As of Aug. 18, 37 people have returned to the United Kingdom after undergoing surgery in India and Pakistan with the superbug gene. The same resistant gene has been detected in Australia, Canada, the Netherlands, Sweden and the United States. In an msnbc.com news service report, scientists are worried that the gene, which is already widespread in India, could spread worldwide as patients bring the bug back home with them.

Lancet Infectious Diseases, a medical journal, reported that this new gene is called NDM-1 and alters bacteria, making them resistant to nearly all known antibiotics. It has been seen largely in E. coli bacteria, the most common cause of urinary tract infections, and on DNA structures that can be easily copied and passed onto other types of bacteria.

Dr. Jeffrey Raval, a double American board certified surgeon practicing in Cherry Creek North at Raval Facial Aesthetics, cautions patients to reconsider decisions to undergo elective cosmetic surgery anywhere outside of the United States. Besides the risk of infection, patients undergoing surgery usually require follow-up visits and care by the surgeon—an impossibility for most patients opting for surgery outside their native country.

Upper Airway Resistance Syndrome disturbs sleep patterns, but can be remedied

It may not be your mattress that’s keeping you from having a good night’s sleep. It could be Upper Airway Resistance Syndrome (UARS), according to Jeffrey Raval, MD FACS, located at 250 Steele St., Denver, CO. While sleep apnea has gotten a lot of press in the last few years, UARS is a more recent diagnosis. It’s so new, in fact, that the equipment used in some sleep clinics is not geared up to diagnose the problem the way that an ear-nose-throat surgeon can.

Sleep apnea affects men far more frequently than women. However, older women suffer from UARS than do any other demographic group, says Dr. Raval, an American Board Certified Facial Plastic Surgeon and Ear/Nose/Throat/Head Neck Surgeon. Curiously, UARS is often diagnosed after nasal surgery to correct crookedness or surgery for a deviated septum.

“We have women patients who report back to us that they had spent years of restless, sleepless nights chalking that up to stress, menopause or insomnia. They’ll tell us they never made the connection between breathing well and sleeping well…until after their surgery to correct the nasal obstruction,” Dr. Raval says. Frequently women who suffer UARS have severe nasal airway obstruction. Simple nasal airway reconstructive surgery such as straightening the septum, called a septoplasty, can vastly improve their life by allowing them to sleep throughout the night.

UARS differs from sleep apnea in that many people suffering from sleep apnea are overweight, while those diagnosed with UARS share the opposite condition of a thin face, a small or narrow jaw and a thin neck. When taking his patient’s health histories, Dr. Raval has found that it’s not uncommon among this group of UARS patients to have had orthodontia as a child to correct overcrowded teeth-one of the defining characteristics of the thin face and small or narrow jaw.

Otolaryngologist Steven Park, M.D. released a book in 2008 called “Sleep Interrupted: A Physician Reveals the #1 Reason Why So Many of Us Are Sick and Tired (Jodev Press), on the topic of UARS. His findings in the book are consistent with those Dr. Raval has witnessed among patients who complain of cold hands and feet, low blood pressure, and the inability to sleep on their backs comfortably.
European studies (one study of French women) show that almost half of the women with chronic insomnia and resulting daytime fatigue have UARS-a sleep disorder caused by resistance to air flow through the nasal passages.

Breathing strips (Breathe Right is one such product) do help some patients with UARS. Others see improvement using nasal dilators such as Nozovent or a saline nasal spray. Over-the-counter Claritin can remedy congestion from allergies. When either of those remedies doesn’t solve the problem, an ENT can prescribe a nasal spray containing itraconazole (Sporanox), xylitol, mupirocin (Bactroban) and dexamethasone. In other cases, Dr. Raval has had success prescribing dental devices that push the jaw forward preventing it from blocking the throat opening. And a special nasal mask called a Continuous Positive Airway Pressure (CPAP) can be recommended to deliver air to the airway while preventing the nasal passages from collapsing during sleep.

“A good night’s sleep is one of the best things a person can do to maintain their health,” adds Dr. Raval. “Now that we understand UARS, we have solutions that can help.”

Just a handful of years ago, it was unheard of to get online to check out your plastic surgeon before making an appointment. That detail was reserved for coffee klatches or girls night out and even that was affected by regional influences, says Jeffrey R. Raval, M.D., F.A.C.S., triple board certified American Board in head/neck surgery, otolaryngology and facial plastic surgery.

That’s changing today as patients rely on the internet for volumes of information about every subject of interest to them, says Dr. Raval. Google.com or msn.com searches aren’t uncommon as a prospective patient begins to sort out the volumes of information about plastic surgery and other minimally invasive treatments they’ve heard about but not experienced yet.

