Women’s Services

Breast Cancer Survivor’s Tale of ‘Consistent, Compassionate Care’ — Even During COVID-19

Posted on Jul 23, 2020 in People, Scroll Images, Sutter Medical Foundation, Women's Services

ELK GROVE, Calif. – Pamela Randall’s breast cancer journey began with her diagnosis in June 2018.

Pamela Randall

Her physician—Joyce Eaker, M.D., who recently retired from Sutter Medical Group—called her after the cancer removal surgery with the pathology report. That’s when Randall, a global workforce consultant who lives in Elk Grove, Calif., learned the road ahead would be difficult, including a double mastectomy, 10 rounds of chemotherapy and five weeks of radiation.

“It was like she was talking to a family member,” Randall says. “What she told me was, ‘I didn’t want anyone else to call you with this news.’ I’d never heard of a doctor with that kind of commitment. She was someone to lean on, someone who was reassuring and kind.”

Mastectomy & Treatment

To help manage her appointments and clinician communications, Randall relied on My Health Online, Sutter’s online patient portal, and the medical staff who cared for her. Dr. Eaker performed her double mastectomy, while Lynne Hackert, M.D., performed the first step in her breast reconstruction, placing the tissue expanders at the time of her mastectomy.

At Sutter Cancer Center, Randall’s Sutter Medical Group oncologist, Nitin Rohatgi, M.D., “was reassuring, clear, comforting, direct and knowledgeable,” she says.

For Randall, the hardest part of the journey was undergoing daily radiation, five days a week for five weeks. But she says her Sutter Medical Foundation radiation oncologist, Carlin Hauck, M.D., understood the emotional strain and connected her with Sutter’s integrative health specialists, who taught her meditation and breathing techniques to use before every treatment.

Randall’s radiation treatments ended in May 2019. She had to wait a year before reconstructive surgery due to tissue damage caused by the radiation.

Reconstructive Surgery During COVID-19

Seeking medical treatment in the midst of the coronavirus pandemic meant taking extra steps to continue her care.

She met by video visit with her California Pacific Medical Center (CPMC) reconstructive surgeon, Gabriel Kind, M.D., who would perform her DIEP flap procedure. In a DIEP flap procedure, tissues and blood vessels are taken from the abdomen to repair areas of the breast tissue that have been severely damaged.

On instruction from her CPMC team, Randall, her son and her boyfriend received COVID tests and isolated themselves before her July 6 surgery. At CPMC’s Davies campus, where Randall’s nearly 10-hour surgery was performed, staff requested that she go to pre-op alone, without her boyfriend, to minimize any possibility of exposing patients to COVID.

“They weren’t taking any chances,” Randall says. “They were keeping COVID out of their facility. That gave me the confidence to give my boyfriend a kiss and go up alone.”

After the surgery, she spent five days in the hospital recovering. Now Randall feels like she’s getting better day by day.

During her time at CPMC, she says, several nurses confided in her that they’d had the same procedure done.

“They said, ‘I was where you are. You’re doing great. You’ve got this. You’re in good hands.’

“And I was, all the way through.”

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.

Care Team Enables Communication Solution for Laboring Mother Who Relies on Lip Reading

Posted on Jun 16, 2020 in California Pacific Medical Center, Quality, Scroll Images, Uncategorized, Women's Services

SAN FRANCISCO – When the COVID-19 pandemic began, Sutter’s California Pacific Medical Center (CPMC) put strict infection control measures in place to keep patients and staff safe. These measures included temperature screenings, masking and visitor restrictions. But while masks are crucial for slowing the virus’ spread, they can present a communication problem for certain patients. That’s why Sutter Health purchased clear face masks for those people who would have difficulties communicating otherwise.

Karma Quick-Panwala was an expecting mom, who relies on lip reading to communicate. The clear face masks allowed her to see her labor and delivery nurses’ facial cues for reassurance and encouragement.

Technology + Teamwork

“Giving birth during COVID-19 has brought new challenges—but also many opportunities,” said Yuan-Da Fan, M.D., chairman of obstetrics and gynecology at CPMC’s Van Ness campus. “We were determined to find a solution that fit Karma’s need. We wanted communication between Karma and her care team to be as seamless as possible in order to provide the best possible care to her and her baby.”

