Latisse

One of science's great accidental discoveries!

Some of science and technology’s most important and fun discoveries happen by accident… Penicillin, Xray, Pacemakers, matches, gunpowder, and some of dermatologist’s favorites… vaseline, superglue and Latisse.

Want long thick dark eyelashes?  Latisse is one of those wonderful products that was discovered by accident.  It started as an eye drop for elevated pressure in the eye.  Those who used the eye drop had extreme growth of their eyelashes to the point that the lashes had to be trimmed with scissors in some cases.

Most people see a significant change in their lashes by 4-6 weeks.  Longer. Thicker. Darker. Without Mascara.  Everyone is different in their maintenance protocol.  I advise patients to “play it by ear”.  In essence, get your lashes to the length you desire then back off to every other day or so.  If you lose the desired effect, step it back up.

As far as side effects, most people have a little irritation on the first few days of use with redness along where we normally apply eyeliner.  The discoloration mentioned in the commercials was primarily seen with eye drops.  However, if someone has pristine blue eyes, I do warn them that they may get some permanent brown flecks in those pristine blue eyes with Latisse use, so be forewarned.

I know there are tons of lash products on the market. Nothing is 100%, but Latisse is as close as it gets.  In fair comparison, I have done side to side comparison, Latisse on one eye and other products on the other eye, many times.  Each time, I have had to stop the experiment because it looked just plain ridiculous to have noticeably long lashes on only one eye.  That is the kind of experiment that makes a scientist smile.  No statistics necessary!

If you want to learn more about Latisse, check out the FAQs at their website.

Curious about other accidental scientific discoveries?  Here’s a few articles I found on the subject.

http://mentalfloss.com/article/53646/24-important-scientific-discoveries-happened-accident

http://www.sciencefocus.com/feature/tech/top-10-accidental-discoveries

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MRSA, now what?

6 common questions and answers about MRSA

“I have MRSA, now what?”

Courtesy on www.medicinenet.com

MRSA, (pronounced mersa), is a word that often evokes worry, fear and concern among patients and families.  Here’s a little information that hopefully will help clarify the diagnosis and bring some clarity to your worries.

What is MRSA?  MRSA is an abbreviation for Methicillin Resistant Staph Aureus.  So, what does that mean? Staph Aureus is a common bacteria that often can live on the skin and can cause skin infection of wounds.  It is a common culprit in skin infections like impetigo that have been around for many years.  MRSA is different because this particular strain of bacteria is resistant to Methicillin (or penicillin) antibiotics. In years past, we wound treat skin infections with two major classes of antibiotics, penicillins and cephalosporins.   MRSA is often resistant to these two classes of antibiotics.  What happened in the early years of MRSA development was that we would treat with the old tried and true antibiotics and the infection got worse, leading to sometimes life threatening infections that spread throughout the body.

How does my doctor know for sure that I have MRSA?  MRSA is diagnosed with a bacterial culture.  A cotton swab is rubbed on the suspected area and then is sent to the lab for a bacterial culture.  It usually takes at least 3-4 days to get a result.  The result of the bacterial culture tells us exactly what bacteria is causing the infection and exactly which antibiotics will effectively kill the bacteria.

Where does it come from?  MRSA is contracted from skin to skin contact with someone who also has the bacteria.  In addition to the skin, many people have MRSA growing inside their nose or other moist areas on the body.  So, contacting nasal secretions to an open wound could also lead to infection. Some people have MRSA growing in their nose, but are asymptomatic.  We call an asymptomatic infected person a carrier of MRSA.  Let me explain, when I was a child I had strep throat a lot.  At some point, we all went to the health department and had throat cultures.  We found out the one of our family was a Strep carrier.  So, to end my frequent infections we had to treat the carrier as well.   This is why we sometimes treat the whole family as I will describe below if a family has had repeated MRSA infections.

How is MRSA treated?  A number of scientific studies have shown that for a MRSA abcess (a pus pocket in the skin), simply draining the abcess can help an infection to resolve.  However, in my experience, if oral antibiotics are not used, the patient will soon develop another infection.  Using the bacterial culture result as I described above, we treat with oral antibiotics often for 2-4 weeks.  I usually treat an initial case with a shorter course.  For those with repeated infections, I often treat for one month.  In addition, to taking an oral antibiotic, I also recommend treating the area topically.  Not all topical antibiotics successfully treat MRSA.  I usually prescribe mupirocin to treat topically a few times a day.  In my experience using this topical also aids in healing of the spot.

