A hospital patient has been waiting nearly four years to leave hospital after being proclaimed fit for discharge.
The unnamed patient, who has a “serious mental health condition”, learning disability and physical health problems, has been in a hospital bed for more than 1,338 days.
The patient is expected to leave hospital in “around six months”, after arrangements were induced for their care.
The hospital is part of the Hywel Dda University Health Board in west Wales.
Conservative AM Darren Millar said the lag was “truly scandalous”.
‘Extremely costly’
Mr Millar, who represents Clwyd West, requested details of so-called “delayed discharge” in hospitals.
The response from the Welsh Health Secretary Vaughan Gething also revealed that, as of January this year, two other patients in Wales had been stuck in hospital beds for more than a year-and-a-half each.
Mr Millar told: “No patient should have to wait almost four years to be discharged from hospital.
“While bed blocking is extremely costly for the NHS in Wales, the real cost is the quality of life of patients for whom it affects.”
Referring to the long-standing patient in his letter, Mr Gething wrote: “We have recently been advised that using a bespoke commissioning approach, the health committee has secured a provider who is able to meet all of the patient’s complex requires, subject to some structural modifications to their premises.”
The numbers of days lost to delays has nearly doubled since 2010 to 200,000 a month. The median cost of a hospital bed is 400 a day.
In January, the James Paget University Hospital in Norfolk shall be used for a court order to remove a patient who had refused to leave for more than two years.
Thanks to the wonderful benefits of food science, there’s more information readily available for the things that are healthy for us.
A lot of that info, is brand new to most people, so there’s nothing to worry about if you’ve missed a few. For example, take the ordinary banana; did you know that eating two bananas a day helps to manage depression?
It’s genuinely no wonder the little Minions love banana’s when you take a look at everything they offer our bodies. It’s unbelievable to think that something so simple, can be so beneficial! Share these health tips with family and friends
Nato chief tells move sends clear and very strong message that there is a cost to Russias reckless actions
Nato has announced it is cutting the size of its Russian mission by a third, removing accreditation from seven Russian staff and repudiating three other pending applications.
The Nato secretary general, Jens Stoltenberg, said the permanent size of the Russian mission would be cut from 30 to 20 people, adding the proclamation was ” a clear and very strong message that there was a cost to Russia’s reckless actions” in poisoning the Russian double agent Sergei Skripal in Salisbury earlier this month.
He claimed Russia had underestimated Nato’s resolve and said the announcements would reduce Russia’s capability to do intelligence work across Nato.
Speaking in Brussels at the end of consultations with Nato allies on Tuesday, Stoltenberg added that he did not gues Russia had expected the west to demonstrate such resolve, pointing to the increased Nato military presence on the Russia border, higher defense spending and continued sanctions for Russia’s illegal annexation of Crimea.
He said the Nato response was aimed not only at the poisoning in Salisbury, the first utilize of a nerve agent on Nato territory, but a response to a broader pattern of unacceptable and illegal behaviour.
The US state department said that Donald Trump had “personally ordered” the expulsion of 60 Russian diplomats in Washington and New York who US intelligence believe to be snoops, and the closure of the Russian consulate in Seattle. It was the biggest single expulsion order in US history.
The department’s spokeswoman, Heather Nauert, said that Washington had played a key role in organising the global reaction. US officials, she said ” have worked tirelessly over the past three weeks to achieve this unprecedented level of cooperation and also coordination “.
Earlier on Tuesday the Russian foreign minister, Sergei Lavrov, claimed the US had use” colossal blackmail” to force European and other western powers to expel Russian envoys, and promised Moscow would respond harshly to the expulsion of more than 100 Russian envoys worldwide.
Speaking at a seminar on Afghanistan in Tashkent, Lavrov told:” When one or two diplomats are asked to leave this or that country, with apologies being whispered into our ears, we know for certain that this is a result of colossal pressure and colossal blackmail, which is Washington’s chief tool in the international scene .”
Briefing the cabinet on Tuesday, the prime minister, Theresa May, reported that 23 countries had expelled more than 115 Russian intelligence envoys. She told her cabinet colleagues this represented an unprecedented series of expulsions that has demonstrated to the Kremlin” that we will not tolerate their attempts to flout international law, undermine our values or threaten our security “.
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Theresa May:’ largest collective expulsion of Russian intelligence officers in history’- video
She added allies were not only taking these actions out of solidarity with the UK but also because they recognised security threats that these Russian networks pose to the security of their own countries and the pattern of aggression that had affected every country.
