Medical

2020-spring-can-you-avoid-being-botched

Can You Avoid Being “Botched”?

The medical aesthetic industry is rapidly becoming one of the most sought after career choices for medical professionals. Due to the rapid growth, new cosmetic injectors are popping up on every corner. Understandably, it can be difficult to know which aesthetic professional to choose. Here are 5 tips to help you avoid being “botched.” Tip […]

The medical aesthetic industry is rapidly becoming one of the most sought after career choices for medical professionals. Due to the rapid growth, new cosmetic injectors are popping up on every corner. Understandably, it can be difficult to know which aesthetic professional to choose. Here are 5 tips to help you avoid being “botched.”

Tip #1: Do NOT price shop! Cosmetic injectables are a luxury, not a necessity.

I am the first person to use a coupon or search for the best deal in town…on toilet paper! Price shopping for aesthetic procedures can leave you with undesirable results and high out of pocket expenses to fix “botched” work. As the aesthetic field becomes more mainstream, there has been an increase in the number of treatments performed without the proper training, qualifications, or through the use of counterfeit products. Beware of deals that are too good to be true, they probably are!

Tip #2: Research! Not the encyclopedia.

I love Instagram! IG, as the millennials refer to it, has been my main referral source since I began practicing 5 years ago. Instagram allows me to build an up to date, detailed portfolio highlighting pictures and videos of various procedures with thorough descriptions of my techniques and product choices. I find it helps the consumer research my work before even making the call to schedule a consultation. 90% of my business is generated through my portfolio on Instagram. Check it out @beauty_rn_jc

Don’t forget to compare, it may be helpful to look at a few different injectors work before making your final decision. Often, injectors will have their work on several social media outlets. So, carry out a quick search on Instagram and other social media sites to see what injector best suits your desired results.

Tip #3: Schedule a consultation.

After you have done some research, it’s time to schedule a consultation. A consultation is an excellent way of building a rapport with your injector. During the consultation, don’t be afraid to ask questions. Here are a few important questions to ask during the initial consultation.

  • “Can you explain the procedure and product you are using?”
  • “Can you explain the dosage or amount of product needed?”
  • “What can I expect to look like after treatment?”
  • If the injections are suspiciously affordable: “How are you able to offer such discounted prices?”
  • “What is your title and specialty?” i.e. Nurse, Doctor, Plastic Surgeon or Dermatologist

Tip #4: Credentials & Continued Education

There is no doubt that education is one of the most critical ingredients for continued growth and success in any industry. In a world of ever-changing trends and technology, every qualified professional must ensure they are at the cutting edge, simply to ensure survival.

In addition to obtaining a medical license, continuing education is equally as important. Due to the current lackadaisical regulations in the medical aesthetic industry, obtaining continuing education certificates can be quite difficult, expensive, and often overlooked. I have traveled to Norway, Florida, California, NYC, DC, and Maryland to learn from some of the best nurse injectors, dermatologists, and facial plastic surgeons in the world. Ask your injector what kind of training they have had. It could make all the difference in the outcome of your treatment.

Tip #5: Feel 100% confident in your decision!

I’m big on vibes! If you do not get a good vibe from the initial consultation, walk away! Do not allow anyone to treat you if you are not 100% confident in their skill as a medical aesthetic provider. If your provider cannot answer some of key questions during your consultation and educate you about what and why a product is being used, don’t do it. There are plenty of injectors out there, and it’s worth taking your time to find someone who is the right fit for your needs.

Ultimately, selecting any medical professional should be a personal and well-researched decision. Credentials, education, cost, and a strong portfolio are factors that should be considered when choosing a provider for cosmetic injections. As I always say, “An educated patient – is a happy patient.”

Share This:

2020-spring-managing-equipment

Managing The Equipment Needs While Designing And Building A Biopharmaceutical Facility

Pharmaceuticals have always been complex products commercialized after years of research and clinical trials.  Launching a new drug requires identifying the root cause of a health problem, determine a strategy to counteract that problem, and execute a research and development strategy.  And if a pharma company is lucky, the clinical trials show the drug is […]

Pharmaceuticals have always been complex products commercialized after years of research and clinical trials.  Launching a new drug requires identifying the root cause of a health problem, determine a strategy to counteract that problem, and execute a research and development strategy.  And if a pharma company is lucky, the clinical trials show the drug is safe and effective, and they can successfully scale it up to manufacturing scale and supply it reliably to the public.

That simplistic overview takes levels of development that all starts with infrastructure.  The modern pharmaceutical research and development space, production facility, or quality testing laboratory is built by incorporating planning, architectural and engineering design, construction management, and execution, and equipment installation and startup.

To successfully startup the equipment needed to facilitate cutting edge research into nad production of biopharmaceutical products at the end of construction, the equipment needs to be defined by the scientists who will use it before anyone ever breaks ground.  The architectural, mechanical, electrical, and plumbing requirements all must be defined so the facility can be properly designed and engineered.  Understanding the overall needs early in the planning phase is critical to successful construction execution, and therefore critical to the eventual installation and startup of that equipment.

