SPECIAL ISSUE
May 2021 Issue 122.4
The Art of Medicine: A Look into Regenerative Medicine with Dr. Ripu Arora Pg 01
Robert Bautista: Tackling Health Misinformation Pg 04
TOP DOCTORS OF THE WEEK
A Doctor's Perspective on the Heathcare System from a Hospital Bed with Dr. Amir Shalev Pg 08
Mental Fitness is Just as Important as Physical Fitness
Pg 14
Contents
01
04
08
14
01
04
The Art of Medicine: A Look into
System with Dr. Faisel Syed from ChenMed
Robert Bautista: Tackling Health
A Doctor's Perspective on the Heathcare System from a Hospital Bed with Dr. Amir
46
Mental Fitness is Just as Important as
50
5 Reasons You Might Be Feeling Cold All the Time
55
Physical Fitness
19
Ushering in Natural Medicine: An Interview with Charlie Piermarini
Shalev
14
Revolutionizing the American Healthcare
Arora
Misinformation
08
41
Regenerative Medicine with Dr. Ripu
A Discussion of Pain Management: The Past, The Present, and The Future
Healthcare In The Workplace With Everside Health
60
Dr. Kellie Stecher: Mental and Psychological Well-Being of Medical
23
Stories from the ER with Dr. Mark
Professionals in the Workplace
Bernardi
28
Dr. Mukesh Kumar - Everything YOU Need
64
Patients and Raising a Family? The Secret
to Know about Stem Cells and the FDA
34
Couch Potatoes Beware! Sedentary Lifestyle Accounts for 8% of Global Deaths
38
Empowering People to be Healthy and Happy: An Interview with Eva Vennari
WHAT'S INSIDE?
How is this Doctor Balancing Seeing is Telehealth!
70
Confessions of a Plastic Surgery Coach
73
Sharing In-Ear Headphones Is Just As Bad as Sharing Your Toothbrush... But Worse
Live in Luxury. Eric Stoller and his team are here to help you find the home, beachfront condo, building, or vacation house of your dreams!
Learn More
Issue 122.4.1
The Art of Medicine: A Look into Regenerative Medicine with Dr. Ripu By Victoria Cook Arora Dr.
Ripu
Arora
is
a
board-certified
pain
management anesthesiologist who has provided exceptional care to his patients for the last 30 years. He focuses in his practice, the Arora Pain Clinic, on Interventional Pain Management and Regenerative Medicine. Through these specialties, he can identify pain triggering mechanisms and target the best treatments for the best patient outcomes. “Our goal is to help the patient as a whole, to improve the quality of life and improve their functionality in life. Sometimes you cannot heal the patient 100%, but at least you can get the functionality back to normal or close to normal,” shared Dr. Arora.
Training to Serve Dr. Arora studied for his medical degree in India before traveling to England to undergo Orthopedic and Surgical training at hospitals in London and Manchester. He then moved to America to further his training in surgery at Baltimore, MD.
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01
Issue 122.4.1 Following this, Dr. Arora attended a residency in
As more patients seek more natural healing
Anesthesiology through Case Western University
methods, physicians need to be educated on how
and, in 2009, graduated with honors from the
they can include regenerative medicine into their
University of Irvine, California, with a master of
practice.
business administration in health care. “We want to stay true to the ethics behind He is an active life member of the American
regulations. We want to make sure that those
Society of Interventional Pain Physicians (ASIPP).
practicing regenerative medicines understand its
He serves on the board of directors as the
limitations
president
regulations,” Arora said.
of
the
California
Society
of
Interventional Pain Physicians (CalSIPP).
and
that
we
must
follow
FDA
Regenerative Medicine as the Art of Medicine After experiencing firsthand the capabilities of regenerative medicine, Arora has delved into its study and is currently offering it with great success to his patients. “I had my own experience with it, so that’s helped me a lot to believe in it. And if you believe in
Expansion of Regenerative Medicine Arora shared that last year CalSIPP surveyed its members, asking what the physicians wanted to learn the most. The number one answer was regenerative medicine. In answer to this desire, the organization put together honest educational resources
to
help
physicians
increase
their
understanding. “The most important thing is to educate the community and additionally the physicians and the different providers on what is available,” Arora said. “The right type of education is vital, especially without doing any sales pitches or false advertisements. There is also the importance of changing the mindset.”
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something and you have a personal experience, then it’s easier to offer it to somebody with confidence,” he said. Arora’s genuine passion for his patients and their success is evident. One of his favorite patient stories is of an engineer with a crushed hand who managed to make a recovery and remove his pain altogether.
Issue Issue 122.4.1 122.1.1
He was able to hold his child for the first time and went on to get a job as an electrical engineer. Arora described the outcome from regenerative therapy as very rewarding. He sees regenerative medicine as a non-invasive way to help people heal and manage their pain. “My feeling is that regenerative medicine is going to be the art of medicine, which everybody will be utilizing in the years to come,” Arora said. If you would like to learn more about Dr. Ripu Arora, you can visit him at his website. He has various resources on Regenerative Medicine available for members.
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TOP DOCTORS OF THE WEEK
Issue 122.4.2
Robert Bautista: Tackling Health Misinformation The coronavirus disease 2019 (COVID-19) hits the United States—and the rest of the world, like a storm,
in
early
2020.
Within
that
period,
governments of different countries had to issue strict precautionary measures to break the chain of infection and deaths. Countries like China limited viral spread by enforcing early and thorough lockdowns, other countries, including the United States, France, Italy, and Spain, were heavily hit. At the time of writing, the pandemic accounts for at least 135 million infections and about 3 million deaths
globally.
Because
of
the
confusion
surrounding the advent of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), a
novel
coronavirus
that
triggers
COVID-19,
misinformation about the virus, its origins, and successful prevention and treatment methods spread rapidly. The World Health Organization (WHO)
developed
and
distributed
shareable
infographics that dispel unique misconceptions about COVID-19 as part of its campaign to spread scientific knowledge over misinformation. However, the
effectiveness
of
health
agency
websites
intended to refute misconceptions has produced inconsistent findings in research.
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|
04
Issue Issue122.4.2 122.1.1 Dr. Robert Bautista, who is presently doing his postdoctoral fellowship at The University of Texas at Austin's School of Information, is no slouch when tackling health misinformation on social media. Dr. Bautista has always been interested in public health, leading him to take a master's program in public health. He then realized that information and communications technologies have a crucial role in promoting public health, leading him to take a Ph.D. in communication science at Nanyang Technological University in Singapore. Over the years, he has done various research on how technology, ranging from smartphones to social media,
influences
the
work
of
healthcare
professionals in the field. "I got into this field when I was collecting data in the Philippines for my Ph.D. thesis. I observed that nurses used their smartphones to communicate and pass vital information to their coworkers and their patients. To some extent, patients may ask nurses with health information and, in some cases, these questions relate to health misinformation found on the Internet." After completing my Ph.D., I applied for fellowships that would allow me to start research on health misinformation. Fortunately, I was granted the Bullard Research Fellowship by UT Austin's
School
of
Information.
Currently,
my
research focuses on how healthcare professionals correct health misinformation on social media." Initially, Dr. Bautista's research did not focus on COVID-19; however, he had to rethink his priorities with it being a pandemic. 'There was much misinformation surrounding COVID-19, like how the virus spreads, how the virus started, and what medications will help in treating COVID-19."
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Issue Issue122.4.2 122.1.1 On the effect of the pandemic on his research, "The Pandemic affected my research. I couldn't interview key healthcare professionals in person due to social distancing measures. So all interviews had to be done online via Zoom or Skype. Initially, the interviews were challenging because they were not face-to-face; I quickly got into the groove because the
technology
provided
the
convenience
of
collecting data at home. That also meant not having to travel at all for research, and that reduced my risk of having COVID."
Trends Set by the Pandemic "Although COVID-19 has its consequences," said Dr. Bautista, "there are also some silver linings that occurred throughout my research. For example, researchers became more innovative and explored other avenues of data collection. The key benefits include greater adherence to safety measures, lesser travel time, and the availability of many participants to communicate online since most are at home."
Are the Trends Here to Stay? "Yes, they will." He says. "Until the country reaches herd immunity and daily cases are much lower." But we suspect that the world is prepared to communicate intimately beyond herd immunity without much physical contact. In December, the CEO of Twitter and Slack told all employees of both companies that they can work remotely forever. Dr. Bautista insists that "We will still have to stick to this kind of setup for the next two years." The delay in reaching herd immunity is because of logistical challenges
(low
vaccine
supply
and
poor
distribution), resulting in the delay of vaccinating adults. Besides, vaccine trials for individuals under the age of 16 are still in progress and may take about a year before completion. PAGE
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Issue Issue122.4.2 122.1.1
The Misinformation Surrounding Vaccination Dr. Bautista is "hopeful that trials reach completion by the end of the year regarding child vaccination. As a result, those under the age of 16 can receive the vaccine in December, similar to what happened in 2020." "The main challenge is the expected hesitancy from parents. It would always be an issue if some children who can think for themselves want to get vaccinated, but the parents are hesitant. Enrollment into vaccine trials for children has also been tougher than enrollment for adults because you need parents' permission. Parents are much more anxious to subject their children to clinical trials. The time needed to conduct trials for children is longer when compared to adults, and hesitancy often comes from misinformation. Some adults do not want the vaccine because they think it's a death trap. However, COVID vaccines "greatly reduce your chance of being severely hospitalized and dying from COVID." "We're using science to combat COVID-19 through vaccines. We use science to explore other worlds like Mars, and that's because of science, and in the future, we can set our feet on Mars." "Eventually, with vaccines, we can reach herd immunity to the extent that people will not die from COVID." Dr. Bautista says.
We understand the negative implications of misinformation and how it can lead to social distress. With social media, spreading fake news and unverified claims is easy. During the heat of the global pandemic, absurd news and claims were fabricated and spread. Many people kicked against some of the guidelines released by the WHO, and some organizations, and even governments, were quick to justify recklessness towards the pandemic using unverified data sources. "Did China deliberately orchestrate the spread of COVID19? Does chloroquine effectively cure the virus? Must you always wear a face mask and use a hand sanitizer?" Many fingers wagged at China; some doctors and reputable politicians claimed that chloroquine could help defeat the virus; others claimed that face masks and sanitizers were a waste of investment in the campaign against the pandemic. Where do you get your news? When you spread fake news, you fuel a system that can lead to property damage and deaths. So always think and verify before you share information on social media.
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07
Issue 122.4.3
A DOCTOR'S PERSPECTIVE ON THE HEALTHCARE SYSTEM FROM A HOSPITAL BED WITH DR. AMIR SHALEV By OYALOLA M. LATEEF The United States healthcare system is regarded as the best and the most innovative in the world. Aside from the billions of dollars invested in health and medical research, pockets of excellence are visible
across
the
fragmented
country.
and
Nonetheless,
complicated
the
healthcare
marketplace created a system that is antithetical to its global reputation. A stunning reality of the healthcare
system
is
that
the
finances
and
resources do not translate to better access to care, coordination,
and
affordability.
The
increasing
complexity of care, care fragmentation, increasing burden of chronic diseases, limitations of outcomes measurement, limitation of evidence for the care provided,
and
lack
of
transparency
in
both
performance and cost are a few of the challenges physicians and patients alike face daily. Healthcare providers dedicated to providing the best care for every patient put in their best effort, ensuring that each patient receives care efficiently.