The solution? Before her due date, Quick-Panwala worked with CPMC’s staff to put into place real-time captioning, also called Communication Access Realtime Translation (CART). CART works by a stenographer translating spoken word into text that then appears in real time on a tablet screen.

When she arrived at CPMC to deliver her baby, Quick-Panwala’s care team called a captioner via the CART service. The captioner listened to the conversations happening in the labor room over speaker phone and translated the speech into text. Nearly instantly, the text appeared on a screen at Quick-Panwala’s bedside.

Seamless Communication

“Thanks to technology, the Internet and iPads, we were able to make it happen so that I could have relatively simultaneous access to speech through all the instructions, questions and answers,” said Quick-Panwala. “From the moment we arrived, everyone [on the care team] knew they needed to put on their clear mask and change the way they communicated a little bit.”

“It’s been a good experience. [The technology] helped my labor and delivery go smoothly because I was able to see, communicate and understand what was taking place in the room. Fortunately, it was a straightforward delivery. Everyone has been absolutely wonderful,” she said.

Axel Panwala arrived happy and healthy on June 10.

“We were happy to make this delivery experience a success for Karma and her husband,” said Dr. Fan. “Our staff were able to adapt to her needs and learn a new piece of patient communication and technology in the process. It was a win for everyone.”

Asit Panwala, Quick-Panwala’s husband, said, “There can be a lot of unpredictability in labor and delivery, so this communication channel was important.”

The San Francisco Chronicle featured Quick-Panwala’s story here: How clear face masks helped a Bay Area mom who’s hard of hearing give birth.

No Need to Put Off Possible Life-Saving Mammogram Any Longer

Posted on May 19, 2020 in Carousel, Expanding Access, Quality, Safety, Scroll Images, Sutter Medical Foundation, Women's Services

ROSEVILLE, Calif. — Laurie Deuschel of Rocklin received news during the COVID-19 crisis that breast cancer runs in her family, but during the first two months of the pandemic, mammograms were considered elective scans and weren’t being performed. The first week they became available again, Deuschel got an appointment.

“I’m here to have my first mammogram, and I’m a little bit scared,” she said, but she wasn’t scared about catching the novel coronavirus while at the Sutter Imaging center in Roseville Monday, May 18.

Why? “Sutter Imaging knows the cleaning procedures and how to keep me safe,” she said.

Sutter Health is going to great lengths to protect its patients and staff in the COVID-19 era. It has created a “new normal” for its imaging centers, focused on a “safety strategy” that is incorporating guidance from the national Centers for Disease Control, California Department of Public Health and the American College of Radiology. Some of those measures include:

  • Temperature screening of all staff, doctors and patients at the door,
  • Universal masking,
  • Social distancing in waiting rooms (patients can wait in their cars if they prefer),
  • Screening patients at the time of scheduling and arrival for symptoms,
  • Deeper cleaning of equipment after every patient,
  • Regular sanitization of chairs and door handles,
  • Thorough wipe-downs of patient lockers and dressing rooms with a “Cleaned” sign placed for patients and staff to know those areas have been disinfected,
  • Regular audits or “double checks” with staff to ensure that the new procedures are being followed. 

Miyuki Murphy, M.D., the director of breast imaging for Sutter Medical Group, was interviewed for a story on the Sacramento NBC affiliate KCRA, Channel 3. Dr. Murphy explains why not delaying your mammogram is important, and the story includes video of some of the safety measures being taken at Sutter Imaging. Click here for that story on their website.

Dr. Miyuki Murphy on KCRA about the safety of mammograms at Sutter Imaging.

Pregnancy, Birth and COVID-19: What to Expect When You’re Expecting

Posted on Apr 2, 2020 in Affiliates, Scroll Images, Women's Services

SAN FRANCISCO – Pregnancy can often be filled with a lot of questions. Parents welcoming babies into the world right now face an unusual new set of fears. Health experts are reassuring expectant mothers and answering key concerns about pregnancy amid the COVID-19 pandemic.

