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Vitamin D deficiency and insufficiency is now a global public-health problem affecting millions of people world wide. Every one talks about it these days, its indeed a hot topic.
The most well-known consequences to not having enough vit D or the “sunshine” Vitamin was associated with bone diseases like rickets, osteoporosis etc,. But these days we see the consequences are numerous and include skeletal diseases, metabolic disorders, menstrual irregularities, autoimmune diseases, cognitive disorders, depression and most important sleep disorders.. The majority of our knowledge about vitamin D has been discovered over the past 20 years, and with the growing issue of deficiencies, more health connections with vitamin D levels are being made.
About Vit D
Vitamins are considered essential nutrients because either your body cannot make them or they are made in an inadequate amount. This means you must provide them through your diet or by taking a supplement. They are essential for your health, and when you are lacking in them, there may be health consequences and diseases.
Vitamin D is one of the four fat-soluble vitamins (A, D, E, and K). There are two forms of vitamin D, D2 and D3. Vitamin D2, also known as ergocalciferol, comes from fortified foods, plant foods, and supplements. Vitamin D3, also known as cholecalciferol, comes from fortified foods, animal foods (fatty fish, cod liver oil, eggs, and liver), supplements, and can be made internally when your skin is exposed to ultraviolet (UV) radiation from the sun. Structurally, these two are not the same
Sun light And Circadian Rhythm
Inherent in all living organisms, nature’s circadian rhythm springs us into activity in the daytime and then into rest and restoration at night. And this circadian rhythm is attuned to the presence and absence of the sun, principally blue light.
Melatonin is critical to regulating the body’s circadian rhythm. When the sun goes down and it becomes dark, our eyes sense the absence of light and send a signal to the brain, which instructs the pineal gland to produce melatonin and put us to sleep.
Now in modern times, the incandescent light began humankind’s earliest assault on nature’s circadian rhythm. This has only worsened with the advent of television, computers, tablets, cell phones, gaming stations and whatever else produces light to interfere with our circadian rhythm. When the lights stay on, melatonin production is slowed or stopped.
I have seen many patients having sleep disorders having low Vit D level. There is definite link between these two. Those working indoors or those coming from sunshine less areas are mostly affected.
How to Get Free Vit D?
Exposure to sunlight — at least 10 to 15 minutes a day is recommended — is also crucial to the production of vitamin D, which is found in very few foods but is important for sleep. A deficiency in vitamin D, has been linked to insomnia and even sleep apnea.
How do you know if you have a vitamin D problem?
You can have your vitamin D levels measured when you get your annual physical and take a blood test, but you will probably need to ask your doctor to include a vitamin D measurement and then follow up to see if your level is sufficient.
Normal level is 30-100ng/ml, Below 30 is insufficient and below 20 is deficient.
You can always take vitamin D supplements (check with your physician first), but you should take the supplements in the morning or no later than early afternoon. Since vitamin D is the sunshine vitamin, it can — like the sunlight or another light source — interfere with your body’s production of melatonin. Therefore, avoid taking vitamin D. in the evening.
I firmly believe that appropriate sun exposure is the best way.
If you have sleep issues, you should always discuss them first with your health care provider. If that consultation doesn’t yield the results you desire, then by all means seek out a physician specializing in sleep disorders.
About low Vit D and Snoring Sleep Apnea, please watch the following video clips:
Rhinoplasty – Cosmetic nose reshaping is also known as Rhinoplasty. The procedure can reduce or increase the size of the nose, narrow the span of the nostrils, change the angle between the nose and upper lip, and change the tip or bridge of the nose. It can also correct some breathing problems.
Rarely patient needs to have revision surgery-touch up procedures, if not happy with the primary surgery. The goal of revision or secondary rhinoplasty is to correct the problems that appear after a previous rhinoplasty.
The principles of “secondary rhinoplasty,” or nasal surgery on a nose that has already been operated on, are very much the same as those in the primary rhinoplasty situation. It is important to consider nasal balance, function, deformities of cartilage and bone, areas that need additional support or reshaping, and to devise a safe plan that satisfies, to the greatest degree possible, the patient’s aesthetic goals.
Usually, the unintended outcomes are related partly to the nose appearance specifically to its contour and shape and the nose function particularly breathing. The most common deformities are polly beak, saddling, mid nasal asymmetry, bossa and columellar retraction. Other abnormalities that can be fixed with revision rhinoplasty are over-reduction, under-reduction, and asymmetry.
Revision rhinoplasty is always more difficult and will require more surgical experience than the first rhinoplasty but it will give you significant improvement and astonishing results. The psychological benefits are very important to take into account as well. There must be an honest rapport between the surgeon and the patient in order to set the proper expectations. The psychological relief of the patient must be of primary concern for the surgeon as well.
Revision Rhinoplasty Procedure
Revision rhinoplasty is considered as a more challenging procedure than primary rhinoplasty. This is because the initial nose anatomy has changed and there is already build up of scar tissue. Moreover, there may have been side effects and complications from the previous surgery already.
Depending on the problems developed after rhinoplasty, the patient\’s preferences, and the surgeon\’s recommendation, there are various surgical techniques available. The diversity of the techniques is related to the repair procedure, the types of implant material, and grafting. In general, the revision rhinoplsty deals with adjusting the cartilage or bone tissues. It attempts to correct what was not accomplished during the first rhinoplasty.
The revision rhinoplasty must be done by an open approach. Usually, the patient\’s tissues are used to rebuild the nasal framework. Grafts may be harvested from septal, ear, or rib cartilage. This will depend on what nasal part has to be reconstructed. For instance, if the bridge of the nose has to be rebuilt then the rib cartilage is often used.
Revision rhinoplasty is performed under general anesthetic. This gives the anesthetist complete control over the airways and will keep any drainage from getting into your lungs.
Revision rhinoplasty is a surgical procedure designed to repair problems of form and function of the nose that were a result form previous unsuccessful rhinoplasty procedures. Men and women who are physically healthy, realistic in their expectations, and have a strong desire to improve the results from the previous rhinoplasty are ideal candidates for revision rhinoplasty.
Secondary rhinoplasty can be just as successful as the primary rhinoplasty, although because the initial problem is worse, there is a higher chance that second operations or minor touchups may be needed to produce the best result. In my practice, the revision rate for patients who undergo secondary rhinoplasty is about 5-10 percent. This is a higher number than for other surgeons, but it reflects both the expectations of my patient population and my own desire to produce the best possible result.
Dr Paulose FRCS, DLO is Consultant ENT Plastic & Laser Surgeon offering private specialist care for ear nose and throat problems as well as the management Read More…