2022 Issue 2, Quarterly Newsletter

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WOMEN’S HEALTH

A newsletter from El Camino Women’s Medical Group

Spring is here, places are opening up, and masks are coming off.   What a difference from last year!

I hope everyone and their families are in good health and looking forward to a more open and social 2022.  Based on activity in Europe, we expect another wave of COVID-19 from a different subtype of the Omicron variant that hit us in January.  Expectations are that this waive will be smaller and milder than what hit us in January.  Both vaccination and previous infection with COVID19 are protective against this subtype.   We encourage everyone to make sure they are COVID19 vaccinated and up to date with their booster shots.

We are finally seeing visitors back in the office, which has been nice.  See our office visitor policies in the Practice Updates section.  The hospital now allows two visitors to the Mother-Baby Unit; you can see their updated policies at the end of this newsletter.

April also brings great news for our patients who are 65 and older.   As of April 1^st, our physicians are all in-network for Medicare!   You can read more about it in the Practice Updates section.  This change doesn’t include Barb Dehn, women’s health nurse practitioner, as she’s set up in a new model since March 1^st.

This month also brings Ramadan, and I wish a blessed and fruitful Ramadan to all those celebrating.  We have guidelines around fasting during pregnancy up on our blog.   Of course, most important for pregnant women is to check in with your personal obstetrician for guidance on fasting in Ramadan.

Finally, please follow us on social media 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 keep your ears open about an upcoming possible repeat COVID19 boosters.

Sarah Azad, MD

In this issue:

Practice Updates

Online Prenatal Classes

Research at ECWMG

Should I Worry About Dense Breast Tissue?

Parenting Through the Pandemic

Hair Loss in Women—What can be done?

How to Fit in Exercise with a Busy Life

GSM—What is it?

Inflammation and Heart Disease

El Camino Hospital Visitor Policy Updates

Highlights from our Women’s Health Blog

PRACTICE UPDATES

Medicare

We have finally enrolled all five physicians into Medicare, effective April 1st, 2022.  We are not yet set up with the Medicare Advantage plans.   For all our existing patients who have traditional Medicare, we will be able to accept your insurance at all appointments on or after April 1^st of this year.  For our patients with Medicare Advantage plans, please email our office with the exact plan you have so that we can enroll.  Unfortunately, until we’re enrolled in your Medicare Advantage plan, we can’t see you at all.   Enrollment doesn’t usually take more than a month, and we are working on it.

We will not be taking new patients to the practice with Medicare, but for our established patients who age into Medicare, we are happy we can not continue to see you and that you can make use of your well-earned Medicare plan.

Office Visitor Policy Updates

Finally!   Patients are now able to bring one visitor with them to appointments.  Visitors must be fully vaccinated against COVID19, including a booster (unless it’s less than sixmo from their 2^nd COVID19 vaccine.   Though this is stricter than the guidelines at the hospital, visits to our office are not as acute or emergent as what happens in the hospital.  Our priority remains the health and safety of our immunocompromised patients.   We appreciate everyone’s patience and understanding over the last two years.   Masking is still required in Santa Clara County in all healthcare facilities.

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 physician and staff communication is always welcome.

Barb Dehn, NP

Just a reminder that Barb Dehn, NP is no longer working directly under El Camino Women’s Medical Group but has a new business structure allowing her to focus more on longer, more education-based appointments.  You can read more in our last newsletter.

ONLINE PRENATAL AND WOMEN’S HEALTH 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 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 will 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’ve well into our trial with the MaternaPrep device!  In the planning stages for a few years, we’ve had several patients successfully complete the process on Labor and Delivery.  It is exciting 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.n1695901874emowo1695901874nimac1695901874le@of1695901874ni1695901874 if you are interested in more information.

Next Gen Jane

We continue to encourage women who have completed NIPT and are less than 20 weeks to consider enrolling in the research being conducted by NextGen Jane, a research company based in the Bay Area.  They are trying 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 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 (5 max).

SHOULD I WORRY ABOUT DENSE BREAST TISSUE?

Denise Johnson Miller, MD, FACS

Breast Surgeon and Surgical Oncologist

Medical Direct of Breast Surgery at El Camino Health

Have you ever had a breast exam, and the doctor told you that you have dense breasts? If you’re like most women, you may have no idea what that means. Dense breasts are more common than you think, but many women don’t know what they are or what causes them. In this blog post, we will discuss key facts about dense breasts. We’ll answer the question “what are dense breasts?” and tell you about the different causes of dense breasts. We’ll also give you tips on improving breast imaging techniques to detect breast abnormalities if you have dense breasts. So read on to learn more!