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Issue Issue122.4.3 122.1.1 However, complicated insurance coverage, political landscape,
consumer
preference,
and
current
socioeconomic structure through health policy decisions
about
funding,
regulations,
and
reimbursements affect organizations and delivery of care in a way that limits healthcare provider's options. Health care has been an important topic of debate in the United States throughout the last decade. As different political parties hold different viewpoints regarding how to run the system properly, each side attempts to create legislation reflecting their political ideology. Stakeholders like insurance and pharmaceutical
industries
prey
on
these
inconsistencies by spending millions of dollars lobbying to influence potential reforms. As a result, establishing long-term solutions to our health care system failed to materialize. Sadly,
the
brunt
is
generally
felt
across
all
demographics and occupations. After a lengthy monologue, Dr. Amir Shalev lamented to Top Doctor Magazine during an interview: "Your pain is out of proportion. There is nothing else we could do." Dr. Shalev, who is also a doctor, listened in disbelief while a physician discharged him in excruciating pain. Even though he has dedicated his life to providing care to patients, he quickly realized the dangerous lapses in the healthcare system when the tables are turned. Dr. Amir Shalev is a podiatrist specializing in diabetic
foot
care
in
Las
Vegas
providing
comprehensive medical care for a broad spectrum of foot and ankle conditions.
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09
Issue Issue122.4.3 122.1.1 Even as a health provider, Dr. Shalev had a fair share of the lapses in the healthcare system when his ulcerative colitis became worse. "So often I'd have a flare-up and would go on steroids or spend a few days in the hospital, and then I would go into remission." In 2019, he requested to see pain management but was denied. In May 2020, Dr. Shalev, who was immunocompromised and trying to avoid going to the ER, contacted his GI doctor, who started him on steroids again. "When my condition got worse, they gave me all the pain medications I needed. When I went to one hospital, all they did was a CT scan. They gave me pain management injection and fluids, and after five days, they repeated it, told me my pain was out of proportion and sent me home." Dr. Shalev complained. Since the right hand does not know what the left hand is doing, Dr. Shalev disclosed that the healthcare system might become appalling unless we see a drastic change. "When I was discharged in pain, I perforated at home. The next day, my colon ruptured. I went to my GI five days later, and he took one look at me, wheeled me to the OR for emergency surgery, where they took out 95% of my colon. He told me if I was 24hrs later, I probably wouldn’t be able to come; I would be dead." While describing physician's complicity in the problem, the Nevada-based doctor noted that patients also play a part in the problem, making it difficult for doctors to do their job. Dr. Shalev, who was a patient a few times, describes his experience when
he
was
receiving
care.
"When
I
had
emergency surgery, I was in the ICU for five days, and I have nerve tuber been in the ICU.
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10
Issue Issue122.4.3 122.1.1 I had what is termed ICU delirium, an acute fluctuating
disturbance
of
consciousness
and
cognition common to patients." Speaking further on his experience as a patient, Dr. Shalev described how he pulled out everything attached to his body, including the NG, which made him bleed. "When they got everything back in me, they restrained me, tied me down, and I still pulled everything out. I did not cooperate with them until after the third night when my wife stayed with me to calm me down." The healthcare system in the US has a trifecta of high cost, below-average outcomes, and unequal access
compared
countries.
Some
to of
other the
highly
factors
developed creating
a
downstream effect in the healthcare system were created by the health insurance industry. During the interview, Dr. Shalev criticized the insurance companies leeching off the hardworking Americans and creating severe health challenges. "Part of the problem is the way the fixed schedule gets reduced every year. This kind of forces doctors to see more patients to make ends meet, pay off student loans, and couple that with Medicare decreases because they
want
to
force
Medicare
guidelines
on
physicians." Dr. Shalev said. For example, Dr. Shalev continued, "…in Vegas, Medicaid did not cover podiatrist services for 2018. So, if some Medicaid patients needed podiatrist services, they had to pay cash." Now, Medicaid does cover podiatry, but many doctors still won’t see Medicaid patients even though they are the population that needs it most. "I know some practices that will never see them. If you only have a 15-minute time slot and you have someone else who triples the pay, you will definitely go to the other patient. I may start picking my patients too. Right or wrong, unfortunately, that is what the
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Issue Issue122.4.3 122.1.1 insurance companies are forcing podiatrists to do." Dr. Shalev informed. The federal government influences the health care system by creating reforms to improve quality and value in the healthcare industry. By establishing Medicare and Medicaid, it ensures access to insurance coverage for most of the population. Additionally, multiple pieces of legislation were created
over
the
years
expanding
federal
healthcare programs, including the Affordable Care Act (ACA) of 2010. As the role of government expanded, multiple initiatives were created. Overall, progress has eluded the health care system.
Dr. Shalev provided a perspective regarding the influence the government has on the health care system. "There are a lot of things out there that are not known or used because they are not familiar to us but are available in other advanced countries. Sadly, we have different government entities that are involved, which should not be part of the equation, but unfortunately, it is."
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Issue Issue122.4.3 122.1.1 For example, Dr. Shalev continued, "stem cells regenerative medicine became more legal or more mainstream in the last 5 to 8 years because the government allows things to be studied and done. Although it's been done in Europe for over 30 years, it's new to us." Going forward, Dr. Shalev told us that he might be forced to ask what insurance a patient has before seeing them. "My goal is to do the best for the patient, hopefully, their insurance covers it, but if they don't, there is not much I can do, but I try to work with them to find a cheaper cash alternative." Dr. Shalev believes that patient care comes first before money, "but I have always liked doing the right thing so that I can sleep at night," he concluded.
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Life Style You work hard. Here are some ways your fellow medical professionals are playing hard too. Acquire the lifestyle of your dreams.
Issue 122.4.4
Mental Fitness is Just as Important as By Joseph P. Smalley Physical Fitness Going to the gym, home workouts, and doing yoga often come up, among others, when talking about health. After all, physical fitness helps reduce the risk
of
various
ailments
like
diabetes
and
cardiovascular disease while also helping manage one’s weight. Treating physical fitness as an integral part of one’s well-being is extremely important in staying healthy, but why is mental fitness rarely given the same priority? Mental fitness is often overlooked but should be valued just as much as physical fitness. Maintaining mental
fitness
means
taking
care
of
one’s
emotional, psychological, and social well-being. This ensures that one’s ability to cope with everyday stress and maintain good relationships with others is improved as time goes on. Here, you’ll find the benefits and some tips for improving
mental
health,
along
importance of doing so in the first place.
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with
the
Issue Issue122.4.4 122.1.1
Why Should You Care about Mental Health? The stigma around mental health has prevented many from communicating with others and seeking help for their troubles. Although much of this stigma is now being addressed in mainstream media, mental health remains an issue requiring more support in awareness and policy campaigns. Here are some reasons why we must treat mental health with the same importance as physical health:
1. Body and mind connection Research has proven that having mental health issues can cause one’s physical health to suffer. For example,
those
suffering
from
depression
or
chronic anxiety may have trouble sleeping and eating properly, thus risking their physical health. Also, having little to no physical exercise can double the risk of having dementia or depression.
2. Mental illness can affect one’s family Some mental illnesses such as bipolar disorder and major depression tend to run in families and affect generations. This genetic risk can lead to children suffering
from
a
greater
risk
of
abuse
and
emotional-behavioral issues as they grow up.
3. Unaddressed mental health issues may be dangerous Unaddressed mental illnesses are a global public concern
brought
on
by
factors
such
as
inaccessibility to mental health resources, lack of funds to avail health services, and the stigma that stops people from seeking treatment. Whatever the case, untreated mental illnesses may lead to dangers such as increased rates of suicide, loss of productivity, and reduced life expectancy.
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Issue Issue122.4.4 122.1.1
If you need advice on how to improve your mental fitness, here are some tips from health professionals that may help:
Tips for Mental Fitness 1. Meditation People often use a variety of stress relief techniques depending on the skills or hobbies they have. One of the most common techniques is mindfulness meditation. This activity helps reduce stress and lower the risk of health issues like high blood pressure and anxiety. Giving your brain some time to recharge can also help you feel more relaxed and ready to take on the rest of your day.
2. Learn something new Learning a new skill or language activates different parts of your brain. Committing to learning leads to increased ability in memory, concentration, and multitasking. This allows you to finish tasks and make decisions with precision and clarity, thus enhancing your mental capacity even as you age.
3. Food for thought Different food can enhance the brain’s health just as much as it can enhance the body’s. It would help if you prioritized a healthy intake of fish oils, nuts, and flax seeds in your diet. It can help increase cognitive
function
necessary
for
maintaining
mental fitness.
If you’re still not sold on why mental fitness is just as necessary as physical fitness, here are some added benefits to prioritizing your mental well-being:
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Issue Issue122.4.4 122.1.1
Benefits of Mental Fitness 1. Mental exercise sharpens the mind A study conducted
by
researchers
from
the
University of Michigan found that mental activities, such as memory training exercises, can enhance one’s “fluid intelligence,” which involves reasoning and problem-solving skills. Various mental exercises also enhance concentration and focus as one age, such as learning a new language, picking up a new skill, or even dancing.
2. Learn effective stress management techniques Taking care of your mental well-being entails knowing how to cope with the stress of everyday life. Although moderate stress is often necessary, there are times when overwhelming stress must be dealt with to avoid serious harm to your mental and physical well-being. When you take steps to be mentally fit, you become better equipped to deal with stress and reduce anxiety, fear, irritability, anger, and more.
3. Improves socio-emotional behavior Engaging in mental and physical exercises allows you to enjoy clearer thinking and improved moods instead of periods of irritability and anxiety when one has deteriorating mental fitness. The ability to think clearly also leads to a greater sense of inner peace, which can be further tapped into through mindfulness meditation.
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Issue Issue122.4.4 122.1.1
Furthermore, when your mood and thinking improve, you can navigate social relationships without having to worry about risks of depression or lowered self-esteem.
1. Enhanced physical health As you take care of your body, you also commit to strengthening your mind. Achieving mental fitness through physical exercise helps limit and prevent pain and several diseases that come with aging. You can also enjoy better sleep, increased energy, and stronger resilience for physical and mental adversities.
2. Counseling benefits Those who have the resources to avail of counseling services find an increase in their self-esteem and self-acceptance
after
working
with
their
psychological counselors. This type of treatment allows for a better understanding of your mental health conditions and emotions, thus improving your emotion regulation skills and communication skills.
Take-away Message Whichever tip or advice you may find helpful, remember that taking care of your mind and body is a constant process. Take your time to figure out how you can best help yourself, and remember that you’re not alone in your struggles and healing. When you take the steps towards strengthening your physical and mental well-being, know that others are fighting alongside you as you try to live a healthier, longer, and happier life.
