2023 Issue 3 Quarterly Newsletter

Go to previous issue

WOMEN’S HEALTH

We hope everyone is enjoying their summer.   A great time for outdoor activities, time with family and friends, and visiting California’s natural wonders.

This issue of Women’s Health has great articles on postpartum depression, weight loss surgery, and treating the inevitable brown spots.  There’s also been a breakthrough treatment for menopause, Veozah.  It was covered in a blog article on our website last month and the Menopause Society has been quoted in many articles on this first-of-its-kind treatment.  In more good news, we have an article on the great strides made in survival rates after diagnosis of breast cancer.  A reminder that we recommend all women start mammograms at age 40 and have them done every year.  If you have a family history of breast cancer, make sure you let us know, as you may need to start screening earlier.

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!

Wishing you all a wonderful summer,

Sarah Azad, MD

In this issue:

Practice Updates

Online Prenatal Classes

Research at ECWMG

Brown Spots and How to Get Rid of Them

Weight Loss Medications vs Bariatric Surgery

Understanding Postpartum Depression

Obesity Appears to Impair Brain’s Response to Nutrients

Sleep Apnea in Pregnancy

Good News in Breast Cancer Survival

El Camino Hospital Visitor Policy Updates

Highlights from our Women’s Health Blog

PRACTICE UPDATES

Office Visitor Policy Updates

We are now allowing asymptomatic visitors with patients to their visits.  Proof of vaccination is no longer required and masking is encouraged but optional.

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.   These classes cover preparing for childbirth, breastfeeding, and newborn care and have been very popular, and we plan to have them every one to two months. These classes are also open to members of the public that wish to register.

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 Educational Videso

We are creating a series of educational videos on things commonly discussed during prenatal visits.  You can see what we have so far here.

RESEARCH AT ECWMG

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

BROWN SPOTS AND HOW TO GET RID OF THEM

Lillian Soohoo, MD

Board Certified Dermatologist

Are you wondering what to do with those dark blotches that continue to appear on your skin, especially your face?

Visiting your dermatologist is the first step to make sure that these spots are not precancerous or cancerous.  Since suspicious lesions may need a skin biopsy to determine if they are benign or not, a thorough examination by a board-certified dermatologist is the best way to treat any skin lesion you are concerned about.  Skin cancer is usually completely curable when diagnosed early. Once a well-trained dermatologist has examined your skin and determined that the brown spots you have are indeed benign and only cosmetic in nature, there are several effective options available to treat and remove them.

Fortunately, most facial brown spots are harmless. There are several benign causes of unwanted skin discoloration. Solar lentigos are brown spots often seen in mature, sun-damaged skin.  Ephelides, otherwise known as freckles, are seen in children and young adults and are also the result of too much sun exposure.  Post-inflammatory hyperpigmentation (PIH) is common in people of color, frequently appearing after any source of skin irritation, including pimples and insect bites.  Melasma is usually seen in women and is often referred to as the brown “mask of pregnancy.”  Melasma can be very difficult to treat and commonly involves the forehead, temples, cheeks, and upper lip. Women may notice melasma during pregnancy or with the use of estrogen-containing medications such as birth control pills, the NuvaRing, and estrogen replacement therapy (HRT) after menopause. If your brown spots are raised and bumpy, these are called dermatosis papulosa nigra (DPN) and most commonly affect people of Asian and African descent.

Many over-the-counter skin care products aimed at removing unwanted brown spots and other signs of skin damage just don’t contain the active ingredients needed to provide the most effective results. By allowing a dermatologist to create an individualized skin care regimen, you will have an expert selecting the most effective products for your skin. An experienced dermatologist will be able to target your specific skin concerns while taking into consideration your skin type and skin sensitivities, as well as your lifestyle. There are many effective ingredients that are available in products specifically designed for dermatologists to use for skin hyperpigmentation. Some newer products available in our office include topical platelet-rich plasma (PRP) and both topical and oral forms of tranexamic acid.

Procedures such as chemical peeling, laser/light treatments (eg, Fraxel, Clear and Brilliant, PicoWay/Sure laser, Intense Pulsed Light), and even liquid nitrogen (freezing) are all effective in improving brown spots, but only when performed under the direction of a dermatologist who has extensive knowledge of your skin type.  An important consideration for any potential patient is their risk for post-inflammatory hyperpigmentation, or worsening of the skin pigmentation which can occur due to the potential irritation from these procedures. Sometimes this rebound darkening may happen 2-3 weeks after a laser/light or chemical peel treatment. In most cases, this can be lessened by pretreatment with prescription-strength topical fading cream for several weeks before the chemical peel or laser/light treatment.  Afterward, a maintenance skin care regimen is strongly recommended to ensure the best, longest-lasting results following any procedure.

