Cultivating Good Health

SERVICE

Brown & Toland Plants
the Seeds for Cultivating
Good Health at Health etc.
an Francisco residents went on a symposium, “Cultivating visitors were given mini-
HealthLink
Spring 2006 S journey of health discovery at an all-day
health and wellness symposium, held Saturday,
Good Health” was created
to emphasize that good
basketballs and encouraged
to take a shot at good
health is a lifelong journey. health. “Not only did we
4 Colorectal Screening “Last year, the focus was want to emphasize that you
Know your risks and what
Jan. 28 at the Moscone Center in San Francisco.
on prevention. This year, we can never be too young
tests you need.
Titled Health etc., the At the Brown & Toland wanted to emphasize that to start learning healthy
6 Women’s Health event, organized by KCBS display, “Plant, Shape, good health is an ongoing habits, we wanted to
Here’s a rundown of the radio, attracted thousands of Rejuvenate — Cultivating process, learned early in re-introduce the concept
exams every woman should
know about. participants from through- Good Health,” participants life, retooled as adults, and of fun activity for adults. All
out the San Francisco Bay visited three different zones redefined when we become you hear is ‘exercise, exer-
10 Men’s Health Area and featured Phil and received stamps from seniors,” says Therese cise,’ but unless you enjoy
A diagnosis of prostate cancer
means big decisions and McGraw, television’s each area as they learned Crossett, Brown & Toland it, you will never make it a
promising treatment options. “Dr. Phil.” Brown & Toland how to make healthy life- marketing specialist. priority,” says Ms. Crossett.
Medical Group was a spon- style choices during all The first stop for visitors After completing the bas-
14 Healthy Seniors
Loneliness undermines your sor and provided health phases of life. was “Planting the Seeds.” ket activity, visitors pro-
health. Take steps now to stay and wellness information in Designed to build upon Armed with a Brown & ceeded to the “Shape” area,
connected. a unique and fun fashion. last year’s KCBS health Toland basketball hoop, where staff from the Brown

Brown & Toland’s HealthLink editor:
Richard Angeloni, Associate Vice
President, Public Relations and
Communications, Brown & Toland
Medical Group, 415.972.4307. PREVENTION
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
Learn How to
newsletter are written by professional
journalists or physicians who strive to
present reliable, up-to-date health
information. Our articles are reviewed
Prevent Stroke
and Recognize
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
Its Symptoms
purposes only. (106) by Peter Alperin, M.D.
Brown & Toland Medical Group

O900,000 every 45aseconds. That translates hasmore
than
n average, someone in the United States
_stroke to
a

strokes 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.

2 Brown & Toland’s HealthLink, Spring 2006 www.brownandtoland.com

Visitors learn the impor-
tance of Brown & Toland’s
iHealthRecord program for
portable medical records.

persuading visitors to take plans. Brown & Toland rep-
charge of their own health.” resents continuity in this “Good health is an
The final stop on the ever-changing market, along
Brown & Toland tour was with patient care innova-
ongoing process,
“Rejuvenate.” With all the tion,” says Ms. Crossett. learned early in life,
recent changes in Medicare, After guests visited all retooled as adults,
the growing population of three zones, they earned
active seniors and rising a raffle ticket and a chance and redefined when
costs of health care, this to win an iPod Nano. In we become seniors.”
area was designed to addition,visitors were invited — Therese Crossett, Brown & Toland
prompt visitors to think to take part in an interactive marketing specialist
about the choices and survey on the importance
options available to them of portable medical records,
as they reach age 65. “San and had a chance to learn Ms. Crossett says. “Our
& Toland Medical Services our best assets is our staff,” Francisco seniors continue more about Brown & approach is simple. Give
Department measured Ms. Crossett notes. “Visitors to have quality health care Toland’s iHealthRecord. people the tools to empower
guests to determine if their really responded to them. services seeing their Brown “I am proud to say that them to take charge of
body types were indicative They were friendly, engag- & Toland physicians in con- once again, Brown & their health, and they walk
of certain risk factors for car- ing and encouraging, a junction with some of the Toland’s booth was the hit away feeling they can
diovascular disease. “One of great combination for new Medicare Advantage of the convention floor,” accomplish anything.” I

Stroke is the common name for cerebral vascular acci- Risk reduction, therefore, centers on reducing these
dent, or CVA. The symptoms of a CVA depend on what risk factors. Of course, stopping smoking is the number one
part of the brain is affected. Common symptoms include thing you can do to reduce your stroke risk. Keeping
the sudden onset of weakness or paralysis of an arm or your blood pressure below 140/90 is also essential. Blood
leg, slurred speech, vertigo or swallowing difficulties. pressure control is easy to dismiss, because elevated
Sometimes, these symptoms will resolve in less than 24 blood pressure produces no symptoms and leads to
hours. This indicates a possible transient ischemic attack, problems over decades, not days. Controlling diabetes
a warning sign of an impending CVA. In any case, the symp- reduces the associated vascular disease.
toms are serious and require immediate medical attention. Atrial fibrillation, common in the elderly, is a condition
CVAs have a variety of origins. In some cases, arteries in in which the heart beats irregularly and leads to clot for-
the brain become progressively narrowed and eventually mation inside the heart chambers. These clots can break
develop a complete blockage. In other cases, blood clots off, move into the brain and cause a stroke. If this irregular Peter Alperin, M.D., of
arising elsewhere in the body move up into the brain. In beating cannot be stopped, and it very often can’t, blood Brown & Toland Medical
either case, when the blockage develops, a part of the thinners must be used. Group, also is in active
brain is deprived of blood. Subsequently, these parts of Of course, eating right and getting regular exercise doesn’t practice at Mills–Peninsula
the brain begin to die. hurt. It never does. As for testing, there are no widely rec- Hospital and is an assistant
The risk factors for stroke are largely the same as those for ommended screening tests for those without symptoms, so clinical professor of medi-
heart disease (remember, both diseases are really diseases of don’t worry that you haven’t been “tested” for stroke. The cine at the University of
the blood vessels). High blood pressure, diabetes, smoking best cure is the proverbial “ounce of prevention.” California–San Francisco.
(stop now!) and elevated cholesterol are the biggies. Until next time, stay healthy. I

