Women’s Health Newsletter, Volume 5 Issue 4

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WOMEN’S HEALTH

We have MOVED!

Eighteen months later than planned, and a year after we had our first walk through a nearly completed suite, we have finally moved into our new, gorgeous office! This means we are now seeing ALL our patients at our new location in the Sobrato Pavilion. In a year like 2020, we are so excited to see all our planning finally come together in this beautiful space. We are looking forward to sharing it with all of you.

October is Breast Cancer Awareness Month! As the pandemic has caused many of us to defer preventative healthcare, cancer diagnoses have dropped dramatically in the US (not a good thing). Dr. Singhal has contributed a timely article on the importance of early screening.

We also encourage everyone to get their flu shots before the end of October. Flu shots are important every year, but especially this winter, as we prepare for a resurgence of COVID-19 cases.

Finally, please follow us on social medial to stay up-to-date on health care issues affecting women and news from our practice. We have been doing giveaways of great skincare and haircare products and will add some pregnancy and parenting books this fall! Find us on Facebook or Instagram for great information and a chance to win free products!

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

We wish all of you good health and encourage you to continue with social distancing, masking in public, and avoiding large gatherings for the foreseeable future. As we approach winter and the holiday season, we wish you all joyful times with family and loved ones.

Sarah Azad, MD

In this issue:

Practice Updates

Online Prenatal Classes

The COVID Chronicles: Reflections of a Dermatologist

ECWMG Will be Joining a Clinical Trial in 2021!

October Is Breast Cancer Awareness Month

COVID 19 and Pregnancy: Early Data from UCSF

Taking Care of Your Voice: Advice from an ENT

Highlights from our Women’s Health Blog

During the two weeks of holidays in December, we will only be scheduling urgent visits and those related to pregnancy, allowing more of our staff time off. Please also make sure you give us enough time for any refills on prescriptions you will need over the holidays.

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. We are excited to announce an additional therapist to be joining us in November. Hopefully the additional therapist will help accommodate all of our patients who’ve been waiting to establish care.

Don’t forget to follow us on social media to stay up to date on office information and 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.

ONLINE PRENATAL CLASSES

Prenatal Classes

We are now offering four virtual prenatal classes a month online. These classes cover preparing for childbirth, breastfeeding, and newborn care. These classes have been very popular, and we plan to have them every month. They are also available for any women interested in signing up, though we prioritize space for our patients.

Virtual Breastfeeding Class

This is a 2-hour class presented by Nadia, RN, our lactation educator. The class is a virtual, in-depth review of breastfeeding. Learn how to get the best start, avoid pain, make sure your baby is getting enough, and when to ask for help!

Virtual Newborn Care & Safety Class

2.5-hour class presented by Nadia, RN

Practical tips for caring for a newborn

• Appearance of newborn
• Normal skin conditions
• Bathing & diaper changing
• Safe sleeping

We have added Newborn safety to this class! which includes

• Car seat safety
• Choking hazards
• Poison control
• Childproofing your home

Childbirth Preparation Part One

2.5 hour class presented by Nadia, RN:

• The last month of pregnancy
• Preparing for the hospital
• Laboring at home, when to call and when to come in
• Admission to the hospital
• Active labor
• Pain management

Childbirth Preparation Part Two

2.5 hour class presented by Nadia, RN covering:

• The last stage of labor: pushing
• Vaginal delivery
• Cesarean delivery
• Initial recovery in the hospital
• The postpartum period

You can learn more about these classes or register here.

THE COVID CHRONICLES: REFLECTIONS OF A DERMATOLOGIST

Lillian Soohoo, MD
Board Certified Dermatologist

It’s been six months since the world came to a halt, and those who could, locked themselves in their homes. Along with the new habits we’ve fallen into during COVID, I’ve noticed an interesting trend in the types of skin conditions my patients have been experiencing since March.

These “new” skin problems are mostly the result of unusual behaviors we have come to normalize in response to the pandemic. In particular, changes in levels of physical activity due to home confinement, stress eating, the disruption of normal sleep patterns, and an obsession to maintain absolute cleanliness have negatively affected many patients. These are what I refer to as COVID lifestyle changes which, together with self-isolation and emotional stress, have created a novel environment for the emergence of several recognizable skin diseases.

