Dr. Dale Prokupek MD
The Importance of Regular Colonoscopies in ...
Dr. Dale Prokupek MD
Don’t Skip Your Colonoscopy

Learn the ABCs of Viral Hepatitis

“May is Hepatitis Awareness Month - a month dedicated to raising awareness and learning more about the virus.”
— Dr. Dale

From Learn the ABCs of Viral Hepatitis

Learn the ABCs of Viral Hepatitis

For Hepatitis Awareness Month and national Hepatitis Testing Day on May 19th, learn more about the different types of viral hepatitis. Find out if you should get tested or vaccinated by taking a quick, online Hepatitis Risk Assessment.

May is Hepatitis Awareness Month. In the United States, the most common types of viral hepatitis are hepatitis A, hepatitis B, and hepatitis C. While each can produce similar symptoms, each hepatitis virus affects the liver differently, has different routes of transmission, and has different populations that are commonly affected.

CDC developed an online Hepatitis Risk Assessment to help people find out if they should get tested or vaccinated for viral hepatitis. The assessment, which takes only five minutes, will provide personalized testing and vaccination recommendations for hepatitis A, hepatitis B, and hepatitis C.

Hepatitis A

Hepatitis A is a highly contagious liver infection that can range from a mild illness lasting a few weeks to a severe illness lasting several months. The hepatitis A virus is usually spread when a person ingests the virus from contact with objects, food, or drinks contaminated by feces or stool from an infected person. Hepatitis A can be easily prevented with a safe and effective vaccine, which is recommended for all children at one year of age and for adults who may be at risk.

Hepatitis A is common in many parts of the world, and many new cases of hepatitis A in the United States have occurred from international travelers eating or drinking contaminated food or water. CDC recommends, therefore, that travelers to countries where hepatitis A is common get vaccinated in advance of travel. Even if travel is restricted to resort destinations, it is still possible to get infected with the hepatitis A virus.

Hepatitis B

Hepatitis B is a liver disease that results from infection with the hepatitis B virus. For some people, especially those infected as infants, the infection leads to a chronic or lifelong illness. The hepatitis B virus is spread primarily when blood, semen, or certain other body fluids from a person infected enters the body of someone who is not infected. The virus can be spread through sexual transmission and through contact with blood, such as sharing injection drug equipment. The hepatitis B virus can also be passed from an infected woman to her baby at birth, if her baby does not receive the hepatitis B vaccine. As a result the hepatitis B vaccine is recommended for all infants at birth and anyone else at increased risk.

Hepatitis B is common in many parts of the world, including Asia, the Pacific Islands and Africa. Unfortunately, many people got infected before the hepatitis B vaccine was widely available. That’s why CDC recommends anyone born in areas where hepatitis B is common, or whose parents were born in these regions, get tested for hepatitis B.

Hepatitis C

Hepatitis C is a liver disease that results from infection with the hepatitis C virus. Most people who become infected with the virus go on to develop a chronic infection that causes serious liver problems. The hepatitis C virus is usually spread when blood from a person infected enters the body of someone who is not infected. Today, most people become infected with hepatitis C by sharing needles, syringes, or any other equipment to inject drugs. In fact, rates of new infections have been on the rise in young people who inject drugs in recent years. While rare, hepatitis C can be transmitted sexually, as well as from an infected women to her baby. . In the past, hepatitis C was spread through blood transfusions and organ transplants. However, widespread screening of the blood supply began in 1990 and the hepatitis C virus was virtually eliminated from the blood supply by 1992.

People born from 1945-1965, or baby boomers, are five times more likely to have hepatitis C. Unfortunately, the reason that baby boomers have high rates of hepatitis C is not completely understood. Most baby boomers are believed to have become infected in the 1960s, 1970s and 1980s when transmission of hepatitis C was the highest. CDC recommends anyone born from 1945-1965, as well as anyone else at risk, get tested for hepatitis C.

Find out if you should get tested or vaccinated for viral hepatitis by taking CDC’s quick online Hepatitis Risk Assessment.

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Does Meditation Really Help With Depression And Anxiety

“For us to be my physically healthy, we must focus on our mental health. ”
— Dr. Dale

From Does Meditation Really Help With Depression And Anxiety?

The Question: I experience depression and anxiety. Will meditation really help me? 

The Answer: Depression and anxiety can make everyday life very challenging. And research suggests that healthy lifestyle habits like meditation may help with some of its symptoms. 

Case in point: A small study published earlier this year in the journal Psychiatry Research. Researchers randomized 70 adult participants with generalized anxiety disorder into two groups. One group received mindfulness-based stress reduction as a technique to cope. The other group, acting as the control, did not receive any sort of meditation training.

The scientists found that participants who learned the mindfulness techniques showed much lower levels of a specific biomarker for stress in the body. This could suggest meditation can not only help how someone feels over time, but also may leave an impression on a cellular level. 

