20 Episode results for "Psoriasis"

Healing Psoriasis From The Inside Out with Dr. Todd LePine

The Doctor's Farmacy with Mark Hyman, M.D.

40:33 min | 1 d ago

Healing Psoriasis From The Inside Out with Dr. Todd LePine

"Coming up on this episode of the Doctors Pharmacy One of the key things I. Always ask my patients also is the component of stress. Not that stress causes psoriasis or stress causes immunity, but stress affects the immune system. Hey everyone start your island. Supplements or one of those things that I'm always being asked about is it worth spending money them? Do we need them if we really eat well and can your body even absorbed him and the answer to most of these questions is it depends there are definitely certain supplements I'd never recommend taking because they aren't made no way that your body can take advantage of any just won't be able to use them, and there are definitely some supplements we can benefit from because our food supply. Even if we're eating whole organic foods, just doesn't provide enough of certain nutrients that we need for Optima health now, major one of those. 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I M. is e e r s dot com slash hyman use the code hyman ten and you'll get ten percent off this really great formula I think you'll love as much as I do do you have F- Elsie What's FLC is when you feel like crap is a problem that so many people suffer from often have no idea that it's not normal or that you can fix it i. mean you know the feeling it's when you're super sluggish your digestion off you can't think clearly or your brain fog or you just feel rundown can you relate nine most people can but the real question is what the heck do we do about it? Well, I hate to break the news, but there's no magic bullet FLC isn't caused by one single thing. So there's not one single solution. However, there is assistance base approach to tackle the multiple route factors that contribute Chelsea and I call that system that ten day reset the ten day reset minds food key lifestyle habits, targeted supplements to address FLC's straight on. It's a protocol that I've used with thousands of community members to help them get their health back contract. It's not a magic bullet. It's not a quick fix. It's a system that works if you WANNA learn more and get your health back on track visit get pharmacy dot com that's get pharmacy with an F. F. A. R. M. Y. dot com. Welcome to this special episode of the Doctors Pharmacy Cau- housecall and I'm sitting down my colleagues at the ultra wellness center in Lenox. Massachusetts discussed some difficult medical conditions that have amazing solutions using functional medicine that you won't get going to your regular doctor. We're getting to the root causes things and today I'm sitting down with Dr Todd Pain who's been one of our featured guests on the doctors pharmacy talking about all sorts of conditions and has the second most popular podcast on the Doctors Pharmacy. I would say congratulations on that, which is no small. We've been working together for twenty five years maybe twenty something like tap. At, Kanye ranch for ten years and then here the ultra wellness center for over a decade Dr Filippini went to Dartmouth. Medical. School is Board Certified Internal Medicine and he certified in Functional Medicine Integrated Medicine and he's one of the smartest guys out there when it comes to understanding the body and how to heal it. I've learned so much from todd over the years as my colleague and friend and we are privileged to take really challenging cases. At the Ultra WanNA center today we're GonNa talk about psoriasis. So welcome, todd thank you. Thank you mark. Now this podcast is about things that matter and if you have psoriasis probably nothing matters more than figuring how to fix it because it's what they call the heartbreak of psoriasis and the reason is it's a miserable condition where you get thick scaly plaques and irritation on your skin, which is like crazy and scarring disfiguring and just a miserable disease. Traditional Medicine doesn't really have a lot of great treatments except ones that are extremely expensive and often come with very significant side effects. Exactly, so todd, what's the general view of? Psoriasis and traditional medicine. The general view is that it's an external condition skin to skin problem. Exactly. It's a skin problem and it's a chronic condition and there's no cure for that's the that's the take home that you get. My training and It really is not a skin condition it's a systemic condition. And I the ways in which we're treating it is really as you said, very expensive and potentially very toxic bomb. So there are lots of things. I think this is a probably almost like the paradigm. Condition from functional medicine approaches where you get so much leverage 'cause, there's not one thing that causes psoriasis or not. Just one case gas rises many variables. We talking about that earlier how you know there's a, there's a genetic component to it. There's the dietary component. There's the environmental component Vitamin D is You know I I I'm a big proponent for vitamin D. I have so many patients who have psoriasis who tell me that you know they get better in the summer when they go to the beach. Yeah and they're in the saltwater and gets sunshine. Well, that's one of the medical treatments is UV light, right? Absolutely. Yes. They do stick people under lights like therapy and medicine believe it or not. Yeah. I think. They all this an older therapy the US also Couva therapy, Sore Lindsey, injected view, and then yeah, it's like an older way. But nonetheless, UV, light is very, very beneficial for modulating the immune system. So it's it's really an the one thing that really I'll never forget this case. I don't know if you've you've probably seen it yourself. But when I was in my regular conventional practice, I had a patient who who presented with got eight psoriasis. PSORIATIC arthritis, and for those who don't know a good aid psoriasis is it's what happens you a ache? That's actually. Gut. Ache but it could be exactly. That's actually maybe that actually caused by the gut exit to that it's actually a good point. So So GATT at gut eight psoriasis. Patient who I treated for a strep in fact, strep throat infection, and then like a week or two later she comes back and she's covered in these. dimed quarter size circular PSORIATIC lesions an like what's going on here. So I did a little research and I found that that that is a well known condition of Iraq Post streptococcal gut psoriasis. and. Her with an antibiotic and guess what her gut eight psoriasis went away. Amazing because you see that the strap the exactly exactly now, the one thing that you need to realize is that strep bacteria is oftentimes involved in cross reactivity. That's why you know people are so so onto strep throat because if you get a strep throat in certain individuals, genetically separate individuals, they can get Gamero nephritis damages, your kidneys, you can get matic heart disease you can get. Pandas Syndrome, the pediatric autoimmune neuro developmental a strep infection. So you get this like OCD and behavioral type conditions. And then you get. Issues Cardiac issues kidney issue everything say right is exactly and deadly. Absolutely. So so strep bacteria play I think probably are one of the key players in some cases of psoriasis impatience. Absolutely. Well that that is fascinating. So essentially, this is seen as a skin condition that's inflammatory and the treatments are using powerful anti-inflammatory drugs. Including Steroids are topical steroids does topical, but they very strong ones get absorbed by and they release the pressure own adrenal glands and have long term consequences and thin the skin the preserve very very they're not like over the counter hydrocortisone. These are really high potency fluorinated steroids and they get absorbed into the system they do decrease inflammation, but they thin the skin and you get you know skip breakage of the skin in such others even though they're creams or systemic side effects to them. Absolutely. Yeah. You know I. I I also see that that The drugs that are being used now promoted on television are very expensive. We call them suppressing see called Tanf Alpha blockers or biologics that Estela fifty, thousand dollars a year, and they can be effective and help people for sure but they do lead to immune suppression. Especially Kovin if you're if you're on these drugs are much more likely to have your immune system not work when you get an infection and exactly, and there are times when there are some patients I have seen. Some patients with either rheumatoid arthritis or significant psoriatic arthritis, which is psoriasis to the next degree. You're developing a systemic symptoms of joint inflammation. Sometimes, you do have to use the biologics in more or less put out the fire for a period of time you're absolutely. So it's not as though I'm against biologics. There's time in a place where everything but sort of a last ditch that's like, okay. You know break the glass, pull up emergency fire extinguisher and put out the fire. Reminding this case on a share for a minute, which is a little girl came to seem as probably like four at the time. And when she was little an and this is this is really how we think differently and functional medicine because functional medicine we see this like you said, it's a systemic problem. It happens to affect the skin and treating skin it's just putting. Topical stuff on that doesn't really have systemic effects or get to the root cause functional as always about the root cause. And this little girl. When I looked at her history born by C. Section not breastfed SAR ready. You know she's got a reduction in her healthy microbiome formation because going through the vaginal canal populates the gut with bacteria that are healthy breastfeeding provides these oliver sacrifice that are essentially non digestible food for the good bacteria and so the kids already set up for problems then. Got Ear infections antibiotics layered on and then developed this horrible psoriasis, a very young age like a year old skin which is covered with it, and the kid was on steroids antibiotics I skin infections often at the psoriasis is bad. It'll break down the skin that's give get infected and you can this vicious cycle and this girl ended up on one of these drugs is biologics. Immune system because she had all over her body and she ended up in the intensive care unit while with Sepsis for a month and the reason she got sepsis or overwhelming systemic infection was because their immune system was and the drugs and it was this vicious cycle. So parents came to me were desperate and this little girl was so sweet at really head to toe psoriasis it was it was not normal kind and in and she went to the bathroom in my office and she was screaming when she went to go pee because the peeing her because you had over her vagina this kid was just mess mess and I'm like. Well, you know let's start with the basics diet. And also helping her gut get sorted out and I think for for most people with inflammation, their body or an autoimmune disease. The. The main thing we look at is the Gut and for this little girl I started with an elimination diet gluten dairy in gluten you know if I look, it's Rice's probably one of the biggest factors. Absolute. So I got rid of the Gluten Clint got rid of dairy clean up your diet, the sugar and stuff, and because of all the antibiotics and steroids means suppressors should I gave her any fungal on an assumption because there's a lot of evidence that yeast. Plays a role fungal infections play a role. That's why they use antifungal shampoos. FOR SCALP PSORIASIS DANDRUFF. And I, got I put her on this program. I got a call from the father. Couple of weeks later, how she doing and he said she's almost completely cleared her skin completely clear up you weeks while and then she did really really well for longtime and then scalped. US. Never recovered and I said, what is she eating while she's having gluten free oats and I'm like I think you know oats even though they say gluten free are often cross-contaminated or not perfectly gluten free and so I got her off of that in her scalp cleared the kid's fine. So this is a case where you do something really simple. And Get an incredible result by fixing the root cause and when I did her testing she did she had terrible gut microbiome on the stool testing. She had elevated anybody's to gluten. We use not just a regular silly Akra anybody who has we look at twenty different proteins that are in we'd and gluten and we look at antibodies against them and she just lit up like a Christmas tree. So I was like, wow, this is the worst I've ever seen and yet well, she got better so fast by dealing with the right 'cause, right? Well that that's That's kind of case they really sticks in your head and in the one thing about psoriasis as I think also it's it's you know people view it with people who have it one thing I've had like a couple of lesions on your elbows in their hidden it's not a big deal for people have really bad surprises is pretty much like having leprosy I. Mean You just you pick your pretty much don't wanNA exposure skin. You don't WanNa, go out bathing some interesting. and. People think it's contagious. It's all these you know these remiss about it and and it definitely has I think a psychological toll for people have really significant summarizes absolutely. There's definitely that psychological component to it. You see these advertisements where their shows people like by the pool with you know taking their their biologic so that they can now go bathing but you know you gotta take this expensive expensive toxic medications just jump in the pool a you you and. I are old enough to remember a time when there was no advertising for drugs on television, right right and and what these advertisement do is they work and the studies have shown that forty percent of the time when the patient goes to the and says, Hey, doc I saw this ad for blobby blonde TB can I get that drug right there like sure. Yeah. So these are working and it's why they spend billions and billions of dollars on these ads. Yeah. It's wrong because Info in functional medicine, there is an incredible pathway help these patients do you have any other cases that come to mind? Oh. Yeah. Yeah. Absolutely. I just had a recent case where and this was like a very interesting case. The patient had a little bit of a perfect storm for getting setups. I rises the patient developed a lot of Strep Throat Infections Inner Twenty S. So, all of a sudden she dwelt lots of strapped for whatever reason maybe you know contamination from her kids or. Whatever, and then was put on a variety of different antibiotics. and. Then after the birth of one of her children, she had coal systemic as she developed gallstones. A gallbladder out gall bladder on exactly call butter and there's actually some really interesting evidence about the role of the bile acids in us. psoriasis is really quite interesting. That's what. Triggered it, and then the then the sort of add fuel to the fire, the patient was on guess what API are acid blocking Proton pump and you know the purple pill riot exactly. So that's we're gonNA talk about in the next a podcast. So this patient was a little bit of a setup for a perfect storm for developing psoriasis and also had some stress in life, and then also one the other things that you see in psoriasis and some patients is metabolic syndrome. If you're overweight if you have prediabetes, that's another potential risk factor for. Developing psoriasis. And then originally, the patient had very recall had a vitamin D. level originally that was in the single digits, which would be like forty or fifty, and you're saying it was like less than tennis than ten less than ten. So this is I. Get I get on my soapbox here because this is my one of my things that I'm really I just love to talk about this is that a low vitamin D. level is not the problem. It's a symptom of the problem. So K. so so that vitamin D is a biomarker for sunshine exposure. We talked earlier about the use of sunshine ultraviolet light which you get through sunlight exposure. So yes, sunlight can cause skin cancer It's associated with you know photo aging and wrinkles and all that kind of thing. So x amount of sunlight. In Sunburn is not healthy for you, but healthy sun exposure is really really beneficial for your face and put a hat on. Yeah. Somebody on your face but the rest of your body get exposed to healthy sunshine at absolutely. So and then in the winter you know I personally will take vitamin D during the fall in the winter because you're not going to get north Dixon Line, you're not going to get the healthy sunshine but I push back on that because I see patients in the summer I. Think I'm GonNa take meeting the summer and. They think it's fine. Just walking, but you need to have full body exposure for twenty minutes between ten and two above. And if you live below Atlanta, you know you're, yes, it's tough to get and and I think it's only the summer but people don't aren't getting that exposure. So often low in this summer and the other clinical pearls of this market and I learned this from another doctor who was she practiced down in Mexico and she used to see a lot of people in Mexico with low vitamin D and You are they got plenty of sun down there? Well, Lo and behold on on your skin is sebnem which is A waxy substance and that that CBA material is a cholesterol derivative and you have to have healthy oil on your skin to get photo activated by ultraviolet light haw. So guess what would most people do every day they hot soap and water all the time, and now it's one thing if you're outside, you know you're digging in the dirt and you really get dirty but most people don't need to be bathing and hot soap and water every day. I. Mean You can know bathe with us and water to your ear. The private parts in your your armpits but we over based somewhat guess what we do. We wash off that healthy oil on the skin which prevents the synthesis of Vitamin D that's a clinical. That's because the I. I only use soap water on those. You know private parts. As you say, the rest is water I don't actually wash my body with. So I think I, you know there are some people that. They'll. They'll be like twice a day I smell. Okay. I Don I doing. Exactly. So vitamin D again is a biomarker for the sunshine exposure and there's a great. Video, which oftentimes will have my patients watch it's on youtube I would highly recommend everybody go to it. It's a two minute video. It's called indoor generation. If you've seen it now it's fantastic and it talks about how we as a human being spend most of our time clothed indoors and it actually has an effect on the immune system. Yeah, and it has effect on our immune system indirectly because of sunshine lack of sunshine vitamin. D and it's a really great visual trying to get ourselves outside fresh air and sunshine and so good well. Just. To you talk and you know the problem with traditional medicine is. We don't have a methodology to navigate to the cause of the problem and we have the ability to diagnose something based on what it looks like where it is in the body and pathology, and that's what we follow. So psoriasis is a diagnosis that tells you the name of what's wrong with you, but doesn't tell you the 'cause exact right and so you can have arises, but it could be four or. Five different things like gluten? Yeast. microbiome issue the strap, the heavy metals all kinds of issues. The people aren't vitamin D issues and medics genetics right. So so we have to really navigate for that particular person what the clauses and it's different for different people. I just show more case than I wanNA talk about how we work up the case. So this was a patient Casey. Mu At psoriatic arthritis yet. The. Same thing. Yeah, which means joints get destroyed. So such as the skin, but it's starting to affect the joints autoimmune issue and these drugs are inexpensive and she had all these other issues that she complained about. So she goes the dermatologist and he's like, okay, I'm GonNa Treat your thrice and sorry athritis and the rheumatologist gives you the rheumatology drunks but she also had terrible bloating and irritable bowel and reflux and she was on acid blockers and she was Struggling with bloating after eating and bacterial overgrowth, and she had depression and shed prediabetes and she was overweight and she was inflamed everywhere and she was depressed. She couldn't sleep. I was like she was a mess I and I'm like, okay. Well, what's going on? Well, her mother most bothersome symptoms this is terrible bloating after eating which we call seaboard bacterial overgrowth, you've talked about it on. The podcast century, the back bugs growing the small intestine and you eat food and then they ferment in and blows up and you get you feel like you have a food baby well treated her with an antibiotic to clear out the bad bugs I gave fungal. Declare out the and rebuilt her gut using what we call the five, our program functional medicine, which is gut restoration program. And I gave her basic multi vitamin vitamin D and fish oil not not a whole lot of stuff. probiotics. Healthy. and. She comes back six weeks later she's lost twenty five pounds or depression Scott. She's sleeping. She's got no more bachelor overgrowth. No more reflects no more heartburn. She's offered drugs she she didn't tell her to stop the biologic she was on for arthritis she stopped at her psoriasis gone or thrice was gone or make. Got Everything, was gone in six weeks and I'm like. It may sound like a miracle, but it's not a miracle is just using the right strategy in the right map to figure out what's wrong with the person and we do this over and over and functional medicine. So if you're out there suffering from the heartbreaker psoriasis or eggs, Amar acne all these skin conditions there systemic conditions that we have to think about the cost. So Todd, tell us how do we figure out and functional? Medicine. What the root causes, what of the tests that we do? How do we look at patients? Differently let's get into what we do to treat them Eso. Some of the testing that I like to use AW is looking at gluten sensitivity. As you mentioned before, a will do the testing where we check for the antibodies against gluten in the breakdown products of balloon. So glutinous big long protein proteins are made up of amino acids in Napa chopped up and the tests that we do which is the Cyrus testing in it looks at a whole bunch of different protein fragments of gluten gluten protein, and that shows antibodies to this. That's I. Think very, very valuable test. The one caveat is that if patients are on immunosuppressant medications are steroids, you may get a false negative test. Yeah. Or if they've been taking immunoglobulins, which is like for different disastrous, they can get false positives. Yeah. Yeah. That's true So that test is very helpful and then testing for intestinal permeability the tests that I got leaky got leaky leaky, gut. So in my explanation to patients, patients of what is leaky got his a very, very simple. Just imagine you have a screen door in your house and screen door. Let's the errand right but it keeps the mosquitos out. And you have leaky gut. Your screen door has holes in it and the -squitoes in coming. That's that's essentially leaky gut the best way to understand more complicated I, use a coffee got coffee filter. Let's in the copy, but not the grinds. The Essay might is they might, and so the leaky gut test is really good because what it does is it checks for the antibodies designing alliance was Aniela Nisus molecule issue facade did a whole bunch of research. Fantastic Harvard expert on. Harvest Celia in connection between Celia can all kinds of autoimmune conditions? So when your body? Has Leaky Gut it produces. One in overtime Zahn Ulan can cause antibody formation to the. So when you have antibodies design and tells you that over time you've had long. Got Leaky exactly. You can have transient leaky gut like every time anybody even if you don't have anybody who eats gluten will have transient he got. Nine levels will go up, but then they come down. But when you have antibodies to the the donyell, that's when you really know this more chronic kind of. And then the other and you don't have to have act by the exactly. So you could just have gluten sensitivity. Yes. This whole phenomenon, non Celia Gluten sensitivity out very real and his ex millions and millions of people linked to all sorts of conditions including a lot of autoimmune disease and it's a it's a spectrum illness because I've had patients who had no symptoms for the throughout their life and all of a sudden they developed full-blown Celia. You've seen that I'm sure of course, many times, and that's and that's probably related to. Yes. There's a genetic component yesterday's and exposure component is probably also relate to the microbiome microbiome is also tied in with Celia. Too. So it's it's really interesting and then the other part of the leaky gut test which I really like is checking for antibodies against the L. P. S. or like Papa sack rides these are the coatings of the gram negative bacteria in the gut. Bacterial, toxin exactly you get absorbed endotoxins, exactly make your immune system react you and your immune system does not like these things as well. It's like when when it sees the the the gram negative endotoxins says off a full steam ahead, we're going to like really try to counteract this, and that's where you get this real systemic inflammation i. mean that's essentially what you talked about sepsis. I mean that's when you get sepsis. You're getting a bacterial endotoxins in your bloodstream and then you get a full full sign storm. That's yeah, exactly. Yeah incredible. So we'll look at. Antibodies against gluten against things are related leaky got look at Cross reactions to other proteins that are in your food whether it's dairy or other grains which are really common. So what happens is a gluten often opens the door. Literally, the Leaky Gut, and then all the other food proteins leak in and your body starts react to those. You get an vicious cycle exactly. I'm getting rid of gluten and healing. The Gut can usually help reverse a lot of that but it's it's a big issue and also look at stool testing. Why are we looking at Poop for the skin? Exactly that's a good. That's a good point. So yeah. So the microbiome and there's is interesting because you know. What is a healthy microbiome more? That's that's what is what is call you by Osa? It varies it's a very interesting concept and what did we call despises what is a you know what is an unhealthy microbial? I. Often want to read a book called Paleo poop Paleolithic Right. Right what is the what is the indigenous microbiome says what are we actually had as we were exact golfing exactly how? Yeah. Absolutely. There's no autoimmune diseases. There's no psoriasis in hunter gatherer. Yeah. Autoimmune disease except that, right there's no. Yeah. To some degree, you know just like you know there's a there's a museum, not a museum, but it's a research into that actually has in. Cold storage all the seeds of the world. Yes. I think that we actually need a freeze. Good poop. Great. Maybe running. We need to go to the Amazon and find that Paleo poop. Exactly. Africa we need to go. Yes. That's true because we we really don't know even what the total healthy microbiome looks like and it can change very quickly your diet if you. To Go Paleo. So it's a very quickly on exactly and the and the and the thing about it is the the microbiome is a dynamic is not a static. Process is always changing and there are a variety of different companies out there that that do testing the test that I like an right now I think it probably the clinically most beneficial one is the map test because it does quantitative PR. It's a great test. It's not a perfect S. in there is no perfect. There really isn't. There's a lot of controversy over like what test there's. You know there's all different ones the volume on the. Canova you, gi yeah there's a whole bunch. There's a whole bunch of them out there and they all have their their role but I think the the quantitative pr which is very, very sensitive and the the key thing about that particular test is so sensitive will pick up a bacterial DNA, which may or may not be significantly oftentimes sometimes, you'll see like Ra right? Yeah. Are are are and pick up bacterial. DNA that that you know let's say you ate a hamburger is a little bit. You might have a little bit interro. HEMORRAHAGIC E-COLI and it may come up on the stool test setting you have an infection from it no high but I'd rather have a test showing me lots of data and then I can use my clinical judgment to say, okay what's what's going on here so and some people don't know how to really read the test in my opinion because they over read the tax. Original context. And I think that as time goes on the stool tests are gonNA. Get better. We're going to have more clinical utility of them. An and again, we're still we're just in the infancy stage of learning about the GUT microbiome. So we we do foods, Cincinnati testing, Luton testing, soil, testing, vitamin D, The other thing about is heavy metals and there's a subset of patients who have autoimmune disease. That have heavy metals because these compounds are toxic and they are immunotoxic at very low levels. So all you have to have a toxic load of this, but it may trigger immune response. Often I've helped patients looking at their heavy metal. Oh, so we do maybe challenged testing other approach. So now we've got the data we're looking at their gut we're looking at food vitamin D we're looking at maybe look at other factors. What what do we do for these patients? How do we start to treat these patients? What does the Functional Medicine Approach? What one of the key things I always ask my patients also is the component of stress. Not that stress causes riot stress causes autoimmune but stress affects the immune system affect everything else exactly. Yeah exactly. So I always a handle on how much stress do you are you having your life and also how is your sleep? Those those two things if you're not getting good sleep and if you're under stress that's like throwing gasoline on a fire Yup and you're not GonNa fix the issue until you address a Good Circadian Rhythm and you also address a person's stress and lifestyle. Those are those are key things too because. That's not going to cure your you know your autoimmune condition but I can't tell you the number of times and I've had a patient who had an autoimmune condition that was triggered by a very stressful event a divorce loss of job loss of a child you name it and stress alone 'cause leaky gut absolutely. Yes. Yeah. Going to healthy people exactly. Absolutely. Yes. Yeah. So you know as you said, you know you address Diet and you know the low hanging fruit are things like gluten dairy sugar. Grains. Dutiful. People rains option Paleo yeah. Yeah. I I I don't even Paleo Diet for people who have significant autoimmune conditions. The AIP died I think is probably the go. That's where you eliminate gluten. Sugar, grains. Dairy and Beans. Will elected electons are another thing that potentially can play a role in some individuals causing leaky gut on nuts and seeds and eggs even or taken out. Yeah. So if you're really an extreme situation, the idea isn't to be extremely restricted your whole life but to remove all the things that are potentially trigger for a short time see what happens if your skin clears up. And that's the exit the night shades. All those things he what happens yeah. The the point of elimination diet is not to eliminate all those foods for the rest of your life because a lot of people say why can't do that? Well, I tell them. Well, let's do it for like two months and let's see what happens and it's SORTA like you know cleaning the sleighs basically decreasing the. immuno-genetic load to the immune system via the got most of your union systems in the Gar-. So when you're eating these foods, it can trigger the immune system. It can feed the bacteria on the are eating the food, but the bacteria eating the food. So sausages eliminating the food, but it's also feeding the good microbiome with he keith of Polyphenols and fibres right We talked about that earlier about the Ackerman, an acronym you. Shake, if you will using polyphenyls to increase that and it's protective type of bacteria. So again in an eventually, you can then start adding in those who it's a one food that will never add in if somebody has a gluten sensitivity like that's it and. I tell them it's Kryptonite. Don't. Don't go don't go near us. Yeah. So we do that but then not just eliminating, but then we have to repair the GUT. So and how do we do that? Well. You repair the gut use can use food also gay can be very helpful bone broth with which is high in Collagen peptides. You can also use beauty rate is one of my favorite goto things. Nowadays, our body produces beauty rates. So when we eat beneficial fibers. High fibers will actually get broken down in the body produces buterere, but some people don't have those bugs at produce the beauty rate. So you can actually use rate in supplement form and actually some convention interventional integrative doctors used beautiful animals people with. Alternative Lightest and Ulster Titus absolutely. So those are things including can be Helpful. Aloe can be really beneficial and probiotics prebiotics probiotics exactly. Yeah. We also use medication to clear out all the bad guys I, call it, the weeding seeding and feeding program because if there's a lot and particularly in in psoriasis I think you know people are cautious about any fumbles like die flu can but but you know I, I've uses for thirty years. It's extremely safe drug really knocked would have had one complication people get some die off one patient I think had another doctor doctrine. Our practice had a labor issue in tried it and it may deliver she worse but it's your liver's okay. Yeah. It's really pretty safe drug and it can be prevailing effective where these upset of patients die flu can. Yes. I mean the one thing that is is is I think drug interactions. So if somebody's not on any drugs, they're they're much less likely to get complications. If you like you said, if you have underlying liver disease, you've got to be very cautious. But if you're not on any of the medications, there's no underlying liver disease it is quite safe. Yeah. I mean, people are afraid of any funds because when we were in training you and I back in the day, they weren't all these new raining fundraiser as the old one call amphotericin which we call input. Terrible. Terrible side effects but now the new ones are not so bad. So we also may have to go deeper than even maybe looking at heavy metals and detoxification. So we really have a systematic way. And believe it or not. If you if you really focus on your diet and clean up your gut. It often goes a long way and you can do this on your own without even seeing a doctor Yup by following the instructions we gave we're looking at some of my books attended detox diet, which provides that kind of inclined anti inflammatory diet. So I'm really I'm excited that that people can have hope for psoriasis because when I see someone I get so excited. Yeah, I'm like slam dunk this is this is what we got and functions and some things are harder like some things are harder to treat for sure have. Cancer other problems but this is one of those diseases and functional medicine that the people should not suffer from this actually acne exit psoriasis. All these things are skin conditions that are starting as systemic problem that trump on the skin, and you can't just ladder on the skin and hope it's GonNa work exactly and then also the the whole aspect that is not psoriasis can lead story arthritis, which really tells you it's not a skin condition. You really shouldn't be seeing a dermatologist, my opinion for psoriasis so if you're using infamous. That's a cycle neuro imminent endo good Allah just like fat. This is great. So for you listening out there, if you know anybody if you've been suffering from psoriasis or skin conditions have hope because. Using this way of thinking functional medicine, we can really help these patients. Tremendously we shared about your cases some of them are pretty extreme and they do well. So we we get the ultra wellness center here have been doing this for fifteen years before that, we all are at the Kenya ranch together for another ten years before that. So we we decades of decades of experience with these kinds of problems and we'd love to see you. We're doing all virtual consults now. So people don't have to travel here and they can do it over zoom and can really help you with remote consultations and testing and working up what's going on helping so I I think for those of you are instant we're here to help and we'd love to see you. So I think todd, you are just one of those incredible thinkers in functional medicine you teach all over the world ninety more. Resume. Did you from by, office up in, my, house. And I just so thrilled that we get to have these conversations about problems that are causing so much needless suffering. Now, we can really solve them. So thank you for joining us again on the Doctors Pharmacy. If you love this podcast, please share with your friends and family on social media leave accommodate love to hear from you talk about your issues and how you've may be found a way to help them and show everybody else what can be done and subscribe where everyday your podcast. We'll see you next time on the Doctors Pharmacy Alright. Great. Thank thank you. I'll just I'M GONNA end right there because. It is really a wonderful video on youtube. This call, the Big Pharma rant you probably have seen it now Bill Bill Marr. It's a really good one and he he basically ends up by saying you know 'cause in functional medicine, what we do is we try to get paid patients better. We don't see him anymore. Yeah. I mean it's like I'm trying to put myself out of business. It's true. And hit what he says is there's no money in healthy people. And there's no money in dead people. You can make a lot of money in really six people chronic who keep seeing you. Spend fifty thousand dollars a year on. Medication, absolutely. But you know it's true. We definitely have the problem where we see people we get better and then we don't hear from them. And then Five years later they call about something else I was totally better I'm cured I. Don't know I find. Something like that yesterday. Wow that's awesome. Yeah. So anyway thank you for joining us the doctor farm. Hey everybody's soccer hyman. Thanks for tuning into the Doctors Pharmacy I hope you're loving this podcast. It's one of my favorite things to do introducing you all the experts that I know and I love and that I've learned so much from and I'm WanNa tell you about something else on doing, which is called marks picks my weekly newsletter and I, share my favorite stuff from foods, supplements to gadgets tools to enhance your health is all the cool stuff that I use, and then my team uses to optimize enhanced our health and I'd love you to sign up for the weekly newsletter only Senate. You once a week on Fridays nothing else a promise. And all you do is go to Dr Hyman Dot. com. Slash. Picks to sign up. That's Dr Hyman Dot com four sized picks. K S and sign up for the newsletter and I'll share with you my favorite stuff that I use to enhance my health and get healthier and better and live younger longer. Hi, everyone I. Hope you enjoyed this week's episode. Just a reminder that this podcast is for educational purposes. Only this podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. For helping your journey, seek out a qualified medical practitioner. If you're looking for a functional medicine practitioner, you can visit ifm dot org and search. They're fine a practitioner database. It's important that you have someone in your corner who's trained, WHO's a licensed healthcare practitioner and can help you make changes especially when it comes to your health.

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Managing Plaque Psoriasis with Biologics in Women of Childbearing Potential

JCMS: Author Interviews (Listen and earn CME credit)

28:47 min | 5 d ago

Managing Plaque Psoriasis with Biologics in Women of Childbearing Potential

"Good day, I'm Kirk Barber. I'm the editor-in-chief of the Journal of cutaneous medicine and surgery and today. I'm bringing you a special edition of jcms author interviews today. We're not going to be looking at a supplement that appeared in the jcms in July August 2020. The supplement was supported by a grant from UCB Canada and titled management of plaque psoriasis with biologic therapies and women of childbearing potential today. I'll be talking to dr. Jensen young a dermatologist in the medical director of the phototherapy Education and Research Center of Women's College Hospital in Toronto. Dr. Young is also an assistant professor of in dermatology at the University of Toronto and an associate editor of here at jcms. Well, thanks to dr. Young for joining us today Johnson. Thank you very much. Yeah. Thanks Kirk for having me again. Yeah, and and I'm really looking forward to having a chat with you about the article. Thank you and your co-authors put in JC mess as a supplement and you've developed a consensus paper for that. It was very topical and needed and I'm assuming that your group collectively had some interesting conversations as you developed this consensus document. Yeah, you know many of us we go through many different conferences and many a sports. This is always a topic that comes up consistently and so I think that really trigger how divorce consensus paper was develop. So I think that too many of us who treat a lot of patients with psoriasis they use of biologics to treat song Isis in women of childbearing potential has been in ongoing area of concern with very limited practical guidance available to direct clinicians off their treatment positions with females representing about half of the psoriasis patients that we see in the clinic this topic of treating young fertile female patient. It's a significant concern and yet the published data in this cohort of patience is limited to your point chance and I could call when the biologics first were on the market and we would have these discussions about how to treat women of childbearing potential and we were frightened because your point is well taken their job was so little literature to give us any guidance whatsoever that we all avoided it. And in fact there were there were many of our colleagues that would not treat wage. Might have childbearing potential with biologic therapies based on the fact that we had no idea. What was going on. I was just going to say I was most impressed by your by the literature review that was done here. This is a look at your from 95 to October 29th. So the last or 2019 rather I want to congratulate you and your co-authors on the on on the development that you put this on a subject to through its really comprehensive and very well-researched. Thank you for acknowledging that and I I should say that I was only a very very small part of it. I there were any other dermatologist most of whom were more experience than me and we all contributed a lot to offer to the paper and it's it's not just my work and you know, I think that the reason that we went back so many years was that as you know that many parallel clinical trial They always exclude pregnant and nursing women. So it's very hard to find information that we want. It just from pivotal phase 3 trial. So we really had to go back to wage too many different Publications including animal models to to get as much information as we could. That was why they're there are so many Publications that were included in in this analysis and it shows and and I want to say that the peer reviewers in the journal as we put each of these supplement articles through the exact same peer review process that we put through put all jcms articles through it's a it's a critical process and the reviewers were were highly lots of praise for the amount of worth the depth that you went into with regard to this. So one thing it's maybe get into the content a little bit here and and I really enjoyed the first section actually wage. And that was just the the way you approach the overview the effective psoriasis on pregnancy and the fact of pregnancy on psoriasis and it was a nice capsule and I wonder and and off and the half of all pregnancies are unplanned. And I think that was the critical bit here, right? Yeah, almost 50% of all pregnancies are unplanned. That's that's shocking right? That's a shocking number which song reminds us that pregnancy is something that we as clinicians need to take into consideration when talking to and treating women of childbearing potential and the fact is that the one we see patients in the clinic many many many women, they they attempt to manage their disease off their own without seeking advice or even informing their health care provider upon discovering that they're pregnant, you know, just as we age Need to be aware of the impact that certain medications can have during pregnancy. We also need to inform our patients that and and control disease can potentially have that track to effect on their developing baby as well. So I think it goes both ways. So I think that covers the the the main reason why we design such a section one in this paper. Yeah. Yeah, and I and I thought and you know that the number of people that are number of women that went into our mission during pregnancy was, you know a lot higher than what you know to hear you. Again, it's fifty percent of women experienced clinical Mission. I mean the fifty percent of women don't and need significant help during the course of their pregnant. I think that I say remember in in residency new study abroad That well, you know in psoriasis during pregnancy you you may not need to treat those patients because psoriasis almost always gets better during pregnancy, but but but that that might be true to a certain extent but about 10 to 20% of of patients off during pregnancy, they experienced disease flare or even worsening of their of their psoriasis symptoms and some might even have their their pregnant trigger the onset of psoriatic arthritis and you know in additional although it's quite rare that a subset of women they develop pustular psoriasis which needs immediate treatment. So I think that it's critical to have conversations on conversations on this topic early and to perhaps Implement wage. Multidisciplinary approach to control the disease once they're pregnant. Yeah. Yeah, and and of course, once you're pregnant, you know, the the issue of disease or condition is well, it's great if it happens if it doesn't we need to deal with it and then in the postpartum period the the drill is that there's another potential flare and in fact, the number that white hai-ya the data shows that about forty to ninety percent of women, they experience a postpartum player. And even for for this reason our group encourages optimizing psoriasis care during pregnancy and proactively counseling patients during the postpartum period as well, you know, if the birth was stopped during pregnancy unless clinically contraindicated it is saved to resume. The biologic therapy immediately after giving birth, of course when the the ones have peeled and so far there's some some limited data off that indicates that there's minimal transport of biologics into breast milk and as a result breastfeeding is a viable option for a new mothers who are who are taking biologics month. Uhm. So if I can summarize if we're dealing with women of childbearing potential women planning pregnancy, we have that individual on a biologic we can keep individual on a biology because we got a pretty good idea for biologics her safe early in pregnancy. There's there's the convention to consider stopping at about the 32nd and 33rd week as the placental transfer of these antibodies kept hers and then restarting as quickly as you say wage. As we can as long as we know that infection has the risk of infection has passed is that got a pretty good summary of our convention today. I think you summarized it quite well, I I don't know if we can go as far as saying that biologics are safe during pregnancy, but I would say that what we have learned so far is that maybe and Logics are not considered unsafe. So I think that being safe and okay, I'm safe. It's a little bit different, you know, unfortunately, there's minimal data in Inhumans on on the topic of continuing biologics throughout the later stages of pregnancy data shows minimal transfer of IGG antibodies in the in the first trimester, but at around 16 weeks the placenta begins expressing the neonate ofc received. Through that actively transports immunoglobulin from mother to baby and that transfer Peaks during the third trimester of pregnancy and and off and and physiologically that provides the infant with the antibodies that are needed for immunity during the first three to six months of life as their own immune system matures, but at the same time when a pregnant women is receiving this receiving a biologic and those those antibodies are being transferred. Um in the second and third trimester to to the infant as well with the exception of certolizumab antibody-based biologic therapies of built on the IGG framework and include the FC portion and therefore they they are transported actively across the placenta birth. In the second and third trimester, so it's the significance of the the presence of these biologics in in in in the fetus during the second and third trimester. As I said so far there hasn't been any data that has demonstrated any travel genetic effects on the fetus, but I don't know if we can conclude that biologics are safe when I'm when when the fetus exposed us to add ring the second or third trimester. Well, we have a little bit of information from the IBD folks. I mean and and and the idea there is they keep their patients on drug or many of them on drug throughout their pregnancies because the Calamity of birth Disease exacerbation during pregnancy can be quite devastating. So we'll do it. It's how we've learned. Yeah with the exception of infliximab which is often wage stopped in the third trimester, bye-bye, G is in the in the treatment of IBD and and and also in in Rheumatology as with that I think rheumatologists have had more experience in in treating patients with Rheumatology diseases with biologics than we have and they they're they're more comfortable with continuing biologics during pregnancy than than dermatologists are and and and that is why wage paper. We've included some of the data from from both the Rheumatology and and the GI literature to make this paper wage. Yeah, more more robust. I would say yeah, but very complete and table to is the the summary of biologic therapies used in women of childbearing potential. It's very complete off. So now if we can go for a minute into your consensus statements, it appears from the numbers in your consensus statements that the majority by far strongly Agree to Agree to each of the the published statements here must have been been quite the job to get a group of people together to go through each of these individually as you know, we you know, many of us within that group Or quite strongly opinionated and to come up with with consensus statements as you alluded to Thursday. It's not an easy job. Yeah, so many of the statements we had to revise and to to vote again and some of the statements were not included in in bath 12 that reached consensus that they were included in the in the supplement many of the statements are not black and white. It's it's not something that is so easy to to agree upon and as you can see that none of the twelve statements all nine of us strongly agree with with with with any of the statements it was it was a challenge and it was a process that took a lot of time and a lot of discussion to revise the statement to to make everyone feel that their statement really rep. That's how they Envision I'd like to spend a minute done two things the 8th and 9th of your twelve statements. The 8th is with regard is in the treatment consideration section. I'll just read it based on real-world experience and animal toxicology data tnf-alpha and I'll 1223 Inhibitors have not demonstrated teratogenicity home or increased risk of negative Maternal-Fetal outcomes experience with I owe 17 Dial 23 Inhibitors in pregnancy is limited and the result was three people strongly agreed with that statement off and six agreed. Nobody disagreed. Yeah. So I think that this is actually one of the statements that has achieved the most often consensus of The Twelve statements. We we do have limited real war experience and animal toxicology data that's available and that dog Did not suggest that tnf-alpha Inhibitors or IO 1223 inhibitor or trailer. Janick nor do they increase the risk of negative Maternal-Fetal outcomes. But at the same time that with the the newer biologics that are available such as I am Seventeen and dial 23 Inhibitors that are becoming more and more popular. We really don't have much experience in these agents off to make a statement as to whether they are trailer genic or not. So it took us quite some time to arrive at that statement and maybe many of us we feel that I owe 17 and I owe 23 Inhibitors. They are also Relatively safe in pregnancy, but we just don't have the data to make a statement of that. So we're sort of where we were with the introduction and T. Exactly. Yeah, I think maybe in five or ten years. We will have a second draft of of this paper and a better idea. So of course, there's always another person involved in this and that's the neonate. So it takes me to a consensus statement number nine and it reads with the exception of surrealism AB infants exposed to biologics during the last two trimesters of pregnancy may have detectable drug levels office and administration of live vaccines is not recommended until after six months of age and in your group. We have one person that strongly agrees and eight who agree help me understand the deliberations here when you look at the all the twelve statements that we have. This is perhaps one of the statements that we all pretty much agreed on so all of us voted off, Either agree or strongly agree versus most of the other statements. So the first part of the statement so Circle ISM a bit. It's the only viable that we use in psoriasis that was study in in pregnant women as you know that as I again, as I said earlier that with clinical trials young women who are pregnant or who are nursing they were excluded from from clinical trials, but in one of the trials that was performed with certolizumab women of at least Thirty women who were at least 30 weeks pregnant who were receiving certolizumab were included in this trial along with their newborns. So in this trial blood samples are collected and a safe for plasma concentrations of drug at delivery. 4 and 8 weeks postpartum and results showed pretty much that the maternal drug levels were in the expected range, but in infants there were undetectable drug levels pretty much at Birth and at 4 and and eight weeks. So I think it provides a lot of comfort to clinicians and and to patients that there's there's really very little transfer of drug from birth mothers to infants with certolizumab. So that that's why we we included that statement and then I guess the second part of that statement it's about vaccinations and of course, we at the back at the back of our mind that we always thinking about this month. That's mother who receive infliximab during pregnancy near near the end of of her of her her pregnancy and in the infant bath receive a BCG vaccine who eventually died after getting that vaccine and you know, this is something that we always think about giving a live vaccine to home and infants who was Mother received. A biological agent during pregnancy and and I think that that that's the only case that that that has been published by the way and find but it is something that we always think about. Okay. Well if the mother receive any type of biologic during pregnancy special near the end of the pregnancy whether the child should receive any light vaccinations and that's why we came up with the statement that that the child should wait for at least six months before he or she should receive that live vaccine well six months because the IGG antibody will be destroyed and not not influence in a child's immune system and and the other point that this makes it quite distinct from the tnf-alpha inhibitor work which shows wage. Second transplant Central transfer up to the point and I think you mentioned in the article in the third trimester can reach approximately 50% of the maternal levels wage. So, you know clearly I can see why you have consensus and the statement it's cuz this is so distinctly different than what we've been working with in our own nation and probably the reason that in 2020 the bjd guidelines consider sort of ism a big as the first line choice in women planning conception a torque. I think one thing that you have seen many patients and I've seen many patients and I think that you know, despite the fact that you tell you tell pregnant women that by the way, this truck has not been shown to be harmful to your child. I don't think that provides enough Assurance to the pregnant mother that well, you know, because the fact that you don't suck Enough data to show that it's not harmful to my baby. I just don't want to take that risk. I don't want to I don't want my baby to have any to have any drug in his or her system. And you know, I think that's some I think that's something that goes through many pregnant women's minds. I think Iraq and you know, we we talked about the fact that we currently we don't have any data to suggest that any biologic which has demonstrated knowledge in the city in in fetuses, but at the same time if a patient had a choice, they I think they would rather not be exposed there with their infant to any any any drug if if that's an option. Yes and something that again we need to discuss all of this early and Ed. Not late after someone is pregnant and already on their drug. So so the we've got the data on pregnant patients long as you point out we exclude from a previous research trials and it's got a it's got to bring some comfort to people not if they're even if they're not worried about themselves about their need for sure found and they can vaccinate as they wish there's I think that that's another the whole other discussion of course, but but the idea is the fact that there's no there's no deductible drug level in there and their newborn as you point. It's got to be got to be good and and tell me to go one step further. Let's talk about breastfeeding for a second cuz that'll be the other thing that would be of concern to a birth mother. So so Kirk to your point. In fact, there's very limited data in this topic of the presence of of biologic in in breast milk and with them. Limited data that shows that there's minimal transport of biologics into into breast milk in general. So as a result breastfeeding is a viable option for a new age others who are taking biologics but amongst all biologics that we use to treat psoriasis certolizumab is the only one that has performed a prospective study to support that there is no to minimal transfer of drug into breast milk. So again another thing to talk about with that very very very first discussion and birth minder that we should all be having that discussion in any woman of childbearing potential that we're considering starting on any of the biological agents. It's a good remains. Absolutely. Yes. So now we've talked a lot about this issue and and as I pointed out earlier, this is the best piece of evidence. We have and you know mid twenty or towards the end of 2020 and I and I think that the management of plaque psoriasis is in women of childbearing potential has been significantly Advanced by the work of you and your colleagues. Is there anything else that you want to talk about that? It came to light during your deliberations with regard to treating this group of patients. I think that to summarize our discussion here. How may decided to embark on this project was was mainly because we wanted to have a full understanding of how we could provide enough counselling and education to women who are either considering pregnancy or or pregnant dead. to give them the best advice that we could based on the the evidence that we have I think that that's essentially how we decided to to start this this this project and you know to to summarize it I think that in order to have a healthy baby need to have a healthy mother and so it is ideal to have low disease activity or or remission going into pregnancy and off during pregnancy and after pregnancy so I think that the goal is for us is to come up with ways that can help patients achieve that fantastic I mean it's all about communication at the end of the day off and education so thank you for spending the time with us I think you've summarized the our challenge very well yeah thank you for having me I was dr. Jose And young the medical director of the phototherapy Education and Research Center and Toronto Women's College Hospital. I hope you enjoyed my conversation with our two young. The article itself will be available to you free of charge for three weeks. It can be accessed at the JCPS website. Once the podcast has been posted. I'm hopeful that you will subscribe to a JC mess author interviews as it is really a pleasure to bring these topics to you and the greater the audience the more joy, we have been doing it. This podcast was sponsored by UCB Canada as a special supplement to the JCS author interview series. I'm Kirk Barber. Thanks so much for listening until next time be good to each other.

pustular psoriasis Kirk Barber UCB Canada College Hospital phototherapy Education and Res Toronto infliximab jcms Dr. Young medical director Journal of cutaneous medicine University of Toronto IBD dr. Jensen birth Disease Johnson JCPS literature review assistant professor
Comparison of international guidelines for the treatment of moderate-to-severe plaque psoriasis

JCMS: Author Interviews (Listen and earn CME credit)

22:49 min | 1 year ago

Comparison of international guidelines for the treatment of moderate-to-severe plaque psoriasis

"Hi, welcome to chase him. As author interviews. I'm Kirk bar with the editor in chief of the journal cutaneous medicine surgery today, I'm interviewing Dr Patrick Fleming. We're looking at psoriasis guidelines. He and his co authors have compared the management guidelines for psoriasis in America Britain Canada in Europe. If my interview with Patrick trying to sort out the differences between all of our countries. And if that is any thing meaningful to us as clinicians. Welcome Patrick, and thank you very much for joining me today for conversation respect to your article that we published in the March, April JC mess articles entitled comparison comparison of management guidelines for monitor's aveer plaque psoriasis review of phototherapy systemic therapies and biologic agents. So why did you and your co-authors think this was important for us? As clinicians understand first off. Thank you for having me in terms of why we chose project or focus on. We've noticed it's been an explosion in the last couple years of multiple guidelines for managing psoriasis particular in your or they have several sets of guidelines currently in use. I also think it's important to be able to compare regional differences of guidelines. I think can I pick up some interesting tidbits and the different practice landscapes across a variety. Of segments of the population. So is a significant review of the literature. And it sounds like as Canadians we had better update our guidelines sometime as we seem to have the old as guideline of this Cortez. If you will I think surprisingly, the American Canaan guidelines were a little bit data at the time of publication. I know there are some efforts or new way to update the caning guidelines, which is great. I think the fact that a lot of the guidelines lacked the more novel therapies, so the interleukin Twenty-three inhibitors some of the concession teens weren't as well elaborated on really helps. You clearly at the fact that guidelines should be becoming living documents similar to how up-to-date functions and other online repositories function. I think the old way of looking at the lens of your five years probably. Isn't going to work much longer the future especially in psoriasis? Whether it's been explosion of novel therapies coming out over the last decade. It's very difficult. I think for the authors of guidelines to be able to keep up with all the new therapeutics on the horizon. So in the context of keeping up with guidelines the electronic versions of these should be easy to date over time rather than sticking to the written. I agree. I think there's still a lot of value in having a definitive published guideline in Emmanuel's reform, but I think in the future one that may be nice as for journal so look at ways of having an online database doll repository similar to other databases like up to date where you could update these guidelines maybe on a yearly basis, and maybe do a full publication every couple of years for wider nation. Alright. So let's go into the content of your manuscript and look at, you know, give us a little idea them on the method used, and then we can move right into the results, and let us know the clinical relevance of what you discuss. Covered in how as conditions. We might use this manuscript to guide our therapy. So the first thing to talk about the methodology is to highlight the team behind the guideline development. I'm it was led by two excellent medical students who had a lot of research experience in their own right Arben an hour on and they did most of the heavy lifting most of the literature reviews. I'm also very team focus when I lead research project. So we had insure that we could have three keeping your leaders involved in the development of the manuscript. And that was a doctor all over from Newfoundland doctor Lind from Markham. And Dr Cher from Toronto. In these individuals have a wealth of international experience as experts in psoriasis also key to the team was Dr Catherine settled, and I recruited her because she's not only dermatologist, she's also very experienced a hosp. Title pharmacist as well to having that team together really made the article come together most which are easily. In terms of these Pacific methods. We use wanted to do a critical comparison of the guidelines. So we did a very comprehensive search of PubMed looking for the most updated guidelines we could access, but because it was comparative in critical. We also sought out some of the key randomized trials in key met analysis, and we peppered this throughout the article to help him rich, some of the data and hope at some context some of the recommendations in the guidelines themselves. This was also quite important as well for looking at their products. We're not yet in the guidelines. And I thought it was important that we should mention these there on the horizon and will likely be in future iterations of these clinical guidelines. Did you have a cutoff date? We did it as updated as possible so up until the time of final submission. We were searching updated guidelines. We didn't have specific cutoff date. We want to keep it as a dynamic as possible. So this should be up to twenty eight the end of twenty s exactly so tell us uh lead us through the manuscript and highlight the things that you found of significance. It's very extensive in the tables, great because it goes through levels of evidence and recommendations for each of the individual guidelines. Yeah. So very comprehensive. Yeah. So we to fight it or or article under few Kice actions. So in section one we reviewed phototherapy data, primarily focusing on narrowband as it's the most commonly use version of phototherapy in practice today. We also looked at the use of exit. Early sir and some other technologies for psoriasis management. I'm inner guidelines. We also briefly touched on Puga, which is an slightly older version of phototherapy that according to most guidelines today, it's not recommended as first line, as you know, there's a high carcinogenic potential with extended use interject as a as a prior Puga user. It was spectacular therapy. Yeah. My limited experience with pufus at work spectacularly, but after a couple of hundred treatments people do get the poodle Antony's and they're prone to squamous cells. Unfortunately, yes, the next section of article focused on some of the conventional therapies and novel oral small molecules. So we spent a lot of time with methotrexate because it is still the most commonly prescribed systemic therapy for psoriasis it's first line in most countries. It's first line for most practitioners. Well, especially with the current payer model in Canada for both public and private insurance cover Roach. And based on some of the Danish studies, we reviews, it still does have an acceptable safety profile and clinicians are quite familiar with using it. Within the conventional therapy section riyal. So looked into cyclosporin as you know, we use this quite often as a short-term rescue therapy. Interestingly one of the differences between the guidelines was at indicating guidelines they recommended a maximal use of twelve weeks at a given time. However, some of the other guidelines include the American British and European they allowed up to one to two years. So I just interject amongst your group when you're discussing the guidelines, what would be the Canadian convention of it's not part of the Canadian guideline? Is there a difference than the way people use cyclist born in comparison to the guy, and I have a lot of patients on cyclosporin for some of them for severe psoriasis for me personally twelve weeks of the little bit short. If I'm putting someone on cyclosporin, though, often quite sec twelve weeks as a minimum, and I would have them on that. And then I would start slowly taper them. I think experienced depends on where you're practicing his wall. What your patient population is like us cyclist born intermittently as well often for people that are having significant fires at the disease often for transitioning to more to therapies that. I know we can use longer. So I too am surprised by the twelve weeks old. Not surprise. I knew it was there. But but the idea is I don't I don't think it's the convention. It might be the guideline, but I doubt if you ask the whole bunch of experience people with the cyclosporin twelve. It'd be really, you know, and they'd wanna use the longer sort of quite short. I think for most people six months, probably what they aimed for if possible and that moves us on nice eat into ASI TRITON, which is not recommended as a rule as a I land therapy in the guidelines averages to seek my own experience. I've often used a with cyclosporine as a transition agent for people who are having diverse flares of posture disease, and it's been somewhat effective in that the next molecule and the section on a conventional therapies as premised which is actually fairly novel on fortunately, it was not included in most of the guidelines. We examined except for the British guidelines mentioned, very briefly. And I think the speaks of the fact that guidelines have a hard time keeping up sometimes with the many third peaches coming out in the marketplace. Now before you move on then into. This the this section three. Then me return you back to methotrexate for second because we all use it so much, and it was not until biologics came along that we really started to look at methotrexate critically. And it when it was our only therapy we thought, wow, this is great. But now that we have all of these other treatments. We're learning that there are limitations not only to its effectiveness, but to its to its use over the long term when I look at the guidelines. I look I I thought okay. Well, we'll look at the American guidelines, and they're still really look like they're using the quote tests dose of five milligrams at as our initial dose. And I think that would be the old Canadian standard, and as Canadians we've probably well, I think most of us have moved onto start patients at fifteen milligrams without be the consensus of thought from your group. Exactly. So. Most in our group would start with fifty milligrams. And then only tape repor taper down up necessary. The American guidelines a little bit stuck in the past for my perspective, giving this small test does which we know would not be effective for psoriasis. I think it also your common also speaks to the fact that, you know, even when I was training not very long ago. We thought about the Turkey was great as an agent for psoriasis. But the more and more we read about a, and when we compare the safety profile trek say to the biologics, especially the newer agents coming out, you realize how much we advance in the field of the last five or ten years and for follow up the liver biopsy store. I mean, we keep revisiting revisiting revisiting it. And I think in my practice at any rate. The fiber scan is really replaced that process and my practices. Well, people who I've. Inherited on methotrexate. They're generally seen by happe- tallest. We have great. Epoch Paula just we have partnerships within the community who are very happy to help us co-manage patients who have been on long-term treks age. I think the fact that with methotrexate you have to do such frequent lab monitoring as a burden especially for the patient to has to have multiple in base of a needle draws. It's also a burden for dermatologists to reforming reams and reams and reams of laboratory investigations when their agents out there, which do not necessarily require any long-term bloodwork monitoring like many of the biological agents. Okay. Well, let's move on. Let's let's look at your section three group. Yeah. In section three whenever briefer sections. We looked at some of the non-conventional therapies that are used these were mostly mentioned in the American guidelines. Nhs, and it would include things that are very awfully for psoriasis. So medications like as Thia prynne few Merrick acid esters hydroxy urea, Mike, finally, mafia and sodium as well as to crawl Mus either agents, we would typically use the caney landscape that being said, I think it's valuable to mention them because they do have many patients with severe story Arctic or threaten us who psoriasis is well controlled on these agents as nice that they do have some efficacy either. It's based on small case series. And and you know, I come from an era pre biologic, and you know, sometimes you had to go to agents because nothing else seemed to be working and nowadays in this in the age of biologics, and really the the comp- the generous compassionate use programs that we see from the companies that are making biologic agents that these these these lesser known and use their appease, I think will become even lesser known. Unless are used overtime exactly think in some cases. Even insurance providers have realized now that the biologic is not going to be something that's us rarely it's going to become the standard of care for managing psoriasis in Canada in North America and internationally. I think it's very difficult to justify having a patient on an agent with lower Africa say with a higher burden of laboratory investigations with a higher burden of multiple side effects and monitoring. Are you taking a you know, every week imperative taking it once I've become a month's. Okay. Well, onto section four the sort of highlight of the peace so section in section for we reviewed biological therapies, most of the guidelines. We had all of them did have recommendations for teen. F- inhibitors and engine looking twelve twenty three inhibitors even on the market for many years. Now, they have a great track record overall base in the review of the literature. I think they're also benefited by the fact that the FDA has become much more stringent over the last ten years. So we have very robust I qualify randomized. Data in multiple phases of studies in many of these cases, we have multiple phase three studies to prove advocacy with quite stringent end points. So when you're looking at the quality of the data for the newer agents compared to some of the older agents like methotrexate and cyclosporine you can. Really see a stark difference in terms of the raw data and the power behind those numbers. Interestingly many other very new agents weren't included in the guideline. So unfortunately, there wasn't any mention of gazelle cab. Nor was any mention of the piglet Tina inhibitor which has recently approved for psoriasis in Canada and of as of today. Actually, we have Riddick his. Yeah. So I got the news today. I'll I'll twenty exactly so another example of how the guideline sometimes have hard time keeping up with all of the new science coming out. When you looked at the guidelines for these biologic agents, it struck me that it was pretty it got more uniform, and and to your point this because of the robustness of the Daggs -actly, and and there's just no there's no reason to differ other than with regard to patient access in and related to colleagues act. So with the near agents, if you have a couple thousand patients in trial, you know, the safety profile, you know, the optimal dosing in many cases, at least for the vast majority of patients, and, you know, the optimal monitoring I think when you're basing your recommendations on case series or very small I'm moderately deported design randomized trials for the older agents. You can see how there has some wiggle room base on the local population, the local patient characteristics and local practice patterns. I look at the British guidelines and their criteria for response at Passy seventy five and Patsy fifty and reflect on the fact that nowadays really if you're not playing in the passing ninety two hundred group, we're not really thinking much about those older agents. So be interesting to see how those guidelines change. I agree. I think it's a great error to be owned because we have so many options to help our patients who have Araya's who've suffered for many years, sometimes decades with sub optimal topical and other oral medications. And now we have some great agents with good safety profiles. Excellent data with the chance of giving them, maybe not a cure, but perhaps functional Karen a sense. And the agents are so good that it seems now that it is the regulatory bodies there that look after cost that are actually dictating our practice guide leagues. -actly? I think if somebody has a disease that interferes with their quality alive that has a higher risk of cardiac disease, a higher risk of depression, a high-risk of anxiety and higher risk of losing work losing sleep. If there's an agent that can get them clear or nine percent player that safe, that's convenient. I don't think cost should be a barrier for those individuals, especially where we live in a wealthy westernized democratic country with a strong economy, and a strong public health system guidelines will still be useful to defend those decisions. I agree. And I think in future iterations of. Guidelines. I'd like to see a perhaps a bigger focus on the impact on the individual patient, and perhaps even having patients involved in developing guidelines, this has been done in some other research bodies. So ver the British journal of British medical journal. They actually encourage patient involvement in the design and conduct of clinical trials and other research projects, and I think that would be a great initiative to make standard across all guidelines that patient advocacy groups individual patients members of the public have some engagement in helping produce those documents because those guidelines are quite important in both advocacy for patients with insurers with the ministry of health as well. So on that note, I would refer our listeners to JC mess. We did have an article on how to develop clinical BRAC practice guidelines. And one of the features was these patient reported outcomes and involving patients in the trials is going to be demanded. And so we should start to get onboard early. When we when we when we're thinking of creating guidelines, I'm really looking forward to the next guideline project. I'm involved where we can involve patients and have their experiences. Enrich, our understanding of both the treatment and the impact Bernard of disease on on their lives. Well, thank you, Patrick for taking the time to bring this very valuable manuscript to lifeforce, and I look forward to your next publication. Thank you very much. Dr Patrick Fleming is dermatologist in private practice in on -tario. He is on the Torey aboard about JC mess and the Canadian Derm foundation. Dr Fleming in his colleagues gave us a very nice overview. The guidelines one thing that stood out for me was the guidelines appear to be always behind the curve, and Dr Fleming and his colleagues are urging us to not only make these living documents but start to use patient reported outcomes and actually get patients on guideline committees. And all of this. I'm sure will add not only greater clinical relevance, but greater clinical excellence in all of these guidelines that we will produce in the future. And so and till next time thank you for listening. And remember that you can subscribe to this podcast for free wherever you obtain your prod casts, I'm Kirk Farber became to each other.

psoriasis methotrexate Dr Patrick Fleming Canada editor in chief American Canaan Europe British journal of British med Dr Cher Paula Emmanuel America Turkey Africa Puga Antony Kirk Farber Dr Catherine ASI TRITON Britain
Mini-Ep 104: Puppies and Tarot Cards

