2022 Issue 4, Quarterly Newsletter | El Camino Women’s Medical Group | OBGYN Mountain View CA

WOMEN’S HEALTH

2022 Issue 4

www.ElCaminoWomen.com

Oct3, 2022

*framed photo by Organic Light Photography

Wishing everyone a wonderful fall! With cooling weather and several holidays, we hope everyone has time away from the Bay Area’s busy schedules to spend time outside and with loved ones.

This newsletter is full of information, from skincare for the men in your life to managing hemorrhoids to the common experience of vertigo. We hope this newsletter continues to provide helpful, relevant health information for you and your families. For our pregnant patients, there’s an introduction to a new comprehensive fitness program for women through pregnancy and postpartum, including a discount code for our patients. Barb Dehn, NP also shares news on her clinical practice and future plans.

Please review our Practice Updates; there are important announcements regarding our holiday schedule and call coverage for our pregnant patients. Visitors continue to be welcome in the office and hospital. You can read more in our Practice Updates and the Hospital Visitors Policy sections.

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!

Wishing you a restful and joyful fall with your family and loved ones,

Sarah Azad, MD

In this issue:

Practice Updates

Online Prenatal Classes

Research at ECWMG

Bittersweet News From Barb Dehn, NP

Common Skin Problems in Men

How to Prevent and Treat Hemorrhoids During Pregnancy

3 Pillars of Health to Prevent Breast Cancer

Optimizing Your Physical Health During Pregnancy, A Comprehensive Approach

Climate, Health, Your Family, and Your Baby

Benign Paroxysmal Positional Vertigo (BPPV)

El Camino Hospital Visitor Policy Updates

Highlights from our Women’s Health Blog

Practice Updates

Holiday Hours

During the holiday weeks, to accommodate the needs of our patients as well as allow for our staff and physicians to spend time with their families, we are only scheduling urgent visits and OB visits. If you want a non-urgent, routine appointment during the next few months, please call ahead and book early.

Welcome Sajal, RN

We are excited to welcome Sajal to our team! A registered nurse and Bay Area Native, Sajal has joined us to help answer patient phone calls and hopefully allow for appropriate questions and messages to be addressed more promptly. Sajal’s work will also free up physician time for higher acuity issues. We hope this addition to our team will improve the quality of care you receive at our office. Nadia, RN is still with us and will continue in her role teaching our prenatal classes and serving as a resource for postpartum and breastfeeding patients.

Upcoming Medical Leave

We are excited to announce another El Camino Women’s Medical Group baby! Dr. Christina Lam will be out on leave at the end of the year and in early 2023. The rest of us will be here and are available for her patients during her leave.

Outside OB Coverage in December

Between the expected holiday vacations and the upcoming maternity leave, there will be an extended period, from December 23^rd to January 3^rd, where only one physician will be available for the entire 12-day stretch. For the first time since Dr. Teng joined El Camino Women’s Medical Group in the fall of 2014, we will be signing out Labor and Delivery and hospital call coverage to fellow female physicians in the community. We haven’t finalized our schedule yet, but due to these extenuating circumstances, several days in those 12 days will be covered by a highly skilled female physician colleague at El Camino Hospital, but not from our specific group. Your insurance/pregnancy billing processes won’t at all be affected. If you have questions or concerns about this, please contact us at moc.n1695899972emowo1695899972nimac1695899972le@of1695899972ni1695899972.

Office Visitor Policy Updates

We are continuing to welcome one visitor at patient appointments. Please remember visitors must be asymptomatic and fully vaccinated against COVID19, including a booster (if it’s been more than six months since 2^nd COVID19 vaccine). We are now also allowing visitors with a negative COVID19 PCR test performed by a formal lab, within 72 hours of the sample acquisition, in place of proof of vaccination. Though this is stricter than the guidelines at the hospital, visits to our office are not as acute or emergent as in the hospital. Our priority remains the health and safety of our pregnant and 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.

ONLINE PRENATAL CLASSES

Prenatal Classes

We offer 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 one to two months. 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 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 of 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 mentioned above.

RESEARCH AT ECWMG

Materna Study

The Materna Device study is not currently enrolling new patients. We will let everyone know when the study is open again.

Next Gen Jane

NextGen Jane, a research company based in the Bay Area, is working on technology 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.

Bittersweet News From Barb Dehn, NP

Barb Dehn, NP
NurseBarb.com

After 35 amazing and fulfilling years practicing as a women’s health Nurse Practitioner, I’ve decided to retire from seeing patients.

