Optimal Health Blog

Do you know your bodies real age? Find out

Wellness Doc — Sun, 25 Feb 2007 21:40:00 GMT

As a vascular surgeon, I deal with the ravages of age on a daily bases. Arterial blockages are known by various names including PAD (peripheral arterial disease), PVD (peripheral vascular disease). Arterial blockages can lead to stroke, heart attack, kidney failure and limb loss. Preventing arterial aging is one of the most important things you can do to live a longer life with higher quality.

The good thing is that there are measureable ways to reliably slow the aging process

One of the most important markers for arterial aging is –Blood Presure

The second leading cause of arterial aging is high cholesterol

Its simple, nothing ages you faster than mistreating your heart and arteries and nothing keeps you younger thatn keeping your CV system healthy. The good news is that most of the premature aging is self inflicted and if we only new how, we could all make some simple change in our lives. The bad news is that most people are not motivated to make change. By virtue of advancing to this point to take the initiative to listen to our DVD, you have distinguished your as having initiative and motivation.

A good way to think about it is the cardiovascular system is like a highway system. Roadways are the infrastructure of the city and blood vessels are the infrastructure of the body. Just as roads take us from here to there, blood vessels take oxygen and nutrients to the tissues of our body and then removes carbon dioxide and other by products.

Its clear that one of the most important steps in any age management strategy is protection of your heart and arteries. We’ll begin with some basics today and build upon these throughout our series of anti aging topics. I want you to begin to think of cardiovascular health in a holistic or integrated fashion. Everything decision that you make either improves your health or detracts from it, but it certainly affects.

For example, simple acts like an aspirin a day, a single glass of red wine at dinner and taking the right vitamins in the proper amount are quick easy and painless ways of improving your cardiac health. So sit back and listen as we discuss more ideas.

Blood pressure measurement is a general overall indicator of the condition of your blood vessels. The difference between having a low normal blood pressure of 115/76 versus 140/ 90 can add as much as 20 years to your chronological age. Nearly a quarter of all Americans 58 million people have a BP over the American Heart Associations danger zone of 140/90. As you know, high blood pressure is a silent killer because people can live for a long time relatively unaffected before severe symptoms appear.

That’s the problem with many of the blood vessel disorders, until their first stroke or heart attack, many people feel relatively little symptoms. And because of that, its very difficult to convince these people that behavioral changes are necessary to prevent some hypothetical occurrence. I use the analogy of an automobile. Nowadays, many people lease their vehicle. If you fail to maintanence the car properly, its probably not a big deal because you will turn the car in after 36 mo. You are stuck with your body for life.

As you age, your blood pressure begins to increase. Why? Because the arteries become less elastic due to where and tear over time and also the buildup of fats and lipids. The hardening of the arteries causes the heart to work harder to pump blood.

1.5 million Americans suffer from heart attacks each year and one-third of those people die. 500,000 americans suffer a stroke each year and one third of them die. Stroke Info

What can be done to prevent you from becoming a statistic.

Nutrition with a low fat diet

Diet to maintain an ideal body weight

Exercise

Stress Reduction

Smoking Cessation

Because these are broad, comprehensive topics we will devote an entire podcast segment to each of them.

The second part of arterial aging is the build up of lipids and plaques along the arterial wall. This buildup causes hardening of the arteries which in turn causes high blood pressure which leads to a vicious cycle of stiffening of the arteries and fatty deposits.

In General men are more likely to suffer from arterial aging at an earlier age. Women usually don’t undergo arterial aging until after menopause.

All of us can do simple things that will help keep our arteries young. Aspirin a day is a quick, easy step toward arterial youth that almost all of us can incorporate into our lives.

While no drug cures everything, If I had to name a drug that came closest to being the cure all of cardiovascular, My choice would be aspirin. Drug of the Century aspirin, with antibiotics running a close second. Got a headache, aspiring. Running a fever aspirin. For the cost of a bottle of asprin, the benefits to your health are tremendous. And now, feeling old. Take an aspirin.

Aspirin has been shown to decrease the risk of heart attack and stroke if taken daily. It works by inhibiting the enzyme that causes platelets to stick together. This decreases the likelihood of clots forming within the artery. The acute formation of clot within the artery is the usual cause of stroke and heart attack.

Moreover, the consistent use of ASA or a similar class of medications called NSAIDS has been shown to decrease the risk of Colon Cancer and perhaps Alzheimers.

