Physician Question and Answer Section -- Need Input on This

[drnase]

Hi Moderators. Looking for input on this thread as this will be just as important to this entire group -- you guys figure out the questions, but we also need constructive input on how you think this should go and various opinions to get to the best approach to keep this section (which will be tough) to keep growing and come across as a very friendly and constructve place that makes physicians want to participate), Ned your input in a think tank way


I am having a pretty good head day. I had my last internal stint taken out and it feels much better. I also dropped one antisiezure medication due to the healing process and the severe mood swings that it caused. Just to put you guys an gals at ease, they said this was a common side effect. They also said that it is quite common for people with tumors in my area to experience daily/hourly mood swings -- and this was in there for at least a couple years growing. I hope that you all understand that my constant movement, my partial rambling sometimes, and my seemingly fleeting feet is just not the true Jeff. No one has seen the true Jeff for a couple years. I am dedicated to this group and will continue to do for as long as you guys want to build and educate.

I have several physicians who are interested in a Physician Q and A section. I told them it would not be about advertising and that we had an extremely bright group. They were all fine with that. Questions. My first thoughts which are definitely changeable:

1. Include a section on Physician answer and question in the main forum. Allow the rosacea sufferers to know who is coming up for interview so they can investigate and then have them advise us on questions and then we can vote. I think 20 moderate level answer questions is reasonable and a few long questions.

2. We then hand the physician a list of those questions so he can prepare answers within a few days. Then he submits them for review by our group.

3. This is followed up by furhter clarity questions and the physician should answer.

4. I would like the chance to focus on one or two questions to constructively debate each physician.

5. If we get a good impression we let them join and start a physician collaboration group?????


So far, I have four laser physicians willing to do this, each with a different machine. I have two dermatologists and think Albert Kligman would definietly respond a flushing expert. All are willing to try this out.

Dr. Darm
Dr. Bitter Sr.
Dr. Diaz
One unsure but leaning towards yes

Dr. Wolverton 00 derm
Well known Internet Derm
Most likely Albert kligman

Skin Flushing expet from Texas

What you think about the section, setup and folow up?

[drnase]

One physician we may want to interview.

Hi Dr. Nase.



My name is Gus Diaz, MD. I am a Facial Plastic Surgeon based in Gulf Shores, Alabama. I would like to thank you for the extraordinary work you are doing in helping patients with rosacea. Currently I have about 3-4 patients that were referred form your board to my practice.



I currently have a Lumenis One since Sep 2004. I currently treat 4 to 5 patients a day. All IPL treatments are preformed by me. I am also currently a teacher for Lumenis for the Lumenis One, ClearLight, LightSheer, and in the near future for 2 new modules that are going to be available for the Lumenis One.



I will like to help you and the group in any way that is possible. My consultations are free, and I think that the prices of my treatments are reasonable. Please, let me know that you received this e-mail.



Thanks once again.



Gustavo A. Diaz, MD

Facial Plastic Surgeon at the McCollough Institute

Medical director of the MedSpa and Laser Center at the McCollough Institute

[Kris Jacobs]

Great to hear you are feeling better Dr. Nase,
This is going to be short because I have to run:
But I think it is important to have physicians know that creams (metronazole, noritate, Retin A Etc Etc Etc) Have absolutely NO efect on rocasea symptoms. And in a lot of cases can make our symptoms worse. I think I is importatnt To let these doctors know that right now creams are not the answer.
I will elaborate more on this later. Sorry I have to run. You guys and gals have a great day
Kris Jacobs

[drnase]

Kris,

That has always been a foremost goal. Actually, most of the physicians that I/we invite I have collaborated with or they have read my book and know that. Our job is to extract more information out of them and also emphasize that we still need better treatments no matter how good they are. Good point.

We could possibly put a short introductory paragraph for all future physician posters to address this, but still listen to some degree to what they have to say if they veer slightly into that area.

[Bob Bear]

This may be irrelevant to this thread, but Iv noticed that most UK GP's have an odd view towards rosacea - they seem to dismiss anything that doesnt show up in their little books with regards to treatment options.

For example, Iv been told by my GP that non of the following should be used or have any place in the treatment of rosacea:

- Moxonidine
- Clonidine
- Clonazepam
- Any kind of laser machine

This is quite contary not only to the facts, but also to my own experience. Iv had great results with IPL, and I know many people using the above drugs.