www.brownandtoland.com Brown & Toland’s HealthLink, Spring 2006 3

COLORECTAL CANCER

When to Get a
Colorectal Cancer Check
xcluding skin cancer, colorectal cancer is the third most common type
E ,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.
That’s why everyone ple with colon cancer Screening tests people at average risk have
should be aware what risk have this condition. The fecal occult blood this test each year.
group they fall into and People with this cancer test (FOBT) looks for hid- Sigmoidoscopy uses a
when to begin screening have parents or siblings den (occult) blood in stool. short, flexible, lighted tube
for colorectal cancer. who developed colorec- Blood in the stool can be that is inserted into the rec-
Those at average risk for tal cancer before age 40. caused by a variety of con- tum and gently moved into
colorectal cancer should They should start screen- ditions; colorectal cancer the lower half of the colon.
have a screening test for ing a few years before is only one of them. The It covers only the lower
colorectal cancer beginning the age of the family FOBT uses a chemical reac- part of the colon, repre-
at age 50 (colorectal cancer member who developed tion to detect blood in senting about half the sur-
is rarely found in people colorectal cancer. small samples of stool that face at risk for developing
under the age of 50). Those who have had have been placed on an cancer. Before this test is
People should be aware People who are at higher colorectal cancer or a FOBT sample card. Usually done, the colon and rectum
what risk group they fall risk for colorectal cancer precancerous polyp. two samples from each of must be cleaned with an
into and when to begin may need to begin screen- Those who have a par- three consecutive stools are enema. The ACS recom-
colorectal cancer screenings. ing tests at a younger age. ent, sibling or child who collected and mailed or mends that people at aver-
People at higher risk include: has had colorectal can- taken to your health care age risk have this test every
Those with familial ade- cer before the age of 60, provider’s office for testing. five years.
nomatous polyposis; that or if more than one rela- The American Gastroenter- Colonoscopy uses a
is, a family history of tive is affected (at any ological Association (AGA) colonoscope, which is
development of multiple age), have a two to four says that if a test is positive longer than the tube used
polyps likely to become times greater risk. for blood in stool, a colon- for sigmoidoscopy. The
A combination of all cancerous. Although only Those who have chronic oscopy should be done to entire colon is examined,
about 1 percent of all inflammatory bowel dis- determine the source of the and if a polyp is found, it
three tests — fecal colorectal cancer ease (ulcerative colitis or bleeding. It could be caused can be removed during the
occult blood test, patients have this gene, Crohn’s colitis), a condi- by cancer, a polyp, hemor- colonoscopy. Before the
those who do have it tion that causes the rhoids, diverticulosis (a con- exam, the entire colon must
sigmoidoscopy and have a 100 percent colon to be chronically dition in which small pouch- be cleaned with laxatives
colonoscopy — offers chance of developing inflamed, have an es form at weak spots in and enemas. It can be
cancer. People with this increased risk of develop- the wall of the colon) or uncomfortable, so an intra-
the best protection. cancer will likely die in ing colon cancer. Screen- inflammatory bowel disease. venous medication is used
their 40s if not treated. ing should be started at If cancer or a precancerous to make you feel sleepy
They should start screen- a young age and be polyp does not bleed, this during the procedure.
ing in their teenage years. done more frequently. test will not detect it. Certain A colonoscopy takes
Those with hereditary A person’s preference foods or drugs can affect the 15 to 30 minutes, longer
non-polyposis cancer, and the recommendation test, so you should follow if a polyp is removed.
which is brought about of the health care provider instructions on diet and A combination of all three
by defective DNA repair should determine the type medications. The American tests offers the best protec-
genes. About 5 percent and frequency of screening Cancer Society (ACS) and tion. For people at average
to 10 percent of the peo- tests. the AGA recommend that risk, the ACS recommends


PATIENT CARE

Brown & Toland’s
Patient Bill of Rights
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
a combination of tests: an screening for colorectal cancer involved in treatment
FOBT every year and a sig- are being developed but are Timely response to requests for services, inquiries and complaints
moidoscopy every five years. not recommended options Second opinions when medically appropriate
If either of these is positive, at this time. These include Titles and specialties of the health care professionals responsible for your care
a colonoscopy is recom- virtual colonoscopy and analy- Privacy and confidentiality regarding your medical and health conditions
mended. A colonoscopy is sis of stool for DNA abnormal- Information regarding the medical group and health plan grievance procedures
recommended every 10 years. ities that may indicate the Recognition of your rights to make decisions regarding your medical care and
Several new methods of presence of cancer. I to complete an advance directive, thereby extending your rights to any person
who may make decisions on your behalf regarding your medical care
SCREENING THOSE AT HIGHER RISK The right to make recommendations to your patient rights and responsibilities

