You want a nose job but want it to look natural. Here’s what to know
Sports medicine experts for years have advocated the importance of safe biomechanics and lower body strengthening and coordination training to prevent injuries, especially to the ACL.
But now some are exploring a brain-injury connection and hoping that targeting the capacity of the nervous system to adapt can both prevent injuries and help with recovery from them.
As many as 200,000 people in the United
States strain or tear an ACL every year, and tears are on the rise among young athletes. The factors involved are numerous. For prevention, researchers have primarily focused on the physical. Despite some success – prevention programs can reduce knee injury risk by more than 50 percent in sports such as soccer that require high-speed running and cutting back and forth – noncontact injuries to the ACL still occur, even in fit and strong athletes.
COGNITIVE INPUT, PHYSICAL MOVEMENT
Physical factors, such as how far the knee bends and collapses inward during landing and cutting activities and hip and leg strength, are controlled and influenced by a complex interaction of the brain and peripheral nerves. Emerging research suggests that how the brain processes this sensory and cognitive input might influence the movement patterns that increase injury risk – in other words, better, more efficient processing may translate into less risky movement.
Movement starts, and continues, with a plan. Rather than coordinating each movement in real
Q. I want to do my nose. Can I have part of my nose remain natural and change things I don’t like?
A. It is possible to get the results you want.
Many of the people who’ve had rhinoplasties have been able to retain much of their natural looks.
Rhinoplasty can be done in two techniques: Open and closed. The open rhinoplasty is used to do significant work on the tip and reconstruct the nose. An open rhinoplasty has an external incision in the medial columella, which is the skin just below the tip of your nose. The skin is then elevated over the time, neuroscience experts believe the brain is constantly planning one step ahead.
“When you go to move, you have this running internal model of your body’s state and the environment,” says Dustin Grooms, a neuroscientist, athletic trainer and professor of physical therapy at Ohio University.
After initial planning and decision-making, the motor cortex sends the impulse down to the muscles to execute the movement, Grooms says. “If everything goes according to the plan, when the brain’s sensory predictions match the environment and movements happen as the brain predicts them, you get a neurally efficient response that keeps the body moving, without any excessive brain activity.”
But if a glitch occurs in integrating what you see and proprioception (the sense that tells you where your joints are in space), look out. And if the prediction error is large, the cartilage.
The open technique is best used when people want a significant change in their tip, need reconstruction after primary rhinoplasty or need significant reconstruction from trauma. In most cases when patients have complete changes of their nose, it’s because they have had a significant amount of cartilage grafting and/or tip work during an open rhinoplasty.
When you consult with doctors, ask them what technique they use and what is the expectation that the tip of the nose will change dramatically. Often, because a significant amount of grafting material is placed on the normal structure, the nose appears to be bigger.
The closed rhinoplasty is when all the incisions are made inside the nose. The nasal tip position can be raised but the change is not so obvious as in the cerebellum – the part of the brain that controls movement – cannot correct fast enough.
In this case, Grooms says, the areas of the brain that are normally used to help with spatial processing, navigation and multisensory integration are being redirected to control just one body part, the leg for instance. With too many competing demands – such as during a competitive game – the brain might not be able to correct a faulty knee or ankle position in the milliseconds it takes to tear a ligament.
“When you start putting athletes under dual-task scenarios or in unanticipated conditions, you start to see some of these risky mechanics become more pronounced,” says Jason Avedesian, a biomechanics expert and director of sports science for
Olympic sports at
Clemson University. “The question becomes, ”Are the [athletes] allocating enough attention to what’s relevant versus what’s not?“
Though it’s difficult for researchers to replicate in a lab the highspeed, dynamic conditions open rhinoplasty operation.
A surgeon should be able to perform both techniques, although there are many excellent rhinoplasty surgeons who perform only one technique. You should pick a board-certified facial plastic or plastic surgeon who specializes in rhinoplasty surgery.
In addition you should look at before and after pictures so your physician will match up to your aesthetic wishes. It would be helpful if your surgeon has an imaging program to show you what they might be able do for you. The single most important part of your consult should be communicating your wishes and seeing whether your physician can perform what you want.
Dr. Carlos Wolf is a partner in Miami Plastic Surgery and is board certified. Email questions to him at Cwolf@miamiplasticsurgery.com that athletes face, one recent study attempted to determine brain activity differences in knee control between athletes with high and low injuryrisk mechanics.