Forever35

36:58 min | 6 months ago

Mini-Ep 104: Puppies and Tarot Cards

"Hello and welcome to forever. Thirty five podcast about the things we do to take care of ourselves. I'm Dorsey Freer and I'm Kate Spencer. And we're not experts but we are two friends who liked to talk a lot about serums and this is a mini episode. Where we hear from you. We share your comments and thoughts and we attempt to answer your questions to the best of our ability an please do remember. We are not experts. We are just podcast hosts and we always encourage you to seek support first and foremost doctor and or a mental health professional as needed. And if you WANNA reach us. Our voicemail number is seven eight one five nine one zero three nine zero. Our email is forever thirty five podcast at G MAIL DOT COM. And if you're looking for some other things to listen to. May We recommend our daily podcast here for you and are forever thirty five produced podcast. Thanks spot at hosted by the always delightful Caroline Moss Indeed Dorey. Yes Kate. My hands are a little bit moist right now because I just put on my hand cream and so I feel like it's only appropriate to kick this mini episode off with some hand cream recommendations great. I'm on board so our first listener writes. I love the POD and want to share some of my faves as I am obsessed with hand creams. I generally love them too thick and feel hydrating but not greasy. That's the holy grail right but not greasy. I feel like I could make it a terrible terrible joke about things. That are thinking hydrating. But I'm not going to sorry. I don't know why they're my top. Faith is the trader Joe's ultra moisturizing. Hand cream they often release seasonal sense which are nice like ginger arose. It's only five dollars. I have multiple tubes at one time bedside. Nail Care Kit purse and work and usually multiple backups. I also enjoy the packaging as it is easy to squeeze each bit out. I have also enjoyed the bird. Species ultimate care handcream great cream available lots of places about thirteen dollars a tube love the gold handcream as another option that is easier to find and lower price point and for more spas ended handcream. I opt for Evita or Loki. I never know how to say this Loki Tant Tan lockton Lausanne La Oak Tan. Very may keep going. La Low slow Catan. How do you say this? This man Lachey Talk. It's I think it's something like that. Like one of the ten options escape. I have never been able to say that brand in my life me neither. I feel like any time I say correctly. It's like a like a crap shoot. Yeah it's like a finger on but but I could be totally off also. I'm pretty sure that's like one way. I did not say it low C Tan. I think that's what it is but I'm sure listeners will be quick to correct. Us lease let us know. Okay I just I don't know and I know look I know I could go on youtube and Google of video of how to pronounce it but sometimes it's fun to be in the dark and just okay and then ends their email but masks never thirty five forever love it love it. Love it okay. Great Rex I mean I am holding the gold bomb ultimate healing hand cream in my hand and that is what my hands on right now. Ooh Nice I mean this is. This is a real plethora of options. Here you can't go wrong with trader Joe's no that's true that is very true period and okay. This next email is a recommendation. I had not heard of had you know I had not this listener. Rights just listened to the most recent episode and thought I'd send a quick recommendation for a handcream. My mom discovered this product through a friend and has now gotten me addicted. Let me introduce you to wool wax. I think I remember one of you talking about Lance Lynn. Before your chapped lips. This is a land based product but for your hands it has been an absolute lifesaver during this time and we now have them scattered around the House Dory style plus during this time. I think it's fantastic to support family. Businesses and farms and this company is owned by a cattle sheep. Ranching family an eastern Montana and we will link to the company website and a couple of places to buy it because this listener very thoughtfully provided us with those things. Thank you listener. Thank you so much wool wax wax. We'll wax okay. All right okay. Shall I read this next Email yes please. Okay Hi Keeton Doria. I just finished my master's degree last week. Which was bittersweet as. It is such an accomplishment. Congratulations but the dream job. I had lined up afterwards was cancelled and being a master student. I seem to have slipped through the cracks in the minds of both my schools and the government's financial bursaries as well as the world in general. I've moved back home for the time being. I'm trying to find temporary work here. My financial stress stress from living at home again and stress from the world is higher than it's ever been because of this. I'm experiencing worse than usual flare ups in my psoriasis. Psoriasis and other skin conditions like ECZEMA or so awful to deal with normal basis. I'm sure I'm not the only one experiencing flare ups during the stressful time. I wanted to share some tips specifically for SCALP PSORIASIS OR SCALP EG Zima. That have really helped me in case others are feeling it to these. Include drinking celery juice in the morning. Washing your hair every day using natural shampoo and conditioner or conditioner only on the ends of your hair avoiding oils on your scalp and the best serum of all time the digital pic- digital route activating scalp serum made with one hundred percent natural ingredients. A digital is a SCALP FACIAL SALON HOOF SCALP FACIAL SALON IN TORONTO. I've been going to for the past twelve months and I've never needed anything more while it is a bit of a splurge the cost is well worth it considering. I've tried everything out there even prescription shampoo and medications and this is what has given me the most long-term improvement. I know. There's some other scalp faithful salons in the United States who performed similar treatments but I highly recommend ordering the serum to help with Scalp related flare ups and support a small business. Ps SCALP facials are for anyone and could be a good indulgence in. This is all over. Thank you so much for being part of my routine last year I truly feel comforted knowing heavy. Both to lean on my dream is forever thirty five to grow so the whole world can benefit and I can work for you. Well okay I have so many things to respond to in this. I do to go email. Okay well my first one is celery juice celery juice never i. I'm so sorry listener. I if I love this. Celery juice cured my own ailments. I think I would have to make myself drink it but I have such an aversion to celery that just the mere mention of celery juice sends me under the bed hiding but I appreciate this as a recommendation and I am not not in any way. Pooh-poohing your suggestion here too. I didn't even know scalp. Facials were a thing I did not either and also our. They've facial if they're not on your face. There is snow scalpels. Yeah wouldn't it be like a sculptural sculptural? Anyway I did you. Had you had never heard of Scalp facials. I had never heard of scout facials but I will tell you in a very funny coincidence last night. I was googling How to get rid of pimples on your hairline which then led me to some articles about Which I'd never heard of. But which is like it's basically like pimples that you get from an angrily good hair which. I've had issues with and I've had pimples on my scalp I was like I think I have fully Kya lettuce and one of the things they said about. This is that if it it does partially caused by oil. Build up in your hair if you don't wash your hair enough and I was like. Oh my God these last couple of years. I've been trying to train my hair to not wash it. As much and perhaps a byproduct of that has been that I've developed this acne problem on my head. Wow this is a journey. I didn't know we were going to go on in this episode. I know so then. Do you think of this listeners. Suggestions might like washing your everyday using the shampoo and conditioner which I thought was interesting. Well she did say only on the ends right right and on your way health. Yes I I have I like. I'm wondering if I should go back to washing my hair everyday. Well what if you went every other day just to kind of see if that made a small difference and then yeah took to every day? Yeah now here's a question. Are you going to get a serum for your head? I don't know I've never even thought about serum for my head and I love this exists. I love that this listener founded and suggested it. I love that. This is the Scalp Salon in Toronto a Scalp Salon. Scott Facial Salon. I think you need a scout facial when we when we were able to like be out in public again I agree. I've found so last night in my googling. Found an article in a lure called everything you need to know about scalp acne. I was like Whoa okay. This this is what I've needed and I didn't even know that it was a real thing and one of the things that someone recommended a shampoo called. I guess it's pronounced clean. It's C. L. N. And it's for scalps prone to fully relate dermatitis dandruff and itchy and flaky. Scalp and I'm thinking Emma getting it. It's called Healthy Scalp Shampoo. I love that after two plus years of doing this podcast we can still discover something new. Yes it's wasn't new to other people but it's new to US SCALP ISSUES SCALP issues. Can you buy this shampoo and report back? I feel like this would make a great full length topic assode. Yeah I will buy it and I will report back. Just separated this. Maybe this listener can can weigh in on that episode as well listener rate hit taught. Yeah I'm really. I'm really intrigued. And I appreciated all this information even the celery juice part Dory. Do you want to read this last email here I would love to? I can't do the bit behind on the podcast so I only just listened to your mini episode where you discussed products. You wish you'd started using sooner. Your conversation about wearing sunscreen on your hands reminded me of a recent discovery for whatever reason. I've always squeezed product out of the tube onto the top of my right hand. I'm left handed and then dabbed it onto my face a little at a time with my fingertips afterwards. I would just rub the leftover product this skin on my hand after doing this with my retina and sunscreen for almost a year. I noticed that my right hand looked so much better than my left like a lot. Lot better so I've taken to applying small amount of retina in Sunscreen to the top of both hands when I mentioned the Snyder tallest. She said that she always recommend squeezing products onto the top of your hand instead of your palm so that you don't waste any product it'll go to work on the tops of your hands too so there you have it something. I wish I'd known ages ago. Hopefully my left hand will be looking as good as the right ones soon. Take Care Anna shall we all get retina for our hands? I mean you learn something new every day. We're supposed to be serum in our hands. We could if we wanted totally totally. I love this. I love this idea. 'cause I smear my sunscreen after like if I have a little bit left a smear it on hands same same same but I liked the idea of like doing my whole skin care routine on my hands. Totally totally well. Well we've learned a lot here today so we truly truly of. Let's take a pause okay and we'll be back with more. All right. Sounds good so I thought this email was really interesting and I wanted to get your take Dory in k. So here we go hi Keeton Dory. I'm the thirty two year old. Stay at home. Mom of a very active very social one year old baby girl. We're currently in self-isolation. I can't say I totally hate it. Being the homebody antisocial person I tend to be since I quit my job to stay home about nine months ago at the advice of many people I sought out and joined a mommy and me group that only lasted two visits. I decided on the excuse that my then six month old was too young for the other kids who were already walking age. The truth is I do not like interacting with other MOMS women or people. My current friends consists of people used to work with no more work. No more friends and honestly I feel fine about that. I stay in touch with those friends. Text every once in a while and we go to each other's kids birthday parties even though I do live far from these women about twenty five miles away now. That my daughter's been walking for a couple of months. I started to think maybe watching the random kids at the park wasn't going to cut anymore as a social activity. My friends with kids who are slightly older than mine are still working. So I've never really had plates with them due to our schedules being so different. Anyway I need help. Maybe ideas on having my child spend time with other children. That won't put a lot of pressure on me having to interact with the MOMS. I just feel like my child is at a crucial age for socializing and the current situation is already sending us back even further basically. I'm just scared that I turned my child into me. Socially as fellow. Mom's a really appreciate any advice. You can send my way very interesting dilemma. Yeah I thought this was really interesting. You know first of all I just want to say like I think your social desires or lack like not wanting to connect or not feeling comfortable connecting are totally normal and sounds like it's fine with you so one I just. I mean if you were feeling bad about that I want to encourage you not to I don. I can't quite tell it. Sounds like you are like kind of comfortable like you know who you are in your person who's like sounds like they don't need a lot of social interaction but how do you give your kid social interaction with now having it yourself so. I have a couple of ideas and these are all post pandemic ideas that that's a good point here because most of the stuff we can't interact or no one is socially interacting right now. Your child does not falling behind. No one is interacting. So it's fine but if you want your child interacting with other children one place to go might be like a gym or a gymboree type place. You have those in your town or city you can sign up for classes. I believe my gym also has like an open gym kind of thing where you can just basic indoor play space and you can sort of sit back and let the kids and the kids kind of play with each other. Indoor places are another place where you can take your kid and they can interact with other kids. Music classes are another option Especially at this age you're still kind of mostly interacting with them. We're not like you I. I didn't I didn't find that I interacted that much with the other parents in music class. those are the ones that. I think your child would get the most interaction with other children in. I think like a a mommy and me. Yoga saying isn't really going to get them. Interacting with other kids so much Yeah those are my suggestions. Yeah I mean another again. I don't know what your financial situation is. This is even feasible but a preschool. Twice a week when they're a little bit older you know from however many my kids were in full time. Daycare and full time preschool. Because my husband and I both worked full time and so they were always around other kids but I think that can be a thing that you begin to do as they get older. They also a Lotta Times. Preschools will have like an afternoon parent and me group for a couple of hours a day that you could do. I know my preschool offered something like that for kids that were under too but I also just wanted to say like your kid is going to be who they are socially no matter who you are I'm very extroverted and I have. One of my kids is very is really introverted. And I talk to my therapist about me understanding it because it's so different from how I am socially and it's just who she is and so I I think who you are is great. And that's who you are and your kid is going to navigate their own path socially as they get as they get older and also like sometimes when we have kids we feel like we have to like. Do all the stuff for them. When they're like very little and like eventually your child will probably be going to school and will in lots of different social situations that are totally age appropriate. So go easy on yourself. Yeah. I think that's really good advice. All right here's another one do. I'm meteorologist okay. Hi Canedo I love your podcast. So you two are the perfect companions. When I'm cooking on a Sunday afternoon I have a question about how to extricate oneself from a friend group that you've been a part of her almost a decade. I enjoy and find a couple of the friendships rewarding but some of the others have been toxic. One member in particular is full of negativity makes a hobby of Gossiping about other members of her small. Schmunity it makes very insensitive comments on the regular. I've had a couple of these hurled at me of late and I'm at a point. Where in my life where? I don't feel the need to surround myself with others. I don't value or find much in common with the other members of the group make excuses for her because she completely spurns people if they cross her others have said they hesitate to speak up because of this. She's a bad apple. That is spoiled a once. Fun Group my question is how do I gracefully exit the group without making a fuss to a turndown invites with more frequency and they get the hint. Stand up to the bully. And how do I maintain the relationships with those? Do WanNa keep without it being the elephant in the room when we get together Solo. I've never navigated this so my advice might be bad. I feel like you. The easiest way to navigate this is by being as honest as possible bonkers story so the only thing that gives me pause about that is that she says she's in a smallish community Yeah that's and this win. That people are scared of this woman and I just worry that. Like she's going to be like shunned or something you know. Yeah Yeah I don't know I don't know like my my read of this is that honesty is not going to get her far in this situation. Like like it's not going to register with this woman seem so narcissistic and possibly like I don't know just not a good person. That like being honest with her isn't probably isn't going to do anything else. Is that crazy? I wasn't I don't know if I was suggesting Necessarily like confronting this the main toxic person. Oh okay okay. I think it's more like how do you exit this group without making a fuss? I mean just turned down invites yet. I think turned on invites. I think you've just been so busy with insert. Excuse here I mean fortunately right now given the global pandemic. There's not much socializing happening. Yes unless you're like zooming every night. Or what and I think you can also say you know what like There's the energy in the group is kind of negative and I need some space. I don't know I mean I don't like. How do you maintain relationships with those? I do WANNA keep without being in the elephant in the room when we get together solo in that situation. I feel like he'd be like hey. You know what Karen has done A. I'm sorry to give her the name. Karen really sets your sister same. I'll call her kate since he's way can take all the blame heat. No this isn't going to work either. All right let's try this. This person has the bully. The bully has said some really inappropriate things to me or made me feel really small or as I don't WanNA spend time it doesn't make me feel good to spend time around them so that's like that's not. I don't know I don't think that that that makes the elephant like once you confront what the elephant talk about what the elephant in the room is. It takes away the the power of the situation. I think yes again. I could be way wrong here and what I have the courage to do that so casually. I don't know this is hard. This is really hard. Do you have other friends in the community? Like if I just worry that like I know what you're saying. Yeah these other. If she stops being friends with the bully that the other women are going to be too and things go south with the bully too much that the other women are. GonNa be scared to hang out with her. Sounds very high school. It does and I hate when this kind of stuff happens especially in adulthood and does I've been yeah situations like this and that's why I feel like what I have found. Is that just being honest? About how feeling is has has worked out the best for me and if that means that these friendships dissolve than that is the consequence. Unfortunately yeah but I would say like you need to do what you can to protect yourself here and so yes you can. Just turn down the invites and move on. Yeah that stinks though. That does stink. I'm sorry you're dealing with us all right. We've got a hot hydration tip Dory yes we do. He dowels love everything doing right now. Thank you so much for providing me with so much content is helps me so much. Get through these long days With my six year old Anyway I wanted to share kind of here for you. But they stopped the mini episode Tip Hot tip for night Hydration every day I kind of have a ritual with a three to ounce mason jar and grew up some hot water and put two bags of either high biscuits. Tean or Camomile peppermint and company. Combo get really exciting. You know t's awesome and so I just and then I put some honey in because you know that helps with allergies and I sweet tickets like Luke warm and then it's so delicious and here's to get at least one windows down a day so figure that Half the battle and it's just it's nice to make tea and and go through that process and have something daily like that so I wanted to share the thought is been Hydrating me and has been a little joy for me 'cause we really have to focus on the real small things right now? The minute scale is kind of where I'm at anyway. Thanks bye love hydration tip. I love this tip. I've never about making a t cooling. It's a lukewarm and then chugging it day this yes thank you I t totally like herbal teas water. Unkowns towards your hydration. Yeah fully get in there. Get in there. I'll write dirty. Let's take another break. Let's do it all right. We've got another relationship quandary This time with a sister-in-law. Oh yeah this listener rights. I have a problem with my sister in law. We are very very different and have not been super close. We are friendly enough but I do not have interest in becoming her best friend. She has had a tough year. She's currently pregnant due next week. But in the meantime she had a cancer scare and her father passed away. She is now stopped talking to me because she feels. I have not checked in with her enough. During the global pandemic I will admit I did not specifically texture. When this first started I will say I have responded to all texts related to the baby excitedly and I have been very supportive on facebook posts etc. I have offered to take her to a doctor's appointment when she was having trouble getting there. I have two young kids of my own age three and four and I am navigating this whole situation myself. I am fortunate to be able to work from home at this time but I do not have childcare as many do not so that has been challenging. Once I found out that she was mad. I started texting her to check in often. And I've apologized. She has ignored everything. Now she is about to have a baby. My nephew and she is ignoring me. I am scared she was going to keep this up. Once the baby is born and I won't be able to quote. Meet him over zoom any advice. This is killing me taking up a ton of brain space at a time when many people are suffering much more. What can I do hear? My brother is talking to me but seems to be mostly taking her side and doing whatever she wants. I don't want to be her best friend and I think that should be. Okay what should I do? Should just be called the narcissist episode. Yeah Yikes Rooney people like this. Drive me crazy this this this makes me when you then do the thing they wanted to wanted you to do. And then they don't respond is so manipulative and it just makes me bonkers like I think if this was a healthy relationship this person would have expressed disappointment. Yeah you you did what you what is I think right you apologize and then you step it up and then they would have been like. Hey thanks for that. I really appreciate that. You did the thing I asked and it means a lot to me and then there's been like you know. I know you have two kids two small kids at home and you're trying to work. That must be really hard but no. This person is not going to do that because they are in our subsist. Yeah I mean this. This person is upset with you because you didn't check in with her enough during the global pandemic will like. We're all everybody is going through a different thing here. But we're all also experiencing this larger thing. That is really hard and traumatic. Can I say yes again? People like this. They have this like they have this expectation of you that they never articulate and then they get mad when you don't fulfill it a but also like how how obtuse to assume that someone else should be checking with you more during the global pandemic when that person also needs checking in on like we all horse of Congress but but that's not what this person is thinking no purchasing. Fury's me. Yeah you know. I think I would invest any more time in those kind of where I'm going to. I think you send a really nice gift when the baby is born and heartfelt card and say like. I can't wait to meet the nephew and you keep talking to your brother but like this woman feels kind of toxic to me and Mike. I know that she's she's technically family. That sucks but I think the more you sort of try to cater to her the more. She's going to kind of see that she has this power over you. Yeah and I'm sorry that your brother is not seeing you what you're going through but that that seems par for the course when partnered with someone like this. Yeah they tend to enable the other person again. Lick look a war. Not psychoanalyst's here but we are two people who dealt with these kinds of people in our lives. Yeah right yeah yeah. I'm really sorry. I mean I just think again. Like this is a situation where you unfortunately do have to set some boundaries for your own self preservation. Yes and you know this is not to take away from the hard year that this person had like having a cancer scare is terrifying and losing a parent is awful. Like I I but it sounds like you have seen all that and been supportive during those things so I think I don't know protect yourself listener. Yeah I'm sorry you're going through this. Yeah me too. And if anyone has thoughts pleased by all means you know where to reach us. Yes all right story. We had a A quick mini episode update from a listener. And I should. I should preface this by saying that this is. This is the second voicemail this listener left which is why they sound like they're picking up a kind of in the middle of something because they had left. They called about something else prior to sending this rate. Okay here we go. Hey cayden jewelry okay. One more thing I I call you because like probably full-time various weird insights But also you guys get beautiful by putting one of my friends who was an is a pretty deep Greece after we lost his friends suddenly anyways. So I just wanted to give you a brief update which is not obviously. Haven't been able to make sense to visit her. Yes works whenever we're allowed to travel again. But in the meantime she adopted a really wonderful party And I sent her Tarot cards and those two things have been. It's been really fun to have a friend who's in like the honeymoon phase of adopting a sweet sweet dog and so instead of just kind of stressing about quarantine together. We talked about things like puppies Cars and it's been really nice Yelled at me to say this like when something buffers up a call from February so I just wanted to give you guys to say all right. Thanks we didn't need to play that Yeah we we are invested. I knew exactly what this the call that this listener. Email that this letter was referring to like immediately lost a friend and this one person was feeling really intensely. And you want to support your. I know exactly what this is about. So thank you for the update. I'm happy to hear that your friend has been having some kind of positive light in her life or his life lately also puppies and Tarot Card Pa abuse and Tarot Cards. Is that the name of this episode. Yes yes poppies and Tarot card. Thank you for that update listener. That was really really great to hear all right. We've got one more voicemail and this is response to another listener. Who had asked how to better ask for help? I can door this Gwyneth in London and I was just listening to mini episode one or two where the listener wrote in and mentioned that they were reluctant to ask for help. I definitely relate to that I don't know if I have the most helpful advice but I thought I would share something that occurred to me a few years ago as I think it was when I was moving. Maybe like ten years ago and I didn't want to ask for help so I put it off I procrastinated and then when I couldn't put it off any longer. I asked my boyfriend at the time. And my dad had maybe one other friend and Moving always terrible but I think that this was worse because I procrastinated and maybe because I didn't ask more people and I think that it made me realize that I was kind of placing undue burden on the few people who I was least uncomfortable. Asking for help from Because I would always just turn to the same people in these situations when I you know really couldn't get away with not asking for help and And then also procrastinating putting putting it off because they didn't want to ask for help So I don't know if that's applicable and the listeners case. I know that it's pretty guilt. Trippy so maybe not the helpful but I think it has made me more aware Of like how? This personal tendency affects the people around me Yeah so I should I chair but anyway I love the pod all the pods and personally. I don't think you need a special sign off by well. Thank you for not for saying we need a special sign up. What is self aware observation? I know I was like whoa thing. Yeah yeah asking for help is it's it's goes way deeper than just the act like. I need help them but it really reveals a lot about ourselves. I think yes I agree. Well we've come to the end story but we don't need a sign off according to London. So No we don't thank you when it's in. London but I wanna say masks never thirty-five forever because that is my personal truth all right well. Nice never thirty five forever. No sign off needed. Thanks for listening bye.

Kate Spencer handcream Us Scalp Salon Joe TORONTO London Psoriasis SCALP PSORIASIS cancer Keeton Dory Lausanne La Oak Tan Caroline Moss Lachey ginger Lance Lynn Karen
Can CBD Relieve Psoriasis and Eczema Symptoms?

Art Beauty

36:25 min | 9 months ago

Can CBD Relieve Psoriasis and Eczema Symptoms?

"Happy Tuesday everyone happy to sorry classes for you. This is forty bitches. Yeah I now now I know but what do you think. Do I feel like they are not going to lie. Feel like they make me look smarter. Smarter sophisticated are. They wore Parker. They are Gorby Parker and I have to give them a shout out. It was so easy to go in to do. I had to have them. Once I got back I had to have them adjusted and they did it and I think they work they look great the really more for reading. So here's all the time they can be but they don't have to be up contacts. Do you wear them just to look smarter to know. I wear them sometimes. Hide the bags on the under. I O smart. I'm like or do you actually have Houston to see I need to see. I need to Z.. I can't say oh you come now really. But my son tells me that he doesn't like them. Okay so look more like a superhero without them. Oh I think. And you're very superhero. Wish with them. It's more like the Clark. Ken Get I know but he really wasn't feeling that story. That's so cute. Though was that he thinks Congra- hero rats to you and your war re Parker Welcome to the club to you as well. I'M GONNA take them off for the show because they keep reflecting speaking of things. Being reflected acted in China. And that's terrible segue but I do want to give a little bit of love to some of our beauty besties. You know we always ask you guys to write right to us to share things with us and we get some love From one woman was Samya. I hope I'm pronouncing that right. She's actually also a a journalist and pop culture writer and her website is the Saami life so she gave us some Love Ryan. She was like I love you. So we're going to give her a little love back and and then also AJ Archie. Who I bumped into on the street and apparently Archie listens to all of these beauty? PODCASTS and I hope she she will add our beauty to her list. Big Fan of the beauty stuff So just a reminder. Everybody if you've got questions you want us to ask we've got topics you want us to explore. Write US hello at art beat podcast. We'll try to get to that in today and proof of that we had another writer right in who has just been diagnosed with psoriasis and asked us to look into some homeopathic or non than traditional non pharmaceutical treatments and you know we know. CD now is kind of like the wild west. I feel alike do you. Yes it is the wild west. But I think we've navigated some real direct paths to get some to land in some good places and some safe places uses. Yeah and I'm excited today. We've got baroni from mellow daily. And she's got a CD company. And I actually met her at this event and was blown away by her knowledge bowl disclosure when I asked her to come onto our show she said I will not come on on to talk about. CBD for beauty. Because in her opinion there just wasn't enough research behind it that said when I wrote her and said Hey. We've got not somebody who wanted to talk about psoriasis. Can conditions like Rosetta. Do you feel prepared to come on and talk about that. And she said Oh absolutely so. Let's hear what she has to say. You guys a super organized. My Gosh of do we look out that I was just saying that my ed web browser was like what. What did you say your Web Browser Ryan? Do you remember what it was. It wasn't disorganized. It was unstable your unstable. I was like a web browser. You have no idea how stable I really am so it can seriously unstable web. Brad's I you have an unstable channel. Donald you need to take CD okay. I've got a couple of times. What happened Ryan guests who came in and stole my mother my mother came and stole my CBD and Baroni? I've been waiting to talk to you. Because does I remember. We met tonic. And he were giving out samples of that little like Caramel. Chew and this. Those are the ones that I want to order. I had to ask you to say those does have a little bit of THC in them to reload to say that you are But they actually have any. Oh okay never mind okay. Yeah the broad spectrum thanks a broad spectrum products don't have any. THC In them and the reason that we did that is because we also ship in the UK nationally and then the the ones that do are called full spectrum. Yes that's correct yeah anything with THC in at its colorful spectrum product and anything redoubt. THC Is broad spectrum German and then anything that is pure savy day is an isolate question for you. So are you a legally or not you. But our company's he's legally allowed to sell things with teach in them yet most products had thc. Oh was remembering okay so if you go to our website website pretty much I would say I would say. Ninety percent of the products on our website have H Sandman enter. That's what we are considered a full spectrum branch but the reason you can do that is because as of December of two thousand eighteen. If it's him derived can have annoyed that have less than wins zero point zero recent. THC It's one hundred percent legal as opposed to marijuana. Yes so have the cannabis cannabis mcnabb the client and then you have marijuana any him got it marijuana. Even if it's a marijuana derived product product that that has less than zero point zero three percent. THC technically that should be illegal because of the cabbage like the bed. It's very specific and it says okay so I think it has to be derived when we first met you. I had asked you to come on to talk about Abudazi and CBD Moody and you said. You really didn't want to do that because you didn't feel. There was enough research behind it correct. It's nice to stand behind will. Can you tell it like so what your thoughts are on that well so in a nutshell that show the way that I stay beauty. I'm obsessed with beauty so I do all the beauty products I love him and I love vitamins. Say I little by Tux. Top Job you know. I'm all about using the active ingredients. It will come to me and say to make us think batch cannabinoid a good for my skin my Acura Sadat as well they. Aw anti-aging they're not going to help help you with the things that you'll probably going to eat IT products school and so I encourage people to save the money and and actually shop on business of shot from businesses that have products with the active ingredients in that. Because there's not enough science support facts it can avenue as being. CD D. C. N. CG or THC have any effect on the skin surface. So I'm not supplied a two anti AJ When you think about anything to do risk abrasions bites or bans yes cannabinoid Illinois can be very good for that because cannot wait can get into the subtitle layer of your skin if you have hot but when you're applying it on an acephalous and you're thinking about using it as an anti aging treatment I would say John G that? Say Your money and buy something else. Gotcha and and then We had a we had one of our listeners. Right in and so the reason that you are here today Is that somebody Eddie. was asking a viewer. Shera listener shared with us a listener slash viewer shared with us that they had recently been diagnosed with psoriasis and then a lot of the traditional pharmaceutical treatments were kind of scary. The drugs had a lot of side effects. And they wrote and Said Hey can you look into the use of CBD. The problem being is that a lot of doctors aren't as knowledgeable about it yet again because this sort of new field and they were asking if there was suggestions on whether or not. CBD is good for things like psoriasis and maybe what the dosing would be and if you have any anecdotal evidence or examples that gas shaw. And so I I am a big proponent of that I think that psoriasis Any kind of a critic any kind of thing that's Inflammatory sorry is very good when you treat it with it is very well traded with cannabinoid And the reason that is is because our body in all facets likes to operate from a place of balance and we're out of balance we get inflammation and the physiological response to that is excellent psoriasis. IBS Olivo Saints. And so there's a lot of scientific studies show that can happen. Treatment helps with inflammation so so you can make that correlation my concern with that Bokram at assigned to respective is. It's not a cool as an effect so there's not real studies that say if you if you have psoriasis. USCIS treat it with cannabinoid known concrete studies that have proven that yet. So really. You're right it's old dance. Anecdotes evidence wants and in my opinion if you use it consistently over a period of time they have been some instances with small study. Lisa was a study done he was in Italy on. There was also a study done recently in the UK where it was treating psoriasis directly and there was some patients eh that had reported that the scene in the itch that you get that immediate stand it is actually Lesson within like five to ten minutes of using cannabinoid oil or a bomb. So that's a really positive results right. But it's not a result that phamaceutical companies will scientists doctors a- jumping going on right now but I think we can separate us that anecdotal evidence and I think it says customers out there who have psoriasis at. They've been given that that they don't the doctor's GonNa say like you need to use Story medication or you need to use anti inflammatory medication. which I think can be really scary three so I would recommend doing that doing rather than a mile away and then wouldn't on top of that? It's never know treatment and I think that that and the studies that show who had been done on that kind of treatment is actually what game and there are a lot of reports showing that it's very good. It's an inflammation. I have very sensitive skin. I have like I just flare up with all the things even after the halo amber are I had that. Remember that one batch under the eye that just kind of didn't go away and I had done some like V.. Beam lasers to it and filing the petition at like doctors offices like honey. Any you have EXA there that's like Donald trump going away under laser. I was like Oh she was if you Hama and put like cortisone on it just for tonight and see if it changes its eggs and then I over the holidays got really stressed out. And then right in the temples of both sides I had I little rat a little breakout a little flair another patch and sure enough. I see every day for like six days seven days. It's it's pretty much gone. You know I want to ask you is there. Is there a certain kind of when we say I put CBD on it. Are you talking about got a bomb or are you talking about an oil does it matter yes it absolutely does okay right so I I mean I I think that if if your customers are coming and is being convinced that CD is treatment. They want to look at that. They need to look at an oil. So a chink. Shah in which a teacher is the one that you put on today Tom. There's no reason why you can't take a couple of drops of that teacher and put that directly on the psoriasis will be excellent and it will help clear it up or it may join habitat already on as they should look in a bomb but one of the things they want to be really careful about buying a bomb. Is that a lot of the bombs out there full recovery so like pain so when you're thinking about that is gonNa have meant though in that there's GonNa be autocratic is going to be you can lift us. A will so they need each book. He added ingredients to make AAC short. is nothing else in there. That's going to inflame the already highness soil condition. It's funny that you just said that story. Actually because I'm the same every now and Dan is as she change of season. I get like a little kind of psoriasis around my head but my hairline and I'm the same I just have a little bit of my take Shah and I it. Just rub it on and it. It does actually hopes to go away from us that story. Oh well what about Brian. What about for my little hair? Patch so Baranja About two months ago I think from stress. I lost a patch of hair. You can see it here. uh-huh thank you sign part but back back in the beginning of episode where it's not really an active so to speak right when it's not going to necessarily regrows plates. Go ahead do it. I wouldn't I wouldn't either will chill you the out if you put it under your tongue hung and allow it to regrow back. In all Sibley. I have a treatment that you would love. Have you heard of treatments. yo-you bat is incredible behead catches a really good friend of mine. At the end of last year he got pneumonia and he had a patch of hair. That went away because all of his stress stress on his body. And I have one of those. IPO face masks and we put the face masks on the patch and within a couple of treatments it grew back we ip a P. L. or no. It's it's nice yellow right. It said Hi. Hi Red Light. IPL's tens pulse light and that's generally for hair removal. The discoloration the red cap that I used to wear all the time to grow my hair in the back. Yeah that's what's The red light. But what is that. What you're talking about Verona? Yeah maybe not. Maybe it's not cold. It l.. Let's let's double check. I can quickly Google it actually our red line but it's light. Yeah it is. This on Amazon was that can last a Korean boss. I think the brand I bought is Desert D. The S. S. E. R. Base Bask on his head wrapped onto the job girl. And it was. I mean it amazing. Do you know why I actually did that. It was totally like out of the blows so too much information but I get chin. Has I mean we also happens with united hormones females in house and I noticed that when I was using the Maas from my face I will start to get more Chin hadn't so it was like Oh my God. This is so annoying by product on anti-aging which is Asking when I'm getting more has so when he was complaining about it I was next one. Let's put it on your head and see what happens and it works so I need to get one then. Dan Aren't they like a thousand dollars. Though mine is six hundred yeah. They're not cheap. Yeah Okay we'll work. Yeah I mean Hello Oh hi us to talk to be stationary. I do I have movement but but just back to your original question. I would not trait that tabloids and back to our our the main point of the topics so when you have a skin inflammation disorder whether it's something that or if it's more of an immune thing like psoriasis. dosing that we should be looking for. Is there you milligrams that we should be looking for. What is your recommendation? How often how much they don't? I don't have a concrete answer for you on that because everybody's biochemistry is different which basically cleanings that we all react differently to cooperate. And you'll get this answer from anyone that's knowledgeable about this. We really don't know exactly what everybody needs. But what I would what I would recommend customers do is. They're either GONNA buy a bomb or they're gonNA buy an oil ride and I would buy the highest strengths that they can get her. Ah Christ that they WANNA THEY WANNA spend. I would also encourage central for a full spectrum product and then experiment like put put two drinks drops drops on your pinky if it's an oil and rub it on if it's a bomb do like one smudge rabbit on and do it morning and Nice for a week or two weeks and see how that that were feeling. It's healing too fast. It's healing juice lower than making up or sewage. Accordingly I in this particular instance because it's a topical when ingesting it so I don't think they need to like be worried about taking too much. I think that they can really give it a good nudge at first to really try and clear it off as quickly as possible and discard format while. We're on that not to derail this conversation but is there can you like overdose on C. B. D.. I've tried Ryan saying Ryan's like now well You know I had a really bad reaction. I did not eat breakfast. I was racing to to work and I did it to my boss to. She didn't eat breakfast and she got a really bad. She got bad information and and she was really upset in the back room. And I got the new batch. 'cause I know the person that was making it in her lab. She dropped it off for me and I there was a new dropper that I wasn't used to new drought new product. Nothing in my stomach full thing full dropper went right under my tongue not three drops like I usually do. Full drop are no food. I needed to go eat a burger. I'll I'll just put it at that like that. What what was that can you can you? What was the exact reaction? I'm just curious for this isn't felt stoned in insidiously and I couldn't I couldn't go I couldn't finish my client I had to. I was in the middle of a haircut. I can't believe I'M GONNA I'm GonNa Stories. I pretended to cut my fingers pretended to cut my finger. Like oh my gosh. She's just cut my finger with my new scissors. The only I think I just took my entire fingerprint off. I sent an assistant over to finish the haircut and I pretended to go to the emergency room. Like why needed pitches handsome in the back just onto needing a burger. It was bad it was a definite. I couldn't function to do the the haircut. That's for sure so I listen. Could it have been the batch. Could it have been my empty stomach could we. You don't know and like you just said everyone is different kind of a lightweight on the scheme of things. I'm a lightweight. So what is it won't teach see. Isn't that what kind of gives you at least teach the marijuana isn't that what gets you stoned. But this wasn't full spectrum. Yeah I was actually just GonNa ask that because when you you to answer the question can you overdose on. CBD that can have annoyed CB. I've actually I could say that. With confidence ne it clearly. I can't say that because you gauge. So that's really interesting to the. I would love her so much more about that. I'd love to know where the product was from Latino all of that information because has it came from The Hague it was it was on the hemp side of the family and I know the farm is in Washington. They grow right there. They have their own lab. It's kind of the most organic situation. I could grab tangibly in the first aid it. It wasn't like I was just like silly and unable to function for a little while like I didn't trust myself to go. Oh in charge up to one hundred dollars for her haircut when I was done like Ho- so but we don't want that we have to be careful of that I think because because I don't WanNa take cbd every day. And I mean you know. I function when I'm taking my CPA. Because I have to I get up in the morning. I go to the gym and I do my work and all that jazz that I would really like if I'm gonNA take us in. It's GonNa make me do that. That would worry me slightly I think it's probably a very very rare case. Never happened again. Bright but how many drops do you feel as an enormous dropper so most trump because our one meal right there were one mil drought and eating within one meal. I think we can get about six to twelve drops out of that I right would you believe I take every single morning I have to kind of do it. And so That's asserts that works really well with may take a really high strength chose so I'm taking at thousand milligram product each dropper I take is the key three milligrams on succeeding which is quite a high doors. And it's a free spectrum for us but that's my buddy a really good friend of mine Can barely take out. You know she has to take one to two drops underneath her tongue and bad is it. You know so I I. I do think that when anyone's trying this kind of thing if it's time you have to go slow and you have to go so CD general and one night when I see Z.. Day really on meeting old cab annoyance so meeting. CBD CG CDN THC because that's who sector Brooke so can always in general when you're endorsing. Yeah I think it's super important That you a patient and and do it and and do a diary so when I whenever I'm studying on up I even wrote a diary so I'll put the time that I take it up how much I took an all kind of make a couple of nerds about feeling that I felt and I'll do that to week to two weeks. Just so I can get a feel for what this brought actors doing many And that that's what helped me find my sweet spot But you you do need to be patient with that because the other thing about it is it can take up to seventy two hours work. So instances I'll maybe having like some sort of weird delayed who knows. Maybe because it's got to do without it's what to do if you think about the economic system as a bucket freight fly as a bucket of annoyed right and when you're sick when you're tired when you're younger would we use those cabinets to outfox. IT IS DEPLETED IF DEPLETED AND DEPLETED. And if when not shopping those up than we consistently operating from a place where we have you know minimal can happen noise. Everybody's different so like we're example. Oh peasant a may have a full bucket so we take the big does say going to get what would happen to you. Ride full bucket fine you. You didn't need to take them probably not I was showing off. Yeah so I love the advice go slow go but speaking of low can we talk. 'cause you know Ryan's all about Dat suty when I met you Rohingya you're like going off about the suppositories right we've been talking about The CBD as a tincture. I took it as the the The caravels but you have it also as a suppository and you said that that's actually one of the best ways to get your CBD. I do tell truly I truly believe that. So okay so the China would. That's in the in the most diplomatic way to say it. Just say it to so yeah right so basically can you take a simple dettori. It is the second best way to take it off and injecting it directly into your bloodstream. Brian to don't recommend main lining anything of course of course but So when you when you when you put a supposedly corey inside your Your you have a lot of very rich. In juicy blood vessels wickedness so what happens is a supposedly dissolved and those rich nestle start to absorb it really quickly. The other thing about that is is you don't have to it doesn't have to bypass fuel So you're taking a capsule or an edible or even when you're putting it onto your town a proportionate will three Paseo live at after essentially metabolize it and work to get it to your bloodstream. When you put it in your? It doesn't have to do that so it happens. Really quickly and your body doesn't as much away so when you're putting through Gi track it's thrown away in your something. It's it's thrown away when your stomach. It's throwing away in your intestine and then at stornoway again only were once you put it into your button. None of those things happen. It goes directly into your web strain green and you get the food shortage so Ryan. I know you said you had done a deep dive of the website which by the way for everybody at home is mellow daily. ELITE DOT com. That's M. e. l.. No W daily Dot Com and you were really excited because you said you saw the suppositories corral many. How many did you order so my question to you is as I already had started doing that? I already started. I already already started putting it there for many reasons as a gay man for Hungary for relaxation accession before it was like before during and after honey so lately absolutely so at the end of the road mellow Loyd buttons because I want to start thinking about broadening absolute. I love it. I love another way. For my girlfriend's to transition to anal I'm so excited Akwei Acquai- yes birth control. Let's move on. So that's not move on because Ryan you brought up an interesting point for people who are considering You know a no sacks. Is this something that helps to relax. Not only your nerves about it which you don't want to be claiming tight right but but also maybe to actually relax. The muscle is does. Yeah one hundred percent so so we pull the millions because obviously we want to encourage bottoming on the folks you know Hetero sex by donal into cross or anal intercourse. But it's with the by because what's actually happening is Can Slough relaxing area. They will they will promote blood flow to that area which will help stimulation They will also help to slow everything downs. So if you know you have image Shula ejaculation situations or anything like that. Actually slow everything down a little bit. So it's various reasons of very good sexual the health products and that is why we actually frankencense in it because Franken sent says is a natural antibacterial. So you know all of that down there can be quite factoria heavy end so that it's very Clean Product Coconut Oil Oil and Frankencense. He had no problems. I didn't either frontier back. Oh you can also put it like into your vagina as well absolutely. Yeah absolutely. It comes of labor patient. You leave it in for like ten to fifteen same minutes you get busy on the be intimate with your partner massage. Whatever you need to do and then ten minutes later you can play right game day? I'm adding a MAG right now. Put it in the bag and all that I did not know this existed until I took the deep dive on your website and I was literally La. Yes 'cause my was literally using tincture really. Yeah so there's nothing wrong with doing that it would just blow out. It wouldn't stay in that position brothers. It's not my first Rodeo. But you know I keep it so at the end of the day I would figured it out but now I don't have to. It's just like SUV. made it so easy. I'm so easy. I cannot wait while Tom Ridge. One thing I will say keeping in the fridge That they nice and call. It can be a little bit like today's when you put them in because it's called Better cold his better for your muscles and true to work it in and start cold is always better are there. Are there products the standout depositories or something that you probably won't find in you know the local store I mean I think I think when you when you look at mallow and you look at the products that I stand behind old products on the side truly I think anytime you come to me. You can trust that products a complete bessette so so we make sure that every single product on the site has a tiny lab tests which basically means that you can understand not just the ingredient in the product that you can actually also also Sadiq inevitably profile. I think that's really important. You can trust it. We have a report from a bed. Patty lab tests. That says it has this much. CD to snatch much thc all that stuff. We also do not have any products that have pesticides also wants to. They really clean. So when you're ingesting these things the create anything that's going to cost majestic your body I also think it's really important as a kind of official one but I think they need to be pretty as yeah and you need to be able to lead them on the show having visited you. Don't WANNA be like. Oh my God I could've put that away. You know you wanNA leave it out. Its Way I have this up right now. So if you're watching You'll see the mellow sea salted caramel and this was the sample that I brought home. I took it that night and had the best night's sleep and I said to my husband the next day. I'm buying like eighteen boxes and he said you better wait and find out if you can od the on it. Because he's right. I wish I could just take one of anything CARAMEL candy. They're delicious now and he was like what happens when you eventually eat five. Live which you will but I guess yeah I I agree. I agree with that. I would say so the camels to May I think that's such a sophisticated hated flavor to. I don't know if you noticed that they've got a very. It's almost a rich and indulgent caramel flavor. It's not it's not your standard. It's it just hurry and LUSCIOUS I. It's it's not just as day thing it's also carols like I can't stop eating myself. She would you believe. I actually tested at once in eight an entire box because I want it to be over and all that happened was I had a great place like. Oh my gosh if you ever need somebody to detest that kind of a desert tree overdoing it. You know who to call and Mom Lynn. Sending you a box of these for Valentine's Day are delicious into what else let's see we've got some vapes some oils out. I guess you look at this. You've got your favorite section. We do. I would say so. One of the keep products on here that I love is the bathrooms. We actually just featured as well on preventing does yesterday and they're really cute married couple that I just adore on. They have such a wonderful story. H But this is a really interesting product as well because it's very clean has which Hazel in which is very soothing to the body's going back to psoriasis. This could be a really interesting thing the people who suffer from summarizes. You put it in the bathtub getting a ball. It's got two hundred milligrams of CD in it. It's very high strength. Brought up the other thing that people don't I think about is when you in CD. It also goes inside Your Regina and your bottom right so you absorb there as well and people don't think about that's not just a transdermal layer of your skin. It's absorbing it it's also those areas so this is another product that I think is really good for recovery and healing it. Can it also be a sexy time. You know you can get a little bit of time with your partner Yup I would totally do a suppository dropped this tub jump in for the ten fifteen get it going inside outside rock and roll instead to I loved it there was two hundred milligrams Napa. I've never seen it that high So that's really cool. Sounds that out. Sometimes when it's like fifteen to thirty Mike that like what are you doing but that really that just set you guys again. You've set yourself apart from quite a bit. Congratulations really really spectacular or site diving and again if people want to know more about this if they wanna try the products themselves you can do that at mellow. Daily Dot Com. That's it's an M. E. L. L. O. O. D. A. I L. Y.. Dot Com Veronia. Thank you so much for coming on if people want to reach Out To you. Is there a place that they can find you. Yeah you can just email may baroni at mellow daily Dot Com or you. Just follow us us on instagram. So instagram handle is mellow daily. CB Day and just the Emma will pretty much respond quickly. Thank you and everybody nobody at home. You know as I said in the beginning of this podcast we brought Baroni on today as in reaction to an email that we received it from one of you. So if you've got questions if you want us to ask Baroni or find other experts you can always do that. Hello at art beatty. PODCAST DOT COM. You can also or find us on instagram and facebook at art beat podcast and check us out on our new handle our youtube page. WWW DOT ww dot youtube dot com slash our liberty. I won't get days one of these jack various sky so sorry but at the end of the day we were always GonNa see you next Tuesday I buy.

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Vaccination Guidelines for Patients With Immune-Mediated Disorders on Immunosuppressive Therapies

JCMS: Author Interviews (Listen and earn CME credit)

30:01 min | 1 year ago

Vaccination Guidelines for Patients With Immune-Mediated Disorders on Immunosuppressive Therapies

"Hi, I'm Kirk barber. The editor in chief of the journal detainees medicine and surgery. Dancing today to our companion broadcast of author interviews. Today. I'm excited to bring you an interview I had with Dr Kim path Dr Pap is one of the leading authorities and psoriasis in the world. Period. Today. I'm going to take them a bit outside his comfort level. And we're gonna talk about a manuscript. He is the lead author of that we presented in our January February twenty nineteen issue. Vaccination guidelines for patients with immune mediated disorders on immunosuppressive therapy. Dr Pap is the lead author is multidisciplinary report and one that is outstanding. So without further ado, my interview with archbishop this podcast is supported by an educational grant from Bausch L made available through the corporate support program. Welcome Dr Pap. Thank you very much for joining us. I'm really looking forward to discussing this article when I was reading it. I kept saying to myself. Okay. I need to know this need to know that I need to whatever. And you kept bringing up as I was reading it. It was like you read my mind is we were going forward. So we've got vaccination guidelines for patients with immune mediated disorders on Munis. Suppressive therapy an impressive piece of work multidisciplinary. And I think that the females I saw was get some information understand it. But make sure you don't do anything in isolation in involve the primary care doctors. Involve everybody to make sure this is all done. Right. So what prompted you to get your group together. The impetus was this is a big gap in terms of our understanding or knowledge, the the default position is do nothing. And that's why there are the contraindications to using live axes in patients who are on immunosuppressive therapies simply because there are no data on patients run immunosuppressive therapies who received by vaccines. And they're the theoretical concerns that the patient made Vela p- active disease or may acquire act of disease that could be devastating potentially figure. Someone who gets say measles. Generally innocuous disease. But as we seen from recent outbreaks that could be significant somebody who gets bear Saleh miles an adult that that's could be actually life threatening though. The the reason for the exclusions for these very categorical positions of thou shalt not us live axes in the face of immunosuppressants is really thank to Madison. It's not physiologically reasonable. It's not medically reasonable. So they idea was to get together a group of conditions multidisciplinary because we use these agents across all of these disciplines gastro, Derm Rheumatology, even transplantation, of course. And having a group of clinicians who are like minded and facing the same concerns. Could we? Bali wait, the literature perhaps indirectly to say what is the evidence that there is risk. And even if you do think there's risk how can you circumscribe it? How can you mitigate the risk? So that you minimize the you you maximize the opportunity to the patient who may require back Saination but minimize the the potential risk of them enquiring an active infection, though, that was really the foundation of it personally. I don't think we quite achieved the objective because it takes this was a two year project. And I think to really get to the hard core of it would have taken either much more time overtime or much more time than anyone had to commit to the project. But I think we made at least a useful contribution because the conclusions are clinically relevant and they're not. A gore cul there cast in a way that you can see that there is some room for maneuver. So if you're very comfortable with the data as it's presented, then you can very comfortably go along one one direction if you or perhaps somewhat more conservative than the the data or the the script is there to support that position as well. And as you were saying you want to involve others. That's always the case. The challenge. We all face though, is are those others informed. That's something. We just have to live with say, look, I like the table one. I mean, it's which I which I think is the it's the multiple statements and the thrust of your presentation, and the thing I liked about most when I went through it at their. Well, gee, there's there's some other statements here. There's some things that you need just know intuitively. And there's a bunch of stuff there where I say, well that didn't I didn't learn anything there. I didn't learn and then actually read the as we go through the article, and you talk about you, give me the information of the duration of Irena, for example, and these vaccinations, so to your point I can take an individual patients, presenting to me, and workout and say, okay, this person is this this, and this this drug they've had that and they need this and work out a plan based on what you present it to me. So it's a work. I I looked at this is dot information. Well, and. Information document. Yes. But something I could really work with that was to make a practical because headlines that are not pragmatic are of very little utility, pray. I think you I think you'll -ccomplish most of what you said up to set out to thank you to get practical the first one to that. I thought of that we could discuss is the herpes zoster story. I mean, it seems like it's boxed up now closed. We can stop thinking so much about it is that true. Humans are not necessarily very rational. So many of the decisions that we make our base upon beliefs our own biases, and there is a smattering of data when you say it's backed up boxed up in closed as far as I'm concerned. Yes. But then I have been living with the data have been immersed in the data. I've been involved in debates and in the controversy for some time. So my level of comfort is going to be different from someone else's. I wouldn't say that it is completely close because there were still be those who are more conservatively minded or who are more cautious and they will take more cautious approach. You can never prove negative. The always you're always searching always searching for the possible. I think it's largely closed, but it's certainly not completely closed came. So just summarize your statement three b but the sub unit vaccine is the preferred alternative, and there you go because there are members of the committee who take very conservative position. And they they they said why why would you have any exposure patient to any risk when you can provide a suitable alternative that his available at no risk. Right. So when when you look at this data, we have as you pointed out a couple of scenarios one is we don't want to give people live axons make them sec. But at the same time, one of our goals is demonize people and make sure that that immunization we give them actually takes. And and is useful. The you know, when we go through the biologic, you give a nice list of of of the the the drugs and their half lives. And and go through the evidence of what might be affected. It sounds. I kept Itis pneumococcal vaccinations may be the two common ones that may be attenuated by biologic therapy and by methotrexate on. Yes, they the we we actually do not have any direct evidence. That indicates how effective vaccines are in the face of patients who are on immunosuppressants. What is used and? In place of direct evidences surrogate marker, which is immune Gina city. That's actually the first test of the an effective -ness of vaccine is determined new municipal. So if the target Bank seeing or propose, Maxine is not very mutagenic. It's highly unlikely that it's going to be affective pot being immuno genyk and being effective in terms of reducing the risk of infection is they're different. They're they're clearly very different. So the the evidence that we do have is based upon these indirect measures and. What is seeing is that generally there is a slight dimension of immuno Gina city across any of the valances for the Polly Valen vaccines in the face of immunosuppressants is somewhat more marked in patients who are on track. Sate, but there is still some not statistically significant suppression of immune agenda city impatience who are on the other biologics. The the NF inhibitors being the ones you have the most information on because they're ones we had the longest correct? And any sense with the new biologic the seventeenth and twenty three's. Is there we have the same questions? So there there are single studies on each of those agents in psoriasis pop in the psoriasis population, which also begets, shall we say question of what is the correct population to use for example in patients with rheumatoid arthritis patients with rheumatoid arthritis have intrinsically altered immune responses, and so it's not clear how much of that diminution is related to the underlying disease compared to the or shall we say an an Accenture nation of their response to vaccine because it's largely B-cell driven. So maybe they just show some hyperactivity. And in fact, the real response that we measure. They're on immunosuppressants is more normal because when you look in psoriasis population, you don't see is great a difference between the your control their native population on those are Unamuno suppressants with the exception of methotrexate, though, the new agents, I think single studies are are sufficient to demonstrate that we do not say appreciable suppression of immuno-genetic in the face of out seventeen blockade or I'll Twenty-three block or I'll twelve twenty three blockade. Okay. So the patient support programs have gotten so good the weekend. Basically get people on drug while they're in the office. And we've had the very first discussion with them. It used to be that we had to wait weeks. Get get through the churns companies and we had time. Now, we don't have so much time. I mean people want to get on drug then get on almost immediately. Do you ever push it off, and wait and say hang on hang in hang on? I can get you the drug now. But let's look at that immunization record of yours and see what needs to be done. Do you ever? Hold back. And let's talk about this teens and twenty three's and specifically personally. No, I don't see any utility in forestalling treatment, the other part of this is when we look at the age group that we are concerned about their usually in their mid forties. Give or take. And so what are what are they do for terms of axons Shen, unless they're traveling happy happy probably not that significant risk for them unless they have some other occupational exposure. What are they going to run into in? If you. You have someone who is in need of vaccination for whatever reason. Then I think it's up to the prescriber to make that deliberation are perhaps a primary care physician. If they're in a position to do. So to say well where where's the real risk, and where's the real benefit? So if the patient is in desperate straits with regard to their psoriasis, rheumatoid arthritis, or whatever it is. Oh, why wait because the downside is very is minimal. On the other hand if you have if you want to optimize a response. And there are any concerns about the risk of using specifically ally vaccine, then there's no harm in waiting until the patient's been vaccinated. So I don't think there's any absolute response. It's very much dependent upon what are your objectives? Are what are the conditions of the facial is specifically I thinking about the fact that it mid forties. Putting something on the I'm I'm treating patient with Munis oppressive therapy lifetime probably anchor and these are current understanding. And so I'm kind of priming them for when they get to sixty sixty five so pneumococcal thing, for example. That's the guest the idea. We'd be you. You didn't worry about it. Then you stop the drug, and if you want, but if you that you're not gonna vaccinate somebody forty five for vaccine that's more appropriate when they're sixty five. So you're not gonna wait till they're sixty five toback Sonate them. And what's the downside of having having vaccinated while they're on immunosuppressants? Yeah. And I think that that whole terminology the the use of the term immunosuppressant is one that we take as being almost like a guillotine either your municipal center, you're not the truth is the agents that we're using have very minimal effect on the overall immune response. They affect not even completely they abrogate partially a pathway one pathway out of the thousands of pathways that are present and active in the immune system. And we know whether it's by vaccine studies, or by the fact that we do not see any profound infectious processes at our current in these patients who are on as you said lifelong now some patients for decades on these drug. Eggs, and we don't see any significant issues. It's not like the good old days when we had high doses or even intermediate doses of corticosteroids or using cyclosporin or tacrolimus those agents were more profoundly immunosuppressant because they had a broader spectrum of activity, though, I think looking on just how we treat these patients where these these drugs work that we're actually. Just touching mildly suppressing immune response. And so pretty the calcium earn inhibitor fear when we were using prototyping Alydar back in the day. Whether they were immune modulating immunosuppressant, you know, that's story. But, but you know, in in the next rewrite of these recommendations, we should probably think of a different term rather than immunosuppressive agents. So the the the category of immunosuppressant is is actually international so WHO or did various regulatory agencies will determine whether drug is classified as being an immunosuppressant or not. So it has nothing to do with anything other than broad categorize ation, which is unfortunate because. Unless very familiar with the process, it's like class labeling. Right. Just because something occurs. One drug doesn't mean it will occur with all drugs that are in the same class and immunosuppressants the very broad class and many of which really don't affect during much of the immune system at all whatsoever. And we don't we don't do mild moderate severe with them. And know, those terms don't exist now dollar. All right. So in practical terms. When you. Are about to start somebody and biologics you get their backs ination record. Have you had difficulties with the newcomers the our immigrant population trying to figure out what they've had what they haven't had guidelines for us. So no. So my my own position on this is that with regard to vaccination or or general maintenance of of health that should revert to the primary care physician, whomever that might be so I I am not about to embark on determining the entire vaccination history. I do not necessarily have the resources, but it may be incumbent upon me to inform the family physician or the primary care physician. Primary caregiver may not be a physician to ensure as best. They can that the vaccination records is appropriate. Maintained an up-to-date for the local jurisdiction. If you will as you point out, the the other thing that that that I wanted to talk about briefly was the the pregnancy story because that's another thing that often comes up and people's offices about when to stop the biologics and wen to immunize. And and so you're you're now you're going off script. Oh, totally. I I'm trying I'm trying to make guideline come to life. Okay. Okay. So if we look at the infant, and they're only seems to be one story there. And that's with the Rotavirus. Well, there are two there. There's only one that may be relevant for most of us in North America. That's a road iris. But in some parts of the world, Great Britain, for example, BC g is still administered to infants in in who were born in an endemic population. You might remember case goes back about three years. I believe of an infant who died of disseminated BCG purportedly as result of the maternal or fetal exposure to inflict some app now that there are many circumstances. Surroun-? Nding the case that our our little bit curious the infant was accented actually as as the Neo Nate. So that's a little bit unusual. The level serum levels are drawn. And there seemed to be multiples greater than maternal lead levels of inflex map. Anyway, there are many things that are just a little bit at odds from what we know about the the general transmission of gamma globulin across the central barrier. But regardless it's it's least instructive to say, you know, what we're a fetus may be at risk and certainly anew. Nate may be at risk if you back Sonate with an agent vaccine that may predispose a child to active disease when immunosuppressant is also known to be effective in obliterated, or at least abrogating normal host response. Monce TANF antagonise, we know inhibit the normal host response in the face of to regular basis, and they also for for any of the Mike bacteria. They're likely to suppress initial immune response. So an infant who was exposed to a t and FM tag nest and received exposure to a Michael bacteria is more likely to acquire active infection done Rotavirus. What do we administer that affects Rotavirus? Nothing. Corticosteroids would definitely affect the host response to Rotavirus because it's going inhibit interferon. Gamma actually, I think all the interferons and corticosteroids modest doses are more immunosuppressant than any of the biologics that we use as demonstrated by the back seen studies that demonstrated by response to TB testing using quantum Feron or PD. So. The risk is low. It's just that. Do you want to take the risk? That's really the question. And hence, the the debate about when you backseat with the Rotavirus technically the serum levels in in the infant will be very low because you're already looking at several half-lives, even even though they're someone extended an infant in Aena Nate than the half-life steer three or four half-lives lower by the time evac Sonate with Rotavirus. So and that's about four months is right. I believe it was okay. It's months, then an and the interesting in Calgary. The pediatric ID group is now actively involved themselves in in in the immunization of infants which was I'm sure. Driven through the GI world. And now that so many people getting biologics they've actually set up a service. They want to see the infants and and council the mothers, and really it's it's really worthwhile. So. Hopefully that'll spread across the country because as you pointed out earlier, it's not something that you and I want to keep up to date on. And that time we need to be aware of it. But yeah to actually be destined in it. None of us have time. And now we're going into measles. I mean, we've got the got cases right in Iran as we speak in Vancouver. There's I think six kids Washington state in Calgary in actual fact Alberta. They've come out and recommended oxidation of of infants and the uptake here in our province is about seventy five or eighty percent again their second shot, which apparently is okay. But not great. They offer on drid. And so we're expecting significant outbreak AMIS -als in Albert over the next two months. So. In the measles were old. And I, you know, so first off I have somebody on an immunosuppressive an immunomodulating drug or suppressant drug or whatever we're gonna call them these days and their kid gets. Vaccinated because now they've decided ups better get my child vaccinated. Whereas I didn't before. Is do you? Do you get any vice specific to that on the say the again, the seventeen Twenty-three specifically, the I I would go back to the original literature that started all of these are concerns about immunosuppressants. And if you read the original papers, which were done in the fifties and into the six days, and they're not even general reviews are really case reports, it's very clear that patients had to be profoundly immunosuppressed before they really acquired any significant or develop any significant risk requiring active infection. Whether it was by maximization, or by secondary exposure to a person who had been vaccinated, you're looking at handful of cases to dozen at most. I I can't even I don't even think the two dozen and in each of those instances, the patients were profoundly suppressed that had marrow ablation they had leukemia lymphoma, and in those days it wasn't. They weren't even as well managed or well controlled as they are now. Now case. Zero yet in our population is rise group. Maybe the transplant group have different different perspective on this. But so in our population, not something we're gonna fuss about it's not worth the bother the risk is I would say remote. And if something if an event did occur. I doubt that it would be related to anything that we had done because there's always a background risk. Even though it's very small say it's one in a million while eventually someone's going to have that experience. Now that doesn't mean in right? All right. Well, thanks very much. Is there something out of this manuscript that you wanted to bring forward that? We didn't talk about him in very complete night clearly urge everyone to to take a couple of hours with it. And it was really well done. Thank you know. I think you pointed out the the major the premise was not necessarily to educate everyone on on everything or anything for that matter. It was really to be intended to be used almost as a point reference of to manage those cases or to fill in those those knowledge gaps when you needed to fill in those knowledge, gaps just to make one more confident in making whatever decision you're going to make whether it is toback Sonate not vaccinate to treat immediately to perhaps stall initiation of the municipal. Isn't treatment. But wh whatever whatever your decision, you want to be informed, and the whole purpose of this guideline was to provide that reservoir of information, hence, a what's the duration of Irena because if you're conservative or you're concerned about the patient than you can say we need this many half-lives before after vaccination before we can safely introduce treatment. That's all it was about just to serve as a real reference. Well, great work. Thank you for sharing very much, AC mess and thank you to your co authors. I mean, it was I'm sure to two years it became painful towards the. But it's it's really been something that's been very useful had dark hair when I started the project. All right. You've been listening to my interview with Dr Kim Pap one of the world's leading authorities on psoriasis. I thought I might be taking out of his comfort zone talking about vaccinations. But clearly not your practice will have improved for having listened to this podcast. I'm sure he's provided. And we're he and his co authors provided a clear path thrust reading to define our own guidelines that we can use when we're assessing individual patients. So I'm Kirk barber. The editor in chief of the journal detainees medicine and surgery and until next time to each other.

psoriasis Rotavirus Dr Kim Pap Sonate editor in chief Kirk barber Calgary Bausch L methotrexate Dr Kim BCG North America Derm Rheumatology bear Saleh Vela Madison Gina city
How to Cover Up Eczema, Cold Sores, Psoriasis and Other Skin Conditions