The process starts at concept.  A new facility is being built, or a current lab needs remodeling.  The researchers are excited about their new home but need direction to navigate budgetary constraints, help to pick the proper equipment and accessories for their needs, and someone to make sure this is translated to the proper quotes, purchases, and installation activities.  This is where a focused group can help complex projects stay on course.  The equipment management team helps translate the scientific needs of the final laboratory customer, the scientist, into the architectural and engineering requirements of the laboratory design team.   

For example, a researcher may need a microscope.  Seemingly simple enough, it takes up some level of physical space, needs to plug into a wall for a light source, aka have electrical requirements, and that’s pretty much it, right?  Some microscopes, however, are highly sophisticated and require more physical space, heating and cooling, and a computer control and data capture capabilities.  If the unit is used to generate data that may support a company’s FDA submission, there are data integrity and IT requirements that must be met; quickly, the simple gains complexity that all needs to be thoroughly planned for.

Once the equipment has been selected, and laboratory planning has been completed, i.e., there is a defined physical space and utilities on the plan for each piece, the team can help manage the installation aspects of the project.  During construction activities, there are sometimes questions of utility placement; how high should this gas line be, should it be on the right or left of the instrument, how long is the cord?  Ensuring there is an available resource who is knowledgeable about the equipment on hand is critical to this execution stage.

Procurement is up next, and the planning and management of lead times vs. early delivery needs or lack of on-site storage are all considered.  Some projects require early delivery of instrumentation that utilizes a computer in order for groups to validate the software and IT connectivity.  Other projects need to rely on just in time (JIT) delivery due to the lack of storage space on site and concerns over moving sensitive equipment around a construction area.

As installation activities progress, there is the need to manage the vendor access to the construction site and the paperwork they generate.  For a facility performing GMP (Good Manufacturing Practice) work, this includes specific Commissioning, Qualification, and Validation (CQV) activities aimed at ensuring there is proof positive that the equipment has been installed properly and operates correctly. Only once this has been performed and approved by all parties can the equipment, and laboratory in general, be used to perform work.

By connecting all of the various stages of the development of a new laboratory, manufacturing, or quality testing facility, a firm can ensure they are handing off a fully operational project upon turnover.  Genesis AEC (Architects, Engineers, Constructors) has identified the need to manage the laboratory equipment needs of our clients proactively.  We have the technical staff on board to provide support throughout the project lifecycle, thereby guaranteeing project success.  Genesis is committed to delivering facilities for life-saving therapies.

Share This:

Never Put Anything Smaller Than Your Elbow In Your Ear!

Ear wax medically known as Cerumen is generally a mystery to the average person. Most feel that if there is wax in their ears, then they are “dirty.” This is simply not the case; it’s supposed to be there! But if that’s true, then what is it for? Why is it there, and most importantly, […]

Ear wax medically known as Cerumen is generally a mystery to the average person. Most feel that if there is wax in their ears, then they are “dirty.” This is simply not the case; it’s supposed to be there! But if that’s true, then what is it for? Why is it there, and most importantly, how do I clean my ears???

Cerumen is made up of oil and sweat glands, the fancy term for these glands are apocrine (oil gland) and sebaceous (sweat gland). One interesting fact is that the body products different consistencies or colors of Cerumen depending on your ethnicity. Hormones and age-related changes can also play a role in its makeup. Sometimes these changes do cause it to build up or get stuck in the canal and require professional removal but more on that later.

The role of Cerumen is to naturally work its way out of your canal to clear the ear of debris or foreign objects. It mostly ends up at the bottom of the ear canal due to a little thing called gravity! I’m sure you are now thinking that if that’s the case, how DO I clean my ears? The answer to that for most people is using a washcloth when bathing. Cotton swabs were not designed to be inserted into the ear canal. They should only be used to clean the outer ear.

Some people’s ears do require a visit to the clinic for the cleaning to be done professionally. This includes tortuous or bendy ear canals, smaller or collapsing ear canals, and ear canals that have undergone surgery or radiation. In these ears is the Cerumen may build up and can cause a significant degree of hearing loss if not treated professionally.

Finally, a few demographic populations that need extra care to their ears are people diagnosed with Dementia, Alzheimer’s disease, and Downs Syndrome. Down’s syndrome tends to affect the shape of the ear canal along with the makeup of the Cerumen, which makes it more difficult to move out of the canal. In addition, people who suffer from cognitive impairments, such as Dementia and Alzheimer’s disease, generally do not realize that their hearing is becoming impaired. It’s more and more common that someone having memory problems or becoming confused are found to have some degree of hearing loss, which may be exasperating their symptoms. These ears should be looked at regularly by a professional such as an audiologist, otolaryngologist (or ENT), or nurse who has been trained in cerumen management.

