2021 Issue 3, Quarterly Newsletter

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WOMEN’S HEALTH

A newsletter from El Camino Women’s Medical Group

With warmer weather, we hope everyone is enjoying the outdoors.  We encourage you all to stay hydrated and safe.  So many of us are vaccinated now, but with the new delta variant coming through California, please continue to follow CDC and California guidelines for best practices related to masking and social distancing.

July is the first month Dr. Balassiano won’t be in the office since she joined us in 2016.   We wish her the best of maternity leaves and look forward to her return in the winter.   We are fortunate to have found Dr. Christina Lam to join us this August!  Her timing is perfect, starting during Dr. B’s maternity leave, you can read more about her here.

This newsletter has great contributions from Bay Area physicians, including an article on exercise in pregnancy by Dr. Dani, a Sports Medicine Physician and a primer on Lifestyle Medicine by Dr. Selvakumar.   Dr. Singhal, a board-certified surgical oncologist, also has a great article on self-care for women undergoing cancer treatment.  You’ll also find information on an upcoming webinar by Dr. Volpe on new treatments for bladder control.

Finally, please follow us on social medial to stay up-to-date on health care issues affecting women and news from our practice.  You can follow us on Facebook, Twitter, LinkedIn, or Instagram.  It’s also a great way to get the latest practice changes related to COVID19 policies, visitor policies, etc.

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

We wish all of you a wonderful and safe summer.

Sarah Azad, MD

In this issue:

Practice Updates

Online Prenatal Classes

Research at ECWMG

Exercise in Pregnancy From a Sports Medicine Physician

Getting Your Skin Ready for Summer

Cancer and Self-Care – Yes, It Can Be Done

What Is Lifestyle Medicine and What Does It Mean?

A FREE Women’s Health Webinar: New Treatments for Bladder Control

World Head and Neck Cancer Awareness Day

El Camino Hospital Visitor Policy Updates

Highlights From Our Women’s Health Blog

Next Gen Jane

Our office is currently working with NextGen Jane, a research company based in the Bay Area to build a safer, more accurate method for non-invasive prenatal testing that can possibly be done as early as 6 weeks of gestation. Since women shed thousands of cells from the placenta as early as 6 weeks of gestation, their study works to collect these cells directly from the fetus through a low absorbency tampon that patients would wear for an hour. Wearing tampons during pregnancy is safe and does not carry any adverse effects. To participate in their study, you can contact NextGen Jane directly, and they will help you start the process. They will ship you a kit with all of the instructions and assist you with the consent process. To thank you for your participation, NextGen Jane will provide you with a $25 amazon gift card.

Exercise in Pregnancy from a Sports Medicine Physician

Dr Dani, SEVEN months pregnanyt, at her last 10K race of her first pregnancy!

By Svetlana Dani, MD
Board Certified in Primary Care Sports Medicine

Is it safe to exercise during pregnancy? And if it is, what kind of exercises are safe and which ones are not? These questions come up all the time in my clinic.

For the most part, in an uncomplicated pregnancy, it is safe and encouraged to continue the exercise routine you’ve had prior to pregnancy. Studies show exercise improves your overall well-being while pregnant. The benefits include reduction of back pain, maintaining your body composition, decreasing chances of gestational diabetes and preeclampsia. Regular exercise can prevent constipation, improve your overall well-being, body image as well as your mood.

The official recommendation by the American College of Obstetricians and Gynecologists is at least 150 minutes of moderate-intensity aerobic activity per week. Moderate-intensity means that you should be able to talk during the activity but not sing. If you were exercising regularly before the pregnancy, for the most part, you can continue to do so during pregnancy. If you’re new to exercise, we still encourage you to start. Begin with a brisk 5-minute walk and build up to 30 minutes per day if you can.

The goal of exercise during pregnancy can be to build and maintain strength and should always be done in a safe way for both mom and baby. Core stabilization, pelvic floor strengthening, leg strength, and balance can be the focus of pregnancy training. Specific exercises should take into consideration the hormonal changes happening in the body during pregnancy.

During the first trimester, there is an increase in a hormone called relaxin, which increases ligamentous laxity and leads to the widening of the pubic symphysis in preparation for birth. During this time, focus on core movements, such as planks, side bridges, bridges, dead bug, and hollow-body holds. All of these engage the pelvic floor muscles, which will be only helpful during and after birth. Your joints are more mobile during this time – avoid jerky movements, which might lead to injury.

