Spring Update: Integrative Healthcare Symposium

 

IHS

                                                                                                                                                                                                                                 Doctor Sheperd and I (Dr. Kingslea, Family Nurse Practitioner) had the opportunity to attend the Integrative Healthcare Symposium (IHS) in New York City this February. The IHS brings together multi-disciplinary healthcare professionals dedicated to improving patient care. I want to keep y’all in the loop of the exciting future of our practice.

 

MKnycWhat is Integrative Healthcare?

In addition to our passion for Dermatology, healthy skin, and healthy living, integrative health care motivates our transition to the Sheperd Medical Institute and patient centered care.

The topics of most interest to us at the conference included cardiovascular health, nutrition, fertility, gut health, autoimmune conditions, integrative nursing, and mind body spirit medicine.

Our focus is tailoring a person’s healthcare to their individual characteristics, medical conditions, genes, circumstances, and values. Putting the patient at the center of the plan, not the disease, will advance personalized, proactive, and patient driven medicine.

How are we going create health and prevent disease?

An Integrative approach includes care based on prevention rather than treatment while fostering continuous healing relationships. The patients (you!) are the source of control with customized care according to patient needs and values.

Compare this to a more traditional medical approach where the physician or insurance company in more in control of the health care choices and where the insurers limit visits and restrict them to conditions where illness is present, rather than educating on prevention.

 Fundamentals of Health

1. Stress management

2. Diet/Nutritional status & Detoxification

3. Exercise

4. Rest

5. Connectedness/social support system

I like to think of these as your “Top 5 for Ultimate Wellness”. Dr. James Gordon from the Center of Mind Body Medicine gave an enlightening lecture on creating health and promoting whole body wellness, watch an interview with him here.  

You can meet these 5 criteria by:

1. What are ways you like to cope with stress, these can be very personal. Such as meditation, massage, counseling, exercise, social activity, and prayer.

2. No Alcohol, No Smoking, How can you incorporate clean eating and non-toxic substances into your daily routine?

Superfood Immune Supporters include: Almond, Apple, Broccoli, Carrot, Chile pepper, Cocoa, Cranberries, Halibut, Pumpkin, Sweet potato, Tumeric, Scallions, Brazil nuts, Eggs, Spinach, Onions.

3. Walking (not running) 30 minutes at least 5 times a week. Start slow and build yourself up for this. If you are an athlete, remember that walking engages the immune system, not running.

4. Sleeping 8 consecutive hours nightly.

5. Having 2 social activities a week with 2 or more people that are not related to you (spouses don’t count), think a book club, bowling league, or spiritual devotion.

 

accupuncture

accupunture

Complementary Alternative Medicine (CAM), such as Chiropractic and Acupuncture, practitioners were also represented. I was able to participate in ear acupuncture, also known as auricular therapy, widely used for many conditions. Auricular therapy emphasizes a holistic approach to medicine, an approach that treats the whole person. The acupuncture points found on the ear help to regulate the body’s internal organs, structures, and functions.

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What is a Living Building?

smi-disc-smSheperd Integrative Dermatology is working with architects, Macmillian Pazdan and Smith and Trident Construction to design and build a new 4,400 sf facility for the Sheperd Medical Institute that embodies several of the seven principles of The Living Building Challenge™. http://living-future.org/lbc

This green building certification program is defined by seven “petals” :

Site: Our location will support a pedestrian-, bicycle-, and transit-friendly lifestyle.  A strong connection to the site will occur through generous north-facing windows.

Health: The building will promote health for its occupants, with  features to promote walking and interacting with the outdoors. In addition to the traditional exam room and office spaces, the design includes a “Discovery Room” which serves as the reception area during office hours, and as a flexible space for art exhibits, educational events,  yoga practice, and social events during non-office hours.

Materials: Natural and sustainable materials will be used throughout. The building will not contain any “Red List” hazardous materials, including PVC, cadmium, lead, mercury and hormone-mimicking substances, all of which are commonly found in building components.

Beauty: Stunning architecture will be integrated within the landscape to minimize its impact and preserve a host of live oak trees.

Water: Rainwater will be collected from the roof, stored in a cistern and used to maintain the medicinal herb garden.

