Tue, 2/22 4:51PM • 1:52:56
SUMMARY KEYWORDS
rosacea, patient, skin, therapy, treat, treatment, dermatology, immune system, conditions, dermatologists, aging, good, cancers, words, skin cancers, warts, fibroblasts, effect, process, cell
SPEAKERS
Bill Clearfield
Bill Clearfield 00:20
Hello why’s guru ah yeah man. Is this a Bohmer night? Is a bomanite a great that okay. Oh yeah and it’s great subject I looked at all the sections. Wonderful. Okay, you know he sent me slides. I don’t know if I’m gonna put them up or he’s gonna put them up so go for it. Alright so I’m gonna I’m gonna minimize you here okay now let’s see hey Mike
01:29
Hey Dr. Bill what’s up?
Bill Clearfield 01:31
Oh you know little it is a little bit at you’re gonna have your slides on I know you sent them to me. What do you need me to
01:37
put them now you don’t have to do anything. I can just share it. Okay, great. I’m good to go brother. All right. That’s that’s the that’s the that’s the five minute freakout. Right?
Bill Clearfield 01:48
That’s it. Any chance you guys are coming out to Vegas?
01:54
There’s 100% chance I’m bringing sans pharmacy and a whole team.
Bill Clearfield 01:58
Okay, did you did you register with us yet? Or no?
02:01
Um, I have to get Sam’s to do it with me. But yes, we are. We’re definitely going to be there. I did but I get all that stuff and I may actually be there I’m gonna be in San Diego for is La the weekend before so I may be able to pop out there earlier I don’t know if you’re
Bill Clearfield 02:17
good. Okay, let you to set up.
02:21
Yeah, I get that.
Bill Clearfield 02:23
I’m a I’m a I’m about to get a four weeks ago and I’m about tapped out here already. I’ve got it.
02:29
Yeah, I don’t blame you. It gets to be first. It’s a lot of work, man. And you know, hopefully we can step up to the plate help me more next time to
Bill Clearfield 02:38
Yeah, now you guys are always great. So I’m actually I’m headed to Phoenix on Thursday. I’m giving a talk for some outfit. Some micro electro might mag micro something or other I don’t know those sorts of things. So good.
02:53
Okay, well, they probably got some cool. Everybody’s gonna pivot away from COVID and there’s a lot of new things to talk about. You know, I’m glad to do it.
Bill Clearfield 03:04
Yeah, let’s let’s I’m happy to pivot away from COVID We get to watch Dr. Burgess pick his teeth here while we’re at it. So that’s all
03:12
right. Yeah, there you go.
Bill Clearfield 03:16
Oh, hold up. They always break.
03:18
I got these little Christmas tree like ones and they work really
Bill Clearfield 03:22
good. Yeah. So you see Joel there. That’s that’s our supplement room behind them.
03:28
Yeah, looks like he’s got the supplement room going, man. Yeah,
Bill Clearfield 03:31
yeah. Well, actually, we’re having a lot of shortages.
03:35
Yeah. Yeah.
Bill Clearfield 03:38
How’s the ivermectin business?
03:40
It’s, it’s about half of what it was. It’s really slowed down you know, as people have gotten better when the pandemic is kind of abated. There’s definitely people still doing it. But you know, it is it is probably half or less of what it was, you know? Absolutely.
Bill Clearfield 03:56
Right. Well, nobody’s giving you nobody’s giving you a hard time about it.
04:01
Oh, no, not at all. How about the methylene blue? Is it catching on for chronic diseases? It is um, yeah, we’re selling more and more all the time, you know, as more people hear about it and and it’s a very useful tool. It you know, it does a lot of different things. So yeah, at some point, you know, if we
Bill Clearfield 04:25
need a refresher here, I know you know, we get Dr. Dr. Losses coming up. Two weeks. Out of the next four, so,
04:31
oh, okay. All right. Yeah, we should maybe do a refresher on it and expand a little bit more as we bring immune polarization and into the discussion, you know, and new therapies, and I’ve got a new pharmacy working with us. That me, I’m trying to get them. Today we were talking about ordering the bulk methylene blue for sterile use. So I’m trying to get them on the sterile wagon. It’s really hard to get people to do it. But I think I’ve got enough sales that I can kind of push their way that will fund it, and that will be put to it. So I’m working with them on that now. So we have a vendor for the product, I think and yeah, I’ve been doing a whole bunch of different stuff with that. But you know, and the other thing I tried to bring in just fresh freshen up the whole dermatology stuff here. There’s a lot of cool interactions between all these conditions that we can work on and supplements and things so
Bill Clearfield 05:28
we get a we get an audience for you. Yeah, well, you never know. Now that usually we get between 20 and 35.
05:35
That’s kind of how it goes for us too. It’s 15 to 2015 to 30 depending on what you know what day of the week it is and how it’s going. Alright, well I can I can see here I can share my screen. So
Bill Clearfield 05:50
yeah, we got it. We got a few minutes yet. We got usually we usually get stragglers in you know, oh, we
05:55
need to wait till 10 After for sure. Let’s see. Let’s see. I guess I can start at the beginning
Bill Clearfield 06:08
of the distinguished Dr. Cruz Joining us now so good.
06:13
Yeah, I know Dr. Cruz. Oh, this is a different Dr. Cruz two we have two kids. Can you see my screen?
Bill Clearfield 06:21
Yes, we can. Okay, good.
06:23
All right. You don’t mind if I do it in this mode? What rather no
Bill Clearfield 06:26
- However, however you want to do it is fine. Okay.
06:31
Okay. Cool. Then what I’m going to do is Oh, hate to be looking at a different screen and you’re always looking at away.
06:48
And hello I saw was Nate Ames. His microphone wrong so I could see him last night was this I can see him talking. All I can see is this. Yeah, he does that all the times. His hands are all waving around.
Bill Clearfield 06:59
Yeah, he does. He starts talking about th one and th two and that’s I don’t know what the hell he’s
07:03
ever Yeah, that goes back.
Bill Clearfield 07:06
Yeah, half the time. I don’t know what he’s even talking about. i There’s no i i hear th one th two they got a match. I don’t know. I don’t know what he’s I don’t know, you know, yeah. I guess he knows what he’s talking about.
07:21
Yeah, it’s immune system polarization. You know, and yeah, we’ll play in some of these term conditions too. But you know, you know, is sometimes at the end of the day, it’s, it can be a rabbit hole. But in the deeper conditions like the immunology and immunotherapy for cancer and all that actually. I’m gonna grab a glass of water real quick before we
Bill Clearfield 07:44
so just a quick update. We’re moving along as far as you know, the conferences concerned. Yes. We have too many speakers actually. Okay, I have 27 speakers now. We’re only accredited for 24 hours. I’m going to see if I can expand it. I’m just talking so you can get your water Mike.
08:08
Okay. Yep. Okay, good.
Bill Clearfield 08:10
We have Dr. McCullough is is signed signed on and will be in the house. He will do the last lecture on Saturday. And he will. She answers. That’s Mike. Who’s got who’s made the noise here. Dr. Burgess. Okay. I think we’re good now. Okay. So we’re going to do Dr. McCall. is going to give us a lecture at 430 on Saturday, and then follow up. We’re gonna follow that with a lecture with a reception that will go seven to nine and we’ll probably get him to do some speaking there. You know, he’s made quite a name for himself in the the alternative medicine world. The one little disappointment is Dr. Kathleen O’Neill Smith is now going to do her program virtually instead of being in person. She’s usually pretty pretty fun to have around. And Roy’s interesting, she’s been on our webinars here. And I was hoping that when she would be there, Dr. gursha will be there. Dr. Teitelbaum told me he would not from from the get go so we weren’t expecting him. We have nine vendors I believe that are paid for which is more than we’ve ever had. And you know, the prices are a little bit more pricey in Las Vegas. So I think we’re we should be in pretty good shape. As far as you know how we’re doing you know how we’re doing. We are by our vid coordinator over the over the last three days and going out, has sent out 47,000 emails, Hawking our program and he says he’s least getting an opening so we’ll see how that goes. We’re going to repeat that every week right up till the end offers offering a discount for virtual, you know, being being online rather than being in person, although it costs more to be there in person than it does online. But that seems to be the consensus of the way to go. If you have a group with 50 or more that will that will sign up at least 10 We can give you a discount. So we have the Nevada integrative Medical Society and the Arizona integrative and homeopathic societies we we’ve we’ve given them $100 off the tuition and if you have a group that’s you know, at least 50 members, we can offer that also. So you know the more the merrier and we want to we want as many as we can get to be in person. This should be at least since I’ve started running at our grandest event yet. The venue is isn’t really as nice as it’s a little bit old. It’s not as nice as the pepper mill where we’ve been in Reno. But it’s it’ll be fine. You know, and, you know, food services good. Dr. Crowley is going to be sponsoring a lunch I think on Friday. And so we have that and we still have a couple of more folks that are available. spaces available if you want if you have a company you want to sponsor something Mike Beamer. Yeah,
11:45
we’re definitely going to be there we will I will be there with my with Kalasa and I will be there and Sam’s pharmacy, our new pharmacy partner will be there. Okay. And we’ve got a nice new offerings and and you know, the it’s a nice 50 states service. So, yeah, and we can help in any way we can.
Bill Clearfield 12:05
And, you know, we like you know, we like to help the, you know, the regional, you know, local compounding pharmacies rather than the big guys. The big guys have been the big guys for a long time. They don’t need our help, or anything. Like my mike here is pretty great with with just about everything if you need something, you know, I personally, you know, send him a message and he’s, he’s on it within an hour almost all the time. So I don’t know how he I don’t know how you do it, but you do. So yeah, we got a good team of people. We get our you know, we get our stuff, what we order, you know, really promptly. It’s always packaged, nice. Everything every comes in the prices are always great. So, so, thank you. Thank you. I can’t I can’t recommend Mike enough and hopefully, that your new partner won’t screw things up.
12:56
Yes. Thank God for that. Yes, that.
Bill Clearfield 13:00
The bigger you get, the more arrogant you get, you know.
13:05
We’re all here to help people at the end.