1. What are dense breasts, and what causes them?
Dense breasts are medically defined as breasts with a high proportion of fibrous and glandular tissue to fatty tissue, which can make it more difficult to detect cancer on a mammogram since the X-ray image in dense tissue has a white background.  Normal breasts contain lobules that produce milk in lactating women and ducts which carry milk to the nipple and supporting structures.  Women during their childbearing years have naturally dense breasts, a higher ratio of glandular tissue than fat.  Generally, after age 40, the glands begin to involute and fatty tissue replaces the glands that are no longer needed in older women.  While doctors don’t know for sure what causes dense breasts after age 40, there are several factors that may contribute, including age, genetics, and body composition. There is currently no cure for dense breasts, but there are steps women can take to help ensure early detection of cancer if they do have them.

2. What are the risks associated with dense breast tissue?
While dense breast tissue can make mammograms more difficult to read, it does not increase the risk of cancer. However, women with dense breasts are at a slightly higher risk of developing cancer than women with less dense breasts. This is because cancers that develop in dense breast tissue are often harder to detect on a mammogram.  In the US, it is estimated that between 40 and 50% of women are classified as having dense breast tissue.

3. How is dense breast tissue diagnosed?
Dense breast tissue can only be diagnosed with a mammogram. Your doctor will look at the density of your breast tissue and compare it to the surrounding fatty tissue. The more dense the breast tissue is, the harder it will be to detect cancer.  The low dose x-rays are unable to penetrate the dense breast tissue, unlike fatty tissue.  The resulting image in women with dense breasts is a white background versus a black or grayish background in fatty replaced breasts.  Breast lesions are also dense or “white in appearance”; therefore, in women with dense breast tissue, the white background can hide an abnormal breast mass or microcalcifications.

4. How can I reduce my risk of developing cancer if I have dense breasts?
There is no surefire way to reduce your risk of developing cancer if you have dense breasts, but there are a few things you can do to help increase your chances of early detection. First, make sure you get a mammogram every year. You may also want to consider getting a breast MRI or an ultrasound in addition to your mammogram. These tests can help detect cancers that may not be visible on a mammogram. In women with normal fatty replaced breasts, the sensitivity of cancer detection with mammography is 85-87%.   In women with dense breasts (seen on a mammogram as areas of opacity ), the sensitivity of a mammogram can drop between 48% to 64%, according to a 2015 review of studies in the American Journal of Roentgenology.  

However, there are things you can do to reduce the risk of developing cancer, including eating a healthy diet, exercising regularly, and avoiding tobacco products.

5. Can dense breasts go away on their own?
Dense breasts are not a medical condition that can be cured, but they can change over time. As you age, your breasts will naturally become less dense. This is because the fatty tissue in your breasts will increase as you get older. Changes in weight can also change breast density.

6. How often should I get a mammogram if I have dense breasts?
The American Cancer Society recommends that women with dense breasts get a mammogram every year at age 40 if you have no strong family history of breast/ovarian cancers or history of prior breast biopsies showing atypical cells.  There are a number of methods to estimate your ten-year and lifetime risk of developing breast cancer based on lifestyle, family history, use of hormones after menopause.  Discussions with your primary providers are helpful in determining additional breast imaging that would be best for you.  For example, you may also want to consider getting a breast MRI or a comprehensive breast ultrasound ( also known as ABUS)  in addition to your mammogram. These tests can help detect cancers that may not be visible on a mammogram.

7. Seven tips to reduce the risk of developing breast cancer
1 in 8 women will develop breast cancer in their lifetime. While there is no sure way to prevent the disease, there are some lifestyle choices you can make to reduce your risk.

Here are seven tips to help lower your chances of developing breast cancer:
-Don’t smoke or expose yourself to second-hand smoke
-Limit alcohol consumption
– Maintain a healthy weight
-Be physically active
-Eat a healthy diet
-Avoid long-term hormone therapy  -Get regular screenings, mammograms, and clinical breast exams starting at age 40 (or earlier if you have a family history of the disease). Talk with your doctor about what’s right for you.

Remember to get annual  mammograms
– Reduces breast cancer mortality rates by up to 25%
– Detects tumors when they are still small and easier to treat
– Low radiation dosage
Discuss additional breast imaging options if you are one of the 40-50% of women who are classified as having dense breasts.
We are happy to help in Breast Imaging Centers and our Breast Surgery offices with discussions regarding breast cancer risks and choice of breast imaging modalities.

Denise Johnson Miller, MD, FACS
Breast Surgery and Surgical Oncology
Medical Director of Breast Surgery, El Camino Health
2500 Hospital Dr. Bldg 15 Suite 1
Mountain View, CA 94040
O: 650-641-7861
F: 650-963-5071

PARENTING THROUGH THE PANDEMIC

Molly Rad, MD
Board Certified Pediatrician

Parenting Through The Pandemic

It’s been two years of the saga of “Pandemic Parenting” for so many women. It’s a difficult time for not only children but for the entire family unit.  Additional stressors are our concerns as parents that social isolation may affect our child’s intellectual and social development.  We all hope these impacts will improve and our communities open back up, but it’s natural for parents to worry.

