SERVICE
Brown & Toland Plants the Seeds for Cultivating Good Health at Health etc. HealthLink Spring 2006
4 Colorectal Screening Know your risks and what tests you need. 6 Women’s Health Here’s a rundown of the exams every woman should know about. 10 Men’s Health A diagnosis of prostate cancer means big decisions and promising treatment options. 14 Healthy Seniors Loneliness undermines your health. Take steps now to stay connected.
an Francisco residents went on a journey of health discovery at an all-day health and wellness symposium, held Saturday, Jan. 28 at the Moscone Center in San Francisco.
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Titled Health etc., the event, organized by KCBS radio, attracted thousands of participants from throughout the San Francisco Bay Area and featured Phil McGraw, television’s “Dr. Phil.” Brown & Toland Medical Group was a sponsor and provided health and wellness information in a unique and fun fashion.
Brown & Toland’s HealthLink editor: Richard Angeloni, Associate Vice President, Public Relations and Communications, Brown & Toland Medical Group, 415.972.4307. 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 newsletter are written by professional journalists or physicians who strive to present reliable, up-to-date health information. Our articles are reviewed 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 purposes only. (106)
At the Brown & Toland display, “Plant, Shape, Rejuvenate — Cultivating Good Health,” participants visited three different zones and received stamps from each area as they learned how to make healthy lifestyle choices during all phases of life. Designed to build upon last year’s KCBS health
symposium, “Cultivating Good Health” was created to emphasize that good health is a lifelong journey. “Last year, the focus was on prevention. This year, we wanted to emphasize that good health is an ongoing process, learned early in life, retooled as adults, and redefined when we become seniors,” says Therese Crossett, Brown & Toland marketing specialist. The first stop for visitors was “Planting the Seeds.” Armed with a Brown & Toland basketball hoop,
visitors were given minibasketballs and encouraged to take a shot at good health. “Not only did we want to emphasize that you can never be too young to start learning healthy habits, we wanted to re-introduce the concept of fun activity for adults. All you hear is ‘exercise, exercise,’ but unless you enjoy it, you will never make it a priority,” says Ms. Crossett. After completing the basket activity, visitors proceeded to the “Shape” area, where staff from the Brown
PREVENTION
Learn How to Prevent Stroke and Recognize Its Symptoms by Peter Alperin, M.D. Brown & Toland Medical Group
n average, someone in the United States has a O _stroke every 45 seconds. That translates to more than 900,000 strokes a 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.
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Brown & Toland’s HealthLink, Spring 2006
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Visitors learn the importance of Brown & Toland’s iHealthRecord program for portable medical records.
& Toland Medical Services Department measured guests to determine if their body types were indicative of certain risk factors for cardiovascular disease. “One of
our best assets is our staff,” Ms. Crossett notes. “Visitors really responded to them. They were friendly, engaging and encouraging, a great combination for
Stroke is the common name for cerebral vascular accident, or CVA. The symptoms of a CVA depend on what part of the brain is affected. Common symptoms include the sudden onset of weakness or paralysis of an arm or leg, slurred speech, vertigo or swallowing difficulties. Sometimes, these symptoms will resolve in less than 24 hours. This indicates a possible transient ischemic attack, a warning sign of an impending CVA. In any case, the symptoms are serious and require immediate medical attention. CVAs have a variety of origins. In some cases, arteries in the brain become progressively narrowed and eventually develop a complete blockage. In other cases, blood clots arising elsewhere in the body move up into the brain. In either case, when the blockage develops, a part of the brain is deprived of blood. Subsequently, these parts of the brain begin to die. The risk factors for stroke are largely the same as those for heart disease (remember, both diseases are really diseases of the blood vessels). High blood pressure, diabetes, smoking (stop now!) and elevated cholesterol are the biggies. www.brownandtoland.com
persuading visitors to take charge of their own health.” The final stop on the Brown & Toland tour was “Rejuvenate.” With all the recent changes in Medicare, the growing population of active seniors and rising costs of health care, this area was designed to prompt visitors to think about the choices and options available to them as they reach age 65. “San Francisco seniors continue to have quality health care services seeing their Brown & Toland physicians in conjunction with some of the new Medicare Advantage
plans. Brown & Toland represents continuity in this ever-changing market, along with patient care innovation,” says Ms. Crossett. After guests visited all three zones, they earned a raffle ticket and a chance to win an iPod Nano. In addition,visitors were invited to take part in an interactive survey on the importance of portable medical records, and had a chance to learn more about Brown & Toland’s iHealthRecord. “I am proud to say that once again, Brown & Toland’s booth was the hit of the convention floor,”
Risk reduction, therefore, centers on reducing these risk factors. Of course, stopping smoking is the number one thing you can do to reduce your stroke risk. Keeping your blood pressure below 140/90 is also essential. Blood pressure control is easy to dismiss, because elevated blood pressure produces no symptoms and leads to problems over decades, not days. Controlling diabetes reduces the associated vascular disease. Atrial fibrillation, common in the elderly, is a condition in which the heart beats irregularly and leads to clot formation inside the heart chambers. These clots can break off, move into the brain and cause a stroke. If this irregular beating cannot be stopped, and it very often can’t, blood thinners must be used. Of course, eating right and getting regular exercise doesn’t hurt. It never does. As for testing, there are no widely recommended screening tests for those without symptoms, so don’t worry that you haven’t been “tested” for stroke. The best cure is the proverbial “ounce of prevention.” Until next time, stay healthy. I
“Good health is an ongoing process, learned early in life, retooled as adults, and redefined when we become seniors.” — Therese Crossett, Brown & Toland marketing specialist
Ms. Crossett says. “Our approach is simple. Give people the tools to empower them to take charge of their health, and they walk away feeling they can accomplish anything.” I
Peter Alperin, M.D., of Brown & Toland Medical Group, also is in active practice at Mills–Peninsula Hospital and is an assistant clinical professor of medicine at the University of California–San Francisco.
