Concierge MD

Concierge MD goes by many names, boutique medicine, retainer medicine, executive health, VIP medicine, and personalized medicine. By any name, Concierge Physician is the solution for doctors trying to maintain their integrity and independence in today’s difficult healthcare environment. Concierge Physician is a new style of practice with old roots, in which doctors limit their patient base in order to provide patients with personalized service, high quality care, 24-7 availability, and other amenities. In exchange for this enhanced personal attention, patients pay the MD an annual fee. This concierge fee enables MD to increase their compensation while managing their workload. In addition to receiving an annual fee, most concierge MDs continue to receive reimbursements from health plans and private pay clients. Concierge MD is a relationship between a patient and a primary care physician in which the patient pays an annual fee or retainer. This may or may not be in addition to other charges. In exchange for the retainer, doctors provide enhanced care. Other terms in use include boutique medicine, retainer-based medicine, and innovative medical practice design. The practice is also referred to as membership medicine, concierge health care, cash only practice, direct care, direct primary care, and direct practice medicine. While all Concierge MDs practices share similarities, they vary widely in their structure, payment requirements, and form of operation. In particular, they differ in the level of service provided and the amount of the fee charged. There are an estimated 5,000 concierge, or membership medicine doctors throughout the U.S. Concierge MD care for fewer patients than in a conventional practice. All generally claim to be accessible via cell phone or email at any time of day or night or offer some other special service beyond the normal care provided. The annual fees vary widely, from $600 to $5,000 per year for an individual, with the lower annual fees being in addition to the usual fees for each service and the higher annual fees including most services.

Sebaceous Glands

Sebaceous glands secrete an oily substance called sebum (Latin, meaning fat or tallow) that is made of fat (lipids) and the debris of dead fat-producing cells. In the glands, specialized cells produce sebum and then released it as these cells burst; sebaceous glands are holocrine glands. Sebum itself is odorless, but its bacterial breakdown can produce odors. Sebum is one cause of some people experiencing "oily" hair or skin when not washed for several days. Earwax is partly composed of sebum. Sebum acts to protect and waterproof hair and skin, and keep them from becoming dry, brittle and cracked. Sebum can also inhibit the growth of microorganisms on skin. Sebaceous glands are a branched type of acinar gland. These glands exist throughout the skin except in the palms of the hands and soles of the feet. Sebaceous glands are present in hair-covered areas, where they link to hair follicles. The glands deposit sebum on the hairs, and bring it to the skin surface along the hair shaft. The structure consisting of hair, hair follicle, arrector pili muscle and sebaceous gland is the pilosebaceous unit. Non-haired areas (glabrous skin) of the eyelids, penis, labia minora and nipples also have sebaceous. Here, the sebum traverses ducts that terminate in sweat pores on the surface of the skin. Pores range in size from 50 to 80 nanometers on average. The inner surface of the lip and the buccal surface of the cheek can potentially contain ectopic sebaceous glands commonly known as Fordyce's spots or Fordyce granules. These occur as yellowish circular dots that form clusters. Eighty percent of the population has Fordyce granules and these sebaceous glands are asymptomatic. At the rim of the eyelids, meibomian glands present as a specialized sebaceous gland. They secrete sebum into the tears coating the eye to slow evaporation.

Lap Band

A lap band is an inflatable silicone device that a surgeon places around the top portion of the stomach, via laparoscopic surgery, in order to treat obesity. Lap band surgery is an example of bariatric surgery designed for obese patients with a body mass index (BMI) of 40 or greater, or between 35 to 40 in cases of patients with certain co-morbidities that are known to improve with weight loss, such as sleep apnea, diabetes, osteoarthritis, high blood pressure or metabolic syndrome, among others. Lap banding is the least invasive surgery of all bariatric surgeries. Lap banding using laparoscopic surgery usually results in a shorter hospital stay, faster recovery, smaller scars, and less pain than open surgical procedures. The patient can continue to absorb nutrients from food normally. Lap bands are made entirely of biocompatible materials, so they can stay in the body without causing harm. However, not all patients are eligible for laparoscopy. Patients who are extremely obese, who have had previous abdominal surgery or have complicating medical problems may require a more open surgery approach. The surgeon creates a small incision near the belly button and pumps carbon dioxide into the abdomen to create a workspace. Then the surgeon inserts a small laparoscopic camera through the incision into the abdomen. The camera sends a picture of the stomach and abdominal cavity to a video monitor. It gives the surgeon a good view of the key structures in the abdominal cavity. The surgeon makes more small incisions in the abdomen. The surgeon watches the video monitor and works through these small incisions using instruments with long handles to complete the procedure. The surgeon creates a small, circular tunnel behind the stomach, inserts the lap band through the tunnel and locks the band around the stomach. Clinical studies of lap band surgery patients found that they felt better, spent more time doing recreational and physical activities, benefited from enhanced productivity and economic opportunities and had more self-confidence than they did before surgery. The placement of the band creates a small pouch, or stoma, at the top of the stomach. This pouch holds approximately one half cup of food. A typical stomach holds about six cups of food. The pouch fills with food quickly, and the band slows the passage of food from the pouch to the lower part of the stomach, causing the sensation of being full. As the upper part of the stomach registers as full, the message to the brain is that the entire stomach is full, and this sensation helps a person to be hungry less often, feel full more quickly and for a longer period, eat smaller portions, and lose weight over time. As patients lose weight, their bands will need adjustments, or "fills," to ensure comfort and effectiveness. The surgeon can adjust the lap band by introducing a saline solution into a small access port just under the skin. There are many port designs and a surgeon may place them in varying positions, but they always connect to the muscle wall in and around the diaphragm via sutures or staples.

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Benzoyl Peroxide

Benzoyl peroxide cream is a topical bactericidal. Widely available over the counter (OTC), bactericidal products containing benzoyl peroxide treats mild to moderate acne. The patient applies the gel or cream containing benzoyl peroxide twice daily into the pores over the affected region. Bar soaps or washes may also be helpful and vary from 2 to 10 percent in strength. In addition to its therapeutic effect as a keratolytic (a chemical that dissolves the keratin plugging the pores) benzoyl peroxide also prevents new lesions by killing P. acnes. In one study, roughly 70 percent of participants using a 10 percent benzoyl peroxide solution experienced a reduction in acne lesions after six weeks. Unlike antibiotics, benzoyl peroxide has the advantage of being a strong oxidizer (essentially a mild bleach) and thus does not appear to generate bacterial resistance. However, it routinely causes dryness, local irritation and redness. A sensible regimen may include the daily use of low-concentration (2.5 percent) benzoyl peroxide preparations, combined with suitable non-comedogenic moisturizers to help avoid over drying the skin. Patients should exact care when using benzoyl peroxide, as it can very easily bleach any fabric or hair it meets.