Wednesday, May 31, 2017

Encouraging signs of openness to improving care

As regular readers know, six weeks ago I had emergency surgery to repair an umbilical hernia that had become life-threatening.

Overall, the surgery was a success--I went home alive and now am mostly recovered, although I guess I could still experience complications for up to a year.

But I am a fixer--and some aspects of this experience were not ideal.

--Before I could be operated, I needed a cardiology clearance--this took almost two months to get and I still had not gotten both tests when the thing turned bad.

After the surgery, which meant a big honking incision, I spent two days in the hospital.

--I felt they were short-staffed--it was Easter weekend, but I had to wait 20 mins when in an extreme situation in the bathroom.

--There was a hospital-based doctor called a hospitalist supposedly in charge of me, but he popped his head in once and then when I was cleared to be discharged, he was nowhere to be found to do the paperwork. The surgeons visited me everyday--which was excellent.

--There turned out to be a weird food service system--you had to order food, they didn't bring trays--it was like hotel room service. This had many strikes against it. For one thing, the nurses and aides never even asked me had I eaten. You need to eat to heal! With this system, it was more trouble than it was worth to get food. I am not talking about indicating what you want for a regular three-meals delivery of trays--this is ordering and if you don't, you don't get food.

--The gowns were coarse and scratchy and only seemed to come in two sizes--I am large but their large was GIGANTIC--I was bundled into that thing like I was velcroed in the bed.

--Yes, the blood people still come in the middle of the night, wake you, and stab you.

On the good side, I had several super nice nurses and aides, and praised them to the hospital higher ups.

Yes, I went beyond the robocall survey I got and wrote to the head of the hospital and also to my surgery group--which was later involved in an unfortunate situation when I had a complication.

This is the encouraging part. Both responded with long calls and emails to me, thanking me for the feedback and promising to look into every comment.

So--it pays to speak up. Maybe you can make it better for the next sick, weak person who comes along...

Tuesday, May 30, 2017

Kids who eat pasta regularly have better diet

Pasta is easy, cheap, and delish--despite the current spurning of carbs on the part of some movie stars and others.

In fact, children love pasta. New research shows that children and adolescents who eat pasta have a better overall diet than those who don't.

True, the study was conducted by the National Pasta Association through a company called Nutritional Strategies.

Basically, they looked a nutritional shortfalls--in other words, where kids did not get enough dietary fiber, folate, iron, magnesium, and vitamin E.

The youngsters who are pasta on a regular basis took in more of those elements--and had a better diet quality as measured by the USDA's Healthy Eating Index, 2010.

They also ate less total fat and saturated fat.

AND--no significant association was found between eating pasta and body weight, waist size, and BMI, In other words, the pasta did not make them fat.

The spokesperson for the National Pasta Association said we should think as pasta as a canvas to which we can add nutrient-dense, fiber-rich foods such as fresh veggies, fruits, cheese, lean meats, and legumes.

Offhand, I wonder if kids who eat pasta a lot are eating home-cooked meals more--which may also contribute to a better diet.

And do kids start out with Kraft Dinner and Spaghetti-Os and move on to pasta primavera? Maybe those boxed pasta dishes are gateway pasta.

Friday, May 26, 2017

Vacations are good for you

Does that sound like one for The Big Book of Duh? Well, it vacations are so therapeutic and necessary, why do 40% of Americans leave vacay days on the table?

In a report called Travel Effect on, we hesitate to get away because the pile of work will be horrendous when we return.

--Or we think we will look like slackers.

--Or we feel guilt when not working.

--Or we think we are indispensable.

Yet, rested employees are more productive and happy.

AND--Fewer vacations have also been linked to more heart attacks.

We should not be a no-vacation nation.

Even workers who take 3-day weekends are healthier.

If you can't afford a two-week vacation with the whole family, walk on your lunch hour. Leave your phone behind.

And remember--planning the vacation is also stress relieving--the benefits begin eight weeks before you leave.

Saying all this, I can never go anywhere because of my mobility and financial issues. Audiobooks are my getaway.

Thursday, May 25, 2017

"Gray Death" newest drug menace

It just sounds bad, doesn't it--Gray Death?

According to the website Route Fifty, the drug gets its name because it looks like powdered concrete.

In just 72 hrs, 11 people died of it in Erie County, NY (Buffalo area).

Gray Death is a charming mixture of heroin, fentanyl, and a new synthetic opioid called U-47700.