Patient Responsibilities
The American Cancer As your health care partner, we ask that you:
Society makes the follow-
Provide professional staff with all pertinent health care information needed
ing recommendations:
to ensure the best possible outcome.
If you have had a pre-
cancerous polyp or Communicate with your primary care physician when you have questions or
colorectal cancer, you concerns about your health care.
should follow the rec- Adhere to instructions and guidelines given for health care services.
ommendations of your Cooperate with health care professionals providing service to you, except in
health care provider. those instances when you have exercised your right to refuse service.
If you have a parent or Educate yourself on your health benefits and services and how to correctly
sibling who had colorectal cancer before the age obtain them.
of 60, or two or more close relatives who had colo- If you have questions about your benefits, call Brown & Toland Medical
rectal cancer at any age, you should have a Group’s Customer Service Department at 415.972.6002, or your health plan’s
colonoscopy beginning at age 40, or 10 years
member services division. I
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 The California Department of Managed
precancerous polyp or cancer. Health Care is responsible for regulat-
If you have a family history of familial adenoma- ing health care plans. The department
tous polyposis (FAP), you should be under the has a toll-free number (888.HMO.2219)
care of a specialist, and you generally should to receive complaints regarding health
begin screenings at puberty. plans. If you have a grievance against
If you have a family history of hereditary non- a health plan, you should contact the
polyposis colorectal cancer (HNPCC), you should health plan and use the plan’s griev-
be under the care of a specialist, and you generally ance process. You may call the
should begin screening at age 21.
California Department of Managed
If you have inflammatory bowel disease, chronic
Health Care for assistance with an
ulcerative colitis or Crohn’s disease, you should be
under the care of a specialist who can determine emergency grievance or a grievance
when screening should begin. that has not been satisfactorily resolved
by the plan.


WOMEN’S HEALTH

For Women: Which
Tests Do You Need?
ou say you feel great, but what do you really know about your
Y 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. Sexually transmitted disease tests
If you’re sexually active, you should be screened for sex-
Mammogram and breast exam ually transmitted diseases. That’s even more true if you’ve
Mammograms can detect cancerous tumors “up to two had multiple partners and any of them has had multiple
Screening tests can catch an
years before a lump can be felt,” says Sonja Eva Singletary, partners. “The most common is chlamydia, which, if left
illness before you see signs,
M.D., of the M.D. Anderson Cancer Center in Houston. untreated, can lead to infertility,” says Elizabeth Swisher,
when treatment may help
Although mammograms can detect tumors, they still may M.D., of the Seattle Cancer Care Alliance. Others are gonor-
most.
miss some. And some mammograms results may lead to rhea, syphilis, HIV, HPV (human papilloma virus), herpes
biopsies that find no cancer. If you feel a lump and your and hepatitis B. (See page 9 for more information on
mammogram is normal, tell your provider. The lump chlamydia.)
could be cancerous.
Although a breast self-exam each month can help a Diabetes test
woman find changes in her breasts and bring them to the In type 2 diabetes, the level of blood sugar rises because
attention of her doctor, your best chance of detecting you can’t make enough insulin or use it normally. The dis-
breast cancer is getting both a clinical breast exam and ease affects 20.8 million Americans, 9.7 million of them
a mammogram. women, according to the American Diabetes Association
Women should (ADA). A lot of women get diabetes in middle age or older,
Pap test and pelvic exam but it’s rising in the young. African American, Hispanic/
know their risk for During a Pap test, doctors take cells from the cervix to Latino, American Indian and Asian/Pacific Islander women
colorectal cancer, too. look for early warning signs of cancer that cause no symp- are two to four times more likely to develop diabetes than
toms. A woman should get the test within three years of Caucasian women. Besides being a member of these racial
See story on page 4. becoming sexually active, and no later than age 21. After or ethnic groups, the risks for developing type 2 diabetes
that, she should have one at least every three years, accord- are age, obesity, lack of physical activity and a family history
ing to 2003 guidelines by the U.S. Preventive Services Task of the disease. It occurs more frequently in women who
Force (USPSTF). have had gestational diabetes (diabetes during pregnancy)
A woman older than 65 does not need routine Pap tests, or in women who have polycystic ovary syndrome, high
the USPSTF says, particularly if she has had normal screen- blood pressure, high cholesterol, impaired glucose toler-
ings in the past and is not in a high-risk group for cervical ance (IGT) or impaired fasting glucose (IFG).
cancer. The ADA recommends getting tested for type 2 diabetes
A woman who has had a total hysterectomy for non- every three years beginning at age 45, if you are at average
cancer reasons does not need a Pap test, the USPSTF says. risk for diabetes. If you have any of the risk factors listed
Although other screening methods for cervical cancer are above or if you are overweight or obese — overweight: body
available, the USPSTF has not endorsed any method over mass index (BMI) is 25 to 29; obese: BMI is 30 or more —
the Pap test for routine tests. you should be tested at an earlier age or more frequently.