The evidence is clear, if you are a man over 40 or a woman reaching menopause, you should begin taking aspirin

As always, you should consult your personal physician before starting any new treatment. The side affects of aspirin are few and primarily related to bleeding ulcers and abdominal pain.

In upcoming podcasts, Learn how vitamin C and E can protect your arteries. Taking both of these vitamins in the appropriate dose can reduce your real age. Also we’ll talk about the use of Folate, which will keep lipids from building up within your arteries.

We’ll talk about how poor dentition and other causes of inflammation can affect ultimately cause hardening of the arteries. And most important, we’ll discuss the combined roll of diet, nutrition, exercise and stress management.

Podcast Alley

Wellness Doc — Mon, 05 Feb 2007 00:30:00 GMT

<a href="http://www.podcastalley.com/"> My Podcast Alley feed!</a> {pca-61115fb3e90a6ade938cc405f60223cf}

The Connection between Inner Health and Outer Beauty

Wellness Doc — Mon, 05 Feb 2007 00:07:47 GMT

As a primary care physician for the past 13 years, I have seen and heard just about everything. As the family doctor, I am given the responsibility to help my patients live better and stay healthy, but what has happened with managed care, is I have less and less time to spend with each person. I have five minutes, may be 10 minutes max to see someone, which is barely enough time to address their top concern, so the things that I believe can make the most difference in your life-wellness and prevention are never addressed.

I have become so dismayed with the whole process, that I have opened up a medical spa and wellness center to deliver the the philosophy I believe in: The integration of inner health and outer beauty. Your skin is a manifestation of what is happening internally. To treat skin well, both the inner and outer aspects need to be addressed. This blog is to help you understand the various skin conditions, the treatments available, as well as how your inner health can be affecting your outer beauty. Furthermore, different skin types have different concerns that need to be addressed and treated accordingly.

One of the most important things that I have learned in medicine is to make things simple. The more simply it is stated, the better people understand it and are more likely to understand how to take care for it. This is by no means to make anyone feel disrespected, but I just think doctors are so caught up in the technical lingo that they have forgetten how to explain things to people.

So, to begin with skin health, the most common reasons people come in to our center are for acne, spots, scars, saggy skin, wrinkles, and unwanted hair. (Wouldn't it be great if we could just get rid of all of these problems?) These skin concerns can be grouped into different categories that offer various treatment options depending on the severity of the condition. Severity is defined by
1. Mild-affecting 1/4th of the face or less
2. Moderate-affecting 1/2 of the the face
3. Severe-affecting more than 1/2 of the face

The five categories are:
1. Acne-there are different types and can affect the body anywhere, which we will discuss in the future.

2. Red skin-this includes rosacea, sensitive & dry red skin, "erythematous skin"-just a fancy term for people who have no skin problem
but just alot of red undertones and easy flushing, psoriasis, broken capillaries

3. Brown discoloration-from scarring, acne, melasma, sun damage,
age related changes to include the most common causes of brown spots and patches

4. Wrinkles-whether they are fine or deep, caused by movement or
are always present;the treatment will vary.

5. Other-are all other things that cause lumps, bumps, and
concerns. After we evaluate these, these can be treated or referred on for
further treatment.

I will break down each of these categories in more detail so you can learn more about them as well as the different treatment options. Yes, people can have multiple combinations of problems together as well! There are many other problems out there but I just wanted to discuss the most common concerns that I address daily and what can be done from them.

Acne: What Causes it?

Wellness Doc — Mon, 05 Feb 2007 00:08:24 GMT

More than 85% of Americans suffered from acne sometime in their life. It can occur anywhere on the body but typically affects the face, neck, chest, shoulders, and back. Acne affects all ages with the teenage years being the most common. However, the disease is not restricted to any age group. Acne is very frustrating for my patients. They are just surprised that it just never goes away! Acne left untreated can cause scarring which for most of us last, for a very long time.

Acne is caused by inflammation in the sebaceous glands. The different terms that doctors use, describe the different types of inflammation.

1. Comedones (aka blackheads and whiteheads) is a sebaceous follicle plugged with sebum (a thick gelatinous oily substance produced by your skin), dead cells from inside the sebaceous follicle, tiny hairs, and or bacteria. When comedones are open, they appear black and hence are known as "blackheads". This is not dirt but oxidized material inside of the skin. Closed comedones are commonly called a whiteheads; They are skin colored or look like an inflamed white "bump" in the skin. Neither blackheads nor whiteheads should be squeezed or picked open, unless extracted by a skin care specialist under sterile conditions. Facials are NOT sterile conditions. I discourage my estheticians from extractions because it usually causes more scarring. If it comes up easily with a treatment, then I let them do it. I have many patients who come in and want an agressive exfoliation of their followed by deep extractions. I do not recommend this at all because the tissue is injured by squeezing or picking and can become infected with more bacteria, worsening the situation.