The latter was legal but has not been added as a Schedule I drug--the most dangerous.

A member of the Georgia Bureau of Investigation says Gray Death is one of the scariest combos he had seen in 20 yrs of forensic chemistry analysis.

"Fast track to the morgue," said another expert.

Oh--and one more huge thing. You don't have to ingest it--if it gets on your skin--as happened with an Ohio police officer--it can also kill. The officer was revived only after several does of Narcan.

Because of this, many depts are no longer field testing drugs--they send them to the lab for special handling.

Sooo...I am thinking...stay away. Far far away.

Wednesday, May 24, 2017

Weight loss surgery still problematic

Every year, 200,000 Americans undergo some sort of weight loss, or bariatric, surgery. This has been going on for 20 years.

University of Michigan researchers, however, took a look at outcomes and have published several papers on the high level of variability of outcomes from facility to facility and the incidence of complications. (Annals of Surgery)

--Nearly one in five Medicare patients with adjustable gastric band surgery (done laproscopically through small incisions) end up needing at least one more operation, either to remove or replace the band or switch to another approach.

--Nearly half of the money Medicare spends on bariatric surgery--47%--is to repair or replace the bands.

--This form of surgery has declined in popularity and constitutes only 5% of operations, but hundreds of thousands of people still have the bands installed.

--In addition--there is tremendous variation between surgery centers in terms of the rates of re-operation.

--Even accredited "centers of excellence" can vary widely as to complications. The worst to the best, even in such centers, varies 17 fold. That's a huge swing.

--Hospitals with the lowest complications rate before the operations cheaper, too.

The conclusion? Efforts to improve the quality of this surgery would affect not only patients, but also costs.

Anecdotally, I also know people who have "eaten" though this surgery and have not achieved close to the expected weight loss or it has not been lasting if it has been achieved.

Do your research!

Tuesday, May 23, 2017

The first visit to the gynecologist

I remember--waaay back in the Wayback--my first visit. The doctor said, "You will do this a million times in your life, so here is how to do it." Zip, zip, kind of embarrassing and gross--but fast.

Julie Jacobstein, a board-certified adolescent gyno with LifeBrige Health, has some tips you can pass on to your daughter:

--Explain why this visit is important, even though your daughter is not sick and has no complaint. This is a safe place to ask questions (without your mother being present). Often, the first time is just to establish a relationship--the "exam" part may not even take place.

--Tell your daughter this involves her medical history--including questions about whether she is sexually active. Also--bring your vaccination history.

--Explain the two parts of the exam. The breast exam and the pelvic exam. Emphasize that all this is over with quickly, which it is, although it can be a little uncomfortable--be honest.

--If your daughter wants to, discuss concerns beforehand--what if your child wants birth control--will she tell you or involve you in the types?

--After, ask her how it went. Your daughter may share a lot or gloss over it. Is she seems disturbed by the practitioner in any way--find a different doctor.

--Tell her this will be a regular part of her health care--get her used to it.

Those stirrups--every woman encounters them at some point.

Monday, May 22, 2017

ESAs versus service dogs

ESAs are Emotional Support Animals. These can be various species and have little or no specific training. They provide companionship, relieve loneliness and can help with anxiety or depression.

In contrast, Service Animals help owners do specific tasks, such as guiding the blind,  and have years of training in helping the disabled.

Certifying ESAs proves to be a problem.

Researchers at the University of Missouri are looking into this.

ESAs can be pets, but legally are not really pets--they can go places pets cannot go.

The laws---Federal and state--concerning ESAs are ever-changing and confusing.

---A landlord can bar a pet, but not an ESA (and often must waive pet deposits for them, too).

---ESAs can go in the main cabin of a plane or even a restaurant.

So mental health professionals must certify these animals somehow.

The researchers agreed that ESAs are appropriate for some patients. Also:

--Requests for ESAs should be met with the same thoroughness of any disability evaluation.

--Professional guidelines are needed.

--Local, state, and national policymakers should meet with mental health professionals to evaluate future legislation involving ESAs.

They also recommended the evaluators not be the owner's doctor or practitioner--this can lead to biased assessments.

So where does that leave us? Pretty much dependent on future actions, I would say. For now, a beloved "pet" could still get special privileges. But, at the same time, those special privileges could benefit the owner greatly and even save his or her life.

Google "emotional support animal"--there are many websites claiming to certify these animals. You will also find out more about the law as it stands now.