During the second and third trimesters, you can focus on balance and continue some of the core exercises to the best of your ability. It is important to discontinue moves requiring you to lay flat on your back as the enlarging uterus can compress the large vein returning blood to your heart and cause dizziness and even loss of consciousness. You want to continue the core and pelvic floor exercises during this time focusing on band walks, step-ups, banded squats, and modified planks. Make sure to drink plenty of water and exercise in a comfortable temperature setting to avoid overheating.

Always talk to your obstetrician before starting a new exercise regimen. You should not exercise if you have the following conditions: lung and heart disease, cerclage, pregnancy with multiples, placenta previa after 26 weeks of pregnancy, preterm labor or ruptured membranes, preeclampsia, and severe anemia. Certain sports are not safe during pregnancy and should be avoided. These include contact sports, skydiving, scuba diving, sports with a risk of falling such as gymnastics and downhill skiing. Contact your obstetrician immediately if you develop any vaginal bleeding or leakage of fluid, dizziness, shortness of breath, chest pain, headache, muscle weakness, calf pain or swelling, or regular uterine contractions.

The bottom line is that exercise can be very safe during pregnancy. Speak to your doctor about your fitness level and goals. Pay attention to how your body is feeling and re-evaluate. Speak to your doctor about any warning signs and change your routine if needed.

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

Getting Your Skin Ready for Summer

Lillian Soohoo, MD
Board Certified Dermatologist

With beautiful weather already here, now is a good time to focus on your skin for summer!

Where to start? A complete, total body skin exam to check for any suspicious skin lesions is an important first step. Since skin cancer is the most common type of cancer in humans, the American Academy of Dermatology recommends that all adults receive a complete skin exam every year. This is the best way to catch skin cancer in its earliest and most curable stage.

At The Menkes Clinic, we are board-certified dermatologists who strive to offer the highest level of dermatologic care to our patients in a friendly, state-of-the-art practice. In addition to a thorough skin screening and treatment of all skin conditions, we also help our patients create a daily skincare regimen tailored to their skin type. We are highly experienced in formulating a skin care plan that is appropriate for you.

This includes the three basic goals of skincare: cleansing, protecting, and correcting your skin. Our practice treats patients of all ages from newborns to adults, with a keen understanding of the different needs of women in their 40s, 50s and beyond.

For example, our personalized skincare approach adjusts for women over 50 who look best with a smooth slightly “shiny” texture rather than a matte finish to the skin. Light reflection from the skin looks fresher and is actually the opposite of a matte finish. Therefore, avoidance of powder foundations and products is key for improving the appearance of mature skin.

Other common skin concerns such as adult acne, brown spots, broken capillaries, and fine lines can also be effectively treated with little down time and no surgery. At The Menkes Clinic, we want our patients to look refreshed and natural-appearing. With summer already here, let us help you maintain healthy, radiant skin.

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

CANCER AND SELF-CARE – YES, IT CAN BE DONE

By Shyamali Singhal, MD

Surgical Oncologist

Founder of Hope & Beauty

Cancer Patients Should Not Put Aside Their Self-Care Practices

Cancer is one of the most critical health problems worldwide today. Studies by different researchers have shown that disease can reduce people’s ability to self-care.

The self-care concept has considerably evolved among patients with chronic diseases, particularly cancer, over the past 35 years, and nurses have managed to enhance their knowledge about self-care remarkably for the clients so that the nurses in healthcare teams have become highly efficient and able to assume the responsibility for self-care teams.

When you’re facing a cancer diagnosis, the treatment plan becomes front and center: is it chemo, radiation, or both? What medications will you need? What side effects will result from the treatments? You’re swarmed with questions from all sides — doctors, family, friends, and anyone else with whom you share your diagnosis.

Intersection Of Nutrition and Self-Care

Throughout her career as a surgical oncologist, Dr. Shymali Singhal, founder of H&B, has had the opportunity to see many women fight hard not to lose themselves to the various pieces of their lives; work, family, friends, social, volunteerism, church, etc.

Although self-care may not seem to fit into a nutrition session, we at H&B believe it’s often one of the first things to come up.

This can manifest itself in:

• on and off dieting
• self-sabotage through food and exercise abuse
• resistance to building or maintaining the foundation of a healthy diet
• emotional eating
• avoiding physical activity

What Actually Is Self-Care?

In short, self-care is all the different practices that ground, elevate or center you. That’s how you know you’re doing something supportive for yourself.

Below we list a few ideas; add your own to create a unique self-care routine.

• Journaling
• Mindfulness
• Aromatherapy
• Massage
• Dancing
• Meditation
• Moving your body
• Unplugging from tech
• Reading inspirational books
• Listening to music
• Sleeping (but not too long!)

