1. Healthcare

CALIFORNIA MEDICAL ASSISTANT
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Published Bi-Monthly by the California Medical Assistants Association, Inc. for Medical Office Professionals
UNITY IS
JANUARY/FEBRUARY
2015
WHAT’S INSIDE
■ PRESIDENT’S MESSAGE .................... 1
■ PRESIDENT-ELECT’S MESSAGE:
Proposed Bylaw Revisions ............ 2-3
■ 2015 ANNUAL MEETING:
Tentative Agenda................................. 4
Registration Form ................................ 5
Introducing the Annual
Meeting Speakers ............................... 6
■ CERTIFYING BOARD UPDATE:
Newly Certified California
Medical Assistants........................ 7-10
■ CONTINUING EDUCATION:
Personal Certiticate of Participation
for Non-CMAA functions.................. 10
Pelvic Organ Prolapse ................ 11-13
Self-Assessment Test ....................... 14
Article Order Form............................. 15
■ HAVE YOU HEARD:
Increased Testing and
Recertifying Fees Reminder ............ 16
________________________
CALIFORNIA
MEDICAL ASSISTANTS
ASSOCIATION, INC.
P.O. Box 5694
Petaluma, CA 94954-5694
Toll Free 1.888.464.2622
Fax 208.730.3763
Bank on your success
with CMAA!
t has been an honor and privilege
to serve as your president. I am
very grateful to the executive
committee and the advisors for
all their support and encouragement.
I hope that each of you will continue to
“bank on your success with CMAA”.
CMAA will continue to provide the
medical assistant with pertinent
medical education. It’s a great way
to load your piggy bank with CEU’s.
I
As I reflect on the past year, I realize
just how important each of and every
one of you is to CMAA. Each member
really does make a difference. I am very
proud to be a part of CMAA. We must
stick together as a team to promote
CMAA’s mission and goals.
As we look to the 2015 year, I am
very excited to pass the gavel over to
the next president. Shannon Tinsley,
CCMA-AC will represent CMAA well.
She will lead CMAA into the next
chapter with her wealth of knowledge
and experience.
Shannon will be installed at the 2015
Annual Meeting in Santa Rosa. Once
again, Empire College has offered to
host the Annual Meeting. We have been
to this site several times, and CMAA is
very grateful for the opportunity to use
the college again. Please make plans
to attend. Sonoma region has worked
hard to make this a very special
occasion and has secured some great
speakers for us.
“What can I do?” This was a question a
student asked me at the Fall Conference
in Anaheim. I thought that, as simple as
the question may seem, it has many
answers. Many things ran through my
mind, step up and volunteer, bring a
friend to the meetings, attend a local
regional meeting, volunteer on the
regional level and state level, or offer
ideas on speaker topics. What can you
do? Step up….CMAA needs you. You
are the future of CMAA. Hopefully, that
student will be a future CMAA president.
See you at Empire College in February!
Theresa Henderson, CCMA-AC
CMAA State President
www.cmaa-ca.org
Email address: [email protected]
CALIFORNIA MEDICAL ASSISTANT — JANUARY/FEBRUARY 2015
1
California Medical Assistant
EDITOR
VICKEY MARTINEZ, CCMA-C
Riverside Region
P.O. Box 2931
Riverside, CA 92516
Email: [email protected]
P U B L I C AT I O N C O M M I T T E E
CHAIRMAN
KATE LOGAN, CCMA-AC
Sacramento Region
THERESA HENDERSON, CCMA-AC
Riverside Region
Certifying Board Administrator
C O O R D I N AT O R
JANICE SAMS, CCMA-C
Redwood Region
CMAA PRESIDENT
THERESA HENDERSON, CCMA-AC
P RESIDENT-E LECT ’ S M ESSAGE
Over the years our organization has seen many changes. One of our privileges as a member is to
choose to participate in those changes and share our opinions about those changes and exercise
our right to vote on those changes.
I have submitted several proposed Bylaws changes to our Vice President who is our Bylaws
Chairman for consideration at our Annual Meeting.
I always look forward to attending our state meetings for many reasons, one of which is to participate in the business of the organization and learning other people’s points of view. I look forward to discussing the proposed bylaws changes submitted this year and moving forward into a
new year for CMAA.
NOTE: The proposed changes listed here are simply excerpts from our full organizational
bylaws. Please contact me or Carol at Headquarters if you would like a complete copy of our
Bylaws emailed to you.
Article IV
Executive Committee
Section 1. Composition
The Executive Committee shall be composed of the officers of this corporation
and the elected committee chairmen of this corporation (Education, Membership,
Nominations and Marketing). The Parliamentarian shall serve without vote.
(951) 212-0722
PROPOSED: Combine the Offices of Marketing & Membership into One:
Membership Chairman.
PROPOSED: ADD Publication Chairman and Ways & Means Chairman to
Executive Committee
RATIONALE: The Publication is the most significant membership benefit to the
majority of our members. It’s Chairman should be a part of all Executive
Committee sessions and participate as such. Similarly, the Ways & Means
Chairman is expected to raise funds for the organization and should work closely
with the Executive Committee.
Email: [email protected]
For Advertising contact:
CALIFORNIA MEDICAL ASSISTANTS
ASSOCIATION, INC.
at
CMAA, INC.
P.O. Box 5694
Petaluma, CA 94954-5694
Toll Free: 1.888.464.2622
Article V
Meetings
Fax: 208.730.3763
California Medical Assistant
— NEXT ISSUE —
March/April 2015
To submit items to be published in this
newsletter, please mail or email:
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CALIFORNIA MEDICAL ASSISTANTS ASSOCIATION, INC.
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Email Address: [email protected]
KNOWLED
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Vickey Martinez, CCMA-C
P.O. Box 2931
Riverside, CA 92516
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ALL ITEMS FOR PUBLICATION
SHOULD BE SENT
DIRECTLY TO THE EDITOR.
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Material contained herein may NOT
be used without the permission of the
California Medical Assistants Association, Inc.
Section 1. Fall Conference
The Fall Conference shall be held in the fall of each calendar year, the date and
place to be determined by the Executive Committee.
A. Composition: The voting body shall consist of California Medical Assistants
Association members who are eligible to vote and who are present at the meeting.
B. Certification
Only members whose dues have been paid may be eligible to vote.
C. Powers and Duties
Hear and act on all business.
D. Quorum shall be a majority of the eligible members present, provided that its
membership has been notified of a scheduled meeting.
E. Voting power shall be the number of eligible members present at the Fall Conference.
There shall be no voting by proxy.
EN
Email: [email protected]
www.cmaa-ca.org
M I S S I O N S TAT E M E N T
UNITY IS
DEADLINE: February 1, 2015
All materials must be submitted by the
deadline date to be included in the next issue!
2
The purpose of the California Medical Assistants Association, Incorporated,
is to promote the professional and educational growth of medical assistants.
CALIFORNIA MEDICAL ASSISTANT — JANUARY/FEBRUARY 2015
Submitted by Shannon Tinsley, CCMA-AC - President Elect
Article V – continued
Section 2. Annual Meeting
The annual meeting shall be held in February of each
calendar year, the date and place to be determined by
the Executive Committee.
PROPOSED: the first quarter of the year
RATIONALE: Additional flexibility is needed for planning purposes.
Section 1.
Section 2.
A.
A.
Section 3.
A.
B.
Article VI
Officers
The officers of this corporation shall be the President,
Vice President, President-Elect, Secretary/Treasurer and
Parliamentarian,
Appointments:
The President with the approval of the Executive
Committee shall appoint the Parliamentarian. This
officer shall serve without a vote.
