Women Physicians OB/GYN Blog

WPMG has received a supply of thimerasol free H1N1 vaccine. Beginning Monday, December 7, we will be offering vaccinations to our high risk patients. If you meet the criteria listed below, please call our office at 650-988-7550 to make an appointment.

The following groups are high risk:
-Pregnant women;
-People who live with or care for infants younger than 6 months of age;
-Healthcare workers (HCWs) and emergency medical personnel;
-Persons 6 months to 24 years of age;
-Persons 25-64 years of age who have chronic diseases (including immunodeficiency states) that pose risk for influenza.

Contraindications to the inactivated vaccine include:
-Previous Guillain-Barré syndrome;
-Life-threatening reaction to previous influenza vaccination; and
-Severe illness (a “moderately or severely ill” patient is advised to wait, but a mild upper respiratory infection or other illness is not a contraindication).

Note that pregnancy and breastfeeding are not contraindications to receiving the inactivated vaccine. The most common side effect with the killed virus vaccine is soreness at the injection site. The cost is $25.

Many of our patients have had questions about the change in recommendations recently released by the U.S. Preventative Service Task Force (USPSTF) regarding mammograms for women in their 40’s. In 2002, the USPSTF recommended screening every 1 to 2 years for women aged 40-74. They now recommend against routine screening for women in their 40’s though they acknowledged the decision of when to start should be based on the individual patient’s characteristics, including the patient’s values about specific benefits and risks. They continue to recommend biennial screening from age 50-74. They also recommended against teaching breast self exam (BSE).

The USPSTF recommendations were based on recent studies published November 17, 2009 in the Annals of Internal Medicine. These showed that both women in their 40’s and women in their 50’s have an equal decreased risk of dying from breast cancer if they get routine screening mammograms. However, women in their 40’s may have denser breasts and so are more likely to require additional imaging studies and perhaps breast biopsies to rule out breast cancer. This could result in harm from radiation exposure, false-positive and false-negative results, overdiagnosis, pain during procedures, and anxiety. The USPSTF decided that for women in their 40’s the risk of harm was greater than for women above 50 but the likelihood of benefit was less since only about half as many women in their 40’s actually have breast cancer identified on routine screening.

The American College of Obstetricians and Gynecologists (ACOG) has also reviewed recent data on risks and benefits of mammograms. At the present time, they recommend:
• Screening mammography every 1-2 years for women aged 40-49 years
• Screening mammography every year for women age 50 or older
• BSE; BSE has the potential to detect palpable breast cancer and can be recommended.
The American Cancer Society (ACS) also continues to recommend routine screening for women 40 and above. The Department of Health and Human Services (HHS) is not changing their current funding guidelines for women 40 and above.

Your doctors here at WPMG support ACOG guidelines until there is compelling evidence to the contrary. We will also individualize recommendations for high risk women.

Unfortunately, Women Physicians Ob-Gyn has not yet received the 250 doses of H1N1 vaccine that we ordered and we are uncertain of the exact date it will arrive. We will announce our receipt on this blog as soon as it arrives. In the meantime, we want to notify all of our high risk risk patients about the clinics provided by the county.

Where to Get the H1N1 Flu Vaccine

The following clinics are for people at higher risk for getting or having complications from the H1N1 flu. Over the next weeks and months, as regular shipments of vaccine continue to arrive, there should be enough vaccine for anyone who wants it.

Public vaccination clinics for the following groups will be held on November 15, and November 21 from 9:30 a.m. to 3:30 p.m.

Pregnant women;
Children and young adults between the ages of 6 months and 24 years;
People who live with or provide care for infants under six months;
Adults between the ages of 25 and 64 years who have medical conditions that put them at higher risk for flu-related complications; and,
Healthcare and emergency medical services workers.
Because the vaccine supply is so limited at this time, it is important that persons not belonging to one of the groups above wait to be vaccinated so that those at highest risk of severe illness can get the vaccine.

Once the demand for vaccine for people at highest risk has been met, the Public Health Department and local providers will begin providing the vaccine to all others who want it. It is important to remember – this is the beginning of a long vaccination effort. We thank you for your patience and understanding.