Art Beauty

25:42 min | 9 months ago

How to Cover Up Eczema, Cold Sores, Psoriasis and Other Skin Conditions

"Here's the thing. I don't understand though. Why people ball make fun of cold? Sores like when you think about it. It's it's it's it's people make fun of AIDS or HIV EH. So why you know aghast. It's like another sexually transmitted disease. Why is that when people make fun of it so much? I don't know I I don't I'm not in a circle where we will make fun of it a lot but but like why is it so shameful to have that 'cause it's visible you can have hp you can't see it you can have AIDS nine times out of ten you can't see it you can be HIV positive Deductible and you can't see it you can have committee and gonorrhea and simple can't see that one ese and it's just like the scarlet ladder of like. Oh he was let but you know what those it's not I mean I don't know it just gets so annoyed because it stigma and and like things like psoriasis and eggs Emma or even like acne and Bacne you know I just wish that we would all kind of just move on there so much more important things to deal with in the world than to be making fun of somebody else because trust me when you have any of these things changes your world immediately changes your world immediately. Okay and you feel awful and I don't know I think that we all need to band together and just love love. Love the love but on that note today we are providing. Awesome really helpful tips for how to help you know minimize the appearance of flare ups. Such as psoriasis or exuma Samat or a cold sore that is like aggressively red pink bruising. We've gotten a lot of tips after we did the psoriasis episode so a lot of feedback this episode and they were like how do we cover it when we still have it. So we've got to rate tips today. I on on that note everyone. Hi I'm amber and I'm Ryan and this is art beauty the real truth about the fake shifts. How's your day going by the way my day is going great? It is such weird weather so it's like you don't know what team Yeah Cold Doc. Cold it's snowy. It's like I know I know so and I don't know about you but like how's your house your skin reacting getting to bat. I went back to back to Murod so I'm back to muirhead. Has They're refreshing cleanser which is really hydrating and not stripping and here is that. It's the pink one it's the it's the it's like this color. And and I also use the hydrodynamic quenching Zarem which is great And I've you know it's funny. The last time that we had at our guest on she swore by this S. K.. Two facial treatment essence. And I have to tell you between those like my skin has actually been pretty good really pain. Yeah I know I've been drinking. A ton of water has been traveling a lot. My died on the other hand has been total shit. Oh Oh yeah. How's your day been? It's been great unlike fresh for of of a true who poisoning not like the one you like tell. Oh you're front jihad because you just didn't want to go to the party the next day. I'm talking a skinny Bitch Hall. My goodness I was poisoned. I've had a handful of times over the years so like I know what to do. And that's just like you know get to go. Oh and and just try and chill out because you're going to be up for a little bit And and not hurts the next day. And it's like the New York stock on like a really simple diet for a little bit but it Yeah I at sick though like I feel like did you hear what I said. I'm like ooh lucky. You feel skinny only in. I don't know America New York like who the F are way that we you celebrate this. It's like so disgusting. What does it from Devil Wears Prada? Were like your stomach bug away from Galway but the thing is though I'm as I mean hi I'm approaching forty right. It's around the corner from me. I am like freaking out. Why can I tell tell you I love forty okay? You know what you're really new in the door of forty. So you're yes you for saying that I will probably love forty two. I will own it just like you you do. We are similar in that way. But I'm saying my recovery off feeling sick with flour. Yeah I know almost like remember when your last really bad hangover so you were like aw I can leave a cat recover like I used to have. I used to be able to kick a stomach bug and and keep it moving. I couldn't do that this time. And then like this morning I woke up. And I'm like my God Ashley Heartburn. I got the other day to that. Part of forty is not fun. What the Fuck I've never had heart by had never in my life ever and I don't like not a big drinker? Okay yes I drink coffee. But I didn't even have anything to eat yet. I woke up with heartburn. I'm like this this old getting all that. That part of it sucks but the fact that we live in a world where you can like laser and inject and do all of these things that you can do not to stop the clock but to really embrace your useful youthful looking south and in sort of press a little bit of pause we live in good times we do we do and do you know. What a little Bapu Bisbo with a long way all right so I'm not note from food poisoning to fixing your to say goodbye to Ryan there? He went I gotcha. Yeah the pink stuff it works you just said you you have been hearing on I just. I'm just going to step aside here. Ah there you go I love it. we've got a great guest today. Area Lewis she was on talking about this bullshit. Brushes awhile ago. If you didn't get to check out that episode you definitely definitely want to. And she's got some really. I think wonderful tips for how to cover up You know any kind of flare up whether it's asthma psoriasis. If you've got Acne A cold sore all of the things and you know what it's easier than you think so. Check this out so in my opinion that it really comes down to there's different formulas write all conceals come in different textures texture formulas there's some really lightweight formulas that are super billable like naked by urban decay. Right Bobby under I areas but would be the worst product product to try to cover up as redness or something. It's heavily textured. Because it's just too lightweight. The other one that comes to mind is a lot of people. Love the MAC body taste body ain't got no. That would not work for something like this you really. It's the one thing where in order to teen the coverage that you want you're going I don't WanNa go with something that's a little bit of a thicker texture so there's a pep options that I think people had you have to keep in mind that the products that you're gonNA put on your face to cover up a a little bit of Asia or psoriasis are going to be completely different than the proxy with put on your skin. So let's say that you're going to an event and since Rice's kind of starts to can you show up right on your declaration and you're wearing a low cut dress. Your body needs a different type of coverage in your face would so I would recommend something like me for a long time. We've had product Dermot. Blend out there. They were buying the thing. I don't love about them is that they tend to oxidized very dark so oxidizing the people who might not know what that is are familiar with the term just means it essentially after a product has lead on your skin or generally after like ten fifteen minutes it starts to kind of deepen by a shade or two or a little bit orange little sallow so a product that oxidises an ideal If you've got really fair there's a a medium medium-grade skin tone that works even oxidized but most one really. It doesn't look great and I tend to compromise space of assuming that most of the people that are listening to you aren't professional makeup artist there everyday women that are like look. I just need like what's GonNa work and take a look at it. I think that the the trends go along. They change all the time and they're always trying to up sell us on stuff. As Consumers Right forget professionals but as consumers you go into a department store origin ulcer whatever. And they're like Oh. This is the newest secret sauce. It's this green stuff in green contrast red. Yeah absolutely it does. But for the woman doesn't really know how to blend and who isn't chameleon with different textures. And how those mediums kind of like can affect one another and doesn't really understand what oxidation is most of those formulas from what is seen. Don't work so I like to stay away from those like very catchy. Brian Tone rhymer colors. Yeah like the Makeup Effects Green Primer right. You know can't Seattle unnecessary. Some sterry noticed. I find your price. I know how to work with those green primers but even still why would I want to make my life any more difficult Koran. Now he's got a new as a consumer right. I've worked at those stores. I'm not sure if you have in your career ever but there are starting on when you checkout. They want when you clock out they used to your point is and you would want they would ask you. What was your you Pi? And I'd be like what does it stand for like your units per transaction. They WanNa know if you were able to sell that client more than one two three four five things and you've got literally Judged on how many items you sold each client sell upsell sow sent From behind the scenes to to you you don't need the green. Don't always take the up south on always necessary. I just know that that is truly truly how those how people are judged that workplace only recommend people. Just you know there's a makeup artists in your life that you love ask her. She'll go into a personal shopping experience with you. You know provide that for a lot of our clients Selling them anything. We're just literally going with them as a professional. It's not in for the commission. Give them that guidance. So ethically around it back to the body. How do you feel about Kim Kardashian's body line that she is exactly what I was? Just GonNa say. Oh so I love it. I was looking for in my kit actually. Let one of my artists Barwick's we have a client coming out. I actually know the plan already repast to she just hasn't returned to. I really really love it. I was GONNA say you. You've had options like Dermot Bland and Hover affects and things like that for a long time. But Kim I think because she had psoriasis she personally is separate from that and being in that world the limelight constantly. And just the unforgiving of the you know high hd quality film in all she's really coined that corner of the market in way that I haven't seen anybody else. Frankly touch I think her product is oxidized at all When you blend it the right way applying it with a brush yet to to see that body brushing brush that's laudi brushes made the same types of bristles business? It's just shaped like a Kabuki which is nice because you can flat lay it right so so it's kind of like paintbrush style for larger areas. That works something like this would be used in a strip your motion. Something like that would be used back and forth flat on the about this product right here. The Skin Perfecting Body Foundation. There's a shimmery versions in their skin. Perfecting yes yeah because sometimes you want that iridescent a eh but like for me when I'm in between sprayed hands and I'm a little blotchy I love it because I can just hit my arms really quick and then I will set it with somewhat of a blow dryer because I think everything kind of oxidises on no matter. What whether it's like which way or another And I make it happen faster and And then I go and it does not transfer to your clothes out. Is it so protect. It doesn't transfer to your clothes. Generally right right. But if you're GONNA go sweating right that's that's never a good idea. You WanNa wear something like that for a photo. Shoot in my opinion. If you'RE GONNA go out dancing and stuff you do you WanNa make sure that you said it with a powder but you don't WanNa make the mistake of going back over. It was some sort of a setting spray is again. You're you're messing with the formula. And it's not guaranteed to not transfer if you they added product to it exactly can break down and the other thing I want to say about. It is just most women again who are not professional makeup artists. They figure. Oh I've got one little red spot uh-huh here. I'm just going to take a job of it like this. And they're like I'm telling me it got spot you want to go at least five times outside the spot if I had one little all star eight here. Let's say the size of a quarter and it was it was really bad or heavily. Textured or just completely you know stood out against my skin tone. It were we're in a client WHO's much fairer than it really doesn't matter I would go out five times the size of where that's faces and that's because you really WanNa make sure that there's some sense of uniformity ended ended looks because to Ryan's point most products do oxidized to some extent. Especially on fair complexions you want to go beyond that spacey. Don't wind up with this little lake lying a On occasion rate. It's clear that makes it a dead giveaway a product that you know is kind of a heavy investment but if you tend to flare up a lot with something specifically like psoriasis which is throughout the body this product. I'm about to recommend is definitely not something you'd use on your face the Durham by ten to and it's it's an airbrush product so use it along with an airbrush gun. WHO's your favorite airbrush gun to to like introduced to clients? Who Do you love? So so my guns pretty expensive. I don't think it's worth the investment non on an average woman dinero gun is fine luminous gone fine I would say though. I'm I'm not sure with this particular products a little bit more heavy duty. You would need a gun that you actually be taken apart so like kemp to. I loved him exclusively. What I use? Okay Yeah so because I can take it apart and clean it. This is alcohol based makeup. It's the same point eight us on like Angelina. Jolie would chest to get all over tattoos. He's covered up. It's what we use for here. We go okay. Sh my point here being. I didn't need something green or yellow home or he. La Or falling. I just needed something that had the coverage that I need and the something like this if I was someone who wrote out a lot with At Saint to try assist brought my legs and my body I would think it would be worth the investment of having something like this because it the only thing that removes alcohol and I've never had a problem with the client Saying that it irritates them. So the F- The other thing you really gotta test malpractice at your skin can't go Willy Nilly Buying Dermot Blending K.. Ten to and slapping it all over your sensitive skin because you might get an a breakout from it. Sure and this might not necessarily work for everyone. Everyone's skin is dipped got it you know and probably not concocted tested on small patches and not about identity tested when you're not having a flare up just to make sure that you don't have some sort of a reaction to it you know when your skin is in in the most unhealthy and COM state. Let's say What about so and so what about you said that? That's for the body. What about for the face so so the one last thing that I was going to recommend the body really quick? They're just because airbrush might not be something that everybody's you know willing to go and invest in. There's some products on the market. Now that are professional your grade Tattoo cover up makeup body impressions total to skip Novak Okay and and these tend to be very convict foundations as you can tell by the crack in this one that you know my recommendation for using something like this is to add a little bit of oil a little bit of beauty oil to it and then kind of work into cheer fingers into your sponge on these brushes are perfect for stuff like got at least make one of these bras. I hate these. What are they used for? I use them for that because because I don't care what happens to them another brand that I seen you ask for face. So I'm not a big fan of this brand for like it's not my go-to for makeup for the most people. Thought if you're looking at someone who has some again highly textured and read Flaring in their in their face. This is safe to use on your face and it's a pretty thick consistency which is going to cover anything up again without the need some sort of additional green or purple alert yellow or orange or lipstick underneath your eyes and then put this on this is GonNa do it all by itself but these products If you can tell me kind of of doing this but here started rubbing that off of mainland from anything but a company is called this assists Mascara Mascara beauty. I've never heard of them. The A. R. O.. I've never even heard of them either. But it looks like it's very thick. It's to protect Superman based sell this as like. Oh this is your foundation everyday life like it's in fact I'm not if you sell L. Mascara beauty. I'm not knocking it. It's just not for me. I don't particularly love this consistency for what I D. I feel very bad when I knock products. Oh what about when you have something like a cold sore right and we're trying to cover up things like that so you wanNA use a small version of a brush like this and you want to make sure it more than anything that it's clean that's the number one thing because that cold sore will spread. If you're just thinking how it's new the Gail I'm GonNa take take my beauty blender that I love and just pop a little bit foundation right on top of it and it's going to go away. Don't do that like cold. Sores are pretty contagious. So you WanNa have a brush that is clean and just to get be giving us a Q.. Tip Works really well. Use Acute Tipper one of those cheap little sponges that you get at the drugstore and and use that with the same product that you're using if you're if you're gonNA use something like this I think foundations thicker conceals are exactly four something like that at Jerez Ladies Hempel or a cold sore like that's where that's useful. That's not great all over your face. It's GonNa be just too much heavy Kiki coverage but in certain areas where you need it but don't forget like with a coats or there's Skin around that in the same thing goes for open acne right so it's not going to change the texture of it so you have to have realistic expectations for what your coverage is GonNa look like you can make it look completely perfect with with a ring light and in some photos you know but in real life you're still going to sie lay Around it and it might lose because let's be real like it's an open wound. Yeah wow you know who used to live would like almost that situation. Every month remember attending McCarthy. She was like. Oh Yeah Marriage Donnie. Wahlberg she's on she was on like. MTV was like one of my favorite favorite MTV personalities. Back in a day and she's just so outspoken. Such a great woman. She gets them like right around the time she gets her period and she gets it in the same spot like right there and she in openly talked about it. I remember when Rosie O'Donnell header show she launch some silly product and then they were talking about like she literally got her sharpie out and dissecting I selected the cover of the products today. Might I have my my monthly cankers. My monthly cold sore by. I was bloated here. And she'd totally all over her own picture and it was so cool and the way that she got around it was she used she would set her foundation the news her lip liner and she would never let the makeup artist touch it. Because she's like they're so contagious Anaheim and why anyone national even really to go near it now when I'm doing it as professional maker part don't I don't touch it with a brush that smart people don't realize that it can you can spread it from Your Lips. Your Eyes Right. Any has any enter into a stock because what young yeah turn guy. Yeah Well you know you can get your eyes can have cold sores. I mean they I think you call them sties though. Don't you or do home. Yeah no no no no you can have herpes of the eye. Looks Yeah Yeah Yeah. It's it's it's you know but it listen I it is what it is and if you're suffering with that You know you're not alone. No you're not you're not alone so not so. Yeah and don't feel maybe. This is valid to say just outlawed hearing it from professional. Makeup artists. Don't feel embarrassed about it. You don't feel like one. Don't you know I don't even know if you can do my makeup. Like a professional knows what they're doing and they know for sure. If you see somebody coming at you with a with a foundation brush. That clearly was just used on somebody else. You WanNA stop. Stop them right away but most professionals know how to deal situations like that and we're not like stiffy about it. We're not freaked out by like short of our profession. It's what we do I. I think it's wonderful that you're saying that I bet there's a lot of people out there who really want to hear that because you know it. Let's be honest those things are gonNA come up anything like is dealing with the nervous system. So you've got psoriasis you've got. Xm Get cold sores. Generally it's GonNa come up when you're nervous about something right or like at the worst time so a lot of times. It's like those big events events like a wedding or you know like a big. I don't know like a big event. You're GONNA have the pimple or have the colder are have the flare up And that's when you're going to need to call professional to say come help me. Thank you Ariel so much I mean I feel like again. People are probably listening to this and you know now when it's on somebody else it's not as big but once it hits your own face once it hits your own body once at your own skin. It can feel like the most epic horrible thing and I love that you really drove home the point listen. People have psoriasis. People get Xm up people get cold sores. People get bruises and you know what try to just put on your best face and put on your game face and don't let it don't let something like that. Stop you from going going to the event from going to the party from not having the best time because at the end of the day you it'll be worth it to get out there but I feel like having that makeup tips. Tips can really give people a little bit of confidence back and Kear point. I think that what you're saying is spot on and I often tell women who may be subconscious about something whether forget if it's not psoriasis. or a breakout or something. They're self conscious about something about their face that they dislike right Klay up your eyes. The plan here is pronounce. Lashes mixture browse fire. Makes your hair looks fabulous in your dress nicely in. It's tailored cut. Well no one is looking looking at whatever that thing is that drives you crazy. No one is looking at it because literally the focal point is right here or just like you overall you know so people people women in general do we need to keep that in mind. Nobody's scaring at our one breaking now looking over on saying Put together and you present. You are exude Johnson and whatever so it reads that way that is such a wonderful wonderful advice aerial. Thank you so much for doing this if people wanna find you. What's the best way to find you on Instagram at A.? R. E. L. E. W. I. S. Llc they can go to our website which area list dot com and. Yeah I mean I do tutorials every Tuesday so if people are interested in more practical recall how to apply to fix things. It's always fun to join us for that. I love you. Wearing the tutorial Tuesday's earn instagram on our story every day. All righty so we will be checking you out out of guess what this is happening on Tuesday. So what time works yeah. It's Tuesday now. If you're listening to this time of year what time of Utah. She toils Sydney Berry. They used to be more in the afternoon. Other were in the evenings feedback as Ben. It's easier to watch on you know after they've gotten home at dinner and stuff so a little bit waiter now amazing so download has. You're you're listening to our podcast now and then when you get home you go check out. Ariel Lewis Tuesday deals and of course you guys coming to find us. You can find us on Instagram facebook at art beat podcast and you can check us out on Youtube. Now you dot com forward slash ARP beauty and as always. We're GONNA see you next Tuesday doc.

psoriasis Ryan Ariel Lewis AIDS Skin Perfecting Body Foundatio Kim Kardashian Emma asthma psoriasis New York hp Murod HIV Instagram Seattle muirhead Durham Bitch Hall Galway Kear point MTV
Dermatologic Conditions for the Primary Care Provider

Mayo Clinic Talks

25:09 min | 1 year ago

Dermatologic Conditions for the Primary Care Provider

"This is mayo clinic toxic curated weekly podcast for physicians uh-huh and healthcare providers. I'm your host daryl chapter general internist at mayo clinic in rochester minnesota in the united states approximately ten ten thousand individuals are diagnosed with skin cancer every day in fact more people are diagnosed with skin cancer each year than all other cancers combined. This is just one of the many dermatological conditions which often present to the primary healthcare provider other common conditions which we see in the the office practice include rosa exa on my coaches. We'll discuss these conditions in more with dr. Mark davis a dermatologist within the department of dermatology at mayo clinic in rochester minnesota mark welcome. Thank you very much daryl well. Let's start by talking about skin cancer because that's the thing we probably worry most about with our patients. In terms of missing a diagnosis <hes> who's at risk for developing skin cancer well basically everybody's at risk but people with lighter skin tones like people with white skin are lighter tones of skin have a greater tendency tendency towards being susceptible to skin cancer so that that is the population that is more at risk any difference between males and females. It doesn't really matter <hes> it doesn't really matter <hes> it is <hes> it affects males and females and in those skin colors. It's really exposure to the sun that poses poses the greatest risk at in terms of susceptibility to skin cancer in the everyday setting all right so an individual his head multiple severe veer sunburns early in their life. Do they continue to be at risk throughout the rest of their life. Is there a safe period. If they've gone like twenty years <hes> the risk goes down. That's a great question. We don't have definitive answers as regards that but we do know that five sunburns are greater when you're a child or not lessened doubles your risk of getting melanoma later on and then we also know that cumulative sun exposure is risk factor for the non melanoma skin cancers so the risk goes up directly with them with with with the amount of sun exposure that you get the older you get because when we were kids you know i don't think sunscreen was even available at the time in fact we were putting things on our skin to enhance the effects of thrive sunburns urns were a common part of growing up in minnesota so let's say again. Somebody has had <hes> previous circa exposure to sun. Some significant sunburns are is the skin at risk for developing skinny answer. Only in the sun exposed area. The answer to that is all of the skin is at risk of developing skin cancer even the areas that we're not exposed to the sun but the risk is greater later in those areas that were exposed to the sun. It's interesting we do know what the non melanoma skin cancers which are called basil silent squamous cell carcinomas are the most a <hes> well known of those most most common of those that they occur in the areas that get the most sun but melanomas can occur in the areas which are intermittently exposed to sun are sunburns for example. You're back am in in men or the legs and women there the the areas pro more prone to melanoma alma <hes> do to listerine skin disease when you're when you're a child do most melanomas arise from a pre existing nevis or order. They start de novo from nothing. People with lots of moles are at increased risk of melanoma but the lesions that appear day novo in in other words the new lesions that appear they're the ones that are more likely melanomas rather than the pre existing moles transforming into melanoma k okay which is an interesting it is are all three types basal cell squamous cell melanoma all related to sun exposure. We definitely think so yes again. Type and timing of the sun exposure seems to be an important factor so for melanoma. It's intermittent severe the serious sun exposure that seems to be the greatest risk for melanoma for non melanoma skin cancer. It's definitely the cumulative risk at cumulative exposure to the sun that that increases your risk so for example where at in this weather out all day in the sun <hes> you will increase your risk in those areas that are exposed to the sun amir face yard dorsal hans. If you very not shirt your upper arms and clouds really protect us all that much do they don't protect us all that much no but there's still an awful lot of u._v._a. And you've been coming through those clouds in fact a yearly seventy to eighty percent of the u._v._a. Be that would be there without any claire still coming through. I've heard mixed opinions about sun coming through a window yet. They generally windows with stop v from coming through but u._v._a. Was still come through and u._v._a. Increases your risk of skin cancer okay now. I've had some patients <unk> who had basal cell squamous cell and melanoma so if you have one type of skin cancer are you at increased risk of getting a second or all three. Yes you are <hes>. If you've had one type then you will be predisposed towards all other types. The risk increases no matter who kind of <hes> a skin cancer that you've developed of getting either melanoma are non melanoma skin cancers. So what should we be telling our patients in terms of preventing preventing them from getting skin cancers. I think the main message is to protect the skin from the sun. The ideal thing is not to get ideally to minimize the risk of skin cancer. You would tell people not to get son at all but <hes> we know that for many reasons it's nice to be exposed to sun a little bit otherwise it makes the endocrinologist unhappy said you don't get any vitamin d exactly but we we know that short exposure to the sun is fine but we want mm to minimize the cumulative sun exposure on the in in on the skin so avoiding the sun completely are if you're going out wearing some protective of clothing is probably one of the best ways to do it and then we also wear sunscreen which is applied before you go out rather than being out in the sun and then suddenly starting to apply it on a beach each and you've already had half an hour of exposure to the sun by that time and a lot of it is unevenly applied when you're on the beach or <hes> and you can't see where you're putting and let's talk a little bit about sunscreen <hes> it is effective absolutely it's well demonstrated that applying sunscreen decreases your risk of melanoma the noma and it also decreases your risk of particularly squamous cell carcinomas under skin. A couple of studies suggested that the effect is not as great for the et non melanoma skin cancer called as carson. We're not really sure why that is but it's been well demonstrated that you protect your skin from the sun with sunscreen green. You will decrease your risk of skin cancer and pre skin cancers and it's listed with an s._p._f. Number what i should we be using both in general although there's a lot of relabeling being being considered by the f._d._a. At the moment <hes> in general we recommend that an s._p._f. Fifteen to thirty should it'd be the minimal that you'd wear and up from that and should be broad spectrum in other words. It should be labeled as protecting your skin from both u._v._a. And not just to 'em u._b. Now that's the first i've heard of that is some out there that does not protect you against both there are but they're less than less because read the f._d._a. Is recommended that in a proper sunscreen should protect against both <hes> now. I've also heard this. I don't know if it's true that the sunscreen has a particular shelf life and if you've had some leftover from last summer you should throw it out right new stuff. You should check the expiration date of that sunscreen because the sunscreens are made up of different chemicals and they can expire and become ineffective after a certain amount of time that sunscreen may not be effective so really check the the expiration date on the bottle and ideally don't use them for much beyond that expiration date because they may be ineffective by once they've gone beyond the expiration date eight right good to know well. Let's turn from skin cancer. Now to <hes> rose atia. Okay got a fair number of patients whose had who've had rosacea who's at risk for developing this more fair skinned people developers asia. It's been reported them and darker colored skin. It's rare <unk> to come across a diagnosis of rose asia. Why that is we're not entirely sure but it's diagnosed much more fair fair skinned people and an particularly of celtic origin so i'm from ireland and russia would be very common in ireland for example with the irish white skin and to have that blush have rosacea and those penpals associated with rotation the changes that other changes that occur with that disorder and it's limited to the face generally it is limited to the face. Yes <hes> rarely affects other areas when would think maybe somewhat related to sun exposure. Yeah it is taught that sun exposure does play a role there with us. It's also taught that some people with very fair skin celtic skin have increased vascular reactivity to you know to different different temperatures and maybe that's playing a role as well. We don't really understand why exactly it happens. We don't really understand the pathogenesis of rose asia very very well. Although it's multi multiple mechanisms postulated for it okay. Are you looking for up-to-date c._m._e. On geriatrics attend the geriatric update for the primary care provider held november fourteenth eighteenth two thousand nineteen at mayo clinic in lovely rochester minnesota. You can maximize your time by receiving the latest need to know updates and practice models battles for evaluating managing caring for your geriatric patients. You can meet them there as well. I'll be speaking on urinary. Incontinence registration nations for this popular chorus fills up quickly visit c. e. dot mayo dot e._d._u. Slash geriatrics two thousand nineteen for more information join us weekly here at mayo clinic talks. We discuss best practices and burning questions subscribe today using itunes or your favorite podcasting app. They will turn to extra how would you describe excellent excellent because i've seen patients with a variety of different types and it's always hard for me to separate those eggs. I think more and more the term eggs zuma is being used synonymous with dermatitis dermatitis when you think about it means skin derm and just means inflammation so it's inflamed skin again and of course influence inflamed skin can happen for an enormous variety of reasons and that's why we see lots of different types of dermatitis matteis or how would you typically treated. Generally you know our magic potion for this topical corticosteroids either a low. Oh potentcy is completely adequate for many types of dermatitis or affecting the areas of thin skinned like the face but the mid potency as such as triumph sin alone cream is very effective for other areas of dermatitis reading no matter where it is unless it's really severe dermatitis and once once you have extra you pretty much destined to have it through the rest of your life well. It depends on what kind of eggs emma the we're talking about. I think when you're using that some people call edge used the term eggs emma for topic dermatitis where people are predisposed towards getting recurrent dermatitis throughout their childhood and that type of eggs may continue on into the adulthood other types of dermatitis do tend to be recurrent like seborrheic dermatitis which affects the scalp and causes dandruff and affects the central central face with scaling that type of dermatitis does tend to be recurrent then there's other types of dermatitis are eggs that happened to you to contact with with with the things that you become allergic to our irritants that you come in contact with to say at work and that's another former titus but once you remove that contact and often the dermatitis will go away. I want to touch a little bit on psoriasis as well because i've i've heard there's some new treatments available for that. Yes well psoriasis esus something that occurs in about two percent of every population in the world and it is a particular form of inflammation of the skin which is distinctive from eczema dermatitis it consists of pink plaques with the very thick scale that can occur in typical areas like on the elbows and knees and scalp and can be much more widespread than that and that form of that-that's called psoriasis and traditionally has been quite hard to treat because house. It's more thickened plaques that occur now traditionally. We've use topical steroids to try and beat it down. We've also used phototherapy where patients go out in the the sun or are exposed to light in other ways and that makes it beaten down and we've had some treatments that shut off the immune system so that the psoriasis is turned off like methotrexate trek sate but in the last few couple of decades. We've had an explosion of new biologic treatments that are very targeted towards the inflammatory pathways that call call psoriasis and those treatments have become more and more commonplace for psoriasis and more and more successful in controlling psoriasis. One of the problems is there's a new class of drugs which are extraordinarily expensive and a big strain on the on the health systems when when we prescribe it because it can be up to two you percent of the population that helps arises so and then the problem is psoriasis is a lifelong disease which waxes and wanes and then the question comes up as to whether patients agents will end up on these medications for their entire lives and <hes> that's that's kind of a an area that is being explored right now but these new treatments for psoriasis assist the biologic treatments are incredibly successful in controlling the outbreak of psoriasis and flares psoriasis. I see them advertised on t._v. All the the time the dimension the cost of the yeah and that is something that i think every health system is struggling with right now because they're in the orders of hundreds hundreds of thousands of dollars per year at the moment there are generics coming out but the new generics that are coming at the moment are not that much cheaper than the originals originals so i think it's something that's being explored very much right now. Of course they're in new class of drugs and as we get used to having them on the market and more generics come on on-board. Hopefully they'll get into more affordable range. I remember when i was a resident in internal medicine and we would have to go do concerts up on the derm floor and methodist kissed and go up there and it smelled like someone just put a fresh coat of asphalt down on these hallway is tire still being used for treating it you know tar is what we used to use before corticosteroids came became available before topical corticosteroids became available in the nineteen fifties and it actually works very well for psoriasis psoriasis in combination with light so we still have that in our back pocket for those rare patients who are not responding to all these new fancy drugs that we have we give them three weeks of light right and tar and believe it or not even though they smell like there that allowed asphalt <hes> for those three weeks actually works incredibly well as is a treatment but you know like every treatment for psoriasis once you stop it your your psoriasis is going to come back at a certain point <hes> remissions of up to a year following that <hes> tire and light treatment are commonplace but then it often does come back and just like the drugs the drugs only last for basically basically as long as you prescribed them and once you stop the drugs the risk of the psoriasis coming back is markedly increased the longer. You're away from the treatment. I just remember the patients being very slippery when that let's talk about a condition that i have a feeling is equivalent to when patients come in saying doctor dr. I'm dizzy britta carrier. Oh yes or to carry it means hives yeah up to twenty percent of the population relation with hives at some time in their life and most often hives are due to a reaction to food or a medication <hes> <hes> or <hes> written an infection of some sort like a viral infection or basically any type of infection those would be the communist causes of acute or to caria carrier unusually theirself limited and they go away these hives and you get them once or twice in your life some unfortunate people get develop <hes> carry out of the blue and and the carrier continues and that's m. becomes quite a clinical problem sometimes <hes> because if it goes on on for more than six weeks than it's classified as chronic to carrier and in that form of her to carry a we rarely find the calls of what's what's making it happen. Which is what patients i want us to do is to find the cause and it's very frustration for them. When we say that we are not going to be able to find the calls and we know straight off the bat that it's probably not gonna be possible. We do know that there's a remission rate each year less and less people who have chronic are to carry will have in other words it remits after after some time so we have to bring patients through that period when they have that flare of march carrier and i imagine the hardcore ones the ones that end up in your office because easy the ones we've already taken care of. That's right the ones we have great antihistamines that response on that work very well. Nowadays for most cases of our to carry about the ones i see in my office are generally the ones that are not responding to those antihistamines. Our first step is always to treat them with antihistamines us. Try different combinations of antihistamines different doses of antihistamines often that has helped sometimes we have to go to more exotic ways of approaching trying to control troll the arctic carrier but at a very tough technical problem for patients but i do tell them that most of the time it's going to remit over time another common. Everything i see in my practice is mycosis mycosis. Yes absolutely incredibly common. I think much more common than even some of the prevalence studies that i've seen reflect i think because so many people have that as you get older your chances of getting on mycosis which means fungal infection of the toenails increases and a lot of older people and and younger people have these taken yellowish discolored toenails which bother them mostly from a cosmetic viewpoint. I think is the retreatment that is permanent. I see it so often being treated and then they see them back next year and it's it's back again well. The funny thing is that when you look at all the ads for all the antifungal treatments for neekam i coast you'd swear that they we had the cure but really any of those treatments only only work about fifty percent of the time and even when they work the recurrence rate is anything from twenty to forty percent and some people even say higher over years so <hes> it can be very frustrating for patients again but it's great that we do have these oral antifungal that at least work fifty percent of the time so when i see somebody with yellowish taken taken toenails that are yellowish discoloration you have to think about abed fifty to sixty percent of those toenails else will be due to fungal infection and i get a clip into just prove that is fungus and then i try if they want to try those oral antifungal we try those the topical antifungal and some of the other treatments would work much less frequently so i i think that the rates of success with those treatments is is really low and so. I usually don't use those very much okay. Finally let's touch on warts. <hes> especially planner awards those are difficult. I think patients will put up with words on the upper extremities but when they're in the bottom of the foot sometimes <hes> causes discomfort when they walked they want him treated needed yeah. What's the best way to get rid of those good question and again. This is an area which we are not great at is warts in management <hes> <hes> one of the reasons that they're so uncomfortable on the bottom of the feet is that they when they when they are getting bigger they don't stick on your foot because you're walking on it all the time they tend to grow inwards and so there then press on the muscles and the nerves under your foot and that's why they feel painful to walk on so one of the techniques to control the discomfort is to get patients to pair those down the treatment with the best proven efficacy is what's over the cantor and that's all all the salicylic acid containing preparations they can be creams ointments <hes> they can come in a band aid they can come in all sorts of ways and they're all available over the counter for treating warts and what they do is basically dissolve the kerogen in the war and have a good success rate in getting rid of warts but of course what we see in the office <music> are those ones that will not go and there's lots of ways to approach those most of the ones the approaches are to basically destroy the war whether it be by digging it out with a knife or by burning it or by freezing it or by laser arena all of these things basically get rid of the war physically in your office they leave you with a hole in your foot which can be quite sore to heal and the problem is they only work a bit every time you do them the treatment it only works about half the time at fifty percent of the time and then the war recurs and the patients have to come back and further treatments and it's quite a painful series of different treatments to get rid of them so many patients. I encourage them to think about just keeping them. Pared-down tried over the counter salicylic acid and wait and see the ward. Go away because we know again as a natural history that warts go away over time in fact. I've heard it said that words galway after about eight weeks of treatment or two months without treatment that's right. That's a good way of thinking about it and the other thing i always say to our trainees is that we rarely see warts in older people. It's funny funny. It's a younger person yes disease and it usually goes away and we don't see them older people with warts. I've got to ask you this question because my friend insists it works and i just don't know if i believe even duct tape duct tape. Yeah i think the nice thing about duct tape is being well published to be quite helpful in managing warts and what it does is it causes inclusion of whatever you're using to the war and increases penetration of the ward so yes i do advise patients that if they're using using a cream or a solution containing salicylic acid to put duct tape over that and what does is it causes a collusion of the wort more penetration of that salicylic acid i said and it also you get maceration under it. In other words it gets soft and water late were waterlogged and tends to be more fragile and be able to be to peel off that war when you take take off the buy the duct tape after a few days. I can't believe he was corrected right. We've been discussing common outpatient. Dermatological conditions with dr mark davis a dermatologist at mayo clinic in rochester minnesota mark. Thank you for sharing this information with. Thank you very much daryl. Join us your weekly. At mayo clinic talks you can access and listened to over one hundred different podcasts covering a variety of medical topics topics pertinent to the primary care provider subscribed today using i tunes or your favorite podcast app. If you've enjoyed mayo clinic talks podcasts. Please subscribe stay healthy n._c. Next week.

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Biologics: when to start them and when to stop.

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42:50 min | 1 year ago

Biologics: when to start them and when to stop.

"Hi, welcome to German lugs. I'm Dr Kerry Purdie. I'm Deborah tala gist that works in Halifax time community part time academic and you hear from me every time. As residents you don't always get a chance to hear from dermatologist outside of your center. And you don't always get a chance to get information about topics that may be aren't as readily available in your center. And so this podcast is designed to try to change some of that. Joining me on this episode, Dr Perry great wall from Edmonton Alberta. He does predominantly dermatology. Practice in a community office. He's involved in a lot of clinical trials. And if you've been at any of the big conferences over the past couple of years, you've probably seen them talk. So thanks so much for joining me. Oh, it's a real pleasure to be here. And thanks so much for having me on. So when I was thinking about topics that we could cover one of the things that comes up frequently at least at my center is Howdy started biologic and thinking about some of the finesse around what you do for investigations. What kind of patients you consider putting on biological or who maybe don't? And so I thought we could talk about some of that stuff. I remember back. So we were residents at the same time, you know, different ends of the country. But I know we wrote our exam the same year. And I feel like we were kinda right at that burning edge of biologics were first becoming available for for psoriasis. And for all of our skin conditions. And so when I feel like when I was a resident I didn't have a whole lot of grasp about all these different nuances, and I've had to learn a lot of that since getting into practice. I you're probably the same. But first before we talk about specifics. Do you have any resources that you would recommend to the residents in terms of thinki- abo- biologics are just a basic place for them to look about information about starting biologics? Yeah. No. It's like you said, I think we came through at a time when there's a lot of transition and dermatology. I remember very clearly back when we were going through even at that time we had some professors who are willing to start by. Logics others who thought it was too new and the required hesitant. But I think as years of past we've come to realize like how much of a value. They are to us in our patients in terms of resources. I think there's multiple sources out there. I know a lot of the textbooks now with below neon Wolverton focus heavily on biologics. There's various guidelines out through the journal of the American Academy of dermatology as well that has a great sort of series on biologics, and what to do and how to sort of start them in what things to monitor. And I think peers are great too. I think especially when you look at conferences advisory meetings different events that are held whether they're national or international. I think you pick up a lot of knowledge just from the people around you. I agree with that. And I still from time to time come across colleagues that are a little bit hesitant to start biologics. And so one of the things I want to make sure that residents get information and get proper information, and these aren't really big bad scary drugs. So I one of the things that they wanted to know is and I'm going to reword their question a little bit. But if you're thinking about a patient that's going to be going on biologics. What do you think about in terms of baseline workup? What do you do right from the outset? And at what point joy? During that interact with the patient. Do you do that that workup? So for example, if you see a patient new console coming into your office thirty percent body surface area of psoriasis. What's your how do you kind of approach that patient? What do you do? Well, it's like you said, I mean, we kinda take a multi modal approach. So I we want to get an idea of psoriasis. How long they've had it. A Comber bid is very important as well in previous therapies in terms of what kind of workup do again. It's like you said if they have quite severe psoriasis, you might know moving down in the future that you're going to have to put them on some sort of biological therapy. So essentially will do baseline blood work so blood counts liver function tests, kidney function tests, like creatine and possibly GFR. If I know I'm going to put them on immunosuppressive down the road. Again. I might start doing chest x rays or TB tests. Some of the biologic companies now. Or even offering Quanta fear on tests or setting up those things on your behalf, which is making it easier and easier for us all the time. And then you might want to look at other Serology as well. So definitely wanna check perhaps hepatitis B potatoes. See in my practice and at varies from location to location. I usually check for HIV as well. But again, it's interesting because a lot of these tests are fairly standard. But again, there's no one specific guideline that people have to follow. But that's essentially what I would do for kind of a workup before putting them on systemic therapy or possibly biologic therapy. And so just just to confirm. So you would think about that before you start them on any systemic maybe adding in that TB test or the hepatitis Serology. I think that sometimes people only do the blood work that's related to say, the cyclosporin or the method trek safe they're going to start, and they don't, and then you're sort of putting in more delay when you eventually go to a biologic. So I know for me, I will often. Do the test right at the outset. So I have it. And it sounds like you would often do that as well. Yeah. I think if they're definitely heading down that, but probably do it in advance. If it someone with a BSA or Patsy score of where they might not qualify for biologics or of from the outset demo. No that they might want to go down that route. Then perhaps I might not do those testings. But she's you know, I mean, there are other issues with false positive TB tests and things like that as well. So I wouldn't say I do it for every case. But again, if it's very severe, and I kind of have that idea that they're going to probably progress to needing something more advanced than like, you said it's just saves everybody time and effort to then everything is kind of lined up ready to go do you routinely. Do a chest. X Ray or do you find that you only do it in people where you may have a concern about an underlying Grady little bit is condition or maybe if they're a longtime smoker that they could have a baseline chest. X Ray to rule out any malignancy. When do you do you routinely? Do chest x Ray or do you just do it again in? Clinical context, and for me personally, again, I routinely do it again. Sometimes you get these equivocal TB skin tests, you know, someone might have a six or seven millimeter tests, and then you go, well, should I do something or not then you look at other risk factors to see whether if it's a positive or not for me in that context. There's not a lot of risk factors in a negative chest x-ray, then it just makes me more comfortable start therapy at that point in time. So again, I'd just like to pre-empt things rather than trying to track down the patient and reorder it all just give them all the forms right at the outset and get them to do it. Now, one of the questions the residents wanted to know was about stran-, Deloitte ease. And I know we've all all all here. Scott Welch talk about something. I'll be in Toronto all be all of a sudden panicked that I'm not checking all these patients for stronger ladies. And then I remember that I live in Halifax, and that the risk loads are most beaches is pretty low in what context would you consider doing these baseline Serology or do you ever do that? Well, it's like you said, we're an Oprah to vote minus forty right now with wind chill. I don't think strong Loyd will ever survive here. So it's like you said you hear it on of the periphery from certain physicians and certain clinical context me personally. I've never ordered the test. I don't think there's any real reason to especially for people that sort of live here. I mean, maybe if you're from tropical or sub tropical nation where there's a higher prevalence perhaps. But again, I've never had to order it myself or never seen any cases of that. So I routinely do not order it. Okay. Good enough in terms of thinking about these patients that I mean, obviously when it comes to any systemic therapy every patient's different every patient's unique, but what type of general patient? Are you looking at for a biologic? And what I mean by that is, you know, you're looking at the BSA or you're looking at the Pez e your maybe one of those people, and you probably are that can kind of think about Apache score in your mind when you're seeing a patient, but what are the general criteria with which you're looking at a patient going? This is going to be a biologic patient. Well, it's like you said, I think it's difficult. I mean, there's no one archetype of patient that walks in that you might think needs a biologic. Like, you said, I mean, definitely you have to consider as Ian BSA and DO Q, I scores essentially because you know, you need certain criteria to get them covered for biologics anyway. But I think a lot boils down to the patient as well. I mean, you get these patients with, you know, quite severe disease whether it's rise his or attic arthritis. Remember, I have one patient to I've been trying for years to get onto biologic, and he's got really bad spawned lower throw at the psoriasis. Basically, his neck is fused can't even really turn or move or shoulder check or anything like that. And despite me, telling them the benefits of these treatments. He's just very resistant and doesn't want to do it. And then you get the flip side. He get someone coming in with two spots saying, oh, I saw this commercial for drug X. And I want to go on it today, and you go, well, it doesn't really work like that the drugs cost X amount. And you gotta take my trek sate phototherapy and different criteria in different provinces. So again, I think it's a little bit difficult. How about one specific? Patient in mind. But I think again like you said if they have like, you know, Pasni of ten BSA of ten DO Q is scores of ten or higher. If they're quite psychosocial bothered by it, if they're developing Comber biddies, I think those are all sort of the type of patient that you're going to see put on biologic. Yeah. I really do love it. When a patient comes in with a little sweaty piece of paper with like, you know, a Humira or Tulse written on it. And then they've got one percent body surface. Oh, yeah. I think managing expectations. Also, one of the things that I always talk to the resin vote. And I think sometimes they forget they get bogged down in the PSA or the ten percent. And so for special sites as well. I'm sure you have a a number of patients in your practice. But you know, I certainly have people have vulgar psoriasis that I have on a biologic or limited scalp with face rises on a biologic. Do you have a number of those patients as well? I guess I never want to forget about biologic. You're one hundred percent, right. I mean, that's a great point. And that's why you can't just strictly go on BSA or Pasi scores. I mean, you know, some of the most severe patients who have a DO coup score of thirty of severe pummeled plunger genital or scalps rises. So these special sites that we talk about on again, a lot of companies are willing to sort of. Finance or pay for these medications. Even if they don't meet that certain threshold, so yeah, I too have lots of patients that benefit from these treatments. So yeah, I think you're right. You definitely can't forget about that sort of group as well. And I think that's a really good point. And we'll come back to it just in terms of coverage. But and I know everything varies from province province, but I will loop back to that. I know one of the things that I found talented starting practice and even still sometimes is calculating Apache or calculating Patsy adequately. Do you have any special tips do use an online module? How do you typically do Patsy in your practice? I think relig- just doing it again and again and again ad nauseam. I mean for us doing clinical trials, I mean, sometimes I'm doing like six seven eight has he scores day. And so again, just doing it again. And again, you just get faster and faster. And then you get pretty good at eyeballing and saying, okay, you know, thirty percent here. Twenty percent here, you know, readiness thickness scale. So for me, it's actually. It's just the memorization and doing it again. And again that kind of makes it faster actually, find it. A bit slower to like us an online tool log into a computer set it up and do it that way. I just do it on papers or quickly. And then just do the math as fast as they can. That's I'm probably terrible at math. So I'm a cheater us petty. When when my phone out of able it's very paid math can be challenging agree with that. That's why went into German-Polish. I have a calculator in every room in terms of, you know, I don't think that it's really a good use of time to talk about how you choose which biologic for which patient because I think there's so many factors that are involved there. But in terms of thinking about starting a patient on a biologic, let's say you already have them on a systemic treatment. So they're on methotrexate or they're on cyclosporin. How do you transition them over to a biologic? Would you do a wash? Oh, do you overlap? What your general practice for an average patient in that regard? So again, I almost never wash anyone out. I mean, we have lots of studies from psoriasis, and you know, other conditions as well like rheumatoid and other diseases like Krones where you have a lot of concomitant use of systemic therapy and biologic therapy. So definitely if they're on things like methotrexate. I mean, I'm okay to basically say one day stop method Trexi applying for biologic, and if the get covered in a week they can start. Whenever they get covered for it. And even if it took them both together and fine with it as per cycle. Sporran? I probably wouldn't want to overlap them for too long. So I would probably you'll comfortable starting them at the same time. But at some point I'd probably want to stop the cyclist born and just keep them on the biologic by itself. Okay. And I guess that would answer my next question. Which would be do you have a lot of patients that are concomitantly taking systemic therapy. Like methotrexate combined with your biologic for patients. Yeah. More of a Rheumatology price. Yeah. I think you're right. I mean when we have more of like RA or sometimes PSA than we're looking at concomitant therapy. But I mean for us dermatology were lucky. Most of our big pivotal studies and trials everything we essentially do as monotherapy. So my personal practice again is to try to keep them on one agent. And I think for dermatology patients it's a bit different. Because you know, we're always telling them like the bad sides of systemic therapy. All the side. Effects? They could get all the problems are going to run into. And so then I think it's a little harder for us to justify saying. Well, no, we want you to stay on that as well. I think the way it's sorta positioned in. I think it's the same for a lot of germs as we say. Well, if this doesn't work, then we'll switch you biologic therapy. So I think that's basically what I end up doing. I think most people follow the same practice. I think that's a really good point. And I think from two I've heard two perspectives on this overtime as well. In one of them is thinking about the fact that some of these drugs, we've had around forever do work. So I try not to forget about the fact that occasionally if I put a patient on methotrexate is going to be effective, and that's all they're going to need. I also think about the cost effectiveness, and so, you know, Stewart's of the whatever whatever you wanna call it. But you know, the financial side of medicine probably is worth a try. So I I like to word it that way to kind of say, we're gonna try you. And then if this doesn't work, then we'll consider these other medications rather than it seeming like ones this terrible side effect late in. Pill from the medieval times and one's us. Wonderful new medication. So I think that's really important point. No, I think that's critical to because again, you're gonna have a lot of patients on methotrexate. And I mean methotrexate does work whether you're talking about s- rises or other conditions like a topic dermatitis. So I've thought several people on very comfortably for years. And even if you bring up the topic of biologics, they'll say, no, I'm happy, I'm doing well. Everything is going good. There's no issues no side effects. And I mean, we know even potentially to some of these drugs can be remitted. So even in the last six months, I had a couple of ladies out on methotrexate for about a year year and a half who stopped their drug and still doing fine, six months year leaders of clear, and I've other people even in their twenties and thirties been on methotrexate for quite some time and very happy. So thank you right to. I mean, it's pretty, you know, all this inundation with all these fancy biologics and. All these advisory meetings and everything else like that. But drugs like methotrexate treatments. Like photo therapy. There's still a huge workforce or sorry. Where course of treatment that we're doing here. So yeah, I'm pretty happy with those treatments as long as they're working. Well, yeah agree. I mean, I made the mistake of having a lady on methotrexate by when my colleagues for twelve or fourteen years and her liver enzymes or searched right on the upper limit of normal. So I got a bit nervous and convince her to switch, and I gotta tell you. She does not have as good control. And she blames me rightfully, but that's a rarity. But I think it does happen. So in any event thinking about that when you have a patient on a biologic, again, not the specifics of which by logic. It is but say they're going along at what point would you typically see them for first? Visit after you start them three months. Six months, twelve months. What would be your average time to see that patient back? Yeah. So if it's an issue biologic, I think almost it's a bit dictated by insurance or almost. Mandated to him back in three months because you have to score their skin again. So I'd say for everybody. Yes. In three months. I'm seeing them back. And then it really depends. I mean, you have some patients that liked to see his for example for Stella injections. So they will basically come every three months on the dot basically just to get through injections, and it's a quick high. And then, you know, you've got your other ones that could be on any drug, whether it's bril- humorous delauro toll to go sentence whatever and they'll just come in once a year again for the Newell or their paperwork. So I think the only trouble we run into when people forget that. The renewal is coming up, and then we're trying to scramble to get them into clinic happens more often than trying to track down. But I guess I really leave it up to the patient like I'll definitely see them once a year. But if they want injections with us, we'll see them more frequently. Okay, I wanted to touch on the idea of switch or esscalation of dose or guess what? To dose optimization. So again, not to pick on a drug, but say a patient on still era. They're on their one hundred kilos ninety milligrams q twelve. At what period of time. Do you make that decision? Like, hey, don't know if it's going to work, and then would you consistently plan to does optimize patient or bump decrease the frequency or would you at that point switch because we have so many options. I guess what's your what are your thoughts on switch versus dose optimization again. Generally, speaking, not for specific patient for sure. I think this concepts been talked about a little bit. And I've heard this kind of saying before of what we call squeeze the lemon. So basically that means you want to try to maximize whatever therapy. Somebody's on whether they're on methotrexate or biologic my preference, especially if they're not having any adverse events is to try to maximize that dosage and sort of push it as much as you can and you can maximize it in one of two ways. So people are not really getting a great initial response, and they're still have residual plots when you're seeing them then I'll try to increase the dosage that they're receiving if they're getting a good response. But then let's say diseases coming back a little bit earlier, like, tear example. So you're on you're doing ninety milligrams. But you know, you can only last ten weeks in its back. So then I'll just shorten the interval. And so we've done a lot of different things for people. I mean, you know, we have some patients on cults eighty milligrams every two weeks, we've got some patients on still. Era. Ninety milligrams every six to eight weeks, so you can really kind of play around with the dosing quite a bit. And then, you know, at the point you get to where you're increasing dosages and decreasing intervals, and it's not working at all. Then at that point ya'll consider switching to something else. Some patients again, you might consider adding on therapy as well. So if they got to residual plots, you cannot on ends or you can do stirred injections, maybe they wanna come back into a cycle phototherapy for two or three months. So that's still fine. But if really you're not getting any kind of response at all which them. And in that same regard thinking about when we were going from a systemic to a biologic if you're switching from biologic biologic, would you tend to just give the next give the new injection at the same time? They would normally get their other injections. So if you were going to like, let's say you're switching from still era two or so you're searching from us to Kenya. Mab to gazelle cab instead of their next Delara injection, you'd give them their Trump fi injection is that how you would do it or do you do a washout for biologic switches again. Yeah. No. I just follow that mandate the problem with some of these longer acting biologics. I mean, they have really long half-lives. Right. So if you're really waiting to do a proper washout, I mean patients could be waiting for weeks or months, and I sort of feel like, you know, if they're flaring up, and it's not really working all that well for their disease. It probably aren't having you know, a tremendous amount of drug in their system. Anyway, doing anything important. So I'm pretty happy to just give them their new biologic, essentially. When old biologic was due. Great. This is a question that I get a lot from patients directly. And I'm sure that you get it too. But you start them on one of these medications, and they go. Okay. Great. Now. How long do I need to be on it like six months year? What do you do in terms of the expectation for the patient? Do you tell them at the set you're going to be on this forever? Do you ever consider a drug holiday? Do you generally try to taper off of it? Or do you just gonna go? Here you go. You're good going to be on this for the rest of your life. It's nicholson. Yeah. I mean, we know psoriasis is a lifelong disease for many people. I mean, it's it's tough to break. A patient's heart right off the bat and say, well, you're stuck with it. This is how it is forever. So I try to give them a little bit of hope if I can and end it is true. I mean, there are studies now showing whether it's with again methotrexate or photo or biologics that people go into remission. So I tell them kind of both ends of the story as you know, there are people that. Have pretty bad surprises. They have at their whole life. And you know, some people have to be on these treatments for years, potentially. And then I do tell them on the flip side there are people who get better. And we see them in clinic all the time as well. So essentially giving them a little bit of hope that. Yeah. The disease could remit, and if it does and at some point they can try to go off the biologic if they want to and I guess the way that I think about it, and this is completely made up in my own head. So I'm going to be curious to see what you do. But if I do have a patient. It's really adamant that they wanna stop or they believe that they're in a remission. What I will tend to do is just extend out there interval between injections, and then see if they're able to get to a certain amount of time. Then stop rather than just sort of coal Turkey stop. But what would your practice be typically, I felt the same thing. I call it the carry permanent. Oh, it's catching on fans. We're gonna we're gonna start. No, I do the same thing. Like, I never tell people to just kind of stopped goal Turkey. Just like you said, I tell them to sort of draw out a little bit. And I do that for a couple reasons like you said, you get a better handle on if they're actually kinda going into remission, but the other thing is just with coverage. I mean, you never want to tell whoever's covering their drug that they don't need it anymore, and they kind of cut off their coverage or lose it. So I'll tell them to and we'll work with them and getting touch with their like, whatever patient support program and say, well, we want to try to stretch out the interval a bit benefit flares. We bring it back. And if it stays pretty good than we just keep it at that. And then like you said if they're doing great than you could give them a break at some point. Okay. Speaking of stopping things cold Turkey. I think this is probably a good time to go to our first question. The world headquarters of the Durham logs podcast, high Dermot, my name is Noel wrong. And I am a dermatology residents as university in regards to buy Rajic's. Are there any surgery that patients will need to have their by logic health for thanks for that question Perry? Although this would not typically be our practice. The thing that I think a lot of us run into is what happens when your friendly neighborhood orthopedic surgeon stops the medication coal Turkey. So I'm married to a surgeon. I feel like in some ways distant little bit. But in general, I find that surgeons are super nervous about biologics. They've really blown the risk of infection out of proportion. Do you try to preempt that if you know that patients going to have a surgery have you had any success in convincing searches that they should keep the patient on the medication? I have to admit I haven't had a lot of success. Yes, I try. But you know, how do you manage that whole Perry surgical biologic conundrum if you will? What's like, you said surgeons are not easy to convince of anything. I mean, they're always writing, you know. Yeah. I know they're always right. I mean, the problem is it's like a duality your with stuck between a rock and a hard place on one hand, they're like, well, we won't operate if they have fluorosis on there like that's going to cause an infection. So you have a real difficult time convincing them that. It's not going to the other hand they won't operate. If you give them a treatment to fix rices. Anyways, you're always kinda stuck between the two options. So for me personally. And I'm sure like you said for you as well. I mean, I don't think they confer tremendously high risk of infections like with surgery, especially if they're more minor kind of local procedures and things like that. And I think that does also been shown in other diseases like Krones colitis for just keep them on their treatments. If they have to do pretty invasive or sections or surgeries and things like that. So again, my practice generally is it's pretty something. Minor local than just kind of stay on treatment. If the bit more invasive than sometimes, I'll get them to try to plan to do the surgery around the next time their biological injection was due and then basically weighed about a week or so or much time it takes for them to heal up. And then when they're kind of on the mend then basically just resumed the biologic. So essentially, you're giving them like maybe a week week and a half break in between. Okay. Yeah. That seems pretty reasonable. And like, you said there were certain surgeries, or maybe, you know, obviously, like an emergency surgery. This is a moot point. But looking at specific types of surgery where you might consider would that be more of like a major Donald surgery? Oral surgery or are there certain looking at the data. I think there's certain types of surgery that are meant to be a little bit more likely to result in an infection. Yeah. No, exactly. I mean, if it's more high risk like mucosal surfaces, or let's say they've had like Endo card Itis or a heart valve or something like that. Or they have a higher risk of infection than. Yeah. You get a little more nervous might be wanting to stop the drug a little more. But again, if it's something that's a bit more, minor, local, they're pretty healthy, otherwise, and they're pretty clean incisions. And I'm okay with it. The problem is when you look at the literature often, they'll suggest stopping these drugs for like three to four to five half lives. And again, you know, if you've run into these drugs that people take that have monthly or every three monthly dosing. I mean, you'd be off of it for such a long time before you could do anything. So I think practicality kind of comes into it as well. So I think you just kinda have to work with the patient and try your best work with the surgeon as much as willing. Listen to you. And then try to get the patient the best outcome right thinking about the other hot topic or hot button issue contentious area around biologics pregnancy. And that brings us to our next question. Hi, my name is the harbor on me. And I am a democ- Haji resident at the university of Toronto. I have a question about how do you start a biologic in a woman who wants to get pregnant Pesident or is best eating? Thanks for her. Okay. Let's look at each of those scenarios separately. So part one what if your patient isn't pregnant, but planning to get pregnant would advise them part partout, what if your patient becomes pregnant when they're on the biologic. What do you do? And then what about post pregnancy in the the breastfeeding realm, what do you advise patients of? So maybe stuck with the first bit. I so let's say you have a young, you know, thirty year old woman looking at maybe getting pregnant in the next one to two years, but has really severe psoriasis that you think needs a biologic how do you broach? That subject or how do you? I guess answer her questions about safety in pregnancy. I just tell them don't get pregnant ever ever. Said it makes my life too. Sure that goes over super well. Yeah. It goes over really well. To be honest with you. Yeah. I mean, it's a big issue. I mean, a lot of our patients are gonna be women of childbearing years, and you really have to take that into context if you're talking about really any treatments doing whether it's systemic methotrexate cyclosporine or biologics. So for me, I mean, I consider phototherapy fairly safe. So if a patient wants to get treated, and they're really nervous about biologics injectables, and they've read this on the internet or read that and they're very nervous. I'm okay to maybe stop their biologic and put them onto phototherapy and topical while they're pregnant and then to resume afterwards, if they want to personally, however, though, I feel most biologics, and we're getting more and more data all the time or fairly safe in pregnancy, especially up to like my personal feelings up to second trimester. So I'm more than willing to keep patients on it through trimester. Again, you might wanna consider stop. Ping, just so they don't have immunosuppressive so vaccines and things like that for the infants will take. But I'm okay, leaving them on up to second trimester. If they're okay with it as well. And now, I mean, we're a little bit lucky over the last few months cert-, Eliza mob or Simms has entered the market as well for we can prescribe that now for psoriasis. And so with its sort of unique peg elated structure, we know what has almost no capacity to pass through the placenta or pass into breast milk either. So I think moving forward again, I've been pretty comfortable up to this point with most biologics. But again, I might lean a little bit towards that one as well. Especially in women who might be actively trying to get pregnant at some point in time. It's really good point. And you know, I often borough from our colleagues GI and know that that risk of Crohn's flare during pregnancy tends to be worse than. Being on these medications during pregnancy. So there's registry data from that side of things. But I think it is something that sometimes a little bit different when we're talking about pure cutaneous arises, so. I like that. So in terms of the breastfeeding as any other. Advice that you give patients surrounding breastfeeding. If you're not thinking or they're not able to be on a medication like Cinzia. Yes. So again, I mean, we know even from previous data with other drugs like a town or sept- and things like that. There's very little transfer into breast milk. So again, if they want to resume right after I'm fine with that. If they wanted to take a little bit of time and do like, you know, topical therapies, phototherapy, whatever until they're finished breastfeeding. I'm okay with that too. I think the biggest issue just working with the patient because you get the two types. He get the ones that are really worried about flare ups that want to keep their disease under control as much as possible. And then you get the other ones that are just really worried about the pregnancy in general or breastfeeding. So I'll kind of give them all the information and facts, and then basically just kind of try to do whatever makes them happy at the end of the day or you have the people like me who were so sick when they were pregnant that they would take any amount of Zo Fran that any doctor would give them at any given time. So there's always. Well. Okay. Let's take one last resident question. Mine Sabrina, and I have a dermatology at the university of Calgary. I question that starting biologic therapy. So see my patient has laying he'd be, but I would like to start a biologic how long do we have to wait before safely starting biologic? Thanks brenna. And I guess I would add to that. What patients do you refer to ide- to be seen prior to initiating biologic? So again, I mean if there's any risk of TV relate and TB with like a chest x Ray positive quantity on or positive skin tests always refer to are like TB clinic. And then basically, they'll do there's s Mentz more often than not they'll start them onto Burkey Laos's therapy, which will typically loss for about nine months. Give or take. Firm firm guidelines as to when you should start biologic therapy. Talking to our colleagues, whether they're driven tall GIS or infectious disease experts. I mean, mostly they think the consensus is you can start after about two to three months of late into burqas therapy. So that's my practice just to make sure they've had two to three months of therapy. And then start biologic and to that point as well in terms of selecting biologics again, if you're worried about Burkey Laos's, let's say you work with a population where it's a bit more endemic, or let's say you're patient travels quite a bit overseas again to more endemic areas, my personal preference with might be to lean more towards an seventeen inhibitor believe as to this date. There's really been no reported cases of reactivation of tuberculosis. And so I think personally I would lean more towards that. If I had to start on something anyway. So I think that one of the challenges now that we have so many drugs on the market. And so many biologic options is deciding what to choose when and again. We've discussed as we've touched on it. There's lots of factors patient Comber biddies half-life to the have psoriasis psoriatic arthritis. Do they have IB D? And of course, you know, all those things have to be taken into consideration individual basis. But I guess I'm looking on a pick your brain a little bit about let's say you have a patient that comes in. They've got severe psoriasis. They've also got oriented arthritis. It's gonna be a while before they see a rheumatologist, so the choices yours what kind of what class of medication would you tend to start within that type of patient? So again, I think I'd probably still favor NFL agents rile seventeen agents, personally, I think they still have the best data or rightous and PSA. So those are probably the ones I favor the twelve twenty three data. I mean, it was okay wasn't as robust, and I think the I'll twenty three's are still a bit of an involving story. I don't think we've got the full picture yet. Whether or not they will be as affective. So those are probably the two categories that still stick with for those patients if you're looking at a person that had maybe Palmer and planters riotous pustules risis, I tend to start with a retinoids, but then moving onto a biologic. What would you have? Would you have a preference in that category? Again, I think he got really good robust data on all the categories. So the TANF style seventeen twelve twenty three's and I'll twenty three's as well. So I think probably just again if you're focusing more on skin clearance. I'd probably stick with twenty three's and I'll seventeens, but like I said TANF's have good data as well. So as long as a patient qualified, it'd be pretty happy to start them on any of those treatments. What about genitals risis? Sometimes I think patients have severe dental psoriasis. When it comes up, then you want to treat them with on the it's going to be affective and fast. What would be your choice genital psoriasis? Yeah. I think my go-to would have to be taught for that. One. I give them credit for doing a lot of the studies for that region. Just because it's something that we just don't talk about much, and unfortunately patients, you're pretty self conscious. Don't really bring it up to us very much either. So for me personally seeing that data of for that specific area. I think I would lean more towards Tulse. Okay. And then one of the other things I often think about or I think now that we have a lot of choices. Maybe it's a little bit different. But if you had a patient that was say just for lack of advocacy failing in T F or failing in an aisle. Seventeen. Would you have a tendency to switch with in class or out of class in that type of patient? Yeah. Well, I think nowadays at probably switch out of class. I think dating ourselves a little bit. If you look back a few years ago, we didn't have a lot of choices. So we were pretty stuck, you know, if he didn't work with one if you didn't have many choices you have to go to another TANF and then find these, oh, maybe I can switch him to still era because that was new at the time as well. But now with all these new agents we have new new I'll seventeen twenty three's. I think with the choices you have. Plus with all the great data. You have of the studies done with switching between classes. I think now it's just so much easier to switch into different class. If you if you just want a better bang for your buck, a better chance of capturing response fair enough. I think I look back at some of the patients that I started with way back when I started practice and any look through their chart notes. And it's like a Tanner septa Tanner said at mad at a let me MAB used to Kenny Kenny MAB and other gazelle gazelle, Kevin. So it's just. Interesting to see that in some of those patients along the way. Yeah. Yeah. Yeah. Exactly known system. It's still interesting in general. I still think of myself, you know, as a fresh term sometimes I really realize I'm not anymore. So when you when you stop getting invited to this or a new in practice stuff, you realize you're a little bit over the hill. Although I had a patient today. I saw after three years, and he's like you look so young. And I was like I'll take the compliment similarly had a patient. Go. Are you enough to be a doctor, and I'm like, okay bless your heart. Go get your eyes checked and moving along. So thinking about the way back to those days when we first started practice. Do you have any real tips or or things that you would send if you could tell yourself starting practice or things that you wish you knew or a couple of top hits on biologic or a practice. Biologics? What would be your things to pass on? Like, what are your paroles words of wisdom? Well, I guess there's a few things number one. It's like you said getting comfortable with paperwork. I mean, when you're a resident you're not studying people were figuring out how to Philo forms. I mean, you're trying to learn about biologics and half-lives side effects and things like that. But really when you get into practice a lot of that stuff falls by the wayside. You gotta know which forms to Philo what the scoring criteria is what agents they have to fail. So I think getting really familiar with that and all the scoring systems like I mentioned earlier like doing Patsy scores again, and again, and again, so becomes like second nature and very quickly. I think the other important thing is having like a good team. I know at varies from province to province in terms of how much nursing stuff or support or things people have. But I would say for me, I'm pretty lucky. You know, the clinic I joined has a pretty good team really good system of doing paperwork and keeping things in track and getting people on biologics. And that's also something we don't really learn. About in residency in terms of hiring people and having you know, sort of systems in place to make things more efficient. So those are probably the two main things I would tell my younger self is. You know, make sure you know, how to founds pretty boring and sad. Not like, hey, these winning lotto numbers, but make sure you know, how to do paperwork hokum to the reality. If you're the sad sad reality. Well, listen period, just wanted to really thank you a lot genuine. Thank you for joining me on this podcast. And I think there's a lot of really good tidbits for the residents and in for myself as well, I'm writing down notes about Lia. So I I do wanna thank you very much for joining me and taking the time out of your busy schedule. And you know, I was also just thinking if we win ahead. We'd be the carry and Perry show. It'd be the we could carry better logs. Thanks as well. I think this is a great initiative, and I honestly kinda wish this was done for me as a resident. So if I was telling my younger self something else, I'd say, hey, listen to this podcast. There you go. Well, thanks again. Nice talking to you. Don't no problem. Yeah. Yeah. You too. You too. Touch Perry gray walls, dermatologist practicing in Edmonton Alberta. That's it for another episode of Dermot logs. Remember, if you have any questions you'd like to ask or if you have any ideas for future topics you'd like us to cover. Let us know. Call toll free at one eight seven seven Derm log or one eight seven seven three three seven six five six four under next up will be speaking Dr Sam Hanna on the topic of injectables, I'm Dr Kerry Purdy. Thanks so much for listening.

psoriasis methotrexate Dr Perry Patsy Edmonton BSA Krones BSA American Academy of dermatolog Alberta Dr Kerry Purdie Dermot Deborah tala Wolverton Ray hepatitis Deloitte Scott Welch Toronto TANF
SKIN MANIFESTATIONS IN PEDIATRIC PATIENTS TREATED WITH A TNF-ALPHA INHIBITOR FOR INFLAMMATORY BOWEL DISEASE

JCMS: Author Interviews (Listen and earn CME credit)

