National Doctors' Day 3/30; Match Day 3/15; Replacing Body Parts; The Importance of Skin; Testosterone Production in Women; Shot for Treatment of Cholesterol; Plastic Surgery & Grandma.

The following reflects subjects discussed live on Let's Talk Medical with Doctor Gigi on Friday March 30, 2012.  Please feel free to listen to the podcast version via

National Doctors' Day - March 30:

March 30 is National Doctors' Day.  It is the day that we as a nation thank physicians for the work they do.  It began as a celebration in Georgia in 1933, & Congress recognized it as a national event in 1991.  The reason it is celebrated on March 30 is because ether was first used as anesthesia on March 30, 1842.  If you think about it, many of the wonderful things we do in modern medicine would be all but impossible without anesthesia.  Just imagine having any surgical procedure without anesthesia!  I guess we should honor this event, & certainly we need to remember that physicians are on the front line of public health.  In the "old days" they provided care to people with TB & other infectious diseases, not always knowing if their health was at risk, as they often did not know the mode of transmission of these diseases.  So was the case in the 1980's when we provided care on the front lines for people with HIV... before we fully understood this virus & how it is transmitted.  I was a resident during this frightening time, & I do remember the hype, but I never remember withholding care due to fear for my own health!  We are professionals who respond to the needs of our patients 24 hours a day, 7 days a week... often ignoring our own needs & those of our families.  So on March 30, we as a nation thank the men & women who provide our medical care... & don't forget to thank the families who support them so they can care for you!

Match Day - March 15:

Students who graduate from medical school are called "Doctor"... but that is usually not the end of their studies.  Most physicians go from medical school to a residency program where they study for 3-5 years more, after which they are considered a "Specialist" in whatever residency program they completed.  I am a specialist in Family Practice (or Family Medicine), & I trained for 3 years post medical school to achieve this credential.  So most of us know that there are residency programs for all specialties in the field of medicine, such as:  Family Medicine, Internal Medicine, Pediatrics, Ob-Gyn, Surgery, Ophthalmology, Dermatology, Hematology-Oncology, & Orthopedics.  What you might not know is that your doctor might not have become the specialist he really wanted to become.  That is because there are a limited number of spots in each specialty each year, & each new doctor has to "match" his wishes with the choices of the residency programs.  This is done through a program called "the Match," which is formally done every year on March 15th.  Senior students in medical school take elective studies & interview at programs where they hope to obtain residency training.  They then make a list of the programs they hope to attend, starting with their number 1 choice.  The residency directors create a similar list, indicating the students they would like to train, starting with their number 1 choice.  A computer program takes these two lists & creates a "match" between them.  My list was short: 1) Family Practice at Bayfront Hospital in St. Petersburg, FL, 2) Family Practice at Earl K. Long Hospital in Baton Rouge, LA, 3) Medicine-Pediatrics at Earl K. Long Hospital in Baton Rouge, LA.  I don't know where I ranked on the list for Bayfront Family Practice, but I "matched" to that program... & thus I studied there for 3 years & became a Family Practitioner.  If a medical student does not "match," he then gets to participate in the "Scramble," which involves getting on the phone to call residency programs with openings to see if you can quickly lock in a position.  Those who participate in the Scramble often get an acceptable residency program, but some have to settle for a program or even a specialty that was not truly on their priority list.  Thus a person can go to medical school & graduate after 4 years, but still not have the opportunity to become the specific type of doctor he wants to become!  The most difficult program to get into when I was a student was Ophthalmology.  Dermatology was also very competitive.  So only the students in the top 10-15% of the class could become Ophthalmologists or Dermatologists.  These programs are highly sought due to high income & great work hours, as there are not too many Eye or Skin emergencies!

I did find it interesting to note that in 2012 there are only 2,764 positions for Family Practice residents to train, & yet these spots were not filled by the Match as only 2,611 students "matched" in Family Medicine.  It should also be noted that many of these spots were filled with "foreign  medical graduates" which means that these students did not train at a medical school in the US.  They may in fact be American, but the school they attended was out of the country... perhaps because they did not get accepted by an American medical school.  So if the future of medicine is in the hands of primary care specialties... which include Family Medicine, Pediatrics, & Internal Medicine... isn't it frightening to see the small number of FP's trained yearly, & perhaps equally frightening that many have spent 1/2 of their medical training years out of the country?  So do you want to know what happens to most US medical school graduates?  Well of course, they choose to go into higher paying specialties with better life-styles!  So the next time you hear the primary care doctors speaking out about how they are under-paid & under-valued, you will better understand why you should care!

Also, if you wonder why physicians seem to be somewhat absent from the political agenda which is trying to re-direct medical care, consider this.   First, we really do spend an enormous amount of time taking care of patients.  Secondly, there are only about 800,000 practicing physicians in the United States, yet there is a population of about 311,800,000 people in the US (according to the 2011 statistics).  Thus there are 311 million more people than there are doctors, making us a very small minority, & truly one with a small voice!  Intelligent people all have their own opinions, & it is almost impossible for physicians to agree on any one issue such as health care reform, but even if we did, I am not sure our voice would be heard.  Oh, & remember, the AMA does not truly represent most physicians, as only about 17% of physicians belong to the AMA!  They have their own agenda, & it should be noted that each Specialty in medicine has it's own agenda as well, especially to insure that their evaluations & treatments receive the highest compensation!  So, I guess Physicians will not be in the forefront of political action... unfortunately... as I must ask, whose profession is it anyway??

