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25 ways to stay warm this winter that won’t break the bank | CNN

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CNN
 — 

As wintry weather whips across the United States, one challenge may be staying warm if you can’t afford or are cutting back on indoor heating.

Staying warm is necessary “for a variety of health reasons” in addition to comfort, said Dr. Georges Benjamin, the executive director of the American Public Health Association. For people with arthritis, stiffness “in your back and neck and sore joints do occur more in colder weather. … People who have metabolic conditions can be sensitive to the weather, like diabetes, for example, and heart disease. The more cold you are, the more stress you put on your heart.”

A little savvy based on our warm-blooded bodies, food, appliances, furniture, the outdoor elements and more can go a long way. Here are 25 ways to stay warm this winter — with or without indoor heating — that won’t break the bank.

How to warm your body

1. Warm up with store-bought hand warmers, microwavable heating pads, hot water bottles or heated blankets. Following the manufacturer’s instructions and concentrating on your torso are key, said JohnEric Smith, an associate professor in the department of kinesiology at Mississippi State University. “If you warm the core you can warm the hands and feet. It is harder to warm the core by warming the hands and feet.”

Be careful that you don’t burn yourself, Benjamin said. “They’re very effective on a knee or shoulder or the back of the neck. … You rarely put it directly on your skin. You usually wrap it in something, maybe a thin towel.”

2. Move your body. Physical activities like indoor exercise or dancing can help you warm up, but don’t get to the point where you’re sweating, Smith said. “We sweat to lose heat and sweating will make us colder.”

3. Think twice about taking a warm shower or bath. “While a warm bath or shower will feel good for the minute,” Smith said, “you will be cold after you get out and your wet skin is losing heat more quickly.”

4. Cuddle. Snuggles really can keep you warm. “Each of us produces heat through our metabolic processes. We lose our heat to the environment as we maintain body temperature,” Smith said via email. “Increasing skin contact decreases opportunities for the heat to be lost to the environment around us. If two people are under a blanket both of their heat losses combined can increase the temperature under the blanket more quickly than either could do independently.”

5. Change how you perceive cold. Some people have trained their minds to perceive cold as an objective, acceptable sensation rather than something dreadful to control. The best ways to adapt include wearing clothing in layers then removing it, or gradually lowering the thermostat and putting on a sweater, Benjamin said.

Enjoying warm foods and beverages is a two-in-one solution: You get heat from the appliances when you cook the food, then warmth when you eat it.

6. Enjoy warm beverages and foods, and use the oven and stove to cook them. Since foods higher in fat and protein are metabolized slowly by the body, those could make you feel warmer, Smith said. “Consider hearty soups with beans and meat.” Slow cooking meals can help generate heat throughout the day.

Drinking warm beverages “certainly helps take the chill off,” Benjamin said. Leaving the oven or stove on is “a bad idea because it burns fuel,” Benjamin said, “but more importantly, people fall asleep, they forget and leave the stove on. Sometimes things on the stove can catch on fire. So like any tool, you should use it for the purpose in which it was designed.”

“It only has to go poorly once to be life changing,” Smith said. If you don’t have children or pets, when you’re done cooking and you turn off the oven, what doesn’t hurt is leaving the oven door open to let residual heat escape.

Cozying up underneath layers of clothing or blankets (or both) can help insulate you from the cold.

7. Layer on the clothes. “Layering is critical,” Smith said. “Even thin layers added together to increase one’s ability to retain heat … focus on keeping the torso warm. Often an extra shirt or vest can warm your hands and feet more than an extra pair of socks or gloves.” Inexpensive pairs of tights or long johns can be worn underneath clothes. However, be sure that layering doesn’t make your clothing tight, he added, since that could reduce blood flow and thus your body’s ability to get warm blood to those areas. Wearing a hat, too, can also keep the heat in.

8. Wear thick socks and slippers. Fuzzy socks, slippers or a pair of shoes you reserve for wearing around the house can add extra comfort.

9. Pile on the blankets. “The more layers you put on, the better it helps trap the air between you,” your sheets and your blankets, Benjamin said. Since you lose a lot of heat from your head while you’re under blankets, he added, wearing a skull cap can help also.

10. Embrace less breathable clothing and linens. Breathable linens (such as the cotton-based variety) are often recommended during the summer, but linens with other materials and higher thread counts may be better for winter since higher thread counts have more weaving per square inch.

Optimize your home and appliances

There are multiple ways to make your heating system work better, or to create your own warmth.

11. Work with the weather. Open your curtains or blinds to let the sun in during the day, or when outside is warmer than inside your home.