This potentially corroborates a large body of meditation research that suggests the practice is a wunderkind for mental health issues. But it’s important to note that previous research outcomes also had its flaws. Some early studies lacked a control group. Other research potentially fell victim to “expectancy bias,” which is when participants expected meditation to work and thus reported feeling better after the experiment. 

The recent Psychiatry Research study took all of this into account, which is why it seems promising. To solve for bias, the researchers said the study was simply about stress reduction without mentioning a meditation component. Mindfulness was introduced later on, and only to some of the participants. This is so researchers could separate out meditation as an active component, according to Elizabeth Hoge, the study’s lead author and associate professor of psychiatry at Georgetown University. 

So, recent research shows it works. But how do you do it?

It all comes down to your thoughts, according to Hoge. Start by sitting in a quiet room and try to focus on your breath. Thoughts will inevitably pop up but the key is to not push them away or give up.

For example, if you are meditating and start to ruminate on a major work mistake or an unfounded fear, notice what’s happening but don’t get frustrated. The thoughts won’t disappear but you will learn to create distance from them, Hoge said.

“Mindfulness meditation is based on the idea of paying attention one’s own inner experience, whether that’s thoughts or sensations or emotions,” she told HuffPost. “Anything that passes through the mind is the internal stimuli that you’re paying attention to.”

Ideally, with enough practice, you’ll learn to create space between negative thoughts and your reactions. 

“See them as distinct objects from yourself,” Hoge said. “As in, ‘My thoughts are not myself.’ That allows a layer of separation so that the person has a little bit more freedom in how to respond to the thoughts or how to cope with them.” 

There is a slight catch

The practice does have some really great mental health perks. But if you truly suffer from anxiety and depression, meditation is likely something you should consider as part of a larger form of treatment like therapy, according to Chloe Carmichael, a clinical psychologist based in New York City.

Carmichael, who specializes in treating anxiety and depression, was a yoga instructor before she became a mental health professional. She uses a blend of mindfulness meditation and psychology tools to treat her clients.

“When you just sit there and follow your breath, that is a mindfulness meditation. It’s one of the early steps of learning how to follow our thoughts,” Carmichael said. “Once you have mindful awareness of what your thoughts are, you’re able to observe them without reacting to them.”

Depression has a tendency to make people think they’re worthless and then they tend to ruminate on that negative idea. People who have anxiety are prone to excessive worrying. Meditation can be a tool to help observe those thoughts, but medical support can provide the methods that help replace those thoughts altogether, according to Carmichael. 

“That’s one of the cornerstones of cognitive behavioral therapy: To analyze someone’s automatic thoughts,” she said. “So they work together really well ― psychology and mindfulness meditation.” 

Ultimately, implementing mindfulness into anxiety or depression treatment can have a very positive impact, according to Sharon Salzburg, a meditation teacher and author of Real Happiness: The Power of Meditation: A 28 Day Program. 

“You try different things to relieve suffering,” she said. “You can celebrate whatever method, or combo of methods, [that] help.” 

Just a little something to meditate on.

How Elite New Yorkers Are Preparing Their Skin for Summer, According to Gwyneth Paltrow-Approved Dermatologist Dr. Robery Anolik

“Top recommended treatments to get you ready for summer.”
— Dr. Dale

From How Elite New Yorkers Are Preparing Their Skin for Summer, According to Gwyneth Paltrow-Approved Dermatologist Dr. Robery Anolik 

With summer just around the corner, it's time to prepare your skin for the season. It's a busy time of year for dermatologist Dr. Robert Anolik, a protégé of Dr. Fredric Brandt. Here, Dr. Anolik, who counts Gwyneth Paltrow as a fan, offers a guide to the three treatments you need right now, his number one tip for beautiful skin, and the latest product he is excited about.

Do you see more patients coming in this time of year?

Yes, my schedule can be a bit hectic in the spring and summer! Once the temperature rises on the East Coast, all my patients want to book an appointment at the same time to get themselves ready for summer in the Hamptons, tropical vacations, etc... I have patients saying that they want to be able to wear tank tops, shorter skirts, and bathing suits this summer but they have age spots, dull skin, love handles, and wrinkles. So, they come in to ask how I can help them.

So, what are your top recommendations for your patients that come in with those requests?

I would say that Coolsculpting, Botox, and lasers for getting rid of sunspots would be the top three pre-summer treatments I recommend for my clients.

The end of winter or early spring is an optimal time for Coolsculpting because it takes about 3-12 weeks to see the results. Some of my patients even start a series of treatments in the fall so that they can do it a few times before beach season.

In the summer we have a greater tendency to squint because of the bright sunlight. This accentuates the appearance of deep lines and folds between the eyebrows and the crow's feet. So, you should invest in a great pair of sunglasses! But for improvement of those lines, Botox is the most popular treatment in my office. As far as sunspots are concerned, if last year's sun damage is still visible on your skin, you'll likely look very damaged once this summer hits. Brown spots develop over time from sun exposure and can often be eliminated with specific lasers, like Ruby, Yag, and Alexandrite. These are specific to pigment particles that make the spots appear. Eliminating them just before summer will make your skin look more even and youthful. It will also prevent them from getting darker. When I treat them, it's advisable not to get too much sun in the few weeks following to avoid complications. And in the summer, when many of my patients are on the beaches or golf courses in the Hamptons, it's best to do this before summer.

