|2018 Issue 3||www.ElCaminoWomen.com||July 16, 2018|
Welcome to Summer!
I hope everyone’s staying hydrated this summer, as we hit records across the globe for some of the hottest weather on record! California’s Death Valley still hold’s the hottest recorded temperature on earth, 134°F in 2012.
With summertime also comes a lot of vacation. As everyone gets in their summer trips, we want to remind everyone that our physicians and staff have short times away as well. With Dr. Teng on maternity leave for the summer, we ask for your patience for any non-urgent appointments as we get everything scheduled as best we can.
This newsletter has a lot in it, I’m sure you will all find something for you and your loved ones. From the value of a prenatal vitamin, to hair loss in women and summer safety for kids, we also have a lot of contributions from physicians in other practices within the El Camino Hospital community.
As always, feedback is always welcome on our practice, customer service, and even this newsletter!
In this issue:
New Treatments and Updates for the Dry Vagina
Winning my Battle with PMS—a patient’s story
Brown Spots and how to get Rid of them
Let the Summer Fun Begin—a Pediatrician’s View
We’ve finally got all our staff up and running. Our aim is to treat all our staff the way we would want our own family treated. There are things about medicine that can be frustrating: appointments not running on time, last minute schedule changes due to urgent or emergent surgeries and deliveries, for example. However, we do aim to do our best with what’s in our control. Your feedback on our office practices and our physician and staff communication are always welcome. Dr. Teng will be out for maternity leave until the fall. Rest assured that we are still here and available for your questions, follow up and any urgent issues that may come up. One of us is assigned to address all her paperwork, results and phone calls every day.
Just a reminder, starting July 19th (delayed from previously announced July 1st) we will begin charging for forms needed by patients. Outside of a quick work/school note, every form required for us to fill out will cost $30. These services are not medical-related but usually for patient’s HR departments and disability insurance programs. Medical insurance doesn’t cover these services and given the healthcare climate we live in, we can no longer provide these services without charging for the administrative cost to the practice.
We outgrew our current space sometime last year, so we’re super excited about the space being built for us in the IMOB across the street. If you’re interested in seeing the progress, you can see the progress here. We’re currently in our third home since we opened in July of 2009. We are all looking forward to finally settling down in this new, larger suite.
What’s in a Prenatal Vitamin?
One of the most common discussions we have in the office is about prenatal vitamins (PNV). PNV are recommended for women who are trying to get pregnant, pregnant, and nursing.
The best way to get the vitamins and minerals you need is a healthy diet. Given modern farming methods and the modern diet, even with a healthy diet, women can find themselves short on key nutrients. As a woman prepares to support a new life, through pregnancy and nursing, PNV help fill any gaps.
PNV are specially formulated multivitamins that mothers-to-be are advised to take for their own health as well as for the health of their babies. These vitamins make up for any nutritional deficiencies in your diet during pregnancy. While the supplements contain many vitamins and minerals; folic acid, iron, and calcium content are especially important for these women.
The American College of Obstetricians and Gynecologists (ACOG), recommends pregnant and lactating women should aim for an average daily intake of at least 200 mg docosahexaenoic acid (DHA) a day in addition to their prenatal vitamins. DHA is an essential Omega-3-fatty acid found primarily in brain and eye tissues that is an important part of our diet. Our own bodies cannot make DHA, it must come from our diet or supplements. Prenatal vitamins, as well as DHA, can be purchased over the counter or with a prescription.
Taking folic acid can reduce your risk of having a baby with a serious birth defect of the brain and spinal cord, called the “neural tube.” A baby with spina bifida, the most common neural tube defect, is born with a spine that is not completely developed. The exposed nerves are damaged, leaving the child with varying degrees of paralysis, incontinence, and sometimes mental retardation.
Taking calcium during pregnancy can prevent a new mother from losing her own bone density as the fetus uses the mineral for bone growth. Taking iron helps both the mother and baby’s blood carry oxygen.
We find that most over the counter PNV are sufficient for women to help support pregnancy and nursing. Specific brands of over the counter PNV that we know are good quality and contain all the needed vitamins and minerals include Women’s One a Day, Nature’s Made, and Rainbow’s Prenatal One (but you would need a separate DHA for this one). There are many prescription PNV, including smaller all in one tablets and an excellent vegan PNV that we often write for. A lot of it depends on what you can tolerate and what your needs are.
For more information on what to do, before you even get pregnant, click here. ACOG also has information on nutrition in pregnancy here.
