Issue 132 - From industry leader to disruptor

FROM INDUSTRY LEADER TO DISRUPTOR: HOW ONE WOMAN REVOLUTIONIZED THE AESTHETIC SPACE AND CHANGED HOW PRACTICES DO BUSINESS

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FEATURING

TERRI ROSS

ISSUE 132

ASSOCIATE EDITOR

ASSOCIATE EDITOR

Brianna Connors

Derek Archer

LEAD JOURNALIST

PROJECT COORDINATOR

Riley George

Lillian Myers

EDITORIAL ASSISTANT

CREATIVE DIRECTOR

Ionuț Raicea

Aviana Roth

DIGITAL MEDIA DIRECTOR

SOCIAL MEDIA SPECIALIST

Hannah Townes

Lauren Rider

PODCAST DIRECTOR Justin Miller

CONTRIBUTORS

Yuko Tabasa, Ionuț Raicea, Gaye Newton, Louisa Emhof, Nathan Pipkin

A WORD FROM THE EDITORS Leading a healthy, well-balanced life is a challenging undertaking for many of us. New advancements in lifestyle or nutrition come to life daily, and the busy rhythm of our lives often prevents us from keeping up with what's fun and fresh.

Here at Top Doctor Magazine, we are on a mission to bring these advancements to your attention and become a source of inspiration for those who want to live their lives to the fullest. Our contributors will constantly keep you up to speed with fresh, entertaining, and reliable content, from nutrition and travel to lifestyle choices!

We hope that our handpicked ideas will guide you towards self-realization, selfimprovement, and willingness to help those around you better themselves.

- Derek & Brianna

Hypertension is on the Rise, and Almost Nobody Knows

07

Cardiac Amyloidosis with Dr. Syed Bukhari

18

How A Plastic Tube Is Playing A Pivotal Role In The COVID-19 Pandemic

26

Antibiotic Use May Now Be Linked to An Increased Risk of Colorectal Cancer

35

A New Hope for Painful Diabetic Neuropathy: An Interview with Dr. Richard P. Winne

04

Understanding Migraines: The Myths

13

The Next Telehealth Revolution is Here

21

An Industry Leader Shares 3 Secrets to Running a Successful Aesthetics Practice

32

Drinking and Smoking while Young Could Age Your Heart

40

Telehealth, It's Come A Long Way!

TABLE OF CONTENTS

01

T H A N K F R O N T L I N E

Y O U H E R O E S

TOP DOCTOR MAGAZINE

OCTOBER

2021 • ISSUE 132

Hypertension is on the Rise, and Almost Nobody Knows

By Louisa Emhof

O

ne of the first things you do when you get to the doctor’s office is get your blood pressure taken. Of course, it’s just part and parcel of the experience, but for a good reason. Rates of hypertension have been on the rise for decades, and it’s time we start paying attention to this “silent killer.” Learning about how common hypertension is, how to avoid it, and how to treat it is a great way to start taking care of yourself today.

Hypertension, commonly known as high blood pressure, is causing problems for millions of people worldwide. These numbers have increased rapidly over the last few decades, even though awareness and diagnosis have remained low. The 2020 projections show that within 20 years, there will be about 1.5 billion hypertension cases worldwide. This is one of the many reasons why focusing on treatment and prevention now is essential.

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Striking Rise of Hypertension Across the World Although about 108 million Americans have hypertension or are treating it with medication, the U.S. is not the only place with widespread hypertension. All across the world, rates of high blood pressure have consistently risen. There are estimates of over 1 billion cases throughout the world today.

The increased rates are significantly higher for low and middle income countries, which make up around 1 billion of the worldwide cases of hypertension.

Although it causes some terrible complications, hypertension is still largely ignored and discounted. It has become known as the “silent killer” in the medical world because of how often it causes death while the person doesn’t know he or she has it. The “silent killer” name stems from the symptoms, which are either hard to identify or nonexistent.

High blood pressure is currently the leading cause of heart disease and premature death worldwide. About half of all people with hypertension are unaware of their condition, even with increasing hypertension rates and higher prevalence of deaths worldwide.

As rates continue to rise, it is essential to know what causes hypertension so you can focus on a lifestyle that will prevent it. Hypertension, although potentially deadly, is relatively easy to treat once identified. So fear not; with the proper awareness and treatment, you can easily control this killer condition.

Causes of Hypertension Blood pressure is a crucial function of the human body. It is measured by the amount of force your blood exerts on the artery walls while your heart pumps blood throughout your body. The condition of high blood pressure happens when something goes wrong in your body, like a constricted or narrowed artery, making it harder for your heart to pump blood. This complication puts excessive pressure on the walls of your blood vessels. The pressure can cause significant damage to your body and lead to complications like vision loss, heart failure, stroke, and kidney disease, among other health problems. Now that we know what hypertension is, let’s look at the causes.

Hypertension can be caused by lifestyle factors such as diet, smoking, and not getting regular exercise. Other health conditions like diabetes and obesity can also increase your risk of high blood pressure. A higher risk of hypertension even sometimes accompanies pregnancies.

Studies link diets high in salt and simple sugars to an increased risk of high blood pressure.

Obesity is also a leading cause of hypertension because of constricted and stiffened arteries.

Lastly, smoking is one of the biggest culprits in causing hypertension.

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Although hypertension and its causes sound scary, most of the causes are avoidable, which makes preventing high blood pressure easier!

Preventing and Treating Hypertension Lifestyle changes combined with first-line antihypertensive medications are the best way to treat hypertension. Thankfully, medications for this condition are relatively cheap throughout the world. However, the main problem the medical world faces while trying to treat hypertension is the lack of awareness in patients.

If people don’t know they have hypertension, they can’t be adequately treated. This unawareness and the fact that symptoms can sometimes be invisible means prevention is incredibly important.

Exercising regularly, eating a balanced diet, and avoiding smoking are all great ways to keep your health intact. Getting regular check-ups with your doctor and making sure you are being monitored for healthy blood pressure is another way to keep yourself healthy.

Our Top Doctor Magazine team hopes that you take this newfound knowledge of the prevalence and dangers of hypertension and use it to check in with yourself and your loved ones. Remember: prevention may be the key to staying happy and healthy. Check in with your doctor and get tested for hypertension if you have any concerns.

Getting regular exercise and eating right are also great ways to take control of your health today!

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Understanding Migraiines The

W

Myths

By Nathan Pipkin

ith migraines affecting over 100 million people worldwide, it’s almost certain that either you or someone you love struggles with the condition. Out of 148 million impacted individuals, 37 million are in the United States alone. Unfortunately, figuring out the myths and realities of migraines can be a headache on its own. If you are a member of this group, it’s essential to understand the truth about this medical issue and its consequences.

Not caffeine! That is the first myth about migraines that we should do away with. While an unusual amount of caffeine can trigger a migraine episode, caffeine alone is not enough. Another misconception is that headache medicine will cure migraines. This isn’t the best way to think about it, as migraines cannot be “cured.” Instead, it’s better to use phrases like “prevent migraines” and “control symptoms.”

What Causes Migraines?

Medicines can help us accomplish these goals, but any product claiming to cure migraines forever is probably a hoax.

While both men and women experience migraines, women are more likely to experience them. Migraines are twice as common in women as they are in men.

Whatever your gender, the experience of migraines can be a serious distraction from your work or social life. Symptoms of a migraine attack often include throbbing pain in one or both sides of the head, a strong sensitivity to light, as well as nausea and vomiting. So, what causes them?

Realistically, your family history and age will play a more significant role than caffeine.

Specifically, around 80% of people who experience migraines have a close relative with the same condition. For example, if only one of two parents has experienced migraines, there is a 50% chance that their child will have them as well. Other influential factors besides family history include stress, changes in sleep, some food additives, and hormonal changes in women.

