Who was the first First Lady to be called “First Lady”? What were they called before that?

From Martha Washington through Julia Grant, presidential wives did not have a title. Martha was called “Lady Washington”; later wives were often called “Mrs. Presidentress.” In 1876, journalist Mary Clemmer Ames referred to Lucy Ware Webb Hayes, as “the First Lady of the Land” in her column “Woman’s Letter from Washington.” Lucy Hayes turned out to be a popular First Lady, so the term stuck.

Source: Do Geese Get Goose Bumps? by The Bathroom Reader’s Institute

Raspberry White Peach Facial – March 2018

Raspberries, White Peach and a Winter Complex come together to gently exfoliate and nourish/hydrate your skin through the use of (1) the DermaPep peptide with retinoic effects to stimulate collagen and reduce photo-damage, (2) the ayurvedic plant Indian Senna to hydrate dry skin, and (3) the Mirabilis Jalapa Flower to sooth sensitive skin. Raspberries are known to be anti-inflammatory to make this a gentle, softening and exfoliating facial. This facial is safe for pregnancy.

Raspberry White Peach Facial

Celebrity Peel Laser Facial – March 2018 Only

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Melasma: a common, disturbing and challenging condition to treat

Melasma is a condition where one develops dark brown patches on the forehead, upper lip, nose and cheeks. It can also occur, rarely, on the forearms and neck.

Melasma is very common. Skin discoloration of the face can be very upsetting and can lower self-esteem. I see patients every day in my dermatology clinic with melasma being the sole reason for their visit.


Melasma is a condition that occurs in both men and women. Ninety percent of melasma cases occur in women and about 10 percent of cases will occur in men. It is estimated that melasma affects 10-25 percent of women and two to five percent of men.

Melasma is seen in all skin colors, but it is observed more frequently in persons of color. Melasma can occur after pregnancy or after the use of birth-control pills, prescribed hormones, or, rarely, other medications.

I consider melasma to be a very rapid, uneven suntan.

Melasma is caused by a combination of genetics, hormone exposure (like pregnancy or birth-control pills or certain medications), and sun exposure. Emerging research has also shown that melasma can be caused by (excessive) heat exposure. This heat exposure can be from cooking, relaxing in a sauna, or just sitting in the direct sun (with sunscreen on) or being outdoors during periods of extreme heat.

The cells in the skin that produce color are named melanocytes. As a result of sun or heat exposure, melanocytes residing in the forehead, cheeks and upper lip can become sensitized and release pigment granules (called melanin) that rapidly darken the skin.

Melanin acts like an umbrella to protect the skin from additional sun exposure and damage. The darkening of skin from sun exposure results in what we commonly call a suntan. If you think about it, a suntan is a direct result of ultraviolet damage to your skin. This is why I tell my patients that I view melasma as a rapid, uneven suntan.

“Chloasma” is the old term for the dark patches that occur after pregnancy; some call it “the mask of pregnancy.” The term melasma is now most commonly used instead of chloasma.

How is melasma diagnosed?

Melasma is diagnosed by a physician after examining the patient’s skin and reviewing the patient’s medical history, including past pregnancies, medication history, and the timing and location of the dark patches. There is a very rare birthmark (called bilateral nevus of Ota) that can look and act like melasma.

In cases where the diagnosis of melasma is in question or if the area diagnosed as melasma is entirely resistant to treatment, a skin biopsy of the involved area may be needed to confirm or explore other diagnoses.

Can melasma be prevented?

Knowing if one’s family history indicates a predisposition for the condition and, as always, implementing proper sun protection are essential. As mentioned earlier, avoidance of heat exposure is vital in preventing melasma. This means minimizing heat exposure when cooking or avoiding prolonged exposure to extreme heat outdoors or any activity that exposes one to significantly high temperatures, such as a sauna.

As far as sun protection, I recommend a sunscreen that is labeled broad-spectrum Ultraviolet protection and an SPF rating of 30. Sunscreens must be applied 30 minutes before going out in the sun, and then reapplied every one to two hours, and more frequently if either perspiring or swimming.