12. Seal your windows and doors. Even if your windows and doors are totally shut and locked, drafts can seep in through small crevices. You can use caulk or shrink film to seal those cracks. Placing inexpensive, transparent shower curtains over windows can keep the sun in but the cold draft out. For the bottoms of doors, cloth draft stoppers are “very effective,” Benjamin said.

13. Close off unoccupied rooms. By shutting the doors of rooms no one is using, you can create additional barriers between yourself and the cold outdoors. This can also aid preventing heat loss from the room you’re in.

14. Reverse your ceiling fan. If possible, send your ceiling fan in a clockwise direction so that it sends the warm air down.

15. Sit near indoor heaters. You can safely use portable heaters if they are space heaters that have automatic shutoffs and can be plugged into a wall outlet instead of an extension cord. Since space heaters are a common cause of fires, they should be at least 3 feet away from any drapes, bedding or furniture. To prevent high levels of carbon monoxide — which can cause potentially fatal poisoning — ensure you have a carbon monoxide monitor installed and that you don’t “use any type of outdoor gas heater or anything that is not electric,” Benjamin said.

16. Move anything that’s blocking heat vents or radiators. The heat will better circulate throughout your home that way.

17. Spend time and sleep in the upper levels of the house. Heat rises, so moving your working, sleeping and living spaces upward may be more comfortable.

18. After showering, don’t run the bathroom fan or close the door. Unless your bathroom is prone to growing humidity-induced mold, the warm steam from the shower can make the nearby air less dry and cool for a short period of time.

19. Buy magnetic vent covers from home improvement stores. Used to cover vents, they can be inexpensive and help to force heat to exit vents in the occupied rooms only.

20. Put down rugs or carpets. These can be warmer to the touch than bare floors.

21. Insulate your attic. If you can afford to, padding your attic with insulation from hardware stores can help to retain some of the heat you usually lose through the attic since heat rises.

22. Research what your residential area offers. Some locations may be running warming centers set up for safety during the pandemic.

Sitting near a fire is a method that's always reliable.

23. Light a fire. If your fireplace runs on wood instead of gas, a fire is another way to keep a room warm and enjoy a cozy night. “Make sure that your flue is properly opened and clean to make sure that smoke doesn’t come back in the home but goes properly up the flue,” Benjamin said. “When the fire is out, you should of course close the flue because it’s like having an open window.”

24. Keep warm and enjoy s’mores. If your state, city, county or neighborhood allows, have a (moderate-size) backyard bonfire to keep warm for a while.

25. Don’t light candles. Candles can emit a small amount of heat, but using them as a source of warmth can be dangerous. “People will light candles and go to sleep, and they fall over,” Benjamin said. “The cat comes in and kicks it over and starts a fire.”

With these tips in mind and any others you find, be “broadly thoughtful about how to stay warm in the winter,” he added. “If it sounds like it’s a bad idea, it probably is. Look it up and check it out before you do it.”

This story has been updated to reflect recent weather advisories.

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Do you really need deodorant? Experts weigh in | CNN

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CNN
 — 

Like brushing your teeth or washing your face, putting deodorant on every day might seem like one of those rituals crucial for basic hygiene.

But your decision is most likely based more on personal and cultural preferences than any potential medical necessity, dermatology experts say.

“People have strong preferences and sensitivities to smell. People, from the beginning of time, have used perfumes (or) colognes to mask odor,” said Dr. Nina Botto, an associate professor of dermatology at the University of California, San Francisco. “But it’s not like flossing your teeth, where there’s data that you’re actually going to live longer if you floss your teeth regularly.”

“We live in a society where body odor is not universally accepted, making deodorant a part of your daily hygiene routine,” said Dr. Joshua Zeichner, an associate professor of dermatology at Mount Sinai Hospital in New York City, via email. “There’s also a stigma surrounding wetness of the clothes because of sweat, which has pushed antiperspirants into daily skincare routines.”

Deodorants neutralize body odor, while antiperspirants reduce wetness on the skin, Zeichner added. Both are often offered in one product.

Despite the commonly accepted reasons why people wear deodorant, natural body odor isn’t necessarily considered unpleasant by everyone.

Ahead of his return from a military campaign, Napoleon is said to have written to his wife, Joséphine Bonaparte, that he would be home in three days and that she shouldn’t wash herself before then, said Tristram Wyatt, a senior research fellow in the department of biology at the University of Oxford, in “Smelling Your Way to Love,” an episode of the CNN podcast “Chasing Life With Dr. Sanjay Gupta.”

Like many people today, Wyatt added, Napoleon was an “enthusiast” of smells — both colognes and natural scents, or at least his wife’s.

One reason why someone might find a certain person’s natural scent more attractive than those of others is due to differing immune systems, Wyatt said, since we tend to be more attracted to people who are immunologically different.

