2017 Issue 4, Quarterly Newsletter

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WOMEN’S HEALTH

As I’vebeen finishing this newsletter, I keep thinking of my professional colleagues in Napa having to evacuate their homes due to the fires, some having lost everything. This news comes on the heels of all the hurricanes hitting the Southeast and the ongoing struggle to restore public services.

These are some very heavy reminders of what’s most important in life. In these last few months of the year, remember to make time for your loved ones and prioritize family and friends over the hustle and bustle of everyday life.

With everything that’s in the news, the timeless advice of Mr. Roger’s holds firm: “Look for the helpers. You will always find people who are helping.” We’re fortunate to work in a city like Mountain View, which joined the growing list of Human Rights Cities in the US, a symbolic proclamation of the city’s values, including the respect for human dignity and equal rights, and a rejection of discrimination in all its forms. There’s also a lot of local charity work to help with the devastation in Puerto Rico. The Puerto Rican Civic Club is made up of Bay Area residents with ties to Puerto Rico who are taking all donations/supplies with them directly to those affected. To help our neighbors in the North Bay, there are excellent lists of where to send monetary and physical donations here and here. Let us all commit to being helpers.

We wish you the best during the upcoming holidays and end of year festivities, enjoy them with those you love and remember our neighbors who may be in need of our kindness.

Sarah Azad, MD

In this issue:

Practice Reminders and End of the Year Appointments

October is Breast Cancer Awareness Month

They make those? Vaginal Dilators, Reinvented

Acupuncture: An Alternative Approach to Infertility

Adventures in Period Protection Options

Caution with Yelp Hospital Listings

Optimistic Research using Cord Stem Cells for Autism

Please Get Your Flu Vaccine

Volunteers Needed for MonaLisa Touch Training

PRACTICE REMINDERS AND END OF THE YEAR UPDATES

As we continue to run fully staffed at both our Mounitan View and San Jose 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. Please remember to cancel any appointments you can’t make with at least 1 business days’ notice. If you hold on to an appointment slot and cancel last minute, there is a fee for that reserved time.

With the upcoming Thanksgiving and Christmas Holidays, our staff and physicians will be taking off time as well and there will be less openings for patient visits some days of the week. For urgent needs, we are always available. However, if you have any medical needs you want addressed before the end of the year, please book your appointments soon. During the two weeks of holidays at the end of the year, we will only be scheduling urgent visits and those related to pregnancy, allowing more of our staff time home with their families.

OCTOBER IS BREAST CANCER AWARENESS MONTH

October is Breast Cancer Awareness Month! Let’s start with the good news and then remind review basic screening guidelines for women with all sorts of medical histories:

In a timely announcement, the American Cancer Society announced that deaths from breast cancer have declined by 40% in the last three decades! There is still a lot of work to be done in prevention, early detection and treatment, especially in addressing disparities across racial and socio-economic groups. But this announcement was a great reminder that early and regular screening in all women makes a difference.

For low risk women, the American College of Obstetrics and Gynecology encourages shared decision making between a woman and her physician. Screening mammograms should be considered starting at age 40 and then on an annual basis. They should not be delayed later than age 50 or done less frequently than every two years.

There is also a personalized genetic test for women with minimal to no family history of breast cancer that tests one’s own genetic markers to calculate a 5 year risk of breast cancer. Brevagen has been helpful in our practice identifying which “low risk” women can continue with basic, less frequent screening mammograms and which “low risk” have genetic markers that require more frequent clinical breast exams and mammograms or other additional studies. The test currently costs $200, if interested please schedule an appointment to take the test. (We have no financial relationship with the company that runs Brevagen, we just find it a helpful test).

For low risk women with dense breasts, 3D mammography (also knowns as tomosynthesis) continues to provide increased detection rates with lower call-back rates for additional studies. In women with dense breasts and additional risk factors, automated breast ultrasound (ABUS) in addition to mammography has also proven very helpful.

