Women’s Health Newsletter, Volume 5 Issue 2

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WOMEN’S HEALTH

What to say?   We’re in the middle of a global pandemic and healthcare and economic crisis, the likes of which our generation has never seen.  I hope everyone is staying safe at home, learning new ways of socializing and staying connected to loved ones.

Everything right now is not what we expected.  Our move is on hold, our plans for adding services are on hold, as with everyone else, our lives are on hold.  In the setting of a pandemic, we are all so grateful to have our health, our jobs, and to be able to serve our patients in your time of need.  For our patients, we have started to host regular webinars on Covid19 and Women’s Health.  We’ve had two already in April and two more coming up.  There are more details in the newsletter.

Our office is still open for patients that need in-person appointments; the rest are scheduled via televisits. Our hours and availability remain the same, but given the change in volume, our San Jose office has been temporarily closed.   We do not yet have an idea of when we may be able to move to our new suite, but some physicians have moved into the Sobrato Pavilion already, including our favorite ENT Katrina Chaung, MD!

As I mentioned in our last newsletter, we’ve started working with an anti-aging skincare company and a hair care company to offer their products to patients looking to prevent or treat wrinkles or thinning hair.  This month we’re going to start free giveaways of some products.   Make sure you follow us on social media (Facebook or Instagram) if you want a chance to win free samples.

As always, feedback is welcome regarding our practice, customer service, and even this newsletter!

Sheltering in place, we wish all of you good health and some time to focus on yourselves, your health, and your loved ones.

Sarah Azad, MD

In this issue:

Practice Updates

Webinars, Online Prenatal Classes

COVID19 and Womens Heatlh

Skin Care During COVID

COVID19 Symptoms?  There’s an app for that…

Your Local ENTs are Doing Televisits!

Highlights from our Women’s Health Blog

PRACTICE UPDATES

Our office remains open to see appropriate patients.  Our pregnant patients still need to be seen and when appropriate we are spacing those appointments out. For women with an urgent issue, we would prefer to see you in our office than have you go to urgent care or ER.  We are doing so many more visits via televisit when appropriate.  If you have health issues you’ve been wanting to consult on (menopause, PCOS, weight loss, etc), please call to set up a televisit appointment.  Both Dr. Awaad (psychiatrist) and Zainab (therapist) are seeing patients via telemedicine, so if the pandemic (or just the stress of sheltering in place) is getting to you, reach out for an appointment.

As excited as we are for our move, it’s currently on hold.  There’s not much more we can say now, the uncertainty around Covid19 affects everything.  I will say we had a lot of fun in January finalizing all the furniture!  Don’t forget to follow us on social media to stay up to date on office information as well as women’s health topics.  You can follow us on Facebook, Twitter, LinkedIn, or Instagram.  Your feedback on our office practices and our physician and staff communication is always welcome.  

WEBINARS AND ONLINE PRENATAL CLASSES

Covid19

We started hosting webinars for our patients on COVID19 and Women’s Health.  With constantly changing information and office and hospital workflows, we want all of you to have a trustworthy, informed source for the most recent information and how it’s affecting care in the Bay Area.

Our next two webinars are on Wednesday, April 15^th at 9:30 am, hosted by Dr. Balassiano and also on Monday, April 27^th at 3:30 pm.   Email moc.n1701992364emowo1701992364nimac1701992364le@of1701992364ni1701992364 to register.

Prenatal Classes

El Camino Women’s Medical Group

We’ve taken our Breastfeeding class online, the first was this past Sunday via Zoom.   We will continue to have them 1-2 times a month online until it’s safe to have in-person classes again.

There is such a demand for online prenatal classes, our office will start offering limited classes on Labor, Delivery and Postpartum and Baby Care.

Pregnant patients will be emailed as these are available.  Make sure your correct email is registered with the office and everything will also be posted on our social media as they are scheduled.

El Camino Health

For women wanting a tour of the Women’s Hospital, there is now a virtual tour here.