Only a handful of EU countries including Austria, Portugal, Greece and Malta, have declined to take any steps. Many countries have confined themselves to a tokenistic expulsion of a single envoy, a move designed to register support for the UK, as opposed to causing disruption to the Russian state.
Britain is now waiting to see if other nations follow May’s example and announce they will not be sending official delegations, as opposed to sporting squads, to the Football world cup in Russia this summer. British officials acknowledge that public opinion in many countries , notably Germany, is not hostile to Russia, and there is a strict political limit to the sanctions the EU collectively is willing to continue to take.
Timeline
Poisoned umbrellas and polonium: Russian-linked UK deaths
September 1978
Georgi Markov
In one of the most chilling episodes of the cold war, the Bulgarian dissenter was poisoned with a specially adapted umbrella on Waterloo Bridge. As he waited for a bus, Markov felt a sharp prick in his leg. The opposition activist, who was an irritant to the communist government of Bulgaria, succumbed three days later. A deadly pellet containing ricin was found in his scalp. His unknown assassin is thought to have been from the secret services in Bulgaria.
November 2006
Alexander Litvinenko
The fatal poisoning of the former FSB officer sparked an international incident. Litvinenko fell ill after drinking tea laced with radioactive polonium. He satisfied his killers in a bar of the Millennium hotel in Mayfair. The pair were Andrei Lugovoi- a former KGB officer turned industrialist, who is now a deputy in Russia’s state Duma- and Dmitry Kovtun, a childhood friend of Lugovoi’s from a Soviet military family. Putin denied all involvement and refused to extradite either of the killers.
March 2012
German Gorbuntsov
The exiled Russian banker survived an endeavor on his life as he got out of a taxi in east London. He was shot four times with a silenced pistol. He had been involved in a bitter dispute with two former business partners.
November 2012
Alexander Perepilichnyy
The businessman collapsed while running near his home in Surrey. Tracings of a chemical that can be found in the poison plant gelsemium were later found in his belly. Before his death, Perepilichnyy was helping a specialist investment firm uncover a $230 m Russian money-laundering operation, a pre-inquest hearing was tell. Hermitage Capital Management claimed that Perepilichnyy could have been intentionally killed for helping it uncover the scam involving Russian officials. He may have eaten a popular Russian dish containing the herb sorrel on the day of his death, which could have been poisoned.
March 2013
Boris Berezovsky
The exiled billionaire was discovered hanged in an apparent suicide after he had expended more than decade waging a high-profile media battle against his one-time protege Putin. A coroner recorded an open verdict after hearing conflicting expert evidence about the way he died. A pathologist who conducted a postmortem examination on the businessman’s body said he could not rule out murder.
December 2014
Scot Young
An associate of Berezovsky whom he helped to launder money, he was found impaled on railings after he fell from a fourth-floor flat in central London. A coroner ruled that there was insufficient evidence of suicide. But Young, who was sent to prison in January 2013 for repeatedly refusing to reveal his finances during a divorce row, told his partner he was going to jump out of the window moments before he was found.
It’s hard to keep up with the ever-growing listing of foods that keep us happy, healthy and, let’s face it, alive the longest. Here are our favorites.
Sardines
The Healthiest Food You’re( Probably) Not Eating
There are a plenty of fish in the sea, but not all of them pack as much of a nutritional punch as the tiny sardine. Although small in sizing, sardines are packed to the gills( literally !) with essential vitamins and minerals that sharpen the mind, keep the heart healthy, and bring your energy up, up, up! Plus, their bones are easy to digest, which constructs these scaly hotshots one of the most calcium-rich , non-dairy foods out there.
Canned Pumpkin
Best Food for Weight Loss
Peter, Peter pumpkin eater may have been on to something. Pumpkin is more than simply a delicious tart filling. It’s low in calories( merely 80 per cup) and high in dietary fiber with a side of protein to boot, which entails it’s a great tool for weight loss. What’s more, it’s also a nutritional powerhouse that’s chock full of beta-carotene- key for healthy eyes and a strong immune system.
Almonds and walnuts may be the hippest nuts on the block, but the peanut deserves some respect. This lowly legume contains just as many heart-healthy fats as its tree-hugging brethren and boasts more protein than any other nut . What’s more, the peanut has one of the highest concentrations of biotin, which may help boost keratin production to strengthen hair and fingernails.
Sure, they’re slimy and can be reasonably dubious if you don’t get them from a trusted source, but the high zinc content in oysters may help keep hair full, nails strong, and skin clear.
Seaweed
Best Food for a Good Night’s Sleep
Just because Thanksgiving turkey feast only happens once a year, it doesn’t mean you can’t sleep like a newborn every night. Next to turkey, seaweed has one of the highest levels of the amino acid tryptophan compared to any other food. What’s more, it contains high levels of iodine, which helps keeps the thyroid functioning properly and hormones in check.