Share This:

2020-winter-recognizing-a-person-in-crisis

Recognizing and Responding to a Person in Crisis

When working in the mental health field, it is not uncommon to interact with an individual in a crisis state.  For those who do not work in the mental health field, it is also likely at some point, you may come across someone in your personal life who is struggling to cope with the stressors […]

When working in the mental health field, it is not uncommon to interact with an individual in a crisis state.  For those who do not work in the mental health field, it is also likely at some point, you may come across someone in your personal life who is struggling to cope with the stressors of everyday life.  When these stressors become unmanageable, a person could go into a crisis state.  So, what is a crisis state?  A crisis state is defined as a temporary state of disorganization, characterized by an individual’s inability to cope with internal or external stressors using common methods of problem-solving.  There are 3 stages of the cycle to achieve a crisis state: the emotional trigger, the escalation, and the crisis state.  A person begins the crisis cycle by first being exposed to an emotional trigger.  The death of a loved one, a divorce, or losing one’s job are all some common examples of emotional triggers that we see in everyday life that may be very difficult for someone to cope with.  When an individual is unable to cope with these emotional triggers, the situation begins to escalate.

Some common reasons an emotional trigger can escalate into a crisis are because the individual may not understand “why” the trigger is happening to them; they may misperceive a situation, have not yet developed healthy coping skills, or are easily overwhelmed.  What does this escalation stage look like in terms of a person’s behavior?  They may become loud or threatening, refuse to cooperate, defiant, aggressive, withdrawn/run away, and talk about self-harm or suicide.  There are not only behavioral signs that a person is in the escalation stage of a crisis cycle but also physical warning signs as well.  These physical changes may include dilated pupils and direct stares, clenched fists and muscle constriction, flushed and angry appearance, invasion of other’s personal space, and rapid, deep breathing.  These are all warning signs that an individual is entering a crisis state and will need either intervention or professional support.  Once the trigger has occurred, and the emotional response escalates to the inability to manage that trigger effectively, the crisis state is realized.   

How do we respond to a person who is now in a crisis state? 

There are both physical and behavioral ways that we can respond to a person in crisis in the hopes to deescalate the situation.  In terms of your physical response, first, begin by using a calm and soothing voice.  Manage your volume not further to escalate the situation.  Use a relaxed and open body posture to appear non-threatening. Maintain soft gestures and facial expressions.  Finally, keep a safe distance from the person to not endanger yourself.  Behaviorally, we want to attempt to verbally deescalate the individual to prevent any physical harm to them or anyone else present.  Use empathy statements to validate the feelings of the individual.  Reflect on the emotion that you hear.  Use encouraging and soothing words.  Don’t lead with the rules or consequences of the individual’s behavior.  Also, do not use critical language or express your own negative emotions.

In summary, whether you are a professional in the mental health field or just a normal person in everyday life, you will most likely encounter a person in a crisis state at some point.  The number one priority is to maintain the safety of everyone involved, including the individual in crisis.  If you find yourself in such a situation and the above suggestions are not useful in deescalating the individual please, reach out to the authorities or dial 911.  We always want everyone to remain safe in a crisis situation.

Share This:

Telehealth: Are We Ready for Better Healthcare at a Lower Cost?

Healthcare, specifically its cost and equitable delivery, is perhaps the most significant domestic social and political agenda of our times. According to the Centers for Medicare and Medicaid (CMS)[1], healthcare-related costs was 17.9% of US GDP (~$3.5 trillion dollars) in 2017. In a recent analysis by Fortune[2] U.S. healthcare costs are projected to become 19.4% […]

Healthcare, specifically its cost and equitable delivery, is perhaps the most significant domestic social and political agenda of our times. According to the Centers for Medicare and Medicaid (CMS)[1], healthcare-related costs was 17.9% of US GDP (~$3.5 trillion dollars) in 2017. In a recent analysis by Fortune[2] U.S. healthcare costs are projected to become 19.4% of GDP by 2027. While we have the most innovative healthcare system in the world in terms of discovering new treatments, we are ranked 27th in the world when it comes to overall healthcare outcomes[3]. To put things in perspective, we have the most powerful military in the world, and it costs us only 3.1% of our GDP. There are a number of reasons contributing to this massive disparity between investments in research, cost of care and outcomes and parsing that is beyond the scope of this article.

So where are we headed into the future?  Is there any hope for us to get quality healthcare at a reasonable cost?