15:14 min | Last month

SKIN MANIFESTATIONS IN PEDIATRIC PATIENTS TREATED WITH A TNF-ALPHA INHIBITOR FOR INFLAMMATORY BOWEL DISEASE

"When you were getting a lot of consultations from our colleagues in gastroenterology for their patients with intestinal inflammatory disease and that they were having cutaneous manifestations and it did come out that you could potentially have paradoxical cutaneous reactions that you weren't going to expect. Those Dr Catherine mcquaid Pediatric Dermatologists Montreal Sainte Justine University Hospital Centre. Quake is also a clinical professor of dermatology and pediatrics at the University of Montreal. She's our guest in this episode adjacent mass author interviews I'm your host Kirk Barber, the editor cheap journo continues medicine and surgery. Clinical professor of medicine at the University of Calgary. Today word speaking with Dr mcquaid. About article. In our July August twenty, twenty issue of the Jason. Articles entitled skin manifestations in pediatric patients treated with a t and F Alpha inhibitor for inflammatory bowel disease retrospective study I chose this because it shows us the pediatric side of this cutaneous side effect and it's a large study which has controls, and I'm very excited to hear Dr mcquaid talk about this. Catherine, thank you very much for joining me today to discuss the article that you and your colleagues. Have in the journal Cutaneous Medicine and surgery of July August, twenty twenty. Well, thank you for the invitation you looked at patients with IBD and their cutaneous side effects. Tell me what prompted you to look research and and and write this manuscript for us I'm glad to share our experience with you We noticed that we were getting a lot of consultations from our colleagues in gastroenterology for their Patients with intestinal inflammatory disease and that they were having cutaneous manifestations and it had come out that you could potentially have paradoxical cutaneous reactions that you weren't going to expect in this population necessarily, and so they would be phoning s to to see the patients the day off and Dr Atom me in particular gotTa resident very involved in this. So Dr Anne Zhenhua, who now practices in coupons me? She was spearheaded this article and pushed ahead into the research project, and then our fellow who had come in from Chile was able to carry it forward. So Abductor Mary Laura Cossio was able to help the significantly with putting our information together doing the statistical analysis and writing up our article for publication in the J. CMS. I was impressed I mean, this is not just a descriptive article. It really had comparative figures. You looked at large data large number three hundred and forty three patients that were over nineteen. We're under nineteen years of age. Forty them referred to your pediatric Dermatology Center but it was really impressed by the fact that most vote will certainly must literature is on adults not in children and and we need more in the on the on the pediatric for sure and the fact that you have a control group most work I see is done descriptively you know we. We saw this many patients this much condition, but you're starting to look at that population and to see what the background problem cutaneous problems are. So I was really impressed and I hope you're planning a prospective trial to look at this and we indeed are. So we've continued to enroll patients in our study and are hoping in the next few years to gather enough data that to make an interesting analysis going forward, and we have the group of patients that do not take biologic medications as well as those with Biologics, and we'll see if if they can tease out the difference in incidence in those two groups as well as presentation. Are Their clinical variants. Well, let's talk about again and the adult side. One of the clues we get is that The people get unusual presentations of psoriasis or or they get palms and soles only involved something. Somebody's a bit odd and the for them because they. Didn't have any skin disease before. So it struck me that your group had a pretty particular clinical presentation. Highlights for yes. So in case of paradoxical psoriasis arising in patients on anti TANF's primarily we found that the psoriasis was. Kind of reaping and was more localized to we would see it in the Scout, but also folds like the rhetoric killer area even Perry nasal and Perry oral folds. We'd see it and it was often very impaired digitized. So in our patient population, we had forty patients with forty five types of skin lesions and twenty percent of the patients with psoriasis had bacterial infection to which they responded better by adding either a topical at or a systemic antibiotic to the corticosteroid. It was the other thing that struck me about this group was there wasn't this a quick flip to a new drug. Many of these people, many of these children responded very nicely to conventional. Therapy based at their skin disease. Yes. Some the there was a previous study out of hospital for sick children. Where in their experience, they often had to change the biologic and up to seventeen percent of cases. But for us, it was really the exception I think there was really only one patient who had to be changed to a different biologic to to the skin complications. Do you recall? So these children present they get treated. And they're staying on their their anti biologic was maintenance therapy required for for many of them or was it a single event? We left them with renewal for the for most cases it it could be limited We did have some cases that recurred and They knew to be on with wet compresses the topical steroid that we would often use a a mid strength corticosteroid and. We would at a topical antibiotic Red Away and that could negate the need for systemic antibiotic when the second flare happens. But most of the patients didn't continue to have the flair says such and so they develop these lesions and they would go away for some time they they weren't necessarily chronic in all cases. So you weren't getting a sense that you were getting phone calls every few weeks. Oh, it's back. It's back. It's bad. It's more a matter of you treated and they got long term remissions if you will from from these things and because they responded so quickly, they were able to self initiate treatment and south. Who? So perhaps a lesson. For the adult side, a of our world because we're very quick to switch biologics now. COMES, well, if they have good control of their. Inflammatory. Bowel disease were happy to leave them on the agents for that. Yeah. And you allow it to happen by managing their skin. So the other thing that sort of struck me about this was the leg, the latency. So isn't it was you know thirteen months. So over a year on. Gut controlled. Everything's looks like it's going along wonderfully and boom they have some cutaneous. Event or flourish put right exactly and that too was surprising to us that it didn't come on a little bit faster in terms of temporal association. many of these children also had a family history of psoriasis for? Instance? However that was not statistically significance in our group. So and it's You make a point in your discussion that that long lag phase isn't necessarily out of keeping with what your colleagues have seen in other pediatric groups that they've described. So. Our data was consistent with what what is out there in the literature right? Well. Rachel switching we're extremely low. The latency we we talked about. Is there anything else that you learned? That that would be. Worth sharing with with us. Well, I think the characteristic sites for the presentation of psoriasis being the falls in this weeping and petition is presentation that I have learned has also arises in adults with the paradoxical psoriasis that was quite interesting and the fact that we were able to manage with topical. To, keep them under control was also reassuring we had very few patients with pommel planter presentation and certainly the did not interfere with them pursuing their anti entity. In the protocol at Sanchez in the patients are all put on remedied initially and then only changed if there's a problem with that the does that include the group that you reviewed or is this a new event? Now? That's that's so everyone of these children all three hundred, forty, three wardens are on inflicts some to start Yes. I- LOGIC Right and so would they and only changed if there's some issue with the remedied would they then be changed to ad Lib Map? For example? Yes. So they put on at eleven mob or Kim App. But. To that, they will will sometimes add methotrexate in low doses probably about half the dose that we would give. It was a right psoriasis in terms of if they're concerned about antibody developments and so they'll they'll put certain patients on that prior to changing their biologic. So if you're on mccade and you're you're not seeing fact. The the methotrexate may have been added on. For Bowel Disease Control. And and may have your. So you're incidents a continuous may have been higher. True. Nip and not the majority added methotrexate but. Probably somewhere in the order of ten to twenty percents. Okay. Well, the the the the prospective look at this I'm sure we'll clarify reynolds forced to see if that makes a difference and maybe that's the way to keep these patients on biologic therapy with the inflict. Some AB, is dad the methotrexate early, not waiting for for a reason to do it and maybe you could prevent. Alright. Alright well. please. Yes. So and we had acne in these patients because often early on the given bursts of corticosteroid that caused acne flares and we had a limited number of hydrogen itis also as a side effect, do you think the hit ride notice was a paradoxical event and the patient that had developed? It did not have it prior to taking the Anti. TANF. So we think it was paradoxical in that case that today I saw patients to started with a hydrogen nitis six months before presentation with all sorts of Colitis. And so you know so difficult. Incredibly. Difficult is our. And Do calling that person on the hitter I notice that they were did you switch biologic or did you just? Was a mild disease it would allow you to continue to treat it topically. Yeah. We were able to treat it topics Glam. Yeah. All right. Well, the the prospective work will be fascinating because you've got to have one of the large discards of maple there followed like this. So I very much. Look forward to this. So. Thank you again. For your time and. I very much appreciate the insight did you gave is into this dermatological event that crosses over into. Our internal. Medicine. Colleagues. Thank you. My interview Dr mcquaid. Paediatric? Dermatologist Interesting University Medical Center in Montreal. Collaborated with their gastroenterology fellows and have collected forty patients with cutaneous side effects from their anti tanf there before they're inflammatory bowel disease. They describe a unique clinical presentation and was stunned by the fact that they don't change from their drug very often. So it's distinction to on the adult-onset we're pretty quick. To switch biologics for these patients. So it was great and thank you very much. Remember that you can review the article yourself over the next three weeks as it's offered to you by publisher without any fee for access. And you can hear our latest episodes by asking your smart speaker to play the JC mess author interviews podcasts give it a try. So I'm perk barber thanks so much for listening and until next time. To each other.

psoriasis Dr mcquaid inflammatory disease methotrexate Cutaneous Medicine Dr Catherine mcquaid Pediatric skin disease Clinical professor of medicine twenty twenty IBD Dr Anne Zhenhua University of Montreal clinical professor Dr Atom bowel disease University of Calgary Kirk Barber Chile Bowel disease pediatric Dermatology Center
Dermatology-Related Uses of Medical Cannabis Promoted by Dispensaries in Canada, Europe, and the United States

JCMS: Author Interviews (Listen and earn CME credit)

28:06 min | 1 year ago

Dermatology-Related Uses of Medical Cannabis Promoted by Dispensaries in Canada, Europe, and the United States

"Kerr farber. I'm the editor in chief of the journal cutaneous medicine and surgery. Welcome back to our author interview podcast today, I'm interviewing darker Mark purchase. Kirchhoff is the division director of dermatology at the university of Ottawa and quickly becoming a national expert on medical marijuana as it applies to Matala g Archer Kirchhoff in his first article in our journal, reviewed the risks and benefits of the use of marijuana in this podcast, Dr Kirchhoff outlines for us the information that our patients are receiving from medical marijuana dispensaries. Welcome back. Mark. Thank you. Once again for joining me to talk about marijuana this article dermatology related uses of medical cannabis promoted by dispensaries in Canada Europe in the United States by yourself and making limb it was enlightening, and I'm really keen to to have you walk me through it and bring this thing to life. I was stunned. Forty three percent of people aged fifteen and older have used cannabis in their lifetime and our country if that's a low number or a high number I think that's a very high number. Now. What do you think it is a high number or low number? I think that's under reported. I mean, we we are seeing cannabis uses at various levels amongst large swath of the population. So it's a very accepted drug now by, you know, college students university students, and then if you add on, you know, the the baby boomer generation who grew up around cannabis and marijuana. I'm I would say it's probably, you know, a three quarters of Canadians would have used marijuana at some point in time in their life. Our prime minister, for instance, has perhaps still is continuing to use marijuana depending on if you believe him or not. So I think there is widespread use and lot of it's unreal. Under reported. I've I've done impromptu surveys amongst my patients where I asked them I have used marijuana recently. And you'd be shocked by the number. In fact, that's the next installment and we wanna do in this series. I guess is looking at the patient perspective in what are dramatically patients are using the marijuana for so Health Canada as said in that they're very wise people because they've listed psoriasis dermatitis and Peretz potential therapeutic uses for cannabis, but they don't endorse its use for therapeutic purposes. Correct. So they're very careful, but the fact that the even state that these are suggested possible uses indicates almost an implicit approval for medical marijuana. Right. I mean, if health candidate lists this on their website that much. I mean that there's some sort of data, right? If you and I read this, or if the the lay person reads, this they're gonna be like, oh, well, obviously my psoriasis will benefit from the use of cannabis if you compare and contrast the sort of hoops that we put big pharma through in order to get a drug approved. This is the contrast is striking. Now, what dermatological conditions is health candidate supporting or suggesting that might benefit from the use of marijuana. So in in the HP or health health protection border, Canada suggests pain psoriasis dermatitis parenthesis, and then insomnia and depressed mood associated with chronic disease. May all be areas were cannabis may have some benefit, and I've selected these as the ones that are dermatological related. There are a list of others on the website. But these are the ones that I thought were important and the ones that are related to our patient ocular. Shen? If you look I've also included the US listing there. And you know, they list similar things so pain psoriasis dermatitis as you can see not on the US list. So there's some differences there. And then there's a lot of these very specific disorders that probably were approved due to lobbying on the part of individuals. Who may have had that z so lime disease neurofibromatosis nail patella syndrome lupus, so these are in conditions that have very little evidence. If any. And yet they've been approved in various states as indications for the use of medical marijuana. In your article, you go through a little bit of the science suggest how these conditions may be affected by cannabis. Tell me the story with respect to psoriasis. And when we have we're booming in treatments for psoriasis these days all unbelievably a fact or not all, but we can really do a very very nice job for people with rises these days. Is there any decent evidence? That's rises may be benefited from the use of medical marijuana. So there are no placebo controlled RC t- studies on either systemic or topical cannabis for psoriasis. So the the the use of medical marijuana in psoriasis based on in vitro data suggesting that Karatina site lift ration- can be affected by cabinet cabinets. And that could avenue it's have an anti inflammatory properties. So that they can alter the cliff ration- activation of immune cells. There is a again, there's no data to suggest that it potentially works psoriasis. But those two pieces of information have been used to suggest well, you know, psoriasis is a disorder of characters type lift ration- end disorder of the system. So therefore. It should work. So it's these logical loops logical jumps that that people go through to to make the connection and just that these are approved uses, but really there's there's no data, and that's that's the danger. Right. And as we talked about in the previous article, the use of medical marijuana is not without its risks. And so people just assume that there's all these benefits without risk that can be a problem. Do you think that the all of this? Flurry to get a new therapy is actually putting people at risk. I mean, would you argue that this we've gone way overboard in allowing the use of medical marijuana or or not standing up in saying enough about its potential risks? Yes. And and allowing the public to believe that it is safe. Yes. And I'm actually surprised that there isn't more regulation around us. I think there should be some sort of vetting process. I mean, if you if you're trying to sell a vitamin in Canada, and you say, this will cure, you know, cancer, and there's no data to support that that that company can be and will be approached by Health, Canada and say you cannot make that claim there maybe legal ramifications from making that claim and yet we have now you can go online, and there's just a interview on. This substance called Rick Simpson oil. And this is basically high THC extract from marijuana plant that claims to be an anti-cancer medication. And if you go online, you will see patients who have used this for melanoma, which as you can imagine has potentially deadly complications. And that's just one example of the false advertising that can lead to very bad patient outcomes. And I think we do need to educate the public when those risks are present. And when serious harm can come to our patients. So it appears to me from what comes across my desk that the industry is trying to train physicians on how to prescribe the drug and how to get more drug out onto the street. But a lot of patient education, isn't really. Currying is there is there websites or their places where people can go to get to make an informed decision. Anything you're aware of. So unfortunately, unfortunately, not again because you're looking for an organization that would provide a scientific approach the analysis of the data most of the organizations or online sources or social media sources are geared towards the promotion of cannabis and cannabis medically related uses. So they are biased. And you know, it's it's fine. If you're in 206 about, you know, drinking water where the worst thing that's gonna happen is you're going to be more. But if you're promoting something that may potentially have serious harm and have serious consequences to patients, then I think you need to do a better job you need to be. More rigorous in Europe, promote near approach of how to promote those products. So I think that's the problem and the internet is wild west now of of individuals that can make all sorts of outland claims without consequence. And I think that's that's a problem. And that was the essence of your work. Yes. To to look at what the internet said about marijuana, correct? What patients are patients are taking from these supposed- reputable? Right. So dispensaries are considered reputable sources that are providing medical marijuana. So these are like pharmacies. Right. If you pharmacist you'd say, you know, tell me what methotrexate what are the side effects, and you get this handout, and here's all the data to support which side effects are common, which ones are serious. But if you go to a dispensary, there's none of that. It's so that they're almost not doing a good job at what they're supposed to do. And we wanted to make people aware of that. Because patients will come to you. And I've had patients come to me. And they'll say, oh, this this. I'm using for my swims carcinoma, and I was like, well, what's what's the data for that? In the said. Well, Rick Simpson used this oil and his skin cancer went away as oh. Well, do you know what kind of skin cancer? That was no, it's just skin cancer. And I was like, okay. Well, we don't have enough data. And how many times was repeated? Do you have any more information other than this one person who had this one success? And so that's the problem, right? We have anecdotal evidence that's being used to promote products in in the same league, as you know, randomized controlled placebo controlled trials, so patients really should be educated on the level of data that supports the claims that are being made. So in your review, you break it down and Canada United States Europe. How does Canada fair in this discussion? So depending on your point of view other poorly or weld, if you're if you're looking for the the most broad descriptions potential uses and a rich source of, you know, future studies than we're doing well because we have all these dispensaries that have promoted wide variety of different uses of medical marijuana Potocki clean systemically a much greater than the United States and even greater than Europe. So Europe is the most conservative and then Canada is by far the most liberal, we we seem to have no limitations on what can be promoted online. And so I think that's a problem. And perhaps our government has been lax in making. King good strides on regulation and policing this because legalization was coming. Right. So this research we did on this was before legalisation occurred. So that's a good thing to point out that this is before legalisation occurred. We have no idea the interesting to repeat this now that legalisation has occurred. Is it even worse? You know, do we even do we see even more uses being promoted by these companies? So might be interesting to do that contrast. But this was before legalisation occurred. And these uses were being promoted online without much data to support. And which is great contrast to the United States in Europe. So tell me a bit about Europe. I it's not legal in Europe. I'm assuming no in in Europe. It is approved for medicinal uses in a variety of different countries. But the interest skyrocketing, we, you know, if you if I when I went to the European Academy of dermatology talking to my colleagues, they're not really prepared for what's coming in. If you go online. There is a massive ground swell. I have one of my colleagues who went to school with me she is currently in England and she's doing a speaking tour on medical marijuana and the use of medical marijuana in England. So this is coming and it's becoming in full force. We're basically the the the first to market and a sort of a canary in the proverbial choline of medical marijuana. And I think Europe is is not prepared for what's coming. So Germany recently. I think it was about two years ago started proving medical marijuana, and you can apply for exemptions. And there's doctors who will prescribe it for you France has a fairly liberal medicinal marijuana law England same thing. So we're going to see increased use in those countries. And then perhaps eventually at some point in time legalization might become reality there. Because usually what we see is the standard protocol is that medical marijuana is lobbied for by patients than that gets approved the indications become wider and wider. And then eventually countries say, well, let's just approve this recreationally because the pencil revenue source, and you know, policing marijuana medicinal use can be expensive. So recreational uses then get approved and we've seen that happen in Canada. We seen that in several states. It's in the United States. Do you think Leila's -ation has reduced the use of medicinal marijuana? By that. Yes. Prescription. So I will say marginally because I think there are a group of people who are using prescription derived marijuana that is being covered by various payers. So an example is the Canadian army, right? So the Canadian army will cover medical marijuana in certain circumstances under doctor supervision in Dr prescription. So I think those prescriptions won't change because the patient doesn't have to pay for the medication in individuals who were self medicating. Definitely, you know, they're not they're not carrying about the medicinal indications as much anymore now they can go to their local cannabis dispensary, and they have much wider selection than they may have had previously. So when one of my aditorial, I'm used about how physicians now are going to bear the brunt of this wave in the people that are using it recreationally feel that it improved their medical condition. Now will come to the physician because marijuana is still expensive and request prescription in order to be covered. So I've never written a prescription. How would I do it? Well, it really depends. I because you as you just alluded to most patients will come to you and say, I've used this and it works for whatever it is. Right. And I have written prescriptions for medical. Rwanda? Particularly in a in a few different scenario. So one is I've used it in HFS patients. And there seems to help with pain. And there is fairly good data suggests that marijuana can be used in pain control. So I have no problems writing prescriptions. If you know, an HSA patient comes to me and says I've been using this for some time, and I'd like to try to get this covered by my insurance. Can you write me a prescription? And so I've done that. And so I will usually inquire as to the method and the amount that they use. And there's a few different ways that marijuana is consumed some people make their own oils at an home, so they'll actually distill and boil down the marijuana in that case, they'll need higher volumes. And then there's others who use vapor is Asian or elation. And there's other people who consume it orally Ross. So they'll eat the marijuana. And so each of those modalities has a different amount. So if you're inhaling marijuana usually people will be consuming from about point two to one gram per day. If you're making your oil from that, I've seen people, you know, you have to usually make it in batches but anywhere from point five to two grams of marijuana day as prescribed and and the eaten marijuana is about point five to one gram -oday. So let's gives you some sort of range of the amounts. That are consumed on average on a daily basis by individuals that are using it. But a lot of my amounts are based on them, as you know, as with any drug people, become immune. I will say there's a tactful access that occurs over time. And sometimes they have to increase their amount. So it's not as you know, the, you know, same thing with methotrexate or cyclosporine or some of the drugs that we prescribe up dosing adjustments are required. And I usually ask patients where they are on the spectrum and how much they need to consume to to get to where they are. Now. Obviously a patient comes to me and says. Like twenty grams a day I'd be enquiring about their actual job. And if they're not doing something else on the side. So there's you know, important caveats and have to be made and how much they're doing. But these are just some ballpark figures that I've used in my prescriptions. So give me the mechanics. I'm what do I write? So usually I will ask patients to select a dispensary, and they usually will go to dispense re and you can go online or you can go in person, and they will come to you with a prescription for much like we have for biologic agents. There's a patient support for him. And then basically you fill out the prescription into little boxes they provide you can also write a free form prescription and give it to the patient, and they can take to the Spencer. So either one works. And other one is available. So for instance, if you wanted to prescribe medical marijuana, you could say cannabis point five to one gram daily, please supply thirty days supply, use PRN as an example of prescription that would be acceptable. And usable usually wanna see an indication on the prescriptions. Just so they because they have to do their due-diligence. And so they can track it, I guess and put it into their system. But usually have to say, you know, for hydrated super TV for pain for sleep. You know, whatever it may be that your indication is us you have to put that down and their preforms also require that that you have to put down what the uses the other place. I mentioned HSS one particular place wife prescribes the other place. I've seen a lot of it used is in a topic dermatitis so in the control of paralysis and. In the inducement of sleep because we know those patients, very itchy sons have lots of problems sleeping, so patients tend to use it for both of those things the it and the sleep and there may be simplemente. This just that it reduces the inflammatory component. But again, I think this needs further study. So you're always prescribing dry. Yes. It's usually young oil people either make it home or. Yeah. Sometimes I will prescribe the oil and that, but that's a that's a rare circumstance people seem to like the ability, you know, at least the people that I prescribed at for to manipulate it as as they see fit and to consume it in the form, they see fit and some people will change their method of consumption, depending on what's going on where they are. Obviously, you know, it's it if you have the ability to boil it down into your own oils, people do that enjoy that process, but you can also prescribe the oil. And usually the oil comes in small vials fifteen milliliters to thirty milliliters approximately. And then usually the indication will be one or two drops. The problem is is oils aren't standardized. So the amount of active ingredient is highly variable, and so the the CBD and the THC content can change in very an often the dispensaries would like to have I will say the latitude to decide with the patient. What formulation what type what strain of cannabis works best for? That was my next question to ask. How you separate that out that component because you're just really saying your take this dry material use a gram a day for thirty days. And you're not specifying teach. See content. No, no. And and I I tend to favor low THC high CBD contents because the THC the psychoactive component. And we know that you know that without the CBD THC alone can lead to psychosis. And so there are psychological side effects to THC containing products greater than the CBD containing products. And we know that a lot of the benefits that are potentially hypothetically associate with marijuana are the CBD content. Right. It's the that's usually anti inflammatory component the anti politic component. That's the pain control component. So I tend to encourage patients to seek out high CBD anywhere from fifteen to twenty percent. The oil the dry product is not as easy to standardize. The bud is the the the actual leaf product is what you're getting has different contents, different amounts. Does easiest standardizes the oils the oils are tested and give you the exact amount on there. But often you'll talk to patients, and they say, I need to experiment. Try few different strains. Few different varieties to know. What's going to work for me? And that's in courage by the dispensary. Yeah. Yeah. And do you put down on your prescription? Low the h c high CD content preferred or this let people figure it out. I I tend not to because of the Spencer is don't like that. They like to have a free rein, they usually have. I will call medical cannabis consultants sometimes their physicians sometimes they're not who will guide patients in selecting quote, unquote, appropriate strains for their condition. So that's why they want you to write down the condition because in their estimating. They have expertise to be able to guide patients to correct strain, the correct oil for them. So this is really going to bring you to article number three in your trilogy. Exactly patients. Why how they select how who helps them select? And what affected they get when they did select and and and. Tried out these various concentrations or products for the conditions that they have correct. And then eventually, and we're still working on this right now, we'd like to do some some randomized controlled trials because I think there's a lack of data that we need we need impartial unbiased rigorous scientific investigation. And I think we dermatologists are positioned. You know, we have experienced doing clinical trials especially in Canada. Right. We're very strong internationally known for doing well documented clinical trials. And so I think we are positioned very well in Canada now to access into do these trials and to analyze whether or not this is truly effective in these patients or not. I can't wait. I can't wait to publish the trilogy. And you always give us really nice practical tips. And now, I know how to write a prescription. I can hardly wait for the first time to do it. Now, we'll ask your patients because they you'll be surprised how many of them actually are using it just doing experiment one day. I mean Calgary may be different than, you know, auto our Kingston the places I've worked or or Vancouver, but do an experiment one day. And just just make a point of asking every patient that walks through your clinic have used medical marijuana or have used marijuana for any kind of intent purpose other than getting high in the past six months to year, and you'll get some interesting results. Well, I would love standardized form if you do one in your clinic. Yeah. That'd be great descend across the country. You could have thousands of people work on the standardized form and in in no time that what I'm hearing. Okay. Yeah. If that'd be wonderful information. Great, right. Well, thank you gain for taking the time to enlighten us and best wishes. Thank you very much. So it was a pleasure. You've been listening to my interview with Dr Mark kerchief regarding his manuscript dermatology related uses of medical cannabis as promoted by dispensaries. I found it very informative but Elsa founded quite frightening. I know my clinical brackets, I'll be asking more questions, and I hope you will too till the next time, please subscribe, and he good to other.

marijuana cannabis Canada Europe United States psoriasis medical cannabis Dr Mark kerchief Rick Simpson methotrexate editor in chief Kerr farber university of Ottawa Archer Kirchhoff prime minister Spencer skin cancer England melanoma Canada United States Europe
New Study! Classification and Staging of Morgellons Disease

Morgellons Discussion

01:55 min | Last month

New Study! Classification and Staging of Morgellons Disease

"Hi anchor and thanks for tuning in to Morgellons disease discussion on anchor. I'm your host Jeremy Murphree. And today I'm going to read a article that I wrote for the statement Community. I'm not sure how anchor Works entirely but I definitely want to thank my friend crystal clear for introducing me to the platform. I found her Morgellons show or she likes determine it more gallon more. I can't I can't do it like Crystal does it you gotta check out her show though. Definitely. Thank you Crystal for introducing me to this platform. I get Google alerts on Morgellons Morgellons trying to do it. But and so that's how I found the anchor down Okay, so New Morgellons research draws on experience learned from syphilis the new paper classification and staging of Morgellons disease lessons from syphilis introducing structure for Physicians to distinguish the condition in their patient population. Most notably this study demonstrates biofilm colonies and intracellular infection resulting in the Morgellons filaments in this data, finally sufficient to legitimize the disease and results in widespread acceptance one prominent guitologist and leading psoriasis expert. Dr. Steve. Feldman says only if the CDC recognizes the condition first, if you guys like this show, feel free to subscribe shoot me a message. I believe I get them in audio in my inbox here on anchor and definitely try to stay up-to-date and produce some quality content for years. Medium you guys take it easy and definitely have a great weekend.

Morgellons Crystal Jeremy Murphree CDC Feldman Google psoriasis Dr. Steve
The Vulvar Dermalogues

Dermalogues

47:31 min | 6 months ago

The Vulvar Dermalogues

"This program is supported by an educational grant from Sun Pharma. Canada Inc made available through the CD corporate supporter program. I welcome to Durham logs. Season two. I'm your host carrying Gertie. I'm a dermatologist. That works and Halifax part-time community in part time university as residents. You don't have to get a chance to hear from dermatologist. Outside your own center but this podcast designed to change some of that. The goal of the series is to help you the dermatology residents get answers from expert dermatologists across the country to some of your burning questions on key areas of our practice. The expert is joining me on. This episode is Dr Mary Lou Baxter. She's one of my previous teachers. And what I would consider to be one of my female. Matale G mentors. She's an assistant. Professor here Dell has university. She's been part time a community practice and she also co manages the Volvo Dermatology Clinic here in Halifax as well so Mary Lou. Thank you so much for joining me on this episode of German locks. It's my pleasure Carey. You know what's interesting? I've done many dermal logs and this is the very first time that I'm actually in the same room physically as the person that I'm interviewing so welcome literally in person so when I was considering what the topic should be for Dermot log season two. Certainly genital dermatology came top of mind. And also we've recorded An episode with Dr Doiron. Talking about male genital dermatology and of course female or Volvo. Dermatology is something that everybody's GonNa see in their practice and to be perfectly frank. I don't know that everybody gets a lot of exposure to we're lucky here endow because we had Dr Baxter's Volvo Dormant Haji Clinic and so we got to go very frequently and get really comfortable with not only the exam but the conditions biopsies etc but merely always hoping we can maybe Chad about some of the things that that you taught me and be able to have the other residents across the country. Learn those things for sure now. This is something that I like to ask everybody but what is it that made you interested in vulgar metastasis in the first place? That's a great question. Carry every day we all as Matala just see patients with volver disorders and I guess part of my interest in the fact that a it was a big challenge. There was lots I didn't know and so wanted to learn more about the area and secondly that this is a very high needs group of patients who are extremely grateful when you can actually make a difference and not that all of our patients aren't so this particular group is somewhat even more so So I spent a little bit of time going to some conferences and learning a little bit more but vulgar Murtala. She and then joined the gynecologist. Who was already running of over clinic at our hospital and since I did that. Approximately ten years ago. I've learned a ton more and I think that's an interesting thing That you said it really is life changing for a Lotta patients and I have to say one of the things that I really enjoy including I saw somebody back today. Who had extreme over edge? I gave her a topical treatment for her reluctance. Colorado's came back and said Oh my God I'm so much better so thankful and I think it really does make a quality of life difference When you're thinking about so I guess what I'm going to back up and say okay. We're talking to dermatology residents. They know some basics Obviously about Dermatology History and physical. But when you're thinking about the vulva patient when you go in for that consult what type things specifically might be you focusing on in history that you might not talk about in a regular Durham console so sorta unique questions that you may ask a patient over dermatology would be to be very specific about their symptoms because they may complain of each and they may complain of pain they may complain of disparue. Neha and knowing what their main symptom is really helps you to sort of go down a different path depending on the DOT or trying to get to the diagnosis and treatment. So I think that's a really important. The timeline is critical and I think most importantly the impact on their quality of life as Carey said because this is a subject that a lot of female patients feel very uncomfortable talking to their physicians about especially when it gets into issues of sexuality. So I think being comfortable sort of opening the door and allowing them to express the impact of this disease or the symptom on their out. Quality of life is really very important. I guess just a drawing on that if you see so you know I. I know that you're often taking a more thorough sexual history from patients at might come in with genital complaint Let's say that you have a younger patient. And you want to broach that sexual history. Are you the type of person that would ask if there might be a parent or caregiver to step out? Or how would you tend to do that? In this instance because it is really important in particular very important and so we would exactly do that. Oftentimes if it's a teenager. Who Comes to our clinic. They are accompanied by particular mother. And so we're very open. We say we need to ask you some questions. That might be quite sensitive. Is this something you'd rather have us do one to one and one or would you prefer to have your parent in attendance and it's quite interesting. How often these young women will want their mothers in attendance. Which makes it all that much more comfortable. That's true and I think people probably a lot more open with parents than they may be used to be quote back in the day if you will but So that's great the other thing I was thinking about on history and I remember asking a lot around the products that might be used in the area. When you're thinking about potential things like contact allergens and are there some very specific products? That right now might be on vogue or that. We really don't WanNa miss like you know. Should we be asked? He wrote about jd eggs and whatever. They're whatever else group is suggest how it is true. One has to be besides asking what prescription products they've had. It's very important to ask the patient. What OVER THE COUNTER NON PRESCRIPTION TREATMENTS? They've used and in most cases there is a long list. Because a lot of women will try to treat this these disorders on their own before even seeking medical attention. And so the the real big red flags would be over the counter. Analgesics Anti itch products particularly those containing Benzel. Cain are commonly used by women in this group and of course as we know this is a common contact allergen and so we questions specifically about products itching pain. We asked about Soaps we ask about baby wipes which are very commonly used again by people in the genital area. Both men and women in the genital reaction. Say and I think that's a key. Also things like menstrual pads or incontinence pads or panty liners Branch which specific type they're using because we can certainly guide people in that direction And other than that. There's a huge huge range of over the counter products and clean cleansing agents. And you name it that people will use and so it's really oftentimes nurse will assist US incurring through this as they council the patient on volver skin and they often come up with even more information. We've gotten in our history and you find still you know I guess. In contemporary people using douching products. Or does that seem to be sort of passe? Yeah not as many douching products anymore. People tend to be using a lot of sort of external cleansers and whites. And that sort of thing. But we're not seeing as much. Don't forget that. Mci Wipes factly now. Okay so we've taken our history. We've gotten what we need to do. We want to go now and do a focused physical exam. So maybe could you walk me through how you do a gentle exam like? Who's in the room? How do you drape? How do you talk to the patient? What are some pearls for sure Kerry? Well first of all. I always do the history with patient dressed because I feel it's less threatening to them And then what we do. Is Once we complete history. I offer them a drape and instruct them to take their clothing off from the waist down. Get onto examining table and covered with drape. And I leave the room while they do that. Pull the the drape the curtain across and then I also inform them that. I'll be returning with minors. So they know to expect to people to come back in for the examination. Sometimes with a resident as well Then what we do. Is We try to get them into a either of the stirrups if we're using a gun club med. Or if we don't using johnny bed such as our office. I tend to not used her up so what I do is I have them. Just put through heels Togetherness Party. You get that sort of. Frog's leg position and it's very easy to do a volver exam in that in that situation. It's a lot easier. If you have an adjustable table that goes up and down so you can get it at the height and good lighting And then we of course warned the patient. We're going to be touching them and we first inspect the thighs and Inguinal area and the label. Labia Majora Before even sort of examining further in and do it very gentle and opening up of Labia Majora and examine the entire Mucosal Volva from the clitoris. Right down to the the apparent NEOM and also the Peri Anal area. Sometimes we need to roll people over onto their side to examine the glue full because at certain can be involved with a lot of the diseases and then depending on what we see we may complete a full skin exam which we often do because as dermatologists that distinct advantage of being able to use clues from other parts of their skin to help us in making the correct diagnosis in the anal genital area. Exactly which I think for me as a learner. I found a lot of times when you were doing even that exam. You'd see your thema or you'd see your rotation's erosion and then you needed to find those other clues because many conditions can look the same exactly and that's the biggest thing with. With General Dermatology is making the right diagnosis. Which can often be very difficult and the presentation of a lot of different conditions can overlap so looking in the mouth looking in the scalp looking on the skin can certainly help to To narrow down the possibilities. Yeah now you know I guess we can talk through. I wanted to cover a few things about common things that you see looking at clinical classifications. But I guess maybe to skip ahead to just talking about biopsy or other investigations or tests that you might do looking at Volvo skin and then we come back to maybe talking about conditions specifically and so If you're going to do a biopsy and so having been in your Guinea Durham Clinic. I realized it's actually fairly slick maneuver. Everything's ready got on a tray It's it's very good for the patients but Sam in my office or say I'm in a teaching clinic and I am not in any Durham Clinic. What are some things that you really? What are must have for a good of vulgar biopsy from freezing to products? So the first thing you need is you need another pair of hands. Because it's almost impossible to do this by your side because you have to be stabilizing the skin. Retracting the Labia doing your punch card arising or whatever you're gonNA use humor stasis and so it's very important to have an assistant who can who can assist with positioning the patient correctly because you've got to get the right spot to biopsy secondly what we use punches and generally dermatologists use a four or five millimeter punch for this area Skin twisted very easily. So you have to really stabilize it. Well to get a good punch and you go the full depth of a punch just like you would anywhere else. I should backtrack and say that we just use came with up an effort for local anesthetic as you would anywhere else. Great Rarely do we use any topical Anaesthesia Future. You do a quick injection of xylocaine. It's it's fine and then Having some forceps and some scissors gently lifting the biopsy out of the whole snipping at the base as you would any other biopsy try not to crush the tissue. You can use a needle to lifted as well as we sometimes do. And normally we don't suture the biopsies that we do evolve. We Use Chemical Qadri silver nitrate. You could use Mancelle solution and your favorite basically Chemical Qadri this the coastal surface heels. Very quickly And we find we don't normally have to suture. Yep that's a great point and I know that I remember using this sort of Nice thicker version of cells in the guy. Needham clinic that I have never found anywhere else. So it's a magical solution side on how they do it. Just just plugs the whole and you hold for honestly less than a minute and usually you get great team status but was check and make sure we have good humour stasis with we provide the patient with a pad to put in in their underclothing for the ride home in case because they will get some even some of the coffee ground like material that comes off of the wound. Once you've actually caught her. Is that right. And of course review aftercare. Yep that that's great and I mean I do think that extra set of hands as key I if I'VE REFUGE GENERAL BIOPSIES IN MY OFFICE. I don't have a nurse so I don't do them there. I bring them to the hospital or I have the good fortune of being able to refer to the dining room clinic for more complex cases. Now Okay so now that we have all the information. I WanNa talk a little bit about some of the common conditions. And then maybe some of the uncommon conditions that you'd see in the Vulva area. So thinking I I I guess you probably would divided into sort of your classic infectious inflammatory malignant. Would that be fair? Absolutely and then there is other sell the communists conditions that we see in our clinic are inflammatory and so at the top of the list would be Lichen Sclerosis Psoriasis LICHEN SIMPLEX CHRONIC COMPLAINTS. They would be the communist inflammatory disorders. We see we also see some plasma salvo Vitus And of course Dermatitis contact dermatitis suburb dermatitis. A topic dermatitis that people have everywhere else and then as far as infectious conditions. We don't see a ton of them in the guy. Newsroom Clinic Std's or manage a separate STD clinic so that sort of handled separately love the family. Dogs will treat obviously the usual Vaginal Infections And we tried to avoid getting into treating those if we can race we're really focusing on bubblegum technology But we do see a lot of secondary candidate assists on the surface of the vulgar skin Cosa and This can be superimposed on any other inflammatory process or can be primary With or without vaginal candidiasis One group that sort of really one has to consider when you see Candida is if someone has really severe candidiasis and it's recurrent and resistant to treatment is is to make sure that you've you've checked them for diabetes. Because diabetic women frequently have horrendous. I candidates the BELVA particularly if they're on drugs. Because you excrete more sugar in your urine and there's an increased incidence of candidiasis the vulva in those. See where I thought you're going with that was to say screened for HIV because of Severe Canada. But actually that would be far more common that you'd catch diabetes. We've diagnosed lots and lots of diabetes in the clinic and people didn't know they had diabetes. But yes you're right away so much commoner than HIV but another thing to consider of course so in terms of infectious things in you in the guy. Needham Clinic You wouldn't tend to see a whole lot of Condoleeza or molest them per se. Lieuten not to. We don't actually accept those referrals we send them to. Std Clinic waiting manage those. Yeah I think. For the purposes of the residents genital warts are treated the same as general words in Moscow street as Moscow and I think the big consideration there which we could maybe talk about briefly And this is more in the context of just genital dermatology. But let's say that you know not in a clinic specifically but you're in your office and you see a younger person that you were concerned about Genital Wart Term Alaska. Do you ever find the need to bring up the idea of potential abuse? Or He's a really controversial topic as you know thirty five years ago when I was training dermatology we. We were red flagged. Everybody that had every child that had genital warts from Alaska was sent to the skin program for you know suspected child abuse neglect However we now have a better understanding of the infectivity of these viruses and understand that Contact through other means besides sexual is certainly possible so I think it's a difficult situation. I think dermatologists we all wrestle with that question again. We don't tend to see a lot of children in our clinic. So don't deal with that but in a in my office. If I saw a child I would certainly do some initial questioning about other people with words and the family of the people with Moscow in their family all h related. If it's a teenager certain you WANNA ask about sexual activity and it's an opportunity to talk about safe sex And also to educate them about getting vaccinated against HP excellent point. Excellent point okay. I always forget about that. It's just teenagers walking around. That never got it. You're just running around Gardasil for everybody. The GARDASIL Queens Actually not not specifically guards. There's other options to our okay. But in general the vaccine one has to remember to even in a mature age group at sometimes right idea. Yeah okay so that was a little segue but back to Back to talking about so I guess one of the big things that I think we always think about what was here about rose looking for is Lichen Sclerosis and so in my head. I had that picture of the porcelain wide figure of aid. You know changes in the anatomy. But what do you find? Are some clinical clues maybe more early? Lichen Sclerosis whereby making Starting treatment could actually impact the outcome and improve the outcome very good question. Because certainly as we all know scarring process and so the earlier we diagnose treat the less likely they're going to be developing scarring and also reducing the risk of squamous cell carcinoma. Which we know was elevated in this group of patients so first of all in history. Almost all legless grossest presents with each so I would. I would go down that pathway. If someone said that they were itchy and It can be chronic In terms of examination in an early case you really have to look hard for the call. Them Porcelain White Patches and communist places to see those porcelain white patches in early Lichens grosses are in the Perry clitoral area and in the Inter labial Celsius. So it's the crease between the Labia Minora and the Labia Majora and then also in the pair neom so sometimes you have to really look hard in those three areas to find it but you will. And then you have the benefit of giving the patient education on the diagnosis Making SURE THEY UNDERSTAND. This is a lifelong affliction that they will have to treat themselves forever but that because they're being diagnosed early can actually reverse some of those changes in early disease and we could also go long way towards preventing some of the destructive architectural changes and reducing their squamous cell carcinoma. Yeah that's that's a really good point and that's one of the things I like to talk to patients about because I find once there. It is under control. Many of them have the urge to stop treating. Here's a question from one of the residents world headquarters of the derm logs. Podcast HIGH-DRAMA LOGS. This is then for me. An and the dermatology resident Atlanta University. My question is is there a good grading score for Genitalia can sclerosis? Is there a good grading score for Genital Lichen Sclerosis? There isn't Basically we would use mild moderate and severe and that is used sort of universally by dermatologists and gynecologists who see people like grosses. Now how often will you see? So this is something I also recall and I found it very striking as a resident that many times in the vulgar clinic patients would come in for a Disparue Neha and then when you went to the exam you recognize that they had very severe Lichen Sclerosis closest probably in the younger age group so the more pediatric version and they had had destruction of their anatomy. How often do you see that? And then these will be like what they had. No idea I don't think anyone ever looked yes. So this is really interesting question because as we all know from our reading that there are two main peaks of onset of LS childhood and then post Menopausal. But you'll often get someone coming in. Who's twenty five? And they say they're kind of itchy and as maybe some just prunier and you examine them. You see really advanced changes that would be associated with a diagnosis of longstanding grow. So then we asked the question. Do you remember when you were young girl having had some itching in this area and and oftentimes they will say Yeah I. I went to the doctor and they gave me some cream but the diagnosis is often not made in child. But they can still get the same destructive changes in childhood and they don't reverse so whereas the disease can go into remission in adolescence. Distract changes never go away? So that's one of the reasons we would see fairly advanced changes in a younger person. Yeah and that's and I think that's a learning point for residents and it's a point for myself as well when I see people with any type of Inflammatory condition I always ask about general involvement or if a child has sent four ish or their parent comments at their itching in the Perugino or general area. Look because I think The unfortunate part is it's uncomfortable sometimes for patients or parents were the care provider and then it gets missed which is far worse in my opinion. Us another resin question. High Dermot logs this Fatima. Her any of the University of L. Britta Dermatology. My question is we typically do not biopsy. Lichen sclerosis are there any clinical factors which might prompt you to biopsy genital Lichen Sclerosis for sure and I agree? We don't normally buy a biopsy for diagnosis if it's a classic presentation because oftentimes you're disappointed the biopsy report doesn't actually confirm your clinical impression but you're one hundred percent sure clinically. This is classic. Ls So we don't do that. The reason that the Bisi may be negative is because there's a lot of secondary change from moisture and maceration and maybe secondary infection and it can be really hard for the pathologist who can be very good to see the classic changes that So. We've we've sort of stopped doing rand routine biopsies for LS diagnosis. So the times when we would be inclined to do a biopsy and L. S. would be if a patient complains of pain in one particular area. And when you examine them they have an integrated or ulcerated lesion. You have to buy see them because it is probably a squamous cell carcinoma. So a patient that goes along and they're doing pretty well and they call the clinic and they say oh and having all this pain you bring them right in because pain is a hallmark of squamous cell in lichens grocers. So that's your number. Two three reason to biopsy okay If you have your treating and you're usually follow these patients. Every six months to a year depending on how severe they are and how far along in the course. They are If they have a particular area that's really resistant to treatment. Particularly if it's thickened hypertrophic the biopsy that as well okay if it has a read a distinct red patch because you don't usually get red patches else would buy that because those could both be precancerous stage Called the I N or L. Sill That you'd want to diagnose treat prior to evolving Carcinoma And I guess the third thing is if you think you have the right diagnosis. Maybe the features on aren't one hundred percent classic and they're not responding to treatment and gone through all the other reasons why someone may not respond to treatment and there you've ruled them out. Then you may biopsy just to confirm your diagnosis like they're using the Korean. Those are the big. The biggest reason people don't respond to treatment is that they don't use their their topical properly. So that's a whole other discussion can have. We'll never gonNA move into next. Which would be your. What's your while I know it? But to share with the other residents What is your general treatment? Approach Algorithm for Volvo Lichen Sclerosis. So in all patients who have not being treated who present to our clinic regardless of age and this is important this includes children we start with a high potency topical steroid -pointment and we would use Kla Beta salt first choice always an ointment base us everything using evolve in a gentle area in general men and women should always be if available and we start with Clo- Betas all or twice a day initially for one to two months depending on how severe their diseases and then we asked him to step down to once a day and then we'll usually bring the back at the four-month point and at that point we assess their response to treatment both in terms of symptoms and signs. If they've done remarkably well then. We aim to reduce the strength of their topical steroid for maintenance so I would go down to something like Beta methods on valor. H full-strength applied once-daily and then again six months later. If they're doing really well we may step that down. One more time to say have strength made a methicillin Valerie. Point zero five percent and keep going down until you get to the lowest concentration of steroid that controls their disease. The other option is for some people prefer to stay with high potency. Steroid use it less often so two or three times a week. Personally I find. That's more difficult from a compliance point of view but it is acceptable treatment in on exams in glance situation. Right that's GonNa ask you either. Decreased frequency or decreased potency. Basically nose pro topic or are topical Costner Niggers. Ever okay for likened Scotto so yes now you know that when you first start using calcium inhibitors you know a fair bit of irritation so we were already treating an uncomfortable lesion with something that's GonNa make them more uncomfortable. So sometimes it's hard to get over that Hump I don't tend to use a lot of calcium hitters for L. S. or L. P. in the Vulva The reason being that. I don't think they work as well to initiate a control You may use them for someone who has very mild disease to sort of maintain control particularly if they are somewhat steroid phobic but we get such good results with topical steroids. We do not have a fear of adverse effects of topical steroids abuse coastal surfaces because they're very resistant to that those effects and we know the safety profile. The other issue was of course the whole black box warning which I know is evolving now And so we know. These patients have a higher risk of squamous cell carcinoma. There was a label thing. And they're still is in some cases saying this may give you cancer so if they did get a squamous cell and you did have them on something like that. You may be in a difficult legal situation so actually if you live self sufficient xactly and that's kind of where we get a lot of our education of from and Ghani Durham is from the USO. So we tend to do some people but mostly if they are reluctant to use a topical Steering Okay and then do you tend to follow these people more or less forever or do you feel that after a period of time with good compliance and good stability that they could be managed by primary care physician. Absolutely we can't possibly follow. Every lichens grossest patient but what we do is we follow them into we feel we have them under control and usually on a regimen. I do the decrease frequency or or decrease strength of steroid And it depends on the severity of the disease. If they have quite severe disease we keep following them because those are the ones that have a higher risk of developing squamous cell. And we see that often so we need to be on top those patients and not that the family doctor isn't they're just not seeing as much of it but for for people that are well controlled with mild moderate disease and a family doctor. He's willing to accept them about or primary care. This willing to accept them back into their care. We definitely transfer the back and invite them to review for if there's a problem or concern. Okay Yep good point now you did mention along the way they're lp and I find it particularly challenging sometimes Early ls if there's not a lot of classic white change and and Maybe a Roosevelt or Mucosal. Lp are there any clinical features are very very correct their carry in saying that Cosa LP is usually erosive so when we see LP on the Vulva in the vagina it is the erosive. Format is not hypertrophic. It's not popular plaque like And it usually presents more with pain rather than issue because it is a rose of. But you're quite right. You can get architectural changes in the Vulva You don't get the white sclerotic plaques that you would get an ls so you really have to look hard for those and look for sort of well demarcated red eroded patches and. I guess that would be an opportunity where you'd be looking the Buckland Costa you'd look for other feature in keeping with LP also the Different Lichen Sclerosis. Lichen Simplex I know clinically. They look very different but I find sometimes other physicians or learners or Patients don't tend to know the difference. What are your key clinical features for a LSC leg or Lichen simplex? I should have savvy user term. Ls is too confusing but like instaflex chronic is so likely some chronic is Some of the differences that we point out to our learners are that it usually is asymmetric. So that Oftentimes one side is much more involved in the other. It's usually on the hair bearing surface of the Labia Majora in on the mucosal surface where L. S. lives And of course you see the classic features of Kathak Ation but you can see some erosions but you do not see any architectural changes. Okay okay. So that's the key feature there and do what would be your treatment approach for that as well do tend to use ultra potent topical steroids or whose alter potent topical steroids for LSC we usually started with a medium potency topical steroid and what I tend to do is I tend to give them a a month or two months. Depending on how severe they are of using the topical steroid routinely regardless of edge to try to dampen down some of that hypertrophy in that paramedic response and I also Would GIVE THE SORRY. Give him a mini medium potency. Topical Steroid appointment twice a day for a month and then decreased to be. Id Pierre An. I'd also introduce a an antihistamine for each because most of these patients scratch nighttime so sedating antihistamine nighttime I will also go through in great detail vulgar skin care. Okay on particular the Noting things that should be avoided and also advice about other things they can use. If you're dry you can use some Bassolino itches. You can put an cold pack on so giving them service to generic non-medical medication related advices. While now would you ever use a? I've never done this and I don't know so teams but it just came into my mind so you know if there's a patient that has a plaque of Lichen simplex somewhere else and it's not responding to that type of treatment. I tend to inject it within traditional steroid. Would you do absolutely? Yeah so we use interleague steroids a lot in the clinic. So we getting back to likeness grosses if you have some areas that you buy up seed in their persistent. But they're not pre malignant than a little inter-regional steroid helps certainly erosive. Lp It's great but LSC again yes combining that with your topical therapy antihistamines. And your vulgar. Skin-care inch relational. Steroids are of great value. Just thinking about the way when you are explaining to a patient how much and where to apply topical steroid. Do you use a diagram. Do you Point how do you do that to make sure that they're not just like glop in it on or conversely not using enough is so critical? And you really do have to spend a lot of time showing them patients where to apply there so we do use a diagram. And it's a preprinted. I gram and we use up highlighter. Pen to kind of identify the areas that they should be putting product and go over that with him but we also use a mirror and actually demonstrate live to put stuff much better and a lot of women aren't used to looking at their volvos can be uncomfortable but it's really helpful And the other thing. Is We review where not to apply because OFTENTIMES PEOPLE WANNA put their topical steroid on the outer surface of Libya Majeur. Which is exactly where you don't need it unless you have. Lsu PSORIASIS and As far as mount we tell them to use like for. Ls A half of a piece is of weight -ment because spread so much you don't need us a ton so that's the sort of quantity we tend to use. Okay do you ever have a specific patients? Like what type of Pee Mommy being like? What are you talking? We have had that quite okay. So I think that's actually super useful because when you show a patient how to apply and how much apply and where to apply makes a huge difference especially when they're their own Model if you will for example Now the other thing people always so scared about and you did mention this already but people are so scared about atrophy of the thin skin. Thinning of the skin An and I find for me. People have overused steroid in the genital area. Tends to be more stretch. Marks are happening not so much you know terrorism perpere on any of that is that been your experience. Also absolutely and as I mentioned earlier D'Amico surface can can handle topical steroid very well. But when you're treating a condition that's on these harboring skin cracked nice skin. Then you have to be really careful about weaning. People down giving them a lot of excess a product and also weeding them down as quickly as possible to a low potency. Steroid pure and but you don't see you don't see purple you don't see till What you do see a stray which really common and even extending onto the FIS and I was just GonNa say that. Some of the reasons may be listening to this and they may be listening to the male genital podcast around the same time and say will you know. Dr Doiron said something different and I think part of it probably really has to do with the fact that there's less mucosal skin on on the peanuts compared with the Volvo where it's all mucosal skin that you're treating so I think that's important to remember that you can use different steroids. Different potencies on different types of skin. And even though boulter genital skin there inherently very different between male and female genital skin. Just shifting gears over to psoriasis. So you know as I mentioned I always like to make sure that I ask about general involvement because a lot of patients either have never been asked. They don't think about it or they don't think it's related Do you see a ton of genital. Psoriasis in your practice or does that tend to be just less common. When you're seeing more of the other inflammatory condition. We see a fair. Bit of general psoriasis. And we're quite proud that our gynecology colleagues are learning to recognize not just on the Volvo. But they're excited. When they find plaques elbows they think high five is right in any case yes we do see a fair bit of psoriasis and I agree with with carry that People often little shy talking about this area of involvement. So when you're seeing US Rice's patient in your general derm clinic or office. Just make sure you ask them because if you ask them they'll be very grateful and want to tell you about it because it's very uncomfortable and itchy. It's one of the places where psoriasis is often very issues the general area so certainly do ask and then we treat very similarly to how he treats rises other places but again bearing in mind. That's Rice's involves the crat nice skin. So you're going to go with sort of medium. Potent steroids down to low potency. You made us some Tulsa trial trial. You may use Some a little bit tar so there you can certainly all of the topics that you would use. Most of the topic was you would use for psoriasis elsewhere in the genital area and there's really nothing special about it you just treat it like you would suffice in any other location. Oftentimes people with genitals Rice's will have inverse psoriasis. So you have to make sure you also check in for involvement under the breasts under the Exceleye because they they don't always associate these things with one another right and I always like to remind the residents. That general area is a special site so that they don't need to qualify for more. I don't use the term aggressive but different treatments difference. Stomachs genital involvement alone severe impact quality of life. And doesn't they don't require ten percent of their body surface to be eligible for those treatments. I was just GONNA ask. This is not specifically related to psoriasis. But just thinking about using topical and using advent topical and I find a lot of Older or post period. Postmenopausal WOMEN ARE APPLYING TOPICAL. Estrogen Estrogen based products. Is that help with more lubrication of the tissue in allow other topics to be absorbed better or something else to it. Well I think it's an excellent question so In the postmenopausal period if women are not on systemic hormone replacement therapy. It's not uncommon for them to develop symptoms of call a trophy Volvo vegetative which is basically estrogen depletion so that can be a secondary condition along with their LS or their psoriasis LLC or the LP so one wants to address both conditions because they're responsible when he'd be partial if you only address the inflammatory condition so that's one part of it because in and of itself a trove of over nights can be itchy and painful Secondly just like you said carry if you I. I like an it to treating a topic dermatitis in using moisturizers. If you don't use a moisturizer in an eight topic all use. Is there topical steroid? They're not going to do as well. It's the same with estrogen. If you use topical estrogen it improves the integrity of the tissue. Therefore it responds better to whatever treatment you're using for their other primary process. We tend to use intra vaginal estrogen at times. If people are complaining of Agile Dryness we tend to use topical estrogen creams and a variety of a combinations for the actual mucosal surface of the vulva will do avoid is highly centered product and there is one product on the market. That's very commonly used because it's been the oldest kid on the block and unfortunately there's a very strong perfume smell and of course we all know as dermatologists that when someone has an inflammatory condition we do not want to use a center product on top of that so one has to be a little bit familiar with the products. That are out there. But don't be afraid to prescribe them. There are also considered very safe in often for people that are have concerns about using hormone replacement therapy. We can say this is just working where we put it as long as you follow the guidelines in terms of dosing and frequency than your absorption systemically is almost measurable. And so you still have to be wary of things like postmenopausal bleeding history of breast cancer and all those sorts of things but one can use their judgement and consult with other treating physicians to see whether they're comfortable with the safety of using products. But you should get familiar with them because they really make everything else. Work Better in their age group and I find one on giving patients more than one topical preparation the big question for them as window. I put it how do I do it? What order do I do it? So if you're gonNA give them say Cla Bettas all weightman Andrew giving them an estrogen cream do you. How do you advise them to use it? So I don't usually when I I see an LS patient for example and I'm going to prescribe KLA Beta's I'll be I D. I don't usually start the estrogen right away for the reason that if someone has an adverse reaction we don't know which products causing it so. I generally introduced the topical steroid. I because that's going to give you the most bang for your buck. And then when they come back for their follow up and we're at the point if decreasing the frequency of their tropical to once a day that if if they need it we do introduce the Estrogen at that point so they would use one in the morning and one at night of their choice now. I think we could probably do multiple hours just on inflammatory conditions of the Vulva. I just want to take a couple of minutes to talk about malignant things and we have touched on concerns for squamous Cell Carcinoma Secondary Schemes. In sort of chronically inflamed skin. Would there be other malignancies that you would be on the lookout for in general when you're doing evolve our exam so I in terms of squamous cell. They're basically two different types of squamous cell carcinoma. That you can get in the genital area. You can get the HP related squamous Cell Carcinoma. Okay and then you can get the the SEC that secondary to chronic inflammation sclerosis. Yup and they look different on biopsy. And this is quite a challenge for pathologist because the one that happens. Squamous cell. That you like. Sclerosis is called differentiated. V I n before it's a squamous cell and actually harder to diagnose because it's more subtle findings on with all g but it's actually a more clinically aggressive form of squamous cell so the squamous cell associated with HP is kind of low grade squamous associated with L. S. and L. P. is very aggressive. So that's why we're so insistent on by up seeing and bringing people in quickly if they develop painful non healing lesion in these conditions so squamous cell is the big one and we see a fair bit of that We see pre-cancer so we see what was called V. I N. Of Over epithelial. Neoplasia or now called also just a different terminology basically Identifying those and treating them appropriately. Obviously it's HP related treat them without Darah or by Luma if it sub if it's a non HP related then we would send them to gynaecology group to take care of surgically so swim sells the big one And the PRI a cancerous variance of that and then the next most common that we tend to see is probably melanoma. And it's not that common so there's a big gap between us too but we certainly always want to look for and we do get a lot of referrals for pigmentation in the Volvo and of course you see these these irregular dark brown patches here there and everywhere in someone's Vulva and the question is assisted new melanoma or is this what we call Labial Bella notice which is a benign condition so We certainly see a lot of that. We do biopsy all of those because if you buy one area and it comes back as benign labial melanomas thing you can be rest assured the rest of. It's probably the same and that you don't have to do anything because it doesn't have any pre malignant potential but we do see volver melanomas. They were present like melanomas anywhere else. They'd be growing rapidly. It'd be erect all of the features of melanoma but remember that you can get developing on the mucosal surfaces well and some of the ones. We see more obvious when you first examined the patient but if you sort of opened up a little further you can just see tucked inside the intruders. So have a really good look does she. If someone's complaining of a painful lesion there We do see paget's disease occasionally in that erase wells over that and has that sort of classic presentation and those would be about the three big ones so again this is like over dermatology and forty five minutes or less. So there's still a ton of things to cover and I guess that leads me to my next couple of questions which is let's see somebody. That has a resident really wants to learn more passionate. They think I wanNA do some Volvo. Dermatology are there any resources in textbooks conferences? Things that you might recommend that they could consider so yes. So there's a there's an international association of people who do volver dermatology is called the International Society for the Study of Oval Vaginal Diseases or I S S v D and they have a website. It's ISP DOT ORG and you can actually access a lot of the handouts the A criteria for treatment the treatment protocols all of that on their website. You can join and become a member and attend the meetings. They have a meeting In North America every second year in Chicago now starting to have some other sites. They have one in Montreal year or so ago. They're having a few others and they have international meetings as well which are really quite interesting because you get perspective from all around the world so if you really have a passion you can join that group. Even just to get their information and beyond their received their communications and their updates is very very helpful. There are a couple of very good textbooks and atlases of evolving technology that Mostly come out of the. Us and you could certainly access those as well That's probably those are probably the two best sources. Okay cool. Well listen. I don't want to take up too much of your time but before I bid you ado Any clinical tips pearls. Little things that you've along the way that you just think. Hey we really should share that with the residence or that you wish you could tell every Canadian dermatology resident like you know merely says Mary Hashtag Mary. Lou Says Oh yeah. That's a good question. I think one of the biggest issues is listening to the patient getting a really good history and I know that sometimes we rushed through that you gotta spend the time because this group of patients is obviously very needy as well and they've often been through many different actors before they see you so you really have to make sure that they understand that you are very interested in what they have to do to help them in you probably can And secondly when you do your examination Be Really really thorough. You know it's so easy to just do a quick little look and you really have to just kind of be really specific about you. Know examining every little part and don't forget to go right around to the back And I guess thirdly is we review with the patient at every visit why they're treating this condition and why they need to treat this condition for example in LS for the rest of their lives. And you have to reiterate that at every visit because Kerry said invariably people when they start feel better. We'll stop their treatment and sometimes they'll be told to by a pharmacist or family doctor. Who doesn't understand so really reviewed all three main reasons for treating. Ls are symptom control prevention of destructor teen changes and reducing the risk assessment. Mozelle carcinomas that over and over again. They may be able to stick with it I guess fourthly you got have time for some of these patients and that's a hard thing in a in a general dermatology office so sometimes having a specialty clinic is great because we can take a little bit more time. We have great nurses who support US and help with education having handouts give them to the patients volver skin care. What is like grossest get you can get those sorts of handles through the resources that I mentioned and have them available if you do a lot of vulgar dermatology because there's too much for people to hold on their heads but if you give them something that's reliable to read rather than what they read on the Internet then at least they'll be they'll be better educated and I guess the last thing is don't be afraid to ask for help so if you have a resource in your community we get calls and emails and texts from our former residents all the time And we're having chipper happy to provide that advice. Because you know it's important but you know try to tap into a resource that you can. You can channel In your community as well that you can get some help with because it's not always as in textbook as you know with all dermatology. People don't always present the way they're supposed to so sometimes cases a really challenging and getting another opinion from someone who may be done a little bit more of it is also very helpful. Listen I think those are amazing? Clinical Pearls in the resin should just listen to those last five things over and over and I think that would really serve them. Well so merely. Thank you so much for joining me for this episode of Dermot Logs. I've really appreciated learning more yet again from you and of happy to have you join me tonight. Thank you carry. So that's me Doctor. Carry purdy signing off from. Dermot log season to That was Mary. Local an talking to us about Volvo Dermatology. She's an assistant professor at Dalhousie University and runs of over Dermatology Clinic. Here in Halifax Nova Scotia. That's it for this episode of Dermot Logs. Please be sure to subscribe you. Don't miss any upcoming episodes. And if you liked it gave a rating you can share with your colleagues and if you have any questions about this or future episodes you can reach me on twitter and Instagram at CA president. Thanks so much for listening until next time. I'm Dr Kerry Pretty.

volvos PSORIASIS Dermot Logs Labia Majora L. S. Dr Mary Lou Baxter LP HP Volvo Dermatology Clinic Dr Kerry Needham Clinic Mary Lou Lichen Sclerosis diabetes Dr Doiron Lichen Sclerosis Sun Pharma candidiasis Carey Volvo Dormant Haji Clinic
How To Look Younger

