Issue 124.1 by topdoctormagazine

July 2021 - Issue 124.1

The Bright Side of Medicine Pg 01

Should You Really Wear That Beauty Mask? Pg 08

Does COVID-19 Cause Skin Rashes? Pg 10

Meet the Godfather of Aesthetic Lasers Pg 04

Contents

05 04

13 01 The Bright Side of Medicine 04 Meet The Godfather of Aesthetic Lasers 08

Just Slap It On: Should You Really Wear That Beauty Mask?

Potential COVID-19 Symptom: Skin Rashes

Reprogrammed Immune Cells May Aid the Spread of Breast Cancer

WHAT'S INSIDE?

TOP DOCTORS OF THE WEEK

Issue 124.1.1

The Bright Side of Medicine: An Interview with Dr. Joshua Goldman About Joshua Goldman Dr. Goldman received his bachelor's degree with honors from Stanford University in biological sciences and a minor in philosophy. His core interests lie in medical education, the intersections of reconstruction and aesthetics, and healthcare ethics. Dr. Goldman has completed a fellowship program in integrated reconstructive microsurgery and craniomaxillofacial surgery at Beaumont Hospital in Royal Oak, MI. At UNLV, Dr. Goldman completed his residency in integrated plastic and reconstructive surgery. Over the years, Dr. Goldman has focused on different types of complex reconstruction surgeries of adult patients.

Reconstructive Surgery and the Bright Side of Medicine Dr. Goldman highlights that clinical aspects boil down to endless causeand-effect parameters. "I tend to look at happier aspects of medicine," said Dr. Goldman. The good doctor believes it takes technical proficiency and artistic mindset to perform the best 3D reconstruction or facial reconstructive surgery. Dr. Goldman professes that constant creative ingenuity and adaptability are the hallmarks of reconstructive surgery. However, he points out that you need a balanced approach with secondary interests to understand the complex dynamics of reconstructive surgeries.

Least and Most Favorite Part about Medicine "I believe the most complex cobweb of medicine is arguably its administrative side," noted Dr. Goldman. He believes that most people are aware of the significant healthcare issues. PAGE

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Interestingly, Dr. Goldman is getting his EMBA (Executive Master of Business Administration) to make the administrative side of medicine more efficient and less stressful. When it comes to the most favorite aspect of medicine, Dr. Goldman points towards educating on the availability of cutting-edge solutions. Primarily, it involves breast microsurgery and autologous reconstruction. "Serving on the honorary advisory board and having the attention of the support group, you get the chance to discuss with breast cancer survivors and deliver modern reconstructive options," Dr. Goldman shares with Top Doctor Magazine.

More Modern Technologies Dr. Goldman highlights that modern technologies are changing many dynamics of reconstructive surgeries. He talks about cases where he changes a specific functionality. For instance, if a patient had oral cancer, you have to consider psychological and physical parameters. "It is highly rewarding when your influence on a patient improves their daily quality of life," added Dr. Goldman.

Challenges in Reconstructive Surgery "Sure, there are numerous challenges in reconstructive surgery, but you can look at mounting challenges through the lens of 'form' and 'function,'" continued Dr. Goldman. "I have to be objective about the assessment and look at what's missing," highlights Dr. Goldman. His approach to constructive surgery is to take into account the patient's goals and desires. In fact, he believes that every aesthetic case requires mastery of anatomy and reconstructive skills.

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Reconstructive Surgery: The Need for a Balanced Approach Dr. Goldman points out that it is crucial to restore the psychosocial outcomes when a patient undergoes mastectomy due to cancer, which can cause decreased self-esteem, negatively impact sexual function and body image. Even before the COVID-19 crisis, reconstructive surgery continuously came up with groundbreaking treatments and techniques.

Future of Reconstructive Surgery "Of course, the future is regenerative medicine, and a combination of virtual surgical planning to perform more efficient reconstructive surgeries can make all the difference in the foreseeable future," said Dr. Goldman. "Virtual Surgical Planning (VSP) is a groundbreaking, cutting-edge technology that improves your capacity to perform plastic and reconstructive surgery to perfection," notes Dr. Goldman. Ultimately, he believes that people are more aware of innovative solutions in healthcare. "Adherence to modern standards can bridge the gap between healthcare providers and patients," notes Dr. Goldman.