Always remember that meticulous sun protection is as important as any treatment choice when considering the removal and prevention of brown spots. Exposure to the sun will ultimately reverse all benefits of any treatment used to remove pigmentation in the skin. To achieve the best results, consult a dermatologist to formulate the most effective treatment plan for you.

Lillian Soohoo, MD

555 Knowles Drive, Suite 220

Los Gatos, CA 95032

408.317.3688

www.goldenstatedermatology.com/los-gatos/

WEIGHT LOSS MEDICATIONS vs BARIATRIC SURGERY: WHICH IS THE BEST OPTION FOR YOU?

Eitan Neidich, MD

General Surgery

Fellowship trained in Minimally Invasive Surgery and Bariatrics

Losing weight can be among the most daunting tasks for someone looking to transform their health. If you’re reading this, you should feel proud of yourself for thinking about the best options you have to improve your health! Obesity-related conditions include heart disease, stroke, type 2 diabetes, and certain types of cancer. These are among the leading causes of preventable, premature death. Generally, surgery for obesity is recommended for people with a BMI (body mass index) >35 kg/m2 or for those with a BMI >30 kg/m2 with symptoms of metabolic disease.

Beyond diet and exercise, there has recently been an explosion in interest in new weight loss medications that has likely left you wondering: What are these medications? Are they safe? Or is bariatric surgery a better option for me?

First off, it’s important to recognize that there is always a team of healthcare providers from nutritionists to pharmacists to obesity-medicine specialists and bariatric surgeons to help you navigate this journey. With that in mind, let’s break down what these new medications can do and whether they’re right for you!

How do the new weight loss medications work?

Glucagon-like peptide-1 receptor agonists or GLP-1 agonists such as Wegovy, Ozempic, and Mounjaro are injectable prescription medications typically administered once a week.

They were initially developed and approved for the treatment of type 2 diabetes but soon it was noticed that patients had substantial weight loss.

These medications work by activating the gut hormone GLP-1. This slows the movement of food in your gut, making you feel full longer, and works for weight loss by suppressing your appetite, so you crave and thus eat less food.

Benefits of Medications:

These new medications represent a significant breakthrough in the treatment of obesity. While results will vary for each patient and depend on a variety of factors, some of the GLP-1 agonists have been shown to reduce a person’s body weight by up to 20%!

So what is the downside of these medications? Well like any medication there are side effects. These include diarrhea, vomiting, constipation, abdominal pain, headache, fatigue, and dizziness. Additionally one has to continue taking the medication to see the benefit.

What about Bariatric Surgery (weight loss surgery)?

For people with obesity, bariatric surgery is still the most effective weight-loss treatment. This class of procedures, predominantly the gastric sleeve or bypass, reconfigures the digestive system so people feel less hungry and more full. Most people experience weight loss of 50 percent, significantly more potent than GLP-1 medications and it is why bariatric surgery remains the gold standard for treating obesity.

In addition to more significant weight loss and lower BMI, bariatric surgery has been shown to reduce the risk of death from any cause by more than 40%.  It also lowers the risk of death by heart disease by 40%, cancer by 60%, and diabetes by 92%.

Can weight loss medications and bariatric surgery be used together?

Absolutely. Tackling weight loss is a team approach and bariatric surgeons work closely with obesity medicine specialists to help prescribe these weight loss medications before and potentially after bariatric surgery.

What about the cost?

Bariatric surgery is also much more affordable than these new weight-loss drugs. Surgery is covered by Medicare and most private insurances. Unfortunately, many of these new drugs have variable insurance coverage and can cost upwards of $1,000 a month indefinitely.

What weight loss programs are covered by insurance?

The best way to find out if your health insurance covers weight loss medication or weight loss surgery is simply to ask. Your insurance very well might cover several options as long as certain criteria are met.

The cost of weight loss medications can vary widely depending on your insurance plan or status. Without insurance, Ozempic® is estimated to cost around $900 a month and Wegovy® is estimated to cost around $1,350 a month. If you do qualify for insurance coverage, the cost of GLP-1s can still vary widely from $0 to hundreds of dollars.