How can I avoid getting infected again?  Not everyone will agree with these recommendations.  However, in my experience, patients who follow these suggestions rarely have a repeat infection.  Many patients who come to see me after struggling for years wish they had done this on the initial infection.

  • Wash with an antibacterial soap at least a few times a week and more often if you are having frequent skin to skin contact with others who may be infected. This especially includes health care workers and athletes.  With the recent ban of antibacterial ingredients, this may require a prescription from a doctor for a surgical scrub like chlorhexidine or a sulfur based wash.
  • Use mupirocin ointment on every little cut and scrape and pimply like spot that anyone in the household develops twice a day until the spot heals. Mupirocin ointment is also by prescription only.
  • This last one I especially recommend to those who have had repeated infections. Everyone in the household and all close contacts can treat their nose with mupirocin. Yes, put the ointment up your nose, twice a day, every day for 5 days.  Everyone do it on the same 5 days.  Then repeat this procedure in 2-3 weeks.

 

What about the rest of my family and other athletes?   I would recommend avoiding skin to skin contact until the area is completely healed over.  In the meantime, keep mupirocin on the spot and keep the area(s) covered.  Clean sports equipment regularly and use antibacterial wipes to clean sports equipment.  You can find the CDC’s recommendations for athletes and athletic directions here.

 

To learn more please check out the CDC’s site about MRSA. 

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Painted Rocks

Cool Family Fun!

I realize this blog post is totally frivolous and has nothing to do with dermatology, except maybe a warning about watching for poison ivy and poisonous insects while hunting painted rocks.  I’ll try to be more educational next time.  Next blog post will focus on the harmful effects of blue light on the skin, including blue light emitting from the screen where you are reading this post.   So cover your face and stay tuned for next week if you like the serious stuff.  If you like cool, cheap family fun, keep reading!

First of all, let me say that I am not often early to the game of exciting new trends.  I am usually way far behind. However, I think I am pretty early to the game of “Painted Rock Hiding” thanks to my daughter Lily and a good friend Missy Mohr.  Well, maybe not so early, the  Marion County WV Rocks (MCWVR) facebook page has 3500 followers!

On Sunday, we joined another friend to celebrate her birthday at Dairy Cream Corner.  (Did I mention that despite living in Fairmont for 12 years this was my FIRST trip to DCC – crazy!.)  While there, the kids were running around acting silly when my daughter Lily found something under a bench.  She ran up to us showing it and Missy immediately excitedly said… “You found a painted rock!”. And that is when the excitement began….   Always good to have children and cool friends to make life more interesting!  Introduction to DCC and painted rocks all in one day.

We started looking on facebook and indeed it was an official painted rock.  Surprisingly, there are a few local Facebook pages for this including:  Marion County WV Rocks (MCWVR) and Fairmont, WV Rock Painting (FWVRP).  Next we were heading up to South Ridge Church, so we thought we would rehide the rock there.  While there, we found two more rocks!  Now, this was getting fun.  Still unsure of the whole process, we just moved the two new rocks around then, but now I understand how it works.

It seems, anyone can paint a rock, hide it, post a picture and a clue of where it is hidden.  Anyone can find them.  Some rocks, like the first one we found, have a code letting you know what facebook page you can repost info about it on and who hid it.  The first rock we found also said to rehide it.  The second rocks we found did not include any of this info.  I think the first way is more fun because you can see who finds your rocks and where they travel.

Cheap, simple, outdoor fun!  Now that is a great fun addition to summer if you ask me.  And yes, we plan to paint some rocks this weekend and hide them!  Have you found or hid any rocks?

ALSO!  REMINDER!  We will be honoring and celebrating Cosmetologists and Beauticians at our Cosmetology night THIS WEEK.  Thursday  June 29th from 6-8PM.  Our special guest will be world renown makeup artist, Jeffrey Tasker.  For more details, see our facebook event page “Cosmetology Night” or call the office.  All are welcome!

This is a photo from when the first person hid the rock Lily found by accident.

