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

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.

Reader question of the week: “A friend of mine recently had her arms treated for sun damage. They painted her arms with a chemical solution and then activated it with a light. Is this safe?” Answer: While this type of treatment isn’t considered dangerous, the chemical burn can cause permanent scarring and is certainly not the current standard of care for hyperpigmentation (sun spots, age spots, liver spots) caused by sun exposure. I have patients that have previously either had hyperpigmentation treated with either burning or freezing that have needed to have their scars removed with our Palomar laser. While burning or freezing the spots will likely remove them, it also damages the surrounding skin. The standard of care for hyperpigmentation is Intense Pulsed Light (IPL) treatment, known as a photofacial when performed on the face and photorejuvenation when performed on other body parts. Have her Google “Palomar photofacial”. The first result will take her to the Palomar website where she can learn about photorejuvenation and/or laser scar removal.

No Sex, No City? That’s right! Without sex the human race will cease to exist.

While sex must be used for procreation, many of us use it for recreational purposes as well. Like to see some simple math? More T = More Sex. Less T = Less Sex. Hmm. Seems like those of us in relationships should be doing things to optimize our testosterone production and replacing it once the T starts to drop. Optimizing testosterone production in men and women revolves primarily around two areas: diet and exercise.

Diet. You are what you eat. Diets high in sugars and saturated fats are not only detrimental to testosterone production; they also lead to obesity. Obesity increases estrogen levels in men and women because the adipocytes (fat cells) are the primary site for conversion of testosterone and other androgens into estrogen via aromatase. Obese women usually don’t experience harsh menopause for this reason. This is also the reason that obese men have high estrogen levels and need either a “bro” (Kramer) or “manssiere” (George’s dad) according to Seinfeld. Extra fat leads to lower testosterone levels. Drop the weight to naturally increase your T!

Exercise. Increasing your exercise to achieve a target heart rate appropriate for your age group will not only help you decrease fat, it will increase your overall health. Lower testosterone is associated with higher risk for cardiovascular disease. Conversely, higher T and lower fat lead to a healthier heart. Not sure how to determine the appropriate exercise level? In Ruidoso, stop by the RAC and speak to one of their personal trainers. They can help get you on your way.

This is the final article in our Sex and the City series. I’m sure there will be future opportunities to come back and revisit the topic of sex and sex hormones, but in the interim, feel free to either drop me an email or stop by with further questions.

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 sex therapist, but he believes that sex can be very therapeutic. Comments or questions? His email address is: DrRath@FusionMedicalSpa.net.

Thanks to my wonderful wife for providing insight into the risk/benefit discussion regarding hormone replacement. As she stated, the risks of any medical therapy need to be weighed against the benefits. That said, what are the risks of bioidentical hormone replacement therapy (BHRT)?

Men often refer to testosterone as vitamin T. It is essential to maintaining our manliness, our mojo. Testosterone peaks at age 30 in men and decreases 1-2% annually. By age 60 a man’s T is approximately ½ of normal. Does testosterone replacement in men cause any increased cancer risk?

Harvard urologist, Dr Abraham Morgentaler, discusses testosterone replacement in his book Testosterone for Life. He discovered that the “modern medicine” practice of physical castration (old school-ouch!) or chemical castration with the drug Lupron was based on a SINGLE patient. In medicine we don’t do ANYTHING based on one patient’s results. So, he started treating biopsy proven prostate cancer patients with testosterone replacement when they requested it. His average patient was followed for a minimum of 2.5 years after study enrollment. The results? His study showed stabilization of PSA (prostate specific antigen, the lab test most commonly used to follow prostate cancer). The patients felt better and the cancer didn’t progress in any of the study patients. Interestingly, 54% of the biopsies AFTER starting testosterone showed NO cancer. Is testosterone replacement a cure for prostate cancer? The data doesn’t support that assertion at present, but I haven’t heard about any young men developing prostate cancer. Prostate cancer is diagnosed well after the testosterone levels begin to drop.

HRT in women? While we know that oral estrogen DOES increase the risk of heart attack, stroke, and blood clots due to the inflammatory cascade started when the liver processes the oral estrogen, to date I am unaware of a single study that shows an increased risk from bioidentical estrogen. Likewise, we know that synthetic medroxyprogesterone DOES increase the risk of breast cancer. We don’t know whether bioidentical progesterone causes an increased risk of breast cancer, but we do know that it is protective against endometrial cancer in patients with an intact uterus. So, oral estrogen replacement and synthetic progesterone need to be avoided to decrease cancer risk. How about bioidentical estrogen and progesterone? What does the data say?

