How Does Air Pollution Affect Your Skin?

Most of us think of air pollution only being an issue for our respiratory health. But did you know that pollution in the air can affect your skin?  
The worst pollutants for skin
Air pollutants can include polycyclic aromatic hydrocarbons (PAHs), volatile organic compounds (VOCs), particulate matter (PM), ozone (O3), cigarette smoke and oxides.  These pollutants contribute to skin aging, including dryness, wrinkling, and dark spots. Additionally, air pollution has been associated with skin cancer, atopic dermatitis, psoriasis and acne.
Pollution creates damage to our skin by creating free radicals which are unpaired atoms with an odd number of electrons. Free radicals are formed when oxygen interacts with certain molecules creating a chain reaction of damage to important cellular structures.
How to combat pollution
Luckily, antioxidants can interact with free radicals to stop cellular damage. The most common antioxidants utilized in skin care products to protect the impact of pollution to our skin are Vitamin E and Vitamin C. Vitamins E and C are most commonly ingested, but they can also be used topically to provide skin protection since they are two of the primary antioxidants found in the skin and are easily absorbed.
Since everyone is susceptible to skin damage from air pollution, we must all be mindful of protecting our skin. Creating a physical barrier with sunscreen and moisturizer is effective before you head out to start your day.  At the end of the day, I recommend cleansing your face with a sulfate-free cleanser to wash away the toxins we are exposed to daily.
Need a sulfate-free cleanser? Check out Clearly Luminous Cleanser!

What You Should Know Before Getting Botox or Filler at a Day Spa

Day spas are a perfect retreat for the busy woman who needs a chance to rest, relax, and rejuvenate. It’s a one-stop shop for massages, manicures, pedicures, facials, and body treatments. As you enjoy the serene ambiance sipping champagne, one of the estheticians informs you that the spa is now offering Botox and other filler services. Your inner voice says, “This would be amazing since I am too busy to make another appointment with my doctor!”
Before you fully succumb to that multi-tasking inner voice, here are a few questions you need to ask of your day spa.

  1. Who is the doctor performing the procedure? It is important to know what kind of physician is performing the procedure. My recommendation is to make sure it is either a Board Certified Plastic Surgeon or ENT Physician who focuses on cosmetic procedures. Surgeons typically have a better understanding of the facial anatomy and facial balance.  
  2. Where is the physician’s practice located? Many day spas have physicians who come from out of town to perform the procedures one or two times a month. Excellent physicians are often plenty busy in their own practices. So, they do not have the time or desire to travel long distances to work.
  3. Will a follow up appointment be scheduled? As a consumer, you must understand how post-procedure questions, concerns, or dissatisfaction with results will be handled.  
  4. Are the procedures performed in a medical environment with medically trained professionals? Make sure the injectables are purchased directly from the manufacturer and not a knock -off website. The staff would should be trained on occupational safety standards from OSHA, and sharps should be disposed of appropriately.  

The last thing to consider is that a physician who travels to perform your procedure may not be as invested in your outcome as a physician that you see regularly. The relationship and communication between physician and patient is of great importance, especially when it comes to your face!
Are you in the St. Augustine area? Come visit me at Avanti Med Spa

Does Your Spouse Have Selective Hearing?

I just love when my patients tell me they have “selective hearing” as if it is a real medical condition. Although the medical literature doesn’t recognize selective hearing as a condition, the Urban Dictionary defines it as the ability that humans have (mostly males) to selectively hear what serves their interests.
Patients will state that they “don’t have hearing loss” and that they can “hear what they want to hear”. Apparently, being deaf is a choice. They can turn it on and off like a light switch. People with “selective hearing” are in denial about the real problem – hearing loss.  
Twenty percent of adults (48 million) in the United States report some degree of hearing loss. At age 65, one in three adults with hearing loss are in the work force or in an educational setting. They have many excuses about why they can’t hear:

  • Women speak too softly
  • Their grand kids mumble
  • They can hear if you talk loud enough (you need to scream)
  • The TV is on too loud because no one speaks clearly anymore

Studies show that seniors are three times more likely to have a cosmetic procedure performed than seek treatment for hearing loss.  A hearing test is as popular as a colonoscopy when it comes to routine health checks.
Why are seniors in denial about their hearing loss?