There’s no right or wrong answer when it comes to your personal preferences, and what — if any — products you might use to mask body odor. With those preferences and other personal factors in mind, CNN asked dermatologists to address common reasons behind people’s choices and how to manage in either scenario.

Sweat has a purpose.

“We sweat to help control our body temperature,” Zeichner said. “However, in some cases we sweat beyond what is necessary. This is known as pathologic sweating, or hyperhidrosis. Sweat itself is odorless. However, bacteria on the skin break down the sweat, creating a foul smell.”

If you choose to use antiperspirant products for this reason, apply them in the evening, Zeichner said. “Since we make less sweat at night, they can more effectively form a plug within the sweat gland if you apply them before bed.”

But if you don’t sweat excessively, blocking sweat production with antiperspirant “is probably not a good idea,” said Dr. Julie Russak, a board-certified dermatologist and founder of Russak Dermatology Clinic in New York City. “(By) blocking it completely, you are risking paradoxical increase of sweat production in other areas.”

Some people prefer wearing deodorant to have a more pleasant smell or if they deal with certain skin issues, such as irritation under breasts or between abdominal skin folds, Russak said via email.

The odor of your sweat can be influenced by diet, too, Zeichner said. The sweat of people who eat large amounts of cruciferous vegetables — broccoli, kale and cauliflower, for example — can have a distinct, sulfurous smell.

“Gut health, health of the skin and health of the microbiome of the skin can all influence our body odor,” said Russak via email. “Some metabolic disorders produce a very particular odor in general (for example, ketoacidosis or uremia from diabetes). Healthy skin and a healthy body should not have malodor.”

If you’re considering forgoing deodorants or antiperspirants because of concerns about potentially harmful ingredients or rumors that wearing such products causes cancer, know that those claims haven’t been scientifically proven, these experts told CNN. Research on whether there’s a causal relationship between cancer and use of talcum powder products that don’t contain asbestos has also been inconclusive.

“Usage of inorganic ingredients like aluminum salts in cosmetics and personal care products has been a concern for producers and consumers,” said Dr. Amanda Doyle, a board-certified dermatologist who works with Russak at the Russak Dermatology Clinic. “Although aluminum is used to treat hyperhidrosis some worries have been raised about aluminum’s role in breast cancer, breast cysts and Alzheimer’s disease. The absorption of aluminum by the skin is not fully understood yet, but the carcinogenicity of aluminum has not been proved.”

Not wearing deodorant or antiperspirant products can have pros and cons depending on how you and others feel about your natural body odor.

“If you stop wearing deodorant or antiperspirant, you can develop a stronger odor over time,” Doyle said. “When you stop using (such products) and sweat more, this creates a breeding ground for bacterial and fungal overgrowth, which can cause odor to become stronger.”

Thoroughly bathing every day, however, is the most important way to avoid bad body odor, experts said. You should focus on bathing the face, under arm and genital areas — these tend to have more sweat than other parts of the body, which can facilitate overgrowth of microorganisms such as yeast and bacteria, Zeichner noted.

Having unusually bad body odor could indicate that you’re not cleansing your skin as you should, he added.

Other ways to reduce odor risk by preventing sweat and bacterial overgrowth include wearing loose-fitting, breathable, cotton clothing and using topical antibacterial washes such as benzoyl peroxide or prescription topical antibiotics such as clindamycin, Doyle said.

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How confusion about textured hairstyles can prevent some patients from getting necessary medical imaging | CNN

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KFF Health News
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Sadé Lewis of Queens, New York, has suffered migraines since she was a kid, and as she started college, they got worse. A recent change in her insurance left the 27-year-old looking for a new neurologist. That’s when she found West 14 Street MedicalArts in New York.

MedicalArts recommended that she get an electroencephalogram (EEG) and an MRI to make sure her brain was functioning properly.

An EEG is a test to measure the electrical activity of the brain. It can find changes in brain activity that can help in diagnosing conditions including epilepsy, sleep disorders, and brain tumors. During the procedure, electrodes consisting of small metal discs with attached wires are pasted onto the scalp using adhesive, or attached to an electrode cap that you wear on your head.

A little over a week before her EEG, Lewis was given instructions that she didn’t remember getting before a previous EEG appointment.

To Lewis’ surprise, patients were told to remove all hair extensions, braids, cornrows, wigs, etc. Also, she was to wash her hair with a mild shampoo the night before the appointment and not use any conditioners, hair creams, sprays, oils, or styling gels.

“The first thing I literally did was text it to my best friend, and I was, like, this is kind of anti-Black,” Lewis said. “I just feel like it creates a bunch of confusion, and it alienates patients who obviously need these procedures done.”