Blackcurrants
Best Food to Beat Disease
Move over blueberries. Blackcurrants have the highest levels of the disease-fighting antioxidant anthocyanin( the pigment that attains berries dark blue and red) compared to any other fruit. What’s more, this unassuming berry contains more than three times the amount of vitamin C found in oranges, inducing it an immunity-boosting powerhouse.
Teff
The Healthiest Food You’ve Never Heard Of
This smallest, ancient grain( teff seeds were found in a pyramid dating to 3359 BC !) demonstrates that big things do come in small packages. With as much calcium as cooked spinach, high levels of vitamin C and a new various kinds of dietary fiber that helps maintain blood sugar and healthy weight, teff is poised to be the next superfood.
Not a new problem, but an annoying one: The federal tax code promotes companies to provide free parking to their employees by exempting the fringe benefit from taxation. That means the government is subsidizing passengers to drive themselves to work instead of carpooling or taking mass transit or stroll or biking or running from home.
The tax break promotes traffic congestion and fees up parking space. It’s worth the most to the people in the highest tax brackets. And it’s worth the most in places where parking is the costliest–that is, the places where congestion is the biggest problem.
Plus, of course, the tax break is money that the governmental forces doesn’t collect that could have been used to reduce other taxes or money other programs.
A new report from TransitCenter, a foundation that tells it” works to improve urban mobility ,” calculates that the parking benefit is worth up to $1,000 a year for passengers who are in high taxation brackets and work in big cities. Collectively, it calculates, the infringe expenses $7.3 billion a year in lost tax revenue.
True, there’s also a tax benefit for mass-transit commuters that costs the government about $1.3 billion a year. TransitCenter says that while it’s good as far as it goes,” it is overshadowed by the parking tax benefit’s much larger adverse impact .”
If “youre working in” a place where there’s lots of free parking in plenties or on the street you don’t benefit from the tax break. That’s because in such places the employee parking lot isn’t an economically valuable fringe benefit; you could have parked for free even if it didn’t exist. The break is merely valuable for people who work in crowded regions. So two-thirds of American workers are in effect transferring money to the other one-third.
One obvious alternative is simply to eliminate the tax break.” Nations such as Australia, Ireland, Austria, and Sweden have established systems for taxing the value of employer-provided parking that could serve as a model for the United States ,” tells the TransitCenter report.
But the organization seems to recognize that outright elimination of the breaking is a political long shot. The last time it was seriously attempted was the 1970 s, and there was ” serious pushback ,” research reports says, referring readers to this 2014 survey for the gory details.( They’re in Appendix B .)
So it lays out a variety of other options, which are important but regrettably wonky. They include such things as expanding benefits for other ways and means of get to work. It’s all in the report,” Who Pays for Parking ?”
One last think: Treating free parking like any other taxable fringe benefit could even, curiously, benefit some passengers by getting them out from behind the wheel. Tells TransitCenter:” A growing body of proof suggests that, compared to drive-alone commuting, workers who stroll, motorcycle, carpool, or ride transit to work arrive energized and refreshed, and experience lower rates of mental health issues .”
The presidential candidate blames everyone but herself for her shock defeat to Trump in this hubristic memoir
In common with everyone who is likely to read this review, I mourned when Hillary Clinton lost the election last November. Now there is an extra reason for unhappines: with time on her hands, the woman who was so qualified to be an able, diligent, clear-headed chairwoman has hurriedly written- or presided over the the time of writing of- an unreflective book that in its combining of number-crunching wonkery and strenuously pious uplift reveals more than she might have intended about why she lost. Her bewilderment is easy to understand, but couldn’t she have waited before monetising failing and relaunching her brand with a nationwide book tour?
Bill Clinton’s mantra was ” I feel your pain”, a phrase he uttered not at the site of a inundation or a earthquake but in a Manhattan nightclub, where he was heckled by an Aids activist. Hillary’s equivalent is not an offer of empathy but a demand for sympathy: she wants us to feel her ache- the numbing shock of election night, the distres of having to face a hostile mob at Trump’s inauguration and listen to him rant about social bloodbath in a speech that George W Bush described as” some weird shit “.
