ADVANCING SKIN DIAGNOSTICS: HIGH-RESOLUTION IMAGING FOR PRECISION AND NON-INVASIVE CARE

 By: Robert L. Bard, MD
Additional contributors: Roberta Kline, MD, Graciella Davi and Lennard Goetze, Ed.D 

Skin cancer diagnosis has long relied on visual examination and histopathological analysis via biopsy, a method that, while definitive, is often invasive, costly, and prone to unnecessary procedures. Current dermatologic standards incorporate dermoscopy as a primary tool for non-invasive assessment, improving diagnostic accuracy by allowing clinicians to visualize subsurface skin structures. However, despite its widespread adoption, dermoscopy remains limited in its ability to assess deeper tissue structures and vascular characteristics.

With advancements in high-resolution ultrasound and optical microscopy, dermatologic imaging is entering a new era. These technologies enable real-time, non-invasive evaluation of skin lesions, offering a functional perspective that extends beyond morphology to include vascular dynamics and tissue perfusion. Studies have demonstrated that high-frequency ultrasound can accurately measure tumor depth and differentiate benign from malignant lesions based on blood flow patterns and structural characteristics. Optical microscopy, in parallel, provides near-cellular resolution, enhancing diagnostic precision without the need for tissue extraction.

Quantifiable Data Capture in Visual Detection
The ability to distinguish benign from malignant skin lesions is particularly crucial in the case of moles, as only one in 33,000 suspicious lesions biopsied ultimately turns out to be melanoma. Advancements in non-invasive imaging modalities provide a means to monitor these lesions without unnecessary biopsies, which can cause scarring or persistent irritation.

Melanoma has long been studied using bio-microscopy, revealing key vascular characteristics that correlate with malignancy. Cancerous lesions exhibit distinct blood flow patterns—low blood flow often indicates less aggressive tumors, whereas high blood flow suggests a highly aggressive and potentially metastatic disease. High-resolution ultrasound not only measures tumor depth but also provides critical information regarding metastatic potential, enabling more informed clinical decision-making.

With the advent of high-resolution ultrasound and microvascular imaging, we can now achieve a level of detail approaching that of microscopy. This allows for the functional assessment of skin tissues, deeper structures like the thyroid and retina, and the detection of abnormal circulatory states, including distinguishing between inflammatory and cancerous blood vessels.

Additionally, microscopy enables visualization of capillary flow in the skin, including the movement of red blood cells and microscopic mites residing in hair follicles. These mites, while often unnoticed, play a role in cleansing dead tissue. From a physiological standpoint, an increased vascular supply in a lesion—whether due to cancer or an inflammatory condition like psoriasis—signals heightened disease activity. This provides a functional approach to not only assessing disease aggressiveness but also monitoring treatment response over time.

As a functional radiologist, my perspective on skin imaging extends beyond cellular morphology to vascular dynamics. My early investigations into optical skin imaging over a decade ago led to the discovery of microscopic movement within hair follicles—later identified as mites. These insights highlight the intricate and dynamic nature of the skin’s microenvironment.

Case Study: High-Resolution Ultrasound in the Early Detection of Melanoma
A 52-year-old male patient presented with a suspicious pigmented lesion on his forearm, initially identified during a routine dermatologic examination. Traditional dermoscopic evaluation revealed asymmetry and irregular vascular patterns, raising concern for possible melanoma. Rather than proceeding directly to biopsy, the clinician utilized high-resolution ultrasound with microvascular imaging to assess the lesion’s depth and vascular characteristics. The ultrasound revealed a well-defined lesion with increased vascular flow and a depth of 1.2 mm—features consistent with early-stage invasive melanoma.

Based on these findings, a targeted excisional biopsy was performed, confirming stage I melanoma. The use of high-resolution ultrasound allowed for precise measurement of tumor depth preoperatively, ensuring appropriate surgical margins and reducing unnecessary tissue removal. Furthermore, the patient benefited from a more streamlined diagnostic process, avoiding multiple biopsies and minimizing scarring. This case highlights the growing role of advanced imaging modalities in improving diagnostic accuracy, guiding clinical decisions, and reducing patient morbidity.

High-resolution ultrasound (HRUS) has proven to be a valuable tool in the preoperative assessment of cutaneous melanoma, enabling precise measurement of tumor thickness and aiding in surgical planning. A systematic review by Machet et al. (2009) demonstrated a strong correlation between HRUS measurements and histopathological findings, underscoring its reliability in evaluating melanoma depth .Madridge PublishersScienceDirect

Furthermore, research by Wortsman et al. (2013) highlighted the utility of HRUS in assessing locoregional metastases in melanoma patients. Their findings suggest that HRUS can significantly improve the early detection of metastatic spread, thereby facilitating timely and appropriate therapeutic interventions .ScienceDirect

These studies collectively support the integration of HRUS into the diagnostic workflow for melanoma, emphasizing its role in enhancing diagnostic accuracy and optimizing patient management strategies.

Vision for the Future
As imaging technology continues to evolve, we can anticipate a shift towards fully integrated, AI-assisted diagnostic platforms that combine multi-modal imaging techniques for enhanced accuracy and predictive analytics. The convergence of high-resolution ultrasound, optical coherence tomography, and advanced bio-microscopy will enable clinicians to diagnose and monitor skin conditions with unprecedented precision. In the near future, portable and point-of-care imaging devices may become standard practice, reducing reliance on biopsies while improving early detection rates and patient outcomes. By leveraging real-time imaging advancements, we are on the cusp of a new paradigm in dermatologic care—one that prioritizes precision, non-invasiveness, and enhanced patient monitoring.

Conclusion & Claim
Advancements in high-resolution ultrasound and optical microscopy have revolutionized the way we assess skin lesions, offering a non-invasive alternative to unnecessary biopsies. The ability to visualize vascular flow, tissue structure, and disease activity in real time enhances diagnostic precision and allows for continuous monitoring of treatment response. This shift parallels the historical impact of dermoscopy, which, since its development in the 1980s, has significantly improved melanoma detection by enabling the visualization of subsurface skin structures without the need for invasive procedures (Argenziano et al., 1998). Similarly, studies have demonstrated that high-frequency ultrasound can accurately assess tumor depth and vascular characteristics, aiding in the early detection and management of malignant skin lesions (Wortsman et al., 2013). Just as dermoscopy transformed early skin cancer diagnosis, modern high-resolution imaging is now redefining dermatologic and oncologic care.