The restrictions could discourage people with thick, curly, and textured hair from going forward with their care. People with more permanent styles like locs — a hairstyle in which hair strands are coiled, braided, twisted, or palm-rolled to create a rope-like appearance — might be barred from getting the test done.

Kinky or curly hair textures are typically more delicate and susceptible to damage. As a result, people with curlier hair textures often wear protective hairstyles, such as weaves, braids, and twists, which help maintain hair length and health by keeping the ends of the hair tucked away and minimizing manipulation.

After receiving the instructions, Lewis scoured the internet and social media channels to see if she could find more information on best practices. But she noticed that for people with thick and textured hair, there were few tips on best hairstyles for an EEG.

Lewis has thick, curly hair and believed that explicitly following the instructions on the preparation worksheet would make it harder, not easier, for the technician to reach her scalp. Lewis decided that her mini-twists — a protective style in which the hair is parted into small sections and twisted — would be the best way for her to show up to the appointment with clean and product-free hair that still allowed for easy access to her scalp.

Lewis felt comfortable with her plan and did not think about it again until she received a reminder email the day before her EEG and MRI appointment that restated the restrictive instructions and added a warning: Failure to comply would result in the appointment being rescheduled and a $50 same-day cancellation fee.

To avoid the penalty, Lewis emailed the facility with her concerns and attached photos.

“I got kind of worried, and I sent them pictures of my hair thinking that it would go well, and they would be, like, ‘Oh yeah, that’s fine. We see what you see,’” said Lewis.

Soon after, she received a call from the facility and was told she would not be able to get the procedure done with her hair in the twists. After the call, Lewis posted a TikTok video detailing the conversation. She expressed her frustration and felt that the person on the phone was “close-minded.”

“As a Black woman, that is so exclusionary for coarse and thick hair. To literally have no product in your hair and show up with it loose, you’re not even reaching my scalp with that,” Lewis said in her video.

The comments section on Lewis’ TikTok video is full of people sharing in her frustration and confusion or recounting similar experiences with EEG scheduling.

West 14 Street MedicalArts declined to comment for this article.

The New York medical center is not the only facility with similar EEG prep instructions. The Neurology Center, which has several locations in the Washington, D.C., area, provides EEG pretest instructions for patients reading, “Please remove any hair extensions or additions. Do not use hair treatment products such as hair spray, conditioners, or hair dressing, nor should you fix your hair in tight braids or corn rows.”

Marc Hanna, the neurophysiology supervisor at the center’s White Oak location in Silver Spring, Maryland, has more than 30 years of experience performing EEGs. He oversees 10-12 EEG technicians at the facility.

Hanna said the hair rules are meant to help a technician get an accurate reading from the test. “The electrodes need to sit flat on the scalp, and they need to be in precise spots on the scalp that are equally apart from each other,” Hanna said.

For people with thick and curly hair, this can be a challenge.

A 2020 article from Science News detailed a study that measured how much coarse, curly hair could interfere with measuring brain signals. A good EEG signal is considered to have less than 50 kilo-Ohms of impedance, but the researchers found unbraided, curly hair with standard electrodes yielded 615 kilo-Ohms.

Researchers are working to better capture brain waves of people with naturally thick and curly hair. Joy Jackson, a biomedical engineering major at the University of Miami, developed a clip-like device that can help electrodes better adhere to the scalp.

Experimentation with different braiding patterns and flexible electrode clips shaped like dragonfly wings, designed to push under the braids, has had promising results. A study, published by bioRxiv, found this method resulted in a reading well within the range for a reliable EEG measurement.

But more research has to be done before products like these are widely used by medical facilities.

Hanna said the facility where he works does not automatically ask patients to remove their protective styles because sometimes the technician can complete the test without them doing so.

“Each one of those cases are an individual case,” Hanna said. “So, at our facility, we don’t ask the patient to take all their braids out. We just ask them to come in. Sometimes, if one of the technicians are available when the patient is scheduling, they’ll just look at the hair and say, ‘OK, we can do it’ or ‘We don’t think we can do it.’ And we even might say, ‘We don’t think we can do it but come in and we’ll try.’”

In practice, Hanna said, it’s not common for hair to be an issue. But for patients whose hairstyle might make the test inaccurate, he said, it becomes a conversation between the doctor and the patient.

When Lewis arrived the following day for her MRI and EEG appointment, she was told her EEG had been canceled.

“It was just kind of baffling a little bit because, literally, as soon as I walk in, I saw about four different Black women who all had either twists, locs, braids, or something,” she said. “And on the call, the woman was saying if you come in and my hair is not loose, we’re going to charge you. And she did recommend to cancel my appointment. But I never approved that.”