NEURAL EFFICIENCY AND INJURY RISK
The researchers, led by Grooms, analyzed, in conjunction with functional brain MRIs, the knee mechanics of a group of female high school soccer players. When the movement involved in landing a jump off a 12-inch box was analyzed, they found that the areas of the brain usually responsible for combining visual information, attention and the body position showed elevated activity in athletes with riskier knee mechanics.
In a sense, the riskier group was borrowing brain power from cognitive processing areas to coordinate the move. That becomes
Q. I play basketball for my high school and I sprained my ankle about three months ago. The trainer said it was a bad sprain and I missed four weeks of basketball. X-rays showed nothing was broken. I returned to play but my ankle is still swollen and painful. How long until I can expect to be back to normal?
A: Ankle sprains usually occur when an athlete twists his or her ankle in an awkward manner. Most sprains involve a tearing of ligaments on the outside of the ankle. Ligaments connect bones together and if a significant tear occurs, the ankle can remain paintor problematic when these athletes are trying to navigate a complex sporting environment, such as trying to elude a defender on the soccer pitch.
Essentially, the subjects who showed less efficiency in their neural processing were more likely to exhibit risky mechanics.
”Everyday tasks and sport environments require us to balance motor and cognitive demands as we attend to and process information from our environment to inform how we move,“says Scott Monfort, a researcher and co-director of the neuromuscular biomechanics lab at Montana State University.
”How well we pick up appropriate cues and respond to them can influence how effectively and safely we move, whether it is walking down a busy street or trying to evade an opponent during sport,“he says.
Monfort is studying how biomechanics tend to be riskier when a movement is made with an added cognitive constraint, such as evading an opponent.
His research, published in the American Journal of Sports Medicine, looked at how cognitive ability was associated with neuromuscular control in a group of 15 male collegiate club soccer players.
In addition to a cognitive assessment of visual and verbal memory, reaction time and processing speed, the subjects were asked to perform 45-degree run-to-cut trials with and without dribbling a soccer ball. Knee position was assessed and analyzed during the cutting movements.
The researchers found that worse visualspatial memory was related to riskier knee mechanics during ball dribbling, when the added demands of tracking and planning soccer ball movement were present.
While the research points to an elevated risk of injury when neural efficiency decreases during dynamic movement, the relationship might exist in the other direction, as well. An injury to the ful and unstable.
When a sprain is severe enough, a bone contusion or stress fracture can result that may not appear on routine X-rays and can add significant time to recovery. Since you have had three months of symptoms and are not getting better, I recommend you see an orthopedic surgeon or foot and ankle specialist.
In addition to the physical exam of the ankle, the docknee or ankle might alter neuromuscular control, further affecting the risk of re-injury.
More recent collaborative research by Monfort and Grooms found more pronounced differences in single-leg balance when subjects who had undergone ACL reconstruction surgery had to also identify and remember information presented on a screen in front of them.
But what hasn’t yet been determined is the relevance of cognitive-motor function in sports injuries, and how that might vary by age, experience level or through genetics.
”There is some evidence that more experienced athletes can demonstrate better performance on tasks that require balancing cognitive and motor demands as well as on isolated tests of cognitive abilities,“Monfort says.
Monfort says he believes training under conditions that reflect real-world scenarios, incorporating simultaneous cognitive and motor demands, ”may improve the potential for benefiting real-world performance.“
MUSCLES VS. MIND
And one hurdle to recovery from injury or surgery might come from rehab programs themselves.
”Our own rehab might be reinforcing this neural compensation strategy – stare and think about your quadriceps muscle – when instead we need to think about progressing this neural aspect of rehab [attention, sensory processing, visual-cognition] as well as typical strength,“Grooms says.
To boost processing skills might be as simple as asking athletes to respond to visual stimuli – such as adding numbers on flash cards or moving in response to different colored lights – while jumping or hopping side-to-side.
Sports and even most activities of daily living create unique nervous system demands, and standard exercise programs may ready the muscles but not the nervous system, Grooms says.
”We get really good at thinking about what the joints have to do, what the muscles have to do,“Grooms says. ”But we should try to think about what the nervous system has to do and how it might need to adapt and accommodate to the demand placed on it.“ may order special Xrays testing the stability of the ankle called stress radiographs. An MRI scan may also be helpful to look for the degree of disruption of the ligaments and a stress fracture. The length of time to full recovery will depend upon the diagnosis.
