2016 Issue 4, Quarterly Newsletter

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WOMEN’S HEALTH

Welcome to the fourth issue of Women’s Health, a quarterly health newsletter focused on you.

As we enter the fall, we’re happy to announce several new babies this summer, joining the growing ECWMG family. Dr. Teng and Nadia are back at work and Sandrine will be back in November.

We also have two new staff, Julie joined us in August as our new Office Manager and Biller and Evelyn is one of our new Medical Assistants.

October is Breast Cancer Awareness Month! As we try to raise awareness about screening methods, we’re excited that El Camino Hospital has finally announced the arrival of Tomosynthesis/3D mammography on campus.

As we head into fall, there’s a lot of preparing to do for the end of the year. This newsletter will include updates for Dr. Sutherland and Crystal patients as well as some new information on mammography, the Zika virus and new contraceptive options.

As our physician staff is back to a full schedule and Barb Dehn, NP has increased her hours, we are again accepting new patients. Thank you always for your kind referrals.

We hope you enjoy this newsletter, let us know if you have topics you want covered in the New Year.

Sarah Azad, MD

In this issue:

Our Growing Family

Dr. Awaad’s Updates

Updates for patients of Dr. Sutherland and Crystal

End of the year appointments

Tomosynthesis/3D mammography now at ECH

Updates on the Zika virus

Endometriosis: Do I have it?

Contraception: increasing options

Six months with the Mona Lisa Touch

Highlights from the Women’s Health Blog

OUR GROWING FAMILY!

Nadia, our RN, delivered a healthy boy named Omar in June. She’s been back working from home since the end of July, her on site breast feeding classes will resume in November. Dr. Teng’s son, Matthew, joined us in July and she returned to seeing patients at the end of September. Sandrine’s son arrived in August and we are looking forward to her return in November.

To add to the theme of baby boys, Dr. Azad will be having one in February!

But our office doesn’t just add babies, we’ve also grown in staff. We’re fortunate to have found Julie, who joined us in August, as our new Office Manager and Biller. She’s fit right into our office and will be focusing on making the office run more efficiently and for all your questions and issues to be dealt with in a more timely manner. Atefeh is still training her and is available for any questions you may have. After more than 6 years with us, we will be sad to see Atefeh leave, but wish her the best in her new pursuits in Sacramento.

Kaela, one of our Medical Assistants, recently moved to Santa Cruz, her last day was September 16th. She was great to work with and will be missed at the office. Evelyn joined us in September as her replacement and has fit right in, she is also helping with Nurse Barb’s patients. We are excited to have such a great, cohesive team.

DR. AWAAD’S UPDATES

Dr. Awaad, a psychiatrist on faculty at Stanford, has been seeing patients in our office for over a year. We are so fortunate to have access to an excellent psychiatrist with a focus on women’s mental health here in our office.

We have also made an effort to bring her in network with all major commercial insurances. She is currently in-network for Anthem Blue Cross EPO/PPO, HealthNet EPO/PPO, United Health Care EPO/PPO, Aetna EPO/PPO and Cigna EPO/PPO. For our HMO patients with Physician’s Medical Group of San Jose, she is in-network, but you must obtain a prior authorization before your first appointment.

Dr. Awaad will be back on 11/9, seeing patients on Wednesdays from 10-2 in our San Jose office and on Thursdays from 10-2 in our Mountain View office.

There is also a new cancellation policy for her appointments. Bringing her in-network has only increased the demand for her services. Our own office patients take priority of course, but any appointments cancelled with less than 3 days’ notice will be charged the full cost of the visit. Insurances do not cover cancellation/no show fees and those charges will be billed directly to the patient.

UPDATES FOR THE PATIENTS OF DRS. CRYSTAL AND SUTHERLAND

We’ve just passed the one-year anniversary of Dr. Crystal’s leaving private practice and Dr. Sutherland’s retirement. At this time Dr. Crystal does not have plans to return to the office, though we’re keeping our door open to her. Dr. Sutherland has been enjoying her well-deserved retirement.

We will continue to remain custodians of their charts and available for care for all their patients. However, safe, good patient care does require office visits, so patients who have not been seen in more than 15 months will not have any further refills or imaging/labs ordered. We encourage all those who have not yet come in for their annual well women care to call to make an appointment soon. If you have chosen another physician in the area, fill out our Release of Information form so that we can make sure your new doctor has your previous records.

Please note that records requests are not generally an “urgent” situation and please allow 7-10 business days for them to be completed.

END OF THE YEAR APPOINTMENTS!