2. A Macule is the temporary red spot left by a healed acne lesion. It is flat, usually red or red-pink, with a well defined border. A macule may persist for days to weeks before disappearing. When a number of macules are present, it looks like the person has very red, irritated skin. This is seen with acne and even my rosacea patients.

3. A Papule is a small, solid bump, slightly elevated above the surface of the skin. A group of very small papules and microcomedones may be almost invisible but have a "sandpaper" feel to the touch. A papule is caused by local skin inflammation.

4. A Pustule aka pus bumps, zits-are small, easily broken bumps containing pus. A pustule that forms over a sebaceous follicle usually has hair in the center. Acne pustules that heal without progressing to cystic form usually leave minimum scars as long as patients don't pick at them. The problem is most of my patients love to break these ugly pus bumps worsening the condition and more likely to cause scarring. I know I have done it and I take care of skin everyday, so I know all of you have done it as well!

5. A Nodule-is a solid, large bump that lies deep within the skin. Patients state it is like a big zit that never comes to a head, its deep inside and really painful. Because they are deep, they are more likely to scar. Nodules need aggressive treatment due to their propensity to scar.

6. A Cyst is a sac-like lesion containing liquid or semi-liquid material consisting of white blood cells, dead cells, and bacteria. It is larger than a pustule, and tends to be more severely inflamed, extending deeper into the skin. It usually is quite painful, and there is great liklihood for scarring. Cysts and nodules often occur together in a severe form of acne called nodulocystic.

Ok, now that you know all the different types of acne. You are still wondering why it even occurs. Acne, regardless of the form you suffer from, occurs due to inflammation. What causes the inflammation? One of the most common reasons is hormonal fluctuations in the body. This is why teenagers are the most commonly afflicted due to the sudden shift in hormones. Women are usually pestered long after this because of the monthly menstrual cycle, pregnancy, or menopause. Women can get it for other reasons such as stress, friction (whether you talk on that cell all day long, keep touching your face, wear caps or clothes that cause more friction against your skin) are all culprits.

Men can be afflicted for different reasons. Yes, it can be due to hormones, but friction (from baseball caps and cell phones), sweating (especially for back acne), and body hair can be potential causes of acne. Remember pustules have hair in the center. So if you have more hair on your body or face, you may be more likely to get acne. (And yes, there are people who are "hairy" but don't have acne. I find that my acneic patients who do laser hair removal get a tremendous improvement in their acne). Clean your cell phone often and try whenever possible to be wireless or with a headpiece.

Other causes of acne are stress. How stress effects your skin is that it suppresses your immune system, thus the normal skin defenses you have are not as strong, predisposing you to acne. And usually, people when they are stressed, do not take care of themselves as well, do not eat or sleep as well, and usually start touching their face or hair in a nervous habit, which all contributes to worsening their acne.

All the literature states diet is not a cause of acne, but what I tell my patients is that, if you find that eating or drinking certain types of foods or liquids, worsens your acne, avoid it. I have seen plenty of people who have acne due to milk, nut, and wheat allergies. Studies look at large populations for changes but can not look at individual responses to allergens or other ongoing problems. I strongly believe in eating a well balanced diet, drinking 2 liters of water a day to keep the body cleansed and detoxified. Skin is an external manifestation of the internal balance. I often due elimination diets on patients to help acne and overall health. Typically, the person who is coming in for uncontrolled acne, also has many other issues in their life that are not being addressed. All of these are contributing to their acne. Most dermatologist do not have time nor the desire to address these "other complaints" and thus the studies are not set up to evaluate for these issues. So these are the causes of acne, coming up next are the treatments for acne.

Acne: Treatment Options

Wellness Doc — Mon, 05 Feb 2007 00:09:01 GMT

Acne treatment varies depending on the severity and skin type.

Mild acne is defined as involving less than 1/4 of the face with some pustules, papules, and black and whiteheads. Generally, these patients can obtain a decent response using mild over the counter products such as Benzoyl peroxide 5-10% to control outbreaks. Usually, by the time I see patients, they have already tried it, failed it, and are on Pro-Active! Pro-active works on mild acne but does not seem to work for more severe cases and or causes too much dryness.