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Meet the Godfather of Aesthetic Lasers CEO Jim Hobart co-founded Sciton, Inc. over twenty years ago. The company’s reputation for pushing the envelope in modern medicine with their innovative laser technology systems is well known to countless forward-thinking physicians, including the country’s leading Plastic Surgeons, Dermatologists, Gynecologists, Medi-Spas, and Cosmetic Surgeons. This success is a consequence of the Sciton company culture perfectly summed up in the company motto: “Because Results Matter.” Still, he is adamant about not taking full credit for Sciton’s success, “We ALWAYS work as a team - this is not a one-man show.” In his interview with Top Doctor Magazine, Jim Hobart describes being at the literal bleeding edge of medical laser technology since he graduated from the University of Michigan with a Ph.D. in Physics in 1963. His obsession with constantly pushing medicine forward with laser-based technology has always been paired with delivering excellent results to clinicians and patients. The company’s groundbreaking laser and lightbased technology and innovatively verifiable return on investment for clinics that use their systems have won Sciton’s long-term business with the leading clinicians in the most competitive markets in the country.

The Blue Ocean Sciton is always looking for ‘The Blue Ocean’ or the newest and latest innovations in medicine that are ripe for breakthroughs for laser technology. This has been a theme of sorts in Jim Hobart’s life. In the late 1960s, Mr. Hobart was involved with the earliest applications of Ruby Lasers with the Office of Naval Research. Shortly afterward, he would help develop the Ion Laser, which proved to be one of the first highly profitable laser ventures for his part in a previous organization, Coherent Radiation, Inc. That success attracted two professors of Ophthalmology from Stanford to inquire if the Ion laser technology could be used to treat eye diseases. In collaboration with others, the revolutionary minimallyinvasive laser photocoagulation treatment was born thanks to this application, which according to Hobart, has saved tens of millions of people from blindness. In the dermatology field, his team’s inventions PAGE

Issue 124.1.2

have even been used to treat tragic burn victim Kim Phuc from the famous “Napalm Girl” photo, an unforgettable symbol of the horrors of the Vietnam War. Her still-painful scar tissue was treated at Miami Dermatology and Laser Institute with the Erbium Resurfacing technology developed by Hobart’s team at Sciton. And, Hobart’s collaboration with visionaries from the field of Women’s Health resulted in breakthrough treatment options for Genital Lichen Sclerosus, an itchy and painful issue for women that completely devastates vaginal health and intimate relationships. The doctors that approach Sciton for new solutions range from Dermatologists, Plastic Surgeons, Sports Medicine experts, or in one case, even the spouse of a doctor that was an aerospace engineer with some ideas for laser application. “We have close relationships with a number of doctors, and in many cases, have discussions with them weekly. We’ll talk to anyone looking for new devices or with conditions that we could treat.”

Growth During a Pandemic and BroadBand Light (BBL) HERO

Surprisingly, the pandemic has done nothing to slow down the rollout of Sciton’s latest upgrades to its leading Intense Pulsed Light (IPL), the BroadBand Light (BBL) system. In fact, the latest offerings have been in such demand that it’s been one of the most profitable years ever for the company. Hobart tells Top Doctor Magazine that BroadBand Light (BBL) is the world’s most powerful IPL device on the market. He goes on to say that despite the downturn in the economy, many clinics and MedSpas were still very keen to invest in the latest iteration of BBL. Using BBL HERO (High Energy Rapid Output), clinicians can treat sun damage, acne, pigmented lesions, rosacea, skin health and countless other applications using the BBL’s increased power, faster cooling rate, and higher speed. It functions like a high-powered swiss army knife for aesthetic clinicians. “Treatments that used to take over an hour on large areas like the back and legs can now be done in three to five minutes with even better results,” Hobart states.

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It functions like a high-powered swiss army knife for aesthetic clinicians. “Treatments that used to take over an hour on large areas like the back and legs can now be done in three to five minutes with even better results,” Hobart boasts.

