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HealthLink January 2006

HealthLink January 2006

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    • SERVICE Brown & Toland Plants the Seeds for Cultivating Good Health at Health etc. an Francisco residents went on a symposium, “Cultivating visitors were given mini- HealthLink Spring 2006 S journey of health discovery at an all-day health and wellness symposium, held Saturday, Good Health” was created to emphasize that good basketballs and encouraged to take a shot at good health is a lifelong journey. health. “Not only did we 4 Colorectal Screening “Last year, the focus was want to emphasize that you Know your risks and what Jan. 28 at the Moscone Center in San Francisco. on prevention. This year, we can never be too young tests you need. Titled Health etc., the At the Brown & Toland wanted to emphasize that to start learning healthy 6 Women’s Health event, organized by KCBS display, “Plant, Shape, good health is an ongoing habits, we wanted to Here’s a rundown of the radio, attracted thousands of Rejuvenate — Cultivating process, learned early in re-introduce the concept exams every woman should know about. participants from through- Good Health,” participants life, retooled as adults, and of fun activity for adults. All out the San Francisco Bay visited three different zones redefined when we become you hear is ‘exercise, exer- 10 Men’s Health Area and featured Phil and received stamps from seniors,” says Therese cise,’ but unless you enjoy A diagnosis of prostate cancer means big decisions and McGraw, television’s each area as they learned Crossett, Brown & Toland it, you will never make it a promising treatment options. “Dr. Phil.” Brown & Toland how to make healthy life- marketing specialist. priority,” says Ms. Crossett. Medical Group was a spon- style choices during all The first stop for visitors After completing the bas- 14 Healthy Seniors Loneliness undermines your sor and provided health phases of life. was “Planting the Seeds.” ket activity, visitors pro- health. Take steps now to stay and wellness information in Designed to build upon Armed with a Brown & ceeded to the “Shape” area, connected. a unique and fun fashion. last year’s KCBS health Toland basketball hoop, where staff from the Brown Brown & Toland’s HealthLink editor: Richard Angeloni, Associate Vice President, Public Relations and Communications, Brown & Toland Medical Group, 415.972.4307. PREVENTION Brown & Toland’s HealthLink is published quarterly and printed in the United States. Copyright 2006 by StayWell Custom Communications, 780 Township Line Road, Yardley, PA 19067, 267.685.2800. Articles in this Learn How to newsletter are written by professional journalists or physicians who strive to present reliable, up-to-date health information. Our articles are reviewed Prevent Stroke and Recognize by medical professionals for accuracy and appropriateness. No magazine, however, can replace the care and advice of medical professionals, and readers are cautioned to seek such help for personal problems. Some images in this publication were provided by ©2006 PhotoDisc, Inc. PhotoDisc models used for illustrative Its Symptoms purposes only. (106) by Peter Alperin, M.D. Brown & Toland Medical Group O900,000 every 45aseconds. That translates hasmore than n average, someone in the United States _stroke to a strokes year, with about 160,000 people dying from the event. The costs associated with stroke are enormous — more than $56 billion in medical costs alone. This doesn’t even take into account the impact from lost wages or decreased productivity. 2 Brown & Toland’s HealthLink, Spring 2006 www.brownandtoland.com
    • Visitors learn the impor- tance of Brown & Toland’s iHealthRecord program for portable medical records. persuading visitors to take plans. Brown & Toland rep- charge of their own health.” resents continuity in this “Good health is an The final stop on the ever-changing market, along Brown & Toland tour was with patient care innova- ongoing process, “Rejuvenate.” With all the tion,” says Ms. Crossett. learned early in life, recent changes in Medicare, After guests visited all retooled as adults, the growing population of three zones, they earned active seniors and rising a raffle ticket and a chance and redefined when costs of health care, this to win an iPod Nano. In we become seniors.” area was designed to addition,visitors were invited — Therese Crossett, Brown & Toland prompt visitors to think to take part in an interactive marketing specialist about the choices and survey on the importance options available to them of portable medical records, as they reach age 65. “San and had a chance to learn Ms. Crossett says. “Our & Toland Medical Services our best assets is our staff,” Francisco seniors continue more about Brown & approach is simple. Give Department measured Ms. Crossett notes. “Visitors to have quality health care Toland’s iHealthRecord. people the tools to empower guests to determine if their really responded to them. services seeing their Brown “I am proud to say that them to take charge of body types were indicative They were friendly, engag- & Toland physicians in con- once again, Brown & their health, and they walk of certain risk factors for car- ing and encouraging, a junction with some of the Toland’s booth was the hit away feeling they can diovascular disease. “One of great combination for new Medicare Advantage of the convention floor,” accomplish anything.” I Stroke is the common name for cerebral vascular acci- Risk reduction, therefore, centers on reducing these dent, or CVA. The symptoms of a CVA depend on what risk factors. Of course, stopping smoking is the number one part of the brain is affected. Common symptoms include thing you can do to reduce your stroke risk. Keeping the sudden onset of weakness or paralysis of an arm or your blood pressure below 140/90 is also essential. Blood leg, slurred speech, vertigo or swallowing difficulties. pressure control is easy to dismiss, because elevated Sometimes, these symptoms will resolve in less than 24 blood pressure produces no symptoms and leads to hours. This indicates a possible transient ischemic attack, problems over decades, not days. Controlling diabetes a warning sign of an impending CVA. In any case, the symp- reduces the associated vascular disease. toms are serious and require immediate medical attention. Atrial fibrillation, common in the elderly, is a condition CVAs have a variety of origins. In some cases, arteries in in which the heart beats irregularly and leads to clot for- the brain become progressively narrowed and eventually mation inside the heart chambers. These clots can break develop a complete blockage. In other cases, blood clots off, move into the brain and cause a stroke. If this irregular Peter Alperin, M.D., of arising elsewhere in the body move up into the brain. In beating cannot be stopped, and it very often can’t, blood Brown & Toland Medical either case, when the blockage develops, a part of the thinners must be used. Group, also is in active brain is deprived of blood. Subsequently, these parts of Of course, eating right and getting regular exercise doesn’t practice at Mills–Peninsula the brain begin to die. hurt. It never does. As for testing, there are no widely rec- Hospital and is an assistant The risk factors for stroke are largely the same as those for ommended screening tests for those without symptoms, so clinical professor of medi- heart disease (remember, both diseases are really diseases of don’t worry that you haven’t been “tested” for stroke. The cine at the University of the blood vessels). High blood pressure, diabetes, smoking best cure is the proverbial “ounce of prevention.” California–San Francisco. (stop now!) and elevated cholesterol are the biggies. Until next time, stay healthy. I www.brownandtoland.com Brown & Toland’s HealthLink, Spring 2006 3
