STD Tests

Sexually transmitted diseases, or STDs, are becoming increasingly common.  I often see patients who would like to be tested for "all STDs".  There are very different tests for the various STDs and it is important for patients to be aware of them.  This is a simple breakdown of the various types of tests we currently use for the most common diseases.

Gonorrhea and Chlamydia - Urine test for men, urine or vaginal swab for women.  Some women are able to have this during their PAP test but urine testing is available at all other times.

HIV - Blood test for screening.  If this test is positive, a test to confirm the disease is also done through blood testing.

Herpes - There are two types of testing for this.  The screening test is a blood test that tells you if you have ever been exposed to HSV (Herpes Simplex Virus), Type 1 or Type 2.  It used to be that one type of herpes was found in the mouth and the other was genital herpes. However, that has now changed and either strain can be found in either site.  Therefore, having a blood test to screen is not very useful because it will be positive even if you have ever had a cold sore.  It does not indicate the presence of an STD.

The better test for herpes is a viral culture.  This is when a patient has a fluid-filled blister that is popped open by the doctor and the fluid is sent for a culture to see which virus grows from it.  This is a definitive test and much better than the inconclusive blood test

HPV - Human Papilloma Virus has many strains that can lead to genital warts in men and women, or cervical cancer in women.  In women, HPV testing is done during a PAP test and can indicate which strain they are carrying.  For warts, there is no blood or genital test for men or women.

Hepatitis - Blood testing is possible for Hepatitis A, B, and C.

Syphilis - A blood test is used for screening.

Trichomonas - Much more commonly tested in women if they have vaginal discharge or itching. Testing is done by a vaginal swab in women and a urethral swab in men.

STD testing is very important in sexually active individuals and has become easier than ever before.  The topic may be somewhat taboo in the community and causes patients to withhold information from their health care provider.  It should be treated as any other disease and tested for as soon as possible to prevent person-to-person transmission.  See your doctor and get tested.  It could save your life or the life of someone else!

Cervical cancer screening and HPV guidelines

The American Cancer Society estimates that 12,360 women will be diagnosed with cervical cancer in 2014.  While rates of cervical cancer have declined over the years due to better screening measures, some women are not sure when they should begin the screening process.  Cervical cancer is caused by a virus known as Human Papilloma Virus or HPV.  The virus causes changes in the cells of the cervix and may lead to cancer.  Fortunately, a PAP smear is a basic test for women that can detect these changes early and lead to more effective treatment.  So when and how often do women need a PAP smear?

In 2013, ACOG (American College of Obstetricians and Gynecologists) released updated guidelines for cervical cancer screening as follows:

• Cervical cancer screening should start at age 21.  This is different than previous guidelines that recommended starting at age 18.
• Women aged 21-29 should have PAP smears ever 3 years.  This is different than yearly PAP smears which was recommended for a long time.  Women may still need annual screening if they have any cervical changes present.
• Women aged 30-65 should have a PAP smear and HPV testing every 5 years or a PAP every 3 years.
• Women should stop having PAP smears after the age of 65 if they have not had any moderate to severe cervical changes

Some exceptions to these guidelines do apply but in general, these are widely accepted to be the standard of care.  These recommendations are also consistent with those made by the US Preventive Services Task Force (USPSTF).

Cervical cancer is one type of cancer that can have a good outcome if proper screening practices are followed.  We know that it is caused by a type of virus and we have ways to detect the virus and treat the disease if it has led to biologic changes.  While many cases are detected in women without easy access to gynecological care, there are too many cases where patients have not followed up with their testing or are too hesitant to have a PAP smear.  Physicians, male and female alike, recognize the fact that women find a PAP smear uncomfortable and this is completely understandable.  However, if we do not take advantage of these great screening tools, we will lose to a disease that is preventable.  So please see your doctor and get tested!

Gonorrhea and Chlamydia rates out of control

Gonorrhea and Chlamydia are very common sexually transmitted diseases in the United States.  In fact, Chlamydia is the most commonly reported notifiable disease in the United States.  Most commonly, these disease are spread by unprotected sexual intercourse.  So how common are they?

