Medicine

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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Bridging the Gap Through Smiles

Setting the standard for excellence in oral surgery, Dr. Wayne J. Saunders began The Center for Oral and Maxillofacial Surgery over 15 years ago as a solo practice.  Now known as St. Luke’s OMS, the practice has grown to a twelve-doctor practice with four locations throughout the Lehigh Valley, and a new location in Stroudsburg, […]

Setting the standard for excellence in oral surgery, Dr. Wayne J. Saunders began The Center for Oral and Maxillofacial Surgery over 15 years ago as a solo practice.  Now known as St. Luke’s OMS, the practice has grown to a twelve-doctor practice with four locations throughout the Lehigh Valley, and a new location in Stroudsburg, PA.  Still, the largest practice in the area, St. Luke’s OMS continues to be the most innovative.  The practice is proud to announce the addition of not only the area’s first and only female oral surgeon but also the first Latina and Spanish speaking surgeon – Dr. Veronica Barreto!

“I feel honored that I was given the opportunity to be the first female oral surgeon in the area,”  states Dr. Barreto.  “I can understand being a female in a male-dominated specialty can come with its own sets of challenges and preconceived notions, but I embrace those challenges with warmth and laughter.”

Dr. Barreto received her dental degree from the Maurie H. Kornberg school of dentistry in Philadelphia, PA where she graduated magna cum laude, then completing her residency training at Temple University Hospital.  She was the recipient of several awards including American Academy of Pediatric Dentists Predoctoral Student Award,  the American Association of Endodontists Student Achievement Award and the Edward B. and Arnold R. Cook Prize in Children’s Dentistry.  During her dental school training, she also volunteered abroad, providing dental care and oral health awareness to the underserved populations in Costa Rica and Panama.

“Barreto is the perfect addition to the practice,” states Dr. Saunders, founder and managing partner of St. Luke’s OMS.   “Aside from being a clearly skilled surgeon, myself and the other doctors are happy to have not only a skilled female surgeon alongside us but also someone who is able to speak Spanish.  Barreto not only is a great doctor, but she embodies the spirit of the practice with her philanthropic background.  Giving back to the community is a large part of what we do, and I have no doubt she will help us continue that mission.”

Barreto hopes to inspire others with her career choice and new position.  “I hope that being a surgeon and a female will help to break barriers and set an example for other aspiring amazing women to join this highly rewarding profession,” Barreto proudly exclaims.  “I plan to offer patients the utmost care just like any one of our doctors at St. Luke’s OMS would provide, and I know that being a female is just the icing on the cake!”
Dr. Barreto and the other St. Luke’s OMS surgeons offer a full range of oral and facial procedures.   The mission of all surgeons at St. Luke’s OMS is to provide patients with affordable, high-quality, state-of-the-art care in a gentle, safe and secure environment.

For more information on Dr. Veonica Barreto or any of the other St. Luke’s OMS Surgeons, please call 610.865.8077, or visit StLukesOMS.com.

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Quality Management Systems for Medical Device Manufacturing and Supply Companies

In general, manufacturing is manufacturing; just make a thing.  When talking about a medical device, a “thing” that could affect human health, there’s more to think about than your production line, though. Quality management systems…really exciting stuff, I know.  Typically, poorly understood and unpopular subjects with fast-moving entrepreneurs, they are usually thought to be blockades […]

In general, manufacturing is manufacturing; just make a thing.  When talking about a medical device, a “thing” that could affect human health, there’s more to think about than your production line, though.

Quality management systems…really exciting stuff, I know.  Typically, poorly understood and unpopular subjects with fast-moving entrepreneurs, they are usually thought to be blockades to market entry or hoops you need to jump through.   Unfortunately, these systems are also necessary evils in the world of medical device manufacturing and supply, and sometimes just good business practice.

