Women’s Health Newsletter, Volume 5 Issue 1

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WOMEN’S HEALTH

Happy New Year to everyone! El Camino Women’s Medical Group’s motto for 2020 is “it’s going to be FABULOUS!”

We’ve got a lot going on this year.  Our brand new website is finally up and running!   Let us know what you think.  With our new website live, so is a link to our Wellness Products.  Our office has started working with an anti-aging skincare company and another hair care company to also offer their products to patients looking to prevent or treat wrinkles or thinning hair.   You’ll be hearing more about their products that help with common issues our patients face over the coming year.  One of the most powerful products to treat everyday cellulite is highlighted in this newsletter!

The biggest, most wonderful thing happening for us this year is our move to the Sobrato Pavilion this Spring!  We still aren’t sure exactly when, we’ve only been reassured it’ll be before June.   You can see some of our updates here.  We’re looking forward to more space. Let us know if there are classes or programs you’d like to see the office add.  Once we move, we’ll be having a Welcome party for all our patients to come to see the new space!

We’re hoping 2020 is fabulous for all of us.   We are committed to doing our part to make your year better for all of you!

As always, feedback is always welcome in our practice, customer service, and even this newsletter!

Sarah Azad, MD

In this issue:

Practice Updates

How to Talk to Someone Newly Diagnosed With Cancer

Bumps and Spots—Common Skin Growths after 45

Taking Care of Our Young Women

Nosebleeds

Help Your Skin Get Ready for Summer

Highlights from our Women’s Health Blog

PRACTICE UPDATES

We’re super excited about our new space in the Sobrato Pavilion across the street. In preparation for the larger space we are training new staff, you’ll be seeing them around the office.

El Camino Women’s Medical Group also plans to consolidate our offices into the new Mountain View location.  This does mean we’ll be closing our much loved San Jose office.  We know it is a convenient location for so many of our patients but with our hospital responsibilities increasing, we could not figure out how to keep that office fully staffed.  We apologize to patients who will be inconvenienced by this change.   There will be at least 30-60 days notice before San Jose appointments will be moved to Mountain View.

Don’t forget to follow us on social media to stay up to date on office information as well as women’s health topics.  You can follow us on Facebook, Twitter, LinkedIn, or Instagram.  Your feedback on our office practices and our physician and staff communication are always welcome.

How to Talk to Someone Newly Diagnosed With Cancer

Shyamali Singhal MD
Surgical Oncology

When a friend or a family member is newly diagnosed with cancer, questions arise: what to do?

How to deal with this new situation?

Dr. Shymali Singhal knows this is probably a time when anybody can find themselves at a real loss for words. Feelings of sadness, anger, confusion, and helplessness can come with a cancer diagnosis. For the person who has been diagnosed with cancer, it is helpful when friends and family members provide a comforting presence and practical support. It is often difficult for others to know what to say or start a conversation with someone who has cancer. However, staying in touch is always better than staying away. Here are some tips to help you show your support.

Show That You Care

In Dr. Singhal’s experience, cancer patients and their friends and family can benefit greatly by reading and drawing from other people’s experiences with cancer and chemotherapy. Find positive and encouraging stories to motivate yourself through this rough period in your life. Through other people’s experiences, you can learn how to talk to a cancer patient about the disease without causing even more stress.

You’ll find that a lot of cancer patients feel that a simple “I’m sorry you have to go through this” is all that they need to hear. A simple text message asking how did the last chemo treatment went is enough to show somebody is thinking of them.

Emotional Support Is Crucial

Each partner may have different emotional needs that change frequently. But both partners may need extra reassurance that they are still loved. Couples need to be sensitive to the changing emotional needs that come with a cancer diagnosis. Spouses or partners may want to consider talking with a professional, such as a therapist or counselor, on their own. Spouses or partners caring for their loved one may find it difficult to express certain feelings for fear of hurting or overwhelming their partner. And it is important that the spouse or partner with cancer is able to express their feelings to someone who can handle the intensity of those feelings without being overwhelmed.

Share Responsibilities

In most relationships, each partner handles specific chores. One partner may do yard work and cook, while the other cleans and pays bills. If cancer and its treatment leave you feeling tired or unable to perform your usual tasks, your partner may have to pick up those duties. If you must stop working, your partner may need to go back to work or work extra hours while perhaps also taking on caregiving duties.