Public figures like to claim that they’re selflessly serving us- the little people, their voters and customers- and Clinton presents this therapeutic exercising as if she had our emotional health in intellect rather than her own.” Perhaps it’ll help you too ,” she says when describing how she mended her sadnes with Chardonnay, alternate nostril breathing, and a daily devotional text emailed by her clergyman( whose anthology of these missives has just been pulped, since some of his feelgood smarminess was plagiarised ). Then she glimpses herself in the mirror and adds:” I doubt that many people reading this will ever lose a general elections .” All commiseration dries up: it’s as self-regarding a statement as Trump’s” I’m the president and you’re not”, or his smugness when he’s devoted two scoops of ice-cream while guests get only one.
This is a classic tale of hubris( nowadays called ” entitlement “). Clinton packaged herself as America personified, wearing successive pantsuits- styled by Ralph Lauren- in red, white and blue for her three debates with Trump, and on election night she intended to declare victory on a stage shaped like a cut-out US map. Her garment bag that evening included the purple suit she planned to wear” on my first trip-up to Washington as president elect “; she had already bought the house next door in suburban New York as overspill accommodation for her travelling troupe of White House aides. Not since Agamemnon swaggered on to the red carpet in the tragedy by Aeschylus has anyone so vaingloriously asked for a comeuppance.
All this triumphalism is recalled with no twinge of compunction. Instead, others are blamed- James Comey for creating the alarm about her emails, Bernie Sanders for splitting the progressive vote, the “odious” Julian Assange for WikiLeaking, and those best buddies Putin and Trump for the Darth Vader-like” dark energy” they conjured up. Everyone who opposed her accuses of doing so out of misogyny: is Assange’s dumping of scurrilous information about the Democratic party genuinely explained by the fact that he” was charged with rape in Sweden “? Despite these accusations, her postmortem on her campaign’s” data analytic platform” and” word-of-mouth favourability metric” discloses why the masses didn’t warm to her. She erroneously assumed that American politics is about policy, whereas Trump considered that it is now an extension of showbiz.
Instead of recuperating, Clinton has opted for a re-enactment of a remote past. Her book grows fat on rosy reminiscences about her childhood baseball games, her first date with Bill, and Chelsea’s breech birth, with victory laps to celebrate her achievements as a “lady lawyer” in Arkansas, a” hometown senator’ in New York( where “shes never” actually lived when she ran for office ), and a secretary of state who travelled” almost a million miles “. She has reason to be proud, but does any of that help explain what happened on 8 November? When the reckoning arrives, she diverges into fantasies about alternative solutions future. She gives details of the legislation she would now be advancing, and even prints( or, as she sets it, “shares”) the oration she” never got a chance to deliver that night”, which ends by announced today that” America is the greatest country in the world” and promising that” we will construct America even greater”- lines that might have dribbled from the mouth of Trump.
It’s all very well to repeat” I love America”, as she ritualistically does: mustn’t she also dislike at the least half of it for rejecting her? Here her immense self-possession comes to her assist. She recollects Dylann Roof, the white supremacist who murdered the worshippers in a church in Charleston, being told by relatives of his victims” I forgive you “. Then she asks herself what she feels about Trump voters, the so-called ” deplorables “. She answers: “It’s complicated”, but the preceding anecdote speaks for her. She forgives them: like the ragtag of crucifiers, they knew not what they did.
A brief, embarrassed including references to earlier periods is inadvertently telling: Bill and Hillary were guests at Trump’s wedding to Melania( and, as the titanically petty bridegroom still recollects, they didn’t bring a present ).” We weren’t friends ,” says Hillary defensively. Then why run? It turns out Bill was ” speaking in the area that weekend”, so they ran for a laugh; Hillary calculates that Trump wanted them for their “star power”. The comment reflects as badly on the Clintons as it does on Trump: they remind me of the Duke and Duchess of Windsor, who subsidised their residence at the Waldorf Astoria by charging a fee for attendance at Manhattan cocktail parties.
There is one wrenchingly perceptive insight about Trump, who seems, she says, as if he” didn’t even want to be president at all”- unlike Clinton, who wanted it almost more than life itself. Yes, he now relives the election as obsessively as she does, and with similar qualms. He thought it would be the award handed out in the season finale of The Apprentice ; it didn’t occur to him that four years- if we’re unlucky- of tedious office work lay ahead. Maddened by the false stance he procures himself in, the captive of a reality that is not at all like reality Tv, he’s therefore concentrating on finding a way to get himself fired. Despite Clinton’s appeal for sympathy, it’s Trump that her book built “i m feeling” momentarily sorry for.