Dual Effect: Saving Clinicians Time and Money With Data Analytics based Return on Investment Hobart recognizes that these laser systems are a significant investment for the working clinician. The JOULE and mJOULE platforms were designed to be upgradeable so that practitioners could always stay ahead and be profitable in highly competitive markets. Remarkably, 95% of all Sciton systems ever sold in the past decade remain in service today, thanks to its built-in-the-USA design and manufacturing quality. What excites many doctors using the platform is the treatment data (not patient data) tracking system, Sciton iQ, which is a more verifiable assessment of what your practice is doing, and how much money it’s making. Sciton iQ can collect the type of treatments being used and correlate that information into a wide variety of data sets. This rare level of transparency has led to several clinicians buying multiple systems, more than doubling their return on investment. “We can show you how much money you’re making so that you can put that money in your pocket.” Critical real-time data, increased productivity, and profitability are why clinics around the country are investing in their future with a long-term relationship with Sciton.

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Women’s Health Sciton also has an innovative laser option designed specifically for Women’s Health called diVa. diVa uses ablative and non-ablative wavelengths, which are considered ideal for gynecological and urological medicine during excision, incision, ablation, vaporization, and soft tissue coagulation. Also a part of the JOULE platform, it’s the only device that includes High Precision Automation (HPA) to ensure optimal outcomes for patients and gives the device operator unseen levels of predictability. Many markets are noticing these services are very ontrend in the aesthetic and medical application of lasers. Hobart even mentions that his lasers have the power to save marriages. How? Gynecological health issues like Genital Lichen Sclerosus are often misdiagnosed and mistreated, resulting in the affected tissue being irreparably scarred due to medical and technological ignorance, but not when you’re using Sciton. Urogynecologists have started looking to Hobart and his team’s lasers as potentially offering a solution for this devastating disease.

What’s Next? The Future of Lasers and Medicine Ever the innovative tinkerer, when asked if he has any game-changing technological projects underway Hobart laughingly shares with Top Doctor Magazine, “Only about 17 of them…some of them are really far out. You have to try a bunch of things.” It’s apparent that even if Sciton wasn’t at the forefront of medical laser technology that this type of technological problem solving would simply be his passion and hobby anyways. The spirit of innovation with results that matter defines the culture at Sciton. Even beyond that, Jim Hobart’s collaborative spirit with his valued employees and the curious minds from the medical field have changed how modern medicine and aesthetic clinics treat the face and body forever.

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Issue 124.1.3

Just Slap It On: Should You Really Wear That Beauty By Yuko Tabasa Mask? In this day and age, having a skincare routine is essential. As a “me-time” imperative, we have gone above and beyond to make sure we give our skin the best of the best. A recent study published in the Aesthetic Surgery Journal shows COVID-19 has affected people’s interest in aesthetic interventions. According to the participants, seeing themselves more often in the mirror leads them to improve their appearance.

How Do Beauty Masks Work? Skincare can be as simple and as rigorous as you want it to be. However, for people with different skin conditions like acne, redness, and excess sebum production, an added skincare boost is never a bad idea. Beauty masks are the perfect regimen because they contain rich ingredients that either hydrate, moisturize, dry, or exfoliate your skin. The beauty mask’s film allows essential components to seep into the skin better in a short amount of time and offers a more concentrated and intense version of your regular skincare.

The Right Beauty Mask for You With the number of beauty masks available in the market, choosing the right mask for you can be pretty overwhelming. The first step to knowing the right beauty mask for you is to know your skin type. Consult your dermatologist and discuss the different needs your skin might have. Once you have your skin type sorted, you can now choose the right product that works best for you. There are three types of beauty masks:

● Overnight Masks These masks are hydrating, moisturizing, and may contain hyaluronic acid, ideal for dry or mature skin types.

● Clay Masks

Sulfur or mud masks soak up excess sebum and may give a slight exfoliation—ideal for oily skin types.

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Issue 124.1.3

● Sheet Masks These masks are the most common ones. They contain moisturizers and antioxidants, which are hydrating. They can be stored in the refrigerator for the added anti-inflammatory effect. Mixed in these beauty masks are vital ingredients that have a specifically targeted skin benefit:

● Salicylic Acid and Alpha-hydroxy acids: for acne ● Vitamin C, Vitamin E, Resveratrol, Retinoids, Hyaluronic Acid: for fine lines and wrinkles ● Niacinamide: for excess sebum, pigmentation, and redness ● Kojic acid, Vitamin C, Retinoids: Dark spots, and pigmentation

