2021 Issue 4, Quarterly Newsletter

WOMEN’S HEALTH

A newsletter from El Camino Women’s Medical Group

2021, Issue 4www.ElCaminoWomen.comOctober 15, 2021

Welcome Fall, and with it, our last newsletter of the year.

A year ago this time, we were just settling into our new office. We hope that you have found it an improvement for our practice. It’s allowed us to increase our services and hopefully provide more comfortable care. We still can’t believe an entire year has passed, and yet so much has happened.

The COVID19 pandemic was just starting its winter surge when we moved into our new space, the Pfizer-BioNTech vaccine was entering Phase III clinical trials, and the 2020 elections were a month away. Since then, the surge has passed, Pfizer-BioNTech has shipped over 1.5 billion doses, some of us are getting our boosters, and there’s a new president.  Of note, we HIGHLY recommend pregnant women get their booster shots!  Dr. Balassiano has been on maternity leave and will be back in the new year and Dr. Christina Lam, who joined us in August, has settled in very well with the group.

October is Breast Cancer Awareness Month! As the pandemic has taught us, when screening was postponed, we are now seeing more advanced diseases at diagnosis and increased mortality. Though small, it’s a big difference from years of gains made in diagnosis breast cancer early and improved treatment and outcomes. If you have a family history of breast cancer, bring it up at your next appointment. Otherwise, we recommend all women to get their mammograms starting at age 40 and come in for annual breast exams.

We’re also excited that El Camino Health has recruited Denise Johnson, MD as the new Medical Director of Breast Surgery at El Camino Health to help ensure the highest standards of care for women with diseases of the breast.

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 find us on Facebook, Twitter, LinkedIn, or Instagram.

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

We wish all of you good health and please make sure you get your flu vaccines before the end of October!

Sarah Azad, MD

 


In this issue:

Practice Updates

Online Prenatal Classes

Research at ECWMG

New Medical Director of Breast Health Surgery

Your Memory and How You Can Keep It!

Minimizing Surgical Scars

Knee Pain in Pregnancy

Silent Reflux

The Conundrum of Modern Endurance Cyclists in Bone Health

Body Gratitude: 8 Ways to Start Loving your Body

El Camino Hospital Visitor Policy Updates

Highlights from our Women’s Health Blog

Practice Updates

The Holidays

With the upcoming Thanksgiving and Christmas Holidays, there will be times when we have less availability for non-urgent appointments as our staff and physicians take time off to be with loved ones. For urgent needs, we are always available. Please try to schedule your appointments soon if you have issues you want to be addressed before the end of the year.

Office Visitor Policy Updates

While we highly recommend everyone get the COVID19 vaccine, including women who are pregnant, we also respect the difficulty of this decision during pregnancy. Many women were unable to get the vaccine before they discovered they were pregnant, and for these women who have chosen to delay the vaccine until postpartum, we want our office to be a safe space for them to visit. To allow for social distancing, we are going to continue to limit office visits to patients only. We will revisit this policy in February when the only pregnant patients would have had access to vaccination in May before becoming pregnant. Of course, we will have to take into account the new circumstances at that time. Masking inside healthcare facilities remains a requirement in Santa Clara County at this time.

Don’t forget we moved, a year ago:

We’ve just passed our one-year anniversary in our new suite in the Sobrato Pavilion. Unfortunately, we still have patients going to our old office first. On January 1st of 2022, we’ll be turning off the “we’ve moved” notification on our website. Remember, we’re located at:

2495 Hospital Drive, Suite 670
Mountain View, CA 94040

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

Don’t forget to follow us on social media to stay updated 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 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
  • Newborn safety:
    • 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:

  • 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.

Pregnancy Q&A Webinars

We started hosting these in July of this year, and they have been very successful. We’re going to continue these once every 1-2 months for our pregnant patients. Every webinar will start with 1-2 common topics that are important to understand in pregnancy and most the session is just open Q&A for women who have questions, general or specific. No personal questions will be answered during the Q&A and they do not replace the wonderful prenatal classes that are offered every 1-2 months.

