Questions answered in this video include:

1. What are the methods for dietary management for a person with diabetes?
2. How does someone who is diagnosed with diabetes prevent long-term complications, mainly damage to blood vessels?
3. What do you do when you are eating at a restaurant and are not aware of the amounts of saturated fats?
4. Is exercise suggested for an individual with diabetes?

Notes on Maudene Nelson, MS, RD, CDE:

Maudene Nelson is a nutritionist (registered dietitian) and a certified diabetes educator. Since 1975 Ms. Nelson has been a nutritionist and instructor at the Institute of Human Nutrition, Columbia University and the Arteriosclerosis Research Center, New York-Presbyterian Medical Center. At New York-Presbyterian she has provided nutrition counseling to patients, co-authored several publications and taught medical, nursing, public health, and graduate nutrition students.

Ms. Nelson received her B.S. in Human Nutrition in 1971 from Cornell University and her M.S. in Public Health Nutrition from Teachers College, Columbia University in 1976. She has been a volunteer and consultant to the American Heart Association and the American Diabetes Association.

Ms. Nelson also provides nutrition counseling and conducts nutrition workshops for employees in the Corporate Wellness and Fitness Services at the Metropolitan Life Insurance Company and the Employee Health Care Services at Merrill Lynch in the World Financial Center.

-Adapted from Ms. Nelson’s biography featured on Healthology.org

-Read an article on diabetes by Ms. Maudene Nelson

Questions answered in this video include:

1. How does the laser work to reduce the size of pores?
2. How do you know how deep you need to go in order to vaporize the right skin cells?
3. Are there any other potential side effects or risks to the procedure?
4. What steps are required to ensure quick healing after the procedure?
5. Does the resurfacing laser have any other applications besides minimizing pore size?

More about Dr. Jaggi Rao:

Dr. Jaggi Rao is a board-certified dermatologist licensed in both Canada and the United States. Immediately after completing his dermatology training, Dr. Rao became the first Canadian physician to be accepted to the prestigious American Academy of Cosmetic Surgery Fellowship Training Program. For a full-year, Dr. Rao was immersed in the art and science of various fields of cosmetic medicine in the heart of southern California. During this time, he was taught by and worked alongside some of the most famous names in cosmetic and laser surgery. With his love for dermatology, physics and technology, Dr. Rao distinguished himself as a reputable researcher, author, teacher, presenter, technician and skilled cosmetic specialist. Dr. Rao was privileged to be an investigator for numerous medical and device trials, exposing him to almost every new laser system and cosmetic technology, advanced uses for Botox, filling substances and novel topical agents, as well as cutting-edge advances in liposculpture, sclerotherapy and cosmetic surgery.

At this early point in his career, Dr. Rao has already earned several achievements. These include having authored over 30 scientific articles and textbook chapters, presented at over 20 medical meetings, mentoring countless physicians of various disciplines, serving as a peer reviewer for prominent medical journals including Dermatologic Surgery and The Journal of Cosmetic Dermatology, and acting as a consultant for various laser, technological and pharmaceutical companies. He has won awards for his research and presentations, and was recently appointed as a Faculty Member of the prestigious Hugh Greenway Superficial Anatomy and Cutaneous Surgery course, the gold standard course in dermatologic and cosmetic surgery hosted annually by some of the top leaders in the field.

Questions answered in this video include:

1. What is Alzheimer’s Disease?
2. Is Alzheimer’s Disease the same as Dementia?
3. How common is Alzheimer’s Disease in Canada?
4. What changes are seen in the brains of patients with Alzheimer’s Disease?
5. Is there a genetic component to Alzheimer’s Disease?
6. What are the risk factors for developing Alzheimer’s Disease?
7. What are some of the treatment options available to individuals with Alzheimer’s Disease?
8. What other possible treatment options are currently being explored by researchers?

Notes on Dr. David Westaway:

Dr. David Westaway is an internationally acclaimed researcher and director of the Alberta Centre for Prions and Protein Folding Diseases at the University of Alberta. Here,  he has become one of two inaugural Prion Institute Scholars. The scholar program was recently established by the Alberta Prion Research Institute, which funds research into the prevention and management of prion-related diseases, like Alzheimer’s and Parkinson’s disease.

Previously a researcher with the Centre for Research in Neurogenerative Disease at the University of Toronto, Westaway is a molecular biologist who completed his postdoctoral training at the University of California with Nobel laureates Harold Varmus and Stanley Prusiner, where he helped to define the molecular biology of prion diseases. His work on cellular prion protein and two related proteins has led to insights about Alzheimer’s disease.

Most neurodegenerative diseases like Alzheimer’s disease are protein-folding diseases. These diseases are caused by prions, a type of protein which causes neurodegenerative diseases when they fold incorrectly. This field of study is relevant to the public on many levels. Prion research is an “enormously practical problem on a very day-to-day level with an impact on agriculture,” says Westaway. Prion diseases are also critical to human health and “some of the tools of prion research have been put to good effect in neurodegenerative diseases that are common in humans.”