According to the CDC, in 2010 there were a total of 1,307,893 cases of chlamydia reported in the United States.  This accounts for 426 cases out of 100,000 population and an increase of 5.1% over the period 1990-2010.  Gonorrhea came in as the second most common STD with 334,826 cases in 2012.  The rate increased 4.1% since 2011 but decreased 2.9% between 2008-2012.  These numbers are staggering!

These numbers may be rising in part due to the fact that we have better screening techniques to detect these diseases.  At a doctor's visit, most adolescents and young adults will be recommended to have a screening exam for these diseases as long as they are agreeable to it.  There are two types of testing: urine and swab.  The urine test is for males and females and results are available within 1 to 2 days.  The swab can be used for women when they are already having a PAP smear.

The problem is that those in their teens or twenties are either not seeing a doctor for symptoms, not being screened during routine visits, or are not taking their treatment medication.  Treating these two diseases is not especially difficult as we have very effective antibiotics against them.  Both the patient and their partner must be treated to prevent spread of the disease between individuals.

I think the battle we are losing is prevention.  We are noticing that people are sexually active at a younger age now and with more partners.  When we couple that with lack of protection or incorrect use of protection, we are headed for trouble.  High schools still offer sex education, but the problem continues to grow.  The responsibility is that of parents and the youth themselves.  Parents must be ready to have those difficult conversations regularly as their children continue to grow.  They should also ask that their children get tested and make it easy for them to do so by allowing them to speak to the doctor privately.  Although privacy in STD transmitting is required by law, some parents try to stay in the room with their children when the doctor asks them to leave to discuss personal matters.  This makes the child uncomfortable and may lead to the child withholding information.

We may never fully eradicate these two diseases, but we have to recognize their wildfire-like spread.  Taking an active role in testing is the only chance we have to make a difference.  Until we make screening for STD's as important as screening for cancers, we will continue to lose this uphill battle.  Spread the word, not the disease.

How do you become a Doctor?

I often get asked by patients, friends, and family members - How do you become a doctor? How long do you have to go to school? I had similar questions before I entered the medical field and thought I would break down the numbers first.

 1. 4 years of college. Your major actually does not matter as long as you take prerequisite courses that all medical school hopefuls take (i.e. 1 year of biology, 1 year of chemistry, 1 year of math, etc.)

 2. 4 years of medical school. Everybody goes through the same general training where the first 2 years are spent in the classroom and the last 2 years are clinical with patient interaction.

 3. Residency training, variable, 3-7 years. Once you finish medical school, you have to complete specific training in a residency program. These include Family Medicine, Internal Medicine, General Surgery, OBGYN, Pediatrics, etc. There are many types of residencies and you have to decide what you want to practice. Hopefully medical school gave you enough of an idea of what you like at this point.

 4. Fellowship, optional, 1+ years. This is where you get to further specialize. Lets say you wanted to become a cardiologist. This would require you to first complete a 3 year residency in Internal Medicine, followed by a 3 year fellowship in Cardiology. This can get very confusing to say the least because you can specialize for years and years.

The variables are residency and fellowship, which can add up to up to 10 years. This is why most doctors will never be practicing independently until the age of 28 or 29, and some as late as 34 or 35. There you have it, the basic steps to becoming a doctor.

How often do you exercise?

Most doctors recommend 30 minutes of moderate exercise 5 times per week.  How often do you exercise?

online survey

How many steps per day to stay fit?

Over the past several years, many individuals have started to count their steps as a way of adding exercise to their daily routines.  Most use a device known as a pedometer to see how many steps they walk in a day and then adjust their routines accordingly.  The question is, how many steps are needed to produce a beneficial health effect?  5,000? 10,000?