Bill Clearfield 13:07
Okay. So anybody have any questions? About about the conference, I’ll put the I’ll put the how to find the AOS or d.org/event and it will take you to the website that we built for specifically for the conference. If you go under registration, there’s a zillion different categories. Find one that fits you. And please sign up. Right now the discount for the room rate is supposed to end March 3, but we’re going to try and extend that and we’re talking four nights in on the strip in Las Vegas for less than $350 so you can’t beat that elite very reason this this day and age. So we’d really love to have you there. We would like to have you know, a show of force if we can. And it’s about five after mike so I if you want to start and anybody else who’s kind of a straggler, we’ll, we’ll let them in and I’ll
14:14
let’s do it. Alright, well tonight we’re going to talk about some chronic disease. As we talked about chronic diseases are tight, we’re gonna focus on some dermatology items. And I say this kind of with the intention that all of our doctors that we work with in our regenerative medicine networks are training and doing a great job of applying all these regenerative medicine principles that help with chronic diseases. And sometimes there’s probably other untreated conditions that patients have you know, even though it may have a primary diagnosis, something else Well, I think we’ll find is that a lot of these dermatology patients exist within that patient base. So your rheumatoid arthritis patient may well have a you know, I know seborrheic dermatitis or some other common condition that you can easily treat if you were able to know a little bit more about the disease and feel comfortable trading it. In addition, I think there’s a really untapped part of dermatology that and I’ll go to my next slide here really, that intertwines really well with dermatology and Regenerative Medicine principles. And I’m always surprised as I work with a lot with dermatology. I see their literature and I hear their their discourse on various disease states and things like that. And, you know, there are some, I don’t know, specialty related issues about dermatology that are different than regenerative medicine or the way they look at illnesses. So for example, our chronic disease prevention and management fellowship are all the things basically that Clearfield talks and teaches. They focus on the root cause of chronic diseases across all medical specialties. And some of these involved dermatologic symptoms are continuous study of the root cause of disease. That leads us to new conclusions about old conditions. So that’s what we’re all doing here, right and so, now, as we noticed the systemic factors that we look at in regenerative medicine, like systemic redox, imbalances, metabolic imbalances, immune function, these also are playing a role in these dermatologic conditions as well as other the chronic diseases that you may be their primary target. So as you’re treating chronic diseases, you’re likely to encounter patients with common dermatology conditions that can be treated and diagnosed rid of worldly easily and affordably. And also, that the regenerative medicine programs that you’re following may also, you know, I won’t say inadvertently, but you know, as a sub sub sub subsequently treat many of these chronic dermatologic conditions. For example, we heard discussion about a doctor Dr. Campbell treating mycotoxin illness, but also getting great results with patients with psoriasis and other chronic conditions because he was correcting the root cause of the problem that was driving and we’re going to see that as a common note throughout a lot of these conditions. Um, you know, so many dermatologic conditions respond over time to chronic disease management techniques, but in the short run, you still need an acute therapy tool, you know what I mean? You will get the results won’t maybe come that rapidly. So if you have a patient with a chronic dermatologic condition, that you’re also treating for another serious regenerative medicine purpose, you may find that the DERM condition improves. So for example, gut health is related to a lot of these diseases allergy and immune to sensitive or sensitization, latent infections, environmental toxins, metabolic and hormonal imbalances, especially the sex hormones, mitochondrial dysfunction, these all obviously function in dermatology as well. But what you’ll find or what I find when I work with dermatology in the Durham literature is they’re very, very concerned in their literature about differential diagnosis, how to tell one condition from another, but sometimes they’re less concerned with the root cause of the disease, because the root cause of the disease lies outside of their specialty. And then it becomes a scope of practice issue. So for example, it astounds me that dermatologists treat hair and alopecia and pigment disorders, but they rarely if ever, worked with a regenerative medicine trained doctor to treat the patient’s underlying hormonal imbalance. So it’s astonishing to me. So I’m hoping that we can bridge that gap and combine the appropriate dermatologic treatments with the appropriate other treatments to treat the systemic drivers of those conditions. So I would think that would be really beneficial for patients and probably for doctors, and especially if you’re in a cash practice and you’re trying to work all your patients, you know, expanding that is probably a good thing. So what are the common drivers of aging and chronic disease? Well, they also affect the skin right? endothelial damage clearly is present and things like rosacea and probably a lot of inflammatory or infectious diseases of the skin. microbiome dysfunction, believe it or not,
19:38
triggers a lot of dermatologic conditions, and obviously, allergy and immune dysregulation is an entire area of environmental toxins. We saw from Dr. Campbell, how much of a role those play Bakker Patel I know speaks to that. chronic infections can probably play a role by driving oxidative stress and chronic inflammation. We know that metabolic and hormonal dysregulation especially sex hormones, drives a lot of dermatologic conditions. And chronic mitochondrial dysfunction, of course, is another area that while one’s malfunctioning, we’re going to have problems.
20:21
But let’s see. So, what are the top 10? When you when you look at a dermatology office, who’s walking in the door and what do they have wrong with the top 10 diagnoses is seen and I pulled dermatologists by the hundreds to get this data, or I have the data anyway. actinic keratosis is a very common that’s, you know, precancerous skin lesions and skin cancers, warts, rosacea, anti aging and separate dermatitis. So those are what we’re going to cover tonight. And then in the section two, I’ll cover alopecia acne, pigment disorders, psoriasis, and hyperkeratotic conditions. And that represents pretty much the top 10 reasons a person walks in the door of a dermatology office. So many of these conditions as you can see are chronic. They are they and they rely on a lot of the processes in our body that you guys are all working with. So just proceeding on to number one right are all big favorite actinic keratosis, but this is really skin cancers. And I’m sure you’ve all seen patients with a chest that looks like this or a lovely scalp that looks like this. You probably can see I have a few divots where the local surgeon has taken out some skin cancers on me so I’ve done a lot of personal treatment on in this area. And so actinic keratosis, what is that right that’s sun damage essentially, now attended keratosis and superficial swayman Super available so cancers are what we’re going to talk about here but mainly really we’re discussing actinic keratosis, as a very needed and probably everybody that has a lot of sun damage, should be doing field therapy on their highly prone areas of actinic keratosis. Every year two or two or three years, maybe at the most. And this also rejuvenates the skin and it also produces a much nicer looking skin. So you know, that’s an area where kind of cosmetics and skin cancer prevention can kind of come together and of course, many of these patients whose immune systems are malfunctioning from drivers of chronic inflammation and oxidative stress that that’s why you know, they’re forming more of these cancers and having more problems. So they Yeah, they have all the UV damage and all this, but they have the underlying processes in their body that also make them more susceptible to it over time. So actinic keratosis are basically keratotic macules papules, or plaques, they mostly are plaques resulting from intra epidermal proliferation of atypical keratinocytes in response to UV radiation. So that’s the whole thing in a nutshell, they’re most now here’s the interesting part. The statistics really are scary on most actinic keratosis little AKs. They do not progress to sway muscles, but almost all squamous cells arise from pre existing a KS. So if you have a squamous cell you probably had an all you almost for sure had an AK that preceded it, but not all K K’s will become swing muscles. Now out of the AKs that do progress, disclaimers, you can’t tell them apart. You can’t look at one and no oh gosh, that was super bad looking and that’s most likely going to be cancer and another one doesn’t look as bad and it may be cancerous. So it’s hard to tell even for for highly trained. Dermatologists to know by looking in which ones are bad, which ones aren’t so that they can’t identify them easily. And then about 10% of AKs convert to squamous cells in healthy persons and up to 40% or even more in immunocompromised patients. So when you see, you know, a lot of AKs popping up or squamous cells popping up on elderly patients or immunocompromised patients or patients that you’re training for other severe chronic diseases they’re probably have a higher prevalence of skin cancer based on their immune function being down and damage to their P 53. Gene and tumor suppression genetics. So routine exams and field therapy of AKs is a sensible and well adopted strategy in dermatology. And you know, you have a lot of treatment options. Some of them were easy and some were more harder but treatment options certainly are surgery, cryo therapy, laser surgery, those more serious things. You know, you want to wait till somebody done a biopsy to determine you got to cancer, but for general AK therapy, there’s no reason in the world that you can’t do photodynamic therapy or trade field therapy with some common agents that are easily available and can be used very effectively to manage skin cancer risks. So you know, we want to encourage the many, many types of practitioners to work in this area and 10 Because they’re not everybody goes to a dermatologist.
25:20
So what happens in this process, how do we end up with actinic keratosis, and it all starts with UV radiation. And then there’s three pathways that it follows. UV radiation can directly damage membrane phospho lipids, triggering an inflammatory process that is ultimately results in hyperproliferation or more keratinocytes. Okay, keratinocytes are produced sort of as your body’s natural sunscreen in a way to protect the inner certain, you know, inner tissues from getting over radiated. So of course, UV radiation directly causes photo damage, it causes mutations or pain 53 Gene, other tumor suppressor genes that are related to p 53, like p 51. And then you have basically a failure of the natural apoptosis and the damage cell genomic instability and you end up with hyperproliferation. Another way that UV radiation causes problems is by creating active reactive oxygen species, which activates platelets and an NF kappa B and you know, all this and we have altered intracellular signaling cytokine dysregulation, immuno suppression, that also can relate, you know, directly to hyperproliferative. So, there’s an immune side there’s inflammatory side, and then there’s a UV radiation damage kind of at the core of the process. So managing and this really applies also not just to skin cancers, but to aging of the skin and other skin conditions as well. So, this is the important message here is that we have an inflammatory side we have an immune side and we have ionizing radiation side, and this all combines together to add up to a bad situation. So now let’s say we have, you know, a patient looking looking like this, right? And we want to know well what can we do for this lady’s chest or this gentleman’s forehead here? Now, the old kind of therapy, the very first therapy that we had that was effective for this as five, four years so which is on the list of, I don’t know the NIH is calm, most most necessary. 100 drugs or whatever, find a few is well studied and it’s a core therapy for actinic keratosis, and also for trading superficial and I say superficial, non invasive, superficial squamous or basal cell cancers can also be treated topically with five of you. And what is five if you do it is very interesting, actually. A lot of people think is just simply that five for yourself is a basically a Trojan horse for uracil and it gets in your DNA and RNA and it messes it up. That’s really not how it works. Five of you inhibits this. The primary mechanism is that it inhibits by middleweights, synthase and it because it is a false flag in for your soul in DNA and RNA, introduces or intro or induces cellular death via interference with transcription and RNA DNA functions. It also activates the P 53 gene. So p 53. activation is still a big part of what five of you is doing. So that’s important to note. The other thing is that five if you actually operates through its metabolites, its metabolites are this.