All other Presidential appointments must also be
approved by the Executive Committee.
Term of Office:
The term of office shall be one year, or until a successor
has been elected and assumed office.
The term of office shall not exceed two (2)
consecutive terms.
PROPOSED: strike item B.
RATIONALE:
Section 4. Nomination:
The Vice President, President-Elect, Secretary/Treasurer,
and Standing Committee Chairmen shall be nominated
by the component regions.
A. All nominations shall be submitted to the Chairman of
the Nominations Committee not later than ninety (90)
days prior to the Annual Meeting to be considered for
the Committee’s slate of nominees. Nominations
submitted in any other manner shall not be considered
by the Committee.
PROPOSED: Delete Item A. Item B becomes A, etc.
RATIONALE: Most officers are nominated from the floor
at the Annual Meeting. The timeline is unreasonable.
Section 8. – continued
B. Vice President
1. The Vice President shall:
a. Assist the President in any way possible.
b. Assume the duties of and/or complete the
unexpired term of the President in his/her absence.
c. Serve as Chairman of the Awards Committee.
d. Serve as member of the Office Committee.
e. Accept speaking engagements and visit regions
in his/her area.
f. Serve as Chairman of the Bylaws Committee
g. Appoint reference committees.
CALIFORNIA MEDICAL ASSISTANT — JANUARY/FEBRUARY 2015
Section 8. – continued
PROPOSED: Strike.
RATIONALE: This task is completed by the President
C. President-Elect
1. The President-Elect shall:
a. Keep informed regarding proceedings of the
corporation.
b. Succeed to the office of President at the
conclusion of his/her term of office.
c. Appoint the individuals who will serve as
chairmen of the Convention, Publications and
News Service, Legislation/CalPac, and Ways and
Means committees as well as the Parliamentarian
during his/her term of office as President, and
half the members of the Regional Advisory Council.
d. Serve as a member of the Office Committee.
PROPOSED: Change “Convention” to Annual
Meeting and strike the two Committee Chairmen
who would be elected by the membership.
Parliamentarian notation in italics to be added
RATIONALE: Correction and alignment with
prior proposals
Article VI
Committees
Section 1. Types of Committees and Terms of Office
A. Standing Committees
1. One (1) year term by election with the possibility of
re-election for additional term(s):
a. Education
1. Must have served as Regional Education
Chairman or
2. Must be an educator and/or
3. Must have served on the CMAA Education
Committee
b. Marketing & Membership
c. Publications
d. Nominations
e. Ways & Means
PROPOSED: Combine Membership and Marketing
Chairmanship into one office as well as add the Publication and Ways & Means Chairmen to be elected.
RATIONALE: Stated previously
B. Special Committees:
2. One (1) year term by appointment by appointment
of the President-Elect
a. Annual Meeting
b. Publication and News Service
c. Ways and Means
d. Legislation/CalPac
e. Fall Conference
PROPOSED: delete
RATIONALE: to align with previous proposals
3
CALIFORNIA
MEDICAL
A S S I S TA N T S
A S S O C I AT I O N ,
INC.
2015 ANNUAL MEETING
TENTATIVE AGENDA
Thursday, February 19, 2015
5:30 pm
Executive Committee Meeting
7:00 pm
BLS CPR Renewal (Additional Fee required for AHA Card)
Friday, February 20, 2015
8:00 am
Registration Opens
8:30 to Noon
Education Session
8:30 to 9:30 am
Topic: Adult Protective Services; Tara Underly LCSW (1 Basic ceu)
9:30 to 9:45 am
Break
9:45 to 11:45 am
Topic: Gang Prevention; Ernesto Oliviares (2 Basic ceu)
Noon
Lunch with Vendors
Education Session
1:00 to 2:30 pm
1:00 to 2:30 pm
Topic: Vaccine for Children Program; Steven J. VanTine CaDPH,
Communicable & Infectious Disease Division, Immunization Branch
Sr. Field Services Representative (1.5 Clinical ceu)
2:45 pm
All Members Register with Credentials
3:00 pm
CMAA Business Meeting for Members and Guests
3:15 pm
Honoring of all New CCMA’s during the Business Meeting
4:30 to 5:30 pm
Education Session
4:30 to 5:30 pm
Topic: Sleep Disorders; Gregory Ackroyd, MD Sleep Medicine
Specialist (1 Basic ceu)
6:30 pm
Dinner
Saturday, February 21, 2015
8:00 am
Registration Opens
8:30 to 10:00 am
Reference Committees
(All members are encouraged to attend!)
10:00 to 12:00 pm
Education Session
10:00 to Noon
Topic: TBD; Steve Wolf, MD (2 ceu)
12:00 pm
Lunch honoring 2014 CMAA Officers and Committee Chairmen
1:30 to 2:30 pm
Education Session
1:30 to 2:30 pm
Topic: Acupuncture/Alternative Medicine; Vladi Starkov (1.5 Basic ceu)
2:45 pm
All Members Register with Credentials
3:00 pm
CMAA Business Meeting Continued
4:00 to 5:00 pm
Education Session
4:00 to 5:30 pm
Topic: Financial Literacy; Donna Zapata (1.5 Administrative ceu)
6:30 pm
Wine Tasting
7:00 pm
Installation Banquet
Sunday, February 22, 2015
8:00 am
Combined Executive Committee Meeting
9:00 to 10:00 am
Education Session
9:00 to 10:00 am
Topic: TBA (1 ceu)
10:15 am
All Members Register with Credentials
10:30 am
Closing Business Session for Members and Guests
4
CALIFORNIA MEDICAL ASSISTANT — JANUARY/FEBRUARY 2015
CALIFORNIA
KNOWLED
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A S S I S TA N T S
A S S O C I AT I O N ,
INC.
2015 ANNUAL MEETING
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OFFICIAL REGISTRATION FORM
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Empire College
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MEDICAL
UNITY IS
3035 Cleveland Avenue, Santa Rosa, CA 95403
February 19-22, 2015
PLEASE TYPE OR PRINT
CHECK MEAL CHOICES
Name: __________________________________________
Credentials: _____________________________________
FRIDAY
_____ Lunch ......................................................... $15.00
______ Meat
Address: ________________________________________
______ Vegetarian
_____ Dinner Buffet............................................. $25.00
Region: _____________________________________
SATURDAY
Telephone: __________________________________
_____ Lunch ......................................................... $15.00
(Please provide a cell number that may be used to
contact you during the conference.)
______ Meat
______ Vegetarian
Email: ______________________________________
_____ Installation Banquet ................................. $25.00
__________________________________________________
**Check if first timer________
MEETING REGISTRATION FEES:
CHECK ONE:
________
Platinum Member
_____ Members & Students ............................... $50.00
________
Gold Member
_____ Non-member............................................. $75.00
________
Silver Member
_____ Late fee (after 2/01/15) ............................... $5.00
________
Student
________
Guest
_____ BLS CPR Card ........................................... $25.00
Professional attire is requested at all
scheduled functions.
REGISTRATION DEADLINE: 02/01/15
No refunds after February 10, 2015
Mail to:
CMAA Inc.
P.O. BOX 5694
PETALUMA, CA 94954-5694
Please make checks payable to:
CMAA
_____ Single Day Registration........................... $25.00
This option is available for Members and
Students only able to attend for one day.
** If single day registration is selected,
please indicate which day you will be
attending here:_______________________
TOTAL AMOUNT ENCLOSED $____________
Additional inquiries or registration
by credit card:
Call Headquarters at 1-888-464-2622
Important information on reverse side - please copy this form, complete and mail.