Quality of life is an important index for evaluating the outcomes of treatment and the long-term survival of patients with cancer. In light of the limitations of current medical science, the goal of cancer treatment is controlling symptoms and delaying disease progression rather than curing the disease. Therefore, quality of life is a crucial determinant of symptom relief and of the rehabilitation needs of patients with cancer.

How Self-Care Relates To Quality Of Life

Quality of life assessments are increasingly used in the care of patients with cancer. Furthermore, quality of life is a particularly important outcome indicator for patients with advanced breast cancer who receive chemotherapy, as this treatment strategy causes side effects such as gastrointestinal problems and neurological disorders that not only impact significantly upon the quality of life but also predict premature discontinuation of treatment.

Promoting and maintaining the self-care behavior that is necessary to manage the side effects of chemotherapy and to improve quality of life are important for patients with cancer. However, given the challenging nature of performing self-care activities while dealing with the side effects of chemotherapy, it is critical to understand the factors and mechanisms that help predict the self-care behavior and quality of life of patients.

Stress Management For Cancer Patients

Coping with cancer can be one of the most stressful experiences of your life. When it comes to health and wellness for cancer patients, acknowledging your stresses and knowing where and how to get help for them is very important.

Here are some helpful tips for successful stress management:

• Listen to cancer survivors’ experiences to learn the most common feelings
• Recognize when you need to seek help in coping with your emotions
• Know where and how to get that help

When dealing with stress, it’s important to have an “active coping” mindset, rather than avoiding the problem. You can acknowledge the things that are causing stress by making a list. This makes them something tangible to overcome, rather than just a feeling. Also, seek out advice and information. Knowing more about the root of the stress can make it feel less intimidating.

Once you’ve done your research, make a plan to deal with the problem. It helps to involve others from your support system and be open about your feelings. Your friends and family will be more than willing to help if you just ask.

There are many things you can do to reduce stress, but they all focus on a common theme: self-care. Take time for yourself to do something you love. Just relax with a good book or go get a message (if you feel you can do so safely during the coronavirus pandemic. Exercise and meditation are also useful tools for managing stress. There are even exercise classes and guided meditations dedicated to wellness for cancer patients.

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

WHAT IS LIFESTYLE MEDICINE AND WHAT DOES IT MEAN?

Pradeepa Selvakumar, MD FACP
Board Certified in Internal Medicine and Lifestyle Medicine

Does it mean taking medicine is a type of lifestyle?  No! Actually, the reverse. The way traditional medicine has been practiced for decades, patients equate a visit to the doctor to mean taking a pill to solve a health issue. The recent medical gig economy of urgent care and televisits with random providers have exacerbated the idea that a health problem is quickly cured by medication. In this model, the patient doesn’t even necessarily need to know what the diagnosis or cure is- they simply take the pill.

Medications have their place in evidence-based medicine but what lifestyle medicine advocates, is that lifestyle changes should be the first approach to a medical problem. Lifestyle changes can help to prevent disease, modify disease progression or limit the number of medications you need to take.

For example, high blood pressure requires treatment for sustained values greater than 130/80. Treatment in the setting of lifestyle medicine would involve making changes to diet to incorporate the DASH diet (Dietary Approaches to Stop Hypertension), evaluating for obstructive sleep apnea, decreasing stress, getting enough sleep, and adding exercise. This would be reevaluated at regular intervals as if you were being monitored on a new blood pressure medication being titrated upwards. Lifestyle medicine counseling is naturally more time-consuming using behavioral management tools and is not conducive in the traditional medicine model.

The tenets of Lifestyle Medicine are:

• Adopting a nutrient-dense, plant-predominate eating pattern.
• Optimizing and individualizing physical activity plans.
• Improving sleep.
• Managing stress with healthy coping strategies.
• Forming and maintaining relationships.
• Cessation of tobacco use and other unhealthy habits.

Eat your veggies and exercise

Physicians generally tell patients “eat healthier, exercise more” but the vagueness of the instructions is difficult for patients to implement.  It’s a lot easier and faster to prescribe medication and frankly, that’s what we as physicians were taught during our training. The elements of lifestyle medicine already form the foundation of traditional medicine. Lifestyle medicine addresses all the factors that can help or prevent disease and establish a program with specifics that can help to engage the patient in their own health care.

For example, for the problem of hypertension (high blood pressure), we could start off with the following plan:

Food- let’s start by learning to read nutrition labels and seeing how much sodium is in the processed food you eat. Let’s discuss how much alcohol you might have in a week.

Movement: start with walking 10 minutes a day, three times a week and gradually increase by 5 minutes a week.