I always thought it was a no-no to get any laser treatments before summer because it would leave skin vulnerable to more sun damage. Is that not true?

Let me say this, and I say this to all my patients in New York City. You can do any beauty treatment any time of year. Remember, in places like Miami and Los Angeles it's summer every day, and patients undergo cosmetic dermatology procedures all year round. That said, what's important is to understand that if it requires some level of downtime, meaning pinkness on the skin surface, sun should be avoided in the days or weeks following the procedure because there is a risk that the patient will burn or tan. My patients who undergo laser resurfacing in the summer understand this and simply wear regular sunscreen and do their normal activities. BUT if a patient in the summer - or winter for that matter is heading off on a vacation - they are advised not to sit at a pool or on the beach or a golf course in the time following treatment. The time-period depends on the treatment, but can range from days to weeks depending on the intensity.

Is there an area that we are neglecting that we need to pay better attention to?

The neck and décolleté. People forget to put sunscreen on these areas and when I laser the skin, I always look for issues here.

I think we are all well versed in Botox by now but Coolsculpting is relatively new. Can you explain what it is? 

Coolsculpting is perfect for trouble spots like love handles and lower abdomen fat that form because of genetic tendencies to store fat there. It reduces the fat layer. It relies on the fact that adipocytes, the cells in our body that hold fat under the skin surface, are sensitive to cold temperatures. After safe exposure, many of the cells shut down and go away permanently over the course of about 12 weeks. Your body simply metabolizes the fat that is released from the cells the way we typically metabolize fat released from the cells as part of normal metabolism. It is not suited to treat obesity, but it is wonderful for a non-surgical approach to reduce the bulges of fat that bother us, like love handles.

The variety of different lasers out there is dizzying! Which ones are best for treating those pesky brown spots from the sun, and how painful is the treatment?

Lasers including Ruby, Yag, and Alexandrite are best to target brown spots. They deliver a wavelength of light and when the correct wavelength is used, the light beam bounces off a target structure. The absorption creates heat that only affects the target and nothing else, making the treatments specific. When the laser passes over the sunspot and delivers the laser light it produces a snapping sensation on the skin. That's it. People do not need to numb for this procedure.

Of course, no-one wants to be hiding out at home for weeks after a getting something done, and I’m sure your celebrity clients can’t afford to miss a day! What’s the downtime?

There is no downtime after Coolsculpting. People go right back to their normal activities, including the gym. The treated area tends to be numb and tingly for a few weeks after treatment.  Uncommonly patients can develop soreness to the treatment site and this tends to come on in the few days after treatment and go away after another few days. With Botox, most of my patients have no downtime. If anything is visible, it's usually a brief period of minutes to hours of pinkness at the needle injection sites. Less commonly people can develop a bruise, and usually this is small. Fortunately, in rare instances where a bruise is particularly noticeable, instead of waiting the days for it to resolve, I have a trick using a pulsed dye laser that can eliminate bruises more quickly. It's an easy laser treatment and very helpful for my patients who are on TV or models before photo shoots in the days after treatment. When treating sunspots with laser therapy, I do expect a scab to form at the treatment site. The duration of the scab depends on the location. For example, a scab might persist 4-7 days on the face and up to 2 weeks on the chest. 

Are there any new products you are really excited for?

Juvederm Vollure XC was just released in March and I am thrilled! Many are just learning about it. It's the first hyaluronic acid filler FDA-approved for moderate to severe wrinkles and folds that lasts up to 18 months. Before this product, these sorts of fillers (hyaluronic acid) for wrinkles and folds have not exceeded durations of one year so 18 months is remarkable! It is a particularly smooth filler, and has a very natural, subtle appearance. 

What is your best skincare advice for the spring/summer?

Sunscreen! This is true for all seasons, BUT reapplication is so important in spring and summer if outdoors for more than two hours. Sunscreen reapplication of an SPF30 or higher product every 2-3 hours will give you good protection. Despite our guidance, some people will seek out summer sun to get color. It's just such an awful thing to do to the skin, since it leads to skin aging and skin cancer. In fact, an astonishing 90 percent of aging that we see on our skin is from the sun.

Any other advice to help protect us from the sun’s harmful rays?

I love sun protective clothing. It works. Sun-exposed areas need sunscreen but clothing-covered areas do not, as long as it's truly opaque. If wearing a light or mesh shirt in intense sun, you are not protected. If it's a high-quality UPF product, you are likely fine without sunscreen on the areas covered. If in a high-intensity sun environment like the Caribbean, why risk it. Put the sunscreen on everywhere, and wear sun protective clothing. Also, I have recommended Heliocare to many of my patients. It can be protective against the sun as well.