28:48
It gets metabolized basically phosphorylated and minor methylated and things. And so normal metabolic processes basically occur to find a few that cause active metabolites to be produced that also amplify the effect of it. So if you really look at the whole pathway that oncologists have four, five, a few is much more complicated than this, but in the skin, essentially, we’re looking at this process. So you are going to have the the thymus the thigh, middle eight synthase is blocked, and this will actually induce more thymidylate synthase to be produced. And then you create this imbalance that causes DNA damage, and then you have direct incorporation of five of you and its metabolites. Excuse me trying to scroll down or replace. The tablets are listed down here in the notes, but they’re these F UTP and F D UTP. And then for fluoro, deoxy era D monophosphate. So all these guys are basically working together to trigger P 53 G, and that and you’ll so that’s how five of us working for skin cancers, the exact now how do you when you’re doing this? Essentially, you apply skin cream twice daily for 14 to 28 days depending on the site of therapy. And you know, that’s that’s kind of how it goes. Very simple treatment. But patients hate it, and they put it off and they don’t want to do it or they avoid doing it or though you know, because it makes your face red basically for a month. And you’ll see how red it actually gets it’s quite severe. So, you know, we want to make this as easy and compliant, compliance friendly for patients as we can. Now what are the compliance factors that people run into? Shockingly, five of you is often not covered on insurance. I don’t know how that can possibly be happened, but it’s not we hear this a lot that people are paying two and three and $400 for a team of five and few. So, you know, you can use custom compounding to help reduce costs for patients and probably create a better and more friendly formulation for five of you. But in the end, it may not really be the drug of choice for everybody, because it is a lengthy therapy. Generally, a lot of times that cover uninsurance and the length of the therapy is really the big complaint to a patient. Why is that? Because you look like this. So this is an example of five a few therapy and this is not really a dramatic picture. This is a pretty pretty mild picture actually. But you can see that when you treat the patient over the course of time, what you see on the left will begin to look like the right and it becomes clearly you know that there’s something wrong when people out releasing the patient. So a lot of dermatology is related to the fact that you know, people are concerned with their appearance. So, you know, you end up with to two and that if the treatment lasts two weeks, then the recovery lasts about two weeks. So it’s a month of this. So patients don’t like it a lot. But now I’m going to show you some things we can do to maybe minimize that. But you can see her what’s happened in five a few is the field of therapy is all red because five a few does affect healthy souls to some degree and just dramatically much more affects the hyperproliferative cells. So you can see here that the drug is targeting into the tissues, where pathology exists, and it’s darkening and reddening them and that it’s also leading to immune response. So there’s sort of a robust immune response that comes from all this apoptosis that’s occurring, and that’s a big part of how 5g also works. So that’s that’s kind of what I’m going to say about five if you that’s the old school treatment it’s a good treatment. It’s a solid treatment with literature behind it. But there are some other treatments available too that can do that. So we also have a very fascinating drug called MC Ahmad and Mako mode is a total like seven in total like eight receptor agonist. So it operates on antigen presenting cells where these exists and it stimulates both your innate any required arms of your immune system so make Ahmad it unlike five if you make Ahmad is not a cytotoxic drug, you could technically you know eat it or something and it will not harm you as a cytotoxic drug it will activate your immune system, but it does not you know have a systemic
33:24
you know cytotoxic effect. So essentially when you when you rub a Mikko Ahmad on to an area of your skin, it’s going to activate the toll like receptor eight and sevens which are kind of go hand in hand with each other on dendritic cells, and it will also attract natural killer T cells and CD for lymphocytes that will release interferon alpha interferon gamma, and this stimulates the immune system dramatically. So essentially what it’s doing is forcing your body to recognize the skin cancer as non self. Okay, it’s overriding the cancers ability to hide and it’s basically calling the police on the cancer and saying, Hey, we got a problem here. And it’s directly triggering the toll like receptor to like, you know, the toll like receptors on the dendritic cells and triggering this response. Now, because of that, it is a slower act, believe it or not, when you start rubbing a maple mite on an exciting these toll like receptors, you don’t get a response immediately. It takes maybe four or five six days for a response to begin. So, but once the response begins, it can get very dramatic as your body attacks the disease. And I’ll show you some more pictures of that. But essentially, is similar to five of you in the way it makes your face red and it makes the actinic keratosis white up they say what are these a turn white up because they become very red and inflamed, and then they will eventually crust and you know, as the skin sloughs off, and make a lot also kills tumors from the bottom up, not the top down. So the surface or upper part of the tumor potentially could be attacked. Also with the, you know, if you were treating a cancer, you could use five of you on the top so to speak and make wide coming from the bottom. You can do various things like that as you as you learn how to use these drugs better. But essentially a nickel mine is going to rely on your immune system, including your antigen recognition response to you know, cause your immune system to target the cancer, the cancer cells, and this turns out to be very effective. Especially for superficial cancers. It’s a slower treatment, it takes two to four weeks, possibly up to six weeks. But it’s very, very good at targeting the most pathological tissue and and as we think back to the original slides we were talking about with field therapy you know, as we know, about 10% of your aka is the worst 10% roughly the most hyperproliferative will become squamous cells. So you know if we can target the aggressive but relatively subclinical looking lesions, then we’re really doing ourselves a favor. Also, there’s a policing effect because once your immune system is amped up against these types of things, it’s going to clear the field of everything. So that continues for several weeks after treatment. So one of the reasons doctors who prefer make woman over five if you like, it is because of that a policing effect, they’re not going to miss it. Um, you know, treatment than the treatment is pretty simple, but you can’t over apply it you’re managing the person’s immune system by stimulating it so you kind of have to drive between the white lines not deviate to being too, too low and slow versus too fast and aggressive. So, generally speaking, what that means is intermittent therapy. So usually you do that make home on Monday, Wednesday and Friday, not daily. But Monday, Wednesday and Friday, once a day for four to six weeks. There’s another protocol that seven days on seven days off and then repeat. So you know we have those protocols for you if you need them. And but they you know, event essentially, is that’s the therapy so rather than being daily use for 14 days is seven often seven on or Monday, Wednesday, Friday for four to six weeks. So you do end up probably with a longer treatment time, but you end up probably with a more thorough treat.
37:39
And not everybody wants to use chemotherapeutic agents. So this is a non chemotherapy way of having your body cure yourself of actinic keratosis and skin cancers. And five a few enemy bromide are demonstrated to be roughly equal in terms of their effectiveness. They’re both in the depends on what studies you look at what exact patient populations and all you look at the study design, but there’s somewhere around 70 to 85%, effective 75 to 85% are the numbers you typically hear with a MC Omada and fiber. So that’s kind of about as good as you can do with topical therapy. Now what do we do with that we oh, you can also pair it very well. A lot of people will use cryo surgery or things, other methods to treat some of the more serious looking places, and then they’ll follow up with a Micklem on field therapy. So example on my scalp. If there was a place here, you might zap that with the cryo, and then D field therapy on the full forehead or whole forehead face. And then that would really produce a very nice change in the patient’s skin as well as protecting them from cancers. So, you know, we can also do compounding that can improve this and I’m going to go around this a little bit more. Now here’s how to make wide targets. This is interesting to see notice that with five a few kind of all the skins a little bit red and then you see the targeted areas with the mikemaya you see a more targeting effect. You can see that the immune system is basically if you look, you know, some of the like the top two pictures, the picture on the right you can see this not very lit up but you can see it starting to find out where the lesions are and you can see how those those same lesions light up and it’s really hard to know which ones are gonna light up like if you tried to look at that lady’s face earlier in the in the process, and then look at it where it’s very red. It’s hard to pick out what places are going to turn red. You don’t really know so that’s the that’s the that targeting effect is really I think a big part of this treatment. Now why do people not like MC robot okay sometimes people don’t like it the reason why is it’s cumbersome Lee packaged product when it was originally approved. They were very concerned with systemic stimulation and they didn’t really know that much about the product and there’s a long story about who developed it and how it all happened. But the bottom line is generic mikemaya products and branding really also they come in these small foil packets and are messy. You only get a little bit of medicine, believe it or not, in that packet, there’s only point two five grams, so it’s a fourth of a gram. If you if you guys who were all familiar with HRT knows that’s not even hardly enough drug to cover hardly anything, you know, it’s a little bit so patients are paying 50 bucks copay for three or six grams of cream, and they don’t like the packaging and the wasting of the medication and it’s cumbersome. The typical daily protocols are Monday, Wednesday, Friday for six or eight weeks. So you might need two or three boxes of this to complete that. So on a large area that it becomes more expensive. So by using your compounding processes, we can compound versions that you know will give you a patient friendly pump container, the proper amount for the area that the new patient needs to treat so they’re not over under purchasing and having to get refills or whatever. And getting all that right is a big part of the compliance aspect when you’re dealing with something patients generally know they need to do but they don’t want it. So how is it Mikko mind working? Okay, it’s basically stimulating both your innate and acquired immunity and so it stimulates toll like receptor here and calculate activates the mid 88 signaling cascade but it’s essentially up regulating the activity of our old bugaboo NF kappa B. And then NF kappa b goes on secretes all of its pro inflammatory cytokines and polarizes the immune system to th one so polarizes the immune system away from th two and to teach one and really to teach 17 Also, which is not mentioned here in this literature. And then you can see here that there’s a wide number of immune cells that are directly impacted. By this. The reason for that is toll like receptors are on our cells for antigen recognition. They’re involved in that. So uh, you know, we’re basically going to our antigen recognition system and hyping it up to say you have missed this
42:18
this invasive, pathogenic disease and you need to get on it. So you can see here we’re going to activate beta cells, we’re going to have our th one activation, we’re going to have you know, more or less in inhibition of th two polarization. And then but we’re also going to be working through all these other sites, different types of cells, natural killer cells are activated. You know, you’re, what do they call those polymorphonuclear sites. interleukin eight will stimulate them into action, or macrophages are stimulated. So there’s a lot of this immune system stimulation, which you can see, you know, here in the patient’s face. So that’s what that looks like when you see this process on paper. On skin. That’s what it looks like. So yeah, very fascinating medicine, that I think has a lot of other opportunities for use in cancer. And a lot of research and things have been cut off on it because again, it was a imiquimod was earned by some drug companies that basically were smaller drug companies that bought it and sold it and they didn’t really manage the the asset of their molecule very well. And so I believe it’s an underutilized medicine that could be probably found a lot of other good things to do with it, including herpes. So, here’s some look on a Micco model. It’s you can see here again, but it targets the the actinic keratosis cells specifically and you don’t see much reddening are damaging to the healthy skin, because it’s not a chemotherapy agent. It’s just only through the immune system. So in this case, you this gentleman’s bald head looks better than it did at the beginning. And this is not a very dramatic case, to be honest with you. I couldn’t find a lot of but you can see here towards the end of it, the more serious lesions that you see here, I don’t know if you can see my pointer, but I’m pointing to some of the lesions that are really lit up here at the end of they’re the most severe, but when you look here, you don’t identify them at all is looking serious when you see in week one, week two, you don’t see those as standouts, you see, you know, so, yeah, I think that we have to somehow let the body find the lesions, because it’s hard to identify them. Now, here’s some more serious cases, but this is what it make WOMAD can do to hyperproliferative lesions. And what you see here is crusting. And you ask where is the treatment endpoint is a common question, you know, how red do you have to get and you want to see some crusting, and that applies with five of you and that applies with imicola you want to treat the patient until some of these more serious looking lesions that have led up and stepped up as the more serious ones. They crust in there, obviously scabbed and crusting. And when you see that you can assume that the medicine has done its job and you’ve eliminated that that lesion. So pretty interesting. stuff, but actually not not that hard to do. It’s a matter of applying to skin cream every other day for four to six weeks. Now, here’s the guys we’re looking for that we don’t want to see right. You see any of these guys, this is what you have a biopsy done and probably send them to a Mohs surgeon unless your host surgeon but these are the conditions you probably don’t want to treat whenever you see a squeamish cell folding in like this. That’s bad news. Very bad news and it’s going to become invasive and that’s get to the doctor right away, or the surgeon at the regular neck.
