcium into bone. Patients with depression are also less likely to exercise, and more likely to smoke, compared with healthy people. For example, studies have reported that depression elevates levels of both the stress hormone cortisol and various immune system cells that promote inflammation — changes that can harm bone.
Bone is constantly being demolished and rebuilt.
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During resorption, osteoclasts gnaw at bone, releasing calcium and other minerals into the bloodstream and leaving troughs behind. If bone-building cells known as osteoblasts cannot keep pace, these tunnels are not completely refilled, and bone becomes weaker and may fracture. More recently, scientists have discovered that bone cells have receptors for various neurotransmitters and are responsive to changes in the brain. A traumatic brain injury, for example, activates cannabinoid type 1 receptors in osteoblasts, which respond by building new bone at a rapid rate.
In the brain, activation of these receptors by smoking marijuana causes euphoria. Other researchers have found that osteoblasts also have receptors for neurotransmitters that are involved in regulation of appetite, such as neuropeptide Y and leptin.
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An emerging theory is that the hypothalamus, which helps control hunger, thirst, and behaviors related to circadian rhythm, may regulate the bone remodeling system in response to signals about food intake and energy stores that it receives from the gastrointestinal system. Most recently, researchers have focused on the impact of serotonin 5-hydroxytryptamine, or 5-HT on bone health. Depressed mood results in part from abnormal levels of this neurotransmitter. It's an intriguing theory, but so far the basic research has produced mixed results. One team found that inhibiting 5-HTT in mice slowed bone formation while accelerating bone resorption.
But another animal study found just the opposite: Other preliminary research suggests that serotonin affects bone remodeling through targets other than 5-HTT. Yet none of that training is required by law. In most states, anyone with a medical license can perform cosmetic surgery. The results can be catastrophic. Serletti says he and colleagues have seen patients come in with improperly placed breast implants and damaged facial muscles after going to poorly trained doctors. And yes, people do die: A recent German study of liposuction deaths concluded that lack of surgical experience was a major contributing factor.
In July, Arizona internist Dr. Peter Normann, was convicted of second-degree murder and manslaughter after three patients died in his care, two after liposuction and the third after a botched fat-shaping procedure. A different path Dr. Gregory Alouf is one physician who created his own route to cosmetic surgery. Alouf, a family practitioner in Salem, Va. In he began doing liposuction, followed by breast implants and other surgical procedures. Alouf learned the techniques primarily at medical conferences, where there was minimal hands-on experience.
Two years after he started offering liposuction, Alouf performed lipo on an obese year-old woman—someone the Virginia Board of Medicine stated "was not a suitable candidate for such surgery" due to her weight. Three other lipo patients experienced complications, resulting in hard and lumpy areas and "visible contour irregularities. Alouf claims that those are the only complications he has had in more than liposuction procedures. In , during a seven-hour mini-face-lift, Dr. The doctor had her sit up and applied pressure to the site while he called a plastic surgeon friend for advice.
go site As a result of these cases, the Virginia Board of Medicine ordered Alouf to stop all "full incisional" surgical procedures, stating that he "lacks the requisite education, training, experience, knowledge, skill, expertise and competence to perform such surgery. Other patients are simply physically unfit for surgery. Ideal liposuction candidates, for example, are relatively healthy, close to their ideal weight, with specific areas that need shaping.
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But some doctors will operate on anyone with a checkbook. He adds, "We have a moral responsibility to our patients. So has every plastic surgeon in the country—both from manufacturer marketing materials and from patients, who have seen the ads and ask for laser lipo by name. In the meantime, "Many doctors feel they have to use these new techniques in order to get more business," Eaves says.
But you do have to be extremely careful about who is operating on you. To guarantee at least a base of training, oversight, and experience, seek out a board- certified surgeon. Look for a doctor who is certified in plastic surgery; in some cases one certified in otolaryngology for cosmetic surgery on the head and neck or ophthalmology for cosmetic procedures in and around the eyes may be appropriate.