2017 Issue 3, Quarterly Newsletter

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WOMEN’S HEALTH

As the “Back to School” signs start to come up, we’re still enjoying the slow, long days of summer. It’s been great seeing all our young adults who are home from college and all the summer babies that make July, August and September the busiest birthing months of the year.

With the warm weather, I hope everyone’s staying hydrated and getting outside and being active. I also hope everyone’s been able to take time off to spend with friends, family and loved ones.

This newsletter has ACOG’s recently release statement on the impact of Climate Change on Women’s health as well as the latest on the Zika Virus. There’s also information on common issues like heel pain and weight loss and less common problems like lichen sclerosis. I hope you find the information interesting and relevant.

In the office, we continue to work on a smooth, timely experience for our patients. Your feedback continues to be of great help. Send any thoughts, suggestions you have directly to Julie, our office manager at moc.n1695901311emowo1695901311nimac1695901311le@ni1695901311mda1695901311, or anonymously via our feedback form /office-info/feed-back.html.

If you’re looking for a way to enjoy the Summer weather, visit the San Jose Rose Garden or Point Lobos State Natural Reserve, you won’t regret it.

Sarah Azad, MD

In this issue:

Practice Updates

ACOG’s Statement on Climate Change and Women’s Health

What Happened to the Zika Virus?

The Challenges of Vulvar Lichen Sclerosus

Tips for Heel Pain

The Value of Storing Cord Blood Stem Cells

What to do when you Have Excess Breast Milk

When your Medications Cost Too Much

Highlights from the Women’s Health Blog

PRACTICE UPDATES

For the first time in over 2 years, we’re excited to say there are no major updates! With Dr. Gupta settled in, we’re now running fully staffed at both our locations. We hope you’ll always be able to get an appointment with your personal doctor in a timely, convenient manner. However, as a small group, we’re fortunate to have partners who can help accommodate very time-specific requests. We continue to have evening hours on Tuesdays, Wednesdays, and Thursdays. We are also open most Saturday mornings.

ACOG’S STATEMENT ON CLIMATE CHANGE AND WOMEN’S HEALTH

In June of 2017, ACOG re-released it’s statement on Climate Change and Women’s Health:

CLIMATE CHANGE AND WOMEN’S HEALTH

Position Statement of The American College of Obstetricians and Gynecologists and The American Congress of Obstetricians and Gynecologists

Conclusive evidence has demonstrated that climate change is having a dramatic impact on the lives of people around the world. Representing physicians dedicated to the whole well-being of women – including their safety, security, and access to quality care – the American College of Obstetricians and Gynecologists recognizes that climate change is an urgent women’s health concern as well as a major public health challenge. We call on our national and international leaders to act to curb greenhouse gas emissions and limit further climate destabilization.

Without question, climate change has a disproportionate effect on global women’s health, as it broadens existing gender-based health disparities. The effects of climate change – such as food and water insecurity, civil conflicts, extreme weather events, spread of disease, and more – put women in affected regions at elevated risk of disease, malnutrition, sexual violence, poor mental health, lack of reproductive control, negative obstetric outcomes, and death. This also has an impact on future generations, with the rate of low-birth weight infants increasing in regions impacted by the effects of climate change, and with the erosion of the health care infrastructure needed to support healthy women and healthy families.

The impact of environmental toxins in the preconception and prenatal period can have a profound and lasting impact on obstetrical outcomes, and these can have negative consequences that last throughout a lifetime. Evidence suggests that climate change can exacerbate the already significant risks to fetal health and the health of future generations.

ACOG also emphasizes that proactive steps to protect and to develop women’s health care access can aid significantly in a region’s recovery. For example, we know that reliable access to reproductive health services enhances the ability of women to contribute to social and economic development.

Moreover, as the effects of climate change continue to threaten the well-being of women across the globe, we ask that government and public health agencies take steps to ensure the protection of women’s health services and human rights.

You can read the original statement here.

WHAT HAPPENED TO THE ZIKA VIRUS?

The Zika Virus continues to be cause for limiting travel before and during pregnancy. Roughly one out of every four fetuses exposed to the Zika Virus will have a complication including: still birth, growth restriction, or microcephaly. The area the CDC recommends restricting traveling has grown from last summer.

Travel Restrictions
(Updated: April 3, 2017)

• Pregnant women should not travel to any area where there is a risk of Zika virus infection, including areas where the virus has been newly introduced or reintroduced and local mosquito-borne transmission is ongoing; areas where the virus was present before 2015 (endemic) and there is no evidence transmission has stopped; and areas where the virus is likely to be circulating but has not been documented. Because Zika infection in a pregnant woman can cause severe birth defects, pregnant women should not travel to these areas. To help pregnant women and others identify areas of Zika risk, see CDC’s interactive World Map of Areas with Zika Risk to search for location-specific Zika information and travel recommendations. CDC updates Zika travel guidance regularly. Fellows should check CDC’s Zika Travel Notices periodically for updates.
• Pregnant women and their partners who must travel to one of these areas should strictly follow steps to prevent mosquito bites during the trip and decrease the risk for sexual transmission (see Prevention).