For women at higher risk for breast cancer, current National Comprehensive Cancer Network guidelines recommend both annual mammogram and annual breast MRI. For women who cannot undergo breast MRI, screening breast ultrasound is also a reasonable study. While screening mammography is generally covered under “preventative” health care for this patient population, breast MRIs are often applies to insurance deductibles. Fortunately, most breast imaging centers can work with patient’s to determine their portion of the cost before proceeding with testing. Without any coverage, breast MRIs can be as low as $750.

As early detection is increasing and advances are being made in screening modalities, Contrast Enhanced Mammography (CEM) is a newer technique available in the Bay Area. CEM is a test that women at higher risk for breast cancer can do in addition to annual screening mammography, instead of a breast MRI. The CEM study is quick (5-10 min), is performed on a mammography machine allowing you to stand and does not require the time commitment of an MRI. This is ideal for patients who are claustrophobic or have metal prosthesis precluding MRI. It is also more cost effective than a breast MRI, closer to $300. All current studies so far show CEM to be equivalent to MRI in detection of breast cancer. Given it’s newness in the field, more data is still needed before CEM can fully replaces breast MRI for screening in high risk women.

With advances in technology and treatments, it’s important that women discuss breast cancer screening every year with their physician. Family history and life circumstances often change and having a thorough discussion with your physician is the best way to determine what kind of screening test best fits a woman’s personal situation and fulfills her personal goals.

THEY MAKE THOSE? VAGINAL DILATORS, REINVENTED

Talking about sex and intimacy is very difficult for most people. You might be surprised to learn that most women have lots of questions about all aspects of their sexuality from how their bodies work, orgasms and how to navigate intimacy with partners to questions about safe sex and how to avoid pain with intercourse. If you’re having concerns, rest assured you are not alone and that here at El Camino Women’s Medical Group, all of our providers are comfortable talking about sexuality.

One area that is rarely talked about is the vagina, especially when the vaginal opening is small or when a woman has trouble inserting anything in to her vagina. This can be caused by many factors from hormonal changes that occur with menopause to a condition known as Vaginismus, where the muscles around the vagina tighten involuntarily so that nothing can be inserted.

Using Vaginal Dilators

Up until recently the only solution available to help women dilate and expand their vaginas has been to recommend that women use a series of 6 to 7 separate vaginal dilators. These were of different sizes that ranged from small to large. Women would insert the smallest dilator and then as she became more comfortable and her vagina expanded, use larger dilators. This was and is a bit of a cumbersome process. Now, we have a new option: Milli, a vaginal dilator that expands from small to large and gets smaller at the push of a button.

Milli eliminates the need for using dilators of different sizes and because it expands by 1 mm at a time a woman can work on dilating her vaginal at her own pace. What’s more reassuring, especially for women who have pain with any insertion, Milli will contract and get smaller within seconds just with the push of a button.

If Vaginismus is a concern

If you or someone you know is experiencing vaginismus, can’t have intercourse because the opening is too small or is having pain with intercourse, then do talk to your health care provider about how Milli might help.

As an added bonus, Milli also has a vibrating feature, which can help make the process of using Milli more fun and comfortable.

Now Available

El Camino Women’s Medical Group has been selected as one of only a handful of gynecology practices around the US that has Milli before it’s formal commercial launch! And you can receive a discount on Milli by completing a survey at this link: https://www.surveymonkey.com/r/millinew

Women who complete the survey will receive a promo code for a substantial discount on the cost of Milli signing up here. To purchase Milli, go to www.milliforher.com and enter the promo code at checkout for the discount.

El Camino Women’s Medical Group is here to help

So far, the feedback has been over 90% positive with women saying that they would highly recommend the use of Milli.

Remember you’re not alone, no matter what your sexual concern is and if you need help with expanding your vagina, the providers at El Camino Women’s Medical Group can help.