Telemedicine/telehealth represents a growing sector within healthcare which has the greatest promise to bend the cost curve while providing better health outcomes. It intends to transform the current paradigm of care delivery through innovative internet-enabled technologies. According to the New England Journal of Medicine, [4] Telehealth is defined as “the delivery and facilitation of health and health-related services including medical care, provider and patient education, health information services, and self-care via telecommunications and digital communication technologies. Live video conferencing, mobile health apps, “store and forward” electronic transmission, and remote patient monitoring (RPM) are examples of technologies used in telehealth.” While some draw parallels to the holographic doctor in the 1990s T.V. series Star Trek, telemedicine is no longer science fiction. An example of a deployed telehealth solution is Project ECHO (Extension for Community Health Outcomes) that is currently in 130 sites in the U.S. as well as in 23 countries. Started in New Mexico by Sanjeev Arora M.D. in 2003, the goal of project ECHO was to extend access to specialists in the care of patients in remote locations, especially in rural areas. This resulted in reducing wait-times to see some specialist from 8 months to 2 weeks while also lowering the cost burden on the healthcare system and dramatically increasing the health and satisfaction of patients![5]

In every instance where telehealth solutions have been deployed, access to care immediately becomes more equitable, easy to get to, and less expensive. More excitingly, over the long run, with data gathered from individual patients, dramatic improvements in health outcomes are possible as it enables personalized medicine through artificial intelligence and machine learning.

The vision of the Affordable Care Act, the largest change to our healthcare system in 30+ years, was to move our entire healthcare model away from fee-for-service to evidenced-based care. In this paradigm, digital health is a critical component – starting with electronic medical records to link payers, providers, and patients seamlessly with data. While a number of states and private payers are investing, innovating and deploying telehealth-based care, there are many social, political and legal barriers that are continuing to prevent telehealth from reaching its full potential of providing Americans with cost-effective quality healthcare. It is important to emphasize that the barriers are not in technology! Here are some.

Resistance from incumbents: The current healthcare system is a physician and provider (hospital, clinic) centric model. This model ensures that a patients’ visit is private, safe, and secure. A physician, in addition to looking at objective data such as lab results, vital signs, and other measurements, also relies on subjective cues that have been honed from decades of training. Telehealth platforms disrupt this normal physician-patient interaction. Furthermore, physicians need to be re-trained on how to interact with patients who are at a remote location. What kind of video streaming is needed? How to perform a virtual patient examination? How does one keep this private? What are the liabilities involved? These are some of the questions that are being raised and actively debated.

Non-uniform national legislation: Because of the hesitation among care providers towards adopting telehealth, policymakers are at a loss on structuring workable rules and legislation around telehealth. A number of state-level pilots are ongoing around the country to determine what works best. These are, however, very ad-hoc local attempts occurring through regional grants with a focus on care accessibility and not so much on savings to the payers. As a result, the data and the lessons learned are spotty and un-coordinated.

Poor re-imbursement: Because the various pilot studies are not measuring true costs and accurately capturing return on investments (ROI), current re-imbursements for telehealth are a miniscule fraction of a physical visit. Neither the physicians, providers, or telehealth technology delivery organizations are able to capture sufficient and sustainable revenue. While a remote visit does cost less than a physical visit, the providers have locked in costs with their current infrastructure that is required to support a traditional physical visit. As a result, unless reimbursements are made higher at least on the outset initially, there is a disincentive to adopt telehealth.

Individual preference: Without elaborating this extensively, some people prefer to have a physical visit no matter how easy, convenient, or cost-effective a virtual visit may be. This is especially true in the generation group that is not digital-natives. The problem is compounded because individuals with insurance do not see the full cost of care, and this lack of transparency does not create any incentives to change to a lower-cost delivery model.

There are a number of organizations, including ours (www.chromologic.com) that are working on making telehealth a reality by focusing on reducing the friction in adoption, access, and cost. We work directly with the U.S. Department of Defense to address their needs for easy and rapid enrollment and verification of wounded warfighters and civilians at the point of need using a unique and dual secured biometric scheme. This technology is also making access to telehealth solutions frictionless in multiple civilian care delivery settings in the Los Angeles area.

The promise of telehealth in terms of reducing cost for better care is real. The adoption can be accelerated once we have a more focused national-level effort that is based on evidence gathered from the multiple pilots that have occurred/occurring around the nation. It is this authors belief that we are at a tipping point where a radical shift towards telehealth centric healthcare system is inevitable. But in this current political climate, we may have to be patient.


 

[1] https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical.html

[2] https://fortune.com/2019/02/21/us-health-care-costs-2/

[3] https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31941-X/fulltext#seccestitle160

[4] https://catalyst.nejm.org/what-is-telehealth/

[5] https://mhealthintelligence.com/features/is-project-echo-the-telemedicine-model-that-healthcare-is-missing

Share This:

fall-2019-scientist

Life Sciences: Understanding the basic differences between Validation and Calibration

The Life Sciences market is evolving at breathtaking speeds these days, and the rapid rise in product innovation and cell therapy technology across the life science market is calling for companies to have a more robust quality and compliance approach in order to meet regulation and produce safe and reliable products. Good manufacturing practice (GMP) […]

The Life Sciences market is evolving at breathtaking speeds these days, and the rapid rise in product innovation and cell therapy technology across the life science market is calling for companies to have a more robust quality and compliance approach in order to meet regulation and produce safe and reliable products.