As a busy dermatologist who has been caring for patients throughout this pandemic, I’ve come to realize that there has literally been a “Covid-Related Skin-Disease-of-the-Month” starting with the lockdown in March.
Below is a monthly timeline of emerging skin-related health problems I have seen since the beginning of Quarantine:

Month 1 (Late March): Itchy, Burning, Scaly “Raw” Hands
Reason:
-Frequent, obsessive hand washing
-Too much exposure to soaps, water, hand sanitizers, and the chemical disinfectants used on hard surfaces, computer keyboards and touchscreen devices
-Extremely common due to widespread fear of contracting the COVID-19 virus

Treatment:
-Reduce frequency of handwashing
-When washing, use hand soap only before eating and after using the bathroom
-Stop using hand sanitizer completely
-Switch to a mild, non-drying soap, such as TolerianeDermocleanser by La Roche Posay (widely available). Avoid Dove and Method brands since they contain preservatives and fragrances that may cause allergic skin reactions and promote dry skin.
-Apply prescription-strength steroid ointments as directed by a physician if the rash persists.

Month 2 (Late Mar-Apr): Painful, Itchy, Purple Skin Patches on Toes, Feet, and Ankles, “COVID toes”
Reason:
-This unique skin finding known as “COVID toes” proved to be one of the first identifiable COVID-19 symptoms in addition to fever, cough, and fatigue.
-Due to small clots in blood vessels.
-Uncommon
-Manifests late during a COVID-19 infection.
-Seen mostly in children and teens
-The incidence has sharply declined in my practice region (Silicon Valley/SF) since lockdown. I diagnosed several pediatric patients in March and April, but none since then.

Treatment:
-No specific therapy
-Goes away within a few weeks without scarring
-Obtain COVID testing to confirm infection status
-Apply prescription-strength steroid ointment for itching, if needed

Month 3 (May): Itchy, Burning, Swollen Rashes on the Face
Reason:
-This is what I call the “Amazon Prime Rash.”
-At this point during the pandemic, patients reported worsening feelings of depression and anxiety.
-In an attempt to improve their appearance on Zoom calls and to feel better about themselves, patients began ordering a myriad of cosmetic products online.
-Amazon purchases surged as patients tried all types of facial products, including masks, anti-aging serums, moisturizers, toners, make-up, and sunscreens.
-Many began using these products for the first time during the quarantine.
-The outcome of this cosmetic product experimentation was a red, swollen, painful, itchy face.

Treatment:
-Immediately stop using EVERYTHING. This includes all the new stuff and even your old mainstay products.
-Once your face is irritated, the skin becomes hypersensitive and face products that you have used for years without a problem can trigger or make your rash worse.
-Use only TolerianeDermocleanser(La Roche-Posay). This product can serve as your daily facial cleanser or be applied as a soothing moisturizer. Stop using everything else.
-Don’t forget to also stop using disposable face wipes, makeup, hair spray, and sunscreens until your skin returns to normal.
-Prescription-strength steroid ointments should be used only as directed by a physician. Prednisone may be required for severe facial swelling and allergic reactions.

Month 4 (June-July): Random Itchy bumps and rashes on the body, arms, and legs
Reason:
-Environmental exposure to biting insects and Poison Oak
-Ankles, waistband, arms and lower legs are classic body areas for insect bites
-After being cooped up for months, a lot of people ventured outside to their backyards and gardens, with many spending leisure time visiting parks, hiking trails and beaches.
-Summer is peak time for biting insects: fleas (found on pets, in the grass and sand–especially sandboxes), mosquitoes, and bird mites on outdoor furniture.
-Hiking trails, mountain biking and off-trail exploration increase exposure to poison oak and biting insects.
-Poison oak rashes typically resolve with routine appropriate medical treatment (see below), but itching may persist for up to 3 weeks after exposure.
-Insect bites can also continue to itch and scab over repeatedly for months.
-Secondary bacterial infection of insect bites is common.

Treatment of insect bites:
-Identify the source and avoid contact with insects.
-Wear long pants/long sleeves to provide a skin barrier to insects.
-Topical steroid ointment for itching.
-Topical antibiotic ointment for secondary bacterial infection.
-Over-the-counter antihistamines such as Zyrtec 10 mg daily, to reduce swelling and itch.
-Exterminator to check for home infestation.

