It's time again to welcome a New Year and to take stock of the old. This year marks the 10th anniversary of the Women Physicians online newsletter!

The last year saw a major change with the retirement of Dr. Christine Litwin, a founder and principal of Women Physicians Ob/Gyn for over 30 years. I appreciate the confidence of many of her loyal patients who have continued to see me for their Women's Health care. Many of you have asked me for updates on how she is doing, so she kindly agreed to write an article for this issue of the newsletter.

A Message from Dr. Christine Litwin

I enjoyed having my mammogram in December. What woman enjoys her mammogram? No, I’m not a masochist and I didn’t really enjoy the procedure. I got to talk to 2 of the mammogram techs, that I’ve known for more than 20 years. Both told me how my patients have told them that they miss me and that I was a great doctor. You can probably guess how good that made me feel. It even helped with the pain of having to have compression views for an abnormality (the final findings were negative). Doctor Sutherland has also been telling me that my patients have been asking about me and that they miss me. I am so grateful to have had the opportunity to be a part of so many lives.

Dr. Sutherland says that everyone would appreciate an update, so here goes.

I wish I could say that I’m enjoying retirement. People are always asking if I like being retired. Some even say: “I know you must be so happy to be retired.” I miss working more than I even thought I would. I miss the challenge of medicine and the constant intellectual stimulation. However, what I miss most is the yearly updates on my patients and their families, especially the children I delivered. Anyone who wants to update me, feel free to email me at drchrislitwin@gmail.com. I’ve had a few emails from patients but would love more.

So what have I been doing? Unfortunately, I haven’t found my 2^nd career yet but I still plan to. If any of you have ideas let me know. I’m seriously considering any and all suggestions.

I did spend the winter of 2013 in Kauai teaching at Kauai Community College as I had talked about. I enjoyed the experience immensely. Of course, how can you not enjoy Hawaii for 4 months? I loved teaching and think I’m pretty good at it. I taught a class called Introduction to Human Disease. My class was made up of all “pre-nursing” students. For an introductory course, the course material was voluminous and difficult. It’s hard to teach about diseases when the students don’t know basic normal anatomy and physiology. In addition, many of them didn’t remember their medical terminology (which was a prerequisite course). Sometime as I was lecturing I’d see a glaze over their eyes and realize they didn’t understand a thing I was saying. It helped that I learned to read people’s faces in my years of practice. My teaching style changed over the semester—sometimes it changed from day to day. I’d try something and continue to use it if it worked or change to something else if it didn’t. Overall I think that I learned more than any of the students in the class. Of course I’m fairly certain that I also worked harder and longer than any of the students in the class. I prepared about 10 hours for every 1 hour of teaching. I don’t know what I would have done without Google Images. I wanted my presentation to keep them interested and you can’t do that with just words on a slide. Also I felt that images gave them more than one way to try to master and remember the material. I think I succeeded because my reviews were pretty favorable.

I didn’t feel my students were well prepared for a college level class and many of them seemed unmotivated (I may have misread lack of motivation with Hawaiian culture). Their basic spelling, grammar and vocabulary skills were weak. Also, all my students worked part time and several had young children so I think it was hard to devote as much time to my class as they should have. I’m not sure that the Hawaiian culture supports higher education. Someone told me that Kauaiians didn’t want their kids to get advanced degrees because that might make them leave the island (there are not many science or technology jobs on the island.) I learned that understanding culture is important in both medicine and teaching.

Those who know me well know that I’m a “fast” person. I walk fast, talk fast and eat fast (not good for watching one’s weight) and generally move fast. I was walking to class from the parking lot one day when I came across a group of my students in front of me. Walking at my normal pace I caught up and passed them in no time. I commented to them that they were slow and one of them turned to me and said: “Dr. Litwin you’re on main land time, we’re Kauaiians.” I guess that said it all.