ACUPUNCTURE: AN ALTERNATIVE APPROACH TO INFERTILITY

Contribution from the Infertility Specialists at CCRM—San Francisco

Used for thousands of years for its therapeutic benefits, acupuncture is the cornerstone of Chinese medicine. Sterile, hair-thin needles are inserted into the skin at specific points (commonly referred to as acupuncture points). When these points are stimulated it has a regulating effect on the endocrine and nervous system.

U.S. doctors are increasingly recommending acupuncture to help ease pain and treat a variety of conditions. The World Health Organization has identified 28 conditions that acupuncture can treat, and evidence suggests that there are therapeutic effects for over 60 more conditions.

Acupuncture and Infertility

Acupuncture has been used in China for centuries to improve reproductive health. Modern research is now confirming that acupuncture does increase fertility. A meta-analysis published in the British Medical Journal reviewing seven research studies of acupuncture used in conjunction with in vitro fertilization (IVF) found acupuncture increased the chance of pregnancy by 65 percent. This study identified acupuncture impacts fertility in the following ways:

• Helps with the release of neurotransmitters, which may stimulate secretion of gonadotrophin-releasing hormone (GnRH). This hormone is key to a woman’s menstrual cycle/ovulation.
• Stimulates blood flow to the uterus by inhibiting uterine central sympathetic nerve activity.
• Stress reduction. When people are under high stress, the hormone cortisol is released in the brain. This alters the brain’s neurochemical balance changing hormone levels and disrupting the balance that is key to the reproductive cycle. Some studies have also shown that stress can create spasms in both the fallopian tubes and the uterus, which can interfere with movement and implantation of a fertilized egg.

In addition, various other research studies have found that acupuncture can impact fertility in the following ways:

• Increased pregnancy rates in IVF
• Improved blood flow to the ovaries
• Improved thickness in the endometrial lining
• Regulation of the menstrual cycle and female hormones
• Reduced risk of ovarian hyperstimulation syndrome in IVF
• Improvements in sperm quality

If you are having difficulty getting pregnant, you might want to consider acupuncture. It’s worth exploring both Western and Eastern medicine treatment options for the best chance of success. Acupuncture is safe, relatively pain-free and is beneficial to both men and women.

The Colorado Center for Reproductive Medicine (CCRM) is one of the nation’s leading fertility clinics providing a wide variety of fertility treatments ranging from basic infertility care to the most advanced in vitro fertilization (IVF) technology available today.CCRM San Francisco, founded by Drs. Salli Tazuke, Sunny Jun and William Schoolcraft, is dedicated to providing patients with industry leading quality patient care and outcomes. The new Menlo Park facility houses an all-inclusive center with an on-site clinic, surgery center, IVF laboratory and clinical laboratory. They offer free fertility education seminars in their Menlo Park office.

ADVENTURES IN PERIOD PROTECTION OPTIONS

By Juliet, patient

My adventure with period underwear began due to my need to end the monthly bedsheet mishaps of my teenage daughters. I had viewed a YouTube video of twentysomethings testing out a Kickstarter company brand, Padkix. The young ladies all made it through the night without period blood leaking on their sheets. An ecstatic “yes” escaped my lips. I had never liked tampons, and my relationship with pads was love/hate. I didn’t like adding something to the environment that would outlive me; I did not like the possible undie mishaps because the pad moved or was not placed in the perfect spot; I did not like feeling like I had on a diaper (this improved with better pad designs) or that someone could see it; lastly, I began to use a ton of pantyliners due extended spotting and found it inconvenient financially.

I invested in several pairs for my daughters and one for me. One month later, I excitedly opened the delivered package that contained the Padkix, a waterproof bag and one net wash bag. The undies were soft and the lining was cotton. My middle daughter is averse to anything scratchy; she exclaimed that they were the softest panties. I was the first to hold my breath and slip into the Padix for a restful night. I was immediately happy that they fit well (I went a size up), were comfortable and I did not have to wrestle with a regular pad that moved around when I shifted during sleep. In the morning, I immediately checked the sheets-nothing! Each daughter reported the same experience no matter how heavy her flow was. My eldest, a new mother, exclaimed that the Padkix and the Thinx (more on that later), were “magical”. Although Padkix were great for bedtime, I found them too bulky to wear under my clothing.