Breast cancer risk in women is less than 0.5 % at age 30 and increases an average of 1% every 10 years up to age 60. But wait! Estrogen (estradiol) levels in women don’t have a severe drop until menopause (average age 52). How can you relate decreasing natural estradiol levels to breast cancer? 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 25, and are ½ normal by age 40. Can increasing breast cancer risk be tied to decreasing testosterone levels? A 2004 study published in the journal Menopause reported a decreased breast cancer risk in women treated with testosterone in addition to “usual hormone therapy”. While we don’t have large studies looking at bioidentical hormone replacement therapy centered around testosterone replacement, the early data makes sense. We typically do not see breast cancer in young women prior to age 25.

I expect that we will see a decreased risk in both breast and prostate cancer when hormone levels are restored to natural physiologic levels. This isn’t “mainstream” medicine, but there is an increasing number of anti-aging and wellness physicians that also support this position. Will your doctor agree? This knowledge is NOT taught in medical school. If your doctor hasn’t personally looked at the data the best they can say is they don’t know. I have not seen a study showing an increased risk in ANY cancer types in patients treated with bioidentical hormone replacement therapy. There isn’t a right or wrong answer. Bioidentical hormone replacement therapy is a personal decision that each patient must make. I can personally say that I would rather face my increasing age with decreased fatigue, better sleep, better memory and concentration, and increased libido- but that’s just me.

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 an endocrinologist, but he is a local expert on bioidentical hormone replacement therapy. Comments or questions? His email address is: DrRath@FusionMedicalSpa.net.

My dear husband asked me to be the guest writer this week. His choice of subject matter was interesting as typically men complain about hormonal changes in others far more than they embrace hormonal changes as an avenue to wellness for both genders. I suppose I should count myself lucky!

When women present to my office to discuss hormone replacement therapy they typically fall into one of two camps. Most women complain of roughly the same symptoms and they usually include fatigue, lack of concentration, decreased libido, depression and the ever-present night sweats. Their approach to treatment varies widely and usually there is not a lot of middle ground. The first group has tried multiple over the counter remedies and strongly desires to avoid hormones of any kind because of their fear of the associated risks. The second group feels that hormones are the answer to the problem whatever the risk. Both groups are tired of living like they currently do and want help. My job today is not to dissuade you from the camp you choose but to help you think about risks in a way that can allow you to obtain treatment without fear.

First – most of the misgivings that people have regarding hormones stem from the Women’s Health Initiative study. The arm of the study that evaluated hormone therapy’s impact on cardiovascular disease and breast cancer contained approximately 65,000 women who were placed on oral conjugated equine estrogen and medroxyprogesterone acetate. Neither of those were bio-identical, but at the time of the study they were the most commonly used medications. When discussing results and studies and thinking about our own health, most times the popular media does not give us the tools we need. For example, this study did show an increased risk in heart disease and breast cancer in women using ONE of many types of available hormone regimens. Does that mean all hormones cause an increase in these risks? Not likely. Multiple studies of bio-identical hormones done after this study have shown no increased risk. What does this mean to you? When you hear something in the media that you think is applicable to you, ask your doctor about it. Don’t jump to conclusions. The study group may not contain patients of your age, ethnicity or with your underlying health conditions.

Second – we must compare apples to apples. I see patients all the time who want to compare the risk of treatment to the risk of no treatment. Realistically, we should compare the risks of treatment to the risks of the untreated condition. Consider birth control pills – yes, there is a very small risk of deep vein thrombosis and pulmonary embolism while using birth control pills. Yes, there is no increased risk if you don’t take birth control pills but what is the risk of deep vein thrombosis in pregnancy? 0.05-0.2% depending on the study you read. The rate in birth control pill users? 0.03-0.09%. Let me go ahead and put a media spin on it to prove the point. “Did you know that pregnant women are 22 times more likely to have a deep vein thrombosis than birth control pill users?!” I bet the FDA wouldn’t approve pregnancy! The better point is that the risk is low in either group but the risks of an unplanned pregnancy don’t stop at DVT. Consider the impact on women’s and children’s lives. Compare apples to apples.

Hormone replacement therapy may not be risk free but neither is walking through life in a fog of exhausted depression. Talk to you doctor and get the real story. Don’t trust the media scare.

Disclaimer: Dr Keri Rath, MD, FACOG is a board certified OB/Gyn practicing in Ruidoso, NM. She lives in our beautiful mountain town with her devoted husband and two darling children. Her opinions don’t always agree with his but he loves her anyway. Comments or questions? The email address is: DrRath@FusionMedicalSpa.net.