RESEARCH AT ECWMG

Materna Study

We’re now actively enrolling for the MaternaPrep device trial! In the planning stages for a few years, we are so excited to be able to help study the possibility of helping women preserve their pelvic floor function. 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. We are actively enrolling women now. Reach out to moc.n1638518232emowo1638518232nimac1638518232le@of1638518232ni1638518232 if you are interested in more information.

Next Gen Jane

Another interesting new technology is being developed by NextGen Jane, a research company based in the Bay Area, to build a safer, more accurate method for non-invasive prenatal testing that can be done as early as six weeks of gestation. The study involves wearing an organic tampon for 20-60 minutes. Wearing tampons during pregnancy is safe and does not carry any adverse effects. To participate in their study, scan the QR code below or 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 for every sample tampon you send in.

BREAST HEALTH CENTER AT EL CAMINO HOSPITAL

Denise Johnson Miller, M.D., F.A.C.S., has recently joined El Camino Health as Medical Director for Breast Surgery. As part of an exceptional team of cancer experts, Dr. Johnson Miller’s recruitment is a true testament to El Camino Health’s commitment to providing the most comprehensive, multidisciplinary approach to cancer care, close to home.

Dr. Johnson Miller has vast experience in general surgery and an extensive background in breast surgery. Before joining the El Camino Health community, Dr. Johnson Miller was a Medical Director at Hackensack Meridian Health, an Associate Professor at Stanford Medical School, and the Medical Director of Breast Surgery at St. Francis Health in Indianapolis. At Stanford, Dr. Johnson Miller led the development of sentinel node programs and held leadership positions in institutional multi-center trials on sentinel node methodology. Dr. Johnson Miller is a frequent presenter at national conferences and regional meetings. She has written numerous publications and abstracts has been recognized for her outstanding work with honors and awards including U.S. News & World Report’s Top 1% of Breast Surgery Physicians (2011, 2014 – 2019); America’s Top Surgeons in Surgical Oncology, Consumer Research Council of America (2015 – 2019); and Top Doctor for Surgical Oncology, Castle Connolly’s Top Doctors for ten consecutive years (2008 – 2018). She also holds several memberships in professional organizations including the American Society of Breast Surgeons, the Society of Surgical Oncology, and the American College of Surgeons.

Denise L. Johnson Miller, M.D., FACS, is a board-certified general surgeon and is fellowship-trained in surgical oncology. As a nationally recognized breast surgeon, she specializes in breast cancer, melanoma surgery, and soft tissue tumors. In her previous hospitals, Dr. Johnson Miller has helped to develop clinical translation trials in support of oncology drug testing, as well as an in-depth genetic testing program for multidisciplinary cancer risk screening in breast cancer.

Dr. Johnson Miller is interested in the following specialties: accelerated partial breast irradiation, autologous “tissue flap” breast reconstruction, and skin and nipple-sparing mastectomies.

Fellowships: City of Hope National Medical Center, Duarte, CA and Department of Immunology, University of Dallas, Irving, TX

Residencies: Jewish Hospital of St. Louis, St. Louis, MO and University of Illinois Affiliated Hospitals, Chicago, IL

Medical Degree: Washington University School of Medicine, St. Louis, MO

Board Certification: General Surgery

Dr. Johnson Miller will be working with the El Camino Health Women’s Breast Center and Oncology Department to attain accreditation for the Breast Program through the American College of Surgeons and the National Accreditation Program for Breast Centers (NAPBC). This aligns with ECH’s Commission on Cancer (COC) Accreditation through the same organization. Her mission is to continue to provide the highest standards of care for patients with diseases of the breast.

Dr. Johnson Miller is currently accepting new patients.

Denise Johnson Miller, MD, FACS
Medical Director of Breast Surgery, El Camino Hospital
2500 Hospital Dr #15-1,
Mountain View, CA 94040
(650) 600-7301
Fax: (650) 963-5071
moc.t1638518232sigol1638518232ocno-1638518232lacig1638518232rus@k1638518232sedtn1638518232orf1638518232

YOUR MEMORY AND HOW YOU CAN KEEP IT!