Friday, May 19, 2017

Patients of older doctors may be at slightly more risk

When I consider a physician, I wonder: Will just out of medical school with fresh information be better? Or will long experience substitute for recent training if the doctor keeps up?

My father was a doctor--he got medical journals every month--but hardly ever looked at them that I could see. I am not saying my dad was a bad physician, just observing.

Doctors are required to undertake Continuing Medical Education--is this enough?

Harvard recently examined more than 700,000 Medicare patients of 19,000 doctors from 2011 to 2014 (Ars Technica).

They found that mortality rates rose with the age of the doctor.

--Doctors under 40--the mortality rates for elderly patients within the first 30 days (of what?) was 10.8%.

--Doctors 40-49, 11.1%

--50-59, 11.3%

--Above age 60, 12.1%

In real terms, this means one more death per 77 patients for a 60-year-old doctor, compared with a 40-yr-old one.

A little over one-fourth of US doctors are over 60 years of age. Nine percent are over 70.

The researchers said this did not mean as doctors get older, their quality of care slips--it probably means there is a difference in training from before and now.

Medical technologies are evolving all the time. It might be harder for older doctors to keep up, the investigators said.

Also a cautionary note--the study involved only older patients. Would this apply to a cross section?

Still--let's keep up the Continuing Medical Ed. And not just that provided by drug companies, either.

Thursday, May 18, 2017

Treating the whole suffering person, not just the pain

I have chronic knee pain, ooo, ouch, I count every step, I talk myself through outings involving long limps, I mean, walks. But I don't want knee replacements. I have just had too bad luck with surgeries, it's as simple as that.

So I take Tylenol--carefully rationed. No more than four a day and only on bad pain days. Did you know pain can vary from day to day? It can.

I have a close relative who got into the pain med cycle--opiate dependence, if you will. It has not been good.

The American Pain Society has said for decades that you must treat the whole person, not just the pain.

Holistic medicine expert David Katz, MD, at Yale (a guy I have interviewed) urges multi-pronged approaches to pain.

Katz recommends medical, social, psychological and lifestyle factors be considered for each patient.

For instance, the doctor can look at your sleep habits. Pain can cause sleep problems. People who sleep less also have less energy, move around less, and gain weight--which can lead to more pain.

Just the exercise from sleeping more and better can improve pain.

What you are looking for is more vitality, a greater sense of well being. Sleep can be a start.

I have slept badly all my life. A few hours at a time. Now, with age making me need more pit stops in the night, this is emphasized. Even that is usually OK--but if I worry and can't sleep, mind racing, I will have terrible knee pain the next day.

So there is a link.

However, I think all this improvement of lifestyle is limited when it comes to pain. The nerves are wired to warn you when you do something the body does not "like"--each and every time you do it.

Those nerves will fire no matter how chirpy you feel.

Wednesday, May 17, 2017

The search for a new primary

I came to Arizona 21 yrs ago to help take care of my mother. In that time, my mother, who died a couple of years ago, and I had too many physicians to count--and many I have repressed. We don't have a car, so are limited to doctors relatively close by.

At this point, I think I have had a doctor in almost every physician group within 10 miles and for one reason (probably more than one), no longer see that doctor.

I have had eight cardiologists--and recently got a ninth.

Am I a nutcase who can't get along with anyone? Not really, but I do seek a doctor who will respect me, keep up with the literature, discuss new findings with me, and not go ballistic when I won't go on my thousandth diet or take big drugs I know will make me nauseated or dizzy. I also like a well-run office, response to calls, prescriptions renewed in a timely way, and consideration for the physical demands of my arthritis when it comes to trotting over to the office for this and that when it's not strictly necessary.

This week, I learned that my primary of about five years has moved too far away to get to.


I spent four hours looking up doctors on my "plan" and googling and reading reviews. (I also check each with the Medical Board for lawsuits and to see where they went to school.)

We have some real characters in the medical profession out here. The most common complaints patients seem to have are: (1) Won't touch me, (2) Doesn't renew prescriptions promptly, (3) Makes me come every three months and there is nothing wrong with me, (4) Has a rude or indifferent office staff,  (5) Turfs me to the nurse or physician assistant, (6) Won't answer all my questions, (7) Won't look at me--just the computer, (8) Is mean.

I saw so many comments along the lines of: Beware. Or Do yourself a favor--don't come here. Or--The worst doctor I ever talked to.

All these commenters cannot be nutcases. They took the time to go to a site and comment. Sure, complainers comment more than praisers, but this is pretty overwhelming.