* What Happened byHillary Rodham Clinton is published by Simon and Schuster( PS20 ). To order a copy for PS17 go to guardianbookshop.com or call 0330 333 6846. Free UK p& p over PS10, online orders merely. Phone orders min p& p of PS1. 99
Got Text Neck? Doctors say neck and pain issues on rise WTVD-TV "Text neck is what I consider a chronic epidemic that goes unnoticed," explained Dr. Korey Revels, a Chiropractor and owner of Revels Chiropractic in Fayetteville. "It's basically a muscular imbalance between the front and back of the neck, you're also …
It acts on opioid receptors, hence the panic. But since some heroin users take it to ease withdrawal, its proscription could have some very harmful effects indeed
Just this morning I got an email from a head shop Id dropped into on my last trip-up to San Francisco. I didnt recall leaving my email address, but I surely recollected the shop, festooned with fascinating herbs in colorful packets, unfamiliar plants, water pipe like octopi, merging aesthetics with efficiency. Sunshine streaming through the windows and the aroma of incense, scarcely noticeable but enchanting as always.
I was visiting the haunts of my hippy days, the famous intersection of Haight and Ashbury, and of course everything appeared so much cleaner, more commercial, and, well, more legal, than it had back then. But what to buy? I dont normally take medications anymore, legal or not, but I distinguished the name kratom on several vividly coloured pockets on display behind the counter.
Kratom( Mitragyna speciosa) is sold as the crushed-up leaf of the kratom plant, grown in jungles throughout southeast Asia. You can construct kratom tea or dissolve it in juice to experience its effects, and its become increasingly popular all over the Western world( though its been around for centuries ). You can buy it at head stores, hundreds of internet site, and now at kratom bars popping up in Los Angeles and other happening places. Obviously some people enjoy this legal high.
Kratom was indeed the topic of the email, and the tone of the message was urgent 😛 TAGEND
Important Info Regarding the Future of Kratom
In case you havent heard, theres a very important development considering your access to this safe and incredibly helpful herb!
And then:
On August 30 the DEA announced their intention to place Kratom on the Schedule I list of substances starting September 30.
You can read all about this remarkable decision by the medication police. Theres a tidy article in Forbes, theres plenties on YouTube, and the DEA sitesuccinctly states their rationale 😛 TAGEND
The Drug Enforcement Administration( DEA) today announced its intention to place the active materials in the kratom plant into Schedule I of the Controlled Substances Act in order to avoid an imminent hazard to public safety.
The first thing you should know is that Schedule I medications most famously heroin, and somewhat embarrassingly marijuana and LSD call for the most severe controls and punishments.( Meth and cocaine are nearby on Schedule II ). So the kratom user may end up cell-mates with meth and heroin addicts.
The second issue is why? Whats the imminent hazard to public safety?
I wasnt well informed any hazard when I asked the pierced young woman behind the counter what type of kratom I should try. I had taken kratom with a friend in the Netherlands where I live. Here its fully legal and sold in shops, as it is in most( but not all) Western countries. Kratom happens to be illegal in Thailand, apparently because it undercuts the lucrative opium industry.
I hadnt felt much the first time Id taken kratom and wanted to give it another try. So I asked the young woman what she recommended and she brought out a menu card. Midnight Blue is the most relaxing, Sunrise is sort of stimulating but melloweds you out at the same day. Starshine only helps you feel … centered. Each concoction was touted to profer a slightly different buzz. So I bought a couple of packs for about $20 and got a little … high?
High is a strong term for what kratom actually offers. This plant is just one of a list of age-old plants and herbal extracts that attain people feel a bit peppier, a little bit happier, a bit more relaxed. A list that includes St Johns Wort, ginseng, wild lettuce, coffee( yes, coffee ), kava, lavender, valerian, betel nut the list goes on and on. The term medicinal is sometimes use. But high? That would be stretching it.
You can read all about kratom on the web, but perhaps one reason the DEA considers it an imminent hazard is because part of its consequence comes from inducing opioid receptors. You know, those receptors that get you smashed when you shoot heroin. Anything that stimulates opioid receptors and induces “youre feeling” pleasant must be very dangerous, so we shouldnt take any opportunities. In fact, lets ban alcohol( martinis owe much of their buzz to opioid receptors ), lets ban jogging( that notorious athletes high a long, gale road to the gutter ). And while were at it, lets ban breast milk, which helps newborns feel relaxed because it too induces opioid receptors.
But kratom is not an opiate. The molecule isnt even vaguely related to morphine or heroin. Its only an herb. Its impossible to overdose on kratom. Youre likely to get a headache if you take too much. The roughly 20 demises attributed to kratom in recent history are thought to be caused by other narcotics: the National Institute on Drug Abuse notes that commercial forms of kratom are sometimes laced with other compounds that have caused demises. And considering the 88, 000 deaths per year linked to alcohol and the 28, 000 overdose deaths from opiates( heroin and analgesics) in the US alone, it seems someone isnt doing their math.
