Colleague's email address:
Your email address:
Subject:	A colleague recommends WH - A Guide to Women's Health: Fall 2006
Message:

• WH - A Guide to Women's Health
• Fall 2006
• At the Doctor's
• Being a Mom
• Healthy You

WH - A Guide to Women's Health

Cleaning, Breathing, Drinking for Two

If you're expecting, you're probably already doing your best to avoid pesticides by washing and peeling fruits and veggies. Below, find some other easy-to-follow tips for avoiding common toxins during pregnancy.

Cleaning Products: Always check labels for warnings, and clean in ventilated areas while wearing gloves. Try safe, natural alternatives, such as baking soda and vinegar.

Cosmetics: Avoid nail salons because of toxic fumes. Hair products such as dyes, permanents and straighteners are harmless when properly used.

Lead: Paint over lead-based paint with latex-based, or have it removed. FYI: Older homes' pipes often contain unsafe amounts of lead. If you're concerned about yours, contact Contra Costa Health Services at (866) FIX-LEAD (349-5323). Let tap water for drinking run cold for 30 to 60 seconds, and never use it in baby formula. Choose water filters with "reverse osmosis"; others may not filter lead.

Source: Journal of Midwifery & Women's Health

[back to top]

Teens Are Short On Shut-Eye

Only about 20 percent of adolescents get the recommended nine hours of sleep on school nights, according to a recent National Sleep Foundation poll. Other of the poll's key findings:

• At least once a week, more than onequarter (28 percent) of high school students fall asleep in school, 22 percent fall asleep during homework and 14 percent arrive late or miss school because they oversleep.
• Sleepy teens are more likely than their peers to get lower grades, while 80 percent of adolescents who get an optimal amount of sleep say they're achieving As and Bs in school.
• During the previous year, 51 percent of adolescent drivers had driven while feeling drowsy.

Kids can get more shut-eye, experts say, if they avoid caffeine drinks after lunchtime and ramp down their day before bed (think warm baths, good books). "Many teens have a technological playground in their bedrooms that offers a variety of ways to stay stimulated and delay sleep," says Mary Carskadon, Ph.D., NSF spokesperson. "Teens need to give the brain better signals about when nighttime starts. Turning off the lights—computer screens and TV, too—is the very best signal."

[back to top]

Getting Schooled on Giving Birth

Labor and delivery are perfectly natural processes, but when moms-to-be learn beforehand what to expect and get support from their partners and peers, everyone stands to gain.

"Giving birth is a journey of a lifetime, a transforming experience," says Faye Mettler, LCCE, a perinatal educator who teaches several of the childbirth and parenting classes at the John Muir Women's Health Center (WHC). "Taking childbirth classes helps women and their partners get emotionally prepared, and that's key. Classes are also a great place to network with other women and start building your own personal support group."

According to research by Lamaze International, Mettler adds, women who feel informed or empowered as part of the birthing process rate their overall birth experience as positive. "And that overall positive experience translates into being a better mom, too," she says. "Women who are satisfied with their birth experience also feel more capable and comfortable taking on their new role as mother."

The WHC's numerous prenatal classes are designed to meet the diverse needs of expectant women. Classes are held primarily at night and on weekends, and are taught by certified childbirth educators and nurses. Observes Mettler, "Moms-to-be can learn about everything from prenatal yoga and breastfeeding to how to care for twins, install a car seat and fit a maternity bra. We encourage online registration, but if anyone has questions, we urge them to call the WHC."

The Lamaze-based childbirth preparation classes and the "low-intervention," smallgroup classes based on the Bradley Method are among the most popular. "These are not your mother's Lamaze classes," explains Mettler. "We don't teach "hee-ho" breathing anymore. We focus on tuning in to your body, breathing and relaxation. Bradley focuses more on natural childbirth, relaxation practice, exercises and nutrition."

[back to top]

Sign up for classes Click here to register online for classes at the John Muir Women's Health Center. For more information or to register by phone, call (925) 941-7900. Visit our new online e-store for other parenting resources.

Hit Your Stride

Thanks to today's advanced procedures and prostheses, total knee replacement can offer relief from pain and a return to daily activities.

Women account for nearly two-thirds of the 400,000 people in the United States who get their knees replaced each year, according to recent data from the National Center for Health Statistics. Thanks to the experienced surgeons, advanced procedures, specialized teams and multiple prosthesis options at John Muir Health, today's total knee replacement surgery can offer relief from pain and a return to daily activities.

The knee is the largest joint in the body. Nearly normal knee function is needed to perform routine, everyday activities. Disease or injury can disrupt normal knee function and result in pain, muscle weakness and less function, and cause you to consider total knee replacement (TKR).

