|April 3, 2023
As we enter Spring, so much is different from last year.
Wonderful news this spring, with all the rain and storms, we are officially out of the drought here in the Bay Area. We know many of our patients, staff, and physicians have had to endure power outages and exposure to unsafe driving conditions. We wish everyone good health and safe accommodations as the rainy season is not yet over.
More positive news: the end of the public health emergency related to COVID-19 on February 28, 2023. As of today, April 3rd, masking will no longer be required in high-risk health care settings. Santa Clara County has updated its county masking policy to require masking in healthcare facilities only during the respiratory virus season (November 1st to March 31st). In the past, only healthcare workers who had not taken the flu shot were required to be masked during that time in healthcare facilities. Santa Clara County also supports private offices making their own decisions. We have decided for the month of April to continue requiring masking for all of our staff and patients and maintain our visitors’ policy to one person.
This issue of Women’s Health has great articles on preventive skin health, managing bladder and bowel issues, advice for parents with young children, and non-hormonal options for managing the vasomotor symptoms of menopause. Of note, there was an excellent article on menopause in the New York Times recently. I highly recommend reading it to anyone over the age of 35.
As always, feedback is welcome regarding our practice, customer service, and even this newsletter!
We are looking forward to safer, less restrictive times this spring and summer.
Wishing you all a wonderful spring,
In this issue:
Dr. Lam is back!
Office Visitor Policy Updates
We are now allowing an asymptomatic visitor with patients to their visits. Proof of vaccination is no longer required, but masking in our office will remain mandatory for now. Check out our office policy page for the most recent updates.
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 is always welcome.
ONLINE PRENATAL CLASSES
We offer four virtual prenatal classes. 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
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.
ANNUAL SKIN EXAM FOR BETTER HEALTH
Skin cancer is the most common type of cancer in humans. An annual complete total body skin exam performed by a dermatologist is one of the best health screenings you can do and it’s quick and pain-free!
What does a complete skin exam mean? First, a dermatologist will ask you to remove all your clothing (including underwear) and to wear a hospital gown. Then, starting from your scalp and moving south to the skin between your toes, your dermatologist will carefully visually inspect your entire skin’s surface to look for any abnormalities or suspicious lesions.
This detailed visual inspection of your entire skin can save your life. Especially since most people are unable to check their own scalp or back by themselves. Melanoma, the deadliest form of skin cancer, can be found anywhere on the body, even in sun-protected skin areas. In men, melanoma is most commonly diagnosed on the back. Early detection and surgical removal of melanoma is the key to long-term survival.
A total body skin exam can help to catch all types of skin cancer at its earliest stage when the opportunity for a cure is highest. The American Academy of Dermatology recommends a yearly complete skin exam for all adults. For patients who have a history of skin cancer or a precancerous skin lesion (such as an atypical mole or an actinic keratosis), the recommendation for follow-up is at least twice a year. If you have a family history of skin cancer or a personal history of extensive sun exposure (such as living in California), it is advisable to make it a habit to see your dermatologist at least once a year for a complete skin exam.
An annual skin exam should be part of your health maintenance routine. It’s a quick (takes less than 5 minutes) and painless process that will help you maintain better health and may even save your life.
Schedule an appointment with your dermatologist today. To access free skin cancer screenings in your area, go to https://www.aad.org/public/public-health/skin-cancer-screenings.
Lillian Soohoo, MD
555 Knowles Drive, Suite 220
Los Gatos, CA 95032
TAKING BACK BLADDER AND BOWEL CONTROL
Half of women have leakage of urine, but we often tell ourselves or are told by those around us that it is a normal part of aging. In fact, incontinence prevents many women from living full lives. They say no to vacations, day trips, and even short outings for fear of having an accident.
Incontinence can be improved by dietary and lifestyle changes, exercises, medications, and surgery. Most women have heard that it’s important to do their Kegels. Some have been placed on medications. But what happens if that doesn’t work?
The FDA approved nerve stimulation to treat incontinence over 20 years ago. It can help patients with urinary urge incontinence, urinary retention, accidental bowel leakage, and urinary frequency. Unlike many other treatments, the stimulation actually normalizes nerve signaling. Patients who are interested undergo a basic evaluation in the office. This test determines whether the bladder problem is due to muscles or nerves. It also allows patients to try out the technology for a week with an external battery. If their symptoms are improved, they are scheduled for a short same-day surgery to implant the device. It’s similar in size to a pacemaker. In the last few years, the devices have improved so that they are now MRI-compatible, and the batteries last 10-15 years.
