Dictamnus albus, Gas Plant(Burning Bush)


Botanical Name: Dictamnus albus L.
Kingdom: Plantae
Order: Sapindales
Genus: Dictamnus
Species: D. albus

Common Name:Burning-bush, False Dittany, White Dittany, and Gas-plant.

Habitat :Native to southern Europe, north Africa and southern and central Asia. It   grows in woodland margins and rocky scree, mainly on calcareous soils.

It is a perennial herb and it grows about 60 cm high. Its flowers form a loose pyramidal spike and vary in colour from pale purple to white. It normally grows in woods in warm places. It is a popular garden plant both for its flowers and for its fragrance. It bears large elegant flowers of various colours: red, white, striped or blue. Its leaves resemble those of an Ash tree. Outside its natural range it is planted in gardens and grows well in warm places. It can also be found in sheltered places in woodlands.
.click to see the pictures……..(01)…....(1).(2)…...(3)..…...(4).(5)…...(6)
In the summer months, the whole plant is covered with a kind of flammable substance, which is gluey to the touch, and has a very fragrant smell; but if it takes fire, it goes off with a flash all over the plant.

The name “Burning-bush” derives from the volatile oils produced by the plant, which can catch fire readily in hot weather, leading to comparisons with the burning bush of the Bible, including the suggestion that this is the plant involved there.

The plant is inedible: the leaves have a bitter and unpalatable taste. Despite the lemon-like smell, the plant is acrid when eaten.

The plant is more commonly known today as the Burning Bush. It is the essential oil, which has a lemon-like smell, that is flammable. The daughter of Swedish botanist Carl Linnaeus is said to once ignite the air, at the end of a particularly hot, windless summer day, above Dictamnus plants, using a simple matchstick.

It grows best in full sun, but will tolerate some light shade during the hottest months.
The Burning Bush is easily grown in most well draining garden soils, but appreciates the addition of a small amount of lime at planting time. Once established, the plant is very drought tolerant.

A mature plant will grow to 24 to 36 inches in height, and produce an abundance of 1 inch diameter white, pink, or red flowers. Propagation may be accomplished by seed which should be sown as soon as they are ripe in the Fall. Dictamnus is a long lived plant which resents transplanting, so choose your planting spot carefully so you won’t have to move it later.

Landscape Uses:Border, Foundation, Massing, Rock garden, Specimen, Woodland garden. An easily grown plant, succeeding in ordinary garden soil. It prefers a dry sunny position with some lime and is not suitable for heavy or damp soils. Established plants are drought tolerant. A very ornamental plant, it should be planted into its permanent position as soon as possible because it dislikes root disturbance. The whole plant contains a very aromatic essential oil, giving out a scent somewhat like lemon peel. When the plant is bruised, this smell becomes more like fine balsam. This essential oil is emitted from the plant in hot weather and, on a still day, can be ignited and will burn for a second or two without harming the plant, thus giving the plant its common name. Slugs are strongly attracted to this plant and can destroy it by eating all the young growth in spring. There are at least 2 named varieties, ‘Pink’ produces a tea with a less lemony flavour but with an added taste of almonds and vanilla, ‘White’ has a lemony fragrance and taste. The flowers are very attractive to bees. Special Features: Attractive foliage, Edible, Fragrant foliage, Not North American native, All or parts of this plant are poisonous, Suitable for cut flowers, Suitable for dried flowers, Fragrant flowers.

Propagation :
Seed – best sown in a cold frame as soon as it is ripe. Cold stratify stored seed for 6 weeks and sow in the spring in a cold frame. The seed usually germinates in 1 – 6 months at 15°c. As soon as they are large enough to handle, prick the seedlings out into individual pots and grow them on in the greenhouse for at least their first winter. Plant them out into their permanent positions in late spring or early summer, after the last expected frosts. Division in spring. Take care since the plant resents root disturbance. The plant can also be divided in autumn. We have found it best to tease out divisions from the side of the clump to avoid the need to dig up the main clump. Try to get divisions that already have formed roots. Pot them up in a greenhouse and grow them on for a year to make sure they are well established before planting them out. Root cuttings in November/December.
Edible Uses: Tea……A lemon-scented tea is made from the dried leaves. Refreshing and aromatic

Historical medical uses
Some use has been made of the plant (chiefly the powdered root) in herbalism. However, as the alternative name “False dittany” implies, it is unrelated to the Dittany found in Crete, which has a much more significant history of medicinal use. Like Dittany of Crete they were believed to be useful for cordial and cephalic ailments, to help resist poison and combat putrefaction, and to be useful in malignant and pestilential fevers. They were also used for cases of hysteria. While the volatile oil does have anti-inflammatory properties, it isn’t used for such ailments today.

An infusion of the tops of the plant was also used as a pleasant and efficacious medicine in the gravel. It was believed to work powerfully by provoking urine and easing colicky pains which frequently accompany that disorder. The root was considered a sure remedy for epilepsies, and other diseases of the head, opening obstructions of the womb and procuring the discharges of the uterus. The plant is known to have emmenagogic properties, but the use of such plants to procure onset of menses is generally considered obsolete today.

The burning bush has been used in Chinese herbal medicine for at least 1,500 years. A lemon-scented tea is made from the dried leaves.
D. albus also produces an oil that irritates some people’s skin. After several hours the oil creates a chemical burn that can produce blisters. The oil appears to be sunlight activated. If you wash the exposed skin before it receives too much direct sunlight, irritation won’t occur.

Dittany, a distillate of very volatile essential oils from the roots and flowers, is rarely used today. It is a diuretic, an anti-spasmodic (relaxes the muscles of the gastro-intestinal tract), an anti-helminthic (expels intestinal parasites), and a stimulant to the contraction of uterine muscle.

Modern medical uses
Today the plant is not used much, but is classified as a stomach tonic. A simple infusion of the leaves may be used as a substitute for tea and as a remedy for nervous complaints. The powdered root combined in equal parts with Peppermint has been administered in doses of 2 drams (4 g) for epilepsy. A homeopathic remedy is made from the fresh leaves. It is used in the treatment of female complaints and constipation

Other Uses:  The plant contains an essential oil. Yields from the fresh flowering plant are around 3% on a dry weight basis. This oil is used as a cosmetic

Known Hazards:…General poisoning notes:
Gas plant (Dictamnus albus) has caused phytophotodermatitis in humans. In one case in Ottawa, a gardener suffered recurring skin eruptions for several summers. The original diagnosis was poison-ivy, but subsequent testing proved that the gas plant was causing the skin reactions. The plant juices are absorbed by the skin and, in the presence of long-wave ultraviolet light, cell damage occurs. Once this cause is recognized, careful avoidance of contact with the gas plant prevents further problems (Henderson and DesGroseilliers 1984). This is an uncommon and colorful plant found in Canadian herbaceous borders.

Disclaimer:The information presented herein is intended for educational purposes only. Individual results may vary, and before using any supplements, it is always advisable to consult with your own health care provider.