I will have a few appointments available on Tuesday afternoons in November and December.

After January 1st, I’m wholeheartedly recommending my colleagues at El Camino Women’s Medical Group. I myself receive care right here with these doctors, who I respect and trust.

I want to thank all of you for inviting me into your lives. Providing care has been an honor and a privilege. I feel so fortunate to have been able to retire with the support of Dr. Azad and the entire team.

As many of you know, I’m active in Global Health Initiatives with FAME hospital in Tanzania and will be devoting more time there.

Feel free to reach out via NurseBarb.com or LinkedIn.

Thank you all for enriching my life.

Barb

Common Skin Problems in Men

Lillian Soohoo, MD
Board Certified Dermatologist

This is the first in a series of articles focusing on skin care for the entire family. Today, I will discuss selected common skin conditions in men.

Shave Bumps
These recurrent pimple-like skin lesions, known as folliculitis, occur on the face in the beard area, nape of the neck, and sometimes the scalp. This is a common skin condition in men and can occur as a result of shaving after which the regrowth of individual (usually coarse) hairs pierce the skin while growing out, promoting hair follicle irritation and infection. The inflamed hair follicles look like pimples (acne) and appear either as solid or pus-filled bumps on the skin’s surface. On the scalp and neck, bumps may occur after close shaving or from repeatedly scratching due to seborrheic dermatitis (see below).

Effective treatments include the use of a mild benzoyl peroxide lotion, 1-2% salicylic acid wash, or topical antibiotics such as clindamycin gel. Growing out the beard or neck hairs after a close shave (even a few days’ worth can be enough) often eliminates the problem—until the next close shave. Aveeno Sensitive Skin Shaving Gel can be helpful when used in combination with the above products and medications.

Like many skin conditions, adjusting grooming habits to avoid triggering or worsening the problem is necessary to manage shave bumps and folliculitis. Sometimes a short course of oral antibiotics for a couple of weeks may be needed to control an extensive outbreak, especially when located on the scalp.

Dandruff and Itchy Scalp

Dandruff and itchy scalp are medical conditions known as seborrheic dermatitis. This condition is very common in men, affecting up to 50% of all adults. It is caused by skin inflammation triggered by an excess of oil (sebum) and the overgrowth of normally-occurring yeast (Malassezia species) on the scalp and other skin areas commonly affected by this condition.

These two factors, excess sebum and yeast overgrowth trigger an immune response that appears on the skin as a red rash, flaky dandruff, and itching. Seborrheic dermatitis most commonly involves the scalp, but other high oil/sebum areas such as eyebrows, around the nose, behind the ears and inside the ear canals, and the mid-chest can also be affected.

Many men have an increased tendency to have dandruff symptoms if they skip washing their hair every day and/or sweat a lot during exercise and times of emotional stress. This makes itching and dandruff worse.

One trick to control dandruff is to increase the frequency of hair washing (daily hair washing may be necessary) and to use an anti-yeast shampoo such as Nizoral 1% or 2% shampoo which contains ketoconazole. Other dandruff shampoos including Neutrogena’s T Gel Shampoo (which contains tar) and Head and Shoulders (which contains pyrithione zinc) are also effective. Of note, the tar ingredient in T Gel shampoo is photosensitizing and causes skin to sunburn more easily after contact.

If scalp itching persists despite the above recommendations, applying a few drops of prescription-strength cortisone solution to the scalp (eg, fluocinolone 0.1%) after shampooing can be very helpful. It is important to remember that seborrheic dermatitis is a condition that can be effectively controlled, not necessarily cured. Grooming (daily hair washing) and the use of effective dandruff shampoos will achieve the best results.

Acne and “Bacne”
Pimples on the face, chest, or back (popularly known as “bacne”) are very common in teenagers and adults of both sexes. When acne pimples are present in men (especially “bacne”), it can be associated with testosterone replacement therapy which promotes acne by activating the skin’s sebaceous (oil) glands. Most men suffering from acne have no identifiable trigger. This can be frustrating and commonly results in purchasing many advertised acne treatments that may or may not work.

The most efficient and effective acne treatments are easily obtained by consulting a dermatologist who can customize a skincare routine according to your skin type, personal preferences, and lifestyle. A dermatologist will also perform a comprehensive skin examination and may suggest the following acne treatments for men:

Topical antibiotics in the form of gels, cleansers, and lotions (clindamycin, sulfa, dapsone, minocycline)
Topical retinoids such as adapalene (known as Differin gel, available over-the-counter), retinol, and prescription topical retinoids like tretinoin (Retin-A and others) and tazarotene (Tazorac cream and gel).
Oral acne medications such as tetracycline antibiotics (ie, minocycline, doxycycline, saracycline). For severe acne associated with scarring, Accutane (isotretinoin) may be prescribed.
Over-the-counter products are widely available and include benzoyl peroxide, salicylic, lactic, and glycolic acids (available in cleansers, creams, and lotions) and silicone pads.

