Individualizing Botulinum Toxin Dosage

Botulinum Toxin Nuances 

I have noticed over the years that people experiencing strong emotions, or who take up something like weightlifting, need to have an increase in their botulinum toxin. The harder and more frequently the muscles are working, the quicker the botulinum toxin wears off. This is the same principle that we use when someone gets too much botulinum toxin: We advise them to work the muscles as hard as they can, for 5 minutes 5 times a day, to speed up recovery of muscle function and strength in the affected area. 

Kevin Smith, MD, FRCPC 

Niagara Falls, Ontario, Canada

Managing Acanthosis Nigricans 

When patients have acanthosis nigricans, I like to encourage exercise (and diet, but especially exercise) as a treatment to reduce the insulin resistance that causes the skin to get thick. 

Steven R. Feldman, MD, PhD 

Winston-Salem, NC

Don’t Forget the Introverts 

We sometimes check in periodically with staff individually rather than as a group to get the inside scoop, especially from the introverts. If an introvert shares something, you better really listen. Also, if you have an introvert who is a great staff member, they may be too shy to ask for a raise but will leave your practice unless paid properly, so give them raises without them having to ask. To learn more about introverts, check out the book Quiet: The Power of Introverts in a World That Can’t Stop Talking by Susan Cain. 

Benjamin Barankin, MD, FRCPC 

Toronto, Ontario, Canada 

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