Your insurance might request a referral from your primary care doctor, along with other documents that show your health history. Your insurance will probably want to know if you’ve tried to lose weight in the past, such as through diet, exercise, or prescription medications. Most insurance plans have some coverage.

According to Duke Health, you will likely have to meet some or all of the following criteria in order to get weight loss surgery covered by your insurance:

• Be over the age of 18
• Have a BMI (body mass index) of 35 or greater, or have a BMI of 30 or greater with a comorbidity such as diabetes or hypertension
• Diagnosis of morbid obesity
• Pass a psychological evaluation determining you’re emotionally fit to undergo weight loss surgery
• Don’t smoke or fully quit smoking before the procedure
• Willingness to complete a weight loss plan mandated by your insurance company before or after surgery
• Well-documented history of weight loss efforts

Even if your policy doesn’t cover weight loss surgery as-is, if you can provide evidence to your health insurance company that weight loss surgery is a medical necessity for you, you may get coverage.

So are the new weight loss medications right for you? As with all of medicine, the answer is tailored to your particular needs. Sometimes the medications alone will be all you need or you may decide with your health care team to combine it with bariatric surgery in addition to making healthier lifestyle choices. Whatever you choose, Dr. Neidich and the team at El Camino Health would be happy to talk with you and begin your health transformation journey!

—

Dr. Eitan Neidich is a board-certified general and bariatric surgeon who specializes in helping patients with obesity-related health issues. He attended medical school at the University of California, San Francisco, and completed his fellowship training in minimally invasive surgery and bariatric surgery at the Mount Sinai Hospital in New York. Dr. Neidich is highly qualified to provide comprehensive care for patients of all ages suffering from obesity. He is passionate about helping his patients transform their health through a supportive, team-based approach. He will be joining MountainView Surgery on October 1, 2023. To make an appointment call 650-600-7301

Mountain View Surgery

2500 Hospital Dr. Bldg 15 Suite 1

Mountain View, CA 94040

O: 650-641-7861

F: 650-963-5071

UNDERSTANDING POSTPARTUM DEPRESSION

OBESITY APPEARS TO IMPAIR BRAIN’S RESPONSES TO NUTRIENTS

Obesity is a complex and multifactorial condition that poses significant health risks. While the detrimental effects of obesity on physical health are well known, emerging research suggests that obesity may also impact brain function and influence eating behavior. A recent study published in Nature Metabolism indicates that obesity impairs the brain’s ability to recognize the sensation of fullness and satisfaction after consuming fats and sugars, potentially explaining why many individuals struggle to maintain weight loss in the long term.

The study involved a group of individuals with obesity who underwent a weight loss intervention program. Magnetic resonance imaging (MRI) scans were performed on the participants’ brains before and after the intervention, allowing researchers to observe changes in brain activity and connectivity. Additionally, participants’ responses to different nutrients were evaluated using taste tests and sensory evaluations.

The findings revealed that obesity significantly altered the brain’s responses to nutrients. Specifically, individuals with obesity displayed reduced activation in brain regions responsible for regulating appetite and reward processing. These regions include the insula, amygdala, and striatum, which play crucial roles in modulating food intake and feelings of satisfaction. Interestingly, these brain changes persisted even after substantial weight loss, suggesting a lasting impact of obesity on neural circuits involved in eating behavior.

The impaired brain responses observed in individuals with obesity may contribute to a phenomenon commonly experienced by those who have lost weight—regaining the pounds lost. The diminished sensitivity to nutrients and reduced feelings of satisfaction after consuming fats and sugars could lead to increased food cravings and overeating, sabotaging weight management efforts. This finding emphasizes the complexity of obesity and highlights the need for comprehensive approaches to address both the physiological and neurological aspects of the condition.

Understanding the underlying mechanisms behind these brain alterations is crucial for developing effective strategies to combat obesity. While the exact causes of the observed brain changes remain unclear, it is believed that chronic overconsumption of high-calorie foods and an unhealthy diet contribute to the development of obesity-related brain dysfunction. Additionally, factors such as genetics, hormonal imbalances, and environmental influences may also play a role in shaping the brain’s response to nutrients.