CALIFORNIA MEDICAL ASSISTANT — JANUARY/FEBRUARY 2015
5
Ernesto
Olivares
Steve
VanTine
Donna
Zapata
Mr. Ernesto Olivares
served as Mayor of
Santa Rosa from
2010-2012. Ernesto
has 30 years of public service with the
City of Santa Rosa as
a law enforcement
officer and has been active in the community for most of his career.
Before being elected, he served as the
manager of the City’s Gang Prevention
and Intervention Services providing the
administration of the Santa Rosa Mayor’s
Gang Prevention Task Force and the management of Measure O funds dedicated to
help reduce gang violence. Since 2008
Ernesto has served as Chair of the Santa
Rosa Mayor’s Gang Prevention Task
Force. Besides his local efforts to reduce
youth violence and keep our community’s
youth connected with their family and
schools, Ernesto is active in youth violence
prevention efforts at the state and national
level. He currently serves on the State of
California Board of State and Community
Corrections Standing Committee on Gangs
and he is the Director of the California
Cities Violence Prevention Network.
Mr. Olivares will be speaking to us about
Gang Violence as a public health issue.
Mr. Steve VanTine is the
Senior Field Services
Representative for the
California Department of
Public Health. Specifically, he works in the
Communicable and Infectious Disease Division, Immunization Branch. Mr. VanTine is
passionate about a job well done. He has
the ability to take a very serious topic and
present it in a very jovial way. Don’t be surprised if he encourages each participant to
get involved in his presentation!
Napa, CA — The
Napa County Hispanic Chamber of
Commerce honored
Donna Zapata, Business Development
Officer for Redwood
Credit Union, as
“Woman of the
Year” at the group’s
fourth-annual award
and recognition gala
“Blend of Cultures” on July 25.
Ms. Zapata joined Redwood Credit
Union in 2013 to focus on the development of partnerships and promotion of
financial literacy in the Hispanic community. She previously served as Executive
Director of the Hispanic Chamber of
Commerce Sonoma County for four
years. Ms. Zapata was also appointed
Vice President of the Napa County
Hispanic Chamber’s board of directors.
She was awarded the “Woman of the
Year” recognition in her community to
acknowledge her role as a mentor and
being a living example of ‘people helping
people’.
Ms. Zapata will be speaking to us
about promoting financial literacy.
Vladi
Starkov
intrigued by the holistic way this treatment
led to miraculous results and addressed
the entire human being. This experience
along with her first class in Chinese
Medicine in college helped set her on a
path of healing and study.
Vladi has been practicing as an
acupuncturist for many years, successfully
addressing a wide variety of health conditions. Vladi loves to help people who are
ready to Flourish! She has helped people
with diverse pain conditions, fertility
trouble, pregnancy related complaints,
emotional problems, PMS, skin and
digestive issues and many others. She has
had more than 5,500 hours of academic
and clinical training in Chinese Medicine
theory, Western Medicine, Acupuncture,
Herbology, Medical Qigong, and Nutrition
and is a graduate of the prestigious Five
Vladi Starkov is a
Licensed Acupuncturist, Herbalist, and
natural health practitioner in Sonoma
County who comes
from a lineage
of women healers in
Bulgaria. From an early age she was fascinated by her grandmother’s stories about
herbs, healing, and medicine. She always
knew this was her calling, and in her
teens became interested in Eastern philosophy, meditation and Yoga. While pursuing her BA at Boston University, a friend
suggested she see an acupuncturist for a
medical condition. She was instantly
6
Steve
Wolf, MD
Dr. Wolf is back by
popular demand!
Those of you who
attended the Annual
Meeting in 2014 will
surely remember his
hands on clinical
presentation in which
we learned many
things, including how
to apply a cast and remove it with a Stryker Saw! Dr. Wolf will bring his humor and
expertise and once again have us learning
while doing in a fun-filled, two hour session
that you won’t want to miss.
Branches University. Vladi, an expert
Santa Rosa acupuncturist, holds extensive
training in the areas of pain, women’s
health, fertility, Ayurveda and psychospiritual emotional balance.
Before founding Flourish Integrative
Health in Santa Rosa, Vladi graduated
from the renowned Doctorate Program
at the International Institute of Medical
Qigong, and earned DMQ status (Doctor
of Medical Qigong). She has had the
greatest honor to be a student of
renowned Dr. Jerry Alan Johnson in his
Taoist mysticism, Medical Qigong
and TaiJi classes for five years. Vladi loves
to integrate “the best of the East” and will
be discussing Acupuncture and Alternative
Medicine during her presentation. ❧
CALIFORNIA MEDICAL ASSISTANT — JANUARY/FEBRUARY 2015
C E R T I F Y I N G
B O A R D
U P D A T E
Congratulations to the newly California Certified Medical Assistants
Certification Codes: A = Administrative C = Clinical AC = Administrative and Clinical
NAME
SPECIALTY
LAST NAME, FIRST NAME
SPECIALTY
ABLES, LENA F.
AC
ABON, LUIS HUMBERTO •
C
ACEVES GUTIERREZ, CINTHIA E.
C
ACHEOUAL, LAHOUCINE M.
C
ACOSTA, DONNA M.
C
ACOSTA, ZULAYKA L.
C
ADAME, ALEJANDRA
AC
ADAMS, HELEN P.
C
ADAMS, TRACY
AC
AFFLERBACH, CHELSEA ++
AC
AGUAYO, MICAELA P.
C
AGUILAR, PABLO A.
C
AKINS, MARY KAY •
AC
ALCANTAR, ERICA A.
C
ALEJO - PACHUQUENO, OMAR JAIRO •
C
ALLEN, SHANNON M.
AC
ALMARI, LANA
C
ALVA, ALMA Y.
C
ALVAREZ, GUILLERMINA
C
ALVAREZ BARAJAS, CECILIA
C
AMADOR, CYNTHIA
C
AMEEN, TONINETTE
C
ANDERSON-TAYLOR, TAMIE
C
ARANDA, ARLENE Y.
C
ARELLANO, VANESSA
C
ARREOLA, ADRIANA S.
C
ATERRADO, JINKY
C
AVINA, MAUREEN •
C
BAER, LISA •
C
BAKER, MICHELLE R.
AC
BALDWIN, KAREN
C
BALZA, IAN FIDEL F.
C
BARCLAY, KELLIE C.
AC
BARNETT, EUGENE J.
C
BARREIRO, SONIA E.
AC
BATEMAN, RENEE D.
C
BATISTE, GUADALUPE
C
BATSON, CARA L.
C
BAUTISTA, MARIA DE LOURDES
C
BELL, AMY •
C
BELLER, BREANNA
C
BENITEZ, GUADALUPE
C
BERGMAN, ELIZABETH A.
AC
BLANCO, DALILA ELIZABETH
C
BOLEY, WANDA E.
A
BONILLA, MIREYA
C
BROUSSARD, JULIE
C
BROWN, LORI A.
A
BROWN, PASHION T.
C
BROWN, RACHEL ELIZABETH
AC
BURGOS, JACKELINE
C
BUSTAMANTE, GRACIELA •
C
BUTTRAM, TRACY
C
CABRAL, ALEJANDRA ++
AC
CACY, DEBORAH
AC
CALDERA, LUCY KORINA
AC
CALDERON, BEATRIZ •
C
CAMPOS, LIANA CHRISTY
C
CANO, LISA GARCIA
C
CARDENAS, CRISTINA M.
AC
CARDENAS, NATALIE •
AC
CARRILLO, RITA C.