Okay, so what is a quality management system?  According to the definition, “A quality management system (QMS) is a collection of business processes focused on consistently meeting customer requirements and enhancing their satisfaction.”  Simplified, it’s making sure what you make meets your client’s needs and keeps them happy.  Seems simple enough, right?  But mention FDA inspections, audits, and potential jail time for the owner or principals of a company, and people get nervous.

I’ve been in the medical device manufacturing and supply industry my entire career and have found that many people really struggle with quality management systems and implementation.  I think it may be out of fear of doing the wrong thing, but this stuff is pretty straightforward and can even be easy. And you should never fear the audit or the inspection…although jail time is a different story!

Really, the key to implementing a QMS is understanding your needs in the scope of your business model and how it’s most easily conveyed to your employees.  If I were manufacturing a pen, for instance, a couple of bins of parts in front of a worker with a diagram of how those parts fit together may be enough.  Machining a small, highly specific part with multiple pieces, like a stent, however, requires a more thorough document describing the nuances of the process; a simple diagram may not be so appropriate.

For medical device manufacturers or supply companies, there are generally two guidelines for your QMS: FDA 21 CFR part 820 and ISO 13485 (google the acronyms for a good time).  Both FDA and ISO 13485 give an outline of what you, as a medical device manufacturer, need in your QMS.  That said, the FDA regulations and ISO standards are open to interpretation as to how they apply to your company and process.

Basically, you need to have control over how you manufacture, starting with raw materials all the way through your product labeling for your customer. You also need to troubleshoot issues and prevent bad products from reaching the market (doesn’t everyone?). Not a wholly unreasonable proposition.

For a raw material supplier, for which I have worked for two (one supplying highly technical raw materials, one supplying a commodity type product), the ISO standard is for you.  Unfortunately, there is another caveat depending on your business model.  Certainly, the FDA regulations are not your concern, but supplying parts is different from manufacturing a final device.

On the one hand, if you specifically want to target device manufacturers, complying with the 13485 standards is a great selling point / marketing tool.  It can make it easier for certain companies to use you as a supplier as well, and any chance to remove a blockade to sales is just good business sense.  It is also expensive to set up and maintain, which can lead to premium pricing for your products.

Conversely, if you are making a more commoditized product, ISO 9001’s general QMS standards for manufacturing (think making refrigerators, paint, HVAC systems, pens, etc.) are enough.  Even a manufacturer of a medical device wants to go to the lowest bidder.  Although your product was never intended for use in a device, the device manufacturer has to control their supply; the onus is on them, not you.   ISO 9001 is also cheaper and easier to maintain, allowing you to stay competitive with price.

In order to manufacture, market, and sell a final medical device, whether a tongue depressor, hip replacement, or blood test, you need to establish a QMS that meets all of the regulations defined in 21 CFR part 820.  There’s no getting around this one; the FDA has to be involved if you want to be a device manufacturer.

To determine your path, just evaluate your overall business model.  Solicit the opinions of your potential customers, but always do what’s best for your company’s particular situation. It’s not one size fits all when it comes to a QMS, and it’s a complicated business.
If you need an outside opinion, shoot me an email. I’d be happy to help.

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A Little Heart Can Make a Big Difference

We all evolve as we go through life, and if we are truly introspective, many of us will find that our life tragedies and everyday experiences shape our future and the causes that call to us.  I know that has been true for me. In 2012, I felt like I was just starting to make […]

We all evolve as we go through life, and if we are truly introspective, many of us will find that our life tragedies and everyday experiences shape our future and the causes that call to us.  I know that has been true for me.

In 2012, I felt like I was just starting to make a name for myself as a young personal injury litigation attorney, despite having just welcomed two babies into the world only 15 months apart.  While I was still figuring out the work-life balance, I did feel like I had my life relatively well under control.

All of this changed, when one day, I had a heart attack completely out of the blue at age 36.  I had decided to train for the SheRox Triathlon and had begun a swim conditioning class.  I had done a few triathlons in the past (albeit at a slow pace), and I thought this would be a great way to reclaim myself and have some “me” time away from work and family.  After a swim conditioning class, when I pulled myself from the pool, I felt a nagging pain in my upper abdomen behind my breastbone.  That feeling lasted about 15 minutes and resolved.  While it caused concern, a heart attack was not on my radar.