The patient question of the week: “My husband recently started testosterone replacement and has too much ENERGY. Is there something you can do to slow him down?”

While I don’t agree with slowing him down, I can bring you back up to speed. The best results from starting bio-identical hormone replacement therapy (BHRT) are achieved when both of you have been adequately treated. More energy is great during the day, but can seem a bit excessive around bedtime when you aren’t speaking the same language. Move your bedtime up by 30 minutes, turn off the TV earlier and talk! Most guys aren’t the best at whispering sweet nothings. If you open a dialog and let him know that discussing plans, home life, and the events of your day help you unwind and get ready to get in the mood, he may step up to the plate. Good luck to both of you!

Last week’s article discussed the origin of the well-woman exam and touched on the difference between men and women regarding being physically and emotionally ready for sex. This article will delve into the benefits of a normal testosterone (T) level for men AND women.

Let’s be candid. A man with a normal T level doesn’t need much inspiration for sex. We continually confound the women with our self-inspiration. “Wait a minute. I was going over the shopping list and asking you about what you would like to eat next week. Were you even listening to me? How can you be ready to have sex?”

Guys- try to pay enough attention that you can parrot back the last sentence. Slip in a remark about how her company is the most valuable thing about dinner and how you would be happy with bread and water as long as she is with you. Mention that as she was talking you were paying more attention to her lips than what she was actually saying and you may pull it off. Otherwise, prepare for another cold night as she tries to teach you a lesson about paying attention to what she says.

Gals- remember how it used to be a lot easier to get in the mood? Testosterone is one of the most important sex hormones, and it decreases in women and men as we age. Depending on the study, T levels in women can start to drop as early as age 25, long before estrogen levels start to decrease.

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 didn’t draw baseline levels at age 14, 18, and 22 when your body was stabilizing hormone production.

I learned to treat the lab results in medical school. “I’m sorry, sir. Your testosterone levels are on the low side, but they are still within the normal range. It’s just part of getting old.” Or worse, “I’m sorry, ma’am. Your symptoms just don’t make sense. Your levels are normal for your age group. It must be in your head.”

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, depression, difficulty concentrating, difficulty losing weight, difficulty gaining muscle, and low libido. Erectile dysfunction? ED usually occurs as a late symptom after other symptoms have been present for a while.

T replacement is a personal choice. There isn’t a right or wrong answer. My professional medical opinion? I think it makes good sense to treat the person, not the paper. Lab results on paper are standardized for the “majority” of patients, not for you. Your body may not do well on the low end of “normal”. T levels are age adjusted, so the older you get, the lower the chance that your level will be abnormally low. Most of my phone calls to patients reporting their low T begin with “None of your lab levels look like you are dying but your testosterone is low enough that you probably feel like you are dying.” Tired of being tired? Give me a call!

Want to learn more about BHRT? Stay tuned for next weeks article as I bring in a guest writer to discuss more sex hormones!

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. Every time he thinks he is an expert on sex his wife adds a new wrinkle. Comments or questions? His email address is: DrRath@FusionMedicalSpa.net.

The reader question of the week: “My wife asked me if it looked like she had gained weight over the holidays. Is there a correct answer?” That depends… Are you planning on separate vacations? Soon? You have two choices. 1) You can answer her honestly and state that yes, it does look like she put on a little weight recently. 2) You can attempt to explain why she can’t fit into her pre-holiday clothes using a complicated argument referencing the time-space continuum and hope that she loses track of her original question. Honesty is typically the best policy. This situation, however, isn’t the best time to be brutally honest. While there isn’t a great answer to the question, I would suggest an answer that re-states your unconditional love and perhaps adds the idea that you have been thinking about ways to improve your own diet and maybe you could do it together. Good luck!

Sex and the City? Does this article belong in a family-friendly newspaper? Relax. While I grew up hearing about hormone imbalances and uteri (is the plural of uterus uteri or uteruses?) at the dinner table from my OB/Gyn father, I am aware that most readers expect a modicum of discretion. I’ll give it a try…

Most people have heard about the annually recommended well-woman exam. Few are aware of its origin. In the early 1950’s most women had a full-time job. Whether it involved taking care of young children, post-war factory work, or doing the behind the scene jobs involved in working/running a farm or ranch- they worked. The man would come home at the end of a long day and relax on the couch while complaining about his difficult job. This of course occurred while she cleaned up the kitchen after making dinner and straightening up the house in expectation of his arrival. At bedtime, the man expected an amorous greeting in the bedroom. The woman? She was tired, and most likely wasn’t willing to be engaged in greater energy output without reciprocation. The typical response involved a headache, bellyache, or ache/pain of any other body part that involved activities other than sleeping. The man was sensitive to her aches and pains the first few times. After that, the standard answer became “Well, woman, go see a doctor!” Thus was born the annual “well-woman” exam.

