Mills-Peninsula Health Services

It’s Time to Get the Care You’ve Been Waiting For

Posted on Jun 18, 2020 in Affiliates, Alta Bates Summit Medical Center, Mills-Peninsula Health Services, Quality, Safety, Scroll Images, Uncategorized, Wellness, Women's Services

OAKLAND, CALIF. — California is slowly reopening, but like so many unknowns with COVID-19, it’s unclear how long our return to routine will last.

“A surge in virus spread and infected patients could occur this fall or winter,” says Bill Isenberg, M.D., chief quality and safety officer for Sutter Health. “If this happens, and overlaps with the normal flu season, there could be a significant strain on healthcare services.”

With this in mind, medical experts agree that if you had an appointment postponed or canceled due to COVID-19, now is the time to reschedule it.

Norma Lester-Atwood, RTRM, is a mammographer at the Carol Ann Read Breast Health Center at Alta Bates Summit Medical Center in Oakland, so she’s well-versed in the importance of catching breast cancer early. Lester-Atwood is typically right on schedule for her own mammogram, but this spring, shelter-in-place orders delayed her mammogram by two months. As soon as she could, she had the screening procedure and she’s glad she did, because her mammogram and a subsequent biopsy revealed a Stage 0 (non-invasive) tumor in one of her breasts. After a lumpectomy to remove the tumor, Lester-Atwood feels she is well on her way to recovery.

“As a mammographer, I’ve always told my patients that it’s important to come in every year for a mammogram because I’ve seen patients who developed fast-growing tumors between screenings,” says Lester-Atwood. “And now because of my personal experience, I’ve seen the other side of the coin and I have even more reason to encourage patients to get their regularly scheduled mammograms.”

Timing is Everything
As Lester-Atwood’s experience shows, timing is everything when it comes to staying healthy. Getting cancer screenings at the recommended intervals can help spot early signs of abnormal cell division or tumor growth before it turns into advanced cancer.

Public health department-mandated cancellation of elective procedures and many routine appointments earlier this year caused many screenings to be delayed, which may, unfortunately, have serious repercussions for some people.

Because of the importance of cancer screenings to maintaining good health, Sutter-affiliated clinicians track annual completion of mammograms, says Isenberg. “We estimate that of every 200 mammograms, one patient’s is suspicious for breast cancer and needs further attention. Because so far to date 4,000 – 5,000 people have postponed mammograms, that means approximately 20-25 cancers may have gone undiagnosed.”

The 0.5 percent detection rate for mammograms is roughly the same for colon and cervical cancer screening, says Isenberg, so similar undiagnosed cancers are likely for these diseases. “Mammograms and screenings for other cancers such as skin or prostate cancer, as well as preventative care are all important to keep on top of,” he says. “And although we often think of cancer as a disease that people get at a later stage in life, cancer can strike at any age. In fact, some hormone-sensitive cancers grow more rapidly in younger patients, so having regularly scheduled Pap test or mammograms can be lifesaving.”

“Some women don’t realize that mammograms are needed regardless of your family history, because most women with breast cancer have no family history or other identifiable risk factors,” says Harriet B. Borofsky, M.D., medical director of breast imaging with Mills-Peninsula Medical Center in San Mateo, Calif., part of the Sutter Health not-for-profit integrated network of care.

Screening for colorectal, prostate and lung cancers are also vital. “Simply put, screening saves lives,” says Borofsky. “Delayed screenings can postpone detection of cancer, which may translate into needing more intensive treatment and a more difficult path for patients.”

Taking Steps to Protect Patients and Staff
Catching up on care is one of the most important things you can do to protect your health. All Sutter imaging centers have resumed some level of cancer screening services, or are preparing to resume soon, and each has taken steps to protect patients and staff from exposure to viruses. These steps include:

Mandatory Masking – Staff, patients and visitors must wear masks at all times.
Isolation – Anyone with COVID-19 symptoms is isolated from waiting areas, patient rooms, entrances and spaces the general population uses.
Cleaning – Our teams have increased the frequency of cleaning and disinfecting in all spaces.
Screening – Everyone is screened for signs and symptoms of COVID-19 before entering our care.
Contact-Free Check-In – Skip the front desk and check in from your mobile device at some locations through Hello Patient, a new feature on My Health Online.

