Medicine

America’s Continuing Autism Epidemic

Merriam-Webster’s dictionary defines autism as: “a variable developmental disorder that appears by age three and is characterized by impairment of the ability to form normal social relationships, by impairment of the ability to communicate with others, and by repetitive behavior patterns.”  On April 26th, 2018 the Center for Disease Control and Prevention released its most […]

Merriam-Webster’s dictionary defines autism as: “a variable developmental disorder that appears by age three and is characterized by impairment of the ability to form normal social relationships, by impairment of the ability to communicate with others, and by repetitive behavior patterns.”  On April 26th, 2018 the Center for Disease Control and Prevention released its most updated autism prevalence estimates for America’s children.  These estimates are pulled from data in a biennial report based off of the evaluation of medical and education records.  1 in 59 children are now estimated to have an Autism Spectrum Disorder.  Let that sink in.  1 out of every 59 children.  This new ratio is an increase of 15% from the last reported estimate in 2016.  This most recent increase in prevalence continues the trend that researchers have seen over the last twenty plus years.

When I began my career in the mental health field in 2004, the autism prevalence ratios were estimated to be 1 in every 166 children.  Throughout my career, I have witnessed this drastic increase in autism cases create the need for a plethora of new services and supports for children to address the social and behavioral needs associated with autism.  Many providers decided to implement autism specific variations of existing mental health programs.  One of the most popular of these services is Behavioral Health Rehabilitative Services or commonly referred to as BHRS.  BHRS services are intensive mental health therapies that are provided in the child’s home, in community settings and occasionally in the classroom.  These services are focused on identifying interventions to help achieve a child’s behavioral treatment goals and to transfer those skills from the provider to a parent, teacher, etc.  The increase in autism diagnoses has also created the opportunity for providers to create new programs to address this need such as afterschool groups that focus on improving social skills.  They have also begun to create support groups for parents and siblings of those with an autism diagnosis.

The mental health and developmental disabilities fields have successfully evolved and adapted over the years in an attempt to meet the growing needs of children diagnosed with autism.  There are additional supports in the home, community and the classroom for these children.  There are also government and private grants available to families to help manage the additional cost of needed sensory and adaptive communication devices for these children.  But what will happen to these children when they grow up, or “age out” of educational and children’s mental health services?  What supports are available for adults diagnosed with autism?  What supports are available to families to help with their adult child with an autism diagnosis?  The answers to these questions are pretty alarming.  Depending on your location, there are very few if any supports tailored to adults with autism in these fields.

For our nation to fully manage the continued autism epidemic; there will have to be some significant changes in our government and to the adult mental health system.  Our legislators and representatives will have first to acknowledge that the lack of supports, services, and funding for adults with autism is a current problem.  Second, they will have to acknowledge that the problem will only get worse in the future as the ever-increasing ratios of children with autism age out of services.  These adults will need assistance with housing, life skills, employment supports, and socialization.  Our legislators and representatives will need to increase funding for mental health services to allow providers to develop programs to meet the needs of these adults.  Providers will need to step up and use the increased funds to develop new programs, thinking outside the box to support this unique population.  Staff in these fields will have to become more educated on providing supports to adults with autism.  They say it takes a village to raise a child.  In order to support individuals with autism throughout their entire life, not just their childhood, we as a society will have to pull together to help our nation manage this continuing autism epidemic.

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Who Can Sell Hearing Aids?

In the state of Pennsylvania, there are two different licenses that will allow you to sell hearing aids, an Audiology License and a Hearing Aid Dispensing License. The training and education that you need to obtain these licenses are very different. These differences are often misunderstood by the general public and will be explored below. […]

In the state of Pennsylvania, there are two different licenses that will allow you to sell hearing aids, an Audiology License and a Hearing Aid Dispensing License. The training and education that you need to obtain these licenses are very different. These differences are often misunderstood by the general public and will be explored below.

In 2007, the degree requirement to become a clinical audiologist was changed.  A Master’s degree was no longer acceptable to obtain licensure and all audiologists were now required to obtain a clinical doctoral degree.  At this time, if one wanted to become an Audiologist or an Au.D., they would now need to first complete a bachelor’s degree in Speech and Audiology, Communication Disorders, or a related field.  Upon completion of a Bachelor’s degree, a candidate would then apply for a doctoral program which is an additional 4 years of school.  Doctoral coursework includes many topics such as: education, anatomy and physiology of the ear and hearing, the science of sound, the diagnosis and treatment of hearing and vestibular disorders, hearing aids and their progression from analog to digital devices, programming and adjusting hearing aids, and counseling and treatment of adults and children of all ages with hearing loss.  Within those classes you learn about candidacy for treatment options, one of the most common of which is hearing aids.  However, the treatment of hearing loss is not limited to just hearing aids but also includes cochlear implants, bone anchored hearing devices and implantable hearing devices.  Audiologists get the opportunity to do clinical rotations in a variety of settings which can help to determine one’s career path.  Some of these settings could include working with an Otolaryngologist or more commonly called an ear, nose and throat physician.  Another possible clinical training setting for doctoral candidates is in a hospital.  When doing clinical internships, a doctoral candidate would perform testing, fitting and dispensing hearing aids on adults or children.  They could also conduct inter-operative monitoring, vestibular testing & rehabilitation, might also work with outside businesses to adhere to Occupational Safety and Health Administration (OSHA) regulations.  The candidate may also choose to use the business management training and clinical experience to open up a private office in the community. When a candidate finishes their Doctorate of Audiology, they will then obtain their Pennsylvania clinical audiology license.  It is then in their scope of practice to dispense and sell hearing aids as stated by Pennsylvania medical guidelines.

