Look Your Best This Year & The Next

Sex and Aging

 

Does anyone else find it odd that the Cialis commercial uses two bathtubs to infer intimacy? I think a single bathtub with two people sounds like more fun than one bathtub per person. As the commercial suggests, increased age puts a damper on intimacy.

How does the aging process affect sex hormone production? (Hint- It doesn’t make your levels go up!) In men, testosterone (T) levels begin to drop at age 30 and continue to decrease approximately 1% per year. Estrogen (estradiol) levels in women don’t have a severe drop until menopause (average age 52). Estradiol is a down-stream product of testosterone. Women make the majority of their estradiol from testosterone. Testosterone is converted into estradiol by the enzyme aromatase. Testosterone levels begin to drop in women as early as age 20 to 25, and are ½ normal by age 40.

All doctors are educated on decreasing sex hormone production in women. Hormone replacement therapy (HRT) has been used for years to slow vaginal atrophy, restore vaginal lubrication, and maintain the sex drive.  Hormone replacement therapy in men is a different story…

I had a six-month personal history of increased fatigue to the point that after our kids were put to bed at 08:30 I was going to bed by 09:30 due to exhaustion. I didn’t have a problem with sexual dysfunction, but you don’t have a lot of sex when you are always tired. We finally ordered blood tests and my testosterone level was low. What!!! I was only 40 when my low T was diagnosed.

Andropause, or MANopause (not a medical term) describes the normal decrease in testosterone production in men. Typical signs of low “T” in men and women include fatigue, depression, loss of muscle mass, and decreased libido. I would venture that most men and women over age 50 that tire more easily and start to notice a decrease in muscle mass just attribute the signs to getting older. Unfortunately, the testosterone blood test values are so broad that a “low-normal” level can create the above symptoms. Hopeless or terminal diagnosis? Not at all. Within a week of starting replacement I was back to my early morning workout routine with a return to my former energy levels.

Doc- you’re saying that if I am above age 30 and have symptoms of low testosterone you would recommend starting hormone replacement? Even though I had my levels checked and they were in the normal range? Hormone replacement is a personal decision. Very rarely do I actually recommend patients start BHRT. I discuss their symptoms, review lab results, and review the likely results of starting replacement. We don’t know if your lab results are normal for YOU. We don’t have baseline lab levels at age 14, 18, and 22 when your body was stabilizing hormone production.

Sex and the sex drive revolve around hormonal responses. As we age, our physiologic hormone levels decline and sex can become more of a chore than a recreational pursuit. Restoring hormone levels to normal is possible, and can make a BIG difference (no pun intended).

Low T made it personal for me. Take a look at the most common symptoms and count how many you have. Low energy or fatigue, poor sleep, anxiety, depression, difficulty concentrating and remembering, headaches, difficulty losing weight, loss of muscle mass, and low libido. Erectile dysfunction in men is a late sign and typically doesn’t occur until after other symptoms have been present for a while.

Questions about bioidentical hormone replacement therapy? Call or stop by and make an appointment for a complimentary consultation with me. As for me? I’m sinking back under the water of our bathtub built for two. My wife is getting impatient…

Disclaimer: Dr Stephen Rath, MD, DABA is a board certified anesthesiologist, Air Force flight surgeon, paramedic, and pilot as well as the owner and medical director of Fusion Medical Spa located in Ruidoso, NM. He is not an expert on bathtubs or plumbing fixtures, but he will be happy to help you with your “medical plumbing emergencies.” Comments or questions? Email us at: Contact@FusionMedicalSpa.net.

Data Driven Docs – Part 3: Let’s Talk About HPV, Let’s Talk About You and Me

 

The article series, Data Driven Docs, is designed to provide a behind-the-scenes view into a few areas of medicine that should be driven by data or best practices and for whatever reason are not. Sometimes our practices are driven, as mentioned in previous articles, by third parties or regulation agencies. Sometimes we ignore best practices because our patients ask us to.

