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FALL 2006

Adopt a Healthful Lifestyle

Simple Changes Yield Great Benefi ts

Breast Cancer Reduce Your Risk

For Seniors Prevent Complications From Diabetes

Brown & Toland’sBrown & Toland’s

HealthLinkHealthLinkA Wellness Magazine for the San Francisco Bay Area

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

PREVENTION

Vaccinate, Don’t Vacillate: New Vaccine Prevents Cancer in Womenby Mark Finch, M.D., Senior Medical Director, Brown & Toland Medical Group

Following on the heels of the FDA license, the Advisory Committee on Immunization Practices (ACIP), a group that advises the Centers for Disease Con-trol and Prevention on indications for vaccines, recommended that all 11- and 12-year-old girls receive the vaccine routinely and that girls as young as 9 and between the ages of 13 and 26 be offered the vaccine.

The ACIP selected 11- to 12-year-old girls for routine vaccination because the vaccine is most effective in preventing cervical cancer when given to girls before the onset of sex-ual activity. The vaccine is given in three shots over a six-month period. The vaccine is extremely safe, does not contain any live virus and has no seri-ous side effects. A small percentage of

patients experience slight soreness at the injection site.

Young women who are vaccinated may still be at risk for cervical cancer, albeit much reduced. Thus, they still need to have regular Pap tests as recommended by the American College of Obstetrics and Gynecology and their physician.

If you, your loved ones or friends have a daughter in the recommended age group, encourage them to speak with their physician about getting this vaccine. All of the major health plans are or soon will be covering this vaccine for young women in the target age group. Additional informa-tion is available online at: www.cdc.gov/nip/vaccine/hpv/default.htm. ■

4 Healthy Living Simple lifestyle changes

reduce your risk for heart disease.

6 Women’s Health Mammograms and

regular checkups lead to early detection of breast cancer — and more successful treatment.

9 Diabetes Care People with diabetes

have a higher risk for vision disorders. Learn how to preserve your sight.

HealthLinkFall 2006

Brown & Toland’s HealthLink editor: Richard Angeloni, Associate Vice President, Public Relations and Communications, Brown & Toland Medical Group, 415.972.4307. 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 newsletter are written by professional journalists or physicians who strive to present reliable, up-to-date health information. Our articles are reviewed by medical professionals for accuracy and appropriateness. No magazine, however, can replace the care and advice of medical profes-sionals, 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 illus-trative purposes only. (306)

STAYING HEALTHY

I n June, the U.S. Food and Drug Administration (FDA) licensed a new vaccine, Gardasil (quadrivalent human papilloma virus recombinant vaccine), which prevents 90 percent

of the most common sexually transmitted infections (STI), human papilloma virus (HPV), and 70 percent of cervical cancers. HPV is responsible for 6.2 million new cases of STI, 10,000 cases of cervical cancer and 3,000 deaths each year in the United States.

The Advisory Committee on Immunization Practices, a group that advises the Centers for Disease Control and Prevention

on indications for vaccines, recommended that all 11- and 12-year-old girls receive the vaccine routinely.

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

“So the shot that protects you one year won’t necessarily protect you the next,” says Suzanne Bradley, M.D., associate professor of internal medicine at the University of Michigan. Scientists track mutations of the virus and develop new vaccines against it.

The fl u can be deadly in older individuals and those with chronic illnesses. Changes in your immune system increase your chance of getting it, and the fl u’s effects can be especially severe if you have a chronic lung or heart condition. “The fl u vaccine is 90 percent effective in preventing deaths and 80 percent effective in preventing hospitalizations,” Dr. Bradley says. “If everyone who should have one got one, it would save lives.”

Your body can take weeks to respond to the vaccine. “That’s why it’s important

to ask for a shot in October or Novem-ber, before the fl u season starts,” says Dr. Bradley. “But even if you miss your shot in the fall, you should still get one as late as February if there is an out-break in your area.”

