Colleague's email address:
Your email address:
Subject:	A colleague recommends WH - A Guide to Women's Health: Fall 2008
Message:

When Vegetarians Eat for Two

This daily meal planning guide can help vegetarian moms-to-be choose foods that provide enough calories and nutrients to promote their own and their baby’s good health.

Food Group	Serving Size	Daily Number of Servings	Comments
Grains	1 slice of bread; 1⁄2 cup cooked cereal, grain or pasta; 3⁄4 to 1 cup ready-to-eat cereal	7 or more	Choose whole or enriched.
Legumes, nuts, seeds, milk products	1⁄2 cup cooked beans, tofu, tempeh; 3 oz. of meat substitute; 2 tbsp. nuts, seeds, nut or seed butter; 1 cup fortified soy milk; 1 cup cow’s milk; 1 cup yogurt	5 or more	Calcium-rich foods such as dried beans, calcium-precipitated tofu, calcium-fortified soy milk, cow’s milk and yogurt should be chosen often. A regular source of DHA and vitamins B-12 and D should be used (DHA and vitamin D are found in some enriched soy milks.)
Vegetables	1/2 cup cooked or 1 cup raw	4 or more	Calcium-rich foods such as kale, collard greens, mustard greens, broccoli and bok choy should be chosen often.
Fruits	1⁄2 cup canned fruit or juice or 1 medium fruit	4 or more	Choose calcium-rich figs and fortified juices often.

Source: Vegetarian Nutrition Practice Group, The Vegetarian Resource Group

[back to top]

Healthy Aging

If you’re among the 78 million baby boomers, now’s the time to focus on preventive measures that can help you stay healthy as you age.

• Exercise: “A regular exercise program can prevent or delay some conditions like diabetes and heart trouble,” says Lawren Hicks, M.D., medical director for John Muir Senior Services. “It can also reduce pain associated with arthritis and help with anxiety, depression and balance issues, in addition to giving patients the energy to live the kind of life they want.” An ideal workout routine includes endurance activities and exercises that enhance strength, flexibility and balance. “Check with your physician before starting any new exercise program,” adds Dr. Hicks.

• Diet: Maintain a diet that’s low in saturated fats and includes five or more daily servings of fruits and veggies. Older adults should also aim to consume 1,200 to 1,400 milligrams of calcium each day. To avoid vitamin D deficiency, 15 minutes a day of direct sunlight on exposed arms and legs is OK in the summer; in the winter, or year-round for those confined indoors, 800 to 1,000 daily units of oral vitamin D is safe. Fiber-rich fruits, vegetables and grains help maintain healthy cholesterol levels and prevent constipation.
• Medical care: Women should talk to their doctor about mammograms, Pap smears and screening schedules. Both women and men should also consult their doctor about colonoscopies, stay current with cholesterol and blood pressure screenings, and know their risk for diabetes.
• Medications: Keep a complete list of your medications—including nonprescription drugs—in your wallet, advises Arlene Phillips, manager for John Muir Senior Services. "It should list any allergies you have, prior adverse reactions, and most importantly, any current medications, with dosage and frequency, that you are taking."

[back to top]

New Tools in Gynecologic Oncology

Our advanced robotics system can bring added precision to laparoscopic procedures, reduce post-op pain and speed recovery

“The word ‘cancer’ puts some fear in you,” says Pat Noceti, recalling how she felt this past spring when she got the diagnosis, after undergoing biopsies of the suspiciously thick lining of her uterus. She and her husband listened carefully as OB/GYN Sandy Hughes, M.D., described what he considered to be her best option for surgery and for gauging the spread of her disease.

“He was the one who recommended Dr. Edraki and robotic surgery at John Muir Health, because it had so many benefits and so many advances.

“After Dr. Hughes told me about the procedure, my son and I did some research on the Internet about robotic-assisted surgery,” adds the Lafayette resident and mother of three sons in their 20s. “First of all, it was less invasive than conventional open surgery, with much shorter recovery time. With the robot, they would be able to remove the disease and biopsy the lymph nodes all at the same time. The procedure would be precise, and we’d see exactly where the cancer was and if it had spread. Hearing these advantages made my decision easy.”

Surgery, Robotics-Style
The surgeon Noceti was referred to was Babak Edraki, M.D., a highly skilled gynecologic oncology specialist on staff at John Muir Health and one of only a few doctors with similar expertise in the Bay Area. Dr. Edraki trained at George Washington, Stanford and Yale universities, serving on the faculties of the latter two and also at the renowned M.D. Anderson Cancer Center at the University of Texas.