Food for Thought

57:55 min | 2 months ago

How To Look Younger

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To find out more head to your body to UK and find it in your local supermarket. Hello, and thank you so much for tuning in defeat thought a podcast on a mission to equip you all with the evidence based advice you need to live and breathe a healthy lifestyle I'm Ran Lambert registered nutritionist bestselling author of Renar simple way to eat while and found of rechristened London's leading private nutrition clinic in each exit. I'm so lucky to be joined by special guests all of whom can be considered authoritative voices in health so that together we learn fact from fiction and empower the healthiest and happiest versions of ourselves with the trusted expert advice. Aging a completely natural part of life but that doesn't mean it's always pleasant. If. You're worried about losing your youth look stunned you to not alone. Thankfully though there are some things that we can do without destroying the bank account or resorting to getting surgery like taking attentive care of your skin and changing your lifestyle. This week's food for thought sees leading dermatologist Angelie Marta and I explore how we can look and feel our best Halley Anti Hi, Ray. Hi. Lovely to remotely speak with you today. Thank you so much for giving up your afternoon on I. Really appreciate you me back actually say thank you I. Know You're one of our second guests on the podcast you've been on twice house very exciting and I think because people want to hit his topic. I just had to get it in the lineup for season seven. It's something that everybody else and I'm sure when they will continue clinic it's probably one of the biggest questions that you get like how do you make your face look younger? That's right. It's a common concern I think becoming increasingly. So as we're spending so much more time on song phones, but also more recently with a viral pandemic looking at all selves on Zoom, for long periods of time while hadn't even thought about that looking on same guard is so interesting and is that is the trick is something people can do with that kind of thing I should wear less makeup is that GONNA help all? Yes. A big thing that Kinda gets all night our still with this. But if you want to make up and it makes you feel better and it makes you feel confident there's no reason why you shouldn't the key thing is that you'll making sure that you're using and you take off properly at the end of the day. Yeah. It's definitely the the skin routine which I'm sure it definitely going to get into so. What do we stop? I mean to see big changes in Austin what kind of beauty regime we need and is it different for men and women? I think fundamentally, we just look at the gender differences to begin with. Essentially, the skin of men and women is the same. You know the layers of the same. But the one thing that you will notice is because men have Mohammed follicles on their face they tend to have more supported Collagen that protein that will give your skin it's support structure. So rather unwillingly, what it means is men tend to age better than women because they have more college to begin with in the skin could bomblet. Yes. Sir Combined with that. It's also regular shaving which explode aging the skin as well. So while skin types of similar men will age better, that's so unfair, I? mean. Not Offensive Courses Probably going to be listening to this as well. I hate but. You obviously is something we can account for what are the first obvious signs of aging. If. We look at what happens when the skin ages You've got the external changes that we see in terms of fine lines, wrinkles, pigmentation, and uneven skin tone and people start noticing these changes as early as probably the mid to late twenties if they've got very fast skin. The changes come a little bit later in Dhaka, skin types of skin of color. You'll start noticing that more probably around your your own thirty s to mid thirties because Daca skin is relatively protected because of Melanin. Dark pigment that gives us skin color. So. Interesting. Yeah. A lot of my friends that have gorgeous different shades and tones of cutted skin I mean yet ask looks it looks healthier as wow. A Lotta actually, it does come down to the fact that it's just more resilient to the effects of sunlight. So about eighty to ninety percent of the things that we associate with skin aging. So the lines, the wrinkles pigmentation changes occur directly because of ultraviolet light from the some at the more pigment you've got the more protection you effectively got against. Some light. So if you look at black skin, the average or some protection factor you've got because of the skin itself is about thirteen point full compared to white skin, which is about three point full narrowly I think that demonstrates the difference quite nicely it is a big percentage and it definitely does show. So would you say as well as being being? Agenda Difference. Then when it comes to beauty regime does not mean that people with dark colored skin should have a different beauty regime to people with light to cut skin. So this is a good question actually. So what I would say routine fundamentally needs to be the same but what you might notice is that you need to start it at different. Ages the second thing that I would say if you look at facial ageing skin of colored ages in a very different way too fast skin and what you'll notice with types is often it'll be around the is or the full head the opposed to the face where you'll notice the aging process begin. So full headlines or number eleven, lines, kind of. Get the screen lines around the eyes. But in dark skin that relatively protected from that upper face changing what you notice this changes in the mid face often black and Asian skin the skin starts to descend a hate the word. SAGGY. But you start to notice the lines between the nose and the mouth nasal labial folds much more early on. From a practical point of view what I noticed with my fat patients is they. Need treatments like book talks full they need Fila on the other hand if it's a skin color patient Republican in Phila- before they need. Botox. Seven GONNA get into feller talks in a minute because that's fascinating. I didn't think we treat people when we're looking at the media and we're looking at skin and beechy regimes it always does seem to be a one size fits all approach on advertising, and it's just the same in the nutrition world people, United Pedal Push Diet plans but actually it should be very bespoke and I'm sure I don't want to put words in your mouth but fuel line of work. It must be incredibly frustrating when you get this one-size-fits-all approach UC kinds, me think, oh, hang on Achy. This isn't taking your unique factors into account absolutely I think that's one that you know I feel very, very cautious about because sometimes you can get people that will come into clinic and they will say i. Want extremely doing. But when you look at face and you look at the balance in the home harmony and symmetry, they don't actually the treatment they think they do they need something else. So it's just about having that conversation about I think what's helpful describing what is going on in their individual face that is making their face potential, maybe tired or not as useless remember it and then. Working backwards. So I agreed arisen issue. The second thing I think is a lot of people will go to social media to find the best pass that treatments and before and after photos and one of my bugbears with that is if you've got a instagram page full of before ofter of finish, let's say it will hone in on the area that's been treated but what you don't. Know is what theirs looks looks like on the full face beforehand and afterwards. So it's very, very small bits of the face that we're seeing, and again you're not seeing the wider picture so I would advise caution against that. Yes I think social media has a lot to answer for in the beauty. Well, it does with every industry particularly with bt I think it can be extremely damaging. On lifestyle must be. Another factor because social media again is dangerous because you don't know what's going on behind the scenes. You know what somebody's doing do exercise regimes and appellation. They also have an impact or absolutely. So if we look firstly a pollution. What we both live in London we live in a city that we know is polluted, but you'll skin is basically it's a barrier. It's your your first line defensive keeping good things in a bad things. And pollution is going to be the biggest target fuel skin. So things like noxious oxide things like sort of tall only things that are released from car exhausts all the rest of it studies do show that when they interact with the skin, they can lead to premature skin aging. So what what will happen is a lot of pollution of air pollution in particular will create the generation of these. Harmful molecules known as free radicals and free radicals can directly damage the DNA fats, the lipids in our skin cells leading to signs of premature skin aging. So again, the fine lines, the the deep wrinkles potentially sagging of the skin as well as the uneven skin textual pigmentation. So using anti-oxidants, for example, in a skincare routine can be beneficial in basically neutralizing those free radicals that pollution will generate. Guys fascinating pollution we did we did a whole focus, accident pollution and. It's just tragic actually impact that it does have ivy. I'm even aware of my my newborn and going out with him in the sling instead of the prime for the impact, the females are going to have on his lungs lead learn how to even thought about his precious little skin is. What about the genetic side of things? That is that will say. Something to do with it yet big politics actually I think we all have at least that one friend that they can wash their face with soap and water or they. May Face this whole or they can fall asleep remake upon skin is still perfect. Six Do have much part to play. You know chances are if you have go first degree relatives, I e modeled ad that have aged well chances are you probably will as well on the other hand if you've gone offense relative that may have a skin condition, a chronic inflammatory skin condition acne or which can create readiness it does increase your likelihood of getting it as well. So whilst the all things we. Can Change like some of our lifestyle factors hey, the ethics on doubts about luck of the drool that's what why stuck way that we're working wit and some people are genetically blessed when it comes to their skin Nia it's so important to take a step back acknowledge what you have and try and work on other areas. Just I think acceptance is a big part of it as well. It must be infuriating to. Have a predisposition to things like you said, cartwright allergies exmoor or something in the skin the you've inherited. But if you look at the other things, what would you say the biggest livestock at people can change? Is it sleep? Would it be stress? I mean sleeps definitely a big one From, around two thousand dollars. So we've actually recognized that your your skin cells have got a biological rhythm or twenty four hour clock Kadian rhythm. So our skin cells all doing the same thing in the morning as they're doing in the evening, they showed patterns and variation, and whilst we sleep at nighttime, there is genuine truth in the fact that that is went off skin cells are repairing and regenerating. So you know having like the old night of a lack of sleep is not going to be an issue but chronic lack of sleep you. Know disturbance happens over a long period of time absolutely, your skin circadian rhythms will actually become disrupted as a result of that, and that can lead to issues with repair mechanisms regeneration of the skin. So you know where possible getting a good night's sleep is absolutely essential an-and stresses. The other big one how does one remove stress from Molten Day life? It's virtually impossible to do so but we do know that stress will activate whole such as coaches all that can lead to inflammation in the skin. So they can cause flare ups of things like acne. PSORIASIS So we recognize that as well. I'm removing stress though how does one do that? You've got to find a method that works A. Car. When he said sleep, I was sudden. Owner I am. Actually. Because I think I've slept one three to four hours in about two months in one guy because of the baby's. Parents pretty much have a time period them when the skin can suffer because I do notice it's it's definitely more dehydrated I think. Yeah. We'll. That's interesting actually because you know saying the skin has twenty s on Cole's often what you can not just increase water loss through consensus at nighttime if you're up for longer at night, it is possible you all just losing lots of water three, the skin. Trade. Is that something Moscow asked as well as a dermatologist, you must get nutritional questions short every industry get get sauce they sold things but they're all genuine links aren't that between food and your skin. There off and I'm always cautious in altering this. I think one of the things that has happened as people started to take such an interest in lifestyle nutrition is often this idea of a superfood for the skin is is soul to us. You know if you have a load of blueberries suddenly X. problem is going to get better and we both know that's not the case eating wealthier skin is eating well for your general health. If you're following a diet is good in vitamins and minerals in your fatty acids that's going to be good not just for your skin but for your heart and your lungs and your kidneys and every other parts of your body. So yes, there are. Key things. The skin needs to function. But I think that we were looking at kind of like healthy eating patterns over a long sustained period of time rather than eating a whole lot of freedom ago hoping that will fix a skin problem. I couldn't agree more. It's definitely overall dietary aspect to consider with everything I can't even begin to tell you how many times I had something Co. if you just eat lots of spinach than sunny, your muscles will get big oil have grow. It must be exactly the same skin while because I remember looking lots of research when I was at university, I was quite interested in skin. I think you I think everyone was ready as things. When you study to become a nutritionist, you think what can I do with my diet that's going to fix something that I have, and then you very quick. You learn the reality that actually you conflicts anything of one type of state but it wasn't of research with fatty acids and you just mentioned those as well. Do you want to delve a little bit into y things come? Alpha hydroxy acid a mentioned those sorts of things in the routine. Okay. So if we go back to a skincare routine, then I think. Really the backbone of a good skincare routine needs to be essentially a good sunscreen in the morning. A topical between a at night. Alpha hydroxy acids, which are really good chemically exfoliating skin. So your alpha hydroxy acids in skin cat off things like your cholic acid lactic acid, your mandelik acids. What they do is they remove the Agha of the OPPA layer of the skin. So your skin top land, the epidemic. And then it's GonNa lay the got the dumbest. Berry player. The epidemic is also got five layers within it on the very layer of the very top layer is known as the straaten cornea. And it's about fifteen to twenty layers of dead skin cells on what the alpha hydroxy acids will do is they will essentially remove part of that straaten quantum. So what that will do essentially is chemically expatriate result in a much brighter complexion of glowing complexion that everybody is looking for these days. It's also really good shifting pigmentation that sitting in the very top layer of skin. So that's the bonus of having an Alpha hydroxy acid in your skincare routine but again, surely, not everybody needs to be investing in adding that order. They in their routine well. I, think if we look at the absolute basics, everyone can benefit from sunscreen and everyone can benefit from Vitamin Manet or retinoids at night. What about those two nails than I think bringing in something like an Alpha hydroxy acid alongside anti-oxidants, Sierra? That kind of like the icing on the cake you know you're covering bases by using essentially those full categories of products right? A K. because that was something interesting when I was pregnant are told him you can't use these products because they contain retinoids in them. I didn't quite get to the bottom of exactly why perhaps you could explain why retinoids are meant to be used once you twenty. Israeli. Not for pregnant women or perhaps she our young people. So a retinoids or effectively vitamin A. Compounds, and Vitim in cream topical full is really One of those well studied skin carry gradients we've got we've got scientific age from the nineteen seventies that shows that retinoids will improve skin cell turnover. They will collagen production in the skin and bear mind you will lose one percent payer of your Collagen from your mid twenties onwards. and. Then they will do to help improve pigmentation as well. The thing weighed topical retinoids as they can potentially be toxic to a developing embryo or fetus. Now, whilst most of the studies come from the oral version because we don't do clinical trials in pregnant women, there are a handful of very small case reports that suggests that using. A, there is a theoretical risk of absorption through the skin. Into the bloodstream and the Wall Street pregnant your blood volume is increased. So the absorption risk is higher that it may cross the center and potentially cause harm to a developing baby. So that's the reason why we kind of blanket say retinoids naughty good idea orly. Weight in pregnancy or it's just not worth the risk I think, can you write the skin being an organ sings will be absorbed in the blood flow you carrying about fifty percent more fluid when you practice while it's it's such a huge difference in everything is. Extremely sensitive, you will hear a lot about job can be an e- especially for the skin as well. I mean recommend any products containing those to commence yet. So Vitamin E. is an antioxidant that's often why you find it in a little skin capulets. It also works very well alongside vitamin C in skin care, which is another anti-oxidants what I generally say with vitamin with the purpose of. It would be to reduce things like damage from pollution for example, It can also potentially mate you sunscreen work a little bit better because it will also help prevent damage from free radicals from ultraviolet light, the vitamin ease oily at room temperature. So it's one of those ingredients that I would say, yes, there is use in using it in an antioxidant serum bats I would only use. E, as an antioxidant in people that have got dry very dry may be sensitive. All mature. Puzzle Skin. My antioxidant of choice for somebody with normal combination always would actually be intimacy because my concern would be that vitamin E. could block your pores and create spots. That's where I would kind of differentiate the two but both Britain and Many topically can be very, very helpful as anti-oxidants at Fascinating Andrea that this is why people need to see an expert like yourself than just reading in I magazines on social media just get lots of skin products with vitamin E. IN IT. That's right I. Don't think which many is for everyone a show and then bitten in common b. you'll find skin-care is nice in my and Nice and allied is another multipurpose ingredients and it's very good at reducing the parents of size it can reduce oil production. It can also function as an antioxidant and it's quite good also improving pigmentation. So that's another one I would. Say if you wanted to add into your routine, you could but I still would say your basics, August sunscreen your vitamin A. if you are able to use it, your alpha, hydroxy acid in your antioxidant on the things that you're not seeing light. I, think they come in a little bit later on a everybody is making nights if you're listening right now because I know I am. And to make sure I've definitely got my skin routine niles. Now let's move onto moisturizer because. They say use it day and night. Yes. So not everybody needs a Lotta moisturizer morning and evening everywhere. So a lot of this does come down to your own individual skin tight. But if we look at Worcester is in general moisturizes usually are they made three categories ingredients. So you've got things like a clue sips. So things like Petra, l'ensemble Monroe loyal and the way that they work. Is You smear the moisturizer on your skin and they form a protective barrier. So they prevent water loss from the skin surface. Then you've got a second group of moisturizing agents, cold emoluments, and what they essentially do is they fill in the cracks between the skin cells to create a smoother appearance of the skin, and then you'll third group is your humectant. So things like hotter on a acid. What they do is they bind water from the deep layers of the skin plumping skin up. Now, most moisturizers will contain a combination of humectants and millions and declare saves but depending on your skin tight, you might want to choose a moisturizer depending on which one is the predominant one. So if your skin is very, very dry or your Xm approach, you want to go for something that's very high in clue saves on the other hand if you've. Got Very oily skin. You're better off leaving the exclusives alone. 'cause they going to block your pause and you WanNa go something like a humectant like a Halawani gasset based when instead so a lot of actually is is recognizing that not always driza created equal. It is about your own individual skins needs because you know for me I'm naturally already skinned I don't wish your is twice a day but I went to your friends at the other extreme moisturizing a few times a day and then layering a moisturizing ceremony moisturizer this can feels dry tight. So you know I think a lot of is you know urine skinned people know what skin is like in terms of how oily will have drier tight feels after cleansing and those sorts of things you need to take into account and is it quite easy to decipher on different products? MOISTURIZER, how do people know the best thing when you're looking at any skin kept remarks is to look at essentially the top four or five things on the list because the way to skin kept product packaging is put together is it's listed in order of descending concentration. So most skin kept products. The first three to five items are what make up the bulk of that item. So if your looking for, for example, I was I'm only skinned on looking for a moisturizer I wouldn't want to see Petra awesome is one of the top three ingredients that would not be good for my skin. On. The other hand if your skin is quite dry but your Acne prone or anything like that than things like glycerine, for example, could be very useful to have a little bit of it actually is familiarizing yourself with some common skin carry gradients off you start doing it for a while. You know if you go to your your bathroom or you go to your skin care products and just look at the top five names, you'll find a lot of the same stuff keeps coming up over and over again. If that's too complicated. The simplest way to do it is look at the actual texture or the full massive the product if you've got a thick greasy creamy product chances are hiring exclusives but if it goes alight Matt Gel, light texture, it probably is much higher humectants. So that's the other way to do it. It's interesting. The chemicals feel the product feel the texture. Dry You want creamy. If you're not dry, you could go something like Jello Sarah. Thank you. That's think that's so useful because, yeah. A lot of the long and long words that the different Easter language names they can be quite intimidating I think if you don't know where to start and what you're looking for. If we look at makeup as well because different make-up's have different bases made with, is it mineral foundation? No there's different types of things to how do we decide for anti can't route because it's so much I want to ask one thing I would say as a general rule award, these generalizations I making but mineral makeup can be really good for people that have sensitive skin at. So if you'll get banning all tangling when you apply products and you know somewhere between thirty to forty percents, women do. Say Skin sensitive mineral makeup can be really helpful. The other place woman make can be really helpful is if you go underlying chronic inflammatory skin condition like Roseanne show psoriasis erect small because the mineral was a fairly announced that less likely to close aggravation with your skin flare up your skin. So that's where I would say the role of mineral makeup his the as a general rule I might make up these days get. It gets a little bit of a bad kind of like if you make will give you skulls. Comes from like years and years ago like most makeup was really heavy oil-based stage makeup that that's not how we use makeup Ni- like the technologies of moved on so much since then that the majority of products that you use a unlikely to cause issues with your skin. A key thing again though is again, look the textures, the formats if you will. You probably don't WanNa go for something that's really creamy in nature on the you want to go for a modified product instead on the other hand if your skin is dry, you probably want to go for those slightly thicker bases because it will probably add hydration to your skin but the key thing would make up in general is wearing it is not a problem, but it's making sure that you remove it adequately and this is why the nighttime cleanses. So important because if you think about it in the morning, you've probably wash your face. You probably apply to moisturizer ideally sunscreen and then you put your makeup top that's fool as that you've got there. You're on the day. You'll skin is coming into contact with sweat grime pollution alongside the fact that you stuck all these layers onto your skin. So I do think that you're wearing will these lay as during the day it is imported that you'll double cleansing at night to make sure that you have removed everything thoroughly before you go to bed. So I tend to say to people you know if you're wearing makeup and sunscreen step one US something like my Selah Water with a cotton pad wipe all of that way, and then for your second plans use either a cream cleanser reframing, cleanse it depending on your preference to make sure that anything residual has also been washed away on any go to clean base for your nighttime routine to stunt. Yes it's it must be so. So important to ensure that you're getting that correct and for people that don't know my Sata watered you style out why would it is and why we use it we asked my civil war to basically it's another form of cleansing really and and the water itself as weeks it's water-based product. It contains these products call myself, which are really good attaching themselves to things like sweat makeup, he and breaking them down on the role so quite. They come in lots of different types of them sensitive skin, oily skin that they were very quick convenient way of doing that I cleanse. I mean you know some people may prefer to wash face twice and there's nothing wrong with that. But you know passing the I find myself if you make what questions makeup during the day I find, it's good way remove my makeup fast art my favorite one of my favorite times of the. Day is just removing anything that's been on my face. You'll right it was the stage makeup because I remember being a teenager I'm fast investing in a Mac lipstick or something ideas from from singing product before nutritionist, and it was so heavy. It was so heavy King off was a nightmare remember I would still wake up no matter how many times I wash my face and I would I would find bits of orange kind of. Cheeks. I think it's just important that we all take a note that you've mentioned as well that sunscreen isn't you said, apply the sunscreen off to the MOISTURIZER. So Walt Suntan Lotion, would you say what factor is a minimum throughout the should we be using? So ideally, you're looking for what I would say a broad spectrum sunscreen. So by that, I mean sunscreen office UBA and UV protection. It should ideally be I would say probably a factor thirty to fifty and the reason. I say that is because most of us grossly under apply sunscreen when clinical trials carried out to measure, the effectiveness will SPF fancher with sunscreen the replied the thickness of two milligrams a to squad. What we do in real life though is we tend to use more like point seven, five, two point, eight milligrams per cent to me to squares because of under up location. So what that means is that fact thirty that you think you're putting on, it's probably more like a factor nineteen. So it's best to go for a higher factor and alive for the fact that you probably haven't used enough of it and what you're looking to use the half a teaspoon to the face neck. Because I think a lot of people just run on the SPF that they find in that foundation whereas I think as you've described said the surface area that you would need tach have actual selection as well. Absolutely and I think the second thing you said there's quite interesting about SPF foundational. MOISTURIZERS. The thing is that SPF, is only a marker of ultraviolet B protection from sunlight. But. Uv a the other ray is also damaging to the skin if anything that's the raid causes skin aging. So if you've got a moisturizer with an SPF thirty that tells you be, but it tells you nothing about TV protection or whether there is any a tool. For that reason, it's much better to go for separate sunscreen. The second reason is because of the amount you would need to hit a factor thirty. In actual fact, you will probably never use that much product of moisturizer will foundation on your face. So you got thirty again that you think you'll get police nowhere near efficiency. So it is better to just use that separate sunscreen alongside your moisturizer. Yeah. I think. So many people myself included until I. Met you Angeles He. Seemed that the weather in the UK is in good enough. I'm sure it's fine if I just use the foundation. Yeah what you know at hope you'll listen do not was well, exactly even on a cloudy day you still get rays of sun going through the face. It's it's so interesting. It could prevent the damaging in the aging and that's something that I think prevention perhaps from speaking with the starts to gather is useful sometimes than putting something on. True because I think one of the problems as once the signs of age have developed. If they bother you you all looking at more expensive treatments than which not everybody has access to everybody can afford to try and reverse those changes. So it's always better to make sure you're you're taking the steps to reduce. You can rather than do nothing then hit a certain age go oh my goodness like I feel like of Asia Law in the past five years or six years and then pretense really all interventional treatments can be quite costly. Yes and what not may kvant marketed anti aging products for instance, 'cause act that quite expensive. Yeah. So skin care I think we need to be really clear about we'll scan can an conde and? Essentially, the beauty industry is that sell to us. It is selling hope in a hole, and in actual fact, you know when we look at facial ageing, for example, the skin aging only a of it, it's not just the skin is changing, but the facial skeleton is remodeling the fat. The subcutaneous tissue underneath the skin is also changing, and there's no amount of slapping a cream on the skin surface that can actually alter the way that your bone and you'll skeleton has changed the fat underneath. Your skin has changed so I think it's it's very easy to kind of get sucked into this idea of if I buy X. Cream with X. Price Tag it will get rid of my four headlines or get rid my skin sagging. It's actually very difficult for cranes to do that because you have to look at all of the layers of what's going on in the face before you can make that decision on my skin cadillac penetrate beyond the upper layer of the player now I remember going. We were giving a lecture together an accident. Remember what event it will remember on your slides when I was watching your presentation. Seeing the actual structure of the skeleton than the large muscles on Taupin seeing as we age now a how they begin to fool. And, it was quite shocking actually, and you also went into the difference between surgery Should we be turning to surgery I'm what kind of non surgical treatments? Right, could you go into a few of those? Are ultra therapy chemical. Yeah. Okay. So let's start with L. Therapy at she therapies actually one of my favorite treatments and it's one that had been having every year for the past three or four years now ever been amazing. So this this is GonNa be my new one. Walker as but I will tell you to die inside the as well. So our therapy is high intensity frequency ultrasound and the purpose of it east to tighten the skin of the neck and the joy line Anglo face. and. It works essentially by using an ultrasound device to look at the different layers of the skin. So you know exactly layer in and then firing sort of a high intensity waves three to skin feels quite halted the time when it's taking place. Through the skin surface to essentially create an injury in the deeper layers, and that injury creates wound healing response in the skin which promotes Collagen and it promotes tightening of that low apostle face. The treatment itself I think it's a good treatment provided. You selects the right passing for it. So it's the kind of thing where by the time you're in your Late fifties or sixties if the skin is become quite lax around your line, it's probably not going to be much good. But if you'll say in your late thirties on what's it's probably a good time to start doing it because there hasn't been that much dissented that stage that you can create a little bit of visible tightening. Now, the treatment itself does actually take an hour to two hours and it is painful. I will not make any cut allies about that. It's an uncomfortable treatment to have when I have it done. I have local anesthetic cream applied to my lower neck and my lower face I take to paracetamol I take to coding as to your. Fan. Am I still feel discomfort. So it some not for the faint hearted is. Say always seems to be the things that the mice defective or a little bit more difficult to to go through that does sound painful. The chemical peels they seem a common than than the old therapy. Chemical peels will have a different pappas. So therapies specifically the skin tightening and reducing laxity chemical pales on the other hand I actually just for improving skin tone as texture and pigmentation. So when you look at chemical peels, lots of different types of pills that you can have but. Law She broken down into very superficial pills, superficial pills. Medium and deep peels, and the very superficial pills will remove the strategy neom that very top layer of the top layer. So chemical peels like cholic acid, lactic, acid, Mandelik, acid you go in you have the stuff painted on your face. It's left on for a couple of minutes on that it's removed your skin will probably be bright red off to the treatments that Retina settles down. But then over the next few days, you get a little bit of. Mile peeling shedding is the old skin kinda comes away. The new skin comes three that the downtime is pretty low with those and then the superficial heels will remove most of the epidemic. So that top layer a medium depth peel would remove the academics at a small part of the Democrats, the layer below. So deep astill. So with each one, that's Deepa there is more recovery time and dying time, but it's also more effective. So that's the tradeoff basically. Appeals, and we don't tend to do a loss of days anymore but medium pills and superficial heels can be very, very good photographer saying fine lines pigmentation post inflammatory hyper pigmentation. So stating that you get into skin off the acne or any injury or shifting not as well. So then will good for general skin texture untied rather than tightening I see your case you've got texture and tone tightening. I'm for somebody out that you said those lucky people that get no problems with skin would you say even people on that would benefit from having something like a pill. Interesting questions I would say is if you have great skin and you're just looking for something else you can do just in terms of maintenance than very superficial chemical peels can be of benefit because it's an accelerated form chemical expropriation. Basically, you know you'll removing those dead skin cells you've brighten new skin coming through. So so yes, it's something that can be done. The only thing I would have yet that with is that you'll skin cells do turnover every twenty eight days also your skin cyclists roughly once a month. So to get the most benefit, you do have to then repeat the treatments monthly. Is a tree as a one that we looked great. But if you wanted to maintain the results, you would have to maintain the treatments as well. It's like Pandora Boxx You peninsula have to. You have to gathering before you know what you try. Everything 'cause I was also a lot of questions. Nice, I wanted to ask on this podcast abound. Laser treatments might Karni link is again you should social media earlier and a load of influences now using and filming them going through these treatments. Yeah. He's taken in some ways. It's demystify the treatments, which is why it's created such an increased appetite Palette for these sorts of things because people alike. Michael. Is that what involves? That's that's terrible. That's not so bad I could do that. You can see how it's driving interest. That micro needling and can be really effective treatment actually for people that have got good skin to begin with and just want to help trump on volumizes skin keeping looking again texture wise in in good nick because the way that micro needling works is essentially it's device that you use. It's got lots and lots of little needles in it. You come into the clinic, we apply local anesthetic cream, t the skin to numb it. That cream is removed in about says, she minutes will say, and then this pen is run buckle or device run back and forth makes lots of lots of little holes or micro injuries to the skin sophists. An each one of these micro injuries generates that wound healing response and will create more collagen overtime. Micro needling can also be really good for very, very superficial acne scarring. It can be helpful for some model stretch marks as well. There's a number of areas where Mike needling can be benefit. And then laser is the next step is looks lots of different types of laser unlike devices depending on what you're trying to do in general times laser can be used the anti-ageing it can be used for pigmentation, it can be used to get rid of acne scars. So we've got lots of functions and purposes, but generally, laser is more effective than micro needling. So interesting you see a lot of people going in and having these laser treatments. Now on an injectable something, we have to watch him because. It's the most common thing. That I think everybody will have heard of an effect I see political a big nationwide store that were appetizing doing Bo talks in store. What are your thoughts on that yet drug actually and I think my concern with that remains that where we're dumbing down the fact, these are still medical treatments and things can go wrong and Wall Street is often don't go wrong. The most important thing is you need to know what you're GonNa do something does I think by doing things like injectables in an environment that is not necessarily a clinical setting a medical setting, you run the risk trivializing the procedure. I think that's a problem because you won't people to go into it. Being fully aware that you know for example, with talks one hundred people you can create bribe drop so they'll have a lopsided eyebrows that's possible with fillers. If you have fellas around the I, their cases of blindness, we recognize that. So I think that these are medical treatments that should be carried out in a medical setting. For migrants of the. It will miss normalizes it too much to only have an underlying subliminal message that. Everybody should be doing it. Everyone should be doing it. It's a bit like buying ahead I like buying toothpaste. Votes as well and it's it's it's not the same thing. I know exactly. So I, I would like to reiterate to everybody listening that it's not a simple procedure. Is it another pun doors bulks, but once you start, you have to keep going. I didn't think so I think it can be a slippery slope depending on your own personality type is what I would say. People. All interested in Inbet- oaks and Angeles and undergo two separate. Pepsi's folks generally would use for treating muscular lines. Abo- talks is good for particularly full headlines. It's good for lines around the eye. It's good for the number eleven's filler on the other hand. The purpose of that more is to treat kind of saggy angle gravitational effects that you'll need to sing. So as we get older, we start to get slightly less fat off as and things do start to descend. So you get prominent lines between the nose and the mouth prominent line sort of Jialing as well as the other word I hate that word. Is injected underneath the skin with a needle to plump up the areas where volume in the skin has been lost and you know in terms of the treatments themselves I think I have a lot of people that will be like, Oh, I've got really important events. I've got my sister's wedding next year I. Really Want to make sure that my skin is looking great and I'm doing all of these things and then they go away they have the treatment done. You didn't see them for a long time because I quite happy with what they had done on the cave with it. And then you've got another group of people that they absolutely love the results and then they're like, oh, my God, it's worn off I. Don't feel like I look a because it's will off and then they will be the people that will be back fatty frequently to have the treatment stung. So we're both talks it whereas on average roughly about every three months. So I think it's a mixed bag I think it depends on what penalty I mean on fool. Now, I've been having talks intermittently since I. was about thirty, six, thirty, seven, I'm quite intimate with it. Do It let once a year or twice a year? Don't feel the need to it regularly. But equally, if you don't do it regularly, the effects of it will wear off. Yes. I. Think that's the most interesting fact about two is getting the balance between how frequently you should be getting. Oh, spacing it out. So it's quite refreshing to actually hear your point of view on that Steffi's something I would be open to considering I think come. It was very scary. There was a time when all of these treatments seemed absolutely terrifying. But now because of qualified experts like yourself and people that are trained and we seem to have more research, it don't seem to be more accessible. One thing before we went questions from listeners is lip figures that I wanted to ask you about because I think I, hear about people go popping to the dentist to get them done. Yes. Sir, I mean it's interesting. So are not prescription medications are seen as medical devices. So you don't have to be a doctor or dermatologist or plastic surgeon to inject lit Fila. So, dentists and giants nurses will inject and I think as long as you're a medical professional, it's probably fine because the bottom line is you know if you think about dentists, they have studied the head and neck inactivity in pretty great detail to be able to Toronto. So I would have no concerns about identity stimulants. But my biggest concern and I think generally, not just me. But in the aesthetics industries hold big concern is beauticians without any medical degree or medical training. That's her injecting because things come to roll with lip seller as well I think it needs to be seen as a medical procedure that is done by a medical professional. Yes. I couldn't agree more agitated Cya much I want to ask you I have eighty skimmed the surface of old questions that are out there. But I have to take those ones from our listeners in Haley is actually mentioned a good point we should've touched. She said that like you and I underline she works central London is worried about the Appalachians won't specifically can she do to help with it? What product perhaps could you m set of finding one this? What should she be putting on? Yes. So in generic terms, I would say here is pollution causes damage fight free radicals. So using oxidants to mop-up these free radicals is absolutely king. So from a skin point of view if your skin is combination or if it's really that I would go through a vitamin C serum. But on the other hand, if your skin is very dry, very sensitive gopher business east serum and what I would do is I would cleanse I would use your antioxidant serum moisturizer on that I would sunscreen in that order are k. that we I thank highly hype you retinal that one down. Fara has ost. I'm thinking about getting nonsurgical treatments but not sure. What credentials desalegn should have before I commit? That's a very good question. It is and it's such a tricky to onsite as well because there was so much debate in the industry at the moment is wild about who should be doing, Wilson who is qualified to do What I would say is there are lots of people in the UK do inject and cannon jet. A good starting point would be looking at one of the organizations or voluntary registers. So if for example, they are a consultant damato largest or plastic surgeon. So in that case, they would be a member of the British cosmetic dermatology group or the Plastic Surgery Groups are BOPs be aps in back press saying that this other than that they're all voluntary registers like say face unbearable have list of people that are accredited but I think as a general rule, you probably won't to take a little bit of recommendation mice. You probably want to do a little bit of your own research and you probably also. Think these days you WanNa make sure passengers treating you is the right pass for you because lots of people were able to do treatments. But what you WANNA make sure is do they engage with you in the right way the past that you trust that you feel comfortable with because it's really nerve wracking having these treatments done for the first time. If you don't know what to expect across, I can be terrifying I. Think can the outcome talking about your face in your skin and? You definitely want to get that rural. Has said this is something a lot of people want to know especially while women in particular that my period plays half of my skin's hormones. Is that any hopes me at that time of mums. It's really tricky. So first, I would say that about fifty percents of women up well up to fifty percent of women can get hormonal flags of acne in particular in the second, half their cycle, the run up to their period. So it's a surprisingly common thing. The thing is I've seen I've seen lots of like articles people suggest Oh you know all that means is you should really up the ante in your skincare and your skincare routine installed using we'll acids in the second half of your cycle to kind of compensate for that. The thing is because your skin cycle as every kind of twenty eight days also often the spot that's filming coming to a head around the time of your period it probably started in the early apostle cycle. So it's very hard to get your skin care to fit with your cycles from a logical point of view. What can you do I? Mean I, think that they're skin ingredients that you can be consistent with in your routine particularly if you all to break outs and those skin care ingredients would include things like Benza, peroxide salicylic acid, tea tree oil, Nice cinema all of those can be quite helpful. So you haven't incorporated those ingredients into your routine. You should probably look for cleanses China's moisturizers that contain them. Very very good advice. Thank you and Lisa, that does this onto the fact or fiction round. Are you ready? Ready. Okay. So if you could hunts a fact of fiction to the following. K. Expensive products are better than cheaper. That is absolute fiction. Brilliant sleeping in your makeup is totally fine. I. Also twice, totally fine doing it. All the time is very bad. So I'm going to go with fiction only because I don't think most people would never take maker pull over long periods of time. Okay. Well, onset heart showers a good feel skin. I would say, probably fiction the hotter the shower the more likely is to create irritation to the skin, but also promote water losses well and dry your skin out. So lukewarm to. Make up with SPF is the same as Santa Nation. So that's fiction. That one chocolate if linked with acne. The New Orleans is this one. I get a go with fiction I don't get a caveat which there is some emerging data in some groups of people or people susceptible that potentially sugar and dairy may aggravate your skin, but that is not the case for everybody. So cutting out chocolate is not going to be the solution to treating acne. Can cut out chocolate as well a tough one and having a base Tan is like an SPF No so that I is fiction by the time your skin, his tanned that Tan is a sign of DNA damage to Karatina sites. You'll skin cells so based on is bad. Facial expressions can reduce wrinkles. That's fiction the more expressive you all the chances are more likely gigs getting lines I know I'm pretty deemed I'm. On my face. Skin color doesn't impact the skincare products you should buy. That's. Fiction. that can be a difference bots. Own A lot. That's a very tricky went to do again with Nuance I. Actually. I'm going to say it's fiction because I think that you do need to be careful with certain issues in Dhaka skins is like two skins. However, most skincare products you buy over the counter that you would just patches. They have been taste tested too high regulatory standards so they should be fine. It's only if you're not using the way that you're supposed to do or if you're using prescription agents, you need to be careful. Brilliant. Daily exfoliating keeps your skin young. Fiction exploitation good feel skin but you don't need to be doing it every day it does depend on your skin type or you skins can probably get away with it every day but dry sensitive skins, you don't need to be exciting every day. And having no skincare regime will accelerate aging. Average person that is fact yes because we do know that ninety percent of skin aging is because of the sun on if you're not protecting yourself from the sun, your skin will age maturity. And today that was one of the nicest informative and fast fact or fiction around we have done. Own. Thank you so much that does unfortunately wrap-up the EPA site, but we will finish Rossi today and I think I. Just liked stop by just saying that it's so clear from Tolkien to you again. In more depth this time that there is no miracle product that can transform your skin is just too easy to be BA laden in by by social media ran and these amazing claims and before and after but it really may be does come down to a simple routine one thing that really stuck with me from what you said today. Is the those people out that have the perfect skin or different colored skin that we have to embrace the world unique. But we can you know we can eat while we can try images stress do best on life ready to make a little bit of an impact, but it's being realistic if you could leave our listeners with a take home message honestly, what would that be? I would say probably consistency over a long period of time with skincare routine don't chop and change. The temptation is using for a week throwing it out and it didn't work. You do need to be consistent with the old your skin kept patterns in routines, and at least try something for about six to twelve weeks before you suck it off. Yet definitely, and I would also say to everybody listing Angelilli has an incredible book with the skincare capable, which is literally a Bible and I would highly recommend having look at that if you want to learn more about what to do if your skin because a lot of what Ashley said stays down in the book if people wanted to find out more, we can make. Oh Okay so I'm on Instagram at Angie Mall turn at I'm practicing at fifty five Hong Street. and. I have been to see I had a Motech which was fascinating. Something I've always wanted to do and I saw a friend visit you alice and I think that's something I should have mentioned on St episode but if anybody needs any more information, check that out Anthony thank you so much for coming on. I'll thank you for having me. If you enjoyed this episode Yoga into absolutely love what's coming next week. So make sure you click subscribe to be the first to hair it and please do if you have the time leave a five star review it does help this poll conce get out there we want to be able to reach more people help more people and maybe even perhaps we tire highs in the charts for more information about my retrenching clinic books, healthy recipes, events, retreats, onslaught much more please visit rechristened dot com, and you can always follow me at rechristened on instagram twitter faith and Youtube.

oily skin UK London Ali Daca Austin Dhaka Angelie Marta Lambert PSORIASIS Petra Toronto
The Ketogenic Lifestyle Part 2

Strong By Design Podcast

47:22 min | 2 years ago

The Ketogenic Lifestyle Part 2

"Here, everyone has their Goto spots. You know whether it's a once-a-week thing or certain foods that they're picking up at the grocery store knows their staple food items. Yup, and eating leftovers or whatever else. But yes, so we all kind of function that same way. We believe that you are strong by design and you were made in God's image to have a strong body mind and spirit. Hi, my name is Chris Wilson, and you're listening to the number one strengthen health authority, podcasts in the world. So let's get ready to unlock your potential and transform your life with today's expert. Hey, if you want the free seven worst testosterone killers report then just text test. Oh two, three, four, five, three, four, five that's test. Oh, t. e. s. t. o. two three, four, five, three, four, five. And you'll get a text from me asking for your Email, then you'll get the free report sent to your Email inbox. And if you're not in the US or Canada than you can grab the free report at critical bench dot com forward slash bonus dash video. Let's dive in. So he has excellent, which I actually deal with like some psoriasis and stuff. And I know a lot of that has a lot to do with I mean, immunity and stuff, but probably has a lot to do with our diet and more more than we, we know, I will say that nothing. I've never been so sure of the power of what your diet can do for your health than I have now. I mean, I see it so much like I just saw today a really good friend of ours. A are d, she's a dietitian and we if I can get everybody to follow her, you know? Absolutely. Because she just sees so smart. She had a patient, a IBS, patient colitis type nasty stuff. And she's like showing the labs before and after a few months of like changing the diet and a few supplements now Noam unisom presses they're going to just knock you out and not. You'd have no immune system. It's like, okay, you know what? You're immune system's overreacting, lettuce. That's just turn off your immune system. That's that's that's medicine today. Like you look at the symptom and you're like, okay, here's a symptom we're gonna treat it, but forget about everything else that happened. All the other cats. Yes, that's there. Yeah. So so with the boys, like we left them with our family and you know, nothing against our family actually, they know because we've told them, like, if you, if you try to feed my kids crap, you're not gonna see my kids to simply and simple. I won't take them to your house, but like they didn't even have that much. They had like some crackers and some cookies, lots of wheat, lots of gluten and the comeback, and doesn't gets really bad nose bleeds like like gushing nosebleeds like, and this is after like a couple of days. Yeah, just a couple of like three days. And so we come back and they're both like just wrecked, and I had already been carnivore my wife on that same triples when she decided to go carnival, which is she was having. So she was trying to cut up. And so what she would do is try to like incorporate much more salads and stuff to get that volume and she'll get these nasty, nasty, bloating, gut issues, and just all the stuff. And she was like, she wake up in the middle of the night to vomit like she did it like several times to. Like I would wake up and how come and see her like she's bombing. I'm like, what the heck? And so she's like, you know what? And I started telling her about all the stuff like the doctors that I was following that were advocating for this, you know, eating meat, this crazy like, how is it that everything that my wife do and I do is so absurd. Like we're just like these crazy libertarian homeschooling, you know, like Mauer were Kito. That's not crazy enough. Let's go carnivore. Fill out tiger. Just so out there and, and so she decides to cut the veggies, just that weekend. And so we're just eating burgers and steaks and seafood. And she uses like three pounds and she feels amazing. And so we come back and the boys are wrecked. You know, like my my dean is all broken out with with exit, and then Dez is like bleeding. And so I'm known for in the Keough community for doing like these self experimentation things. So my wife is like, hey, Desmond, would you want to do like a three day on me experiment? And he's all for not only is how all the displaced. Seven. So he's all in all. Desmond is like he's an angel man, and he's like, he has. I have to be careful him because he wants to please. So you gotta like comb through like words, real real, you know. But you know, sometimes it helps. So him and dean, both. They were just eating meat for three days and they both. They both did awesome. And then like we were like, well, d- wanna you wanna keep doing this. We could keep doing Kito. And so we transitioned the boys to Kito and like the main thing that you gotta do. It's very simple. It's not. It's not about restricting is you get the crap out of the house. And if you're in a public place, the way we do anything with the boys, if they want to buy themselves something they gotta make some money. You know, like I, I went through that first meltdown at three years old at DisneyWorld when Desmond realized that at the end of every ride was a gift shop and we're not going to buy gifts. We're just not about stuff done right, rather do and experiences and traveling, you know, I don't wanna raise all this crap. That becomes forgotten three days anyway, and you get all care about that. They're not going to end they have so many options at the. They don't even play with them. Yeah, and they don't have they don't. It's like, here's another toy thorn in the pilot. So he he had a meltdown at three at the part, and we just sat on the bench and I know it sucks. You don't. You're not going to get that. And you know what? Let's find a way that this never happens again. And that was when he started working for stuff. And like for instance, he started a dream catcher company may like two hundred bucks selling dream catches that. He would take sticks from like the YMCA or go to YMCA and he would make these drink paint them and send them to people. And so when we're out if they wanna buy themselves junk, they can what ends up happening is they don't, you know. And we also would do like give them some autonomy. So we would say, okay, here we did it with Desmond. 'cause dean was really young, Desmond started, you know? So we would say, here's ten bucks spending, however you want. So Desmond. And you know, you would think he's gonna look for the candy aisle and he didn't, you know, he would buy some Hubei some interesting things like he would buy some fruit. He would buy like some chocolate bar like a like a dark chocolate bar or something. He buys one time. He bought fear. You didn't even know what you fear was fear. He loved it. And so like I think that some things happen when you give a kid autonomy, he give them some power. They feel like the responsive share share. We're gonna make a good choice and they feel like you trust your trusting their judgment. Yes, I better not get this wrong because maybe it'll get taken away. And so like it's like I want to enjoy myself, but maybe I don't. Maybe maybe I don't go nuts, you know. And so that's kind of how we do everything with them. Like we don't have. It's weird. We don't have bedtime in our house, but it's because we don't if they went to school and had to be up at a certain time and then we would. But since we are kind of like we home school. Yeah, so we don't have bad times. That's one example of like how that whole philosophy. He works and think about it, no bedtime. When they go to bed, they go to sleep. They, they self-regulate some nights very rarely if ever they stay up later. You know, we also go to bed super early. So we go to bed like at nine thirty at night night, you know? 'cause I'm before my wife tries to get up like around five to do devotional with me in the morning. Sometimes it works sometimes you know, because he's different in the morning. I'm like a morning person, but you know, they're just kinda like they like us. You know, sometimes we stay up late, you know, and they'll do that too. But very rarely said, it's been interesting to see like how that freedom works out in the real world, but it's worked out what, like you said, you're not. You're really not you and your wife obviously have chosen this path and they, but you've allowed your kids to pretty much Jews themselves. So we had lots of conversations. Yeah. They know we, you know, what do you think that's going to do? Like Desmond's like so Desmond had, here's an example to like five months ago, we were in Miami as we grew up and and there was a birthday party and doesn't have the pizza and the con- candy when you eat well, all the time stuff, tears you, I news going to happen. Man, like thirty minutes lady later was double door and he was crying and I was like the phones. Pictures of it, and I just was like. I just for later to show him. And so he's like, I wish I'd never aided. I wish enter AL's like, no, no, no, no. Don't say that. Remember this, remember this and just remember help it. 'cause I always tell my son, winners, don't lose. They learn, you know. So you learn from this in think about that next time you wanna eat the pizza, like the cheese off, don't eat the bread on the pizza. The cotton candy is garbage. Don't ever eat the just just, yeah, I always you can literally piercers way. Yeah, four bites of in the rest of it's just thrown garbage. And you know, people say people say they're just kids let them live, right? So that's there's these. Are I two that I hear let them live, which to me two things with that number one, they're not gonna live. Well, if the feel like crap. Okay. And number two, they're gonna resent me when they're older if they knew that I knew better and I wasn't trying to immune Saddam guidelines and trying to house aptly. And so the other thing that you'll hear is like, well, let them live once in a while and we. Totally do we totally that, but see once in a while thing, if you're really doing it once in a while, so like you know. Mike every other day? Exactly. Like these kids are getting treats every single day. You know, like the food that they're eating is pure sugar. And so like for them Holloway, lean eat all the candy. So we try to, we offer to buy the candy Desmond actually. So he made like twenty five bucks selling us the candy and then dean he. So he sold you guys back. He's handy. So mom and dad, that's a good little business. Good one, right. Well, the first thing he did was we ran out of candy this year, and he started giving his candy out to kids at the dog. And so he had a bunch left and we bought it at twenty five bucks the younger one dean. That's another one. We've got that on video mount as my wife's filming him and he's taking these. He's been out for like from August October's. It's been like two months ready, and he's like trying it taking her by spitting trying t- like all of them. He's wanting something, but it's not happening is now working in pal is agreeing. Yeah, he just in with dean like we're much more lenient with him, but still he doesn't eat, you know, like if he wants, he's we'll get him, we'll make them you. That's the thing with kiddos kiddos like you can do everything. Yeah, there's recipes. They're, it's not convenient. You gotta make make it? Yeah. And that's what my wife she, she went. Full out Kito begin earlier this year she was dedicated and she saw great results and she felt good to on it. And she wants to. I mean, we still implement elements of of what she was doing then, but she would like to go back to what she was doing where both cooking on Sundays making a bunch of stuff that could be her go to for the whole week. Oh yeah. And and I was getting the benefit to because he would encourage me to eat some of what she had made. So I was getting some Keno diet infused into my, you know, my my regular diet. So when it comes to cruciferous vegetables? Yeah, we're, are you there? Are you? Are you eating any of those? See I when I, when I first because there are there super low carb. Yeah. Yeah, they're super carbon. And from Keitel standpoint, you'll see a bunch of Kito people doing the cruciferous veggies. Right? I personally like from. Okay. So for me, it's like a cost-benefit. Right. So what are the possible benefits? Micronutrients fiber, right. Those are the main thing. Maybe I oxidants. Right, right. And then I start to think about, and I was always like when I went, oh, that was another thing that I was like really priding myself on trying to hit all my basis trying to get all those things in and making improving my health all the way around. You know, because you can. You can go Kito and eat the hotdogs without buns and burgers. You give me a bunch of weight, right? Optimistic crap. Kito. Yeah, like junk pet sounds like almost like a karate crap. Keadilan. Tito. Yes, that's like, so that's obviously over trying to. Yeah, and I'm very much really have a big focus now, especially recently on real food Kito let's do real quality. Let's let's have the same mentality that we had with paleo with the quality of food. What happens with Kito sometimes is that people get so focused on lowering the carbs that they forget that they're like consuming, like five thousand sugar alcohols and having raven much fiber, they're killing their gut. The destroying their gut, you know, like the the poops and they got, you know. And so the reason why we don't really do the vegetables will do low sugar fruit. So I let me start with meet meet the reason why meat is like the very pretty complete when it comes to stuff. There's a few things by him and see which the USDA basically didn't even measure the vitamin c. me they just assumed zero. So they put it at zero. Right. And so you. You're supposed to the RDA's. The recommended daily allowance say that we're supposed to have a thousand milligrams of vitamin c and the if you don't have enough vitamin c. you can get scurvy, right. The problem is that carbohydrates and vitamin c. compete for the same receptors. So when you eat lots of carbohydrates, you need to have lots of vitamin c. interest. So like you really only need about ten milligrams of vitamin c, guess what? Like upon a steak has shown milligrams, invite. And I have like I probably have on a lo- day, two pounds. That's a really loaded like I have usually around three pounds of meat a day, probably like two to three quarters to three pounds of me today. And so all these b. vitamins, iron, minerals, vitamins that I'm getting. Not only am I getting more vitamins and minerals, and a lot of people were surprised by telling me out a lot of the time. Meat is more has more vitamins than vegetables and not only does it have more, but it's more bioavailable because it's with animal fat that you need to absorb because a lot of these are fat soluble, so so that's like I cover them outta my basis with that. I also do awful. So I do like liver. I have, I still have about fifteen pounds of liver in my deep freeze all do liver, liverwurst, Brown, Schweiger. Both of those all three of those actually are grass-fed. I try to grasp as much as possible, especially if I'm doing like liver. Hi. How are you preparing this? You? Well, the Browns swagger and the liverwurst is actually for people who don't like organ me is your best like intro into organ meat because it's like it looks like that cold, right? You can have a cold, but it's like if you don't like organ meat, I would suggest doing I do it this way most of the time anyways, slice it, and then I'll fry it in butter and it tastes like spam essays as vicious, 'em with eggs, man, we all know it's fan and it's delicious man. And so like a liver, I actually just made up this recipe recently is pretty good onto a bathe it in like heavy whipping cream for like a day, not even a day, maybe like eight hours overnight and then take it out, dry it. And then I'll do an egg wash of of a and heavy cream and and some spices. And then I dip it in pork Penco. So like pork pinko is like pork rinds fried pork rinds. So it's like panko, but it's. Penco. And so like a frie- that up and that that will make out like the first time I did it. That's another thing too, like with liver. So there's there's win when food is really micro nutrient dense? Yeah, it fills you more. It's weird like I can eat like two pounds of state easily, and I'm not saying that it's not micronutrient dense, but like liver is like the super food of the world. Like if you talk to a VN and vegans like, well, you don't get. I just say liver. What doing animals go for, right. Yeah. When they, you know, animals, obviously that are carnivores predators. They go first surrogate parts of the body kidney, and so so I'm getting a lot of that from that. So now then if you wanna talk about fiber, then there are some benefits to fiber fibers, not essential at all at all. Dietary fiber. Yeah, you do not need fiber. You know, you don't need fiber in your diet. You know you, especially people think, oh, man, how you pooping getting like? Are you going to get constipated? Actually at the beginning by wife and I both were. The opposite happened for like a month and habits. A lot of people number one, because when you eat lots of fiber, the soluble fiber tends to absorb lots of the water that you're that you're having. And that's the job usually of the colon. So the Colin kind of gets like the large intestine kinda gets lazy when you when you're eating fiber. So you remove that fiber from the diet, and you gotta get your colon back in shape so that water is worn right through guy thing. So, and then there's other things that fiber does like, you know, short chain, fatty acid like gut health, gut microbiome stuff. That's good. And so I do for a while. I was like, you know, who cares? You know? But now I have like an avocado a day in my little Keitel multiple that I've been told you about, and you know, I like fruits vegetables are a little bit different because vegetables, they don't want to be eaten there like an animal. They don't have a bar. They don't have a bite, what they do have to defend him from like little insects and little. Critters is biological warfare, so they attack with biological offers. So they have these things that are basically anti nutrients that they attacked the lining of our gut. They inhibit the absorption of a lot of these nutrients. And so if I'm going to eat vegetables, I'm gonna cook him for sure. Cookham as much as possible. Broccoli, I wouldn't really do kale anything that tastes bitter. Think about it. Like we've we've kind of like adapted to the states. You know, we like all. It's nice when there's a reason why it's better. Why do you think fruit is sweet fruit is sweet because the fruit wants you to eat it because in the real world before all the garbage cans and stuff like we ate the fruit, we put out the seeds and we spread, we protected that mother apples baby, and we spread it somewhere else. So the these vegetables are trying to protect their young which which is like the the seeds and nuts and the and. All this stuff. So. So for me, it's like the benefits don't really outweigh the risks, you know? And like if you'd like vegetables eat them and a lot of us are can handle more than than others. You know, there's a lot of people that do the carnivore thing because they they have to. I'm not one of those people, you know, I'm just like, oh, I don't have to vessels to solve awesome castle. I do like I do like avocados do like low sugar fruit like zucchini and cucumbers. Like we just got a mandolin, those mandolin things that you can like take like cabbage, slice it up. So you can do Julianne to like with cucumbers and stuff. Berries are awesome, but for the Brian, any oxidants is several areas. Yeah. Take your. Yeah. So the kids and the kids leave vegetables, you know, always funny thing. My wife is that sprouts the other day, and she's like. You want to know how to get kids see vegetables of how she's like, don't give them vegetables. Dean sees the rainbow carrots and they're all these different colors. He said ou vegetables, so we have kringle care. So I, I had some rain McCain today. But like Desmond, if we're out, he's going to get a spare with butter Desmond. When we were paleo, he used to crush sweet potatoes all the time. So now they're, they're Kito. So often that when we go to like fresh kitchen, you guys don't have on here. There's one in Saint Pete kitchen. Really. It's like one of these for for people who aren't local. Yeah, it's like one of these places that has really good ingredients. You make a bowl, you pick a meet you pick like veggies and and stuff, and you and you mix it all up together and it's delicious. So we go to fresh kitchen. They have sweeping, you're making yourself. Well, there are many. You're just subway like you've worked down the line and tell them what the put in it. Yeah, and they'll and when we go there, that's cool. They're always going to get the potato noodles and they're always going to get the slice sweet potatoes. I, I know it doesn't get the barbecue chicken because it's like that's sweet sugar in the saw and that for them like a treat, but it's still good food. Right? You know. So I think the most important thing is like. I don't think parents should focus on trying to make their kids Kito or whatever, but definitely removing sugar sticking to real food, finding foods that their kids like and really trying to simplify the menu like they don't. We only eat on average, ten different types of meals. If you look at your actual menu, you go to that one place every day that you're going to eat your lunch. You know, you go, you eat this pretty much like two or three different meals a week, right? You're not like tonight we're going to have. No, you're right. Everyone has their Goto spots. Yeah, you know whether it's a once a week thing or certain foods that they're picking up at the grocery store, those their staple food items and eating leftovers or whatever else. But yes, so we all kind of function that same way. Looking the winsome free critical here. Here's how just write an awesome five star review on itunes for the strong bydesign podcast. We'll post the winters on Instagram, just go to at the critical bench. Watch our podcast highlights story to see if you've won. We post a winning review there. And if you have one, be sure to DM us. It's it's a, it's funny because I can't help, but think you're talking and I'm thinking about my own because our kids are almost identical eight. Yes. And just thinking about, you know, this look like the good, the good things that that they're eating and they, you know, relatively my, my kids have a good diet. We don't give him crap. We definitely aren't pushing crab on them. You know, but there's absolutely it stems from mommy and daddy. That's the first thing we tell people is you gotta you gotta model the behavior? Yeah, you're not going to be eating like, don't eat when I'm eating at come on now they see. That's the whole saying that they do a lot more of what they see them with their. There's seen as drinking water. Yeah, they're gonna probably want water, you know, versus like if we're down in diet cokes all day, then to be in the soda. It's funny because my kids, I, I like like a coke zero every once in a while there's something I really don't. I don't drink it ever when I'm here at work. It's like a treat thing for them out at a dinner. We are of go to the movies. We'll say, like, let's cheat with some dyke. I don't necessarily way, but we don't really. We don't have it at the house. I, we drink water and we drink, like, you know, the club soda or whatever the Croix all. Carbonated water naturally flavored nothing in it. So. Every once in a while though, if I'm having like a coke zero or at like Chick-fil-A or something right in my kid, they run out their water, their milk or whatever they're drinking. They go in make this face. Let's my kids. Eight. Okay, good. But yeah, I went through Tuesday because like for me, like when they try certain things, they're like a more more of that. And that's why we don't like we don't get that much fruit because then like all they want to eat his fruit, you know. So we'll we'll, we'll get the fruit for a week and the food will be gone and we're not going to get any more food that week. You know, we'll just wait to the next week, you know? So it's you're like pacing them a little. Yeah. 'cause then like it does. It does. It does like it's not that food is bad for his awesome. But then if it's taking away from the main event, which is a me, that's the main thing that's gonna make my kids my seven year old. Where's ten year old kids clothes like he's, they're growing like weeds, but like you know, they're going to be picky. Every kid is picky. Our kids are picky. But like if you don't be. Afraid. I'm trying to tell people who want if they want to do this is like, don't be afraid of. They're going to have. There's going to be that struggle the first three days. It was three days for us. I remember because I remember when she came home with the groceries, like on the third day, it was like gimme that what is that? Turkey cheese and a crush on on cheese, you know? And so like, you know, don't be afraid that if they're going to some of them are going to like, and it's just like the movie, the magic pill, it's on Netflix. I don't know if you've seen that I've heard of. I've heard about it. I I watch Netflix, but gosh, is a million shows on that. This is a documentary about Kito and like, you know, they follow different people in like two of them are like they're like autistic kids and this girl. She basically like she didn't eat for like a few days. And then after that when she started eating, it was when the magic happened like she got better and it was amazing than I tell people don't be afraid your kids not gonna die if they're like not eating that much for a few days, you know, it's going to reset their palate a little bit and it's gonna. To, you know, help them move. I, I'm not a professional medical professionals. Like I say, whatever I want. Right? They can't hold you to not right. I had. I did have another thing I wanted to touch on with you. Two Australian and being Kito. Oh yeah. Yeah, yeah. So what are what are in terms of all the reading that you've done and the things that you've come across over the last few years? Well, what what correlation is there? So only going to give you stuff that I've heard and I haven't really done a lot of research on this. But what I have seen is seen some people have complained about lower testosterone or whatever, but then like for instance, one of the guys that I was listening to early on Dr Adam, Allie, he's out in surprise Arizona. He's, he is a. What do you call it? The ones that they do the stomach stapling and all that stuff. Oh, a ga- ga- gastro inter- like, well, no, he's, he's a, he's a doctor, but he focuses on that type of medicine. I forget that type of managing. It's like he treats obese people. And a lot of these people what happens. Of course, we know the estrogen is bound to fat, and so you have all this fat, and so you're estrogen dominant. I mean, what? A terrible situation man like not only are you like you're overweight and you're obese, but now you're estrogens up like you can't even have that man like, come on, you're my. I can't even be a guy. Now on this thing. Yeah. And it's really it's really hurting you in that way. So what he seen and I think he's actually quoted and I'm never looked into it, but he's Kito can raise your to social by twenty thirty percent, you know, like as much as twenty thirty percent, which it makes sense, you know, because cholesterol. So there's a whole different one I know, right? That's like an actually, that's I won't go to vintage, but that's, that's that's a really cool subject cholesterol because we cholesterol so important and like I'm like the biggest cholesterol fan ever like if someone who's keyed and people are thinking, oh, well, your cholesterol must be super high because. It years in line is high ninety tonight, but what's the? What's the difference between your HDL and your LDL, right, because isn't that more of the indicator? Big thing that's important, but more important than anything. Triglycerides understand like HD l. DO are just transport molecules of these things that they're, they're fuel transport their fuel transport system. So they're basically taking the fat that you're and triglycerides actual fat in your blood. That's what's important. So if one of the things that's been kind of talked about recently and one of the one of the guys that I really love who does stuff in this area's doctrine, a dear l. e. he's a cardiologists. He's the guy who's putting stints in people all the time, and he's also like checking out the research on this stuff and he's like, looking at all this stuff and he's like, wait a second higher LDL. These people are eating low carbohydrate diets. He's looking at all these studies, seventy years studies, like I'm not wearing my little tiny studied. Yeah. Yeah. These people are the most the highest performers to healthiest the the all of the best brain power. Like all these things have higher LDL and there's there's something that happens with some people. Some people's cholesterol gets better with Kito. You know, some people are what we call lean mass. Hyper responders me right. Lean mass, hyper responders. What happens with them is like, you'll see is your HDL will go up. The LDL goes up a little bit, but you're dragging us rides. Go down, right? So you'd triglycerides you want to be under a hundred. You want you to try your HDL to be like at least of fifty right now. But like my HDL is eighty nine in my last test. My LDL was like one ninety something super high. So combined, which is your total cholesterol. I'm growing to ninety Seattle. Oh, anything over to hundreds too hot. Yeah. Yeah. And so like what I look at other things speaking of testosterone, if you this is I'm gonna have worn every single man in this. On this podcast was listening. If your doctor tells you to take Staten, I personally would fire him because there is absolutely nothing good about a Staten causes erectile dysfunction. That's why I wanted to bring that up because that's one of the things that you can call it. Statins are status as an example of treating that we got LDL's bad. So we gotta lower LDL and we can take that LDL and we can lower it to thirty. We can are drug and do that. And they've actually in some of the rat research that they've done, they'll they'll take that that and they'll take their genes in the switch him so that their genes work like the Staten. And so these rats have really, really law deal and these rats do not do well, you know, if you're if HDL l. dear LDL high and your triglycerides are low. Chances are you're very, very healthy. If you're following a low carbohydrate diet, because you're you're, you're basically able to your, there's all this fat there because you're using. As energy, right? So that's your energy source. You're not plugging in the carbs to fuel your body didn't go in family that transports happy. But what what would you say if I asked you what would happen to someone's LDL if they fasted for seven days. Well, you you would you think it would go down? Yeah, right, right. These people like by seventy percent or something ridiculous. Like there was a study that they did like the seven day fasting study LDL skyrocketed. So there's like kind of like an inverse relationship between cholesterol numbers and the amount of fat you eat. One of the other guys, this he's a, he's an engineer. His name's Dave Feldman. He's like schooling doctors on this. Doctors are saying, thank you for your work is amazing. He he started to do like a low carb high fat diet years ago, and he was like freaking out about his cholesterol numbers. He realized that this is me, this is what I, he's a lean mass, hyper responder. And so he can tell you if you have insurance issues like because they're telling you gotta get, he can basically say, this is what you gotta do. Here's the protocol to get your cholesterol down and we'll do it. Like within four days, he'll be able to tell you what your how to like how your cholesterol number would be, because it's a snapshot in time of what the energy status in your body is. So. Cholesterol's important and it transplant, you know, it's important for for to SaaS room. And so that's how it would make sense to Sasha will go up with higher cholesterol, higher fat. You know, low fat diets. He's think about it like you don't feel good. You don't prefer on. Exactly. And that's, that's the unfortunate thing that happened. I don't know what it was a visit, eighties physics, man. It was way back then where I made fat the bad guy and they made sugar. Yeah, because it wasn't if you go to the because that's when all the cereals and everything were popping up is like, this is what you eat. Nineteen. Aerials. Edmund Dr. Ansell keys did the seven countries study which what he did was like his whole hypothesis was that the more fat you eat, the more heart attacks you have. So he took seven countries. Look these these countries, all eight more fat, and they all had more heart attacks where there was like eight or nine different study countries that had a bunch of fat and didn't have heart attack time. Good. He's selectively yet. Yeah. And then it's a hypothesis called the diet heart hypothesis into this day. We are treating people. We have food pyramids. We have all these recommendations based on hypothesis that was never. Even it's just it doesn't make at least I think people are a little bit more aware of this now. Mirror pyramid is a kind of a bunch of crags servings of of Brandon rains and rains every day, you know, and these people these poor. Imagine these. These people are like they're going to like a registered dietitian and they're like putting put me on a diet and they're like, you need to eat fifteen hundred calories a day. So you starve yourself. And then on top of starving yourself, have most of those from carbohydrates. So you're always hungry. And what happens after only eight weeks of eating, a low calorie diet is your grilling, which is your hunger. Hormones can be elevated for up to a year later. So why do you think there's no reunion episodes for the biggest loser? These people are wrecked mandate. They put, they put them exactly what the government has told us to exercise more move more, eat less and these people are just, yeah, while you're doing it working out four hours a day and eating twelve hundred calories, you just gonna shed on the spot, but it's gonna come back man and these people, you know. They should. They should. These people should come on TV and talk about this stuff. You know, they don't because it's probably barest, you know, there's none of these people. It comes down to what, what? What sustainable to? Yes. Ultimately, it's like you got to be able to eat a certain way that's not just temporary. I mean, sure. There's deep reasons to detox short term thing and then get back to get back, but what's what's your your to? What's your consistent day of eating look like? And he has to be that you're saying she aided. Yeah, and that your got clarity, and you have a fair amount of energy and you're sleeping well, and you're able to perform the exercise or whatever it is you do for active duty. And so, I mean, it's like you said, you know, it's, it's. When you did your the car thing that you did the two hundred cards and like having a PD I don't ever eat carbs. Yeah. And then you were advised all you're gonna do what fifty thousand meters or role in two thousand meters of ROY. There's somebody was like. Oh, yeah. Like gonna have some carbs before that. And I had I had two hundred that night and then I had eighty the next day on top of that. And what ended up happening is like I woke up because I'm always testing blood sugar and blood key tomes. And I'm always looking to see what happens. So I expected my blood sugar be little bit. Elevated by key tones were still a little bit high, but keystones us like you don't just like eat carbs and they poof disappeared. There's there's like they gotta be used up and then maybe tomorrow they'll keep those weed out. But what ended up happening is he's like, do your as much as possible fasted. So you got those carbs in your system was going to happen is you're gonna have like a duel, fuel system going on only if you fat adapted, not if you're not if you're not that adapted the worst of both way, right? So what ended up having ended up to thirty seven thousand meters without anything. And by the end of that thirty, seven thousand meters by blood was already like in the low eighties, and my key tones were like two point something. And then I had the eighty carbs. And then I waited a few hours and ended the last thirteen thousand meters that lasts thirteen. Thousand meters by the end of that, my blood sugar was at sixty eight and my key tones were at four point four. Now, let me tell people, they're probably thinking, wow, that's Hypo seeming. If you're Kita genyk and you have low blood sugar, it's different. You don't have the symptoms because your blood sugars naturally lower. So as key tones go up, blood sugar goes down. It's like an inverse relationship. And so what ended up happening is you're so insulin sensitive that that your your body was like, carbs, the intimate was like, I know exactly what to do. You just touch that insulin in the incident was like, take those carbs to the muscles. We're gonna use those carbs up when those carbs of done, then we'll get to the fat. So I was able to use all those car lines as then us all the fat. And that's why I think more people should look at low carb at least have to be Kito because they can really get those benefits and people who do long distance, whether they're Kito or not. They feel that high at in the middle of a race because when you're you're. You're, you're carbohydrate can only lasts along the the strongest person with like a decent amount of size and even body fat or whatever only has about two to three thousand calories worth of glycogen in their muscles and their liver, and then they're going to have to start pounding the gels right. The everybody has forty, two hundred thousand calories of fat, you know. And if you're not going to tap into that fat, if insulin's high from eating all those carbs, so incident has to be low enough to where your body's like his incident says, stop, keep the fat there. We got carbohydrates so use. So if insulin's low, then the bodies like, okay, let's let's use this fatness, mobilize some of this fat. So it's a cleaner burning fuel, you know, it's in, it's a more abundant fuel, so I it makes a lot of sense now totally does. It's just it can. Can you get to that point? Are you willing to sacrifice us what we've been so conditioned to e. And what we've faced with socks, you know, you gotta go to the Kito flu what they say, which is a lot of the time due to not only cutting the carves from your diet, but also went insulin drops. Like I said, from the car was being dropped to what had what happens when insulin drops it signals your body to like your kidneys to p stuff out. So that's part of why people knew so much weight in the first weekend Kito because a lot of its waterway, but your body's not like just being water. It's peanuts, sodium, potassium, calcium all the electrolytes, magnesium. And so I tell people if they're switching is very, very important to have electrolytes, like take a quality, magnesium supplement, not something that even GNC or vitamin Shoppe. Has you gotta get the health food stores like the hippy stores yet? They're going to have like magnesium glycemic key later, magnesium, magnesium citrate, obviously not the fluids so you're not gonna blow it out, you know, right. The pills. And then take like potassium, you'll, you'll get potassium in. Avocados, I think some of these leafy greens have potassium like hill and, and then sodium salt. All your food go against what your doctors telling you. The American Heart Association is telling us to eat dangerously low levels of sodium. No one follows it. Thank God because especially athletes athletes need sodium. It's so important to stay hydrated, and it's a little. It's not like you should be putting salt tablets, water or salt your food from salt on your food. And actually for like a guy like me. I haven't done this in a while 'cause I have like a electrolyte drinks that I drink, and my meat had kids like when they want juice, it's either gonna be amino acids, or electrolyte drinks, or sometimes executives keystones because they're tasting really good knowledge. They've made them taste good, and I don't give it to them. Like here kid take keystones no, there. They might get the benefits of the key tomes, but they also get sodium from the key tones to because they're bound to him. So. So like, yeah, I, I used to take like a teaspoon of salt in my water like that was my my pre workout so that I'm well hydrated. Because if I if I am not diligent, especially as a carnivore, which I, I could say I'm carnivore, but I have one meal days going to have some sort of plant matter in it like today was advocating on. Carrots has avacado and cabbage. My dinner's always usually like a huge stake, you know, like like a pound and a half rib eye or something like that. So in some where can people find you like what is the best place I've actually much earlier, we mentioned fat, fueled family. Where can they find you? We're the best places to find you and learn more about what you do. So Kito counterculture, Instagram, Facebook, we have the fat, fuel dot family. If you go to WWW dot fat field family, they're going to go there and it's gonna say, sign up for your Email and we'll let you know. And then it's on Facebook and Instagram. We have the genyk athlete podcast, which is the key to Jack dot com. Fantastic. I mean, great information. We, I think we got through quite a lot of stuff here. I said you had to work, could I know. Too much. Interesting backstory. So I wanted to talk about some of that, but I've I wanted to dive in Kito and the whole philosophy and how it it's in your home and it's, you know, it's not just you, it's your wife, it's your kids still live, you know, it's interesting. I mean, it's very interesting, right because you don't hear it. You don't really don't here, and there's a lot to learn about it. And I mean, no, there's a, we often look at each other and wonder why in our world today, why there's so much. Crap. You know, with our with our kids have a lot of it. I feel like comes down to like nutrition. I mean, there's so much of nutrition base thing and and just like the way they act in the mood and their growth and their illness or the way, you know, just all these things are connected to what we're feeding. Think about it this way you give a kid all the sugar, and then you like sit down I and then classroom for forty five minutes. And we're like, yeah, you made you say, do give looking out the window and your twitching y'all. He doesn't know if he likes girls are not right. He's got too much sugar, and it systems really would like to be outside running around the soccer ball, but he's just like, and then they wanna label it. And let's medicate. Yeah, exactly. And it's like, oh my gosh, like where we going, we're so we're going, we're going so far in so many ways like far forward. But we're going so fact words, but now is, is. Making all this stuff, you know, because information used to be so much in concentrated like you had to go to your doctor and you had to book an appointment for him to read you your bloodwork. Now you can go to private labs dot com. Get your bloodwork show up, get your labs, two days later, they send it to you and and you're, you're able to read what other doctors are doing that are may not be the standard of care and you can say, why aren't you doing this? And the doctor, you know, they're going to say. Going to be a jerk about it, or they're going to be like, you know what? I'm not. I never heard of that. Let me look into, you know, and that's what some of my doctor friends who are like Kito friendly. They're like, listen to tell you doctor. He's not caught up on his reading. He needs to catch up on his reading. There's lots of stuff. He's not just because they're a an MD or whatever there. It doesn't mean that they're the expert in all these other nutrition. It's not as it's not. It's not applicable. It's totally irrelevant to me like someone and this is what they throw that in your face, especially I don't get into these online things. I don't know how this happened recently because I never and someone's like, well, I'm a nurse in such as like, listen, you're not the first nurse to talk to me and try to shut me down because your nurse. Okay. If you didn't get an RDA or you didn't like studying nutrition, you being nurses not relevant to this conversation at all. There's people in this Facebook group was a Facebook group that can teach you lots of things, and they're not nurses, right? But they've spent who knows how many hours reading and rows. Information? Yes. Kalispell there's like these websites that are like, you know, like, you know, telling these people that they're like, hippy, dippy? Stuff that's maybe not based on science and I get that. But at the same time, it's nice to have that that democratization of information, you know. So that's fantastic. I, yeah, it's a crazy world we live in and I guess we should just be happy that we're living in it. The threat they wake up to you if you were free, but two feet on the ground and thank God for for van here. You know. So to that man. Well, it's, it's been a real pleasure. We'll have to have you back and tied. There's obviously a lot of different topics that we can cover with you. And so now I think it's time for us to go out in the in the compound navy and that's exercise or film a few YouTube video. So I think I think we're gonna move on. Thank you all for listening. Be sure to check out Danny Vega and some of the sites and places that you can find him that he just mentioned. And it's been a real pleasure having him here today. Talk and Kito and a little bit of everything else, and we'll talk to him real soon. Hey, if you want the free seven worst disaster on killers report than just text test. Oh two, three, four, five, three, four, five that's test. Oh, t. e. s. t. o. two three, four, five, three, four, five. And you'll get a text from me asking for your Email, then you'll get the free report sent to your Email inbox. And if you're not in the US or Canada than you can grab the free report at critical bench dot com forward slash bonus dash video. Thank you for listening and stay strong by design.