Clinic locations, days, and hours may change based on the vaccine’s availability and public demand. Please check www.sccphd.org/h1n1flu for weekly updates to clinic schedules.

November 15th to November 21st

Times
Sunday, November 15
Saturday, November 21 9:30 a.m.
3:30 p.m.
Location
Santa Clara County Fairgrounds
EXPO HALL
334 Tully Road
San José, CA 95111

For more information about the H1N1 flu and vaccination clinics offered by the Santa Clara County Public Health Department, visit www.sccphd.org.

Many of you have been concerned with the delays in the availability of the H1N1 vaccine. Here are some hints you can utilize to minimize your risk of becoming infected in the meantime. These are recommendations by Dr. Vinay Goyal who is an MBBS,DRM,DNB (Intensivist and Thyroid specialist) with clinical experience of over 20 years. He has worked in institutions like Hinduja Hospital , Bombay Hospital , Saifee Hospital , Tata Memorial etc..

“The only portals of H1N1 entry are the nostrils and mouth/throat.. In a global epidemic of this nature, it’s almost impossible to avoid coming into contact with H1N1 in spite of all precautions. Contact with H1N1 is not so much of a problem as proliferation is.

While you are still healthy and not showing any symptoms of H1N1 infection, in order to prevent proliferation, aggravation of symptoms and development of secondary infections, some very simple steps, not fully highlighted in most official communications, can be practiced (instead of focusing on how to stock N95 or Tamiflu):

1. Frequent hand-washing (well highlighted in all official communications).

2. “Hands-off-the-face” approach. Resist all temptations to touch any part of face (unless you want to eat, bathe or slap).

3. *Gargle twice a day with warm salt water (use Listerine if you don’t trust salt). *H1N1 takes 2-3 days after initial infection in the throat/ nasal cavity to proliferate and show characteristic symptoms. Simple gargling prevents proliferation. In a way, gargling with salt water has the same effect on a healthy individual that Tamiflu has on an infected one. Don’t underestimate this simple, inexpensive and powerful preventative method.

4. Similar to 3 above, *clean your nostrils at least once every day with warm salt water. *Not everybody may be good at Jala Neti or Sutra Neti (very good Yoga asanas to clean nasal cavities), but *blowing the nose hard once a day and swabbing both nostrils with cotton buds dipped in warm salt water is very effective in bringing down viral population.*

5. *Boost your natural immunity with foods that are rich in Vitamin C (Amla and other citrus fruits). *If you have to supplement with Vitamin C tablets, make sure that it also has Zinc to boost absorption.

6. *Drink as much of warm liquids (tea, coffee, etc) as you can. *Drinking warm liquids has the same effect as gargling, but in the reverse direction. They wash off proliferating viruses from the throat into the stomach where they cannot survive, proliferate or do any harm.”

To view a video clip on how to do saline irrigation, you can go to the following site: http://www.mayoclinic.com/health/nasal-lavage/MM00552

El Camino Hospital is offering a great program which includes healthy discounts, as well as health information and education. The $25 lifetime fee will be waived if you sign up by October 31. For more information, go to http://www.elcaminohospital.org/Womens_Hospital/HealthPerks/

You may have heard the news lately that taking Yaz or Yasmin increases your risk of developing a blood clot or stroke. The reality is that taking any birth control pill (BCP) increases your risk. Blood clots are the most serious risk that is increased by taking BCPs, but fortunately they are very rare events.

The risk of having a blood clot or stroke is 1 in 10,000 in the general population. In a study published by the British Medical Journal this year, the risk increases to 3.6-7.3 in 10,000 with BCP use. Pills containing levonorgestrel such as Seasonale/Seasonique and Alesse have a risk of 3.6 per 10,000; those containing desogestrel such as Desogen, Mircette and Orthocept have a risk of 7.3 per 10,000; and drospirenone birth control pills such as Yaz or Yasmin have a risk of 6.3 per 10,000. The risk of getting a clot while taking BCPs is 3.6 to 7.3 times higher than if a person is taking no BCPs, but it is important to remember that the the risk of developing a clot during a normal pregnancy is even higher than when using BCPs. Women who have a normal pregnancy have a rate of blood clots of 8-10 per 10,000.

