What are they?

Fine lines, wrinkles and folds are varying degrees of ridges or creases of a surface such as on fabric or skin.   They used to be considered a sign of wisdom and experience when present on the skin, and individuals with lines and wrinkles were respected members in their communities. Nowadays, most people would prefer not to have these visible reminders of the years, especially on the face.

What causes them?

Skin wrinkles, fine lines and folds are caused by a combination of factors that include the normal aging process, sun damage, habitual facial expressions, smoking, and heredity.

Who is more likely to get them?

Individuals with lighter skin coloring are more susceptible to sun damage when exposed to ultraviolent radiation from the sun.  In addition, other skin types whose occupation or recreational activities expose them to more of the sun’s rays are also at greater risk for developing wrinkles, lines and folds. Smoking inhibits the bodies’ normal ability to fight damage from ultraviolet rays, thus smokers with even the minimal amount of sun exposure will tend to develop more lines than a non-smoker with a similar history of sun exposure. Take home message:  individuals with excess exposure to ultraviolet radiation, either from natural sunlight or via tanning beds and those who smoke are at greater risk for developing wrinkles, lines and folds.  Luckily, these two risk factors are within each person’s control and things can be done to minimize skin changes from them.

What treatments are available?

Be aware that most over the counter products only claim to “minimize the appearance of fine lines” by varying degrees and do nothing to address the either the development of wrinkles or remove wrinkles that have already developed. There are a variety of medical skin care treatments and products that can help erase and reduce the development of wrinkles.  These include but are not limited to medical grade skin care products with Vitamin A, alpha-hydroxy acids, and anti-oxidants as well as chemical peels, microdermabrasion, Laser Photorejuvenation, Botox^® and dermal fillers.  For some individuals cosmetic surgery may be the answer to looking younger.

Let JAVĀNI Med Spa help Discover A New You for the Holidays!

For the average consumer, the word “investment” conjures up images of stock portfolios, homes and cars; not their health.  Without our health though, none of the others are possible. 

Why do we take our good health for granted?  We just assume for the most part that other than the occasional cold or strained muscle, we will be able to continue being healthy indefinitely.  Even if we already have a chronic illness such as hypertension or diabetes, many of us believe that just taking the prescribed medication will keep the risks of heart disease, stroke, etc. at bay.  Individuals who are overweight or obese or have very strong family histories for debilitating chronic illnesses, know logically that they should do something about their situation to improve their health, but procrastinate because there is always something more important to do today.  And well, let’s face it, starting that diet tomorrow or next week won’t hurt, right?  Problem is tomorrow and next week in most cases becomes next month, or next year or even the next decade and by then there is a lot of back pedaling to do to get regain lost health. Living a healthy lifestyle also does not provide the immediate gratification most of us need to continue engaging in activities such as exercise and eating right.  How many of us who are busy building our careers and raising our families take the time necessary to even see our doctors for preventative health evaluations and discussions?

 Unlike adolescents, adults do recognize their own mortality – yes, we will all die one day — but we don’t spend much time contemplating what would happen to us, our families and our lifestyle if we developed a chronic illness, lost our job, then our health insurance and had to file for personal bankruptcy.  Unfortunately, having worked in the Harris County Hospital District for almost 10 years, I saw this story play out hundreds of times.  Many of my patients were small business owners, engineers who had worked overseas for big companies and even nurses who worked in the Texas Medical Center alongside leading specialists.  They all led successful careers prior to developing complications from heart disease, diabetes or cancer.  These complications eventually kept them from continuing in their chosen profession.  Many of them lost their health insurance and became one of the 47 million people in the country without health insurance.

Good health is our greatest asset. With it, we are able to enjoy our life, our families and friends, experience travel and engage in activities that fulfill us.  Good health is also the best anti-depressant.  Chronic illness not only affects our physical health, but also our mental health.  It is estimated that about 1/3 of individuals with chronic illnesses have depression.

Hopefully by now many of you will be thinking about your health as an investment….the greatest investment you can ever make.  So ask yourself, is this investment worth the extra time and attention that a physician engaged in retainer medicine can provide?

Wonder whatever happened to the traditional physician-patient relationship?  In the world of third party payers, gatekeepers and declining reimbursements, the traditional Marcus Welby type physician-patient relationship most physicians aspired for as medical students and the relationship patients continue to desire has become part of our social and medical history. 