Claim: High-resolution ultrasound and optical microscopy represent the next major evolution in skin diagnostics, providing a functional, non-invasive, and highly accurate alternative to traditional biopsy methods—ultimately improving patient outcomes and reducing unnecessary procedures.

References

1. Argenziano, G., Soyer, H. P., Chimenti, S., et al. (1998). "Dermoscopy: A Tutorial." Cancer, 85(1), 69-76.

2. Wortsman, X., Wortsman, J., Matsuoka, L. Y., et al. (2013). "High-resolution ultrasound applications in dermatology." Journal of the American Academy of Dermatology, 69(1), 105.e1-105.e11.

THYROID HEALTH: WHY ULTRASOUND MATTERS

3-25-2025   By: Dr. Leslie Valle-Montoya

Have you ever had your thyroid checked? If not, now is the time! While standard thyroid function tests measure hormone levels in the blood to detect disorders like hypothyroidism (underactive thyroid) and hyperthyroidism (overactive thyroid), they don’t tell the whole story. That’s where modern ultrasound technology steps in.

Unlike blood tests, which focus on hormone production, ultrasound provides a real-time, detailed view of the thyroid gland itself. This imaging technique uses sound waves to assess the gland’s size, shape, and structure—offering insights that hormone tests simply can’t provide.

Advanced ultrasound methods, such as 3D Doppler Blood Flow and Elastography, enhance diagnostic accuracy by measuring blood flow and tissue stiffness. These features help differentiate between benign and potentially malignant nodules, offering a clearer picture of thyroid health. By identifying whether nodules are solid or fluid-filled, ultrasound aids in assessing cancer risk and guiding further evaluation.

If you've never had a thyroid ultrasound, consider it an essential step in understanding your thyroid health beyond just hormone levels. A complete evaluation means looking at both function and structure—because when it comes to your health, knowledge is power.

Prologue:

LEARNING FROM THE ULTRASOUND GURU - (Day One)

Since COVID, I’ve connected with countless health professionals over Zoom. Even today, virtual meetings remain the norm for work engagements, often replacing in-person visits and hands-on collaborations.

But today, we broke that mold. I had the privilege of finally meeting Dr. Robert Bard in person—a true pioneer in diagnostic imaging! After five years of remote referrals, I traveled from Santa Barbara, CA, to New York City for a firsthand look at his cutting-edge arsenal of medical technology. More than just a tour, I also received an intensive crash course in ultrasound operation. Dr. Bard had previously mailed me a hospital-grade Terason T-3200 for my practice, and now, under his guidance, I was able to put it to use.

This marks the beginning of our TelemedScan remote overreading collaboration, and learning from "The Cancer Detective" himself was an incredible honor—an opportunity few get to experience from the front row.

"The best way to learn ultrasound is to be a patient," Dr. Bard explained. "Its real-time scanning ability lets you see as you scan—the screen tells all, right on the spot!"

With that in mind, we decided to scan my thyroid, a first for me. Given our collaboration on a perimenopause project, I knew it was time to practice what I’m about to preach. Having access to one of the best thyroid imaging experts in the field was an unexpected luxury—one I wasn’t about to pass up. During the session, I was introduced to the concept of sonology—where the radiologist directly controls the probe, eliminating the middle step of a technician. This hands-on approach allows for immediate interpretation, deeper exploration, and a more interactive learning experience between doctor and patient.

ABOUT THE AUTHOR

LESLIE VALLE-MONTOYA, MD is the Founder of Biomed Life and the Santa Barbara Longevity Center. After medical school, Dr. Valle focused on managing chronic disease starting with its links to poor nutrition and then introducing them into the world of energy frequencies.  She explores and includes non-invasive modalities such as: frequency therapies (including biofeedback), PEMF, proper detoxification, nutritional guidance and binaural beats as needed. - visit: www.biomedlifesb.com

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The Essentials of Thyroid Imaging (part 2)

By: Dr. Robert Bard

When imaging detects a suspicious area, it can guide selective biopsies to obtain small tissue samples for further laboratory analysis (pathology). Combining imaging with pathology provides the most accurate information about the size, location, and aggressiveness of any issue detected.  In the case of thyroid imaging, use of an ultrasound uses sound waves to create images of the thyroid gland in the neck. It is often used for this organ because it is a non-invasive procedure that does not use ionizing radiation. It’s commonly used to evaluate lumps or nodules detected during a physical exam or other imaging tests and requires minimal preparation.

 Thyroid nodule (tumor) - doppler ultrasound

The ultrasound helps doctors visualize the thyroid's size, shape, and potential abnormalities like nodules, cysts, or inflammation, aiding in diagnosis and treatment planning. It’s typically performed when physical exams show:

 - A growth on the thyroid, known as a thyroid nodule (image - R).

- An enlarged or irregular thyroid (goiter).

- Abnormal lymph nodes near the thyroid.

THE ROLE OF THE THYROID GLAND: The thyroid is a butterfly-shaped organ in the endocrine system that regulates hormones influencing various bodily functions. These hormones affect both physical and mental performance, so unexplained symptoms may indicate a thyroid issue.

HYPERTHYROIDISM AND THYROID DISORDERS: Thyroid disorders can stem from various causes and affect the balance of hormones in the body. A range of treatments is available for managing thyroid issues, from medication to non-invasive procedures.

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Part3:

THYROID CANCER:
Thyroid tumors are common but can be hard to diagnose by touch alone. Sonography is the primary method for detecting and monitoring suspicious nodules. Areas with calcium deposits are especially concerning and often require biopsy under ultrasound guidance. Parathyroid masses, which can cause significant health issues like bone loss in women or kidney stones in men, may also be detected. Ultrasound can also identify cancer spread to nearby lymph nodes, which can be biopsied with imaging guidance.

THYROID CANCER FAQ's

Q: Why is a sonogram important if I visit my doctor annually?
Blood tests often miss thyroid tumors, which can be difficult to detect through physical examination, especially if they are deep within the gland.

Q: What happens if a tumor is found?
Many benign conditions, like cysts, can be differentiated from cancer without a biopsy. Ultrasound can assess calcium content, which may indicate cancer, requiring further tests.

Q: Does every suspicious area require a biopsy?
Ultrasound screening and other tests can reduce unnecessary biopsies. Small suspicious areas are typically monitored for growth every 3-6 months before considering a biopsy.