Parents should always discuss any concerns about their child’s development with their child’s pediatrician. For any child experiencing developmental challenges, early intervention services from birth to three years of age can drastically improve the long-term outcomes for kids. We’re fortunate in the Bay Area to have so many resources for our children; please reach out to your pediatrician with concerns; there’s no need to wait for scheduled routine exams.

Another important part of parenting: we need to take care of ourselves.  Though cliché, we can’t give to our children and families when we’re completely burnt out.  Social support is a very important factor in our overall mental and physical well-being, and social isolation has been a significant challenge for many individuals during the pandemic. It’s important for all of us to consciously make time to connect with family and friends as well as to make time to unwind from our electronic devices and be present with the entire family unit.

Checking in with your pediatrician for developmental or social behavioral concerns as well as taking care of your own social and mental health needs can help you to approach child-rearing in the way we all want, a way that combines warmth, sensitivity, and positive parenting.

Molly Rad, MD
Board Certified Pediatrician
763 Altos Oaks Drive, Suite 4
Los Altos, CA 94024
Phone: (650) 864-0000
moc.d1695901874aryll1695901874om@of1695901874ni1695901874

HAIR LOSS IN WOMEN–WHAT CAN BE DONE?

Lillian Soohoo, MD
Board Certified Dermatologist

Thinning scalp hair is usually not related to serious health issues but can be a huge source of stress and anxiety for women. In most cases, the reason can be determined by consultation with a board-certified dermatologist.

Many women experience thinning hair on the scalp. There are several common reasons related to hormonal changes (particularly around menopause), immune system abnormalities (e.g., thyroid disease), stress, family history, and physical damage done to the hair through overuse of chemicals, heat, and processing. Not all types of hair loss can be prevented, but several can be treated effectively.

When the cause of hair loss isn’t clear, a skin biopsy of the scalp or blood tests may be helpful. Alopecia is the medical term for abnormal hair loss from any cause. A dermatologist has the medical training and expertise to manage all types of alopecia and will be able to guide you to determine if you need further testing and review your treatment options.

What are the most likely reasons for hair loss in women? It is actually natural to have some hair loss or shedding. The American Academy of Dermatology reports that people lose up to 150 scalp hairs each day. This is completely normal. If you are noticing thinning scalp hair or see smooth scalp areas completely devoid of hair, you may be experiencing abnormal hair loss.

Common Causes of Hair Loss:

Androgenetic Alopecia/Female Pattern Hair Loss (FPHL)

This is the female version of male baldness, which affects 50% of men over the age of 50. The good news is that, unlike men, women almost never go completely bald. In women, this pattern of hair loss occurs on the crown or topmost part of the scalp. It is related to the effect of hormones called androgens (testosterone and dihyrotestosterone, or DHT) on the hair follicles of the scalp. These androgens actually bind to receptors on the hair follicle and work to miniaturize or shrink hair follicles so that they only grow tiny, peach fuzz-type hairs. The affected scalp hairs become so tiny that they are almost too small to see. Some women may experience more severe FPHL due to a genetically increased sensitivity of their hair follicles to androgens. Testosterone and DHT also shorten the length of the growth period (the anagen phase) during the hair growth cycle. This means that hairs stop growing sooner and shed earlier than normal, leading to the appearance of hair thinning and increased hair loss.

Androgenetic alopecia is very common and affects 30-50 million women in the US. It’s no surprise that women start to experience this form of hair thinning when estrogen levels start to decline during their 40s and 50s. It becomes more noticeable after menopause when estrogen production completely ceases, and the androgen effect on hair follicles is no longer offset by estrogen, leading to further miniaturization, earlier shedding, and the appearance of thinning scalp hair.

Alopecia Areata

 This type of hair loss is an autoimmune condition and often develops suddenly with the appearance of smooth, coin-shaped, completely hairless patches of skin on the scalp. The affected scalp is pink and smooth, resembling a “baby’s bottom.” The cause of alopecia areata is unknown, but genetics and environmental factors such as stress are thought to be possible factors. Approximately 2% of the population may develop alopecia areata in their lifetime, and it often begins in childhood.

This autoimmune condition specifically targets the hair follicle, is usually harmless, and is not associated with other serious autoimmune conditions. Occasionally, both autoimmune thyroiditis (i.e., Hashimoto’s disease) and alopecia areata may develop in the same person. The hairless patches on the scalp usually grow back spontaneously after a few months, and the first hair regrowth may appear white before resuming its normal color.

Alopecia areata can relapse unexpectedly. New areas of hair loss may develop suddenly, sometimes after many years of no sign of activity. Although this can be distressing, your dermatologist can administer scalp injections directly into the affected areas using a dilute concentration of cortisone. This treatment is safe, very effective, and is repeated every 4-6 weeks until hair regrowth is sufficient.