    • COLORECTAL CANCER When to Get a Colorectal Cancer Check xcluding skin cancer, colorectal cancer is the third most common type E ,of cancer in the United States. It strikes more than 100,000 Americans and kills about 56,000 every year. It’s one of the most curable cancers if detected early, but it often produces no symptoms until it’s beyond successful treatment. It is thought that colon cancer develops when environmental factors interact with a person’s inherited or acquired susceptibility. Most colon cancers (about 90 percent) come from a type of growth in the large intestine called adenomatous polyps. These polyps can slowly change, usually taking decades to develop into cancer. That’s why everyone ple with colon cancer Screening tests people at average risk have should be aware what risk have this condition. The fecal occult blood this test each year. group they fall into and People with this cancer test (FOBT) looks for hid- Sigmoidoscopy uses a when to begin screening have parents or siblings den (occult) blood in stool. short, flexible, lighted tube for colorectal cancer. who developed colorec- Blood in the stool can be that is inserted into the rec- Those at average risk for tal cancer before age 40. caused by a variety of con- tum and gently moved into colorectal cancer should They should start screen- ditions; colorectal cancer the lower half of the colon. have a screening test for ing a few years before is only one of them. The It covers only the lower colorectal cancer beginning the age of the family FOBT uses a chemical reac- part of the colon, repre- at age 50 (colorectal cancer member who developed tion to detect blood in senting about half the sur- is rarely found in people colorectal cancer. small samples of stool that face at risk for developing under the age of 50). Those who have had have been placed on an cancer. Before this test is People should be aware People who are at higher colorectal cancer or a FOBT sample card. Usually done, the colon and rectum what risk group they fall risk for colorectal cancer precancerous polyp. two samples from each of must be cleaned with an into and when to begin may need to begin screen- Those who have a par- three consecutive stools are enema. The ACS recom- colorectal cancer screenings. ing tests at a younger age. ent, sibling or child who collected and mailed or mends that people at aver- People at higher risk include: has had colorectal can- taken to your health care age risk have this test every Those with familial ade- cer before the age of 60, provider’s office for testing. five years. nomatous polyposis; that or if more than one rela- The American Gastroenter- Colonoscopy uses a is, a family history of tive is affected (at any ological Association (AGA) colonoscope, which is development of multiple age), have a two to four says that if a test is positive longer than the tube used polyps likely to become times greater risk. for blood in stool, a colon- for sigmoidoscopy. The A combination of all cancerous. Although only Those who have chronic oscopy should be done to entire colon is examined, about 1 percent of all inflammatory bowel dis- determine the source of the and if a polyp is found, it three tests — fecal colorectal cancer ease (ulcerative colitis or bleeding. It could be caused can be removed during the occult blood test, patients have this gene, Crohn’s colitis), a condi- by cancer, a polyp, hemor- colonoscopy. Before the those who do have it tion that causes the rhoids, diverticulosis (a con- exam, the entire colon must sigmoidoscopy and have a 100 percent colon to be chronically dition in which small pouch- be cleaned with laxatives colonoscopy — offers chance of developing inflamed, have an es form at weak spots in and enemas. It can be cancer. People with this increased risk of develop- the wall of the colon) or uncomfortable, so an intra- the best protection. cancer will likely die in ing colon cancer. Screen- inflammatory bowel disease. venous medication is used their 40s if not treated. ing should be started at If cancer or a precancerous to make you feel sleepy They should start screen- a young age and be polyp does not bleed, this during the procedure. ing in their teenage years. done more frequently. test will not detect it. Certain A colonoscopy takes Those with hereditary A person’s preference foods or drugs can affect the 15 to 30 minutes, longer non-polyposis cancer, and the recommendation test, so you should follow if a polyp is removed. which is brought about of the health care provider instructions on diet and A combination of all three by defective DNA repair should determine the type medications. The American tests offers the best protec- genes. About 5 percent and frequency of screening Cancer Society (ACS) and tion. For people at average to 10 percent of the peo- tests. the AGA recommend that risk, the ACS recommends 4 Brown & Toland’s HealthLink, Spring 2006 www.brownandtoland.com
    • PATIENT CARE Brown & Toland’s Patient Bill of Rights Patient Rights The physicians of Brown & Toland Medical Group are dedicated to quality patient care. As a patient of a Brown & Toland Medical Group physician, you will receive: Courteous, considerate and respectful treatment at all times Candid discussions of appropriate or medically necessary treatment options for your conditions, regardless of cost or benefit options Access to preventive health care services Information about benefits, where and how to seek care, and the risks a combination of tests: an screening for colorectal cancer involved in treatment FOBT every year and a sig- are being developed but are Timely response to requests for services, inquiries and complaints moidoscopy every five years. not recommended options Second opinions when medically appropriate If either of these is positive, at this time. These include Titles and specialties of the health care professionals responsible for your care a colonoscopy is recom- virtual colonoscopy and analy- Privacy and confidentiality regarding your medical and health conditions mended. A colonoscopy is sis of stool for DNA abnormal- Information regarding the medical group and health plan grievance procedures recommended every 10 years. ities that may indicate the Recognition of your rights to make decisions regarding your medical care and Several new methods of