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This surgery weight loss 7-day juice cleanse buy generic shuddha guggulu line, Raynauds phenomenon: Condition in which cold tempera which is used most frequently on the hands to restore func tures or strong emotions cause blood vessel spasms that tion weight loss exercise buy 60 caps shuddha guggulu overnight delivery, reconstructs the damaged tendon by attaching an intact block blood flow to the fingers weight loss pills prescribed by dr order shuddha guggulu 60caps without prescription, toes weight loss pills in india order shuddha guggulu with mastercard, ears, and nose. Care Settings Related Concerns Client is treated at community level unless surgical procedure Psychosocial aspects of care, page 729 is required. Total joint replacement, page 625 Client Assessment Database Data depend on severity and involvement of other organs (e. Red, swollen, hot joints (during acute exacerbations) by soft tissue swelling in joints. Note: Radiographic erosion is typically fastest in the first year of disease (Graudal, 1998. Incorporate relaxation skills and diversional activities into pain control program. Note precipitating factors determining pain management needs and effectiveness of and nonverbal pain cues. Suggest client assume position of comfort while in bed or sit In severe disease or acute exacerbation, total bedrest may be ting in chair. Promote bedrest when indicated, but resume necessary until objective and subjective improvements are movement as soon as possible. Place and monitor use of pillows, sandbags, trochanter rolls, Stabilizes joint, decreasing joint movement and associated splints, and orthotics. Note: Orthotic devices play an important role in re habilitation management to decrease pain and inflamma tion, improve function, reduce deformity, and correct biomechanical malalignment (Temprano, 2013. Recommend that client take warm bath or shower on arising Heat promotes muscle relaxation and mobility, decreases pain, and/or at bedtime. Encourage use of stress management techniques, such as Promotes relaxation, provides sense of control, and may en progressive relaxation, biofeedback, visualization, guided hance coping abilities. Involve client in diversional activities appropriate for individual Refocuses attention, provides stimulation, and enhances self situation. Promotes relaxation, reduces muscle tension and spasms, facilitating participation in therapy. Collaborative Administer medications, as indicated, for example: Because irreversible joint damage occurs within the first 2 years, early diagnosis and intervention are necessary. Medications are the mainstay of treatment with a goal of (1) managing pain, (2) slowing joint destruction, and (3) preserving joint function. Given by injection or infusion, these drugs [Remicade], certolizumab pegol [Cimzia], golimumab are able to stop disease progression. Note: Because of the effect of these drugs on the immune system, the client is at greater risk for infections. Therefore, screening for tuberculosis is recommended for all clients who are beginning or currently receiving biologic agents. Corticosteroids, such as prednisone (Deltasone) and these drugs have both anti-inflammatory and immunoregula methylprednisolone (Medrol) tory activity and are useful in early disease as temporary adjunctive therapy. Assist with other modalities, as indicated, such as blood Prosorba Column is a device similar to a kidney dialysis ma filtration. Prepare for surgical interventions, such as tendon realignment Corrective surgical procedures may be indicated to reduce pain and repair, tunnel release procedures, total joint replacement, and/or improve joint function and mobility. Systemic rest is mandatory during acute exacerbations and important throughout all phases of dis ease to reduce fatigue and improve strength. Note: Inadequate exercise leads to joint stiffening, whereas excessive activity can damage joints. Encourage client to maintain upright and erect posture when Maximizes joint function and maintains mobility. Discuss and provide safety needs, such as raised chairs and Helps prevent accidental injuries and falls. Facili and assist with transfer techniques and use of mobility aids, tates self-care and clients independence. Provide joint Promotes joint stability, reducing risk of injury, and maintains support with splints. Decreases pressure on fragile tissues to reduce risks of immo bility and development of decubitus