Category: Age Management

Dr. Alan Terlinsky is proud to announce the arrival of the new Verjú Cellulite device using Low-Level-Laser-Therapy at his Nu-living Optimal Wellness and Longevity Center located in Arlington, VA. Dr. Terlinsky’s practice will be the first office in Metropolitan Washington DC and Northern VA to use the novel Verjú technology which, after an impressive scientific study, has been recently approved by the FDA for safety and efficacy in permanent cellulite removal.

Zerona for Body Slimming, Contouring, and Sculpting

Dr Terlinsky notes that the cutting edge Verjú, was developed by Erchonia Inc, an innovator and leader in producing medical lasers for treating various conditions such as chronic musculo-skeletal pain, acne, and facial wrinkles. Erchonia is best known for its famous non-invasive Low-Level-Laser-Therapy devices using a cold “red“ laser, the Zerona and Zerona AD. Both are FDA approved for body slimming, contouring and sculpting. Application of the Zerona laser dissolves fat from hips, waist, thighs, abdomen and arms resulting in a reduction of 1-2 pants or dress sizes in a matter of a few weeks.

The Next Level – Verjú

Erchonia has now tested and released a new, more advanced device using Low-Level-Laser-Therapy technology called the Verjú. The Verjú is a Low-Level-Laser-Therapy device using a cold “green” laser and the Zerona, a Low-Level-Laser-Therapy device using a cold “red”” laser. Both the Verjú and the Zerona lasers are non-thermal and produce no heat, so patients do not feel anything while the procedure is performed. The Verjú, is more powerful than the Zerona, and not only dissolves fat, but it can break up fibrous tissue, tighten skin and stimulate new collagen deposition. These unique treatment effects are central to non-invasively and painlessly resolving the displeasing aesthetic appearance of cellulite.

Verjú treatments are typically 30 minutes long, and average two weeks to three weeks in length. Dr Terlinsky says, “we can pinpoint the body areas which require customized treatment. We configure the Verjú to treat problematic areas in the midsection, buttocks, and thighs. We are able to treat those areas most annoying to the patients and often resistant to all other non-surgical treatments.” “It’s very simple”, as Dr Terlinsky relates, “Patients are given a menu from which they can merely indicate their desired body area priorities to improve skin appearance.”

Benefits

In a recent clinical trial, not only did the Verjú laser system allow permanent cellulite removal, but pre and post measurements showed the Verjú also significantly reduced the circumference of the thighs. In just two weeks with six treatments with the Verjú cellulite laser, patients experienced significant improvement in the appearance of cellulite in their thighs, buttocks, and lower abdomen when compared with those treated with the placebo laser.

According to Dr Terlinsky, “Studies performed on the Verjú have shown that, in contrast to other available non-invasive technologies, Verjú is, safe and effective as a stand alone procedure for significantly improving the appearance of cellulite after only two weeks.” Dr. Terlinsky notes that the Verjú produced excellent results without any other adjuvant therapy such as massage, mechanical manipulation special diet, exercise, topical preparations, or medications. Verjú is unique among cellulite treatments in not requiring adjuvant treatments.

As patients come to the Nu-living Optimal Wellness and Longevity Center and undergo Verjú cellulite treatment, Dr Terlinsky says, “Patients will benefit from the scientifically proven Verjú cellulite procedure. Before the publication of the Verjú study, there had been no definitive, non-invasive proven treatment approach for cellulite which scientifically has been demonstrated to resolve or significantly improve the distressing cellulite effect. Unlike the enduring Verjú effect, many existing therapies fail to create improvements which last.”

What Is Cellulite?

It is most important to begin to answer this question by stating that cellulite is NOT a disease. It is easy to spot cellulite as it appears as little “dimples” or “pockets” in the skin which give the skin a lumpy, bumpy or “orange peel” effect. The areas most involved are on the buttocks and thighs but the arms and abdomen can also be affected. Cellulite is more common in women than men and often begins at puberty suggesting a hormonal basis to some extent. In some studies, cellulite to some degree is present in almost 90% of women.