So, I think its important that treatments such as these become regonised as standard by the medical world. Its no good for patients to be at odds with their physicians.

I agree that UK GPs do not believe lasers have any association with rosacea, in fact they seem to think Metrogel and antibiotics is where it starts and ends but i don't think Dr Nase can do much to remedy that situation sadly.

[Kris Jacobs]

I could'nt agree with you more Dr. nase,
How (what angle) do you think is best when approaching this?
I have no idea how these doctors will respond. maybe you could give us an outline or guidelines as to what we should cover.
Kris jacobs

[drnase]

UK people,

I am sorry to hear that and have heard that often from Andrew Reid of the UK. That is probably why Dr. Patterson is the only known guru in the whole land.

On a separate note, Dr. Patterson does listen to me often (I mean we collaborate, he listens and we talk). He has prescribed moxonodine because most need less laser treatments, he does prescribe clarithromycin XL and he does experiment quite a lot.

I will leave the UK people who kindly responded to either find a UK doctor who supposedly knows his stuff and re-educate or we can go right for Dr. Patterson.

Thank you for your comments

[Kris Jacobs]

Hi Dr. Nase,
I think that if these doctors are already somewhat educated on rosacea, then we should concetrate on near-future treatments- that is VEGF inhibitors, sansrosa etc.
From what you say, VEGF seems to be the most promising. If we can get IPL treatments and then inhibit vessel re-growth, Via VEGF inhbitors, then we are really onto something.

Also, like you have said in the past, beating rosacea will probabely lie at attacking it at the genetic level. We should ask these doctors if they are willing to study this at the genetic level, or if they already have, what have they found?

thanks
Kris Jacobs

[drnase]

Nice follow up with Dr. Diaz which shows postive potential of Physician Q and A.


Hi Dr Nase.



I am honored with your invitation for the section of Physician Questions and Answer. Being a Facial Plastic Surgeon and worried about cosmetic results might bring a different twist to the traditional vision that the dermatologist bring to rosacea. I also understand that you are trying to keep advertisement to a minimum and I will also try to keep it that way. But, my experience is with the Lumenis One and rosacea is very successful and I will like to help as much as I can. It also depends on what equipment the physician has and also if they are able to bring it to the maximum that that particular technology allows.



I will like to join the group, but also it will have to be done in a way that I am not bombarded also with questions and also taking into consideration not to cause any bias to a treatment modality, medical specialty, or professional controversy with any other physician inside or outside the board. You know how patients like to place you in the spotlight with questions referring to treatment specifics between us physicians and why our way works and the others physician don’t. That is one thing that we have to try to keep to a minimum. This could be a good beginning for a group to take improvements in their condition and make us learn how to improve between each others as patients and physicians. It is funny, but the times that I have learned the most about a condition have been the times that I have sit down and really listen to what the patient has to say about it.



I will keep your information and phone number confidential.



Thank you,

Gustavo A. Diaz, MD




--------------------------------------------------------------------------------

From: Dr. Geoffrey Nase [mailto:drnase1000@hotmail.com]
Sent: Saturday, July 02, 2005 12:06 AM
To: drdiaz@mccolloughinstitute.com
Subject: RE: Hi



Hello Dr. Diaz,

Sorry for the delay, I receive too many emails to ever get to so I have to weed through sometimes. Warren and I are moderators of a great forum with very intelligent rosacea sufferers. We are builiding a Physician Question and Answer Section and I would love to have you on as a guest physician.

I was thinking about allowing the rosacea sufferers 15 questions and then sending them to you to fill out at your liesure, submit your answers and then have one more follow up for cliarification. You would then be certainly welcome to join our group. We try to keep advertising to a minimum, but as you are aware I am very impressed with the Lumenis One and experienced Laser Specialists because this attacks the heart of the neuro-vascular rosacea beast.

Please feel free to email or give me a call in the afternoon anytime after 5 PM. Please, please keep this number confidential or patients will force me to change my number for the countless time. I look forward to hearing from you. I am working closely with Dr. Jerry Darm of Portland Oregon, but I am first and foremost a patient advocate and an Academician...... so collaboration and choices are very important to me.