2021 Issue 1, Quarterly Newsletter

WOMEN’S HEALTH

2021, Issue 1www.ElCaminoWomen.comJanuary 22, 2020

Welcome, 2021!

It couldn’t have come soon enough! We hope you all are doing well and excited for what this year holds in store for all of us.

Every January comes with New Year’s Resolutions, and we hope good health is one of yours. If weight loss is one of your goals, we put out a series of articles on lasting weight loss in 2020. The series of articles remain some of our most popular blog articles. If it’s getting up to date on your preventive health care, don’t forget breast cancer and cervical cancer screening. And if it’s your pelvic floor, Dr. Volpe wrote an article for this newsletter on Bladder Control in 2021!

2021 has also come with the COVID19 vaccine! Our physicians and staff are nearly all completely vaccinated and looking forward to this vaccine in conjunction with new federally-guided public health measures helping to bring this pandemic under control. We’ve written about the COVID19 vaccine and the nuances around women-specific issues in this issue.

Finally, please follow us on social medial to stay up-to-date on health care issues affecting women and news from our practice. We will continue this year to do monthly giveaways of great skincare and haircare products. Find us on Facebook or Instagram for great information and a chance to win free products!

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

We wish all of you a year of great health and encourage you to continue with social distancing, masking in public, and avoiding large gatherings for the foreseeable future. As we come out of this winter, we wish you all joyful times with family and loved ones.

Sarah Azad, MD

 


In this issue:

Practice Updates

Online Prenatal Classes

Mystery Face Rash—Resolved!

Cancer and the COVID19 Vaccine

Bone Health in Women

COVID19 Vaccine and Women’s Health

COVID19 Associated Loss of Smell and Taste

Bladder Control in 2021

Highlights from our Women’s Health Blog

PRACTICE UPDATES

Don’t forget our new address:

After talking about it for two years, we finally moved last October. You can find us now at:

2495 Hospital Drive
Suite 670
Mountain View, CA 94040

The new space also means there’s always parking in the Sobrato parking structure, but you do need to allow a little more time to park, enter the building and come find us on the 6th floor.

Materna Study

We are excited to be working with Materna in their upcoming trial for the MaternaPrep device. We hope to start enrolling patients in the spring. This NIH funded trial will look at the device’s safety and ability to reduce pelvic floor injuries and the length of labor in first-time mothers.

Office Practices to Keep Patients Safe

In addition to nearly all our physicians and staff getting the COVID19 vaccine, we continue to be diligent about office workflows.  For the safety of all patients and staff:

  • We are scheduling televists when appropriate
  • All physicians and staff are screened daily
  • All patients are being screened the day before and the day of their visits
  • Office entrance is limited to patients-only
  • Face coverings are required by everyone in the office

If you have been putting off your care, please call to schedule.

Mental Health

Between the pandemic and its impact on every area of life, so many people need an outlet.  We now have two therapists, Zainab and Sanaa, scheduling patients via telemedicine.   If you feel you would benefit from therapy, reach out for an appointment.

Don’t forget to follow us on social media to stay up to date on office information and 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 is always welcome.

 

ONLINE PRENATAL CLASSES

Prenatal Classes

We are now offering four virtual prenatal classes a month online. These classes cover preparing for childbirth, breastfeeding, and newborn care. These classes have been very popular, and we plan to have them every month. They are also available for any women interested in signing up, though we prioritize space for our patients.

Virtual Breastfeeding Class

This is a 2-hour class presented by Nadia, RN, our lactation educator. The class is a virtual, in-depth review of breastfeeding. Learn how to get the best start, avoid pain, make sure your baby is getting enough, and when to ask for help!