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Issue 122.4.5
Healthcare In The Workplace With By Kayla Schleining Everside Health Nobody shies away from admitting that healthcare is complicated. And it’s not just complicated for active patients, as healthcare providers, businesses, employees, and even governments can all testify to the complexities of our healthcare system. Amidst all
the
bureaucracy,
legalities,
compensations,
premiums, paperwork, economics, and tons more, it’s no wonder that things get bogged down. But Everside Health is determined to make healthcare more straightforward, more accessible, and all the more effective for people all over the United States. Dr. Gaurov Dayal, President and Chief Operating Officer of Everside, was eager to tell Top Doctor Magazine about how their direct primary care model is making healthcare better. “The essence of what we do is provide direct primary care to employers and employees,” he describes. “We work with self-funded employers who have their employees come to us. We don’t charge the employees anything; we provide unlimited access and unlimited primary care onsite that improves population health and lowers the total cost of care for the employer. We want to make the employees healthier and, ideally, more productive by not wasting time waiting to get to a doctor.”
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Issue Issue122.4.5 122.1.1 With physical sites in 32 states and a plan to
explains. “Have a persistent cough? Everside
launch 50 additional health centers later this year,
wants to help. Suffering from a sprained ankle?
Everside has already made an impact all over the
Come to Everside. Feeling unusual nausea? Yep,
country and shows no sign of stopping. When
Everside
talking about the services Everside offers, Dr.
nuisances may seem like no big deal, but
Dayal stresses the benefits of value-centered care.
sometimes these issues need more attention
is
ready.
These
seemingly
simple
than most think at first glance. These issues may be a signal that there needs to be a lifestyle change for better overall health maintenance. Our current theme is accessibility. We want patients to come to us for anything.” Dr. Dayal hopes that Everside can help set a precedent for the future of healthcare. By offering accessible, value-based help, Everside differs from the overall national perspective on healthy living “We hear a lot of stories from people who claim
and doctor treatment. In America, it’s not unusual
they went to see one of our nurse practitioners
for patients to put their own lives at risk to save
because they had something relatively minor, like
money.
a headache. Upon further review, however, they
ambulances, and skimping on medicine are a few
learned that their blood pressure was sky high
common ways that many people save money on
and they were immediately sent to the hospital to
healthcare. But these “money-savers” are often at
avoid a stroke,” says Dr. Dayal.
the cost of their well-being and, in some cases, at
Avoiding
the
doctor,
not
calling
the cost of their lives. Dr. Dayal notes that this He believes that the best form of healthcare is
significant flaw is rampant within the American
preventive, meaning that patients shouldn’t have
healthcare system. Good healthcare has gotten so
to wait until the last moment to receive medical
expensive that Americans will risk their lives over
help. ”The goal of preventive care is to avoid those
it.
dramatic, just-in-time care diagnoses because they shouldn't happen in the first place,” adds Dr. Dayal. “We impact lives every single day: helping people avoid strokes, obesity, depression, and other chronic problems. That’s what we’re doing. We’re not selling anything magic. We’re selling ongoing, continuous care within a great network.” Everside wants to care for employees no matter the ailment. “If you have good primary care, you don’t need a magic bullet later on,” Dr. Dayal
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Issue Issue122.4.5 122.1.1
The flaws of the American healthcare system have especially been spotlighted during the COVID-19 crisis. While COVID has forced doctors to advance their technology, it’s in some ways a zero-sum game. “Easy access to primary care is a big problem, “says Dr. Dayal. “Even though virtual care has been accelerated by maybe 10 years because of COVID, we have to be cautious. We have to make sure primary care is being administered in person.”
Another benefit to virtual care is that it allows for better patient-doctor connection. “By using virtual, you get better access to the patient and, thus, better care,” explains Dr. Dayal. ”It’s convenient and patients tend to prefer it. They might not immediately go to their doctor for something seemingly minor – say, a stomach ache – but will be far more likely to pick up their phones and schedule a virtual appointment. If the doctor advises patients to go to the office after the virtual appointment, they will. Ultimately, the patients get into the office, something they may not have done without the virtual accessibility.” COVID will eventually come and go, but the effects and consequences of this life-changing pandemic will not soon be forgotten. In talking about what lessons can be learned, Dr. Dayal’s recommendation to America is simple: Education. “People need to understand what COVID is,” he says. “I think we should learn from our mistakes and we should not politicize a very public health and science issue. For example, if you wear a tight-fitting mask, COVID is reduced by 96%. whether people agree or disagree with that fact doesn't make it any less true.”
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Issue Issue122.4.5 122.1.1
Dr. Dayal notes that implementing educational efforts can be complicated. “I believe public health experts and physicians are critical in solving these problems. The problem is that they do not always think the exact same things. Everyone needs to remember that there is misinformation out there, some deliberate and some not. Even still, people have different approaches to the issue, and that’s okay. For example, I believe in vaccines, but I understand the perspective of those concerned. We need to be more open-minded and hear different opinions, using logic and making educated decisions.” Dr. Dayal stresses that the American people should be looking to their healthcare providers and scientific experts for guidance on how to address COVID. “We should not rely on politicians,” he reminds Top Doctor Magazine. “I think this goes back to the earlier point that this has become such a political issue. Let’s rally together against this horrible thing that has impacted us on a global scale. Let’s use common sense rather than just fighting over political beliefs.” Dr. Dayal hopes that the United States has learned from past mistakes and that the future of healthcare can rally around the people, the science, and the facts rather than money. For Everside, it comes down to a focus on value-based care.. By caring about its patients, the quality of their care, and the basic sentiment of caring for your neighbor, Everside is helping people live healthier lives. Dr. Dayal concludes, “If COVID has taught us nothing else, I hope it has brought us to the realization that we can and need to be better. We need to treat people where they are and provide access in ways that make healthcare accessible to everyone.”
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Issue 122.4.6
Stories from the ER with Dr. Mark By Ionuț Gabriel Raicea Bernardi About Dr. Mark Bernardi Dr. Mark Bernardi is an Emergency Room physician practicing in the Greater Seattle Area, WA. He began his studies at Cornell University with a degree in Human Biology, graduated from the University of California, San Diego School of Medicine, and completed his residency at the University of Arizona in 2018. Aside from his work in the emergency room, Dr. Bernardi, after completing research at the Harvard Institute of Medicine, took part in numerous other research programs as a coordinator. Furthermore, he took his expertise outside the American soil and in less-developed areas of the world, such as SubSaharan Africa.
The Harsh Reality of the COVID-19 Pandemic From a young age, Dr. Bernardi developed an interest in health care systems. He had a particular interest in the Canadian model, which offers universal health care to all its citizens. However, after deciding to undergo his studies and training in the U.S., Dr. Bernardi, who dreamed about joining Doctors Without Borders first, saw himself forced to jump right into the fray. From the start, he showed eagerness to learn more about COVID-19 and the different pathways that each state chose to tackle the pandemic. PAGE
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23
Issue Issue122.4.6 122.1.1 During his interview, Dr. Bernardi shared stories more appropriate for a dystopian novel rather than for the 21st-century U.S. healthcare system. From every single state where he worked, he reported what seemed to be chaos: hospitals in IL where nurses questioned the virus’s existence entirely, others who saw the mask more like a discardable accessory rather than a helpful tool, and hospitals in AZ that refused to front the resources for rapid testing willing to put the staff at risk, etc. “I don’t know exactly how other countries handled this, but I know that we didn’t handle it very well,” Dr. Bernardi admits.
In a search for the culprit, Dr. Bernardi points towards the U.S. health care system. The system turned the COVID-19 pandemic into a “survival of the fittest” type battleground, where everything from logistics to patient care hit constant bumps on the road. “Logistically, we couldn’t test in AZ for COVID, or the testing was so slow that we couldn’t transfer
patients.
“We
were
stuck
managing
patients in our emergency rooms for days when new patients should have been transferred out within a few hours.” Such shortcomings placed everyone in danger, especially those who pulled extra shifts due to staff shortage: “I, personally, had COVID twice.”
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24
Issue Issue122.4.6 122.1.1 “It wasn’t about people. It was about dollars.” The COVID-19 pandemic exposed more cracks in the fault line. With no centralized health care system,
big
monopolized
pharmaceutical and
divided
corporations the
COVID-19
battleground, putting dollar signs above patient care: “In America, the health care is all about money.” However, precisely when health care needed a sense of concord the most, these big corporations turned against one another, putting the vaccination campaign in jeopardy: “Some hospitals who weren’t able to rapid test for COVID didn’t because they lacked proper lab equipment. Because of a disconnected healthcare system this was especially burdensome for small towns with limited resources. In these towns, if one hospital had the proper equipment (lab or proper freezers to store COVID vaccines) and the other didn’t, unfortunately I did not see them sharing.”
With business driving COVID-19-relief efforts, this harsh reality led to corporate entities trying to supplement the dwindling patient numbers with job cuts. The result? Numerous doctors, some with 30-40 years of experience, were forced into retirement or lost their jobs or even their pensions. “Business is ruining U.S. health care, and I don’t know why no one’s talking about it,” Dr. Bernardi shares with Top Doctor Magazine.
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25
Issue Issue122.4.6 122.1.1 With such division and only personal goals in mind, it’s hard to believe in future change. For Dr. Bernardi, nothing but a universal health care system could prepare the country for the next pandemic. However, this highly politicized subject is not expected to become a palpable reality in the near future, Dr. Bernardi admits.
Turning Telemedicine into a Business As the COVID-19 pandemic kept patients indoors, numerous doctors turned towards telemedicine. Dr. Bernardi himself saw the advantages of a remote approach to patient care and decided to join two telemedicine companies when (quite ironic in a pandemic!) he knew his hours would be cut. “It’s providing access to care, which is good for patients who don’t have their physicians.” However, not all doctors shared in his enthusiasm. With no legislation that protects physicians from liability, telemedicine provided an ineffective backup plan to a struggling health care system. Furthermore, it wasn’t long before telemedicine companies saw the opportunity for extra revenue: “Overreaching with telemedicine to make a buck, which some of the telemedicine companies are doing, is inappropriate.” Dr. Bernardi disclosed to us several appalling examples of such inappropriate conduct: telemedicine companies who targeted people with anxiety issues to sell more antidepressants or doctors who prescribed Viagra to young adults who were in no need of such stimulants, etc. However, by far, the most shocking example is the following: “Another telemedicine company I was working for was selling COVID-19 tests. The COVID-19 tests are free!” For Dr. Bernardi, only strong legislation can make the difference between frauds and true telemedicine.
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26
Issue Issue122.4.6 122.1.1
What Does 2021 Have in Store for Dr. Bernardi? The perspective of a COVID-19-free year truly excites Dr. Bernardi. However, as he admits, two main concerns are troubling him: the difficulty of finding a stable job as an E.R. physician and the health care system's state after the pandemic. "I don't know if we've learned as much as we should have from this." We can only hope that Dr. Bernardi's vision for a stronger health care system will come to life before the next pandemic.
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27
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Issue 122.4.7
Dr. Mukesh Kumar - Everything YOU Need to Know about Stem Cells and the FDA About Dr. Mukesh Kumar Dr. Mukesh Kumar, PhD, RAC, is a Washington DCbased consultant in regulatory affairs and quality assurance for manufacturers and developers of pharma and biotech products. With more than 100 multinational clinical trials, Dr. Kumar is one of the world’s leading experts in pharmaceutical, biotech, and medical product development from early stage to commercial markets. He authors a popular Weekly Newsletter on FDA related issues, FDA Puran,
read
by
more
than
80,000
readers
worldwide. Academically,
Dr.