HEALTHY CHILDREN

Diabetes Tops
Child Obesity’s
Health Risks
hildren who weigh
C _too much face a broad
array of health problems, with
type 2 diabetes leading the list.
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
Heart disease screening imagine,” says Janet Silverstein, M.D.,
Obesity, high blood pressure, high-fat diets and diabetes chief of the university’s division of on disability from their diabetes and
fuel heart disease, the top killer of U.S. women. And pediatric endocrinology and a member the many diseases that accompany dia-
women may not recognize their heart attack symptoms. of the American Academy of Pediatrics betes,” says obesity researcher Richard
Women are more likely than men to experience indiges- executive committee on endocrinology. L. Atkinson, M.D., president of the
tion, breathing trouble or muscle pain instead of the clas- Doctors estimate that half of over- American Obesity Association.
sic, spreading chest pain. The USPSTF recommends that weight kids will grow up to be over- But diabetes is just one of many
all adults ages 18 and older be screened regularly for high weight adults. Once they’ve been too health problems tied to obesity. “We
blood pressure. If your blood pressure is less than 120 sys- heavy for too many years, experts say, had an 18-year-old girl with a stroke,”
tolic (the top number) and less than 80 diastolic (the bot- they’re at risk for diseases that doctors says Dr. Silverstein, whose Florida pro-
tom number), you should be screened every two years. If usually see in people in their 60s, 70s gram is swamped with children. “It’s
either number is higher, or if you have other risk factors and 80s. “We’ll be treating them when like this across the country.
for heart disease (such as high cholesterol or diabetes), they’re in their mid-30s,” says Francine “This is a huge public health prob-
you should be screened more frequently. R. Kaufman, M.D., past president of the lem and it’s going to get worse,”
The National Heart, Lung, and Blood Institute recom- American Diabetes Association. “Their says Dr. Silverstein. “The trend is
mends that all adults over the age of 20 have their diabetes will lead to so many problems.” still going up.” I
cholesterol measured once every five years. Total choles- The average age of kids being treated
terol should be 200mg/dL or less, LDL cholesterol should in obesity clinics is about 12. “When
be less than 100mg/dL and HDL cholesterol should be these kids grow up and into their most AILMENTS
higher than 40 mg/dL (the higher the better). Talk to productive years, many of them will be
your health care provider to find out when you should Childhood ailments linked
begin screening. with obesity:
Diabetes
High cholesterol and other
Bone density test blood fats
Women start with less bone mass than men. “When you High blood pressure
become postmenopausal, you’re at high risk for rapid bone Gallbladder disease
loss, which may lead to osteoporosis,” says E. Michael Polycystic ovary disease (PCOD)
Lewiecki, M.D., past president of the International Society Kidney failure
for Clinical Densitometry. Osteoporosis increases the risk Blindness
of sustaining a broken bone. Orthopedic difficulties
The USPSTF recommends that women ages 65 and older Sleep apnea
be routinely screened for osteoporosis. If you have other Psychological problems
risk factors for osteoporosis (such as underweight or smok- Social problems
Obstructive sleep apnea
ing), you should be screened beginning at age 60. I


PERINATAL CARE

New Perinatal Group
Opens Office
in San Francisco Full range of services
San Francisco Perinatal Associates, Inc., is
new perinatal physician group, San Francisco Perinatal
A _Associates, Inc., was scheduled to open its office March 1.
a comprehensive private perinatal practice
providing the full range of maternal-fetal
medical services, including:
The new facility Medical Group, San Associates, Inc., are James High-risk pregnancy consultation
features state-of-the-art Francisco Perinatal D. Goldberg, M.D., Michael and management
equipment, such as GE Associates, Inc., will be Katz, M.D., Thomas J. Diabetes in pregnancy management
Healthcare’s Voluson 730 one of the first physician Musci, M.D., Per Sandberg, Obstetric ultrasound including
Expert, GE’s leadership offices in San Francisco M.D., and Melinda M. 3D/4D imaging
ultrasound system for and the first perinatal Scully, M.D. For more Genetic counseling
women’s health care. practice to go completely about each physician, Amniocentesis
The Voluson 730 features paperless by using tools please see the article below. Chorionic villus sampling
Nuchal translucency integrated/
superior 3D imaging, such as Allscripts The new office is located
combined screening
Real-Time 4D imaging, TouchWorks® electronic at One Daniel Burnham
advanced volume medical record, which Court, Suite 230c, in
ultrasound tools and will help improve service San Francisco. are a unique subspecialty, information about San
unparalleled patient data quality and reduce costs. The practice is now patients are usually seen Francisco Perinatal
management capabilities. The physicians practicing accepting patient referrals. via referral by their primary Associates, Inc., please visit
Part of Brown & Toland at San Francisco Perinatal Because perinatal services obstetrician. For more 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 residency in obstetrics and gynecology at UCSF; his fellowship in maternal-fetal
School and served as a resident at the University of California–San Francisco medicine at UCSF’s Department of Obstetrics Gynecology and Reproductive
(UCSF) in obstetrics and gynecology. He also served as a fellow in maternal-fetal Sciences and in the UCSF Cardiovascular Research Institute; and a fellowship
medicine and genetics at Mount Sinai School of Medicine in New York. Board in medical genetics at UCSF. Following his scientific training, he was a tenured
certified in obstetrics and gynecology, maternal-fetal medicine, and genetics, faculty member at UCSF in the Department of Obstetrics and Gynecology and
Dr. Goldberg is a founding fellow of the American College of Medical Genetics. the Department of Biochemistry and Biophysics. Dr. Musci remains on the clini-
He previously was director of the Reproductive Genetics Unit at UCSF and co- cal faculty of UCSF as an associate clinical professor of obstetrics, gynecology
director of the Prenatal Diagnosis Center at California Pacific Medical Center. and reproductive sciences. He is board certified in obstetrics and gynecology,
Dr. Goldberg has published extensively in the area of prenatal diagnosis and maternal-fetal medicine, and in medical genetics.
was listed for three consecutive years in American Health Magazine's “The Best
Doctors in America.” Per Sandberg, M.D.
Per Sandberg, M.D., graduated cum laude from The Ohio State University School
Michael Katz, M.D. of Medicine–Columbus, Ohio. He completed his post-doctoral training as a
Michael Katz, M.D., obtained his pre-medical education at the Medical Faculty, resident in obstetrics at Magee–Women’s Hospital, University of Pittsburgh
University of Vienna in Austria, and his M.D. degree at the Technion, Israel, Medical Center, followed by a fellowship in maternal-fetal medicine at UCSF’s
Institute of Technology. Dr. Katz completed his residency in obstetrics and gyne- Department of Obstetrics, Gynecology and Reproductive Sciences. He is board
cology at the Department of Obstetrics and Gynecology, Brookdale Hospital certified in obstetrics and gynecology, and board eligible in maternal-fetal
Medical Center, State University of New York, Brooklyn, N.Y. He subsequently medicine. After he finished his post-doctoral training, Dr. Sandberg was an
had his fellowship in maternal-fetal medicine at the Department of Obstetrics, assistant clinical professor at UCSF’s Department of Obstetrics, Gynecology
Gynecology and Reproductive Sciences and the Cardiovascular Research and Reproductive Sciences and Director of Obstetric Services for the Fetal
Institute, at UCSF. He is board certified in both obstetrics and gynecology and Treatment Center.
maternal-fetal medicine. Dr. Katz serves as chief of perinatal services, California
Pacific Medical Center (CPMC), and is currently a clinical associate professor of Melinda Scully, M.D.
obstetrics, gynecology and reproductive sciences at UCSF. His areas of clinical A graduate of the Pritzker School of Medicine University of Chicago, Dr. Scully
research interest focus on pre-term birth prevention and cervical competency. completed her internship in obstetrics and gynecology at the University of
Chicago and residency at UCSF. She completed fellowships in maternal-fetal
Thomas J. Musci, M.D. medicine, medical genetics, and biostatistics and epidemiology through the
Thomas J. Musci, M.D., graduated cum laude from the Georgetown University Advanced Training in Clinical Research Program at UCSF. Dr. Scully was the
School of Medicine in Washington, D.C. He completed his internship and medical director of the CPMC Diabetes and Pregnancy Program.


