2023 Issue 1, Quarterly Newsletter

WOMEN’S HEALTH

2023, Issue 1www.ElCaminoWomen.comJanuary 9, 2023

The New Year always catches me by surprise.  But with so many improvements in the global COVID-19 pandemic, supply chain issues, and ease of travel (until the winter storms), I’m looking forward to a wonderful year full of community, exploring, and good health.

This newsletter, we’ve got great articles on ways to lower your cancer risk, manage a chronic cough, and ensure you get all your health screenings scheduled.

2023 will also see the joyful return of Dr. Lam from her maternity leave and Barb Dehn, NP’s bittersweet retirement from clinical practice.   Dr. Lillian Soohoo, a Board-Certified Dermatologist and regular contributor to our newsletter, is also opening a new office in Los Gatos, and you’re ALL invited to the Open House!  Drs. Soohoo and Clark have discounts, raffle prizes, and free brow waxing planned for women who drop by on January 26th!  Make sure to RSVP if you’re interested in going.

Finally, please follow us on social media to stay up-to-date on healthcare issues affecting women and news from our practice. You can find us on Facebook, LinkedIn, or Instagram.

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

Hoping you have an amazing 2023,

Sarah Azad, MD


In this issue:

Practice Updates

Online Prenatal Classes

Research at ECWMG

Chronic Cough

Ear Infections and Tubes

Drs. Lillian Soohoo and Ashley Clark Open New Los Gatos Office!

Lowering Cancer Risk, One Step at a Time

Miscarriages: an Overview 

Farewell Barb Dehn, NP

Health Care Screening for Women

El Camino Hospital Visitor Policy Updates

Highlights from our Women’s Health Blog

PRACTICE UPDATES

Dr. Lam will be back soon!
We look forward to seeing Dr. Christina Lam return to the office in February.   For those who’ve been waiting to see her, reach out early to schedule your appointments.

Barb Dehn, NP, has officially retired.
Barb Dehn, NP, saw her last patients with us at El Camino Women’s Medical Group on December 27, 2022.  After many years with us and many more as an NP in women’s health, we wish her well in her new endeavors.  By now, all her established patients should have transitioned to a new primary care and gynecologist.   Prescription refills will be honored for only the first three months of 2023.

Office Visitor Policy Updates
We are continuing to welcome one visitor at patient appointments.  Please remember visitors must be asymptomatic and fully vaccinated against COVID-19, including a booster (if it’s been more than six months since 2nd COVID-19 vaccine).  We are now also allowing visitors with a negative COVID-19 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, LinkedIn, or Instagram.  Your feedback on our office practices and physician and staff communication are always welcome.

ONLINE PRENATAL CLASSES

Prenatal Classes
We offer four virtual prenatal.   These classes cover preparing for childbirth, breastfeeding, and newborn care and have been very popular.  We try to offer them every one to two months. They are also available for women and couples who are not our patients at ECWMG.

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 2021 and 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 has been on hold, but we will hopefully be able to restart enrollment in the next few months.  More information to come at your prenatal visits.

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.

Sunbeam Study

If you’re pregnant and have decided not to store or donate your cord blood, please consider enrolling in Stanford’s Sunbeam StudyThe study hopes to learn how environmental and genetic factors play a role in food allergy and eczema development.  If interested, you can enroll here.

CHRONIC COUGH


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

Figuring out your chronic cough.

A cough that just doesn’t quit can be really annoying. Sometimes it takes awhile to notice that you still have an occasional cough months later, or your cough is so frequent that it interrupts your sleep or disrupts your quality of life.

What is a cough?

A cough is a neurologic reflex. There are cough receptors that are in the lining of your upper and lower respiratory tracts but these receptors are also in the lining outside your heart, your esophagus, the base of your lungs and in your stomach. There are both mechanical cough receptors, that are triggered by touch, displacement and acidity and chemical cough receptors that are sensitive to cold, heat, capsaicin-like compounds and other chemical irritants.

Some people have cough reflex hypersensitivity, so things like esophageal reflux, air pollution or tobacco smoke can trigger coughing even at low levels of exposure.

Some cough definitions:

Acute cough: can last up to three weeks. Usually due to an acute illness.
Subacute cough: from three to eight weeks. Some coughs after a viral illness can last up to 8 weeks.
Chronic cough: this cough has gone on longer than 8 weeks.