Kumar
holds
a
PhD
in
Biochemistry and is a visiting professor at George Washington University, Washington DC. Because of his world-renowned expertise in global regulatory affairs, Dr. Kumar has been an invited speaker at several professional and academic organizations worldwide.
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28
Issue Issue122.4.7 122.1.1
In the world of medicine and patient care, nothing, absolutely nothing is left to the gods of Fate. From the clinical trials under Investigational New Drug applications or INDs to dealing with the FDA, researchers and proponents face a journey similar to Odysseus’ Odyssey, a journey ridden with uncharted dangers and unsuspected plot changes. What it takes to find your way outside the labyrinth is finding the right guide. Enter Dr. Mukesh Kumar. Dr. Mukesh Kumar, one of the top FDA experts, has been
gaining
invaluable
experience
in
INDs
approvals for more than 20 years now, helping pharmaceutical
companies
develop
IND
applications and aligning these applications to FDA standards. With an average of approximately 10 to 15
successful
INDs
every
year,
Dr.
Kumar
comfortably sits at the top of the IND hierarchy with an unparalleled success rate. However,
Dr.
Kumar’s
work
extends
beyond
investigational new drugs, reaching a field of medicine that, with enough research, resources, and time, will probably bring patient care and medicine as a whole to a new level: STEM cells. With such exciting topics and an abundance of knowledge from Dr. Kumar, how does one choose between the two? The short and easy answer is, they do not! For that reason, let’s tune in to Dr. Kumar’s interview and learn more in the beginning about INDs and their approval process, continuing with how STEM cells work miracles into our bodies and how they represent the future of medicine.
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29
Issue Issue122.4.7 122.1.1
Learning from One’s Mistakes In a nutshell, the FDA describes investigational new drug applications as follows: "An Investigational New Drug Application (IND) is a request for authorization
from
Administration investigational
the
(FDA) drug
or
Food to
and
Drug
administer
biological
product
an to
humans." One can sense the burden and the level of responsibility falling upon FDA regulators right away, which is why the process of approving an IND is difficult, entails a heap of bureaucracy, and can take up to several months. "If you do your homework, if you prepare well, the process is pretty well defined. You know, it's not magic. It's just a lot of hard work that goes into these obligations, and people who do put in hard work, they do get, you know, positive results from the regulators." Dr. Kumar shares with Top Doctor Magazine. At the end of the day, doing one's homework and dealing with inevitable future mistakes are the way to bring an IND to fruition. "You want to find people with the right kind of experience, who've learned from their mistakes, who have dealt with the FDA many times. […]" Dr. Kumar shares with us in a more cheerful tone. "It's a pretty, well-defined, clear process if you know what you are doing." However, why do so many applications end up in failure? Dr. Kumar points out two main reasons. One,
lack
of
communication
between
the
proponents and the regulators sets the former months back on the application writing process. Two, the proponents do not listen to the regulators' concerns, which, in one particular case, cost one of Dr. Kumar's clients almost nine months before having their application accepted by the
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30
Issue Issue122.4.7 122.1.1 FDA. On the other hand, as long as one respects the regulator's requests and maintains constant communication with the latter, an IND can receive its approval in just a few weeks, a true example of efficacy. To learn more about IND applications, you can check out Dr. Kumar’s weekly video blog at www.FDAMap.com.
How Does an IND Go from Project to Reality? As an organization, the FDA’s mission is to protect the public for risky products, even those in clinical trials. As such, to become a reality, every IND must go through a rigorous, thoroughly objective FDA review process. FDA looks through every aspect of an IND, from the design of the study to its ethics, to the validity of the scientific questions being asked in the trial. FDA could have many questions for the clinical trial and may need the trial to be revised to make it safer. In addition to the FDA, independent review boards or IRBs also review a clinical trial plan to make sure it is not unreasonably risky for the volunteers who will participate in the planned trial. At the end of the review process, both the FDA and the IRB have to approve the clinical trial before the trial can be started. Once the clinical trial is started both the FDA and IRB require periodic updates to stay on top of the trial. At any time a trial approval can be suspended if there are concerns about the conduct of the trial or new safety issues.
101 STEM Cell Course with Dr. Kumar Aside from bringing INDs to reality, Dr. Kumar turns his knowledge and interest towards a definitely more exciting, more engaging, more futuristic field of medicine, and that's the field of STEM cells. We all have a vague idea of what these miracle-working cells are supposed to do, but can we be so sure of our knowledge? To dispel any mystery, Dr. Kumar took a few moments to explain where these STEM cells are located in our bodies and how they work their magic.
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31
Issue Issue122.4.7 122.1.1 The first word(s) that must come to mind when talking about STEM cells is the stromal vascular fraction or SVF. Briefly, when physicians remove fatty tissue, either through liposuction or through other means, from the body, this fatty tissue contains many blood vessels, and the walls of these blood vessels are lined with STEM cells! The STEM cells arrive at the injury site using the blood vessels as means of transportation for maintenance work and repairs. The speed with which these cells travel to the injury site depends mostly upon age: the younger we are, the feistier the STEM cells are! However, as we age, STEM cells take longer to reach the body areas in need, allowing injuries to pile up gradually.
Are All STEM Cells the Same? Not at all, according to Dr. Kumar. On the contrary, STEM cells differentiate from one another through the range, locality, and ability to convert. First off, we
have
the
STEM
cell
"quarterbacks,"
the
mesenchymal stromal cells, or MSCs. Traveling through the blood vessels, MSCs can repair any defect in the body. However, their extended range deprives them of a significant portion of their strength, which is why they act as a support structure for the more potent, more localized cells, called semi-differentiated STEM cells. This "offensive line" of cells resides in every organ, with the ability to convert into the cells found in the same tissue. As such, liver STEM cells will replicate only other liver cells, hematopoietic STEM cells can only convert into blood cells, and so forth. Regardless of their range and ability to convert, STEM cells are the body's best means of keeping itself free from injuries.
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32
Issue Issue122.4.7 122.1.1 For that reason, Dr. Kumar pays close attention to anything STEM-cell-related: research, journal articles, you name it. Furthermore, he's working on his own SVF IND approval, to which other doctors can contribute as investigators as well.
The Importance of STEM-Cell Banking in Future Research Once the STEM cells are extracted from the tissue, the next and vital step is to conserve them in the appropriate habitat. That's when STEM cell banks come to the rescue. In cold temperatures (-196 degrees Celsius), STEM cells can be deposited for years, keeping their quality intact. Since such special conditions are necessary for STEM cells to survive, physicians must store them in specialized laboratories where they can be kept away from contaminations and loss of quality. Furthermore, the FDA has taken additional steps to prevent unwanted accidents related to, for example, contaminations with toxins. As such, from June 1 onwards, the new FDA regulations will only allow physicians to make use of STEM cells in IND settings and for specific procedures. Patients who aim to get such procedures would either need to enrol in clinical trials or pursue these treatments in other countries where they are legally available.
What's Next for STEM Cells? "You know, we are at the cusp of many, many inventions coming in the next five years." With a very optimistic tone, Dr. Kumar sees STEM cells as the future of the next generation's findings in medicine. For that reason, as a parting reminder, he advises us to keep working towards raising awareness and storing STEM cells dedicated to research and patient care. Patients should explore banking their own stem cells for future use. There are few options to bank your stem cells for future use. If you would like to learn more about Dr. Kumar's work, make sure that you check out the following website.
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Issue 122.4.8
Couch Potatoes Beware! Sedentary Lifestyle Accounts for 8% of Global Deaths From diseases to short life span, physical inactivity has become one of the leading causes of death globally. Prolonged non-active physical behavior promotes increased high blood pressure, type-2 diabetes, stroke, heart disease, and different kinds of cancers. It may sound disturbing, but, as of now, sedentary behavior is the cause of 8% of deaths across the globe. On the surface, a sedentary lifestyle may sound appealing, but it comes with many strings attached.
COVID-19 and Lack of Exercise Yes, people with inactive physical lifestyles have a high chance of hospitalization. In fact, a study confirms that COVID-19 in patients who indulge in sedentary habits is more likely to be fatal. The AFP report also highlights that the lack of exercise is associated with severe COVID-19 symptoms. Researchers had made it clear that many non-communicable diseases boil down to the sedentary lifestyle even before the pandemic crisis. And apart from high blood pressure, an inactive physical lifestyle increases the chances of dementia by 8%.
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34
Issue Issue122.4.8 122.1.1
Sedentary Behavior: Geographic Outlook Officially, the American National Heart, Lung, and Blood Institute views 150 minutes or less sedentary behavior as physical inactivity. Ironically, individuals from rich and developed nations are 2x times more likely to suffer from a major disease due to physical inactivity. However, individuals from middle-income nations are at high risk of sedentary behavior due to large populations. What’s disheartening is that more than 70% of heart disease fatalities are related to physical inactivity worldwide. According to Peter Katzmarzyk’s research, Caribbean countries, Asian Pacific nations, and Latin America bear the burden of most fatalities from prolonged physical inactivity. Peter Katzmarzyk’s published research in the British Journal of Medicine also highlights the collective reasoning behind sedentary behavior.
The Need for More Awareness and Advocacy There is an urgent need to advocate for issues that stem from physical inactivity. It means that a mainstream approach to raise awareness about the natural consequences of sedentary behavior across the globe should be implemented. The same study also mentions that the lowest sedentary rates are in Southeast Asia and Sub-Saharan Africa.
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35
Issue Issue122.4.8 122.1.1
High Obesity Rate in America Remember that the highest obesity rate is in the United States, which calls for more mental health and fitness initiatives to reduce sedentary behavior. Another study characterizes the cause-and-effect of physical inactivity for a long time. Ultimately, it mentions that sedentary behavior as a public health crisis deserves attention on a global scale. The reality dictates an international collaboration that would help devise, implement, and streamline public health objectives.
Global Initiative Matters A few years ago, the World Health Organization decided to bring down the global physical inactivity levels by at least 15% by 2030. But there is a need for more grass-root level initiatives that can decrease the total number of individuals with inactive physical behavior around the world. After all, the active physical drive of at least five years reduces the risk of fatal diseases by 44%. Regular exercise makes it possible to prevent common diseases. An active physical routine is now a recognized way to avoid diseases such as type-2 diabetes and colon cancer.
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36
Issue Issue122.4.8 122.1.1
Recommended Physical Activity According to the British Journal of Sports Medicine, an adult should take up moderate exercise for at least 30 minutes 5 times a week. Scientifically, this moderate exercise is equivalent to 3-6 METs, and ideally coincides with disease prevention. On average, trials from the study highlight additional benefits to undertaking at least 30 minutes of exercise daily. Individuals can also take 10-15 minutes of exercise at a time to reach the 30 minutes mark. But healthcare professionals and fitness experts insist that people need more motivation in the digital age to take up an exercise routine. As the pandemic managed to force the vast majority of the global population indoors, it is even more crucial to undertake various physical exercises. In fact, COVID-19 is the main reason why medical professionals concur there might be an increased number of sedentary individuals worldwide.