Diet, Stress, and Pregnancy

 These factors commonly lead women to notice that their hair feels thinner than usual. This form of alopecia is called telogen effluvium, which literally means “a flood of hair loss,” and typically occurs rapidly over a period of weeks to months following a major stressful event. Telogen effluvium may also be triggered by crash dieting or rapid weight loss, surgery, extreme emotional distress (e.g., after the loss of a loved one), or an illness with fever. In all of these situations, the cause of the “flood” of hair loss is the effect of stressors on the hair follicle. This results in an abrupt shortening of the hair growth cycle from a normal 3-year period of growth for each hair to only a few months’ growth before the hair is shed.

With telogen effluvium, hair loss can be dramatic. Large clumps of hair can fall out suddenly, leading to diffuse thinning or obvious baldness around 3-4 months after the inciting event. Fortunately, this type of alopecia is completely reversible, and you should be reassured that your hair will grow back normally within a year or so.

Medical Conditions

 Thyroid disease (both over-and under-active thyroid), iron deficiency anemia, connective tissue diseases (such as lupus), eating disorders, and nutritional deficiencies (ie, protein, vitamins, minerals) can result in diffuse scalp hair loss. Treatment of these medical conditions and restoration of health through the combination of medications, proper diet, and close medical follow-up can often be helpful in reducing the related hair loss and bringing back the normal hair growth cycle.

Central Centrifugal Cicatricil Alopecia(CCCA)

This is a scarring form of hairloss on the scalp that results in permanent hair loss.

It is the most common type of scarring alopecia seen in Black women. CCCA is characterized by slowly progressive hair loss beginning at the crown or mid-scalp area and extends outward in a centrifugal manner. There is a gradual loss of hair follicles, and the scalp appears shiny. Tenderness, itch, and burning are common.

Early diagnosis of CCCA is important because medical intervention can help to prevent further progression, which results in extensive, permanent hair loss. A scalp biopsy may be performed when the diagnosis is uncertain and will show inflammation and scarring of the hair follicles.

The exact cause of CCCA is unknown, and a genetic component has been proposed with a link to mutations of a gene that is necessary for normal formation of the hair- shaft. Haircare practices, such as the use of the hot comb, relaxers, tight extensions, and weaves, have not shown a consistent link with the development of CCCA.

The treatment goal in CCCA is to stop the progression of the disease since regrowth of hair is not possible once scarring has occurred. Topical steroid ointments, steroid injections, oral antibiotics, Plaquenil, minoxidil, and hair transplantation have all been tried with variable success. Natural hairstyles are encouraged in women with CCA, and discontinuation of all traumatic hair care practices is essential to prevent further loss through hair breakage.

Frontal Fibrosing Alopecia

This is a scarring form of hair loss that affects postmenopausal women. FFA is characterized by slowly progressive alopecia along the front and sides of the scalp. This eventually results in the appearance of a receding frontal hairline that can involve all the way around the scalp margin, both front and back. The affected scalp looks shiny or mildly scarred, without visible hair follicle openings. Single “lonely” hairs often persist in the bald areas, and loss of eyebrows can also occur. Itch and pain are common symptoms.

A skin biopsy of the scalp may be required to make the diagnosis of FFA, which shows the characteristic scarring and inflammation of this autoimmune disease. FFA is also frequently reported in women with other autoimmune diseases, including lupus, hypothyroidism, and rheumatoid arthritis.

Unfortunately, there is no uniformly effective treatment for frontal fibrosis alopecia. A short course of oral steroids, steroid injections directly into the affected scalp areas, anti-inflammatory antibiotics such as tetracyclines, antimalarial pills (Plaquenil), or Propecia (finasteride) may benefit some patients. Newer oral biologic agents used in other autoimmune diseases to suppress inflammation (JAK inhibitors) are currently promising.

FFAisaslowlyprogressiveformofhairlossthatceasesafterseveralyears. As it is a scarring alopecia, the receding hairline does not regrow unless treatment is started early.

Treatment:

5% Minoxidil (Rogaine)

 This is a topical product that is available without prescription in both foam and liquid preparations and is applied directly on the scalp twice daily. In people who use minoxidil as directed, one-third will experience some hair regrowth, another third will maintain the amount of hair they already have, and another third of people will see no benefit.

Minoxidil is the only FDA-approved medication for female hair loss (FPHL) and is safe and effective for many users. However, it should not be used if you are pregnant or breastfeeding since it is not known whether minoxidil passes into breast milk or if it could harm a nursing baby. You also will need to continue using it twice daily to maintain any new hair growth. Side effects are uncommon and are limited to irritation, possible allergy, and unwanted excessive hair growth in other body areas which are inadvertently exposed to it. For this reason, do not apply minoxidil immediately before bedtime to avoid getting it on your pillow— this could result in unwanted facial hair growth. Available at Costco and local pharmacies without a prescription.