Q: How far can thyroid cancer spread?
Most thyroid cancers grow slowly and spread locally. Metastasis is rare and can be evaluated using MRI scans.

Q: Can ultrasound detect parathyroid tumors that cause osteoporosis?
Parathyroid adenomas are typically benign but can lead to significant physical effects due to hormonal imbalances. These tumors can often be diagnosed with 3-D Power Doppler Histogram .

In summary, ultrasound imaging plays a crucial role in evaluating thyroid health by providing a safe, non-invasive, and highly detailed view of the gland. When combined with pathology, it enhances diagnostic accuracy, guiding appropriate treatment decisions. This synergy between imaging and laboratory analysis ensures a comprehensive approach to identifying and managing thyroid conditions effectively.

 

ABOUT THE AUTHOR-

ROBERT L. BARD, MD, PC, DABR, FASLMS - Advanced Imaging & Diagnostic Specialist

Having paved the way for the study of various cancers both clinically and academically, Dr. Robert Bard co-founded the 9/11 CancerScan program to bring additional diagnostic support to all first responders from Ground Zero. His main practice in midtown, NYC (Bard Diagnostic Imaging- www.CancerScan.com) uses the latest in digital Imaging technology has been also used to help guide biopsies and in many cases, even replicate much of the same reports of a clinical invasive biopsy. Imaging solutions such as high-powered Sonograms, Spectral Doppler, sonofluoroscopy, 3D/4D Image Reconstruction and the Spectral Doppler are safe, noninvasive, and does not use ionizing radiation. It is used as a complement to find anomalies and help diagnose the causes of pain, swelling and infection in the body’s internal organs while allowing the diagnostician the ability to zoom and ‘travel’ deep into the body for maximum exploration.

THE ESSENTIALS OF THYROID IMAGING (Extra: Thyroid CancerScanning)

By: Dr. Robert Bard

When imaging detects a suspicious area, it can guide selective biopsies to obtain small tissue samples for further laboratory analysis (pathology). Combining imaging with pathology provides the most accurate information about the size, location, and aggressiveness of any issue detected.  In the case of thyroid imaging, use of an ultrasound uses sound waves to create images of the thyroid gland in the neck. It is often used for this organ because it is a non-invasive procedure that does not use ionizing radiation. It’s commonly used to evaluate lumps or nodules detected during a physical exam or other imaging tests and requires minimal preparation.

 Thyroid nodule (tumor) - doppler ultrasound

The ultrasound helps doctors visualize the thyroid's size, shape, and potential abnormalities like nodules, cysts, or inflammation, aiding in diagnosis and treatment planning. It’s typically performed when physical exams show:

 - A growth on the thyroid, known as a thyroid nodule (image - R).

- An enlarged or irregular thyroid (goiter).

- Abnormal lymph nodes near the thyroid.

THE ROLE OF THE THYROID GLAND: The thyroid is a butterfly-shaped organ in the endocrine system that regulates hormones influencing various bodily functions. These hormones affect both physical and mental performance, so unexplained symptoms may indicate a thyroid issue.

HYPERTHYROIDISM AND THYROID DISORDERS: Thyroid disorders can stem from various causes and affect the balance of hormones in the body. A range of treatments is available for managing thyroid issues, from medication to non-invasive procedures.

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Part2: 3-25-2025

THYROID HEALTH: WHY ULTRASOUND MATTERS

By: Dr. Leslie Valle-Montoya

Have you ever had your thyroid checked? If not, now is the time! While standard thyroid function tests measure hormone levels in the blood to detect disorders like hypothyroidism (underactive thyroid) and hyperthyroidism (overactive thyroid), they don’t tell the whole story. That’s where modern ultrasound technology steps in.

Unlike blood tests, which focus on hormone production, ultrasound provides a real-time, detailed view of the thyroid gland itself. This imaging technique uses sound waves to assess the gland’s size, shape, and structure—offering insights that hormone tests simply can’t provide.

Advanced ultrasound methods, such as 3D Doppler Blood Flow and Elastography, enhance diagnostic accuracy by measuring blood flow and tissue stiffness. These features help differentiate between benign and potentially malignant nodules, offering a clearer picture of thyroid health. By identifying whether nodules are solid or fluid-filled, ultrasound aids in assessing cancer risk and guiding further evaluation.

If you've never had a thyroid ultrasound, consider it an essential step in understanding your thyroid health beyond just hormone levels. A complete evaluation means looking at both function and structure—because when it comes to your health, knowledge is power.

Prologue:

LEARNING FROM THE ULTRASOUND GURU - DAY ONE!

Since COVID, I’ve connected with countless health professionals over Zoom. Even today, virtual meetings remain the norm for work engagements, often replacing in-person visits and hands-on collaborations.

But today, we broke that mold. I had the privilege of finally meeting Dr. Robert Bard in person—a true pioneer in diagnostic imaging! After five years of remote referrals, I traveled from Santa Barbara, CA, to New York City for a firsthand look at his cutting-edge arsenal of medical technology. More than just a tour, I also received an intensive crash course in ultrasound operation. Dr. Bard had previously mailed me a hospital-grade Terason T-3200 for my practice, and now, under his guidance, I was able to put it to use.

This marks the beginning of our TelemedScan remote overreading collaboration, and learning from "The Cancer Detective" himself was an incredible honor—an opportunity few get to experience from the front row.

"The best way to learn ultrasound is to be a patient," Dr. Bard explained. "Its real-time scanning ability lets you see as you scan—the screen tells all, right on the spot!"

With that in mind, we decided to scan my thyroid, a first for me. Given our collaboration on a perimenopause project, I knew it was time to practice what I’m about to preach. Having access to one of the best thyroid imaging experts in the field was an unexpected luxury—one I wasn’t about to pass up. During the session, I was introduced to the concept of sonology—where the radiologist directly controls the probe, eliminating the middle step of a technician. This hands-on approach allows for immediate interpretation, deeper exploration, and a more interactive learning experience between doctor and patient.

TBC

---

Part3:

THYROID CANCER:
Thyroid tumors are common but can be hard to diagnose by touch alone. Sonography is the primary method for detecting and monitoring suspicious nodules. Areas with calcium deposits are especially concerning and often require biopsy under ultrasound guidance. Parathyroid masses, which can cause significant health issues like bone loss in women or kidney stones in men, may also be detected. Ultrasound can also identify cancer spread to nearby lymph nodes, which can be biopsied with imaging guidance.