The other way one can legally dispense hearing aids in the state of Pennsylvania is to obtain a Hearing Aid Dispensing license.  To obtain this license, there is a high school level educational requirement, and the candidate must find another licensed Hearing Aid Dispenser to conduct an internship with.  During the internship, the candidates are taught to program and adjust hearing aids.  They are also taught to instruct adults on the use and expectations of hearing aids. Most of the time, this internship is done with someone who was willing to hire the candidate work and sell hearing aids at the same office. When the internship is complete, that candidate must then sit for a written state test.  Upon passing that test, they are awarded a Hearing Aid Dispensing license for the state of Pennsylvania.

When choosing a licensed hearing aid dispenser, it is up to the customer’s discretion which of these two licensed dispensers to choose.   It is important for the customer to realize the different level of educational requirements and clinical knowledge between the two.  Not all hearing aid dispensers are created equal, and it is important for a customer to be able to distinguish between them.  If you are in the market for a hearing aid, I hoped this article helped you to be able to make a more informed decision on your purchase.

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Staying Ahead in Business with Botox (and a Few Other Things)

It’s tough out there.  Seasoned professionals are constantly forced to look behind them to see if the up-and-coming (and often younger) professionals are nipping at their heels. Many professional women are no longer ashamed to admit they’ve had a little Botox.  Men, increasingly worried about the younger/cheaper competition, are a different story. Competition in the […]

It’s tough out there.  Seasoned professionals are constantly forced to look behind them to see if the up-and-coming (and often younger) professionals are nipping at their heels.

Many professional women are no longer ashamed to admit they’ve had a little Botox.  Men, increasingly worried about the younger/cheaper competition, are a different story.

Competition in the boardroom and beyond is driving more and more professional men into our practice for a few non-surgical tweaks to stay youthful and competitive on the job.

Here’s a list of what we see most:

Botox and Fillers

 They don’t call it “Brotox” for nothing.  With a few units of Botox, we can get rid of wrinkles and reshape the brows, eyes, mouth, and neck.  Botox injected skillfully by a board-certified dermatologist, can even eliminate the need for some surgeries.

Fillers, such as Juvederm, can help smooth out deep creases and acne scars.  Used together, a more youthful face can help men and women remain relevant and look refreshed.

The name of the game with both is that I can offer subtle changes with no downtime.  Results are seen in less than two weeks.

Hair Restoration

Hair replacement surgery was a big thing a few years ago.  Techniques are always improving, but there’s downtime to consider.

We’re seeing a different area of no-downtime growth (literally and figuratively).  We started offering PRP injections in our office to restore hair late last year.  Our phones have been ringing off the hook.

We are using the Selphyl® Platelet-Rich Fibrin Matrix System. Your own blood is drawn and spun in a centrifuge to separate the cells from the plasma. The plasma is then injected into your scalp where your hair is thinning.

You have to commit to three treatments or more and then wait for your result to grow in.  It works best for those just starting to lose their hair and who want to thicken things up before those hairs are lost forever.  The treatment works for men and women with thinning hair.

Photofacials, Lasers, and Microneedles

 Non-surgical skin procedures have seen an incredible resurgence.  In fact, the American Society of Aesthetic Plastic Surgeons, a group that keeps track of cosmetic trends, says IPL Photo Rejuvenation was the fifth most popular non-surgical procedures for men in 2017. We’ve been huge fans of IPL for years!

IPL harnesses light to help zap away signs of aging from your face, neck and even hands., The gentle treatments use broad spectrum light to attack sun damage and redness.  There is a little discomfort and minimal downtime.  Four to six treatments are required to get the best results possible.

Laser resurfacing is a step above the IPL treatments.  The Erbium laser is designed to remove moderate lines and wrinkles. There’s also a bit of recovery time.  The CO2 laser is for more advanced treatments.  Downtime can be up to two weeks.  Results are long-lasting.