STAYING HEALTHY

Get Tested
for a Silent STD
hlamydia is a sexually transmitted disease (STD) caused by
C _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.
If not treated, however, In women, the bacteria Treatment and
chlamydia can cause seri- initially infect the cervix prevention
ous complications and and the urethra (urine Current guidelines rec-
infections for both men canal). Symptoms can ommend that all sexually
and women. include unusual vaginal active women younger than
Chlamydia can be passed discharge, bleeding during 25 be screened annually for
from one person to another intercourse or between chlamydia. Recommenda-
through oral, vaginal or periods, burning during tions for women older than mends that if you have if you have no symptoms.
anal sex with an infected urination, pain with inter- 25 are based on overall risk multiple sex partners, and Getting a regular check-
partner. Reinfections can course, or lower back or and exposure. Your health especially if you are a up is one of the main ways
occur if sexual partners are abdominal pain. Men also care provider will first woman younger than 25, you can help prevent
infected and not treated. may have pain during uri- screen for chlamydia with a you should be tested for serious problems from
Chlamydia is common nation, or they may notice culture during a pelvic chlamydia regularly, even chlamydia. I
among high school and a burning and itching exam, a swab test (for men)
college-age women, but around, or discharge from, or a urine test. If you are
less so among middle-aged the penis, or pain and infected with Chlamydia
PREVENTION
and older women. The swelling in the testicles. trachomatis, your doctor To prevent chlamydia, experts generally recom-
CDC says this is because The infection may move will give you a prescription mend that you:
women in their 30s and inside the body if it is not for an antibiotic. A preg- Always use male latex condoms correctly
older usually have settled treated, and cause two very nant woman also can be during vaginal, anal and oral intercourse.
down with one partner. serious illnesses. In women, treated for a chlamydial Don’t engage in unprotected sex unless both
it can cause pelvic inflam- infection with antibiotics. A parties have had a thorough STD exam and
matory disease (PID). In single dose of azithromycin testing.
men, it can cause epididy- or a week of doxycycline Know your partner’s sexual disease history.
mitis, an inflammation of (this is not prescribed for
the tube that carries the pregnant women) are the
sperm from the testes. Both most commonly used treat-
of these illnesses can lead ments. Reinfection is com-
to sterility. mon and can occur within
The bacteria can cause a few months of treatment.
Model used for illustrative purposes only. an inflamed rectum from Because of this, routine
anal intercourse; an screening is still recom-
Symptoms inflammation of the lining mended following
About three-quarters of of the eye (“pinkeye”) if treatment.
infected women and about the bacteria is present Infected men and women
half of infected men have during birth; and a throat who have no symptoms
no symptoms, the CDC infection from oral sex may pass the bacteria on to
says. If symptoms do occur, with an infected partner. their sex partners without
they usually appear within If you notice any of the knowing it, according to the
one to three weeks after above symptoms, consult National Institutes of Health
exposure. your health care provider. (NIH). The NIH recom- Models used for illustrative purposes only.