Two mornings later, the feeling returned and eventually led to classic heart attack symptoms – pressure across the chest, shortness of breath, nausea, vomiting, and weakness in the arms.  After a trying time in the hospital, with some initial dismissive treatment from an ER doctor, a heart attack was confirmed, but the cause was something I had never heard before – spontaneous coronary artery dissection or SCAD.

I was told that the doctors rarely see this and know little about it.  Essentially, SCAD occurs when a tear forms in the innermost layer of the coronary artery. The dissection can lead to clot formation at the tear site or otherwise obstruct blood flow starving the heart muscle of oxygen, causing a heart attack.  Unlike the typical heart attack involving atherosclerosis, SCAD is relatively uncommon and often strikes people living healthy lifestyles. For that reason, it is often misdiagnosed.  SCAD disproportionately impacts many more women than men, and because research has historically focused on men, it was not hard to believe that my doctors, in 2012, knew little about SCAD.

The fortuity of the timing of my SCAD heart attack was that the condition was just starting to get some media attention.  The Mayo Clinic in Rochester, MN, had just begun studying the condition, and Robert Alico, with the death of his wife as motivation to find answers, had started the non-profit SCAD Research, Inc., to help fund research endeavors into why SCAD occurs.  The weekend of my SCAD marked the very first 5K fundraiser that SCAD Research hosted in the Chicago, IL, area to raise funds.  The media showed SCAD survivors who were walking, running, and most importantly living after this life altering diagnosis.  I knew what I had to do.

I immediately booked a flight to the Mayo Clinic to be seen by the study doctors and to enroll in the study.  I read every article I could get my hands on.  I joined the Board of Directors for SCAD Research.  I learned that Fibromuscular Dysplasia (“FMD”) is an associated vascular condition, which makes people more susceptible to dissections and aneurysms, and that I have that condition.  I became active in FMDSA.

Because SCAD and FMD are diagnoses that are often overlooked by doctors, raising awareness that these vascular conditions exist and funding the research that will help us fully understand their impact is critical.  The Mayo Clinic doctors now believe that SCAD may be the #1 cause of heart attacks in women under 50 and is the #1 cause of heart attacks in Post-Partum women.

The Lehigh Valley has an opportunity to greatly impact this research as it is now the site of the East Coast 5K SCADaddle fundraiser.  In September 2016, the first Lehigh Valley 5K SCADaddle and Gratitude Gala grossed over $20,000 in donations and proceeds, thanks in large part to friends and family of a local woman, Meagan Duarte, who was taken much too soon from her family as result of SCAD.  We are hopeful to make an even bigger impact on this research in 2017. Consider being a Title Sponsor for the second 5K SCADaddle and Gratitude Gala in the Summer of 2017. Contact SCAD Research, Inc., at 5Keastcoast@scadresearch.org for sponsorship information.

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Winter-Wonders

Winter Wonders for your Skin

Winter is often the time to wear layers and cover up. Believe it or not; it’s actually the best time of year to focus on improving your skin. Many cosmetic dermatology treatments take a series of sessions to get the best results, and no one will ever know what you’re doing since you’re dressed for […]

Winter is often the time to wear layers and cover up. Believe it or not; it’s actually the best time of year to focus on improving your skin. Many cosmetic dermatology treatments take a series of sessions to get the best results, and no one will ever know what you’re doing since you’re dressed for winter! Here are four different conditions we commonly treat this time of year:

1 Sun Damage

As we age, our skin ages with us. Irregularities in pigmentation, called liver spots or age spots, can form. Skin loses youthful tension and collagen, creating wrinkles, and exposure to the sun can give us irregularities called sun spots. Laser Skin Rejuvenation is the process of bringing youthful firmness and complexion to skin that has suffered aging, wrinkles, or sun damage, and restoring a young-looking appearance and youthful feel to the skin.