After returning from Kauai, I began the arduous task of cleaning out our family home after living there for 21 years. It’s time for my husband and I to downsize. Though we’ll miss our home we both know it’s the right thing to do. First, I needed to prepare and stage the house for sale. Renting a storage locker for my valuables and fragile items was the first task. Not sure that I liked the final result of the staging—it just wasn’t my home! The next task was getting rid of stuff and you can accumulate a lot of stuff in 21 years. (My advise to you is to start de-junking now). No one should be allowed to have an attic where “treasures” that ultimately get thrown out are stored. Our estate sale (glorified garage sale) got rid of a lot of our furniture and some household items as did many donations. Our house finally sold and we vacated November 30^th.

Unfortunately, all the clean out ended up my responsibility. My husband began having severe arthritis in both his hips while I was in Kauai. He became all but immobile by the fall. So I couldn’t count on him for much. I was planning on our daughter (the jockey) to end her season, return to California and help. (Especially since a lot of the accumulated “treasures” were hers.) Alas, on one of the last races of the season her horse broke down (fractured it’s front legs) and dumped her resulting in a vertebral fracture, wearing a brace and no lifting. So, I was the best of a sad lot! Because of my arthritis, I could only work short periods of time and then needed to rest. Good thing I had several months before the house sold. Eventually all got done. I think those years as an obstetrician paid off—patience knowing it would finally end.

I tried an experimental treatment for my arthritis in September. It sounded hopeful but as all experimental treatments nothing was guaranteed. The procedure is fascinating and sounds promising. I hope my lack of results isn’t substantiated with further study.

There are 500,000-1,000,000 stem cells in 1cc of body fat. That’s a lot of cells! Under local anesthesia, in the office, the doctor does a mini-liposuction (I wanted him to take more!). The cells are processed and then deployed (don’t you like that word?) into the specific joints and since I had a lot of stem cells also IV (intravenously). Dr. Sutherland stood by my side the whole time. Actually, I thought it was interesting. I even watched the liposuction with a mirror. Unfortunately, 3 months later I have seen no improvement.

My husband had bilateral hip replacements in November. Surgery went well. It’s always interesting to be on the “patient side” of medical care after a long career in medicine. I’m happy to report that we received excellent care. “We” is the right word because the caregiver is receiving care too in the way of support.

One of the interesting things about being a patient is receiving 2 totally different opinions on what to do. (You may call this upsetting rather than interesting.) I frequently spoke with patients about 2^nd opinions telling them that they were great but could be a problem if they disagreed. Then, you the layman needed to make the medical decision. In our case, the 2 surgeons disagreed on the surgical approach (make the incision in the front vs the back) and whether or not to do both at the same time. Luckily for us, I was able to communicate with the surgeon who recommended doing both at the same time (our 1^st choice) and he provided medical articles for me to review which helped make the decision. He’s now almost 2 months out and on Christmas day we walked over a mile!

I’m grateful that I have been able to hike with Dr. Sutherland most Saturdays. We never seem to run out of things to talk about and before we know it we’ve hiked between 5.5 and 6 miles. I hope you’re all remembering my recommendation for a regular exercise program. It helps to do something you like and exercising with a friend helps with motivation and passing the time pleasantly. So get out there and move!

So, What’s next? I’m still not sure but I know that change is inevitable and that I need to learn from Charles Darwin that:

"It is not the stongest of the species that survive, 

nor the most intelligent, 

but the one most responsive 

to change"

Time to Shed those Holiday Pounds

A common resolution for this time of year is to improve health, diet and exercise. Often weight loss is part of that plan. The article in this newsletter issue on how to increase your metabolism should be helpful. As people age, their metabolism decreases by 5 – 10% every ten years, mostly due to loss of muscle mass and decreased physical activity.

If you are overweight with medical problems or if you are obese (BMI > 30) with or without medical problems, then weight loss should be a health priority. Studies confirm that that most people are most successful working with a structured weight management program. We have been very successful in the last year with the medically supervised Weight Management Program at Women Physicians. Some patients have lost up to 50 pounds! Please visit our website or call the office at 650-988-7550 if you would like more information.