For patients who are planning pregnancy or pregnant please let the office know before arranging any travel to Zika-endemic areas.

THE CHALLENGES OF VULVAR LICHEN SCLEROSUS

An uncommon skin condition, lichen sclerosus causes the thinning of vulvar or peri-anal skin with patchy, white discoloration. While it can affect anyone, women are particularly vulnerable after menopause.

In its most mild forms, some women have no noticeable symptoms. However, women usually note:

• Vulvar itching, which can be severe
• Discomfort or pain
• Smooth white spots on your skin
• Blotchy, wrinkled patches
• Easy bruising or tearing
• In severe cases, bleeding, blistering or ulcerated lesions
• Painful intercourse

If any of this sounds familiar, you should come in for an exam. If you’ve already been diagnosed with lichen sclerosus, you should continue to come in every six to 12 months to be checked for any skin changes or treatment side effects. The exact cause of lichen sclerosus isn’t known, but an overactive immune system or an imbalance of hormones may play a role. Previous skin damage at a particular site on your skin may increase the likelihood of lichen sclerosus at that location.

Lichen sclerosus isn’t contagious and cannot be spread through sexual intercourse.

Unfortunately, treatment options are pretty limited. Corticosteroids continue to be the mainstay of treatment. Daily use for the first few weeks to get symptoms under control is safe, however then we recommend you decrease usage to twice a week or less to prevent side effects from over-exposure to steroids. Other treatments include immune-modulating medications, such as tacrolimus and pimecrolimus. Though topical hormone creams have been studied in the past, they have shown no improvement in the literature.

With the arrival of the MonaLisa Touch to the American market in the fall of 2014, a lot of OB/GYNs started using this CO2 laser for treatment of lichen sclerosus with a lot of success. We’ve had several patients in our office try the MonaLisa Touch Laser for their lichen sclerosus with marked improvement in their symptoms. Dr. Baggish published a great article at the end of 2016, documenting his success with treating women with lichen sclerosus using CO2 laser

If you have symptoms similar to what’s listed above, or have a known diagnosis of lichen sclerosus and want to discuss your current treatment regimen, call or email for an appointment.

TIPS FOR HEEL PAIN

You wake up in the morning and are scared to step out of bed. You know that stabbing, burning pain will start in bottom of your foot as soon as you put weight on it. Does this sound familiar? This kind of difficult morning routine is a sign that you may have Plantar Fasciitis.

Plantar fasciitis is the most common cause of heel pain in women. Involving inflammation of the plantar fascia—the thick bank of tissue that connects your heel bone to your toes—it’s associated with at stabbing, burning pain that occurs with first steps in the morning. The discomfort usually improves during the day but is exacerbated again with long periods of standing. It’s more common in runners, people who are overweight and those who wear shoes with inadequate support.

Under normal circumstances, your plantar fascia acts like a shock-absorbing bowstring, supporting the arch in your foot. If tension and stress on that bowstring become too great, small tears can arise in the fascia. Repetitive stretching and tearing can cause the fascia to become irritated or inflamed, though in many cases of plantar fasciitis, the cause isn’t clear.

Other risk factors for developing Plantar Fasciitis include:

• • Age. Most common between the ages of 40 and 60.
  • Certain exercises. Activities that place a lot of stress on your heel and attached tissue — such as long-distance running, ballistic jumping activities, and ballet dancing and aerobic dance— can contribute to an earlier onset of plantar fasciitis.
  • Foot mechanics. Being flat-footed, having a high arch or even having an abnormal pattern of walking can affect the way weight is distributed when you’re standing and put added stress on the plantar fascia.
  • Obesity. Excess pounds put extra stress on your plantar fascia.

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• Occupations that keep you on your feet. Factory workers, teachers and others who spend most of their work hours walking or standing on hard surfaces can damage their plantar fascia.

Fortunately, there are things you can do to make it better. The most important thing to do is to get good shoes. The Walking Company is a great place to start. Sneakers are great for running and sports, but not so much for people who’s days include a lot of walking and standing. You should have your feet measured and then find a shoe that’s meant for your specific shape.

Next, start regular stretches to help loosen and stretch the plantar fascia. There are some to do before and after getting out of bed.