Usually, acne pimples located on the back and chest are best treated with pills. This is because acne found on these body areas is usually more extensive and treatment-resistant than facial pimples alone. A dermatologist can be very helpful in formulating an effective treatment regimen for those who require prescription medication.

Athlete’s Foot and Fungal Toenails
Scaly, itchy feet, and thick, yellow toenails are the result of a common fungal infection often acquired by contact with contaminated floor surfaces, shoes, towels, nail files, and clippers. Affected feet usually show loose skin scales on the soles and sides of the feet, often accompanied by moist peeling between the toes, and sometimes even itchy or painful blisters.

Athlete’s foot, also known as tinea pedis, is caused by the same type of fungi (called dermatophytes) associated with ringworm and jock itch. Damp socks, shoes, and warm humid conditions favor the growth of these fungi which are found everywhere, including on carpets, floors, and soil. Interestingly, not everyone exposed to dermatophytes develops tinea pedis, even though it is extremely common.

Athletes’ foot is best treated with a prescription antifungal cream used daily for at least two months. Early treatment of athlete’s foot fungus can help prevent the development of toenail fungus. Toenails can become infected due to the migration of the fungus from the skin into the nearby toenails. This leads to thick, yellow crumbly toenails, known as onychomycosis.

Toenail fungus (onychomycosis) typically requires daily treatment with antifungal pills for at least three months (Lamisil) or once-weekly pills for at least a year (Diflucan) for a complete cure. Prescription nail lacquers containing antifungal ingredients such as Jublia 10% solution (efinaconazole) are helpful too, with the best results usually achieved in combination with pills.

Treatment for fungal infections takes many months until the skin and nails grow out sufficiently clear. Re-infection is common if precautions are not taken to prevent re-exposure to sources of dermatophyte fungi, such as avoidance of infected floor surfaces, shoes, and nail grooming tools.

Skin Cancer
Men should be screened for skin cancer at least once per year. This is accomplished by scheduling an appointment for a full body skin exam by a dermatologist or by attending a free skin cancer screening event in your area sponsored by the American Academy of Dermatology.

There are several types of skin cancer, each beginning in a specific cell within the skin. The three most common forms of skin cancer diagnosed in men are basal cell carcinoma, squamous cell carcinoma, and melanoma.

Basal cell carcinoma tends to grow slowly and usually remains within one area of the body, meaning it does not metastasize. This type of cancer is usually treated by surgical removal in the dermatologist’s office.

Squamous cell skin cancer can sometimes spread to lymph nodes and other organs and can be deadly. When detected in its earliest stages, this form of skin cancer is usually completely curable. As with basal cell skin cancer, squamous cell carcinoma is usually treated surgically in the office.

Melanoma is a cancer of the pigment-making cells (melanocytes) associated with moles and tanning. It is now the number one cause of cancer death in people 25-40 years old. Melanoma generally affects men on the neck, head, and upper body and in women, it is often on the back of the lower leg (calf). It is one of the most common forms of cancer and can appear anywhere on the body which is why it’s important to recognize the important signs of melanoma—specifically, any new or changing mole. Seeking medical care as soon as possible can be lifesaving and most can be treated in the office.

Each of these types of skin cancer typically develops on sun-exposed skin areas such as the face, head, neck, arms, and hands. However, it is important to note that skin cancer can develop on any area of the body, even areas that are typically protected by clothing.

Over one million cases of skin cancer will be diagnosed in the United States this year. Visiting a dermatologist at least annually for a total body skin examination will help identify skin cancer early when treatment is often curative.

Maintaining healthy skin in men requires attention to new and changing skin lesions and symptoms. A dermatologist is the best resource for the diagnosis and management of all skin, hair, and nail diseases.

Dr. Lillian Soohoo is a board-certified dermatologist in private practice in Mountain View across from El Camino Women’s Hospital. She specializes in general, pediatric, and cosmetic dermatology.