Finally, there’s a skincare newcomer that is coming on strong. Microneedling is exactly what it sounds like.  Tiny needles make small channels in your skin where we can infuse serums to hydrate your skin.   We’ve had such great success with these collagen builders; we now offer three levels of this treatment.  After a few treatments and a little time, your own collagen plumps up your skin.

In fact, Aesthetica boasts over 30 devices, laser, and RF, that allow us to customize a treatment to rejuvenate your skin.  We can tweak the appearance and texture, minimize scars and even remove unwanted hair.  There’s something for men and women in our advanced arsenal.

The best way to put your best face forward is to focus on high-quality skin care and gently, minimally invasive treatments.  Figure out what your individual goal is, and we can customize the right combination of treatments to meet or exceed your expectations.  A few non-surgical tweaks can help you stay competitive at work and at play.

David B. Vasily, M.D., F.A.A.D. is an American Board of Dermatology certified dermatologist with over 30 years of experience in the field of dermatology and skin care. Founder and president of Lehigh Valley Dermatology Associates, Inc, Dr. Vasily is a fellow of the American Academy of Dermatology, the American Society for Laser Medicine & Surgery, and the American Society for Dermatologic Surgery.

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Forget the App; There’s a Test for That

How many of you have had your blood taken during an annual exam?  That’s right, the yearly blood test.  It’s relatively standard these days to get a report detailing your Complete Blood Count (CBC) that tells you how many red and white blood cells and platelets you have pumping around, and your levels of iron.  […]

How many of you have had your blood taken during an annual exam?  That’s right, the yearly blood test.  It’s relatively standard these days to get a report detailing your Complete Blood Count (CBC) that tells you how many red and white blood cells and platelets you have pumping around, and your levels of iron.  Add to that the standard blood chemistry assays which test for blood urea nitrogen (BUN), carbon dioxide (CO2), creatinine, glucose, and potassium, chloride, and sodium, and you have quite a snapshot of your health.  (Check online for reference levels and what each test tells you; there’s a lot of useful resources.)
What’s relatively new and interesting in the healthcare field, however, aren’t those standard tests that have been around for decades, but the newer, more complex assays.  There are three relatively interesting growth points in the diagnostics industry right now; companion diagnostics, genetic testing, and biomarker tests.
Companion diagnostics were almost forced on the pharma industry, and for good reason. When a pharma giant brings a drug to market, they have to conduct a bunch of clinical trials, eventually including humans.  Throughout the years, the FDA and these companies learned that just because a drug was doing what it was supposed to, that didn’t mean it wasn’t ending up somewhere that was less than ideal.  Or the concentrations were too high or too low for certain people based on their individual metabolism.
The idea of testing for the amount of drug in an individual gained popularity; how much of a drug is in their bloodstream, or liver, or in a cancerous mass.  The FDA soon started requiring testing, and the pharma industry initially partnered with others to make the diagnostic tests.  That is until they realized they could sell the test and the drug; double the income.  Companion diagnostics were born, and now most new drugs are accompanied by a blood test to either screen the patient’s health prior to using the drug, or for levels of the active drug in the body. Those tests are actually a required part of the treatment in some cases.
Genetic testing is well known to individuals with a family history of certain diseases.  A large diagnostics company has a line of genetic screening assays on the market that test for certain genes that predispose you to certain cancers.  Their most popular is for breast cancer and utilizes a specific genetic mutation in the BRCA1 and BRCA2 genes.  If you have the mutation, you’re more likely to get breast cancer at some point during your life than those who do not.  This allows you to drive your own future, and individuals who test positive for the mutations then are urged to undergo more frequent cancer screenings.  Some even opt for a preemptive double mastectomy.  Knowledge, in this case, is innately very powerful.
Biomarker assays take it one step further.  Certain diseases, Alzheimer’s, for instance, are caused by a progressive change that takes place in your body that is not readily visible.  In the Alzheimer’s example, there are a number of proteins that exist in the fluid around our brain that are supposed to be there.  Our own neural cells make these proteins.  Research has shown that individuals who develop Alzheimer’s show a shift in these proteins, specifically in the ratio of one protein to another, that predicts your progression into having the disease.  Yet the only way to positively identify those with the disease is during an autopsy.
That’s exactly how it starts; some research figures out how something affecting our health happens.  Maybe eventually a drug will be developed to reverse or stop the changes that lead to Alzheimer’s.  In the meantime, a test will probably be first on the market to identify people with a higher likelihood of progression.  Then further studies on those people can help determine how we can fix it.
The future of diagnostics in healthcare was cemented years ago, yet innovation keeps pushing the realm of possibility into reality.  Add to that the sheer availability of most tests (they can be ordered online!), and the idea they now have assays that show the overall “age” of your cells (lookup telomere testing), life expectancy is sure to be above 100 before we know it.
This all leaves us with some interesting questions to ask of ourselves.  Do you want to know if that drug or therapy is working correctly?  The answer is most likely yes.  But on the other hand, would you want to know how your health will be in 10 or 20 or 30 years? Would you make any changes in your lifestyle now to possibly live longer or decrease your chances of disease?  Those questions are very personal, and the answers are probably as individualized as we are just being human.