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Male Genital Dermatology with Dr Phil Doiron

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40:44 min | 7 months ago

Male Genital Dermatology with Dr Phil Doiron

"This program is supported by an educational grant from Sun Pharma. Canada Inc made available through the CD corporate supporter program. Hi welcome to dermot logs season two. I'm your host Dr. carry a dermatologist. Who WORKS IN? Halifax time community and part time academic as residency. Don't always get a chance to hear from dermatologist. Outside your own center this podcast designed to change some of that. The goal of the series is to help you. Dermatology residents get answers from experts told us across the country to some of your burning questions on key areas of our practice. One of those experts. Who's joining us on this episode? This Dr Phil Doiron. He's a program director for Dermatology at the University of Toronto. And he's a staff dermatologist. Women's College he's a clinical teacher and he spends a ton of time teaching medical students residents from a variety of programs including Matala G and beyond so first and foremost thank you so much Phil for joining me on this episode. Hello you're welcome today. We're GONNA discussing. The I was GONNA say burning topic of male genital dermatology. Maybe we don't WanNA use that qualifier. So we'll talk about male genital dermatology. I have to say you know. Being a resident in Halifax I have a fair number of staff dermatologist. Who were males so? I did get a chance to see a fair amount of things but I will note that many times patients felt uncomfortable with an opposite gendered learner coming in and so most of my learning around male genital dermatologists resident seemed to be from books and then now as a staff person seeing stuff because the patients don't necessarily have an option so I think it's a really important topic that maybe not all of the resins getting equal experience with do you think that's fair. That's very fair in very much happens. I think definitely happens for trainees. If there is a bit of perhaps gender bias where patients do feel more comfortable with a trainee of their same gender. I think it actually does happen. Even a bit as staff perhaps depends on where you work if there are other physicians at Your Center. I work in a center with Some female dermatologists so that sort of self select out so I feel like it. That does definitely happen for people. That's a fair point. Actually my office has two females to males and I find that oftentimes patients do self select but I will also find that. I do also find that I've seen a lot more male general dermatology since being a staff and a lot of it. I was kind of like Whoa. I don't really know what to do with this so I think this is going to be be very helpful. The biggest comment I get from. Residents is it is an area that we just get so little exposure to. I totally agree. And the one thing that I thought was of interest to was the urology residents here do different topics and I was the adviser to review the the dermatology chapter and it was one of those interesting things where I thought you know. There's not lot of great resources in this topic And the way that they had their set up was kind of not that easy to understand and so I started thinking about the way that we have our resources set up and you know. Do you have any resources that you think are particularly useful for the male genital dermatology topics? Yeah there's One textbook written by Christopher bunker from England okay which is kind of the The seminal textbook on dermatology which I think it's in a second or third edition now and it is a very comprehensive volume so if you really wanted a comprehensive volume that is that is the one I would look to okay. It's a whole textbook so civil is looking for a quick review. I'm actually unfortunately unaware of of any apart from a few power points that I've come across of any of them shorter collection. I will suggest we do not look to the Gold Standard Urology textbook because it's totally all over the place but Listen before we start delving into some specific topics. Let's take a question from dermatology resident the world headquarters of the dermal logs podcast. This is Melinda at the University of Calgary Residency Program. My question is about the general approach to a male genital examination. Do you wear gloves. And do you ask the patient hold and manipulate their genital area. Or do you do it yourself? Absolutely I always find it most helpful to have the patient laying down a lot of patients will want to stand in sort of just pull their pants down yet and I I find it much easier examined. I'm much more comfortable position. If they're lying down and I'm standing next to them on the bed. I do always wear gloves. I depends on the exam. What what I need to look at or if any patients required but I will often get them to move their genitalia. But then if I need to I will with gloved hands. Pump aid is necessary. I do always really emphasize with the trainees how important it is to respect patients. Privacy always and really especially always during genital exams patients can be cavalier comfortable and I do appreciate that and I have some patients that I've seen for quite some time. That are quite flippant in are very very casual experience. Shall we say but with new patients I always make a point of pulling a curtain and often patients will frankly and again. This is perhaps biased. Because I'm a male provider and the patient is male. I get a lot of variations of. You'RE GONNA all seat on the second anyway. So what's the point or don't bother? I don't care no one people. I always offer a gallon. It is rarely used but I always offer it at least and I do always pull a curtain and I don't watch someone on disrobe and I think that's important to do to respect people's privacy one hundred percent. Now when you're doing a genital exam do you routinely include? I guess it would depend on the pathology but would you re routinely include ensuring that you look at all the scrotal area into the pair Neiman Peri anal skin or does it depend on the diagnostic considerations. It depends but I usually do try to take a look at least the inguinal folds and depending on the area I also tend to do a focus physical exam again depending on what condition. I think it might be for psoriasis and like implants for example that can be helpful focused physical but it will depend on. What the pathology show okay and the other thing I guess would be you know. Sometimes people come in for a particular lesion and then. I don't know if this is my bias. As a female I always have to try to remember to to have uncircumcised males like pullback the foreskin because I feel like it's important to always look at that area. Is that true it is again? We always think of the worst case examples but I have a couple. I've is one example that I use in my talks of a man I met during my fellowship who I have a photograph of him a US with his consent of him with his foreskin forward and it looks perfectly normal and then he pulls his foreskin back and he has a very prominent squamous cell carcinoma glands of his penis and I use that to emphasize the point of just as you were saying it is really important to always do a complete physical exam. I know it takes more time. It can be uncomfortable but I do often especially with genital concerns. Have people tell people to pull back their own? Foreskin or pullback yourself you don't WanNa Miss Anything there because I find some of the like you said malignant lesions in particular tend to hide in that area sometime so if you're not looking for ya so this seems like maybe a broad. Catch all question if you're looking at genital skin. Do Use the traditional vindicate type. A how do you classify lesions or do you have some sort of big heavy hitters in your brain. When you're looking I do at this point I do try to go with Gestalt as to what I think it may be based on the patient's history. And what may first impression is impression is looking at it. But you know I do tend to follow a broad infectious inflammatory malignant pre malignant some variation of. Yes vindicate or some something like that. If I'm trying to be you know very thorough and making sure I'm not forgetting anything. Okay now thinking about that You know one of the things that I probably most people panic abode they really don't WanNa miss or malignant or pre malignant conditions. And you know I remember memorizing all the way through pleasure and Blah Blah Blah. And then. I think I've seen a lot more zunes ballerinas and maybe some sort of this in the older gentlemen or things that you look at and think that Bella nitis erotica is it precancerous as a cancerous and I know that mixing up inflammatory and Malignant. It might diagnoses but it can be heard she'll sometime. Do you ever look at something and say I'm GONNA treat that on SPEC and if it doesn't get better than I'll biopsy or if you have that tiny snifter right at the beginning. Always go straight for a biopsy. I definitely do treat things on SPEC. If I think they're inflammatory if I have I guess it depends on how much clinical comfort level is. If I'm concerned something carcinoma insight you or a squamous cell carcinoma. I'm probably GonNa buy it right then and there but if I'm reasonably suspected but I actually think it's probably an inflammatory dramatises than I definitely have will treat on specify you know make sure the patients reliable comeback etc etc. I will do and do you tend to use. Do you. Tend to go with sort of ultra potent topical steroids. In the General Area for query inflammatory things are with that also very it varies based on the inflammatory condition for sclerosis. I will use ultra potent like Klay dissolve for a short period of time at one month. Maximum I make sure to give a small trade size with no repeats on it and that is probably the only conditional use that four for most other inflammatory genital conditions. I will try to get away with medium sorry low potency and then maybe medium potency for short periods of time. Okay now speaking of biopsy this is something that when I see a patient in my community office I always bring it into the hospital to do a biopsy because I think it's the most important to have an extra set of hands beyond yet patients but some of the residents did have questions about the logistics of a biopsy. So let's listen to another question from one of the dermatology residents high dermot logs. This seren Westby. I'm a third year dermatology resident at Dalhousie University. My question is about doing a piano. Biopsy particularly along the shaft of the penis or close to the mediators are there any specific considerations or risks. That should be discussed with the patient prior to the procedure. Aside from the general risk of scar bleeding infection. Thank you. It is definitely classics Scar bleeding infection with a few asterix's always add Depending on where you biopsy the scar can be more prominent right and depending on where you're seeing. The risk of bleeding can be much higher and again depending on where you're by up seeing the risk of Of creating a Fistula in the Aurora is which is probably that when I say there's the danger zone that's the one area in the Penis. I won't biopsy is the Perry area okay. We can talk about that and when to urology urology. Yeah with the often do is put fully in and then Asher that they're buying up seeing And not transaction the ARETHA gather from. My urology colleagues is exceptionally difficult to repair. Yeah they probably don't like that too much so it's been to have it's one of those things where if they're gonNA make a mistake. Better be them rather than probably yes okay. Do you have any technical pearls or do you have any like I said I like an extra set of hands and that it it is a it is a relatively relatively challenging area by C. Do you have any pearls? What do you do that makes it easier for you I do? I always have an exit of hands because it is a mobile area and definitely you need to have the tissue staying in one place I will use. Lyda came with epinephrine and I'll use a very small amount like point one or point to CICI's that's it and what I do is like the scalp or other very vascular areas. I will put that point one or point to CCA FREEZING. Let that sit for fifteen or twenty minutes to let the Epi really work and it saves you so much agony later on. I'm also let the patient freeze very well. Which is nice. I know some colleagues. Do use topical things like M La before I don't find most people are kind of okay with a with a small amount of pain for a moment and then then it's numb? Ah That's my. That's the freezing tip in terms of what what type of biopsy I do. I will do a punch but if I am using punch I will tell people to go. Shallow we're not trying to get corpus cavernous in here. Just want the skin so there's no need to go to the hilt of the bunch in fact please. Don't some people? I know also will do a SNIP BIOPSY. So they'll take the FORCEPS N. To lift a little bit of the skin up and then kind of do a shave. That is a technique that lets you get away with using aluminum. Chloride for Hema Stacy's instead of a suture. But you really have to be careful that you're not pulling up too far because then you may get some deeper structures that you didn't intend to fair enough and then would you typically for he. Most aces do you tend to use the suture or do you use the chemical dependency for a small punch. I will often use a single Three Oh sorry. A single four or five. Oh absorbable suture. Nylon is incredibly uncomfortable. Especially under someone's foreskin if you're in. That area is very very unforgiving quickly so I always use sutures. I would say in terms of location for biopsy if you have a choice in location if someone is uncircumcised the inside of the foreskin is very forgiving in terms of scarring tizzy. Glands is not the glands will leave a much more prominent mark if you can avoid it and the one area that I said I will not biopsies the Perry Friendlier area. We're kind of the inside of the the ventral foreskin because the ARETHA is quite superficial. They're right yeah. That's a good point and I can't stress enough for the residents to give that time to allow the To allow the epinephrine component to work. I always do that for Scalps and noses and genitals and it just makes a world of different absolutely do it. Yes The other thing I I wondered about too just in terms of pigmentation and I don't know that we see it so much with the biopsy but you have a lot of issues with just pigmentation after. Say Like cryotherapy to the genital skin. Do you have a different technique? If you're doing cryotherapy to that area I have not seen thankfully a great amount of justice pigmentation in patients that I've seen back myself I have seen quite severe just pigmentation and people that have have cryotherapy other places and I do think has to do with the the level of aggression I tend to be. It's hard to quantify don't count but I I freeze the lesion hold for a few seconds like keep it frozen for a few seconds and go from there. If we're talking about Benign Kandalama genital warts. I think some people really blessed them quite hard in that can leave a pretty prominent ring of hyper pigmentation afterwards. Now I should ask. Are there any other diagnostic techniques us? You're going to be there all right. I'm okay let me take the old adage of if it is scaly scrape it and if there's an erosion swab it really applies genital skin. Excellent by my you know. Apparently an expert in this and I've been fooled by herpes a few times already. More in the Peri Anal area than the genital area. But I think it is it really. Is You know if there is an erosion or a sore there. Even if it's not a classic cluster. This not classically symptomatic. Swab it for virus. And if it's scaly take a little scraping and see if it's a great point and you know and the other key point that I'll make us to answer that use a viral swamp and so I don't know if this is as much of a problem for the germs but I know I've gotten away from just asking nursing staff to just do a viral swab without me indicating. Exactly which swab it is. Because I find often. They pulled the bacterial swab. And then it gets turf. Ter- obviously doesn't grow up can't get a virus so on that note. I think it's a good segue into talking about the infectious or some key. Infectious Diseases male genitals. And so you know. We just saw some news recently. There's a huge blip in like syphilis and so have you been by huge blip. I think there was eighty five cases in Nova Scotia since two thousand and four. So we're not you know saw to not an epidemic but have you seen much or do you see much syphilis at your center. We do the risk. The rates are certainly increasing. I think a guest thankfully the rates used to be very low so the relative rates are dramatically high. I think the absolute rates are rewrite not astronomical but I think in all population groups or at least many different population groups. Syphilis another STI is unfortunately all on the rise. I see honestly far more secondary syphilis than I do primary. I'd like to think that I think you know. I work in downtown Toronto so there are a lot of sti clinics near and around us in the family. Physicians that work in our area. I think are pretty versed in that area. So I like to think that most primary Schenker's get caught by primary care. I got a lot more of the scaly rash. What is this can I see your mom's? Is hoops here now. A clearly? That's more of a zebra when you're looking at infectious diseases of the general area. You mentioned herpes earlier. You know if you're thinking about all the different infectious diseases that you would see. What do you think are the top three that we should always have in mind? When we're looking at the genital area. Interesting I guess. Obviously it'd be it would differ depending on the clinical appearance. Just sort of like what are the big. What are the common things that are always coming through the door? I mean in terms of infectious diseases. I mean Kandalama genital warts. Hp are by far the most common like lion. Share for sure Right after that. I think I mean Tinian. Herpes are probably the two most common. I see in terms of genital. Ward's I have a couple questions about that first off do you tend to and again you know. I'm sure it depends on the extent size at Cetera. But do you tend to lean towards more destructive therapies. Cryotherapy offline etc or. Do you tend to use more of the topical MC MoD type of what would you are you kind of like I guess it depends. I tend to use both honestly and I think there are studies that show that a combined approach is more successful genital warts really to treat everyone especially the immuno-compromised as we all know But duly pronged approach is is generally the most successful so I will try to do cryotherapy and topical Destructive Immune modulator that a patient can use at home between office treats now. I one time a few years ago gave a gentleman Imad five percent with the sort of use it once a day up to eight weeks. Send him on his way. He took that very literally and used at the entire eight weeks despite gigantic belay and then Allie wrote it and then he had horrible dissertation and took two years to get it under control and I felt terrible and then I thought to myself perhaps I should have been a little bit more clear in my direction when you give someone an echo to use gentle area. Do you give them okay. Here's your endpoint type of thing or do I have my little spiel that I give for these things and I do have one for. Makoma that is it will get red angry swollen sore and we want a little bit of that because it's a sign that it's working if it is too angry too sore to painful just take a break for a couple of days and then jump back on board is verbatim what. I say to people every now. I should've taken my own advice. That's how I talked about their actinic. Yes I kind of was I will admit not. Not As many men will tolerate that intensity that this gentleman must have gone through and I thought Oh my God. Yeah he was just. He thought that's what he had to do. I will say those words were. They never back. We'll see actual at one of their little tip. I have is that. If and is using a maximum odd or a few decks for benign hordes precancerous lesions on the genitals. The scrotum is very sensitive. And if there is no pathology. You're treating on the scrotum I tell people to either cover Vaseline or put gauze on it because often if they're applying something to their penis and then they go to bed and their penis rests on the Scrotum. It can be very very Angry in the morning pretty sure that may have been what contributed to my my patients undergo issues but yeah excellent point now one more question the topic of each peavy and I suspect you get asked this but you know. Typically when it's when it's something that I diagnose genital warts whatever the questions are always like. Where did I get this? How can I pass it on? How can I not pass it on to condoms protect? And so how do you answer those questions? Yeah it is. Tricky moves definitely a conversation. I very much try to avoid the assigning blame game. I tell people that you know. I I try to normalize it That HP the virus causes warts is incredibly common over. Eighty ninety percent of the sexually active population will be exposed to it. And so it's very common in that way. I rarely I think maybe mercifully have gotten into really detailed discussions with people. Who are really fixated on who they got it from. Most people are happy with a. Oh it could have been anyone over the past couple years. That kind of is enough. I do tell people that it is possible. Even after the war or gone to transmit the virus we don't know if it is completely cleared or if some remains in that condoms are partially protective and they protect the places they cover and nowhere else okay. Excellent that's what I've said to so glad I'm aligned with that message a last last infectious question before we move on and I think you know it pertains to the idea that you said scrutiny is a common thing and I think we do a lot of red slightly scaly and I I was fine and Januarius scales a little bit different. It's not that sort of prominent clearly scaly. Do you tend to use more in terms of topical treatment or you systemic treatment. If you approve that there is a fungal infection in the general area usually. I've definitely will try that. It's been overwhelmingly successful. Okay I would say okay so thinking about all these things that you see and you do see relatively commonly and recognizing that many of these things often do at least to me come. If they're not sort of typical they come from an STI clinic. But what when you see a patient prompts you to consider doing a full STI workup. Do you think everyone deserves one or do you think it depends on the clinical scenario. I think if you have one sti you're obviously at risk of having another. I don't personally do a lot of STI testing apart from swabs and visual exam but I will put a minute back to their family. Doctor and I will tell them that. They should have a screen for the other STI K. if I'm clinically concerned about syphilis v. than I will do blood tests and that was my question to thinking I guess thinking about HIV and so I've been doing a lot of HEP C. Have HIV screening in the context of other therapeutic options. That we use. But I don't always I definitely don't always think about it. Just if I see somebody with genital common genital infection might just kind of say. Well the I think the same you know in terms of prescreening immunosuppression I always do HIV testing regardless of any potential risk factors of the patient But in terms of I see them with genital warts being the most common. I I will admit I don't test all those people for HIV. But I recommend that their family doctor does okay fair enough so I'M GONNA shift gears over to these sort of more inflammatory side of things and you know. I think one of the things that possibly not having a great resource or seeing as many patients that does our learners disservice and it probably the same goes for male earners maybe not seeing as many vault but I feel like not seeing the common to see so much psoriasis on the general area now because I always look and ask about the general area when I'm doing psoriasis that I've realized that it can look different. I don't always catch it. I didn't have a good sense of exactly how it would look because it's not the same as on elbows or knees. I'm not really asking a question here. Other than just making a comment on my own experience. That's really important to talk about genital psoriasis. And that such a third of patients with psoriasis will have genital involvement and a boat. They say anywhere from three to five percent of people who have psoriasis will only have genitals rice and I see a few people every year. Tends to be men who have only genital psoriasis. And I have one patient. I saw had had several biopsies for Query Carcinoma. Insight you for these scaly plaques on the genitals that were psoriasis. That kept moving around. I think it's wonderful. That his position was proactive. Enough to do those biopsies and be concerned but but maybe didn't require those what other common inflammatory conditions again. Thinking able the top ones you know. What do you tend to see? Most Herbie referred to most for generally. I think I mean again. Common things being common absolutely Dermatitis often allergic contact dermatitis. Irritant contact dermatitis under the foreskin and psoriasis. Are the most common things I see. I think again that probably in a bit of a biased position In that I do get most of the inflammatory dermatitis that come to my center but Lichen Sclerosis like in Planas Zunes Ballerinas. Probably the second tier of of common inflammatory infections. And very rare things would be fixed drug eruption and Sark. Lloyd and things like that right yes. Never forget about those. So just thinking about psoriasis. You know when you see a patient. That maybe has whatever type of psoriasis. How do you tend to ask? I always say you know anything in the general area the Crock of your bomb. How do you ask patients about whether they have ECZEMA PSORIASIS? Whatever in the general area if that's not what they're specifically referred to like. How do you bring it up if I have someone? That has psoriasis. I will sort of try to normalize it in part of their list of anything on your scalp anything in your elbows in the Obama. Anything on the genitals you ask you is Kinda. Throw it in there the same way. Yeah Yeah Yeah. That's what I always say. You know scalp eared elbows knees general you know belly button genitals bubba. I just WanNa do the better way of asking those special technique. And how many people do you find because I find this to be a lot? I do have something yes I thought it was something bad and then you reassure them at psoriasis. And you treat it If you see somebody that has something that you do. Believe to be inflammatory. You give them that. You know treatment on SPEC. How long will you accept before you say now? Time for a biopsy. That's not acting the way it's supposed to. I usually see people back after six weeks. I'll give them a month of treatment. If let's Anthony. About for example right I will give people a month of treatment. I'll see them back and I tried to explain to use it for a month and then stop and I want you to four weeks after that to see it's coming back or are you know flaring up again. That's sometimes worked sometimes doesn't but then if things have responded the way expected them to that. I may continue with treatment. If they haven't then I would consider a biopsy up point again. Biopsy is often for me guided by physical exam and the way the lesion looks and feels is is is where I would be concerned vote. Frankly we're talking chrome inside to in squamous Cell Carcinoma. Being the over ninety seven percent of male genitals can cancers are squamous cell carcinomas. How many people do you think? So shift into the malignant side of things. Also just like you know I. I find if you're by being there. I think that men's number one fear at least many of the express this to me is that this is going to result in like a P. Nectarine and so. How do you allay those fears? When you're going in for the biopsy when you do believe it to be something malignant or pre malignant. How do you frame that for them? Thankfully enemy does depend sort of knowing. You're urology center in what surgeries are available in your area. thankfully nowadays really only invasive squamous carcinoma would connect to me even entered the list of options for treatment and even then partial surgeries and other. Things are possible. It all depends on the tumor in how invasive and differentiated it is. But I do try to tell. People is if we catch it now and treated earlier. We can use creams. We can use freezing and can maybe avoid a more serious surgery by not letting it get worse right. Yeah I think that's a good point. I just it's one of these things I feel like when I'm going in with the freezing needle. They kind of always yellow. My God does this mean you're gonNA have to cut it off like no. No no no very very very very very unlikely when you see something. And it's sort of creeps into your mind that is probably malignant or pre malignant. What are the clinical features that you think are most in keeping with that presentation? I mean obviously the Red Scaly plaques that our firm that are fixed the don't move around that are single discrete area as opposed to there are several scaly plaques over the genital skin. That's more likely an inflammatory matosinhos than a single plaque anything that has any sort of palpable infiltration or substance beneath it concerned about anything that is persistently eroded or fissured. I worry about as well I had a man with on the inside of his force can have just a persistently. Sort of pink thin fissured plaque. This one little crack that kept splitting and that was a Christian woman too and so I'm very I will again try empirical treatment but if that doesn't work and it's one area that always is cracking always splitting always bleeding. I don't hesitate. I don't wait too long before I biopsy that okay. And would you routinely include examination inguinal lymph nodes? If you're seeing something that you think malignant or do you kind of I mean I think that the catcher that would be pretty low thankfully of only ever got one and the person had the lesions on the genitals itself was quite obviously squamous Cell Carcinoma in people that I'm just wondering I still sort of reflexively do out of reflects but I thankfully haven't caught anything and I think you're yield yeah yield is low. I mean so is so. Is it for melanoma regular exams. But we do it anyway. The other thing that I find I didn't get a lot of exposure to as a resident and for some reason probably didn't come across in reading all of the benign things that you see frequently in Male genital area and so you know The ones that come to mind for me are NGO Caritas of the Scrotum. I remember the first time a gentleman showed me that when I was a staff I was like. Oh my God and I dragged in one of the guys and they were like yeah. That's super normal. Like everybody has over fifty. I was like Oh good to know. And similarly other things like pearly penile Pat. Buell's these little sort of cysts and what's your list of common or do you have a list of common benign things that you get referred to a lot of people that think it's something bad. I do by far the most common things that is benign lesions. I see on the Penis are Andrew. Fibro MS AKA pearly penile. Andrew Kerr Thomas and Idiopathic scrotal casino or calcified strode assists. Yep Right those are probably less common than the other two. But quite common I do see a couple of people a year. Who unfortunately have been told that they're really being popular are genital warts or are excessively concerned. That they're really popular genital warts in. I'm not perhaps believed the other physicians that have seen previously as it was nice to try to provide some reassurance. Okay for that again. Per leaping pap you'll should be symmetrical Usually along Corona You know if if they're off the corona asymmetrical very monomorphous that can be a clue that they're Kandalama and honestly be hard to tell sometimes there's sometimes that can be tricky engineer. Tomi very very common. And once you've seen them sometimes a couple times it does lock in. But yes and they can bleed which can frighten people to yes. Yeah often often. That's what they bring it to my attention and like I said the first time I saw it. I don't even ever really seen them. I probably read about it. And then just kind of didn't commit it to memory will also say. I know we're talking about male genital skin disease but those both those conditions have counterparts on the female anatomy. And I've seen a few female patients. Who have they call them? Volvo vestibular populace equivalent of who've also been treated for Genital Warts? So it is important to have those normal variance at least an awareness of them one hundred percent and we'll You know I'm going to try to cover the same type of topics with Dr Back. We do the Volvo are or the female genital series to Kinda think about that same thing because it is now this also actually thinking about from a Volvo perspective when a woman has Lichen Sclerosis. You know I remember when I was a trainee. It was like no no. There's no increased risk of SEC. And I was like no no no there. Is You really have to treat it? And so I have made it my practice to kind of follow those people even if they're clinically stable. Just once a year. I take a peek unless they have you know if they have a really solid Primary Care Provider. Who's able to feel confident with that? I I will differ them but or refer them back. But how do you do the same for men with Lichen Sclerosis or or do the exact same thing? The thinking at least in men is that if the inflammation is controlled that we hope that obviates or eliminates the risk of Carcinoma Carcinoma their largest. Study we have of men and his three hundred men from London. Uk and and people that had their disease controlled. None of those men developed carcinoma insight. You were SCC. It's not the study was a few years. Yeah but it's something. So we like to hope that active inflammation. That's causing that pre-cancerous Chris Cooper setting that environment up. We don't know that for sure. Even when someone has quiescent disease I still make sure followed annually by someone be that me or their primary care. Doctor and do you tend to put those people similarly I guess about the the Parallel with all of our. You know often times. We'll settle them with an ultra potent steroid and then flip over to something like two Colo Mess. Do you do the same type of thing or do you just tend to use like low potency? Topical Steroids less frequently overtime. I will tend to do. And there's no Recipe book on this people have their own patterns and things they do all over the world. I will try an ultra potent steroid for a month to get things under control but remind people that that is not something we just keep doing. Over and over and over again I will then use anywhere from a lower to medium potency. Steroid or calcitonin inhibitor. If they have access on a more long-term basis again my real fixation point is to make sure the information for the most part is always controlled if someone constantly has active disease that's always read despite daily hydrocortisone daily to Crawl Mus. I'm not happy with that. Bethany control to me. So that's not an enduring solution. In men unlike and women we do have the option of circumcision. Which in men of normal body hazardous is always. Curative it is a discussion. Yes posters had people that have had to go that route but It's always challenging surgery. I think for them to endure as adults. I will say that the men that I've and I can think of dozens now that I've witnessed through the process. The vast majority of them are really happy. They've done because they're more comfortable during sex. They don't have possibly use creams their skin cracking splitting all the time. They feel more mentally piece that they don't know they they probably don't have an increased risk of skin cancer anymore. It is a surgery there are possible side effects certainly but by and large it can be quite helpful for people absolutely. It's probably more the idea of the surgery rather than the outcome of surgery which so often the case so do. Is there anything that you think I mean? This is obviously a high level. There's so many things you can think about in terms of general policy and it's not feasible to discuss them all in depth but is there any big area that you think we haven't talked about or like some clinical. Pearl that you're just like really think they're residents should hear it. I mean you're resins. But what about the non? You've teepee interesting interesting question. I'm trying to think I feel like things like trying to again. Remember SWAB. Also rations scrape scaly skin for tenure. Are Important are important things to do? I think a focused physical exam can be helpful. If you're thinking of like implants or psoriasis. Looking at other places for those caught like implant several times that way I think in terms of what I really try when a clinical case walks into my clinic. I really try to have the residents be able to see it are. The signs of sclerosis can be settled at first a lot of textbooks. Have that you know sort of end stage. Sclerotic White. Nobody's yeah at that point. It's quite obvious earlier on. It can be more diffuse. Air Fema Inflammation. It can be hard to tell from. Zunes balance sometimes some hints. Though are that Zunes Valenite. It's tends not to be scarring Lichen Sclerosis. People will start to have adhesions where the inner foreskin kind of sticks in adheres to glance penis. They'll have friendlier damage. Other friends will become sclerotic and can on can be totally destroyed. Frankly and those can be some of the earlier signs of Lichens closys before someone gets to the point where they have large white. Plaques can't pull the foreskin back that kind of stuff right yeah. Excellent points and stuff. That's really important to think of. And I think the thing I always try to pass onto. Learners is like. Don't forget to ask about the genital skin or look at the general scan because it's just because it's not the most necessarily comfortable thing for people to either show or people to ask about. I feel like we really need to be looking at that area. And the more you look at the more you can have that idea of what the spectrum of normal unquote normal is great. There is some variation there I do. I offered on all my full skin exam when someone's referred for whatever reason I do ask. The uptake is not huge. But I always at least ask about trying to make it very casual as because I do ask it many times. A day populations that I'm a little Pushier in our HIV positive and organ transplant immunosuppressed populations because their risk of HPV mediated SCC is astronomically higher hundred for so I. If if an average person off the street who has immuno competent declines? I will leave it at that. If someone who's GONNA compromise declines at least make them aware of their increased risk yeah and that someone should be looking at least once a year. Good Point Yeah. That's an excellent point. Well Listen Phil I wanted to thank you so much for joining me to have this riveting discussion because you know I I learned a few tidbits and reminded myself a few things. So thank you so much for joining me. I really appreciate you so much for having me. I appreciate it as well. That was Dr Phil Doiron. He's director of the Dermatology Program at the University of Toronto and a staff dermatologist at women's College Hospital. That's it for this episode of Dermot Logs. Please be sure to subscribe. So you don't miss upcoming episodes. If you have questions for us you can reach us on twitter at CD Ender Atoll Aji or a TDA president. Thanks so much for listening in until next time. I'm Dr Kerry Ferdie.

psoriasis scaly skin trainee Your Center Lichen Sclerosis Dr Phil Doiron genital psoriasis HIV Volvo epinephrine University of Toronto Sun Pharma Halifax Gold Standard Urology Canada Inc Matala G program director Infectious Diseases US Christopher bunker
Healing eczema and skin conditions from a non-diet approach, with Christa Biegler

Real Talk with Dana | Nutrition, Health

57:32 min | 3 months ago

Healing eczema and skin conditions from a non-diet approach, with Christa Biegler

"Welcome to the real talk with Dana podcast. I'm your host Dana. Montes licensed Dietitian nutritionist and body image coach. This show you'll learn how to listen to entrust your body instead of trying to control it, we'll dig into the healing power of nutrition from a non diet weight inclusive had every size approach. My guests and I will guide you through how to heal from digestive issues and hormonal imbalances all while making peace with food and your body without obsession or restriction. Hey guys and welcome back to the real talk with Dana podcast with me your host. Dana obviously. We have a `nother nutrition, nerdy science ish episode today from a non, diet approach and our guest. Today is Krista Bigler who is an award-winning dentition, nutritionist, online educator, and the host of the less stressed life podcast, which you may have listened to before because we have. Have a lot of overlap in our philosophies as you will see, so Chris specializes in helping health conscious high performance women overcome bloating fatigue and food reactions. She's often the owner of exit, nutritionist, Dot Com and the author of the extra relief, Diet and cookbook and today to know and surprise. We're talking about ECZEMA PSORIASIS. Acne and other skin conditions in. We're talking. Talking specifically about the pitfalls of conventional treatment of these skin conditions, the different subtypes Eczema and what those types can actually tell us about the best route causeway to treat it, and the major roadblocks to healing eggs, and these other skin conditions then were also diving into the weeds about how to use a non diet, non restrictive approach to healing skin conditions because. Because there's a very popular non-steroid approach or like a food as medicine kind of prescription here is to cut out a bunch of different foods and doing elimination diet, which is very popular as you'll hear in the trying to treat skin conditions with a elimination diet approach Krista is actually talking about the dangers of long-term food restriction in exile or any other condition. I'm excited to get a little bit nerdy with you. where non diet approaches to some little nerdy nutrition science things specifically we're in be talking about exit in skin conditions, but I would love to know. If and I know you do, but if you have a personal story that led you to where you are today in terms of being a Dietitian and then specifically specializing in the treatment of skin conditions as well. Well I. Mean these are stories to different is actually the first one I was just always interest like I. It's funny because I think as a child. I was like a quote unquote picking eater, and it worked in restaurants in high school I. Just I would talk to cook into showing me. And I had to make something so I could eat it for free and I mean that's literally the purpose, but there was my first restaurant job though. Woman and man who owned it. They had bought it kind of from an uncle who was like letting the restaurant go into the ground, and she was at Isis, and he was a food scientist and she would teach me little things that I just thought were so interesting, and that was probably one major factor on how I decided to become. Just it was always. Always like it always always just interested in this I'm just like learning about it and I just thought it was fun so I, really like the quick nutshell of becoming a decision and honestly I did some job shadowing. I always thought it was awesome like I. Always like all these different areas somethings. I didn't like as much but I always enjoyed it so. Actually as total tangent, I would just go for both journals antitax because I wanted to write about nutrition, because I felt like a lot of stuff out. There wasn't like that. Awesome and I did try that for a while, but I found podcast way more fun so i. don't actually write for a living I actually see clients right in podcast and things like that, and it's still a great way. Way Be, but it's it's. It's still the investigative side right and you connect and give people information and integrate way, so, but as far as The exit thing that was like definitely didn't want to embrace that that was really my personal story, and so you know with eggs may actually had a friend, a kind of a colleague that I was helping mentor the other day dietician and she said. Do, you know if you know it's like a normal gut issue or one that I actually do something about it and I said you know it's funny in the way you. The answer is in the way you ask it. Because something is only as big of a problem as you view it to be so in a similar way. I thought my exit that I had in high school was just kind of normal I thought it was genetic familial like other people. My family had had a and of course, because it's the as big as the toolboxes. Honestly you use some different creams, and you're like okay, it's. It's on and off its worst during this season during the season and I'm GonNa live with it, but it wasn't until I took. My I was an adult, and took my children to a week of swimming lessons, and in there's the this is the thing about Eczema is. It's like you listen to what's better and worse for and it helps you understand how to fix it in minds, the tricky annoying kind in so after five or seven days at the pool straight like taking him swimming lessons every day. I broke out in this horrendous rash, and it was handily on my face and on my neck. So I, barely talk about it with anyone. No, so it's like it was really a horrible experience. which a lot of times our body will give us whispers of things at once. I mean body, awareness, big, big, big deal right into like working toward body. Awareness is a big deal, but if you don't think it's a problem, it's not a problem and Intel, sometimes like often I'll. I'll talk to people. And until it shows up on their skin, ignored a lot of other signs and symptoms right and I did the same thing until you've Renault about them. Sometimes are little sub clinical things. You may not worry about him until the you're like Oh actually. This is kind of awful and I am actually dealing with it pretty significantly so coincidentally. This was around the. Early, time, but my private practice. Probably meant that was also under more stress. Because when you're starting something new, and it's a newer thing to you. You're just naturally more stress whether even realize it at that time or not so I. Really didn't want to deal with the extra piece at all. It took me a long time to fix I. Looked for people to help me to fix it, but it turns out. There's not a lot of people who do that. actually like there's a lot of like generic boxes, but not a lot of good stuff, so I kind of collected a lot of things took me a lot longer to fix than I would've liked and I don't know. Know if you wanted the story, this song someone, but it's funny how things happen? I'm always interested in how things manifest because they don't just fall into your lap. Always right I didn't want to work with eggs. Emma initially, but someone had asked. need to give a presentation in a facebook group about the difference between allergies and sensitivities and intolerance is and whatnot, so I did that, and I had a couple of women that wanted me to help their kiddos with ECZEMA, and honestly the rest is history. It was like Oh this works. We can do this and it was really rewarding, and it's a big big big need so here we are. A couple of years three four five years later. Whatever it is, but it's interesting because it's been an interesting journey how effective people by skin issues and we call, we call a myriad of skin issues like sometimes one or two names. You know which is sort of a disservice, isn't it? So yes, that's the nutshell of things Yat will so thank you for sharing that and you're right it is. It's so tricky because Eczema in all of these other skin conditions. There's there's no like one thing that works for them. But that is part of the traditional treatment is like. Oh, here's steroid grams like it's on your skin. Just do the topical things, but you don't really think about unless you take more of a functional approach going from the root and coming up, so you mentioned that Weiner Story. There's a couple of different kinds of EXUMA, but people just say Eczema so. Can you go into a little bit more about like what are the different kinds or manifestations of X. amount because I bet a lot of people don't know about that. Right so let's talk about how the world classifies it. And then I've actually been really mulling over this because I've been doing it for a long time in my head and I've just now kind of created a little bit of a quiz for it to try to help people because honestly what I used to tell people. Was You have the you know you had the kind I had which sucks? And then you've got this other kind, which is a little bit more straightforward. If you kind of knows exactly what to do, and so, but the world views, Zima actually I think there's eleven may be subtypes of of exodus. Typically, we're not even talking about the other skin rashes right because their psoriasis, which looks a little different. There's Asia which looks different. There's acne and there's a few other things but eggs. Zima is maybe ten subtypes just under that, so there's contact dermatitis hand, dermatitis, topic Dermatitis Exmoor, the same thing just to be clear, which isn't always obvious, seborrheic dermatitis, which is usually on the head, and actually on that note. There is a fungal called Malaysia and it goes from like shoulders up, and so we often think that that's fungal, so you see it as early as cradle cap rate, but is a huge problem or not like. Does it become a thing, or does it not really become? A thing is really the thing, so it's like we all have we all have this. Bacteria are microscopic. Go System have microbiome, which is our fungal ecosystem which we don't we don't. We're not. We're not super savvy with science yet like we know it's there, but we're not like when they say. Oh, we're still learning about the microbiome like we're really still learning about the microbiome, so actually says a side note. When you do Fungal Cultures `bacterial cultures which can be very important. We can talk about that It's actually a really big deal if something's infected on the outside, but as far as fungal culture, sometimes, they're not that accurate, which I learned from a a term that I had interviewed because, and I had seen that happen in practice. Oh Man! We really think this is fungal accents responding to fungal things, but it was cultured negative just because it's not that accurate there is N-. Mueller, dermatitis which is like round circles, and sometimes it makes you I just got off the phone with line. She's like it makes me freak out because you can get ringworm. which you know, is that a thing? And then so new Mueller I mean, there's many many different types, but also total side, no of like sometimes even the dry feet with a skin peeling off. That can be I'm not saying ECZEMA, but it's a skin manifestation as well so there's different. We're using one name for many types, which is kind of problem because if you don't create some certain subtypes than you're going to try to. To put the same treatment toward everything, which doesn't work as you had mentioned. Yes, our toolbox, small steroids and skin does go from the inside, outside Nice to be aware of in the other tricky part about skin issues is that we want them to be simpler than they are so actually. I prefer to see someone with Crohn's Colitis, which sounds horrific. Great sounds like a kind of a crappy condition. But it's almost easier because you don't have to convince someone that it's coming from the inside out right but that's really what what we see, so let me talk about my subtypes, and then we can also maybe talk about like when we're talking about the inside out, actually dropped us in here because I think it's useful or appropriate. We usually think about Exuma as we know it is, it coexists with staphylococcus, Aureus or particular bacterial strain on the. The, skin right, so so just to be aware right like there is, we've already said there's a bacterial balance going on in the skin, and by the way some topical use allow for that to proliferate, because they have a different Ph, and so they allow for it to become worse. There's like many angles we can learn this trump, but in general as a skin issue, it's now more difficult because now we have to go from the outside. And the inside right and a lot of times we're only looking at from the outside, instead of dealing with the too, but we do need to deal with from inside so I look at skinny. She's just a little bit differently and one. Because when you have we've had an issue about you. I'm because I don't know what your personal story is as well, but we have an issue. You tend to have A. A more intimate knowledge of it right like I know more than I would like to about that problem, and so when you have that intimate knowledge in the listen really well how it behaves to people you start to of categorize and sub type as well so I have just a few that I've that I've kind of put into buckets and I would call one inflammatory subtype in this is the kind of like. It very commonly as presenting the elbow creases behind the knees, other places, kind of pinker redder spotted actually with darker melon and skin. By the way the skin can look darker. I'm supposed to have a an episode totally about that 'cause. That's really tricky and sometimes this gets misdiagnosed. Overall as as measured so kind of the opposite of what we would think, sometimes so anyway, but the typical kind of the inflammatory kind this may also coincide with seasonal allergies or food allergies it may. Get worse with certain hormonal things or not. It may get worse with in the summer. It may get worse from. Anyway, essentially like it's kind of a typical, or it's like I think you've been adult. Sometimes, it always starts this, and then it can kind of. Become multi-layered, so the other kinds I have inflammatory, which is honestly a lot of things underneath that umbrella, which is I mean inflammatory sort of me is sort of. Ridiculous term rate, it means a lot of things, but I've kind kinda grouped it because it's all like I'm still working on more guts off. And then the other one is more environmental, and that's the one I had. You may have heard that because I was at that pool. That was kind of the straw that broke the camel's back, so there was still the inflammatory piece, but I'd added on the environmental stressors, and that was where it really manifested in created problem, so this type of stuff is when people have like a lot of chemical sensitivities, contact dermatitis right so they're touching things that are kind of reacting to it. or they have like an environmental trigger of some type. So this a little bit different thing. I, focus on and I know that when it becomes, it tends to have been either there for longer, so that'll happen to adults so. So with Kiddos is almost always almost always inflammatory at least the ones icy, but sometimes it does kind of delve into that other one, and then the third is stressed and I wouldn't say that's always on its own, but it's always a piece of the puzzle. How do you get away from talking about that? I'm so interested in how your body physiologically changes under stress, right so different things happen in your stomach, your micro outta changes it allows things to manifest rate. I would say like one thing I'm trying to get better about being very clear to people's I want them to know. Hey, if you already have the cards for skin issue that means like genetically like I'm kind of predisposed a little bit more like I might have stuff, Sean but my skin instead of like. This other condition like it's GonNa. Show up on my skin, so if you already have those cards, it's possible that like sometimes you're going to. Play the game a little bit goofy right and you're gonNA have a little bit of a relapse possibility or you're a little bit more predisposed, so it's really about understanding how to call nut flair, and then play those cards rights. You don't have those continuous flares if that makes sense and I think that's where like the stress piece comes in in. That can be difficult like I just heard from a past. Past client who said hey? Kinda back slid a little bit. And of course you brought up. She was like with this whole. The state of the world problem like I all everything was kind of messy and Mike well. When that happens, we have shifts in it allows for other stuff to come in and take hold essentially like and you've seen this in a very. We've all seen in a simplistic way. Life is stressful, and maybe we're not getting. It could be vacation. I'm not getting as much sleep and come down with something right, or it's after like finish a big project and I stayed up late or whatever or under more stress, and then after that happened, I got sick. Guess what that unused secretary, edgy all that stuff get suppressed without any just allow something to come in and take hold where normally our Our defenses would be a little bit better. So many angles off I go to many tangents, but. But there's there's all conventional subtypes, and then what are those actually tell you and so literally I can't find this in the research, but this is just where I'm like Oh. Yes, you Mueller. Yes, you respond under inflammatory of contact. Oh, you respond under environmental, literally also I'm trying to convey is that is a longer healing process in this one, so inflammatory would be a little bit more quickly. If you kind of know what you're, you can be kind of strategic and work on those pieces whereas environmental. It's like Oh, it's you know it's a few more things here, so so help a little bit what? Yeah we as to what's what's interesting is in the in all of the let's say conventional subtypes right like the ten or eleven different ones we look at those, and then we also look at the way that all of them are attempted to be treated right with topical steroids and when you were describing them, it's like Oh. That's interesting. It's just showing how it's manifesting on the body, but it doesn't tell you about. Looking at the title tells you basically here's a confirmation of your symptoms right, but it doesn't tell you what to do about it, and even by you just dividing those into the three subtypes it it's comes from more of a functional like whole body root cause approach tells you not only what it is, but exactly what you have to do about it, and that's going from deeper level whether it's addressing gut issues or addressing the inflammatory response or the stress, response or anything like that, so we've kind of talked about like what's the number one issue with the Conventional Treatment It doesn't go to the root cause. It's just doing the. It's just doing really the surface level, literally the surface level of the skin, but I thought that it was so interesting when you said that some of the topical treatments can actually make it worse because it's not using the right P. H., o. while these are just like body products that you use and so I wanna say this correctly because. I actually learned about this kind of I was I was helping write an article for kind of dermatology cme site, and so it had to be it was I almost died because I did mine on micronutrients implicated in all skin conditions I think ought to be fifteen hundred words. Mine was like seven thousand and sixty something citations I. This is why. It was like an I did a short amount of because it came on the team lake, but anyway so learned about this through their staff, and actually their whole symposium on the integrative naturopathic approaches to dermatology is free because of sponsorship. If anyone is like a nutrition, professional or a health professional, they wanted to go check it out. We could probably find that link for. For you we know with, we have the stomachs overgrowth, so we know we don't really WanNa like lean into that too much, but the like the human body has ph levels all over the place inside your stomach is really low ph acidic. It's supposed to kill things right, whereas with a really high ph or more at line page, it allows for certain bacterial overgrowth. But as far as topically, which is not common knowledge, but it's out there. It's in the literature is all well sited There is an up. If you have things that are higher pige like, let's say you're using a particular like just off the shelf skin product, and it actually has a higher Ph. a lot of them have higher peaches. That's going to allow staff Arias to over grow more so. Than some other things that are a little bit more neutral, and it's just like I. Don't want to give brand names, but they're just like the most generic things there can range from like about eight to eleven to twelve, and that's very alkaline. So neutrals at seven acidic is under seven climbs above seven, and if you're using those popular cleansers. Very Standard names that are high Ph and we're allowing staff overdosed to happen. We're just like exacerbating. That's all you know so, and the bottom line is this is like. You can Google and find this extremely well, right? This was like hard for this doctor to put together because it was like you had to pull from a lot of sources, but what I wanna say is that I actually just recommend you. Go with the simplest product possible the whole thing like how do you support your skin on the exterior? Remember because it's interior. Extra Etcetera expert on the supported on the exterior actually say. Like to talk about things in triads, because it makes it simpler, I always say like there's a cleansing peace and kind of kind of sort of an antimicrobial piece that some have to want to stay at that way, but like there's a cleansing gruber like if there's actual staff overgrowth happening than you need to be like conferencing, not sort of and there's a different. The dermatologist been recommending this for a long time putting a cup of bleach in a baffler I find like ice shiver. Some as it works fine, but like as someone who broke out from chlorine, which is basically bleach I shiver at that I'm like okay. There's some other ways you could be a little bit advantage to and I will say. I will sometimes suggest you have to be so careful proxided. Proxy is actually superabrasive, too, but it will evaporate, so you be. You are so careful. Please do this to a child as an adult. Your skin like has a bigger barrier with skin issues. You have thinner skin barrier anyway, so my point is is the Kobe version I will recommend using like food grade hydroxide, but you put it in like a cup and a whole bathwater kind of wait and let it of do it sting for a little bit in you as an adult, you would try like there should be plenty dilute, but you have to be so careful because they use a relation on proximity. You like you'll burn. So that's not cool either so you have to be careful with these things, and bleach I honestly think very caustic as well right. We also have to be careful with that one. Which is why I was okay. Mentioning the proxy thing, it's like the one that's usually talked about. His is quite caustic. Right in so anyway, so there is the cleansing version, which is what we're generally talking about. The Clintons Ian is is very often high alkaline. So like what can you do this very simple? Right the other tricky thing, and like this is just sort of like a. let's think beyond the normal. Were like soap, people right like soap soap, but with Xm A- We have these natural oils on our skin, and those are protective barrier, so if we're always stripping the oils away constantly, we're GONNA. Make it much worse. There is like a whole lot of people out there with really horrible handbags right now who have to wash their like crazy people right now right and it's really stripping oil, so just continues to offend offended. Offend the already compromised barrier the back of the trial, so we've got cleansing into the point of the cleansing conversation that. You can use some different things at home, right? You like Afonso Ping. And then you need to wash every single partly washed the parts that actually need to be washed instead of like scrubbing soap all over your body, and really stripping your your skin up natural oils, right and drying out. That's something anyone could use that tip honestly like. Is this really extremely dirty right now or is it? connect-. Will it rinse off? The shampoo etc.. So it got cleansing. We got into microbial ish stuff like kind of trying to work on that topical staff situation, and then we've got nourishing and healing baths and I love those and that's kind of like different varieties. There I pretty much. The there are multiple options. There are rice fastened oatmeal Aston Lurch Literature I personally just use Salt Baz. Because you're getting a quite a bit of magnesium, they're topically absorbed, and then some of the salts have other additives that are really nourishing to the skin so anyway i. do think. It would be would be remiss. If I didn't mention like externally. You can be very supportive but internally regardless you have to calm it from the outside and also calm and nourish from the inside as well. Yeah, definitely, so, can you talk a little bit more? Let's go a little bit deeper and in so in your clinical practice, and when you've worked with people what are some of the most common like roadblocks to healing ECZEMA and other skin conditions. Oh. Yeah, absolutely so. This is a great question. Because I always kind of us a framework and teach people like here's how you here's how you fish, and like now you should be able to fish, but people always get stuck at these initial roadblocks I think there's four or five here. So, and we've kind of talked about them. In different ways, so one is stress, and again I really love the physiology of stress, so when stress or cortisol goes up with dumping magnesium, which is going to have a lot of different factors. It's GonNa Affect the stomach acid, which is going allow bacteria to come in and set up residence it can. Also, there are just other physiological manifestations that happen the Michael. Beta and a Lotta Times of terrible flair will come after a stressful period, so it's it makes a difference anytime. Fighter flight is activated more than rest and Digest. You can just hear the problem there. We are not rest digestion absorbing nutrients. ETC, so stressed is a thing. And a lot of times we don't realize how significant to this so I'm not saying like Oh relax stressed on I'm like Oh, I'm just really interested in what happened to your nutrients in your body while you were under stress and like now we go in and clean up. That stuff on stress is one big roadblock, but when people don't like are unable to slow down and do anything about it. I promise you're not going to advance actually with the current events. Events of the world right now. I had a couple of people that it was a really big blessing for because otherwise they were gone so much traveling so much like flying across the world so much that they couldn't stop and work on things long enough to make the progress that they needed so for a few people. It was just like exactly what they need right. They needed that like intentional resting point, one of my friends called at the glorious reset. Even though she lost a business and she was like it was glorious rate, and she needed nick, she said I needed to because of destroying my health so thing, the next one up would be environmental things. Environmental Toxins Environmental stressors, so let's pretend and I don't think even I said. One of the subtypes is environmental something that sometimes gets pulled. This is A. A possible cause of skin issues. It definitely is I would say. Is it as common as we think I? Don't know about that so like mold growth in house mice. What I'm saying is if you are living in a house that's got these environmental exposures, and you can't get rid of them. It's going to be pretty hard to heal another one. That's kind of tricky because people don't always have pain is like tooth infections. We didn't always we went and think about it like that, but I'm saying like. If you've created an environment that doesn't allow this to heal, then that's your problem, right? So that's what I'm saying, when I'm saying environmental and it can come in multiple ways, people are like using products that are not support. That are like allowing staff to overgrown or something. That's a barrier right so there's all of that. People have already adjusted those things before they get to. The professional practitioner those are things you can simply do at home. You can clean up your You can change out your products, etc and I guarantee anyone that's dealt with eggs. That's you know not that good has has done that already, right? That's kind of one of the first things people do is adjust their products, so stress environmental things, toxins, etc, garbage, like whatever the environment is and then the next two I spend more time on and practice, but one of them is food stressors. So that can be. TALKED ABOUT FOOD AS A. Broken Ankle analogy to that amendment so food and then got imbalances with the last two, so let me mention how food sometime helps sometimes doesn't help. So food is sort of like can feel like sitting on the couch if you have a broken ankle, if you make some adjustments that are causing large amounts of inflammation of the skin right now, but sitting on the couch forever doesn't heal the broken ankle like you need to go, put a cast on an elevated, and I said and you know, give it the rest of the needs, etc, in order to heal at long term so that we can run again because if you're just going to sit on the couch, like might feel good, so this is when people get into restriction because they've read like. Take this out this out. they get into restriction forever, and some people digging themselves into quite a whole, and actually it makes the skin flares worse because if we restrict too much for too long, we actually decrease the macrobiotic diversity in our gut. We decrease the diversity. It makes it easier for bad imbalances to come in and take hold. That are related to skin issues, so we talked about staff Arias overgrowth on the skin. Definitely we I. See Staff Arias overgrowth on the inside as well so talking about cutting balances. So you know as a Dietitian, I really always started. People come and they're like. Yeah, help me food. Stuff and I always did a lot of food. Things at first until I was like Dang I need like something else here. And so that's what I really got into like gut, remodeling and gut imbalances and things like that because it until you fix got imbalances. Basically nothing works right. Like it throws a wrench into natural enzyme processes that should right, and it looks like a disaster like earlier today. Skirl said I had. A Mosa for my university because she's like I. Don't really drink for a drink like maybe vary seasonally over the last three years. Because I've noticed flaring things from it, I'll get redness. Get Hot or whatever? And Yeah, these were the weird stupid things. When we were like eating things in processes that would normally happen to break things down and move out aren't working right and essentially. If you have something showing up on your skin, your body's not moving something out because your body gets rid of things, one of four ways like I'm jump around four away three ways whatever gets rid of things in multiple ways it gets rid of things through bowels, urine skin in the paddocks right, so it's like you've been swelling. People get swollen before their period rate but just a backup to those barriers. If you don't address fully stress, environmental factors food things. If it's a stressor for that person isn't always and I would say like. Like sometimes, it gets too much. It just depends on who you're listening to is pretty much the answer to that right like I'll get Dietitians and they're like I didn't know there was any food relationship here. I hear that a lot right? I were plenty of dieticians and their children and answer. I didn't think there was anything and then some people come, and they've already restricted a bunch of things and they're like. This seemed like I was working out. It's not working. Yes, that is a problem and so the what I'm trying to say as you can't sit on the couch forever and just expect to run again like it doesn't work, and so got imbalances or a big deal. For Making you be able to digest in in use nutrients right? ETC, so lots of details are, but if you don't have those stressors in the right place, and then the last one that sometimes with brought up is really mindset stuff because if you're not if you don't really think it's a problem, then it's not a problem for you, so you can just move on with your life. But if you are annoyed by it than it is a problem like your body shows you things, right? It's always trying to whisper things. And by the time as we talked about earlier like my buddy was whispering things, but I didn't even notice them until show button link. Hello Map to show up like this now. Dulles all over. That's that's when it becomes a bigger room so in you address, so is that kind of go over that with people but in that can seem a little over one, but like this is just one fourth of the first step like each of those pieces and so. I. Don't even understand how you can go about most or any health condition, especially excellent without being extremely brands of because I won't be able to understand the things I want you to because I don't want people to say. Can I avoid this and like? Will it work Yeah, it's not really that simple like some people have had that experience or like. Sometimes we found like there's some very light research in the seventies. That said yes. You could do this but what we often see more often especially united just finished that article I had written that article that I. I almost died from about fat soluble nutrients for skin issues, and what? I was I was actually kind of distraught what I found I really feel like nutrient is become a secondary problem like to one of those first barriers like Oh this broke down deficiencies, which is further exacerbating it. It's what I find is I guess you went on this nutrient? The end they saw so much improvement in skin issues, but then they went off, and maybe had some had relapsed, didn't why because we still when you're talking about what causes? What's the root causes of that nutrient issue? Digesting absorbing however, you manufacturing, how are you making a all those all those details so anyway? It's a fun. It's like for me. It's fun because I like like a deep topic like something investigative, but like you have to be in the right mindset. If you don't right if you're like I, just need a thing real. Quick for fixing US then you know you're probably better off with the steroid. 'cause it's the the goal of the steroid is just to turn off the light switch. It's like or to turn off the inflammation. It's only gets fixing it. It's just like oh now. The inflammation Oh, awesome worked. That was fun now off the steroid and sometimes pops right back. With vengeance actually, and that is a concern and the other big concern about steroid. Use Long term there's. No shame and using steroids hundred percent because you need to sleep for. You need to not be miserable for, too. But. there is a whole sub category of people that have pretty horrific actions coming off of them, and the other thing of steroids is that they're supposed to be used short-term and tapered off, and that's not very well educated about in this. It's like Oh. You're your kid. You have a little spot lake. Here's an steroid cream and sometimes that works out, and it's not like a big deal, but I I still have a used steroids for a very short ish time like overall shortish timeframe between high school, in maybe a little bit of college and I still have like thinner skin in the places I. Use them because it's the side effects. So I just I just want people to be informed about things right, and that often gets missed especially with quick appointments, or like not a lot of appointments I don't know I'm so biased, right I'm like you have to understand things in order to fix them right like if you don't understand things, how do you fix them? But everyone's kind of a different place, and that's why I would think a mindset is superior, because if you're not quite ready to deal with the thing in a comprehensive way, then doesn't really matter like. You know we won't have that conversation, 'cause. It's wasted their right so now people know. I love that and you knew the whole understanding pieces so important too because. We are in the conventional medicine world like in in the Western culture were so used to kind of outsourcing the answers to other people and to practitioners experts in link, obviously, experts and practitioners are extremely necessary. That's why we became practitioners in the first place, right? But at the same time, we also need to learn to listen to entrust our bodies. What they're telling us because we know our personal bodies better than anyone else will. I love how you said like your body's GonNa. Keep whispering to you and it's like telling you these things as yelling at you and we kind of tend to ignore these things if It film, it's only like a little bit of acne or just like a little bit of Eggs Malik. It'll be fine I. don't need to make major life overhaul until something like spring twenty twenty happens, and then it's like you'd literally yelling at you. And then all of a sudden. We were getting this like inflection patients like Oh, my God, what do I do? Do like well. Definitely. One of the things that's causing you to flare is unfortunately something that we can't get rid of so now we need to go to these other root causes and see what they are, but at the same time the interesting thing that you keep reiterating here is like the gut imbalances, and then also the food stressors right and people assume. At again conventional right like Oh. You got a gut imbalance here. Attack this elimination diet on it. Oh, you've got a skin imbalanced. Tack this elimination. Diet on it, but like you said. Even, though that's a common prescription for skin issues, writer for gut issues is to like cut out a bunch of different foods and doing elimination diet, but then there's also these dangers of long-term food restriction non only for amount, but also for the issues and the stress is used that can lead to even further problems. Absolutely so there are some crazy things out there for a horrific and our people be like do this six food elimination Iot. And people do like people will sometimes see. Oh, I'm seeing a flare or relationship, so they'll back up more and more and more, and what is telling me more so is you're not digesting break food issues into like two categories. Are you having a reaction of food like an allergy sensitivity intolerance, which all of that has its gray area? Honestly it really does, or are you having a problem? Problem Digesting Food, because if you have a problem digesting food and may feel a little bit different, but it's going to pause the other type of food reaction for some for something listening allergies aren't valid. They are hundred percent valid, but by the way when you're Kiddo is three and under the allergy tested, we may grow out of that on purpose, because your immune system is developing. So we don't actually know if they're gonNA, stick or not, and the ideally at the end of the day we can like get testing. Get Chesney gift testing, but can we improve the overall immune system? Because by the way we're inoculated birth, and sometimes we are. We are at a disadvantage because life happens. It's happened with Mike at like life happened. Sorry, does you have a couple of years to influence the immune system and you want to write? Write like you don't WanNa kill that sick all the time I am jumping back to kids, and it's because one two three or five percent of adults are affected with Eczema and ten to twenty percent of kids are affected with that so likely. A lot of people are listening to it on behalf of someone. They know that's a younger person, honestly kind of by a judge Brown to that a little bit like statistically. You probably know a child with excellent. So, yeah, the long-term elimination is not in the thing is and I'm sure you see this as well. It's like elimination diets. If someone has a good food, relationship could possibly have a place at one point, but we are feel that there is a movement to move away from that as a primary or only intervention I hope it is I think we are as well because my concern is. What if someone really is like oh? Yeah, I think the concern is I. See progress initially and then I I feel like I have to keep doing that only that thing, but I feel like there's multiple other pieces that help you sustain. Those things in the goal is a the broadest most colorful awesome like nourishing. Diet, you love you know in that you enjoy. You're just feel normal, and you're not thinking the problem is hunter new thinking about food as a concern or something that's worrying are stressing like. How much is that being your stressor? I think that's the concern like if you're thinking about this. A lot or at all during the day other than like hey, I got up. I need 'cause. It's lunch and I. Love Food and I would like to go do that. You give your about. If you're over stressing too much, it's time to step back and just like. Take a pause and realize Oh, shoot! This is a bit of a problem. I want to you know what I want you to know is like. Are you going to sit on the couch forever with a broken ankle like that's essentially what? This is like a UNICENTER forever You can't just restrict everything forever. There are things that we know that can be a little bit more irritating to. A lot of times that breaks down to They're just more difficult things to digest. There's a little bit more difficult so. We can spend this conversation. Many ways I'm glad we're having a because I. don't want it to seem like food is the only wanted to seem like it doesn't have a role. It can have a role for sure it's nourishing when skin grows when every cell makes up the skin right all the cells makeup skin, and it's growing like and nutrients makes getting cells, like. Of course it can be supportive. Right like we wanted to be able to. We want to be able to digest an similarly the food we have, so we can get the most out of it because it's kind of annoying. Making an effort to have a great, you know food intake our whatever. And you're not even able to use those nutrients. That's exciting, right? That's a good waste of money and time. So anyway lots of pieces here. Yeah, and then you know when you talk about, so we've got the two pieces of like food issues. I think even just added a third one, too is like when you have when food is constantly on your mind, and your constantly stressing about it whether it's because you feel like you should be eating certain foods or he shouldn't be eating. Eating certain foods, or if you're afraid that eating certain foods is GonNa, caused you these reactions, even that stress of thinking about those foods or thinking about restricting those foods, and whether you should or shouldn't be eating. Them can turn on the stress response, which can then lead to a flare up of the skin conditions that you're trying to get rid of by eliminating these foods. Yes absolutely I'm glad you brought that up. Because that's such a good point and I think sometimes it's so hard to see. This when you're in the thick of it, the how dare say this when you're not dealing with what I'm dealing with, or whatever right as listener, but I would say I i. do I am familiar with the feeling of throwing spaghetti at the wall because it just sucks at that Moma, I am familiar with wind up in the middle and ransacking your covers in looking for something upon your skin. Because you're like, it can't go to sleep. I am familiar with signs. What I want you to know? Is that when things calm down? this won't be. This'll be easier to grasp right, and sometimes it just feels I think the problem is and I've done a lot of I'm working on. A Better, but I see this as A. Issue for for people, not having tools for this and not everyone's able. You know one person can work with everyone right cow do I continue to improve because podcast are amazing. They allow us a whole section or to like changed the way someone feels or change like or give you hope or give you a Pearl or whatever? But what about beyond that? As well so anyway? I'm just been I've been thinking about all that quite a bit and so. I, just want you to know like there's there's like. You can be kind of strategic as my point, and what I what I'm learning from people as I'm pulling them, as they're just overwhelmed with like what do I do next right, and so I just I just want people. There are frameworks guides and I would just. Caution you on anything that looks crazy restrictive for too long, because or you know with anything anything that looks crazy restrictive for too long is a bit of is a bit of problem, and that's the big concern is I'm I just want people to know like? Hey, there's other steps that help kind of things up and make things like magazine. Don't have crazy reactions in so it's just easier to say it right right now. What I understand it may fall like. It can fall on like how dare you say like that has a problem or not a problem in the throes of it, and I get that it is stressful, but it will be less. It'll be easier as it starts to calm down which we all have I think. A lot of people with skin issues. They'll have ups and downs. Sometimes. It's just really chronic, and it's gotten really bad and you're in a horrific. Like I had had but a lot of times. There's ups and downs. I'm hoping at minimum we can. We can reach the people that like have. Those ups and downs to realize like Oh. Yeah, maybe it's not as normal as I thought it was, and maybe there is another thing. Maybe I should listen to a few other symptoms like one of the common things. I liked potential or love to see Go along with skin issues. Jihad like normal perfect bowel movements like a banana every day because if you don't if we're talking about those methods of elimination, if you've got a three. If you've got the freeway backed up, you know what is the what are the liver was delivering to say like his skin buddy. Can you help me out here like I'm? Kinda backed up and I could use a place for the trash and. So here! We are on the skin. Exactly. Yeah, we'll. Even though there are so many different manifestations of X. men, there's so many different reasons why it happens and treatment methods and everything. It sounds like definitely one overarching factor that needs to be addressed. Is The gut right, so can you we? talked a little bit about the gut skin connection before on the podcast, but can you talk specifically about how exit could be related to things like CBO or bacterial imbalance or anything like that? Oh, absolutely, so we were talking earlier about staff Arias on the skin being thing I definitely see staff in strap being overgrowth overgrown inside the microbiome actually H. Pylori. So this is kind of like a gray zone because we think thirty h pylori affects thirty percent of the US population in the first time I heard that at a conference I was like. Gosh I think I heard that wrong and then I was at another conference a month later, and it came up again. I was like Oh and then it became a little bit super interested in that topic for a while and so. The goal of me. Saying this isn't like. Please don't go jump down that rabbit hole There's ways to figure this out, but I'm just saying that there's a lot of bacterial imbalances Morgan Ella for example Cup Sihala. Less officer means specially like when it when it grows and dies so there's just I would just call these weeds in when there's bad than good. It'll affect things going on in your skin and a bunch of other symptoms. Do like sometimes when you feel like I have this weird. Random and crazy. You can thank bacterial imbalances for a lot of things like all kinds of weird stuff. You. Said something about CBO. So and I do WANNA! Mention this so conventionally were becoming more. You know we're becoming more like hey. CBO's thing think it's been around for what fifteen seventeen years something like that? It's kind of kind of recognized, but there's also a lot of stuff out there like Oh, I can't heal this or whatever so small overgrowth. In my opinion, we're basically looking at two gases We're looking to `bacterial right in this long test, which is like? there would be a lot more bacteria going on the large like I look at largely large intestine and I'll use these terms. CBO enlarge vowel imbalances interchangeably, because if someone's not fixing small imbalance, please go downstream and be like okay. These things are not totally like silo off from each other whatsoever and so Actually, don't even look at Stephanie more if someone feels like bloated or they have digestive stuff whatsoever zero two hours after a meal I will say like yeah, you might have some imbalances that are not allowing you to break down and process things as well as you should. So now look at the large intestine and see what those things are because. If this is to bacteria in volunteer Stein I'm really like. I'm really only catching sliver of this, but we do know in the literature, because the CBO's little morale well recognize people is related to Rose Asia is related Texoma we know each other is related to xmatch excetera. sometimes that stuff is a little bit harder to find, but it is in there. So when we have imbalance bacteria, we're not going to break down. Certain enzymes that will create foodery, I'm sorry. Skin reactions essentially so. I mean worse case scenario like if you're listening to this, that's cool. I would say start with a probiotic I because because the other stuff is not always extra simple to deal with and I would say in general. Sometimes we think that gut things when we were out there like breeding and googling stuff it kind of looks like yeah, I shouldn't bone broth into this other stuff, and like as not really doubt simple. Sorry, it just isn't and so I think the simplest thing to say a podcast is if you haven't used any kind of product or tried some different things than I would start there. There because a probiotic. Even it has, it has its flaws, think about it like turf, grass or like? It doesn't always take hold, or it's kind of like a cool. Get a party in. It's like wants to invite other cool kids to the party. We're trying to bite more good stuff. You know the bad stuff so it's sort of like you can just try one, and you can try to different doses new. Try a different one and see if it makes any difference at all and sometimes. VR issues for a long time walnut. Sometimes it will right so, but it's a good like simple thing to trial and test play with at least for a bit of time and it doesn't. It doesn't require restriction either. Some decent is a decent option to trial. Earn start. Are there specific strands in the literature that you found are helpful for? ECZEMA, the bubble or show the bubble or like different manifestations of it. Yeah, there is some and do you think I would say those like off the top of my head? No, because I in practice I don't use them. There is actually I mentioned this so there is a product called skin NASA, and it has five think five strains of got around her more. It's got five strains of and I've used this a little bit, but I think that responds a little bit better to psoriasis. or Response a little bit better. Just in what I've used for. It's got five. I believe clinically researched transfer both ECZEMA answer. Sings at that can be an okay option for sure. I tend to use for based products because they jive well with like other things I'm doing for the so that's really my preference, but there are some other bacteria that Jimmy my book. There are some specific strains so they are. LACTOBACILLUS CELERA's They found that. One in a low say it had to just an overall improvement in in the research. There's something called score out like. Is basically like reduction lesions and. Symptoms so. Like the outcome is there's not like a a huge percentage here, so bifida bacteria Rebbe Y Y. LACTOBACILLUS! LS A one. LACTOBACILLUS, para, que case, avenue one. Freeze dried lactobacillus, various and Bacteria. Bri- Yaro three and saccharomyces thermo files, so those are some however I know skin has another product and they are using five. Her research backed strains. Force rises and EXUMA and I have found I. Don't use it as much because I kind of like a process I'm going through. Typically, some people come to me on their product like you can stay on this until we get to a point where we're going to just shift a little bit and that's fine, and some people have found some sort of works for them, or they're using something. That's Kinda high dose in that's. Totally, cool without us up things that you come with as long as it's not your dating. And then I found that sometimes like. Psoriasis. it's. Now the company there says uses for three months to relieve confer a benefit now in general. We're just talking about probiotics. Just take, it can happen quickly, but if that's the only tool you're using, it would take a while to you know things can happen quickly but it also take off more times I would just give it. Just give it a fair amount of time. and sometimes a low dose wouldn't wouldn't be. That useful either you can play around with the dose as well, but we do know some time. Sometimes you'll see made a little bit worse short-term. Sometimes, it'll just be better so I just want to know either within can happen depending on what's going on in the. And then again I. Don't always use the ones that we have in the research for this. Because one finding a product that's got these things altogether is been an issue, and then sometimes I'm doing other things in the gut. Where would they survive as well? No, so I will use some him. SACCHAROMYCES Belotti, which is kind of an Antifungal type probiotic sometimes, or I'll use other spices, sacrifices the lardy. room stable temperatures stable, etc, sports probiotic, and so I tend to use those just because they're a little bit each us. If something's complicated us, it's annoying so looking for like the right fit of things essentially yeah, and just for the listeners. I asked that question because we were talking about CBO. Before there are certain gut conditions. Where if you notice you take probiotics and you feel worse. It's probably because you have a bacterial imbalance of more of the weeds like you mentioned right, and if you have more of those weeds and you're taking probiotics, they're feeding the bacteria and making you feel. Feel worse so if you feel like you, have you know you have and you think you have some gut issues going on? which as we've talked about on this show? You have asthma. You definitely have some issues going on. You don't want to just like. Go to the store and get like. Oh, whatever like this broad spectrum probiotic? In case you do have some kind of underlying bacterial imbalance. If you've tried those in, you start to feel worse definitely time to work with like a gut specialist practitioner as you can figure out what's going on in actually how you can start feeling better. Yet into just tat attack gone to something you said I see that a lot with products, and sometimes that's not even a well understood things we think about prebiotics is kind of being food for probiotics in what products are supposed to do is feed gut bacteria, but as practitioners say if people take prebiotics and see a little bit of a worsening symptoms, we actually do feel pretty strongly that they probably feed bacteria as well and so I. think that can go multiple ways anything also taking products infield. Could. Also it just totally depends on the type It can also be am I. Trying to nudge this out in it also like feels over there, those multiple scenarios for sure and so you know like I, think our bottom line here that we're trying to say is like gut. Health isn't quite straightforward as products Umbro Broth. Not so sorry, it's not. It's not as straightforward sometimes you do need to like look inside and see what's going on. Am a proponent of that and I feel like a lot of clients say like I'm just ready for like I'm sick of guessing what's going on right so I mean you don't have to you can always experiment some things you can. Change up some things, but I'm just saying you have options I. Think the bottom line is I want people to know they have options frequently. People come and say I've tried all these things I've tried everything and like I doubt it. Doubt they tried everything, but you know I'll listen to all the things that you said so exactly. Did mention also that you had a book. It came out right in the middle of quarantine and the spring. So if people have eggs, or they know someone who has eggs, IMA or skin conditions, or if they just want to learn more about everything that we were talking about today, tell us a little bit more about the book. And they'll tell you the kind of reason I wrote the book. Because when I was getting clients coming in and being really restrictive, they were coming, and they were breeding another exit book and. I felt like they would just be restricted and I thought you know I think. There's room in the market for another one that talks about food and its impact on. And talks about the research there, but also gives someone an actionable thing that they can do and says you need to move on like if this is not if you like, evaluate an and realize that this problem because a lot of people will like randomly, try things, and then it starts to become like a all year of their life, and they're like that I've now Adams. I'm just overwhelmed 'cause it's taken so long and so I'm like. Can we do this efficiently all at once? ETC, so the whole. That was kind of like my. My motivation for writing the book which is called. The Relief Diet and cookbook short-term your plans to accom- flare ups but that was like primarily. The reasons to the First Section is like backgrounder, and it talks about some of those causes in the second piece is just recipes. Really and the rest is good for like anymore with allergies. Honestly, so it kind of considers all those things. In the goal is not to be overly restrictive for too long, but you know. I had to cut out like ten words for the publisher I wanted to, of course wanted right like a lot of things. You want to solve everyone's problem all at once and there were like there is not room, says a cookbook as well Krista and so. I just took the I took the tip and I like finished the book. And then now I've got so people will say I'm overwhelmed, so I have a little masterclass that is current I. Don't know when this will come out, but in a couple of weeks it will be free to go through live with people, and it's basically like a guide on where I go through like. Like literally strategically like start here than this SMS depending on the subtype. You have like your subtype and then here's a guy like where you could go from there. which I think is a missing piece right there, so if it's up when this comes out, it will be on one of my websites. It'll say like you can join us. Free masterclass will make sure it's there because it's not live yet, but it's going to be happening over the next couple of weeks. And then speaking of books unrelated to while could be related to Eczema, but could also be unrelated. One thing that I love asking my guests is what is one book that you think everyone should read. Oh, actually I do know the answer that question. If you're a woman, I think. A great book. If you're like a nerdy science, person is really liked the period or pierre-emmanuel by Lara Bryden, I. Mean Gets A. Women's manual I always recommend kinds that are interested in hormone Steph to read it in a jar together. Because I'm like this, will the you will understand your body better, which is. Kind of what I'm after like I want you to understand your body better, but a book. That was really transformative bike for anyone that changed. My life was i. only half of it was the mindset by KEROUAC and most people are familiar with that book. And I just read part of the early parts of it. but I thought that was like because I didn't realize what mindset I was in until I. Read that book years ago, so that was very transformative in so if someone isn't. Aware of what stage of mindset that they're in than I would recommend. Starting there will definitely put this in the show notes in Chris. Thank you so much for coming on the podcast today besides your book, tell people all of the places that they can find you. Yes, so we've kind of like. I have my regular upset with my podcast and everything on it, and that's at less stressed nutrition dot com, because it's less stress, life podcast, and honestly if you're here. You found this enjoyable then I'd love to see you there. Because podcastone is my favorite so so that's one place and then I have another site called examine nutritionist, and there is an associated instagram per both of those so we just kind of put them in different places where people can find exactly what they're looking for a little bit more easily great and we'll be sure those and the link to the masterclass in the show notes so people can sign up for that to. Hey there. Thanks for listening to the real talk with Dana podcast with me, your host, Dana, obviously and I just wanted to say you're the best. If you enjoyed the show, please share it with your family and friends. Maybe send a five star reading review on Itunes or wherever you listen to your podcast. Why would you do that? Yeah, asked because this helps more people find the show so that we can spread the food and body piece word breakdown die culture, and the unrealistic beauty standards that make us all feel like we need to shrink ourselves with food and exercise in order to be worthy in the world, which sucks for discussion on the show episodes. If you WANNA requesting. Question, if you'd like some support, please join the Non Diet community on Facebook Free Group, where you can go get some community and support I'll see you over there and see you next week.

