Issue 124.2 - Addressing Physician Burnout Due to the COVID-19 Pandemic by topdoctormagazine

July 2021 - Issue 124.2

Dr. Mark Malone Advanced Pain Care Pg 04

Addressing Physician Burnout Due to the COVID-19 Pandemic: An Interview with Dr. Priya Bansal Pg 01

How to Survive Nursing Burnout Pg 09

Contents

05 04

01 Addressing Physician Burnout Due to the COVID-19 Pandemic: An Interview with Dr. Priya Bansal

04 Dr. Mark Malone - Advanced Pain Care 09

How to Survive Nursing Burnout

Radiology: The Eyes into the Patient

The Telehealth Medical Cart That is Revitalizing the Dental Industry

19 The Bright Side of Medicine: An Interview with Dr. Joshua Goldman

22 Meet The Godfather of Aesthetic Lasers 26

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?

Issue 124.2.1

Addressing Physician Burnout Due to the COVID19 Pandemic: An Interview with Dr. Priya Bansal Since the start of the COVID-19 pandemic, our nation’s physicians have been pushed to the limit. Top Doctor Magazine interviewed Dr. Priya J. Bansal MD, an allergist and immunologist with published research on how the pandemic has increased burnout among doctors.

“We’re

taught in residency: tough it out, tough it out, tough it out…but you can only do ‘tough it out’ so much.” She is also a member of the AAAAI COVID-19 Task Force, a rapid response team formed to address and communicate urgent issues related to the practice of allergy and immunology in the context of the pandemic.

Experience with Asthma and Allergy Wellness Dr. Bansal remembers that she discovered her interest in practicing medicine during her experiences with persistent illness as a child. She would pursue her studies at Pennsylvania State University-Jefferson Medical College and earn her medical degree at the University of Illinois College of Medicine in Chicago. At the University of Illinois, she was Chief Resident in her internal medicine and pediatrics residency. Dr. Bansal then completed her fellowship in Allergy and Immunology at the Rush University Medical Center. During her rotations, Dr. Bansal discovered a love of taking medical care of both adults and children.

Identifying Personal and Institutional Burnout Before the pandemic hit the world in early 2020, physicians were already showing signs of high levels of burnout. Dr. Bansal tells Top Doctor Magazine that there are several levels of underappreciated physician burnout. PAGE

Issue 124.2.1 First is taking stock of the physician’s baseline mental health, depression, and anxiety levels. She suggests that one of the first things physicians should do is grow personal and professional support networks. This can be done by communicating common issues to peers in groups on social media, forming advocacy teams to address physician fatigue. Another way to achieve this is by taking extra precautions to ensure that the individual physician or a coworker’s baseline mental health needs are being met before dealing with the stress of working during a pandemic. Dr. Bansal describes burnout as commonly occurring at an institutional level as well. Payment from insurance companies is requiring more energy from physicians than ever before. For example, with today’s over-thecounter allergy medicine, insurance companies are now often incentivized to delay payment for modern allergy therapy. Getting an authorization for a prior prescription from insurance companies is met with endless insurance company cost-saving tactics such as unnecessary delays. Another issue fatiguing doctors is the insurance company’s insistence on using the cheapest treatment. For allergists, insurance companies tend to prefer patients take older treatments such as steroids which are less expensive than newer therapies. “For the physician and patient, this is a problem because steroids have several side effects such as hypertension, possible cataracts, immune suppression, you can go on and on.”

Communicating, Patient Education, and Physician Burnout during COVID-19 As a member of the American Academy of Allergy Asthma and Immunology COVID-19 Task Force, Dr. Bansal has been monitoring the impact of COVID 19 on practicing allergists and immunologists. Patient education regarding the novel coronavirus has been particularly tricky. Many doctors have to expend significant energy addressing patient resistance to masks, vaccines, or developments in safety protocols. Reestablishing the trust of confused patients has been a major struggle. The pandemic started during a presidential election year, and many patients reported having received conflicting medical messaging and news from social media. PA PG AE G E | | 0 20 2

Issue 124.2.1 Dr. Bansal stressed that advances with the technological advances in telehealth have allowed physicians to access patients safely, but it is not without problems. During the pandemic, “Telehealth basically went from 0 to 100 overnight,” said Dr. Bansal. The biggest issue is the doctor’s time. They are seeing more patients virtually while already experiencing high patient volume at the clinic. Other examples of physician burnout from COVID-19 stem from law changes. Many offices received government financial assistance, and the taxation implications are still unclear. Also, recent laws that granted patients instant access to lab results have created a situation where patients are presented with sophisticated data without a medical training context. An example would be a patient finding out lab results from an oncologist before the patient’s doctor could review them. This information overload can give the patient higher anxiety levels which then turns into more phone calls to the doctor’s office. The result is an unsustainable increase in call volume for both physicians and staff.