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The Future of Health Insurance

The Patient Protection and Affordable Care Act passed on March 23, 2010. The underlying philosophy was to make coverage available and affordable to all Americans.  At the time, there were approximately 45 million uninsured individuals in the US. Today, that number is about 28 million. The tax credits or subsidies have helped many to afford […]

The Patient Protection and Affordable Care Act passed on March 23, 2010. The underlying philosophy was to make coverage available and affordable to all Americans.  At the time, there were approximately 45 million uninsured individuals in the US. Today, that number is about 28 million. The tax credits or subsidies have helped many to afford health insurance coverage. The expansion of Medicaid in Pennsylvania has also allowed more to find the coverage they need. Yet health insurance rates have been on a steady increase for both employers purchasing health insurance coverage and for individuals. The ACA has imposed a myriad of regulations on health insurance carriers and the Federally Facilitated Marketplace in Pennsylvania; also known as the Exchange.

President Trump campaigned on repeal and replacement of the ACA, but that has not yet come to fruition. The House passed the AHCA, American Health Care Act. The Senate created its own bill, BCRA, the Better Care Reconciliation Act. Versions of each, with necessary updates, continue to be discussed among the Legislators.  There is a bipartisan group of 43 in the House, the Problem Solvers Caucus. They want to discuss the reforms needed within the ACA. Their main concerns are: to continue the Cost Sharing Reduction subsidies for individuals below 250% of the Federal Poverty Limit; a dedicated stability fund to help states to keep costs down (reinsurance); exempt “small” businesses from the employer mandate by raising the definition to those businesses with more than 500 employees; repeal of the medical device tax, a 2.3% tax on items like pacemakers and knee replacements; and the ability to sell insurance across state lines.

There are a few other ideas that have continued to garner support as a way to fix the ACA. One of those is to increase the rating ratio from 3:1 to 5:1. Currently, a 64-year-old cannot be charged more than three times the 21-year-old. Along with this comes the suggestion to give more generous subsidies to older Americans. There are discussions of price controls on prescriptions drugs, allowing Medicare to negotiate pricing, and reviewing how other countries control the prices of pharmaceuticals. The use of bundled payments for care versus episodic payments has helped to reduce costs. A knee replacement, as an example, would be one payment to the Hospital and another to the Doctor for pre-operation, operation, and post-operative care.  Antitrust reform to control the hospital mergers; the consolidation of services can be positive, but the elimination of competition often drives prices higher. Tort reform has always been debated as a way to reduce costs. The abuse of malpractice suits means that hospitals and doctors over-treat and over-test.

The idea of “Medicare for All” was a campaign highlight for the Democrats in the last presidential election process. There has been talk about reducing the eligibility to age 55, instead of 65, to enroll in Medicare. Of course, this would require some changes in the type of plans offered. Those 55 and older and still actively at work have demands for health care that are different from those who are retired.

There is not much language available now to show how we would transition from our current system to a “Medicare for All” system. Private insurance companies have no role in the Sanders version of single-payer, other than providing supplemental insurance. The biggest concern is how to pay for it. Vermont studied the viability of a single-payer Exchange for their state, before scrapping the idea, in part, because of cost. It was on the ballot for Colorado voters, who turned it down. California continues to debate the idea of a state single-payer Marketplace. Financing has been a stumbling block. Rep. Conyers has over 100 backers in the House for his version of a single-payer legislation. It will be a tough road ahead with a Republican-controlled House, Senate, and President.

A recent Pew Research Center poll shows that overall, 33% of Americans believe health care should be a single-payer setup. The poll also found that roughly 60% of Americans believe the government is responsible for making sure all Americans have health insurance. Where do you stand on the issue? Use your vote in the upcoming 2018 elections to make your voice heard.

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Recharge – Reset – Repeat

How many times have you felt the need to get out of town for the weekend to recharge and feel like yourself again? In today’s fast paced society we are stressed more than ever before and often do not do enough to reset and recharge. At some point in our life, we must cope with […]

How many times have you felt the need to get out of town for the weekend to recharge and feel like yourself again? In today’s fast paced society we are stressed more than ever before and often do not do enough to reset and recharge. At some point in our life, we must cope with stress. You cannot always anticipate when something will make you feel overwhelmed. Often, the best you can do is to use the healthy coping skills that you have developed throughout life to help you manage your current stressors.

Managing stress comes in all shapes and sizes. In times of change, you want to realize and understand your perception and interpretation of the situation that determines how change affects us. You want to change toxic and irrational thought patterns, such as “I must be competent at all times!” and replace absolutes with “I am not perfect- I am doing the best I can do.”