ulcers. Ascertain how client views self in usual lifestyle func with others will determine need for further intervention or tioning, including home, employment, and sexual aspects. Acknowledge and accept feelings of grief, hostility, and Constant pain is wearing, and feelings of anger and hostility dependency. Note withdrawn behavior, use of denial, or overconcern with May suggest emotional exhaustion or maladaptive coping meth changes. Assist client to identify Helps client maintain self-control, enhancing self-esteem. Enhances feelings of competency and self-worth and encourages independence and participation in therapy. Collaborative Identify community resources, local and national support Provides role models and assistance with problem-solving and groups, disability advocate as appropriate. Disability advocates pro vide additional support when dealing with problems within the community. Employment counselors provide client with information regard ing available assistive devices and appropriate worksite accommodations or modifications. Administer medications as indicated, such as anti-anxiety and May be needed in presence of severe depression until client mood-elevating drugs. Allow client sufficient time to complete tasks to fullest extent May need more time to complete tasks by self but provides of ability. Identify and plan Prepares for increased independence, which enhances for environmental modifications. Identify sources for necessary equipment such as lifts, elevated Provides opportunity to acquire equipment before discharge. Collaborative Consult with rehabilitation specialists, such as occupational Helpful in determining assistive devices to meet individual therapist. Arrange for consult with other agencies, such as Meals on May need additional kinds of assistance to continue in home Wheels, home-care service, or nutritionist. Determine financial resources to meet needs of individual situ Availability of personal resources and community supports will ation. Identify support systems available to client, such as affect ability to problem-solve and choice of solutions. Collaborative Coordinate home evaluation by occupational therapist and Helpful in identifying potential or existing health and safety rehabilitation team as indicated. Provides opportunity to schedule or perform necessary home repairs or upgrades in a timely manor. Identify and meet with community resources, such as visiting Can facilitate transfer to , and support continuation in, home nurse, homemaker service, social services, and senior setting. Develop a plan for self-care, including lifestyle modifications consistent with mobility and/or activity restrictions. Discuss clients role in management of disease process Goal of disease control is to suppress inflammation in joints through nutrition, medication, and balanced program of and other tissues to maintain joint function and prevent exercise and rest. Assist in planning a realistic and integrated schedule of activity, Provides structure and defuses anxiety when managing a rest, personal care, drug administration, physical therapy, complex chronic disease process. Identify individually appropriate exercise program compo Can increase clients energy level and mental alertness and nents, such as swimming, stationary bike, or nonimpact minimize functional limitations. Stress importance of continued pharmacotherapeutic Benefits of drug therapy depend on correct regimen, dosage, management. Identify adverse drug effects, such as tinnitus, gastric intolerance, Prolonged, maximal doses of aspirin may result in overdose. If tinnitus occurs, the dosage is usually decreased by one tablet every 2 to 3 days until it stops. Review importance of balanced diet with foods high in vitamins, Promotes general well-being and tissue repair or regeneration. Encourage obese client to lose weight and supply with weight Weight loss reduces stress on joints, especially hips, knees, reduction information, as appropriate. Provide information about and resources for assistive devices, Reduces force exerted on joints and enables individual to par such as wheeled dolly or wagon for moving items, pickup ticipate more comfortably in needed or desired activities.