These added responsibilities may become overwhelming and lead to feelings of frustration and resentment. Meanwhile, you may feel guilty, saddened, or frustrated. Talking openly about limitations and possible solutions will help you both feel more comfortable with these changes.

In addition, although it may be difficult for both partners, it is important to accept outside help from friends, family members, or professionals.

Offer Your Help

As any person with cancer knows all too well, a cancer diagnosis also affects family members and friends. Sometimes, the complex feelings and massive lifestyle changes caused by cancer and its treatment become as overwhelming for others in your life as they are for you.

Understanding the potential changes means a world to cancer patients during this battle. Being close and supportive to family members and friends may help you take steps to grow healthy, mutually supportive relationships during this challenging time. Offer specific examples of ways you could help during cancer treatment. Ask if those suggestions sound helpful. Ideas include running errands, caring for pets, driving the person to an appointment, or picking up children from school. Pick up the phone and call your friend or family member. Visit as often as you can.

At the end of treatment, shy away from asking cancer patients if everything is done and are they cured. The term ‘cure’ is used very sparingly in the cancer world. Just congratulate them for getting through a very rough time. And don’t expect them to be the same person as they were pre-cancer. They’ve had a life-altering event and have had to fight for their life. Their body has been assaulted and it will take time to heal. Patience and understanding will go a long way. And above all always show positivity. All a newly diagnosed person wants is to be normal and have their life back. With a little kindness from you along the way, they hopefully will.

Sincerity and simple actions seem to be a theme that is important to people with cancer. Even if it is offering a hug, offering your company, or just giving them the gift of your time, all of those simple things are appreciated. Show your loved ones that you care about.

Shyamali Singhal MD
Board Certified Surgeon and Fellowship Trained Surgical Oncologist
Founding Director of the El Camino Cancer Center
Founder of Hope & Beauty
2500 Hospital Dr. Bldg 15-1
Mountain View, CA 94040
650-641-7861

Bumps and Spots—Common Skin Growths after 45

Lillian Soohoo, MD
Board Certified Dermatologist

As we mature, women over 45 may notice the sudden development of new skin lesions on the face and body. What are these things?

Sometimes occurring singly, or maybe as multiple spots, these skin growths can be unsightly and often cause concern about their potential for skin cancer.

In this blog post, we will explore many of the common skin growths women experience after age 45. This information is not meant to be a substitute for a thorough, skin examination by a physician, but as an overview of skin lesions that occur commonly but not exclusively, in middle age.

Seborrheic Keratosis (SK)
This is pink to dark brown, raised “warty barnacle” felt on the skin’s surface which usually appears in women after age 45. Extremely common in both sexes, it is not unusual to have anywhere from one or a few, to a hundred of these lesions. Typically found on the chest and back, SKs can develop anywhere on the body, including the face and scalp. They are usually painless unless irritated by being inadvertently scratched or rubbed–particularly under tight clothing such as bra straps and waistbands.

If an SK is a dark brown in color, it can resemble a malignant melanoma and therefore should be evaluated and diagnosed by a dermatologist.  After being reassured that these skin lesions are just benign, an unwanted reminder of the aging process (similar to barnacles on an old boat), patients often request removal of SKs for cosmetic purposes.  This can be done quickly and easily by a dermatologist. A woman’s tendency to develop this lesson seems to be hereditary and less likely to be a result of sun exposure.

Acrochordons (Skin Tags)
These soft, fleshy skin lesions are most frequently seen in the body fold areas such as the neck, armpits, and groin. As we age, and more often when we experience significant weight gain, these skin tags pop up out of nowhere and can be cosmetically embarrassing. Painless skin tags sometimes become entwined in hair or twist on themselves, cutting off their blood supply and leading to sharp and intense pain. The removal of acrochordons is easily performed by a dermatologist.

Lentigos (Freckles) and Melasma
These brown spots and patches develop in sun-exposed areas of the skin (face, legs, hands) and are very common in all skin types and colors. As we accumulate more brown spots over a lifetime, this can become a significant cosmetic problem for those who prefer a clear, uniform skin color. Treatment options include topical products applied to the skin, oral medication, laser therapy, and chemical peeling. Depending on your skin type, lifestyle and budget, a dermatologist can help you to formulate a treatment plan to improve this challenging skin problem.