Good manufacturing practice (GMP) regulators in the United States the European Union and other internationally recognized GMP regulators have sharpened their focus on quality and compliance practices. Driving this trend is a shift in regulatory thinking from quality-by-test to quality-by-design systems/processes with emphasis on the level of risk to product quality and patient safety.

There’s an increased emphasis by regulators in the Healthcare and Life Sciences (HLS) industry to comply with rules and regulations across all aspects of their business, such as development, design, equipment operation, processes, test methods, standard operating procedures, computerized systems, and data security amongst other things. Realizing there is an urgency for growth, leadership, and knowledge that can serve and grow with our ever-changing industry, I wanted to share some basic insights from within my profession that seem to come up more often as people enter the regulated space of the Life Sciences industry.  Validation, calibration, and qualification are extremely critical in Healthcare and Life Sciences processes. Understanding them is necessary in order to meet GMP guidelines.

I’m often asked; “What is the difference between calibration vs. validation – are they the same? Is one a subset of the other?”

“I am still struggling to separate the two from each other – Can you provide me with a definition of Calibration vs. Validation and how the two differ.”

At the most basic level, calibration indicates the error of an instrument and measurers for any lack of trueness by comparison against a reference standard and validation stands for a process of testing and documenting.

Many people in the Healthcare and Life Sciences industry know the terms, but not everyone is aware of the differences.

Just a little insight will help you understand the differences between them.

Validation is the documented act of demonstrating that a procedure, process, and activity will consistently produce results meeting predetermined acceptance criteria. Pharma & Biotech’s most common way of establishing evidence or documenting test results is through the implementation of Protocols. Protocols, such as Installation Qualification (IQ), Operational Qualification (OQ) and Performance Qualification (PQ), along with essential design and planning documents such as User Requirement Specification (URS) and Validation Master Plan (VMP) are the building blocks of the validation framework.

Why is this essential? ‘If it’s not written down, then it didn’t happen!’

The FDA requires establishing documented evidence that a specific process will consistently produce results meeting specifications and quality attributes. Without supporting documentation, one runs the risk of being out of compliance.

Calibration on the other hand specifically refers to measurement devices, instruments and tools that record, monitor, and control environmental conditions or parameters. Calibration can also be defined as a process that demonstrates a particular instrument or device to produce results within specified limits with reference to a traceable standard over a range of parameters. This process also includes the adjustment of an instrument to realign with the acceptable standard.

Taking measurements involving any GxP process requires calibration to ensure the accuracy of the measurement. Instruments that record, monitor, control critical environmental variables require calibration. Instrument calibration must be enforced on a regular basis to ensure reproducible results. GMPs require written procedures for calibrating, inspecting, and checking automated, mechanical, and electronic equipment.

Screen Shot 2019-10-22 at 9.52.00 PM

Understanding these generally basic concepts are an integral step to understanding quality assurance and the many different aspects of compliance in the Life Sciences industry. It all might seem like a long, drawn-out process, but there’s a good reason for it. If you can ensure your products perform consistently and meet all the requirements of the industry, the value of both the product and patient safety increases. Along with this increased value comes a greater need to understand that the work we do matters, and that helping Life Science organizations ensure compliance and consistency with current regulations when carrying out commissioning, validation and qualification projects in a safe and efficient manner ultimately leads to saving lives.

 

Share This:

summer-2019-do-you-use-protection

Do You Use Protection?

Do you use protection? No, not the kind of protection you’re likely thinking of.  It’s a provocative question from the American Academy of Dermatology, designed to get you to think about and use sunscreen regularly.  It’s imperative to slather on the sunscreen during the summer but also important year-round. I’ve been a member of AAD […]

Do you use protection?

No, not the kind of protection you’re likely thinking of.  It’s a provocative question from the American Academy of Dermatology, designed to get you to think about and use sunscreen regularly.  It’s imperative to slather on the sunscreen during the summer but also important year-round.

I’ve been a member of AAD since I began my career as a board-certified dermatologist, and the need for sunscreen has never been greater.  Skin cancer is the most common cancer diagnosis in United States.  In fact, one in five Americans will develop some form of skin cancer in their lifetime. It is estimated that approximately 9,500 people in the U.S. are diagnosed with skin cancer every day.

By definition, skin cancer is an abnormal growth of skin cells. It most often develops on areas of the skin exposed to the sun’s rays. Skin cancer affects people of all colors and races, although those with light skin who sunburn easily have a higher risk. It’s why we encourage everyone to wear protective sunscreen daily. We also encourage annual skin cancer checks in our office.

Melanoma is the deadliest form of skin cancer, while basal cell and squamous cell carcinomas, are the two most common forms of skin cancer. Here are some basic facts about each:

Melanoma is the most serious.

  • Frequently develops in a mole or suddenly appears as a new dark spot on the skin.
  • Early diagnosis and treatment are crucial.
  • Is often treated surgically.  May also require chemotherapy.

Squamous Cell is the second most common form of cancer.