  • They don’t think their hearing is bad enough to warrant hearing aids
  • It’s part of aging  and not life threatening, so it’s no big deal
  • They don’t want to look old
  • They lack trust in hearing aids because they know people who have had poor experiences.

Seniors don’t realize how much hearing loss adversely affects their quality of life.  It results in depression, isolation, anger, and cognitive decline. They avoid people they can’t hear and situations in which they can’t hear.
As an Otolaryngologist, wife, and mother, I find this denial concerning. Hearing loss needs to be identified and treated.  The stigma of hearing aids needs to be removed because they are helpful when fitted and adjusted properly. Modern hearing aids are small and discreet.  They are actually less noticeable than glasses!
If you know someone that who has “selective hearing”, urge them to see an Otolaryngologist and obtain a hearing test. The proper diagnosis and treatment plan, in addition to the right physician, can significantly improve their quality of life and yours.

Nutritional Supplements — Are They Necessary?

Some of us faithfully suck down our vitamin supplements every morning, while others do not believe supplementation is necessary. These people state that they do not feel a difference or improvement in their health when they do take their supplements. Why do we need to take supplements? Don’t we get all our nutrients from our food?
Declining Nutritional Value in Our Food
A landmark study, conducted by Donald Davis at the University of Texas published in the Journal of American College of Nutrition in December 2004, compared nutritional data from 1950 to 1999 that compared different fruits and vegetables. There were reliable declines in the amount of protein, calcium, phosphorous, iron, riboflavin, and Vitamin C in our produce. This decline can be attributed to pesticides and efforts to breed crops to provide greater yield. There have also been declines in other nutrients, such as magnesium, Vitamin B-6, and E.
Healthier soil undoubtedly leads to healthier produce. But, to keep soil healthy, fields should be alternated between growing seasons because it gives the land time to restore. Pesticides and fertilizers are avoided in organic growing methods, and therefore, vegetables and fruits are more nutritious.
Supplements to Bridge the Gap
As much as this is preferable, it can be difficult to achieve for those of us who live in an urban setting. This is where supplementation can bridge the gap by providing essential nutrients not found in our food.
But, do supplements really work? Are they all created equal? These are the common questions that most of us need to know the answers to prior to making an informed decision.  
In the US, prescription and non-prescription drugs are regulated by the Food and Drug Administration (FDA). Supplements are treated more like special foods, not drugs, so they are not put through the same safety and effectiveness requirements that drugs are.  Supplements do not have to be proven effective before being sold.
The Recommended Daily Allowance (RDA) is the minimal daily allowance of nutrients necessary to prevent disease. It isn’t necessarily the amount of that nutrient that is required for optimum performance, as we have been lead to believe.  
Self-Regulated Supplement Industry
The supplement industry itself is not well regulated.  Therefore, it is the responsibility of the supplement company to maintain a standard and be self-regulated. As you can imagine, this is costly, and therefore not a common practice.
There are multiple issues with supplement distributors.  Most supplements do not even contain the actual supplement noted on the label or the amount claimed. Additionally, herbal suppliers may mix or substitute their crops with less expensive or more readily available plants. There is accidental contamination when one plant grows in with others or mistaken identity – when one plant looks like another.  
Now, let’s take a closer look at what really happens.  In 2013, researchers in Toronto sampled and analyzed 44 herbal supplements sold in the US and Canada that contained single herbs. DNA bar coding analysis was used to test the supplements and less than 48% contained any of the herb listed on the label. More than half contained substitutions, fillers, or contaminants.
In 2015, the New York Attorney General sent warning letters to major retailers selling supplements that were mislabeled after performing a DNA analysis. Some herbal supplements have even been found to contain prescription drugs or other compounds not listed on the labels.  
What’s in Your Supplements?
Needless to say, once I found this information, I relocated all my supplements to the trash bin and started searching for effective and safe supplements. After months of research, I found high-quality, effective supplements good enough for my family and patients.
I strongly believe supplementation is vital to those of us who wish to thrive. Obtaining the RDA of some nutrients isn’t enough for some of us who want to live the best and healthiest life possible!  
The company I chose personally sources their raw materials.  Additionally, the supplements are manufactured in an FDA facility which has stricter standards. They have multiple seals from Leaping Bunny, Good Manufacturing Practices, Natural Products Association and many others. The supplements are non-GMO, gluten-free, and do not contain soy, binders, fillers, chemical slurries or artificial sweeteners. Finally, my search has ended!
Want to check out the company I trust for my supplements? Click here to view my store