Stress does not always have to be negative. Some aspects of stress can be both healthy and rewarding, such as engaging in a sport or recreational activity as well as working hard to complete a project. Work stress can also be seen as positive. Too many times the stress one encounters at work does not stay there which can negatively affect our relationship with others and yourself. Work stress can help one grow and change. Work stress forces one to learn new skills and creative ways to think to solve problems. Practicing self-care techniques improves the body and the mind. Remember how important it is to meet the physical and psychological needs for exercise, rest, good nutrition, and recreation. Disconnect from the screens we are connected to and try new activities!

It is important to remember to focus on what you can control, not what you cannot control. Do not attempt to control the uncontrollable! Change can be overbearing. A way to make change more bearable is to break the change up into smaller steps and short-term goals. Remember to welcome feelings, both good and unpleasant, and learn to cope well with the “bad” ones. When you are stressed and experience unpleasant feelings, the best thing is to recognize and accept them. Unpleasant feelings are unavoidable and normal. They grow and intensify when you push them out of sight. Those who do not judge their feelings and accept their own doubts and limitations will have less stress and enjoy their lives more.

No matter how stressful things can be, do not forget to laugh and use your sense of humor. Reach out and connect with others, so you do not feel alone. When you develop good, supportive relationships change is easier to understand. It is important to not keep your feelings in and isolate yourself. Remember you can seek professional help when you feel over-stressed. It is not a sign of weakness; it shows strength and courage to realize that help is needed.

There are many ways to manage stress. A few good rules include:

  • Do not take responsibility for the things you cannot control
  • Take care of yourself, or you can’t take care of anyone else
  • Rushing can increase stress, remain in the present
  • Be accepting of yourself, don’t ignore feelings and needs; accept limitations
  • Limit the “should’s”
  • Be accepting of others
  • Ask for support when you need it
  • Accept, Alter or Avoid a negative situation
  • If you never make mistakes, you’re not learning anything
  • Life is not fair or a contest, do not compare
  • One has to begin where one is

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Breast Reconstruction

Rebuilding Since 1895 Plastic surgery. Both praised and criticized in the mass media; cosmetic surgical procedures have always been seen as slightly taboo. Shrinking factions of modern-day culture often look down upon the altering of one’s physical features, a criticism admittedly not without merit. While many believe cosmetic surgery is simply a tool used to […]

Rebuilding Since 1895

Plastic surgery. Both praised and criticized in the mass media; cosmetic surgical procedures have always been seen as slightly taboo. Shrinking factions of modern-day culture often look down upon the altering of one’s physical features, a criticism admittedly not without merit. While many believe cosmetic surgery is simply a tool used to enhance one’s existing features and increase body positivity, others attack its artificiality; “natural” beauty is to be embraced without alterations, they argue. But one often overlooked portion of the plastic surgery industry, encompassing over a quarter of all procedures, will rarely draw controversy.

Whether through physical trauma or disease, disfigurements to the body are emotionally devastating. And it’s up to a plastic surgeon to restore a patient’s confidence in their own skin. According to the American Society of Plastic Surgeons, over 5.8 million reconstructive procedures were performed in the United States in 2016. Of those (excluding tumor removals), laceration repairs, maxillofacial surgeries, and scar revisions topped the charts.

But the next most common procedure is fairly unique in origin. While lacerations and maxillofacial injuries and scars are often the results of physically traumatic accidents, the disfigurement caused by breast cancer is incomparable in nature.

The removal of cancerous breast tissue can be devastating both physically and mentally to a breast cancer patient. And considering the fact that breast cancer is the most common cancer among women, amounting to about a quarter of all female cancer cases, extensive research has been done into treatment options for those affected. In fact, the oldest evidence of breast cancer treatment comes from the Edwin Smith Papyrus, estimated to have been written about 3600 years ago in Egypt. It describes eight cases of breast tumors which were treated with cauterization of the breast, noting that “there is no treatment” for this disease.

Between ancient Egypt and the 17th century, little advancement towards treatment was made. Medical practitioners occupied themselves with postulating preventative measures rather than responsive treatments. And the treatments that were proposed were often barbaric; prescriptions of poisonous herbs and chemicals, including arsenic, were common due to the danger associated with surgical removal of the affected tissue. Even when it was discovered that excision of the tumor was often necessary for a positive prognosis, little thought was given to recovery after surgery. Early mastectomies from the 6th century and on were brutal and disfiguring, leaving a woman’s chest looking “like a skeleton” in most cases; as time passed, surgeons began to remove more of the affected area, including lymph nodes and underlying muscles. These procedures were later refined and became known as radical mastectomies, a term popularized by American surgeon William Stewart Halsted, who was aided by modern anesthesia and aseptic technique decreasing the risk of pain, trauma, and infection in the late 1800’s.