For mild acne, I personally like to use the Neostrata Antibacterial cleanser for acne. It is a physician grade product sold in doctor's offices and now in some CVS drug stores. It is an alpha hydroxy product so it causes the skin to exfoliate faster, reducing acne outbreaks with time. I also prefer salicylic gel or solution to benzoyl peroxide. Salicylic products help "thin" the skin by removing any dead skin cells and sebum around the hair follicles, thus making it harder for pustules and comedones to form. I use this because I had a lot of facial hair that worsened my acne. After my laser hair removal, I use it for the occasional outbreak. I also use it on men around their beard line and women for their bikini line if they suffer from acne or ingrown hairs there. Please note that salicylic is contra-indicated in pregnancy!

Most of my acneic patients don't want to use moisturizers because they feel it will worsen their acne. Moisturizers are important to keep the skin's immune barrier working, which will prevent further skin damage. From over the counter, mild products again like neutrogena, Cetaphil, and Purpose are good. In my center, the two products I use for my mild acneic patients are alpha and poly hydroxy moisturizers. Both of them cause the skin to exfoliate while hydrating. The difference is that the alpha hydroxy is a smaller molecule and penetrates the skin faster, thus causing more irritation in the beginning. This irritation subsides after a few weeks. I use the polyhydroxy products on my more sensitive patients whereas for my oily skin patients, I use the alpha hydroxy products. For super sensitive skin, Avene makes Diacneal cleanser and moisturizer for acne which are great.

Treatments for mild acne can include chemical peels and microdermabrasions. Use chemical peels (glycolic peels that help exfoliate the skin faster) for active acne and microderm, a mechanical exfoliation for acne scars and maintenance of great, glowy skin. Both are relatively mild treatments and there is no down time with it! It is great for maintenance as well as for acne!

For moderate acne, which involves at least 1/2 to up to 3/4's of the face, treatment needs to start early to prevent scarring. For my Caucasian patients, they will complain of pink, red, and brown marks on their face, while my people of color (Asians, Latinos, African Americans) will complain of dark brown to black marks on their face. For many of my patients, these marks can last for 1-2 years if not longer and that is what frustrates them (and me!)

The most important thing is to control the acne using both skin care products and skin treatments to stop the acne and improve on the scarring. I start patients on good skin care products as discussed in the mild acne treatment, add a few additional items, and start on treatments. Using good skin care products is a must because you do not want to start an expensive treatment and not be able to maintain the results using clinically ineffective products from the drug store!

For moderate acne, a good cleanser, salicyclic acid acne treatment, moisturizer that is an alpha hydroxy acid, and SPF are a must. I also add hydroquinone and Retinols. I like to use hydroquinone, a skin lightening cream to reduce the formation of dark marks as well as the existing ones. In this country we use Hydroquinone 2-4% to stop the melanocytes, the cells that cause pigment from being overactive. No, you do not become lighter and look like Michael Jackson, but your skin will lighten to your natural color which is like the inside color of your forearm (take a look, that's your normal skin color).

In many countries, they do not use Hydroquinone because of a reported increase in cancers. We have not seen it in this country and thus, the FDA allows only physicians to use these products. Kojic Acid is another lightener which I will often use together to enhance the action or separately for patients who do not want to use hydroquinone. Use the Hydroquinone once or twice a day on the full face. For the stubborn spots, reapply it on the spots after 5 minutes for more effect.

Retinols are great to help the skin exfoliate faster. When the skin exfoliates faster, you help prevent acne from forming and help lighten scars. The best one's are prescriptions such as Retin-A, Tazorac, Retin-A micro, Renova, etc. Retin-A (the generic is Tretanoin) causes a lot of dryness and peeling because it forces the skin to exfoliate faster. If this gets to be too much, you can use it every other day or try adding a "blender" to it to make it less irritating. A blender product I use is from a wonderful skincare line called OBAGI. You blend the two products together and it allows for a smoother, gentler delivery of RetinA with less side effects. I also like to use the Avene Retrinal, a break down product of Retin-A so it is less irritating and gets you great results (cheaper too!)

For procedures to treat moderate acne, you have several options of peels to lasers. The treatments vary due to the depth of penetration in the skin. The deeper it penetrates the skin, the more expensive the treatment becomes because it leads to better results faster.