Virtual Newborn Care & Safety Class

2.5-hour class presented by Nadia, RN

Practical tips for caring for a newborn

  • Appearance of newborn
  • Normal skin conditions
  • Bathing & diaper changing
  • Safe sleeping

We have added Newborn safety to this class! which includes

  • Car seat safety
  • Choking hazards
  • Poison control
  • Childproofing your home

Childbirth Preparation Part One

2.5-hour class presented by Nadia, RN:

  • The last month of pregnancy
  • Preparing for the hospital
  • Laboring at home, when to call and when to come in
  • Admission to the hospital
  • Active labor
  • Pain management

Childbirth Preparation Part Two

2.5-hour class presented by Nadia, RN covering:

  • The last stage of labor: pushing
  • Vaginal delivery
  • Cesarean delivery
  • Initial recovery in the hospital
  • The postpartum period

You can learn more about these classes or register here.

MYSTERY FACE RASH—RESOLVED!

Lillian Soohoo, MD
Board Certified Dermatologist

In recent months, I have seen a definite spike in the number of patients who report puzzling skin rashes on the face and neck. Appearing as rough, mildly itchy areas usually on the eyelids, cheeks, and neck, these skin changes are probably due to a reaction to frequent applications of hand sanitizer and/or disinfecting wipes.

Can hand sanitizers and wipes be a trigger for intermittent dry, itchy patches on the face? Yes.

Remember, hand sanitizers and wipes are “leave on” products that typically contain at least 70% isopropyl alcohol (very drying) among other ingredients. They may also contain fragrance—which is a leading skin allergen worldwide. Especially in patients with eczema and sensitive skin, products with isopropyl (rubbing) alcohol and fragrance may often trigger itching, stinging, and redness.

Since we touch our face several times a minute without even being aware of it, it’s quite easy to develop an irritant contact rash to hand sanitizer and disinfecting wipes. Treatment may require prescription-strength medication to relieve your symptoms and changing up your skincare routine (for both hands and face) to prevent a recurrence.

As the Covid-19 vaccine becomes universally available and the pandemic ends, I expect that these mysterious rashes will decrease.

Just keep this in mind—hand sanitizer may be the culprit of your face rash. It’s not only on your hands anymore.

I hope this simple skin tip will help you and your loved ones stay healthy and safe.

The Menkes Clinic is open to evaluate and treat new and established patients in person in our office or via teledermatology. If you would like to schedule an appointment with Dr. Soohoo, please call 650.962.4600 or schedule appointments online at www.menkesclinic.com.

The Menkes Clinic, Medical, Surgical, Pediatric & Cosmetic Dermatology
2490 Hospital Drive, Suite 201
Mountain View, CA 94040

The Menkes Clinic is open to evaluate and treat new and established patients via teledermatology. If you have more questions or would like to schedule an appointment with Dr. Soohoo, please call 650.962.4600 or schedule appointments online at www.menkesclinic.com.

Lillian Soohoo, MD
Board Certified Dermatologist
The Menkes Clinic
2490 Hospital Drive Suite 201,
Mountain View, CA 94040
650-962-4600

CANCER AND COVID19 VACCINE

By Shyamali Singhal, MD

Surgical Oncologist

Founder of Hope & Beauty

Should People Living With Cancer Get The Coronavirus Vaccine?

People living with cancer must have a lot of questions about the coronavirus vaccine. Here we tried to provide some answers to the most typical questions we’ve been asked.

The Importance Of Good Information

Ever since the coronavirus pandemic brought the world to a stop back in April, there has been a lot of talk about a vaccine.

COVID-19 vaccines are our biggest chance to control the spread of the virus and subsequent return to normal life as it was before all of this. For the last ten months, researchers and scientists worldwide have been trying to bring the much-sought vaccine into reality. There are currently more than 300 different potential vaccines in development, many in their final testing stages before being released publicly.

With initial trial data now public from different trials, the anticipation is rising astronomically. With vaccine news coming in, we would like to ensure everyone has access to quality information about the COVID-19 vaccine and what it could mean for people living with cancer.

How Many Vaccines Are Currently Being Researched?

The World Health Organization currently counts over 300  different research projects for the development of a vaccine. The vaccine should confer protective immunity against the SARS-CoV-2 virus. Among those 300 potential results in search of a  vaccine, 52 have entered the clinical development phase. New technologies, previous experience with vaccine projects against related viruses , and the presence of a pandemic health risk have sped up the usual development cycle, so it took months instead of years.