Another myth is that migraines can cause brain damage. While the pain of a migraine episode might make this scary idea seem plausible, there is no evidence that brain damage will result from migraines. And while there is a risk of stroke associated with migraines, that risk is extremely small - only 1 or 2 out of 100,000 people will experience this.

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What Can I Do? Fortunately, just because your family has passed migraines down to you doesn't mean you have to suffer forever. There are steps you can take to manage the symptoms of migraines, and we’re going to discuss those in the next few paragraphs.

Medication is one approach to treating migraines, but we should understand that there are two different categories of migraine medication. The abortive category should be taken at the first signs of an oncoming migraine, and these medications should decrease your symptoms. The other category of medication is designed to reduce the frequency and severity of headaches for people with more than four migraines per month. Another myth we can dismiss is that pregnant women cannot take migraine medication. While some medications designed for migraines are not safe for pregnant women, others are safe and will help ease the discomfort.

Since migraines often make you sensitive to things like harsh light or loud sounds, finding a private environment with soft lighting should go a long way in helping you tolerate the discomfort. Temperature therapy, such as ice packs or washcloths rinsed in warm water, can have a helpful numbing or relaxing effect. These are some of the best strategies for managing or reducing your discomfort during an episode.

But is there anything you can do to prevent migraines? Yes! You can organize three huge areas of your lifestyle to reduce the chance of experiencing migraines. The first is sleep.

Establishing regular sleep hours, going through a relaxing routine at the end of the day, and eliminating distractions in your bedroom will all help you get a better, more consistent night’s sleep.

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This will keep away any migraines that a poor night’s sleep might trigger.

In addition to sleep, your diet and exercise habits can also play a role in fighting off migraines. The chemicals that your brain releases during exercise often alleviate anxiety and depression, which can predict migraine episodes. Cardio activities like walking, running, or biking are especially helpful!

The most important eating habit to maintain to avoid migraines is consistent mealtimes.

Missing a meal entirely is one of the most common migraine triggers for people who already have the condition. Eat regularly and choose foods other than cheese, chocolate, caffeine, and alcohol (which can sometimes trigger migraines) to give yourself the upper hand.

A Final Word No matter what strategy you use, you’re not alone in the fight against migraines. While this genetically inherited condition cannot be cured forever, knowing how migraines affect you and exposing myths about them is a great way to reduce your discomfort and stay engaged with your life. Stay tuned for more!

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An Exclusive Interview with

Dr. Syed Bukhari

By Ionuț Raicea

Cardiac Amyloidosis with Dr. Syed Bukhari The innate human curiosity and thirst for knowledge have driven us to growth and prosperity for centuries. Yet, after each discovery, we're left thinking, "What's next?"

"Are there more avenues to explore?" "Where's the true final frontier?" Such an instinct will ensure humanity's growth and preservation for many years to come.

Although resounding breakthroughs are the ones that make the news or the first page in the papers, smaller but sometimes more applaudable progress is made every day, and we must bring to the spotlight medicine's unsung heroes. Their unshakeable dedication and unyielding patience were the seed that was always going to bring copious fruit to the field of medicine.

"I always wanted to be a doctor [...] When I started primary school, from that point I had in my mind that I would become a doctor and that never changed." These are the words of Dr. Syed Bukhari, MD, a researcher from the University of Pittsburgh Medical Center, who has received the ANSC (i.e., American Society of Nuclear Cardiology) 2020 Young Investigator Award in Clinical Science for his abstract, "Development and Validation of a Diagnostic Model for Transthyretin Cardiac Amyloidosis." Through his solid research and deserved recognition, Dr. Bukhari strives towards bringing more awareness towards this not only misdiagnosed disease but also underdiagnosed" cardiac disease.

Acknowledging the necessity to spread the word on his mission, we at Top Doctor Magazine had the honor and the pleasure to interview Dr. Bukhari himself and decode cardiac amyloidosis through his wisdom and encyclopedic wealth of knowledge. Therefore, join us in today's learning quest, and we will explain the ins and outs of this under-researched disease, from causes and symptoms to available avenues to amelioration!

First Steps into the World of Cardiac Amyloidosis Cardiac amyloidosis (or "stiff heart syndrome") is a disorder stemming from amyloid proteins (i.e., liver proteins that carry thyroid hormone and vitamin A in the blood). Due to various reasons (e.g., the aging process, genetics, etc.), these proteins create deposits in the heart tissue (or other organs), thus impeding the heart from relaxing. This process, in turn, hinders the heart from accumulating and pumping enough blood to the body.

Hence, patients with cardiac amyloidosis experience symptoms akin to heart failures, such as shortness of breath and constant fatigue.

Moreover, the heart itself begins to work at a lower capacity, resulting in a condition called bradycardia (i.e., slow heart). Unless treated, cardiac amyloidosis can prove fatal.

Dr. Bukhari further discusses cardiac amyloidosis by mentioning the two faces of this disease: immunoglobulin light chain amyloidosis (localized in the patient's bone marrow) and transthyretin amyloidosis (localized in the heart tissue).

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Due to its complexity, the latter especially interests Dr. Bukhari, who sees more transthyretin amyloidosis patients every day.

As he shares with us, "Because it's a more specialized field, people prefer sending patients to specialized amylose centers for the diagnostic workup, treatment, and follow-up."

How Common Is Cardiac Amyloidosis?

Up until the last few years, cardiac amyloidosis was considered a rare disease due to poor testing. However, as Dr. Bukhari tells us, the real numbers are bewildering.

"We found that around 20% of our patients who are hospitalized for congestive heart failure, especially above the age of 70, suffer from the amyloid disease. And the reason is, it's not a rare disease anymore." The past poor numbers lie in the applied testing methods, mainly biopsies, which older patients tend to avoid.

Today, however, physicians are much better prepared to detect this disease ahead of time.

The merit falls on the pyrophosphate (PYP) scan. This nuclear test employs the Tc99mPYP radioactive agent, which detects the amyloid protein or other abnormal antibodies present in the heart.

The PYP scan enjoys sustained popularity amongst physicians, primarily due to its effectiveness and noninvasive approach (unlike biopsies, the Tc99m-PYP agent is delivered intravenously (IV)). This innovation allowed physicians to bring more cases of cardiac amyloidosis to light and understand the disease's pervasiveness.

As Dr. Bukhari explains, "With the advent of this noninvasive testing, we found that the prevalence in the community is far higher than we anticipated."

Cardiac Amyloidosis Treatment The research behind cardiac amyloidosis derives its urgency from the disease's irreversible trait. Unfortunately, the current treatment options do not go further than alleviating its symptoms, as Dr. Bukhari confesses. "​​The available therapies stop the further progression of the disease; they do not reverse the disease. Whatever has been deposited in the heart has been deposited. [...] (i.e., Current medicine) stops the step in which the protein becomes unstable."

However, the odds for patients with cardiac amyloidosis improved drastically once Tafamidis, the first FDA-approved oral medication for the age-related amyloid disease, was released in 2019. Tafamidis acts as a stabilizer on TTR (i.e., transthyretin), a protein responsible for transporting thyroid hormones and vitamin A to specific organs, impeding it from breaking down and converting into amyloid protein. Therefore, less amyloid protein in the heart tissue is synonymous with reduced heart failure risks and hospitalization and improved survival chances for patients.

How Do Patients with Cardiac Amyloidosis Fare against COVID19?