45:51
And then same thing here so you can see that basal cell cancers a little harder to identify they’re not as distinct because they’re in deeper tissue, as opposed to a squamous. So any of this stuff’s it’s just see that’s that’s that’s the time for to have a biopsy. But I don’t want to I don’t want that to scare you off from being able to do basic field therapy. Because I think field therapy is really important and many, many more people should getting this as a routine treatment. And if they don’t see a dermatologist for any other conditions, and they’re seeing you for Regenerative Medicine and you know, chronic disease management, all these other things. You may be the only person that they ever see that has the opportunity to tell him this. So I was hoping that that would be an important maybe an important message in your in your screening and a business opportunity to to treat that patient. Now here’s what the dermatologists really started using. Now, both of those treatments. Essentially you find dermatologists that are in camp A or B they like to make wide or they don’t or they like five if you really don’t or they kind of do 5050 That’s what you find and publish study this is interesting a study was published about 2017 or 18 where some dermatologists theorize that combining five if you the effect of five if you and the effect of callaspo train together might have a synergistic effect in for sure they were right. So there’s a study of a fairly small number of patients that I’ve quoted here, that the entire dermatology profession really kind of pivoted on and accepted and they’ve used now a combination of five FQ and calcipotriene. Now what does that do? It’s very interesting. So there’s a synergistic effect between callaspo train and five if you because they it actually ends up activating a lot more CD for T cells. callaspo train induces the production of that thymic, stromal lymphopoietin which is an epithelium derived peptide cytokine and induces a robust anti tumor immunity and you know, in the skin, and so combining that effect with the five of you has cut look what it does for the treatment protocol. Instead of 14 days to 28 days. It becomes four to five days and on you know, so these are this is the goal right here because these are the protocols I’ve derived from looking at many 1000s of patients that were treated. So on the face, the ideal time frame is twice daily for four to five days and the face, neck or ears, seven days on arms or lower leg because they tend to be crustier or harder to treat less vascularized and then on the trunk of the body you may be able to go on a heavier case on the back or something weird or the lower legs. You may find that up to 10 days may be needed. But basically four to five days on the face for the neck is a very great meaning to the patient. Because not now the whole entire process of treatment recovery occurs in a two week period or less. Whereas just the treatment phase was taking two weeks before so a significant reduction in the timeframe and the acceptability to the patient. Now you do get real red and white up really quick on this. So you didn’t you know you will it is dramatic and you have to be prepared for that. But it’s not that bad. You know, and it again it clears that field of all the AKs that are likely to become that 10% That could be a squamous. So this is a really nice therapy. It’s easy to do. It’s inexpensive, and it pretty much has to be compounded. I guess I’m not I don’t believe there’s any commercial product that combines these although you could purchase them separately and combine them but then you have cut the strength in half. So when you take product A and product B in the both 5% When you put them together now you have 2% of each. That’s how that works. So you don’t have a stronger product.
50:01
Anyway, so that’s what I had to say about actinic keratosis. And another really nice chronic condition that you can manage for your regenerative medicine patients that they probably have high comorbidity for because of their other chronic diseases. Now what is the very closest friend of the skin cancer is the word. Okay, we’re talking about all the horrible guys today. So we pivot now toward therapy and I do that second because it really is almost the same treatment. Words hide from the immune system by various means. And viruses and skincare. I think viruses and cancer share a lot of the same or exploit a lot of the same immunologic tricks that they can use to exist inside the host because at the end of the day, they’re both something growing inside of a host. So you want to reduce the hosts defenses against yourself. But you don’t really want to kill the host per se because the host is necessary for the for the virus so and are the cancers so they tend to do some of the similar things. You’ll see that here. So warts, most warts in dermatologist hate works and so to podiatrists, they can be a can of worms, but they can also be really easily treated and there’s really no prescription drugs to treat them. You don’t really have a good treatment option. The over the counter stuff of salicylic acid, it’s not that effective. He has these kind of gimmicky freezing devices that kind of imitate cryo surgery which you really can’t do that they may work a little bit and there are some other therapies that work I have heard about this thing called a wart a Bader which is some kind of electronic device that kills works, and it seems to work. But uh, you know, that’s a whole different, different thing and kind of outside the mainstream. The mainstream treatments are going to be similar to aka treatments. immune dysregulation and chronic inflammation pay makes patients more likely to be infected. That’s why word spontaneously resolved for a lot of people for some people like if they get very stressed or upset, and then this upsets their immune system and then they become susceptible to a viral infection. They get the HPV in their skin, they develop a wart and then they mess with it and adopt two or three more words and then miraculously, they’ll go away after six months. But what happened is their immune system finally regained its strength and caught up with it and dealt with it but for many people that never happens. So common treatments, you know, or I’m sorry that they’re the warts are caused by over 100 different strains of HPV to this is another thing. So when you look at different words like a common word aperi on wall wart, the genital wart and a really deep plantar wart. What makes them different, and why do they present so differently? Or flat warts is another example. The reason is, is they’re caused by different strains of HPV. So different strains just basically present differently now, this others in the real three distinct causes or cases are plantar warts, which are separate and they’re very vascularized. Genital Warts which kind of had their own etiology and then flat warts. And then common warts Of course, which you normally see. Now, some of the other big thing about warts why do we treat them, they they are contagious, they can spread from one person to another easily and they can also spread from you to another place on you. And whenever you see these clusters of warts, which they call quote, unquote, mosaic words, what that means is that they’ve spread, right so you had one word, and then you started and now you’ve got this broccoli, kind of a cauliflower looking thing, where you have all these nodes of words that are kind of clustered together. Oftentimes that happens because the patient is caught it made it bleed. So when people go after the word and they go take the the facial razor, you know shaved whip and they dig on it or they take the fingernail clippers and try to cut it out. They’ll make it bleed and it will spread and will form a cluster. So my opinion never if you make a work bleed, you probably messed up and children will resolve them better because their immunity is better, but children are also likely to spread them. OTC treatments are slow and they require a lot of patient diligence. You got to put that compound W on that work every day for you know, however many weeks or months it takes, and you can’t miss any days and you’ve got to really keep after it and all that. So you can get rid of words with salicylic acid but it’s not very fast and it’s not very reliable.