Presenting SARS-CoV-2 antigens to the host in the context of vaccine advancement relies on technologies based on messenger RNA (mRNA), inactivated or genetically modified viruses, synthetic long viral peptides, and plasmid DNA vaccines. Two vaccines have been approved by some regulators and are increasingly available in the United States.

A third one  is expected to go through the same process very soon.  Many more vaccines are being tested in placebo-controlled phase III studies. These studies are carried out for enhanced efficiency and overall safety in a total of more than 100,000 participants.

Can Patients With Cancer Get Vaccinated Against COVID-19?

Patients with cancer may be offered vaccination against COVID-19 as long as components of that vaccine are not contraindicated to their current disease and therapy. The current US CDC guidance around vaccination does not discuss cancer but does consider immunocompromised individuals. Immunocompromised individuals may still receive COVID-19 vaccination if they have no contraindications to vaccination. However, they should be advised about the unknown vaccine safety profile and effectiveness in immunocompromised populations.

The expert panel reported that while some immunocompromised patients may encounter a limited response to the vaccine, it may still present some benefit for them. It is important to diminish the risk or severity of COVID-19 to cancer patients, particularly with recent data of higher rates of critical infection. More information on the vaccines can be found on the CDC website.

The Progress of COVID-19 Vaccine

The progress of various COVID-19 vaccines over an amazing 10-month period has brought up some questions about why there haven’t been similar transformative leaps in cancer treatment.

Cancer is an extremely complex disease, with over 200 different kinds that vary in biology, genetic make-up, and behavior. Each person’s cancer is different with its own set of hurdles to overcome, so it’s highly improbable there will ever be one single cure for it.

One of the most important challenges researchers face is that cancer can evolve, adjust, and change and eventually deceive the immune system. COIVD-19 doesn’t appear to quickly change its make-up like cancer. And with COVID-19, researchers have been able to define particular targets that are found on the virus, which makes it much easier to treat than cancer.

Much of the science following the development of the recent COVID-19 vaccines have been underlined by previous analysis to learn the body’s immune system for other diseases, including cancer. And the remarkable development of the COVID-19 vaccine is in part because scientists, governments, industry, and academic institutes around the world turned their focus and resources to this one goal. To additionally stimulate development, various phases of vaccine trials and production have been overlaid.

Shyamali Singhal, MD
Board Certified Surgical Oncologist
2500 Hospital Dr #15-1,
Mountain View, CA 94040
(650) 641-7861

BONE HEALTH IN WOMEN

By Svetlana Dani, MD

Board Certified in Primary Care Sports Medicine

Why is bone health important?

Most of us think of bones as being lifeless, but in actuality bones are living tissue, constantly developing and changing. Bone mass is the amount of bone tissue in your skeleton. This determines how strong our bones are and helps us determine whether we are at risk of fracture. Peak bone mass is the highest bone mass we can achieve. Typically, we reach our peak bone mass during the 3rd decade of life.

What are bones made of?

Bones are made of 3 main components:

  1. Collagen, which provides the framework for bone structure
  2. Calcium-phosphate mineral complexes, which provide bones with strength
  3. Multiple cells which work on replacing bone cells every single day

Are women at more risk of fracture than men?

Women’s peak bone mass tends to be lower than men’s, which puts us at a higher risk of osteoporosis and fracture than men. Despite this genetic variability, there is plenty a woman can do at every stage of her life to protect her bones. It is never too early or too late to improve your bone health. There are plenty of lifestyle choices – such as nutrition and exercise – to ensure good bone health.

What is Calcium and why is it important?

Calcium is a mineral, which we need to build bone strength (It’s one of the main components of the calcium-phosphate complex). Our body uses Calcium for other body functions as well, muscle and heart contractions, for example. We store 99% of our Calcium in our bones and teeth. We lose Calcium on a daily basis and our bodies cannot produce their own. This is why it’s so important to get Calcium from food sources – whatever calcium we use for other body functions will be taken from the storage in our bones, which makes them weaker. Some calcium-rich foods are milk, yogurt, cheese along with some green vegetables such as collard greens, broccoli, rabe, and kale as well as seafood such as salmon and sardines.