How is melasma treated?

Melasma is notoriously difficult to treat.

In my experience, 25 percent of the time, even with our very best heroic efforts, we cannot successfully treat melasma to the patient’s satisfaction. Fortunately, 75 percent of the time treatments can make a difference.

I use topical medicines either independently or use a combination of them, including hydroquinone, retinol, Kojic acid, anti-inflammatories preparations and vitamin C. In addition to these measures, alpha-hydroxy acid chemical peels, deep arbutin peels, a series of HydroFacial-infusion peels, platelet rich plasma treatments, and the use of a specialized lasers can be helpful.

In a minority of cases, the removal of the causative hormone (birth-control pills) may improve the condition. In the majority of cases of melasma, treatment becomes a lifelong battle.

Sometimes, based on a patient’s genetics, the cells that produce color (melanocytes) deposit melanin pigment deep in the skin. The treatments described above can only penetrate so far and may not reach deeply enough for good results in these cases. I caution patients that the treatment of melasma can be extraordinarily complicated, and I don’t want a goal of “perfection” to ruin the reality of “very good” results.

Additionally, if we are fortunate enough to successfully treat melasma, without continual and ongoing meticulous sun protection and heat avoidance the melasma can return. In fact, even the amount of sun that touches the skin walking from a car to a store on a cloudy day is enough to trigger the reappearance of melasma in some people!

Ultraviolet lights in buildings and the sun exposure while riding in a car can also be culprits. I tell patients that the treatment of melasma, without sun and heat protection, is like trying to walk up an escalator that is going down. It will be very difficult to make any progress without heat and sun protection.

Action steps for melasma treatment

  • Do not use brightening products purchased at cultural stores that contains clobetasol or other metallic ingredients to lighten the skin. These are both inappropriate and dangerous.
  • Talk to your pharmacist about over-the-counter cream treatment options.
  • If over-the-counter medications don’t work, see a board-certified dermatologist for other treatment options.
  • Medications that contain the lightening agent hydroquinone can only be used for a short period. Hydroquinone has the odd side effect (called exogenous ochronosis) that actually causes the skin to become darker if used for too long. Your dermatologist can recommend the appropriate amount of time to use hydroquinone before needing a break.
  • Most importantly, if melasma is successfully treated, appropriate sunscreen and heat avoidance must be used meticulously, for a lifetime, to manage this chronic condition and prevent the recurrence of melasma.

Gene research offers hope for those with brain disorders

Doctors are getting a much better understanding of the causes of mental illness and other brain disorders. Researchers, for the first time, are discovering the genes that are active in different types of common neurologic diseases.

Let’s first review some common neurologic disorders:

  • Schizophrenia: a long-term mental disorder of a type involving a breakdown in the relation between thought, emotion and behavior, leading to faulty perception, inappropriate actions and feelings, withdrawal from reality and personal relationships into fantasy and delusion, and a sense of mental fragmentation.
  • Alzheimer’s disease: a progressive mental deterioration that can occur in middle or old age due to generalized degeneration of the brain. It is the most common cause of premature senility.
  • Bipolar affective disorders: a mental disorder marked by alternating periods of elation and depression.
  • Alcoholism: an addiction to the consumption of alcoholic liquor or the mental illness and compulsive behavior resulting from alcohol dependency.
  • Autism: a mental condition, present from early childhood, characterized by difficulty in communicating and forming relationships with other people and in using language and abstract concepts.
  • Parkinson’s disease: a progressive disease of the nervous system marked by tremor, muscular rigidity, and slow, imprecise movement, chiefly affecting middle-aged and elderly people. It is associated with degeneration of the basal ganglia of the brain and a deficiency of the neurotransmitter dopamine.
  • Depression or depressive disorder: a mental condition characterized by feelings of severe despondency and dejection, typically also with feelings of inadequacy and guilt, often accompanied by lack of energy and disturbance of appetite and sleep.