The Health of the Healthcare Industry Still, Dr. Bansal sees technology as one way to relieve physician burnout. A pressing issue for doctors today is really about a bottleneck in workflow. To lessen strains on the physicians, offices would benefit from government standardized electronic medical records. On their end, physicians should form support networks and legislative advocacy groups to address problems with insurance companies. Next, Dr. Bansal sees a move towards the “blended approach” of a mix of telemedicine and face-to-face visits as a way of balancing high-level patient care with the physical limits of today’s practicing physician’s workload. A look into Dr. Bansal’s research on the topic of physician burnout shows that clinicians can alleviate the stress of the pandemic by leveraging easily accessible tools, like the Strength-Focused and Meaning-Oriented Approach to Resilience and Transformation (SMART) crisis management approach, wellness apps, mindfulness, and

gratitude.

These

are

highly

essential

measures

safeguard

physician

wellness,

critically

underappreciated priority. PA PG AE G E | | 0 20 3

TOP DOCTORS OF THE WEEK

Issue 124.2.2

Dr. Mark Malone - Advanced Pain Care By Ionuț Raicea

About Dr. Mark Malone Dr. Mark T. Malone is a Board-Certified pain specialist currently residing in Austin, TX. After receiving his undergraduate degree from the University of Texas at Austin, he attended the University of Texas Southwestern Medical School. Dr. Malone completed his residency and training in anesthesiology at the Baylor College of Medicine and a fellowship in pain management at the Texas Orthopedic Hospital in 1998. Ever since he founded his private clinic, Advanced Pain Care, in 2002, Dr. Malone has strived to improve the quality of care in chronic pain, helping innumerable patients regain their quality of life with state-of-the-art treatments, especially for chronic back pain. Furthermore, he sought to instill his approach in the minds of young students as a clinical instructor at Baylor College of Medicine. In 2017, Dr. Malone became a Clinical Assistant Professor of Surgery and Perioperative Care at UT Dell Medical School. Aside from holding a double-certification in anesthesiology and pain management from the American Board of Anesthesiology, Dr. Malone is a proud member of elite anesthesiology and pain management-related associations, such as the American Medical Association, the American Society of Anesthesiologists, the International Spinal Intervention Society, the American Society of Interventional Pain Physicians, and the Travis County Medical Society. When outside the clinic, Dr. Malone enjoys spending time with his wife and three children, water-skiing, cycling, and traveling.

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Issue 124.2.2

Letting Go of the Drumsticks to Become a Physician Hailing from the Lone Star State, the young Dr. Malone followed a career path quite different from his current interests, a career path focusing less on his scientific and more on his artistic self. A promising drum player, Dr. Malone earned a scholarship from the Baylor School of Music, a prestigious institution within the homonymous university. However, the future had quite a different path in store for Dr. Malone, who decided to rethink his career trajectory and shoot for the stars in a completely unrelated field: "I got some testing done, and it turns out I'm pretty good in science. So I changed careers and changed my major into pre-med, which is what I really wanted to do. And, you know, the rest fell into place over the years." Dr. Malone shares with Top Doctor Magazine.

From Physician to Patient As he settled into this new and exciting career path, Dr. Malone found himself at home, eager to exhaust the knowledge on everything related to pain management. After graduating from the Baylor College of Medicine as a trained anesthesiologist, he immersed himself even more in this medical field and completed a pain management fellowship at the Texas Orthopedic Hospital in 1998. Once he completed his training, Dr. Malone was more than happy to return, at his fellow physicians' invitation, to the Austin area and set the foundation to his own pain management clinic, Advanced Pain Care, in 2002. "Then, one day, I lifted something heavy. I felt a pop in my back, fell to the ground, and my back was never the same. And I became a chronic pain patient." Injections, physical therapy, and everyday medications became the norm for Dr. Malone in treating his chronic back pain. At the time, surgery seemed the only solution, to which he reluctantly consented because of his fellow physician's pleas. PA PG AE G E | | 0 20 5