These protocols apply to all visits to our outpatient care centers, including scheduled office visits, radiology, lab and walk-ins to Urgent Care.

Resources to Help with Health Insurance Disruption

Health insurance coverage can be disrupted by wage or job loss, but there are options that provide access to important cancer screenings, even if you’ve lost your normal source of coverage.

In California, the Every Woman Counts program covers mammograms and cervical cancer screening for women with no or limited insurance who meet other eligibility criteria. To learn more, patients can call 1(800)-511-2300.

Other options include extending employer-based coverage through COBRA and CalCOBRA, shopping for plans and applying for premium assistance through Covered California, or applying for and qualifying for Medi-Cal. Charity care and financial assistance options may also be available. You can learn more about these options by visiting sutterhealth.org/coverage-options.

Stroke and Heart Attack Rapid Response: Timing is Everything!

Posted on May 13, 2020 in Affiliates, Alta Bates Summit Medical Center, Mills-Peninsula Health Services, Scroll Images, Uncategorized

May is National Stroke Awareness Month

If you or a loved one is experiencing a medical emergency, call 911 or visit your nearest emergency room.

SAN FRANCISCO –Fear of exposure to COVID-19 shouldn’t keep you away from the emergency department – especially if you’re experiencing signs of stroke or heart attack.

Sutter emergency departments have COVID-19 precautions in place and the capacity to treat those in need. Safety measures include masking patients; keeping patients with COVID-19 symptoms away from common waiting areas, entrances and other patients; arranging for environmental service staff to perform extra cleaning and disinfecting; visitor restrictions (with a few exceptions) and requiring all staff to have their temperature taken before each shift. (Read more here.)

Each year, thousands of people come to Sutter emergency departments with stroke or heart attack symptoms.

David Tong, M.D., director of the Mills-Peninsula Medical Center Stroke Program and regional director of stroke programs for Sutter’s West Bay Region said in a recent interview with The Mercury News, that as a result of people avoiding hospitals for fear of exposure to the coronavirus, some things like CAT scans or MRIs may be easier to schedule now than they were six months ago.

Time is of the essence for treatment of strokes and heart attacks in order to forestall long-term consequences.

With Stroke, Time = Brain
“For strokes in particular, the faster you treat the patient, the better the outcome,” Tong says. “This is not the time to ignore important symptoms because you’re going to miss the opportunity for treatment. We have all appropriate emergency department and hospital protocols in place to keep patients safe.”

According to the Centers for Disease Control and Prevention (CDC), an easy way to remember the most common signs of stroke and how to respond is with the acronym F.A.S.T.:

F = Face drooping: Ask the person to smile. Does one side droop?
A = Arm weakness: Ask the person to raise both arms. Does one arm drift downward?
S = Speech difficulty: Ask the person to repeat a simple sentence. Are the words slurred?
T = Time to call 9-1-1: If a person shows any of these signs, call 9-1-1 immediately. Stroke treatment can begin in the ambulance.

With Heart Attack, Time = Muscle
Experts warn “time is muscle” with heart attacks. The longer treatment is delayed, the more damage can occur to the heart muscle – and the chances for recovery decrease.

According to Brian Potts, M.D., medical director of the emergency department at Alta Bates Summit Medical Center’s Berkeley campus, the most common symptom of heart attack for men and women is pain or discomfort in the chest or in other areas of the upper body (in one or both arms, back, neck, jaw or stomach). Other symptoms include shortness of breath (with or without chest discomfort); breaking out in a cold sweat; nausea or lightheadedness.

“It’s vital to treat heart attacks as soon as possible. Our best-case scenario is a patient who comes to the emergency department as soon as symptoms begin. Many people rationalize away chest discomfort or jaw pain as a momentary digestion issue, but it’s better to be safe than sorry,” says Potts. “If you’re in so much pain or discomfort that you’re wondering, ‘should I go to the emergency department?’ the answer is probably yes.”