Improved Options at Patient Fusion

I would encourage those of you who have not yet signed up for Patient Fusion to be sure to do so. Currently this program gives you access to your personal health information online. You can schedule your appointments or see your labs, vaccination records, or diagnoses on-line. Later this year, it is expected that we will also be able to communicate with you by secure messaging through this portal. No more telephone tag! Scheduling can also be done online through http://elcaminowomen.com/newsletters/appointments.htm.

For your safety and security, we must be certain we know who you are when you register, so it is easiest to register when you are in for an appointment, though Mandi can register some patients by telephone.   Mandi will assign you a PIN number.  You will then receive an email from Patient Fusion with a link to your unique registration page. You will enter your PIN on that page.  Then you can create your own username and password to log in to Patient Fusion, your online chart access.

Get Your Flu Shot Now!

Santa Clara Valley is seeing a sudden upsurge in the number of patients with influenza like illness (ILI) and influenza A/H1N1.  If you have now yet had your flu shot, get it now!  Our office still has vaccine available.

Since December, 18 patients have been admitted to El Camino Hospital with confirmed influenza resulting in 6 admissions to the ICU and one death.  Last week, the emergency department saw 20-50 patients/day with ILI.  Many cases appear to be due to a resurgence of pH1N1 which is included in the flu vaccines, though the vaccines do not provide 100% prevention.   If you think you have the flu, contact us.  An anti-flu medicine called Tamiflu may be helpful.

El Camino Hospital Receives Award for Clinical Excellence

El Camino Hospital announced that it was named to Healthgrades top 5 percent of U.S. hospitals based on clinical outcomes across multiple specialties. Of 4,500 U.S. hospitals evaluated, El Camino Hospital is one of 262 – and the only one in Santa Clara County – to receive the 2013 Distinguished Hospitals Award for Clinical Excellence from Healthgrades in its new report, Hospital Quality Clinical Excellence Report 2013.

Make Your Metabolism Your Friend

The holiday season has finally come to end. As we return to our former routines, we relish the fond memories of time spent with family and friends, as well as make the not-so-fond realization that we need to drop a few of the pounds that we had so much fun putting on.

In addition to eating better and exercising, boosting metabolism is a great way to shed that unwanted weight. Here are five tips that will get your sluggish metabolism into gear:

1.  Exercise

Thirty minutes of aerobic exercise temporarily boosts your metabolism. To get even more bang for your buck, increase the intensity of your run, swim or walk for 30-second intervals, which will maximize the calories you burn after exercise. For example, walk at 3.5 mph for 5 minutes, then increase the speed to 4.0 mph for 60 seconds, and return to 3.5 mph for 90 seconds. Repeat this sequence 5 times during your workout.

2.  Strength training

Don’t be scared of weights! Not only does muscle weigh more than fat, but it uses more energy as well. In fact, strength training is the only way to increase your Resting Metabolic Rate (RMR), which accounts for 60 to 70 percent of the calories you burn daily. The average woman in her 30s who strength-trains 30 to 40 minutes twice a week for four months will increase her resting metabolism by 100 calories a day.

3.  Eat Breakfast

You’ve heard it before, but I’ll say it again. Do not skip breakfast. Eat within an hour of waking up to kick your metabolism into gear.

4.  Eat small frequent meals

Keep your metabolism going throughout the day by eating six small meals instead of two or three larger ones. Aim for 300 calories each meal, or divide your usual day’s calories by six. Small, frequent meals do not mean snacking on chips or crackers every couple hours. Instead, make each meal complete, such as a serving of vegetables and healthy protein. Also, high-fiber or high protein foods require more energy for digestion than processed carbs or fats. And don't eat less than your RMR or your body will go into starvation mode.

5.  Get your zzzz's

Getting a good night sleep is key to ensuring your metabolism is operating at its optimal level. Not getting enough sleep can alter your metabolism by decreasing the number of calories your body burns just resting.

Although these five tips may seem obvious, they are the factors that truly affect your metabolism. Though articles often claim to know the magic ingredient, such as cayenne pepper or green tea, these five are guaranteed to get your RMR where it should be so that you can keep those pounds off for good!