After Lewis explained what happened during the phone call, she said, the receptionist was very apologetic and said the information Lewis was given was not true. Lewis said she spoke with one of the EEG technicians at the facility to confirm that her mini-twists would work for the test — and felt a sigh of relief when she saw the technician was also a Black woman.

“The technician, I think overall, they just made me feel safe,” Lewis said. “Because I felt like they could identify with me just from a cultural standpoint, a racial standpoint. So, it did make me feel a little bit more valid in my feelings.”

Lewis later returned to the facility to get the procedure done while still wearing mini-twists. This time, the process was seamless.

Her advice for other patients? “When you feel something, definitely speak out, ask questions.”

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Medical tourism to Mexico is on the rise, but it can come with risks | CNN

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CNN
 — 

One of the four Americans who were kidnapped in Mexico last week was traveling for medical tourism, a friend said. A growing number of US residents are traveling internationally to seek more affordable medical care, more timely care or access to certain treatments or procedures that are unapproved or unavailable in the United States.

Latavia “Tay” Washington McGee, 33, drove to Mexico with Shaeed Woodard, Zindell Brown and Eric Williams for cosmetic surgery that was scheduled to take place Friday, according to a close friend of Washington McGee’s who did not want to be identified.

The four Americans were found Tuesday near the border city of Matamoros, officials said. Washington McGee and Williams were found alive, and Woodard and Brown were found dead, a US official familiar with the investigation told CNN. Investigators are still piecing together what happened after they were abducted.

Medical tourism takes people all over the world, including to Mexico, India and Eastern Europe. Violence against medical tourists is generally thought to be rare, but the US Centers for Disease Control and Prevention warns about other risks such as quality of care, infection control and communication challenges with medical staff.

“It’s on the daily, without a doubt. There are people going daily to get this kind of stuff done,” said Dr. Nolan Perez, a gastroenterologist in Brownsville, Texas, which is across the border from Matamoros. “Whether it’s primary care provider visits or dental procedures or something more significant, like elective or weight loss surgery, there’s no doubt that people are doing that because of low cost and easier access.”

One study published in the American Journal of Medicine estimated that fewer than 800,000 Americans traveled to other countries for medical care in 2007, but by 2017, more than 1 million did.

More current estimates suggest that those numbers have continued to grow.

“People travel because there may be a long waiting time, wait lists or other reasons why they can’t get treatment as quickly as they would like it. So they explore their options outside the United States to see what’s available,” said Elizabeth Ziemba, president of Medical Tourism Training, which provides training and accreditation to international health travel organizations.

Also, “price is a big issue in the United States. We know that the US health care system is incredibly expensive,” she added. “Even for people with insurance, there may be high deductibles or out-of-pocket costs that are not covered by insurance, so that people will look based on price for what’s available in other destinations.”

The most common procedures that prompt medical tourism trips include dental care, surgery, cosmetic surgery, fertility treatments, organ and tissue transplants and cancer treatment, according to the CDC.

“With Mexico and Costa Rica, it’s overwhelmingly dental and cosmetic surgery. However, certain countries are known for specialties. For example, in Singapore, stem cell and oncology is huge. In India, South India and Chennai Apollo hospitals does incredible work with hip and knee surgeries,” said Josef Woodman, founder of Patients Beyond Borders, an international health care consulting company.

“In Eastern Europe, a lot of people from the UK – but also people from the United States – travel to Hungary, Croatia and Turkey for everything from dental to light cosmetic surgery,” he said.

Mexico is the second most popular destination for medical tourism globally, with an estimated 1.4 million to 3 million people coming into the country to take advantage of inexpensive treatment in 2020, according to Patients Beyond Borders.

Matamoros – where officials said the four kidnapped Americans were found – is “not considered a primary medical travel destination,” Woodman said, “largely because there are no internationally accredited medical centers/specialty clinics there or in the immediate region.”

Mexico City, Cancun and Tijuana are more frequented and reliable destinations in the country, Woodman said.

On average, Americans can save 40% to 60% across the most common major procedures received by medical tourists in Mexico, according to an analysis of 2020 health ministry data conducted by Patients Beyond Borders.

Woodman said that violence against medical tourists was extremely rare, but he added that “price shopping” – searching for the cheapest location for a procedure – is a “blueprint for trouble,” namely substandard medical care.

Medical tourism can be dangerous, depending on the destination and the person’s condition.

“There are the complexities of traveling if you have a medically complex situation. There are fit-to-fly rules. And your health care providers should take into consideration the impact of traveling if you have orthopedic injuries or issues,” Ziemba said.

“The quality of care may be an unknown,” she said. “It may be that the quality of care is not up to the standards that you would like. So there’s a bit of an unknown there, and then the last thing I would say is, if something goes wrong, what’s going to happen?”

Perez said he commonly manages complications from medical tourism in his practice.