Coronavirus Science: Two Studies Raise New Concerns

Posted on May 5, 2020 in Carousel, Innovation, Mills-Peninsula Health Services, Palo Alto Medical Foundation, Pediatric Care, People, Research, Scroll Images, Uncategorized

Every day brings new scientific insights into COVID-19 and the coronavirus that causes it. Studies authored by Sutter Health experts examine the virus’s impact on children and diabetic adults.

COVID-19 and Kawasaki Disease

Recently, doctors began warning of a potential consequence of COVID-19 infection in children; some youngsters appear to develop an abnormal immune response that results in symptoms commonly associated with Kawasaki disease or toxic shock syndrome – two rare, but well-characterized inflammatory conditions. The first known U.S. case of Kawasaki disease possibly connected to COVID-19 was reported by Veena Jones, M.D., (lead author) and Dominique Suarez, M.D., both pediatric hospitalists with the Palo Alto Medical Foundation, part of the Sutter Medical Network.

Veena Jones, M.D.

Their six-month-old patient was diagnosed with classic Kawasaki disease, admitted to the hospital for treatment, and subsequently received a positive test result for COVID-19. The main reason for treatment in children with Kawasaki disease is to prevent further complications of the disease on the heart. The patient received appropriate treatment and has since fully recovered and has maintained normal heart function. But the case caused the doctors to question: could the COVID-19 infection have led the patient to develop Kawasaki disease?

“Our patient met the classic criteria for Kawasaki disease, so there was little doubt about the diagnosis or treatment plan,” said Dr. Jones. “But we do wonder if the COVID-19 infection could have caused the Kawasaki disease, especially because Kawasaki disease is widely thought to be triggered by an infection or an abnormal immune response to an infection.”

Dominique Suarez, M.D.

A careful review of the existing medical literature found that COVID-19 co-occurring with Kawasaki disease had not previously been reported, so the doctors decided to write up the case and submit it to the Journal of Hospital Pediatrics for publication. “Researchers still know very little about exactly why Kawasaki disease develops in some patients, so our hope was to accurately describe the novel case that we encountered and share that with the medical community to encourage further investigation and dialogue,” said Jones. In the race to understand the burden of COVID-19 on the human body this kind of early observation by doctors on the frontline can help inform future decisions around diagnosis and treatment.

COVID-19 and Diabetes

Since the start of the coronavirus pandemic many have warned that people with existing chronic illness who contracted the infection would become sicker than those without. Now, research authored by Sutter Health clinician David Klonoff, M.D. suggests that diabetes, one of the most serious chronic illnesses in the world, is strongly correlated with death among hospitalized patients diagnosed with COVID-19.

David Klonoff, M.D.

Accepted by the Journal of Diabetes Science and Technology, Dr. Klonoff’s paper represents the largest study yet reported on outcomes of patients with COVID-19 and diabetes or uncontrolled hyperglycemia. The observational study of 1122 inpatients with COVID-19 at US hospitals between March 1 and April 6, 2020, found that those with diabetes or hyperglycemia throughout their hospital stay had a four-fold greater inpatient mortality than those without diabetes or hyperglycemia. In a further subset analysis, death rates were seven-fold greater among those who did not have evidence of diabetes prior to admission, but developed hyperglycemia during their hospitalization.

The study also demonstrated that during a hospitalization for COVID-19, the presence of diabetes or hyperglycemia was associated with a longer hospital stay and slightly worse kidney function.

“I am now analyzing the same database to determine whether COVID-19 patients with diabetes and uncontrolled hyperglycemia, who were better controlled in the hospital, had better outcomes,” said Klonoff. If an association between greater survival and achieving target glycemia (following initial hyperglycemia) is demonstrated, and acted on, lives could be saved.

“These data may have wide implications for how we care for COVID-19 positive patients who experience hyperglycemia during their hospital stay or who have already been diagnosed with diabetes.”

Surprise Salute to Our Healthcare Heroes

Posted on Apr 24, 2020 in Carousel, Mills-Peninsula Health Services, People, Scroll Images, Uncategorized, We're Awesome, Year of the Nurse

BURLINGAME, Calif., — On Wednesday April 22nd the staff of Sutter’s Mills-Peninsula Medical Center received a special surprise. 