THYROID CANCER FAQ's

Q: Why is a sonogram important if I visit my doctor annually?
Blood tests often miss thyroid tumors, which can be difficult to detect through physical examination, especially if they are deep within the gland.

Q: What happens if a tumor is found?
Many benign conditions, like cysts, can be differentiated from cancer without a biopsy. Ultrasound can assess calcium content, which may indicate cancer, requiring further tests.

Q: Does every suspicious area require a biopsy?
Ultrasound screening and other tests can reduce unnecessary biopsies. Small suspicious areas are typically monitored for growth every 3-6 months before considering a biopsy.

Q: How far can thyroid cancer spread?
Most thyroid cancers grow slowly and spread locally. Metastasis is rare and can be evaluated using MRI scans.

Q: Can ultrasound detect parathyroid tumors that cause osteoporosis?
Parathyroid adenomas are typically benign but can lead to significant physical effects due to hormonal imbalances. These tumors can often be diagnosed with 3-D Power Doppler Histogram .

In summary, ultrasound imaging plays a crucial role in evaluating thyroid health by providing a safe, non-invasive, and highly detailed view of the gland. When combined with pathology, it enhances diagnostic accuracy, guiding appropriate treatment decisions. This synergy between imaging and laboratory analysis ensures a comprehensive approach to identifying and managing thyroid conditions effectively.

 

ABOUT THE AUTHOR-

ROBERT L. BARD, MD, PC, DABR, FASLMS - Advanced Imaging & Diagnostic Specialist

Having paved the way for the study of various cancers both clinically and academically, Dr. Robert Bard co-founded the 9/11 CancerScan program to bring additional diagnostic support to all first responders from Ground Zero. His main practice in midtown, NYC (Bard Diagnostic Imaging- www.CancerScan.com) uses the latest in digital Imaging technology has been also used to help guide biopsies and in many cases, even replicate much of the same reports of a clinical invasive biopsy. Imaging solutions such as high-powered Sonograms, Spectral Doppler, sonofluoroscopy, 3D/4D Image Reconstruction and the Spectral Doppler are safe, noninvasive, and does not use ionizing radiation. It is used as a complement to find anomalies and help diagnose the causes of pain, swelling and infection in the body’s internal organs while allowing the diagnostician the ability to zoom and ‘travel’ deep into the body for maximum exploration.

A LEGACY OF HOPE

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Introduction: 

Captain Harry Schwartzbard

Family heirlooms may sometimes carry hidden treasures- the kind that could be a significant part of world history.  In the case of a unique news clipping from World War II, a unique feature interest story about a Jewish American Soldier received a major honor from battle at a time when Jews were at the height of persecution in Europe.

Published and written in the Yiddish language (often known to be an "old people's" language), the beneficiary held this special news clipping for over 80 years without any idea of its contents. Until recently, the beholder of this news excerpt had very little interest in getting the news piece translated due to the limited popularity of Yiddish-speaking/reading people around. Decades later, the news clip made its way to several historians who found significant value in the military success story.  It also spoke of cases and events of what would eventually become the future Jewish national Home (Israel).

Translated by: Shimmy Schwartz

An excerpt from the former YIDISHES ṬAGEBLAṬṬ (יידישעס טאגעבלאט = Jewish Daily News)

BROOKLYN JEWISH DOCTOR PRAISED FOR HIS HEROISM ON THE MARSHALL ISLANDS

1944 - Captain Harry Schwartzbard, a young Jewish doctor from Brooklyn, received widespread acclaim from the Associated Press for his heroic actions during the invasion of the Marshall Islands. Amidst the chaos of war, with people burning and bullets flying in all directions, Dr. Schwartzbard remained steadfast in his duty, tending to the injured and saving numerous lives. His bravery and selflessness in the face of extreme danger earned him well-deserved recognition. 

Mrs. Schwartzbard, residing at 1211 Avenue I in Brooklyn, recently gave birth to a baby two months ago. In a heartwarming moment on Christmas, her husband, Dr. Henry Schwartzbard, called from Honolulu and was able to hear their infant son cry for the first time over the telephone. Although he had yet to see a photo of their child, this moment brought joy to the new father. Mrs. Schwartzbard expressed her pride and happiness regarding the recognition her husband has received for his heroic actions. Dr. Schwartzbard, a graduate of City College and the University of Basel's medical program, was previously affiliated with Lincoln Hospital.

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LEGACIES OF COURAGE:  ENTERING A NEW WORLD IN BATTLE

Family heirlooms may sometimes carry surprise hidden treasures- the kind that may hold a landmark in world history. A treasure trove of letters by the late Captain Harry Schwartzbard recently surfaced, passionately journaling life and times in the front lines of World War II to his recently-born and only son Robert between 1944-1945.  

Between the recklessly stored stack of letters was a mysterious news clipping that ignited the inspiring foundation behind “LEGACIES OF COURAGE”.  At a time when Jews in America were a small and underserved community, a local Brooklyn newspaper reported (in Yiddish) about our Jewish American Soldier who received a major military honor from battle- highlighting his unusual and courageous contribution during the height of Jewish persecution in Europe.  Such an award was a milestone for Jews at a time when prosperity in the new world for its people was most uncertain. After 80 years, the news clipping finally gained the attention of translators and several historians who found significant value as a military success story.

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ARCHIVING 80-YEAR OLD LETTERS FROM THE WAR: PRESERVING HISTORICAL TREASURES

Dr. Bard recently brought to light a treasure trove of vintage photographs, news clippings and private letters from the front lines of WW2. These fragile reflections of world history are all that's left of the expressions of one Capt. Harry Schwartzbard to his baby son Robert (Bard) in the United States.  According to the archivalists at the AngioInstitute, such prints are so brittle and easily crumbled from the mere human touch.  Light and durable papers such as Moleskin and Crane were commonly used for air mailed letters back then- and are found to break apart under constant daylight and repeated photo flash after decades of being entoombed in storage.  The very oils of one's fingers and exposure to sunlight and incandescent light are enough to add to the deterioration process of these papers.  But thanks to current archival management techniques and storage tools, such articles and documents may stand to survive their next journey which involves scanners, photography and general handling from transcribers and publishers.