What kind of acute illness can cause an acute cough?
The most common causes are the common cold, bronchitis, COVID, rhinosinusitis and asthma/chronic obstructive pulmonary disease. We do worry about other disease but try treat the most common things first.

What are the most common causes for a subacute cough?

The most common causes of a subacute cough tend to be the post infectious cough that can last up to eight weeks. Usually from a respiratory viral infection and the cough lingers past resolution of the acute symptoms. Half of patients usually have resolution of a post infectious cough spontaneously.

A specific cause of subacute cough is pertussis, also known as “whooping cough”. It is highly contagious and is a bacterial infection. Significant cough can sometimes start the second week of illness, and can last 2 to 3 months, with worsening symptoms at night. This does need to be treated with antibiotics. Forntunately, we have a vaccination for this, usually part of the TDAP vaccine.

Causes of chronic cough?

Most people with chronic cough have underlying asthma, COPD, bronchitis, gastroesophageal reflux disease, or a post-nasal drip. Surprisingly, 10 to 12% of the population has chronic cough. Chronic cough, with a cough lasting longer than eight weeks, is usually when people seek out medical help. Patients are encouraged to seek evaluation at any time for a cough, whether acute or chronic.

Asthma is the most common cause of cough in adults as well as children. Many people will have wheezing and shortness of breath but there is a variation called “cough variant asthma”. It’s when asthma presents only with cough but can later progress to wheezing and shortness of breath. The patient does not necessarily need to have childhood asthma or a family history of asthma, although this is common. Asthma can happen after a viral infection but can also happen after exposure to specific triggers such as dust, cold air, mold, certain fumes and fragrances.

Gastroesophageal reflux disease (GERD) seems to be the second or third most common cause of chronic cough. Other symptoms of GERD that might accompany a cough include heartburn, a sour taste in the back of the mouth, nasal symptoms and change in your voice. There are no definitive tests to evaluate whether GERD is causing a chronic cough so a trial of anti-reflux therapy for three months is a reasonable option. Also changes in lifestyle, like the following are useful:

  • Weight loss for patients who are overweight
  • Elevation of the head of the bed
  • Smoking cessation, including vaping
  • Avoidance of reflux inducing foods like fatty foods, chocolate, alcohol and caffeine
  • Avoidance of very acidic beverages like carbonated beverages, red wine, orange juice
  • Avoidance of meals 2 to 3 hours before lying down

A special population of GERD are those with obstructive sleep apnea. Chronic cough in those with obstructive sleep apnea can be more than 30% and it may be related to GERD. Using a CPAP machine at night can help GERD.

Another common cause of chronic cough is upper airway cuff syndrome (UACS) thought to be due to postnasal drip. These are nasal secretions like mucus that drip back into your throat into the upper airway. The secretions could be due to allergy, viral rhinosinusitis, or any other cause that would cause you to have nasal secretions. People usually have a sensation of liquid flowing into the back of the throat and having to clear their throat frequently. But it can also be silent so you do not have to have these symptoms to have a postnasal drip. A lot of times we can visualize a cobblestone appearance to the back of your throat. Again, we do a trial of medications to see if there’s an improvement in chronic cough. Usually these medications are targeted towards reducing nasal secretions like flonase, azelastine, antihistamines, nasal rinse and steaming.

Medication side effects can cause a cough too!

ACE inhibitors: Angiotensin converting enzyme inhibitors (ACE). ACE inhibitors are a very common medication is used for blood pressure control and to protect kidneys. An ACE inhibitor-induced cough usually starts within one week of starting the medication but sometimes people can develop symptoms up to six months after starting. It presents with a tickling, scratchy or itchy sensation in the throat. It does not seem to happen more frequently in patients with asthma. If you stop the medication, the cough usually goes away in 1 to 4 days after stopping, but sometimes can take up to four weeks to totally go away. It can come back if you try to use the same medication again or another medication in that same class.

Patients with cough due ACE inhibitors can be switched to angiotensin IIreceptor blockers (ARB). Incidence of cough in multiple studies with angiotensin II receptor blockers was much less than those seen ACE inhibitors and are now a first-line choice to manage hypertension.

Calcium channel blockers and bisphosphonates: calcium channel blockers are often used for blood pressure control and some other indications and bisphosphonates for osteoporosis. These medications can increase gastroesophageal reflux disease and can potentially increase an existing cough.