I finally picked a guy...Who knows...I might be writing this same post in a few months.

By the way, I saw a couple of prospective doctors give a little talk on YouTube--that was interesting...Something I had not encountered before.

Tuesday, May 16, 2017

The landfill can't digest all these nutrients

In a world where people scrounge for grains of rice on the ground, the Johns Hopkins Center for a Livable Future just calculated all the protein, fiber, and other nutrients than end up thrown out in the US in a single year.

Nutrient-dense foods like fruits, veggies, seafood, and dairy are discarded a disproportionately high rates.

Previous research indicated that 40% f food is wasted nationally.  But this study shows how nutritional much of that is (J of Academy of Nutrition).

They looked at the nutritional value of the retail and consumer-level food waste in 213 categories, using US Dept of Ag data.

In all, they looked at 27 nutrients:

--1217 Calories per person PER DAY
--33 grams of protein
--5.9 grams of dietary fiber
--1.7 mcgs of Vitamin D
--286 milligrams of calcium
--880 milligrams potatssium

Why so much food waste?

--Food looks "bad"
--Large portion sizes
--Bad management of perishables

We are dumping a lot of high quality, nutritious food people could be enjoying, one researcher said.

Enjoying and benefiting from.

Monday, May 15, 2017

Really? You would let kids swim without supervision?

Little kids swim like rocks without training.

Yet, a national poll done by the University of Michigan shows that a more than one out of three parents surveyed--37%--would let their children swim in a home, hotel, or community pool unsupervised.

In a lake? 16%/ In the ocean, 13%.

Familiar places--like your own backyard pool--provide a false sense of security.

Even if the child is a good swimmer, kids should not be in the water without a watchful adult present.


Nearly ONE THOUSAND kids a year drown. Five times that many end up in the ER with non-fatal water-related injuries.

All parents polled thought kids should have basic swimming skills--but one in seven parents of kids who could not swim independently thought it was OK to leave the child in the water unsupervised.


--Half of white parents said their kid had taken swimming lessons

--39% of Hispanic kids

--37% of black kids

Black children drown at 5.5 times the rate of white children.

Communities must work to find ways to make swimming lessons more affordable, the researchers said.

That's all well and good--but use your noggins parents. All it takes is taking that one long phone call or looking away from your child in a packed, splashy pool , or depending on some 16-yr-old lifeguard to watch your kid along with 50 others.

Friday, May 12, 2017

Another medical adventure

I hate this bed! I hate this sight!
Are we having fun yet? As regular readers know, I had emergency surgery to correct a hernia a month ago. Trauma surgeon--the whole nine yards. You can scroll down for details.

After three weeks, the surgical glue began to loosen on the 7-inch incision and part of it--about 1.5 inches worth--gapped. I was afraid my entrails would tumble out or something else unappealing.

It was a Friday. The surgeon's office said to text a picture of my wound, which looked infected--white and green goop.

By the time, I got the picture to them, it was Saturday...and the receptionist (or whoever's phone number it was) said go to the ER.

When I hauled my sore, arthritic self over there, they kept saying why are you here? No tests, no IV--just why. I said because my doctor said to come.

The nurse assigned to me told me my guts were not going to spill out. Pretty much all I wanted to know.

We kept asking was a doctor from our group there to talk to me? No one seemed to know.

After three hours on their rock hard cot, my right knee was dislocated and screaming in pain.

Finally a young man showed up, introduced himself by first name only, and under questioning, indicated he was from our doctor's group--but was a Physician Asst, not a doctor.

He glanced at my gaping incision and said make an appt in the office for Monday.

What? We already had an appt for the following Friday.

All this cost me a $75 copay for the ER, plus money for Ubers there and back...$100. For nothing.

I will take it up with the surgeon today at the scheduled appt.

This young man also made it clear that he had much better things to do than look at some old gal coming apart at the seams...He could not wait to get away from me.

Medicine today?

Thursday, May 11, 2017

New weight loss drugs

As we slog into the 21st century, fat shamed, doctor shamed, spouse shamed, self shamed, what about a magic pill?

I was clapped onto amphetamines when I was 12--lost enormous amounts of weight three times, but it always found me again.

Now, according to an article in ELLE by Joseph Hooper, the FDA has approved four new drugs to combat obesity: Qsymia and Belviq (2012), Contrave and Saxenda (2014).

In 2010--Meridia was yanked off the market--it increased heart attack and stroke.