PradeepaSelvakumar, MD FACP
Board Certified in Internal Medicine and Lifestyle Medicine

We are all living longer, and many of us think aging is synonymous with memory loss. But it doesn’t have to be. While there is no “cure” for Alzheimer’s Dementia (AD), there is much we can do to reduce our risk of developing dementia or slow its progression.

Can’t remember where you put your keys? Probably not dementia.
Normal forgetfulness is forgetting something once in a while, taking a little longer to learn something new but these are not memory problems.

Memory problems occur when you repeat the same question, getting lost in a place you know well, trouble following recipes or directions, getting confused about people, places, or time.
Mild Cognitive Impairment (MCI) is the intermediate condition between normal cognitive function and dementia. Not everyone with Mild Cognitive Impairment goes on to develop dementia.

When we talk about dementia, the most prevalent is Alzheimer’s Dementia. It is one of the leading causes of illness and death in older people. AD is thought to occur because of deposits of a protein called beta-amyloid, the loss of nerve cells in certain parts of the brain, and disorganized masses of protein fibers in brain cells. This diagnosis could only be confirmed by autopsy in the past but we can now do PET (positron emission tomography) to see these plaques. These tests are currently done in the research setting as the presence of these plaques doesn’t necessarily mean you will develop Alzheimer’s dementia.

I can’t remember what month it is?
Have your doctor do a cognitive assessment and collect information from family or friends. Look for reversible causes of memory loss like checking for low thyroid, vitamin B12 deficiency, checking for symptoms of depression, medication side effects, sleep disturbances, and checking an MRI for stroke, mass or inflammation. If there are no reversible causes of memory loss but your test says you have some cognitive impairment, the next step is a neuropsychological evaluation. This is an objective test that can see if depression is the cause of memory impairment or at least contributing to it.

What can I do?

Well, YOU are the prevention and the cure! Lifestyle change is the only intervention that has been shown to prevent, slow, and in some cases reverse cognitive decline.

Lifestyle changes involve all kinds of categories, from avoiding toxic exposures to creating pottery, and it’s never too early to start:

Beginning in childhood:
Attaining a higher level of education, avoiding air pollution/secondhand smoke exposure/pesticides, and avoiding traumatic brain injuries all help to prevent MCI.

Starting in midlife, around age 45:
Lifestyle changes take on more significance: physical activity, social interaction, and management of chronic diseases like hypertension, diabetes, abnormal lipids, obesity, cerebrovascular disease, peripheral arterial disease.

Social interaction:
This is beneficial from mid-life and beyond. Families are scattered throughout the country, and people do not live in the same house/neighborhood for years anymore. Thus many people no longer have that “village” to support them. Social interaction is more than just texting a friend on your phone; it is verbal communication via phone and video calls, in-person visits, religious or social clubs, volunteering, and activities. There is no data that determines exactly the minimum interaction necessary, but this will also vary from person to person.

The Harvard Study of Adult Development started in 1938 with 238 male Harvard sophomores, is one of the longest ongoing studies of adult life. Dr. Robert Waldinger, director of the study, notes “Loneliness kills. It’s as powerful as smoking or alcoholism.” The current surgeon general, Dr. Vivek Murthy, has written an entire book about this: Together, The Healing Power of Connection in a Sometimes Lonely World. Treating loneliness intentionally, among many other benefits, can help to preserve memory and it’s never too early or late to start.

Challenging your brain:
There was a burst of brain-training apps and books in the last couple of years, but these haven’t been proven to be of benefit in preventing, slowing, or reversing memory loss. One thing we have learned about the brain is that neurogenesis, the growth of new brain cells, can happen throughout life, even in older ages. To make your brain malleable (neuroplasticity) forming new neuronal pathways requires you to challenge your brain in different ways. For example, learning to paint, learning a new sport, learning to dance, even things as simple as eating with your non-dominant hand forces your brain to accommodate to new things.

Diet:
This is my favorite topic because we can make changes to something we have to do every day: eat! Many studies advocate for a plant-forward diet, incorporating as many different colored plants as you can. There are many specific types of diets but the Mediterranean diet is one that incorporates many important foods: rich in fruits, vegetables, whole grains, beans, nuts, and seeds, and include olive oil as an important source of fat. Low to moderate fish, poultry, dairy, and very little red meat have been shown to have a lower incidence of MCI and AD and slower rates of decline in memory of those already with MCI and AD.