As a guest writer, I will make a departure from the glamorous world of aesthetic and flight medicine and delve into something as mundane as the Pap smear. Men – you are not yet welcome to put the paper down and leave. I’m going to talk about something you might find interesting as well if you are a bit of a science nerd. Ladies – I know that Pap smears are something that you have historically felt were your annual duty. Skip them and you could be sure to feel the wrath of your disapproving provider and potentially even have to beg for your birth control. Take heart, times are changing.

Described initially by Dr. George Papanicolaou in 1943, the Pap smear has been the single most life saving screening test we as a species have ever dreamed up. Cheap, easy, fast and readily available; it is performed around the world more often than any other cancer screening test in existence. Is it perfect? No. Is any screening test? No. We have, however, gotten much closer to perfect since 1943. I’ll explain. A Pap smear consists of cells from the cervix taken during a pelvic exam being evaluated under a microscope to see if they have any characteristics of cancerous cells. That was, until 1999, the best we could do. In 1999, the FDA approved a molecular test to diagnose the viral infection (human papilloma virus or HPV) that caused cervical cancer. The test was not easy to use until Pap smear collection changed a bit and we could test for the virus without a second visit or second pelvic exam. After a few years with the HPV testing technology and some more studies, we began to understand more fully the progression from viral infection to cancer. We began to see that most of the women who had this virus got rid of it all by themselves in a year or two. In 2006, the Pap smear screening intervals changed as women were risk stratified by their age. Our management of borderline Pap smears changed to include HPV testing. In 2012, the recommendations changed again to further extend the screening interval to five years.

Five years?!? I have many patients who don’t believe it and feel that skipping their Pap smear is akin to a death wish. I have heard a number of times “I know about the new recommendations but I would feel better if you just went ahead and did my Pap smear.” Before you start to feel like five years is long enough to slip through the cracks consider that screening tests are a balancing act. They don’t diagnose anything. It takes more testing, more expense and more emotional trauma to make the diagnosis and the job of the screening test is to help us determine when further testing is warranted. The new guidelines were designed to get more bang for our buck. If you have an abnormal pap smear in 2012 we are already much closer to a significantly risky diagnosis than we were with an abnormal Pap smear in 1998. I am in no way arguing that abnormal Pap smears should not be investigated appropriately. In some cases this includes repeating the test in a year. In some cases, this includes a diagnostic test called a colposcopy. In some cases, the Pap smear is significantly abnormal enough to warrant skipping the diagnostic test and going straight to treatment. In NO cases does it ever include repeating the Pap smear in few months and believing a better result. At your next visit, ask where you fall on the screening interval spectrum. Ask where you are spending your healthcare dollar. Let’s make them count.

Disclaimer: Dr. Keri Rath, MD, FACOG is a board certified Ob/Gyn in Ruidoso, New Mexico. She finds molecular diagnostic technology exciting as she was originally a biochemistry and genetics nerd and will be happy to whip out a flow chart or draw an explanation on exam table paper for you if you want one. Comments or questions? Email Contact@FusionMedicalSpa.net.

Data Driven Docs – Part 2

 

The article series, Data Driven Docs, is designed to provide a behind-the-scenes view into a few areas of medicine that have fallen well below the standards that we, as healthcare recipients, should find acceptable. The first article discussed the antiquated and outlawed (at least in the UK) practice allowing the use of white coats, long-sleeve shirts, and ties in the patient care setting. This article examines the use of scrubs in the health care setting.

In 2010, the Association of periOperative Registered Nurses (AORN) published Perioperative Standards and Recommended Practices. This update serves as the practice standard quoted during credentialing visits from agencies such as the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO). One would assume that any document referenced by a credentialing organization would be the last word in the setting of standards (ask any military veteran the meaning of “assume” if you need a chuckle).

Recommendation I of the AORN’s 2010 Perioperative Standards and Recommended Practices states that “All individuals who enter the semirestricted and restricted areas of the surgical suite should wear freshly laundered surgical attire intended for use only within the surgical suite.” The document cited as a reference for Recommendation I is the article by Dr Nathan Belkin, PhD published by the Association for Professionals in Infection Control and Epidemiology (APIC). Dr Belkin’s APIC State of the Art Report article entitled Use of scrubs and related apparel in health care facilities was designed to “provide infection control professionals and others with a process for making decisions regarding the use of these garments in health care facilities”. So far, so good, right?