Research scientists have come to a better understanding of many brain (neurologic) conditions and diseases that were common, yet poorly understood. These disorders include the likes of depression, autism, bipolar disorder, schizophrenia and alcoholism.

Unlike other neurologic conditions like Parkinson’s disease or Alzheimer’s disease, many neurologic conditions were classified and diagnosed based on a patient’s behavior. If one looked at their brains, there were no apparent changes.

In Parkinson’s and Alzheimer’s, the analysis of brain tissue shows remarkable differences from those of healthy brains, so that these conditions can be diagnosed anatomically by just looking at them, and not just based on a patients behavior. In these diseases, the brain demonstrates obvious and dramatic physical changes.

Fortunately, doctors’ understanding of the causes of mental illness and other brain disorders is rapidly improving. In a recently published report in the journal Science, Dr. Geschwind and colleagues at UCLA decided to evaluate diseased brains not by how they look at autopsy, but rather by what was happening in the brain cells when they had a specific disease. Scientists can do this by looking at what genes are turned on and what genes are turned off inside brain cells.

Humans have about 25,000 different genes. All 25,000 genes are contained in (almost) every human cell. The reason why a kidney cell is entirely different from a muscle cell is in what genes are turned on and what genes are turned off. Scientists call this “gene expression.”

The reason we have different tissues and organs in the human body depends entirely on the gene expression in that organ. That is why the heart and brain are completely different.

(Technically, scientists measure gene expression by analyzing different types of RNA, produced by genes, inside brain cells.)

Scientists are now looking at the gene expression patterns in brain diseases like autism, depression, schizophrenia and bipolar disorder, and they have made some fantastic discoveries. Many brain disorders have similar patterns of gene expression.

Interestingly, in addition to similar patterns of gene expression, they also have unique patterns of gene expression that may allow, for the first time, to better diagnose brain diseases based on what is happening inside the brain cells at the molecular level instead of relying solely on the way a patient is behaving.

The molecular gene expression is a new “signature of a disease” and is a breakthrough for doctors to assist in diagnosing neurologic disorders and mental illness. As a result, scientists can develop new research programs for better future treatments.

Although very promising, this research will take some time to become available for daily use by doctors. This study looked at the gene activity of brains in deceased patients. It is now essential to be able to transfer this research into evaluating gene expression in living patients.

This brain disorder research is just a first, yet monumentally critical step in the better diagnosis and treatment of devastating neurologic diseases that affect so many people. Kenneth Kendler, a psychiatrist and geneticist at Virginia Commonwealth University, commented: “This [research] is changing fundamental views about the nature of mental and psychiatric illness.”

As a result, the future appears very bright when it comes to a better diagnosis of and treatment for mental illness and brain diseases.

Source: NPR, Science. Reference: American Academy of Dermatology

Identifying CPS — Cancer Prone Skin — can be a real lifesaver

Americans today recognize acronyms and abbreviations for a wide range of important medical terms: ED is short for “Erectile Dysfunction,” OCD is an abbreviation for “Obsessive Compulsive Disorder,” UTI stands for “Urinary Tract Infection,” and OIC stands for “Opioid Induced Constipation,” just to name a few.

However, most people are not familiar with one acronym that could help save millions of lives: CPS. CPS stands for Cancer Prone Skin. Skin cancer is the most common cancer, with over two million Americans diagnosed with skin cancer each year.

  • One American dies of skin cancer every hour.
  • Almost 10,000 people are diagnosed with skin cancer every day.
  • The survival rate for melanoma that is detected early is over 98 percent.
  • One in five Americans will develop skin cancer in their lifetime.

It is imperative that we make a household term the primary aid in identifying skin that is most at risk. No matter your skin color, you can get skin cancer. Some people have a higher risk of developing skin cancer than others, placing them in the CPS category.

