Thursday, March 28, 2013

Botox and Dysport for wrinkles

 Here's a little information about a procedure we offer at our practice.
    Botulinum Toxin, or Botox is one of the fastest growing procedures in Cosmetic Medicine. Derived from the bacteria, Clostridium botulinum, Botox is a highly refined neuromuscular paralyzing agent. There are seven distinct neurotoxins produced by this bacteria, types A,B,C,D,E,F, and G. Botox is purified Toxin Type A. Another product on the market consisting of the same neurotoxin Type A is called Dysport. These products are essentially the same, but are manufactured by different pharmaceutical companies. Dysport does tend to migrate a little more from the injection site, which can be good and bad, depending on which region of the face is being injected.  The forehead can be more diffuse, but you don't want to migrate too much around the eyes or you can have a drooping eyelid.  The effects of the purified neurotoxin is not permanent, but does last about 3 months.
    It is used as a cosmetic procedure to temporarily paralyze an injected muscle in order to provide wrinkle reduction and/or to sculp the face by preventing muscular contraction. It's medical applications include treatment of strabismus, blepharospasm, dystonias, and severe intractable tension headaches. The FDA has only approved botulinum toxin A for Glabella wrinkle reduction and axillary hyperhydrosis, due to an odd side effect of inhibiting normal function of apocrine sweat glands.  It's use is cosmetic medical practice has been extended to include other facial muscles similar to the procerus and corrugators of the glabellar region which include, but are not limited to the horizontal forehead lines, crow's feet, bunny lines, verticle lip lines, brow lifting, mental crease, dimply chin, horizontal neck lines, platysma bands, nasal flare, bummy smile, and nasolabial folds. Not all injectors will know these applications, but most injectors will know how to treat the brow, glabella, crows feet, and bunny nose areas, which seem to be most popular.
    Why choose a cosmetic procedure that only lasts 3 months? Why paint your nails? Facelifts are permanent and much more costly and involve more risk and involve more down time for healing than the average cosmetic patient would like to invest in. Botulinum toxin A treatment is relatively painless, numbing creams can be applied pre-treatment for patients who do not have contraindications. The patient can return to work immediately after having it done and there is no downtime. The effects of the toxin take several days to reach maximum effectiveness, so don't expect to look any different for a few days. The cost of Botox and Dysport are very similar to each other, usually about $8-$12 per unit per treatment depending on location. Usually a place that injects more regions of the face will discount the units as they go along or bundle the costs with other sales in the office. The actual procedure takes about 15-20 minutes. When combined with fillers, Botox/Dysport treatments can be subtle, but stunning. It's a nice treat before a wedding, class reunion or holiday occasion. The effects are more effective when combined with other aesthetics procedures like microdermabrasion or chemical peels and, of course good skin care. The wrinkles fade after 2-3 weeks as old skin exfoliates and new, unfolded skin, forms.

There are certain myths that come up repeatedly, so let me address one of them. "It results in a frozen look," or "I will lose all expression." This is only the case when a client chooses to have too many areas in their face done all at once or staggers the treatements with multiple clinics or when the physician/nurse injector uses way too much toxin in too many areas. Most of the time I try to talk patient-clients out of doing too much. I like to treat 1-2 areas and bring them back to see if they are happy with the results. I also like to maximize the effects of Botox inections by combining them with gel peels and/or microdermabration to give their skin a clean glow and tighten their pores and fine wrinkles. You can always add more, but you can't take it back too easily once you've injected it.
    Does a doctor have to do the injections? Not necessarily. Doctors, both MD and DO can perform the procedure as well as Dentists, Oral Surgeons, Nurse Injectors of all sorts. Most importantly, they should have received adequate training in the procedure and have a certificate of that training posted in the office. Every doctor, dentist and nurse is trained to give injections, but additional training in Botox/Dysport technique is important to avoid unnecessary bruising, discomfort, and maximize theraputic efficacy. We have a trained and licensed esthetist in our office, but I'm the only person who does the Botox injections. I'm kind of a control freak and enjoy the peace of mind knowing that I do my own injections.  How do you find a certified injector in your area? You should be able to go to Dysport or Botox product web site and see who is ordering their products and dyspensing in your area. Those offices should have a web site to look at what they offer and may or may not list pricing. Then, just call and make a consultative appointment to see the office, meet the people performing the procedures and get some pricing.
    Botulinum toxin is a fast, easy, safe and cost effective way to take the wrinkles and creases out of your skin and look years younger. I hope you found this article insightful and enjoyable, now go out there and get fit and beatiful!