As the Delta COVID-19 variant runs amok throughout the country, we were curious to learn what coronavirus means for cardiac amyloidosis patients. Right away, Dr. Bukhari warns patients to always be on the lookout for COVID-19 since their hearts are

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already weakened and less capable of tackling the virus. "A normal heart has the capacity of recovering pretty quickly, but unfortunately, these hearts that are already very thick, very stiff and are going through a lot, like even under normal circumstances, they're not working efficiently."

Since we cannot predict the COVID-19 disease's evolution, it all boils down to the virus' behavior. As Dr. Bukhari further explains, "A lot of times, COVID-19 does impact the heart, and it causes inflammation because COVID-19 affects those receptors in the heart, also the ACE receptors. So it can cause inflammation in many circumstances."

However, as long as COVID-19 does not attack the heart tissue, cardiac amyloidosis patients are not significantly disadvantaged compared with healthy patients. With proper care, they will see the end of the COVID-19 disease.

Detecting Cardiac Amyloidosis through Links with Other Diseases Assessing symptoms is frequently the most straightforward way towards disease detection. However, what happens when symptoms paint a blurry picture, inconsistent with the patient's medical history? For example, as Dr. Bukhari suggests, "someone having bad heart failure without a good cause to explain that heart failure, without any underlying coronary artery disease."

Therefore, Dr. Bukhari advises us to look for other diseases and their symptoms, such as high blood pressure, hypertrophic cardiomyopathy (i.e., muscle heart thickening), and aortic stenosis (i.e., narrowing of the aortic valve opening).

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Furthermore, cardiac amyloidosis might be wearing the mask of other diseases, surprisingly unrelated to cardiac diseases.

For example, patients with a history of bilateral Carpal tunnel syndrome are at risk.

Why? As Dr. Bukhari fascinatingly explains, "before this amyloid disease starts depositing in the heart, it starts to deposit in the tendons; it's very interesting. How and why does this happen? We don't know yet." Add heart failure symptoms into the equation, and you get a solid cardiac amyloidosis sign.

"Concomitant heart failure symptoms should raise the alarm in our minds about the amyloid disease."

A Parting Reminder Dr. Bukhari's insights on cardiac amyloidosis are essential in enriching our understanding and raising awareness on cardiac diseases, which took almost 18 million people in 2019 alone. Such numbers prompt Dr. Bukhari and other cardiovascular physicians to stress once more the gravity of a healthy lifestyle and constant exercise. "It's really important to tell them (i.e., the patients) why it's important for their health, why they have to do at least 30 to 45 minutes of exercise every day, at least brisk walk every day, why they don't have to smoke, why they have to take care of their diets."

Here at Top Doctor Magazine, we can only hope that Dr. Bukhari's dedication and patience will lead to more relevant discoveries in the fight against cardiac amyloidosis. If you're curious to consult his award-winning article, make sure to check out the following link.

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health

The Next Telehealth Revolution is Here

By Ionuț Raicea

Being a physician in today’s times is no walk in the park. Aside from working amidst a pandemic, focusing on technological advancements, insurance company disputes, and management tasks make it harder for physicians to manage their businesses and careers independently.

However, what if we told you that you, the physician, could improve patient care, save lives, and increase profitability while regaining your peace of mind and freedom to enjoy your life?

Here at Top Doctor Magazine, we are delighted to welcome you to the future by introducing our newest technology and telehealth medical partner, ready to assist physicians all across the country in helping millions of patients better take care of their health – TopDocRX! Over the next few minutes, we will learn how TopDocRX helps physicians in every layer of their practices, from chronic care solutions to remote patient monitoring. Furthermore, we will show you how to attract more patients and expand your own practice through these efficient and straightforward approaches to patient care!

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TopDocRX, Revolutionizing Chronic Care Solutions As opposed to acute care, chronic care is targeted at long-term illnesses. TopDocRX understands the expense that comes with maintaining the care of chronically ill patients.

Annually, the total cost of chronic care treatments in the U.S. is roughly $1.65 trillion.

This is why TopDocRX offers solutions like remote patient monitoring that brings down the cost of delivering chronic care solutions.

TopDocRX also recognizes the challenges of chronic care treatment that can lead to therapeutic competition

As patients deserve the best when it comes to their care and don’t deserve to get stuck in the middle of insurance and medical practice and hospital and in-home care agency competitive squabbles, TopDocRX’s telehealth solutions help to create a higher standard as the new common denominator across the medical landscape, which is a direct win for patients and chronic care patients in particular.

TopDocRX’s Chronic Care Solutions Just Work The TopDocRX call center, staffed by over 900 telehealth workers which includes nurses and physicians, provides an ever-present, on-call solution for patients around the country.

Think of this as a virtual hospital with specialists in every field available at your fingertips through their award-winning app.

Starting with only a simple 20 minute call from our certified and trained nurses, your patients will have direct access to these professionals, without the many bureaucratic overhead costs associated with traditional chronic care. Get the help you need and want when you need and want it. As their nurses work with your patients, they will also tailor and build the needed program that is perfect for each patient. No matter the level of care needed, they will build the appropriate program required. After compatibility has been established, enrolling your patients into their Remote Patient Monitoring (RPM) platform becomes our top priority for you and your patients. This is because the technological advances that RPM brings to the table allows TopDocRX’s staff to monitor patients 24/7 from the comforts of their own homes.

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TopDocRX, the Ultimate Remote Patient Care Monitoring System Caring remotely for patients is now an everyday reality, and the waiting rooms are nearly empty as a result. With RPM, you can easily keep an eye on your patients more safely even than in-person visits!

However, the following reasons have been listed as the most common deterents among physicians from choosing RPM solutions in the past: Legal compliance Lack of a proper billing system (over 80% of medical bills contain errors) Lack of FDA-approved electronic equipment Low patient retention, and Patient-unfriendly platforms As if these reasons were not enough, the actual costs (staff training, RPM kit, initial office setup, software costs, etc.) for a 300-patient practice ranges anywhere between $143,500.00 and $260,000.00! With such skyrocketing costs and no clear return on investment in sight, it’s no surprise that very few medical practices adopted the burgeoning RPM technological developments.

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Considering how primary care practices were expected to lose up to $15 billion in 2020, additional costs were the last thing that any practice would consider incurring. This game has now completely changed thanks to TopDocRX’s RPM system which is the donefor-you remote patient monitoring system that practices have wanted but not been able to execute as a solo venture. That is why the TopDocRX RPM system is here to assist your patient care efforts free of charge… that is, to you and your patients. Once you outsource to TopDocRX, you can have highly effective and qualitative care direct to chronic and acute care patients using specialized monitoring equipment and personnel. Furthermore, using our VAC (Visual, Audio, and Kinesthetic) method of communication, our staff constantly receives training on how to see, hear, feel, and solve any patient issue simply and professionally.

Which Kind of Medical Practices Will Benefit the Most from TopDocRX RPM? As a physician, especially one with a packed waiting room, you need to share your attention with a vast array of patients, regardless of their current medical conditions. At such times, the ability to sift through data and deliver patientcare-relevant conclusions quickly becomes paramount. TopDocRX RPM was designed to be your solution here by collecting and analyzing the data for you automatically and behind the scenes.

If you find yourself in need of a virtually costfree digital assistant backed by over 900 medically trained personnel to assist you with your practice’s growth, TopDocRX gives you the ability to scale your medical practice infinitely.

With its comprehensive data collection, TopDocRX RPM allows you to implement patient care more straightforwardly; you will benefit your patients by reaching conclusions to support patient care faster and more efficiently. In turn, your patients are able to respond promptly to their medical issues and avoid specific health issues in the future. RPM is the ounce of prevention that is better than a pound of cure.

Once the system is in place (which takes about a day of work in total from the applications and inoffice equipment setup and demonstration), keeping an eye on your patients' health will never be easier! You can choose to monitor your patients and data directly or have our medical staff do it for you.