HISTORICAL SIGNIFICANCE OF MARSHALL ISLANDS Invasion of the Marshall Islands (Operation Flintlock):  Jan. 31-Feb. 23, 1944  Following the Gilbert Islands Campaign, the Marshall Islands Campaign consisted of two separate invasions of the Kwajalein and Eniwetok Atoll Groups.  Beginning on January 31, 1944 with the landings at Kwajalein, the campaign was declared secure at Eniwetok on February 22.  The landing forces met with light, but determined resistance, on both atolls.  The forces captured flight bases on the atolls which were crucial to the Mariana Islands Campaign.   (Source 1: US NAVY | Source 2: US ARMY) After WWII, Nuclear testing at Bikini Atoll consisted of the detonation of 23 (or 24) thermonuclear weapons by the United States between 1946 and 1958 on Bikini Atoll in the Marshall Islands. Tests occurred at 7 test sites on the reef itself, on the sea, in the air, and underwater. The test weapons produced a combined yield of about 77 Mt of TNT in explosive power. After the inhabitants agreed to a temporary evacuation, to allow nuclear testing on Bikini, which they were told was of great importance to humankind, two nuclear weapons were detonated in 1946. About ten years later, additional tests with thermonuclear weapons in the late 1950s were also conducted. The first thermonuclear explosion was much more powerful than expected, and created a number of issues, but did demonstrate the dangers of such devices. (Source, Wikipedia)

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EPILOGUE

In the post-war era of global migration to the US, it was common to “Americanize” lengthy or challenging names for easier social connectivity and community integration. By the next generation, the Schwartzbard family name was streamlined for this reason.  The infant in this story whose name is recognized as one of the most honored figures in diagnostic medicine and cancer imaging is Dr. Robert Bard.

In May of 2022, Dr. Robert Bard receives one of the highest national achievement awards commemorating his life's work in cancer imaging research and clinical care. The Ellis Island Medal of Honor is presented to those who advocate understanding, tolerance, and unity among Americans, transcending cultural, ethnic, and religious differences.  For almost four decades, Dr. Bard's commitment to the study of diagnostic imaging contributed to the advancement of non-invasive medical scanning technologies.  As a second generation medical professional and military veteran, Dr. Bard's pursuit to battle disease through research and patient care is a dedication to the life-saving legacy and worldly philosophies as that of his father, Dr. Schwartzbard during and after WWII.

Dr. Bard continues to run his active practice in NYC today. He maintains a pre/postop imaging facility for his cancer patients and others suffering from chronic disorders.  Dr. Bard is also the clinical director for Firefighters Against Cancer & Exposures, a national foundation in support of first responders health.  Moreover, as of August, 2024, his office has been confirmed to be the first official diagnostic  center, an early detection screening facility and recurrence detection site for the American Breast Cancer Foundation and the Male Breast Cancer Global Alliance.

PAVING MEDICAL HISTORY FROM THE FRONT LINES (Reprise from Jul 2021)

THE ULTRASOUND MOVEMENT- A CAREER RETROSPECTIVE 

By: Dr. Robert Bard

I attribute my career in radiology to the US Air Force, having served in military hospitals in Thailand and Laos in the early ‘70’s.  There, I  witnessed the critical demands for immediate response and real-time diagnostic technology where time and accuracy are of the ultimate essence. I attribute my critical eye of  many medical imaging devices to the 'battle hardened' challenges of a military hospital setting, easily paralleled to our emergency responders and the ICU facilities of today

Moving on to civilian life (back in the US), I watched diagnostic imaging history unfold throughout my career and marveled at the inspired evolution of the ultrasound protocol.  Its remarkable growth in engineering, its data-gathering (quantifiable) milestones and breakthrough features conquered the arena of patient scanning while forging a safe, non-invasive and high-performance paradigm to physicians and health responders alike. From the high-powered large format hospital scanners to the latest in hand-held portable designs (aka. the digital stethoscope),  ultrasound technology holds a solid place in the ever-shaping future of medicine and ancillary disciplines it supports.  In 1974, my residency program director told me not to waste my time learning, ultrasound. I went to the Armed Forces Institute of Pathology in D.C. and then to Europe to advance my training. 50 years later, ultrasound has replaced many other invasive imaging technologies.

A GAME CHANGER IN PATIENT CARE

The point of care ultrasound unit practically reinvented the doctors' visit.  By generating instantaneous scan results, the ultrasound completely supports the interactive collaboration between doctor & patient.  Unlike any other scanning solution, the ultrasound is the only device that allows the patient to steer the probe to the exact area of pain or concern. The dynamics of its real-time output sets the stage for future tech designs.

In the United States, imaging is mostly performed by a technician where the patient holds no interactive part in the scanning process. In Europe, it is standard procedure for the medical team to perform the imaging directly on the patient - creating a more efficient diagnostic experience overall. Patient and physician can see what's going on and discuss treatment options at the same time. This real-time assessment comes direct from the doctor without any potential misinterpretation from secondary parties like the technician.  

EARLY ADVANTAGES IN CANCER-SCANNING: AN HISTORICAL BOOST TO THE MAMMOGRAM
In 1976, during my early days as a young radiologist, I was approached by Dr. Henry Leis Jr., the pioneer doctor who wrote the very first text on breast cancer and developed mammography 18- a means of early diagnosis and instrumental in the use of many of the less invasive procedures used in the treatment of breast cancer today. He confessed with great concern that he had all these patients with lumpy or cystic breasts developing tumors that he could clearly feel but the mammogram kept missing it.  Seeking my help through sonogram technology, we worked on his patients together and the sonogram clearly identified and quickly diagnosed a mass as either a cancer or a benign cyst, in a dense, lumpy breast.  Since then we've incorporated the sonogram in high-risk patients’ regimen every six months religiously because it finds tumors while they're small and “lumpectomy” surgery is curative if the mass is less than 1 cm.  This is alongside doing mammograms once a year in women over 50 or unless they have a history of cancer- at which case, we do it starting at age 45.

9/11 & DISASTER RESPONSE HEALTH ISSUES

A decade after the disaster, health reports continue to show thousands of new and aggressive cancer claims 15 years after the 9/11 attacks. By June, 2016, the Centers for Disease Control and the WTC Health Program enrolled more than 5,400 people who have been diagnosed with cancer within a two-year period (4,692 were first responders, recovery and cleanup workers and volunteers). Experts state that cancers from "burning asbestos and the entire toxic cauldron of Ground Zero" carries a latency period of 15-20 years after exposure, and a major spike in advanced cancer cases is expected within the next 10 years. With my practice centralized in midtown, Manhattan, first responders and civilians alike have received additional screening and monitoring for 9/11 related disorders as an alternative to standardized diagnostic protocols.  The advantages of the 4D Doppler Technology helps to identify, detect and analyze many tumors from pre-malignant areas to advanced cancerous cases. The regular sonogram shows a malignant disorder while the 4D scan displays a mass filled with cancerous arteries and veins meaning this is highly aggressive requiring immediate attention.

INTERNATIONAL IMAGING ALLIANCE: UPGRADES FOR THE COVID FRONT LINES

2020- Thanks to its digital format, the ultrasound imaging protocol became the ideal medical collaboration platform, making electronic file sharing and remote/real-time scanning a complete reality. My international alliance comprised of research pioneers including Dr. Danilo Buonsenso (Rome, Italy) who published reports about "ultrasound equipment as an effective replacement of the stethoscope.”  Dr. Buonsenso's review presents the valid uses and benefits of Lung Ultrasound in identifying respiratory disorders that may be associated with Covid-19.  

Front line physicians in Italy and Spain are reportedly triaging with portable (hand-held) ultrasound units that reduce logistical problems of a chaotic environment and healthcare worker exposure. Since imaging with CT or ultrasound is not diagnostic, determining who needs hospitalization is essential in a pandemic overwhelming medical providers.  Dr. Buonsenso, at the viral epicenter in Rome, uses sonograms to decide who requires a CT scan. With the current pandemic, clinicians worldwide have been earmarking how identifying issues in the lungs (and the cardiopulmonary area) through the use of ultrasound equipment can be quite helpful in monitoring, screening, scanning and tracking pulmonary vulnerabilities and infections that may require follow-up testing for Coronavirus.

A SUSTAINABLE WORK PRACTICE

 Burnout is a huge problem for the radiologic community. Imaging readers usually handle thousands upon thousands of images whereby interaction is only with a screen, not with the patient.  Ultrasound scanning puts the radiologist in direct interactive contact with the patient each time.  Here, the dynamics of patient care brings gratifying engagement in communicating diagnoses and CLOSURE with each patient's case. This work cycle is a significant upgrade in occupational endurance and consistent performance.

THE NATIONAL DISABILITIES COALITION - 2025 LAUNCH

FOR IMMEDIATE RELEASE - (Originally published in IPHA NEWS/ Integrative Pain Healers Alliance)

2/11/2025 -  Dr. Robert Bard, NYC medical imaging specialist & founder of the AngioInstitute, officially authorized his support for the launch of the National Disabilities Coalition (NDC) to support burn and wound victims of traumatic events. Alongside outreach partner, Ret. FDNY FF Sal Banchitta, this network initiative builds upon an original platform (9/11 CancerScan program) for first responders and is reignited by their advocacy role with the national Firefighters Against Cancers & Exposures (F.A.C.E.S.). The NDC’s mission is to unite educators, resources, innovators, and clinical experts in the field of wound care to support the improvement of treatment strategies and recovery for survivors.

FROM TRAUMATIC INJURY TO REHABILITATION TO LIFESTYLE CHANGE

The NDC covers a much wider scope of care and awareness. Though launched to support first responders, the coalition never shies away from anyone in search of support.  With its already-growing set of health professionals, research materials, service providers and rehab innovations, the first half of the year is dedicated to uniting some of the key associations and resources.

Leaders of the Integrative Pain Healers Alliance (NYC), including Lennard Goetze and Gina Adams (Rehabilitation Innovations Advocates) were key coordinators of strategic conferences between wound care experts and coalition leaders to outline the 2025 initiatives of the newly established National Disabilities Coalition, uniting advocacy groups and clinical partners to promote a nationwide outreach campaign centered on the theme of “unity through collaboration.” This initiative aims to connect survivor support organizations with scientific and medical advancements that enhance recovery. Dr. Bard’s clinical and research efforts expanded into the public sector with the support of Ms. Geri Barish, President of the Hewlett House and a senior member of the Nassau County Disabilities Committee. 

LEARNING THE WORLD OF REHAB IN CONGRESS By: Gina Adams / IPHA News Editor *ACRM: I attended the American Congress of Rehabilitation Medicine 102nd Annual Fall Conference & EXPO in Chicago from 27–30 October. This inspiring venue provided the perfect setting for the world’s most passionate rehabilitation professionals, researchers, clinicians and consumers to come together to connect, share insights and shape the future of rehabilitation medicine. The ACRM Annual Fall Conference is truly unique. It’s the only event that brings together every member of the rehabilitation team, across all disciplines and professions from around the world. Whether you’re a seasoned professional, beginning your journey, or simply curious about rehabilitation research, ACRM offers an inclusive, welcoming environment that fosters collaboration, innovation and personal growth. Mar 3-6 2025 AMSUS Annual Meeting: AMSUS, The Society of Federal Health Professionals is a non-profit, member-based association providing education and professional development benefits to support federal health professionals and their missions at the Departments of Defense, Veterans Affairs, Health and Human Services, and Homeland Security, and our industry partners and advocates for advancing health for all. Learn and collaborate with health professionals focused on advancing federal, public, and global health. Earn CMEs for your health profession—as a physician, nurse, physician assistant, dentist or dental technician, pharmacist or pharmacy tech, psychologist, or health care executive—as you learn about innovative medical advances and superior practices in patient care and health administration, and connect with others who share your interest in advancing healthcare.

Ms. Barish is also a staunch supporter of the local first responders groups and victims of traumatic injuries on Long Island. “I learned early in life that making a difference is not a solo performance”, states Ms. Barish. “Dr. Bard’s boundless energy and his vast clinical resources offers a new phase in supporting the disabled. Not just as a medical professional who advocates for all patients, but as an individual living with disabilities himself, his momentum to get this involved with public causes is truly inspiring!

”February 11, 2025 – Daniel Gropper (burn survivor) of the Nassau County Disabilities Committee and brother Joshua Gropper, members of the Phoenix Society for Burn Survivors joined the NDC team to offer insights, common goals and collaborative opportunities. Recognized as the leading national nonprofit dedicated to empowering burn injury survivors, the Phoenix Society provides life-changing peer support and advocacy. "I started with this Disabilities Council about two and a half years ago", says Gropper. "Aside from burn victims, we support all different types of disabilities (from) burn survivors, amputees, autism, the deaf/hearing impaired. There are little people, cerebral palsy, muscular dystrophy...it has been a little bit of a tough road- but we continue to do more for those who need help!"