As an office of physicians, we are available 24 hours a day for urgent and emergent care. It’s an honor for us to be able to care for our patients when they need us most. However, as we plan for the end of the year holidays, we would all like to spend time with our families. From December 19th until the New Year, there will only be one doctor in the office each day, available for urgent appointments and needed OB visits. We will not be scheduling any routine follow ups or Well Woman Exams during these two weeks.

For those of you that are planning on your Well Woman Exam before the end of the year, please call soon and schedule it in the earlier part of December.

TOMOSYNTHESIS/3D MAMMOGRAPHY NOW AT EL CAMINO HOSPITAL

By Silaja Yitta, MD

Director of Breast Imaging & Intervention at El Camino Hospital

What an exciting time in breast health! With the latest technology in cancer detection, we are finding breast cancer at earlier stages resulting in improved outcomes for our patients. Did you know that the 5 year survival rate for stage 1 breast cancer is 100%? Screening mammograms help to detect early stage breast cancer while it is easier to treat resulting in excellent outcomes for women.

3D mammography (also known as tomosynthesis) offers significantly improved breast cancer detection rate and decreased call back rates compared to standard 2D mammograms. When used in addition to mammography, whole breast screening ultrasound (ABUS) can also improve breast cancer detection in women with dense breasts.

We offer the latest technology for breast cancer detection at El Camino Hospital Breast Health Center along with many other patient centered benefits:

• 3D mammography/tomosynthesis (available to all patients in December 2016)
• Whole breast screening ultrasound (ABUS) with latest GE technology
• Screening & Diagnostic breast MRI with dedicated breast coil and 3Tesla magnet
• Image guided biopsy (including tomosynthesis, stereotactic, ultrasound and MRI guided biopsies)
• Needle localization prior to surgery
• DEXA (bone density evaluation)
• Same or next business day telephoned results
• Free mammogram program benefiting those who are eligible
• Second opinion evaluations by expert fellowship trained breast imager
• Multi-lingual staff including Spanish, Russian, Mandarin, Cantonese, Filipino speaking staff members.
• Partnership with the El Camino Cancer Center and programs.
• Complimentary transfer of previous mammograms & records from other facilities
• Free valet parking

Why choose El Camino Breast Health Center?

• Comprehensive, up-to-date breast imaging & care from start to finish
• Patient centered approach in a soothing & calm environment
• Warm, compassionate and knowledgeable staff who are focused on quality
• Recognized as a Breast Center of Excellence by the American College of Radiology

To schedule your mammogram or breast imaging test, please obtain an order from your doctor and call (650) 940 7050, option #2. Transfer of records may be arranged at the time of appointment scheduling.

UPDATES ON THE ZIKA VIRUS

The Zika virus epidemic has been very challenging for pregnant women and those planning pregnancy. From the initial reports of microcephaly, the information about the epidemic has been changing on an almost weekly basis.

We now have confirmed science that the Zika virus infection itself is what leads to fetal microcephaly and other fetal abnormalities.

MAP

The latest recommendations from the CDC include:

• Pregnant women should NOT travel to areas with active Zika virus transmission.
• If she must travel, steps should be taken to avoid mosquito bites and to prevent sexual transmission during the trip.
• If a pregnant woman has a partner who lives in or has traveled to a Zika area, she should use condoms every time she has sex for the duration of her pregnancy. (Vaginal, anal and oral sex).
• There is now much more available testing for Zika virus testing and all pregnant women who have been exposed to the virus (travel to an area with active transmission or sexual encounter with someone who has traveled to a Zika area) should be tested.
• The Zika virus is endemic to 11 Southeast Asian countries (Brunei, Burma/Myanmar, Cambodia, Indonesia, Laos, Malaysia, the Maldives, the Philippines, Thailand, East Timor, Vietnam). The CDC recommends all pregnant women avoid all non-essential travel to these 11 countries.
• Couples who are planning on pregnancy who have been exposed by travel or sexual contact with someone who has traveled to a Zika area and are without any symptoms should wait at least 8 weeks before attempting conception. The Zika virus has been shown to live in semen for longer periods of time and waiting up to 6 months, especially if the male partner has had any Zika symptoms, is prudent.

Visit the CDC website for more information about the Zika epidemic and the most recent updates.

The American College of Obstetricians and Gynecologists also has an excellent video on the Zika virus and pregnancy.

ENDOMETRIOSIS: DO I HAVE IT?

Endometriosis is a condition that affects about one in ten women of reproductive age. Though it can start in the teens, it is usually diagnosed in women in their 30s and 40s.

When the type of tissue that forms the lining of the uterus (the endometrium) is found outside of the uterus, often on the ovaries and Fallopian tubes, this tissue can grow and bleed like the uterine lining does during the menstrual cycle. Since the blood from this abnormally located tissue can’t train out the uterus as menstrual bleeding, it can irritate the surrounding area causing inflammation and swelling. This can often lead to scar tissue and certain organs to become attached in places they usually don’t. This can cause pain and bloating, especially before and during menstruation.