presence of cancer. I to complete an advance directive, thereby extending your rights to any person who may make decisions on your behalf regarding your medical care SCREENING THOSE AT HIGHER RISK The right to make recommendations to your patient rights and responsibilities Patient Responsibilities The American Cancer As your health care partner, we ask that you: Society makes the follow- Provide professional staff with all pertinent health care information needed ing recommendations: to ensure the best possible outcome. If you have had a pre- cancerous polyp or Communicate with your primary care physician when you have questions or colorectal cancer, you concerns about your health care. should follow the rec- Adhere to instructions and guidelines given for health care services. ommendations of your Cooperate with health care professionals providing service to you, except in health care provider. those instances when you have exercised your right to refuse service. If you have a parent or Educate yourself on your health benefits and services and how to correctly sibling who had colorectal cancer before the age obtain them. of 60, or two or more close relatives who had colo- If you have questions about your benefits, call Brown & Toland Medical rectal cancer at any age, you should have a Group’s Customer Service Department at 415.972.6002, or your health plan’s colonoscopy beginning at age 40, or 10 years member services division. I before the youngest case in the immediate family. Screening by colonoscopy should continue every five years as long as the results do not show a The California Department of Managed precancerous polyp or cancer. Health Care is responsible for regulat- If you have a family history of familial adenoma- ing health care plans. The department tous polyposis (FAP), you should be under the has a toll-free number (888.HMO.2219) care of a specialist, and you generally should to receive complaints regarding health begin screenings at puberty. plans. If you have a grievance against If you have a family history of hereditary non- a health plan, you should contact the polyposis colorectal cancer (HNPCC), you should health plan and use the plan’s griev- be under the care of a specialist, and you generally ance process. You may call the should begin screening at age 21. California Department of Managed If you have inflammatory bowel disease, chronic Health Care for assistance with an ulcerative colitis or Crohn’s disease, you should be under the care of a specialist who can determine emergency grievance or a grievance when screening should begin. that has not been satisfactorily resolved by the plan. www.brownandtoland.com Brown & Toland’s HealthLink, Spring 2006 5
    • WOMEN’S HEALTH For Women: Which Tests Do You Need? ou say you feel great, but what do you really know about your Y health? To find out, get the screening tests that are recommended. From mammograms to cholesterol tests, they couldn’t be more crucial. “Women today have greater life potential than ever before, and they can extend it even further with preventive care and a healthful lifestyle,” says Gerson Weiss, M.D., professor and chair of obstetrics, gynecology and women’s health at the University of Medicine and Dentistry of New Jersey/New Jersey Medical School. Screening tests can catch an illness before you see signs, when treatment may help most. Your lifestyle, health record and family history help determine what tests you need. Only you and your doctor know what’s best for you. Sexually transmitted disease tests If you’re sexually active, you should be screened for sex- Mammogram and breast exam ually transmitted diseases. That’s even more true if you’ve Mammograms can detect cancerous tumors “up to two had multiple partners and any of them has had multiple Screening tests can catch an years before a lump can be felt,” says Sonja Eva Singletary, partners. “The most common is chlamydia, which, if left illness before you see signs, M.D., of the M.D. Anderson Cancer Center in Houston. untreated, can lead to infertility,” says Elizabeth Swisher, when treatment may help Although mammograms can detect tumors, they still may M.D., of the Seattle Cancer Care Alliance. Others are gonor- most. miss some. And some mammograms results may lead to rhea, syphilis, HIV, HPV (human papilloma virus), herpes biopsies that find no cancer. If you feel a lump and your and hepatitis B. (See page 9 for more information on mammogram is normal, tell your provider. The lump chlamydia.) could be cancerous. Although a breast self-exam each month can help a Diabetes test woman find changes in her breasts and bring them to the In type 2 diabetes, the level of blood sugar rises because attention of her doctor, your best chance of detecting you can’t make enough insulin or use it normally. The dis- breast cancer is getting both a clinical breast exam and ease affects 20.8 million Americans, 9.7 million of them a mammogram. women, according to the American Diabetes Association Women should (ADA). A lot of women get diabetes in middle age or older, Pap test and pelvic exam but it’s rising in the young. African American, Hispanic/ know their risk for During a Pap test, doctors take cells from the cervix to Latino, American Indian and Asian/Pacific Islander women colorectal cancer, too. look for early warning signs of cancer that cause no symp- are two to four times more likely to develop diabetes than toms. A woman should get the test within three years of Caucasian women. Besides being a member of these racial See story on page 4. becoming sexually active, and no later than age 21. After or ethnic groups, the risks for developing type 2 diabetes that, she should have one at least every three years, accord- are age, obesity, lack of physical activity and a family history ing to 2003 guidelines by the U.S. Preventive Services Task of the disease. It occurs more frequently in women who Force (USPSTF). have had gestational diabetes (diabetes during pregnancy) A woman older than 65 does not need routine Pap tests, or in women who have polycystic ovary syndrome, high the USPSTF says, particularly if she has had normal screen- blood pressure, high cholesterol, impaired glucose toler- ings in the past and is not in a high-risk group for cervical ance (IGT) or impaired fasting glucose (IFG). cancer. The ADA recommends getting tested for type 2 diabetes A woman who has had a total hysterectomy for non- every three years beginning at age 45, if you are at average cancer reasons does not need a Pap test, the USPSTF says. risk for diabetes. If you have any of the risk factors listed Although other screening methods for cervical cancer are above or if you are overweight or obese — overweight: body available, the USPSTF has not endorsed any method over mass index (BMI) is 25 to 29; obese: BMI is 30 or more — the Pap test for routine tests. you should be tested at an earlier age or more frequently. 6 Brown & Toland’s HealthLink, Spring 2006 www.brownandtoland.com