  • Squamous cell carcinoma often looks like scaly red patches, open sores, elevated growths with a central depression, or warts; they may crust or bleed.
  • Cases tend to form on skin that gets frequent sun exposure, such as the rim of the ear, face, neck, arms, chest, and back.
  • Most squamous cell carcinomas of the skin can be completely removed with surgery, radiation therapy or occasionally with a topical medication.

Basal Cell is the most common and slowest growing form of skin cancer.

  • Basal cell carcinomas often look like open sores, red patches, pink growths, shiny bumps, or scars.
  • Early diagnosis and treatment are important.
  • Doesn’t commonly spread to other parts of the body, but it’s still recommended to be removed.
  • Basal cell carcinoma that is superficial and doesn’t extend very far into the skin may be treated with creams or ointments.

While Mohs surgery remains the “go to” treatment for melanoma, it has also been the traditional choice for basal cell carcinoma and squamous cell carcinoma treatment. Depending on the severity of the case, it has drawbacks. Moh’s surgery, even when done by the best surgeon , can develop complications such as post-operative bleeding, infection or scarring   Patients must also stop taking their blood thinners before surgery, which  puts susceptible patients at risk for blood clots or stroke, especially in patients with AFib.  With that, we were looking for an alternative for patients who don’t need Mohs.

At Lehigh Valley Dermatology, we’re excited by the renewed use of superficial radiation therapy (SRT) for non-melanoma skin cancer.  Interestingly, it’s one of the oldest treatments, having been developed more than 100 years ago.  It’s been refined for use today.  In fact, we’ve just added this treatment back into our arsenal at the practice by bringing in SkinCure, a leader in this SRT Therapy renaissance.

SRT is a highly evolved technology that allows high resolution imaging of the tumor, and delivery of safe and precise doses of superficial radiation.  It’s a proven non-invasive procedure that has been used to treat non-melanoma skin cancer for decades.  Because the x-rays concentrate the superficial radiation dose on the skin surface, the treatment has several advantages over surgical procedures for skin cancer.  Cosmetic results are excellent and no cutting is necessary.  Most importantly patients are not put at risk by holding their anticoagulants!  It’s a painless, safe and highly effective non-surgical option for skin cancer treatment. We’re pleased to be putting the power of it to use again in the Lehigh Valley.    

The best offense is a good defense when it comes to fighting skin cancer.  Start with that sun protection and be vigilant with skin cancer checks.  If treatment is needed, technology is on your side.  We hope our provocative question prompts you to protect yourself this summer and year-round.

Share This:

summer-2019-mild-trauma-brain-injuries

MILD TRAUMATIC BRAIN INJURIES – A SILENT EPIDEMIC

We hear more about brain injuries than ever before.  After his tour bus was struck by a Walmart tractor-trailer in 2014, actor and comedian Tracy Morgan underwent daily speech, cognitive, occupational and physical therapy for his traumatic brain injury.  In an interview a year later, Morgan said, “I have my good days and my bad […]

We hear more about brain injuries than ever before.  After his tour bus was struck by a Walmart tractor-trailer in 2014, actor and comedian Tracy Morgan underwent daily speech, cognitive, occupational and physical therapy for his traumatic brain injury.  In an interview a year later, Morgan said, “I have my good days and my bad days, or I forget things,” as he also described recurring headaches.  And in sports, with the beginning of the 2013-14 NFL season, an independent neurological consultant stays on the sideline of each team for every game as part of the NFL’s concussion protocol.

About 85% of the time, symptoms from a concussion or minor head trauma (other names for mild TBI) resolve within a short time.  More than 50% of these cases result from falls or motor vehicle crashes.  Unfortunately, about 15% of those injured have more persistent effects, some permanent.

More Common Effects of Mild Traumatic Brain Injury

Mild TBI has been referred to as a “silent epidemic” because the signs and symptoms are often subtle.  Someone feels fine a few weeks after an accident, only to find out from a loved one, co-worker or friend that all is not the same.  Many people experience the most common signs of mild TBI, including nausea, persistent headaches, double vision, or dizziness.  Problems with concentration and recurrent headaches are common and are viewed by some as the brain “working overtime” to heal completely.

Within months, many generally feel better, but upon returning to the workplace or to school, some are overwhelmed.  Unable to remember the name of a co-worker or a simple chemical formula, they have problems with basic cognitive skills.  It becomes challenging to learn new material, to concentrate or to pay attention.  The injured person has a low threshold for confusion and thinks more slowly.  When using a computer screen, headaches return, often accompanied by problems with double vision or blurriness.  Complaints of disbelief range from, “I’ve forgotten my bank account PIN number,” to “I can no longer parallel park.”

Psychological Disruption

Not expecting what may have been a relatively mild car crash to cause long-term issues, the mild TBI patient often minimizes the deficits or tries to compensate.   In leaving notes all over the house or carrying an index card with the names of co-workers, there is an effort to both dismiss and to compensate.  If recall and concentration abilities continue to fail, then frustration and depression can set in.  The TBI patient feels socially isolated, not wanting the “secret” to be disclosed.  However, the deficits are often apparent to others, and they may encourage the injured to seek further medical evaluation and care.