Dr. Arthrur J. Ronan is a Board Certified, D.O. Family Physician who is also a certified physician injector of Botox and Dysport forms of botulinum toxin A.

Friday, March 22, 2013

Muffin in a Mug...Yum

I saw this on Pinterest last night and I just had to try it this morning. It is a blueberry muffin in a mug. My mug should have been a little bigger, but it worked.
It takes about 2 mins in the microwave and about 5 mins to prepare. I topped it off with a dob of vanilla Greek yogurt and set it in the refrigerator for a few minutes to cool off before eating. Doing that gave me time to make coffee to go with it.

Try this out:
put 1/4 cup Quakers oats in coffee mug with
1 tsp brown sugar or Stevia
1 egg
1 tbs skim milk or almond milk
mix together and add a handful of blueberries and sliced almonds
put in microwave for about 90 seconds and add 30 seconds if not completely cooked.
tip upside down onto plate and add a dab of your favorite yogurt and another handful of berries, and you just made a gluten-free muffin for breakfast.
You could add a tablespoon of protein powder and some applesauce to add a little kick to it.
Dr. Ronan

Sunday, March 17, 2013

Spring is starting to pop

Signs of Spring are popping up near our doorstep. I'm pretty sure these are Tulips and Hyacinths. I hear more birds in the morning and now I'm seeing green leafy things coming out of the ground, so it must be we are on the verge of Spring. Time to fill the bicycle tires with air, re grip the golf clubs and clean up the dog bombs littering my yard. I did get out and walk the dog today, but it was deceptively cold out there in East Lansing, Michigan today. Sunny, but windy. This makes my soul feel good.

Wednesday, March 13, 2013

What is your path to fitnesss??

I'm learning about health coaching. A funny statement came up about losing weight. You know, you don't have to lose weight. Dr. Phil says you can be overweight until the day you die. But, do you really want to be overweight until the day you die?

My wife is training to be a Health Coach and her questions caught me a little off guard last night. She asked what I want to be as far as fitness goes. I thought about it today and I guess my answer is I'd like to be a healthier version of my parents. My dad had his first heart attack when he was 58 years old and I'd prefer not to have one or if I have to have one, then I'd like one 10 years later. Both my parents are active and social people and both are alive in their 80's and living independently. I can only hope to do as well. My fitness goal is to keep doing the things that I like to do physically, mentally and socially until I can't do them anymore. I don't really want to run marathons or climb mountains I just want to play golf, tennis, ride bikes, walk my dog, read and write. I think I would like to add mental fitness to physical fitness. I'd like to be a productive member of my family and society for as long as I can.

I think eating sensibly, staying physically active and learning new things regularly is my path for now...

Find your path.

Tuesday, March 12, 2013

Baked French Toast - Diabetes Friendly

Recipes have been pretty popular, so here's another one for you from the patient resource site of Sanofi Company, makers of Lantus and Apidra insulin products. This is a low glycemic version for people with Diabetes and/or Heart Disease.

Baked French Toast with Raspberry Sauce

Serves 4
serving size: 2 slices

4 egg substitute equivalents
2/3 cup skim milk
1 tsp maple extract
1 tsp cinnamon
1/2 tsp nutmeg
8 slices whole-wheat bread
2 cups frozen or fresh raspberries
1 Tbsp orange juice
1 tsp vanilla extract
2 tsp cornstarch

Beat together eggs, milk, maple extract, cinnamon, and nutmeg in a medium bowl. In a casserole dish, lay bread slices side by side. Pour over the egg-milk mixture, cover, and place in refrigerator overnight. The next day, bake the French toast at 350 degrees for about 30 minutes until golden brown and slightly puffed. To make raspberry sauce, puree raspberries in a blender. Strain to remove seeds. In a small saucepan, combine pureed berries with orange juice, vanilla, and cornstarch. Bring to a boil and cook for 1 minute until mixture is thickened. Serve over French toast.