CPS typically includes several or more of the following risk factors:

  • Light-colored skin
  • Skin that burns or freckles rather than tans
  • Blond or red hair
  • Blue or green eyes
  • More than 50 moles
  • Irregularly shaped or darker moles
  • Use or used indoor tanning devices
  • History of sun exposure from outdoor activities
  • Family member with a history of melanoma or other skin cancer

Skin cancer is most commonly caused by extended ultraviolet light exposure and genetics. These people have Cancer Prone Skin, or CPS.

Additional CPS risk comes from extended sun exposure such as people get who spend a lot of time outdoors, like lifeguards, roofers, or anyone with a job or activity that involves extended hours in sunlight. Also, people who have experienced multiple chronic blistering sunburns are at increased risk.

Other factors that can cause skin cancer include certain genetic disorders, exposure to toxins (including cigarette smoke), radiation therapy, or immune deficiencies.

With early detection and treatment, skin cancer is highly curable. The most common warning signs of skin cancer include changes in size, shape or color of a mole or other skin lesion or the appearance of a new growth on the skin. If you have any lesion or mole change at all, or if you have a spot that bleeds and doesn’t heal in three weeks, see a dermatologist. That’s something everyone can do.


The ABCDE’s of skin cancer detection

Here are some signs to look for when examining changing moles. If you notice any of these, be sure to contact your doctor/dermatologist.

A = Asymmetry: One half of the mole is unlike the other half.

B = Border: Mole has an irregular, scalloped or poorly defined border.

C = Color: Mole is varied from one area to another; has shades of tan, brown or black, or is sometimes white, red, or blue.

D = Diameter: Melanomas are usually greater than 6mm (the size of a pencil eraser) when diagnosed, but they can be smaller.

E = Evolving: A mole or skin lesion that looks different from the rest, is changing in size, shape or color, or is becoming thicker, or  “Elevating.”

Also, remember that skin color doesn’t give you a free pass. It doesn’t matter what color your skin is; everyone can get skin cancer. In fact, melanoma skin cancer in African Americans that occurs on the palms and soles can be the most serious and challenging to treat. The musician Bob Marley died from acral melanoma of his foot.

A person with any of the CPS risk factors should not panic, but they should begin a lifelong routine of visiting their board-certified dermatologist for a regular skin check. Dermatology has made incredible advances in identifying risks and early diagnoses. For patients with CPS, routine monitoring is the best means to early detection of skin cancer, leading to a great prognosis for successful treatment.

Remember, CPS stands for “Cancer Prone Skin.” Be sure to schedule a regular skin examination with your dermatologist. Based on your personal and family history, the dermatologist will recommend a regular exam schedule that is best for you.

Reference: American Academy of Dermatology

Sidney’s Taste of the Twin Cities

Where our very own foodie, Sidney, dishes on what’s good to eat in the Twin Cities.


4312 S Upton Ave,  Minneapolis, MN 55410

If you’re into food even a little bit you may have heard of Martina. It is an Italo-Argentinian restaurant in Linden Hills. Despite opening just a few months ago it is already one of the most talked about and most popular restaurants. I’ve been there for brunch three times already. That may sound like a lot, but if you’ve been there you know why.

Martinas burger

The double cheeseburger is arguably one of the very best in the Twin Cities. The Crab Carbonara, Lobster Toast and Potato Churros are equally as incredible. The space itself is beautiful and perfect for dates or foodie brunch with friends! 😉 I can’t wait to try dinner there!

sydney of minneapolisFollow Sidney on Instragam @minneapolis.eats

Futuristic medicine may be closer than we think

There are some monumental shifts occurring in health care. One of the most exciting is the field of pharmacogenetics. Pharmacogenetics is the field where your personal DNA is evaluated, and it can be determined what medications will work best for you. This evaluation with a precise treatment recommendation is also called “precision medicine.”

Precision medicine

Precision medicine is a direct result of the Human Genome project. The Human Genome Project began sequencing in 1990, and by 2002 the entirety of all the genes coded for in a human was mapped and recorded. We discovered that humans have almost 21,000 different genes that make us who we are.