Uniformed personnel from Central County Fire Department, Burlingame Police, Hillsborough Police, San Mateo County Sheriff’s Department (Millbrae Division), and the San Bruno Police Department had come in the pre-dawn hours, with their vehicles and home-made signs, to honor our healthcare heroes.

Doctors, nurses, respiratory therapists, and others were surprised by the show of support, having had no idea that their daily bravery was going to be recognized by their community’s public safety heroes. The secret was so well kept that reactions ranged from dismay over lack of make-up, to shocked shyness, to touched tears.

Both staff arriving for their 7 a.m. start time, and the overnight crew just ending their shift, received applause and cheers for their professionalism and dedication during the COVID-19 pandemic. 

The event was made even more special by the use of signs made by children who attend the Champions Childcare program – a local daycare that reopened on March 30th with priority enrollment for the children of “essential” workers. Parents in public safety and healthcare professions are relying on Champions to care for their children while they care for the community, and having the kids involved in the surprise salute echoed the strong ties between all essential workers. 

Over 20 vehicles with lights flashing, and over 100 participants with hands clapping, honored healthcare workers in Burlingame and beyond on this uplifting and memorable morning. 

To Prevent Stroke, Start with the Heart

Posted on Feb 13, 2020 in Affiliates, Cardiac, Carousel, Expanding Access, Innovation, Mills-Peninsula Health Services, Neuroscience, Quality, Research, Scroll Images, We're Awesome, Women's Services

BURLINGAME, Calif. – Does it sometimes feel like there are butterflies in your chest? Does your heart race or skip a beat? If it’s not your crush making your heart go pitter-pat, it could be a common heart condition called atrial fibrillation or AFib for short. This Valentine’s Day, take heart and consider seeing an expert if you are experiencing these symptoms. After all, AFib dramatically increases the odds of having a life-threatening stroke.

“Stroke occurs when arteries in the brain are either blocked by a blood clot or burst under high pressure,” said Ilana Spokoyny, M.D., neurologist who cares for patients at Sutter’s Mills-Peninsula Medical Center. “So when we talk about stroke prevention, it’s natural that we emphasize how to keep clots from forming or keep blood pressure regulated—and both start with the heart.”

Heart health and stroke prevention were the focus of a recent educational event, hosted by United Airlines, and led by Sutter Health. Attendees toured Northern California’s only Mobile Stroke Unit – a specialized ambulance that has the staff and equipment on-board to start stroke treatment while enroute to a hospital – and heard from the unit’s director, Dr. Spokoyny, about two common heart conditions that increase stroke risk.

Atrial fibrillation

AFib is caused when the upper part of your heart beats out of sync with the lower half. While not usually life-threatening by itself, AFib alters the normal function of the heart which leads to the formation of blood clots in the heart. Eventually these clots are pumped out of the heart and can travel to the brain where they causes a stroke.

According to Dr. Spokoyny, nearly one in every six strokes is the result of AFib, and these strokes are often more serious. “Not only are AFib patients nearly five times more likely to suffer a stroke than those without the condition, AFib-related strokes are nearly twice as fatal and twice as disabling as non-AFib-related strokes.”

“AFib may be asympomatic or symptoms show up intermittently, and because they come and go many people don’t take them seriously,” Dr. Spokoyny explained. “We need to spread the word that you shouldn’t ignore the butterfly feeling in your chest or dismiss the occasional fatigue or shortness of breath you experience.” When diagnosed, AFib is treatable with medication or medical procedures, including surgery, to reduce your risk of stroke.

High blood pressure

High blood pressure increases the strain on blood vessels transporting blood throughout your body. When blood is routinely pumped through arteries at a higher than optimal pressure, the arteries may become weakened or narrowed, creating conditions where they burst or clog more easily.

Dr. Spokoyny reminds patients that high blood pressure is the single most important risk factor for stroke. “About three out of four people who have a stroke for the first time have high blood pressure.” High blood pressure often presents along with atrial fibrillation. The good news is that blood pressure can be managed with lifestyle changes and medications.