On the following pages, get answers to common questions about total knee replacement surgery, based on recent interviews with several experienced John Muir Health orthopedic surgeons: Robert Buckley, M.D.; John Kronick, M.D.; Doug Lange, M.D.; John Merson, M.D.; and Ramiro Miranda, M.D.

Q: When should a patient consider a total knee replacement?

The most common cause of chronic knee pain and disability is arthritis. Although there are different types, arthritis damages the cartilage and eventually causes knee pain and limited knee function. If medications, changing your activity level and lifestyle, physical therapy, using walking supports, or other less invasive procedures are no longer helpful and you cannot perform desired activities, it may be time to consider total knee replacement surgery.

"A doctor can tell you that you have the appropriate diagnosis for knee replacement, but a doctor cannot tell you it is time to do it," says Dr. Kronick. "The patient decides when it is time to have a knee replacement."

Q: What are the benefits and risks of a TKR?

More than 90 percent of individuals who undergo total knee replacement experience a dramatic reduction of knee pain and a significant improvement in the ability to perform common activities of daily living. TKR is a major operation, and the most common risks include blood clots, infection, stiffness and falls.

Q: What surgical alternatives are available for total knee replacement?

"There is no one single procedure or prosthesis that fits everyone's needs," says Dr. Miranda. "When choosing to have a TKR, discuss with your surgeon which procedure is best for you."

• Traditional TKR: Your orthopedic surgeon removes damaged cartilage and bone and then positions the new metal and plastic joint surfaces to restore the alignment and function of your knee. Once inserted, the prosthesis is tested and balanced. The TKR may be cemented, cementless or hybrid, which refers to the fixation used to hold the implant in place.
• Minimally Invasive Knee Replacement: Minimally invasive TKR utilizes a minimally invasive approach with smaller incisions to expose the joint. This approach does not cut the tendon around the knee. Patients typically experience faster recovery and less pain.
• Unicompartmental or Partial Knee Replacement: Although not as common as a total knee replacement, the partial or unicompartmental knee replacement is a viable alternative in limited situations. It is used to replace a single compartment of the arthritic knee. Because the partial knee is inserted through a relatively small incision that does not interrupt the main muscle controlling the knee, rehabilitation is faster, hospitalization is shorter and return to normal activities is more rapid.
• Navigation System: The goal in computer navigation is to help surgeons operate with smaller incisions and greater precision. Computer-assisted surgery helps surgeons align the patient's bones and implants with a degree of accuracy not possible with the naked eye.

Q: How do I select an orthopedic surgeon and medical center for a total knee replacement?

"You should look for a surgeon who specializes in joint replacements and is board certified in orthopedic surgery. Additionally, you should feel comfortable with your orthopedic surgeon and have a good rapport," says Dr. Buckley.

When choosing a medical center, you should look for one that performs a high number of joint replacements each year and offers a specialized program. This program should include an operating room team specially trained to assist the surgeon in TKRs. The medical center should provide a specialized program with staff trained specifically in total joint replacement who can educate you before and after surgery. You should feel comfortable and supported throughout your recovery.

More joint replacement surgeries are performed on the knee than on any other joint in the body, and John Muir Health performs the most total joint procedures in the East Bay.

"Patients should be reassured in knowing that knee replacement surgery has an exceptionally good track record," Dr. Merson points out. "It's a good operation for the vast majority of people and can be a life-changing experience. The success rates for knee replacements are overwhelmingly positive."

[back to top]

A Closer Look: Knee Joint Implants Many different types of designs and materials are currently used in total knee replacement surgery. There are multiple options and sizes designed for the "average" man or woman. Nearly all of them consist of various types of metal, with plastic providing the "cushioning" of the knee. Some are made of ceramic. Knee joint implants consist of three basic components: femoral, tibial and patellar components, referring to the bones that make up the knee joint. Not every implant is right for every patient. When choosing your TKR prosthesis, discuss the pros and cons of each with your surgeon. Among the newer options are the following: Mobile Bearing: The difference between the mobile bearing implant (also called rotating platform knee implant) and the more traditional fixed bearing implant is mainly in the design of the tibial component. The tibial component is topped with a flat metal piece that securely holds the polyethylene insert. In the rotating platform knee prosthesis, the polyethylene insert can rotate slightly. Gender Specific: One orthopedic company has developed a knee prosthesis that accommodates the distinct differences between a woman's and a man's knees. "A woman's knee is shaped differently and is not just a smaller version of a man's knee," says Doug Lange, M.D. "The Gender-Specific knee has a narrower shape, is thinner in the front and provides for improved patellar alignment to more closely simulate the natural female knee anatomy. "John Muir is one of the first hospitals in Northern California and the first in the Bay Area to offer gender-specific knee replacements," adds Dr. Lange. "Women are pleased when they hear there's something designed for them. It just makes total sense to have a number of options."

[back to top]