Dr Belkin’s summary? “There is no scientific evidence that the use of scrubs or other related apparel contributes to either the cause or the prevention of infections associated with health care facilities.”  Hmm… One of the leading authors on infection control states that there isn’t any science behind Recommendation I of AORN’s 2010 document. Even more interesting is that the AORN thought to use his article to substantiate their recommendation. The other resource cited was the Center for Disease Control’s 1999 article Guideline for Prevention of Surgical Site Infection. Neither my wife nor I could find a reference to support the wearing or non-wearing of scrubs (plenty of references to surgical hand and body scrubs and the best soaps to accomplish each).

So, we have a guideline document used by credentialing agencies that is NOT based on science. I’ll bet you didn’t think there was a place for science fiction buffs among reviewers of medical literature! To add insult to injury, we recently had an inspector at our own Lincoln County Medical Center list the AORN guideline as a reason to alter our local policy. Our inspector was paid by the Greeley Company to pre-screen our hospital prior to an actual JCAHO inspection. If you haven’t been able to read between the lines, let me spell this out for you. We (Lincoln County residents) are using our healthcare dollars to pay an independent consultant to tell our hospital administration how to “best” run our local facility. This consultant is using data not based on science, but science fiction. My two cents? If we are going to pay a consultant to come in prior to the actual JCAHO inspection, we should expect them to give us recommendations based on good data that actually makes a difference in patient care!  Healthcare dollars aren’t endless.  We MUST use them wisely.

Join me in using data to drive our healthcare system toward increased efficiency, increased patient safety and decreased cost. Please feel free to email me questions relating to community medical policy during this article series. Stay tuned for a data driven checklist designed to keep you safe.

Disclaimer: Dr Stephen Rath, MD, DABA is a board certified anesthesiologist, Air Force flight surgeon, paramedic, and pilot as well as the owner and medical director of Fusion Medical Spa located in Ruidoso, NM. He wears his own scrubs because hospital scrubs don’t fit and they chafe. Comments or questions? His email address is: DrRath@FusionMedicalSpa.net.

Data Driven Docs- Part 1

Dateline September 2007: The BBC rocks the medical establishment with a report on the United Kingdom’s National Heath Service ban on the wear of white coats, ties, and long-sleeve shirts during clinical activities. What! Doctors aren’t allowed to wear white coats or ties when they see patients! Strangely enough, this announcement wasn’t met with the expected outrage in the United States due to the data behind the new policy. Numerous studies have shown that white coats and full-length ties are fomites. What’s a fomite? According to Wikipedia, a fomite is “any inanimate object or substance capable of carrying infectious organisms, such as germs or parasites, and hence transferring them from one individual to another.”

Picture this. You are in your usual state of wellness and see your primary care physician (PCP) for your annual wellness exam. Your PCP sees a diabetic patient with a methicillin-resistant staphylococcus aureus (MRSA) infection prior to your 15-minute visit. As an aside, MRSA is now prevalent in most communities, including Ruidoso and the surrounding areas. Although your doc does an admirable job with hand-washing before and after the wound check, and wears gloves during actual patient contact, he thinks it is important to present a professional appearance and dutifully wears a long-sleeve shirt and tie and completes the look with the trademark white coat. We’ll give him extra credit for daily laundering of his white coat (folks-it doesn’t happen). During his exam, and unseen by the doc, the sleeve of his coat and the tip of his tie brushes against the open wound surface, picking up the MRSA bacteria without visible soiling of the sleeve or tie.

You are the next patient. Will you ask your doc to start out with a new wardrobe prior to seeing you? How many times have you asked your doctor to remove his shirt, tie, and white coat? Never? Me neither.

Numerous studies show that patients are placed at greater risk for infection due to the trademark professional appearance that most docs maintain. The United Kingdom made great strides in the fight against spread of hospital-acquired infections when they banned white coats and ties. I remember reading the initial report of the ban. While a professional appearance was required during my residency training, I hung my white coat on the door and wore short sleeves and a bow tie. (And yes, I CAN pull off the bow tie look.)

