TAG: "Women’s health"

SF celebrates 3 new hospitals with stars, lights and action


UCSF Hard Hat Walk, Lights On Festival draw thousands to Mission Bay.

San Francisco’s Mission Bay district became a melting pot of celebrities, civic dignitaries, community members and assorted creatures of unknown species with dazzling outfits and daring dance moves, as the city marked the upcoming opening of the new UCSF Medical Center.

Thousands joined in Saturday’s revelry, starting with the 5K Hard Hat Walk along the waterfront and through the Mission Bay neighborhood and ending with the Lights On Festival in the public plaza outside the medical center complex. The event culminated in a multicolor light show illuminating the windows of the three hospitals opening on Feb. 1, 2015: UCSF Benioff Children’s Hospital San Francisco, UCSF Bakar Cancer Hospital and UCSF Betty Irene Moore Women’s Hospital.

Donors and attendees of the celebration raised more than $525,000 for the new hospitals, exceeding the fundraising goal of $500,000.

Kicking off the Hard Hat Walk, UCSF Medical Center CEO Mark Laret paid tribute to the construction crew, staff and fundraisers. He urged the crowds to remind themselves that with “every step you take, think about a child whose life is going to be saved in that hospital and a mom who’s going to have an easier birth because of innovations here.”

There was plenty of levity to offset the serious moments.

A number of teams assembled for the walk dressed in fun costumes. UCSF Chief Information Officer Joe Bengfort nixed the sweats in favor of Luke Skywalker duds to lead his team, the Jedi Masters, which raised close to $12,000. The UCSF Cancer Crusaders donned superhero masks and capes; the Children’s Emergency Department team all wore rainbow tutus; and Remembering Maggie McDonald – one of the top patient fundraising teams – sported yellow hard hats in tribute to 19-year-old Maggie, a longtime patient of UCSF Benioff Children’s Hospital San Francisco who passed away earlier this year.

At the festival, families enjoyed pastries, tacos and other tasty treats from top local restaurants, while children got their faces painted, participated in wall art, played bungee run and danced to Vocal Rush, a teen a cappella group from the Oakland School for the Arts. Other participants decompressed with chair messages or a snuggle with a friendly possum from the San Francisco Zoo’s Zoomobile.

Adding razzle-dazzle to the event were Jesse Tyler Ferguson, star of the ABC television show “Modern Family,” Olympic champion figure skater Kristi Yamaguchi and San Francisco Giants home run king Barry Bonds, a longtime friend and supporter of UCSF Benioff Children’s Hospital San Francisco (“my brother from another mother,” according to Ferguson).

The midafternoon sun had segued into an early evening chill by the time celebrated singer and Bay Area native Michael Franti took the stage. But the audience warmed up dancing to his hits, “I’m Alive” and “Say Hey.”

At his invitation, a group of patients joined him on stage. The new hospitals were very personal to him, Franti explained, because his 15-year-old son had been a long-term patient at UCSF Benioff Children’s Hospital San Francisco. The audience nodded in unison, knowing the hospitals will play a key role in their health and that of their loved ones for generations to come.

David Chiu, president of the San Francisco Board of Supervisors, said it best when he addressed the crowd: “This is a moment in time so special for San Francisco.”

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Breastfeeding may delay onset of puberty in girls


Girls with early-onset puberty at risk for multitude of health challenges.

Julianna Deardorff, UC Berkeley

In a recent study, maternal and child health researchers at the UC Berkeley School of Public Health looked into the idea that breast feeding may serve as a protective mechanism to delay onset of puberty in girls. They found that, in some cohorts, girls who were predominantly breastfed (as opposed to predominantly formula fed) showed later onset of breast development.

Girls with early-onset puberty are at risk for a multitude of health challenges, including greater risks of obesity, hypertension and some cancers. Early maturation is also associated with lower self-esteem, higher rates of depression and norm-breaking behaviors, and lower academic achievement.

“These findings are unique in suggesting that exclusive breastfeeding may delay onset of girls’ pubertal timing,” says Julianna Deardorff, assistant professor of maternal and child health and co-author of the study. “Given the limited number of modifiable factors influencing puberty, this is a promising area of research for intervention.”

