Index -- WPGYN Newsletter -- Volume 10, Issue 2, April 2013
If you’re like me, I find I often only think about making appointments for myself at the end of a busy day after I’ve finished taking care of everyone else. And of course, that’s when offices are closed. Women Physicians has now joined the world of high tech to allow you to securely make your next appointment online. To access this, just sign onto our website at www.elcaminoobgyn.com, choose the appointments page, and then look for the bold heading entitled Scheduling Appointments. You will readily see the links that will take you to the direct scheduling page for Dr. Katherine Sutherland or Nurse Practitioner Barbara Dehn. You will receive an email confirmation or denial of the appointment with instructions to call the office if there is a problem with the time you have selected. Only established patients can schedule appointments on-line. No more excuses for ignoring that email reminder about your annual! The links will be right on the email.
If you need to be seen urgently and no apparent time is available, then call us at 650-988-7550. We try to save room for same-day appointments. Calling for an appointment will continue to be necessary if you are a new patient or if you have a complex problem that will require extra time.
Have you ever wanted to see your pap or lab results, to double-check the dose of your medicines, or to find out if you’re up-to-date with vaccinations? When you get your healthcare at Women Physicians, you can now easily and securely have access to that information on-line.
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.
In order to see your lab results, they must be drawn at a participating lab. Currently this includes Quest, LabCorp, and Hunter. The El Camino Hospital labs are not part of the structurally integrated system. We send all pap smears to participating labs. Don’t be surprised if your diagnosis codes look a little funky. They often look that way to us as well. Sometimes our choices are limited and the descriptions don’t match the medical conditions very well.
We are excited to offer the Patient Fusion service and hope it will enhance your healthcare experience at Women Physicians GYN Medical Group!
Ah, medical science. What a fickle friend you are! Yesterday calcium supplements were a must for healthy menopausal bones, and today they’re a stepping stone on the path to a heart attack. This is very reminiscent to the story on postmenopausal hormone replacement 10 years ago. In the 1990s, the “studies” showed hormones were the fountain of youth and health. Then, when the original WHI study came out in 2002, hormones were thought to be only one step above snake venom. Now, with more studies under our belt, we’ve stopped oversimplifying and realize hormones can be helpful at certain ages for certain conditions and harmful at other times. So what’s the scoop on calcium?
There has recently been a flurry of studies evaluating calcium and heart disease. It is important to remember that each study can only reach conclusions for the population that was studied and all studies have limitations. If we did a study on calcium supplements in 20 year-olds, it would probably not show an increased risk of heart disease, because the risk of heart disease in that group is so low to start with. Most studies have a hard time controlling for all variables. For example, a large study may show an increased risk of iron supplements and death, but then it may turn out that all of the deaths were due to a subset of patients that had hemachromatosis, and there were no increased deaths in the group that did not have hemachromatosis. It is because of such things that we must be cautious in interpreting and acting on results of studies.
Calcium and Heart Disease
Calcium has become a very popular supplement as more women head into menopause, and therefore it has been a popular item to study. One study associated calcium with a decreased risk of stroke, so multiple studies followed looking at other aspects of heart disease. The smaller earlier studies reached variable conclusions, so we resorted to a popular maneuver in medical research, a meta-analysis. That means all of the studies were combined to have a larger number of participants and hopefully reach a more valid conclusion. The problem with a meta-analysis is that garbage in leads to garbage out. They do not have the same credibility as randomized controlled prospective studies. But they do have more power than the individual studies. A meta-analysis looking at calcium and the risk of a heart attack showed that calcium was associated with an increased risk if the combination of dietary and supplemental calcium was greater than 800 mg.