As a patient, I expect my physician’s highest priority is my safety and wellness. As such, professional dress should be redefined where my safety and wellness are the highest priority. Goodbye to the suit and tie! I expect my physician to wear either scrubs or a short sleeve shirt (without a coat or long tie) to ensure I am not placed at any greater risk. I understand that it is unprofessional to place me at greater risk for the sake of appearance or personal pride. The data supports this paradigm shift, not only in the United Kingdom but in the United States.

Join me in using data to drive our healthcare system toward increased efficiency, increased patient safety and decreased cost. The data is there. Let’s use it for our benefit.

This is the first article in a series entitled “Data Driven Docs”. The series will examine the available data concerning some important medical issues and compare current hospital policies and procedures with data-supported guidelines. Please feel free to email me questions relating to community medical policy during this article series. Stay tuned for a data driven checklist to keep you safe. Use it to replace the profit driven survey that “keeps you satisfied.”

Disclaimer: Dr Stephen Rath, MD, DABA is a board certified anesthesiologist, Air Force flight surgeon, paramedic, and pilot as well as the owner and medical director of Fusion Medical Spa located in Ruidoso, NM. He keeps a white coat solely for picture opportunities. Comments or questions? His email address is: DrRath@FusionMedicalSpa.net.

Shootin’ for the Smiley – Part 2

Reader question of the week: “You recently started a friend of mine on bioidentical hormone replacement therapy using testosterone pellets. I was surprised to hear that her hot flashes and night sweats went away even though she isn’t receiving any estrogen or estradiol. Can testosterone fix all the menopause symptoms?”

Answer: Yes! Testosterone CAN fix most (if not all) symptoms associated with menopause as well as other non-menopausal symptoms. Menopause actually occurs because the body’s precursor hormones (testosterone and androstenedione) decrease to the point that there isn’t enough to convert into estradiol. Testosterone is converted to estradiol in fat cells by the enzyme aromatase. I do place a few patients on estradiol pellets if their estrogen symptoms (hot flashes, night sweats, vaginal dryness) are unbearable, but most patients have more relief when the body is allowed to naturally convert testosterone to replace estradiol.

The body typically responds better to natural processes. While my last article called for a paradigm shift in how physicians and patients both respond to medical problems, this week’s article will focus on how physicians can use medicine to restore normal function. To review- Physicians better serve their patients by treating symptoms and using laboratory and clinical tests to validate the symptoms (treat the patient and not the paper). Patients need to hold physicians accountable for providing good health care (ask questions, be involved, and expect wellness counseling). I would like to continue the call for change by discussing how we all can improve our response to aging or the loss of normal.

Aging is a natural process and certainly beats the alternative. Aging is NOT a graceful process. Aging entails a lot of negatives: decreased memory and concentration, decreased energy levels, decreased restful sleep, decreased libido, and for men, decreased erections. The increases? Increased risk of osteoporosis, increased cholesterol levels, increased blood pressure, increased anxiety, and increased depression. Feel free to add in a few of your own. Definitely a huge combination of NOT graceful!

What can we do to mitigate the negatives associated with aging? A healthier lifestyle is a great place to start. Better diet, more exercise, weight loss, and smoking cessation (if necessary) all contribute to a healthier you. Interestingly, the symptoms listed in the paragraph above which we typically associate with the aging process all respond to bioidentical hormone replacement therapy (BHRT).

As a nation we are using up our natural hormones faster than ever before. Our high stress lifestyles, which usually include poor sleep, poor diet, and lack of exercise, cause a decrease in hormone production at an earlier age. While the standard of care isn’t to check women’s hormone levels prior to starting BHRT, I do need to look at a few lab tests for the guys. Similar to the military testing showing pre-pubertal testosterone levels in young men exposed to combat stress; I have seen men as young as 22 with low free testosterone levels. Our stress and sex hormone levels are peaking sooner and falling faster than ever before. At the same time, we have added to our average longevity. The result? We live longer feeling like we are dying.