Glaucoma medications: latanoprost is a glaucoma eyedrop that can pass through your tear ducts to the back of your throat and cause cough. Another eyedrop, Timolol, is a type of beta blocker that can cause cough in patients with asthma.

Other causes of chronic cough:

Infections that have caused a cough for longer than eight weeks after the acute infection was over include pertussis, pneumonia caused by mycoplasma and chlamydia, and COVID. Treatment as symptomatic since the acute infection has resolved.

There are multiple other serious reasons for chronic cough that are: bronchiectasis, interstitial lung disease, lung cancer, chronic bronchitis, tuberculosis, aspirating foods liquids or other foreign bodies that go into the lower airways if you have difficulty swallowing, as well as chronic heart failure.

How do we work up a chronic cough?

You need to see your physician for a thorough history and a physical exam. A good history of all medical problems, medications, symptoms can point your physician in the right direction. They may ask bout fevers, night sweats, weight loss, your sputum, is their blood in your sputum, shortness of breath and if your immune system is normal, any type of smoking, inhalants at work or at home. If it has been less than 8 weeks, you may have a trial of treatment of a specific cause- like for allergic rhinosinusitis, GERD, asthma etc.

If it has been over 8 weeks, a chest x ray is a good idea to look for many of the above conditions. A CT scan of your chest is only indicated to further evaluate something on a chest x ray or something worrisome in your history.

Pulmonary function testing if helpful in evaluating the severity of your asthma or COPD.

Subsequent testing after initial workup, trial of treatment, is specific depending on what direction the evaluation takes. For example, if you have severe sinusitis, you may need a CT of your sinuses and if positive, a long course of antibiotics or possibly a nasal endoscopy. If your GERD does not resolve with a trial of acid blockers, you may need to be evaluated for H Pylori or need an upper endoscopy. If a sputum culture shows that you are positive for a fungal infection or tuberculosis, there may be more testing or treatment.

There are a subset of patients who we never find the reason for their cough and this can be related to hypersensitivity of cough receptors in the patient. Cough symptoms themselves can be suppressed with a variety of treatments and medications that vary from speech therapy, breathing exercises to inhalers, neurologic medications or cough suppressants/expectorants.

The important message is to follow up closely with your primary care physician for a step by step work up so nothing crucial is missed. The work up could fast and quick, or it might take time, trial and error and involve other subspecialists.

PradeepaSelvakumar MD
Internal Medicine
Bloomprimarycare.com
101 South San Mateo Drive Suite #301
San Mateo, CA 94401
650-435-8211
moc.e1716094373racyr1716094373amirp1716094373moolb1716094373@olle1716094373h1716094373

EAR INFECTIONS AND TUBES


By Katrina Chaung, M.D.
Board Certified ENT

The holidays are over but ‘tis the season still for ear infections especially for the little ones in our lives.

The ear has three main parts: the outer, middle, and inner ear. The outer ear is the external part we see and includes the ear canal extending to the eardrum. The eardrum separates the outer ear from the middle ear. Behind the eardrum, is a space called the middle ear that contains three tiny bones that vibrate to transmit sound waves to the inner ear. The inner ear encompasses the cochlea, which contains the hearing nerve, and the labyrinth, which helps our balance. The

middle ear space is also connected to the back of the nose via the eustachian tube. When we “pop” our ears, the eustachian tube opens to allow the pressure of our middle ear cavity to equalize with that of the outside world.

While ear infections can affect different parts of the ear, an infection of the middle ear cavity, or an acute otitis media, is the type people typically think of when referring to an ear infection. When this occurs, inflammation and fluid build up in this space, usually caused by a virus or bacteria. Children experience middle ear infections more frequently than adults.

Ear infections can cause pain, pressure sensation, and hearing loss. In children, especially those too young to verbalize their discomfort, other symptoms can include tugging at the ears, fever, equilibrium issues, fussiness, and difficulty sleeping.

Most ear infections do not require antibiotics but some do. After the infection resolves, the fluid in the middle ear space can sometimes take up to weeks to months to resolve. In children (and adults!) that experience frequent infections, have fluid in the middle ear cavity that does not resolve after 3 months, or are at risk for developmental or  language/speech issues, ear tubes may be considered.