Sleep: if you are not getting 7-9 hours a night, let’s take a look at your sleep hygiene. Avoid screens at least 2 hours before sleep, avoid caffeine after 2 pm.

Stress: what small changes can you make at work or family or let’s start with 3 minutes of meditation a day.

This would be followed up in 4 weeks at regular intervals with this “prescription” given to the patient.

Food as Medicine

Lifestyle medicine promotes a plant-based/plant-forward diet and stresses the importance of “Food as Medicine”. We now know the importance of what we put in our bodies can determine not just diseases like diabetes and heart disease but can also affect mood disorders, cognitive impairment, inflammatory disorders like arthritis and skin conditions and play a part in oncology treatment and recurrence. Food as medicine can focus on anti-inflammatory foods, high fiber foods, complex carbs, and herbs and avoiding processed foods, sugars, and minimizing meat and dairy. This is an important distinction to note, that you don’t have to avoid meat altogether- it should just be a much small part of your diet.

The Mediterranean diet is well known to help prevent heart disease and numerous other conditions. It is a traditional diet that evolved over the course of 5000 years in a specific region where the people who live there were noted to have significantly lower rates of heart disease. It typically includes olive oil, grains, fresh fruits and vegetables, beans, legumes, fish. Multiple past and ongoing studies have demonstrated the continued benefits of this diet that encourages plants and healthy fats in the form of olive oil and fatty acids from fish.

The main components of the Mediterranean diet include:

• Daily consumption of vegetables, fruits, whole grains, and healthy fats
• Weekly intake of fish, poultry, beans, and eggs
• Moderate portions of dairy products
• Limited intake of red meat

Dr. Dean Ornish has long been a proponent of a plant-based diet and a has cardiac rehabilitation program (Ornish Lifestyle Medicine Program- marinhealth.org) in Larkspur, CA covered by Medicare and some PPOs that consists of four components: a low-fat, whole-food, plant-based diet; at least 30 minutes of exercise each day; a practice of stress management techniques; and active engagement in supportive relationships. Dr Ornish is also currently part of a research trial with UCSF studying lifestyle medicine in the area of Alzheimer’s Disease.

The MIND (Mediterranean-DASH intervention for the neurodegenerative delay) is a diet recommended for Alzheimer’s Disease and is a combination of the Mediterranean diet and the DASH diet, with an emphasis on berries and leafy green vegetables. There is currently no known cure for Alzheimer’s disease but a small study at UCLA in 2014 showed that intensive lifestyle changes were able to slow the progression of the disease, and in some cases, reverse Alzheimer’s Dementia. The above-mentioned trial at UCSF and the current PREVENTION trail in Southern California are also studying what intensive lifestyle changes can make on the clinical course of Alzheimer’s Disease and changes to the brain itself.

The DASH diet (Dietary Approaches to Stop Hypertension) mentioned above, focuses on foods that are rich in potassium, calcium, and magnesium to help lower blood pressure. It does avoid foods high in sodium, saturated fats, and sugar. The DASH diet originated in the early 1990s from the NIH (National Institutes for Health) and continues to be effective in helping to not only lower blood pressure but also lipid profiles too.

Despite the different names, all these eating patterns incorporate the common theme of more plants, less saturated fats, good fats, and complex carbs. These “diets” are not short-term plans but are really lifetime eating patterns. These accompany all the other lifestyle changes such as sleep, stress, and exercise.

To learn more about lifestyle medicine, please see  https://www.lifestylemedicine.org.

To learn about a lifestyle program located in the South Bay, see https://www.elcaminohealth.org/services/lifestyle-medicine.

Pradeepa Selvakumar, MD
Board Certified Internal Medicine
DipABLM (American Board of Lifestyle Medicine)

Bloom Primary Care
101 S San Mateo Drive Suite 102
San Mateo, CA 94401
650-435-8211
http://www.bloomprimarycare.com
moc.e1679346446racyr1679346446amirp1679346446moolb1679346446@olle1679346446h1679346446

A FREE WOMEN’S HEALTH WEBINAR: NEW TREATMENTS FOR BLADDER CONTROL

Bay Area Gynecology Oncology presents:

A FREE Women’s Health Webinar:  NEW TREATMENTS FOR BLADDER CONTROL

Featuring: Dr. Katherine Volpe, Urogynecology specialist

Do you:

• Leak while sneezing, lifting, or jumping?
• Have trouble holding it as you hurry to the bathroom?
• Wear pads or liners to protect against unplanned leaks?

Tune in anonymously. We’ll explore the condition and the latest research on treatments options. In addition, you’ll have the opportunity to submit questions. Except for questions, the materials presented will be the same on both days.