Platelet Rich Plasma (PRP)

 PRP is an effective treatment for female and male hair loss. It has gained tremendous popularity in recent years since it requires no medication and is a relatively simple procedure performed in the dermatologist’s office.

How does it work? Platelets in human blood are a natural source of growth factors that serve to promote cell growth, proliferation, and regeneration. The use of platelet-rich plasma (PRP) has also seen numerous applications in medical therapy in the last decade. These include important innovations in surgery for wound healing and ligament and cartilage repair, as well as in dermatology for acne scarring and skin rejuvenation.

For treating hair loss, PRP is obtained by drawing a few milliliters of your blood and then putting it in a centrifuge, a machine where the blood is spun at high speed to separate the platelets from the red cells. Your platelets are then transferred to syringes and injected in small amounts throughout your scalp. The treatment itself takes only a few minutes and is repeated once a month for four to six treatments. This is followed by maintenance treatments (using the same protocol) every three months to maintain and increase new hair growth. The discomfort of the procedure is minor and can be minimized by preparing the scalp with a cooling device or ice immediately prior to the injections.

Many peer-reviewed scientific studies in the medical literature have shown that the majority of patients treated with PRP experience successful hair growth both in female and male androgenetic alopecia, as well as for alopecia areata. My own experience is that PRP treatment is highly effective in achieving cosmetically acceptable new hair growth in both female and male patients. This is a cosmetic treatment (not covered by medical insurance) that is performed by a dermatologist. Cost is approximately $600-$700 per treatment.

Spironolactone

 This oral medication has been used for thirty years as an off-label treatment for female androgenetic alopecia (FPHL). Spironolactone prevents the progression of hair loss due to its anti-androgenic properties and has a favorable long-term safety profile. It is used in doses higher than when it is used for acne and must be prescribed only to women who are not planning to become pregnant.

For women of childbearing potential (i.e., pre-menopausal), it is highly recommended that when taking spironolactone, you also use a birth control pill or other effective contraception in order to prevent birth defects. Due to its anti-androgen activity, spironolactone should also be avoided in women with a personal or family history of estrogen receptor-positive breast cancer.

Botanical Supplements: Saw Palmetto

There are several oral hairloss supplements that are sold online, in retail stores, and in doctors’ offices without a prescription. Many of these over-the-counter supplements claim to grow hair in women.

One of the most popular of these over-the-counter oral supplements is currently marketed as Nutrafol, a pill that contains the active ingredient, Saw palmetto. This ingredient is extracted from a small palm native to the Southeastern United States called Serenoa repens. Saw palmetto functions to reduce the androgen effect on hair follicles. It achieves this by inhibiting a major enzyme called 5- alpha-reductase. This important enzyme converts testosterone to a more potent androgen, DHT. By blocking the production of DHT, it lowers the amount of androgens available to bind to the hair follicle and helps to stop the miniaturization or shrinkage of hair follicles, preserving hair thickness.

Important: Saw palmetto also activates estrogen receptors and may be harmful in women with a history of estrogen receptor-positive breast cancer. For this reason, non-prescription supplements such as Nutrafol vitamins should always be cleared by your physician prior to use.

Other

 Low-Level Laser Therapy (LLLT)

Small studies with patients using a low-level laser light device with light-emitting diodes, fashioned as a helmet, comb, or headband, show some improvement for FPHL. The mechanism is not clear, but it is suggested that low-level laser light may activate hair follicles, increase blood flow and stimulate energy metabolism of the hair follicle. Convenient, FDA approved, and available online.

Hair Transplantation

Highly dependent on the skill of the surgeon and the technique used. A cosmetic procedure, hair transplantation is not covered by medical insurance. Often expensive, uncomfortable, time-consuming, and with variable results.

Vitamins Supplements

B vitamins such as Biotin and B12, zinc, vitamin A and other nutrient supplements have been purported to increase hair growth. Most healthy people are not deficient in these nutrients. There appears to be little to no benefit in adding more of these nutrients to your normal diet if you are otherwise well. In fact, excessive vitamin A may actually cause hair loss. If desired, a daily women’s multivitamin (such as One-a-Day for Women) is safe and reasonable for those who are interested in ensuring optimal levels of these nutrients in the body.

Topical Products

Shampoos, oils, serums, and other hair products that claim to grow hair are simply coating the hair shafts or adding pigment to the scalp in order to give the appearance of increased hair thickness. These may be suitable for many consumers who are satisfied with their cosmetic effects. With the exception of 5% Minoxidil which is FDA approved for FPHL, none of these topical products have shown scientific evidence that they stimulate hair growth.

If you are a woman experiencing hairloss, see a dermatologist to determine the cause and the best treatment options for you.

