Iβm a board-certified dermatologist who saves lives (!) by helping people reduce their risk of succumbing to common chronic diseases by fixing their immune systems and getting great looking and feeling skin, hair, and nails along the way. My weekly newsletter is an opportunity for you to get to know and trust me by learning from what I'm building in life and business.
I was a jerk... ππ
At a glance
Welcome to this week's edition of the Above & Beyond Dermatology Newsletter. Thanks for reading. Feedback is encouraged and appreciated. If there's something you'd like to see more (or less) of here, please let me know by replying to this email. I want this to be worth your time and attention. Yeah, I was a jerk. ππSomething tells me I'm not alone here. If you've ever messaged me on Instagram and received a response weeks to months later, you already know I don't spend much time there. This is likely a defense mechanism because I know I can easily get riled up by the things I see there. That sometimes leads to me running my mouth in unproductive and hurtful ways. That happened recently. While the details are neither important nor appropriate to share, the broader idea that I was a jerk is important. It's important because, with the help of some honest feedback from a confidante, I had the humility to do some introspection and realize that a reparative apology was in order. Have you been a jerk lately? If so, consider apologizing in an authentic, vulnerable, and reparative way. It will surely do some good for the person(s) you hurt. And it will likely do even more good for you. The Direct Care Derm β A Podcast from Above & Beyond DermatologyThe show is up to 999 (!) listens in 7 weeks. Thanks to all of you who have listened, subscribed, rated, reviewed, and given me feedback/encouragement. It helps keep the train running and means a lot to me. Episode #010 is now available! βSarah Asch, MD, FAAP, FAAD, is a trailblazer in direct care pediatric dermatology. She's on a mission to expand high-quality pediatric dermatology care throughout underserved areas of the Upper Midwest and beyond. She LOVES her work in pediatric dermatology, and she wanted to love her job again. She decided to solve that problem by founding Hometown Pediatric Dermatology. Join us for the Part 1 of a wide ranging, provocative, educational, and fun conversation with a wildly talented doctor and delightful person. Part 2 will be out next Thursday. Dr. Asch is a triple board-certified pediatric dermatologist (Temple University School of Medicine, MD; Residencies: Pediatrics, Children's Hospital of Pittsburgh; Dermatology, UCSF; Fellowship: Pediatric Dermatology, Mayo Clinic - Rochester). She founded and is building Hometown Pediatric Dermatology, her pediatric teledermatology practice taht operates via a direct care model, which she simply calls "practicing medicine". She is also the Project ECHO lead for Pediatric Dermatology for the Upper Midwest, the first session of which is scheduled for March 2024 (I'll be there!). She fills her soul by volunteering at the American Academy of Dermatology's Camp Discovery. I had so much fun reconnecting with and learning from her. Termination Day π₯³As some of you know, I was abruptly terminated β without cause β back in August 2023 from my position with Aspirus Medical Group after a bit more than 2 years of 5-star service. Yesterday marked my official termination day. I'llβ¦ most definitely not be back. :) I'm excited to be doing my own thing, serving a market of people who deserve something so much better than what is typically available from Big Healthcare. Abrupt termination without cause of physicians who speak their mind and stand up for what they believe in is unfortunately becoming more common. If you'd like to learn more about this insidious symptom of our broken sick care system, check out this story that my friend, pediatric emergency medicine physician, and fellow abruptly terminated physician, Dr. Ashley Saucier, wrote about her experience for the SoMeDocs (Doctors on Social Media) magazine. I'm grateful for her courage. Winter Clinical Miami 2024 β Rapid ReviewI had the pleasure of attending a fantastic dermatology conference in Miami, FL last weekend. Here's a rapid review. #1 β Working on My Disordered Conference Eating Behaviors (Bear with Me Here...)Typically, when I'm at a conference, I turn back into a food hoarding and scavenging medical student (if you know, you know). As I get older and more secure, I recognize I can fight this urge and