The hospital has also started with an online Childbirth Express class to be conducted virtually.  The first classes scheduled are for women who were registered already and have had their classes canceled.  They plan on adding more classes and we’ll update you as we know more.

COVID19 AND WOMEN’S HEALTH

We are flattening the curve!  Flattening the curve refers to community isolation measures that keep the daily number of disease cases at a manageable level for medical providers.

We are fortunate that the Santa Clara Public Health Department was early to start limiting gatherings and then on March 16th, announcing a formal, legally binding “Shelter in Place” order for six Bay Area Counties.  The Governor was quick to follow on March 19th with a statewide order.   These early actions have caused the virus to spread more slowly, allowing public health agencies to put in place the supplies and support systems needed to best take care of those severely affected by COVID19.

You can learn about projections for when the virus will peak in different states and how that matches up to the healthcare facilities available.

COVID19 and Women

What we know so far is that women who contract COVID19 are at lower risk of symptoms, severe disease, and death.   The number of diagnosed cases is equally distributed by gender.   But the number of confirmed deaths shows that women are 60% less likely to die of the infection than men.   This has been noted in China, Italy and many other countries affected by the pandemic.

It’s too early to know why, but there are theories.  We know that men have a higher rate of preexisting medical issues that are known to make COVID19 harder to recover from, like hypertension.  There is also data to support that women generally mount a stronger immune response than men.

There is a gender disparity in smoking that may favor better outcomes in women, but we’ve seen lower death rates in women even in countries where smoking rates are similar between men and women.

It’s just too early to know why women do better; all we know is that they do.

COVID19 and Pregnancy

So far, we have very limited data from only 2nd and 3rd trimesters.  The data has all been very reassuring so far:

• Pregnant women do not seem to have more severe illness from COVID19 compared to the general public
• There is no documentation of a fatality in pregnancy
• No data have shown worse outcomes for exposed fetuses.
• No data have shown any virus in the amniotic fluid or cord blood.

As in all cases, fevers in the first trimester must be treated, as high fevers can cause fetal harm, whether from COVID19, the regular flu, or other infections.  Though we have NO first trimester data, UCSF has started a registry to collect data.  If any of our pregnant patients test positive for COVID19, we will discuss the UCSF registry with you.

What if I think I have COVID-19?

If you may have been exposed to COVID19 & have a fever or cough, please call your primary care physician.  If you have persistent shortness of breath, chest pain or pressure, sudden confusion, bluish lips or anything more severe, go to the ER or call 911

What if I am diagnosed with COVID-19?

Stay home, separate yourself from others in your home, leave only for medical care, with a mask, and notify any health care offices before arriving (“self-isolation”)

When can I end self-isolation?

If you’ve been fever-free for at least 72 hours (without meds), and have been at least seven days since any symptoms and they are also better, you can end your self-isolation.

How do I avoid catching COVID19?

• Wash hands often with soap and water for at least 20 seconds
• Avoid touching your eyes, nose, and mouth
• Stay home if possible and stay at least 6 feet away from other people when out
• Avoid people who are sick
• Stay healthy: Nutritious diet, regular exercise, plenty of sleep

Should women wear a face mask?

If you are out in public to shop, work, or other essential needs, we recommend wearing a face mask.  For people who are coughing or have a fever, please wear a mask around others.  If you are caring for a person with COVID19, wear a mask

Can I travel if I am pregnant?

Regular travel advice still applies; however, in the setting of a pandemic, travel is NOT advised.  Of note, local, state, federal and global restrictions are constantly changing, so when we come out of “shelter in place” orders here, your destination may not open to travelers.

Would it be safer to have a home birth?

We believe that the safest place to give birth is still at a hospital.  The hospital has extensive screening and cleaning procedures that we believe make it safer than going to your local grocery store. Complications during labor and delivery are often sudden; the resources available at the hospital prevent harm and save lives every day.  In our area, homebirths are attended by lay midwives “CPM,” which requires a high school degree and 18 months of coursework that is often done by “correspondence.”   We do not recommend trusting your life or that of your baby to the hands of other than an OBGYN or a supervised Certified Nurse Midwife “CNM.”