-adapted from an article on the website of “Canadians for Health Research

Alzheimer’s Disease:

Dementia can be defined as a serious loss in cognitive ability attributed to factors beyond natural aging. Alzheimer’s disease is the most common form of dementia; affecting an individual’s memory, cognition and behaviour. Currently the incidence rate of Alzheimer’s disease in Canada is approximately 1 in 11 individuals over the age of 65, making Alzheimer’s disease a common disease amongst senior citizens. While Alzheimer’s disease is currently an incurable disease, and treatment options mainly focus on the management of the disease, a significant amount of research is being performed in order to learn more about this complex disease and hopefully develop more advanced treatment techniques.

Pathophysiology

The pathophysiology of a disease is basically describing the abnormal changes occurring in the body that causes the symptoms experienced in patients with that particular disease. As such, the pathophysiology of Alzheimer’s disease will describe what is happening in a patient’s brain as the disease progresses (however it may not describe what causes these changes to occur). Alzheimer’s disease is characterized by the loss of neurons (brain cells) and the connections between neurons (known as synapses). This results in the deterioration of various parts of the brain, including the parietal and temporal lobe, as well as parts of the frontal cortex. The deterioration of these areas of the brain leads to the symptoms experienced by patients with Alzheimer’s disease (including memory loss, loss of cognition, etc.). The exact cause of this deterioration is not well understood however, an increased number of substances called amyloid plaques and neurofibillary tangles are noted in the brains of patients who have Alzheimer’s disease.  Amyloid plaques are insoluble protein structures that form around the brain cells, while neurofibrillary tangles are incorrectly developed proteins (Tau proteins) that accumulate inside the brain cell. As you may notice, both amyloid plaques and neurofibillary tangles are forms (or mis-forms) of proteins. As such, Alzheimer’s disease has been identified as a protein mis-folding disease caused by the accumulation these abnormally formed proteins.

The cause of the proteins accumulating in and around the brain cells of Alzheimer’s patients is not yet fully understood, however mutations in several genes have been identified as events leading to the protein accumulations. As genes serve as the ‘instructions’ for the construction of proteins in the body, genetic mutations could give rise to the formation of proteins that can interfere with the normal functioning of the body. With regards to Alzheimer’s disease, mutations of the APOE gene has been found cause the symptoms associated with Alzheimer’s disease, with individuals carrying this genetic mutation having an increased chance of being diagnosed with Alzheimer’s disease. The other possible genetic links are not as clear, but current research is looking into further identifying the mutations and genes that can lead to the protein mis-folding seen in patients with Alzheimer’s disease.

Causes and Symptoms

The exact cause of the disease is not fully understood, but there are several theories that attempt to explain certain aspects of the disease. One theory is that Alzheimer’s disease is caused by a deficiency in the neurotransmitter acetylcholine. A neurotransmitter is a molecule that neurons (brain cells) use to communicate with other cells in the body. According to this postulate (“theory”), the deficiency in acetylcholine is the primary cause of the cognitive impairment seen in patients with Alzheimer’s disease. Many current drug treatments are based on this theory however several other researchers have proposed different postulates to explain the cause of Alzheimer’s disease. One of these alternative causes focuses on how genes play a role in Alzheimer’s disease. The influence of the APP gene and APOE4 gene are thought to cause excess amyloid plaque build-up and account for the neuron death and cognitive impairment seen in patients with Alzheimer’s disease. Finally, the “tau hypothesis” proposes that abnormalities with the tau proteins present in the human body that result in the tau molecules clumping together and forming neruofibrillary tangles, strongly correlates with the cell death seen with Alzheimer’s disease.

Whatever the cause, it has been found that the damage to the brain starts about 10 years before the initial onset of symptoms. During this time, the connections between neurons in the brain become weak and ineffective at transmitting impulses that are needed for the full function of the brain. As the connections are slowly lost and the neurons die, parts of the brain become weaker and symptoms can begin to appear. For instance, when the neurons begin to weaken and die in an area of the brain called the Hippocampus, memory loss starts becoming apparent. In fact, severe memory loss is often an early symptom of Alzheimer’s disease, however it should be noted that memory loss can be a symptom associated with a variety of other disease as well. Other early symptoms of Alzheimer’s disease include a decline in cognitive ability, including difficulty in tasks requiring visual/spatial skills as well as impaired reasoning and judgement.

As the disease progresses, a number of routine daily activities will become increasingly difficult, such as speaking (due to a decrease in vocabulary) and tasks requiring motor skills (ie: tying a shoe, getting dressed). In addition, the neurological effects will become increasingly more profound, leading to possible delusions, personality and emotional changes, and losing the awareness of one’s condition and environment.

In the final stages of the disease, the patient will be fully dependant on a caregiver and may lose their ability to communicate verbally (however they can still hear and interpret messages), eventually lose the ability to independently eat and drink (due to decreased muscle mass) and become more fatigued and tired. While Alzheimer’s disease is a terminal disease, the more common cause of death for Alzheimer’s patients is due to external factors, such as infections or pneumonia.

Treatment

As previously mentioned, current treatment options focus mainly on the management of symptoms rather than the treatment of the disease. The two main types of medications used to manage the symptoms of Alzheimer’s disease are Acetylcholinesterase inhibitors and memantine.  Acetylcholinesterase inhibitors are often used to manage mild to moderate Alzheimer’s disease by blocking the acetylcholine neurotransmitter. The most common side effects of this treatment are nausea and vomiting. Memantine is a NMDA receptor antagonist and works by blocking the action of the NMDA receptors (which respond to the neurotransmitter glutamate). This treatment has shown to be effective in treating moderate to severe Alzheimer’s disease. Side effects of memantine include hallucinations, confusion, dizziness, headaches and fatigue.