 

 

 

Jeffrey Tasker

JEFFREY TASKER

MAKEUP ARTIST

 

Personal Profile

Jeffrey is a highly experienced, creative and innovative makeup artist contributing his skills throughout the world.  After receiving his degree from the Makeup Institute of San Diego as well he has his Master’s Degree in Clinical Psychology.  He has worked throughout North America and eventually settled in New York for 12 years working with several projects. Jeffrey was employed by celebrity clientele, pageant contestants, models and tv personalities for outlets such as stage, runway fashion shows, tv, editorial magazines and award shows. He has also resided in L.A., Washington, D.C., Cleveland and most recently Houston now residing in Cumberland, MD.

  • Fashion Houses- Oscar de la Renta, Jenny Packham, Gucci, Yves St. Laurent, Pamela Roland
  • Fashion Department Stores: Saks Fifth Avenue, Bergdorf Goodman, Bloomingdales, Sephora (U.S.), Rustans (Philippines) , Liberty, Harrods House of Fraser, John Lewis and Selfridges (London), David Jones and Meyer (Australia), Robinson Sukhumvit (Bangkok) and many others.
  • Artistry companies: Laura Mercier, Yves St. Laurent, Paula Dorf, Bobbi Brown, Prescriptives and Chanel.
  • Fashion Week in NYC, Houston, London, Paris and Tokyo
  • Television: Good Morning America, The Today Show, Sex and the City, Who Wants to be a Hilton and Oprah. His work has also been featured at the Grammys, Emmy’s and the Oscars.
  • Traveled throughout the world taking him to over 20 countries featuring his talent:             Tokyo, Thailand, South Korea, Philippines, Taiwan, Malaysia, Singapore, London, Paris, Germany, Switzerland, Italy, Stockholm, Ireland, Scotland, Canada, Mexico, Australia, New Zealand, Turkey, Moscow and Sweden.
  • Magazines: Vogue, Harpers Bazaar, People, Nylon, Elle, Apple Daily and other magazines throughout the countries he has visited.
  • Pageants: Miss America Scholarship Program, Miss USA.
  • Youtube videos of various kinds of teaching, educating, his work and personality.

While he is pursuing his Ph.D. in Counseling Psychology and now working as a psychotherapist, he remains active in artistry on a part-time basis.

Cosmetology Night

June 29th 2017

Did you know that National Beautician and Cosmetology Day is in June?

In honor of all they contribute to our lives, we are hosting Cosmetology Night on June 29th, 2017 from 6-8PM.

As a dermatologist , I value and appreciate what all the ways that these professionals assist me.  I have had SO MANY PATIENTS referred for a skin cancer because their beautician, hair dresser or cosmetologists spotted it.  I am so thankful for all they do!   This event is geared toward Cosmetologists but is open to everyone.  Come and bring a friend!

Why should you come and what will we do?

LIVE DEMONSTRATION and Q&A with MAKEUP ARTIST – JEFFREY TASKER!

REFRESHMENTS

SKIN CANCER DETECTION EDUCATION

LIVE DEMONSTRATION OF COSMETIC PROCEDURES

GREAT DOOR PRIZES  – BOTOX, SKIN CARE PRODUCTS and MORE!!!

 

Jeffrey Tasker is a world renowned makeup artist originally from Cumberland, MD.  His work has been featured in major runway fashion shows and publications including InStyle & Vogue.  He has also made appearances in numerous TV shows including Sex and the City, The Today Show, Oprah Winfrey, Good Morning America and Project Runway.  To see his full and amazing resume check out this link – Jeffrey Tasker Resume.

We’re Hiring! May 2017

We are looking for a bright new face to join our staff.

SUMMER OFFICE ASSISTANT – Summer is a busy time in the office!  We could use a few extra hands. This position would be a great fit for a student who is interested in medicine to see how an office functions.  The most important qualification is a friendly smile and willingness to fill in wherever needed this summer.  Hours are Monday to Thursday 7AM to 5PM.

There is potential that this position could be extended to a year round position if we find a great asset for our time.  We have a great retirement plan and disability insurance, but we do not offer medical insurance benefits.

Those interested should submit resumes to wvderm@hotmail.com

 

Sun and Light Protection 2017

How to pick a sunscreen this year!

 

 

Does this photo overwhelm you?  It does me.  It is the sunscreen section at Walmart in May 2017.  If you don’t live in Fairmont, please be slow to judge.  In our town, Walmart still is the go to store for a lot of people.  I scoured the whole thing and took lots of pictures.  Good news is that the selection is better than usual.  Hope to save you some time and give you confidence when picking sunscreen for the summer.