El Camino Hospital in specific has been and continues to be proactive in every aspect of its COVID19 response and we are very comfortable recommending having our patients labor and deliver at this hospital.

Can COVID-19 pass to a baby through breast milk?

Data has found zero virus in the breast milk of infected mothers and is considered safe in women with COVID19, with precautions.  The data, however, is limited.

How can I avoid passing COVID-19 to my baby if I am positive?

Wash your hands before touching your baby and wear a face mask while breastfeeding.  It’s also important to wash your hands before touching any breast pump or bottle parts and clean all pump and bottle parts after each use.  You also can have someone who is not sick feed your breast milk to your baby after you pump.   Though difficult and disruptive, these precautions are only until you can end self-isolation.

COVID19 and Young Children:

The data for young children is robust and reassuring.   Children are less likely to develop symptoms and for those symptoms to become severe.  Death is rare.  For the published data we have, the risk of death from COVID19 in children is lower than the general infant mortality rate in the US.

What we’re doing differently at El Camino Women’s Medical Group:

For our pregnant patient, we are spacing out appointments as appropriate for each specific patient.  We have televists available for any issue that can be appropriately addressed without an in-person physical exam.

If you do have an appointment at the office, we’re screening all patients the day before their visit.  The schedule has been set to space out onsite visits so there’s no crowding in our waiting room.  In fact, 95% of the day, the waiting room is just empty.  We’re asking patients to come alone and leave visitors in the car.  All of our staff and physicians are masked while in the office and they are also screened daily to make sure it’s appropriate for them to be at work.

We have always had detailed cleaning procedures for our exam rooms between patients.  Those procedures have been intensified and include the entire office.

What El Camino Hospital is doing differently:

The Women’s Hospital has a totally separate entrance from the main hospital.  At the entrance, every patient and visitor is screened.  Patients in the Women’s Hospital may only have one visitor and they do have to pass through screening.   The main hospital is not allowing any visitors.  The entire hospital system is also undergoing rigorous and the most up to date cleaning protocols for every room and every shared space.

The Impact of Social Distancing

Social distancing is hard.   Please do your best to take care of yourself. Try your best to:

• Stay connected virtually with friends and family
• Take breaks from the news and social media
• Book a Televisit with us if you’re feeling sad or anxious
• Take on a new hobby or topic or language to learn
• Call to book a Televisit with our Psychiatrist or Therapist

Resources

Substance Abuse and Mental Health Services Administration:

1-800-985-5990 (TTY 1-800-846-8517)

Text TalkWithUs to 66746

National Domestic Violence Hotline:

800-799-SAFE (7233) and 800-787-3224 (TTY)

Live chat option at www.thehotline.org

If you feel like you want to harm yourself or others, call 911 right away

WHO Mythbusters

What have you heard?   5G causes coronavirus?  Staying in the hot sun prevents it?   Verify rumors you hear at the WHO Mythbusters website!

SKIN CARE DURING COVID

Lillian Soohoo, MD
Board Certified Dermatologist

Early last month when the community threat of COVID-19 became a reality, my patients began asking questions about skin care products to use and my thoughts on the best skin care practices needed to prevent infection and to maintain skin health.

In this issue, I share a few simple tips and observations about how to keep your skin healthy while learning to live with COVID-19. As we all adjust and cope during this uncertain time, it’s more important than ever to stay calm and have ready access to accurate, helpful information.