Other non-medicinal treatment options may be effective at managing Alzheimer’s disease including the use of emotional intervention methods. Methods of emotional intervention include using reminiscence therapy and sensory integration. Reminiscence therapy is performed by having the patient recall different memories from their past sometimes utilizing memory aids such as pictures. This therapy may be used to help with cognition and mood. Sensory integration is performed by altering the patient’s surrounding by including differ objects that are both soothing and stimulating to one’s senses (such as lava lamps). This type of room is often called a snoezelen room and is also used as a sensory therapy for other mental disorders. While little scientific research has been performed to determine the effectiveness of these therapies, there may be some evidence that these therapies can help with the patient’s mood and emotions.

It is also essential that a patient with Alzheimer’s disease has adequate care from a caregiver, as during the final stages of Alzheimer’s disease, many normal functions (such as eating) will be hard to perform without assistance. In addition, the caregiver is able to provide emotional support for the patient, further necessitating a caregiver for the individual.

Some researchers are also looking into how certain lifestyle changes/activities could prevent or delay the onset of dementia or Alzheimer’s disease. Examples of recommended changes/activities include preforming activities that engage the brain (such as playing games or learning a new skill), keeping physically active and eating a healthy diet that is supplemented with Omega 3 fatty acids (found in fish and certain nuts). While there is not conclusive evidence on whether these lifestyle factors can help those who may develop Alzheimer’s disease, all these factors presented have shown to be effective in helping with certain chronic diseases such as heart disease, type II diabetes and obesity. Therefore, on the advice of a physician, it is recommended that at least some of these lifestyle actions be included in some aspect of the individual’s daily routine (especially if they are a senior citizen) for the prevention of a variety of chronic diseases, and also to possibly prevent or delay the onset of Alzheimer’s disease or dementia.

Current Research

Currently, there is a large amount of studies being conducted in order to better understand and find an appropriate treatment for Alzheimer’s disease. While extensive research is being conducted on many aspects of Alzheimer’s disease, two research areas that were recently highlighted include research into potential biomarkers of Alzheimer’s disease and the possibility of creating a vaccine for Alzheimer’s disease.

In a recent research article published in Nature (July 14, 2011), the possibility of using ‘biomarkers’ to help doctors identify patients who may develop Alzheimer’s disease was explored. Biomarkers are biological indications (ie: genes types, proteins in the blood, etc.) whose presence could indicate the patient’s susceptibility to developing particular diseases. Discovering biomarkers for Alzheimer’s disease would help doctor’s diagnose the disease before symptoms appear and help researchers develop a effective drug that can prevent the onset of the disease. At the University of Pennsylvania’s Alzheimer’s Disease Center, hundreds of thousands of blood and cerebral spinal fluid (the fluid that exists in your brain and spine) samples are stored and made available to researchers who are looking into Alzheimer’s disease. These samples along with high-resolution brain scans are vital sources of information for the Alzheimer’s Disease Neuroimaging Initiative, an organization that is devoted to Alzheimer’s research and specifically, identifying potential biomarkers. Currently, research has shown that the presence of a certain amyloid protein or an elevated total level of tau protein could be used to determine an individual’s susceptibility to developing Alzheimer’s disease; with the presence of a special form of tau protein (with additional phosphate groups) serving as the most effective biomarker . Researchers studying biomarkers are hopeful that further tests will show that these biomarkers are accurate and effective at determining ones likelihood of developing Alzheimer’s disease and could soon become standard medical tests that a doctor could perform on an individual who is at risk of developing Alzheimer’s disease.

Some researchers are also exploring the possibility of developing a vaccine for Alzheimer’s disease.  The main goal of a vaccine for Alzheimer’s disease is to utilize the body’s own immune system to attack and destroy the mis-formed proteins that cause the symptoms, such as amyloid proteins. While previous trails of a vaccine did not turn out very promising, recently a group of researchers have found that administering IVIg (intravenous immunoglobulin) to a group of Alzheimer’s patients was effective at improving or stabilizing their symptoms.  IVIg is a treatment that is often used to boost immunity in a patient whose immune system is compromised (often due to genetic reasons or certain diseases). Drug trails are currently being performed on the use of IVIg in the treatment of Alzheimer’s disease and the results could be made available by the end of 2012. One problem with using IVIg as a treatment for Alzheimer’s disease is that patients would require relatively high doses and there is a limited supply of IVIg (as it is obtained from donated blood). In addition, while IVIg has been shown to improve the symptoms in some Alzheimer’s disease patients, the effects are not permanent and can wear off within a couple of months. However, more research into alternative ways of developing and distributing a vaccine for Alzheimer’s disease is being conducted and some believe that an effective vaccine could be developed within the near future.