MEN’S HEALTH

Prostate Cancer:
A Range of Treatment Options
y the time an average reader can finish this story,
B _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
treatment,” says George L.
Wright Jr., M.D., professor
of urology at Eastern
Virginia Medical School.
estimate by the American Cancer Society (ACS). The medical field has a
Mention the word Journal of the American of treating it effectively, letter and number system
“prostate” to men over 50, Medical Association what will happen if it goes for different stages and
and many will wince or ( JAMA) found that “while untreated, what will be the scope of prostate cancer,
cringe. urologists and radiation side effects of an operation identifying everything from
It brings to mind pain, oncologists do agree on a and much more. one splotch to out-of-
less-than-manly doctor’s variety of issues regarding Then ACS recommends control spreading.
office positions and a prob- detection and treatment of that you consider other fac- Understanding this sys-
ing physician’s finger in prostate cancer, specialists tors, such as your age, what tem for measuring prostate
places down under. overwhelmingly recom- lifestyle you wish to have, cancer, learning the scope external beam radiotherapy
And then there’s the mend the therapy that they whether you can live with of your prostate cancer, and and brachytherapy are
C-word: cancer. themselves deliver.” potential incontinence or considering your age and potentially lifesaving treat-
If your physician has told Ironically, almost all the sterility and what chances lifestyle are crucial to decid- ments for localized prostate
you that you have prostate specialists may be right in you’re willing to take com- ing what treatment to use. cancer in men whose nor-
cancer, you may soon face many cases, according to fortably. For example, some mal life expectancy is 10
a blizzard of treatment the study, which said that elderly men choose to have Treatments years or longer.”
options. no conclusive evidence cur- no treatment at all because The two primary treat- Other treatments include
rently backs any particular of operation dangers and ments for prostate cancer hormone therapy, chemo-
In the next 24 hours, treatment over another. lifespan issues. Other men are radical prostatectomy therapy and deferred
So how can you know with localized (in one spot) (removal of prostate) and therapy (no action taken).
prostate cancer will which treatment is best prostate cancer may feel they radiation therapy, in which The information that fol-
claim the lives of more for you? need no operation at all. radiation is beamed into lows on the above treat-
“Unfortunately, although the prostate or inserted ments comes from the
than 100 American men. Before you pick we are getting much more with a “seed” pellet National Comprehensive
a treatment proficient at diagnosing (brachytherapy, pronounced Cancer Network (NCCN),
“One of the critical issues The first thing you should prostate cancer, we are not “break-ee-ther-uh-pee”). which has gathered experts
right now in prostate can- do, according to the ACS, is very good at distinguishing The JAMA survey found from 17 of the nation’s
cer is that all these men ask your physician many the cancers that need active that “the two groups of spe- leading cancer centers to
have a big decision to make questions about the severity treatment from those that cialists largely agree that develop cancer treatment
after they’re diagnosed,” of your cancer, the chances can be followed without radical prostate surgery, guidelines for cancer care
says David Perlow, M.D., a professionals.
urologist in metro Atlanta “Cancer specialists regard
who performs mostly the NCCN treatment guide-
“seed” radiation treat- lines as the defining treat-
ments. “Frankly, many of ment standard,” says Louis
the patients I have are torn M. Weiner, M.D., chairman
by the decision.” of medical oncology at Fox
And patients will often Chase Cancer Center in
find that the specialists per- Philadelphia.
forming one treatment usu-
ally espouse that treatment Radical
over others. prostatectomy
A survey of urologists and This “gold standard” of
oncologists published in the prostate cancer treatment


“One of the critical issues right now
in prostate cancer is that all these men popular. Its side effects are an increased chance of
minimal, with claimed infection, and more.
have a big decision to make after they’re much lower rates of incon-
diagnosed. Frankly, many of the patients tinence and impotence. Deferred therapy
“If patients see a similarity The best strategy for
I have are torn by the decision.” in treatment success, they some patients is to simply
—David Perlow, M.D., urologist who performs
mostly “seed” radiation treatments.
want the ‘seeds’ to avoid “watch and wait” with care-
impotence or inconti- ful observation but no
nence,” says Dr. Perlow. immediate active treatment.
“Seeds are done as an out- This approach may be rec-
patient or during a one-night ommended if a prostate
stay in the hospital, and the cancer is not causing any
risks are much lower.” symptoms, especially if it is
Critics of this method say very small and contained to
that not enough studies one area of the prostate or
have been done thus far to expected to grow slowly.
confirm its effectiveness. Also, if a patient is elderly
or frail, or has some serious
Hormone therapy health problems, this treat-
This treatment is often ment may be an option.
used for patients whose Some men may decide that
cancer has spread beyond the side effects of more
is still the most performed. notion that a laparoscopic between 40 percent and the prostate or has recurred aggressive treatments out-
This operation removes the technique would never 60 percent of patients have after treatment. Its aim is to weigh the benefits of an
entire prostate gland and supplant open surgery for some degree of impotence reduce the levels of the male operation.
some tissue around it and is radical prostatectomy must afterward. Radiation oncol- hormone androgen, the
used most often when the be strongly reconsidered,” ogist Gerald Hanks of the main one being testosterone, Ask your physician
cancer is believed to have says Carl A. Olsson, M.D., Fox Chase Cancer Center which causes prostate can-
not spread past the prostate. of Columbia University believes a new “three- cer cells to grow. many questions about
Conventional prostatec- College of Physicians and dimensional conformal radi- Side effects of this the severity of your
tomies require incisions Surgeons in New York after ation therapy,” or 3DCRT, therapy include reduced
near the rectum or abdo- seeing French surgeons per- should replace standard or absent sexual desire, cancer, the chances of
men, and can lead to incon- form a laparoscopic surgery. radiation treatment for impotence and hot flashes. treating it effectively,
tinence (inability to control prostate patients. “It’s Some men also have breast
the bladder) and impotence Radiation therapy clearly superior,” he says. tenderness and growth of
what will happen if it
(inability to achieve erec- High-energy rays (such as “It cures more patients and breast tissue. To greatly goes untreated, what
tion because nerves were X-rays) and particles (such causes fewer complications.” reduce androgen levels, will be the side effects
cut during surgery). Normal as electrons and protons) The technology targets some doctors recommend
bladder control usually are used to kill cancer cells. the prostate directly, bypass- an orchiectomy, the of an operation.
returns within several This therapy is sometimes ing the rectum and bladder. removal of the testicles. —advice from the
American Cancer Society
weeks or months after a used to treat prostate cancer Since no other organs are The side effects are similar
radical prostatectomy but that is still confined to the affected, higher doses of to hormone therapy but
has persisted in up to 35 prostate gland or has spread radiation can be used with- perhaps more exaggerated. In the next 24 hours,
percent of men. Impotence to nearby tissue. If the dis- out serious side effects. prostate cancer will claim
can be as high as 65 per- ease is more advanced, radi- Brachytherapy uses needles Chemotherapy the lives of more than 100
cent to 90 percent, but ation may be used to reduce to insert radioactive pellets This is an option for American men.
between 25 percent and the size of the tumor. (about the size of a grain of patients whose prostate For those of you in the
30 percent when surgery The two main types are rice) into the prostate with cancer has spread outside earlier stages of the dis-
does not remove nerves on external beam radiation and the aid of imaging tests to the gland and for whom ease, the ACS and other
either side of the prostate. brachytherapy (internal pinpoint the cancer for hormone therapy has reputable cancer organiza-
A new “keyhole,” or lapar- radiation). External focuses accurate placement. failed. The anti-cancer drug tions recommend that you
oscopic, prostatectomy uses a beam from outside the The radiation dies out is not expected to destroy get the facts about your
a thin lighted tube with a body onto spots determined after several weeks or all the cancer cells, but it own condition, as well as
camera and surgical instru- beforehand precisely by spe- months, and the pellets are may slow tumor growth determine your own state
ments on the end to reduce cialists. A small percentage allowed to remain harm- and reduce pain. This of mind while you assess
“collateral” damage on the of men experience perma- lessly in the prostate. This treatment may lower blood the best treatment option
patient. “My previously held nent incontinence, and therapy is becoming more cell counts, resulting in among many. I


Make the most
of the changes
in Medicare.

Obtenga el
mayor beneficio
posible de los
cambios en
Medicare.


Many people are confused by the changes in Medicare this affordable monthly premiums and low co-payments for
year. But all you have to do is keep your Brown & Toland hospital stays when medically necessary. In addition, Brown
doctor to make the most of the new Medicare. & Toland’s Medicare Advantage plans include prescription
Brown & Toland contracts with two Medicare Advantage drug coverage, which offers a choice between brand-name
plans, Health Net’s Seniority Plus and PacifiCare’s Secure and generic prescriptions included in the plan’s formulary.
Horizons. Each includes a rich prescription drug benefit. All of this for one low monthly premium.
When you choose one of these plans, you’ll enjoy great These are just some of the reasons why we encourage
benefits, keep your Brown & Toland doctor, and have access people with Medicare to learn more about Medicare
to San Francisco’s best hospitals. Advantage and the Brown & Toland Medical Group by
Brown & Toland doctors are San Francisco’s finest group attending an informational meeting. To receive a list of
of primary and specialty care physicians. Dedicated to pro- upcoming Medicare Advantage meetings, please
viding you with quality health care, Brown & Toland physi- call 1.866.488.7088.
cians understand the time-honored doctor–patient
relationship.
By choosing a Medicare Advantage plan, you’ll enjoy

Muchas personas están confundidas por los cambios que se han hospital cuando éstas sean médicamente necesarias. Adicionalmente,
dado en Medicare este año. Pero todo lo que usted tiene que hacer los planes de Medicare Advantage de Brown & Toland incluyen la
es conservar a su médico de Brown & Toland para obtener el cobertura de fármacos con receta médica que ofrece la elección entre
mayor provecho de Medicare. fármacos comerciales o genéricos con receta médica que se encuen-
Brown & Toland tiene contrato con dos planes Medicare tran en el formulario del plan. Todo esto por una prima mensual
Advantage, Health Net’s Seniority Plus y PacifiCare’s Secure razonable.
Horizons. Cada uno incluye un amplio beneficio de fármacos Éstas son algunas de las razones por las que animamos a las
con receta médica. Al escoger uno de estos planes disfrutará de personas con Medicare a asistir a una reunión informativa para
grandes beneficios, podrá continuar con su médico de Brown & que conozcan más sobre Medicare Advantage y el Grupo médico
Toland y tendrá acceso a los mejores hospitales de San Francisco. Brown & Toland. Para recibir una lista de las próximas reuniones
Los médicos de Brown & Toland pertenecen al mejor grupo de de Medicare Advantage comuníquese al 1.866.488.7088.
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

1.866.488.7088.


HEALTHY SENIORS

Staying Connected Is the
Key to Avoiding Loneliness

L
oneliness is one of the most A hidden enemy?
Unfortunately, recognizing this enemy isn’t as easy as we
formidable obstacles to health might think.
and quality of life for the nearly “Loneliness is not what most people think it is, and that’s
why many seniors don’t see the warning signs soon enough
35 million Americans age 65 to head off disaster,” says Marcia Ory, Ph.D., M.P.H., profes-
or older. As more of us join that gen- sor and director of the Active for Life program at Texas A&M
University.
eration — which statisticians predict With loneliness, says Dr. Ory, a person “disconnects
will double to 70 million by 2030 — socially from the world around them, isolating themselves
from involvement with people.” Living alone isn’t part of
the threat of loneliness will grow. every case.