Stress does bad things to your hormone levels. Adequate sleep, a good diet, and exercise all contribute to maintaining normal hormone levels for as long as possible. Even when you are doing everything right, environmental factors beyond your control will likely cause you to outlive your ability to adequately produce the hormones you need. Feel like your body is running on empty? I can help!

Disclaimer: Dr Stephen Rath, MD, DABA is a board certified anesthesiologist, Air Force flight surgeon, paramedic, and pilot as well as the owner and medical director of Fusion Medical Spa located in Ruidoso, NM. While he doesn’t have a solution for the chronic shortage of petroleum products, he does have a solution for low hormone levels. Comments or questions? His email address is: DrRath@FusionMedicalSpa.net.

Running on Empty

Reader question of the week: “You recently started a friend of mine on bioidentical hormone replacement therapy using testosterone pellets. I was surprised to hear that her hot flashes and night sweats went away even though she isn’t receiving any estrogen or estradiol. Can testosterone fix all the menopause symptoms?”

Answer: Yes! Testosterone CAN fix most (if not all) symptoms associated with menopause as well as other non-menopausal symptoms. Menopause actually occurs because the body’s precursor hormones (testosterone and androstenedione) decrease to the point that there isn’t enough to convert into estradiol. Testosterone is converted to estradiol in fat cells by the enzyme aromatase. I do place a few patients on estradiol pellets if their estrogen symptoms (hot flashes, night sweats, vaginal dryness) are unbearable, but most patients have more relief when the body is allowed to naturally convert testosterone to replace estradiol.

The body typically responds better to natural processes. While my last article called for a paradigm shift in how physicians and patients both respond to medical problems, this week’s article will focus on how physicians can use medicine to restore normal function. To review- Physicians better serve their patients by treating symptoms and using laboratory and clinical tests to validate the symptoms (treat the patient and not the paper). Patients need to hold physicians accountable for providing good health care (ask questions, be involved, and expect wellness counseling). I would like to continue the call for change by discussing how we all can improve our response to aging or the loss of normal.

Aging is a natural process and certainly beats the alternative. Aging is NOT a graceful process. Aging entails a lot of negatives: decreased memory and concentration, decreased energy levels, decreased restful sleep, decreased libido, and for men, decreased erections. The increases? Increased risk of osteoporosis, increased cholesterol levels, increased blood pressure, increased anxiety, and increased depression. Feel free to add in a few of your own. Definitely a huge combination of NOT graceful!

What can we do to mitigate the negatives associated with aging? A healthier lifestyle is a great place to start. Better diet, more exercise, weight loss, and smoking cessation (if necessary) all contribute to a healthier you. Interestingly, the symptoms listed in the paragraph above which we typically associate with the aging process all respond to bioidentical hormone replacement therapy (BHRT).

As a nation we are using up our natural hormones faster than ever before. Our high stress lifestyle, which usually includes poor sleep, poor diet, and lack of exercise, causes a decrease in hormone production at an earlier age. While the standard of care isn’t to check women’s hormone levels prior to starting BHRT, I do need to look at a few lab tests for the guys. Similar to the military testing showing pre-pubertal testosterone levels in young men exposed to combat stress; I have seen men as young as 22 with low free testosterone levels. Our stress and sex hormone levels are peaking sooner and falling faster than ever before. At the same time, we have added to our average longevity. The result? We live longer feeling like we are dying.

Stress does bad things to your hormone levels. Adequate sleep, a good diet, and exercise all contribute to decreasing stress and maintaining normal hormone levels for as long as possible. Even when you are doing everything right, environmental factors beyond your control will likely cause you to outlive your ability to adequately produce the hormones you need. Feel like your body is running on empty? I can help!

Disclaimer: Dr Stephen Rath, MD, DABA is a board certified anesthesiologist, Air Force flight surgeon, paramedic, and pilot as well as the owner and medical director of Fusion Medical Spa located in Ruidoso, NM. While he doesn’t have a solution for the chronic shortage of petroleum products, he does have a solution for low hormone levels. Comments or questions? His email address is: DrRath@FusionMedicalSpa.net.