Links

Alzheimer Society of Canada – http://www.alzheimer.ca/

Alzheimer’s Disease Neuroimaging Initiative – http://www.adni-info.org/

References

“Alzheimer’s Disease Fact Sheet.” National Institute on Aging. July 2011. Web. 12 Sept. 2011. <http://www.nia.nih.gov/Alzheimers/Publications/adfact.htm>.

“Alzheimer’s Disease: Statistics.” Alzheimer Society of Canada – Société Alzheimer Du Canada. Web. 12 Sept. 2011. <http://www.alzheimer.ca/english/disease/stats-intro.htm>.

Schnabel, Jim. “Vaccines: Chasing the Dream.” Nature 475.7355 (2011): S18-19. Print.

Williams, Ruth. “Biomarkers: Warning Signs.” Nature 475.7355 (2011): S5-S7. Print.

Photo Credits

http://www.ahaf.org/alzheimers/about/

Questions answered in this video include:

1. What is Rheumatoid Arthritis?
2. What exactly causes Rheumatoid Arthritis?
3. Who is usually affected by rheumatoid arthritis, and what are some risk factors for getting it?
4. What are some signs and symptoms that might indicate an individual has RA?
5. Aside from the joint symptoms, what are some common systemic symptoms of RA?
6. How is the diagnosis of RA made?
7. Is there a single test that can indicate if a Patient has RA?
8. What are the current treatments available for RA?
9. Is this disease curable?
10. Would patients with RA have to remain on these treatments for life?
11. Are there any complications associated with RA?
12. Is there a possibility that some of these complications will improve with age?
13. Will Rheumatoid Arthritis improve with age, or is this something that will get worse?
14. If an RA patient receives appropriate treatment, will their life expectancy improve?
15. Are there any reliable online resources you would recommend for RA patients?

Questions answered in this video include:

1. What are the lifestyle factors that contribute to obesity?
2. How much of a role do genetics play in the development of obesity?
3. Do the hormones leptin and ghrelin play as big a role in obesity as some people believe?
4. What are some long-term health consequences of obesity?
5. What measures can be taken to prevent obesity?

About Dr. Sharon Akabas

Questions answered in this video include:

1. What is phimosis?
2. How common is it to become a disease?
3. What are some consequences of untreated phimosis?
4. What are the treatment options for phimosis?
5. Do you have any online learning resources you could recommend to parents or youths?

About Dr. Peter Metcalfe

Dr. Peter Metcalfe is one of two pediatric reconstructive urologists at the University of Alberta Hospital. He completed his undergraduate training at the University of Alberta and was accepted into the prestigious urology residency program at Dalhousie University.  After residency, Dr. Metcalfe received fellowship training in pediatric urology at Indiana University and completed a Master of Science in experimental Surgery in 2010. He is currently an assistant professor in the Department of Surgery.

Questions answered in this video include:

1. What is circumcision?
2. Are there any medical reasons that require a circumcision?
3. What are the risks associated with a circumcision?
4. How common is the risk of abnormal scarring?
5. What is the current trend in the incidence of circumcisions?
6. Is circumcision covered by Health Canada?
7. How much does it cost to have a circumcision?
8. What advice would you give to parents considering circumcised (for their child)?
9. Can you suggest any online learning materials?

General Notes about Dr. Peter Metcalfe

Dr. Peter Metcalfe is one of two pediatric reconstructive urologists at the University of Alberta Hospital. He completed his undergraduate training at the University of Alberta and was accepted into the prestigious urology residency program at Dalhousie University.  After residency, Dr. Metcalfe received fellowship training in pediatric urology at Indiana University and completed a Master of Science in experimental Surgery in 2010. He is currently an assistant professor in the Department of Surgery.

Notes on Dr. Janice Liao:

Dr. Janice Liao is a dermatologist specializing in hair transplantation, with over 25 years of experience in the field. Dr. Liao is the past president of the Alberta Society of Dermatology and board member of both the Canadian Dermatology Association and Canadian Society of Dermatological Surgery.

Background Information – Androgenic Alopecia:

Alopecia (balding) is a very common problem in both males and females. At age 50, about 50% of the male population will be affected by it. In females, around 30% of the population will experience balding to some degree by age 40. The exact amount of money spent yearly on treating alopecia is unclear, but figures suggest that it is a multibillion dollar industry. Alopecia can be caused by genetic factors, medication (e.g. chemotherapy), and nutritional deficiencies such as a lack of iron. Many types of alopecia occur in humans, such as traction alopecia, alopecia areata, scarring alopecia and androgenic alopecia. Androgenic alopecia, commonly known as male pattern baldness, contributes to the vast majority of hair loss seen in both males and females and is caused predominantly by genetic factors.

Pathophysiology:

Male pattern baldness (MPB) typically begins with a receding hairline, slowly becoming an “M” shape, sometimes referred to as a widow’s peak. The hair on the crown then begins to thin out, along with other existing hair at the frontal hairline. Depending on the severity, the top of the head may eventually become completely bald, leaving a horseshoe-shaped bald patch. Characteristically, MPB spares the lateral aspects of the scalp, leaving a ring of hair follicles resistant to hair loss along the sides of the head. This is due to a lack of receptors on these hair follicles to the androgen DHT, which causes hair loss in hairs at the back and side of the head.

This loss of hair is a completely physiological process, although it can commonly result in adverse psychological effects in an affected individual.

