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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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.

Probiotics and IBS

“Read about how probiotics can be effective in IBS.”
— Dr. Dale

From Probiotics and IBS 

Irritable bowel syndrome (IBS) is a chronic gastrointestinal condition that is prevalent in anywhere between 8 and 22 percent of the population. Associated symptoms include abdominal pain, flatulence, changes in bowel habits and bloating, in the absence of organic intestinal disease.

The cause of IBS has not yet been determined. Genetic predisposition, environmental factors such as infections and psychologic stress, and disorders of colonic digestion absorption and microbial fermentation may be involved in the etiology of the disease.

Microbiota and IBS

It is of interest that the fecal microbiome is obviously abnormal in IBS, with respect to the proportion of facultative organisms, and the reduction in the number of bifidobacteria and lactobacilli.

In some cases, this is caused by bacterial infections, and antibiotics may be useful because they are able to wipe out the disrupting bacterial strains. On the other hand, antibiotics are also the most common cause of this type of microbiome disturbance.

Disruption of the microflora leads to abnormalities in many functions that they perform in the human gut.

Probiotics in IBS

Probiotics are microbes that are ingested in the appropriate numbers in order to bring about health-related effects on the body beyond their nutritive value. These are live organisms and have been studied in many conditions affecting the gastrointestinal tract, such as Clostridium difficile colitis, antibiotic-associated diarrhea, and inflammatory bowel disease.  Many studies have now shown that their use is associated with better outcomes in irritable bowel syndrome.

Other applications in which probiotics have been of clinical benefit include necrotizing enterocolitis, traveler’s diarrhea, antibiotic-associated diarrhea and pouchitis, which is inflammation of a restorative ileal pouch. Probiotics are not a panacea for all inflammatory bowel conditions because they are ineffective in inflammatory bowel disease and Crohn’s disease.

In IBS, probiotics are found to be effective in the general sense, but the available evidence is heterogeneous. Some studies have used single and others multiple probiotics. There is a general improvement in IBS symptoms, but overall, the efficacy is usually confined to one symptom. Research on IBS and probiotics has been confounded by the differences between the parameters used from study to study in terms of dose, strains, duration, formulation, study design, and other treatments used.

Mechanisms of probiotic action

It is now understood that the mucous membrane and microbiome of the intestine are one physiological unit which is of great importance in maintaining intestinal homeostasis, modulating immune responses, and regulating mucosal immunity as well as cytokine production. The benefits brought about by probiotics is best understood in the context of dysbiosis-induced metabolic and inflammatory changes, and include:

  • Inhibition of the growth of pathogenic bacteria

  • Suppression of pathogen binding via their effects on adhesins

  • Improvement of the quality of the epithelial barrier in the gut

  • Enhanced host immune activity: some Lactobacillus species enhance immune function, by activation of dendritic cells (DC) which present antigen to the T cells of the innate immune system to produce cell activation and recruitment. This changes the cytokine pattern of the enteric mucosa. They may also be used to deliver other biologically active drugs to the intestine.

  • Colonic transit time is also affected by probiotic use in IBS with bloating as a prominent symptom.

Changes in the lumen include:

  • Reduced production of gas with fewer Clostridia and Veillonella

  • Increased consumption of nutrient substrates in the colon with SCFA production

  • Better colon motility, perhaps due to SCFA-induced peristalsis or fluid absorption

  • Less bile acid absorption in IBS with diarrhea due to bacterial deconjugation, with a lower load of bile salts to the colon, resulting in less damage to the mucosa

  • L. acidophilus leads to the overexpression of opioid and cannabinoid receptors which results in suppression of visceral hypersensitivity that occurs with disrupted gut microflora

Some of these effects are probably mediated by short chain fatty acids, which acidify the pH and result in bactericidal protein production. One of them is butyrate, which is a nutritive substrate for colonic enterocytes and improves the integrity of the mucosa. They may correct bowel motility problems, and also inhibit epithelial apoptosis.

Commonly used probiotics

One of the most studied probiotics in IBS treatment is Bifidobacterium infantis, which produces reductions in the levels of several pro-inflammatory chemicals such as TNF-α, gamma-interferon, and IL-6. It may also increase tryptophan levels which can suppress abnormal nervous signaling in the gut.

Other species that have been considered in this area and which produce similar effects on the pro-inflammatory (IL-12) and anti-inflammatory (IL-10) cytokine balance include the following strains of Lactobacillus:

  • L. plantarum 299v

  • L. rhamnosus LGG

  • L. reuteri

  • L. acidophilus

  • L. casei

There are also Bifidobacterium strains such as:

  • B. infantis

  • B. lactis

  • B. brevis

Another role for probiotics is to act as vehicles for targeted anti-inflammatory therapy at required areas in the gut, such as the use of Lactococcus lactis with the recombinant IL-10 secreting gene, which acted in a manner like that of corticosteroids.

The use of probiotics such as Lactobacilli and Bifidobacteria is safe unless the patient is immunosuppressed, and the dose given is large, or they are used following intestinal resection.