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Younger You — 20 Anti-Aging Herbs and Spices to Add to Your Diet

The typical American diet that is high in simple carbohydrateswhite flour, white salt, and processed food–is aging us. We are getting all the bulk without the nutrients, plus adding to our propensity for developing real food cravings. So whether you are a vegetarian or an omnivore, you can start to reverse aging by simply choosing to eat the right foods to keep you full of vim, vigor, and vitality, especially over the holidays.

The easiest way to make sure you are getting more nutrients into every meal.

Every time you flavor your meals with herbs or spices you are literally “upgrading” your food without adding a single calorie. You are taking something ordinary and turning it into something extraordinary by adding color, flavor, vitamins, and often medicinal properties.

Here’s why:

* Spices and herbs maximize nutrient density. Herbs and spices contain antioxidants, minerals and multivitamins. At the cocktail party, choose the Thai chicken satay stick over the tried and true fried chicken strip.

* Spices and herbs create a more thermogenic diet. Because spices are nutrient dense, they are thermogenic, which means they naturally increase your metabolism.

* Some spices and herbs increase your overall feeling of fullness and satiety, so you’ll eat less. One study conducted at Maanstricht University in the Netherlands showed that when one consumes an appetizer with half a teaspoon of red pepper flakes before each meal, it decreased their calorie intake by 10-16 percent.

* Spices and herbs have real medicinal properties. Study after study shows the benefits of distinct herbs and spices. For example, one 2003 trial of 60 people with type 2 diabetes reported that consuming as little as two teaspoons of cinnamon daily for six weeks reduced blood-glucose levels significantly. It also improved blood cholesterol and triglyceride levels, perhaps because insulin plays a key role in regulating fats in your body.

Choose flavor over blandness every time, and try to incorporate these specific herbs and spices into your diet if you have the following health concerns:

*rosemary and basil for their anti-inflammatory power
*cumin and sage for their dementia-fighting power
*cayenne and cinnamon for their obesity-fighting power
*coriander and cinnamon for their sugar regulating powers
*lemon grass, nutmeg, bay leaves and saffron for their calming effects on your mood
*turmeric for its cancer fighting power
*oregano for its fungus-beating power
*garlic, mustard seed and chicory for their heart-pumping power
*basil and thyme for their skin-saving power
*turmeric, basil, cinnamon, thyme, saffron, and ginger for their immune-boosting power
*coriander, rosemary, cayenne, allspice and black pepper for their depression-busting power

Sources: The Huffington Post December 20, 2008

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New Drug Makers: Goats

They have four legs, fuzzy faces and udders full of milk. To the uninitiated, they look like dairy goats. To GTC Biotherapeutics Inc, they’re  cutting-edge drug-making machines.


The goats being raised on a farm in central Massachusetts are genetically engineered to make a human protein in their milk that prevents dangerous blood clots from forming. The company extracts the protein and turns it into a medicine that fights strokes, pulmonary embolisms and other life-threatening conditions.

GTC has asked the Food and Drug Administration to clear the drug, called ATryn. An expert panel voted overwhelmingly on Friday that it is safe and effective, putting it on the verge of becoming the first drug from a genetically engineered animal to be approved in the US. The agency is expected to make a final decision in February, said the Los Angeles Times.

If approved, the drug would be followed by hundreds of others made from milk produced by genetically engineered goats, cows, rabbits and other animals. Other products in the pipeline are designed to treat people with haemophilia, respiratory diseases and debilitating swollen tissues.

“As soon as we were able to make genetically engineered animals, this was an obvious thing to do,” said James Murray, a geneticist and professor of animal science at UC Davis. “It’s totally cut-and-paste. This is kindergarten stuff with molecular scissors.”

The biotechnology industry is rooting for ATryn. The FDA’s endorsement would signal to Americans that they have nothing to fear from the futuristic technology—and suggest that the millions they’ve invested in the technology could soon begin to pay off.

If the drug is approved, “it takes a big question mark off the table in terms of products that are developed from this technology,” said Samir Singh, president of US operations for Pharming Group, which is developing medicines using milk from genetically engineered cows and rabbits.

The public has had misgivings about eating food from genetically modified animals, and some vocal critics of such technology say the wariness could extend to medicines. “I think many people are going to have the same revulsion,” said Jaydee Hanson, a policy analyst at the Center for Food Safety, a Washington advocacy group that opposes genetic manipulation of food and animals.

For scientists, the appeal is obvious. Many drugs are now synthesized in bioreactors by bacteria or Chinese hamster ovary cells, and they require extensive processing to be suitable for humans. Genetically engineering animals is a better alternative for producing proteins, which form the basis of all biological drugs. “We’re taking advantage of the fact that the mammary gland was designed by nature to make proteins,” said Tom Newberry, GTC’s vice president for government relations.

Sources: The Times Of India

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Some Health Quaries & Answers

Jobless and lethargic :-

Q: My parents did not want me to study engineering, as I am an only child and a girl. Their old fashioned idea was that I should get a bachelors degree and get married. I finished my BE and was recruited on campus. Unfortunately, the company has been postponing my joining. Now I feel I may never get the job. I feel lethargic, am putting on weight and sleep all day.

A: Perhaps a feeling of being out of control and uncertainty about your professional future has caused this change in your personality. It is unsettling and depressing. Try to establish a routine even though at present you do not need to. Get up in the morning, jog for 40 minutes, do some ground exercises and keep an eye on your diet. Join a course that will enhance your skills. If you are still worried, check your haemoglobin and thyroid functions to see if your symptoms are due to some correctable extrinsic cause like anaemia or thyroid malfunction.

Irregular periods ..
Q: I have irregular periods which appear embarrassingly unscheduled. I am now 23 years old and my parents are looking for a “suitable alliance”. They are convinced that “everything will be alright after marriage” but I am not. Will pregnancy be a problem?

A: Your body won’t change and start behaving differently just because you are married. It is better to investigate the reasons for your irregular periods before you proceed with an “alliance”. The doctor will probably do an ultrasound scan of your uterus and ovaries and suggest blood tests to check your hormone levels. The cause of the irregularity can usually be treated. It is better to know and be aware rather than proceed blindly with the surmise that “everything will be alright after marriage”.

No sex :-
Q: I was recently diagnosed as being diabetic and hypertensive. Now I am facing erectile problem and the problem of premature ejaculation. Can these be cured?

A: This problem can occur in people with diabetes and hypertension. It is due to a neuropathy or nerve dysfunction. It can get aggravated if the diabetes is uncontrolled and also by some medications prescribed for hypertension. You need to control your blood sugar well and inform your physician about this problem so that suitable alterations can be made in the medication.

Small head :
Q: My child has a very small head and is also not developing normally. The doctor said this is “microcephaly”. She is three years old and has stiff limbs. She speaks only a few words and has seizures. Will this recur in the next pregnancy?

A: Microcephaly can be present at birth or it may develop in the first few years of life. It occurs due to interference with the growth of the brain during the early months of development in the uterus. It can be genetic, or occur because the mother unfortunately develops an infection with cytomegalovirus, rubella (German measles) or varicella (chicken pox) virus.