The Clinical Setting

Because mild TBI can be difficult to identify objectively, medical providers look at the entire clinical picture, including the severity of the original blow to the head, whether there was a loss of consciousness, how the patient scores on basic tests of recalling numbers and words, and, upon reviewing test results, whether more subtle neuro-psychological symptoms emerge.  Vision disturbances, including subtle but rapid movement of the eyeball, may provide clues.  Even more recent developments in MRI imaging of the white matter of the brain can help the radiologist determine whether the axons (the connectors between the brain cells) have been torn.

Treatment and Support

When all of these tests, evaluations, and scans are considered together by a treatment team, then truly effective treatment can begin.  Eyeglasses with subtle prisms can help restore peripheral vision and re-train the brain to see.  Social workers, psychologists and concussion specialists are more in tune with the cognitive and emotional effects.  A mild TBI patient’s sense of mental wellness can be improved with acceptance and rehabilitation of the brain through mental and visual exercises.  Targeted medication can alleviate mood impairment.  Family, co-workers and friends can be educated to understand that a person with TBI may be irritable, experience mood swings or may simply zone out, but these are not intentional, and over time they can be better controlled.

Summary

The impact of a traumatic brain injury may not become apparent until long after the cuts and bruises have healed following an accident and blow to the head.  The feelings of isolation, depression, and frustration can only be lessened through an inter-disciplinary approach with the patient, the family, and health care professionals.   

While this collective effort can never lessen the blow to the head, it can make the

“new normal” easier to bear for the patient, as well as the injured’s friends, co-workers, and family.

Share This:

2019-massage

Massage Isn’t A Luxury Anymore; It’s a Necessity!

When you think of massage, do you think of special occasions like Mother’s Day or Valentine’s Day?  Do you think massage is just for people with injuries or people who have nothing better to spend their money on?  Well, think again!  In this day and age, massage is not a luxury anymore; it’s a necessity!  […]

When you think of massage, do you think of special occasions like Mother’s Day or Valentine’s Day?  Do you think massage is just for people with injuries or people who have nothing better to spend their money on?  Well, think again!  In this day and age, massage is not a luxury anymore; it’s a necessity!  Almost every person can benefit and needs a massage on a regular basis to prevent and help manage knots as well as overall tightness in muscle tissue throughout the body.  Whatever your walk of life, stay at home mom, a person who travels or who sits at a desk all day long; we are all prone to these issues.

So, what are knots? According to 1Healthline, “muscles knots are hard, sensitive areas of muscles that tighten and contract even when the muscle is at rest.” Knots can also radiate pain to another part of the body. These are called trigger points.  Skeletal muscle is made up of muscle tissue fiber, made of “small fiber like units called myofibrils, “as explained by 2Medeiros and Wildman, myofibrils break down into an even smaller unit which is called the sarcomere, the smallest unit of muscle tissue.  Messages are sent to the sarcomere through nerve impulses that allow muscles to contract.   Sarcomeres are stimulated by the regulation of calcium, both intracellularly and extracellularly.  3AMTA explains that when muscles are overworked, it can cause an “influx of calcium into the sarcomeres in the affected area which, in turn, causes the sarcomeres to contract.”  This ultimately causes undue tension in muscle tissue fiber forming knots, which can eventually become trigger points.

You may be wondering what you are doing that would cause your muscles to be overworked or overloaded?  It’s called life!  Overworking our bodies physically is a common reason for these knots to develop, but also emotional stress, poor diet, and reduced water intake can be a factor.  According to 4Medical News Today, common causes of muscle knots include “stress and tension, injuries related to lifting and repetitive motion, poor posture, prolonged bed rest or sitting without stretching.”  Who doesn’t have stress in their life, whether it be at home, work or otherwise?  Stress, among many other components, can deplete our body’s supply of minerals, which we desperately need for optimal organ and muscle function.  Another reason why drinking enough quality (filtered or purified) water throughout the day is so important.

Not only does stress affect our muscles adversely, but also repetitive motion.  Obvious examples of repetitive motion could include a worker on an assembly line or a builder using a hammer.  However, a hardworking mom uses repetitive motion when rocking her baby to sleep, over and over again.   A violinist uses her arms and shoulders in a repetitive motion performing in a concerto.   Athletes use the same muscles repetitively, as well as the average person that works out using various exercise programs such as weight lifting, cross fit, cycling, Zumba, Insanity or P90X!  The most overlooked way to develop knots is by just sitting at a desk without getting up to stretch and move around, which will reduce lymphatic flow and blood circulation, leading to muscle stiffness.