With the aid of John Muir’s advanced robotic equipment, Dr. Edraki removed Noceti’s uterus, ovaries, fallopian tubes, 30 lymph nodes and her appendix (a prophylactic treatment to minimize chances of subsequent abdominal surgery). The three-hour laparoscopic procedure went well, and there was more good news. “My cancer had not spread. My lymph nodes were clear,” says Noceti, at the same time acknowledging her deep appreciation for Dr. Edraki’s skilled treatment. “Dr. Edraki is an amazing doctor and an excellent surgeon. When I look at the small incisions and think of all he was able to do—it is truly amazing.”

Equally amazed was Linda Woolsey, a registered nurse, who recently underwent robotic-assisted laparoscopic surgery to determine whether a suspicious ovarian cyst was cancerous. “Fortunately the cyst was benign, but because of my age, I am at greater risk for ovarian cancer, so Dr. Edraki performed a bilateral salpingo oophorectomy (removal of both fallopian tubes and ovaries) for precautionary reasons,” says Woolsey. “At the same time, he did a mesh colpopexy for a vaginal vault prolapse. My recovery was pretty easy because I only had four ‘Band-Aid incisions.’ ” A week later, she was out driving, and six weeks later was back into full swing due to Dr. Edraki’s expertise and the precise surgery that is possible with the robot.

The advanced surgical technology used in Noceti’s and Woolsey’s gynecologic oncology procedures and others at John Muir Health is the da Vinci Surgical System. It features four robotic arms; one wields a tiny video camera and the others manipulate complex surgical instruments, all controlled by a surgeon seated at a nearby monitor and console. The gear allows surgeons to perform a variety of complex, minimally invasive procedures with extreme precision.

“With robotic instruments, the surgeon has more degrees of motion in manipulating instruments, allowing more wrist-like actions with the laparoscopic instruments than you would have otherwise,” says Dr. Edraki. “The surgeon can access more angles and approaches to the operative field. The magnification used enables us to see better. With robotics, you can do things that otherwise would be more difficult or impossible to do with standard laparoscopic instruments. Robot-assisted procedures are more precise, which allows the surgeon to get much better results than in open surgery.”

Speedier recovery and less pain are other notable benefits of robot-assisted laparoscopic procedures as compared with open surgical techniques, because they are done through smaller incisions. “Patients usually stay in the hospital one night and go home the next day,” says Dr. Edraki, pointing out that typical hospital stays for open-surgery patients can range from three to seven days depending on the procedure performed. During the procedure, there is less blood loss in general and there may be fewer wound complications. It allows more rapid return to work and potentially it causes less postoperative adhesions.”

Minimizing Pain, Easing Recovery

Noceti says her recovery matched this description and Dr. Edraki’s expectations. She came home from the hospital the day after her surgery and right away felt well enough to walk up and down her hall. It wasn’t long before she resumed her daily 30-minute walking regimen. A veteran speech therapist for early intervention programs in three area school districts, she’s excited about the new school year and working with her 80 to 100 preschoolers. She is even thinking about volunteering at The Wellness Community to see “if there’s any way to help another woman who receives this diagnosis and wants more information.”

It’s a way for her to give back, to return the compassionate care she received at John Muir, she says. “I’m very fortunate I need no further treatment and have a 93 percent to 95 percent chance of the cancer not coming back again. My experience at John Muir was very positive. It’s not just about the robot or the technology, it’s also about the people.”

Ahead of the Curve

“John Muir Health is to be congratulated for being one of the first in the area to acquire the robotic system,” says Dr. Edraki. “They saw its potential, purchased the robot and developed the expertise.

“It’s really opened up the application of this type of surgery to the treatment of women with gynecologic cancers. Patients are being referred here from all over the Bay Area and Northern California.”

It’s a service to her local community that this technology is right at hand, adds Noceti. “I was so fortunate that there was a robot in my area, that I currently need no more treatments, and that my cancer was picked up right away. Dr. Edraki is a wonderful doctor and an amazing surgeon. I just feel very fortunate and wish everyone had access to this type of quality care.”

[back to top]

Copyright © 2008 by John Muir Health. WH is published three times a year by John Muir Health as a community service and is not intended for the purpose of diagnosing or prescribing. WH Editorial Advisory Board: American Heart Association and the Office on Women's Health, U.S. Public Health Service. Produced by DCP.

[back to top]