For patients on a more strict budget, a series of peels at higher strength is a good beginning. It will not take care of deep scarring. Progressive Peels are can penetrate about 5-12 microns deep in the skin and will work for more superficial acne, but not for that deep cystic acne. I use Neostrata Chemical Peels because they are made from natural sugar cane juice that is acidic allowing it to penetrate the skin and cause it to exfoliate faster. The reason this is important is that as we age or if we have problem skin, the exfoliation process that occurs naturally in our skin every six weeks, slows down. So less and less skin exfoliates, leading to more problem skin, a thicker layer of dead skin on top making products useless after a few weeks (just because it can not penetrate through).

When we do peels, we can remove that superficial dead skin, and penetrate a little deeper to where the acne is. And, no, you will not look like Samantha from Sex in the City (she had a peel and was lobster red for a day). Our peels are superficial progressive peels that are physician grade but gentle. Peels done at the salon/spa and at home are very mild even though they may say 50% glycolic. They can not use a true acid because they are not medical professionals and thus, their peels are buffered. Be a smart shopper and get a real peel with a physician!

A better option for moderate acne is using ALA and an intense pulse light treatment because it penetrates deeper (about 20-25microns deep). ALA is amino levulinic acid which has been shown to dry up the sebaceous glands to stop acne from forming (this is how accutane works without the same side effects). It needs a series of treatments and generally provides good results. People may need a touch up after the series of treatments are done to maintain their results. The ALA is applied to the skin for one hour and then an intense pulse light laser is used to "activate" the ALA. You may be sunburned looking for a few days. Repeat treatments occur every four weeks. I am not to impressed with just using the blue light acne laser treatment. I have not seen great results with it. Most of my patients state that they would not do it again, and thus, I do not offer it as a sole treatment, but only in conjunction with the ALA. Darker complexions can do the ALA and the blue light without concern. If you are going to do the ALA and the skin rejuvenation, I recommend that you use hydroquinone 4% for about 4 weeks in advance to minimize any risk of hyperpigmentation. Darker skin is more likely to get injured by the laser light due to the extra melanin. Using hydroquinone one month in advance will reduce this risk. Many places don't even bother, but since I am of Indian descent and have been burned in the past by "other laser places" I highly recommend it. Why take a chance...this is your face!

Another option and my favorite is the Pixel resurfacing laser. This is a true laser treatment (not an intense pulse light) that can penetrate deep into the skin (about 30-150 microns! That is the deepest you can go without needing sedation!). How it works is that it causes new collagen and elastin to be made and dessicating any current acne. You do need several treatments every 4-6 weeks apart to get optimal results. There is down time of looking sunburned with dry peeling skin for a few days. For patients with more moderate to severe acne, it may cause "new acne" because the treatment will bring up whatever is going on under the skin up to surface. This does not mean it is not working but rather its its penetrating deep into the skin, making differences. Acne can start about 2-6 weeks under the skin before it shows up on the skin surface. A normal skin cycle is about 6-8 weeks long. When we do any skin treatments, we expedite the exfoliation process, causing the skin to turnover faster, thus, if you had some new acne forming underneath, it will come up to the surface. Don't worry, the next treatment will take care of it. And once again, for my patients with darker complexions, I believe that using hydroquinone 4% 2-4 weeks in advance will provide optimal results.

For more severe acne, you need treatments ASAP. These patients have scars for their acne already and what we want to do, is prevent new scarring and help with the old scarring. I only recommend the laser treatments because we need deep penetration. I usually do a combination treatment with some ALA and intense pulse light followed by the Pixel. Because you will be getting treatments, we keep you on our mild Avene or Neostrata cleansers to help your skin heal and prevent new outbreaks. These patients need about 6 treatments of the Pixel or some combination with the the ALA and Pixel. The reason you need so many, is that the skin is very damaged and needs more treatment. After the treatments are finished, you must stay on good products to maintain what you just did! I use our Neostrata line or for another wonderful product line called OBAGI. This is the cadillac of skin care lines! This is what the plastic surgeons use after a face lift and many derms after all treatments are done. It can be used on all skin types and all ages except for women planning on having kids in the next six months because it does use both Retin-A and hydroquinone which are both contra-indicated in pregnancy.

Acne is a frustrating skin condition that requires a multi-faceted approach. While doing these skin treatments, I usually ask my clients to look at their diet and regular activities. I see alot of recurrent acne where people hold their phone to their face. Invest in Blue Tooth technology or an ear piece! Clean your phone often! Also, after working out, wash your skin. This is when it is prone to everything. And stop touching your face! That is a bad habit many of my acneic clients have that needs to slowly changed.