Final Thoughts Although there are various economic and cultural factors, international cooperation is the key to bring down the high number of inactive individuals throughout the world. The pressure of capitalist society and modern living are not easy. But most studies hint towards an immediate response to mobilize and mitigate a severe public health crisis. PAGE
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Issue 122.4.9
Empowering People to be Healthy and Happy: An Interview with Eva Vennari By Victoria Cook Eva Vennari is no stranger to ongoing health problems. As a little girl, she went to various doctors who would attempt to diagnose her properly, but to no avail. After experiencing a draining career that led to burnout, Vennari realized that she wanted no - needed real change. That place of burnout propelled Vennari to where she is today: a CEO and founder of The Elevate Institute,LLC, an organization focused on health and energization. Vennari is a certified Nutritional Counselor in Mineral Balancing and Hair Mineral Analysis
and
has
certifications
for
Personal
Nutrition, Chakra Healing, and Akashic Record Reading. Vennari's enlightenment came at 3 a.m. as she was fighting insomnia. She decided to look online for any illnesses that met her symptoms and came across an article on mineral balancing. Mineral balancing is about utilizing nutrition (minerals) to remove toxins from the body. On further research, Vennari decided to try mineral balancing on herself, and her symptoms were alleviated entirely. For the first time in a while, she felt better. PAGE
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Issue Issue122.4.9 122.1.1
A Practitioner in Nutritional Health Her physical change inspired Vennari to become a practitioner in nutritional health. At first, she intended to provide help to herself and family, but the loss of someone close made her realize she could help people beyond her family. She began her business, The Elevate Institute, shortly after. Elevate offers education and a program for those wanting to pinpoint their nutritional imbalances. Different from bloodwork, Vennari
takes
hair
samples
to
analyze
the
relationships between minerals.
"I affectionately call the hair analysis report the trash report because it captures what is leftover at the end of the body's rejuvenation process," Vennari said. "We're just tapping into the body's natural healing processes by watching how it prioritizes what you eat, drink, and breathe in. And then it makes more you and spits out the rest into soft tissue, which is your hair." This analysis balanced with a holistic approach to pinpointing stresses helps Vennari walk her clients through a path of regaining their energy and living life to their fullest. PAGE
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Issue Issue122.4.9 122.1.1
Lasting Change and Real Empowerment One such client was a father depressed, unable to work and be a partner in h is marriage. He was unable to eat, or enjoy anything and had severe anxiety. With the help of Vennari's program, he gradually came to a healthy place emotionally and physically. The change to his nutrition ultimately boosted his energy and restored his confidence along with establishing new boundaries. His wife and some of his children then also went through the program to reach a place of wellness. "When you start taking supplements, and you're paying attention to yourself, that is a form of self-love. Sometimes that's the only first step a person can afford to make in their emotional place," Vennari said. "When you give your body more energy, it frees your mind and emotional space to open up, and you're allowed to process things that you haven't been able to." Stress is one of the biggest inhibitors to people absorbing the minerals they need, so Vennari works with her clients to set healthy boundaries and meditative practices that help with mental and emotional health. Helping each client be aligned holistically is how Vennari empowers people to be happy and healthy. But Vennari recognizes that there is no cure-all for each person. Health, in many ways, is a process, and she, above all, encourages discernment and discipline in pursuing the answer to a healthy life. "The answer is unique to each of us just as our thumbprints," Eva Vennari said. "The foundation to knowing the secret of your life is that you have to put the work in to find out what makes you happy and then make sure you do it."
Want to know more about Eva Vennari? You can find The Elevate Institute here, and you can listen to her podcast "When Doctors Say 'We Don't Know'" here.
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Issue 122.4.10
Revolutionizing the American Healthcare System with Dr. Faisel By Yuko Tabasa Syed from ChenMed About Dr. Faisel Syed Dr. Faisel Syed, MD, earned his medical degree from the Iberoamerican University in Santo Domingo, Dominican Republic. He completed his
residency
at
the
Columbus
Regional
Medical Center in Georgia and became a board-certified
family
medicine
physician.
From then on, he has dedicated his time to serving the Tampa community with top-notch primary care.
Fueled by his passion for providing healthcare for the underserved, Dr. Syed decided to join ChenMed,
a
physician-led,
family-oriented
primary care organization dedicated to serving seniors in low-income areas. He is now the National Director of Primary Care for the organization and continues to advocate for holistic medicine and a healthy lifestyle.
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Issue Issue122.4.10 122.1.2
ChenMed’s Value-Based Care Model Dr. Syed takes great pride in working with ChenMed. What makes it so unique is that it operates on a full cost, value-based care model committed to giving seniors VIP care. In other words, they take 100% responsibility for their patient’s care, and assume 100% of the cost. Both patients and doctors no longer have to worry about billing fees. Such an approach contrasts with other healthcare systems that follow a fee-for-service model, which means there is a transaction for every healthcare visit. The problem with a fee-for-service model is that doctors are forced to become more focused on filing documentation for billing their patients and less on giving them care. In ChenMed, doctors have a team that takes care of all the paperwork, leaving the doctor focused solely on providing outstanding care to their patients. That is also why ChenMed has a smaller panel size of about 400 patients per doctor. Most doctors in America see about 2000 patients per year. Since their focus is on quality over quantity, ChenMed can build a solid and lasting doctor-patient relationship, the heart of good primary care.
The Number One Cause of Bankruptcy in America Did you know that the number one cause of bankruptcy in America is medical billing? Why? Dr. Syed spills the secrets of hospital administrations and how they’re sucking your wallet dry. Here’s the truth: “People are getting bankrupted by bills from emergency room visits.” Dr. Syed shared a personal experience of a time when he was rushed to the ER for pneumonia. He was charged $10,000 for treatments consisting of X-rays, EKGs, saline, Tylenol, and many other tests. And now here comes the crazy part, Dr. Syed said that when he told his colleagues about it at ChenMed, they told him this: “What they did for you in the emergency room would have cost us $7 in the outpatient setting.” Ridiculous, right?
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Issue Issue122.4.10 122.1.2
Is Your Healthcare Money Going to Waste? The cost of healthcare in America today for people over the age of 65 has surpassed 1 trillion dollars, and that is only for 45 million out of a 330 million population. When you look at such statistics, it makes you wonder where all that money is going. Dr. Syed brings the spotlight to medical waste described here as unnecessary procedures and visits to the hospital. “As of last year, we crossed the $1 trillion dollar mark for medically unnecessary procedures,” he said. The top cause for medical waste is unnecessary hospitalizations which are fueled by unnecessary emergency room visits. Most of them do not depend upon medical assistance, and the same care could have easily been done in an outpatient setting at a cheaper cost, just like Dr. Syed’s experience. But because emergency room visits cost more than outpatient settings, hospitals continue to promote this practice as they earn more from it. The
second
cause
of
medical
waste
is
unnecessary specialist visits. Dr. Syed shares his father’s first-hand experience of being sent to multiple specialists by his previous healthcare provider without having a true purpose of doing so. When Dr. Syed’s father finally decided to switch to a ChenMed physician, he found that the cure to all his problems was just a change of mattress. This simple and inexpensive solution improved Mr. Syed’s back pain and memory loss and his overall quality of life without being prescribed dozens of drugs - which brings us to the third leading cause of medical waste.
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Issue Issue122.4.10 122.1.2 Overprescribing brand-name drugs when generic drugs are just as effective also contributes to the incredible amount of medical waste. Moreover, the overprescription of medication is not as effective as prevention, which we will discuss a little more in-depth next.
Prevention Is Better Than Cure There is a saying that goes, “When you’re young, you sacrifice your health for wealth. And when you’re old, you spend all that wealth on health.” This is especially true for Americans,” Dr. Syed points out. “The thing is, Americans do not receive adequate education on living a healthy lifestyle. People run on this mentality that they wait for a problem to arise and then fix it instead of focusing on prevention.” Healthcare systems are doing little about that because they are focused on generating revenue by billing. And the sicker patients become, the more revenue they can generate. “So it’s really not healthcare. Truly, the system we have in place is the sick care system,” Dr. Syed conveys to Top Doctor Magazine. In ChenMed, Dr. Syed says they are centered around prevention and enhancing the quality of life for their patients and their doctors. They even go so far as providing a wellness program for their doctors and limiting their work capacity. They believe that a healthy and well-rested doctor will serve a patient with much better care, which is the ultimate goal of ChenMed. A happy doctor equals a healthy patient.
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Issue Issue122.4.10 122.1.2
Seniors Love TeleHealth Since ChenMed treats seniors, the most exposed population at risk for COVID-19, they did everything to keep them safe. Their new pursuit was to keep patients healthy, happy, and at home. To do this, ChenMed moved to telehealth, and their patients loved it. It even strengthened the doctor-patient bond because the doctors are spending hours of virtual face time with their patients and getting a virtual glimpse of seniors in their homes. They even went to the extent of providing groceries for their patients who were unable to go outside. Talk about going the extra mile! ChenMed’s success through quality service is proven in their recently published study of a 40% reduced mortality rate based on the healthcare system they use.
Conclusion Even though this model only makes up for 1% of the healthcare systems in America, ChenMed is dead set on its goal to become the country’s leading primary care provider. ChenMed is on track to open 500 more new locations in the next five years devoted to giving affordable, compassionate, and human-centered care to medically underserved communities. “We are leading this primary care revolution,” Dr. Syed announced, and Top Doctor Magazine is here to cheer them along for the ride. PAGE
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Issue 122.4.11
Ushering in Natural Medicine: An Interview with Charlie Piermarini By Victoria Cook and Brianna Connors
Devil's lettuce, weed, pot - all of these names are associated with recreational marijuana and often carry unhelpful negative stigmas associated
with
medical
cannabis.
Enter
Charlie Piermarini . Piermarini
actively
promotes
holistic
education and healthcare utilizing natural medicine,
focusing
on
medical
CBD
(cannabidiol). He is a PA, co-founder of The Healing Joint and Integrative Medicine, and founder of Restorative CBD. He has three Masters in Physiology, Public Health, and Physician Assistant Sciences. Piermarini remembers what he first thought of
marijuana
medicinal
before
benefits
of
learning
about
marijuana's
the
cousin,
hemp. "I thought people were just trying to get high," he said. "They [medical schools] don't
teach
us
anything
about
the
endocannabinoid system, so I researched it and started learning what I could."
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Issue Issue 122.4.11 122.1.3
Integrative Medicine The Western approach to medicine, Piermarini found, was limiting. It focused on solving a specific problem instead of looking at the body and its issues as interconnected and fluid. His research, coupled with mentorship from Dr. Jyotiy Patel, inspired Piermarini to expand into integrative medicine. "She instilled in me that you have to look at the patient as a whole. For example, you can't just give diabetic people Metformin and talk about glipizide and send them on their way," Piermarini said. Instead of just prescribing medicine for an ailment, he also talks with his patients about their lifestyle choices what they are eating, how they are exercising, and other related questions.
"We've talked about high dose, 20,000-milligram vitamin C IVs and supplements, doing micronutrient testing
and
testing
functional
pathways
for
deficiencies in vitamins and micronutrients, and keeping you on a good regimen," he said. "People are searching these things out. So I kind of want to meet patients where, you know, where they needed to be met." Piermarini pointed out that some medications may not work on a patient because they are vitamin and nutrient deficient. Focusing on the health of their gut and that they are synthesizing their intake properly, Piermarini believes, gets to the root of many patients' health problems.