Placement of ear tubes, or tympanostomy tubes, is the most common outpatient surgery performed on children in the United States. These are tiny tubes that are placed through a small incision on the eardrum to maintain a small controlled hole in the eardrum. This decreases the frequency of ear infections. Ear infections can still develop and if they do, the fluid that would otherwise build up behind the ear drum will drain out through the tube. This prevents many of

the above-mentioned symptoms of infections such as hearing loss and pain. This also allows easier treatment of the infection, usually with topical drops rather than oral antibiotics. The tubes typically stay in place for 1-2 years before falling out on their own.

If you or your child experience frequent ear infections, you may benefit from an ear, nose, and throat evaluation.

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

DRS. LILLIAN SOOHOO AND ASHLEY CLARK OPEN NEW LOS GATOS OFFICE!

                                                

Lillian Soohoo, MD                                                 Ashley Clark, MD
Board Certified Dermatologist                             Board Certified Dermatologist


The Menkes Clinic
2490 Hospital Drive, Suite 201
Mountain View, CA
555 Knowles Drive, Suite 220
Los Gatos, CA

Appointments:  650.962.4600

LOWERING CANCER RISK, ONE STEP AT A TIME

                                                                                    

Denise Johnson Miller, MD, FACS                                                       Sarah Zimmerman, PA
Breast Surgeon and Surgical Oncologist                                             Physicians Assistant
Medical Direct of Breast Surgery at El Camino HealthMountain View Surgery

This time of year, it’s common to make diet and fitness resolutions, but we often choose unrealistic goals that are impossible to adhere to long-term. We get discouraged and give up, berating ourselves as failures, ending up in worse-shape, mentally and physically, than when we started. Instead of tackling a “whole body makeover” or demanding a “new year, new me,” why don’t we gently love ourselves through small, sustainable healthy improvements this year? The scale and tape measure can be triggering, so let’s keep a broader perspective and focus on how we feel, celebrating the ways we are caring for ourselves in long-term, reliable ways. Let’s make manageable commitments to ourselves like walking thirty minutes every day. If we look at fitness not as a sprint to fix imperfections but rather a lifelong effort to nurture our bodies and gift ourselves wellness and longevity, we can expect to be healthier and more peaceful.

Also, by taking measures to get fit, we are actively preventing cancer. According to the American Cancer Society, “At least 18% of all cancers diagnosed in the U.S. are related to excess body weight, physical inactivity, excess alcohol consumption, and/or poor nutrition, and thus could be prevented.” Let’s not view this as an indictment on choices we’ve made in the past, but an opportunity to have some control over our future. It’s possible to actively work to prevent cancer by not smoking, being more physically active, and eating deliberately and mindfully. These efforts can also lower our risk of developing heart disease and diabetes, lower our weight, lower stress, and strengthen the immune system.

What does this look like in real terms? How much exercise is enough to reduce our cancer risk?  

It is recommended that adults get “150-300 minutes of moderate intensity or 75-150 minutes of vigorous intensity activity each week (or a combination of these).” If we break that down, this is approximately twenty to forty-five minutes of this much activity each day. Even for the busiest among us, that is achievable. For children and teens, it’s slightly higher at one hour of moderate/vigorous activity every day.

What ‘moderate and vigorous’ level activities are vary by the individual. MD Anderson Cancer Center gives us various ways to quantify our activities, but says that the simplest method is The Talk Test. “It doesn’t require any additional equipment. To perform the talk test, see if you can talk or sing while performing the activity. If you’re doing a moderate exercise, you should be able to talk, but not sing. If you’re doing a vigorous exercise, you shouldn’t be able to say more than a few words.”

The studies that demonstrate a reduction in cancer rates with an increase in activity are compelling, and for all of us, no matter our size or level of fitness. “You don’t have to be a marathon runner to consider yourself physically active. Walking at about 3 mph (or 20 minutes per mile) is considered moderate intensity. You can get in the recommended activity levels by just walking on your lunch break for 30 minutes, 5 days a week.” Also, “exercise is linked with lower cancer risk, regardless of body size! One of the ways in which physical activity may lower risk of cancer is through weight maintenance. However, many other biologic processes are affected by physical activity that are independent of body weight. For example, physical activity is associated with lower estrogen and insulin levels, both of which may lower the risk of some types of cancer.”

What about diet? 