New Treatments and Updates for the Dry Vagina
For women going through or having completed menopause, for women postpartum and nursing, and for those on treatment for breast cancer, a dry, painful vagina can be a daily struggle. This is something we discuss often in our office.
In November of 2016, the FDA approved the use of prasterone, a synthetic form of DHEA, as a daily vaginal suppository for the treatment of painful sex due to vaginal atrophy from menopause. It became commercially available as Intrarosa in 2017. Unlike vaginal estrogens, use of Intrarosa does not increase serum levels of estrogen. It has no “black box” warning like vaginal and transdermal estrogen treatments for the same problem. It does increase serum levels of DHEA, though slightly. Since the low levels of increased DHEA in blood serum haven’t been adequately studied at this time, women with a personal history of breast cancer or who are currently taking Tamoxifen should not be using Intrarosa. Like Osphena and the MonaLisa, full effect can take up to 12 weeks. For women wanting to avoid estrogens, Intrarosa is a new addition to the options available.
Milli is finally out! Many patients have been asking about it. The Milli is the only expanding vaginal dilator on the market and was a great success when it first came out. After having improved some of the issues that came up with the first design, Materna just began sales again of the improved Milli in June of this year.
We’ve written about vaginal dilators before. No matter what your reason or treatment option for painful sex, a vaginal dilator nearly always helps. It’s gentle, slow expansion under your full control which allows for the comfortable, gradual dilation of your vagina. Used immediately before intercourse, it also helps decrease anxiety around whether or not your vagina is “too tight.”
We’ve now completed 2 years of treatments with the MonaLisa Touch CO2 laser in our office. Results continue to be extremely positive. Though the treatment hasn’t been great for every single patient, about 95% of our patients who have completed the initial full course continue to remark on how much it has improved their vaginal health. Most women have been able to completely wean off their estrogens as well. For women whose primary issue is vaginal discomfort or irritation and/or painful sex, the MonaLisa Touch CO2 laser remains our first recommendation for treatment. It is hormone free and essentially risk free. All the physicians in our office are fully trained and regularly provide this service. Contact Shar if you have further questions or want to set up a free consultation or appointment for treatment.
Hair Loss in Women
Although I am a surgical oncologist, I have listened to all sorts of patients complaining about hair loss, and what can be done to solve it. Most of the time the patients have really pressing health issues and the hair is the least of the trouble. However, hair is one of the least discussed medically, but most important feature regarding personal appearance. Hair loss can contribute significantly to anxiety, loss of self-esteem, and emotional distress. Having a full head of hair contributes to our sense of well-being. We often speak about hair loss in the cancer patient, but hair loss in women is very prevalent. In the US there are over 21 million women affected by female pattern hair loss. The incidence in women in their 30s is approximately 12% and rises to 30-40% for postmenopausal women.
Each hair follicle undergoes continuous cycles of growth (anagen), resorption (catagen) and rest (telogen). The portion that is visible is called the hair shaft. That which is below the surface of the skin is called the follicle. Hair loss can be a result of disturbances to the hair cycle, damage to the hair shaft, or disorders affecting follicles. We lose, on average, between 100-200 hairs per day.
The cause of hair loss is multi-factorial. A detailed medical history is important in identifying the cause.
Some questions to think about:
- When the hair loss started? Was it sudden or gradual?
- Have you noticed if most the hair loss is localized or diffuse? Where? Near your part or hairline? Or in round patches?
- What is my normal hair care routine? Do I bleach, color and/or perm my hair? Do I blow dry and shampoo daily?
Some Medications can lead to hair loss:
- Chemotherapy medications such as Adriamycin
- Anticoagulants: blood thinners can cause hair loss that affects the entire scalp. This usually begins around 12 weeks after beginning the medication
- Gout medications like allopurinol
- Beta-blockers including atenolol, metoprolol, and propanolol
- Angiotensin-converting enzyme inhibitor- captopril, enalapril
- Hormones including contraceptives and hormone replacement therapy
- Antidepressants including Prozac and Zoloft
Clinical patterns of female pattern hair loss: non-scarring progressive miniaturization of the hair follicle, which appears as thinning of the hair
- TYPE I: Diffuse thinning of the crown region with preservation of the frontal hairline (Ludwig’s type)
- TYPE II: frontal mid-line recession with thinning and widening of the central part of the scalp without diffuse hair loss. This pattern also involves the superior part of the scalp with thinning that is wider at the frontal scalp giving the hair loss area a triangular-shaped appearance resembling a Christmas tree.