So you’re saying that sex involves more than just compatible body parts? Yes I am! 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). Testosterone, estrogen, and even cortisol are contributors to making things happen. Want to learn more about it? Stay tuned for next weeks article!

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 an expert on medical history, but he believes it is important to enjoy making his own history. Comments or questions? His email address is: DrRath@FusionMedicalSpa.net.

The reader question of the week: Does bio-identical hormone replacement therapy really work? Yes it does! I spoke with three of last week’s hormone replacement therapy patients the day after Christmas. They reported better sleep, less fatigue, better memory, and an overall feeling that getting older wasn’t going to be as bad as expected. Magic? If replacing the hormones that your body produced when it was younger is magic, then yes, it qualifies as magic. Some people are okay with getting older naturally. I feel better feeling younger naturally. You make the call.

My family was fortunate to wake up to a white Christmas. Weather Underground says there is a chance we will wake up to a white New Year’s Day. Snow or no, the New Year offers a chance to change the status quo. We all have areas that need improvement. I’d like to offer three suggestions regarding your healthcare.

• Become more involved in your personal health. Blow the dust off the scales, take a reading, and then educate yourself on your numbers. Type the letters BMI into a Google search box. One of the top hits will be a link to the National Institute of Health’s Body Mass Index calculator. Enter your height and weight and see where you stand. A BMI of 25 of greater puts you at increased risk for high blood pressure, heart attack, and diabetes. Dropping your BMI into the normal range in most cases will decrease the prescription medications you need to manage high blood pressure, high cholesterol, and high blood sugar (diabetes). Tired of taking so many medications? Change your eating habits. Most adults need approximately 1500 calories per day to maintain weight. Many adults consume 500 to 1000 additional calories per day. Want to gain one pound per week? An extra 500 calories per day will do the trick. Make a New Year’s resolution to take an active role in your health.
• Become more involved in your personal health. Schedule an annual visit with your doctor and ask how you can decrease your health risk. Annual visits are designed for just that purpose. If you don’t ask questions, you won’t receive answers. Most physicians are inundated with visits from sick patients and will welcome the opportunity to keep you on the well side of the waiting room.
• Become more involved in your personal health. Have a health problem or a new onset of symptoms? Do your homework. Internet research from reputable sources such as WebMD can be a good start to your question list before you see your doctor. And before you go, don’t forget to do a web search on your doctor. Make sure their credentials are in order. Don’t be afraid to ask about their Continuing Medical Education hours and topics they reviewed over the past year. Patients sometimes have more information about a particular condition than the doctor. In medical school I was taught that medical knowledge doubles every five years. That means that some of what I learned in school is either wrong or outdated. Don’t be afraid to offer your doctor the opportunity to research a topic and get back to you with an answer.

We all have an opportunity to change. You CAN teach an old dog new tricks if you take the time. Resolve to become more involved in your personal health!

Happy New Year from the Doctors Rath and the staff of Fusion Medical Spa!

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 an expert on healthcare reform, but he has a few ideas regarding reforming local medical care. Comments or questions? His email address is: DrRath@FusionMedicalSpa.net.

I will continue to try to reply to questions presented as long as space allows. The reader’s question (paraphrased): Why do you offer “potentially questionable services” such as photo-rejuvenation and laser resurfacing at Fusion Medical Spa? Answer: I’d like to say it isn’t just smoke and mirrors, but it is! Our Bladeless Facelift laser resurfacing procedure does produce a small amount of smoke as the wrinkles are vaporized. Mirrors? An important part of everything we do! Patients visit my practice because of issues they discover while looking in the mirror. We hand them a mirror at the end of a procedure (in addition to the before and after pictures) to show the improvement. Visit Palomar Medical’s website or stop by to see our before and after pictures.

The benefits of all services and products that we provide have been scientifically proven to a very high standard. We use the most expensive laser system in the United States not because of it’s cost, but because it is the only laser system that can reliably provide 100% patient satisfaction. Please, don’t make my services “potentially questionable”; make them completely questionable. Make my services and those of all physicians include answering all of your questions. Be an informed patient!