However, while TopDocRX RPM has vast applications for all patients and practices, it works best for: Chronic care patients - These are patients with chronic diseases such as diabetes, depression, Alzheimer's, or multiple sclerosis who can then enjoy their freedom at home without supplementary physical human supervision.

Critical care patients - TopDocRX RPM helps monitor patients in hospices.

Why Should I Outsource to TopDocRX RPM? The answer is multiple, yet simple – first off, outsourcing to TopDocRX will allow you access to the TopDocRX Connect, the first genuinely comprehensive virtual care platform, meeting the patient at the point of care. They provide preventative, 24/7 healthcare to high-need patients in detail while collecting enough data for you to draw faster, more effective, and cost-efficient conclusions to support patient care! They provide all the medical devices and wearables necessary for data collection, as well as the patient health kits, to the patient while following, of course, all HIPAA and FDA regulations! As for the patients, they will enjoy copious benefits for a service that is covered

by Medicare and Medicaid: Telehealth direct access chat to nurses 24/7 Telehealth video access to doctors 24/7 900+ call center staffers ready to assist their needs Real-time, automated data and insights

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Second, the platform allows you and your personnel to immediately respond to any drastic changes in your patients’ health, track their medicine intake, and send push notifications when needed. You will be able to track your patients’ heart rate, glucose, step count, and any other essential variables to their health on a straightforward interface, friendly to young and old users alike!

Third, the platform offers trustworthy billing services. For other RPM systems, billing is frequently accompanied by errors, namely in over 80% of cases, so TopDocRX has automated as much of this as possible for you.

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Are you ready to introduce your patients to the wonderful modern world of remote patient monitoring, providing better care for them, better patient retention for you, and allowing you to scale your business infinitely? This truly is a business growth proposition… literally in a box. If you are ready to get started, that is fantastic! It is time for you to take the next step towards improving your patient care and contact TopDocRX here.

If you aren’t quite ready to get started and have additional questions call 1-855-904-1047 or schedule a consultation here.

Microvascular Testing System TopDocDX presents a real-life picture to the patient, with all its positive and negative influences. Therefore, physicians will have an enhanced understanding of the patient's overall health.

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15-minute Non-invasive Onsite Diagnostic Tests This clinically powerful and noninvasive testing system for hidden diseases in asymptomatic patients provides the patient with an inside-out look on their health.

Early Detection of Chronic Disease in Asymptomatic Patients Diagnose Complex Symptoms Increase Patient Compliance with Treatments

How A Plastic Tube Is Playing A Pivotal Role In The COVID-19 Pandemic

By Ionuț Raicea

Years before the pandemic, a medical student saw a 19-year-old young woman coming to the ICU with postpartum complications. After being put on ventilation, her condition deteriorated even further; she contracted a very antibioticresistant infection called ventilator-associated pneumonia (VAP). Unfortunately, the woman's immune system gave up, and she passed away.

We employed Dr. Wang's knowledge to write a thorough article on how an overlooked detail is becoming critical in caring for the sickest patients during the pandemic. Let us learn how Dr. Wang's approach could be the turning point in the battle against ventilatorassociated pneumonia and COVID-19!

The medical student had to relay the tragic news to her family; "this newborn child does not have a mother because she got an infection." This whole experience left our student baffled with questions surrounding the quality of breathing tubes. After identifying the breathing tube as the problem, he realized that someone needed to make a better breathing tube. Such a device would need to prevent fluid, bacteria, viruses, and other pathogens from reaching the lungs, but more importantly, it would need someone to devote themselves to creating it. "And I said, 'I'm going to make a breathing tube that will prevent cases like this from ever happening again.'"

His name is Benjamin Wang, MD, and we are pleased to say that he honored his pledge. Today, Dr. Wang founded NeVap, a company producing breathing tubes that have been instrumental in saving the lives of COVID-19 patients. Our Top Doctor Magazine team was delighted to learn about Dr. Wang's work and its role in the pandemic.

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Ventilator Systems and VAP

Multiport Subglottic Suctioning

Although frequently critical, invasive mechanical ventilation is not devoid of risks. Because of the invasive nature of endotracheal or tracheostomy tubes, oropharynx or stomach secretions, rich with bacteria, will almost always leak along with the airway device into the patient's lungs. The longer a patient spends on a ventilator, the higher their risk. The inability to protect the patient's lower respiratory tract leads to numerous cases of VAP and unnecessary fatalities amongst COVID-19 patients (44%-50% rate of VAP in COVID-19 patients).

To improve the safety of mechanical ventilation, Dr. Wang and his NeVap team set about creating a solution that could improve the efficacy of subglottic suction drainage in the ICU and bring this technology into other settings to benefit patients who would otherwise not be helped. They determined that a breathing tube that could reduce aspiration in all settings without engaging airway tissue could benefit clinicians and patients without requiring any additional equipment. Thus, the NeVap Aspire Subglottic Suction Endotracheal Tube, or ASSET, was born after several years of development.

The Introduction of Single Port Subglottic Suctioning Ventilator systems were improved by creating breathing tubes that could drain secretions before entering a patient's lungs. Over the past 15 years, single port subglottic (i.e., under the tongue) suctioning endotracheal and tracheostomy tubes have been clinically beneficial by reducing VAP incidence (40%-67%), antibiotic exposure, length of mechanical ventilation, and mortality. Compared with previous technology, subglottic suctioning is a clear step forward.

However, this new technology is not without flaws. For example, respiratory care practitioners must often deal with subglottic suction blockage due to entrapment of airway tissue, often exceeding 50% within 5-15 minutes.

In addition, due to both the device's efficacy and reduced clinical benefits, only approximately 20% of hospitals currently utilize this class of breathing tube. Consequently, using these tubes effectively in Operative or Emergency settings hasn't been possible, further limiting the number of patients who can benefit from these devices.

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The ASSET tube uses 24 suction fenestrations and a tissue blocker to significantly reduce suction blockage while providing more effective suction removal of the secretions that cause VAP. The tissue helps point suctioning away from the patient's tissue and decreases the distance between the suction source and airway fluid. In testing, NeVap ASSET removes ten to fifteen times more secretions responsible for VAP when compared to other tubes. It has been successfully used in a variety of patients during surgical procedures and emergencies.

A Superior Way of Preventing VAP Dr. Wang and his team have devoted nearly a decade to develop what he believes to be the most logical and straightforward way to prevent VAP. Aside from superior design, NeVap ASSET is already benefiting patients in ways no other breathing tube has been able. Patients who need transplant surgeries, cardiac surgeries, trauma patients, and even COVID-19 patients benefit from better infection prevention due to the NEVAP breathing tube. In addition, this simple device benefits patients without using any chemical or pharmacological agents, so its infection prevention benefits can be used indefinitely. Moreover, with the average VAP treatment costing hospitals over $40,000/case, the NeVap ASSET is a clinically significant innovation and a critical way to save hospitals.

With professional societies like CHEST reporting the high rates of VAP in COVID-19 patients, it is clear the critical role innovative devices like the NEVAP ASSET tube play in combating the pandemic. Keeping ICUs from becoming overcrowded and helping patients recover without mechanical ventilation should be every hospital's goal. Over 30,000 NEVAP tubes have been sold worldwide, and the device is winning the trust of clinicians worldwide. In the coming months, we hope more hospitals will take a hard, honest look at this breathing tube that is making a difference during the pandemic and ushering in an age of safer mechanical ventilation.

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An Exclusive Interview with

Terri Ross

By Yuko Tabasa

An Industry Leader Shares 3 Secrets to Running a Successful Aesthetics Practice

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n the hyper-competitive field of Aesthetics Practices and Medi-spas, it’s never been more vital to have a comprehensive system in place to ensure the practice’s growth and profitability.