Issue 124.2.2

The Wonders of Spinal Cord Stimulators But the actual cure to his chronic pain didn't lie in the two surgeries that he underwent. Four years ago, Dr. Malone discovered the wonders of spinal cord stimulators, devices engineered to interrupt the pain signals that travel along the spinal cord to the brain, and decided to give them a try. "So I had my partner, Dr. Michaud, install one of these in my own back, and I was instantly better, almost a hundred percent better." It's unbelievable how "a small device about the size of an Oreo cookie," as Dr. Malone calls it, can relieve patients from so much chronic pain. "It's a revolution in pain medicine. We call it a cure, and it essentially is the cure. There's never been a cure for chronic back pain before." Dr. Malone's belief in these devices is so profound that the Advanced Pain Care clinic became one of the top spinal cord stimulator providers in the country: "I'm told that we're the number one provider in North America. We do about 200 of those (i.e., spinal cord stimulators) a month."

The Problem of Failed Back Surgery Dr. Malone was one of the lucky patients who discovered the benefits of spinal cord stimulators and used them to undo the unsatisfactory back surgery results. The same applies to one of his favorite patient cases, the case of Chester Jones, a former combat soldier who underwent two failed back surgeries before resorting to a spinal cord stimulator. Today, Mr. Jones is an avid promoter of spinal cord stimulators and an Advanced Back Pain ambassador. It's no coincidence that numerous patients that put their faith in spinal cord stimulators come from the same failed back surgery background as Mr. Jones does: "The biggest patient population for the stimulator is what we call failed back surgery. That means you had, you had some tremendous pain, you were motivated to get back surgery, and it didn't work. Either it stayed the same, or it got worse. So about half of all our stimulators are given to failed back surgery patients." PA PG AE G E | | 0 20 6

Issue 124.2.2

Defining a Failed Back Surgery But why do we call it a failed back surgery? Does it have something to do with medical malpractice? On the contrary, Dr. Malone points towards the surgery's futility in the first place: "It does not mean technical failure or any mistake. The only mistake is that the patient was never going to get better by surgical intervention. So, you operate on a patient hoping that it will make their pain better, but you don't know in many cases." In a bleak tone, Dr. Malone mentioned several studies that put the number of failed back surgeries up to 50% of the total number of back surgeries, an excellent incentive to research alternatives before committing to an unclear outcome.

Telemedicine and New Techniques in Treating Chronic Pain Jumping from Mr. Jones' story to more recent matters, Dr. Malone and his practice managed to brave the hardships brought by the COVID-19 pandemic while continuously providing essential chronic pain care to his patients. "We maintained all of our doctors and nurses and assistants and managers and laboratory workers and everyone; we didn't lay off a single person in our whole company of 500 people." Dr. Malone tells us. Behind this extraordinary feat lies the ability to provide telemedicine to patients, something unheard of before COVID-19 in the world of chronic pain: "The medical board has never allowed telemedicine for pain management before because pain medicine is seen as something that needs to be regulated." About 50% of the total number of patient visits went to telemedicine in the blink of an eye. This did not affect Dr. Malone's practice at an administrative level since insurance programs were more than happy to pay for telemedicine. However, patients still prefer to come to Advanced Pain Care in person, proof of the solid patient-physician relationship cultivated in Dr. Malone's clinic.

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Issue 124.2.2

Furthermore, Dr. Malone is expanding his array of techniques to alleviate chronic pain in other troublesome body areas as well. As such, he mentioned his intention to help relieve patients of chronic headaches, which are more than ordinary in today's society: "We're starting to use spinal stimulators for chronic headaches, which I think is important because there's a huge population of chronic, severe headaches out there."

Always Remember to Give Thanks Advanced Pain Care has become one of the best-reputed chronic pain management clinics in the U.S., a token of Dr. Malone's long years of hard work, dedication, and sacrifices. However, as a parting reminder, Dr. Malone reminds us that behind every successful physician lies an entire team of hardworking doctors, nurses, medical assistants, and managers who helped Advanced Pain Care become what it is today: "If I'm a top doctor, it's because I have a wonderful group working with me, 500 dedicated professionals, and we do more spinal stimulators than anyone else in the country." Here at Top Doctor Magazine, we would like to wish Dr. Malone the best of luck in improving chronic pain management even further. If you'd like to learn more about his mission, make sure that you check out his website here.