54:48
So here’s an example of a cluster of words. This is a plant our work but you can see these are fairly deep, but not too bad. But this is the this is just kind of a photo of of what you’re looking at the very typical patient presents with something like this. So what are our home based therapies that we have? I’ve got a real good stable of these that we’ve developed with dermatologists over many years salicylic acid 65% paste is a good starting point for a small wart. You know that is kind of the the gold standard for OTC treatment. You can’t get 65% paste. OTC you’d have to prescribe it but that’s an option. And it does work for some cases. You can amp that up a little bit with five a few the most common probably the most common and I think the most effective thing we have for small warts. A superficial common words or periungual words is the five if you sell silk gas and paste. Now you’ll hear a lot about people using this stuff called Work peel and work peel is a I don’t know if it’s really a product. It’s just kind of a common formulation out there. And it’s a five if you solution and with salicylic acid and you’ll see it different strings from different places. Some people I think you could buy it over the counter and Canada or you can sell it out of your office. If you buy it from Canada. You can sell a product called wart peel in your office. And it’s got like it’s I think it’s five of you. And I think 20% Sell acid. The one we have is 30% Sell acid. I’m not a huge fan of a solution. If you use the Paste in the solution, you’ll never go back to the solution. The paste is good or the solution is fine and that’s a very common item out there. And it’s usually sold really cheap like 3040 bucks or 50 bucks. But it’s not nearly as good as the paste. The reason why is the solution does not satisfy a few and it chemotherapy agent. It doesn’t stay on top of the war. It ends up training the localize tissue around it and messing that up. So I think you’re better off with the pace because it stays on the word and and in the cell acid is much stronger, and you just get a more robust effect. So I’ve seen the word pace, peel a word off in just a couple of days. You may not even be able to apply it every day because you know strong and it gets sort of quick so my recommendation there be the pace but the solutions fine, especially if you like we’re appealing you want to be at the lowest possible price. Now make online sell acid. That’s another word treatment. If you notice that all we really done here is added salicylic acid to the Mikulov because as the work knows to command system attacks, it is to start growing as fast as it can. I don’t know why but they see that and they start growing. So when you start to have the immune system attack on that cell acid is nice to keep D keratinizing. The top of the ward while while you’re also stimulating the immune system in the same manner we just discussed with a case but to make wide and five if you do a great job of treating words, either one of them. The word kit we have developed this thing called Work kit. For podiatrists, podiatrists really struggle with some of these very deep, long term super recalcitrant warts. And we ended up having to treat them on and off by alternating all these agents. So you can alternate and make Ahmad and sell acid with you know the cells of gas and paste or you can alternate anything to throw five fpu in with the chemical mind and do both. You don’t want to do that any healthy tissue or it’ll set them on fire. But for work you when you have a difficult work, we can guide you through that process that almost deals with any recalcitrant work that I’ve ever seen some that are still recalcitrant, there is cidofovir available stuff here is I believe it was developed during the HIV boom of antivirals, but it is very effective against HPV and can be used but it’s very costly. It’s hard to find. Now molluscum contagiosum sometimes come up when we talk about words we’ll ask them are not HPV words. They’re words that are caused by pox virus, so they called water wars to get my kids a lot. It’s a little bump with a little red bump with fluid in it. And that fluid should not be drained. Obviously that is pox virus.
59:26
Generally these resolve on their own. So in children, we usually tell people not to treat Blasco unless they’re afraid that other kids are going to get it if you have a whole family and one child’s got it is highly contagious. But most pediatricians don’t treat it so moleska contains to some he would either use a low dose of a maple mod, you would cryo them, he would use katharyn and on the individual lesions, or you just give them a little bit of sass and cream and let them go home and it’ll work itself out over time. Children generally do not have problems with velocity that they can last six months. So you have this itchy condition under your armpit but lasts for six months, and I can give it to my friend. So a lot of you know to treat or not to treat becomes a question because we’re usually talking about pediatric patients in this case. So you know, I tend not to treat them or if I would, I’d use a very low dose of marijuana, or just five if you are excused or no five of you and just maybe some cell acid or something to try to kind of help break them up. So that’s the word on malesko.
1:00:30
Now you got office baseboard therapy’s a lot of doctors treat warts in their office and there’s a great way and that’s a good thing to do. Um, cryo therapy is the most common thing that dermatology office that they use, but deep warts Will not you can’t freeze them. They’re too deep and the patient cannot stand the pain of the cryo. So really, the limit of cryo therapy is how much pain can how much freeze how deep freezing is required? And if that’s if so, can the patient withstand that pain? So children obviously aren’t a great candidate for cryo anything that’s deeper on the foot or on the hand or on on the genitals or any of that, of course, you’re not going to be able to cry it so what do they do then? They use camp ferritin which is Beetlejuice remember Beetlejuice can’t there it is a brown stop brown camp there is a clear liquid. That is point 7% Can’t ferritin and it basically just induces an a massive immune response because this camp ferritin is a just a massive immune irritant, and it’ll cause a blister to form. So the theory is if the words pretty superficial, and I put the camp there and right on the top of it, it’s going to form a blister underneath the wart that comes from the dermis and pushes the ward out in the porches literally peels off and falls off. Similar to cryo therapy really, which is doing that same thing by freezing. Okay, so that’s a very valid method, but again, can’t there it is dangerous. It’s an office use item, and it’s super hazmat. So you don’t want to fill the camp there been some of the worst lab accidents with a compounding pharmacy that I’ve ever seen. Involve cam ferritin and it can blind a person it can, you know, cause you to have an ulcer like if it gets on your skin, you can have an Ulcerative lesion. You know, it’s very bad so you don’t want to get that on yourself or have you know, if you’re, well maybe have it in your office at all. Some offices aren’t even allowed to have it in the building. can’t tear it and sell acid put off which is an old mixture for genital warts and you quote unquote, paint the genital warts with it. I also heard of it used like on cervical HPV cancers are words but put off wood is very old school. It’s a highly toxic substance but it does work. Got laser therapies, of a lot of people, you know, laser therapies are great. It’s a time consuming it can be a costly option. They’ll show you a slide on that. Um Candida injection. You can also inject Candida antigen you can buy a vial of that injected under the wart and sometimes that will cause the work to peel off. And then you have your various destructive agents such as trifluoroacetic acid D PCP. These are literally just chemicals that just literally kill everything. And D keratinized skin and just you know mass rate the ward and some people use those oral sigh metody it also has been noted for work therapies because it modifies the immune system. And it might work for some people you know, it’s not it’s hard to try if you have somebody with a lot of recalcitrant worse give them a week worth of SIMATIC Dean or something. It might work. It works inexplicably for some number of patients. So usually that will get tried in there if there’s a recalcitrant problem. And, you know, my feeling is what is it really hurt? It can’t really hurt anybody to try it for a couple of weeks. And if it helps, the worse resolved quickly, sometimes it like magically resolves. So, you know, and I realized that’s not correct, and there is a mechanism of action, but nobody really seems to know what it is. So it’s just the dermatologist know that it’s worth a shot in a case where you know, there’s not really much risk to do it. And here’s what laser therapy looks like. This is actually very well done laser therapy on the foot. But you can imagine that took somebody a lot of time and probably cost the patient quite some bit of money, because you’re going to get charged for each one of those extractions and when to go wrong. Here’s kind of what happens here. That’s an example of what went wrong. It’d becomes infected and then you got well and you got more problems. So that’s why people don’t like words is these kinds of things can really be a bugaboo. Anyway, I hope that makes you a little bit more comfortable and familiar with the treatments that you can use to treat warts in your office. So basically it Mako monitor five of you and we have some nicely packaged products that you can use for that purpose if you wanted to. So moving on again, if you have any questions please stop me if you want.
1:05:03
Onwards but moving to rosacea. Rosacea is another really common condition millions of people every day. It’s one of the most common dermatologic conditions in the US or probably worldwide. It’s a chronic skin disease involving skin barrier damage, immune dysregulation, and endotoxin. So we have pathogens on the skin producing endotoxins we have a damaged skin barrier that doesn’t keep those endotoxins away from our inner cell tissues. And then we have a also immune component of it which is your immune system is polarized to teach 17 A and you an interleukin six is highly involved in rosacea elusive sick, so th 17 polarization is part of your host defense against extracellular pathogens. So you’re basically I think that your body sees these endotoxins and then that stimulates your t th 17 response, particularly because th 17 exists particularly at the mucosal and epithelial barriers so your you know your skin is directly connected to your have are directly responsive to th 17 So Intertape 17 dominated illnesses you are likely to see rosacea. With the and then many rosacea patients also believe it or not, report SIBO right. Our friend the gut microbiome is highly related to rosacea. Etiology SIBO tends to cause B 12 deficiency and it causes elevated pro inflammatory cytokines particularly as we know interleukin six and TNF alpha and combine that with the cage 17 polarization and there you have rosacea. And you have four types, a vascular papular with the cold final notice an ocular an ocular Rosacea is also commonly just confused with periorbital dermatitis, which is more pollution related or like toxin related. And so you have to kind of differentiate that. That would be one thing to look at and I can show you a little bit about that. But the main patient’s complaints are and I can’t pronounce the word but it’s basically the blood vessels that are visible tell injector cysts or whatever they call that I can’t pronounce the I’m sorry, and I didn’t write it down, but that the red blood vessels in the skin that show is particularly unsightly to patients very disturbing to them. And it’s also probably the root cause of what they call the fight fight. minutess part of realization which I’ll show you here. So, rosacea progresses, in a way from the you’ll have the vascular signs, then you have the inflammatory signs, and then you have these five notice changes that’s what the the the old, you know, Bob Bob Wheeler knows and the fibrotic changes that take place over time where the disfiguring effects can occur. So rosacea can be a disfiguring disease of the face. And, you know, so that makes it doubly important to treat it so that it doesn’t progress and fortunately, we don’t see too much untreated rosacea today it’s a disease that can be treated. But the main thing is we have you know, vascular inflammatory fibrotic changes that are occurring. The ocular Rosacea is hard to differentiate from other forms of dermatitis. So the question is, if you put a steroid on it, that’s the wrong thing to do if it’s rosacea, but it would be the right thing to do. If it is simple, you know, periorbital dermatitis. So, that’s the differential diagnosis that we would need to learn to make. But basically, if you try it, if you see the rosacea on the face, and nothing on the eyes, I would not assume that that rosacea would begin to show itself on the eyes only. So I think that’s probably your differential diagnosis. If the person is lit up with rosacea over their face, and their eyes are affected, probably most likely, it’s realization. So you don’t use steroids in rosacea.