Actinic keratosis (precancerous)
These are flaky skin spots that persist for at least two months, without going away, even with a daily moisturizer. At first, they are seen as pink, rough spots, no larger than a sesame seed, that eventually become sensitive to touch and even painful over time. Commonly occurring in sun-exposed skin areas such as the entire face and nose, backs of the hands and forearms, and tops of the ears, these precancerous skin growths can develop into a certain aggressive form of skin cancer, known as Squamous Cell Carcinoma. Examination and treatment by a dermatologist are strongly advised.

When treated early, you can effectively avoid the development of skin cancer in these lesions.

Dermatofibroma
These are smooth, firm, round skin bumps which are often the result of an insect bite, pimple or ingrown hair. Typically the size of the end of a pencil eraser, dermatofibromas have a unique feature of “dimpling” or sinking into the skin when trying to pick it up or squeeze it with your fingertips. This is essentially a unique type of scar made up of dense collagen and is easily recognized by a dermatologist. No treatment is required.

Sebaceous hyperplasia
Have you noticed the onset of pinkish-yellow bumps on your face that increase in size and become less noticeable during certain times of the month? These tiny cauliflower-like growths are actually oil glands (ie, sebaceous glands) that emerge from deep within facial pores and respond to normal female hormonal changes, specifically androgen stimulation. During menopause, our estrogen levels plummet, allowing our androgens to stimulate the growth of these normal oil glands.  Although not cancerous or even precancerous, sebaceous hyperplasia can be clinically mistaken for basal cell skin cancer since they look similar. Examination by a dermatologist is recommended and treatment is simple if desired.

Skin cancer
It is highly recommended that if you do notice a new skin lesion or one that has changed in size, shape or color, that you visit a board-certified dermatologist to confirm the diagnosis and determine the appropriate treatment, if needed. Discussion of skin cancer is beyond the scope of this post, but as you read above, skin cancer can be difficult to distinguish from benign skin growths. Dermatologists are specifically trained and experienced in diagnosing and treating all types of conditions involving the skin, hair, and nails. The American Academy of Dermatology recommends that you see a dermatologist for a yearly total body skin exam to make sure you are skin cancer-free. Have a healthy and happy New Year!

Lillian Soohoo, MD
Board Certified Dermatologist
The Menkes Clinic
2490 Hospital Drive Suite 201, MV
650-962-4600

Taking Care of Our Young Women

High school is a time of immense personal, physical and emotional growth.   This is a time when our young women learn a lot about themselves, build confidence in their role as independent young adults, and begin to explore their desires for their place in the world.  For many young women, high school is also a time of first serious relationships and initiation of sexual activity.

The vast majority of these young women are still living at home with their families, and yet serious relationship issues are more common than most parents may suspect.  A recent study of young women highlighted the risks they face that we don’t often associate with young love and romance.   One fifth (1/5) of high school female students in the United States experienced physical or sexual violence from a romantic partner in the last year.  Almost 1/8^th reported recent reproductive coercion.  There were no significant differences in demographics between any of the groups, so this data applies to all our young women, regardless of what we look like, where we live or how much we make.

Issues of physical and sexual abuse, as well as relationship coercion, are associated with an increased risk of STIs, depression, substance abuse, and subsequent intimate partner violence in adulthood.

“Reproductive coercion” is a form of abuse that increases a woman’s risk for an unplanned pregnancy.   It includes pressure to become pregnant and sabotage of contraception (for example, altering a condom or stealing birth control pills).

As with adults, violent relationships can result in the death of one or both partners, even after the relationship has ended.  A recently published study in JAMA Pediatrics found that 90% of deaths among young people from intimate partner violence were adolescent girls.

As OBGYNs, this is a primary area of screening for us caring for our sexually active teens.   But as parents and community members, this is something of which we should all be aware.  Parenting and mentoring young women through their adolescence has its rewards and its challenges.  Helping young women navigate relationships is something parents and mentors need to remember when considering their overall wellbeing.

Communication

Having open communication between parents and teens is the foundation of strong relationships.  Teens should know they can talk with their parents about issues that arise at school, with friends, and with their romantic interests.  These are often conversations that begin before high school but should make sure they are an ongoing topic of discussion.