That Smell!

Breakfast on the griddle, jasmine in the garden, your lover’s favorite perfume – No doubt each of these conjure a particularly pleasing emotion. After all, our sense of smell, more than any of the other senses, is psychologically linked with memory and can have a profound effect on the ways in which we connect with the world around us.
Common Reasons for Olfactory Loss
So, imagine for a moment, that you’ve lost your sense of smell. Scary, isn’t it? Unfortunately, it’s an all-too-common occurrence. Among the top direct or indirect contributing factors to a partial or full loss of the ability to smell are:

  • Nasal obstruction
  • Degenerative nerve disease
  • Exposure to hazardous chemicals, such as pesticides or solvents
  • Head and neck cancers and related radiation treatments
  • Chronic respiratory infections
  • Oral disease
  • Radiation therapy
  • Dementia, Parkinson’s or Alzheimer’s
  • Traumatic head injuries
  • Hormonal disturbances
  • Diabetes
  • Hypertension
  • Obesity
  • Multiple Sclerosis
  • Cigarette smoking
  • Certain medications or drug abuse
  • Advanced age

Dangers of Olfactory Loss
Any of these conditions can negatively affect the functionality of not only our olfactory nerve cells (those responsible for your sense of smell) but also your gustatory nerve cells (those responsible for taste). That loss of functionality can affect not only your quality of life, but your safety, and perhaps your very life, as well. For example, the smell of certain gasses, smoke, or spoiled foods can alert us to danger, allowing us to act before it’s too late. And, research on the psychology of smell shows that body odor, produced by the genes which make up our immune system, can help us subconsciously choose our life partners.
While most people would report a loss of sight or hearing as a top worry, it’s clear that the loss of smell is a far underestimated misfortune. Fortunately, however, help is available.
Treatment Options
If you suspect you’re beginning to lose your sense of smell, a highly-trained otolaryngologist can perform a thorough examination of your head and neck to pinpoint signs of infections, inflammation, or physical obstruction that may be affecting your sense of smell or taste. Treatment options may include prescription or over-the-counter medications, including decongestants or antibiotics, or surgery to remove nasal polyps or other obstructions.

5 Most Common Allergy Triggers

Statistics show that some 20 percent of people develop allergies of some sort. Allergic reactions develop when the immune system overreacts to an otherwise harmless antigen, resulting in a range of symptoms from sneezing to hives to life-threatening anaphylaxis. While potential allergens are innumerable, there are a few common culprits.

  1. Pollen: Multiple varieties of trees, grasses, weeds, and flowers produce pollen that can trigger hay fever or seasonal allergies. Most result in irritating, but non-life-threatening reactions like sneezing, runny nose, and watery or itchy eyes.
  2. Pet Dander: The physical and emotional health benefits of owning a pet are countless, but life with Fido and Fluffy can be tough if you suffer from allergies. That’s because of pet dander, a protein mix secreted in an animal’s skin and saliva that can trigger allergic reactions.
  3. Dust Mites: You can’t see them, but you sure can feel the effects of their presence if you’re prone to allergies. These microscopic buggers live in house dust and feed on pollen, fungi, bacteria, and dead skin that naturally falls from humans and animals daily.
  4. Insect Stings and Bites: Stings and bites by honeybees, yellow jackets, hornets, wasps, and fire ants can cause mild to severe allergic reactions, including swelling of the face, mouth, tongue, and throat, as well as, difficulty breathing and low blood pressure, itching and hives.
  5. Molds: Multiple types of molds can grow in persistently damp or wet areas, like bathrooms and basements, that lack adequate ventilation.