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Issue Issue 122.4.11 122.1.3
Improving Health with CBD Cannabis and CBD provide unique opportunities for improving patients' health because they can act as stimulants to the brain. "We have a whole system in our body that is made to just respond to plant-like molecules like cannabis," Piermarini said. "There's a lot of healing properties behind cannabis." According to Piermarini, cannabis has zero overdose deaths. "There are no receptors on your brain stem that will suppress your breathing, unlike opioids," he explained. Cannabis affects the brain and helps increase energy production. It also has shown to be a suitable replacement for opioids because it helps rewire the brain's neural pathways and doesn't pose the overdose risk.
Piermarini also offers a more controlled environment for patients to try cannabis as a natural alternative to their ailments. In integrative medicine, medications and dosages are tailored to the patient's needs and then tailored again after monitoring the first-round results. This involved process can reap better results, as all of a person's health variables are considered. "It's
more
of
a
collaborative
authoritative one," he said.
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effort
than
an
Issue Issue 122.4.11 122.1.3
Starting the Conversation Piermarini is a vocal advocate for CBD and natural medicine. He is a speaker for the USA CBD expo, Lucky Leaf Expo, and The CBD Expo and would have spoken at the World CBD Expo if not for CV-19. He continues to write and create resources for patients and doctors. He co-authored a review paper about how CBD works for pain management and was a lead author for a letter to the editor calling for more legitimate CBD products. He also finished his first book titled, "CBD Education From A Medical Professional”, to continue to help educate patients and other medical professionals about CBD. His book is available on Amazon and Kindle. When CV-19 affected his clinic, Piermarini took the opportunity to create an online course for medical professionals and laypeople to educate them about CBD, the endocannabinoid system, and the difference between cannabis and hemp. "I think it's a great place to at least get people up to speed and understand the vernacular and what the endocannabinoid system is," he said. Piermarini wants to educate people properly, especially since other resources on marijuana can fall to the extreme. "CBD is not a cure-all for everything," Piermarini stated. Currently, Piermarini is working with the Arizona state legislature to allow physician assistants to prescribe medical marijuana. "I'm working closely with a few legislators, and they just floated a bill right now for me to give all PAs and NPs the ability to recommend medical marijuana to our patients." The work has just begun for PA Charlie Piermarini, but he has a balanced view of the situation. More people are seeking natural alternatives to their medicine, and that's encouraging.
"Vaccines are great antibody therapies, but all these other medications we're doing are like Hail Mary's," Piermarini said. "If we were a society that prioritized primary prevention of disease, such as activity, eating a well-balanced diet, good supplements, getting good rest, I think we would have been in a little bit better of a situation." You can learn more about CBD and Piermarini's work here. If you are interested in learning more about CBD, here's our latest article, "Is a Recently Discovered Oil-Free CBD Technology the New Fountain of Wellness?". PAGE
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Issue 122.4.12
5 Reasons You Might Be Feeling Cold All the Time By Joseph P. Smalley
To feel cold when out in the cold is one thing, but feeling icy when other people nearby feel rather toasty hot is another. For women, the condition is not uncommon - partly due to physiology and partly due to susceptibility to factors promoting coldness. Concerning medical causes, it is not safe to be just
guessing.
Medical
conditions
need
checking and confirmation by a specialist. To unravel the cause of the problem, the specialist needs to know the patient's history and have him/her undergo a physical exam. Laboratory and imaging works are helpful as well. Reasons why some people constantly feel cold include (but not limited to):
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Issue Issue122.4.12 122.1.4
#1: Hypothyroidism Always being cold can be a telltale sign of slow metabolism due to a thyroid malfunction. In hypothyroidism, the malfunction is about this gland being unable to secrete enough thyroid hormone. Such a condition prevents the body from generating an adequate amount of heat. Accompanying signs include fatigue, dry skin, thinning hair, and cold hands and feet. About 4.5% of Americans suffer from this condition, which is more prevalent among women who have been pregnant recently and are 60 years old and above. A suspected thyroid problem needs checking by a physician to confirm a diagnosis using a blood test.
Hypothyroidism symptoms are not exclusive to this condition. Other conditions with the same symptoms include anemia and inefficient circulation. These conditions generally result in a low body temperature.
#2: Anemia Not having adequate levels of iron is another reason for being always cold. Iron helps the red blood cells carry oxygen throughout the body. Heat and energy production requires a sufficient supply of oxygen all the time. In some cases, it is not a deficiency in iron that is the culprit for developing anemia. The American Society of Hematology (ASH) explains that the condition may also result from the body's inability to produce enough red blood cells. It may also be that the body is destroying too many red blood cells or losing blood due to some conditions.
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Issue Issue122.4.12 122.1.4 Any of these causes lead to a lack of oxygen supply and poor circulation. In such a case, the patient receives less circulation to the limbs and feels cold in these parts, particularly in the hands and feet. Anemia's symptoms include: Chest pain Awareness of the heart beating Headache Dizziness Lack of energy Shortness of breath
#3: Too Low Body Mass Index (BMI) The healthy BMI range is between 18.5 and 24.9. A person who has a BMI of less than 18.5 falls within the underweight range. This low level of BMI can make that person feel chilly even in normal conditions. Being too underweight can mean a person is too thin and has not enough body fat to provide enough insulation against cold temperatures. Some people intentionally maintain a low BMI, and for them to do that, they reduce their food intake. It is worse if they are not eating much at all. Skimping on calories pushes the brake against metabolism, which reduces efficiency in producing enough energy and heat.
Also, if the weight loss stems from a lack of caloric consumption, it can cause a slowing down of metabolism and reduced efficiency in temperature regulation. Increasing healthy foods with lots of protein, carbohydrates, and fats may be the best solution to this problem.
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Issue Issue122.4.12 122.1.4
#4: Lack of Sleep Proper temperature regulation also relates to getting enough sleep. A person that does not get enough sleep may feel being constantly on ice. The reason has something to do with a mess that happens with the person's circadian rhythm due to disturbance in sleep patterns. As part of the system's normal processes during sleep, the body temperature drops while melatonin production increases. The circadian melatonin rhythm is associated with sleep rhythm. Aging, certain diseases (diabetic neuropathy, degeneration of the autonomic nervous system, Alzheimer's diseases, etc.), and drugs such as anti-inflammatory agents and beta-blockers eliminate melatonin production. If you suspect one of these conditions affects your sleep, talk to your doctor. He may consider prescribing a melatonin treatment. Melatonin is not a sedating substance. It has sleep-promoting effects similar to the natural physiological sequence people experience at night. Under the condition of insufficient sleep, the body thinks that there is a need to doze off. In such a condition, the circadian rhythm naturally lowers the body temperature, and the person can feel colder. Nonetheless, talk to your doctor to establish the root cause of why you do not get enough sleep. Getting enough sleep will help restore your body's natural thermostat to the right setting.
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Issue Issue122.4.12 122.1.4
#5: Being a Woman Being a woman makes a person also susceptible to the condition. Experts call it "the gendered condition." It means that the female body conserves heat better than the male body. The female body does it by directing and maintaining more blood flow to the larger organs (heart, brain, kidney, etc.). This tendency causes less blood flow to smaller and more distant organs such as the feet and the hands, leaving these parts in a woman feel colder than in a man. Other reasons to check for why you are feeling cold include: Dehydration: the water level in the plasma is low Lack of vitamin B12: like iron, vitamin B12 keeps the red blood cells healthy Diabetes: Diabetes can cause circulation issues Anxiety and panic attacks: cold sensations are common symptoms of anxiety Raynaud's disease: this disease makes blood flow go into a temporary spasm
Conclusion When feeling cold all the time, there is no reason to panic. Get to the root cause of the problem and remember: the usual cause of feeling cold all the time is just poor circulation. Feeling cold all the time is not something that should affect your general well-being. Nonetheless, your condition needs an assessment by an expert to know the root cause of your problem. Make sure that you consult your physician. He will run tests to determine whether it is anemia or a thyroid issue causing you to feel cold all the time. Get enough sleep and exercise to improve your circulation. Walking at any pace is a good form of exercise for people with such a problem. Walking, as a form of exercise, increases blood flow throughout the body. Massaging your fingers and toes can increase your body temperature as well.
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May 9 HAPPY MOTHER'S DAY ALL MONTH LONG
Issue 122.4.13
Pain Is No Match for This Doctor and Her Daughter A Special Mother's Day
Interview with Dr. Dawn Sparks
By Ionuț Raicea and Brianna Connors
Ever-growing societies ask for role models, for people who, as Plato would say, divert their vision from their own pond towards the larger world, who can instill hope in our souls, help us get through the day, and dream of a brighter tomorrow. In other words, all of us are looking for modern superheroes, whose heroic acts transpire through little daily deeds, always giving and asking nothing in return. And who is better to play this capeless part than mothers, who give birth, nurture, and watch us grow and prosper, and whose happiness is equivalent to ours? This is why our Top Doctor Magazine team wishes to dedicate this article to mothers, our capeless heroes, on this most special of days. As a token of appreciation, we would like to bring to the light the story of a true hero mother, whose drive, determination, and dedication to her objective let her reach unimaginable peaks in anesthesiology and
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Issue Issue122.4.13 122.1.4 pain management medicine, bringing sustainable solutions to the Hawaii community of pain management patients. As Dr. Dawn Sparks, a Case Western Reserve University, OH alumnus trained at the world-renowned Cleveland Clinic, told us during her interview, "If you really want something and you really put your mind to it, and you really put your heart and soul in it, you can pretty much produce anything that you want."
Dr. Sparks’ Early Steps into Medicine Starting from a young age, Dr. Sparks has sealed her connection with medicine. Following in her father's footsteps, who performed the first lung transplant in the state of Ohio at the Cleveland Clinic, Dr. Sparks immersed herself in the noble field of medicine and joined Case Western Reserve University, OH. Right from the start, she had to face people who saw only roadblocks down her path because she brought a miracle into the world at such a young age: "I had my daughter when I was still nineteen, and I had her on a Friday night and went back to school Monday morning." But where others saw impediments, Dr. Sparks saw her destined path: "I had this goal of becoming a doctor, and everybody said, this was going to stop me. And I was like, no, this is just part of my path."
Taking the Pain Management Path Looking back to those college years, Dr. Sparks still can't believe how she managed to attend medical school, work a demanding job, and raise her daughter at such a fragile age. "And then, during that time, I never stopped or thought that I wouldn't get into medical school or stop the pursuit." Her efforts were never in vain; she joined the anesthesiology department at the Cleveland Clinic, where Dr. John, one of her mentors, gifted the book called "Pain: The Fifth Vital Sign" to her. PAGE
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Issue Issue122.4.13 122.1.4 Inside, a message written in a dedication note was about to open her horizon towards a deeper understanding of pain: "Pain is the experience; suffering is the interpretation." Dr. Sparks shares with Top Doctor Magazine the way she understood those words: "And I just remember thinking, that was so profound because pain is super subjective and nobody understands it. So, many doctors just blow it off and just want to give it medication. I remember thinking there was a faulty issue with how we treated pain even early on and why weren't we addressing the source of it. We weren't treating the source. We weren't investigating why people had their pain and where the sources of pain were actually derived from. For that reason, Dr. Sparks took it upon herself to "solve that piece of the puzzle."