So now we’re working to reduce our cancer risk by getting activity daily, how else can we increase our odds of living long, healthy lives? Nutritious food, of course! As Detroit-based dietician, Lana Scales, MS, RD, CNSC, ACSM, EP-C, tells us, “In the end food is either going to heal us or kill us.” The most healing foods are those that are high in nutrients; a variety of dark green, red, and orange vegetables, fiber-rich legumes (beans, peas), a variety of fruits, especially berries, whole grains, avoiding or significantly limiting alcohol, red meat, and sugar-sweetened beverages and highly processed foods.

Specifically for breast cancer, studies show that “dietary patterns rich in plant foods and low in animal products and refined carbohydrates lower risk (US Dietary Guidelines Advisory Committee 20157) and the Mediterranean diet pattern lowers risk (Toledo 20158).”  Dr. Denise Johnson-Miller, medical director of the breast program at El Camino Hospital, has both personally and professionally witnessed the profound health benefits  of a plant-based diet. She recommends finding recipes that work for the whole family and encourages exercise activities in which the whole family can participate like going on a hike or playing at the beach. “The earlier kids are taught to make healthy daily choices, the better.” Dr. Johnson-Miller also says that consistency is key when it comes to both diet and exercise, and that, “It helps to give yourself rewards, such as a spa day every month or a treat meal once a week.”

Lana also agrees that it’s wise to choose a “livable” diet that we can reasonably and comfortably sustain over time. The key is moderation and discernment. The more deliberate we are with what we eat and how we move, the more we can affect our long-term health.

Let’s make 2023 our year to start taking care of our bodies in impactful ways. No matter where we’re starting, we can reduce our likelihood of developing cancer, heart disease, and other illnesses by being more active. In dedicating a small amount of time every day to exercising and by eating more intentionally, we can save our own lives. Now, that’s a resolution we can get behind!

 

MISCARRIAGES

A miscarriage is a common term to describe a pregnancy that starts to form inside the uterus and then stops growing sometime before 20 weeks from a woman’s last menstrual period.

When women ovulate, an egg is released from her ovary and travels through the fallopian tube.  Fertilization usually occurs in the fallopian tube as the egg travels toward the uterus.  The newly fertilized egg starts to rapidly divide and multiply into new cells, which then implants on the wall of the endometrium, the lining of the inside cavity of the uterus.

 

As cells continue to multiply, an amniotic sac with fluid forms as the embryo grows inside.  After several weeks, this is called a fetus.

 

How common are miscarriages?

 

They are very common.  Often, a newly fertilized egg starts to grow into an embryo and then stops growing before implantation or just after.   This can occur even before a woman knows she’s pregnant.   Some 25-30% of fertilized eggs stop growing before a missed period.   After a woman knows she’s pregnant, another 20-25% will discover their pregnancy is a miscarriage, usually by the time they have their first pregnancy visit.

 

Studies show that approximately 8 to 20 percent of persons who know they are pregnant have a miscarriage sometime before 20 weeks of pregnancy; the vast majority occur in the first 12 weeks.

 

What causes miscarriages?

 

There are many reasons a fertilized egg doesn’t achieve a successful pregnancy, and it’s hard to know what causes a specific woman’s miscarriage.

 

One out of three pregnancy losses in the first eight weeks are the result of an empty amniotic sac, meaning the embryo itself never developed.   Another very common cause is abnormal chromosomes.   Data suggests that when miscarriage specimens undergo genetic testing, 30-50% have a major chromosomal abnormality.   This is not usually related to any genetic issue in the parents, but a result of the very complicated process of two cells with different genomes (the egg and the sperm), coming together to form a new, genetically unique fetus.

 

Some maternal conditions can lead to miscarriage, such as uncontrolled diabetes, abnormal structures inside the uterus (ie. fibroids), and autoimmune disorders.

 

Risk factors for miscarriage:

 

  • Age
  • History of miscarriages
  • Smoking or tobacco abuse
  • Alcohol
  • Fever
  • Trauma
  • Less commonly: certain infections, medications, radiation, environmental chemicals
  • Of note, caffeine intake at less than 1000mg in a short period of time does NOT increase the risk of miscarriage.

 

Signs of a miscarriage:

The two most common signs of a miscarriage are vaginal bleeding and abdominal pain.   Unfortunately, these are also common symptoms of early normal pregnancies.   When women have more than just a few days of light spotting or mild cramping, it’s best to be evaluated by a physician.

 

How a miscarriage is diagnosed:

 

In very early pregnancy, a series of blood tests for the hormone HCG can be helpful to show early on a normal rise or an abnormal one associated with miscarriages.