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Issue 124.2.3

How to Survive Nursing Burnout Introduction Like most burnouts, nursing burnout also boils down to demographic traits and work conditions. According to NAM (National Academy of Medicine), around 50% of professional caretakers in different medical fields experience severe burnout symptoms. The most common nursing burnout symptoms include cynicism, emotional exhaustion, and lack of professional achievement. If nursing burnout is left untreated, it can lead to job-specific mistakes, a high turnover rate, and poor performance. In some cases, severe nursing burnout even triggers suicidal tendencies. Stress for a prolonged period leads to disengagement and emotional exhaustion among many nurses. Nursing burnout is a harsh truth for some caretakers, but it doesn’t have to define their careers.

What Constitutes a Nursing Burnout? In a traditional sense, burnout refers to mental, emotional, and physical exhaustion. You can view this stress as a result of over-engagement that led to detachment and dulled emotions. Think of nursing burnout as a demoralizing factor that undermines motivation and creates a sense of hopelessness.

The Major Reasons for Nursing Burnout The most common factors that led to nursing burnout include:

● Long shifts ● Coping with death or sickness ● Working in a stressful environment ● Prioritizing others first

Remember that nursing burning can impact healthcare professionals and patients. PAGE

Issue 124.2.3

What Does it Take to Survive Nursing Burnout?

❖ Get Proper Sleep

It is hard to overstate the importance of getting full sleep. A good night’s proper sleep comes with a lot of benefits. When it comes to nursing, getting a sufficient amount of sleep is crucial to avoid burnout. And even if you experience other burnout symptoms, getting proper sleep can help you survive the burnout. You can follow the path of professional nurses and adjust the sleep schedule that allows you eight hours of sleep each night or day. Think of the consistent sleep routine as a way to maintain concentration, motivation, stamina, and alertness throughout the shift.

❖ Develop Interpersonal Relationships

Nurses must have solid relationships in the workplace environment and at home to maintain impressive job performance and avoid potential burnout. If you’re a nurse, talk about your emotional distress and devise a strategy to create a balance between professional and personal life. You should even reach out to other nurses about work pressure that may be building up stress. Emotional support matters and you’re going to need someone inside or outside work to confide.

❖ Pay Attention to Your Mental and Physical Health

It would be fair to state that nurses must prioritize their physical and mental health to avoid or survive burnout. As a nurse, if you believe you’re on the verge of burnout, call in sick. Former nurses, mindset coaches, productivity experts, and therapists suggest taking some time off if there is mental or physical exhaustion. If the symptoms are severe, opt for a therapy program.

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Issue 124.2.3

❖ Create a Balanced Personal and Work Life

It may look easy to achieve on the surface, but it takes a lot of motivation and dedicated effort to create a balance between personal and work life. You’d be surprised how common it is for nurses to cross the thin red line between personal and work. The trick is to be mindful and present about your work and priorities at home.

Bottom Line Professional nurses concur that the essential thing to avoid or survive burnout is learning to love oneself. It may sound straightforward, but nurses must be cautious not to become a slave to their patients and maintain a healthy work and life balance. After all, nurses have to practice what they preach, which means putting your physical and mental health first. If you spot the signs, don’t hesitate to reach out for help when you need it the most. In retrospect, always take time to unwind and relax to manage your emotions and stress.

REFERENCES: i.https://health.usnews.com/health-care/patient-advice/slideshows/how-to-help-curb-burnout-amongnurses?slide=2 ii. https://www.usa.edu/blog/nurse-burnout/ iii. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5798741/ iv. https://www.ncbi.nlm.nih.gov/books/NBK2668/ v. https://human-resources-health.biomedcentral.com/articles/10.1186/s12960-020-00469-9

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Issue 124.2.4

Radiology: The Eyes into the Patient By Ionuț Raicea and Brianna Connors The stories of true heroes who have worked their way to the peak of their successes with their own two hands are always welcome to readers who believe that with patience, confidence, and enough effort, they too can accomplish and become stronger versions of themselves. Such is the story that we are proposing to our esteemed Top Doctor Magazine readers today, the story of a registered nurse who, using her business administration superpowers, climbed to the top of the ladder and became Chief Operating Officer (COO) at Premier Radiology. However, Tori Thompson, who started at Premier Radiology in March 2009, kept her humble spirit and still puts on the scrubs almost daily, regardless of her current position. "I still wear scrubs many days of the week, and I will go work in the clinic, alongside the staff. I think that it is important to have that perspective as a COO, to understand every process, from scheduling to registration, to completing an MRI or a CT study. Placing yourself in the staff’s shoes, gives an insight into workflow, which enables me to create better practices.

