Newsletters - Fall 2019
Women’s Care Medical Group/Stanford Children’s Health  

1. What’s Up, Doc? Dr. Virginia Chan is out of her cast and into a walking boot. Just a reminder to all of our patients: slipping on wet floors or misjudging a step can happen to any one of us so work on your balance exercises and don’t take chances when carrying boxes up or down the stairs when you can’t see where you are placing your feet. Oh, yes: socks + wood floors = bad idea. 

2. Election season: The primary is over and we are heading into the election- California’s health care system revolves around those elected in the fall so it behooves all of us to pay attention to the candidates and their views on health policy and financing. Our next governor will focus more on universal access to health care and controlling the spiraling costs faced by all of us. This summer take time to learn about the candidates and the issues -- and then exercise your right to vote! Margins in the primaries were way too close--- showing that YOUR vote really does matter!!!  

3. “HeartMath": research since 1993 has focused on the relationship of stress to emotional states, and the effect of stress on the autonomic nervous system, the hormonal and immune systems, heart and brain. There are pretty dramatic changes that occur when heart rhythms influence one’s ability to deal with stress and difficult situations. It is as if the “heart has a mind of its own”! Stanford University has suggested that physicians read up on these inner balance tools as one technique to improve mental clarity, creativity, emotional balance and personal effectiveness- just think: the heart has its own brain! 

4. Sugar-sweetened beverage: Did you know that sports and energy drinks are overtaking soda as the primary source of liquid sugar in kids’ diets? Drinking beverages that contain added sweeteners is linked to adults and children becoming overweight or obese, which increases the risk of developing Type 2 diabetes, liver disease, dental decay and other health problems. Nearly 1 in 3 California adolescents ages 12 to 17 is overweight or obese. The office of WCMG has switched to sparking waters and herbal teas- and remember that the Bay Area has the healthiest tap water of any region in California so spare the environment and fill your flasks right from the taps. In case you didn’t hear: there will be a major showdown coming in 2019 between doctors/dentists and the beverage industry over taxing sugar-sweetened beverages to pay for children’s health care. 

5. Pap smears: not only are we offering the classic pap smear but now there is HPV DNA testing which increases our ability to accurately diagnose and predict risk of severe dysplasia and cervical cancer. Different recommendations exist based on age, risk factors, and past history. To complicate matters, some of your health plans are now trying to dictate how often we can perform the test. Keep in mind that the “annual well women visit” for those under age 65 is still allowed under all plans except Medi-Cal, and is your opportunity once-a-year to “get your questions answered” – and figure out how to email us through the portal in case you forgot that one last question! Many women still call it their “annual pap smear” but the visit is so much more so--don’t let this valuable benefit pass you by since there is usually no deductible or co-pay linked to the well-woman visit once a year and problem visits always go against your (progressively increasing) deductible.  

6. Medicare Well-Woman visit: Unfortunately Medicare has cut back to every other year as a “well women breast/pelvic check” (coded G0101), but you can still see us in the other year to go over your problems and concerns (followup on prolapse, use of hormones, fibrocystic breast changes, abnormal bleeding, repeated infections, or any other symptoms). This visit would be labelled with whichever problems were discussed by us and be billed to Medicare with an E/M code, and paid by Medicare just as any other problem visit is paid subject to deductibles and co-pays. Since gynecologists are not considered primary care physicians by Medicare, we do not do the complete “wellness exams” and lab work that your internist does- so everyone of our patients over the age of 65 should have a relationship with an internist as well. 

7. Hormone replacement therapy: the North American Menopause Society took a position in 2017 that: “Hormone therapy remains the most effective treatment for vasomotor symptoms and the genitourinary syndrome of menopause and has been shown to prevent bone loss and fracture. The previous position that hormone therapy should be prescribed only for the ‘lowest dose for the shortest period of time” may be inadequate or even harmful for some women. The more fitting concept is “appropriate dose, duration, regimen and route of administration” that provides the most benefit with the minimal amount of risk”. Those on HRT, or considering HRT use, can breathe easier.

8. Contraception: Thanks to the Affordable Care Act, most contraceptives are covered from early teen years to age 52- that includes oral contraceptives, DepoProvera injections, IUDs (both Copper and Progestin), Nexplanon inserts, and tubal ligations. Check the website for easy- to-read information about each type, and side-by-side comparisons, or come in and discuss with us confidentially. Evidence supports that lifelong use of oral contraceptives guards against future risk of both uterine and ovarian cancers in a woman’s lifetime and does not affect her future risk of breast cancer).

9. Shingles: tends to affect those who are ill and stressed. The new vaccine is much more effective than prior ones, and is now available in pharmacies and covered by most health plans for those over 55. Ask at your next visit if we forget to remind you.

10. Flu season: we should be hearing about the flu vaccines any day now. Last year our physicians at WCMG administered more than 400 doses to our patients and we plan to have it available again this year.

Greetings from Drs. Andy Liu, Dolly Shoup, Beverly Joyce, Tanya Spirtos, Virginia Chan and Anjie Li with nurse practitioners Lindsay Pettit and Marjan Hafezi, and office manager Karen Palladino.