Male pattern baldness has been studied extensively, and it is evident that it is predominantly dictated by a few hormones and enzymes, the most influential of which is dihydrotestosterone, or DHT. This substance is created from another hormone called testosterone, of which approximately 5% is reduced by an enzyme called 5-alpha-reductase to produce dihydrotestosterone. DHT facilitates pubic and body hair growth during puberty, and a lack of this hormone can lead to a deficiency of body hair or more serious developmental abnormalities during normal male development. However, despite promoting hair growth and the development of male secondary sexual characteristics earlier in life, the role of DHT can curiously reverse and begin to promote hair loss in individuals with a genetic susceptibility and/or sensitivity to this hormone. The extent to which hair follicles on the scalp are sensitive to DHT determines the total extent of hair loss an individual will experience.

Thus, the genes that dictate the hormonal receptor’s response to DHT play a central role in the onset of androgenic alopecia. Studies had shown that a certain variant of androgen receptor is needed for male pattern baldness to occur. The genes responsible for this type of receptor are recessive (meaning one copy of the gene from each parent is required for it to work), and are located on the X chromosome.

Treatments:

One of the most widely used treatments for androgenic alopecia is a drug called finasteride (Propecia^TM, Proscar^TM). It is a synthetic substance that inhibits 5-alpha-reductase, the enzyme that converts testosterone to DHT. Studies have shown that this treatment can prevent further hair loss in up to 90% of the individuals, while a certain percentage of people may in fact experience hair regrowth. However, the effect of finasteride lasts only as long as it is taken, and therefore the pill must be taken long-term and on a daily basis for optimal results. Hairs grown or maintained through the use of finasteride are at risk of being lost within 6-12 months after treatment stops. Since this drug inhibits the production of DHT, a male sex hormone, adverse side effects may include erectile or ejaculatory dysfunction and decreased libido. A few European agencies have warned of permanent sexual dysfunction, and this warning is included on the European product label but not North America warning label. Importantly, this drug should also not to be handled or ingested by pregnant and breastfeeding women, or by women planning on becoming pregnant soon. Additionally, it is recommended that males who intend to try to conceive a child with their partner should cease taking finasteride for a period of at least 3 months. In all, though, this medication is very well tolerated by the majority of patients, and it is the most effective medical treatment option currently available for MPB.

Minoxidil (or Rogaine^TM) is another popular treatment option for androgenic alopecia. Originally developed for high blood pressure, the side effect of increased hair growth in patients soon led to its adoption as a hair loss treatment option. Topical minoxidil is made specifically for treating hair loss. It often comes in the form of a liquid or foam in both a 2% and 5% concentration, and is directly applied to the scalp once or twice each day. The exact mechanism of how minoxidil works is still unknown, but its effect is thought to be related to increased blood flow and oxygenation to the scalp. As with finasteride, treatment should be maintained long-term for optimal results, as hair loss will resume after minoxidil is discontinued. Minoxidil can be used to treat male pattern baldness in both men and women, and can in fact produce more pronounced results in the latter. The side effects of minoxidil may include local skin irritation and flaking, although in general this medication is very well tolerated by patients. A sometimes bothersome secondary side-effect is the unsightly flaking of the liquid preparation of this medication when applied to the scalp. In this circumstance, flaking can often be minimized by switching to the foam preparation.

For individuals who have failed medical therapy for MPB and in those patients for whom hair loss is particularly psychologically distressing, the next and most definitive treatment option is hair transplant surgery. This surgery involves transplanting small areas of hair follicle-containing skin, harvested from the peripheral areas of the scalp where follicles tend to be resistant to hair loss, to areas of the scalp where hair loss has occurred. Though the transplanted hair will not be as dense as it was prior to when hair loss first occurred, a properly done re-distribution of resistant scalp hair can significantly reduce the effects of MPB on a patient’s overall cosmesis. Side effects may include continued thinning of hair, scarring, and a small risk of skin infection. Importantly, it is important that patients maintain a strict regimen of additional hair loss-prevention measures (namely minoxidil and/or finasteride therapy) after the procedure has been completed, to prevent continual loss of non-resistant hair follicles.

Research:

Currently, there are several exciting avenues of research being explored in the field of male pattern hair loss. Of these, the most cutting-edge and potentially most promising is the harvesting and growth of stem cells into new, fully functional hair follicles, which would then be surgically implanted into the scalp in much the same manner as hair transplant are currently conducted. If this technology is brought to fruition, stem cell-based hair transplantation would mitigate the limiting factor affecting our current transplant technology, namely the availability of viable, resistant hair follicles.

Questions answered in this video include:

1. What is skin cancer?
2. How does a skin tumor develop, and what processes are involved?
3. Are there different forms of skin cancer?
4. What are some specific types of Non-melanoma skin cancers (NMSC’s)?
5. How common are NMSC’s in society?
6. Of the BCC and SCC, which is more commonly found?
7. Do certain segments of the population have a higher risk of developing NMSC’s?
8. Do artificial tanning beds increase your risk of developing skin cancer?
9. Can people from any age group develop an NMSC, or are certain ages more prone?
10. What features or aspects of the skin might lead a specialist to suspect a BCC or SCC?
11. Are there warning signs that allow skin cancers to be detected early?
12. What are some potential consequences of a BCC that goes unchecked for a long period?
13. What are some dangers of leaving a SCC unchecked for a long period?
14. Is there anything patients can do to prevent these types of skin cancers?
15. What treatment options are available to someone who is diagnosed with an NMSC?
16. What is Mohs Micrographic Surgery?
17. How does Mohs Micgrographic Surgery differ from regular surgical excisions?
18. After receiving treatment for a BCC or SCC, what are the chances of the tumor reappearing or recurring?
19. Are there any other long-term complications that can arise after treatment?