The shot doesn’t guarantee you won’t get sick, nor will it protect you against other respiratory diseases, Dr. Bradley says, “but it’s important to remember that the fl u kills — colds don’t.”

Warding off pneumoniaImmunization also can lower the risk

for pneumonia. Many kinds of bacteria can cause pneumonia, and the vaccine won’t protect you against all of them. But if you are over 65, talk with your doctor about when to get the shot and when to get a booster, because it can protect you against a number of them.

Dr. Bradley says getting a pneumo-nia shot is even more important today. When bacteria cause pneumonia, “we use antibiotics to treat it. Some of the bacteria are becoming resistant. So you really gamble if you don’t get the shot. There’s a chance that the medicine won’t work” if you wait until you have pneumonia.

Viruses also can cause pneumonia. There is no immunization against those types of pneumonia, which don’t respond to antibiotics. ■

F lu shots are important because the virus that causes the fl u changes constantly, and a new strain appears almost every spring.

Why Flu Shots MatterPREVENTION

Brown & Toland’s Patient Bill of Rights Patient RightsThe 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 benefi t options

Access to preventive health care services Information about benefi ts, where and how to seek care, and the risks involved in treatment

Timely response to requests for services, inquiries and complaints

Second opinions when medically appropriate Titles and specialties of the health care professionals responsible for your care

Privacy and confi dentiality regarding your medical and health conditions

Information regarding the medical group and health plan grievance procedures

Recognition of your rights to make decisions regard-ing your medical care and to complete an advance directive, thereby extending your rights to any per-son who may make decisions on your behalf regard-ing your medical care

The right to make recommendations to your patient rights and responsibilities

Patient ResponsibilitiesAs your health care partner, we ask that you:

Provide professional staff with all health care infor-mation needed to ensure the best possible outcome

Communicate with your primary care physician when you have questions or concerns about your health care

Adhere to instructions and guidelines given for health care services

Cooperate with health care professionals providing service to you, except in those instances when you have exercised your right to refuse service

Educate yourself on your health benefi ts and services and how to correctly obtain themIf you have questions about your benefi ts, call

Brown & Toland Medical Group’s Customer Service Department at 415.972.6002, or your health plan’s member services division. ■

The California Department of Managed Health Care is respon-sible for regulating health care plans. The department has a toll-free number (888.HMO.2219) to receive complaints regarding health plans. If you have a grievance against a health plan, you should contact the health plan and use the plan’s grievance pro-cess. You may call the California Department of Managed Health Care for assistance with an emergency grievance or a grievance that has not been satisfactorily resolved by the plan.

The fl u vaccine is 90 percent effective in preventing deaths and 80 percent effective in preventing hospitalizations. If everyone who should have one got one, it would save lives.

— Suzanne Bradley, M.D., associate professor of internal medicine,

University of Michigan


HEALTHY LIVING

Making Your Lifestyle Heart-Healthy

“While it’s certainly necessary to take medications to lower high cholesterol or blood pressure, it’s equally important to have a healthy lifestyle,” says Richard Stein, M.D., chief of the department of medicine in the Singer Division at Beth Israel Hospital in New York City, and a spokesman for the American Heart Asso-ciation. “People who are informed and proactive when it comes to lowering their health risks are very likely to avoid heart disease and heart attacks.”

By following these recommendations, people at normal risk for heart disease can reduce their risk and make their lives more enjoyable.

Eat a healthful dietEating a healthful diet has been proven

to reduce the risk for heart disease.To eat a heart-healthy diet:

Eat 2 cups fresh fruits and 2½ cups of vegetables every day. Limit saturated and trans fats by using olive oil or other vegetable oils instead of butter or margarine. Eat more chicken and fi sh and less red meat. Eat 6 ounces of grains, of which at least 3 ounces should be from whole-grain bread and cereal. Limit or eliminate fast foods, which are often loaded with salt, sugar and fats. If you drink alcohol, do so moderately — no more than two drinks a day if you’re a man, one if you’re a woman. Limit your salt/sodium to 2300 mg per day or less.