C
HOMETOWN
NAME
HOMETOWN
MODESTO
FONTANA
INDIO
ATASCADERO
PALMDALE
COACHELLA
HUNTINGTON BEACH
AZUSA
LANCASTER
PITTSBURG
CALIPATRIA
COLTON
VISALIA
HIGHLAND
WATSONVILLE
NEWPORT BEACH
SANTA CLARA
INDIO
INDIO
SANTA ROSA
COLTON
COACHELLA
VICTORVILLE
REDLANDS
LANCASTER
HESPERIA
CLOVIS
MENIFEE
VISALIA
FARMERSVILLE
BANNING
TUSTIN
LA JOLLA
LANCASTER
LOS ANGELES
LANCASTER
SALINAS
COMPTON
VISALIA
MORRO BAY
COLFAX
INDIO
PALERMO
BEAUMONT
MARYSVILLE
YUCCA VALLEY
HANFORD
VICTORVILLE
CARSON
WOODLAND
RIALTO
COACHELLA
TWENTY NINE PALMS
BELL GARDENS
FRESNO
HAYWARD
LAMONT
INDIO
LANCASTER
STOCKTON
WATSONVILLE
HESPERIA
CARTER, TAMMIE L.
CASEY, DUSTY J.
CASTAÑEDA, MIRIAM
CASTAÑEDA, REYNA
CATALAN, ANA MARIA
CATUIZA, IRMA •
CAVAZOS, GLORIA
CHAMBERLIN, EMILY R. •
CHAND, JENNIFER •
CHAVEZ-ARAUJO, MARIA
CHRISTENSEN, NANCY •
COAD, NANCY •
COLEMAN, CARLA MARYLAND
COLLINS, ELIZABETH ANN
COLLINS, RAMONDA N.
CONROY, KIMBERLY
CONTRERAS, ALMA •
COOK, KELSEY M.
COOPER, LISA
CORONA, JASMIN C.
CORRAL, IDALIA VARGAS
CORTEZ, BRENDA V.
CORTEZ, CRISTINE •
CORTEZ, RAMON
COTE, SEASON
COVAL, MICHELLE •
COX, BRANDI
COX, KIMBERLY •
CRAIG, ASHLEE
CRAWFORD, CYNTHIA
CURRY, TERRI LYNN
CUSSINS, DIANA
DAVID, MARILOU S.
DAVILA-RIVAS, FABIOLA
DAVIS, PENELOPE LA DEAN ++
DEGAMO, MARY N.
DEL VALLE, ELIZABETH C.
DELA CRUZ, ROWENA VILLAMARZO ++
DELGADO, LORENE
DENT, JESSICA •
DESROSES, RUTH E.
DHINDSA, PENNY K.
DIAZ, VERONICA
DINSMORE, PAM
DOMINGUEZ, LORENA
DOWELL, CAREY
DYER, MALLIE L.
EARNEST, KEITH
ELERATH, CHARLEE M.
ELLIS-McCURRY, VALARIE J.
ELSFELDER, KATRINA LACEY
ELZIG, CHRISTINA •
ESCALANTE III, ERNEST E
ESCLOVON, CHANEL ARLENE
ESPARZA, IRMA
ESPINOSA, ALLISON M.
ESPINOSA, YESENIA I.
ESPINOZA, JESSICA J.
ESPINOZA MEJIA, MONICA L.
ESQUIVEL, ELIZABETH
ESTRADA, CHRISTINA M. •
ETTER, HOLLY R.
EVANS, EUGENE
• RECERT
++ ADDING 2ND SPECIALTY
CALIFORNIA MEDICAL ASSISTANT — JANUARY/FEBRUARY 2015
SPECIALTY
C
AC
C
C
AC
C
C
C
C
AC
C
C
C
C
AC
C
C
A
C
C
C
C
C
AC
A
C
C
AC
AC
A
C
AC
C
C
AC
C
C
AC
C
C
C
AC
C
C
C
C
AC
AC
C
A
C
C
C
AC
C
A
AC
A
AC
A
C
C
C
HOMETOWN
MODESTO
BROWN VALLEY
SAN DIEGO
VICTORVILLE
PALMDALE
BAKERSFIELD
INDIO
MILPITAS
FREMONT
SALIDA
FERNDALE
CUPERTINO
LOS ANGELES
WEST SACRAMENTO
CAMPBELL
LANCASTER
WATSONVILLE
TEHACHAPI
MODESTO
PORTERVILLE
COACHELLA
PALMDALE
SHAFTER
NAPA
ANDERSON
SANTA ROSA
REDLANDS
PALMDALE
REDDING
MISSION VIEJO
HESPERIA
SANTA ROSA
FREMONT
SANTA ROSA
HEALDSBURG
DELANO
LOS ANGELES
SANTA CLARA
COACHELLA
PARADISE
RUNNING SPRING
FRESNO
COACHELLA
EUREKA
LOS ANGELES
HESPERIA
TRACY
GRASS VALLEY
SAN JOSE
CORONA
RED BLUFF
ACAMPO
LANCASTER
VICTORVILLE
AZUSA
ADELANTO
GERBER
RED BLUFF
HAYWARD
VICTORVILLE
VISALIA
YUCCA VALLEY
NORTH HILLS
continued on page 8
7
7
C E R T I F Y I N G
B O A R D
U P D A T E
– continued from page 7 –
Certification Codes: A = Administrative C = Clinical AC = Administrative and Clinical
NAME
FARBER, KIMBERLY ANN RUBIS
FARIAS, JESSICA C. ROSAS •
FARMER, MARILYN
FENTON, NICOLE
FERRE, JAMI ANN
FERRIS, AIMEE L.
FIGUEROA, NICHOLE MARIE
FISCHER, CORINA A. •
FITZPATRICK, JESSICA DOMINQUE
FLORES, BLANCA ESTELA
FLORES, CECILIA
FLORES, RENE RAUL
FLORES, STACI V.
FLORES, VANESSA
FONSECA, JAMIE
FOSTER, SHELBY
FOWLER, ANDREA J.
FRANCIS, VICTORIA F.
FRANCO, ADA •
FREDERIKSEN, MELANIE
FRIAS, REBECCA
FUENTES, DIANE
GARCIA, CLAUDIA
GARCIA, JUAN (JOHNNY) M.
GARCIA, LILIANA
GARCIA, NELLY
GARCIA, SANDRA L. •
GARCIA, JACQUELINE
GASTELUM, BERTHA J. •
GEISEL, LAURA J.
GIL JR., JOSE ANGEL
GLASCOE, BARBARA M.
GOMEZ, LESLIE
GONZALEZ, IRENE
GONZALEZ CEJA, MARIA FELIZ •
GRAHAM, MARQUETTE T.
GREGGE, SHANITA ROSHAN ++
GRIMES, PAMELA J.
GUADARRAMA CERVANTES, LIZBET
GUDINO, CHRISTINA M.
GUERRERO, ANGELA M. •
GUERRERO, MELINDA VANESSA
GURMU, ALEMAYEHU K.
GUSTAFSON, TAMMY
GUTIERREZ, CARLOTA
GUTIERREZ, SARAH L.
GUZMAN, JAIMIE LEE
GUZMAN, MARIA THRIXIE
GUZMAN, MARTHA E.
HALL, ABIGAIL LAYDA
HANG, SOUA
HARRINGTON, LORI A.
HEDEGAARD, KAYLEE ANNE
HENDERSON, SANDRA I.
HENG, VICHANNA
HENMAN, RACHELLE
HERNANDEZ, EVA
HERNANDEZ, MARIA T.