If there are other affected family members, or if you are married to a close relative, the likelihood of recurrence is greater. Immunisations against varicella and rubella are available. Folic acid supplements (5 mg a day) started even before pregnancy occurs and continued for the first five months of conception also helps normal brain development.

Thumping headache :

Q: I develop a severe headache on one side of the head whenever I have a cold and then I cannot concentrate.

A: Your nose may be blocked because of the discharge caused by the cold. Try putting saline nose drops into each nostril with the head tilted back and then take steam inhalations. Avoid vaporising mosquito repellents (available as mats coils and liquids) or room fresheners which aggravate the problem. If the headache still persists try taking paracetemol and an over the counter antihistamine like non-sedating levocetrizine.

: The Telegraph (Kolkata, India)

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LASIK Eye Surgery

Introduction:LASIK or Lasik (laser-assisted in situ keratomileusis) is a type of refractive laser eye surgery performed by ophthalmologists for correcting myopia, hyperopia, and astigmatism. The procedure is generally preferred to photorefractive keratectomy, PRK, (also called ASA, Advanced Surface Ablation) because it requires less time for the patient’s recovery, and the patient feels less pain overall.

It is a  surgical procedure intended to reduce a person’s dependency on glasses or contact lenses. LASIK  is a procedure that permanently changes the shape of the cornea, the clear covering of the front of the eye, using an excimer laser. However, there are instances where a PRK/ASA procedure is medically justified as being a better alternative to LASIK.

…….Click to see:LASIK Eye Surgery pictures

The LASIK technique was made possible by the Colombia-based Spanish ophthalmologist Jose Barraquer, who, around 1950 in his clinic in Bogotá, Colombia, developed the first microkeratome, used to cut thin flaps in the cornea and alter its shape, in a procedure called keratomileusis. Stephan Schaller assisted in this landmark procedure. Barraquer also researched the question of how much of the cornea had to be left unaltered to provide stable long-term results.

The eye and vision errors
The cornea is a part of the eye that helps focus light to create an image on the retina. It works in much the same way that the lens of a camera focuses light to create an image on film. The bending and focusing of light is also known as refraction. Usually the shape of the cornea and the eye are not perfect and the image on the retina is out-of-focus (blurred) or distorted. These imperfections in the focusing power of the eye are called refractive errors.

There are three primary types of refractive errors:

*Myopia: persons with myopia, or nearsightedness, have more difficulty seeing distant objects as clearly as near objects.

*Hyperopia: persons with hyperopia, or farsightedness, have more difficulty seeing near objects as clearly as distant objects.

*Astigmatism: astigmatism is a distortion of the image on the retina caused by irregularities in the cornea or lens of the eye.

Combinations of myopia and astigmatism or hyperopia and astigmatism are common. Glasses or contact lenses are designed to compensate for the eye’s imperfections. Surgical procedures aimed at improving the focusing power of the eye are called refractive surgery. In LASIK surgery, precise and controlled removal of corneal tissue by a special laser reshapes the cornea changing its focusing power.

Other types of refractive surgery:-
Radial Keratotomy or RK and Photorefractive Keratectomy or PRK are other refractive surgeries used to reshape the cornea. In RK, a very sharp knife is used to cut slits in the cornea changing its shape. PRK was the first surgical procedure developed to reshape the cornea, by sculpting, using a laser. Later, LASIK was developed. The same type of laser is used for LASIK and PRK. Often the exact same laser is used for the two types of surgery. The major difference between the two surgeries is the way that the stroma, the middle layer of the cornea, is exposed before it is vaporized with the laser. In PRK, the top layer of the cornea, called the epithelium, is scraped away to expose the stromal layer underneath. In LASIK, a flap is cut in the stromal layer and the flap is folded back.

Another type of refractive surgery is thermokeratoplasty in which heat is used to reshape the cornea. The source of the heat can be a laser, but it is a different kind of laser than is used for LASIK and PRK. Other refractive devices include corneal ring segments that are inserted into the stroma and special contact lenses that temporarily reshape the cornea (orthokeratology).

FDA regulations:-
In the United States, the Food and Drug Administration (FDA) regulates the sale of medical devices such as the lasers used for LASIK. Before a medical device can be legally sold in the U.S., the person or company that wants to sell the device must seek approval from the FDA. To gain approval, they must present evidence that the device is reasonably safe and effective for a particular use, the “indication.” Once the FDA has approved a medical device, a doctor may decide to use that device for other indications if the doctor feels it is in the best interest of a patient. The use of an approved device for other than its FDA-approved indication is called “off-label use.” The FDA does not regulate the practice of medicine.

The FDA does not have the authority to:
*Regulate a doctor’s practice. In other words, FDA does not tell doctors what to do when running their business or what they can or cannot tell their patients.

*Set the amount a doctor can charge for LASIK eye surgery. “Insist” the patient information booklet from the laser manufacturer be provided to the potential patient.

*Make recommendations for individual doctors, clinics, or eye centers. FDA does not maintain nor have access to any such list of doctors performing LASIK eye surgery.

*Conduct or provide a rating system on any medical device it regulates.

The first refractive laser systems approved by FDA were excimer lasers for use in PRK to treat myopia and later to treat astigmatism. However, doctors began using these lasers for LASIK (not just PRK), and to treat other refractive errors (not just myopia). Over the last several years, LASIK has become the main surgery doctors use to treat myopia in the United States. More recently, some laser manufacturers have gained FDA approval for laser systems for LASIK to treat myopia, hyperopia and astigmatism and for PRK to treat hyperopia and astigmatism.
When LASIK is  not for YOU ?

You are probably NOT a good candidate for refractive surgery if:

*You are not a risk taker. Certain complications are unavoidable in a percentage of patients, and there are no long-term data available for current procedures.

*It will jeopardize your career. Some jobs prohibit certain refractive procedures. Be sure to check with your employer/professional society/military service before undergoing any procedure.

*Cost is an issue. Most medical insurance will not pay for refractive surgery. Although the cost is coming down, it is still significant.

*You required a change in your contact lens or glasses prescription in the past year
. This is called refractive instability. Patients who are more likely to have refractive instability and probably should not have a refractive procedure are:

*In their early 20s or younger,
*Whose hormones are fluctuating due to disease such as diabetes,
*Who are pregnant or breastfeeding, or
*Who are taking medications such as steroids that cause fluctuations in vision.

*You have a disease or are on medications that may affect wound healing. Certain conditions, such as autoimmune diseases (e.g., lupus, rheumatoid arthritis), immunodeficiency states (e.g., HIV) and diabetes, and some medications (e.g., retinoic acid and steroids) may prevent proper healing after a refractive procedure.

*You actively participate in contact sports. You participate in boxing, wrestling, martial arts or other activities in which blows to the face and eyes are a normal occurrence.

*You are not an adult.
Currently, no lasers are approved for LASIK on persons under the age of 18.

The safety and effectiveness of refractive procedures has not been determined in patients with some diseases. Do NOT have LASIK surgery if you have a history of any of the following:

*Herpes simplex or Herpes zoster (shingles) involving the eye area.
*Glaucoma, glaucoma suspect, or ocular hypertension.
*Eye diseases, such as uveitis/iritis (inflammations of the eye) and blepharitis (inflammation of the eyelids with crusting of the eyelashes).
*Eye injuries or previous eye surgeries.