The implications of this study extend beyond weight management. The altered brain responses to nutrients in individuals with obesity may have broader implications for overall health and well-being. Poor diet choices and excessive calorie intake, often driven by dysfunctional brain circuits, can lead to the development of chronic diseases such as diabetes, cardiovascular disorders, and metabolic syndrome. By better understanding the neurological aspects of obesity, healthcare professionals can develop more personalized and targeted interventions to promote healthier eating habits and prevent long-term weight regain.

Further research is needed to delve deeper into the complex interplay between obesity and brain function. Longitudinal studies that follow individuals over an extended period are necessary to investigate the long-term effects of obesity on brain health and determine whether these brain alterations can be reversed or attenuated through interventions such as dietary modifications, cognitive-behavioral therapy, or pharmacological approaches.

In conclusion, the recent study published in Nature Metabolism sheds light on the impact of obesity on the brain’s responses to nutrients. The findings suggest that obesity impairs the brain’s ability to recognize fullness and satisfaction after consuming fats and sugars, potentially contributing to weight regain after successful weight loss efforts. These brain alterations highlight the need for a comprehensive approach to address obesity, focusing not only on physical health but also on neurological factors influencing eating behavior. By gaining a deeper understanding of the complex relationship between obesity and brain function, we can develop more effective strategies to combat obesity and promote long-term weight management.

SLEEP APNEA IN PREGNANCY

Sleep apnea, a common sleep disorder characterized by interrupted breathing during sleep, can also affect pregnant women. Sleep apnea in pregnancy poses unique challenges due to physiological changes and potential risks to both the mother and the developing fetus. Though best discussed with your OBGYN or Sleep Medicine Specialist, this is meant to be a good introduction to a rarely discussed issue.

Prevalence:

Sleep apnea affects approximately 2% to 12% of the general population. Among pregnant women, estimates suggest that up to 20% may experience sleep-disordered breathing, which includes sleep apnea. The prevalence of sleep apnea tends to increase with advancing gestational age.

Symptoms:

The symptoms of sleep apnea in pregnancy may resemble those experienced by non-pregnant individuals. Common signs include:

• Loud snoring
• Frequent awakenings during sleep
• Excessive daytime sleepiness and fatigue
• Gasping or choking episodes during sleep
• Morning headaches
• Restless sleep
• Difficulty concentrating

Evaluation and Diagnosis:

If sleep apnea is suspected in a pregnant woman, a thorough evaluation is necessary to determine its presence and severity. The following steps may be involved:

Medical History: The healthcare provider will assess the patient’s medical history, including any symptoms and risk factors such as obesity, hypertension, or a family history of sleep apnea.

Physical Examination: A physical examination may be conducted to identify physical attributes or anatomical factors that contribute to sleep apnea, such as obesity or enlarged tonsils.

Sleep Study: Polysomnography (PSG), the gold standard test for diagnosing sleep apnea, may be recommended. PSG monitors various physiological parameters during sleep, including airflow, oxygen levels, brain activity, and muscle movements.

Management Options:

The management of sleep apnea in pregnancy aims to improve sleep quality and mitigate potential risks. Here are some common management options:

Lifestyle modifications: Pregnant women with sleep apnea can benefit from adopting healthy lifestyle habits, including maintaining a regular sleep schedule, avoiding supine sleeping positions, maintaining a healthy weight, and practicing relaxation techniques before bedtime.

Continuous Positive Airway Pressure (CPAP): CPAP therapy is the primary treatment for moderate to severe sleep apnea. A CPAP machine delivers a continuous flow of air through a mask, keeping the airway open during sleep. It is safe to use during pregnancy and can significantly improve sleep quality.

Oral Appliances: In some cases, oral appliances may be recommended to help alleviate sleep apnea symptoms. These devices help reposition the jaw and tongue to keep the airway open. Consultation with a dentist or a sleep specialist is necessary for proper fitting and monitoring.

Surgical Interventions: Surgery is usually considered a last resort for sleep apnea and is typically reserved for cases that do not respond to conservative treatments. Surgical options may involve removing excess tissue, correcting structural abnormalities, or realigning the jaw.

Sleep apnea in pregnancy is a condition that requires attention and management to ensure the well-being of both the mother and the developing fetus. Recognizing the symptoms, seeking appropriate evaluation, and exploring the available management options are crucial steps toward addressing sleep apnea effectively. It is essential for pregnant women with suspected sleep apnea to consult their healthcare providers for proper diagnosis and guidance on suitable treatment strategies.