Terri Ross is a world-renowned practice management consultant with years of leadership experience in the sales divisions of Fortune 500 medical device companies, corporate sales training programs, and was recruited as a business growth consultant by some of Beverly Hills’ top plastic surgeons such as Garth Fisher, MD, Paul Nassif, MD, David Amron, MD, and Andrew Frankel, MD. Her new company, Aesthetics Practice Accelerator (APX), takes the experience of launching and growing medical aesthetic practices in competitive markets such as Beverly Hills and gives medical professionals worldwide a proven platform for optimizing their business and increasing their bottom line. In her interview with Top Doctor Magazine, Ross tells us some of her many secrets that APX has identified as critical to a successful aesthetics practice.

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Training for Profitability Let's dive in deeper into training for profitability - which is ultimately the primary goal of any successful business. Ross' proven track record of turning around all the businesses she’s handled has rightfully earned her a spot as one of the top aesthetic industry leaders. A great example of her exemplary powers is when she transformed an underperforming medical spa in Beverly Hills by growing its revenue to over half a million dollars in one year. The practice doubled the space, she grew the team from two to eleven, and she reduced debt by 75%. But that's just the beginning. She started her aesthetics career as the Sales Director for Medicis, now Galderma, then was recruited to Zeltiq as the Regional Sales Director. Ross launched Coolsculpting on the West Coast and in Canada, which generated $5 million in sales.

How did she do all of this, you might ask? What lies at the heart of all these professional successes is quality training for every hire and a proven program in which staff can maximize sales opportunities. One of APX's most unique resources that businesses have used to achieve massive growth (even during a pandemic) is the foundational sales and finance courses for each aesthetics practice team member. From the beginning, the onboarding process includes high-level training to operate with profitability in mind for the company. Ross ingrains these words in every client she works with, "Be smart with the treatments that you plan to offer, understand the profitability of those treatments, invest in knowing the numbers, and invest in training your team and creating a culture of leaders.

That's my advice."

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Know Your Benchmarks Ross has a deep understanding of industry benchmarks and competitive trends. To get into the business, one must know “WHY” they are getting into the aesthetics market in the first place, and if in business for several years, knowing what your UVP is, your unique value proposition. In addition, what services they can offer, who their ideal clients are, and how much money they should be making for their services. Unfortunately, many doctors or business owners are still not aware of the concept, and they go into the business unprepared. This sets up failure for their practice, but luckily for them, Ross and APX are here to save the day.

One of the APX platform’s core components is called GAUGE, which gives businesses up-todate access to industry benchmarks and competitive trends. “We teach them what services generate the most profit, what your rooms need to generate per hour, what your services need to generate per hour, and what your providers need to generate per hour.

When they understand these metrics, it's actionable data that allows them to make informed decisions that affect growth and profitability,” The power in knowing this information allowed one of our practices to grow 2800% in 2020 Ross explains.

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Setting Up Chart of Accounts Accurately Another not-so-secret piece of advice to running a successful aesthetics practice is having the right financial analysis. "People think setting up your P&L is a daunting thing, and it can be - but if it's set up correctly where you have your service revenue, your cost of goods, and provider cost of labor, you can accurately measure your net profit.

Unfortunately, some people have their P&L all messed up," Ross points out the usual case scenario she runs into with her clients. But, with APX's ABACUS, clients get six financial calculators that translate raw data from practice management software into actionable insights such as profit per treatment or revenue per hour. These financial calculators and analytics give you actual information that tells you what your gross profit is, which should be well over 50%, if not you are losing money. What your weighted revenue per hour is by service category and by provider. If you are not hitting industry benchmarks then you have the ability and information to coach to improve the process or team and the overall practice. It takes the guesswork out for the medical professionals who often struggle in the area of data. In addition, Ross also highlights the correlation between business efficacy and profitability. "Profitability lies in making an effort to be efficient." And what

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does that mean? You're efficient in your cost of goods, your practice productivity, you're efficient in your processes, you're efficient in your protocols, you're efficient in running your software systems, you understand what KPIs to measure. More importantly, what to do with those KPIs to make an informed decision that's going to increase or decrease something?" says Ross. Having an expert by your side to help you with training, education and analytics has proven to provide practices with on-demand training, knowledge, resources, and coaching they need to run and sustain a profitable practice.

The Future of Aesthetics Ross notes that demographic shifts are going to play a significant role in changing industry trends. While baby boomers have more disposable income or purchasing power, millennials are becoming more interested in aesthetics treatment, anti-aging, and wellness. Treatments such as facial injections and body contouring are still popular, but sexual health, new laser developments, hormonal treatments, supplements, and holistic wellness are definitely rising. With the continued growth in the aesthetic market, millennials, and males, it’s critical to stay on top of industry trends; moreover ensuring it makes financial sense. APX has a built-in network called LUCID, which monitors over 50+ marketing analytics in real-time on one dashboard. The company also has a weekly live coaching session called COMMUNITY, where Ross and her team interact with practices worldwide. This live weekly session allows companies and clients to get real-time coaching in a wildly changing and competitive marketplace and have access to the support and accountability they need.

ANTIBIOTIC USE:

RISKS & ALTERNATIVES

Antibiotic Use May Now Be Linked to An Increased Risk of Colorectal Cancer

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By Louisa Emhof

uppose you've ever gone to the doctor's office with a persistent cold, the flu, or a myriad of other common illnesses affecting your life. In that case, you're probably familiar with antibiotic prescriptions. To be fair, they get the job done! They have been widely used in Western medicine for decades to treat and heal illnesses caused by bacterial infections.

However, there are some downsides to excessive antibiotic use.

The whole point of antibiotics is to kill illnesscausing bacteria growing in your body. But don't forget that there are trillions of good bacteria growing in your microbiome, whose absence makes human life impossible!

Unfortunately, antibiotic overuse has some serious adverse effects: one of the most pressing ones is the possible increased risk of colorectal cancer. Commonly known as colon cancer, this disease is the second leading cause of cancer-related deaths in the United States for both men and women. New studies show that there could be a connection between antibiotic use and an increase in your risk of colon cancer.

The Uses and Misuses of Antibiotics Since ancient times, civilizations have been using forms of antibiotics to heal and treat infections.

Although these people did not yet understand what bacteria was or even what the cause of some illnesses was, civilizations like the ancient Egyptians developed ways to heal through primitive antibiotic use. In the 1920s, scientists discovered penicillin, the first mass-produced antibiotic, which saved countless lives. However, despite the amazing things that the study and use of antibiotics have done for humans, this doesn't mean there aren't any downsides or dangers.

Antibiotics can’t choose between what we like to call "good" and "bad" bacteria. So when you're taking antibiotics for a common bacterial infection, the "good" bacteria in your microbiome are affected just like that "bad" bacteria causing the sickness. This feature of antibiotics can have some pretty severe drawbacks.

The prevalent use of antibiotics in the current medical world has led to many unintended consequences affecting the body's "good" bacteria in the microbiome. Increasing studies show that there may be a link between this attack on the microbiome and the start or progression of colorectal cancer. For that reason, many researchers are beginning to warn against the overuse of antibiotics.

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Excessive Use of Antibiotics Although antibiotics can be beneficial and have done a lot of good throughout history, there can be too much of a good thing. Both the rates of antibiotic use and colon cancer diagnoses have skyrocketed across the globe since the 1980s. The coexistence of these rates caused some researchers and medical professionals to begin questioning whether the overconsumption of antibiotics was causing the increased rate of cancer.