455 O’Connor Dr. Ste 370
San Jose, CA 95128
SYMPTOMS OF GALLSTONES: WHY WOMEN ARE MORE LIKELY TO SUFFER A GALLBLADDER ATTACK
Founder of Hope & Beauty
Women are more likely than men to develop gallstones because they have higher levels of cholesterol in their bile and less ability than men to dissolve cholesterol in their bile. Pregnancy, the use of birth control pills, and postmenopausal hormone therapy also increase a woman’s risk for developing gallstones. Pregnancy is a time of great physical and hormonal changes. These changes can put a woman at an increased risk for certain conditions, such as biliary colic and acute and chronic cholecystitis. In this blog post, we’ll be taking a closer look at gallstones—what they are, what causes them, and what you can do to prevent them.
What are gallstones?
Gallstones are hard, pebble-like deposits that form in the gallbladder. The gallbladder is a small, pear-shaped sac located under the liver on the right side of the abdomen. The main function of the gallbladder is to store and concentrate bile, a yellowish-brown digestive fluid produced by the liver. Bile is composed of water, electrolytes, cholesterol, bile acids, and bilirubin (a breakdown product of red blood cells). Bile acids are secreted by the liver and help break down fats in the small intestine during digestion. When these components are out of balance, gallstones can form. These stones can range in size from as small as a grain of sand to as large as a golf ball.
There are two types of gallstones:
- Cholesterol stones – These are made mostly of cholesterol and are usually yellow-green in color. They make up about 80 percent of all gallstones.
- Pigment stones – These are made mostly of bilirubin and are usually small and dark. They make up most of the rest of gallstones.
Symptoms of Gallstones
Most people with gallstones never experience any symptoms (asymptomatic) and do not need treatment. However, when they do cause symptoms, they can be quite painful. The most common symptom is pain in the upper abdomen or back, known as biliary colic or a gallstone attack. This pain can last several minutes to several hours and may be severe enough to land you in the hospital emergency room for treatment.
Other symptoms can include:
- indigestion or gastroesophageal reflux disease (GERD) after meals
- nausea or vomiting
- abdominal pain near your breastbone
- belching or burping gas from your stomach through your mouth
- clay-colored stools
The gallbladder is a small organ located under the liver. It stores bile, which helps the body break down fats. People with gallstones during pregnancy have the same symptoms as those who are not pregnant, such as pain in the right upper area or center of the abdomen (biliary colic). More serious complications can cause more severe symptoms: continuous and severe pain, ongoing vomiting, fever, light-colored stools, dark urine, or yellowing of the skin and eyes. These symptoms can indicate an infection of the gallbladder (cholecystitis) or blockage of the bile ducts (choledocholithiasis), which can lead to infection of the biliary tree (cholangitis) or inflammation of the pancreas (pancreatitis).
Risks for developing gallstones
- Being female
- Being over the age of 40
- Having obesity
- Eating a high-fat diet
- Eating a low-fiber diet
- Having diabetes
- Family history of gallstones
- Pregnant women are also at an increased risk for developing gallstones because their bodies produce more estrogen during pregnancy. This hormone causes the liver to send more cholesterol into the bile.
- Rapid weight loss
Prevention of Cholecystitis
There are several things you can do to prevent cholecystitis from occurring in the first place. One of the most important things you can do is to maintain a healthy weight through diet and exercise, as being overweight increases your risk of developing gallstones. You should also avoid consuming high-fat foods as they can contribute to gallstone formation. If you have had chronic cholecystitis in the past, it’s important to see your doctor regularly so that they can monitor your condition and make any necessary changes to your treatment plan.
Are there any home remedies for gallstones?
While there is no cure for gallstones, there are some home remedies that may help relieve the pain and discomfort associated with them. Some of these home remedies include:
- avoiding high-fat foods
- eating smaller meals more frequently
- drinking plenty of fluids
- resting after meals
- applying heat to the area (e.g., using a heating pad)
If you are experiencing pain or other symptoms associated with gallstones, it’s important to see your doctor so that they can recommend the best course of treatment for you.
Can gallstones go away on their own?
Gallstones do not go away on their own, but they can be present and not cause any symptoms. Gallstones that do not cause any symptoms or complications can often be left untreated. If you have gallstones that are causing pain or other symptoms, however, treatment will likely be necessary.