HERNANDEZ, NOEMI
HERNANDEZ, PATRICIA L.
HERRERA, LORENA
HERRERA, MARIELA •
HERRON, VERONICA
SPECIALTY
A
C
C
C
AC
C
C
AC
C
C
C
C
AC
C
C
AC
C
C
C
AC
C
C
C
C
AC
C
C
C
C
AC
AC
C
C
C
AC
C
AC
AC
A
A
C
C
AC
C
C
C
C
C
C
C
C
C
C
C
AC
AC
C
AC
C
C
C
C
C
HOMETOWN
NAME
CERES
SAN LORENZO
BEAUMONT
LAFAYETTE
WATSONVILLE
PALM SPRINGS
PALMDALE
GRASS VALLEY
CASTRO VALLEY
SAN LUIS OBISPO
HESPERIA
ARLETA
MEADOW VISTA
MODESTO
SAN JOSE
OAK HILLS
TRACY
MECCA
BAY POINT
COSTA MESA
VICTORVILLE
HIGHLAND
COACHELLA
LOS ANGELES
CORNING
STOCKTON
LAS VEGAS NV
LANCASTER
BAKERSFIELD
OAK RUN
ELK GROVE
BANNING
VICTORVILLE
SAN MIGUEL
WINDSOR
BARSTOW
LOS ANGELES
YUBA CITY
WESTMINSTER
ADELANTO
ROCKLIN
INDIO
HAYWARD
PALM SPRINGS
LA QUINTA
SACRAMENTO
MODESTO
SAN BERNARDINO
DESERT HOT SPRINGS
SUNNYVALE
FRESNO
PHELAN
VISALIA
BRAWLEY
LONG BEACH
ROSEVILLE
NAPA
LOS ANGELES
VISALIA
PALMDALE
VISALIA
WATSONVILLE
OAKLAND
HOLMES, TANGELA O.
HONG, AMANDA B.
HORAN, DEBORAH J.
HOUSTON, SARAH E.
HOWARD, PAULA
HUMPHREY, SHIRLEY
HURTS, RONKEISHA SHANA
INGALLA, JHOANA MARIE •
IVY, CHRISTINA M.
JACKSON, JESSICA
JACOBO, ANNALISA •
JACQUEZ, MARIA D.
JAMES, CAROLANN •
JARQUIN, NORMA
JAVIER, KIM M.
JAVORSKY, DANA ELAINE
JAWORSKI, TAYLOR
JOHNSON, ALYSSA
JONES, LYDIA C.
JONES, MARY E.
JUAREZ, SARA L.
KAPUSKAR, GUNDULA •
KEENER, TERESA
KONGYOTH, CHEERAWAN
KUBALA, PATTY W.
KUE, KATALINA
KUHNS-MC CAIN, ASHLEY
LABBE, DANIELLE
LABRADA, YENI K.
LAMAS, LUCIA
LARA, ANGIE M.
LARIOS, ZENAIDA TRINIDAD •
LAVENDER, SARAH
LAZO, ANNIE
LAZO, CONNIE
LE, EVELYN TRAN
LEBELL, JEANETTE L.
LEGNITTO, CAROL A.
LEMONS, ERICA
LEPPARD, MARCIA
LEWIS, MARCUS
LIERA, EVA AUREA
LINDEN, MEGAN MARIE
LIU, MARIA DEL CARMEN
LIZAMA, ROMINA
LOPEZ, LUIS JOSÉ
LUCAS, MARLA
LUZAME, MARY C. •
MACHADO, ELAINE E.
MALLA, RALNA C.
MALTA, JOSEFINA ADRIANA
MANCILLAS, DAISY
MANRIQUE, TIFFANY
MAROF, EDRIS •
MARSHALL, BREEANNA M.
MARTEL, OFELIA HARO
MARTINEZ, MARIA ISABEL
MARTINEZ, VERONICA •
MARTINEZ SALGADO, VERONICA
MASTER, KIMBERLY D.
MATT, IRENA •
MAYES, CELENE
MAYORAL, CARA L.
• RECERT
8
SPECIALTY
AC
AC
A
AC
C
C
AC
C
C
C
C
C
C
C
AC
A
AC
AC
AC
C
C
AC
C
C
C
C
AC
C
C
C
C
C
A
C
C
AC
AC
AC
AC
C
C
C
AC
C
C
AC
AC
AC
C
AC
C
C
C
C
C
C
C
C
C
AC
C
C
C
HOMETOWN
SACRAMENTO
ALBANY
SAN MARCOS
SAN BRUNO
BANNING
CATHEDRAL CITY
FAIRFIELD
SANTA CLARA
PALMDALE
PALMDALE
SCOTTS VALLEY
PEARBLOSSOM
RED BLUFF
HURON
AUBURN
CASTRO VALLEY
ORANGEVALE
VICTORVILLE
CORNING
REDLANDS
MORENO VALLEY
FOUNTAIN VALLEY
CERES
REDLANDS
EUREKA
FRESNO
REDDING
BANNING
HESPERIA
ACTON
SAN BERNARDINO
ARROYO GRANDE
APPLE VALLEY
PALMDALE
PALMDALE
WESTMINSTER
SEBASTOPOL
YUBA CITY
PHILO
PHELAN
PALMDALE
SAN FRANCISCO
SOQUEL
ALHAMBRA
LOS ANGELES
LONG BEACH
SAN FRANCISCO
EUREKA
CANYON COUNTRY
LANCASTER
PACOIMA
PALMDALE
MORENO VALLEY
PALO ALTO
EL CAJON
PALMDALE
BALDWIN PARK
SAN JOSE
SAN BERNARDINO
VENTURA
PALO ALTO
BEAUMONT
SAN BERNARDINO
++ ADDING 2ND SPECIALTY
CALIFORNIA MEDICAL ASSISTANT — JANUARY/FEBRUARY 2015
C E R T I F Y I N G
B O A R D
U P D A T E
– continued from page 8 –
Certification Codes: A = Administrative C = Clinical AC = Administrative and Clinical
NAME
MAZUREK, JULIANA EILEEN •
MC DOWELLvCAROLINA
MC KINLEY, LINDSEY ISABELLA
McBRIDE, DEBORAH DARLENE •
McCLAIN, MARISA ROSE
MEDINA, JAZMIN N.
MEIER, BETHANY
MENDOZA, PATRICIA
MESA, LETICIA A.
MIMS, CAROLYN
MIRA, VIRGINIA
MOBLEY, LINDSAY KAY
MOCLING, SHERYLL P.
MOE, ANGELA
MONJARAS, SARAH
MONTERROSA, FATIMA
MORALES, JESUS
MORALES, TERI LYNN
MORATAYA, LOURDES REBECCA
MORENO, DELINA R.
MORENO, VERONICA M.
MORENO GARCIA, JESUS FRANCISCO
MORRISS, ASHLEY
MOSAAD, GIHAN M.
MULHORN, CAROL
MUNOZ, LUZ MARIA
MUNOZ, MAYRA
MUNOZ-ELLIOTT, ASHLEY
MUSICK, ANN MARIE
MUSIYENKO, KYRYLO
MYERS, MELISSA
MYL, JONATHAN
NAVARRO, NINFA M.
NELSON, HEIDI AMBER
NELSON, JILL C.
NELSON, NICOLE MARIE
NGO, VICKY TINH
NICHOLSON, PATRICIA L.
NINO, MONICA M.
NOGUERON, ULISES
OBANDO, SHELLANE LEANNA C.
O’DONNELL, LISA M.