Soon, I came across Thinx panties. These were thin, cute and came in several different styles (Briefs, bikini, sport, boyshorts and thongs). Each style could hold 1/2 a tampon to 2 tampons worth of period blood. I immediately thought, “there is no way they can do what is advertised”. Even so, I took a leap of faith. I purchased a thong (holds ½ tampon) for spotting days, and 2 briefs (holds 2 tampons) for heavy days. I concur with my eldest daughter-They are magical. I have not purchased pads or tampons for 1 year. The panties are comfortable and discreet. I have leaked past the lining of my panties only a few times and that was due to an excessive amount of blood with my period changes. Even so, nothing was on my clothing.

You may wonder how I can function with dirty undies through the day. I do not. The technology of Thinx pulls the liquid away. I have my small, waterproof carrier bag and change my panties like I did with pads…except changes are far less frequent. I soak my undies in a tiny bucket (my teens do the same), and then put them in with the wash in a lingerie bag. I hang them to dry. The process makes me feel connected to being a woman. Why should I feel squeamish about my own body and what it does? Females have been told it is dirty to have our cycles and many have internalized it. I have seen the same towards breastfeeding. For me, the period pantie adventure has been a wonderful experience. All in all, it comes down to what makes one feel comfortable. It is another option-a way to empower yourself.

CAUTION WITH YELP HOSPITAL LISTINGS

Yelp has affected the way we chose almost any service: restaurants, plumbers, hair dressers, you name a business in the service industry, it’s likely on Yelp. The more people use Yelp, the more we learn to take every review with a grain of salt, but it’s becoming an almost essential part of making a decision between different places of business.

Yelp’s role in healthcare has been more difficult, as health care providers primary role is provide a necessity, not an optional service. The cost of healthcare decisions requires that physicians, hospitals, and other healthcare institutions make decisions based on medical needs, not wants. The hospital with the best “ambience” doesn’t necessarily have the best medical outcomes and the surgeon who spends the most amount of time with you doesn’t necessarily have the best surgical technique and outcomes. And yet, Yelp is helpful in helping separate already respected offices, hospitals, and urgent cares into categories of better customer service, wait times, and cost.

In July of this year, in California, Yelp rolled out its effort to increase transparency in maternal health outcomes at hospitals. California hospitals that provide maternity care—like El Camino Hospital in Mountain View—now have a box on their page listing 5 measures of maternity care statistics. The data comes from the California Health Care Foundation, and this joint effort aims to help empower and protect patients.

More information about choices we make in pregnancy is helpful. The very complicated structures of hospitals (and the very different structures between any two hospitals) do make the statistics less meaningful. Some things to keep in mind: many hospitals have a team that takes care of all the pregnant patients, so outcomes don’t vary much between who’s doing the actual delivery, these are hospitals like Kaiser and Santa Clara Valley Medical Center. Other hospitals have a hybrid model of both a team that takes care of most patients, but independent physicians that care for their own patients. And other hospitals have no specific team but different patients are cared for by their independent physicians or physician groups. So, at a hospital like Kaiser, the data on cesarean rates applies really to all patients that come in the door. But at a hospital like El Camino Mountain View, the specific cesarean rate of a patient’s personal physician or physician group are the only statistics that matter and can vary between doctors by over 50%.

There’s also the issue of patient population. A place like Stanford Medical Center has some of the most complicated patients in the Bay Area, who are at baseline at a much higher risk of cesarean section compared to other women. A woman’s baseline BMI and dietary habits in pregnancy are also big predictors of their risk of a cesarean section. The patient population a hospital serves can have dramatically different baseline BMIs and dietary habits

All hospitals have Quality Assurance teams that focus on patient outcomes and work to implement system changes to provide the best outcomes to all patients. With these numbers public and so readily available to consumers, the hope is that hospitals will be encouraged to re-examine their efforts to have practices based on evidence that promotes the best outcomes for the health of laboring women and their newborns. This also brings up a good point of discussion between a patient and her physician on what her risks of a cesarean are under her specific physician’s care at her planned hospital for delivery. But as with all Yelp reviews, these numbers, displayed as they are on a Yelp listing, need to be taken with a grain of salt.

