New Pertussis Vaccine Now Available at WPMG

Pertussis (commonly known as whooping cough) is a disease that most people probably think was long ago eradicated. But, in fact, right here in Santa Clara County, the number of cases have been on the rise in recent years. In adults, pertussis rarely results in serious complications. However, for infants younger than twelve months, pertussis potentially can cause significant respiratory compromise, hospitalization, and even death.

For that reason, the national committee that sets guidelines for immunizations (ACIP) recommends that adults be vaccinated with a newly available pertussis vaccine (Tdap). Although we were all vaccinated against pertussis in childhood, the immunity it confers wears off by adulthood. Tdap also contains a booster for tetanus and diptheria. (Tdap should not be given if you have received a tetanus booster within 2 years.)

By vaccinating adults who have or will have close contact with infants under age one, we can markedly reduce the likelihood of pertussis infection in those infants. This target group includes parents, grandparents, nannies, and child care workers.

Women Physicians Ob/Gyn Medical Group wanted you to know that we already have available in our office the new Tdap vaccine. Our doctors and employees will be lining up for their immunization in the very near future. This is just a minor discomfort for us, and helps us honor our commitment to healthy moms and babies!

Our own Dr. Rita Leard, who begins her one-year term as Chief of the Department of Ob/Gyn at El Camino Hospital on July 1, has made it a priority that within the next few months Tdap vaccination gets added to the standard postpartum orders for new moms at ECH. Until the hospital vaccination option gets implemented, we will encourage our new moms to stop by the office for vaccination within a few days after delivery.

In addition, we will recommend Tdap immunization for our dads-to-be sometime during the last few months of their partner’s pregnancy. Other infant caregivers, such as grandparents and nannies are invited in for a vaccination as well, even if they are not our patients. In fact, if you are aware of new or expectant parents that do not have other access to the Tdap vaccine, our office is willing to see them to administer this vaccine until it is more widely available. For the long term, we plan on recommending Tdap vaccination to patients and their partners when we see them for pre-pregnancy consultations.

Working together, we hope to help reverse the concerning trend of an increasing incidence of pertussis in our area.

Urinary Incontinence

Nearly 19 million Americans suffer from urinary incontinence and most are women. In fact, over 30% of women complain of some degree of urinary leakage. Women are especially vulnerable because of weakened muscles from pregnancy and vaginal delivery and decreased estrogen level after menopause. Certain medical conditions such as Parkinson’s disease, multiple sclerosis, diabetes, and obesity may also cause urinary incontinence.

There are different types of incontinence: stress, overflow and urge. People with stress incontinence leak urine when they cough, sneeze, laugh, exercise or get up from a chair. They often sleep through the night without leaking. People with overflow incontinence dribble urine throughout the day. They feel the urge to urinate but sometimes can’t. They urinate small amounts and feel they are not completely empty afterward. They get up frequently during the night to urinate. People with urge incontinence leak if they don’t get to the bathroom immediately. Sometimes, by just putting the key in the door when they come home, they leak. They go to the bathroom at least every two hours. They feel as if they have to go all the time and they get up frequently during the night to urinate.

If you suffer from any of these symptoms, we can help. A thorough history and physical exam can sometimes point to the right diagnosis. We may have you keep a bladder diary to help us figure out when you’re leaking. We can also perform a simple in-office urodynamic test to help determine the cause of your incontinence. The test takes less than 30 minutes and involves placing a thin catheter into your bladder to measure pressures as it is filled with water.

Behavior treatments are often helpful in preventing episodes of incontinence. In bladder retraining, you gradually increase the length of time between urination. Avoid caffeinated beverages, grapefruit and other acidic fruit juices, tomatoes, milk products, artificial sweeteners, spicy foods and alcohol. Wear clothes that you can remove quickly when the urge to urinate occurs. Don’t smoke. If you are overweight, lose weight.

Kegel exercises may help in the treatment of urinary incontinence. They strengthen the muscles around the bladder and urethra. Squeeze the muscles that you would use to stop the flow of urine and try to hold it for 10 seconds. Do not tense the muscles of your legs, buttocks or abdomen. Repeat 10 times. Do this 2-3 times a day.

Medication may help if you have urge incontinence. These are anti-cholinergics that limit the sensation to urinate. These medications may cause dry mouth, constipation, nausea, blurred vision or sleeplessness.

A pessary can be tried if you have stress incontinence, particularly if you are no longer sexually active and could not tolerate a surgical procedure. Pessaries are placed in the vagina and support the pelvic organs. They prevent leakage by pressing against the urethra.