Since then, researchers have conducted numerous studies to see whether they could figure out the link here and hopefully begin cautioning people against the overuse of antibiotics. Unfortunately, despite the findings of many studies showing that there does seem to be a clear link, prescriptions for antibiotics continue to be one of the first reactions to bacterial infections. Therefore, it is essential to know how these medications could impact your risk of cancer.

Increased Risk of Colorectal Cancer Colon cancer is one of the leading causes of cancer-related deaths in the United States. It is also the third most common cancer diagnosis in America. The American Cancer Society estimated that in 2017 alone, there were 136,830 people diagnosed with the disease and 50,310 deaths. Based on recent research, these chilling numbers are linked with antibiotic overuse.

One study's findings suggested that antibiotic use potentially played a direct role in tumor growths in the colon. This same study also noted that these findings were especially true of people younger than 50 years old. Such conclusions raise even bigger red flags since most cancers are found in older patients.

Additionally, another relevant study found that the link between antibiotics and colon cancer was predominantly in a “dosedependent fashion.” This means that the number of antibiotics and even the specific kind of antibiotics you take may impact your increased risk.

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Preventative Healthcare is the Best Healthcare Other, more commonly known risk factors are also associated with colon cancer, such as tobacco use, obesity, and genetic disposition.

However, especially with the increased use of antibiotics in America since the 1980s, awareness of the link between antibiotics use and an increased risk of colon cancer is helpful for prevention. Knowing that this link affects younger people more often is also an important thing to note. Medical providers are beginning to push for colon cancer screening among younger people to help with prevention. As always: the best kind of healthcare is preventative healthcare.

Our Top Doctor Magazine hopes you will take this newfound knowledge of the risk factors of antibiotics and make choices that are best suited for you and your healthcare journey.

Asking your doctor for early screening for colon cancer or alternative options to antibiotics when prescribed are great places to get started!

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Antibiotic Use May Now Be Linked to An Increase Risk of Colorectal Cancer PART II

By Louisa Emhof

Antibiotics have become an everyday part of the medical world. They are used to fight bacterial infections and have saved millions of lives worldwide since their discovery. If you’ve ever had a bacterial infection, you're probably already pretty familiar with antibiotics.

However, the prevalent overuse of antibiotics is leading to some serious unintended consequences.

Although there have been remarkable benefits that antibacterial use has brought about, there is a dark side to it as well, such as an increased risk of colon cancer. Another problem that the overuse of antibiotics causes is antimicrobial resistance, which causes more dangerous forms of bacterial illnesses. Still, there’s no time to despair! Medical professionals and researchers are working hard to find alternatives to antibiotic treatments.

The Risks of Antibiotic Use Antimicrobial resistance, caused by the overuse and misuse of antibiotics, is one of the reasons that finding alternatives to antibiotic use is wise. Their life-saving effectiveness causes physicians and patients alike to rely heavily upon antibiotics, even for common bacterial infections. An example of the misuse of antibiotics is when they are prescribed for non-bacterial illnesses like colds and the flu.

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However, sometimes antibiotics are still prescribed for this. The overuse of antibiotics led to antimicrobial resistance by creating bacteria that are not affected by the medicine.

Another big antibiotic-related concern is the link to increased risk of colon cancer. Colon cancer is the second leading cause of cancer-related deaths in the United States. Rates of antibiotic use have skyrocketed since the 1980s, and scientists have also reported an alarming rise in colon cancer rates. What is especially concerning about this increased risk of cancer is that it affects people younger than 50 at a disproportionate rate.

Additionally, a study found a "dose-dependent" aspect to the link between antibiotics and colon cancer. Essentially, this means that the different kinds and doses of antibiotics you take impact your risk level. So what's the solution here?

Doctors, medical professionals, and researchers have been working hard to discover alternative ways to treat bacterial illnesses to avoid antibiotics' harmful effects.

The human body has many good bacteria in it that the antibiotics can't differentiate from the bad ones. This affects the balance of the microbiome in your gut and could be the link between the potentially cancer-causing aspect of antibiotics.

Protecting the good bacteria in your body is essential, which is why looking into alternatives to antibiotics is a great way to approach your health.

The Most Advanced and Promising Alternatives to Antibiotic Use Alternatives to Antibiotics The good news is that medical professionals are becoming increasingly aware of the negative repercussions of antibiotics misuse and overuse and are rigorously testing out replacements. Some of these different approaches to bacterial infections were used in ancient times.

Ancient medical techniques that involve natural elements like clay and minerals are being studied because of how extensive their antimicrobial activity is.

Just as researchers are taking note of more unconventional and ancient methods, they are also delving into new fields of research and technology.

One potential alternative method involves using what are called bacteriophages.

Bacteriophages, or phages, as they are often called, are naturally occurring viruses that target and kill bacteria. If you think about it, they accomplish the same thing that antibiotics do! This is why they are serious contenders for replacements for antibiotics. reign substance, antibodies retain that information and protect the body against future infection.

Lastly, vaccines are an outstanding scientific and medical invention that trains your body's natural immune system to recognize and neutralize foreign threats in small or benign doses so that your body can better handle the real thing. Your immune system essentially memorizes how to deal with an imitation of an infection and is then prepared to fight off the actual illness.

These three are the most advanced and promising alternatives to antibiotic use.

However, while we are still developing and researching these replacements, basic and reasonably limited antibiotic use will still need to happen.

A Parting Reminder Our Top Doctor Magazine team hopes this overview equips you with fresh knowledge on the potential dangers of antibiotic overuse and misuse. Now you can feel comfortable discussing different options with your doctor! Ask your doctor if you have any questions about whether you should be using antibiotics or an alternative method.

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Drinking and Smoking while Young Could Age Your Heart

BY IONUȚ RAICEA

The teenage years are the threshold when we form our personalities for the future adult life. It is also the time for once-in-alifetime experiments, when we take a shot at all-known vices with a just-once mentality.

Such endeavors, of course, are always risky, considering that most of our adult vices stem from our teenage years. "Just once" can quickly turn into "forever."

Out of all vices, drinking and smoking are the adolescent favorites, although secrecy doesn't allow us to grasp the severity of the situation. In 2019, almost 25% of people aged 14 and 15 had at least one drink, and in 2020, 4.5 million teenagers consumed tobacco products, especially e-cigarettes. Although one sip of alcohol doesn't cause PAGE

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addiction, one cigarette is often enough to get hooked, which is no wonder why 200 young Americans turn experiments into addiction daily. Social pressure, the link between smoking and AOD (i.e., alcohol and other drugs), and a precarious understanding of addiction lead our nation's youth to adulthood with medical problems.

Teenagers rarely ponder the immense workload that organs have to put in to keep up with their vices. Your body's engine, the heart, beats about 100,000 times per day and delivers blood through a network of vessels long enough to circle the Earth four times!

Such a Herculean effort does not leave room for error or unhealthy lifestyle choices.

Unfortunately, our conscious sabotage leaves marks on the cardiac system, especially in the arteries. Did you know that a smoker and drinker's arteries can significantly stiffen from a young age? Keep reading below to find out more.

The Effects of Smoking and Drinking on the Human Body Every mosaic loses its grandeur once enough people have stepped and caused the little pebbles to lose their color. Once a single pebble fades, the whole mosaic becomes incomplete. Drinking and smoking have the same effect on the human body, although multiple organs live with the consequences. The liver, the pancreas, the brain all have to suffer such faulty choices, not to mention the weakened immune system and the increased risks of certain cancers. Basically, we consciously sabotage ourselves without receiving anything in return.

But the most alarming drinking and smoking threats to our bodies have to do with the cardiac system. Both vices are linked with different forms of cardiovascular disease (or CVD). For example, indulging in more than three drinks per day enhances the risk of ischemic stroke (i.e., caused by blood flow deficiency) and myocardial infarction (i.e., heart attack). Furthermore, smoking, regardless of form, adds insult to injury by increasing the chance of congestive heart failure, hemorrhagic stroke (i.e., bleeding in the brain), and arterial disease.