The Menkes Clinic
2490 Hospital Drive, Suite 201
Mountain View, CA
Appointments: 650.962.4600

New Location Announcement:
Dr.Soohoo will open a new office in Los Gatos in Nov-Dec 2022. Dr. Soohoo will continue to see patients in both Mountain View and Los Gatos locations.
555 Knowles Drive, Suite 220
Los Gatos, CA
Appointments: 650.962.4600 (anticipated Grand Opening Nov-Dec 2022)

Please also join Dr. Soohoo in welcoming her newest associate, Dr. Ashley Clark.

Dr. Clark completed her dermatology residency this year as Chief Dermatology Resident at the University of Pennsylvania. She is now accepting new patients at our MV office and will also partner with Dr. Soohoo in the new Los Gatos office. Please call 650.962.4600 to schedule an appointment.

How to Prevent and Treat Hemorrhoids During Pregnancy

By Shyamali Singhal, MD
Surgical Oncologist
Founder of Hope & Beauty

Hemorrhoids are a common and uncomfortable condition that can occur during pregnancy. According to the American College of Obstetricians and Gynecologists, about 50% of pregnant women experience hemorrhoids. While they can be quite painful, there are some things you can do to prevent and treat them. Most women who develop hemorrhoids during pregnancy do not need surgery for hemorrhoids.

What are hemorrhoids?
Hemorrhoids are swollen blood vessels in the rectum or anus. They can be either internal, which means they’re inside the rectum, or external, which means they’re under the skin around the anus. Internal hemorrhoids are usually painless, but external hemorrhoids can cause pain and irritation, itching, and bleeding.

What causes hemorrhoids during pregnancy?
There are a few things that can contribute to the development of hemorrhoids during pregnancy:

-The extra weight from pregnancy puts pressure on the blood vessels in your pelvis and rectum.

-Your growing uterus crowds your pelvic region, making it difficult for you to have a BM. When you finally do go to the bathroom, you might strain too hard, which can also cause hemorrhoids.

-Constipation is common during pregnancy due to hormonal changes and pressure from your growing uterus on your rectum and intestines. This can cause hard stools that are difficult to pass, which can lead to straining and eventually hemorrhoids.

How can I prevent hemorrhoids?
Here are a few things you can do to help prevent hemorrhoids:

-Eat a high fiber diet including fruits, vegetables, whole grains, and beans. Fiber helps keep things moving through your digestive system, so you don’t have to strain when you go to the bathroom.

TIP: 1/4 All Bran Cereal a day with 2-3 8 oz glasses of water

-Drink plenty of fluids, especially water, to stay hydrated and help keep things moving through your digestive system. Prune juice 1-2 oz especially warm is a natural laxative that can also help with constipation.

-Avoid sitting or standing for long periods of time. If you have a sedentary job, get up and move around every few hours if possible. Take a walk around the office or do some simple stretches at your desk. When you’re at home, take breaks from sitting on the couch or watching television. Taking a brisk walk is a great way to get some exercise while also relieving constipation.

-Don’t strain when you have a BM–this is one of the most common causes of hemorrhoids! Adding more fiber and fluids to your diet will usually help relieve constipation so you don’t have to strain when going number two. Sit on the toilet for several minutes even if you don’t feel like you need to go–this will help relax your rectal muscles and make it easier for you to go when nature calls. Try putting your feet up on a step stool while sitting on the toilet–this position takes pressure off of your rectal area and may make it easier for you to pass stool without straining.

5 things that make hemorrhoids more irritating

-Constipation and Straining :
As previously mentioned, constipation and straining are two of the most common causes of hemorrhoids. If you’re already dealing with hemorrhoids, it’s important to avoid anything that makes them worse.

Sitting for long periods of time:
This can exacerbate hemorrhoids by increasing pressure on the veins in your bottom. If you have a sedentary job, make sure to get up and move around every few hours.

Thrombosed hemorrhoid :
This is when an external hemorrhoid develops a blood clot and can become extremely painful. If you think you have a thrombosed hemorrhoid, it’s important to see your doctor so they can decide whether draining the clot is an option. The other option does not require any surgical intervention, and the clot will reabsorb in 2 weeks. Supportive care with Sitz baths for pain management.

Rubbing or scratching the area:

This can irritate the already inflamed skin and make hemorrhoids even more painful. If you’re dealing with an itchy bottom, try to resist the urge to scratch! Hydrocortisone cream topical can be of benefit

Swelling and inflammation:

This is a common symptom of hemorrhoids. Unfortunately, there’s not much you can do to reduce the swelling other than using ice packs or cold compresses and taking over-the-counter anti-inflammatory medications like acetaminophen.

How can I treat hemorrhoids?