Icing your heel or taking ibuprofen or naproxen are also helpful for temporary relief of pain from the inflammation.

You can also request a referral to Physical Therapy for more one on one training.

There are also night splints made specifically for women with Plantar fasciitis to be worn at night while sleeping. There are also orthotics-custom fitted arch supports—that help distribute the pressure to your feet more evenly.

If you feel these treatments aren’t helping enough, or want a thorough exam, the best person to visit is a podiatrist. You can call our office for a referral.

THE VALUE OF STORING CORD BLOOD STEM CELLS

One of the decisions expecting parents have to make is whether or not they should bank cord blood and/or cord tissue. The American College of Obstetrics and Gynecology currently does not recommend storing cord blood as a “biologic insurance” against future disease. They have a great brief patient handout here on the topic and a more detailed position statement here.

There is still a lot of unknown potential in these powerful stem cells. Dr. Verter started a website called A Parent’s Guide to Cord Blood to provide balanced information to expecting parents on the science and potential of cord blood storage.

The term “cord blood” refers to the blood left behind in the umbilical cord and the placenta after the delivery of a baby. “Cord tissue” refers to the rest of the umbilical cord. The cord blood, cord tissue, and the placenta are all very rich sources of newborn stem cells.

Transplants of cord blood stem cells can cure over 80 diseases, most of which are rare among children. Inherited blood disorders, like sickle cell anemia and thalassemia, are an example of an exception. In recent years trials with cord blood have showed promise for treating more common childhood conditions, such as cerebral palsy, autism, and others.

While some parents may choose banking because of their family history and others may choose it for added peace of mind, the underlying reason is to help ensure their child’s and family’s future health and well-being. Why to bank cord blood and why to bank cord tissue are ultimately medical decisions based on the relatively recent discovery of where to find and isolate stem cells and the growing use of these stem cells in the treatment of diseases. Cord blood and cord tissue contain an abundance of stem cells that can easily be collected and banked (cryopreserved) in the event that they are needed later in life.

If you want more information on donating or privately storing cord blood or tissue, you can read more here.

WHAT TO DO WHEN YOU HAVE EXCESS BREAST MILK

If you or someone you know has extra breast milk and are not sure what to do with it, consider sharing with other families.

One option is to donate to a local milk bank, like Mothers’ Milk Bank in San Jose.

Another, less known option, is to connect with another, specific family and directly share with them and their newborn. Human Milk 4 Human Babies (HM4HB) is a global network where families in need can connect with women who have milk to share. HM4HB affirms that human milk is the biological norm for human infants and children. HM4HB does not support the sale of human milk on our network. They have groups across the globe, but the page for the local California group is here and their FAQ are posted here.

WHEN YOUR MEDICATIONS COST TOO MUCH

The healthcare system in the US is complex.  Designed by the health insurance industry, the pharmaceutical industry and government and hospital bureaucrats, there’s very little transparency, or common sense, in the cost of care to the average patient.  When talking about medications, if you walked into a Walgreens to buy a month’s supply of Lipitor (common medication for high cholesterol), it would cost you roughly $140 without insurance.  If the same person walked across the street to a Safeway, it would be closer to $30.

The difference in price makes no sense, but the lack of transparency makes it common for people to pay much higher out of pocket than they need too.  Currently, up to 45% of Americans have trouble paying for the prescriptions they require, and 26% of Americans simply don’t fill prescriptions because they simply can’t afford it. The #1 reason Americans don’t take their medications as prescribed is cost.

There’s a website (and an app) called GoodRx.com that helps make pharmaceutical pricing a little more transparent. It doesn’t cover insurance discounts or specific pharmacy programs that may be available, but it makes it a lot easier to see what the pricing options are in your area.

For the uninsured, it’s often easy to get an affordable price.  There are many ways to save 80% or more – coupons, savings tips, pharmacy discounts, manufacturer discounts, cheaper alternative drugs or even just asking for a better price.   For the insured, sometimes you can get meds for cheaper than your co-pay.  For example, hundreds of generic medications are available for $4 or even free without insurance …if only you know where to go. Your insurance co-pay of $10 doesn’t sound so great if GoodRx can point you to the exact same drug for 60% less.

The next time you’re frustrated by the cost of prescription, check what GoodRx has to say, there may be a cheaper option for you.

***We have no financial relationship with GoodRx, it’s a website we discovered a few years ago that has helped out many of our patients get the treatment they’ve needed at an affordable cost.

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 a great article by a woman with a high risk of breast cancer who had to start getting mammograms in her 30s.  There’s also an article on getting mammograms when you have breast implants.  With the ongoing success of the MonaLisa Touch, there was a recently published article on its safety and longer term success rates.  .

GENERAL OFFICE INFORMATION