Christmas is here, and the New Year is upon us! Time to gather with friends and loved ones and catch up on the good and bad that we have missed due to our high-speed lives. It wasn’t always this way. One hundred and fifty years ago we gathered to catch up on everything missed due to slow communication. The telegraph, telephone, and now internet have brought great changes to our lives, but have drastically increased it’s complexity. Even if the rest of the year is too busy, the holiday season is time we need to use to slow down and enjoy life itself. Too often we become so mired in the Doing that we forget about the Living.

I certainly wasn’t a good example of Living at the start of 2012. Military physician/flight surgeon 3 to 4 days per month, anesthesiologist with 24-hour hospital call 4 to 5 days per month, ski patrol during winter weekends, and a full-time job with our medical spa. I was Doing all the time, and while that kind of busy schedule has always been invigorating for me, I was brought to a crawl by my own biology. After a personal encounter with early onset “old age” this summer, both my wife and I were delighted to discover that I wasn’t terminally tired, I just suffered from a testosterone deficiency. I have since started bio-identical hormone replacement and feel like I am Living again.

This Christmas season, focus on opening your eyes to the joy around you. Give an unexpected gift. Help a friend in need. Pay attention to the little ones as they open presents. Take a break from the Doing and spend time Living. Rediscover the magic of Christmas!

Merry Christmas from the Doctors Rath and the staff of Fusion Medical Spa!

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. This year he has resolved to turn in his Grinch costume in exchange for a dose of true Christmas spirit. Comments or questions? His email address is: DrRath@FusionMedicalSpa.net.

This is the third of two articles (yes, I’m aware of the math problem) looking into the difference between “modern” medicine and “wellness” medicine. This article was written in response to requests from local healthcare professionals that felt additional information would be beneficial…

The Checklist Manifesto, written by surgeon Atul Gawande, recounts a study that found the average patient in the ICU required 178 individual actions PER DAY. That’s one hundred seventy eight chances per day to miss a step and cause patient harm. More patients die from preventable medical errors each year than from motor vehicle accidents, breast cancer, or AIDS according to the 1999 report published by the Institute of Medicine. We are all prone to making mistakes. Doctors can’t do it alone.

Nurses are the backbone of both modern medicine and wellness medicine. They are another layer of patient safety and information. Their close contact with patients places them in the position to help catch medical errors and educate patients. I recently spoke to a nurse who exhibited her displeasure that she wasn’t allowed to appropriately counsel a patient upon discharge for fear of affecting the patient satisfaction survey numbers. Nurses are rewarded for being “nice”, not for educating patients, not for providing good, safe patient care. Hospitals shouldn’t be a place to go to be treated nicely, they should be a place to go for good care. The goal of being hospitalized is to get the patient well enough to be discharged and not have the need to come back.

If a patient satisfaction survey is to be used, in my opinion it should be short. A one-question survey with a yes or no response should suffice. “While you were hospitalized, did the doctors, nurses, and techs do their best to ensure that your overall health improved since the time of admission?” Yes? No action needed. A no answer would necessitate an automatic visit with the hospital administrator to discuss either a failure with the provision of healthcare or a failure in communication. Survey companies are not in the business of improving patient care. They are in the business of taking needed money away from healthcare provision. Ask your hospital administrator how much the survey companies receive in compensation. I bet you won’t get a straight answer.

Why are patient satisfaction survey scores used as a metric for healthcare provision? It is much easier to measure patient satisfaction than it is to measure good, safe care. When doctors and nurses provide good patient care, patients will get better, get worse, or stay the same. Unfortunately, when doctors and nurses provide poor patient care, patients will get better, get worse, or stay the same.

Where does patient satisfaction come in? It certainly weighs heavily on the “getting worse” side according to the March 2012 Archives of Internal Medicine study quoted in last week’s article. I don’t advocate being rude to patients but I do think my role should not be that of a friend or buddy but rather someone using my years of training to help you get better by appropriately utilizing the available technology.

We need to take a stand against the medical machine that is “modern” medicine. Mail the surveys back, but don’t fill them out. Call your hospital administrator and let him know that you not only appreciated surviving your hospitalization but you valued the patient education and safety that was provided. Didn’t receive any patient education prior to discharge? Let him know. We need to show dissatisfaction with a healthcare system that encourages doctors and nurses to willfully ignore their duty to address risk factors that contribute to our decline in “wellness”.

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. The opinions given here reflect a new way of thinking about medicine and are not necessarily endorsed by the U.S. Air Force, Lincoln County Medical Center, or even his wife. Comments or questions? His email address is: DrRath@FusionMedicalSpa.net.