The study was led by Aarti Kale, M.P.H. ’11, who analyzed data from a population of 1,237 girls recruited across three geographic locations — New York City, Cincinnati and the San Francisco Bay Area. Breast feeding practices were assessed using self-administered questionnaires with the primary caregiver. The girls were seen on an annual basis to assess breast and pubic hair development. In addition to breastfeeding correlating with pubertal onset, duration of breastfeeding was also directly associated with age at onset of breast development. However, a stratified analysis showed the association only in the Cincinnati cohort.

“The results varied across the sites, suggesting that unique characteristics of these cohorts and their environments modify effects,” says Deardorff. “Further research into the contexts within which breastfeeding and girls’ development occur would potentially illuminate sources of variability.”

The study was published in the Journal of Maternal and Child Health.

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After ovarian cancer strikes daughter, mother raises money for research


Paulinda Babbini’s nonprofit raises money to fund ovarian cancer research at UCLA.

Paulinda Babbini and her late daughter, Robin Babbini, who died of ovarian cancer at 20. (Photo courtesy of Paulinda Babbini)

When Paulinda Babbini’s daughter, Robin, was diagnosed with ovarian cancer in 2004 at age 17, the mother’s first reaction was shock. Robin was a typical, active teenager and honor student, co-captain of the cheerleading squad, homecoming queen and involved in the dramatic arts.

How could her baby have cancer at 17 — worse, stage three ovarian cancer?

But Robin did have ovarian cancer, a disease that will strike nearly 22,000 American women this year alone, killing more than 14,000. Ovarian cancer accounts for 5 percent of cancer deaths among women, and causes more deaths than any other cancer of the female reproductive system.

Mother and daughter decided to fight and face the daunting disease together.

As part of her treatment, Robin underwent a total hysterectomy, followed by chemotherapy treatments. Unfailingly optimistic, Robin completed her classes, graduated from high school and began her freshman year at the University of California, Santa Barbara.

But six short months later, Robin’s cancer returned. She underwent another surgery, during which doctors discovered the cancer had spread. She fought on, joining the Kappa Kappa Gamma sorority and continuing her studies. She served as co-captain of her team at the American Cancer Society’s Relay for Life event. And despite her weakened condition, Robin gave a gut-wrenching, inspirational speech, hoping that one day there would be a cure found for ovarian cancer and no one would have to suffer like she had.

Just six weeks later, Robin lost her battle with ovarian cancer at 20.

“Losing a child is an anguish no parent should ever experience. It is utterly devastating. But how to move forward becomes the next challenge,” Babbini said. “I knew I had to shine a light on Robin’s memory and give her brief life a lasting purpose. Committing myself to fundraising to fight ovarian cancer keeps her in my heart.”

Babbini vowed that her daughter would not die in vain. Single-handedly, the grieving mother in 2010 launched the nonprofit The Ovarian Cancer Circle/Inspired by Robin Babbini and set out to raise money for ovarian cancer research. All the money she raises goes to fund the work of Dr. Sanaz Memarzadeh, an associate professor of obstetrics and gynecology at UCLA and director of the G.O. Discovery Lab at UCLA.

The donations from The Ovarian Cancer Circle/Inspired by Robin Babbini have enabled Memarzadeh and her team to make critical steps in understanding why ovarian cancers are not detected early and why these tumors often relapse despite surgery and chemotherapy.

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How breast cancer usurps powers of mammary stem cells


Finding provides insight into how aggressive breast cancer might be treated.

Mammary cells found during pregnancy that express integrin beta3 (CD61) act as stem cells, capable of reconstituting a new mammary gland in mice. This property may be to blame for the more aggressive nature of beta3-expressing breast cancer cells. Shown is a section from a mammary “outgrowth” harvested at lactation and immuno-stained for the epithelial markers E-cadherin (brown) and alpha-SMA (red).

During pregnancy, certain hormones trigger specialized mammary stem cells to create milk-producing cells essential to lactation. Scientists at the UC San Diego School of Medicine and Moores Cancer Center have found that mammary stem cells associated with the pregnant mammary gland are related to stem cells found in breast cancer.