OGREN, HANNAH JORGINE
OLEA, CHRISTINE HELEN
OLIEKAN, MANDY
OLIVER, ELIZABETH A.
OLIVERA, MORGAN •
OLVERA, VICTORIA M.
ORNELAS, KARINA
PALACIOS, SANDRA
PARRY, VIRGINIA
PAUL, TEESHA
PAVON COLINDRES, TATIANA
PEDDY, CAROL LEIGH •
PENA, MARIA DEL JESUS
PENALOZA, THELMA
PETERSON, JANE N. •
PETROCCHI, JENNIFER
PINONES MACIEL, STEPHANIE
POLAND, JESSICA MICHELE
QUIJAS, MARIA ELIZABETH
QUINTERO, DANIELA
QUIROZ, MARTHA F.
SPECIALTY
AC
A
AC
AC
AC
C
A
C
C
A
AC
AC
C
AC
AC
C
C
AC
C
C
A
C
C
C
C
C
C
C
A
C
C
A
C
C
C
C
C
C
C
C
C
C
C
C
A
C
C
C
C
C
A
C
C
C
C
C
C
C
AC
C
C
C
C
HOMETOWN
NAME
LIVERMORE
MONTCLAIR
FAIR OAKS
VALLEY CENTER
CHICO
RIVERSIDE
PALMDALE
LOS ANGELES
COACHELLA
REDDING
NOVATO
MARYSVILLE
BERKELEY
CLOVIS
SACRAMENTO
LITTLEROCK
LANCASTER
VICTORVILLE
CATHEDRAL CITY
YUCCA VALLEY
UKIAH
VAN NUYS
VISALIA
LAKE FOREST
REDLANDS
INDIO
INDIO
WATSONVILLE
HESPERIA
FAIR OAKS
HIGHLAND
SAN LUIS OBISPO
SUN VALLEY
JOSHUA TREE
REDLANDS
VICTORVILLE
OAKLAND
MODESTO
BAKERSFIELD
SANTA CRUZ
FREMONT
CATHEDRAL CITY
MISSION VIEJO
RIVERSIDE
HESPERIA
COVELO
YUBA CITY
SAN LUIS OBISPO
SAN JOSE
PALMDALE
ANDERSON
BAKERSFIELD
LOS ANGELS
SANTA CRUZ
COACHELLA
SAN BERNARDINO
PLEASANT HILL
SAN CARLOS
TRACY
CERES
SANTA ROSA
LITTLEROCK
COLTON
RABAGO, GRECIA G.
RAEI, ANDREW T.
RAHMAN, SHARON
GARITA
RAMIREZ, JAZMIN
RAMIREZ, CRISTINA S.
RAMIREZ ORTEGA, ROCIO IRMA
RAMOS-RODRIGUEZ, ELIZABETH
RANDALL, LAURIE J.
RATCLIFF, TRACEY RAQUEL
RESENDEZ, LETICIA
REYES, RAUL UDAVE
REYES, ZULIKEY
RIFFEL, MICHELLE R. •
RIOS, ROCIO
RIVERA, MARIA
ROBINSON, AMBER
RODRIGUEZ, AYME
RODRIGUEZ, EMMA
RODRIGUEZ, GRICELDA
RODRIGUEZ, REBECCA IRENE
RODRIGUEZ JR, PEDRO
ROSADO, JENELL N.
ROTHENBERGER, ESTHER
RUBIO, MAYTE N.
RUEDA, ROSA E.
RUIZ, MARICELA •
RUTH, SHEILA
SALAS, ALEJANDRA
SALAZAR, LISANDRA
SALAZAR, SANTIAGO J.
SALDANA, OLGA A.
SAMS, TAMRA L. •
SANCHEZ, HILDA LAURA
SANCHEZ, MARIA JUDITH
SANCHEZ, ROSA E.
SANCHEZ, ROSA M.
SANCHEZ, SHERYL L.
SANCHEZ-SOLIS, ASHLEY
SARMENTO, JULIANA
SCHROEDER, MONICA LYNN
SCHULTZ, MORGAN ROSE
SEYMOUR, WANDA
SIGG, REBECCA L. •
SILLAS, PATRICIA I.
SILVA, LUCIANA M.
SIMENTAL, NOEMI
SMITH, DAWN NICOLE
SMITH, MONIQUE
SOLIS, JEANINE S.
SORIA, CAROLE A.
ST. MARTINvSUSAN ANNE
STATON, OLIVIA MARY FRANCES
STEENLAND, KARI ANNE
STEFFENS, GINA M.
STEPHENS, KEOSHA R.
STILL, IRMA
STITT, KRISTA A.
STUBENDORFF, RAMEENA
SUAREZ, MARIA ELENA
SUNDITA, JULIE
SWEENEY, HEATHER M.
TADEO, CRISTINA
• RECERT
++ ADDING 2ND SPECIALTY
CALIFORNIA MEDICAL ASSISTANT — JANUARY/FEBRUARY 2015
SPECIALTY
HOMETOWN
C
C
A
CHULA VISTA
PALM SPRINGS
RANCHO SANTA MAR-
A
C
C
C
C
AC
C
C
C
AC
AC
C
C
A
AC
C
C
AC
C
C
C
C
C
C
C
C
C
C
AC
C
C
C
C
C
C
AC
C
AC
C
C
AC
C
C
C
AC
C
C
C
C
AC
C
C
A
C
AC
AC
AC
C
C
LANCASTER
COACHELLA
CASTRO VALLEY
LA QUINTA
SAN BERNARDINO
LODI
BEAUMONT
COACHELLA
LANCASTER
WOODBRIDGE
EL DORADO
PALMDALE
VISALIA
STOCKTON
SACRAMENTO
HESPERIA
PALM DESERT
COMPTON
PALM SPRINGS
LODI
PALMDALE
BURBANK
WATSONVILLE
MCKINLEYVILLE
APPLE VALLEY
SANTA CLARITA
BANNING
SYLMAR
UKIAH
INDIO
TEMPLETON
BANNING
CATHEDRAL CITY
BERMUDA DUNES
DESERT HOT SPRINGS
SANTA ROSA
CAMINO
FOLSOM
INDIO
LANCASTER
LOS ANGELES
PALM SPRINGS
OAKLAND
BANNING
STOCKTON
COLTON
STOCKTON
THREE RIVERS
EL CAJON
REDDING
YUCCA VALLEY
SAN LEANDRO
VICTORVILLE
YUCCA VALLEY
APTOS
SANTA ROSA
HAYWARD
JOSHUA TREE
LANCASTER
continued on page 10
9
C E R T I F Y I N G
B O A R D
U P D A T E
– continued from page 9 –
Certification Codes: A = Administrative C = Clinical AC = Administrative and Clinical
NAME
SPECIALTY
TAPIA, GABRIELA M. •
TARANGO, ESTEBAN
THAO, MAI ZOUA
THOMAS, ELAINE NICHOLE
TILGER, REBECCA ANN
TORRES, ALEJANDRA
TORRES, MICHELLE
TREICHELT, EMILY
TRUBEY, EMILY C.
TRULL, TIFFANY DENISE
TRUONG, MINERVA
VALDEZ HERNANDEZ, CRISTINA
VANG, CHENG
VAZQUEZ, ROCIO
VELASQUEZ, ANARELY G.
VERA, AMABEL H.
VERGARA, VANESSA
VIGIL QUINTANA, ANDREA
VILLAGRANA, MARIBEL
VILLANUEVA, EVELIN G.