Other common allergens include certain foods and medications, latex, fragrances, and – believe it or not – cockroaches. Many allergic reactions can be avoided by keeping your home clean and dust-free, using a home air filtration system, changing your air conditioning filters regularly, clearing your home of dust collectors like stuffed animals and certain types of carpet, and bathing your pet regularly.

The Obesity Epidemic

We are in a worldwide crisis, but it is a crisis that we choose to overlook.  No one wants to accept the responsibility because it is an ugly word.  Obesity is a word that brings about feelings of shame, diminished self-worth, and often anger. But we cannot ignore the crisis anymore. Obesity has more than doubled since 1980 and over 69 percent of adults are considered to be overweight or obese. Forty-two million children under the age of five are overweight or obese.
Obesity is defined as excessive fat accumulation which can impair your health. The World Health Organization defines obesity as a Body Mass Index (BMI) over 30.
What Is Causing Obesity?
In my specialty, Ear, Nose and Throat, I commonly see patients who believe that they have a condition called hypothyroidism (under active thyroid) that is responsible for their weight gain but usually the thyroid labs are normal. This leaves them wondering why they are gaining weight.
Next, they immediately want to see a gynecologist because they believe menopause is the second most likely cause of their weight gain. The implications of poor diet or sedentary lifestyle are not often considered.
The sleep apnea patients want to have surgery to “cure” their sleep apnea so that they don’t have to wear their CPAP (continuous positive airway pressure) machine every night.  They are shocked that I can’t guarantee a cure with a BMI of over 40.  
Americans need to take an honest inventory of diet and exercise routines to accept responsibility for their lifestyle choices. The American diet consists of highly processed and sugary foods. Obesity can be reduced by increasingly replacing these foods with fruits, vegetables, whole grains and nuts.  Fats found in fried foods and oils should be replaced with healthy fats. Regular physical activity of a minimum of 150 minutes per week should be part of the required routine.  Obesity is preventable.  
Health Risks of Obesity
Advertising is largely to blame.  We all see commercials to “grab a Coke and a smile” or “fight your hunger with a Snickers”. There are never any sexy television commercials advertising broccoli, carrots, or asparagus!
The health risks of obesity include the following:

  1. Coronary Heart Disease
  2. High Blood Pressure
  3. Stroke
  4. Type 2 Diabetes
  5. Abnormal Blood Fats – high levels of triglycerides and LDL (“bad”) cholesterol and low levels of HDL (“good”) cholesterol. Abnormal levels of these blood fats are a risk factor for coronary heart disease.
  6. Metabolic Syndrome – a group of risk factors that raises your risk for heart disease and other health problems, such as diabetes and stroke.
  7. Osteoarthritis
  8. Sleep Apnea
  9. Obesity Hypoventilation Syndrome (OHS) – breathing disorder that affects some obese people. In OHS, poor breathing results in too much carbon dioxide (hypoventilation) and too little oxygen in the blood (hypoxemia).
  10. Reproductive Problems
  11. Gallstones

Our country’s health care burden would be significantly decreased if our nation started being more focused on preventing disease rather than treating it.  “There’s nothing more important than our good health – that’s our principal capital asset.” Arlen Spector