- TYPE III: Thinning associated with recession at both temples
Diagnosis: How it’s made at the doctor’s office
- Examination of the scalp: With a magnifying glass, to determine the health and density of the hair follicles
- Hair pull test: In which the examiner gently pull on tufts of hair along the scalp.
- Hair Density: Devices including Hairquick, Dermatoscope
- Examination of other skin, looking for acne, excessive hair, elevated BMI
If the patient has generalized signs of hirsutism, acne, irregular periods, infertility, galactorrhea, and/or insulin resistance then polycystic ovarian syndrome (PCOS) is a consideration.
Laboratory tests that may be performed: Thyroid function, ferritin, and vitamin D levels to exclude factors that can increase shedding and aggravate the hair loss. Patients with a history of irregular menses, elevated body mass, or skin signs of hyperandrogenism should be referred to an endocrinologist for diagnosis of PCOS.
Other diagnoses that need to be considered in hair loss
- Telogen effluvium: Normally, the majority of the scalp hair is in the growth phase with a small percentage of hair in the resting phase being shed 100-200 daily. Under certain circumstances a higher percentage of hair cycles into the resting phase (instead of the growing phase) and the woman may notice a sudden onset of marked shedding. The exam usually reveals normal hair density and good scalp coverage on global exam, but because more than 50% of the hairs must be lost before hair loss is clinically apparent, no diagnosis of hair loss can be made. If the patient is examined while the hair loss is still active, the pull test might be positive. Otherwise hair regrowth with tapered ends may be seen. The common cause of hair loss could include a high fever, childbirth, severe infections, severe flu, severe chronic illness, major surgery, thyroid disorder, crash diets, inadequate protein, and certain drugs. Shedding often starts months before the inciting cause but is self-limited and reversible if the offending causes are corrected.
- Hair breakage: Hair is composed primarily of keratin. Damage to the hair shaft by improper cosmetic techniques can cause hair breakage. There is little damage from normal dying. However, damage can occur with bleaching, straightening and weaves. Hair breakage can occur with too much tension during the weaving, weaving solutions left on too long or improperly neutralized, or weaving and bleaching on the same day. Other causes of hair breakage include the tension from braids, ponytails, and cornrows. Treatment of hair breakage usually requires some changes in the hair care routine. These types of hair styles should be made with looser hair bands. A cream rinse conditioner with silicone will make the hair more manageable and easier to comb. When the hair is wet its more fragile so vigorous rubbing with a towel and rough combing or brushing should be avoided. The use of wide tooth combs and brushes with smooth tips are recommended. Also, using heat on wet hair causes increased damage hair loss. The damage is reversible if the cosmetic procedures are stopped and the hairs are handled gently.
- Androgenic alopecia: Due to the influence of androgen hormones, the hair follicle gradually thins. Woman with hereditary thinning first notice the thinning of the hair on the top of their heads. This means the scalp becomes more visible over time. The hair on the sides may become thinner in the patient. Many women notice that their ponytail is smaller than before.
- Alopecia areata: An autoimmune disease that impacts around 2% of the population. In this disease, the patient’s inflammatory cells target hair follicles which prevent hair from growing. Typically, a small round patch of hair loss is noticed. It is important to notice and diagnoses this type of hair loss because steroids and other immune therapy medications can successfully treat this.
The good news is that there are lots of options for treatment.
- Changing the hair care routine to decrease heat treatments, blow-dry, and frequency of shampoo
- Include products that maintain the health of the hair, and some which increase the diameter of the hair shaft.
- Medications including minoxidil which stimulates follicle growth
- Laser light therapy which can stimulate hair growth
- PRP ( platelet rich plasma) to promote hair growth
- Hair transplantation
If you are interested in a consultation, please contact us:
Winning my Battle with PMS—a patient’s story
Yelling at my parents, drama with my high school besties, giving up on my life goals for a few days out of every month….my memories of my PMS go back to when I was 14. I know there are some boyfriends I broke up with because I was lost in my PMS rage and I’m positive there were some that broke up with me because it was just so bad.
I would bring it up with my family doc and my gynecologist and even my therapist. I did birth control pills, I did therapy, I did breathing exercises. I exercised, took my vitamin D, downloaded an app. Everything made it a little better, but a little better from terrible was never quite enough. There’s also the ongoing commitment, a pill every day, the gym every day, it was hard for me to keep anything up for long. And I could never bring myself to start a depression medicine.