Brown & Toland’s HealthLink, Spring 2006
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COLORECTAL CANCER
When to Get a Colorectal Cancer Check xcluding skin cancer, colorectal cancer is the third most common type ,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.
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People should be aware what risk group they fall into and when to begin colorectal cancer screenings.
A combination of all three tests — fecal occult blood test, sigmoidoscopy and colonoscopy — offers the best protection.
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That’s why everyone should be aware what risk group they fall into and when to begin screening for colorectal cancer. Those at average risk for colorectal cancer should have a screening test for colorectal cancer beginning at age 50 (colorectal cancer is rarely found in people under the age of 50). People who are at higher risk for colorectal cancer may need to begin screening tests at a younger age. People at higher risk include: Those with familial adenomatous polyposis; that is, a family history of development of multiple polyps likely to become cancerous. Although only about 1 percent of all colorectal cancer patients have this gene, those who do have it have a 100 percent chance of developing cancer. People with this cancer will likely die in their 40s if not treated. They should start screening in their teenage years. Those with hereditary non-polyposis cancer, which is brought about by defective DNA repair genes. About 5 percent to 10 percent of the peo-
Brown & Toland’s HealthLink, Spring 2006
ple with colon cancer have this condition. People with this cancer have parents or siblings who developed colorectal cancer before age 40. They should start screening a few years before the age of the family member who developed colorectal cancer. Those who have had colorectal cancer or a precancerous polyp. Those who have a parent, sibling or child who has had colorectal cancer before the age of 60, or if more than one relative is affected (at any age), have a two to four times greater risk. Those who have chronic inflammatory bowel disease (ulcerative colitis or Crohn’s colitis), a condition that causes the colon to be chronically inflamed, have an increased risk of developing colon cancer. Screening should be started at a young age and be done more frequently. A person’s preference and the recommendation of the health care provider should determine the type and frequency of screening tests.
Screening tests The fecal occult blood test (FOBT) looks for hidden (occult) blood in stool. Blood in the stool can be caused by a variety of conditions; colorectal cancer is only one of them. The FOBT uses a chemical reaction to detect blood in small samples of stool that have been placed on an FOBT sample card. Usually two samples from each of three consecutive stools are collected and mailed or taken to your health care provider’s office for testing. The American Gastroenterological Association (AGA) says that if a test is positive for blood in stool, a colonoscopy should be done to determine the source of the bleeding. It could be caused by cancer, a polyp, hemorrhoids, diverticulosis (a condition in which small pouches form at weak spots in the wall of the colon) or inflammatory bowel disease. If cancer or a precancerous polyp does not bleed, this test will not detect it. Certain foods or drugs can affect the test, so you should follow instructions on diet and medications. The American Cancer Society (ACS) and the AGA recommend that
people at average risk have this test each year. Sigmoidoscopy uses a short, flexible, lighted tube that is inserted into the rectum and gently moved into the lower half of the colon. It covers only the lower part of the colon, representing about half the surface at risk for developing cancer. Before this test is done, the colon and rectum must be cleaned with an enema. The ACS recommends that people at average risk have this test every five years. Colonoscopy uses a colonoscope, which is longer than the tube used for sigmoidoscopy. The entire colon is examined, and if a polyp is found, it can be removed during the colonoscopy. Before the exam, the entire colon must be cleaned with laxatives and enemas. It can be uncomfortable, so an intravenous medication is used to make you feel sleepy during the procedure. A colonoscopy takes 15 to 30 minutes, longer if a polyp is removed. A combination of all three tests offers the best protection. For people at average risk, the ACS recommends www.brownandtoland.com
PATIENT CARE
Brown & Toland’s Patient Bill of Rights
a combination of tests: an FOBT every year and a sigmoidoscopy every five years. If either of these is positive, a colonoscopy is recommended. A colonoscopy is recommended every 10 years. Several new methods of
screening for colorectal cancer are being developed but are not recommended options at this time. These include virtual colonoscopy and analysis of stool for DNA abnormalities that may indicate the presence of cancer. I
SCREENING THOSE AT HIGHER RISK The American Cancer Society makes the following recommendations: If you have had a precancerous polyp or colorectal cancer, you should follow the recommendations of your health care provider. If you have a parent or sibling who had colorectal cancer before the age of 60, or two or more close relatives who had colorectal cancer at any age, you should have a colonoscopy beginning at age 40, or 10 years 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 precancerous polyp or cancer. If you have a family history of familial adenomatous polyposis (FAP), you should be under the care of a specialist, and you generally should begin screenings at puberty. If you have a family history of hereditary nonpolyposis colorectal cancer (HNPCC), you should be under the care of a specialist, and you generally should begin screening at age 21. If you have inflammatory bowel disease, chronic ulcerative colitis or Crohn’s disease, you should be under the care of a specialist who can determine when screening should begin.