It’s important that young women have other trusted sources of advice.  Aunts, former or current teachers, pediatricians, and gynecologists can be sources of advice for teens.   It’s a useful strategy for parents to encourage their children to consider certain, trusted adults for them to go to if they ever want to discuss something they are uncomfortable discussing with their parents.   We may not want to acknowledge the necessity of this, but if you think back to your teen years, there are probably several things you never felt discussing with your parents.   For teens to go to an aunt or friend that you trust ensures that the advice they get is sincere and in her best interest.

We encourage parents to bring their teens in for just one “teen” visit early on.  These appointments help your daughter meet one of us in a non-threatening way and allows us to explain to them a little about growth, development and the confidentiality they would have if they came to us with an issue of sexual or gynecologic health.

Pay attention to red flags

Some things that teens go through can catch a parent off guard.  Depression, withdrawal, substance abuse are changes that would raise concern to any parents, but these should also raise a concern about relationship issues your daughter may be having.  If you notice these changes in your daughter, try to emphasize the importance of her wellbeing and that you’re there to help.  If you find it difficult for her to open up to you or another close adult, consider offering to have her come to see her pediatrician or gynecologist.

Relationship risk factors to pay attention to include a large age gap between your daughter and her partner, having 2 or more recent sexual partners, and using hormonal birth control but not using condoms.  If a young woman’s relationship has any of these factors, try to discuss relationship issues with her related to boundaries, consent, and autonomy over her body and sexual choices.

Being there to guide help young women navigate relationships to avoid situations of coercion or violence is an important role for all parents and mentors.   Once a difficult situation has occurred, it’s even more important that we help our young women learn to enforce boundaries, heal from the trauma and continue to grow to be strong, healthy and independent women.

There are so many resources available for young women and parents.  Reach out to your pediatrician or gynecologist if you are struggling or your child is struggling with a situation you need help with.

Nosebleeds

Courtesy of: TenarAiuola [CC BY-SA]

By Katrina Chaung, M.D.
Board Certified ENT

Nosebleeds, or epistaxis, can strike anyone at any time.  They can range from a nuisance to a medical emergency.

The lining of your nose is very delicate and has many blood vessels close to the surface.  Most nosebleeds actually originate from the front part of the septum, or the middle wall of the nose.  This is because this area is susceptible to trauma and contains a denser network of blood vessels.

The majority of nosebleeds are due to the nasal membranes drying out.  Another major cause is trauma – anything from taking a punch to the nose to a good finger-picking.

Other factors like having a cold or allergies (leading to frequent nose rubbing or blowing), the use of some nasal sprays, high blood pressure, taking blood thinners, and even pregnancy can increase the risk of nosebleeds.

Rarely, nosebleeds can be the cause of growth in the nose or blood clotting disorders.

How to Stop a Nosebleed

What do you do if you’re bleeding from, say, your arm?  You hold pressure.  The same concept applies to the nose but it can be trickier to do so.  An easy way to accomplish this is to pinch the nose with your thumb and forefinger at a point just past the nasal bones (the soft part of the nose) but not at the very tip of the nose either.  The pressure needs to be quite firm and continuous for at least 10 minutes.  A young child or an elderly individual may need help with this.

A common misconception is that leaning the head back will stop a nosebleed.  You do not want to do this because blood will then flow down your throat.  This will not only be uncomfortable but if you swallow blood, it can make you nauseous and sick to your stomach.  You also do not want to bend over and lower your head as this can increase pressure on the nose, which could make the bleeding worse.  Instead, keep your head elevated and upright or with a very slight tilt forward.

An ice pack gently placed on the bridge of the nose may also help to slow down bleeding by constricting the blood vessels.  In some patients, a couple of sprays of Afrin, an over-the-counter nasal decongestant spray, may also help to slow down the bleeding.  You should always check with your physician before using Afrin because it can cause blood pressure issues and other side effects.  It may also NOT be recommended during pregnancy so always check with your OBGYN prior to use.

If a nosebleed does not stop with these measures, you may require nasal packing.  You may have heard this jokingly referred to as putting a “tampon” in your nose.  Specialized nasal packing has specific sizing and materials to prevent further trauma to the nose.

Sometimes, a cauterization procedure performed by an Ear, Nose, and Throat physician can decrease or stop frequent nosebleeds. This is a quick procedure done in the office with usually no “down-time”.