Is kratom addictive? Maybe a little. But not as much as coffee and cigarettes or Q-tips, tattoos, and Pokemon Go. And if you take it daily, guess what? It loses its effect.
Ive constructed the DEAs announcement sound silly, even stupid. There they go again, banning whatever bothers them until voters in Colorado or somewhere start to object. But theres a terribly tragic outcome to be expected if kratom is banned. Because kratom attaches to opioid receptors, its an ideal route for heroin junkies to get off heroin with minimal withdrawal symptoms a harmless, herbal methadone replace. This folk-wisdom is splashed all over the net and freely shared among drug users. If kratom is banned in the US, many heroin junkies who want to quit will go back to heroin instead, and many, many more people will die.
Russian president Vladimir Putin has announced that his nations scientists have developed an effective anti-Ebola treatment.The legality of this claim, however, remains in doubt since he has not any further details, scientific publishings, or even stated if this is a therapy or vaccine.
State-operated news agency RIA Novosti quoted Putin as saying we have good news as he revealed that we have registered a drug against Ebola, which after the corresponding tests has been shown to be highly effective, more effective than the medications utilized worldwide up to now.
The brevity of this statement creates a number of questions, and until more is known about the nature of this supposed possible vaccine, as well as how clinical trials were conducted, many will have their doubts about Putins surprising assertion.
His claims came as the World Health Organization( WHO) proclaimed the Ebola crisis in West Africa over, after no new infections were reported in the past 42 days. However, several countries in the region, including Liberia and Sierra Leone, had already been reached this milestone, merely for the virus to afterward reappear. Therefore, while the news is undoubtedly positive, it is worth bearing in intellect that the affected countries are not fully out of the woods just yet.
The Ebola crisis has claimed the lives of over 11,300 people in West Africa since the outbreak began in December 2013. Several attempts to develop a vaccine have been documented over the past two years, with some presenting potential during clinical trials, although none have been approved as an effective treatment for the virus.
Among the most promising of these was a vaccine thatappeared to offer 100 percent protection against infection, yet scientists have yet to develop a technique for actually curing those who have already contracted the disease. Most recently, the first surveys employing the blood of Ebola survivors to treat sufferers yielded disappointing results.
As such, there remains a need for an effective vaccine for the virus, andif Putin’s claim turns out to be legitimate, efforts to ensure Ebola does not return to West Africa could receive a significant boost.
Every day millions of internet users ask Google some of lifes most difficult questions, big and small. Our novelists answer some of the more common queries
The nose job. Such an inoffensive, even cheerful, euphemism. An unwanted bump is straightened or the long nose sweetly bobbed.
The nose is simply fixed. Matter-of-factly, we tell friends and family: I dont like my snout, so Im having it done. Once the province of celebrities and the affluent, the nose job has become one of the most popular and accessible procedures. Theres something nearly coy about the term, playing conceal and seek as it does with its stern medical equivalent rhinoplasty, the word the plastic surgeon will use during the consultation.
While rhinoplasty remains a popular cosmetic surgery in both the USand the UK, plastic surgeons admit that it has low patient gratification rates compared to other aesthetic procedures. Many surgeons blame poor patient selection by which they entail patients with unrealistic expectations. Others acknowledge that rhinoplasty is one of the most technically challenging cosmetic surgeries and thus prone to more botched results.
Advertisement from the 1930 s for the Trilety nose shaper, a nose-shaping device. Photograph: Flickr
As a teenager, I had a nose job that went seriously awry and required revision, a journey that was emotionally and financially draining. For Jewish Americans like me in the 1970 s , nose jobs were fairly common, especially on the two coasts. My parents fostered me to narrow the broad tip-off and, although initially hesitant, I was open to what seemed at the time like a minor intervention. But my surgical outcome was anything but. I was left with a lump on one side of what had been a straight bridge and a flat columnella( the piece between the nostrils ). In chiselling the tip, the surgeon had removed too much of the lower snout, which left me feeling as though part of my face was missing. As period went on, the tip was beginning to sag due to lack of support. After two revise surgeries, I resigned myself given the fact that there existed mistakes that could not be reversed, even by a very talented surgeon.
Still, most patients are very pleased with their outcomes. If you go online to discussion boards that focus on rhinoplasty, you will find abundant accounts by delighted patients extolling their surgeries as life-changing. Some acknowledge that the new nose isnt identical to the perfect nose they anticipated, but are pleased nonetheless.