“There are a lot of bad outcomes. There are a lot of infections and a lot of botched procedures gone wrong, and patients have to come back to the United States and then have a revision of the surgery,” he said. “So it’s really unfortunate.”

Yet Ziemba added that there can be benefits to medical tourism, including that someone could receive a service that they need faster overseas than locally.

“And price: If you simply can’t afford the out-of-pocket costs of health care in the United States, and assuming the risks involved, it may make much more sense for you financially to travel outside the United States,” she said.

Medical tourism is not just for people traveling around the world. Many living along the US-Mexico border, where access to health care can be scarce, cross into Mexico for care.

The Rio Grande Valley, at the southernmost point of Texas, is considered to be a medically underserved area. The region has some of the nation’s highest rates of comorbidities, including obesity and diabetes, and one of the lowest physician-to-patient ratios.

There is a “dire need” for health care professionals along the border, Perez said.

“There are not as many doctors given our big and our growing population down here. So the demands on primary care doctors and specialists are very high because there are not enough of us for this population,” he said. “So that’s one reason why people end up going to Mexico to visit with physicians, because of easier access.”

People interested in medical tourism can take some steps to help minimize their risk, the CDC says.

Those planning to travel to another country for medical care should see their health care provider or a travel medicine provider at least four to six weeks before the trip and get international travel health insurance that covers medical evacuation back to the United States.

The CDC advises taking copies of your medical records with you and checking the qualifications of the providers who will be overseeing your medical care. Also, make sure you can get any follow-up care you may need.

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Beware the budget butt lift, regulators warn amid social media-inspired boom | CNN

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In hindsight, Nikki Ruston said, she should have recognized the red flags.

The office in Miami where she scheduled what’s known as a Brazilian butt lift had closed and transferred her records to a different facility, she said. The price she was quoted – and paid upfront – increased the day of the procedure, and she said she did not meet her surgeon until she was about to be placed under general anesthesia.

“I was ready to walk out,” said Ruston, 44, of Lake Alfred in Central Florida. “But I had paid everything.”

A few days after the July procedure, Ruston was hospitalized due to infection, blood loss, and nausea, her medical records show.

“I went cheap. That’s what I did,” Ruston recalled recently. “I looked for the lowest price, and I found him on Instagram.”

People like Ruston are commonly lured to office-based surgery centers in South Florida through social media marketing that makes Brazilian butt lifts and other cosmetic surgery look deceptively painless, safe, and affordable, say researchers, patient advocates, and surgeon groups.

Unlike ambulatory surgery centers and hospitals, where a patient might stay overnight for observation after treatment, office-based surgery centers offer procedures that don’t typically require an inpatient stay and are regulated as an extension of a doctor’s private practice.

But such surgical offices are often owned by corporations that can offer discount prices by contracting with surgeons who are incentivized to work on as many patients per day as possible, in as little time as possible, according to state regulators and physicians critical of the facilities.

Ruston said she now lives with constant pain, but for other patients a Brazilian butt lift cost them their lives. After a rash of deaths, and in the absence of national standards, Florida regulators were the first in the nation to enact rules in 2019 meant to make the procedures safer. More than three years later, data shows deaths still occur.

Patient advocates and some surgeons – including those who perform the procedure themselves – anticipate the problem will only get worse. Emergency restrictions imposed by the state’s medical board in June expired in September, and the corporate business model popularized in Miami is spreading to other cities.

“We’re seeing entities that have a strong footprint in low-cost, high-volume cosmetic surgery, based in South Florida, manifesting in other parts of the country,” said Dr. Bob Basu, a vice president of the American Society of Plastic Surgeons and a practicing physician in Houston.

During a Brazilian butt lift, fat is taken via liposuction from other areas of the body – such as the torso, back, or thighs – and injected into the buttocks. More than 61,000 buttock augmentation procedures, both butt lifts and implants, were performed nationwide in 2021, a 37% increase from the previous year, according to data from the Aesthetic Society, a trade group of plastic surgeons.

As with all surgery, complications can occur. Miami-Dade County’s medical examiner has documented nearly three dozen cosmetic surgery patient deaths since 2009, of which 26 resulted from a Brazilian butt lift. In each case, the person died from a pulmonary fat embolism, when fat entered the bloodstream through veins in the gluteal muscles and stopped blood from flowing to the lungs.

No national reporting system nor insurance code tracks outcomes and patient demographics for a Brazilian butt lift. About 3% of surgeons worldwide had a patient die as a result of the procedure, according to a 2017 report from an Aesthetic Surgery Education and Research Foundation task force.

Medical experts said the problem is driven, in part, by having medical professionals like physician assistants and nurse practitioners perform key parts of the butt lift instead of doctors. It’s also driven by a business model that is motivated by profit, not safety, and incentivizes surgeons to exceed the number of surgeries outlined in their contracts.