Treatment of Poison Oak:
-Topical and/or oral steroids, depending on severity and extent of involved body areas.
-May require prescription strength antihistamines, such as Hydroxyzine (Atarax) during the day and at bedtime
-Antibiotic ointment. If rash is extensive, oral antibiotics may be needed for secondary bacterial infection.

Month 5 (July-August): Worsening Acne, AKA “Mask-ne”
Reason:
-Sweating and breathing under a face mask may irritate skin and cause pimples
-Stress hormones, worsening pre-menstrual acne flares
-Poor diet choices during lockdown (junk food, carbs)
-Disrupted sleep hygiene
-Use of acne-causing facial products, such as moisturizers and oily serums

Treatment:
-See your dermatologist for the best advice and appropriate treatment for your acne.
-Prescription-strength topical and oral medications are the most effective to treat all types of acne.
-Maintain a healthy diet and exercise routine.
-Practice consistent sleep hygiene.
-Keep wearing your mask as recommended since COVID-19 infection is a serious illness with potential permanent long-term health effects. The risk of residual COVID lung disease and the development of cancer and autoimmune diseases in later life is still uncertain. Don’t risk getting infected.

Month 6 (Late Aug-Sept): Sexually Transmitted Diseases (STDs)
Reason:
-I have noticed an uptick during the past month in the number of patients with STDs such as syphilis, molluscum contagiosum, genital warts (HPV) and genital herpes.
-This may be an early, anecdotal observation, but it also warrants further consideration. After a six month-long nationwide lockdown, there may be a surge in STD cases as quarantine restrictions are lifted.
-STD transmission is facilitated by the use of social media dating platforms

Treatment:
-If a person is diagnosed with an STD, they should also be tested for HIV, Hepatitis C, and syphilis.
-Immediate treatment with appropriate antibiotic/antiviral therapy as well as HPV vaccination, if not already immune.
-Contact tracing and notification of all known sexual partners.
-Public awareness about STDs is important during COVID, especially in non-monogamous, sexually-active patients. Secondary syphilis has been diagnosed in my suburban dermatology practice during COVID in a young, otherwise healthy adult male.
-Syphilis in the skin can be indistinguishable from pityriasis rosea, a common non-specific viral rash seen in children and young adults. All patients presenting with a pityriasis rosea-like rash should get a blood test for syphilis to rule out infection.

Top Tips— No Matter What Month You’re In, Post-Covid:

-Since the beginning of the pandemic, dermatologists have been recognizing new rashes and skin symptoms associated with the virus.

-Most COVID-related skin problems are due to lifestyle changes, not actual infection with COVID-19.

-Stop using any skin product that causes redness, stinging or burning. Throw it away. Skin discomfort means skin irritation, not product effectiveness. Better to get rid of it before a rash develops.

-Price does not guarantee safety, effectiveness or tolerability of skin products. Expensive skin care products can still trigger rashes, irritation and allergic reactions.

-Visit a dermatologist to create a personalized skin care routine that works for you. Call to ask if they are scheduling virtual “teledermatology” appointments if you are concerned about going to an office.

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

ECWMG WILL BE JOINING A CLINICAL TRIAL IN 2021!

El Camino Women’s Medical Group is pleased to announce that we are expecting to join Materna Medical in a study to see if we can help first-time moms have a faster delivery with less pelvic floor injury during childbirth. Materna is currently conducting a clinical trial, partially funded by The National Institutes of Health (NIH), for an investigational product called Materna Prep. We hope to begin enrolling in Early 2021 in our practice. Study volunteers will meet the following criteria to be included:

• A first-time mother
• At least 18-years old
• Expect to deliver your baby at full term
• Expect to have a vaginal delivery

There is no cost to participate, and patients who qualify will receive a $150 honorarium (in the form of a gift card). We look forward to discussing with you!

OCTOBER IS BREAST CANCER AWARENESS MONTH

By Shyamali Singhal, MD
Surgical Oncologist
Founder of Hope & Beauty

The Importance of Early Screening

Every October, people worldwide show their care for people whose lives were touched by breast cancer. Raising awareness is always important, but October is when this prevalent disease gets the most attention. For almost a year by now, the coronavirus pandemic has disrupted preventative healthcare. Screening mammograms and clinical breast exams are a huge part of early detection of breast cancer and it is important that we encourage all women to stay up-to-date with their screening tests and exams.