Your doctor will likely start with a physical exam and ask about your symptoms. They may also order blood tests to check for an infection or other conditions that could be causing your symptoms. Elevated bilirubin is an indication of blocked ducts, and elevated lipase is an indication that the pancreas is inflamed. An ultrasound is the most common imaging test used to diagnose gallstones. This test uses sound waves to create pictures of your gallbladder and can often identify stones as small as 2mm. In some cases, your doctor may also recommend a CT scan or MRI to get a more detailed view of the gallbladder. HIDA scan is another imaging test that may be used to diagnose gallstones. This test uses radioactive dye to identify stones and blockages in the bile ducts. It allows the physician to diagnose acute cholecystitis.
Treating symptomatic gallstones
There are two types of treatment: medical and surgical. Medical treatment involves taking medications to dissolve the stones. This type of treatment is only an option for people with small cholesterol stones. An additional procedure called endoscopic retrograde cholangiopancreatography (ERCP) may be used to remove a stone that is obstructing the common bile duct. Surgical treatment involves removing the gallbladder through a minimally invasive procedure called a laparoscopic cholecystectomy. This is the most common treatment for gallstones and is usually considered the best option for people who have larger stones or who experience frequent attacks. Removal of the gallbladder prevents other complications such as acute cholecystitis, gallstone pancreatitis, and cholangitis.
Which doctor is best for gallbladder surgery?
There is no one-size-fits-all answer to this question, as the best doctor for you will depend on your individual situation. If you have gallstones that are causing pain or other symptoms, your primary care doctor may refer you to a gastroenterologist or a surgeon who specializes in gallbladder surgery (cholecystectomy).
Pregnancy and Gallstones?
Pregnancy increases a woman’s risk of developing gallstones, biliary colic, and acute and chronic cholecystitis. This is due to the many physical and hormonal changes that occur during pregnancy. For example, during pregnancy, the levels of estrogen and progesterone increase. These hormones can cause the gallbladder not to function properly and can lead to the formation of stones in the gallbladder. Gallstones can lead to biliary colic and acute and chronic cholecystitis.
Managing Biliary Colic
If you are pregnant and have been diagnosed with biliary colic, there are things that can be done to manage your symptoms and prevent further complications. First, it is important to rest as much as possible and avoid anything that may trigger your symptoms (e.g., fatty foods). You should also drink plenty of fluids (e.g., water, juice) to stay hydrated and help your body flush out toxins. If your pain is severe, your doctor may prescribe pain medication and antibiotics for you to take as needed. If you have a fever, vomiting, or jaundice, you should call the doctor. In some cases, surgery may be necessary to remove the gallbladder (cholecystectomy).
Treatment Options for Acute Cholecystitis During Pregnancy
If you are diagnosed with acute cholecystitis during pregnancy, your doctor will likely recommend conservative treatment options first. These may include antibiotics to clear the infection, pain relief, and rest. If your symptoms do not improve with conservative treatment, you may need to be hospitalized for more aggressive treatment. This may include surgery to remove the gallbladder (cholecystectomy). Surgery for acute cholecystitis during pregnancy carries an increased risk for complications such as bleeding and infection. For this reason, it is usually only recommended if other treatment options have failed.
Symptoms of Gallstones & When to See a Doctor
- The majority of people who have gallstones don’t experience any symptoms. However, if a stone becomes stuck in the bile duct, it can block the flow of bile and cause serious symptoms, such as:
- Sudden, severe abdominal pain
- Nausea & vomiting
- Jaundice (yellowing of the skin and eyes) fever If you experience any of these symptoms, it’s important to see a doctor right away as they could be signs of a more serious condition.
Gallstones are hardened deposits of digestive fluid that can form in your gallbladder and range in size from something as small as a grain of sand to as large as a golf ball. Although the actual cause of gallstones is unknown, there are certain risk factors that may increase your chance of developing them, such as being female or over the age of 40. If you experience any severe abdominal pain or other related symptoms, it’s important to seek medical attention right away, as they could be signs of a more serious condition. If you are pregnant and have been diagnosed with gallstones, call your doctor or Mountain View Surgery today at 650 600 7301 to schedule an appointment with one of our specialists. We can help you determine the best treatment option for you and your baby.
2500 Hospital Dr. Bldg 15 Suite 1
Mountain View, CA 94040
ALLERGY SEASON AND CHILDREN
With spring around the corner, the chorus of birds, bees, & allergies are about to make their debut again for the year. Unfortunately, sniffles & coughs aren’t as melodic as the rest — and are far less comfortable, too.
