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Index -- WPGYN Newsletter -- Volume 9, Issue , January 2012 El Camino
Hospital Offers Deborah’s Palm — What about vitamin supplements? Should you have the Shingles vaccine? What’s new in menopause management? What’s new in minimally invasive surgery?
El
Camino Hospital Offers Many
women suffer from urinary urgency, incontinence, or bladder prolapse. If possible, many women
would like to have solutions that don’t involve surgery or medications. Now
El Camino Hospital is offering a seven-week program for women of all
ages to help correct and strengthen the muscles of the pelvic floor. Classes are taught by Meenal Mujumdar,
a physical therapist with special expertise in pelvic floor therapy. The one-hour workout is
followed by a brief educational discussion of nutritional,
behavioral, and lifestyle changes
that can have a positive impact on pelvic health. In the privacy of the
class setting, women discover a supportive environment where they can
share their most embarrassing moments and take pride in their
successes. Class meets twice weekly for seven weeks and costs $150. There are also free
introductory classes, including one on January 4 and one on January 6
at the Park Pavilion. Registration
is required. For
more information on this program, go to http://www.elcaminohospital.org/Womens_Hospital/Pelvic_Health_Program
Deborah’s
Palm —
I just learned about an
interesting community resource for women of
all ages. Deborah’s
Palm is a non-profit organization that serves as a resource for women
in the community by providing support and information in an encouraging
and warm environment.
As
society becomes more challenging and stressful, women of all ages can
find help, support, understanding and friendship through carefully
selected groups, classes and activities. The
founder, Katie Ritchey, has done research on stress, isolation, and the
importance of social support systems. Katie, a native Palo Altan, saw
that there was no women’s center in her community for women to gather
and encourage one another during daily challenges and seasons of change
throughout a woman’s life. She took on the task of renovating an 1896
Victorian, in order to create a welcoming space, for women’s
relationships to form and grow, and life to be celebrated. To learn about the options for
counseling, classes, resources, connections, and volunteering, go to http://www.deborahspalm.org/
or
drop by at Deborah's Palm at 555 Lytton Ave., Palo Alto from 9 am to 6
pm Monday through
Friday or call 650/473-0664 or email: info@deborahspalm.com.
What about vitamin supplements?
Another
recent study in the Archives of Internal Medicine showed that women
aged 55-69 who took multivitamins had a 2.4% increase in death rates. Other supplements that
increased mortality in that study included Vit B6, folic acid, Fe,
magnesium, zinc and copper. Copper
was the worst of all with an 18% increased mortality rate. On the other hand, calcium
reduced the risk of death by 3.8%. It
is important to remember that the Archives study was looking at
postmenopausal women. In
women planning a pregnancy, or newly pregnant, prenatal vitamins with
extra folate and iron will reduce the risk of birth defects and anemia
in pregnancy.
A
fun and interactive website to help decide if certain supplements are
right for you is http://www.informationisbeautiful.net/play/snake-oil-supplements/ .
A
sample of how it looks is on the right.
You
can select a condition of interest and it will show what supplements
have been studied for that condition and how strong the evidence is to
show if it can benefit the condition.
For example, the 2 supplements that appear
beneficial for cancer are calcium/Vitamin D and fish oil/omega 3 fatty
acids. For
cardiac disease, there is evidence supporting garlic, fish oil/omega 3
FA, green tea, dark chocolate, CoQ10, niacin, olive leaf extract, and
omega 6. When
doing your own
research on things like supplements, be careful about the source of
information. Many
websites are primarily commercial since vitamins and supplements
represent a multi-million dollar market.
Always consider the source of any websites. A site ending in .gov will
have the highest quality evidence-based health information, such as the
fda site. Always
consider the credentials of the author and whether there are financial
ties or bias. Watch
out for sensationalized content and patient testimonials. A good place to start a
search is the National Medical Library Web site at
http://www.mlanet.org/resources/userguide.html.
The
National Library of Medicine and National Institutes of Health also
provide an outstanding 16-minute lesson on how you can evaluate online
health information. Find
it at http://www.nlm.nih.gov/medlineplus/webeval/html.
One
thing that all studies agree on is that a healthy life style can
improve your well-being and decrease your mortality.
Eating
a healthy diet with adequate vegetables, fruits, and grains will
provide you with the vitamins, minerals, and antioxidants that your
body needs. Making
a point of eating
healthy and nutritious foods will also reduce your cravings for foods
that are high in animal fats, processed carbohydrates and sugars. A bit of dark chocolate is
a nice treat. Regular
exercise of at least 30 minutes 5 days a week has also been shown to
reduce mortality from both cancer and heart disease.
Should
you have the Shingles vaccine? There
have been some changes in recommendations regarding the Shingles
vaccine (named Zostavax). In
the past, it was only recommended for people aged 60 and above. The FDA has now approved
its use for anyone 50 and above. Should
you be vaccinated? The
information below may help you decide.
What is Shingles and post-herpetic neuralgia? Anyone
who had chicken pox as a child (which is just about everyone 50 y/o and
above) could potentially get shingles since it is a reactivation of the
chicken pox virus named Herpes Zoster.
It is especially likely to happen as one ages or if
one is immune suppressed. Shingles
is a painful rash that may appear like blisters on one side of the
body, often in a line or small grouping.
Some
people who get Shingles will develop pain along the nerve tracks where
the blisters appeared that may last long after the blisters have gone
away and may be severe and disabling.