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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 involved in treatment Timely response to requests for services, inquiries and complaints Second opinions when medically appropriate Titles and specialties of the health care professionals responsible for your care Privacy and confidentiality regarding your medical and health conditions Information regarding the medical group and health plan grievance procedures Recognition of your rights to make decisions regarding your medical care and to complete an advance directive, thereby extending your rights to any person who may make decisions on your behalf regarding your medical care The right to make recommendations to your patient rights and responsibilities Patient Responsibilities As your health care partner, we ask that you: Provide professional staff with all pertinent health care information needed to ensure the best possible outcome. Communicate with your primary care physician when you have questions or concerns about your health care. Adhere to instructions and guidelines given for health care services. Cooperate with health care professionals providing service to you, except in those instances when you have exercised your right to refuse service. Educate yourself on your health benefits and services and how to correctly obtain them. If you have questions about your benefits, call Brown & Toland Medical Group’s Customer Service Department at 415.972.6002, or your health plan’s member services division. I The California Department of Managed Health Care is responsible for regulating health care plans. The department has a toll-free number (888.HMO.2219) to receive complaints regarding health plans. If you have a grievance against a health plan, you should contact the health plan and use the plan’s grievance process. You may call the California Department of Managed Health Care for assistance with an emergency grievance or a grievance that has not been satisfactorily resolved by the plan. Brown & Toland’s HealthLink, Spring 2006
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WOMEN’S HEALTH
For Women: Which Tests Do You Need?
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ou say you feel great, but what do you really know about your 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.
Screening tests can catch an illness before you see signs, when treatment may help most.
Women should know their risk for colorectal cancer, too. See story on page 4.
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Mammogram and breast exam Mammograms can detect cancerous tumors “up to two years before a lump can be felt,” says Sonja Eva Singletary, M.D., of the M.D. Anderson Cancer Center in Houston. Although mammograms can detect tumors, they still may miss some. And some mammograms results may lead to biopsies that find no cancer. If you feel a lump and your mammogram is normal, tell your provider. The lump could be cancerous. Although a breast self-exam each month can help a woman find changes in her breasts and bring them to the attention of her doctor, your best chance of detecting breast cancer is getting both a clinical breast exam and a mammogram. Pap test and pelvic exam During a Pap test, doctors take cells from the cervix to look for early warning signs of cancer that cause no symptoms. A woman should get the test within three years of becoming sexually active, and no later than age 21. After that, she should have one at least every three years, according to 2003 guidelines by the U.S. Preventive Services Task Force (USPSTF). A woman older than 65 does not need routine Pap tests, the USPSTF says, particularly if she has had normal screenings in the past and is not in a high-risk group for cervical cancer. A woman who has had a total hysterectomy for noncancer reasons does not need a Pap test, the USPSTF says. Although other screening methods for cervical cancer are available, the USPSTF has not endorsed any method over the Pap test for routine tests.
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Sexually transmitted disease tests If you’re sexually active, you should be screened for sexually transmitted diseases. That’s even more true if you’ve had multiple partners and any of them has had multiple partners. “The most common is chlamydia, which, if left untreated, can lead to infertility,” says Elizabeth Swisher, M.D., of the Seattle Cancer Care Alliance. Others are gonorrhea, syphilis, HIV, HPV (human papilloma virus), herpes and hepatitis B. (See page 9 for more information on chlamydia.) Diabetes test In type 2 diabetes, the level of blood sugar rises because you can’t make enough insulin or use it normally. The disease affects 20.8 million Americans, 9.7 million of them women, according to the American Diabetes Association (ADA). A lot of women get diabetes in middle age or older, but it’s rising in the young. African American, Hispanic/ Latino, American Indian and Asian/Pacific Islander women are two to four times more likely to develop diabetes than Caucasian women. Besides being a member of these racial or ethnic groups, the risks for developing type 2 diabetes are age, obesity, lack of physical activity and a family history of the disease. It occurs more frequently in women who have had gestational diabetes (diabetes during pregnancy) or in women who have polycystic ovary syndrome, high blood pressure, high cholesterol, impaired glucose tolerance (IGT) or impaired fasting glucose (IFG). The ADA recommends getting tested for type 2 diabetes every three years beginning at age 45, if you are at average risk for diabetes. If you have any of the risk factors listed above or if you are overweight or obese — overweight: body mass index (BMI) is 25 to 29; obese: BMI is 30 or more — you should be tested at an earlier age or more frequently. www.brownandtoland.com
HEALTHY CHILDREN
Diabetes Tops Child Obesity’s Health Risks hildren who weigh _too much face a broad array of health problems, with type 2 diabetes leading the list.