Other Risk Factors:-some of the more frequently reported complications of LASIK:
*Surgery induced dry eyes
*Overcorrection[ or undercorrection
*Visual acuity fluctuation
*Halos or starbursts around light sources at night
*Light sensitivity
*Ghost images or double vision
*Wrinkles in flap (striae)
*Decentered ablation
*Debris or growth under flap
*Thin or buttonhole flap
*Induced astigmatism
*Corneal Ectasia
*Epithelium erosion
*Posterior vitreous detachment
*Macular hole

Complications due to LASIK have been classified as those that occur due to preoperative, intraoperative, early postoperative, or late postoperative sources


A subconjunctival hemorrhage is a common and minor post-LASIK complication.

Your doctor should screen you for the following conditions or indicators of risk:

*Large pupils. Make sure this evaluation is done in a dark room. Younger patients and patients on certain medications may be prone to having large pupils under dim lighting conditions. This can cause symptoms such as glare, halos, starbursts, and ghost images (double vision) after surgery. In some patients these symptoms may be debilitating. For example, a patient may no longer be able to drive a car at night or in certain weather conditions, such as fog.

*Thin Corneas. The cornea is the thin clear covering of the eye that is over the iris, the colored part of the eye. Most refractive procedures change the eye’s focusing power by reshaping the cornea (for example, by removing tissue). Performing a refractive procedure on a cornea that is too thin or has too few cells lining the back surface (endothelial cells) may result in blinding complications.

*Previous refractive surgery (e.g., RK, PRK, LASIK). Additional refractive surgery may not be recommended. The decision to have additional refractive surgery must be made in consultation with your doctor after careful consideration of your unique situation.

*Dry Eyes.
LASIK surgery tends to aggravate this condition.

Risk Factors:
Most patients are very pleased with the results of their refractive surgery. However, like any other medical procedure, there are risks involved. That’s why it is important for you to understand the limitations and possible complications of refractive surgery.

Before undergoing a refractive procedure, you should carefully weigh the risks and benefits based on your own personal value system, and try to avoid being influenced by friends that have had the procedure or doctors encouraging you to do so.

*You may be undertreated or overtreated. Only a certain percent of patients achieve 20/20 vision without glasses or contacts. You may require additional treatment, but additional treatment may not be possible. You may still need glasses or contact lenses after surgery. This may be true even if you only required a very weak prescription before surgery. If you used reading glasses before surgery, you will still need reading glasses after surgery.
*Results are generally not as good in patients with very small amounts of astigmatism or very large refractive errors of any type. You should discuss your expectations with your doctor and realize that you may still require glasses or contacts after the surgery.
*Results may not be lasting. The level of improved vision you experience after surgery may be temporary, especially if you are farsighted or currently need reading glasses. It is especially important for farsighted individuals to have a cycloplegic refraction (a vision exam with lenses after dilating drops) as part of the screening process. Patients whose manifest refraction (a vision exam with lenses before dilating drops) is very different from their cycloplegic refraction are more likely to have temporary results.
*Some patients lose vision. Some patients lose lines of vision on the vision chart that cannot be corrected with glasses, contact lenses, or surgery as a result of treatment. There is little known about how refractive procedures affect other aspects of vision, such as contrast sensitivity (the ability to see objects clearly against a similar background or in dim lighting conditions). Some studies suggest that patients do not see as well in situations of low contrast, such as at night or in fog, after treatment as compared to before treatment. Therefore, patients with low contrast sensitivity to begin with probably should not have a refractive procedure. It is important for you to know that not all eye centers test contrast sensitivity, and that when it is tested, it should be done in a dark room.
*Some patients may develop severe dry eye syndrome. As a result of surgery, your eye may not be able to produce enough tears to keep the eye moist and comfortable. This condition may be permanent. Intensive drop therapy and the use of plugs or other procedures may be required.
Additional Risks if you are Considering the Following:

Monovision is one clinical technique used to deal with the correction of presbyopia, the gradual loss of the ability of the eye to change focus for close-up tasks that progresses with age. The intent of monovision is for the presbyopic patient to use one eye for distance viewing and one eye for near viewing. This practice was first applied to fit contact lens wearers and more recently to LASIK and other refractive surgeries. With contact lenses, a presbyopic patient has one eye fit with a contact lens to correct distance vision, and the other eye fit with a contact lens to correct near vision. In the same way, with LASIK, a presbyopic patient has one eye operated on to correct the distance vision, and the other operated on to correct the near vision. In other words, the goal of the surgery is for one eye to have vision worse than 20/20, the commonly referred to goal for LASIK surgical correction of distance vision. Since one eye is corrected for distance viewing and the other eye is corrected for near viewing, the two eyes no longer work together. This results in poorer quality vision and a decrease in depth perception. These effects of monovision are most noticeable in low lighting conditions and when performing tasks requiring very sharp vision. Therefore, you may need to wear glasses or contact lenses to fully correct both eyes for distance or near when performing visually demanding tasks, such as driving at night, operating dangerous equipment, or performing occupational tasks requiring very sharp close vision (e.g., reading small print for long periods of time).

Many patients cannot get used to having one eye blurred at all times. The difference between monovision with contact lenses and monovision with LASIK is that you can always take contact lenses out or have them changed (the treatment is reversible and adjustable) as opposed to LASIK, where the result of the surgery is not reversible or adjustable. Therefore, if you are considering monovision with LASIK, make sure you go through a trial period with contact lenses to see if you can tolerate monovision, before having the irreversible surgery performed on your eyes. Just before this trial period starts, find out if you pass your state’s driver’s license requirements with monovision, or if you need supplemental glasses to drive.

In addition, you should consider how much your presbyopia is expected to increase in the future. Ask your doctor when you should expect the results of your monovision surgery to no longer be enough for you to see near-by objects clearly without the aid of glasses or contacts, or when a second surgery might be required to further correct your near vision.

Bilateral Simultaneous Treatment
You may choose to have LASIK surgery on both eyes at the same time or to have surgery on one eye at a time. Although the convenience of having surgery on both eyes on the same day is attractive, this practice is riskier than having two separate surgeries. The second eye may have a higher risk of developing an inflammation if surgery is done on the same day than if surgery is performed on separate days. If a malfunction of the laser or microkeratome occurs causing a complication with the first eye, the second eye is more likely to also experience the same complication if the surgery is performed on the same day rather than on separate days.

If you decide to have one eye done at a time, you and your doctor will decide how long to wait before having surgery on the other eye. If both eyes are treated at the same time or before one eye has a chance to fully heal, you and your doctor do not have the advantage of being able to see how the first eye responds to surgery before the second eye is treated.

Another disadvantage to having surgery on both eyes at the same time is that the vision in both eyes may be blurred after surgery until the initial healing process is over, rather than being able to rely on clear vision in at least one eye at all times.