Although young drinkers and smokers believe they can kick these vices before suffering from any medical issues, the truth is, they might already be suffering the consequences, especially in their arteries. Research has proved that even mild alcohol and tobacco consumption can cause arterial stiffening, therefore setting teenagers on a course to CVDs. The remaining questions are, "How far is the arterial stiffening process? and "How can we reverse the process?"

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What Happens to Our Arteries?

Typically, as the aging process kicks in, our arteries naturally lose their elasticity.

However, drinking and smoking heavily influence the speed at which the stiffening process develops. Therefore, the further teenagers indulge in these vices, the more the CVD risk increases.

Researchers from the UCL have shown that teenagers who drank more than 10 drinks in a typical drinking day had a 4.7% increase in arterial stiffening than "light" drinkers (i.e., less than three drinks). At the other end, high-intensity smokers (more than 100 cigarettes ever) had an arterial stiffening increase of 3.7% compared with lightintensity smokers. However, at the top of the ladder sit teenagers who heavily indulge in these two vices, whose arteries thicken 10.8% faster than those who "stay clean." Although slight in the short run, these percentages can prove troubling at a later age, when arterial stiffening gives rise to other CVDs.

How Can Teenagers Reverse Arterial Stiffening?

However, the battle is not yet lost. Vices do leave a stain on our health, but all stains can be removed with proper care. The researchers who conducted the Avon Longitudinal Study of Parents and Children (ALSPAC) in the U.K. encourage teenagers to bid smoking and drinking goodbye and embrace a healthy lifestyle. Professor John Deanfield, one of the ALSPAC researchers, affirms that "If teenagers stopped smoking and drinking during adolescence, their arteries returned to normal." And the benefits don't stop there -- ex-smokers frequently cite improved breathing, appetite, sleep, taste, and smell as short-term benefits of kicking this habit, not to mention the improved cardiac function and blood flow that follow suit. So there's no better time to defeat these vices right now, during the teenage years, while the body still preserves its miraculous healing capabilities!

Your Body Is Your Temple Worship It! Here at Top Doctor Magazine, we advise teenagers to spend their precious adolescent years healthily, without resorting to vices for social recognition. From personal experience, ex-drinkers and ex-smokers can testify that these vices are nothing but parasites who take your energy and health away without giving anything helpful in return. Therefore, we hope that our young readers will ponder the implications of their decisions before lighting another cigarette or ordering another pint and settle up with these vices forever.

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An Exclusive Interview with

Dr. Richard P. Winne

By Gaye Newton

A New Hope for Painful Diabetic Neuropathy: An Interview with Dr. Richard P. Winne If you are struggling with nerve pain, you may feel like someone is following you around, randomly jabbing you with a needle. Maybe you ache all day or don't sleep well. It's difficult to lead an everyday life when your daily flow is constantly brought to a screeching halt by a jolt of sharp pain. For many people with diabetes, painful diabetic neuropathy (PDN) can be annoying and frustrating at best, disabling at worst.

Board-certified in pain management and anesthesiology, Dr. Richard P. Winne, Jr., MD, shares with us his insights into neuropathy and its treatments. He is one of the most sought-after doctors for an uncommon condition known as Complex Regional Pain Syndrome (CRPS), also known as Reflex Sympathetic Dystrophy (RES). This is a painful neuropathic condition that can require a great deal of treatment by a very knowledgeable and experienced doctor and team.

Dr. Winne’s dedicated team provides the full spectrum of pain care—medical, psychological, physical, and interventional services, including spinal cord stimulation. To ensure the complete care their patients need, they also work closely with neurosurgeons, orthopedic spine surgeons, physical therapists, an acupuncturist, a psychologist, and nearly every other kind of medical specialist.

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Recently Dr. Winne discussed with us an exciting breakthrough device that can bring a new level of pain relief. This spinal cord stimulation device, called HFX, was approved by the FDA with a specific indication for treating PDN.

Painful Diabetic Neuropathy

Symptoms

Neuropathic pain is caused by damage within the nervous system - the nerves, spinal cord, or brain. The effects of neuropathic pain are not just physical; they can trigger depression and anxiety, which, in turn, can exacerbate the pain.

Caused by long-term high blood sugar levels, PDN may bring mild symptoms or be extremely painful and debilitating. Depending on the nerve damage, it can affect almost any part of the body, from head to feet, and cause sharp pain, numbness, digestive illness, vision trouble, and problems with various organs and systems. Symptoms can intensify without treatment.

Diabetes brings on a host of complications.

The American Diabetes Associates states, "about half of all people with diabetes have some form of nerve damage." PDN can be one of the more debilitating conditions to live with and manage, and, until recently, there have been few effective treatment options beyond medications, which don't always produce the desired results.

However, Dr. Winne is quick to point out that not all diabetic neuropathy is painful neuropathy, and that PDN is located in the peripheral body areas, mainly arms and feet.

“They can get all kinds of problems from diabetic neuropathy, but it's not painful. So we don't do stimulators if you have a fast heartbeat from diabetes because your heart nerves are affected by your diabetes, which happens, or your bowels don't work as well because you're nourishing. That's all diabetic neuropathy, but it's not painful peripheral neuropathy -- that's the difference,” he says.

Treatments Currently there is no cure for PDN. The goals of treatment are to slow its progression, address complications, alleviate pain, and improve the patient’s ability to function. You can take steps to prevent, delay, improve, or slow the progression of nerve damage, such as controlling blood sugar levels and blood pressure, surgery that destroys pain-causing nerves, or medications that provide widely varying degrees of relief.

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Some patients benefit from physical or occupational therapy. And then some forms of injections can be utilized to help reset the sympathetic nervous system, so it behaves more normally--a sympathetic blockade. You turn off the sympathetic nervous system for a brief time, which allows that nervous system to reboot. Dr. Winne describes this process more clearly through a computer analogy -“Just like if your computer wasn't working properly, you just turn it off, turn it back on, and somehow it reboots properly. Same thing with neurosis.”

Dr. Winne recommends spinal cord stimulation as a long-term solution. He further explains to us how electrical impulses interrupt pain signals with a very relatable example. “Say you hit your head on a desk, right? And then you pull away, and you rub it.

It feels much better, which makes no sense, right? Because you just smashed it; now, you're rubbing it. Why does it feel better?

Because when you rub it, you're activating the nervous system to help inhibit the pain signals. So you actually turn on that part of the nervous system that inhibits pain, and that's what the stimulator does, is it stimulates a spinal cord to turn on and activate a part of the nervous system, which pivots pain being felt,” he says.

New Treatment An extremely important recent FDA approval was just announced authorizing spinal cord stimulation (SCS) for the treatment of painful diabetic neuropathy. We expect this to help the lives of thousands. Dr. Winne’s enthusiasm is apparent, as this new device may alleviate nerve pain more effectively and reliably than previous methods.

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Approval Nevro Corp, a medical device company, received FDA approval for HFX, its Senza system for treating chronic pain associated with PDN. Approval was based on the system's demonstrated safety and efficacy in the SENZA-PDN trial published in JAMA Neurology.

It was shown that high-frequency, or 10 kHz, SCS is safe and effective for people suffering from extreme pain and for those whose medication does not provide the necessary relief. After a year, patients reported clear, sustained benefits--less pain, improved sleep, and better quality of daily life. This may mean that some patients can leave their mediations (and accompanying side effects) behind.