If diet changes don’t help relieve constipation or if other measures haven’t helped reduce your symptoms, there are treatments available for hemorrhoids both at home and from your doctor:

-Rectal cream or suppositories containing hydrocortisone may help reduce inflammation and itching caused by external hemorrhoids–talk with your doctor before using any over-the-counter medications as some are not safe during pregnancy!

-Apply ice packs or cold compresses to the area for 10 minutes at a time several times per day

-Take over-the-counter medications such as Acetaminophen for pain relief

-Sitz baths (a shallow tub of warm water) may help relieve pain associated with external hemorrhoids–you can buy these at most pharmacies or online retailers catering to pregnant women/new moms/etc., or simply fill up a basin with warm water at home. Soak in the sitz bath for 10-15 minutes 2-3 times per day as needed for relief from discomfort caused by external hemorrhoids–just make sure the water isn’t too hot as this could further irritate already swollen blood vessels!

-Witch Hazel pads as needed for comfort. TIP: Put them in the freezer and use cold

-Banding surgery and hemorrhoidectomy can be done safely but are not recommended during pregnancy. Usually, the hemorrhoids will resolve 2-3 weeks post delivery with conservative measures.

Conclusion:
Hemorrhoids are unfortunately common during pregnancy and more so after 28 weeks, but there are things you can do both to prevent them and ease any discomfort if they do occur! By following the tips above, hopefully, you can avoid any issues with this uncomfortable condition throughout pregnancy and enjoy all the other wonderful changes taking place in your body!

If you have any concerns about hemorrhoids or any other pregnancy-related issues, be sure to talk with your doctor at El Camino Women’s Medical Group! They can help advise you on how to best deal with anything that comes up and are always happy to answer any questions you may have.

3 Pillars of Health to Prevent Breast Cancer

Shyamali Singhal, MD      &            Denise Johnson Miller, MD, FACS
Surgical Oncologist                         Breast Surgeon and Surgical Oncologist
Founder of Hope & Beauty            Medical Direct of Breast Surgery at El Camino Health

Breast cancer is a disease that can be caused by many things, but there are three main pillars of cancer prevention that everyone should be aware of. Prevention is always better than cure. This is especially true when it comes to breast cancer. Breast cancer can be a debilitating disease that takes a toll not just on the patient, but on the patient’s loved ones as well. While there is no surefire way to prevent breast cancer, there are certain lifestyle choices you can make to minimize your risk. Watch what you eat, get active, and take precautions against environmental factors – these are the three pillars of cancer prevention.

Pillar 1: Early detection.

Breast cancer is much easier to treat when it’s caught early, so it’s important to get regular screenings and checkups. This way, if you do have cancer, it can be caught and treated before it becomes too advanced. Breast cancer screening with mammography is recommended by American Cancer Society guidelines starting at age 40, annually. For women at high risk of developing breast cancer and patients with a strong family history, genetic screening is important. If you have dense breasts, you may need additional screening tests. Ask your doctor.

Identifying Risks of Breast Cancer: Understanding your risk of breast cancer is important.

Getting older. The risk for breast cancer increases with age. Most breast cancers are diagnosed after age 50.
Genetic mutations. Women who have inherited changes (mutations) to certain genes, such as BRCA1 and BRCA2, are at higher risk of breast and ovarian cancer.
Reproductive history. Starting menstrual periods before age 12 and starting menopause after age 55 expose women to hormones longer, raising their risk of getting breast cancer.
Having dense breasts. Dense breasts have more connective tissue than fatty tissue, which can sometimes make it hard to see tumors on a mammogram. Women with dense breasts are more likely to get breast cancer.
Personal history of breast cancer or certain non-cancerous breast diseases. Women who have had breast cancer are more likely to get breast cancer a second time. Some non-cancerous breast diseases such as atypical hyperplasia or lobular carcinoma in situ are associated with a higher risk of getting breast cancer.
Family history of breast or ovarian cancer. A woman’s risk for breast cancer is higher if she has a mother, sister, or daughter (first-degree relative) or multiple family members on either her mother’s or father’s side of the family who have had breast or ovarian cancer. Having a first-degree male relative with breast cancer also raises a woman’s risk.
Previous treatment using radiation therapy.Women who had radiation therapy to the chest or breasts (for instance, treatment of Hodgkin’s lymphoma) before age 30 have a higher risk of getting breast cancer later in life.
Hormone Replacement Therapy: Most types of HRT increase the risk of developing breast cancer, but the risk is higher with combined HRT (both estrogen and progesterone).

https://www.cdc.gov/cancer/breast/basic_info/risk_factors.htm

Pillar 2: Lifestyle choices.