Most patients spend at least 30 minutes to 1 hour in the practice waiting room and then the exam room before being seen by their physician.  The average medical visit now lasts 10 minutes or less.  A phone call to the physician office for a medication refill or non-urgent question can take 2-3 days before being returned.  In some practices, it can take days before an appointment is available.  Is it no wonder so many retail health clinics are popping up all over the place as consumers want accessibility to health care when they are acutely ill?

What are some of the reasons for this?  More and more primary care physicians are required to see 20-30 patients per day to meet their practice overhead, are managing patient panels of 2500 to 3000 individuals, and spend hours each day in insurance paperwork and phone calls.  Fewer and fewer medical school graduates, with student loans nearing $100,000 at the time of graduation, are choosing primary care as a specialty for many of these reasons.  In addition, physician burnout is happening at an alarming rate, mainly in the specialties of Family Medicine, Internal Medicine and Pediatrics.  In a 2006 survey of primary care physicians by the physician recruitment firm Merritt Hawkins & Associates, only 1/3 of respondents reported that they would choose primary care specialties if they had their education and training to do over again.¹ 

Addressing this health care need is the concept of retainer medicine, also known as concierge medicine or boutique medicine.  Traditionally a service only the very wealthy could afford, the current models are more accessible to the average consumer.  Fees range from $1500 per year to as much as $20,000 depending upon the services offered and the age of the patient.  Each practice is unique in its offering, but the end result is a higher quality of service to members.  Physicians in this model are able to keep their panels significantly more manageable, anywhere from 200-600 patients.  This allows them ample opportunity to spend time with each patient, return phone calls and emails from patients, speak with specialists to be proactive in coordinating care, stay current with the ever expanding field of medicine, and really get to know their patients to  develop that ideal physician-patient relationship.

The question for consumers becomes, what is such an investment in their healthcare worth to them?

To be continued….

Does any of the below hit close to home?

1.     You are sick, but can’t get an appointment with your doctor until next week.  You’re thinking about walking into a clinic at the local CVS or HEB, but aren’t sure if this is the right thing to do.  After all they don’t know you from Adam.

 2.    You are due for your annual checkup and scheduled an appointment one month ago with your PCP.  Your appointment time is set for 1:30 pm, but that morning your boss says you need to be in a very important meeting at 3 pm.  From past experience, you know you’ll never get out of your doctor’s office until after 3 pm, because you will have to endure a 30 minute to 1 hour wait to be seen.  If you reschedule your appointment, it will take another month for availability.  Meanwhile you are running out of your blood pressure medication and the doctor’s office will not refill it until you are seen since it has been one year since your last visit.  What do you do?

 3.    You have a family history of diabetes.  Your doctor does routine blood work and calls you in for the results. He tells you that your results show that you are also diabetic, says you should follow an 1800 cal ADA diet and exercise.  He hands you a prescription for a diabetes medication and gives you hand outs to review.  You have a lot of questions, but the doctor seems distracted and gets up to leave the room telling you to follow-up in 3 months.

 4.    You are on a business trip out of town and get a bad cold.  You have to be on your game for the presentation to an important client, so you want to take some over the counter medicines for your symptoms, but do not know which ones can safely be taken with your prescription medicines.  You call your doctor for advice and leave a message with the nurse.  Your phone call is returned 24 hours later, but by now you are on your way back home, hoping you were able to still make a good impression on the client despite the fact that your head was in a fog.

 Does any of this sound familiar?  If it does you are not alone. 

 Declining reimbursements, increased amounts of paperwork and practice overhead have strained the doctor-patient relationship.  The average office visit in primary care now lasts 10 minutes or less. 

 Believe it or not there was a time when doctors had the time and energy to get to know there patients and their families and vice versa.  Now most patients have to select their physician from a provider book and hope that this physicians personality suites theirs.  Often enough patients may need to change their physician every couple of years as their insurance plans change or if their physician drops the insurance plan.

 As Dr. Steven Knope asks in his book Concierge Medicine, “Who Killed Marcus Welby, M.D.?” 

 To be continued……

October is the American Cancer Society’s Breast Cancer Awareness Month

Last week I wrote about the effects of chemotherapy on the skin.  Many cancer treatments require radiation therapy either with or without chemotherapy and can impact the skin as well.

Radiation therapy can affect the skin at the site of treatment.  Effects are usually not seen until about 3 weeks after treatment is started.  Reactions range from redness at the site of treatment, to darkening, itching, peeling, and occasionally blistering and superficial burns.  Severity of reactions increases with higher doses of radiation. Individuals who receive chemotherapy shortly before or during radiation treatments are more susceptible to skin reactions.  Virtually all skin reactions are temporary and can usually be managed with the use of skin emollients during the course of treatment.  Some individuals may require topical antibiotic or steroid medications.