Addressing your skin concerns during a consultation can help us create a customized solution to rejuvenate your skin. A combination of the highly sophisticated skin care products and the latest laser and light sources for rejuvenation of your skin will be recommended and a timeline established.

2 Spider Veins

If you cover up your legs during the summer because of unsightly (and sometimes uncomfortable) spider veins, winter is an excellent time to treat. Spider veins typically appear on the face or legs and inherit their name from the blue or red spider web shape they take. Since it’s good to have options, we have many lasers at Aesthetica for the treatment of leg veins and spider veins including the visible light V-Beam® Perfecta Pulsed dye laser and Palomar’s Icon™ System. A number of long-pulsed YAG lasers, the Cool Touch Varia V3 laser, and Cutera Excel V laser, are also utilized in treating leg veins.

3 Hair Removal

If you’re sick of shaving or waxing, laser hair removal makes good sense for you. It’s fantastic for people with brown hair and can be performed on the legs, underarms, and bikini line. In fact, I was one of the first physicians in the United States to perform laser hair removal and actively participated in the development of effective treatment parameters for this procedure. Currently, we are using Palomar’s Icon™ system as the primary treatment tool 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. We also have solutions reserved for resistant hair in patients with darker skin types. It’s one of the very first treatments we offered at our practice, and we continue to run specials to make it cost effective (look for one in early 2017).

4 Body Contouring

If you enjoyed a little too much holiday cheer, Aesthetica offers excellent solutions for body contouring. While they aren’t for weight loss, our new Exilis Ultra, Cellutone® and the Viora Reaction systems are used to treat stubborn spots that don’t respond to diet and exercise. We can address lax upper arm skin, baby belly ” pooch,” love handles, “bra fat,” waist and belly areas, “saddle bags,” and cellulite!

As always, it’s best to come in so we can customize a solution for your specific treatments. The right time to get started is now to allow yourself ample time to get ready for summer 2017.

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A Primer for Attorneys

The Not-So-Obvious Medication Misadventure Medication adverse effects are not always obvious, even to the trained medical professional. There are reasons for this. A patient may have medical conditions that cloud the picture of an adverse drug reaction. There may have been a medication error (that is, wrong drug, wrong dose, or wrong patient) but it […]

The Not-So-Obvious Medication Misadventure

Medication adverse effects are not always obvious, even to the trained medical professional. There are reasons for this. A patient may have medical conditions that cloud the picture of an adverse drug reaction. There may have been a medication error (that is, wrong drug, wrong dose, or wrong patient) but it went unnoticed. The medication error was noticed but not reported by the health care provider for fear of retribution despite a “just cause” culture.

There are some scenarios that may send some red flags up that there was harm done to a patient by medication. The simplest (but unfortunately least likely) scenario is when a healthy patient, taking no other medications, says “I just started taking this medication, and as soon as I started taking it, something went wrong”. And the “what went wrong” part has been well-documented in the medical literature. But harm from medications is not always that easy to detect.

As a toxicologist, the first thing I am looking for when reviewing medical records is, was there a chance that any of the drugs given to a patient could have contributed to the patient’s medical condition. And of course, if a medication harmed a patient, how can this harm be prevented in other patients.

For attorneys, there are the “Top 5” things to think about when reviewing details of a medical case, which may or may not be a medication error case from the get-go. Of course a toxicology or other medical expert may be at your fingertips, but here are some tips for attorneys before that step is even a thought:

1 Did a patient receive too much medication?

The dose makes the poison. As a toxicologist, this is one of my favorite sayings. There is so much truth to it. Yes, a drug or even a chemical can have a lot of dangerous effects associated with it. But the question becomes, how much was the patient actually exposed to? That is not always easy to answer. In the case of a hospitalized patient, we can only go by what is documented in the chart, and we hope that the documentation is accurate. In the case of a patient who returns home with prescriptions, we don’t know with certainty if the patient was taking the drug as prescribed. Or, we don’t know if the patient was taking a drug even intended for them.