Energy: We will use energy efficiency as a guiding principe for all fixtures, building material choices and personal choices in energy consumption.

Equity: All workstations will be within 20 feet of large operable windows, offering access to fresh air and natural daylight

 

The building  is to be located in Mount Pleasant, SC at 912 Old Georgetown Highway.  While we will not be able to achieve the entire 7-petal “challenge” of a living building (we will not be net zero energy efficient),  we are excited by the prospect of creating a healthy and harmonious place for the new medical facility.

smi-ext-sm

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Black History Month is a time of celebration, assessment and examination.

blackhistoryThis February, our practice is questioning a different aspect of African-American history: skin cancer.

Indeed, the overall rates of skin cancer are much lower than those of European-Americans, but when melanoma occurs in a darker-skinned American of African heritage, that person is three times more likely to die than someone of lighter skin.

        The cancers that do occur may be more aggressive due to genetic factors but dermatologists are falling short of detection because we do not routinely screen people with darker skin types for skin cancer.  Melanoma is certainly more difficult to detect on dark skin because there is less obvious contrast of color, making it less noticeable to the patient and physician alike (Cress, 1997).

How we can contribute to early detection, prevention and saving lives?

 Getting the word out to ALL Americans, regardless of color, that a skin check is simple, easy (I would even venture to say it can be fun!) and it saves lives!

bobmarley

Health care providers and the public need to be more aware of skin cancer on skin of color. Melanoma took the life of legendary reggae musician Bob Marley. What was dismissed as a soccer injury under his toenail turned out tobe an aggressive form ofmelanoma that ultimately caused his death at 36. Among African Americans, melanomas are most likely to appear on the palms of the hands, soles of the feet and under the nails (Gloster, 2006). It may also occur in the mouth, your dentist or primary care provider will include during physical exams.

In conjunction with Black History Month, the American Cancer Society has released Cancer Facts & Figures for African Americans. This publication identifies areas of significant disparities. Cancer disparities, or health inequity, are caused by a number of societal problems that result in greater suffering and more people dying from cancer.

Why are we missing this crucial diagnosis?

Melanoma in black patients is more often to have advanced disease at time of diagnosis.  Delayed diagnosis in blacks is be related to perceived lower risk therefore, delaying treatment (Myles, 2012). Skin cancer comprises 2%  of all cancers in African Americans. With squamous cell carcinoma (SCC) being the most common skin cancer among African Americans (Ahmedin, 2010). SCC in African Americans tends to be more aggressive and are associated with a 40 percent risk of spreading (Hu, 2006). Annual skin exams are recommended, as well as monthly self exams. “I have a dream that one day this nation will rise up and live out the true meaning of its creed. We hold these truths to be self-evident that all men are created equal”, Martin Luther King, Jr.

Source: NCI Visuals Online. Skin Cancer Foundation. http://visualsonline.cancer.gov/about.cfm

Source: NCI Visuals Online. Skin Cancer Foundation. http://visualsonline.cancer.gov/about.cfm

Reference:

Ahmedin J, Siegel R, Xu J, Ward E. Cancer Statistics, 2010. CA Cancer J Clin 2010; 60:288-296

Cress RD, Holly EA.  Incidence of cutaneous melanoma among non-Hispanic whites, Hispanics, Asians, and blacks: an analysis of California cancer registry data, 1988-93. Cancer Cause Control 1997; 8:246-52l for these populations.

Gloster HM, Neal K. Skin cancer in skin of color. J Amer Acad Dermatol 2006; 55:741-60.

Hu S, Soza-Vento RM, Parker DF, Kirsner RS. Comparison of stage at diagnosis of melanoma among Hispanic, black, and white patients in Miami-Dade County, Florida. Arch Dermatol 2006 Jun; 142(6):704-8.

Myles ZM, Buchanan N, King JB, et al. Anatomic distribution of malignant melanoma on the non-Hispanic black patient, 1998-2007. Arch Dermatol 2012; 148:797.

bobmarley(2)

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Beauty Fix: Are You Flaking Out?