Immune systems are designed to protect the body: they do so by recognizing & fighting off unusual substances present in the bloodstream. This is meant to include malignant cells of the body, bacteria, viruses, & fungi.
Allergies occur when the immune system reacts to a neutral or safe substance, like pollen or dander, that has entered the body. The immune cells perceive this substance as a threat & deploy antibodies & other chemical signals like histamine, all of which are proteins produced by immune cells that target immune threats in a variety of ways. This may include surrounding the substance to attract immune cells to help break it down or activate other immune defenses
in the body, like inflammation or fever.
Allergies can be caused by any substance, including various foods, ingredients in pharmaceuticals, pollen, bee venom, or pet dander. Many allergies can be mitigated by simply avoiding the allergen — for example, someone allergic to peanuts should be careful to avoid ingesting (or in some cases, even touching) peanuts or peanut-contaminated foods.
Other substances, like pollen, aren’t so easily avoided, especially in flowering seasons like spring. Still, there are a few steps that can be taken to minimize the havoc pollen can wreak on your (or your little one’s) immune system.
While pollen can be hard to avoid, it is possible to help your child minimize exposure. Try to limit their outdoor activity early in the morning, when pollen count is the highest, by having them play indoors until the afternoon — for older kids, avoid outdoor chores like gardening or lawn mowing. Keep the windows & doors closed too.
Going out just after rainfall is best since rain will help wash away any pollen lingering in the air. If you do need to go out with your child, have them wear a mask & ensure that it fits snugly around their face to avoid breathing in the pollen. You can also have them try a nasal saline rinse to clear any pollen in their sinuses after going out.
Avoid bringing pollen into the home as well: make sure to take off your child’s outdoor clothes & have them a shower to rinse off any pollen clinging to hair or skin — or at least make sure your kids wash their hands & face with cold water. It also helps to wash the sheets regularly. Try not to hang their clothing outside to dry, as it can gather pollen while it hangs.
Air conditioning can help rid the indoor air of any allergens too, and dehumidifiers help keep indoor air dry & free of pollen. HEPA filters on vacuums help keep the floors clean of pollen & dust, as well as any dirty residue left behind by little ones.
In terms of over-the-counter medication, several options are commonly available. Antihistamines target the chemical signal released by immune cells that activates inflammation in allergic responses, so oral antihistamines can help resolve symptoms. Another option includes nasal corticosteroid sprays, which target inflammation in the sinuses to minimize nasal discomfort.
When taking medication to resolve allergy symptoms, make sure to speak with your healthcare provider about any long-term effects of these medications, drug interactions with other medications, & efficacy for your particular problems.
For allergies worse than what can be controlled with at-home steps, speak with your healthcare provider: they may recommend various treatment options, such as a blood panel or skin test to identify particular allergen triggers for your child. They may also offer allergen immunotherapy, a series of low-dose injections that desensitize your child’s immune system to the allergy trigger. Other options may be available based on the specific details of the allergy, so make sure to speak with your healthcare provider to see what they can do for your family!
Dr. Arti Jain, M.D.
860 E Remington Dr, Suite B,
Sunnyvale, CA 94087
408 462 9261
MENOPAUSE: MANAGING THE VASOMOTOR SYMPTOMS
Menopause is a natural biological process that occurs when a woman’s menstrual cycle stops, marking the end of our reproductive years, but only the halfway mark for most of us in the course of our lives. Vasomotor symptoms (VMS) are common during this time and can significantly impact a woman’s quality of life. These symptoms include hot flashes and night sweats, which can cause discomfort and interfere with sleep, work, and daily activities.
Initially, it’s best to have an assessment by your OBGYN; at our office, we do a full “perimenopause” or “menopause” consult for women entering into these periods of life. Once you know what you’re experiencing are the natural vasomotor symptoms that occur during this time of life, there are many options for managing them.
Hormone replacement therapy (HRT) has traditionally been the first-line treatment for VMS in menopause. Including estrogen and often progesterone, It is the most effective way to quickly treat these types of symptoms. The New York Times has recently published an excellent (though long) article on menopause and management with HRT.
HRT may not suitable for all women, including those with a history of breast cancer or blood clots. Many women also prefer to avoid medications if possible. Fortunately, there are many non-hormonal therapies women can use to help manage their symptoms, and some very interesting non-hormonal medications are in development. Here are some non-hormonal therapies that have been shown to be effective:
- Cognitive-behavioral therapy (CBT): CBT is a type of talk therapy that helps women develop skills to cope with menopausal symptoms. A systematic review and meta-analysis of 12 randomized controlled trials (RCTs) found that CBT significantly reduced VMS frequency and severity in menopausal women compared to no treatment or usual care.