Most studies state that diet is not related to your acne. I feel that there are plenty of things that can make it worse. For people who are very sensitive to hormones, meat and dairy are loaded with hormones given to the animals to grow quickly. Try organic dairy products or just move to soy products and try free range meats (this is meat from animals that were not fed artificial feed that is loaded with bad fats and hormones). I firmly believe less soda is better for the body because it keeps sugar levels lower and the body in general does better when the sugar levels are lower. So avoid the junk food (hence the name-JUNK)

For women on birth control, there are birth control pills that are better for your acne such as Yasmin and Ortho Tri Cyclen lo. Use those instead of the others.

Also, if you have alot of facial hair, really think about laser hair removal. It will help your acne out tremendously! The best thing to do for acne, is come in and have someone take a look at your skin and get you on a skin care program that works for you!

Spots and Scars-What to do?

Wellness Doc — Mon, 05 Feb 2007 00:09:28 GMT

Most people can relate to spots and scars which can occur anywhere on the body. Spots and scars are due to any injury on the skin. It can be from acne, sun damage, an infection (such as a boil, severe dry skin from eczema, psoriasis), skin conditions that causes ulcerations and patches, bug bites, ingrown hairs, picking at the skin, etc. There are so many reasons I can't list them all but you get the picture. The skin got hurt and it left a mark. This happens because when the skin is injured, cells that provide color in our skin the melanocytes become too active and lay down extra pigment. If you have very fair skin, it will look red to light brown. If you have more olive to light brown complexion, it will look light to dark brown. If you have more brown to black skin, it will look more brown to black but darker than your normal skin color always. The medical terminology for this is post inflammatory hyper pigmentation (PIH).

It is important to understand what caused the spot or scar in the first place to understand what treatment is the best. The most important thing to do is stop the injury from occurring in the first place. If it is from acne, we need to treat the acne. For more information on that refer to the acne blog. If it is dry skin or ulcerations, the cause of this needs to addressed and the skin needs to be intact before any other treatment can be started. The most common cause for spots is usually from sun damage and from acne scarring.

What I do for this is start on good skin care products. We need to use products that will exfoliate the skin and lighten the spots/scars. Two items that will exfoliate the skin are alpha hydroxy acids and retinols. The skin cycle which is the renewal of new skin that matures and comes up to the surface of the skin to be sloughed off is 6 weeks long. As we age, the percentage of skin that turns over or exfoliates every cycle begins to diminish. When we are young, most of our skin exfoliates every 6 weeks leaving healthy, glowy skin. As we begin to age or if we have skin problems, this process slows down leaving more dull, irritated skin.

Alpha hydroxy products expedite the exfoliation process to keep the skin looking healthier and younger. Retinols penetrate deeper to exfoliate and if used for over one year with consistency, can actually correct any damaged DNA to leave the skin looking radiant. It does take one year of use at 0.1% strength to achieve this. The typical prescription is for 0.025% or 0.05% only. In fact, studies on transplant patients show a reduction in skin cancer using retinols at high strengths, so I am a firm believer in using Retinols for not only problem skin, but for wrinkle correction and prevention as well as for the prevention of skin cancer. (No, it will not protect you if you continue to be a sun worshipper!) . Using exfoliation products will cause lightening of the spots/scars over time. This does take about 6-9 months to see the results with products alone. Retin-A is contra-indicated in pregnant and breast feeding women.

I also use lightening creams/gel and Vitamin C. Lightening Gels/Creams are from Hydroquinone 4%, which is prescription strength to use two times daily to the affected area. If it is really bad, wait five minutes and reapply it in 5 minutes to get optimal results. Most people will need 3 months to see optimal results. Hydroquinone is contra-indicated in pregnant and breast feeding women.

I love using Vitamin C serum to brighten the skin and it helps prevent wrinkles! It is the only product out there that will do that. Vitamin C must be at the right pH, right molecular structure, and a clear serum for it to work well. There are many products that claim to do a great job but have no studies behind it. Skinceuticals and Obagi have great Vitamin C serums. I like Obagi better because you can use it on the eyes. The eyes are where everyone starts to age and for many of us, this is where dark circles from chronic sleep deprivation, genetics, etc begin. Vitamin C does not make these circles go away, but can soften and blend the color closer to your natural skin tone. I use Vitamin C daily around the eyes and 3 times per week to the full face. My patients always ask me if their oral Vitamin C will work. If you took 25 pills of 500mg of Vitamin C a day then maybe but the one to two pills that people take will not do it. Vitamin C stops free radicals from causing destruction to the skin. The skin does super saturate with it so you do not need to use it everyday, but many people do because they love the way their skin looks. It does take about 3 months to see good results with this as well.