Should You Really Wear That Beauty Mask? After finding a mask that works for you, learn to integrate it into your routine. It should be used after a face serum before a moisturizer or a replacement to your nighttime moisturizer. As with anything in excess, it can be inadequate for you. Make sure not to overdo the use of beauty masks. They should only be used about once a week to prevent irritation. It’s essential to be wary of red flags when using a beauty mask. Some of the signs include breakouts, redness, pain, dry or peeling skin, and worst, a skin flare-up due to hives. Beauty Masks are not magic. They will not make your skin soft, supple, and beautiful overnight. Using beauty masks may not erase all your poor skincare habits after one use, but they can provide you with that extra skincare boost in your routine. These beauty masks can be an easy, effective, and inexpensive way to give your skin that extra tender loving care when used correctly. Having great skin still heavily relies on having a routine that works for you and staying hydrated. Know your skin type and what it needs. Stick to a skincare routine that cleanses, moisturizes, and protects your skin. And don’t forget that all skin types can benefit from a dab of gentle, non-drying cleanser and exfoliant and a smudge of broad-spectrum sunscreen to protect you from sun damage. PA PG AE G E | | 0 20 9

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Potential COVID-19 Symptom: Skin Rashes By Victoria Cook COVID-19, also known as the Coronavirus, has quite literally taken the world by storm. At this point, COVID-19 has been in the spotlight of every media outlet for the past year and a half. But they haven’t accurately covered everything. While the current symptoms are a combination of fatigue, aches, and difficulty breathing, a new symptom has appeared in more recent studies: skin rashes. Though the Centers for Contagious Diseases and Prevention (CDC) has not updated their list to include skin rashes, they do indicate that there can be other symptoms that they have not confirmed. According to an extensive study published by the British Journal of Dermatology in January, skin rashes can indicate COVID-19.

The Current Findings The results of the British study cannot be counted as conclusive evidence. Still, it is interesting to note that COVID-19 studies underway in 2020 indicated that skin rashes could be one of the few external factors through which we can recognize the virus. Those studies had limited test subjects and multiple variables, leading them to be inconclusive. PP AA GG EE | | 010

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Since COVID-19 primarily targets the respiratory system, finding external indicators of the virus can prove helpful to identifying and controlling the pandemic further. The British Journal of Dermatology study had a larger sample size than past studies, using a COVID-19 app to track symptoms amongst 336,847 users in the UK. Seventeen percent of positive cases had indicated skin rashes, and twenty-one percent had skin rashes as the only external factor. A few past studies with smaller sample audiences were conducted in Spain, Italy, and China, showing a less than 20% indication of skin rashes with COVID-19. To document these rashes, the British Association of Dermatology created the website, COVID-19 Skin Patterns, which contains the pictures and information of all noted rashes. These rash types include papular, vesicular, urticarial, and COVID digits. COVID digits are a unique skin condition of chilblains, which involve purple and pink blisters on the fingers and toes.

COVID digits could be caused by muscle atrophy, decreasing the blood flow within the muscles and tissues and creating conditions for blistering in the digits. Definite connections between COVID-19 and skin rashes are not final, but continued efforts to document these limited results could improve future patient care.

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For Further Consideration As more research comes forward, maintaining a healthy state through needed nutrition and physical exercise is essential. Current studies do not indicate that rashes are caused by physical contact since that symptom is not consistently present in each COVID-19 patient. However, this virus is more easily spread than the flu, so being cautious about possible exposure, especially for those with underlying symptoms, is still essential. Minimizing vitamin deficiency can also decrease the chances of contracting the virus and its following symptoms.

If you would like to read more about COVID-19, you can browse our articles here. Read “What COVID-19 Has Taught Us About Mental Health” here. Please note that further research is necessary and underway to confirm that skin rashes are directly and consistently results of the Coronavirus.

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Reprogrammed Immune Cells May Aid the Spread of Breast Cancer By Joseph Smalley In the United States, breast cancer accounts for the most common diagnosis in women, affecting at least 13% of women throughout their lifetime. It is invasive cancer that centers around the breast tissue, often appearing as irregular breast lumps, irregular nipple fluids, and red patches around the skin. If left untreated, the tumor can spread to other organs in the body. There are several risk factors for breast cancer, such as obesity, lack of exercise, alcoholism, women who had children later in life, family history of breast cancer, etc. Around 5-10% of breast cancer cases can be traced to genetics inherited by the person’s parents. In the past, breast cancer was seen as something to be afraid of and only spoken in low voices, as if it was covered by stigma. Because surgical procedures back then were still primitive and there was a lack of knowledge about the disease, many women had to suffer in silence rather than find treatment. Unfortunately, this led women with breast cancer to have low survival rates.