Being on the Patient’s Side It wasn't only mentorship but also her own life experience that shaped Dr. Sparks' towards pain management. She was involved in a terrible car accident before her daughter was born, out of which she miraculously escaped alive: "I was in a coma for four days. I was in the ICU. I had multiple surgeries. I broke all the bones from the left side of my face, both my wrists and my hands. I had to have my trachea resected, and my chin sewed to my chest." By means of this experience, Dr. Sparks learned how out-of-touch physicians were concerning pain medicine since they would prescribe fentanyl lollipops, something unimaginable to us, and other longacting drugs that, without surprise, drove patients towards addiction and crime. She even shared a story about a doctor in Minnesota who was killed by a pain medicine addict. "It's like, they're addicted, right? It's their drug; they go crazy." Unwilling to risk her and her daughter's safety over this matter, Dr. Sparks chose to roll with the Aloha spirit and relocate to Hawaii, where she has been living since 2015.
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Issue Issue122.4.13 122.1.4
Using the Aloha Spirit to Perfect Pain Management But the stories about endless pain management drug prescriptions are far past fentanyl lollipops. Today's technological advancements are seeing such a constant and speedy process that pain management can be "managed" through electronic devices. Nowadays, Dr. Sparks is an active promoter of neuromodulators, which she calls "pacemakers for pain." These devices intervene between the nerve signals and the brain, forbidding the former from ever reaching the latter. Dr. Sparks is more than grateful for being able to not only identify the source of pain but also see "what's going on psychologically, what's going on with your physical wellbeing and your energy levels and cause all of those things to contribute to pain." With both expertise and compassionate care, she performs true miracles on her patients, relieving them of pain while psychologically bringing them on their own two feet. "They're off their medication; they're able to move around, they're getting full-time jobs. You know, some of them had horrible foot pain, they couldn't even put on socks and shoes, some of them were in wheelchairs, and now they're walking!"
The Future of Pain Management Looking towards the future, Dr. Sparks brings the true pain management enthusiast that she is to the stage to bless us with her optimism. "The future is super bright, and I think because we have people in the world like Elon Musk and thinkers that are always striving to improve
the
realm
of
pain
management."
With
technology advancement promoters like Elon Musk's Neuralink, insurance programs such as Medicare ready to reimburse patients for neuromodulators, and a close pack of 5,500 pain management physicians in the U.S. alone, the sun will surely shine bright on pain management's horizon. In the meantime, as a parting reminder, Dr. Sparks would like to thank from the bottom of her heart all the physicians and medical personnel who braved the hardships of the COVID-19 pandemic one step at a time, encouraging them to stay resilient and keep up the hard work in this never-ending battle against the virus. "I think it's been a really hard time to be a physician
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Issue Issue122.4.13 122.1.4 and I just want to tell people, 'Don't give up, never ever give up.'" The Fates are not kind to every one of us, and some of us are constantly tested, constantly forced to break our own barriers to fulfill our purpose, our calling in life. And one of these people is Dr. Dawn Sparks, whose story truly deserves to stand as a model and an inexhaustible well of hope for those who recognize themselves in her story but require help to keep pushing forward. However, Dr. Sparks would not have become the accomplished model of today had she taken heed of all those negative voices that couldn't understand the beauty in being a young mother. Instead of being an overwhelming burden, her daughter always stood as her primary source of inspiration, or courage, of motivation, the one who always understood her struggles and comforted her in a time of need. Even today, Dr. Sparks' daughter, who works by her mother's side, uses small gestures to help her mother start her day on the right foot: "Now, she's working out of my office, and she'll put little notes sometimes on my computer when I'm having a really busy day, that'll say, 'You can do it.' 'You're doing a great job.' 'I love you.' 'I'm so proud of you,' little things like that make me realize now that she probably understands in a different way all of the stuff that I endured." If you would like to learn more about Dr. Sparks and her mission, make sure that you check out her website.
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Issue 122.4.14
Dr. Kellie Stecher: Mental and Psychological Well-Being of Medical Professionals in the Workplace The physical and psychological well-being of employees says quite a lot about a workplace. A workplace should promote their employees' general well-being by treating its mental and psychological aspects similar to the physical environment. Poor mental health not only affects the client but also hurts business income. Every business is different, from the employees to the stakeholders leading the organization, the size of the enterprise, the social climate that affects the community, to the external support the business uses. There is
no
one
"right
approach"
to
build
a
psychologically stable workplace. Due to this, Dr. Kellie Stecher started an organization specifically on mental health issues
in
the
medical
line.
"With
that
organization, we are trying to create a haven for anyone who takes care of patients. We are providing a free barrier, free access to mental health resources," says Dr. Stecher.
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Issue Issue122.4.14 122.1.4 "I always knew I wanted to be a physician. In college, I decided that I wanted to be an OB-GYN." She says. With experience in child delivery, "I have seen, firsthand, how much good a positive environment can do to people." Her first delivery support experience pushed her to do her residency in Grand Rapids. "I went there for residency and then from there decided to move back to Minnesota because my in-laws are here." Today, Dr. Stecher's work focuses on workplace harassment, stress, and mental health issues that medical students and residents face. It's a journey, a bold journey to reform the medical culture. "The trainees are the most vulnerable because of the loans. They often feel trapped. she says. "I wanted to make sure that we were advocating for them so that they have a safe learning environment."
On COVID-19 and Its Effect on Medical Trainees and Residents "Mental stress escalated with the rise in the COVID-19 pandemic." Dr. Stecher says. She created her organization, Patient Care Heroes, an organization set to help medical professionals and caregivers with emotional and psychological support. The organization also provides free access to mental health resources.
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Issue Issue122.4.14 122.1.4
Obstacles to Helping Medical Professionals with Mental Health Issues "One of the issues we have is each state is left to their own devices and has an entirely different physician license application and some of the applications are actually in conflict with the ADA— American Disability Act." Part of her mission is to "create new policies and fix the application processes and cultural acceptances that are toxic." She cited practical examples of harmful practices like the 'noncompete' that prevent people from leaving toxic and depressing workplaces. Mandatory Arbitration prevents justice when a healthcare worker is harassed or intimidated.
What Can Be Done? "Many things can be done to ensure a high quality of life for medical professionals." She argues. "Aside from the policy issues, this organization was created to ensure that we take care of ourselves and each other. We need some empathy. The stress of the pandemic increased suicide rate of physicians in the country." "We've always had issues with physician suicide rates, and I wanted to create a space where people didn't feel alone." She says. "My organization gives a
support
system
to
struggling
healthcare
professionals. We try to let them feel loved and supported—and yes, they can be vulnerable within our safe space."
The Organization: Its Growth, Successes, and Setbacks The organization took off in January. "I had been doing advocacy work, but the organization was my primary goal. I partnered with Goyal, an anesthesiologist, and CEO of Bob capital," said Dr. Stecher. "I have been working through grassroots efforts and local and national organizations and partnering with many institutions to ensure that we make substantial changes." While her network of organizations currently focuses on the effect of the pandemic on physicians' mental health, they also hope to create a growing community of people and physicians who will consistently push for better care for the mental health of physicians.
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Issue Issue122.4.14 122.1.4 On women in the healthcare industry, she laments the fewer women in leadership roles when compared to men. "We want to advocate for women internationally to find their voice in these systems so that we can create changes that we need." Achieving such heavy feats can only be achieved through incredible partnership, and Dr. Stecher already has plans to partner with the United Nations and people from different parts of the world on workplace safety, equality, and effective justice systems against harassment. On the high suicide rates, "The assistance should be rendered to the people feeling suicidal because it isn't affordable to lose any more physicians, nurses, or medical personnel. Without doing this, there would be severe consequences in the public healthcare system." "We've teamed up with some national organizations like Rexel Pharmaceuticals to help provide depression and substance abuse therapy at no cost to the medical community." Dr. Stecher says. Her work has already opened up spaces where people can efficiently work on their struggles in their spare time. Dr. Stecher is also part of the Minnesota mental health advocates. "Minnesota Mental Health Advocates is an organization that Shereen McConnell created, and she is a former nurse. So these issues are very near and dear to her heart." The organization has teamed up with various people because it is not just focused on aiding medical personnel; it attends to all groups of people. It has helped in getting medical resources for communities. Using some of these resources has opened up space where people can do things at their leisure and then work on some of the issues that they're struggling with. On her life journey and remarkable achievements, she says, "As cliché as it may sound, it's the delivery. There is joy in helping patients who have struggled with infertility get pregnant. The joy is immense when I get to deliver their amazing, beautiful babies. Being there with them through the whole journey is rewarding." She gave a final thought on the issue of mental health in the healthcare industry: "We've only started to understand the magnitude of these issues. I want to make sure that people know that they're not alone, build a communication bridge to them, and ensure that they have all the resources they need to fight and grow."
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Issue 122.4.15
How is this Doctor Balancing Seeing Patients and Raising a Family? The By Ionuț Raicea Secret is Telehealth! Dr. Lauralee Yalden is a Family Medicine physician currently residing in Englewood, NJ. She received her Bachelor's of Science with General Academic Honors from the University of Miami and her Doctor of Medicine from the Ross University School of Medicine, Dominica, West Indies. Dr. Yalden
pursued
a
Post-Doctoral
Research
Fellowship at Yale University School of Medicine, Department of Vascular Surgery, and finished her Residency
program
at
UHS/Wilson
Regional
Medical Center, Department of Family Medicine. Besides her solid training in both vascular surgery and
family
medicine,
Dr.
Yalden
has
been
advocating for the benefits of telehealth for several
years
now,
with
numerous
lectures,
presentations, and publications on this subject. Outside the clinic, Dr. Yalden is very fond of teaching and has been part of numerous higherlearning institutions, such as the State University of New York and Ross University School of Medicine.
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Issue Issue122.4.15 122.1.4 In her free time, she enjoys being a working mom, traveling and wandering around in new and old places, hiking in the national parks, gardening, cooking and baking gourmet meals for family and friends, reading, writing, and sketching in her journal.
Dr. Yalden’s Journey into Medicine Looking
back
towards
her
first
memories
surrounding the medicine field, Dr. Yalden shares some
powerful,
emotional
details
from
her
childhood. Her mother and father were diagnosed with cancer, which left an understandable mark on Dr. Yalden's childhood and teenage years. From such a fragile age, taking care of her parents within her limits became an everyday reality, a reality that shaped both her future career and vision towards patient care. "It's helped me a lot in all the work that I've had to do and given me a greater
understanding
families
go
through,
of
what
having
patients gone
and
through
something like that at such a young age. I think it's made me a better doctor." She shares with Top Doctor Magazine.
From Vascular Surgery to Family Medicine Throughout
her
medical
training,
Dr.
Yalden
showed an enthusiastic interest in operational surgery. With solid training in vascular surgery at Yale, she had the chance to work with the best in the field and immerse herself even more in her specialty field during training programs abroad.
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Issue Issue122.4.15 122.1.4 However, the Fates were sewing a different path for Dr. Yalden. As a woman who always intended to put family first, she decided to take a more suitable approach to her desired way of life, which is why she decided to devote herself to family medicine. “As a woman who wanted to be married and have kids I didn't think that surgery would be a good fit for me for the future, as much as I loved it, so I switched to family medicine." Dr. Yalden shares with Top Doctor Magazine.