For the treatments of spots and scars, it will depend on how long they have been there, are they indentations or pick marks deep in the skin, and any other conditions you may have. The longer they have been there, the deeper they are. If you have some superficial spots that have been there less than a few months, high strength chemical peels and aggressive medical dermabrasion may work for the face. For the rest of the body, I usually recommend lasers and microderm treatments because the skin is usually thicker and does not respond as quickly.

To understand how deep things are, let me tell you that for acne scarring and pits, that scar mark is about 800microns deep in the skin. The best laser out there penetrates about 150microns so that is why repeated treatments are necessary. Think about an indentation in the skin as a big pot hole in the skin. This pot hole is usually treated in three ways. It can be filled with something temporarily, the skin around it can come down so it looks less noticeable, or it can be filled with new collagen and elastin to be a more permanent solution.

To fill the scar, we can use a filler such as Restylane, Juvaderm, Radiesse or Sculptra. The first two last about 6 months and the latter two, last 1-2 years. You will need to return back to get this filled regularly just like the pot hole does every year. Option two is a resurfacing laser. This is a procedure that requires sedation and down time for a week to 3 weeks depending on how deep they went. The resurfacing laser removes all of the skin and lets new skin grow back. To go back to the pot hole analogy, the whole road around the pot hole got taken off and then it was slowly filled. It does not always fix the very deep scars because they do not get filled. It is rather the skin around it came down so it looks less obvious. The third option is a fractional resurfacing. This uses similar technology as the latter but there is only a weekend of down time and it actually fills the pot hole with new collagen and elastin. It does take time to get optimal results because the marks are deep.

For patients with spots secondary to sun damage-using an intense pulse light or the fractional resurfacing laser are two great options. Once again, the difference is how long has it been there and how deep is it. The deeper it is, the more treatments it requires and the better you will do with the one that penetrates deeper in the skin-the fractional resurfacing laser is my choice.

For scars that come from trauma-bug bites, boils, dry skin, etc, the resurfacing laser is our best treatment. But once again, using the skin care products is complementary to this and it will take time.

Spots and scars are a long topic and cover a lot of different problems. This I hope will at least provide you with some preliminary background to help you understand the choices out there and also to differentiate what people are just trying to sell to you. I really think a lot of my patients with bad scarring will try anything but not everything will work. The best thing to do is do your homework, go and talk to the specialist, see what they offer, see what results they have gotten, and have them answer all of your questions! Make an informed decision and give it a try. I really do think these treatments help soften and blend down spots and scare but people just have such unrealistic expectations of what will happen. It is important to understand that you will not achieve perfection as much as an improvement. [

Is there a role for Prevention, Wellness?

Wellness Doc — Mon, 05 Feb 2007 00:10:01 GMT

As a vascular surgeon, I am generally at the opposite end of the patient care cycle. That is, I see patients after all of the ravages of diet, behaviors and genetics have operated in concert to take their toll on an individual's health system. Common disorders that I see include carotid artery stenosis which may cause stroke in the undiagnosed and untreated state, kidney failure and its complications, aneurysmal change of the aorta and peripheral vascular disease which can cause one to have pain when ambulating and in its more severe form amputation of the leg. The most benign disorder that I treat is varicose vein formation, although in its severe form, this may lead to ulceration. If you want to see some pictures of these processes that Im describing or the operations to treat them, visit youtube.com/drkirkseytv.

Its quite striking that most of these diseases probably are preventable with the appropriate modification of ones diet and lifestyle behaviors. Obviously, one's genetic predisposition is static but the current analysis of the human genome will most certainly correct that in the future.

The disconnect lies in that period of life where all of destructive habits that we have show no outward consequences with regards to how they affect our body. Those are the adolescent thru mid-late thirties when we habitually abuse our bodies. By the time detectable disease is discovered because of symptoms, the deleterious affects are largely irreversible. We are then placed on a maintenance medication to treat this problem and so the cycle begins. If no one acknowledges that our poor diet or our associated weight gain are the inciting factors then we are doomed to be on a cascade of medications. At some point we'll be changed to the latest and greatest hypertensive agent or cholesterol medication. At all times we'll hold our breath with each FDA report that the pharmaceutical company has withdrawn another medication because of under-reported side affects.