Writing in today’s (Aug. 11) issue of Developmental Cell, David A. Cheresh, Ph.D., Distinguished Professor of Pathology and vice chair for research and development, Jay Desgrosellier, Ph.D., assistant professor of pathology and colleagues specifically identified a key molecular pathway associated with aggressive breast cancers that is also required for mammary stem cells to promote lactation development during pregnancy.

“By understanding a fundamental mechanism of mammary gland development during pregnancy, we have gained a rare insight into how aggressive breast cancer might be treated,” said Cheresh. “This pathway can be exploited. Certain drugs are known to disrupt this pathway and may interfere with the process of breast cancer progression.”

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UC Riverside physicians to provide women’s services at RCRMC


Supervisors approve contract as UC Riverside School of Medicine’s role expands.

UCR Health, the clinical arm of the UC Riverside School of Medicine, will begin providing comprehensive women’s health services at the Riverside County Regional Medical Center under a new contract approved today (July 1) by the Riverside County Board of Supervisors.

The contract becomes effective July 15.

“Our partnership with UCR Health physicians is an important step in the development of a world-class medical system that will meet the needs of all Riverside County’s communities,” said Third District Supervisor Jeff Stone, chairman of the board. “Our county’s health care system has always been good. Now, it’s about to get a whole lot better.”

The contract calls for UCR Health to staff women’s health services with board-certified and board-eligible physicians to care for routine and high-risk obstetrics, including labor and delivery. The physicians, who will all be faculty of the UCR School of Medicine, also will provide an array of gynecological specialty services such as gynecological oncology, urogynecology and endocrinology.

“UCR Health is pleased to be providing these services to patients in the outpatient clinics and inpatient setting at RCRMC,” said John Heydt, M.D., senior associate dean for clinical affairs in the UCR School of Medicine. “This is one more example of the UCR medical school’s commitment to partner with Riverside County in meeting the health care needs of its residents.”

UCR Health expects to staff the women’s health service initially with eight physicians who will be medical school faculty, according to Heydt. Karen L. Noblett, M.D., will join the UCR School of Medicine faculty and become chair of obstetrics and gynecology at RCRMC in early September. Noblett is board-certified in obstetrics and gynecology specializing in urogynecology and pelvic reconstructive surgery. She is bilingual in Spanish and English. Noblett is currently the interim chief medical officer at the UC Irvine Medical Center.

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Few obstetricians counsel patients on environmental toxics


UCSF study finds most agree exposures can be reduced, but only half take patients’ histories.

Naomi Stotland, UC San Francisco

In the first national survey of U.S. obstetricians’ attitudes towards counseling pregnant patients about environmental health hazards, nearly 80 percent agreed that physicians have a role to play in helping patients reduce their exposures, but only a small minority use their limited time with patients to discuss how they might avoid exposure to toxics, according to a UC San Francisco-led study.

Only 1 in 5 of the 2,500 physicians surveyed said they routinely asked about these exposures, and just 1 in 15 said they had received training on the harmful reproductive effects of toxic chemicals that are ubiquitous in the bodies of pregnant women in the United States.

The doctors surveyed said they didn’t know enough or were too uncertain of the evidence to feel comfortable making firm recommendations to pregnant women. They also said their patients often have more pressing and immediate health concerns, such as poor diet, sedentary lifestyles, obesity and chronic medical conditions like diabetes. In focus groups, physicians said they were afraid of scaring their patients about the chemicals found in the workplace and in thousands of household and industrial products, since it’s almost impossible to avoid being exposed to them.

While acknowledging that the problem can seem overwhelming, the authors said there are still things that doctors can do to help patients, even those who may have little control over their living and working environments and cannot afford luxuries like organic food.

“Many environmental exposures are unavoidable,” said Naomi Stotland, M.D., an associate professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences at UCSF, a physician at one of UCSF’s partner hospitals, San Francisco General Hospital and Trauma Center, and the study’s lead author. “So, we counsel women on the substances that we know are most likely to cause harm, while providing them with practical ways of reducing their exposures.”