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Heart disease screening Obesity, high blood pressure, high-fat diets and diabetes fuel heart disease, the top killer of U.S. women. And women may not recognize their heart attack symptoms. Women are more likely than men to experience indigestion, breathing trouble or muscle pain instead of the classic, spreading chest pain. The USPSTF recommends that all adults ages 18 and older be screened regularly for high blood pressure. If your blood pressure is less than 120 systolic (the top number) and less than 80 diastolic (the bottom number), you should be screened every two years. If either number is higher, or if you have other risk factors for heart disease (such as high cholesterol or diabetes), you should be screened more frequently. The National Heart, Lung, and Blood Institute recommends that all adults over the age of 20 have their cholesterol measured once every five years. Total cholesterol should be 200mg/dL or less, LDL cholesterol should be less than 100mg/dL and HDL cholesterol should be higher than 40 mg/dL (the higher the better). Talk to your health care provider to find out when you should begin screening. Bone density test Women start with less bone mass than men. “When you become postmenopausal, you’re at high risk for rapid bone loss, which may lead to osteoporosis,” says E. Michael Lewiecki, M.D., past president of the International Society for Clinical Densitometry. Osteoporosis increases the risk of sustaining a broken bone. The USPSTF recommends that women ages 65 and older be routinely screened for osteoporosis. If you have other risk factors for osteoporosis (such as underweight or smoking), you should be screened beginning at age 60. I www.brownandtoland.com
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 imagine,” says Janet Silverstein, M.D., chief of the university’s division of pediatric endocrinology and a member of the American Academy of Pediatrics executive committee on endocrinology. Doctors estimate that half of overweight kids will grow up to be overweight adults. Once they’ve been too heavy for too many years, experts say, they’re at risk for diseases that doctors usually see in people in their 60s, 70s and 80s. “We’ll be treating them when they’re in their mid-30s,” says Francine R. Kaufman, M.D., past president of the American Diabetes Association. “Their diabetes will lead to so many problems.” The average age of kids being treated in obesity clinics is about 12. “When these kids grow up and into their most productive years, many of them will be
on disability from their diabetes and the many diseases that accompany diabetes,” says obesity researcher Richard L. Atkinson, M.D., president of the American Obesity Association. But diabetes is just one of many health problems tied to obesity. “We had an 18-year-old girl with a stroke,” says Dr. Silverstein, whose Florida program is swamped with children. “It’s like this across the country. “This is a huge public health problem and it’s going to get worse,” says Dr. Silverstein. “The trend is still going up.” I
AILMENTS Childhood ailments linked with obesity: Diabetes High cholesterol and other blood fats High blood pressure Gallbladder disease Polycystic ovary disease (PCOD) Kidney failure Blindness Orthopedic difficulties Sleep apnea Psychological problems Social problems Obstructive sleep apnea
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PERINATAL CARE
New Perinatal Group Opens Office in San Francisco
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new perinatal physician group, San Francisco Perinatal _Associates, Inc., was scheduled to open its office March 1.
The new facility features state-of-the-art equipment, such as GE Healthcare’s Voluson 730 Expert, GE’s leadership ultrasound system for women’s health care. The Voluson 730 features superior 3D imaging, Real-Time 4D imaging, advanced volume ultrasound tools and unparalleled patient data management capabilities. Part of Brown & Toland
Medical Group, San Francisco Perinatal Associates, Inc., will be one of the first physician offices in San Francisco and the first perinatal practice to go completely paperless by using tools such as Allscripts TouchWorks® electronic medical record, which will help improve service quality and reduce costs. The physicians practicing at San Francisco Perinatal
Associates, Inc., are James D. Goldberg, M.D., Michael Katz, M.D., Thomas J. Musci, M.D., Per Sandberg, M.D., and Melinda M. Scully, M.D. For more about each physician, please see the article below. The new office is located at One Daniel Burnham Court, Suite 230c, in San Francisco. The practice is now accepting patient referrals. Because perinatal services
Full range of services San Francisco Perinatal Associates, Inc., is a comprehensive private perinatal practice providing the full range of maternal-fetal medical services, including: High-risk pregnancy consultation and management Diabetes in pregnancy management Obstetric ultrasound including 3D/4D imaging Genetic counseling Amniocentesis Chorionic villus sampling Nuchal translucency integrated/ combined screening
are a unique subspecialty, patients are usually seen via referral by their primary obstetrician. For more
information about San Francisco Perinatal Associates, Inc., please visit 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 School and served as a resident at the University of California–San Francisco (UCSF) in obstetrics and gynecology. He also served as a fellow in maternal-fetal medicine and genetics at Mount Sinai School of Medicine in New York. Board certified in obstetrics and gynecology, maternal-fetal medicine, and genetics, Dr. Goldberg is a founding fellow of the American College of Medical Genetics. He previously was director of the Reproductive Genetics Unit at UCSF and codirector of the Prenatal Diagnosis Center at California Pacific Medical Center. Dr. Goldberg has published extensively in the area of prenatal diagnosis and was listed for three consecutive years in American Health Magazine's “The Best Doctors in America.” Michael Katz, M.D. Michael Katz, M.D., obtained his pre-medical education at the Medical Faculty, University of Vienna in Austria, and his M.D. degree at the Technion, Israel, Institute of Technology. Dr. Katz completed his residency in obstetrics and gynecology at the Department of Obstetrics and Gynecology, Brookdale Hospital Medical Center, State University of New York, Brooklyn, N.Y. He subsequently had his fellowship in maternal-fetal medicine at the Department of Obstetrics, Gynecology and Reproductive Sciences and the Cardiovascular Research Institute, at UCSF. He is board certified in both obstetrics and gynecology and maternal-fetal medicine. Dr. Katz serves as chief of perinatal services, California Pacific Medical Center (CPMC), and is currently a clinical associate professor of obstetrics, gynecology and reproductive sciences at UCSF. His areas of clinical research interest focus on pre-term birth prevention and cervical competency. Thomas J. Musci, M.D. Thomas J. Musci, M.D., graduated cum laude from the Georgetown University School of Medicine in Washington, D.C. He completed his internship and
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residency in obstetrics and gynecology at UCSF; his fellowship in maternal-fetal medicine at UCSF’s Department of Obstetrics Gynecology and Reproductive Sciences and in the UCSF Cardiovascular Research Institute; and a fellowship in medical genetics at UCSF. Following his scientific training, he was a tenured faculty member at UCSF in the Department of Obstetrics and Gynecology and the Department of Biochemistry and Biophysics. Dr. Musci remains on the clinical faculty of UCSF as an associate clinical professor of obstetrics, gynecology and reproductive sciences. He is board certified in obstetrics and gynecology, maternal-fetal medicine, and in medical genetics. Per Sandberg, M.D. Per Sandberg, M.D., graduated cum laude from The Ohio State University School of Medicine–Columbus, Ohio. He completed his post-doctoral training as a resident in obstetrics at Magee–Women’s Hospital, University of Pittsburgh Medical Center, followed by a fellowship in maternal-fetal medicine at UCSF’s Department of Obstetrics, Gynecology and Reproductive Sciences. He is board certified in obstetrics and gynecology, and board eligible in maternal-fetal medicine. After he finished his post-doctoral training, Dr. Sandberg was an assistant clinical professor at UCSF’s Department of Obstetrics, Gynecology and Reproductive Sciences and Director of Obstetric Services for the Fetal Treatment Center. Melinda Scully, M.D. A graduate of the Pritzker School of Medicine University of Chicago, Dr. Scully completed her internship in obstetrics and gynecology at the University of Chicago and residency at UCSF. She completed fellowships in maternal-fetal medicine, medical genetics, and biostatistics and epidemiology through the Advanced Training in Clinical Research Program at UCSF. Dr. Scully was the medical director of the CPMC Diabetes and Pregnancy Program.