Dr. Harlan Selesnick is team physician of the Miami Heat and director of Miami Sports Medicine Fellowship, Doctors Hospital.
A reader writes that she’s been getting 25 or more spam emails per day that end up in the junk folder of her AOL email account.
She uses an iPhone 8 for her email.
Her question is how to stop them or block them without opening them, since she knows you shouldn’t open spam emails.
She said she knows how to block calls on her phone, but not emails that end up in the junk folder.
My initial advice is to not spend much time worrying about email messages in your junk email folder. They’ll stay in the junk folder for a month, then they’ll be deleted.
If your email provider’s spam filtering is working, count your blessings and spend your time worrying about other things.
I understand some people are bothered by spam, even if it is filtered out of their inbox. For these people, just knowing there is spam taking up space on your phone can be maddening.
If you only do your email on your phone (meaning you don’t have a computer), then you can use your iPhone to block email senders.
Touch and hold your finger on the message until you see a popup menu. At the bottom of the pop-up menu, you can choose to block the sender.
Be aware, spammers tend to frequently change the accounts they use to get around these types of blocks.
What can you do to minimize spam?
Don’t waste your time trying to click “unsubscribe” links in these messages. Giving the spammers any kind of feedback will just keep you on their lists.
Just ignore them.
The Miami City Commission has often been a spectacle to watch. There was the time Commissioner Joe Carollo showcased a video of then police chief Art Acevedo impersonating Elvis Presley, freezing it to show his crotch prominently displayed in a tight white suit. There was the time Carollo told Commissioner Alex Diaz de la Portilla, “You make me want to vomit” during a heated discussion on the dais.
Miami is known for its pugilistic, often bizarre style of politics. The problem is that commissioners have often aimed their ire not only at each other but at members of the public speaking before them. Citizens who speak at City Commission meetings too often are met with insults from the dais.
This behavior isn’t new, and many City Hall watchers have grown numb to it. But it is a disservice to the democratic process and an insult to the people whose tax dollars support elected officials. The issue came up during February’s special election in District 2. The winner, Sabina Covo, made restoring decorum a point during her campaign.
“A lot of the constituents that I’ve been talking to feel disrespected when they go and they talk during the meetings,” Covo told the Herald Editorial Board last month. “So there is a lack of respect that I think that needs to be restored.”
HARD TO CRITICIZE
Covo, a first-time elected official, is walking into the lion’s den As we often hear, commissioners know how to count to three, the number of votes needed to pass anything on this five-member body. That makes it harder for commissioners to call out their disrespectful colleagues without facing repercussions.
Covo wasn’t the only one who brought up this up to the Editorial Board during candidate interviews.
“I’ve been going to City Hall for quite some time and I’ve been called an actor and an activist by some of the commissioners,” candidate Javier Gonzalez, a longtime Coconut Grove resident, said.
When Grove residents flocked to City Hall last year to oppose a redistricting plan that divided room for everyone who wants to live here.
With almost 1,000 people moving into Florida daily, and Miami-Dade being the top market in the nation for foreign investment properties, we are like a toy store with empty shelves at Christmas. the historic Black Grove, Diaz de la Portilla dismissively said: “There’s a group of activists from Coconut Grove who don’t want to be part of Miami.”
If being engaged with what’s happening in their community makes them activists, that’s not a bad thing; it’s not the pejorative term it has become.
Another common line of attack from the dais is to dismiss residents who don’t live in the city, but who are stakeholders in what’s happening at City Hall. In September, Carollo attacked Jeanette Ruiz, who spoke during a budget hearing on behalf of the Miami Climate Alliance. She advocated for more funding for storm resilience and criticized the commission for what she considered a lack of proper advertising of the meeting. Carollo told her she doesn’t have the same right to speak as Miami residents.
“Your words are a little, kind of harsh, I thought, when you’re not a resident. You’re coming from outside,” he said.
Speakers routinely give their addresses and, although Ruiz lives outside city limits, she said she works in Miami. And there are no rules preventing people who aren’t Miami residents from speaking, much less on issues that affect people who live across Miami-Dade. It appears the issue wasn’t Ruiz’s residence but her criticism.
“The decisions you guys make here impact my life as well, impact my family, who lives in the city,” Ruiz responded. The exchange was first reported by the blog Political Cortadito.