Replacement of Body Parts:

With all the wonders in medicine, are there body parts that are not replaceable?  Certainly the brain & spinal cord are on the top of the list, but I don't think we replace the stomach, the bowel, or the bladder, nor do we replace entire bones... at least to my knowledge.  Sometimes we don't replace an organ, but instead we just replace the hormone or chemical it would produce, such as insulin to replace the pancreas, or thyroid hormone (like Synthroid) to replace the thyroid.  I think the future of organ replacement lies in the creation of new organs from your own body.  In other words, science will some day be able to use your own tissue to grow you new organs.  I read that this has been done recently for a man who had bladder cancer.  The doctors removed some healthy bladder cells & grew a new bladder which was transplanted into his body when his sick bladder was later removed!

And as a last thought, the skin is the largest organ of the human body, & I believe it is the one most taken for granted!  But, you really do not want to have significant burns which necessitate skin grafts, as that is painful, & often the grafted skin is not as pliable or as cosmetic as you would like.  So, take good care of your skin, & be sure to protect it from sun damage by using lots of sunscreen or protective clothing such as hats & shirts!

Testosterone Production by Women:

Men have testicles to produce testosterone, but obviously women do not.  So Cindy asked where is testosterone produced in the female body.  Well, I answered that the ovaries produce testosterone as well as estrogen & progesterone, but I must correct myself a bit.  Though it is true that the ovaries produce all 3 of these hormones, I failed to remember that the adrenal glands also produce testosterone.  So at menopause, when the ovaries either die or are surgically removed, the woman's testosterone level will decrease significantly, but there will still be some testosterone produced by the adrenal glands.  These are little glands that sit on top of your kidneys, & though they are small they are mighty, as they produce several important hormones such as Cortisol & Epinephrine which help us cope with stress.  

Shot for Treatment of high Cholesterol:

There was interest in a recent announcement regarding a new "shot" for high cholesterol treatment.  This is a new medicine being studied in clinical trials, & it was given by injection every 2-4 weeks with promising results.  It works by causing a decrease in a protein that inhibits degradation of LDL (= Lousy or bad cholesterol), thus the LDL is more vigorously broken down.  This is a novel approach to treating hypercholesterolemia, so it is an exciting medicine.  It is however just going into phase 2 trials, so it will be a while before we know if it really works & if it is safe.  If it makes it to market, it will likely be an option for those who cannot tolerate statin medicines (which are the typical meds used to treat high cholesterol), or for those who have high cholesterol in spite of taking high dose statins.  So, we wait...

Plastic Surgery & Grandma:

Should a 73 year old lady have plastic surgery?  What if she wants a "nose job" & breast augmentation?  Well, several factors need to be considered.  First, it is truly her decision, as the choice to pursue cosmetic surgery is always personal.  Secondly though, she must discuss this with her primary care physician & get medical "clearance" for the procedure.  If she is healthy, she can then proceed, but I would recommend she have the procedure done in an out-patient surgery center & not in the Plastic Surgeon's office.  The surgery center has multiple personnel to provide her with care, such as Anesthesiologists & nurses, & they insure that their staff (including the Plastic Surgeon) is appropriately credentialled.  I believe that doctors who operate in these facilities practice more main-stream medicine, & are more likely to have the respect of their colleagues.  Those who practice solely out of their offices do so without oversight from the outside world, & many of their colleagues can't truly attest to their skillfulness as they never witness them caring for patients.  Also, if grandma has a complication, it would be beneficial to have the surgery center have an affiliation with a hospital where she could be admitted & stabilized... & it would be optimal if the Plastic Surgeon was on staff at that facility so he could be involved with her hospital care should that be necessary.  I might also suggest that she pursue only one procedure at a time, thus limiting the time she is under anesthesia, as this will likely lead to a better outcome.  In this case, I would do the "nose job" first, as this is the body part most seen by the public.  If grandma does well with this, she can later pursue the breast augmentation (=enhancement or enlargement), but if she does not opt to pursue a second surgery, she can perhaps just get a better bra!

Have a wonderful week, & I hope you participated in Earth Hour on Saturday March 31st.  I did participate, thus I turned out all of the lights in my home from 8:30-9:30PM.  This provided me an opportunity to eat supper by candlelight & to spend an hour of quality time with my family!  Perhaps we should have Earth Hour every night... or at least once per week!

Here's to our health!

Doctor Gigi

PS  Remember you can tune into the radio show live on Fridays at 1:00PM Eastern time via WTAN 1340-AM in the St. Pete/Clearwater/Tampa area, or you can listen on the computer via where you can listen live or to recorded podcasts.  Also, keep those questions coming:  (727)-441-3000 local, or toll-free at (866)-TAN-1340, or