There are certain lifestyle choices that can increase your risk of developing breast cancer, such as smoking or drinking alcohol excessively. Making healthy choices like eating a balanced diet and exercising regularly can help reduce your risk.

Healthy Diet:

A healthy diet is key to breast cancer prevention. Eating plenty of fruits and vegetables ( nine servings of fruits and vegetables the size of your palm per day) has been shown to reduce the risk of developing cancer. Fruits and vegetables are rich in antioxidants and other nutrients that help keep the body healthy. It is also important to limit your intake of processed foods, as they are often high in sugar and unhealthy fats. Furthermore, avoid or limit your consumption of alcohol and red meat, as both have been linked to an increased risk of developing cancer.

Exercise:

Exercise is another important aspect of cancer prevention. A sedentary lifestyle has been linked to an increased risk of developing cancer, while regular exercise has been shown to reduce the risk. Maintaining a healthy weight is also key. For every 5 kg/m2 increase in body mass index was associated with a 12% increased relative risk of postmenopausal breast cancer. 150 minutes per week of moderate exercise or 75 min of vigorous exercise is suggested by guidelines. Exercise helps to boost the immune system and helps the body to better fight off infection and disease. Furthermore, exercise helps to promote healthy cell growth and repair, which can help prevent the formation of cancerous cells.

Cigarette Smoke:

Smoking is the leading cause of preventable death in the United States and is responsible for more than 480,000 deaths each year. Smoking is also a major risk factor for developing cancer and is estimated to cause about 20% of all cancer deaths in the United States. Women who are current smokers and have been smoking for more than 10 years appear to have about a 10 percent higher risk of breast cancer than women who’ve never smoked.

Alcohol:

Drinking alcohol has been linked to an increased risk of developing breast cancer. The overall estimated association is an approximate 30-50% increase in breast cancer risk from 15-30 grams/day of alcohol consumption. The more alcohol you drink, the greater your risk of developing cancer. If you do drink alcohol, it is important to limit your consumption to no more than one drink per day.

Pillar 3: Environmental factors.

There are many environmental factors that can increase your risk of developing breast cancer, such as exposure to harmful chemicals or radiation. You can reduce your risk by avoiding known carcinogens, such as asbestos and radon gas, and by limiting your exposure to UV radiation from the sun. Things like air pollution or exposure to certain chemicals can increase your risk of cancer. Avoiding these things can help reduce your risk

Conclusion:

Cancer is a devastating disease that can have a profound impact on those who are diagnosed with it. While there is no surefire way to prevent breast cancer, there are certain lifestyle choices you can make that will help minimize your risk of developing the disease. Eating a healthy diet, exercising regularly, and taking precautions against environmental factors are the three pillars of cancer prevention. By following these guidelines, you can help reduce your risk of developing cancer.

Optimizing Your Physical Health During Pregnancy, A Comprehensive Approach

Dr. Carolle Jean-Murat, MD, FACOG
Lead Medical Advisor
Andrew Martinez
Founder
Built Well^TM for Birth

*Discount code for patients of El Camino Women’s Medical Group* BWFBELCAMIMOWG

Clinical research surrounding the pre/postnatal fitness and health field most often concludes with two points. One, if there’s any time a woman should improve her overall fitness, it is during her pregnancy. Two, there is an insufficient amount of research in the field, and more research is necessary to provide a higher quality of care to all pre/postnatal mothers. A lack of accessible, comprehensive resources for women is a major contributing factor to the increasing rates of overall pregnancy-related complications.

A positive shift has been made; solutions set into action. My name is Dr. Carolle Jean-Murat, MD, FACOG and I am a board-certified OB-GYN, a fellow of the American College of Obstetricians and Gynecologists, and a primary care specialist. I have partnered with strength and conditioning specialist, and Built WellTM for Birth Founder, Andrew Martinez, to provide women with education in Prenatal Fitness, Labor and Delivery Training, and Postpartum Support.

The intentions of our fitness protocols for pre/postnatal women are the following: strengthening the core (in reference to the anterior and posterior slings, Thomas Myers, Anatomy Trains, and Weck Method), understanding the breath and how it relates to energy management, properly bracing/pushing during exercise and delivery, and the assessment/improvement of gait mechanics, alleviating the “Pregnancy Waddle,” the root cause of the majority of back pain experienced. I have even added additional material on understanding and alleviating pre/postnatal stress, connecting the mind and body, to support the Whole You.