    • HEALTHY CHILDREN Diabetes Tops Child Obesity’s Health Risks hildren who weigh C _too much face a broad array of health problems, with type 2 diabetes leading the list. Closely linked to obesity, type 2 diabetes was once so rare among children that it was called adult onset diabetes. But University of Florida doctors, like colleagues nationwide, are seeing “more 12- and 13-year-olds with type 2 diabetes than you can Heart disease screening imagine,” says Janet Silverstein, M.D., Obesity, high blood pressure, high-fat diets and diabetes chief of the university’s division of on disability from their diabetes and fuel heart disease, the top killer of U.S. women. And pediatric endocrinology and a member the many diseases that accompany dia- women may not recognize their heart attack symptoms. of the American Academy of Pediatrics betes,” says obesity researcher Richard Women are more likely than men to experience indiges- executive committee on endocrinology. L. Atkinson, M.D., president of the tion, breathing trouble or muscle pain instead of the clas- Doctors estimate that half of over- American Obesity Association. sic, spreading chest pain. The USPSTF recommends that weight kids will grow up to be over- But diabetes is just one of many all adults ages 18 and older be screened regularly for high weight adults. Once they’ve been too health problems tied to obesity. “We blood pressure. If your blood pressure is less than 120 sys- heavy for too many years, experts say, had an 18-year-old girl with a stroke,” tolic (the top number) and less than 80 diastolic (the bot- they’re at risk for diseases that doctors says Dr. Silverstein, whose Florida pro- tom number), you should be screened every two years. If usually see in people in their 60s, 70s gram is swamped with children. “It’s either number is higher, or if you have other risk factors and 80s. “We’ll be treating them when like this across the country. for heart disease (such as high cholesterol or diabetes), they’re in their mid-30s,” says Francine “This is a huge public health prob- you should be screened more frequently. R. Kaufman, M.D., past president of the lem and it’s going to get worse,” The National Heart, Lung, and Blood Institute recom- American Diabetes Association. “Their says Dr. Silverstein. “The trend is mends that all adults over the age of 20 have their diabetes will lead to so many problems.” still going up.” I cholesterol measured once every five years. Total choles- The average age of kids being treated terol should be 200mg/dL or less, LDL cholesterol should in obesity clinics is about 12. “When be less than 100mg/dL and HDL cholesterol should be these kids grow up and into their most AILMENTS higher than 40 mg/dL (the higher the better). Talk to productive years, many of them will be your health care provider to find out when you should Childhood ailments linked begin screening. with obesity: Diabetes High cholesterol and other Bone density test blood fats Women start with less bone mass than men. “When you High blood pressure become postmenopausal, you’re at high risk for rapid bone Gallbladder disease loss, which may lead to osteoporosis,” says E. Michael Polycystic ovary disease (PCOD) Lewiecki, M.D., past president of the International Society Kidney failure for Clinical Densitometry. Osteoporosis increases the risk Blindness of sustaining a broken bone. Orthopedic difficulties The USPSTF recommends that women ages 65 and older Sleep apnea be routinely screened for osteoporosis. If you have other Psychological problems risk factors for osteoporosis (such as underweight or smok- Social problems Obstructive sleep apnea ing), you should be screened beginning at age 60. I www.brownandtoland.com Brown & Toland’s HealthLink, Spring 2006 7
    • PERINATAL CARE New Perinatal Group Opens Office in San Francisco Full range of services San Francisco Perinatal Associates, Inc., is new perinatal physician group, San Francisco Perinatal A _Associates, Inc., was scheduled to open its office March 1. a comprehensive private perinatal practice providing the full range of maternal-fetal medical services, including: The new facility Medical Group, San Associates, Inc., are James High-risk pregnancy consultation features state-of-the-art Francisco Perinatal D. Goldberg, M.D., Michael and management equipment, such as GE Associates, Inc., will be Katz, M.D., Thomas J. Diabetes in pregnancy management Healthcare’s Voluson 730 one of the first physician Musci, M.D., Per Sandberg, Obstetric ultrasound including Expert, GE’s leadership offices in San Francisco M.D., and Melinda M. 3D/4D imaging ultrasound system for and the first perinatal Scully, M.D. For more Genetic counseling women’s health care. practice to go completely about each physician, Amniocentesis The Voluson 730 features paperless by using tools please see the article below. Chorionic villus sampling Nuchal translucency integrated/ superior 3D imaging, such as Allscripts The new office is located combined screening Real-Time 4D imaging, TouchWorks® electronic at One Daniel Burnham advanced volume medical record, which Court, Suite 230c, in ultrasound tools and will help improve service San Francisco. are a unique subspecialty, information about San unparalleled patient data quality and reduce costs. The practice is now patients are usually seen Francisco Perinatal management capabilities. The physicians practicing accepting patient referrals. via referral by their primary Associates, Inc., please visit Part of Brown & Toland at San Francisco Perinatal Because perinatal services obstetrician. For more www.sfperinatal.com. I MEET THE DOCTORS OF SAN FRANCISCO PERINATAL ASSOCIATES, INC. James D. Goldberg, M.D. James D. Goldberg, M.D., is a graduate of the University of Minnesota Medical residency in obstetrics and gynecology at UCSF; his fellowship in maternal-fetal School and served as a resident at the University of California–San Francisco medicine at UCSF’s Department of Obstetrics Gynecology and Reproductive (UCSF) in obstetrics and gynecology. He also served as a fellow in maternal-fetal Sciences and in the UCSF Cardiovascular Research Institute; and a fellowship medicine and genetics at Mount Sinai School of Medicine in New York. Board in medical genetics at UCSF. Following his scientific training, he was a tenured certified in obstetrics and gynecology, maternal-fetal medicine, and genetics, faculty member at UCSF in the Department of Obstetrics and Gynecology and Dr. Goldberg is a founding fellow of the American College of Medical Genetics. the Department of Biochemistry and Biophysics. Dr. Musci remains on the clini- He previously was director of the Reproductive Genetics Unit at UCSF and co- cal faculty of UCSF as an associate clinical professor of obstetrics, gynecology director of the Prenatal Diagnosis Center at California Pacific Medical Center. and reproductive sciences. He is board certified in obstetrics and gynecology, Dr. Goldberg has published extensively in the area of prenatal diagnosis and maternal-fetal medicine, and in medical genetics. was listed for three consecutive years in American Health Magazine's “The Best Doctors in America.” Per Sandberg, M.D. Per Sandberg, M.D., graduated cum laude from The Ohio State University School