The most common question I am asked is …What SPF should I get? 

Actually, as you will read I care more about the active ingredients than the SPF, here’s why…

SPF measures the length of time a product protects against skin reddening from UVB, compared to how long the skin takes to redden without protection. If it takes 20 minutes without protection to begin reddening, using an SPF 15 sunscreen theoretically prevents reddening 15 times longer – about 5 hours. (Actually, it may take up to 24 hours after sun exposure for redness to become visible.) To maintain the SPF, reapply sunscreen every two hours and right after swimming.

The Skin Cancer Foundation recommends SPFs of at least 15, which block 93 percent of UVB. While SPFs higher than 30 block only 4 percent more UVB, they are advisable for sun-sensitive individuals, skin cancer patients, and people at high risk of developing skin cancer. They also allow some margin for error if too little sunscreen is applied. Considering that the SPF is developed using a whole ounce to the entire body, most everyone does not apply enough sunscreen and does not get the full SPF suggested on the label.

While SPF is the universal measurement of UVB protection, no comparable standard exists for UVA. Scientists worldwide are working to develop a standardized testing and certification method to measure UVA protection.   Also there is no effective measurement for protection against blue light HEV and Infrared that is now also known to be harmful.

Even with the ideal sunscreen, some UV rays can get through to your skin and cause damage. The Skin Cancer Foundation considers sunscreen one part of a comprehensive sun protection program, along with sun-protective clothing, sunglasses, shade, and sun avoidance from 10 A.M. to 4 P.M.

What kind of light is the most harmful? 

UVB (Ultraviolet-B)  Short-wave solar rays of 290-320 nanometers. More potent than UVA in producing sunburn, these rays are considered the main cause of basal and squamous cell carcinomas as well as a significant cause of melanoma.

UVA (Ultraviolet -A) Long-wave solar rays of 320-400 nanometers. Although less likely than UVB to cause sunburn, UVA penetrates the skin more deeply, and is considered the chief culprit behind wrinkling, leathering, and other aspects of “photoaging.” The latest studies show that UVA not only exacerbates UVB’s carcinogenic effects, but may directly induce some skin cancers, including melanomas.

The new issues to discuss include not just UV protection but also protection from HEV and Infrared rays.  Increasing data suggests that these sources of light cause addition damage to the skin.

HEV?  (High-energy visible (HEV) radiation) This radiation, also known as “blue light,” actually includes light from 400-500nm, and it can be just as harmful to skin, leading to inflammation, impaired healing, wrinkling and discoloration. Most common sources of HEV include computer, television , phone and ipad screens.  Studies have shown that melanin (the pigment our body naturally makes) is the best protector against HEV in the skin.  A number of sunscreens are starting to incorporate melanin in them to block against HEV.

IR (Infrared radiation)  Infrared radiation is what provides that warm sensation in the sun.  According to the atlas of science “ The spectrum of solar radiation reaching the Earth is divided as follows: 6.8% UV, 38.9% visible, and 54.3% near infrared radiation (NIR). IR has been divided into three bands: IR-A (760–1400 nm), IR-B (1400–3000 nm), and IR-C (3000 nm – 1 mm) . IR radiation can penetrate in and under the skin depending on the exact wavelength range being studied. Exposure to IR is perceived as heat.”   There is still some scientific disagreement about the extent of the impact of infrared exposure on the skin.  At this time, we can say that protection against IR  is a plus.  The new generation of ZO Skin Health sunscreens we carry is one of the few that                                                                                             protect against IR.

 

MY FAVORITE PICKS!

 I recommend an SPF>30.  Make sure the bottle says that it protects against UVA and UVB, preferably 100% of UVA and UVB.  Remember that sunscreens generally wear off or the chemical breaks down in 2 hours.  So sunscreen needs to be reapplied throughout the day.  CHECK THE ACTIVE INGREDIENTS!   I particularly like sunscreens containing zinc oxide and titanium dioxide.  Zinc and titanium are physical barriers that work much better and last longer than the chemical sunscreens. Zinc has a more complete and broader coverage than Titanium. Sunscreens that incorporate melanin also block against HEV. 

To say that I am super picky about sunscreen is an understatement.  There are so many great choices.  I work hard to find ones that meet individual needs.  We carry things that are not easily commercially available in our Spring Boutique.  Feel free to stop in and try them out.