Finding the Right Doctor:-

If you are considering refractive surgery, make sure you:

*Compare. The levels of risk and benefit vary slightly not only from procedure to procedure, but from device to device depending on the manufacturer, and from surgeon to surgeon depending on their level of experience with a particular procedure.

*Don’t base your decision simply on cost and don’t settle for the first eye center, doctor, or procedure you investigate. Remember that the decisions you make about your eyes and refractive surgery will affect you for the rest of your life.

*Be wary of eye centers that advertise, “20/20 vision or your money back” or “package deals.” There are never any guarantees in medicine.

Read. It is important for you to read the patient handbook provided to your doctor by the manufacturer of the device used to perform the refractive procedure. Your doctor should provide you with this handbook and be willing to discuss his/her outcomes (successes as well as complications) compared to the results of studies outlined in the handbook. Even the best screened patients under the care of most skilled surgeons can experience serious complications.

During surgery. Malfunction of a device or other error, such as cutting a flap of cornea through and through instead of making a hinge during LASIK surgery, may lead to discontinuation of the procedure or irreversible damage to the eye.
After surgery. Some complications, such as migration of the flap, inflammation or infection, may require another procedure and/or intensive treatment with drops. Even with aggressive therapy, such complications may lead to temporary loss of vision or even irreversible blindness.
Under the care of an experienced doctor, carefully screened candidates with reasonable expectations and a clear understanding of the risks and alternatives are likely to be happy with the results of their refractive procedure.

Be cautious about “slick” advertising and/or deals that sound “too good to be true.” Remember, they usually are. There is a lot of competition resulting in a great deal of advertising and bidding for your business. Do your homework.

What should you expect before, during, and after surgery ?
What to expect before, during, and after surgery will vary from doctor to doctor and patient to patient. This section is a compilation of patient information developed by manufacturers and healthcare professionals, but cannot replace the dialogue you should have with your doctor. Read this information carefully and with the checklist, discuss your expectations with your doctor.

Before Surgery
If you decide to go ahead with LASIK surgery, you will need an initial or baseline evaluation by your eye doctor to determine if you are a good candidate. This is what you need to know to prepare for the exam and what you should expect:

If you wear contact lenses, it is a good idea to stop wearing them before your baseline evaluation and switch to wearing your glasses full-time. Contact lenses change the shape of your cornea for up to several weeks after you have stopped using them depending on the type of contact lenses you wear. Not leaving your contact lenses out long enough for your cornea to assume its natural shape before surgery can have negative consequences. These consequences include inaccurate measurements and a poor surgical plan, resulting in poor vision after surgery. These measurements, which determine how much corneal tissue to remove, may need to be repeated at least a week after your initial evaluation and before surgery to make sure they have not changed, especially if you wear RGP or hard lenses.

If you wear:
*soft contact lenses, you should stop wearing them for 2 weeks before your initial evaluation.
*toric soft lenses or rigid gas permeable (RGP) lenses, you should stop wearing them for at least 3 weeks before your initial evaluation.
*hard lenses, you should stop wearing them for at least 4 weeks before your initial evaluation.

You should tell your doctor:
*about your past and present medical and eye conditions
*about all the medications you are taking, including over-the-counter medications and any medications you may be allergic to

Your doctor should perform a thorough eye exam and discuss:
*whether you are a good candidate
*what the risks, benefits, and alternatives of the surgery are
*what you should expect before, during, and after surgery
*what your responsibilities will be before, during, and after surgery

You should have the opportunity to ask your doctor questions during this discussion. Give yourself plenty of time to think about the risk/benefit discussion, to review any informational literature provided by your doctor, and to have any additional questions answered by your doctor before deciding to go through with surgery and before signing the informed consent form.

You should not feel pressured by your doctor, family, friends, or anyone else to make a decision about having surgery. Carefully consider the pros and cons.

The day before surgery, you should stop using:


These products as well as debris along the eyelashes may increase the risk of infection during and after surgery. Your doctor may ask you to scrub your eyelashes for a period of time before surgery to get rid of residues and debris along the lashes.

Also before surgery, arrange for transportation to and from your surgery and your first follow-up visit. On the day of surgery, your doctor may give you some medicine to make you relax. Because this medicine impairs your ability to drive and because your vision may be blurry, even if you don’t drive make sure someone can bring you home after surgery.

During Surgery:-
The surgery should take less than 30 minutes. You will lie on your back in a reclining chair in an exam room containing the laser system. The laser system includes a large machine with a microscope attached to it and a computer screen.

A numbing drop will be placed in your eye, the area around your eye will be cleaned, and an instrument called a lid speculum will be used to hold your eyelids open. A ring will be placed on your eye and very high pressures will be applied to create suction to the cornea. Your vision will dim while the suction ring is on and you may feel the pressure and experience some discomfort during this part of the procedure. The microkeratome, a cutting instrument, is attached to the suction ring. Your doctor will use the blade of the microkeratome to cut a flap in your cornea.

The microkeratome and the suction ring are then removed. You will be able to see, but you will experience fluctuating degrees of blurred vision during the rest of the procedure. The doctor will then lift the flap and fold it back on its hinge, and dry the exposed tissue.

The laser will be positioned over your eye and you will be asked to stare at a light. This is not the laser used to remove tissue from the cornea. This light is to help you keep your eye fixed on one spot once the laser comes on. NOTE: If you cannot stare at a fixed object for at least 60 seconds, you may not be a good candidate for this surgery.

When your eye is in the correct position, your doctor will start the laser. At this point in the surgery, you may become aware of new sounds and smells. The pulse of the laser makes a ticking sound. As the laser removes corneal tissue, some people have reported a smell similar to burning hair. A computer controls the amount of laser delivered to your eye. Before the start of surgery, your doctor will have programmed the computer to vaporize a particular amount of tissue based on the measurements taken at your initial evaluation. After the pulses of laser energy vaporize the corneal tissue, the flap is put back into position.

A shield should be placed over your eye at the end of the procedure as protection, since no stitches are used to hold the flap in place. It is important for you to wear this shield to prevent you from rubbing your eye and putting pressure on your eye while you sleep, and to protect your eye from accidentally being hit or poked until the flap has healed.

After Surgery:-
Immediately after the procedure, your eye may burn, itch, or feel like there is something in it. You may experience some discomfort, or in some cases, mild pain and your doctor may suggest you take a mild pain reliever. Both your eyes may tear or water. Your vision will probably be hazy or blurry. You will instinctively want to rub your eye, but don’t! Rubbing your eye could dislodge the flap, requiring further treatment. In addition, you may experience sensitivity to light, glare, starbursts or haloes around lights, or the whites of your eye may look red or bloodshot. These symptoms should improve considerably within the first few days after surgery. You should plan on taking a few days off from work until these symptoms subside. You should contact your doctor immediately and not wait for your scheduled visit, if you experience severe pain, or if your vision or other symptoms get worse instead of better.

You should see your doctor within the first 24 to 48 hours after surgery and at regular intervals after that for at least the first six months. At the first postoperative visit, your doctor will remove the eye shield, test your vision, and examine your eye. Your doctor may give you one or more types of eye drops to take at home to help prevent infection and/or inflammation. You may also be advised to use artificial tears to help lubricate the eye. Do not resume wearing a contact lens in the operated eye, even if your vision is blurry.