Shootin’ for the Smiley

Reader question of the week: “My friend told me that you started her on bioidentical hormone replacement therapy without first checking any of her hormone levels. Is this a good idea?”

Answer: The American College of Obstetricians and Gynecologists (ACOG) just released an updated version of screening guidelines (dated 2/6/2013). They do NOT recommend checking hormone levels. Instead, they recommend asking the patient about her symptoms. While I don’t always agree with consensus statements, I wholeheartedly support the new ACOG guidelines. They have adopted a very unique position in medicine- Treat the Patient! Too many medical schools center their education on treating the lab results printed on paper. The problem in treating the paper is that we don’t have an appropriate baseline; we don’t know what the patient’s testosterone and estradiol levels were when she was younger and symptom free. The gold standard treatment is to start the patient on bioidentical hormone replacement and follow their symptoms. I will check thyroid levels and start my patients on natural thyroid replacement (Armour) if they haven’t had thyroid levels checked recently, but otherwise- no labs necessary. Keep up the great questions!

Any Ruidosoan who drives on Hull Road has seen the new interactive speed limit signs. The signs incorporate radar speed tracking and rate your compliance with an icon. We like to receive positive feedback, and these interactive signs capitalize on the studies that have verified their effectiveness. I use the signs as a personal challenge to make sure I get the smiley face from the moment the sign “sees” my vehicle. I’m sure Judge Rankin will appreciate seeing me in her courtroom less frequently as well! (Sorry, ma’am.)

As physicians, we tend to shoot for the smiley when we interact with our patients. We like to please, and the tendency is to order tests that may not be necessary or put patients on antibiotics for a viral illness (antibiotics do nothing to viruses) when the patient requests we do so. Constrained and packed schedules only make things worse. Instead of educating the patient on why their request is unnecessary and could actually cause harm, we tend to comply to ensure we get the smiley (don’t get me started on patient satisfaction surveys again).

As patients, we want to be validated and feel like the visit has been productive. If we walk out of a doctor’s office without a new Dx (diagnosis) that can be Tx (treated) with an Rx (prescription), we feel like the visit has been wasted. Our docs have taught us we don’t have to participate in our own wellness other than to take the medications prescribed.

I would like to again suggest a paradigm shift. As physicians, we need to return to patient based medicine. Treat the patient, not the paper. Only order labs or tests that will create a change in the treatment plan. As patients, we need to hold our physicans and healthcare providers accountable. If you are overweight and a physician doesn’t provide some counseling as to how to lose weight, ask them why they didn’t. If you smoke, expect to hear about smoking cessation. If your doc orders labs or tests, ask them what they are looking for and how the results will change the treatment. Be interactive with your healthcare!

Change is difficult and often resisted. Sometimes, small things like interactive signs can be the catalyst needed to help effect change. I pay better attention to my speed now that I have a goal. I’m shootin’ for the smiley!

Disclaimer: Dr Stephen Rath, MD, DABA is a board certified anesthesiologist, Air Force flight surgeon, paramedic, and pilot as well as the owner and medical director of Fusion Medical Spa located in Ruidoso, NM. His possible career in law enforcement has been (temporarily?) curtailed by his moving violations. Comments or questions? His email address is: DrRath@FusionMedicalSpa.net.

 

Retirement

Reader question of the week: “My friend told me that you recommended that she have sex a minimum of three times per week. Isn’t this excessive?”

Answer: From whose point of view? Her husband might think three or more times a week is excessive if his testosterone (T) is low. I was there. Sleep is exceedingly more important as the T level decreases. Younger men? Thirty minutes sleep is sufficient if the opportunity presents itself. I replaced your friend’s testosterone and she WANTS to have sex at least three times per week. Three times a week is a good number to maintain the vaginal mucosal health. The old adage rings true- If you don’t use it, you lose it! What other doctor will give an order for sex three times a week?

At Fusion Medical Spa we primarily deal with reversing the aging process in the body. Whether reversing the effects of age on the endocrine system through bio-identical hormone replacement therapy, or reversing the effects of age damage in the skin through lasers and dermal fillers; the end effects are the same- a body that looks and feels younger.