Cellulite is also known as adiposis edematosa, dermopanniculosis deformans, status protrusus cutis, and gynoid lipodystrophy. Cellulite is created in the subcutenous lays of the skin where capillaries, lymphatics, structural “fibrous” tissue, waters and emulsified fat interact. There appears to be some defect in the structural fibrous tissue architecture extending from muscle layers to the dermis which causes trapping or water and fat in small circular areas or cells. Contraction of the supporting fibrous strands results in the dimpling effect of cellulite.

While overweight and obese people commonly have cellulite, many people with cellulite are not overweight or have excess body fat. Indeed, the fat contained in the trapped areas is not inside adipose or fat cells. It is mainly liquid fat, water and other substances which form a “puddle” trapped by fibrous tissue.

While people who have cellulite are often perfectly healthy, medical conditions such as obesity, poor circulation, lymphatic flow impairment, and impaired detoxification mechanisms are thought to play a significant role. Stasis of lymphatic flow caused by inactivity, immobility and general low exercise habits are also thought to play a role in the severity of cellulite. Some studies point to nutritional factors.

Cellulite has many classification scales. In the Verjú study, the classification used to define baseline and post treatment status of cellulite was called the Nurnberger-Muller scale.

If you would like to learn more about the Verjú Laser and see if you are a candidate for treatment, contact the Nu-living Optimal Wellness and Longevity Center at 703-379-7110, or complete our getting started form here.

In 2002  the results of a landmark and controversial clinical study known as The Women’s Health Initiative, or the WHI were reported. This study had  enrolled older women (average age 63) who were many years past their menopause to assess the answers to very specific questions regarding the risks and benefits associated with  hormone therapy (HT) for women after menopause.

The WHI was notable for its size with about 16,000 women participating and being divided into 2 study groups. Group 1 consisted of about 8000 women within an intact uterus.They were given a combined oral conjugated estrogen and a synthetic progestin  known as Prempro.  In group 2 the women had had an hysterectomy and were only given an oral conjugated estrogen known as Premarin without the progestin. There was a control group of women who were given a placebo without any hormone. Both Prempro and Premarin are not bio-identical hormones as the estrogen comes from horses and the progestin is completely synthetic. The term “bio-identical” refers to the same exact estrogen found in women such as estradiol or the progestin progesterone.

Prior to the WHI, physicians strongly believed that HT (bioidentical or not ) protected women from heart attacks, strokes and dementia over the long run. Concern over risks such as breast cancer and blood clots were down played mainly because earlier results of a large scale epidemiologic study of relatively young nurses. These healthy young women entering their perimenopause and menopause had started HT (not bioidentical) in their late 40s or early 50s  for symptoms such as hot flashes, sleeplessness, poor memory and reduced quality of life.  After initiating HT, yearly reports about  their health and quality of life were collected. The results were impressive. The nurses seemed free of any chronic diseases such as diabetes, hypertension, high cholesterol or arthritis and they were quite active and vital. The nurses reported minimal side effects or serious illness.

The results of the WHI had a major impact on clinical practice as the study reported there was no heart attack, stroke or dementia protection in the women given HT in both groups 1 and 2. In group 1 there was a small increase in breast cancer compared to the control group. Interestingly in group 2, comprised of the hysterectomized women given estrogen only, there was actually a 33 percent decrease in breast cancer ( yes even with the non bioidentical estrogen ). Both groups seemed to have increased blood clots and both had some benefit in the form of bone protection against post menopausal osteoporosis and colon cancer.

Nevertheless, NIH stopped the group 1 study citing the lack of benefit in the presence of increased blood clots and breast cancer. However NIH also allowed the group 2 to continue as there had been a decrease in breast cancer. Unfortunately so many women in group 2 were alarmed at the scary and sensational reporting over the findings in group 1 pertaining to breast cancer that many women in group 2 dropped out of the study. With the members of study group 2 now down to an insignificant number, NIH closed it down the following year.

Following the results of the WHI, many doctors and medical specialty organizations advised against the use of HT for women at menopause believing HT to be more risky than helpful in most situations.