Still, little consideration was made towards post-surgical physical rehabilitation in the form of reconstruction. Radical and so-called “super radical” mastectomies left little tissue to work with. The first documented attempt at a breast reconstruction did not occur until 1895 when Vincent Czerny, a surgery professor in Heidelberg, transplanted a lipoma from the patient’s flank to her breast. Over the next few decades, rare attempts at reconstruction were made using various tissues from other locations on the body. Early reconstructive attempts were often risky and laden with complications such as necrosis of the tissue and heavy scarring; reconstruction was rarely recommended.

It wasn’t until 1963 with the introduction of the silicone implant that the modern era of breast reconstruction began. From there, research advanced quickly. Implants were generally inserted with a brief delay following mastectomy, but in 1971 it was reported that immediate silicone implants inserted in place of the removed tissue underneath the breast wall proved to be more effective and less traumatic.

Various types of flaps were also designed, using the patient’s own tissue to reconstruct a breast mound.  Continued refinements were made to improve surgical procedures and appearance of the reconstructed breast.

Significant research in the 1980’s and 1990’s confirmed that breast reconstruction performed immediately after mastectomy, during the same surgical procedure, did not lead to increased recurrence of breast cancer.  This led to the current standard of care of immediate breast reconstruction where an oncologic surgeon performs the mastectomy procedure and a plastic surgeon performs the breast reconstruction immediately afterwards so that when the patient wakes up from anesthesia, she does not have a devastating mastectomy defect, but rather has begun the process of moving forward to become whole again.

Today plastic surgeons work closely with their oncologic surgeons to determine the best surgical plan for treatment of the patient who requires mastectomy for treatment of breast cancer.

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Hair On… Hair Off

It’s a running joke that when men lose the hair on their heads, it inevitably shows up somewhere unwanted. Many will shave or wax during the summer.  Others opt for a more permanent solution. I’ve treated thousands of men and women in the Lehigh Valley who have wanted to discreetly and permanently get rid of […]

It’s a running joke that when men lose the hair on their heads, it inevitably shows up somewhere unwanted. Many will shave or wax during the summer.  Others opt for a more permanent solution.

I’ve treated thousands of men and women in the Lehigh Valley who have wanted to discreetly and permanently get rid of hair in a variety of places (men often ask for back and shoulders.  Women aim for the underarms, legs and bikini line).  I am proud to say I was one of the first physicians in the country to use lasers to remove hair.  Since then, I’ve been active in the development of new treatment parameters to make certain laser hair removal remains safe and effective. Typical treatment to reduce and remove hair involves a series of four to six treatments, spaced six weeks apart.  The hair needs to be treated across the entire growing cycle to make sure you get it all.  So if you want the hair removed before summer, it’s best to start the process in the Fall or Winter.

All that said, one laser is never enough.  Always look for a practice with experience and access to multiple lasers to treat multiple kinds of hair.  Your skin tone and hair color all work into the equation.  A person with light skin and dark hair responds to many systems, but patients with light hair need different wavelengths of light to successfully treat and reduce hair.  I cannot tell you how many blonde or gray haired laser hair removal patients we see after they’ve cashed in a Groupon at a laser clinic with just one laser, only to be disappointed with the results.  Shop around!  Currently, we are using Palomar’s Icon™ system as our primary system at our Bethlehem office. The Icon system utilizes the revolutionary SkinTel system that performs exact pigment typing that allows for optimized and safe laser parameters, while our long pulsed YAG laser is reserved for resistant hair in patients with darker skin types.  Other available lasers for hair removal at Aesthetica include the Spectra Q-switched YAG laser, the Lutronic Advantage, and the Viora V20.

There’s something for even the most stubborn cases.

On the opposite side of the discussion, there are men and women who struggle with hair loss.  There are emerging solutions for that, too.

We always suggest our patients try topical treatments first (things like Rogaine, etc.) or oral medications.  If those fail, surgical hair transplants have been widely used for years.  Now, we have an exciting option that can delay or completely negate the need for surgery, platelet rich plasma (PRP) that can stimulate hair growth at the site.

PRP utilizes the body’s own potent growth factors found in platelets to stimulate natural hair growth. By delivering the platelet-derived growth factors to a patient’s area of thinning hair, PRP treatment is able to promote the growth of healthy hair.

We use the Selphyl® system in our office.  We take a small sample of your own blood and spin it in a centrifuge, separating the platelet rich plasma.  The PRP is injected into the scalp, stimulating each hair shaft.  Most patients come in for a series of three different visits.  While not instant, optimum results are seen in the first 12 months.  Hair gets thicker, more hairs grow, and fewer are lost.  Results are natural and lasting, often improving over time.

Sports medicine has used PRP for years to treat injuries to the Achilles tendon, joints and muscles by stimulating stem cells. In the case of hair loss, the injected platelets prompt inactive or newly implanted hair follicles to enter an active growth phase, causing the hair to start growing again.