My Favorite Supplements for Skin Health

Although there may not be a direct correlation between skin conditions and internal body conditions, maximizing your body’s nutritional health can improve the elasticity and radiance of your skin. Glowing healthy skin tends to catch our eye.
In contrast, weathered skin makes us appear as if we are rusting from the inside. Oxidative stress can be a strong contributor to the aging process. On a cellular level, oxidative stress leads to damage within the mitochondria (the energy producer) of the cell which produces increased amounts of reactive oxygen.  Without another electron to bind to, these free radicals wreak havoc within our internal organs.  
Surprisingly,  there are things you can do from the inside that can help you look better on the outside.  Here are few of the best ingredients to supplement beauty:
Antioxidants. Vitamin C is necessary for the formation and maintenance of collagen. Vitamin A is necessary for the repair and maintenance of skin tissue.  It can make a dramatic difference when used topically in the form of Retinaldehyde or Retinol, but foods high in beta carotene are beneficial to the skin. Vitamin E protects the body tissue from free radicals.
Antioxidants should be taken in a preventative manner as they are not effective once the damage is done. Additionally, when antioxidants are combined, there can be a synergistic effect.  These powerful antioxidants can be obtained from natural sources such as fruits and vegetables but these days it is difficult to get the amount of antioxidants we need.
Vitamin B7/Biotin can beneficial for hair, skin, and nails. It must be ingested to be fully beneficial. The data on this is weak but it has not been found to be harmful to humans in large doses.
Minerals such as Selenium, Copper and Zinc can also be effective.  Selenium can help protect the skin from sun damage. Copper, especially combined with Vitamin C and Zinc can help develop elastin fibers that support skin structure. Zinc and sulfur can be helpful in acne patients.  

The decision to supplement is a personal one. Some believe that we can obtain all of our vitamins and minerals from our diet. However, with the use of pesticides and poor farming practices, the nutritional quality of our food has decreased. So much so that we would have to consume a ridiculous amount of food to obtain the same nutrients in comparison to years past. I personally believe supplementation is vital to those of us who wish to thrive.
If you do opt to supplement, choose a company that personally sources their raw materials. Supplements manufactured in an FDA facility have stricter standards. Look for seals from Leaping Bunny, Good Manufacturing Practices, Natural Products Association and many others. I prefer supplements that are Non-GMO, gluten-free, and do not contain soy, binders, fillers, chemical slurries or artificial sweeteners.
My favorite products
If you’re looking for a couple of new products to try, here are two of my favorites:

Beauty Boost is a great supplement that promotes healthy hair, skin and nails.

Vinali promotes youthful skin through a blend of vitamin C and grape seed extract, a powerful antioxidant shown in studies to produce anti-aging effects

Should You Get the Flu Vaccine?

Every year, the influenza epidemic results in significant morbidity and mortality, as well as a significant economic cost to society. An estimated 200,000 excess hospitalizations and 36,000 deaths occur each year due to influenza and its complications. Influenza kills more Americans than any other disease that can be prevented by a vaccine. Therefore, physicians and the CDC (Center for Disease Control) urge Americans to get their flu vaccine, but each year, Americans hesitate to get the vaccine for many reasons.

  • The flu vaccine doesn’t work. Flu shots are at best 50-60% effective at preventing lab confirmed influenza requiring medical care. Despite this shortcoming, the CDC still recommends the vaccination as it prevents some infections with the currently circulating influenza virus and can prevent serious influenza-related complications. Each year medical researchers do their best to determine which strain of the influenza virus will likely hit each season, and they prepare the vaccine accordingly.
  • I will get the flu if I get the vaccine. There has been some speculation that live virus vaccines can potentially transmit influenza, but the consensus is that this is unlikely, unless you are immunocompromised or allergic to the vaccine.
  • I don’t need it because I don’t get sick. Getting vaccinated not only protects you, but it also helps others who may not be able to fight off an illness as well as you can.
  • The vaccine has side effects. The side effects are usually mild, including redness and soreness surrounding the area of the shot or mild body aches. Gillian Barre syndrome is a rapid onset muscle weakness caused by the immune system damaging the peripheral nervous system. It is a well recognized side effect of the influenza vaccine, but there are only 1.7 cases per 1 million people vaccinated.
  • It’s too late to get the vaccine now. Flu activity usually peaks in January and February, and in some cases, the season can last until May.

Keep in mind that there are also other ways of preventing against the flu, including optimizing Vitamin D levels, eating a proper diet avoiding sugar and processed foods, getting plenty of sleep, minimizing stress, and of course, frequent hand washing.
Medical professionals have not come to a consensus on the flu vaccine, but there are more doctors in favor of it than not. The biggest debate is whether influenza is too much of a low-risk disease to vaccinate against, but since there is a large number of people that are hospitalized and even killed by influenza-related complications, the answer seems obvious.