Prevention is Key

Once an area in the nose is traumatized, nosebleeds can be frequent until that area heals.  Prevention is key to avoid this problem.  First and foremost, “hands off the nose”!  That means no nose picking, rubbing, or blowing.  This may be difficult for young children (and adults as well) but it is probably the most important tip.  Secondly, sneeze with your mouth OPEN.  This allows pressure to escape from the mouth instead of through the nose where it can cause trauma.  Thirdly, avoid bending over, straining, or lifting to reduce pressure on the blood vessels in the nose.  If possible, avoid activities such as heavy exercise or contact sports for 1-2 weeks to allow the area in the nose to heal.  Occasionally, if you are on aspirin or other blood-thinning medications, these may need to be temporarily stopped by your prescribing physician.

Additionally, moisturizing and humidifying the nose will also help.  Frequent nasal saline spray and saline gel (e.g. Ayr gel) very gently applied just to the inside of the nostrils can help.  A humidifier can be very beneficial too.  Lastly, if you have medical issues such as high blood pressure, they may be contributing to nosebleeds, and you will need to work with your managing physician to correct these issues.

While many of these tips may seem very simple, together, they can be very effective in preventing nosebleeds.  If you have nosebleeds that do not stop with these measures, it may be time to be evaluated by an Ear, Nose, and Throat physician.

Katrina Chaung, M.D.
Board-certified, Otolaryngology-Head and Neck Surgery (Ear, Nose, & Throat)
2204 Grant Road, Suite 102
Mountain View, CA 94040
(650) 988-4161

Help Your Skin Get Ready for Summer

Though still 6 months away, getting swimsuit ready takes time.   Although time in the sun can greatly benefit your mental and emotional health, many people hesitate to head outdoors because they’re self-conscious about their cellulite. But no one wants to miss all the great activities and fun-in-the-sun warmer weather brings.

If you’re reluctant to shop for shorts, tanks and swimwear because you don’t like the look of your skin, there’s hope. The right skincare products can help firm and tighten the appearance of troubled areas, making skin appear sleek and toned to create a more youthful look. Now is the perfect time to enhance your skincare routine with a product that addresses cellulite, so it can help you welcome summer with confidence.

Smooth Out Cellulite

Nearly all women (and some men) have stubborn cellulite. It commonly appears on hips, thighs, buttocks, stomachs, and arms. Cellulite is caused by small clusters of fat that bunch up underneath the skin, and tight fibrous bands called septa. The combination of these two factors gives the skin a bumpy texture, similar to an orange peel. Although exercise and a nutritious diet can help minimize the appearance of cellulite, the condition often has more to do with genetics or hormones than a healthy lifestyle. The good news is, researchers have developed new, scientifically advanced skincare formulas that are specifically designed to tighten and improve the skin’s appearance and elasticity.

Add Contour Cream to Your Daily Routine

Before you head to the pool or the beach this summer, add a secret weapon to your skincare routine with Neora’s breakthrough Firm Body Contour Cream. This clinically tested Contour Cream is proven to improve your skin’s hydration and texture. Before and after photos sent in by our loyal customers demonstrate what one clinical trial revealed: 83% of Firm Body Contour Cream users reported a visible improvement in their cellulite.

To apply, simply smooth a quarter-size dollop of Contour Cream onto damp skin fresh out of the shower to maximize the toning and tightening effects, and let the rich shea and cocoa butter lock in moisture. Our invigorating blend of ingredients includes forskolin root and white willow bark extract, green tea leaf extract, caffeine, and a rich peptide matrix. For the best results, apply Firm Body Contour Cream twice daily, once after a warm shower, and again before bedtime.

Despite their best efforts year-round to eat right and stay in shape, many people still have dimpled skin. But you can beat the battle against cellulite by going on the offensive to get your skin ready for summer. Add Contour Cream to your daily routine now, and by the time shorts weather comes around, you’ll be ready to strut your stuff with confidence!

Be sure to check out the inspirational Real Results people experienced using Firm in our 90-Day Challenge Gallery.

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.  Our most popular article this last quarter was from a year ago: Seeking Help for Vaginal Dryness. This article has been our most popular article on the blog for at least the last 6 months!  An article on a related topic Lowest Effective Estrogen Dose for the Treatment of GSM was a close second.   An article on exercise in pregnancy Put on Your Running Shoes, was the next most popular.

Follow us on Facebook, Twitter, LinkedIn, or Instagram to be informed when we post new articles and stay up to date on the latest in women’s health.

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