"Our Number One Priority Is Patient Care" To help expand a company and see it flourish, one truly must understand how every single wheel sustains the entire mechanism, beginning with the smaller yet fundamental one: the patient. "Our number one priority is patient care, and taking care of the patients as efficiently and as best that we can." What does this translate into at Premier Radiology? "If that means we need to stay open later or come in earlier, that's what we do. We truly strive to accommodate the patient" The genuine willingness "to treat each patient as if they are a member of our family" is what guides Tori and Premier Radiology to success.

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Issue 124.2.4

"The Eyes into the Patient" Patients seek out Premier Radiology's services to get a superior grasp of the state of their bodies as a whole, to learn which parts are in good shape and which one might be a little rusty. As such, radiology takes the patient on a journey from diagnosis to creating their care plan. However, for Premier Radiology, their mission is more than X-rays and CT scans; it's about "establishing a relationship with the patient even before they step foot in the door." Tori describes how Premier Radiology invests in its relationship with patients both before and after their appointments: "We have created a patient follow-up module, which allows us to track patients who need any type of follow-up imaging. If the patient missed their follow-up window, we notify their referring physician. Since the follow-up module’s inception, we have successfully scheduled 205,000 patients for imaging that may have otherwise slipped through the cracks. “ For Tori, going the extra mile for each patient has been the secret behind Premier Radiology's success. She understood the fact that a more human approach to patient care, where small gestures such as a confirmation phone call can make the patient feel more appreciated and respected:

“Something that sets us apart from other imaging practices, is that our technologists do their own confirmation calls. This allows the technologist to establish a relationship with the patient, and to answer any questions related to their study, before they even make it to the clinic.”

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Issue 124.2.4

Although such a human approach towards patient care is not necessarily the rule of thumb during these unpredictable times, Tori believes that Premier Radiology's recovery from the first harsh months of the pandemic stems mainly from patients who trusted their attachment to safety and superior patient care. "During the peak of Covid, many practices were closing their doors to screening exams. Premier worked to establish new protocols and practices, which enabled us to continue operating in a safe, and efficient manner. We felt that it was important to establish an enhanced sense of trust and comfort for the patient.”

"We Never Turn Away a Patient" What lies ahead for Tori and Premier Radiology? As she tells us, "We never turn a patient away, for inability to pay" is Premier Radiology's motto, and they do intend to stick by it as a mainstay of the company. "We always want people to feel like they can have a study done because these studies are very important. We don't feel that a patient should delay care because they can't pay their $10 copay or $200 copay, whatever the cost maybe." With the addition of eight brand-new locations opening up in the Wisconsin market, further plans to expand the Tennessee and Florida markets, and established partnerships with Radiology Partners and Ascension, Premier Radiology is sure to experience constant growth and a prominent presence within the market.

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Issue 124.2.5

The Telehealth Medical Cart That is Revitalizing the Dental Industry By Joseph Smalley Dental care includes regular visits to the dentist. However, this is a challenge for many people. The COVID-19 pandemic makes matters worse, not just for the patients, though. Even the dental industry struggles as well. The good news is that there's a telehealth medical cart reviving the industry by adjusting the way dentists provide care. Fred Babaee, CEO of Simply Mobile Industry Inc., expounds on the latest trend (and future) of so-called teledentistry.

Fred Babaee's Foray into Teledentistry Telehealth is a broad term that covers the use of communication technologies and digital information in managing one's health. Mr. Babaee

stated,

"Telehealth

has

been

around

for

some

time."