I recently attended the American College of Sports Medicine's Annual Meeting in San Francisco and was able to attend a clinical lecture that discussed just that.  Dr. Catrine Tudor-Locke and Dr. Michael D. Schmidt explained their detailed studies by presenting some intricate data that I will try to summarize.  The average individual takes about 5,000 steps per day with their normal activities, with men taking more than that.  If you think about it, that sounds like quite a few steps, and it is.  That amounts to about 2.5 miles.  You would think that this is surely enough to account for a healthy lifestyle but those individuals that take that many steps are typically classified as "sedentary" or "inactive."  I know that sounds unreasonable, but it is actually a valid statement.  This is because exercise should be considered an activity that takes place outside of an individual's normal routine.  Unless an individual runs or walks for a living, they are unlikely to get enough steps to be considered exercise.

That's all fine and dandy, but what is the magical number of steps that you should take?  A good rule of thumb is that you should add 3,000 steps to your daily routine.  The best way to figure out your total number needed is to use a pedometer to see how many steps you normally take.  Do this for a week and get your average steps.  You can now add 3,000 steps to this to get your goal number of steps.  For some individuals this may be 6,000 steps and for others it may be 11,000 steps.  Another good general rule of thumb to follow is that you should take 8,000 to 11,000 steps per day.  The more you take, the better off you are.

Here are some easy ways to increase your steps:
-Take the stairs at work instead of the elevator or escalator
-Park at a further spot in the parking lot (you know they are available!)
-Go for an actual walk around your neighborhood.  This is the best because your steps are concentrated within a time frame and can be considered true exercise
-Walk to lunch or to the local store
-Take your kids to the park and walk while they bike
-Window shop at the mall (I know this is sensitive territory for some), but avoid the pretzel store
-Hop on a treadmill or go for a run
-Walk your dog even if it runs around the yard all day
-If none of the above do the trick, walk in place at home while you watch TV.

If anybody already uses a pedometer, I would love to get some feedback on your success, challenges, or tips.  Now get up and go for a walk!  It's as easy as taking a few steps.

Interval Training to Burn Calories

If you enjoy running on a treadmill, then High Intensity Interval Training (HIIT) is something you might want to try.  This mode of running was previously used only by high-level athletes but has now become increasingly popular amongst the general public.  It consists of running at an average pace and adding bursts of high intensity running in between.

The benefits of interval training are multifold.  The most popular benefit is the ability to burn more calories.  With interval training, not only do you burn more calories during your workout, but you continue to burn calories for several hours after.  Some studies claim that this burn can last for up to 24 hours.  In addition, you will attain a higher level of cardiovascular fitness due to these intense bursts.  This means that your body will learn to exercise more intensely and likely for even longer periods of time.

So how does High Intensity Interval Training work?  Here is a sample treadmill workout:

• 5 minute warm-up at a moderate pace
• Alternate 1 minute of a very hard interval with 1 minute of a moderate interval for 20 minutes.  Example: 1 minute at a speed of 7 mph, then 1 minute at a speed of 5 mph.
• 5 minute cool-down at a slow pace

If you're like me and not a big fan of the treadmill, then try this on a stationary bike by alternating resistance levels.  Most individuals should start off at slower paces and gradually increase as your body adjusts to the intensity. If you are persistent with this form of exercise, you should find yourself losing some inches around the waist.  Remember to not give up too soon as most exercise forms will likely take 6 to 8 weeks to start producing noticeable results.  Good luck and HIIT the ground running!

How do you buy the right Sunscreen?

Summer is right around the corner and I'm sure most people are ready to spend some time enjoying the outdoors.  When hitting the beach or going on your favorite hike, you will hopefully apply sunscreen to protect yourself from the dangers of the sun.  However, when you walk down the sunscreen aisle, you may find yourself trying to figure out which one offers the most protection and the best price.  Suddenly, you will be lost in a jungle of SPF numbers and wonder if one is really better than the other.  You then walk out with an SPF 50 bottle that costs you $12 and hit the beach to tackle those nasty UV rays.  But does an SPF 50 offer any more protection than SPF 30?