Michael Katz, M.D. of Medicine–Columbus, Ohio. He completed his post-doctoral training as a Michael Katz, M.D., obtained his pre-medical education at the Medical Faculty, resident in obstetrics at Magee–Women’s Hospital, University of Pittsburgh University of Vienna in Austria, and his M.D. degree at the Technion, Israel, Medical Center, followed by a fellowship in maternal-fetal medicine at UCSF’s Institute of Technology. Dr. Katz completed his residency in obstetrics and gyne- Department of Obstetrics, Gynecology and Reproductive Sciences. He is board cology at the Department of Obstetrics and Gynecology, Brookdale Hospital certified in obstetrics and gynecology, and board eligible in maternal-fetal Medical Center, State University of New York, Brooklyn, N.Y. He subsequently medicine. After he finished his post-doctoral training, Dr. Sandberg was an had his fellowship in maternal-fetal medicine at the Department of Obstetrics, assistant clinical professor at UCSF’s Department of Obstetrics, Gynecology Gynecology and Reproductive Sciences and the Cardiovascular Research and Reproductive Sciences and Director of Obstetric Services for the Fetal Institute, at UCSF. He is board certified in both obstetrics and gynecology and Treatment Center. maternal-fetal medicine. Dr. Katz serves as chief of perinatal services, California Pacific Medical Center (CPMC), and is currently a clinical associate professor of Melinda Scully, M.D. obstetrics, gynecology and reproductive sciences at UCSF. His areas of clinical A graduate of the Pritzker School of Medicine University of Chicago, Dr. Scully research interest focus on pre-term birth prevention and cervical competency. completed her internship in obstetrics and gynecology at the University of Chicago and residency at UCSF. She completed fellowships in maternal-fetal Thomas J. Musci, M.D. medicine, medical genetics, and biostatistics and epidemiology through the Thomas J. Musci, M.D., graduated cum laude from the Georgetown University Advanced Training in Clinical Research Program at UCSF. Dr. Scully was the School of Medicine in Washington, D.C. He completed his internship and medical director of the CPMC Diabetes and Pregnancy Program. 8 Brown & Toland’s HealthLink, Spring 2006 www.brownandtoland.com
    • STAYING HEALTHY Get Tested for a Silent STD hlamydia is a sexually transmitted disease (STD) caused by C _bacteria called Chlamydia trachomatis. Chlamydia is the most frequently reported bacterial STD in the United States, according to the Centers for Disease Control and Prevention (CDC). It is known as a “silent” disease because it seldom causes symptoms. If not treated, however, In women, the bacteria Treatment and chlamydia can cause seri- initially infect the cervix prevention ous complications and and the urethra (urine Current guidelines rec- infections for both men canal). Symptoms can ommend that all sexually and women. include unusual vaginal active women younger than Chlamydia can be passed discharge, bleeding during 25 be screened annually for from one person to another intercourse or between chlamydia. Recommenda- through oral, vaginal or periods, burning during tions for women older than mends that if you have if you have no symptoms. anal sex with an infected urination, pain with inter- 25 are based on overall risk multiple sex partners, and Getting a regular check- partner. Reinfections can course, or lower back or and exposure. Your health especially if you are a up is one of the main ways occur if sexual partners are abdominal pain. Men also care provider will first woman younger than 25, you can help prevent infected and not treated. may have pain during uri- screen for chlamydia with a you should be tested for serious problems from Chlamydia is common nation, or they may notice culture during a pelvic chlamydia regularly, even chlamydia. I among high school and a burning and itching exam, a swab test (for men) college-age women, but around, or discharge from, or a urine test. If you are less so among middle-aged the penis, or pain and infected with Chlamydia PREVENTION and older women. The swelling in the testicles. trachomatis, your doctor To prevent chlamydia, experts generally recom- CDC says this is because The infection may move will give you a prescription mend that you: women in their 30s and inside the body if it is not for an antibiotic. A preg- Always use male latex condoms correctly older usually have settled treated, and cause two very nant woman also can be during vaginal, anal and oral intercourse. down with one partner. serious illnesses. In women, treated for a chlamydial Don’t engage in unprotected sex unless both it can cause pelvic inflam- infection with antibiotics. A parties have had a thorough STD exam and matory disease (PID). In single dose of azithromycin testing. men, it can cause epididy- or a week of doxycycline Know your partner’s sexual disease history. mitis, an inflammation of (this is not prescribed for the tube that carries the pregnant women) are the sperm from the testes. Both most commonly used treat- of these illnesses can lead ments. Reinfection is com- to sterility. mon and can occur within The bacteria can cause a few months of treatment. Model used for illustrative purposes only. an inflamed rectum from Because of this, routine anal intercourse; an screening is still recom- Symptoms inflammation of the lining mended following About three-quarters of of the eye (“pinkeye”) if treatment. infected women and about the bacteria is present Infected men and women half of infected men have during birth; and a throat who have no symptoms no symptoms, the CDC infection from oral sex may pass the bacteria on to says. If symptoms do occur, with an infected partner. their sex partners without they usually appear within If you notice any of the knowing it, according to the one to three weeks after above symptoms, consult National Institutes of Health exposure. your health care provider. (NIH). The NIH recom- Models used for illustrative purposes only. www.brownandtoland.com Brown & Toland’s HealthLink, Spring 2006 9