- Exercise: Exercise has been shown to improve various aspects of menopausal health, including VMS. A systematic review and meta-analysis of 19 RCTs found that exercise reduced the frequency and severity of VMS in menopausal women. The most effective exercise programs included aerobic exercise and resistance training.
- Acupuncture: Acupuncture involves the insertion of fine needles into specific points on the body to balance energy flow. A meta-analysis of 16 RCTs found that acupuncture significantly reduced the frequency and severity of VMS in menopausal women.
- Black cohosh: Black cohosh is a plant-based supplement that has been traditionally used to treat menopausal symptoms. A systematic review and meta-analysis of 16 RCTs found that black cohosh reduced the frequency and severity of VMS in menopausal women. However, the evidence for black cohosh is mixed, and more research is needed to confirm its efficacy and safety.
- Mind-body therapies: Mind-body therapies, such as yoga and meditation, have been shown to reduce stress and improve overall well-being. A systematic review and meta-analysis of 17 RCTs found that mind-body therapies reduced the frequency and severity of VMS in menopausal women.
It is important to note that the effectiveness of non-hormonal therapies may vary depending on the individual. It is reasonable to try them, but then we recommend sticking with the intervention for at least 12 weeks before deciding whether it’s helping or not. These options can also be combined, and some women may require several therapies to manage their symptoms effectively.
Ultimately, women have varying degrees of vasomotor symptoms, and while some will require HRT to keep them from interfering with their daily life, many will manage with no treatment or only non-medication type interventions. Non-hormonal therapies, such as CBT, exercise, acupuncture, black cohosh, and mind-body therapies, have been shown to be effective in reducing the frequency and severity of VMS. As always, your OBGYN should be able to review options with you. If you feel you need a physician more specialized in menopause, you can find certified physicians from the North American Menopause Society.
A PEDIATRICIAN’S ADVICE FOR PLAYGROUNDS
Playgrounds can be great places for children to play and have fun, but they can also be dangerous if not used properly. With warmer weather coming and spring and summer breaks, here are some simple guidelines for the safe use of playgrounds:
- Supervision: Children should always be supervised while playing on a playground. Parents, guardians, or other responsible adults should be present to watch over them and ensure their safety.
- Age-Appropriate Playgrounds: Children should only play on playgrounds that are designed for their age group. Playgrounds that are designed for older children can be dangerous for younger ones.
- Proper Clothing: Children should wear appropriate clothing for playground activities. Loose clothing, jewelry, and accessories that can get caught in the equipment should be avoided.
- Proper Footwear: Children should wear proper footwear, such as closed-toe shoes with good traction, to prevent slips and falls.
- Check Equipment: Adults should check playground equipment before children start to play. Look for broken or damaged equipment, sharp edges, or anything that could cause injury.
- Soft Ground Cover: Playgrounds should have soft ground cover, such as mulch, sand, or rubber tiles, to cushion falls.
- Sun Protection: Children should wear hats and sunscreen to protect them from the sun while playing on a playground.
- No Rough Play: Children should be taught to use the playground equipment properly and to avoid rough play, such as pushing or shoving.
- No Climbing on Slides: Children should not climb up the slides, which can cause collisions and injuries.
- Follow Rules: Children should be taught to follow the rules of the playground and to respect other children’s right to play safely.
Pediatrician – Los Altos
763 Altos Oaks Drive, Suite 4
Los Altos, CA 94024
EL CAMINO HOSPITAL VISITOR POLICY UPDATES
For the main hospital, El Camino Health allows two visitors per day with patients on Labor & Delivery and nearly all inpatient units. Check the link above before you plan to come to the main hospital for any new updates.
For details specific to the Orchard Pavillion, also known as the Women’s Hospital, please read 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 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 again the most-read article last quarter; some 1,200 people have read the article since January 1, 2023. This is followed by an older article on the science behind couples trying to conceive a baby of a certain gender, with over 1,100 people wanting to see if they can influence the gender they conceive. Finally, our most popular weight loss article on intermittent fasting was the third most-read article this last quarter; almost 700 people, no doubt working on New Year’s Resolutions, hopefully finding helpful information..
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 Contrast-Enhanced Mammography for High-Risk Patients, Updates in Weight Loss Medications, and information on the MOMS program at El Camino Hospital. 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
|2495 Hospital Dr. Suite 670
Mountain View, CA 94040