Get the equivalent of 3 cups of fat free or low-fat milk or dairy products.

Exercise moreRegular exercise keeps your heart and

the rest of your body in shape.To add more activity to your life:

Check with your doctor before start-ing an exercise program if you’ve been sedentary and/or have a chronic disease. Start slowly and increase your activity gradually to a total of 30 to

60 minutes of moderate exercise most days of the week.

Do weight training and stretching exercises several times a week.

Stop smokingSmoking is a major risk factor for

heart disease.To live smoke-free:

Decide to quit and set a quit date. Try again if you fail. Successful quitters have “quit” an average of nine times.

While it’s certainly necessary to take medications to lower high cholesterol or blood pressure, it’s equally important to have a healthy lifestyle.

— Richard Stein, M.D.

T he millions of Americans diagnosed with heart and cardiovascular diseases can benefi t from

making healthful choices in their day-to-day lives.

Eating a healthful

diet will reduce

the risk for

heart disease.


Ask your doctor for information about cessation aids, such as a patch, inhaler and counseling or support program.

Monitor your healthBe proactive when it comes to your

heart’s health. To do so, work with your health care provider to reduce your heart disease risk by following up with him or her for treatment for high blood pressure and cholesterol levels.

“Denial is the number one risk factor for having a heart attack,” says Dr. Stein. “Call 911 immediately if you have chest pain if you’re a man, or are short of breath, dizzy and have a burning sensation in the chest area if you’re a woman. If you can get to a hospital in the same hour these symptoms start, it’s possible to prevent a heart attack or limit the damage.” ■

RAISING AWARENESS

Walking the Talk: Brown & Toland Employees Join in Heart Walk 2006

On Sept. 15, employees from various departments within Brown & Toland Medical Group descended upon Justin Herman Plaza in San Francisco to

walk in support of research and education for heart disease.The American Heart Association’s annual Heart Walk raises more than

$1 million nationwide to fund research and educational programs to help reduce risk, disability and death from the nation’s number one and num-ber three killers: heart disease and stroke.

Brown & Toland employees were enthusiastic about the walking chal-lenge, which dovetailed well with the medical group’s lunchtime “Walk This Way” program. Twice each week, employees are encouraged to join in half-hour and hour walks around the South of Market area.

“Heart Walk gave our walking program one more goal for the year,” says Brown & Toland Walk This Way committee member Ann Hardesty. “Walking at lunch is something many of our employees enjoy, and we used the Heart Walk as an opportunity to train and recruit more members into our program.”

Employees formed teams to raise money for the Heart Walk, and train-ing took place during the lunchtime walks around the Embarcadero and AT&T Park.

“We wanted our team to be prepared and ready to make a splash at the Heart Walk,” says Hardesty. “It was a great day for all Brown & Toland employees. We were proud to be part of the San Francisco community, raising awareness and making an impact.”

With its own comprehensive disease management program for con-gestive heart failure, Brown & Toland strives to help its members man-age their health and avoid hospitalization. For more information on this free program, go to www.brownandtoland.com and click on “Our Medical Services.” ■

We were proud to be part of the San Francisco community, raising aware-ness and mak-ing an impact.

Ann Hardesty, Brown & Toland

Walk This Way committee member

LEARN TO RELAX

Chronic anger and stress can damage your heart. To better cope with life’s pressures:

Try to be positive instead of negative in your outlook on life. Take 15 to 20 minutes a day to sit quietly and breathe deeply. Take time for yourself each day. Read a book, listen to music or enjoy a hobby.

Brown & Toland employees formed teams to raise money for the Heart Walk. Training took

place during lunchtime and included walks around the Embarcadero.


WOMEN’S HEALTH

Reduce Your Risk for Breast Cancer

You may think that the only news about breast cancer is bad news. Although more women die

of it than from any other cancer except lung cancer, there also is good news. If you fi nd breast cancer early, you can get treated more successfully.

Research also shows that making some lifestyle changes, such as exercising more and cutting down on alcohol, can reduce the risk for breast cancer.