Then there was a day when my motivation and my GYN’s advice all lined up. Finally, I found myself in a relationship with a really good guy. Because of work and family circumstances, I managed to hide my PMS issue for quite some time but one day, we had the “you really have to do something about this” conversation. I made an appointment with Dr. Azad, hoping for something, thinking I may finally have to try the depression medicine, but dreading it. She gave me the same list: the pill, exercise, vitamin D, regular visits with a therapist, yes…the app to warn me. But she added something new, Serenol. She also told me what most of us with PMS know, at some point, winning the battle has to be more meaningful to me than avoiding the daily pill. I’m already on the birth control pill, so I committed to adding the vitamin D and the Serenol. She told me I had to promise to stick with it for 3 months and I promised. And, if this didn’t work, depression medications was all that was left.
2 months of taking two tablets a day, I felt better. I still had my lows, but I didn’t have my internal mental tantrums. Likely placebo, right? So, I made it to 3 months and still felt better. Now 6 months on it and I clearly still have PMS, but now it’s not destructive and it’s not draining, and my partner and I are still together. I haven’t cried myself to sleep, not once, in 5 months, that’s got to be a record for me.
I wrote to Dr. Azad to thank her and said I was trying to get all my friends to take it, so she asked me to write about my experience. I just want to say, if you just don’t want to take a pill every day, do it anyways. It’s a natural supplement, it tastes gross, but it’s 2 seconds out of your morning routine and really, if you’re at the point where you’ve got to do something, try it, it’s worked well for me. But she was right, you shouldn’t give up on it until you’ve given it 3 months. And if you’re lucky like me, you’ll never quit after you hit 3 months.
Brown Spots and How to Get Rid of Them
Are you wondering what to do with those dark blotches that continue to appear on your skin, especially on the face?
Visiting your dermatologist is the first step in making sure that these spots are not pre-cancerous or even cancerous, and to initiate the proper medical treatment, if needed.
Most facial brown spots however, are harmless. There are several benign causes of this unwanted discoloration of the skin. They may be solar lentigos (literally meaning sun-induced spots occurring in mature, sun-damaged skin), ephelides (common freckles seen in children and young adults due to excessive sun exposure), post inflammatory hyperpigmentation (seen in people of color due to skin irritation after pimples, insect bites, rashes and other causes of skin inflammation) or melasma (skin darkening due to the influence of UV light exposure in combination with estrogen). Melasma, which is usually seen in women and often referred to as the brown “mask of pregnancy” commonly involves the forehead, temples, cheeks and upper lip and may occur during pregnancy or with the use of hormonal contraceptives (eg, estrogen-containing birth control pills, NuvaRing) and estrogen replacement therapy (HRT).
Once a well-trained dermatologist has examined your skin and determined that the brown spots you have are indeed benign and only cosmetic in nature, there are several effective options available to treat and remove them.
Prescription-strength topical skin care products. Many over-the-counter skin care products aimed at removing unwanted brown spots and other signs of skin damage just don’t contain the concentration levels in their active ingredients to provide the most effective results. For example, most skin-lightening products available at the dermatologist’s office are far stronger in concentration while also formulated to be gentler to the skin than the products you find at high-end department stores. By allowing a dermatologist to create an individualized skin care regimen for you, you will have an expert selecting the most effective products for your skin. Your dermatologist will be able to target your specific skin concerns while taking into consideration your skin type and skin sensitivities, as well as your lifestyle.
Chemical Peels and Lasers
Procedures such as chemical peeling, laser treatments (Fraxel, Clear and Brilliant, PicoWay laser, Intense Pulsed Light), and even liquid nitrogen (freezing) are all effective in improving brown spots, but only when performed under the direction of an experienced dermatologist who has extensive knowledge of patients’ skin types and risks for post-inflammatory hyperpigmentation (see above) which may occasionally occur due to the potential for irritation from these procedures. In most cases, pretreatment of patients with the use of prescription-strength topical fading products both before and after the chemical peel or laser treatment, is strongly recommended to ensure the best, longest-lasting results. Remember, the cause of brown spots is sun exposure, and the sun is not going away anytime soon!
It is critical to always remember that meticulous sun protection of your skin is as important as any treatment choice when considering removal of brown spots.
Have a wonderful summer and remember to protect your skin from the sun!