Br J Psychiatry 1991; oxetine in treatment-resistant major depressive 159:510?514 [E] disorder weight loss drops order shuddha guggulu online. J Clin Psychopharma efficacy and safety of aripiprazole as adjunctive ther col 1999; 19:427?434 [E] apy in major depressive disorder: a multicenter weight loss 30 days buy shuddha guggulu 60 caps line, ran 444 weight loss kickboxing buy generic shuddha guggulu 60 caps. McIntyre A weight loss dr oz order 60 caps shuddha guggulu mastercard, Gendron A, McIntyre A: Quetiapine systematic review of randomized trials. Am J Psy adjunct to selective serotonin reuptake inhibitors or chiatry 2005; 162:1805?1819 [E] venlafaxine in patients with major depression, co 445. Practice Guideline for the Treatment of Patients With Major Depressive Disorder, Third Edition 123 tiapine augmentation of fluoxetine in major depres 466. Cephalon: Updated Safety Information: Warn 66:1468?1476 [B] ings regarding serious rash, including Stevens 460. Int double-blind, placebo-controlled trial of aug Clin Psychopharmacol 2007; 22:179?182 [B] mentation with an extended release formulation of 473. Barbosa L, Berk M, Vorster M: A double-blind, methylphenidate in outpatients with treatment randomized, placebo-controlled trial of augmenta resistant depression. J Clin Psychopharmacol 2006; tion with lamotrigine or placebo in patients con 26:653?656 [A] comitantly treated with fluoxetine for resistant 464. J Clin Psychi Psychopharmacol 1981; 1:264?282 [F] atry 2003; 64:1057?1064 [A] 475. J Clin Psychopharmacol one-year comparison of vagus nerve stimulation 2007; 27:614?619 [A] Copyright 2010, American Psychiatric Association. Int J therapy in the prevention of relapse following elec Neuropsychopharmacol 2007; 10:817?826 [B] troconvulsive therapy: a randomized controlled 479. Psychother Psychosom J Clin Psychiatry 2005; 66:1097?1104 [B] 2007; 76:266?270 [E] 480. J Affect cognitive behavior therapy of depression: potential Disord 2008; 110:1?15 [E] implications for longer courses of treatment. Am J Psychiatry 1996; 153:945?947 [B] during fluoxetine continuation or maintenance 495. J Clin Psychiatry for major depressive episodes: how long should it 2000; 61:518?524 [A] be maintained? Am J Psychiatry 1985; 142:469?476 [F] with cognitive therapy: a randomized controlled 486. J Consult Clin Psychol 2000; Guideline Number 5: Depression in Primary Care, 68:615?623 [A?] Copyright 2010, American Psychiatric Association. Practice Guideline for the Treatment of Patients With Major Depressive Disorder, Third Edition 125 499. Behavioural Recurrence after recovery from major depressive Psychotherapy 1992; 20:25?36 [B] disorder during 15 years of observational follow-up. Lejoyeux M, Ades J: Antidepressant discontinua Am J Psychiatry 1999; 156:1000?1006 [C] tion: a review of the literature. J Clin Psychopharma tenance pharmacotherapy for unipolar and bipolar col 1996; 16:356?362 [D] mood disorders. Psychother Psychosom 2002; DeVeaugh-Geiss A, Krebs E, Lohr K: Meta-analysis 71:195?199 [A] of major depressive disorder relapse and recurrence 521. J Clin Psychiatry 2003; 64:14? Comparison of full-dose versus half-dose pharma 19 [C] cotherapy in the maintenance treatment of recur 523. Br J Psychiatry selective serotonin reuptake inhibitors: a retrospec 2006; 189:393?398 [E] tive study. Aust N Z J Psychiatry 2006; 40:941? line for the Treatment of Patients With Alzheimer?s 950 [F] Disease and Other Dementias, Second Edition. J Child Adolesc Psy Psychiatry 2005; 58:204?210 [G] chopharmacol 2006; 16:25?32 [E] 543. Br J Psychiatry 2008; 193:10?17 [E] Patterns of psychotropic medication use among pa 534. J Neuropsychiatry etine combination for major depression with Clin Neurosci 1989; 1:347?361 [C] psychotic features. J Clin Psychopharmacol 2004; 24:365?373 [A] Copyright 2010, American Psychiatric Association. Practice Guideline for the Treatment of Patients With Major Depressive Disorder, Third Edition 127 550. J Affect Disord 1999; 54:1?19 [F] parison of nortriptyline plus perphenazine versus 564. J Affect Disord 2005; 84:209?217 [G] E, Merello M, Migliorelli R, Leiguarda R: Catato 569. Arch Gen Psychi (eds): Catatonia: From Psychopathology to Neuro atry 1988; 45:129?137 [A? Am J Psychiatry 1988; patients diagnosed with neuroleptic malignant syn 145:306?311 [A] drome. The Venlafaxine French Inpatient Study sponders with atypical depression: a new applica Group. Ann Clin Psychiatry 1989; 1:119? clic versus selective serotonin reuptake inhibitor 122 [C] antidepressants. Ann Clin Psychiatry 1991; 3:311?313 [C] Copyright 2010, American Psychiatric Association. J Clin Psychiatry 2008; 69:406?411 [B] depression: effect of nefazodone, cognitive behav 579. 