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STAYING HEALTHY
Get Tested for a Silent STD hlamydia is a sexually transmitted disease (STD) caused by _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.
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If not treated, however, chlamydia can cause serious complications and infections for both men and women. Chlamydia can be passed from one person to another through oral, vaginal or anal sex with an infected partner. Reinfections can occur if sexual partners are infected and not treated. Chlamydia is common among high school and college-age women, but less so among middle-aged and older women. The CDC says this is because women in their 30s and older usually have settled down with one partner.
Model used for illustrative purposes only.
Symptoms About three-quarters of infected women and about half of infected men have no symptoms, the CDC says. If symptoms do occur, they usually appear within one to three weeks after exposure. www.brownandtoland.com
In women, the bacteria initially infect the cervix and the urethra (urine canal). Symptoms can include unusual vaginal discharge, bleeding during intercourse or between periods, burning during urination, pain with intercourse, or lower back or abdominal pain. Men also may have pain during urination, or they may notice a burning and itching around, or discharge from, the penis, or pain and swelling in the testicles. The infection may move inside the body if it is not treated, and cause two very serious illnesses. In women, it can cause pelvic inflammatory disease (PID). In men, it can cause epididymitis, an inflammation of the tube that carries the sperm from the testes. Both of these illnesses can lead to sterility. The bacteria can cause an inflamed rectum from anal intercourse; an inflammation of the lining of the eye (“pinkeye”) if the bacteria is present during birth; and a throat infection from oral sex with an infected partner. If you notice any of the above symptoms, consult your health care provider.
Treatment and prevention Current guidelines recommend that all sexually active women younger than 25 be screened annually for chlamydia. Recommendations for women older than 25 are based on overall risk and exposure. Your health care provider will first screen for chlamydia with a culture during a pelvic exam, a swab test (for men) or a urine test. If you are infected with Chlamydia trachomatis, your doctor will give you a prescription for an antibiotic. A pregnant woman also can be treated for a chlamydial infection with antibiotics. A single dose of azithromycin or a week of doxycycline (this is not prescribed for pregnant women) are the most commonly used treatments. Reinfection is common and can occur within a few months of treatment. Because of this, routine screening is still recommended following treatment. Infected men and women who have no symptoms may pass the bacteria on to their sex partners without knowing it, according to the National Institutes of Health (NIH). The NIH recom-
mends that if you have multiple sex partners, and especially if you are a woman younger than 25, you should be tested for chlamydia regularly, even
if you have no symptoms. Getting a regular checkup is one of the main ways you can help prevent serious problems from chlamydia. I
PREVENTION To prevent chlamydia, experts generally recommend that you: Always use male latex condoms correctly during vaginal, anal and oral intercourse. Don’t engage in unprotected sex unless both parties have had a thorough STD exam and testing. Know your partner’s sexual disease history.
Models used for illustrative purposes only.
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MEN’S HEALTH
Prostate Cancer: A Range of Treatment Options y the time an average reader can finish this story, _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 estimate by the American Cancer Society (ACS).
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Mention the word “prostate” to men over 50, and many will wince or cringe. It brings to mind pain, less-than-manly doctor’s office positions and a probing physician’s finger in places down under. And then there’s the C-word: cancer. If your physician has told you that you have prostate cancer, you may soon face a blizzard of treatment options.