Now that we know what knots are and how we get them, let’s talk about how to manage them. Prevention is the best remedy!  Drink half your body weight in water in ounces, generally no more than 100 ounces a day.  Eat plenty of fruits and vegetables that will naturally hydrate you, not to mention provide essential antioxidants and phytonutrients.  Limit caffeine since this is a natural diuretic and causes frequent urination, which causes a loss of minerals.

Even with our best efforts to prevent knots, we will get them at some point.  Consistent massage with a licensed massage therapist is absolutely essential to help loosen the knots and allow the tissue to return to a normal state.  Massage therapists use various strokes and techniques, such as effleurage, petrissage, stripping, tapotement, as well as trigger point therapy and myofascial release.  Massage will increase lymphatic movement and blood circulation, allowing toxins to be filtered and released through the lymph nodes, spleen, liver, and kidneys.  5Athletico Physical Therapy agrees that “massage is not just some occasional luxury saved for vacations and spa days. Massage therapy can help keep your muscles healthy, pliable, and oxygenated.”  Licensed massage therapists are plentiful, whether in private practice or working at a spa and have hours and prices to accommodate anyone’s schedule or budget.

Start feeling better; schedule your massage today!

Share This:

2019-got-anxiety

Got Anxiety?

Odds are, you or someone you know probably does.  Anxiety disorders are the most common mental health diagnoses in the United States, affecting 40 million adults, or roughly 18% of the population (aada.org).   So, what is anxiety?  Anxiety is a healthy and normal emotion.  The American Psychological Association (APA) defines anxiety as “an emotion characterized by feelings […]

Odds are, you or someone you know probably does.  Anxiety disorders are the most common mental health diagnoses in the United States, affecting 40 million adults, or roughly 18% of the population (aada.org).   So, what is anxiety?  Anxiety is a healthy and normal emotion.  The American Psychological Association (APA) defines anxiety as “an emotion characterized by feelings of tension, worried thoughts and physical changes like increased blood pressure.”  Anxiety can remind us of our “to do” list, upcoming deadlines, or help us focus before that big presentation.  These are not necessarily negative things.  So, then what’s the concern with anxiety?  A person goes from feeling normal healthy anxiety levels to having a psychological disorder when they feel disproportionate levels of distress, worry, or fear over an emotional trigger.

Anxiety is an overarching, general term that includes several psychological disorders.  Some such disorders are: Generalized Anxiety Disorder, Panic Disorder, Post-Traumatic Stress Disorder, Phobias, and Obsessive-Compulsive Disorder.  These disorders are treated with a variety of methods.  Many are traditional, and some are newer concepts in the field of psychology.  The first traditional method of treating anxiety is with medication.  Several types of medications are used to treat anxiety, such as Selective Serotonin Reuptake Inhibitors (SSRIs), Benzodiazepines, and Beta-Blockers.  These medications can be prescribed by your primary care physician or a psychiatrist.  Another traditional method to treat anxiety is through outpatient therapy.  Therapy methods could include the use of Cognitive Behavioral Therapy, Exposure Therapy or even Hypnosis.

The treatment methods listed above may not come as news to many of you, as they have been in use for several years in the mental health field.  There are, however, some very new and interesting methods for people to learn to manage their own anxiety without the help of a doctor or therapist.  The first of which is through proper diet and nutrition.  There is ample evidence of causal links between certain vitamin and mineral deficiencies and anxiety.  Studies have shown lack of vitamins D, B6 and B12, magnesium and zinc can all be related to increased levels of anxiety.  Adding these vitamins to your diet through supplements or food intake can help reduce anxiety levels.  Other nutrients shown to help reduce anxiety include tryptophan, vitamin E, and omega 3 fatty acids.  Exercise is another effective way to manage your own anxiety.  When the body is active, the brain produces endorphins which are hormones that promote feelings of wellbeing and improve mood.   20 minutes of cardio 3 times a week can do great benefits for one’s mental wellbeing.  Higher level activities that require concentration such as playing an organized sport can also keep the mind occupied and limit racing thoughts.

Meditation is also an excellent strategy to manage one’s anxiety levels independent of a mental health professional.  Meditation is the practice of engaging in contemplation and reflection.  Through meditation, one tries to focus their thoughts in a specific direction and not allow the mind to wander.  Many people find the practice of meditation difficult at first, but with practice, it becomes easier over time.  In the fast-paced modern world, there are many distractions for our minds and many opportunities for thoughts to wander, but this practice can have great benefits in helping us to control the directions of our thoughts.  There are many options to help one who wants to begin the practice of meditation.  One of the most recent options is the use of smartphone apps.  These apps are convenient as your phone is always with you making them readily available to use over a lunch break or before bed to help you put your mind at ease.

Overall, anxiety is becoming much more prevalent in our society.  In the information age, we are aware of so much happening around us that it is not uncommon to feel overwhelmed and anxious.  If you or someone you know is experiencing unhealthy levels of anxiety, please do not feel ashamed or stigmatized, these feelings are all too common.  Please consult your physician and discuss the treatment options to find what method will work best for you.

Share This: