Age Management Questions

Age management is about healthy aging: living long while remaining well. It has also been called longevity and anti-aging medicine. Age management medicine is a new field of medical expertise, which aims to prevent or reverse the physical and mental decline of aging. We think of it as turbo-charged preventative medicine.

With age management medicine there is a paradigm shift in the underlying premise of the aging process. Often, conventional medicine views aging and age-related disease as inevitable; the loss of function and dependence unavoidable. Age management views aging as a condition which can be treated, and aims to prevent or slow the aging process by treating the underlying causes. This new paradigm influences both the evaluation you will have and the program developed for you.

There are numerous differences between the assessment and treatment plan you receive at Live Young and the routine checkup you may have within conventional medicine. We take more time; the visits are typically 1- 2 hrs long. We do a comprehensive review of your medical history, current health status, risks and exposures, family history and lab and other tests in order to assess not only how you are currently feeling and functioning but also to determine the diseases and disability you may be at risk for. Our model is based on the assumption that optimal health is achieved by using youthful benchmarks and ranges for function as well as for lab and other test results.

After the evaluation, we build a program specifically for you that addresses your physical, mental and sexual health for the short and long term. Our goal is to help you live out your life expectancy while maintaining youthful, resilient and optimally functioning organ systems.

We do this by modulating or balancing hormones and counsel you regarding effective lifestyle changes. The seven pillars of an anti-aging program are diet and nutrition, exercise for body and mind, nutritional supplementation, stress and sleep management, risk factor reduction, elimination of toxic exposures and hormone balancing. The goal with our treatment plans is to address the root cause for diseases, not just the diseases themselves.

A customized program will give you:

  • Better energy
  • Improved memory and concentration
  • A greater sense of wellbeing
  • Decreased body fat and increased muscle and bone mass
  • Improved physical performance and reaction time
  • Improved immune function
  • Improved sexual function
  • Skin rejuvenation
  • Less stress
  • Better mood

It will show you what diseases you are at risk for and the path for prevention. Not only will you feel better, but you will also have an accurate idea of what you need to do to maintain your health and vigour over a long lifetime.

When the levels of hormone decline our physical and mental function is impaired. Hormones decline due to age, menopause/andropause, disease or trauma. When our hormone levels fall the aging process begins to accelerate. This is because hormones are essential for normal cellular function for all organ systems. This influences not only our energy and vigour but also the body’s ability to repair and regulate itself.

As we age we often develop hormone insufficiencies – levels lower than youthful, physiological levels. The hormones that commonly decline are testosterone, progesterone, estradiol, DHEA, melatonin, growth hormone and thyroid. (The hormones cortisol and insulin tend to rise.) The symptoms can include: weight gain, loss of muscle mass, degenerative diseases (such as diabetes, heart disease and osteoporosis), compromised immune system, memory and cognitive decline, depression and stress, insulin resistance, loss of sex drive and poor sexual function, fatigue, sleep disorders, and wrinkled and thinning skin. This influences not only our energy and vigour but also the body’s ability to repair and regulate itself.

The good news is that replenishing these hormones to optimal physiological levels can address these age-related changes. Hormone modulation is beneficial to men and women at any age, but the best long-term protective benefits achieved if they rebalanced sooner rather than later.

At Live Young, we do assessments and lab tests to assess all the hormones – thyroid, DHEA, estrogen, progesterone, testosterone, insulin, cortisol, growth hormone and melatonin. When there are insufficiencies or excesses, we restore levels to normal youthful ranges.

We also provide ongoing evaluation following the initiation of hormone replacement or modulation to ensure the blood hormone levels remain in the optimal youthful ranges but never exceed what the body was accustomed to in its younger years.

The terms natural and bio-identical hormone replacement are often used interchangeably. Natural hormones are those chemical messengers which have existed in our bodies since conception. Bio-identical hormones used for hormone treatment are structurally identical to the hormones our bodies naturally create but are made in a lab and are used to replace falling natural hormone levels. The hormone receptors cannot tell the difference; the body accepts and metabolizes these bio-identical hormones as if it made them. They are not drugs in the usual sense although they are produced by pharmaceutical manufacturers or compounding pharmacies. This is different from the creams sold without a prescription as the active bioidentical hormone is not present in non-prescription items.

In contrast, synthetic hormones are chemically altered from the natural hormone’s structure. Synthetic hormones can produce many desirable effects but may also have adverse side effects or unsafe long-term effects.

At Live Young, we use bio-identical hormone replacement wherever possible.