The Menkes Clinic is open to evaluate and treat new and established patients. 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
650-962-4600

HOW TO FIT IN EXERCISE WITH A BUSY LIFE

Juliet Malray
Transformation Coach and Women’s Circle Leader

Life gets busy with work, family,  household chores, and more. You may feel you are juggling too much to get activity in, even when you tell yourself that you really want to (or should) do it.

You wake up, drink your coffee then go to work.  After a long day, you arrive home ready to eat and relax on the couch. Perhaps you have other family obligations, making the idea of exercising even more distasteful.

And yet, 𝐲𝐨𝐮 𝐬𝐭𝐢𝐥𝐥 𝐰𝐚𝐧𝐭 𝐭𝐨 𝐝𝐨 𝐢𝐭 𝐟𝐨𝐫 𝐲𝐨𝐮𝐫 𝐡𝐞𝐚𝐥𝐭𝐡.

𝐇𝐞𝐫𝐞 𝐚𝐫𝐞 𝟓 𝐭𝐫𝐢𝐜𝐤𝐬 𝐈 𝐭𝐞𝐥𝐥 𝐦𝐲 c𝐥𝐢𝐞𝐧𝐭𝐬:

1. 𝐒𝐞𝐭 𝐚 𝐠𝐨𝐚𝐥 𝐭𝐨 𝐠𝐞𝐭 𝐚𝐜𝐭𝐢𝐯𝐞 𝐭𝐡𝐚𝐭 𝐢𝐬 𝐧𝐨𝐭 𝐨𝐯𝐞𝐫𝐰𝐡𝐞𝐥𝐦𝐢𝐧𝐠.  If it is for  10 minutes 5 times a week,  30 minutes 2 times a week or 40 minutes every day let that decision be based on what your know you are confident you can complete.  Start small! You can always change your original plan when you feel you can add more time.

2. 𝐅𝐢𝐧𝐝 𝐬𝐨𝐦𝐞𝐭𝐡𝐢𝐧𝐠 𝐲𝐨𝐮 𝐚𝐜𝐭𝐮𝐚𝐥𝐥𝐲 𝐞𝐧𝐣𝐨𝐲.  Dance in your living room,  take an aerial fitness class, jump rope, or take a walk.  Even if you circle your backyard, drinking a cup of coffee until it’s finished, every movement counts.

3. 𝐆𝐞𝐭 𝐚𝐜𝐭𝐢𝐯𝐞 𝐟𝐢𝐫𝐬𝐭 𝐭𝐡𝐢𝐧𝐠 𝐢𝐧 𝐭𝐡𝐞 𝐦𝐨𝐫𝐧𝐢𝐧𝐠.  Studies show that people who plan an early morning workout are more likely to actually do it.  As the day goes on and you become more tired, there is a bigger chance for excuses why you “shouldn’t” workout.  Added bonus: you feel like you have accomplished something early and it boosts your motivation and confidence for the day!

4. 𝐅𝐨𝐜𝐮𝐬 𝐨𝐧 𝐜𝐨𝐦𝐩𝐥𝐞𝐭𝐢𝐧𝐠 𝐭𝐡𝐞 𝐟𝐢𝐫𝐬𝐭 𝟐 𝐦𝐢𝐧𝐮𝐭𝐞𝐬 𝐢𝐧𝐬𝐭𝐞𝐚𝐝 𝐨𝐟 𝐭𝐡𝐞 𝐰𝐡𝐨𝐥𝐞 𝐭𝐡𝐢𝐧𝐠.  Example: you are going for a 2-mile walk; instead of looking at the whole thing you tell yourself that you are going to lace up your sneakers, walk outside and lock the door.  The odds are once you are there, you will keep going.

5. 𝐅𝐢𝐭 𝐢𝐧 𝐦𝐨𝐯𝐞𝐦𝐞𝐧𝐭 𝐢𝐧𝐭𝐨 𝐲𝐨𝐮𝐫 𝐝𝐚𝐢𝐥𝐲 𝐥𝐢𝐟𝐞. Park your car at a distance,  walk your dog a little longer, take the stairs or run around with your kids.

Exercise doesn’t have to be painful, sweaty, boring, or time-consuming. Exercise, even in small doses, can raise energy, improve your health and bring on good-feeling endorphins.  There are lots of opportunities to get in movement…and every step counts!

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

GSM—WHAT IS IT?

GSM is a term first introduced in 2014 by a consensus of the International Society for the Study of Women’s Sexual Health and the North American Menopause Society.  The purpose of establishing a new term for the myriad of symptoms related to GSM was to separate these symptoms, which worsen over time, from the vasomotor symptoms that are usually transient.   A distinct name has allowed for better data collection on the frequency of the syndrome and the effectiveness of treatment options.  NAMS already put out an updated position paper in 2020, emphasizing that physicians can help their patients with many of the distressing symptoms of GSM.  The genitourinary syndrome of menopause (GSM) includes genital and urinary symptoms associated with the decline in estrogen during and after menopause.