SPF stands for the Sun Protection Factor.  An SPF of 15 basically means that if your skin burns in 10 minutes without sunscreen, you can go 15 times that without burning.  This is obviously not a hard and fast rule because if it was, then you could use SPF 50 and stay out in the sun for about 8 hours.  I definitely would not recommend that unless you are looking to come home looking extra crispy.  So which SPF should you buy?  The American Melanoma Foundation and the American Academy of Dermatology advises buying an SPF of 30 or greater.  A sunscreen of SPF 30 absorbs about 97% of ultraviolet radiation, whereas an SPF 50+ absorbs about 98%.  Additionally, you still have to apply both of those as frequently as the other.  If you're a perfectionist and looking for 100% protection, you will be disappointed because there are no sunscreens that offer total protection.

When buying sunscreen, make sure you buy one that offers "broad-spectrum protection."  This protects you against UVA and UVB rays.  Both can cause skin cancer, but UVA in particular can also prematurely age your skin.  New FDA regulations in June will require manufacturers to list the types of rays that you are protected against.  They will also eliminate words such as "waterproof" or "sweatproof" since all sunscreen will eventually wash off.  Instead, you will see "water resistant" as a common label.  Regardless of what you buy, you have to apply it early, generously, and often.  Sunscreen should be applied 30 minutes before you go out in the sun and should amount to about 1 ounce (the size of one shot glass!).  It must also be reapplied every 2 hours or in 80 minutes if you go into the water.

Sunscreen is important on sunny days, on warm and cloudy days, and even in the snow.  The sun has the capability to harm you through clouds or while you're hitting the slopes in cold temperatures.  The most commonly missed spots are the temples, the back of the ears, the top of your feet, and under your eyes.  So the next time you're out and about on a warm summer day, remember to apply that sunscreen.    Just remember, it's you against the sun.  You can fight the battle, but one of you is sure to get burned.

Optimizing your doctor visit

Going to the doctor is not the highlight of your week, and it probably never will be.  You don't want to be there.  We get it.  But there are ways to optimize your visit so that you can convey your message, receive your advice, and leave with minimal confusion.  Besides arriving on time (I know, I know...doctors run late), there are some steps to improving your visit:

1.  Be a good historian.  You have a medical issue and we are trying to diagnose it.  Before any of us ever spoke to a "real" patient, we were taught to obtain the best history possible.  While patients believe that a physical exam is the most important part of a diagnosis, most physicians agree that there is nothing as important as an accurate history.  This is the reason we ask so many questions.  Some of the most common questions are:  How long have you had this?  What have you tried for it?  Does anything make this better or worse?  Has this ever happened before?  What symptoms are associated with it (fever, chills, cough, congestion, sweating, bowel changes)?  The point is, the more information you can give us, the easier it is for us to diagnose it.  We don't need an hourly log for the past six days, but an accurate and concise description is crucial.

2.  Know your medications.  If you're taking medications, know what they are and how often you take them.  If you take a bag full of medications, bring them with you or bring an active list.  Medications and their interactions with each other can be responsible for many medical problems.  This includes over the counter medications, vitamins, supplements, herbal/natural drugs, and cultural home remedies.

3.  Read up, but don't self-diagnose.  A lot of times, a physician will ask a patient what brings them in today and the response they get is "I have bronchitis" or "I have tonsillitis."  This can bias the physician's history-taking, diagnosis, and treatment.  Report your symptoms, have your physical exam, and then ask if it can be a possible diagnosis that you read about.  Most physicians are open to discuss your ideas because in many cases, you may be very well informed of certain medical conditions and can provide valuable insight.

4.  Limit your list of chief complaints.  This one is hard to do, but it is one of the most important.  Most physician visits are limited to a 20 minute time slot.  This includes the process of having your vitals taken by the nurse, the visit, and any paperwork that needs to be done after.  Believe it or not, one chief complaint can take more than 5 minutes to address.  Something like chest pain can take longer due to the many things that can cause chest pain, the most important being heart disease.  If you have a list of 5 or 6 things to talk about, you can bet some things will be brushed off lightly due to time constraints.  If you do indeed have multiple concerns, schedule a follow-up appointment to have your needs adequately addressed.  Trust me on this one, walking in with a list of problems will lead to a disappointing visit for you both.

