Does SPF Really Protect You From the Sun?

The higher the number the better it is. Right? I would rather have $1000.00 than $100.00. I would rather have a 18th grade education than an 8th grade education. I would rather bat 350 than 250. All right. I would rather have a golf score of 120 than 90. WRONG! I would rather walk up 4 flights of stairs at home than 2 flights. WRONG! I would rather use SPF 50 than SPF 15. NOT NECESSARILY!
SPF tells you how many times the normal exposure to sunlight you can tolerate before burning. So if an SPF 50 is better than 15 where are you going to go to get 50 times normal burning exposure. An oven? This is getting to be more aof a marketing gimmick than a health issue.
What does matter is how often you put on the sunscreen so that it forms a reservoir to protect your skin. Ideally you put on sunscreen an hour before going outside, then reapply it just before exposure. If you will maintain direct exposure as on the golf course or on a boat put the sunscreen on again every 2 hours. That's the secret.
The other thing you need to know is that there are chemical and non-chemical sunscreens. Titanium dioxide and Zinc oxide are non-chemical and all the others are chemical. So if you havge sensitive skin use non-chemical and make sure you cover all your exposed skin and not parts of it.
Read labels, use sunscreens, wear tee shirts when possible, and use sun hats with a circumferential brim. Have fun and be safe.
Edward Lack, MD www.metropolitanmds.com

A Civics Lesson for Adults

I have just returned from 5 days in Washington DC. As past President of the American Academy of Cosmetic Surgery I was there to attend a board meeting and to begin a process of getting to know my representatives in the Congress and in the Senate on a professional level. The Academy has initiated a program of meeting our national legislators to promote the interests of those of us who provide health care and those of us who receive health care. The experience this past week is one of the most meaningful I have had in my life.
This was like an 8th grade civics class, except that having an adult perspective completely changes the experience. Let me tell you about Washington DC and then my impression of the legislators. Washington DC is the repository of the soul of our nation. Its boulevards, its architecture, its museums, its friendly citizens create an ambiance of welcome and pride for every American. To say that it is beautiful diminishes the impact of the experience. It is at once fulfilling and consuming. My wife and I walked a lot as all visitors do. On Wednesday we visited the Holocaust Museum , cried at the desecration of man promoted by the Nazis, and decried the abuse that present day bigots create by denying what is a shameful experience in the history of man . On Thursday we visited the Newseum, a recently opened museum of the history of news in the United States. It is a journey that starts with written communications and progresses through the newspaper, the radio, the television, and the internet. The museum consists of 6 floors of exhibits and each floor has 1-3 theaters where you watch the news as it was created in its day. On the 3rd floor is a theater where we experienced once again the horrors of 9-11. Close ups of the footage revealed some of the falling debris to be human beings as they hurled themselves out of the windows of the destroyed buildings to escape the desecrating heat. There was not a dry eye in the audience as journalists and photographers at the scene were overcome with emotion. In my grief I once again uttered “This shall not happen again!”. I urge all of you to visit both of these museums as well as the many other attractions of the Smithsonian.
The next day we were treated to a special tour of the Capitol Building. We visited Nancy Pelosi’s private dining room and her private office where matters before the Congress can be discussed in the privacy of a closed room. I was able to sit on the House Floor as it was not in session and paid a visit to the balcony of the Capitol Building facing the Washington Monument. And, as a visiting “lobbyist”, I was able to ride the underground tram between the Capitol and the various House buildings. I also visited the Senate quarters and was awed by the sanctity of our forefathers who used these halls to create the greatest tribute to freedom and liberty in the history of man.
As a visiting citizen I had pre-arranged visits with the staffs of several senators and congressman. First, I must tell you that I had briefings arranged by Alan Wheat, former Congressman from Missouri and now a noted lobbyist. I had always felt that lobbyists are self serving promoters who are well paid by wealthy clients to promote their clients wealth. In reality lobbyists are highly intelligent and very knowledgeable advocates of various factions of our democracy. We cannot each spend the time or the money and our representatives do not have the time to listen to each of us individually. These lobbyists, however, can present intelligent arguments representing our needs and our views so that our leaders can sift through them and come to reasoned decisions. Whether we agree with decisions or not, this is democracy at work at a very high and efficient level. Alan Wheat and his team of Julie Shroyer and Annie Mininguez were superb educators, guides, and hosts as we had so much to do in so little time. It was my privilege to have meetings with the liaisons for Senators Obama and Durbin, and Congressmen Kirk, Emmanuel and Davis. Once again I was stunned by the intelligence, awareness, and consideration displayed by these dedicated public servants. I am so proud to be an American and to know that our leadership is guided by such well qualified servants who must combine and balance their own feelings of idealism with the necessity to be pragmatic in order to make things happen.
They listened attentively and asked appropriate questions as I explained to them that the American Academy of Cosmetic Surgery represents not only the interests and opinions of more than 2000 cosmetic surgeons, but also the opinions of more than 2000 concerned physicians with backgrounds in primary care and various specialties of medicine. They educated me on ways in which I can participate in the health needs of our nation from a legislative perspective and I came away feeling a sense of duty to be a part of a solution for what has become a debilitating national health care problem.
In summary I learned more than I taught, I enjoyed more than I could give pleasure, I am blessed to experience so much passion for this country which I love. Visit Washington DC for the first time or as a repeat experience and enjoy gifts of our great country.
Edward Lack, MD www.metropolitanmds.com

Smart-lipo laser lipolysis for sweaty armpits

Now that summer has arrived, it has arrived hasn’t it, we adjust our lives to warmer weather and begin to experience the inconvenience of hot weather and sweaty bodies. We bring along a change of clothes or an extra shirt and when possible we may take 2 showers in one day.
There are people who have these problems all year long. They have a condition called hyperhidrosis which is excessive sweating. It can occur on face and head, palms and soles, and armpits. Usually it leads to self-consciousness.

Many treatments have been used in the past including talcum powder, deodorants, and antiperspirants. For the lucky few they work. For others a trip to the dermatologist might have brought them iontophoresis. Iontophoresis is a treatment where the skin is subjected to a low level electrical current in a wet environment. This treatment shrinks the glands but it is messy and time consuming and must be repeated up to several times per week. There are several oral medications that have been used for sweating including, beta blockers, anticholinergics, anti-depressants and tranquilizers. These are all non specific treatments and while somewhat effective they do come with their own peculiar side-effects.

The newest very effective treatment is botox injections. These block transmission of nerve stimulation to the sweat gland. Botox is reproducible, expensive, and needs repeating up to several times each year. It is probably the best treatment for sweaty palms and soles.
Surgery to remove parts of the armpits or to block nerve transmission do work, but they have the risk of significant scarring or other side effects which makes them seldom appropriate.

Ironically minimally invasive surgery for armpit glands using liposuction has been around for the past decade. It is safe, has few side effects including minimal scarring, and significantly reduces both sweat and body odor. It can now be accomplished with variations that include smartlipo laser lipolysis, ultrasonic assisted liposuction, and radiofrequency ablation. The common thread is sucking out and/or shrinking the sweat glands. The treatment is almost always successful and rarely needs to be repeated.
What will be next for palms and soles- possibly radiofrequency ablation.