While none of the hair reduction or replacement treatments are typically covered by insurance, the cost ranges from hundreds of dollars versus the thousands you can spend on surgical solutions.

Whether it’s hair on…or off.  We’ve got you covered!

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Why the proposed changes to Medicaid are a really bad idea.

Seventy-four million people in the U.S. currently receive their health insurance through Medicaid. When the Affordable Care Act was introduced, almost 20 million of these gained medical insurance through Medicaid expansion*.  As a result, healthcare has become more accessible to millions of people, and the primary point of care has shifted from hospital emergency rooms […]

Seventy-four million people in the U.S. currently receive their health insurance through Medicaid. When the Affordable Care Act was introduced, almost 20 million of these gained medical insurance through Medicaid expansion*.  As a result, healthcare has become more accessible to millions of people, and the primary point of care has shifted from hospital emergency rooms to physician’s offices, as it should be.

The Medicaid program delivers health insurance to poor, working-age people, including children, the disabled, and patients needing long-term care in nursing homes. The individual states administer it within Federal statutes and rules, and the states are reimbursed at least 50% by the federal government. Each state creates their own policies, eligibility and reimbursement rates for doctors, nursing homes, and hospitals.

The proposed cuts to Medicaid now working their way through Congress as the American Health Care Act (AHCA), will shift the financial burden of treatment back to hospital emergency departments, as millions of Americans lose their health insurance. The House’s proposed changes to Medicaid funding will have a significant impact on state spending, vastly reducing enrollment in Medicaid and reducing physician and hospital reimbursement. Governor Wolf has predicted that Pennsylvania would lose $2 Billion in federal funding for Medicaid – an amount which he says, the state couldn’t possibly absorb, since Pennsylvania is already facing a $3 Billion deficit.

How the AHCA will change Medicaid

The proposed changes, if passed, would reduce each state’s flexibility in adapting to the unique changes in the needs of its Medicaid enrollees. The needs of each state differ and are influenced by a number of factors, primarily age and income. The states with the highest poverty rates and an older, working-age population would carry an especially heavy burden.

Under the proposed Medicaid changes,

  • There would be a strict ceiling on federal funding for every Medicaid beneficiary.
  • States would be limited to the benefits they could offer Medicaid enrollees and their reimbursements to physicians.
  • The federal government would continue paying Medicaid reimbursement through 2019. But In 2020, Medicaid expansion would be frozen, and the financial burden for new enrollees would fall on the individual states.

The Congressional Budget Office (CBO) estimates that the AHCA will result in a near-doubling of the U.S.’s uninsured rate to 19% of the poor, working-age population, up from the current 10%. The largest segment of those who lose coverage would be older, low-income Americans, a group which tends to have higher overall health care costs. The burden for covering the health concerns of these patients would fall to the states and local hospitals through charity care funding.

PA Foot and Ankle Associates is one of the largest podiatric practices in the Lehigh Valley, being that we treat a significant number of Medicaid patients. Foot, ankle and lower leg problems which occur as the result of obesity, old age, and diabetes, must be treated in a timely manner – preferably as soon as symptoms are detected. When a patient has no health insurance, they typically delay treatment until a problem becomes severe and sometimes life-threatening. These patients frequently require hospitalization and surgery, when in most cases, in-office treatment and monitoring during the early stages of their condition would have avoided these serious and costly consequences.

Pennsylvania, and indeed every state, has spent 50 years building their Medicaid programs to care for their most vulnerable citizens. These programs have been built according to federal guidelines and federal reimbursements. Dismantling Medicaid to the degree the AHCA proposes would be disastrous for patients, physicians and hospitals alike.
*According to the Henry J. Kaiser family Foundation

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Vaccine Refusal and Delay

MEDICAL AND LEGAL IMPLICATIONS FACTS DO MATTER Should all children be required to have all recommended vaccines/some vaccines for school entry, Day Care, college? Do parents who refuse or delay vaccines for their children have a responsibility to other children and the community? Liability for not doing so? Vaccines have been one of the most […]

MEDICAL AND LEGAL IMPLICATIONS

FACTS DO MATTER

Should all children be required to have all recommended vaccines/some vaccines for school entry, Day Care, college?

Do parents who refuse or delay vaccines for their children have a responsibility to other children and the community? Liability for not doing so?

Vaccines have been one of the most effective preventive health measures in medical history. A study by the CDC(Centers for Disease Control) found that among children born between 1994 and 2013, full vaccination would have prevented 732,000 deaths. Scientific studies have shown that unvaccinated children (primarily for nonmedical reasons) have a 9-fold increased risk of varicella (chickenpox), up to a 35-fold increased risk of measles and a 6-28-fold increase in pertussis (whooping cough) compared to vaccinated peers. Delay in receiving vaccines at the recommended times generally results in more severe disease in infants and younger children who contract vaccine-preventable diseases. In addition, there is a risk of community outbreaks of these diseases.