    • MEN’S HEALTH Prostate Cancer: A Range of Treatment Options y the time an average reader can finish this story, B _two more men will have been diagnosed with prostate cancer, which claims nearly 30,000 lives every year in this country, according to a 2004 treatment,” says George L. Wright Jr., M.D., professor of urology at Eastern Virginia Medical School. estimate by the American Cancer Society (ACS). The medical field has a Mention the word Journal of the American of treating it effectively, letter and number system “prostate” to men over 50, Medical Association what will happen if it goes for different stages and and many will wince or ( JAMA) found that “while untreated, what will be the scope of prostate cancer, cringe. urologists and radiation side effects of an operation identifying everything from It brings to mind pain, oncologists do agree on a and much more. one splotch to out-of- less-than-manly doctor’s variety of issues regarding Then ACS recommends control spreading. office positions and a prob- detection and treatment of that you consider other fac- Understanding this sys- ing physician’s finger in prostate cancer, specialists tors, such as your age, what tem for measuring prostate places down under. overwhelmingly recom- lifestyle you wish to have, cancer, learning the scope external beam radiotherapy And then there’s the mend the therapy that they whether you can live with of your prostate cancer, and and brachytherapy are C-word: cancer. themselves deliver.” potential incontinence or considering your age and potentially lifesaving treat- If your physician has told Ironically, almost all the sterility and what chances lifestyle are crucial to decid- ments for localized prostate you that you have prostate specialists may be right in you’re willing to take com- ing what treatment to use. cancer in men whose nor- cancer, you may soon face many cases, according to fortably. For example, some mal life expectancy is 10 a blizzard of treatment the study, which said that elderly men choose to have Treatments years or longer.” options. no conclusive evidence cur- no treatment at all because The two primary treat- Other treatments include rently backs any particular of operation dangers and ments for prostate cancer hormone therapy, chemo- In the next 24 hours, treatment over another. lifespan issues. Other men are radical prostatectomy therapy and deferred So how can you know with localized (in one spot) (removal of prostate) and therapy (no action taken). prostate cancer will which treatment is best prostate cancer may feel they radiation therapy, in which The information that fol- claim the lives of more for you? need no operation at all. radiation is beamed into lows on the above treat- “Unfortunately, although the prostate or inserted ments comes from the than 100 American men. Before you pick we are getting much more with a “seed” pellet National Comprehensive a treatment proficient at diagnosing (brachytherapy, pronounced Cancer Network (NCCN), “One of the critical issues The first thing you should prostate cancer, we are not “break-ee-ther-uh-pee”). which has gathered experts right now in prostate can- do, according to the ACS, is very good at distinguishing The JAMA survey found from 17 of the nation’s cer is that all these men ask your physician many the cancers that need active that “the two groups of spe- leading cancer centers to have a big decision to make questions about the severity treatment from those that cialists largely agree that develop cancer treatment after they’re diagnosed,” of your cancer, the chances can be followed without radical prostate surgery, guidelines for cancer care says David Perlow, M.D., a professionals. urologist in metro Atlanta “Cancer specialists regard who performs mostly the NCCN treatment guide- “seed” radiation treat- lines as the defining treat- ments. “Frankly, many of ment standard,” says Louis the patients I have are torn M. Weiner, M.D., chairman by the decision.” of medical oncology at Fox And patients will often Chase Cancer Center in find that the specialists per- Philadelphia. forming one treatment usu- ally espouse that treatment Radical over others. prostatectomy A survey of urologists and This “gold standard” of oncologists published in the prostate cancer treatment 10 Brown & Toland’s HealthLink, Spring 2006 www.brownandtoland.com
    • “One of the critical issues right now in prostate cancer is that all these men popular. Its side effects are an increased chance of minimal, with claimed infection, and more. have a big decision to make after they’re much lower rates of incon- diagnosed. Frankly, many of the patients tinence and impotence. Deferred therapy “If patients see a similarity The best strategy for I have are torn by the decision.” in treatment success, they some patients is to simply —David Perlow, M.D., urologist who performs mostly “seed” radiation treatments. want the ‘seeds’ to avoid “watch and wait” with care- impotence or inconti- ful observation but no nence,” says Dr. Perlow. immediate active treatment. “Seeds are done as an out- This approach may be rec- patient or during a one-night ommended if a prostate stay in the hospital, and the cancer is not causing any risks are much lower.” symptoms, especially if it is Critics of this method say very small and contained to that not enough studies one area of the prostate or have been done thus far to expected to grow slowly. confirm its effectiveness. Also, if a patient is elderly or frail, or has some serious Hormone therapy health problems, this treat- This treatment is often ment may be an option. used for patients whose Some men may decide that cancer has spread beyond the side effects of more is still the most performed. notion that a laparoscopic between 40 percent and the prostate or has recurred aggressive treatments out- This operation removes the technique would never 60 percent of patients have after treatment. Its aim is to weigh the benefits of an entire prostate gland and supplant open surgery for some degree of impotence reduce the levels of the male operation. some tissue around it and is radical prostatectomy must afterward. Radiation oncol- hormone androgen, the used most often when the be strongly reconsidered,” ogist Gerald Hanks of the main one being testosterone, Ask your physician cancer is believed to have says Carl A. Olsson, M.D., Fox Chase Cancer Center which causes prostate can- not spread past the prostate. of Columbia University believes a new “three- cer cells to grow. many questions about Conventional prostatec- College of Physicians and dimensional conformal radi- Side effects of this the severity of your tomies require incisions Surgeons in New York after ation therapy,” or 3DCRT, therapy include reduced near the rectum or abdo- seeing French surgeons per- should replace standard or absent sexual desire, cancer, the chances of men, and can lead to incon- form a laparoscopic surgery. radiation treatment for impotence and hot flashes. treating it effectively, tinence (inability to control prostate patients. “It’s Some men also have breast the bladder) and impotence Radiation therapy clearly superior,” he says. tenderness and growth of what will happen if it (inability to achieve erec- High-energy rays (such as “It cures more patients and breast tissue. To greatly goes untreated, what tion because nerves were X-rays) and particles (such causes fewer complications.” reduce androgen levels, will be the side effects cut during surgery). Normal as electrons and protons) The technology targets some doctors recommend bladder control usually are used to kill cancer cells. the prostate directly, bypass- an orchiectomy, the of an operation. returns within several This therapy is sometimes ing the rectum and bladder. removal of the testicles. —advice from the American Cancer Society weeks or months after a used to treat prostate cancer Since no other organs are The side effects are similar radical prostatectomy but that is still confined to the affected, higher doses of to hormone therapy but has persisted in up to 35 prostate gland or has spread radiation can be used with- perhaps more exaggerated. In the next 