When looking at the risk, also take into account the benefits of being on BCPs. In addition to preventing pregnancy, BCP cause lighter periods, less cramping, less acne and hair growth, fewer ovarian cysts, decreased PMS, and lower risk of ovarian and endometrial cancer.

Not all pills are tolerated well by all patients. Although clotting risk needs to be considered when prescribing a pill, the overall response to the pill is important. If you have tried other pills and are happy with your current pill, stick with it. You can decrease your risk of getting a clot by not smoking and maintaining a healthy weight.

Some women fear that BCPs will cause other problems like cancer or infertility. Actually, BCPs help to prevent ovarian and endometrial cancers and they do not increase the risk of breast cancer. They do not cause infertility and can actually help preserve fertility by decreasing the risk of endometriosis and ovarian cysts.

If you have concerns about whether or not you are a good candidate for using the pill, make an appointment with your doctor who will review your family history, your health habits, your current symptoms, and your fertility goals and timing to help you decide if BCPs are right for you.

If you have suffered from endometriosis or preterm labor, you may be able to participate in medical research to determine which genes might be involved with these diseases. Such knowledge could lead to new diagnostic tests, treatments, and preventative therapies. This research is being carried out by Juneau Biosciences in Salt Lake City. To learn more about these studies and determine if you are a candidate, go to www.juneaubiosciences.com.

The Army of Women is seeking Recruits for Breast Cancer Research

The Dr. Susan Love Research Foundation and the Avon Foundation for Women have joined forces to launch the Love/Avon Army of Women. This revolutionary initiative has two key goals: 1) To recruit one million healthy women of every age and ethnicity, including breast cancer survivors and women at high-risk for the disease, to partner with breast cancer researchers and directly participate in the research that will eradicate breast cancer, 2) To challenge the scientific community to expand its current focus to include breast cancer prevention research conducted on healthy women. All women are invited to join this movement that will take us beyond a cure by creating new opportunities to study what causes breast cancer—and how to prevent it. You can join at http://www.armyofwomen.org As of 10/13/09, there were 315,284 participants.

From October 13 to November 23, you can enter a contest to sign up the greatest number of new recruits. The winner will get unique PINK Vespa. For more information on the contest, go to

http://www.armyofwomen.org/Pink_Vespa_Contest

The lastest issue of Pause, an on-line newsletter for women in perimenopause and menopause, has just been released. This issue highlights cancer prevention.
Go to http://pause.acog.org/president/ovarian-cancer?utm_source=Pause+E-Newsletter&utm_campaign=f11ac70b11-PauseOctober2009&utm_medium=email

To sign up for a free e-mail copy of the newsletter and to see other articles of interest for women in their 40’s and above, go to http://pause.acog.org.

With all of the buzz about the influenza vaccines this year, it’s a good time to review a few of the new indications for the Pneumovax vaccine. Since many of the flu-related deaths are actually related to a secondary pneumonia, all smokers and all people with asthma or other pulmonary diseases or a compromised immune system should be sure to get the Pneumovax vaccine. If you fit these categories, even if you are not 65, get your vaccine now. We have Pneumovax and all other currently available adult vaccines at our office at 650-988-7550.

After all, “Vaccines are among the most effective public health and medical strategies for protecting and preserving health,” wrote Gregory A. Poland, MD, MACP, Mayo Clinic and Foundation, Rochester, Minnesota, and William Schaffner, MD. Like any medical intervention, vaccines only work if people take them, and the United States has consistently failed to achieve immunization goals. On average, almost 50,000 adults die in the United States each year of vaccine-preventable diseases. In addition to the human toll, the total economic burden associated with annual influenza was estimated to be over $87 billion in 2003.

For more complete information on vaccines, go to

http://www.cdc.gov/vaccines/