New terms for the same definition of reversing the aging process are “anti-aging”, “regenerative”, and “ageless” medicine. According to the World Bank, life expectancy in the United States went from 70 years in 1960 to 78.2 in 2010. Our life expectancy has increased due mainly to advances in medicine. However, these advances have come with a price. Instead of adding years on the “front-end”, the additional years are added after age 70. Instead of years with extra youth and vitality, the additional years come after the body has “retired”. Anti-aging and regenerative medicine focuses on restoring youth and vitality to the “retired body”.

Would you rather have quantity or quality? I can tell you from my personal experience with low testosterone at age 40- quality wins. I have no desire to live extra years feeling like I am just punching the clock. I have already received my 20-year letter from the military telling me that I am eligible for retirement. Why retire? I have finally achieved a rank where my opinion is valued and I can make a difference. Moreover, my body doesn’t feel like it is ready to retire now that my hormones are balanced.

Have you already retired? Don’t get me wrong; retirement from the workforce can be a great thing. Premature retirement of your body? Definitely not a great thing. One of your main jobs after retirement should consist of working to keep your body in good shape. What can you do to combat the aging process? Focus on proper diet, exercise, and a healthy lifestyle. Take care of your body. Do an inventory of how you feel, and then take steps to change the negatives into positives. Reduce your prescription medication intake if possible. Weight loss and a healthy diet typically result in reduced need for medications to control diabetes, high blood pressure, and high cholesterol. Invest in you!

Final note: I appreciate the positive response my articles have received. More and more people have joined the fight against the aging process and I need to spend more time dedicated to helping them win the war. To that end, I will be moving my articles from a weekly format to a twice a month format. I will always be available for a free consult at my practice or to answer reader questions submitted via email. Thanks for your support!

Disclaimer: Dr Stephen Rath, MD, DABA is a board certified anesthesiologist, Air Force flight surgeon, paramedic, and pilot as well as the owner and medical director of Fusion Medical Spa located in Ruidoso, NM. He is eligible for retirement, but hasn’t yet figured out what he wants to do when he grows up. Comments or questions? His email address is: DrRath@FusionMedicalSpa.net.

Questions and Answers

This issue will be dedicated to answering a few of the questions that have stacked up in the past few weeks.

Reader question: “I have been thinking about fixing the ‘sunken’ look in my cheeks. What is the best filler for my problem?”

Answer: Volume loss in the upper cheek area is a common complaint. During the aging process, not only does the face lose the “apples” in the cheeks; it also suffers from the breakdown of collagen and elastin fibers, contributing to the lines and wrinkles that appear beside the nose (nasolabial folds), beside the mouth (marionette lines) and jaw line (pre-jowl or jowl). Most people actually experience some degree of cheek volume loss, although women seem to notice the problem more frequently than men. Do some people watching. You are not alone; and “sunken cheeks” will not adversely affect your health. That said, if you still would like to address your issue, there is a big difference among dermal fillers. Dermal fillers can be divided into two major categories- hyaluronic acid (HA) and non-HA fillers. HA fillers like Juvederm, Restylane, and Perlane use a cross-linked hyaluronic acid gel matrix to restore volume to areas that have lost the youthful appearance. Non-HA fillers are typically designed to restore volume while also stimulating production of new collagen. (Collagen based fillers have a high potential to create allergic type reactions and are generally not used anymore). While HA fillers like Juvederm can restore some of the lost volume, they don’t have the ability to stimulate collagen and most HA fillers do not work well in the cheek area. Radiesse is a non-HA filler composed of calcium-based microspheres suspended in a gel matrix. The microspheres do a great job in providing extra volume in difficult to treat areas while the gel matrix stimulates your body to produce collagen to extend the results of the filler. Radiesse is less expensive when considering the amount in each syringe, lasts longer, and is a better filler choice for most areas of the face.

Reader question: “I have symptoms of low testosterone that haven’t improved despite taking ‘testosterone’ supplements. Am I beyond help?”