Are you at risk?If you are a woman, you are at risk

for breast cancer, and your risk increases as you get older. Some factors, such as having a close relative (for example, a mother or sister) who had breast cancer or having had it yourself in the past, increase your risk. Having your fi rst child after age 30 also can make your risk slightly higher.

Another risk factor for breast cancer is being obese or overweight, the American Cancer Society says. This is especially true for women after meno-pause. The Society says that although your ovaries produce most of your estrogen, fat tissue in your body can change other hormones into estrogen. Higher estrogen levels increase your risk for developing breast cancer. The link between weight and breast cancer risk is complicated: Women who have been overweight since childhood have less of a risk than women who gained extra weight as adults. Excess fat tissue around the waist increases the risk more than extra fat on the hips and thighs.

Some studies of dietary fat and breast cancer risk have found that women with diets low in saturated fat and total fat have less of a risk. Other studies have not found any connection between dietary fat and breast cancer risk.

Many women who get breast cancer have no family history of the disease and no known risk factors for breast cancer.

What can you do? Take action: Have mammograms and breast exams performed by your doctor, and develop healthy habits. Schedule a checkup with your doctor every year. Discuss when you should get a mammogram, a special X-ray that can show breast cancer. Mam-mograms can detect cancer sooner than you or your doctor can feel it. At your checkup, your doctor should also do a manual breast exam. Develop healthy habits. Exercise has many benefi ts, such as lowering high blood pressure, keeping your heart healthy and lowering your chance for stroke. And research shows that it may help prevent breast cancer. Smoking and drinking alcohol may also increase your risk for breast cancer. The Society says

that women who consume one alco-holic drink a day have a very small increase in risk, and those who have two to fi ve drinks daily have about 1½ times the risk of women who drink no alcohol. Team up with your doctor. Your doctor can help you stop smok-ing or drinking, and lose weight if you are overweight.Also, talk with your doctor if you

take birth control pills or are on hor-mone or estrogen replacement therapy. HRT and ERT may help relieve meno-pausal symptoms and help prevent osteoporosis, but they increase other health risks. Talk to your health care provider to fi nd out what is best for you.

The thought of cancer can be scary, but knowledge and action can help you stay in charge of your life and health. ■

Many women who get breast cancer have no family history of the disease and no known risk factors for breast cancer.

A mammogram is a special X-

ray that can show breast cancer.

Mammograms can detect can-

cer sooner than you or your doc-

tor can feel it.

Research

shows that

exercise may

help prevent

breast cancer.


IN THE COMMUNITY

The event, which drew more than 100,000 runners, walkers and other participants, converged on the Embar-cadero Ferry Place on Sept. 24. Teams, individuals, friends and family raised money to walk in solidarity to help bring awareness to the third leading cause of death for women.

Money raised by the Susan G. Komen Breast Cancer Foundation supports research, education, screenings and treatment. According to race organizers, 75 percent of all funds raised directly impact local community organizations. Last year, the Race for the Cure helped fund a program for free breast cancer screening and mammography services for uninsured Bay Area women.

Brown & Toland has been a sponsor of this event for years, and executives were pleased to continue the relation-ship with the Komen Foundation and the San Francisco community in 2006.

“Brown & Toland understands the importance of education and preven-tion,” says Brown & Toland Marketing Specialist Erin Hovendick. “By partner-ing with organizations that feel the same way, we are one step closer to curing the disease.”

A mammogram is the best way to detect cancer at its earliest stages.

Women age 40 and older should have a mammogram every year. They are a valuable and effective tool for detecting breast cancer early, improving the effec-tiveness of treatment. This year, remem-ber to make time for a mammogram! ■

Brown & Toland Sponsors Race for the Cure, Stresses Education and Prevention

This fall, Brown & Toland celebrated its commit-ment to fi nding a cure for breast cancer by spon-

soring the 2006 Susan G. Komen Race for the Cure.

Brown & Toland understands the importance of education and prevention. By partnering with organizations that feel the same way, we are one step closer to curing the disease.