2490 Hospital Drive Suite 201
Melchor Pavilion, El Camino Hospital
Mountain View, CA
Let the Summer Fun Begin—A Pediatrician’s View
Please talk about these tips with your kids and ask friends and parents to do the same. Then enjoy the summer and remember to keep having fun.
TIPS FOR PLAYGROUND SAFETY
- Teach children that pushing, shoving or crowding while on the playground can be dangerous.
- Little kids can play differently than big kids. It is important to have a separate play area for children under 5.
- Ensure that your children are dressed appropriately for the playground. Avoid the risk of strangulation by removing necklaces, purses, scarves, and clothing with drawstrings that could get caught on equipment. Even helmets can be dangerous on a playground, so save those for bikes.
- Take your kids to playgrounds with shock-absorbing surfaces such as rubber, synthetic turf, sand, pea gravel, wood chips or mulch. If your child falls, the landing will be more cushioned than on asphalt, concrete, grass or dirt.
- Sunlight exposure during childhood and adolescence is generally considered to increase the risk of melanoma. We’ve heard it all before, but make sure your family and caregivers all have the same sun-strategy.
- Apply early and repeat. For kids 6 months and older (as well as adults), sunscreen with a Sun Protection Factor (SPF) of 15 or greater reduces the intensity of UVRs that cause sunburns. Apply liberally 15 to 30 minutes before sun exposure so it can absorb into the skin and decrease the likelihood that it will be washed off. Reapply every two hours and after kids swim, sweat or dry off with a towel. For most users, proper application and reapplication are more important factors than using a product with a higher SPF.
- Cover. Dress kids in protective clothing and hats. Clothing can be an excellent barrier of UV rays. Many light-weight, sun-protective styles cover the neck, elbows and knees.
- Keep infants out of the sun. Keep babies younger than 6 months out of direct sunlight, dressed in cool, comfortable clothing and wearing hats with brims. The American Academy of Pediatrics (AAP) says sunscreen may be used on infants younger than 6 months on small areas of skin if adequate clothing and shade are not available.
- Plan early morning play. For kids beyond that baby stage, Cokkinides advises parents plan outdoor activities to avoid peak sun hours (10 a.m. to 4 p.m.) as much as possible. Does that sound impossible for your active kids? Make sure you all can get a break from the sun when needed.
- Beware of shade. Many people think sitting in the shade is a simple sun compromise. Shade does provide relief from the heat, but it offers parents a false sense of security about UVR protection. You can still get a sunburn in the shade, because light is scattered and reflected. A fair-skinned person sitting under a tree can burn in less than an hour.
Splash Safely and Other Water Rules
Some helpful tips to prevent accidents around the water:
- Stay off cell phones. Don’t allow yourself to get distracted when your kids are in the water. And yes, chatting with other parents counts as another common distraction.
- Know your skills. Adults and caregivers should refresh their Infant Child CPR certification EACH YEAR. Since summer can come with lots of time near water, refreshing your skills before summer is a good option. Kids should never swim alone, and having adults or caregivers know water safety skills is smart.
- Put a guard up. Even kiddie pools in back yards should be drained after use. For houses that have swimming pools, fencing should be at least 4 feet high and surround the pool on all sides, with doors that close and lock by themselves. Pool supply companies may offer options for alarms and other safety systems. Remember to never rely solely on an alarm or a fence. Train your kids to never go near the pool without an adult.
- Educate yourself. The Consumer Product Safety Commission (CPSC) has a pool safety guide where families can find out how to keep kids safer at any pool — whether it’s the community park or your child’s camp.
Beware of Bugs
Unfortunately, blood-sucking critters like mosquitoes are a part of summer nights, and, yes, even days.
- Spray and repeat. Parents or caregivers should spray kids’ exposed skin and clothing. Reapply whenever the spray gets washed off or the child starts getting bitten again. For an alternative to sprays, try insect repellent pads that clip on clothes.
- Check for allergic reactions. Some kids react to insect bites more than others. If your child gets bitten and seems to have an allergic reaction to the bite, always seek medical attention to see if you should give your child an oral antihistamine
- You may be surprised how much —and when — kids should drink liquids. To prevent dehydration, kids should drink 12 ounces of fluid 30 minutes before an activity begins and take mandatory fluid breaks (like many day camps require).
- The Safe Kids Coalition urges parents and caregivers to watch for warning signs of dehydration, such as thirst, dry or sticky mouth, headache, muscle cramping, irritability, extreme fatigue, weakness, dizziness, and/or decreased performance.