24 hours, percent of men. Impotence to nearby tissue. If the dis- out serious side effects. prostate cancer will claim can be as high as 65 per- ease is more advanced, radi- Brachytherapy uses needles Chemotherapy the lives of more than 100 cent to 90 percent, but ation may be used to reduce to insert radioactive pellets This is an option for American men. between 25 percent and the size of the tumor. (about the size of a grain of patients whose prostate For those of you in the 30 percent when surgery The two main types are rice) into the prostate with cancer has spread outside earlier stages of the dis- does not remove nerves on external beam radiation and the aid of imaging tests to the gland and for whom ease, the ACS and other either side of the prostate. brachytherapy (internal pinpoint the cancer for hormone therapy has reputable cancer organiza- A new “keyhole,” or lapar- radiation). External focuses accurate placement. failed. The anti-cancer drug tions recommend that you oscopic, prostatectomy uses a beam from outside the The radiation dies out is not expected to destroy get the facts about your a thin lighted tube with a body onto spots determined after several weeks or all the cancer cells, but it own condition, as well as camera and surgical instru- beforehand precisely by spe- months, and the pellets are may slow tumor growth determine your own state ments on the end to reduce cialists. A small percentage allowed to remain harm- and reduce pain. This of mind while you assess “collateral” damage on the of men experience perma- lessly in the prostate. This treatment may lower blood the best treatment option patient. “My previously held nent incontinence, and therapy is becoming more cell counts, resulting in among many. I www.brownandtoland.com Brown & Toland’s HealthLink, Spring 2006 11
    • Make the most of the changes in Medicare. Obtenga el mayor beneficio posible de los cambios en Medicare. 12 Brown & Toland’s HealthLink, Spring 2006 www.brownandtoland.com
    • Many people are confused by the changes in Medicare this affordable monthly premiums and low co-payments for year. But all you have to do is keep your Brown & Toland hospital stays when medically necessary. In addition, Brown doctor to make the most of the new Medicare. & Toland’s Medicare Advantage plans include prescription Brown & Toland contracts with two Medicare Advantage drug coverage, which offers a choice between brand-name plans, Health Net’s Seniority Plus and PacifiCare’s Secure and generic prescriptions included in the plan’s formulary. Horizons. Each includes a rich prescription drug benefit. All of this for one low monthly premium. When you choose one of these plans, you’ll enjoy great These are just some of the reasons why we encourage benefits, keep your Brown & Toland doctor, and have access people with Medicare to learn more about Medicare to San Francisco’s best hospitals. Advantage and the Brown & Toland Medical Group by Brown & Toland doctors are San Francisco’s finest group attending an informational meeting. To receive a list of of primary and specialty care physicians. Dedicated to pro- upcoming Medicare Advantage meetings, please viding you with quality health care, Brown & Toland physi- call 1.866.488.7088. cians understand the time-honored doctor–patient relationship. By choosing a Medicare Advantage plan, you’ll enjoy Muchas personas están confundidas por los cambios que se han hospital cuando éstas sean médicamente necesarias. Adicionalmente, dado en Medicare este año. Pero todo lo que usted tiene que hacer los planes de Medicare Advantage de Brown & Toland incluyen la es conservar a su médico de Brown & Toland para obtener el cobertura de fármacos con receta médica que ofrece la elección entre mayor provecho de Medicare. fármacos comerciales o genéricos con receta médica que se encuen- Brown & Toland tiene contrato con dos planes Medicare tran en el formulario del plan. Todo esto por una prima mensual Advantage, Health Net’s Seniority Plus y PacifiCare’s Secure razonable. Horizons. Cada uno incluye un amplio beneficio de fármacos Éstas son algunas de las razones por las que animamos a las con receta médica. Al escoger uno de estos planes disfrutará de personas con Medicare a asistir a una reunión informativa para grandes beneficios, podrá continuar con su médico de Brown & que conozcan más sobre Medicare Advantage y el Grupo médico Toland y tendrá acceso a los mejores hospitales de San Francisco. Brown & Toland. Para recibir una lista de las próximas reuniones Los médicos de Brown & Toland pertenecen al mejor grupo de de Medicare Advantage comuníquese al 1.866.488.7088. médicos de atención primaria y especialistas de San Francisco. Los médicos de Brown & Toland están dedicados a brindarle un cuidado de la salud de calidad y comprenden la respetada relación de siempre de médico–paciente. Al escoger un plan Medicare Advantage usted obtendrá primas mensuales a precios razonables y copagos bajos por estadías en el 1.866.488.7088. www.brownandtoland.com Brown & Toland’s HealthLink, Spring 2006 13
    • HEALTHY SENIORS Staying Connected Is the Key to Avoiding Loneliness L oneliness is one of the most A hidden enemy? Unfortunately, recognizing this enemy isn’t as easy as we formidable obstacles to health might think. and quality of life for the nearly “Loneliness is not what most people think it is, and that’s why many seniors don’t see the warning signs soon enough 35 million Americans age 65 to head off disaster,” says Marcia Ory, Ph.D., M.P.H., profes- or older. As more of us join that gen- sor and director of the Active for Life program at Texas A&M University. eration — which statisticians predict With loneliness, says Dr. Ory, a person “disconnects will double to 70 million by 2030 — socially from the world around them, isolating themselves from involvement with people.” Living alone isn’t part of the threat of loneliness will grow. every case. It’s a way of life SIX WAYS TO AVOID LONELINESS “We assume that an 80-year-old woman living by herself in an apartment must be lonely, yet she may have plenty of pos- Get advice. Seek suggestions on making your itive social interaction with others outside the home,” Dr. Ory senior years the good years. Go to such organiza- says. “At the same time, we think that a 70-year-old man liv- tions as the AARP or peer groups of seniors look- ing with his son’s family cannot be lonely, yet he spends all ing out for each other. Get connected. Rebuild a broken social network, day in front of the TV set and shuns all social activities.” or create a new one if old friends aren’t readily It’s how you live that makes you lonely, adds Carol Ryff, available. Seek out social groups or activities for Ph.D., director of the Institute on Aging at the University of seniors at your place of worship, community cen- Wisconsin–Madison. “Our research, and that of others who ter or local recreation department, for example. “Don’t wait for others to study the social habits of the elderly, shows that seniors outreach to you; get to them first,” says Roy F. Baumeister, Ph.D. who are ‘socially integrated’ — in other words, connected