1:09:21
So a little bit more about it. Now what’s going on? Okay. We end up essentially, here’s what’s showing us what what is going on with the endotoxins. So we’ve set the stage we have a susceptible patient, you know who has some of these propensities of chronic diseases. And then we have the age we have habits there are things that trigger rosacea which we can go into, but and then this condition of their skin, right? If they have low water content, or what TEA TEA who is trans epidermal water loss what that basically means if you have aging skin, or you have dehydrated skin, that you you are going to have an effect on your microbiome. And the microbiome is what kind of controls rosacea flare ups. So you have bacteria that live on the skin these propionyl bacteria, which is the guys that cause acne, we have staff which is all over our skin as we know, we have these new guys called Demo decks, mites, and then we have our normal normal flora. So when we have a low normal flora and our microbiome of our natural bacteria on our skin is disrupted. Then we have an overgrowth of these demo decks, mites, right. These are mites, their skin mice, they’re insects by definition, but they also are so tiny that they produce their own endotoxins they secrete polysaccharides and lipoproteins and glyco. lipoproteins and all this stuff. And this essentially becomes immune system triggering. Now, we also know that staff and propionibacterium and acne also can cause a lot of inflammation and that’s part of the acne process or part of the other, just soft tissue and skin infection, and they produce endotoxin staph and produce endotoxins as we well know. So these endotoxins then flare up so part of the control of the disease is to control the bacteria to control the demo Daxamites to help improve the condition of the skin with regard to the physiological condition of the skin with regard to its health, and then look at the microbiome of the skin. So those are the areas that we’re going to be working in to treat to treat rosacea. Now Demodex mites, what do they do? And these bacteria, here’s how these endotoxins basically create this immune cascade of hyper inflammation and immune dysregulation and it leads to fibrosis in the end. So what we do is we’re going to trigger I guess it makes sense that we would trigger mast cells, when we have an offensive agent like the DEM index or the proteases and these inflammatory
1:12:13
endotoxins that are produced and this stimulates macrophages. Neutrophils and mast cells in different ways that essentially produce inflammation, angiogenesis, and fibrosis. So those are all part of the immune systems response to these endotoxins and that’s what creates in large part the disease. Okay, so moving past that, what a little bit more is going on, we can break into the immune system polarization, but without going too far down the rabbit hole of immunology, we have the rosacea triggers, which are your bacterial proteases your Demodex is proteases it could be heat, stress, could be UVB, they all are going to trigger various pro inflammatory cytokines that polarize our immune system to th 17 Okay, and away from th one to th 17 This is what leads to the angiogenesis and the inflammation and the fibrosis of the fibrosis actually, excuse me comes from MASL. So I misspoke there. The th 17 is what’s leading to your inflammation, angiogenesis, that’s the visible blood vessels and that’s no good okay? Mast cells also participate in that process by triggering the growth factors, the VEGF in your TNF alpha and that also leads to angiogenesis inflammation. So, you can also see that neutrophils and macrophages play a role in all these pro inflammatory cytokine processes. But the key one is that is th 17. Diamond dominant and interleukin six plays a big role in that and we don’t really have interleukin six on this, but I know that to be the case. So that’s a little bit better slide going a little bit deeper. into it. But that gives you the basic, the basic etiology. So what do you do about it? Um, as we know, Metro gel has kind of been always the gold standard, right? metronidazole what were we treating with metronidazole we were looking back at this we’re treating the propionibacterium we might METRON ouzels. Not really very good staff, you know that it doesn’t do anything for Demodex mites. So really all we’re doing is we’re killing off the bacteria. So the demographics mites and the staff can take over. So it’s not a really great therapy, but it does work for some people. Usually metronidazole is combined with a low dose of doxycycline as that’s the first line of therapy doxycycline does address some of the anti inflammatory components because it does suppress interleukin six to some degree, but it’s really not the right guy. For the job. So metronidazole is one part that controls the propionyl bacteria in the in the in the anaerobic bacteria that are in there, but as Lake acid is probably better. It also polarizes the immune system away from th 17 and it helps a little bit more with the acne like aspects of it, any redness. And ivermectin actually is also a great item for rosacea. Interesting. So we’ve learned a lot about ivermectin with COVID. But what is it about ivermectin that makes it effective for rosacea? Well, remember we talked about the dev index mites. So, these demo decks mites, are an insect and they are killed by ivermectin. Therefore, that stops there, you know production of endotoxin and if we use it the same time antibacterials like as oleic acid or metronidazole, we are addressing the propionibacterium in the staff, and then we’re also helping to establish a more functional skin barrier, and microbiome. So now we’re starting to get somewhere with our therapy, right? We’ve had we so now what are we talking about? We’re talking about as oleic acid metronidazole ivermectin and this is conveniently called triple rosacea cream. And it’s very popular in dermatology and really people outside of dermatology do not even know about but it’s a kind of a one one treatment one shot deal for rosacea. And it works very, very well.
1:16:31
It doesn’t always address 100% of the concerns the patient because sometimes the patient’s main concerns a flare up and you know, you’ve not treated them before they walk in the office. They’re red inflamed, they’re upset. In that case, you can use one of two commercial products or you have compounding options. They there’s a product called row feed, which is the better of the two is it’s axioma taslim 1% Cream is stiff dos, and remember xe, xe McCaslin and Brimonidine are both alpha agonists. So they are causing basal constriction of the blood vessels. Brimonidine is a strong Alpha. I believe Alpha One agonist is too strong for most patients it provides it’s a profound basal constrictor so we found that this is a little bit too strong for most patients. oximeter azulene. Then came out a few years later and it’s been better. It doesn’t really seem to cause a lot of rebound. And it’s about the right strength. You know what I mean? It it is a mixed agonist. It is not only a pure alpha one, it’s a Alpha one Alpha two, so it’s doing a little bit less at the at the key receptor, and it just seems to be in the right zone as far as potency goes for the best effect without further side effects. We don’t want people to be pale looking because we’ve cut off all their circulation on their skin, right? It doesn’t sound like a good idea. So a mild reduction in a or a mild vasoconstrictive effects great but a profound one just doesn’t strike me as healthy for any reason. So the two components that you need probably are a topical that addresses the micro Mike you know like the the bolt all of the etiology, but then you need a separate thing that has the redness reducer in it because you don’t want to read this reducer just to use every day needed or not all that kind of stuff. It’s really not appropriate to combine those two therapies at all. So that is rosacea in a nutshell. So yep, triple rosacea cream, really, really good idea if you got rotation. And again, that could be compounded for 50 to 60 bucks for a couple months supply patients happy. works pretty good. So any questions about rotation? We’re stop and I can do it. And if not, we can do that at the end too. All right. I’ll move on to my last subject for the evening, I think or No, I have two more. One is a cosmetics and anti aging therapies. Okay, let’s run through this real quick. The NA aging and cosmetic dermatology markets are huge and there’s a giant opportunity there. But there’s a risk of crossing over into fads in unnecessarily cosmetic therapies that desperate patients will pay for and this is a slippery slope that requires the physicians judgment to step in and say you know Mrs. Jones, your lips really don’t need to be four times the size they are you look very fine. You know, could we could we think about other options. So that’s one aspect of what we get it again aging and some of the treatments surrounding it, and appearance related stuff. board certified dermatologists are very cautious about product claims in the area of anti aging. And their literature does exist, but they really only go with their literature and this is an area I think where regenerative medicine doctors can really bring a lot more to the table because you can provide systemic therapies that are good for anti aging that also benefit the skin. And then you know, the topicals can remain pretty pretty simple. So in term literature What do you see you see retinoids you see vitamin C, vitamin d alpha hydroxy acid, which is like like colic acid, you see co q 10. You see ECGC hyaluronic acid nice and a wide surmise. So we’re gonna basically combine all those and come up with some good anti aging therapies. The other big thing about anti aging is that there’s a dysfunction in what’s called NMF for your skin barrier and MF bees are natural moisturizing factor. What that is, is basically this goo or sebum or oils that your body makes by breaking down squamous cells and recycling them. So when you break down the skin and recycle it, those oils are then repurposed as to become your NMF and that has a lot of interesting recycled chemicals in it that you see from the and then you have the skin microbiome, which guess horrifically is feeding all this. So it literally eats the IMF. So all this stuff necessary to work together to have healthy skin. So regenerative medicine, I do believe that the people here all of you can really come up with some interesting ideas to to address some of these things. So and I quote a nice article here and skin barrier just as something to work at. So what are we going to what? Whoops, I got a bad slide here in
1:21:28
this area. So all right. Pardon for the blank. Okay, so what is the ad the American Academy of Dermatology? What do they say about anti age? They say protect your son every day. Protect your skin with a sunscreen. Don’t tan don’t smoke. Don’t avoid repetitive facial expressions eat a healthy well balanced diet drink less alcohol exercise, clean your skin gently is that to you know physically harm it. Wash your face twice a day and after having sweat a heavy sweating, apply a moisturizer and you skincare and don’t use any products that sting or burn. Now that’s pretty basic advice. And I think a lot of it coincides with what we’re all telling people right? Use a sunscreen don’t tan and avoid. So what are you doing? You’re protecting yourself from UV radiation that creates free radicals and drives chronic inflammation smoking course drives free radicals and chronic inflammation and causes vasoconstriction and capillary beds. So all these things are all bad for every condition not just the scan is my point. So not only giving you that much here to do you know that you don’t already know. I’m now in menopause they go on to say menopause triggers many skin conditions that treated symptomatically or that get treated symptomatically while the underlying hormonal condition is not treated. This is one of my main points that I’m trying to make is there are things that regenerative medicine doctors treat that highly impact dermatology that dermatologists do not treat. So there needs to be a partnership form there where if menopause triggers many skin conditions, why not treat the underlying hormonal imbalances? I realized that’s not their expertise, but certainly it is the expertise of many of you guys. So you can either treat the dermatology conditions as well. Or you could partner with somebody that treated dermatology and do their hormones and probably do their service their practice a great service. female sex hormones decrease in menopause, skin can become drier, thinner, leading to wrinkles and other appearance altering effects. Relative androgen dominance leads to increase facial hair and thinning hair on the scalp. So as alopecia and facial hair women, low estrogen especially with high sun exposure leads to pigment disorders because pigment is operated in part by estrogen. These all directly affect people’s appearance and are highly sought after therapies that we can discuss further because we are going to go over pignut disorders at another time. So the ad recommend sunscreen annual screening mild cleansers, skin rejuvenation procedures and avoid any drying treatments for any conditions that you already have like like like rosacea, and expect more bruising, slower healing and the possible increase in sensitivity to irritants and no tanning and no sunscreen and no sun. So micro circulation is reduced skin barriers become less effective. Less collagen synthesis, less cellular regeneration and hormonal balances lead to most of this. So my question is regenerative medicine can help with a lot of these things. And these are all right from the ad webs. Ad advice a product selection. Use one product don’t use 10 Because that way if there’s a problem you don’t know what caused it, test the product before applying stop using products if they hurt you follow directions you know some products are going to counteract with each other. So don’t use the wrong product at the wrong time. This is such basic advice. And so I think what I’m showing trying to show here is they’re not really looking at the root causes of the disease. This is explaining that they’re just kind of looking at practical things that people can do. And I think that’s the area where you know the regenerative medicine doctors can help deepen the systemic aspects of dermatology therapy. So what are they harping on all the time basically is don’t get exposed to UV light, right? Don’t damage your endothelial health with smoking or whatever. Keep your skin moist so it functions we’re gonna see why that’s such a big deal.