In May, after a fifth patient in as many months died of complications in Miami-Dade County, Dr. Kevin Cairns proposed the state’s emergency rule to limit the number of butt lifts a surgeon could perform each day.

“I was getting sick of reading about women dying and seeing cases come before the board,” said Cairns, a physician and former member of the Florida Board of Medicine.

Some doctors performed as many as seven, according to disciplinary cases against surgeons prosecuted by the Florida Department of Health. The emergency rule limited them to no more than three, and required the use of an ultrasound to help surgeons lower the risk of a pulmonary fat clot.

But a group of physicians who perform Brazilian butt lifts in South Florida clapped back and formed Surgeons for Safety. They argued the new requirements would make the situation worse. Qualified doctors would have to do fewer procedures, they said, thus driving patients to dangerous medical professionals who don’t follow rules.

The group has since donated more than $350,000 to the state’s Republican Party, Republican candidates, and Republican political action committees, according to campaign contribution data from the Florida Department of State.

Surgeons for Safety declined KHN’s repeated interview requests. Although the group’s president, Dr. Constantino Mendieta, wrote in an August editorial that he agreed not all surgeons have followed the standard of care, he called the limits put on surgeons “arbitrary.” The rule sets “a historic precedent of controlling surgeons,” he said during a meeting with Florida’s medical board.

In January, Florida state Sen. Ileana Garcia, a Republican, filed a draft bill with the state legislature that proposes no limit on the number of Brazilian butt lifts a surgeon can perform in a day. Instead, it requires office surgery centers where the procedures are performed to staff one physician per patient and prohibits surgeons from working on more than one person at a time.

The bill would also allow surgeons to delegate some parts of the procedure to other clinicians under their direct supervision, and the surgeon must use an ultrasound.

Florida’s legislature convenes on March 7.

Consumers considering cosmetic procedures are urged to be cautious. Like Ruston, many people base their expectations on before-and-after photos and marketing videos posted on social media platforms such as Facebook, Snapchat, and Instagram.

“That’s very dangerous,” said Basu, of the American Society of Plastic Surgeons. “They’re excited about a low price and they forget about doing their homework,” he said.

The average price of a buttocks augmentation in 2021 was $4,000, according to data from the Aesthetic Society. But that’s only for the physician’s fee and does not cover anesthesia, operating room fees, prescriptions, or other expenses. A “safe” Brazilian butt lift, performed in an accredited facility and with proper aftercare, costs between $12,000 and $18,000, according to a recent article on the American Society of Plastic Surgeons’ website.

Although Florida requires a physician’s license to perform liposuction on patients who are under general anesthesia, it’s common in the medical field for midlevel medical practitioners, such as physician assistants and nurse practitioners, to do the procedure in office settings, according to Dr. Mark Mofid, who co-authored the 2017 Aesthetic Surgery Education and Research Foundation task force study.

By relying on staffers who don’t have the same specialty training and get paid less, office-based surgeons can complete more butt lifts per day and charge a lower price.

“They’re doing all of them simultaneously in three or four different rooms, and it’s being staffed by one surgeon,” said Mofid, a plastic surgeon in San Diego, who added that he does not perform more than one Brazilian butt lift in a day. “The surgeon isn’t doing the actual case. It’s assistants.”

Basu said patients should ask whether their doctor holds privileges to perform the same procedure at a hospital or ambulatory surgery center, which have stricter rules than office surgery centers in terms of who can perform butt lifts and how they should be done.

People in search of bargains are reminded that cosmetic surgery can have other serious risks beyond the deadly fat clots, such as infection and organ puncture, plus problems with the kidneys, heart, and lungs.

Ruston’s surgery was performed by a board-certified plastic surgeon she said she found on Instagram. She was originally quoted $4,995, which she said she paid in full before surgery. But when she arrived in Miami, she said, the clinic tacked on fees for liposuction and for post-surgical garments and devices.

“I ended up having to pay, like, $8,000,” Ruston said. A few days after Ruston returned home to Lake Alfred, she said, she started to feel dizzy and weak and called 911.

Paramedics took her to an emergency room, where doctors diagnosed her with anemia due to blood loss, and blood and abdominal infections, her medical records show.

“If I could go back in time,” she said, “I wouldn’t have had it done.”

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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How many times can you wear pajamas, jeans and other clothes without washing them? Experts weigh in | CNN

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The number of times it’s appropriate to wear clothing items without washing them often seems based more on folklore or a person’s upbringing than professional advice.

TikTok user Allison Delperdang started a heated online debate when she posted a video January 10 saying she wears the same pajamas multiple times.