In the next 24 hours, prostate cancer will claim the lives of more than 100 American men. “One of the critical issues right now in prostate cancer is that all these men have a big decision to make after they’re diagnosed,” says David Perlow, M.D., a urologist in metro Atlanta who performs mostly “seed” radiation treatments. “Frankly, many of the patients I have are torn by the decision.” And patients will often find that the specialists performing one treatment usually espouse that treatment over others. A survey of urologists and oncologists published in the
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Journal of the American Medical Association ( JAMA) found that “while urologists and radiation oncologists do agree on a variety of issues regarding detection and treatment of prostate cancer, specialists overwhelmingly recommend the therapy that they themselves deliver.” Ironically, almost all the specialists may be right in many cases, according to the study, which said that no conclusive evidence currently backs any particular treatment over another. So how can you know which treatment is best for you? Before you pick a treatment The first thing you should do, according to the ACS, is ask your physician many questions about the severity of your cancer, the chances
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of treating it effectively, what will happen if it goes untreated, what will be the side effects of an operation and much more. Then ACS recommends that you consider other factors, such as your age, what lifestyle you wish to have, whether you can live with potential incontinence or sterility and what chances you’re willing to take comfortably. For example, some elderly men choose to have no treatment at all because of operation dangers and lifespan issues. Other men with localized (in one spot) prostate cancer may feel they need no operation at all. “Unfortunately, although we are getting much more proficient at diagnosing prostate cancer, we are not very good at distinguishing the cancers that need active treatment from those that can be followed without
treatment,” says George L. Wright Jr., M.D., professor of urology at Eastern Virginia Medical School. The medical field has a letter and number system for different stages and scope of prostate cancer, identifying everything from one splotch to out-ofcontrol spreading. Understanding this system for measuring prostate cancer, learning the scope of your prostate cancer, and considering your age and lifestyle are crucial to deciding what treatment to use. Treatments The two primary treatments for prostate cancer are radical prostatectomy (removal of prostate) and radiation therapy, in which radiation is beamed into the prostate or inserted with a “seed” pellet (brachytherapy, pronounced “break-ee-ther-uh-pee”). The JAMA survey found that “the two groups of specialists largely agree that radical prostate surgery,
external beam radiotherapy and brachytherapy are potentially lifesaving treatments for localized prostate cancer in men whose normal life expectancy is 10 years or longer.” Other treatments include hormone therapy, chemotherapy and deferred therapy (no action taken). The information that follows on the above treatments comes from the National Comprehensive Cancer Network (NCCN), which has gathered experts from 17 of the nation’s leading cancer centers to develop cancer treatment guidelines for cancer care professionals. “Cancer specialists regard the NCCN treatment guidelines as the defining treatment standard,” says Louis M. Weiner, M.D., chairman of medical oncology at Fox Chase Cancer Center in Philadelphia. Radical prostatectomy This “gold standard” of prostate cancer treatment www.brownandtoland.com
“One of the critical issues right now in prostate cancer is that all these men have a big decision to make after they’re diagnosed. Frankly, many of the patients I have are torn by the decision.”
popular. Its side effects are minimal, with claimed much lower rates of incontinence and impotence. “If patients see a similarity in treatment success, they want the ‘seeds’ to avoid impotence or incontinence,” says Dr. Perlow. “Seeds are done as an outpatient or during a one-night stay in the hospital, and the risks are much lower.” Critics of this method say that not enough studies have been done thus far to confirm its effectiveness.
—David Perlow, M.D., urologist who performs mostly “seed” radiation treatments.
is still the most performed. This operation removes the entire prostate gland and some tissue around it and is used most often when the cancer is believed to have not spread past the prostate. Conventional prostatectomies require incisions near the rectum or abdomen, and can lead to incontinence (inability to control the bladder) and impotence (inability to achieve erection because nerves were cut during surgery). Normal bladder control usually returns within several weeks or months after a radical prostatectomy but has persisted in up to 35 percent of men. Impotence can be as high as 65 percent to 90 percent, but between 25 percent and 30 percent when surgery does not remove nerves on either side of the prostate. A new “keyhole,” or laparoscopic, prostatectomy uses a thin lighted tube with a camera and surgical instruments on the end to reduce “collateral” damage on the patient. “My previously held www.brownandtoland.com
notion that a laparoscopic technique would never supplant open surgery for radical prostatectomy must be strongly reconsidered,” says Carl A. Olsson, M.D., of Columbia University College of Physicians and Surgeons in New York after seeing French surgeons perform a laparoscopic surgery. Radiation therapy High-energy rays (such as X-rays) and particles (such as electrons and protons) are used to kill cancer cells. This therapy is sometimes used to treat prostate cancer that is still confined to the prostate gland or has spread to nearby tissue. If the disease is more advanced, radiation may be used to reduce the size of the tumor. The two main types are external beam radiation and brachytherapy (internal radiation). External focuses a beam from outside the body onto spots determined beforehand precisely by specialists. A small percentage of men experience permanent incontinence, and
between 40 percent and 60 percent of patients have some degree of impotence afterward. Radiation oncologist Gerald Hanks of the Fox Chase Cancer Center believes a new “threedimensional conformal radiation therapy,” or 3DCRT, should replace standard radiation treatment for prostate patients. “It’s clearly superior,” he says. “It cures more patients and causes fewer complications.” The technology targets the prostate directly, bypassing the rectum and bladder. Since no other organs are affected, higher doses of radiation can be used without serious side effects. Brachytherapy uses needles to insert radioactive pellets (about the size of a grain of rice) into the prostate with the aid of imaging tests to pinpoint the cancer for accurate placement. The radiation dies out after several weeks or months, and the pellets are allowed to remain harmlessly in the prostate. This therapy is becoming more
Hormone therapy This treatment is often used for patients whose cancer has spread beyond the prostate or has recurred after treatment. Its aim is to reduce the levels of the male hormone androgen, the main one being testosterone, which causes prostate cancer cells to grow. Side effects of this therapy include reduced or absent sexual desire, impotence and hot flashes. Some men also have breast tenderness and growth of breast tissue. To greatly reduce androgen levels, some doctors recommend an orchiectomy, the removal of the testicles. The side effects are similar to hormone therapy but perhaps more exaggerated. Chemotherapy This is an option for patients whose prostate cancer has spread outside the gland and for whom hormone therapy has failed. The anti-cancer drug is not expected to destroy all the cancer cells, but it may slow tumor growth and reduce pain. This treatment may lower blood cell counts, resulting in
an increased chance of infection, and more. Deferred therapy The best strategy for some patients is to simply “watch and wait” with careful observation but no immediate active treatment. This approach may be recommended if a prostate cancer is not causing any symptoms, especially if it is very small and contained to one area of the prostate or expected to grow slowly. Also, if a patient is elderly or frail, or has some serious health problems, this treatment may be an option. Some men may decide that the side effects of more aggressive treatments outweigh the benefits of an operation.