About Dr. Taher

Dr. Taher completed his dermatology training at the University of Alberta. Prior to this, he underwent fellowship training in Moh’s micrographic surgery in Dermatologic surgery in Los Angeles and Santa Monica, California. While in the United States, he was on faculty at USC and also lectured at UCLA. Dr. Taher has an interest in general medical dermatology and cutaneous oncology and provides advanced skin cancer surgery skills to his patients.

Read about Dr. Taher’s innovative skin cancer screening and treatment clinic for organ transplant patients

Keystone Dermatology Institute

Nonmelanoma Skin Cancer – Backgrounf Information

Skin cancers are abnormal growths of the skin that have many possible etiological factors and varying degrees of severity. There are two major categories of skin cancer, namely melanoma and non-melanoma skin cancers (NMSCs). Of the non-melanoma skin cancers, the two most common types are squamous cell and basal cell carcinoma. Together, they make up about three quarters of all NMSCs, and are the most commonly diagnosed of all human cancers.  The squamous and basal cells are cells that make up the epidermis, or the outmost layer, of the skin. The squamous cells are the mature cells that gradually move toward the surface of the skin, and basal cells are the infant stage cells being constantly produced deeper in the epidermis, pushing the squamous cells upwards.

Pathophysiology:

Basal cell carcinoma (BCC) is most commonly found on skin that’s been exposed to the sun, with 80% occurring on patients’ face and neck. It usually has the appearance of a smooth, shiny bump on the skin. Sometimes the bump is translucent in nature, and blood vessels can be seen. Some types of basal cell cancers can resemble a thickening of skin or scar tissue. It should also be noted that it is difficult to differentiate between basal cell carcinoma and acne scars, amongst other skin conditions. This type of carcinoma is the most common type of skin cancer, with a person’s lifetime risk of developing BCC around 30%. Luckily, BCC is one of the most treatable forms of skin cancer, with metastasis or death occurring in only extremely rare instances. Nevertheless, uncontrolled proliferation of BCC has the potential to cause substantial local tissue destruction, and thus prompt treatment and careful follow-up is very important.

There are a few primary etiological factors which have been identified that lead to the development of basal cell carcinoma. It has been observed that certain genetic traits, namely Caucasian traits, such as light colored skin, blue or green eyes, and blonde or ginger hair can elevate the risk for basal cell skin cancer. Also, overexposure to strong radiations such as ultra violet and X-ray radiation also increases the risk for this type of skin cancer. As with all cancers, genetic pre-disposition is also a major factor. Early signs and symptoms that may indicate the presence of basal cell carcinoma includes a sore on the surface of skin that bleeds easily and refuses to heal, or the emergence of a scar-like sore in an area that has not previously been injured.

Squamous cell carcinoma (SCC) occurs less commonly than basal cell carcinoma, although it does still make up a significant proportion of the overall skin cancer burden. It appears as a growing bump that may take on different textures and colors. Commonly, it presents as a reddish, scaly papule which may have a rough of crusty surface. It is also most prevalent in areas on the face or neck, as well as other areas that are exposed to the sun. Patients commonly describe SCC as having a sore which doesn’t seem to heal. This type of cancer can also occur in organs other than the skin, including lung, liver, prostate, cervix, etc. Appearances and symptoms of the cancer may vary with the organ.

Squamous cell carcinoma can be caused by a variety of different environmental factors. It tends to appear in individuals with lighter skin and those who have been overexposed to X-ray and ultra violet radiation. Risks for this cancer are also higher in individuals who have had contact with environmental toxins such as arsenic. Old age is itself a risk factor for SCC development. Finally, another important risk factor for the development of SCC is immunosuppression, such as is the case with organ transplant recipients who receive lifelong immunosuppressive therapy to lower the chances of tissue rejection. Thus, patients such as this require close monitoring and regular skin check-ups performed by a dermatologist.

Treatments:

To determine whether the case is indeed skin cancer, a biopsy will is usually performed in which a small piece of skin tissue is removed for further examination in a laboratory. Basal cell skin cancers are relatively easy to treat, and the rate of recurrence is under 10%; squamous cell skin cancer can be cured with a high success rate if discovered and treated promptly. However, compared to BCC, SCC is somewhat more likely to recur locally and is also associated with a slightly higher chance of distant metastasis.

Many treatments are currently used to treat skin cancers. These include surgical excision, Mohs micrographic surgery, curettage and electrodesiccation, radiation therapy, and skin creams. Doctors will recommend and employ different treatment methods depending on the size and location of the tumor, age of the patient, and other factors which may result in a specific treatment modality being indicated.