Individuals with cancer should take extra special care of their skin before, during and after treatment.  This includes using emollients for dry skin, drinking plenty of water and protecting the skin from the ultraviolet rays of the sun.

October is the American Cancer Society’s Breast Cancer Awareness Month

Treatments for cancer can take a toll on the body including the skin.  Effects of chemotherapy treatments can range from slight skin irritations to skin flaking and rashes.  Many times these side effects can be controlled with medications and generally go away with cessation of the chemotherapy medications.

Chemotherapy hair loss is a common side effect of treatment.  Hair loss most commonly occurs on the scalp, but can include eyebrows, facial hair, and underarms as well as other areas.  Hair loss can range from slight thinning of the hair to complete loss and generally occurs from several days to weeks after the initiation of chemotherapy.  The good news is hair regrowth resumes within 8-12 weeks of cessation of treatment and but can take up to a year to completely return.  What can you do to try and minimize chemotherapy induced hair loss from the scalp?  Get your haircut in a shorter, attractive style suited for you.  Shorter hair tangles less and requires less hair brushing which can pull hair from the follicles.  Use a wide toothed comb or a brush with soft bristles. Avoid washing your hair more than 3 times per week as frequent washing dries the scalp and contributes to itching.  Avoid hot rollers, curling irons and flat irons as heat weakens the hair and can cause more scalp irritation. If you use a blow dryer, use it only on the cool setting.  Avoid hair care products with harsh chemicals such as ammonia, peroxide, bleach, etc.  Hair loss occurs while sleeping due to movement and rubbing of the head on pillows. Try sleeping on satin pillowcases to reduce friction.  

To support the fight against breast cancer, JAVANI Med Spa will match contributions made by clients to the American Cancer Society up to a maximum of $50 each.  Team JAVANI continues it’s support for the American Cancer Society and the fight against breast cancer by participating in the Fort Bend Pink Ladies Golf Tournament on October 27th at the Sugar Creek Country Club. 

Next week:  Radiation treatments and your skin

Our skin is the largest organ of our body. It is said that if the skin of a typical 150 lb adult male were stretched out flat, it would cover about 2 square yards and weigh about 9 pounds. Our skin encases the network of muscles, bones, nerves, blood vessels, and everything else inside our bodies. If you want to see what we would look like without our skin check out the Houston Museum of Natural Science exhibit Body Worlds 2 coming Sept. 12^th. 

Our skin also functions to serve as a physical barrier to the environment, allows for the elimination of waste and regulate body temperature.  Skin is the thinnest on our eyelids and lips and thickest on the soles of our feet.

 Hair and nails are modified types of skin. Hair grows everywhere on the human body except the palms of the hands, soles of the feet, eyelids, and lips (thank goodness). Hair grows more quickly in summer than winter, and more slowly at night than during the day.

Nails protect the sensitive tips of our fingers and toes. Human nails provide support for the tips of our fingers and toes, protect them from injury, and aid in picking up small objects. Imagine trying to scratch an itch or untie a tight knot without them.

Illnesses and nutritional deficiencies can affect the health of our hair and nails.  If you are having an unusual amount of hair loss or general thinning of the hair, see your health care professional who can determine if there is an underlying medical condition needing to be treated.  If your nails are brittle and break easily, this may be from nutritional deficiencies such as biotin, although this is rarely seen.  Discolored nails, pitting or clubbing of the nails can be signs of other medical conditions and should be evaluated by a physician.

Last week, I presented information on how nutrition impacts the health of our skin.  A balanced diet is essential for adequate nutrition and for the intake of macro and micronutrients.  However, even a balanced diet cannot provide the optimal doses of vitamins and minerals the body needs. 

Here are a few reasons why:

·         Vitamins are destroyed or inactivated during the cooking and storage of food

·         Certain diets, especially a diet high in processed foods, create a greater need for micronutrients

·         Water soluble vitamins must be replenished constantly as the body does not store them

·         Changes in the agricultural industry and harvesting techniques create shorter times that foods need to grow – thus  limiting the time they can absorb minerals from the earth

·         Full benefit may require larger doses than those found in dietary sources

Nutritional supplementation can help to fill the gap between what we consume and what our bodies need.  Many factors affect our need for micronutrients such as our age, genetics, chronic illnesses, and diet.  For example someone who is a vegan needs Vitamin B12 as this is derived only from animal sources or someone with a genetic variation that inhibits B12 absorption may need to supplement their diet.  All in all, each person has differences in how the body absorbs micronutrients and how effectively it uses them. 