Get involved. Draw on your years of experience or your wealth of free to others in an active, positive way — are in better health, time to benefit someone else. “Teach a class, mentor in the public retain more mental sharpness, and in general live longer schools, volunteer to help the needy — but give of yourself,” says Carol than those who become ‘social recluses.’” Ryff, Ph.D. “You don’t just get the reward of making a difference in some- one’s life; you get the bonus benefits to your mental and physical health Prone to isolation due to changes gained with improved self-worth, fulfillment and purpose.” Get active. Take a walk, ride a bike, study tai chi or join a ballroom danc- Seniors are more likely than younger people to experi- ing group. The activity doesn’t matter as long as you get up and move. ence changes that, if not handled properly, can isolate Research shows a correlation between regular exercise and a better them. Examples include: quality of life. “And those who exercise are less prone to loneliness Health problems that reduce or bar mobility because they are likely to be interacting with others when they work The death of a spouse, relative or close friend out,” says Dr. Ory. A drastic change in routine, especially to a boring or Get educated. Go back to school. Communities, colleges and organiza- inactive lifestyle after retirement tions offer learning opportunities for seniors in everything from agricul- Loss of contact with family or ture to zoology. “Programs such as Elderhostel and the Plato Society friends who move or have less time encourage ‘life-long learning’ to keep one’s mind and one’s spirit bright,” Dr. Ryff says. Even worse is loneliness that Get online. Reap the benefits of the information revolution. A computer class can teach you the latest technology. “The Internet is a wonderful results from a deeper problem. means of social communication and interaction, especially for those Lack of involvement in life as a whole (not just social activ- seniors who are not mobile,” Dr. Baumeister says. “It’s hard to feel lonely ities) may signal depression, says Roy F. Baumeister, Ph.D., a when you can virtually visit the Sistine Chapel or play chess with a new- Case Western Reserve University social psychologist. “You have found friend in Australia.” to treat the depression first before you can have any hope of returning them to normal relationships with others.” I 14 Brown & Toland’s HealthLink, Spring 2006 www.brownandtoland.com
    • BENEFITS FOR SENIORS Make Medicare Work for You Understanding the Changes in Medicare A s of Jan. 1, 2006, Medicare speaking, all covered services, including prescriptions, are included in the monthly premium. prescription drug coverage Medicare Advantage plans offer tremendous value and is available to everyone coordination of care. with Medicare. One of No. 3: Who needs to enroll? the best ways to enjoy the added If you’re not covered through an employer or union, you may want to consider enrolling in a Brown & Toland con- benefits offered by Medicare is to tracted Medicare Advantage prescription drug plan. Brown join a Medicare Advantage plan. & Toland contracts with two Medicare Advantage plans – Health Net Seniority Plus and PacifiCare’s Secure Horizons Let’s break down the changes in Medicare by the num- — and each includes a rich prescription drug benefit. bers. This article will cover the following: The election period for designating a Brown & Toland 1. Can I combine affordable benefits, great doctors and Medicare Advantage plan ends May 15. If you choose not great hospitals? to enroll in a Medicare drug plan by May 15, you may 2. What are my plan choices? enroll at a later date, but there will be a penalty. Medicare 3. Who needs to enroll in a plan? is encouraging everyone to enroll, even if you seldom need prescription drugs. Brown & Toland also recom- No. 1: Combine comprehensive benefits, great mends that all Medicare beneficiaries seriously consider doctors and respected hospitals. enrolling in a prescription drug plan, such as one offered With a Medicare Advantage plan, you’ll have easy access through a Medicare Advantage plan. Fact is, you may need to the Brown & Toland physician network, arguably San prescription drug coverage as you age, so now may be the Francisco’s finest group of primary and specialty care best time to get affordable prescription drug benefits. physicians. Choosing this health care option also gives Whatever your situation, take a few minutes to learn you access to San Francisco’s best hospitals, including more about your options. You may call 800.MEDICARE California Pacific Medical Center, the University of to learn all the options you have. We also encourage California–San Francisco, St. Mary’s Medical Center, people with Medicare to learn more about Medicare Saint Francis Hospital and St. Luke’s Hospital. Advantage and the Brown & Toland Medical Group by With a Medicare Advantage plan, you may choose from attending an informational meeting. I among hundreds of Brown & Toland primary care doc- tors and have easy access to a Brown & Toland specialist. Plus, you’ll enjoy many advantages, including affordable To learn more about monthly premiums, low co-payments for doctor office visits, and low co-payment hospital stays when medically Medicare Advantage necessary. In addition, a Medicare Advantage plan and Brown & Toland, includes excellent prescription drug coverage as part of please call 866.488.7088. the affordable monthly premium. These plans also pro- vide a choice between brand-name and generic prescrip- tions that are included in the plan’s formulary. No. 2: Understanding prescription drug choices Understanding the dozens of prescription drug plan choices is the hard part for many people. But here’s an easy way to sort things out. Most Medicare Advantage plans offer a prescription drug benefit, and often the Medicare Advantage drug benefits exceed Medicare’s standards. Generally www.brownandtoland.com Brown & Toland’s HealthLink, Spring 2006 15
    • Free Seminar by Pacific Eye Specialists at St. Mary’s Medical Center Spend your morning learning more about taking care of Common Eye Diseases your vision. Don’t miss presentations from Brown & Toland in the Senior Population physicians Bernd Kutzscher, M.D., Lee Schwartz, M.D., and Michael Hee, M.D., of Pacific Eye Specialists on health Date: Saturday, March 25, 2006 topics such as: Time: 10 a.m. to 1 p.m. G Cataracts and new technology in cataract surgery Place: St. Mary’s Medical Center G Glaucoma prevention and 450 Stanyan St., San Francisco treatment G Macular degeneration — the newest developments in treatment G Common eye diseases in the Bernd Kutzscher, M.D. aging eye G Diabetes and the eye G Laser vision correction Free glaucoma screenings will be available. Refreshments will be served. Sponsored by St. Mary’s Medical Center, Brown & Toland Medical Group and Health Net. Call Brown & Toland at 866.488.7088 to reserve your seat today. PRSRT STD U.S. POSTAGE The Doctors Behind Every Good Health Plan PAID P.O. Box 640469 Effingham, IL San Francisco, CA 94164-0469 Permit No. 148