While the hormone treatments in the WHI were not bioidentical, the FDA applied the same warning label to bioidentical hormones considering all forms of estrogen and all progestin’s to be equally dangerous and on beneficial as those studied in the WHI. This is another controversial area related to the results of the WHI i.e. to the results of clinical studies using non-bioidentical hormones apply to bioidentical hormones?

The intense media reporting, much of it inaccurate, created great anxiety among women. This led to a 70% World-wide decline of menopausal HT with almost universal recommendations from physicians and medical specialty organizations for women to avoid HT if possible or use HT at the lowest dose and for the shortest amount of time. Following the 2002 WHI results, a generation of doctors, doctors in training, medical students and allied health personnel were “warned “ not to advise  women there were any long term health benefits associated with menopausal HT.

Despite the widespread opinion from health professionals following the WHI results for women to avoid HT due to high risks without counterbalancing benefit, some doctors remained skeptical of the complete turnaround in recommending HT for women at menopause. Why had the younger nurses followed yearly shown health benefits without medical side effects? Could there be a difference in risk/benefit of HT when it was given to younger women closer to their natural menopause as opposed to women who were older and often 15-20 years removed from their menopause?

NIH was asked for data on women in the study groups who were relatively young and it took over 5 years for NIH to finally analyze this subgroup of women in the WHI who were between 50-59 years old.  In fact this age group did demonstrate cardiovascular protection with the use of HT. This new revelation led to the so-called “window of opportunity” theory which proposed that estrogen did provide  cardiovascular protection  as long as it was given within 10 years of woman’s natural menopause.

Over the past 13 years since the WHI, the breast cancer issue has diminished as a concern as reanalysis of the original data by NIH suggested there was no statistical increase in breast cancer in the study group 1 compared to the control group. This combined with emerging recognition of cardiovascular protection of HT use for younger women has turned the results of the WHI upside down. Moreover, women who had been treated with estrogen only, showed an actual decrease in breast cancer rates. In recent years the focus on a possible culprit for breast cancer in the WHI study group 1 pointed towards the synthetic progestin in Prempro as a possible cause of increased breast cancer occurrence. The synthetic progestin is known as methoxy progesterone acetate or MPA or Provera. A large study group in France using bioidentical progesterone in women demonstrated no increased in breast cancer in women on HT for over 10 years.

The incidence of blood clots seems also related to the type and method of estrogen administration. Taking estrogen through the skin or transdermally has been shown to be safe compared to oral estrogen which is associated with the risk of blood clots. The WHI used oral estrogen and in the study groups. Of note, only estradiol, a bioidentical estrogen, can be applied to the skin while the non-bioidentical estrogen, Premarin, must be swallowed. Here may also be another advantage of using bioidentical hormones.

Several recent large European epidemiological studies of women on HT around the start of their menopause or within the “window of opportunity”have demonstrated impressive cardiovascular disease protection compared to women who did not use HT at menopause. The studies used bioidentical estradiol however one study also employed the synthetic progestin MPA. Similarly, recent epidemiological studies are now emerging suggesting HT is protective against dementia. Women are affected by Alzheimer’s 3-1 compared to men and the incidence of dementia is increasing every year as women are living longer. Irrational fear of HT at menopause or physician unwillingness to recommend HT may be depriving women of crucial treatments protecting their long term health.

Dr. Terlinsky has been a member of the Endocrine Society and the North American Menopause Society (NAMS) for over 10 years. Attending annual meetings and focusing on the developments in HT for women over the past 13 years has been a major interest of his  and it has kept him  up to date with respect to developments in the field. Dr. Terlinsky  vividly remembers the beginning of the “nuclear winter” for HT following the WHI.  He  has seen and  read the initial post  WHI guidelines from such respected medical organizations as the American College of Obstetrics and Gynecology, The Endocrine Society, the American Association of Clinical Endocrinologists, the American College of Physicians, International Menopause Society, the North American Menopause Society (NAMS), and U.S. Preventive Services Task Force. Those initial 2002-2003 guidelines were virtually in lockstep with one another with the exception of the International Menopause Society as they proclaimed HT was dangerous and had little benefit. The International Menopause Society has always been skeptical of the dire findings associated with HT which came from the WHI. It has been recommending the use of HT for long-term health benefits for women since at least 2011.