Ask your physician many questions about the severity of your cancer, the chances of treating it effectively, what will happen if it goes untreated, what will be the side effects of an operation. —advice from the American Cancer Society
In the next 24 hours, prostate cancer will claim the lives of more than 100 American men. For those of you in the earlier stages of the disease, the ACS and other reputable cancer organizations recommend that you get the facts about your own condition, as well as determine your own state of mind while you assess the best treatment option among many. I
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Make the most of the changes in Medicare.
Obtenga el mayor beneficio posible de los cambios en Medicare.
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www.brownandtoland.com
Many people are confused by the changes in Medicare this year. But all you have to do is keep your Brown & Toland doctor to make the most of the new Medicare. Brown & Toland contracts with two Medicare Advantage plans, Health Net’s Seniority Plus and PacifiCare’s Secure Horizons. Each includes a rich prescription drug benefit. When you choose one of these plans, you’ll enjoy great benefits, keep your Brown & Toland doctor, and have access to San Francisco’s best hospitals. Brown & Toland doctors are San Francisco’s finest group of primary and specialty care physicians. Dedicated to providing you with quality health care, Brown & Toland physicians understand the time-honored doctor–patient relationship. By choosing a Medicare Advantage plan, you’ll enjoy
affordable monthly premiums and low co-payments for hospital stays when medically necessary. In addition, Brown & Toland’s Medicare Advantage plans include prescription drug coverage, which offers a choice between brand-name and generic prescriptions included in the plan’s formulary. All of this for one low monthly premium. These are just some of the reasons why we encourage people with Medicare to learn more about Medicare Advantage and the Brown & Toland Medical Group by attending an informational meeting. To receive a list of upcoming Medicare Advantage meetings, please call 1.866.488.7088.
Muchas personas están confundidas por los cambios que se han dado en Medicare este año. Pero todo lo que usted tiene que hacer es conservar a su médico de Brown & Toland para obtener el mayor provecho de Medicare. Brown & Toland tiene contrato con dos planes Medicare Advantage, Health Net’s Seniority Plus y PacifiCare’s Secure Horizons. Cada uno incluye un amplio beneficio de fármacos con receta médica. Al escoger uno de estos planes disfrutará de grandes beneficios, podrá continuar con su médico de Brown & Toland y tendrá acceso a los mejores hospitales de San Francisco. Los médicos de Brown & Toland pertenecen al mejor grupo de 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
hospital cuando éstas sean médicamente necesarias. Adicionalmente, los planes de Medicare Advantage de Brown & Toland incluyen la cobertura de fármacos con receta médica que ofrece la elección entre fármacos comerciales o genéricos con receta médica que se encuentran en el formulario del plan. Todo esto por una prima mensual razonable. Éstas son algunas de las razones por las que animamos a las personas con Medicare a asistir a una reunión informativa para que conozcan más sobre Medicare Advantage y el Grupo médico Brown & Toland. Para recibir una lista de las próximas reuniones de Medicare Advantage comuníquese al 1.866.488.7088.
1.866.488.7088.
www.brownandtoland.com
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HEALTHY SENIORS
Staying Connected Is the Key to Avoiding Loneliness
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oneliness is one of the most formidable obstacles to health and quality of life for the nearly 35 million Americans age 65 or older. As more of us join that generation — which statisticians predict will double to 70 million by 2030 — the threat of loneliness will grow.
SIX WAYS TO AVOID LONELINESS Get advice. Seek suggestions on making your senior years the good years. Go to such organizations as the AARP or peer groups of seniors looking out for each other. Get connected. Rebuild a broken social network, or create a new one if old friends aren’t readily available. Seek out social groups or activities for seniors at your place of worship, community center or local recreation department, for example. “Don’t wait for others to outreach to you; get to them first,” says Roy F. Baumeister, Ph.D. Get involved. Draw on your years of experience or your wealth of free time to benefit someone else. “Teach a class, mentor in the public schools, volunteer to help the needy — but give of yourself,” says Carol Ryff, Ph.D. “You don’t just get the reward of making a difference in someone’s life; you get the bonus benefits to your mental and physical health gained with improved self-worth, fulfillment and purpose.” Get active. Take a walk, ride a bike, study tai chi or join a ballroom dancing group. The activity doesn’t matter as long as you get up and move. Research shows a correlation between regular exercise and a better quality of life. “And those who exercise are less prone to loneliness because they are likely to be interacting with others when they work out,” says Dr. Ory. Get educated. Go back to school. Communities, colleges and organizations offer learning opportunities for seniors in everything from agriculture to zoology. “Programs such as Elderhostel and the Plato Society encourage ‘life-long learning’ to keep one’s mind and one’s spirit bright,” Dr. Ryff says. Get online. Reap the benefits of the information revolution. A computer class can teach you the latest technology. “The Internet is a wonderful means of social communication and interaction, especially for those seniors who are not mobile,” Dr. Baumeister says. “It’s hard to feel lonely when you can virtually visit the Sistine Chapel or play chess with a newfound friend in Australia.”