VO, HANG
WADE, NICOLERENEE
WALKER, CAHLIAH MANDISE
WALKER-DAVIS, CAROLYN •
WALLACE, HEATHER
WATSON, SYDNEY R
WATTS, ALISON
C
C
C
AC
A
C
AC
AC
C
AC
C
C
C
C
C
C
A
C
C
C
C
C
C
C
C
AC
AC
HOMETOWN
NAME
WATSONVILLE
SAN DIEGO
STOCKTON
SANTA ROSA
ATWATER
SYLMAR
POLLOCK PINES
SACRAMENTO
FARMINGTON UT
LODI
SAN DIEGO
INDIO
FRESNO
CATHEDRAL CITY
RIVERSIDE
LANCASTER
STOCKTON
SANTA ROSA
MIRA LOMA
HAYWARD
FONTANA
JOSHUA TREE
BRENTWOOD
MANTECA
MANTECA
OXNARD
SACRAMENTO
WEIGEL, KARI •
WENCK, SHERRIE
WHITENDALE, CHRISTINA
WHITMER, CYNTHIA
WIELAND, CHRISTINA •
WILLIAMS, KARPAGAM
WOODS, SANDRA
WYATT, KATHY LYNN •
YAO, JESUS
YOUNG-DAVIS, HELEN
YZAGUIRRE, PATRICIA
ZAMORA, YANETH A. •
ZERMEÑO, GLORIA •
ZUNIGA, LUIS
• RECERT
SPECIALTY
HOMETOWN
C
C
C
C
AC
C
C
AC
AC
C
C
C
C
C
STOCKTON
REDLANDS
VISALIA
FONTANA
SAN JOSE
SAN JOSE
BEAUMONT
PETALUMA
STOCKTON
HESPERIA
HIGHLAND
HAYWARD
WATSONVILLE
CORONA
Congratulations
to each of these medical assistants.
From the California Certifying Board
for Medical Assistants
++ ADDING 2ND SPECIALTY
Just a friendly reminder to use the proper form (below) to document continuing medical education
when attending non-CMAA functions. Your help in this matter will be greatly appreciated.
Continuing Medical Education
Personal Certificate of Participation
Name of Participant _______________________________________________________________________
Program or Topic Title _____________________________________________________________________
Date_______________________ Time____________to ____________ Totals Hours/Credits____________
Circle Category:
Basic
Administrative
Clinical
Speaker Information:
Name: ___________________________________________________________________________________
Sponsoring Organization:___________________________________________________________________
Address: _________________________________________________________________________________
All CEU’s are subject to final approval by CA Certifying Board
Retain this certificate for your records
10
CALIFORNIA MEDICAL ASSISTANT — JANUARY/FEBRUARY 2015
CONTINUING EDUCATION
Pelvic Organ Prolapse
ransvaginal Mesh, we’ve all heard the commercials
“Thousands of women affected”, but why would so many
women have this surgery? Pelvic Organ Prolapse (POP) is
the major reason. It is estimated that half of all women who
have had children experience some form of POP, and 50% of
all women over the age of 50 have symptoms.
T
POP is a medical condition that occurs when there is a weakness or
damage to the normal support of the pelvic floor. This is similar to the
weakening in the abdominal wall that results in a hernia. The pelvic
organs include the vagina, cervix, uterus, bladder, urethra, intestines and
rectum. These organs are held in place by layers of connective tissue;
the fascia (ligaments, muscles, and nerves), known as the pelvic floor.
When the pelvic floor can no longer support these organs they begin to
prolapse (meaning –slipping forth) causing the organs to fall down. Usually women will start feeling a bulge near the opening of the vagina, like
sitting on a ball, or feel shifting of the organs out of place with normal
movement like sitting or standing. Symptoms such as discomfort or
pressure in the pelvis or vagina, difficulty having bowel movements,
trouble emptying your bladder or leakage, pain with intercourse, and
lower back pain, can all be indications of POP.
Prolapse is rarely caused by just one single event but rather the culmination of life, working conditions, lifestyles, and heredity.
Life-the biological process (ageing) and menopause cause our
muscles to weaken, and that includes the pelvic floor. The natural
reduction in estrogen after menopause causes the pelvic floor muscles
to become less elastic.
Pregnancy and childbirth are thought to be the main cause of POP.
Hormonal changes, increased intra-abdominal pressure and the damage
from labor and delivery can all contribute to pelvic floor damage.
Women who have had multiple births, births in close succession, large
babies and having babies later in life, can all contribute to exasperated
weakening and damage to the pelvic floor.
The type of work a women does such as heavy lifting, manual labor
and standing for long periods of time can all contribute to POP. Extracurricular activities such as the types of exercise or sports like weight
lifting, and long distance running can also increase the incidence of POP.
Genetics also plays a major role in whether a woman will be susceptible to POP. The strength of our bones, muscles and connective
tissue are influenced by our genes and our ethnicity. Caucasians
are 4 to 5 times more likely to suffer from POP compared to
Asians and Africans. Some indicators of connective tissue weakness
include hypermobility (double-jointedness), red hair, fair skin and
stretch marks.
Other contribution factors are constipation and chronic straining,
smoking and chronic coughing, obesity (obese women have a 40 to
CALIFORNIA MEDICAL ASSISTANT — JANUARY/FEBRUARY 2015
75% increase risk of POP) and diseases that affect nerves and muscles
can be contributing factors to the deterioration of the pelvic floor.
There are a number of different types of POP depending on what
organs are involved.
Cystocele is the prolapse of the front (anterior) vaginal wall,
weakening of this wall between the bladder and the vagina allows the
bladder to fall down into the vaginal cavity presenting as a bulge from
the front of the vagina. Cystocele may cause discomfort and problems
with empting the bladder or urine leakage. Women with this condition
sometimes report that they have to push the bulge back in with their
finger when they want to empty their bladder (splinting).
Rectocele is the prolapse of the back (posterior) vaginal wall
allowing the rectum (large bowel) to protruded into the vaginal
cavity presenting as a bulge from the back of the vagina. Note: a
rectocele is different than a rectal prolapse (when the lining of the
rectum falls out of the anus). Women with this condition report that
they have to push the bulge back in when they are having a bowel
movement.
Uterine prolapse is when the uterus (womb) drops down in to
the vagina. This occurs when the tissues that supports the uterus
and the top of the vagina wall weakens allowing the vagina to turn
inside out.
Enterocele occurs when the small intestine drops into the vaginal cavity causing a “vaginal hernia”. The symptoms can be vague, including
bearing down pressure in the pelvis and vagina, and lower back pain.
Vaginal vault prolapse happens most often after a woman has
had a hysterectomy, and the top of the vagina wall drops down into
the vagina.
Although a woman may have just one type of POP it is not uncommon for her to have a combination of prolapses of these different
areas of the pelvic region.
Typically the diagnosis of POP is done by a simple pelvic exam during
a comprehensive physical. The clinician may use a system of measurement such as the “pelvic organ quantification”, POP-Q or the
Baden-Walker System to enable the tracking and assessment of the
severity of the prolapse.
The Baden-Walker (grades 0 through 4) this system is a reasonable
clinical method to evaluate the three pelvic compartments. POP-Q
(stages 0 through IV) measures the most distal portion of the prolapse
during straining/Valsalva maneuver. The POP-Q, is an international
system is more complex but highly reliable and is used in clinical
assessment and research.
continued on page 12
11
CONTINUING EDUCATION
Pelvic Organ Prolapse – continued from page 11
Pelvic Organ Prolapse Quantification System (POP-Q)
Stage
Description
0
No descent of pelvic structures during straining.
