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• WH - A Guide to Women's Health
• Winter 2008
• Healthy You
• Being a Mom
• At the Doctor's

WH - A Guide to Women's Health

One-Dose Chickenpox Vaccine Isn't Enough

The varicella (chickenpox) vaccine has "substantially reduced" the incidence of chickenpox since 1995, when it became recommended for all U.S. children. However, researchers now say the vaccine's effectiveness may wane with time.

That's why the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (ACIP) now advises that the vaccine be administered in a two-dose regimen, with the first dose given at 12 to 15 months and the second dose between the ages of 4 and 6, based on ACIP research published recently in The New England Journal of Medicine. (This recommendation replaces the earlier single-dose standard for kids vaccinated up to age 13 and two doses for those immunized later.)

Other ACIP recommendations include:

• A second "catch up" vaccination for children, adolescents and adults who had previously received a single dose of the chickenpox vaccine.
• Routine immunization of all healthy individuals over age 13 who have no evidence of immunity.
• Prenatal assessment and postpartum vaccination.

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The Scoop on Soccer Injuries

Soccer isn't usually regarded as an unsafe sport, but soccer-related injuries landed more than 1.6 million U.S. children in the emergency room during a 13-year period, according to recent research.

The study, published in The American Journal of Sports Medicine, investigated injuries during organized and non-organized soccer play from 1990 to 2003. While nearly 60 percent of the injuries were sustained by boys during the study period, the rate of injuries among girls rose faster. Researchers theorize that this may be because more girls are now playing soccer.

Hand, wrist or finger injuries were the most common identified in the study, followed by ankle injuries and knee injuries. Girls were more likely than boys to sustain ankle and knee injuries and to suffer strains and sprains.

To safeguard against injury, medical experts advise parents to make sure that children wear appropriate protective equipment; play on fields that are even and well maintained; compete on age-, size- and skill-appropriate teams; and never play through pain, which is a sign of overuse or injury.

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Spotting Lung Cancer Sooner

Screenings for breast, cervical and colorectal cancer are pretty routine nowadays, but screening for lung cancer is another matter.

John Muir Health is currently participating in a study called the International Early Lung Cancer Action Program (I-ELCAP) that could change that. In collaboration with Weill Medical College of Cornell University, John Muir Health is one of 39 sites worldwide conducting patient trials to determine if lung cancer can be detected earlier and if early detection can improve long-term survival rates.

"This is a multi-institutional study designed to look at whether early detection of lung cancer is possible using CT (computed tomography) scans," says Michaela Straznicka, M.D., thoracic surgeon and medical director of the John Muir Thoracic Oncology program, who is leading the research at John Muir. "By the time somebody develops symptoms like coughing or shortness of breath, there's a 75 percent chance that the tumor has already spread," says Dr. Straznicka. "And right now, once lung cancer advances, our treatments are limited. But we have very sophisticated CT scans today that weren't available 10 or 15 years ago. So this study will, hopefully, show that we can identify very small lesions, and that if we do find cancer early, we can cure patients."

John Muir Health began enrolling study participants in November 2007. Enrollees must be between 45 and 80 years old and be at high risk for developing lung cancer as a result of such factors as a history of smoking, a first-degree relative who has or had lung cancer, or exposure to asbestos or radon gas. The goal of the program is to sign up 100 enrollees annually.

Study participants, who must have a primary care doctor, will receive an annual CT scan. The scans will be examined by a John Muir I-ELCAP-trained radiologist, and patients will receive their results within 10 days. If a scan shows abnormalities, patients will be assisted through diagnosis and follow-up on treatment recommendations. Participants are asked to pay a fee for each scan out of pocket. If any treatment is needed, however, they can bill their insurance company. (Currently, screening for lung cancer is not covered by most insurance companies.)

For information about enrollment in the I-ELCAP study, call (925) 674-2660.

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Not Your Mother's Labor And Delivery

At the state-of-art John Muir Birth Center, the miracle of childbirth meets the modern age

It's not unusual for a new mom-to-be to get advice about pregnancy and childbirth from her mother, an aunt, even a middle-aged neighbor. Learning about the past generation's experiences can be helpful, but there's no getting around one simple fact: Times have changed.

Today at the John Muir Birth Center, expectant mothers have the benefit of recent advances in the field—everything from new prenatal tests and state-of-the- art ultrasound screening to childbirth classes on the Internet and a more family-friendly atmosphere during labor. Here, two physicians on staff at John Muir Health, OB/GYN Gerald Katz, M.D., and perinatologist Rosa H. Won, M.D., reflect on the ever-evolving birth experience and hallmarks of the exceptional care at John Muir Birth Center, the area's premier birth center.