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A hidden enemy? Unfortunately, recognizing this enemy isn’t as easy as we might think. “Loneliness is not what most people think it is, and that’s why many seniors don’t see the warning signs soon enough to head off disaster,” says Marcia Ory, Ph.D., M.P.H., professor and director of the Active for Life program at Texas A&M University. With loneliness, says Dr. Ory, a person “disconnects socially from the world around them, isolating themselves from involvement with people.” Living alone isn’t part of every case. It’s a way of life “We assume that an 80-year-old woman living by herself in an apartment must be lonely, yet she may have plenty of positive social interaction with others outside the home,” Dr. Ory says. “At the same time, we think that a 70-year-old man living with his son’s family cannot be lonely, yet he spends all day in front of the TV set and shuns all social activities.” It’s how you live that makes you lonely, adds Carol Ryff, Ph.D., director of the Institute on Aging at the University of Wisconsin–Madison. “Our research, and that of others who study the social habits of the elderly, shows that seniors who are ‘socially integrated’ — in other words, connected to others in an active, positive way — are in better health, retain more mental sharpness, and in general live longer than those who become ‘social recluses.’” Prone to isolation due to changes Seniors are more likely than younger people to experience changes that, if not handled properly, can isolate them. Examples include: Health problems that reduce or bar mobility The death of a spouse, relative or close friend A drastic change in routine, especially to a boring or inactive lifestyle after retirement Loss of contact with family or friends who move or have less time Even worse is loneliness that results from a deeper problem. Lack of involvement in life as a whole (not just social activities) may signal depression, says Roy F. Baumeister, Ph.D., a Case Western Reserve University social psychologist. “You have to treat the depression first before you can have any hope of returning them to normal relationships with others.” I www.brownandtoland.com
BENEFITS FOR SENIORS
Make Medicare Work for You
Understanding the Changes in Medicare
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s of Jan. 1, 2006, Medicare prescription drug coverage is available to everyone with Medicare. One of the best ways to enjoy the added benefits offered by Medicare is to join a Medicare Advantage plan. Let’s break down the changes in Medicare by the numbers. This article will cover the following: 1. Can I combine affordable benefits, great doctors and great hospitals? 2. What are my plan choices? 3. Who needs to enroll in a plan? No. 1: Combine comprehensive benefits, great doctors and respected hospitals. With a Medicare Advantage plan, you’ll have easy access to the Brown & Toland physician network, arguably San Francisco’s finest group of primary and specialty care physicians. Choosing this health care option also gives you access to San Francisco’s best hospitals, including California Pacific Medical Center, the University of California–San Francisco, St. Mary’s Medical Center, Saint Francis Hospital and St. Luke’s Hospital. With a Medicare Advantage plan, you may choose from among hundreds of Brown & Toland primary care doctors and have easy access to a Brown & Toland specialist. Plus, you’ll enjoy many advantages, including affordable monthly premiums, low co-payments for doctor office visits, and low co-payment hospital stays when medically necessary. In addition, a Medicare Advantage plan includes excellent prescription drug coverage as part of the affordable monthly premium. These plans also provide a choice between brand-name and generic prescriptions that are included in the plan’s formulary.
speaking, all covered services, including prescriptions, are included in the monthly premium. Medicare Advantage plans offer tremendous value and coordination of care. No. 3: Who needs to enroll? If you’re not covered through an employer or union, you may want to consider enrolling in a Brown & Toland contracted Medicare Advantage prescription drug plan. Brown & Toland contracts with two Medicare Advantage plans – Health Net Seniority Plus and PacifiCare’s Secure Horizons — and each includes a rich prescription drug benefit. The election period for designating a Brown & Toland Medicare Advantage plan ends May 15. If you choose not to enroll in a Medicare drug plan by May 15, you may enroll at a later date, but there will be a penalty. Medicare is encouraging everyone to enroll, even if you seldom need prescription drugs. Brown & Toland also recommends that all Medicare beneficiaries seriously consider enrolling in a prescription drug plan, such as one offered through a Medicare Advantage plan. Fact is, you may need prescription drug coverage as you age, so now may be the best time to get affordable prescription drug benefits. Whatever your situation, take a few minutes to learn more about your options. You may call 800.MEDICARE to learn all the options you have. We also encourage people with Medicare to learn more about Medicare Advantage and the Brown & Toland Medical Group by attending an informational meeting. I
To learn more about Medicare Advantage and Brown & Toland, please call 866.488.7088.
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
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Free Seminar by Pacific Eye Specialists at St. Mary’s Medical Center Spend your morning learning more about taking care of your vision. Don’t miss presentations from Brown & Toland physicians Bernd Kutzscher, M.D., Lee Schwartz, M.D., and Michael Hee, M.D., of Pacific Eye Specialists on health topics such as: G Cataracts and new technology in cataract surgery G Glaucoma prevention and 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.
Common Eye Diseases in the Senior Population Date: Saturday, March 25, 2006 Time: 10 a.m. to 1 p.m. Place: St. Mary’s Medical Center 450 Stanyan St., San Francisco
Call Brown & Toland at 866.488.7088 to reserve your seat today.
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