Dr Lisa Mark, an obstetrician/gynaecologist, takes care of woman from conception to delivery on the obstetrician side of her profession and on the gynae side performs surgery and deals with any sort of female problems from adolescence to menopause and thereafter: "So it is anything to do with women. We deal with the whole woman and any problems relating to women."
Now thirty-seven years old, Lisa, from as far as she could remember, "since I saw my first delivery at age nine" always wanted to do medicine and specifically that branch.
How did a nine year old become part of a baby's delivery? Lisa, the elder daughter of Venus Mark, midwife/owner/director of Amicus Maternity Center at La Puerta in Diego Martin for the past thirty years explained. "I always used to be around staying there with my Mom so they would stick me in to see deliveries. I was always curious about it." Unlike her sister Lori, who is a paralegal in the United States.
After graduating with O levels from St Francois Girls' College where she focused on the science subjects, Lisa went directly to Iona College in New York and completed a Bachelor of Science degree, then moved to New York Medical College in Valhalla, New York, and graduated with a combination of a medical degree and Masters in public health. "Usually you obtain a medical degree, but I had this desire to do further studies in public health with possible opportunity to serve the public interest and did a Masters in maternal and child health."
A four year residency at St Luke's/Roosevelt Hospital in Manhattan which gave Lisa her specialty in obstetrics/gynaecology, was followed by private group practice in Bethpage, Long Island, with two other physicians and a midwife.
It was gruelling but she found the time to marry Curtis Drayton, and have three daughters, an eight year old and four year old twins. Coming home after spending 18 years in New York, Dr Mark is back where she started as a very real part of Amicus delivering babies and seeing patients in her private practice, concentrating specially on the menopausal woman.
This is one doctor who does not believe in pushing Hormone Replacement Therapy as the only treatment for the menopausal woman. While she does believe it relieves symptoms, such as, the intense hot flushes, and that it is recommended for those who are at risk for cardiovascular disease and osteoporosis once there is no family history of breast cancer, Dr Mark looks at other options.
"From the time the peri menopausal phase prior to menopause commences, when women start off having irregular periods, mood swings, insomnia, night sweats, once they are aware they come in for consultation as it is a very uncomfortable phase of life for women to deal with, but they will have a better idea of what to do because there is medical treatment for these symptoms."
There are a variety of treatments for menopausal patients. Depending on the severity of a patient's symptoms, hormone replacement therapy is the way to go, but the patient must be informed of the risk which may already be there for breast cancer, and must be closely evaluated on HRT. "Other options include natural vitamins, but there is no documentation that these really help the patient. If the symptoms are relieved then you document that this treatment will work for specific patients" says Dr Mark.
A lot of patients go through menopause very gracefully without medication comparing themselves to their mothers who never had anything wrong. So you eat correctly, exercise, and are not at risk for cardiovascular disease or osteoporosis - the two main problems, and these patients will have no need for HRT.
"For those with intense symptoms, HRT definitely works" says Dr Mark "but it is not something that you take a tablet and everything will suddenly disappear. It is the whole picture, a combination of the proper diet and exercise, not just this one thing. You cannot force HRT on a healthy patient without complaints, so these women must continue their annual check ups, which include the so important breast exam, with annual mammograms from age forty, the pap smear and other things, such as, cholesterol every five years once everything is normal. A colonoscopy from age fifty, every three to five years. All these checks have to be done with menopausal women."
One of the main reason why women are afraid of HRT, explains Dr Mark is that after years of not having a bleeding episode, they will experience menses but it is temporary and in the majority of patients will eventually stop even though you continue on the therapy. Of course, younger women who may still be having a period and are placed on HRT will still have a period.
While the controversy between HRT and breast cancer is still being debated, studies have shown that menopausal patients are at higher risk of getting cardiovascular disease and osteoporosis before breast cancer.
But as an obstetrician/gynae, again you counsel patients of risks vis a vis benefits of any medication. "The majority of patients are those who come in with a desire to go on HRT. Some refuse flatly even after counselling, and those you just follow closely. You can't force things on any individual, it is really by choice" says Dr Mark, whose other special interest is in adolescent patients, "since the pediatrician sees children to a certain point, and sometimes a gap is left between leaving the pediatrician and moving on to the general practitioner."