5.  Be patient.  Medicine is an ever-evolving art.  It does not have a cook book and it will never be mastered.  Sometimes patients and physicians alike want an answer and they want it immediately.  We live in a world of drive-thrus, delivery service, and online everything.  This doesn't work in medicine.  Many office visits are only a starting point, not the finish line.  Medicine requires testing, thinking, formulating, and sometimes guessing.  We as physicians and patients may not get our answer today, tomorrow, or ever.  A 150 years ago, Charles Darwin was trying to figure out genetics by mating pea plants.  Today we have the human genome mapped out.  Some things just take a while.

The ways in which medical care is administered has come a long way.  Long gone are the days of home visits by your neighborhood doctor.  They are replaced by double-booked office visits and self-diagnosing internet sites.  This isn't so much a problem of the patient or the physician, but more likely a product of a distressed health system.  Whether we like it or not, it is here to stay.  So the next time you visit your doctor, empower yourself and have a worthwhile visit.  Your clock starts...now.

Chicken Soup for the...Common Cold

This past weekend in Los Angeles was a reminder of what beautiful California sunshine is all about.  The birds were out chirping, the kids were out running, and my friends were out soaking in some sun at the beach.  I was home.  Coughing.

Catching a cold every year is expected, especially while working in the medical field where dodging a patient's precisely-guided cough is an essential skill.  Unfortunately, most of us have to accept defeat after a direct hit while trying to examine the throat with a tongue depressor.  (Note: when asked to say "aahh," it is entirely possible to do so without coughing.)  After my latest date with the common cold or sinus infection, I found myself bed bound and hopped up on Sudafed and Mucinex.  I'm sure most people can attest to the bad taste medication leaves in your mouth after a couple of days, and I was willing to try anything different.  I had heard a lot about chicken soup as a possible home remedy and the great taste was surely a huge plus as well.  So I tried to find out what was so special about chicken soup, and here it is.

When chicken is cooked into soup, it releases an amino acid called Cysteine.  This amino acid is actually a part of a medication known as N-acetylcysteine that is used to help break down secretions or mucus in the lungs.  Therefore, the cysteine from chicken soup is thought to aid in the process of mucus breakdown during the common cold or sinus infection.  I would say that the whole concept of cysteine seems theoretical but in reality it is actually manufactured into a medication.  This gives it significantly more credibility.

While there probably won't be any studies to back up the finding of chicken soup for the common cold, there also aren't any studies for many home remedies.  At the end of the day, we all know that a viral illness has to play itself out and there isn't much we can do to expedite it.  However, we have to try to treat the symptoms to maintain our own sanity.  So the next time you have a cold and want to keep it natural, head over to the poultry aisle and make some broth.  Cattle and pigs...carry on.

Is 5-Hour Energy the real deal?

When 5-Hour Energy was first introduced, it was primarily in specialty stores and certain grocery stores.  Last week I saw 5-Hour Energy next to the gas station cash register, sandwiched between the Slim Jims and Skittles.  The popular energy shot is now so popular that most people can recognize the small shot-sized bottle.  I assumed that 5-Hour Energy contained some sort of vitamin and herb mixture but I wasn't sure if it was effective.

It turns out that 5-Hour Energy contains some amino acids, B Vitamins, Citicholine (thought to help with memory), and caffeine.  I know, caffeine is the kicker and you probably forgot all the other ingredients after you read that one.  Some people are shocked that 5-Hour Energy contains caffeine and some people are not the least bit surprised.  So how much caffeine are we talking?  ConsumerLab.com did an independent analysis of the product and found one shot to contain 207 milligrams of caffeine.  Putting that in perspective, an 8 oz. cup of Starbucks coffee contains 160 milligrams of caffeine according to cspinet.org.