- Helmet safety is extremely important, particularly during the summer when kids spend a lot of time outdoors riding bikes. Kids should always wear a properly fitting helmet. Make a family rule: no helmet, no wheels! And parents and caregivers, you must serve as an example: Wear your own helmet.
Never Wait in a Hot Car
It only takes 10 minutes for a car to heat up by 19 degrees. Every so often, we hear news stories of parents forgetting infants or leaving a sleeping toddler in the car and the terrible tragedies that ensue. Never leave a child alone in a car, even for a minute. Degrees can be deceiving. Fatalities can occur at temperatures as low as the mid-50s because a vehicle heats up so quickly. Children are at a great risk for heat stroke because their bodies heat up three to five times faster than an adult’s does. Cracking a window? Not a solution. Some advanced technologies are still being developed that may help prevent heat stroke deaths in vehicles, but nothing has proven effective yet.
Summer is a great time of year that our children remember forever. Do your best to enjoy every minute with your children as they grow so fast. Taking appropriate safety precautions makes sure that the memories will be lasting and joyful!
763 Altos Oaks Dr. Ste 4
Los Altos, CA, 94024
Vitamin D Deficiency
What is a vitamin D deficiency?
A vitamin D deficiency is when you do not have enough vitamin D in your body. This is a problem, because the body needs vitamin D to absorb calcium and for other important jobs. People with vitamin D deficiency can have symptoms which include bone pain and tenderness, muscle weakness, fracture, and difficulty walking.
- Vitamin D deficiency is when titers are less than 20 ng/ml.
- Vitamin D deficiency appears to be common among several populations including those who are dark skinned, obese, taking medications that accelerate the metabolism of vitamin D, hospitalized, those who have limited effective sun exposure due to protective clothing or consistent use of sun screens, osteoporosis, and malabsorption.
- Vitamin D deficiency in children is common for groups like premature infants or exclusively breastfed infants and dark-skinned children on vegetarian diet.
Benefits of maintaining normal levels of vitamin D:
- Improved muscle function and a reduction in the risk of falls
- Increased bone density
- Improved immune system and function
- Improved cardiovascular health
- Decreased symptoms from PMS
- Mild improvement in mood
Natural sources of vitamin D:
Vitamin D is made in the skin under the influence of sunlight. People who have darker skin need more sun exposure to produce adequate amounts of vitamin D, especially during the winter months. However prolonged exposure to the sun or tanning beds is not recommended as a source of vitamin D, because of the risk of skin cancer.
Foods and drinks that have a lot of vitamin D include milk, cheese, orange juice, or yogurt with added vitamin D, cereals/oatmeal with added vitamin D, almond milk, fortified tofu, cooked salmon, sardines, oysters, shrimp, canned tuna fish, cod liver oil, egg yolk and mushrooms.
Treatment and Monitoring:
If your doctor recommends that you take vitamin D supplements, ask him or her which type, how much, and when to take the supplements. Vitamin D3 (cholecalciferol) is available in capsules of 400, 800, 1000, 2000, 5000, 10,000, and 50,000 International Units (IU). A blood test is recommended to monitor blood levels of vitamin D three months after beginning treatment. The dose of vitamin D may need to be adjusted based on these results.
Side effects of vitamin D are uncommon unless level becomes very elevated (>100 ng/mL) and the person is taking high dose calcium supplements. If vitamin D levels do become very elevated, complications such as high blood calcium levels or kidney stones can develop.
Prevention of vitamin D deficiency:
In general, adults are advised to take a supplement containing 800 IU of vitamin D per day to maintain a normal vitamin D level. In addition, all adult patients should maintain a daily total calcium intake of 1200 mg.
For exclusively breastfed infants we recommend vitamin D supplementation of 400 IU daily, this comes in the form of drops to make it easy to give infants.
I treat vitamin D deficiency in my practice on daily basis and I would welcome your visit to discuss this or any other health conditions you may be dealing with.
500 East Remington Dr. Ste 20
Sunnyvale , CA 94087
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. Near 25% of women report disorders related to achieving orgasm and so it’s not surprising that was our most popular blog article this past month. There’s also an article on assisted reproductive technology, of note, there are now an estimated 8 million babies that have been born via IVF and related technologies! And people must be in the pregnancy planning mood, an article from 2 years ago on how to have a boy (or girl) has been getting a lot of attention lately!
GENERAL OFFICE INFORMATION
|Address:||2500 Hospital Dr. Bldg 8A |
Mountain View, CA 94040
1685 Westwood Dr. Ste 3