Finding a Balance between Work and Family Life If there's any analogic trait that would best describe Dr. Yalden's professional life, by far, it would be her bee-like hardworking nature. While she resided in FL, Dr. Yalden took care of patients in her family medicine practice and community hospital, made house calls for hospice patients, taught classes and mentored medical students at a local university in the hospital her office, and worked within the Miami Veteran Affairs (VA) ER system. Not without immense joy she remembers her time spent with retired military personnel, learning all about their medical history and, most exciting, learning about their entire history in the military. However, as Dr. Yalden confesses, "After you have kids, it's hard to make a commitment to do all of these things." She decided to cut back her hours, considering her sincere desire to take care of the children's upbringing and education. However, in her quest, Dr. Yalden managed to find the right balance between work and family life, leaving her with enough time to raise her five and three-yearolds while continuing to practice family medicine.
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Issue Issue122.4.15 122.1.4
Going Over One’s Strength to Help a Patient Finding the perfect story patient seems to be difficult for Dr. Yalden; after all, innumerable patients have sought and received help from her. However, all of her stories have one common denominator, the drive to give her best when treating a patient, and no other story speaks more to this virtue (one of Dr. Yalden's many) than the story of a young man training for an endurance competition. After noticing some drops of blood in the young man's urine, Dr. Yalden thought it wise to investigate this further and get to the root of the matter. She was both thunderstruck at the sight of analysis results indicating cancer and happy to know that it could be cured, which is what eventually happened. Dr. Yalden remembers this story as if it were yesterday, bringing to light a beautiful example of thanksgiving from the patient's family: "I remember the day that he came in with his wife and his kids and everybody gave me a big kiss and hug, in tears and thankful for what I did to take
care
of
their
father.
It
was
very
overwhelming for me." For such stories and the opportunity to get to know numerous generations of the same family, Dr. Yalden appreciates her mission: "One of my great joys in my practice of family medicine: getting to know the whole family, parents, children, the grandparents, and everybody over time."
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Issue Issue122.4.15 122.1.4
Balancing Work and Family with Telehealth While many of us would believe that telehealth is a more recent construct, dating since the start of the COVID-19 pandemic, Dr. Yalden surprises us with the following statement: "I've been seeing patients online by telehealth for about nine years now." And Dr. Yalden doesn't hesitate to praise telehealth, which allowed her to start her own family, breastfeed her children, and spend real time with them. Aside from such familial advantages, Dr. Yalden points out more valuable advantages to caring for patients from afar. Aside from limiting the patient's exposure to COVID-19, telehealth represents a viable and safe guarantee to future consultations: "Patients are more compliant now than ever before because of the ease of the follow-up plan...patients can connect anytime from anywhere." With physicians available for follow-up consultations in a safe environment, there's no wonder why a growing number of patients have opted for telemedicine since the start of the pandemic.
Over the course of years, telehealth went through several metamorphoses, finding more efficient ways of consulting patients over the screen. However, this development was exacerbated by the COVID-19 pandemic, which turned telehealth into a more versatile approach to medicine: "We do some exams with some of the Tyto products, otoscopes, stethoscopes, and derma scopes that you can plug into your smartphone and do an exam of heart lungs and ear, skin, everything…. there's so much that you can do." After seeing and studying its benefits, Dr. Yalden believes that telehealth has become a major player in the field of medicine, a player that will shape its future for generations to come: "I definitely think it's here to stay. I don't think anybody's going back to the way it was, without using a lot of telehealth."
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Issue Issue122.4.15 122.1.4
Looking towards the Future through Dr. Yalden’s Lens We've had a pandemic that turned the world upside down, brought both the best and the worst from us, and made us look towards the future with skepticism. But what does Dr. Yalden think of the future? Aside from educating people on the subject of vaccination, she turns our attention towards more endemic issues plaguing our society, the racial issues: "I think probably in the United States, one of the issues that's concerning me the most is racial inequality." While no flick of a wand could bring an end to racial tensions in the U.S., Dr. Yalden sees empathy as the key component of this putative solution: "I don't know what the answer is, but I think racially, we need to do a better job of taking care of everybody no matter your race, background or affiliations, we all need to just to do our best to take care of the world. The world needs a lot of TLC (tender loving care)." In such troubled times, Dr. Yalden has found peace in her work and family, which she sees as her little blessings: "I feel like I'm pretty blessed. I'm pretty happy in my career right now as a working mom; I love my job. I really enjoy practicing online. I genuinely like the doctors, support staff and people that I work with, especially the patients and families I have the privilege of caring for. I love spending time with my kids. I've always been very happy in my practice; it really didn't matter what I was doing, but especially now as a physician practicing family medicine online from home I have the best of both worlds." As such, we at Top Doctor Magazine support her kind words and invite our readers to take the race of life a little bit slower, enjoying what lies in front of us and thinking less about what lies ahead.
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Issue 122.4.16
Confessions of a Plastic Surgery Coach Michelle Emmick has 20 years of experience in the aesthetic field. She has worked in the plastic surgery chain, including small practice and startup companies acquiring
plastic
surgery
practices.
Focusing
on
improving patient experience, Michelle has performed over 10,000 cosmetic consultations. She has trained over 3000 staff members, including doctors, front desk, and back-office staff. In her attempt to provide next-level patient experience through
virtual
education
and
support,
Michelle
Emmick co-founded MyCoachMD. As CEO, Michelle Emmick offers two primary services: educating and providing non-medical support to consumers interested in cosmetic procedures. Furthermore, Michelle Emmick is determined to make the process easy for patients and help uncover their aesthetics, all within their budget.
Plastic Surgery and Perspective "Even though plastic surgery has so many benefits, 70 percent of the people that call in for information will never set foot in the door because there are so many negative connotations out there, but we are trying to help people have a positive belief in what plastic surgery can do for them," said Michelle Emmick in an interview with Top Doctor Magazine. She is determined to answer people's questions in a way that eliminates all fear.
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Transitioning to Telemedicine: Technology and its Impact on Aesthetics Medicine Michelle Emmick explains that the virtual consultation has been a game-changer for the industry by allowing potential patients to get comfortable with the doctors right from the comfort of their homes. She revealed that the pandemic triggered a huge boom in the business. "More people were working from home, which caused less social interaction, and people spent more time on social media; this led to hypercriticism of somebody's appearance and triggered the need to look and feel better," added Michelle.
Pandemic and its Effect on the Cosmetic Field Michelle revealed that the lockdown triggered a selfie boom, and the filters on social media created hypersensitivity to people's image. Sadly, it also created negative self-esteem. There was just overall selfobsession, which surprised and triggered people's interest in cosmetic surgery. "For years, doctors have been rushed between visits, but the pandemic created an opportunity to space out appointments, giving them more time to create a better patient experience. Of course, there are many awful things about the virus, but we looked at the positives and continue to do what we can to change people's lives," said Michelle Emmick.
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Learning to Improve Patient Experience Michelle Emmick added that it is vital to educate people on procedures and services they can do for themselves. She emphasized that this is key to having an aesthetic procedure, and it is the best investment people can make for themselves. "I just always want to make sure that people are confident in their decisions too." If you would like to learn more about Michelle and her company, please visit her website: www.MyCoachMD.com Check out her best-selling book Blue-Collar Beauty: Confessions of a Plastic Surgery Coach here.
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Issue 122.4.17
Sharing In-Ear Headphones Is Just As Bad as Sharing Your Toothbrush... But Worse Sharing a pair of in-ear headphones sounds innocent, but it comes with long and lasting effects. It may sound gross, but using someone else’s earphones is not so different than sharing a toothbrush. Over the years, studies have managed to affirm and reaffirm that human ears are susceptible to bacteria. A comprehensive study proves that bacteria can grow at an exponential rate with the consistent use of earphones. Of course, no one is a fan of germs, and branded earphones allow people to experience music at its best. But the fact remains that in-ear headphones are a cause of bacterial growth. Of course, there are people with enough sense not to share their earbuds with just anyone. If you form a visual image of compressing bacteriacovered earbuds into both of your ears, that would be more than enough to give you a pause before sharing them with someone else.
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Wearing Earbuds If you wear earbuds for an extended period, expect a build-up of thick ear wax. Now, it won’t harm your ear, but it creates bacteria that can lead to more problems later on. Technically, when you decide to close both ear passageways for a long time, you’re covering the exit points.
And whether you wear earphones or use wireless earbuds, you’re blocking the natural ear discharge. As a result, heat is compressed due to the build-up of moisture and wax. The next time you think about whether or not sharing your earbuds is a good idea, think about the bacteria you might be swapping.
Summer Season Means More Bacteria Doctors concur that summer increases the chances of otitis externa. There is a good chance you may have heard of otitis externa as Swimmer’s Ear. The hot summer season causes more sweating, and that leads to more bacteria. From toilets and gas bumps to water fountains and handshakes, think twice before putting germ-infested earbuds in your ears. On average, using headphones for a straight hour increases the bacteria levels in the ears by 700%.
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Issue Issue122.4.17 122.1.4 Often, many missing variables such as Haemophilus influenzae and Streptococcus pneumoniae can lead to more bacteria in the ear. Of course, the use and quality of earphones differ from person to person. Still, “how” you store your earbuds can also make a huge difference.
How You Should Clean Your Ears When it comes to cleaning ears, you have to exercise caution and care. The fact is that anything you put in your ears is always a bad idea. Use fresh cotton swabs to remove ear wax without a rush. Interestingly, your ears can clean themselves on their own and don’t need special care until you start putting things in them. And contrary to naïve misconception, ear wax is not bacterial. In fact, it acts as an antibacterial filter for ears that wards off dust and dirt. Essentially, it works as trapping to prevent dust, dirt, or other harmful elements in the air from going deeper. When it comes to the health and hygiene of your ears, diet plays a crucial role. The best strategy is not to share your earphones at all, but that might not sound practical in this day and age. You may feel lazy, tired, or too busy to clean ears and earbuds, but think of the bacteria risk right away.
So, make sure to disinfect your earphones and clean off wax residue regularly. After that, use a small and dampened cotton ball to wipe down your earbuds with alcohol or disinfectant. As far as hearing goes, people tend to wear earbuds that create more noise than waves of pleasant sound. Noise-based hearing loss is more common than you think. In the U.S., one out of five teenagers experiences some hearing loss issue. In comparison, there is a 30% increase in hearing loss cases compared to two decades ago. Experts highlight that the rollout of new and advanced headphones is the leading cause of hearing loss among teenagers.
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Wrap Up Once you read enough about the bacteria earbuds contain, you may not even want to listen to music through in-ear headphones anymore. In layman’s terms, take a piece of advice from doctors and wipe down and clean your earbuds with 70% or more alcohol. After that, let your earbuds dry for a few minutes. In short, cleaning your earbuds before they fit in your ears is the best way to avoid bacteria.
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A Word from the Editors Top Doctor Magazine is a magazine from doctors for doctors and patients. We cover everything from cutting edge medical techniques and procedures to enterprising doctors, dentists, surgeon, naturopaths, chiropaths, orthodontists and more who are thought leaders within their own medical practice and changing the way we all experience medicine for the better. We wish to be your one-stop digest for inspiration by other professionals in your field who are making waves and setting trends and if you too are a trend-setter, reach out to us so that we can interview you for your own spotlight within an upcoming Top Doctor Magazine issue!
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