Eczema Mueller Arias Dana contact dermatitis PSORIASIS CBO US Krista Bigler Intel Mike Asia Dot Com scientist Montes Chris Dietitian nutritionist Zima bloating Google
Ross and Carrie Meet Britt Hermes: Former Naturopath Edition

Oh No Ross and Carrie

49:59 min | 1 year ago

Ross and Carrie Meet Britt Hermes: Former Naturopath Edition

"Rawson listen carried the show where we don't just report on fringe science spirituality and claims of the paranormal no no no no no. No we take pride ourselves. That's right when they make the claims. We show up so you don't have to. I'm ross blocher and i'm kerri pappy have a very special guest today. Yeah we're excited about this so you may remember a few months ago now. We got our own. Diplomas is as natural paths so we are now certified on some level but we have someone far more qualified to tell us about the world of natural at the and the science around it and that is britain hermes welcome brit hi. Thanks so much for having me well. Thank you for making time for us. You have an amazing story. Lori and i don't wanna even summarize it off the bat because i want to have you towelettes so what initially drew you to naturopathy. Oh wow well it goes all the way back to my teenage years when to try to make a long story a little bit shorter. I had a bad experience with a doctor who diagnosed me with psoriasis. I was a teenager. I was living in the los angeles area. That's very self conscious us about my looks of course and i was looking for a sure treatment plan to make me feel comfortable showing my skin again. I essentially had these large plaques of psoriasis which i don't know if you're familiar with but it's sort of like an auto inflammatory skin condition where you develop these red ed sort of raised silvery scaled lesions and it's it can be disfiguring. It's unsightly and i was pretty embarrassed about it and i was fairly fairly familiar with the disease because my mom has it and so i had seen her struggle with it for years and take pretty serious medications and essentially when i started to develop the symptoms my mom was like oh yeah. We know what this is of course go to my dermatologist. You know he'll give you some medicine and you know carry on with life and so that's what i did i went and saw this old sort of grouchy dermatologist best and he recommended steroids which was expected because i knew that that was the medicine that my mom took but then i wanted to engage with him further about what psoriasis is first of all. I didn't have any understanding of what it was. It is knew that i had it now and i assumed it was genetic because my my mom obviously but i also wanted to know like you know other skin products that are contributing as my diet contributing. Can i have control all over this in some way or you know. Is it like okay from sixteen for the rest of my life. Am i going to have to use these medications and he essentially was like sorry kid. <hes> bad luck. This is the way it is and when he saw that i started to get upset into actually cry. He was just like get over it. It's not that big of a deal. You know it's not life life threatening you're over reacting and that's what set me on the course of of hating doctors really and just feeling distrustful of medicine listen and feeling like my feelings were not going to be validated in a medical setting so when the doctor said oh sorry kid was he saying you're. We're gonna take this medicine forever yeah. That was my understanding out it okay for sure and i was like i don't want to believe you. I don't i don't accept zapped or rather like challenge accepted like when i go well improved prove you wrong and figure out some other way and that led me down own slowly but surely this path of just looking for anything alternative to medicine at first. I didn't really like conceptualize actualized it this way or even really understand that that's what i was doing. It was more like you know learning about healthy foods and incorporating more healthy foods into my died and then in coming up with the fad which was to give up soda and i was like okay so i won't drink coca cola now because that seems to be the healthy thing to do and you know i taking supplements that i saw being advertised i went and looked up specific foods and supplements that might help with these inflammatory skin conditions attends and ate everything and took everything that was on the list eventually went to college blah blah blah just curious any of those things help ah one of our refrains on our shows that i have eczema on the bottom of my foot and i've been trying various things over the years including steroid creams now which have helped up to but did any of these things that you were trying to help the psoriasis get better well. This rice has got better but i was doing all of these things in conjunction with using steroids okay so hard separate those so my in my mind i was like it's all of these other things that is helping us. Rice has got better not not the magical medicine of steroids. I think that's a pretty common experience where like when people are doing something medicinal like real medicinal plus something else they attribute more power that can give credit wherever you want. Well yeah so then you decided to help others by by getting into naturopathy. It sounds like it was kind of a selfless act or at least something that you thought you could help others by getting cert. Yeah i mean i don't know if i would call it selfless selfless but i would call it delusional you know so i started to develop this idea that medicine was very incomplete pleat and not patient centered and that going to medical school would not provide me with the tools that i needed to be a good clinician. What in fact i needed was a more air quote holistic education that looked at the lifestyle of the patient and mike with doctors thus far had been lifestyle doesn't matter it doesn't actually matter what you do at all. It doesn't matter what you eat you know you get diseases are you don't and then you take this this medication and hopefully it works for you and so that approach didn't work for me. Yeah sure like emotionally. It didn't work for me and so i felt like naturopathy. Apathy was the medicine of the future. So where did you go for your schooling and if you don't mind saying how much did that cost and what was it like so i graduated graduated from san diego state with a bachelor's and then i went to naturopathic school at best year university outside of seattle washington and it costs as much as going to harvard medical woes all my gosh i had no yeah i borrowed hundreds of thousands of dollars to go. Oh auber it. I'm sorry i know i know. I know it's so this is the part of the story where i dislike. Take that piece of information and we put it in a box and then think about it. It is natural oppa. The-they're main thing at astier astier yeah is that they're kind of yeah. It's their bread and butter now chris so it started. I believe it started out as a naturopathic school and it's developed the new curricula in the meantime so now they offer programs acupuncture and traditional chinese medicine. I think there's like a clinton nicole nutrition degree are- there there's a whole host of other things at various collegiate levels so now from undergraduate all the way to the so-called graduate level and i say so called yeah. I don't really believe that like getting a doctorate and naturopathy as really graduate school. Was there anything while you were there. Stood out to you as a red flag made. You worry a little bit like wait a second. What kind of education is this kind of. You know i went in really naive and really ready to take in in everything in a very uncritical willingness to learn openminded sort of way. I do not know much about alternative medicine before i started school at best year so i really believed that alternative medicine or naturopathic medicine centered on counseling lean nutritional counseling sort of motivational counseling with the patient getting to know the patient in this specific way to help that patient asian make important and difficult to implement changes in their life. I believed supplements. Were part of this sort of like on a as needed basis s. I did not understand or know anything about acupuncture homeopathy. How naturopathy is basically based on in this like extraneous supplementation business and it's really a sort of a very close financial relationship between the supplement industry and a naturopathic practitioners eurodollar. I had never heard of our example so there was a lot of these satanic practices that i knew absolutely nothing about and was exposed to you and learned of my first years there and so in that s- homeopathy seem bizarre for example but i didn't know anything else ahead zero experience with it outside of this environment where people were like yeah go. Homeopathy homeopathy is amazing. Quantum blah blah and i was like oh. I don't know anything think about quantum physics quantum molecular add big word here now so they don't know either since i've never heard of this like you know i had never heard these terms before and like they were all strung together and so it sounded really profound and like oh. This is really special so on the one hand it was was well. This is strange homeopathy. Is this thing where there's actually no molecules left in the product and you just are given the sugar pill and the energetic. Whatever noushin of the substance makes you. He'll like that's odd but then i'm surrounded by hundreds of people who are like home amazing. Oh my gosh you should experiment armament this and so you start to get into the psyche of the nonsense you know and like you slowly start to become i really feel like i was slowly brainwashed by the whole process because because the blinders just got more and more narrow and like it became virtually impossible for me to take in and receive any outside aside critical information and i'm just curious you mentioned irritability. That's another one that just seems so how could even work what were some of the wilder are things that you learn their best year and did any of them kind of strike you as outlandish <hes> so i learned a bunch of wild things i don't know oh how many great examples i can pull off the top of my head but i i took a year of homeopathy courses and so to all sorts of like homeopathic a pathetic miracle stories for example patients being treated or venomous spider bites for example with with homeopathy. We learned a lot of a lot of like intravenous nutrient supplementation and so like we were basically told that you you could inject vitamins into patients and have these amazing therapeutic benefits when they aren't deficient in vitamin just like in general enron like anybody can benefit from intravenous vitamin c according to a natural path for example and did they ever have any arguments amongst themselves where some some professors may be would poo poo some of the ideas of others share. Yeah there was one there was one professor that i've met in my entire career who expressed some critical and skeptical ideas about naturopathic practices in particular homeopathy <hes> and i think that was important but it was such a lone voice and at the end of the day even though this professor was critical cole of many of these practices this professor also chose to work and make a living by teaching steer so it was a little bit you took look it took it with a grain of salt like you know. Maybe he's being too skeptical. You know maybe he chooses not to believe or use this one therapy but ninety nine percent the other natural path do right and if he really felt that way maybe he wouldn't be here yeah and truthfully. I don't know that i thought about it that hard. It was like you were kind of exposed to this criticism in class or on occasion perhaps in passing but then it was so easy to brush off and forget forget about because like i said there was so much other propaganda coming from everywhere else that it was just this little tiny piece of the overall picture so you then graduated with essentially what is the best qualification. You can have a natural path. Can you talk a bit about how you could advertise your credentials and then your practice that you set up after leaving school specifics of how a natural path who graduates from an accredited naturopathic school which is where i graduated from. There's a a handful of them in the country depends on the state so in washington where i worked originally and arizona where i worked later. I could call myself a doctor. I call myself myself physician. I could advertise myself as a primary care. I know that's really it's really misleading for super misleading so i could say i'm a family any medicine primary care physician. Oh wow who practices naturopathic medicine so people would come to me fully believing that i that i was a like a real full fledged doctor. Did they teach you basic. Things like here's how to use the stuff the scope here's how to check someone's reflexes yeah yeah for sure so we had a year of of this sort of physical exam lesson of how to do these things listening to heart sounds we had that fake patients like they do in real medical school where you common or you get to go and practice on fake patients and do a number of exams so a lot of that is set up to emulate unreal medical school and if you're looking at the course curricula and you're doing a side by side comparison on paper it really very much looks. It's like these two medical institutions parallel each other but there's a couple of important differences so in the naturopathic curricula even when you're taking courses titled cardiology or physical clinical diagnosis it's important for the public to know that these courses are being taught by natural paths so they're not being taught by people with p._h._d.'s on the subject or medical doctors and so all of the information that is being provided to the students has a naturopathic slant for example. If we learn about how to treat high blood pressure or hypertension we may perhaps learn about the most common medication used to treat treat this disease which are called stanton's. We're also going to learn a whole host of other natural pathak e stuff from the homeopathic remedy for patients with high blood pressure to all sorts of diet information that may or may not be supported by evidence. Sometimes it is sometimes it's not tons and tons sons of supplements. The clinician or the natura pass will say that they're teaching us whether the supplements and herbs and foods have interactions with the drugs but the truth is is that these herbs and stuff up laments and these types of interactions are very under studied so it's actually not accurate to be be able to say that we were providing students with the sort of well rounded education because the information just simply doesn't exist so i it's very misleading absolute. Ah were there any conditions that your patients would have that would cause you to refer them to an quote unquote although patrick doctor. How did you refer to people on the regular medical profession so while we were going through our training at best steer the naturopathic clinic did not have any medical facilities or any any capabilities to treat any urgent care or emergency patients so if a patient showed up to the clinic thinking they were having a serious asthma attack doc had a serious be staying. Perhaps we're having a heart attack all of these types of patients a broken bone all of these types of patients which are really the bread and butter of primary care family medicine all had to be referred out because it was impossible for the students and the natura pass at the best ear clinic to treat right these things. I'm glad they knew that much. Well yeah well. You know my ability now practice insurance. You're sort of you're required. It's really misleading because again like especially in a state like washington where naturopathic are allowed to advertise themselves as primary care practitioners. These are like super mainstay primary care conditions and it's like. I never saw each in for example. I never had to go through the triage process of a patient who i thought might be having having a heart attack which is like crazy when you think about it yeah to then go out and practice medicine and be like oh yeah baby to grandma and then nino when i was in practice outside of my training afterwards in seattle i worked at a family practice of made up of natural gas and i saw a lot of kids so there were kids that came in with breathing problems different respiratory conditions as mike symptoms i saw newborn babies who you were more jaundiced or yellow than i was comfortable treating and really felt like was beyond my my depth and those were all referred out and in in arizona i saw an older patient population and there were numerous patients that i thought had cancer for example that needed to be referred out to oncologist but that is not on typical like my go-to referring patients out like patients cannot go to a naturopathic and assume which unfortunately they do but they should not assume that the natural will know when it's appropriate to send them out for real medical care and wait naturopathy is actually within their field of competence because their field out of competence is like you know the size of a quarter it's team. How many years were you in practice. I practiced for about three and a half years. Okay okay and i assume people have kind of figured out now. Obviously you don't agree with former brit so you went through this amazing transition that not many people we'll have. Can you talk a bit about that. What what got you started in questioning where you were and what you were doing. I was in practice in arizona working at a naturopathic clinic. My boss who still owns and runs the clinic. There treats primarily cancer patients he still does and while i was there he he was giving patients. This medicine that was described as a natural like chemotherapy agents and this medicine was being brought into the practice. It was coming in overseas and then it was being injected intravenously into patients who might these patients all hanser. They all had different state of cancer so anything from stage one to terminal illness. Some of these patients had been other words escaping me but like like excused uh-huh from from oncology kerry stage for they were passed help said like there's nothing else that do for you. The treatment will cause more harm or ruin your quality of life so you know i recommend hospice whatnot and some of these patients came to the clinic for additional alternative cancer care what what was the what what's it called. This therapy is called ukraine country and basically what happened was the medicine just just didn't show up one day and this was really concerning because the patients were paying for the medication in advance and they're paying for in cash. The clinic clinic wouldn't accept any credit card for it yeah so it's like sites parents get. I said to him on like hey you know. The patients are concerned that this meant that ukraine hasn't shown up yet because our on this rudge demand of of the crane and you know they fully believe that at exactly and like you know it was sold to them like you have to do so many treatments and a certain amount of time otherwise therapy won't work and it costs thousands of dollars so it's like this whole thing and my boss was like oh oh you know. Maybe it was confiscated. You know maybe the f._d._a. Confiscated the package in the mail and i thought that was super strange and couldn't quite figure out like a why by the f._d._a. Would be interested in intercepting packages that were being sent to our clinic. If that was indeed what happened essentially i went home and started the two google the medication what it meant for the f._d._a. To be confiscating packages of medicine coming into the country what it meant to be importing and administering non f._d._a. Approved substances for the treatment of anything only to find out this is a big big deal and it is is illegal and could be considered a federal crime meaning dispensing that faulty medicine. That's what could be a crime right so importing reporting and administering a non f._d._a. Approved substance could be a crime ours understand at the way that the the u._s. Government the f._d._a. Look at it is that you know it hasn't gone through their vetting process and the medication could be very dangerous so like going around the government regulations to bring something in on your own discretion. He's putting patients in harm's way and was there a steep markup on the price of ukraine for the patients. I don't know what the markup was. The the patients were paying around ten thousand dollars for a treatment round as far as iran cheese is one of the traditional arguments against actual medicine. Listen is that oh well. They just want your money. It's a business well yes but so as naturopathy they want your money to oh my gosh. We made natural pass. We the collective naturopathic pathak we we made so much money off of supplements and these <hes> incestuous relationships supplement companies and crazy markups cups crazy mark one hundred percent markups so any patient that's buying a supplement out of an office are paying twice the wholesale price. At least hey kerry oh hear us us. You know hate to interrupt his interview with brit. Hermes talking to brit is fantastic yeah. But what an intelligent woman we'll get back to britain. I think it's important though that we take take a moment to talk about our teeth. Oh yeah yeah no. I feel yeah. She was talking. I was like hold up so germany you know her. Time is very important but my teeth hurt so what can we do to make our teeth as healthy and clean as possible well. That is a great question you you know sometimes we're rushing around in the morning you wanna get our teeth cleaned but maybe you just do a crappy job growth just doing the perfunctory up down left right. I'm done more somehow. How do i simplify my morning exactly you ross can actually simplify your morning and your evening and he's back into your post summer routine with a simpler electric toothbrush from quip funny enough. I have equipped toothbrush and it's fantastic well then. There's no way for me to simplify your morning routine. It's already perfect well. At least i can know in confidence as i use the sonic vibrations that cover the basics and just take two minutes that i am optimizing my performance on tooth exac- you just use your quip twice a day. It covers every part of your mouth in those two minutes. You know you're gonna make sure you hit each quadrant <music> and it has a multi use cover that doubles as a mirror mount. That's really convenient. 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Oh no now to find your perfect fitting bra and get fifteen percent off your first. I purchase that third love dot com slash. Oh no for fifteen percent off today all right now back to back so you saw that you were potentially. The clinic was breaking the law or doing something very dangerous. Where did you go from there. I went to a lawyer's office. Okay okay so far. I totally i totally freaked out. I was super super freaked out. I was incredibly upset. I felt like i had found myself. South in the middle of this massive medical scam yeah you could buy was worried about it's exactly right. I was super worried that patients were going to get that sick or you know suffer. Extra consequences extra side effects because it turns out that this drug had gone through the f._d._a. Approval process us and had been denied for serious side effects so like it wasn't just a benign natural substance there was actually real like chemo therapeutic agents and in the product and it was a very dangerous product or is continues to be a very dangerous product that causes really serious side effects potentially so i was totally you like huge. Emotional wreck just showed up at a lawyer's office monday morning at eight a._m. Like as soon as the law office open i didn't even call i just walked in and like went to the secretary's desk and i had lawyers name in mind that i had looked up and was supposed to be really good with malpractice and like in tears. I'm like i i would like to talk to lawyer so and so please just a total mess and he was so nice he came out and he's super super seasons super prestigious lawyer and he really patiently and kindly listened to my story with all of the minute show an extra mr detail because i i'm just reeling and he was super dry and super frank and he was like here's what you need to do you you need to quit. I'm going to help you do that. We need to report this crime. The attorney general's office right. I will help you do that. We need to contact the state licensing board or regulation board for natural gas. I will help you do that and you know now that you know you have a duty to report uh-huh so there's no there's no gray area here. You didn't know before we'll deal with that if we need to but you know now so you were ethically obligated gated act this is cut and dry and it was just so clarifying for me and so amazingly helpful to have someone like that helped me navigate yeah what i had additionally perceived to be a very sticky situation but actually turned out to be very like clear cut like you know this is clearly on the side of wrong and so yeah we're gonna move for no great knowledge and so you became an outspoken critic of natural up at the and i'm just so impressed by this because i think the typical human response is to sort of protect ourselves identity and the work that we've done you put so so much effort into this and time and money and devotion but you were able to criticize former brit and and the natural path that community itself off. How's that going for you gone from me. Well it's had highs and lows. There was a significant time gap between these two events so so i left that practice and the spring of two thousand fourteen and then i started speaking out in january february of two two thousand fifteen so i had some time to go through the grieving process <hes> which i definitely definitely did and it was during that grieving process that i became angry instead of sad and it was sort of that anger that fueled me to to do something about it. I really felt like i was duped. You you know it's one thing to accept that you're stupid and it's like okay. I did the stupid thing and there's massive financial consequences to that and i have to deal with that. Okay whatever but we were duping again. The collective naturopathic would be were duquesne patients and literally putting patient's lives at risk and there's this whole like professional machine that is working to recruit students into this naturopathic medicine program under in my opinion opinion. These false pretenses that naturopathy is equal to or as good as medicine so i went into this lucile blower mode really as a way to protect future students so they don't find themselves hundreds of thousands of dollars in debt and in a position where they literally can't ever pay that money off because they're not qualified to practice medicine and the sad reality is that most naturopathic clinics don't survive and a lot of people who get naturopathic degrees have to change careers and do something else in order to pay off that debt that's just like a harsh and sad reality and also to protect patients into sort of publicly apologize legit to the patients that i cared for and sold bogus mez and to inadvertently you know unwittingly and it's been that motivation to kind kind of move forward. It's been met with a lot of kindness from the science and skeptic community. You know folks like you a ton of support and that's it's been immensely sustaining and gratifying however it's also been met with a ton of vitriol from the naturopathic community community super-duper ostracize. I'm sure best your university wasn't thrilled about you talking about their program and i'm sure your former boss this wasn't thrilled and i know so i haven't heard a thing from my former boss which is probably a smart move on on his end but i've i was served a cease and desist letter from best year university basically demanding that i stopped speaking about them. They threatened to sue me and both germany where i live now and in the u._s. <hes> um and then i was threatened and then ultimately sued by another naturopathic from arizona who became very upset. I think pink over sort of persistent speaking out about the measly education of naturopathic so-called doctors and <hes> how scary the naturopathic cancer profession is this particular path. She treats cancer patients in her in in her arizona office and she uses things like the high doses of vitamin c and i don't <hes> we'll have to check her website. I don't remember if she does baking soda or hydrogen injured in peroxide famously but she doesn't want to let hold on while you're looking that up. Oh i hate to interrupt brit again off. Keep doing this but you just need to talk about quality entertainment mint incisive commentary impulsion yeah at some point. This podcast has to end and i'm sad about it but i need to fill my life with more audio after that. I'll be on a car ride and i've got a switch to something else. What can i listen to see you want something. That's either educational or entertaining haning improves your life comedy culture. Yes oh my gosh. I'm so glad you said that. Have you heard of max von max. Oh maximum fund podcast network so good. They make a lot of great shows like this one. Hi i'm dave hill from showbusiness and while i'm not from canada my grandfather other clearance vincent blake senior was and he wouldn't shut up about it. My grandfather moved onto that great penalty box in the sky way back in the eighties. Still we'll all these years later. I can't help but wonder what do we really know about canada and its people which is why my friend chris girls beckon i decided had to make so you're canadian brand new podcast from the maximum fund network on which i attempt to get to know our neighbors to the north one canadian at a time coming to maximum fund august twenty seven and i'm not sewri so once you had had realized that this cancer medicine was faulty. Did you then sort of back up and go oh now. I need to go go homeopathy now. I need to irritable adji. Was there sort of going back through history as here yeah so what happened was i left the practice and then found myself feeling like i they didn't know anything i felt super ignorant and i didn't even know how to move forward. Everything i knew was wrong. Basically so oh i found a book called trick or treatment alternative medicine trial great book written by ernst and simon singh and i went through this book chapter by chapter on a very pain staking sort of a slow fashion starting with the subjects that would not evoke an emotional response so like reading the acupuncture chapter was like okay you know i don't really know much about acupuncture and i didn't make money doing acupuncture so so i can read that chapter and and then moving to the chiropractic chapter for example and then slowly working my way up to the domains of naturopathy that i was intimate intimate with and it took months and months and months to get through this book. It sat on my bedside table for a long time intimidating book. I'm sure her intimidating book but just just painful mpho paid what it down and cry and cry and cry they come back to it ten days later it was really it was really really hard and then at the end of it i emailed edzard ernst to like thank you for this buck tuck and here's what's happening and he was so kind and gracious and awesome about it and i was just sort of actually the beginning reign of me thinking about becoming a whistle blower and wanting to speak out because he was like you should write about this. This is fascinating and no one's ever contacted contacted me. No one knows what you know like imagine. Yes you imagine experience yeah and so you started a log and is that what kind of where you came to prominence people started reading the blog. You're writing exactly so the for the way that i decided to go about it was launching a blog in early. Two thousand fifteen call naturopathic diaries dot com and just call it confessions of a of an ultra pathak doctor. I was not it was super emotional the initial post where diary entries and really dealt with why i got into naturopathy and the emotional harm that i suffered going through naturopathic school because one of the things that i came to realize sort of in hindsight was the mind f that is natural as sort of this like health and and healthfulness obsession and needing to embody it and feeling like i had to be the perfect representation of health in order to because the natural path that i could be i mean you guys are in l. A. m. this elliot's sort of like the prime example of this of like needing skinny and youthful and juice and d- talks and i can't have a pimple and like you know all of these things you now. I'd like to make time to meditate and be mindful and do yoga and also walk my dog and then i need the surf in the evening and then i have to do all of my tumor humor drinks in the middle and all my god. I can't have dairy now. I have to talk for ten days assistant. There was a lot a lot of that and it was super psychologically damaging for me really bad and i didn't have any any awareness of that was coming out the other end so there was a lot of like emotional processing diary entry sort of style post. Oh so you're talking about all of these efforts to stay healthy and connected ed. It's just interesting to hear you describe how unhealthy that can be when you take it to that level and it dominates your life yeah yeah we could. We could talk for five hours on it but basically like you can name an alternative therapy europe. Anything and i've done it like role thing animas check. I've hairpiece check done it. Wow so you mentioned that best asked year had sent you a cease and desist. I know you've had some legal tussles. How you emerged from that yes so i was sued here in germany <hes> in my hometown by this arizona naturopathic cancer quack named colleen hct who uses baking soda venus read paul <music> treat her patients. She stood me to silence me and we just found out a couple months ago that i won the case and i was awarded legal. Oh fees wonderful anti yeah. She decided not to appeal so it's like officially the fish over she lost right and you know things that then been a little bit quiet on both on my end because i'm reeducating myself. I'm getting a p._h._d. Gauge d i had a baby about a year ago so my my my life is moving on and i'm still trying to figure out the time management of family baby p._h._d. Gauged logging etcetera being on podcast. What is ask what is the p._h._d. You're studying for so it's in the field field of evolutionary genomics but what i actually do is studied the mammalian microbiome on the skin also super cool full circle story actually because i now find myself working with dermatologists and patients with auto inflammatory tori skin disorders and i am analyzing their skin micro biota which has just totally. I did not set out to do that. It just happened and life is crazy sometimes okay so then to take that story full circle when you're working with the dermatologists. Are you ever like hey. Here's what my matale just missed that you need to implement so people don't don't fall into natural grasp. No i haven't done it yet. We don't send any sixteen year olds off into home. Beyond what do so you think you know. Actual doctors can learn from your story. What is it that there may be not offering that they could yeah absolutely so it's about being present with with the patient and helping the patient feel heard and so i think the new generation of doctors. I think they're much better and this. I think there's an awareness. There's there's better bedside manner. There's a sense that patients need more than just a clinical diagnosis. You know they also need to be heard and have their emotional needs understood. We don't expect doctors to meet their emotional needs but to at least have that acknowledged i think is is really important for that physician patient interaction and so <hes> a lot of the doctors that i work with who are clinicians. Don't have a patient direct patient contact but i'm also finding that a lot of them. The ones that do are are younger and i sp there's more females in the field to and so there's a lot of this like nurture rain that comes into the clinical experience and i genuinely believe believe that it's it's getting better and there is a well rounded awareness that patients can't be viewed as clinical specimens yeah so then one thing that i kept hap- thinking as you were speaking is we often hear this argument that we shouldn't engage with these bad ideas because even engaging with them kind of lends them credence makes it seem seem like they're the other side of the discussion. I wondered what your take on that is. Should we be engaging naturopathy and people who practice it so that we can speak back so their claims or do you think that's kind of giving them credence. They don't deserve. I us it. Probably the the best answer is probably it depends but my answer is. We should not engage with them. I think it's really i think it's really easy to accidentally engage in this sort of false false dichotomy where giving platform to people who are promoting pseudoscientific ideas and fake medicine if there then you know put against against a real physician or someone with board certification in real training can provide the impression to the public that these people are on equal footing so just like a quick example. I was asked to be on the daytime television. Show the doctors and they wanted to have me on in addition to you currently practicing natura path and the whole discussion centered around like i am happy to go on the show the doctors and talk about alternative medicine in naturopathy and why i think it's dangerous but i'm not gonna do it alongside or like in a debate form of currently practicing natura path because they're just setting up this fall kadhamy like exactly like here are two options and go ahead public. You can decide when it's actually like that's not how it works. I think it's super unfair and super dangerous to. I don't think it's fair that the patient should have to vet thrown doctors so i don't think that like they should be like that. They should look up a doctor and read the words primary care physician and then have to stop and think wait a minute. What does that mean. Are they natura path. Are they a medical doctor. Who licensed them. Where do they go to school. Did they do a residency because if you're a natural path you didn't i do a residency or not licensed by the medical board etc etc etc and so i don't think it's fair for the public or for journalists or government bodies or really like like anyone in the public ire the media to sort of like continue to perpetuate these confusing terms to make it harder on the public than it already is interesting using it sounds like it's more of an argument for yes engage with the ideas but not necessarily the proponents of the idea right right so maybe like the it depends depends answer would be like depended upon the menu yeah you know so like if the venue clear like here we have a proxy naturopathy but let's be clear with a means it means is that they go to medical school that means that they didn't complete a residency that means a swazi then at least you're providing the public with all of the information so that is true informed consent can then exist it was a pretty extreme situation that led you to question where you're at and and i think you're pretty extraordinary in that. You did take that step to say okay. I need to own this and do something different. What do you think people can do to kind of help. People people who are in that profession or people who very much believe in naturopathy homeopathy to question those beliefs what sort of the the most productive way to have those conversations uh-huh right. I mean they need to happen. In person they need to happen slowly over time so it's not like a one and done conversation and the person has to be met where they're at with relevant life examples so you know coming to a patient who is healthy and dabbles apples in alternative therapies and coming to them and talking to them about like dangerous alternative cancer therapies probably isn't going to have the same impact then if you're talking to a cancer patient for example like talk to that patient long enough and know that patient well enough in order to find whatever that in is and then once you know that end then then you can tailor your your examples tailor your conversation to provide illustrative examples to help that patient or that person see the other side and so it's very requires an investment. It's very time consuming to do that. It's not it's not an easy fix yeah well. This has been amazing. Thank you so much for for it. Is there anything we didn't cover that. You wish we'd asked you know you guys did a good job thank you i can't state enough. Just how impressed i am with your story and how you really did own this whole you put yourself in and you climbed out of it and now you're doing something really productive in helping people. I think it's fantastic. That's nice. Thank you thank you. I really appreciate that. How can people follow you. You mentioned your blog. How else can people find your work and support you right so my blog naturopathic diaries dot com and i most active on twitter at natural diaries and that's where you'll find all information related to the past lawsuit and what i'm currently doing nice. I'll stick everyone. Go there. Thank you so much brit been wonderful to have you on the show. Yes thank thank you so much. Thank you thank you well again. Thank you to brit and that's for show our theme music is by brian keith dalton or administrative managers kramer. Our facebook is facebook. Dot com slash on rak and our twitter is podcast. You can support us by writing positive reviews on whatever delivery service you get this podcast from or by telling your friends or by going to maximum fun dot org slash donate and that's a really good way to help us. We have a lot of fun stuff coming coming up and some of it's expensive so come help us. Please and we forgot to ask brit for an an remember so we're going to quote bread from her. Your twitter feed which you should check out. Match your oh diaries and remember naturopathic. Medicine is only good for natural paths. Here's why money money <music> <music> <music> lesson. I'm a hotshot hollywood movie producer you have until i finished my glass of kombucha to pitch your idea idea. Go all right. It's called who shot ya a movie podcast. That isn't just a bunch of straight white dude's i'm if he why the new host of the show and a certified b._b._n. P b the end of black nerd. I'm a long rally an elderly gay and legit film critic who wrote a book on christmas movies clark allowed white lady for minnesota each week talk about a new movie in theaters and all the important issues going on in the film industry. It's like guess who's coming to dinner mitch cruising and if it helps seal the deal i can flex muscles while record each episode. I'm sorry this is podcast. I'm a movie producer. How did you get in here if he quick start flexing bicep lattes chess who shot ya dropping every friday maximum fun dot org or wherever you listen to podcasts maximum fund dot org comedy and culture artists owned audience supported.

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NutriMedical Report Show Wednesday Sept 11th 2019  Hour One  Jim Cole, Sonic Life, Sine Wave BEST Whole Body Exercise, EpiGenetic Mineral Resonance mRNA Gene Therapy, Sabbath Edenic EMF Protection, Nagalase Blocking Therapy,

NutriMedical Report

53:49 min | 1 year ago

NutriMedical Report Show Wednesday Sept 11th 2019 Hour One Jim Cole, Sonic Life, Sine Wave BEST Whole Body Exercise, EpiGenetic Mineral Resonance mRNA Gene Therapy, Sabbath Edenic EMF Protection, Nagalase Blocking Therapy,