Surgical excision, including Mohs micrographic surgery, is the preferred method in dealing with most skin cancers. This method results in removal of the tumor and results in the lowest rates of local recurrence and metastasis. Due to the limitations of conventional surgical removal in cosmetically sensitive or high risk areas such as the face, Mohs smicrographic surgery is often the preferred choice. This type of surgery removes a thin layer of skin cancer, which is immediately examined under a microscope to check for cancer cells. The base and side of the sample is specifically assessed, and the surgeon will then continue to remove layers of skin until the sample observed is free of cancer cells. This method allows for maximal tissue sparing, lower recurrence rates and a higher degree of confidence that all of the cancer has been removed.

The curettage and electrodesiccation method is often used for tumors of smaller size and in non-cosmetically sensitive areas. This method uses a curette to scrape away the tumor, before an electric current is applied to further eliminate any remaining cancer cells. The cure rate is highly varied and depends on the size and type of the tumor.

Radiation therapy (RT) involves utilizing damaging radiation to destroy cancer cells. The normal tissues around the tumor are also be affected to some degree, and thus a recovery period is needed in between treatments to allow for healing. The resting period does not allow the cancer to recover much since the cancer cells are not as apt at restoring themselves. Radiation therapy is used when cancer has spread to other organs or lymph nodes and surgical removal would be difficult. Fragile areas that are difficult to reconstruct (i.e. nostril rim) are also sometimes treated by radiation therapy. RT is also used for elderly patients that are not well-suited for surgery. It takes multiple visits to complete the treatment, and can require anywhere from 5 to 25 visits. Radiation therapy can deliver a high success rate in curing tumors, although the exact cure rate depends on the type of tumor in question as well as its stage of progression.

Skin cream that contains imiquimod or 5-fluorouracil is used to treat superficial skin cancers. It is reported that such treatment is very effective in reducing and even removing the tumor, although marked inflammation often occurs as a side effect when using this treatment. This method is often used in conjunction with Mohs surgery to ensure the complete removal of the tumor.

Research:

A synthetic inhibitor of the Hedgehog Pathway that is known to induce tumor growth is currently under active investigation. This inhibitor is known as GDC0449, developed by the Curis Inc. and is currently under clinical trials by the Genetech company. It has been shown to slow or even stop the development of tumors, and can cause existing tumors to shrink. It does not only work on skin, but other organs such the esophagus and cervix as well.

References:

Canadian Cancer Society

http://www.cancer.ca

National Library of Medicine

http://www.nlm.nih.gov

Questions asked in this interview include:

1. What is a tattoo?
2. How does a tattoo remain permanent given that the skin is constantly shedding?
3. What are the options for tattoo removal?
4. How are lasers used to remove the tattoos?
5. Are certain colours of tattoos easier to remove than others?
6. How much does the laser treatment hurt the individual?
7. Is tattoo removal covered by health insurance coverage?
8. What are the costs associated with laser tattoo removal?
9. How many laser treatments are required to remove a tattoo?
10. How does the skin heal after tattoo removal? Is there noticeable scarring?
11. Does the skin revert back to its pre-tattoo state?
12. Are there risks involved with laser tattoo removal?
13. What advice would you give to somebody to insure proper tattoo removal?
14. Are there differences to having tattoos removed in a hospital (clinic) versus a tattoo parlor?

Notes on Dr. Jaggi Rao:

Dr. Rao is a board certified dermatologist licensed in both Canada and the United States. He is also a clinical professor of Dermatology and a coordinator of the residency training program at University of Alberta. After completing his dermatology training, Dr. Rao was the first Canadian physician to be accepted to the prestigious American Academy of Cosmetic Surgery Fellowship program.

Tattoo Removal:

Tattoos represent an ancient form of art, and has been an important means of self-expression for many millenia. In fact, archeological evidence suggests that the use of tatttoos dates back to 4-5000 B.C. Tattooing involves inserting indelible ink into a layer of the skin called the dermis, which is the layer found below the epidermis. This process results in permanent skin markings, removable only by very invasive, painful procedures. The most effective and safe of all removal strategies is laser tatto removal. In this video, footage showing an actual laser tattoo removal session is featured, together with an explanation of the procedure by an experienced laser tattoo removal expert.

Background Information

Overview:

Tattoo removal probably has a history as long as the art of tattoo itself. In fact, statistics show that a large proportion of people who choose to get tattoos later end up regretting their decision. Early forms of tattoo removal consisted of applying or injecting substances such as garlic or lime into the skin, as a way of mechanically extracting the tattoo ink. More modern techniques include invasive medical procedures such as cryosurgery as well as surgical excision. Probably the most cutting-edge form of tattoo removal, often considered to be the gold standard, is the laser tattoo removal method. This method makes use of Q-switch lasers—lasers capable of producing high-power laser pulses—to remove a tattoo. This method rarely results in scars, and is also non-invasive, reducing the chance of adverse side effects.

Methods:

One of the older methods of tattoo removal uses specialized gel to drive the ink into the deeper skin layer up to the surface layer, eventually to be shed along with the surface skins. More invasive methods include surgery akin to that of skin transplant or skin grafting Due to the high rate of scarring, unpredictable results, and potential for infection, invasive methods to remove tattoos are no longer very popular. The newest laser tattoo removal method makes use of a phenomenon termed selective photothermolysis, which uses high energy laser beams to target a specific structure, producing sufficient heat to destroy the target. In this case, the targeted structure is the ink in the tattoo, which, after being fragmented by heat, will be broken down and removed by the body.