The intended results: Decrease in time spent in 2 nd stage of delivery. Decrease in chances of C-sections, postpartum depression, and overall pregnancy-related complications. Healthier outcomes for mother and baby. A greater awareness of posture, breath, and movement. A greater quality of life.

We encourage all women to ask as many questions, learn as much as possible when it comes to their overall awareness of safe pre/postnatal training, and create a comprehensive plan. You can learn more about our training for mothers and fitness/birthing professionals at www.builtwellforbirth.com.

#LongLiveStrongMoms
Dr. Carolle Jean-Murat, MD, FACOG
Lead Medical Advisor
Built Well^TM for Birth

*Discount code for patients of El Camino Women’s Medical Group* BWFBELCAMIMOWG

Climate, Health, Your Family, and Your Baby

Santosh Pandipati, MD
Maternal-Fetal Medicine Specialist

Not too long ago I delivered a preterm infant at 24 weeks gestation via classical C-section for preterm labor, ruptured membranes, and beech fetal lie — bread and butter for many practicing maternal-fetal medicine physicians. I knew our superb neonatal team would do their very best to reduce morbidity and mortality risk for the neonate. If lucky, the baby would be discharged from the NICU many months hence, ideally with minimal long-term physical and neurologic sequelae. I thought of the enormous cost and efforts of a whole host of clinical workers, from physicians to nurses, therapists to social workers, and to countless others who would be invested in ensuring that a single human being would be given the best chance to survive with a decent quality of life. As with all such cases that would of course not be the end of care for that baby, but just the start, and with success, the child would eventually become an independent and self-sufficient human being. This whole future vision rolled out in my mind as I was delivering this tiny baby. I pondered the thousands of times every year a similar story would be repeated in the United States alone. I wondered about the world that child would grow up in and whether that world would truly be able to sustain her, much less my own children.

For the past two decades, I have spent time speaking to medical audiences all around the United States on the perils of the ongoing climate crisis. While for many this topic seems removed from day-to-day existence, I am struck by the hypocrisy of all the arduous efforts we make in safeguarding the most premature of human beings, while we as a global civilization existentially jeopardize the wellbeing of future generations from our wanton destruction of the environment at large. For many of us Californians the climate crisis is already an all-too-real phenomenon as we experience heat waves, wildfires, and drought year after year. As of 2022, many people worldwide are finally realizing the folly of our civilizational ways as they see the suffering of human brothers and sisters all around our planet. Ultimately, the climate crisis affects each of us as individuals in the here and now, and the healthcare industry is finally waking up to the threat.

The key points about climate change are quite simple. The Earth is unequivocally warming due to rising levels of atmospheric greenhouse gases (GHG) from human activities. The average global temperature is now 1.1°C warmer than the pre-industrial era (before 1850). The primary culprit is carbon dioxide (CO₂), the rise of which is unprecedented during the entire period of human evolution. Carbon dioxide concentrations were last at their current levels 15–20 million years ago when average temperature and sea level were respectively ~3–6°C and 25–40 meters higher than they are today. Alarmingly, there has been an acceleration in GHG emissions since the first UN Intergovernmental Panel on Climate Change (IPCC) report published in 1990, with more than half of all historical CO₂ emissions having been released in the past 30 years. Matching this trend, the warmest years on record have occurred since 1970, with seven of these having occurred since 2015; the three warmest years on record are 2016, 2019, and 2020. With unabated “business-as-usual” human activity, current projections by the IPCC portend that by 2100 CO2 concentrations will reach levels nearly two and a half times higher than 2019 levels, resulting in average surface temperature increase by more than 3–4°C.

The ongoing as well as anticipated impacts of climate change include sea level rise; ocean acidification; more intense droughts, flooding, and storms; more frequent hot and fewer cold extremes, resulting in increased frequency and intensity of heatwaves; and more wildfires as well as extreme weather events. With a changing environment, anticipated impacts on human health include:

Injuries, fatalities, and mental stress from extreme weather events
Heat-related illness and death
Worsening asthma, respiratory diseases, respiratory allergies, and cardiovascular disease from particulate air pollution
Deterioration in water quality and quantity resulting in higher rates of water-borne infectious diseases (e.g., campylobacter, cholera, crytospiridiosis, etc.)
Threatened food supply and safety resulting in worsening rates of malnutrition and undernutrition, as well as food-borne diseases (e.g., salmonella)
Spreading of vector-borne infectious diseases (e.g., malaria, Lyme disease, dengue, chikungunya, West Nile infection, etc.)
Physical and mental harms from destabilized societies resulting in violent conflict and forced migration

