Monday, April 29, 2013

Avoid the White Plate

When I talk to patients/clients about eating healthy, I use an analogy called the White plate (Carbohydrates). This is NOT a White plate. This is a Green (Vegetables) and Brown (Protein) plate with a dab of White.  It has 2 servings of vegetables (broccoli and bok choy), about 8oz of flank steak and 1/4 cup of white rice. The drink is water.

This meal takes about 20 minutes to make and is under 700 calories. Even my kids like it. The more Green and Brown you put on a plate the longer it stays in system and the less you desire the White stuff.

The next time you go through a buffet line or are grabbing items for your lunch, just try to make it 3 parts Green and Brown and 1 part White and you'll be on the right path.

Monday, April 15, 2013

Facial Fillers

Though not as long lasting as a face-lift, dermal fillers have become popular among women seeking a younger look and offer yet another alternative to cosmetic surgery.  As we age skin loses its volume and elasticity and hence, wrinkles appear. This is due, in part, to skin losing its ability to produce enough of a naturally occurring substance called hyaluronic acid (HA). Doctors have been using HA for years in knees for advanced degenerative arthritis, where the knee joint just doesn’t have as much of that squishy fluid as it used to, which causes the joint to wear out.  Two of the most popular fillers used today are Juvederm and Restylane, although other products are available.

Dermal fillers are substances injected into the skin of the face to fill in deep folds and wrinkles. They are used mainly for "static" facial lines and folds, the ones that don't come and go as you change your expression. They work chiefly as a substitute for lost collagen and fat under the skin. Their results may vary in different areas of the face, as does the duration of their effect.

The dermal filler field is booming because the effects are immediate, the procedure doesn't involve real surgery,  Depending on the areas treated, the procedure can be done during lunch and the results immediate.  The voluming effects of fillers can last nine months to a year or more.  Fillers are highly effective when combined with Botox or Dysport. The Botox inhibits strong facial muscles from creasing the skin and the fillers add some volume under the skin to smooth out the wrinkles. When combined together it is called a “Liquid Facelift” and the cost is significantly less than a surgical facelift. There is no missed work or downtime recovery.

Fillers are used mainly in the lower two-thirds of the face. Vertical frown lines between the eyes and right below the eyes can also be treated, but complications are more common in these areas. Thin lips can be plumped up to reduce wrinkles above and below the mouth. The winkles that most people are unhappy with are the ones that run from your nose the the corners of your outer mouth called the Nasolabial creases.

No cutting or stitching is required to increase dermal volume. Except for a little bruising at the puncture sites, there is very little evidence a procedure was performed. I generally recommend 5 days of recovery just in case my patients are planning on attending a wedding or other special occasion, especially for lips, which have a tendency to bruise more.

One other nice feature of fillers is that you can always add a little more at a later date. I can’t tell you how many times people come into the office complaining about wrinkles around the mouth and eyes and when I suggest fillers they say, “please don’t make me look like Angelina Jolie.” I tell them that I’ll use my best judgment and that I have a tendency to be conservative so that we can add some more later, if necessary.

Fillers don’t keep you from surgical options down the road, but they are an affordable treat for the person who doesn’t like what they see in the mirror.

Tuesday, April 9, 2013

Physician Assistants and Nurse Practitioners

Our office utilizes what are called Mid-Level Providers to help increase the access to Healthcare Services. We have 2 Family Physicians in our office, but let's face it, there are only so many appointments each day to meet with the doctor. Our practice got so busy a few years ago, that we hired a Penny Dabney, a Nurse Practitioner, to meet the need for same-day appointments and to do routine health screenings including PAP smears and well child examinations, wart treatments and other lesion removals. She works independently under the supervision of a physician in our office. It was such a tremendous success, that we later hired second type of Mid-Level Provider called a Physician Assistant to help Penny have openings as well. A PA degree is another mid-level provider that can work independently with physician supervision and has medication/lab order/imaging prescribing priveledges just like a NP. With the expansion of Healthcare benefits under the Affordable Healthcare Act, Mid-Level Providers like Penny will play a very important role in getting people into the healthcare system and keeping costs down. Some of my patients complained initially about not being able to see their physician, but most have been won over by our NP and PA in the office and have no problem being seen by one of them instead of me if I'm not available for a few days or out of the office.