You should wait one to three days following surgery before beginning any non-contact sport
s, depending on the amount of activity required, how you feel, and your doctor’s instructions.

To help prevent infection, you may need to wait for up to two weeks after surgery or until your doctor advises you otherwise before using lotions, creams, or make-up around the eye. Your doctor may advise you to continue scrubbing your eyelashes for a period of time after surgery. You should also avoid swimming and using hot tubs or whirlpools for 1-2 months.

Strenuous contact sports such as boxing, football, karate, etc. should not be attempted for at least four weeks after surgery. It is important to protect your eyes from anything that might get in them and from being hit or bumped.

During the first few months after surgery, your vision may fluctuate.
*It may take up to three to six months for your vision to stabilize after surgery.
*Glare, haloes, difficulty driving at night, and other visual symptoms may also persist during this stabilization period. If further correction or enhancement is necessary, you should wait until your eye measurements are consistent for two consecutive visits at least 3 months apart before re-operation.
*It is important to realize that although distance vision may improve after re-operation, it is unlikely that other visual symptoms such as glare or haloes will improve.
*It is also important to note that no laser company has presented enough evidence for the FDA to make conclusions about the safety or effectiveness of enhancement surgery.

Contact your eye doctor immediately, if you develop any new, unusual or worsening symptoms at any point after surgery. Such symptoms could signal a problem that, if not treated early enough, may lead to a loss of vision.


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FDA Approves Two New Stevia-Based Sweeteners

The FDA approved two versions of a new zero-calorie sweetener developed by the Coca-Cola Company and PepsiCo.


Cargill, which is marketing the sweetener Truvia from Coca-Cola, received notification from the FDA that it had no objection to the product, calling it “generally recognized as safe.”

PepsiCo said it also had received a similar letter and the same “generally recognized as safe” designation for its sweetener, PureVia.

Both products use rebiana, an extract from the stevia plant.

Sources: New York Times December 17, 2008

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A Separate Reality

Disconnecting from the Source
We all experience periods where we feel separated from the loving ebb and flow of the universe. These times of feeling disconnected from the source may occur for many reasons, but self-sabotage is the most common cause for us choosing to cut ourselves off from the flow of the universe. We purposefully, though often unconsciously, cut ourselves off from this flow and from the embrace of humanity so we can avoid dealing with painful issues, shun the necessary steps for growth, or prevent the success that we are afraid of achieving from ever happening. When you choose to disconnect from the source, you block the flow of the universe’s energy from passing through you. You become like a sleepwalker who is not fully awake to life, and your hopes, plans, and dreams begin to appear as distant blurs on a faraway horizon. Universal support has never left you, but if you can remember that you became disconnected from source by choice, you can choose to reconnect.

Reconnecting with the universe grounds you and is as easy as you making a concerted effort to become interested in the activities you love or responding to what nurtures or stimulates you. You may also want to make a list of the activities and kinds of experiences that touch your soul. Try to pinpoint the times when you have felt fully engaged and aware and ask yourself what you were doing. But one of the easiest ways to reconnect is simply by stating the intention of doing so.

When you disconnect from the universe, your sense of purpose, creativity, and ability to be innovative are not as easy to access. You may also experience a deep and empty sense of longing or feel devoid of ideas or unworthy of love. It’s important, however, to recognize that being disconnected from the universe is never a permanent state, and it can be reversed any time you decide that you are ready to reconnect. When you are connected to the universe, all aspects of your being will feel alive as the flow of the universe pours through your being and into your life.

Sources: Daily Om

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Could Drinking Heavy Atoms Lengthen Your Life?

In a back room of New Scientist‘s offices in London, I sit down at a table with the Russian biochemist Mikhail Shchepinov. In front of us are two teaspoons and a brown glass bottle. Shchepinov opens the bottle, pours out a teaspoon of clear liquid and drinks it down. He smiles. It’s my turn.

A sip a day of heavy water could reduce damage to ageing tissue that is caused by oxygen free radicals (Image: John Sann/Stone/Getty)

I put a spoonful of the liquid in my mouth and swallow. It tastes slightly sweet, which is a surprise. I was expecting it to be exactly like water since that, in fact, is what it is – heavy water to be precise, chemical formula D2O. The D stands for deuterium, an isotope of hydrogen with an atomic mass of 2 instead of 1. Deuterium is what puts the heavy in heavy water. An ice cube made out of it would sink in normal water.

My sip of heavy water is the culmination of a long journey trying to get to the bottom of a remarkable claim that Shchepinov first made around 18 months ago. He believes he has discovered an elixir of youth, a way to drink (or more likely eat) your way to a longer life.

Many anti-aging medications are based on supplementing your body’s own defenses with antioxidant compounds such as vitamin C and beta-carotene, though there is scant evidence that this does any good.

Shchepinov realized there was another way to defeat free radicals. While he was familiarizing himself with research on aging, his day job involved a well-established – if slightly obscure – bit of chemistry called the isotope effect. On Christmas day 2006, it dawned on him that putting the two together could lead to a new way of postponing the ravages of time.

The basic concept of the isotope effect is that the presence of heavy isotopes in a molecule can slow down its chemical reactions.

All of this is conventional chemistry: the isotope effect was discovered back in the 1930s and its mechanism explained in the 1940s. The effect has a long pedigree as a research tool in basic chemistry for probing the mechanisms of complex reactions.

Shchepinov, however, is the first researcher to link the effect with aging. It dawned on him that if aging is caused by free radicals trashing covalent bonds, and if those same bonds can be strengthened using the isotope effect, why not use it to make vulnerable biomolecules more resistant to attack? All you would have to do is judiciously place deuterium or carbon-13 in the bonds that are most vulnerable to attack, and chemistry should take care of the rest.

*New Scientist November 27, 2008
*Rejuvenation Research March 1, 2007; 10(1): 47-60

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Medicinal Plants Slowly Going Extinct

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The health of millions could be at risk because medicinal plants used to make traditional remedies, including drugs to combat cancer and malaria,   are being overexploited.

“The loss of medicinal plant diversity is a quiet disaster,” says Sara Oldfield, secretary general of the NGO Botanic Gardens Conservation International, told New Scientist.

Most people worldwide, including 80% of all Africans, rely on herbal medicines obtained mostly from wild plants. But some 15,000 of 50,000 medicinal species are under threat of extinction, according to a report this week from international conservation group Plantlife. Shortages have been reported in China, India, Kenya, Nepal, Tanzania and Uganda.

Commercial over-harvesting does the most harm, though pollution, competition from invasive species and habitat destruction all contribute. “Commercial collectors generally harvest medicinal plants with little care for sustainability,” the Plantlife report says. “This can be partly through ignorance, but [happens] mainly because such collection is unorganised and competitive.”

Medicinal trees at risk include the Himalayan yew (Taxus wallichiana), a source of the anti-cancer drug, paclitaxel; the pepper-bark tree (Warburgia), which yields an antimalarial; and the African cherry (Prunus africana), an extract from which is used to treat a prostate condition.