change my behavior. I don't need to eat the food just because it's there and it tastes good. Overall, I eat fewer ultra-processed foods and smaller quantities of food in general. I try to adhere to a whole-food, plant-based style of eating. To keep me on track, I aim to eat at least 30 different plants per week, as Dr. Tim Spector advocates. I'm not a zealot, but this change has undeniably influenced my cravings and disordered eating habits (e.g., constant snacking and unnecessary binging). If 30 different plants per week sounds like a lot to you, the first 4 photos below contain at least 37 of them (38 if you count the hops in the πΊ! πͺ). The most important part: I didn't feel like I was depriving myself. And I felt good β mentally, physically, and spiritually β about how I was eating. Also, Pinkglow π! Like I said, I'm not a zealot. I still enjoy all kinds of food. Case in point β This (below) was my breakfast on the final day of the conference. As recently as a year or so ago, I would have eaten a plate twice this size with similar items for breakfast every day of the conference if it was available. Thankfully, those days are gone, and it feels great. This paella! Wow. I love spending some time close to the ocean where I can enjoy ultra fresh seafood and throw the shells back in the ocean. Pro tip for conference-going when traveling with your family: don't forget about them! I was blessed to have my wife and 4-year-old son join me on the trip, but I took care of them whenever I could. Sorry for the dopey elevator selfie. If you know me well, you know I'm not a selfie person, but it's good to lean into your discomfort if you want to grow. #2 β Networking. Like Nike says, Just Do It.I was excited to see Dr. Seemal Desai speaking at the conference. Seemal is the president-elect of the American Academy of Dermatology. He begins his one year term as president in March 2024, just a few days away. He's an expert in vitiligo, a passionate advocate of all things dermatology, and a fantastic all around guy. He's also the brother of Dr. Dhaval Desai. I had the pleasure of interviewing Dhaval on Episode #006 of The Direct Care Derm podcast. When I was interviewing Dhaval, who openly suffers from severe vitiligo, he mentioned that his brother is a dermatologist. Since Desai is a relatively common surname, I didn't think much of it in the moment, but I sheepishly asked him after the interview: "Is your brother, by any chance, Seemal...?" Small world. I hadn't yet met Seemal, and I likely wouldn't have had the courage to introduce myself to him at this conference, where he was typically surrounded by folks wanting his attention. I'm grateful that Dhaval encouraged me to do it anyway. We had a nice quick chat, took a photo per Dhaval's orders, and went on our separate ways. Now it might be easier to lock down a three-way conversation on the podcast with the brothers Desai that would surely be a hit... #3 β Speaking of Vitiligo...βOpzelura (ruxolitinib) cream 1.5% is an excellent new topical option available to people suffering from vitiligo and atopic dermatitis. I wrote about one of my patient's experiences with it for dermsquared, the company behind Winter Clinical Miami 2024, the conference I was attending when I took these photos. As of this writing, I have no conflict of interest with Incyte, the company that manufactures Opzelura. #4 β Learn from the BestβContinuing medical education (CME) is an essential part of being a good physician. When I'm at a dermatology CME conference, I try use it as an opportunity to learn from the best. Winter Clinical Miami 2024 delivered big time in this regard. βMark Lebwohl, MDβ There's no one on the planet I'd trust more than Dr. Lebwohl when it comes to psoriasis. βApril W. Armstrong, MD, MPHβ β¦and if I can't find Dr. Lebwohl, I'm calling Dr. Armstrong! βNatasha Mesinkovska, MD, PhD (@natashaderm) Dr. Mesinkovska works at UCI Health, the only academic health system in Orange County, CA. She's well known for her expertise in alopecia (hair loss), and folks are eager to PAY for it. Despite working within an academic system that accepts many forms of medical insurance, she shared that she has to had to raise prices for a 15-minute "hair loss" consult (when there is not yet a confirmed medical diagnosis) to over $600 due to overwhelming demand. I'm not surprised. Hair loss is a big, big deal for many who suffer from it, and high quality diagnosis and management is often quite complex and taxing for all involved. βDavid M. Pariser, MDβ I