Nutrition Information
2 1/2 Starch
Calories: 216
Calories from Fat: 25
Total Fat: 3g
Saturated Fat: 1g
Cholesterol: 1mg
Sodium: 400mg
Total Carbohydrate: 38g
Dietary Fiber: 8g
Sugars: 8g
Protein: 12g

for more information about Diabetes and other healthy meal ideas, go to


Monday, March 11, 2013

Spin Class

One of my favorite things I look forward to all week is doing my Monday night spin class at the health club. I didn't realize how much I liked it until my wife told me I had a meeting to go to tonight and had to miss it. Then I found out the meeting was next week and I could go, yee haw. The other thing I really like about doing the evening class is I always stop by the snack shop and power up with a Great Harvest snack bar. The 500 calories in the bar are a bit excessive, but i burn over 500 calories in the 60min class, so, it's a push.
I enjoy the Monday night class so much that I've added a Thursday morning class to my routine and it really gets me off to a good start. I don't feel pressed to get an evening workout in that day. I find different instructors have differing styles and formats for the classes they teach, so each one is a little different.
I always tell my patients to find something you like and can make a habit...I like this habit.
Dr. Ronan

Thursday, March 7, 2013

Know Your Numbers

The tubes on the right represent two different patient's blood samples. The one one the right is a normal sample with spun down red blood cell products on the bottom and a relatively clear/yellow layer of serum. The sample one the left has a milky serum that is high in cholesterol and Triglycerides (fats). A normal Triglyceride level is about 150ng/dl or less, but this person's TG's were over 1000ng/dl or nearly 10 times over the normal limit.  Blood like this leads to pancreatitis, fatty liver disease, coronary artery disease and other atherosclerosis or fatty deposits within the walls of arteries. This patient is 38 years old and completely unaware that he is heading towards an early heart attack.
The take home message is go to a doctor at least once a year to get basic blood work done, check your weight and blood pressure and see if you are due for any vaccinations. Just 30 minutes once a year can make you aware of an impending health problem like this person.
What are your numbers? Find out.

Tuesday, March 5, 2013

You Are What You Eat

One of my patients got his blood drawn in the office today to check his cholesterol. The blood was spun down and my lab technician just about fell over when she looked at the tube. A normal tube of blood like the one on the right, should have red blood cells on the bottom, and a clear serum on the top.

The tube on the left looks like it has melted ice cream in it. That is because the person who donated that blood just ate 3 tacos for lunch today. It is what we call a Lipemic blood sample. I would have preferred a fasting sample of blood, but I've been trying to get a blood sample from  this person for 3 years now and this seemed like the best opportunity I would have for a while.

That creamy/milky triglyceride layer is what builds up in the walls of arteries. This patient is a relatively young person at age 38, but if he keeps eating like this, he'll start to have more health problems at an earlier age than expected. Your body just can't process that much fat, sugar and oil meal after meal. Eventually your liver and pancreas can't keep up and people start to develop a thing called Cardio-Metabolic Syndrome. Blood pressure goes up, sugars elevate in the blood serum leading to Diabetes, Lipid levels rise and your risk of Heart Disease or Stroke go up exponentially.

Be proactive, eat better!... you're worth it.

Monday, March 4, 2013

Online Messaging

Technology definitely has a place in health care. Sometimes we adopt technologies in our practice and find new ways to adapt them to patient care over time. One case is our patient portal from Relay Health.
Our practice adopted this system of patient to physician messaging about 10 years ago with the idea we could use it to start messaging with our patients from home or when we were out of town. It was a way to take some of the pressure off of the on-call provider and to introduce electronic prescription writing to the practice. We now have over 1400 patients online and growing. It has reduced our office call volume by about 270 phone calls per month, so our staff like it.

I used it today to take care of a nephew with special needs that lives in Detroit, but couldn't get into either of his doctors this week, since they are both out of town. My sister was able to attach a picture of a skin problem to a message and I could look at it from over an hour away and send a prescription and a care plan to the local pharmacy for him to start medication today. His treatment is documented in his chart and can be passed on to the local hospital or forwarded to his doctor when they are back in town. I did all of this from my desk at lunch.

Ask your doctor if they do web messaging or have a patient portal. Many Electronic Medical Records have them today.