Dr. Terlinsky is cognizant of the revisions in guidelines for HT for women made by many of the  above-mentioned medical organizations over the years since 2002 as new research information has accumulated. With the exception of the International Menopause Society none of the above-mentioned societies has openly reversed their position about advising HT for women at menopause for long-term health benefit.

But there is breaking news on the HT front. Data from Finland was presented at the most recent North American Menopause meeting once again demonstrating long-term benefit for women who take HT at menopause. The North American Menopause Society is likely to change its position on the use of HT for long-term benefit as the “nuclear winter” of hormone therapy slowly lifts. It is expected that the North American Menopause Society will likely join the International Menopause Society in recommending hormone therapy for some women for long-term health benefit and chronic disease prevention particularly if hormone therapy is started within the “ window of opportunity” years mentioned above. Those new recommendations are likely to be issued in early 2016.

Unfortunately, many physicians and allied health care providers have been discouraging women from taking hormones for years, and an entire generation of providers has been trained and indoctrinated into being, “anti-hormone”. This has caused women to be offered advice that is not based on current, up to date information regarding menopause hormone therapy. A good example of the unintended consequences of the 2002 post  WHI entrenched recommendations today is the published data which estimates an extra 70,000 postmenopausal osteoporotic bone fractures annually  that could have been prevented by hormonal treatment for osteoporosis protection. Many women with fractures had declined hormone therapy at their menopause on account of fear which was not counted by current information from the providers. As mentioned above emerging data also suggests women are allowing themselves to be at a much higher risk of dementia, stroke, and heart attack by not considering hormone therapy at menopause.

The real problem is another long-term large prospective trial as needed to once again assess recommending and providing women with hormone therapy at menopause and observing the beneficial effects over decades. That trial also needs to answer the question of whether bioidentical hormones hold advantages over synthetic hormone. For a variety of reasons this is unlikely to occur so that physicians who want to offer women the very best recommendations regarding hormone therapy must provide menopausal women with the best current data along with a scientific explanation of the preponderance of evidence that is now available. In subsequent articles on his website Dr. Terlinsly will explore other related topics dealing with menopausal hormone therapy.

Why Should I Get a Hormone Test?

There are many reasons for one to get a hormone test. Perhaps you have been displaying symptoms of hormonal imbalance. Maybe you just got pregnant, for instance. You could just want the information to maintain the proper homeostasis for your body. Whatever your reason to get a hormone test, it is a good one. Hormones are very important to regulating our bodies, day in and day out. They are needed to keep us at our best and bring us back when we are at our worst. Men and women both can get a hormone test to make sure they are at their optimal levels.

Your hormone levels are as individual as your fingerprint. No two people have the same exact levels and therefore it is important when getting a hormone test that the medical professional has experience. There are several main hormones that get tested and they all play integral parts in our lives. The main hormones tested are estrogen, progesterone, testosterone, DHEA, and cortisol. These five hormones contain a lot of information about you including deficiencies, excesses, and daily patterns. For example, cortisol levels differ throughout the day, they are normally higher in the morning and dwindle at night.

What is a Hormone Test?

When getting a hormone test for estrogen you are actually getting a hormone test of the three estrogens; estradiol, estriol, and estrone. Men and women both produce estrogens. Estradiol is the type of estrogen tested in women who are not pregnant and the levels will vary during a menstrual cycle. Estriol is normally only measured during pregnancy because that is when those levels are highest and will continue to rise throughout the pregnancy. Estrone is measured in women who have gone through menopause or in men and women who might have cancer in their ovaries, testicles or adrenal glands.