According to the National Human Genome Research Institute: “The Human Genome Project (HGP) was one of the great feats of exploration in history — an inward voyage of discovery rather than an outward exploration of the planet or the cosmos; an international research effort to sequence and map all of the genes — together known as the genome — of members of our species, Homo Sapiens.

“Completed in April 2003, the HGP gave us the ability, for the first time, to read nature’s complete genetic blueprint for building a human being.”

We now know that there are variations in the way our genes make products that influence how we respond to medications. Over 95 percent of people have some variations in how they process medications.

I often tell patients that if you go to a public place like a mall and look around, you will see people of all different sizes, heights, colors and shapes. Just as people appear different, they can also respond to medications (slightly) differently.

In some cases, the genetic differences can cause the medications not to work very well, or cause them to get eliminated from a body too fast, so they are not very useful. In other cases, the differences can cause the medications to remain in our body too long or at levels that are too high and can then create unwanted harmful side effects.

Pharmacogenetics has the promise to evaluate your DNA and genetic profile to suggest the appropriate medicines at the correct dosage and at the exact right time. Pharmacogenetics will enable patients to minimize or even eliminate side effects while taking the most effective and best medication available to them.

Physicians and researchers are continually updating and refining information on human genetic profiles to develop better medicines and recommend the best medications for patients. This process gets better every month.

Almost every disease can be better treated with precision medicine. This includes treatments for cancer (as we discussed in “Good news: We are winning the war on cancer,” Spokesman-Recorder, January 2018), heart disease, diabetes, cardiovascular disease, obesity, depression, and transplantation medicine, just to name a few.


In addition to precision medicine, a revolution is occurring when it comes to doctor visits. This revolution comes from what we call telemedicine or telehealth. As one example, there is a company (Tyto Care) that has developed a small set of medical instruments that can be used by almost anyone with ease to take someone’s temperature, look into their ears, eyes, throat, at their skin and moles, and listen to their heart and lungs.

This information is recorded and directly connected to an app that keeps the data securely in the cloud and is available for a doctor to review. Think about it: When you or one of your children is sick, the last thing you want to do is trudge to and sit in a doctor’s office, around other sick people, waiting for help.

In the future, the system may also be able to evaluate different health aspects like blood profiles (e.g., sugar levels, etc.) using infrared sensors, avoiding the need for blood pokes. The whole exam can be done in your child’s bedroom, and the doctor will have enough information to quickly and conveniently make a correct diagnosis and suggest the best treatment plan.

The medical instrument home kits will have a price point of just over $200, but like all things, the price will come down over time. More information and pictures can be found at Tyto Care.com.

Now, let’s add another player to the mix. Recently there have been rumblings that Amazon may enter the pharmacy arena. In fact, the company has secured pharmacy licenses in several states, but Amazon will not currently comment on this.

A recent FoxBusiness.com article stated, “This is UberEATS for health care,” imagining a future where a patient uses telehealth services (e.g., Tyto Care) to visit with a doctor, and Alexa begins filling the prescription as it is given, using the lowest available price points. Amazon can execute deliveries in many cities within one to two hours, while consumers never leave the comfort of their homes.

“That could blow the entire [healthcare] ecosystem apart,” according to the article.

Access to medical records

Finally, two more exciting developments are occurring. Both Apple and Google have announced that they are interested in developing healthcare record platforms that are uniform so that a patient’s electronic medical records can be accessed anywhere at any time.

IBM has already provided the super-computer, Watson, to both physicians and hospitals to act as a consultant, scanning millions of scientific and medical articles, in seconds, to assist with new treatment recommendations for rare diseases. It’s only a matter of time before Watson will be helping with more common yet challenging medical cases.

I should point out that, first and foremost, we must develop and secure the appropriate consumer protections, privacy, and care protocols for patients. That being said, the future of medical care is both exciting and bright.