2 Was a medication appropriate for a patient?

The dose makes the poison. But…even a “normal” dose may be harmful to a patient. How can this be? Didn’t we just ascertain that the dose makes the poison? That is not completely true. Some other scenarios can be at play here. For example, were there other medical conditions that made a certain drug less tolerable and more toxic to a patient? Were there medications that interacted with one another intensifying the effect of one or more of the drugs or extending the time the drug stayed in the body? As an attorney, don’t write off a possible medication adverse reaction just because the dose was acceptable.

3 The dose of the drug was fine. Or…was it?

What is an acceptable dose of a drug? Sometimes the answer is very patient-specific. There are drugs with very narrow margins of safety. That is, a little bit off from an acceptable dose can lead to harm. Some drugs are based on the patient’s weight. Is there a weight documented in the medical records? Or was an “average adult” weight used to calculate the dose? This one is a little trickier and probably warrants a call to a medical expert.

4 Were any antidotes included on a patient’s drug list? If so, why was it used?

An antidote is used to reverse the effects of a drug. An attorney may not know why an antidote was used when it is encountered in a medical record. For example, was it simply to reverse the effects of anesthesia? Or was a drug given in an excessive amount and now its effect needs to be reversed by an antidote? Or did a patient have an adverse reaction to a drug that needs to be treated? It’s helpful to know why each and every drug on a medical record was used. You may be surprised what you find out.

5 I see drug levels. Why are they here and what do they mean?

Keep an eye out for drug levels in medical records. Why were they performed? Was it for routine monitoring of a patient or was it because there was an adverse medication event?  Interpreting drug levels are challenging. Drug levels do not always correlate with how sick a patient is or will become. Drug levels are measured in different ways, and the interpretations of these tests is a science in itself. Keep your radar up when you see drug levels in a medical chart. But discuss them with a medical expert to help you connect the dots. Connecting the dots is what medical experts are there for.

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Are Electronic Medical Records Taking The Care Out Of Healthcare?

How long did you wait to see your doctor the last time you were sick? 20 minutes, 45 minutes, 1 hour? During your visit, did your physician spend more time staring at their laptop instead of at you? These complaints are all too common today. But they both are the result of physicians and their […]

How long did you wait to see your doctor the last time you were sick? 20 minutes, 45 minutes, 1 hour? During your visit, did your physician spend more time staring at their laptop instead of at you?

These complaints are all too common today. But they both are the result of physicians and their office staff struggling to learn and comply with the new laws regarding Electronic Medical Records (EMR’s) and new insurance reimbursement requirements. More parameters must be met and more metrics delivered than ever before.

EMR vs EHR

That big file of papers your doctor used to page through in the exam room is now a digital file called an Electronic Medical Record (EMR). It contains all of your medical history from your visits at one medical office.

You also now have an Electronic Health Record (EHR), which goes beyond a single provider’s office – it’s your comprehensive history from many hospital and doctor’s office visits, across all health systems.

The intent behind EHR’s and EMR’s is a good one: over time, they track your medical data and can be used to indicate whether you’re due for a preventative visit or screening, monitor how you’re treated by other providers and improve the overall quality of your care. The new laws intended for your physician to be able to access your EHR during your visit to make a more accurate diagnosis, to avoid duplication of diagnostic tests and possibly catch a symptom or pattern you may be unaware of.

But the path to this medical interconnectivity has been rocky, to say the least. Progress has been hampered by reluctance on the part of so inter connectivity me providers to share their information and software from vendors that is incompatible. Some software vendors, unable to keep up with the sweeping changes, have gone out of business, leaving practices scrambling to find new vendors.

Additionally, physicians are now required to follow a checklist regarding your complaints so that he or she can be properly compensated for your visit by your insurance provider. Doctors and their staffs are getting bogged down in the minutia of compliance.