Here’s your quick, all-natural beauty fix for the day: if your skin is flaking out, the remedy might not be in the drugstore aisle. Altering your diet by cutting out some foods and nutrients—and getting more of others—is your best bet. What are we talking about? Basically, dandruff, or flaky skin on the scalp, in the eyebrows, and behind the ears. It can also occur on the face, around the nostrils, and in the smile lines, causing a serious disruption to your normally smooth, healthy glow. Here are three quick tips for fixing this less-than-sexy beauty snafu:

 

1. Sugar fix:  A diet high in refined sugars and fats actually encourages yeast growth on the skin. Cut out processed fats and white carbs (this means white flour, white sugar, and high fructose corn syrup) to lower blood sugar levels and decrease inflammation and flaking of the skin.

 

2. Plant fix: In addition to avoiding what comes in a plastic wrapper, choose to eat more plants.  I tell my patients to eat from the rainbow—if you’re eating seven colors of fruits and vegetables each day, you won’t be hungry for much else.  A plant-rich diet will also make the body more alkaline (less acidic) by raising the pH above 7.0. This decreases inflammation throughout the body. Try it and trust me, you will be glowing within a matter of weeks! Oh, and your aches and pains may make their exit, too.

 

3. Fix the holes: Itchy flaky skin can also clue you into which nutrients might be missing from your diet. Selenium and zinc deficiencies have been cited as causing seborrheic dermatitis. In addition, adding the B vitamins, folate, and omega-3 oils (flax seed and fish oils) have all been shown to improve dandruff when a deficiency is present. A good quality supplement may be in order, in addition to a dietary rainbow approach to get you back on track with your optimal glowing skin.

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Your Fresh-Face, Fountain-of-Youth Guide to Spring

Isn’t it funny how our cultural perspective values a thin body, but we like our faces “fat?” Full and round and sensual a la Mila Kunis, Emma Stone. Now a word of warning here: cultural perspective does not equal truth. Our views of beauty are subject to the time and place in which we are living. True beauty transcends these limitations, and many people age beautifully with no intervention at all.

But as a simple result of aging, we do lose volume in our face—it comes with a loss of fat in our cheeks, which can make our face sag and jowls appear. What else takes away from that healthy roundness? Well, we also lose fat in our temples, and around our eyes, nose, and mouth, which can contribute to a gaunt and a downturned appearance to the face. There is also some loss of bone structure in the jawline, and this can make our chins recede and our lips seem to disappear and “turn inward.”

 

That’s the bad news. But there’s a ton of good news… and while some of these fountain of youth tidbits are well-known, I’ve got a few that just might surprise you.

 

Here’s how to stave off that facial volume loss (or keep it to a minimum):

 

Well known: Stay hydrated. Drink tap water, filtered through a high-quality filter.

Lesser known: Drink from glass, not plastic (plastic has estrogen like compounds which are bad for you).

 

Do this everyday: Consume good fats and oils. This means monounsaturated fats (such as avocado) and polyunsaturated fats (found in fish oil, nuts, and seeds, such as flax seeds or sesame seeds).

 

Try this: Using a hyaluronic gel moisturizer. Why? It can help improve facial fullness to a certain extent by hydrating the top layers of the skin, but stay tuned, as this technology is being refined. We may soon have a facial filler that is truly wonderful at penetrating deeply and restoring volume through topical application.

 

Try this, too: Retinoid and topical antioxidants. Vitamin C can help keep skin elasticity and boost collagen production.

 

Well known: You can minimize the thinning effect of UV irradiation by avoiding prolonged exposure to the sun’s rays (especially dangerous on hot Charleston days) and wearing an SPF every day.
Lesser known: Damaging heat ALSO comes from your cell phone pressed against your cheek all day. Two products that protect skin from infared and ultraviolet radiation are Skinceuticals Antioxidant Serums (both CE Ferrulic and Phloretin CF).

 

 

Best thing you can do to maintain facial plumpness: Sleep on your back.

Worst thing you can do to deflate facial fullness: Smoke!