A 2012 study entitled the European Prospective Investigation into Cancer and Nutrition Study (EPIC—Heidelberg) studied 61,000 Swedish women who were followed for 19 years. They evaluated the relationship between calcium and heart attack, stroke, and overall cardiovascular mortality. They found that the women who fared the best were those who got between 600 and 1000 mg of calcium a day. Less than 600 mg a day had an increased mortality from MI, all cardiovascular causes, and even stroke. For women who had greater than 1400 mg of calcium a day, the risk of heart attack was 1.86 times that of those getting from 600 to 1000, however there was no increased risk of stroke. If the high intake of calcium was related to use of supplements, the risk of heart attack was 2.57 whereas if it was due to dietary intake alone, the risk was only 1.17. I would conclude from this study that the optimal dose of calcium is 600 to 1000, and that it is better to get that from dietary sources than calcium supplements.
The other recent study was the NIH trial involving 388,000 participants over 12 years. This looked only at calcium supplements and did not take dietary calcium into account. They found that men taking supplemental calcium in doses of greater than 1000 mg had a 19% increase in the incidence of cardiovascular death. However, women taking calcium supplements had no increased risk of heart disease. Neither men nor women had an increased risk of stroke. Heart disease and bone health are both areas where we find a gender gap. Women are at 5X the risk of osteoporosis and fracture as men, but mortality and morbidity relating to heart disease occurs, on average, about 10 years later.
Calcium, Vitamin D, and Bone Loss
Calcium supplementation does not appear to have a significant effect on protection against fracture. The earliest studies were encouraging, but the prospective randomized Women’s Health Initiative Study (WHI) did not show a reduction of fractures in women taking 1000 IU of calcium and it did show an increased risk of kidney stones. This study has been criticized because many women were already on 1000 mg of calcium before they started the study. Furthermore, adherence was not taken into account. If one looked a subgroup of women who were older and at high risk of fracture, and only considered those that were adherent, calcium supplements did result in reduced fractures.
Menopausal bone health is an important issue with our aging population. Over 50% of postmenopausal women will sustain a fracture. Although studies on supplementation have not been exciting, many studies have shown that calcium deficiency is a problem for bones. Menopausal women should be sure to get at least 600—800 mg of calcium a day.
On the other hand, Vitamin D has been shown to reduce fractures by 12% in postmenopausal women with or without calcium. Furthermore, Vit D insufficiency can increase the risk of heart disease. So far, vitamin D has not been associated with any serious adverse effects. I would recommend Vit D levels between 30 and 50. Your levels depend on an interaction between your sun exposure, your genetics, and your daily intake. The best way to tell if you are in the normal range is to do a blood test. If you are not in the normal range, you may need high dose supplements to boost you into the normal range. Then you are likely to need a daily maintenance dose to stay there. If you quit taking the maintenance dose, your levels will decrease again.
What’s the bottom line?
· Optimal intake of calcium is from 600 to 1000 mg a day.
· Dietary calcium is safer than calcium taken by supplements.
· No more than 500 mg of calcium should be taken at a time.
· Vitamin D is more important than calcium for bone health.
If you have osteoporosis and no risk factors for heart disease, then focus on optimizing your Vit D levels and getting 1000 mg of Ca a day. If you can’t tolerate dairy or other high calcium containing foods, then a supplement may be best for you, taking no more than 500 mg at a time.
If you have significant heart disease or risk factors for heart disease and strong bones, you may be better off to get no more than 600 mg of Ca a day and only through your diet.
For a comprehensive listing of the amount of calcium contained in various foods,
Join Relay for Life of Mountain View - 5/18/13 to 5/19/13
Time to Fire Up for Relay for Life of Mountain View 2013!
The energy and momentum are starting to build for a fantastic Mountain View Relay for Life 2013! Over the weekend of May 18th and 19th, Cuesta Park will become a 24-hour instant village of unstoppable warriors to Celebrate our Survivors, Remember our Heroes & Fight Back against our common foe, the nefarious C-Monster, through expanding awareness & massive fundraising for the American Cancer Society!
This year Mountain View RFL has been chosen to be a CPS-3 registration site. In order to sign up to be part of the study you just need to be between the ages of 30 to 65 an have never been diagnosed with cancer. To think, with just a little bit of blood, a waist measurement and answer a survey, you could help to find the cure for cancer.