The authors said that if physicians had better training and evidence-based guidelines, they could be more proactive, without fear of unduly alarming their patients. Previous studies have shown that women want to know about the adverse effects of the chemicals they’re exposed to and that they can react productively to this information.

“We have good scientific evidence demonstrating that pregnant women are exposed to toxic chemicals, and there’s a link between these exposures and adverse health outcomes in children,” said Tracey Woodruff, Ph.D., M.P.H., who directs the UCSF Program on Reproductive Health and the Environment at UCSF and is the study’s senior author. “But physicians are not offering this information to their patients.”

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Using bubbles to reveal fertility problems


New ultrasound procedure can identify blockages in fallopian tubes.

Sanjay Agarwal, UC San Diego

Many women struggling to become pregnant may suffer from some degree of tubal blockage. Traditionally, an X-ray hysterosalpingogram (HSG) that uses dye is the most common procedure to determine whether a blockage exists, but it can cause extreme discomfort to the patient. UC San Diego Health System’s doctors are the first fertility specialists in the county to use a new ultrasound technique to assess fallopian tubes by employing a mixture of saline and air bubbles that is less painful, avoids X-ray exposure and is more convenient to patients during an already vulnerable time.

Using the FemVue Sono HSG, the physician delivers the mixture of saline and air bubbles into the uterus through a small catheter, which then flows into the fallopian tubes. Under ultrasound, the air bubbles are highly visible as they travel through the tubes, allowing the physician to determine if a blockage exists.

“The traditional X-ray approach involves higher pressure and usually causes significant cramping as the dye is administered. The anticipated pain prevents some women from even attempting the test. Others cannot do the test because they are allergic to the dye. Assessing the tubes for a blockage is a key component of the diagnostic workup in fertile couples, and not doing so because of pain or allergy is a real concern,” said Sanjay Agarwal, M.D., director of fertility services in the Department of Reproductive Medicine at UC San Diego Health System. “The new approach is not only much more comfortable for patients, it also uses saline, so the issue of an allergy does not arise. We are also able to assess the cavity of the uterus at the same time – all without X-rays.”

Kristina, a mother who has been trying to conceive a second child for almost a year, agreed: “I was willing to do whatever it took to address the fertility issues we were facing, but after everything we had been through emotionally, it was a relief to undergo a procedure that wasn’t physically painful.”

The ultrasound is performed in the clinic, and at present, ideal candidates include those with a prior pregnancy and those at low risk for tubal disease.

“Like the traditional X-ray HSG, the new test should be performed after the period has ended but before ovulation. The fact that the patient can schedule this ultrasound-based test in the clinic and not in radiology prevents a delay in care and allows the patient’s physician to be more involved in the process,” said Agarwal, also director of the UC San Diego Center for Endometriosis Research and Treatment (CERT).

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Risk of pregnancy greater with newer method of female sterilization


Study provides “essential information” for women, doctors discussing permanent sterilization.

Mitchell Creinin, UC Davis

The risk of pregnancy among women using a newer method of planned sterilization called hysteroscopic sterilization is more than 10 times greater over a 10-year period than using the more commonly performed laparoscopic sterilization, a study by researchers at Yale University and UC Davis has found.

Published online today (April 22) in the medical journal Contraception, the study found the higher risk of pregnancy with a newer sterilization method marketed under the brand name Essure.

“This study provides essential information for women and their doctors discussing permanent sterilization,” said lead study author Aileen Gariepy, assistant professor in the Department of Obstetrics, Gynecology and Reproductive Sciences at the Yale School of Medicine.

Female surgical sterilization is the most popular method of pregnancy prevention worldwide and the most commonly used method of contraception among women age 35 and older in the United States. Each year, 345,000 U.S. women undergo sterilization procedures, and a total of 10.3 million U.S. women rely on female sterilization for pregnancy prevention.

Hysteroscopic sterilization is a multistep process that requires women to have a procedure to place coils inside the opening of the Fallopian tubes, use another method of contraception for three months after the procedure, and then have a special X-ray test in which dye is pushed into the uterus to confirm whether the tubes are blocked.

“When Essure was first approved by the Food and Drug Administration in 2002, data presented to physicians and patients only included those women who successfully completed all of the steps to be sterilized using the procedure,” said study co-author Mitchell Creinin, professor and chair of the Department of Obstetrics and Gynecology at the UC Davis School of Medicine.