“We get many hundreds of visitors to our website daily,” says Dr. Raval, who sees patients Monday through Friday and sometimes on Saturdays. “We know from the reports we get monthly that the inquiries are about specific products and treatments. People are searching for these topics by name, sometimes highly specific product names. They may have read about a treatment in a national magazine and then want to find a doctor locally that performs the treatments they’re interested in.”

The New York Times reported in April that roughly 5,700 plastic surgeons are certified with the American Board of Plastic Surgery and that roughly 113 million Americans have used the internet to get healthcare information, according to the 2006 Pew Internet & American Life Project.

Then again patients are very likely to go to the website to review it after they’ve heard from a friend or co-worker that they have been treated in Dr. Raval’s office. “They hear a personal testimonial, look our office up on the internet and then call to make an appointment. Or sometimes they hear a personal testimonial, call information for our phone number and after they’ve made their first appointment will cruise through the website to learn more about us before actually coming in for treatment,” Dr. Raval adds.

To that end, the design of one’s website is significant. Dr. Raval has chosen to run streaming videos of his frequent appearances on local TV channels during which he demonstrates a specific procedure. “Because I watched a video of Dr. Raval online on his website, it was almost as if I had met him previously when I went into his office for the first time,” reports one patient. Videos, especially, give viewers a better perspective of the doctor’s personality and presentation—qualities that are important to assess when selecting a doctor.

Obviously, one of the most motivating experiences to prompt calls for appointments is a personal endorsement. Says Dr. Raval’s receptionist: “We often hear from first-time callers that they are ‘friends with so-and-so’ or that ‘so-and-so referred them.’”

While many patients are talkative about their procedures and the outcome, some patients keep mum and want others to think they’ve got great DNA or luck. Patients in Miami, Florida or Los Angeles, California have historically been far more likely to open up about their plastic surgery and/or non-invasive treatments like BOTOX or Restylane injections, says Dr. Raval. In fact, it’s not unusual for the conversation between complete strangers to revolve around these topics in those areas of the country. In a curious way, you could almost overlay the regions of the country where patients are more inclined to discuss their physical surgical improvements with a weather map. The warmer the weather and the skimpier the clothing, the more patients are likely to reveal that they’ve been “improved.”

Another factor that impacts openness about the topic of plastic surgery (or any topic, for that matter) is cultural. Folks living in the bread-basket of America are known to be conservative and not likely to make fast friends. And sometimes it’s religious. And, of course, income levels have an especially profound impact on the decision to proceed with cosmetic surgery. Since most cosmetic surgery is elective and most insurance carriers won’t pay out on elective treatments, it means that the patient has to have the money to pay for the treatment. Considering that a syringe of the injectable Perlane is about $800, the limits on the credit cards these patients pull out to fund treatment generally are five-figures or six.

Dr. Raval practices in Cherry Creek North, the upscale neighborhood known for its fine spas and high end retail boutiques. It’s not unusual for a patient to pull up to Dr. Raval’s practice in a $60,000 car, wearing a $2500 suit showing off a glowing tan from an $8,000 vacation the week prior. By the same token, Dr. Raval has patients who prioritize their limited funds, making a choice between one luxury or another in order to have plastic surgery.

The tendency to prefer a lot of smaller, less-invasive treatments that don’t require down-time or at the very least require minimal down-time, is an increasing phenomenon, says Dr. Raval who has observed that the bulk of his patients lead highly active lives—with families and high powered jobs. That kind of thinking is directly in line with Dr. Raval’s preference for recommending and performing more frequent, less invasive treatments that allow the patient to enjoy immediate results and satisfaction while not keeping them from being productive otherwise.

The fact is, says Dr. Raval, that it’s the patients who are currently undergoing a treatment or say a series of treatments as in Sciton Laser microdermabrasion who are more inclined to talk up their treatment—in part because they’re so happy with the immediacy of the results, the return to looking younger that they can witness overnight. In some instances, says Dr. Raval, patients share their experience with friends and co-workers because they themselves are so amazed at how far medical technology has come in the last decade. Plus, they enjoy the compliments which typically include mention of them looking rested or young.  “Upon hearing that they look happy or rejuvenated, they’ll often jump in and offer the information about a simple procedure they’ve just had,” Dr. Raval says of the feedback he regularly hears from patients.

“When I get a new car, I tend to notice all the other cars on the road that are the same make and model as mine,” Dr. Raval admits with a chuckle. “When I have just returned from a vacation in a tropical place, I’m more likely to talk about that trip to people I know versus months later. Let’s face it, one of the favorite subjects most people have is themselves, so they tend to talk about what they’re doing and what they’re up to. If I remodel a room in my house, I’m more inclined to talk about the progress while I’m in the middle of it—good or bad—than I am months later after the remodel is complete and my focus has turned to another subject.”

Reach Dr. Jeffrey Raval at 303-744-2300 or visit his website at www.ravalmd.com.