NOT JUST MIAMI
Unfortunately, stymieing criticism is not unique to the city of Miami. Last year, then-County Commission Chair Jose “Pepe” Diaz was criticized for enforcing a rule that prohibits speakers from directly addressing any commissioner on the dais. Diaz took it to mean that you can’t address your own commissioner by name — unless, of course, you’re flattering them.
We’re not defending speakers who don’t respect the rules of decorum, who use curse words or threaten elected officials. There are procedures to deal with disruptive people.
But the basic requirement for someone who’s paid to represent the people is to get through long, arduous meetings and listen to public complaints, as small or annoying as they may seem.
Members of the public should get a chance to express their displeasure — respectfully, always — without fear of repercussion or ridicule. This is local government, not high-school and we expect our elected leaders to live up to their duty.
Authentic” has become a political cliche to describe unpretentious, down-toearth and earnest politicians. That such qualities deserve praise tells you a lot about the state of our performance politics. Nevertheless, Rep. Elissa Slotkin, D-Michigan, personifies these attributes — which is a good thing for her future and for Democrats now that she has announced her run for the Senate.
If the MAGA Republican Party is pining to return to a time when white males dominated, Slotkin shows how Democrats can win on shared values in a Senate campaign announcement ad that is finely crafted for her swing state and for contemporary America.
Most striking is how she talks about her home state. Slotkin’s affection for Michigan is not bathed in nostalgia for a bygone era but in a sense of home. “No matter where I’ve gone in my life, no matter who I’ve met, nothing is more important to me than this place,” she says. She speaks with deep affection for the values her fellow Michiganders hold. She voices pride and affection for her family’s beginning (starting a meat company that eventually sold hot dogs to baseball stadiums), but she is not trapped in the past nor angry about change. She is not trying to make Michigan great again.
Moreover, Slotkin doesn’t mention her opposition at all. In contrast to presidential candidate Nikki Haley’s opening ad, she does not show scary pictures of Republicans or demonize “Washington politicians.” Noting that she served under both a Republican and Democratic president, she makes clear her enemies are America’s enemies, stressing her CIA service in Iraq. Her objective is not pummeling Republicans, but solving problems: “There are certain things that should be really simple,” she says, “like living a middle-class life in the state that invented the middle class.”
It’s also noteworthy that she does not explicitly use Jan. 6 images. Instead, she ties democracy to love of country. She talks about “preserving our rights and our democracy so that our kids can live their version of the American Dream.”
Few politicians so adeptly make the case that without democracy, our freedom and our right to self-determination disappear. Democrats would be wise not to speak of democracy or rule of law in the abstract, but rather to emphasize that we have opportunities because we have a democracy. That serves to underscore the common stake we have in defeating authoritarianism.
Certainly, Slotkin doesn’t sugarcoat what people have endured. “We all know America is going through something right now. We seem to be living crisis to crisis,” she says. In channeling the collective sense of emotional exhaustion — with causes from economic recession to COVID-19 to gun violence — she does not fall into the trap of arguing people are better off than they think. But neither does she flood them with images of shuttered factories, schools that look like war zones and hospitals bursting at the seams. Simply reminding Americans of traumas is not leadership. Indeed, it’s demoralizing and paralyzing. Other Democrats would be wise to project such steadiness, confidence and hope.
Political pundits focus excessively on ideology, stressing a candidate like Slotkin’s moderation. But tone and demeanor can communicate far more than a politician’s words. Republican politicians these days appear perpetually outraged, belligerent and hysterical. That’s the way social media and right-wing “news” outlets keep the MAGA base engaged.
But something in Slotkin’s approach seems to echo President Biden’s promise of a return to normalcy. Indeed, the constant Sturm und Drang emanating from the House and from MAGA presidential contenders is not wearing well with voters, as polls suggest. Voters might welcome a quiet, calm and mature voice, delivered without phony emotion and ginned-up anger.
That’s what Slotkin delivers in her announcement. Savvy Democrats will follow her lead.
Jennifer Rubin writes reported opinion for The Washington Post.
The Washington Post
When the 2023 Florida Legislature convenes Tuesday to begin its 60-day regular session, it is widely expected to pass measures that could cause more than 4.2 million Floridians to lose their chance to vote in important races in a key phase of the election cycle.