“However, physicians quickly realized that at least 1 in 10 women would not be able to have the coils placed and that many would not return for follow-up testing,” he said.

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Experts question routine mammograms in elderly


UCSF-Harvard study finds tests offer limited benefit to oldest female patients.

Louise Walter, UC San Francisco

Doctors should focus on life expectancy when deciding whether to order mammograms for their oldest female patients, since the harms of screening likely outweigh the benefits unless women are expected to live at least another decade, according to a review of the scientific literature by experts at UC San Francisco and Harvard medical schools.

National guidelines recommend that doctors make individualized screening decisions for women 75 and older. But the analysis, published online in JAMA (March 31), concluded that since this age group was not included in mammography trials, there is no evidence that screening helps them live longer, healthier lives.

The authors said that many women in this age group receive regular mammograms anyway, with no discussion about the uncertain benefit or potential harms of continued testing, which include unnecessary treatment for slow-growing cancers or pre-cancerous lesions that pose no real threat to the women’s lives.

They concluded that women who are expected to live a decade or more should talk with their doctors and weigh the potential benefits of diagnosing a dangerous but treatable cancer through mammography against the possibility of being misdiagnosed or treated aggressively for a cancer that posed no real harm.

“People should be informed that everything we do in medicine can have good and bad effects, and that goes for mammography,” said Louise Walter, M.D., UCSF professor of medicine and chief of the Division of Geriatrics.

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Bariatric surgery decreases risk of uterine cancer


Findings indicate obesity may be a modifiable risk factor for endometrial cancer.

Researchers at the UC San Diego School of Medicine and Moores Cancer Center report that bariatric surgery resulting in dramatic weight loss in formerly severely obese women reduces the risk of endometrial (uterine) cancer by 71 percent and as much as 81 percent if normal weight is maintained after surgery.

Published in the April issue of Gynecologic Oncology, the official publication of the Society of Gynecologic Oncology, the findings indicate obesity may be a modifiable risk factor for endometrial cancer, and bariatric surgery a viable option for eligible patients. They are based on a retrospective cohort study of 7,431,858 patients in the University HealthSystem Consortium database, which contains information from contributing academic medical centers in the United States and affiliated hospitals. Of this total, 103,797 patients had a history of bariatric surgery and 44,345 had a diagnosis of uterine malignancy.

Obesity is a widespread public health problem in the United States, with an estimated two-thirds of the U.S. adult population considered to be overweight or obese. The condition is strongly linked to a host of health risks, among them heart disease, diabetes and cancer, in particular endometrial cancer.

“Estimating from various studies that looked at increasing BMI and endometrial cancer risk, a woman with a body mass index (BMI) of 40 would have approximately eight times greater risk of endometrial cancer than someone with a BMI of 25,” said first author Kristy Ward, M.D., the senior gynecologic oncology fellow in the Department of Reproductive Medicine at UC San Diego School of Medicine. “This risk likely continues to go up as BMI goes up.”

Bariatric surgery is often the last resort for obese patients after all other non-surgical weight loss efforts have failed. To qualify, patients must be an acceptable surgical risk and be defined as either severely obese with a BMI of 40 or greater or have a BMI of 35 or greater with at least one related condition: diabetes, obstructive sleep apnea, obesity-related cardiomyopathy or heart muscle disease or severe joint disease.

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Statewide public cord blood collection begins


UC Davis Health System administers the state-funded program.

Mothers of newborns can now donate their babies’ umbilical cord blood at UC Davis Medical Center and other hospitals throughout the state as part of California’s first comprehensive public system of collecting cord blood for lifesaving transplantations and medical research.

“This program enables new mothers to be both life-givers and lifesavers,” said Laurel Finta, medical director for Maternity Services at UC Davis Medical Center. “Parents now have the opportunity to donate to a publicly funded cord blood collection program that costs them nothing and can provide benefits to so many others.”