Below are my recent observations:

1. If you have sheltered in place for the past 2 weeks, you are feeling completely healthy, and you do not have a household member at high risk for COVID-19 exposure (such as a healthcare worker, transit or emergency personnel) stop spraying disinfectant everywhere in the house every day. The virus is likely not going to spontaneously generate in your home and I have been seeing and treating many patients with itchy rashes over the face, eyelids and neck due to contact exposure to aerosolized disinfectants such as Lysol. Especially computer keyboards and other digital devices need to be wiped down again with a clean cloth after treating with a disinfectant.
2. Handwashing is important, but soap and hand sanitizer can cause raw, itchy hands— especially on the backs (not so much the palms) of the hands. Again, be selective about your cleansers. All soaps are drying and can be irritating on already chapped hands. If you are noticing your hands are dry and chapped, stop what you’re using now. My favorite hand and face cleanser is Toleriane Dermocleanser by LaRoche Posay. It can be used in all skin types and is not irritating. If you already have dry, irritated hands, this is a good alternative to the hand sanitizer and whatever soap you’re using now. Remember the length of time you wash—at least 20 seconds-is just as important. After drying hands, Vaseline (not Aquaphor which contains lanolin and may cause allergy) may be applied to irritated patches as needed.
3. While sheltering in place, try to maintain a healthy diet and exercise to keep skin, mind and body well. Acne may flare during times of stress such as this (due to hormonal changes), so keeping a daily routine with an adequate sleep schedule is important.

I hope these few simple skin recommendations will help you and your loved ones stay healthy and safe.

The Menkes Clinic is open to evaluate and treat new and established patients via teledermatology. If you have more questions or would like to schedule an appointment with Dr. Soohoo, please call 650.962.4600 or schedule appointments online at www.menkesclinic.com.

Lillian Soohoo, MD
Board Certified Dermatologist
The Menkes Clinic
2490 Hospital Drive Suite 201, MV
650-962-4600

COVID19 SYMPTOMS?  THERE’S AN APP FOR THAT…

One of the best ways to help flatten the curve of COVID19 infections and hospitalizations is to know when to self-isolate, when to stay home, and when to seek care.  Apricity Health has recently developed an app that allows people to input their symptoms, have them reviewed by a physician or trained nurse and get feedback as to next best step.   The initial registration includes a televisit.  Your daily symptoms will be monitored and if you need evaluation by a physician, a televisit will be available.

Learn how to register here: https://bit.ly/ARxCV19

Or register online at: https://covid19.apricity-health.com/login or via QR code above

*El Camino Women’s Medical Group (and its physicians and staff) have no affiliation with this product

YOUR LOCAL ENTs ARE DOING TELEVISITS!

By Katrina Chaung, M.D.
Board Certified ENT

While we all protect ourselves and loved ones during this uncertain time, we know that other health problems will continue and new issues will arise.

Our Ear, Nose, and Throat (ENT) office remains open to serve our community.

We are currently offering virtual telehealth visits.  Simple user-friendly video platforms can provide “face to face” consultation between the physician and patient and can also provide important examination information.

Concerns that may be addressed include (but are not limited to):

– Hearing problems

– Other ear issues

– Allergy concerns

– Sinus and nasal issues

– Mouth problems

– Questions about lumps or bumps

– Thyroid issues

– Throat concerns

– Voice problems

Based on the evaluation and information obtained during a virtual visit, we will make recommendations and/or schedule an evaluation in the office.

Above all, we hope you continue to stay safe and healthy!

Katrina Chaung, M.D.
Board-certified, Otolaryngology-Head and Neck Surgery (Ear, Nose, & Throat)
2495 Hospital Dr. Suite 450
Mountain View, CA 94040
(650) 988-4161

Highlights from our Women’s Health Blog

Our Women’s Health Blog is a way for us to put out up to date information on various topics.  Our most popular article was not surprisingly Information on the Coronavirus.  The next is from a year ago on The Lowest Effective Estrogen Dose for the Treatment of GSM.  I’m not sure why but the third most-read blog article in the last few months was from almost 5 years ago on Hysteroscopy: Evaluation and Treatment of Abnormal Uterine Bleeding.  We update our blog at least a few times a month with information on all kinds of women’s health issues.  Follow us on Facebook, Twitter, LinkedIn, or Instagram to be informed when we post new articles and stay up to date on the latest in women’s health.

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