Okay so 5-Hour Energy contains caffeine and a bunch of other stuff, but does it actually work?  The producer of 5-Hour energy did its own study with 90 participants and obviously found individuals who took 5-Hour "significantly outperformed" those that did not.  There have been no outside studies to date but Consumer Reports states that "5-Hour Energy will probably chase away grogginess at least as well as a cup of coffee."  They also found little if any research that proves to support that Vitamin B and that other stuff give the average person a boost.

The bottom line from all that is that the caffeine content of 5-Hour Energy is likely about the only thing you would be getting to boost your day.  So unless we find out 10 years from now that Citicholine is the difference between appearing on Jeopardy and Wheel of Fortune, I'll stick to my cup of overpriced Starbucks!

The 10 most common reasons for visiting a doctor

Ever wonder why the doctor's office or urgent care is always so busy?  I thought it would be interesting to look at the most common chief complaints that patients present with at their doctor's visit.  I left out things such as "physical exam" and "prenatal exam" because those will obviously be significantly more common than medical problems.  According to the CDC, the most common chief complaints for which individuals saw a physician in 2008 were:

• Cough
• Symptoms referable to sore throat
• High blood pressure
• Knee symptoms
• Fever
• Skin Rash
• Abdominal pain
• Back symptoms
• Visual problems
• Earaches

To put the first two symptoms in perspective, it's interesting to look at the total number of visits for those complaints.  Cough accounted for over 26 million visits and sore throat accounted for over 17 million visits.  Of course these two conditions can also be attributed to things such as acid reflux, emphysema, smoker's cough, etc.  However, the majority of them are due to the common cold.  We also know that 90% of all colds are caused by viruses and resolve by themselves with symptomatic treatment that does not involve antibiotics.  So the next time you catch a cold, give it some time to resolve.  The guy with high blood pressure and knee pain thanks you.

Soccer player "Dead" for 78 minutes.

Fabrice Muamba is a soccer player who recently collapsed during a soccer match.  He suffered cardiac arrest on the field and CPR was begun immediately.  The medical staff worked on him for 48 minutes before he reached the hospital.  Resuscitation at the hospital continued for another 30 minutes until his heart began to beat independently.  This was also 15 shocks later from a defibrillator.  Fabrice is now in the ICU and has spoken his first words.  If you didn't believe in miracles or medical marvels, now is the time to think again.

This healthy and fit athlete is one of many that have suddenly collapsed during a sporting event, but his story of survival is certainly not the norm.  I assume he has hypertrophic cardiomyopathy (an enlargement of a portion of the heart) or one of several other conditions that can lead to sudden collapse.  With increased knowledge and improved response protocols, some of these athletes do survive this type of collapse.  The fact that Fabrice was shocked 15 times suggests that his heart did not necessarily stop completely for 78 minutes.  This is because the shockable rhythms are ventricular fibrillation and pulseless ventricular tachycardia.  Without getting into the details of these, they both imply that the heart is pumping irregularly and ineffectively.  They do not indicate that the heart completely stopped.  Regardless of the details and actual events that took place, the story of Fabrice Muamba is pretty amazing.

Fabrice's survival was dependent on two things: his willpower and that of the medical team.  For a team to  perform CPR and resuscitation for 78 minutes is remarkable.  Even if individuals are switching off on CPR, those of us that have done chest compressions will tell you that it is exhausting!  It is also mentally challenging to continue when the outlook for resuscitation is dismal.  At the same time, I don't believe this type of resuscitation would have been successful in most individuals.  Whether Fabrice survived due to his level of fitness or due to his willpower or simply by luck, his story is one of encouragement.

With all the bad publicity that athletes and the medical field receive these days, this is an example of why we each do what we do.  Whether you believe in modern medicine or miraculous feats of survival, there is no denying the intentions of the medical team and that of a young man who refused to give up.  I'm not sure Fabrice will ever play soccer again or what his mental capacity will be, but at least he will have the opportunity to see another day.  He may not be Kobe Bryant and the Black Mamba, but he is Fabrice Muamba...and he has the heart of a champion.

