WH - A Guide to Women's Health

Be Ready For Your Mammogram

What woman doesn't want her mammogram to go smoothly? The following info and tips can help you prepare:

• Your breasts are often the least tender during the week after your menstrual period, so that's a good time to schedule your test.
• If you're going to a new facility for your mammogram, take time a few weeks beforehand to gather any previous mammograms. Bring them to your appointment, along with related reports, so radiologists can use them for comparison.
• On the day of the test, don't apply deodorants, antiperspirants, lotions, creams, perfumes or powders under your arms or on your breasts. Metallic particles in these products could be visible on your mammogram and distort results.
• To help ease discomfort during the test, consider taking an over-the-counter pain medication—such as aspirin or ibuprofen—about an hour before your mammogram.

Source: Radiological Society of North America, www.mayoclinic.com

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Know Your Numbers

Do you know when to be relieved and when to be concerned about your blood pressure level? Here's some information to help you. The first number in a blood pressure reading (the 100 in a 100/70 reading, for example) is a measure of your maximum pressure, taken right after your heart pumps, and is called systolic blood pressure. The second number refers to your lowest blood pressure, measured when your heart is relaxed, and is called diastolic blood pressure.

The chart below displays blood pressure categories for adults, as defined by the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. Note: A relatively new category, called prehypertension, identifies people at higher risk for high blood pressure, heart disease and stroke.

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Q&A: Pituitary Tumors

Problems with your pituitary gland may not be on your radar screen of leading health concerns, but they shouldn't be ignored. Certain tumors, for instance, that effect this small pea-sized gland can cause menstrual problems, reduce your sex drive or impair your vision. To learn more about pituitary tumors and John Muir Health's advanced treatments, read the following Q&A with Douglas Zlock, M.D., an endocrinologist on staff at John Muir Medical Centers, and Terence Chen, M.D., John Muir Health's medical director of Neurosurgical Services.

Q: Where is the pituitary located in the body, and what role does it play in good health?

Dr. Zlock: The pituitary hangs down on a stalk from the main part of the brain, right behind the sinuses ... and between the eyes. It regulates six different glands, including the thyroid and the adrenals, and determines hormone levels in the body, including the sex hormones, estrogen and testosterone.

Q: What is a pituitary tumor? Are they common? Are they deadly?

Dr. Zlock: A pituitary tumor, or pituitary adenoma, is an abnormal growth of pituitary cells and accounts for about 10 percent of all brain tumors.

Dr. Chen: Typically, pituitary tumors are not deadly, but they can cause serious health problems. There are two ways that these tumors show up. If the tumors secrete hormones, then people complain about whatever system or target organ is out of whack and it gets diagnosed, usually when the tumors are still relatively small and easiest to treat. If the pituitary tumor does not produce a hormone, then it can grow to a rather large size before it's discovered, when it typically starts effecting the optic system ... causing blindness or some sort of impairment in vision.

Q: Do some pituitary tumors effect women more than men?

Dr. Chen: Tumors that produce prolactin, a hormone that stimulates production of breast milk, have almost no symptoms in men but in women can cause spontaneous lactation, which obviously is a little disconcerting. Prolactin-producing tumors can also create havoc with a woman's period and affect her regularity. Women should know, though, that only a small portion of menstrual disorders are due to pituitary problems.

Q: How are pituitary tumors treated?

Dr. Zlock: Almost all pituitary tumors are benign. Yet, given the location, even benign tumors require treatment. Some tumors respond to medications, however most will need surgery or radiation therapy.

Dr. Chen: Pituitary tumors can be treated with surgery, using an incision under the lip or nose. However, with the latest generation of therapy, called stereotactic radiosurgery, we don't make incisions at all. High-resolution MRI scans locate the tumors, then we direct very finely focused, high-dose radiation beams to the abnormal growth. This causes tumor cells to die off without harming surrounding tissues. It's the most elegant solution to the problem, and John Muir Health is the only health-care facility in Northern California that has this advanced Novalis shaped-beam radiosurgery system.

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Hope For Troubled Adolescents

Navigating the teen years, filled with their emotional hills and valleys, can be a challenge for anyone. For kids who are struggling with a mental health issue—such as anxiety, depression, anger or psychosis—it can be downright daunting. Parents often do not know where to get help.

The John Muir Behavioral Health Center in Concord has long provided a youth treatment program, offering quality inpatient care and an after-school program for teens who don't require hospitalization but need more than a weekly visit with a therapist.

Recently, the center unveiled an additional day program to help teens who have serious emotional difficulties and are unable to attend school regularly. The day program runs from 11 a.m. to 6 p.m. and includes daily therapy groups designed to build important coping skills. Education on illness, medications and symptom management is provided. Parents are included in education and parenting groups to further enhance the successful treatment of their teens.

"Teens who struggle with mental illness deal with pivotal issues daily," says Bette Sindzinski, R.N., M.N., manager of Youth Services at the Behavioral Health Center. "We love working with teenagers. Behaviors exist because of the interaction with a person's environment, chemistry and developmental level. Our program addresses each area contributing to the teen's difficulty. We help teens understand what their behaviors mean, how to express themselves and how to build healthy coping mechanisms for survival." (Although patients also learn about drug and alcohol use, the day program isn't suited for those who have serious addictions.)

Beyond group therapy, Program Coordinator Yesenia Selva-Feustel schedules daily classes and lectures on various topics given by mental health and alcohol/ drug abuse specialists. Patients meet weekly (more often if necessary) with Peg Grimley, M.D., a board-certified child psychiatrist, who provides further guidance and can prescribe or adjust medication. Because she sees day program patients so frequently, Dr. Grimley can pick up on improvements or medication side effects very quickly.

Another component of the program is family therapy, which is key to success. "I've come to believe that no child or teen treatment can be effective without involving the parents," Dr. Grimley says. "We can have great talks and great understanding, but unless it's translated to the home environment, it's really not going to be very helpful." It's also important that kids don't fall behind in their studies as they're healing, so the day program includes an hour of schooling every day with a teacher from the Mt. Diablo Unified School District.

"It's up to parents to take the first step to seek help if they notice their teen withdrawing, becoming violent or exhibiting other worrisome personality changes," says Sindzinski. "In my 20 years in private practice, I saw parents who wanted to believe that what they're seeing is just part of normal adolescence. But the most loving thing a parent can do is bring their teen in for a mental health assessment to see if there is a serious problem.

"During the assessment, we interview the teen and the parents in order to place the teen into the most appropriate level of care. The team evaluates all patients regularly to determine whether their treatment can be tapered down. Our programs are very focused on getting kids back into the mainstream. This program is not a teen's life. A teen's life is being back in school and doing well."

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