It’s a way of life
SIX WAYS TO AVOID LONELINESS “We assume that an 80-year-old woman living by herself in
an apartment must be lonely, yet she may have plenty of pos-
Get advice. Seek suggestions on making your itive social interaction with others outside the home,” Dr. Ory
senior years the good years. Go to such organiza- says. “At the same time, we think that a 70-year-old man liv-
tions as the AARP or peer groups of seniors look-
ing with his son’s family cannot be lonely, yet he spends all
ing out for each other.
Get connected. Rebuild a broken social network,
day in front of the TV set and shuns all social activities.”
or create a new one if old friends aren’t readily It’s how you live that makes you lonely, adds Carol Ryff,
available. Seek out social groups or activities for Ph.D., director of the Institute on Aging at the University of
seniors at your place of worship, community cen- Wisconsin–Madison. “Our research, and that of others who
ter or local recreation department, for example. “Don’t wait for others to study the social habits of the elderly, shows that seniors
outreach to you; get to them first,” says Roy F. Baumeister, Ph.D. who are ‘socially integrated’ — in other words, connected
Get involved. Draw on your years of experience or your wealth of free to others in an active, positive way — are in better health,
time to benefit someone else. “Teach a class, mentor in the public retain more mental sharpness, and in general live longer
schools, volunteer to help the needy — but give of yourself,” says Carol than those who become ‘social recluses.’”
Ryff, Ph.D. “You don’t just get the reward of making a difference in some-
one’s life; you get the bonus benefits to your mental and physical health
Prone to isolation due to changes
gained with improved self-worth, fulfillment and purpose.”
Get active. Take a walk, ride a bike, study tai chi or join a ballroom danc-
Seniors are more likely than younger people to experi-
ing group. The activity doesn’t matter as long as you get up and move. ence changes that, if not handled properly, can isolate
Research shows a correlation between regular exercise and a better them. Examples include:
quality of life. “And those who exercise are less prone to loneliness Health problems that reduce or bar mobility
because they are likely to be interacting with others when they work The death of a spouse, relative or close friend
out,” says Dr. Ory. A drastic change in routine, especially to a boring or
Get educated. Go back to school. Communities, colleges and organiza- inactive lifestyle after retirement
tions offer learning opportunities for seniors in everything from agricul- Loss of contact with family or
ture to zoology. “Programs such as Elderhostel and the Plato Society friends who move or have less time
encourage ‘life-long learning’ to keep one’s mind and one’s spirit bright,”
Dr. Ryff says.
Even worse is loneliness that
Get online. Reap the benefits of the information revolution. A computer
class can teach you the latest technology. “The Internet is a wonderful
results from a deeper problem.
means of social communication and interaction, especially for those Lack of involvement in life as a whole (not just social activ-
seniors who are not mobile,” Dr. Baumeister says. “It’s hard to feel lonely ities) may signal depression, says Roy F. Baumeister, Ph.D., a
when you can virtually visit the Sistine Chapel or play chess with a new- Case Western Reserve University social psychologist. “You have
found friend in Australia.” to treat the depression first before you can have any hope of
returning them to normal relationships with others.” I


BENEFITS FOR SENIORS

Make Medicare Work for You
Understanding the
Changes in Medicare

A
s of Jan. 1, 2006, Medicare speaking, all covered services, including prescriptions,
are included in the monthly premium.
prescription drug coverage Medicare Advantage plans offer tremendous value and
is available to everyone coordination of care.

with Medicare. One of No. 3: Who needs to enroll?
the best ways to enjoy the added If you’re not covered through an employer or union, you
may want to consider enrolling in a Brown & Toland con-
benefits offered by Medicare is to tracted Medicare Advantage prescription drug plan. Brown
join a Medicare Advantage plan. & Toland contracts with two Medicare Advantage plans –
Health Net Seniority Plus and PacifiCare’s Secure Horizons
Let’s break down the changes in Medicare by the num- — and each includes a rich prescription drug benefit.
bers. This article will cover the following: The election period for designating a Brown & Toland
1. Can I combine affordable benefits, great doctors and Medicare Advantage plan ends May 15. If you choose not
great hospitals? to enroll in a Medicare drug plan by May 15, you may
2. What are my plan choices? enroll at a later date, but there will be a penalty. Medicare
3. Who needs to enroll in a plan? is encouraging everyone to enroll, even if you seldom
need prescription drugs. Brown & Toland also recom-
No. 1: Combine comprehensive benefits, great mends that all Medicare beneficiaries seriously consider
doctors and respected hospitals. enrolling in a prescription drug plan, such as one offered
With a Medicare Advantage plan, you’ll have easy access through a Medicare Advantage plan. Fact is, you may need
to the Brown & Toland physician network, arguably San prescription drug coverage as you age, so now may be the
Francisco’s finest group of primary and specialty care best time to get affordable prescription drug benefits.
physicians. Choosing this health care option also gives Whatever your situation, take a few minutes to learn
you access to San Francisco’s best hospitals, including more about your options. You may call 800.MEDICARE
California Pacific Medical Center, the University of to learn all the options you have. We also encourage
California–San Francisco, St. Mary’s Medical Center, people with Medicare to learn more about Medicare
Saint Francis Hospital and St. Luke’s Hospital. Advantage and the Brown & Toland Medical Group by
With a Medicare Advantage plan, you may choose from attending an informational meeting. I
among hundreds of Brown & Toland primary care doc-
tors and have easy access to a Brown & Toland specialist.
Plus, you’ll enjoy many advantages, including affordable To learn more about
monthly premiums, low co-payments for doctor office
visits, and low co-payment hospital stays when medically
Medicare Advantage
necessary. In addition, a Medicare Advantage plan and Brown & Toland,
includes excellent prescription drug coverage as part of please call 866.488.7088.
the affordable monthly premium. These plans also pro-
vide a choice between brand-name and generic prescrip-
tions that are included in the plan’s formulary.

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


Free Seminar by Pacific Eye Specialists
at St. Mary’s Medical Center
Spend your morning learning more about taking care of Common Eye Diseases
your vision. Don’t miss presentations from Brown & Toland
in the Senior Population
physicians Bernd Kutzscher, M.D., Lee Schwartz, M.D., and
Michael Hee, M.D., of Pacific Eye Specialists on health Date: Saturday, March 25, 2006
topics such as: Time: 10 a.m. to 1 p.m.
G Cataracts and new technology

in cataract surgery Place: St. Mary’s Medical Center
G Glaucoma prevention and 450 Stanyan St., San Francisco
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.

Call Brown & Toland at 866.488.7088 to reserve your seat today.

PRSRT STD
U.S. POSTAGE
The Doctors Behind Every Good Health Plan PAID
P.O. Box 640469 Effingham, IL
San Francisco, CA 94164-0469 Permit No. 148

Cultivating Good Health

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