1:25:49
And then, you know, develop a daily routine that maintains all this. So, molecular mechanisms of dermal aging and anti aging approaches. This is a nice study. It basically says the dermis is composed of mainly of extracellular matrix. So most of what you see in your dermis is not like cells, it’s just extracellular matrix. And then fibroblasts are in this as well and we’re going to talk about that because fibroblast activity is a big part of aging of the ECM is mainly made up of collagen, and fibroblasts are differentiated from mesenchymal cells and they live in the if you envision it like fiber and ropes for fiber strands, elastin fibers, they make a network and then within that network, the collagen kind of attaches to it so you have the sort of like the elastin and the proteins are like rebar, and the ECM collagen is like the concrete. So you’re combining the concrete and rebar to get a stronger product. Okay, that’s essentially what your your your dermis is doing. And so with aging, the collagen production is reduced, and it fit in so when the collagen is reduced, that means just like taking the concrete away, and leaving only the rebar and some of the concrete exposed. The fibroblasts are the guys that are secreting a lot of this stuff. So the ECMP made by the fiberglass, the fiberglass attach to the fiber network. And then when the fiber network becomes physically distorted, the fibroblasts themselves become disconnected from it at and then they atrophy and die. So fibroblasts are downregulated basically by the process of aging. So all three layers of your skin, your epidermis, your dermis, and subcutaneous ish tissue all undergo degeneration with aging, but the dermis is most obvious because your extracellular matrix goes away, and your collagen goes away, and that destroys your fibroblasts. And when that’s destroyed, you can’t make any more collagen. You can’t make any more elastin and all that stuff, so you lose your ability to make it. So it’s a it’s a vicious cycle. So intrinsic aging occurs. Naturally and mainly causes fine wrinkles in the epidermis. But extrinsic aging from sun damage is mainly that’s the deeper, more serious problems. And so you can see how it all kind of adds up into a problem here. We’ll take a little further effective aging on the dermis is essentially driven by reactive oxygen species that are triggering MAP kinase an NF kappa B indirectly or directly. And then at the end of the day, the sun and aging increase oxidants they trigger NF kappa B and proinflammatory cytokines directly dis regulates your collagen management and your ECM and your dermis it leads to collagen degradation. fiber networks are also degraded and as this whole network degrades, the fibroblasts are stressed and then what do they do? They go become senescent. And they start pushing out free radicals. So when that happens, of course that further damages the whole process and everything goes downhill. So that’s the process and head. So what do we do about it? What are our goals of treatment to increase collagen production prevent destruction to increase the elastin fiber network and then to bolster fibroblasts to buffer the RS signaling to reduce activation of inflammatory cytokines to write UV exposure and RS formulation and genetic damage of p 53. And then, which is our tumor suppression system and then increase cell cycle speed. Because when we do that, we’re going to cause the whole process to make more collagen because the the when the epidermal cells exfoliate, they trigger more proliferation of these things in the ECM. So those are our goals of treatment. So now what really works for anti aging in the human skin, right? What is what can we really do about it? So here are actors and our drugs and from our drugs, we can create our protocol.
1:30:12
So we want retinoic acid or subarachnoid Okay. retinoids are well studied so that they will basically increase all three types of collagen. It will decrease these negative proteins reorganizes the elastin fibers, and it normalizes what they call gag disposition. Which is another negative process that impairs collagen production. So basically track no interact nature works to improve your skin by many, many factors that are all mediated through the retinoid receptors retinoids have their own receptors they are AR they are XR receptor, but they basically stimulate collagen production. And they stimulate sloughing off of the the epidermal layer, and it causes all this really good effects in the ECM. So that’s what we’re looking for. Now, another process we talked about was we need to quench free radicals there, there their literature and DERM doesn’t talk about a lot of the antioxidants that we know of. They’re mainly focused on ascorbic acid because that’s where their studies are. But vitamin C basically will make clinically improvements to photodamage scantiness proven in studies and it’s also a cofactor in the biosynthesis of collagen and elastin and supportive of that process. So vitamin C, not only is a free radical quencher but also participates in the production process of the ECM, so that’s good. The other thing glycolic acid which is an alpha hydroxy acid, than any of the alpha hydroxy acids will perform the same function but glycomics kind of the best one. It’ll also basically stimulate more production of collagen in the dermis improves the histologic quality of the elastin fibers. So again, that’s supporting fibroblasts that’s supporting all the things that we’re looking to do in our treatment goals. Now there’s peptides such as copper peptide, GH, K, it also can it regulate fibroblasts and help to support them? So I’m a fan of that. Um, we also have energy based therapies. For example, he actually can stimulate the dermis and ablative techniques. So there’s a lot of in office techniques with lasers and laser resurfacing, they’re very popular for collagen building and aging and these work and then you have radio frequency use and high intensity ultrasound even can do this to produce the plasticity of the skin of the neck. These are all things that have been done and then we come to fillers now fillers I have mixed emotions about but the fact is, what you’re doing when you’re using a filler is you’re basically using hyaluronic acid or some form of it or some similar substance collagen like substance that’s going to substitute for the ECM. And interestingly, fibroblasts will attach to this embroidery, so the fillers can actually be populated by living cells. It’s just that filler that you’re pumping in there it can actually begin to become part of the ECM if it’s done well and done appropriately. So it does have a good role, but you can see there’s many things we can do. But we can also see that’s a notable exception of a lot of the ANAx that we use. So treatment options. Here we go. retinoids tretinoin array adapalene are the two that you probably want to use to zero 18 is really too strong for an aging use, even though it’s a great retinoid it’s more like for other stronger purposes. Retinol is okay if you have track sensitivity and can’t tolerate retinoids but they don’t it doesn’t have the same effect. So but it Retinol is good for people who can’t use Track knowing because they’re irritates them or they have some other pregnancy are some other reasons why they can’t use it. The dermatology is fairly limited to retinoids ascorbic acid but these ages that I expand we I believe we can expand this to other antioxidants, poly phenols vials nutraceuticals in some cases, and these guys could be topical or oral supplements. You know there’s no reason oral curcumin might not help your active patient.
1:34:34
So in office procedures also can be great. PRP and platelet lysate can directly stimulate skin, you know to produce more fibroblasts and stimulate those guys. Another big thing we haven’t talked about is Sara minds, Syrah wines. All lotions and creams aren’t the same. They’re Sarah V is unique. And that is contained Sara mines which are the food that your skin actually is made of and it contains single weapons that are not synthesized by the body. And they can’t be that they can only actually be gotten through supplementation. So I’m a firm believer in topical nutritional supplementation starting with ceramides and Cerave is the best thing I know about it, you can get more expensive stuff but for the price of therapy, I don’t know that it would be nice cinema is also a nice option in here to add and we all know that hyaluronic acid is a big part of this. Hyaluronic Acid is probably the most effective thing that you can do to make your patient’s skin look better quickly. It is a glucose amino Blackhand and it is part of the structure of the ECM you’re directly feeding the ECM and it’s just a very, very important item for anti aging and appearance. And I mentioned before fillers can artificially augment augment the ECM and provide a network so fillers can play a part and liposomal topicals that we can make can also have improved absorption tissues due to the added transport mechanism of the liposomal delivery. So it’s diffusion of the drug plus liposomal. Delivery so that adds a different additional effect. So that’s a looking at our treatment options. No treatment ideas. I like customized therapies for patients rather than have people put on five or 10 different things and switch them all up when they want to. I like the idea of having a single item that kind of compasses all of this. We have used and many doctors recommended to us tretinoin niacin mine and hyaluronic acid. You can use a unique anti aging vehicles if you want and add some of these other nice agents. For example, vitamin C, vitamin E ceramides, copper peptide DMA II, other peptides can be used. You could use glycolic acid cell acid, but you know people can’t take tretinoin you can use either retinol or cell acid which is what they call a beta hydroxy acid. So and then, nitric acid also has a unique vehicle that we developed that is really to boost nitric oxide and in the body. But it can contains a lot of interesting things that we can use in this area and have used and there’s a whole host of commercial and cosmetic items you can sell through your office, but also do these things. So if you use these criteria to help select some products, that that can also help. So one thing I did want to mention is topical nutraceuticals are not the same thing as malling Somalians are just a fatty substance or an oil or petrol atom that you can put directly on the skin to prevent evaporation, but they don’t feed the skin any nutrients. So I consider them totally different, and both good, but not the same thing. So there’s that. Now, Dr. Bill I know we’ve gone on for an hour and a half. I got one more topic to cover. Should I continue or would you like me to stop here?
Bill Clearfield 1:38:14
How much more you got to go.