Vaccine refusal and delay is a complex problem influenced by several factors, including convenience, confidence, and complacency. Convenience relates to availability, affordability, and accessibility of vaccines. Vaccines are widely available and covered by almost all insurers, including Medicaid. In addition, there is a program in our state that provides free vaccines to children without insurance. Health departments also provide free vaccines to those in need.

Confidence in vaccine effectiveness and safety has declined in recent years because of lower trust in our government, vaccine manufacturers, and health professionals. Complacency has occurred because of a widely held belief by parents who have not seen vaccine-preventable diseases that these diseases are not serious and do not pose a risk to their children or other children. Because vaccines have been so effective in nearly eliminating many diseases, many parents have not seen these diseases and don’t know about the potentially serious complications and effects of the diseases covered by the vaccines.

Immunization laws are state-regulated and vary among states. Vaccines are required for all children attending Day Care and school, but states vary as to which vaccines are required. Exemptions are granted for three reasons-medical, religious and philosophical.

Pennsylvania allows all of these exemptions. The most controversial and nonspecific exemption is philosophical, interpreted as personal, moral or philosophical belief against some/all vaccines. States with religious and philosophical exemptions have higher rates of vaccine-preventable diseases. Nonmedical exemptions are the primary reason for vaccine refusal or delay, which occurs in up to 6.2% of children.

Parents primarily refuse vaccines because of safety concerns and studies indicate that 60-70% of all exemptions are due to safety concerns. These concerns vary and include many alleged side effects such as autism(not shown), neurological damage(not shown), overload of the immune system(not shown), autoimmune diseases(not shown), Guillain-Barre syndrome(rare), susceptibility to infection(not shown) and intussusception (coiling of intestine within itself requiring emergency treatment-rare). Some of the concerns relate to rare, but serious or potentially serious side effects. Most vaccine side effects are minor, self-limited and modifiable, consisting of low-grade fever, injection site redness and tenderness.

The Institute of Medicine has systematically reviewed well over 200 studies regarding potential side effects and found a true causal relationship between vaccines and only a small number of significant side effects. They concluded that vaccines do not cause autism, neurological/developmental problems or Diabetes. There has been a great deal of scientifically unfounded public attention regarding thimerosal, used as a preservative in multiple-dose vaccines, and neurological side effects. There are also several misperceived concerns resulting in vaccine delay or refusal, including low-grade fever, minor illnesses, prior mild injection site reactions, antibiotic use at the time of immunizations, recent exposure to infections and penicillin or non-vaccine allergies.

The true medical reasons to withhold or delay vaccines include potential allergic reactions to the vaccines or one of its components. The other main category relates to risk in children who have certain types of deficiencies in their immune systems. The potential allergic reaction of most concern is anaphylaxis, a life-threatening multi-system allergic reaction. The actual incidence of this problem has been shown to be very small, 5 cases/7.5 million doses in one large study. In many cases, the vaccines can be administered as long as the staff can manage a potential allergic reaction. The concerns for children with certain specific immune deficits is primarily with live vaccines, and many of these conditions are temporary (chemotherapy, HIV, certain medications) and vaccines can be resumed when conditions improve.

Regarding religious exemptions for vaccines, there are some specific concerns expressed by certain religions and groups. Some vaccines use cells from aborted fetuses to grow the specific virus and manufacture the vaccine. These fetuses were aborted for other reasons and the Catholic Church has endorsed vaccines because of the overriding public health benefit of vaccines. Jewish and Islamic people do not consume pork and some vaccines use pork-derived gelatin as a stabilizer. However, Jewish and Muslim scholars endorse vaccines because vaccines are not ingested as food.

Vaccine effectiveness varies and no vaccine is 100 percent effective or can be expected to be so. Most are highly effective and protect 95 percent or more of those immunized according to the recommended schedule. They provide a great benefit to individuals as well as the community because of a key public health concept of herd immunity. This relates to the protection of those who cannot safely receive certain vaccines being dependent on the complete vaccination of the rest of the community(90-95% of community needs to be immunized). There have been several outbreaks of highly contagious and potentially dangerous diseases like measles, mumps, and pertussis because of vaccine refusal and delay.

Ethical concerns have been raised and are a consideration in vaccine requirements. The key issues relating to the balance of parental rights and personal liberty and the societal rights to protect children and the community. Most believe that the public health value of vaccines and allowing nonmedical exemptions are not equal alternatives. Nonmedical exemptions have resulted in increased outbreaks of vaccine-preventable infections along with their complications.

In summary, the effectiveness of vaccines balanced against the common minor side effects and rare more serious side effects strongly supports their use in all children other than those who truly cannot receive certain vaccines because of medical reasons. The science and many decades of successful vaccine implementation, as well as the continued improvement in the technology with the development of new vaccines, have a profound benefit for the health of children and communities.

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