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X Action: Binds to specifc nuclear receptors and affects gene transcription such that many aspects of infammation are suppressed weight loss camps for adults purchase genuine shuddha guggulu line. Y Use: Used as an inhaled corticosteroid in the management of Z infammatory airway disease in dogs and cats weight loss pills zynadryn proven shuddha guggulu 60caps. C Adverse reactions: Inhaled steroids are known to suppress the hypothalamic-pituitary-adrenal axis weight loss pills venom hyperdrive 30 generic shuddha guggulu 60caps visa, although they are considered D generally safer than systemic steroids weight loss vegan diet shuddha guggulu 60caps for sale. Action: Serotonin uptake inhibitor that causes increased serotonin K concentrations at the brain synapses with resultant anxiolytic, antidepressant and compulsive effects. L Use: Treatment of canine compulsive disorders, anxieties, phobias M and panic attacks, especially when involving signs of impulsiveness and aggression. In cats it has been suggested for use in a range of fears and anxieties and in the treatment of wool-eating. Do not use in pregnant and lactating animals or those with epilepsy, cardiovascular R disease, diabetes mellitus, a history of bleeding disorder, or renal or hepatic compromise. Drug interactions: Fluvoxamine may be an inhibitor of cytochrome V P450 3A4 and so should not be given in association with drugs metabolized by this cytochrome, such as alprazolam, cisapride and W erythromycin. Do not give fuvoxamine in combination with, or within 2 weeks of therapy with, monoamine oxidase inhibitors. N Action: Aminoglycosides inhibit bacterial protein synthesis and require an oxygen-rich environment to be effective, thus they are O ineffective in low-oxygen sites (abscesses, exudates), making all obligate anaerobic bacteria resistant. They are bactericidal and their P mechanism of killing is concentration-dependent, leading to a marked post-antibiotic effect, allowing pulse-dosing regimens which Q may limit toxicity. Framycetin is particularly effective R against Gram-negative bacteria, although the combination preparation Canaural has a broad spectrum of activity. U Adverse reactions: Aminoglycosides are potentially ototoxic, and ataxia, deafness and nystagmus may be observed in cats where V drops have been administered with a perforated tympanum. C Action: Loop diuretic, inhibiting the Na+/K+/Cl? cotransporter in the thick ascending limb of the loop of Henle. It also increases excretion of calcium, magnesium and hydrogen as well as renal blood E fow and glomerular fltration rate. G Use: Management of congestive heart failure (acute and chronic), non-cardiogenic oedema, hypercalcuric nephropathy, acute renal H failure, hyperkalaemia and hypertension. The use of chronic diuretic monotherapy in the management of heart failure is not I recommended, as patients receiving concomitant therapies (e. Use J with caution in patients with severe electrolyte depletion, hepatic failure and diabetes mellitus. M Adverse reactions: Hypokalaemia, hypochloraemia, hypocalcaemia, hypomagnesaemia and hyponatraemia; dehydration, polyuria/ N polydipsia and prerenal azotaemia occur readily. A marked reduction in cardiac output can occur in animals with severe pulmonary O disease, low-output heart failure, hypertrophic cardiomyopathy, pericardial or myocardial disorders, cardiac tamponade and severe P hypertension. R Drug interactions: Nephrotoxicity/ototoxicity associated with aminoglycosides may be potentiated when furosemide is also used. S Furosemide may induce hypokalaemia, thereby increasing the risk of digoxin toxicity. Increased risk of hypokalaemia if furosemide T given with acetazolamide, corticosteroids, thiazides and theophylline. The excretion of aspirin and furosemide may be reduced as they both U compete for renal excretory sites; dose reduction may be required. Furosemide may inhibit the muscle relaxation qualities of V tubocurarine, but increase the effects of suxamethonium. Once clinical signs improve, increase dosing interval to q8-12h, monitor urea, creatinine and electrolytes, and start oral Z therapy once tolerated. The goal is to use the lowest dose of furosemide that effectively controls clinical B signs. Doses in excess of 10 mg/kg/day (cats) or 15 mg/kg/day C (dogs) are unlikely to be benefcial and additional diuretic therapy is required. Acute renal failure/uraemia: after replacing fuid defcit give furosemide at 2 mg/kg i. Use: Active against Gram-positive bacteria, particularly S Staphylococcus pseudointermedius. It is used topically in the management of staphylococcal infections of the conjunctiva, skin or T ear. Fusidic acid is able to penetrate skin and penetrate the cornea gaining access to the anterior chamber of the eye. The carbomer U gel vehicle in the ocular preparation may also be effcacious as a surface lubricant. Contraindications: Do not use preparations containing X corticosteroids in pregnant animals, birds and rabbits. Birds: Skin: apply a thin layer q24h; Ophthalmic: 1 drop per affected E eye q12-24h. Gabapentin does not interact with sodium-dependent channels and demonstrates no M affnity for the common neurotransmitter receptors, including benzodiazepine, glutamate, glycine and dopamine. N Use: Adjunctive therapy in the treatment of seizures refractory to treatment with conventional therapy. Also treatment of neuropathic O pain, particularly if insensitive to opioid analgesics. After multiple dosing, peak plasma concentrations of gabapentin are usually P achieved within 2 hours of a dose and steady state achieved within 1-2 days. Q Monitoring of serum levels in dogs and in human patients does not appear useful. In one study of dogs on doses of approximately R 10 mg/kg q8h, serum levels after 3 months of therapy ranged from 2. Use with caution in patients with renal impairment, S behavioural abnormalities or severe hepatic disease. U Adverse reactions: the most commonly reported adverse effect in dogs is mild sedation and ataxia. False-positive readings have been V reported with some urinary protein tests in human patients taking gabapentin. Cimetidine has been reported to reduce the renal clearance of gabapentin but the product information Z does not consider this to be of clinical importance. I Action: Promotes retention of fuid in the vascular system through the exertion of oncotic pressure. J Use: the expansion and maintenance of blood volume in various forms of shock including hypovolaemic, haemorrhagic and septic shock. The K main difference between gelatine-based solutions and other synthetic colloids is that they have lower molecular weights (and hence are L excreted rapidly), appear to have few antigenic or anticoagulative effects. The plasma half-life of most gelatines is approximately 8 hours M (oxypolygelatine 2-4 hours), so that the duration of plasma expansion is much shorter than with etherifed starch. There appears to be little N effect on coagulation or blood loss following gelatine administration. Use with caution in animals with congestive heart failure or renal O insuffciency as will increase risk of circulatory overload. Q Adverse reactions: Anaphylactoid reactions to gelatine solutions are rare; it is uncertain whether these reactions represent a specifc R immune response. In normal circumstances do not exceed replacement of >25% of U circulating blood volume with gelatines in a 24 h period. B Action: Aminoglycosides inhibit bacterial protein synthesis and require an oxygen-rich environment to be effective, thus they are C ineffective in low-oxygen sites (abscesses, exudates), making all obligate anaerobic bacteria resistant. They are bactericidal and their D mechanism of killing is concentration-dependent, leading to a marked post-antibiotic effect, allowing pulse-dosing regimens which E may limit toxicity. Use: Active against Gram-negative bacteria, but some staphylococcal F and streptococcal (Streptococcus faecalis) species are also sensitive. Use in domestic animals is limited by nephrotoxicity and, more rarely, ototoxicity and neuromuscular blockade. Microbial H resistance is a concern, although many bacteria resistant to gentamicin may be susceptible to amikacin. Monitoring serum I gentamicin levels is recommended for those with pre-existing renal dysfunction if the use of this drug is considered essential. When used for ?blind? therapy of undiagnosed serious infections, gentamicin is K usually given in conjunction with a penicillin and/or metronidazole.

The process involves nipple stimulation with use of an electric breast pump beginning about two months before the adoptive mother expects to begin breast-feeding weight loss unintentional generic shuddha guggulu 60caps amex. In addition weight loss pills japanese purchase shuddha guggulu 60 caps amex, hormonal therapy weight loss 30 day challenge order 60caps shuddha guggulu visa, such as supplemental estrogen or progesterone weight loss pills or powder purchase 60caps shuddha guggulu with mastercard, may be prescribed to mimic the effects of pregnancy. Typically, hormone therapy for induced lactation is discontinued shortly before breast-feeding begins. Authorized under provisions of the Patient Protection and Affordable Care Act, the U. New health plans and non-grandfathered plans and issuers are required to provide coverage consistent with these guidelines in the first plan year (in the individual market, policy year) that begins on or after August 1, 2012. These recommendations also should be followed by women receiving ant-iretroviral therapy. Back to Top Date Sent: 3/24/2020 170 these criteria do not imply or guarantee approval. Prophylactic mastectomy to prevent the onset of breast cancer when a clinical determination has been made that there is a high risk for breast cancer; B. Back to Top Date Sent: 3/24/2020 171 these criteria do not imply or guarantee approval. Criteria | Codes | Revision History g) Breast implant removal and subsequent re-implantation performed to produce a symmetrical appearance when the original implant was in the unaffected breast prior to the disease in the affected breast. SurgiMend Autologous fat injections for post-mastectomy breast reconstruction (autologous fat grafting, autologous fat transfer, breast fat grafting, lipoinjection, lipofilling) A. Autologous fat injection coverage is covered only for breast reconstruction (dimpling and contouring), if medical necessity criteria for breast reconstruction is met. Total breast reconstruction is not covered using the Brava system (autologous fat injection for complete reconstruction. All other bioengineered skin substitutes other than listed above see Wound Care criteria B. Suction lipectomy or ultrasonically assisted suction lipectomy for correction of donor site asymmetry. Ongoing surgery for treatment of natural changes due to age or weight changes is considered cosmetic and not covered. Replacements within this 6-month period are covered when medically necessary due to a change in the Member?s condition. Background While breast reconstructive surgery can be considered a cosmetic procedure, under both state and federal law, carriers must provide coverage for this type of surgery in certain clinical circumstances. Back to Top Date Sent: 3/24/2020 172 these criteria do not imply or guarantee approval. Washington state law also has provisions for the coverage of reconstructive surgery following a mastectomy. In addition to the above statutes, guidance for interpretation of these state statutes is found in Carr v. Fat transfer was first performed by Neuber in 1893 for the correction of a depressed face scar, and two years later it was performed by Czerny for breast construction after excision of a large fibroadenoma. Since then, several surgeons have used free fat grafts for the reconstruction of breast defects. Autologous fat is considered an ideal injectable agent for soft tissue augmentation; it is easily available for most patients, easy to use, inexpensive, nontoxic, biocompatible, and potentially long lasting, and removable (Mu 2009, Fraser 2011, Bucky 2011. Breast fat grafting is a promising technique to correct contour deformities in breasts reconstructed with either prosthesis or autologous tissues. The value of the procedure is controversial due concerns about its safety and efficacy. The mechanism underlying the survival of dissected autologous fat after grafting is unknown but is believed to be dependent on revascularization of fat granules. One of the main concerns with autogenous fat grafting for the breast is the development of fat necrosis leading to liponecrotic cysts and microcalcifications that could be mistaken for cancerous calcifications. Compression of the breast tissue by the transferred fat may also make it difficult to identify subtle changes in architectural patterns seen with early breast cancer presentation. Another concern relates to the potential oncologic risks of breast fat grafting, as fat transfer into a previous breast-cancer area may potentially stimulate local recurrence. Other complications with autologous fat transfer include edema, hematoma, induration, infection, granuloma formation, oil cyst formation, fat liquefaction, sclerosis and resorption (Pulagam 2006, Mu 2009, Mizuno 2010, Fraser 2011, Bucky 2011, Rietjens 2011, Serra-Renom 2011. After gaining much popularity, the interest in autologous fat transfers waned in the 1950s and 1960s due to low rates of graft survival and the increased use of artificial