How much Calcium do women need?

Age 50 & younger: 1,000 mg daily

Age 50 & older: 1,200 mg daily

6 oz of greek yogurt, for example, contains 200 mg

What is vitamin D and why is it important?

Vitamin D helps your body absorb calcium from the food we eat. Vitamin D helps children to build their bones and adults to keep their bones healthy. The only way to get vitamin D is through your skin, food, or supplements. The skin makes vitamin D when it’s exposed to sunlight but this depends on the amount of time we spend outdoors, our skin color, the latitude of where we live, and our age. Vitamin D is naturally found in very few foods, such as wild-caught salmon, tuna, and mackerel. Our milk, orange juice, soymilk, cereals, and other dairy are generally fortified with vitamin D. Despite the fortification, it is very difficult to get all our vitamin D from food and most people have to supplement.

How much vitamin D do we need?

Women under 50: 400-800 IU/daily

Women over 50: 800-1000 IU/daily

Some women might need more or less vitamin D depending on their bone mass – please speak to your physician before starting any supplement.

What can we do to improve bone health?

Age 0-9 years old

At this point, it is important to ensure that children are getting enough vitamin D and Calcium to develop strong and healthy bones.

Age 10-20 years old

Approximately 95% of peak bone mass is reached by age 20! Most girls go through puberty and develop a regular menstrual period during this time – having a regular period shows they are producing an adequate amount of estrogen, which is a key player in Calcium absorption and its integration into bones. It’s very important to have adequate Calcium and vitamin D intake during this time. It is also important to engage in weight-bearing exercises. This includes walking, running-based sports such as soccer, lacrosse and tennis.

Age 20-30

This is when the bones in your body reach their peak strength. It is very important to continue to take adequate calcium, vitamin D and engage in weight-bearing exercises for 30 minutes, four or more times per week. This includes a brisk walk or running-based sports.

Age 30-50

This is when we gradually begin to lose our bone mass. At this point, it is more important than ever to get your Calcium and Vitamin D as well as continuing to exercise.

Age 50-70

Most women will enter menopause at this stage, and their levels of estrogen go down. This leads to decreased Calcium absorption and can cause bones to lose their strength, resulting in osteoporosis. It is extremely important to continue to get dietary Calcium and vitamin D, as well as exercise. It is also important to get screened for osteoporosis. Age of screening depends on your risk factors – please speak to your physician about screening.

Age 70 and above

You guessed it – Calcium, vitamin D, and exercise continue to play an important role in your bone health. Exercise should focus on improving balance and fall prevention.

No matter your age, Calcium, vitamin D, and exercise play a major role in bone health. If you have any questions or would like to learn more about bone health, you can see your primary care physician or a sports medicine physician.

Svetlana Dani, MD
Board Certified in Primary Care Sports Medicine
2430 Samaritan Dr.
San Jose, CA 95124
408-559-3889

COVID19 VACCINE AND WOMEN’S HEALTH

More than a month after first approved by the FDA for use, the Pfizer and Moderna COVID19 vaccines have been given to over 13,000,000 people in the US.   There has been a lot of clear and factual information published by the CDC, ACIP, and ACOG.   Unfortunately, myths, conspiracy theories, and false claims are also spreading like wildfire on social media.

The COVID19 vaccines currently given emergency use authorization (EUA) in the US are both mRNA vaccines. This technology has allowed these vaccines to be developed quickly and also to be rapidly produced in large quantities.   The initial safety and efficacy data for both the Pfizer and Moderna vaccines has been very reassuring.

In the absence of long-term data, which we simply cannot have less than 12 months into the pandemic, what we do know is that the vaccine appears to be safe, causes side effects consistent with the body’s inflammatory response needed to build immunity and that it works to prevent the vaccinated person from developing clinical COVID19 illness.