 

Ideally, after 6-7 weeks, an ultrasound can be performed to confirm a visible pregnancy in the uterus and whether it is appropriate in size and details in reference to the woman’s last menstrual period.  Usually, after 6 weeks, a heartbeat can be detected, which confirms a viable pregnancy.

 

When a heartbeat of over 120 bpm is detected in an intrauterine pregnancy, the risk of miscarriage drops significantly from the 20-25% stated above to less than 5%.   After a pregnancy reaches 10 weeks in size and still has a normal heartbeat, the risk of miscarriage drops even further to less than 1%.

 

How are miscarriages treated?

Generally, there is no way to stop a miscarriage from happening.

Once diagnosed, there are a few options for management:

Observation — Most women diagnosed with a miscarriage before 12 weeks can wait for their body to expel the failed pregnancy on its own.   This includes cramping, pain, and bleeding.   Over 85% of women will spontaneously pass the miscarriage tissue within 4 weeks of it having stopped growing.   A follow-up ultrasound is recommended to confirm no remaining tissue in the cavity.  While a safe and low intervention option, for many reasons, women often prefer a more active management strategy.

Medical treatment — A very safe and common option is to use medications (taken orally or vaginally) to stimulate the uterus to pass the pregnancy tissue.   Miscarriage usually occurs within 48 hours after taking medication but can take up to 4-7 days.   Again, a follow-up ultrasound is recommended to confirm no remaining tissue.   This is a common choice women make as it avoids the risks of surgical intervention while allowing some control over the timing of the process.

 

Surgical treatment — The conventional treatment for early miscarriage is a surgical procedure called dilation and curettage, or D&C. The cervix (the opening to the uterus) is dilated, and an instrument is inserted that uses suction and/or a gentle scraping motion to remove the contents of the uterus.  Though medical treatment has become more common, D&Cs remain a safe and common procedure.  Surgical management is recommended for people who do not want to wait, who do not want to do this on their own at home, who have anxiety around the bleeding and pain, or in women who have any signs of infection or have started to bleed heavily.

What next?

Generally, women are advised to avoid anything in the vagina for two weeks.

For women with a blood type that is Rh negative, RhoGAM is given to protect future fetuses.

For women wanting to conceive again, the recommendations of when to resume trying vary.   Our group recommends waiting for one normal menstrual cycle and then resuming unprotected, frequent intercourse.

For women who are not wanting another pregnancy, most forms of contraception can be started immediately.

Emotional health

Women’s experiences after a miscarriage vary greatly; there is no right or wrong way to feel.  For some, the loss of a pregnancy can cause significant grief. Sometimes these reactions are strong and long-lasting. You should let us know if you feel profound sadness or depression following pregnancy loss, especially if it continues for several weeks. A referral for grief counseling or other treatment may be helpful.

 

FAREWELL, BARB DEHN, NP

On December 27th, Barb Dehn, NP, saw her last patients before her well-deserved retirement.   As happy as we are for her as she embarks on new projects, we will miss her dearly at El Camino Women’s Medical Group.

Barb Dehn, NP, joined El Camino Women’s Medical Group in April of 2016.  It has been a wonderful seven years of having her in our office.  Not only has she served women in our community with various health issues, but she has impacted so many women with her special ways of counseling and educating and has been our honorary personal office therapist!   Loved by patients, staff, and physicians, Barb is going to be deeply missed.  After years of service and dedication to women’s health, we all wish her the best as she dedicates her time in new directions.

She has done her best to inform all her established patients of her retirement, but for those of you who were unaware, you must make sure you have both a primary care physician and an OB/GYN for your ongoing health care needs.  Medication refills will be managed by Barb’s previous supervising physicians for the first three months of 2023.

As many of you know, she is active in Global Health Initiatives with FAME hospital in Tanzania and will devote more time there.

Feel free to continue to follow Barb Dehn’s projects via NurseBarb.com or LinkedIn.

 

HEALTHCARE SCREENING FOR WOMEN

As we enter a new year, we encourage all women to make sure they’re up to date on health screenings:

 

Your annual well-woman exam

We highly recommend you schedule your 2023 annual well-woman exam.   These visits are not to discuss any issues or problems you are having—please schedule appointments to address any issues separately.   These are visits to review your personal and family medical history, lifestyle changes, and a preventive exam (and sometimes tests) to assess your health and counsel you on opportunities to improve your health and longevity.  We are no longer scheduling annual well-women exams in the month of December, so please plan accordingly.