What about specific anti-inflammatory foods? There have been studies linking inflammation with cognitive decline and possibly plaque formation in AD. There are no specific recommendations except that the Mediterranean diet is neuroprotective and anti-inflammatory. Specific foods include green leafy vegetables, tomatoes, nuts like walnuts/almonds, olive oil, fatty fishes like salmon/sardines, and berries.

The Nurses Health Study, started in 1978, followed over 16000 female nurses’ cognition for >30 years. Those that had a diet high in flavonoids, particularly those in berries, had a slower rate of decline. The same benefit was not seen for isoflavone soy protein.

Can red meat and processed meat worsen your memory? There are a lot of conflicting studies regarding this and it is difficult to make a recommendation on food to avoid- red meat is higher in saturated fat and implicated in cardiovascular and cerebrovascular disease, but more studies are needed to determine a direct correlation. What we do know is what foods to consume to help prevent and slow memory decline, as above.

Supplements:
There are many on the market that make all kinds of claims that they prevent dementia, but there are no data to show benefit. Only Vitamin E at 1000 units twice a day showed mild benefit taken over many years. Omega 3 fish oil supplements have yet to show benefit. Gingko Biloba, a popular supplement in the past, has also not shown benefit.

Many postmenopausal women ask about estrogen or hormone replacement. The Women’s Health Initiative (WHI) and the WHI Memory Study (WHIMS) were unable to produce any supporting data at this time, although there are ongoing studies. Conversely, ongoing estrogen replacement may increase the risk of breast cancer. The role of testosterone as possibly being neuroprotective is being studied.

Harmful Medications:
You can start by avoiding certain prescription and over-the-counter medications: Some medications have immediate side effects of memory loss but some medications can possibly predispose you to permanent memory impairment- like benzodiazepines (Xanax, Ativan, Valium), opiates, antihistamines like Benadryl, anticholinergics like Ditropan and widely used proton pump inhibitors (stomach acid blockers). These medications are appropriate to use in the short term but talk to your physician if these are necessary long-term and weigh the risk-benefit of each medication.

Toxic exposure:
Just like in childhood, avoid smoking/secondhand smoke/vaping, air pollution, and excess alcohol consumption. Traumatic Brain Injuries in young adulthood also predispose patients to dementia.

Alcohol:
Is moderate consumption of alcohol protective? It is still controversial, and we certainly wouldn’t tell someone to start drinking alcohol to prevent dementia. We do know that excess alcohol does increase the risk of MCI and AD separate from alcohol-related dementia. One European study found that middle-aged men who consumed 2.5 drinks/day demonstrated cognitive decline six years earlier on average than lighter drinkers. And older patients who continue to drink will find that their body does not metabolize alcohol as well and may interact with other medications and can accelerate their MCI and AD.

Extremely important and an easy lifestyle change to implement. During sleep, certain brainwaves are produced that help in storing memory. Most people need 7-9 hours of uninterrupted, good-quality sleep. If you are sleeping longer than 9 hours, you likely have poor quality sleep.

If you feel fatigued or have daytime sleepiness, get evaluated for obstructive sleep apnea (OSA). Implement changes to sleep hygiene, like avoiding alcohol before sleep – alcohol may be sedating but disturbs REM (rapid eye movement) sleep and avoid coffee after 2 pm. Avoid looking at screens at least 1-2 hours before sleep; avoid intense exercise or heavy meals just before sleep. Regular exercise any other time during the day can help with improving sleep quality. Try to avoid naps during the day and if necessary, power-nap it for 20 minutes. Try to avoid anything intense right before sleep and have a wind-down protocol that might include meditation or deep breathing right before bed.

Exercise::
Start now! One of the most important deterrents to memory impairment, especially if patients are active starting in midlife. The minimum required is 150 minutes/ week of activity. A meta-analysis of 11 studies on middle-aged people showed a 30% reduction of MCI and up to 45% reduction of AD. What kind of exercise should you do? There are no specific recommendations except for “aerobic” activity which can also include walking, sports but also gardening, or doing chores around the house, regularly for at least a year. Aerobic activity can be any activity that raises your heart rate.