Unfortunately, the rest of the information we have comes from extrapolation or comparison from previous mRNA technology.   There are also necessary risk/benefit discussions to compare the unlikely—but unknown—risk of the vaccine to the known risk of COVID19 itself and the individual’s risk of getting sick.

We do not have a single, clear recommendation for women-specific health issues:  pregnancy, breast-feeding, and post-menopause.   But we do have guidance on what issues are important to the decision-making progress.

Most importantly, the CDC and the American College of Obstetricians and Gynecologists (ACOG) have clearly stated that pregnant and lactating women should have access to the COVID19 Vaccine.

Pregnancy

So far, pregnant women have not been included in the vaccine trials for the Pfizer or Moderna vaccines.   We do know that the vaccines are not live virus vaccines and extrapolating from this information, it is thought that the COVID19 vaccine is likely to be safe in pregnancy.   Since no direct testing has been done, we simply cannot know for sure.

Things for a pregnant woman to consider when deciding to get the COVID19 Vaccine:

  • Prevalence in her community of COVID19
  • Personal risk of acquiring COVID19 due to occupation/living situation
  • Risks of COVID19 to her and potential risks to the fetus
  • Efficacy of the vaccine
  • Known side effects of the vaccine
  • The lack of data about the vaccine during pregnancy

Breastfeeding

Like pregnant women, lactating women have not been included in the initial trials of the Pfizer and Moderna vaccines.   Given the mRNA design of the vaccine and that it’s not a live virus, the COVID19 vaccine is again thought to be safe for breastfed infants.   In the absence of direct testing, we cannot know for sure.  For women who would otherwise get the COVID19 vaccine, ACOG recommends that they get it even if they are breastfeeding.  There is no need to delay or stop breastfeeding due to vaccination.

Postmenopausal Women

There is nothing specific in the data for the Pfizer and Moderna vaccines around the hormone changes of menopause.   Decisions to get the COVID19 vaccine should be based on the same priorities as premenopausal women.   Of course, the highest risk groups for severe COVID19 include women over the age of 65, and we encourage all our patients without contraindications to the vaccine to get the COVID19 vaccine as soon as it is available to them.  Even women who have underlying medical conditions are encouraged to discuss the pros/cons of the COVID19 vaccine with their physicians and are very likely candidates for the vaccine.

Some recent data from Norway has suggested some additional nuance is needed in advising patients over the age of 80 for vaccination.   We know there are side effects from the COVID19 vaccine, and the inflammatory response can be strong in some people.  After 13 deaths in patients over the age of 80 who were also considered “frail,” Norway’s public health authority has put out recommendations that in this patient population, additional discussion is had around the risks of the side effects of the vaccine on an already frail individual.

As more information is available on women’s health-specific concerns and the COVID19 vaccine, both ACOG and the CDC will be updating their resource pages.   We are also available for consultation regarding our patients’ specific health concerns around the vaccine, just call or email for a televisit appointment.

 

COVID19 ASSOCIATED LOSS OF SMELL AND TASTE

By Katrina Chaung, M.D.

Board Certified ENT

Nearly one year after settling into a “new normal,” we are still learning about the effects of COVID19.  One known symptom, and for some people, the only symptom of COVID19 is the loss of smell and taste.  Anosmia is the medical term for loss of smell.  With anosmia also comes ageusia, which is the loss of taste.

When you inhale, odors are detected by special cells called olfactory receptors high up in your nose.   When these olfactory receptors are activated, nerve impulses are triggered, which transmit the information about the smell to the brain.  Research has shown that COVID19 infection can cause an inflammatory reaction inside the nose that can injure these smell receptors and neurons.

While current studies and research are limited, it is encouraging that the majority of people do regain their sense of smell and taste within six months.  Some patients regain their smell sooner than others.  For now, it seems that these smell receptors are not permanently damaged from the infection but we will hopefully know more about the mechanism that affects them in the future.

Losing your sense of smell and taste can certainly have a negative impact on more than just your appetite.  You may not be able to tell if your food is spoiled or your nutrition may be impacted if you stop eating certain types of food.  Furthermore, it can be dangerous if you cannot smell certain odors like smoke or a gas leak.