Future conferences are being scheduled around the advancement of Burn Care between legislators, industry associations, health providers and the growing advocacy alliance comprising the NDC. Senior coordinators have alluded to a major upcoming drive to join functional health practices who support victims of the recent disasters inspired by the Eaton and Palisades fires that swept across L.A. County. Also, talks of proposing educational and clinical programs about occupational injuries for labor unions and industrial associations.

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AFTERMATH:
REGENERATIVE CARE FOR VICTIMS AND RESPONDERS

Dr Leslie Valle-Montoya of Sta. Barbara CA is the medical director of Biomed Life and Santa Barbara Longevity Center. This year, she also launched the BrainWave Wellness institute, a non-profit facility offering supportive alternative health services for community responders. For the firefighters battling the blaze of the L.A. wildfires, Dr. Valle-Montoya was one of the facilities that received major calls for post-exposure treatments.  She noted of respiratory disorders, dermal inflammatory infections, neuromuscular injuries and mental health issues.  

"Dr. Lesie" is recognized as a national ranking health member of the Firefighters Against Cancer & Exposures (F.A.C.E.S.) and is a staunch advocate for non-invasive modalities to address chronic issues.  For emergency responder, she introduced the most notable regenerative innovations from top developers worldwide. Advancements such as near infrared laser/light therapy (PBMT), neuromagnetics (PEMF), biofeedback, hyperbaric therapy, heart rate variability, ozone therapy, vitamin infusions- to name but a few.

The BrainWave Wellness Institute was originally launched as a partnership with the AngioInstitute (NY) and the Integrative Health Research Center (IHRC) under Dr. Robert Bard's medtech efficacy validation program. Exploring new technologies has been the crux of their common bond as co-writers of HealthTechReporter.com.  By the fall of 2024 Dr. Valle-Montoya was appointed a clinical role with F.A.C.E.S. when she received a commendation for her smoking cessation program, treating a retired fire dept. member as part of her 'front line battle' against lung cancer.

Today, Dr. Leslie continues to volunteer her health services to the many responders of the L.A. fires of 2025 and she reports on the many unique and chronic health issues accrued by the rescue members.

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THE VALUE OF COLLABORATION

By: Roger Simpson, MD

▪ Plastic, Reconstructive, and Hand Surgery ▪ Facial Paralysis Reanimation

▪ Past President Long Island Plastic Surgical Group

Multidisciplinary partnerships are the basis for mitigating the complexities of acute burn care in our Center. Dr. Bard’s concept of collaboration of survivor support groups with the medical community is essential in maximizing advancements that will enhance recovery. Dan Gropper and I share a patient-doctor relationship. I have had the ability to follow his acute recovery and his long-term rehabilitation. Early on in his care, he was an advocate for quality burn recovery, directly aiding patients hospitalized or in a rehabilitative program. His positive attitude was recognized by the Phoenix Society for Burn Survivors.

His work towards functional recovery has been an inspiration for not only those patients injured by burns, but also those who sustained functional disabilities following other traumatic injuries. Danny leads by example. Working closely with his brother, together they have been creative in their approach toward functional disability, getting very positive results. Understanding the injury and the possibilities for improvement are the basis for open communication that can advance our collective knowledge of the problem and the solution. He also sees the patient as a whole, from a different perspective. The core behind the NDC program is a fine example of collaboration of multidisciplinary fields working together to improve treatment strategies, achieving greater functional recovery.

[ See full spotlight on Dr. ROGER SIMPSON @ 360 Health Alert ]

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Exposures: Occupational Hazards in Today’s Emergency Response  By: Captain Chris Conner (Bedford TX Fire Dept)

ResponderNews conducted a special interview with founder and CEO of F.A.C.E.S. (Firefighters Against Cancers & Exposures) Capt. Chris Conner.  Having focused on CANCER as the main topic of his advocacy group, this leg of our safety review extends to the other half of his foundation’s target interests covering a major report on EXPOSURES covers a span of topics incorporating toxicity levels of incendiary compounds that significantly add to the dangers of emergency response.  

On-the-Job Injuries

Firefighters today are experiencing more on-the-job injuries than ever before. While our protective gear has improved significantly over generations, we are still seeing an increase in thermal and chemical burns. The variety of hazardous materials we encounter has expanded, and with different materials burning at varying rates and temperatures, injuries often manifest later—sometimes as delayed burning sensations. Chemical burns, in particular, have become a growing concern.

Another critical exposure risk occurs after the fire is extinguished. Once firefighters remove their air packs and begin overhaul operations, they are still exposed to lingering toxins in the air. This phase of firefighting poses a significant health risk that many may not immediately recognize.

Hydrogen Cyanide Exposure

Hydrogen cyanide (HCN) is a highly toxic gas that is produced when materials containing nitrogen—such as plastics, wool, and synthetic fabrics—burn. It is a major concern for both fire victims and firefighters due to its rapid poisoning potential through smoke inhalation(1). Our hydrogen cyanide levels at fire scenes are alarmingly high. As a result, we now carry hydrogen cyanide detectors to monitor exposure levels. The presence of this gas contributes to an increase in inhalation and respiratory burns, as well as long-term health risks. Even with improved thermal imaging technology, firefighters are still at risk when they remove their masks, believing the danger has passed. Many injuries occur after exposure to residual heat, chemicals, and airborne toxins.

Wildland Firefighting Exposures

One of the greatest challenges in wildland firefighting is the unpredictability of weather conditions. In large fires, the blaze itself can create its own weather patterns, making the situation even more volatile. Firefighters on the ground face immense danger, often working without access to nearby water sources. These teams rely on hand tools—shovels, chainsaws, and dirt lines—to contain fires, putting them directly in harm’s way.

When wildfires move into populated areas, exposure risks increase exponentially. Residential neighborhoods contain a wide variety of hazardous materials—pool chemicals, propane tanks, and other household substances—that create additional dangers.
The unpredictability of what is burning adds another layer of risk to an already perilous situation.

Building Construction and Toxic Exposures

Modern building construction has introduced new hazards for firefighters. In the past, structures were primarily made of solid wood, but today, synthetic materials and plastics dominate. Every piece of furniture, fabric, and household item contains some form of synthetic polymer, which releases toxic substances when burned. These exposures go beyond the immediate risk of fire-related injuries. Long-term health consequences, including cancer, are a growing concern. However, the full extent of these risks remains unknown. Even decades from now, we will likely continue uncovering the effects of the hazardous materials we are exposed to today. Firefighting is an ever-evolving profession, requiring constant education and adaptation to mitigate these emerging dangers.