The drop in estrogen affects the labia, clitoris, introitus, vagina, urethra, and bladders. Over half of menopausal and postmenopausal women develop some aspect of GSM. These include:

• Vaginal dryness
• Irritation/burning/itching of the vulva or vagina
• Decreased lubrication a
• Pain with sex or sexual activity
• Postcoital bleeding
• Reduced arousal, orgasm, and desire
• Pain with urination
• Urinary frequency
• Urinary urgency

Some physical changes include:

• Decreased moisture
• Loss of elasticity of the vaginal wall
• Labia minora resorption
• Pallor or erythema of the vulva
• Loss of vaginal rugae
• Fragility of the vaginal and vulvar tissue
• Eversion or prolapse of the urethra
• Recurrent urinary tract infections (UTI)

What’s important is recognizing that while these changes are natural and normal, there are many things women can do to help prevent, decrease or treat the symptoms they find disruptive.   The development of any of the listed symptoms can greatly impact a woman’s quality of life, especially for those who are sexually active.

The primary goal of treatment is education and then symptom management.

When menopause begins: regular use of the vagina can help maintain normal diameter and natural lubrication. This includes stretching the vaginal walls through penetrative intercourse or the use of a dilator as well as blood flow to the vaginal walls through orgasms.  Knowing this before or early on in menopause is important.

Treatment options include over-the-counter therapies such as lubrication and moisturizers, non-hormonal prescription options, and hormonal medications.  The newer options include selective estrogen receptor modulators (SERMs) or laser technologies.

Reach out to your gynecologist if you are experiencing symptoms related to GSM.  Our physicians at ECWMG are all well equipped to go through your history and come up with a plan that best fits your symptoms and your goals.   In addition to over-the-counter meds and prescription hormonal and non-hormonal medications, our office has the MonaLisa Touch CO2 laser.

INFLAMMATION AND HEART DISEASE

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

The Numbers

Heart disease is the most common cause of death in both men and women in the United States. It kills 1 out of 3 women. It is the No. 1 killer of new moms and accounts for over one-third of maternal deaths. 10% to 20% of women will have a health issue during pregnancy, and high blood pressure, preeclampsia, and gestational diabetes during pregnancy greatly increase a women’s risk for developing cardiovascular disease later in life. With these numbers, there still is not adequate data as only 38% of participants in clinical cardiovascular trials are women.

We also know that women with heart disease often present with the same symptoms of chest pain or discomfort but can also present with shortness of breath, arm, neck, jaw, or back pain, or nausea and/or vomiting. They are more likely to attribute their symptoms to acid reflux or stress. Women wait 30% longer to get treatment and are 50% more likely to be misdiagnosed when they do seek care.

It’s Not Just Heart Attacks

The importance of cardiac disease grows more day by day as it is linked to other medical concerns like stroke and dementia.   Heart disease is not just about heart attacks; heart disease includes congestive heart failure, arrhythmias, and heart valve problems. Strokes are caused by the same factors implicated in heart disease and have two main causes- atherosclerosis and atrial fibrillation.

Unfortunately, women are more likely than men to die from heart disease. Heart disease is still considered a “man’s” disease, and the signs and symptoms of heart disease are largely ignored by patients themselves and the healthcare system. The “Red Dress Campaign” started in 2004 by the American Heart Association, was meant to educate women to advocate for their own health.

Heart disease in Young Women- Coronary Microvascular Dysfunction and Coronary Spasm.

What is it? It is a problem of the small coronary artery vessels and is more common in women, especially young women. The large vessels of the heart are usually not involved. Decreased blood flow in the small vessels of the heart can cause symptoms of discomfort, chest pain, shortness of breath, or fatigue. Another mechanism is that of coronary vessel spasm that can cause vessels to temporarily narrow or close, causing cardiac symptoms and even a heart attack. Not much is known but some of the same risk factors such as high blood pressure, diabetes and high cholesterol can be involved. Often, patients will have a positive cardiac stress test but a negative coronary angiogram.

Prevention

The first step is knowing to recognize heart disease, and the second is knowing how to prevent and minimize heart disease, whether you have developed some risk factors or have a family history.

We know that atherosclerosis, the buildup of plaque along the walls of the arteries, causes heart disease. We also know that inflammation causes atherosclerosis.

What is inflammation?

Inflammation is the body’s complex reaction triggered by the immune system. In the acute setting of an infection or an injury, the immune response is massive, and it helps to fight viruses/bacteria or heal injury in that setting. But there is another kind of inflammation which is low level, associated with atherosclerosis.

There are many theories, but layers of lipids (among other things) line the vessel walls, resulting in atherosclerosis. Inflammation facilitates that process. Inflammation is caused by a number of things: high blood pressure, diabetes, high cholesterol, obesity, smoking, chronic stress, lack of sleep, and poor diet. Inflammation can be measured by a blood test called a C reactive protein to see current level of inflammation. (other inflammatory markers?’