 

What about fillers to replace lost volume? Hyaluronic acid fillers (Juvederm, Restalyne, etc) are quickly replacing the facelift as the mainstay of youth-i-fying the face. Hyaluronic acid is naturally occurring in your skin already. They are FDA approved for correcting “parentheses lines” around the mouth and nose and the “marionette lines” from the corners of the mouth downward. They can also be used to make the lips fuller and to correct those lines around the lips. “Off-label” they are being used for plumping the cheeks and filling hollow temples as well as for filling scars and correcting asymmetry anywhere on the face.

 

How long do fillers last? Nine months to more than a year and with subsequent “corrections”—along the way, less and less product tends to be required. The cost runs $550 to $2000+ for full correction, depending on how much volume has been lost over time. Bruising and lumps are common within the first few days after a procedure, but you can minimize this by eating pineapple for the preceding few days and taking arnica tablets before and after the procedure. Within a week the filler becomes your own tissue and feels completely natural.

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Hormones, Bottled Water and Obesity: What You Don’t Know Makes You Fat

Obesogens are foreign chemical compound s that disrupt human development and metabolism and cause obesity. They are found in our bottled water (BPA) and canned foods as well as in pesticide residues in food, some shampoos and cosmetics.  They make us fat; they make our children fat and they interfere with our sex hormones.  Their effect on infants when mothers are exposed during pregnancy is particularly notable.  Read more in Nicholas Kristof’s excellent article from the NY Times.

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Get That Glow

 

If your New Year’s resolution includes a fresher, brighter, more beautiful you—why not start with square one? (Your skin.) Here are three mind, body, spirit tips to shine:

 

1) Protect It:

Applying SPF-30 (or higher) to exposed skin in an elegant, non-toxic form is a daily must, even in the winter months. In our fair city, the UV index remains moderately high even in January. But brown spots, premature aging, and skin cancers can be prevented with a morning application of your favorite, carefully selected product. I say carefully selected because not all SPF ratings are the same (most don’t relate to UVA protection, only UVB), and mineral sunscreens (those that include titanium dioxide and zinc oxide) deflect the sun without being absorbed into the skin, which is healthier.

 

Some of my favorite daily sunscreen products include two locally developed brands: Mission Essentials SPF-30 (we love this product so much, it is our “house brand” at my office) and Luca Max Sport Spray SPF-30, a pump spray and a favorite of my active male patients for its ease of application. I also recommend SkinCeuticals Physical Fusion and Sheer Physical UV Defense, which are both SPF-50 and have a light-as-air feeling, even while offering water resistance and oil-absorbing coverage.

 

2) Breathe It:

Did you know your skin looks and feels better when it is oxygenated? One of the best ways to ensure that all of your cells are getting the benefit of maximum oxygen tension is to exercise regularly, using a breath-based exercise practice such as yoga, pilates, or vigorous walking. A breath-based exercise practice pairs deep, conscientious breathing with movement. This does two things: the deep inhalationups the oxygen content, bringing vitaility to all the cells of the body (in skin, this causes a glow), and a full exhalation decreases inflammation throughout the body (by raising the internal pH of the cells).

 

*Hint: Lactic acid is what causes muscles to be sore. Soreness can be a clue to breathe more deeply and slow it down a bit.

 

3) Meditate on Beauty:

I can not overemphasize the power of thoughts and images to create positive change in the skin and in our overall appearance. Culturally, we are trained to be critical of our appearance, but that is not our real truth. There’s a meditation that I do myself and which I highly recommend to restore the remembrance of beauty. Try it for just three minutes a day for about three weeks and see how radiant you feel.   Here ‘tis:

 

Close your eyes. Take several slow breaths and focus on the image of a pale, soft pink rosebud in the center of your chest. Feel your heart “smile.” Feel the smile become a little brighter each time you inhale. You can let the smile spread throughout your body and you may even feel it in your face and in your eyes as you see and feel the pink rosebud there in your chest.

 

Tah dah!! To a resplendent and beautiful you in 2013!!