Yes, we do, for many reasons:

  • It is not possible to obtain all the micronutrients we need in sufficient quantities from diet alone. For example, the vitamin C content in five serving of fruits and vegetables is about 200mg; we need 500mg/day. This is especially important as crops are often grown in depleted soil.
  • The traditional recommendations based on preventing deficiency states not on achieving optimal levels.
  • Now even the most conservative organizations are recommending people take a multivitamin/mineral.
    • Canada Food Guide
    • Harvard revised guidelines for vitamins, Lancet 2002

As we age our needs change, because there is:

  • Less efficient absorption or production of many micronutrients: calcium, Vit B12, Vit D and Vit K to name a few examples.
  • Higher demand for anti-oxidants as wear and tear accumulates
  • Higher demand for natural anti-inflammatory as chronic inflammation takes hold. (This is where Omega 3 fatty acids play an important role.)
  • Higher demand for detoxification i.e. Homocysteine metabolism and B12/B6 and folic acid
  • Increased need for the compounds needed for cellular energy production especially for optimal function of:
    • Cardiac cells
    • Brain cells
    • Immune cells

Live Young has its own line of nutritional supplements that have been developed for two primary reasons:

  • Compliance – they are put together so that they are easy, convenient to take and provide not only the baseline essentials but also additional supplements for optimized cardiac, brain, immune and bone health.
  • Safety – they are made from pharmaceutical-grade ingredients in sufficiently high doses to be useful but won’t cause toxicity through inadvertent multi-dosing. For example, I have seen several cases where patients were getting far too much selenium as it was in several of the supplements they were taking.

It is a bonus if you have an active job or lifestyle but everyone needs to exercise in ways that specifically target the declining cardiovascular function and lean body mass that we experience as we age. Exercise truly is the fountain of youth and reduces our risk for all known diseases of aging. Not only that, it makes us feel and sleep better and improves our appearance as it raises metabolism, builds muscle and burns fat.

At Live Young, we advocate interval training for two essential components of fitness: cardiovascular and strength training.

A little bit of stress is motivating but the problem with our lifestyles is that we often experience excessive and prolonged stress and do not know or have the time to implement stress management. A strategy to counter stress is essential because we now know that stress not only affects our sleep and makes us feel lousy, but it is also a major risk factor for cardiovascular disease, which is the leading cause of death for men and women in North America. Not only that, it raises obesity rates, causes memory problems, impairs immune function, raises the risk for osteoporosis and mood disorders, and interferes with the secretion of repair and regeneration hormones such as growth hormone and melatonin. Stress causes so many ill effects primarily through the secretion of excess cortisol and adrenalin – the stress hormones.

At Live Young, our goal is early detection or prevention of disease. Every program is developed by putting together each patient’s individual risk profile and this incorporates the risks due to family history. The wonderful thing about prevention is that we can change the course of history by intervening before disease sets in. This is true for a number of illnesses including diabetes, heart disease, stroke, Alzheimer’s, osteoporosis and some cancers. Your assessment will involve screening for these and other common illnesses and if you are at risk for less common medical problems we will explore that too. Once we have assessed your current health status Dr. Sweeney will develop a program to address the risk factors. For example, we will treat and closely monitor your weight, insulin, cholesterol, homocysteine, blood pressure and refer you for advanced diagnostic tests as needed. We use the 7 pillars framework for your treatment plan. (See question 2 above.)

If you already have diabetes or other established disease Dr. Sweeney will develop a program to control or reverse that as well.


Aesthetic medicine is a new area of medical expertise which uses minimally invasive procedures to enhance physical appearance. It employs non-surgical treatments to prevent or reverse changes in appearance caused by age, the sun and other environmental factors. Typically, the procedures are more affordable than surgery and do not carry the same risks or recovery time. They are also used for many age-related changes that surgery does not address and in cases where surgery is not yet appropriate. For example, when there is sagging or loss of fullness in the cheeks a facelift may be too radical. When aging changes are early, dermal fillers rather than surgery may be a better choice and can reverse up to a decade of lost volume and restore a more youthful look to the cheek, under-eye and the smile lines in the cheeks. In some cases, patients are choosing to use our treatments as a means to prevent the changes that aging brings.

Cosmetic medical treatments are a luxury treatment but are often much less expensive than people think, especially if you consider their effectiveness. We can’t give an accurate assessment of price for most treatments without consultation because most treatments are individualized but to give you an idea, a typical Botox treatment for the glabellar frown lines (those ones between the eyebrows) costs about $400-$450. It lasts for 3-6 months. The lasers and dermal fillers are in the same ballpark. When you calculate how much it costs to get your haircut and coloured every month, the cosmetic treatments and hair care are in the same price range. The difference is that we are used to paying for great hair and pay for it monthly rather than every 3-4 months in a larger payment. The great news about Botox and other treatments is that they last longer the more you do them. Many of our patients who have been using Botox for over a year now only need to be treated twice a year.

No cream can reverse significant wrinkles or even deeper lines, but they help with skin texture and tone and minimize fine lines and pores. At Live Young, we see them as support for the treatments we provide at the clinic. Some can help stimulate collagen and others are exfoliators. Vitamin A or Retinol/ Retinoic Acid remains the gold standard for wrinkle treatment but we also carry the peptides (Argireline and others) and other active ingredients for those who can’t tolerate vitamin A or who want an added boost.