In the 1990s, patients downed fen-phen, which did cause weight loss, but also, if you took it long enough, injured your heart valves.

Now--do the researchers have it right? One said--maybe "righter."

They think they know more about the physiology of weight loss--weight-specific pathways in the body, as mysterious as that sounds.

Qsymia and Contrave are drugs prescribed for other ailments besides obesity--they have a history of being used. Still, Qsymia should not be taken by anyone with heart disease--it contains the "phen" part of fen-phen--phentermine. this substance can make you feel "speedy."

Each of the four drugs had to cause test subjects to lose 5% of their body weight, which may not sound like much, but as most dieters know, is not all that easy.

These drugs dial hunger down or satiety up, basically.

But even if you are not "hungry," you may eat for a taste reward or other reason.

Contrave, for example, contains an anti-depressant (Wellbutrin) and the anti-opiate drug naltrexone, which blunt cravings.

Belviq is an all-new drug, which affects the brain's response to the happy chemical serotonin (but not the receptors in the heart valves like fen-phen did).

All the drugs list side efx, of course. For Saxenda nausea applies to all that take it until the body "adapts." Charming.

Also, these drugs are expensive. Try a thousand bucks a month for Saxenda. And usually not covered by insurance.

So this is no miracle "cure." It's not for those last ten pounds. It's medicine. You need to thrash this out with your doctor.

The FDA, it should be noted, would not even test these on people with a BMI under 30, or 27 if the subject had an accompanying problem related to weight.

Half of American adults could meet that standard.

Wednesday, May 10, 2017

Giving older people psychiatric meds tied to falls, sorta

Researchers at the University of Michigan's School of Nursing have found that a moderate increase in depressive symptoms among people over 65 was associated with a 30% increase in the likelihood of falling over the next two years from first date of measurement.

Why? They say it's may reflect a greater use of psychiatric medications.

Still, they backed continued use of such medication while improving the monitoring of fall risk.

The depressive symptoms and presumably the medication came before the falls, though.

I found their ultimate conclusions pretty wishy-washy.

--Older adults should stay active and reduce risks of falls.

--If you are depressed, talk to a family member or your doctor about it.

--Doctors should dispense big drugs carefully at proper doses. Duh. I would add--they should also discuss side efx with the patient and family or caregivers.

A third of Americans over 65 fall at least once a year.

Big, woozy-making drugs cannot be helping.

Tuesday, May 09, 2017

Do you know the BEFAST stroke symptoms?

A friend of a friend recently went to the ER with vague strokey-maybe symptoms, which made me think of the acronym BEFAST.

B--Balance loss
E--Eyesight changes
F--Face drooping
A--Arm weakness
S--Speech garble or difficulty
T--Time to call 911

The cues used to spell FAST..the latter four--but now the B and E have been added to pick up back of brain strokes. Now 10% more strokes are being identified.

A stroke there may make you off balance or have trouble walking. There also can be vision loss in one of both eyes.

If you can't talk or be understood--the stroke may be in the process of happening.

This applies to younger people, too--strokes in those 65 and older ate down 65%. Strokes in people 25 to 44 are up 44%.

Time saved is brain saved. Don't screw around--get help.

To get the big anti-stroke drug TPA, you need to react within 3 hours. Eighty-six percent of stroke victims don't make the cutoff.

Monday, May 08, 2017

Rich and poor--we all eat fast food sometimes

The popular conception is that only down-and-out, ignorant people grab a fast food burger a few times a week--or month.

A new nationwide study, however, shows that middle-income Americans are most likely to eat fast food.

Even the richest people were only slightly less likely to report that they, too, went to our popular fast fooderies.

The study, done at Ohio State's Center for Human Resource Research, used data from the National Longitudinal Survey of Youth, which has questioned the same group of Americans since 1979.

The data came from 8,000 people who were asked about their fast food habits in 2008, 2010, and 2012.

The participants--in their 40s and 50s when surveyed--were asked how many times in the last week they had eaten food from McDonalds, KFC, Pizza Hut, Taco Bell or the like.

Overall, 79% had eaten fast food at least once and 23% more than three meals in the week.

About 80% of the lowest 10% in income ate fast food at least once a week--but for those near the middle in income, this was 85%.

If their incomes changed over the study period, their fast food consumption did not.

The researchers also found people who ate all their meals at fast food joints--a la Morgan Spurlock, who made the film Supersize Me.