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Get Holiday-Ready Skin… My 4 Best Tips

Red and flaky skin can have you sulking through the season, looking more like Rudolph than a glowing party princess. Plus, parched, dehydrated skin? That’s a hallmark of winter.  But no matter, I’m going to give you a few of my favorite skin-saving tips to have you looking fabulous for the decadent, festive season. Here we go:

1. Turn to hyaluronic acid. This is a “goo” molecule that’s a primary player for hydration in skin, particularly helpful when the barrier has been compromised by cold days, travel, and too many drinks (alcohol and caffeine!). It can be used liberally, even in acne-prone skin because it does not clog pores. My favorite formulas include supercharged bonus ingredients such as Vitamin B5 for skin repair (as in Skinceuticals B5 gel) and growth factor peptides (Neocutis Bioserum) to really plump the skin.

 

2. Change up your facial lotion for a more emollient cream, which can help combat stressed-out skin. See, when we eat too many carbs, skimp on sleep, and stress out, we “sugar-coat” our cells. That’s right: we add a sugar molecule to our cells in a process called glycation. Think of a Snicker-doodle, all cracked and rough textured on the surface! This is what sugar looks like on our skin cells too, making us look older than our years. Minimizing white flour and sugar, breathing deeply, and retiring early are all ways to minimize glycation of all our tissues. One rich emollient, specifically targeting the sugaring of skin cells, is the aptly named Skinceuticals A.G.E. Interrupter (Anti-Glycation End-product). It takes the “crepe” out overnight.

 

3. Calm the Rudolph effect. For red flaky and swollen skin, I’ll sometimes recommend a very light topical steroid lotion for three or four days.  My favorite is a super smooth Aquanil-HC lotion (Pearson and Covey). In general, a steroid lotion is a quick fix, not a daily solution (long term use can cause thinning of the skin). Hyaluronic Acid gel is, again, very helpful here. For redness I like a formula with extracts of thyme and cucumber, which cool down inflammation. Skinceuticals Phyto-Corrective Gel is my go-to for reddened stressed skin.

 

4. Finally, don’t forget your sunscreen this winter. Even though the days are cooler, the UV factor remains high in Charleston year-round. I prefer a mineral-based formula, which also protects from wind burn. My fave is a product created locally by Gail and Steve Solomon, a.k.a.: Mission Essentials. It is our staff favorite!

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Don’t Flip Out if Your Hair Falls Out

Ladies, a health crisis—particularly one brought on by aging—is never pretty. Believe me, I’ve been through it. But when it has to do with our hair, or loss of it, it’s cause for five-alarm panic. I see a lot of this in my practice. Hair loss is many women’s worst nightmare, and most physicians do not have a clue of how to treat it.

Mark my words, it’s almost always treatable. Some women do indeed have the gene for baldness, but genes are not the final word—remember the concept of epigenetics that I wrote about last time; specifically, what we eat, what we drink, what we smoke, and what we think can change the expression of our genes permanentlyand for successive generations. by altering our life and health choices, we can alter the activity of our genes and turn them on or off.
When patients who are experiencing hair loss are questioned further, most have symptoms of burnout, such as insomnia, anxiety, brain fog, loss of libido, slowed metabolism, weight gain, and quite often, depression. Rather than seeing the skin and hair in isolation, I like to approach their restoration by optimizing hormones, sleep, and nutrition, which can ameliorate not just the hair and skin problems, but can improve other symptoms as well.
Typically, lab values for thyroid, progesterone, estrogen, and other health parameters may be in the “normal range.” This means in a traditional medical model, no therapy will be offered. I liken the “normal range” to a passing grade which has been curved to assure as many people as possible will pass. And within that range, we have As and we have Ds—where would you rather be?
Truly, “normal values” are an average of everybody’s values, not the healthiest ones among us. And, the ranges are skewed down each decade to reflect the average decline of age. We feel, look, think, and function better when our hormone and nutritional parameters are in the “optimal range,” or the upper end of the spectrum.
While it might seem that I am stepping beyond the bounds of dermatology with this hormonal solution for hair loss, here’s the bottom line: it works. Supplementing with hormones, vitamins, and minerals helps preserve hair and allow it to grow back if it has been compromised. Not only does this approach work, but it is also safe (I covered this in Part II of my A-Game series) and meanwhile, it’s protective against other degenerative changes of aging. Not a bad deal: baldness to badass in four months or less
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Your A-Game, Part IV: Meet the Sex Stars

I’ve told you about how, in my mid-30s, I suffered a personal health crisis. My own successful recovery using supplemental bio-identical hormones and nutrition launched me on a path of learning what the “new game of medicine” is.