Change can be painful, but a good thing in the long run.

On the upside, many new changes are on the horizon, such as virtual house calls – for minor complaints, you can now communicate with a physician via your computer or mobile device. Some doctors, in an effort to get back to the quality care of old, are abandoning insurance altogether and introducing different models like Direct Primary Care. In this model, you pay a fixed fee every month based on your age and health, and the practice only sees a certain number of patients. This relieves the provider of having to squeeze in as many patients as possible each hour, and the doctor can spend more time with each patient without being tethered to a predetermined checklist for your complaint.

So during your next visit to your physician, if your doctor is looking at their laptop more than at you, don’t take it personally. It’s now part of their job – they’re feeling pain, too.

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5 Dermatology Must Do’s This Summer

When you’re a business person, it’s important to put your best face forward.  No matter what your age or stage, keeping your skin in good health is important. It’s your largest organ after all!   Here are 5 “Must do’s” to keep your skin healthy this summer. 1 Wash your face with your own products.  Beyond […]

When you’re a business person, it’s important to put your best face forward.  No matter what your age or stage, keeping your skin in good health is important. It’s your largest organ after all!   Here are 5 “Must do’s” to keep your skin healthy this summer.

1 Wash your face with your own products.  Beyond a bar of bath soap, wonderful skin care products are made specifically with men and women in mind.  Everyone should wash their face daily with products designed for your skin type and then follow with moisturizer.  Your skin care specialist can help steer you to products that will work best for you (or you can try one I invented-MDRejuvena- available at Aesthetica Cosmetic & Laser Center).

2 If you’ve spent most of your life soaking up the sun, it’s important to schedule an annual skin cancer checkup with a board certified Dermatologist.  If you have a history of skin cancer in your family, you should be seen more often.  It goes without saying that you should wear broad spectrum sunscreen with at minimum of 15 SPF daily.  If you’re planning to be outside, use SPF30 or more and apply often.  You should also avoid tanning beds year round.

3 Since youth is often valued in the workplace, keep an eye on signs of aging.  If you’re starting to see wrinkles, consider minimally invasive and no downtime procedures. Injectables including Botox® and cosmetic fillers such as Juvéderm® can provide both fullness and smoothness to the skin, reducing the appearance of lines and wrinkles in the forehead, eyes, as well as a sagging neck skin.  We feature products by Allergan and Galderma in our practice, which allows us to customize these products to bring out the best in you. We also pride ourselves in offering the very latest in cosmetic and laser technology.  My years as a medical researcher in the field has helped us tailor treatments to address the common signs of aging including; sagging skin around the face, fine lines, wrinkles and age spots.

4 If you are bothered by heavy sweating, sometimes deodorant isn’t enough.  Botox injections in the area can help but you must repeat treatment ever few months.  We also offer an FDA-approved in-office procedure called miraDry™.  In fact, we were the first practice in the state of Pennsylvania to bring it to patients and have since become one of the premier providers of this treatment in the country.  MiraDry uses microwave energy, delivered in a handheld wand, to “zap” sweat glands.  Two treatments are typically needed to complete the process but improvement can be seen after one.  The procedures are done in my dermatology office and are spaced six weeks apart.  Our first patients, who had the procedure over two years ago, still report that they are sweat free!

5 Finally, if you struggle with embarrassing toenails, sandal season can be especially difficult.  Millions of men and women have onychomycosis (the fancy name for toenail fungus infections).  You see the ads all over TV and radio for prescription medications.  You can avoid harsh chemicals and pills by trying treatments like Q-Clear™, available at Lehigh Valley Dermatology.  It’s the only FDA-approved laser on the market designed to clear nails in patients with Onychomycosis.  It’s painless and takes very little time–just less than a minute per nail.  There’s no downtime and a series of treatment is cost effective.

Don’t let the summer heat get you the best of you.  Your skin will thank you.

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