As we take the time this month to celebrate survivors and their loved ones and do what we can to raise awareness around the importance of early detection and screening in their community, please make sure your own care is up to date.

Breast Cancer Is the Most Common Type of Cancer Among Women

Next to skin cancer, breast cancer is the most frequent type of cancer among American women. Mammograms are still the best-known way to catch breast cancer in its early stages, when it is easier to treat it, and before it grows large enough to cause serious symptoms.

Globally, there are over 1.30 million new cases of breast cancer and 458 000 deaths from it every year. This puts breast cancer at the top of the list, as it is by far the most common cancer in women worldwide. In low- and middle-income countries, the incidence of breast cancer has been rising in recent years due to an increase in life expectancy, increased urbanization, and the adoption of a sedentary lifestyle.

Less Known Facts About Breast Cancer

• Most breast cancers occur in women over 50 years or older, but this doesn’t mean that breast cancer can’t affect younger women as well.
• Men can also develop breast cancer, even if it is not as common. One out of every 100 breast cancers diagnosed in the United States is in a man
• One in eight women will be affected by breast cancer in their life.
• In the US, breast cancer is the most commonly diagnosed cancer in women
• After lung cancer, breast cancer is the second leading cause of cancer-caused death
• Every year in the United States more than 250,000 women will be diagnosed with breast cancer and more than 42,000 women will die from this disease.
• Early cancer detection is, by far, the most efficient way of surviving cancer. When cancer is caught early enough, chances of survival exceed 90 percent.

Get Yourself Checked

Currently, there is not enough knowledge on what exactly causes breast cancer, so early detection of the disease continues to be the cornerstone of breast cancer control. When breast cancer is caught early, and if satisfactory diagnosis and treatment are accessible, there is a chance of complete cancer resection or full remission. But, when detected in later stages, curative treatment is often no longer a viable option. In those cases, aggressive surgery, chemotherapy, radiation are often required and not always successful.

If you have no family history or genetic predisposition for breast cancer, breast exams with your primary care physician or OBGYN should begin at the age of 25 and should be done at least once a year when you turn 40. Mammograms should start between the ages of 40-45 and repeated every 1-2 years.

If you are at a higher risk of getting breast cancer, your doctor will develop a more tailored plan, which may include clinical breast exams every six months, mammograms every year starting earlier than 40, or breast MRIs. If you have a significant family history, genetic testing and referral to a genetic counselor may also be important.

October is a great month to remind ourselves and our loved ones to stay up to date on healthcare screening, especially around the early detection of breast cancer. If you haven’t seen your primary care physician in the last 12 months, it’s a good time to make that appointment.

COVID 19 AND PREGNANCY: EARLY DATA FROM UCSF

PRIORITY (Pregnancy CoRonavIrus Outcomes RegIsTrY)

Early in the pandemic, UCSF and UCLA launched a registry for pregnant women diagnosed with COVID19. PRIORITY (Pregnancy CoRonavIrus Outcomes RegIsTrY) is a nationwide study of pregnant or recently pregnant people who are either under investigation for Coronavirus infection (COVID-19) or have been confirmed to have COVID-19. This study was initiated to help patients and physicians better understand how COVID-19 impacts pregnant women and their newborns. Data on active enrollees is available real-time through their public dashboard.

PRIORITY just closed enrollment this month and has started publishing some of its results including nearly 600 women and over 260 infants of pregnancies affected by COVID19.

Major findings:

• Pregnant women have less specific symptoms than the general population
• The most common first symptom is cough, then sore throat. Only 12% present with a fever.
• Pregnant women take longer to recover, on average 37 days
• 1/4th of pregnant women diagnosed with COVID-19 had persistent symptoms over 8 weeks after diagnosis
• Babies born to mothers infected with the virus generally do well six to eight weeks after birth
• If the mother had COVID-19 within 2 weeks of delivery, there was a higher rate of neonatal intensive care unit (NICU) admissions.
• For mothers testing positive for COVID 19, the risk of the infant being positive is 1.1%. The vast majority of these babies are not affected.
• The data published so far is mostly from pregnancies affected by COVID19 in the third trimester. Data from the full set of registered patients is needed before we can fully understand the effects on the mother and baby’s health.