Patients considering a nose job necessarily have a range of fears, and its indisputable that surgery will cause physical discomfort. With rhinoplasty, the most unpleasant part tends to be during the course of its initial aftermath. Patients are bruised and swollen and their snouts are packed with gauze, but it looks much worse than it feels. Once the initial post-op edema subsides( relatively quickly ), some swell may persist for many months. The degree of pain and post-op swelling and bruising depend on the individuals own threshold for pain as well as the extensiveness of the surgery( rhinoplasties differ from minor to major interventions. Typically, when individuals try plastic surgery, they are so invested in the transformation that the relatively short period of discomfort seems worth it. When I was first considering surgery, I was apprehensive about both the pain and the recovery period( how long before I could re-enter the world looking normal ?), yet I discovered both easily manageable.
What can be truly distressing, however, is the discrepancy between expectation and outcome. Most patients eagerly await the resolution of the swelling as a kind of final unveiling of their beautiful new nose; but sometimes the objective is stunned, as I was, by the revelation of all that went wrong. What was indiscernible in the swollen tip is now exposed as lopsided or dented. The broad bridge of the swollen nose resolves into a twist, the opposite of the smooth straight line the patient was after. Post-operatively, the patient may not exhale as well as they once did.
Other changes can manifest themselves decades after the original surgery. Thinning skin can expose hitherto concealed cartilage grafts, while contracting scars might compromise the nasal structure.
Even though plastic surgeons concede that the operation is complex, much of the popular literature enthusiastically suggests the inevitability of a positive result and minimises, omits or misrepresents the risks. While minor primary surgeries to the nose( say, shaving off a bump) mainly have successful outcomes, more extensive interventions necessitate commensurately more surgical skill.
Surgeons Ive interviewed explain that for young and less experienced surgeons, rhinoplasty has an remarkably steep learning curve due to the lag time between the surgery and its final result a year later; only then can surgeons assess what they should do differently. A recent issue of Annals of Plastic Surgery, published this month, is wholly to be given to rhinoplasty, and its sobering reading. Most articles make clear what the general public doesnt know about the procedure that the technique( as well as outcome) of the nose job remains heavily disputed among surgeons. And there are many things that affect the outcome, from the inherent structure of the individuals snout to the surgeons experience, planning and skill.
Patients who experience poor outcomes often have to resort to expensive revise surgeries. Ones fixed nose, the nose that was intended to increase ones confidence, instead leaves one impression damaged.
For a long time after the initial surgery, my nose was all I insured when I appeared in the mirror. The very idea of cosmetic surgery stirs up fictions of miraculous transformation. Most of us like to believe we are realistic about what surgery can accomplish, but cosmetic surgery comes with implicit promises of the largest physical perfection that can be psychically distorting. When the result is not only less than the patient expected but also worse than the original, it can feel devastating.
Nevertheless, because the healing process is protracted, one tells oneself that what seems bad in the short term is wholly attributable to swelling( at least, thats what my surgeon assured me ). Dont obsess, in other words everything will turn out right in the end. So many “girls ” have been raised on fairytales about ugly ducklings becoming swans “that weve” pre-programmed to be patient in anticipation of beauty. Every day, we look in the mirror, waiting.
Surgical error isnt the only problem. Patient dissatisfaction also ensues from significant disconnections between the surgeons aesthetic goal and the patients. Surgeons might be exhaustively pleased to see results that leave patients distressed. The nose seems strangely short, for example, or the altered tip the surgeon deemed too narrow, the patient now sees as bulbous. The dorsal hump the patient hated before surgery is still in plain view. In these cases, there was a bad match between surgeon and patient.
My first revise surgery was just such a bad match. Because the surgeon agreed that my first surgery was disastrous, I didnt seem any further. Before I went under, I heard him tell a nurse: Seem what some joker did to this poor girls nose. He harvested cartilage from behind my ear in order to replace those bits excised during the original surgery. The surgery on my ear was more painful than my nose and took considerably longer to resolve. Some patients are advised that so much cartilage is required for graftings that the surgeon will need to invaded the ribs for a bountiful furnish. There are associated hazards; although rare, pneumothorax( collapsed lung) is one, and surgeons describe in chilling detail how to assess its severity and remedy it on the operating table. Pain( perhaps prolonged) always results from such intercostal harvesting.
Advertisement for a nose-shaping device, 1923. Photograph: Alamy
This second nose was very small and didnt suit my face or my notion of what real noses should look like. Put differently, it was a great nose on someone elses face. If I had been paying more attention, if I had even momentarily put aside my driving fantasy about being fixed, I should have recognised that every woman in its term of office, from nurses to receptionists, was branded by his signature style the tiny up-tilted nose.