You may need to get a progesterone hormone test for infertility or for tracking ovulation. Progesterone is produced in high levels during pregnancy, starting during the first trimester and continuing until the baby is born. Getting a hormone test for progesterone may also help assess the risk of a miscarriage. It may also help diagnose problems with your adrenal glands and some types of cancer in both men and women.

Testosterone is very important to men and women. Though the level of this hormone is much smaller in women than men it still plays an important role. It affects the brain, sexual functioning, genital tissues, and your energy levels, among other things. Testosterone may affect a man’s ability to have a baby which is one of the reasons why a man might choose this hormone test. He might also be losing his sex drive which is linked to testosterone. High levels of testosterone in a woman might cause her to take on male attributes such as facial hair. Getting a testosterone hormone test might also help find the cause of osteoporosis in men. DHEA is linked to testosterone so often times the two hormones are linked in their tests. DHEA levels can be linked to delayed puberty, Cushing’s Disease (a type of Cushing’s Syndrome), and adrenal gland tumors.

You may need to get a hormone test for cortisol if there is a potential problem with your pituitary gland. This could be either making too much or making too little. Adrenal fatigue happens when your body is not making enough cortisol because it has been in a high stress situation for too long. Cortisol levels change through the day and they are highest in the morning. The changing levels of cortisol are very important and if your cortisol levels maintain a high level it is known as Cushing’s Syndrome. If your doctor thinks that you are producing too much they would perform the test later in the day, if they don’t think you’re making enough the test will happen in the morning. Either way, you will likely be asked to avoid too much activity the day before.

Endocrine diseases or disorders would be more of a proper term for hormonal imbalance. There are three broad categories of endocrine diseases; hypo-secretion (lack of), hypersecretion (too much), and tumors on the endocrine glands. But how does this affect men? Or women? What are some signs or symptoms of a hormonal imbalance? What is hormonal imbalance to me or you?

What is Hormonal Imbalance in Men?

Sometimes, a hormonal imbalance can have similar signs as aging and therefore can be confused quite easily. Some of the signs can be memory loss, muscle loss or weakness, erectile dysfunction, hair loss, depression, and many others. Andropause (also known as male menopause or androgen decline) is a decline in testosterone. However, there is no defined period of time that a man might go through these changes. Symptoms may include weakness, depression, and fatigue. Andropause is still somewhat controversial in the medical community because it isn’t as well defined as menopause. Often times this imbalance can be treated with testosterone replacement therapy and that will also help with the symptoms but does come with risks. Make sure to ask questions about any symptoms you might be having and have an open, honest conversation with your doctor about it. There are many other hormonal imbalances a man might experience in his life, andropause is just an example.

What is Hormonal Imbalance in Women?

Well, we talked about andropause so why not touch on menopause. Menopause, basically, is the sign that a woman is leaving her reproductive age and is the gradual discontinuation of estrogen. Symptoms include hot flashes, mood swings, and if you are undergoing premature menopause (many experts consider it premature menopause if you are experiencing it before the age of 40) you may have other physical and emotional hurdles coming your way.

What is Hormonal Imbalance in Women Besides Menopause?

To be honest, women can experience many hormonal imbalances. She can experience hormonal imbalances during and after pregnancy. She can also experience them while menstruating. It is often a case of an improper relationship with the hormones progesterone and estrogen. If a woman ignores any signs or symptoms of a hormonal imbalance it can lead to some serious health issues, so be sure to consult a health professional. Sometimes when women have hormonal imbalances they will grow facial hair or thicker hair on their extremities.

What is Hormonal Imbalance to Both Men and Women?

Can the same things affect both genders? The answer is yes. Things like environment, stress, and nutrition can affect men and women and cause hormonal imbalance. Hormones regulate the human body in many ways and need to work together to maintain homeostasis. Adrenal fatigue is being discussed more in the medical community and happens when people are in high stress situations for long periods of time. It happens when your glands are no longer able to maintain your needed levels of cortisol. Ingesting certain types of foods en mass can also cause imbalances in men and women. And too much pollution in anyone’s environment is bad.