You can learn more about the PRIORITY registry or the new ASPIRE Study on the UCSF website.

TAKING CARE OF YOUR VOICE: ADVICE FROM AN ENT

By Katrina Chaung, M.D.
Board Certified ENT

Everyone’s routine looks a bit different these days. Recently, many of my patients have complained about hoarseness or other issues with their voice. Whether it’s endless Zoom meetings for work or hours of phone calls to connect with friends and family, our voices are in high demand. More than ever, we need to maintain good habits to maintain a strong and resonant voice.

Hydrate!

Our vocal cords rely on good lubrication to not only generate a strong and smooth voice quality but also to avoid injury. Drink plenty of water and other non-acidic fluids. Don’t forget that caffeinated beverages (coffee, soda, teas) and alcohol will dehydrate the body including the larynx (or voice box) area. Being dehydrated will also produce thicker mucous that will prompt more throat clearing. More on that below.

Avoid excessive clearing of your throat.

Clearing your throat is quite harsh on your vocal cords and can cause them to swell. This leads to increased risk of irritation, bruising, and injury. Instead, try to swallow and gargle with salt water to help loosen the mucus.

Hydrate!

Our vocal cords rely on good lubrication to not only generate a strong and smooth voice quality but also to avoid injury. Drink plenty of water and other non-acidic fluids. Don’t forget that caffeinated beverages (coffee, soda, teas) and alcohol will dehydrate the body including the larynx (or voice box) area. Being dehydrated will also produce thicker mucous that will prompt more throat clearing. More on that below.

Avoid excessive clearing of your throat.

Clearing your throat is quite harsh on your vocal cords and can cause them to swell. This leads to increased risk of irritation, bruising, and injury. Instead, try to swallow and gargle with salt water to help loosen the mucus.

Avoid irritants.

Irritants in the environment will affect not only the nose and lungs but also the vocal cords. Try your best to avoid areas with second-hand tobacco smoke, chemical fumes, wildfire smoke, and allergens that you are sensitive to like dust, pollen, molds.

In addition to all the horrible effects of smoking, it also causes significant irritation to the vocal cords. It can also cause cancer of the vocal cords in addition to many other sites in the body.

Be aware of your volume.

It is best to use a moderate conversational level of volume when you speak. Yelling and shouting cause your vocal cords to clap together harshly and can cause irritation and injury. Surprisingly, whispering is actually just as harsh if not harsher on you vocal cords than yelling.

Try to face your audience to limit how much you have to strain to be heard. If you are a teacher or lecturer, you may want to think about a microphone system. Lastly, maintaining good back and neck posture will also help minimize extraneous strain when you are generating a voice.

Give your voice a break.

If you find yourself speaking for a long period of time, start to sound hoarse, or feel the sensation of tension or fatigue, allow your voice a chance to rest. This is your body’s message to you that your voice needs a break. Limit the amount of talking and certainly don’t try to speak even louder or sing. You will only add further strain by pushing through. Preventing an injury is much easier than healing from one.

Avoid foods and habits that increase acid reflux.

The effects of acid reflux can extend beyond the discomfort of heartburn. Acidic contents can also irritate the throat and larynx. For many, adjusting dietary and lifestyle habits can make a huge difference. Avoid spicy or acidic foods, limit caffeine intake, and do not lie down or recline for at least several hours after you eat.

If you are having issues with your voice, you may benefit from an Ear, Nose, and Throat evaluation.

Katrina Chaung, M.D.
Board-certified, Otolaryngology – Head and Neck Surgery
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. Like last quarter, our most popular article was Stop Eating all The Time: Snacking and Intermittent Fasting. Imvexxy continues to remain interesting for patients as an article from over a year ago was the second most read: The Lowest Effective Estrogen Dose for the Treatment of GSM. The treatment of vaginal changes after menopause is always a popular subject. We do our best to bring in the most effective treatments to the office. Another older article on Hysteroscopy was the 3rd most popular article last quarter. We update our blog at least 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 updated on the latest in women’s health.