This is called post-herpetic neuralgia or PHN. How common is Shingles and post-herpetic
neuralgia? About
1 million people will develop Shingles every year.
The overall incidence is somewhere between 1 in 5
people and 1 in 3 people. If
you live to 85 years old, there is a 50% chance you will get it. The incidence of PHN also
varies by age. It
is only about 20% overall, but in people over 60, it is 40% and in
people over 70, it is 50%. It
is most likely to occur under periods of immune suppression that may be
caused by stress, chemotherapy, or other illnesses.
What is the Shingles vaccine? The
Shingles vaccine reduces your risk of developing Shingles and the
persistent pain that sometimes follows.
It
contains the same virus that causes chicken pox but the virus has been
altered so it is not strong enough to cause chicken pox or shingles. Because
is is a living virus, it cannot be used if you are immune suppressed so
it is important to take it when you are healthy rather than waiting
until you think you need it. It
also cannot be used if you are allergic to neomycin.
The main side effect is redness and tenderness at
the injection site. How effective is the Shingles vaccine? Overall,
Zostavax prevents 51% of shingles outbreaks and 67% of post-herpetic
neuralgia. The
effectiveness depends on the age since the older you are, the less
likely you will be able to develop an immune response.
The reduction in incidence is as follows: Where can you get the vaccine and how much does
it cost? Women
Physicians now has the vaccine in stock, although at times it is in
short supply. It
costs approximately $220. It
is covered by Medicare part D, but not by Medicare part B. Check with your insurance
as different insurers handle it differently.
What else can you do for Shingles? If
you think you have Shingles, come in for an appointment right away. If
we start anti-viral medicine within 3 days of the outbreak, the
outbreak will resolve sooner and you are less likely to get
post-herpetic neuralgia.
What’s
new in menopause management? Every
year since the shocking report of the WHI in 2004 we have new
information to help clarify how to safely and effectively help women
manage the menopause transition and beyond.
In
2004, the combined estrogen and progesterone arm of the study was
stopped prematurely due to an increased risk of breast cancer and heart
disease. Many women
discarded their hormone treatments, preferring to suffer hot flashes
than take serious risks with their health.
Many
women entering menopause also suffered significant symptoms, even
though the WHI study focused on asymptomatic women and didn’t really
apply to them. In
2011, 2 major studies
presented some data that helps us to identify women for whom the
benefits of hormone therapy may outweigh the risks.
The data is reassuring for the younger, recently
menopausal women who tend to have the worst hot flashes.
One
of the surprising things about the original WHI study is that it showed
an increased risk of heart disease with hormones whereas previous
studies had suggested that hormones protected against heart disease. Since then, review of the
WHI study and the Nurse’s Health Study suggested the timing of when
hormones were started had a major influence on whether or not they
increased the risk of heart disease.
The patients who did poorly in the WHI had often
been in menopause for 10 years when hormones were suddenly started. Now
we have a third study, the California Teacher’s Study (CTS) with more
than 71,000 participants followed for 5 to 7 years that showed a
decreased risk of heart disease for hormone users compared to non-users
with a risk ratio of 0.54 when the hormones were started in recently
menopausal women for control of bothersome symptoms.
Another interesting report that came out in
2011 was a follow-up to the WHI Estrogen-Only study.
The original study had followed women who had
hysterectomies on estrogen-only therapy for 7 years.
Though
women taking the estrogen had shown a lower risk of breast cancer and
heart disease than those who were not taking them, the study was
stopped because the women on estrogen had an increased risk of stroke. Many women in the original
trial were looked at again after 4 years of being off the hormones. This
follow-up study showed the reduced risk of breast cancer continued and
there was no increase in heart disease, stroke, deep venous thrombosis,
hip fracture, colorectal cancer or mortality in the group that had used
estrogen. Once
again, the younger women who used the hormones did the best.
These 2 studies confirm the information
provided by previous studies and other ongoing studies.
Current
evidence suggests that women going through the menopause transition
with significant hot flashes and night sweats can use hormones as
treatment with no increased risk of heart disease and, in the case of
estrogen-alone, no increased risk of breast cancer.
Bottom line:
In young symptomatic women who need hormone
treatment the most, there is a wide margin of safety.
What’s
new in minimally invasive surgery?
Two recent studies
also confirmed
the benefits of having hysterectomies performed by minimally invasive
surgery, including the daVinci Robot, instead of a large abdominal
incision. Benefits
included less bleeding, lower infection rates, less antibiotics, fewer
hospital days, and less pain. The
overall rate of intraoperative complications decreased significantly
from 7.2% to 4% and the rate of minor postoperative complications
decreased significantly from 18% to 5.7%.
The
cost of the equipment and the surgery itself is more expensive but that
is offset by the shorter hospital stays and the decrease in
complications so overall the costs are the same.
Hysterectomy
is one of the most-frequently performed procedures in the United
States, with 600,000 operations performed each year. According to the
study, 90 percent of the patients undergoing hysterectomies are doing
so for benign reasons—leiomyomas, pelvic pain, pelvic organ prolapse
and abnormal uterine bleeding, among the most common reasons. Unfortunately,
only 1 in 3 hysterectomies are performed by minimally invasive surgery
techniques. Dr.
Sutherland is glad that she learned the technique when she did and now
is among a small group of gynecologists at El Camino who are proficient
with the da Vinci Robot. She
is happy to consult with patients who need a hysterectomy and are
looking for an alternative to the abdominal approach.
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