In the Months Before Childbirth

If you ask Dr. Katz, he'll tell you that the most significant changes in obstetrics in the past 20 or 30 years have been in prenatal testing. "There have been tremendous advances," he says. "The tests are better and can be performed at an earlier gestational age. The whole point of testing early is that it gives families more options for decision-making and treatment."

At the John Muir Birth Center, perinatologists perform a comprehensive range of diagnostic and therapeutic services, including consultation for genetic and maternal indications, complete ultrasound services, and first and second trimester screening. "John Muir now offers first trimester screening for Down syndrome and Trisomy 18, chromosomal abnormalities that cause developmental problems," says Dr. Won. "This screening isn't available at every hospital. It requires special certification in order to conduct the specialized test."

Ultrasound screening during pregnancy (typically performed at 11 to 13 weeks of gestation and again at 18 to 20 weeks) has seen "huge advances," according to Dr. Won. "Ultrasound technology is so much better now. With today's detailed ultrasound, we can detect fetal problems like heart abnormalities or other congential abnormalities—earlier and before birth, so we can make plans for delivery and referrals to specialists, all of which improves outcomes."

Similarly, women benefit from advances in diagnosing and treating medical conditions that can affect their health and their baby's, such as diabetes and hypertension. "We routinely test women for these conditions and treat them throughout their pregnancy," says Dr. Katz. "We also have better tests for diagnosing a woman's risk for preterm labor and treating that condition."

Prepared for Contingencies

Women who deliver at the John Muir Birth Center can feel confident that the facility offers the most advanced technology and medical expertise along with experienced, nurturing and highly specialized nursing care. "We have 24-hour, in-house coverage by board-certified obstetricians, anesthesiologists and pediatricians," says Dr. Katz. "From a safety standpoint, that's very important. If there's a problem, it can be addressed by the appropriate personnel within a matter of minutes."

"The John Muir Birth Center also is equipped with a Level III neonatal intensive care nursery, providing the highest level of care in the area for premature newborns," adds Dr. Won. Advanced technology, better medication regimens and staff with specialized training in caring for premature infants have helped babies to survive and thrive at much earlier gestational ages.

A Family-Centered Event

Notwithstanding all such advances, childbirth has always been more than a medical experience. Yet, the trend among hospitals to treat childbirth as a family-centered event began only in the 1970s and 1980s. Now that's the standard of care, according to Drs. Won and Katz. "At the Birth Center, the patient is more involved in the process than ever before," says Dr. Won. "There's more collaboration between patients and physicians during pregnancy and during childbirth. It makes the birth experience much more family friendly and involves everyone from step one."

"Today's expectant parents want to know as much as possible about what to anticipate during labor and delivery," adds Dr. Katz. "The John Muir Women's Health Center (WHC) offers a wide variety of childbirth classes—and we encourage moms and dads to sign up. For women who are too busy or can't attend a class in person, the WHC offers online childbirth classes." Parents-to-be can also take an online tour of the John Muir Birth Center and obtain a wealth of information regarding pregnancy, labor and delivery.

At the Birth Center itself, the very design of the facilities is meant to promote a warm, homelike environment. "Women don't have to labor in one place and move to another to deliver," explains Dr. Katz. "They labor and deliver and recover in the same room, creating a calmer birth experience. Family members are encouraged to participate in the birth. The spacious birthing suites are comfortable and can accommodate family members and support people before and during the birth. Having support people in the room often helps the woman in labor feel more at ease."

Timeless Traditions

As much as advances in planning and preparing for childbirth have evolved for families and physicians, some aspects of ushering in new life remain indisputably the same—and that's a good thing.

"What hasn't changed at John Muir," says Dr. Katz, "is our commitment to the health of the mom and the baby." Dr. Katz has been on staff at John Muir Health for 14 years. He estimates he's been involved in more than 200 births annually. And still, he says, the experience is "never routine. For every couple, having a baby is one of the most important, if the not the most important experiences of their life. It makes me proud to be involved in a significant event in people's lives."

Dr. Won says that she, too, is always moved by the opportunity to witness and assist birth. "It's the best feeling you can have when you see the look of joy on the parents' faces as they see the baby for the first time," she says. "It really touches me."

Both physicians also agree that John Muir Health's commitment to excellence is another unchanging childbirth tradition—one that the community can always count on. "Caring and highly trained medical personnel attend to every family's personal needs," says Dr. Katz. "The experience provided to patients is now, and always has been, memorable. I don't think there's a better place to have a baby."

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