GOOD NEWS IN BREAST CANCER SURVIVAL

Breast cancer is a formidable foe that has affected the lives of countless women around the world. However, there is reason for hope and celebration as recent research reveals encouraging statistics regarding long-term survival rates. A study published in the BMJ highlights a substantial reduction in the risk of death among women diagnosed with early breast cancer since the 1990s. These findings offer a glimmer of hope and signify significant progress in the fight against this devastating disease.

According to the research, conducted on a large scale, the average risk of dying from breast cancer within five years of diagnosis dropped from 14% in the 1990s to a remarkable 5% today. This substantial decrease is a testament to the advancements made in early detection, diagnosis, and treatment options. It demonstrates the incredible strides made by researchers, medical professionals, and advocates in the field of breast cancer.

Furthermore, the data from the study revealed that more than 60% of women diagnosed with breast cancer between 2010 and 2015 had a five-year risk of 3% or less. This statistic is particularly heartening as it highlights the growing number of women who can expect to become long-term survivors. It signifies the increasing effectiveness of early interventions, improved therapies, and enhanced support systems.

One of the key factors contributing to this positive trend is the emphasis on early detection through regular mammograms and breast self-examinations. Detecting breast cancer at an early stage allows for timely intervention, increasing the chances of successful treatment and improved long-term outcomes. Moreover, advancements in screening technology, such as digital mammography and 3D mammography, have enhanced the accuracy and reliability of breast cancer detection.

Additionally, improved treatment options have played a crucial role in the increased survival rates observed today. Targeted therapies, including hormone receptor-targeted treatments and HER2-targeted therapies, have revolutionized the way breast cancer is treated. These therapies specifically target the characteristics of the tumor, resulting in more effective treatment with fewer side effects.

There have also been significant advancements in surgical techniques, such as breast-conserving surgeries and nipple-sparing mastectomies, which have improved cosmetic outcomes and quality of life for breast cancer survivors. The integration of surgery with other treatment modalities, such as radiation therapy and chemotherapy, has also contributed to better survival rates.

In addition to medical advancements, the increased awareness and education surrounding breast cancer have been instrumental in improving outcomes. Organizations and advocates have worked tirelessly to spread awareness about the importance of early detection, risk factors, and the significance of seeking timely medical attention. This heightened awareness has led to more women being proactive about their breast health and seeking medical help promptly.

Moreover, the support systems available for breast cancer patients have expanded and improved over the years. Support groups, counseling services, and survivorship programs offer emotional, psychological, and practical support to patients and their families. These resources play a vital role in empowering individuals, fostering resilience, and promoting overall well-being during the challenging journey of breast cancer treatment and recovery.

While the progress made in breast cancer survival rates is indeed commendable, it is essential to remember that challenges still exist. Some women may face barriers to accessing timely and appropriate healthcare, and certain subtypes of breast cancer may be more aggressive and challenging to treat. Continued research, innovation, and equitable access to healthcare are imperative to further improve outcomes for all women affected by breast cancer.

In conclusion, the latest research published in the BMJ brings forth heartening news in the field of breast cancer survival. The substantial reduction in the risk of death since the 1990s is a testament to the advancements in early detection, treatment options, and support systems. The increasing number of long-term survivors is a cause for celebration and motivation to continue the fight against breast cancer. By promoting awareness, investing in research, and ensuring access to quality care, we can strive toward a future where breast cancer is not only survivable but ultimately preventable.

EL CAMINO HOSPITAL VISITOR POLICY UPDATES

General information on visitor’s policy

Last updated visitor guidelines from April 4, 2023

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.

Information for Labor & Delivery, NICU, and the Mother-Baby Unit:

Last updated April 4, 2023

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 older article for couples hoping to conceive a baby of a certain gender was the most-read article last quarter.  Over 1,000 people checked in for tips.  A popular article on avoiding cancer-causing chemicals in cosmetics, written by Dr. Shyamali Singhal, a guest author and founder of Hope and Beauty, came in second having been read by over 900 people.  Finally, our most popular weight loss article on intermittent fasting was again the third most-read article this last quarter, read by over 700 people.

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 Fatty Liver Disease, Maximizing Health in the Midlife, Natural Remedies for PMS, and an introduction to Veozah, a breakthrough medication in the management of the vasomotor symptoms of menopause.  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