I
The leading edge of the prolapse is more than 1 cm above the hymeneal ring.
II
The leading edge of the prolapse is from 1 cm above to 1 cm below the hymen.
III
The leading edge of the prolapse extends more than 1 cm beyond the hymen, but less than the total vaginal length
minus 2 cm.
IV
The leading edge of the prolapse protrudes more than the total vaginal length minus 2 cm.
*Staging can also be sub grouped for individual points or compartments.
Baden-Walker System
Grade
Anterior
Apical
Posterior
1
Extends halfway to the hymen
Extends halfway to the hymen
Extends halfway to the hymen
2
Extends to the hymen
Extends to or over the perineal body
Extends to the hymen
3
Extends outside hymen
Extends beyond the hymen
Extends beyond the hymen
Each vaginal compartment can be staged separately: for example,
the anterior compartment (cystocele), the apical compartment
(uterine prolapse or enterocele), and the posterior compartment
(rectocele).
Other test that may be used to asses POP include:
Multi-channel Urodynamic — a study of the bladder function
used to evaluate urinary incontinence or difficulty with urinating
Cystoscopy — the uses of a camera to look into the bladder for
anatomic abnormalities
Defecography — a radiologic study to look at prolapses
associated with bowel function
Pelvic Ultrasound — looks at reproductive organs, the bladder,
or muscles of the pelvic floor
Pelvic Floor MRI — can be used to assess how the pelvic floor
functions with straining
CT Scan of Abdomen and Pelvis — can be used to rule out
other medical conditions that have similar symptoms.
Prevention of POP when possible can be attained with diet to
avoid constipation, exercises such as Kegels to strengthen the
pelvic muscles, and healthy lifestyles such as maintaining your
weight and not smoking.
12
Treatment for POP usually will depend on the severity of the
symptoms and how the symptoms interfere with daily activities
and a general quality of life.
Mechanical devices such as a pessary, a plastic or rubber
dish/ring that looks similar to a diaphragm is inserted into the
vagina to provide support and reduce the bulge. Pessaries can
relieve symptoms for years but cannot prevent the prolapse
from getting worse.
Surgery is another option. The type of surgery required will
depend on the organ(s) involved and the severity of the prolapse(s),
your general health and age. Whether you want to keep your uterus
or not and whether you wish to have children in the future or not,
and whether you are still sexually active. Most of the surgical
treatments for prolapse aim to lift the prolapsed organs back into
place and repair the defect. Hysterectomy (for uterine prolapse) is
the only treatment that removes the prolapse organ altogether.
There are two types of surgery: 1) obliterative surgery and 2)
reconstructive surgery. Obliterative surgery narrows or closes off
the vagina to provide support for prolapsed organs. Sexual intercourse is no longer possible after this surgery. Reconstructive
surgery reconstructs the pelvic floor with the goal of restoring the
organs to their original position. Some types of reconstructive
surgery are done through an incision in the vagina. Others are
done through an incision in the abdomen or with laparoscopy.
CALIFORNIA MEDICAL ASSISTANT — JANUARY/FEBRUARY 2015
CONTINUING EDUCATION
Pelvic Organ Prolapse – continued from page 12
There are different types of reconstructive surgery:
Fixation or suspension using your own tissues (uterosacral ligament
suspension and sacrospinous fixation)—these procedures are performed through the vagina and may involve less recovery time than
those performed through the abdomen. A procedure to prevent urinary incontinence may be done at the same time.
Anterior and posterior colporrhaphy—because these procedures are
performed through the vagina, recovery time usually is shorter than
with procedures performed through the abdomen.
Sacrocolpopexy and sacrohysteropexy—these abdominal procedures
may result in less pain during sex than procedures performed through
the vagina.
Transvaginal mesh is usually made from a type of plastic called
polypropylene. The term tranvaginal refers to the type of surgical
technique used to implant the mesh –through the vagina.
Looking at the history of tranvaginal mesh:
In the 70s surgeons began using mesh product originally used for hernia repair in the 1950s, using this mesh transvaginally to treat POP
and Stress Urinary Incontinence (SUI). Manufacturers took notice and
began to create product specifically designed to treat POP.
1996 The U.S. Food and Drug Administration (FDA) approved the
first transvaginal mesh device for treatment of SUI.
has not worked those who have a medical condition that makes
abdominal surgery risky, or whose own tissues are too weak to be
repair without mesh.
Severe complication like mesh erosion and organ perforation require
revision surgery. Synthetic surgical mesh was designed to stay in the
body indefinitely making removal of the mesh extremely difficult.
Urogynecologists are surgeons specially trained in revision surgery.
POP is not life threatening but it can be life changing for those
who experience the associated symptoms. There are a lot of precautionary measures you can try to prevent POP or relieve symptoms.
Although surgery may be indicated for some women, there are still
options to consider in the types of surgeries and the type of surgical
materials available.
RESOURCES:
www.physio4women.com/pelvi-organ-prolapse.html
ACOG, The American Congress of Obstetricians and Gynecologists
FAQ 183, December 2013
www.poise.com.au/female-incontinence/prolapse/surgery
http://www.nafc.org/pelvic-organ-prolapse
Thinking-long-term-after-pelvic-reconstruction Post Surgery Care for
Pelvic Organ Prolapse
www.drugwatch.com/transvaginal-mesh What is Transvaginal Mesh?
1999 The first recall of a transvaginal mesh device occurred because
of safety concerns.
2002 The first surgical mesh product specifically designed for POP
repair was released.
2008 The FDA released a warning about complications from
transvaginal mesh used for treatment of POP and SUI, but that
complications were rare.
2011 Reports of 4,000 complications related to transvaginal mesh
in the previous six years.
2012 The FDA orders manufacturers to conduct post market studies.
2013 One manufacture agreed to pay $54 million to settle an undisclosed number of mesh lawsuits
www.ucurology.org/areas-of-specialization/female-pelvic-organ-prolapse Female pelvic organ prolapse
http://loyolamedicine.org/medical-services/pelvic-organ-prolapse
http://northtexasurologist.com/pelvic-floor-reconstruction-surgery-dallas-tx
www.voicesforpfd.org/p/cm/ld/fid=6 Take the Floor: Pelvic Organ
Prolapse
www.uptodate.com/contents/pelvic-organ-prolapse-in-women-choosing-a-primary-surgical-procedure
www.uptodate.com/com/contents/overview-of-transvaginal-placement-of-reconstructive-materials
http://en.wikipedia.org/wiki/Female_genital_prolapse
April 2014 The FDA re-classified transvaginal mesh from moderate
risk to high risk and increased regulations of the devices.
Use of surgical mesh for transvaginal POP repair has potentially higher anatomic success rates than repair without mesh, but also a higher
complication rate than traditional vaginal surgery. Surgery using vaginally placed mesh has a significant risk of complications, including
mesh erosion, pain, and infection. Because of these risks, vaginally
placed mesh is usually reserved for women in whom previous surgery
CALIFORNIA MEDICAL ASSISTANT — JANUARY/FEBRUARY 2015
Read the Continuing Medical Education Article
Pelvic Organ Prolapse
located on pages 11 - 13, then complete the
Self-Assessment Test on page 14 for CME credit.
13
CONTINUING EDUCATION
Pelvic Organ Prolapse – Self-Assessment Test
Earn Your Continuing Education Credits
by reading the CME article, completing and passing
the Self-Assessment Test in this issue!
SELF-ASSESSMENT TEST
AVAILABLE FOR DOWNLOAD SEPARATELY.
14
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CONTINUING EDUCATION
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