Again, loss of smell and taste can be the only symptom of COVID19, so take precautions and consider getting tested if you notice this.  We can never be reminded enough to continue to wash our hands thoroughly and frequently, wear masks, and socially distance to keep healthy.

Keep in mind that many other reasons unrelated to COVID19 can cause loss of smell and taste.  Other common factors are allergies, dementia, sinus problems, and polyps in the nose.

If you are having issues with your sense of smell or taste, you may benefit from an Ear, Nose, and Throat evaluation.

Katrina Chaung, M.D.
Board-certified, Otolaryngology, Head and Neck Surgery
2495 Hospital Dr.
Suite 450
Mountain View, CA 94040
(650) 988-4161

BLADDER CONTROL IN 2021

Katherine Volpe, MD
Board Certified Gynecologist
Fellowship trained in Female Pelvic Medicine and Reconstructive Surgery

As women, we are often too busy balancing work with home life and responsibilities to prioritize our own health needs. Despite the fact that one in three of us has urinary incontinence, we may not feel comfortable speaking with our physician. And even if we do, many times,we’re told that leaking urine is normal after having babies or with aging. Rarely are we told that there is a myriad of safe, effective options for treatment!

Leaking with coughing, sneezing, jumping:

This is called stress urinary incontinence and is caused by weakening in the pelvic floor muscles that come with repeated pressure, childbirth, and aging. Pelvic floor physical therapy is a popular and effective option for those wishing to avoid surgery, but in the last few years, several devices have come on the market which offers biofeedback in the home environment. A few have phone apps that simulate video games for additional motivation. For most women, home muscle training is as effective as pelvic floor physical therapy for strengthening. Please make sure to stretch as well! Surgical options for urinary incontinence have also evolved. Most last less than one hour and patients return home the same day.

Leaking on the way to the bathroom:

Nerves that control the bladder can begin to show signs of dysfunction with diabetes, aging, pregnancy and after certain surgeries, and with other neurological conditions. When patients are urinating more than eight times per day, more than twice at night, or lose control of the way to the bathroom we call it overactive bladder or urge incontinence. Because of the interaction between the nerves and the brain, many behavioral therapies are effective for urge incontinence. Clinical trials have shown that bladder training, mindfulness-based stress reduction, and even hypnotherapy can significantly improve this type of incontinence. Medications are also available as are in-office therapies such as neuromodulation and bladder Botox, both of which are generally covered by insurance.

No matter where you’re at, remember you’re not alone. Contact us for a consultation and check out our website for additional information and tips.

Katherine Volpe, MD
Board Certified Gynecologist
Bay Area Gyn Oncology
455 O’Connor Drive, Suite 370
San Jose, CA 95128
408-827-4274

HIGHLIGHTS FROM OUR WOMEN’S HEALTH BLOG

If you haven’t seen our Women’s Health Blog, you should check it out!   It is a way for us to put out up to date information on relevant women’s health issues.  For the third quarter in a row, our most popular article was Stop Eating all The Time: Snacking and Intermittent Fasting.  An article about a rare condition called Mayer-Rokitansky syndrome, titled A Woman without a Womb, was the second most read.   An article by guest author Dr. Shyamali Singhal on Keeping your Self Esteem After a Mastectomy was the third most popular article last quarter. If you or someone you know is going through cancer treatment or a survivor, Dr. Singhal’s Hope & Beauty website is full of wonderful self-care information.

We update our blog at least a few times a month with information on all kinds of women’s health issues.  Follow us on Facebook, Twitter, LinkedIn, or Instagram to be informed when we post new articles and stay updated on the latest in women’s health.

GENERAL OFFICE INFORMATION

Address:2495 Hospital Dr. Bldg 670
Mountain View, CA 94040

Phone:650-396-8110

Fax:650-336-7359

We've Moved!

Our office has finally moved into our brand new, larger space in the Sobrato Pavilion.
Please allow yourself additional time to find our space, park in the Sobrato Parking Structure, and find our suite on the 6th floor!

We can't wait for you to see it!

Map of ECH campus and our new location