Newsletters - Spring 2020
Women’s Care Medical Group/Stanford Children’s Health  

1. COVID 19: Three months ago, between Christmas and New Year’s, we were barely paying attention to what was happening in Wuhan, China, and living our lives comfortably with family and friends. Now, we read and worry about what is happening all over the world as well as to ourselves and those we love. That is all I will write: by the time this newsletter reaches you the status will have changed drastically yet again. All of us at Women’s Care Medical Group urge you to take care of yourselves and family: eat well, walk in our perfect weather and enjoy the green hills and blooding flowers. All your anxiety and worry won’t change what is to come and will only weaken your immune system. Stay safe and know we are here for you any way we can be useful. 

2. Sleep: so important to a healthy body, a strong immune system and a functioning brain. Time spent during deep sleep is time that our bodies and brains repair damage sustained during the daily wear and tear, and transfer short term into long term memories. There are multiple studies that document higher mortality/shorter life expectancy in those who sleep fewer hours.  

3. Stress Management: you can never control what is happening in the world, in our country, or even in your own family—but you can control how you let it affect you and that is the definition of stress. There will always be “stress: but figure out how to best deal with it: use tools such as mindfulness meditation, yoga, HeartMath and music! Yes, music has been shown to elicit brain waves that are restorative and calming.

4. “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. 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! You can access the reading materials, purchase the ear clip to monitor heart rate, download the cell phone app and lots more at: 

5. Sugar-sweetened beverages: Drinking beverages that contain added sweeteners is linked to obesity in adults and children, which increases the risk of developing Type 2 diabetes, liver disease, dental decay and other health problems. Check the label on those energy and vitamin drinks before you buy to be certain there is no added cane sugar. 

6. “Telehealth” visits: the federal and state governments have changed the rules on virtual visits and physicians can connect to patients with personal devices that make it easier for even the least tech-savvy to navigate. Any medical issue that can be managed without a physical exam are eligible for this modality; call and speak to our wonderful receptionists who can arrange and then walk you through the “tele-consent” needed. Not only does this save you driving time and risk of contacting anyone ill, but it is better for your carbon footprint in terms of reducing climate change. All the health plans and Medicare are covering payment for these telehealth visits, same as office visits. 

7. Email your doctor: through MyChart, you can send a message to your doctor directly, rather than calling the front desk and leaving a phone message in the queue. That communication from you is saved, as is our response, so all of us can refer back to it as needed. Emails and phone calls of less than 5 minutes are without charge; if your questions require a longer explanation, a Telehealth visit will be offered instead of a simple visit. 

8. “Do I need an annual exam? YES: it is a once-a-year opportunity to “touch base” with a physician and make sure health screenings and recommended treatments are appropriate for illnesses and your continued great health. We make every effort to avoid “unnecessary tests” and allow time for you to voice concerns about what is really bothering you (weight, memory, sleep, sex—or no sex!). Most plans offer this as a once-annual “free of deductibles or co-pays” opportunity so why waste it? Some still call if an “annual pap? But it is SO MUCH MORE! And not everyone has to go through a pelvic exam depending on age and circumstances. 

9. Medicare women’s annual visit: You are entitled to a G0101 visit every TWO years which consists of a breast and pelvic exam, pap if needed, to rule out cancer; this visit is completely paid by Medicare with no bill to you. It is not a follow-up for known gyn problems or concerns; those are billed to Medicare/supplement as an E/M office visit with the usual restrictions, subject to co-pays and deductibles. There is no limit to how many of these E/M visits you have under Medicare as long as all the codes are listed to justify the time spent with the doctor and the tests that are ordered or treatment that are prescribed. Sounds confusing? Just email and ask. At the beginning of any visit that is listed on our schedule as an “annual visit” the doctor will clarify with you whether it meets criteria as a G0101 (free visit) or E/M visit (you will pay some portion as usual). 

10. Primary care doctors: patients over the age of 65 who have Medicare are required to have a primary care doctor who is either an internist or a family practitioner. Under Medicare rules, gynecologists are NOT primary care but are specialist doctors. We always send a not to YOUR primary doctor after a visit so he/she is aware of your care and condition from our perspective. Healthy patients between the ages of 18 and 85 will usually be able to use our services for all their care and we will recommend referrals to specialists for issues beyond our scope. 

11.Pap smears: HPV DNA testing 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. These recommendations may change annually as we learn more about the progression and long term consequences of HPV in terms of cancers. 

11.HPV and cancer: The CDC reports that cancers linked to HPV have increased significantly over the past 15 years with throat cancer now the most common HPV-related malignancy: 43,000 new cases in 2015 alone. HPV vaccination rates around the world rates are also rising with nearly half of those aged 13-17 having received all the recommended doses, and two thirds having received the first dose. Already there is a marked decrease in new cervical cancer incidence around the world in both men and women who have been vaccinated. All boys and girls should receive the vaccine at ages 11-12. For those unvaccinated, it is strongly recommended to age 26. Concerns that the vaccine has “worn off” its protection has led to new CDC recommendations for booster vaccines at age 45 depending on one’s situation (eg risk of catching HPV due to a new sexual partner). 

12.Shingrix: the new shingles vaccine is much more effective than prior vaccines, and is now available in pharmacies and covered by most health plans for those over age 55. Shingles tends to strike when one is stressed or ill so our current pandemic sets that stage. 

Happy Spring! And thanks for all the Rain!!! From Drs. Andy Liu, Dolly Shoup, Beverly Joyce, Tanya Spirtos, Virginia Chan and Anjie Li with nurse practitioners Lindsay Pettit and Marjan Hafezi; office manager: Karen Palladino.  
Dr. Li has welcomed a baby daughter and advice nurse Cyrell is also returning from maternity leave; congratulations to our families!!