— Erin Hovendick, Brown & Toland Marketing Specialist

A mammogram

is the best way

to detect cancer

at its earliest

stages. Women

age 40 and older

should have a

mammogram

every year.


HEALTHY SENIORS

Easy Ways for the Elderly to Prevent Falls

E ach year, thousands of older men and women are disabled, sometimes permanently, by falls that result in broken bones. Yet small changes in homes and lifestyles can prevent such falls.

The changes associated with aging include a decrease in vision, hearing, muscle strength, coordination and refl exes. These changes can make people more likely to fall.

Older people also are more likely to have disorders that may affect their balance, such as diabetes and conditions of the heart, blood vessels, nervous system and thyroid. In addition, they often take medications that may cause dizziness or lightheadedness.

Steps to takeTaking these steps will

reduce your chances of falling: Talk to your doctor or pharmacist about the side effects of the drugs you take. Could they affect your coordi-nation or balance? Have your vision and hearing tested often. Wear a properly fi tted hearing aid and eyeglasses if recommended by your doctor. Don’t get up too quickly after eating, lying down or resting. A sudden decrease in blood pressure caused by standing too quickly may cause dizziness at these times. This can be made worse by medications, particularly those used to regulate blood pressure and to treat benign pros-tatic hypertrophy, or enlarged prostate. If you get too hot, especially when taking any medications, you might get dizzy and faint. Drink adequate amounts of water and other liquids and limit exercise on hot days, according to your doctor’s instruc-tions. Try to stay in an air-conditioned place during the hottest part of the day. If your gait is unsteady, use a cane, walking stick or walker to help stay balanced. This is especially important on uneven or unfamiliar ground. Use special care when walking outdoors on wet or icy sidewalks.

Limit how much alcohol you drink. Even a small amount can affect your balance and refl exes. Wear rubber-soled, low-heeled shoes that fully support your feet. Don’t wear smooth-soled slippers or

socks on stairs or waxed fl oors. Exercise regularly. Doing so can help you maintain your strength and muscle tone and keep your joints, tendons and ligaments more fl exible. Ask your doctor or a physical therapist to plan an exercise program suitable for you. Weight-bearing exercise can keep your bones stronger and help prevent fractures should a fall occur. Always keep one hand on a handrail when using a stairway.

Make your home safeMany older people fall because of unsafe surroundings at

home. Use the following suggestions to safeguard against some likely household hazards. Besides being clutter-free, stairways, hallways and pathways should have good lighting and fi rmly attached carpet with rough texture or abrasive strips to ensure secure footing. Stairways also should have tightly fastened handrails running the whole length of all stairs. You may want to double up on handrails, adding railing to the opposite side of the stairs. Bathrooms should have grab bars placed both in and out of tubs and showers and near toilets. Nonskid mats and abrasive strips or carpet should be installed on all surfaces that may get wet. Bedrooms and living areas should have carpet or area rugs that are fi rmly attached to the fl oor, and electrical cords and telephone wires should be placed away from walking paths. ■


DIABETES CARE

Essential Eye Carefor Diabetes

M ost people who have diabetes suffer nothing more than minor eye disorders related to the disease. However, they do have a higher risk for blindness than other people, according to

the American Diabetes Association (ADA).If you have diabetes, you can take steps to reduce your

risk for vision loss or blindness.Diabetes can cause the following eye disorders:

Glaucoma. Diabetes can lead to glaucoma, or increased pressure within the eye that over time damages the optic nerve, the ADA says. People with diabetes are 40 percent more likely to suffer from glaucoma than people without diabetes. The longer a person has diabetes, the greater the risk for glaucoma. The risk for glaucoma also increases with age.Cataracts. A cataract is a clouding of the lens of the eye. People who have diabetes are 60 percent more likely to develop this condition than people who don’t. People with diabetes also are more likely to develop cataracts at a younger age, the ADA says. Cataracts in someone with diabetes tend to progress more quickly than in someone without diabetes.Retinopathy. Diabetic retinopathy is a general term for disorders of the retina caused by diabetes. Diabetic retinop-athy comes in two forms: nonproliferative and prolifera-tive, the ADA says.In nonproliferative retinopathy, the most common form,

capillaries balloon and form pouches. Nonproliferative reti-nopathy doesn’t usually cause vision loss and needs no treat-ment at this stage. However, the capillary walls may lose their ability to control the passage of substances between the blood and the retina. As a result, the ret-ina becomes swollen, and fatty deposits form within it, the ADA says. If this swelling affects the center of the retina, the prob-lem is called macular edema, and vision loss can result.

In some people, retinopathy progresses after several years to a more serious form called proliferative retinopathy, in which the blood vessels become so damaged that they close off, the ADA says. In response, new blood vessels start grow-ing in the retina. These new vessels are weak and can leak blood, blocking vision. The new blood vessels also can cause scar tissue. After the scar tissue shrinks, it can distort the retina or pull it out of place, causing retinal detachment.

Your retina can be badly damaged before you notice any change in vision, and most people with nonproliferative reti-nopathy have no symptoms, the ADA says. Even with prolif-erative retinopathy, people sometimes have no symptoms until it’s too late to treat the condition. That’s why it’s crucial for people with diabetes to see an eye care professional every year for eye examinations.

Steps to takeThe longer you have diabetes, the more likely you are to

have nonproliferative retinopathy, the ADA says. Almost everyone with type 1 diabetes will eventually develop it, as will most people with type 2 diabetes. But proliferative reti-nopathy, the form of retinopathy that destroys vision, is far

less common.The following steps can

help you preserve your sight:Keep your blood sugar levels under tight control. People who keep these levels closer to normal are less likely to have retinopathy.Control high blood pressure, which can make eye prob-lems worse.If you smoke, quit. Smoking is a risk factor for macular degeneration. ■

WARNING SIGNS

See an eye care professional at least once a year for a dilated eye exam. See your eye care professional right away if:

Your vision becomes blurry. You see double. You see spots or fl oaters. One or both of your eyes hurt. Your eyes get red and stay that way. You feel pressure in your eyes. Straight lines don’t look straight. Your side (peripheral) vision deteriorates. You have any sudden change in your vision You have trouble reading signs or books.

PRSRT STDU.S. POSTAGE

PAIDEffi ngham, ILPermit No. 148

The Doctors Behind Every Good Health Plan

P.O. Box 640469San Francisco, CA 94164-0469

C hanges to Medicare’s managed care program mean that people approach-

ing their 65th birthdays this year have options beyond traditional Medicare for affordable and comprehensive care.

However, the milestone birthday often can lead to more questions than answers regarding health care cov-erage. Brown & Toland Medical Group can help seniors navigate their Medicare decisions.

Brown & Toland is San Francisco’s preeminent physi-cian network. Brown & Toland doctors practice quality health care at California Pacifi c Medical Center, UCSF Medical Center, UCSF/Mount Zion Medical Center, St. Mary’s Medical Center, Saint Francis Memorial Hospital and St. Luke’s Hospital.

Brown & Toland contracts with two Medicare Advan-tage Plans to provide Medicare benefi ciaries with more coverage for hospitalization and emergencies, and access to an extensive network of private practice physicians.

Seniority Plus is a Medicare Advantage plan offered by Health Net. Secure Horizons is a Medicare Advantage plan offered by Pacifi Care. By enrolling in one these Medicare Advantage plans, Medicare benefi ciaries have a wide range of important benefi ts, including doctors’ visits and Medicare Part D prescription drug coverage.

We encourage you to fi nd out more about Brown & Toland’s Medicare Advantage plans: Health Net’s Seniority Plus and Pacifi Care’s Secure Horizons. To learn more about Medicare Advantage and Brown & Toland, please call 866.488.7088 or return the enclosed business reply card for a free informational packet. ■

Making Medical Choices After 65

BENEFITS FOR SENIORS

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