I just came back from Las Vegas where I attended the annual meeting of the A4M which stands for the American Academy of Antiaging and Restorative Medicine.  Prior to the conference, I attended two workshops. One workshop was Reversing Physical Aging with Hormone Therapies and the other was Peptide Therapy. The first workshop reviewed the characteristics of aging of the various organs and systems of the body and how they related to various hormone deficiencies which develop with aging. The main focus was on testosterone, growth hormone, IGF-I, Thymosin–alpha–1 and Insulin.

The peptide workshop was all about using growth hormone releasing hormones (GHRH), growth hormone secretagogues (GHRP), and various fragments of growth hormone and IGF-I (insulin-like growth factor). These peptides which are small proteins consisting of amino acids usually less than 50, can do much to restore muscle mass, reduce body fat, improved endurance, improved brain function, improved immune system, improved bone, and counter many of the chronic problems associated with aging. Peptides have become very specialized and some are now being used to facilitate healing, increased libido the sexual function and med women, stimulate stem cells and restorative joint function. I have already been prescribing peptide therapy using Sermorelin, however, there are now new peptides such as Ipamorelin which provide additional benefits.

While the concept of antiaging sometimes seems to be wishful thinking, is basically the ideas embodied in the NIH sponsored Precision Medicine Initiative, which you can learn more about here. Precision Medicine is a powerful tool integrating complex health data into actionable guidance and personalized intervention to improve individual health. The process involves detecting potential health problems both present and in the future, predicting health conditions based on lifestyle and genetics, reversing the impact of genetic, lifestyle and metabolic problems and helping patients understand her own health destiny.

New services and features which will be available in my practice will include telomere testing, metabolomics, improved methods to recommend supplements, advanced hormone therapy and expanded Peptide therapy.

Hello from beautiful Philadelphia where I am Menopause  the annual meeting of the 2017 North American Menopause Society or the NAMS. NAMS is a leading organization in  the area of women’s health . On Wednesday , I attended an all day session on diagnosis and up to date treatment  osteoporosis . There are new approaches and new medicines to learn about . Many of the top doctors and researchers from the ASBRM ( American Society of Bone and Mineral Health) and the NOF (National Osteoporosis Foundation) lectured at the meeting . These international thought leaders were available to talk with physicians like myself who attended the meeting . It was a wonderful educational opportunity for me . Moreover, my patients will directly benefit from what I learned.

On Thursday , the newest NAMS recommendations on the use, value and safety  of hormones was introduced and discussed. There is so much misinformation being provided to women who should be on hormones because of the failure of the medical community in general to keep up with developments for the past 18 years! It is estimated that 75, 000 osteoporotic bone fracture occur each year because women have been made fearful of hormone use.

I also learned about the newest data, in preventing coronary heart disease  and reducing  mortality  with hormone therapy  in young postmenopausal  women. Presently , I am listening to an excellent presentation on migraine in women . More to come……

Having returned from Orlando where the annual meeting of the Age Management Medical Group  has just ended, I was impressed by several presentations. The safety of testosterone replacement in hypogonadal men has recently been raised by two studies over the past 2 years. Before these concerning studies , there had been many positive studies supporting the benefit of middle age and elderly men using testosterone. While both of these recent studies have been critized for poor methodolgy of study design , their combined impact has caused some physicans and the FDA to caution patients about potential adverse  cardiovascular events in older men using testosterone. There are now 4 new studies reported this year  , small in scope, but nevertheless  reassuring that testosterone use is not a cardiovascular risk for men who use it. . I will publish the details in a news article in a few days.

Endo 2015 also had news for women concerninfg the use of hormone replacement therapy and it was also good. A large meta-analysis  looking at the mortality data of women who have used hormone replacement therapy has found no difference in mortality . For those women  who use hormones after menopause for “quality of life ” reasons this is very reassuring . I will also discuss this study in detail in anothger news article.

I have been to the American Academy of Anti-aging and Restorative Medicine in Las Vegas in December 2014 and now the Age Mangement Medical Group and the themes at both meeting stress the emerging topic of how clinical genomics, nutrition , hormone balance, detoxification promote healthy aging. More comments on this to follow.