Color Blind St. Patty's Day: I hope this is green!

If you can read the number "45" in the image on the right, you belong to the approximately 93% of the world that is not color blind.  For the rare 7% of us, that image is nothing but a circle of scattered, colored dots.  I know, it's hard to believe that some of us cannot see a number that is clearly sitting smack in the middle of that circle.  Welcome to the world of color blindness.

When those with color blindness tell their friends about their unique dilemma, the first two questions are: 1) "So you can't see any colors?" and 2) "What color is that over there?"  Color blindness is somewhat of a misnomer because true color blindness, the inability to see anything but black and white, is almost non-existent.  Instead, most people are red-green color blind.  This usually means that when the colors red and green are held together closely or presented in certain shades, an individual may be unable to differentiate between them.  I know that sounds ridiculous to those with normal color vision, but the problem is actually biologic.  Those with color blindness have defects in photopigments in their retina and are therefore unable to perceive certain colors correctly.  Furthermore, it is actually a genetic issue since the genes for these photopigments are on the X chromosome.  Without getting into the the mechanism of gene transmission, just know that this makes color blindness predominantly a male condition.  It is inherited from mothers that function as carriers but don't actually have the condition.

You might be wondering how people with color blindness can actually function normally.  After all, how do they know when to stop at a stop light?  Rest assured, there is a reason we pass our driver's tests and don't run into intersections on a daily basis.  The reason is that a stop light "red" actually does look red and the "green" does look green.  These shades are generally very easy to differentiate as are those of roses, plants, strawberries, blood, spinach, and apples.  The trouble arises with man-made objects: clothes, Google Maps traffic (come on Google, help us out!), confetti, school mascots, and TV.  So on this day, St. Patrick's day, don't discriminate against the guy at the bar and his brown t-shirt.  He just didn't have the luck of the Irish.

Wish you were a little bit taller? Hold that thought.

Limb-lengthening is a complicated procedure that is performed by various surgeons around the world, and now by several in the US.  It was initially intended for those with short stature or dwarfism, but it has now developed a cosmetic niche as well.  That's right, for $85,000 you can grow 6 inches in 3 months.  Sounds too good to be true?   That's because it probably is.

The process of limb-lengthening begins with a surgeon breaking your lower leg (shin) bones and then inserting telescoping rods into the space.  The rods then extend by about a millimeter a day, allowing new bone, nerves, and tissue to regenerate around it.  If that sounds reasonable, just think about it one more time.  Another individual actually breaks your bones and hopes that equally sturdy bone will form in its place.  While the procedure does work, it is not without complications.  A study in the journal International Orthopaedics found there to be frequent complications with this procedure (2006 study) including nerve damage, unequal lengthening, paralysis, and hip problems.  That does not include the possibility of weaker bone formation and possible fractures in the future.

If that didn't sound bad enough, how about the inability to use anti-inflammatory medications because they may suppress bone growth?  As a result, patient's end up on high doses of narcotics such as Vicodin, Morphine, etc.  I assume a portion of them now have to deal with addiction issues and withdrawals.  Not only that, but some individuals that travel overseas for the procedure return home and have to adjust these rods themselves by some sort of leg maneuver.  Tell me THAT doesn't sound painful!

I think cosmetic surgery has come a long way and has become very mainstream.  While no procedures are entirely safe, some are safer than others.  When someone undergoes rhinoplasty (a nose job), the surgeon has to break their nose and readjust it.   This is clearly not on the level of having your legs broken for 3 months and having to undergo strenuous physical therapy to try to get your function back.  I can understand the medical uses of the procedure, but the cosmetic use is certainly extreme.  The obsession with cosmetic surgery continues to grow, but its complications are often overshadowed by its glamour.  In the case of limb-lengthening, it's hard to imagine the benefits outweighing the risks, some of which are unknown.  Besides, longer pants are so much harder to find.