The key is getting the right ingredients, in sufficient quantities, in a delivery system that will deliver the active ingredients into the skin’s deeper layers. Our clinic sells skincare that does all of this, as well as a selection of sunscreens for protection. Our prices are very reasonable – you don’t need to spend a fortune to get what you need in skin care.

I have read that microdermabrasion will treat skin discoloration such as brown spots; I have also heard you need a laser to do this.

Laser or IPL is the best way to treat colour discoloration in the skin that is caused by pigment deposits or dilated blood vessels. Microdermabrasion is a superficial treatment that polishes the skin and improves the sheen but does not go deep enough to lift the brown pigment deposits that cause sun or age spots. Both can be used together to get great looking, healthy skin because they treat all the skin layers.

Photorejuvenation is a series of laser or IPL treatments that gradually improve skin texture, decrease redness and broken capillaries and lighten dark spots on the skin. It is most often used for treating the face, chest, arms and hands but can treat any skin area. The treatments should not be done if you have a tan because the light will be attracted to the melanin in the skin causing the tan and away from the problems we want to target. Following the treatment, you need to avoid tanning because your body may get irregular pigment if you tan in the four weeks after. We encourage you to give up tanning altogether as ultraviolet light is the most important accelerator of skin aging and promotes skin cancer.

That depends on where the wrinkles are and how deep they are. Fine lines treated with collagen boosting procedures such as a course of microdermabrasion and peels. Better yet we can increase collagen production with 3-5 laser or IPL treatments (this is called photorejuvenation) or with 1-3 photodynamic therapies where we combine Levulan with the IPL.

Thicker lines and wrinkles are often best treated with Botox, especially in the upper face or the dermal fillers, which are best in the lower front face. These treatments address the wrinkles or folds at a deeper level and have the added advantage of rebalancing the facial expressions, so you do not look so tired, sad or stressed.

Botox is often confused with botulism poisoning. The two are very different just like penicillin is very different from the mould it comes from. With botulism poisoning, large quantities of toxin are ingested usually from a contaminated food source. When Botox is used for cosmetic and medical treatments the protein is purified from its natural source. This purification is carried out under strict quality control by the pharmaceutical company Allergan. During the treatment, tiny amounts are delivered by injection into targeted muscle groups to relax them. There are no systemic effects.
Botox has been used in medicine for over 20 years and is extensively studied for its safety. It has a better safety and tolerability profile than many drugs we do not think twice about taking such as the use of tetracyclines when treating acne or rosacea. It is so safe that it’s approved for use in children as young as two years old.

There are a lot of dermal or soft tissue fillers available today. Dermal fillers are categorized as temporary, semi-permanent or permanent. We use either temporary or semi-permanent fillers for several reasons but most importantly because as our face ages and descends due to volume loss and gravity the appearance of permanent filler in the face may become less desirable. In addition, fashion changes, as well as our face structure and what looks great at one time, may not be the look you want at another. We see this sometimes with permanent makeup.

At present, Dr. Sweeney is using dermal fillers which come from hyaluronic acid or collagen, but she is continually reviewing and evaluating what is new. These two products have a track record for safety and give natural-looking results.

Typically, the dermal fillers work best in the lower face for lines and folds and are used in the cheeks, lips, jaw line and under the eyes to restore the volume that’s lost with time. They are used alone or in combination with Botox and photorejuvenation for a real impact. At all times, our focus is to deliver exceptional results which appear natural.

There is a big difference. Dr. Sweeney will see you for your initial assessment and will perform most procedures or directly oversee them. Being assessed and treated by a medical doctor ensures you will be given advice with scientific backing and be recommended treatments which are not only effective but also safe. The treatments will be different as the actual laser treatments are given at higher settings with a more powerful system. Not only will your treatment have the benefit of medical expertise but you can be assured of the appropriate follow-up and post-treatment care and will be in the hands of a professional who can manage complications should they occur. This holds true for microdermabrasion, chemical peels, Botox, Lipodissolve and the dermal fillers.

Be careful of facilities claiming to be medispas. To be called a medical spa they must have a medical director who is a licensed MD.

The term laser is used for all light-based systems. However, not all light-based systems are created equally and, I am afraid, your friend was probably treated with a system that did not deliver enough energy to do the job. This is both a good thing and a bad thing. On the positive side, from a safety standpoint, the higher-powered medical lasers should only be used by a well-trained medical professional. In the wrong hands, even the weaker lasers sold to spas have caused unsightly pigment changes in darker skinned individuals. The bad news for your friend is that she had a disappointing result for which she invested both time and money.

Our results are what we predict, for the most part, but as with all things dealing with the human body, results vary from person to person so we cannot guarantee results. However, I can assure you that you will get scientifically based advice and professional treatment.

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