“Above everything, we don’t want moms to worry. Our teams are going to take good care of both mom and baby,” says Yuan-Da Fan, M.D., department chair of obstetrics and gynecology at Sutter’s California Pacific Medical Center in San Francisco.

Pregnant mom using digital technology

Pregnancy Best Practices

Common sense hygiene—even when there isn’t a novel coronavirus among us—is the best way to avoid getting sick. Dr. Fan says that precautions are the same for pregnant women. He advises expectant mothers to, “wash your hands for a full 20 seconds as often as possible, and routinely clean and disinfect frequently-touched objects and surfaces.”

Katarina Lannér-Cusin, M.D., administrative director of Women’s Services at Sutter’s Alta Bates Summit Medical Center in Berkeley, encourages pregnant women to “limit in–person social interaction and remain at home to avoid potential exposure to COVID-19.”

“If you’re pregnant and you are experiencing potential COVID-19 symptoms, such as a high fever (greater than 100.3), sore throat and dry cough, contact your primary care physician to see if you should have testing done,” says William Isenberg, M.D., OB-GYN and VP, chief quality and safety officer at Sutter Health.

Preparing for Birth

“Staying positive is the best thing for pregnancy,” says CPMC’s Dr. Fan. Anxiety isn’t good for anyone—but especially expectant mothers. Click here for tips on limiting anxiety from a Sutter mental health expert.

Additionally, pregnant women should engage in frequent communication with your OB-GYN as your pregnancy progresses. Talk to your care team about your options for virtual appointments like video visits through My Health Online as well as taking childbirth classes via online platforms such as YouTube, Zoom, and Skype.

The Big Day Arrives: What to Expect at the Hospital

Labor and delivery units across the Sutter Health not-for-profit network of care are putting measures into place aimed at keeping expectant mothers and their newborns safe. Sutter hospitals have also instituted temperature checks for all visitors and staff before entering any of the facilities.

William M. Gilbert, M.D., regional medical director for women’s services, Sutter Health Valley Region in Sacramento, wants to let all patients know that Sutter is following all recommended procedures to keep our mothers and their babies safe even if this may mean some inconveniences for our families. Limiting numbers of visitors is just one example to help prevent COVID-19 infection.

“This is an unprecedented situation and our top priority is to protect the health of mothers and newborns. So, for safety’s sake, laboring mothers are allowed one support person, such as a spouse or partner, to accompany them to the delivery room and remain postpartum. The support person must be healthy and thoroughly wash their hands,” says Alta Bates Summit’s Dr. Lannér-Cusin. “We’re also encouraging new parents to use technology like FaceTime to connect with friends and family after the baby is born.”

For pregnant moms who have tested positive for COVID-19 or who are considered a “person under investigation” when you go into labor, you’ll likely be placed in a negative pressure room, where the ventilation system is sealed off from the rest of the facility, and physicians and staff wear additional personal protective equipment.

Positive New Research

According to Dr. Fan, who has consulted with colleagues in Wuhan, China, by Skype, early research shows that pregnant women may be at no greater risk for contracting COVID-19 than other healthy adults. In smaller recent studies completed since the outbreak began, Dr. Fan says doctors in China found that no infants born to mothers with COVID-19 tested positive for COVID-19 viral infection. Additional cases showed the virus was not passed to newborns from their mothers’ amniotic fluid or breastmilk (Lancet study here).

Postpartum Support

Giving birth during a pandemic isn’t ideal and it’s important to be realistic about what to expect.

“Consider building your virtual village to keep yourself connected,” says Dr. Isenberg.

After your baby is born, talk to your provider about what appointments can be done virtually—for you and your baby. Explore new ways to connect. For example, if you were preparing to go to ‘mommy and me’ classes after your new baby arrives, you may want to investigate virtual meet-ups up via Google Hangouts with other new moms in your area. Remember, staying connected through a screen is better than total isolation, especially if you were planning on having a family member stay with you during your first few weeks post-partum to help care for you and your new baby.

For more information about COVID-19, please visit Sutter Health’s resources page.

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.