Expertise in action

Not-for-profit Sutter Health encourages doctors to work across specialties to ensure that patients receive high quality, coordinated care. Sutter includes sixteen Primary Stroke Centers across its integrated network.

Quelling the storms of seizures in people with epilepsy: Part 2 of a series highlighting Sutter epilepsy research

Posted on Nov 13, 2019 in Affiliates, California Pacific Medical Center, Innovation, Mills-Peninsula Health Services, Neuroscience, Quality, Research, Scroll Images, Uncategorized

Epilepsy—a neurological disorder caused by abnormal electrical activity in the brain—impacts almost 3.4 million nationwide. Despite advances in epilepsy treatment, approximately one-third of adults with the illness experience recurrent seizures. Read more to learn how Sutter researchers are uncovering new clues about how epilepsy develops and how it can be treated more effectively.

Stimulating the brain with neuromodulation

“Neuromodulation” is a technique that stimulates the brain or spinal cord with electrical pulses or chemicals. When used to treat epilepsy, the approach may be used as an alternative to traditional epilepsy surgical approaches or to work in synergy with them.

David King-Stephens, M.D., FAAN, Director of the Sutter Pacific Epilepsy Program in San Francisco, and Peter Weber, M.D., the program’s surgical director, were instrumental in the testing and U.S. Food and Drug Administration (FDA)’s approval in 2013 of one type of neuromodulation, the Responsive Neuromodulation System® (RNS) developed by NeuroPace.

Similar to a pacemaker that monitors and responds to heart rhythms, the RNS® System is a medical device implanted in the skull that monitors and responds to brain activity to help prevent seizures. The device is approximately the size of a stopwatch.    

CPMC was the highest enrolling site in the RNS® System Pivotal Study—a national, multicenter clinical trial of the RNS® System for the treatment of uncontrolled seizures in adults with epilepsy.

Peter Weber, MD“Many patients experience a 70-80% reduction in seizure frequency, and the severity of seizures is also significantly reduced,” says Dr. Weber, lead neurosurgeon at Sutter for the RNS® System clinical trial. He notes that the RNS® System plus medication-based treatment is usually, for these patients, superior to standard medical management alone.

Now, nine-years after completion of the pivotal study, follow-up data is still being collected and assessed. “Results show that, for many patients, the RNS® System led to substantial reductions in seizures, with additional benefits such as improved quality of life, cognition, and memory,” says Dr. Weber.  The RNS® System is also now available at the Sutter Sacramento Epilepsy Center.

Targeting the epicenter of epileptic seizures

To understand the nuances of a seizure, researchers study the brain cells (neurons) that misfire and cause the underlying electrical storm. When a seizure occurs, networks of brain cells involved in the seizure begin pulsing abnormally, leading to the symptoms patients experience during a seizure.

Anti-epileptic drugs (AEDs) are designed to modify the way neurons “fire” and how they communicate with each other and the brain’s network, thereby stopping or preventing seizures. AEDs are categorized by their main mechanism of action, although many of them have several actions and others have unknown mechanisms of action. Most of these medications are anticonvulsants or sedative medications.

There is currently no FDA-approved AED that targets potassium channels that help regulate the communications between neurons involved in the cascade of synaptic events that promote seizures.

A randomized, double-blind, placebo-controlled clinical trial called Xenon 1101, sponsored by Xenon Pharmaceuticals, is underway to test a new anticonvulsant that acts on potassium voltage-gated channels.

“The potassium channel is a novel area of epilepsy study and one that offers potential to prevent seizures through agents that target it,” says Dr. Laxer, principal investigator of the trial at CPMC with co-investigator Dr. King-Stephens. “Our epilepsy program is the only center in Northern California evaluating this new anticonvulsant.”

Three hundred patients will be enrolled in the Xenon clinical trial from enrolling sites across the U.S., Canada, Spain, and the UK.

Stay tuned later this month for Part 3 of this series on Sutter epilepsy research, which will include information on laser ablation surgery.

Read Part 1, which described new ways to map and monitor brain activity in people with epilepsy.

Read More