History In the 1900s, women tried to raise awareness for breast cancer, and one of the first organized campaigns was done by the American Society for the Control of Cancer, the “Women’s Field Army.” It was not until the 1980s and 1990s that the Breast Cancer Movement finally made enough waves to reach out to everyone nationwide.

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Feminist

and

women’s

health

movements

managed

raise

awareness regarding breast cancer and its widespread impact on women in society. The result had a positive impact, inspiring a series of political and educational campaigns. With technological advancements, many medical institutions and research centers studied breast cancer intensively, resulting in better breast cancer screening, effective treatment plans, medicinal drugs, prevention methods, and so on. As the study of breast cancer continues, immunologists have discovered the mechanism in how some immune cells become brainwashed to help breath tumors thrive.

Breast Cancer: A Short Review Breast cancer occurs between a genetically susceptible host and an external factor. Cells are programmed to divide as many times as they need, whereas cancer cells stop dividing. Cancer cells lose the ability to become normal cells. It starts to attach itself to other cells, thus spreading to other normal cells, mutating them in the process. If a cell is no longer useful, it will typically self-destruct. But until then, several protein clusters and pathways protect the cell from selfdestructing. One of the pathways is the PI3K/AKT, and the other is the RAS/MEK/ERK pathway. However, an incident can occur when the genes along the pathway become mutated, preventing the cell from self-destructing. Not letting the cell self-destruct is the initial step towards cancer. There are two commonly used screening tests to see if a woman has breast cancer. One is a physical examination done by a healthcare provider. The other is a mammography test, which detects lumps to be cancerous or not.

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Suppose the results are indeterminate and require further testing. In that case, the healthcare provider can take sample fluid from the lump and send it to the lab for microscopic analysis (also called fine-needle aspiration). If all three screening tests are done together, it can provide a better degree of accuracy for diagnosing women suspected of breast cancer.

What About the Immune System? The immune system helps fight back against diseases, infections, and sometimes cancer. They are considered foot soldiers whose goal is to kill any harmful invaders that make their way inside the body. But as it turns out, some immune cells end up helping the invaders instead. Margareta Wilhelm and her colleagues, a team of medical experts, have been studying the exact reason why immune cells help spread breast cancer. They observed how macrophages, a type of immune cell, end up turning into breast cancer tumors and reprogrammed to increase tumor growth. Based on an article published in PNAS, she states that the infiltration of immune cells into tumor cells is vital for the progression of tumor growth; and that there is a delicate balance between the two interactions. Studies have identified TAp73, a tumor-suppressing protein, to be the key. TAp73 is a member of the p53 protein family, which acts as a tumor suppressor. Their studies show decreased levels of TAp73 to be related to certain aggressive types of breast cancer. They observed that TAp73 acts as an inhibitor of NFkB activation. NFkB is a protein complex found in all animal cell types. NFkB plays a vital role in regulating the immune response to infection and is also linked to cellular responses to external forces.

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Issue 124.1.5 In short, the decrease of TAp73 sets off a chain condition in which NFkB becomes

hyperactive

and

starts

increasing

the

production

chemokine CCL2. The chemokine attracts monocytes towards the tumor. The monocytes mutate into a particular type of macrophage, which, in turn, aggressively increases tumor growth. Studies show that both high levels of CCL2 and high macrophage infiltration correlate with poor prognosis in breast cancer patients. TAp73 is identified to be a regulator for macrophage recruitment and plays an essential role in immune cell regulation in cancer.

Summary The majority of women are susceptible to breast cancer. In the United States, estimates say at least 1 in 8 women may experience breast cancer in their lifetime. This is saddening to hear, but there are also many silver linings, such as advanced treatment and studies, to prevent breast cancer. Governments and big companies fund several international research institutes to study and research the exact cause of breast cancer, and the results have saved countless lives. By understanding the ins and outs of breast cancer, many lives can be saved. That is why visiting the doctor for regular health checks is a must for women and the elderly. With today's modern medical advancements and treatments, it is possible to prevent having breast cancer before it becomes too late. Early detection of breast cancer can save countless lives and forgo the suffering of losing a loved one too soon.

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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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