don't know anyone who has contributed more to the science and clinical management of hyperhidrosis (excessive sweating) than Dr. Pariser. I'm passionate about helping people with this disease. Many people who suffer from it don't even know it's a disease, let alone that there are ways they can get life-changing relief. They suffer in silence. I was doing an internship at Dermira in Menlo Park, CA when they received news of official FDA approval of a medication they developed called Qbrexa, a glycopyrronium containing cloth approved for treatment of excessive underarm sweating (primary axillary hyperhidrosis). That marked a new era in the recognition of the morbidity of this disease and the effort to bring relief to those who need it. βLinda F. Stein Gold, MDβ Dr. Stein Gold is the queen of rosacea and acne. Based on what I learned from one of her talks, I've adopted a new standard of care for topical treatment of rosacea. I'm excited to start discussing it with my clients. βDarrell S. Rigel, MD, MSβ Have a question about melanoma? Dr. Rigel is your guy. He's also the Consultant Dermatologist for the New York Yankees! βLisa Swanson, MD and James Q. Del Rosso, DOβ Dr. Swanson is new favorite person. Just behind pediatric hematologist/oncologists, pediatric dermatologists are the best people on the planet. I hope to snag her for the podcast one of these days. Dr. Del Rosso, among his many other hats, is the host of the Derms and Conditions podcast. I introduced myself to him at the beach party. He could not have been less interested. π€£ Gotta shoot your shot! π€·ββοΈ βAaron Farberg, MD and Dawn L. Merritt, DOβ As a result of an excellent presentation from Drs. Farberg and Merritt, I'll be making an effort to offer access to Xolair (omalizumab) to my client's who suffer from chronic spontaneous urticaria (chronic hives). Prior to this, I, like many other dermatologists, relied on referral to allergists when we thought Xolair was needed. This is largely due to misconceptions about the risk of anaphylaxis with this medication. This talk opened and changed my mind. βMark S. Nestor, MD, PhDβ I bet your local self-proclaimed "Master Injector" isn't attending talks like this one from Dr. Nestor on the science of botulinum toxins (e.g., Botox). Be careful β sometimes you get what you pay for. βSusan H. Weinkle, MDβ β¦same goes for this lecture on practical clinical anatomy for safe filler injection. Dr. Weinkle is a gem and has been injecting since the early 1970s. Just my two cents β if someone calls themself a "Master Injector," be careful. Despite the many times I've come across that label, I don't think I've ever seen or heard a physician use it. #5 β Come PreparedWant to try Sun Powder? I got you β and for nearly 20% less than you'd pay on Amazon. #6 β Have Fun!This woman captured the vibe at the Fontainebleau Miami Beach. π― Needless to say, we were happy to have an excuse to stick to the kids pool... I'll always remember the night we taught Stellan to twirl spaghetti on his fork at Pizza Tua on Lincoln Road (successful attempt not pictured). "Silenzio, Bruno!" While laughing with Stellan, I was moved to call out this melodic mantra from Disney's Luca. Our waiter, pictured below, parroted it back immediately and told us his hometown of Positano looks just like the fictional town depicted in Luca! Positano was also the inspiration for the fictional seaside town in The Talented Mr. Ripley. Always be on the lookout. This beautiful guy/gal had just devoured a small, unsuspecting π¦ when I took this photo. *David Attenborough voice* β If you look hard and use your imagination, you might even be able to make out the π¦'s head, left-front leg, and body at the inflection point of the predator's neckβ¦ π¬ Chestnutπ° CheckersNahβ¦ that's plenty for this week. We'll get back at that next time. In next Monday's newsletter, I'll reveal the winner of The Direct Care Derm podcast launch giveaway (a SkinMedica haul with a total retail value: $481), sponsored by my friends at RegimenPro.
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βAbove & Beyond Dermatology
Iβm a board-certified dermatologist who saves lives (!) by helping people reduce their risk of succumbing to common chronic diseases by fixing their immune systems and getting great looking and feeling skin, hair, and nails along the way. My weekly newsletter is an opportunity for you to get to know and trust me by learning from what I'm building in life and business.
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