Chemical Free For the face (Zinc and Titanium):  Fallene SPF 58 and ZO Skin Health Sunscreens. Both of these are available in our office.  The ZO Skin Health products also protect against HEV and IR.

Chemical Free for the Body:  Cerave Face and Body SPF 50, Neutrogena Pure & free Baby, Neutrogena Sensitive skin PureScreen, , Aveeno Baby Continuous Protection, Yes to Cucumbers Natural Sunscreen SPF 30 and 40, Safe Harbor SPF 50 Sensitive Lotion, Hang Ten Kids Mineral 50, Goddess Garden Organics, Australian Gold Mineral Lotion, Blue Lizard,   These are the ones I found on my recent trip to our local Walmart.

For KIDS I have found a few that my kids actually don’t mind using… Glitter Tots Sparkle Suncreen multiple different glitter colors and scents is available in the office.  Girls love it!  Also my kids love being able to put on their own sunscreen with sunscreen sticks.  I like …Neutrogena’s Pure Baby Sunscreen Stick the best, but others include Aveeno Baby Continuous Protection Stick.  Both available at Walmart.

Spray Sunscreens WITH Chemicals: In hard to treat areas like the scalp and ears, a spray is better than nothing at all.  Make sure you rub it in after spraying.  Neutrogena Fresh Cooling and UltraSheer Body Mist Sunscreen Broad Spectrum SPF 70,

Spray Sunscreen WITH Zinc –  Elta MD UV Aero SPF 45 .  Available in our office the convenience of a spray and the efficacy of Zinc combined!

 Natural Sunscreen PLUS bug repellent – Jungle Screen .  Available in our office.

In addition to the traditional sun protection agents, I have a few new ones and a few that were new to us last year.

Klenskin Shower on SPF. Available in a shampoo, body wash and bar soap.  I think this is a great addition for men who hate to use sunscreen.  Wash in the morning before you head out for golf or work. This exciting new technology provides SPF 20-30 with 80 minutes of water resistance.  It functions as a base layer of protection.  If someone is in the sun for an extended period of time they will need to reapply a traditional sunscreen.  These products do include chemical sunscreens, but they are encapsulated to minimize interaction of the chemicals with the skin.

 

UVO Sun Protection Drink  I am so excited about this amazing and honestly delicious drink.  Drink one bottle or powder pack (1) before sun exposure for 3-5 hours of sun protection from head to toe including your eyes, (2) after overexposure to the sun to help soothe the skin, and (3) daily to repair years of sun damage, provide anti-aging benefits, beautify the skin and promote overall health and wellness. UVO was made for everyone who is exposed to the sun—especially those with an active, outdoor lifestyle.  The basic scientific premise is the use of a fern Polypodium  leucotomos extract, which has been available for many years in a pill formulation called Heliocare.   UVO adds a number of other antioxidants as well.

 A wide brimmed hat and protective clothing are also great.  I recommend the Coolibar website (www.coolibar.com) for protective clothing.  Look for the Skin Cancer Foundation Seal of Approval on Sun Protection Products (www.skincancer.org).Protect the eye area further by wearing sunglasses or contacts that block 100% of UVA and UVB.

 

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Sleep Smarter by Shawn Stevenson

Book Review

If you talk with me for any length of time, there is one thing you will quickly notice.  I love to learn.  These days I learn in two main ways… First, I listen to a TON of podcasts, probably 10-12 a week.  Recently, I heard the book I am about to review pop up in multiple different podcasts.  When multiple different people suggest a book, I take notice.  My second way of learning is reading.  Now, admittedly I don’t read as much as I would like.  Motherhood has a way of cutting into leisure time.   This book, however is an easy, fun and applicable read.

Lots of books give lots of suggestions based on the author’s opinion.  But, what I like about this one is that he firmly backs up his assertions with lots of scientific studies.  I want to highlight some of his suggestions, but not give away all his secrets.  I actually sleep annoyingly well, but one can always improve.  I have enacted several of the tips and have had sounder sleep as evident on my FITBIT data.   I strongly encourage you to buy the book and read it yourself.  To be clear, I don’t know him, and I have no financial interest in recommending this book.

What does sleeping have to do with dermatology?  Lots.  Many skin rashes impact the ability to sleep soundly.  Plus, lack of sleep makes the skin more irritable and itchy.  Not to mention those old assertions about needing our beauty sleep.