Answer: Failure to respond to supplements that are supposed to naturally increase your body’s testosterone (T) production does not mean that your body won’t respond to real T. I will admit that I have tried the best supplements at great expense in an effort to combat low T. The best supplements did raise my T level slightly, but not enough for me to notice a difference in my symptoms. Genuine testosterone is prescription only and in some cases can be less expensive than the most effective supplements. In most cases, replacing a daily designer coffee habit will cover the cost of T replacement. Don’t give up! I have yet to see a single patient who has not responded to prescription testosterone replacement.

Disclaimer: Dr Stephen Rath, MD, DABA is a board certified anesthesiologist as well as the owner and medical director of Fusion Medical Spa located in Ruidoso, NM. Comments or questions? His email address is: DrRath@FusionMedicalSpa.net

A Bright Ray of Sunshine?

Reader question of the week: “I’ve lost my tan over the past few months. Is it safe to “top off” my tan in a tanning booth?”

Answer: No. A July 2012 study posted in the British Medical Journal reported a 20% increase in melanoma skin cancer risk in patients that had EVER used a tanning bed as well as a 42% increase in melanoma risk in heavy users. Tanning before you have reached age 35? An 87% increased melanoma risk compared with those who have never tanned. Ouch! And not just from the sunburn possibility. Think you are alone? I’m afraid I fall into the 87% increased risk category.

I always tell my patients that none of my soapboxes are too high as I have made the majority of mistakes personally; and yes, I logged time in a tanning booth when I was younger. However, our medical knowledge in the aesthetic and anti-aging field has been advancing exponentially. We now know that not only does sun tanning increase your risk for skin cancer, it also accelerates the aging process in your skin. Take a look around the next time you are in a public place. You can identify the tanners by the worn, weathered look of their skin. The modeling and fashion industries have recognized this. You either see spray on tans or the new “bright white” look made more popular by the Twilight movie series (I still get to keep my man card, I have only seen short clips due to the bad influence of my wife).

You’re saying that sun tanning is bad, it accelerates the aging process, and increases my risk for skin cancer. Is melanoma really that bad? That depends. Is death considered a bad outcome? While the 2012 cancer death statistics have not been officially finalized, the National Cancer Institute projects that more than 9000 people in the United States alone will die of melanoma skin cancer in 2012. Whoa! The future doesn’t look as bright and sunny anymore. While the melanoma death rate is less than 6% for the under 45 age group, it more than doubles for the 45-54 age range (13.5%) and continues to increase until it reaches a high of 24% for the 75-84 age group.

Well doc, like you, I made mistakes when I was younger. What can I do to decrease my risk of skin cancer death? Self-inspection is first and foremost. If you have read the previous series of articles dealing with sex you should be familiar with getting naked with your partner. This is an instance where you need to keep the lights on, as skin cancer likes the shadows. Start with a visual inspection of your partners skin and specifically look for skin lesions larger than a pencil eraser. Red flags are increasing size, irregular border, changing color, irregular margins, and changing texture. While a personal or partner exam is great for identifying new or changing skin lesions, it doesn’t obviate the need to have a board-certified dermatologist perform an annual skin inspection. I recommend that my patients see a board-certified dermatologist by age 40 if they have a history of increased sun exposure and age 50 (also the age for your first colonoscopy) if they don’t report active sun tanning.

We don’t have a dermatologist in Ruidoso, but there are a couple in Roswell, and more in Las Cruces and Albuquerque. Make sure you check your physicians credentials on the New Mexico Medical Board website (www.nmmb.state.nm.us) and verify board certification at www.abms.org prior to your visit. Board certified dermatologists have four years of specialty training and thousands of patients worth of experience working to keep you alive. Until then, do your part. Stay out of the tanning beds and wear sunscreen!

Disclaimer: Dr Stephen Rath, MD, DABA is a board certified anesthesiologist as well as the owner and medical director of Fusion Medical Spa located in Ruidoso, NM. He isn’t a dermatologist, but he is doing his part to educate patients about the risks of skin cancer. Comments or questions? His email address is: DrRath@FusionMedicalSpa.net.

Fusion Medical Spa