“When I was younger my parents always made us wear pajamas … multiple nights in a row because they weren’t dirty, and I still do that as an adult,” she said. “I need to know if, like, as adults we’re still doing that, or should I be literally making dirty clothes every single night?”

The answer — for pajamas as well as other clothes — technically depends on personal aspects such as sweat level and lifestyle, though for many people other, more abstract factors may come into play, experts say.

Our beliefs about clothing hygiene are largely “societal and cultural,” said Dr. Anthony Rossi, an assistant attending dermatologist at Memorial Sloan Kettering Cancer Center in New York City and a fellow of the American Academy of Dermatology. “People tend to over wash and ‘over hygiene’ themselves, because especially in America, we have a luxury of being able to do all that stuff all the time.”

Rewearing the same clothes — particularly on consecutive days — is “linked to avoiding decision fatigue, hence wearing the same clothes involves less decisions to make and less stress every morning,” said Manal Mohammed, senior lecturer of medical microbiology at the University of Westminster in London.

Not knowing when to wash your clothes can have consequences on both ends of the spectrum. Washing them too seldom could lead to skin problems or infections, and washing them too often could harm your clothing. The latter can also result in unnecessary laundry and use of resources.

Here are some guiding principles to help you determine when a garment can be worn again without washing and when it’s time to toss it in the hamper.

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There’s no hard and fast rule for how many times you can wear clothing again, but experts say there are a few types that should be washed after every use: underwear, socks, tights, leggings and activewear. This advice also applies to any other clothes with stains, sweat, odor or visible dirt, Mohammed said.

These kinds of clothes are “on a part of our body that just has a lot of natural bacteria that lives on our body, like our microbiome, (yeast) and bacteria,” Rossi said. “Then from day-to-day activities, we sweat. That just breeds moisture and an environment where this bacteria can overgrow.”

Bacteria overgrowth can lead to infections, fungus and other skin issues, he added.

In addition to bacteria from sweat, clothes worn in gyms or sports settings can come into contact with bacteria such as Staphylococcus aureus, resulting in infections common in community and hospital settings. Those infections can become serious if they enter internal tissues or the bloodstream.

Some people might let their workout clothes dry via air or a dryer, intending to make them safe to wear again the next day. But that approach makes the situation worse, Rossi said.

“Heat is going to make the bacteria grow. It’s not hot enough to sterilize them,” he said. “It’s really the washing with soap and water (that you need) — and with hot water, especially, because it’s going to help loosen that dirt and sebum and really get rid of bacteria.”

When it comes to why you shouldn’t wear socks again without washing first, “fungal infections on the feet and toes are just rampant,” said dermatologist Dr. Jeremy Fenton, medical director for Schweiger Dermatology Group in New York City and a clinical instructor of dermatology at Mount Sinai Hospital. “Inside of our shoes is the perfect environment for breeding fungus. It’s warm, it’s humid, it’s dark.”

Because of that, you should wash your shoes or at least the insoles in a washing machine at least once per month, Rossi said.

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For pajamas, outerwear, jeans and other clothes, how many times you can wear them without washing is based on the same principles for undergarments or activewear.

“As far as your pants and your shirts, I think it’s all a level of comfort and how much you’re perspiring throughout the day,” Rossi said. “A lot of people wear undershirts. The undershirt would be something to wash, whereas your top shirt you don’t really need to wash.”

If you don’t wear underwear, you need to wash your clothing before wearing it again since it came into contact with your genital skin, Rossi said.

If you usually shower before bed, wear underwear and sweat little to none when wearing pajamas, you could wear them for a week without washing, experts said. But if you don’t do these things, you’d need to wash them every time.

Outerwear — such as coats or jackets — typically doesn’t need to be washed more than once a month since it doesn’t touch your skin, Rossi said. “If you’re wearing it every day, probably (wash it) every two weeks,” he suggested.

Whether and how often to wash jeans can be a hot topic, since many people want to maintain the integrity of the fabric, which is usually stiffer and more durable than others. If jeans aren’t sweaty, dirty or stained, they don’t have to be washed often, Rossi said. “I personally don’t wash my jeans,” he added.

Mohammed recommended washing jeans monthly but acknowledged it depends on your lifestyle and environment.

“If somebody were to tell me that they were wearing their jeans for months on end and not washing them and they hadn’t had any problems with their skin or problems with odor, I wouldn’t see any problem at all,” Fenton said.

The most important questions you should ask yourself, experts say, when considering whether to wear something again without washing are these: Does it smell? Do I have any skin conditions, such as eczema, a rash or a skin lesion? Is it visibly dirty? Is it sweaty? Did I wear underwear with this?

“The main point is that the answer is going to be very variable,” Fenton said.

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