How to fight inflammation?

The most important first step is to manage any chronic disease like high blood pressure, diabetes, and cholesterol. Patients may or may not need medication to achieve this but the following lifestyle changes will not only help reduce inflammation but will also help chronic conditions as well.

1. Exercise– the American Heart Association recommends that adults get 150 minutes of moderate-intensity aerobic activity a week, at least two days of strengthening or resistance training a week and spending less time sitting. Start small, like 10-20 minutes a day to start building consistency.

What are some examples of moderate-intensity exercise:

• • • Brisk walking (about 2.5mph)
    • Water aerobics
    • Gardening
    • Doubles tennis
    • Biking (<10 mph)

2. Sleep– 7-9 hours of good quality sleep. When you wake up in the morning, you should feel rested and alert. If not, consider whether you may have sleep apnea. Do you get up in the middle of the night to urinate or have poor sleep hygiene?

3. Stress– is sometimes unavoidable, but we can control how we react and manage stress. Exercise helps but meditation/yoga/any contemplative activity can help keep stress manageable.

4. Avoid smoking- even one cigarette a day can cause measurable inflammation. Vaping has also been shown to cause inflammation. Smoking marijuana may cause inflammation to the lung but can also suppress the immune system. While marijuana likely may not cause

5. Systemic inflammation– it can raise heart rate 20-50 beats per minute for up to 3 hours, causing stress to the heart.

6. Oral health– we know that poor dental hygiene can cause an increased risk of stroke and heart disease by increasing inflammation. Gum disease and cavities have been linked to also higher blood pressure. So don’t skip preventive dental visits and keep up with regular brushing and flossing.

7. Diet- Foods that have been shown to cause inflammation are refined carbohydrates, like white bread and pastries, fried foods like French fries, soda and other sugar-sweetened beverages, red meat, and processed meat (sausages, deli meat) and margarine/shortening/lard.

The good news is that there are a lot more inflammation-fighting foods that can be incorporated into the daily diet: including green leafy vegetables, colorful vegetables, whole grains, coffee, and tea.

A typical example of a healthy diet that is also anti-inflammatory is the Mediterranean diet, which has been shown to lower the risk of heart disease and stroke. Some specific food examples you can incorporate into your diet include tomatoes, olive oil, spinach/kale/collards, nuts like almonds/walnuts, fatty fish like salmon/mackerel/tuna/sardines, and fruits like strawberries/blueberries/cherries/oranges.

Fruits, vegetables, and tea contain antioxidants and phytochemicals that can fight off certain chemicals that cause inflammation. Dietary fiber can be metabolized by gut bacteria into chemicals that researchers have found to be associated with a lower risk of some chronic diseases.

Studies at UCSF have shown that a plant-based diet, regular exercise, quality sleep, and minimizing stress can help to slow and maybe in some patients, reduce cardiac atherosclerosis. Medicare actually covers a particular intensive Lifestyle program for patients with established heart disease in Marin called the “Ornish Lifestyle Medicine Program” named after Dr. Dean Ornish, who is a preventive medicine physician and researcher who advocates for a plant-based diet and lifestyle changes.

You can estimate your own ten-year risk of heart disease and stroke with this link: https://tools.acc.org/ldl/ascvd_risk_estimator/index.html#!/calulate/recommendation/

Discuss the results with your primary care physician and know that you can take control of your health despite an unhealthy past or genetics. Small tweaks can lead to consistent habits. The American Heart Association has helpful information and resources on its website Heart.org.

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.eracyramirpmoolb@olleh

EL CAMINO HOSPITAL VISITOR POLICY UPDATES

General information on visitor’s policy
Last updated visitor guidelines from March 25, 2022

For the main hospital, El Camino Health is now allowing one visitor with patients in the Emergency Department and two visitors in nearly all inpatient units.  Check the link above before you plan to come to the main hospital for any new updates.

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.

Masking is still required in all health care facilities in Santa Clara County.

Information for Labor & Delivery, NICU, and the Mother-Baby Unit:
Last updated March 25, 2022

Since December 2021, only one visitor (in addition to a doula) is being allowed on L&D, and it must be the same visitor for the entire time on L&D.   However, two visitors are now allowed on the postpartum unit.  The NICU continues only to 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 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 part of our website, attracting over a thousand readers a month worldwide.  We find it helpful to put out up-to-date information on relevant women’s health issues.  An article by guest author Dr. Shyamali Singhal on avoiding cancer-causing chemicals in cosmetics was the most read article last quarter.  This is followed by another blog favorite: Stop Eating all The Time: Snacking and Intermittent Fasting. An article on a very early study for a new potential treatment for endometriosis was the third most-read article this month.

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 PCOS and the predisposition to weight gain, and how Ovarian Cancer may not be so silent. 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.

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