So here, we go.  The book has 21 tips for better, more efficient more restful sleep.  I will hit the top ones, and you can get the book to read the rest…

1 – Get more sunlight – What?  Now that does not mean bake.  Optimally, we should get outdoor sun exposure first thing in the morning to maintain a correct circadian rhythm.

2 – Avoid screen time in the evening – Here, the focus is on blue light from electronic screens at least 90 minutes before bedtime.  This also interrupts our circadian rhythm.  As an aside, studies have now should that blue light also has a negative impact on our skin.  I will do an upcoming blog post on limiting our blue light exposure.

3-Avoid caffeine in the afternoon and evening – I know I went to medical school, but I had forgotten that caffeine has a half-life of up to eight hours.  I have an admitted problem with drinking way too much diet pepsi.  It is my vice.  I used to drink it up until I went to bed.

4- Create a sleep sanctuary – Make your bedroom a sanctuary for sleep ( and marital activity) only.

5- Eliminate all light in the bedroom – Black out curtains, nightlights etc.

6-Exercise – What interested me here was the data on time of day for exercise.  For sleep cycle maintenance and improved athletic performance, the data recommends working out in the early morning.

7-Stay cool – His data strongly shows that the optimal sleep temperature is 68 or below.  BRRRR Rabbit!  Have I mentioned that I have a heated mattress pad that I use all year long.  This will be a hard habit to break.

8- Go to bed early  – UGH!  The data he presents demonstrates that the most restorative sleep occurs between 10pm and 2am.

9- Don’t keep your phone by your bed.

10- Avoid alcohol consumption – No drinks at least 3 hours prior to going to sleep.

11- Get a good mattress.

12 – Calm down the internal chatter – with meditation (or prayer).

13- Go to bed at approximately the same time each evening and get up early.

14- Get a massage

15 –Where loose, cool clothing. This goes against my suggestion that I often make to patients to wear fitted water wicking clothing to bed to prevent them from itching at night.

Hope you find this book as helpful and interesting as I did.  Here is a link to his site.  http://sleepsmarterbook.com/

If you have a friend or relative who has trouble sleeping, please share this information with them!

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Micellar Water

Expensive French Water or Something More?

What is micellar water?  Should you pay $10-20 for a bottle of French water to wash your face?  Micellar water is now available from a number of cosmetic companies including Garnier, Simple, Avene, Bioderma and many more.  Bioderma was the first in this recent trend that according to cosmetic companies started with French women who wanted to avoid their harsh water supply.

What is a micelle?  A micelle is a surfactant ball.  Surfactants are an important component to all soaps and anything that lathers.  For an excellent science lesson and review, I would recommend reading this article by Lab Muffin.  http://www.labmuffin.com/what-is-micellar-water-and-how-does-it-work/ and check out the diagram below.

Courtesy of funsci.com

What are the active ingredients in these waters?   Again I will defer to lab muffin who compares the active ingredients of the most common brands in the table below. 

How do you use micellar water?  It is applied using a cotton ball or pad and the oil attracting part of the surfactant molecule pulls the oily debris from your face.  It will not remove all makeup and may not work as well for those with really oily skin.  You don’t actually “wash” your face, you use this more like a toner.

How is it different than regular soap?  Proponents and marketers claim it is less harsh than traditional soaps.  I guess the best explanation is that in micellar water the “soap” surfactant is contained in microscopic “micelle” balls.  Otherwise, most of these “waters” don’t have as many other dyes, fragrances and colors like a traditional wash.

Should I try one?   If you are happy with what you are using now, I would stick with it.  If you are looking for something new, try one and let us know how it goes.

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If you would like to find some skin care products that fit best with your skin and your lifestyle, call the office at 3043680111 and stop by our Spring Boutique.

Kiosk Check In!

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Something new has arrived at Appalachian Spring!  Our new kiosk station.  If you are not a fan of kiosks, don’t dismay!  When you arrive, you will use your driver’s license or type in you name to locate your appointment.  There is a series of simple questions.  You will scan your insurance card and pay your copay from the kiosk as well.

Dr. Rosenberger has spent hours designing questionnaires for the kiosk.  Now, you will answer a limited number of questions that are specific to the reason for your visit.  For those of you who dislike paperwork.  The kiosk is great!  It will save lots of time!  Try it at your next visit.