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Index   --   WPGYN Newsletter  --  Volume 9, Issue 2,  April 2012

Women's Health Forum 4/28/2012

Eldercare Consultations

To Pap or Not to Pap

Do You Have Medical Questions?

Leg Cramps - Painful, Common, and Neglected

El Camino Hospital presents Women’s Health Forum 4/28/12


El Camino Hospital is again presenting a Women’s Health Forum on April 28th, Saturday, from 9 am to noon.  To register call 800-216-5556. 

The morning will include health lectures on a variety of topics including advances in GYN surgery, senior health, bones and joints, pelvic health, veins, skin cancer prevention, GI/Colon health and dealing with depression.  A morning exercise class to warm-up before the event starts.  There will also be free health screenings including osteoporosis heel screening, vein screening and a skin cancer screening (a separate appointment is required for the skin cancer screening).  Come and enjoy the giveaways, health fair information tables, brunch and more. 

The free skin cancer screening will take place from noon to 3:00 pm and requires a separate registration and appointment.  To register, call 800-216-5556.  These events are always popular and fill up fast.   


Eldercare Consultations


One of the services offered by El Camino Hospital's Health Library & Resource Center is eldercare consulting. 

Talk with one of the eldercare consultants to discuss any concerns or questions that you may have about aging, whether about yourself, an aging family member, or friend. Consultants assist older community members and their families with such concerns as maintaining independence, caregiver stress and burnout, driver safety, moving decisions and dealing with depression, to name just a few. You may arrange for an appointment in the office, talk to them by phone or communicate by e-mail.

An eldercare consultant can evaluate your needs and assist you with developing a prioritized action plan, and provide you with pertinent information and referrals for: in-home care,  care management, caregiver support resources, adult day programs, dementia/memory loss, housing/living options, mental health services, and meal programs.

To make an appointment to meet with one of the eldercare consultants in Los Gatos, call 408-866-4044.  In Mountain View, call 650-940-7210.

Written by Catherine M. Chavez, Eldercare consultant



To Pap or Not to Pap

In February 2012, a symposium, cosponsored by the American Cancer Society (ACS), the American Society of Colposcopy, the Cervical Pathology ASCCP, and the American Society for Clinical Pathology (ASCP) issued new “guidelines” regarding tests for cervical cancer screening.


What is a guideline?  A medical guideline (also may be called a clinical guideline, clinical protocol or clinical practice guideline) is a document, developed by a medical organization, with the aim of guiding decisions and criteria regarding diagnosis, management, or treatment of a specific medical problem.  Remember, Guidelines are not hard and fast rules.


In the past, guidelines were based on tradition and experience.  Now, appropriately, guidelines are based on evidence based medicine.  Evidence based medicine is data collected from medical studies which are designed to determine the efficacy of specific diagnostic or treatment protocols. Unfortunately, it is not as simple, nor as exact as it sounds.   Medical studies are not perfect nor does every study come to the same conclusion.  Therefore, there is still an element of interpretation of the “evidence” that comes into play when developing guidelines.


Furthermore, in spite of access to the same evidence based data, different organizations frequently come to different conclusions and recommendations.  This can be confusing (even upsetting) to patients and their physicians.


The most recent guidelines issued by the above organizations are:

· Begin screening at 21 years of age, regardless of sexual activity or other risk factors.  Do not screen before age 21.

· Between 21-30 screen every 3 years with Pap alone.

· Between 30-65 screen, with Pap (cytology) and HPV, every 5 years (preferred) or cytology alone, every 3 years (acceptable).

· Do not screen with HPV alone.

· After 65, when there is evidence of adequate negative previous screening, without significant abnormality, screening can be discontinued.

· In the 65+ age group, screening should not be reinstituted for any reason, even if the woman has a new sexual partner.

· After a hysterectomy, without a prior significant abnormal pap, pap smears should not be done.

· Screening is the same as above, with or without, prior HPV vaccination (Gardasil® or Cervarix®).


The major change from previous guidelines is the lengthening of the screening interval both in the 21-30 and the 30-65 age groups.


ACOG (the American College of Obstetricians and Gynecologists) has yet to issue new guidelines.   Their latest guidelines are from 2009, when the standard yearly pap was called into question.  ACOG guidelines call for every 2 year screening with a pap smear in women under the age of 30 and every 3 years after.  Their guidelines state that: “women aged 21 to 30 years who not at high risk be screened every 2 years.”  Like most guidelines, unfortunately, there is always some ambiguity.  What is a woman who is not at high risk?  Most women between age 21 and 30 have more than one partner and some would call that high risk.


Appropriately, guidelines attempt to look at not just benefits but potential harm from a procedure or diagnostic test.  In the new guideline this was definitely a factor.  HPV is very common, especially in the younger age group, and it is frequently (though not always) self-limiting.  Unfortunately, if you find an abnormality, physicians and their patients want to evaluate further and usually treat.  The concern is that we may be over treating and potentially causing harm.  There may be fertility consequences from cervical treatment with LEEP or conizations.  There is, of course, also monetary and personal costs associated with both diagnostic and treatment procedures.


The rationale for some of the decreased screening is that invasive cervical cancer is rare in women younger than 21 while HPV and associated abnormal pap smears are high.  This can result in more invasive testing and possible more aggressive treatments than is absolutely necessary.


Are you confused yet?