material. The interest in autologous fat grafting for aesthetic and reconstructive purposes was renewed in the 1980s with the introduction of liposuction that provided a minimally invasive means of obtaining large amounts of adipose tissue in a semiliquid form. However, the procedure was again discontinued for some time due to concerns over post operative calcifications and risk of obscuring developing malignant lesions. More recently, autologous fat transfer re-emerged after a number of surgeons introduced ?lipomodelling? and used the technique alone or with in combination with other reconstructive procedures. Several harvesting and transplantation techniques have been developed and refined, yet no standard procedures have been adopted by all practitioners. There is no consensus on the ideal cannula, technique for harvesting, processing, or grafting the fat. Once harvested, the fat is prepared for injection by one of several methods including: washing with physiological buffers, centrifugation for separating the cells from the debris, decantation, or concentrating it using cotton towels or other adsorbent media. For grafting, the fat is injected with a variety of delivery methods using sharp or blunt needles. It is reported that the fat ?takes? if it is obtained using atraumatic methods, but it does not acquire the shape of the breast and remains flattened. Back to Top Date Sent: 3/24/2020 173 these criteria do not imply or guarantee approval. Criteria | Codes | Revision History the grafted fat to acquire the desired cone shape. The procedure is not simple and should be performed by skilled and trained surgeons. It requires careful calculation of the amounts of fat injected at one time, number of injections needed, appropriate sites for injections, and proper administration of the transferred fat (Hyakusoku 2008, Mu 2009, Fraser 2011, Bucky 2011, Parrish 2010. They emphasized that the patients should be made aware of the potential risks and complications of the procedure and indicated that physicians should be cautious when considering high-risk patients (Gutowski 2009, Mizuno 2010. The studies used different techniques, donor site, volume of fat transplant, as well as various outcome measures and follow-up durations. Most of the series included patients undergoing the procedure for breast augmentation, reconstructive surgery after mastectomy, as well as other indications. The largest published series of 880 patients over 10 years was reported by Delay, et al in 2009. The intervention was not compared to another procedure, and the study had several limitations including, but not limited to , lack of reporting inclusion/exclusion criteria, patient characteristics, and lack of clearly defined outcomes and reporting of duration or completeness of follow-up. The authors indicate that the procedure was successful to the patients and surgeons but did not clearly define success other than comparison of photographs. They reported that the incidence of fat necrosis was 15% for the first 50 patients and declined to 3% for the last 100 patients suggesting a surgical learning curve. The authors concluded, ?None of the imaging results are likely to confuse the diagnosis of cancer for radiologists who are experienced in breast imaging. Oncologic follow-up (now at 10 years for our first patients) shows no increased risk of local recurrence or of development of a new cancer?. Illouz and Sterodimas (2009), reported on a series of 820 consecutive patients who underwent autologous fat transplantation over 25 years. These included patients undergoing the procedure for breast reconstruction after a mastectomy, patients with congenital asymmetry, or women requesting breast augmentation. A total amount of fat transplanted in each breast ranged from 25-900 ml (mean 540 ml), and a mean of 3 sessions (range 1-5) were needed to achieve the desired results. The authors indicted that the majority of patients were satisfied with the results. They did not measure the longevity of the transplantation, did not discuss loss of follow-up, injected fat survival, or necrosis. They indicate that calcifications, cysts, and cancer were not apparent in the first year after the procedure and thought that they may not be directly associated with the procedure. In conclusion, data from published studies do not provide sufficient evidence to determine the components of a successful, consistent, durable, and safe autologous fat transplantation for breast reconstruction.