Talk to your primary care physician if you have any questions about what you can do to reduce your risk of MCI and AD.

PradeepaSelvakumar, 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.e1638518232racyr1638518232amirp1638518232moolb1638518232@olle1638518232h1638518232

MINIMIZING SURGICAL SCARS


Lillian Soohoo, MD
Board Certified Dermatologist

I often am asked by patients how to minimize scarring of the skin after a surgical procedure. Actually, this is very straightforward and the following instructions can be applied to both surgical wounds as well as traumatic cuts and burns.

Wound healing can be optimized whether it results from the removal of a small mole, a burn or cut, or a larger surgical procedure such as a cesarean section.

My first recommendation is to optimize skin healing by preventing wound infection. Once the wound has been properly cleaned and treated to stop bleeding, it is very important to keep it moist. Covering a healing skin wound with an ointment (Polysporin, Mupirocin or Vaseline) and a clean sterile dressing or bandaid is the first step to ensure that it will heal quickly and with minimal scarring. I try to avoid Neosporin ointment since it contains neomycin which may cause skin allergy in many patients.

The clear (serous) fluid that looks like water in the wound is actually a component of plasma that contains all kinds of growth factors to encourage skin cells to grow and multiply, leading to faster healing. Without this serous fluid, the wound becomes dry and takes longer to heal. A scab occurs when this serous fluid mixes with blood, dries up, and forms a hard crust over the wound. Scabs delays healing, literally forming a roadblock to new skin cells trying to grow to cover the wound. Picking off a scab increases the chances of scarring since it may result in a deeper wound.

So contrary to popular belief, it is best to cover your wounds with a clean dressing or bandaid (with or without an antibiotic ointment) rather than let wounds heal by leaving them “open to the air.” Using a bandaid or dressing with an ointment such as polysporin or Vaseline keeps the wound moist and prevents scab development which delays skin healing.

After wounds heal, some patients develop itchy, raised scars. This is more common in patients who have a history of keloids. These patients may benefit from using silicone gel dressings such as Cica-care gel sheets to their wounds immediately after healing or on discharge from the hospital after removal of sutures or staples. I have found the Cica-care brand of silicone gel to be the most effective when used on new scars 24/7 for a couple of months, particularly after a cesarean section. It is available on Amazon.

If you have concerns about minimizing scarring or would like to treat an existing scar, consult a dermatologist to help you achieve the best results.

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.

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

Lillian Soohoo, MD
Board Certified Dermatologist
The Menkes Clinic
2490 Hospital Drive Suite 201,
Mountain View, CA 94040
650-962-460

KNEE PAIN IN PREGNANCY


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

Knee pain is very common during pregnancy. This is caused by multiple factors and can usually be treated with simple physical therapy and specific preventative exercises.

Anterior knee pain is most often caused by patellofemoral malalignment. The kneecap (patella) sits in a groove in the thigh bone (femur) and tracks in the groove every time the knee is bent. If there is malalignment of the patella and the femur groove, there will be abnormal tracking of the kneecap. This can lead to swelling and eventually damage of the cartilage lining both the kneecap and the thigh bone.

Patellofemoral malalignment is often seen in pregnancy for several reasons. There is gradual weight gain, which puts more stress on the knee joint. A hormone called relaxin is secreted during the third trimester to loosen the pelvic ligaments in preparation for childbirth. This hormone inadvertently relaxes some of the ligaments holding the kneecap in place and may cause malalignment. After the pregnancy is done, parents of infants and toddlers tend to bend their knees more often to pick their kids up off the floor, leading to exacerbation of pain.

There are several ways to prevent anterior knee pain. The following exercises, done 2-3 times a week, can strengthen the muscles around the knee and prevent malalignment.

  • Body Weight Squats
  • Clamshells
  • Walking Lunges
  • Standing Hip Abduction and Adduction with Resistance Bands

Three sets of ten repetitions of each exercise will lead to significant improvement. It’s okay to feel some soreness after each set but sharp pain should be avoided. Please advise a medical professional if you’re feeling pain with these exercises.