Guidelines are developed and revised all the time.  Different guidelines are given by different organizations (who presumably analyze the same scientific data).  There will always be the Art versus the Science of medicine.

At this time, Drs. Litwin and Sutherland (and our local gyn oncologist) are uneasy about routinely extending the pap smear screening interval to 5 years. We both have patients who, if the screening interval had been 5 years, would have had a delayed serious diagnosis and potentially less favorable outcomes.   We will try to determine the best frequency for you individually. We will take into account prior screening results, age, sexual history and your level of anxiety.   Feel free to discuss, at your next visit, what we recommend for you and why. 

Christine Litwin-Sanguinetti, MD



Do You Have Medical Questions?




Often patients have a simple question that they forgot to ask during their appointment, but they would like to have the answer before the next time they see the doctor.  It is common today to turn to the internet for such answers, but often you come away more confused than when you started.  Much health information has been posted by marketers who want you to buy their product so it is not always trustworthy.  In a recent study by the Pew Internet and American Life Project entitled “Chronic Disease and the Internet” published in 3/24/2010, 48% of adults without a chronic condition and 59% with a chronic condition rated the health information found online as being “no help”. 

In the spirit of interactive social media, there is now an interactive health network site called HealthTap (www.healthtap.com) designed to provide free, reliable, and independent health information 24/7.  It is designed as a question and answer format.  Your question is posted and doctors from the appropriate specialty will see it and answer it.  Several doctors may give their opinions.  Or doctors may agree with a posted answer giving it stronger validity. 

Women Physicians Gyn was one of the physician groups invited to participate in the initial pilot launch over a year ago.  At that time it was limited to Ob-Gyn topics.  It has since become open to the public with no restriction on patients, physicians, or medical specialities.  It has grown exponentially with over 10,000 physicians participating and over 50,000 answers posted to specific questions.  Of course, many questions are too complicated for this type of format, and many medical problems require an exam for adequate assessment. 

Take a look at the site and see what you think.  Next time you have a simple question, you may find it to be the “go-to” place.  There is also a HealthTap app which you can put on your smart phone or electronic device. 



Leg Cramps—Painful, Common, and Neglected



Are you one of the 40% of people who suffer from leg cramps?  Do you sometimes find yourself hopping out of bed in the middle of the night to relieve the cramps?   This can be quite distressing to many adults yet many never mention it to their doctors. 


What causes leg cramps? - In the majority of cases, the cause of leg cramps is not known.  They are more common in females and more common as people get older.  A few specific diseases can be contributing factors, such as clogging of the arteries that go to the legs, arthritis in the joints, electrolyte imbalances, or nerve changes called peripheral neuropathy.  Your doctor can help determine if you have any of these problems and may want to do some lab tests on things like electrolytes, thyroid function tests, iron studies, and kidney tests.  If there is a concern about restless legs or periodic limb movements, they may even recommend a sleep study. 


What at-home remedies work for leg cramps? - Unfortunately there are not many good clinical trials to support suggestions that have been made for treating leg cramps, but they may be worth a try.  Hydration, warm or cold compresses, exercise, and calf stretches may provide some benefit.  A Vitamin B complex containing a combination of B vitamins (fursultiamine 50 mg, hydroxocobalamin 250 mcg, pyridoxal phosphate 30 mg, riboflavin 5 mg) showed an 86% efficacy in a small trial (only 28 patients) whereas placebo had no effect.   Some patients report improvement with taking magnesium supplements.  Although it is not FDA approved and may have some risks, some patients will try a glass of tonic water before bed. 


What medicines work for leg cramps? - In the old days, a common and effective treatment of leg cramps was quinine pills, a medicine used to treat malaria.  It had some minor side effects, like headaches and ringing in the ears, but more importantly, it was also associated with some very serious side effects, like blood disorders and even deaths.  The incidence of very serious side effects was rare, less than 1%, but because of the seriousness of the events, the FDA recommends against its use.  There is a very small amount of quinine in tonic water,  about 83 mg in 1 liter, so it would take 2 to 4 liters to equal a full dose.  The FDA recommends against the use of tonic water for treatment of leg cramps since people might try to take toxic doses which could lead to serious health risks.  


Some other prescription medicines have been studied in clinical trials.  Gabapentin which is a medicine used for epilepsy and neuropathic pain and migraine prevention has been shown to be helpful when taken with the evening meal at a dose of 600 mg.  The main side effect is drowsiness.  Diltiazem which is in a class of drugs known as calcium channel blockers, is used for hypertension, chest pain and migraine prevention.   It works by dilating blood vessels and has some data suggesting it is useful for leg cramps when taken before bed at a dose of 30 mg. 


What can you do next? - If you have tried the home remedies without success, and are frustrated enough with your symptoms that you would like to try the medical therapies, make an appointment with Dr. Litwin or Dr. Sutherland.  We can review side effects, risks, and expectations of the medicines in more detail and prescribe them for you if you are an appropriate candidate. 


El Camino Women's Medical Group provides comprehensive Obstetric & Gynecologic care for patients throughout the Bay Area. Minimally invasive surgery, infertility, women's mental health, and the MonaLisa Touch are just a few of the specialized services we offer.
The MonaLisa Touch treatment is available at El Camino Women's Medical Group. Call the office (650-396-8110) or email Shar (Shar@ElCaminoWomen.com) for more information.
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