If the government's investment in programs to alter our behavior at a young age were as substantial as the marketing, advertising and lobbying investments of the food industry and big pharmacia- I would probably be looking for a new job. But instead, I now see more and more people in there 30's with premature presentation of severe disease requiring life saving procedures such as leg artery bypass and carotid endarterectomy. It's very concerning.

Its somewhat of a commentary on the perverse consequences of the capitalistice structure of our society. If an individual or group creates a product or service then they have every right to sale and distribute that product or service to everyone. Our free market encourages the food industry to market directly to children and the obese with chips, ice cream , one dollar burgers and every other great tasting, fat-laiden product. Cigarettes with increasing levels of nicotine. And our pharmaceutical companies benefit tremendously from all of the chronic disorder, hypertension, cholesterol elevation, heart burn, anxiety, depression; that come from these detrimental habits. These is what I mean about the financial incentives within this perverse set of circumstances which allow each of these groups to flourish at the expense of our population at large.

The next time you speak with a group of your friends about illness, healthcare or doctors; ask them when is the last time their physician asked them to keep a dietary journal. When is the last time their physician talked about behaviors and diet for the length or their visit. Part of this was explained by a very compelling article in the medical journal, JAMA which showed that many physicians are embarrassed to counsel patients on these issues because many physicians themselves are overweight and many have poor dietary eating habits. I can tell you that prior to my epiphany, I was on the road to dietary ruin. Eating bagels for breakfast, a slice of pizza on the run for lunch and a late dinner to finish off the day. I felt that as long as I didnt gain weight, I was OK. You know the old skinny is healthy philosophy.

I encourage you to read this editorial and consider some of the ideas mentioned. You may agree or you may not. Chances are that you'll be somewhere in the middle. Upcoming articles will elaborate on each of these points. There is compelling evidence that something must change for our general population. One more thing. I'm sure that you recognize that many people are already well aware of this connection. And these issues do have some class, geographic and demographic components. It's my general impression that I see a lot more organic, health stores when I visit Santa Monica then when I visit Houston, Texas.

Optimal Performance through Optimal Health

Wellness Doc — Mon, 05 Feb 2007 00:10:21 GMT

Today is the inaugural blog presentation for Optimal Health Today. We'll focus on an integrated approach to Age Management, Preventive Medicine and Cosmetic Skincare Issues. A Look Good, Feel Great and Live Long philosophy. At Optimal Health Today, we believe that a complimentary approach to Anti-Aging with diet, nutrition, exercise, stress management and hormone optimization is the key to a sound quality of life. I don't believe that the combination of physical deterioration, mental decline and episodic depression are necessarily the inevitable consequences of aging. In fact, we all know of individuals, personal friends even who leave us wondering "Why does she/he have so much energy and vitality" conversely we know of those who time has not been so kind to.

As a physician, I always tell patients that there are 3 groups of individuals. On one extreme is the group of people who smoke, drink, don't exercise, eat terribly and live to the age of 90. Its my belief that this group probably has some genetic resistance and no environmental insult could change that...On the other end is the 20 year old woman with breast cancer or the 20 year old man with testicular cancer. Clearly this individual represents a person who was prone to some genetic mishap regardless of the environmental issues.
Most of us reside somewhere in the middle. Some underlying dormant genetic mishaps waiting to be activated by our diet, lack of exercise, smoking or chronic inflammation that accompanies many of mankinds chronic illnesses including diabetes, hypertension, many forms of cancer, coronary artery disease. Although we have seen daylight related to the discovery of the link between inflammation and these disorders, the degree of association and causality has not been completely elucidated.

I intentionally emphasize that there is a degree of connection between the physical and the spiritual in terms of the way individuals respond and cope with disease. Clearly, our ability to manage environmental change is a large part of disease response. Our perception of the circumstances surrounding illness, our ability to develop a strategy; a strategy which in some cases of untreatable disease or immutable circumstances may mean that we accept the conditions and adopt a "life experience, learning lesson mentality"

By introduction, I am a Board Certified vascular surgeon who at some point in my early career identified the global need for a change in the health and wellness principles of our population. By trade, I treat the most severe ravages of genetics, behavior and environment; many times with a life saving procedure www.youtube.com/drkirkseytv I felt compelled to address the more complex issue of how people end up in my office. With adolescent obesity and diabetes at epidemic rates, the solution is critical.

I invite you to return periodically for discussions that will range from light hearted to serious, superficial to soul-searching.