You can wear a patella-stabilizing brace, which lifts the kneecap from the thigh bone and prevents the grinding caused by maltracking. Additionally, adding comfortable shoes with proper arch support stabilizes the knee by preventing the foot from rolling inward or outward as you move, creating more stability at the knee. Icing the knee after exercising or long stretches of activity can be helpful as well.

If you’re having anterior knee pain, reach out to Dr. Svetlana Dani for more help.

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

SILENT REFLUX


By Katrina Chaung, M.D.
Board Certified ENT

Many people have experienced heartburn at some point. This is a typical symptom of gastroesophageal reflux disease (GERD). When acid or stomach contents, which can be acidic or non-acidic, leak up beyond the esophagus and irritate the tissues of the larynx (voice box) or pharynx (throat) areas, this may cause symptoms of laryngopharyngeal reflux (LPR).

Symptoms of LPR may include throat pain or irritation, voice changes like hoarseness, difficulty swallowing, frequent throat clearing, coughing, the sensation of a lump or something stuck in the throat, excess mucus in the throat, and/or a bitter or sour taste in the mouth.

These symptoms may occur with or without a history of heartburn and are sometimes called “silent reflux”. This might be because the esophagus has some natural protection against small amounts of acid reflux, but the voicebox and throat do not. These tissues are vulnerable to damage by reflux.

LPR can be diagnosed by examination of the throat to see if there is evidence of irritation, swelling, or redness from reflux changes. Sometimes a small camera is used to examine areas, such as the voicebox, that are not able to be seen through the mouth. The changes can be subtle, or, in other cases, the changes can be severe. Other tests can include visualizing or measuring the pH level (acidity) of the esophagus.

LPR can be treated with both lifestyle modifications and medications. Because it may take time, even several months, for the irritation to heal, it may take a while for symptoms to resolve.

Changes to your diet are often a key factor in controlling LPR symptoms. Foods that are spicy, acidic, or high in fat and grease often worsen symptoms. Limit foods that are tomato-based, have high citrus content or contain chocolate, licorice, and peppermint. Caffeinated and carbonated beverages are also a trigger for reflux and reflux-related issues. Eating smaller meals and waiting at least 3-4 hours after eating before lying down are important ways to improve symptoms. Tobacco use, alcohol consumption, stress, and obesity are also risk factors for LPR and GERD.

Medications are sometimes recommended as well. These may include over-the-counter or prescription medications. Examples include a group of medications called histamine blockers (e.g. famotidine or Pepcid) or proton pump inhibitors (e.g. omeprazole or Prilosec; esomeprazole or Nexium) that decrease stomach acid production. Timing is often important in taking these medications as they may be most efficacious when taken 30 to 60 minutes prior to a meal.

If you are having possible symptoms of laryngopharyngeal reflux, 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

THE CONUNDRUM OF MODERN ENDURANCE CYCLISTS IN BONE HEALTH


By Lakshmi Myneni, MBBS, FACP, FACR
Board Certified Rheumatologist

Are you an endurance athlete or do you have a family member who is one?

Even as more athletes are participating in endurance events like a triathlon, the popularity of ultra -endurance events are also increasing. Some of these may last four to six hours.

Studies have shown that endurance sports athletes in running, bicycling, and swimming often have lower bone density than those who participate in ball and power sports. Rarely they have been known to have bone density measurements that are lower than their inactive peers.

This is the conundrum.

Is this due to a selection bias in athletes as they usually have lean body mass? Lean body mass may translate to lower bone density scores on DEXA imaging. It is known that lean body mass translates eventually to more fractures in a lifetime. But is it the same in endurance athletes?

Is low BMD in endurance athletes preventable?

Do diet and nutrition have a role to play in these athletes?

Is it enough to improve caloric nutrition? Or are calcium and vitamin D supplements required?

Is a stress fracture that is commonly seen in athletes a cause for concern?

Do stress fractures in an athlete translate to increased fractures later in life?

When should such an athlete have their first bone health consult and BMD screening?

These are among the many unanswered questions in the arena of bone health.

In the meantime, it is recommended that endurance athletes of all ages should be evaluated for risk factors by a bone health specialist. Further investigations may be warranted.