1:38:16
I think I could do it in five minutes. Guys. Go for it. Alright, I’ll go for it. Separate dermatitis guys seasonal seborrheic dermatitis is a very common condition. Okay, and we can treat it pretty easily too, but it requires a couple different medications. Seb DERM is a common condition affects 25 to 50% and even higher in immunosuppressed patients. It’s an inflammatory disease like psoriasis and a fungal infection is at the same time. As a fungal infection. Seb DERM is caused by this Malassezia yeast which is pittosporum they’ve changed the name of pittosporum to Malassezia. But the condition has changed right in response to treatments with the anti fungals but there also is an underlying inflammatory condition. So some view suberb is a fungal infection. Some view Seb DERM as a chronic psoriasis like can condition that has a fungal component. So that Jury’s out there. Now how do you deal with it actually it’s pretty simple. You just need a treatment regimen. How do you diagnose it? I don’t know if you use a Koh test but with microscopy but you use potassium hydroxide. It’s just like the toenail fungus test where you scrape the toenail and you put it a little vial you put the Koh in there, and then you can look at it under a microscope and you can see if there’s fungi or yeast present, it’ll stain them. So that’s your diagnostic thing to separate it from psoriasis or something else. But you also may want to do testing on other things. The pathology isn’t that well defined. Here’s according to eight ad is disruption of skin microbiota, an immune reaction to Malassezia. Notice it’s like rosacea in that the micro organism that’s prominent is also triggering through endotoxin and immune response which in this case is a diminished T cell response. Then they call quote unquote activation of complement. So that is as far as dermatology usually seems to go into immunology, they’ll just say it’s an activation of Kabul it’s quite clearly some kind of immune system. event that we could better characterize. But the they also know it’s related to the increased presence of unsaturated fatty acids on the skin surface, okay, that disrupt and that’s what’s feeding the fungi. Disruption of cutaneous neurotransmitters that tells us there’s an autonomic nervous system component that’s not well discussed in the literature. Abnormal shedding of keratinocytes we know that’s happening. We see the skin sloughing and then we have epidermal burial disturbed barrier disturbance associated with genetic factors they’re talking about filaggrin, filaggrin is an important enzyme in the production of your skin barrier, and there are people who have a genetic inability or their fact their filaggrin doesn’t work and they don’t produce functional filaggrin. So those people have a messed up skin barrier and they are oh hi candidates for this disease. So anyway, the the mouse easy to use includes degradation of sebum, some cotton and all this business, we end up with a fungal infection the skin the and what I’m showing here is the journal literature is more concerned with accurate differential diagnosis and physical symptoms than finding the root cause of the disease because the root cause the disease often wise outside of their specialty, that’s a big point. So how do we handle some term and I think I have two more slides. So the sub term is usually presents one hairline or back to the ears and neck so go back to the pictures. This is classic right here the behind the ear. That is where you’ll normally see it. frequently. You’ll see it like this too. And it’s more or less common along the nose and African American patient, you’ll frequently see it along the hairline like you see here. And then also you’ll commonly see it around the chin and the mouth like kind of in a circle around these areas. And that’s classic separate dermatitis. Um, so how do we treat it that you need two or three different phases? You need a cleanser, which is your antifungal, okay, and that would be either ketoconazole shampoo or keto Sal acid if you have a Plex, that is a cleanser that you can use to wash the face. Or you can use it as a shampoo for the for on the scalp because sometimes comment on the scalp
1:42:52
topicals basically we’re going to combine an antifungal and a mild a steroid. Now oftentimes with antifungal treatments, we do not use steroids, and we don’t normally want to but you won’t get your patient better very quickly. If you do and then the patient will be unhappy. So usually to control a flare up of seven DERM you have to use steroids, but for if you have a patient that’s on maintenance, then you might try if you can to avoid the steroid entirely, or use a very mild steroid like hydrocortisone or destinate or one that’s approved for you know long term use on the face so that’s your core cast of characters. They’re zinc Pyro thyroid is also actually really effective for some people, but you almost always need the other agents. Now if you’re having a bad flare up, you need a stronger steroid on the side. That’s usually beta episode I propionate and they can apply that to the really bad lesions to get them under control. But as you know, the steroids working against your fungal infection so you don’t want to do that too much. But in a nutshell, that’s that’s your recommended treatments for Sep DERM. And that will control almost every case if you kind of play Whack a Mole with it and get the patient on on a routine. That’s the key, and then you go through the risk factors a little bit. Anyway, I hope that encourages you to look at some of the dermatology conditions that your patients probably already have. It may be presenting to your office, it gives you another treatment option. And I also wanted to make sure that I clarified that, you know the dermatology profession, can leave the help of regenerative medicine experts because some of the root causes of the illnesses they treat lie outside of their scope of practice. So I’ll close with that. And any questions I can answer I appreciate your attention.
Bill Clearfield 1:44:41
Well Mike, and he said you got another half to go.
1:44:44
I know was that a long one? I’m sorry. Yeah, it’s okay.
Bill Clearfield 1:44:47
We got a few questions in the chat. We’ll get one my work if the immune system is compromised.
1:44:53
That’s a good question. The answer is no. If it’s slightly compromised, yes. But basically if you have a patient and you use a MC robot, and you don’t get much of a response or a slow response, that’s an indicator that they do have immuno suppression. But so yes, that is correct. And Mikko mind completely relies on the patient’s intact immune system. So that would be a reason that you might have to use five a few and somebody
Bill Clearfield 1:45:19
does Dr. Orr tells asking if do you have a pre printed order sheet for these types of therapies?
1:45:24
Oh, of course I do. I do. Yeah.
Bill Clearfield 1:45:29
Can you send it and we’ll we’ll post it on on our website and we can send it out to
1:45:35
a lot of that’s customized here. But absolutely, we have these things that all these treatments can be compounded or handled with commercial products. The problem with commercial products is they tend to add up, you get in the coupons and all the baloney you have to go through to get covered. Then, you know, you end up with a lot of problems. So sometimes compounding is the easiest, fastest way to get the job done and the cheapest Yeah,
Bill Clearfield 1:45:57
and funny you should say that the next question is a nickel mine cheaper if it’s compounded?
1:46:02
That’s a great question. It can be the problem with the cost of a nickel mine is usually they can get it on a copay for say 4050 bucks, but they get they get three grams of cream. So then they end up needing multiple refills that need prior offs or coverages and all that. So yeah, it’s definitely cheaper for large application areas. So if you need 10 grams or 20 grams of liquid, you we would be, you know less very much lower in cost, unless the patient has really good insurance so they could get like five boxes of a package or something.
Bill Clearfield 1:46:36
Dr. Smith asks, do we need to check hormone levels of patients who have rosacea?
1:46:42
Absolutely. That’s right. Because that’s kind of where I was going is that these regenerative medicine techniques in the dirt Do you think that dermatologists are doing that? I doubt it. You know, so yeah, they don’t have your level of knowledge in the series. So I agree with that. 100%. That’s kind of one of my points. Yep.
Bill Clearfield 1:46:57
And as a follow up, what about now Trek’s own in low dose Naltrexone in, you know, in a trans dry?
1:47:03
Well, yes, so we know that polarizes the immune system away from th 17 Right. So if we have th 17 dominated disease, like root like rosacea, then it would be reasonable to think that low dose Naltrexone would play a beneficial role. Yes.
Bill Clearfield 1:47:19
Our usual attaboys from some of our participants
1:47:22
appreciate that. Yeah.
Bill Clearfield 1:47:24
Okay. Would methylene blue be beneficial and compounded with some other therapies?
1:47:29
I believe it does. It’s a little bit drying. Okay, I’ve used it in our anti aging products. I think as you mentioned, methylene blue is a fantastic candidate for addition to an anti aging regimen, scope skincare, as we know, it massively quenches free radicals and buffers, oxidative stress. So absolutely. I believe that one of the problems is methylene blue is blue. And we don’t we don’t have to use very much so you can do it and won’t stain the skin or have any coloration I have gotten that figured out. So it does happen. One of the downsides of using methylene blue topically really the main one is that the product can change color, because the methylene blue inside the product can you know the product basically has more or less oxygen in it. So methylene blue can be you know changed because the product has changed color slightly. And so I there’s no way that I can get that out of it. So patients just to be advised to that but doesn’t mean it doesn’t work or anything has gone down.
Bill Clearfield 1:48:29
Okay, anybody else have any questions or comments? I know it’s getting on quarter court almost 20 of 10.
1:48:36
I know and I apologize everybody. Oh, don’t
Bill Clearfield 1:48:38
apologize. You
1:48:40
can give this some so I’ll have to maybe make it the top four.
Bill Clearfield 1:48:44
Okay, I’m putting the conference where to find the conference. Aos or d.org/event Click on that and you will get a get to our the conference website. Mike will certainly want you back shortly. Next week, Dr. Rich wine will be speaking on our we’re going back to our roots we’ll be discussing osteopathic medicine. Imagine that. Right? So we’re going to look forward to that he’s going to talk about some some old time treatment techniques. And, you know, it’s something that we sort of emphasize again and again. We have Dr. Kalasa coming back for a couple of his immuno therapies. And March 15. Don’t miss it. Jacob Teitelbaum will be here on Tuesday night. We have Nathan Bryan, who lectures on nitric oxide. He’ll be at the conference. He’ll be here on a wink on a Tuesday night. So we have a lot of good stuff coming up. Please, please make an effort to you know, support us in our efforts here in Las Vegas is a little bit more expensive than we’re used to we usually in Reno. So it is it a bit more expensive. If you have an email list of 50 or more if you let us use it we will give you a discount. Guaranteed is a discount for being virtual online. And you know we have a great lineup. We have you know fabulous speakers, you would pay $2,500 minimum for three days this three day weekend from a for him and it’s 24 CME credits category one AMA and AOA. So you know, it’s in Las Vegas, it’s on the strip. And if you right now it’s March 3. The discount for the for the hotel is that’s the deadline but we’re going to try to extend it. I think we’ll be able to is less than three it was $330 for me for four nights and I’m staying Sunday night and that’s amazing clean up. So, you know, please make an effort to come in to support us. Anybody else have any questions, comments? The chat line looks good. Mike fabulous talk and you can go on and on and on. And I’ll chat with you later. We’ll set up the second half. The last weekend March the first weekend April’s the earliest I have everything’s booked to them. And for Mike, thank you everybody. We’ll see you in Vegas, Mike. We’ll be there. I hope to see you and Dr. Spiro will be there. Dr. Burgess is going to be virtual I believe. I hope you can make it. And Dr. Chang, we want to see you and Dr. Ortel and Dr. Smith. Dr. Cruz will be speaking for us. We have a couple of new names that I don’t know Bambi. Bambi. Bambi Bambi? I don’t know who that is welcome Danny
1:51:59
BAMMY Allah traduced me he is the research and development pharmacist from Sam’s pharmacy our new focus
Bill Clearfield 1:52:07
Okay, great. Don’t be Don’t Don’t be a stranger. Dr. Patel will also be speaking virtually for us. And, and, and Dr. Giovanni is here every week. Thank you so much. We really appreciate it. Spread the word that you know we’re here. We’ll be here next week, same time, same station. Dr. Richwine will be speaking on osteopathic medicine. So we’ll see that. Okay, thanks, everybody. This will be posted within 48 hours. Okay. Thank you so much. I can go home okay. Okay, John. Anything else? We need to go over? Nope. Okay. All right. Thank you, everybody. Bye bye.
1:52:53
Bye bye.