The solution, says the report’s author, Alan Hamilton, is to provide communities with incentives to protect these plants. Ten projects in India, Pakistan, China, Nepal, Uganda and Kenya showed this approach can succeed.

Sources: The Times Of India

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Hair Transplantation

A man suffering from MPB (Male Pattern Baldnes...
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Hair transplantation is a surgical technique that involves moving skin containing hair follicles from one part of the body (the donor site) to bald or balding parts (the recipient site). It is primarily used to treat male pattern baldness, whereby grafts containing hair follicles that are genetically resistant to balding are transplanted to bald scalp. However, it is also used to restore eye lashes, eye brows, beard hair, and to fill in scars caused by accidents and surgery such as face lifts and previous hair transplants. Hair transplantation differs from skin grafting in that grafts contain almost all of the epidermis and dermis surrounding the hair follicle, and many tiny grafts are transplanted rather than a single strip of skin.

Since hair naturally grows in follicles that contain groupings of 1 to 4 hairs, today’s most advanced techniques transplant these naturally occurring 1 – 4 hair “follicular units” in their natural groupings. Thus modern hair transplantation can achieve a natural appearance by mimicking nature hair for hair. This recent hair transplant procedure is called “Follicular Unit Transplantation.”


The use of both scalp flaps, in which a band of tissue with its original blood supply is shifted to the bald area, and free grafts dates back to the 19th century. Modern transplant techniques began in Japan in the 1930s, where surgeons used small grafts, and even “follicular unit grafts” to replace damaged areas of eyebrows or lashes. They did not attempt to treat baldness per se. Their efforts did not receive worldwide attention at the time, and the traumas of World War II kept their advances isolated for another two decades.

The modern era of hair transplantation in the western world was ushered in the late 1950s, when New York dermatologist Norman Orentreich began to experiment with free donor grafts to balding areas in patients with male pattern baldness. Previously it had been thought that transplanted hair would thrive no more than the original hair at the “recipient” site. Dr. Orentreich demonstrated that such grafts were “donor dominant,” as the new hairs grew and lasted just as they would have at their original home. Today Dr. Orentreich’s practice still performs hair transplants.

For the next twenty years, surgeons worked on transplanting smaller grafts, but results were only minimally successful, with 2-4 mm “plugs” leading to a doll’s head-like appearance. In the 1980s, Uebel in Brazil popularized using large numbers of small grafts, while in the United States Rassman began using thousands of “micrografts” in a single session.

In the late 1980s, Limmer introduced the use of the stereo-microscope to dissect a single donor strip into small micrografts. In 1995, Bernstein and Rassman published the first paper on “Follicular Unit Transplantation,” where hair is transplanted exclusively in naturally occurring groups of 1-4 hairs. With microscopic dissection of donor pieces from an excised portion of scalp, individual follicular units containing but 1-4 hairs could be prepared and individually relocated into needle punctures in the recipient areas. Since the transplanted hair mimics the way hair grows in nature, close to natural results were attainable.

The follicular unit hair transplant procedure has continued to evolve, becoming more refined and minimally invasive as the size of the graft incisions have become smaller. These smaller and less invasive incisions enable surgeons to place a larger number of follicular unit grafts into a given area. With the new “gold standard” of ultra refined follicular unit hair transplantation, over 50 grafts can be placed per square centimeter, when appropriate for the patient.

Surgeons have also devoted more attention to the angle and orientation of the transplanted grafts. The adoption of the “lateral slit” technique in the early 2000s, enabled hair transplant surgeons to orient 2 to 4 hair follicular unit grafts so that they splay out across the scalp’s surface. This enabled the transplanted hair to lie better on the scalp and provide better coverage to the bald areas. One disadvantage however, is that lateral incisions also tend to disrupt the scalp’s vascularity more than sagitals. Thus sagital incisions transect less hairs and blood vessels assuming the cutting instruments are of the same size. One of the big advantages of sagitals is that they do a much better job of sliding in and around existing hairs to avoid follicle transection. This certainly makes a strong case for physicians who do not require shaving of the recipient area. The lateral incisions bisect existing hairs perpendicular (horizontal) like a T while sagital incisions run parallel (vertical) along side and in between existing hairs. The use of perpendicular (lateral/coronal) slits verses parallel (sagital) slits however, has been heavily debated on patient based hair transplant communities. Many elite hair transplant surgeons typically adopt a combination of both methods depending on what is best for the patient.

The procedure:
At an initial consultation, the surgeon analyzes the patient’s scalp, discusses his preferences and expectations, and advises him/her on the best approach (e.g.,single vs. multiple sessions) and what results might reasonably be expected.


For several days prior to surgery the patient refrains from using any medicines, or alcohol, which might result in intraoperative bleeding and resultant poor “take” of the grafts. Pre-operative antibiotics are commonly prescribed to prevent wound or graft infections.

Hair transplantation is a surgical technique in which a physician redistributes hairs from an area of thick growth to bald areas.

This Procedure is Performed because:
In patients who are concerned about their balding, hair transplantation can significantly improve their appearance and self confidence. Realistic expectations are important, however. It is important to remember that hair still cannot be created; it can only be redistributed from the back of the scalp to the front.

Most patients undergoing hair transplantation have traditional male or female pattern baldness, with hair loss on the front or top of the scalp. Patients must still have thick hair on the back or sides of the scalp, or there may not be enough hair follicles to move. In some cases, patients with hair loss from lupus, injuries, or other medical problems may be treated with hair transplantation.

Patients undergoing hair transplantation should be otherwise relatively healthy, or surgery is less likely to be safe and successful. Always discuss your risks and options with your physician before undergoing any elective surgery.

Transplant operations are performed on an outpatient basis, with mild sedation (optional) and injected topical anesthesia, and typically last about four hours. The scalp is shampooed and then treated with an antibacterial chemical prior to the donor scalp being harvested.

In the usual follicular unit procedure, the surgeon harvests a strip of skin from the posterior scalp, in an area of good hair growth. The excised strip is about 1-1.5 x 15-30 cm in size. While closing the resulting wound, assistants begin to dissect individual follicular unit grafts from the strip. Working with binocular microscopes, they carefully remove excess fibrous and fatty tissue while trying to avoid damage to the follicular cells that will be used for grafting.

The surgeon then uses a fine needle to puncture the sites for receiving the grafts, placing them in a predetermined density and pattern, and angling the wounds in a consistent fashion to promote a realistic hair pattern. The assistants generally do the final part of the procedure, inserting the individual grafts in place.

Risk Factor:As with any surgical procedure, risks exist. The most common complications of hair transplantation are bleeding, infection, and scarring.

Though less dangerous, it is also possible that the transplanted hair won’t look as good as you had desired. Older techniques often resulted in unnatural appearing tufts of new hair growth. With modern techniques, this complication is infrequent.

Post-operative care:
Advances in wound care allow for semi-permeable dressings, which allow seepage of blood and tissue fluid, to be applied and changed at least daily. The vulnerable recipient area must be shielded from the sun, and shampooing is started two days after the surgery. Some surgeons will have you shampoo the day after surgery. Shampooing is important to prevent scabs from occurring around the hair shaft. Scabs adhere to the hair shaft and increase the risk of losing newly transplanted hair follicles during the first 7 to 10 days post-op.