This possibility looms because lawmakers, prompted by Gov. DeSantis, now seem ready to pass resolutions for constitutional amendments that would make most local offices partisan instead of officially non-partisan, as they currently are.
In primary elections for seats on non-partisan bodies such as city and county commissions and school boards, all voters — Democrats, Republicans, Greens, Socialists and those independent-minded folks dubbed NPAs (No Party Affiliation) — are allowed to vote.
When these offices become partisan, however, only Democrats can vote in the Democrats’ primary, only Republicans in the GOP’s primary.
Worse, because of gerrymandering and other factors, many voting jurisdictions are totally dominated by one party or the other, so winning the primary is tantamount to winning the election.
NPAs? You’ll be excluded from these intra-party races. Granted, you’ll still get to cast a ballot in the general election in November, but you’ll be choosing among nominees whom you played no role in selecting.
Moreover, if a primary features a large field of candidates, as often happens when there’s an open seat, the nominees may well represent their parties’ most extreme fringes now that primary elections no longer have a runoff in which the field of also-rans may coalesce around a second-place finisher who’s less extreme.
TERM LIMITS LOOM
Speaking of open seats, expect them to occur more often if the Legislature decides, as now seems likely, to impose eight-year term limits on local office holders.
As for partisanship, it’s not that having certain elected offices be partisan is a problem per se. For seats in Congress and state legislatures, for instance, the party labels are a form of branding that arguably helps voters make informed decisions in races where the winners will be crafting our laws.
Although excessive partisanship can lead to gridlock, having at least two viable political parties competing for our support makes sense for those kinds of governmental bodies, which historically have been organized around the reality of our nation’s two-party system.
But does it make sense for city and county governments? Not so much. As a Florida Association of Counties spokesperson told the News Service of Florida, “As one of my commissioners told me the other day, that pothole doesn’t care if we’re Republicans or Democrats. People just want the pothole fixed.”
Until recently, when Florida’s school boards got caught in the crossfire of the culture wars, their focus was similarly on routine, but important, issues such as ensuring that the campuses were safe, the teachers union was happy and the school buses ran on time. Now there are academic controversies and book bans to be weighed, and these often spotlight the political parties’ contrasting views.
Even so, the governor’s injection of divisive ideological issues into school board agendas and school board races doesn’t justify excluding millions of NPAs from voting in elections that decide who guides the schools their kids attend.
If voters are curious as to where candidates in non-partisan races stand politically, their party affiliation is a matter of public record, even though it’s not next to their names on the ballot. Moreover, in many races for seats on city and county commissions and school boards, well-informed voters will already know the candidates’ party affiliation because the parties try to ensure that their voters know who’s who.
THE VOTERS’ CHOICE
Meanwhile, if the Legislature approves the relevant resolutions, voters in November 2024 — amid all the noise of a presidential election that could feature a candidate from Florida — will get to decide on whether to amend the state Constitution to make these local offices partisan. Passage requires approval by 60% of those voting on the amendments.
The GOP is obviously in favor of these amendments. The NPAs have every reason to oppose them. The unsettled question is this: What will the Democrats do? Several in the Legislature spoke out against the amendments, but that was to be expected because they tend to oppose anything that the GOP and/or DeSantis favors.
The key question is, will the Democrats’ party apparatus — Chair Nikki Fried, county leaders and others — will try to mount a strong campaign against these amendments, thereby denying them the 60% they need to pass? Or will the Democrats, so often at a fundraising disadvantage compared with the GOP, refrain from taking a strong public stand and, instead, go for the money?
Money? What money? When candidates qualify to run for a partisan public office, they pay what’s often referred to as a filing fee. In partisan races, it is set at 6% of the salary for the office they’re seeking. If a position pays $100,000, for example, the filing fee is $6,000.
Who gets this money? Most of it goes into the coffers of the respective political parties. So, if all the races in Florida’s 411 municipalities, 67 counties and 67 school boards were partisan and attracted large fields of candidates, that’s going to be a lot of money, possibly in the millions.
Bottom line: What’s it going to be, Democrats? Money or principle? Voter inclusion or exclusion? When all is said and done, that’s what’s at stake.
Robert F. Sanchez, of Tallahassee, is a former member of the Miami Herald Editorial Board. He writes for the Herald’s conservative opinion newsletter, Right to the Point. It’s weekly, and free. Go to miamiherald.com/ righttothepoint to subscribe.