For my third, and final, surgery I went to a surgeon whose practice was largely devoted to rewriting other surgeons bad rhinoplasties. He not only improved function( the second surgery had partially blocked my airway with bone ), he expanded the bridge and supplemented the supporting structure of the lower third of my snout. This last surgery took place 20 years after the initial operation.
Whatever picture they may bring to the surgeon, patients should be aware that surgeons remake noses in line with their own aesthetic vision. And like any manner tendency, esthetics in noses differ over day. Indeed, they can go out of style. The history of the nose job in the United States is deeply linked to the pursuit of ethnic assimilation to an ostensibly generic American appearance. The paradigm of the perfect snout, unmoored from any particular face, is what resulted in the proliferation of cookie cutter 1960 s and 70 s nose jobs among certain affluent populations in the United States. The ski-slope nose coveted by so many Americans whose ethnic appearance diverged from the persisting white Anglo-Saxon Protestant esthetic, was often tried with little regard to facial context. These surgical noses tended to exaggerate aspects of the Wasp ideal too small, too turned-up, pinched and over-sculpted nasal tips-off. Patients who were initially pleased with their results became less so as fashions in beauty shifted. By the 1980 s, surgeons began to identify the various deformities( such as alar retraction, by which they mean flared nostrils ), links with what for years had been the quintessential fixed nose.
Some surgeons specialised in revising snouts that were now deemed overdone. In the 1990 s, there was widespread criticism of the operate and maintain nose and, in its place, surgeons claimed to build a natural-looking nose tailored to enhance the individual face. Since that time, there has been a growing body of surgical literature exhorting surgeons to attend to racial and ethnic changes, both anatomically and in the service of culturally appropriate aesthetic outcomes. Still, many plastic surgeons persist in aesthetic homogeneity and rely on what they consider the ideal( white) proportions for their surgical templates. Just last year, for example, a study claimed to have confirmed the most attractive measurings for nasal tip projection and rotation among young white girls. Despite increased consciousness among surgeons of aesthetic relativism, “were not receiving” avoiding the obduracy of each surgeons perspective. The plastic surgeon isnt simply a technician; instead, she or he is an individual guided by personal savor. Yet, in a mass culture dominated by celebrity images of beauty, we can feel as though beauty is altogether objective and its criteria universally shared. The presumption of a shared aesthetic can misinform both patients and surgeons.
This is not intended to dissuade people from having surgery. Rather, I am urging prospective patients to be as informed as possible about how experienced their surgeon is, about the varying approaches( eg closed rhinoplasty, where the surgeon works within a limited visual field, v open, where the surgeon unmoors the nose from the face) as well as the real physical the limit of the body itself.
As members of a culture deep invested in physical appearances, we are all at some risk when we visit plastic surgeons, those self-styled architects of beauty. We may be overly vulnerable to their assessment of our flaws because, after all, they are the experts, arent they? There are surgeons who will sweet-talk you. My first surgeon reeled me in with a photo of a model he had operate and maintain, all the while promising an enormous( and candidly impossible) improvement to my appearance.
Make sure you schedule consultations with several surgeons. Ironically, although we commonsensically tend to seek multiple bids on a new roof for our home, when it comes to our own bodies we can be easily swayed by the first magical surgeon we visit. If the surgery have started to audio extensive( if it involves grafts, for example ), you should be doubly cautious because more can go amiss.
If you are looking for an outcome congruent with your race and ethnicity, go to a surgeon who is both surgically experienced with and aesthetically sensitive to a diverse patient population. Different surgeons may present different operative schemes and objectives to you, and you will need to decide among them. One important factor is whose work you like best insist on watching a lot of before and after photos. Of course, photographs can misinform through carefully staged angles and lighting, but at least you will know if you and the surgeon are on the same page regarding appearance.
Imaging software both 2D and 3D are applied to simulate what the change will look like on your own face, is a marketing tool that can be simultaneously informative, seductive, and beside the point. Real flesh and bone will not yield to the scalpel like a two-dimensional image.
The clairvoyant danger posed by such technology comes with the implicit temptation to imagine ourselves as infinitely mutable; this morphed version of our face beckons us into a future of potentially unsatisfying surgeries that dont measure up to the screen image.
Failed nose jobs can become lifelong preoccupations, as patients wander from one expensive surgeon to another. It is not simply the search for the perfect snout that compels us. Many of us yearn for our pre-operated, intact nose so we can go back to the beginning, before the physical and emotional damage caused to our appearance from which we cannot recover. The real risk of rhinoplasty is not inevitably physical at all. It is about becoming more preoccupied with ones appearance after the surgery than before.
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