Lakshmi Myneni,MBBS,FACP,FACR
Rheumatology, Immunology and Bone health.
Core Heath Infusion center
2490 hospital Drive, Suite102
Mountain View Ca 94040
Call 650 969 7006
Fax 650 969 7007

 

BODY GRATITUDE: 8 WAYS TO START LOVING YOUR BODY


By Juliet Malray
Transformation Coach and Women’s Circle Leader

Body positivity can be difficult to have if there has been a pattern of breaking yourself into pieces that get judged. Looking in the mirror can trigger uncomfortable thoughts. We can find our eyes darting to all the areas we hate.

As the months move from Spring to Summer, and the days get hotter, we show more of us to the world. The beauty industry, our culture, and what loved ones say to us help us form an opinion about why pieces of us do not meet the beauty standards.

Loving all of your body, as it is, no matter the size or shape can be a reality when you take baby steps with your thinking. Having body gratitude is a way that you can begin to accept, then love, your body.

Here are 8 ways to help gain body gratitude:

  • Every day pay tribute to a body part and 3 reasons why you have gratitude for it. You use your body to hug and walk and reach for things you need, and much more!
  • Write a body-positive mantra on a Post-It that is personal to you and place it on your mirror (ex: My body is a vessel for my awesomeness; there is more to life than worrying about my weight and I am ready to experience it; my body takes care of my soul and I am taking care of it).
  • When you do look in a mirror, be mindful of the self-talk that turns negative. Say “stop it” out loud and replace the negative with your mantra or another positive statement about yourself.
  • Wear clothes that fit and make you feel good.
  • Get your body moving. Studies show that when you exercise, you feel more positive and powerful.
  • Care about what you eat. I know there are many diets out there; you can be confused, dismayed, and even disgusted with the word diet. Strive for 80/20: 80% whole foods and 20% “fun” foods.
  • Go on a diet…with social media! Stop reading fashion magazines and scrolling through websites or apps that make you feel bad about yourself.
  • Pamper yourself in ways that feel luxurious!

Loving your body can be difficult and it is normal to not like the way it looks all of the time. Every woman-tall, short, slim, curvy of every background- can feel that their body is not “up to par”, at times. You are not alone!

Strength is found in numbers. Connect with one to three friends and hold each other up, and accountable, to gaining body gratitude. In time, you will bring in body love together!

Juliet Malray, MCHC
Transformational Coaching
Reach out here if you are interested in a free discovery call!

EL CAMINO HOSPITAL VISITOR POLICY UPDATES

General information on visitor’s policy
Last updated visitor guidelines from August 2021

For the main hospital, El Camino Health is now allowing one visitor with patients in the Emergency Department and two visitors in the inpatient units.

All visitors must be over the age of 16 (18 for the ED), have proof of COVID19 vaccination status or proof of a negative COVID19 test performed no more than 72 hours prior. For complete details click here.

Information for Labor & Delivery, NICU, and the Mother-Baby Unit:
Last updated August 2021

Two visitors, in addition to a doula, are being allowed both on L&D and the postpartum unit. The NICU continues to only allow the parents of the newborn to visit. All visitors must have proof of vaccination or proof of a negative COVID19 test performed no more than 72 hours prior. There is a one-time exemption for an unstable situation (for maternal health and/or newborn health) until the patient is stable, at which time a visitor not meeting requirements will be asked to leave and return with a negative test.

For more complete details, click here.

As we all know, this pandemic has been in several different phases with several different recommendations, so these visitor policies may change. At no point during the pandemic has El Camino Hospital prevented laboring or postpartum women from having at least one visitor with her that met requirements.

HIGHLIGHTS FROM OUR WOMEN’S HEALTH BLOG

Our Women’s Health Blog continues to be a very popular section on our website attracting readers from all over the world. We find it helpful to put out up-to-date information on relevant women’s health issues. For over a year now, our most popular article remains 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 again the next most read article last quarter. A surprise third was an older article written as a primer on the MonaLisa Touch treatment for vaginal atrophy.

We update our blog at least a few times a month with information on all kinds of women’s health issues. Recent posts have been on the new recommendations on the COVID19 vaccine and booster shot. 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