During the first ten days, virtually all of the transplanted hairs, inevitably traumatized by their relocation, will fall out (“shock loss”). After two to three months new hair will begin to grow from the moved follicles. The patient’s hair will grow normally, and continue to thicken through the next six to nine months. Any subsequent hair loss is likely to be only from untreated areas. Some patients elect to use medications to retard such loss, while others plan a subsequent transplant procedure to deal with this eventuality.

Modern techniques:
There are two main ways in which donor grafts are extracted today. These are the Strip Harvesting Technique and the Follicular Unit Extraction (FUE) Technique.

The Strip Harvesting Technique involves removing a strip containing a large group of follicular units from the donor area – almost always from the back and sides of the scalp. The strip is then divided into grafts (or follicular units) containing 1 to 4 follicles.

The Follicular Unit Extraction (FUE) Technique involves removing one follicular unit at a time directly from the donor area – usually the back and sides, but also sometimes from the chest, legs or face (beard hair) – using a small punch usually of between 0.5mm and 1mm in diameter.

Side effects:
Hair thinning, known as “shock loss”, is a common side effect that is usually temporary. Bald patches are also common, as fifty to a hundred hairs can be lost each day.

Other side effects include swelling of areas such as the scalp and forehead. If this becomes uncomfortable, medication may ease the swelling. Additionally, the patient must be careful if his scalp starts itching, as scratching will make it worse and cause scabs to form. A moisturizer or massage shampoo may be used in order to relieve the itching.

Relevant Anatomy
The scalp is divided into 5 layers, which are easily remembered by the mnemonic SCALP, which represents, in order from outermost to innermost layer, the skin, connective subcutaneous tissue, galea aponeurosis, loose connective tissue, and periosteum over the cranium.
The skin contains all the epidermal appendages, including hair follicles, which extend into the connective subcutaneous layer. In areas that have undergone hair loss, thinning of the outer 2 layers usually occurs. This situation can be appreciated when one compares the thickness of the scalp in recipient areas to that in donor areas.

The subcutaneous layer is well vascularized and contains the main penetrating branches of the named main arteries that travel primarily along the external surface of the galea. The importance of staying superficial along the connective subcutaneous tissue layer (when one makes slit recipient sites to avoid compromising circulation) has only recently become apparent. The scalp has an excellent blood supply. The supraorbital, supratrochlear, superficial temporal, postauricular, and occipital arteries are the primary vessels, and they typically travel with the veins.

The galea aponeurotica is a nonelastic layer that connects the frontalis muscles anteriorly with the occipitalis muscle at its posterior aspect. The temporoparietal fascia, in which the superficial temporal artery travels, is also connected to the galea. The galea sliding over the loose connective tissue layer allows for most scalp mobility. This loose connective tissue layer and the periosteum below have minimal sensory innervation.

The sensory innervation of the scalp closely follows the vascular supply. At the anterior aspect, the supraorbital and supratrochlear nerves provide sensation to the anterior half of the scalp. On occasion, sensation to the frontal scalp can diminish for several weeks when a large number of graft recipient sites are made along the hairline. The occipital nerve serves the posterior half of the scalp, whereas the supraauricular and superficial temporal nerves contribute innervation from the sides.

Perhaps no anatomic feature of the scalp is more important with regard to hair transplantation than the microscopic distribution of hair. Scalp hairs usually do not grow individually; they most often grow in tiny follicular-unit bundles, which usually contain 2-3 hairs and occasionally 1 or 4 hairs. A follicular-unit contains these 1-4 terminal hairs, a sebaceous gland element, and insertions of the arrector pili muscles, all wrapped in an adventitial tissue sheath. These follicular units are dispersed throughout the scalp, where non–hair-bearing skin constitutes up to 50% of the total tissue. By transplanting only these follicular units and dissecting away the 50% of unnecessary non–hair-bearing tissue, the most natural-appearing results can be attained.
Most modern hair transplants result in excellent hair growth within several months after the procedure. Often, however, more than one treatment session is needed to create the best-looking results. The replaced hairs are usually permanent, and no long-term care is necessary.

During the recovery period after surgery, the scalp is often very tender. Strong pain medications taken by mouth may be necessary for several days. A bulky surgical dressing, or sometimes a smaller dressing protected by a baseball cap, must be worn for at least a day or two. Some surgeons may also recommend several days of antibiotics or anti-inflammatory drugs following surgery. After this very brief recovery period, no special treatment is needed.

In recent years hair transplants have become less expensive. Prices typically range from $3.00 to $7.00 per graft, with $4 to $5 per graft being about average. Normally the price per graft also drops as the size of the surgical session increases. Depending on the needs of the patient a typical surgical session can range from 1,500 to over 4,000 grafts, resulting in a total cost of approximately $6000 to $15,000. A few clinics offer larger sessions of up to 6000 grafts in one sitting.

Perhaps the most difficult part of being a surgeon is knowing when not to operate. In elective cosmetic surgery, sound judgment must certainly be exercised.

Individuals must be motivated to undergo hair transplantation. Although the author does not conduct a formal psychological evaluation by means of lengthy questionnaires and examinations, some surgeons use this method. During the consultation, the present author generally reads to the individual to ensure that he or she is mature enough to decide to undergo the planned procedure. A prospective patient who has realistic motivations and expectations before the procedure is likely to be happy after the procedure. Honest and thorough preprocedural consultation is perhaps the most important part of the process.

Poor medical health is a potential contraindication for elective surgery of any kind. Individuals cannot be taking anticoagulants (eg, Coumadin, aspirin) before the procedure. Good surgical judgment must be exercised when one considers surgery in individuals with potentially complicating medical conditions. Age is not a medical contraindication. The author has performed procedures on men in their late 70s. Ensure that such patients provide medical clearance from their internist.

Perhaps no single hair-loss condition calls for more conservatism in judgment than premature MPB. Teenagers and men in their early 20s are particularly self-conscious about hair loss because most of their peers still have full heads of hair. These young men often hold unrealistic expectations, desiring a youthful hairline that will not be appropriate as they age. Worse, early surgical correction uses a large number of donor hairs, which will be sparse in the future, potentially resulting in an unnatural look and a disappointed patient.

In general, attempt to delay the procedure in individuals in their 20s or younger, though the author has performed procedures in select individuals as young as 20 years. When counseling young men about hair loss, the author advises a conservative approach to give patients time to consider hair transplantation. If the patient and surgeon agree on transplantation, restore a relatively high hairline and instruct the patient to use minoxidil for the crown region. Perhaps in the future, as effective medical therapies that end or substantially slow MPB progression become available, a less conservative approach can be taken.

For a number of medical conditions that are associated with or that can cause hair loss, treatment with hair transplantation is not appropriate. Examples are the active phases of alopecia areata, lupus, and infections. Scalp conditions, such as vitiligo and psoriasis, must be evaluated because hair transplantation can aggravate them.


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