OPTIMISTIC RESEARCH USING CORD STEM CELLS FOR AUTISM

Just after our last newsletter, some amazing scientists at Duke University published some cautiously optimistic results of small, early-stage study of using stem cells from umbilical cord blood as treatment for children with autism.

The study was designed only to establish the safety of the stem cell treatment, but also showed very promising results as the majority children showed improvement in speech, socialization and eye contact. This study paves the way for a larger, double-blinded clinical study to establish firm conclusions on the effect of this treatment on autism.

You can learn more about the value (or lack thereof) of Cord Blood Storage after delivery from our website.

PLEASE GET YOUR FLU VACCINE—YOU CAN EVEN JUST WALK IN!

Flu season is upon us, but fortunately flu activity is still low. In the US, flu season is from November to March, though it starts to show up earlier (El Camino Hospital had cases starting in August) and can last until May. Peak activity is usually between December and February. Every year hundreds of thousands of Americans are hospitalized because of the flu and tens of thousands die. In the last decade, annual deaths as a result of the flu (influenza) has ranged from 12,000 to 56,000, depending on the severity of the season.

The CDC has a lot of information on this year’s flu season, but we can’t predict which years will be worse than others, until we’re in the midst of it, like during the 2012-2013 season, when the severity of the season was announced, the flu vaccine was sold out at most locations and even then it would take the standard two weeks to become effective. The CDC recommends EVERYONE over the age of 6 months get the flu vaccine before the end of October. If you’ve missed the October 31 goal, it’s STILL useful to get the vaccine. The most vulnerable populations are infants and children, pregnant women, and the elderly. If you fall into one of those categories, you should get the flu vaccine. If you live with someone, know someone, or shop at the same grocery store of anyone that falls into that category, you should get the flu vaccine—that’s basically everyone.

At El Camino Women’s Medical Group, we have a recombinant, quadrivalent vaccine (FluBlok) that is preservative, gelatin, and egg free. It’s available to all our patients at any appointment and you can also walk in to our Mountain View location on Thursday mornings from 830am to 1pm and get vaccinated. We are well stocked, but later in the season it’s worth calling ahead (650-396-8110) to make sure we have enough vaccines in stock.

VOLUNTEERS NEEDED FOR MONALISA TOUCH TRAINING

The MonaLisa Touch continues to prove extremely effective in helping women with the vaginal and vulvar changes that occur after menopause and/or breast cancer treatments. The MonaLisa Touch is a medical laser that delivers controlled energy to the vaginal tissue. The laser itself provides one of the most advanced techniques to relieve the most troublesome symptoms associated with vaginal atrophy, including vaginal dryness and painful intercourse. We continue to do our best to offer the most affordable cost we can, as this is a treatment that is still not covered by insurances.

Drs. Teng and Azad both currently perform this treatment in the office. With increasing demand, Drs. Balassiano, Gupta and our Women’s Health Nurse Practitioner Barb Dehn are currently being trained to perform the procedure as well. If you have been interested in the MonaLisa Touch but have not yet had the treatment and are willing to have you procedure done as part of a training session (Dr. Teng or Azad will be supervising the trainee and discussing nuances of technique during the treatment) at our office, your first treatment would be at no cost. Please email Shar (moc.n1679333602emowo1679333602nimac1679333602le@ra1679333602hs1679333602) if you are interested in this opportunity so she can schedule you appropriately.

If you want to learn more about the MonaLisa Touch treatment, our website has a lot of information, a video, and answers to commonly asked questions. You can also schedule a free consultation with one of our physicians by calling the office (650-396-8110) or emailing Shar.

GENERAL OFFICE INFORMATION