El Camino Hospital’s Women’s Health Forum—4/20/13
Don’t miss the annual spring Women’s Health Forum sponsored by El Camino Hospital. You can learn about the latest advances in women’s health, enjoy a healthy lunch, and participate in health screenings. This event is free, but space is limited.
Register now by visiting www.elcaminohospital.org/healthforum
Have you ever felt like you want to do your part in participating in medical research, but have no idea where to start? It’s easier than you might think, with some good ideas close to home.
American Cancer Society Relay For Life—Cancer Prevention Study 3 (CPS-3)
Since the 1950s the American Cancer Society has sponsored some of the most significant studies ever done because of their commitment to large numbers or participants over a long period of time. For example, they identified the effect of smoking on lung cancer and the effect of obesity on at least 8 major cancers. Now is your chance to enroll in another possibly groundbreaking study.
Eligibility: Between the ages of 30 and 65, and never been diagnosed with cancer
Requirements: Enrollment in person at RFL (informed consent, survey, waist measurements, and a blood draw), with periodic follow-up surveys every few years filled out at home for the next 20 years.
Enrollment: Just come to this year’s Relay For Life at Cuesta Park, Mountain View between 11:00 am and 3:00 pm on Saturday, May 18, 2013.
You can learn lots more about this study at www.cancer.org/cps3.
Open Medicine Institute
Open Medicine Institute (OMI) is a local research and patient care center that has a number of studies in progress for especially difficult, diseases, including Autism, ME/CFS, Multiple Sclerosis, blood cancers, and mental health disorders. In order to study biomarkers and genetic markers, they require large databases including control specimens from healthy adults.
OMI has developed a lab draw station so a patient who needs to have blood drawn anyway can have it done there and, if the patient consents, they can also donate a sample of blood for research purposes. OMI then sends blood for the tests the physician requested to the lab of the patient’s choice (I recommend Quest, LabCorp, or Hunter for my patients so you can easily access it through our EMR). There is no extra charge and no extra needle-sticks and I promise you won’t become anemic because of a few extra tablespoons of blood. They handle your “research blood” with confidentiality, either using it for ongoing studies or storing it for future studies.
If you would like to donate a blood specimen to their research, then the next time I give you a lab slip, take it to Open Medicine Institute located at 2500 Hospital Drive, Bldg 2, (corner of Hospital and South Drive), Mountain View, CA 94040. They are open from 9 to 5 on Mondays through Fridays.
El Camino Hospital REACT trial — Lung Cancer Detection Study
El Camino Hospital has a number of studies for cancer patients, but with my emphasis on prevention and genetics, I would like to introduce you and your network to the REACT trial. We know that smoking increases the risk of lung cancer, but why do some smokers develop lung cancer and others don’t? The REACT trial is designed to help answer that question by doing blood tests on volunteers to see if we can identify certain genetic markers that may increase their risk. Trial participants then have a CT scan to look for early lung cancer. CT scans can be life-saving in patients at high risk of lung cancer.
Eligibility: Age 50 or older with a smoking history the equivalent of 20 cigarettes per day for 20 years
Requirements: Willing to participate in smoking cessation counseling if actively smoking and able to have a CT scan.
Enrollment: Please call 650-988-7623.
If you have any family or friends that might qualify for this study, please help them sign up. It could save their life. For more information, go to http://www.elcaminohospital.org/Cancer_Center/Clinical_Trials/Lung_Cancer_Detection_Study.
23andMe Genomic Medicine
As mentioned in the last newsletter, when you submit your saliva to 23andMe, the dna is added to a large database used by multiple research partners. Short surveys are offered to make better conclusions about how the traits actually match the genes. This test costs $99, but you also get some data back about your genetic make-up which could have some medical implications for you (but often doesn’t). You can learn more about it or order a kit at www.23andMe.com.
Information on this website is for educational and reference purposes only and should not be interpreted as specific medical advice.
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