Teledentistry is a branch of telehealth that focuses more on giving dental care using modern technology. Mr. Babaee can be considered as one of the pioneers in teledentistry. "So my background has been in technology since the early nineties," he said. His journey began when he had a company that manufactured personal computers and even enterprise storage level servers. Back then, their products mainly catered to corporations in the United States. Later on, the company shifted its focus towards making medical equipment for clinics and hospitals. Among these are telehealth medical carts. In 2018, their team designed a cart specifically for dentistry. Mr. Babaee describes it as "sort of an all-in-one cart that can do anything that the dentist needs in terms of services, in terms of telehealth, in terms of video conferencing." PAGE

Issue 124.2.5

The Uses of Teledentistry before the COVID-19 Pandemic Teledentistry evolved from contacting dentists via phone call or email. Then the video call became available. This made online consultations more feasible. The COVID-19 pandemic highlighted the importance of this service. However, teledentistry has been used even before the global health crisis. The primary recipients were those over 65 years of age. Mr. Babaee explained that these people aren't as mobile as the younger crowds. He further added, "They just want to have the dentistry service delivered to them." How is this possible? Through teledentistry, dentists can talk to and look at their patients through a video call. This requires the teledentistry cart, phone, and/or laptop. Additionally, Mr. Babaee stressed, "The patient can communicate with the doctor as long as they have this intraoral camera." The said camera lets dentists check the patient's mouth even if the latter isn't physically present in the clinic (Or, it's also possible that the dentists aren't in their clinics but still want to check on their patients.)

Before the pandemic, hygienists and registered nurses aided dentists in carrying out teledentistry. They did so by visiting nursing homes and providing cleaning services. Aside from cleaning, they also assessed their patients' teeth to see if there were other procedures needed. For example, what if their teeth were decaying, or what if the crowns were broken? Through teledentistry, the dentists could guide the hygienists and nurses on how to check these things. "Before we can send the dentist, let's take a look at him through televideo," Mr. Babaee illustrated how teledentistry would work.

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Issue 124.2.5

The Importance of Teledentistry During the COVID-19 Pandemic To manage the pandemic, governments and healthcare professionals discouraged people from going out. Establishments were closed, too. These included dental clinics. Dentists couldn't see their patients. However, Mr. Babaee's medical cart helped them find a new way to do so. "Now they can see the advantage of all these," said the doctor. At first, the technology's main advantage was that it eliminated an extra visit to the dentist's office. This meant the patient could save time and avoid travel costs. But during the pandemic, teledentistry helped prevent the spread of the virus. As Mr. Babaee pointed out, "… we're actually eliminating a lot of touches between human bodies."

Other Advantages of Teledentistry Teledentistry makes it possible for dentists and patients to contact each other anytime and anywhere as long as they have the tools. This means that even during dental emergencies, dentists can provide treatment sooner. "So, by having our medical cart that is converted into a dental cart, having that present at the facility and having a dentist on call when emergencies like that happen, they can have a dentist available to see those patients and get them treated rather than sending them home with an opioid or a drug," Mr. Babaee explained. He further elaborated on the need to have the said medical cart in emergency rooms, urgent care facilities, and nursing homes.

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Issue 124.2.5

But the medical cart doesn't have to be in a permanent location. Mr. Babaee noted, "They can move this around from one office to another." The cart comes in different sizes, after all. There's the small suitcase type that dentists can practically carry around in their cars. There's also another type that can be installed in vans. This one is perfect for more complex dental procedures.

The Future of Teledentistry Teledentistry is likely here to stay. The exciting part is that it's bound to go to another level in the future. "How would the AI, the artificial intelligence type of technology, benefit dentistry?" That's just one of the things that Mr. Babaee looked forward to in the teledentistry field. For innovators like him, they ask themselves how they make things faster, easier and better, especially for patients. He cited the use of multiple x-rays as an example of the improvements in teledentistry. In the past, doctors only looked at one image and decided on a treatment based on that. Today's technology makes it easy to collect and examine multiple images, which will determine the treatment. "Of course, the doctor has to do a final signature on it," Mr. Babaee assured. As for his favorite part in teledentistry, he said, "…seeing how happy our customers, patients, are in terms of the services, and in terms of our equipment, I think with what we've done, we made it." The good news is that Mr. Babaee's teledentistry cart isn't just for dentists and patients in the US. Even those in Europe and other parts of the world can take advantage of this technology.

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Issue 124.2.6

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

Issue 124.2.6

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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Issue 124.2.6

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

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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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Life Style You work hard. Here are some ways your fellow medical professionals are playing hard too. Acquire the lifestyle of your dreams.

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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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● 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 22 7

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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 | | 02 1 8

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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 124.2.10 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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