The populations who will feel the initial brunt of climate change will be the most societally disadvantaged, such as children and the elderly, as well as various minority groups. These populations are invariably poor and are already living in environmentally marginal circumstances. Among such populations, women have been recognized as a uniquely vulnerable group, since in many parts of the world they lack adequate access to family planning services, educational resources, and sufficient income. Additionally, given the differing roles men and women play in most societies, as well as women’s unique reproductive burden, climate change impacts are expected to have a differential impact on women versus men. In many cases, adverse impacts are likely to be worse for women than men by widening health disparities that already exist in many parts of the world. Examples of adverse health effects to be felt disproportionately by women include:

Respiratory and cardiovascular disease from greater exposure to poor-quality air, especially due to particulate air pollution from both indoor sources (e.g., cooking and heating sources), as well as from outdoor environmental sources
Anemia and malnutrition from food insecurity and increased nutritional needs due to childbearing and menstruation
Pregnancy-related complications (e.g., intrauterine growth restriction, preterm birth, congenital anomalies, stillbirth)
Reduced access to prenatal care, contraception, and family planning options
Physical and sexual violence, as well as anxiety, depression, and other mood disorders related to climate-induced migration and environmental disasters

In regards to pregnancies, harm especially arises from exposure to heat and particulate air pollution. Systematic studies have shown excess heat exposure during pregnancy to be associated with higher rates of preterm birth, low birth weight, and stillbirth. Individual studies have also shown a strong association between heat exposure in utero and fetal congenital anomalies, especially fetal cardiac defects and congenital cataracts, as well as increased rates of maternal hypertensive disorders (gestational hypertension and preeclampsia). Particulate air pollution, as results from fossil fuel combustion, indoor cook stoves, and wildfires, have also been associated with higher rates of preterm birth, low birth weight, and stillbirth. Exposed offspring have also been demonstrated to have higher rates of impaired lung development, asthma, and respiratory allergies. Studies have shown that fetuses exposed in utero to natural disasters such as Hurricane Sandy and Hurricane Katrina have altered neurodevelopmental outcomes and higher central adiposity, while their mothers have higher rates of anxiety, depression, and PTSD. It is clear that the climate crisis is already leading to a continuum of adverse health effects that will ripple across future generations of humanity with unpredictable effects.

Given what we know, what can we do now, practically speaking, to protect ourselves and our patients, reduce our emissions, and live healthier lives? It’s a set of simple, and yet quite powerful tools, especially when practiced en masse:

Avoid exposure to excess heat, especially early in the hot season before there has been time to acclimate
Monitor the Air Quality Index: reduce outdoor activities when the AQI is 50 — 100, and avoid outdoor activities at 100 or higher
Avoid wood-burning stoves and fires
Use tick and mosquito repellants in at-risk geographic areas and seasons
Eat more plant-based foods for better nutrition and to reduce emissions
Walk, bike, and use public transportation as these have lower emissions than gas-powered automobiles

While these are useful adaptive solutions for a changing climate, ultimately prevention, i.e., elimination of emissions, is the preferred and best long-term solution since with unabated emissions the crisis will only worsen. The adverse health outcomes previously listed are not fixed in stone — they represent an initial phase of adversity to the human species, but if left unchecked, this adversity will quickly become an existential threat as temperatures continue to rise and tipping points are reached. Our human civilization has evolved in a stable climate, including all of our agriculture, technology, infrastructure, and socioeconomic and political systems. Just as all creatures, we human beings are homeostatic creatures, and we do not react well to disequilibrium.

Consideration of the interconnections between climate, population groups, and health is not in our usual mindset as healthcare providers, as we have historically focused on cultivating one-on-one relationships with our patients. However, we can no longer ignore climate change as it threatens to undo all of our diligently-acquired gains in reducing women’s morbidity and mortality related to pregnancy, infectious diseases, and chronic medical illnesses. Healthcare providers now have an ethical imperative to alert societies at large as to the impending dangers of climate change, and to urge policymakers, corporations, and government leaders to act decisively for the betterment of humanity.

The late astronomer Carl Sagan once wisely surmised that we alone in the vastness of the universe are aware of our own physical limitations in space and our mortal limitations in time. Despite these constraints, we somehow possess an unmatched and remarkable capacity for insight that can allow us to transcend these very spatial and temporal boundaries. If only for this reason the persistence of our individual and collective human consciousness has the utmost meaning and importance. Indeed, this provides a more than sufficient reason to fight for the health, prosperity, and survival of our species — including that of a 24-week premature infant.

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