Of course, the participants were not asked what they got at the fast food places. Maybe salads or just a cup of coffee.

Sure. I am positive that's what they got.

Friday, May 05, 2017


We once had an influx of dog ticks--outside in the yard, inside on the (then) dog, riding on the backs of the cats like jockeys...ticks crawling the walls...dreadful.

I loathe ticks.

But prepare for a bad tick season, says a Cornell University tick expert. A relatively mild winter means more deer and mice--and more ticks.

Even in the city--like NY--there are large mammals, meaning ticks can thrive.

The best-known "bad" tick is the blacklegged tick or "deer tick"--which carries Lyme Disease, babesiosis, and anaplasmosis.

If you now anyone who finally got a Lyme diagnosis, you know this is a long-lasting or chronic disabling ailment and is often not diagnosed for years.

The lone star tick is spreading out in the Northeast and Midwest, thriving in hotter, dryer places and transmitting ehrlichlosis and tularemia.

You need to learn to identify ticks and how to protect yourself.

--Use permethrin-based tick repellent on clothing when in wooded outside areas, even Central Park.

--Inspect yourself and kids for ticks after outings or even everyday.

--Remove a tick carefully, pulling on the head, not the body, with a tweezers.

--Try to keep the head intact in case you get sick and it has to be identified. Put it in an empty pill bottle.

Yick to ticks. Still, we have to be aware.

Thursday, May 04, 2017

The problem--no recess, kids don't play outside?

Not that this is only about money, but if we could increase the number of grade school children who participate in 25 mins of physical activity three times a week from 32% to 50%, we could avoid $21.9 billion in medical costs and lost wages over the lifetimes of these kids.

In a study done by researchers at the Bloomberg Global Obesity Prevention Center, published in Health Affairs, just a small increase in the frequency of exercise among children 8-11 could save 340,000 kids from being fat,

Running around makes kids feel better and develop healthy habits.

The scientists looked at various levels of activity. If we stay at the current level of 32% of kids exercising 25 mins 3 days a week, 8.1 million youths will be fat.

I guess we could start boosting these numbers one kid at a time...Send the tots out to play!

Put down that joystick and learn the joy of running around like a wild animal.

Do kids run around like feral beasts--we did as kids--sadly, I doubt it.

We were horrible brats and loved it.

Wednesday, May 03, 2017

Good eating--it's childsplay

If good health were as simple as eating more fruit and veggies and exercising 30 minutes a day, says Audra Rankin, a pediatric nurse practitioner at Johns Hopkins, everyone would be fit.

Not sure about that claim, but I do think kids could be enlisted into their own "health" changes.

Rankin has co-authored a book called Gordon Galloway's Mealtime Makeover--a tale of a young cow who loves junk food and doesn't get enough physical activity.

Gordon breaks down his changes into bite-size pieces (sorry)--such as eliminating one soda a week or taking a walk after dinner each day.

Beyond the book, Rankin has created a four-week program called "Lit and Fit." It's being rolled out in Kentucky. Kids and parents not only get the Gordon book but training in making healthy meals.

The latter could be effective---kids will eat what they prepare and will buy into something in which they have an active role. Adults, too.

About that title "Lit and Fit." I assume it means "lit" for literature--meaning the book--and not lit as in stoned. As we know, the latter will not lead to the healthiest food or lifestyle choices.

Monday, May 01, 2017

Thinking about face filler?

Rare--but do your research
Looking at Trump's baggy face every living second and also getting my own self videotaped last weekend, facial filler surfaced in my mind...not that I could ever afford it or even need it really.

Also--I have seen some examples of unfortunate uses of these techniques.

Now, in an article in Plastic and Reconstructive Surgery, the official mag of the American Society of Plastic Surgeons, some researchers from the Dallas Plastic surgery Institute wrote about some facial "danger zones" docs should take into consideration in shooting in fillers.

Soft tissue dermal fillers can reduce lines and wrinkles and present a younger, fuller appearance. Recovery time is short. Fillers are now second only to botox in popularity. In 2016, 2.8 million filler procedures were performed.

But--whoever does this (and it's not just plastic surgeons anymore), that doctor needs to avoid injecting into or damaging blood vessels. Partly for this reason, the doctors who wrote the article often prefer hyaluronic acid where possible--these can be reversed with a rescue injection.

The researcher say there are six danger zones on the face, from forehead to chin.

In the article is a link to a video showing how to handle each danger zone.

Might be worth discussing with your doctor before you pump up the facial features.