REFERENCE:

1) Cyanide intoxication as part of smoke inhalation - a review on diagnosis and treatment from the emergency perspective

https://pmc.ncbi.nlm.nih.gov/articles/PMC3058018/#:~:text=The%20most%20common%20occurrence%20of,only%20glowing%20embers%20%5B7%5D.

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INSIGHTS FROM THE FRONT LINES: An interview with Dr. Dianne Rudolph - wound care specialist 

Edited by: Gina Adams / Women's Health Collaborative Rehab Coalition

Our editors continue expanding our coverage on the science of WOUND HEALING by connecting with current experts in the field. From a recent presentation at the AAWC (Association for the Advancement of Wound Care), we are fortunate to interview Dr. Dianne Rudolph, DNP, APRN, GNP-BC, CWOCN, a board-certified gerontological nurse practitioner and wound care specialist with over 30 years of experience across trauma, acute, home, hospice, and long-term care. Passionate about complex adult and geriatric care, she serves as adjunct faculty at the University of Texas Health Science Center in Houston and has contributed extensively to lectures, publications, and book chapters. Dr. Rudolph currently practices at South Texas Wound Associates, providing advanced wound care in clinical, acute, and long-term care settings.

I’ve been Wound Care certified for quite a few years. I first obtained my wound certification in 1996 after attending a program at MD Anderson Cancer Center. Since then, I’ve been practicing wound care in various capacities. In 2004, I became a nurse practitioner and naturally incorporated my passion for wound care into my practice as an advanced clinician. Over the years, I’ve worked in multiple settings, including acute care hospitals, outpatient clinics, long-term care, home health, and hospice/palliative care.

Currently, I work with Tenet, a large hospital corporation in San Antonio, Texas, where I practice both in inpatient and outpatient settings. In our busy clinic, we specialize in wound and hyperbaric medicine, and I also round on inpatients who require wound care.

Wound Care Certification

There are several national organizations that offer wound care certifications. I chose to certify through the Wound Ostomy and Continence Nurses (WOCN) Board, which provides recognition in three areas: wound care, ostomy care, and continence care. I hold certifications in all three.

Another highly reputable organization is the American Board of Wound Management (AABWM), which offers the Certified Wound Specialist (CWS) designation. Depending on your education and training, you can obtain a CWS certification as an advanced practice clinician, physician, or nurse.

There are also other respected organizations, such as the Wound Care Education Institute. While I can’t name all of them off the top of my head, I strongly believe that certification is important. It demonstrates a clinician’s proficiency and specialized skills in wound care, which is far more complex than simply choosing the right dressing. It requires a comprehensive understanding of the patient’s overall health and healing process.

Publications and Training

I’ve published several articles and contributed chapters to books, including Chronic Wound Care by Dr. Jay Shah and his Wound Care Certification Guide. My journey in wound care began with my training at MD Anderson Cancer Center. At the time, they had a specialty program that combined classroom instruction with clinical experience. Since MD Anderson is at the forefront of cancer care, their interest in wound, ostomy, and incontinence education likely stemmed from their work with patients undergoing treatment for intestinal malignancies, which often required ostomy management.

Wound Care and Dermatology

There is significant overlap between wound care and dermatology. For example, we often see patients in our clinic with atypical lesions that require biopsies, which sometimes reveal malignancies. In such cases, we refer them back to dermatology for further excision or Mohs surgery. Conversely, dermatologists refer patients to us when wounds are not healing properly. We frequently manage non-healing wounds that develop after excisions for basal or squamous cell carcinomas.

Advances in Wound Care in the U.S.

The U.S. has made significant progress in wound care, though regulatory barriers can sometimes slow innovation. The approval process for new treatments, such as advanced wound dressings and therapies, often involves extensive FDA oversight. However, clinicians increasingly recognize the importance of treating not just the wound but the whole patient.

Alongside traditional wound care techniques, we’re seeing an exciting rise in advanced topical therapies, as well as a more holistic approach to patient management. For instance, a diabetic patient with poor glycemic control will struggle to heal, regardless of the wound care interventions used. Similarly, vascular ulcers won’t improve unless perfusion, venous, or lymphatic issues are addressed.

Emerging Technologies in Wound Diagnostics

Advanced imaging and diagnostic tools are underutilized in wound care, often due to insurance limitations and access issues. However, promising technologies include:

• Near-infrared imaging, such as the Snapshot tool, which allows us to assess tissue perfusion noninvasively.

• Bacterial mapping technologies, like the MolecuLight, which helps us determine bacterial bioburden in a wound before and after debridement.

• Transcutaneous oxygen measurements (TCOM), which measure tissue oxygenation and help assess a patient’s healing potential, often used in hyperbaric medicine.

Hyperbaric Oxygen Therapy (HBOT)

Insurance restrictions limit the use of hyperbarics, but we commonly treat:

• Diabetic foot ulcers
• Gas gangrene
• Compromised surgical flaps
• Crush injuries
• Radiation-induced wounds

Hyperbaric oxygen therapy has been beneficial in these cases, though its accessibility depends on insurance coverage.

Legal Aspects of Wound Care

In addition to my clinical work, I’ve done extensive legal consulting as a nurse consultant. I was recently asked to give a talk on the legal aspects of wound care, covering key concepts in medical malpractice and case analysis. The goal was to help clinicians understand what factors could lead to lawsuits and how to mitigate legal risks in their practice.

Challenges in Wound Care: Denial, Neglect, and Fungating Lesions

In my experience—especially in home care and palliative settings—I’ve seen many patients with late-stage cancer present with fungating lesions, which can be extremely difficult to manage. A crucial issue in wound care is the psychological and emotional component of seeking treatment. Some patients delay care due to denial, fear, financial concerns, or lack of knowledge. Understanding these barriers is essential to improving patient outcomes.

Women’s Health and Wound Care

Wound care overlaps significantly with women’s health. Many patients require wound care following mastectomies or gynecological surgeries. Additionally, research suggests that menopause may affect wound healing, yet this area remains largely unexplored. Hormonal changes could impact healing outcomes, making this an important topic for further study. Historically, menopause was seen as an inevitable phase with little medical intervention. However, as awareness grows, more women are seeking treatments to manage its effects. I find this a fascinating and valuable area to explore further.

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