Surgery is the most successful treatment for stress incontinence. Recent advances in surgery include development of a suburethral sling technique. This is a simple, outpatient surgery that takes less than 15 minutes to perform. Our own Dr. Janet Pulskamp has been trained in this technique. It involves placing a narrow mesh beneath the urethra under the vaginal tissue. You will not see or feel the mesh. You may experience some thigh pain after the surgery but in general, the recovery is quick. We do ask that you take it easy for 2 weeks. Sexual intercourse, heavy lifting or rigorous activity should be avoided for 4-6 weeks. Most women will see results within a few days after surgery.

Urinary incontinence is a very common problem. If you are bothered by these symptoms, call our office at 650-988-7550 to schedule an appointment. In most cases, urinary incontinence can be successfully treated.

Are you tired of frown lines, crows feet and forehead worry lines? Have you been thinking about giving Botox® a try?

This would be a great time since we are offering a summer special of a $50 reduction on each site. That means the first site will cost $225 and each additional site will cost $175.

Please be assured that the Botox® we use is purchased directly from theAllergan Corp (an FDA licensed manufacturer of Botox.) www.allergan.com

Botox® treatments are given by our Nurse Practitioner, Barbara Dehn, NPMS. She has been administering Botox® since FDA approval in 2002 with no complications. www.elcaminoobgyn.com/barbara_dehn.htm.

Many patients have asked for our advice regarding choosing insurance plans. The cost of health insurance and the insurance reimbursement for health care expenses are tough issues for all of us. We deal with insurances not only as physicians receiving reimbursements but also as small business owners that provide insurance to our employees and as users of health care services ourselves, i.e. patients. We encourage you to seek professional advice from a health care insurance broker, but we thought we could share a few things we have learned along the way.

First it is important to know your own health care goals. For ourselves and our employees, we value the option of being able to seek out the best physicians, hospitals and services no matter what medical problem might arise. We value long-term relationships with providers and don’t feel that annual changes in insurance carriers should force annual changes in providers. Unfortunately, insurances do not always recognize the value of a physician’s time even though extra time may be what separates a successful visit with a physician from a less satisfying one. If you share these values, then you should choose a PPO or POS plan although it is likely to cost you or your employer more than an HMO plan.

Because insurance has become such a significant expense for employers, current trends are for employers to choose plans that shift some of the health care costs back to the employees. The most common way to do this is with high deductibles. It is not uncommon to have deductibles of $500, $1,000, or even up to $5,000. If you have a plan with a high deductible, it is best to think of it as catastrophic health care insurance. It will not cover annual exams, mammograms, pap smears, etc. all of which are important for your health care. Since these are inevitable out of pocket expenses no matter where you go, plan ahead to put that money aside, and then choose health care you trust where you feel you are getting value with your exams.

We have recently provided ourselves and our employees with an innovative health care plan called a Health Savings Account or HSA. In this plan, either the employer or the employee can put aside either $2700 or the deductible, whichever is less, into a health savings account that can be used for qualified medical expenses. If deposited by the employer, it is a tax deduction to the employer and is tax free to the employee. Since employers may save 20-50% on the insurance premiums compared to standard PPO plans, they may be willing to fund some or all of the employees’ accounts and still save money or at least come out even. The premiums for HSA accounts typically cost about the same as HMO premiums. If the employer does not fund the whole amount, any money the employee contributes is tax free. Furthermore, if the money is not used, it can roll-over to be used the next year, and accrue tax-deferred, like an IRA. In addition, when an employee leaves that company, any accrued HSA fund can be converted to a rollover IRA account.

The HSA plan benefits patients currently on a PPO because they can have tax-free money put away to meet the medical expenses not covered because of high deductibles. When the account is depleted they will have met their deductible, and the insurance plan will kick in to cover expenses. If a health care expense occurs before the HSA has accumulated enough funds, a patient can pay for the expense and reimburse herself from the HSA account. It benefits patients more than an HMO because an HSA plan allows patients to choose whichever health care providers are best suited to their needs.

We see the HSA program as being beneficial for patients, employers, and physicians. This is something to consider investigating for those of you who are self-insured or the owners of small businesses. If you work for a large corporation, you may want to check with your benefits department and be sure they are aware of these programs.

We know health insurance issues are an ongoing problem for all of us. We appreciate the fact that you continue to use our services even though you sometimes could get healthcare at a lower price elsewhere. Our goal continues to be to provide the optimal in patient care and to give you value for your healthcare expenditures.

New Pertussis Vaccine Now Available at WPMG

Information on this website is for educational and reference purposes only and should not be interpreted as specific medical advice.

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Women Physicians Gyn Medical Group