"Well it's the doctor bill show presented by neutral medical dot com call eight one eight eight six four zero one and welcome back to the report. We Have Jim Cole here in Jim the latest life machine. Can you give us the updates. It's going great. It's all about moving your shoes. You know we want. I bought the machines then I could see that. Stagnation of fluid in lack lack of motion was really causing a lot of you know accelerated aging a lot of problems a lot of joint goblins and brought this machine. It's just been a miracle. Michael worker of the sensory form of exercise is not. There's not the thing you could do. I mean even rebound or you can't rebound it. You know anything over three or four Hertz. we're this machine to seventy hurts and then you take it into a whole another dimension with your resonant frequency so now it's an amazing device exchange a Lotta live. He'd never had a complaint and everybody loved him. It is amazing now. Where there's a couple of things we had yesterday borough. She's actually she a nurse's thirty five years. She's got a machine over a year ago and she's read the manual and updated. We talked about things like that are in prolapse and so on and it's a the big problem. Fifty percent of women over fifty actually haven't especially if they have multiple babies and one of the problems happens is even the young mother under thirty or forty that has has decided to get to physically active after they have their baby will sometimes was writing actually precipitated problem not only that we have man who have we call bladder laugh with their prostate. So the same thing can work you can do pelvic strengthening exercises with widow to pass rate or or Kegalle balls and you can improve things dramatically the average person in a couple of months on the machine sometimes we talked to go you know doing the regular cycle because if you go to the full frequency eight to ten hertz say forty percent power it really puts a lot of extra strain on the body so you gotTa make sure you're doing other excises laying on your back and insulin otherwise you may end up with a flair and the thing is it will cure it. It'll prevent you from needing big surgery. It's big surgery to do the ligaments in the problem. Is We just ligament surgery. It tends to recur. It doesn't get better if you don't strengthen the muscles so the the sonic life teen fixes that the what I go through the ten frequency go for the Tim Cycle and I have resistance bands bolted the ceiling on an athletic bar and free weights and I can tell you that ten minutes is given onto according to the physiological and hour and a half of aerobics plus. It has more things that are overseas ever. Do this is far better than cross fit or independent independent weightlifting or anything so whatever the kind of exercise you do you need a sonic life machine whole body sine wave vibration exercise continued each muscle group your bones ligaments connective tissue poppy. Bernard place and then we have the genetic frequency therapy and now of course I give machine they automatically get the Sabadell Sabbath identify frequencies to Larry regenerate their body with every major minor mineral and inaugurated Nautilus it passed into or cancer generates actually nocco your immune cells so your immune system can be tuned up to actually get rid of styles passages so the combination is amazing. I mean I've been trying for the last week or so. Using using the sonic life me was savvas identify frequency with Naga lays blocking frequencies and it's absolutely mind boggling and doing more the research when I do a console actually do either quantum testing and or blood testing whole blood blood testing and I'm working on any frequency analysis through the acupuncture yeah puncher point so I can actually take specific minerals in each organ based on a quantum test or a surface spectral analysis of the mineral deficiency in each organ where there's Z. State because every disease state is deficiency mineral and gene induction the regulates structural proteins and enzymes and we're actually now discovering covering that that every disease has that kind of signature interesting isn't it oh it's very interesting very interesting and there's and there's more and more research with actual clinical research coming out on the benefits vibration therapy and was honored. Gibe region and I know there is one that was published and we have copies of all of us if people would like a copy of it but the study was for trail sclerosis and they found that fifteen hurts and I've been doing fifteen hurts daily it fifteen hurts actually Louis arrest the trails Karosas from becoming a worse in some cases reversed. That's that's another frequency. They republished one study on on twenty five actually stimulated adipose tissue stem cells in the body a lot a lot of research going on with the whole-body vibration yeah exactly it makes a huge difference val the genetic frequencies air is the other side and you can actually hear the sound in the room because it says it has a broadcaster sound platform and the base but you also can put an ear Jackson listen to it and it was ipods or a headset while you're exercising the genetic frequency therapy is right now we can put the mineral amino acid residents and I've also can put resin frequencies into blocks Pacific passenger so you got lyme disease. Thirteen virus for example cancer has a Epstein Barr virus in fungi in particular cancers stealth infection saying vascular disease so so vague but the resonant frequency in an awful the passage along with taking our anti pathogenic like neutral dine. PLAS- Miocene Allison met etcetera if I can give you specific nutrients to rebuild your organs like for example. We've got my red deer velvet. Dr Witches Patents. I A product that brings you back to the Beatles. We don't age we use optimize Orca Kathleen and these specific Oregon Peptides and I'm actually working on extracting the radiology frequencies from the peptides there so can actually put broadcast frequency not into the sonic life machine so we're trying to regenerate your liver your heart whenever I can actually down the road. I'll build actually via specific frequency for specific Argon regeneration while you take the peptides or without dependents because the way they work actually is a Senate resonant frequency to help you real Argon because as a present proteins degrade aid that resonant frequencies tells. DNA It's time to rebuild the organ and I'm working on extracting that radio frequency from knee together Santa Frequency from the peptides that were developed by Dr Cabinet at Russian Academy Wall-to-wall Yeah so what we're doing here by the way you you're you're. The only distributor of these machines has support Cetera in North America so you're not going to get a better price and you can't get service. If you have managed to get one say overseas he's and ship it here. You won't get service Dr Deal. You need a purchase romy. Answer my distributors you. I think you have to people are distributed. North America and we have a few months. The GO-TO tried to see if she could get a rose and get an alternative or better price. I'm thinking why do that. We're going to give you the best price we can and they found out that Oh JIM is a master distributor so those two people just work for him. They're not gonNA give better pricing has because he has the best he's not over gouging people giving the best price you canvassed machine brought in from South Korea right exactly and we have full parts in stock. We have full support. we offer the two year warranty. There are fat-storing machine that are out there in the black market machines out there and unfortunately I mean they're. They're pretty much crooks that are selling those machines and they they do. They have no warranty. Though in some cases we've got a lot of complaints they they the money they haven't gotten the machine's always going to be a black market to everything and unfortunately there has been with the phonic machines and I've been bringing these machines exclusively since two thousand five two thousand six I with the triple phonic and then the sonics and it's everybody needs to come with come to us or give us a call. You know will say legitimate ones do or not and just eh going on out there. Most unscrupulous people have their account well. The problem is the world. There's always gougers. That'll do things of Chris. You don't provide support afterwards so he wants part right right the thing I find most amazing of all this is the and and again all of the other machines out there. They're non sine wave are traumatic to the body the joints and get rid of mine ahead one from. Deke and we also used it was called TRIPOS. I pay one called Beiber slim and those are in years ago years ago and this life is far superior. When I wanted to make joint sore afterwards it actually makes better and it actually regenerates your body jewelry. Pablo you verbally and in fact I find after machine I can make a few stretches in here. Poppy Papa Papa while I'm on the machine actually does chiropractic on you. It's kind of a chiropractor this legs time between chiropractic sessions to keep their spying in their join right. Oh you're you're in it. Yeah and I think something that don't something that people don't really address. A lot is the stress special uh-huh exercise with everything in our life and once we start just with the gay today and watching the news you know people's Cortisol levels or adrenaline levels or nerve Robert knepper muscles are going up and and these are things that have to be controlled and they will you know what those triplane machines. They're going in several directions at the same time time and a couple of those directions are not healthy and they're going to induce stress response over time for sure divest. Tell us to take a gel like and put it into your gel container on top one of these non sine wave machines and it'll it'll shatter the GEL apart. I mean horses are not good for your physical body Wadi. Where's the sign we won't do that now. We're things are going and I called nutrients. Determine I've coined you. Don't just I ne- nutrients you need nutrients and I'm GonNa go back a bit the Earth's magnetic flux field if falls and rises and right now. It's been falling for many tens of thousands of years years. at the time of Adam Eve was four thousand times stronger. Shuman residents of the earth the primary frequency at nine points hurt the side band frequencies and they affect practice called the Lynn Afaq which pro push electrons dealer overall shooter. DNA telomere antenna talks to you ryan channels and opened up and turned on messenger to make structural proteins eighteen since I've been all an enzyme is a protein wrapped around a mineral to make your break chemical bonds those building blocks of life. DNA doesn't go for anything other than protein. That's it every other metabolic activity body is due to an enzyme which is a protein wrapped around Mono Tomek mineral to make or break boss and everything to regulate saddest minerals or mental risen frequency so you don't have the mineral in your body which you need the right supplements and you don't have been residents. I called nutrients now. What's happening happening is we're. Introducing to the Environment Talk E toxins I call them which are frequencies that basically shut off your DNA and set off Brooklyn Message Ernie so if you have any toxin let's say a Murray Bell. sleipner ceiling should save every mercury in your body and anything in that vertical. I'm the periodic table of elements. It has a similar vaillant. It's GonNa Knock it out so Michael. Zinc and zinc Matala enzymes should be like copper zinc. Sob One so you're gonNA surge of superoxide. Re Free Radical in your body so depending on the particular enzymes molybdenum or mercury. Whatever if you knock on specific important minerals sometimes you get effects of maybe up to hundreds of different enzymes are are affected by toxic scaler. I call toxin. Do you like that E. Toxins talks any minerals nutrient minerals the for example we use in our Sabbath frequency. I one of the reasons why Adam and Eve lives along because we're they live. They actually lived in a place with sharing the e- I I called the denic Sabbath frequency of Sabbath piece. You're all minerals that were fixed by the Agra bacteria mycobacterium in soil that the plants Bryson's could pick up and then the plant would have food value vitamin content tastes in color without the mirror minerals becoming gamified by Agra bacteria plant resolves. Cam- take them up. They can't convert inorganic minerals to mentor organic ones now what they've done the soil since nineteen forties actually blasted the soil all to classic clean it with gases and what that does is kill off the acura bacteria so the mineral onto the soles dropped in some cases over ninety to ninety five percent of trace minerals important like chromium vanadium lifted them a no zinc and so's result what it does the food value of the food is dramatically less because it just put fertilizer president grow things and don't take things like minerals from the Dead Sea in Israel and actually put that into the into the mixture mineralized soil which is why they talked about the Bible Sabbath Rats. Now what my identify civil seventh frequencies do is they actually sent the frequency correct all the toxic effects of the radio on your home so they'll generate up to five hundred meters with affects up to twenty five miles so the little voice actually I'll give you the frequency the frequency antenna watch you broadcast almost like a shortwave radio broadcast based mineral residents have major minor minerals and Naga lased actually nocco Nagasaki's but but also the minerals to that liberty in change your tissues so you're counteracting the toxic effect of of e pollution Mukalla which is why fight fight network smart meters when towers out soon five six g network everywhere and so people need to realize we you need a nutrient now to rocky toxins because the with the toxins are actually shutting off for DNA. You know I can make you know I have skill Elsa non lethal weapon using this technology what else Aletha one and one of my guys back in the NFC back in July July sorry Beck in summer of Nineteen ninety-four explained to me in great detail how the make faced ray direct energy weapons the no such agency the NSA and military military so I understand the physics of peeling. No we have a positive good side might advice and of course sonic life machines sheen a savvas frequency with my ethnic frequenting testimony decided to do you have have difficulty taking supplements. Are you searching for a high-quality complete nutritional drink as your whole family will love neutral medical before has arrived all of your daily nutritional requirements in one quick delicious drink and talk there. Ville Eagles life support is a proprietary blend of vegan protein activated vitamins minerals Amino Acids probiotics anti-japanese enzymes anti-inflammatories cancer prevention detoxification and much more in your body will high five you for this one place before the vet complete nutritious meal replacement on the market whether you are an elite athlete have post operative challenges chronic illness elderly or family that you once a quick delicious drink. Dr Build Eagles life support for optimize optimize nutrition in one great tasting smoothie just add cold water almond milk cruise or anything else you like neutra medical life support. Try our great tasting chocolate or Vanilla Vanilla today call triple eight eight hundred seventy one or visit US online at neutral medical dot com neutral medical dot com for the whole family legacy merchandise foods is the top recommendation Dr Bells Eagle for the loss auction concentration the largest entrees so high savannah protein the most whilst varied entrees as well the longest food storage shed light nothing like legacy emergency foods. If you place a regular monthly order you get twenty percent off and free shipping. Do get an emergency foods for your supply for preparation and get it from legacy foods contact. Dr Bill Diggle for the LINCOLN DETRIMENTAL DOT COM Joe to the shop byproducts link and dropdown message at nutraceutical dot com and then place your orders for regular emergency food for yourself and your family. It's nothing like emergency food if the power goes out and you can't go to grocery stores or if there's an emergency in the national crisis so neutral medical com top recommendation recommendation legacy foods neutral medical dot com go to the shop. Buy Products have dropped on menu and stay well with nutraceutical every day of your life. Lumine photon therapy infrared light far aired fred is extremely important for pain control nitric oxide group revision and stem cell activation and reduction a psychiatrist. Dr Bill uses it for pain control for regeneration techniques for our generation and forced to mutation of your stem. Am Selectivity this amazing limit Photon therapy this year will probably have an additional device was frequency therapy during phase of the lights to obtain a photon machine contact Dr Bell at neutral medical dot com triple eight to onto an eight seventy one. He'll prescribe it was providing nutro-ceuticals to help with your regeneration Russian healing and pain control nothing like the limited Photon therapy for easy therapy for your is your pain your joints regeneration Oregon's detoxification indication of the body get a little time machine from Dr Bell diggle neutral medical dot com triple eight two and two thousand eight hundred seventy one to stay well with neutral medical the sonic life machines one of the most amazing therapies. Dr Bell provides is the best exercise machine on the planet doing whole body reparation opening up the muscle to reduce insulin resistance improve perfusion release stem cell therapy throughout the body and genetically stimulate the body to release. DNA activated the genetic therapy with the sine sine wave curve of frequencies given for Tomek residents but cited linus pauling for minerals and amino acids seem agency production messenger Naidu Prek structural protein protein enzyme deficiency for almost every illness. There's nothing like the sine wave therapy for improving healing for exercise but also genetic treatments. Dr Belkin provide can help neutralize Ramsey's for disease states in illness. Get an sonic life machines. Dr Bill at Neutral Medical Dot com contact attacked us at nutraceutical dot com triple eight two one two eight seventy one or go to the website neutral medical and give us a contact doctor bills available to help you get well with neutral medical need a powerful ally to fight daily bugs and Serious Pathogens Ellison Med is the powerful universal pathogen killer's latest advance of German sourced alison ends medically stabilize applies to clear the body of bacteria fungi Michael Bacteria and parasites it penetrates body biofilms and is non toxic to tissues pathogen resistance cannot develop develop for long-term body optimize wellness clear stealth pathogens that promote autoimmune disease cancer and vascular inflammation and plaque and promote healing of tissues now pathogen pathogen free with two hundred milligrams more power than prior al-Ahmed. You can't get a more powerful ally to fight daily bugs and serious pathogens. Give your body what it needs. Allison Med order Dr Bill Eagles Neutra Dine at triple eight two one two eight seven one or neutral medical dot com. That's AAA two one two eight eight seven one or neutral medical medical dot com and listen to the mission medical report on the Genesis Radio Network with open lines every weekday neutral medical dot com bringing nutrition and medicine together and welcome back. We have family from ruin photon. Welcome back Pamela Bill. How are you great now. Loom photons my buddy. I I have a machine gene by my right leg here. I won't these long pads is the blue pads for my skin issues which I use my fancy nutraceutical. 's In this pad I also have the smaller ones thirty two pets and at one eighty pat and I call my sleep buddy that wrap around my head and I actually take my nutraceutical and turn it on boom go to sleep and end you can use this for traumatic brain injury you can use it for regenerating your eyes and you're hearing and your John Factor going through a procedure called evils life where music and a dental appliances modifying my airway and nine months in I'm actually at the point now where I can actually do some tests to see if I can stop my bypass which means after twenty years I can actually turn it off off and won't need it anymore. Now actually modifies your bones and you can reverse NICA with this machine in other words. You can put the Pat over your jaw was Nico Frequencies. Yes and modify your gums and get rid of cavitational and help regenerate teasing your bones and your job. It's pretty amazing so there's infinite numbers of uses for living photon from the head. You can regenerate your hair of us. are things like our reciprocal hair tonic at our college's. Maxon neutral meds Royal Jelly and hormone blockers which we have you can use it for regenerating ear your brain your eyes and ears. You can use it along with her brain. Peptides Red Velvet NOCCO mizen. You can use it over your thyroid thyroid and parathyroid glands. You can use it over your lungs to turn off chronic obstructive lung disease mucus production in US over your heart. Stop in China it. Is it on your spine your bones regenerate your bone structure us on your skin and turn off pain in fact every post op recovery place whether it's dental or surgical should have these devices you use it to the literally turn off abdominal pain. You've got period pain and women are having regular cycles for uterine problems or if you have chronic gastritis straightness so uses a full neuropathy uses uses for regenerating joint and turning off arthritic pain. It's amazing isn't it. This device has I've got I mean every home should have you know hot and cold running water and they should have aluminum pat. I mean it's almost like having a shower. Do you have electricity. You should have aluminum pad and I usually tell me position too because they're gonNA end up blowing into their friends and relatives in original visiting relatives aren't GonNa back when see finding how good are they happens all the time does and of course if you have pets pets love it. I mean the pets you can't. You're not gonNA talk to them and say hey. I'm GonNa Talk Doc into thinking this pads good. If you have a dog that's got arthritis one larger dogs. This'll turn off their arthritis. You're trying to regenerate tissue. You've read your velvet which works in animals as well and you can use aluminum pat and turn off their pain and the pad the animals will they'll steal your pads of your way to the bathroom restroom. Use It on large animals like horses. some people have these new pet ponies. Now I saw a picture. We've lady brought her pet pony on a flight. I couldn't believe the dog actually so there were not released that scary and they're actually pretty pretty. Passive compared to some large dogs on flight are like you know pit bulls and stuff that you know if they bite you. They don't unlock their jaws. I don't take a pony will bite you but you tend to find animals then to age seven seven three times faster than humans so prone to arthritis and this is really good for bone isn't it yeah it is excellent for those those issues it will actually help to regenerate cartilage and tendon and bone and it will clear out scar tissue and take out the inflammation flirtation that leads to joint enlargement and so on and so forth washes out excess calcification which is wonderful to help reverse calcification education your heart ticker vitamin K to our call error CARDIOVASC- etc and a new head to limit photon over your chest and your China goes away and you could actually repeat your high speed. CT SCAN with takes eight seconds into your calcium score improve it's pretty amazing and what I tell people is the frequency real simple to follow frequency wanted to list demilitary demilitary frequency three is for your central nervous system including is years of bounce mechanism and your brain and your personal nurse frequently force for internal organs like like bowel stomach liver kidneys frequency five is for glance ovaries testicles adrenal glands parasol gland etcetera and frequency six hundred seven inflammation off and then you can go through each rotation frequencies called Nica that should nico this call the frequencies used for generating involved so he's got weak bone decks on scan or a DMZ period idiom in particularly in urine tests. It shows your your bones apart. You can start taking a looming photon. Oh Ton- and your sturge entering your bones so if you got week surgical neck of your left hip on indexes can slap the pat over it and take your supplements and boom. You're bondsman Donovan regenerate. You'RE NOT GONNA end up with a broken hip and knee hip replacement so I mean this device is amazing and all variations of got our website. We've got a Lotta different pads include the blue light pads include blue light actually postions because most skin conditions actually have installs passage. You know that act that Eczema Zima ninety percent of the people have star on their skin. Perhaps you staff Arias Ninety percent people with ECZEMA. We've being examined. Dermatitis have staph aureus understand you look at psoriasis they have mites and have an immune reaction against the might in the brickell. Cell Layer Dermal junction that causes the release of Interleukin twenty-seven and they get scanning dermott houses which we call the curve phenomenon. That's typical of of psoriasis us so each skin condition even is helped by light pad being anti pathogenic and Super Dettori. I called as part of the make in project you know take her college. AMAC's tremendous Royal Jelly internally to make college lasted ironic acid and things joint performance regenerate your joints cartilage intended vendor under and our anti inflammatories like flam accent sell defense plus then you put out aluminum pat on the outside and take stem cell support Red Velvet. Dr Uncle Mycenaean specific peptides for particular organs and Lewin pads speeds up the raising energy level of tissue it made regenerates increases regenerative capacity petition so as soon as you put it over. Let's say the kidneys it drops a C reactive protein an anti tencent converting enzyme which kidneys perceive and there's not enough perfusion till it drives of your blood pressure sure so they've done studies at universities and found that the Lynn Pat Warrior C. R. P. C. Reactive Protein by ninety percent was just a few weeks pretty the amazing hey that we talked about this a few years ago. What other studies do you know about looming pad because it's pretty universal reversal and I wanna go through and make some requested some of the regulatory agencies to they have a whole section that call genetic frequency therapy and we have a lot of other machines that can generate frequencies to actually do I call. EFTA ELECTRA ELECTROMAGNETIC field therapy or energetic field therapy the interesting using communication by luminol is that cells communicate with infrared light and so little telemarketer chromos converting for infrared light actually open your Orion channels to let minerals and deter on your DNA interesting. Hey Pat is on the right frequency for your body in other words. It's your infrared light eight bodies that actually regulates your DNA and that's where low incomes in to raise your energetics to detox you to stimulate your lymph addicts to stimulate your stem cells in fact slap. This over anarchy in your stem cells would love it this way. I can build your now. I've got going on over me harder kidneys. Are Your job your skin. If you've got psoriasis somebody condition and of course lew page particularly good for beautification. I called it beautification Patsy Bluer beauty pads which is nice. You can just put it over an area if you WANNA so. I'm sure a lot of cosmeticians are saying I WANNA get wells lumens blue pants because I can put it on my face and take the college maximum news Royal Royal Jelly and I'm GonNa take not only make up. I'M GONNA take make in in other words. Use The light and use the nutraceutical Sta Bil college lasted ironic acid to make wrinkles away right right exactly building healthy college on from within instead of through injury which is what a lot of have medic procedures do now. Don't don't take the the stupid things block your muscles you know. I think it's kind of obscene people. We'll say paralyze muscles permanently. I'm thinking I don't think that's a good idea yeah. I just was reading some research that they're now now starting to accumulate evidence at that the Botox toxin is migrating from these injections sites and is causing systemic problems of George it. Does I mean why. Do you think when you check something seconds. Do you think it takes a strict. Let your body right now seven seconds when you get a you you know he returned from your your Venus System to your heart pump back tissue seven seconds. That's the average it can be less or more on that some Secca. Yeah the body's just so efficient yeah so the woman Pan Number one is great for people for Pets for little birds for a big horses. It's great for any living thing in fact you know. I'm wondering if you have an idea very aluminum pants even make your plants grow bigger are better. I haven't but that would be a really interesting thing to try even a few minutes today. I have a feeling 'cause zero lifeforce. Okay do you. I Schumann Resonance Generates feel actually stimulates your electrons to push the orbital's is an energetic field and I know Nikola Tesla and the research was talking about non wire transfer of energy. I have suspicion that just a few minutes around your favorite plants in your window. Were little you know seeing the avenue that say no tree you put a few minutes of pet would increase the rate of growth in the blooming or the even the the mineral content of the of the tissue there for the feud food value color and taste. That's really interesting. I might try to do a little you know home experiment without a greenhouse and I can try dave versus plant be planned peppy aluminum efficient plant and see what the differences in the blooming or or beauty or or yeah yeah great idea. Every living thing I think is a is a basically a four dimensional time space space frequency Hologram. I'm working on math backs of actually the radio frequencies. I know how to make a nonlethal and also how to make weapons based on scaler. Taylor faced Rey frequency else's of radio frequencies also nocco pathogen or toxin to your body using the frequency say aspartame Taymor mercury or specific passing lime disease I can actually we're go the resonant frequency to neutralize them. Which is why eventually I'd like to have. Aluminum Pan out of there have other options to on top of all the cool ones already has already. It's the most I think the most efficacious device I mean there are lots of ways of delivering CONC- sound electromagnetics but to be honest sued the ultimate frequency of life is Fred. Isn't it right so you want to get there which is actor nausea by the way he was not only a medical. Michael Doctrine scientists views also medical intuitive intuitively knew these frequencies are were there specific anti-chavez tissue so when the embryos developing the neuro actor your money not part of the developing embryo hasn't frequency like a radio station of three so skin and central nervous system frequency for internal organs of frequency five for glance so it's interesting you actually found all these like the FM channels for each different attachments tissue for the embryo pool. Oh yeah it's like each tissue has a specific radio frequency for frequency modulation and interesting nervous system and skin had the frequency of gold. Isn't it fascinating I think so I think that's very suggestive be thinking about the historic how the idea of Al Chemical Gold has been associated with the idea of union with God. Let me give you the explanation of okay because you're interested in this. I had to vote seven years ago. Gentleman new contact me north of Pelham rinker basis actually here in southern California figured out a way of extracting or mister gold from the ocean and two hundred forty dollars now now turns out or monetary goals made by ancestor Moses who is supposed to be the next Pharaoh even though he's adopted he was so bright and so talented they wanted him to be the next Pharaoh. That's why his name was Moses which means like Tuck Moses Moses means endure the next guy people know that they think it's like say say. If somebody's like Johnson like calling somebody son Moses means he was going to be the next Pharaoh all right. He's smarter than all the other hyper he's supposed to be the next Pharaoh and he was actually a physician and surgeon. They used to make Ormuz now. In the ancient world armistead actually amplify healing or miss basically attached to his own proteins if your DNA increases supervisory turn your DNA so I can make more miss actually have or miss available on atomic determined to the gold in liposomes and the view and I put a specific inductive field a goldfield for the topic residents of golden you take or miss it actually increases your DNA the other one that uses India which actually increase your DNA induction and let's all minerals in junior DNA John's in the immigrant increase your life expectancy in fact that populations eat eight Indian population of one hundred times more centenarians. I have that product every now very science. Are you still working looking for that. One iodine that you can really trust a medical doctor endorsed product that is backed by honest research and true integral science then search no further go order nuclear medical dot com for Dr Bill Eagles New trion proven time and time again to be the very best iodine available for you is the only castle astle activated monitoring plasma in the world optimizes might Oh conrail function generation of new might oh Qendra from totally neutralizing the venom then from desert recluse spider bite in southern California to eliminating malaria parasites reported by medical missionaries in Central India doctor bills you try. ADINE is simply. The most those powerful healing formula other is trying to dine clears the body of all known pathogens restores it to an alkaline state and even promote them cell regeneration order doctor bills new today at triple eight two one two eight anyone or visit US online neutral medical dot com bridgier velvet. Dr Is an amazing new product with a patent to preserve three bio-molecules hormones same as fetal life where you don't age age at all the state of fetal life allows the three hundred molecules and six hormones produced by the Placenta to be supportive of the Arriba generation of tissues and organs was maximum eight pop tosa changing the tissue architecture of fetus. That's why field surgery driest performed through his no scar taking a two to three capsules twice. A day was on Commisson. Michael D to provides an amazing support for regeneration ratio any tissue and organ in the body. Even advance stem cell therapy support treatment do get neutral medicals red deer velvet. Dr From Dr Building dramatical Michael Dot Com and not radical dot com triple eight to unto us one. Stay well and stay young with medical hi. I'm Dr Bill Legal Empty E. M. A. C. A. M a forum of neutral medical dot com and a consultant providing email advice free an advanced protocols for your optimize wellness and advanced technologies to heal and regenerate you. He didn't contact us at neutral medical dot com. That's tier. I medical dot com or eighty. Ah to onto eight hundred seventy one get free email starter protocols of our top better grade nutraceutical initial testing and recommendations for your own primary Dr to do as well as recommendations to give you an idea of consultation and full protocols and try to help you regenerate tissues heal naturally without the use of toxic Poly Pharmacy Masih I can send tests gets you anywhere in the world and provide you recommendations referral of specialty clinics worldwide so contact me Dr Bill Bagel at neutral medical dot dot com. That's medical dot com or eight eight eight two onto eight hundred seventy one dramatical L. DOT COM. We held the most amazing drinks invest both feel highest quality by nutrient exposure to your body to heal a regenerate and the most powerful persistence assistance or nutrient to heal your body dramatically. We have ageless which makes you aged lasts which repairs your DNA exchange your telomeres etc.. We have life support. The detox is face to detox pathways gear on a nation salvation and methylation pathway support. We have glycemic some blocks of carbohydrate absorption healthily diabetes. IBS or weight loss as well helps with people. They're trying to build a bustle using things like our special formulas from Dr Wolf Call Mega Mega Muscles between meals along with sports energy like we have the amazing neutra complete the most complete red and green streak in the world the best most feel and flavor you could offer Mexico to better mineral. Mex- wages are fruit flavored mix power vitamins. Stay with neutral medical every day. I remember when win ask Bob Water Systems Fallback routes now the water system to the best water system for home and for pure water bed one hundred snaps under tap in a matter of minutes anti and can give you clean filtered water. That's still don't require electricity. Just the water pressure the bath two hundred system as a tackle box system you connect with a twelve old pump. You can drop a line into a puddle. Speier then distill the BEV. Three hundred system is one. I have to in my different. Voltages has a five gallon reserve tank provides as a cleaner to stillwater just hit her Palmiro to check to see are filters see how clean they weren't doing great because we have a whole home system as well that will pull out what was the street twenty minutes long filters all the toxins that are major effects of affect your bathing and washing so with your washing clothes or food or your bathing. You don't be watching trichloroethylene. Swayne a radio toxins heavy metals are industrial chemicals that are recycled your water supply either overtly or inadvertently because it get into water supplies for the water reserves. There's this involves for safe as a linear charcoal which is the most contact the best reverse osmosis membrane and then an I in exchange and the only thing coming out the other end is water molecules. There literally is nothing not even mineral so we had back ninety parts of calcium magnesium to bring the jeanine in half ten. I have my job week beside me for example my daughter system water and I put my lows musicals and then I add my instaflex hydrogen. That's that's one of my water jugs. One of course my drink which is Kito power sports energy light mega muscles combine in vain bank and I can tell you if you wanted to you talk to your body. You have to clean water. You can't be drinking toxic water and expect to detox your body can also bay the toxic water and you're gonNA be healthy is being transferred. Emily absorbed the toxins like trichloroethylene etc so tells marble system and why so superior and how it's very important for people to understand if you are just relying on the government to take care of you your suicide because the government doesn't give a damn they're going to regulate say thirty eight or forty two chemicals over ten thousand eight hundred seven new every day and they don't care. They don't know actually there blithering you. You know I I call the Terminator Blizzard Idiotic. They don't even know what they don't know so. Tell us all about it. Well documented. Thanks for having me back. You know you're you're. We're when we talk about government regulation a lot or it's really you know. Most people don't underst- Well of course most people don't have much understanding at all how the bureaucracy work working until they bump into it and then they go old Dang. That isn't what I thought it was. It's a pain in my rare and bureaucracy. This is populated by people who are power hungry people who have bought to be class president have a marginal like you have a big ego and usually untalented but they wanNA control everybody nobody else because it makes them feel like they're influencing control their world including US then they feel okay unhemmed this kind of need to control other people in order to be able to feel like somehow they are have a purpose. Even if you don't know what the heck they're doing they. WanNa be in control and we see the politicians in fact it attracts people that psychiatric type and you see this was a demon wraps and even to some extent with Donald Trump. He's narcissist. He wants people to like them. elway's decent person and he wants to do the right thing but look at the Nieman rats and look at the regulators inside their deeply embedded just like a barnacle on a ship. are people working in the various aspects government. They really don't care rows behind what's going on as long as they can maintain their job and get their pensions and they don't WanNa hear people raise issues that they can't answer and if you raise these issues they act like Oh like somehow they want to see if they can unqualified you even if you proved who've that you're qualified and they couldn't pass a PhD or master's thesis. It doesn't matter if they're decision of control they have the geopolitical control well and you don't and that's the problem with our this big burgeoning government regulations and big industry is that they decided not you and they don't decide dinosaur in your best interests so if you don't doing point service water filtration don't expect water to be clean enough to drink. Wash your clothes or your dishes or debate it. I mean and people need to get that. Don't they yeah. They need to understand that you know I mean. Let's face it. Government has a role in society and one of the one of the roles is infrastructure and delivering water to your house is part of the infrastructure. We count on the government for doing that for us. They think their responsibility is to deliver water to your house with it being free of bacteria system virus so they poisoning now. They don't always get it right. That's why you you get boil water alert. That's why you get all kinds of issues with municipal water. and you know in that doesn't mean that the water that they're starting with is the same everywhere people got understand. Water is tremendously different from one side of the town to the next in many cases. I have people who have a well on an island up in the San Juan Island in Washington state. One Gang has the well he's got different water than the guy across the street has another well and so all the water that they're starting with waters not all the same but we count on the government to deliver it to our house without Bugden so that means after poisoning in some cases they treated a little bit I sometimes they just dumped in chlorine someplace to use chlorine but they're putting poison in the water and they're trying to do some kind of regulation of currently on the list of regularly contaminants is about ninety three chemicals and then and if they want to add a new chemical on there that they might be harmful for you and they decide should be regulated it goes to about a twenty year process of quote unquote quotes scientific evaluation before they decide whether this is something they want to regulate or not and that means in the meantime. You're drinking it. That means well well. There's spending time decide whether it's killing you or not. You're drinking it and then if they come along and decide hey guess what we decided that we're going to go ahead and start to regulate regulate contaminant. XYZ And so you've been drinking XYZ for the last thirty years sorry about that. You should only be drinking. let's see Ten ten parts per million and then five years later they well. We were wrong on that one to really should only be one part per million so guess what now the community munity that spent all the time and energy developing the techniques to remove that from your water down to ten parts per million now house to retool and dig it out down to one part per million Elliot so they petitioned the government so they can have exemptions so they can spend five or another ten years building infrastructure to regulate to to remove the contaminant down to the new level well in the meantime. You're drinking it and so this is the problem with counting on the government to deliver to you. Water are truly safe to drink is it. They don't know number one number two. They take forever to get it right if they do it. It all and number three right. Today might not be the same right tomorrow. So why are you counting on the government to take care of this vital vital vital resource. That's part of your life food water air. You know and that's pretty simple. You gotTa have those components. Well water is one place sadly where we get polluted and contaminated in our own body because waters carrying all these contaminants with it scholten. Don't stop using your own body to filter water. That's just silly starting to put a good filter on your water supply why right at the point of us right before used that way it doesn't have time to pick up toxins from the lead pipes in your house or other contaminants from the pipes in your house you know just filter right at the point of view that way you ensure that you have absolutely pure water. If you WANNA monkey with the water after that you want to add some minerals. We have a module to add back a little calcium magnesium. You can add different things you can use doctor bills nutraceutical cervical. Some people choose to waive a gander pen in the water. There's all kinds of things that you can do but the most important thing you have to do is make sure that the water water is pure know that you're starting with a pure substrate and then after that you get the benefit of detoxification that water that you drink his. GonNa help purify your body carry away the other toxins that you're getting from the food in the ad and so you know it's just essential that you don't rely on the the government to do you know what they deliver to your house. Is I consider the raw material for drinking water. That's the raw material now. We need to make it into drinking water and the way you do that. Filter it remove all the contaminants that exist in the water so that your drinking nothing but h two O. Oh the way nature rain water comes down out of the sky except for when the air's all polluted right and so you know you can't count on the the organic crop is getting rained down on with whatever's in the atmosphere it could be radioactivity could be all the toxins from the smoldering during a PCB says waste collection places in China that they just burn all these old circuit boards from computers computers. You know when you recycle your computer where's that crap end up gets put in a container ship to China put onto a pile of smoldering debris and it burns fills the air with cadmium and all kinds of other nasty chemicals and so that gets up in the atmosphere rains down on. You rains down on in the air. Are you breathe. rains down on your crops rates down on your carefully tended organic food so you have to have ways to eliminate toxins funds from your environment pure water one of the ways that you number one stop ingesting contaminants number two you get you allow your body to help detoxifying. Get that crap out of your body so it's not lurking around hanging out in your in your glandular tissue in your adipose tissue waiting to combine with some other molecule that flip the bit. You're the guy looks in the mirror and one of us got cancer so you know you have to eliminate out these toxins from your environment water is one of the places we get it eliminated from your water and let your water do what he does best help. detoxify talks by your body carry other contaminants out yeah exactly now the important thing. I think that people should understand is that all the other systems will release heavy metals. They don't stop flow right. You don't stop pathogens example to water to sterile so this water you mm you drink for example. If you've got cancer you're told not to drink tap water because tap water is going to be contaminated in fact you've had chemo radiation in your immune system suppressed. You drink tap water. You're going to die not just have a bad day. You can get a serious enough. Gi tract infection because it meant suppression that if you drink tap water that's not sterilized. You're you're going to get seriously sick and may well die and you can't with with pure water system water. The problem I see is that people understand. The water is getting dirtier. The recycling more toxic water we have more industrial waste worldwide circulating from industrial countries like Asia where they don't have industrial standards. We have more recycled water. That's being put back into our water aquifers I think it's pretty crazy. Don't you think the idea of of recycling this water is really insane because we just don't have the infrastructure we are infrastructure has never been built with this idea of recycling recycling water because what are you gonNA. Right back. You're going to recycle the same water that came from your toilet with some industrial chemical plants and then you're GonNa think think somehow unless you've got Biki level pure water system level purification. That water is not going to be safe to drink. They can treat it a little bit and then and pump it up a mountain stream and let the sunlight shining on it and think oh. It's going to be okay to drink. That's insane. Who knows what's going to happen. We're all those chemicals mixed together together into a toxic soup and then the sunlight gets on them and changes the molecules even more. You don't know what's coming your body. That's just it's just a crazy idea. Does that makes sense to recycle the water. You know if you're gonNA take that water and it's going to get sprayed onto a golf course or something that people long green so the golfers can chase that crazy white ball around that's a good thing or bad thing for the Golfer but they'll already crazy 'cause they are chasing the low white ball around but you know there are places that you can up that that you could use this recycled water but not for human consumption. That's just insane not for crops. You don't want to put that on your crops. You don't want your body. Ridiculous really is isn't it it it. It just makes no sense at all until you nope nope. We always say thank you for years of affiliation. You've you've been generous to listeners for so long at ten percent discount down with the with the Promo Code Neutra bed. PRI and your body your the Children Dr Bill absolutely amazing stuff. Thank you Bob we will see next week and of course three the important understand that if you don't have pure water you're not thinking new taxes. I watering how don't become the filter get a filter at their water systems have of your dramatical back home with our two party. Brisk number is nine eleven eighteen years ago nine eleven happened.

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Ep. 210: How Stress Affects Your Skin with Dr. Amy Wechsler

Fat Mascara

53:24 min | 4 months ago

Ep. 210: How Stress Affects Your Skin with Dr. Amy Wechsler

"Everyone is jess I'm Jen. I'm still JEN ALWAYS JEN? We Are Fatma's Skara and we are back for another week of beauty. News were fat Mascara I like it. It's like our band name now. Famous Garra rocking the house We are excited to back with you I. feel like we're gathering around. We know every every Wednesday or whenever you listen to us we've got a lot to talk about. We know it's been. It's been a tough week. A rough. We all over the world. Yeah, we thank you hope everyone is hanging and staying safe, and if you are joining us this week, we thank you for coming back and hope that we can provide a little bit of a break for everyone on that note. WHAT ARE WE GONNA? Talk about this week. Let's see so I up. To issue a correction, an episode or two ago, we talked about deep stuff bikini line bumpy, if you. Are like me in are taking bikini line grooming into your own hands during the quarantine, you may be experiencing some bikini line bumpy as an I, asked my good pal Dr, Rinella. How to handle this. I came out with a lot of great tips and one of those was to treat with Hydro Court of over the counter hydrocortisone I was so caught up in her tips so excited just like going crazy and I said ten percent hydrocortisone and a couple of you, you guys. I like you guys because you're so informed. And you wrote me some friendly friendly criticism, a correction and you said correction, a correction they sacked, checked us, and one of the emails was from a registered nurse, and said you cannot get ice at ten percent hydrocortisone can't you cannot get ten percent hydrocortisone at like a CVS? It's one percent and I look back at my notes from Manila and. And of course Ronel, said one percent guys sometimes I get really excited and carried away, but if you have inflamed skin bumps, look for one percent topical Hydrocortisone, really sorry, so editor's note I was wrong and I hope you'll stick with me. I. Do not tend to make these kind of mistakes and I'm really excited that you guys are so informed and kind to correct me. Kindly, so we are going to also hit you with the headlines of the week Jen right correct, and we also have sunscreen news to share with everyone, and then our guest is I think it's really timely right now. We have Dr Amy. Wechsler, she's a board certified psychiatrist and dermatologists, so we're going to talk about the link between mental health and your skin so should be really interesting. You're ready to do it. So much news discuss. It has been a week. Even though there's been so much going on in the world, beauty doesn't stop it so I up in the week following George Floyd's murder here in the United States has protests unfolded around the world, the beauty and fashion industry was having its own reckoning rightfully so and we're all taking a closer look at how racism permeates the way we do business. We're doing that here at fat Mascaro, as well one change we saw. saw that we thought was really interesting. It was a call to action from designer. Aurora James so she's a fashion designer, but on her instagram she was asking American retailers. People like sephora target saks fifth avenue lot of the places. We all shop for beauty to play fifteen percent of their shelf space to black owned businesses, which was if that doesn't make sense to you if you're not in the United States, says because in America the population is about fifteen percent black. And I thought that was a really interesting way to put your money where your mouth is like. We can't just be talking about how we want to be better in the future if you can do hard numbers of. Sharing Black beauty businesses. That's a really great way to help. Move this conversation forward. Yeah, I like that it was very actionable, and it's something that you can see and it gives people an actual him at work. They talk about like a smart goals, and you know it's an actionable like quantifiable thing, and there's a lot of lip service happening right now and I. Think a lot of it is you know people mean well? But what are you going to do about it and we should say here at fat, Mascara we two been thinking about it? So Jessica I val to going forward continue to show a diversity of voices in the interviews that we. We do here and also increase the number of black-owned beauty businesses that we talk about so when we talk about products, we're not always calling out who the founder is, but working to do our best in the future to make sure that we're really diverse with the types of brands that we feature and just let you know about more small indie brands that could use your dollars right now. A lot of you have been asking. Where can we shop for black on beauty or on the facebook group There's an amazing thread going on with a lot of guys sharing black on PD brands you love that love. That's great. I wanted to wreck you to. Jen and I can certainly rattle off some great brands right now, but I really WANNA share. Whoa, Ma Minted Lauren. NAYPYIDAW should I stop. I really WANNA share our friend Julie Wilson's lab. Great instagram highlight reel while his name is familiar Julie Wilson was Jen's Guest Co.. When I wasn't. Available one day she is fantastic. She is the former essence beauty and style director. Now she is the cosmic beauty director congratulations Julie, she just got the job a couple of months ago a she has this highlight reel of almost two hundred right now. This over the Dave cowens was two hundred black own beauty fashion businesses. All small brands definitely shopped the highlight reel Julie Wilson is at Miss Julie M. I.. I. S. S., J., U., l., E. Good. Her real is right there. You know what else just I should add as an update on. She did adjust beauty version of this for cosmopolitan dot com with one hundred and twenty-five, so we can link to that on the Blab. That was one hundred twenty-five black-owned beauty brand batteries go on instagram. Lots of resources that follow her too because she's a really good. Absolutely, so check it out. I think you're going to be seeing a lot of brands. Really kind of get with the program and I think they really all are having a good hard look at themselves. If they if they're. They're paying attention. US included okay, next up is the my French is burberry's new global beauty director, so she's a makeup artist very artistic, like just like abstracts amazing stuff. She's worked with YSL in the past, she was also with Tom Ford beauty as a creed of artists consultant at one point. Even she's worked with Christian Lubaton to now. She's at burberry. Let's see what she does there. You know what's interesting about Samaya French. I think she's really ushered in that very kind of. Let's say like ugly beauty. Beauty, that is not necessarily meant to seduce or impress grotesque. Yes, it's makeup that isn't like enhancing your features makeup making a statement and looks artistic. She is a really cool aesthetic. So watch what she does at burberry okay engender. Science Corner had to I. Just read this really interesting study. This was published in the Journal of the American Academy of Dermatology so there was a survey of people with psoriasis in China during the covid nineteen pandemic there and the quarantine, and they found that that resulted in people, psoriasis, having negative effects on both their skin, their skin condition the. The psoriasis and their mental health, so part of the problem was that people weren't working, so they didn't have money to to pay for a lot of their psoriasis treatments, but a corrected for that, and they still found that there was a impact from the pandemic and the thinking. Is that It was partially because people weren't having outdoor access, and they were more stressed, and that's what you know played up the psoriasis. I feel like this is something we'll be talking about with our guest in the interview. So if that's intriguing to you definitely keep listening through the interview. another news item earlier, this spring, America's first native American beauty brand opened in window rock Arizona with a storefront I should say all of its employees are from the Navajo nation and the company beauty makes skincare and makeup I actually read about this company to feature in beauty. Independence linked to that on the blog but I love how the owner. Her name is a sake bottle of France SASSARI and she describes the products this way, which is just I just like smiling when I read this, the quotas quote our skincare line is ninety eight percent botanically based gentle yet effective life is already complicated, and my goal is to make sure our products are uncomplicated easy to use. Preach preach preach, preach, preach US ocoee Bois. I'm excited to see this brand. I'm going to order some so I can try it out, but for now just an interesting news. And next up in the business corner. Can I also have a business corner just? Not just the science corner sounds like you got a lot of corners right now. Five. Guess what Charlotte Tilbury has indeed sold a majority stake of her company. It was one of the companies that we talked about was possible. Owner, puge, superior Spanish conglomerate. They own brands like John Paul Gauthier fragrances. They also have a lot of licenses. Product perfumes is one of their license. They are now the majority stake owner Charlotte is going to stay on as the chairman president and chief creative officer. Unfortunately I do not have hard numbers for yet. 'cause I just. Just and I had a bet going on how much they paid for this pretty pretty little company. What do you think chests? What do we say I think over a billion? Yes, so in the next week. I bet you in the reporting. It will come out with that number is and we will let you know next time we record. I think you know I didn't see huge. As you know a player in this in this fight, I really didn't. But I think it's interesting for them because they don't have a color brand doesn't spring to mind they don't they barely even have skincare care. They're just so heavy and fragrance there so heavy in fragrance, and they also don't have a real personality brand, right? They'VE SHAKIRA THEY SHAKIRA FRAGRANCES, but they're all perfume I think put Shakira and Charlotte just would not even put them in the same. They're not comparable. Yeah, and they don't have a color brand at all I looked at their brand portfolio in this news came in and I was like this makes a lot of business. They obviously realize like. We can't just be so heavy in fragrance when there's all these other. Places to play in so yeah, that's some news there. We'll try and find out how much how much they paid. I WanNa know let's let's talk a little bit about numbers exact clay last item. Let's talk about Kylie Jenner the beauty entrepreneur. She has sadly lost her billionaire status, so that's according to Forbes. Who gave her the billionaire status in the first place in a recent article? Article they looked at her cash out from selling her company to cody and her personal fortune, and they re estimated it to be a little less than nine hundred million, which sounds like a lot of money either way, but there's some important facts in this story right just so basically the it's bigger than them. Being not quite billionaires the Forbes. Editors are basically saying that the. have been inflating their success for quite some time over the years. The KARDASHIANS have invited the Forbes editor of their mansions, and over to their CPA has offices, basically trying to make them live. They were richer filings. You know they were given the full PR press to try and get like a big number for their families, so they looked richer and you know they wanted to. Have you know be on the Forbes List? When they were on the number fifty nine spot Chris was according to their publicist. This is in quotes, guys so frustrated. We've done so much she. She said, and then honestly the the Skin Carolina. Last year. They said that they did one hundred million in revenue, the first month and a half, but the filings show that they were on track to finish the year with twenty five million in sales. That's twenty five percent of what they claimed. That's hard math people, so it just goes to show like PR spin and a big powerful name that doesn't let you just inflate numbers and say you have things you don't. It's really it's kind of annoying. So of course the Jenner's have said that this is all untrue. Let's see how this plays out. Okay guys. This next segment is brought to you by Neutrogena remember, we said we tell you and it was sponsored segment. This is one so they're sponsoring this and help. Make it possible for us to bring you the podcast every week. We've always gone to Neutrogena for the fax on Sun Protection so when they told us they had some interesting news about sunscreen Justin I were like. Yes, please. We will talk about it and we will share it with you, so we're not really talking about their sunscreens. They make lovely sunscreens. This is more of like a service announcement about some. Some News Jeff share the news. I was like Whoa, so I saw the new poll that Neutrogena conducted this spring and I read that thirty nine percent of Americans twenty two and over say they're so focused on handwashing right now, and avoiding all the germs that they're not even thinking about sunscreen application, and that seemed crazy, but maybe it's just like a temporary slip I. Don't know I know you think liquid once the pandemic is done ever is going to go back to remembering to wearing sunscreen, so they let me talk to. This woman is the prevention researcher and clinical psychologist. Psychologist who specializes in Behavioral Medicine Sherry Pagot. That's who she is. We had a lovely chat and she was saying. Yes, of course, we all realize this is going to be happening, because you're so focused on other health things, but she pointed me to this other study. That was really interesting. They studied Danish Gym Goers Gym exercisers. You would call them, and basically, if they were on vacation for a week and not exercising, you think okay when they get back. They go right back to exercising for two months afterwards. There was decreased Jim Attendance meaning just the act of getting out. Out of the habit of something. Even when you think you're back in the habit, you might not be sued. She's very worried that this could mean for the rest of the summer. People aren't wearing sunscreen so i. get that you know. Behavioral changes have lasting effects, but personally for me like if I do one healthy thing, it kind of snowballs, and it makes me act healthier all around Oh like snowballs in a good way. Yes, yes, so balls is like a bad thing, but you mean like it rolls into more healthy stuff. Yes, yeah, I voted the positive because snowballs going. Downhill Way, right? What's the uphill way I don't know what give me an example of this puzzle case, so this is the best example. I remember this commercial and it was for a healthy breakfast bar in this woman started the day. You are like in her body, and like looking through her eyes, had this healthy breakfast bar, and then you saw her like go to work, and maybe like you know, there is a bunch of donuts at the office and someone's like you know Susan like Joanna and she was like no thanks, Carl, and then the next thing was you know? She was literally worked with people. They've Susan Karl. They like are in everybody's office. Go on, yeah, you get it the next thing the next thing and then. She decided that she was going to. Walk instead of take the bus or whatever it was, but you could kind of all this little small choices, and it was like one small choice lead to the next thing, and that's how I feel when I do something good for myself. I just believe in myself to do the next thing I. It's funny because I feel the same way. I called it like a halo effect. I was talking to Dr go about this. She called it like a synergy like you're just in the mode of be, she said. said it's definitely she's knows that with Diet and exercise, but like there's no research that's true for Sunscreen, but I feel like it should be like I feel like when I'm like. I've been keeping my sunscreen near the mask like the face mask and the hand sanitizer, so it's like helping me remember to use it and I feel like I've just been healthier all around because I'm like okay putting on the mask. That's a good thing and honestly like. I've been floss my teeth more because I'm like just like. All these weird little things little things to just try to keep you in check especially right now. Keep your health check and sunscreen is a part of that. Yeah, and also I was thinking about the mask. This like. Can you imagine a Mask Tan? You'd only farmer's Tan. They call it here. In the states I don't know if elsewhere in the world, but when you're wearing a t shirt, and like that crazy arm Bentley. Are we going to get these face vans? Nobody wants that probably you know so. I S our listeners. How do you remember to put on Sunscreen? How do you keep up with this great healthy habit and like you? Jen a Lotta is about placement. You say you keep the sunscreen right by your mask. I have people putting it in their shoes, which is hilarious. Remind the door that's funny. I thought that was really cute in their baby stroller. Which I think is really smart, because I think about that whenever I'm out with Les. How could get you have a baby now? Which means it'll be wearing more sunscreen. Shiva baby stroller to push your sunscreen around in exactly and if and if the baby is old enough yet. Keep the baby sunscreen in there, too. That's important next to their keys. And then somebody else bought a huge jumbo bottle of Sunscreen, and they bought that and they. They spent the big money to get this. This jumbo bottles through like Oh, I'm getting through this I got to get through it by the end of the summer or something like that. Get your money's worth I. Love It. Yeah, yeah, if you've invested that much sure so really good tips there. It's on our facebook group are fan, facebook group Oh cool. Maybe we'll keep them coming throughout the summer to and honestly thank you to Neutrogena I for the poll because I did not know that was happening, but thanks them for sponsoring this segment because you know how important sun-protection is to I and we're just really proud to have them as a sponsor here on the show. So Amy, Wechsler one of only a few physicians in the United States. Who is board certified in both psychiatry and Dermatology? She graduated from Duke. University went to medical school at Cornell University Medical College then. She completed her psychiatry residency and as if that wasn't enough from there, she decided to do a second residency in dermatology. She's an adjunct assistant clinical professor in psychiatry at Weill. Cornell Medical College. She's also the author of the mind body connection, which was published in two thousand eight. It's such an excellent resource for anyone who wants learn more about what we discussed this interview and with that here's the interview. Dr. Are Welcome to fat Mascara thank you so much. Thanks for having me Oh. We need you. We need you right now. This is this is going to be a really timely topic I think. Our listeners are GonNa love so I'm just going to start out right away. Let's talk about you are both a psychiatrist anoterh just so you're the perfect person to talk to us about this. Thank you. People are stressed out right now. I think it's safe to say heightened levels of stress from. From both the pandemic social unrest, all the things going on the world, their usual lives money matters unless if people have chronic stress all the time, so cues just going to chemical level. What's happening when you're stress like what happens to your body? And how is your skin? Even involved in that sure, of course, so all these bad things happen when you're stressed. We can start with the brain. So there's a molecule called Cortisol and that's a molecule that goes up during the fight or flight response, and we need it, too, because it gets us to run away from danger, you know in the Savannah if we're being chased by a Cheetah, but then bet danger, either they catch us, and we're dead, or we've gotten away in a minutes and then. Then, the court has all levels supposed to go back down to normal heart rate will go back down to normal all that, but record is all is getting pumped out from chronic stress over hours days weeks months. It does a lot of bad things to the body with interesting. Is that the brain and the skin or formed from the same embryo logic layer so there so many interconnections? When! I learned that I was like Oh that makes so much sense. In embryology and Cortisol that's made. makes its way to the skin real easily there, so many vascular interconnections also, the skin actually probably makes its own cortisol. There's a couple of studies on that court is all the so many bad things, so it's called. Pro Inflammatory inflammation is really bad so to the skin cortisol does it breaks down Collagen so that's why people feel like. They can get a new wrinkle overnight when they're really stressed and they can. It also causes acne so acnes disease of inflammation. So that's why everyone gets stressed pimples, lots of studies like they've done so many studies on college campuses during exam time count pimples. And PIPPA counts. Go Up to three fold. It also messes with the skin's barrier, so the skins are really good barrier, keeping the good things and bad things out. The skin gets leaky when there's too much cortisol around, so it's called Trans Epidermal water loss. T w. l just means the skins leaky. It's leaking water and in being leaky it. Let's stuff in that. It shouldn't just to the surface, so that's why some some people are like. Oh, my gosh, like my normal products are now giving me rashes like what's going on or someone who has like really kind of hardy skin and can try all sorts of different fragrances. Gets Arash. Also Sorry go ahead I was just gonNA. Ask about the inflammation thing because that's always confused me 'cause. I picture inflammation like oh I stopped my toe. It's red and hot and swollen, but like do your little cells and your skin. Look if you can't see it on your face, are they like? Are they getting swollen? What is that like cellular inflammation? Sure so yeah, so inflammation doesn't necessarily mean swelling. You can see, but it is microscopic swelling so a bunch of years ago. Cardiologists figure out that heart attacks aren't just caused by coronary arteries getting stuck with. Cholesterol, it's that cholesterol plex sits there until it gets inflamed and swollen is when a heart attack happens so similarly in the skin. Inflammation in the cells breaks down college right right, but it also if you're thinking about a poor with pimp like that can make a pimple, acne is a is a is a disease of inflammation so as psoriasis so as exit. Just different cells get inflamed. You can't see the inflammation itself, so you've mentioned acne. A couple of times and its connection to stress so I was doing a little research prior to our chat, and certainly over the years you know, Jenin I. We meet with lots of people and acne, and the and the connection to depression has come up over and over again out there. There was a twenty eighteen study where researchers found that patients with acne. Acne this is we don't need to study to tell us. This. have an increased risk with developing meter depression, the risk for major depression was highest within one year of acne diagnosis, a sixty three percent higher risk compared with individuals without acne. Do you think that people still even though we're hearing this over and over again? Still underestimate that acne has as major effect on mental health. Yes, I do. It's underestimated all the time, and it's so sad to me because I see these patients all day long every day and they're suffering. It's real suffering it's real depression. There's so many studies like that and there's a great study a few of them on accutane I love. The strong acne treatment and gets a really bad rap for a couple of reasons, but some big studies have shown that during accutane depression scores all the way down and self esteem scores. Go all the way up. which is what we always see. Yeah I, think you mentioned that like? It's underestimated too quick, personal anecdote I know somebody who their child had such bad cystic acne, the someone who's close to me but such bad cystic acne, terrible terrible and they. You know this is a smart person. They said Oh. It's a phase teenage years teenagers they could offer. It's the chips like they're going. These old wives tales. It's the sweat from the summer like his face. Yeah, exactly, so, what is that gap is that they're not getting? We all have the Internet, now most of us do not all of us know. Most of us have accessed information is if the cost of getting to the dermatology? What is we're kind of talking about two different things here, but their depression. is so serious with. Acne And it's accutane I was on. ACCUTANE wants. It's not like they're there must. There is a generic. It's not like this huge threshold to get the drug right like it's right. I'm just trying to think the hurdles to solve this problem. We know that depression leads to such more serious things like to me. This is a crisis I agree with you. I think depression in general is underestimated in teenagers, especially because teenagers are quote supposed to be Moody, but that's not actually true. Yeah, and depression in teenagers looks a little different than adults like when a teenager withdraws from his or her activities or like. That's really bad sign they can. Anyway and they're more irritable than adults who get depressed just generation, but it can look it can look the same and I think a lot of parents just think back to their own teenage life, and if their parents didn't take their acne seriously or like gave them ten bucks to buy some clear Ciller. They don't really remember very well, you know. It. It's very hard for some people to take it seriously and I think it's their own psychology and their own upbringing, and sometimes their own education level, and their own ability to be insightful and empathic. Whenever apparent brings me a kid to treat. I always think the parent You've done such a great thing for your child bringing him or her in here like that's, it's a real gift. I'm thinking about people who are listening here that maybe don't have access to someone like yourself. What can they do if they see somebody suffering with very bad acne and Consequentially, you know maybe some depression. That's their child, rather their child, or maybe maybe it's even them listening. Oh, well first of all a lot of people with acne in depression feel hopeless. And, when you feel hopeless than you, you don't try to get help. You think nothing can help me. So just knowing that there's always help, like acne can always be treated and always be improved upon soak in depression. Depression can take long or sometimes, and sometimes it's tricky in the acne something you have to play around with the medicines, and it's a little bit of trial and error and takes a little bit of time, but there's always hope and the other thing I hear a lot of people with acne feel like they're alone like they're the only ones with such bad quote, really bad skin, everyone else's clear skin. All my friends are clear all the if your friends have clear skin in a teenager than you're either not seeing their acne, because it's on their body, and it's covered. Covered, or the very had treatment, because ninety two percent of teenagers have acne and the the number still in the eighties twenty somethings, so it so common and yet people feel so alone with it, which makes me sad, so that's why I love to try to educate people about how while it's so common. It doesn't mean you have to live with it that it's like a normal right of passage. It's a medical condition, so if you do go to the doctor, the drugs to treat acne would be covered by insurance. Correct, the short answer is yes, if you're a teenager, some insurance companies have made the arbitrary decision that after the age of twenty five. They're not gonNA cover, act. which makes zero sense since acnes still really high, until will for women until menopause and ferment could be their whole life, so if I have an insurance company that will cover medicine mean I, fight it to get the medicine for the patient, and what about another skin issue that is also very much connected to mental state is psoriasis so that was rice I read has a thirty nine percent of increased risk of being diagnosed. If you have psoriasis, you have a thirty nine percent increase of depression. Anxiety thirty one percent higher chance of being diagnosed with anxiety would have you observed all of that I mean I think we. We've known that for a long time. The thing about the skin is at its on the outside right, so if someone has an ulcer suffers from migraines, they feel horrible and not to discount that, but they don't have to deal with the world interacting with their illness right, but if someone has psoriasis on the outside of their body, it's very common on hands and arms. And it can take over your whole scalp, and 'cause like tons of Dandruff. It's also very uncomfortable or acne if it's on the face like Tara hide so that interaction with the world becomes really difficult. You're wearing your pain on your face exactly. And psoriasis associated with with arthritis, which can be really debilitating, but. Since I graduated from residency that when I was resident, that's when the first biologic treatment I rises came out, which was called and Bro. And since then there's thirty of them now, so there are these amazing treatments that can really clear up skin and. Talk about insurance, like many can be covered by insurance drug companies who make them have a program for people who don't have insurance and they can get them, so you can get to a doctor. You can get one of these medicines, and if you can't get to the doctor, I'm just jumping ahead a little bit here. If you're able to in some way, bring down your cortisol levels. Yes, of course, you probably need medical help as well, but would that have a positive effect on these types of skin. Conditions yes, it. It always does actually but. If someone has really bad psoriasis, and that's causing them. Depression I to put the onus on the patient to say like. Yeah, okay, now you have to, but if someone's going through a stressful period, let's say they didn't have acne for a while, but they used to be acne prone, and they start breaking out, and they can be mindful and figure out. Oh! What's going on in my life to cause his flare up? I think being the cool thing about being mindful is that it's free right, but it it takes time and you have to be thoughtful. And I always talk about sleep because cortisol is at its lowest during sleep. And during sleep is when all the anti inflammatory molecules are at their highest, those really great molecules that he'll like growth hormone Beta endorphin until if you bathe your skin in those for as long as possible and for adults at seven and a half to eight hours a night. People like roll their eyes at me when I say that. Is really important. catnaps help to then you could heal these things faster for sure so this is good when people tell me to meditate to have less stress. Could I just like sleep a half an hour more? Yes, yes, unlike this advice, soccer weck of meditation to like feels like that's not for you. Then you shouldn't do it. I'll sleep I like that. Sleep is awesome. Speaking of some other conditions that have a tie distress. I'm not sure if this is your area of expertise, but I've always wanted to ask a guest one of our interviews about this so. Picking like I'm a picker, I feel like literally. Everybody is a picker, but we just two different levels. Talk about how we pick. Our skin or hair are eyebrow. Friends that pick SCABS, other people that pick mosquito bites, or whatever can you explain why we as humans even have that urge like? Why can't we just leave it alone? I think thinking is so interesting. Some people aren't pickers. Really. They're rare, but some people really don't pick it their skin. There's a whole spectrum, but I think it's about part of it's about self grooming, and so I'm a crazy lover of chimpanzees and I last. Last was in Africa last year, and I just I'm like really into Jayne good on all that stuff and I sit there with the chimps, and they're grooming each other, because they're getting bugs off of each other, but also they groom each other, when there are no bugs there to self, soothe or end to sue each other and to decrease anxiety levels, so there's definitely something to manipulating our bodies that is meant to soothe. And so you know people who you see like twirling their hair or inadvertently picking it something it gives a little pleasure, and I think it does decrease your cortisol level, but then sometimes you can scar your skin and leave marks car. The problem obviously there can be. It can be problematic, but a lot of people do something. It's rare in this world for. For someone not to do something to their skin or their hair or their house. It's interesting that there's like a evolutionary biological reason. We do that you said that it can be problematic. Like how do you know when picking habit you might have is like is entering into the realm of okay. We have a medical problem. Will I? How how much time? Time does it take during your day if it's less than a minute, is probably not going to be a problem, but if it's fifteen minutes or more, I always think like that's a lot of time to be picking like each day. I mean I've spent fifteen minutes on like a pimple like pre post. Spot ball that business cleaning it on. You know, but. But you're talking about every day. Someone who's like going over their face and body. Yes, and how do you help these people well? They have to have insight into being a problem, so a lot of people pick in private. They never tell anybody sometimes I'll see it inadvertently. Someone comes in for a skin cancer checks examining their whole body and I see scraps. But. Patients know that I'm psychiatrist and a dermatologist, and they get referred to me for picking or they seek me out because it's bugging them. Some people pick on areas that are always covered by clothing, so no one else would know. And, it's the people who pick their faces. It's so hard to hide. That is their drugs. Like what would you tell you have a friend or a few? Yourself are listening, and you are one of these people and you just like it's. It's a personality trait, but is there a way to fix that will sure so there are some medicines that make picking worse like all the medicines for adhd like Ritalin although stimulants. Can Start, picking. The people can start picking the side effect. Interesting so that's GonNa make people don't often think about that, and there are other medicines that can make it worse than their medicines that can help make it better. A lot of the antidepressants anti anxiety medications help it not that everyone needs medicine for this, but right if someone's. Listening now realizing, Oh, I kind of do that a lot of close myself in the bathroom in front of my Magnifying Mirror for ten to twenty minutes late for data of late for work, because I've kind of lost track of time in the bathroom. That's a sign oth. Maybe I should talk to somebody about that, and it can be a psychologist or psychiatrist or therapist doesn't have to be dermatologist at first though I often work with a psychologist, if it's a really serious thing for the person, so what about somebody who is very focused about their appearance or Very just just to focused or maybe a little dismore fake. How does somebody know if their thoughts are dismore, Vic and even people? Maybe who listeners podcast, we love beauty. This is something that we do for recreation. This is fun but when do we know if the the thinking becomes a little problematic? How can you kind of diagnose that pretty easy for me to diagnose when someone comes in, but the thing is if a person's at home. Many people with body just Moorefield. Don't have insight into it. Like if you think of Anorexia as an extreme example of by disorder, it's the rare anorectic that knows that he or she has that issue. It often takes someone in their life to point it out to help. You never know sometimes so there are patients who go people who go from plastic surgeon plastic surgeon with a perceived imperfection. That isn't there and sometimes I'll get people operate on them. And since there's no way for a doctor in La to know that the doctor in Chicago has opera, people can hide stuff and go but good thoughtful doctors sitting with the patient. Taking a good history can get can get a good sense of. It's hard with those patients because they really believe that they're right. I gently point out that maybe they think something is really bad or disfigured, but it's not like I. Disagree with them and why? and. It's rare in that moment for the person to say Oh. You're right. Doc like this is fine. You know it's the usually need therapy for, but even like the people who haven't gotten to that level like you know I'm not talking about the the kind of cat woman lady who is like who's been jumping from surgeon to surgeon, maybe like somebody that just kind of a little, a little, too obsessed I mean beauty has gone from something that I think. Think the beauty industry has exploded so much in the past five ten years were now. Everybody's really into it. All Ages everyone and it's it's recreation, and it's fun, but I think a lot of people take it very seriously, and everyone's very into their image. That sits in cell. Phones and everything have become now. Everyone is like as a profile. It's become something that I think it's very easy to I've even questioned myself like my to into this like a my. You know I think I. Have a pretty good grip on myself, but sometimes I wonder like how much mental space does this consume in my brain I think anyone who's who's perceptive can think like how how important is this stuff? So do you find yourself asking that question? Maybe not of yourself, but you know of just people who have walked through your office. I myself to yeah yes. And I think if someone is particularly stressed, they might be ultra focused for that moment on that perceived imperfection, and it just seems bigger and worse, but when I talk to them, it's like Oh relationships. Falling apart works bad I'm not saying there's almost always something behind that symptom, and then that's helpful to figure it out. That's really interesting. Can we talk about when it's not a medical problem? I feel like a lot of. Women men, they talk to each other in this way that I found where they'll like. Your friend will say to you like Oh, I hate my nose or like my skin so wrinkly, and I look at these people and I'm like you look fine. Slash amazing, but I don't want to dismiss their concerns, because clearly their concerns, but I also don't want to offer platitudes, so my questions like how do you talk to someone when they bring you their insecurities about their appearance in a way that isn't. Right, so it's all about empathy, so you might want to be like. Are you kidding me like you look amazing? What is she talking about? But like well? Why do you think that like what's going on in? That might be like. Oh, well I, keep seeing all these photos on instagram of so on the list of few people, and then remind mind that there are filters and photos that they think are just like candidates or not candidates, and just like when I was a kid reading vote magazine thinking. Oh my God, like I'll never look like that well. They didn't look like that. either. Without touch-ups, you know photo shopping, and all that stuff so I think part of it is the barrage of social media in photos videos that are meant to look. Natural, no makeup, and all that like this whole thing about having no pores will then you're not a human like everybody has pores. There's no right, so but people like. My pores are so huge, and then you say you're looking at your skin a magnifying mirror. Yes well. Don't because you don't really look like that, so ask questions I. Think is what you're saying. Don't just be like Oh. You're beautiful. Don't worry about it right because then that person thinks oh. She didn't understand me. She didn't hear me and they just still feel crappy. They feel worse because they still have that feeling about himself. La Think Oh and you don't understand. It's good advice so I read this thing. Was This writer G Tolentino? wrote? She was buying like an exfoliating serum, and she said my buying a car or a cleanser, my buying cleanser. Cleanser or a psychological safety blanket and I was like Oh. That is ringing true to me, I think a lot of women find a lot psychological comfort in buying skincare products and using them it could that be actually true, and like why and how would like having a product? Be Comforting mentally. I think it's totally true. I called hoping a bottle. So does the industry, but like you mean like real mental hope, there is a lot of parts to it so first of all some of these products are expensive, and if so someone spends money on herself. It's a good feeling I was able to buy that for myself. This product is so amazing. I was able to buy I saved up in. It's going to be awesome, so there's I that thought well okay. Do Something Nice for myself. And then the packaging is a beautiful in the marketing, and and you buy into it because it says like. GonNa lift or it's. Going to take years off your, whatever it says, whatever excited to buy it a Mike. What is it? What is it, don't you? A. and. Marketing like there's a whole psychology of marketing, right? It means something until there's placebo effect of I bought something I spent money on it. The more expensive it is, maybe the better it is. And it's special smells good. At Bell's bad, so it must be really good for me. I'm missing all. There's that whole thing. And then if if the product has a nice like censorial feel to it, then there is at experience of applying it and feeling good. This is before. It's even done anything to your skin right, so you've probably lower your cortisol level a bit. You've probably lower your heart rate your blood pressure in an just feeling good, and that's a good moment in whether or not that products really doing anything as long as it's not hurting you. I think that's a that's a real boost and I'm okay with it I. Don't like people to spend their last diamond products like that's terrible, I hear those stories like. To me, but for the most part people don't do that. It's more of that monkey self care like retouching ourself with the serum I totally get it when you were talking. Justice is we're like relaxing? Enclosing I was going to a place I was going to my fantasy bathroom that I've built in my head. Yeah, it's an there's an elevated tub. There are plants all around it. There's a huge double saying happy place that sounds awesome so now that we've all like pictured are perfect bathroom and we wanNA apply all these products in the TUB. You guys just carry on okay. She's in the mental tub. So what are some of the things that you do yourself care with like skincare shore, but also like makeup and hair care so I'm not great with makeup. I've taught myself in. My daughter's taught me a lot of stuff on applying I. Make Pretty Well. How old are your daughters? My daughter's always twenty one and my son Jaden is. Okay and Zoe's like really good at make up and she can do like the perfect is that she learned on Youtube like a few years ago. She's she's sort of can do it in both is perfectly. She did my toes last weekend. which is really much better that stuff that I am, but she's taught me stuff, but. It's funny because I was at tomboy growing up and never were makeup I remember my dad telling me like in seventh grade. You know I think he should start wearing some light blue liner your friend. I've never heard usually the. I don't WanNa wear light blue island, but anyway so it's what's funny. That I've been working with Chanel as their skincare consultant for almost ten years and my friends from high school. Tease me because they're like seriously. Miss Tomboy like Now you're Chanel got into it and I've learned a lot from the Chanel team on all that stuff so I'm i. don't i. don't wear makeup on my face, but I always wear sunscreen on a wear, always moisturizer well. It's funny because in quarantine I stopped wearing any makeup announcing patients, but I'm wearing a mask so. I don't even have to worry about. Blush or anything I just put a little under I conceal her. Mascara I go is only so, what do you have a favorite sunscreen? So during the year? When I'm in the city, I wear the Chanel easy essential fifty guys shaky shaky one the little sugar. Shake it up and it's so cool because it has seventeen point one percent zinc oxide in it, but it rubs in. Really cosmetically elegant, but it's it's a tiny bottle. It's pretty thin and when I'm at the beach. I usually lay her a bunch of sunscreens because my skin is so fair, does that help put like? Is it a different product because they have different light? Yes, Oh, okay, so you're getting. All the wavelengths covered I'm getting all the wavelengths covered, and I'm replying every hour like a crazy person, but look how fair am very fair I am, and I have asthma which is at like darkening of the skin from the sun and birth, control, pill, and pregnant and stuff, and it hates the son, so I have to be really careful so I I have some sunscreens from France they. Mostly. The amphibious ones Laroche. Say but only I only liked the ones from France I. Have Some sunscreen from Australia. One called invisible zinc, and then in the US have got the Shinto on, and then there are some much better zinc ones from the US. Right now like even Vino and Neutrogena makes him zinc sunscreens, zinc blocks UVA and UV rays like. It doesn't cog force story about Oh. Is that why you like zinc? You keep saying zinc, but I was like I wonder why zinc so great. Yeah, zinc is awesome, because it works right away blocks UVA MVP doesn't pores can't be allergic to it. It's a mineral. It's not not bad for coral reefs. We're going to get some zinc for sure before we let you go. Though we do this thing with all of our guests we ask them five quick questions like a speed round pressure. This is this is meant to lower your cortisol levels in. DEEP CHESTS! You want to take it away. Ask The question. I'm ready okay. I feel refreshed. I felt rejuvenated. How is the mental tub? That was nice. It was great I. I'm designing it in my mind I. Don't have a house housecat. Designing this bathroom in my mind that is just for me. It's like completely. All about serenity cannot wait to show you okay. So the famous five questions we always ask. What is the first beauty product you fell in love with I'm such a nerd. It was a body moisturizer because I had really really bad exit and dry skin as a kid. Lamy mom got me this vassil in intensive care. It was called. A formula. Oh my Gosh! That's so great into being. Discontinued it like ten years later? I thought my life was over, but then I gotta fill out the. Beauty product, but it really since I was a kid. I have MOISTURIZER, my body, my face to after the shower of my whole life, so you have to do while the skin is damp, bright. Yeah, just I shower a towel off and the skin just like a sponge in sucks it in, and it only takes one to one and a half minutes to do my whole body, so people say that off time like I've timed it you've you've minute I? We have we have no excuse. Okay. That's always my excuse at the time it got to do. Who is a celebrity that you haven't met? But you just know you'd be best friends with Ruth Bader GINSBURG. I'm dying to meet her and we would totally hit it off. I love it I love this. We haven't gotten her yet and we don't have a lot to do. We don't have a lot of dupes I just love that. You said that okay. What's your most indulgent snack and be specific? Your favorite indulgence neck I would say Mala Mars. The best cookie. Would you put it in the fridge? Sometimes although I don't love the marshmallow and the Graham, cracker getting so hard Oh. We can't find him right now. It's summer they only they only sell stock up now for people around the world, so they don't know the only seldom in the fall and winter because they melt in shipment. If it's warm out for our, Australian and UK listeners go on. Just love. Alamar love milner. Okay? WHAT SONG PUMPS YOU UP Steve Winwood while you see a chance? We haven't gotten that one yet. Hi there, but I'm probably dating my. Now we've got a lot of we've we? We've hit all the errors. We have to start the fat Mascara spotify pup list so I would love that. And what do you want to raise a wand to and by Razor Wand? That is like what kind of what product are you obsessed with? TV show movie whatever it is, so I have an answer for all those but kind of preoccupy right now with black lives matter. I can't think about anything else. Raise the WAN to the movement. Raise onto the Movement for shore. Excellent answer. You've been light. I feel like there was a lot of actionable advice in this interview like a lot of things I'm going to do to to end things for our friends and family that we can help them with. Yeah, this is a great conversation. Thank you so much Dr Wexler. Thanks, Jeff. Thanks Jen for having me. This is great. It is time to raise the wind. Remember when I used to sing. Raise the wand Michael do that for you. Oh! God I got about the singing or listeners, probably like no longtime listeners are like. Please don't please don't okay, so let's raise a one first up. We have a listener. Raise the one with a little commentary to like. We told you last week. Please just call us or send us your voice memos. Whatever you're feeling and thinking this is tricia young. Take it away, Tricia. And, just hi, I'm leaving. You guys a message for the first time I WANNA say. Your podcast is just spot on incredibly amazing I. Am a licensed Aestheticians in the state of Massachusetts and I work in sales in hair care with salons. In Massachusetts, so I started listening you probably right before Cova. And Dry for a living so normally I'd listen to you all day long, but now I just get the pleasure of listening really on my drives to and from the forest where I spend all of my time walking, but I just wanted to let you know I love your podcast and being in the beauty industry. It's always great to hear. About everything, obviously, I have my hands in everything. I read everything one thing I wanted to mention. Is You gotTA CHECK? Out Zits DECA. And yes, I said that with the Boston accent I. Don't have a Boston accent, but it's called zits sticker, and it's brilliant I wish I invented it. It is for a blemish it sticks right onto the the top of the blemish. It has little teeny needles in it, and it pokes into the blemish and feeds really good ingredients to kill and clear up that one blemish. You got to check it out. They're not cheap, but they are rockin amazing, so thanks for all you do. Hopefully you can throw this on one of your podcast and talk about Trish. EON gives you ZITS DECA information. Piece Tricia I love it. I love the way he pronounced it sticker. I can tell you those product. That is really cool. They're not like needles. They're like made of. They're made of the ingredient and they barely hurt. When you put the stickers on, so don't think it's a needle needle, but very good products. Nice, raise a wines. If you guys want to send us your raise, Wan's you can email a voice memo to info at Fat Mascara. Dot Com or you can always call us. Our number is hit jen. One day I'm GonNa make you say six, four, six, four, eight, one, eight, one, eight two, Jess. What are you raising a one two? I am raising a wand to finally a dupe a dupe. Dupe for my discontinued maybelline purple eyeliner, so my God, our biggest link out ever on the blog, so many people have you clicked on this line of the just loves so it was this purple liner for getting the the name of it. Maybe it's like Moonlit, purple or something, but it was It doesn't matter because you can't even buy it anymore, but it was a Shimmery Lilac long wear pencil for maybelline from about two years ago, maybe three years ago, and they. They discontinued it I. Don't know why you guys did. That may lean. I know that I've talked to Claire the publicist on numerous occasions about this and there's nothing there's nothing maybelline can do, but they they said goodbye, and I put it on our instagram, because I was like the last the last stroke in the in the Pencil I did my makeup see a month or two ago, and I said you guys have any dukes while you guys are on the case are FM detectives. I have now my Marc. Jacobs beauty. The, Gel I pencil. I think it's the high liner. In s excellent I pencil lunatic. L. U. N.. Lunatic you I don't love the name guys don't love the name I'm not a lunar nerdy. There's a moon reference and both of them maybelline moonlit purple, and then make it was called Moonlit purple. I might have made up moonlit purple, but it was something purples, just for pretend, and it was the lunatic. It's L.. U. N. A.. comprends tick. It is a lilac with silver sparkle in it, and it sounds like it's made for teens and tweens. It's not. It really looks great on like all. All Ages, it's not to let clubby It's great right now. It really is the ultimate dupe. It's a little too expensive. Those twenty six dollars as also twist up. Those airliners are worth it. Oh, they're good. They don't drag her polar. Skip at all like especially. If you have crappy leads like I'm getting like even with little wrinkles. You can still get a really inside so great, and you don't have to sharpen it. Get The shavings everywhere. It's twist up liner. Love it. Okay, I'm raising a want. To foot file here it is. I brought a visual for you girl. My feet are a mess so between the I've been wearing the cast or the boot whatever for the broken foot. I think because the other foot is now getting harder working because it's carrying the weight of everything, other foot's not working the calluses on the front of my toes I. Don't know if it's also 'cause. It's summer and you could see them more. You know I had the electric file which I use for the bottom, but there was nothing like my second toe there so crooked now my feet. The second toe is bigger than I. Oh, and it just gets this weird callous on top. The only thing that I have found that that works is the Checchi I. Hope I'm pronouncing it right. personal care product razor file. File it's a diamonds laced file. I've had this thing I want to thank I. WanNa say seven years maybe six or seven years, I've never gotten a new file for it. It has never gone down. It's like diamond powder on it, and you just file it in the shower when your feet or damp, and it gets rid of any callous. Even those fancy electronic one I have like doesn't do it the way this thing does so. It's twenty four bucks, but I'm telling you. You never have to replace this thing. It is truly been in my shower for It's probably more than seven years, so raise the. The one to this. I'll put a link with a while. The water's running or after when you're showers done, do it while the water's running at the very end of the shower while it's warm. Because you will get, you'll see. It'll get on it like the little bits of dead skin, so then I wanna keep rinsing under the warm water while I keep going, and it doesn't hurt you know how some of them are just like kind of painful and then the police stones. They're just found. Cut It. Don't cut it I need some of this Checchi Shit. It's good so I'll link out to it's you guys? Guys can have smooth feet all summer them. Thanks, thanks for listening. Our show is produced by astral media. Be Sure to follow us on Instagram at Fat Mascara. GO TO FAT MISCARRIAGE DOT COM to get a link to our private facebook group and hit us up. If you have a beauty question, you can send it to us at Info at Fat Mascara Dot Com. We'd love if you send US voice memo. We also want to hear your reason. Ones send those to the same address INFO at Fat Mascara. Dot Com and if you like what you're hearing, please leave us our view on. Itunes just throw some stars.

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