Dr. Viral Dhiraj Gala, MD

Before the procedure, a skin evaluation is done to determine which type of peel will produce the best results. Dark skin tends to respond well to light peels, while severely sun-damaged skin will likely benefit from a moderate or deep peel. Pre-treatment creams and sunscreen need to be applied every day for several weeks prior to the procedure. Doing this may help shorten the healing process.

During the peel, the area to be treated is cleaned thoroughly, and the chemical solution is applied on the skin for several minutes, which produces a stinging sensation. A neutralizing agent is then used, and the stinging sensation gradually goes away. For more intense peels, a cool compress may be placed on the area to relieve any stinging or burning, or the solution may be applied in intervals to limit exposure to the strong chemicals.

Following a light peel, there will be redness and swelling, which typically fade in a few days. Swelling after a moderate or deep peel may last for a week, and mild redness may continue for a few weeks. To help improve the final results of a peel, treated areas must be kept cool, moisturized, and protected from sunlight.

Joint problems include bursitis and arthritis. Bursitis is the inflammation of a fluid-filled sac cushion on the outside of a joint, causing symptoms including pain and swelling. Arthritis is the inflammation and damage of a joint due to wear and tear or disease. There are several treatments for arthritis, but if the damage progresses far enough, joint replacement may be necessary. In joint replacement, a metal or plastic implant is surgically placed within the joint to make movement easier.

Bone problems include scoliosis, fractures, and osteoporosis. Scoliosis is a curvature of the spine, making the normally straight spine look like a 'C' or 'S.' It is treated with braces or surgery. Osteoporosis is a disease that causes bones to weaken and break easily. It's most common in women, especially older women. Fully half of all women over 65 have osteoporosis. Fractures are any break in the bone. They can be a simple crack or a severe and complicated shatter. Osteoporosis causes fractures in people who have it, but other causes are trauma (such as a fall) or overuse.

Tendon and ligament problems most often result from injury or overuse. Two good examples are ligament tears and tendonitis. The most common ligament tear is the ACL tear in the knee. This ligament supports and stabilizes the knee and is most often torn during sports activities. Tendonitis happens when a tendon, which connects muscles and bones together, becomes irritated and inflamed. This happens most often in older patients who push their bodies too far, leading to pain and swelling. Treatment for both tendon and ligament problems usually includes rest, ice, and supporting the area to let it heal.

Pain and numbness problems can be caused by overuse, disease, an injury, or a compressed nerve. Lower back pain and carpal tunnel syndrome are two of the most common conditions patients encounter. Lower back pain may be caused by sore muscles that have been overworked, or an injury to the disks separating the vertebrae in the spine. Lower back pain usually goes away on its own within a few days, but it may require medical treatment depending on the cause. Carpal tunnel syndrome occurs when the nerve at the base of the palm becomes trapped or pinched. Symptoms include tingling, pain, numbness, or weakness in the hand. Treatment involves rest and sometimes steroid injections.

Because the musculoskeletal system involves so much of the body, problems here can be incredibly varied in their type and severity. Some musculoskeletal problems will go away on their own or only require rest, while others may require medication, physical therapy, or even surgery.

The most widely performed sleep test is the traditional polysomnogram (PSG). This test is typically used to determine whether patients have sleep apnea (lapses in breathing while asleep). Polysomnograms are conducted overnight in a specialized sleep clinic or sleep center, where a patient enters the sleep center and is assigned to a room with a bed, medical equipment, and monitoring system. An overnight sleep technician attaches electrodes to the patient's head, chest, and legs. This application process lasts for around an hour. A sleep technician watches and evaluates the patient as they sleep. Objects such as a comfortable pillow from home, toiletries, and small personal items may be helpful in easing patients into sleep in unfamiliar surroundings.

Patients receive their physician-interpreted sleep study results within a few weeks of the test. If sleep apnea is detected, patients may be asked to return for a titration sleep study. A titration study involves the same procedures and electrode placement of a polysomnogram, but also includes a mask attached to a CPAP (continuous positive airway pressure) machine. The CPAP machine brings pressurized air to the patient. The technician may monitor and adjust the CPAP's air pressure throughout the night. The purpose of a titration study is to determine the appropriate air pressure for patients with obstructive sleep apnea (blocked upper airway).

A split night study combines the polysomnogram and titration sleep studies into two sessions on the same night. Split night studies enable patients to complete both studies quickly instead of waiting weeks in between tests and may expedite the interpretation of results and treatment.

Multiple sleep latency test (MSLT) measures how fast someone is able to fall asleep. Unlike other sleep tests, this test is performed during the day. It may take place after an overnight sleep study. The MSLT test monitors napping and potential for daytime sleepiness and exhaustion.

At-home sleep tests are fully conducted by patients in their own homes. Patients attach fewer electrodes, a breathing sensor, a microphone, and a data collection device to themselves and sleep in their own beds. The following morning, patients gather the data collection device and return it to their medical providers. While at-home sleep tests are convenient, they are not recommended for patients with severe sleep problems. At-home sleep tests are less precise than clinical tests and do not measure brain activity.

Sleep studies are essential to helping patients receive accurate sleep disorder diagnoses and proper treatment. A sleep study can be the first step towards higher quality sleep and physical health.