Two sessions:

• Thursday, July 8, 6:30 pm
• Tuesday, July 13, 10:00 am

REGISTER AT: https://bayareago.com/pelvic-floor-webinar/

A link will be provided a few days before each webinar.

Bay Area Gynecology Oncology
455 O’Connor Drive, Suite 370
San Jose, CA 95128
408-827-4274

WORLD HEAD & NECK CANCER AWARENESS DAY

By Katrina Chaung, M.D.
Board Certified ENT

Each year, about 55,000 individuals in the United States develop head and neck cancer.  These cancers usually originate from the mucosal lining of the mouth, nose, throat, voicebox area, or salivary glands.

While some risk factors are uncontrollable such as gender and age (males and those over 40 years old are statistically more at risk), others are certainly avoidable.

The biggest known risk factor for head and neck cancers is tobacco use (such as smoking cigarettes or cigars or chewing tobacco).  In fact, about 85% of head and neck cancers are attributed to tobacco use. Quitting or at the very least reducing tobacco use can significantly reduce the risk of head and neck cancer.  Excessive alcohol use is also a major known risk factor for head and neck cancer.  Risk increases as the amount and duration of alcohol use increases.

Some types of head and neck cancers are also related to human papillomavirus (HPV) infection.  While there is a vaccine that can protect against certain strains of HPV linked to cervical cancer, there is not yet a vaccine to protect against the strains that are linked to head and neck cancer.  Practicing safe sex, including oral sex, can help reduce this risk.

UV light exposure is also a risk factor for skin cancers of the head and neck, especially around the lips and ears.  Reducing sun exposure, wearing wide-brim hats, wearing sunscreen, and re-applying routinely is recommended to minimize this risk.

Radiation exposure, poor oral hygiene, eating preserved foods, occupational exposure to wood dust, asbestos, and synthetic fibers are other risks factors for head and neck cancer.

Early detection is key to successful treatment!  Many cases, if found early, can be successfully cured with surgery; some cases may also require radiation or chemotherapy.

Possible symptoms of head and neck cancer may include a lump in the neck that does not go away, a growth or sore in the mouth that does not heal, a persistent sore throat, difficulty swallowing, or hoarseness that does not improve.  It is a good idea to take a look at your mouth, gums, tongue, and throat once a month in the mirror.  If you notice anything new or different such as an area of discoloration, a white spot, or ulceration that does not go away within 1-2 weeks, please have it examined by your primary care physician or an Ear, Nose, and Throat physician.

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

EL CAMINO HOSPITAL VISITOR POLICY UPDATES

From the hospital’s website: 

El Camino Health regularly reevaluates its visitor policy to support our patients’ needs while minimizing the risk of potential communicable diseases throughout our hospitals. These changes are based on the most recent recommendations from the Centers for Disease Control and Prevention (CDC), as well as local health authorities. The visitor guidelines below are in place to ensure you and your family continue to receive safe, quality care.

For the safety of all, support persons/visitors will be asked to follow the entry requirements outlined below and follow social distancing guidelines.

All support persons/visitors will be required to:

• Be 16 years old or older.
• Minors must be accompanied by an adult.
• Accommodations can be requested.
• For the Emergency Department, be 18 years old or older.
• Be screened for symptoms upon entry into the hospital.
• Wear a hospital-provided mask. This mask must be worn at all times in the building, even if the support person/visitor or the patient is vaccinated.
• Use hand sanitizer upon entry.
• Limit personal belongings brought into the hospital during the visit.
• Limit outside food to no more than one single-day meal or food item in a disposable container. Note there is no storage available for food items.
• Limit your visit to the patient room only.

Your health, safety, and well-being are our top priorities.

Below are guidelines for a trained professional doula attending active labor and delivery:

• The doula needs to bring documentation of a negative COVID-19 test within the last 14 days when arriving at the hospital.
• The doula needs to bring the printed proof of business documentation when arriving at the hospital.
• The doula will be screened upon entry to the hospital and will be required to wear a mask in the hospital. They will be rescreened every eight hours.
• The doula should remain in the patient’s room as much as possible and minimize leaving and returning to the room.
• The doula can only accompany a mom during active labor and delivery, not after the birth.

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 over a year now, our most popular article remains to Stop Eating all The Time: Snacking and Intermittent Fasting! An article by guest author Dr. Shyamali Singhal on avoiding cancer causing chemicals in cosmetics was the next most read article last quarter.  A close third was an article on the use of Hysteroscopy in the evaluation of abnormal uterine bleeding.

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