 

… And what is it? Well first, let’s talk about the old game. In the old game of medicine, we wait for the body or mind to degenerate, then either address the problem—be it blood pressure, cholesterol, depression, anxiety, bone loss, diabetes, etc.—with drugs, or ignore it. Though most of these treatments work pretty well, most have side effects and don’t work for everyone. And for some things, like Alzheimer’s disease, there aren’t effective drugs. In this game, we hope and pray we stay healthy. We may exercise and eat well most of the time or some of the time. In general, however, we accept our genetics as we accept the risks of dementia, bone fractures, heart attacks, cancer, and arthritis.

 

“Restorative medicine” and “health optimization” are both terms for playing the new game of medicine, which puts the focus on the root causes of illness, rather than just addressing the symptoms. In the new game of medicine, we know about epigenetics—the ability to override our genes by the addition of a tiny chemical “tag,” which can be switched on and off with choices that an individual makes. What we eat, what we drink, what we smoke, and what we think can change the expression of our genes permanentlyand for successive generations.

 

Our hormones are one of the most powerful epigenetic tags we have—they can turn off degeneration and disease. And we have the ability to supplement bio-identical hormones that are designed to fit like a lock and key mechanism with your body, turning on youthful restorative effects that can repair, rejuvenate, protect, and prevent. In my last post, I covered the key players in the family of bioidentical hormones, including thyroid hormone, melatonin, DHEA, and others. Now, as promised, here the sex stars, which really deserve their own time in the spotlight. Both men and women have all three of these sex hormones (progesterone, estrogen, and testosterone) just in different proportions.

 

 

THE SEX HORMONE STARS: What they are and what they do

Progesterone: Mainly a female hormone, it typically declines in our 30s, causing depression, thinning hair, bone loss, and fertility issues. Progesterone is “pro-gestational,” meaning it supports fertility and pregnancy. It works in harmony (or disharmony) with estrogen to balance our moods, protect from cardiovascular disease and cancer, help maintain strong bones, and keep us healthy throughout our adult life. According to my friend and mentor, Dr. Sangeeta Pati, “A decline in progesterone levels is the most common reason for a Prozac prescription.” The majority of the women I see for hair loss have low progesterone levels (and low thyroid levels), and some of these women also have had fertility problems. The good news? Progesterone can be supplemented to an ideal level and is a safe and effective treatment.

 

Estrogen: This hormone comes in three flavors: E1, E2, and E3. For the vast majority of benefits, E2 (or Estradiol) is the key player. It protects in much the same way as progesterone goes against decline and degeneration in all organs. E3 (Estriol) has the best effect on skin and vaginal tissues, making the epidermis firm and juicy, but it delivers less total-body benefits and protection. E1 (Estrone) tends to dominate after menopause, and can actually be detrimental to health when supplemented in excess. Usually Estradiol is what we are talking about in bioidentical hormone replacement. For optimum safety, it should be used topically (applied directly to a part of the body). Estrogen has a protective effect on cardiovascular health in both women and men, but, culturally-speaking, we don’t like man-boobs, so estradiol is not a popular supplement for men.

 

Testosteone: A male and female hormone of metabolism, libido, sexual response and orgasm, muscle strength, body composition, stamina, mood, mental clarity, memory, and energy. Clearly, testosterone is powerful! It is illegal for professional athletes to use as a supplement because of its potential enhancement on athletic performance. But for the rest of us, it is fair game. When used under a doctor’s supervision it is safe and effective in health optimization—cream and injectable forms are most popular in my practice. Testosterone can be a great help to a man entering andropause (more on this next time) or a woman with a withering libido.

 

There you have them: your very own ménage a trois!

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  • Dr. McLean Sheperd

    Dr. McLean Sheperd, of Sheperd Integrative Dermatology, is a board certified dermatologist, advocating a whole body approach to skin wellness. Dr. Sheperd pairs traditional practices with holistic and organic healing for a comprehensive and tailored treatment plan based on individual patient needs.