PDN can now be treated with stimulators, which Dr. Winne has been doing slightly in the past. As he tells us, “Now, painful diabetic, peripheral neuropathy has been studied and now approved to be treated with stimulators, which we've kind of been doing a little bit over the years, and I've been talking to various patients about doing it, but it's never been fully approved. Not that we can't do it, not that Medicare wouldn't pay for it, but now they (i.e., Medicare) definitely will.” This is excellent news to patients who desperately need this treatment.

How It Works Here’s a quick summary of the device's ultimate goal: When you stick this wire in someone's back, you stimulate the spinal cord, and that inhibits their pain.

Delivering 10,000 electric pulses per second, HFX does not allow the painful sensation to be relayed up to the brain.

The use of HFX begins with a test. Before implantation, the wires are temporarily placed on the intended spot on the body and connected to an external control box.

You can test it for one to two weeks in order to see how it feels and if you like it.

Unlike surgery, HFX is minimally invasive and totally reversible. If the pain improves within a few years, patients can have the system removed. HFX may be a viable option for people with nonoperative conditions or who are too ill for surgery. “If an 85-year-old lady who is not a good surgical candidate, either because her disease is too extensive or she’s too ill, that spinal cord stimulator is certainly a lot less than basic procedure and option for her,” explains Dr. Winne.

Conclusion The HFX device brings a new level of hope to people with diabetes. It puts into play a powerful new weapon against the debilitating effects of painful diabetic neuropathy.

We thank Dr. Winne for sharing with us his expertise in the world of neuropathy management, and we appreciate his dedication to giving his patients as many pain-free moments as possible. With the new HFX device in their arsenals, physicians now have more options to manage patients' pain and offer them a much-improved quality of life.

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Telehealth, It’s Come A Long Way!

By Melissa Blatt, CEO of indipop

Telehealth has been around a lot longer than you may think. The pandemic has made telehealth and telemedicine more of a household word as physicians limited patient’s in-person visits out of concern of spreading Covid-19. Since 2020, virtual visits have become the norm and adding a blood pressure kit, oximeter and improved electric thermometer to your Amazon cart has happened for almost all of us.

But did you know that telehealth first appeared in the 1940’s through telephone lines? And with the advancement of the motion picture industry came the technology that influenced today’s video medicine.

In addition to platforms like Skype, and Zoom for health, there are many new HIPAA compliant technologies that enable you to speak with your provider via computer, phone or tablet almost anytime, day or night. This round the clock availability provides you with access to a healthcare provider at those times of day previously regulated to an “urgent care” or emergency room visit.

Dr. Janice Johnston, MD, Chief Medical Officer and Co-Founder of Redirect Health tells us that telehealth allowed her to diagnose and treat conditions virtually that range from pink eye to managing someone’s glucose levels. “Telehealth has benefited the person with open access but also meaningful follow up.” says, Dr. Johnston. A patient that met with her at 2p.m. could follow up that evening if the symptoms got worse.

This ease of connection offers great relief to both patient and caregiver, as no one has to be untethered from the care they need.

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If things get worse, a Redirect Health provider can schedule a virtual follow-up visit to determine the best next steps, coordinate care at the local hospital or urgent care clinic and then alert the facility when the patient is on their way.

The New Approach to Managing Medical Needs Redirect Health makes healthcare work with a people-first approach to care, offering access to streamlined, affordable healthcare. Redirect Health combines physician expertise via the company’s own employed staff, easy-to-use technology and pro-active population health to bring transparency to care and cost.

It works like this: if you wake up with a sore throat, instead of calling your primary care doctor or heading over to the urgent care, a patient uses the Redirect Health app or care number. A concierge team speaks with you as a person, not an ID or group number. They ask what your symptoms are and help guide you to the best care. You may have a virtual visit with a provider or perhaps it will be to order your lab work. If that is the case, you’ll head directly to the lab and then have a follow up visit to go over results.

This is all included in the monthly fee. You are not limited to the number of times you can speak with a provider and don’t have to worry about co-pays, deductibles and excessive time spent with a provider. It’s all part of the standard plan.

The big difference is that, instead of stepping into a doctors office, you are in the comfort of your own home. Your providers are dressed just like you, so no white coat syndrome. They want you to feel as comfortable as possible and not rush you out the door.

If your telehealth plan is like one from Redirect Health, your provider is equipped with your medical history, current and past medications and has any on hand notes from past appointments, all to help you get the best care possible.

If you were seeing a traditional doctor or lab, the time spent traveling to different offices alone would have taken significantly longer and could have amounted to weeks of lost time. Telehealth makes it possible to have a virtual visit and start treatment almost immediately without needing to go to the ER or urgent care. This basic difference saves time, money, offers faster relief and more complete answers to you.

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Benefits of Managing a Chronic Condition What about chronic conditions like diabetes or thyroid conditions? A telehealth provider can help monitor your health with lab orders to stay on top of your levels and have a direct contact to check in with you 24/7.

Covid-19 is a perfect example of how telehealth can be a lifeline when you are battling an unknown virus. Each case is so different, one minute you are breathing fine and the next minute gasping for air. A telehealth provider can assess your symptoms virtually by watching how you speak, cough and your appearance to make quick decisions about the care you need. They are also there throughout the night to contact if any new symptoms may arise and can prescribe the medications that may be necessary to get you feeling better again.

Healthcare can have many Barriers and Cost Shouldn't be One of Them Far too many people get concerned when they see their provider and the visit calls for additional procedures and tests. If you don’t have a comprehensive insurance plan and/or if you are self-pay, the unknown costs can cause you to hesitate. What will the tests cost? How many will there be? What other unknown procedures are lurking around the corner? If you have ever been in this situation, you know it can feel scary staring at an open bill. Unfortunately, some people stop their treatment at this stage for this very reason, resulting in prolonging your symptoms and extending the time to start the healing process.

It’s important to note not all physicians are aware of the cost of medication or tests. On a telehealth plan, your provider can often begin with just one or two items on a bigger list to see if the first tests/procedures bring relief. The ease of frequent check-ins allows for easier connection between patient and provider and eases the stress of waiting for appointments and additional cost associated with it.

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Telehealth, an Option to Explore Inquire with your insurance if they offer a virtual service. If they do not, you can find plans out there that offer telemedicine services and have regular open enrollment so you can sign on as a member and have access to their providers. Consider your lifestyle if you think this may work for you. Services like Redirect Health are a great option if you have children because no one wants to get out of their comfy bed at 2a.m. to go to the ER for their 5 years old’s rash or upset tummy.

Remember as you look at plans to be sure and include the following items: Ability to see the same provider multiple times Available 24/7/365 Easy access to health history once you have provided it The pandemic may have propelled virtual medicine into our lives, but the quality and access to care will launch this service into the mainstream soon. The good news is that this shift will improve the healthcare experience for everyone, not just people who are on specialized plans.

A Word from indipop Founder & CEO, Melissa Blatt In 2019, I left the corporate world to start a new chapter in my life. I craved the freedom offered by working with clients and projects that sparked my interest. I knew being self-employed would be a challenge, but I did not expect the sticker shock I found when it was time to look for healthcare. I could not afford the COBRA plan and became deeply frustrated with the options I found.

I was worried about the “what if” scenarios and knew I wasn’t alone – 57 million Americans are self-employed, or what I like to call the “Independent Population.”

I found my solution in healthshares. Although not mainstream, they are a different approach to managing medical needs, with fair medical pricing, concierge care and lower monthly rates. I created indipop because I want to offer you the same solutions.

Then, you too can be free to do your best work and pursue your dreams, without worrying about “what-if” scenarios.

I’m excited that you’re here and exploring an important alternative to traditional health insurance. I want to personally invite you to review our handpicked plans so you’re prepared for the expected, and unexpected, medical needs in life.

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