Laser Tattoo Removal:

As the name implies, the laser tattoo removal method uses laser to remove the tattoo’s coloration of the skin. The laser used must be able to provide enough energy (upwards of gigawatts) to shatter the color pigments of the dye, and Q-switched lasers are one of the only commercially available lasers capable of delivering such enormous amounts of energy. However, due to the nature of lasers—namely they will be absorbed differently by different colors—removal of multicolored tattoos often require many different lasers of different wavelengths to work together.

There are a few types of lasers used for tattoo removal: Q-switched Ruby Laser, Q-switched Nd:YAG, Q-switched Alexandrite Laser, and Flashlamp-Pumped Pulsed Dye Laser. The Ruby Laser is effective on most tattoo ink colors except for red and yellow; the Nd:YAG laser works well on red and orange tattoos, and also works better on individual with darker skin; the Alexandrite Laser works great on green colored tattoo. And all three work most effectively on the darker colored tattoos. The Flashlamp-Pumped Pulsed Laser works best on more brightly colored tattoos, but has the disadvantage of being unable to reach tattoos deeper in the skin.

The procedure of laser tattoo removal is quite simple. Most of the time, a topical anesthetic cream is applied to the tattoo area to help ease the pain, which has been described as comparable to snapping a rubber band against the skin. The doctor will then target the tattoo with a pulsing laser and cover the entire tattoo area with the appropriate type of laser. The procedure itself usually takes under an hour to complete, depending on the size of the tattoo. The fragmented ink will then be broken down and processed by the body. In order for the tattoo to completely disappear, however, multiple treatments are required. Due to the blistering and scabs that will follow the treatment (the laser will heat the skin as well), a resting period of about 4-8 weeks is often required before the next treatment. Most of the tattoo will be removed after 5 to 15 treatments, but the exact number of treatments needed varies greatly between individuals, depending on how fast the body processes the ink fragments, the skin tone, and the tattoo itself. Generally speaking, darker tattoos (black tattoos, for instance) are easier to remove than light colored ones (such as green tattoos). Also, tattoos using professional and more permanent ink, and tattoos with multiple layers are harder to remove.

The cost of each procedure varies depending on the size, type, and the surgeon. However, the typical cost per visit ranges from roughly $100 to $500. Taking into consideration the number of treatments needed, the total cost of removing a tattoo via laser tattoo removal can be anywhere from several hundred to a few thousand dollars.

Risks and Side Effects:

Mechanical tattoo removal has a high risk for scarring and ink retention. Change in pigmentation of the skin is also a probable side effect.

Laser tattoo removal sometimes causes changes in the skin pigmentation; however, in most cases the altered pigmentation goes away within a year or so, with a few rare cases being permanent. Blistering and scabs will often form post-treatment, and any tampering with these will raise the risk of scarring. Textural changes have also been known to occur, and in most cases subside within a few months. Hyperpigmentation of the skin, particularly in dark-skinned individuals is another potential side-effect, especially of care is not given to select the appropriate type of laser for the skin-tone of the patient. It has also been noted that bulla, large fluid-filled vesicles on the surface of the skin akin to blisters, can rarely develop. But if treated quickly by the practitioner, long-term consequences are unlikely to ensue.

Questions answered in this interview include:

1. What factors can result in an unhealthy fetus?
2. How does alcohol affect the health of a fetus? What about smoking?
3. Can medications negatively affect fetal health?
4. Should certain activities be avoided during pregnancy?
5. Can a mother’s health impact fetal well-being?

Dr. Nestor Demianczuk is a faculty member in the department of Obstetrics and Gynecology at the University of Alberta. His clinical practice and research interests focus on maternal-fetal medicine, and he has published a large body of scientific articles on the topic of fetal development.

For more information on fetal well-being and other pregnancy-related topics, you can visit the following credible websites, suggested by Dr. Demianczuk:

1. Society of Obstetricians and Gynecologists of Canada
2. American College of Obstetricians and Gynecologists
3. MOTHERISK : information on medication use during pregnancy
4. Center for Disease Control and Prevention (CDC)

Questions answered in this interview include:

1. How is fetal well-being defined?
2. What strategies are used to assess fetal health during pregnancy?
3. What are some of the indicators used by physicians to determine the health of a fetus?
4. What are some examples of developmental abnormalities which can be detected during fetal assessment?
5. During what stage of pregnancy are malformations most likely to develop?

Dr. Nestor Demianczuk is a faculty member in the department of Obstetrics and Gynecology at the University of Alberta. His clinical practice and research interests focus on maternal-fetal medicine, and he has published a large body of scientific articles on the topic of fetal development.

For more information on fetal well-being and other pregnancy-related topics, you can visit the following credible websites, suggested by Dr. Demianczuk:

1. Society of Obstetricians and Gynecologists of Canada
2. American College of Obstetricians and Gynecologists
3. MOTHERISK : information on medication use during pregnancy
4. Center for Disease Control and Prevention (CDC)