 

Primary care physician

Everyone should see a primary care physician once a year.   With all the advances in medicine and innovations in screening and early intervention, we highly recommend all our patients have an established relationship with a primary care physician and see them once a year for an annual health exam.   This relationship will also make it easier to see a doctor when you have a general health issue.   There is already a national shortage of physicians that will likely get worse in the coming years as many physicians plan to leave traditional medicine.   The wait for patients looking for a new primary care physician in our area can be 4-6 months.   In California, insurances cover an annual preventive health exam with BOTH a primary care physician AND an OB/GYN every calendar year.  At El Camino Women’s Medical Group, we insist on patients having a primary care physician by age 40 and require it after age 50.  You can email the office to ask for a list of recommended primary care physicians in our area.

 

Breast Health

Clinical breast exams are important to have once a year and are done at your annual OBGYN visit.   For women with a strong family history of breast cancer, we may recommend a clinical breast exam in the office twice a year.

 

For women aged 40 and over, we recommend a breast mammogram every year.

 

Cervical Cancer Prevention and Screening

Cervical Cancer rates continue to drop in the US as the impact of the HPV vaccine is becoming more widespread.  That being said:

  • For all women aged 9-26, make sure you’ve had your HPV vaccine (3-shot series)
  • For all women aged 26-45 at risk for contracting HPV, consider getting the HPV vaccine if you haven’t had it already.
  • All women need a Pap Test at least every 5 years, our office recommends at least every 3 years, and if you have had recent abnormal Pap Tests, you will have customized recommendations.

 

Bone Health

For women 65 and older, an initial DEXA scan of your bones to evaluate you for osteopenia or osteoporosis is important.  Screening may be done earlier for women with risk factors or family history.

 

Colon Cancer Screening

Colon cancer remains a leading cause of cancer and death in the US for both men and women.   For patients aged 45 or higher, please schedule a consultation with Gastroenterology for a screening colonoscopy.   Most patients do not need a referral for these visits, but you can reach out to our office for a list of recommended GI offices and/or a written referral.

 

For those with a family history of colon cancer, bring it up at your annual visit, as you may need earlier screening or genetic testing.

 

Eyes, Ears, and Teeth!

Don’t forget your annual vision exam and your regular dental exams!  For people over the age of 60, annual hearing exams are also recommended.

 

Vaccines

Everyone should be up to date on their vaccines:

  • TdaP (every 10 years)
  • COVID19 (initial series, booster, and the latest booster that was released in September of 2022)
  • Flu vaccine (annually, available from September to March)
  • Shingles vaccine (age 50 and older)
  • Pneumococcal vaccine (age 65 and older)

EL CAMINO HOSPITAL VISITOR POLICY UPDATES

General information on visitor’s policy
Last updated visitor guidelines from October 28, 2022

El Camino Health allows two visitors per day with patients in Labor & Delivery and nearly all inpatient units for the main hospital.  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), attest to having no symptoms of COVID-19, and wear a hospital-provided mask.   Proof of vaccination or negative COVID-19 testing is no longer required.  For complete details, click here.

Masking is still required in all healthcare facilities in Santa Clara County.

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

Please read here for details specific to the Orchard Pavillion, also known as the Women’s Hospital.

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 provide 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 an older article on the science behind couples trying to conceive a baby of a certain gender.  Finally, an article on canker sores has taken the place of our most popular weight loss article as the third most-read article this last quarter.

We update our blog at least a few times a month with information on all kinds of women’s health issues. Recent posts have been on COVID-19 Vaccination and Infant Positivity rates, Advances in Endometriosis, and updates on Egg Freezing. Follow us on Facebook, LinkedIn, or Instagram to be informed when we post new articles and stay updated on the latest in women’s health.

GENERAL OFFICE INFORMATION

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

Phone:650-396-8110

Fax:650-336-7359

Email:moc.n1716094373emowo1716094373nimac1716094373le@of1716094373ni1716094373

Email (billing):moc.n1716094373emowo1716094373nimac1716094373le@gn1716094373illib1716094373

Website:www.ElCaminoWomen.com

pop up imaging stating that ECWMG is not accepting new patients starting 3/1 and you can ask to be put on a wait list.