Endometriosis

Many of the symptoms of endometriosis—painful periods, bloating, heavy periods—can also be normal menstrual symptoms. These problems are usually managed by pain medications and hormonal contraceptives. Often, it’s not until the more advanced symptoms—chronic (long-term) pelvic pain or pain during sex or urination—begin that a diagnosis of endometriosis is seriously considered.

To diagnose endometriosis with certainty, laparoscopy is necessary. This is an outpatient surgical procedure using a narrow camera that looks inside your abdomen and pelvic area. Tissue that looks consistent with endometriosis is biopsied to confirm the diagnosis.

Since some women undergoing infertility evaluations are suspected of having endometriosis, laparoscopy is often recommended as part of their work up. Almost 40% of women with infertility have endometriosis. The inflammation this condition causes can damage the sperm, egg, Fallopian tubes or lining of the uterus preventing successful fertilization and implantation. On occasion, endometriosis can cause the Fallopian tubes to be blocked from scar tissue. During a laparoscopy, endometriotic tissue can be biopsied and also ablated to prevent recurrent symptoms and also improve chances of pregnancy.

The mainstay of treatment for patients with endometriosis is hormonal contraceptives. These medications can suppress the growth of endometriosis and also treat the painful, heavy periods associated with the condition.

Many women suffer from endometriosis without knowing. If you worry this may be something you’re dealing with, come in for evaluation by contacting our office. Dr. Balassiano is specially trained in the surgical evaluation and training of endometriosis.

For more information on endometriosis, both ACOG and Women’s Health.org have great fact sheets for patients. UpToDate also has a wonderful patient-targeted article on the condition.

CONTRACEPTION: INCREASING OPTIONS

As OB/GYNs, we love caring for women through all stages of life. This includes pregnancy and delivery, which can be some of the most memorable times in a woman’s life. However, unplanned pregnancy continues to be a major issue in women’s health and as advocates of women’s access to the best care, we’re always ready to support women in planning and achieving pregnancy and more often than not—in preventing pregnancy. It’s exciting to have so many more options to offer women who want to delay or prevent pregnancy. There are two Long Acting Reversible Contraceptives (LARC) that we want to highlight today. The Nexplanon is unique for its placement in the patient’s arm and is still not that well-known. Kyleena is a brand new intrauterine device (IUD) that was approved by the FDA just this month.

Hitting it’s five year birthday, the Nexplanon is an etonogestrel implant (68mg, progesterone-only) that is about the size of a matchstick.

LARC

• The implant is inserted just underneath the skin in the upper, inner arm during a brief office visit with local anesthesia
• Once inserted, it is effective at preventing pregnancy (>99% effectiveness) for up to three years, though it can be removed earlier.
• Menstrual bleeding is overall lighter and less painful
• Main side effect is irregular bleeding, worst during the first three months after insertion

Brand new just this month, Kyleena adds to the choices of the levonorgestrel IUDs (19.5mg, progesterone-only).

hand

• From Bayer, the same makers of the much beloved Mirena and Skyla IUDs
• Same small size as the Skyla (2.8mm wide)
• Lower daily dose (about half) compared to the Mirena
• Effective at preventing pregnancy (>99% effectiveness) for up to five years, though it can be removed earlier.
• Periods are much lighter and less painful
• Main side effect is irregular bleeding, worst during the first month after insertion, usually resolved by the third month

SIX MONTHS WITH THE MONA LISA TOUCH

As women transition through and after menopause, one of the most common issues is the changes that occur to the vagina. For women who are not candidates for or do not want hormone treatment, the MonaLisa Touch—a CO2 laser—has proven to be one of the most effective, successful treatment options available. We brought it into the office just over 6 months ago given how important an issue this is and how many women it affects. Our results after the standard 3 treatments have been phenomenal:

• Near resolution of vaginal dryness and irritation
• Dramatically more comfortable sex (average pretreatment pain scores 9 and post treatment 1.5!)
• Complete success in treating mild urinary continence—without surgery
• Mild improvement in symptoms from Lichen Sclerosis

Learn more about this painless, hormone free outpatient treatment here or come in for a consultation.

MONA LISA

HIGHLIGHTS FROM OUR WOMEN’S HEALTH BLOG

Our Women’s Health Blog is a way for us to put out up-to-date information on various topics. There is an entry on Domestic Violence Awareness Month that is from https://WomensHealth.gov. We also put together a primer on the Annual Well Woman Exam, since so much of it has been in the news of late.

General Office Information