Even subtle deficiencies in micronutrients have been shown to contribute to health problems such as difficulty with concentration, lack of energy, sleep disturbances and irritability.

More pronounced deficiencies can lead to vision problems (deficiency of vitamin A), osteoporosis (deficiency of Vitamin D & calcium), neurological damage (deficiency of B₁ and B₁₂), and birth defects (deficiency of folic acid).

Because the FDA does not regulate the manufacturing of nutritional supplements in the same fashion as medications, it is important to ensure the supplements you purchase are produced to pharmaceutical standards with the purity and quality of products and bioavailability (amount that is actually absorbed and available for use by the body) necessary to provide a positive effect on your overall health.  If you are unsure of what products to purchase, ask your health care provider for a recommendation.   New diagnostic tests, such as MyCellf and Spectracell are available now to help determine what your body needs and what levels of micronutrients are present in your cells.  When it comes to nutritional supplementation as in so many other things, there is not a ONE SIZE FITS ALL solution.

The old saying, “You are what you eat” holds true perhaps at no other time than now in our society.  The low cost and convenience of many fast food choices has shifted the dietary intake of a large portion of the US population.  Unfortunately, this has led to an obesity epidemic never before seen in the history of the world.  Not only do our nutritional choices affect us with regards to heart health, cholesterol and diabetes, they impact many other organ systems of our bodies. 

The skin’s health is intertwined with the health of the body; as the largest organ of the body, the skin is a reflection of our overall health.  Not only is it important to use good products on the skin, it is equally important to nourish the skin from the inside.  Even minor nutritional deficiencies can affect the health and appearance of the skin by impairing its ability to renew itself.  People who improve their dietary habits often find that their skin is more youthful looking with a smoothness, firmness, plumpness, elasticity and improved skin tone often seen in younger skin.

Nutrients important for healthy skin include antioxidants such as Vitamins A, C, E, Coenzyme Q10 and Alpha Lipoic Acid to fight aging due to free radical damage.  Other key micronutrients essential for healthy skin include minerals such as Copper, Selenium and Zinc and B – complex vitamins.  Omega-3 fatty acids help to improve dry skin, cracked nails and dull hair. 

Eating a well balanced diet with lots of fruits and vegetables, limited amounts of meats, oils, nuts and low fat dairy products helps to provide the skin with the nourishment it needs.  In addition, drinking plenty of water is a must for the skin to maintain hydration and be able to perform its basic functions.  

What are the safe-sun guidelines?

Safe-sun guidelines are the following 4 ways to protect your skin and reduce your risk of skin cancer:

1. Avoid the sun.

Sunlight damages your skin. The sun is strongest during the middle of the day, between 10 a.m. and 4 p.m. During these hours, the sun can do the most damage to your skin. Sunburns and suntans are signs that your skin has been damaged. The more damage the sun does to your skin, the more likely you are to get early wrinkles, skin cancer and other skin problems.

2. Put on sunscreen.

Use a sunscreen or sunblock with a sun protection factor (SPF) of at least 15, even on cloudy days. Use a lot of sunscreen and rub it in well (about one ounce). You should put the sunscreen on 30 minutes before you go into the sun. Put the sunscreen everywhere the sun’s rays might touch you, even on your ears and the back of your neck. Men should also put it on any bald areas on the top of their head. Put more sunscreen on every hour or so if you’re sweating or swimming.Remember that using sunscreen is just one part of a program to prevent skin cancer. To greatly lower your risk, you must follow all of the safe-sun guidelines.

3. Wear a wide-brimmed hat, protective clothing and sunglasses.

If you have to be out in the sun, cover up your skin. A wide-brimmed hat will help protect your face, neck and ears from the sun. A hat with a 6-inch brim all around is the best. Baseball caps don’t protect the back of your neck or the tops of your ears. Wear sunglasses to protect your eyes from the sun. Choose sunglasses that block both ultraviolet-A (UVA) and ultraviolet-B (UVB) rays. Sun exposure increases your risk of getting cataracts.Wear protective clothing, such as long-sleeved shirts and long pants made of tightly woven fabric. If the clothes fit loosely, you will feel cooler. Special sun-protective clothes are available from several companies, like Solumbra Sun Precautions.

4. Don’t try to get a tan.

Don’t use tanning salons. Tanning booths damage your skin just like real sunlight does. In fact the ultraviolet rays from tanning booths are 10-15 times as powerful as the sun (why do you think they call it the ten minute tan?)