Created by state legislation in 2010, California’s Umbilical Cord Blood Collection Program (UCBCP) is a unique, state-funded system designed to broaden the diversity of umbilical cord blood units for public banking and use in unrelated transplants as well as provide a source of high-quality cord blood units for qualified researchers. UC Davis Health System administers the program, which is funded by a $2 dollar fee on birth certificate copies.

“The main goal of this program is to expand the diversity of publicly available cord blood by making it easy and convenient for new mothers to donate,” said Suzanne Pontow, co-director of the program and a scientist at the UC Davis Institute for Regenerative Cures in Sacramento. “Only a tiny fraction of cord blood is collected and preserved right now, so this is the beginning of an important effort to enable parents around the state to voluntarily and easily donate cord blood at no cost.”

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Young mother delivers baby, develops heart disease


UC San Diego Sulpizio Cardiovascular Center among first in region to implant cardiac device.

Amanda and her husband, Nathan, doting on their beautiful daughter, Kassidy, minutes after her arrival.

Three weeks after delivering her first child, Amanda began to suffer from extreme fatigue, headaches, a tight chest and stomach pain. An initial diagnosis of pneumonia changed for the worse: Amanda was experiencing heart failure. The 28-year-old’s life was at risk. She was quickly transferred to UC San Diego Sulpizio Cardiovascular Center (SCVC) where a multidisciplinary team implanted a novel cardiac device under her skin, leaving the heart untouched, to prevent sudden cardiac arrest.

“When Amanda first arrived at SCVC, she was in critical condition. It became clear within 24 hours that she needed emergency surgery or she would not survive,” said Eric Adler, M.D., director of cardiac transplant and mechanical circulatory support at UC San Diego Health System.

The new mother was diagnosed with peripartum cardiomyopathy, a rare disorder in which a woman develops heart disease within the final month of pregnancy or within five months after delivery. Adler adds that one in 2,000 women suffers from the condition, the cause is not exactly known and it can be hard to correctly diagnosis.

“I knew I had to fight for my daughter,” said Amanda. “I am not a quitter and always strive for success. I wasn’t going to let heart failure beat me.”

A left ventricular assist device (LVAD) – a mechanical heart of sorts that helps pump oxygen-rich blood throughout the body – was first implanted in Amanda.

“The patient’s heart was failing. She was in a dire situation and needed the LVAD device immediately implanted to support her heart function and restore blood circulation,” said Victor Pretorius, M.B.Ch.B., cardiothoracic surgeon at UC San Diego Health System, who implanted the LVAD in Amanda.

Amanda was also a candidate for the new Boston Scientific Subcutaneous Implantable Cardioverter Defibrillator (S-ICD) System. The device is used for the treatment of patients at risk for sudden cardiac arrest. To date, more than 3,000 devices have been implanted in patients around the world.

The S-ICD System monitors cardiac activity and shocks the heart when it goes into a dangerous rhythm, a function not performed by the LVAD. The S-ICD does not use traditional wires, called “leads,” threaded to the heart through blood vessels. Rather, the device is implanted just under the skin near the breastbone, and heart patients who require an ICD may be candidates.

“Leads in standard ICDs have been known to fracture or disconnect at times. The S-ICD has fewer long-term complications, an easier removal process and puts the patient at less risk for infection,” said Ulrika Birgersdotter-Green, M.D., director of pacemaker and ICD services at UC San Diego Health System, who implanted the device in Amanda. “It is an advancement in defibrillation technology that is simple to implant and can be life-saving.”

Amanda was the first patient at UC San Diego Health System to receive the S-ICD. The procedure took about an hour, and she was able to walk around the next day. As she continues to heal, she will be closely monitored to see if her heart function improves. If not, she will be placed on a heart transplant list.

“As part of the region’s only academic hospital, we are dedicated to using a team approach to treat high risk patients, who five to ten years ago, may not have survived,” said Adler.

Amanda is now sharing her story to raise awareness about heart disease.

“Knowledge and early detection for heart disease, especially peripartum cardiomyopathy, are key. I hope my story helps others to understand the warning signs and the technology available for treatment,” said Amanda. “The first time I was able to hold my daughter after the procedure, I became very emotional after the journey I had just been through. Because of the team at SCVC, I am able to embrace my family every day.”

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